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Malaysian Family Physician : the... 2023Evidence on the impacts of accreditation on primary health care (PHC) services is inconsistent. Thus, this study aimed to assess the impacts of accreditation on the...
INTRODUCTION
Evidence on the impacts of accreditation on primary health care (PHC) services is inconsistent. Thus, this study aimed to assess the impacts of accreditation on the performance of PHC centres.
METHOD
This study systematically reviewed articles published from 2000 to 2019 in the Web of Science, Scopus, ScienceDirect, Springer, PubMed and ProQuest. The following keywords were used: ((primary care OR primary health care) AND (accreditation) AND (impact OR effect OR output OR outcome OR influence OR result OR consequences)). The database search yielded a total of41256 articles, among which 30 articles were finally included in the review.
RESULTS
Accreditation showed the most positive impacts on the quality, effectiveness, human resource management and strategic management of PHC services. Accreditation also positively affected safety, responsiveness, accessibility, customer satisfaction, documentation, leadership, efficiency and continuity of care. Few negative impacts were noted, including the possibility of accreditation being used as a bureaucratic tool, high cost of acquiring accreditation, difficulties in understanding the accreditation process, high staff turnover rate in accredited PHC centres and weak sustainability of some accreditation programmes.
CONCLUSION
Given its numerous positive impacts, accreditation could be used to effectively improve the performance of PHC centres.
PubMed: 38026575
DOI: 10.51866/rv.274 -
BMC Medical Education Jul 2023The purpose of this systematic review was to (1) determine the scope of literature measuring USMLE Step 1 and Step 2 CK as predictors or indicators of quality resident...
BACKGROUND
The purpose of this systematic review was to (1) determine the scope of literature measuring USMLE Step 1 and Step 2 CK as predictors or indicators of quality resident performance across all medical specialties and (2) summarize the ability of Step 1 and Step 2 CK to predict quality resident performance, stratified by ACGME specialties, based on available literature.
METHODS
This systematic review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [16]. The original search strategy surveyed MEDLINE and was adapted to survey Cochrane Library and Embase. A study was deemed eligible if it provided all three of the following relevant information: (a) Step 1 or Step 2 CK as indicators for (b) resident outcomes in (c) any ACGME accredited specialty training program.
RESULTS
A total of 1803 articles were screened from three separate databases. The 92 included studies were stratified by specialty, with Surgery (21.7% [20/92]), Emergency Medicine (13.0% [12/92]), Internal Medicine (10.9% [10/92]), and Orthopedic Surgery (8.7% [8/92]) being the most common. Common resident performance measures included ITE scores, board certification, ACGME milestone ratings, and program director evaluations.
CONCLUSIONS
Further studies are imperative to discern the utility of Step 1 and Step 2 CK as predictors of resident performance and as tools for resident recruitment and selection. The results of this systematic review suggest that a scored Step 1 dated prior to January 2022 can be useful as a tool in a holistic review of future resident performance, and that Step 2 CK score performance may be an effective tool in the holistic review process. Given its inherent complexity, multiple tools across many assessment modalities are necessary to assess resident performance comprehensively and effectively.
Topics: Humans; United States; Educational Measurement; Internship and Residency; Clinical Competence; Licensure, Medical; Internal Medicine
PubMed: 37525136
DOI: 10.1186/s12909-023-04530-8 -
Journal of Clinical Medicine Nov 2023Shoulder pain is a disabling musculoskeletal disorder worldwide. Thus, it is important to identify interventions able to improve pain and disability. (Review)
Review
Effect of Mobilization with Movement on Pain, Disability, and Range of Motion in Patients with Shoulder Pain and Movement Impairment: A Systematic Review and Meta-Analysis.
BACKGROUND
Shoulder pain is a disabling musculoskeletal disorder worldwide. Thus, it is important to identify interventions able to improve pain and disability.
OBJECTIVE
To investigate the effects of mobilization with movement (MWM) on pain, disability, and range of motion in patients with shoulder pain and movement impairment.
METHODS
A systematic search of different databases was performed. The systematic review protocol has been registered in PROSPERO (CRD42023404128). A random-effects model for meta-analysis was used to determine the mean difference (MD), standardized mean differences (SMD), and 95% confidence interval for the outcome of interest.
RESULTS
Twenty-six studies were included. Of these, eighteen were included in the meta-analysis. MWM improved pain during movement with a moderate effect SMD of (-0.6; 95% confidence interval, -1.1 to -0.1, I = 0%; N = 66;) and shoulder abduction MD of (12.7°; 1.3 to 24.0; I = 73%; N = 90) compared to sham MWM in the short term (0-6 weeks). Combined MWM and conventional rehabilitation improved pain at rest, with a MD of (-1.2; -2.2 to -0.2; I = 61%; N = 100), and disability SMD of (-1.3; confidence interval -2.2 to -0.4; I = 87%; N = 185) compared to conventional rehabilitation alone in the short term. Combined MWM and conventional rehabilitation also resulted in improvement in shoulder abduction and external rotation. Compared to Maitland, MWM resulted in improvement in the shoulder abduction MD (20.4°; confidence interval 4.3 to 36.5; I = 89%; N = 130) in the short term. There is no information regarding long-term effects.
CONCLUSION
Evidence suggests that MWM may reduce shoulder pain and restore shoulder range of motion and function. Our findings are promising, but the evidence is not strong enough to recommend it pragmatically.
PubMed: 38068468
DOI: 10.3390/jcm12237416 -
Nurse Education in Practice Aug 2023The clinical learning environment offers meaningful learning opportunities for nursing students to apply theoretical knowledge to practice on actual or simulated... (Review)
Review
OBJECTIVES
The clinical learning environment offers meaningful learning opportunities for nursing students to apply theoretical knowledge to practice on actual or simulated patients. A previous systematic review assessed the quality of several instruments that evaluated the quality of clinical learning environments. This updated systematic review aimed to identify: any additional instruments that have been researched in the last 5 years, ii) the psychometric properties of available instruments and iii) the estimated comparable psychometric properties of the available instruments.
DATA SOURCES
Medline, CINAHL and Cochrane databases REVIEW METHODS: Databases were searched from January 2016 to January 2023. Studies were included if they: a) validated instruments evaluating the experience and quality of clinical learning environments; b) assessed the pre-licensure nursing student experience; c) were published in English; and d) were published after April 2016. Two independent reviewers conducted title and abstract screening, full text screening, data extraction and methodological quality assessment. Any disagreements were resolved by consensus. A summary of the findings was tabulated using the same format as the initial review.
RESULTS
An additional 18 studies were found, which used seven different clinical learning environment evaluation instruments. Internal consistency and structural validity were the most frequently reported psychometric properties. In almost all studies, methodology for these properties were of sufficient quality according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) tool evaluation. Other properties were inconsistently reported, with differing qualities in the methodology. Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) remains the most translated and validated instrument across several countries.
CONCLUSIONS
Instruments developed and validated using a systematic, transparent and high-quality methodology assist in accurately assessing the skills, attitudes and decision-making abilities of the preregistration level nursing student. These tools can be used in clinical placement accreditation and quality improvement of nursing education. The methodology for evaluation of the psychometric properties of instruments should be clearly described.
Topics: Humans; Education, Nursing; Learning; Students, Nursing; Clinical Competence; Psychometrics; Reproducibility of Results
PubMed: 37536179
DOI: 10.1016/j.nepr.2023.103732 -
Mothers' experiences and perceptions of breastfeeding peer support: a qualitative systematic review.International Breastfeeding Journal Jan 2024The global issue of low breastfeeding rates has been widely reported. Quantitative studies have shown the positive effects of peer support on breastfeeding. However, the... (Review)
Review
BACKGROUND
The global issue of low breastfeeding rates has been widely reported. Quantitative studies have shown the positive effects of peer support on breastfeeding. However, the experiences of mothers who receive breastfeeding peer support have been found to vary. To date, no systematic qualitative summary has been conducted to document the impact of peer support, nor to provide advice for its implementation from the perspective of breastfeeding mothers. This review aims to systematically synthesize qualitative findings on mothers' experiences of breastfeeding peer support to provide evidence for optimizing peer support services and ultimately enhancing their role in promoting breastfeeding.
METHODS
PubMed, Embase, Cochrane Library, Ovid, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI), WanFang Datebase, VIP Database and Chinese Biomedical Database (CBM) were searched from the inception of each database until January 2023, to collect qualitative studies and mixed methods studies that included qualitative findings on mothers' experiences with breastfeeding peer support. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to extract data and evaluate the quality of the included articles. The meta-integration method was used to explain and integrate the research findings. The review process was carried out by two authors independently, and the disagreements were resolved through consensus.
RESULTS
A total of 15 articles were included in the study, consisting of 13 qualitative studies and 2 mixed methods studies. The analysis identified four integrated themes: (1) obtaining psycho-emotional support; (2) acquiring knowledge and skills; (3) expectations for breastfeeding peer support; and (4) feeding perceptions and behavior change. It should be noted that the articles reviewed are in English and mostly originate from developed countries or regions. Therefore, the generalizability of the integrated findings to underdeveloped regions or non-English speaking countries may be limited.
CONCLUSION
Mothers perceived that peer support had a positive impact on breastfeeding. To improve the effectiveness of peer support in promoting breastfeeding, it is important to consider the individual needs of each mother. It is recommended that peer support services should be standardized in the future, including the accreditation, training, supervision, and management of peer supporters.
Topics: Female; Humans; Mothers; Breast Feeding; Counseling; Peer Group; Qualitative Research
PubMed: 38243287
DOI: 10.1186/s13006-024-00614-3 -
BMJ Quality & Safety Dec 2023Health and social care standards have been widely adopted as a quality improvement intervention. Standards are typically made up of evidence-based statements that...
BACKGROUND
Health and social care standards have been widely adopted as a quality improvement intervention. Standards are typically made up of evidence-based statements that describe safe, high-quality, person-centred care as an outcome or process of care delivery. They involve stakeholders at multiple levels and multiple activities across diverse services. As such, challenges exist with their implementation. Existing literature relating to standards has focused on accreditation and regulation programmes and there is limited evidence to inform implementation strategies specifically tailored to support the implementation of standards. This systematic review aimed to identify and describe the most frequently reported enablers and barriers to implementing (inter)nationally endorsed standards, in order to inform the selection of strategies that can optimise their implementation.
METHODS
Database searches were conducted in Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SocINDEX, Google Scholar, OpenGrey and GreyNet International, complemented by manual searches of standard-setting bodies' websites and hand searching references of included studies. Primary qualitative, quantitative descriptive and mixed methods studies that reported enablers and barriers to implementing nationally or internationally endorsed standards were included. Two researchers independently screened search outcomes and conducted data extraction, methodological appraisal and CERQual (Confidence in Evidence from Reviews of Qualitative research) assessments. An inductive analysis was conducted using Sandelowski's meta-summary and measured frequency effect sizes (FES) for enablers and barriers.
RESULTS
4072 papers were retrieved initially with 35 studies ultimately included. Twenty-two thematic statements describing enablers were created from 322 descriptive findings and grouped under six themes. Twenty-four thematic statements describing barriers were created from 376 descriptive findings and grouped under six themes. The most prevalent enablers with CERQual assessments graded as high included: available support tools at local level (FES 55%); training courses to increase awareness and knowledge of the standards (FES 52%) and knowledge sharing and interprofessional collaborations (FES 45%). The most prevalent barriers with CERQual assessments graded as high included: a lack of knowledge of what standards are (FES 63%), staffing constraints (FES 46%), insufficient funds (FES 43%).
CONCLUSIONS
The most frequently reported enablers related to available support tools, education and shared learning. The most frequently reported barriers related to a lack of knowledge of standards, staffing issues and insufficient funds. Incorporating these findings into the selection of implementation strategies will enhance the likelihood of effective implementation of standards and subsequently, improve safe, quality care for people using health and social care services.
Topics: Humans; Delivery of Health Care; Quality of Health Care; Social Support; Quality Improvement
PubMed: 37290917
DOI: 10.1136/bmjqs-2022-015287 -
Design, delivery and effectiveness of health practitioner regulation systems: an integrative review.Human Resources For Health Sep 2023Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility,...
BACKGROUND
Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions.
METHODS
We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework.
FINDINGS
This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners.
CONCLUSION
We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.
Topics: Humans; Government Programs; Government; Accreditation; Databases, Factual; Health Education
PubMed: 37667368
DOI: 10.1186/s12960-023-00848-y -
Complementary Therapies in Medicine Mar 2024Systematic reviews suggest that animal-assisted therapy (AAT) and pet-robot interventions (PRI) achieve a reduction in mental health variables such as depressive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Systematic reviews suggest that animal-assisted therapy (AAT) and pet-robot interventions (PRI) achieve a reduction in mental health variables such as depressive symptoms. However, these systematic reviews include both randomised and non-randomised studies, which prevents an adequate assessment of the effect of confounding variables.
OBJECTIVE
This systematic review and meta-analysis aimed to evaluate the comparative effectiveness of AAT and PRI through randomized controlled trials (RCTs) in reducing depression in older adults.
METHODS
Our study is a systematic review. We searched three databases of scientific articles: SCOPUS, Web of Science and PubMed. We included studies that their population was older adults, aged 65 years or older, with or without a clinical condition, clinical diagnosis based on mental examination/test or documentation from medical records, accredited by the facilities' staff. We included trials in which the comparator was a passive intervention or an active intervention. We used the Cochrane risk-of-bias tool for randomised trials (RoB 2) to assess the risk of bias for each study. Our study was registered in PROSPERO (CRD42023393740).
RESULTS
Twenty-three studies were included in this systematic review. However, only 19 trials were included in the meta-analysis. At the overall risk of bias level, 78.9% of the studies were at high risk of bias (n = 15). We found that AAT (g= -0.72; 95%CI -1.13 to -0.31; p = 0.001) has a moderate and statistically significant effect as an intervention to reduce depressive symptoms in older adults. However, the PRIs do not show a significant effect on reducing depressive symptoms in older adults. In addition, a sub-analysis based on dog-assisted therapy (g= -0.65; 95%CI -1.21 to -0.08; p = 0.025), a specific type of AAT, showed a modest effect on reducing depressive symptoms.
CONCLUSIONS
Our study concluded that AAT and DAT had a moderate and statistically significant effect as interventions to reduce depressive symptoms in older adults. On the other hand, PRI did not show a significant effect in reducing depressive symptoms.
Topics: Humans; Animals; Dogs; Aged; Depression; Robotics; Animal Assisted Therapy; Mental Health
PubMed: 38232905
DOI: 10.1016/j.ctim.2024.103023 -
BMC Medical Education Jun 2024Few published articles provide a comprehensive overview of the available evidence on the topic of evaluating competency-based medical education (CBME) curricula. The... (Review)
Review
BACKGROUND
Few published articles provide a comprehensive overview of the available evidence on the topic of evaluating competency-based medical education (CBME) curricula. The purpose of this review is therefore to synthesize the available evidence on the evaluation practices for competency-based curricula employed in schools and programs for undergraduate and postgraduate health professionals.
METHOD
This systematized review was conducted following the systematic reviews approach with minor modifications to synthesize the findings of published studies that examined the evaluation of CBME undergraduate and postgraduate programs for health professionals.
RESULTS
Thirty-eight articles met the inclusion criteria and reported evaluation practices in CBME curricula from various countries and regions worldwide, such as Canada, China, Turkey, and West Africa. 57% of the evaluated programs were at the postgraduate level, and 71% were in the field of medicine. The results revealed variation in reporting evaluation practices, with numerous studies failing to clarify evaluations' objectives, approaches, tools, and standards as well as how evaluations were reported and communicated. It was noted that questionnaires were the primary tool employed for evaluating programs, often combined with interviews or focus groups. Furthermore, the utilized evaluation standards considered the well-known competencies framework, specialized association guidelines, and accreditation criteria.
CONCLUSION
This review calls attention to the importance of ensuring that reports of evaluation experiences include certain essential elements of evaluation to better inform theory and practice.
Topics: Competency-Based Education; Humans; Curriculum; Clinical Competence; Program Evaluation; Education, Medical, Undergraduate; Education, Medical
PubMed: 38831271
DOI: 10.1186/s12909-024-05609-6 -
The British Journal of Surgery Jan 2024There is a need to standardize training in robotic surgery, including objective assessment for accreditation. This systematic review aimed to identify objective tools...
BACKGROUND
There is a need to standardize training in robotic surgery, including objective assessment for accreditation. This systematic review aimed to identify objective tools for technical skills assessment, providing evaluation statuses to guide research and inform implementation into training curricula.
METHODS
A systematic literature search was conducted in accordance with the PRISMA guidelines. Ovid Embase/Medline, PubMed and Web of Science were searched. Inclusion criterion: robotic surgery technical skills tools. Exclusion criteria: non-technical, laparoscopy or open skills only. Manual tools and automated performance metrics (APMs) were analysed using Messick's concept of validity and the Oxford Centre of Evidence-Based Medicine (OCEBM) Levels of Evidence and Recommendation (LoR). A bespoke tool analysed artificial intelligence (AI) studies. The Modified Downs-Black checklist was used to assess risk of bias.
RESULTS
Two hundred and forty-seven studies were analysed, identifying: 8 global rating scales, 26 procedure-/task-specific tools, 3 main error-based methods, 10 simulators, 28 studies analysing APMs and 53 AI studies. Global Evaluative Assessment of Robotic Skills and the da Vinci Skills Simulator were the most evaluated tools at LoR 1 (OCEBM). Three procedure-specific tools, 3 error-based methods and 1 non-simulator APMs reached LoR 2. AI models estimated outcomes (skill or clinical), demonstrating superior accuracy rates in the laboratory with 60 per cent of methods reporting accuracies over 90 per cent, compared to real surgery ranging from 67 to 100 per cent.
CONCLUSIONS
Manual and automated assessment tools for robotic surgery are not well validated and require further evaluation before use in accreditation processes.PROSPERO: registration ID CRD42022304901.
Topics: Humans; Robotic Surgical Procedures; Artificial Intelligence; Clinical Competence; Robotics; Laparoscopy
PubMed: 37951600
DOI: 10.1093/bjs/znad331