Effectiveness of cardiac rehabilitation programs on medication adherence in patients with cardiovascular disease: A systematic review and meta-analysis.

Background: Education to improve medication adherence is one of the core components of cardiac rehabilitation (CR) programs. However, the evidence on the effectiveness of CR programs on medication adherence is conflicting. Therefore, we aimed to summarize the effectiveness of CR programs versus standard care on medication adherence in patients with cardiovascular disease. Methods: A systematic review and meta-analysis was conducted. Seven databases and clinical trial registries were searched for published and unpublished articles from database inception to 09 Feb 2022. Only randomised controlled trials and quasi-experimental studies were included. Two independent reviewers conducted the screening, extraction, and appraisal. The JBI methodology for effectiveness reviews and PRISMA 2020 guidelines were followed. A statistical meta-analysis of included studies was pooled using RevMan version 5.4.1. Results: In total 33 studies were included with 16,677 participants. CR programs increased medication adherence by 14 % (RR = 1.14; 95 % CI: 1.07 to 1.22; p = 0.0002) with low degree of evidence certainty. CR also lowered the risk of dying by 17 % (RR = 0.83; 95 % CI: 0.69 to 1.00; p = 0.05); primary care and emergency department visit by mean difference of 0.19 (SMD = -0.19; 95 % CI: -0.30 to -0.08; p = 0.0008); and improved quality of life by 0.93 (SMD = 0.93; 95 % CI: 0.38 to 1.49; p = 0.0010). But no significant difference was observed in lipid profiles, except with total cholesterol (SMD = -0.26; 95 % CI: -0.44 to -0.07; p = 0.006) and blood pressure levels. Conclusions: CR improves medication adherence with a low degree of evidence certainty and non-significant changes in lipid and blood pressure levels. This result requires further investigation.

Effectiveness of nurse-led interventions versus usual care to manage hypertension and lifestyle behaviour: a systematic review and meta-analysis.

AIMS: This review aimed to investigate the effectiveness of nurse-led interventions vs. usual care on hypertension management, lifestyle behaviour, and patients' knowledge of hypertension and associated risk factors. METHODS: A systematic review with meta-analysis was conducted following Joanna Briggs Institute (JBI) guidelines. MEDLINE (Ovid), EmCare (Ovid), CINAHL (EBSCO), Cochrane library, and ProQuest (Ovid) were searched from inception to 15 February 2022. Randomized controlled trials (RCTs) examining the effect of nurse-led interventions on hypertension management were identified. Title and abstract, full text screening, assessment of methodological quality, and data extraction were conducted by two independent reviewers using JBI tools. A statistical meta-analysis was conducted using STATA version 17.0. RESULTS: A total of 37 RCTs and 9731 participants were included. The overall pooled data demonstrated that nurse-led interventions may reduce systolic blood pressure (mean difference -4.66; 95% CI -6.69, -2.64; I2 = 83.32; 31 RCTs; low certainty evidence) and diastolic blood pressure (mean difference -1.91; 95% CI -3.06, -0.76; I2 = 79.35; 29 RCTs; low certainty evidence) compared with usual care. The duration of interventions contributed to the magnitude of blood pressure reduction. Nurse-led interventions had a positive impact on lifestyle behaviour and effectively modified diet and physical activity, but the effect on smoking and alcohol consumption was inconsistent. CONCLUSION: This review revealed the beneficial effects of nurse-led interventions in hypertension management compared with usual care. Integration of nurse-led interventions in routine hypertension treatment and prevention services could play an important role in alleviating the rising global burden of hypertension. REGISTRATION: PROSPERO: CRD42021274900.

Effectiveness of alternative vs traditional exercises on cardiac rehabilitation program utilization in women with or at high risk of cardiovascular disease: a systematic review protocol.

OBJECTIVE: This review will evaluate the effectiveness of alternative vs traditional forms of exercise on cardiac rehabilitation program utilization and other outcomes in women with or at high risk of cardiovascular disease. INTRODUCTION: Exercise-based cardiac rehabilitation programs improve health outcomes in women with or at high risk of cardiovascular disease. However, such programs are underutilized worldwide, particularly among women. Some women perceive traditional gym-based exercise in cardiac rehabilitation programs (eg, typically treadmills, cycle ergometers, traditional resistance training) to be excessively rigorous and unpleasant, resulting in diminished participation and completion. Alternative forms of exercise such as yoga, tai chi, qi gong, or Pilates may be more enjoyable and motivating exercise options for women, enhancing engagement in rehabilitation programs. However, the effectiveness of these alternative exercises in improving program utilization is still inconsistent and needs to be systematically evaluated and synthesized. INCLUSION CRITERIA: This review will focus on randomized controlled trials of studies measuring the effectiveness of alternative vs traditional forms of exercise on cardiac rehabilitation program utilization as well as clinical, physiological, or patient-reported outcomes in women with or at high risk of cardiovascular disease. METHODS: The review will follow the JBI methodology for systematic reviews of effectiveness. Databases including MEDLINE (Ovid), CINAHL (EBSCOhost), Cochrane CENTRAL, Embase (Ovid), Emcare (Ovid), Scopus, Web of Science, LILACS, and PsycINFO (Ovid) will be searched. Two independent reviewers will screen articles and then extract and synthesize data. Methodological quality will be assessed using JBI's standardized instruments. GRADE will be used to determine the certainty of evidence. REVIEW REGISTRATION: PROSPERO CRD42022354996.

Interventions to prevent or manage workplace violence against student nurses during clinical placement: a systematic review protocol.

OBJECTIVES: The objective of this review is to investigate the effectiveness of workplace violence management or prevention interventions, including strategies, protocols, and policies, to address violence against, and provide support to, registered nursing students (RNS) following incidents of violence during clinical placement. INTRODUCTION: Workplace violence is a global issue that affects victims' physical and mental health. RNS are especially vulnerable to workplace violence because of their limited work experience and confidence. These students often feel shocked and unprepared when experiencing workplace violence due to limited education and support provided by educational institutions or clinical sites. Workplace violence can lead to anxiety, decreased confidence, and professional attrition. There is a need to systematically synthesize the evidence on workplace violence management and prevention to support nursing students during clinical placement. INCLUSION CRITERIA: The review will consider studies assessing the effectiveness of interventions to address workplace violence or improve support for RNS. Studies that report on educational interventions or pre-clinical placement strategies and measure the preparedness of students will also be considered. Study designs will be limited to quantitative methods that evaluate intervention effectiveness. METHODS: Databases to be searched include MEDLINE (Ovid), CINAHL (EBSCOhost), Web of Science Core Collection, Scopus, Embase (Ovid), Cochrane Central, ERIC (ProQuest), ProQuest Central, ProQuest Social Science Premium Collection, and ProQuest Dissertations and Theses Global. Two independent reviewers will screen, review, appraise, and extract data from eligible articles. For data synthesis, studies will be pooled using JBI SUMARI. The GRADE approach for grading the certainty of evidence will be followed and a Summary of Findings will be created. REVIEW REGISTRATION: PROSPERO CRD42022377318.

Health System Enablers and Barriers to Continuity of Care for First Nations Peoples Living with Chronic Disease.

Introduction: Failings in providing continuity of care following an acute event for a chronic disease contribute to care inequities for First Nations Peoples in Australia, Canada, and Aotearoa (New Zealand). Methods: A rapid narrative review, including primary studies published in English from Medline, Embase, PsycINFO, and Cochrane Central, concerning chronic diseases (cancer, cardiovascular disease, chronic kidney disease, diabetes, and related complications), was conducted. Barriers and enablers to continuity of care for First Nations Peoples were explored considering an empirical lens from the World Health Organization framework on integrated person-centred health services. Results: Barriers included a need for more community initiatives, health and social care networks, and coaching and peer support. Enabling strategies included care adapted to patients' cultural beliefs and behavioural, personal, and family influences; continued and trusting relationships among providers, patients, and caregivers; and provision of flexible, consistent, adaptable care along the continuum. Discussion: The support and co-creation of care solutions must be a dialogical participatory process adapted to each community. Conclusions: Health and social care should be harmonised with First Nations Peoples' cultural beliefs and family influences. Sustainable strategies require a co-design commitment for well-funded flexible care plans considering coaching and peer support across the lifespan.

Meet us where we are: non-Indigenous young peoples' ideas on how to reduce alcohol-related harm in Mparntwe (Alice Springs).

OBJECTIVE: This research sought to understand the strategies young people in a remote central Australian town believed would reduce alcohol-related harms amongst their peers. METHODS: A total of 38 non-Indigenous residents of Mparntwe (Alice Springs), aged between 14 and 18 years, participated in focus groups at their school. Participants discussed strategies they thought would reduce alcohol-related harms among people their age. Data were analysed using thematic analysis. RESULTS: Participants suggested that young peoples' drinking behaviour developed with peers. Through social learning in peer groups, drinking alcohol was perceived as fun and normal. Participants indicated a willingness to learn about strategies to stay safe around alcohol. Their ideas for doing so reflected their existing social methods of learning about alcohol: having comfortable conversations and storytelling with a small group of peers and a relatable role model. CONCLUSIONS: Young residents of Mparntwe (Alice Springs) advised that alcohol-related harm reduction strategies would be most effective if focussed on safety, rather than abstinence, and applied social-learning strategies. IMPLICATIONS FOR PUBLIC HEALTH: Young people value their burgeoning self-determination. Youth health interventions must engage youth in intervention co-design and aim to assist young people to make safer decisions, rather than making decisions on their behalf.

A systematic review of the measurement properties of aspects of psychological capacity in older adults.

OBJECTIVE: to examine the measurement properties of instruments that have been used to measure aspects of psychological capacity in adults aged 60 years and over. METHODS: the databases PsycINFO, MEDLINE, EMCARE and Scopus from 2010 were searched using search terms related to psychological capacity, older persons and measurement properties. Both data extraction and risk-of-bias assessment were conducted using the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) criteria using Covidence software. RESULTS: the full text of 326 articles were reviewed and a total of 30 studies were included, plus two further articles identified from reference lists (n = 32). No single instrument measuring psychological capacity was identified. Twenty (n = 20) instruments were identified that measure seven constructs of psychological capacity: Resilience; Sense of coherence; Hope; Mindfulness; Optimism; Attachment to life; Emotional regulation. CONCLUSIONS: this systematic review identified potential measures of psychological capacity in older adults. The review will inform further work to develop a single comprehensive measure of psychological capacity in older adults.

Interprofessional disaster exercises for undergraduate nursing students: a scoping review.

OBJECTIVE: The aim of this scoping review was to report on the planning and implementation of a disaster exercise for undergraduate nursing students, which included the participation of other health students, allied health students, or professionals, for the purpose of preparing them to respond to a disaster. INTRODUCTION: Recently, the world has witnessed an increasing frequency of natural disasters, emergencies, and public health events. These events often adversely influence many individuals' health, and as such, require health professionals to be prepared and ready to effectively respond. Health students, including nursing, medical, and allied health professionals, need to be provided with opportunities to learn about disasters and to practice responding to them within a team context. This scoping review examined the planning and implementation of disaster exercises that have conceptualized an interprofessional team approach inclusive of nursing students. INCLUSION CRITERIA: Quantitative studies, qualitative studies, mixed method studies, discussions, and text or opinion papers reporting a disaster simulation or drill, involving undergraduate nursing and other health students, allied health discipline students, practitioners, and non-health personnel were included. There was no limit on the publication period or languages. METHODS: MEDLINE (EBSCOhost), CINAHL (EBSCOhost), ERIC (EBSCOhost), Embase (Ovid), Web of Science Core Collection, ProQuest Nursing and Allied Health (Ovid), and PsycINFO (Ovid) were searched for relevant reports. Titles and abstracts and then full texts were screened independently by 2 reviewers. A data extraction tool developed specifically for this review was used to chart evidence pertaining to planning and implementing a disaster exercise, nursing students' roles, and measured outcomes. RESULTS: A total of 1429 titles were screened; 42 full texts were assessed against the eligibility criteria and 13 papers were selected for review. Nursing students had opportunities to practice performing a single role or a combined role as observers, triage nurses, direct care providers, or assisting health professionals, depending on their year level. Nursing students' roles were sometimes not well identified and not clearly communicated to them prior to the exercise, resulting in ambiguous expectations for some participants. By involving multiple health students and professionals, the nursing students had the opportunity to participate and perform tasks within their scope of practice while observing the roles of other disciplines. In a few studies, participants teamed up to triage, assess, and provide care for simulated patients. A variety of outcomes were categorized, such as students' knowledge, skills, attitudes, satisfaction with the learning experience, self-confidence, communication, collaboration, readiness for a disaster event, critical decision-making, and empathy. Important lessons regarding decision-making preparations (such as planning, coordinating, and implementing a disaster exercise), scheduling and sequencing for optimal times to ensure participating disciplines can attend, identification and effective communication of students' roles, plus ensuring manageable group sizes will optimize a more authentic learning opportunity for all involved in disaster exercises. CONCLUSIONS: Overall, the exercises were perceived as a positive learning opportunity for students to understand what is required in disaster responses and to practice their skills. Adequate preparation for a disaster exercise is crucial for a successful experience and should prepare nursing students and other participants for the roles they need to fulfill. SUPPLEMENTAL DIGITAL CONTENT: A Vietnamese-language version of the abstract of this review is available as Supplemental Digital Content http://links.lww.com/SRX/A24 .

Measurement properties of utility-based health-related quality-of-life measures in cardiac rehabilitation: a systematic review protocol.

OBJECTIVE: This review will identify and appraise existing evidence on the measurement properties of utility-based health-related quality-of-life (HRQoL) measures used in cardiac rehabilitation programs. The review will map the measure domains against the International Classification of Functioning, Disability and Health and the International Consortium of Health Outcome Measures domains for cardiovascular disease. INTRODUCTION: Improving HRQoL is an international key indicator for delivering high-quality and person-centered secondary prevention programs. Many instruments and measures assess HRQoL in individuals undergoing cardiac rehabilitation. Utility-based measures are suitable for calculating quality-adjusted life years, a required outcome metric in cost-utility analysis. Cost-utility analysis requires the use of utility-based HRQoL measures. However, there is no consensus on which utility-based measure is best for populations undergoing cardiac rehabilitation. INCLUSION CRITERIA: Eligible studies will include patients aged ≥18 years with cardiovascular disease who are undergoing cardiac rehabilitation. Empirical studies that assess quality of life or HRQoL using a utility-based, health-related, patient-reported outcome measure or a measure accompanied by health state utilities will be eligible. Studies must report at least 1 of the following measurement properties: reliability, validity, responsiveness. METHODS: This review will follow the JBI methodology for systematic reviews of measurement properties. The following databases will be searched from inception to the present: MEDLINE, Emcare, Embase, Scopus, CINAHL, Web of Science Core Collection, Informit, PsyclNFO, REHABDATA, and the Cochrane Library. Studies will be critically appraised using the The COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) risk of bias checklist. The review will be reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. REVIEW REGISTRATION: PROSPERO CRD42022349395.

Models of social prescribing to address non-medical needs in adults: a scoping review.

BACKGROUND: The health and wellbeing consequences of social determinants of health and health behaviours are well established. This has led to a growing interest in social prescribing, which involves linking people to services and supports in the community and voluntary sectors to address non-medical needs. However, there is considerable variability in approaches to social prescribing with little guidance on how social prescribing could be developed to reflect local health systems and needs. The purpose of this scoping review was to describe the types of social prescribing models used to address non-medical needs to inform co-design and decision-making for social prescribing program developers. METHODS: We searched Ovid MEDLINE(R), CINAHL, Web of Science, Scopus, National Institute for Health Research Clinical Research Network, Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registry Platform, and ProQuest - Dissertations and Theses for articles and grey literature describing social prescribing programs. Reference lists of literature reviews were also searched. The searches were conducted on 2 August 2021 and yielded 5383 results following removal of duplicates. RESULTS: 148 documents describing 159 social prescribing programs were included in the review. We describe the contexts in which the programs were delivered, the program target groups and services/supports to which participants were referred, the staff involved in the programs, program funding, and the use of digital systems. CONCLUSIONS: There is significant variability in social prescribing approaches internationally. Social prescribing programs can be summarised as including six planning stages and six program processes. We provide guidance for decision-makers regarding what to consider when designing social prescribing programs.

Effectiveness of strategies to reduce risky alcohol consumption among youth living in rural or remote areas: a systematic review.

OBJECTIVE: This review aimed to evaluate the effectiveness of strategies to reduce risky alcohol consumption among youth living in rural and remote areas. INTRODUCTION: Youth living in rural and remote areas are more likely to drink alcohol and experience alcohol-related harm than youth living in urban locations. This review assessed the effectiveness of strategies to reduce young people's risky alcohol consumption in rural and remote areas. INCLUSION CRITERIA: We considered papers that included youth (aged 12 to 24 years; also referred to in this review as young people ) who were identified as living in rural or remote locations. Any intervention or strategy designed to reduce or prevent alcohol consumption among this population was included. The primary outcome was frequency of short-term risky alcohol consumption as measured by self-reported incidents of drinking 5 or more standard drinks in 1 session. METHODS: We conducted this systematic review in accordance with the JBI methodology for systematic reviews of effectiveness. We searched for published and unpublished English-language studies and gray literature from 1999 to December 2021. Two authors screened titles and abstracts before full-text screening and data extraction. Two authors reviewed the extracted data to identify studies that reported duplicate data (eg, due to progressive publication of longitudinal data sets) and, where multiple studies reported the same data set, the study with the measure most proximal to the primary outcome measure and/or with the longest follow-up was selected. Two authors then critically appraised the studies. There were no interventions that were assessed for impact on the primary outcome in more than 1 study; in turn, the feasibility and utility of statistical pooling and the Summary of Findings were limited. Instead, results and certainty of evidence is provided in narrative format. RESULTS: Twenty-eight articles reporting on 16 studies were included in the review: 10 randomized controlled trials, 4 quasi-experimental studies, and 2 cohort studies. All studies except 1 were conducted in the United States. Only 3 studies measured the primary outcome of short-term risky alcohol consumption and included a comparison group. A meta-analysis of 2 of these studies showed that interventions that included motivational interviewing had a small and non-significant effect on short-term risky alcohol consumption among Indigenous youth in the United States. Meta-analyses of the effect of a variety of interventions on secondary outcomes demonstrated that intervention was not more effective than control for reducing past month drunkenness; however, intervention was more effective for reducing past month alcohol use (odds radio 0.3; 95% CI 0.13 to 0.67; P =0.003). The heterogeneity of effects was evident within these meta-analyses as well as in the studies unable to be meta-analyzed. CONCLUSION: Based on this review, no interventions can be broadly recommended for reducing short-term risky alcohol consumption among youth in rural and remote areas. Further research to increase the robustness of available evidence in relation to the effectiveness of strategies to reduce short-term risky alcohol consumption among youth in rural and remote areas is urgently required. REVIEW REGISTRATION: PROSPERO CRD42020167834.

Characteristics and processes of registered nurses' clinical reasoning and factors relating to the use of clinical reasoning in practice: a scoping review.

OBJECTIVE: The objective of this review was to examine the characteristics and processes of clinical reasoning used by registered nurses in clinical practice, and to identify factors reported to relate to the use of clinical reasoning by registered nurses in clinical practice. INTRODUCTION: Significant variability in the clinical reasoning of graduate registered nurses has been identified in research, with underdeveloped and unsafe clinical reasoning being linked to failure-to-rescue and sentinel events in the clinical setting. The identification of characteristics and processes of clinical reasoning, and factors relating to registered nurses' clinical reasoning when engaged in clinical practice, will increase understanding of the clinical reasoning requirements for undergraduate registered nurses and of potential factors that may affect their clinical reasoning. INCLUSION CRITERIA: Studies including registered nurses who met the criteria for registered nurse registration in Australia and who used clinical reasoning to engage with health care consumers in all practice environments were eligible for inclusion. METHODS: Eight databases were searched, with articles identified through CINAHL, MedNar, PubMed, Science Direct, ERIC, PsycINFO, Scopus, and ProQuest Dissertations and Theses. Database searches were conducted on December 31, 2020, and updated August 20, 2021, with primary qualitative and quantitative research studies in English from 2000 onwards considered for inclusion. Opinion papers, text, and reports were not included. Data were extracted based on the draft charting tool from the scoping review protocol, with results presented in tabular format and in a narrative summary. RESULTS: The 29 qualitative and 5 quantitative research studies included in the scoping review utilized exploratory descriptive, descriptive rationalist, narrative, ethnography, correlational, observational, and grounded theory methodologies in their research designs. Observation, think-aloud sessions, questionnaires, surveys, interviews, and focus groups were used to collect data from the 1099 participants in 9 countries. Multiple concepts related to the characteristics (n=35) and processes (n=30) of clinical reasoning were detected in the research studies, with 5 categories identified: i) situation management, ii) data management, iii) interpreting, iv) implementing and evaluating, and v) professional practice, with an additional processes category identified (decision-making processes). The factors (n=26) reported to relate to clinical reasoning were categorized into environment of care, care requirements, professional practice, experience, knowledge, and decision-making processes. Connections between the various concepts were evident throughout the review. CONCLUSIONS: The scoping review identified characteristics and processes of clinical reasoning, as well as factors reported to relate to clinical reasoning in all studies. The concepts that comprise the clinical reasoning of registered nurses in clinical practice must be considered in undergraduate registered nurse education. Registered nurses must complete their baccalaureate program with well-developed clinical reasoning to ensure safe clinical practice. Understanding the characteristics and processes of registered nurses' clinical reasoning in clinical practice, and the factors reported to relate to clinical reasoning, supports the creation of targeted resources for development and assessment of clinical reasoning.

Cardiac rehabilitation, physical activity, and the effectiveness of activity monitoring devices on cardiovascular patients: an umbrella review of systematic reviews.

AIMS: To consolidate the evidence on the effectiveness of activity-monitoring devices and mobile applications on physical activity and health outcomes of patients with cardiovascular disease who attended cardiac rehabilitation (CR) programmes. METHODS AND RESULTS: An umbrella review of published randomized controlled trials, systematic reviews, and meta-analyses was conducted. Nine databases were searched from inception to 9 February 2022. Search and data extraction followed the JBI methodology for umbrella reviews and PRISMA guidelines. Nine systematic reviews met the inclusion criteria, comparing outcomes of participants in CR programmes utilizing devices/applications, to patients without access to CR with devices/applications. A wide range of physical, clinical, and behavioural outcomes were reported, with results from 18 712 participants. Meta-analyses reported improvements in physical activity, minutes/week [standardized mean difference (SMD) 0.23, 95% confidence interval (CI) 0.10-0.35] and activity levels (SMD 0.29, 95% CI 0.07-0.51), and a reduction in sedentariness [risk ratio (RR) 0.54, 95% CI 0.39-0.75] in CR participants, compared with usual care. Of clinical outcomes, the risk of re-hospitalization reduced significantly (RR 0.49, 95% CI 0.27-0.89), and there was reduction (non-significant) in mortality (RR 0.27, 95% CI 0.05-1.54). From the behavioural outcomes, reviews reported improvements in smoking behaviour (RR 0.87, 95% CI 0.67-1.13) and total diet quality intake (RR 0.79, 95% CI 0.66-0.94) among CR patients. CONCLUSIONS: The use of devices/applications was associated with increase in activity, healthy behaviours, and reductions in clinical indicators. Although most effect sizes indicate limited clinical benefits, the broad consistency of the narrative suggests devices/applications are effective at improving CR patients' outcomes.

Effectiveness of activity-monitoring devices in patients with cardiovascular disease participating in cardiac rehabilitation programs: an umbrella review protocol.

OBJECTIVE: The objective of the review is to investigate the effect of activity-monitoring devices and mobile applications on physical activity and health outcomes of patients with cardiovascular disease who are participating in cardiac rehabilitation programs. INTRODUCTION: Supporting patients with cardiovascular conditions to achieve and maintain healthy physical activity levels is the cornerstone of cardiac rehabilitation programs. The effectiveness of activity-monitoring devices and mobile applications (such as physical activity interventions) utilizing consumer-grade monitoring devices and applications to support patients to improve exercise levels during and after program completion has been investigated. Several systematic reviews evaluating the effectiveness of monitoring devices and applications have indicated varying clinical impact, depending on patient characteristics, stage of rehabilitation, and type of intervention. INCLUSION CRITERIA: This review will consider systematic reviews and/or meta-analyses of randomized controlled trials of patients who participated in cardiac rehabilitation programs that included a physical activity intervention that incorporated activity monitoring using electronic devices and/or mobile applications and reported activity and patient health outcomes. METHODS: MEDLINE, Embase, Sport Discus, the Cochrane Database of Systematic Reviews, Scopus, CINAHL, the International Network of Agencies for Health Technology Assessment database, Epistemonikos, and Web of Science will be searched from inception to the present. PROSPERO will be searched for unpublished reviews. Articles will be screened by two independent reviewers for inclusion, and methodological quality will be assessed using a JBI critical appraisal tool. Data will be extracted from systematic reviews and a data synthesis of findings will be presented. The certainty will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022298877.

Effectiveness of cardiac rehabilitation programs in improving medication adherence in patients with cardiovascular disease: a systematic review protocol.

OBJECTIVE: The objective of this review is to measure the effectiveness of cardiac rehabilitation programs versus standard care on medication adherence in patients with cardiovascular disease. INTRODUCTION: Poor adherence to long-term medications increases the risk of morbidity and mortality, and decreases quality of life in patients with cardiovascular diseases. Several strategies have been trialed to improve medication adherence, one of which is cardiac rehabilitation programs. Although evidence has indicated that such programs increase medication adherence, the extent of their effectiveness and translation into clinical practice is not well documented. Our systematic review will collect and analyze the available evidence for clinical practice implementation. INCLUSION CRITERIA: The search will aim to locate randomized controlled trials. Where randomized controlled trials are not available, quasi-experimental studies, case-control studies, observational studies, and other study designs will be included. Studies that measure effectiveness of cardiac rehabilitation programs compared with standard care on medication adherence in cardiovascular disease patients will be included. METHODS: Databases, including MEDLINE (Ovid), Emcare (Ovid), Embase (Ovid), Cochrane CENTRAL, Scopus, CINAHL (EBSCO), and unpublished sources will be searched. Articles in English and non-English-language articles with an English abstract, published from database inception to the present, will be included. Articles will be screened and reviewed by 2 independent reviewers for inclusion. Critical appraisal tools will be applied to the included studies. Data will be extracted using the appropriate extraction tools and synthesized for the objectives of the study. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021284705.

Association between alcohol restriction policies and rates of alcohol-related harms in remote Australian Aboriginal and Torres Strait Islander communities: a systematic review.

OBJECTIVE: The objective of this review was to examine the association between alcohol supply restriction policies and rates of alcohol-related harms in remote Australian Aboriginal and Torres Strait Islander communities. INTRODUCTION: Aboriginal and Torres Strait Islander peoples living in remote communities experience a higher rate of alcohol-related harms than other Australians. High rates of alcohol consumption are associated with a range of physical and social harms. Restricting the supply of alcoholic beverages in Aboriginal and Torres Strait Islander communities is often used by governments as a strategy to reduce these harms, but the current evidence is conflicting. INCLUSION CRITERIA: This review considered all quantitative studies with Aboriginal and Torres Strait Islander participants living in remote communities in Australia, where the participants were exposed to restrictions on the supply of alcoholic beverages. Harms of interest were i) physical injuries (whether secondary to assaults or accidents), measured as hospital admissions, Royal Flying Doctor Service attendance and transfers, and reported assaults, including intimate partner or family violence; ii) alcohol-related illnesses, measured as hospital admissions for conditions primarily attributed to alcohol consumption; and iii) rates of alcohol consumption, measured as alcohol sales per person or as self-reported consumption. METHODS: We searched a wide range of databases and gray literature resources for published and unpublished, English-language studies from 1998 to 2020. Two reviewers independently screened search results and selected citations for full-text retrieval. Two reviewers independently assessed each article for congruence to the inclusion criteria. Critical appraisal and data extraction were conducted by two reviewers working independently. Data were narratively synthesized because statistical pooling was not possible. RESULTS: We included 13 observational studies with more than 15,800 participants. Most included studies reported some harm reductions in association with a variety of alcohol supply restrictions; however, these reductions were sometimes short-lived. Studies reported on a variety of supply reduction strategies, ranging from small limitations on when alcohol could be sold to total prohibition of alcohol within the community. None of the interventions examined in the included studies reported consistent results. Total prohibition of alcohol was initially associated with large reductions in consumption but also led to unintended consequences, such as illicit substance use, alcohol consumption outside of the community, and illegal importation of alcohol into the community. We were unable to make any strong recommendations based on the included studies due to inherent bias in the study designs employed. CONCLUSIONS: Problematic use of alcohol by Aboriginal and Torres Strait Islander peoples is unlikely to be solved by a single strategy. Total alcohol prohibition does not stop people from seeking and accessing alcohol, and may in fact lead to a range of negative unintended consequences. Future studies should be more rigorously designed and reported to increase the strength of the evidence and certainty in the results.

Causal theoretical frameworks that explain veteran mental health help-seeking behavior: a scoping review protocol.

OBJECTIVE: This scoping review will determine what causal theoretical frameworks have been used to examine veteran mental health help-seeking behavior. The review will also examine the causal factors proposed by these theoretical frameworks, and whether they account for the complex cultural, social, and affective experiences of veterans, which may drive both uptake or avoidance of mental health help-seeking. INTRODUCTION: Some military veterans delay mental health help-seeking, preventing early intervention, creating poor long-term quality of life and functional outcomes, and increasing the likelihood of reaching crisis point before seeking help. There is a distinct lack of research utilizing causal motivational frameworks to explain veteran mental health help-seeking behavior (both engagement and avoidance). To date, no review has been conducted on motivational frameworks used to explain veteran help-seeking behavior. This scoping review will be the first to identify the motivational models that have been used to explain veteran mental health help-seeking, as well as table the proposed causal factors, and determine whether the models account for the cultural, social, and affective experiences of veterans. INCLUSION CRITERIA: This scoping review will only consider studies on veteran cohorts. Studies in English that utilize or create an explanatory theory, model, or framework for veteran mental health help-seeking behavior will be included. Literature that focuses solely on intentions rather than behavior will be excluded. METHODS: Published and unpublished studies and gray literature will be included. Titles and abstracts will be screened, followed by full-text screening. Factors, theories, models, and frameworks used to explain veteran help-seeking behavior will be extracted, charted, and narratively summarized. The JBI methodology for scoping reviews will be used.