Review Of Grey Literature Research Articles

Current learning strategies in fire evacuation for seniors and people with disabilities in private seniors' residences and long-term care homes: a scoping review.

Current strategies for teaching evacuation methods in private seniors' residences (PSR) and long-term care (LTCH) homes may pose risks to people with disabilities (PWD) and seniors' physical and psychological health. This study aimed to address the following questions: (1) Which are the current fire evacuation learning strategies used with PWD or seniors? (2) What are the barriers and facilitators for PWD and seniors' during fire evacuation and learning strategies in PSR and LTCH? (3) What is the existing equipment that could be used with PWD seniors?. A scoping review of grey and scientific literature was done in six databases and Google scholar. Additional information was found on Québec government websites. This review identified 13 scientific papers and 22 documents. Twenty barriers (personal = 9, environmental = 11), and 14 facilitators (personal = 4, environmental = 10) were extracted. The current fire evacuation learning strategies currently used can be grouped into three categories: drills; training; promotion of a fire safety plan. Six types of evacuation equipment were found; however, their use has been scarcely documented. Safety for seniors during fire evacuation is still an important issue to be improved. Increasing awareness and creating new practices and tools that consider the strengths and difficulties of seniors seems to be a promising avenue for improving evacuation.

Innovative Models of Care for Hospitals of the Future.

New ways of providing acute care outside of traditional hospital building complexes, such as virtual care or hospital in the home, are becoming more common. Despite this, many hospitals are still conceived as "bricks and mortar" centralised constructions, and few health service infrastructure organisations meet intensively with consumers or clinicians prior to conceptualising hospital design. Our study sought to understand the needs and expectation of community members and healthcare providers, and co-design innovative models of acute care to inform development of a new metropolitan hospital in Australia. Our study used a three-step approach, consisting of academic and grey literature reviews; a demographic analysis of the hospital catchment population; and a series of 20 workshops and 6 supplementary interviews with community members and local healthcare providers. We found that care should be tailored to the healthcare needs and expectations of each consumer, with consumers cared for in the community where possible and safe. We propose an innovative model of care for hospitals of the future, consisting of fully integrated acute care underpinned by appropriate digital architecture to deliver care that is community focussed. It is vital that new hospitals build in sufficient adaptability to leverage future innovation and meet the needs of growing and changing communities.

How can intersectoral collaboration and action help improve the education, recruitment, and retention of the health and care workforce? Ascoping review.

Inadequate numbers, maldistribution, attrition, and inadequate skill-mix are widespread health and care workforce (HCWF) challenges. Intersectoral-inclusive of different government sectors, non-state actors, and the private sector-collaboration and action are foundational to the development of a responsive and sustainable HCWF. This review presents evidence on how to work across sectors to educate, recruit, and retain a sustainable HCWF, highlighting examples of the benefits and challenges of intersectoral collaboration. We carried out a scoping review of scientific and grey literature with inclusion criteria around intersectoral governance and mechanisms for the HCWF. A framework analysis to identify and collate factors linked to the education, recruitment, and retention of the HCWF was carried out. Fifty-six documents were included. We identified a wide array of recommendations for intersectoral activity to support the education, recruitment, and retention of the HCWF. For HCWF education: formalise intersectoral decision-making bodies; align HCWF education with population health needs; expand training capacity; engage and regulate private sector training; seek international training opportunities and support; and innovate in training by leveraging digital technologies. For HCWF recruitment: ensure there is intersectoral clarity and cooperation; ensure bilateral agreements are ethical; carry out data-informed recruitment; and learn from COVID-19 about mobilising the domestic workforce. For HCWF retention: innovate around available staff, especially where staff are scarce; improve working and employment conditions; and engage the private sector. Political will and commensurate investment must underscore any intersectoral collaboration for the HCWF.

Factors influencing health-related quality of life among long-term care residents experiencing pain: a systematic review protocol

BackgroundPain is highly burdensome, affecting over 30% of long-term care (LTC) residents. Pain significantly reduces residents’ health-related quality of life (HRQoL), limits their ability to perform activities of daily living (ADLs), restricts their social activities, and can lead to hopelessness, depression, and unnecessary healthcare costs. Although pain can generally be prevented or treated, eliminating pain may not always be possible, especially when residents have multiple chronic conditions. Therefore, improving the HRQoL of LTC residents with pain is a priority goal. Understanding factors influencing HRQoL of LTC residents with pain is imperative to designing and evaluating targeted interventions that complement pain management to improve residents’ HRQoL. However, these factors are poorly understood, and we lack syntheses of available research on this topic. This systematic review protocol outlines the methods to identify, synthesize, and evaluate the available evidence on these factors.MethodsThis mixed methods review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We will systematically search Medline, EMBASE, PsycINFO, CINAHL, Scopus, Cochrane Database of Systematic Reviews and ProQuest Dissertation and Thesis Global from database inception. We will include primary studies and systematically conducted reviews without restrictions to language, publication date, and study design. We will also include gray literature (dissertation and reports) and search relevant reviews and reference lists of all included studies. Two reviewers will independently screen articles, conduct quality appraisal, and extract data. We will synthesize results thematically and conduct meta-analyses if statistical pooling is possible. Residents and family/friend caregivers will assist with interpreting the findings.DiscussionThis proposed systematic review will address an important knowledge gap related to the available evidence on factors influencing HRQoL of LTC residents with pain. Findings will be crucial for researchers, LTC administrators, and policy makers in uncovering research needs and in planning, developing, and evaluating strategies in addition to and complementary with pain management to help improve HRQoL among LTC residents with pain.Systematic review registrationPROSPERO CRD42023405425

What Interventions are Cost Effective in Reducing Violence Against Women? A Scoping Review.

To systematically summarise the recent literature on the cost and cost effectiveness of interventions implemented to reduce violence against women (VAW) and decision frameworks guiding resource allocation. A scoping review of scholarly and grey literature on the cost-effectiveness and/or resource allocation for interventions addressing intimate partner violence (IPV), dating violence and non-partner sexual violence perpetrated against women aged 15 years and over. All settings and contexts were eligible, with papers published in English between 2010 and March 2023 included. Nineteen papers fulfilled the inclusion criteria reporting the cost, cost savings and/or cost effectiveness of 24 interventions to prevent IPV and to a lesser extent, other forms of interpersonal violence. Among the 16 economic evaluation studies reviewed, four types of interventions were cost effective in multiple settings or studies, including community activism (Uganda, Ghana), gender transformative interventions with couples and individuals (Ethiopia, Rwanda), specific justice and law enforcement measures (USA) and a combined personnel training, support, and referral programme in General Practice in the UK. Other interventions were cost effective in a single study or had conflicting evidence. Three remaining papers conducted a partial evaluation or cost appraisal providing limited information on the cost or cost-savings of other implemented interventions. No frameworks on resource allocation for the prevention of VAW were identified. While there is some evidence of cost effectiveness emerging for interventions implemented in specific contexts, overall, we find the recent evidence on costs and cost effectiveness of interventions for the prevention of VAW to be limited. Embedding economic evaluation in future effectiveness trials will build critical evidence needed to inform policy and resource allocation decisions based on the value-for-money of interventions. Modelling the benefits and costs of interventions to better understand the societal impacts of programmes at scale is a further research opportunity.

Evaluating emergency service response to COVID-19: A scoping review.

The issue of how emergency services (police, fire, ambulance, local authorities) respond to pandemics has received greater research focus recently in relation to the COVID-19 outbreak, which saw agencies going beyond usual roles to support communities for prolonged periods. A critical appraisal is needed of this published evidence to take stock of what is known about the effectiveness of emergency service response to Covid-19. A scoping review of scientific and grey literature identified 17 qualitative (N=9), quantitative (N=6), or mixed methods (N=2) studies from across the UK and internationally that focus on the effectiveness of emergency service response to the Covid-19 outbreak. A narrative review was conducted using an interpretive approach. Papers were read, summarised, and then sorted into inductive themes that addressed some aspect of the review question. Eight critical themes emerged from the narrative review. Across countries, emergency services were required to quickly adapt working practices to reduce spread of infection, support partner agencies facing unprecedented demands, and make effective use of limited resources. Use of technology, access to timely, accurate and relevant information, strong leadership, prior experience, and emergency training were critical to this. However, most research is descriptive rather than evaluative. Overall, findings highlight the need for further research that examines what mechanisms facilitate and hinder emergency response to pandemics. This scoping review provides a knowledge framework for informing future research that can support emergency services in preparing for events of national and international significance.

Impacts of the COVID-19 pandemic on food systems in Manitoba, Canada and ways forward for resilience: a scoping review

Various studies over the past 3 years have synthesized trends and impacts of the COVID-19 pandemic on Canada’s national food system. However, less research has characterized the effects of COVID-19 within regional and provincial food system contexts. This article presents results from a scoping review of peer-reviewed and grey literature published from March 2020 until end of March 2023 examining the impacts of the COVID-19 pandemic on food systems in the province of Manitoba, Canada. Findings are presented according to the categories of food security funding, policy, and programming; individual and household food security; and food systems. In each area we synthesize key findings and discuss their significance in relation to existing food systems scholarship and national trends. Using review results, we propose priority areas for research and practice to support equitable and resilient food systems in Manitoba, including: (1) undertaking evaluation of food system policies, programs, and funding implemented during the pandemic (2) enhancing food security monitoring for vulnerable populations (3) further exploring community experiences and responses to food security, and (4) examining opportunities for local food systems development.

Test Code Flakiness in Mobile Apps: The Developer’s Perspective

Context:Test flakiness arises when test cases have a non-deterministic, intermittent behavior that leads them to either pass or fail when run against the same code. While researchers have been contributing to the detection, classification, and removal of flaky tests with several empirical studies and automated techniques, little is known about how the problem of test flakiness arises in mobile applications. Objective:We point out a lack of knowledge on: (1) The prominence and harmfulness of the problem; (2) The most frequent root causes inducing flakiness; and (3) The strategies applied by practitioners to deal with it in practice. An improved understanding of these matters may lead the software engineering research community to assess the need for tailoring existing instruments to the mobile context or for brand-new approaches that focus on the peculiarities identified. Methods:We address this gap of knowledge by means of an empirical study into the mobile developer’s perception of test flakiness. We first perform a systematic grey literature review to elicit how developers discuss and deal with the problem of test flakiness in the wild. Then, we complement the systematic review through a survey study that involves 130 mobile developers and that aims at analyzing their experience on the matter. Results:The results of the grey literature review indicate that developers are often concerned with flakiness connected to user interface elements. In addition, our survey study reveals that flaky tests are perceived as critical by mobile developers, who pointed out major production code- and source code design-related root causes of flakiness, other than the long-term effects of recurrent flaky tests. Furthermore, our study lets the diagnosing and fixing processes currently adopted by developers and their limitations emerge. Conclusion:We conclude by distilling lessons learned, implications, and future research directions.

Barriers and enablers of integrated care in the UK: a rapid evidence review of review articles and grey literature 2018-2022.

Integrated care refers to person-centered and coordinated, health and social care, and community services. Integrated care systems are partnerships of organizations that deliver health and care services which were placed on a statutory footing in England, April 2022. Due to the need for fast, accessible, and relevant evidence, a rapid review was conducted according to World Health Organization methods to determine barriers and enablers of integrated care across the United Kingdom, 2018-2022. Nine databases were searched for review articles reporting evaluation of integrated care interventions involving medical (clinical and diagnostic) and nonmedical (public health services and community-based or social care/person-centred care) approaches, quality checked with the Critical Appraisal Skills Program qualitative checklist. OpenGrey and hand searches were used to identify grey literature, quality checked with the Authority, Accuracy, Coverage, Objectivity, Date, and Significance checklist. Thirty-four reviews and 21 grey literature reports fitted inclusion criteria of adult physical/mental health outcomes/multiple morbidities. Thematic analysis revealed six themes (collaborative approach; costs; evidence and evaluation; integration of care; professional roles; service user factors) with 20 subthemes including key barriers (cost effectiveness; effectiveness of integrated care; evaluation methods; focus of evidence; future research; impact of integration) and enablers (accessing care; collaboration and partnership; concept of integration; inter-professional relationships; person-centered ethos). Findings indicated a paucity of robust research to evaluate such interventions and lack of standardized methodology to assess cost effectiveness, although there is growing interest in co-production that has engendered information sharing and reduced duplication, and inter-professional collaborations that have bridged task-related gaps and overlaps. The importance of identifying elements of integrated care associated with successful outcomes and determining sustainability of interventions meeting joined-up care and preventive population health objectives was highlighted.

In the name of development? The moral economy of a private sector–NGO partnership in Ethiopia

Private actors have, over the past decade, entered the field of development operating in new forms of partnerships with established aid actors. Private actors now constitute a central means and objective of publicly funded development aid, causing a growth in actors operating in the name of development but without being compelled to follow established development discourses or principles. This article explores the formation of one such ‘strategic partnership’ in northern Ethiopia, between a small publicly funded Norwegian NGO and a multinational corporation. The research draws on several fieldworks in Ethiopia, stakeholder interviews, and project observations in 2018 and 2019, complemented with grey literature review. Using the concept of ‘interface’, the article explores the various encounters between actors with different rationales and mandates that prove hard to reconcile in practice; the seemingly altruistic development aid drawing on participatory approaches to target beneficiaries’ needs is at odds with the corporate logic and accountabilities to shareholders and investors. The partnership and project formations are undermined by the practical encounter of these distinct logics, as the private actor gradually withdraws from joint project operations to maintain its corporate reputation. Any notion of participatory planning and local knowledge – here conceived of in terms of moral economy – are omitted from the project formation process, thus, not only undermining a central principle of aid programming, but also making the publicly funded aid project into a proxy for corporate interests.

MHealth interventions for postpartum family planning in LMICs: A realist review.

The unmet need for family planning is a pervasive public health concern in many low- and middle-income countries (LMICs). Mobile health (mHealth) interventions have been designed and implemented in LMIC settings to address this issue through health information dissemination via voice calls, apps, and short message services (SMS). Although the impact of mHealth programmes on postpartum family planning outcomes have been systematically reviewed, the contexts, conditions, and mechanisms underpinning programme engagement and their impact on outcomes remain unclear. This study aims to formulate hypotheses in the form of context-mechanism-outcome configurations (CMOCs) of whether, how, why, for whom, and in what contexts mHealth interventions implemented in LMICs influence postpartum family planning (PPFP) outcomes. We conducted a realist review of peer-reviewed and grey literature. Peer-reviewed literature was identified through MEDLINE, Embase, Global Health, Web of Science, and Google Scholar. Grey Literature was identified through The National Grey Literature Conference, FHI 360, Guttmacher Institute, Population Council, and MSI Reproductive Choices. Inclusion criteria were updated as the review progressed. Narrative data were analysed using dimensional analysis to build CMOCs. Two overarching concepts (underpinned by 12 CMOCs) emerged from the 37 included records: mobile phone access, use, and ownership as well as women's motivation. Women's confidence to independently own, access, and operate a mobile phone was a central mechanism leading to mHealth programme engagement and subsequent change in PPFP knowledge, awareness, and outcomes. Receiving family and social support positively interacted with this while low digital literacy and harmful gender norms pertaining to prescribed domestic duties and women's household influence were barriers to programme engagement. Intrinsic motivation for health improvement functioned at times both as a context and potential mechanism influencing mHealth programme engagement and PPFP outcomes. However, these contexts rarely occur in isolation and need to be evaluated as co-occurring phenomena. (Review registration: PROSPERO CRD42023386841).

Misaligned or misheard? Physical activity and healthy eating messaging to ethnic minority communities during the COVID-19 pandemic: A qualitative study and scoping review.

This mixed-methods study identified physical activity (PA) and healthy eating messages produced during the COVID-19 pandemic and explored how they were received by UK ethnic minority communities. A scoping review of research and grey literature identified categories of PA and healthy eating messaging targeted at ethnic minorities. Individual and group interviews were conducted, audio-recorded, transcribed and analysed using inductive thematic analysis. There was active community engagement in all study phases to ensure relevance and co-production of findings. Interviews were held with 41 study participants aged 18-86 years (20 men) residing in England and Wales using digital conferencing and in person. The scoping review identified 24 records containing messages grouped into three categories: 1) PA messages; 2) healthy eating messages; 3) risk messages. Five themes described participants' views of these messages: 1) lack of awareness of messaging; 2) responses to PA messaging; 3) responses to healthy eating messaging; 4) perceptions of risk messaging and 5) perceptions of conflict in messages. The review revealed that physical activity and healthy eating messaging specifically targeting ethnic minority communities is limited. This limited messaging was almost entirely missed by these communities. When received, the messaging was not interpreted as intended, perceived to be conflicting and risk messaging was perceived as blaming. More work with ethnic minority communities needs to be done to co-produce meaningful and appropriate PA and healthy eating messaging in a timely manner.

A Review of the Impact of Sporting Role Model-Led Interventions on Physical Activity and Sport Participation of Female Youth

There is a lack of evidence of on the impact of how sporting role models (SRM) influence adolescent physical activity (PA) and/or sport participation (SP) levels. The main aim of this review was to identify SRM-led interventions and highlight the evidence of impact of SRMs on female adolescents’ participation in PA and/or SP. A systematic review of peer-reviewed literature using key search terms was completed using electronic databases (APA PsycInfo, SPORTDiscus, and PubMed). The inclusion criteria were as follows: (a) Participants were ≤18 years old, (b) results were reported for female participants, (c) the study included an intervention arm/element, (d) an SRM or equivalent terminology was used as part of the intervention, (e) PA levels and/or SP was evaluated, and (f) peer-reviewed articles published in English. A total of 7,169 peer-reviewed articles were identified and screened. A systematic review of grey literature to identify SRM programs was also carried out through Google search engine, direct contact with relevant sporting organizations, and with authors who had written about role models, and 45 programs were identified. Identified documents were screened using the same inclusion criteria as described above. The results identified one peer-reviewed and 15 grey literature programs, all of which were deemed to be of poor quality. The programs revealed a lack of theoretical base and rigor in methodology, no objective PA or SP assessment, poor demographic context of participants and role models, and lack of evaluation.

A comparative assessment of accommodation strategies based on elevated buildings for coastal adaptation

Elevating parts or the entirety of the structure of buildings in exposed coastal areas can be an effective way of managing the growing risks associated with climate change and sea level rise. While these accommodation measures are well known, there is little to no research on their role in coastal adaptation policy in Europe or on accommodation taking place at all. A systematic review of grey literature was carried out in metropolitan France, the UK and Ireland to assess the current state of structural accommodation. The analysis shows that although measures such as the raising of floor levels of new developments are common practice as part of property-level resilience and flood risk management on the coasts of the three studied countries, accommodation remains driven by local spatial planning and poorly integrated in overarching adaptation policies. Accommodation is found to be unevenly distributed along the assessed coasts and in many locations is happening in protected or sheltered locations to manage residual risk. Comparisons with the experience from the US – where elevated buildings have been an established strategy for over 50 years – suggest that accommodation could be enhanced by providing guidelines that better account for coastal processes such as the impacts of waves, as well as by promoting financial incentives through subsidies or insurance schemes. National coastal adaptation policies are rapidly evolving in Europe and could benefit from a better understanding of the advantages and limitations of accommodation by elevating buildings.

Towards a comprehensive understanding of Integrated Community Care (ICC)

Introduction: Health and functional decline in older people greatly affects their need for care and support. Governments, when confronted with ageing populations, therefore use the policy perspective of ‘ageing in place’, which supports social and health care in the personal environment of people. Recent studies also accentuate the influence of the location in which people live on their health and social care needs. One possible way to implement social and health care in localities is by integrated community care (ICC) or caring neighbourhoods. In Flanders (Belgium), we see a couple of initiatives and policy using the concept of ICC. Although internationally there is progressively more attention towards this concept, there is virtually no agreement between scholars on what exactly it entails. This study aims to develop a framework for a better understanding of ICC by providing insight in its objectives and critical success factors. This framework can be used by initiators of ICC projects and policy makers to develop ICC projects and to formulate policy recommendations. 
 Method: The study consisted of five focus groups with stakeholders of ICC to identify the objectives and critical success factors. Two main groups of stakeholders were defined in Flanders and Brussels: (1) stakeholders with experiences regarding ICC, and (2) academic experts or policy makers of the Flemish or Brussels’ Government. The first group was questioned using the Multi-actor multi-criteria analysis method (Macharis et al., 2012). The second group reflected on the results of the first focus groups, using a semi-structure interview scheme. The results of the descriptive thematic analysis were compared and combined with key elements of ICC, as found in a review of academic and grey literature.
 Results: The five focus groups with the stakeholders led to the identification of objectives and critical success factors. We identified two sets of objectives: (i) process goals; and (ii) operational objectives, or effective objectives. For every objective, accompanying and general critical success factors were formulated. All objectives can be connected to key elements of ICC found in literature, dealing with methods or strategies, goals or ambitions and stakeholders. The presence of involved stakeholders was mostly cited in the critical success factors. The effective objectives correspond with the goals formulated in literature, however, there are some differences. In literature they focus heavily on social and health care, while goals formulated by the stakeholders target mainly social and societal changes.
 Conclusion: Focus groups allowed to define a clear set of stakeholder objectives that determine the success of ICC. The use of the Multi-actor multi-criteria analysis method allowed to build a framework that enable both practitioners and scholars to understand which quantitative and qualitative factors contribute to the success of an ICC project. Future research is needed to understand the relative importance of each factor and objective and how it contributes to the success of ICC. 
 Reference: 
 Macharis, C., Turcksin, L., & Lebeau, K. (2012). Multi actor multi criteria analysis (MAMCA) as a tool to support sustainable decisions: State of use. Decision Support Systems, 54(1), 610-620. https://doi.org/10.1016/j.dss.2012.08.008 
 
 

Safeguarding nursing homes in a pandemic: lessons learnt and implications for future workforce planning and development.

Introduction: COVID-19 posed formidable challenges to Singapore’s nursing home (NH) sector. Singapore’s swift implementation of non-pharmaceutical interventions, staff management protocols, and rapid rollout of vaccinations and therapeutics successfully limited COVID-19 mortality and morbidity in the sector. Additionally, the pandemic highlighted the need to strengthen workforce resilience in a crisis. In this study, we identify challenges, opportunities and ways forward to inform the NH sector’s preparation for future outbreaks and ensure sustainability of actions. Here, we present findings on workforce capacity and capability-building.
 Methods: We conducted a qualitative study in two parts to characterise the pandemic response in NHs in Singapore: (i) A rapid review of peer-reviewed and grey literature, including media reports, policy documents, and advisories to synthesise the public health measures implemented from Jan 2020 to Jun 2021 and (ii) n=42 semi-structured in-depth interviews with key stakeholders working in the NH, public health, healthcare, and integrated care sectors, with interview data thematically analysed. 
 Findings: The key challenges identified were NH sector reliance on foreign manpower, early introduction of interventions to curb transmission risks that were maintained for longer than restrictions in community settings, and high resource demands to facilitate implementation of and compliance to restrictions. Care staff reported fatigue, fear, and anxiety. Alongside, strict border controls, quarantine measures, and staff segregation policies limited the NH sector’s ability to flexibly respond to manpower attrition. 
 To cope with these challenges, NHs upskilled junior staff and cross-trained non-nursing staff to take on reassigned tasks and built new capabilities across surveillance and testing. Public hospital manpower supported the NH sector with infection prevention and control advice, tele-consultations, and knowledge-sharing on case management and diagnostics. 
 Opportunities for COVID-19 collaboration between the NH sector and health and integrated care agencies were grounded in social capital accumulated over many years of inter-agency partnerships and collaboration. Boundarylessness and open communication between organisations/agencies facilitated timely decision-making, information sharing, and flexible deployment of resources, including additional funding support. 
 Ways forward: Moving forward, findings pointed to the pandemic providing impetus to build a strong local manpower core, invest in schemes to boost competitiveness and attractiveness, consider a review of existing staffing models, and increase resourcing support to enable the NH sector to keep up with policy changes and future demands. Findings also suggested the importance of greater investment into supporting healthier work environments and prioritising staff mental and physical health.

Scaling up integrated care: a realist evaluation on the role of country-specific policy dialogues and scale-up roadmaps in Belgium, Slovenia, and Cambodia

Background: The ‘SCale-Up of diaBetes and hYpertension care’ (SCUBY) project aims to support the scale-up of integrated care for diabetes and hypertension in Cambodia, Slovenia, and Belgium through the co-creation, implementation, and evaluation of contextualized roadmaps. These roadmaps offer avenues for action and are built on evidence as well as stakeholder engagement in policy dialogues. These two implementation strategies – roadmaps and policy dialogues – are very much intertwined and considered to be key elements for successful stakeholder supported scale-up. Yet, little is known about how, why, and under which conditions a roadmap leads to successful implementation and scale-up of integrated care. Therefore, the resulting research question is: ‘How, why, and under which context conditions does a co-created scale-up roadmap lead to adoption, implementation, and scale-up of integrated care?’.
 Methods: A realist approach is used towards testing the initial programme theory (IPT) in the three countries. The IPT draws on political science theory of the multiple streams model (MSM) adapted by Howlett and includes five streams (problem, solution, politics, process and programme) that can emerge, converge and diverge across all policy stages. To test the IPT, information from different sources was collected. Firstly, qualitative interviews were conducted with the researchers in the SCUBY country teams as well as with key stakeholders (health facility managers, policy makers, civil servants, professional medical and patient associations, NGOs, and implementers). Secondly, a document review of grey literature, meeting reports, and official documents was performed. Finally, a workshop was organised with SCUBY researchers from all country teams to refine the IPT. We used the Intervention-Context-Actors-Mechanism-Outcome (ICAMO) configuration to synthesise information into a configurational map.
 Results: In each country case, the project partner’s mandate was key in the approach to scale-up, the design, and content, leading to different mechanisms, scale-up pathways, and outcomes. In Belgium, the (scientific) solutions stream was dominant with creating common understanding as a key mechanism; in Slovenia, the programme stream became the dominant focus whilst exemplifying good practices of patient empowerment; and in Cambodia, the political stream was dominant yet closely knit together with the solutions stream – with knowledge sharing and credibility as key mechanisms. A finding across all three countries was that a lack of political support can derail or slow down scale-up.
 Discussion: This study extends the knowledge base about the use of co-creation in policy dialogues to build a roadmap for scale-up. The roadmaps illustrate how the MSM theory can be used to theorize the policy process of roadmap and policy dialogues in different contexts, aligning the context-dominant stream with the context-specific scale-up strategy. By testing theories in real cases, the theories can be adapted, refuted and/or reconstructed to elicit a refined theory of how and why a roadmap co-created in policy dialogues for scale-up works.

Vom Burnout zur Balance – Programme in deutschen Krankenhäusern

From burnout to balance – programmes in German hospitals. Grey literature review with semi-structured interviews Objective: Healthcare professionals are increasingly being affected by stress and burnout. This review evaluates current stress and burnout-prevention projects in respect of content and implementation. The findings serve as a basis for developing a programme for nurses and physicians that is compatible with everyday practice. Methods: A grey literature search was conducted on Google and Google scholar search machines between 11 March and 14 April 2022, limited to the years ≥ 2017. Projects included were focused on workplace health promotion for (1) nurses or/and physicians at German hospitals, (2) conducted in in-person, blended or hybrid form, (3) offered as modules or consecutively, that (4) explicitly aimed to reduce stress or to prevent burnout with resilience or mindfulness-based interventions. Project leads were interviewed between 1 June and 30 July 2022. Results: Of 55 projects identified, five were included. The projects were 1) peer-based stress training; 2) an empathy-based project concept; 3) a carefocused webinar; 4) a tailored nurse workshop project; and 5) a blended weekly e-learning online course on healthy routines and relaxation. Four of the five are being evaluated scientifically. Interview results emphasise a lowthreshold course design, target group and team orientation, the importance of institutional integration and systematic anchoring. Conclusions: Projects aimed at preventing stress and burnout exist at some German hospitals but vary significantly in content and scientific evaluation. This review reflects the importance of need-based approaches that not only strengthen between the individual and teams in a good balance, but also foster incremental organisational changes beyond behavioural aspects for mental health among healthcare professionals. Keywords: burnout – stress – healthcare professionals – prevention – occupational health promotion

ESSENTIAL CAPABILITIES FOR MANAGING THE LONG-TERM CARE WORKFORCE: EVIDENCE FROM AN INTERNATIONAL SCOPING REVIEW

Abstract Amid ongoing concerns about meeting the staffing needs of long-term care providers, arguably exacerbated by the COVID-19 pandemic, there is a need to better understand the skills and capabilities required of managers in the sector. Internationally, the management of the long-term care workforce has been somewhat neglected by both the research literature and recent enquiries into the sector. There is fundamental agreement that well-managed staff provide better care. The sector’s leadership and its workforce have been under scrutiny for some time and the context of COVID-19 has shone further light on their limited ability to respond to crises. It is recognised that operational deficiencies in terms of the organization and characteristics of the sector’s workforce as well as its socio-cultural positioning have contributed to sub-optimal functioning. This project collated evidence and recommendations that could inform policymaking among long-term care providers as well as policy and decision makers. An evidence review of relevant international gray and academic literature was undertaken and examples of successful models of management practice across a range of dimensions were identified and written up as vignettes. The paper reports key information regarding the building of capabilities in long-term care workforce management, including: current and future workforce considerations, value proposition, onboarding of staff, career development and retention. Recommendations regarding essential management capabilities in the long-term care workforce are set out with the intention of providing a basis for developing innovative and novel methods for improving and monitoring the quality and impact of management on the workforce.

MicroProf : Code-level Attribution of Unnecessary Data Transfer in Microservice Applications

The microservice architecture style has gained popularity due to its ability to fault isolation, ease of scaling applications, and developer’s agility. However, writing applications in the microservice design style has its challenges. Due to the loosely coupled nature, services communicate with others through standard communication APIs. This incurs significant overhead in the application due to communication protocol and data transformation. An inefficient service communication at the microservice application logic can further overwhelm the application. We perform a grey literature review showing that unnecessary data transfer is a real challenge in the industry. To the best of our knowledge, no effective tool is currently available to accurately identify the origins of unnecessary microservice communications that lead to significant performance overhead and provide guidance for optimization. To bridge the knowledge gap, we propose MicroProf , a dynamic program analysis tool to detect unnecessary data transfer in Java-based microservice applications. At the implementation level, MicroProf proposes novel techniques such as remote object sampling and hardware debug registers to monitor remote object usage. MicroProf reports the unnecessary data transfer at the application source code level. Furthermore, MicroProf pinpoints the opportunities for communication API optimization. MicroProf is evaluated on four well-known applications involving two real-world applications and two benchmarks, identifying five inefficient remote invocations. Guided by MicroProf , API optimization achieves an 87.5% reduction in the number of fields within REST API responses. The empirical evaluation further reveals that the optimized services experience a speedup of up to 4.59×.