Adopting an ethics and human rights lens, this paper provides a critical analysis of national dementia care guidance from countries ranked highly in providing quality of care towards the end-of-life, including Australia, Ireland, New Zealand, Switzerland, Taiwan and the United Kingdom. The aim of this paper is to determine areas of consensus and disagreement among guidance and to understand current gaps in research. Overall, studied guidances showed consensus regarding patient empowerment and engagement, promoting independence, autonomy and liberty through; establishing person-centered care plans, providing ongoing care assessment, resources and support to individuals and their family/carers. Consensus was also seen in most end-of-life care issues; re-assessing care plans, rationalizing medication, and most importantly carer support and well-being. Disagreement could be found in criteria relating to decision-making after losing capacity, i.e. through appointment of case managers or a power of attorney, reducing barriers to equitable access of care, stigma and discrimination for minority and disadvantaged groups - including younger people with dementia, medicalized care strategies such as alternatives to hospitalization, covert administration, and assisted hydration and nutrition, and also in identifying an active dying phase. Potential for future development includes a greater emphasis on multidisciplinary collaborations, financial and welfare assistance, exploring the use of artificial intelligence technologies for testing and management, while also providing safeguards against such emerging technologies and therapies.

The COVID-19 pandemic has boosted the adoption of digital health technologies such as teleconsultation. This research aimed to assess and compare barriers and facilitators for teleconsultation uptake for primary care practitioners in Hong Kong and the Netherlands and evaluate the role of their different healthcare funding models in this adoption process within the context of the COVID-19 pandemic. A qualitative research following a social constructivist paradigm was performed. The study employed a conceptual framework from Lau and colleagues that identifies four levels of factors influencing change in primary care: (1) external contextual factors; (2) organization-related factors; (3) professional factors; and (4) characteristics of the intervention. The four levels were studied through semi-structured, open-ended interviews with primary care physicians. External factors were additionally assessed by means of a literature review. Hong Kong and the Netherlands showed different penetration rates of teleconsultation. Most stakeholders in both settings shared similar barriers and facilitators in the organizational, professional, and intervention levels. However, external contextual factors (i.e., current teleconsultation legislation, available incentives, and level of public awareness) played an important and differing role in teleconsultation uptake and had a direct effect on the organization, the professionals involved, and the type of technology used. Political and organizational actions are required to develop a comprehensive legal framework for the sustainable development of teleconsultation in both settings.

Background The introduction of massive parallel sequencing has contributed to a decline in sequencing costs. In recent years, whole-exome sequencing (WES) and whole-genome sequencing (WGS) have been increasingly adopted for diagnostic purposes in individuals with suspected genetic diseases. However, a debate is still ongoing in the scientific community about the superiority of WGS over WES in terms of cost-effectiveness. The aim of this study is to assess whether WGS, for the pediatric population with suspected genetic disorders, is cost-effective with respect to WES and chromosomal microarray (CMA) by pooling incremental net benefits. Materials and methods Articles were retrieved from PubMed, Web of Science, Embase and Scopus from 2015 to 2021. The dominance ranking matrix (DRM) tool was adopted to provide a qualitative synthesis of all the included studies. Incremental net benefits (INBs) were estimated and meta-analysis was implemented to pool INBs across studies. Results The database search identified 1600 publications of which four articles were considered eligible for the meta-analysis. The pooled INB of WGS over WES was estimated at I$4073 (95% CI I$2426 – I$5720). The pooled INB of WGS over CMA amounted to I$6003 (95% CI I$2863 – I$9143). Conclusions WGS could be cost-effective in the diagnostic workup of affected infants and children. Further economic evaluations however are needed for comparing WGS versus WES and confirm the present conclusions.

ObjectiveTo assess the registration quality of traditional Chinese medicine (TCM) clinical trials for COVID-19, H1N1, and SARS.MethodWe searched for clinical trial registrations of TCM in the WHO International Clinical Trials Registry Platform (ICTRP) and Chinese Clinical Trial Registry (ChiCTR) on April 30, 2020. The registration quality assessment is based on the WHO Trial Registration Data Set (Version 1.3.1) and extra items for TCM information, including TCM background, theoretical origin, specific diagnosis criteria, description of intervention, and outcomes.ResultsA total of 136 records were examined, including 129 severe acute respiratory syndrome coronavirus 2 (COVID-19) and 7 H1N1 influenza (H1N1) patients. The deficiencies in the registration of TCM clinical trials (CTs) mainly focus on a low percentage reporting detailed information about interventions (46.6%), primary outcome(s) (37.7%), and key secondary outcome(s) (18.4%) and a lack of summary result (0%). For the TCM items, none of the clinical trial registrations reported the TCM background and rationale; only 6.6% provided the TCM diagnosis criteria or a description of the TCM intervention; and 27.9% provided TCM outcome(s).ConclusionOverall, although the number of registrations of TCM CTs increased, the registration quality was low. The registration quality of TCM CTs should be improved by more detailed reporting of interventions and outcomes, TCM-specific information, and sharing of the result data.

Background Without adequate reporting of research, valuable time and resources are wasted. In the same vein, adequate reporting of practice guidelines to optimise patient care is equally important. Our study examines the quality of reporting of published WHO guidelines, over time, using the RIGHT (Reporting Items for Practice Guidelines in HealThcare) reporting checklist. Methods We examined English-language guidelines approved by the WHO Guidelines Review Committee from inception of the committee in 2007 until 31 December 2017. Pairs of independent, trained reviewers assessed the reporting quality of these guidelines. Descriptive data were summarised with frequencies and percentages. Results We included 182 eligible guidelines. Overall, 25 out of the 34 RIGHT items were reported in 75% or more of the WHO guidelines. The reporting rates improved over time. Further, 90% of the guidelines reported document type in the title. The identification of evidence, the rationale for recommendations and the review process were reported in more than 80% of guidelines. The certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was assessed in 81% of the guidelines assessed. While 82% of guidelines reported funding sources, only 25% mentioned the role of funders. Conclusions WHO guidelines provide adequate reporting of many of the RIGHT items and reporting has improved over time. WHO guidelines compare favourably to guidelines produced by other organisations. However, reporting can be further improved in a number of areas.

Introduction In the last years there has been a significant increase in reported cases of pertussis in developed countries, in spite of high rates of childhood immunization. Health institutions have recommended different vaccination strategies to reduce child morbidity and mortality: vaccination of adolescents and adults, pregnant women, people in contact with the newborn (cocoon strategy) and health care workers. The aim of this paper is to review the scientific evidence supporting these recommendations. Methods Systematic review on the effectiveness and cost-effectiveness of the above strategies for the reduction of morbidity and mortality from pertussis in infants under 12 months. The electronic databases Medline, PreMedline, Embase, CRD, Cochrane Central, and Trip Database were consulted from 1990 to October 2012. The evidence was assessed using the GRADE system. Results There were eight studies on the efficacy or safety of the strategies analyzed, and 18 economic evaluations. Direct evidence on the efficacy of these strategies is scarce. Economic evaluations suggest that vaccination of adolescents and adults would be cost-effective, although there is major uncertainty over the parameters used. Conclusions From the perspective of health technology assessment, there is insufficient evidence to recommend the vaccination strategies evaluated.

Authors' objectives: Human immunodeficiency virus/sexually transmitted infections, sexual risk, substance (alcohol and other legal and illegal drugs) use and mental ill health constitute a ‘syndemic’ of mutually reinforcing epidemics among men who have sex with men. Electronic health (e-health) interventions addressing these epidemics among men who have sex with men might have multiplicative effects. To our knowledge, no systematic review has examined the effectiveness of such interventions on these epidemics among men who have sex with men. The objective was to synthesise evidence addressing the following: (1) What approaches and theories of change do existing e-health interventions employ to prevent human immunodeficiency virus/sexually transmitted infections, sexual risk, alcohol/drug use or mental ill health among men who have sex with men? (2) What factors influence implementation? (3) What are the effects of such interventions on the aforementioned epidemics? (4) Are such interventions cost-effective?