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.

BackgroundActive workstations have been proposed as a feasible approach for reducing occupational sedentary time. This study used a network meta-analysis (NMA) to assess and compare the overall efficacy of active workstation interventions according to type and concomitant strategy for reducing work-specific sitting time in office workers.MethodsPubMed, Web of Science, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from database inception until May 2022 to obtain randomized controlled trials (RCTs) assessing the efficacy of active workstations with or without concomitant strategies for reducing occupational sedentary time in office workers. The risk of bias of the RCTs included in this study was assessed according to the Cochrane Handbook. An NMA with STATA 15.1 was used to construct a network diagram, league figures, and the final surface under the cumulative ranking curve (SUCRA) values. The certainty of evidence was assessed using the grading of recommendations, assessment, development, and evaluation (GRADE) approach.ResultsA total of 23 eligible studies including eight different types of interventions with 1428 office workers were included. NMA results showed that compared to a typical desk, multicomponent intervention (standardized mean difference (SMD) = - 1.50; 95% confidence interval (CI) - 2.17, - 0.82; SUCRA = 72.4%), sit-stand workstation + promotion (Reminders of rest breaks, posture variation, or incidental office activity) (SMD = - 1.49; 95%CI - 2.42, - 0.55; SUCRA = 71.0%), treadmill workstation + promotion (SMD = - 1.29; 95%CI - 2.51, - 0.07; SUCRA = 61.6%), and sit-stand workstation (SMD = - 1.10, 95%CI - 1.64, - 0.56; SUCRA = 50.2%) were effective in reducing occupational sedentary time for office workers.ConclusionsMulticomponent intervention, sit-stand workstation + promotion, treadmill workstation + promotion, and sit-stand workstation appear to be effective in reducing work-specific sedentary time for office workers. Furthermore, multicomponent interventions and active workstations + promotion better reduced work-specific sedentary time than active workstation alone. However, the overall certainty of the evidence was low.

The objectives of this research are to evaluate the impact of a health policy (the Strategy for Normal Birth Care, EAPN) on caesarean rates and perinatal mortality in Spanish public hospitals belonging to the National Health System (NHS) and to assess the related cost savings. Data from the Spanish Ministry of Health for the period 2002−2011 and quantitative impact evaluation techniques (double difference method) are used to compare the effects of this policy in a treatment group composed of the NHS hospitals and a control group made up of private for-profit hospitals outside the scope of the EAPN. Both groups are compared some years before and after the health policy initiated in 2006 and approved in October 2007. The estimation results show that the EAPN had a significant effect in reducing caesarean rates of approximately 2 percentage points between 2007 and 2011, with increasing cost savings over the years ranging from 24 to 44 million euros depending on the year. Furthermore, EAPN reduced perinatal mortality levels by 0.08% in years 2008−2009.

Many policies promote patient and public involvement (PPI) in health research and healthcare provision. However, research points to uncertainties about its impact. The aim of the article was to compare what types of impact have been reported in reviews of PPI in health research and healthcare, respectively, and to map differences and similarities between the review studies. A review of reviews was undertaken with a search strategy based on the PCC mnemonic for scoping reviews. Four online databases were searched. Studies published in English between the years 2000-2020, using a review-based method and aiming to demonstrate impact of PPI were included, resulting in sixty-one articles. More reviews of PPI impact in healthcare than in health research were found, although the latter included a larger number of empirical studies. Systematic reviews, quality assessment and quantitative studies were less common in health research. Many original studies were from the United Kingdom. In health research, reported impacts most often related to research design and delivery, while in healthcare the most commonly reported impacts were individual health outcomes/clinical outcomes. However, there is still uncertainty about the strength of evidence for PPI, in particular when it comes to collective involvement in healthcare, that is in policymaking and service improvement initiatives at hospitals or the like.

Cost-of-illness studies, the systematic quantification of the economic burden of diseases on the individual and on society, help illustrate direct budgetary consequences of diseases in the health system and indirect costs associated with patient or carer productivity losses. In the context of the BURQOL-RD project (“Social Economic Burden and Health-Related Quality of Life in patients with Rare Diseases in Europe”) we studied the evidence on direct and indirect costs for 10 rare diseases (Cystic Fibrosis [CF], Duchenne Muscular Dystrophy [DMD], Fragile X Syndrome [FXS], Haemophilia, Juvenile Idiopathic Arthritis [JIA], Mucopolysaccharidosis [MPS], Scleroderma [SCL], Prader-Willi Syndrome [PWS], Histiocytosis [HIS] and Epidermolysis Bullosa [EB]). A systematic literature review of cost of illness studies was conducted using a keyword strategy in combination with the names of the 10 selected rare diseases. Available disease prevalence in Europe was found to range between 1 and 2 per 100,000 population (PWS, a sub-type of Histiocytosis, and EB) up to 42 per 100,000 population (Scleroderma). Overall, cost evidence on rare diseases appears to be very scarce (a total of 77 studies were identified across all diseases), with CF (n = 29) and Haemophilia (n = 22) being relatively well studied, compared to the other conditions, where very limited cost of illness information was available. In terms of data availability, total lifetime cost figures were found only across four diseases, and total annual costs (including indirect costs) across five diseases. Overall, data availability was found to correlate with the existence of a pharmaceutical treatment and indirect costs tended to account for a significant proportion of total costs. Although methodological variations prevent any detailed comparison between conditions and based on the evidence available, most of the rare diseases examined are associated with significant economic burden, both direct and indirect.

Authors' objectives: BACKGROUND: Zoledronate, ibandronate, and denosumab are licensed bone-targeting agents (BTAs) in Switzerland. Patients with bone metastases are treated monthly with BTAs to reduce fracture risk and hypercalcaemia. Long-term exposure to BTAs is linked to possible severe side effects such as hypocalcaemia, renal failure, or cumulative risk of osteonecrosis of the jaw (ONJ). Recent studies suggest that reduced treatment frequency is as efficacious as the current monthly therapy. Consequently, the question arises as to whether the monthly administration of BTAs in patients with bone metastases should be replaced by a 3-monthly administration. OBJECTIVE: The objective of this health technology assessment (HTA) was to assess the evidence pertaining to 3-monthly versus 1-monthly administration of BTAs in cancer patients with bone metastases in terms of efficacy, effectiveness, and safety, as well as cost, cost-effectiveness, budget impact, legal, social, ethical, and organisational issues.

Authors' objectives: BACKGROUND: Subclinical hypothyroidism (SCH) is a hormonal disorder in which the serum thyroid-stimulating hormone levels (TSH) are elevated while the thyroid hormone levels are within the normal reference range. SCH can be treated with hormone replacement therapy using levothyroxine, a synthetic version of the endogenous thyroid hormone thyroxine (T4), to raise low levels of endogenous thyroid hormones. In Switzerland, levothyroxine is approved by the Swiss Agency for Therapeutic Products (Swissmedic) for the treatment of hypothyroidism. There is no standard alternative treatment option for patients diagnosed with SCH. OBJECTIVE: The aim of this health technology assessment (HTA) report is to evaluate the clinical and economic consequences of levothyroxine treatment for patients diagnosed with SCH in Switzerland.

Authors' objectives: Background: Currently, no disease-modifying treatment is available for Alzheimer disease (AD) or Parkinson’s disease dementia (PD). Professional societies in Switzerland generally recommend symptomatic treatment using non-pharmacological therapies, and to add antidementia drugs when needed. However, scientific literature is inconclusive about the clinical benefit of antidementia drugs. A health technology assessment (HTA) was requested to compare the available evidence on Acetylcholinesterase (AChE) inhibitors and memantine for the symptomatic treatment of AD and PD. Objective: This HTA examines the efficacy, effectiveness, safety and cost-effectiveness of antidementia drugs compared to treatment without antidementia drugs or placebo in AD and PD and presents the health economic impact of a potential removal of these drugs from the list of pharmaceutical specialties in Switzerland. Furthermore, ethical, legal, social and organizational aspects are considered. Research questions: Is it efficacious, effective, safe and cost-effective 1) to treat mild to moderately severe AD patients with donepezil, galantamine or rivastigmine compared to not treating them with antidementia drugs? 2) to treat moderate to severe AD patients with memantine compared to not treating them with memantine? 3) to treat mild to moderately severe PD patients with rivastigmine compared to not treating them with rivastigmine? What is the budget impact of donepezil, rivastigmine, galantamine and memantine? Are there ethical, legal, social, or organizational issues related to antidementia drugs?

Authors' objectives: Objective The aim of this health technology assessment (HTA) is to evaluate the safety, effectiveness and economic impact of folate testing in an asymptomatic general population and in patients with suspected folate deficiency due to the presence of symptoms, underlying medical disorders or external factors. In addition, ethical, legal, social and organisational issues related to folate testing are investigated.

Authors' objectives: Background The aim of this health technology assessment (HTA) is to evaluate the safety, effectiveness, cost, cost-effectiveness and budget impact of revascularisation with percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or both (i.e. PCI or CABG) in comparison to optimal medical therapy (OMT) in patients with chronic coronary syndrome (CCS). Ethical, legal, social and organisational issues related to the interventions are also explored.