Interventions addressing maternal and child health among the urban poor and homeless: an overview of systematic reviews.

BACKGROUND: Inequalities in access to and utilization of maternal and child health (MCH) care are hampering progress on the path to achieving the Sustainable Development Goals. In a number of Low- and Middle-Income Countries (LMICs) population subgroups at disproportionate risk of being left behind are the urban poor. Within this neglected group is the further neglected group of the homeless. Concomitantly, a number of interventions from the antenatal period onward have been piloted, tested, and scaled in these contexts. We carried out an overview of systematic reviews (SRs) to characterize the evidence around maternal and child health interventions relevant to urban poor homeless populations in LMICs. METHODS: We searched Medline, Cochrane Library, Health Systems Evidence and EBSCOhost databases for SRs published between January 2009 and 2020 (with an updated search through November 2021). Our population of interest was women or children from urban poor settings in LMICs; interventions and outcomes corresponded with the World Health Organization's (WHO) guidance document. Each SR was assessed by two reviewers using established standard critical appraisal checklists. The overview was registered in PROSPERO (ID: CRD42021229107). RESULTS: In a sample of 33 high quality SRs, we found no direct relevant evidence for pregnant and lactating homeless women (and children) in the reviewed literature. There was a lack of emphasis on evidence related to family planning, safe abortion care, and postpartum care of mothers. There was mixed quality evidence that the range of nutritional interventions had little, unclear or no effect on several child mortality and development outcomes. Interventions related to water, sanitation, and hygiene, ensuring acceptability of community health services and health promotion type programs could be regarded as beneficial, although location seemed to matter. Importantly, the risk of bias reporting in different reviews did not match, suggesting that greater attention to rigour in their conduct is needed. CONCLUSION: The generalizability of existing systematic reviews to our population of interest was poor. There is a clear need for rigorous primary research on MCH interventions among urban poor, and particularly homeless populations in LMICs, as it is as yet unclear whether the same, augmented, or altogether different interventions would be required.

The Development and Use of Evidence Summaries for Point of Care Information Systems: A Streamlined Rapid Review Approach.

BACKGROUND: A systematic review of evidence is the research method which underpins the traditional approach to evidence-based health care. As systematic reviews follow a rigorous methodology, they can take a substantial amount of time to complete ranging in duration from 6 months to 2 years. Rapid reviews have been proposed as a method to provide summaries of the literature in a more timely fashion. AIM: The aim of this paper is to outline our experience of developing evidence summaries in the context of a point of care resource as a contribution to the emerging field of rapid review methodologies. METHODS: Evidence summaries are defined as a synopsis that summarizes existing international evidence on healthcare interventions or activities. These summaries are based on structured searches of the literature and selected evidence-based healthcare databases. Following the search, all studies are assessed for internal validity using an abridged set of critical appraisal tools. Once developed, they undergo three levels of peer review by internal and external experts. RESULTS: As of November 2014, there are 2458 evidence summaries that have been created across a range of conditions to inform evidence-based healthcare practices. In addition, there is ongoing development of various new evidence summaries on a wide range of topics. Approximately 60-70 new evidence summaries are published every month, covering research in various medical specialty areas. All summaries are updated annually. LINKING EVIDENCE TO ACTION: Systematic reviews, although the ideal type of research to inform practice, often do not meet the needs of users at the point of care. This article describes the development framework for the creation of evidence summaries, a type of rapid review. Although evidence summaries may result in a less rigorous process of development, they can be useful for improving practice at the point of care.

The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies.

Systematic reviews of effectiveness offer a rigorous synthesis of the best evidence available regarding the effects of interventions or treatments. Randomized controlled trials are considered the optimal study design for evaluating the effectiveness of interventions and are the ideal study design for inclusion in a systematic review of effectiveness. In the absence of randomized controlled trials, quasi-experimental studies may be relied on to provide information on treatment or intervention effectiveness. However, such studies are subject to unique considerations regarding their internal validity and, consequently, the assessment of the risk of bias of these studies needs to consider these features of design and conduct. The JBI Effectiveness Methodology Group has recently commenced updating the suite of JBI critical appraisal tools for quantitative study designs to align with the latest advancements in risk of bias assessment. This paper presents the revised critical appraisal tool for risk of bias assessment of quasi-experimental studies; offers practical guidance for its use; provides examples for interpreting the results of risk of bias assessment; and discusses major changes from the previous version, along with the justifications for those changes.

The revised JBI critical appraisal tool for the assessment of risk of bias for cohort studies.

Cohort studies are a robust analytical observational study design that explore the difference between two different cohorts on an outcome, differentiated by their exposure status. Despite being observational in nature, they are often included in systematic reviews of effectiveness, particularly when randomized controlled trials are limited or not feasible. Like all studies included in a systematic review, cohort studies must undergo a critical appraisal process to assess the extent to which a study has considered potential bias in its design, conduct, or analysis. Critical appraisal tools facilitate this evaluation. This paper introduces the revised critical appraisal tool for cohort studies, completed by the JBI Effectiveness Methodology Group (EMG), who are currently revising the suite of JBI critical appraisal tools for quantitative study designs. The revised tool responds to updates in methodological guidance from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group and reporting guidance from PRISMA 2020, providing a robust framework for evaluating risk of bias in a cohort study. Transparent and rigorous assessment using this tool will assist reviewers in understanding the validity and relevance of the results and conclusions drawn from a systematic review that includes cohort studies. This may contribute to better evidence-based decision-making in health care. This paper discusses the key changes made to the tool, justifications for these changes, and provides practical guidance on how this tool should be interpreted and applied by systematic reviewers.

Tools to assess quality of life in adults with chronic conditions in India: A scoping review.

Background: Chronic diseases are a major contributor to mortality, morbidity, and socio-economic costs globally, including in India. Quality of life (QoL) is an important patient-centered outcome for chronic disease. Measurement properties of tools for assessing QOL in the Indian context have not been assessed systematically. Methods: A scoping review was conducted, and four major electronic databases were searched. Screening was conducted by at least two independent reviewers, with a third person acting as an arbiter. Data from the retrieved full texts were extracted by one reviewer, with a sample verified by another reviewer to reduce any data extraction errors. A narrative synthesis was done with a focus on measurement properties of tools, including but not limited to internal consistency, inter-rater reliability, test-retest reliability, validity, and acceptability. Results: Out of 6706 records retrieved, a total of 37 studies describing 34 tools (both generic and disease-specific tools) for 16 chronic conditions were included. Most of the studies were cross-sectional (n = 23). Overall, most tools had acceptable internal consistency (Cronbach's alpha value ≥0.70) and good-to-excellent test-retest reliability (intra-class correlation coefficient = 0.75-0.9), but there was variability in acceptability. In terms of acceptability, seven tools were positively assessed (meeting psychometric property requirements), but all except the World Health Organization QoL tool were disease specific. Many tools have also been tested for local context, and many translated and tested in one or few languages only, thus limiting their usability across the nation. Women were underrepresented in many studies, and tools were not evaluated in other genders. Generalizability to tribal people is also limited. Conclusion: The scoping review provides a summary of all QOL assessment tools for people with chronic diseases in India. It supports future researchers to make informed decisions for choosing tools. The study highlights the need for more research to develop QOL tools which are contextually applicable and enables the comparability across diseases, people, and regions within India and potentially in the South Asian region.

Facilitation as a component of evidence implementation: a multinational perspective.

BACKGROUND: Facilitation is a key component of JBI's approach to evidence implementation along with context analysis and evaluation of process and outcomes. Although the role of facilitation is recognized as a critical component of evidence implementation, what constitutes effective facilitation is poorly understood. AIM: This article presents a descriptive exploration of facilitation as it occurs in evidence implementation initiatives conducted in various healthcare and geographical contexts. All projects used the JBI approach to evidence implementation. METHODS: To provide a multinational perspective on how facilitation was operationalized to promote positive changes in clinical practice and health outcomes, five case studies of evidence implementation projects are presented. RESULTS: The cases highlighted that facilitation is a multifaceted process that can be met through a variety of roles that address aspects of education and capacity building, partnerships, action planning, problem solving and evaluation. Facilitation in all cases appeared to be collaborative, with multiple 'players' within and outside of the health organization being involved in the process. Although there are similarities in activities, facilitation involved some level of local contextualization where there were unique or additional activities performed to accommodate the local needs and requirements of the health organization involved in each case. Numerous contextual factors influenced the success of the implementation initiative. CONCLUSION: The cases emphasized the complex nature of facilitation as a strategy for evidence implementation, indicating that contextual attributes and features define the range of knowledge, skills, and activities that should take place in order for facilitation to be effective. Although there appears to be some core components, tailoring and adaptation of the facilitation process (or roles) is required.

Diagnostic accuracy of screening tools for chronic obstructive pulmonary disease in primary health care: Rapid evidence synthesis.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) contributed significantly to burden of diseases in India, with missed, incorrect, and delayed diagnosis in primary care. We conducted a rapid evidence synthesis, to summarize the evidence on accuracy of the screening tests for COPD in primary health care on request form State Health Resource Centre, Chhattisgarh. METHODS: Considering the rapid nature of decision making, our approach was to first search for existing systematic reviews. We identified one existing systematic review on the topic with the search conducted until 2014. We updated the review by searching in two major databases screened, title/abstracts, and full texts of studies as per eligibility criteria and extracted relevant data. A narrative synthesis was conducted. RESULTS: We retrieved 7,007 and included five new studies, to add to 10 studies of the existing systematic review. Overall, 13 studies assessed diagnostic accuracy of screening questionnaires [e.g., COPD Diagnostic Questionnaire (CDQ)], five assessed handheld flow meters (COPD6 and PICO-6), and four assessed the combination of both the tests. The CDQ questionnaire using a score threshold ≥16.5 or >17 demonstrated comparatively a higher sensitivity both in pooled result for ever-smokers [87.5% (95% CI 83.1--90.9%)] and among the adults >35 years [73.8--93% (95% CI 69--98%)] when compared to a different score threshold of CDQ and other questionnaires. Handheld flow meters reported a pooled high sensitivity of 79.9% (95% CI 74.2--84.7%) in ever-smokers and 87.9% in adults with age >35 years. CONCLUSIONS: The need for better diagnosis of COPD in primary healthcare can be addressed by using of COPD Diagnostic Questionnaire alone or in combination with hand-held flow meters. There is scope for more implementation research on the domain.

Nutritional screening and nutritional interventions in patients following gastrointestinal surgery in a general surgical ward: a best practice implementation project.

OBJECTIVES: The aim of this implementation project was to improve nutritional screening and nutritional interventions for patients scheduled for gastrointestinal surgery in a general surgical ward. INTRODUCTION: Malnutrition is common in hospitalized surgical patients and has many adverse outcomes affecting the patients' quality of life. Improving nutritional risk screening and nutritional support could reduce the incidence of malnutrition and its adverse outcomes. METHODS: The project used the JBI audit and feedback method to implement evidence into practice. JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used for promoting change in general surgical wards. Six audit criteria were created based on an evidence summary, including using screening tool, patients' and caregivers' education, nurses' education on nutritional screening and support, preoperative nutrition support and postoperative early food intake. A baseline audit was conducted, followed by nursing information system improvement, education, multidisciplinary meetings targeted at clinicians and two cycles of follow-up audits. RESULTS: Results from the baseline and follow-up audits showed improvement for all the criteria. Compliance for criteria 1-3 increased from 0 to 100%, and that for criterion 4 increased from 32 to 100%. These four criteria sustained 100% in follow-up cycle 2. Compliance for criterion 5 increased from 8 to 50% in follow-up cycle 1 audit, but decreased to 0% in follow-up cycle 2 audit, and similarly for criterion 6, compliance increased from 45 to 56% in follow-up cycle 1 audit, but decreased to 48% in follow-up cycle 2 audit. CONCLUSION: The objectives related to nutritional risk screening, nurse knowledge, patients and families were successfully realized and sustained positive results. This project demonstrated that a nursing information system and long-term patient education are essential strategies to achieve and sustain positive results. The objectives related to preoperative nutritional support and postoperative early enteral food intake were challenges and represented barriers. In future, a multiple-pronged strategy will be implemented to achieve overall success and change according to best practice.

Prevention, control and management of leptospirosis in India: an evidence gap map.

Leptospirosis is an emerging public health problem in India. We developed an evidence gap map (EGM) on prevention, control and management of leptospirosis in India to inform research priorities. The EGM framework was developed in consultation with stakeholders and noted key parameters to influence state and national level research priorities. We searched six electronic databases and three relevant websites and included 27 studies (humans, 23; animals, 4; both, 0). Most studies (17/27 [63%]) were from three high-burden states. Controlled clinical trials (non-randomised, 6/27 [22%]; randomised, 2/27 [7%]) and pre-post studies (6/27 [22%]) suitable for evaluating interventions were sparse. Only 26% studies (6/23 human studies) included high-risk groups like animal caretakers, tribal people, relief/sanitation workers, pregnant women and people from slums. Nearly 56% of studies (15/27) evaluated pharmacological interventions at an individual level. Community-level interventions were limited (4/27 [15%]) with no studies on vaccination, personal protection, antibiotic policy or water, sanitation and hygiene interventions. Health systems and policy or multicomponent studies were rare (5/27 [19%]) with no reporting of key outcomes like healthcare coverage, quality of care and other relevant outcomes to evaluate interventions. There is a need for prioritising research to evaluate prevention and control interventions, including the One Health approach. Embedding national-level EGMs for research prioritisation exercises should be considered.

A rapid review of evidence on the determinants of and strategies for COVID-19 vaccine acceptance in low- and middle-income countries.

BACKGROUND: Vaccine acceptance and hesitancy among the general population and health care workers play an important role in successfully controlling the Coronavirus Disease (COVID)-19 pandemic. While there is evidence for vaccine hesitancy across the globe, wide variation in factors influencing vaccine acceptance has been reported, mainly from High-Income Countries (HIC). However, the evidence from Low- and Middle-Income Countries (LMICs) remains unclear. The objective of this review was to describe the determinants of vaccine acceptance and strategies to address those in an LMIC context. METHODS: The World Health Organization's (WHO) Measuring Behavioral and Social Drivers of Vaccination (BeSD) Increasing Vaccination Model was employed to identify factors that influenced vaccine acceptance. All evidence related to supply-side and demand-side determinants and social and health system processes were examined. A comprehensive search for published literature was conducted in three databases and grey literature in relevant websites of government, multinational agencies, and COVID-19 resource aggregators, followed by a narrative synthesis. RESULTS: Overall, the results showed that the vaccine acceptance rates differed across LMICs, with a wide variety of reasons cited for vaccine hesitancy. Vaccine acceptance was reportedly greater among males, those with higher education, elevated socio-economic status, the unmarried, those employed as health care workers. Evidence suggested that exposure to misinformation about COVID-19 vaccines and public concerns over the safety of vaccines may contribute to lower acceptance rates. Strategies to increase vaccine acceptance rates included direct engagement with communities through influencers, including community leaders and health experts; clear and transparent communication about COVID-19 vaccines, financial and non-financial incentives; and strong endorsement from health care workers. Trust in government was identified as a significant enabler of vaccine acceptance. CONCLUSIONS: There is a need for measures to address public acceptability, trust and concern over the safety and benefit of approved vaccines. Local context is essential to consider while developing programs to promote vaccine uptake. The governments worldwide also need to strategize to develop plans to address the anxiety and vaccine related concerns of community regarding vaccine hesitancy. There is a need for further research to evaluate strategies to address vaccine hesitancy in LMIC.

Leptospirosis prevalence and risk factors in India: Evidence gap maps.

Leptospirosis is a zoonotic disease of public health importance in India. A country-level evidence gap map was developed to identify gaps on epidemiology of leptospirosis. It is the first such on leptospirosis globally and on any single disease condition in India. The steps for development of evidence gap map were development of a framework to map evidence, retrieval of evidence, data extraction parameters and mapping of available evidence in evidence gap map framework. The prevalence evidence gap map consisted of 157 studies (102 in humans, 55 in animals, and 12 in both). The evidence gap map on risk factors had 120 studies (102 in humans, 11 in animals and 7 in both). There were inter-state differences in availability of research and disparity between animal and human research. Research on high-risk groups was limited and studies did not use the One Health approach to identify epidemiology, which can help understand the issue more comprehensively. The study demonstrates the potential of evidence gap maps to inform research priorities.

Mid-level health providers for primary healthcare: a rapid evidence synthesis.

Background: Health care services, in many countries, are increasingly being provided by cadres not trained as physicians, but capable of performing several diagnostic and clinical functions. These substitute health workers are referred to as mid-level health providers (MLHPs). The health and wellness centres under India's Comprehensive Primary Health Care programme have teams led by MLHPs who can aid doctors. The objective of this study was to rapidly synthesise evidence on the effectiveness of MLHPs for primary health care. Methods: The review team undertook a rapid overview of systematic reviews that compared MLHPs with doctors and different types of MLHPs involved in the delivery of health care were included, with a perspective on low- and middle-income countries, including India. Results: Seven systematic reviews were included in the final report. Mortality outcomes in relation to pregnancy and childbirth care services showed no significant differences in care provided by MLHPs when compared with doctors. Pregnancy care provided by midwives was found to slightly improve quality of care when compared to care delivered by doctors. The risk of failure or incomplete abortion for surgical abortion procedures provided by MLHPs was twice when compared to the procedures provided by doctors. Moderate to high certainty evidence showed that initiation and maintenance of antiretroviral therapy for HIV-infected patients by a nurse or clinical officer slightly reduced mortality. High certainty evidence showed that chronic disease management by non-medical prescribers reduced some important physiological measures when compared to medical prescribing by doctors. Conclusions: To date, this is the first rapid overview of evidence on MLHPs. Evidence suggests that MLHPs might be suitable to deliver quality care in certain areas of health and they may be relevant and feasible in countries like India. However, the roles and subsequent training and regulation of MLHPs might be different for different care domains.

Community health workers for pandemic response: a rapid evidence synthesis.

INTRODUCTION: Coronavirus disease (COVID-19), affects 213 countries or territories globally. We received a request from National Health Systems Resource Centre, a public agency in India, to conduct rapid evidence synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control in 3 days. METHODS: We searched PubMed, websites of ministries (n=3), public agencies (n=6), multilateral institutions (n=3), COVID-19 resource aggregators (n=5) and preprints (n=1) (without language restrictions) for articles on CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data with another reviewer cross-checking it. A framework on CHW performance in primary healthcare not specific to pandemic was used to guide data extraction and narrative analysis. RESULTS: We retrieved 211 records and finally included 36 articles. Most of the evidence was from low-and middle-income countries with well-established CHW programmes. Evidence from CHW programmes initiated during pandemics and for CHW involvement in pandemic response in high-income countries was scant. CHW roles and tasks change substantially during pandemics. Clear guidance, training for changed roles and definition of what constitutes essential activities (ie, those that must to be sustained) is required. Most common additional activities during pandemics were community awareness, engagement and sensitisation (including for countering stigma) and contact tracing. CHWs were reported to be involved in all aspects of contact tracing - this was reported to affect routine service delivery. CHWs have often been stigmatised or been socially ostracised during pandemics. Providing PPE, housing allowance, equal training opportunities, transportation allowance, improving salaries (paid on time and for a broad range of services) and awards in high-profile public events contributed to better recruitment and retention. We also created inventories of resources with guiding notes on guidelines for health workers (n=24), self-isolation in the community (n=10) and information, education and counselling materials on COVID-19 (n=16). CONCLUSIONS: CHWs play a critical role in pandemics. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. More implementation research on CHWs in pandemics is required.

The ripple effect of evidence implementation: a descriptive evaluation of JBI's Evidence-based Clinical Fellowship Program.

BACKGROUND: Across healthcare there are acknowledged gaps in the translation of evidence into clinical practice. Undertaking a structured implementation program may assist clinicians to achieve this in their clinical practice setting. AIMS/METHODS: The current study descriptively evaluates and analyzes the impact of JBI's (formerly known as the Joanna Briggs Institute) Evidence-based Clinical Fellowship program, since its inception in 2005. RESULTS: Since its inception the JBI Evidence-based Clinical Fellowship Program has trained over 560 Clinical Fellows. The program consists of two 1-week intensive training workshops at JBI, collaborating with a JBI Research Fellow facilitator, with each participant then conducting a workplace evidence implementation project over the intervening 6 months in their own clinical setting. A 'train-the-trainer' program was established to provide accredited trainers to run the program through established JBI Collaborating Entities. CONCLUSION: Implementation of research evidence into the clinical setting is challenging for health professionals. A pragmatic approach adopted through the JBI Evidence-based Clinical Fellowship Program ensures that the Clinical Fellow remains central as the program leader, but has direction and support from their team of various stakeholders, and ongoing collaboration with a JBI facilitator. This ensures increased capacity for engagement and ongoing sustainability of future implementation programs.

Methodological quality of case series studies: an introduction to the JBI critical appraisal tool.

INTRODUCTION: Systematic reviews provide a rigorous synthesis of the best available evidence regarding a certain question. Where high-quality evidence is lacking, systematic reviewers may choose to rely on case series studies to provide information in relation to their question. However, to date there has been limited guidance on how to incorporate case series studies within systematic reviews assessing the effectiveness of an intervention, particularly with reference to assessing the methodological quality or risk of bias of these studies. METHODS: An international working group was formed to review the methodological literature regarding case series as a form of evidence for inclusion in systematic reviews. The group then developed a critical appraisal tool based on the epidemiological literature relating to bias within these studies. This was then piloted, reviewed, and approved by JBI's international Scientific Committee. RESULTS: The JBI critical appraisal tool for case series studies includes 10 questions addressing the internal validity and risk of bias of case series designs, particularly confounding, selection, and information bias, in addition to the importance of clear reporting. CONCLUSION: In certain situations, case series designs may represent the best available evidence to inform clinical practice. The JBI critical appraisal tool for case series offers systematic reviewers an approved method to assess the methodological quality of these studies.

The development of software to support multiple systematic review types: the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI).

AIM: Systematic reviews play an important role in ensuring trustworthy recommendations in healthcare. However, systematic reviews can be laborious to undertake and as such software has been developed to assist in the conduct and reporting of systematic reviews. The Joanna Briggs Institute and its collaborating centres consist of thousands of researchers, academics and clinicians across the globe conducting systematic reviews of various types. To support them in their work, modern software and online tools are required. Our aim was to develop a software program to support systematic reviewers across the globe. METHODS: A working party was formed with extensive consultation with members of the Joanna Briggs Collaboration focusing on ideal features of a software program to support systematic reviews. The new systematic review software was built using an agile methodology and designed to be a modern web application. RESULTS: The new systematic review software, the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI), was successfully developed through an iterative process of development, feedback, testing and review. The software is now available (https://www.jbisumari.org/) and supports the entire systematic review process for different types of systematic reviews. CONCLUSIONS: An agile software development approach combined with wide consultation and user testing can facilitate systematic review software design and development. This new software can support systematic reviews and guideline developers to create systematic reviews for a diverse range of questions.

The prevalence of disability among people with cancer, cardiovascular disease, chronic respiratory disease and/or diabetes: a systematic review.

BACKGROUND: Cardiovascular disease (CVD), cancer, diabetes and chronic respiratory disease are noncommunicable diseases (NCDs) that cause extensive social and economic burden worldwide, particularly in low-income and middle-income countries. There is growing recognition of the importance of the disabilities that individuals experience as a consequence of these NCDs. OBJECTIVES: This systematic review examined the prevalence of disabilities associated with cancer, CVD, chronic respiratory disease and diabetes. METHODS: A comprehensive literature search was conducted in PubMed, CINAHL, Embase, Web of Science, PsycINFO, CIRRIE, WHO database, LILACS and AIM. Studies were included if their samples were representative of people with at least one of these four conditions and if prevalence estimates of disability were provided. As random sampling was not feasible in the majority of cases, studies were included where they offered evidence that their sample was representative of the general population being investigated. RESULTS: A total of 105 articles were included in the review. Most studies were conducted in high-income countries. The prevalence of difficulties with activities of daily living (i.e. eating, bathing, dressing) was reported to be 10.4-34.5% amongst cancer survivors, 21.1-64.1% in those with CVD, 7.4-49.8% in those with chronic respiratory disease and 12.2-54.5% for those with diabetes. The prevalence of a range of other physical, cognitive and psychological impairments (systemic or structural) was additionally described for each disease. CONCLUSION: Substantial proportions of people with cancer, CVD, chronic respiratory disease or diabetes experience some form of disability - although there was great variance in prevalence and definitions. The findings of this review support the evidence base of global impact associated with NCD, indicate frequency measures for specific disabilities and inabilities associated with each NCD and provide direction for future systematic reviews. WHAT IS KNOWN ABOUT THE TOPIC: WHAT THIS ARTICLE ADDS.

Artemisinin based combination therapy for uncomplicated malaria management among children under five in Cameroon: a best practice implementation project.

OBJECTIVE: The aim of this evidence implementation project is to promote evidence-based practice in artemisinin-based combination therapy for managing uncomplicated malaria in children under five, thereby improving patient outcomes and resource utilization in the Bali Health District, Cameroon. INTRODUCTION: The burden of disease attributable to malaria has significantly improved in the last three years, however morbidity and mortality risks are still present, especially for children under five. In children with uncomplicated P. falciparum malaria, there is strong evidence to suggest that artemisinin-based combination therapy (ACT) is effective in treating malaria. The World Health Organization has strong recommendations with high-quality evidence guiding practice in the "test, treat and track" approach using microscopy, rapid diagnostics tests and ACTs. METHODS: This evidence implementation project used the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool for promoting evidence-based healthcare involving three phases of activity. RESULTS: We compared compliance with best practice recommendations at baseline against a follow-up compliance at four months, following implementation of strategies identified. Compliance rates improved overall by 31% (R: 20-42) for all criteria and sites, with differences noticed between sites. Nineteen barriers were identified, stratified into clinician, community health worker, patient and policy maker related barriers. CONCLUSIONS: Despite existing barriers to evidence implementation, getting research into practice is possible and does improve quality of care.

Initial perceptions of, and intention to use, an online guideline adaptation framework: a descriptive survey.

AIM: The aim of this research was to evaluate CAN-Implement.Pro as a structured and systematic process for planning local evidence implementation, to develop a contextual and demographic profile of potential users and assess their initial perceptions and intention to use CAN-Implement.Pro. METHODS: Ethics approval was obtained from the University of Adelaide Human Research Ethics Committee (Approval number: H-2016-157). A descriptive cross-sectional study was undertaken to capture the demographic characteristics of participants, as well as their initial perceptions of, and intention to use, the software for guideline adaptation projects. RESULTS: A total of 21 individuals representing guideline groups completed the survey. Only 43% had taken part in at least one previous implementation project. Thirty-three percent reported embarking on their first implementation project; 24% had yet to participate in an evidence implementation project. Nursing was the most highly referenced profession at 75%, followed by medical specialties (40%); two respondents indicated allied health professions were included in their implementation group. Respondents represented countries or regions of high and upper middle income as classified by the WHO Regional Office for the Eastern Mediterranean. The majority (67%) found CAN-Implement.Pro to be well-organized, easy to navigate and reliable. Most (80%) also indicated they were more likely to return to the software than not; 20% were neutral. In terms of overall satisfaction, more than half (60%) were very satisfied or satisfied, a third (33%) was neutral and 7% were dissatisfied. Over 66% of the respondents considered their group to be familiar with the knowledge-to-action model. A slightly higher percentage (74%) reported software based upon the knowledge-to-action model had a strong conceptual framework. In terms of evidence informed functionality, 75% of the respondents concluded that the software could assist guideline groups to provide structure for their implementation planning; a similar proportion (75%) indicated that the software would also enhance or improve coordination, communication and logistics management in guideline-related implementation projects. Participants were familiar with a range of resources, models, theories and frameworks for implementation, implementation planning and guideline adaptation. The most common frameworks were related to behavioural theories or variations of the Promoting Action on Research Implementation in Health Services framework. CONCLUSION: Eighty percent of the respondents indicated that their group would be likely to use the software to guide implementation planning in future projects, whereas 20% were neutral. In terms of expectations for contemporary software, multimedia resources rated highly, as did interactive components within the knowledge-to-action model.

Strategies to reduce medication omissions in an acute medical unit of an acute tertiary hospital: a best practice implementation project.

BACKGROUND: Medication incidents are the second most frequently occurring incident in Australian hospitals. The number of medication incidents in the targeted unit of this project has increased this year compared with previous year, and medication omissions accounted for a significant portion of these incidents. AIMS AND OBJECTIVES: The aim of this project was to identify medication omissions and develop and implement strategies to reduce medication omissions in the targeted medical unit in compliance with best practice. METHODS: This implementation project was conducted in an acute medical unit of an acute tertiary hospital. Evidence-based audit criteria were developed on the basis of an evidence summary developed by the Joanna Briggs Institute. Using the Joanna Briggs Institute Practical Application of Clinical Evidence System software, a baseline audit was conducted including a sample size of 21 patients followed by an identification of barriers of medication omissions and development of strategies to reduce medication omissions. A follow-up audit including a sample size of 24 patients was conducted by using same audit criteria. Twenty-four nursing staff were surveyed in both baseline and follow-up audits. RESULT: The baseline audit results showed that most audit criteria results were found to be less than 50%, which indicated poor compliance with the current evidence. Following implementation of the strategies, which included education, development of a "Medication Omission Reminder Card" and a regular weekly audit on medication omissions, there was an improvement in all the criteria audited, with criteria 3 and 4 achieving 100% compliance, and criteria 1 and 2 showing 45% and 13% compliance, respectively. CONCLUSION: Medication omissions were reduced on the completion of the project as there was an increased awareness of the medication omissions standards and medication safety among the nursing staff in the unit.