The medline UK filter: development and validation of a geographic search filter to retrieve research about the UK from OVID medline

Effectiveness of non-pharmaceutical interventions as implemented in the UK during the COVID-19 pandemic: a rapid review

BACKGROUND

Although non-pharmaceutical inventions (NPIs) were used globally to control the spread of COVID-19, their effectiveness remains uncertain. We aimed to assess the evidence on NPIs as implemented in the UK, to allow public health bodies to prepare for future pandemics.

METHODS

We used rapid systematic methods (search date: January 2024) to identify, critically appraise and synthesize interventional, observational and modelling studies reporting on NPI effectiveness in the UK.

RESULTS

Eighty-five modelling, nine observational and three interventional studies were included. Modelling studies had multiple quality issues; six of the 12 non-modelling studies were high quality. The best available evidence was for test and release strategies for case contacts (moderate certainty), which was suggestive of a protective effect. Although evidence for school-related NPIs and universal lockdown was also suggestive of a protective effect, this evidence was considered low certainty. Evidence certainty for the remaining NPIs was very low or inconclusive.

CONCLUSION

The validity and reliability of evidence on the effectiveness of NPIs as implemented in the UK during the COVID-19 pandemic is weak. To improve evidence generation and support decision-making during future pandemics or other public health emergencies, it is essential to build evaluation into the design of public health interventions.

How LGBTQ + adults' experiences of multiple disadvantage impact upon their health and social care service pathways in the UK & Ireland: a scoping review

BACKGROUND

Despite increased awareness of the significant health and healthcare inequalities experienced by minoritised groups, limited research considers the interaction of multiple domains of social disadvantage. This review therefore sought to explore how LGBTQ + adults' experiences of homelessness, substance use, and criminal justice involvement impact upon their access to and use of health and social care services in the UK and Ireland.

METHODS

A qualitative scoping review was conducted in accordance with the PRISMA-ScR framework. Electronic database and web searches identified 26 eligible peer-reviewed and grey literature documents published between 2010-2024. The data were charted, coded, and knowledge gaps identified.

RESULTS

Data were coded thematically, clustered around the concept of normativity. Descriptive qualitative techniques were applied to explore how this was enacted and experienced. Synthesis across the literature identified experiences of discrimination and anticipated stigma that acted as barriers to accessing and engaging with services.

CONCLUSIONS

Structural normativity and the privilege afforded to hegemonic population groups impacted upon this population's access to and use of services. The review adds depth and context to questions around the lack of visibility or engagement in services by LGBTQ + people with experience of disadvantage, and contributes to the wider literature on improving service access for marginalised, underserved, or disadvantaged communities.

Factors affecting UK anaesthetic trainees' wellbeing and stress: a scoping review

BACKGROUND

Poor wellbeing and stress in UK anaesthetic trainees impacts significantly on clinical performance, workforce retention and patient care. This study aimed to provide an overview of the evidence in this field and to explore the factors affecting wellbeing and stress in UK anaesthetic trainees.

METHODS

MEDLINE, Embase, PsycINFO, and ERIC were searched, in addition to organisational websites. Literature reporting factors affecting wellbeing and stress in UK anaesthetic trainees from 2009 to present were included.

RESULTS

Following exclusions, 45 studies were identified. Only five papers included qualitative analyses. Within these studies, 28 different phenomena related to wellbeing and stress were investigated. Thirty-one different factors affecting anaesthetic trainees' wellbeing and stress were identified in this review. These have been summarised as individual; training; clinical role; progression; work patterns; resources; rest; support; and cultural factors. External factors were described as affecting wellbeing and stress more frequently than internal factors. The most frequently cited individual factors were fatigue and pre-existing health status.

CONCLUSIONS

The wide scope of phenomena of interest and measurement tools emphasises the challenge of defining and researching the concept of wellbeing. Despite these limitations, we have created a novel conceptual model of individual and external factors affecting UK anaesthetic trainees' wellbeing and stress. This supports an increased awareness and understanding of these factors, so that improvements can be made to practice and policy.

Women's Menopausal Experiences in the UK: A Systemic Literature Review of Qualitative Studies

BACKGROUND

Menopause, defined as the cessation of periods for over 12 months, can have a profound impact on women in numerous ways. Understanding women's experiences of menopause can lead to improved care and support during this transformative period.

OBJECTIVES

The objective of this systematic review is to identify and summarise published qualitative studies that consider the lived experiences of women with menopause in the UK and to serve as a basis for future research in the field of menopause.

SEARCH STRATEGY

EMBASE, MEDLINE and PsycINFO databases were searched initially in March, and then updated in April 2024.

INCLUSION CRITERIA

Peer-reviewed papers with full text available in English, focused on women experiencing menopause in the UK, studies published from January 2000 to April 2024, qualitative or mixed methods study design with qualitative analysis.

DATA EXTRACTION AND SYNTHESIS

Two authors independently performed title and abstract screening for eligibility. Conflicting opinions were resolved with a third author. Reviewers familiarised themselves with the data and coded the text line by line. Thematic analysis was utilised to place the codes into broader themes. All studies were assessed using an appropriate quality assessment tool.

MAIN RESULTS

Thirty-two studies were included in the review with 3462 participants involved. 173 primary codes were extracted and organised into subthemes and 3 overarching themes. These key themes were the biopsychosocial dimensions of menopause, understanding of menopause and strategies to manage menopause.

DISCUSSION

Menopausal experiences documented in the literature are shaped by a range of individual and societal factors. While initiatives to support menopausal women are in place, this review also identifies key knowledge gaps and marginalised groups that would benefit from targeted research and interventions. It emphasises that menopause is not merely a collection of symptoms, but, for many, a pivotal life transition. A deeper understanding of these experiences allows us to more effectively support women through this significant phase of life.

CONCLUSIONS

This review concluded that the menopausal experience extends beyond physical symptoms, also affecting mental health, personal and professional life, and self-identity. Additionally, menopause is shaped by individual life experiences and various personal factors.

PATIENT OR PUBLIC CONTRIBUTIONS

The studies analysed in this review contain original data from women in the UK undergoing menopause. The qualitative data delves into their experiences with symptoms, accessing various sources of support from NHS and non-NHS sources as well as alternative therapies.

What services are currently provided to people with heart failure with preserved ejection fraction in the UK, and what are their components? A protocol for a scoping literature review

AIMS

Heart failure (HF) with preserved ejection fraction (HFpEF) is increasing in incidence and is increasingly the most common HF diagnosis. Patients with HFpEF are often excluded from specialist HF services, which has negative impacts on their healthcare experiences and health-related outcomes. As emerging evidence-based treatments are being incorporated into clinical guidelines, it is timely to focus on the management of this phenotype. This review aims to explore literature around care provision for HFpEF in the UK, to characterize and assess HFpEF care pathways against current standards, and to generate evidence to create an optimized framework of care.

METHODS AND RESULTS

A scoping review of the evidence from six databases will be performed, alongside a search of grey literature search and consultation with relevant experts. Given the expected heterogeneity, multiple lines of synthesis are anticipated. Data analysis will follow best practice guidelines for the synthesizing methodologies selected. Patient and public representatives will assist with analysis and in identifying priority components for HFpEF clinical services.

CONCLUSION

This scoping literature review will enable an in-depth examination of the current health service provision for those with HFpEF in the UK. Synthesis of key components of services and illumination of challenges and barriers will inform current and future practice. There is a long history of specialist HF care in the UK, including seminal work on nurse-led care. Therefore, evidence derived from this review will likely be useful to HF services across Europe. The proposed combination of the search across both peer-reviewed literature and grey literature, combined with patient and public involvement, will identify the key components of a framework of care for those with HFpEF.

REGISTRATION

This scoping review protocol was published on the public Open Science Framework platform (no registration reference provided) and can be accessed at: https://osf.io/5gufq/.

Use and application of geographical restrictions in systematic reviews with the aim of including studies about Germany: An update of a methodological review

BACKGROUND

In systematic reviews (SRs), geographical limitations in literature searches can aid in focussing research efforts. A methodological review published in 2016 examined the approaches SR authors use to identify studies about Germany, analysing 36 SRs.

OBJECTIVE

The aim of this study was to update the original review.

METHODS

We conducted a literature search on PubMed for SRs synthesising evidence from studies about Germany published between 22 January 2016 and 7 June 2022. Two reviewers independently performed study selection and data extraction. We evaluated the application of search syntax for restricting studies to those about Germany using the peer review of electronic search strategies criteria. The updated findings were reported and summarised alongside those of the original review.

RESULTS

Thirty-two additional SRs were newly included (total = 68). Geographic restrictions were applied in 57 SRs, representing 72% in the original review and increasing to 97% in the newly included SRs. Moreover, there was an increased use of truncations and field tags.

CONCLUSION

Although geographical restriction methods are increasingly utilised, additional tools are necessary to enhance the robustness of search strategies. The development of a dedicated geographical search filter would facilitate the identification of studies about Germany.

Development and validation of a geographic search filter for MEDLINE (PubMed) to identify studies about Germany

While geographic search filters exist, few of them are validated and there are currently none that focus on Germany. We aimed to develop and validate a highly sensitive geographic search filter for MEDLINE (PubMed) that identifies studies about Germany. First, using the relative recall method, we created a gold standard set of studies about Germany, dividing it into 'development' and 'testing' sets. Next, candidate search terms were identified using (i) term frequency analyses in the 'development set' and a random set of MEDLINE records; and (ii) a list of German geographic locations, compiled by our team. Then, we iteratively created the filter, evaluating it against the 'development' and 'testing' sets. To validate the filter, we conducted a number of case studies (CSs) and a simulation study. For this validation we used systematic reviews (SRs) that had included studies about Germany but did not restrict their search strategy geographically. When applying the filter to the original search strategies of the 17 SRs eligible for CSs, the median precision was 2.64% (interquartile range [IQR]: 1.34%-6.88%) versus 0.16% (IQR: 0.10%-0.49%) without the filter. The median number-needed-to-read (NNR) decreased from 625 (IQR: 211-1042) to 38 (IQR: 15-76). The filter achieved 100% sensitivity in 13 CSs, 85.71% in 2 CSs and 87.50% and 80% in the remaining 2 CSs. In a simulation study, the filter demonstrated an overall sensitivity of 97.19% and NNR of 42. The filter reliably identifies studies about Germany, enhancing screening efficiency and can be applied in evidence syntheses focusing on Germany.

Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010-2023

BACKGROUND

Large-scale improvement programmes are a frequent response to quality and safety problems in health systems globally, but have mixed impact. The extent to which they meet criteria for programme quality, particularly in relation to transparency of reporting and evaluation, is unclear.

AIM

To identify large-scale improvement programmes focused on intrapartum care implemented in English National Health Service maternity services in the period 2010-2023, and to conduct a structured quality assessment.

METHODS

We drew on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidance to inform the design and reporting of our study. We identified relevant programmes using multiple search strategies of grey literature, research databases and other sources. Programmes that met a prespecified definition of improvement programme, that focused on intrapartum care and that had a retrievable evaluation report were subject to structured assessment using selected features of programme quality.

RESULTS

We identified 1434 records via databases and other sources. 14 major initiatives in English maternity services could not be quality assessed due to lack of a retrievable evaluation report. Quality assessment of the 15 improvement programmes meeting our criteria for assessment found highly variable quality and reporting. Programme specification was variable and mostly low quality. Only eight reported the evidence base for their interventions. Description of implementation support was poor and none reported customisation for challenged services. None reported reduction of inequalities as an explicit goal. Only seven made use of explicit patient and public involvement practices, and only six explicitly used published theories/models/frameworks to guide implementation. Programmes varied in their reporting of the planning, scope and design of evaluation, with weak designs evident.

CONCLUSIONS

Poor transparency of reporting and weak or absent evaluation undermine large-scale improvement programmes by limiting learning and accountability. This review indicates important targets for improving quality in large-scale programmes.

Ceftazidime with avibactam for treating severe aerobic Gram-negative bacterial infections: technology evaluation to inform a novel subscription-style payment model

Background

To limit the use of antimicrobials without disincentivising the development of novel antimicrobials, there is interest in establishing innovative models that fund antimicrobials based on an evaluation of their value as opposed to the volumes used. The aim of this project was to evaluate the population-level health benefit of ceftazidime-avibactam in the NHS in England, for the treatment of severe aerobic Gram-negative bacterial infections when used within its licensed indications. The results were used to inform National Institute for Health and Care Excellence guidance in support of commercial discussions regarding contract value between the manufacturer and NHS England.

Methods

The health benefit of ceftazidime-avibactam was first derived for a series of high-value clinical scenarios. These represented uses that were expected to have a significant impact on patients' mortality risks and health-related quality of life. Patient-level costs and health-related quality of life of ceftazidime-avibactam under various usage scenarios compared with alternative management strategies in the high-value clinical scenarios were quantified using decision modelling. Results were reported as incremental net health effects expressed in quality-adjusted life-years, which were scaled to 20-year population in quality-adjusted life-years using infection number forecasts based on data from Public Health England. The outcomes estimated for the high-value clinical scenarios were extrapolated to other expected uses for ceftazidime-avibactam.

Results

The clinical effectiveness of ceftazidime-avibactam relative to its comparators was estimated by synthesising evidence on susceptibility of the pathogens of interest to the antimicrobials in a network meta-analysis. In the base case, ceftazidime-avibactam was associated with a statistically significantly higher susceptibility relative to colistin (odds ratio 7.24, 95% credible interval 2.58 to 20.94). The remainder of the treatments were associated with lower susceptibility than colistin (odds ratio < 1). The results were sensitive to the definition of resistance and the studies included in the analysis. In the base case, patient-level benefit of ceftazidime-avibactam was between 0.08 and 0.16 quality-adjusted life-years, depending on the site of infection and the usage scenario. There was a high degree of uncertainty surrounding the benefits of ceftazidime-avibactam across all subgroups, and the results were sensitive to assumptions in the meta-analysis used to estimate susceptibility. There was substantial uncertainty in the number of infections that are suitable for treatment with ceftazidime-avibactam, so population-level results are presented for a range of scenarios for the current infection numbers, the expected increases in infections over time, and rates of emergence of resistance. The population-level benefit varied substantially across the scenarios, from 531 to 2342 quality-adjusted life-years over 20 years.

Conclusion

This work has provided quantitative estimates of the value of ceftazidime-avibactam within its areas of expected usage within the NHS.

Limitations

Given existing evidence, the estimates of the value of ceftazidime-avibactam are highly uncertain.

Future work

Future evaluations of antimicrobials would benefit from improvements to NHS data linkages, research to support appropriate synthesis of susceptibility studies, and application of routine data and decision modelling to assess enablement value.

Study registration

No registration of this study was undertaken.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Policy Research Programme (NIHR award ref: NIHR135592), conducted through the Policy Research Unit in Economic Methods of Evaluation in Health and Social Care Interventions, PR-PRU-1217-20401, and is published in full in Health Technology Assessment; Vol. 28, No. 73. See the NIHR Funding and Awards website for further award information.

Understanding healthcare professionals' responses to patient complaints in secondary and tertiary care in the UK: A systematic review and behavioural analysis using the Theoretical Domains Framework

BACKGROUND

The path of a complaint and patient satisfaction with complaint resolution is often dependent on the responses of healthcare professionals (HCPs). It is therefore important to understand the influences shaping HCP behaviour. This systematic review aimed to (1) identify the key actors, behaviours and factors influencing HCPs' responses to complaints, and (2) apply behavioural science frameworks to classify these influences and provide recommendations for more effective complaints handling behaviours.

METHODS

A systematic literature review of UK published and unpublished (so-called grey literature) studies was conducted (PROSPERO registration: CRD42022301980). Five electronic databases [Scopus, MEDLINE/Ovid, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Health Management Information Consortium (HMIC)] were searched up to September 2021. Eligibility criteria included studies reporting primary data, conducted in secondary and tertiary care, written in English and published between 2001 and 2021 (studies from primary care, mental health, forensic, paediatric or dental care services were excluded). Extracted data included study characteristics, participant quotations from qualitative studies, results from questionnaire and survey studies, case studies reported in commentaries and descriptions, and summaries of results from reports. Data were synthesized narratively using inductive thematic analysis, followed by deductive mapping to the Theoretical Domains Framework (TDF).

RESULTS

In all, 22 articles and three reports met the inclusion criteria. A total of 8 actors, 22 behaviours and 24 influences on behaviour were found. Key factors influencing effective handling of complaints included HCPs' knowledge of procedures, communication skills and training, available time and resources, inherent contradictions within the role, role authority, HCPs' beliefs about their ability to handle complaints, beliefs about the value of complaints, managerial and peer support and organizational culture and emotions. Themes mapped onto nine TDF domains: knowledge, skills, environmental context and resources, social/professional role and identity, social influences, beliefs about capability, intentions and beliefs about consequences and emotions. Recommendations were generated using the Behaviour Change Wheel approach.

CONCLUSIONS

Through the application of behavioural science, we identified a wide range of individual, social/organizational and environmental influences on complaints handling. Our behavioural analysis informed recommendations for future intervention strategies, with particular emphasis on reframing and building on the positive aspects of complaints as an underutilized source of feedback at an individual and organizational level.

Care Under Pressure 2: a realist synthesis of causes and interventions to mitigate psychological ill health in nurses, midwives and paramedics

BACKGROUND

Nurses, midwives and paramedics comprise over half of the clinical workforce in the UK National Health Service and have some of the highest prevalence of psychological ill health. This study explored why psychological ill health is a growing problem and how we might change this.

METHODS

A realist synthesis involved iterative searches within MEDLINE, CINAHL and HMIC, and supplementary handsearching and expert solicitation. We used reverse chronological quota screening and appraisal journalling to analyse each source and refine our initial programme theory. A stakeholder group comprising nurses, midwives, paramedics, patient and public representatives, educators, managers and policy makers contributed throughout.

RESULTS

Following initial theory development from 8 key reports, 159 sources were included. We identified 26 context-mechanism-outcome configurations, with 16 explaining the causes of psychological ill health and 10 explaining why interventions have not worked to mitigate psychological ill health. These were synthesised to five key findings: (1) it is difficult to promote staff psychological wellness where there is a blame culture; (2) the needs of the system often over-ride staff psychological well-being at work; (3) there are unintended personal costs of upholding and implementing values at work; (4) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; and (5) it is challenging to design, identify and implement interventions.

CONCLUSIONS

Our final programme theory argues the need for healthcare organisations to rebalance the working environment to enable healthcare professionals to recover and thrive. This requires high standards for patient care to be balanced with high standards for staff psychological well-being; professional accountability to be balanced with having a listening, learning culture; reactive responsive interventions to be balanced by having proactive preventative interventions; and the individual focus balanced by an organisational focus.

PROSPERO REGISTRATION NUMBER

CRD42020172420.

Cefiderocol for treating severe aerobic Gram-negative bacterial infections: technology evaluation to inform a novel subscription-style payment model

Background

To limit the use of antimicrobials without disincentivising the development of novel antimicrobials, there is interest in establishing innovative models that fund antimicrobials based on an evaluation of their value as opposed to the volumes used. The aim of this project was to evaluate the population-level health benefit of cefiderocol in the NHS in England, for the treatment of severe aerobic Gram-negative bacterial infections when used within its licensed indications. The results were used to inform the National Institute for Health and Care Excellence guidance in support of commercial discussions regarding contract value between the manufacturer and NHS England.

Methods

The health benefit of cefiderocol was first derived for a series of high-value clinical scenarios. These represented uses that were expected to have a significant impact on patients' mortality risks and health-related quality of life. The clinical effectiveness of cefiderocol relative to its comparators was estimated by synthesising evidence on susceptibility of the pathogens of interest to the antimicrobials in a network meta-analysis. Patient-level costs and health outcomes of cefiderocol under various usage scenarios compared with alternative management strategies were quantified using decision modelling. Results were reported as incremental net health effects expressed in quality-adjusted life-years, which were scaled to 20-year population values using infection number forecasts based on data from Public Health England. The outcomes estimated for the high-value clinical scenarios were extrapolated to other expected uses for cefiderocol.

Results

Among Enterobacterales isolates with the metallo-beta-lactamase resistance mechanism, the base-case network meta-analysis found that cefiderocol was associated with a lower susceptibility relative to colistin (odds ratio 0.32, 95% credible intervals 0.04 to 2.47), but the result was not statistically significant. The other treatments were also associated with lower susceptibility than colistin, but the results were not statistically significant. In the metallo-beta-lactamase Pseudomonas aeruginosa base-case network meta-analysis, cefiderocol was associated with a lower susceptibility relative to colistin (odds ratio 0.44, 95% credible intervals 0.03 to 3.94), but the result was not statistically significant. The other treatments were associated with no susceptibility. In the base case, patient-level benefit of cefiderocol was between 0.02 and 0.15 quality-adjusted life-years, depending on the site of infection, the pathogen and the usage scenario. There was a high degree of uncertainty surrounding the benefits of cefiderocol across all subgroups. There was substantial uncertainty in the number of infections that are suitable for treatment with cefiderocol, so population-level results are presented for a range of scenarios for the current infection numbers, the expected increases in infections over time and rates of emergence of resistance. The population-level benefits varied substantially across the base-case scenarios, from 896 to 3559 quality-adjusted life-years over 20 years.

Conclusion

This work has provided quantitative estimates of the value of cefiderocol within its areas of expected usage within the NHS.

Limitations

Given existing evidence, the estimates of the value of cefiderocol are highly uncertain.

Future work

Future evaluations of antimicrobials would benefit from improvements to NHS data linkages; research to support appropriate synthesis of susceptibility studies; and application of routine data and decision modelling to assess enablement value.

Study registration

No registration of this study was undertaken.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Policy Research Programme (NIHR award ref: NIHR135591), conducted through the Policy Research Unit in Economic Methods of Evaluation in Health and Social Care Interventions, PR-PRU-1217-20401, and is published in full in Health Technology Assessment; Vol. 28, No. 28. See the NIHR Funding and Awards website for further award information.

Evaluating the impact of local alcohol licensing decisions on outcomes for the community: a systematic review

Background

International evidence reviews suggest that reducing the availability of alcohol positively impacts both levels of alcohol consumption and associated harms. To understand the impact of recent changes to alcohol licensing and public health in the UK, this review aimed to identify and synthesise quantitative research evidence on the impact of local alcohol licensing decisions on the health and well-being of the community.

Methods

We searched peer-reviewed articles and grey literature for UK studies. We extracted and tabulated key data from the included papers and appraised study quality. We included topic expert and public consultation to confirm the scope of the evidence synthesis and suggest evidence for inclusion. We synthesised narratively and made recommendations based on our findings.

Results

We identified a small volume (seven papers) of evidence regarding the health (and related) impacts of local alcohol licensing decision undertaken in the UK local authorities. The evidence we identified did not demonstrate a consistent or sustained association between local interventions and health or crime outcomes downstream. This was despite relatively sophisticated study designs using a range of available data sources and some longer-term analysis.

Conclusion

Given that the impacts of local licensing decisions are currently limited, greater regulatory powers are needed if local licensing interventions are to be an effective public health interventions to reduce alcohol-related harms.

Non-pharmaceutical interventions to reduce COVID-19 transmission in the UK: a rapid mapping review and interactive evidence gap map

BACKGROUND

Non-pharmaceutical interventions (NPIs) were crucial in the response to the COVID-19 pandemic, although uncertainties about their effectiveness remain. This work aimed to better understand the evidence generated during the pandemic on the effectiveness of NPIs implemented in the UK.

METHODS

We conducted a rapid mapping review (search date: 1 March 2023) to identify primary studies reporting on the effectiveness of NPIs to reduce COVID-19 transmission. Included studies were displayed in an interactive evidence gap map.

RESULTS

After removal of duplicates, 11 752 records were screened. Of these, 151 were included, including 100 modelling studies but only 2 randomized controlled trials and 10 longitudinal observational studies.Most studies reported on NPIs to identify and isolate those who are or may become infectious, and on NPIs to reduce the number of contacts. There was an evidence gap for hand and respiratory hygiene, ventilation and cleaning.

CONCLUSIONS

Our findings show that despite the large number of studies published, there is still a lack of robust evaluations of the NPIs implemented in the UK. There is a need to build evaluation into the design and implementation of public health interventions and policies from the start of any future pandemic or other public health emergency.

Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review

Background

Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves.

Aim

To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions.

Methods

Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards' reporting guidelines.

Data sources

First round database searching in Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), was undertaken between February and March 2021, followed by supplementary searching strategies (e.g. hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied.

Results

We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 context mechanism and outcome configurations. The key findings identified the following: (1) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; (2) it is difficult to promote staff psychological wellness where there is a blame culture; (3) the needs of the system often override staff well-being at work ('serve and sacrifice'); (4) there are unintended personal costs of upholding and implementing values at work; and (5) it is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors.

Conclusions

Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to (1) rebalance the working environment to enable healthcare professionals to recover and thrive; (2) invest in multi-level system approaches to promote staff psychological well-being; and use an organisational diagnostic framework, such as the NHS England and NHS Improvement Health and Wellbeing framework, to self-assess and implement a systems approach to staff well-being.

Future work

Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with front-line staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs.

Limitations

The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder/expert suggestions to augment our sample.

Study registration

This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172420.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129528) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.

Validated geographic search filters for bibliographic databases: a scoping review protocol

OBJECTIVE

The purpose of this scoping review is to identify validated geographic search filters and report their methodology and performance measures.

INTRODUCTION

Data on specific geographic areas can be required for evidence syntheses topics, such as the investigation of regional inequalities in health care or to answer context-specific epidemiological questions. Search filters are useful tools for reviewers aiming to identify publications with common characteristics in bibliographic databases. Geographic search filters limit the literature search results to a specific geographic feature (eg, a country or region).

INCLUSION CRITERIA

We will include reports on validated geographic search filters that aim to identify research evidence about a defined geographic area (eg, a country/region or a group of countries/regions).

METHODS

This review will be conducted in accordance with JBI methodology for scoping reviews. The literature search will be conducted in PubMed and Embase. The InterTASC Information Specialists' Sub-Group Search Filter resource and Google Scholar will also be searched. Reports published in any language, from database inception to the present, will be considered for inclusion. Two researchers will independently screen the title, abstract, and full text of the search results. A third reviewer will be consulted in the event of any disagreements. The data extraction will include study characteristics, basic characteristics of the geographical search filter (eg, country/region), and the methods used to develop and validate the search filter. The extracted data will be summarized narratively and presented in a table.

REVIEW REGISTRATION

Open Science Framework https://osf.io/5czhs.

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Background

Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway.

Aims

To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment.

Objectives

To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: i. to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context ii. to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK.

Data sources

Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites.

Review methods

A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines.

Results

From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan.

Limitations

Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment.

Conclusions

No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement.

Study registration

This study is registered as PROSPERO CRD42021276671.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

Experiences of remote consultation in UK primary care for patients with mental health conditions: A systematic review

Objectives

There has been a rapid shift from face-to-face to remote consultation across healthcare settings. 90% of patients with mental health conditions are cared for entirely in primary care. Remote consultation can present challenges and benefits for patients with mental health conditions. The aim of this systematic review was to collate and examine the evidence relating to remote consultation in UK primary care on the experiences of patients with mental health conditions.

Methods

Six major databases were searched for empirical studies published in the English language between 1 January 2010 and 21 October 2022. Studies were included where remote consultation occurred between a patient and primary care clinician. Outcomes of interest include mode of remote consultation, patient experiences and characteristics. Final included studies were assessed for quality, and results analysed with narrative synthesis.

Results

Six studies met the inclusion criteria, covering a range of mental health conditions and remote consultation modalities (telephone, video, online, email, text-based). Patients were overall satisfied with remote consultation, with particular benefit for certain mental health conditions or anxious patients. However, several studies found that face-to-face was the preferred method, with highlighted negatives to remote consultation, such as inflexibility of online formats. Acceptability of remote consultation is context specific and influenced by the purpose of the consultation and individual patient. Remote consultation may reduce anxiety in some patients, but is potentially less acceptable than face-to-face for relational appointments.

Conclusions

Acceptability of remote consultation is context dependent. There is a lack of evidence surrounding patient characteristics and access to remote consultation.

Explanation of context, mechanisms and outcomes in adult community mental health crisis care: the MH-CREST realist evidence synthesis

Background

Mental health crises cause significant disruption to individuals and families and can be life-threatening. The large number of community crisis services operating in an inter-agency landscape complicates access to help. It is unclear which underpinning mechanisms of crisis care work, for whom and in which circumstances.

Aim

The aim was to identify mechanisms to explain how, for whom and in what circumstances adult community crisis services work.

Objectives

The objectives were to develop, test and synthesise programme theories via (1) stakeholder expertise and current evidence; (2) a context, intervention, mechanism and outcome framework; (3) consultation with experts; (4) development of pen portraits; (5) synthesis and refinement of programme theories, including mid-range theory; and (6) identification and dissemination of mechanisms needed to trigger desired context-specific crisis outcomes.

Design

This study is a realist evidence synthesis, comprising (1) identification of initial programme theories; (2) prioritisation, testing and refinement of programme theories; (3) focused realist reviews of prioritised initial programme theories; and (4) synthesis to mid-range theory.

Main outcome

The main outcome was to explain context, mechanisms and outcomes in adult community mental health crisis care.

Data sources

Data were sourced via academic and grey literature searches, expert stakeholder group consultations and 20 individual realist interviews with experts.

Review methods

A realist evidence synthesis with primary data was conducted to test and refine three initial programme theories: (1) urgent and accessible crisis care, (2) compassionate and therapeutic crisis care and (3) inter-agency working.

Results

Community crisis services operate best within an inter-agency system. This requires compassionate leadership and shared values that enable staff to be supported; retain their compassion; and, in turn, facilitate compassionate interventions for people in crisis. The complex interface between agencies is best managed through greater clarity at the boundaries of services, making referral and transition seamless and timely. This would facilitate ease of access and guaranteed responses that are trusted by the communities they serve.

Strengths and limitations

Strengths include the identification of mechanisms for effective inter-agency community crisis care and meaningful stakeholder consultation that grounded the theories in real-life experience. Limitations include the evidence being heavily weighted towards England and the review scope excluding full analysis of ethnic and cultural diversity.

Conclusions

Multiple interpretations of crises and diverse population needs present challenges for improving the complex pathways to help in a crisis. Inter-agency working requires clear policy guidance with local commissioning. Seamless transitions between services generate trust through guaranteed responses and ease of navigation. This is best achieved where there is inter-agency affiliation that supports co-production. Compassionate leaders engender staff trust, and outcomes for people in crisis improve when staff are supported to retain their compassion.

Future work

Further work might explore inter-agency models of crisis delivery, particularly in rural communities. Future work could focus on evaluating outcomes across crisis care provider agencies and include evaluation of individual, as well as service-level, outcomes. The implementation and effect of mental health triage could be explored further, including via telehealth. Barriers to access for marginalised populations warrant a specific focus in future research.

Study registration

The study is registered as PROSPERO CRD42019141680.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 15. See the NIHR Journals Library website for further project information.

Barriers and facilitators of community-based implementation of evidence-based interventions in the UK, for children and young people's mental health promotion, prevention and treatment: rapid scoping review

BACKGROUND

Community-based organisations continue to take on a greater role in supporting children and young people in the UK with their mental health. However, little evidence exists on the capacity and capability of these settings to effectively implement evidence-based interventions (EBIs).

AIMS

To identify barriers and facilitators of the implementation of EBIs within community settings in the UK, for children and young people's mental health promotion, prevention and treatment.

METHOD

A PRISMA-guided, rapid scoping review was conducted, using predefined criteria and a relevant search strategy on eight databases: Ovid EMBASE, Ovid Medline, Ovid PsycINFO, Ovid Global Health: Scopus, Web of Science All Databases, EBSCO CINAHL and EBSCO ERIC. Study characteristics and data on barriers and facilitators were extracted, with results narratively synthesised.

RESULTS

Five out of 4899 studies met the inclusion criteria, addressing the barriers and facilitators of community-based implementation of EBIs for children and young people's mental health promotion, prevention and treatment. All of the studies that were identified focused on school settings, but we identified no studies that included data on barriers or facilitators of implementing EBIs in other community-based or voluntary sector settings.

CONCLUSIONS

There is a lack of available evidence on the capacity and capability of community settings in the UK to effectively implement EBIs and adhere to evidence-based practice. However, existing findings within schools have highlighted key barriers and facilitators to implementation, such as the importance of meaningful involvement of stakeholders throughout the research process, and greater allocation of resources to support evidence-based decision-making in these settings.

Determining optimal strategies for primary prevention of cardiovascular disease: systematic review of cost-effectiveness analyses in the United Kingdom

BACKGROUND

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The aim of the study was to guide researchers and commissioners of cardiovascular disease preventative services towards possible cost-effective interventions by reviewing published economic analyses of interventions for the primary prevention of cardiovascular disease, conducted for or within the UK NHS.

METHODS

In January 2021, electronic searches of MEDLINE and Embase were carried out to find economic evaluations of cardiovascular disease preventative services. We included fully published economic evaluations (including economic models) conducted alongside randomised controlled trials of any form of intervention that was aimed at the primary prevention of cardiovascular disease, including, but not limited to, drugs, diet, physical activity and public health. Full systematic review methods were used with predetermined inclusion/exclusion criteria, data extraction and formal quality appraisal [using the Consolidated Health Economic Evaluation Reporting Standards checklist and the framework for the quality assessment of decision analytic modelling by Philips et al. (Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004;8(36)].

RESULTS

Of 4351 non-duplicate citations, eight articles met the review's inclusion criteria. The eight articles focused on health promotion (n = 3), lipid-lowering medicine (n = 4) and blood pressure-lowering medication (n = 1). The majority of the populations in each study had at least one risk factor for cardiovascular disease or were at high risk of cardiovascular disease. For the primary prevention of cardiovascular disease, all strategies were cost-effective at a threshold of £25,000 per quality-adjusted life-year, except increasing motivational interviewing in addition to other behaviour change strategies. Where the cost per quality-adjusted life-year gained was reported, interventions varied from dominant (i.e. less expensive and more effective than the comparator intervention) to £55,000 per quality-adjusted life-year gained.

FUTURE WORK AND LIMITATIONS

We found few health economic analyses of interventions for primary cardiovascular disease prevention conducted within the last decade. Future economic assessments should be undertaken and presented in accordance with best practices so that future reviews may make clear recommendations to improve health policy.

CONCLUSIONS

It is difficult to establish direct comparisons or draw firm conclusions because of the uncertainty and heterogeneity among studies. However, interventions conducted for or within the UK NHS were likely to be cost-effective in people at increased risk of cardiovascular disease when compared with usual care or no intervention.

FUNDING

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in Health Technology Assessment. See the NIHR Journals Library website for further project information.

Development and validation of paired MEDLINE and Embase search filters for cost-utility studies

BACKGROUND

Search filters are standardised sets of search terms, with validated performance, that are designed to retrieve studies with specific characteristics. A cost-utility analysis (CUA) is the preferred type of economic evaluation to underpin decision-making at the National Institute for Health and Care Excellence (NICE). Until now, when searching for economic evidence for NICE guidelines, we have used a broad set of health economic-related search terms, even when the reviewer's interest is confined to CUAs alone.

METHODS

We developed search filters to retrieve CUAs from MEDLINE and Embase. Our aim was to achieve recall of 90% or better across both databases while reducing the overall yield compared with our existing broad economic filter. We used the relative recall method along with topic expert input to derive and validate 3 pairs of filters, assessed by their ability to identify a gold-standard set of CUAs that had been used in published NICE guidelines. We developed and validated MEDLINE and Embase filters in pairs (testing whether, when used together, they find target studies in at least 1 database), as this is how they are used in practice. We examined the proxy-precision of our new filters by comparing their overall yield with our previous approach using publications indexed in a randomly selected year (2010).

RESULTS

All 3 filter-pairs exceeded our target recall and led to substantial improvements in search proxy-precision. Our paired 'sensitive' filters achieved 100% recall (95% CI 99.0 to 100%) in the validation set. Our paired 'precise' filters also had very good recall (97.6% [95%CI: 95.4 to 98.9%]). We estimate that, compared with our previous search strategy, using the paired 'sensitive' filters would reduce reviewer screening burden by a factor of 5 and the 'precise' versions would do so by a factor of more than 20.

CONCLUSIONS

Each of the 3 paired cost-utility filters enable the identification of almost all CUAs from MEDLINE and Embase from the validation set, with substantial savings in screening workload compared to our previous search practice. We would encourage other researchers who regularly use multiple databases to consider validating search filters in combination as this will better reflect how they use databases in their everyday work.

Systematic review of the effectiveness of the health inequalities strategy in England between 1999 and 2010

OBJECTIVES

The purpose of this systematic review is to explore the effectiveness of the National Health Inequality Strategy, which was conducted in England between 1999 and 2010.

DESIGN

Three databases (Ovid Medline, Embase and PsycINFO) and grey literature were searched for articles published that reported on changes in inequalities in health outcomes in England over the implementation period. Articles published between January 1999 and November 2021 were included. Title and abstracts were screened according to an eligibility criteria. Data were extracted from eligible studies, and risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.

RESULTS

The search strategy identified 10 311 unique studies, which were screened. 42 were reviewed in full text and 11 were included in the final review. Six studies contained data on inequalities of life expectancy or mortality, four on disease-specific mortality, three on infant mortality and three on morbidities. Early government reports suggested that inequalities in life expectancy and infant mortality had increased. However, later publications using more accurate data and more appropriate measures found that absolute and relative inequalities had decreased throughout the strategy period for both measures. Three of four studies found a narrowing of inequalities in all-cause mortality. Absolute inequalities in mortality due to cancer and cardiovascular disease decreased, but relative inequalities increased. There was a lack of change, or widening of inequalities in mental health, self-reported health, health-related quality of life and long-term conditions.

CONCLUSIONS

With respect to its aims, the strategy was broadly successful. Policymakers should take courage that progress on health inequalities is achievable with long-term, multiagency, cross-government action.

TRIAL REGISTRATION NUMBER

This study was registered in PROSPERO (CRD42021285770).

The ScHARR LMIC filter: Adapting a low- and middle-income countries geographic search filter to identify studies on preterm birth prevention and management

Search filters are used to find evidence on specific subjects. Performance of filters can be varied and may need adapting to meet the needs of research topics. There are limited geographic search filters available, and only one pertaining to low- and middle-income countries (LMICs). When searching for literature on preterm birth prevention and management in LMICs for a research project at the School of Health and Related Research (ScHARR), we made use of the Cochrane Effective Practice and Organisation of Care (EPOC) LMIC geographic search filter for the databases; Ovid MEDLINE, Ovid Embase, Cochrane Library. During screening following a broad scoping search in Ovid MEDLINE, it was found that the EPOC LMIC filter did not identify a relevant study. Adaptations were made to the LMIC geographic search filter to maximise retrieval and identify the missing study. Institution was included as a search field, and the search terms high burden or countdown countries were added. The filter was translated for the databases; Ovid Embase, Cochrane Library, Ovid PsycINFO, and CINAHL via EBSCO. The adapted ScHARR LMIC filter is a non-validated 1st generation filter which increases the sensitivity of the EPOC LMIC search filter. Validating the filter would confirm its retrieval performance and benefit information professionals, researchers, and health professionals. We recommend that the ScHARR LMIC filter is used to improve sensitivity of the Cochrane EPOC LMIC filter and reduce the risk of missing relevant studies.

Psychological and psychosocial aspects of major trauma care in the United Kingdom: A scoping review of primary research

Introduction

More people are surviving major trauma, often with life changing injuries. Alongside physical injury, many survivors of major trauma experience psychological and psychosocial impacts. Presently, there is little guidance at the UK national level for psychological and psychosocial aspects of major trauma care. Set in the context of the regional model of major trauma care implemented in the UK in 2012, the purpose of this review was to identify and bring together primary research about psychological and psychosocial aspects of major trauma care in the UK to produce an overview of the field to date, identify knowledge gaps and set research priorities.

Methods

A scoping review was undertaken. Seven electronic databases (MEDLINE, Cochrane Library, CINAHL, Embase, PsycINFO, SocINDEX with Full Text and PROSPERO) were searched alongside a targeted grey literature search. Data from included studies were extracted using a predefined extraction form and underwent bibliometric analysis. Included studies were then grouped by type of research, summarised, and synthesised to produce a descriptive summary and overview of the field.

Results

The searches identified 5,975 articles. Following screening, 43 primary research studies were included in the scoping review. The scoping review, along with previous research, illustrates that psychological and psychosocial impacts are to be expected following major trauma. However, it also found that these aspects of care are commonly underserved and that there are inherent inequities across major trauma care pathways in the UK.

Conclusion

Though the scoping review identified a growing body of research investigating psychological and psychosocial aspects of major trauma care pathways in the UK, significant gaps in the evidence base remain. Research is needed to establish clinically effective psychological and psychosocial assessment tools, corresponding interventions, and patient-centred outcome measures so that survivors of major trauma (and family members or carers) receive the most appropriate care and intervention.

Access to, usage and clinic outcomes of, online postal sexually transmitted infection services: a scoping review

BACKGROUND

There has been considerable expansion in online postal self-sampling (OPSS) STI services in many parts of the UK, driven by increasing demand on sexual health services and developments in diagnostics and digital health provision. This shift in service delivery has occurred against a backdrop of reduced funding and service fragmentation and the impact is unknown. We explored characteristics of people accessing and using OPSS services for STIs in the UK, the acceptability of these services and their impact on sexual health inequalities.

METHODS

A scoping review was conducted of studies published in English-language based on pre-agreed inclusion/exclusion criteria, between 01 January 2010 and 07 July 2021. Nine databases were searched, and 23 studies that met the eligibility criteria were included. Studies were appraised using the Mixed Methods Appraisal Tool.

RESULTS

Study designs were heterogeneous, including quantitative, qualitative and mixed-methods analyses. The majority were either evaluating a single-site/self-sampling provider, exploratory or observational and of variable quality. Few studies collected comprehensive user demographic data. Individuals accessing OPSS tended to be asymptomatic, of white ethnicity, women, over 20 years and from less deprived areas. OPSS tended to increase overall STI testing demand and access, although return rates for blood samples were low, as was test positivity. There were varied results on whether services reduced time to treatment. OPSS services were acceptable to the majority of users. Qualitative studies showed the importance of trust, confidentiality, discretion, reliability, convenience and improved patient choice.

CONCLUSION

OPSS services appear highly acceptable to users. However, uptake appears to be socially patterned and some groups who bear a disproportionate burden of poor sexual health in the UK are under-represented among users. Current provision of online self-sampling could widen health inequalities, particularly where other options for testing are limited. Work is needed to fully evaluate the impact and cost-effectiveness of OPSS services.

Existing evidence on antibiotic resistance exposure and transmission to humans from the environment: a systematic map

BACKGROUND

Antimicrobial resistance (AMR) is predicted to become the leading cause of death by 2050 with antibiotic resistance being an important component. Anthropogenic pollution introduces antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) to the natural environment. Currently, there is limited empirical evidence demonstrating whether humans are exposed to environmental AMR and whether this exposure can result in measurable human health outcomes. In recent years there has been increasing interest in the role of the environment and disparate evidence on transmission of AMR to humans has been generated but there has been no systematic attempt to summarise this. We aim to create two systematic maps that will collate the evidence for (1) the transmission of antibiotic resistance from the natural environment to humans on a global scale and (2) the state of antibiotic resistance in the environment in the United Kingdom.

METHODS

Search strategies were developed for each map. Searches were undertaken in 13 bibliographic databases. Key websites were searched and experts consulted for grey literature. Search results were managed using EndNote X8. Titles and abstracts were screened, followed by the full texts. Articles were double screened at a minimum of 10% at both stages with consistency checking and discussion when disagreements arose. Data extraction occurred in Excel with bespoke forms designed. Data extracted from each selected study included: bibliographic information; study site location; exposure source; exposure route; human health outcome (Map 1); prevalence/percentage/abundance of ARB/antibiotic resistance elements (Map 2) and study design. EviAtlas was used to visualise outputs.

RESULTS

For Map 1, 40 articles were included, from 11,016 unique articles identified in searches, which investigated transmission of AMR from the environment to humans. Results from Map 1 showed that consumption/ingestion was the most studied transmission route. Exposure (n = 17), infection (n = 16) and colonisation (n = 11) being studied as an outcome a similar number of times, with mortality studied infrequently (n = 2). In addition, E. coli was the most highly studied bacterium (n = 16). For Map 2, we included 62 studies quantifying ARB or resistance elements in the environment in the UK, from 6874 unique articles were identified in the searches. The most highly researched species was mixed communities (n = 32). The most common methodology employed in this research question was phenotypic testing (n = 37). The most commonly reported outcome was the characterisation of ARBs (n = 40), followed by characterisation of ARGs (n = 35). Other genetic elements, such as screening for intI1 (n = 15) (which encodes a Class 1 integron which is used as a proxy for environmental ARGs) and point mutations (n = 1) were less frequently reported. Both maps showed that research was focused towards aquatic environments.

CONCLUSIONS

Both maps can be used by policy makers to show the global (Map 1) and UK (Map 2) research landscapes and provide an overview of the state of AMR in the environment and human health impacts of interacting with the environment. We have also identified (1) clusters of research which may be used to perform meta-analyses and (2) gaps in the evidence base where future primary research should focus.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s13750-022-00262-2.

Enabling women to access preferred methods of contraception: a rapid review and behavioural analysis

BACKGROUND

Many pregnancies in the UK are either unplanned or ambivalent. This review aimed to (i) explore barriers and facilitators to women choosing and accessing a preferred method of contraception in the United Kingdom, and (ii) identify opportunities for behavioural interventions based on examination of interventions that are currently available nationally.

METHODS

Three databases were searched, and experts contacted to identify grey literature for studies presenting barriers and facilitators to women choosing and accessing a preferred method of contraception, conducted in the UK and published between 2009 and October 2019. Information on barriers and facilitators were coded into overarching themes, which were then coded into Mechanisms of Actions (MoAs) as listed in the Theory and Techniques Tool. National interventions were identified by consulting stakeholders and coded into the Behaviour Change Wheel. The match between barriers/facilitators and intervention content was assessed using the Behaviour Change Wheel.

RESULTS

We included 32 studies and identified 46 barrier and facilitator themes. The most cited MoA was Environmental Context and Resources, which primarily related to the services women had access to and care they received. Social Influences, Beliefs about Consequences (e.g., side effects) and Knowledge were also key. The behavioural analysis highlighted four priority intervention functions (Modelling, Enablement, Education and Environmental Restructuring) that can be targeted to support women to choose and access their preferred method of contraception. Relevant policy categories and behaviour change techniques are also highlighted.

CONCLUSIONS

This review highlights factors that influence women's choices and access to contraception and recommends opportunities that may be targeted for future interventions in order to support women to access preferred contraception.

REGISTRATION

Protocol was registered with PROSPERO (an international database of prospectively registered systematic reviews in health and social care) in December 2019, CRD42019161156 .

Assessing demographic access to hip replacement surgery in the United Kingdom: a systematic review

Persisting evidence suggests significant socioeconomic and sociodemographic inequalities in access to medical treatment in the UK. Consequently, a systematic review was undertaken to examine these access inequalities in relation to hip replacement surgery. Database searches were performed using MEDLINE, PubMed and Web of Science. Studies with a focus on surgical need, access, provision and outcome were of interest. Inequalities were explored in the context of sociodemographic characteristics, socioeconomic status (SES), geographical location and hospital-related variables. Only studies in the context of the UK were included. Screening of search and extraction of data were performed and 482 articles were identified in the database search, of which 16 were eligible. Eligible studies consisted of eight cross-sectional studies, seven ecological studies and one longitudinal study. Although socioeconomic inequality has somewhat decreased, lower SES patients and ethnic minority patients demonstrate increased surgical needs, reduced access and poor outcomes. Lower SES and Black minority patients were younger and had more comorbidities. Surgical need increased with age. Women had greater surgical need and provision than men. Geographical inequality had reduced in Scotland, but a north-south divide persists in England. Rural areas received greater provision relative to need, despite increased travel for care. In all, access inequalities remain widespread and policy change driven by research is needed.

Understanding variations in reported epidemiology of major lower extremity amputation in the UK: a systematic review

OBJECTIVE

Estimate the prevalence/incidence/number of major lower extremity amputations (MLEAs) in the UK; identify sources of routinely collected electronic health data used; assess time trends and regional variation; and identify reasons for variation in reported incidence/prevalence of MLEA.

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

Medline, Embase, EMcare, CINAHL, The Cochrane Library, AMED, Scopus and grey literature sources searched from 1 January 2009 to 1 August 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Reports that provided population-based statistics, used routinely collected electronic health data, gave a measure of MLEA in adults in the general population or those with diabetes in the UK or constituent countries were included.

DATA EXTRACTION AND SYNTHESIS

Data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Instruments were performed by two reviewers independently. Due to considerable differences in study populations and methodology, data pooling was not possible; data were tabulated and narratively synthesised, and study differences were discussed.

RESULTS

Twenty-seven reports were included. Incidence proportion for the general population ranged from 8.2 to 51.1 per 100 000 and from 70 to 291 per 100 000 for the population with diabetes. Evidence for trends over time was mixed, but there was no evidence of increasing incidence. Reports consistently found regional variation in England with incidence higher in the north. No studies reported prevalence. Differences in database use, MLEA definition, calculation methods and multiple procedure inclusion which, together with identified inaccuracies, may account for the variation in incidence.

CONCLUSIONS

UK incidence and trends in MLEA remain unclear; estimates vary widely due to differences in methodology and inaccuracies. Reasons for regional variation also remain unexplained and prevalence uninvestigated. International consensus on the definition of MLEA and medical code list is needed. Future research should recommend standards for the reporting of such outcomes and investigate further the potential to use primary care data in MLEA epidemiology.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020165592.

The NICE OECD countries' geographic search filters: Part 2-validation of the MEDLINE and Embase (Ovid) filters

Objective:

We previously developed draft MEDLINE and Embase (Ovid) geographic search filters for Organisation for Economic Co-operation and Development (OECD) countries to assess their feasibility for finding evidence about the countries. Here, we describe the validation of these search filters.

Methods:

We identified OECD country references from thirty National Institute for Health and Care Excellence (NICE) guidelines to generate gold standard sets for MEDLINE (n=2,065) and Embase (n=2,023). We validated the filters by calculating their recall against these sets. We then applied the filters to existing search strategies for three OECD-focused NICE guideline reviews (NG103 on flu vaccination, NG140 on abortion care, and NG146 on workplace health) to calculate the filters' impact on the number needed to read (NNR) of the searches.

Results:

The filters both achieved 99.95% recall against the gold standard sets. Both filters achieved 100% recall for the three NICE guideline reviews. The MEDLINE filter reduced NNR from 256 to 232 for the NG103 review, from 38 to 27 for the NG140 review, and from 631 to 591 for the NG146 review. The Embase filter reduced NNR from 373 to 341 for the NG103 review, from 101 to 76 for the NG140 review, and from 989 to 925 for the NG146 review.

Conclusion:

The NICE OECD countries' search filters are the first validated filters for the countries. They can save time for research topics about OECD countries by finding the majority of evidence about OECD countries while reducing search result volumes in comparison to no filter use.

Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review

OBJECTIVES

In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK.

DESIGN

A scoping review was undertaken following JBI methodological guidance.

METHODS

13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative.

RESULTS

191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway.

CONCLUSION

This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.

The NICE OECD countries' geographic search filters: Part 1-methodology for developing the draft MEDLINE and Embase (Ovid) filters

Objective:

There are no existing validated search filters for the group of 37 Organisation for Economic Co-operation and Development (OECD) countries. This study describes how information specialists from the United Kingdom's National Institute for Health and Care Excellence (NICE) developed and evaluated novel OECD countries’ geographic search filters for MEDLINE and Embase (Ovid) to improve literature search effectiveness for evidence about OECD countries.

Methods:

We created the draft filters using an alternative approach to standard filter construction. They are composed entirely of geographic subject headings and are designed to retain OECD country evidence by excluding non-OECD country evidence using the NOT Boolean operator. To evaluate the draft filters’ effectiveness, we used MEDLINE and Embase literature searches for three NICE guidelines that retrieved >5,000 search results. A 10% sample of the excluded references was screened to check that OECD country evidence was not inadvertently excluded.

Results:

The draft MEDLINE filter reduced results for each NICE guideline by 9.5% to 12.9%. In Embase, search results were reduced by 10.7% to 14%. Of the sample references, 7 of 910 (0.8%) were excluded inadvertently. These references were from a guideline about looked-after minors that concerns both OECD and non-OECD countries.

Conclusion:

The draft filters look promising—they reduced search result volumes while retaining most OECD country evidence from MEDLINE and Embase. However, we advise caution when using them in topics about both non-OECD and OECD countries. We have created final versions of the search filters and will validate them in a future study.

High-sensitivity troponin assays for early rule-out of acute myocardial infarction in people with acute chest pain: a systematic review and economic evaluation

BACKGROUND

Early diagnosis of acute myocardial infarction is important, but only 20% of emergency admissions for chest pain will actually have an acute myocardial infarction. High-sensitivity cardiac troponin assays may allow rapid rule out of myocardial infarction and avoid unnecessary hospital admissions.

OBJECTIVES

To assess the clinical effectiveness and cost-effectiveness of high-sensitivity cardiac troponin assays for the management of adults presenting with acute chest pain, in particular for the early rule-out of acute myocardial infarction.

METHODS

Sixteen databases were searched up to September 2019. Review methods followed published guidelines. Studies were assessed for quality using appropriate risk-of-bias tools. The bivariate model was used to estimate summary sensitivity and specificity for meta-analyses involving four or more studies; otherwise, random-effects logistic regression was used. The health economic analysis considered the long-term costs and quality-adjusted life-years associated with different troponin testing methods. The de novo model consisted of a decision tree and a state-transition cohort model. A lifetime time horizon (of 60 years) was used.

RESULTS

Thirty-seven studies (123 publications) were included in the review. The high-sensitivity cardiac troponin test strategies evaluated are defined by the combination of four factors (i.e. assay, number and timing of tests, and threshold concentration), resulting in a large number of possible combinations. Clinical opinion indicated a minimum clinically acceptable sensitivity of 97%. When considering single test strategies, only those using a threshold at or near to the limit of detection for the assay, in a sample taken at presentation, met the minimum clinically acceptable sensitivity criterion. The majority of the multiple test strategies that met this criterion comprised an initial rule-out step, based on high-sensitivity cardiac troponin levels in a sample taken on presentation and a minimum symptom duration, and a second stage for patients not meeting the initial rule-out criteria, based on presentation levels of high-sensitivity cardiac troponin and absolute change after 1, 2 or 3 hours. Two large cluster randomised controlled trials found that implementation of an early rule-out pathway for myocardial infarction reduced length of stay and rate of hospital admission without increasing cardiac events. In the base-case analysis, standard troponin testing was both the most effective and the most costly. Other testing strategies with a sensitivity of 100% (subject to uncertainty) were almost equally effective, resulting in the same life-year and quality-adjusted life-year gain at up to four decimal places. Comparisons based on the next best alternative showed that for willingness-to-pay values below £8455 per quality-adjusted life-year, the Access High Sensitivity Troponin I (Beckman Coulter, Brea, CA, USA) [(symptoms > 3 hours AND < 4 ng/l at 0 hours) OR (< 5 ng/l AND Δ < 5 ng/l at 0 to 2 hours)] would be cost-effective. For thresholds between £8455 and £20,190 per quality-adjusted life-year, the Elecsys® Troponin-T high sensitive (Roche, Basel, Switzerland) (< 12 ng/l at 0 hours AND Δ < 3 ng/l at 0 to 1 hours) would be cost-effective. For a threshold > £20,190 per quality-adjusted life-year, the Dimension Vista® High-Sensitivity Troponin I (Siemens Healthcare, Erlangen, Germany) (< 5 ng/l at 0 hours AND Δ < 2 ng/l at 0 to 1 hours) would be cost-effective.

CONCLUSIONS

High-sensitivity cardiac troponin testing may be cost-effective compared with standard troponin testing.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42019154716.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 33. See the NIHR Journals Library website for further project information.

Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature

BACKGROUND

Managing multimorbidity is complex for both patients and healthcare systems. Patients with multimorbidity often use a variety of primary and secondary care services. Country-specific research exploring the healthcare utilisation and cost consequences of multimorbidity may inform future interventions and payment schemes in the UK.

AIM

To assess the relationship between multimorbidity, healthcare costs, and healthcare utilisation; and to determine how this relationship varies by disease combinations and healthcare components.

DESIGN AND SETTING

A systematic review.

METHOD

This systematic review followed the bidirectional citation searching to completion method. MEDLINE and grey literature were searched for UK studies since 2004. An iterative review of references and citations was completed. Authors from all articles selected were contacted and asked to check for completeness of UK evidence. The National Institutes of Health National Heart, Lung, and Blood Institute quality assessment tool was used to assess risk of bias. Data were extracted, findings synthesised, and study heterogeneity assessed; meta-analysis was conducted when possible.

RESULTS

Seventeen studies were identified: seven predicting healthcare costs and 10 healthcare utilisation. Multimorbidity was found to be associated with increased total costs, hospital costs, care transition costs, primary care use, dental care use, emergency department use, and hospitalisations. Several studies demonstrated the high cost of depression and of hospitalisation associated with multimorbidity.

CONCLUSION

In the UK, multimorbidity increases healthcare utilisation and costs of primary, secondary, and dental care. Future research is needed to examine whether integrated care schemes offer efficiencies in healthcare provision for multimorbidity.

A systematic review of the factors - barriers and enablers - affecting the implementation of clinical commissioning policy to reduce health inequalities in the National Health Service (NHS), UK

OBJECTIVE

The aim of the present study is two-fold. First, it attempts to identify the barriers and enablers of implementing clinical commissioning policy. Second, it synthesises how these barriers and enablers affect the success of National Health Service (NHS) efforts to reduce health inequalities in the UK.

METHODS

A systematic review was conducted. We searched large biomedical bibliographic databases, namely MEDLINE, EMBASE, CINAHL, Allied & Complementary Medicine, DH-DATA, Global Health and CINAHL for primary studies, conducted in the UK, that assessed the factors - barriers and enablers related to health inequalities, published from 2010 onwards and in English, and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We used Joanna Briggs Institute (JBI) Critical Appraisal and Mixed Methods Appraisal tools to assess the methodological qualities, and synthesised by performing thematic analysis. Two reviewers independently screened the articles and extracted data.

RESULTS

We included six primary studies (including a total of 1155 participants) in the final review. The studies reported two broad categories, under four separate themes: (1) the agenda of health inequalities has not been given priority; (2) there was very little evidence for reducing health inequalities through the clinical commissioning (CC) process; (3) CC was positively associated with the restructuring of NHS; and (4) CC brings better collaboration and engagement, which led to some improvements in health services access, utilisation and delivery at the local level.

CONCLUSION

This study provides useful factors - barriers and enablers - to implement and deliver clinical commissioning policy in improving health and well-being. These factors could be assessed in future to develop objective measures and interventions to establish the link between commissioning and health inequalities.

The NICE UK geographic search filters for MEDLINE and Embase (Ovid): Post-development study to further evaluate precision and number-needed-to-read when retrieving UK evidence

BACKGROUND

The National Institute for Health and Care Excellence's (NICE) United Kingdom (UK) geographic search filters for MEDLINE and Embase (OVID) retrieve evidence in literature searches for UK-focused research topics with high recall. Their precision and number-needed-to-read (NNR) was examined previously in case studies using a single review. This paper details a larger post-development study that was conducted to test the NICE UK filters' precision and NNR more extensively.

METHODS

The filters' recall of included UK references from 100 reviews was calculated. As reproducible search strategies were not available for every review, the MEDLINE filter's precision and NNR were calculated using strategies from 25 reviews. Strategies from nine reviews were used for the Embase filter.

RESULTS

The MEDLINE filter achieved an average of 96.4% recall for the included UK references from the 100 reviews and the Embase filter achieved an average of 97.4% recall. Compared to not using a filter, the MEDLINE filter achieved an average of 98.9% recall for the 25 reviews. Precision was increased by an average of 7.8 times, reducing the NNR from 357 to 46. The Embase filter achieved an average of 97.1% recall for the nine reviews. Precision was increased by an average of 5.1 times, reducing the NNR from 746 to 146.

CONCLUSION

There is more evidence to demonstrate that the NICE UK filters retrieve the majority of UK evidence from MEDLINE and Embase while increasing precision and reducing NNR. The filters can save time spent on selecting evidence for UK-focused research topics.

Epidemiology of major lower limb amputation using routinely collected electronic health data in the UK: a systematic review protocol

INTRODUCTION

It is estimated that peripheral arterial disease occurs in one in five people aged over 60 years in the UK. Major lower limb amputation is a debilitating and life-changing potential outcome of peripheral arterial disease. A number of risk factors are involved in the development of the disease including smoking and diabetes. There is debate over the prevalence of major lower limb amputation in the UK with regional variations unexplained. The choice of data source can affect the epidemiological calculations and sources can also differ in the ability to explain variation. This study will aim to estimate the prevalence/incidence/number of major lower limb amputation in the UK. It will also identify sources of routinely collected electronic health data which report the epidemiology of major lower limb amputation in the UK.

METHODS AND ANALYSIS

A systematic search of peer-reviewed journals will be conducted in Medline, Excerpta Medica database, Cumulative Index of Nursing and Allied Health Literature, Allied and Complementary Medicine Database, The Cochrane Library and Scopus. A grey literature search for government and parliament publications, conference abstracts, theses and unpublished articles will be performed. Articles will be screened against the inclusion/exclusion criteria and data extracted using a pretested extraction form by two independent reviewers. Prevalence, incidence or number of cases (depending on data reported) will be extracted. Disagreements will be resolved by discussion. Data synthesis will be performed either as a narrative summary or by meta-analysis. Heterogeneity will be assessed using the I² statistic. If heterogeneity is low-moderate, pooled estimates will be calculated using random-effects models. If possible, meta-regression for time trends in the incidence of major lower limb amputation will be performed along with subgroup analysis, primarily in regional variation.

ETHICS AND DISSEMINATION

Ethics approval is not required for this study as study data are anonymised and available in the public domain. Dissemination will be by publication in a peer reviewed journal and by appropriate conference presentation.PROSPERO registration numberCRD42020165592.

Characterising the evidence base for advanced clinical practice in the UK: a scoping review protocol

INTRODUCTION

A global health workforce crisis, coupled with ageing populations, wars and the rise of non-communicable diseases is prompting all countries to consider the optimal skill mix within their health workforce. The development of advanced clinical practice (ACP) roles for existing non-medical cadres is one potential strategy that is being pursued. In the UK, National Health Service (NHS) workforce transformation programmes are actively promoting the development of ACP roles across a wide range of non-medical professions. These efforts are currently hampered by a high level of variation in ACP role development, deployment, nomenclature, definition, governance and educational preparation across the professions and across different settings. This scoping review aims to support a more consistent approach to workforce development in the UK, by identifying and mapping the current evidence base underpinning multiprofessional advanced level practice in the UK from a workforce, clinical, service and patient perspective.

METHODS AND ANALYSIS

This scoping review is registered with the Open Science Framework (https://osf.io/tzpe5). The review will follow Joanna Briggs Institute guidance and involves a multidisciplinary and multiprofessional team, including a public representative. A wide range of electronic databases and grey literature sources will be searched from 2005 to the present. The review will include primary data from any relevant research, audit or evaluation studies. All review steps will involve two or more reviewers. Data extraction, charting and summary will be guided by a template derived from an established framework used internationally to evaluate ACP (the Participatory Evidence-Informed Patient-Centred Process-Plus framework).

DISSEMINATION

The review will produce important new information on existing activity, outcomes, implementation challenges and key areas for future research around ACP in the UK, which, in the context of global workforce transformations, will be of international, as well as local, significance. The findings will be disseminated through professional and NHS bodies, employer organisations, conferences and research papers.

Integrated Care Search: development and validation of a PubMed search filter for retrieving the integrated care research evidence

Background

Integrated care is an increasingly important principle for organising healthcare. Integrated care models show promise in reducing resource wastage and service fragmentation whilst improving the accessibility, patient-centredness and quality of care for patients. Those needing reliable access to the growing research evidence base for integrated care can be frustrated by search challenges reflective of the topic’s complexity. The aim of this study is to report the empirical development and validation of two search filters for rapid and effective retrieval of integrated care evidence in PubMed. One filter is optimised for recall and the other for precision.

Methods

An Expert Advisory Group comprising international integrated care experts guided the study. A gold standard test set of citations was formed from screening Handbook Integrated Care chapter references for relevance. This set was divided into a Term Identification Set (20%) for determining candidate terms using frequency analysis; a Filter Development Set (40%) for testing performance of term combinations; and a Filter Validation Set (40%) reserved for confirming final filter performance. In developing the high recall filter, recall was steadily increased while maintaining precision at ≥50%. Similarly, the high precision filter sought to maximise precision while keeping recall ≥50%. For each term combination tested, an approximation of precision was obtained by reviewing the first 100 citations retrieved in Medline for relevance.

Results

The gold standard set comprised 534 citations. The search filter optimised for recall (‘Broad Integrated Care Search’) achieved 86.0–88.3% recall with corresponding low precision (47–53%). The search filter optimised for precise searching (‘Narrow Integrated Care Search’) demonstrated precision of 73–95% with recall reduced to between 55.9 and 59.8%. These filters are now available as one-click URL hyperlinks in the website of International Foundation for Integrated Care.

Conclusions

The Broad and Narrow Integrated Care Search filters provide potential users, such as policy makers and researchers, seamless, reliable and ongoing access to integrated care evidence for decision making. These filters were developed according to a rigorous and transparent methodology designed to circumvent the challenges of information retrieval posed by this complex, multifaceted topic.

What is the research evidence for antibiotic resistance exposure and transmission to humans from the environment? A systematic map protocol

BACKGROUND

Antimicrobial resistance (AMR) is a public health crisis that is predicted to cause 10 million deaths per year by 2050. The environment has been implicated as a reservoir of AMR and is suggested to play a role in the dissemination of antibiotic resistance genes (ARGs). Currently, most research has focused on measuring concentrations of antibiotics and characterising the abundance and diversity of ARGs and antibiotic resistant bacteria (ARB) in the environment. To date, there has been limited empirical research on whether humans are exposed to this, and whether exposure can lead to measureable impacts on human health. Therefore, the objective of this work is to produce two linked systematic maps to investigate previous research on exposure and transmission of AMR to humans from the environment. The first map will investigate the available research relating to exposure and transmission of ARB/ARGs from the environment to humans on a global scale and the second will investigate the prevalence of ARB/ARGs in various environments in the UK. These two maps will be useful for policy makers and research funders to identify where there are significant gluts and gaps in the current research, and where more primary and synthesis research needs to be undertaken.

METHODS

Separate search strategies will be developed for the two maps. Searches will be run in 13 databases, and grey literature will be sought from key websites and engagement with experts. Hits will be managed in EndNote and screened in two stages (title/abstract then full text) against predefined inclusion criteria. A minimum of 10% will be double screened with ongoing consistency checking. All included studies will have data extracted into a bespoke form designed and piloted for each map. Data to be extracted will include bibliographic details, study design, location, exposure source, exposure route, health outcome (Map 1); and prevalence/percentage of ARB/ARG (Map 2). No validity appraisal will be undertaken. Results will be tabulated and presented narratively, together with graphics showing the types and areas of research that has been undertaken and heatmaps for key exposure-health outcomes (Map 1) and exposure-prevalence (Map 2).

Access to primary and community health-care services for people 16 years and over with intellectual disabilities: a mapping and targeted systematic review

Background

In 2015, approximately 2.16% of adults were recorded as having intellectual disabilities. UK government policy is that adults with intellectual disabilities should access mainstream health services. However, people with intellectual disabilities experience challenges when accessing primary and community health services that can lead to inequalities and shorter life expectancy.

Objectives

To map and review the evidence on access to primary and community health-care services for adults with intellectual disabilities and their carers. To identify influencing factors for gaining access to primary and community health-care services. To determine which actions, interventions or models of service provision improve entry access to these services for people with intellectual disabilities and their carers. Finally, to identify the gaps in evidence and provide implications for health care and recommendations for research.

Data sources

MEDLINE, The Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC) were searched from 2002 to 2018.

Review methods

The mapping review methodology included an extensive literature search, article selection and data extraction of relevant abstracts. Findings from the mapping review informed the scope of the targeted systematic review. Methodology for the targeted systematic review included an extensive literature search informed by the mapping review, article selection, data extraction, quality appraisal and narrative synthesis.

Results

The mapping review included 413 studies with data extraction completed on abstracts. The targeted systematic review synthesised the evidence from 80 studies reported in 82 publications. During the review process, the team identified three key points at which people with intellectual disabilities potentially interacted with primary and community health-care services: identifying needs, accessing services and interaction during a consultation. In addition, there were a number of papers about interventions or innovations to improve access. Evidence from the studies was synthesised within the four clusters. Influencing factors were identified: staff knowledge/skills, joint working with learning disability services, service delivery model, uptake, appointment making, carer/support role, relationship with staff, time, accessible information and communication. The influencing factors were cross-cutting through the literature, with certain factors having more importance in certain clusters.

Limitations

The main limitation was the weak evidence base. The studies generally had small samples, had study designs that were open to potential biases and measured only short-term outcomes.

Conclusions

Health checks were found to help identify health needs and improve the care of long-term conditions. Important factors for accessing health services for adults with intellectual disabilities were consistency of care and support, staff training, communication skills and time to communicate, and provision of accessible information. Health professionals need to ensure that there is joint working between different services, clear communication and accurate record-keeping. Future research questions centre on the need to develop and value creative study designs capable of addressing the complex issues identified in the findings of the review for this complex population.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 5. See the NIHR Journals Library website for further project information.

The Embase UK filter: validation of a geographic search filter to retrieve research about the UK from OVID Embase

BACKGROUND

The authors developed a validated geographic search filter to retrieve research about the United Kingdom (UK) from OVID Embase. It was created to be used alongside their previously published OVID MEDLINE UK filter in systematic literature searches for context-sensitive topics.

OBJECTIVES

To develop a validated geographic search filter to retrieve research about the UK from OVID Embase.

METHODS

The Embase UK filter was translated from the MEDLINE UK filter. A gold standard set of references was generated using the relative recall method. The set contained references to publications about the UK that had informed National Institute for Health and Care Excellence (NICE) guidance and it was used to validate the filter. Recall, precision and number-needed-to-read (NNR) were calculated using a case study.

RESULTS

The validated Embase UK filter demonstrated 99.8% recall against the references with UK identifiers in the gold standard set. In the case study, the Embase UK filter demonstrated 98.5% recall, 7.6% precision and a NNR of 13.

CONCLUSION

The Embase UK filter can be used alongside the MEDLINE UK filter. The filters have the potential to save time and associated resource costs when they are used for context-sensitive topics that require research about UK settings.

Topic search filters: a systematic scoping review

BACKGROUND

Searching for topics within large biomedical databases can be challenging, especially when topics are complex, diffuse, emerging or lack definitional clarity. Experimentally derived topic search filters offer a reliable solution to effective retrieval; however, their number and range of subject foci remain unknown.

OBJECTIVES

This systematic scoping review aims to identify and describe available experimentally developed topic search filters.

METHODS

Reports on topic search filter development (1990-) were sought using grey literature sources and 15 databases. Reports describing the conception and prospective development of a database-specific topic search and including an objectively measured estimate of its performance ('sensitivity') were included.

RESULTS

Fifty-four reports met inclusion criteria. Data were extracted and thematically synthesised to describe the characteristics of 58 topic search filters.

DISCUSSION

Topic search filters are proliferating and cover a wide range of subjects. Filter reports, however, often lack clear definitions of concepts and topic scope to guide users. Without standardised terminology, filters are challenging to find. Information specialists may benefit from a centralised topic filter repository and appraisal checklists to facilitate quality assessment.

CONCLUSION

Findings will help information specialists identify existing topic search filters and assist filter developers to build on current knowledge in the field.

[Publications German-speaking countries in high impact journals: development and validation of a search filter]

Publications German-speaking countries in high impact journals: development and validation of a search filter Abstract.

BACKGROUND

The number of publications in journals with a high impact factor is an indication of a discipline's participation in international discourse. A search filter allows reliable and reproducible searches for specific publications.

AIM

Development and validation of a geographic search filter for publications by nursing scientists affiliated to German-speaking countries in nursing journals with a high impact factor.

METHODS

The search filter was objectively developed following several steps: (i) creation of a development and a validation set, each consisting of relevant and non-relevant publications, (ii) generation of the search filter by means of text analysis of the development set, (iii) internal validation based on the development set and (iv) external validation using the validation set. The validity was examined regarding several accuracy parameters, e. g. sensitivity, specificity, positive predictive value (PPV) and number needed to read (NNR).

RESULTS

The search filter correctly identified 22 of 30 relevant and 16 of 21 non-relevant publications in the development set: sensitivity 80 % (95 % CI 66 - 94), specificity 76 % (95 % CI 58 - 94), PPV 83 % (95 % CI 69 - 97). External validation yielded similar or better results: sensitivity 81 % (95 % CI 67 - 96), specificity 88 % (95 % CI 71 - 100), PPV 88 % (95 % CI 75 - 100). The NNR was 1.2 and 1.1, respectively.

CONCLUSIONS

The search filter has the potential to identify the intended publications.

WHICH DATABASES SHOULD BE USED TO IDENTIFY STUDIES FOR SYSTEMATIC REVIEWS OF ECONOMIC EVALUATIONS?

Objectives:

This study investigated which databases and which combinations of databases should be used to identify economic evaluations (EEs) to inform systematic reviews. It also investigated the characteristics of studies not identified in database searches and evaluated the success of MEDLINE search strategies used within typical reviews in retrieving EEs in MEDLINE.

Methods:

A quasi-gold standard (QGS) set of EEs was collected from reviews of EEs. The number of QGS records found in nine databases was calculated and the most efficient combination of databases was determined. The number and characteristics of QGS records not retrieved from the databases were collected. Reproducible MEDLINE strategies from the reviews were rerun to calculate the sensitivity and precision for each strategy in finding QGS records.

Results:

The QGS comprised 351 records. Across all databases, 337/351 (96 percent) QGS records were identified. Embase yielded the most records (314; 89 percent). Four databases were needed to retrieve all 337 references: Embase + Health Technology Assessment database + (MEDLINE or PubMed) + Scopus. Four percent (14/351) of records could not be found in any database. Twenty-nine of forty-one (71 percent) reviews reported a reproducible MEDLINE strategy. Ten of twenty-nine (34.5 percent) of the strategies missed at least one QGS record in MEDLINE. Across all twenty-nine MEDLINE searches, 25/143 records were missed (17.5 percent). Mean sensitivity was 89 percent and mean precision was 1.6 percent.

Conclusions:

Searching beyond key databases for published EEs may be inefficient, providing the search strategies in those key databases are adequately sensitive. Additional search approaches should be used to identify unpublished evidence (grey literature).