Integrating virtual patients into undergraduate health professions curricula: a framework synthesis of stakeholders' opinions based on a systematic literature review.

BACKGROUND: Virtual patients (VPs) are widely used in health professions education. When they are well integrated into curricula, they are considered to be more effective than loosely coupled add-ons. However, it is unclear what constitutes their successful integration. The aim of this study was to identify and synthesise the themes found in the literature that stakeholders perceive as important for successful implementation of VPs in curricula. METHODS: We searched five databases from 2000 to September 25, 2023. We included qualitative, quantitative, mixed-methods and descriptive case studies that defined, identified, explored, or evaluated a set of factors that, in the perception of students, teachers, course directors and researchers, were crucial for VP implementation. We excluded effectiveness studies that did not consider implementation characteristics, and studies that focused on VP design factors. We included English-language full-text reports and excluded conference abstracts, short opinion papers and editorials. Synthesis of results was performed using the framework synthesis method with Kern's six-step model as the initial framework. We appraised the quality of the studies using the QuADS tool. RESULTS: Our search yielded a total of 4808 items, from which 21 studies met the inclusion criteria. We identified 14 themes that formed an integration framework. The themes were: goal in the curriculum; phase of the curriculum when to implement VPs; effective use of resources; VP alignment with curricular learning objectives; prioritisation of use; relation to other learning modalities; learning activities around VPs; time allocation; group setting; presence mode; VPs orientation for students and faculty; technical infrastructure; quality assurance, maintenance, and sustainability; assessment of VP learning outcomes and learning analytics. We investigated the occurrence of themes across studies to demonstrate the relevance of the framework. The quality of the studies did not influence the coverage of the themes. CONCLUSIONS: The resulting framework can be used to structure plans and discussions around implementation of VPs in curricula. It has already been used to organise the curriculum implementation guidelines of a European project. We expect it will direct further research to deepen our knowledge on individual integration themes.

The Use of a Comprehensive Concept of Capability for Wellbeing Assessment: A Best-Fit Framework Synthesis.

Developing an instrument with the capability approach can be challenging, since the capability concept of Sen is ambiguous concerning the burdens that people experience whilst achieving their capabilities. A solution is to develop instruments with a comprehensive concept of capability, such as the concept of 'option-freedom'. This study aims to develop a theoretical framework for instrument development with the concept of option-freedom. A best-fit framework synthesis was conducted with seven qualitative papers by one researcher. Two researchers supported the synthesis by discussing interim results during the synthesis. A priori concepts of option-freedom were used to deductively code against. Themes and subthemes were developed inductively when data did not match a priori themes. Seven paper were identified that fulfilled the eligibility criteria. Four themes emerged from the synthesis. (1) Option Wellbeing represents a range of options that need to be satisfied for individuals to experience wellbeing. (2) Self-Realization represents that there are experiences in an individual's life that have value beyond realizing options. (3) Perceived Access to Options represents the perceived ability of individuals to realize freedoms. (4) Perceived Control represents the experience of having control. Developing an instrument with the proposed framework has two benefits. First, it acknowledges the importance of assessing impediments in realizing capabilities for wellbeing assessment. Secondly, the themes form a broad informational base by including themes related to subjective wellbeing. Future research should study the feasibility of implementing the framework for instrument development.

Opioid prescribing and use in the Military Health System: a framework synthesis, FY2016-FY2021.

BACKGROUND: Opioid misuse is a nationwide issue and is of particular concern with regard to military readiness. The 2017 National Defense Authorization Act charges the Military Health System with greater oversight of opioid use and mitigation of misuse. METHODS: We synthesized published articles using secondary analysis of TRICARE claims data, a nationally representative database of 9.6 million beneficiaries. We screened 106 articles for inclusion and identified 17 studies for data abstraction. Framework analysis was conducted, which assessed prescribing practices, patient use, and optimum length of opioid prescriptions after surgery, trauma, and common procedures, as well as factors leading to sustained prescription opioid use. RESULTS: Across the studies, sustained prescription opioid use after surgery was low overall, with <1% of opioid-naïve patients still receiving opioids more than 1 year after spinal surgery or trauma. In opioid-exposed patients who had undergone spine surgery, sustained use was slightly lower than 10%. Higher rates of sustained use were associated with more severe trauma and depression, as well as with prior use and initial opioid prescriptions for low back pain or other undefined conditions. Black patients were more likely to discontinue opioid use than were White patients. CONCLUSIONS: Prescribing practices are well correlated with degree of injury or intensity of intervention. Sustained prescription opioid use beyond 1 year is rare and is associated with diagnoses for which opioids are not the standard of care. More efficient coding, increased attention to clinical practice guidelines, and use of tools to predict risk of sustained prescription opioid use are recommended.

Patient, carer and family experiences of seeking redress and reconciliation following a life-changing event: Systematic review of qualitative evidence.

INTRODUCTION: We conducted a systematic review of qualitative evidence to improve understanding of the processes and outcomes of redress and reconciliation following a life-changing event from the perspectives of individuals experiencing the event and their families. METHODS: We searched six bibliographic databases for primary qualitative evidence exploring the views of individuals who have experienced a life-changing event, and/or their family or carers, of redress or reconciliation processes. This was supplemented with targeted database searches, forward and backward citation chasing and searches of Google Scholar and relevant websites. Title and abstract and full-text screening were undertaken independently by two reviewers. Data extraction and quality appraisal were conducted by one reviewer and checked by a second. We used a best-fit framework synthesis approach, drawing upon procedural and restorative justice concepts. FINDINGS: Fifty-three studies (61 papers) were eligible for inclusion. Forty-one studies (47 papers) were included in the synthesis, from which we identified four themes. Three themes 'Transparency', 'Person-centered' and 'Trustworthy' represent the procedural elements required to support a fair and objective process. The fourth, 'Restorative justice' encapsulates how a fair process feels to those who have experienced a life-changing event. This theme highlights the importance of an empathic relationship between the different parties involved in the redress-reconciliation process and the significance of being able to engage in meaningful action. CONCLUSION: Our findings highlight the procedural aspects and context of redress-reconciliation processes required to ensure that the process and outcomes are experienced as fair. These criteria may be applied to the processes used to investigate both recent and historical patient safety events. PUBLIC CONTRIBUTION: One member of the public affiliated with the Exeter Policy Research Programme Evidence Review Facility helped develop the review protocol. Two people with experience of medically life-changing events provided insight which corroborated our findings and identified important limitations of the evidence included in this review.

Assessing the acceptability of technological health innovations in sub-Saharan Africa: a scoping review and a best fit framework synthesis.

Acceptability is a key concept used to analyze the introduction of a health innovation in a specific setting. However, there seems to be a lack of clarity in this notion, both conceptually and practically. In low and middle-income countries, programs to support the diffusion of new technological tools are multiplying. They face challenges and difficulties that need to be understood with an in-depth analysis of the acceptability of these innovations. We performed a scoping review to explore the theories, methods and conceptual frameworks that have been used to measure and understand the acceptability of technological health innovations in sub-Saharan Africa. The review confirmed the lack of common definitions, conceptualizations and practical tools addressing the acceptability of health innovations. To synthesize and combine evidence, both theoretically and empirically, we then used the "best fit framework synthesis" method. Based on five conceptual and theoretical frameworks from scientific literature and evidence from 33 empirical studies, we built a conceptual framework in order to understand the acceptability of technological health innovations. This framework comprises 6 determinants (compatibility, social influence, personal emotions, perceived disadvantages, perceived advantages and perceived complexity) and two moderating factors (intervention and context). This knowledge synthesis work has also enabled us to propose a chronology of the different stages of acceptability.

A qualitative evidence synthesis (QES) exploring the barriers and facilitators to screening in emergency departments using the theoretical domains framework.

BACKGROUND: Validated screening tools can be utilised to detect early disease processes and risk factors for disease and adverse outcomes. Consequently, identifying individuals in need of early intervention and targeted assessment can be achieved through the implementation of screening in the ED. Successful implementation can be impacted by a lack of resources and ineffective integration of screening into the clinical workflow. Tailored implementation processes and staff training, which are contextually specific to the ED setting, are facilitators to effective implementation. This review will assist in the identification of barriers and facilitators to screening in the ED using a QES to underpin implementation processes. Healthcare workers engage in screening in the ED routinely. Consequently, this review focused on synthesizing the experience of healthcare workers (HCWs) who are involved in this process. This synthesis is informed by a QES protocol published by the lead author in 2021 (Barry et al., HRB Open Res 3:50, 2021). METHODOLOGY: A comprehensive literature search, inclusive of grey literature sources, was undertaken. Initially, an a priori framework of themes was formed to facilitate the interpretation and organisation of search results. A context specific conceptual model was then formulated using "Best fit" framework synthesis which further assisted in the interpretation of data that was extracted from relevant studies. Dual blind screening of search results was undertaken using RAYYAN as a platform. Thirty studies were identified that met the inclusion criteria. Dual appraisal of full text articles was undertaken using CASP, GRADE CERQual assessed confidence of findings and data extraction was performed by two reviewers collaboratively. FINDINGS: This is the first known synthesis of qualitative research on HCW's experiences of screening in the ED. Predominantly, the findings illustrate that staff experience screening in the ED as a complex challenging process. The barriers and facilitators identified can be broadly categorised under preconditions to screen, motivations to screen and knowledge and skills to screen. Competing interests in the ED, environmental stressors such as overcrowding and an organisational culture that resists screening were clear barriers. Adequate resources and tailored education to underpin the screening process were clear facilitators. TRIAL REGISTRATION: PROSPERO: CRD42020188712 05/07/20.

Self-collection for HPV-based cervical screening: a qualitative evidence meta-synthesis.

BACKGROUND: Cervical cancer is the fourth most common cancer affecting women worldwide, with 85% of the burden estimated to occur among women in low and middle-income countries (LMICs). Recent developments in cervical cancer screening include a novel self-collection method for the detection of oncogenic HPV strains in the collected samples. The purpose of this review is to synthesise qualitative research on self-collection for HPV-based testing for cervical screening and identify strategies to increase acceptability and feasibility in different settings, to alleviate the burden of disease. METHODS: This review includes qualitative studies published between 1986 and 2020. A total of 10 databases were searched between August 2018 and May 2020 to identify qualitative studies focusing on the perspectives and experiences of self-collection for HPV-based cervical screening from the point of view of women, health care workers and other key stakeholders (i.e., policymakers). Two authors independently assessed studies for inclusion, quality, and framework thematic synthesis findings. The Socio-Ecological Model (SEM) was used to synthesize the primary studies. RESULTS: A total of 1889 publications were identified, of which 31 qualitative studies were included. Using an adapted version of SEM, 10 sub-themes were identified and classified under each of the adapted model's constructs: (a) intrapersonal, (b) interpersonal, and (c) health systems/public policy. Some of the themes included under the intrapersonal (or individual) construct include the importance of self-efficacy, and values attributed to self-collection. Under the intrapersonal construct, the findings centre around the use of self-collection and its impact on social relationships. The last construct of health systems focuses on needs to ensure access to self-collection, the need for culturally sensitive programs to improve health literacy, and continuum of care. CONCLUSION: This review presents the global qualitative evidence on self-collection for HPV-based testing and details potential strategies to address socio-cultural and structural barriers and facilitators to the use of self-collection. If addressed during the design of an HPV-based cervical cancer screening testing intervention program, these strategies could significantly increase the acceptability and feasibility of the intervention and lead to more effective and sustainable access to cervical screening services for women worldwide.

Early impacts of the COVID-19 pandemic on mental health care and on people with mental health conditions: framework synthesis of international experiences and responses.

PURPOSE: The COVID-19 pandemic has many potential impacts on people with mental health conditions and on mental health care, including direct consequences of infection, effects of infection control measures and subsequent societal changes. We aimed to map early impacts of the pandemic on people with pre-existing mental health conditions and services they use, and to identify individual and service-level strategies adopted to manage these. METHODS: We searched for relevant material in the public domain published before 30 April 2020, including papers in scientific and professional journals, published first person accounts, media articles, and publications by governments, charities and professional associations. Search languages were English, French, German, Italian, Spanish, and Mandarin Chinese. Relevant content was retrieved and summarised via a rapid qualitative framework synthesis approach. RESULTS: We found 872 eligible sources from 28 countries. Most documented observations and experiences rather than reporting research data. We found many reports of deteriorations in symptoms, and of impacts of loneliness and social isolation and of lack of access to services and resources, but sometimes also of resilience, effective self-management and peer support. Immediate service challenges related to controlling infection, especially in inpatient and residential settings, and establishing remote working, especially in the community. We summarise reports of swiftly implemented adaptations and innovations, but also of pressing ethical challenges and concerns for the future. CONCLUSION: Our analysis captures the range of stakeholder perspectives and experiences publicly reported in the early stages of the COVID-19 pandemic in several countries. We identify potential foci for service planning and research.

Barriers and facilitators to implementation of menu labelling interventions from a food service industry perspective: a mixed methods systematic review.

BACKGROUND: Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry. METHODS: Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the 'best fit' framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR). RESULTS: Seventeen studies met the eligibility criteria, with the majority rated as average quality (n = 10). The most frequently cited barriers were coded to the CFIR constructs 'Consumer Needs & Resources' (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and 'Compatibility' with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs 'Relative Advantage' of menu labelling (e.g. improved business image/reputation) and 'Consumer Needs & Resources' (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains. CONCLUSION: This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort. TRIAL REGISTRATION: Systematic review registration: PROSPERO CRD42017083306.

A framework synthesis reviewing the impact of neonatal care unit admission on early caregiver-infant relationships.

AIMS: To critically review and synthesize qualitative research pertaining to the establishment of early caregiver-infant relationships in the neonatal care unit (NCU). BACKGROUND: It is well-established that bonding and attachment, established across the prenatal and early childhood periods, affect child cognitive and behavioural development. Proximity, reciprocity, and commitment are key to the formation of these early relationships. It is intuitively likely that an admission to the NCU may affect early reciprocal caregiver-infant relationships. DESIGN: A qualitative best-fit framework synthesis. DATA SOURCES: A systematic search of four databases (PsycINFO, MEDLINE, British Nursing Index and CINAHL) was conducted, from January 2000-December 2018. REVIEW METHODS: The RATS quality appraisal tool was used to evaluate study quality. To ensure reliability, 20% of studies were randomly selected for independent rating. A "best-fit" synthesis approach using an existing framework of early parent-infant attachment and bonding was adopted to synthesize the review findings. FINDINGS: Twenty studies, from an original 3,526 unique articles, were included in the review. Studies varied in the extent to which they demonstrated transparency of procedures and in the quality of recruitment information provided. The meta-synthesis demonstrated that proximity, reciprocity, and commitment were affected by admission to a NCU and identified that parental reflections on bonding and the role of staff in this process, were important factors to consider. CONCLUSIONS: Caregiver-infant relationships are affected by admission to the NCU. The review theoretically supports moves to Family Integrated Care. Units should evaluate caregiver emotional state and consider the role of peer support. IMPACT: The synthesis revealed that areas typically implicated in the formation of attachment and bonds were affected by admission to a NCU. Results have implications on the clinical care delivered as part of neonatal care.

Systematic mapping of existing tools to appraise methodological strengths and limitations of qualitative research: first stage in the development of the CAMELOT tool.

BACKGROUND: Qualitative evidence synthesis is increasingly used alongside reviews of effectiveness to inform guidelines and other decisions. To support this use, the GRADE-CERQual approach was developed to assess and communicate the confidence we have in findings from reviews of qualitative research. One component of this approach requires an appraisal of the methodological limitations of studies contributing data to a review finding. Diverse critical appraisal tools for qualitative research are currently being used. However, it is unclear which tool is most appropriate for informing a GRADE-CERQual assessment of confidence. METHODOLOGY: We searched for tools that were explicitly intended for critically appraising the methodological quality of qualitative research. We searched the reference lists of existing methodological reviews for critical appraisal tools, and also conducted a systematic search in June 2016 for tools published in health science and social science databases. Two reviewers screened identified titles and abstracts, and then screened the full text of potentially relevant articles. One reviewer extracted data from each article and a second reviewer checked the extraction. We used a best-fit framework synthesis approach to code checklist criteria from each identified tool and to organise these into themes. RESULTS: We identified 102 critical appraisal tools: 71 tools had previously been included in methodological reviews, and 31 tools were identified from our systematic search. Almost half of the tools were published after 2010. Few authors described how their tool was developed, or why a new tool was needed. After coding all criteria, we developed a framework that included 22 themes. None of the tools included all 22 themes. Some themes were included in up to 95 of the tools. CONCLUSION: It is problematic that researchers continue to develop new tools without adequately examining the many tools that already exist. Furthermore, the plethora of tools, old and new, indicates a lack of consensus regarding the best tool to use, and an absence of empirical evidence about the most important criteria for assessing the methodological limitations of qualitative research, including in the context of use with GRADE-CERQual.

State of art of nanotechnology applications in the meat chain: A qualitative synthesis.

BACKGROUND: Nanotechnology is a promising area in industry with a broad range of applications including in the agri-food sector. Several studies have investigated the potential benefits deriving from use of nanomaterials in the context of the whole food chain drawing scenarios of benefits but also potential for concerns. Among the agri-food sector, animal production has potential for nanomaterial application but also for safety concerns due to the possibility of nanomaterial accumulation along the farm-to-fork path. Scope and Approach: The aim of this work was to define the state of the art of nanomaterial applications in the animal production sector by assessing data belonging to recently publishes studies. To do this, a qualitative synthesis approach was applied to build a fit-for-purpose framework and to summarise relevant themes in the context of effectiveness, feasibility and health concerns. Key findings and conclusions: Nanomaterials have potential for use in a wide range of applications from feed production and farming to food packaging, including several detection tools designed for the benefit of consumer protection. The current high degree of variability in nanomaterials tested and in study designs impairs external validation of research results. Further research is required to clearly define which safe nanomaterial applications have the potential to reach the market.

Challenges with access to healthcare from the perspective of patients living with HIV: a scoping review & framework synthesis.

Accessing healthcare can be difficult but the barriers multiply for people living with HIV (PLHIV). To improve access and the health of PLHIV, we must consider their perspectives and use them to inform standard practice. A better understanding of the current literature related to healthcare access from the perspective of PLHIV, can help to identify evidence gaps and highlight research priorities and opportunities. To identify relevant peer-reviewed publications, search strategies were employed. Electronic and grey literature databases were explored. Articles were screened based on their title and abstract and those that met the screening criteria, were reviewed in full. Data analysis was conducted using a collaborative approach that included knowledge user consultation. Initial concepts were extracted, summarized and through framework synthesis, developed into emerging and final themes. From 20,678 articles, 326 articles met the initial screening criteria and 64 were reviewed in full. The final themes identified, in order of most to least frequent were: Acceptability, Availability, Accessibility, Affordability, Other Barriers, Communication, Satisfaction, Accommodation, Preferences and Equity in Access. The most frequently discussed concepts related to negative interactions with staff, followed by long wait times, limited household resources or inability to pay fees, and fear of one's serostatus being disclosed. Knowledge users were in agreement with the categorization of initial concepts and final themes; however, some gaps in the literature were identified. Specific changes are critical to improving access to healthcare for PLHIV. These include improving availability by ensuring staff and healthcare professionals have proper training, cultivating acceptability and reducing stigma through improving HIV awareness, increasing accessibility through increased HIV information for PLHIV and improved dissemination of this information to increase patient knowledge and health awareness. Finally, ensuring proper protocols are implemented and followed to guarantee patient confidentiality and overall satisfaction with healthcare services are recommended.

A comprehensive map of the evidence on the performance evaluation indicators of public hospitals: a scoping study and best fit framework synthesis.

INTRODUCTION: Key performance indicators are essential navigation tools for hospitals. They provide managers with valid information enabling them to identify institutional strengths and weaknesses and improve managerial performance. In this study, the synthesis of evidence relating to hospital performance indicators was carried out by means of a field review and the indicators were analyzed through the Best Fit Method. METHODS: The five-step approach of Arksey and O'Malley was used as follows: selection of the research question; search for related studies; selection and refinement of the studies; synthesis and tabulation of key information; derivation of the related summary and report. Applying the Best Fit Framework Synthesis Method, the initial themes and subthemes were created and a model of public hospitals performance evaluation finally generated. RESULTS: Forty-nine studies were considered eligible to form part of the synthesis. The final model included the efficiency/productivity, effectiveness and financial themes. The efficiency/productivity sub-themes incorporated human resources indicators, hospital beds, costs, operating room productivity, emergency rooms, ICU, radiology, labs, technology and equipment productivity. Other sub-themes relate to general indicators such as BOR, ALS, number of outpatients and hospitalized patients. Financial themes included profit, revenue, cash flow, cost, investment, assets, debt and liquidity. Concerning effectiveness, the indicators were categorized in terms of access (equity), safety, quality and responsiveness. The accountability indicators were classified into patient-centeredness, staff orientation, and social responsibility. CONCLUSION: Hospital performance management is a multi-dimensional issue, each dimension having its own significance. Based on the evidence, indicators are dependent on the evaluation model employed, the evaluation objective, and the views of executive managers and participants in the study. Selection of the most appropriate indicators is therefore key to a comprehensive performance evaluation system.

A mixed methods review to develop and confirm a framework for assessing midwifery practice in perinatal mental health.

AIM: To ascertain whether a new framework examining midwifery practice in perinatal mental health (PMH) is supported by the research literature. BACKGROUND: The identification and care of women with PMH problems is increasingly considered part of midwifery practice. Research suggests that many midwives lack knowledge, skills and confidence. It would be useful to be able to determine barriers and facilitators to effective clinical practice. The authors propose a framework comprising five potentially measurable domains which have an impact on midwives' ability to identify, assess and care for women with PMH problems. DESIGN: This mixed-methods review uses an innovative qualitative convergent design based on framework synthesis. DATA SOURCES: Relevant electronic databases were searched for the period from January 2007-December 2016; 33 studies from nine countries met the inclusion criteria. REVIEW METHODS: Study quality was assessed using critical appraisal tools. Study findings were mapped onto the five domains of the framework: knowledge, confidence, attitudes, illness perception and infrastructure. Findings were then synthesized for each domain. RESULTS: All five domains are substantially represented in the literature, thus supporting the proposed framework. Several sub-domains and relationships between domains were identified. Varying levels of knowledge, confidence, attitudes and illness perceptions were found; evidence suggests that midwives benefit from further training within these domains. Features of organizational infrastructure act as barriers or facilitators to effective care; these need to be addressed at organizational level. CONCLUSION: The proposed framework was confirmed and can be used to inform practice, policy and research.

A systematic review of qualitative research into people's experiences of living with venous leg ulcers.

AIM: To systematically identify, evaluate and synthesize qualitative research that examined the symptoms and health-related quality of life themes that are important from the perspective of patients with venous leg ulceration. BACKGROUND: Venous leg ulceration is a common chronic condition; the symptoms and associated treatments have a negative effect on health-related quality of life. Qualitative research methods can provide insight into the personal experiences of patients with venous leg ulceration. DESIGN: Qualitative evidence synthesis (using framework synthesis). DATA SOURCES: Multiple electronic databases including MEDLINE, EMBASE, PsycINFO and CINAHL were comprehensively searched from inception to November 2015. REVIEW METHODS: Systematic identification, quality assessment and synthesis of existing qualitative research were performed; framework synthesis was conducted on included studies. An inductive approach was used and emergent themes were identified. The final stage in the synthesis involved the development of new interpretations. RESULTS: Thirteen studies met the inclusion criteria; the overall quality of the included studies was good. Four overarching themes were identified; physical impact, psychological impact, social impact and treatment and, in these, further subthemes were identified. Ulcer and treatment-related pain, as well as odour and exudate appeared to have significant and direct negative effects on quality of life, with additional and cumulative effects on sleep, mobility and mood. CONCLUSION: The themes identified in this review should be considered by professionals providing services, care and treatment for venous leg ulcer patients and in the selection, or development, of patient-reported outcome measures for use with this population.

From screening to synthesis: using nvivo to enhance transparency in qualitative evidence synthesis.

AIMS AND OBJECTIVES: To explore the experiences and perceptions of healthcare staff caring for people with dementia in the acute setting. This article focuses on the methodological process of conducting framework synthesis using nvivo for each stage of the review: screening, data extraction, synthesis and critical appraisal. BACKGROUND: Qualitative evidence synthesis brings together many research findings in a meaningful way that can be used to guide practice and policy development. For this purpose, synthesis must be conducted in a comprehensive and rigorous way. There has been previous discussion on how using nvivo can assist in enhancing and illustrate the rigorous processes involved. DESIGN: Qualitative framework synthesis. METHODS: Twelve documents, or research reports, based on nine studies, were included for synthesis. CONCLUSION: The benefits of using nvivo are outlined in terms of facilitating teams of researchers to systematically and rigorously synthesise findings. nvivo functions were used to conduct a sensitivity analysis. Some valuable lessons were learned, and these are presented to assist and guide researchers who wish to use similar methods in future. RELEVANCE TO CLINICAL PRACTICE: Ultimately, good qualitative evidence synthesis will provide practitioners and policymakers with significant information that will guide decision-making on many aspects of clinical practice. The example provided explored how people with dementia are cared for acute settings.

Stigmatisation in clinical consultations for persistent physical symptoms/functional disorders: A best fit framework synthesis.

INTRODUCTION: Stigma is a social attribute that links a person to an undesirable characteristic and leads to actions that increase the social distance from that person. This includes different or discriminatory treatment. Stigma is common in healthcare, particularly in people with persistent physical symptoms (PPS) and functional disorders (FD). The aim of this study is to create a new actionable framework to aid understanding of stigmatisation in consultations about PPS/FD and to improve the consultation experiences. METHODS: This framework development used the Best Fit Framework approach to data collected for a scoping review of stigma in functional disorders. The stages included selection of an initial framework from existing conceptual models, mapping quote data from published papers to the framework and an iterative process of revision and re-mapping. The final framework was tested by re-mapping all the quote data to the framework following classification rules. RESULTS: 253 quotes were obtained from the results sections of qualitative studies from a previous scoping review. The framework comprises of prejudice, stereotypes and actions to increase social distance. Stereotype refers to the focus of stigma: this may be the condition, the patient, or their behaviour. Actions that increase social distance include: othering; denial; non-explanation; minimising, norm-breaking; and psychologising. By breaking down stigma into recognisable components, the framework provides a way to understand the difficulties that patients and clinicians face during consultations and a way to develop intervention materials. CONCLUSIONS: This new framework for stigma in clinical consultations for PPS/FDs provides a useful tool for the study of stigma in clinical consultations.

Evaluation of Digital Mental Health Technologies in the United States: Systematic Literature Review and Framework Synthesis.

BACKGROUND: Digital mental health technologies (DMHTs) have the potential to enhance mental health care delivery. However, there is little information on how DMHTs are evaluated and what factors influence their use. OBJECTIVE: A systematic literature review was conducted to understand how DMHTs are valued in the United States from user, payer, and employer perspectives. METHODS: Articles published after 2017 were identified from MEDLINE, Embase, PsycINFO, Cochrane Library, the Health Technology Assessment Database, and digital and mental health congresses. Each article was evaluated by 2 independent reviewers to identify US studies reporting on factors considered in the evaluation of DMHTs targeting mental health, Alzheimer disease, epilepsy, autism spectrum disorder, or attention-deficit/hyperactivity disorder. Study quality was assessed using the Critical Appraisal Skills Program Qualitative and Cohort Studies Checklists. Studies were coded and indexed using the American Psychiatric Association's Mental Health App Evaluation Framework to extract and synthesize relevant information, and novel themes were added iteratively as identified. RESULTS: Of the 4353 articles screened, data from 26 unique studies from patient, caregiver, and health care provider perspectives were included. Engagement style was the most reported theme (23/26, 88%), with users valuing DMHT usability, particularly alignment with therapeutic goals through features including anxiety management tools. Key barriers to DMHT use included limited internet access, poor technical literacy, and privacy concerns. Novel findings included the discreetness of DMHTs to avoid stigma. CONCLUSIONS: Usability, cost, accessibility, technical considerations, and alignment with therapeutic goals are important to users, although DMHT valuation varies across individuals. DMHT apps should be developed and selected with specific user needs in mind.

Optimization of cerium-based metal-organic framework synthesis for maximal sonophotocatalytic tetracycline degradation.

Wastewater treatment is inevitably required to alleviate the pollution of water resources by various contaminants such as antibiotics. MOFs are novel materials with photocatalytic activities. In this study, sonophotocatalytic degradation of tetracycline (TC) by the Cerium-based MOF (Ce-MOF) is optimized by modification of its synthesis route. Ce-MOF synthesis by room temperature (RT), hydrothermal (HT), and sonochemical synthesis (SC) are studied. TC degradation experiments revealed the superiority of SC synthesis. The interplay of main synthesis parameters, namely, initial ligand concentration, ultrasound (US) power and time on sonophotocatalytic activity of Ce-MOF, were investigated by response surface methodology model (RSM) utilizing the central composite experimental design (CCD). The optimum SC synthesis conditions are an initial ligand concentration of 8.4 mmol/L, a sonication power of 50 amplitude, and a US time of 60 min. The optimally synthesized Ce-MOF was characterized by infrared spectroscopy, FTIR, XRD, FE-SEM, TEM, zeta potential analysis, diffuse reflectance spectroscopy, particle size analysis, Mott-Schottky analysis, photocurrent analysis, electrochemical impedance spectra, and photoluminescence spectroscopy. The findings indicate that the removal efficiency of TC can reach up to 81.75% within 120 min in an aqueous solution containing an initial TC concentration of 120 ppm and 1 g/L Ce-MOF at pH of 7. Mineralization efficiency of the process is 71% according to COD measurements. The Ce-MOF catalyst retained its chemical stability and remained active upon TC degradation which makes it a promising candidate for wastewater treatment.