Review Questions Research Articles

Using artificial intelligence to support and streamline rapid systematic evidence reviews

Abstract Issue The Rapid Evidence Service, initiated by the National Collaborating Centre for Methods and Tools (NCCMT) during COVID-19, supports public health decision making by conducting rapid reviews on priority topics. Description of issue Integral to rapid reviews is an expedited timeline but the quantity of available literature for most public health review questions takes significant time to screen manually. NCCMT integrated 4 artificial intelligence (AI) features into the screening process. DAISY Rank applies predictions learned from manual screening patterns to re-order remaining studies, with most relevant appearing first. AI Screening automatically screens remaining studies based on prediction scores. Check for Screening Errors and Re-Rank Report use previous screening patterns to identify studies that were potentially falsely excluded and predict the total number of included studies, respectively. These features were tested by comparing results provided by AI with those produced manually for select test sets. Results NCCMT used AI to support and expedite screening, assess screening progress, and/or minimize risk of inappropriately excluding studies for 35 rapid reviews on 20 topics. Using DAISY Rank enabled one screener to review over 4000 references in 9 hours, compared to a different review, where the same amount of screening took 28 hours without DAISY Rank. AI Screening correctly excluded up to 80% of irrelevant search results across reviews. Check for Screening Errors identified 37 potential includes manually excluded in one review; these were reviewed and 3 were included. Re-Rank Report allowed NCCMT to re-allocate staff to subsequent steps in the review process when most included studies were identified. Lessons Integrating AI features into screening led to less time required, better anticipated timelines, more accurate staff allocation and reduced errors. More rigorous study of AI best practices is needed to continue to improve rapid review method efficiencies. Key messages • Rapid reviews can be an important source of evidence for decision makers if they can be completed quickly but maintain rigor and accuracy. • AI holds promise as a way to improve screening efficiency.

Scope of nursing work and models of service delivery in Australian primary and secondary schools: a scoping review protocol.

The objective of this review is to generate a national picture of the scope of nursing work and models of service delivery in Australian primary and secondary schools. Schools are an important setting for providing health services to school-aged children and youth. Early intervention with identified health needs has the potential to improve health and educational outcomes across the life course. Additionally, many children and young people present with health issues requiring sophisticated management at school. Nurses have worked in Australian schools for more than a century, but there is a lack of clarity about the scope of nursing work and models of service delivery in Australian schools. The review will include papers describing the work of registered or enrolled nurses in primary and secondary Australian schools providing education to children aged 3-18 years, in urban, regional, and remote areas of all states and territories. Peer-reviewed, non-peer-reviewed, and gray literature, not limited by publication date or language, will be included. The review will be conducted in accordance with the JBI methodology for scoping reviews. Databases to be searched will include CINAHL, MEDLINE, PsycINFO (all via EBSCOhost), together with ERIC, Informit, and Google. Two authors will independently screen titles and abstracts, and extract data from included papers. Data will be analyzed by state/territory and by education sector (government/non-government) to generate a national picture. The findings will be reported in a narrative synthesis aligned with the review questions. Open Science Framework https://osf.io/6yqrm.

Influence of social media and the digital environment on international migration of health workforce from low- and middle-income countries post COVID-19 pandemic: a scoping review protocol

IntroductionMigration of the health workforce from low- and middle-income countries (LMCIs) is increasingly becoming a phenomenon of interest within migration governance systems. The COVID-19 pandemic aggravated health workforce shortages that...

The experiences and perspectives of abortion seekers who travel for care: a qualitative evidence synthesis.

This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: This QES aims to address the following question: What are the lived experiences and perceptions of abortion seekers (i.e. pregnant women, transgender men, and non-binary people of any gender) traveling to obtain care? The review objectives are to: synthesize the qualitative evidence to address the review question; identify factors that influence abortion travel experiences and perspectives, which may include the specific abortion regulatory and care delivery context (e.g. legal restrictions, unavailability) and abortion seekers' personal circumstances (e.g. age, race/ethnicity, gender, partnership status, gestational duration, social/family support, income/wealth).

A review on social work and climate change: the need for a transdisciplinary approach

ABSTRACT Climate change is a global emergency due to its social and economic impacts. This comprehensive review examines how climate change affects society and emphasises the role of social work in solving this problem with a multidisciplinary approach. Despite the least responsible, marginalised groups suffer hugely from climate change impacts and the global GDP will plummet, if no action is taken to mitigate its effects causing severe economic hardship for developing nations, and marginalised communities, which already face inequalities, resource shortages, and poor governance. There is a necessity for strategies to lower vulnerable population risks, thus emphasising the role of social work in addressing the inequalities of the climate change impacts. This paper discusses how social work concepts relate to environmental challenges and how they advocate for sustainability during climate change adaptation and mitigation, and promote environmental justice. Furthermore, the review also emphasises the need for transdisciplinary action on climate change. Scopus and Google Scholar databases was used to retrieve literature, based on the review questions, 51 literature items were selected for the evaluation and case examples. The review concludes that transdisciplinary action, including social workers’ role in decision-making and implementation, can create an equitable climate change mitigation plan.

Virtual simulation for teaching cardiology in nursing: a scoping review protocol

IntroductionVirtual simulation (VS) can be an effective learning strategy in the context of nursing education on cardiovascular disease; however, its use in teaching cardiology in nursing is less studied. The...

Diagnostic accuracy of point-of-care tests for acute respiratory infection: a systematic review of reviews.

Acute respiratory infections are a common reason for consultation with primary and emergency healthcare services. Identifying individuals with a bacterial infection is crucial to ensure appropriate treatment. However, it is also important to avoid overprescription of antibiotics, to prevent unnecessary side effects and antimicrobial resistance. We conducted a systematic review to summarise evidence on the diagnostic accuracy of symptoms, signs and point-of-care tests to diagnose bacterial respiratory tract infection in adults, and to diagnose two common respiratory viruses, influenza and respiratory syncytial virus. The primary approach was an overview of existing systematic reviews. We conducted literature searches (22 May 2023) to identify systematic reviews of the diagnostic accuracy of point-of-care tests. Where multiple reviews were identified, we selected the most recent and comprehensive review, with the greatest overlap in scope with our review question. Methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Summary estimates of diagnostic accuracy (sensitivity, specificity or area under the curve) were extracted. Where no systematic review was identified, we searched for primary studies. We extracted sufficient data to construct a 2 × 2 table of diagnostic accuracy, to calculate sensitivity and specificity. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Where possible, meta-analyses were conducted. We used GRADE to assess the certainty of the evidence from existing reviews and new analyses. We identified 23 reviews which addressed our review question; 6 were selected as the most comprehensive and similar in scope to our review protocol. These systematic reviews considered the following tests for bacterial respiratory infection: individual symptoms and signs; combinations of symptoms and signs (in clinical prediction models); clinical prediction models incorporating C-reactive protein; and biological markers related to infection (including C-reactive protein, procalcitonin and others). We also identified systematic reviews that reported the accuracy of specific tests for influenza and respiratory syncytial virus. No reviews were found that assessed the diagnostic accuracy of white cell count for bacterial respiratory infection, or multiplex tests for influenza and respiratory syncytial virus. We therefore conducted searches for primary studies, and carried out meta-analyses for these index tests. Overall, we found that symptoms and signs have poor diagnostic accuracy for bacterial respiratory infection (sensitivity ranging from 9.6% to 89.1%; specificity ranging from 13.4% to 95%). Accuracy of biomarkers was slightly better, particularly when combinations of biomarkers were used (sensitivity 80-90%, specificity 82-93%). The sensitivity and specificity for influenza or respiratory syncytial virus varied considerably across the different types of tests. Tests involving nucleic acid amplification techniques (either single pathogen or multiplex tests) had the highest diagnostic accuracy for influenza (sensitivity 91-99.8%, specificity 96.8-99.4%). Most of the evidence was considered low or very low certainty when assessed with GRADE, due to imprecision in effect estimates, the potential for bias and the inclusion of participants outside the scope of this review (children, or people in hospital). Currently evidence is insufficient to support routine use of point-of-care tests in primary and emergency care. Further work must establish whether the introduction of point-of-care tests adds value, or simply increases healthcare costs. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159948.

Centering Racial Health Equity in Systematic Reviews Paper 5: A Methodological Overview of methods and interventions

We aim to 1) evaluate the methods used in systematic reviews of interventions focused on racialized populations to improve racial health equity, and 2) examine the types of interventions evaluated for advancing racial health equity in systematic reviews. We searched MEDLINE, Cochrane and Campbell databases for reviews evaluating interventions focused on racialized populations to mitigate racial health inequities, published from January 2020 to January 2023. We analyzed 157 reviews on racialized populations. Only 22 (14%) reviews addressed racism's role in driving racial health inequities related to the review question. Eleven percent (7) of reviews considered intersectionality when conceptualizing racial inequities. Two-thirds (105, 67%) provided descriptive summaries of included studies rather than synthesizing them. Among those that quantified effect sizes, 54% (21) used biased synthesis methods like vote counting. The most common method assessed was tailoring interventions to meet the needs of racialized populations. Reviews mainly focused on assessing interventions to reduce racial disparities rather than enhancing structural opportunities for racialized populations. Reviews for racial health equity could be improved by enhancing methodologic quality, defining the role of racism in the question, usingreliable analytical methods, and assessing process and implementation outcomes. More focus is needed on assessing structural interventions to improve opportunities for racialized populations and prioritize these issues in political and social agendas.

Online peer-to-peer health communities for individuals affected by chronic kidney disease: a scoping review protocol.

The objective of this scoping review is to identify and describe research exploring online peer-to-peer health communities for individuals affected by chronic kidney disease. The proliferation of online peer-to-peer health communities has created new opportunities for individuals affected by chronic kidney disease to come together for mutual social, emotional, and informational support. This scoping review will include qualitative, quantitative, mixed methods, and evidence synthesis studies, as well as gray literature relating to online peer-to-peer health communities for individuals affected by chronic kidney disease. The search will not be limited by language, time frame, geographic location, or publication date. This review will be undertaken in accordance with JBI methodology for scoping reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The following databases will be searched: Cochrane Register of Controlled Trials (CENTRAL), CINAHL (EBSCOhost), Embase (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science. Gray literature will be searched via MedNar, Google Scholar, and ProQuest Dissertations and Theses. After duplicates have been removed, 2 reviewers will independently screen the title, abstract, and full text of the search results. Data will be extracted using a modified data extraction tool as per JBI, and presented in tabular format, accompanied by a narrative summary describing how the findings relate to the scoping review questions. https://osf.io/kfj9v.

Carnosic Acid and its Pharmacological Activities: An Updated Review

Carnosic acid (CA), a polyphenolic diterpene naturally found in Rosmarinus officinalis, has demonstrated a wide range of pharmacological activities according to scientific research, making it a key candidate for new therapeutic product development. The aim of this manuscript is to present an updated review of the literature on the latest research findings about carnosic acid, emphasizing its most relevant biological functions. Accordingly, this work highlights the main reported pharmacological activities, such as antioxidant, antidiabetic, anti-inflammatory, antimicrobial, antiobesity, anticancer, and neuroprotective properties. We conducted a systematic search of bibliographic databases for peer-reviewed literature based on a specific review question, utilizing scientific databases including PubMed, Scopus, Science Direct, and Google Scholar published since 1990. Numerous studies have highlighted the extensive therapeutic applications of carnosic acid. Among others, carnosic acid was found to have antioxidant, antidiabetic, anti-inflammatory, antimicrobial, antiobesity, anticancer, and neuroprotective activities. Further, carnosic acid displayed low toxicity levels and few side effects. CA shows great promise as a therapeutic agent in the prevention and treatment of many diseases, such as numerous cancers, infectious diseases, and newly emerging illnesses like Alzheimer’s and Parkinson’s diseases. In recent times, there has been a significant push to improve PBMs, proposing their application as natural drugs for several pathological conditions, with a focus on their anti-inflammatory and antioxidant capabilities. Carnosic acid exhibits antidiabetic, antimicrobial, antiobesity, and neuroprotective effects, as well as antitumor, anti-infectious, CNS, and endocrine system activities. However, further research on its precise pharmacological mechanisms is required before it can be reliably used to treat human diseases.

Characteristics of natural environment use by occupational therapists working in mental health care: a scoping review.

The objective of this review was to identify and characterize the use of the natural environment/outdoor space by occupational therapists working in mental health care. This included consideration of the characteristics of the environment used, interventions, mental health conditions being treated, and the outcomes being used. Research has demonstrated the link between human health and the environment. The benefits appear to be particularly relevant to people with mental health conditions. Occupational therapists already consider the environment when assessing and developing interventions, and therefore are well placed to consider and use the natural environment in mental health practice. However, the use of the natural environment by occupational therapists working in mental health is unclear. The scoping review included any publication relating to the use of the natural environment/outdoor space in mental health occupational therapy practice. All forms of the natural environment or outdoor space were included, such as hospital gardens and local parks. There were no geographical, gender, or age restrictions. All mental health diagnoses were eligible for inclusion. Seven databases were searched: Embase (Ovid), Emcare (Ovid), MEDLINE (Ovid), PsycINFO (ProQuest), AMED (Ovid), Trip Database, and CINAHL (EBSCOhost). Gray literature was also searched using a selection of websites and digital repositories. Papers written in English were searched, with no time limit set on publication. Titles and abstracts were screened by 2 independent reviewers for assessment against the inclusion criteria, followed by a full-text review and data extraction. Data were extracted using the data extraction tool developed by the authors. Findings were presented in a tabular format, accompanied by a narrative summary describing how the results relate to the review objectives and question. Of peer-reviewed publications, 7 papers used qualitative methods and 7 used mixed methodology. The remaining sources included conference abstracts, unpublished works, a book chapter, and a website article. The environments used included forests, beaches, gardens, and parks. A variety of interventions were delivered in these environments, including gardening and nature-based activities, physical activities, and animal-assisted interventions. Such activity-focused interventions are largely delivered in a group context, thus providing a social element. A diverse range of mental health conditions were treated. Several methods were used to consider the outcomes on the individual, including both qualitative measures and quantitative outcome measurement tools. The review highlights many characteristics of how the natural environment is being used across mental health services by occupational therapists. A variety of conditions are targeted for such interventions, and several outcome measures have been used to understand impact. This review can support further development and implementation of nature-based approaches in mental health occupational therapy.

Evaluating Performance of ChatGPT on MKSAP Cardiology Board Review Questions

Chat Generative Pretrained Transformer (ChatGPT) is a natural language processing tool created by OpenAI. Much of the discussion regarding artificial intelligence (AI) in medicine is the ability of the language to enhance medical practice, improve efficiency and decrease errors. The objective of this study was to analyze the ability of ChatGPT to answer board-style cardiovascular medicine questions by using the Medical Knowledge Self-Assessment Program (MKSAP).The study evaluated the performance of ChatGPT (versions 3.5 and 4), alongside internal medicine residents and internal medicine and cardiology attendings, in answering 98 multiple-choice questions (MCQs) from the Cardiovascular Medicine Chapter of MKSAP. ChatGPT-4 demonstrated an accuracy of 74.5 %, comparable to internal medicine (IM) intern (63.3 %), senior resident (63.3 %), internal medicine attending physician (62.2 %), and ChatGPT-3.5 (64.3 %) but significantly lower than cardiology attending physician (85.7 %). Subcategory analysis revealed no statistical difference between ChatGPT and physicians, except in valvular heart disease where cardiology attending outperformed ChatGPT (p = 0.031) for version 3.5, and for heart failure (p = 0.046) where ChatGPT-4 outperformed senior resident. While ChatGPT shows promise in certain subcategories, in order to establish AI as a reliable educational tool for medical professionals, performance of ChatGPT will likely need to surpass the accuracy of instructors, ideally achieving the near-perfect score on posed questions.

Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications.

The use of opioids for pain is linked to an increased risk of developing opioid use disorder, and has resulted in the emergence of the opioid crisis over the last few years. The systematic review question is "How does the use of opioid medications in pain management, compared with non-opioid medications, affect pain intensity over the short, intermediate, and long-term in adults with acute traumatic pain?". The protocol was prospectively registered on the International Prospective Register of Systematic Reviews: CRD42021279639. Medline and Google Scholar were electronically searched for controlled peer-reviewed studies published in full, with the PICO framework: P: Adult patients with traumatic injuries, I: Opioid medications, C: Non-opioid medications, O: A minimum clinically important difference (MCID) in pain. After full-text screening, we included 14 studies in the qualitative synthesis. Of these 14 studies, 12 were randomized clinical trials (RCTs) and 2 were pseudo-RCTs with a total of 2347 patients enrolled. There was heterogeneity in both medication utilized and outcome in these studies; only two studies were homogeneous regarding the type of study conducted, the opioid used, its comparator, and the outcome explored. The MCID was evaluated in 8 studies, while in 6 studies, any measured pain reduction was considered as an outcome. In 11 cases, the setting of care was the Emergency Department; in 2 cases, care occurred out-of-hospital; and in one case, the setting was not well-specified. The included studies were found to have a low-moderate risk of bias. Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal injury. Intravenous ketamine may cause more adverse events than other routes of administration.

Comparison of Gemini Advanced and ChatGPT 4.0's Performances on the Ophthalmology Resident Ophthalmic Knowledge Assessment Program (OKAP) Examination Review Question Banks.

Background With advancements in natural language processing, tools such as Chat Generative Pre-Trained Transformers (ChatGPT) version 4.0 and Google Bard's Gemini Advanced are being increasingly evaluated for their potential in various medical applications. The objective of this study was to systematically assess the performance of these language learning models (LLMs) on both image and non-image-based questions within the specialized field of Ophthalmology. We used a review question bank for the Ophthalmic Knowledge Assessment Program (OKAP) used by ophthalmology residents nationally to prepare for the Ophthalmology Board Exam to assess the accuracy and performance of ChatGPT and Gemini Advanced. Methodology A total of 260 randomly generated multiple-choice questions from the OphthoQuestions question bank were run through ChatGPT and Gemini Advanced. A simulated 260-question OKAP examination was created at random from the bank. Question-specific data were analyzed, including overall percent correct, subspecialty accuracy, whether the question was "high yield," difficulty (1-4), and question type (e.g., image, text). To compare the performance of ChatGPT-4 and Gemini on the difficulty of questions, we utilized the standard deviation of user answer choices to determine question difficulty. In this study, a statistical analysis of Google Sheets was conducted using two-tailed t-tests with unequal variance to compare the performance of ChatGPT-4.0 and Google's Gemini Advanced across various question types, subspecialties, and difficulty levels. Results In total, 259 of the 260 questions were included in the study as one question used a video that any form of ChatGPT could not interpret as of May 1, 2024. For text-only questions, ChatGPT-4.0.0 correctly answered 57.14% (148/259, p < 0.018), and Gemini Advanced correctly answered 46.72% (121/259, p < 0.018). Both versions answered most questions without a prompt and would have received a below-average score on the OKAP. Moreover, there were 27 questions utilizing a secondary prompt in ChatGPT-4.0 compared to 67 questions in Gemini Advanced. ChatGPT-4.0 performed 68.99% on easier questions (<2 on a scale from 1-4) and 44.96% on harder questions (>2 on a scale from 1-4). On the other hand, Gemini Advanced performed 49.61% on easier questions (<2 on a scale from 1-4) and 44.19% on harder questions (>2 on a scale from 1-4). There was a statistically significant difference in accuracy between ChatGPT-4.0 and Gemini Advanced for easy (p < 0.0015) but not for hard (p < 0.55) questions. For image-only questions, ChatGPT-4.0 correctly answered 39.58% (19/48, p < 0.013), and Gemini Advanced correctly answered 33.33% (16/48, p < 0.022), resulting in a statistically insignificant difference in accuracy between ChatGPT-4.0 and Gemini Advanced (p < 0.530). A comparison against text-only and image-based questions demonstrated a statistically significant difference in accuracy for both ChatGPT-4.0 (p < 0.013) and Gemini Advanced (p < 0.022). Conclusions This study provides evidence that ChatGPT-4.0 performs better on the OKAP-style exams and is improved compared to Gemini Advanced within the context of ophthalmic multiple-choice questions. This may show an opportunity for increased worth for ChatGPT in ophthalmic medical education. While showing promise within medical education, caution should be used as a more detailed evaluation of reliability is needed.

Spatio-temporal occurrence, burden, risk factors and modelling methods for estimating scrub typhus burden from global to subnational resolutions: a systematic review protocol.

Scrub typhus is a neglected life-threatening vector-borne disease mainly caused by the bacterium Orientia tsutsugamushi, which is occasionally transmitted to humans during feeding of larval mites. It has been estimated that more than 1 billion persons are potentially threatened and 1 million clinical cases occur annually across the world; however, it is unclear how this estimate was computed (and what the original source was) and much remains unknown regarding its global burden and risk factors. This systematic review aims to provide a comprehensive overview of the spatial-temporal distribution of scrub typhus, associated burden and risk factors at global, national and subnational resolutions, and to review the burden estimation models used at those different scales. A systematic search for literature on scrub typhus occurrence, risk factors and modelling methods will be conducted. PubMed and five other databases will be searched for published literature, and Google Scholar and nine other databases will be used to search for grey literatures. All titles/abstracts of the searched records will be separately assessed by two reviewers, who will then screen the full-text of potential records to decide eligibility. A pre-formatted spreadsheet will be used by one reviewer to extract data from qualifying research, with a second reviewer checking the results. Data will be tabulated, synthesized descriptively, and summarized narratively for each review question. Where appropriate, meta-analyses will be conducted. The risk of bias will be assessed, and potential publication bias will be detected. This review will provide a comprehensive understanding of the current occurrence, spatial-temporal distribution, and burden of scrub typhus, identify associated risk factors from global to subnational resolutions, consolidate the best practice modeling framework(s) to estimate the burden of scrub typhus at various geographic/temporal resolutions, and decompose the relative contributions of various risk factors at scale. CRD42022315209.

Auditory Prognosis of Patients With Sudden Sensorineural Hearing Loss in Relation to the Presence of Acute Vestibular Syndrome: A Systematic Literature Review and Meta-Analysis.

Hearing recovery following idiopathic sudden sensorineural hearing loss (ISSNHL) is influenced by various prognostic factors, and the presence of acute vestibular syndrome (AVS) may adversely impact auditory outcomes. Evaluating vestibular function in SSNHL patients could offer insights into predicting hearing recovery. This systematic review aims to assess whether the presence of AVS exacerbates the audiological prognosis of ISSNHL. A comprehensive systematic review was conducted using databases such as PubMed, Cochrane Library, EMBASE, and Scopus, encompassing articles published in the last decade. Included were retrospective and prospective case-control and cohort studies, as well as randomized clinical trials. Meta-analysis was performed based on the findings from these studies. Among 386 articles identified, six addressed the systematic review's question, all being retrospective studies. These articles collectively involved 393 patients for the meta-analysis. Vestibular function assessment methods varied widely, posing challenges for direct comparisons. The likelihood of unfavorable hearing outcomes was 2.29 times higher in patients with associated AVS. Hearing recovery was 3.22 times more likely to be worse in patients with altered cervical vestibular evoked myogenic potentials-air-conducted sound. Abnormal caloric test results showed no significant association with worse hearing prognosis, although patients with unaltered caloric tests demonstrated a significantly greater improvement in pure-tone audiometry. Hearing recovery from ISSNHL appears to be diminished in patients with associated AVS and abnormal vestibular test results.

Experiences of Inpatient Healthcare Services Among Children With Medical Complexity and Their Families: A Scoping Review.

Children with medical complexity (CMC) have high healthcare utilization and face unique challenges during hospital admissions. The evidence describing their experiences of inpatient care is distributed across disciplines. The aim of this scoping review was to map the evidence related to the inpatient experience of care for CMC and their families, particularly related to key aspects and methodological approaches, and identify gaps that warrant further study. This scoping review was conducted in accordance with JBI methodology and included all studies that reported experiences of acute hospital care for CMC/families. All study designs were included. Databases searched included EMBASE, CINAHL Plus with Full Text, Web of Science, MEDLINE(R) and APA PsycInfo from 2000 to 2022. Details about the participants, concepts, study methods and key findings were abstracted using a data abstraction tool. A thematic analysis was conducted. Forty-nine papers were included: 27 qualitative studies, 10 quantitative studies, six mixed methods studies, two descriptive studies and four reviews. Some quantitative studies used validated instruments to measure experience of care, but many used non-validated surveys. There were a few interventional studies with a small sample size. Results of thematic analysis described the importance of negotiating care roles, shared decision-making, common goal setting, relationship-building, communication, sharing expertise and the hospital setting itself. CMC and families value relational elements of care and partnering through sharing expertise, decision-making and collaborative goal-setting when admitted to hospital. This review was conducted in alignment with the principles of patient and family engagement. The review was conceptualized, co-designed and conducted with the full engagement of the project's parent-partner. This team member was involved in all stages from constructing the review question, to developing the protocol, screening articles and drafting this manuscript.

Initial assessment and management of adults with suspected acute respiratory infection: a rapid evidence synthesis of reviews and cost-effectiveness studies.

This work was undertaken to inform a National Institute for Health and Care Excellence guideline on the initial assessment of adults with suspected acute respiratory infection. To undertake a rapid evidence synthesis of systematic reviews and cost-effectiveness studies of signs, symptoms and early warning scores for the initial assessment of adults with suspected acute respiratory infection. MEDLINE, EMBASE and Cochrane Database of Systematic Reviews were searched for systematic reviews and MEDLINE, EMBASE, EconLit and National Health Service Economic Evaluation Database were searched for cost-effectiveness studies in May 2023. References of relevant studies were checked. Clinical outcomes of interest included escalation of care, antibiotic/antiviral use, time to resolution of symptoms, mortality and health-related quality of life. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool or the National Institute for Health and Care Excellence economic evaluations checklist. Results were summarised using narrative synthesis. Nine systematic reviews and one cost-effectiveness study met eligibility criteria. Seven reviews assessed several early warning scores for patients with community- acquired pneumonia, one assessed early warning scores for nursing home-acquired pneumonia and one assessed individual signs/symptoms and the Centor score for patients with sore throat symptoms; all in face-to-face settings. Two good-quality reviews concluded that further research is needed to validate the CRB-65 in primary care/community settings. One also concluded that further research is needed on the Pneumonia Severity Index in community settings; however, the Pneumonia Severity Index requires data from tests not routinely conducted in community settings. One good-quality review concluded that National Early Warning Score appears to be useful in an emergency department/acute medical setting. One review (unclear quality) concluded that the Pneumonia Severity Index and CURB-65 appear useful in an emergency department setting. Two poor-quality reviews concluded that early warning scores can support clinical judgement and one poor-quality review found numerous problems with using early warning scores in a nursing home setting. A good-quality review concluded that individual signs and symptoms have a modest ability to diagnose streptococcal pharyngitis, and that the Centor score can enhance appropriate prescribing of antibiotics. The cost-effectiveness study assessed clinical scores and rapid antigen detection tests for sore throat, compared to delayed antibiotic prescribing. The study concluded that the clinical score is a cost-effective approach when compared to delayed prescribing and rapid antigen testing. Several early warning scores have been evaluated in adults with suspected acute respiratory infection, mainly the CRB-65, CURB-65 and Pneumonia Severity Index in patients with community-acquired pneumonia. The evidence was insufficient to determine what triage strategies avoid serious illness. Some early warning scores (CURB-65, Pneumonia Severity Index and National Early Warning Score) appear to be useful in an emergency department/acute medical setting; however, further research is required to validate the CRB-65 and Pneumonia Severity Index in primary care/community settings. The economic evidence indicated that clinical scores may be a cost-effective approach to triage patients compared with delayed prescribing. Only systematic reviews were eligible for inclusion in the synthesis of clinical evidence. There was a great deal of overlap in the primary studies included in the reviews, many of which had significant limitations. No studies were undertaken in remote settings (e.g. NHS 111). Only one cost-effectiveness study was identified, with limited applicability to the review question. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159945.

Delphi Technique on Nursing Competence Studies: A Scoping Review.

This scoping review was conducted under the Joanna Briggs Institute (JBI) framework. It included primary studies published until 30 April 2023, obtained through a systematic search across PubMed, Web of Science, CINAHL, and MEDLINE databases. The review focused on primary studies that used the Delphi technique in nursing competence research, especially those related to defining core competency frameworks and developing instruments to assess professional competence. The goal was to analyze the different methodological approaches used by authors, synthesize them, and propose recommendations to enhance methodological rigor, reliability, and validity in the application of the Delphi technique. For this purpose, the following review question was established: "What is the available evidence on the use of the Delphi technique in the study of professional competence in nursing?". The extracted textual elements underwent a content analysis, resulting in dimensions established through an inductive approach. Twenty studies were included, yielding insights into diverse methodological options for conducting Delphi studies, organised around a set of dimensions: (1) preparatory procedures; (2) procedures for accessing and selecting experts; (3) acquisition of expert input; (4) data analysis and consensus; and (5) ethical and legal procedures and guarantees. The study's limitations include the inability to include certain studies due to a lack of response to requests for clarification from corresponding authors. Additionally, the primary studies' methodological quality was not assessed, which is another relevant aspect. The study's results offer valuable insights for researchers intending to utilise the Delphi technique within the context of the research referenced in the included studies. This information encompasses important methodological choices, highlighting their potential benefits and associated risks. The review was prospectively registered on the Open Science Framework (Registration No: osf.io/kp2vw).

Does orthodontic treatment using fixed appliances cause initial caries lesions?

Systematic review and meta-analysis of randomized clinical trials (RCTs), non-randomized studies of intervention (NRSIs), cohort and cross-sectional studies. The systematic review was registered in advance on PROSPERO, and was conducted following the Cochrane Handbook of Systematic Reviews of Interventions and PRISMA checklist. An electronic search in three databases (PubMed, Scopus, and Embase) was conducted by two authors to evaluate studies published from 1990 until May 2023. The review question was defined in PICOS format as follows: Population (P), subjects with permanent dentition who having/had orthodontic therapy; Exposure (E), orthodontic therapy with fixed orthodontic appliance; Comparison/Control (C), no orthodontic treatment or intervention; Outcome (O), assessing incidence and/or prevalence of initial caries lesions (ICLs) at subject and teeth levels was the primary outcome, whereas evaluating the influence of demographics and treatment-related variables were secondary outcomes; studies (S), randomized clinical trials, non-randomized clinical studies, cohort and cross-sectional studies. Meta-analysis was conducted of three or more included studies had comparable findings. The following factors were calculated for each study; sample size, number of patients with ICLs, number of teeth with ICLs, number of teeth affected per patient, and number of surfaces affected. Statistical heterogeneity of effects among studies was assessed by means of the Cochran's test was used to evaluate the statistical heterogeneity of effects in the included studies. Funnel plot approach was used to assess publication bias, whereas Begg's and Egger's correlation test were used to identify asymmetry. Meta-analysis was conducted using a random effects model owing to high methodological and clinical heterogeneity. A descriptive analysis was presented when the meta-analyses appeared inappropriate. Statistical significance level was set at p < 0.05 for all statistical analyses. 21 studies were included in the qualitative synthesis (systematic review); 11 RCTs; 7 NRSIs, and 3 observation studies. Of the included studies, 19 studies were analyzed in the quantitative synthesis (meta-analysis). In regard to the prevalence rate of ICLs; 57% of patients had ICLs, with a mean of 2.24 lesions per patient and 22% of surfaces were affected. In regard to the incidence rate; 48% of patients developed new ICLs, with a mean of 2.29 new lesions per patient, and 15% of surfaces became affected. Both prevalence and incidence rates were positively associated with the duration of the orthodontic therapy (P = 0.01 and P < 0.01, respectively), illustrating an elevation in the ICLs numbers as the treatment duration (number of months) increases. There was no association between patients' age and ICLs numbers. Orthodontic therapy using fixed appliances can increase the risk of accumulating plaque and developing caries lesion. However, other risk factors may play a role in developing ICLs; thus, controlling for these factors is paramount to better evaluate the true influence of orthodontic therapy on the ICLs development. Implementing caries preventive measures during orthodontic treatment may be needed to minimize the potential risks.