Barriers to sexual health care for sexually diverse Muslim men: a scoping review.

Sexually diverse Muslim men (SDMM) are seen to present later and with more advanced symptoms of HIV and other sexually transmitted infections (STIs). The limited access to sexual healthcare services is attributed to the stigma associated with their multiple intersecting identities. We conducted a scoping review to synthesise research on barriers impeding SDMM's access to sexual health care. We used Arksey and O'Malley's five-stage framework as the methodology for the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses' extension for scoping reviews, was used as a guide for the presentation of the results. Searches conducted in EBSCOhost, Scopus, MEDLINE, Embase, CINAHL, Global Health, and Google Scholar yielded 1382 results, of which 18 studies were deemed eligible for this review. Bronfenbrenner's socioecological model was employed as a framework to analyse the studies. Through analysing the eligible studies, we identified factors operating at three different levels that can impede SDMM's access to sexual health care. Limited awareness and low-perceived risk of HIV/STIs, coupled with the fear of sexual identity disclosure might act as individual-level barriers to sexually diverse Muslim men's access to sexual health care. The experiences of discrimination within clinical settings were presented as a healthcare system-related issue discouraging SDMM from revisiting those services. Heteronormative and religious ideologies, homophobic government programs, and poverty might manifest in the more intimate domains of healthcare delivery, creating hostile spaces for SDMM. Intensive research and advocacy efforts are required to improve SDMM's access to sexual health care, which can reduce their risk of HIV/STIs.

Research on the barriers to accessing sexual healthcare for sexually diverse Muslim men: protocol for a scoping review.

INTRODUCTION: Sexually diverse Muslim men are seen to be at a higher risk for HIV and other sexually transmitted infections due to their limited access to sexual healthcare services. We outline a protocol to conduct a scoping review of research on the barriers that may impede these men's access to sexual healthcare. METHODS AND ANALYSIS: To conduct this scoping review, we will follow the methodological framework developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' extension for scoping reviews. To classify the barriers to sexual healthcare, we will employ Bronfenbrenner's socioecological model as a conceptual framework. We will conduct a literature search via Medline, Embase and Global Health (OVID); Scopus; CINAHL on EBSCOhost along with several other EBSCOhost databases (Academic Search Complete, Canadian Reference Centre, Alternative Press Index, Family & Society Studies Worldwide, Social Work Abstracts) and Google Scholar, published until November 2023. Journal articles, published in the English language, describing quantitative and qualitative research on sexual healthcare access barriers for sexually diverse Muslim men will be included in the review. Commentaries and correspondences, along with grey literature including research reports and conference abstracts, as well as studies that do not include men with the Muslim faith, will be considered ineligible. Following screening of titles and abstracts, we will conduct a full-text screening to determine the final number of studies to be included in the review. A Microsoft Excel spreadsheet will be used to extract study characteristics, and information on sexual healthcare access barriers will be classified according to the socioecological model's core concepts. ETHICS AND DISSEMINATION: Our review does not require ethics approval. We will disseminate the review findings through peer-reviewed academic journals, seminars and conference presentations.

Services, models of care, and interventions to improve access to cancer treatment for adults who are socially disadvantaged: A scoping review protocol.

Timely access to guideline-recommended cancer treatment is known to be an indicator of the quality and accessibility of a cancer care system. Yet people who are socially disadvantaged experience inequities in access to cancer treatment that have significant impacts on cancer outcomes and quality of life. Among people experiencing the intersecting impacts of poor access to the social determinants of health and personal identities typically marginalized from society ('social disadvantage'), there are significant barriers to accessing cancer, many of which compound one another, making cancer treatment extremely difficult to access. Although some research has focused on barriers to accessing cancer treatment among people who are socially disadvantaged, it is not entirely clear what, if anything, is being done to mitigate these barriers and improve access to care. Increasingly, there is a need to design cancer treatment services and models of care that are flexible, tailored to meet the needs of patients, and innovative in reaching out to socially disadvantaged groups. In this paper, we report the protocol for a planned scoping review which aims to answer the following question: What services, models of care, or interventions have been developed to improve access to or receipt of cancer treatment for adults who are socially disadvantaged? Based on the methodological framework of Arksey and O'Malley, this scoping review is planned in six iterative stages. A comprehensive search strategy will be developed by an academic librarian. OVID Medline, EMBASE, CINAHL (using EBSCOhost) and Scopus will be searched for peer-reviewed published literature; advanced searches in Google will be done to identify relevant online grey literature reports. Descriptive and thematic analysis methods will be used to analyze extracted data. Findings will provide a better understanding of the range and nature of strategies developed to mitigate barriers to accessing cancer treatment.

Experiences and Outcomes of Indigenous Patients Undergoing Bariatric Surgery: a Mixed-Method Scoping Review.

Obesity and type 2 diabetes (T2D) are growing global health concerns. Evidence suggests that Indigenous peoples are at higher lifetime risk of obesity and its associated conditions. Obesity increases the risk of T2D, cardiovascular disease, and all-cause mortality. Bariatric surgery is the most sustained and effective intervention for treating obesity-associated medical problems. This review aims to explore the experiences and outcomes of Indigenous peoples undergoing bariatric surgery in Canada, the USA, Australia, and New Zealand (CANZUS). Analysis of quantitative data revealed that Indigenous patients had fewer bariatric procedures, poorer clinic attendance, similar weight loss outcomes and slightly higher post-operative complication rates. Qualitative data analysis revealed that Indigenous patients living with obesity have a desire to improve their health and quality of life.

Research on Abuse in Home Care: A Scoping Review.

Home care is the preferred care option for most people who need support; yet abuse exists in these settings toward both home care workers and clients. There are no existing reviews that assess the scope of current research on abuse in home care, and tangentially related reviews are dated. For these reasons, a scoping review is warranted to map the current state of research on abuse in home care and examine current interventions in this field. Databases selected for searching were Medline and EMBASE on OVID, Scopus, and the following databases in EBSCOhost: Academic Search Complete, AgeLine, and Cumulative Index to Nursing and Allied Health Literature. Records were included if: (a) they were written in English; (b) the participants were home care workers or clients age 18 years or older; (c) they were published in journals; (d) they undertook empirical research; and (e) they were published within the last 10-year period. Following Graham et al. (2006), the 52 included articles are categorized as either knowledge inquiry or as intervention studies. We find three themes among knowledge inquiry studies: (1) prevalence and types of abuse in home care, (2) abuse in the context of living with dementia, and (3) working conditions and abuse. Analysis from the intervention studies suggest that not all organizations have specific policies and practices to prevent abuse, and no existing interventions to protect the well-being of clients were identified. Findings from this review can inform up-to-date practice and policymaking to improve the health and well-being of home care clients and workers.

Surgical closure of enlarged tracheoesophageal fistula after laryngectomy: A systematic review of techniques.

OBJECTIVES: The objectives of the study were (1) systematically review the data on surgical closure of enlarged tracheoesophageal fistula after laryngectomy and (2) to perform a comparison of reconstruction of surgical techniques. METHODS: Systematic review was performed using PRISMA methodology. Cumulative patient data were compared between patients reconstructed with vascularized tissue (sternocleidomastoid fascia and muscle, pectoralis major, deltopectoral, radial forearm) and those closed primarily (two-layer, three-layer, and tracheal transposition). RESULTS: Fourteen studies reported outcomes for the reconstruction of tracheoesophageal fistula. Primary closure was used in 98 patients, vascularized flap in 74, and occlusive device in 8. Vascularized flap resulted in successful closure of the fistula in 89 % of cases compared to primary closure in 62 % (p = 0.0003). CONCLUSION: Systematic review of the literature supports an improved surgical closure rate with vascularized flap interposed between the esophageal and tracheal lumens compared to primary closure.

Indigenous communities and the mental health impacts of land dispossession related to industrial resource development: a systematic review.

Globally, many resource extraction projects such as mines and hydroelectric dams are developed on the territories of Indigenous Peoples. Recognising land as a determinant of Indigenous Peoples' health, our objective is to synthesise evidence about the mental health impacts on Indigenous communities who experience land dispossession due to industrial resource development (mining, hydroelectric, petroleum, and agricultural). We systematically reviewed studies that focused on Indigenous land dispossession in Australia, Aotearoa (New Zealand), North and South America, and the Circumpolar North. We searched Scopus, Medline, Embase, PsycINFO, and Global Health on OVID for peer-reviewed articles published in English from database inception to Dec 31, 2020. We also searched for books, research reports, and scholarly journals specialising in Indigenous health or Indigenous research. We included documents that reported on primary research, focused on Indigenous Peoples in settler colonial states, and reported on mental health and industrial resource development. Of the 29 included studies, 13 were related to hydroelectric dams, 11 to petroleum developments, nine to mining, and two to agriculture. Land dispossession due to industrial resource development had predominantly negative mental health impacts on Indigenous communities. The impacts were consequences of colonial relations that threatened Indigenous identities, resources, languages, traditions, spirituality, and ways of life. Health impact assessment processes in industrial resource development must expressly consider risks and potential impacts on mental health and respect Indigenous rights by making knowledge about mental health risks a central component to decisions about free, prior, and informed consent.

A critical appraisal and recommendation synthesis of delirium clinical practice guidelines relevant to the care of older adults in the emergency department: An umbrella review.

RATIONALE: Older adults are at high risk of developing delirium in the emergency department (ED); however, it is often missed or undertreated. Improving ED delirium care is challenging in part due to a lack of standards to guide best practice. Clinical practice guidelines (CPGs) translate evidence into recommendations to improve practice. AIM: To critically appraise and synthesize CPG recommendations for delirium care relevant to older ED patients. METHODS: We conducted an umbrella review to retrieve relevant CPGs. Quality of the CPGs and their recommendations were critically appraised using the Appraisal of Guidelines, Research, and Evaluation (AGREE)-II; and Appraisal of Guidelines Research and Evaluation-Recommendations Excellence (AGREE-REX) instruments. A threshold of 70% or greater in the AGREE-II Rigour of Development domain was used to define high-quality CPGs. Delirium recommendations from CPGs meeting this threshold were included in the synthesis and narrative analysis. RESULTS: AGREE-II Rigour of Development scores ranged from 37% to 83%, with 5 of 10 CPGs meeting the predefined threshold. AGREE-REX overall calculated scores ranged from 44% to 80%. Recommendations were grouped into screening, diagnosis, risk reduction, and management. Although none of the included CPGs were ED-specific, many recommendations incorporated evidence from this setting. There was agreement that screening for nonmodifiable risk factors is important to define high-risk populations, and those at risk should be screened for delirium. The '4A's Test' was the recommended tool to use in the ED specifically. Multicomponent strategies were recommended for delirium risk reduction, and for its management if it occurs. The only area of disagreement was for the short-term use of antipsychotic medication in urgent situations. CONCLUSION: This is the first known review of delirium CPGs including a critical appraisal and synthesis of recommendations. Researchers and policymakers can use this synthesis to inform future improvement efforts and research in the ED. REGISTRATION: This study has been registered in the Open Science Framework registries: https://doi.org/10.17605/OSF.IO/TG7S6OSF.IO/TG7S6.

Prognostic Value of Initial Diagnostic Imaging Findings for Patient Outcomes in Adult Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

INTRODUCTION: Termed the "silent epidemic," traumatic brain injury (TBI) is one of the greatest global contributors not only to post-traumatic death but also to post-traumatic long-term disability. This systematic review and meta-analysis aims to specifically evaluate the prognostic value of features on initial imaging completed within 24 h of arrival in adult patients with TBI. METHOD: The authors followed the PRISMA 2020 checklist for systematic review and meta-analysis design and reporting. Comprehensive searches of the Medline and Embase databases were carried out. Two independent readers extracted the following demographic, clinical and imaging information using a predetermined data abstraction form. Statistics were performed using Revman 5.4.1 and R version 4.2.0. For pooled data in meta-analysis, forest plots for sensitivity and specificity were created to calculate the diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) curves were generated using a bivariate model, and diagnostic accuracy was determined using pooled sensitivity and specificity as well as the area under the receiver operator characteristic curve (AUC). RESULTS: There were 10,733 patients over the 19 studies. Overall, most of the studies included had high levels of bias in multiple, particularly when it came to selection bias in patient sampling, bias in controlling for confounders, and reporting bias, such as in reporting missing data. Only subdural hematoma (SDH) and mortality in all TBI patients had both an AUC with 95% CI not crossing 0.5 and a DOR with 95% CI not crossing 1, at 0.593 (95% CI: 0.556-0.725) and 2.755 (95% CI: 1.474-5.148), respectively. CONCLUSION: In meta-analysis, only SDH with mortality in all TBI patients had a moderate but significant association. Given the small number of studies, additional research focused on initial imaging, particularly for imaging modalities other than NECT, is required in order to confirm the findings of our meta-analysis and to further evaluate the association of imaging findings and outcome.

Initial CT Imaging Predicts Mortality in Severe Traumatic Brain Injuries in Pediatric Population-A Systematic Review and Meta-Analysis.

The purpose of this systematic review was to analyze evidence based on existing studies on the ability of initial CT imaging to predict mortality in severe traumatic brain injuries (TBIs) in pediatric patients. An experienced librarian searched for all existing studies based on the inclusion and exclusion criteria. The studies were screened by two blinded reviewers. Of the 3277 studies included in the search, data on prevalence of imaging findings and mortality rate could only be extracted from 22 studies. A few of those studies had patient-specific data relating specific imaging findings to outcome, allowing the data analysis, calculation of the area under the curve (AUC) and receiver operating characteristic (ROC), and generation of a forest plot for each finding. The data were extracted to calculate the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predicted value (NPV), AUC, and ROC for extradural hematoma (EDH), subdural hematoma (SDH), traumatic subarachnoid hemorrhage (tSAH), skull fractures, and edema. There were a total of 2219 patients, 747 females and 1461 males. Of the total, 564 patients died and 1651 survived; 293 patients had SDH, 76 had EDH, 347 had tSAH, 244 had skull fractures, and 416 had edema. The studies included had high bias and lower grade of evidence. Out of the different CT scan findings, brain edema had the highest SN, PPV, NPV, and AUC. EDH had the highest SP to predict in-hospital mortality.

Gender-affirming care in undergraduate nursing education: a scoping review protocol.

INTRODUCTION: Transgender and gender-diverse (TGD) people face a multitude of barriers to safe, accessible healthcare. One way to overcome access inequities is through the provision of gender-affirming care. Gender-affirming care is culturally safe and engaged care that values TGD identities and is focused on depathologising TGD people. Additionally, gender-affirming care encompasses awareness and support of TGD individuals as unique beings, including supporting gender-affirming medical goals for those who are interested. The discipline of nursing is well situated to advocate for gender-affirming care, however, receives little undergraduate education in the subject. Undergraduate schools of nursing (including faculty and curriculum) are in a crucial position to implement gender-affirming care, though how they have done this is not widely known. Our scoping review aims to understand how Canadian and US undergraduate schools of nursing teach and integrate gender-affirming education. METHODS AND ANALYSIS: Our scoping review will follow the six stages by Arksey and O'Malley and the advancements by Levac et al, reported on as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The review will be completed in 2023, with the database searches carried out in spring 2023, followed by screening and analysis. ETHICS AND DISSEMINATION: Ethics approval is not required for this protocol. To aid in knowledge translation, a visual representation of the findings will be created. Results from the final scoping review will be published in a peer-reviewed journal, promoted on social media to schools of nursing, and presented at conferences and seminars. PROTOCOL REGISTRATION NUMBER: Open Science Framework (https://doi.org/10.17605/OSF.IO/Q68BD).

Examining the experiences of Indigenous families seeking health information about caring for sick or injured children: a scoping review.

OBJECTIVE: Mapping literature on Indigenous families' experiences seeking child health information and identifying barriers and facilitators to information access. DESIGN: Scoping review. DATA SOURCES: We searched Medline, EMBASE, PsycINFO, Scopus and CINAHL for peer-reviewed literature and Google Advanced for grey literature. We screened tables of contents of two Indigenous research journals not consistently indexed in online health databases and used snowball sampling to supplement searches. ELIGIBILITY CRITERIA: We included full-text, English-language articles, published from 2000 to the time of the search in April 2021, based on: participants (Indigenous families), concept (experiences of families seeking health information) and context (child health). DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted: citation details, study purpose, country of study, publication type, study design, data collection method, Indigenous group, family member participants, home/healthcare setting, child health area, how health information was accessed, and information-seeking barriers and facilitators. Data were examined for patterns and trends, results and implications. RESULTS: Among 19 papers (representing 16 research projects) included, nine described family/friends and 19 described healthcare professionals as sources of child health information. Barriers include racism/discrimination during healthcare visits, ineffective communication with healthcare providers and structural barriers (eg, transportation). Facilitators include easy access, improved communication and relationships with healthcare providers, and culturally safe healthcare. CONCLUSION: Indigenous families perceive they do not have access to necessary child health information, which can lead to insensitive, ineffective and unsafe healthcare. A critical gap exists in understanding Indigenous families' information needs and preferences when making decisions about children's health.

A critical appraisal of delirium clinical practice guidelines relevant to the care of older adults in the emergency department with a synthesis of recommendations: an umbrella review protocol.

BACKGROUND: Up to 35% of older adults present to the emergency department (ED) with delirium or develop the condition during their ED stay. Delirium associated with an ED visit is independently linked to poorer outcomes such as loss of independence, increased length of hospital stay, and mortality. Improving the quality of delirium care for older ED patients is hindered by a lack of knowledge and standards to guide best practice. High-quality clinical practice guidelines (CPGs) have the power to translate the complexity of scientific evidence into recommendations to improve and standardize practice. This study will identify and synthesize recommendations from high-quality delirium CPGs relevant to the care of older ED patients. METHODS: We will conduct a multi-phase umbrella review to retrieve relevant CPGs. Quality of the CPGs and their recommendations will be critically appraised using the Appraisal of Guidelines, Research, and Evaluation (AGREE)-II; and Appraisal of Guidelines Research and Evaluation - Recommendations Excellence (AGREE-REX) instruments, respectively. We will also synthesize and conduct a narrative analysis of high-quality CPG recommendations. DISCUSSION: This review will be the first known evidence synthesis of delirium CPGs including a critical appraisal and synthesis of recommendations. Recommendations will be categorized according to target population and setting as a means to define the bredth of knowledge in this area. Future research will use consensus building methods to identify which are most relevant to older ED patients. TRIAL REGISTRATION: This study has been registered in the Open Science Framework registries: https://doi.org/10.17605/OSF.IO/TG7S6 .

Impact on mental health and wellbeing in Indigenous communities due to land loss resulting from industrial resource development: protocol for a systematic review.

BACKGROUND: Indigenous Peoples are impacted by industrial resource development that takes place on, or near, their communities. Existing literature on impacts of industrial resource development on Indigenous Peoples primarily focus on physical health outcomes and rarely focus on the mental health impacts. To understand the full range of long-term and anticipated health impacts of industrial resource development on Indigenous communities, mental health impacts must be examined. It is well-established that there is a connection between the environment and Indigenous wellbeing, across interrelated dimensions of mental, physical, emotional, and spiritual health. METHODS: This paper identifies how the Community Advisory Team and a team of Indigenous and settler scholars will conduct the review. The literature search will use the OVID interface to search Medline, Embase, PsycINFO, and Global Health databases. Non-indexed peer-reviewed journals related to Indigenous health or research will be scanned. Books and book chapters will be identified in the Scopus and PsycINFO databases. The grey literature search will also include Google and be limited to reports published by government, academic, and non-profit organizations. Reference lists of key publications will be checked for additional relevant publications, including theses, dissertations, reports, and other articles not retrieved in the online searches. Additional sources may be recommended by team members. Included documents will focus on Indigenous Peoples in North America, South America, Australia, Aotearoa New Zealand, and Circumpolar regions, research that reports on mental health, and research that is based on land loss connected to dams, mines, agriculture, or petroleum development. Literature that meets the inclusion criteria will be screened at the title/abstract and full-text stages by two team members in Covidence. The included literature will be rated with a quality appraisal tool and information will be extracted by two team members; a consensus of information will be reached and be submitted for analysis. DISCUSSION: The synthesized evidence from this review is relevant for land use policy, health impact assessments, economic development, mental health service planning, and communities engaging in development projects. SYSTEMATIC REVIEW REGISTRATION: Registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration number CRD42021253720 ).

Integrative review protocol for Indigenous youth participation in health equity promotion.

INTRODUCTION: Indigenous youth participation in decision-making is internationally recognised as a pathway to promote health equity, decolonisation and social inclusion. Hearing Indigenous youth voices and actively involving them in decisions that affect their lives and their communities has the potential to address disproportionate health and social challenges they encounter. Yet the existing evidence-base on participatory approaches remains fragmented and vast leading to a lack of integration. METHODS AND ANALYSIS: An integrative review methodology will be used to conduct a comprehensive, multidisciplinary review of the literature about Indigenous youth participation in health equity promotion. The literature search is anticipated to be carried out in July-August 2022. We will search online databases Scopus, Ovid MEDLINE, Embase and PsycINFO along with several interdisciplinary databases indexed in EBSCOhost and ProQuest. Key Indigenous research journals not consistently indexed in the online databases will be examined to identify additional journal articles. We will employ a blinded, dual-reviewer two-step selection process with established inclusion/exclusion criteria and limit data to English-language publications related to Indigenous populations in Canada, USA, Aotearoa New Zealand and Australia. Focusing on qualitative empirical and theoretical studies, they will undergo quality appraisal and Covidence software will be used to manage the review. Data will be sorted, extracted and analysed. We will codify data for descriptive reporting and conduct a narrative synthesis to identify a common conceptualisation for Indigenous youth participatory approaches across disciplines, its barriers and facilitators, and knowledge gaps. ETHICS AND DISSEMINATION: Ethical review is not required for the integrative review. The review will be shared through various publication and non-academic platforms as well as our university and community research networks. Findings will have broad relevance for those seeking to involve Indigenous youth to be active decision-makers across a range of fields, but with specific implications for health equity.

Risk of recurrence of subdural hematoma after EMMA vs surgical drainage - Systematic review and meta-analysis.

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common and debilitating neurological condition whose treatments, including burr hole drainage and craniotomy, suffer from high rates of recurrence and complication. Embolization of the middle meningeal artery (EMMA) is a promising minimally invasive approach to manage CSDH in a broad set of patients. METHODS: To evaluate the efficacy and safety of EMMA, a database search was conducted including the terms "subdural hematoma; embolization; embolized; middle meningeal" was performed and yielded a total of 260 results. Following exclusion based on predefined criteria, a total of four studies were identified and outcomes including recurrence rates and complication rates were extracted for analysis. RESULTS: Four studies including intervention and control groups were included with a total of n = 888 patients. The relative risk of CSDH recurrence in the EMMA (3.5%) compared to control group (23.5%) was significantly reduced when EMMA was performed (risk ratio = 0.17; 95% confidence interval (CI) 0.05-0.67). In addition, rates of complication were not significantly different between patients with conventional therapy and those who received EMMA (OR = 0.77; 95 confidence interval (CI) 0.3-1.99). CONCLUSION: Based on limited data, EMMA reduces the risk of recurrence by 20% compared to surgical treatment for CSDH.

Protocol for a systematic review of living labs in healthcare.

INTRODUCTION: Healthcare is increasingly challenged to meet the demands of user involvement and knowledge mobilisation required by the 21st-century patient-centred and knowledge-based economies. Innovations are needed to reduce problematic barriers to knowledge exchange and improve collaborative problem solving. Living labs, as open knowledge systems, have the potential to address these gaps but are underexplored in healthcare. METHODS AND ANALYSIS: We will conduct the first systematic review of living labs across healthcare contexts. We will comprehensively search the following online databases from inception to 31 December 2020: Scopus, the Cochrane Library (Wiley), Medline (OVID), Embase (OVID), Web of Science, PsycINFO (OVID) and EBSCOhost databases including Academic Search Complete, Business Source Premier, Canadian Reference Centre, CINAHL, MasterFILE Premier, SPORTDiscus, Library & Information Science Source, Library, Information Science & Technology Abstracts, AgeLine, EconLit, Art Full Text, Women's Studies International and Social Work Abstracts. We will search for grey literature using Google advanced techniques and books/book chapters through scholarly and bibliographical databases. We will use a dual-reviewer, two-step selection process with pre-established inclusion criteria and limit to English language publications. Empirical studies of any design examining living lab development, implementation or evaluation in health or healthcare will be included. We will use the Mixed Methods Appraisal Tool (MMAT) for methodological quality appraisal and Covidence software for review management, and we will extract data on pre-established variables such as lab context and technological platforms. We will create evidence tables and analyse across variables such as focal aim and achievement of living lab principles, such as the use of cocreation and multimethod approaches. We will tabulate data for descriptive reporting and narrative synthesis to identify current applications, approaches and promising areas for living lab development across health contexts. ETHICS AND DISSEMINATION: Ethical approval was not required for this review. This review will inform research into living labs in health environments, including guidance for a living lab in paediatric rehabilitation. Academic publications shared through collaborative networks and social media channels will provide substantive knowledge to the growing tech-health development sector and to researchers, practitioners and organisations seeking enhanced patient/stakeholder engagement and innovations in knowledge translation and evidence-based practice. PROSPERO REGISTRATION NUMBER: CRD42020175275.

Bleomycin for Head and Neck Venolymphatic Malformations: A Systematic Review.

BACKGROUND: Venolymphatic malformations are rare benign vascular lesions of the head and neck. Sclerotherapy has become the first-line therapy of these lesions with bleomycin being a sclerosing agent commonly used. PURPOSE: To perform a systematic review of the published literature to synthesize evidence on the safety and efficacy of bleomycin for the treatment of head and neck venolymphatic malformations. DATA SOURCES: A systematic review of the literature (January 1995-May 2019) was performed in PubMed, Embase, and Cochrane Library databases to identify studies on sclerotherapy of venolymphatic malformations of the head and neck. STUDY SELECTION: A total of 32 studies with participants met the inclusion criteria among which 1121 patients were included in the systematic review. DATA ANALYSIS: Two reviewers independently screened and extracted data and assessed the risk of bias. The primary outcome was the subjective or objective reduction of lesion size as well as minor and major complications. DATA SYNTHESIS: The bleomycin/pingyangmycin sclerotherapy achieved subjective or objective lesion size reduction in 96.3% (95% CI 94.1%-98.5%) of patients. Minor complications were observed in 16.2% and major complications in 1.1%. CONCLUSION: Bleomycin is a highly effective treatment of venolymphatic malformations of the head and neck with a low rate of major adverse events. This study represents an update on the "available" evidence, but only low-to-moderate quality studies were available. LIMITATIONS: This study reviewed 32 studies performed in different parts of the world, but there was heterogeneity of the study designs and interventions.

Bleomycin for orbital and peri-orbital veno-lymphatic malformations - A systematic review.

BACKGROUND: Orbital and peri-orbital venolymphatic malformations (VLM) are low flow vascular malformations. Intralesional bleomycin is now commonly being used to treat such malformations. OBJECTIVE: The purpose of this systematic review is to synthesize evidence on the safety and efficacy of bleomycin/pingyangmycin sclerotherapy for the treatment of orbital and peri-orbital VLM. METHODS: We searched Medline, Embase, Scopus and Cochrane database for studies reporting outcomes of bleomycin/pingyangmycin sclerotherapy for orbital and peri-orbital VLM between 1974 to April 5th, 2019. Nine retrospective cohort studies enrolling 132 patients were included. Two reviewers independently screened and extracted data and assessed the risk of bias. Predefined outcome measures were subjective and objective reduction of the lesion and associated complications. RESULTS: Subjective reduction of the lesions was seen in 96.2% of the studies. Objective reduction of the lesion and symptomatic improvement were reported in 91.6 and 95% of the studies respectively. Non responders were 9.0%. Minor adverse events were reported in 18.1% of the studies. Major complications like pulmonary toxicity or pulmonary fibrosis was not encountered in any of the included studies. Quality of evidence was generally low. CONCLUSION: Bleomycin/pingyangmycin sclerotherapy is very effective and relatively safe for the treatment of orbital and periorbital VLM and is not associated with any major side effects including pulmonary fibrosis.Limitations: The systematic review is limited mainly due to low quality of the included studies with retrospective design.