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A rapid review was conducted to explore the implementation determinants of human papillomavirus (HPV) vaccination in the World Health Organization African Region and describe their dynamic relationship. PubMed and Google Scholar were searched in October 2023 to find relevant literature. A total of 64 published studies that reported factors affecting HPV vaccination were identified. Analysis of identified factors yielded 74 implementation determinants of HPV vaccination across the five domains of the Consolidated Framework for Implementation Research (CFIR): two (2.70%) were in the innovation domain, seven (9.46%) were in the outer setting domain, 14 (18.92%) were in the inner setting domain, 37 (50%) were in the individual domain and 14 (18.92%) were in the implementation process domain. A causal loop diagram of these implementation determinants revealed four balancing and seven reinforcing loops. Applying systems lens promoted a more holistic understanding of the implementation determinants of HPV vaccination, exposing leverage points for interventions.

UNASSIGNED: The CaRi-Heart® device estimates risk of 8-year cardiac death, using a prognostic model, which includes perivascular fat attenuation index, atherosclerotic plaque burden and clinical risk factors.
UNASSIGNED: To provide an Early Value Assessment of the potential of CaRi-Heart Risk to be an effective and cost-effective adjunctive investigation for assessment of cardiac risk, in people with stable chest pain/suspected coronary artery disease, undergoing computed tomography coronary angiography. This assessment includes conceptual modelling which explores the structure and evidence about parameters required for model development, but not development of a full executable cost-effectiveness model.
UNASSIGNED: Twenty-four databases, including MEDLINE, MEDLINE In-Process and EMBASE, were searched from inception to October 2022.
UNASSIGNED: Review methods followed published guidelines. Study quality was assessed using Prediction model Risk Of Bias ASsessment Tool. Results were summarised by research question: prognostic performance; prevalence of risk categories; clinical effects; costs of CaRi-Heart. Exploratory searches were conducted to inform conceptual cost-effectiveness modelling.
UNASSIGNED: The only included study indicated that CaRi-Heart Risk may be predictive of 8 years cardiac death. The hazard ratio, per unit increase in CaRi-Heart Risk, adjusted for smoking, hypercholesterolaemia, hypertension, diabetes mellitus, Duke index, presence of high-risk plaque features and epicardial adipose tissue volume, was 1.04 (95% confidence interval 1.03 to 1.06) in the model validation cohort. Based on Prediction model Risk Of Bias ASsessment Tool, this study was rated as having high risk of bias and high concerns regarding its applicability to the decision problem specified for this Early Value Assessment. We did not identify any studies that reported information about the clinical effects or costs of using CaRi-Heart to assess cardiac risk. Exploratory searches, conducted to inform the conceptual cost-effectiveness modelling, indicated that there is a deficiency with respect to evidence about the effects of changing existing treatments or introducing new treatments, based on assessment of cardiac risk (by any method), or on measures of vascular inflammation (e.g. fat attenuation index). A de novo conceptual decision-analytic model that could be used to inform an early assessment of the cost effectiveness of CaRi-Heart is described. A combination of a short-term diagnostic model component and a long-term model component that evaluates the downstream consequences is anticipated to capture the diagnosis and the progression of coronary artery disease.
UNASSIGNED: The rapid review methods and pragmatic additional searches used to inform this Early Value Assessment mean that, although areas of potential uncertainty have been described, we cannot definitively state where there are evidence gaps.
UNASSIGNED: The evidence about the clinical utility of CaRi-Heart Risk is underdeveloped and has considerable limitations, both in terms of risk of bias and applicability to United Kingdom clinical practice. There is some evidence that CaRi-Heart Risk may be predictive of 8-year risk of cardiac death, for patients undergoing computed tomography coronary angiography for suspected coronary artery disease. However, whether and to what extent CaRi-Heart represents an improvement relative to current standard of care remains uncertain. The evaluation of the CaRi-Heart device is ongoing and currently available data are insufficient to fully inform the cost-effectiveness modelling.
UNASSIGNED: A large (n = 15,000) ongoing study, NCT05169333, the Oxford risk factors and non-invasive imaging study, with an estimated completion date of February 2030, may address some of the uncertainties identified in this Early Value Assessment.
UNASSIGNED: This study is registered as PROSPERO CRD42022366496.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR135672) and is published in full in Health Technology Assessment; Vol. 28, No. 31. See the NIHR Funding and Awards website for further award information.
Coronary artery disease affects around 2.3 million people in the United Kingdom. It is caused by a build-up of fatty plaques on the walls of the blood vessels that supply the heart muscle. This can reduce the flow of blood to the heart and result in people experiencing chest pain (angina), especially when they exercise. Over time, the fatty plaques can grow and block more or all of the artery and blood clots can also form, causing blockage. A heart attack happens when the supply of blood to the heart muscle is blocked. People who have episodes of chest pain, whose doctors think that they may have coronary artery disease, can have a type of imaging (computed tomography coronary angiography) which shows whether there is any narrowing of their coronary arteries. When offering treatment, specialist heart doctors are likely to consider a person’s symptoms and other risk factors (such as family history of heart disease, diabetes and smoking history), as well as how much narrowing of the arteries has happened. CaRi-Heart® is a computer programme that uses information about inflammation in a person’s coronary arteries, together with recognised risk factors, such as age, sex, smoking, high cholesterol levels, high blood pressure and diabetes, to estimate an individual’s risk of dying from a heart attack in the next 8 years. There is evidence that CaRi-Heart® is better at estimating this risk than using information recognised risk factors alone. However, there is a lack of information about how treatment could change as a result of using CaRi-Heart® and whether any changes would improve outcomes for patients. There is also a lack of information about how much CaRi-Heart® would cost the National Health Service.

UNASSIGNED: This study addresses the growing demand for palliative care (PC) by exploring the role of advanced nursing practice (ANP) within the multidisciplinary team. The purpose is to outline the background of ANP in PC, its interest, training needs, and some recommendations for its establishment in the Moroccan healthcare system.
UNASSIGNED: A rapid review of relevant studies was carried out through databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards, edition (2020). The inclusion criteria focussed on studies published within the nursing domain between 2012 and 2022, with a preference for the English language.
UNASSIGNED: Study selection allowed to obtain eight relevant studies. The studies agreed that ANP improves the quality of care provided. It has a major role to play in the multidisciplinary team by mobilising all the knowledge required to offer a complete range of care for patients with needs. Nevertheless, its implementation is fraught with challenges.
UNASSIGNED: ANP will be able to address the complexity of patient and family needs and serve as cost-effective medical care coordinators for patients and families with both chronic and life-limiting illnesses, to reduce suffering and improve the quality of living and dying across the lifespan. Advanced practice nurses execute assigned authorisations by mobilising the knowledge acquired through university training. The establishment of this cadre in the healthcare system is subject to many challenges that Morocco must anticipate.

In the United States, patients with chronic conditions experience disparities in health outcomes across the care continuum. Among patients with multiple sclerosis, diabetic retinopathy, and lung cancer, there is a lack of evidence summarizing interventions to improve care and decrease these disparities. The aim of this rapid literature review was to identify interventions among patients with these chronic conditions to improve health and reduce disparities in screening, diagnosis, access to treatment and specialists, adherence, and retention in care. Using structured search terms in PubMed and Web of Science, we completed a rapid review of studies published in the prior five years conducted in the United States on our subject of focus. We screened the retrieved articles for inclusion and extracted data using a standard spreadsheet. The data were synthesized across clinical conditions and summarized. Screening was the most common point in the care continuum with documented interventions. Most studies we identified addressed interventions for patients with lung cancer, with half as many studies identified for patients with diabetic retinopathy, and few studies identified for patients with multiple sclerosis. Almost two-thirds of the studies focused on patients who identify as Black, Indigenous, or people of color. Interventions with evidence evaluating implementation in multiple conditions included telemedicine, mobile clinics, and insurance subsidies, or expansion. Despite documented disparities and a focus on health equity, a paucity of evidence exists on interventions that improve health outcomes among patients who are medically underserved with multiple sclerosis, diabetic retinopathy, and lung cancer.

BACKGROUND: In recent years, there has been an upwelling of artificial intelligence (AI) studies in the health care literature. During this period, there has been an increasing number of proposed standards to evaluate the quality of health care AI studies.
OBJECTIVE: This rapid umbrella review examines the use of AI quality standards in a sample of health care AI systematic review articles published over a 36-month period.
METHODS: We used a modified version of the Joanna Briggs Institute umbrella review method. Our rapid approach was informed by the practical guide by Tricco and colleagues for conducting rapid reviews. Our search was focused on the MEDLINE database supplemented with Google Scholar. The inclusion criteria were English-language systematic reviews regardless of review type, with mention of AI and health in the abstract, published during a 36-month period. For the synthesis, we summarized the AI quality standards used and issues noted in these reviews drawing on a set of published health care AI standards, harmonized the terms used, and offered guidance to improve the quality of future health care AI studies.
RESULTS: We selected 33 review articles published between 2020 and 2022 in our synthesis. The reviews covered a wide range of objectives, topics, settings, designs, and results. Over 60 AI approaches across different domains were identified with varying levels of detail spanning different AI life cycle stages, making comparisons difficult. Health care AI quality standards were applied in only 39% (13/33) of the reviews and in 14% (25/178) of the original studies from the reviews examined, mostly to appraise their methodological or reporting quality. Only a handful mentioned the transparency, explainability, trustworthiness, ethics, and privacy aspects. A total of 23 AI quality standard-related issues were identified in the reviews. There was a recognized need to standardize the planning, conduct, and reporting of health care AI studies and address their broader societal, ethical, and regulatory implications.
CONCLUSIONS: Despite the growing number of AI standards to assess the quality of health care AI studies, they are seldom applied in practice. With increasing desire to adopt AI in different health topics, domains, and settings, practitioners and researchers must stay abreast of and adapt to the evolving landscape of health care AI quality standards and apply these standards to improve the quality of their AI studies.

BACKGROUND: The generation of research evidence and knowledge in primary health care (PHC) is crucial for informing the development and implementation of interventions and innovations and driving health policy, health service improvements, and potential societal changes. PHC research has broad effects on patients, practices, services, population health, community, and policy formulation. The in-depth exploration of the definition and measures of research impact within PHC is essential for broadening our understanding of research impact in the discipline and how it compares to other health services research.
OBJECTIVE: The objectives of the study are (1) to understand the conceptualizations and measures of research impact within the realm of PHC and (2) to identify methodological frameworks for evaluation and research impact and the benefits and challenges of using these approaches. The forthcoming review seeks to guide future research endeavors and enhance methodologies used in assessing research impact within PHC.
METHODS: The protocol outlines the rapid review and environmental scan approach that will be used to explore research impact in PHC and will be guided by established frameworks such as the Canadian Academy of Health Sciences Impact Framework and the Canadian Health Services and Policy Research Alliance. The rapid review follows scoping review guidelines (PRISMA-ScR; Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews). The environmental scan will be done by consulting with professional organizations, academic institutions, information science, and PHC experts. The search strategy will involve multiple databases, citation and forward citation searching, and manual searches of gray literature databases, think tank websites, and relevant catalogs. We will include gray and scientific literature focusing explicitly on research impact in PHC from high-income countries using the World Bank classification. Publications published in English from 1978 will be considered. The collected papers will undergo a 2-stage independent review process based on predetermined inclusion criteria. The research team will extract data from selected studies based on the research questions and the CRISP (Consensus Reporting Items for Studies in Primary Care) protocol statement. The team will discuss the extracted data, enabling the identification and categorization of key themes regarding research impact conceptualization and measurement in PHC. The narrative synthesis will evolve iteratively based on the identified literature.
RESULTS: The results of this study are expected at the end of 2024.
CONCLUSIONS: The forthcoming review will explore the conceptualization and measurement of research impact in PHC. The synthesis will offer crucial insights that will guide subsequent research, emphasizing the need for a standardized approach that incorporates diverse perspectives to comprehensively gauge the true impact of PHC research. Furthermore, trends and gaps in current methodologies will set the stage for future studies aimed at enhancing our understanding and measurement of research impact in PHC.
UNASSIGNED: PRR1-10.2196/55860.

Positive health (PH) has been described as a promising transformative innovation to address the challenges of promoting well-being and reducing the burden of disease. For this study, we conducted a scientific literature review of the current state of knowledge about PH as introduced by Huber and colleagues, following the Cochrane Rapid Review recommendations. Three databases were searched (PubMed, Google Scholar, and CINAHL). Data were extracted and synthesised using a narrative approach. A total of 55 articles were included. The initial evaluation revealed promising results at both the individual and collective levels. However, several articles gave reason for further refinement of the conceptualisation of PH and of ways to measure the effects of PH interventions in greater detail. Professionals also expressed a desire for a more informed application and elaboration of the PH method, in various settings and populations, to increase its effectiveness in practice. The results from the rapid review highlight the transformative potential of PH in shifting from a disease-oriented to a health-oriented paradigm of healthcare. This underlines the need for continued research regarding further development of the concept and its practical method, along with the necessity for methodological innovation.

This article was migrated. The article was marked as recommended. Background: In the last decade, reflexivity has emerged as a key concept in family medicine, as evidenced by its increasing integration in competency statements and frameworks in the field. However, the concept of reflexivity is inconsistent and ill-defined in medical education literature, with variable purposes and associated processes, which is an important barrier to learning and implementing reflective practices. This project built on the results of a rapid review to develop an educational tool supporting the learning and teaching of reflexivity in family medicine. Methods: We conducted a rapid review of quantitative, qualitative and mixed studies relating to reflexivity in family medicine between May 2007 to May 2017 in PubMed, Embase, PsychInfo, CINHAL, ERIC and Education Source. Two reviewers independently identified, selected and reviewed studies. Results of the review were used to frame the content of the tool. Results: Our research strategy initially identified 810 studies, from which 65 studies were retained for analysis. The different conceptions of reflexivity encountered in the included studies were analyzed using thematic analysis. Four conceptions of reflexivity (i.e. clinical, professional, relational and social reflexivity), with related definitions, goals and processes were identified in the included studies and were used as a basis to develop the Reflexivi-Tool. Conclusion: There is a need to provide clear guidelines regarding the purpose and process of reflexivity, as well as better equipping mentors so they can better facilitate these kinds of skills. Based on a rapid review, this study has allowed the development of a tool that presents and clarifies four main types of reflexivity for medical practice in a concise and user-friendly way. Tools such as Reflexivi-Tool are crucial to support reflective processes that target different dimensions of professionalism.

BACKGROUND: Stroke readmissions are considered a marker of health quality and may pose a burden to healthcare systems. However, information on the costs of post-stroke readmissions has not been systematically reviewed.
OBJECTIVE: To systematically review information about the costs of hospital readmissions of patients whose primary diagnosis in the index admission was a stroke.
METHODS: A rapid systematic review was performed on studies reporting post-stroke readmission costs in EMBASE, MEDLINE, and Web of Science up to June 2021. Relevant data were extracted and presented by readmission and stroke type. The original study\'s currency values were converted to 2021 US dollars based on the purchasing power parity for gross domestic product. The reporting quality of each of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.
RESULTS: Forty-four studies were identified. Considerable variability in readmission costs was observed among countries, readmissions, stroke types, and durations of the follow-up period. The UK and the USA were the countries reporting the highest readmission costs. In the first year of follow-up, stroke readmission costs accounted for 2.1-23.4%, of direct costs and 3.3-21% of total costs. Among the included studies, only one identified predictors of readmission costs.
CONCLUSIONS: Our review showed great variability in readmission costs, mainly due to differences in study design, countries and health services, follow-up duration, and reported readmission data. The results of this study can be used to inform policymakers and healthcare providers about the burden of stroke readmissions. Future studies should not solely focus on improving data standardization but should also prioritize the identification of stroke readmission cost predictors.