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Background While the need for digital health capability and technological innovation in palliative care services is growing rapidly, relatively little is known about the current uptake and views of individual palliative care practitioners. This study aims to explore palliative care practitioners’ current use of and perspectives on digital health innovation in palliative care. Methods A descriptive cross-sectional survey with a web-based questionnaire was used. Participants were multidisciplinary palliative care practitioners in Australia. Results Surveys were returned by 170 medical, nursing, and allied health practitioners working in palliative care. Most respondents reported using a variety of digital health technology associated with clinical information systems, mobile devices, SMS text messaging, teleconferencing, and Wi-Fi. These technologies were used for the purpose of communicating with other health professionals, accessing web-based or mobile health palliative care resources, collecting or managing patient data, and providing information or education. However, few reported electronic access to patients’ advance care planning documentation or could update these data. Respondents were moderately confident in their ability to use digital health, held positive beliefs that palliative care could be enhanced through digital health, and were generally supportive of ongoing innovation through digitally-enable models of care. Palliative care providers would most like to see digital health innovations in the areas of client health records, telehealth, and personal health tracking. Conclusion This is the first national study of digital health in Australian palliative care providers. It contributes new knowledge in this important area of palliative care practice to guide policy and education, whilst informing future directions for research.

This study assessed Australian clinical practice guidelines for life-limiting index conditions for the extent to which they acknowledged comorbidities and framed management recommendations within the context of older age and reduced life expectancy. A comprehensive search identified current, evidence-based Australian guidelines for chronic life-limiting conditions directed at general practitioners. Guideline content was analysed qualitatively before comorbidity acknowledgements were quantified using a 17-item checklist. Full guidelines were quality appraised using AGREE-II. Ten documents covering chronic obstructive pulmonary disease, heart failure, cancer pain, dementia and palliative care in aged care were identified. Most guidelines addressed one ‘comorbid’ condition and prompted clinicians to consider patient quality of life and personal preferences. Fewer addressed burden of treatment and half suggested modifying treatments to account for limited life expectancy, age or time horizon to benefit. Half warned of potential adverse drug interactions. Guidelines were of moderate to very high quality. Guidelines naturally prioritised their index condition, directing attention to only the most common comorbidities. However, there may be scope to include more condition-agnostic guidance on multimorbidity management. This might be modelled on the ‘guiding principles’ approach now emerging internationally from organisations such as the American Geriatrics Society in response to increasing multimorbidity prevalence and evidence limitations.

Objectives: To investigate causes of death of people with cancer alive five years after diagnosis, and to compare mortality rates for this group with those of the general population. Design, setting, participants: Retrospective cohort study; analysis of South Australian Cancer Registry data for all people diagnosed with cancer during 1990–1999 and alive five years after diagnosis, with follow-up to 31 December 2016. Main outcome measures: All-cause and cancer cause-specific mortality, by cancer diagnosis; standardised mortality ratios (study group v SA general population) by sex, age at diagnosis, follow-up period, and index cancer. Results: Of 32 646 people with cancer alive five years after diagnosis, 30 309 were of European background (93%) and 16 400 were males (50%); the mean age at diagnosis was 60.3 years (SD, 15.7 years). The median follow-up time was 17 years (IQR, 11–21 years); 17 268 deaths were recorded (53% of patients; mean age, 80.6 years; SD, 11.4 years): 7845 attributed to cancer (45% of deaths) and 9423 attributed to non-cancer causes (55%). Ischaemic heart disease was the leading cause of death (2393 deaths), followed by prostate cancer (1424), cerebrovascular disease (1175), and breast cancer (1118). The overall standardised mortality ratio (adjusted for age, sex, and year of diagnosis) was 1.24 (95% CI, 1.22–1.25). The cumulative number of cardiovascular deaths exceeded that of cancer cause-specific deaths from 13 years after cancer diagnosis. Conclusions: Mortality among people with cancer who are alive at least five years after diagnosis was higher than for the general population, particularly cardiovascular disease-related mortality. Survivorship care should include early recognition and management of risk factors for cardiovascular disease. Refereed/Peer-reviewed

One approach to manage people with behaviours of concern including agitated or aggressive behaviours in health care settings is through the use of fast-acting medication, called chemical restraint. Such management often needs to be delivered in crisis situations to patients who are at risk of harm to themselves or others. This paper summarizes the available evidence on the effectiveness and safety of chemical restraint from 21 randomized controlled trials (RCTs) involving 3788 patients. The RCTs were of moderate to high quality and were conducted in pre-hospital, hospital emergency department, or ward settings. Drugs used in chemical restraint included olanzapine, haloperidol, droperidol, risperidol, flunitrazepam, midazolam, promethazine, ziprasidone, sodium valproate, or lorazepam. There was limited comparability between studies in drug choice, combination, dose, method of administration (oral, intramuscular, or intravenous drip), or timing of repeat administrations. There were 31 outcome measures, which were inconsistently reported. They included subjective measures of behaviours, direct measures of treatment effect (time to calm; time to sleep), indirect measures of agitation (staff or patient injuries, duration of agitative or aggressive episodes, subsequent violent episodes), and adverse events. The most common were time to calm and adverse events. There was little clarity about the superiority of any chemical method of managing behaviours of concern exhibited by patients in Emergency Departments or acute mental health settings. Not only is more targeted research essential, but best practice recommendations for such situations requires integrating expert input into the current evidence base.

STUDY OBJECTIVES: The referral burden on health care systems for routine sleep disorders could be alleviated by educating primary care providers (PCPs) to diagnose and manage patients with sleep health issues. This requires effective professional education strategies and resources. This scoping review examined the literature on existing approaches to educate PCPs in sleep health management. METHODS: A comprehensive literature search was conducted across 8 databases to identify citations describing the education of PCPs in diagnosing and managing sleep disorders, specifically insomnia and sleep apnea. A conceptual framework, developed from the knowledge-to-action cycle, was used to analyze citations from a knowledge translation perspective. RESULTS: Searches identified 616 unique citations and after selection criteria were applied, 22 reports were included. Reports spanning 38 years were analyzed using components of the knowledge-to-action cycle to understand how educational interventions were designed, developed, implemented, and evaluated. Interventions involved didactic (32%), active (18%), and blended (41%) approaches, using face-to-face (27%), technology-mediated (45%), and multimodal (5%) delivery. Educational effectiveness was assessed in 73% of reports, most commonly using a pre/post questionnaire (41%). CONCLUSIONS: While this scoping review has utility in describing existing educational interventions to upskill PCPs to diagnose and manage sleep disorders, the findings suggest that interventions are often developed without explicitly considering the evidence of best educational practice. Future interventional designs may achieve greater sustained effectiveness by considering characteristics of the target audience, the pedagogical approaches best suited to its needs, and any environmental drivers and barriers that might impede the translation of evidence into practice. CITATION: King S, Damarell R, Schuwirth L, Vakulin A, Chai-Coetzer CL, McEvoy RD. Knowledge to action: a scoping review of approaches to educate primary care providers in the identification and management of routine sleep disorders. J Clin Sleep Med. 2021;17(11):2307–2324.

General practitioners (GPs) are increasingly expected to provide palliative care as ageing populations put pressure on specialist services. Some GPs, however, cite barriers to providing this care including prognostication challenges and lack of confidence. Palliative care content within clinical practice guidelines might serve as an opportunistic source of informational support to GPs. This review analysed palliative care content within Australian guidelines for life-limiting conditions to determine the extent to which it might satisfy GPs’ stated information needs and support them to provide quality end-of-life care. Six databases and guideline repositories were searched (2011–2018). Eligible guidelines were those for a GP audience and explicitly based on an appraisal of all available evidence. Content was mapped against an established palliative care domain framework (PEPSI-COLA) and quality was assessed using AGREE-II. The nine guidelines meeting inclusion criteria were heterogenous in scope and depth of palliative care domain coverage. The ‘communication’ needs domain was best addressed while patient physical and emotional needs were variably covered. Spiritual, out-of-hours, terminal care and aftercare content was scant. Few guidelines addressed areas GPs are known to find challenging or acknowledged useful decision-support tools. A template covering important domains might reduce content variability across guidelines.

Additional file 1. Detailed development of Search Component 2.

Background Obesity and musculoskeletal pain are strongly related, but there is emerging evidence that body fat, not body weight, may be a better indicator of risk. There is, therefore, a need to determine if body fat is associated with musculoskeletal pain as it may improve management strategies. The aim of this systematic review was to investigate the association between body fat and musculoskeletal pain. Methods Seven electronic databases were searched from inception to 8th January 2018. Cross-sectional and longitudinal studies investigating the association between measures of body fat and musculoskeletal pain were included. All included articles were assessed for methodological rigour using the Epidemiology Appraisal Instrument. Standardised mean differences (SMDs) and effect estimates were pooled for meta-analysis. Results A total of 10,221 citations were identified through the database searching, which after abstract and full-text review, yielded 28 unique articles. Fourteen studies were included in the meta-analyses, which found significant cross-sectional associations between total body fat mass and widespread pain (SMD 0.49, 95% CI 0.37–0.61, p

Adolescent obesity is a risk factor for obesity and other chronic disease in adulthood. Evidence for the effectiveness of community-based obesity treatment programs for adolescents is required to inform policy and clinical decisions. This systematic review aims to evaluate recent effective and scalable community-based weight management programs for adolescents (13-17 years) who are overweight or obese. Eight databases (Medline, Embase, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Informit, and Scopus) were searched for studies published between January 2011-2 March 2017 which are scalable in a community setting and reported primary outcome measures relating to weight. Following deduplication, 10,074 records were screened by title/abstract with 31 publications describing 21 programs included in this review. Programs were heterogeneous in nature (including length, number and frequency of sessions, parent-involvement and technology involvement). Reduction in adolescent BMIz ranged from 2 to 9% post-program and from 2 to 11% after varied lengths of follow-up. Study quality varied (n = 5 weak; n = 8 moderate; n = 8 high), and findings are limited by the risk of selection and retention bias in the included studies. Factors including the effectiveness and acceptability to the target population must be considered when selecting such community programs.

This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant “grey” literature and websites. Included studies were checked for cited and citing papers. Primary studies corresponding to national and provincial ED and ES reforms in the four countries were considered. Only studies from Australia and the United Kingdom were eventually included, as no studies from the other two countries met the inclusion criteria. The reviewers involved in the study extracted the data independently using standardized forms. Studies were assessed for quality, and a narrative synthesis approach was taken to analyze the extracted data. The introduction of health care reforms in the form of time-based ED and ES targets led to improvement in ED LOS and ES access. However, the introduction of targets resulted in unintended consequences, such as increased pressure on clinicians and, in certain instances, manipulation of performance data.

Review objective: The objective of this scoping review is to identify, describe and compare studies investigating patient-reported outcomes (PROs) in esophageal cancer patients following neoadjuvant (preoperative) chemotherapy(CT) and surgery or neoadjuvant chemoradiotherapy (CRT) and surgery.After preliminary searching of the literature and consultation with experts in the fields of esophageal cancer surgery,behavioral science, information systems and scoping review methodology, the following research objectives were defined as follows: To identify, describe and compare the characteristics and timing of PROs, specifically, psychological and somatic quality of life and symptoms, experienced by esophageal cancer patients during and/or followingneoadjuvant CT or CRT. To identify and describe the instruments used to measure PROs in esophageal cancer patients followingneoadjuvant CT or CRT.

Purpose: This systematic narrative review describes and compares the development and operational approaches of monitoring systems without a clinical care component that collect patient-reported outcome (PRO) data from cancer survivors. Methods: Searches were conducted using Medline, PubMed, PsycINFO, the Cochrane Library, CINAHL, Scopus, Joanna Briggs Institute EBP Database and Google Scholar (Advanced). Sources of grey literature and websites of relevant organisations were also searched for relevant published and unpublished material. Articles were included if they described the development (including piloting) of monitoring systems with ongoing recruitment that collect PRO at more than one time point, from 6 months post-diagnosis onward. Results: The initial searches returned 7290 unique citations. After screening titles and abstracts, 39 full-text articles were retrieved for more detailed examination. Eleven articles were included in the review, representing seven international monitoring systems. Systems varied in their scope, implementation process, governance and administration, recruitment and data collection, consent rates, PRO collection, use of PRO and translation strategies. Conclusions: The most suitable approach for setting-up and implementing a monitoring system for ongoing surveillance will differ depending on the unique requirements, aims and level of resourcing available within a particular context. Better specification and consideration of how PRO data will be used, for what purpose, and by whom, is required to inform effective translational strategies to improve outcomes for cancer survivors. Implications for Cancer Survivors: The findings from this review may inform the future development of survivorship monitoring systems in varied environments, which in turn may improve practices that lead to better outcomes for survivors. Refereed/Peer-reviewed

Background The achievement of optimal results out of total knee arthroplasty surgery depends on fit and sizing of the implant over the bone. Mismatch between resected bone and implant alters the outcome of the surgery. Identifying the medial-lateral and anterior–posterior measurement in the resected femur lays the foundation for identifying the implant size. The ratio of medial-lateral and anterior–posterior measurement figures out the match between implant and bone. The bony architecture is influenced by ethnicity. Therefore it becomes essential to study distal bone notability from different indigenous origin groups. Questions/purposes This study incorporates a systematic review analysis of the English literature published on the anthropometric dimensions of the distal femur. The anterior–posterior and medial-lateral width values are assessed to determine the inherent ethnic differences in bony parameters. Methods An extensive search in seven search engines was performed to produce 9820 responses. This collection was imported in endnote library to finally obtain 6320 publications after duplication. Further detailed examination produced only 65 papers to undergo full-text inspection. After a thorough review of the full text, only 20 papers were found to be relevant for a systematic review. Results There were 8 different racial populations assessed in the various studies. Caucasians were studied by most of the authors. All papers imply the need of alterations in the current implant sizing to improve fitment in Asian population. Conclusions Most of the studies were performed with patients of Caucasian origin. The Asian sub-populations studies demonstrated the incongruence in implant sizing and anthropometric measures and therefore recommending that these ethnic differences need to be addressed in future implant design.

Background General practitioners (GPs) increasingly manage patients with multimorbidity but report challenges in doing so. Patients describe poor experiences with health care systems that treat each of their health conditions separately, resulting in fragmented, uncoordinated care. For GPs to provide the patient-centred, coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address this epidemiologic transition. This systematic review seeks to understand if and how multimorbidity impacts on the work of GPs, the strategies they employ to manage challenges, and what they believe still needs addressing to ensure quality patient care. Methods Systematic review and thematic synthesis of qualitative studies reporting GP experiences of managing patients with multimorbidity. The search included nine major databases, grey literature sources, Google and Google Scholar, a hand search of Journal of Comorbidity, and the reference lists of included studies. Results Thirty-three studies from fourteen countries were included. Three major challenges were identified: practising without supportive evidence; working within a fragmented health care system whose policies and structures remain organised around single condition care and specialisation; and the clinical uncertainty associated with multimorbidity complexity and general practitioner perceptions of decisional risk. GPs revealed three approaches to mitigating these challenges: prioritising patient-centredness and relational continuity; relying on knowledge of patient preferences and unique circumstances to individualise care; and structuring the consultation to create a sense of time and minimise patient risk. Conclusions GPs described an ongoing tension between applying single condition guidelines to patients with multimorbidity as security against uncertainty or penalty, and potentially causing patients harm. Above all, they chose to prioritise their long-term relationships for the numerous gains this brought such as mutual trust, deeper insight into a patient’s unique circumstances, and useable knowledge of each individual’s capacity for the work of illness and goals for life. GPs described a need for better multimorbidity management guidance. Perhaps more than this, they require policies and models of practice that provide remunerated time and space for nurturing trustful therapeutic partnerships.

Background Integrated care is an increasingly important principle for organising healthcare. Integrated care models show promise in reducing resource wastage and service fragmentation whilst improving the accessibility, patient-centredness and quality of care for patients. Those needing reliable access to the growing research evidence base for integrated care can be frustrated by search challenges reflective of the topic’s complexity. The aim of this study is to report the empirical development and validation of two search filters for rapid and effective retrieval of integrated care evidence in PubMed. One filter is optimised for recall and the other for precision. Methods An Expert Advisory Group comprising international integrated care experts guided the study. A gold standard test set of citations was formed from screening Handbook Integrated Care chapter references for relevance. This set was divided into a Term Identification Set (20%) for determining candidate terms using frequency analysis; a Filter Development Set (40%) for testing performance of term combinations; and a Filter Validation Set (40%) reserved for confirming final filter performance. In developing the high recall filter, recall was steadily increased while maintaining precision at ≥50%. Similarly, the high precision filter sought to maximise precision while keeping recall ≥50%. For each term combination tested, an approximation of precision was obtained by reviewing the first 100 citations retrieved in Medline for relevance. Results The gold standard set comprised 534 citations. The search filter optimised for recall (‘Broad Integrated Care Search’) achieved 86.0–88.3% recall with corresponding low precision (47–53%). The search filter optimised for precise searching (‘Narrow Integrated Care Search’) demonstrated precision of 73–95% with recall reduced to between 55.9 and 59.8%. These filters are now available as one-click URL hyperlinks in the website of International Foundation for Integrated Care. Conclusions The Broad and Narrow Integrated Care Search filters provide potential users, such as policy makers and researchers, seamless, reliable and ongoing access to integrated care evidence for decision making. These filters were developed according to a rigorous and transparent methodology designed to circumvent the challenges of information retrieval posed by this complex, multifaceted topic.

Introduction: Integrated care research evidence should be optimally visible and accessible to stakeholders. This study examines the contribution of specific databases to the discovery of integrated care evidence, and tests the usefulness of Medical Subject Heading (MeSH) indexing of this literature within PubMed. Methods: We used bibliometric methods to analyse the integrated care literature indexed within six databases between 2007 and 2016. An international expert advisory group assessed the relevance of citations randomly retrieved from PubMed using MeSH term ‘Delivery of Health Care, Integrated’. Results: Integrated care evidence is diffuse, spread across many journals. Between 2007 and 2016, integrated care citations grew substantially, with the rate of increase highest in Embase. PubMed contributes the largest proportion of unique citations (citations not included in any of the other databases analysed), followed by Embase, PsycINFO and CINAHL. On average, expert reviewers rated 42.5% of citations retrieved by MeSH term ‘Delivery of Health Care, Integrated’ as relevant to integrated care. When these citations were dual reviewed, inter-rater agreement was low. Conclusion: MeSH terms alone are insufficient to retrieve integrated care content from PubMed. Embase and CINAHL contain unique content not found in PubMed that should not be overlooked. A validated search filter is proposed to simplify the process of finding integrated care research for clinicians, managers and decision-makers.

Introduction Paramedics are often the first trained personal to assess sick or injured children. This raises the question of how well trained paramedics are to identify signs of child abuse or neglect. This systematic literature review seeks to establish the extent to which training programs improve a paramedic’s competence and confidence when it comes to identifying and reporting child abuse and neglect. Methods Selected search terms were entered into eight databases to identify potentially relevant publications. Inclusion and exclusion criteria were applied and articles were categorised as relevant or irrelevant based on a review of title and abstract and, when necessary, full text review. Results The initial electronic search yielded 872 articles. After duplicates were removed and the inclusion and exclusion criteria applied, four publications were identified as relevant and included in this systematic literature review. Of these, three were cross-sectional studies and one was a one-group pre-test post-test study. In total, 2499 subjects were examined across the four articles. Despite the limitations of each study, the results for all four studies were consistent with one another, demonstrating that higher levels of training correlated with greater knowledge and/or confidence regarding both the identification process and the correct procedures for reporting child abuse. Conclusion The limited evidence published so far suggests that training improves confidence and ability levels of the paramedic in recognising and reporting child abuse. However, the limitations of these studies need to be considered before drawing robust conclusions. We call for further research into the topic and suggest that, owing to the complexity of the issue, a qualitative study may be the best way of exploring the variety of barriers to reporting, and the extent to which training would overcome these.

This systematic review and meta-analysis synthesised the post-1990 literature examining the effect of human milk on morbidity, specifically necrotising enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and neurodevelopment in infants born ≤28 weeks’ gestation and/or publications with reported infant mean birth weight of ≤1500 g. Online databases including Medline, PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched, and comparisons were grouped as follows: exclusive human milk (EHM) versus exclusive preterm formula (EPTF), any human milk (HM) versus EPTF, higher versus lower dose HM, and unpasteurised versus pasteurised HM. Experimental and observational studies were pooled separately in meta-analyses. Risk of bias was assessed for each individual study and the GRADE system used to judge the certainty of the findings. Forty-nine studies (with 56 reports) were included, of which 44 could be included in meta-analyses. HM provided a clear protective effect against NEC, with an approximate 4% reduction in incidence. HM also provided a possible reduction in LOS, severe ROP and severe NEC. Particularly for NEC, any volume of HM is better than EPTF, and the higher the dose the greater the protection. Evidence regarding pasteurisation is inconclusive, but it appears to have no effect on some outcomes. Improving the intake of mother’s own milk (MOM) and/or donor HM results in small improvements in morbidity in this population.

Ovid Medline search strategy. Example of database search strategy. (DOCX 73 kb)

Reasons for exclusion from meta-analysis. Reasons for exclusion of cross-sectional studies from the meta-analyses. (DOCX 135 kb)

Objectives Health professionals must be able to search competently for evidence to support practice. We sought to understand how palliative care clinicians construct searches for palliative care literature in PubMed, to quantify search efficacy in retrieving a set of relevant articles and to compare performance against a Palliative CareSearch Filter (PCSF). Methods Included studies from palliative care systematic reviews formed a test set. Palliative care clinicians (n = 37) completed a search task using PubMed. Individual clinician searches were reconstructed in PubMed and combined with the test set to calculate retrieval sensitivity. PCSF performance in the test set was also determined. Results Many clinicians struggled to create useful searches. Twelve used a single search term, 17 narrowed the search inappropriately and 8 confused Boolean operators. The mean number of test set citations (n = 663) retrieved was 166 (SD = 188), or 25% although 76% of clinicians believed they would find more than 50% of the articles. Only 8 participants (22%) achieved this. Correlations between retrieval and PubMed confidence (r = 0.13) or frequency of use (r = −0.18) were weak. Conclusions Many palliative care clinicians search PubMed ineffectively. Targeted skills training and PCSF promotion may improve evidence retrieval.

Background The aim of this review was to systematically assess the current evidence available regarding knee instability after TKA to identify time to failure between primary and revision TKA. In addition, we considered the patient, surgical and implant characteristics of primary TKA patients revised for knee instability, and investigated methods used for knee instability diagnosis. Methods A systematic search of six databases and the unpublished literature was performed. Studies referring to instability in post-operative primary TKA patients, reporting on revision TKA due to instability, and published or available between 2005 to 30-Mar-2015 were eligible for inclusion. Quantitative data for continuous variables were pooled in statistical meta-analyses. Results A total of 1841 unique studies were identified, 42 of which met the selection criteria and a total of 22 studies included in the review. Time to failure between primary and revision TKA was 44.7 months (95% CI [33.8, 55.7]), and the weighted mean age at time of revision surgery was 67.6 years (95% CI [65.38, 69.75]). A gender distribution was identified, with approximately 16.4% more females revised for instability, however this was unable to be corrected for the baseline population. The majority of studies used a combination of radiographic and clinical testing to diagnose knee instability. Conclusions Research on knee instability following primary TKA reported early failure and subsequent revision knee surgery. The need for revision due to instability was frequently reported in a younger patient cohort and most commonly in female TKA patients. Early revision at a younger age highlights the severe implications of an unstable knee.

The vision for Australia's national electronic health record system included empowering consumers to become active participants in their own health care. This paper aims to critically review the literature on consumer perspectives of Australia's My Health Record (formerly PCEHR). The review is based on a subset of articles (n=12) identified in the Australian EHR Repository (N=143), a repository of metadata of Australian Research on EHR located at Flinders University. Results show low levels of awareness and concerns about sharing records and equity of access for all Australians, which in view of the change from opt in to opt out raises concerns about explicit consent. Improved promotion and support, along with different models of access might lead to higher consumer engagement with, and use, of My Health Record, especially for populations at risk of digital exclusion.

BACKGROUND Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide, and chest pain is one of the most common symptoms of ACSs. A rapid response to chest pain by patients and appropriate management by health professionals are vital to improve survival rates.People from different ethnic groups are likely to have different perceptions of chest pain, its severity and the need for urgent treatment. These differences in perception may contribute to differences in response to chests pain and precipitate unique coping strategies. Delay in seeking medical care for chest pain in the general population has been well documented; however, limited studies have focused on delay times within ethnic groups. There is little research to date as to whether ethnicity is associated with the time taken to seek medical care for chest pain. Consequently, addressing this gap in knowledge will play a crucial role in improving the health outcomes of culturally and linguistically diverse (CALD) patients suffering from chest pain and for developing appropriate clinical practice and public awareness for these populations. OBJECTIVES The current review aimed to determine if there is an association between ethnicity and delay in seeking medical care for chest pain among CALD populations. INCLUSION CRITERIA TYPES OF PARTICIPANTS Patients from different ethnic minority groups presenting to emergency departments (EDs) with chest pain. TYPES OF EXPOSURE The current review will examine studies that evaluate the association between ethnicity and delay in seeking medical care for chest pain among CALD populations. TYPES OF STUDIES The current review will consider quantitative studies including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. OUTCOMES The current review will consider studies that measure delay time as the main outcome. The time will be measured as the interval between the time of symptom onset and time to reach an ED. SEARCH STRATEGY A comprehensive search was undertaken for relevant published and unpublished studies written in English with no date restriction. All searches were conducted in October 2014. We searched the following databases: MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest (health databases only), Informit, Sociological Abstracts, Scopus and Web of Science. The search for unpublished studies included a wide range of 'gray literature' sources including national libraries, digital theses repositories and clinical trial registries. We also targeted specific health research, specialist cardiac, migrant health, and emergency medicine organizational websites and/or conferences. We also checked the reference lists of included studies and contacted authors when further details about reported data was required to make a decision about eligibility. METHODOLOGICAL QUALITY Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to being included in the review. Validity was assessed using standardized critical appraisal instruments from the Joanna Briggs Institute. Adjudication was produced by the third reviewer. DATA EXTRACTION Data were extracted from included articles by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS The extracted data were synthesized into a narrative summary. Meta-analysis could not be performed due to the heterogeneity of study protocols and methods used to measure outcomes. RESULTS A total of 10 studies, with a total of 1,511,382 participants, investigating the association between ethnicity and delay met the inclusion criteria. Delay times varied across ethnic groups, including Black, Hispanic, Asian, South Asian, Southeast Asian and Chinese. Seven studies reported delay in hours and ranged from 1.90 to 3.10 h. Delay times were longer among CALD populations than the majority population. The other three studies reported delay time in categories of time (e.g.

Introduction: Integrated care IC is a multifaceted concept, with a vast range of overlapping terminologies. Bibliometric analyses have demonstrated the evidence base for IC is diffuse. Peer-reviewed research is published in a range of journals which are indexed in bibliographic databases with subject coverage extending beyond health. A significant amount of relevant IC literature is found outside conventional publishing channels in the grey literature. Thus, practitioners and researchers face significant challenges to finding relevant IC literature. To address the issues associated with retrieving integrated care literature, an IC search filter, badged as Integrated Care Search ICS, was developed. A search filter is an evidence-based search strategy with a known level of retrieval effectiveness. Various “value adding” products were also developed to enhance the effectiveness and usability of the search filter. Methods: Following a well-established experimental methodology [1], and informed by bibliometric analyses and consultation with an established Expert Advisory Group EAG, ICS was developed and validated for use in PubMed. Additionally, a research librarian translated the validated search filter for use in other databases, and developed a guide for searching the grey literature for content relevant to IC. Finally, input from the EAG was solicited via survey to guide the development of relevant topic searches to be combined with the search filter to further refine results. Results: Given the challenges associated with IC literature retrieval, two versions of the validated search filter were developed. ICS Narrow enables more precise searching, whereas ICS Broad enables more sensitive searching. Supplementary topic searches covering care settings, populations, geographic regions and facets of IC are provided, to enable more focused searching by end-users. Both search filters were translated for use in other databases including: Medline Ovid, Embase Ovid, PsycINFO Ovid, CINAHL EBSCOhost, Cochrane Library Wiley, Scopus, Web of Science, and ProQuest. Finally, step-by-step instructions for searching for relevant IC grey literature were developed.These products are available on an interim site https://www.caresearch.com.au/caresearch/tabid/4757/Default.aspx, and it is planned that they will be moved to the IFIC website in time for launch at ICIC18. Discussion: ICS and its associated value-adding products provide end users with the ability to locate difficult-to-retrieve published and unpublished IC literature. Conclusions: A flexible approach to database searching using a combination of keyword and subject headings is required for optimal retrieval of the published IC literature across a range of databases. Lessons learned: The polymophous nature of IC necessitated the development of not one but two validated search filters, and an additional suite of products, including guidance for IC grey literature retrieval. Limitations: The envisioned functionality of the search filters has not been fully achieved, as they are currently hosted on an interim site. Suggestions for future research: Further research studies could include an evaluation of the impact of Integrated Care Search on end-user satisfaction with retrievals and search confidence. References: 1- Tieman JJ, Lawrence MA, Damarell RA, Sladek RM, Nikolof A. LIt.search: fast tracking access to Aboriginal and Torres Strait Islander health literature. Australian Health Review. 2014;385:541-5. doi:10.1071/ah14019.

Introduction: Evidence from quality research is vital for demonstrating the effectiveness of integrated care in reducing health care fragmentation. Locating that evidence should be a crucial precursor to its use in informed policy making and organisational reform. Finding integrated care research may, however, present challenges due to a multiplicity of definitions and frameworks, and relevance across a range of sectors, organisations, and professional groups. Understanding difficulties in finding integrated care evidence could aid in the development of practical measures to make it more visible. This might include customised repositories, search tools, or strategies for improving dissemination. Bibliometric analysis is one method for examining published literature relevant to a field of research or practice. It is particularly useful for mapping complex, fluid and diffuse fields such as integrated care. This study builds on and extends a previous bibliometric analysis by Sun[1] by investigating: the growth of the integrated care literature; the core journals in which it is published; the combination of bibliographic databases required to find the majority of the literature; and the value of the PubMed standardized term Medical Subject Heading for retrieving it. Methods: The broad term ‘Integrated care’ was searched across the title, abstract, and subject heading fields within PubMed, CINAHL, EMBASE Ovid, PsycINFO Ovid, EconLit Ovid and Cochrane Central Register of Controlled Trials. The citations retrieved were analysed for frequency by year and country of publication, author, journal name, natural language terms, and subject headings. In addition, the performance of the Medical Subject Heading MeSH term ‘Delivery of Health Care, Integrated’ was tested by asking an advisory group of integrated care experts n=8 to each screen a set of 100 citations retrieved by this heading and indicating relevance of each. Results: A wide range of terms and journal titles contribute to the integrated care body of evidence and multiple databases provide access to a significant number of unique citations beyond PubMed. Furthermore, Interrater agreement was low on the relevance of citations retrieved by PubMed’s main integrated care MeSH term. Discussion: This study confirms the diffuse nature of the integrated care research literature and highlights factors that may make it inherently difficult to find via search mechanisms. This includes a lack of consensus between experts as to the relevance of literature retrieved by its main indexing term in PubMed. Conclusions: Our findings suggest a need for search solutions to enhance the identification and, by extension, utilisation, of the integrated care literature. Limitations: The use of the single broad term ‘integrated care’ to find citations across databases was a pragmatic approach to finding a core set of literature for analysis. We acknowledge that integrated care is described by a variety of terms and this approach would not find a substantial subset of relevant citations. Suggestions for future research: Following this study, an integrated care search filter was developed for finding the literature in PubMed. Other practical tools for finding integrated care literature are advocated.

Introduction : This workshop is an interactive demonstration of a validated search filter which has been developed to assist clinicians and managers in locating published research on integrated care. The presenters will give a brief overview of the project and the methodology used. They will demonstrate the beta version of the search filter and invite comment and feedback from the audience. Attendees are encouraged to share their experiences in locating the peer-reviewed literature on IC, including specific questions on aspects of IC for which evidence is sought. Integrated care (IC) is a prime driver of healthcare policy and practice reform internationally as governments and healthcare organisations endeavour to enhance efficiencies and patient-centred care . It is, however, a multifaceted concept, with a vast range of overlapping terminologies, and arguably lacks a unifying definition [1]. Search filters represent one innovative solution to this problem, by enabling brokered access to the underlying evidence base for rapid utilisation. Methods : The International Foundation for Integrated Care (IFIC), Central Coast Local Health District (NSW), The University of Newcastle (NSW), and Flinders Filters, Flinders University (SA)[2] collaborated to create an IC search filter (or “search strategy”) with known retrieval effectiveness in the PubMed Database, using a well-established experimental methodology[3]. Results: An IC search filter with a known level of sensitivity has been developed and validated for PubMed. This filter will be combined with a range of topics of interest to the IC community for more focused retrieval. These topics will include patient-centred care; health and social care integration; and chronic disease management. The search filter, badged as Integrated Care Search, will be made available on the IFIC website at https://integratedcarefoundation.org/ Discussions : IC is a polymorphous topic with contextually different meanings. Despite inherent complexities, under the guidance of international experts, it was possible to develop and validate a search filter which is capable of retrieving PubMed indexed IC literature at multiple levels of granularity through simple, one-click links. Integrated Care Search will improve the ease, speed, and accuracy by which IC evidence is found. End-users can rely on the fact that it comprises a range of core IC concept terms, comprehensively identified and tested in a set of literature deemed of importance by IC experts. References : 1- World Health Organization. Health Services Delivery Programme. Division of Health Systems and Public Health. Integrated care models: an overview. Copenhagen: WHO Regional Office for Europe; 2016. 2- Flinders University. Flinders Filters [internet]. Bedford Park SA: Flinders University [unknown date] [cited 2017 Sept 29]. Available from: http://www.flinders.edu.au/clinical-change/research/flinders-filters/ 3- Tieman JJ, Lawrence MA, Damarell RA, Sladek RM, Nikolof A. LIt.search: fast tracking access to Aboriginal and Torres Strait Islander health literature. Australian Health Review. 2014;38(5):541-5. doi:10.1071/ah14019.

BackgroundDespite the potential of technology-based mental health interventions for young people, limited uptake and/or adherence is a significant challenge. It is thought that involving young people in the development and delivery of services designed for them leads to better engagement. Further research is required to understand the role of participatory approaches in design of technology-based mental health and well-being interventions for youth. ObjectiveTo investigate consumer involvement processes and associated outcomes from studies using participatory methods in development of technology-based mental health and well-being interventions for youth. MethodsFifteen electronic databases, using both resource-specific subject headings and text words, were searched describing 2 broad concepts-participatory research and mental health/illness. Grey literature was accessed via Google Advanced search, and relevant conference Web sites and reference lists were also searched. A first screening of titles/abstracts eliminated irrelevant citations and documents. The remaining citations were screened by a second reviewer. Full text articles were double screened. All projects employing participatory research processes in development and/or design of (ICT/digital) technology-based youth mental health and well-being interventions were included. No date restrictions were applied; English language only. Data on consumer involvement, research and design process, and outcomes were extracted via framework analysis. ResultsA total of 6210 studies were reviewed, 38 full articles retrieved, and 17 included in this study. It was found that consumer participation was predominantly consultative and consumerist in nature and involved design specification and intervention development, and usability/pilot testing. Sustainable participation was difficult to achieve. Projects reported clear dichotomies around designer/researcher and consumer assumptions of effective and acceptable interventions. It was not possible to determine the impact of participatory research on intervention effectiveness due to lack of outcome data. Planning for or having pre-existing implementation sites assisted implementation. The review also revealed a lack of theory-based design and process evaluation. ConclusionsConsumer consultations helped shape intervention design. However, with little evidence of outcomes and a lack of implementation following piloting, the value of participatory research remains unclear.

Background: Reports from patients on seeing or hearing a dead relative or dreaming a highly significant dream at the end of life can be perplexing for health professionals who may wonder how best to respond. Aim: The aim of this study was to systematically review the literature on deathbed phenomena (DBP), and provide suggestions for a clinical response to dying patients’ recounts of these hard-to-explain phenomena. Methods: The authors searched for relevant studies which reported on DBP within a palliative care context. Eligibility criteria were established, a review process was employed and a narrative synthesis approach was used to interpret the data. Results: In total, eight papers met the inclusion criteria. Reported prevalence of DBP ranged from 24–51% with common themes described. Distinguishing between DBP and hallucinations was discussed, requiring very different clinical responses. Phenomena were timed most often in the last hours or days before death. Experiencing a DBP was, in most cases, deeply meaningful, bringing comfort, peace and reassurance. Health professionals were not surprised to hear of a DBP, but were not always well prepared to respond appropriately. Conclusions: Rather than simply dismissing DBP as medication related or the physiological effects of dying, the significance of these events and the comfort afforded by them to patients and carers should be recognised. Disclosure of DBP may enable health professionals to discuss more spiritual and existential concerns, which have the potential to offer hope, meaning and connection. We propose strategies and approaches for strengthening compassionate clinical practice in this area.

REVIEW QUESTION: What is the effectiveness of non-pharmacological interventions for the management of cancer treatment-induced cardiotoxicity? INCLUSION CRITERIA: Types of participants : This review will consider any studies that include patients, irrespective of age or gender, diagnosed with any type of cancer, who are treated with chemotherapy and/or radiotherapy, with or without an additional surgical intervention, and diagnosed with a cardiac complication as a result of that treatment. Studies will be included regardless of active or previous cancer therapy undertaken by participants prior to involvement with the study intervention(s). Non-English language studies will be assessed by scientific translation services if required and included, based on inclusion criteria. Types of intervention(s): The types of interventions to be explored in this review are non-pharmacological interventions for cardiac function and may include but are not limited to: Cardiac rehabilitation, Exercise, Cessation of smoking, Dietary modifications, Meditation, Yoga and Massage. Comparator: Participants who were offered standard care for the ongoing management cancer and/or heart failure. Types of outcomes: This review will consider studies that include the following outcome measures. Primary outcomes (changes to cardiac function): Primary signs of heart failure such as shortness of breath and changes in resting heart rate measured by beats per minute VO 2MAX measured by peak expiratory volume (ml/kg/min or L/min) during exercise test on cycle ergometer or treadmill Six-minute walk test measuring the total distance in steps or meters walked in six minutes measuring aerobic capacity Body Mass Index as measured by approved body composition analyzer or manual calculation (height [kg]/weight [cms] 2 ).

Background The evidence base developed by, and relevant to, primary health care (PHC) is rapidly increasing. With the wealth of literature available, searchers trying to find PHC-specific citations can feel overwhelmed. Objectives Flinders Filters and the Primary Health Care Research & Information Service collaborated to develop a search filter enabling efficient and effective retrieval of relevant PHC literature. Methods Stage 1 involved developing a PHC Search Filter in the OvidSP Medline platform using a rigorous experimental methodology. The search filter was then translated for Web-based ‘one-click searching’ in PubMed during Stage 2. Stage 3 involved planning and implementing a mixed-methods evaluation. Results The search filter sensitivity was 77.0% with a post hoc relevance assessment of 78.3%. Four months after its launch, a mixed-methods study evaluated the PHC Search Filter. With 90 respondents, analysis of data from the online survey demonstrated overarching benefits, a positive response to the tool and directions for further refinement of the PHC Search Filter. Discussion Designing the PHC Search Filter followed an established method that ensures the tool offers a validated search strategy. Evaluation results suggest that the PHC Search Filter is a useful tool that is easy to navigate. Challenges for the Filter relate to access to full text articles, while challenges for the evaluation relate to the small sample size. Conclusions The PHC Search Filter reduces the burden associated with literature searching, increases the value of the results that are received and provides a useful resource to improve the likelihood of incorporating relevant evidence into policy and practice.

Objective To develop and validate a PubMed search filter, LIt.search, that automatically retrieves Aboriginal and Torres Strait Islander health literature and to make it publicly accessible through the Lowitja Institute website. Methods Search filter development phases included: (1) scoping of the publication characteristics of Aboriginal and Torres Start Islander literature; (2) advisory group input and review; (3) systematic identification and testing of MeSH and text word terms; (4) relevance assessment of the search filter’s retrieved items; and (5) translation for use in PubMed through the web. Results Scoping study analyses demonstrated complexity in the nature and use of possible search terms and publication characteristics. The search filter achieved a recall rate of 84.8% in the full gold standard test set. To determine real-world performance, post-hoc assessment of items retrieved by the search filter in PubMed was undertaken with 87.2% of articles deemed as relevant. The search filter was constructed as a series of URL hyperlinks to enable one-click searching. Conclusion LIt.search is a search tool that facilitates research into practice for improving outcomes in Aboriginal and Torres Strait Islander health and is publicly available on the Lowitja Institute website. What is known about this topic? Health professionals, researchers and decision makers can find it difficult to retrieve published literature on Aboriginal and Torres Strait Islander health easily, effectively and in a timely way. What does this paper add? This paper describes a new web-based searching tool, LIt.search, which facilitates access to the relevant literature. What are the implications for practice? Ready access to published literature on Aboriginal and Torres Strait Islander health reduces a barrier to the use of this evidence in practice. LIt.search encourages the use of this evidence to inform clinical judgement and policy and service decision-making as well as reducing the burdens associated with searching for community practitioners, academics and policy makers.

Background Heart failure is a highly debilitating syndrome with a poor prognosis primarily affecting the elderly. Clinicians wanting timely access to heart failure evidence to provide optimal patient care can face many challenges in locating this evidence. This study developed and validated a search filter of high clinical utility for the retrieval of heart failure articles in OvidSP Medline. Methods A Clinical Advisory Group was established to advise study investigators. The study set of 876 relevant articles from four heart failure clinical practice guidelines was divided into three datasets: a Term Identification Set, a Filter Development Set, and a Filter Validation Set. A further validation set (the Cochrane Validation Set) was formed using studies included in Cochrane heart failure systematic reviews. Candidate search terms were identified via word frequency analysis. The filter was developed by creating combinations of terms and recording their performance in retrieving items from the Filter Development Set. The filter's recall was then validated in both the Filter Validation Set and the Cochrane Validation Set. A precision estimate was obtained post-hoc by running the filter in Medline and screening the first 200 retrievals for relevance to heart failure. Results The four-term filter achieved a recall of 96.9% in the Filter Development Set; 98.2% in the Filter Validation Set; and 97.8% in the Cochrane Validation Set. Of the first 200 references retrieved by the filter when run in Medline, 150 were deemed relevant and 50 irrelevant. The post-hoc precision estimate was therefore 75%. Conclusions This study describes an objective method for developing a validated heart failure filter of high recall performance and then testing its precision post-hoc. Clinical practice guidelines were found to be a feasible alternative to hand searching in creating a gold standard for filter development. Guidelines may be especially appropriate given their clinical utility. A validated heart failure filter is now available to support health professionals seeking reliable and efficient access to the heart failure literature.

Quality assessment. Quality assessment of the articles included in the systematic review. (DOCX 140 kb)

Background: PubMed translations of OvidSP Medline search filters offer searchers improved ease of access. They may also facilitate access to PubMed’s unique content, including citations for the most recently published biomedical evidence. Retrieving this content requires a search strategy comprising natural language terms (‘textwords’), rather than Medical Subject Headings (MeSH). We describe a reproducible methodology that uses a validated PubMed search filter translation to create a textword-only strategy to extend retrieval to PubMed’s unique heart failure literature. Methods: We translated an OvidSP Medline heart failure search filter for PubMed and established version equivalence in terms of indexed literature retrieval. The PubMed version was then run within PubMed to identify citations retrieved by the filter’s MeSH terms (Heart failure, Left ventricular dysfunction, and Cardiomyopathy). It was then rerun with the same MeSH terms restricted to searching on title and abstract fields (i.e. as ‘textwords’). Citations retrieved by the MeSH search but not the textword search were isolated. Frequency analysis of their titles/ abstracts identified natural language alternatives for those MeSH terms that performed less effectively as textwords. These terms were tested in combination to determine the best performing search string for reclaiming this ‘lost set’. This string, restricted to searching on PubMed’s unique content, was then combined with the validated PubMed translation to extend the filter’s performance in this database. Results: The PubMed heart failure filter retrieved 6829 citations. Of these, 834 (12%) failed to be retrieved when MeSH terms were converted to textwords. Frequency analysis of the 834 citations identified five high frequency natural language alternatives that could improve retrieval of this set (cardiac failure, cardiac resynchronization, left ventricular systolic dysfunction, left ventricular diastolic dysfunction, and LV dysfunction). Together these terms reclaimed 157/834 (18.8%) of lost citations. Conclusions: MeSH terms facilitate precise searching in PubMed’s indexed subset. They may, however, work less effectively as search terms prior to subject indexing. A validated PubMed search filter can be used to develop a supplementary textword-only search strategy to extend retrieval to PubMed’s unique content. A PubMed heart failure search filter is available on the CareSearch website (www.caresearch.com.au) providing access to both indexed and non-indexed heart failure evidence., This study was conducted as part of the work of the CareSearch Project. CareSearch is funded by the Australian Government Department of Health and Ageing.