The integration of palliative care in the Intensive Care Unit (ICU) is crucial for mitigating end of life suffering and upholding patient autonomy. However, effective implementation is often hampered by communication challenges. This review aims to synthesise the best evidence on communication strategies to facilitate palliative care in the ICU. To integrate the best evidence on communication strategies for palliative care in ICU patients and to establish an evidence-based foundation for standardising-related practices in critical care settings. A systematic search was conducted across multiple databases and platforms including UpToDate, BMJ Best Practice, Joanna Briggs Institute (JBI), Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), PubMed, Web of Science, Embase, Cochrane Library and CINAHL. Eligible study designs included clinical practice guidelines, evidence summaries, clinical decision support systems, expert consensus publications and systematic reviews related to palliative care communication in the ICU. The search period was from database inception to December 2024. Two independent researchers trained in evidence-based methodology conducted literature screening, quality assessment and evidence synthesis. Standardised appraisal tools were used for critical appraisal. Fourteen publications were included: three clinical practice guidelines, two evidence-based guidelines and nine systematic reviews. Thirty-four evidence-based recommendations were synthesised across seven key domains: (1) Structured family conferences, (2) Patient value assessment and shared decision-making, (3) Prognostic information disclosure, (4) Written materials and bereavement support, (5) Ethics consultation services, (6) Multidisciplinary team collaboration and (7) Clinician communication training. The evidence hierarchy followed the JBI evidence classification system. Effective communication strategies encompassing multiple domains are essential for facilitating palliative care in the ICU, addressing the complex needs of critically ill patients and their families. For clinical practice, this review advocates translating evidence into action by standardising family conferences and integrating multidisciplinary teamwork, thereby enhancing the quality of palliative care communication, respecting patient autonomy and offering sustained support to families in critical care settings.
Peri-operative thirst is the second most common source of distress among surgical patients, yet its clinical management remains suboptimal and unstructured. This evidence implementation project aimed to improve the prevention and management of pre-operative thirst in patients undergoing elective sequential gynecological surgery at a public tertiary hospital in Hangzhou, China. This project employed a before-and-after study design guided by the JBI Evidence Implementation Framework, utilizing the JBI Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) tool. A baseline audit was conducted using 21 evidence-based audit criteria to assess compliance with best practices. Barriers to compliance were identified, and targeted strategies were implemented. Three follow-up audits were conducted to evaluate compliance improvement and strategy sustainability at 3, 6, and 9 months post implementation. The baseline audit revealed an overall compliance rate of 5.29%. Following the implementation of targeted strategies, three sequential follow-up audits demonstrated progressive and sustained improvement: overall compliance increased to 40.65%, 76.19%, and 92.19% at 3, 6, and 9 months, respectively. In the final follow-up audit, 16 of the 21 criteria (76.2%) achieved full compliance (100%). This project improved surgical nurses' management of pre-operative thirst and promoted hospital-wide, evidence-based practice. The evidence-based recommendations reduced the gap between current and best practices, thereby enhancing both the quality of care and patient satisfaction. Future practice should embed the new protocols into routine workflows and address the specific challenges in pre-operative fasting for sequential surgery patients. http://links.lww.com/IJEBH/A553.
Immune checkpoint inhibitors (ICIs) have been widely used as an important approach to treat tumors. However, about 30% patients receiving ICIs develop immune-related dermatologic toxicities (IDTs), which may lead to treatment interruption and poor prognosis. This evidence implementation project was carried out in the Department of Radiation Oncology at Nanfang Hospital in Guangzhou, China and aimed to improve the management of IDTs in cancer patients treated with PD-1/PD-L1 inhibitors. The project used the JBI Evidence Implementation Framework, which is based on an audit and feedback process. Criteria for audits were derived from JBI Best Practice Evidence Summaries. The baseline audit was used to identify gaps in compliance with best practices and barriers and facilitators of implementation. After the implementation of change strategies, a follow-up audit was conducted to measure changes in compliance. Gaps between evidence and practice were noted for six of the criteria, and five barriers to implementation were identified. The follow-up audit revealed that compliance with audit criteria 1-5, 7, and 8 reached 100%, while criterion 6 partially improved from 36.7% to 50%. The results indicate that this project improved compliance with evidence-based practices for the management of IDTs by standardizing clinical practices and improving the quality of nursing management. http://links.lww.com/IJEBH/A550.
Laparoscopy is widely used in benign gynaecological surgeries. However, postoperative gastrointestinal dysfunction, abdominal distension, abdominal pain, nausea, vomiting and delayed defecation are often negatively affected after surgery. At present, the management of gastrointestinal function in these patients is not standardised; therefore, this project used the available evidence to improve awareness and practice of standardised management of postoperative gastrointestinal function recovery in patients undergoing laparoscopic surgery for benign gynaecological diseases. This project aimed to standardise the management of postoperative gastrointestinal function recovery in patients undergoing laparoscopic surgery for benign gynaecological diseases according to best practice. This study used clinical audit strategies under the JBI Practical Application of Clinical Evidence System (JBI PACES) module. An audit-feedback cycle was used from September 2023 to December 2023. Twenty-seven best practice recommendations were used for the audit cycle, and the baseline audit was conducted using 15 nurses and 45 patients in a gynaecological surgery ward. The Getting Research into Practice audit and feedback tool was used to identify the barriers, strategies, resources and outcomes. After implementing evidence-based strategies, a re-audit was conducted following the same number of samples and criteria. We analysed compliance with best practice and its impact on the degree of abdominal distension 24 h after the operation, the first flatus time and the first defecation time after surgery. After implementing best-practice strategies, the compliance rate of the 27 criteria was as follows: the implementation rate of indicators 1, 2, 3, 4, 8, 9, 11, 12, 13, 14 and 18 remained above 80%, among which the implementation rates of indicators 1, 2, 3, 11, 12, 13, 14 and 18 reached 100%. The implementation rates of criteria 5, 6, 7, 10, 15, 19-27 had all improved, among which the implementation rate of criteria 6, 7, 19, 22, 23, 24 reached 100%, criteria 5, 10, 15, 16, 17, 20, 21, 25, 26, 27 were 93.56%, 90.89%, 6.67%, 87.89%, 70.56%, 86.40%, 88.89%, 60.67%, 70.89%, 78.60%, respectively. In the follow-up audit cycle, the time of patients' first postoperative anal exhaust (Z = -4.810, p < 0.001) was shorter than the baseline audit group, the time of patients' first postoperative defecation time (Z = -2.934, p < 0.01) was shorter than the baseline audit group, and the degree of abdominal distension (Z = -2.567, p = 0.010 < 0.05) was reduced than the baseline audit group, which all showed statistically significant. The results indicate that evidence-based practice has significantly improved the management of gastrointestinal function in patients after laparoscopic surgery for benign gynaecological diseases, improved the implementation rate of audit criteria, shortened the time of first flatus and defecation and reduced the degree of abdominal distension after surgery.
Compliance with surgical safety checklists remains a concern worldwide and is responsible for more than half of in-hospital complications. The aim of this implementation project was to assess and promote compliance with evidence-based practices regarding custom surgical safety checklists and safe staffing levels in a general private hospital in Iran. This evidence implementation project was conducted in the peri-operative setting of a general private hospital in Tabriz, Iran. The project adhered to the JBI Evidence Implementation Framework and used the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback strategy to develop three audit criteria for the baseline and two follow-up audits. The baseline and follow-up audits revealed that compliance for Criterion 1 (customization of checklists for specialized surgical procedures) decreased from 79% at baseline to 68% at the first follow-up audit but improved to 90% at the second follow-up audit. The compliance rate for Criterion 2 (demand-based staffing level in the peri-operative area) improved from 55% at baseline to 93% at the first follow-up and 100% at the second follow-up. Lastly, the compliance rate for Criterion 3 (staff competence in the peri-operative area) increased from 75% to 100% at both follow-ups 1 and 2. The implementation of educational and policy-related strategies led to improved compliance across all audit criteria. However, future audit cycles and implementation strategies are needed to sustain improvements. http://links.lww.com/IJEBH/A576.
Pregnancy-related Willis-Ekbom disease/restless legs syndrome (WED/RLS) is associated with adverse maternal outcomes, such as preeclampsia, an elevated risk of cesarean delivery, and perinatal depression. Although several guidelines address the management of WED/RLS, most target the general population, with only limited and fragmented recommendations specifically for pregnant women. Furthermore, existing guidelines vary substantially in quality and evidentiary basis, hindering the development of a clear, actionable care pathway for gestational WED/RLS. This study therefore aimed to systematically retrieve, appraise, and synthesize available evidence on the management of WED/RLS during pregnancy to inform obstetric clinical care practice. Evidence retrieval was guided by the 6S evidence pyramid, using a top-down approach to identify relevant guidelines, expert consensus statements, evidence summaries, clinical decision aids, systematic reviews, and meta-analyses. Literature published from database inception to December 2025 was included. Four reviewers independently screened and appraised the evidence. Evidence extraction and synthesis were subsequently conducted by two sleep medicine physicians using the JBI Grading of Evidence and Recommendation System. From nine included publications (three guidelines, two evidence summaries, three clinical decision aids, and one algorithm), 27 practice recommendations were formulated. These span five core domains: (1) avoidance and management of aggravating factors, (2) preconception counselling and health education, (3) iron supplementation, (4) non-pharmacological treatments, and (5) pharmacological treatments. Together, they outline a stepped-care management strategy for gestational WED/RLS, progressing from pre-pregnancy prevention, through post-diagnosis prioritization of non-pharmacological interventions alongside iron repletion, to pharmacological therapy-restricted to the lowest effective dose and shortest necessary duration in the second or third trimester-only for severe, refractory cases. This study proposes a stepped-care pathway for managing pregnancy-related WED/RLS. Implementation should align recommendations with patient preferences and locally available healthcare resources to ensure contextual applicability and clinical utility.
Implementation science frameworks - including process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks - are increasingly used to guide the translation of evidence-based interventions into practice. In paediatric rehabilitation, where interventions are complex and often require multidisciplinary collaboration, these frameworks can support systematic and context-sensitive implementation. However, the extent to which these frameworks have been used has not been comprehensively reviewed. Determine the extent, nature, and specific contexts of the existing literature on the use of implementation science models, theories, and/or frameworks (MTFs) in paediatric rehabilitation. This scoping review will follow the Joanna Briggs Institute (JBI) methodological guidance for scoping reviews. A comprehensive search strategy will be developed with a health sciences librarian and applied across multiple electronic databases: MEDLINE (Ovid), Embase, CINAHL, PsycINFO, ACM Digital Library, Web of Science, the Cochrane Central Register of Controlled Trials, PEDro, and RehabData. We will search English language articles published since 2006. Studies will be included if they report on the application of implementation science MTFs in the context of paediatric rehabilitation. Screening of titles and abstracts and full texts will be performed independently and in duplicate using Covidence. Discrepancies will be resolved through discussion or a third reviewer. Data will be extracted using a standardized form. Quantitative data will be summarized using numerical counts. Qualitative data will be analyzed using content analyses. This review will report on the use of implementation science MTFs in paediatric rehabilitation, identifying trends on the specific types applied, highlight gaps and/or underutilization across domains or developmental stages, and potentially uncover emerging frameworks. Finally, the results may inform the development of future implementation strategies and capacity-building initiatives within the field.
Family-Centered Care (FCC) and Family-Integrated Care (FICare) are widely adopted models in Neonatal Intensive Care Units (NICUs), designed to foster parental involvement and support both neonatal and family outcomes. This review synthesizes and critically appraises the best available evidence on FCC and FICare interventions to inform their implementation, adaptation, and scale-up across diverse health systems and cultural contexts. Guided by the 6S evidence model, a top-down search identified relevant guidelines, best practices, evidence summaries, expert consensus statements, systematic reviews, and meta-analyses published up to 20 May 2025. Two reviewers independently performed study selection, methodological appraisal, and data extraction, with evidence graded using the Joanna Briggs Institute system. A total of 25 publications were included: three clinical guidelines, three best practice documents, four expert consensus statements, and fifteen systematic reviews and meta-analyses. Synthesis revealed seven key domains: core components of FCC/FICare models, implementation strategies, clinical outcomes, safety considerations, cultural adaptability, ethical considerations, and digital health applications. From these, 28 high-quality recommendations were formulated. Overall, FCC and FICare consistently improved neonatal outcomes and enhanced family well-being. Structured parent education, psychosocial support, environmental optimization, and interdisciplinary collaboration emerged as essential elements for effective implementation. Digital health tools may serve as valuable adjuncts but should complement rather than replace relational and presence-based care. Addressing cultural, ethical, and organizational barriers is critical to achieving equitable and sustainable integration. These findings reinforce FCC/FICare as a foundational model for advancing neonatal care globally. Main findings: This review synthesizes high-level evidence on FCC and FICare in NICUs, highlighting seven key domains for effective implementation. Structured parental involvement consistently improves neonatal outcomes and parental competence and reduces psychological stress.Added knowledge: Integrating clinical guidelines, best practice documents, expert consensus statements, and systematic reviews/meta-analyses using the 6S model and the JBI grading framework, the review generates 28 actionable recommendations, offering a consolidated framework for effective, safe, and culturally adaptable FCC/FICare implementation.Global health impact for policy and action: The findings offer actionable guidance for policymakers and health system leaders to support the adaptation and scaling up of FCC/FICare across diverse health system and cultural contexts. These recommendations can inform workforce training, service design, and resource allocation, contributing to more equitable and family-centered neonatal care globally.
To improve physical health screening and assessment practices for individuals with severe and persistent mental disorders treated at a Psychosocial Care Center in Brazil. A best practice implementation project following the JBI Evidence Implementation Framework conducted in the municipality of Itatiba in the state of São Paulo, with users of the Psychosocial Care Center II. The baseline audit (n = 278) and follow-up audit (n = 134) assessed compliance with seven evidence-based criteria. The data collection process occurred in different phases, which included identifying the area of practice to be changed, engaging change agents, assessing the context and readiness for change, auditing current service practices, implementing practice changes, evaluating the implemented strategies, and monitoring changes in practice. Baseline compliance was low, with several indicators below 10%. After implementing standardized documentation tools, integrating nursing assessments at intake, and planning inter-service coordination, key improvements were observed. Documentation of physical examination increased from 9.0% to 47.1% (+38.1 pp), Body Mass Index recording from 0% to 22.4% (+22.4 pp), and scheduling of follow-up appointments from 1.1% to 21.6% (+20.5 pp). However, minimal or no progress occurred in laboratory testing, electrocardiogram requests, and monitoring of antipsychotic side effects. The project strengthened internal routines and demonstrated the feasibility of implementing evidence-based practices. Nevertheless, limited progress in criteria dependent on external factors and the need for stronger professional integration highlight the importance of greater investment to address persistent care gaps. Melhorar as práticas de triagem e avaliação da saúde física de indivíduos com transtornos mentais graves e persistentes tratados em um Centro de Atendimento Psicossocial no Brasil. Projeto de implementação de melhores práticas seguindo a Estrutura de Implementação de Evidências da JBI realizado no município de Itatiba, no estado de São Paulo, com usuários do Centro de Atendimento Psicossocial II. A auditoria inicial (n = 278) e a auditoria de acompanhamento (n = 134) avaliaram a conformidade com sete critérios baseados em evidências. O processo de coleta de dados ocorreu em diferentes fases, que incluíram a identificação da área de prática a ser alterada, o envolvimento de agentes de mudança, a avaliação do contexto e da prontidão para a mudança, a auditoria das práticas atuais de serviço, a implementação de mudanças na prática, a avaliação das estratégias implementadas e o monitoramento das mudanças na prática. A conformidade inicial foi baixa, com vários indicadores abaixo de 10%. Após a implementação de ferramentas de documentação padronizadas, a integração das avaliações de enfermagem na admissão e o planejamento da coordenação entre serviços, foram observadas melhorias significativas. A documentação do exame físico aumentou de 9,0% para 47,1% (+38,1 pp), o registo do Índice de Massa Corporal de 0% para 22,4% (+22,4 pp) e o agendamento de consultas de acompanhamento de 1,1% para 21,6% (+20,5 pp). No entanto, houve um progresso mínimo ou nenhum progresso nos exames laboratoriais, nos pedidos de eletrocardiogramas e na monitorização dos efeitos secundários dos antipsicóticos. O projeto fortaleceu as rotinas internas e demonstrou a viabilidade da implementação de práticas baseadas em evidências. No entanto, o progresso limitado em critérios dependentes de fatores externos e a necessidade de uma integração profissional mais forte destacam a importância de um maior investimento para lidar com as lacunas persistentes nos cuidados de saúde.
The hybrid effectiveness-implementation typology has become a cornerstone in implementation science, offering a way to classify studies according to their focus on effectiveness versus implementation outcomes. However, this typology reveals little about how implementation occurs in practice or the degree to which trials mirror real-world conditions. In this editorial, I argue that implementation trials should also be characterized by their level of pragmatism, defined by how much researcher control, support, or local leadership shapes implementation delivery. Drawing on my experiences with the INPREP, GLOW, and DEFENCE trials, and informed by the work of Greenhalgh and colleagues, I propose three pragmatic orientations-make-it-happen, help-it-happen, and let-it-happen-that reflect increasing contextual autonomy. Explicit reporting of a trial's pragmatic orientation using frameworks such as PRECIS-2-PS-which characterizes trials across domains, including implementation resources, flexibility of provider strategies, and delivery context-would enhance interpretation, synthesis, and scalability.
Hand hygiene for both health care workers and patients is an important measure to prevent health care-associated infections in residential aged care facilities. Studies on health care workers' and patients' perceptions and behaviors have indicated that despite understanding its importance, patient hand hygiene is not a deliberate practice. This project aimed to promote evidence-based practices regarding patient hand hygiene in a residential aged care facility. Guided by the JBI Evidence Implementation Framework, six best practices were used as audit criteria. Baseline audits were conducted through observations, staff surveys, and electronic health record reviews. Barriers to best practices were identified and strategies were implemented to address those barriers. Follow-up audits were conducted and compared to baseline results. The baseline results showed 64% compliance with the six best practice recommendations. Barriers included health care workers' lack of knowledge of the multimodal approach to patient hand hygiene, limited hand hygiene products, patients' inability to use products independently, and missing or inaccurate education documentation in the health record. Strategies to improve compliance included education for health care workers, increasing the availability and usability of hygiene products, and standardizing patient hand hygiene documentation in the electronic health record. Post-implementation audits showed a 12% increase in compliance, which rose to 76%. Through education initiatives, increased product accessibility, and standardized documentation, this evidence implementation project successfully improved adherence to best practices for patient hand hygiene in a residential aged care facility. Sustained efforts, including integration into staff orientation and competency programs, will be critical to maintaining these gains. http://links.lww.com/IJEBH/A567.
Effective pain management is crucial for burn patients in emergency departments due to the complex nature of burn pain. This project aimed to assess and improve compliance with best practices in burn pain management in the emergency department of a hospital in Iran. This project used the JBI Evidence Implementation Framework. We conducted baseline and follow-up audits over 3 months to identify barriers to compliance with best practices, implement targeted interventions, and re-evaluate practice. Following the implementation of intervention strategies, the follow-up audit revealed significant improvements across all six criteria over a 3-month period. We observed increased compliance for individualized pain management plans (87.80% to 95.12%), appropriate pharmacological agent selection (95.12% to 100%), and multimodal pain management (80.49% to 92.68%). Furthermore, adherence to tailored opioid therapy significantly improved (60.98% to 85.37%), as did the practice of using fewer opioid types for effective pain management (48.78% to 80.49%). Patient education regarding pain medications also notably increased (68.29% to 90.24%). Barriers included lack of staff awareness concerning opioid administration and general best practices. These were addressed through standardized evidence-based training, educational workshops, and a simplified documentation checklist in Farsi. This project achieved substantial advancements in burn pain management practices, highlighting the success of individualized, evidence-based strategies. These positive outcomes underscore the need for continued education, rigorous protocol adherence, and active patient engagement to sustain and enhance the quality of care for this vulnerable patient population. http://links.lww.com/IJEBH/A522.
COVID-19 antigen-based rapid diagnostic tests (Ag-RDTs) for self-testing (C19ST) have been widely implemented. However, evidence on population health and implementation outcomes remains limited. We systematically evaluated population health and implementation outcomes of C19ST to inform WHO guidelines and pandemic preparedness. We conducted a systematic review and meta-analysis (PROSPERO CRD42022299977), searching Embase, MEDLINE, Web of Science, MedRxiv, clinicaltrials.gov and the Cochrane Library from Dec 1, 2020, to Oct 1, 2025. We included cohort, case-control, cross-sectional, before-and-after, and randomised studies with symptomatic and asymptomatic participants using commercially available C19ST Ag-RDTs. Primary outcomes included C19ST population health (case detection, test positivity, number needed to test (NNT)) and implementation outcomes (uptake, adherence, result reporting). Meta-analyses used binomial-normal generalised linear mixed models; study quality assessment used the JBI Quasi-Experimental Tool. Of 19,473 records screened, 61 studies (87 datasets) with 25,288,225 participants (78% asymptomatic) were included. C19ST detected 31 (95% CI 14-65) cases per 1000 individuals, missing 14% (95% CI 1-65%) compared to molecular testing. Test positivity was 7 per 1000 tests (95% CI 3-15); false positives occurred in 0.4% (95% CI 0.2-1.0%). NNT was 75 in symptomatic and 1002 in asymptomatic individuals. Uptake, adherence, and result reporting were high, but estimates were limited by selection bias. C19ST was also reported to improve perceptions of safety, and reduce self-isolation, workplace absenteeism, and other societal disruptions, supporting the continuity of daily activities. Heterogeneity was substantial. C19ST improves case detection and supports pandemic control with acceptable accuracy and meaningful societal benefits. These findings support the use of antigen-based self-testing as a complementary tool for a pandemic response. Studies included further highlight the limited use of standardised frameworks for evaluating population health and implementation outcomes of novel diagnostics. Ministry of Science, Research and Arts of the State of Baden-Wuerttemberg, Germany.
Persistent impairments in trunk control, balance, and mobility are frequently observed after stroke, even after standard task-specific rehabilitation. Quadrupedal-derived training (QT)-which involves four-point support, dynamic contralateral tasks, transitional kneeling, and crawling-has attracted clinical interest because it may activate bilateral and spinal sensorimotor networks. Nonetheless, the evidence supporting QT has not been thoroughly systematically mapped. Objective: To synthesize the extent, characteristics, mechanisms, and clinical applications of quadrupedal-derived training in adult post-stroke rehabilitation. A scoping review was conducted in accordance with the JBI Manual for Evidence Synthesis and the PRISMA-ScR guidelines. It involved searching five databases and additional sources from 2010 to 2025 to find studies on QT in stroke populations, along with mechanistic and translational evidence. The outcomes were pre-mapped to the International Classification of Functioning (ICF) domains. Data on intervention types, total dosage, supervision, progression criteria, safety, and feasibility were gathered. Stakeholder input from stroke survivors, clinicians, and researchers helped shape implementation considerations. Eighteen studies met the inclusion criteria, including five randomized controlled trials and one case study involving stroke populations, as well as mechanistic and translational research. QT consistently improved trunk control and balance, with effects on functional mobility and certain gait parameters varying depending on the variant and dose. Kneeling-based QT showed greater balance benefits than treadmill-based training in subacute inpatient settings, while static and dynamic four-point variants were mainly used with chronic outpatient groups. No serious adverse events occurred, and adherence was high where recorded. Mechanistic evidence indicates a pathway connecting quadrupedal loading to activation of spinal and interlimb networks, bilateral proximal muscles, and functional improvements. Quadrupedal-based training is a biologically plausible, resource-efficient, and clinically practical method for improving trunk and balance issues after a stroke. More well-designed studies that include standardized progression, dose-response evaluations, and neurophysiological biomarkers are needed.
Clinical decision support significantly enhances effective healthcare delivery by empowering healthcare providers with the necessary tools and resources to make evidence-based decisions. To date, only limited research studies have discussed the effective implementation of clinical decision support systems (CDSS) in managing cardiovascular care. To identify the barriers and facilitators of integrated CDSS implementation through electronic health records in cardiovascular care. A convergent integrated design aligned with Joanna Briggs Institute (JBI) methodology for mixed methods review was followed. Four databases were included from October 2023 to July 2025. Eligible peer-reviewed studies (quantitative, qualitative, or mixed-methods) reported on barriers or facilitators to implementing CDSS in cardiovascular care. A total of 718 articles were screened; 12 studies were included in this review (2008-2025). Studies spanned diverse settings across five countries and included qualitative (n = 4), quantitative (n = 2), and mixed-methods (n = 6) designs. All studies evaluated knowledge-based CDSS applied in cardiovascular care, in primary (n = 9) and tertiary care settings. Barriers and facilitators were synthesised into a three-level framework: macro (organisational and regulatory), meso (technical and clinical), and micro (patient and training). Common barriers included workflow disruption, alert fatigue, limited interoperability, regulatory burden, and lack of staff training. Key facilitators included leadership commitment, workflow integration, stakeholder engagement, iterative tool refinement, and targeted clinician training. Our review underscored the critical need for contextual, multi-level strategies to enable the effective adoption and sustainability of CDSS in cardiovascular care. The establishment of standardised guidelines to systematically address implementation barriers was also considered essential. A coordinated governance framework encompassing organisational commitment, technical integration, clinician involvement, patient engagement, and regulatory alignment must be supported by ongoing training and capacity building. Recognising and addressing these interdependent factors can equip healthcare systems to scale CDSS adoption, optimise clinical workflows, and improve patient outcomes through enhanced decision-making.
This scoping review explores the environmental impact of nursing interventions in acute care settings, focusing on waste reduction, energy consumption, and carbon emissions, while identifying nurse-led sustainability practices, assessment frameworks, and implementation barriers/enablers. Guided by Arksey and O'Malley's framework and reported per PRISMA-ScR guidelines. Data Sources: PubMed, CINAHL, Scopus, and Google Scholar were searched for peer-reviewed, English-language studies published between 2020 and 2025. A five-stage process was employed: (1) research question formulation, (2) comprehensive literature search, (3) study selection using the Population-Phenomenon-Context (PPC) framework, (4) data charting via a structured extraction form, and (5) thematic synthesis. Methodological quality was appraised using Joanna Briggs Institute (JBI) tools. Of 400 identified records, 25 met inclusion criteria. Findings show nurses reduce environmental impact through reusable linen use (e.g., 496 kg/year ICU waste reduction), energy-efficient equipment, and improved waste segregation. However, time constraints, limited resources, and inadequate sustainability training impede consistent implementation. Awareness among nurses and students is moderate but rarely translates into practice. Nursing interventions hold significant potential to reduce healthcare's environmental footprint. Embedding sustainability competencies into curricula and reinforcing them with institutional policies and leadership support are essential. This review informs nurses and clinical leaders that sustainable practices-such as switching to reusable linens and optimizing energy use-are both feasible and impactful in acute care. It provides actionable evidence for reducing waste and carbon emissions while maintaining patient safety, supporting the integration of environmental stewardship into daily nursing practice. Findings from this review highlight the measurable environmental benefits of nurse-led sustainability interventions, such as waste reduction and energy conservation in ICUs. The evidence supports updating nursing curricula, clinical guidelines, and hospital policies to equip nurses with the knowledge and tools needed to lead sustainability efforts, thereby reducing healthcare's carbon footprint without compromising care quality.
Digital twins (DTs) show promise in critical care by enabling personalised treatment and optimising clinical decision-making. Despite the complexity and data-intensive nature of critical care, the implementation of DTs in this setting remains under-investigated. This scoping review aimed to summarise DT research in critical care and identify current evidence gaps. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, seven electronic databases were searched. Studies reporting the development or evaluation of DT models in adult critical care were included. Data were extracted on study characteristics and DT development features, including modelling approaches, levels of data integration, and key findings. Twenty-three studies were included, with most originating from North America and Europe. Retrospective designs using hospital datasets derived from intensive care unit and emergency department settings were common. Data integration predominantly corresponded to the digital model level of the DT maturity, whereas fully automated DT implementations were rare. Regarding modelling approaches, mathematical models were most frequently developed, followed by machine learning-based predictive models. DT application primarily focused on predictive modelling and virtual patient simulations to enhance personalised treatment, support clinical decision-making, and optimise organisational resource allocation. DT technologies in critical care remain in the exploratory and early stages of development and implementation. Further research incorporating higher levels of data integration, real-time deployment, and longitudinal external validation is warranted, alongside broader consensus on ethical governance and data privacy.
Pelvic floor muscles can undergo significant trauma and physical changes during childbirth. This may result in urine leaking involuntarily in postnatal mothers after normal vaginal delivery. Pelvic floor muscle exercises (PFME) have been found to be beneficial in preventing urinary incontinence after delivery. This project aimed to prevent and reduce urinary incontinence among postnatal mothers who received PFME education prior to discharge. This was achieved through the implementation of best practice recommendations. This project was guided by the JBI Evidence Implementation Framework which comprises a baseline audit, analysis of barriers, tailored strategies, and follow-up audit to assess impact and sustainability. The maternity ward midwives and nurses were trained how to educate the participants about PFME. Urinary incontinence symptoms were evaluated using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Two follow-up audits were conducted to measure changes in compliance with best practices. The percentage of mothers who received training on PFME was 53.3% at baseline, 50% at follow-up audit 1, and 60% at follow-up audit 2. The percentage of mothers who received a physical copy of the patient information leaflet increased from 80% at baseline to 90% in follow-up audit 1, and 96.7% in follow-up audit 2. In addition, mothers who performed PFME after discharge reported fewer urine incontinence symptoms. The project results showed that urinary incontinence had decreased among postnatal mothers who had practiced PFME. Sustainability plans involve regular audits, educating new nurses, and nursing leadership support for an evidence-based culture. http://links.lww.com/IJEBH/A569.
Individuals living in rural areas and low-income communities are at an increased risk of nutrient-poor diets and associated metabolic disorders, including obesity, cardiovascular disease, and type 2 diabetes. This study aimed to enhance the nutritional education process, identify barriers and facilitators to improving compliance, and develop strategies to address areas of non-compliance for villagers in Gotvand, Iran. In accordance with the JBI Evidence Implementation Framework, this clinical audit study was conducted in 2023 at a health center in Gotvand, Iran. Forty adult villagers referred to the health center took part in a baseline audit to evaluate compliance with recommended practices. After 1 month, a follow-up audit was conducted, during which 20 villagers were randomly selected and their data analyzed. Data collection methods included direct observation and interviews. The baseline results indicated that face-to-face interviews or experiential learning approaches had the highest compliance rate (70%), followed by other strategies in addition to nutrition education (60%). Training aimed to increase nutritional knowledge recorded a compliance rate of 55%, while self-monitoring to facilitate nutrition education by individuals had the lowest rate at 33%. After the 1-month follow-up, compliance rates improved significantly, revealing audit scores of 100% for Criteria 1-3, and 94.4% for Criterion 4. The findings suggest that employing local educators, using educational packages (including illustrated pamphlets), and conducting face-to-face sessions are effective strategies for delivering nutritional education in rural areas, taking into account local community knowledge, language differences, and cultural context. http://links.lww.com/IJEBH/A517.
LIFE is a Japanese digital database introduced by the Ministry of Health, Labour and Welfare to promote evidence-based care for older adults. Training sessions to promote the dissemination of the Long-term care Information system For Evidence (LIFE) commenced in 2021 in Japan. However, participants' subsequent understanding of the system and their self-efficacy in using it remained unclear. This study aimed to clarify the participants' understanding and self-efficacy regarding LIFE on the day of training and 3 months after the training. A "LIFE Workshop (Basic)" was held in 2024 in Japan in the cities of Hakata, Sapporo, and Sendai. An online survey was administered to participants directly after the workshop, on the same day of the training session, and again, 3 months later. The survey included 12 items to gauge the participants' (and by extension, their work colleagues') understanding in self-efficacy and engagement with LIFE. An analysis was conducted of 42 matched data using a paired t-test, with the effect size calculated using Hedges' g. Three months after training, participants' understanding of the LIFE outline improved significantly (from 5.12 (2.43) to 6.19 (1.71), p  < .001, Hedges' g = -0.471, 95% confidence interval [CI] [-0.736 to -0.206]). Significant improvements were observed in the following areas: performing the tests and measurements used in LIFE; interpreting and using the tests and measurements; planning and submitting LIFE data; and using the system within the organization. From the respondents' perspective, no significant improvement was found in their colleagues' understanding, practices, or use of the system. When introducing new initiatives to existing services, support must be provided for the organizational structure and the personnel who will take on leadership roles.