Global prevalence of quackery practices: A scoping review of definitions, regulations and allied healthcare.

Advancements in medical science and digital access made it easier for individuals to seek appropriate treatment. Despite living in the current information era, the practice of quackery has continued worldwide. The current scoping review was planned to explore different definitions and laws related to quackery, and the acceptance of allied healthcare services in traditional, cultural and legal contexts. The review examined a total of 3,327 published studies and 400 pieces of grey literature, including existing laws, regulatory authority websites, news articles and reports. A total of 56 studies and 21 excerpts were shortlisted for analysis. The definitions of quackery varied significantly across regions, but a general consensus is that unauthorised healthcare practices constitute quackery. Legal perspectives differed worldwide, with Europe, North America and Oceania discouraging allied healthcare services, such as homeopathy, naturopathy and traditional methods, considering them quackery. In contrast, Asian and African regions endorsed allied healthcare and established provider registration and licensing systems.

Clinical care of childhood sexual abuse: a systematic review and critical appraisal of guidelines from European countries.

Background: The clinical management of Child sexual abuse (CSA) demands specialised skills from healthcare professionals due to its sensitivity, legal implications, and serious physical health and mental health effects. Standardised, comprehensive clinical practice guidelines (CPGs) may be pivotal. In this systematic review, we examined existing CSA national CPGs (NCPGs) from European countries to assess their quality and reporting. Methods: We systematically searched six international databases and multiple grey literature sources, reporting by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Eligible guidelines were CSA guidance from national health agencies or societies in 34 COST Action 19106 Network Countries (CANC), published between January 2012 and November 2022. Two independent researchers searched, screened, reviewed, and extracted data. NCPGs were compared for completeness with reference WHO 2017 and 2019 guidelines. We used the Appraisal of Guidelines for Research and Evaluation (AGREE II) to appraise quality and reporting. PROSPERO: CRD42022320747. Findings: Of 2919 records identified by database searches, none met inclusion criteria. Of 4714 records identified by other methods, 24 NCPGs from 17 (50%) of CANC countries were included. In 17 (50%) of eligible countries, no NCPGs were found. Content varied significantly within and between countries. NCPGs lacked many components in state-of-the art clinical practice compared to WHO reference standards, particularly in safety and risk assessment, interactions with caregivers, and mental health interventions. Appraisal by AGREE II revealed shortcomings in NCPG development, regarding scientific rigour, stakeholder involvement, implementation and evaluation. Interpretation: A notable number of European countries lack an NCPG; existing NCPGs often fall short. The healthcare response to CSA in Europe requires a coordinated approach to develop and implement high-quality CPGs. We advocate for a multidisciplinary team to develop a pan-European CSA guideline to ensure quality care for survivors. Funding: Funding was provided by the International Centre for Missing and Exploited Children.

Appraisal of published guidelines in European countries addressing the clinical care of childhood sexual abuse: protocol for a systematic review.

INTRODUCTION: Childhood sexual abuse (CSA) is a global public health problem with potentially severe health and mental health consequences. Healthcare professionals (HCPs) should be familiar with risk factors and potential indicators of CSA, and able to provide appropriate medical management. The WHO issued global guidelines for the clinical care of children with CSA, based on rigorous review of the evidence base. The current systematic review identifies existing CSA guidelines issued by government agencies and academic societies in the European Region and assesses their quality and clarity to illuminate strengths and identify opportunities for improvement. METHODS AND ANALYSIS: This 10-database systematic review will be conducted according to the Centre for Reviews and Dissemination guidelines and will be reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Guidance for HCPs regarding CSA, written by a national governmental agency or academic society of HCPs within 34 COST Action 19106 Network Countries (CANC) and published in peer-reviewed or grey literature between January 2012 and November 2022, is eligible for inclusion. Two independent researchers will search the international literature, screen, review and extract data. Included guidelines will be assessed for completeness and clarity, compared with the WHO 2017/2019 guidelines on CSA, and evaluated for consistency between the CANC guidelines. The Appraisal of Guidelines for Research and Evaluation II tool and Grading of Recommendations Assessment, Development and Evaluation methodology will be used to evaluate CANC guidelines. Descriptive statistics will summarise content similarities and differences between the WHO guidelines and national guidelines; data will be summarised using counts, frequencies, proportions and per cent agreement between country-specific guidelines and the WHO 2017/2019 guidelines. ETHICS AND DISSEMINATION: There are no individuals or protected health information involved and no safety issues identified. Results will be published in a peer-reviewed medical journal. PROSPERO REGISTRATION NUMBER: CRD42022320747.

Stakeholders perspectives and deployment strategies of health information exchange illustrated through an in-depth case study of Pakistan.

Background: Ready access to reliable data is essential to support decision-making in patient care planning and delivery. Health information exchange (HIE), which is fundamental to achieve this, is currently limited in many low- and middle-income countries (LMICs), reflecting the lack of prioritization of this issue and the many barriers to its successful implementation.Objective: We sought to explore and understand stakeholders' perspectives on the context of and deployment strategies for HIE in Pakistan.Method: Data collection comprised interviews with purposefully selected groups of stakeholders across Pakistan, field notes, and a critical review of key national and international policy documents.Results: We identified reports of small pockets of effective HIE existing mainly in private hospitals, but in a patchy and fragmented form overall. Many problems were attributed to the absence of effective HIE, these ranging from 'delays in retrieving records' to contributing to 'the increase in antibiotic resistance'. The mindset of policymakers, poor infrastructure, lack of finance, training and data interoperability, and health-care providers' resistance to recording consultations due to poor documentation skills and concerns about liability considerations were highlighted as major barriers to HIE. Sharing regional health information with international organizations was perceived by some participants to increase the risk of regional espionage. A clear government policy directive for evidence-based decision-making, constant supply of electricity, training, widespread adoption of common data standards and public pressure to adopt mobile technology frameworks were identified as potential facilitators of HIE.Conclusion: HIE can be achieved with the support of the federal and provincial governments coupled with financial and technical backing from international donor organizations. The transition to HIE is likely to be very dependent on improving governance capabilities and bolstering the informatics skill-base in Pakistan and indeed many other LMICs.

The characteristics and capabilities of the available open source health information technologies supporting healthcare: A scoping review protocol.

INTRODUCTION: Due to the many advantages of open source software (OSS), including reduced cost of licensing, more flexibility in terms of customisation and redistribution, better quality and no vendor lock-in, OSS in healthcare is increasingly gaining importance. Various open source health information technologies (OS-HITs) are continuously being designed and developed for different areas of healthcare to increase organisational efficiencies and quality of care at minimum costs. The objective of this scoping review is to identify the kinds of existing OS-HITs, their characteristics (e.g. functions) and capabilities (e.g. advantages/disadvantages) for various healthcare stakeholders (physicians and patients) and healthcare sectors (e.g. clinical, administrative). METHODS: We will conduct a scoping review to identify the range of available OS-HITs in international literature from 1980 to September 2018. Searches will be conducted in six major international databases, namely: Cumulative Index to Nursing and Allied Health Literature Plus, Excerpta Medica Database, Global Health, Library Information Science and Technology Abstracts, Medline and Web of Science to identify relevant published research. We will also search the Google search engine and Google Scholar for on-going and unpublished work and the grey literature. Searches will be peer-reviewed by two independent reviewers and will not be limited by methodology or language. Next, selected references will be tabulated for study characteristics by author affiliation, country of origin, the name of OS-HIT, healthcare area/sector, system requirements, stakeholders, complete solution and web link. Furthermore, functions, benefits/advantages, disadvantages and outcomes (e.g. usability) of OS-HITs will be extracted. Narrative and interpretative synthesis of data will be undertaken. RESULTS: We will report our findings in a peer-reviewed journal.

Health Information Exchange as a Complex and Adaptive Construct: Scoping Review.

OBJECTIVE: To understand how the concept of Health Information Exchange (HIE) has evolved over time. METHODS: Supplementary analysis of data from a systematic scoping review of definitions of HIE from 1900 to 2014, involving temporal analysis of underpinning themes. RESULTS: The search identified 268 unique definitions of HIE dating from 1957 onwards; 103 in scientific databases and 165 in Google. These contained consistent themes, representing the core concept of exchanging health information electronically, as well as fluid themes, reflecting the evolving policy, business, organisational and technological context of HIE (including the emergence of HIE as an organisational 'entity'). These are summarised graphically to show how the concept has evolved around the world with the passage of time.  The term HIE emerged in 1957 with the establishment of Occupational HIE, evolving through the 1990s with concepts such as electronic data interchange and mobile computing technology; then from 2006-10 largely aligning with the US Government's health information technology strategy and the creation of HIEs as organisational entities, alongside the broader interoperability imperative, and continuing to evolve today as part of a broader international agenda for sustainable, information-driven health systems. CONCLUSIONS: The concept of HIE is an evolving and adaptive one, reflecting the ongoing quest for integrated and interoperable information to improve the efficiency and effectiveness of health systems, in a changing technological and policy environment.

Defining Health Information Exchange: Scoping Review of Published Definitions.

OBJECTIVE: The term Health Information Exchange (HIE) is often used in health informatics, yet uncertainties remain about its precise meaning. This study aimed to capture and analyse existing definitions in order to map variations in its use and the concepts associated with it. METHODS: Systematic literature search to identify published definitions of HIE and equivalent terms such as Clinical Information Exchange. Medline, Web of Science, Library Information Science and Technology Abstracts, EMBASE and CINAHL Plus were searched to identify relevant research, and Google to identify grey literature. Searches were not limited by language or date of publication. In order to warrant inclusion documents had to either define the concept explicitly or do so via a concrete description.  Included references were tabulated by author affiliation, source of quote, year of publication, country of origin and definitions and the definitions themselves were analysed thematically. RESULTS: Searches revealed 603 scientific articles and 5981 website links. From these, a total of 268 unique definitions of HIE were identified and extracted: 103 from scientific databases and 165 from Google. Eleven constructs emerged from the thematic analysis. Contextual factors influenced the emphasis of the definitions and the framing of HIE as a concept/process, a set of enabling technologies, or an entity/organisation.ConclusionsHIE is a complex and evolving concept and uses of the term vary across settings, presenting challenges for communication.  Developing a generic term is difficult, given the importance of context, but the authors suggest one covering key attributes of HIE, which may be helpful.

Barriers and facilitators to health information exchange in low- and middle-income country settings: a systematic review.

The exchange and use of health information can help healthcare professionals and policymakers make informed decisions on ways of improving patient and population health. Many low- and middle-income countries (LMICs) have however failed to embrace the approaches and technologies to facilitate health information exchange (HIE). We sought to understand the barriers and facilitators to the implementation and adoption of HIE in LMICs. Two reviewers independently searched 11 academic databases for published and on-going qualitative, quantitative and mixed-method studies and searched for unpublished work through the Google search engine. The searches covered the period from January 1990 to July 2014 and were not restricted by language. Eligible studies were independently, critically appraised and then thematically analysed. The searches yielded 5461 citations after de-duplication of results. Of these, 56 articles, three conference abstracts and four technical reports met the inclusion criteria. The lack of importance given to data in decision making, corruption and insecurity, lack of training and poor infrastructure were considered to be major challenges to implementing HIE, but strong leadership and clear policy direction coupled with the financial support to acquire essential technology, improve the communication network, and provide training for staff all helped to promote implementation. The body of work also highlighted how implementers of HIE needed to take into account local needs to ensure that stakeholders saw HIE as relevant and advantageous. HIE interventions implemented through leapfrog technologies such as telehealth/telemedicine and mHealth in Brazil, Kenya, and South Africa, provided successful examples of exchanging health information in LMICs despite limited resources and capability. It is important that implementation of HIE is aligned with national priorities and local needs.

Barriers and facilitators to health information exchange in low- and middle-income country settings: a systematic review protocol.

INTRODUCTION: The ability to capture, exchange and use accurate information about patients and services is vital for building strong health systems, providing comprehensive and integrated patient care, managing public health risks and informing policies for public health and health financing. However, the organisational and technological systems necessary to achieve effective health information exchange are lacking in many low- and middle-income countries (LMIC). Developing strategies for addressing this depends on understanding the barriers and facilitators to health information exchange (HIE) at the individual, provider organisational, community, district, provincial and national levels. This systematic review aims to identify, critically appraise and synthesise the existing published evidence addressing these factors. OBJECTIVE: To assess what is known, from published/unpublished empirical studies, about barriers and facilitators to HIE in LMIC so as to identify issues that need to be addressed and approaches that can fruitfully be pursued in future improvement strategies. METHODS: We will conduct a systematic review to identify the empirical evidence base on the barriers and facilitators to HIE in LMIC. Two reviewers will independently search 11 major international and national databases for published, unpublished and in-progress qualitative, quantitative and mixed methods studies published during 1990-July 2014 in any language. These searches of scientific databases will be supplemented by the eligible reports available online. The included studies will be independently critically appraised using the Mixed Method Appraisal Tool, version 2011. A descriptive, narrative and interpretative synthesis of data will be undertaken. RESULTS: These will be presented in an article that will be published in the peerreviewed literature. The protocol is registered with the International Prospective Register for Systematic Reviews (PROSPERO) CRD 42014009826.