The impact of elder abuse training on subacute health providers and older adults: study protocol for a randomized control trial.

BACKGROUND: Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers' recognition, response, and referral of elder abuse. METHODS: This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e. clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training programme for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are change in health providers' knowledge of responding to elder abuse and older people's sense of safety and quality of life. We will include all inpatients at participating sites, aged 65 + (or aged 50 + if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses. DISCUSSION: This will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral. TRIAL REGISTRATION: ANZCTR, ACTRN12623000676617p . Registered 22 June 2023.

Cancer Screening and Prevention in the Transgender and Gender Diverse Population: Considerations and Strategies for Advanced Practice Nurses.

OBJECTIVES: This discussion paper presents recent evidence regarding cancer screening and prevention among the transgender and gender diverse (TGD) community and highlights where and how advanced practice nurses (APNs), particularly those in primary care, can better contribute to closing the gap between healthcare disparities between TGD and cisgendered populations. METHODS: Relevant publications on the topic and professional guidelines and evidence have formed the basis for this discussion paper. RESULTS: TGD individuals are a vulnerable population with unique needs. They remain at risk of cancer and might be at greater risk of developing some cancers compared to cisgendered people but are underscreened. Barriers to gender-affirming care need to be addressed to improve access to prevention and screening services and improve the cancer care experiences and outcomes of TGD people. CONCLUSION: APNs can work in collaboration with TGD individuals and the healthcare system to improve access to culturally safe cancer screening and more effective prevention of cancer and poor cancer outcomes. IMPLICATIONS FOR NURSING PRACTICE: APNs have the potential to improve access to cancer screening for TGD people by increasing their understanding of the needs of the population, providing culturally safe care, and advocating for more preventative care and cancer screening. With greater knowledge and understanding of the needs and preferences of TGD people both broadly and in relation to cancer screening and prevention, targeted interventions and care approaches can be implemented. APNs should also aim to conduct evaluations and research into cancer prevention and screening to build the currently limited evidence base and nursing knowledge in this important field.

Large scoping reviews: managing volume and potential chaos in a pool of evidence sources.

Scoping reviews can identify a large number of evidence sources. This commentary describes and provides guidance on planning, conducting, and reporting large scoping reviews. This guidance is informed by experts in scoping review methodology, including JBI (formerly Joanna Briggs Institute) Scoping Review Methodology group members, who have also conducted and reported large scoping reviews. We propose a working definition for large scoping reviews that includes approximately 100 sources of evidence but must also consider the volume of data to be extracted, the complexity of the analyses, and purpose. We pose 6 core questions for scoping review authors to consider when planning, developing, conducting, and reporting large scoping reviews. By considering and addressing these questions, scoping review authors might better streamline and manage the conduct and reporting of large scoping reviews from the planning to publishing stage.

Culturally safe, appropriate, and high-quality breast cancer screening for transgender people: A scoping review.

Background: There is a recognized need for evidence to inform breast cancer screening guidelines and services for transgender people, who face barriers to accessing appropriate and inclusive health care. Aims: This review summarized evidence for breast cancer risk and screening guidelines in transgender individuals, including the potential impact of gender-affirming hormone therapy (GAHT); factors that may influence screening decision-making and behaviors; and considerations for providing culturally safe, high-quality screening services. Methods: A protocol was developed based on the Joanna Briggs Institute scoping review methodology. Searches were performed in Medline, Emcare, Embase, Scopus, and the Cochrane Library for articles reporting information on the provision of culturally safe, high-quality breast cancer screening services for transgender people. Results: We identified 57 sources for inclusion: 13 cross-sectional studies, 6 case reports, 2 case series, 28 review or opinion articles, 6 systematic reviews, 1 qualitative study, and 1 book chapter. Evidence on rates of breast cancer screening among transgender people and the association between GAHT and breast cancer risk was inconclusive. Factors negatively associated with cancer screening behaviors included socioeconomic barriers, stigma, and lack of health provider awareness of transgender health issues. Breast cancer screening recommendations varied and were generally based on expert opinion due to the lack of clear evidence. Considerations for providing culturally safe care to transgender people were identified and mapped to the areas of workplace policies and procedures, patient information, clinic environment, professional conduct, communication, and knowledge and competency. Discussion: Screening recommendations for transgender individuals are complicated by the lack of robust epidemiological data and clear understanding of the role GAHT may play in breast cancer pathogenesis. Guidelines have been developed based on expert opinion and are subsequently not uniform or evidence based. Further work is required to clarify and consolidate recommendations.

Experience of sudden sensorineural hearing loss following a mild COVID-19 infection.

A woman in her 30s was referred to an otolaryngologist with an acute onset of aural fullness, noise sensitivity, unilateral sudden onset hearing loss, vertigo and tinnitus. She had a confirmed COVID-19 infection 5 weeks prior. A pure tone audiogram confirmed sensorineural hearing loss. MRI identified an empty sella of the pituitary gland and without an obvious cause for hearing loss. Oral prednisolone and betahistine were prescribed, and her audiovestibular symptoms slowly improved over the subsequent months. The patient continues to experience intermittent tinnitus.

Time to solve persistent, pernicious and widespread nursing workforce shortages.

AIM: This paper discusses four main strategies for addressing nursing shortages that have been persistent, widespread and growing. Fallout from the COVID-19 pandemic might offer valuable impetus to address this tenacious challenge. BACKGROUND: Nursing shortages are common, widespread and have been persistent for most of a century. Many of the reasons behind these shortages are well known and are themselves enduring, as are the types of strategies put forward for addressing them. These strategies can generally be classified into four main categories: enhancing retention, improving recruitment, encouraging return to practice and drawing on international human resources. The COVID-19 pandemic is the latest major threat to ensuring a sufficiently sized and skilled nursing workforce. Many nurses have succumbed to burnout as well the plethora of factors that predated the pandemic and have a negative impact on nurse wellbeing, turnover and intention to leave. SOURCES OF EVIDENCE: This discussion paper draws on international sources of evidence. DISCUSSION/CONCLUSION: This paper highlights how many of the factors behind and strategies for addressing nursing shortages at the local, national and global levels are widely studied and known. A sustained combination of strategies that focus both within and beyond health and nursing, including on the broader social context, is necessary. While COVID-19 has been extremely damaging, it might present an opportunity to make sustainable, effective reforms to address nursing shortages. IMPLICATIONS FOR POLICY: Knowledge users must recognise that a combination of approaches across the gamut of policies that influence nursing workforces is necessary to address nursing shortages. Attention must also focus on factors beyond nursing and healthcare if shortages are to be remedied.

Reflection in the training of general practitioners in clinical practice settings: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to explore formalized methods of reflection that are used in clinical settings in general practice when training medical students, postgraduate trainees, general practitioners, and family physicians. INTRODUCTION: Medical professionals are increasingly required to demonstrate competency in their ability to reflect on clinical practice. To accommodate this, the teaching of reflection is common in medical programs; however, there is a lack of clarity in the literature on how reflection is taught. INCLUSION CRITERIA: This review will seek evidence describing the tools and approaches to reflection used by medical students, postgraduate trainees, and other registered medical professionals in general practice. The review will also include any evidence from those who teach reflection in a general practice setting. Evidence regarding reflection in training programs for other medical specialties will not be considered for inclusion. METHODS: This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), and the JBI methodology for scoping reviews. Databases to be searched will include MEDLINE (Ovid), Emcare (Ovid), Embase (Ovid), Web of Science, Scopus, and the Cochrane Database of Systematic Reviews. Extracted evidence will be presented using figurative, tabular, and accompanying narrative synthesis, in line with the review questions. REVIEW REGISTRATION NUMBER: Open Science Framework https://osf.io/uxw7d.

Barriers and enablers of culturally safe care for transgender and gender-diverse people in hospital emergency departments: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify barriers and enablers of the provision and accessibility of culturally safe care to transgender (trans) and gender-diverse patients in the emergency department. INTRODUCTION: Emergency departments have a unique role in creating patient experiences that influence positive or negative health outcomes. It is vital that emergency departments provide equitable experiences for all patients regardless of gender. Culturally safe care aims to support inclusive, effective, and appropriate care for trans and gender-diverse patients. Identifying the reported barriers and enablers of culturally safe care for trans and gender-diverse people in emergency departments will support knowledge users to advocate for and implement improvements to care. INCLUSION CRITERIA: This review will consider studies that describe barriers and enablers of accessing culturally safe care in emergency departments reported by trans and gender-diverse people, their families and loved ones, as well as health care workers involved in the provision of care. English-language, published, and gray literature sources from January 1, 2000, to the present from all countries will be eligible. METHODS: The review will follow the JBI methodology for scoping reviews and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Database searches of MEDLINE, Emcare, Embase, ScienceDirect, PsycINFO, Web of Science, Scopus, Google Scholar, and ProQuest will be undertaken. Data will be presented in tabular format or graphs, with an accompanying narrative summary.

Recommendations for the extraction, analysis, and presentation of results in scoping reviews.

Scoping reviewers often face challenges in the extraction, analysis, and presentation of scoping review results. Using best-practice examples and drawing on the expertise of the JBI Scoping Review Methodology Group and an editor of a journal that publishes scoping reviews, this paper expands on existing JBI scoping review guidance. The aim of this article is to clarify the process of extracting data from different sources of evidence; discuss what data should be extracted (and what should not); outline how to analyze extracted data, including an explanation of basic qualitative content analysis; and offer suggestions for the presentation of results in scoping reviews.

The role of scoping reviews in reducing research waste.

OBJECTIVES: Scoping reviews and evidence map methodologies are increasingly being used by researchers. The objective of this article is to examine how scoping reviews can reduce research waste. STUDY DESIGN AND SETTING: This article summarizes the key issues facing the research community regarding research waste and how scoping reviews can make an important contribution to the reduction of research waste in both primary and secondary research. RESULTS: The problem of research waste is an enduring challenge for global health, leading to a waste of human and financial resources and producing research outputs that do not provide answers to the most pressing research questions. Research waste occurs within primary research but also in secondary research such as evidence syntheses. The focus of scoping reviews on characterizing the nature of existing evidence on a topic and including all types of evidence, potentially reduces research waste in five ways: (1) identifying key research gaps on a topic, (2) determining appropriate outcome measures, (3) mapping existing methodological approaches, (4) developing a consistent understanding of terms and concepts used in existing evidence, and (5) ensuring scoping reviews do not exacerbate the issue of research waste. CONCLUSION: To ensure that scoping reviews do not themselves end up contributing to research waste, it is important to register the scoping review and to ensure that international reporting standards and methodological guidance are followed.

Nurse practitioner models of care in aged care: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify current and potential use of nurse practitioner models of care in aged care and to examine factors that have been linked to their failure or success in terms of establishment, sustainability, and expansion. INTRODUCTION: Nurse practitioners work across a variety of sectors, including aged care. Nurse practitioner models of care have been found to be safe, effective, and highly regarded by clients and patients across many areas. They have particular benefit in areas where access to physicians is challenging, as well as for vulnerable populations. This review will provide a consolidated evidence base to determine the current state of the evidence on nurse practitioner models of care in the aged care sector. INCLUSION CRITERIA: The review will consider studies on nurse practitioner models of care within aged care that report barriers/challenges and facilitators/success factors to their establishment, sustainability, and expansion. Evidence from all countries will be examined. Published and gray literature primary studies in English produced from 2010 onward will be eligible for inclusion. Expert opinion, including literature reviews, commentaries, and discussion, papers will be ineligible. METHODS: This review will utilize the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Databases to be searched include MEDLINE, Emcare, Embase, Web of Science, and Scopus. Figurative, tabular, and accompanying narrative synthesis will be used to present the results, in line with the review questions.

Putting People First: The Importance of Recommending Minimum Staffing Levels and Skills Mix.

Australia's Royal Commission into Aged Care Quality and Safety has concluded. The Commission's final report described a sector failing to deliver care that older Australians deserve despite the best efforts of many staff. Throughout the Commission, staffing was a frequent concern, with the size and composition of the direct care workforce a prominent focus. Throughout the Commission, many stakeholders campaigned for mandated staffing levels in skills mix in nursing homes and the Commission's report and Commonwealth Government response included recommendations for these. While this is a necessary step toward wider reform, the Royal Commission's recommendation and the Australian Government's response must support the delivery of best practice care more strongly. This column argues that the minimum standard for nursing home staff care time must be higher, and that higher minimum staffing levels and more clearly defined skills mix are critical to the delivery of safe, respectful, dignified person-centred care.

Moving from consultation to co-creation with knowledge users in scoping reviews: guidance from the JBI Scoping Review Methodology Group.

ABSTRACT: Knowledge user consultation is often limited or omitted in the conduct of scoping reviews. Not including knowledge users within the conduct and reporting of scoping reviews could be due to a lack of guidance or understanding about what consultation requires and the subsequent benefits. Knowledge user engagement in evidence synthesis, including consultation approaches, has many associated benefits, including improved relevance of the research and better dissemination and implementation of research findings. Scoping reviews, however, have not been specifically focused on in terms of research into knowledge user consultation and evidence syntheses. In this paper, we will present JBI's guidance for knowledge user engagement in scoping reviews based on the expert opinion of the JBI Scoping Review Methodology Group. We offer specific guidance on how this can occur and provide information regarding how to report and evaluate knowledge user engagement within scoping reviews. We believe that scoping review authors should embed knowledge user engagement into all scoping reviews and strive towards a co-creation model.

Addressing vaccine hesitancy and resistance for COVID-19 vaccines.

The COVID-19 vaccine rollout has had various degrees of success in different countries. Achieving high levels of vaccine coverage is key to responding to and mitigating the impact of the pandemic on health and aged care systems and the community. In many countries, vaccine hesitancy, resistance, and refusal are emerging as significant barriers to immunisation uptake and the relaxation of policies that limit everyday life. Vaccine hesitancy/ resistance/ refusal is complex and multi-faceted. Individuals and groups have diverse and often multiple reasons for delaying or refusing vaccination. These reasons include: social determinants of health, convenience, ease of availability and access, health literacy understandability and clarity of information, judgements around risk versus benefit, notions of collective versus individual responsibility, trust or mistrust of authority or healthcare, and personal or group beliefs, customs, or ideologies. Published evidence suggests that targeting and adapting interventions to particular population groups, contexts, and specific reasons for vaccine hesitancy/ resistance may enhance the effectiveness of interventions. While evidence regarding the effectiveness of interventions to address vaccine hesitancy and improve uptake is limited and generally unable to underpin any specific strategy, multi-pronged interventions are promising. In many settings, mandating vaccination, particularly for those working in health or high risk/ transmission industries, has been implemented or debated by Governments, decision-makers, and health authorities. While mandatory vaccination is effective for seasonal influenza uptake amongst healthcare workers, this evidence may not be appropriately transferred to the context of COVID-19. Financial or other incentives for addressing vaccine hesitancy may have limited effectiveness with much evidence for benefit appearing to have been translated across from other public/preventive health issues such as smoking cessation. Multicomponent, dialogue-based (i.e., communication) interventions are effective in addressing vaccine hesitancy/resistance. Multicomponent interventions that encompasses the following might be effective: (i) targeting specific groups such as unvaccinated/under-vaccinated groups or healthcare workers, (ii) increasing vaccine knowledge and awareness, (iii) enhanced access and convenience of vaccination, (iv) mandating vaccination or implementing sanctions against non-vaccination, (v) engaging religious and community leaders, (vi) embedding new vaccine knowledge and evidence in routine health practices and procedures, and (vii) addressing mistrust and improving trust in healthcare providers and institutions via genuine engagement and dialogue. It is universally important that healthcare professionals and representative groups, as often highly trusted sources of health guidance, should be closely involved in policymaker and health authority decisions regarding the establishment and implementation of vaccine recommendations and interventions to address vaccine hesitancy.

What are scoping reviews? Providing a formal definition of scoping reviews as a type of evidence synthesis.

ABSTRACT: Evidence synthesis encompasses a broad range of review types, and scoping reviews are an increasingly popular approach to synthesizing evidence in a number of fields. They sit alongside other evidence synthesis methodologies, such as systematic reviews, qualitative evidence synthesis, realist synthesis, and many more. Until now, scoping reviews have been variously defined in the literature. In this article, we provide the following formal definition for scoping reviews: Scoping reviews are a type of evidence synthesis that aims to systematically identify and map the breadth of evidence available on a particular topic, field, concept, or issue, often irrespective of source (ie, primary research, reviews, non-empirical evidence) within or across particular contexts. Scoping reviews can clarify key concepts/definitions in the literature and identify key characteristics or factors related to a concept, including those related to methodological research.

Best practice guidance and reporting items for the development of scoping review protocols.

OBJECTIVE: The purpose of this article is to clearly describe how to develop a robust and detailed scoping review protocol, which is the first stage of the scoping review process. This paper provides detailed guidance and a checklist for prospective authors to ensure that their protocols adequately inform both the conduct of the ensuing review and their readership. INTRODUCTION: Scoping reviews are a common approach to evidence synthesis for researchers, clinicians, and policymakers across a variety of fields. Scoping reviews are not concerned with making analytical comparisons based on pooling results data from multiple primary sources of evidence, but rather on collating and describing the evidence and presenting the summation in a clearly illustrated format. Methods for undertaking and reporting scoping reviews continue to be refined. Some prospective reviewers may be uncertain how to plan, structure, and report scoping review protocols, as there is little or no specific guidance for scoping review protocols yet available. METHODS: This guidance was developed by members of the JBI Scoping Review Methodology Group based on previous experience and expertise in developing scoping review and evidence synthesis methodologies, protocols, and reviews, as well as through experiences working with and guiding authors to develop scoping review protocols. Elements of a comprehensive scoping review protocol are outlined and explained in detail. CONCLUSION: Knowledge users of evidence syntheses rely on clear and transparent reporting to understand and use the results of published work to drive evidence-based improvements within health care and beyond. It is hoped that readers will be able to use this guidance when developing protocols to assist them in planning future scoping reviews and to carry them out with a high degree of transparency.