Policy options for strengthening evidence-informed health policy-making in Iran: overall SASHA project findings

Background The institutionalization of evidence-informed health policy-making (EIHP) is complex and complicated. It is complex because it has many players and is complicated because its institutionalization will require many changes that will be challenging to make. Like many other issues, strengthening EIHP needs a road map, which should consider challenges and address them through effective, harmonized and contextualized strategies. This study aims to develop a road map for enhancing EIHP in Iran based on steps of planning. Methods This study consisted of three phases: (1) identifying barriers to EIHP, (2) recognizing interventions and (3) measuring the use of evidence in Iran's health policy-making. A set of activities was established for conducting these, including foresight, systematic review and policy dialogue, to identify the current and potential barriers for the first phase. For the second phase, an evidence synthesis was performed through a scoping review, by searching the websites of benchmark institutions which had good examples of EIHP practices in order to extract and identify interventions, and through eight policy dialogues and two broad opinion polls to contextualize the list of interventions. Simultaneously, two qualitative-quantitative studies were conducted to design and use a tool for assessing EIHP in the third phase. Results We identified 97 barriers to EIHP and categorized them into three groups, including 35 barriers on the “generation of evidence” (push side), 41 on the “use of evidence” (pull side) and 21 on the “interaction between these two” (exchange side). The list of 41 interventions identified through evidence synthesis and eight policy dialogues was reduced to 32 interventions after two expert opinion polling rounds. These interventions were classified into four main strategies for strengthening (1) the education and training system (6 interventions), (2) the incentives programmes (7 interventions), (3) the structure of policy support organizations (4 interventions) and (4) the enabling processes to support EIHP (15 interventions). Conclusion The policy options developed in the study provide a comprehensive framework to chart a path for strengthening the country’s EIHP considering both global practices and the context of Iran. It is recommended that operational plans be prepared for road map interventions, and the necessary resources provided for their implementation. The implementation of the road map will require attention to the principles of good governance, with a focus on transparency and accountability.

Automation of literature screening using machine learning in medical evidence synthesis: a diagnostic test accuracy systematic review protocol

Background Systematic review is an indispensable tool for optimal evidence collection and evaluation in evidence-based medicine. However, the explosive increase of the original literatures makes it difficult to accomplish critical appraisal and regular update. Artificial intelligence (AI) algorithms have been applied to automate the literature screening procedure in medical systematic reviews. In these studies, different algorithms were used and results with great variance were reported. It is therefore imperative to systematically review and analyse the developed automatic methods for literature screening and their effectiveness reported in current studies. Methods An electronic search will be conducted using PubMed, Embase, ACM Digital Library, and IEEE Xplore Digital Library databases, as well as literatures found through supplementary search in Google scholar, on automatic methods for literature screening in systematic reviews. Two reviewers will independently conduct the primary screening of the articles and data extraction, in which nonconformities will be solved by discussion with a methodologist. Data will be extracted from eligible studies, including the basic characteristics of study, the information of training set and validation set, and the function and performance of AI algorithms, and summarised in a table. The risk of bias and applicability of the eligible studies will be assessed by the two reviewers independently based on Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Quantitative analyses, if appropriate, will also be performed. Discussion Automating systematic review process is of great help in reducing workload in evidence-based practice. Results from this systematic review will provide essential summary of the current development of AI algorithms for automatic literature screening in medical evidence synthesis and help to inspire further studies in this field. Systematic review registration PROSPERO CRD42020170815 (28 April 2020).

Effects of Body-Oriented Interventions on Preschoolers' Social-Emotional Competence: A Systematic Review

Objective:A growing body of evidence supports the effectiveness of body-oriented interventions (BOI) in educational contexts, showing positive influences on social-emotional competence. Nevertheless, there is a lack of systematization of the evidence regarding preschool years. This is a two-part systematic review. In this first part, we aim to examine the effects of BOI on preschoolers' social-emotional competence outcomes.Data Sources:Searches were conducted in Pubmed, Scopus, PsycInfo, ERIC, Web of Science, Portal Regional da BVS and CINAHL.Eligibility Criteria:English, French and Portuguese language articles published between January 2000 and October 2020, that evaluated the effects of BOI implemented in educational contexts on social-emotional competence of preschool children. Only randomized controlled trials (RCT) or quasi-RCT were included.Data Extraction and Synthesis:Two reviewers independently completed data extraction and risk-of-bias assessment. The level of scientific evidence was measured through the Best Evidence Synthesis.Results:Nineteen studies were included. There was strong evidence that BOI do not improve anger/aggression, delay of gratification and altruism. Nevertheless, there was moderate evidence that BOI effectively improve other social-emotional outcomes, such as empathy, social interaction, social independence, general internalizing behaviors, and general externalizing behaviors. The lack of scientific evidence was compromised by the methodological quality of the studies.Conclusion:BOI effectively improve specific social-emotional competences of preschool children.Systematic Review Registration:PROSPERO, identifier CRD42020172248.

‘Working relationships’ across difference - a realist review of community engagement with malaria research

Background: Community engagement (CE) is increasingly accepted as a critical aspect of health research, because of its potential to make research more ethical, relevant and well implemented. While CE activities linked to health research have proliferated in Low and Middle Income Countries (LMICs), and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood to ‘work’, and the aims and purposes of engagement are varied and often not made explicit. Ultimately, the evidence base for engagement remains underdeveloped. Methods: To develop explanations for how and why CE with health research contributes to the pattern of outcomes observed in published literature, we conducted a realist review of CE with malaria research – a theory driven approach to evidence synthesis. Results: We found that community engagement relies on the development of provisional ‘working relationships’ across differences, primarily of wealth, power and culture. These relationships are rooted in interactions that are experienced as relatively responsive and respectful, and that bring tangible research related benefits. Contextual factors affecting development of working relationships include the facilitating influence of research organisation commitment to and resources for engagement, and constraining factors linked to the prevailing ‘dominant health research paradigm context’, such as: differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Conclusions: The development of working relationships contributes to greater acceptance and participation in research by local stakeholders, who are particularly interested in research related access to health care and other benefits. At the same time, such relationships may involve an accommodation of some ethically problematic characteristics of the dominant health research paradigm, and thereby reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.

Management of psychotropic medications in adults with intellectual disability: a scoping review protocol

Introduction: Psychotropic medications are commonly prescribed among adults with intellectual disability (ID), often in the absence of a psychiatric diagnosis. As such, there is great disparity between the estimated prevalence of mental illness and the rates of psychotropic medication use amongst people with ID. ‘Off-label’ use of these medications may account for much of this discrepancy, in particular their use in the management of challenging behaviour. This has come under scrutiny due to the myriad of side effects and the deficiency of high-quality data supporting their use for this indication. Understanding the causes and justifications for such disparity is essential in discerning the efficacy of current prescription practice. Objective: To explore the existing evidence base regarding the prescription and management of psychotropic medications in adults with ID. The aim will be achieved through identifying the psychotropic medications commonly prescribed, the underlying rationale(s) for their prescription and the evidence available that demonstrates their appropriateness and effectiveness. Additionally, the paper will seek to evaluate the availability of any existing guidance that informs the management of these medications, and the evidence and outcomes of psychotropic medication dose reduction and/or cessation interventions. Inclusion criteria: This review will consider studies that focus on the use of psychotropic medications amongst patients with ID. Methods: Research studies (qualitative, quantitative and mixed design) and Grey Literature (English) will be included. The search will be conducted without time restrictions. Databases will include: Ovid MEDLINE, Embase, CINAHL, JBI Evidence Synthesis, Cochrane Central Register of Controlled Trials, Cochrane Databased of Systematic Reviews, PsycINFO and Scopus. A three-step search strategy will be followed, with results screened by two independent reviewers. Data will be extracted independently by two reviewers using a data extraction tool with results mapped and presented using a narrative form supported by tables and diagrams.

Healing Architecture in Healthcare: A Scoping Review

Objectives: The purpose of this scoping review is to identify evidence on how characteristics of healing architecture in clinical contexts impact clinical practice and patient experiences. Based on these insights, we advance a more practice-based approach to the study of how healing architectures work. Background: The notion of “healing architecture” has recently emerged in discussions of the spatial organization of healthcare settings, particularly in the Nordic countries. This scoping review summarizes findings from seven articles which specifically describe how patients and staff experience characteristics of healing architecture. Methods: This scoping review was conducted using the framework developed by Arksey and O’Malley. We referred to the decision tool developed by Pollock et al. to confirm that this approach was the most appropriate evidence synthesis type to identify characteristics related to healing architecture and practice. To ensure the rigor of this review, we referred to the methodological guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Results: There are two main findings of the review. First, there is no common or operative definition of healing architecture used in the selected articles. Secondly, there is limited knowledge of how healing architecture shapes clinical and patient outcomes. Conclusions: We conclude that further research is needed into how healing architectures make a difference in everyday clinical practices, both to better inform the development of evidence-based designs in the future and to further elaborate criteria to guide postoccupancy evaluations of purpose-built sites.

Team-based rehabilitation after traumatic brain injury: a qualitative synthesis of evidence of experiences of the rehabilitation process

Objective: To synthesize and explore experiences of the rehabilitation process for adults with traumatic brain injury receiving team-based rehabilitation. Data sources: A qualitative evidence synthesis was conducted according to the "Enhancing transparency in reporting the synthesis of qualitative research" (ENTREQ) Guidelines, of qualitative studies published in 5 databases in 2000–21. Study selection and data extraction: Screening, selection of relevant studies, assessment of methodological limitations, systematic qualitative content analysis and assessment of confidence with GRADE-CERQual [AQ5] were carried out by independent researchers. Data synthesis: The 10 included studies revealed how people with traumatic brain injury perceived that they struggled on their own for a long time to adapt their daily life. They experienced that access to team-based rehabilitation was scarce and that the interventions offered were neither individually tailored nor coordinated. A respectful attitude from professionals and individually adapted information facilitated their rehabilitation process. Conclusion: This qualitative evidence synthesis indicates areas for improvement and a need to develop person-centred team-based rehabilitation for adults with traumatic brain injury, in terms of accessibility, coordination, continuity, content and participation. Given the limited opportunities for team-based rehabilitation after hospital discharge, further research is needed to understand how rehabilitation can support the adaptation of daily activities.

Transformational Change in maternity services in England: a longitudinal qualitative study of a national transformation programme ‘Early Adopter’

Background Large system transformation in health systems is designed to improve quality, outcomes and efficiency. Using empirical data from a longitudinal study of national policy-driven transformation of maternity services in England, we explore the utility of theory-based rules regarding ‘what works’ in large system transformation. Methods A longitudinal, qualitative case study was undertaken in a large diverse urban setting involving multiple hospital trusts, local authorities and other key stakeholders. Data was gathered using interviews, focus groups, non-participant observation, and a review of key documents in three phases between 2017 and 2019. The transcripts of the individual and focus group interviews were analysed thematically, using a combined inductive and deductive approach drawing on simple rules for large system transformation derived from evidence synthesis and the findings are reported in this paper. Results Alignment of transformation work with Best et al’s rules for ‘what works’ in large system transformation varied. Interactions between the rules were identified, indicating that the drivers of large system transformation are interdependent. Key challenges included the pace and scale of change that national policy required, complexity of the existing context, a lack of statutory status for the new ‘system’ limiting system leaders’ power and authority, and concurrent implementation of a new overarching system alongside multifaceted service change. Conclusions Objectives and timescales of transformation policy and plans should be realistic, flexible, responsive to feedback, and account for context. Drivers of large system transformation appear to be interdependent and synergistic. Transformation is likely to be more challenging in recently established systems where the basis of authority is not yet clearly established.