innovative

创新
  • 文章类型: Journal Article
    脑瘫(CP)患者面临其病情的终身后果,他们的医疗保健需求随着年龄的增长而变化。这些患者的过渡性护理尚未普遍可用,并且已经描述了各种模型。在这篇文章中,作者回顾了目前围绕CP患者的过渡期护理的文献,主要关注过渡护理的神经外科方面,他们描述了北美项目目前采用的方法。他们进一步描述了自己为CP患者开发过渡性护理诊所的经验,以及该计划与多学科诊所的整合,以解决我们地区不断增长的患者面临的具体挑战。
    作者进行了文献综述,以确定模型,障碍,并评估CP患者的有效过渡护理。他们还审查了各专业协会关于过渡护理做法的建议。他们对相关文献进行了定性分析。
    过渡性护理大致分为过渡性护理诊所,由多学科团队和主持人主导的过渡性护理。CP患者必须克服各种障碍,包括来自医疗保健系统以及环境和个人的那些,在他们的过渡时期。这些挑战都是相互关联的,和导航要求医疗保健专业人员与患者及其护理人员密切合作。描述了多种仪器来衡量成功的过渡,这可能反映了患者可能需要的独特需求。现行指引建议神经外科医生根据自己当地的实践和现有服务,选择合适的护理模式,制定一个明确的过渡计划,并确定主要的过渡促进者或护理协调员。
    考虑到不同的护理模式和过渡期内他们所面临的障碍,为CP患者提供有效的过渡期护理仍然具有挑战性。在为这些患者制定过渡性护理计划时,必须注意区域可用的资源,努力纳入成功的过渡性护理计划的最佳实践。
    Patients with cerebral palsy (CP) face lifelong consequences of their condition, and their healthcare needs evolve as they age. Transitional care for these patients is not universally available and various models have been described. In this article, the authors review the current literature surrounding transitional care for patients with CP, focusing predominantly on the neurosurgical aspects of transitional care, and they describe current approaches adopted by programs in North America. They further describe their own experience developing a transitional care clinic for patients with CP, as well as the integration of this program with a multidisciplinary clinic to address the specific challenges that growing patients face in our region.
    The authors performed a literature review to identify models, barriers, and assessments of effective transitional care for CP patients. They also reviewed the recommendations of various professional societies regarding transitional care practices. They performed qualitative analysis of the relevant literature.
    Transitional care has been broadly categorized into transitional care clinics with multidisciplinary teams and facilitator-led transitional care. CP patients have to overcome a variety of barriers, including those from within the healthcare system as well as environmental and personal, during the period of their transition. These challenges are all interconnected, and navigation requires healthcare professionals to work closely with patients and their caregivers. Multiple instruments are described to measure successful transition, which is likely a reflection of the unique needs that a patient may require. Current guidelines recommend that neurosurgeons select a suitable model of care based on their own local practice and available services, develop a well-defined transition plan, and identify a primary transition facilitator or care coordinator.
    Providing effective transitional care to CP patients remains challenging given the different models of care and the barriers faced by them during the period of transition. In developing a transitional care program for these patients, attention must be given to the resources that are available regionally, with an effort to incorporate the best practices from successful transitional care programs.
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  • 文章类型: Journal Article
    许多行为改变理论随着时间的推移而演变。最初,第一个概念优先考虑基于信息的干预措施,例如提高认识和传授知识。第二代理论优先考虑技能的发展和意识的提高。1990年代基于证据的技术的出现产生了第三代理论,例如计划行为理论和社会认知理论。目前,第四代趋势将多种理论中的各种成分合并起来,以实现准确的治疗,采用技术,强调有针对性的行为改变。本文旨在在计划物质使用预防和治疗的背景下,对健康行为改变干预措施的多理论模型(MTM)进行简要评估。目前旨在预防和治疗药物使用的干预计划领域可能受益于MTM,创新的第四代行为改变模型。烟草,酒精,和其他药物都是实验的主题,横截面,和定性研究。我们已经提出,需要进行更多的研究来比较MTM与基于知识的疗法或基于其他理论的干预措施。金标准是随机对照试验和行为改变干预措施,尤其是对此有用。此外,评估干预措施有效性的研究必须仔细计划和执行。
    Many behavior change theories have evolved over time. Originally, the first conceptions prioritized interventions based on information, such as raising awareness and transferring knowledge. Second-generation theories prioritize the development of skills and the promotion of awareness. The emergence of evidence-based techniques in the 1990s gave rise to third-generation theories such as the Theory of Planned Behavior and Social Cognitive Theory. Presently, fourth-generation trends amalgamate various components from multiple theories to implement accurate treatments, employing technology and emphasizing targeted behavior change. This paper aims to do a concise evaluation of the multi-theory model (MTM) of health behavior change interventions in the context of planning substance use prevention and treatment. The current area of intervention programs aimed at preventing and treating substance use may benefit from MTM, an innovative fourth-generation behavior change model. Tobacco, alcohol, and other drugs have all been the subjects of experimental, cross-sectional, and qualitative research. We have presented that additional research is required to compare MTM with knowledge-based therapies or interventions grounded in other theories. A gold standard would be the randomized controlled trials and behavioral change interventions particularly useful for this purpose. In addition, research evaluating the interventions\' efficacy must be carefully planned and executed.
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  • 文章类型: Journal Article
    背景:去骨瓣减压术(DC)是一种广泛用于缓解高颅内压的手术。多学科团队设计并实施了外部医疗原型,以提高患者的生活质量,并避免等待颅骨修补术(CP)的患者在DC后出现并发症。包括3D打印和石膏原型。
    目的:本范围审查旨在了解在等待CP期间接受DC的患者的创新外部原型证据的范围和类型。
    方法:此范围审查将使用JoannaBriggsInstitute方法进行范围审查。此范围审查将包括等待CP时接受DC的成年患者的非侵入性医疗设备。搜索策略将在MEDLINE中实施,Embase,WebofScience,Scielo,Scopus,和世界卫生组织(世卫组织)全球健康指数药物。专利文件也在Espacenet中分配,谷歌专利,和世界知识产权组织(WIPO)数据库。
    结果:此范围审查不受伦理批准,因为不会涉及患者。传播计划包括在同行评审的期刊上发表评论结果,并在与创新和神经外科最相关的利益相关者互动的会议上展示结果。
    结论:这项范围审查将作为基线,为目前设计这些非侵入性创新的多学科团队提供证据,以降低DC后相关并发症的风险,希望能够实施更具成本效益的模式,特别是在低收入和中等收入国家。
    DERR1-10.2196/50647。
    BACKGROUND: Decompressive craniectomy (DC) is a widely used procedure to alleviate high intracranial pressure. Multidisciplinary teams have designed and implemented external medical prototypes to improve patient life quality and avoid complications following DC in patients awaiting cranioplasty (CP), including 3D printing and plaster prototypes when available.
    OBJECTIVE: This scoping review aims to understand the extent and type of evidence about innovative external prototypes for patients who undergo DC while awaiting CP.
    METHODS: This scoping review will use the Joanna Briggs Institute methodology for scoping reviews. This scoping review will include noninvasive medical devices for adult patients who undergo DC while waiting for CP. The search strategy will be implemented in MEDLINE, Embase, Web of Science, Scielo, Scopus, and the World Health Organization (WHO) Global Health Index Medicus. Patent documents were also allocated in Espacenet, Google Patents, and the World Intellectual Property Organization (WIPO) database.
    RESULTS: This scoping review is not subject to ethical approval as there will be no involvement of patients. The dissemination plan includes publishing the review findings in a peer-reviewed journal and presenting results at conferences that engage the most pertinent stakeholders in innovation and neurosurgery.
    CONCLUSIONS: This scoping review will serve as a baseline to provide evidence for multidisciplinary teams currently designing these noninvasive innovations to reduce the risk of associated complications after DC, hoping that more cost-effective models can be implemented, especially in low- and middle-income countries.
    UNASSIGNED: DERR1-10.2196/50647.
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  • 文章类型: Systematic Review
    这项研究在精神卫生保健创新设计研究中检查并反映了具有精神病症状和特征的人作为目标人群的频率。
    This study examined and reflected on the frequency of people with psychotic symptoms and features as the target population in design studies for mental health care innovation.
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  • 文章类型: Journal Article
    BACKGROUND: Intra-articular hyaluronic acid (IAHA) products are often used in the treatment of adults with mild-to-moderate knee osteoarthritis (KOA). The International Symposium on Intra-Articular Treatment (ISIAT) convened a multidisciplinary technical expert panel to define characteristics for an innovative IAHA product that should answer unmet needs in the clinical management of adults with mild-to-moderate KOA.
    METHODS: An initial set of evidence-based statements was developed based on data extracted from articles identified through a comprehensive literature search. A Delphi panel comprising 19 experts in KOA voted in 3 rounds to rate their degree of agreement with accepted statements.
    RESULTS: The final set of 13 accepted statements focus on the effect of an innovative IAHA across 5 key domains of nociceptive pain, joint function, quality of life, joint structure and integrity, and adverse effects. The statements set thresholds for clinically meaningful improvements that exceed those generally achievable by currently available IAHA products.
    CONCLUSIONS: The characteristics described by these statements from the ISIAT set new standards for what should be expected from an innovative IAHA. These statements should serve as a framework for driving the development of innovative IAHA products that will surpass the actual outcomes achieved by current viscosupplements in patients with mild-to-moderate KOA.
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  • 文章类型: Systematic Review
    近几十年来,已经开发了用于痴呆症患者的替代住房形式。这些概念为居民提供了一小群熟悉的环境,并努力提供正常的日常生活。本系统综述的目的是整理和分析这些关于居民生活质量的更具创新性的住房形式,行为方面,以及功能,认知和情感方面。
    在PubMed中进行了搜索,EMBASE和PsycInfo将于2020年11月发布。比较痴呆症患者传统和更具创新性的生活环境的研究是合格的。基于附加搜索的结果来描述概念。使用JoannaBriggs研究所的清单评估纳入研究的偏倚风险。
    共纳入21项研究,涉及11个不同的概念。即绿色房屋(美国),团体生活(瑞典),Cantou(法国),团体住宅(日本),小规模团体生活(奥地利),特殊护理设施(加拿大),共享住房安排(德国),住宅团体(德国),住宅护理中心/伍德赛德场所(美国/加拿大),小规模生活(荷兰/比利时),绿色护理农场(荷兰)。这些概念在护理概念方面大致相似,但部分不同的是群体规模,员工资格和职责。几项研究表明,创新的住房形式可能会鼓励社会行为,与更传统的环境相比,保持活动表现和/或积极影响情绪状态,而其他研究未能证明这些影响。一些研究还显示,居住在更具创新性的住房概念中的居民的痴呆症(BPSD)的行为和心理症状增加。对认知的影响仍然不明显。
    积极影响可能归因于固有特征,包括小团体大小,一个刺激的设计,以及改变员工的角色和职责。可以说,这些特征中的一些也可能是增加BPSD的原因。研究的方法学质量参差不齐,必须谨慎考虑结果。未来的研究应该更密切地研究这些影响,并应该调查人群在痴呆症发生时对住房的偏好。
    Alternative forms of housing for persons with dementia have been developed in recent decades. These concepts offer small groups of residents familiar settings combined with efforts to provide normal daily life. The aim of this systematic review is to collate and analyze these more innovative forms of housing regarding residents\' quality of life, behavioral aspects, as well as functional, cognitive and emotional aspects.
    Searches were conducted in PubMed, EMBASE and PsycInfo in November 2020. Studies comparing traditional and more innovative living environments for persons with dementia were eligible. Concepts are described based on the results of additional searches. Risk of bias of included studies was assessed using checklists from the Joanna Briggs Institute.
    A total of 21 studies corresponding to 11 different concepts were included, namely Green Houses (USA), Group Living (Sweden), Cantou (France), Group Homes (Japan), Small-scale Group Living (Austria), Special Care Facilities (Canada), Shared-housing Arrangements (Germany), Residential Groups (Germany), Residential Care Centers / Woodside Places (USA/Canada), Small-scale Living (Netherlands/ Belgium), and Green Care Farms (Netherlands). The concepts are broadly similar in terms of care concepts, but partly differ in group sizes, staff qualifications and responsibilities. Several studies indicate that innovative forms of housing may encourage social behavior, preserve activity performance and/or positively influence emotional status compared to more traditional settings, while other studies fail to demonstrate these effects. Some studies also show increased behavioral and psychological symptoms of dementia (BPSD) in residents who live in more innovative housing concepts. The effect on cognition remains indistinct.
    The positive effects may be attributable to the inherent characteristics, including small group sizes, a stimulating design, and altered staff roles and responsibilities. Arguably, some of these characteristics might also be the reason for increased BPSD. Studies had variable methodological quality and results have to be considered with caution. Future research should examine these effects more closely and should investigate populations\' preferences with regards to housing in the event of dementia.
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  • 文章类型: Journal Article
    目标:本文综合了所谓的创新国内卫生筹资机制的证据(即任何允许政府从传统方法如一般税收多元化的国内创收机制,增值税,使用费或任何类型的健康保险)旨在增加非洲国家卫生的财政空间。本文旨在回答以下问题:在非洲各地使用了哪些类型的国内创新金融机制来资助医疗保健?这些创新融资机制筹集了多少额外收入?或者是注定的,指定用于健康?关于与它们的设计和实施相关的政策过程有什么了解?
    方法:对已发表和灰色文献进行了系统回顾。审查的重点是确定提供定量信息的文章,说明通过创新的非洲保健国内融资机制产生的额外财政资源,和/或与这些融资机制的设计或有效实施相关的政策过程的定性信息。
    结果:搜索导致了4035篇文章的初始列表。最终,选取了15项研究进行叙事分析。确定了广泛的研究方法,从文献综述到定性和定量分析以及案例研究。实施或计划的筹资机制多种多样,最常见的是手机税,酒精和汇款。很少有文章记录可以通过这些机制筹集的收入。对于那些这样做的人,预计增加的收入相对较低,如果采用多次征税,则从酒精税占GDP的0.01%到GDP的0.49%不等。无论如何,实际上,显然没有任何机制得到实施。文章透露,在实施之前,政治可接受性,机构是否愿意适应拟议的改革,以及这些改革可能对目标行业产生的潜在扭曲影响,都需要仔细考虑。从设计的角度来看,事实证明,指定用途的根本问题在政治上和行政上都很复杂,实际上指定的机制很少,从而质疑他们是否能有效填补部分卫生筹资缺口。最后,确保这些机制支持全民健康覆盖的基本公平目标被认为是重要的。
    结论:需要进行更多的研究,以更好地了解创新的国内创收机制的潜力,以填补非洲卫生方面的融资缺口,并使其多样化,摆脱更传统的融资方式。虽然他们的绝对收入潜力似乎有限,它们可以代表更广泛的税收改革以支持健康的途径。这将需要卫生部和财政部之间的持续对话。
    OBJECTIVE: This article synthesizes the evidence on what have been called innovative domestic financing mechanisms for health (i.e. any domestic revenue-raising mechanism allowing governments to diversify away from traditional approaches such as general taxation, value-added tax, user fees or any type of health insurance) aimed at increasing fiscal space for health in African countries. The article seeks to answer the following questions: What types of domestic innovative financial mechanisms have been used to finance health care across Africa? How much additional revenue have these innovative financing mechanisms raised? Has the revenue raised through these mechanisms been, or was it meant to be, earmarked for health? What is known about the policy process associated with their design and implementation?
    METHODS: A systematic review of the published and grey literature was conducted. The review focused on identifying articles providing quantitative information about the additional financial resources generated through innovative domestic financing mechanisms for health care in Africa, and/or qualitative information about the policy process associated with the design or effective implementation of these financing mechanisms.
    RESULTS: The search led to an initial list of 4035 articles. Ultimately, 15 studies were selected for narrative analysis. A wide range of study methods were identified, from literature reviews to qualitative and quantitative analysis and case studies. The financing mechanisms implemented or planned for were varied, the most common being taxes on mobile phones, alcohol and money transfers. Few articles documented the revenue that could be raised through these mechanisms. For those that did, the revenue projected to be raised was relatively low, ranging from 0.01% of GDP for alcohol tax alone to 0.49% of GDP if multiple levies were applied. In any case, virtually none of the mechanisms have apparently been implemented. The articles revealed that, prior to implementation, the political acceptability, the readiness of institutions to adapt to the proposed reform and the potential distortionary impact these reforms may have on the targeted industry all require careful consideration. From a design perspective, the fundamental question of earmarking proved complex both politically and administratively, with very few mechanisms actually earmarked, thus questioning whether they could effectively fill part of the health-financing gap. Finally, ensuring that these mechanisms supported the underlying equity objectives of universal health coverage was recognized as important.
    CONCLUSIONS: Additional research is needed to understand better the potential of innovative domestic revenue generating mechanisms to fill the financing gap for health in Africa and diversify away from more traditional financing approaches. Whilst their revenue potential in absolute terms seems limited, they could represent an avenue for broader tax reforms in support of health. This will require sustained dialogue between Ministries of Health and Ministries of Finance.
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  • 文章类型: Systematic Review
    抑郁症的慢性是一个主要问题。多巴胺刺激剂(DSA)被认为在抑郁症管理中具有很有希望的潜力。尤其是老年人,其中由于衰老引起的多巴胺缺乏可能是一个根本原因。需要更多的证据来支持这些药物治疗抑郁症。因此,我们进行了系统的文献综述和荟萃分析.数据来自18项随机对照试验和8项开放标签研究。进行了其他荟萃回归分析,以检查单一疗法与增强疗法的优越性,并排除假定的年龄效应。发现DSA可减轻抑郁症状(SMD=-0.26,95CI[-0.43;-0.10])。异质性很高,显著的Egger检验表明发表偏倚。对缺失研究的调整,使用修剪和填充方法,减少了效应大小(SMD=-0.17,95CI[-0.39;0.05]),失去了统计意义。从分析中删除离群值研究,效果大小仍然很小,但有统计学意义(SMD=-0.17,95CI[-0.31;-0.02])。增强或单一疗法均无优势。没有发现年龄效应。可以得出结论,标签外DSA在减轻抑郁症状方面总体有效。然而,证据不足,关于出版偏见,和适度到微弱的治疗效果。非常需要精心设计的高质量试验,在多巴胺刺激剂可以在未来的抑郁症治疗方案中充分定位之前。
    The chronicity of depressive disorders is a major problem. Dopamine stimulating agents (DSA) are suggested to hold a promising potential in depression management, particularly in older adults, in whom dopamine deficiency due to aging may be an underlying cause. More evidence is needed to support these drugs in the management of depression. Therefore, we conducted a systematic literature review and meta-analysis. Data was extracted from eighteen randomized-controlled-trials and eight open-label-studies. Additional meta-regression-analyses were performed to examine superiority of monotherapy versus augmentation, and to rule out a putative age effect. DSA were found to reduce depressive symptoms (SMD=-0.26, 95%CI[-0.43;-0.10]). Heterogeneity was high and a significant Egger\'s test indicated publication bias. Adjustment for missing studies, using trim-and-fill-methodology, reduced the effect size (SMD=-0.17, 95%CI[-0.39;0.05]), which lost statistical significance. Removing the outlier study from the analysis, the effect size remained marginally small, but was statistically-significant (SMD=-0.17, 95%CI[-0.31;-0.02]). Neither augmentation nor monotherapy was superior. No age effect was found. It can be concluded that off-label DSA are overall effective in reducing depressive symptoms. However, the evidence is weak, regarding the publication bias, and modest-to-weak treatment effects. Well-designed high-quality trials are highly needed, before dopamine stimulating agents can be adequately positioned in future depression treatment protocols.
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  • 文章类型: Journal Article
    未经评估:表征和评估创新医疗技术的整体价值(例如,治疗,服务)构成了最大化有限资源的关键目标。然而,创新的特征还没有得到很好的识别。本文旨在描述医疗保健创新的特征。
    UNASSIGNED:我们使用PubMed进行了全面的系统搜索,Embase,PsycINFO,和Econlit从成立到2022年7月。如果文章描述了医疗保健技术的创新或创新特征,则包括在内。从所包含的文章中提取了直接或间接描述为创新的创新的特征或定义。然后,两名独立的审阅者将已识别的创新特征概念化,以生成医疗保健中的创新属性。
    未经批准:总共,这篇综述包括103篇文章。描述创新的八个属性,即,新奇,阶跃变化,巨大的好处,对现有技术的改进,便利性和/或依从性,附加值,可接受的成本,和数不清的好处,被概念化了。大多数确定的创新属性都是基于研究人员的观点。
    UNASSIGNED:本研究基于文献中定义的医疗保健创新特征,将医疗保健中的创新属性概念化。需要进一步的研究,以获得对研究人员和其他利益相关者观点的完整理解,包括患者,医疗保健提供者,医疗保健支付者,和制药业,认识到医疗保健领域的创新。关键点这是第一个将医疗保健创新属性概念化的系统综述。我们概念化了描述创新的八个属性,即,新奇,阶跃变化,巨大的好处,对现有技术的改进,便利性和/或依从性,附加值,可接受的成本,以及基于类似概念的未计算收益。在现有文献中,患者和护理人员的视角描述创新属性的频率较低。未来的研究需要确定,measure,重视各种利益相关者,包括患者和护理人员对医疗保健创新的看法。
    UNASSIGNED: Characterizing and evaluating the holistic value of innovative healthcare technologies (e.g., treatments, services) constitutes a crucial goal to maximize limited resources. However, the characteristics of innovation have not been well identified. This review aims to describe the characteristics of healthcare innovation.
    UNASSIGNED: We performed a comprehensive systematic search using PubMed, Embase, PsycINFO, and Econlit from inception to July 2022. Articles were included if they described innovation or the characteristics of innovation of the technologies in healthcare. Characteristics or definitions of innovation directly or indirectly described as innovation were extracted from the included articles. Two independent reviewers then conceptualized the identified characteristics of innovation to generate innovation attributes in healthcare.
    UNASSIGNED: In total, 103 articles were included in this review. Eight attributes describing innovation, i.e., novelty, step change, substantial benefits, an improvement over existing technologies, convenience and/or adherence, added value, acceptable cost, and uncounted benefits, were conceptualized. Most of the identified innovation attributes were based on the researchers\' perspective.
    UNASSIGNED: This study conceptualized innovation attributes in healthcare based on the characteristics of healthcare innovation as defined in the literature. Further research is warranted to obtain a complete understanding of the perspectives of researchers and other stakeholders, including patients, healthcare providers, healthcare payers, and the pharmaceutical industry, on recognizing innovation in healthcare.Key pointsThis is the first systematic review to conceptualize attributes of healthcare innovation.We conceptualized eight attributes describing innovation, i.e., novelty, step change, substantial benefits, an improvement over existing technologies, convenience and/or adherence, added value, acceptable cost, and uncounted benefits based on the similar concept.In existing literature, patients\' and caregivers\' perspectives were less frequently found to describe the innovation attributes.Future research is needed to identify, measure, and value various stakeholders, including patients\' and caregivers\' perspectives on healthcare innovation.
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  • 文章类型: Journal Article
    远程工作是指由于技术的使用,员工可以在组织之外从事工作任务的一种工作模式。几篇研究论文表明,不同的假设与远程工作有关,因为员工在远程或在家工作时具有灵活性和自主性。这篇综述旨在描述远程工作在员工福祉和绩效中的作用。使用系统评价和荟萃分析(PRISMA)指南的首选报告项目,从2010年到2021年发表的20篇同行评审论文被选入本综述。研究结果表明,对员工的绩效和幸福感有各种不同的影响。具体来说,远程工作会影响员工对自己和工作场所的看法,并有助于他们的身心健康,尤其是工作与生活的平衡。本文将讨论远程工作实施的管理含义。
    Remote working refers to a working model in which employees can pursue work tasks outside the organization due to the use of technology. Several research papers showed that different assumptions are linked to remote work because of the flexibility and autonomy granted to employees when working remotely or from home. This review consistently aims to describe remote work\'s role in employees\' well-being and performance. Using the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, 20 peer-reviewed papers published from 2010 until 2021 were selected for this review. Findings showed various and mixed consequences on employees\' performance and well-being. Specifically, remote working affects employees\' perceptions about themselves and their workplaces and contributes to their physical and mental health, particularly regarding work-life balance. Managerial implications for remote working implementation will be discussed in the paper.
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