Grey Literature Search Research Articles

An assessment of variation in quality of hypertension guidelines across income settings using the AGREE II tool

Background Hypertension affects over one billion people worldwide, posing a significant global health burden. Clinical practice guidelines could play a key role in guiding healthcare providers in improving hypertension management. However, how the quality of hypertension CPGs differs across country income settings is not well understood. This study aims to explore variation in the quality of hypertension CPGs, comparing low-, middle-, and high-income countries, using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Methods A Medline and grey literature search was conducted to identify hypertension CPGs in English from every country from January 2012 to September 2022. Two reviewers independently assessed and scored each CPG against the AGREE II tool. Results were described and the Kruskal-Wallis test was used to test for statistically significant difference in the domain scores across country income groups. Results Forty-three CPGs were included for analysis from across income settings. Guidelines from HICs scored higher in four out of the six domains. The highest scoring domain was 4: “clarity and presentation” (median score 83%), the lowest scoring was domain 6 “editorial independence” (median score 0%). Statistically significant differences between income settings were observed for domain 3 “rigour of development” (p <0.001), domain 4 “clarity and presentation” (p = 0.03) and domain 6 “editorial independence” (p = 0.04). Conclusions Whilst some variation exists in guideline quality across country income levels, the greatest degree of variation exists across the domains of the AGREE II tool. Global efforts to improve the quality of hypertension guidelines should focus on the transparent statement of editorial independence of guideline committees and apply rigorous replicable methods in the authoring of guidelines. Establishing national and international communities of practice to collaborate across income settings may reduce duplication of resource, allow for shared learning and promote the development of high-quality hypertension CPGs.

Comparative Effectiveness of Teledermatology Versus In-person Consultations: A Systematic Review of Diagnostic Information Elements

Context: Teledermatology is delivered through two primary methods: Live video conferencing, which enables real-time interaction between patients and doctors, and the store-and-forward technique, where images of skin lesions are sent over the internet for later examination. Objectives: This systematic review evaluates the concordance between in-person and telemedicine follow-up methods in dermatology. Methods: In February 2024, a comprehensive literature search was conducted across PubMed, Medline, ISI Web of Science, and the ACM Digital Library. Keywords such as "teledermatology," "telemedicine," and "mobile health" were used, following the PICOS criteria. Results: Initially, 716 articles were identified from the databases, along with four studies from the gray literature search. After removing duplicates, screening studies, and applying the inclusion and exclusion criteria, 21 studies were selected for the final review. These studies detailed follow-up procedures and assessed both direct and indirect costs and effectiveness. The consensus indicates that teledermatology reduces costs and satisfies both patients and healthcare professionals. Conclusions: Teledermatology has been shown to potentially increase the efficiency of follow-up care compared to traditional methods. However, further research is needed to develop standardized evaluation protocols and to more accurately measure and validate key variables. Publications suggest that teledermatology is cost-effective, reduces patient wait times, extends access to dermatological care in remote areas, and enhances satisfaction among patients, doctors, and nurses.

Mapping health-related quality of life of children and families receiving pediatric invasive home mechanical ventilation: a scoping review protocol

BackgroundChildren utilizing invasive home mechanical ventilation (administered via tracheostomy tube) receive intensive care at home without the support of trained staff typically present in an intensive care unit; within the context of worsening home nursing shortages, much of the 24/7 care burden falls to families which are likely under supported. Prior reviews have explored the quality of life of children receiving various forms of mechanical ventilation, without addressing the impact on the family. Additionally, the literature inconsistently differentiates the unique experience of families with children using invasive home mechanical ventilation from non-invasive, which has lower morbidity and mortality and requires less nursing care in the home. Therefore, our study aims to explore and map the existing literature regarding the impact of invasive home mechanical ventilation on the child and family’s quality of life. Identified gaps will inform future research focused on improving the family quality of life of children with invasive home mechanical ventilation.MethodsFive databases will be searched using keywords and controlled vocabulary to identify relevant studies: Ovid Medline, Embase, Scopus, and Cochrane Library. English language studies will meet inclusion criteria if they include primary research studies of children or families of children utilizing invasive home mechanical ventilation at home and assess quality of life. Children and young adults aged 0–25 years will be included. We exclude studies of hospitalized children, studies focused solely on healthcare professional experiences or clinical outcomes, and those focused on the period surrounding discharge from admission for tracheostomy placement. Two independent reviewers will screen studies at the title/abstract and full-text levels. Two independent reviewers will extract data from relevant studies. Disagreements will be resolved by an independent third reviewer. A targeted grey literature search will be performed utilizing ProQuest, clinicaltrials.gov, WHO trial registry, Google Scholar, and professional societies. Findings will be presented in tables and figures along with a narrative summary.DiscussionThis scoping review seeks to map the literature and provide a descriptive report of the health-related quality of life of children using invasive home mechanical ventilation and their families.RegistrationOpen Science Framework https://doi.org/10.17605/OSF.IO/6GB84Date of Registration: November 29, 2023.

Less is more? A review of psilocybin microdosing.

The applications of psilocybin, derived from 'magic mushrooms,' are vast, including a burgeoning practice known as microdosing, which refers to the administration of sub-hallucinogenic doses of psychedelic substances to obtain benefits without experiencing significant cognitive and perceptual distortion. However, current research is fairly new with several limitations and gaps that hinder adequate conclusions on its efficacy. This semi-structured review aimed to identify and highlight research gaps in the field of psilocybin microdosing for future research. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses based strategy was employed, utilizing a chain of keywords and key phrases across multiple databases, augmented by a cross-sectional Google search for relevant grey literature in the form of the top 10 search results. A total of 40 studies and 8 unique websites were identified, summarized and tabulated into four distinct categories, namely non-clinical, clinical, observational and anecdotal evidence. The majority of available evidence originates from observational studies, while non-clinical and clinical study findings remain comparatively sparse and inconsistent. Web-based findings were consistent with current research findings. Key research gaps were highlighted: the imperative for more randomized placebo-controlled trials, exploration of dose-response ranges, psychological and personality testing of participants, utilization of active placebos, greater diversity in study populations, an increase in psilocybin-exclusive microdosing studies and the refinement of animal models. Definitive conclusions regarding the efficacy of psilocybin microdosing remain elusive, emphasizing the need for further study. Numerous research gaps necessitate consideration for future investigations.

How might shared decision-making meetings reduce the need for children to be in care? A rapid realist review

Summary Meetings to enhance shared decision-making, such as family group conferences, potentially contribute to enhancing meaningful involvement of families. Such meetings are also claimed by some to reduce the need for children to be in care, either by increasing support from family for parents or by identifying care from within the family network. This rapid realist review aims to develop an understanding of how meetings that facilitate shared decision-making between professionals and families might work to safely reduce the need for children to be in care. It identifies mechanisms that are thought to make a difference and contextual factors that influence the impact of identified mechanisms. Findings A comprehensive search of academic and gray literature identified 64 documents spanning seven types of shared decision-making meetings. Data from these papers were collected using an iterative process of juxtaposition, comparison, contrast, and combination with a developing program theory. Data from the literature was supplemented with consultation to ensure relevance to the UK setting. The review identified three key mechanisms that made shared decision-making meetings more likely to be effective in safely reducing children's entry to care: enabling participation and engagement; building trust and reducing shame; enabling participation in decision-making processes. It describes how these work before, during, and after meetings. Applications The findings help us understand the complicated research findings about the relationship between meetings and care entry and provide a theory about what is needed to make such meetings work that is of practical use for practice and future research

Narrative review of value frameworks in urothelial carcinoma and positioning of enfortumab vedotin

Aims Evaluate existing oncology value frameworks in terms of their methodology, structure, characteristics, and functionality using the example of enfortumab vedotin, an approved therapy for urothelial carcinoma. Methods A search of PubMed, grey literature, and official websites of relevant international organizations was performed from January 2022 to March 2023. Results Six frameworks were identified and analyzed, including the American Society of Clinical Oncology’s assessment framework, European Society for Medical Oncology’s Magnitude of Clinical Benefit Scale, the National Comprehensive Cancer Network’s Evidence Blocks, Memorial Sloan Kettering Cancer Center’s DrugAbacus, Institute for Clinical and Economic Review’s assessment framework, and the Drug Assessment Framework. Comparisons across frameworks were challenging, owing to differing approaches, objectives, perspectives, methodology, and criteria. Based on the results of the EV-301 study (NCT03474107), the European Society for Medical Oncology’s Magnitude of Clinical Benefit Scale assigned a score of 4 out of 5 to enfortumab vedotin administered after chemotherapy and immunotherapy. The National Comprehensive Cancer Network’s Evidence Blocks enabled assessment of enfortumab vedotin compared with other treatments for locally advanced or metastatic urothelial carcinoma, resulting in the positioning of enfortumab vedotin as a preferred regimen after chemotherapy and immunotherapy. Conclusions Application of value frameworks in oncology can contribute to informed value-based decision-making. However, comparisons across frameworks should be made with caution and limited to the same lines of treatment. Enfortumab vedotin may contribute to optimizing outcomes in patients previously treated with chemotherapy and immunotherapy for locally advanced or metastatic urothelial carcinoma.

Examining attitudes to uptake and sustainment of technology among care aides in the delivery of care: a scoping review protocol

IntroductionCare aides are health workers who deliver hands-on care to patients across the healthcare continuum. The use of technology in healthcare delivery is increasing, and evidence regarding how care aides’...

Optimizing Hospice Care: A Scoping Review of Staffing Strategies to Enhance Practice

Background Investigating hospice staffing models is vital for ensuring patient-centered care by aligning workforce capabilities with evolving patient needs. With the opening of the Hospice Residence at Providence Care Hospital, effective staffing can enhance operational efficiency, staff well-being, retention, and elevate the quality of end-of-life care. Objective: The primary objective is to investigate models of hospice care, staffing characteristics across disciplines, staff qualifications, training and operational metrics. Methods A comprehensive search of academic literature was conducted using MEDLINE, CINAHL, and Embase, following the PRISMA-ScR framework. The review focused on hospice care for adults, covering staffing and care models. Studies on general palliative care, pediatric/NICU care, non-full-text studies, and those published before 2013 were excluded. A grey literature search was also performed. Results Out of 1,579 imported studies, 1,082 were screened, 260 full texts reviewed, and 51 met inclusion criteria. Published between 2013 and 2024, the studies were conducted in North America, Europe, and Asia, covering various designs including randomized control trials, observational, qualitative, and mixed-methods. Patient populations included terminally ill individuals with diagnoses such as cancer, COPD, and heart failure. The majority of studies examined inpatient hospices. Facility sizes ranged from 6 to 33 beds (median = 16). Key topics included staffing models, staff-to-patient ratios, training, volunteer roles, care delivery, and patient satisfaction, with common ratios being 5.5:1 to 6.5:1 for physicians and 1.5:1 to 2.7:1 for nurses. Hospice staff included physicians, nurses, aides, social workers, spiritual care providers, and volunteers, with training ranging from specialized education to minimal instruction. Conclusion Understanding staffing strategies is crucial for hospices to meet growing demand and patient complexity. This review emphasizes optimal staff-to-patient ratios, diverse care models, and the vital role of volunteers. Further research is needed to establish best practices for sustainable, high-quality hospice care. Contributors: Patel, V.; Aghakhani Barfeh, K.; McDonald, H.; Kang, J.; Pranajaya, P.; Toon, D.; Wong, M.; Goldie, C.L.

SP7.1 - Risk Profile of Administration of 3- and 4-factor Prothrombin Complex Concentrate in Adult Anticoagulated Trauma Patients: A Systematic Review and Meta-Analysis

Abstract Aims To establish thromboembolic complication (TC, primary outcome) and mortality (secondary outcome) Odds Ratios (ORs) following 3-factor Prothrombin Complex Concentrate (PCC3, Comparator Group [CG] 1) and 4-factor Prothrombin Complex Concentrate (PCC4, CG2) administration, compared to Fresh Frozen Plasma (FFP) alone, in adult Vitamin K antagonist-anticoagulated trauma patients. Methods Systematic database and grey literature searches were performed. Random effects model meta-analyses were undertaken for each of this study’s outcomes, producing ORs and 95% Confidence Intervals (95%CIs). The I2 statistic was used to quantify interstudy heterogeneity. Inverse Variance, Mann-Whitney U and Kruskal-Wallis tests were used to examine interstudy demographic/treatment differences. Risk of bias was assessed with the Newcastle-Ottawa Scale, study quality with the GRADE tool. Results 8 papers met inclusion criteria (CG1 n=3, CG2 n=3), 2 were excluded due to insufficient reported information. TC incidence was not significantly increased following PCC3 administration (ORcombined effect1.57, 95% CI 0.24-10.51, p=0.64). Meta-analysis was not performed on TC incidence in CG2 owing to only 1 paper reporting this outcome. Mortality risk was not significantly increased following PCC3 (ORcombined effect1.61, 95%CI 0.27-9.51, p=0.60) or PCC4 (ORcombined effect2.19, 95%CI 0.96-4.98, p=0.06) administration. Admission Injury Severity Score (ISS) and age varied significantly between papers included in CG1 (mean­ISS=15.5, 95%CI=12.0-20.1, p<0.05, meanage=75.3years, 95%CI=65.5-86.7, p<0.05) and CG2 (meanISS=15.1, 95%CI=13.4-17.0, p<0.05, meanage=79.2years, 95%CI=74.7-84.1, p<0.05). Conclusion TC risk is not overtly increased following PCC3 administration, compared to FFP. The same is true for mortality risk following PCC3 and PCC4 administration. There is substantial room for bias in the results reported, further research is warranted.

SP6.12 - Do Pregnant Females Experiencing Physical Traumatic Injury have Different Mortality Outcomes Compared to Non-pregnant Females? A Systematic Review and Metanalysis

Abstract Aims To collate and analyse literature capturing mortality rates in pregnant and non-pregnant individuals of childbearing age who experienced physical trauma. Additionally, to identify any statistically significant differences in interventions received. Methods Comprehensive searches of PubMed, MEDLINE, and grey literature were conducted using MeSH terms. Data extraction by two independent reviewers was followed by quality assessments using the Newcastle-Ottawa Scale. A random effects meta-analysis assessed the effect of pregnancy on mortality post-physical trauma, employing risk ratios (RR) and 95% confidence intervals. Publication bias was evaluated through linear regression, Eggers test, and funnel plots. Results Twelve studies met eligibility criteria, yielding 1,113,376 pregnant and 18,185,789 non-pregnant females of childbearing age who experienced physical trauma. Low publication bias was observed. Pregnant females demonstrated a 35% mortality reduction vs. non-pregnant females (pooled RR: 0.65 [0.47-0.89], p=0.008), though significant heterogeneity existed across studies (I2 = 77%). A subgroup analysis focusing on mechanism of injury found the mortality reduction in pregnancy increased to 59% in motor vehicle accidents (pooled RR = 0.41 [0.32-0.52], p<0.001) with minimal study heterogeneity (I2 = 0%). Pregnant (vs. non-pregnant) females were less likely to be intubated (pooled RR = 0.69 [0.58, 0.81], p=<0.001, I2 = 9), but there were no other significant differences in the types of intervention received. Conclusions Pregnant females have a lower mortality risk from physical trauma than non-pregnant counterparts, particularly where the mechanism of injury is a motor vehicle accident. Additional research is warranted to elucidate the underlying factors contributing to this observed difference.

Is artificial intelligence for medical professionals serving the patients?

BackgroundAlgorithmic decision-making (ADM) utilises algorithms to collect and process data and develop models to make or support decisions. Advances in artificial intelligence (AI) have led to the development of support systems that can be superior to medical professionals without AI support in certain tasks. However, whether patients can benefit from this remains unclear. The aim of this systematic review is to assess the current evidence on patient-relevant benefits and harms, such as improved survival rates and reduced treatment-related complications, when healthcare professionals use ADM systems (developed using or working with AI) compared to healthcare professionals without AI-related ADM (standard care)—regardless of the clinical issues.MethodsFollowing the PRISMA statement, MEDLINE and PubMed (via PubMed), Embase (via Elsevier) and IEEE Xplore will be searched using English free text terms in title/abstract, Medical Subject Headings (MeSH) terms and Embase Subject Headings (Emtree fields). Additional studies will be identified by contacting authors of included studies and through reference lists of included studies. Grey literature searches will be conducted in Google Scholar. Risk of bias will be assessed by using Cochrane’s RoB 2 for randomised trials and ROBINS-I for non-randomised trials. Transparent reporting of the included studies will be assessed using the CONSORT-AI extension statement. Two researchers will screen, assess and extract from the studies independently, with a third in case of conflicts that cannot be resolved by discussion.DiscussionIt is expected that there will be a substantial shortage of suitable studies that compare healthcare professionals with and without ADM systems concerning patient-relevant endpoints. This can be attributed to the prioritisation of technical quality criteria and, in some cases, clinical parameters over patient-relevant endpoints in the development of study designs. Furthermore, it is anticipated that a significant portion of the identified studies will exhibit relatively poor methodological quality and provide only limited generalisable results.Systematic review registrationThis study is registered within PROSPERO (CRD42023412156).

Local anaesthetic to reduce injection pain in patients who are prescribed intramuscular benzathine penicillin G: a systematic review and meta-analysis

Three to 4-weekly intramuscular injections of benzathine penicillin G (BPG) for a prolonged period (e.g., 10 years, until age 40 years, or lifelong) are recommended for preventing group A streptococcal infections that cause recurrent acute rheumatic fever (ARF) and potential progression to rheumatic heart disease (RHD). The duration of treatment, frequency and local pain associated with BPG injections may lead to reduced compliance. Shorter courses of BPG are recommended for the treatment of syphilis and Streptococcal infections. We aimed to assess the effects of local anaesthesia in reducing injection pain in patients who are being treated with BPG. In this systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Conference Proceedings Citation Index-Science and LILACS from database inception up to May 4, 2024, and performed additional searches for grey literature. Randomised controlled trials comparing BPG vs. BPG administered alongside local anaesthetics were included. Randomized controlled trials using BPG, irrespectively of indication, and testing any local anaesthetic agent for pain alleviation were considered eligible. We applied GRADE to assess the quality of evidence. Summary data were extracted from included trials. The primary outcome was injection pain, assessed through mean differences. A random-effects model was utilized to account for study heterogeneity. This study is registered with PROSPERO, CRD42022342437. Database searches identified a total of 3958 records, and 3 additional records were retrieved from grey literature searches. After removal of duplicates, screening of abstracts and full-text review, eight trials were included, combining a total of 489 patients (151 patients with RHD). Immediate pain level, as reported by patients, was of high intensity in most studies. Low intensity pain was still reported at 24h. Administration of lidocaine mixed with BPG was associated with a significant reduction in immediate post-injection pain (mean difference-3.84, 95% confidence interval-6.19 to-1.48, P=0.0001; 4 studies; I2=98%; GRADE: moderate quality), pain at 5 min (mean difference-2.85, 95% CI confidence interval-3.78 to-1.92, P<0.0001; 1 study; GRADE: moderate quality), and pain at 20 min (mean difference-1.85, 95% confidence interval-2.61 to-1.09, P<0.0001; 1 study; GRADE: moderate quality) on a 1 to 10 scale. One study assessed lidocaine cream applied to the skin prior to BPG injection and showed no significant reduction in injection pain (mean difference=-0.54, 95% CI confidence interval-1.17 to 0.09, P=0.13; 1 study; GRADE: low quality). Mepivacaine mixed with BPG in patients with syphilis showed a significant reduction of immediate post-injection pain (mean difference-2.19, 95% CI confidence interval-2.49 to-1.89, P<0.0001; 1 study; GRADE: moderate quality). Two studies assessed procaine mixed with BPG and reported: lower immediate pain levels or pain assessed at 1h (mean difference and 95% CI confidence intervals not provided, P=0.001 and P=0.008, respectively; 1 study; GRADE: low quality), or less immediate pain and pain at 24h on the buttock injected with procaine mixed with BPG (mean difference and 95% CI confidence intervals not provided, P<0.001 for both; 1 study; Grade: low quality). No severe adverse reactions were reported. In patients receiving intramuscular BPG injections, moderate quality quantitative evidence suggests that BPG injections diluted with lidocaine or mepivacaine may improve post-injection pain scores compared to BPG injections diluted with sterile water. Procaine may also have a benefit, but quality of evidence was lower. Most studies included small patient samples and assessed pain levels at different timepoints. Due to insufficient data we were not able to assess the impact of injection volume, and local anaesthetics' dose on pain intensity and duration of pain relief. WHO.

Artificial intelligence applied in human health technology assessment: a scoping review protocol.

This scoping review aims to map studies that applied artificial intelligence (AI) tools to perform health technology assessment tasks in human health care. The review also aims to understand specific processes in which the AI tools were applied and to comprehend the technical characteristics of these tools. Health technology assessment is a complex, time-consuming, and labor-intensive endeavor. The development of automation techniques using AI has opened up new avenues for accelerating such assessments in human health settings. This could potentially aid health technology assessment researchers and decision-makers to deliver higher quality evidence. This review will consider studies that assesses the use of AI tools in any process of health technology assessment in human health. However, publications in which AI is a means of clinical aid, such as diagnostics or surgery will be excluded. A search for relevant articles will be conducted in databases such as CINAHL (EBSCOhost), Embase (Ovid), MEDLINE (PubMed), Science Direct, Computer and Applied Sciences Complete (EBSCOhost), LILACS, Scopus, and Web of Science Core Collection. A search for gray literature will be conducted in GreyLit.Org, ProQuest Dissertations and Theses, Google Scholar, and the Google search engine. No language filters will be applied. Screening, selection, and data extraction will be performed by 2 independent reviewers. The results will be presented in graphic and tabular format, accompanied by a narrative summary. osf.io/3rm8g.

Mapping Public Health Nursing competencies: A comparative document analysis of competency frameworks and practice standards in the USA and Ireland.

The Public Health Nursing discipline plays a crucial role in promoting sustainable health services. The establishment of competency frameworks and practice standards pertaining to Public Health Nursing has emerged as a cornerstone for guiding practice, education, and research. This study aimed to identify contemporary Public Health Nursing competency frameworks and practice standards and establish a robust list of competency domains. This will inform a subsequent phase of this project that will conduct a review of recent scholarly literature to discern prevailing research trends and delineate strategic directives and research priorities for the discipline. A systematic search of three databases and a grey literature search was undertaken by incorporating keywords to identify existing Public Health Nursing-specific competency frameworks and practice standards. Through screening and selection based on our inclusion criteria, three documents were analyzed. A comprehensive document analysis was conducted to generate a unified domain list and associated descriptors. Three competency-based frameworks and practice standards emanating from two countries, the United States of America and the Republic of Ireland met the inclusion criteria. The document analysis identified 16 individual domains. There was consistent evidence of similarity across the three documents. There were minimal divergences featured within the frameworks which are discussed and compelling justifications for inclusion as universal domains are provided. This document analysis has generated a list of 16 common Public Health Nursing competency domains which will be utilized in phase two of this project as a foundational framework for the purpose of analyzing research trends, influencing research priorities, and enhancing the focal areas for future research agendas within the discipline.

Preoperative Micronutrient Repletion Strategies in Metabolic and Bariatric Surgery: A Systematic Review

BackgroundEvidence is lacking to inform how micronutrient deficiencies should be prevented and treated before metabolic-bariatric surgery to optimize patient outcomes. ObjectiveThis systematic review aimed to examine the effect of preoperative repletion strategies for micronutrient deficiencies on micronutrient biochemistry, quality of life, and complication rates among candidates for metabolic and bariatric surgery compared with usual care, alternate strategies, or no treatment. MethodsPubMed, Embase, CINAHL, and CENTRAL was searched in April 2024. A grey literature search was updated in April 2024 via Google search. Eligible observational and interventional studies were those that provided micronutrient repletion before the surgery and measured micronutrient status pre- and/or postsurgery. Studies with participants who were pregnant, lactating, or elected jejunocolic bypass, jejunoileal bypass, vertical banded gastroplasty, and biliopancreatic diversion were excluded. Risk of bias was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Findings were narratively synthesized and the Grading of Recommendation, Assessment, Development and Evaluations was adopted when applicable. Twenty studies (n = 27 groups) were included (n = 15 observational; n = 5 interventional). ResultsStrategies targeted vitamins A, D, E, B6, B12, C, thiamin, folate, calcium, iron, selenium, and zinc, including chronic dosing of oral supplements and multivitamins (n = 21), megadoses of oral supplements (n = 1), intramuscular injection (n = 1), intravenous infusion (n = 1), and a mix of injection and oral supplements (n = 3). Preoperative repletion strategies varied in efficacy. Chronic dosing of oral supplements increased vitamin D levels (n = 4 interventional studies; Grading of Recommendation, Assessment, Development and Evaluations rating: moderate). Multivitamins did not improve vitamin B12 status but improved status of vitamin B6, vitamin C, and folate. Iron infusion (n = 1) increased ferritin levels, despite small sample size and low adherence rate, whereas oral iron supplementation resulted in unchanged (n = 4) or decreased (n = 1) ferritin levels. ConclusionsProactive and personalized micronutrient repletion schedules may decrease the risk of preoperative and early postoperative deficiency.

Quality indicators to monitor the quality and safety of care for older people: a scoping review protocol.

The objective of this review is to identify quality indicators used to monitor the quality and safety of care provided to older people (≥ 65 years old) in 8 care settings: primary care; hospital/acute care; aged care (including residential aged care and home or community care); palliative care; rehabilitation care; care transitions; dementia care; and care in rural areas. There is a need for high-quality, holistic, person-centered care for older people. Older people receive care across multiple care settings, and population-level monitoring of quality and safety of care across settings represents a significant challenge. National and international quality indicators used to monitor and evaluate the quality and safety of care at the population level for older individuals in the 8 key care settings will be considered for inclusion. English-language quantitative and mixed method studies published from 2012 will be considered. Academic (MEDLINE, Embase) and gray (government websites, clinical guidelines, Google) literature searches will be conducted. A standardized data extraction tool will be used to describe the identified quality indicators and associated tools. Quality indicators will be categorized by key domains (ie, pain, function, consumer experience, service delivery); quality indicator type (structure, process, outcome); and the Institute of Medicine's 6 dimensions of care quality (eg, efficiency, effectiveness, appropriateness, accessibility, acceptability/person-centered, safety). The scoping review will be conducted in accordance with the JBI methodology for scoping reviews and will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Open Science Framework https://osf.io/8czun.

Classification and Communication of Critical Findings in Emergency Radiology: A Scoping Review

PurposeTo identify the published standards for the classification and communication of critical actionable findings in emergency radiology and the associated facilitators and barriers to communication and message management or dissemination of such findings. Materials and methodsSearch terms for resources pertaining to critical findings (CFs) in emergency radiology were applied to two databases (PubMed, Embase). Screening of hits using the following pre-established inclusion and exclusion criteria were performed by three analysts with subsequent consensus discussion for discrepancies: (1) the resources include any standards for the classification and communication of imaging findings as critical, or (2) the resource discusses any facilitators to the communication of CFs, or (3) the resource discusses any barriers to the communication of CFs. Resources with explicit focus on a pediatric population or predominant focus on artificial intelligence or natural language processing were omitted. Accompanying gray literature search was used to expand included resources. Data extraction included year, country, resource type, scope or purpose, participants, context, standards to identifying or communicating CFs, facilitators and barriers, method type, recommendations, applicability, and disclosures. ResultsSeventy-six resources were included in the final analysis, including 16 societal or commission guidelines. Among the guidelines, no standardized list of CFs was identified, with typical recommendations suggesting application of a local policy. Communication standards included direct closed-loop communication for high acuity findings, with more flexible communication channels for less acute findings. Applied interventions for CFs management most frequently fell into four categories: electronic (n = 10), hybrid (ie, electronic or administrative) (n = 3), feedback or education (n = 5), and administrative (n = 4). ConclusionThere are published standards, policies and interventions for the management of CFs in emergency radiology. Three-tier stratification (eg, critical, urgent, incidental) based on time sensitivity and severity is most common with most CFs necessitating closed-loop communication. Awareness of systemic facilitators and barriers should inform local policy development. Electronic and administrative communication pathways are useful adjuncts. Further research should offer comparative analyses of different CF interventions with regards to cost-effectiveness, notification time, and user feedback.

Capability as a concept in advanced practice nursing and education: a scoping review.

The objective of this review was to map the literature about the concept of capability in advanced practice nursing education and practice to achieve greater clarity on the concept and its application. Advanced practice nursing roles make up a growing segment of the global nursing workforce. Capability has been proposed as an overarching description of the attributes of advanced practice nursing roles within complex workplace environments. Capability includes knowing how to learn, and the ability to creatively integrate prior knowledge, skills, judgment, and experience in both new and familiar situations. This review looked at the literature about capability applied to advanced practice nursing in any setting globally. We were guided by the International Council of Nurses' definition of advanced practice nursing, which includes nurses with both graduate education and an expanded scope of practice. Drawing from an initial review of the literature, we used a working definition of capability, which was a combination of knowledge, skills, experience, and competencies that enables advanced practice nurses to provide appropriate care for patients in both known and unfamiliar clinical settings. We included literature about individual capability as a concept in any setting related to advanced practice nursing and education. We searched 18 electronic databases and included qualitative, quantitative, and mixed methods study design methodologies, reviews, and reports. The gray literature search included policy and practice documents from the World Health Organization, the International Council of Nurses, and websites of 48 nursing and health organizations. Two reviewers independently completed title and abstract screening prior to full-text review and data extraction. Conflicts were resolved via discussion or with a third reviewer. Extraction was completed by 2 reviewers using a piloted data extraction tool. Articles published in English from 1975 to the present were included. Sources in languages other than English were not included in the review due to the difficulties in accurately translating the concept of capability. Thirty-five sources were included in the review with publication dates from 2000 to 2023. Most sources originated from Australia, the United Kingdom, and the United States. Sources included frameworks and clinical guidelines, peer-reviewed articles, and gray literature. Capability was discussed in a range of settings, including specialized clinical roles. Applications of capability in educational settings included the use of capability frameworks to guide nurse practitioner education, nursing practice doctorates, and postgraduate nurse practitioner training. Definitions of capability, where provided, were relatively consistent. Capability was proposed as a distinguishing characteristic of advanced practice nursing, as a descriptor of clinical proficiency that moved beyond competency, and as a framework that accounted for complexity in health care settings. Capability was used as a concept and framework to describe advanced practice nursing within complex practice environments that necessitate flexible approaches. Capability frameworks were applied holistically and to specific areas of practice or education, including in pregraduate and postgraduate advanced practice nursing education. Strategies for teaching and learning capability focused on flexibility, student-directed learning, and development of flexible learning pathways. A Norwegian-language version of the abstract of this review is available: http://links.lww.com/SRX/A58.

Plastic induced urinary tract disease and dysfunction: a scoping review.

In 2019 the World Health Organisation published a report which concluded microplastics in drinking water did not present a threat to human health. Since this time a plethora of research has emerged demonstrating the presence of plastic in various organ systems and their deleterious pathophysiological effects. A scoping review was undertaken in line with recommendations from the Johanna Briggs Institute. Five databases (PubMed, SCOPUS, CINAHL, Web of Science and EMBASE) were systematically searched in addition to a further grey literature search. Eighteen articles were identified, six of which investigated and characterised the presence of microplastics and nanoplastics (MNPs) in the human urinary tract. Microplastics were found to be present in kidney, urine and bladder cancer samples. Twelve articles investigated the effect of MNPs on human cell lines associated with the human urinary tract. These articles suggest MNPs have a cytotoxic effect, increase inflammation, decrease cell viability and alter mitogen-activated protein kinases (MAPK) signalling pathways. Given the reported presence MNPs in human tissues and organs, these plastics may have potential health implications in bladder disease and dysfunction. As a result, institutions such as the World Health Organisation need to urgently re-evaluate their position on the threat of microplastics to public health. This scoping review highlights the rapidly emerging threat of microplastic contamination within the human urinary tract, challenging the World Health Organisation's assertion that microplastics pose no risk to public health. The documented cytotoxic effects of microplastics, alongside their ability to induce inflammation, reduce cell viability and disrupt signalling pathways, raise significant public health concerns relating to bladder cancer, chronic kidney disease, chronic urinary tract infections and incontinence. As a result, this study emphasises the pressing need for further research and policy development to address the challenges surrounding microplastic contamination.

Methodological components, structure and quality assessment tools for evidence summaries: a scoping review.

The objective of this review was to identify and map the available information related to the definition, structure, and core methodological components of evidence summaries, as well as to identify any indicators of quality. Evidence summaries offer a practical solution to overcoming some of the barriers present in evidence-based health care, such as lack of access to evidence at the point of care, and the knowledge and expertise to evaluate the quality and translate the evidence into clinical decision-making. However, lack of transparency in reporting and inconsistencies in the methodology of evidence summary development have previously been cited and pose problems for end-users (eg, clinicians, policymakers). Any English-language resource that described the methodological development or appraisal of an evidence summary was included. PubMed, Embase, and CINAHL (EBSCOhost) were systematically searched in November 2019, with no limits on the search. The search was updated in June 2021 and January 2023. Gray literature searches and pearling of references of included sources were also conducted at the same time as the database searches. All resources (ie, articles, papers, books, dissertations, reports, and websites) were eligible for inclusion in the review if they evaluated or described the development or appraisal of an evidence summary methodology within a point-of-care context and were published in English. Literature reviews (eg, systematic reviews, rapid reviews), including summaries of evidence on interventions or health care activities that either measure effects, a phenomena of interest, or where the objective was the development, description or evaluation of methods without a clear point-of-care target, were excluded from the review. A total of 76 resources (n=56 articles from databases and n=20 reports from gray literature sources) were included in the review. The most common type/name included critically appraised topic (n=18) and evidence summary (n=17). A total of 25 resources provided a definition of an evidence summary: commonalities included a clinical question; a structured, systematic literature search; a description of literature selection; and appraisal of evidence. Of these 25, 16 included descriptors such as brief, concise, rapid, short, succinct and snapshot. The reported methodological components closely reflected the definition results, with the most reported methodological components being a systematic, multi-database search, and critical appraisal. Evidence summary examples were mostly presented as narrative summaries and usually included a reference list, background or clinical context, and recommendations or implications for practice or policy. Four quality assessment tools and a systematic review of tools were included. The findings of this study highlight the wide variability in the definition, language, methodological components and structure used for point-of-care resources that met our definition of an evidence summary. This scoping review is one of the first steps aimed at improving the credibility and transparency of evidence summaries in evidence-based health care, with further research required to standardize the definitions and methodologies associated with point-of-care resources and accepted tools for quality assessment. A Chinese-language version of the abstract of this review is available at http://links.lww.com/SRX/A59, studies ineligible following full-text review http://links.lww.com/SRX/A60.