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BackgroundThere is a growing role of digital health technologies (DHTs) in the management of chronic health conditions, specifically type 2 diabetes. It is increasingly important that health technologies meet the evidence standards for health care settings. In 2019, the National Institute for Health and Care Excellence (NICE) published the NICE Evidence Standards Framework for DHTs. This provides guidance for evaluating the effectiveness and economic value of DHTs in health care settings in the United Kingdom. ObjectiveThe aim of this study is to assess whether scientific articles on DHTs for the self-management of type 2 diabetes mellitus report the evidence suggested for implementation in clinical practice, as described in the NICE Evidence Standards Framework for DHTs. MethodsWe performed a scoping review of published articles and searched 5 databases to identify systematic reviews and primary studies of mobile device–delivered DHTs that provide self-management support for adults with type 2 diabetes mellitus. The evidence reported within articles was assessed against standards described in the NICE framework. ResultsThe database search yielded 715 systematic reviews, of which, 45 were relevant and together included 59 eligible primary studies. Within these, there were 39 unique technologies. Using the NICE framework, 13 technologies met best practice standards, 3 met minimum standards only, and 23 technologies did not meet minimum standards. ConclusionsOn the assessment of peer-reviewed publications, over half of the identified DHTs did not appear to meet the minimum evidence standards recommended by the NICE framework. The most common reasons for studies of DHTs not meeting these evidence standards included the absence of a comparator group, no previous justification of sample size, no measurable improvement in condition-related outcomes, and a lack of statistical data analysis. This report provides information that will enable researchers and digital health developers to address these limitations when designing, delivering, and reporting digital health technology research in the future.

BackgroundHandheld computers and mobile devices provide instant access to vast amounts and types of useful information for health care professionals. Their reduced size and increased processing speed has led to rapid adoption in health care. Thus, it is important to identify whether handheld computers are actually effective in clinical practice. ObjectiveA scoping review of systematic reviews was designed to provide a quick overview of the documented evidence of effectiveness for health care professionals using handheld computers in their clinical work. MethodsA detailed search, sensitive for systematic reviews was applied for Cochrane, Medline, EMBASE, PsycINFO, Allied and Complementary Medicine Database (AMED), Global Health, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. All outcomes that demonstrated effectiveness in clinical practice were included. Classroom learning and patient use of handheld computers were excluded. Quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A previously published conceptual framework was used as the basis for dual data extraction. Reported outcomes were summarized according to the primary function of the handheld computer. ResultsFive systematic reviews met the inclusion and quality criteria. Together, they reviewed 138 unique primary studies. Most reviewed descriptive intervention studies, where physicians, pharmacists, or medical students used personal digital assistants. Effectiveness was demonstrated across four distinct functions of handheld computers: patient documentation, patient care, information seeking, and professional work patterns. Within each of these functions, a range of positive outcomes were reported using both objective and self-report measures. The use of handheld computers improved patient documentation through more complete recording, fewer documentation errors, and increased efficiency. Handheld computers provided easy access to clinical decision support systems and patient management systems, which improved decision making for patient care. Handheld computers saved time and gave earlier access to new information. There were also reports that handheld computers enhanced work patterns and efficiency. ConclusionsThis scoping review summarizes the secondary evidence for effectiveness of handheld computers and mhealth. It provides a snapshot of effective use by health care professionals across four key functions. We identified evidence to suggest that handheld computers provide easy and timely access to information and enable accurate and complete documentation. Further, they can give health care professionals instant access to evidence-based decision support and patient management systems to improve clinical decision making. Finally, there is evidence that handheld computers allow health professionals to be more efficient in their work practices. It is anticipated that this evidence will guide clinicians and managers in implementing handheld computers in clinical practice and in designing future research.

The approach to identifying evidence for inclusion in realist reviews differs from that used in 'traditional' systematic reviews. Guidance suggests that realist reviews should be inclusive of diverse data from a range of sources, gathered in iterative searching cycles. Saturation is prioritised over exhaustiveness. Supplementary techniques such as citation snowballing are emphasised as potentially important sources of evidence. This paper describes the processes used to identify evidence in a selection of realist reviews focused on primary health care settings and examines the origin and type of evidence selected for inclusion. Data from five realist reviews were extracted from (a) reviewers' reference management libraries and (b) records kept by review teams. Although all reviews focused on primary health care, they used data from a wide range of document types and research designs, drawing on learning from multiple perspectives and settings, and sourced the documents containing this data in a variety of ways. Systematic searching of academic databases played an important role, supplementary search techniques such as snowballing were used to identify a significant proportion of documents included in the reviews. Our analysis demonstrates the diverse data sources used within realist reviews and the need for flexible, responsive efforts to identify relevant documents. Reviewers and information specialists should devise approaches to data gathering that reflect the individual needs of realist review projects and report these transparently.

The involvement of non-researcher contributors (eg, stakeholders, patients and the public, decision and policy makers, experts, lay contributors) has taken a variety of forms within evidence syntheses. Realist reviews are a form of evidence synthesis that involves non-researcher contributors yet this practice has received little attention. In particular, the role of patient and public involvement (PPI) has not been clearly documented. This review of reviews describes the ways in which contributor involvement, including PPI, is documented within healthcare realist reviews published over the last five years. A total of 448 papers published between 2014 and 2019 were screened, yielding 71 full-text papers included in this review. Statements about contributor involvement were synthesized across each review using framework analysis. Three themes are described in this article including nomenclature, nature of involvement, and reporting impact.

Objective To explore how primary care organizations assess and subsequently act upon the social determinants of noncommunicable diseases in their local populations. Methods For this systematic review we searched the online databases of PubMed[R], MEDLINE[R], Embase[R] and the Health Management Information Consortium from inception to 28 June 2019, along with hand-searching of references. Studies of any design that examined a primary care organization assessing social determinants of noncommunicable diseases were included. For quality assessment we used Cochrane's tool for assessing risk of bias in non-randomized studies of interventions. We used narrative data synthesis to appraise the extent to which the assessments gathered data on the domains of the World Health Organization social determinants of health framework. Findings We identified 666 studies of which 17 were included in the review. All studies used descriptive study designs. Clinic-based and household surveys and interviews were more commonly used to assess local social determinants than population-level data. We found no examples of organizations that assessed sociopolitical drivers of noncommunicable diseases; all focused on sociodemographic factors or circumstances of daily living. Nevertheless, the resulting actions to address social determinants ranged from individual-level interventions to population-wide measures and introducing representation of primary care organizations on system-level policy and planning committees. Conclusion Our findings may help policy-makers to consider suitable approaches for assessing and addressing social determinants of health in their domestic context. More rigorous observational and experimental evidence is needed to ascertain whether measuring social determinants leads to interventions which mitigate unmet social needs and reduce health disparities. [phrase omitted] [phrase omitted] Objectif Etudier la fagon dont les organlsmes de soins primaires evaluent et ensuite agissent sur les determinants sociaux des maladies non transmissibles au sein de leur population locale. Methodes Pour cette revue systematique, nous avons mene nos recherches dans les bases de donnees en ligne de PubMed[R], MEDLINE[R], Embase[R] ainsi que du Health Management Information Consortium, depuis sa creation jusqu'au 28 juin 2019, mais aussi cherche manuellement plusieurs references. Quel que soit leur modele, toutes les etudes qui portaient sur des organismes de soins primaires evaluant les determinants sociaux des maladies non transmissibles ont ete incluses. Afin de mesurer la qualite, nous avons employe l'outil Cochrane destine a determiner le risque de biais dans les etudes non randomisees sur les interventions. Nous avons egalement etabli une synthese narrative de donnees, pour definir dans quelle mesure les evaluations recoltaient des donnees dans les domaines couverts par les determinants sociaux de la sante caracterises par l'Organisation mondiale de la Sante. Resultats Nous avons identifie 666 etudes, dont 17 figurent dans cette revue. Toutes avaient eu recours a des modeles descriptifs. Les enquetes et entretiens realises dans les cliniques et aupres des menages etaient plus frequemment utilises que les donnees sur l'ensemble de la population pour reperer les determinants sociaux a l'echelle locale. Nous n'avons trouve aucun exemple d'organisme tenant compte des moteurs sociopolitiques en lien avec les maladies non transmissibles; tous se concentraient sur des facteurs sociodemographiques ou des conditions de vie specifiques. Neanmoins, les actions visant a avoir un impact sur les determinants sociaux etaient multiples: des interventions au niveau individuel jusqu'aux mesures applicables a l'integralite de la population, en passant par une representation inedite des organismes de soins primaires dans les strategies de systeme et les comites de planification. Conclusion Nos decouvertes pourraient aider les legislateurs a envisager des approches plus adaptees pour evaluer et aborder les determinants sociaux de la sante dans leur contexte national. Des observations et preuves experimentales supplementaires sont necessaires, afin de verifier si le fait d'identifier les determinants sociaux engendre des actions concretes qui repondent partiellement aux besoins sociaux non satisfaits et reduit les inegalites sanitaires. [phrase omitted] Objetivo Estudiar como las organizaciones de atencion primaria evaluan y aplican posteriormente los determinantes sociales de las enfermedades no transmisibles en sus poblaciones locales. Metodos Para esta revision sistematica se realizaron busquedas en las bases de datos en linea de PubMed[R], MEDLINE[R], Embase[R] y el Health Management Information Consortium desde su inicio hasta el 28 de junio de 2019, junto con una busqueda manual de referencias. Se incluyeron estudios de todos los disenos que analizaron a una organizacion de atencion primaria en la que se evaluaban los determinantes sociales de las enfermedades no transmisibles. Para la evaluacion de la calidad se utilizo la herramienta de Cochrane para evaluar el riesgo de sesgo en los estudios no aleatorizados de las intervenciones. Se utilizo la sintesis narrativa de datos para evaluar el alcance de las evaluaciones para recopilar datos sobre los dominios del marco de los determinantes sociales de la salud de la Organizacion Mundial de la Salud. Resultados Se identificaron 666 estudios, de los cuales 17 se incluyeron en la revision. Todos los estudios utilizaron disenos de estudio descriptivos. Se utilizaron las encuestas y las entrevistas en los consultorios y en los hogares con mayor frecuencia que los datos a nivel de la poblacion para evaluar los determinantes sociales locales. No se encontraron ejemplos de organizaciones que evaluaran los factores sociopoliticos determinantes de las enfermedades no transmisibles, ya que todas se centraban en los factores sociodemograficos o en las circunstancias de la vida cotidiana. No obstante, las medidas que se adoptaron para abordar los determinantes sociales fueron desde intervenciones a nivel individual hasta medidas a nivel de la poblacion y la integracion de la representacion de las organizaciones de atencion primaria en los comites de planificacion y de politicas a nivel del sistema. Conclusion Los resultados obtenidos pueden ayudar a los responsables de formular las politicas a considerar los enfoques adecuados para evaluar y abordar los determinantes sociales de la salud en su contexto nacional. Se necesitan evidencias observacionales y experimentales mas rigurosas para determinar si la medicion de los determinantes sociales conduce a las intervenciones que mitigan las necesidades sociales que no se atienden y que reducen las desigualdades en la salud., Introduction Primary health care is a whole-of-society approach to health that depends on integrated primary care and essential public health functions; empowered people and communities; and multisectoral policy and action. [...]

Objective: The primary aim of this overview was to synthesise results from studies including digital education and its effect on knowledge or learning outcomes, student satisfaction, student enrolment, attendance rate, course completion rate, clinical practice, health outcomes for patients and cost-effectiveness in health-care education. A secondary aim was to report on successful instructional design strategies, and barriers or contextual factors influencing the effectiveness of online learning course delivery in healthcare education. Method: We conducted an overview of systematic reviews (SRs) for digital education interventions delivered to health-care students and practitioners. Results: We scanned 848 titles, reviewed 247 abstracts and assessed 49 full-text articles against pre-determined inclusion and exclusion criteria. This overview includes data collected from 31,730 participants across 16 SRs. The quality of evidence included in the SRs ranged from very low (n = 2), low (n = 6) to moderate (n = 8). The best available SRs were of moderate quality (7.4 of 11 AMSTAR). SR authors did not report other teaching methods as being superior to digital learning. In most cases (n = 9), digital education when used in addition to traditional methods augmented knowledge acquisition. Other SRs (n = 7) did not show statistically significant differences across interventions including digital education as a replacement, or additive resource to traditional intervention. Conclusion: Student enrolment, attendance rates, course completion rates, cost-effectiveness and changes in clinical outcomes for patients are underreported in the existing evidence. Although the quality and quantity of data are limited, evidence-based instructional design for digital education is becoming more possible, especially as educators establish learning activities that track to learning objectives for knowledge acquisition in health care.

Simple Summary: Blood tests are commonly requested by doctors.Blood tests are done for many reasons and invesitgating symptoms or monitoring existing conditions are just examples. For instance, blood tests can also be done as part of a routine health checkup to investigate symptoms or monitor existing conditions. For instance, blood tests can also be done as part of a routine health checkup. Some clinical guidelines for doctors include recommendations to investigate for cancer if a blood test indicates results that are lower or higher than normal levels. These recommendations are only helpful for a small number of cancers, such as bowel or pancreatic cancers. A patient can have repeated blood tests, allowing doctors to monitor how blood test results change over time. These changes over time are referred to as 'trends' and may provide doctors with more information than the results of a single blood test. For example, noting a small drop in a steady trend could be more useful than waiting for the blood test to drop below a normal level. Until now, there has been no research regarding whether blood test trends can identify patients who should be investigated for cancer. We aimed to assess this possibility in this research project. Clinical guidelines include monitoring blood test abnormalities to identify patients at increased risk of undiagnosed cancer. Noting blood test changes over time may improve cancer risk stratification by considering a patient's individual baseline and important changes within the normal range. We aimed to review the published literature to understand the association between blood test trends and undiagnosed cancer. MEDLINE and EMBASE were searched until 15 May 2023 for studies assessing the association between blood test trends and undiagnosed cancer. We used descriptive summaries and narratively synthesised studies. We included 29 articles. Common blood tests were haemoglobin (24%, n = 7), C-reactive protein (17%, n = 5), and fasting blood glucose (17%, n = 5), and common cancers were pancreatic (29%, n = 8) and colorectal (17%, n = 5). Of the 30 blood tests studied, an increasing trend in eight (27%) was associated with eight cancer types, and a decreasing trend in 17 (57%) with 10 cancer types. No association was reported between trends in 11 (37%) tests and breast, bile duct, glioma, haematological combined, liver, prostate, or thyroid cancers. Our review highlights trends in blood tests that could facilitate the identification of individuals at increased risk of undiagnosed cancer. For most possible combinations of tests and cancers, there was limited or no evidence. [ABSTRACT FROM AUTHOR]