<p>Telemedicine in Resource-Limited Setting: Narrative Synthesis of Evidence in Nepalese Context</p>

Evidence-based management is an approach to establishing ‘best evidence’ which developed from approaches in medical research in the form of systematic reviews. Its goal is to identify and verify relevant and reliable evidence. Interest in the approach has grown in the management field and new techniques have emerged to support this. We tested one of these techniques - narrative evidence synthesis - as a way to systematically identify and evaluate the evidence on employee engagement. Unlike systematic review, narrative evidence synthesis seeks to explain the effects and the contexts of research studies, to ‘tell the story’ of the research, through plausible explanation. However, it is a technique that has a number of strengths and weaknesses, not least placing overwhelming demands on researchers that are difficult to manage. We describe the use of this technique in some depth and the learning that arose from it.

BACKGROUND: Human Immunodeficiency Virus (HIV) infection is one of the most devastating human pandemics in Sub-Saharan Africa (SSA) and this is the region most hit by pandemic. Adherence to Antiretroviral Therapy (ART remains challenging and varies between 27% and 80% compared to the required level of 95%. Lack of adherence is of one the major causes of treatment failures. Given the increase in the use of mobile phones in Africa, text messaging is seen as a potential strategy to improve medication adherence although there is little evidence to support this argument. The aim of this review is to evaluate the efficacy of text messaging interventions to improve adherence to antiretroviral treatment.
 
 METHODS: The Effective Public Health Practice Project (APHPP) tool was used to ensure that included Randomized Controlled Trials (RCT) studies follow vigorous methodological standards including selection bias, study design, confounders, blinding, data collection methods, and withdrawal and dropout. Selected bibliographic databases MEDLINE, Web of Science, and CINAHL Plus were searched for relevant articles published in English and dated between 2005 and 2018. Six trials met the inclusion criteria as set out in the protocol. Due to the inconsistency and the likely observed heterogeneity, narrative synthesis of evidence was carried out.
 
 RESULTS: The results from 2/3 of included studies provided evidence that text messages reminders improve adherence to antiretroviral treatment whereas 1/3 produced contradictory results. Nevertheless, weekly Short Messaging Service (SMS) reminders were more effective than daily (SMS) in achieving 95% self-reported adherence to antiretroviral treatment and in reducing the frequency of treatment interruptions. The results indicated that patients receiving text messages had their plasma HIV viral load suppressed, median CD4+ cell counts increased and were on 100% on time picking up monthly ART refills compared to the control.
 
 CONCLUSION: Included studies in this review provided evidence that simple SMS reminders were important in improving and sustaining optimal ART adherences. Text messaging is seen as potential strategy to improve medication adherence. Therefore, it should be included in health systems strategies to help improve sustainable development goals. The results suggest that preventing treatment failure can be achieved by SMS reminders in a resource limited setting.

The quality of health care remains generally poor across primary health care settings, especially in low- and middle-income countries where tertiary care tends to take up much of the limited resources despite primary health care being the first (and often the only) point of contact with the health system for nearly 80 per cent of people in these countries. Evidence is needed on barriers and enablers of quality improvement initiatives. This systematic review sought to answer the question: What are the enablers of and barriers to quality improvement in primary health care in low- and middle-income countries? It adopted an integrative review approach with narrative evidence synthesis, which combined qualitative and mixed methods research studies systematically. Using a customized geographic search filter for LMICs developed by the Cochrane Collaboration, Scopus, Academic Search Ultimate, MEDLINE, CINAHL, PSYCHINFO, EMBASE, ProQuest Dissertations and Overton.io (a new database for LMIC literature) were searched in January and February 2023, as were selected websites and journals. 7,077 reports were retrieved. After removing duplicates, reviewers independently screened titles, abstracts and full texts, performed quality appraisal and data extraction, followed by analysis and synthesis. 50 reports from 47 studies were included, covering 52 LMIC settings. Six themes related to barriers and enablers of quality improvement were identified and organized using the model for understanding success in quality (MUSIQ) and the consolidated framework for implementation research (CFIR). These were: microsystem of quality improvement, intervention attributes, implementing organization and team, health systems support and capacity, external environment and structural factors, and execution. Decision makers, practitioners, funders, implementers, and other stakeholders can use the evidence from this systematic review to minimize barriers and amplify enablers to better the chances that quality improvement initiatives will be successful in resource-limited settings. PROSPERO registration: CRD42023395166.

The quality of health care remains generally poor across primary health care settings, especially in low- and middle-income countries where tertiary care tends to take up much of the limited resources despite primary health care being the first (and often the only) point of contact with the health system for nearly 80 per cent of people in these countries. Evidence is needed on barriers and enablers of quality improvement initiatives. This systematic review sought to answer the question: What are the enablers of and barriers to quality improvement in primary health care in low- and middle-income countries? It adopted an integrative review approach with narrative evidence synthesis, which combined qualitative and mixed methods research studies systematically. Using a customized geographic search filter for LMICs developed by the Cochrane Collaboration, Scopus, Academic Search Ultimate, MEDLINE, CINAHL, PSYCHINFO, EMBASE, ProQuest Dissertations and Overton.io (a new database for LMIC literature) were searched in January and February 2023, as were selected websites and journals. 7,077 reports were retrieved. After removing duplicates, reviewers independently screened titles, abstracts and full texts, performed quality appraisal and data extraction, followed by analysis and synthesis. 50 reports from 47 studies were included, covering 52 LMIC settings. Six themes related to barriers and enablers of quality improvement were identified and organized using the model for understanding success in quality (MUSIQ) and the consolidated framework for implementation research (CFIR). These were: microsystem of quality improvement, intervention attributes, implementing organization and team, health systems support and capacity, external environment and structural factors, and execution. Decision makers, practitioners, funders, implementers, and other stakeholders can use the evidence from this systematic review to minimize barriers and amplify enablers to better the chances that quality improvement initiatives will be successful in resource-limited settings. PROSPERO registration: CRD42023395166.

The use of systematic approaches to evidence review and synthesis has recently become more common in the field of organizational research, yet their value remains unclear and largely untested. First used in medical research, evidence review is a technique for identifying, evaluating, and synthesizing existing empirical evidence. With greater demand for the best evidence about “what works” in organizational settings, nuanced approaches to evidence synthesis have evolved to address more complex research questions. Narrative synthesis is perceived to be particularly suited to evaluating diverse evidence types spanning multiple disciplinary fields, characteristic of the HRM domain. This article evaluates the narrative evidence synthesis approach, explains how it differs from other techniques, and describes a worked example in relation to employee engagement. We consider its strengths, the challenges of using it, and its value in HRM research.

Genetic polymorphisms may play a role in muscular injury associated with simvastatin, but results were inconclusive. This study aimed to summarize evidence from the literature investigating the effects of genetic polymorphism on simvastatin-induced myopathy. Studies regarding the association between genetic polymorphisms and simvastatin-induced myopathy were retrieved through electronic databases from February 1, 1990 to March 15, 2018. Two authors independently extracted data, including PMID, author, publication year, country, race, age, population characteristics, drugs, definition of case and control, gene, allele, SNP position, Hardy-Weinberg equilibrium, number of genotypes (case and control), minor allele frequency of cases and controls, association, study type and the Newcastle-Ottawa scale. Due to high heterogeneity in study design and outcome measurements among the included articles, a narrative synthesis of the evidence was conducted. A total of 10 association studies were identified in this study, including SLCO1B1, ABCB1, GATM, HTR3B, HTR7, RYR2 and HLA-DRB1. The evidence linking myopathy to rs4149056 in SLCO1B1 is of high quality, and this association has been reproduced in randomized trials and clinical practice-based cohorts. As for other candidate genetic markers, the evidences are limited or controversial, and additional well-designed studies with larger sample sizes, are required to further elucidate this association. SLCO1B1 genotype is a useful biomarker for predicting an increased risk of simvastatin-induced myopathy.

In narrative synthesis of evidence, it can be the case that the only quantitative measures available concerning the efficacy of an intervention is the direction of the effect, that is, whether it is positive or negative. In such situations, the sign test has been proposed in the literature and in recent Cochrane guidelines as a way to test whether the proportion of positive effects is favorable. I argue that the sign test is inappropriate in this context as the data are not generated according to the binomial distribution it employs. I demonstrate possible consequences for both hypothesis testing and estimation via hypothetical examples.

Aim This work aimed to conduct a comprehensive literature review with narrative synthesis of evidence in relation to the surveillance of environmental health indicators by Public Health agencies internationally. This will strengthen the All-Hazards approach to Health Protection in Ireland. Methods The project proposal was registered on PROSPERO. Preferred Reporting Systems for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. A systematic search was conducted across five databases. In addition, relevant websites, reference lists and the grey literature were searched. Data were extracted following TIDieR-PHP guidelines. Risk of bias was considered and quality appraisal was performed using SANRA and AGREE-HS tools. A narrative synthesis of the evidence was completed. Results 12 papers were included in the final review. Four were narrative review articles describing European and worldwide initiatives and the remaining eight described a single health system. Only three papers were deemed high quality. The number of indicators monitored varied widely from one in Italy to over 400 in the USA. The most established programmes described the use of a framework such as Drivers-Pressures-States-Exposures-Effects-Actions (DPSEEA) and indicator selection criteria were applied. The papers described a variety of public health actions arising from the surveillance of environmental health indicators. The knowledge provided by this review can inform the implementation process. Establishment of a project team, and beginning with monitoring one domain is suggested. Air quality is the most frequently monitored domain internationally. The DPSEEA framework is recommended, and Briggs’ indicator selection criteria should be applied to any indicator under consideration. The system should measure both hazard and outcome measures. Finally, meaningful public health action should result from the monitoring. Key messages • Environmental health indicator surveillance is essential to all-hazards health protection. • Few public health agencies internationally are systematically monitoring environmental health outcomes.

Difficulties associated with access to training and clinical support for Reporting Radiographers – A narrative evidence synthesis

ObjectivePandemics negatively impact healthcare workers’ (HCW’s) mental health and well-being causing additional feelings of anxiety, depression, moral distress and post-traumatic stress. A comprehensive review and evidence synthesis of HCW’s mental...

BackgroundPrevention of obesity is economically and sociologically preferable to treatment, with early intervention key to preventing excess weight gain and obesity. The transition from adolescence to young adulthood is a critical intervention period. An expert-led, top-down model has dominated obesity prevention research and practice with limited success. Participatory design (PD) offers potential in transforming obesity prevention research and practice by delivering bottom-up solutions that young people value and may therefore voluntarily engage with over time. An evidence synthesis of PD application in obesity prevention targeting adolescents and young adults is currently lacking.ObjectivesReport the protocol for a mixed-methods systematic scoping review which aims to integrate and synthesise available evidence on PD application in obesity prevention targeting adolescents and young adults. Specifically, the review will address three research questions:RQ1: How is PD defined in obesity prevention interventions targeting adolescents and young adults?RQ2: To what extent is PD applied in obesity preventions interventions targeting adolescents and young adults?RQ3a: How is the utility of PD evaluated in obesity preventions interventions targeting adolescents and young adults?RQ3b: What is the utility of PD application in obesity prevention interventions targeting adolescents and young adults?MethodsThis mixed-methods systematic scoping review protocol adheres to the PRISMA-P guidelines and is informed by the PRISMA extension for scoping reviews (PRISMA-ScR). The search strategy and eligibility criteria are informed by the sample, phenomenon of interest, design, evaluation, and research type tool. Eligible studies will be peer-reviewed literature published in English, reporting on PD application in obesity prevention interventions (including intervention development, implementation, and/or evaluation) targeting adolescents and young adults (aged 10–35 years). Study designs will include qualitative, quantitative, and mixed methods. The review will comprise a systematic literature search, eligibility screening, data extraction, quality assessment using the Mixed-Methods Appraisal Tool (MMAT), and data analysis using an iterative narrative evidence synthesis approach. Evidence on PD application will be thematically integrated in terms of who was involved, when they were involved, and how and why they were involved. Further thematic analyses will be conducted according to the MATE taxonomy and the United Kingdom Medical Research Council (UK MRC’s) key functions of process evaluations. The MATE taxonomy classifies PD application in terms of methodology, agent of change, training, and engagement. The MRC describes three functions of process evaluations: implementation, mechanisms of impact, and context. Applying both in the evidence synthesis is intended to provide a more complete picture of PD application. Exploratory analyses will be conducted to assess any potential associations between PD application and effectiveness across key outcomes (weight, physical activity, sedentary time, nutrition and dietary habit, mental health, and sleep) reported within intervention evaluations.ConclusionsElucidating PD application is a prerequisite to establishing its utility. Through the location and synthesis of available evidence on PD application in obesity prevention targeting adolescents and young adults, this review will categorise and describe different methods of PD application and explore the utility of PD application including whether any differences may be observed between PD method applied and the effectiveness of obesity prevention interventions. Implications will be delineated from the narrative evidence synthesis to inform future research and advance practice in this context.Systematic review registrationPROSPERO CRD42021268240

People who have experienced intimate partner violence (IPV) or child maltreatment (CM) are at risk of having lower resilience and adverse psychological outcomes. In keeping with the social and environmental factors that support resilience, there is a need to take a public health approach to its investigation and to identify existing initiatives in particular settings and populations that can guide its deliberate promotion. This narrative synthesis examines quantitative and qualitative studies of interventions with resilience-related outcomes in specified health and other settings. Clinical RCTs are excluded as beyond the scope of this review. Twenty studies were identified for review in several settings, consisting of 14 quantitative studies, 2 review studies, 2 qualitative studies and 2 mixed-methods studies. Three quantitative studies produced strong evidence to support: a home visitation program for at-risk mothers; a methadone program for women and a substance abuse program. This review reveals that few studies use specific resilience measures. The topic has been little studied despite high needs for public health interventions in countries of all types. Interventions and research studies that use specific resilience measures are likely to help measure and integrate what is currently a disparate area. The participation of people with IPV or CM history in program and research design and implementation is indicated to support advocacy, innovation and sustainable interventions. This is especially pertinent for interventions in LAMIC and indigenous settings where continuing programs are sorely needed.

Transcranial magnetic stimulation and electrical stimulation techniques used to measure the excitability of distinct neuronal populations that influence motor output in people with persistent musculoskeletal conditions: A scoping review and narrative synthesis of evidence.

Globally, tuberculosis (TB) is the leading infectious cause of morbidity and mortality, with the risk of infection affected by both individual and ecological-level factors. While systematic reviews on individual-level factors exist, there are currently limited studies examining ecological-level factors associated with TB incidence and mortality. This study was conducted to identify ecological factors associated with TB incidence and mortality. A systematic search for analytical studies reporting ecological factors associated with TB incidence or mortality was conducted across electronic databases such as PubMed, Embase, Scopus, and Web of Science, from each database's inception to October 30, 2023. A narrative synthesis of evidence on factors associated with TB incidence and mortality from all included studies, alongside random-effects meta-analysis where applicable, estimated the effects of each factor on TB incidence. A total of 52 articles were included in the analysis, and one study analysed two outcomes, giving 53 studies. Narrative synthesis revealed predominantly positive associations between TB incidence and factors such as temperature (10/18 studies), precipitation (4/6), nitrogen dioxide (6/9), poverty (4/4), immigrant population (3/4), urban population (3/8), and male population (2/4). Conversely, air pressure (3/5), sunshine duration (3/8), altitude (2/4), gross domestic product (4/9), wealth index (2/8), and TB treatment success rate (2/2) mostly showed negative associations. Particulate matter (1/1), social deprivation (1/1), and population density (1/1) were positively associated with TB mortality, while household income (2/2) exhibited a negative association. In the meta-analysis, higher relative humidity (%) (relative risk (RR) = 1.45, 95%CI:1.12, 1.77), greater rainfall (mm) (RR = 1.56, 95%CI: 1.11, 2.02), elevated sulphur dioxide (μg m-3) (RR = 1.04, 95% CI:1.01, 1.08), increased fine particulate matter concentration (PM2.5) (μg/ m3) (RR = 1.33, 95% CI: 1.18, 1.49), and higher population density (people/km2) (RR = 1.01,95%CI:1.01-1.02) were associated with increased TB incidence. Conversely, higher average wind speed (m/s) (RR = 0.89, 95%CI: 0.82,0.96) was associated with decreased TB incidence. TB incidence and mortality rates were significantly associated with various climatic, socioeconomic, and air quality-related factors. Intersectoral collaboration across health, environment, housing, social welfare and economic sectors is imperative for developing integrated approaches that address the risk factors associated with TB incidence and mortality.

BackgroundPatient-reported experience measures (PREMs) are used to drive and evaluate unit and organisational-level healthcare improvement, but also at a population level, these measures can be key indicators of healthcare quality. Current evidence indicates that ethnically diverse communities frequently experience poorer care quality and outcomes, with PREMs data required from this population to direct service improvement efforts. This review synthesises evidence of the methods and approaches used to promote participation in PREMs among ethnically diverse populations.MethodsA rapid evidence appraisal (REA) methodology was utilised to identify the disparate literature on this topic. A search strategy was developed and applied to three major electronic databases in July 2022 (Medline; PsycINFO and CINAHL), in addition to websites of health agencies in Organisation for Economic Co-operation and Development countries via grey literature searches. A narrative evidence synthesis was undertaken to address the review question.ResultsThe review resulted in 97 included studies, comprised 86 articles from electronic database searches and 11 articles from the grey literature. Data extraction and synthesis identified five strategies used in PREM instruments and processes to enhance participation among ethnically diverse communities. Strategies applied sought to better inform communities about PREMs, to create accessible PREMs instruments, to support PREMs completion and to include culturally relevant topics. Several methods were used, predominantly drawing upon bicultural workers, translation, and community outreach to access and support communities at one or more stages of design or administration of PREMs. Limited evidence was available of the effectiveness of the identified methods and strategies. PREMs topics of trust, cultural responsiveness, care navigation and coordination were identified as pertinent to and frequently explored with this population.ConclusionsThe findings provide a basis for a maturity model that may guide change to increase participation of ethnically diverse communities in PREMs. In the short-medium term, health systems and services must be able to recognise and respond to cultural and linguistic diversity in the population when applying existing PREMs. In the longer-term, by working in collaboration with ethnically diverse communities, systems and services may co-create adapted or novel PREMs that tackle the factors that currently inhibit uptake and completion among ethnically diverse communities.