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.

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.

Introduction: The concept of transition refers to the shift from hospital-based care to home-based palliative care, encompassing the physical, emotional, and logistical adjustments patients and families face. This study aimed to synthesize the experiences of people in palliative situations at home. Methods: A systematic review using thematic synthesis was guided using Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) to organize the extracted information. Preparation of the qualitative synthesis followed ENTREQ-Enhancing transparency in reporting the synthesis of qualitative research recommendations. The literature search was carried out in MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection, ProQuest, and Worldcat, until October 31, 2023, for articles addressing the experiences of people over 18 years of age in a palliative situation at home. Data analysis employed thematic synthesis, involving inductive coding, development of themes, and interpretative synthesis to provide a comprehensive understanding of patient experiences. Results: Of the 441 articles identified, 17 studies were included. Data analysis was guided by Meleis 's Theory of Transitions, and six distinct categories were included in the conditions of the transition (facilitators or inhibitors): "Personal Facilitators," "Community Facilitators," "Social Facilitators," "Personal Inhibitors," "Community Inhibitors," and "Social Inhibitors." Conclusions: Findings indicate that the unique nature of the palliative condition and self-perception requires nursing care adapted to the person's experiences. The data collected and the analysis carried out in this thematic synthesis of the literature collectively contributed to identifying the facilitating and inhibiting factors regarding the complex transition process, considering the Theory of Transitions. The findings highlight the importance of personalized care approaches that address patients' emotional, social, and logistical needs during the transition to home-based palliative care. They underscore the need for enhanced communication, caregiver support, and accessible healthcare resources to improve patient and family experiences, guiding future interventions and policy development in palliative care.

Objectives: The rapid integration of artificial intelligence (AI) in healthcare requires robust legal safeguards to ensure safety, privacy and non-discrimination, crucial for maintaining trust. Yet, unaddressed differences in disciplinary perspectives and priorities risk impeding effective reform. This study uncovers convergences and divergences in disciplinary comprehension, prioritisation and proposed solutions to legal issues with health-AI, providing law and policymaking guidance. Methods: Employing a scoping review methodology, we searched MEDLINE (Ovid), EMBASE (Ovid), HeinOnline Law Journal Library, Index to Foreign Legal Periodicals (HeinOnline), Index to Legal Periodicals and Books (EBSCOhost), Web of Science (Core Collection), Scopus and IEEE Xplore, identifying legal issue discussions published, in English or French, from January 2012 to July 2021. Of 18 168 screened studies, 432 were included for data extraction and analysis. We mapped the legal concerns and solutions discussed by authors in medicine, law, nursing, pharmacy, other healthcare professions, public health, computer science and engineering, revealing where they agree and disagree in their understanding, prioritisation and response to legal concerns. Results: Critical disciplinary differences were evident in both the frequency and nature of discussions of legal issues and potential solutions. Notably, innovators in computer science and engineering exhibited minimal engagement with legal issues. Authors in law and medicine frequently contributed but prioritised different legal issues and proposed different solutions. Discussion and conclusion: Differing perspectives regarding law reform priorities and solutions jeopardise the progress of health AI development. We need inclusive, interdisciplinary dialogues concerning the risks and trade-offs associated with various solutions to ensure optimal law and policy reform.

Background with Europe's demographic diversity growing due to immigration, understanding and addressing the barriers to healthcare experienced by immigrants is of paramount importance. However, an updated systematic review of the literature on this topic is missing. Methods we systematically searched the PubMed and Scopus databases to synthesise quantitative evidence regarding self-perceived barriers to healthcare access faced by immigrants in Europe. Peer-reviewed articles, written in English, published from 2011 onwards, studying adult populations not in detention centres were eligible for the review. Articles were charted according to the population of study, sample size, geographical area and level of study (local vs national), and applied methodology (descriptive vs inferential). Results linguistic and health literacy barriers emerge as the most prominent, and most studied, barriers to healthcare for immigrants. The extant literature covers disproportionally Northern European countries; often uses small sample sizes and convenience sampling; and is particularly limited as far as the undocumented population is concerned. Discussion policies should aim at increasing the availability of interpreters and healthcare materials translated in different languages, as well as at better training health professionals to address specific immigrants’ needs. We encourage future research to focus on healthcare barriers faced by immigrants in Southern and Central European contexts; to improve results’ robustness and external validity by using high quality sampling techniques and larger sample sizes, and including native populations as comparison groups; and to put more attention to the experience of undocumented immigrants, as they are the immigrant population with the most critical and precarious healthcare status.

A critical component of Saudi Arabia's Vision 2030 reform agenda is its alignment with the Sustainable Development Goals (SDGs), particularly SDG 3, which is dedicated to the promotion of health and well-being for all. This narrative review offers a mid-term assessment of Saudi Arabia's progress in attaining these objectives, with a particular emphasis on the public health initiatives and comprehensive healthcare reforms that have been implemented as part of this vision. The Kingdom has accomplished substantial reductions in maternal and neonatal mortality rates, with skilled birth attendance reaching nearly universal levels. Saudi Arabia is a regional leader in the field of infectious diseases, having achieved the 95-95-95 HIV targets and significantly reduced the incidences of tuberculosis and malaria. Additionally, the rates of premature mortality from conditions such as cancer, diabetes, and cardiovascular diseases have decreased as a result of efforts to combat non-communicable diseases. Mental health services have been substantially expanded, which has resulted in one of the lowest suicide rates reported worldwide. Substantial investments have collectively improved the universality and quality of healthcare services in health infrastructure, such as the expansion of primary healthcare centers and the integration of digital health solutions, which have supported these health achievements. Saudi Arabia continues to confront persistent obstacles, including the management of the increase in non-communicable diseases, the mitigation of environmental health risks, and the reconciliation of healthcare access disparities, despite these accomplishments. The review recommends that the social determinants of health be addressed through a sustained commitment to cross-sectoral collaboration, enhanced data collection and utilization for health policy-making, and further integration of technology in healthcare delivery. This review not only emphasizes the Kingdom's successes but also the intricate challenges it has encountered, providing valuable insights into the strategic planning required to maintain health gains and achieve SDG 3 by 2030. Saudi Arabia's innovative approach and robust policy implementation serve as a model for the integration of health priorities into national development frameworks, thereby improving health outcomes and contributing to sustainable development.

Introduction: Multimorbidity is associated with adverse clinical outcomes, including increased symptom burden and healthcare utilisation, particularly towards the end of life. Despite this, there is no accepted method to identify the point at which individuals with deteriorating health due to long-term conditions are nearing the end of life or might benefit from a palliative care approach - conceptualised as 'Advanced Multimorbidity'. This scoping review explored how Advanced Multimorbidity is described and operationalised within the literature. Methods: Multiple electronic databases and Grey Literature sources were searched following scoping review frameworks. Two reviewers independently performed screening and data extraction. Content analysis was used to examine the different descriptions of Advanced Multimorbidity. Stakeholder consultations were undertaken with clinicians, academics and public participants. Patient and public involvement was separately integrated throughout this review from conceptualisation, design and reporting. Results: Forty-four different descriptions of Advanced Multimorbidity were identified from 38 publications. These varied in terms of the clinical conditions and descriptors used. Eighteen descriptions relied on a single indicator to identify Advanced Multimorbidity; 24 used a multidimensional approach. Stakeholder consultations highlighted the need for descriptions that are user-friendly and actionable. Conclusion: The lack of a standardised definition of Advanced Multimorbidity risks variance in clinical and research practice, potentially affecting patient care. A consensus on defining Advanced Multimorbidity would enable better identification of patients who could benefit from a palliative care approach, ensuring more consistent and person-centred care, as well as supporting research and policy development.

Background: Sexual and reproductive health (SRH) programmes and services aim to prevent complications of pregnancy and childbirth, unintended pregnancies, unsafe abortions, complications caused by sexually transmitted infections, including HIV, sexual violence and impacts from avoidable cancer. Objective: To systematically identify published economic evaluations of SRH programmes and services, assess the methods used and analyse how costs and outcomes are estimated in these studies. Settings: Low- and middle-income countries. Design: Systematic review and narrative synthesis. Methods: Eight databases were searched, including EMBASE, MEDLINE, Scopus, Health Technology Assessment, Web of Science, PsycINFO, National Health Service Economic Evaluation Database (NHS EED) and African Journals Online (AJOL) from 1998 to December 2023. The inclusion and exclusion criteria were developed using the Population, Intervention, Comparator, Outcome and Study Design framework. The review included economic evaluations alongside randomised trials and economic studies with modelling components. Study characteristics, methods and results of economic evaluations were extracted and tabulated. The quality of the studies was assessed using the Consensus Health Economic Criteria list and Philips checklists for trial-based and model-based studies, respectively. The review followed the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the results were synthesised narratively in line with Centre for Reviews and Dissemination guidance. Results: 7575 studies were screened and categorised. 20 studies were included in the review. The studies assessed the cost-effectiveness and costs of SRH programmes and services from an individual, healthcare or societal perspective. The main SRH programme considered was contraceptive services. The main outcome measures reported were disability-adjusted life years, quality-adjusted life years, couple years of protection and pregnancies averted. Most of the studies did not indicate the costing approach used, and many of the studies evaluated direct medical costs only. Most of the study designs were model-based with significant heterogeneity between the models. The review showed that many studies did not fulfil all of the requirements for a high-quality economic evaluation. 1 out of the 20 studies reviewed considered equity. Conclusions: The review revealed heterogeneity in approaches to evaluating the costs and outcomes of SRH programmes. These methodological limitations may have implications for their use by public health decision-makers to inform optimal decision-making. Prospero registration number: CRD42023435241.

Our review examines the operational dynamics and effectiveness of integrated healthcare models in Australia, focusing on their relevance for older rural adults with preventable chronic diseases. Using Whittemore and Knafl's (2005) systematic integrative review methods, we conducted a search across five databases, including Medline-EBSCO, PubMed, CINAHL, EMBASE, and SCOPUS. The Sustainable Integrated Chronic Care Models for Multimorbidity (SELFIE) framework, established by Leijten et al. (2018), was used for reflexive thematic synthesis. A two-stage screening process identified 15 integrated healthcare models, with five RCTs evaluating their effects on chronic conditions. The analysis revealed two key themes: aspects of care integration (service delivery, leadership, workforce, technology, and finance) and changes in patient and healthcare outcomes. Care coordination and multidisciplinary team care were common features, bridging gaps between health and social services for older patients. Despite challenges such as irregular funding and underutilisation of technology, several models demonstrated positive patient and healthcare outcomes. Virtual care platforms and remote monitoring systems have shown promise in improving patient engagement and enabling real-time care adjustments, particularly in rural areas with limited healthcare access. Our review highlights the need for integrated healthcare for older rural Australians with preventable chronic conditions, revealing the complexity of service models. Policy shifts towards coordinated services and changes in leadership and healthcare practices are essential to ensure this demographic receives integrated care that meets their needs.

Background: Women with a history of hypertensive disorders of pregnancy are at an increased risk of cardiovascular disease. Although clinical practice guidelines for management of hypertensive disorders of pregnancy recommend involvement of a general practitioner for ongoing cardiovascular disease preventative care, there are no intervention strategies embedded within primary care aimed at improving risk assessment or management for women after hypertensive disorders of pregnancy. The study aim was to co-design an intervention to improve implementation of cardiovascular disease risk assessment and management following hypertensive disorders of pregnancy for primary care settings in a local health district in New South Wales, Australia. Method: Using the Integrated Knowledge Translation framework, a series of five co-design meetings with the investigative team and end users were conducted online. Meetings were informed by the Behaviour Change Wheel framework for intervention development and incorporated research findings from a systematic review and meta-analysis, surveys and an online discussion. Data from activities and audio recordings following each meeting were analysed thematically using inductive-deductive thematic analysis. Results were summarized after each meeting, and findings used to inform ongoing intervention development. Results: The 18 end users included women with lived experience of hypertensive disorders of pregnancy (n = 8), obstetricians (n = 2), midwives (n = 5) and general practitioners (n = 3). Target priorities were to improve communication between hospital staff and general practitioners following the occurrence of hypertensive disorders of pregnancy and increase the knowledge of general practitioners and women regarding cardiovascular disease prevention after cardiometabolic pregnancy complications. Part 1 of the intervention is set within the hospital setting and delivered via physical resources to address the communication gap between hospital and primary care providers about the occurrence of hypertensive disorders of pregnancy. Part 2 is delivered via an update to an existing general practice education platform and through resources for use within consultations to provide education for women and general practitioners about cardiovascular disease prevention after hypertensive disorders of pregnancy. Conclusion: The Integrated Knowledge Translation and Behaviour Change Wheel frameworks aided in the development of a targeted intervention to improve implementation of cardiovascular risk assessment and management for women after hypertensive disorders of pregnancy, based on gaps identified in current primary care practice.

Background: Surgical procedures present intricate challenges within healthcare delivery, often associated with higher risks of adverse events compared with non-surgical contexts. Patient and family engagement (PFE) throughout the perioperative journey is a possibility to enhance care quality, safety and patient-centredness. However, literature addressing PFE across the entirety of the perioperative journey remains sparse. Objective: The current scoping review aims to comprehensively map the existing interventions with PFE approach focused on improving patient safety across various types of surgical procedures throughout the perioperative journey. In addition, the review aims to understand the level and type of PFE approach adopted in this context. Eligibility criteria: Articles published in indexed peer-reviewed journals from 2003 to 2023, written in English, Portuguese or Spanish, that report on interventions with PFE approach targeting adult surgical patients, their families, caregivers, patient advocates and patient champions. The review includes articles reporting on both inpatient and ambulatory surgical patients. Methods: Following Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews framework, this review systematically searched PubMed, Web of Science, SCOPUS, CINAHL, and PsycINFO for relevant articles. Eligible interventions were categorised using PFE framework regarding the level of engagement and mapped according to the WHO Global Patient Safety Action Plan 2021-2030. Results: Out of 765 records initially identified, 32 met the eligibility criteria for data extraction and analysis, of which 40% originated from the USA, followed by the UK (18%) and Canada (12%). 47% of the interventions targeted 'multiple/all types' of procedures, 19% focused on cardiothoracic surgeries and 9% on gynaecological procedures or organ transplant. The majority of the interventions (88%) focused on PFE at the direct care level, predominantly adopting a consultation-based approach. Furthermore, 81% of eligible interventions emphasised patient information and education, 16% addressed codevelopment of policy and 3% of interventions focused on patient advocacy. Conclusion: The findings show a predominant focus on PFE interventions targeting patient safety at the direct care level, particularly in the provision of patient information and education. However, interventions at organisational and policy-making levels are notably scarce. Further investment is required to promote interventions engaging patients and families at broader organisational and policy-making levels.

Background: In response to the significant increase in the global aging population, countries have increasingly prioritized Age-Friendly Primary Health Care (AFPHC) to address the unique needs of older adults. This study aims to develop a comprehensive model for assessing the progress of PHC systems in achieving the goals of an elderly-centered services. Method: A qualitative study design was utilized to develop the progress assessment model for AFPHC initiatives. This process involved a literature review (academic databases and manual search), semi-structured interviews, an expert panel discussion, and the Delphi technique for achieving consensus on the final model. Participants in the semi-structured interviews were selected based on specific inclusion criteria, which required professionals and stakeholders to have a minimum of two years of experience in care for older adults and active involvement in PHC. Additionally, older adults with a university education who had accessed PHC services in Iran at least three times were included. The expert panel was composed of multidisciplinary professionals who met similar criteria, ensuring a diverse and informed perspective. Findings: According to literature review results, 16 main domains and 28 sub-domains were identified. In the next step, through interviews, 7 main domains and 71 indicators were extracted. After summarizing the results of literature reviews, and interviews, and analyzing the results of the Delphi technique, the initial model with 7 main domains, including policymaking and planning processes related to older adults, principles of respect and interaction with older adults, education for older adults, principles of care and provision of services to older adults, access to PHC facilities, physical environment, specialized facilities and equipment, and human resources, was finalized along with the 60 indicators. Conclusion: The developed model for assessing progress of AFPHC Initiatives offers a comprehensive framework by focusing on key domains and indicators tailored to the needs of older adults. This model serves as a practical tool for assessing the progress of AFPHC, facilitating improvements in the quality and accessibility of PHC services for older adults.

Accreditation of health services is one of the criteria for achieving the predetermined standards for health organizations. Therefore, the purpose of this systematic study was to investigate the primary health care (PHC) accreditation programs in the world and compile a summary of these programs in order to identify the areas and dimensions of these standards. This systematic review was conducted on online database studies, including PubMed, Scopus, Web of Science, and Google Scholar, using comprehensive terms. The inclusion criteria included all qualitative, quantitative, and mixed-method studies published in any language from 1990 to December 2022. The studies were evaluated with Joanna Briggs Institute Critical Appraisal Tools (JBI) critical appraisal tools checklist, and finally, the data were analyzed using the framework analysis method. The findings of 10 studies that were included in this study cover four main topics regarding the functions of the health system: stewardship, resource production, financing, and service delivery, as well as 10 sub-topics: policy making, interdepartmental leadership, monitoring and evaluation, human resources, equipment and medicine, information management, gathering of financial resources, capacity to provide services, access, and quality of services. In the accreditation of PHC, in addition to paying attention to performance indicators, indicators such as satisfaction and rights of clients and employees, access, information technology, coordination, integration of care, financing, and management of resources and equipment should also be considered.

Background: In Ireland the role of advanced nurse practitioner has developed significantly since 2001. This evolution is rooted in the growing recognition of the need for highly skilled nursing professionals to address complex healthcare demands and improve patient outcomes. Objective: To scope the landscape and identify the effect of advanced nurse practitioners on healthcare provision in Ireland. Design: A systematic search of eight academic databases (CINAHL, Embase, PsycINFO, Scopus, Medline and Academic Search Complete, Cochrane, Web of Science) relevant to nursing and health care were performed. Settings: Nursing care environment. Participants: Advanced nurse practitioners delivering care. Methods: A pre-defined systematic search of eight academic databases was conducted, and two reviewers screened each study against the inclusion criteria. Additional hand-searching of the reference lists (backward chaining) and citations (forward chaining) of papers that met the inclusion criteria was conducted. The methodological details of each paper were extracted and assessed for quality and rigour utilising the Mixed Methods Appraisal Tool and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for appraising grey literature. Data were mapped and analysed onto the six domains of advanced nurse practitioner practice, and the review was reported in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Results: All papers included in this review spanned across the last 20 years. In total, 45 papers met the inclusion criteria: quantitative (n = 11), qualitative (n = 15), mixed methods (n = 4), and discussion/clinical cases (n = 15) papers. Advanced nurse practitioners in Ireland contribute substantial impacts on management and team competence, clinical-decision making, leadership and professional scholarship, professional values and conduct, communication and interpersonal competence, and knowledge and cognitive competence domains. Advanced nurse practitioners in Ireland enhance healthcare outcomes through expertise, coordination, and patient-centred approaches, emphasising their critical role in healthcare delivery and system improvements. Conclusions: We have highlighted the active role advanced nurse practitioners play in enhancing patient care, improving management and team coordination, and advancing professional scholarship. These insights have provided a foundation for future research and policy development to optimise the advanced nurse practitioner role.

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.

Background: Considerable changes in health policy in the area of publicly funded primary dental care in Hungary over the past 25 years have shaped primary care dentists' financing, training and working conditions and the forms of association between dental providers. This study aims to describe the advancement of primary care dentistry in Hungary and the progress of the dental cluster model since the 2021 legislation. Methods: A mixed method study was designed that included a scoping review of the literature in December 2023 to collect information on the health policy developments of Hungary's publicly funded primary dental care system; (b) secondary data analysis was carried out to assess the development of primary care dentistry and the formation and operation of dental cluster practices in Hungary. Results: Primary care dental clusters in Hungary were established to allow active professional cooperation within the dental clusters to improve the population's access to preventive dental services and the quality of services. From its legislative base until December 31, 2023, 74 primary dental clusters were formed nationwide, representing 30% of dental practices. On average, the primary dental clusters contain nine practices. There is an uneven geographical distribution of primary dental clusters by counties. Up to the date of this research, primary care dental clusters were set up exclusively in the form of consortia. Adult and mixed dental practices, practices from county towns, county capitals and the capital city, as well as practices from districts with more dentists in the proportion of the population were more likely to join a dental group practice. Conclusion: Monitoring and evaluating of the operation, performance and impact of primary care dental clusters in the future will provide important information about the Hungarian model.

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.

Background: The Saudi Food and Drug Authority (SFDA) plays a pivotal role in safeguarding public health through robust pharmacovigilance. Since establishing its signal detection in 2015, SFDA has implemented a comprehensive framework to monitor and evaluate drug safety through proactive data collection, advanced analytical methods, and international collaborations. Objective: To provide a comprehensive analysis of the current practices in signal detection at SFDA, assess the effectiveness of its regulatory framework, in-house priority system, active surveillance programme, and global collaborations, and to offer recommendations for future enhancements in pharmacovigilance. Methods: A scientific review was conducted using publicly available literature, official SFDA guidelines, and internal reports. The evaluation focused on the regulatory mandate, data collection methodologies, signal generation processes (including weekly scanning of diverse sources), case validation, and the integration of advanced statistical techniques. Special emphasis was given to the in-house priority algorithm, active surveillance initiatives, and collaborative efforts with international bodies. Results: The review highlights that SFDA's robust regulatory framework and innovative in-house priority algorithm have enhanced the efficiency of signal detection. The active surveillance programme has significantly increased the capacity for real-time monitoring, while global collaborations have facilitated knowledge exchange and harmonised methodologies. However, challenges persist regarding data quality, resource allocation, and the need for continuous training and improved communication among stakeholders. Conclusion: SFDA's signal detection system effectively contributes to drug safety in Saudi Arabia by combining rigorous regulatory practices with innovative analytical methods and international cooperation. Addressing current challenges through advanced technologies, enhanced resource allocation, and strengthened stakeholder communication is recommended to further improve pharmacovigilance practices and ensure public health protection.

The Arctic region, characterised by its remote and geographically challenging environment, is home to predominantly Indigenous populations who experience significant healthcare disparities compared to urban counterparts. This paper synthesises evidence on the persistent challenges in delivering healthcare in the Arctic, including geographical remoteness, healthcare personnel shortages, and cultural and language barriers. Telehealth emerges as a crucial solution, offering a nuanced approach to overcoming physical and systemic barriers. We review current implementations of telehealth in the Arctic, highlighting successful adaptations to local cultural contexts and technological limitations. By integrating a patient-centred approach, infrastructure readiness, and relevant telehealth services, a holistic healthcare delivery model tailored for the Arctic environment is proposed. New type of technologies is also proposed to enhance remote care possibilities. This paper underscores the need for collaborative efforts in research, policy making, and healthcare provision to ensure the sustainability and effectiveness of health services in the Arctic, aiming to close the gap in health equity. Key references from seminal works and recent studies provide a foundation for the discussions and recommendations presented.

This review investigates the effectiveness of utilizing foreign physicians or International Medical Graduates to alleviate medical shortages in rural and underserved areas of developed countries. Conducted in February 2024, this systematic review follows PRISMA 2020 guidelines, analysing 15 English-language studies from the United States, Canada, Australia, and New Zealand. The focus is on comparing physicians with international graduation to national graduates in rural and underserved contexts. Results reveal diverse trends across countries: in the United States, national graduates are generally more represented in rural areas, while foreign physicians are more prevalent in Health Professional Shortage Areas. In Canada, foreign graduates are more common in rural areas, varying by province. Australia and New Zealand show foreign physicians practicing more in rural areas than national counterparts. This study underscores significant reliance on foreign physicians to mitigate rural healthcare disparities. While this strategy partially addresses immediate shortages, long-term effectiveness is uncertain due to retention and integration challenges. Future policies should focus on sustainable solutions for equitable healthcare access and physicians’ retention in underserved areas. This review emphasizes also the need for Europe-specific studies and further evaluation of policy effectiveness.