scholarly journals Initiatives for improving delayed discharge from a hospital setting: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044291
Author(s):  
Lauren Cadel ◽  
Sara J T Guilcher ◽  
Kristina Marie Kokorelias ◽  
Jason Sutherland ◽  
Jon Glasby ◽  
...  
Keyword(s):  
Best Practices ◽  
Information Sharing ◽  
Scoping Review ◽  
Grey Literature ◽  
Hospital Setting ◽  
Practice Change ◽  
Multidisciplinary Teams ◽  
Delayed Discharge ◽  
Delayed Discharges ◽  
Future Work

ObjectiveThe overarching objective of the scoping review was to examine peer reviewed and grey literature for best practices that have been developed, implemented and/or evaluated for delayed discharge involving a hospital setting. Two specific objectives were to review what the delayed discharge initiatives entailed and identify gaps in the literature in order to inform future work.DesignScoping review.MethodsElectronic databases and websites of government and healthcare organisations were searched for eligible articles. Articles were required to include an initiative that focused on delayed discharge, involve a hospital setting and be published between 1 January 2004 and 16 August 2019. Data were extracted using Microsoft Excel. Following extraction, a policy framework by Doern and Phidd was adapted to organise the included initiatives into categories: (1) information sharing; (2) tools and guidelines; (3) practice changes; (4) infrastructure and finance and (5) other.ResultsSixty-six articles were included in this review. The majority of initiatives were categorised as practice change (n=36), followed by information sharing (n=19) and tools and guidelines (n=19). Numerous initiatives incorporated multiple categories. The majority of initiatives were implemented by multidisciplinary teams and resulted in improved outcomes such as reduced length of stay and discharge delays. However, the experiences of patients and families were rarely reported. Included initiatives also lacked important contextual information, which is essential for replicating best practices and scaling up.ConclusionsThis scoping review identified a number of initiatives that have been implemented to target delayed discharges. While the majority of initiatives resulted in positive outcomes, delayed discharges remain an international problem. There are significant gaps and limitations in evidence and thus, future work is warranted to develop solutions that have a sustainable impact.

scholarly journals Evidence-informed interventions and best practices for supporting women experiencing or at risk of homelessness: a scoping review with gender and equity analysis

2021 ◽  
Vol 1 (1) ◽  
pp. 1-13
Author(s):  
Anne Andermann ◽  
Sebastian Mott ◽  
Christine M. Mathew ◽  
Claire Kendall ◽  
Oreen Mendonca ◽  
...  
Keyword(s):  
At Risk ◽  
Best Practices ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Randomized Trials ◽  
Grey Literature ◽  
Exposure To Violence ◽  
Well Being ◽  
Homeless Population ◽  
Equity Analysis

Introduction While much of the literature on homelessness is centred on the experience of men, women make up over one-quarter of Canada’s homeless population. Research has shown that women experiencing homelessness are often hidden (i.e. provisionally housed) and have different pathways into homelessness and different needs as compared to men. The objective of this research is to identify evidence-based interventions and best practices to better support women experiencing or at risk of homelessness. Methods We conducted a scoping review with a gender and equity analysis. This involved searching MEDLINE, CINAHL, PsycINFO and other databases for systematic reviews and randomized trials, supplementing our search through reference scanning and grey literature, followed by a qualitative synthesis of the evidence that examined gender and equity considerations. Results Of the 4102 articles identified on homelessness interventions, only 4 systematic reviews and 9 randomized trials were exclusively conducted on women or published disaggregated data enabling a gender analysis. Interventions with the strongest evidence included post-shelter advocacy counselling for women experiencing homelessness due to intimate partner violence, as well as case management and permanent housing subsidies (e.g. tenant-based rental assistance vouchers), which were shown to reduce homelessness, food insecurity, exposure to violence and psychosocial distress, as well as promote school stability and child well-being. Conclusion Much of the evidence on interventions to better support women experiencing homelessness focusses on those accessing domestic violence or family shelters. Since many more women are experiencing or at risk of hidden homelessness, population-based strategies are also needed to reduce gender inequity and exposure to violence, which are among the main structural drivers of homelessness among women.

Medical assistance in dying: implications for health systems from a scoping review of the literature

2019 ◽  
Vol 24 (3) ◽  
pp. 207-216 ◽  
Author(s):  
Jamie K. Fujioka ◽  
Raza M. Mirza ◽  
Christopher A. Klinger ◽  
Lynn P. McDonald
Keyword(s):  
Health Systems ◽  
Scoping Review ◽  
Grey Literature ◽  
Models Of Care ◽  
Careful Examination ◽  
Multidisciplinary Teams ◽  
Medical Assistance ◽  
Implementation Barriers ◽  
Regulatory Oversight ◽  
Medical Assistance In Dying

Objective Medical assistance in dying (MAiD) is the medical provision of substances to end a patient’s life at their voluntary request. While legal in several countries, the implementation of MAiD is met with ethical, legislative and clinical challenges, which are often overshadowed by moral discourse. Our aim was to conduct a scoping review to explore key barriers for the integration of MAiD into existing health systems. Methods We searched electronic databases (CINAHL, Embase, MEDLINE, and PsycINFO) and grey literature sources from 1990 to 2017. Studies discussing barriers and/or challenges to implementing MAiD from a health system’s perspective were included. Full-text papers were screened against inclusion/exclusion criteria for article selection. A thematic content analysis was conducted to summarize data into themes to highlight key implementation barriers. Results The final review included 35 articles (see online Appendix 1). Six categories of implementation challenges emerged: regulatory (n = 26), legal (n = 15), social (n = 9), logistical (n = 9), financial (n = 3) and compatibility with palliative care (n = 3). Within four of the six identified implementation barriers (regulatory, legal, social and logistical) were subthemes, which described barriers related to legalizing MAiD in more detail. Conclusion Despite multiple challenges related to its implementation, MAiD remains a requested end-of-life option, requiring careful examination to ensure adequate integration into existing health services. Comprehensive models of care incorporating multidisciplinary teams and regulatory oversight alongside improved clinician education may be effective to streamline MAiD services.

scholarly journals The current landscape of pre-exposure prophylaxis service delivery models for HIV prevention: a scoping review

2020 ◽  
Author(s):  
Jef Vanhamel ◽  
Anke Rotsaert ◽  
Thijs Reyniers ◽  
Christiana Nöstlinger ◽  
Marie Laga ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Service Delivery ◽  
Scoping Review ◽  
Real World ◽  
Grey Literature ◽  
Hospital Setting ◽  
Potential Game ◽  
Key Populations ◽  
Service Delivery Models ◽  
Delivery Models

Abstract Background: Strengthening HIV prevention is imperative given the continued high HIV incidence worldwide. The introduction of oral PrEP as a new biomedical HIV prevention tool can be a potential game changer because of its high clinical efficacy and the feasibility of its provision to different key populations. Documenting the existing experience with PrEP service delivery in a variety of real-world settings will inform how its uptake and usage can be maximised. Methods: We conducted a scoping review using the five-step framework provided by Arksey and O’Malley. We systematically searched the existing peer-reviewed international and grey literature describing the implementation of real-world PrEP service delivery models reporting on four key components: the target population of PrEP services, the setting where PrEP was delivered, PrEP providers’ professionalisation and PrEP delivery channels. We restricted our search to English language articles. No geographical or time restrictions were set.Results: This review included 33 articles for charting and analysing of the results. The identified service delivery models showed that PrEP services mainly targeted people at high risk of HIV acquisition, with some models targeting specific key populations, mainly men who have sex with men. PrEP was often delivered centralised and in a clinical or hospital setting. Yet also community-based as well as home-based PrEP delivery models were reported. Providers of PrEP were mainly clinically trained health professionals, but in some rare cases community workers and lay providers also delivered PrEP. In general, in-person visits were used to deliver PrEP. More innovative digital options using mHealth and telemedicine approaches to deliver specific parts of PrEP services are currently being applied in a minority of the service delivery models in mainly high-resource settings.Conclusions: A range of possible combinations was found between all four components of PrEP service delivery models. This reflects differentiation of care according to different contextual settings. More research is needed on how integration of services in these contexts could be expanded and optimised to respond to key populations with unmet HIV prevention needs in different settings.

scholarly journals Understanding transitional care programmes for older adults who experience delayed discharge: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032149
Author(s):  
Katherine S McGilton ◽  
Shirin Vellani ◽  
Jessica Babineau ◽  
Jennifer Bethell ◽  
Susan E Bronskill ◽  
...  
Keyword(s):  
Older Adults ◽  
Narrative Analysis ◽  
Scoping Review ◽  
Transitional Care ◽  
Community Dwelling ◽  
Term Care ◽  
Delayed Discharge ◽  
Review Protocol ◽  
Delayed Discharges ◽  
Community Dwelling Older Adults

IntroductionMany hospitalised older adults experience delayed discharges due to increased postacute health and social support needs. Transitional care programmes (TCPs) provide short-term care to these patients to prepare them for transfer to nursing homes or back to the community with supports. There are knowledge gaps related to the development, implementation and evaluation of TCPs. The aims of this scoping review (ScR) are to identify the characteristics of older patients served by TCPs; criteria for transfer, components and services provided by TCPs; and outcomes used to evaluate TCPs.Methods and analysisThe study involves six-step ScR and is informed by a collaborative/participatory approach whereby stakeholders engage in the development of the research questions, identification of literature, data abstraction and synthesis; and participation in consultation workshop. The search for scientific literature will be done in the Medline, PsychINFO, Emcare and CINAHL databases; as well, policies and reports that examined models of transitional care and the outcomes used to evaluate them will be reviewed. Records will be selected if they involve community dwelling older adults aged 65 years or older, or indigenous persons 45 years or older; and presented in English, French, Dutch and German languages. Records will be screened, reviewed and abstracted by two independent reviewers. Extracted data will be analysed using descriptive statistics and a narrative analysis, and organised according to Donabedian’s model of structure (characteristics of older adults experiencing delayed discharge and served by TCPs), process (TCP components and services) and outcome.Ethics and disseminationThis ScR does not require ethics approval. Dissemination activities include integrated knowledge translation (KT) (consultation with stakeholders throughout the study) and end-of-grant KT strategies (presentations at national and international conferences; and publication in peer-reviewed interdisciplinary journal).

scholarly journals Patient and caregiver experience with delayed discharge from a hospital setting: A scoping review

2019 ◽  
Vol 22 (5) ◽  
pp. 863-873 ◽  
Author(s):  
Amanda C. Everall ◽  
Sara J. T. Guilcher ◽  
Lauren Cadel ◽  
Maliha Asif ◽  
Joyce Li ◽  
...  
Keyword(s):  
Scoping Review ◽  
Hospital Setting ◽  
Delayed Discharge

scholarly journals A scoping review of vision rehabilitation services in Canada

2021 ◽  
pp. 026461962110293
Author(s):  
Atul Jaiswal ◽  
Sangeetha Santhakumaran ◽  
Sadie Walker ◽  
Mahadeo A Sukhai ◽  
Tanya Packer ◽  
...  
Keyword(s):  
Scoping Review ◽  
Vision Loss ◽  
Service Providers ◽  
Grey Literature ◽  
Age Related ◽  
Comprehensive Search ◽  
Index Terms ◽  
Vision Rehabilitation ◽  
Delayed Referral ◽  
Future Work

Around 1.5 million Canadians live with some form of vision impairment. The demand for vision rehabilitation (VR) services is projected to increase as the number of older adults with age-related vision loss rises. To inform programmes and policies for VR, we aimed to answer two research questions: (1) How are VR services delivered in Canada? and (2) If gaps exist in current delivery of VR services, how can they be characterized? We used Arksey and O’Malley scoping review framework. A comprehensive search of five databases (PubMed, CINAHL/EBSCO, EMBASE, ProQuest, and Global Health) was performed during January 2019 and then updated in March 2021. Index terms and keywords relating to vision loss or impairment and rehabilitation were used. Non-peer-reviewed (grey) literature, in the form of reports and policies on VR in Canada, was sourced via Google/Google Scholar. To be included, sources had to (1) focus on VR services in Canada, (2) be available in English or French, and (3) be published after 2003. Data were extracted and analysed thematically to describe VR services across provinces and to identify gaps in service delivery in Canada. Out of 1311 studies identified, 62 were included. Findings indicate that the structure of VR services as well as provincial funding for assistive devices varies across provinces. The reported gaps at the level of service providers, users, and delivery systems were lack of awareness about the benefits of VR, limited collaboration and coordinated services between eye care and VR services, delayed referral to VR, shortage of specialists, and insufficient funding and training for vision devices. This article describes VR services in Canada and documents important gaps in VR services and research evidence across provincial jurisdictions. Future work to address gaps, and develop and evaluate interventions to facilitate optimal VR services is imperative.

scholarly journals Education and training to support physiotherapists working in dementia care: a scoping review protocol

2021 ◽  
Vol 4 ◽  
pp. 27
Author(s):  
Trish O'Sullivan ◽  
Tony Foley ◽  
Joseph G. McVeigh ◽  
Suzanne Timmons
Keyword(s):  
Scoping Review ◽  
Data Extraction ◽  
Grey Literature ◽  
Education And Training ◽  
Dementia Care ◽  
Multidisciplinary Teams ◽  
Publication Date ◽  
Scoping Reviews ◽  
Data Extraction Tool ◽  
And Training

Background: The care of people with dementia is of global concern. Physiotherapeutic intervention can be of benefit to patients with dementia. Physiotherapists can play a role in assessment, falls prevention, pain management and gait re-education. Dementia care forms a significant part of the workload of a physiotherapist. However, there is a paucity of evidence on what constitutes effective education and training for physiotherapists working in dementia care. Objective: This scoping review aims to explore and map the evidence on education and training for physiotherapists working in dementia care. Inclusion criteria: Studies that explore dementia training and/or education for physiotherapists or for multidisciplinary teams, in which physiotherapists have been included. Studies that explore student physiotherapy training will also be considered. Qualitative, quantitative, mixed methods studies, case studies and observational studies will be included. Methods: This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews. Databases to be searched as part of this review include: Medline, SocINDEX, CINAHL and, PsycINFO, with no limitation on publication date. Google Scholar and Open-Grey will be searched for grey literature, limited to the first 100 searches. Titles and abstracts will be screened for inclusion and identified full texts reviewed independently by two reviewers. Data will be extracted using a draft data extraction tool based on the JBI data extraction tool. A chronological narrative synthesis of the data will outline how the results relate to the aims and objective of this scoping review.

scholarly journals How can we build and maintain the resilience of our health care professionals during COVID-19? Recommendations based on a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e043718
Author(s):  
Anja Rieckert ◽  
Ewoud Schuit ◽  
Nienke Bleijenberg ◽  
Debbie ten Cate ◽  
Wendela de Lange ◽  
...  
Keyword(s):  
Mental Health ◽  
Working Conditions ◽  
Scoping Review ◽  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Psychosocial Support ◽  
Grey Literature ◽  
Hospital Setting ◽  
Physical And Mental Health ◽  
The Impact

ObjectiveTo explore how to build and maintain the resilience of frontline healthcare professionals exposed to COVID-19 outbreak working conditions.DesignScoping review supplemented with expert interviews to validate the findings.SettingHospitals.MethodsWe searched PubMed, Embase, PsycINFO, CINAHL, bioRxiv and medRxiv systematically and grey literature for articles focusing on the impact of COVID-19-like working conditions on the physical and/or mental health of healthcare professionals in a hospital setting. Articles using an empirical design about determinants or causes of physical and/or mental health and about interventions, measures and policies to preserve physical and/or mental health were included. Four experts were interviewed to reflect on the results from the scoping review.ResultsIn total, 4471 records were screened leading to an inclusion of 73 articles. Recommendations prior to the outbreak fostering resilience included optimal provision of education and training, resilience training and interventions to create a feeling of being prepared. Recommendations during the outbreak consisted of (1) enhancing resilience by proper provision of information, psychosocial support and treatment (eg, create enabling conditions such as forming a psychosocial support team), monitoring the health status of professionals and using various forms and content of psychosocial support (eg, encouraging peer support, sharing and celebrating successes), (2) tasks and responsibilities, in which attention should be paid to kind of tasks, task mix and responsibilities as well as the intensity and weight of these tasks and (3) work patterns and working conditions. Findings of the review were validated by experts.ConclusionsRecommendations were developed on how to build and maintain resilience of frontline healthcare professionals exposed to COVID-19 outbreak working conditions. These practical and easy to implement recommendations can be used by hospitals and other healthcare organisations to foster and preserve short-term and long-term physical and mental health and employability of their professionals.

scholarly journals Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e055488
Author(s):  
George N Okoli ◽  
Otto L T Lam ◽  
Viraj K Reddy ◽  
Leslie Copstein ◽  
Nicole Askin ◽  
...  
Keyword(s):  
Cancer Diagnosis ◽  
Scoping Review ◽  
Grey Literature ◽  
Current Evidence ◽  
Bibliographic Databases ◽  
Future Research ◽  
Multidisciplinary Teams ◽  
Early Cancer Diagnosis ◽  
Scoping Reviews ◽  
Nurse Navigator

ObjectivesTo summarise the current evidence regarding interventions for accurate and timely cancer diagnosis among symptomatic individuals.DesignA scoping review following the Joanna Briggs Institute’s methodological framework for the conduct of scoping reviews and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.Data sourcesMEDLINE (Ovid), CINAHL (EBSCOhost) and PsycINFO (Ovid) bibliographic databases, and websites of relevant organisations. Published and unpublished literature (grey literature) of any study type in the English language were searched for from January 2017 to January 2021.Eligibility and criteriaStudy participants were individuals of any age presenting at clinics with symptoms indicative of cancer. Interventions included practice guidelines, care pathways or other initiatives focused on achieving predefined benchmarks or targets for wait times, streamlined or rapid cancer diagnostic services, multidisciplinary teams and patient navigation strategies. Outcomes included accuracy and timeliness of cancer diagnosis.Data extraction and synthesisWe summarised findings graphically and descriptively.ResultsFrom 21 298 retrieved citations, 88 unique published articles and 16 unique unpublished documents (on 18 study reports), met the eligibility for inclusion. About half of the published literature and 83% of the unpublished literature were from the UK. Most of the studies were on interventions in patients with lung cancer. Rapid referral pathways and technology for supporting and streamlining the cancer diagnosis process were the most studied interventions. Interventions were mostly complex and organisation-specific. Common themes among the studies that concluded intervention was effective were multidisciplinary collaboration and the use of a nurse navigator.ConclusionsMultidisciplinary cooperation and involvement of a nurse navigator may be unique features to consider when designing, delivering and evaluating interventions focused on improving accurate and timely cancer diagnosis among symptomatic individuals. Future research should examine the effectiveness of the interventions identified through this review.

scholarly journals Promising best practices implemented in long-term care homes during COVID-19 pandemic to address social isolation and loneliness: a scoping review protocol

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e053894
Author(s):  
Idrissa Beogo ◽  
Eric Nguemeleu Tchouaket ◽  
Drissa Sia ◽  
Nebila Jean-Claude Bationo ◽  
Stephanie Collin ◽  
...  
Keyword(s):  
Best Practices ◽  
Social Isolation ◽  
Scoping Review ◽  
Long Term Care ◽  
Grey Literature ◽  
Care Homes ◽  
Term Care ◽  
Ageing Society ◽  
Scoping Reviews

IntroductionPrior to the COVID-19 pandemic, social isolation and loneliness (SIL) affected at least one-third of the older people. The pandemic has prompted governments around the world to implement some extreme measures such as banning public gatherings, imposing social distancing, mobility restrictions and quarantine to control the spread and impact of the novel coronavirus. Though these unprecedented measures may be crucial from a public health perspective, they also have the potential to further exacerbate the problems of SIL among residents in long-term care homes (LTCHs). However, some LTCHs have developed promising best practices (PBPs) to respond to the current situation and prepare for future pandemics. Key aspects of such practices revolve around maintaining and strengthening social connections between residents and their families which helps to reduce SIL. This scoping review looks at existing PBPs that have been implemented to reduce SIL among LTCH residents during the most recent pandemics.Methods and analysisWe will follow Arksey and O’Malley’s framework of scoping review, further developed by Levac et al. In addition, we will also apply the Joanna Briggs Institute Reviewers’ ‘Methodology for Scoping Reviews’. Ten electronic databases and grey literature will be searched for articles published from January 2003 to March 2021 in either English or French. Two reviewers will independently screen titles and abstracts and then full texts for final inclusion. Data will be extracted using a standardised form from ‘Evidence for Policy and Practice Information’. The results will be presented in a tabular form and will be summarised and interpreted using a narrative synthesis.Ethics and disseminationFormal ethical approval is not required as no primary data are collected. Findings will be used to develop a solid knowledge corpus to address the challenges of SIL in LTCHs. Our findings will help to identify cutting edge practices, including technological interventions that could support health services in addressing SIL in the context of LTCHs and our ageing society.

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