International migration is contributing to changes in the sociocultural and the economic landscapes of many cities in the world. As part of the changes in cities, we are witnessing an increased use of community gardens as spaces for wellbeing restoration, for social connection, and for addressing the challenge of food insecurity, particularly cultural food insecurity. Cultural food security is one major under-recognized issue, yet is pivotal to address given its role in positively supporting immigrants' settlement and health. However, there is lack of comprehensive evidence of how neighborhoods are changing to accommodate these initiatives and meet the cultural food needs of diverse communities. Our scoping review explored evidence from existing literature on how neighborhoods are changing to accommodate community gardens (CG) as a novel means to address cultural food insecurity among immigrant communities and support place-making and resettlement. Our literature search identified several areas of transformations including the different kinds of community gardens that have emerged, the associated physical, social, cultural, environmental, economic, and policy changes that have been reported in other countries in the Global North. The review also identified multifold benefits of CG in this regard, including benefits to health and wellbeing - the physical (i.e. nutrition and physical activity), mental (e.g., a place for healing for immigrants fleeing war-torn countries, domestic violence, trauma; fostering a connection to the land in new environments via place-making), and social (e.g., fostering community connections and cultural knowledge exchange). Despite the known benefits of community gardens to immigrants' health and wellbeing, there remains a lack of comprehensive evidence in Canada on how neighborhoods are changing to accommodate these initiatives and meet the cultural food needs of diverse communities. Such studies will serve as sources of evidence for novel ideas to address the cultural food needs and food insecurity of immigrant communities, which is becoming a growing public health concern.

Objectives: The charge of the newly formed Society of Critical Care Medicine Sustainability Task Force is to describe actionable items supporting environmental stewardship for ICUs, to discuss barriers associated with sustainability initiatives and outline opportunities for future impact. Data sources: Ovid Medline, EBSCOhost CINAHL, Elsevier Embase, and Scopus databases were searched through to March 2024 for studies reporting on environmental sustainability and critical care. Study selection: Systematic reviews, narrative reviews, quality improvement projects, randomized clinical trials, and observational studies were prioritized for review. Bibliographies from retrieved articles were scanned for articles that may have been missed. Data extraction: Data regarding environmental sustainability initiatives that aimed to quantify, manage, or mitigate pollution and/or carbon emissions with a focus on ICUs, barriers to change, and opportunities for development were qualitatively assessed. Data synthesis: ICUs are resource-intensive and as such, methods to attenuate carbon emissions and waste can play a substantial role in mitigating the sizable burden of healthcare-related pollution and greenhouse gas emissions. Several initiatives and strategies exist for clinicians and providers to engage in environmental stewardship, with specific attention to avoiding low-value care while maintaining or improving patient safety and high-quality care. Increased focus on sustainability can be met with resistance to change, including institutional, financial, and behavioral barriers. Collaboration and innovative thinking create valuable opportunities for clinicians, patients, families, and policymakers to advocate for patient and planetary health. Conclusions: Within the healthcare system, ICUs are well positioned to lead sustainability action, policy, and practice. Critical care teams have the capability and the moral responsibility to mitigate the negative impact of critical care medicine upon our environment and become change agents promoting sustainable healthcare for the benefit of human health.

International migration is contributing to changes in the sociocultural and the economic landscapes of many cities in the world. As part of the changes in cities, we are witnessing an increased use of community gardens as spaces for wellbeing restoration, for social connection, and for addressing the challenge of food insecurity, particularly cultural food insecurity. Cultural food security is one major under-recognized issue, yet is pivotal to address given its role in positively supporting immigrants' settlement and health. However, there is lack of comprehensive evidence of how neighborhoods are changing to accommodate these initiatives and meet the cultural food needs of diverse communities. Our scoping review explored evidence from existing literature on how neighborhoods are changing to accommodate community gardens (CG) as a novel means to address cultural food insecurity among immigrant communities and support place-making and resettlement. Our literature search identified several areas of transformations including the different kinds of community gardens that have emerged, the associated physical, social, cultural, environmental, economic, and policy changes that have been reported in other countries in the Global North. The review also identified multifold benefits of CG in this regard, including benefits to health and wellbeing - the physical (i.e. nutrition and physical activity), mental (e.g., a place for healing for immigrants fleeing war-torn countries, domestic violence, trauma; fostering a connection to the land in new environments via place-making), and social (e.g., fostering community connections and cultural knowledge exchange). Despite the known benefits of community gardens to immigrants' health and wellbeing, there remains a lack of comprehensive evidence in Canada on how neighborhoods are changing to accommodate these initiatives and meet the cultural food needs of diverse communities. Such studies will serve as sources of evidence for novel ideas to address the cultural food needs and food insecurity of immigrant communities, which is becoming a growing public health concern.

BackgroundCerebral palsy (CP) is the most common childhood physical disability, imposing substantial costs on individuals and society. Early interventions that promote brain optimization and reorganization are vital for children with CP. Integrating early evidence-based practice (EBP) remains challenging but enhances functional outcomes.MethodsFollowing a scoping review methodology, databases were searched to identify studies examining the impact of knowledge translation (KT) strategies for pediatric CP interventions. Extraction included study characteristics, methodology, KT strategies, barriers, and facilitators. Numerical and inductive content analysis identified themes among KT strategies. A final stakeholder consultation to discuss the results was conducted.ResultsThis review included seventeen articles. Common outcomes included participant change in EBP knowledge and behaviour. Common barriers included a need for more resources, protected time, and funding. Most studies followed a multifaceted KT approach. Various KT strategies were used, primarily mentoring, workshops, case studies, and online tools.InterpretationResults underscored the need for tailored KT strategies for implementing EBP for children with CP. Additionally, user-friendly KT tools and involving mentors to facilitate the intervention can haste EBP uptake. Successful adoption depends on challenges in healthcare settings. This study provides insights into current KT strategies for advancing best practices for children with CP. Employing multifaceted knowledge translation strategies in a pediatric rehabilitation setting can support the adoption of evidence-based practices for children with cerebral palsy.It is important to identify and address common barriers hindering the use of evidence-based practices in cerebral palsy rehabilitation in a specific context to tailor a knowledge translation strategy.Having qualified rehabilitation professionals act as evidence-based practice leaders in a healthcare setting is crucial for promoting evidence-based practices among other professionals.

Objective: To apply an intersectional lens to explore how the interconnected social identities of women across global settings impact access experiences for gender-based violence (GBV) supports. Design: A scoping review. Data sources: We systematically searched seven databases to identify studies published in English from the database inception to January 2023. Inclusion criteria: We included peer-reviewed studies with a primary objective of examining the access experiences of populations who self-identify as women (aged 15 years or older) who have experienced GBV, have intersecting identities (ie, racialisation, poverty, etc) that can further contribute to marginalisation and utilised or sought support services. Methods: Two reviewers independently completed title/abstract, full-text screening and data charting. Integrating intersectionality theory and the McIntyre access framework, we analysed support service access and utilisation across social identities, axes of marginalisation and geographic contexts. Results: 210 papers (195 distinct studies) met the inclusion criteria. Most studies (60%) were published since 2015 and used qualitative methods (63%). Findings reflected intersectional differences in women's experiences of accessing GBV services across contexts and lived experiences. Common findings indicate that seeking GBV support was motivated and enabled by informal supports and positive prior experiences in accessing services. However, findings highlight that structural and systemic constraints in existing support systems (in all study settings) impact access to necessary support services and their alignment with women's needs. Few studies examined health and non-health outcomes associated with unhindered access to care. Conclusions: Women's experiences with GBV support systems in different geopolitical contexts highlight barriers across axes of racialisation, poverty, multidimensional violence and other systemic factors, which are often eclipsed in generic one-size-fits-all models of support. This research can inform transformational policy development and tailored interventions to improve outcomes for all women who experience GBV and thus advance gender equality and equity goals.

Objectives: Primary care attachment represents an inclusive, equitable and cost-effective way of enhancing health outcomes globally. However, the growing shortage of family physicians threatens to disrupt patient-provider relationships. Understanding the consequences of these disruptions is essential for guiding future research and policy. The objectives of this study were to map the existing evidence on the impacts of changes in primary care attachment, identify research gaps and recommend areas for further investigation. Design: Scoping review following Joanna Briggs Institute (JBI) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Two researchers conducted all stages of screening, and study quality was assessed using JBI critical appraisal tools. Key themes included causes of attachment change, direction of change and outcomes aligned with the quintuple aim framework. Both qualitative and quantitative findings were synthesised narratively. Eligibility criteria: Peer-reviewed, English-language articles published between 1999 and 2024 on primary care attachment changes. Information sources: PubMed, Scopus and Web of Science. Results: Of 2045 studies screened, 31 met inclusion criteria, with 60% published after 2020. Most studies originated from high-income countries, particularly the USA (35%) and Canada (29%). Attachment losses and transfers were the most frequently studied, while attachment and unattachment durations were less explored. These changes in attachment were consistently shown to impact patients, providers, clinics and the healthcare system, influencing all aims of the quintuple aim framework, including clinical outcomes, healthcare utilisation, costs, equity and patient experience. Commonly assessed outcomes included clinical impact (68%), health equity (48%), patient experience (32%) and costs (23%), with no study assessing provider experience. Conclusions: This scoping review maps the published literature on changes in primary care attachment and introduces clarifying terminology. Key research gaps include geographical diversity (lack of studies from low- and middle-income countries), attachment gain (limited research on strategies to reconnect unattached patients), attachment duration (insufficient evidence on long-term health outcomes), economic implications (underexplored costs of physician turnover and disruption), provider experiences (lack of studies on how changes in primary care attachment impact provider burnout, job satisfaction and workload) and patient health outcomes (focus on healthcare utilisation rather than direct health outcomes). These findings underscore the need for further research and offer valuable insights for future studies and policy development.

Objective: To estimate the relative efficacy of individual and combinations of prehabilitation components (exercise, nutrition, cognitive, and psychosocial) on critical outcomes of postoperative complications, length of stay, health related quality of life, and physical recovery for adults who have received surgery. Design: Systematic review with network and component network meta-analyses of randomised controlled trials. Data sources: Medline, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science were initially searched 1 March 2022, and updated on 25 October 2023. Certainty in findings were assessed using the Confidence in Network Meta-Analysis (CINeMA) approach. Main outcome measures: To compare treatments and to compare individual components informed by partnership with patients, clinicians, researchers, and health system leaders using an integrated knowledge translation framework. Eligible studies were any randomised controlled trial including adults preparing for major surgery who were allocated to prehabilitation interventions or usual care, and where critical outcomes were reported. Results: 186 unique randomised controlled trials with 15 684 participants were included. When comparing treatments using random-effects network meta-analysis, isolated exercise (odds ratio 0.50 (95% confidence interval (CI) 0.39 to 0.64); very low certainty of evidence), isolated nutritional (0.62 (0.50 to 0.77); very low certainty of evidence), and combined exercise, nutrition, plus psychosocial (0.64 (0.45 to 0.92); very low certainty of evidence) prehabilitation were most likely to reduce complications compared with usual care. Combined exercise and psychosocial (-2.44 days (95% CI -3.85 to -1.04); very low certainty of evidence), combined exercise and nutrition (-1.22 days (-2.54 to 0.10); moderate certainty of evidence), isolated exercise (-0.93 days (-1.27 to -0.58); very low certainty of evidence), and isolated nutritional prehabilitation (-0.99 days (-1.49 to -0.48); very low certainty of evidence) were most likely to decrease length of stay. Combined exercise, nutrition, plus psychosocial prehabilitation was most likely to improve health related quality of life (mean difference on Short Form-36 physical component scale 3.48 (95% CI 0.82 to 6.14); very low certainty of evidence) and physical recovery (mean difference in meters on the six min walk test 43.43 (95% CI 5.96 to 80.91); very low certainty of evidence).When comparing individual components using component network meta-analysis, exercise and nutrition were the individual components most likely to improve all critical outcomes. The certainty of evidence for all comparisons across all outcomes was generally low to very low due to trial level risk of bias and imprecision; however, results for exercise and nutritional prehabilitation were robust with exclusion of high risk of bias trials. Conclusions: Consistent and potentially meaningful effect estimates suggest that exercise prehabilitation, nutritional prehabilitation, and multicomponent interventions including exercise may benefit adults preparing for surgery and could be considered in clinical care. However, multicentre trials that are appropriately powered for high priority outcomes and that have a low risk of bias are required to have greater certainty in prehabilitation's efficacy. Registration: International prospective registry of systematic reviews CRD42023353710.

OBJECTIVE To estimate the relative efficacy of individual and combinations of prehabilitation components (exercise, nutrition, cognitive, and psychosocial) on critical outcomes of postoperative complications, length of stay, health related quality of life, and physical recovery for adults who have received surgery. DESIGN Systematic review with network and component network meta-analyses of randomised controlled trials. DATA SOURCES Medline, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science were initially searched 1 March 2022, and updated on 25 October 2023. Certainty in findings were assessed using the Confidence in Network Meta-Analysis (CINeMA) approach. MAIN OUTCOME MEASURES To compare treatments and to compare individual components informed by partnership with patients, clinicians, researchers, and health system leaders using an integrated knowledge translation framework. Eligible studies were any randomised controlled trial including adults preparing for major surgery who were allocated to prehabilitation interventions or usual care, and where critical outcomes were reported. RESULTS 186 unique randomised controlled trials with 15 684 participants were included. When comparing treatments using random-effects network meta- analysis, isolated exercise (odds ratio 0.50 (95% confidence interval (CI) 0.39 to 0.64); very low certainty of evidence), isolated nutritional (0.62 (0.50 to 0.77); very low certainty of evidence), and combined exercise, nutrition, plus psychosocial (0.64 (0.45 to 0.92); very low certainty of evidence) prehabilitation were most likely to reduce complications compared with usual care. Combined exercise and psychosocial (-2.44 days (95% CI -3.85 to -1.04); very low certainty of evidence), combined exercise and nutrition (-1.22 days (-2.54 to 0.10); moderate certainty of evidence), isolated exercise (-0.93 days (-1.27 to -0.58); very low certainty of evidence), and isolated nutritional prehabilitation (-0.99 days (-1.49 to -0.48); very low certainty of evidence) were most likely to decrease length of stay. Combined exercise, nutrition, plus psychosocial prehabilitation was most likely to improve health related quality of life (mean difference on Short Form- 36 physical component scale 3.48 (95% CI 0.82 to 6.14); very low certainty of evidence) and physical recovery (mean difference in meters on the six min walk test 43.43 (95% CI 5.96 to 80.91); very low certainty of evidence).When comparing individual components using component network meta-analysis, exercise and nutrition were the individual components most likely to improve all critical outcomes. The certainty of evidence for all comparisons across all outcomes was generally low to very low due to trial level risk of bias and imprecision; however, results for exercise and nutritional prehabilitation were robust with exclusion of high risk of bias trials. CONCLUSIONS Consistent and potentially meaningful effect estimates suggest that exercise prehabilitation, nutritional prehabilitation, and multicomponent interventions including exercise may benefit adults preparing for surgery and could be considered in clinical care. However, multicentre trials that are appropriately powered for high priority outcomes and that have a low risk of bias are required to have greater certainty in prehabilitation's efficacy. REGISTRATION International prospective registry of systematic reviews CRD42023353710.

Objectives: The COVID-19 pandemic has had a disproportionate impact on the health of Indigenous Peoples in Canada, Australia, New Zealand and the USA, as reflected in the growing literature. However, Indigenous Peoples are often homogenised, with key differences often overlooked, failing to capture the complexity of issues and may lead to suboptimal public health policy-making. The objective of this review was to assess the extent to which the heterogeneity of the Indigenous Peoples in Canada, Australia, New Zealand and the USA has been reflected in COVID-19 research. Design: This study took the form of a scoping review. Data sources: Medline, Embase, CINAHL and Web of Science were searched for studies investigating COVID-19 pandemic outcomes among Indigenous Peoples in Canada, Australia, New Zealand and the USA. The search dates included January 2019 to January 2024. Eligibility criteria: All citations yielded by this search were subjected to title and abstract screening, full-text review and data extraction. We included original, peer-reviewed research investigating COVID-19-related outcomes among Indigenous Peoples in Canada, Australia, New Zealand or the USA. Data extraction and synthesis: Data extraction was conducted as an iterative process, reaching consensus between two of the study authors. All included studies were analysed through a combination of quantitative descriptive summary and qualitative thematic analysis. Results: Of the 9795 citations found by the initial search, 428 citations were deemed eligible for inclusion. Of these citations: 72.9% compared Indigenous participants to non-Indigenous participants; 10.0% aggregated Indigenous and non-white participants; and 17.1% provided findings for Indigenous participants exclusively. Conclusions: By overlooking the heterogeneity that exists among Indigenous Peoples in Canada, Australia, New Zealand and the USA, researchers and policy-makers run the risk of masking inequities and the unique needs of groups of Indigenous Peoples. This may lead to inefficient policy recommendations and unintentionally perpetuate health disparities during public health crises.

In response to emerging challenges that intersect humans, animals, and environments, there is growing international exigent need to adopt 'One Health' approaches. While One Health efforts are emerging in British Columbia in Canada, there are still challenges to overcome in the adoption of a One Health approach in policymaking. We conducted a comparative analysis of One Health policies in Asia, specifically, Singapore, Hong Kong, Bangladesh, and Thailand, which have well-established and sophisticated One Health approaches, to determine good practices in the implementation of One Health that could be considered for adoption in British Columbia. We conducted a literature review and scan of public-facing One Health websites, strategic action plans, and health databases, complemented by 13 semi-structured interviews with researchers, educators, service providers, human and animal health experts, and policymakers in our chosen Asian jurisdictions and British Columbia. While there was diversity in the One Health approaches taken by four jurisdictions, three key characteristics were present in policymaking processes in all of them: a national One Health strategic action plan, inter-ministerial coordination, and flexibility in the working relationships of public servants. One Health presents an opportunity for British Columbia to take a novel approach to public health policymaking, the one that is more holistic and effective at addressing shared health challenges.

Background: Competency-Based Medical Education (CBME) aims to align educational outcomes with the demands of modern healthcare. Entrustable Professional Activities (EPAs) serve as key tools for feedback and professional development within CBME. With the growing body of literature on EPAs, there is a need to synthesize existing research on stakeholders' experiences and perceptions to enhance understanding of the implementation and impact of EPAs. In this synthesis, we will address the following research questions: How are Entrustable Professional Activities experienced and perceived by stakeholders in various healthcare settings, and what specific challenges and successes do they encounter during their implementation? Methods: Using Thomas and Harden's thematic synthesis method, we will systematically review and integrate findings from qualitative and mixed-methods research on EPAs. The process includes a purposive literature search, assessment of evidence quality, data extraction, and synthesis to combine descriptive and analytical themes. Discussion: This study aims to provide insights into the use of EPAs for competency-based education, reflecting diverse contexts and viewpoints, and identifying literature gaps. The outcomes will guide curriculum and policy development, improve educational practices, and set future research directions, ultimately aligning CBME with clinical realities. Trial registration: Not required.

Objective To explore the role of local public health organisations in antimicrobial stewardship (AMS) and antimicrobial resistance (AMR) surveillance.Methods A scoping review was conducted. Peer-reviewed and grey literature from countries within the organisation for economic co-operation and development was searched between 1999 and 2023 using the concepts of local public health, AMR and AMS. Thematic analysis was performed to identify themes.Results There were 63 citations illustrating 122 examples of AMS and AMR surveillance activities with local public health involvement. Common AMS activities (n = 105) included healthcare worker education (n = 22), antimicrobial use (AMU) evaluation (n = 21), patient/public education (n = 17), clinical practice guidelines (n = 10), and antibiograms (n = 10). Seventeen citations described local public health activities in AMR surveillance; the majority focussed on communicable diseases (n = 11) and/or AMR organisms (n = 6).Conclusions Local public health capabilities should be leveraged to advance high-impact activities to mitigate AMR, particularly in the areas of knowledge translation/mobilisation, optimising surveillance and establishing strategic collaborations.Policy implications Future work should focus on better understanding barriers and facilitators, including funding, to local public health participation in these activities.

According to the World Health Organization (WHO), tobacco use causes over 8 million deaths annually including 1.3 million due to second-hand exposure. Furthermore, data from the Tobacco Atlas show that the tobacco industry continues to target new markets in the WHO African region, one of two regions where absolute numbers of smokers continue to increase. Understanding context contributes to policy formulation and implementation ensuring relevance to a country's political economy. Focusing on the WHO African region, this scoping review (i) maps the extent of academic research examining contextual factors on the WHO Framework Convention on Tobacco Control (WHO FCTC) national-level implementation, and (ii) reports on contextual factors impacting the WHO FCTC implementation. Using a stepwise structured approach, we conducted a search across four academic databases, yielding 10 342 articles and 42 were selected for full data extraction. Leichter's four categories of context (situational, structural, cultural and exogenous) and the stages of heuristic policy model guided data extraction. Study findings indicated that situational contextual factors such as the burden of disease or its impact on health can push governments toward policy formulation. Structural contextual factors included political considerations, economic interests, funding, institutional congruence, strength of policy and institutional capacity as important. Cultural contextual factors included the influence of policy entrepreneurs, current social trends and public opinion. Exogenous contextual factors included the WHO FCTC, tobacco industry influence at the national-level and bi-lateral partnerships. Further understanding contextual factors affecting the WHO FCTC national implementation can strengthen policy formulation and align required support with the WHO FCTC Secretariat and other relevant bodies.

Effective diabetes management can prevent avoidable diabetes-related hospitalizations. This review examines the impact of financial incentives for diabetes management in primary care settings on diabetes-related hospitalizations, hospitalization costs, and premature mortality. To assess the evidence, we conducted a literature search of studies using five databases: Medline, Embase, Scopus, CINAHL and Web of Science. We examined the results by health insurance system, study quality or diabetes population (newly diagnosed diabetes). We identified 32 articles ranging from fair- to high-quality: 19 articles assessed the relationship between financial incentives for diabetes management and hospitalizations, 8 assessed hospitalization costs, and 15 assessed mortality. Many studies found that financial incentives for diabetes management reduced hospitalizations, while a few found no effects. Similar findings were evident for hospitalization costs and mortality. The results did not differ by the type of health insurance system, but the quality of the studies did matter; most high-quality studies reported reduced hospitalizations and/or mortality. We also found that financial incentives tend to be beneficial for patients with newly diagnosed diabetes. We conclude that well-designed diabetes management incentives can reduce diabetes-related hospitalizations, especially for newly diagnosed diabetes patients.

Background: This rapid review assessed evidence to inform policy on the clinical effectiveness and optimal frequency of dental scaling and polishing (S&P) for adults, including those with low incomes eligible for the Canadian Dental Care Plan.Methods: A rapid review was conducted according to Cochrane Recommendations for Rapid Reviews. Populations included all adults, adults with periodontitis, and those with inequitable access to dental care. Primary outcomes included gingival inflammation, probing depths, and tooth loss. Secondary outcomes included oral health-related quality of life and economic impact. Four databases were searched for randomized clinical trials, systematic reviews, cohort studies, and practice guidelines. Risk of bias was evaluated using Cochrane Risk of Bias, Newcastle-Ottawa, ROBIS, and AGREE II tools. A qualitative synthesis was planned.Results: In total, 3,181 references were retrieved: 4 applied to all adults and 4 to those with periodontitis. All reports had low risk of bias. One systematic review and one multicenter trial of adults with regular dental care found no clinical benefit regardless of S&P interval; however, patients valued and were willing to pay for regular scaling. One claims-based study reported regular S&P reduced tooth loss, and 2 clinical practice guidelines found a reduced risk of future attachment and tooth loss, lower overall health care costs for diabetes, and reduced costs for and incidence of acute myocardial infarction in those with regular S&P. There were no studies of underserved populations.Conclusions: For adults with no or early periodontal disease and regular access to dental care, routine S&P may have little clinical benefit but reduces tooth loss and some health care expenses. In patients with periodontitis, scaling intervals tailored to individual risk profile and periodontal status can maintain health. There is no evidence on the impact of routine S&P on patients with barriers accessing care.Knowledge Transfer Statement: In terms of the benefits of routine scaling and polishing in adults, this rapid review found mixed evidence with a high level of certainty due to minimal risk of bias in the appraised studies for regular dental attenders and those with a diagnosis of periodontal diseases. Tailored intervals for dental scaling are beneficial for those diagnosed with periodontitis but may not provide the clinical benefits previously expected for adults at low risk. There is no evidence that dental polishing is effective. No evidence was found to support recommendations about the clinical effectiveness of scaling or the most appropriate recall intervals for scaling for low-income Canadians eligible for dental services under the new Canadian Dental Care Plan.

Background: Implementation strategies targeting individual healthcare professionals and teams, such as audit and feedback, educational meetings, opinion leaders, and reminders, have demonstrated potential in promoting evidence-based nursing practice. This systematic review examined the effects of the 19 Cochrane Effective Practice and Organization Care (EPOC) healthcare professional-level implementation strategies on nursing practice and patient outcomes. Methods: A systematic review was conducted following the Cochrane Handbook, with six databases searched up to February 2023 for randomized studies and non-randomized controlled studies evaluating the effects of EPOC implementation strategies on nursing practice. Study selection and data extraction were performed in Covidence. Random-effects meta-analyses were conducted in RevMan, while studies not eligible for meta-analysis were synthesized narratively based on the direction of effects. The quality of evidence was assessed using GRADE. Results: Out of 21,571 unique records, 204 studies (152 randomized, 52 controlled, non-randomized) enrolling 36,544 nurses and 340,320 patients were included. Common strategies (> 10% of studies) were educational meetings, educational materials, guidelines, reminders, audit and feedback, tailored interventions, educational outreach, and opinion leaders. Implementation strategies as a whole improved clinical practice outcomes compared to no active intervention, despite high heterogeneity. Group and individual education, patient-mediated interventions, reminders, tailored interventions and opinion leaders had statistically significant effects on clinical practice outcomes. Individual education improved nurses' attitude, knowledge, perceived control, and skills, while group education also influenced perceived social norms. Although meta-analyses indicate a small, non-statistically significant effect of multifaceted versus single strategies on clinical practice, the narrative synthesis of non-meta-analyzed studies shows favorable outcomes in all studies comparing multifaceted versus single strategies. Group and individual education, as well as tailored interventions, had statistically significant effects on patient outcomes. Conclusions: Multiple types of implementation strategies may enhance evidence-based nursing practice, though effects vary due to strategy complexity, contextual factors, and variability in outcome measurement. Some evidence suggests that multifaceted strategies are more effective than single component strategies. Effects on patient outcomes are modest. Healthcare organizations and implementation practitioners may consider employing multifaceted, tailored strategies to address local barriers, expand the use of underutilized strategies, and assess the long-term impact of strategies on nursing practice and patient outcomes. Trial registration: PROSPERO CRD42019130446.

Background Implementation strategies targeting individual healthcare professionals and teams, such as audit and feedback, educational meetings, opinion leaders, and reminders, have demonstrated potential in promoting evidence-based nursing practice. This systematic review examined the effects of the 19 Cochrane Effective Practice and Organization Care (EPOC) healthcare professional-level implementation strategies on nursing practice and patient outcomes. Methods A systematic review was conducted following the Cochrane Handbook, with six databases searched up to February 2023 for randomized studies and non-randomized controlled studies evaluating the effects of EPOC implementation strategies on nursing practice. Study selection and data extraction were performed in Covidence. Random-effects meta-analyses were conducted in RevMan, while studies not eligible for meta-analysis were synthesized narratively based on the direction of effects. The quality of evidence was assessed using GRADE. Results Out of 21,571 unique records, 204 studies (152 randomized, 52 controlled, non-randomized) enrolling 36,544 nurses and 340,320 patients were included. Common strategies (> 10% of studies) were educational meetings, educational materials, guidelines, reminders, audit and feedback, tailored interventions, educational outreach, and opinion leaders. Implementation strategies as a whole improved clinical practice outcomes compared to no active intervention, despite high heterogeneity. Group and individual education, patient-mediated interventions, reminders, tailored interventions and opinion leaders had statistically significant effects on clinical practice outcomes. Individual education improved nurses' attitude, knowledge, perceived control, and skills, while group education also influenced perceived social norms. Although meta-analyses indicate a small, non-statistically significant effect of multifaceted versus single strategies on clinical practice, the narrative synthesis of non-meta-analyzed studies shows favorable outcomes in all studies comparing multifaceted versus single strategies. Group and individual education, as well as tailored interventions, had statistically significant effects on patient outcomes. Conclusions Multiple types of implementation strategies may enhance evidence-based nursing practice, though effects vary due to strategy complexity, contextual factors, and variability in outcome measurement. Some evidence suggests that multifaceted strategies are more effective than single component strategies. Effects on patient outcomes are modest. Healthcare organizations and implementation practitioners may consider employing multifaceted, tailored strategies to address local barriers, expand the use of underutilized strategies, and assess the long-term impact of strategies on nursing practice and patient outcomes. Trial registration PROSPERO CRD42019130446.

Introduction Indigenous people experience a unique set of health inequalities and social determinants that can negatively affect their physical health, mental health and wellness. This critical state of affairs is compounded by the limited availability of culturally appropriate care services and treatments for the different groups. In response, increasing numbers of studies are turning their focus to art-based interventions and how these might benefit Indigenous lives. The proposed scoping review aims to map this growing field of research.Methods and analysis This scoping review is based on the Arksey and O'Malley methodological framework and the subsequent enhancements proposed by Levac et al. Academic databases and grey literature sources will be searched to identify appropriate studies for inclusion. The search strategies of all databases were tested on 25 April 2024. This will be followed by a two-step screening process to be conducted by two researchers and consisting of (1) a title and abstract review and (2) a full-text review. Data from the selected studies will be extracted, collated and charted to summarise all relevant interventions, their outcomes and key findings. An Indigenous research partner will be hired as a consultant, and the research will be further informed by other stakeholders.Ethics and dissemination This study is the first step in a research programme involving working with Indigenous artists to codesign a pilot art-based intervention aimed at improving mental health and wellness among Indigenous people. The scoping review will identify the specific components in documented art-based interventions that have proven beneficial to this group. Since it will draw exclusively on data from published and public sources, no ethics approval is required. The results will be disseminated through knowledge translation activities with Indigenous organisations and art therapy groups; a summary of the results will also be distributed through Indigenous networks.

Background: Air pollution has several negative health effects. Particulate matter (PM) is a pollutant that is often linked to health adversities. PM2.5 (PM with an aerodynamic diameter of ≤2.5μm) exposure has been associated with negative cardiovascular (CV) outcomes. However, the impact of PM10 (PM with an aerodynamic diameter of ≤10μm) exposure is often overlooked due to its limited ability to pass the alveolar barrier. This study aims to assess the association between PM10 exposure and risk of myocardial infarction (MI) amongst adults (≥18 years of age) as this has been poorly studied. Methods: The study protocol was published on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023409796) on March 31, 2023. Literature searches were conducted on 4 databases (Ovid Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Web of Science) on January 17, 2023, for studies looking at associations between PM and MI. English studies from all time periods were assessed. Studies selected for review were time-series, case-crossover, and cohort studies which investigated the risk of MI as an outcome upon PM10 exposure. The quality of evidence was assessed using Cochrane's Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Data for different risk outcomes (risk ratio (RR), odds ratio (OR), hazard ratio (HR)) and 3 lags was meta-analyzed using an inverse variance statistical analysis using a random effects model. The pooled effect sizes and the 95% confidence intervals (CIs) were reported in forest plots. Results: Among the 1,099 studies identified, 41 were included for review and 23 were deemed eligible for meta-analysis. Our analysis revealed that there is an increased risk (OR = 1.01; 95% CI:1.00-1.02) of MI with a 10 μg/m3 increase in PM10 after a lag 0 and lag 1 delay. Conclusions: Our findings indicate that PM10 exposure is associated with an increased risk of MI. This can aid in informing environmental policy-making, personal-level preventative measures, and global public health action.

Background: Oral health is an integral aspect of overall well-being and quality of life. Population groups such as two-spirit, lesbian, gay, bisexual, transgender, and queer, including other sexual and gender minorities (2SLGBTQ+), have reported poor oral health outcomes. Therefore, the aim of this review was to investigate the extent and scope of the literature describing 2SLGBTQ+ oral health outcomes, including unmet oral health needs and patterns of oral health care service utilization, as well as the risk factors affecting both. Methods: A comprehensive search strategy was developed to review the scope of the literature pertinent to unmet oral health needs and factors affecting access to oral health care among 2SLGBTQ+ members, globally. In total, 6 databases were searched with a combination of keywords relevant to 2SLGBTQ+ oral health status and oral health care utilization. Results: Our review identified 10 studies that met the eligibility criteria. Five out of 10 studies were based in India, 4 in the United States, and 1 in Brazil. Two studies reported poorer oral health outcomes among transgender people as compared with cisgender people, while 2 studies reported similar patterns of dental service utilization between their transgender and cisgender participants. Five studies explored the personal and structural risk factors associated with poor oral health outcomes, including financial affordability and income level and perceived discrimination, including instances of misgendering in health care settings. However, further comprehensive studies must be conducted to validate the trends and findings reported by the studies in the review and to generate data from diverse regional contexts. Conclusions: Our review identified that the extent of the literature in this research area is sparse and scarce. The evidence indicates poorer oral health status among 2SLGBTQ+ communities. Wider studies with diverse, representative samples are required to gain a comprehensive understanding of 2SLGBTQ+ oral health outcomes. Knowledge transfer statement: The results of this review will undoubtedly be important for many years to come as 2SLGBTQ+ oral health equity is prioritized by experts in public health dentistry. This review will allow other researchers to understand and fill literature gaps regarding 2SLGBTQ+ oral health outcomes, furthering this area of research.