Mixed Methods Appraisal Tool Research Articles

Implementing AI in Hospitals to Achieve a Learning Health System: Systematic Review of Current Enablers and Barriers.

Efforts are underway to capitalize on the computational power of the data collected in electronic medical records (EMRs) to achieve a learning health system (LHS). Artificial intelligence (AI) in health care has promised to improve clinical outcomes, and many researchers are developing AI algorithms on retrospective data sets. Integrating these algorithms with real-time EMR data is rare. There is a poor understanding of the current enablers and barriers to empower this shift from data set-based use to real-time implementation of AI in health systems. Exploring these factors holds promise for uncovering actionable insights toward the successful integration of AI into clinical workflows. The first objective was to conduct a systematic literature review to identify the evidence of enablers and barriers regarding the real-world implementation of AI in hospital settings. The second objective was to map the identified enablers and barriers to a 3-horizon framework to enable the successful digital health transformation of hospitals to achieve an LHS. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adhered to. PubMed, Scopus, Web of Science, and IEEE Xplore were searched for studies published between January 2010 and January 2022. Articles with case studies and guidelines on the implementation of AI analytics in hospital settings using EMR data were included. We excluded studies conducted in primary and community care settings. Quality assessment of the identified papers was conducted using the Mixed Methods Appraisal Tool and ADAPTE frameworks. We coded evidence from the included studies that related to enablers of and barriers to AI implementation. The findings were mapped to the 3-horizon framework to provide a road map for hospitals to integrate AI analytics. Of the 1247 studies screened, 26 (2.09%) met the inclusion criteria. In total, 65% (17/26) of the studies implemented AI analytics for enhancing the care of hospitalized patients, whereas the remaining 35% (9/26) provided implementation guidelines. Of the final 26 papers, the quality of 21 (81%) was assessed as poor. A total of 28 enablers was identified; 8 (29%) were new in this study. A total of 18 barriers was identified; 5 (28%) were newly found. Most of these newly identified factors were related to information and technology. Actionable recommendations for the implementation of AI toward achieving an LHS were provided by mapping the findings to a 3-horizon framework. Significant issues exist in implementing AI in health care. Shifting from validating data sets to working with live data is challenging. This review incorporated the identified enablers and barriers into a 3-horizon framework, offering actionable recommendations for implementing AI analytics to achieve an LHS. The findings of this study can assist hospitals in steering their strategic planning toward successful adoption of AI.

Diagnostic Accuracy of Cone-Beam CT for Acute Intracranial Hemorrhage: A Systematic Review and Meta-Analysis

ObjectiveOur purpose was to synthesize evidence in the literature to determine the diagnostic accuracy of cone-beam CT (CBCT) for the detection of intracranial hemorrhage (ICH) and hemorrhage types, including intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH), and intraventricular hemorrhage (IVH). MethodsWe performed a meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Our protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO-CRD42021261915). Systematic searches were last performed on April 30, 2024, in EMBASE, PubMed, Web-of-Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases. Inclusion criteria were (1) studies reporting diagnostic metrics of CBCT for ICH and (2) studies using a reference standard to determine ICH. Exclusion criteria were (1) case reports, abstracts, reviews and (2) studies without patient-level data. Pooled estimates and 95% confidence intervals (CIs) were calculated for diagnostic odds ratios (DORs), sensitivity, and specificity using random-effects and common-effects models. Mixed methods appraisal tool was used to evaluate risk of bias. ResultsSeven studies were included in the meta-analysis yielding 466 patients. Mean or median age ranged from 54 to 75 years. Female patients represented 51.4% (222 of 432) in reported studies. Multidetector CT was the reference standard in all studies. DOR, pooled sensitivity, and pooled specificity for ICH were 5.28 (95% CI: 4.11-6.46), 0.88 (95% CI: 0.79-0.97), and 0.99 (95% CI: 0.98-1.0). Pooled sensitivity for IPH, SAH, and IVH was 0.98 (95% CI: 0.95-1.0), 0.82 (95% CI: 0.57-1.0), and 0.78 (95% CI: 0.55-1.0). Pooled specificity for IPH, SAH, and IVH was 0.99 (95% CI: 0.98-1.0), 0.99 (95% CI: 0.97-1.0), and 1.0 (95% CI: 0.98-1.0). DiscussionCBCT had moderate DOR and high pooled specificity for ICH and hemorrhage types. However, pooled sensitivity varied by hemorrhage type, with the highest sensitivity for IPH, followed by SAH and IVH.

Platelet-Rich Plasma in Aesthetic Dermatology: Current Evidence and Future Directions.

Platelet-rich plasma (PRP) has emerged as a promising treatment in aesthetic dermatology. This systematic review aims to evaluate the current evidence for PRP applications in skin rejuvenation, hair restoration, wound healing, and fat grafting. FollowingPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted across multiple databases and 13 studies meeting the inclusion criteria were selected for review. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies. The reviewed studies consistently reported positive outcomes for PRP across various applications. In skin rejuvenation, significant improvements in collagen density and overall skin appearance were observed. For hair restoration, studies showed mean increases of 18-27.7 hairs/cm² in treated areas. PRP demonstrated efficacy in accelerating wound healing across various wound types, including chronic ulcers. In fat grafting, PRP was associated with improved graft survival and integration. Patient satisfaction was generally high across all applications. However, there was significant heterogeneity in PRP preparation methods and treatment protocols among studies. This systematic review provides evidence supporting the efficacy of PRP in aesthetic dermatology, particularly in skin rejuvenation, hair restoration, wound healing, and fat grafting. PRP demonstrates a favorable safety profile across applications. However, the variability in study designs and PRP protocols highlights the need for standardization. Future research should focus on large-scale randomized controlled trials with standardized protocols and longer follow-up periods to solidify the evidence base for PRP in aesthetic dermatology.

A systematic review on the level of risk perception of diabetes mellitus: The role of environmental factor.

Risk perception plays important role in motivating preventive health behaviours. The objective of this systematic review was to explore the level of diabetes risk perception among individuals with and without apparent risk for diabetes, and to consider the effect of environmental factors on the level of diabetes risk perception. This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search was carried out through PubMed, Web of Science, and Scopus. Original articles written in English and published between 2013 and 2023 were considered. Study quality was appraised using the Mixed Methods Appraisal Tool. Narrative synthesis was undertaken due to methodological heterogeneity in the included studies. A total of 13 cross-sectional studies, two randomized controlled trials, two cohort studies, two mixed methods studies and one quasi-experiment with a control group were included. An overall low level of diabetes risk perception was reported particularly in those without apparent risk for diabetes. The 20 included studies reported widely varied measures for calculating diabetes risk perception. The influence of environmental factors on the risk perception of diabetes was highlighted. The use of study-specific and non-validated measures in the included studies weakens the authors' ability to compare across studies. The role of language and publication bias within this systematic review should be acknowledged as we included only English-language studies published in peer-reviewed journals. Another limitation is the exclusion of dimensions of risk perception such as optimistic bias as search terms. The overall low risk perception of diabetes calls for urgent need of public health interventions to increase the risk perception of diabetes. In the future, researchers should ensure the validity and reliability of the measures being used. The influence of environmental factors on the diabetes risk perception indicates that diabetes preventive interventions targeting environmental factors may be effective in increasing the risk perception of diabetes.

Advance directives in amyotrophic lateral sclerosis – a systematic review and meta-analysis

BackgroundAmyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of the upper and lower motoneuron. It is associated with a life expectancy of 2–4 years after diagnosis. Individuals experience paralysis, dysphagia, respiratory failure and loss of communicative function, rendering advance care planning (ACP) critically important. This systematic review primarily aimed to internationally compare the application of advance directives (AD) and ACP in ALS. Its secondary aim was to identify ACP preferences, identify fields for future research and to generate recommendations for improving patient care through ACP.MethodsWe conducted a systematic literature review and meta-analysis. Five electronic databases (Embase, Medline, Scopus, PsycInfo and CENTRAL) were searched for qualitative and quantitative primary literature from 1999 to 2024. Cross-references were used to identify additional publications. Study selection was performed based on inclusion criteria. Number and content of AD were extracted systematically. After statistical analysis consecutive meta-analysis was performed for international differences and changes over time. Quality assessment of studies was performed using the MMAT (Mixed Methods Appraisal Tool). PROSPERO Registration (June 07, 2021) : CRD42021248040.ResultsA total of 998 records was screened of which 26 were included in the synthesis. An increase in publication numbers of 88.9% was observed from 1999 to 2024. Results regarding use and content of AD were heterogeneous and international differences were detected. AD were signed in 60.4% of records (1,629 / 2,696 patients). The number of AD decreased over time when separating the review period in two decades (1st 1999–2011: 78% vs. 2nd 2012–2024: 42%). Study quality was superior in qualitative and mixed method designs compared to quantitative studies.ConclusionFurther prospective studies should include detailed analyses on preferences regarding ventilation and artificial nutrition in ALS and should encompass countries of the global south. Despite the complexity of ACP with regard to individual patient needs, ACP should be part of each individual support plan for ALS patients and should specifically comprise a discussion on the preferred place of death. The available disease-specific AD documents should be preferred.

Facilitators and barriers to contraception access and use for Hispanic American adolescent women: An integrative literature review.

Hispanic American adolescents experience high rates of pregnancy with profound consequences. Compared with White teens, Hispanic teens use contraception less frequently and often choose less effective forms of contraception. Access to contraception is a primary barrier to use which contributes to relatively high and disparate rates of pregnancy in Hispanic teens. This integrative review identifies facilitators and barriers of contraception access and use for Hispanic women, 13-17 years of age, living in the U.S. Following the Whittemore and Knafl (2005) methodology and PRISMA guidelines, peer reviewed studies were retrieved from PUBMED, CINAHL and EMBASE. The Mixed Methods Appraisal Tool was used to assess the study quality and thematic analysis was used to categorize barriers and facilitators. Of 131 studies retrieved, 16 met inclusion criteria. Individual, interpersonal and healthcare provider factors were identified as primary categories of barriers and facilitators with structural issues comprising an additional barrier category. Individual level barriers were disproportionately represented and further categorized into themes: beliefs/misconceptions, dislike of contraception, pregnancy risk perception, lack of knowledge, and lack of control. Barriers related to cultural and religious influences were identified in individual, interpersonal and structural levels. The most frequently reported facilitators were perceived parent comfort discussing sexual health and past experience of pregnancy. Limitations in this review may stem from heterogeneity in the acculturation and geography of participants and analysis by a single reviewer. Implications include considering the range of information sources and the influence they have on risk perception and risk mitigation for this population. Adolescents describe many modifiable influences on contraception access and use. Misperceptions related to contraception, stemming from beliefs and perceptions, can be corrected through increased access to reliable sources of sex education, parental support, and direct access to nurses and healthcare providers. Awareness of these influences can inform further research and intervention development to address these health disparities.

Investigation of prevalence and risk factors of musculoskeletal disorders among tea harvesting farmers - A systematic review.

Tea harvesting is a common agricultural occupation, usually conducted in mountainous regions with steep slopes and high altitudes. Despite the utilization of modern technology and mechanized equipment in agriculture, a substantial portion of tea harvesting continues to be traditional and physically strenuous. This dependence on manual labor can lead to a higher likelihood of musculoskeletal disorders among tea harvesting farmers. The objective of this research was investigation of prevalence and risk factors of musculoskeletal disorders in tea harvesting farmers. In this review study, we analyzed all published articles on the prevalence and factors influencing musculoskeletal disorders in tea harvesting farmers from March 10, 2010, to November 10, 2023 (last search date). We systematically searched for articles using keywords (risk factor, risk assessment, lower limb, upper limb, musculoskeletal disorders, tea harvesting, posture, manual handling, discomfort, ergonomics, prevalence, farmers) in PubMed, Google Scholar, SID, Web of Science, Scopus, Magiran, Iran Medex, Cochrane Library, and Embase. The quality of the articles was evaluated using the Mixed Methods Appraisal Tool (MMAT), 2018 version. Unrelated articles were excluded following PRISMA statement guidelines, and only articles directly related to the study were reviewed. GraySource and BASE databases were also utilized to identify Gray sources.. Initially, 128 articles were found across different databases, and a total of 17 articles were selected for the final assessment. The primary areas of the body that workers are commonly exposed to musculoskeletal issues are the back, hands, wrists, shoulders, neck, and knees. The research identified four main categories of factors: personal, occupational, environmental, and psychosocial that contribute to musculoskeletal problems. Among these factors are women working in physically demanding environments, lifting heavy bags of harvested tea, time pressures during tea collection, repetitive hand motions from using harvesting tools, the height of the tea plants in the field, working in wet and slippery conditions, uneven ground surfaces, extended working hours, low pay, and lack of support from employers. Ergonomic interventions such as redesigning tea harvesting tools, enhancing tea plants and workspaces, teaching ergonomic principles of body posture and manual movement, and organizing work with job rotation and adequate rest are recommended to alleviate musculoskeletal disorder symptoms.

Patients' perspectives on feedback interventions to support adherence to long-term medication: a systematic review with thematic synthesis of qualitative evidence

Abstract Background Medication optimisation is a global issue with up to 50% of people not taking medicines as prescribed. Numerous interventions have been developed to address this, many of them including feedback on behaviour and outcomes. Understanding patients’ views on such interventions is essential for successful adoption and use. Purpose The purpose of this systematic review is to: (1) Understand patients’ perspectives and experiences of medication adherence feedback interventions and (2) Identify barriers and facilitators which influence their implementation within practice. Methods CINAHL, MEDLINE, EMBASE, PubMED, PsycINFO and Google Scholar were systematically searched to identify relevant studies. The inclusion criteria included; studies with qualitative or mixed method designs describing patients’ perspectives on medication adherence feedback interventions, primary studies with adult participants on long-term medications and studies involving interventions suitable for self-management in primary or community care. Quality assessment was completed using the Mixed Methods Appraisal Tool. The review was reported using the PRISMA and conducted using ENTREQ guidelines. Data were extracted and analysed using thematic synthesis (NVivo 20). Findings were presented narratively. Results From the 1,031 records screened, ten studies were included. Five studies were conducted in the United States, two in the United Kingdom, and one in the Netherlands, Canada, and Tanzania, respectively. Medication adherence interventions included the use of therapeutic drug monitoring methods and digital adherence technologies such as mHealth and eHealth for people living with asthma, HIV, coronary heart disease, hypertension, and type 2 diabetes. Patients found interventions acceptable if they were simple to use, allowed control over data sharing options, incorporated audio visual cues, and provided emotional and motivational support. Building trust between patients and healthcare providers and the resulting benefit of shared decision-making were also considered key factors for intervention success. However, developing interventions without user input was identified as a potential barrier to intervention implementation. Patients expressed an overall desire to have interventions tailored to meet their personal needs and preferences, highlighting the importance of placing user needs at the centre of intervention development. Conclusion Placing user needs at the centre of adherence intervention development is crucial for successful implementation. Further research which facilitates user involvement in co-designing interventions to compliment patients’ characteristics and preferences would be key for intervention implementation.

Palliative Care Coordination Interventions for Caregivers of Community-Dwelling Individuals with Dementia: An Integrative Review.

Alzheimer's disease is a serious illness with a protracted caregiving experience; however, care coordination interventions often lack the inclusion of palliative care. The purpose of this integrative review is to identify and synthesize existing care coordination interventions that include palliative care for individuals with dementia and their caregivers living in community settings. The Whittemore and Knafl framework guided the review, with data analysis guided by the SELFIE framework domains. Study quality was assessed using the Mixed Methods Appraisal Tool, while the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines informed reporting results. Nine care coordination interventions involving family caregivers across eighteen publications were identified. Only a single intervention explicitly mentioned palliative care, while the remaining interventions included traditional palliative care components such as advance care planning, symptom management, and emotional support. Many of the identified interventions lacked theoretical grounding and were studied in non-representative, homogeneous samples. Further research is needed to understand the lived experiences of people with dementia and their caregivers to alleviate care coordination burden.

A Systematic Literature Review of Strategies Implemented in Extended Education Settings to Address Children's Mental Health and Wellbeing.

Mental health and wellbeing problems in middle childhood are increasing worldwide which needs more support than just clinical services. Early intervention has been explored in other settings, but not in extended education care settings such as outside school hours care (OSHC). A systematic literature review was undertaken to determine what interventions have been tested in extended education settings to address or promote emotional, behavioural, or social wellbeing in children, and to assess how effective they have been. A PRISMA guided search found seven peer reviewed articles from an initial pool of 458. Data from the articles were extracted and the mixed method appraisal tool (MMAT) was applied to assess methodological quality of the studies design, data collection, and analyses. The final selections were methodologically heterogeneous with an average MMAT quality rating of 71%. All but one of the interventions were delivered to children in small group settings and were a mix of activities. Studies that trained educators to deliver the interventions were limited and no data were collected for them. The two interventions that trained educators to deliver content to children were seen as promising. This review showed an overall paucity of research examining interventions delivered in extended education settings to improve children's wellbeing. Given variations in extended education services and the absence of formal qualifications required for educators, further research is needed to understand what interventions may be effective and what role educators could play in such interventions or in supporting children's wellbeing in extended education.This review protocol was prospectively registered with PROSPERO . Registration ID: CRD42023485541 on 03/12/2023.

Urinary Incontinence in Female Athletes: A Systematic Review on Prevalence and Physical Therapy Approaches.

Urinary incontinence (UI) is an involuntary leakage of urine and is classified as stress, mixed, or urge. It is more common in females due to anatomical and physiological body differences. Moreover, the literature remarks an evident presence of UI with high-intensity physical activities. Therefore, the present integrative systematic review focused on the studies aimed at investigating the prevalence of UI in nulliparous sportswomen, studies illustrating sport-specific prevalence of UI, and studies demonstrating the impact of physical therapy intervention on UI. A literature search was carried out systematically on electronic databases consisting of Cochrane and Google Scholar databases from 2018 to December 2023. The keywords utilized to perform the literature search and include relevant articles consisted of "urinary incontinence," AND "nulliparous," AND "sportswomen," OR "female athletes," AND "physical therapy". A total of nine studies were included in the present systematic review. The quality assessment of the studies was performed by using a measurement tool to assess systematic reviews (AMSTAR 2) scale, and the Mixed Methods Appraisal Tool was used for cross-sectional and randomized controlled trial studies. The data extracted included first author and year of publication, study design, sample or number of individuals involved in the study, age range of the participants, type of UI, type of sports involved, purpose of the study, methodological part, outcome measures derived, conclusion, and quality assessment of the studies. The review concludedthat nulliparous athletes, especially those participating in high-impactactivities, have a significant prevalence of UI. In addition,the physical therapy intervention consisting of pelvic floor muscle training (PFMT)along with education about pertinent pelvic anatomy was mostly performed on female athletes for the prevention and management of UI.

Impact and effect of imaging referral guidelines on patients and radiology services: a systematic review.

The objective of this systematic review was to offer a comprehensive overview and explore the associated outcomes from imaging referral guidelines on various key stakeholders, such as patients and radiologists. An electronic database search was conducted in Medline, Embase and Web of Science to retrieve citations published between 2013 and 2023. The search was constructed using medical subject headings and keywords. Only full-text articles and reviews written in English were included. The quality of the included papers was assessed using the mixed methods appraisal tool. A narrative synthesis was undertaken for the selected articles. The search yielded 4384 records. Following the abstract, full-text screening, and removal of duplication, 31 studies of varying levels of quality were included in the final analysis. Imaging referral guidelines from the American College of Radiology were most commonly used. Clinical decision support systems were the most evaluated mode of intervention, either integrated or standalone. Interventions showed reduced patient radiation doses and waiting times for imaging. There was a general reduction in radiology workload and utilisation of diagnostic imaging. Low-value imaging utilisation decreased with an increase in the appropriateness of imaging referrals and ratings and cost savings. Clinical effectiveness was maintained during the intervention period without notable adverse consequences. Using evidence-based imaging referral guidelines improves the quality of healthcare and outcomes while reducing healthcare costs. Imaging referral guidelines are one essential component of improving the value of radiology in the healthcare system. There is a need for broader dissemination of imaging referral guidelines to healthcare providers globally in tandem with the harmonisation of the application of these guidelines to improve the overall value of radiology within the healthcare system. The application of imaging referral guidelines has an impact and effect on patients, radiologists, and health policymakers. The adoption of imaging referral guidelines in clinical practice can impact healthcare costs and improve healthcare quality and outcomes. Implementing imaging referral guidelines contributes to the attainment of value-based radiology.

Healthcare delivery to patients from culturally and linguistically diverse backgrounds in emergency care: a scoping review protocol

BackgroundWorldwide, the culturally and linguistically diverse (CALD) population is increasing, and is predicted to reach 405 million by 2050. The delivery of emergency care for the CALD population can be complex due to cultural, social, and language factors. The extent to which cultural, social, and contextual factors influence care delivery to patients from CALD backgrounds throughout their emergency care journey is unclear. Using a systematic approach, this review aims to map the existing evidence regarding emergency healthcare delivery for patients from CALD backgrounds and uses a social ecological framework to provide a broader perspective on cultural, social, and contextual influence on emergency care delivery.MethodsThe Joanna Briggs Institute (JBI) scoping review methodology will be used to guide this review. The population is patients from CALD backgrounds who received care and emergency care clinicians who provided direct care. The concept is healthcare delivery to patients from CALD backgrounds. The context is emergency care. This review will include quantitative, qualitative, and mixed-methods studies published in English from January 1, 2012, onwards. Searches will be conducted in the databases of CINAHL (EBSCO), MEDLINE (Ovid), Embase (Elsevier), SocINDEX (EBSCO), Scopus (Elsevier), and a web search of Google Scholar. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram will be used to present the search decision process. All included articles will be appraised using the Mixed Methods Appraisal Tool (MMAT). Data will be presented in tabular form and accompanied by a narrative synthesis of the literature.DiscussionDespite the increased use of emergency care service by patients from CALD backgrounds, there has been no comprehensive review of healthcare delivery to patients from CALD backgrounds in the emergency care context (ED and prehospital settings) that includes consideration of cultural, social, and contextual influences. The results of this scoping review may be used to inform future research and strategies that aim to enhance care delivery and experiences for people from CALD backgrounds who require emergency care.Systematic review registrationThis scoping review has been registered in the Open Science Framework https://doi.org/10.17605/OSF.IO/HTMKQ

Factors influencing job satisfaction and professional competencies in clinical practice among internationally educated nurses during the migration journey: Amixed-methods systematic review.

The increasing migration of internationally educated nurses (IENs) from developing to developed countries highlights the importance of implementing integration strategies that facilitate their workplace transition, leading to improved job satisfaction and professional competence. The mixed-methods systematic review aimed to synthesise the current literature on factors influencing job satisfaction and professional competencies among IENs throughout their transition process, including the pre-migration, migration, and post-migration periods. This study conducted a mixed-methods systematic review from 2013 to 2023, using the CINAHL, Scopus, and PubMed databases and employing a Population, Interventions, Comparisons, Outcomes (PICO) framework. Quality assessment employed the Mixed Methods Appraisal Tool (MMAT), and data analysis followed a convergent parallel design. Data synthesis was presented narratively, and the literature review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Out of 565 articles, eleven studies (eight qualitative, two quantitative, and one mixed-method) met the inclusion criteria. Three key themes that influenced job satisfaction and professional competencies among IENs were identified: pre-migration and pre-deployment demands, challenges in workplace integration, and post-migration career challenges and retention strategies. The study primarily focused on IENs recruited from developing countries, potentially limiting the generalisability of the findings to IENs from other regions or countries. Furthermore, the inclusion of nurses from developed countries who also migrated was limited in the available studies, which further restricts the applicability of the research findings. It is essential to reconsider the pre-migration language requirements and evaluate the feasibility of completing them during the integration period to enhance the job satisfaction and professional competencies of IENs. Additionally, key factors for improving job satisfaction among IENs include providing personalised support, addressing managerial barriers, facilitating career advancement, efficiently managing workloads, and promoting effective communication within the healthcare team.

The facilitators and barriers to implementing virtual visits in intensive care units: A mixed-methods systematic review.

Visitation has a positive effect on patients and families, yet, it can disrupt intensive care unit (ICU) care and increase the risk of patient infections, which previously favoured face-to-face visits. The coronavirus disease 2019 (COVID-19) pandemic has raised the importance of virtual visits and led to their widespread adoption globally, there are still many implementation barriers that need to be improved. Therefore, this review aimed to explore the use of ICU virtual visit technology during the COVID-19 pandemic and the barriers and facilitators of virtual visits to improve virtual visits in ICUs. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six databases (CINAHL, China National Knowledge Infrastructure [CNKI], PubMed, Cochrane, VIP and Wang Fang databases) were searched for empirical studies published between 1 January 2020 and 22 October 2023. Studies that investigated and reported barriers to and facilitators of implementing virtual visits in ICUs during the COVID-19 pandemic were included. Evidence from the included studies was identified and thematically analysed using Thomas and Harden's three-step approach. Study quality was appraised with the Mixed-Methods Appraisal Tool. A total of 6770 references were screened, of which 35 studies met the inclusion criteria after a full-text review. Eight main barriers to virtual visits use were identified: technical difficulties; insufficient resources; lack of physical presence and nonverbal information; low technical literacy; differences in families' perceptions of visual cues; privacy and ethics issues; inequitable access and use of virtual visit technology; and lack of advance preparation. Four facilitating factors of virtual visit use were identified: providing multidimensional professional support; strengthening coordination services; understanding the preferences of patients and their families; and enhancing privacy and security protection. In the quality appraisal of 35 studies, 12 studies were rated as low, five as medium and 18 as high methodological quality. This review identified key facilitating factors and barriers to ICU virtual visits, which can foster the development of infrastructure, virtual visiting workflows, guidelines, policies and visiting systems to improve ICU virtual visiting services. Further studies are necessary to identify potential solutions to the identified barriers.

Factors Related to the Recurrence of Sickness Absence Due to Common Mental Health Disorders: A Systematic Review.

Employees who experience sickness absence (SA) due to common mental disorders (CMD) are at increased risk of recurrent sickness absence (RSA). This systematic literature review examines the factors at different levels in the work and non-work context that increase or decrease the likelihood of RSA due to CMD. The resulting knowledge enables more accurate identification of employees at risk of RSA. We conducted a search in June 2023 using the following databases: PubMed, PsycInfo, Web of Science, Cumulative Index to Nursing & Allied Health Literature (Cinahl), Embase and Business Source Ultimate (BSU). Inclusion criteria were as follows: (self-)employees, CMD, related factors, RSA. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). The Individual, Group, Leader, Organisation and Overarching/social context (IGLOO) model were used to cluster the found factors and these factors were graded by evidence grading. Nineteen quantitative and one qualitative studies of mainly high and some moderate quality were included in this review. A total of 78 factors were found. These factors were grouped according to the IGLOO levels and merged in 17 key factors. After evidence grading, we found that mainly low socioeconomic status (SES) and the type of previous SA (short-term SA and SA due to CMD) are predictors of an increased risk of RSA. Having a low SES and previous experience of SA (short term, or due to CMD) are factors that predict the chance of RSA, implying the need for prolonged support from occupational health professionals after the employee has returned to work.

The utility of website-based quality improvement tools for health professionals: a systematic review.

As technology continues to advance, it is important to understand how website-based tools can support quality improvement. Website-based tools refer to resources such as toolkits that users can access and use autonomously through a dedicated website. This review examined how website-based tools can support healthcare professionals with quality improvement, including the optimal processes used to develop tools and the elements of an effective tool. A systematic search of seven databases was conducted to include articles published between January 2012 and January 2024. Articles were included if they were peer reviewed, written in English, based in health settings, and reported the development or evaluation of a quality improvement website-based tool for professionals. A narrative synthesis was conducted using NVivo. Risk of bias was assessed using the Mixed Methods Appraisal Tool. All papers were independently screened and coded by two authors using a six-phase conceptual framework by Braun and Clarke. Eighteen studies met the inclusion criteria. Themes identified were tool development processes, quality improvement mechanisms and barriers and facilitators to tool usage. Digitalizing existing quality improvement processes (n = 7), identifying gaps in practice (n = 6), and contributing to professional development (n = 3) were common quality improvement aims. Tools were associated with the reported enhancement of accuracy and efficiency in clinical tasks, improvement in adherence to guidelines, facilitation of reflective practice, and provision of tailored feedback for continuous quality improvement. Common features were educational resources (n = 7) and assisting the user to assess current practices against standards/recommendations (n = 6), which supported professionals in achieving better clinical outcomes, increased professional satisfaction and streamlined workflow in various settings. Studies reported facilitators to tool usage including relevance to practice, accessibility, and facilitating multidisciplinary action, making these tools practical and time-efficient for healthcare. However, barriers such as being time consuming, irrelevant to practice, difficult to use, and lack of organizational engagement were reported. Almost all tools were co-developed with stakeholders. The co-design approaches varied, reflecting different levels of stakeholder engagement and adoption of co-design methodologies. It is noted that the quality of included studies was low. These findings offer valuable insights for future development of quality improvement website-based tools in healthcare. Recommendations include ensuring tools are co-developed with healthcare professionals, focusing on practical usability and addressing common barriers to enhance engagement and effectiveness in improving healthcare quality. Randomized controlled trials are warranted to provide objective evidence of tool efficacy.

A systematic review of the nature and efficacy of Rational Emotive Behaviour Therapy interventions.

In the absence of a single comprehensive systematic review of Rational Emotive Behaviour Therapy interventions across all settings, we reviewed the methodological quality, effectiveness and efficacy of Rational Emotive Behaviour Therapy interventions on irrational/rational beliefs. We explored the impact of Rational Emotive Behaviour Therapy on wider outcomes (e.g., mental health) and identified the characteristics of successful interventions. PsycARTICLES, PsycINFO, Scopus, SPORTDiscus, and PubMed were systematically searched up to December 2023 with 162 Rational Emotive Behaviour Therapy intervention studies identified which included a validated measure of irrational/rational beliefs. Where possible, effect size for irrational/rational belief change was reported and data was analysed through a qualitative approach. Using the Mixed Methods Appraisal tool, methodological quality within the Sport and Exercise domain was assessed as good, whilst all other domains were considered low in quality, with insufficient detail provided on intervention characteristics and delivery. Most studies were conducted in the United States, within the Education domain, and assessed irrational beliefs in non-clinical adult samples. Overall, studies reported significant reductions in irrational beliefs, increases in rational beliefs and improvements in mental health outcomes (e.g., depression). More successful interventions were delivered by trained Rational Emotive Behaviour Therapy practitioners, adopted the ABC framework and were longer in duration. We highlight the importance of designing and conducting rigorous future Rational Emotive Behaviour Therapy research to generate clearer insights as to its impact on irrational/rational beliefs and mental health outcomes.

Medication administration in aged care facilities: A mixed-methods systematic review.

To synthesize aged care provider, resident and residents' family members' perspectives and experiences of medication administration in aged care facilities; to determine the incidence of medication administration errors, and the impact of medication administration on quality of care and resident-centredness in aged care facilities. A mixed-methods systematic review. CRD42023426990. The AMED, CINAHL, MEDLINE, EMBASE, EMCARE, PsycINFO, Scopus and Web of Science core collection databases were searched in June 2023. Included studies were independently screened, selected and appraised by two researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was followed, with the Mixed Methods Appraisal Tool was used for critical appraisal. Convergent synthesis of data, thematic synthesis and meta-analysis were performed. One hundred and twenty-eight studies were included (33 qualitative, 85 quantitative and 10 mixed-methods). Five themes were formulated, including 1) Staffing concerns, 2) The uncertain role of residents, 3) Medication-related decision-making, 4) Use of electronic medication administration records and 5) Medication administration errors. Educational interventions for aged care workers significantly reduced medication administration errors, examined across five studies (OR = 0.37, 95%CI 0.28-0.50, p < .001). Medication administration in aged care facilities is challenging and complex on clinical and interpersonal levels. Clinical processes, medication errors and safety remain focal points for practice. However, more active consideration of residents' autonomy and input by aged care workers and providers is needed to address medication administration's interpersonal and psychosocial aspects. New directions for future research should examine the decision-making behind dose form modification, aged care workers' definitions of medication omission and practical methods to support residents' and their family members' engagement during medication administration. It is important that medication administration in aged care facilities be more clearly acknowledged as both a clinical and interpersonal task. More attention is warranted regarding aged care workers clinical decision-making, particularly concerning dose form modification, covert administration and medication omissions. Resident-centred care approaches that support resident and family engagement around medication administration may improve adherence, satisfaction and quality of care. What Problem Did the Study Address? Medication administration in aged care facilities is a complex clinical and interpersonal activity. Still, to date, no attempts have been made to synthesize qualitative and quantitative evidence around this practice. There is a need to establish what evidence exists around the perspectives and experiences of aged care workers, residents and resident's family members to understand the challenges, interpersonal opportunities and risks during medication administration. What Were the Main Findings? There is a lack of empirical evidence around resident-centred care approaches to medication administration, and how residents and their families could be enabled to have more input. Dose form modification occurred overtly and covertly as part of medication administration, not just as a method for older adults with swallowing difficulties, but to enforce adherence with prescribed medications. Medication administration errors typically included medication omission as a category of error, despite some omissions stemming from a clear rationale for medication omission and resident input. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The findings of this systematic review contribute to aged care policy and practice regarding medication administration and engagement with older adults. This review presents findings that provide a starting point for aged care workers in regards to professional development and reflection on practice, particularly around clinical decision-making on dose form modification, medication administration errors and the tension on enabling resident input into medication administration. For researchers, this review highlights the need to develop resident-centred care approaches and interventions, and to assess whether these can positively impact medication administration, resident engagement, adherence with prescribed medications and quality of care. This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page etal., 2021). No patient or public contribution to this systematic review.

The impact of evidence-based nursing leadership in healthcare settings: a mixed methods systematic review

BackgroundThe central component in impactful healthcare decisions is evidence. Understanding how nurse leaders use evidence in their own managerial decision making is still limited. This mixed methods systematic review aimed to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurse leaders and their performance, organizational, and clinical outcomes.MethodsWe included articles using any type of research design. We referred nurses, nurse managers or other nursing staff working in a healthcare context when they attempt to influence the behavior of individuals or a group in an organization using an evidence-based approach. Seven databases were searched until 11 November 2021. JBI Critical Appraisal Checklist for Quasi-experimental studies, JBI Critical Appraisal Checklist for Case Series, Mixed Methods Appraisal Tool were used to evaluate the Risk of bias in quasi-experimental studies, case series, mixed methods studies, respectively. The JBI approach to mixed methods systematic reviews was followed, and a parallel-results convergent approach to synthesis and integration was adopted.ResultsThirty-one publications were eligible for the analysis: case series (n = 27), mixed methods studies (n = 3) and quasi-experimental studies (n = 1). All studies were included regardless of methodological quality. Leadership problems were related to the implementation of knowledge into practice, the quality of nursing care and the resource availability. Organizational data was used in 27 studies to understand leadership problems, scientific evidence from literature was sought in 26 studies, and stakeholders’ views were explored in 24 studies. Perceived and measured effects of evidence-based leadership focused on nurses’ performance, organizational outcomes, and clinical outcomes. Economic data were not available.ConclusionsThis is the first systematic review to examine how evidence is used to solve leadership problems and to describe its measured and perceived effects from different sites. Although a variety of perceptions and effects were identified on nurses’ performance as well as on organizational and clinical outcomes, available knowledge concerning evidence-based leadership is currently insufficient. Therefore, more high-quality research and clinical trial designs are still needed.Trail registrationThe study was registered (PROSPERO CRD42021259624).