Background: The SARS-CoV-2 pandemic had a major impact on nursing and healthcare as well as on research. The aim of this study was to analyse the characteristics of nursing- and SARS-CoV-2-related research in Germany. Methods: A scoping review was conducted. We systematically searched (06/2023) Medline, CINAHL, the German Register of Clinical Trials, abstract books of conferences and conducted a manual literature search. We included empirical studies addressing aspects of nursing and the pandemic and involving German researchers. Study selection and data extraction were conducted independently by two reviewers. Results were analysed descriptively. Results: We included 131 publications (85 quantitative, 27 qualitative, 6 mixed-/multi-methods studies, 12 systematic reviews, 1 discussion paper); 49 % of the studies were published in 2021. First authors were mostly from medicine, psychology and nursing science, last authors from medicine. Most studies were explorative. Most of the quantitative studies used observational designs, only four were experimental. Nurses and other healthcare professionals were the most common target group; people with care needs or relatives were rarely addressed. The most common topics included health, perceived burden, working conditions, and characteristics of care during the pandemic. A quarter of the studies were not externally funded, 32 % did not provide information on funding. The Federal Ministry of Education and Research (21 %) was the most common funding body. Conclusion: Pandemic-related nursing research was published to a limited extent by nursing scientists; clinical nursing research was particularly underrepresented. Dependable funding and the development of a research infrastructure for nursing research are necessary to ensure evidence-based nursing in times of crisis and to generate findings that are relevant to clinical practice and health policy decision-makers.

Abstract Background: Contact time in general practice (GP) refers to the duration a physician spends with a patient during an appointment. There are significant differences in contact times across OECD countries, raising questions about the influencing factors and potential consequences of these variations. Objective: To study the determinants and consequences of the length of consultations in GP care. Method: We descriptively investigate differences in average appointment durations in GP care across OECD countries. We then conduct a scoping review of the literature encompassing 150 studies in seven topical clusters. Results: We identify considerable differences in contact times across countries and find evidence for substitution effects between the length of consultations and the number of consultations per year. There is also an association between reimbursement schemes and visit lengths. The review reveals consistent evidence for a few determinants, such as patient characteristics and physician experience, but mixed evidence on the effects of contact time on shared decision-making and health outcomes. The literature is dominated by correlational studies. Conclusion: Descriptive comparisons show shorter contact times are substituted with more frequent visits, and fee-for-service payment systems result in longer contact times compared to capitation systems. For future health policy discussions, it is crucial to clarify which service delivery form is socially desired and economically sustainable.

Objective: This systematic review investigates the effectiveness of different communication strategies to increase COVID-19 vaccine uptake and willingness. Design: Systematic review and meta-analysis of randomised controlled trials (RCTs), following recommendations from the Cochrane Handbook and reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Data sources: We searched the following databases until 27 July 2022: Cochrane COVID-19 Study Register, PsycINFO, CINAHL, Web of Science Core Collection and WHO COVID-19 Global literature. Eligibility criteria for study selection: We included RCTs investigating, any population, communication-based interventions to increase COVID-19 vaccine uptake and comparing these with no intervention (with or without placebo), another communication strategy or another type of intervention. Methods: Screening, data extraction and bias assessment, using the Cochrane ROB 1.0 tool, were conducted by two authors independently. We performed meta-analyses if studies were homogeneous using the Review Manager (RevMan 5) software, synthesised the remaining results narratively and assessed the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: We identified 49 studies reporting on the predefined four categories of communication interventions. Evidence from our meta-analyses shows that COVID-19 vaccine uptake may increase when education and information strategies are applied (risk ratio (RR) 1.23, 95% CI 1.17 to 1.28; high-certainty evidence) or social norms are communicated (RR 1.28, 95% CI 1.23 to 1.33; high-certainty evidence) compared with no intervention. The different communication strategies mostly have little to no impact on vaccine intention; however, there may be a slight increase in vaccine confidence when gain framing is applied compared with no intervention. Conclusion: Overall, we found that education and information-based interventions or social norm-framing strategies are most effective compared with no intervention given. Our findings show that some of the investigated communication strategies might influence policy decision-making, and our results could be useful for future pandemics as well. Prospero registration number: PROSPERO (CRD42021296618).

Objectives: The relationship between the volume of medical procedures conducted in hospitals and the resulting health outcomes has been described for various surgical and non-surgical medical interventions. As a policy response to this, several countries have implemented minimum volume standards. However, there is currently a lack of systematically compiled evidence assessing their impact. To close this research gap, we conducted a systematic review on the effects of minimum volume standards in hospitals. Design: Systematic review using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Data sources: MEDLINE, PubMed Central and Bookshelf (PubMed), EMBASE (Elsevier), CENTRAL (Cochrane Library), CINHAL (EBSCO), EconLIT (EBSCO), PDQ-Evidence for Informed Health Policymaking, Health Systems Evidence and three trial registries were searched until June 2023. Additionally, manual searches were conducted. Eligibility criteria for selecting studies: For inclusion in this review, studies must investigate the effects of minimum volume standards. We accepted all categories of outcomes. Following the Cochrane Effective Practice and Organisation of Care (EPOC) criteria, only a strict set of study designs, namely randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted time series studies, were included. No restrictions were placed on language, publication date or publication status. Data extraction and synthesis: Two reviewers independently screened titles and abstracts for eligibility, reviewed the full texts and performed data extraction of the included articles. Risk of bias was assessed using the 'Risk Of Bias In Non-Randomised Studies-of Interventions' (ROBINS-I) tool. Certainty of evidence was rated using the GRADE approach. For data synthesis and statistical analyses, we adhered to the EPOC guidance. Results: We included nine studies into our systematic review. Overall, the outcomes reported in the studies are heterogeneous, which did not allow for a meta-analysis, resulting in a narrative analysis of the found evidence. While travel distance increased and length of stay decreased, other reported outcomes such as complications or reoperations were not affected by the introduction of minimum volume standards. Overall, the risk of bias was considered serious for results on outcomes of seven out of the nine included studies and moderate for the remaining two. The certainty of evidence was rated low for complications, reoperations, length of stay and travel distance and very low for mortality (in-hospital; 30 days). Conclusion: This systematic review does not provide conclusive evidence on the effects of minimum volume standards in hospitals regarding any outcomes. The certainty of evidence for mortality (in-hospital; 30 days) is very low and low for complications, reoperations and travel distance. The results are based on a relatively small number of studies for most outcomes. There is a need for studies researching the effects of minimum volume standards based on a robust study design. Prospero registration number: CRD42022318883.

Background As hospitals expand their roles within transforming health systems, their governance structures must adapt to changing demands, with novel leadership structures evolving to meet new challenges. Objective This review aims to provide a comprehensive overview on the evidence of the influence of hospital C-level positions on key organisational performance parameters. It maps key concepts from the existing literature relating to hospital performance and leadership and identifies mediators and moderators of top management team impacts based on the Upper-Echelons-Theory. Methods The scoping review was conducted according to the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, covering studies from 1990 to the present. Eligible studies addressed at least one identifiable hospital C-Suite role and one hospital-wide leadership effect. Results Out of 5,430 articles identified, 60 were included. The analysis covers seven distinct C-Suite roles and their effects on six performance dimensions: quality of care, structural quality, patient satisfaction, work satisfaction, financial performance, and process efficiency. Conclusions The findings suggest that the influence of C-Suite positions on hospital performance is multifaceted, with the Chief Executive Officer's influence extending beyond financial performance to shaping the quality of care. Additionally, the impact of newer roles such as the Chief Quality Officer, as well as leadership roles like the Chief Medical Officer and Chief Nursing Officer, appear to depend on a collaborative approach and alignment with the Chief Executive Officer. From a policy perspective, the findings emphasise that hospital governance, shaped by regulations, determines key performance indicators and strategic priorities.

Abstract Background: As hospitals expand their roles within transforming health systems, their governance structures must adapt to changing demands, with novel leadership structures evolving to meet new challenges. Objective: This review aims to provide a comprehensive overview on the evidence of the influence of hospital C-level positions on key organisational performance parameters. It maps key concepts from the existing literature relating to hospital performance and leadership and identifies mediators and moderators of top management team impacts based on the Upper-Echelons-Theory. Methods: The scoping review was conducted according to the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, covering studies from 1990 to the present. Eligible studies addressed at least one identifiable hospital C-Suite role and one hospital-wide leadership effect. Results: Out of 5430 articles identified, 60 were included. The analysis covers seven distinct C-Suite roles and their effects on six performance dimensions: quality of care, structural quality, patient satisfaction, work satisfaction, financial performance, and process efficiency. Conclusions: The findings suggest that the influence of C-Suite positions on hospital performance is multifaceted, with the Chief Executive Officer's influence extending beyond financial performance to shaping the quality of care. Additionally, the impact of newer roles such as the Chief Quality Officer, as well as leadership roles like the Chief Medical Officer and Chief Nursing Officer, appear to depend on a collaborative approach and alignment with the Chief Executive Officer. From a policy perspective, the findings emphasise that hospital governance, shaped by regulations, determines key performance indicators and strategic priorities.

INTRODUCTION: Over the last years, videoconference-delivered psychotherapy (VCP) has found its way into clinical practice. This meta-analysis is the first to evaluate the effectiveness of VCP for children and adolescents with a mental disorder and their parents. METHODS: A systematic literature search was performed to identify randomized controlled trials (RCTs) that compared the effectiveness of VCP for youths with a mental disorder to a control condition. Twelve studies were included. Two reviewers independently extracted data and rated study quality. RESULTS: Effect size estimates for measures of children's symptoms of mental disorders were large for comparison between VCP and waitlist (posttreatment: Hedges's g = -1.26, k = 5) and negligible for comparisons between VCP and in-person treatment (posttreatment: g = 0.00, k = 6; follow-up: g = -0.05, k = 3). Similarly, effect size estimates for measures of children's functional impairments were large for comparison between VCP and waitlist (posttreatment: g = -1.10, k = 3) and negligible for comparisons between VCP and in-person treatment (posttreatment: g = -0.23, k = 3; follow-up: g = 0.04, k = 2). VCP more effectively reduced symptoms in children with an internalizing disorder (g = -0.88, k = 5) compared to externalizing disorders (g = 0.25, k = 2) or tic disorders (g = -0.08, k = 3). DISCUSSION: The results provide preliminary evidence that VCP is an effective treatment for youths with a mental disorder and their parents. VCP was equally effective as in-person treatment in reducing children's symptoms and functional impairments. Limitations include the limited number of RCTs and incomplete reporting of methodological features.

Background: Digital competences are essential for lifelong learning, as highlighted by the European Commission and emphasized in the Digital Education Action Plan 2021-2027. The COVID-19 pandemic necessitated an unprecedented shift to online education, profoundly impacting fields like physiotherapy that heavily rely on practical skills. This scoping review aims to provide an overview of currently applied digitally enhanced learning methods, content, effect on knowledge gain and student perceptions in physiotherapy education. Methods: Following PRISMA guidelines for scoping reviews, a comprehensive search was conducted across multiple databases, including Medline, Web of Science, and ERIC, incorporating hand searches and expert consultations. Studies were included if they reported on any digitally enhanced educational methods in physiotherapy education, involving qualitative studies, clinical trials, observational studies, or case reports published in English or German from 2010 to February 2024. Data extraction focused on the digital tools that were used, the educational contents, individually measured outcomes, and the impact of digital education. Results: Out of 2988 screened studies, 67 met the inclusion criteria, encompassing 7160 participants. These sources of evidence primarily used quantitative methods (n = 51), with a minority using qualitative (n = 7) or mixed methods (n = 6). Nearly half employed hybrid educational approaches. Outcome measures included knowledge, performance, perception, satisfaction, and attitudes. Most sources of evidence reported positive impacts of digitally enhanced education, particularly in knowledge transfer and skill performance. Synchronous and asynchronous methods were used, with varying success across theoretical and practical courses. Gamification and virtual reality emerged as promising tools for enhancing engagement and learning outcomes. However, challenges included the limited direct interaction and perceived self-efficacy among students. Conclusion: Digitally enhanced learning formats in physiotherapy education can enhance learning experiences and is generally welcomed by students, especially when blended with traditional methods. The integration of innovative digital strategies holds promise for the future of physiotherapy training, contingent on comprehensive support and training for educators and students alike.

Background: The rapid evolution of large language models (LLMs), such as Bidirectional Encoder Representations from Transformers (BERT; Google) and GPT (OpenAI), has introduced significant advancements in natural language processing. These models are increasingly integrated into various applications, including mental health support. However, the credibility of LLMs in providing reliable and explainable mental health information and support remains underexplored. Objective: This scoping review systematically maps the factors influencing the credibility of LLMs in mental health support, including reliability, explainability, and ethical considerations. The review is expected to offer critical insights for practitioners, researchers, and policy makers, guiding future research and policy development. These findings will contribute to the responsible integration of LLMs into mental health care, with a focus on maintaining ethical standards and user trust. Methods: This review follows PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and the Joanna Briggs Institute (JBI) methodology. Eligibility criteria include studies that apply transformer-based generative language models in mental health support, such as BERT and GPT. Sources include PsycINFO, MEDLINE via PubMed, Web of Science, IEEE Xplore, and ACM Digital Library. A systematic search of studies from 2019 onward will be conducted and updated until October 2024. Data will be synthesized qualitatively. The Population, Concept, and Context framework will guide the inclusion criteria. Two independent reviewers will screen and extract data, resolving discrepancies through discussion. Data will be synthesized and presented descriptively. Results: As of September 2024, this study is currently in progress, with the systematic search completed and the screening phase ongoing. We expect to complete data extraction by early November 2024 and synthesis by late November 2024. Conclusions: This scoping review will map the current evidence on the credibility of LLMs in mental health support. It will identify factors influencing the reliability, explainability, and ethical considerations of these models, providing insights for practitioners, researchers, policy makers, and users. These findings will fill a critical gap in the literature and inform future research, practice, and policy development, ensuring the responsible integration of LLMs in mental health services. International registered report identifier (irrid): DERR1-10.2196/62865.

Background: Information exchange regarding the scope and content of health studies is becoming increasingly important. Digital methods, including study websites, can facilitate such an exchange. Objective: This scoping review aimed to describe how digital information exchange occurs between the public and researchers in health studies. Methods: This scoping review was prospectively registered and adheres to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Eligibility was defined using the population (public and researchers), concept (digital information exchange), and context (health studies) framework. Bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science), bibliographies of the included studies, and Google Scholar were searched up to February 2024. Studies published in peer-reviewed journals were screened for inclusion based on the title, abstract, and full text. Data items charted from studies included bibliographic and PCC (Population, Concept, and Context) characteristics. Data were processed into categories that inductively emerged from the data and were synthesized into main themes using descriptive statistics. Results: Overall, 4072 records were screened, and 18 studies published between 2010 and 2021 were included. All studies evaluated or assessed the preferences for digital information exchange. The target populations included the public (mainly adults with any or specific diseases), researchers, or both. The digital information exchange methods included websites, emails, forums, platforms, social media, and portals. Interactivity (ie, if digital information exchange is or should be active or passive) was addressed in half of the studies. Exchange content included health information or data with the aim to inform, recruit, link, or gather innovative research ideas from participants in health studies. We identified 7 facilitators and 9 barriers to digital information exchange. The main facilitators were the consideration of any stakeholder perspectives and needs to clarify expectations and responsibilities, the use of modern or low-cost communication technologies and public-oriented language, and continuous communication of the health study process. The main barriers were that information exchange was not planned or not feasible due to inadequate resources, highly complex technical language was used, and ethical concerns (eg, breach of anonymity if study participants are brought together) were raised. Evidence gaps indicate that new studies should assess the methods and the receiver (ie, public) preferences and needs that are required to deliver and facilitate interactive digital information exchange. Conclusions: Few studies addressing digital information exchange in health studies could be identified in this review. There was little focus on interactivity in such an exchange. Digital information exchange was associated with more barriers than facilitators, suggesting that more effort is required to improve such an exchange between the public and researchers. Future studies should investigate interactive digital methods and the receiver preferences and needs required for such an exchange.

Introduction: Patient and public involvement (PPI) is considered part of best-practice for health care delivery, research and policy. However, people with dementia are frequently excluded from PPI initiatives. While recent studies have investigated PPI of people with dementia in research, little is known about their involvement at the macro-level of care, that is, in health policy and guideline development. This scoping review maps the evidence on PPI of people with dementia at the macro-level of care, focusing on the methods, outcomes and mechanisms of involvement. Methods: We systematically searched MEDLINE via PubMed, CINAHL, the Cochrane Library and GeroLit. Additionally, we performed forward and backward citation searching, manually tracked individual references, searched abstract books and yearbooks, and contacted authors of included reports to seek additional references. We analysed each method's mechanisms of involvement to assess whether measures were taken to maximise effective information transfer. Results: We included 43 reports and identified 35 involvement methods, which we structured into six categories: 'focus groups and interviews', 'surveys and questionnaires', 'public events', 'meetings with decision-makers', 'serving as members of working groups', and 'multiple-step methods'. Most of the involvement took the form of consultations during the early stages of policy or guideline development. All involvement methods required verbal communication skills, almost all of the participants had mild dementia. We found that most reports did not clearly state the involvement outcomes. While a majority of methods had some facilitation in place to elicit information from participating people with dementia, only nine methods used a structured aggregation to synthesise participants' contributions into a joint statement. Conclusion: We found limited evidence of dementia-adapted involvement. Future research might focus on exploring the mechanisms of involvement to adapt methods to specific target groups, such as people with impaired verbal communication or advanced dementia. We recommend using existing guidance to report PPI initiatives, as the reporting was often incomplete, which limits reproducibility. Patient or public contribution: We discussed both our study protocol and our results with a working group of people with dementia, who provided valuable insight for our data interpretation. Our findings can serve such groups for future consultations.

Abstract Background: Voluntary stopping of eating and drinking (VSED) is a way to end one's life prematurely. We synthesized the empirical data on VSED. Methods: In this systematic mixed-methods review, we searched MEDLINE, CINAHL, PsycINFO, Google Scholar, and BELIT for English and German articles published between January 1, 2013 and November 12, 2021. We included quantitative and qualitative research examining the experiences, attitudes, and knowledge of people confronted with VSED. We inductively analyzed the data after quantitative data transformation. We assessed quality and confidence using the Mixed-Methods Appraisal Tool and GRADE-CERQual approach, respectively. This study was registered in PROSPERO (CRD42022283743). Findings: We identified 22 eligible articles, comprising 16 studies. The participants were healthcare professionals and relatives, but not individuals undertaking VSED. We present here our findings on the challenges of accompanying VSED, positive experiences with VSED, and the identified needs. Support during VSED is needed at multiple levels (medical care, family relief, course planning), and the willingness to accompany VSED is very high among healthcare professionals. However, there are several problems, the most obvious being the lack of knowledge and expertise regarding VSED, placing a great burden on families and professionals. The confidence in the review findings ranged from moderate to low. Interpretation: Evidence-based guidance, in-depth knowledge, and training of healthcare professionals can greatly reduce the burden and fear among individuals accompanying VSED.

Background: Racism in the healthcare system has become a burgeoning focus in health policy-making and research. Existing research has shown both interpersonal and structural forms of racism limiting access to quality healthcare for racialised healthcare users. Nevertheless, little is known about the specifics of racism in the inpatient sector, specifically hospitals and rehabilitation facilities. The aim of this scoping review is therefore to map the evidence on racial discrimination experienced by people receiving treatment in inpatient settings (hospitals and rehabilitation facilities) or their caregivers in high-income countries, focusing specifically on whether intersectional axes of discrimination have been taken into account when describing these experiences. Methods: Based on the conceptual framework developed by Arksey and O'Malley, this scoping review surveyed existing research on racism and racial discrimination in inpatient care in high-income countries published between 2013 and 2023. The software Rayyan was used to support the screening process while MAXQDA was used for thematic coding. Results: Forty-seven articles were included in this review. Specifics of the inpatient sector included different hospitalisation, admission and referral rates within and across hospitals; the threat of racial discrimination from other healthcare users; and the spatial segregation of healthcare users according to ethnic, religious or racialised criteria. While most articles described some interactions between race and other social categories in the sample composition, the framework of intersectionality was rarely considered explicitly during analysis. Discussion: While the USA continue to predominate in discussions, other high-income countries including Canada, Australia and the UK also examine racism in their own healthcare systems. Absent from the literature are studies from a wider range of European countries as well as of racialised and disadvantaged groups other than refugees or recent immigrants. Research in this area would also benefit from an engagement with approaches to intersectionality in public health to produce a more nuanced understanding of the interactions of racism with other axes of discrimination. As inpatient care exhibits a range of specific structures, future research and policy-making ought to consider these specifics to develop targeted interventions, including training for non-clinical staff and robust, transparent and accessible complaint procedures.

Many transgender individuals face inequities, discrimination, and sometimes even a lack of transgender-specific knowledge in health care settings. Educational curricula can address such disparities and help future health professionals to become more knowledgeable, confident, and well-prepared for addressing the needs of transgender individuals. This systematic review aims to summarize current training interventions about care of transgender individuals for health and allied health students, and to analyse the effects of the respective intervention. A total of six databases (Pubmed, MEDLINE, Scopus, Web of Science, Embase and SciSearch) were screened for original articles published between 2017 and June 2021. Search terms and eligibility criteria were pre-specified, and after a structured selection process 21 studies were included into further analysis. Extracted data contained information on general study properties, population, design, program format and outcomes of interest. A narrative synthesis was used to summarize detected results. Study quality was assessed for each individual study. A self-developed 18-item checklist combining criteria of two prior published tools was used to assess overall quality of quantitative studies. For qualitative studies a 10-item checklist by Kmet et al. [HTA Initiat, 2004] was applied. Eligible studies were designed for multiple health or allied health profession students, and varied widely regarding program format, duration, content, and assessed outcomes. Almost all (N = 19) interventions indicated improvements in knowledge, attitude, confidence and comfort levels or practical skills concerning care for transgender clients. Major limitations included the lack of long-term data, validated assessment tools, control groups and comparative studies. Training interventions contribute to prepare future health professionals to deliver competent and sensitive care and which may improve the prospective experienced health care reality of transgender individuals. However, currently there is no common consensus about best practice of education. Additionally, little is known about whether detected effects of training interventions translate into noticeable improvements for transgender clients. Further studies are warranted to assess the direct impact of specific interventions in the light of the respective target populations.

Objectives: Chronic pain in children and adolescents (CPCA) is widespread with an increasing prevalence. It is associated with a decreased quality of life and an increased parental work loss. Accordingly, CPCA may pose a substantial economic burden for patients, health care payers, and society. Therefore, this systematic review aimed to synthesize (1) the results of existing cost-of-illness studies (COIs) for CPCA and (2) the evidence of economic evaluations (EEs) of interventions for CPCA. Methods: The systematic literature search was conducted in EMBASE, MEDLINE, PsycINFO, NHS EED, and HTA Database until February 2023. Title, abstract, and full-text screening were conducted by 2 researchers. Original articles reporting costs related to CPCA published in English or German were included. Study characteristics, cost components, and costs were extracted. The quality of studies was assessed using standardized tools. All costs were adjusted to 2020 purchasing power parity US dollars (PPP-USD). Results: Fifteen COIs and 10 EEs were included. The mean annual direct costs of CPCA ranged from PPP-USD 603 to PPP-USD 16,271, with outpatient services accounting for the largest share. The mean annual indirect costs ranged from PPP-USD 92 to PPP-USD 12,721. All EEs reported a decrease in overall costs in treated patients. Discussion: The methodology across studies was heterogeneous limiting the comparability. However, it is concluded that CPCA is associated with high overall costs, which were reduced in all EEs. From a health-economic perspective, efforts should address the prevention and early detection of CPCA followed by specialized pain treatment.

BACKGROUND: Healthcare providers have to make ethically complex clinical decisions which may be a source of stress. Researchers have recently introduced Artificial Intelligence (AI)-based applications to assist in clinical ethical decision-making. However, the use of such tools is controversial. This review aims to provide a comprehensive overview of the reasons given in the academic literature for and against their use. METHODS: PubMed, Web of Science, Philpapers.org and Google Scholar were searched for all relevant publications. The resulting set of publications was title and abstract screened according to defined inclusion and exclusion criteria, resulting in 44 papers whose full texts were analysed using the Kuckartz method of qualitative text analysis. RESULTS: Artificial Intelligence might increase patient autonomy by improving the accuracy of predictions and allowing patients to receive their preferred treatment. It is thought to increase beneficence by providing reliable information, thereby, supporting surrogate decision-making. Some authors fear that reducing ethical decision-making to statistical correlations may limit autonomy. Others argue that AI may not be able to replicate the process of ethical deliberation because it lacks human characteristics. Concerns have been raised about issues of justice, as AI may replicate existing biases in the decision-making process. CONCLUSIONS: The prospective benefits of using AI in clinical ethical decision-making are manifold, but its development and use should be undertaken carefully to avoid ethical pitfalls. Several issues that are central to the discussion of Clinical Decision Support Systems, such as justice, explicability or human-machine interaction, have been neglected in the debate on AI for clinical ethics so far.

Artificial intelligence (AI) in the domain of healthcare is increasing in prominence. Acceptance is an indispensable prerequisite for the widespread implementation of AI. The aim of this integrative review is to explore barriers and facilitators influencing healthcare professionals' acceptance of AI in the hospital setting. Forty-two articles met the inclusion criteria for this review. Pertinent elements to the study such as the type of AI, factors influencing acceptance, and the participants' profession were extracted from the included studies, and the studies were appraised for their quality. The data extraction and results were presented according to the Unified Theory of Acceptance and Use of Technology (UTAUT) model. The included studies revealed a variety of facilitating and hindering factors for AI acceptance in the hospital setting. Clinical decision support systems (CDSS) were the AI form included in most studies (n = 21). Heterogeneous results with regard to the perceptions of the effects of AI on error occurrence, alert sensitivity and timely resources were reported. In contrast, fear of a loss of (professional) autonomy and difficulties in integrating AI into clinical workflows were unanimously reported to be hindering factors. On the other hand, training for the use of AI facilitated acceptance. Heterogeneous results may be explained by differences in the application and functioning of the different AI systems as well as inter-professional and interdisciplinary disparities. To conclude, in order to facilitate acceptance of AI among healthcare professionals it is advisable to integrate end-users in the early stages of AI development as well as to offer needs-adjusted training for the use of AI in healthcare and providing adequate infrastructure.

BACKGROUND: Digital transformation is currently one of the most influential developments. It is fundamentally changing consumers' expectations and behaviors, challenging traditional firms, and disrupting numerous markets. Recent discussions in the health care sector tend to assess the influence of technological implications but neglect other factors needed for a holistic view on the digital transformation. This calls for a reevaluation of the current state of digital transformation in health care. Consequently, there is a need for a holistic view on the complex interdependencies of digital transformation in the health care sector. OBJECTIVE: This study aimed to examine the effects of digital transformation on the health care sector. This is accomplished by providing a conceptual model of the health care sector under digital transformation. METHODS: First, the most essential stakeholders in the health care sector were identified by a scoping review and grounded theory approach. Second, the effects on these stakeholders were assessed. PubMed, Web of Science, and Dimensions were searched for relevant studies. On the basis of an integrative review and grounded theory methodology, the relevant academic literature was systematized and quantitatively and qualitatively analyzed to evaluate the impact on the value creation of, and the relationships among, the stakeholders. Third, the findings were synthesized into a conceptual model of the health care sector under digital transformation. RESULTS: A total of 2505 records were identified from the database search; of these, 140 (5.59%) were included and analyzed. The results revealed that providers of medical treatments, patients, governing institutions, and payers are the most essential stakeholders in the health care sector. As for the individual stakeholders, patients are experiencing a technology-enabled growth of influence in the sector. Providers are becoming increasingly dependent on intermediaries for essential parts of the value creation and patient interaction. Payers are expected to try to increase their influence on intermediaries to exploit the enormous amounts of data while seeing their business models be challenged by emerging technologies. Governing institutions regulating the health care sector are increasingly facing challenges from new entrants in the sector. Intermediaries increasingly interconnect all these stakeholders, which in turn drives new ways of value creation. These collaborative efforts have led to the establishment of a virtually integrated health care ecosystem. CONCLUSIONS: The conceptual model provides a novel and evidence-based perspective on the interrelations among actors in the health care sector, indicating that individual stakeholders need to recognize their role in the system. The model can be the basis of further evaluations of strategic actions of actors and their effects on other actors or the health care ecosystem itself.

BACKGROUND: Games and game components have become a major trend in the realm of digital health research and practice as they are assumed to foster behavior change and thereby improve patient-reported and clinical outcomes for patients with type 2 diabetes. OBJECTIVE: The aim of this systematic review was to summarize and evaluate the current evidence on the effectiveness of digital health interventions containing game components on behavioral, patient-reported, and clinical outcomes for patients with type 2 diabetes. METHODS: An electronic search was conducted in MEDLINE and PsycINFO in April 2020; updated in April 2022; and supplemented by additional searches via Google Scholar, Web of Science (which was used for forward citation tracking), and within the references of the included records. Articles were identified using predefined inclusion and exclusion criteria. In total, 2 reviewers independently conducted title, abstract, and full-text screening and then individually performed a critical appraisal of all the included studies using the Cochrane risk-of-bias tool version 2. A consensus was reached through discussion. RESULTS: Of 2325 potentially relevant titles (duplicates excluded), 10 (0.43%) randomized controlled trials were included in this review. Quality assessment revealed a high risk of bias for all randomized controlled trials except for 10% (1/10), with performance bias due to the lack of blinding being the major source of bias. There is evidence suggesting that digital health interventions containing game components can substantially improve motivation for physical activity (1/1, 100% of the studies dealing with PA motivation), exercise intensity (3/5, 60%), dietary behavior (4/4, 100%), health literacy (1/3, 33%), mental quality of life (2/2, 100%), glycated hemoglobin level (2/6, 33%), BMI (1/3, 33%), fasting plasma glucose level (1/2, 50%), waist circumference (1/1, 100%), and aerobic capacity (1/1, 100%). CONCLUSIONS: Published studies indicated that digital health interventions containing game components might improve health behavior patterns, quality of life, and clinical outcomes in patients with type 2 diabetes. However, the intervention types and outcomes studied were heterogeneous, and study quality was mostly low, which translates to ambiguous results. Future research should focus on sound methodology and reporting as well as on identifying game components that contribute to significant positive effects.

Introduction: Personalization is a much-discussed approach to improve adherence and outcomes for Digital Mental Health interventions (DMHIs). Yet, major questions remain open, such as (1) what personalization is, (2) how prevalent it is in practice, and (3) what benefits it truly has. Methods: We address this gap by performing a systematic literature review identifying all empirical studies on DMHIs targeting depressive symptoms in adults from 2015 to September 2022. The search in Pubmed, SCOPUS and Psycinfo led to the inclusion of 138 articles, describing 94 distinct DMHIs provided to an overall sample of approximately 24,300 individuals. Results: Our investigation results in the conceptualization of personalization as purposefully designed variation between individuals in an intervention's therapeutic elements or its structure. We propose to further differentiate personalization by what is personalized (i.e., intervention content, content order, level of guidance or communication) and the underlying mechanism [i.e., user choice, provider choice, decision rules, and machine-learning (ML) based approaches]. Applying this concept, we identified personalization in 66% of the interventions for depressive symptoms, with personalized intervention content (32% of interventions) and communication with the user (30%) being particularly popular. Personalization via decision rules (48%) and user choice (36%) were the most used mechanisms, while the utilization of ML was rare (3%). Two-thirds of personalized interventions only tailored one dimension of the intervention. Discussion: We conclude that future interventions could provide even more personalized experiences and especially benefit from using ML models. Finally, empirical evidence for personalization was scarce and inconclusive, making further evidence for the benefits of personalization highly needed.