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Aboriginal and Torres Strait Islander peoples hold deep cultural strengths, kinship structures, and knowledge systems that are central to health and wellbeing. Yet, health research in Australia has historically been dominated by deficit-based approaches, often overlooking Indigenous knowledges and leadership. The Indigenous Health Research Priorities (I-Priorities) study aimed to prioritise Indigenous community voices in identifying health research priorities across Queensland, with a focus on early life, perinatal and family health. Using Indigenous Methodology and a participatory action research framework, communities across Far North, North, Central and South-East Queensland identified and refined their health research priorities. This was achieved in two phases: initial yarning sessions followed by Delphi workshops. Data were analysed thematically and validated through community review processes to ensure cultural integrity. The study engaged 403 participants through 40 yarning sessions and 13 Delphi workshops conducted between May 2022 and October 2024. The study included participants across diverse age groups, with 80.5% identifying as Indigenous. Communities consistently highlighted key health priorities, with an overwhelming number of participants identifying access to health services, particularly transport, affordability, and overcoming institutional racism. Social and emotional wellbeing, along with family and domestic violence, also emerged as top priorities. Overall, the findings affirm that Indigenous-led research provides solutions grounded in cultural strengths and guided by principles of self-determination. The I-Priorities study offers a clear roadmap for aligning research, service delivery and policy with priorities defined by Aboriginal and Torres Strait Islander communities, fostering stronger beginnings, healthier families and intergenerational wellbeing across Queensland. Importantly, findings from communities underscore that health equity requires more than biomedical solutions and demands sustained investment in cultural, social and structural determinants of health.

Large language models (LLMs) are being integrated into qualitative research processes, yet the scope, function, and reporting quality of their use remain poorly understood. Existing reporting guidelines for qualitative research, including for example the Consolidated Criteria for Reporting Qualitative Research (COREQ), provide minimal guidance for documenting LLM use. This scoping review provides an overview of the emerging use of LLMs applications in qualitative research and assesses the associated reporting practices. A scoping review was conducted following the PRISMA-ScR guidelines and the Joanna Briggs Institute methodological framework. Five databases (PubMed, CINAHL, PsycINFO, Business Source Premier, and Scopus) were searched for peer-reviewed empirical studies published between January 2020 and May 2025 that employed at least one LLM in a substantive qualitative research stage. The search yielded 5,049 records, of which 4,201 remained after duplicate removal. Studies were screened independently by multiple reviewers, and data were extracted using a standardized template capturing study metadata, methodological characteristics, and comprehensive LLM implementation details. Seventy-five studies were included. OpenAI GPT models dominated the field, appearing in 93% of studies. LLMs were applied across the full spectrum of qualitative research, with coding assistance (n = 43) and theme identification (n = 41) as the most common applications. Thematic analysis was the predominant qualitative method (n = 38), and content analysis (n = 12). Technical reporting was highly inconsistent: only 13 studies reported temperature settings, 12 documented context length, and 4 provided top_p values. Approximately half of studies (45%, n = 34) did not specify the deployment configuration (API, web interface, or local), and 75% (n = 56) reported no parameter settings at all. While 61% of studies provided complete or partial prompts, 13% reported no prompting details. Agreement rates between LLM and human coders ranged from 36% to 99%, reflecting substantial variation related to task complexity, prompt engineering quality, and validation rigor. Nearly all studies (95%) discussed ethical considerations, and 97% incorporated human verification of AI outputs. LLMs have been adopted across qualitative research workflows, yet critical methodological details are frequently underreported, undermining comparability. The findings highlight an urgent need for dedicated reporting guidelines, such as the COREQ + LLM extension, to ensure that LLM-assisted qualitative research meets standards of transparency, rigor, and interpretive depth. Future research should address the predominance of proprietary models, the limited evidence for non-English contexts, and the need for systematic comparison of models, prompting strategies, and validation approaches.

EQUATOR (Enhancing the QUAlity and Transparency Of Health Research) reporting guidelines aim to improve transparency and completeness in biomedical research; however, their adoption remains inconsistent across medical specialties. We quantified declared reporting guideline use in high-impact ophthalmology journals and assessed whether editorial policies are associated with their implementation across specialties. We conducted a cross-sectional study of original research articles published in 2024 across five first-quartile ophthalmology journals. Reporting guideline use was identified through systematic full-text searches. An "advisable use rate" was defined as the proportion of articles declaring guideline use among those for which use was methodologically appropriate. Journal enforcement policies were characterized through analysis of instructions for authors. Guideline use in ophthalmology was contextualized through comparison with previously published datasets from orthopedics, rheumatology, and infectious diseases. Among 794 original research articles, reporting guidelines were deemed advisable for 672 (84.6%). Of these, 192 articles (28.6%) declared guideline use. Advisable use rates ranged from 5% to 120% across journals. STROBE was the most frequently applicable guideline but was declared in only 27% of eligible articles. Ophthalmology guideline use exceeded orthopedics (10.2%), rheumatology (7.2%), and infectious diseases (6.3%). Although enforcement policies varied across journals, no significant correlation was observed between enforcement level and guideline use (Kendall's τ = 0.24, p > 0.05). Despite higher adoption relative to other specialties, reporting guideline use in ophthalmology remains limited. Substantial inter-journal variability and the absence of an association between enforcement policies and use highlight opportunities to better align editorial expectations with reporting practices.

Mental health problems among undergraduate medical students are a major global public health concern that emerge early during training and are shaped by demanding educational environments, emotional stressors and organisational pressures. Although research has expanded rapidly, the literature remains fragmented across themes, regions and methods. This scoping review aims to map the global quantitative literature on medical students' mental health and identify gaps in scope, geography, methodology and equity. This scoping review will be conducted in accordance with the Joanna Briggs Institute methodological guidance and reported in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We will include quantitative studies assessing mental health among undergraduate medical students. MEDLINE (Ovid), Web of Science (Clarivate), the Cochrane Library (Wiley) and PsycINFO (Ovid) will be searched without date or language restrictions using a keyword-based search strategy. Two reviewers will independently screen titles, abstracts and full texts and extract data using a standardised form. Data will include publication year, country, study design, sample size, mental health measures, thematic domains and patterns of collaboration. Mental health domains will be classified using an a priori thematic framework encompassing psychological symptoms and distress, psychological resources, academic environment, social support and physical health and lifestyle factors. Equity-related variables (sex, gender identity, sexual orientation, race/ethnicity, socioeconomic status) will be operationalised based on analytical use. Results will be synthesised descriptively using tables and visualisations. Ethical approval is not required. Findings will be disseminated through publication and presentations. The dataset and code will be openly available on publication. Protocol registration will be made available online via the Open Science Framework (doi:10.17605/OSF.IO/2EHNU).

Effective participant recruitment is crucial for the success of clinical trials, yet little is known about facilitators and barriers to recruitment in pediatric populations with visual impairment. Understanding which methods yield the highest participant engagement can help optimize recruitment efforts and improve study outcomes. Thus, we assessed factors associated with recruitment in the SeeMyLife study, a European multi-center cohort study about quality of life and participation of children and young people with visual impairment. Data on the perceived effectiveness of recruitment strategies were collected from principal investigators, study coordinators, clinical and research staff using an online survey. Additional information on recruitment approaches was obtained through document analysis of study-related communications, including e-mails and meeting minutes. Descriptive statistics were used to summarize recruitment rates and perceived effectiveness scores. Open-ended responses regarding recruitment challenges were analyzed thematically to identify common barriers and facilitators. Seventeen clinical and research staff members from six countries participated in the survey and shared their insights and experience with participant recruitment. In total, study staff reported using twelve distinct recruitment sources to enhance participant enrolment. These sources were grouped into three broad categories: healthcare settings, community engagement and educational settings, and professional and system-level approaches. The recruitment of participants using the hospital information system was perceived as the most effective recruitment strategy, used by 71% of respondents. Other highly ranked sources included pediatric visual rehabilitation centers, patient associations, and affiliated university ophthalmology departments, where staff actively presented the study to their patients and referred eligible participants. Commonly reported recruitment challenges included restrictive inclusion criteria, limited parental responsiveness, concerns about the impact of study participation on children's well-being, and institutional barriers. Successful strategies for enrolling children and young people with visual impairment into clinical research include direct interactions between clinical staff and families, likely due to established trust, easier identification of eligible participants, and clearer communication about the study. In contrast, recruitment approaches outside clinical care settings were perceived as less effective. These findings highlight the importance of integrating recruitment efforts within established healthcare networks when conducting pediatric vision impairment research.

Successfully recruiting respondents to complete surveys is integral for ensuring representative samples and providing adequate power for analyses. However, obtaining survey responses for public health and health services research can be challenging, especially when working with populations with varied engagement with the providers of the institution conducting the study. Recruitment may be particularly challenging when selecting potential participants based on historical medical encounters that they may not remember, such as a brief health screen. Many researchers implement the Tailored Design Method (TDM) to optimize response rates. Adaptations to TDM, however, may be needed for researchers in federal institutions conducting surveys of populations with varied levels of healthcare engagement. This manuscript describes TDM implementation techniques and modifications that comply with federal regulations, and factors associated with response rates and survey response type. We surveyed a random, stratified sample of 9,775 U.S. Iraq and Afghanistan war veterans whom the Veterans Health Administration (VHA) had screened between 2007 and 2018 for post-deployment health concerns. We implemented a modified TDM that complied with federal regulations to survey veterans by email and USPS between July 2020 and August 2021. Twenty-one percent (N = 2,025) responded. It took a median of 21 and 69 days to receive responses via electronic survey and paper booklets, respectively. The random sample of veterans had varied levels of engagement with the VHA at the time of health screening and survey. Respondents and non-respondents used equal amounts of neurology, physical medicine and rehabilitation, and mental health VHA services in the 6 months post-screens. At the time of the survey (an average of 9 years post-screen), 21% of respondents reported not having recently used VHA services. Respondents were more likely to be older, White, and female than non-respondents, although differences were small in magnitude. Compared to electronic survey respondents, paper booklet respondents were more likely to be older, rural, and screened earlier, and less likely to live in the same state as the research team. When controlling for first contact mode (email vs. USPS), only age predicted whether veterans responded by paper booklet or electronic survey. Investigators working in federal organizations should be aware of possible lower response rates when compared to surveys of civilians. Researchers in federal institutions seeking to optimize response rates may find our TDM adaptations useful when surveying historical cohorts or populations without regular interaction with the research institution. Our response rate (~ 21%) may be useful for researchers conducting sample size calculations with similar populations.

Scoping reviews are widely used across the health sciences to map evidence, clarify concepts, and identify knowledge gaps. Although protocol development and registration are increasingly encouraged, empirical evidence describing contemporary registration practices remains limited. This study aimed to evaluate current practices in scoping review protocol registration and reporting in high-impact health sciences journals published between 2024 and 2025. We conducted an empirical meta-research study of scoping reviews published in first-quartile journals according to the Journal Citation Reports and indexed in PubMed. Data were extracted independently using a standardized form and included protocol registration status, registry platform, public accessibility, peer-reviewed protocol publication, reported protocol components, and methodological guidance cited. Descriptive analyses were used to assess registration patterns and methodological consistency. Multivariable logistic regression models were fitted to explore factors associated with protocol registration reporting and the presence of a peer-reviewed protocol. Among 2,546 screened records, 1,267 scoping reviews underwent full data extraction. Overall, 549 reviews reported a registered protocol, of which 483 were publicly accessible and included in the analysis. Protocol registration was identified in 43.3% of scoping reviews, while peer-reviewed protocol publication was rare (5.1%). Most protocols were registered on the Open Science Framework (OSF) (n = 478). Protocol content frequently included core methodological elements but also reported additional items beyond those addressed in the JBI Manual for Evidence Synthesis. Although many methodological documents were cited, only two provided explicit guidance for scoping review protocol development. Post hoc analyses identified substantial heterogeneity in protocol registration practices across journals, publishers, and corresponding author countries, suggesting that registration practices are influenced by a combination of editorial policies, local research cultures, and differing methodological perspectives. Protocol registration practices in scoping reviews remain heterogeneous across high-impact health sciences journals. The findings demonstrate substantial variability in protocol content, registration approaches, and use of methodological guidance, while reinforcing ongoing methodological discussions regarding protocol registration and standardization in scoping reviews.

The International Classification of Functioning, Disability and Health (ICF) provides a biopsychosocial framework for describing patients' functioning, but its comprehensive structure poses challenges for routine clinical use and health system reporting. In Poland, rehabilitation services lacked a standardized approach to functioning assessment that would support coordinated care and comparable outcome documentation at national level. This paper aims to describe the development and implementation of a tool for the quality assessment of therapeutic rehabilitation in Poland, focusing on the standardisation of patient functioning assessment using the International Classification of Functioning, Disability, and Health (ICF). The study was structured around the creation of functioning assessment standards (categorical profiles), a unified system for planning patient support (intervention sheet), and post-rehabilitation assessment sheets to ensure comprehensive evaluation of rehabilitation effectiveness at individual, hospital, and national levels. Within a national implementation project, we developed an ICF‑based functioning assessment system for inpatient and outpatient rehabilitation, including categorical profiles for major rehabilitation types, auxiliary tools (Short Intuitive Descriptions, rating guides, conversion protocols) and a dedicated IT application. The system was pilot‑tested in 12 rehabilitation centres (1 800 patients; 1 200 inpatients and 600 outpatients) using pre‑ and post‑rehabilitation assessments and WHO's WHODAS 2.0 questionnaires. The pilot indicated that ICF‑based categorical profiles were feasible to use in routine practice and sensitive to changes in patients' functioning over the course of rehabilitation. The system differentiated outcomes between centres and showed moderate to high inter‑rater agreement for most ICF categories, with several codes reaching very high ICC values, which require cautious interpretation. WHODAS 2.0 scores were broadly consistent with ICF‑based profiles, particularly in activity and participation domains. This pilot suggests that an ICF‑based functioning assessment system can support more standardized, biopsychosocially oriented rehabilitation in Poland, while highlighting important implementation challenges, including resource demands, staff training needs and difficulties in assessing environmental factors. Further research is needed to establish long‑term outcomes, refine psychometric properties and evaluate cost‑effectiveness of system‑wide implementation. The aim of this article is to present how a tool for assessing the quality of rehabilitation was developed and implemented in Poland. The tool was based on the International Classification of Functioning, Disability and Health (ICF). The project involved the creation of functioning assessment standards (categorical profiles), a system for planning patient support (intervention sheet), and tools for evaluating the effectiveness of rehabilitation. The methodology focused on adapting selected ICF sets to Polish conditions and the needs of patients, as well as developing straightforward guides for different specialists. The implementation of the ICF system has resulted in the standardisation of patient assessments, improved communication between teams, and more precise documentation of outcomes. The project received support from key health institutions and funding from the European Social Fund. The introduction of ICF tools is intended to improve the quality and effectiveness of rehabilitation in Poland.

Practical estimation of patient risk is often complicated by predictor values being unobserved or missing. In this paper we study the calibration and application of models for patient risk prediction when both the past patient data to which the prediction models are fit contains such missing values, while the future patient records may also be partially observed. Typical applications are often encountered in prognostic observational research or with registry data. This paper presents a detailed study on the use of multiple imputation in prediction, to deal with missing values in both past (calibration data) as well as future patient predictor records. We present the two distinct approaches which may be considered to use imputations to account for the presence of missing values. One method directly averages survival predictions obtained from separate models which are fitted on distinct imputations of the data. The other method first pools the intermediate effect and baseline estimates of these models, before calculation of the predictions from the pooled model. Such pooled estimates could be obtained from Rubin's rules, for example. Methods are introduced and demonstrated based on two motivating datasets. The application for Cox regression survival modeling is studied in detail. Method performance is verified through cross-validation, a separate validation set and an extensive simulation study. All methods are comparable with respect to bias and Brier score (accuracy) assessment. Major differences are however found between both methods when comparing predicted per-patient risks between repetitions of the fitting procedure with a different set of imputations and when the same number of imputations is used. Predictive averaging is preferable, because the difference between such replicate predictions can be reduced to zero by increasing the number of imputations, which is not the case with the pooled model. Predictive averaging should be preferred to use of a single pooled model, when using multiple imputations for missing predictor data. Single imputation should not be used in prediction on missing data.

The electronic health record (EHR) provides an opportunity for extracting a wealth of up-to-date real-world longitudinal data. Although the main limitations of using EHR data have been well-recognized and well-described, under-recognized factors may threaten the reliability of inferences made regarding the impact of EHR variables on chronic disease outcomes. A problem not well-recognized is the impact of routinely acquired variables that are documented with every patient encounter regardless of the reason for the encounter such as vital signs, height, and body weight. We utilized a landmark approach to identify occurrence of 10 cardiovascular-related disease outcomes after a 5-year observation period during which all body weights recorded in the EHR were used in multivariate cox regression modeling to identify the strongest of 9 weight-based predictor variables for each of the 10 disease outcomes. We found that the number of recorded weights, as an independent variable, was the strongest predictor for all 10 cardiovascular-related disease outcomes when compared to all other weight-based variables (lowest weight, highest weight, average weight, last weight, absolute weight change, maximum weight change, weight fluctuation, and weight cycling) as well as BMI. The findings demonstrate the importance of recognizing and accounting for the number of times a more frequently measured clinical variable, such as body weight, is recorded as it is critical to determine the true impact of other similar variables on disease outcomes when conducting longitudinal analysis of EHR data.

Burkitt lymphoma (BL) is an aggressive B-cell lymphoma predominantly affecting children in sub-Saharan Africa. It constitutes 50-70% of pediatric non-Hodgkin lymphomas in the region. In Tanzania, understanding the treatment outcomes and one-year survival rates at two major oncology centers can inform strategies to enhance survival. This retrospective cohort study analyzed children under 18 diagnosed with Burkitt lymphoma and treated at two tertiary care hospitals between January 2020 and December 2022. The study utilized Stata 18 to analyze data from medical records, focusing on demographic and clinical characteristics, Kaplan-Meier survival analysis, and Cox proportional hazards models to identify mortality predictors. The study analyzed 72 children with Burkitt lymphoma (mean age: 5.8 years), predominantly male (70.8%), with 52.8% from rural areas. Tumor sites were mainly mandibular (47.2%) and abdominal (41.7%). Treatment outcomes varied between hospitals: Kilimanjaro Christian Medical Centre had a higher complete remission rate (61.3%) compared to BMC (36.6%), while BMC experienced higher relapse (19.5%) and treatment abandonment rates (22.0%) than KCMC (6.5% and 3.2%, respectively). The one-year post-treatment survival rate was 75% overall, with a significantly longer mean survival time at KCMC (37.1 months) versus BMC (16.4 months). Key predictors of mortality included bone marrow involvement, adjusted hazard ratio (AHR) = 32.48 and CNS involvement (AHR = 34.00, 95% CI). The study reveals a 75% one-year survival rate for children with Burkitt lymphoma in Tanzania. However, this reflects short-term (one-year) survival and cannot be directly compared with the WHO Global Initiative for Childhood Cancer 2030 target, which refers to five-year overall survival. However, high treatment abandonment, relapse, and death rates, along with low complete remission rates, pose significant challenges. Key factors contributing to poor prognosis include CNS and bone marrow involvement. The study recommends comprehensive interventions, improved care access, and exploring alternative treatments like stem cell transplantation.

The United Kingdom has a history of world-leading health research, showcased most recently in its response to the Covid pandemic. However, while the UK's performance in academic clinical research remains strong, its global position in the delivery of commercial research has declined. In 2023 Lord O'Shaughnessy reviewed the barriers and drivers to the delivery of commercial trials, identifying 27 recommendations to improve commercial trial performance. Highlighted within the report was the importance of the UK being globally competitive in the delivery of its trials, including study set up and approval times. A dataset from the National Institute for Health and Care Research (NIHR), containing 28,188 site observations from 5,421 unique commercial studies provided data on first recruits to commercial studies spanning a 15-year period from 2010 to 2024. Where there were issues with data quality or reliability, data were cleaned, leaving 23,622 observations from 4,849 studies for analysis. Logistic regression and generalised linear mixed effects models were applied to determine whether sites that recruited their first participant to commercial studies more quickly had a higher probability of recruiting to time and target. Sites that recruited their first participant more quickly were significantly more likely to recruit to time and target (RTT); (odds ratio per one-month increase in time 0.88, 95% CI 0.87 to 0.89, p&#x2009;<&#x2009;0.0001). The model suggests that the predicted probability of RTT for a site falls to <&#x2009;50% if it takes more than 8 months to recruit its first participant. A secondary analysis showed a highly significant increase in probability of a site meeting RTT if they recruited the 'first' Global, European or UK participants onto a study (odds ratio 2.96, 95% CI 2.20 to 4.05, p&#x2009;<&#x2009;0.0001). Sites that recruit first participants more quickly are more likely to recruit to time and target in commercial studies. This is likely to lead to them being selected by sponsors to participate in subsequent studies, increasing research opportunities for their patients and revenue for their organisation. Achieving quicker firsts requires proactive planning and coordination by R&D departments and study teams. Setting up sites in a timely manner is a key determinant of successful study delivery and a key component of the UK government's 10-Year Health Plan for England and Life Sciences Sector Plan. Not applicable.

Moral distress is a major ethical and psychological challenge in nursing practice that adversely affects nurses' well-being, patient care quality, and healthcare organizations. This umbrella review aimed to synthesize and critically appraise evidence from existing systematic reviews regarding the prevalence, severity, causes, and consequences of moral distress primarily among nurses across diverse healthcare settings worldwide, with particular attention to regional and contextual variations. This umbrella review was conducted according to the JBI methodology for umbrella reviews and reported in accordance with PRISMA 2020 guidelines. A comprehensive search was performed in PubMed, Scopus, Web of Science, and Google Scholar from inception until 10 March 2025. Systematic reviews and meta-analyses (with or without meta-analysis) published in English were included if they focused on moral distress among nurses or reported extractable nurse-relevant findings within mixed healthcare professional populations. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Due to considerable heterogeneity in populations, settings, and outcome measures, a narrative synthesis was undertaken. Of 435 records identified, 19 systematic reviews published between 2009 and 2025 met the inclusion criteria. Reported moral distress scores varied across settings and instruments. Higher levels were consistently reported in intensive care, coronary care, and oncology units. Key contributing factors include younger age, female gender, poor teamwork, inadequate resources, and perceived futile or non-beneficial care. Major consequences comprise burnout, depression, reduced quality of nursing care, medication errors, and intention to leave the profession. Significant global and contextual variations were observed. Moral distress remains a complex, multifaceted phenomenon influenced by individual, interpersonal, organizational, and systemic factors. Organizational and educational interventions may help mitigate its impact; however, further high-quality research is needed to strengthen the evidence base and inform effective strategies. This umbrella review synthesizes current evidence and highlights important implications for nursing practice, management, education, and future research. Not applicable.

Despite the high prevalence of fatigue after acquired brain injury and the major impact of fatigue on people's lives, evidence-based interventions are scarce. We developed a new personalized blended care intervention, Tied by Tiredness, which was found to be feasible in a pilot study. In this paper, we present the design of a study of patient-related outcomes and the societal costs of the intervention. This study is a multicentre prospective nonrandomized patient preference trial with baseline (T0), posttreatment (T1), 3-month (T2) and 6-month (T3) follow-up data. The participants will be 45 adults who have experienced brain injury (stroke or traumatic brain injury) and are seeking treatment for fatigue symptoms. The participants will choose whether to receive Tied by Tiredness or treatment as usual. The Tied by Tiredness intervention consists of a 6-week blended care treatment, which combines experience sampling methodology (participants answer momentary questions about fatigue and their daily lives sent via a phone application) with personalized face-to-face feedback by a health care professional. Treatment as usual entails occupational therapy sessions once a week for 6-8 weeks. Measures of fatigue and secondary outcomes (mood, cognitive complaints, participation, and quality of life) will be collected via questionnaires at each time point. To investigate the changes in fatigue severity from pre- to postintervention and follow-up, a linear mixed-effects model with fatigue severity score (FSS) as the dependent variable and time point (T0, T1, T2, T3) as a within-subject factor will be used. In addition, a cost analysis will be performed from a societal perspective, including both direct medical costs (e.g., intervention costs) and societal costs (e.g., informal care, productivity losses). Fatigue after brain injury is multifactorial with high individual variability. We hypothesize that the personalized blended care intervention Tied by Tiredness may be an efficient and effective intervention to reduce fatigue and related problems TRIAL REGISTRATION: Clinical trial number: ID: NL-OMON21265; Overview of Medical Research in the Netherlands (OMON). The trial was first registered in the Overview of Medical Research in the Netherlands (ID: NL-OMON21265) on May 31st, 2021, before recruitment started.

Informal payments (IPs) remain a persistent challenge across health systems worldwide and may undermine equity, transparency, and public trust in healthcare delivery. Despite a growing body of research, evidence regarding the determinants of IPs and the strategies proposed to address them remains fragmented and lacks a comprehensive synthesis. This scoping review aimed to: (1) map and synthesize existing evidence on the key determinants of IPs in health systems globally; and (2) identify, categorize, and summarize the range of strategies proposed to curb them. Following the Joanna Briggs Institute (JBI) methodology, we conducted a systematic search across five databases-PubMed, Web of Science, Scopus, ProQuest, and ScienceDirect-from database inception through January 2025. Two reviewers independently screened all records against predefined eligibility criteria. Data from the included studies were extracted using a standardized form and thematically analyzed. This review synthesized evidence from 68 studies. Determinants of IPs were categorized into five interconnected levels: (1) patient-level factors (e.g., fear of poor-quality care, desire for faster services, and limited knowledge); (2) structural/contextual factors (e.g., underfunding, weak regulation, and type of service); (3) provider-level factors (e.g., low salaries and shortages of supplies); (4) cultural/ethical factors (e.g., norms of gratitude and social acceptance of informal payments); and (5) organizational-level factors (e.g., corruption and lack of accountability). Proposed interventions were grouped into five strategic categories: patient empowerment (education and patient-rights mechanisms); cultural-normative strategies (shifting social norms and fostering trust); financial strategies (improving provider remuneration, formalizing payments, and expanding insurance coverage); structural strategies (strengthening health systems and improving service accessibility); and governance and regulatory strategies (legal frameworks, oversight mechanisms, and sanctions). An analytical framework was developed to illustrate the mechanisms of action and key contextual considerations associated with each strategy, highlighting that implementation processes and outcomes are highly context dependent. IPs are a multifactorial phenomenon rooted in systemic weaknesses, economic incentives, and sociocultural norms. Isolated interventions are unlikely to be effective. Addressing IPs requires integrated, multi-pronged strategies that reduce financial pressures on providers, strengthen governance and transparency, improve service quality and accessibility, empower patients, and reshape cultural norms. This review provides a foundational evidence map to support the design of context-sensitive, system-level policies aimed at reducing and ultimately eliminating informal payments. Future research should evaluate the effectiveness and sustainability of interventions across diverse health system contexts, particularly in underrepresented settings, and further examine the institutional and contextual factors that perpetuate informal payment practices. Not applicable.

A common cause of injury, disability, mortality, and health-related costs, falls affect a third of adults aged 65 years and older. Falls Management Exercise (FaME) is an evidence-based, progressive falls prevention programme, shown to significantly reduce falls and concerns about falls among community-dwelling older adults. Despite the proven benefits of FaME, there are inconsistencies in implementation fidelity and programme delivery. Variances in attendance, adherence and dose, required to ensure efficacy, can negatively impact real-world effectiveness of FaME. This scoping review aims to address the paucity of evidence synthesis on FaME implementation. Identifying key characteristics relating to intervention delivery, implementation and behaviour change strategies, participant uptake, adherence, meeting of effective dose, attrition, and fidelity. Adopting an approved methodology for conducting scoping reviews, seven electronic databases were searched using the Population, Context and Concept inclusion criteria. These relate to; older adults (&#x2265;60 years), 'community-dwelling' and FaME. From an initial 10,888 papers, 26 research papers (13 studies), were included in the full text review, of which ten papers (six studies) used technology in delivering FaME. Key themes: challenges in meeting recruitment target and uptake of FaME, particularly underserved ethnic and socioeconomic populations; significantly fewer older men participating in FaME when compared to older women; issues of poor adherence and meeting of effective dose, especially with home-based exercise components; high rates of attrition and the value of Instructor qualities in delivering FaME. Studies which included technology-assisted implementation reported increased participation by older men, with programmes performing better in terms of adherence, attrition and exercise dose. With digital health technologies showing promising effects on persistent challenges to adherence, dose, and attrition, technology-assisted implementation of FaME has potential to effectively support a wider uptake of FaME among community-dwelling older adults who decline or withdraw participation. Further research is needed to increase our understanding of under-served community-dwelling older adults experiences, and perceptions about FaME and falls prevention. We need to further explore the acceptability of technology-assisted implementation of FaME, and feasibility for supporting a wider roll-out of FaME across the United Kingdom. Not applicable.

Traditional methods of stroke management are increasingly used in sub-Saharan Africa and encompass a wide range of practices. To determine the level of awareness and perception of the traditional methods of stroke management among stroke survivors in Anambra State. This study was a mixed-method embedded design (a research methodology combining qualitative and quantitative approaches in a single research) involving 106 stroke survivors recruited from selected health facilities and traditional stroke management centers in Anambra State. Data was summarized using descriptive statistics of mean, frequency, and standard deviation. The relationship between the sociodemographic variables and the study variables was analyzed using the Chi-square test. A structured questionnaire was used to assess stroke survivors' awareness and perception of traditional stroke management, with statistical significance set at &#x3b1;&#x2009;=&#x2009;0.05Thematic analysis was used to analyze qualitative data. Of the participants, 51 (48.1%) had moderate knowledge, while 85 (80.2%) demonstrated a positive perception of traditional methods of stroke management. There was a statistically significant association between awareness of traditional methods of stroke management and gender (X2&#x2009;=&#x2009;7.9, df&#x2009;=&#x2009;2, p&#x2009;=&#x2009;.019). Thematic analysis shows an overall high awareness and perception of the traditional method of management. The participants have high awareness, positive perception and preference for traditional method of stroke management. Gender appears to influence participants' awareness and perception of traditional stroke management.

Conventional evaluations of psychological treatment effects have primarily focused on changes in average symptom levels, thereby overlooking intra-individual variability. However, evidence from intensive longitudinal data demonstrates that psychological states fluctuate dynamically over time, suggesting that treatment effects may manifest not only in mean levels but also in temporal instability. It is imperative to acknowledge the impact of variability on treatment efficacy, particularly in the context of clinical intervention research. Failure to account for this variability can lead to the misinterpretation of treatment outcomes, potentially compromising the accuracy of research findings. The proposed methodology, under a randomized controlled trial design, is intended to facilitate the dynamic assessment of clinical treatment. The present method is based on a dynamic structural equation model framework, which allows individual-specific residual variances to be contingent on treatment allocation, thereby facilitating the direct evaluation of the impact of treatment on psychological instability. The proposed framework is illustrated with an empirical case, and the performance of dynamic treatment assessment parameters is systematically evaluated under different conditions using Monte Carlo simulations. Empirical evidence has demonstrated the efficacy of the dynamic structural equation model in capturing variations in dynamic treatment effects between experimental and control groups. The simulation results further indicate that this method provides accurate parameter recovery and stable estimates under various conditions, thereby supporting its robustness and flexibility for simulating dynamic treatment effects in intensive longitudinal data settings. The present study proposes a novel perspective on dynamic treatment evaluation based on a dynamic structural equation model framework. By conceptualizing residual variance as a dynamic outcome, this framework facilitates a more nuanced comprehension of clinical change and offers a significant extension to conventional treatment-evaluation methods in randomized controlled trials.

Simulation has played a vital role in training medical professionals. The COVID-19 Pandemic has highlighted the need for physically distant educational assessment methods. Screen-based simulation (SBS) demonstrates one alternative to traditional in-person simulation methods to assess learners clinical reasoning and communication skills. This study aims to compare in-person simulation to SBS as assessment methods in Emergency Medicine (EM). A rapid review literature search methodology of an electronic database (PubMed) was performed in February 2022 with search terms such as "Computer Simulation," "Patient Simulation," "Simulation Training," "Education, Distance," "Virtual OSCE," "Academic Performance," or "Emergency Medicine." Reference lists of relevant articles were manually analyzed for additional studies. Studies were manually reviewed by multiple authors following strict inclusion/exclusion criteria. 751 articles were identified based on title and abstract. Sixty articles were selected for retrieval, of which seven pilot and small population studies were included. Study participants varied based on experience level. Three key findings were derived from these studies. First, SBS is comparable to in-person simulation as a clinical competence and communication skill assessment method when evaluated by independent raters and mock EM oral board examination scores. Second, SBS is capable of discerning EM learners by educational level given SBS/serious game mean clinical score clustering. Lastly, various SBS software demonstrated strong participant interest across the EM learner spectrum through subjective exit questionaries. Current research regarding SBS as an assessment method for EM learners is severely limited as demonstrated by low number of included studies and small populations. Even so, SBS shows promise as a possible alternative and/or supplement to traditional in-person simulation to assess clinical reasoning/communication skills and discern learners by educational level. Further large-scale studies are required to establish the validity of SBS as an assessment method.