Background: Telehealth technologies can enhance patients' and their families' access to high-quality resources in home-based palliative care. Nurses are deeply involved in delivering telehealth in home-based palliative care. However, no previous integrative systematic reviews have synthesized evidence on nurses' roles, facilitators, and barriers to implementing nurse-delivered telehealth in home-based palliative care. Objective: This integrative systematic review aimed to provide a comprehensive understanding of the roles of nurses and the multilevel facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care, which could inform future policy development, research, and clinical practice. Methods: This integrative systematic review was conducted using Joanna Briggs Institute methodological guidance. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We systematically searched articles published from January 1, 2014, to May 2024 in PubMed, Embase, Web of Science, CINAHL, and Cochrane Library. We included English-language; peer-reviewed; original; and qualitative, quantitative, and mixed methods studies that centered on nurse-delivered telehealth in home-based palliative care. We used the Mixed Methods Appraisal Tool to assess the quality of the included articles. Furthermore, 3 authors independently assessed eligibility, extracted data, and assessed the quality of articles. The entities to extract were identified by research questions of interest regardless of the type of study. We applied a convergent synthesis approach to integrate quantitative and qualitative data. Guided by the updated Consolidated Framework for Implementation Research (CFIR) 2.0, we synthesized the facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care. Results: This integrative systematic review identified 4819 unique articles, including 34 papers encompassing 29 unique primary research studies. Innovations were mainly delivered by nurses (n=8) and nurse-involved multiprofessional teams (n=18). The roles of nurses in telehealth home-based palliative care involve palliative care nurses, community nurses, nurse coordinators, nurse coaches or nurse navigators, and nurse case managers. Guided by CFIR 2.0, facilitators and barriers to implementing nurse-delivered, telehealth, home-based palliative care were identified to 6 implementation levels and 20 constructs. The key facilitators included the COVID-19 pandemic, cost avoidance to the health care system, engagement of patients and their family caregivers, and so on. The barriers included a lack of reimbursement and payment mechanisms, technical problems, insufficiently trained health care providers, and so on. Conclusions: This integrative systematic review synthesizes evidence on nurses' evolving roles in telehealth home-based palliative care and identifies multilevel facilitators and barriers to nurse-delivered, home-based palliative care implementation. With the empowerment of telehealth technologies, nurses could establish a stronger professional identity and develop leadership in home-based palliative care. Nurses should leverage influence to promote nursing practice, clinical management, and policy support in the implementation of telehealth home-based palliative care. Trial registration: PROSPERO CRD42024541038; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024541038.

Objective: By studying the Technology-Organization-Environment Framework (TOE), this research explores the impact of various indicators in technology, organization, and environment on the performance of family doctor services during major public health emergencies. It aims to identify the driving paths to improve performance. Methods: A stratified sampling of 34 community health service centers in Shanghai was conducted, using the comprehensive performance score of family doctors as the outcome variable. The Average Internet Medical Service Person-times and the Information Technology Expenditure per Thousand Population were considered as technology-related variables. The Fiscal Allocation per Thousand Population (/1,000), the Family Doctor Team Members per Thousand Population, and the Medical Social Workers and Volunteers per Thousand Population were identified as organization-related variables. The Proportion of Older Adult Population, Fiscal Allocation per Thousand Population, and the number of patient self-education organizations per thousand population were taken as environment-related variables. Fuzzy-set Qualitative Comparative Analysis (fsQCA) was employed to conduct necessity analysis, truth table analysis, and configurational analysis of antecedent conditions, with robustness tests performed by adjusting consistency thresholds and case frequencies. Results: The study found that the performance of family doctor services was influenced by multiple factors, with no single decisive factor. In overall communities, five configurations, including per capita fiscal allocation and community participation, affected performance, explaining 4.2% of the variance. In central urban areas, information technology expenditure and the Proportion of Older Adult Population were core conditions, influencing 27.5% of performance paths. In non-central urban areas, core conditions such as financial support and IT covered 53.9% of data cases. The fsQCA results, which were robustly tested, begin to provide a strong basis for resource allocation and policy formulation. Conclusion: This study begins to fill the gap in research on family doctor service performance during major public health emergencies, exploring the synergistic effects and causal asymmetry among multiple indicators such as technology, organization, and environment from a holistic, or configurational, perspective.

Background: Head nurses face challenging job content while executing their roles as nurses, managers and leaders. However, no European compilation for portraying head nurses' job content within a hospital setting is available. Objectives: This study aimed to develop and validate a compilation that portrays the job content of head nurses employed in European hospitals. Methods: A scoping review was conducted according to Arksey and O'Malley's (2005) five-stage framework. Articles focusing on the job content of head nurses with 24-h first-line organizational and hierarchical responsibility for one or two units in a hospital setting were included. An electronic search was performed via PubMed, CINAHL and Embase. The Journal of Nursing Administration, Journal of Nursing Management, Journal of Healthcare Management and Nursing Management were screened manually to identify additional articles. Subsequently, a two-round multinational Delphi study following the methodology of Yussof (2019) was carried out. Eligible opinion leaders originated from Europe and included head nurses, as well as second-line nurse managers and hospital executives with head nurse experience. Twenty-three opinion leaders participated in the first round of the Delphi study, and 16 opinion leaders from the initial round subsequently participated in the second round. The item-level content validity index and scale-level content validity index based on the average method were calculated. Results: The scoping review included 90 articles published between 1934 and 2024. In total, 64 terms were found to name the head nurse position. Job content could be categorized according to four main themes: operational management, patient care, human resources management and unit-level policy development. Fifteen subthemes were determined, namely quality and safety management, staff planning, administrative and financial management, resource and technology management, care planning, direct and indirect patient care, individual and general staff management, learning opportunities, strategic management, creative thinking, and change management. After two Delphi rounds, the final compilation comprises four main themes, 10 subthemes and 53 task descriptions, excluding staff planning, care planning, direct patient care, administrative management and financial management. Conclusions: Head nurses' job content mapped by international evidence differs from the job content considered relevant by European opinion leaders. Fragmentation in what European opinion leaders considered relevant within the head nurses' job content became apparent. The compilation can be tailored to different countries or types of hospitals and serve as a guide for second-line nurse managers and hospital executives to determine the key job content based on the priorities and strategic direction of the hospital.

Background & Objective: This systematic review evaluates the impact of guidelines on healthcare professionals' behavior and explores the resulting outcomes. Methods: Using PRISMA methodology, Scopus and Web of Science databases were searched, yielding 624 results. After applying inclusion criteria, 67 articles were selected for in-depth analysis. Results: The studies focused on key clusters: Target behaviors, Effectiveness, Research designs, Behavioral frameworks, and Publication outlets. Prescription behavior was the most studied (58.2 %), followed by other health-related behaviors (31.3 %) and hygiene practices (10.4 %). Significant behavior changes were reported in 46.3 % of studies, with 17.9 % showing negative effects, and 22.4 % reporting mixed results. Quantitative methods dominated (56.8 %), while qualitative methods (19.4 %) and review designs (13.4 %) were less common. Theoretical Domain Framework (TDF) and Behavior Change Wheel (BCW) were frequently used frameworks, with the UK and the USA contributing most studies. Medical doctors (44.8 %) were the primary participants, followed by general healthcare providers (37.3 %). Conclusions: The study highlights the varied effectiveness of guidelines, with prescription behavior being the most investigated. Guidelines influenced behavior positively in less than half of the cases, and doctors were the primary focus, rather than nurses. The complexity of interventions suggests a need for further research to develop more effective behavioral interventions and to standardize methodological approaches to reduce clinical variation in healthcare.

Introduction Episodes of alienation and/or anomie in pharmacists have been reported in historical accounts since the 19th century. Alienation and anomie are distinct types of psychological or social ills where people are problematically separated from, or their skills and values are misaligned with, others and their environment. Alienation and/or anomie can be important precursors of many negative work experiences, including job dissatisfaction, burnout and/or intention to leave.Methods and analysis We aim to study alienation and/or anomie in pharmacists from across the globe, reviewing all types of methodological designs, published in peer-reviewed journals, including all primary qualitative, quantitative and/or mixed-method research studies. We will narratively describe any focuses, causes, associated factors and/or consequences of alienation and/or anomie. We will identify all published peer-reviewed research by searching seven electronic databases (MEDLINE, Embase, APA PsychINFO, CINAHL Plus, Cochrane Library, Web of Science Core Collection and Scopus) and Google Scholar in May 2024. Extensive hand and citation-searching will also take place. Two independent reviewers will identify eligible studies, conduct a critical appraisal of the study conduct, extract data and synthesise reported findings by narratively exploring relationships within and between studies. The synthesis will follow a hybrid thematic analysis. Initially, we will deductively structure the findings according to six themes from underpinning alienation and anomie theory: Care, Values, Meaning, Recognition, Autonomy and Shared Responsibility. This structure may thereafter be inductively adapted, by creating new additional themes, if required from the data. A GRADE Confidence in the Evidence from Reviews of the Qualitative research approach will be used to determine a confidence profile of each theme. A thematic map showing the links between themes will also be produced.Ethics and dissemination Ethical permission is not required, as this study uses data from published research. Dissemination will be through publication in peer-reviewed journals and conference presentations.PROSPERO registration number CRD42024536336.

目的:探讨临床护理人员突发公共卫生事件应急能力的影响因素，为提高临床护士突发公共卫生事件应急能力提供科学依据。方法:计算机检索PubMed、中国知网、Web of Science、维普数据库、the Cochrane Library、中国生物医学文献服务系统、Embase和万方数据库中关于临床护理人员突发公共卫生事件应急能力影响因素研究的文献，检索时限为建库至2023年5月31日。采用澳大利亚学者循证护理中心研制横断面研究偏倚风险评价标准进行文献质量评分。根据I2值和P值对文章进行异质性判断，并选用相应的效应模型；观察通过去除任意1项研究后其合并效应量的稳定性来进行敏感性分析。结果:共纳入8篇横断面研究，提取6个相关的影响因素。Meta分析结果显示，性别[SMD=0.46,95%CI（0.34,0.58）]、职称[SMD=-0.17,95%CI（-0.22,-0.13）]、突发公共卫生事件培训课程[SMD=0.74,95%CI（0.57,0.92）]、灾害救援活动经历[SMD=0.49,95%CI（0.43,0.54）]、突发公共卫生事件演练[SMD=0.61,9...

目的 对Gibbs反思循环模型在护理教学中应用的研究进行范围审查，探讨国内外Gibbs反思循环模型在护理教学中的应用现状、教学策略及其教学效果。方法 计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、Cochrane library、Embase数据库，检索时限为建库至2023年11月30日，应用Arksey和O'Malley提出的报告框架对纳入文献进行范围综述。结果 共纳入19篇文献，其中10篇英文文献，9篇中文文献，发表时间为2017-2023年，Gibbs反思循环模型已广泛应用于护理专业教学中，但目前国内师资培训尚不规范，部分教学实施步骤欠严谨，教学评价科学性不足。结论 Gibbs反思循环模型应用有利于提升护理教学质量，对增强学生及护士的专业水平及综合能力具有重要意义，但应规范师资培训过程，明确实施步骤和各阶段教学重点，建立双向、多维度教学评价机制。

This systematic review provides an overview of the unique challenges allied health professions face in the translation and implementation of evidence into practice, which remain relatively under reported and uninformed by a theoretical basis of behaviour change. MEDLINE, EMBASE, CINAHL and Scopus databases from 2010 to 2022 were searched for primary study designs resulting in 21 articles included in this review (PROSPERO: 2022 CRD42022314996). Allied health disciplines reported in the review were mainly from occupational therapy, physiotherapy, dietetics, and speech pathology. The most frequently reported implementation determinants across the Theoretical Domains Framework were identified as 'environmental context and resources', and 'knowledge'. The results also identified a greater influence of 'social influences' and 'beliefs about consequences' in implementation. Implementing evidence into clinical practice is a multifaceted, complex process, and the use of the Theoretical Domains Framework provided a systematic approach to understanding the drivers behind the target behaviours. However, there is a paucity of studies across the allied health professions that describe implementation strategies used and their impact. Many of the studies focused on implementation by the individual clinician rather than the role organizations can play in the translation of evidence into practice.

Background: Despite increasing interest in quality end-of-life care (EOLC), critically ill patients often receive suboptimal care. Critical care nurses play a crucial role in EOLC, but face numerous barriers that hinder their ability to provide compassionate and effective care. Methods: An integrative literature review was conducted to investigate barriers impacting the quality of end-of-life care. This review process involved searching database like MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, EBSCO, and ScienceDirect up to November 2023. Search strategies focused on keywords related to barriers in end-of-life care and critical care nurses from October 30th to November 10th, 2023. The inclusion criteria specified full-text English articles published between 2010 and 2023 that addressed barriers perceived by critical care nurses. This integrative review employs an integrated thematic analysis approach, which combines elements of deductive and inductive analysis, to explore the identified barriers, with coding and theme development overseen by the primary and secondary authors. Results: Out of 103 articles published, 11 articles were included in the review. There were eight cross-sectional descriptive studies and three qualitative studies, which demonstrated barriers affecting end-of-life care quality. Quality appraisal using the Mixed Method Appraisal Tool was completed by two authors confirmed the high credibility of the selected studies, indicating the presence of high-quality evidence across the reviewed articles. Thematic analysis led to the three main themes (1) barriers related to patients and their families, (2) barriers related to nurses and their demographic characteristics, and (3) barriers related to health care environment and institutions. Conclusion: This review highlights barriers influencing the quality of end of life care perceived by critical care nurses and the gaps that need attention to improve the quality of care provided for patients in their final stages and their fsmilies within the context of critical care. This review also notes the need for additional research to investigate the uncover patterns and insights that have not been fully explored in the existing literature to enhance understanding of these barriers. This can help to inform future research, care provision, and policy-making. Specifically, this review examines how these barriers interact, their cumulative impact on care quality, and potential strategies to overcome.

Aim: CPR training for schoolchildren to increase bystander CPR-rates is widely applied. HCPs are regarded as the instructor gold standard, but using non-HCP instructors (e.g., peer-tutors, schoolteachers, medical students) challenges that. This systematic review assesses whether cardiopulmonary resuscitation (CPR) training for children led by peer-tutors, schoolteachers, or medical students results in different learning outcomes to training by health-care professionals (HCPs). Methods: We searched studies that compared CPR training for schoolchildren (population) delivered by peer-tutors, schoolteachers, or medical students (intervention), with training led by HCPs (comparison), assessing student knowledge, skills, willingness and/or confidence to perform CPR (outcome). We included randomized and non-randomized controlled trials (study design). Medline, Embase, Psychinfo, Cinahl, Cochrane, Scopus, Web of Science, and Eric were searched from inception until December 23rd, 2023 (timeframe). Two independent reviewers performed title, abstract, full text screening, bias assessment, and grading of certainty of evidence. We followed the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) guidelines, and registered the review with PROSPERO. Results: Of 9'092 studies identified, 14 were included. Comparison of intervention groups to HCP-led training showed similar overall results (knowledge, skills, self-confidence). Superior results for HCP training were only reported for 'ventilation volume', while schoolteachers and medical students achieved superior knowledge transfer. A meta-analysis was possible for 'compression depth' between peer-tutors and HCPs showing no significant differences. Certainty of evidence was 'low' to 'very low'. Conclusion: This systematic review of CPR training for school children revealed that peer-tutors, schoolteachers and medical students achieve similar educational outcomes compared to those of HCPs. Non-HCPs training schoolchildren is an appropriate cost-efficient alternative and easy to implement in school curricula.

The number of health care educational institutions/organizations adopting implicit bias training is growing. Our systematic review of 77 studies (published 1 January 2003 through 21 September 2022) investigated how implicit bias training in health care is designed/delivered and whether gaps in knowledge translation compromised the reliability and validity of the training. The primary training target was race/ethnicity (49.3%); trainings commonly lack specificity on addressing implicit prejudice or stereotyping (67.5%). They involved a combination of hands-on and didactic approaches, lasting an average of 343.15 min, often delivered in a single day (53.2%). Trainings also exhibit translational gaps, diverging from current literature (10 to 67.5%), and lack internal (99.9%), face (93.5%), and external (100%) validity. Implicit bias trainings in health care are characterized by bias in methodological quality and translational gaps, potentially compromising their impacts.

目的 对国内外社区护士突发公共卫生事件应急处置胜任力评估工具的方法学质量和测量学特性进行比较、分析及总结，为研究者选择高质量的评估工具提供参考依据。方法 系统检索PubMed、Embase、Web of Science核心数据库、CINAHL、Cochrane、中国知网、维普数据库、万方数据库、中国生物医学文献数据库9个数据库中有关社区护士突发公共卫生事件应急处置胜任力评估工具测量学特性的文献，检索时限均为建库至2023年11月27日。由2名研究者独立进行文献筛选和资料提取，并以基于共识的健康测量工具选择标准（the consensus-based standards for the selection of health measurement instruments,COSMIN）为指导对纳入评估工具的方法学质量及测量学特性进行分析、比较。结果 共纳入10个评估工具，主要包括对社区护士突发公共卫生事件应急处置胜任力的综合评估和专项评估。基于评价结果，所有评估工具均为B级推荐。结论 目前社区护士突发公共卫生事件应急处置胜任力评估工具较为多样，但测评内容差异较大，并且测量学特性均有待进...

Aims: The aim of this review is to identify and map the evidence available on the factors that influence the implementation of clinical supervision for nurses. Design: The scoping review was conducted and reported following the JBI methodology for scoping reviews. Data sources: Searches were conducted on MEDLINE, PsycINFO, and CINAHL databases on 28 March 2023. Review methods: A total of 1398 studies were imported into Covidence for screening. Researchers screened the papers according to the inclusion criteria. Empirical studies in English focusing on the implementation of clinical supervision for nurses were included, without year restrictions. Data from 16 studies were extracted and organized according to the constructs within the Consolidated Framework for Implementation Research (CFIR) domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. Results: When compared with the CFIR constructs, it was found that the influence of the outer setting on implementation was less explored in the literature. Most of the reviewed data highlighted recurring factors, particularly logistical challenges of nursing work such as shift work and lack of control over work time. Organizational culture and managerial support were also identified as significant factors in the implementation. Another significant challenge in implementation was the variety in clinical supervision's design, purpose, and application, despite sharing the same label, leading to questions about whether studies are implementing the same practice. Conclusion: Policy documents should clearly define both the design and purpose of clinical supervision, beyond just its conceptual definition. Greater emphasis on equitable implementation of clinical supervision is necessary to prevent perpetuating existing inequalities. We conclude that implementation of such complex interventions is not linear, and the implementation strategies need to align with expected implementation challenges. Impact: The advantage of using the implementation framework lies not only in observing what exists as a form of evidence but also in identifying what is underdeveloped. Healthcare services and policy developers can utilize our review to recognize and address potential challenges in introducing, modifying, scaling up, or sustaining their clinical supervision implementation. Patient or public contribution: No patient or public contribution.

Aim: Amidst the mounting challenges posed by climate change, the healthcare sector emerges as a vital frontliner, with nurses standing as its linchpins. This review delves into the pivotal role of nurses in combatting the health consequences of climatic alterations, particularly within the nuanced environment of Saudi Arabia. Design: A rapid literature review. Method: Drawing from a rigorous analysis of 53 studies, our exploration revolves around the preparedness strategies formulated in response to Saudi Arabia's changing climate. The variables analysed included study design, sample size, focus area, geographical coverage and key findings related to nurse competencies. Data were collected using a structured data extraction form and analysed using thematic content analysis. Employing content analysis, we discerned essential domains: from grasping the health impacts of climate change to customizing care for the most susceptible populations and championing advocacy initiatives. Findings: Salient findings highlight nurses' profound understanding of both direct and secondary health implications of climate shifts. Additionally, the results emphasize the tailored interventions needed for vulnerable groups, capacity building and disaster readiness. Crucially, our findings spotlight the significance of weaving cultural, ethical and regional threads into nursing strategies. By painting a comprehensive picture, we showcase the delicate balance of environmental evolution, healthcare dynamics and the unique socio-cultural tapestry of Saudi Arabia. Conclusion: The results of our analysis revealed key competencies required for nurses, including the ability to address immediate health impacts, provide tailored care for vulnerable populations and engage in advocacy and policy formulation. In summation, nurses' multifaceted roles-from immediate medical care to research, advocacy and strategizing-underscore their invaluable contribution to confronting the health adversities sparked by climate change. Our review accentuates the essential contributions of nurses in tackling climate-related health hurdles and calls for more nuanced research, policy adjustments and proactive measures attuned to Saudi Arabia's distinct backdrop.

Background: Evidence-based practice is defined as using the best available research and clinical evidence by incorporating patients' values and preferences for their health needs. The use of evidence-based intrapartum care practices is an essential tool to improve the quality of obstetrics care. Objective: The primary objective of this study was to determine the prevalence of evidence-based intrapartum care and associated factors among obstetrics care providers in Ethiopia. Method: Important articles were retrieved from universally accepted and used databases, including Cochran, PubMed, HINARI, Google Scholar, Web of Science, African OnLine, and repositories of Ethiopian Universities. We extracted articles by using a standard JOANNA Briggs Institute data extraction sheet. To determine the existence of heterogeneity in studies, I 2 statistics and Cochran Q tests were used. The publication bias of the included studies was checked using Egger's test and a Funnel plot. Result: A total of 2035 obstetrics care providers were involved in this systematic review and meta-analysis. The estimated overall rate of evidence-based intrapartum care practice in Ethiopia was 54.45% (95% CI: 43.06, 65.83); I 2 = 96.6%, p < 0.001). The studies with a sample size greater than 300 count for 47.25% (95% CI: 36.14, 65.83). Whereas obstetrics care providers have a decent knowledge of intrapartum care evidence 3.31 times, a positive attitude toward evidence 3.34 times, training 2.21 times, and work experience ⩾5 years 3.31 times associated with the practice of evidence-based intrapartum care. Conclusion: The overall practice of evidence-based intrapartum care among obstetrics workers in Ethiopia is estimated to be low. Therefore, there should be a focused effort on training and disseminating protocols and guidelines to enhance knowledge and foster a positive attitude among obstetrics care providers. Additionally, the Ethiopian government should prioritize the implementation of the 2021 to 2025 National Health Equity Strategic Plan to achieve its objective of improving the quality of health services.

　随着居民疾病谱的改变和国家分级诊疗的推进，全科医生在疾病诊疗中扮演着重要角色。同时， 医学知识的不断更新和居民卫生服务需求的持续变化，需要全科医生不断参与继续教育培训，给患者提供最佳的诊疗 决策和疾病管理。目的　分析近十年（2013—2022 年）我国全科医学继续教育培训研究的发展现状、培训质量与研究 质量。方法　2023 年 1 月，以 PubMed、Cochrane Library、Embase、CINAHL、ERIC、中国知网、万方数据知识服务平台、 中国生物医学文献服务系统 8 个中英文数据库为数据来源，获取有关中国全科医生继续教育的培训研究，进行阅读、 分析、整理和总结，检索时限为 2013 年 1 月—2022 年 12 月。利用医学教育研究质量量表（MERSQI）对文献的研究 质量进行综合评价。结果　本综述共纳入文献 49 篇，其中英文文献 11 篇，中文文献 38 篇。继续教育的培训主题集 中于心脑血管疾病（22.4%）、急救相关内容（6.1%）、精神疾病（6.1%）；培训形式较为单一，以传统的专家授课 为主（69.3%），仅 6.1% 采用技能培训的形式，4.0% 的研究采用 PBL/TBL 教学的培训形式；通常缺乏严格的评价： 有 31 项（63.2%）研究采用问卷对培训效果进行评估，其中 19 项未经信效度检验。研究设计中，单组前后对照的研 究设计占比最大（53.1%），随机对照前后测占比 26.5%，对照前后测占比最小（4.1%）。明确提及进行伦理审批的 研究有 9 项（18.3%），大多数研究未进行伦理审批（81.7%）。评估集中于针对全科医生培训前后的知识和技能提升 （85.7%），较少涵盖实际行为改变（14.2%）及对于患者和医疗机构的获益（22.4%）。结论　近 10 年全科继续教育 研究的关注度不足，但发展空间较大。未来需要根据实际需求，拓展培训主题、采取多元的培训方式，利用信效度佳 的评估工具，并关注培训后所带来的实际行为改变，以此让患者获益，多维度提升全科医生继续教育培训的质量。

Importance: The overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low. Objective: To describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions. Data sources: A literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021. Study selection: Publications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included. Data extraction and synthesis: Two reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons. Main outcomes and measures: The primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria. Results: A total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug. Conclusions and relevance: In this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.

目的 系统评价新型冠状病毒感染流行期间医护人员的心理健康状况，深入分析不同特征医护人员心理问题检出率差异，整体评估新型冠状病毒感染疫情对医护人员心理健康状况的影响。方法 检索PubMed、ScienceDirect、Web of Science和中国知网等数据库收录的有关新型冠状病毒感染流行期间医护人员压力、焦虑及抑郁状况的研究文献，检索时限2020年1月—2022年3月。分别采用RevMan 5.3和Stata 16软件对纳入研究进行文献管理和Meta分析。结果 检索获得2020—2022年相关研究2 637篇，筛选后纳入文献66篇，包括被试50 428名，其中医护人员整体压力、抑郁、焦虑症状检出率分别为18.19%(95%CI:0.128 9～0.234 9)、36.13%(95%CI:0.320 3～0.402 3)、34.18%(95%CI:0.299 3～0.384 2)。检出率在性别、岗位、年龄、科室和城市上存在显著差异。结论 新型冠状病毒感染疫情对医护人员的心理健康状况造成了强烈冲击，需重点关注女性、护士、30～<40岁年龄组、重点科室和一线城市等因素，强化适用不同...

Objective: This meta-analysis aimed to assess and evaluate the effect of nurse-led health management on the quality of life of patients with atrial fibrillation. Methods: We compared the outcomes of patients who received nurse-led intervention during hospitalization with those who did not, using a systematic retrospective and randomized controlled trial (RCT) analysis. We searched the studies in Cochrane Central Register, including PubMed, EmBase, Web of Science, Cochrane Library, WAN Data, CBM, CNKI, etc. Bias risks included in the study were evaluated by Cochrane Bias risk tool , and combined risk estimates were calculated. The main endpoints are the SF-36 and HADS scores and endpoints after surgery. We used a random effects model to combine the data. For continuous variables (such as SF-36 and HADS scores), we used standard mean difference for analysis, and for binary variables (such as the presence or absence of mental health problems), we used hazard ratio for analysis. The data are based on fixed or stochastic effects models, with standard mean differences and risk ratios for continuous and heterotaxic variables. Results: 3064 patients from 7 clinical studies were included in this meta-analysis. Postoperative SF-36 scores at 6 months in the nurse-led group were significantly higher than those in the routine nursing group in Role-Physical and Mental health. Postoperative SF-36 scores at 12 months in the nurse-led group were not significantly higher than those in the routine nursing group. The nurse-led group had a significantly lower HADS depression score than the conventional care group, but there was no significant difference in HADS anxiety score between the two groups. Conclusion: The main findings of this meta-analysis are that the nurse-led comprehensive management of atrial fibrillation can significantly improve the role-physical and mental health status of SF-36, reduce the HADS depression score, the incidence of cardiovascular hospitalization and atrial fibrillation at 6 months atrial fibrillation surgery. Additional high-quality RCTs should be conducted in the future. nurse-led interventions have the potential to significantly impact the care of patients with atrial fibrillation. By providing comprehensive management, education, and support, nurses can improve patient outcomes, enhance quality of life, and reduce healthcare burdens for both patients and providers. While this meta-analysis provides valuable insights, there are limitations that should be considered. Standardizing interventions and outcome measures, conducting larger studies with longer follow-up periods, including diverse populations and settings, and assessing the economic impact of nurse-led interventions are potential directions for future research in this field. Addressing these limitations would provide a more comprehensive understanding of the role of nurse-led interventions in the care of patients with atrial fibrillation.

Introduction: In recent years, the role of pharmacists has undergone significant transformation to become more patient-centered and involved in managing chronic diseases. Nonetheless, it remains unclear whether pharmacist involvement in diabetes management is cost-effective. This study aimed to systematically review the cost-effectiveness and reporting quality in comprehensive economic evaluations of pharmacist management compared to standard care in diabetes. Methods: Eligible studies included cost-effectiveness analyses employing pharmacist professional services as the intervention for diabetes. A literature search was conducted in the bibliographic databases Pubmed, Scopus, China National Knowledge Infrastructure (CNKI), and the International Health Technology Assessment (HTA) database from their inception until July 2023. Two independent reviewers performed title, abstract, full-text screening, and data abstraction and assessed the quality of reporting and methodological approaches using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklists. Results: Twelve studies were identified with an average research quality score of 19.8, including cost-utility (n = 5) and cost-effectiveness (n = 7) analyses, with only four studies rated as high quality. The efficacy data were derived from randomized controlled trials (n = 7), retrospective studies (n = 2), and published literature sources (n = 2). Half of the included studies were conducted in high-income countries, while the other half was in upper-middle and lower-middle-income countries, respectively. Despite significant variations in the cost of pharmacist intervention, consistent findings demonstrate that pharmacist involvement in diabetes management is more cost-effective or even cost-saving than standard care, primarily attributed to better glycemic control, enhanced patient compliance, and reduced risks of medication-related problems. Conclusion: This systematic review substantiates that pharmacist involvement in diabetes management is cost-effective compared with standard care. However, the overall quality of reporting needs to be improved, and high-quality evidence is urgently needed to support healthcare decision-making in pharmacy practice.