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

Background: 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.

Background: Essential services ensure the health, safety, and well-being of individuals and their communities. However, there is currently a lack of consensus on what constitutes an essential service in Australia. This gap hinders a detailed spatial understanding of essential service provision, access, and influence on populations. This systematic review critically assessed the literature on essential services and their impact on quality of life to understand service definitions and their relative contributions to quality of life. Methods: A systematic search of ten databases was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Five criteria were established for the inclusion of studies: (i) major developed economies, (ii) defined essential service and focus on spatial access, (iii) quality of life outcome, (iv) peer-reviewed, and (v) published between 2000 and 2024. Results: From 1,473 unique records, seven studies met the inclusion criteria, with studies from Europe, Asia-Pacific, and North America. Across the studies, services were characterised based on their primary function and contributions to quality of life. Service categories included food, retail, personal services, health, education, culture and recreation, and faith-based services. Despite demographic and scale variations, services that fostered social connection and a sense of place showed the highest positive impact on quality of life. Conclusions: Findings indicate limited and inconsistent evidence on essential service measures and their relationship with quality of life. The persistent lack of justification for classifying services as essential in research hinders definitive conclusions about which services most effectively enhance quality of life. Future research should adopt standardised, validated measures, and address representation gaps across diverse populations and regions. This work is fundamental for developing a validated set of essential services, to improve national modelling of geographic access and inform policy, decision-making, and understanding of how access to services influences quality of life.

Background: Mobile health (mHealth) interventions promoting healthy lifestyle changes offer an adaptable and inexpensive method for accessing health information but require cultural appropriateness and suitability for acceptance and effectiveness in Indigenous populations. No systematic review on effective mHealth interventions for Indigenous women during pregnancy and the early childhood years has been conducted. Objective: This review evaluated the effectiveness of mHealth interventions promoting healthy behaviors for Indigenous mothers and children from conception to 5 years post partum. It also aimed to explore the observed effectiveness differences based on participant engagement, intervention design, and provision of context. Further, the review explored if the interventions were co-designed. Methods: A systematic search of 5 databases was conducted: SCOPUS, MEDLINE, CINAHL, PsycINFO, and ProQuest (Dissertation or Thesis). Studies were included if they were either a randomized controlled trial, pre-post comparison, or a cohort study using mHealth with Indigenous women for maternal and child health following a preregistered PROSPERO protocol (CRD42023395710). HealthInfoNet was searched for gray literature and the reference lists of included studies were hand searched. The initial title and abstract screen for eligibility were performed by 1 reviewer. A full-text screen of eligible studies and a quality appraisal of included studies was performed by 2 reviewers independently. The appraisal tools used were the Mixed Methods Quality Appraisal Tool and the Centre of Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE). A descriptive synthesis of the extracted data was performed. Results: Of the 663 articles screened, only 3 met the eligibility criteria. Each paper evaluated a different mHealth intervention: Remote Prenatal Education; the SMS Parent Action Intervention (two-way text messaging); and the Screening, Brief Intervention and Referral to Treatment (SBIRT) eCHECKUP To Go (web-based screening and intervention). Statistically significant changes were reported in some outcomes, including an increase in the parental participation rate in face-to-face prenatal education; increased rate of breastfeeding initiation and exclusive breastfeeding (2-12 months); improved overall children's behavior related to sleep, diet, physical activity, screen time, and intake of sugary beverages; improved individual children's behavior related to physical activity and sleep; and decrease in alcohol drinks per week and binge drinking episodes per 2 weeks due to time effect. However, no study provided a sample size calculation for the reported significant outcomes. Also, due to the small number of included studies and each study evaluating a different intervention, it was not possible to combine results to ascertain if the participant engagement, intervention design, or community context had any impact on the effectiveness. Conclusions: Due to the lack of sample size calculation, it was not possible to establish whether differences in the effectiveness were due to the interventions or a type I statistical error. Therefore, caution is required in the interpretation of these findings. Trial registration: PROSPERO CRD42023395710; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023395710.

Objective: The objective of this review is to assess and synthesize the available qualitative evidence on health professionals' experiences in screening for postpartum depression (PPD). Introduction: PPD is a significant public health problem. Clinical screening is essential to develop appropriate interventions to meet the needs of women and their families. The findings of this review have important implications for decision-making and policy development for continuous professional development programs that promote evidence-based PPD screening. Inclusion criteria: This review considered studies that explore the experiences of health professionals who screen for PPD in any geographic location at any health care facility, scenario, or setting. The review focused on qualitative data, including methods such as phenomenology, grounded theory, ethnography, action research, and feminist research. Methods: The review followed a 3-step search strategy in line with JBI methodology for systematic reviews of qualitative evidence. The databases searched included PubMed, CINAHL (EBSCOhost), Embase (Elsevier), Scopus, LILACS (BVS), ScienceDirect (Elsevier), PsycINFO (Ovid), Index Psi Journals (BVS-PSI), and PePsic (IPUSP). Unpublished studies were searched for in Google Scholar, Cybertesis, Dart-E, EthOS, and Open Access Theses and Dissertations (OATD). Two independent reviewers evaluated the included studies for methodological quality and extracted data using the JBI data extraction and synthesis tools. Studies published in English, Portuguese, and Spanish from database inception until October 2023 were included. Results: Twenty-four qualitative studies from 14 countries across 5 continents involving 392 health professionals were included. A total of 113 findings were extracted and grouped into 5 categories: i) education and training; ii) responsibility of PPD screening, referral, and follow-up: role of the job and work overload; iii) screening, referral, and follow-up; iv) disclosure, judgment, culture; v) and health system structure. Two synthesized findings evolved from these categories: i) The need for training and ongoing education, professional role, professional practice, and ways of caring in screening postpartum women for depressive symptoms; ii) External barriers, facilitating factors, and health system issues. Conclusions: Health professionals' experiences caring for women and families concerning PPD are influenced by their culture, practices, training, and worldview. Regular workshops and practical training sessions that emphasize the development of PPD-screening skills, particularly in recognizing subtle signs of depression and conducting culturally sensitive assessments, could be highly effective for health professionals. Policymakers should collaborate with health care professionals to develop and implement policies tailored to different contexts and cultures. Providing educational subsidies and ensuring monitoring and follow-up after PPD screening are fundamental for the sustainability of PPD screening and management.

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.

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.

Introduction: There is no recent consensus on the effectiveness of teledentistry versus in-person examination in the diagnosis of dental caries, especially after the COVID-19 pandemic. Objective: To assess the diagnostic accuracy of teledentistry versus in-person examination for dental caries diagnosis (PROSPERO #CRD42023410962). Methods: This systematic review and meta-analysis compared the effectiveness of teledentistry versus in-person examination for dental caries diagnosis. The eligibility criteria were peer-reviewed studies published in English between January 2013 and December 2021 that reported diagnostic parameters (specificity and sensitivity) for caries detection in primary and permanent dentition. Articles were extracted using search strategies from PubMed and CINAHL databases and screened using PRISMA-DTA guidelines, following a review for quality assessment and risk of bias using the QUADAS-2 and JBI Critical Appraisal Checklists. Meta-analysis was conducted in R using the MADA package. A descriptive analysis of the sensitivity, specificity, diagnostic odds ratio, and confidence intervals was performed with respective forest plots. Heterogeneity was assessed using Cochrane and Higgins's 2 tests. Univariate measures of diagnostic accuracy were performed based on the DerSimonian-Laird random effect and reported summary diagnostic odds ratios. Results: Twelve studies met the inclusion criteria and were reviewed and included in the meta-analysis. The diagnostic parameters ranged from 45.6% to 88.3% for sensitivity, 55.2% to 98.3% for specificity, 79% to 92% for positive predictive value, 48% to 97% for negative predictive value, and 70% to 96% for accuracy. The κ scores ranged from 0.46 to 0.89 for teledentistry modalities. Tests for equality of sensitivities and specificities were significant ( < 0.001). The studies were not heterogeneous with Cochran's : 14.502 ( = 0.206) and Higgins's 2 of 24%. The multivariable analysis showed a diagnostic odds ratio based on the DerSimonian-Laird random effect of 35.14, which indicates that the odds of caries detection via teledentistry is 35 times more true positive (i.e., correctly identifying a positive condition) than false positive. Conclusions: Diagnosis of caries via teledentistry is effective and comparable to in-person diagnosis. Remote assessments are consistent in diagnostic accuracy for caries.Knowledge Transfer Statement:This systematic review and meta-analysis added to the evidence about using teledentistry assessment as a diagnostically accurate tool to detect dental caries. Using teledentistry dental practices could promote greater access to dental and oral health care in the absence of in-person assessment.

Introduction: There is no recent consensus on the effectiveness of teledentistry versus in-person examination in the diagnosis of dental caries, especially after the COVID-19 pandemic. Objective: To assess the diagnostic accuracy of teledentistry versus in-person examination for dental caries diagnosis (PROSPERO #CRD42023410962). Methods: This systematic review and meta-analysis compared the effectiveness of teledentistry versus in-person examination for dental caries diagnosis. The eligibility criteria were peer-reviewed studies published in English between January 2013 and December 2021 that reported diagnostic parameters (specificity and sensitivity) for caries detection in primary and permanent dentition. Articles were extracted using search strategies from PubMed and CINAHL databases and screened using PRISMA-DTA guidelines, following a review for quality assessment and risk of bias using the QUADAS-2 and JBI Critical Appraisal Checklists. Meta-analysis was conducted in R using the MADA package. A descriptive analysis of the sensitivity, specificity, diagnostic odds ratio, and confidence intervals was performed with respective forest plots. Heterogeneity was assessed using Cochrane Q and Higgins's I(2 )tests. Univariate measures of diagnostic accuracy were performed based on the DerSimonian-Laird random effect and reported summary diagnostic odds ratios. Results: Twelve studies met the inclusion criteria and were reviewed and included in the meta-analysis. The diagnostic parameters ranged from 45.6% to 88.3% for sensitivity, 55.2% to 98.3% for specificity, 79% to 92% for positive predictive value, 48% to 97% for negative predictive value, and 70% to 96% for accuracy. The kappa scores ranged from 0.46 to 0.89 for teledentistry modalities. Tests for equality of sensitivities and specificities were significant (P < 0.001). The studies were not heterogeneous with Cochran's Q: 14.502 (P = 0.206) and Higgins's I-2 of 24%. The multivariable analysis showed a diagnostic odds ratio based on the DerSimonian-Laird random effect of 35.14, which indicates that the odds of caries detection via teledentistry is 35 times more true positive (i.e., correctly identifying a positive condition) than false positive. Conclusions: Diagnosis of caries via teledentistry is effective and comparable to in-person diagnosis. Remote assessments are consistent in diagnostic accuracy for caries. Knowledge Transfer Statement: This systematic review and meta-analysis added to the evidence about using teledentistry assessment as a diagnostically accurate tool to detect dental caries. Using teledentistry dental practices could promote greater access to dental and oral health care in the absence of in-person assessment.

Background: Population-wide newborn blood spot screening programmes are a successful public health intervention used to detect whether the baby is at risk of certain rare conditions, with the aim of earlier diagnosis and provision of optimal care and treatment. Evaluating candidate conditions to include in newborn blood spot and genetic sequencing raises questions regarding acceptability to parents/carers. Methods: In the context of the possible expansion of the newborn blood spot screening programme in the United Kingdom, this review aimed to systematically review research on the acceptability to parents of newborn blood spot screening and genetic sequencing. A protocol was developed prior to commencing the review and was registered on the PROSPERO database. A team of researchers carried out the review, with checking at all stages carried out by at least two individuals. We included research published after 2013 with participants who were pregnant or a recent parent of a newborn and were resident in a high-income country. We included quantitative and qualitative studies that investigated the acceptability to parents/carers of newborn blood spot screening or genetic sequencing. Quantitative studies were narratively synthesised, and theories/frameworks identified and evaluated. Qualitative studies were analysed for recurring themes, and a meta-synthesis was carried out to compare and contrast these two types of data. We quality appraised included articles using tools appropriate for their study design. Results: Searches were carried out in September to November 2023 and screening identified 25 relevant research articles. Just over half were from North America, with four existing reviews and nine qualitative studies. Domains of acceptability described in the literature were: support for screening; level of anxiety, information and knowledge; consent; views of the procedure; and support after screening. The research indicated consensus support for blood spot screening, and for expanding to some other conditions, although some parental anxiety was reported. Parents/carers mostly perceived that they had received sufficient information, but the timing of this could be improved. While parents indicated interest in genomic screening, studies highlighted the need for clearer consent procedures and greater support for parents following genomic screening than for blood spot screening. Only three included studies reported using any kind of theoretical framework. Discussion: Most parents/carers found newborn blood spot screening programmes to be acceptable and favoured their large-scale implementation. A minority of parents/carers expressed concerns regarding the acceptability of processes underpinning newborn blood spot screening, such as consent, the timing of receiving information and support available after testing. More research is needed regarding the acceptability of newborn genomic sequencing screening programmes, which are less established compared with newborn blood spot screening programmes. Limitations: The over-representation of studies conducted in the United States has implications for the applicability of findings to other countries where testing is not typically mandatory and health systems differ considerably. Most studies were of cross-sectional design and there was limited representation of people from lower incomes and non-white ethnicity. While the inclusion of studies only in populations of future or very recent parents provided coherence to the findings, unclear reporting of participants may have resulted in under- or overinclusion of some studies. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159927.

Background: The economic and public health benefits of adult pneumococcal vaccines vary across countries due to different epidemiology and costs. We systematically reviewed and summarized findings and assumptions of cost-effectiveness analyses (CEA) of the recently introduced 15- and 20-valent pneumococcal conjugate vaccines (PCV15 and PCV20) in adults. Methods: We performed a systematic search for CEA studies of PCV15 and/or PCV20 versus existing strategies via PubMed, EMBASE, CEA Registry, EconLit, HTA Database, and NITAG resource center through April 23, 2024. Study characteristics, methods, assumptions, and findings were extracted independently by two reviewers; quality was assessed using ECOBIAS. Results were synthesized qualitatively to summarize key attributes and conclusions. Results: Of 137 identified records, 26 studies were included; the majority (24/26) concerned high-income countries. All employed static Markov-type models comparing higher-valent PCVs used alone or in combination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) to current recommendations (PPSV23 alone, PCV13 alone, PCV13 + PPSV23, no vaccination). Most studies (22/26) concluded PCV20 used alone was cost-saving (dominant) or cost-effective compared to other adult pneumococcal strategies (PPSV23 alone, PCV13 ± PPSV23, PCV15 ± PPSV23, or no vaccination). PCVs were generally assumed to have serotype-specific effectiveness equal to PCV13 efficacy in the pivotal trial, though four studies used estimates from a Delphi panel; protection was assumed to last between 10 and 20 years. PPSV23 was assumed to have lower effectiveness against non-bacteremic pneumonia and shorter duration of protection. Herd effects from higher-valent PCVs in childhood (12/26), serotype replacement (2/26), or both (1/26) were included in half (13/26) of studies, which attenuated adult vaccine impact. Most studies were assessed as low risk of bias; five abstracts did not provide sufficient information for assessment. Conclusion: Current evidence indicates that 20-valent PCV used alone is likely to be cost-effective or dominate other adult pneumococcal strategies. Future research is needed to address remaining uncertainties in assumptions and to support evidence-based policymaking.

Background and objective: Robotic-assisted radical prostatectomy (RARP) is a surgical option for localized prostate cancer. Cost-effectiveness analysis (CEA) findings are inconsistent when comparing it with open (ORP) and laparoscopic (LRP) radical prostatectomy approaches. We performed a systematic review and meta-analysis to pool the incremental net benefit (INB) of these approaches. Methods: Relevant CEA studies of RARP were identified by searching the PubMed, Embase, Scopus, International Health Technology Assessment database, Tufts CEA Registry, and Centre for Reviews and Dissemination databases from January 2005 to October 2023. To be included, studies must compare costs, and quality- adjusted life years (QALYs) of RARP versus ORP or LRP, and report the incremental cost per QALY gained. Study characteristics, economic model, costs, and outcomes were extracted. INBs were calculated in 2022 US dollars adjusted for purchasing power parity. A pooled analysis was performed using a random-effect model stratified by country income level. Heterogeneity was assessed using the Q test and I2 statistic. Key findings and limitations: Thirteen studies with 17 comparisons, ten from high- income (HICs) and three from middle-income (MICs) countries, were included. Ten and five studies compared RARP with ORP and LRP, respectively. From a payer perspective, RARP was cost effective but not statistically significant compared with LRP in HICs (pooled INB: $7507.83 [-$1193.03 to $16 208.69], I2 = 81.15%) and not cost effective in MICs (%; -$4499.39 [-$16 500 to $7526.87], I2 = 17.15%). RARP showed no statistically significant cost effectiveness over ORP in both HICs ($3322.38 [-$1864.39 to $8509.15], I2 = 90.89%) and MICs ($2222.60 [-$2960.64 to $7405.83], I2 = 58.92%). Conclusions and clinical implications: RARP is cost effective compared with LRP in HICs but lacks statistical significance. When compared with ORP, RARP is not cost effective in HICs and MICs. Our findings may support decision-making for prostate cancer treatment options in countries with different health care systems, especially those with limited resources. Patient summary: Our systematic review and meta-analysis provide important information regarding robotic-assisted radical prostatectomy (RARP) compared with open (ORP) and laparoscopic (LRP) radical prostatectomy. In high-income countries, RARP is generally cost effective compared with LRP, but not with ORP, while in middle-income countries, RARP is not cost effective compared with LRP or ORP. The findings of this review can support decision-making for prostate cancer treatment options. (c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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.

Rationale: Despite growing emphasis among healthcare decision-makers on patient perspectives and real-world outcomes to inform care and access decisions, understanding of patient journey experiences in rare diseases remains limited due to data collection and evaluation challenges. Aims and objectives: This systematic literature review (SLR) assessed study designs, methodologies, and outcomes reported in real-world investigations of rare disease patient journeys. Methods: Searches in PubMed and Google Scholar targeted English-language publications and congress proceedings from 1 January 2014, to 30 April 2024, including rare disease patients, caregivers, or healthcare providers. Keywords included 'Journey', 'Path', or 'Odyssey'. Two reviewers independently assessed eligibility and abstracted data. Descriptive analyses and quality assessments were conducted. Results: Thirty-one studies met inclusion criteria, with 296,548 participants spanning over 600 rare diseases. Most studies used prospective observational (61%) and cross-sectional (26%) designs and were conducted in Europe (45%). Interviews (39%) and surveys (29%) were common methodologies. Patients (87%) were the primary research focus, compared to caregivers (32%) or providers (10%). The most studied journey stages were 'Pre-diagnosis/Screening' (97%) and 'Diagnosis' (84%), while 'Disease Awareness' (16%) and 'Treatment Adherence' (6%) were less common. Across 164 outcomes reported, frequent outcomes included 'Healthcare Resource Utilization' (94%), 'Symptoms' (74%), and 'Time-to-Diagnosis' (71%). Fewer studies reported 'Costs' (19%), 'Caregiver/Family Burden' (16%), and 'Productivity' (13%). Time-to-diagnosis averaged 11.8 years and a median of 6.1 years. All but one study (97%) was rated low or very low quality due to observational designs. Conclusion: Most rare disease patient journey evidence focuses on 'Pre-diagnosis/Screening' and 'Diagnosis' stages using qualitative methods and surveys. While symptoms, time-to-diagnosis, and resource utilization were commonly reported, evidence gaps included treatment adherence, caregiver burden and productivity. Longitudinal assessments to collect real-world care and treatment burden outcomes, including caregiver perspectives, can enhance both clinician and policy decision-making for individuals living with rare diseases.

Objectives: This study aimed to evaluate the effectiveness of interventions in reducing loneliness among community-dwelling older adults. Design: A network meta-analysis (NMA) and systematic review. Setting and participants: Interventional studies were included if they contained original quantitative data on interventions to reduce loneliness among community-dwelling older adults. Qualitative studies were included if they contained views on loneliness coping strategies or intervention evaluation. Methods: Six English databases and 3 Chinese databases were searched for studies published before August 2023. We extracted mean and standard deviation for the NMA to examine the overall effectiveness and efficacy of different interventions on loneliness. Thematic analysis was used to derive perspectives on coping strategies to mitigate loneliness. Results: Forty-six quantitative studies with 6049 participants and 40 qualitative studies with 1095 participants were included in the analysis. The pooled effect size was large and significant [standardized mean difference (SMD), -0.95; 95% CI, -1.32 to -0.58; P < .001], indicating a strong effect of interventions in reducing loneliness. Subgroup analyses revealed significant differences in effect sizes by study region and health risk. Results of the NMA suggested interventions seem to be most effective when having psychosocial interventions as the content, a combination of individual and group as the delivery mode, and a mixture of face-to-face and online methods as the contact mode. Findings of the qualitative synthesis revealed 2 main dimensions of activities for reducing loneliness, including delivery modes (individual or group or combination) and settings (indoor or outdoor or combination). Strategies for coping with loneliness at the social, cognitive, and behavioral levels were also identified. Conclusions and implications: The present study identified the most effective components of loneliness interventions in reducing loneliness among older adults. Findings offer important insights for practice and policy-making on potential strategies that can be used to reduce loneliness among community-dwelling older adults.

Several systematic reviews support nature-based interventions (NBIs) as a mechanism of enhancing mental health and wellbeing. However, the available evidence for the effectiveness of these interventions is fragmentary and mixed. The heterogeneity of existing evidence and significant fragmentation of knowledge within the field make it difficult to draw firm conclusions regarding the effectiveness of NBIs. This can only limit the development of interventions to support personal and planetary wellbeing, potentially resulting in ineffective and ill-targeted investment decisions. These concerns have hindered the translation of research evidence into practice and guidelines are urgently required to assist researchers, practitioners and policymakers in developing interventions to promote environmental stewardship and meet the health needs of diverse communities. A higher-order or meta-level synthesis is required to make sense of this evidence. This umbrella review synthesises evidence on the barriers and enablers to nature-based interventions through a summative review of existing published systematic reviews and meta-analyses. A systematic search in PsycINFO, PubMed, Greenfile, Web of Science, Embase, Scopus, Academic Search Complete (EBSCO), Environment Complete (EBSCO), Cochrane Library, CINAHL, Health Policy Reference Centre and Google Scholar was performed. This is a mixed method review, and systematic reviews with both quantitative and qualitative data synthesis were included. 64 systematic reviews were included in the synthesis. The descriptive data, extracted from each study, forms an overview of the characteristics of available evidence on nature-based interventions. A narrative synthesis is used to present the potential factors influencing the outcomes of NBIs. The risk of bias of the systematic reviews was assessed using a 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist. Directions for future research, potential quality needs and recommendations for future research, policymaking, and practice are discusssed.

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.

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.

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