Introducing the i-Rainbow©: An Evidence-Based, Parent-Friendly Care Pathway Designed for Critically Ill Infants in the NICU Setting.

PURPOSE: This study investigated the feasibility and effectiveness of a novel, evidence-based developmental care pathway to be used by health care providers and parents in the neonatal intensive care unit (NICU) setting. The i-Rainbow is based on current evidence and responds to individual infant health status. It is not based on infant age. METHODS: After development and implementation of the i-Rainbow, pre- and postimplementation nurse and parent survey data were collected and pre- and post-developmental care rates were compared. RESULTS: After i-Rainbow implementation, disagreement among providers on appropriate developmental care interventions significantly decreased, total minutes of daily developmental care and swaddled holding increased significantly, and parents reported that they would recommend the tool. CONCLUSION: The i-Rainbow is a unique, parent-friendly, infant-based tool that guides sensory interventions in the NICU by staging infants based on cardiorespiratory status and physiologic maturity, not age. The i-Rainbow improved the delivery of developmental care activities in our unit and was well received by parents and nurses. VIDEO ABSTRACT: Supplemental Digital Content available at: http://links.lww.com/PPT/A516.

Brachytherapy on-a-chip: a clinically-relevant approach for radiotherapy testing in 3d biology.

We describe the first microfluidic device for in vitro testing of brachytherapy (BT), with applications in translational cancer research. Our PDMS-made BT-on-chip system allows highly precise manual insertion of clinical BT seeds, reliable dose calculation using standard clinically-used TG-43 formalism and easy culture of naturally hypoxic spheroids in less than 3 days, thereby increasing the translational potential of the device. As the BT-on-chip platform is designed to be versatile, we showcase three different gold-standard post-irradiation bioassays and recapitulate, for the first time on-chip, key clinical observations such as dose rate effect and hypoxia-induced radioresistance. Our results suggest that BT-on-chip can be used to safely and efficiently integrate BT and radiotherapy to translational research and drug development pipelines, without expensive equipment or complex workflows.

Trace Amount of Bi-Doped Core-Shell Pd@Pt Mesoporous Nanospheres with Specifically Enhanced Peroxidase-Like Activity Enable Sensitive and Accurate Detection of Acetylcholinesterase and Organophosphorus Nerve Agents.

The urgent need for sensitive and accurate assays to monitor acetylcholinesterase (AChE) activity and organophosphorus pesticides (OPs) arises from the imperative to safeguard human health and protect the ecosystem. Due to its cost-effectiveness, ease of operation, and rapid response, nanozyme-based colorimetry has been widely utilized in the determination of AChE activity and OPs. However, the rational design of nanozymes with high activity and specificity remains a great challenge. Herein, trace amount of Bi-doped core-shell Pd@Pt mesoporous nanospheres (Pd@PtBi2) have been successfully synthesized, exhibiting good peroxidase-like activity and specificity. With the incorporation of trace bismuth, there is a more than 4-fold enhancement in the peroxidase-like performance of Pd@PtBi2 compared to that of Pd@Pt. Besides, no significant improvement of oxidase-like and catalase-like activities of Pd@PtBi2 was found, which prevents interference from O2 and undesirable consumption of substrate H2O2. Based on the blocking impact of thiocholine, a colorimetric detection platform utilizing Pd@PtBi2 was constructed to monitor AChE activity with sensitivity and selectivity. Given the inhibition of OPs on AChE activity, a biosensor was further developed by integrating Pd@PtBi2 with AChE to detect OPs, capitalizing on the cascade amplification strategy. The OP biosensor achieved a detection limit as low as 0.06 ng mL-1, exhibiting high sensitivity and anti-interference ability. This work is promising for the construction of nanozymes with high activity and specificity, as well as the development of nanozyme-based colorimetric biosensors.

Examining cover crop agri-environmental program participation: Evidence from a western US farmer survey.

Agri-environmental programs (AEPs), which pay farmers to adopt conservation practices, are increasingly important environmental and agricultural policy tools used in both the US and the EU. Despite large budgetary shares allocated in a 20-year application window, several studies identify lower-than-expected environmental outcomes. In the US, reasons for low environmental outcomes include low participation rates, lack of program awareness, and poor targeting levels. Research has identified low levels of awareness and variation in participation across the US in the Environmental Quality Incentives Program (EQIP), the largest working lands program in the US. Using a survey of Western US farmers, this paper provides an analysis of awareness and participation levels in cover crop AEPs in the Western US. Second, this paper analyzes motivations and barriers to participation in cover crop AEPs through the Environmental Quality Incentives Program (EQIP) and the Conservation Stewardship Program (CSP). Third, the paper uses a survey experiment to examine different types of incentives. The results highlight that participation is low due to lack of awareness and policy barriers. Using a logistic regression, predictors of AEP participation include frequent contact with NRCS, having a succession plan, and a positive attitude toward governments' role in conservation programs. The survey experiment found that non-financial factors, such as more information on cover crops, is an effective policy incentive.

Ultra-Large Stress and Strain Polymer Nanocomposite Actuators Incorporating a Mutually-Interpenetrated, Collective-Deformation Carbon Nanotube Network.

Stimulus-responsive polymer-based actuators are extensively studied, with the challenging goal of achieving comprehensive performance metrics that include large output stress and strain, fast response, and versatile actuation modes. The design and fabrication of nanocomposites offer a promising route to integrate the advantages of both polymers and nanoscale fillers, thus ensuring superior performance. Here, it is started from a three-dimensional (3D) porous sponge to fabricate a mutually interpenetrated nanocomposite, in which the embedded carbon nanotube (CNT) network undergoes collective deformation with the shape memory polymer (SMP) matrix during large-degree stretching and releasing, increases junction density with polymer chains and enhances molecular orientation. These features result in substantial improvement of the overall mechanical properties and during thermally actuated contraction, the bulk SMP/CNT composites exhibit output stresses up to 19.5 ± 0.97 MPa and strains up to 69%, accompanied by a rapid response and high energy density, exceeding the majority of recent reports. Furthermore, electrical actuation is also demonstrated via uniform Joule heating across the self-percolated CNT network. Applications such as low-temperature thermal actuated vascular stent and wound dressing are explored. These findings lay out a universal blueprint for developing robust and highly deformable SMP/CNT nanocomposite actuators with broad potential applications.

Ultrasound measurement of traumatic scar and skin thickness: a scoping review of evidence across the translational pipeline of research-to-practice.

OBJECTIVES: To identify the ultrasound methods used in the literature to measure traumatic scar thickness, and map gaps in the translation of these methods using evidence across the research-to-practice pipeline. DESIGN: Scoping review. DATA SOURCES: Electronic database searches of Ovid MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature and Web of Science. Grey literature searches were conducted in Google. Searches were conducted from inception (date last searched 27 May 2022). DATA EXTRACTION: Records using brightness mode (B-mode) ultrasound to measure scar and skin thickness across the research-to-practice pipeline of evidence were included. Data were extracted from included records pertaining to: methods used; reliability and measurement error; clinical, health service, implementation and feasibility outcomes; factors influencing measurement methods; strengths and limitations; and use of measurement guidelines and/or frameworks. RESULTS: Of the 9309 records identified, 118 were analysed (n=82 articles, n=36 abstracts) encompassing 5213 participants. Reporting of methods used was poor. B-mode, including high-frequency (ie, >20 MHz) ultrasound was the most common type of ultrasound used (n=72 records; 61% of records), and measurement of the combined epidermal and dermal thickness (n=28; 24%) was more commonly measured than the epidermis or dermis alone (n=7, 6%). Reliability of ultrasound measurement was poorly reported (n=14; 12%). The scar characteristics most commonly reported to be measured were epidermal oedema, dermal fibrosis and hair follicle density. Most records analysed (n=115; 97%) pertained to the early stages of the research-to-practice pipeline, as part of research initiatives. CONCLUSIONS: The lack of evaluation of measurement initiatives in routine clinical practice was identified as an evidence gap. Diverse methods used in the literature identified the need for greater standardisation of ultrasound thickness measurements. Findings have been used to develop nine methodological considerations for practitioners to guide methods and reporting.

Cognitive and neuroscientific perspectives of healthy ageing.

With dementia incidence projected to escalate significantly within the next 25 years, the United Nations declared 2021-2030 the Decade of Healthy Ageing, emphasising cognition as a crucial element. As a leading discipline in cognition and ageing research, psychology is well-equipped to offer insights for translational research, clinical practice, and policy-making. In this comprehensive review, we discuss the current state of knowledge on age-related changes in cognition and psychological health. We discuss cognitive changes during ageing, including (a) heterogeneity in the rate, trajectory, and characteristics of decline experienced by older adults, (b) the role of cognitive reserve in age-related cognitive decline, and (c) the potential for cognitive training to slow this decline. We also examine ageing and cognition through multiple theoretical perspectives. We highlight critical unresolved issues, such as the disparate implications of subjective versus objective measures of cognitive decline and the insufficient evaluation of cognitive training programs. We suggest future research directions, and emphasise interdisciplinary collaboration to create a more comprehensive understanding of the factors that modulate cognitive ageing.

New and emerging therapies for systemic lupus erythematosus.

Systemic Lupus Erythematosus (SLE) and lupus nephritis treatment is still based on non-specific immune suppression despite the first biological therapy for the disease having been approved more than a decade ago. Intense basic and translational research has uncovered a multitude of pathways that are actively being evaluated as treatment targets in SLE and lupus nephritis, with two new medications receiving FDA approval in the last 3 years. Herein we provide an overview of targeted therapies for SLE including medications targeting the B lymphocyte compartment, intracellular signaling, co-stimulation, and finally the interferons and other cytokines.

Advancing the utilization of real-world data and real-world evidence in clinical pharmacology and translational research-Proceedings from the ASCPT 2023 preconference workshop.

Real-world data (RWD) and real-world evidence (RWE) are now being routinely used in epidemiology, clinical practice, and post-approval regulatory decisions. Despite the increasing utility of the methodology and new regulatory guidelines in recent years, there remains a lack of awareness of how this approach can be applied in clinical pharmacology and translational research settings. Therefore, the American Society of Clinical Pharmacology & Therapeutics (ASCPT) held a workshop on March 21st, 2023 entitled "Advancing the Utilization of Real-World Data (RWD) and Real-World Evidence (RWE) in Clinical Pharmacology and Translational Research." The work described herein is a summary of the workshop proceedings.

Programmatic considerations and evidence gaps for chikungunya vaccine introduction in countries at risk of chikungunya outbreaks: Stakeholder analysis.

Chikungunya can have longstanding effects on health and quality of life. Alongside the recent approval of the world's first chikungunya vaccine by the US Food and Drug Administration in November 2023 and with new chikungunya vaccines in the pipeline, it is important to understand the perspectives of stakeholders before vaccine rollout. Our study aim is to identify key programmatic considerations and gaps in Evidence-to-Recommendation criteria for chikungunya vaccine introduction. We used purposive and snowball sampling to identify global, national, and subnational stakeholders from outbreak prone areas, including Latin America, Asia, and Africa. Semi-structured in-depth interviews were conducted and analysed using qualitative descriptive methods. We found that perspectives varied between tiers of stakeholders and geographies. Unknown disease burden, diagnostics, non-specific disease surveillance, undefined target populations for vaccination, and low disease prioritisation were critical challenges identified by stakeholders that need to be addressed to facilitate rolling out a chikungunya vaccine. Future investments should address these challenges to generate useful evidence for decision-making on new chikungunya vaccine introduction.

Evidence-based interventions for identifying candidate quality indicators to assess quality of care in diabetic foot clinics: a scoping review.

BACKGROUND: Foot ulcers in people with diabetes are a serious complication requiring a complex management and have a high societal impact. Quality monitoring systems to optimize diabetic foot care exist, but a formal and more evidence-based approach to develop quality indicators (QIs) is lacking. We aimed to identify a set of candidate indicators for diabetic foot care by adopting an evidence-based methodology. METHODS: A systematic search was conducted across four academic databases: PubMed, Embase CINAHL and Cochrane Library. Studies that reported evidence-based interventions related to organization or delivery of diabetic foot care were searched. Data from the eligible studies were summarized and used to formulate process and structure indicators. The evidence for each candidate QI was described in a methodical and transparent manner. The review process was reported according to the "Preferred Reported Items for Systematic reviews and Meta-Analysis" (PRISMA) statements and its extension for scoping reviews. RESULTS: In total, 981 full-text articles were screened, and 322 clinical studies were used to formulate 42 candidate QIs. CONCLUSIONS: An evidence-based approach could be used to select candidate indicators for diabetic foot ulcer care, relating to the following domains: wound healing interventions, peripheral artery disease, offloading, secondary prevention, and interventions related to organization of care. In a further step, the feasibility of the identified set of indicators will be assessed by a multidisciplinary panel of diabetic foot care stakeholders.

Enhancing grid-connected photovoltaic system performance with novel hybrid MPPT technique in variable atmospheric conditions.

This paper proposes an innovative approach to improve the performance of grid-connected photovoltaic (PV) systems operating in environments with variable atmospheric conditions. The dynamic nature of atmospheric parameters poses challenges for traditional control methods, leading to reduced PV system efficiency and reliability. To address this issue, we introduce a novel integration of fuzzy logic and sliding mode control methodologies. Fuzzy logic enables the PV system to effectively handle imprecise and uncertain atmospheric data, allowing for decision-making based on qualitative inputs and expert knowledge. Sliding mode control, known for its robustness against disturbances and uncertainties, ensures stability and responsiveness under varying atmospheric conditions. Through the integration of these methodologies, our proposed approach offers a comprehensive solution to the complexities posed by real-world atmospheric dynamics. We anticipate applications in grid-connected PV systems across various geographical locations and climates. By harnessing the synergistic benefits of fuzzy logic and sliding mode control, this approach promises to significantly enhance the performance and reliability of grid-connected PV systems in the presence of variable atmospheric conditions. On the grid side, both PSO (Particle Swarm Optimization) and GA (Genetic Algorithm) algorithms were employed to tune the current controller of the PI (Proportional-Integral) current controller (inverter control). Simulation results, conducted using MATLAB Simulink, demonstrate the effectiveness of the proposed hybrid MPPT technique in optimizing the performance of the PV system. The technique exhibits superior tracking efficiency, achieving a convergence time of 0.06 s and an efficiency of 99.86%, and less oscillation than the classical methods. The comparison with other MPPT techniques highlights the advantages of the proposed approach, including higher tracking efficiency and faster response times. The simulation outcomes are analyzed and demonstrate the effectiveness of the proposed control strategies on both sides (the PV array and the grid side). Both PSO and GA offer effective methods for tuning the parameters of a PI current controller. According to considered IEEE standards for low-voltage networks, the total current harmonic distortion values (THD) obtained are considerably high (8.33% and 10.63%, using the PSO and GA algorithms, respectively). Comparative analyses with traditional MPPT methods demonstrate the superior performance of the hybrid approach in terms of tracking efficiency, stability, and rapid response to dynamic changes.

Multilevel modeling analysis of bottle feeding and its determinants among children 0-23 months in East Africa: evidence from recent DHS data (2015-2022).

BACKGROUND: Despite breastfeeding recommendations, the prevalence and length of breast milk feeding in developing nations is rapidly decreasing, with bottle feeding taking its place. This reduces the effectiveness of breastfeeding and is associated with diarrheal disease mortality and morbidity. The purpose of this study was to determine the prevalence, distribution, and determinants of bottle feeding among under-two-year-old children in the region. METHODS: The ten East African countries' Demographic and Health Surveys (DHS) recent data from 2015 to 2022 was used. The data were weighted using sample weights for probability sampling and nonresponse. The study used 43,150 weighted children. A multi-level logistic regression model was used, and P - values of ≤ 0.2 and < 0.05 were used to declare candidate variables in the binary, and multivariable to declare significant variables, respectively. RESULTS: The prevalence of bottle feeding among children under-two-years-old in East Africa was 10.08% (95% CI 9.79, 10.36), ranging from 4.04% (95% CI 3.56, 4.53) in Tanzania to 33.40% (95% CI 32.72, 34.08) in Kenya. High antenatal care communities (AOR 1.22; 95% CI 1.11, 1.35), mothers aged 25-34 years (AOR 1.17; 95% CI 1.06, 1.28), high wealth index communities (AOR 1.12; 95% CI 1.02,1.25), women who had at least one types mass media exposure (AOR 1.64; 95% CI 1.53, 1.77), women from communities with high level mass media exposure (AOR 1.36; 95% CI 1.23, 1.52), given first birth after teenage years (AOR 1.17; 95% CI 1.09, 1.26), having more than one health visit in the year (AOR 1.37; 95% CI 1.27,1.47), multiple children (AOR 1.46; 95% CI 1.22, 1.75) were associated with higher rates of bottle feeding. Whereas a primary education (AOR 0.51; 95% CI 0.47, 0.54), having 3-5 living children (AOR 0.86; 95% CI 0.79, 0.95), a rural setting (AOR 0.53; 95% CI 0.49, 0.58), and a long distance from health facilities (AOR 0.84; 95% CI, 0.78, 0.91) were associated with lower rates of bottle feeding. CONCLUSIONS: The overall prevalence of bottle feeding was moderate in East African countries. Improving the availability and accessibility of health facilities to mothers, utilizing maternal healthcare, and media exposure will contribute to a significant decrease in the inappropriate bottle feeding of children in East Africa.

Engineered exosomes in emerging cell-free therapy.

The discovery and use of exosomes ushered in a new era of cell-free therapy. Exosomes are a subgroup of extracellular vesicles that show great potential in disease treatment. Engineered exosomes. with their improved functions have attracted intense interests of their application in translational medicine research. However, the technology of engineering exosomes still faces many challenges which have been the great limitation for their clinical application. This review summarizes the current status of research on engineered exosomes and the difficulties encountered in recent years, with a view to providing new approaches and ideas for future exosome modification and new drug development.

Smallholder farmers' vulnerability to climate change and variability: Evidence from three agroecologies in the Upper Blue Nile, Ethiopia.

This study delves into the profound impact of climate change on agriculture in Ethiopia, particularly the vulnerabilities faced by smallholder farmers and the resulting implications for poverty. Focusing on three distinct agroecologies, namely: highland, midland, and lowland zones. The study employed a robust methodology, combining a cross-sectional survey, spatial-temporal trend analysis using GIS, and the development of an overall vulnerability index through the balanced weighted average method. The study, encompassing 646 households, combines data from a variety of sources and analytical tools like the vulnerability index, ArcGIS 10.8, and ERDA's IMAGINE 2015. Utilizing the LVI-IPCC scale, the study shows that climate change is an immediate vulnerability in all agroecological zones. It identifies highland areas as the most sensitive and exposed regions, while lowland households are found to be the most vulnerable in terms of overall vulnerabilities. The research reveals specific challenges faced by communities, such as inadequate health facilities and insufficient food and water supplies in both highland and lowland agroecosystems. Additionally, our investigation has observed a significant alteration in land use practices, specifically the shift from communal grazing land to private cultivation and plantations, emphasizing eucalyptus. This alteration enhances the ecosystem's vulnerability to climate disturbances. The study suggests targeted interventions, such as advocating for sustainable land-use practices, afforestation, and adopting climate-smart agriculture practices. It is important to implement policy measures that prioritize conserving and restoring shrubland, grazing land, and natural forests to ensure both long-term socio-economic and ecosystem resilience. The study's nuanced insights are instrumental in understanding the diverse challenges posed by climate change in Ethiopian agriculture, supporting informed policymaking and sustainable interventions.

Analysis of comprehensive biomolecules in critically ill patients via bioinformatics technologies.

Each patient with a critical illness such as sepsis and severe trauma has a different genetic background, comorbidities, age, and sex. Moreover, pathophysiology changes dynamically over time even in the same patient. Therefore, individualized treatment is necessary to account for heterogeneity in patient backgrounds. Recently, the analysis of comprehensive biomolecular information using clinical specimens has revealed novel molecular pathological classifications called subtypes. In addition, comprehensive biomolecular information using clinical specimens has enabled reverse translational research, which is a data-driven approach to the identification of drug target molecules. The development of these methods is expected to visualize the heterogeneity of patient backgrounds and lead to personalized therapy.

From bench to policy: a critical analysis of models for evidence-informed policymaking in healthcare.

Background: The use of research evidence in policy making is a complex and challenging process that has a long history in various fields, especially in healthcare. Different terms and concepts have been used to describe the relationship between research and policy, but they often lack clarity and consensus. To address this gap, several strategies and models have been proposed to facilitate evidence informed policy making and to identify the key factors and mechanisms involved. This study aims to critically review the existing models of evidence informed policy making (EIPM) in healthcare and to assess their strengths and limitations. Method: A systematic search and review conducted to identify and critically assess EIPM models in healthcare. We searched PubMed, Web of Science and Scopus databases as major electronic databases and applied predefined inclusion criteria to select the models. We also checked the citations of the included models to find other scholars' perspectives. Each model was described and critiqued each model in detail and discussed their features and limitations. Result: Nine models of EIPM in healthcare were identified. While models had some strengths in comprehension, flexibility and theoretical foundations, analysis also identified limitations including: presupposing rational policymaking; lacking alternatives for time-sensitive situations; not capturing policy complexity; neglecting unintended effects; limited context considerations; inadequate complexity concepts; limited collaboration guidance; and unspecified evidence adaptations. Conclusion: The reviewed models provide useful frameworks for EIPM but need further improvement to address their limitations. Concepts from sociology of knowledge, change theory and complexity science can enrich the models. Future EIPM models should better account for the complexity of research-policy relationships and provide tailored strategies based on the policy context.

Validating evidence for the knowledge, management and involvement of dentists in a dental approach to sickle-cell disease.

This study validated the content of an instrument designed to assess the knowledge, involvement (attitudes) and management (practice) of dentists relative to sickle-cell disease (KAPD-SCD). The instrument consisted of five domains composed of a total of thirteen items: I. Dentist's self-assessment relative to sickle-cell disease; II. Dentist's knowledge of the repercussions of sickle-cell disease on the stomatognathic system; III. Dentist's knowledge of the complications of sickle-cell disease in the stomatognathic system; IV. Dentist's knowledge concerning the dental management of sickle-cell disease patients; and V. Dentist's involvement in an approach to sickle-cell disease. Twelve experts assigned scores to each item of the instrument. The criteria were clarity, understanding and appropriateness, leaving open fields for comments. Descriptive and content analyses of the data were made. Each expert analyzed 39 assessment units. The percentages considered for agreement were high (>80%), medium (70%-80%), or low (<70%), and each item was maintained or revised according to the percentage observed. There was high consensus in 74% of the assessment units (the corresponding items were maintained), medium consensus in 24% of them (the corresponding items were revised), and disagreement in 2% of them, namely as regards the "appropriateness" of item 5 ("Are there oral complications in sickle-cell disease?"), which was revised. The final version of the instrument had 16 items for different applications such as in the clinical care program, teaching program, or research program, with different cut-off scores for each application. In conclusion, the level of agreement among experts showed evidence of the content validity of the instrument.

The prevalence of depression, determinants, and linkage with functional disability amongst postmenopausal women in India: Evidence from the Longitudinal Ageing Study in India.

BACKGROUND: The study objective was estimating the prevalence and determinants of depression amongst postmenopausal women in India. Additionally, we used panel mediation analysis to model the extent to which multimorbidity was associated with depression after adjusting for the effects of functional disability in the participants. METHODS: Data from 28,160 women aged 50 and above from the Longitudinal Aging Study in India (LASI) Wave 1 were analyzed. Depression was assessed using the Composite International Diagnostic Interview-Short Form (CIDI-SF), with multimorbidity and functional disability (ADL and IADL) considered as key predictor variables. Logistic regression and Karlson-Holm-Breen (KHB) mediation analysis were employed. RESULTS: The weighted prevalence of depression among women aged ≥ 50 years was 21.76% (95% CI: 20.81, 22.73), significantly higher women aged < 50 years (17.60%, 95% CI: 16.33, 18.94). Factors independently associated with increased odds of depression included being unmarried, rural residence, and multimorbidity, while higher educational status was associated with lower odds of depression. The relationship between multimorbidity and depression was partially mediated by ADL and IADL disabilities. Notable regional (state) variations in the magnitude of depression were observed. CONCLUSIONS: Nearly one in five postmenopausal women in India aged 50 years and older have clinical depression. Community screening for reaching the unreached with primary care mental health strengthening need enhanced policy focus.

Hitting the target and missing the point? A BEME systematic review of evidence regarding the efficacy of statutory and mandatory training in health and care: BEME Guide No. 87.

BACKGROUND: Mandatory training is considered fundamental to establishing and maintaining high standards of professional practice. There is little evidence however, of the training either achieving its required learning outcomes, or delivering improvement in outcomes for patients. Whist organisations may be hitting their compliance target for mandatory training, is the purpose missing the point? This systematic review aims to synthesize and evaluate the efficacy of statutory and mandatory training. METHODS: PubMed, EMBASE, CNAHL, ERIC and Cochrane Central registers were searched on 23rd May 2023. All research designs were included and reported training had to specify an organisational mandate within a healthcare setting. Data was coded using a modified Kirkpatrick (KP) rating system. Critical appraisal was undertaken using the Modified Medical Education Research Study Quality Instrument, Critical Appraisal Skills Programme Qualitative Studies checklist and Mixed Methods Assessment Tool. RESULTS: Twenty-five studies were included, featuring 9132 participants and 1348 patient cases audited. Studies described evaluation of mandatory training according to Kirkpatrick's outcomes levels 1-4b, with the majority (68%) undertaken in the UK and within acute settings. Training duration varied from 5 min to 3 days. There is a lack of consensus regarding mandatory training rationale, core topics, duration, and optimum refresher training period. Currently, mandatory training does not consistently translate to widescale improvements in safe practice or improved patient outcomes. CONCLUSIONS: Due to the lack of international consensus regarding the need for mandated training, most papers originated from countries with centrally administered national health care systems. The rationale for mandating training programmes remains undefined. The assumption that mandatory training is delivering safe practice outcomes is not supported by studies included in this review. The findings of this review offer a basis for further research to be undertaken to assist with the design, facilitation, and impact of mandatory training.