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Introduction: The Enhanced Recovery After Surgery programme (ERAS) is an approach to the perioperative care of patients encompassing multiple interventions and involving a wide range of different actors. It can thus be defined as a complex intervention. Despite the strength of the evidence-base in its support, the implementation of ERAS has been slow. This paper specifically explores the utility of Normalization Process Theory (NPT) as a methodological framework to aid exploration of ERAS implementation, with a focus on the core NPT construct coherence. Methods and materials: The study employed qualitative methods guided by NPT. Semi-structured interviews were conducted with twenty-six healthcare professionals working in three specialities (thoracic, colorectal, head and neck) in a UK hospital. Data were analysed using an adapted Framework Approach. Results: Coherence, or sense-making work, was key to successful implementation and demonstrated in the importance of participants believing in ERAS both as an individual and as a team. In order to invest in ERAS individuals needed to be able to differentiate its practices favourably with those enacted pre-implementation (differentiation). Participants also needed to understand their specific tasks and responsibilities (individual specification) and build a shared understanding (communal specification), resolving differences in planning meetings. Belief in the worth of ERAS was often aligned to evidence for its effectiveness or benefit to patients (internalization), so implementing ERAS therefore ‘made sense’. Sense-making work had strong links with aspects of implementation related to other NPT constructs including resource issues such as funding for data collection and feedback (reflexive monitoring: systemization) and failure to replace key staff members (collective action: skill set workability). Conclusions: NPT was found to be a valuable heuristic device to employ in the exploration of ERAS implementation processes. NPT was useful in facilitating recognition of the importance of coherence work to successful implementation. However despite participants’ strong beliefs in the worth of ERAS, it was in translating these beliefs into action that barriers were encountered, highlighting the interconnectedness of NPT constructs and the complicated nature of implementing complex interventions. [ABSTRACT FROM AUTHOR]

In health sector, trust is considered important because it indirectly influences the quality of health care through patient satisfaction, adherence and the continuity of its relationship with health care professionals and the promotion of accurate and timely diagnoses. One of the important requirements of TRSs in the health sector is rating secrecy, which mandates that the identification information about the service consumer should be kept secret to prevent any privacy violation. Anonymity and trust are two imperative objectives, and no significant explicit efforts have been made to achieve both of them at the same time. In this paper, we present a framework for solving the problem of reconciling trust with anonymity in the health sector. Our solution comprises Anonymous Reputation Management (ARM) protocol and Context-aware Trustworthiness Assessment (CTA) protocol. ARM protocol ensures that only those service consumers who received a service from a specific service provider provide a recommendation score anonymously with in the specified time limit. The CTA protocol computes the reputation of a user as a service provider and as a recommender. To determine the correctness of the proposed ARM protocol, formal modelling and verification are performed using High Level Petri Nets (HLPN) and Z3 Solver. Our simulation results verify the accuracy of the proposed context-aware trust assessment scheme. [ABSTRACT FROM AUTHOR]

Background: Agreed international development standards underpin high quality de novo clinical practice guidelines (CPGs). There is however, no international consensus on how high quality CPGs should ‘look’; or on whether high quality CPGs from one country can be viably implemented elsewhere. Writing de novo CPGs is generally resource-intensive and expensive, making this challenging in resource-poor environments. This paper proposes an alternative, efficient method of producing high quality CPGs in such circumstances, using existing CPGs layered by local knowledge, contexts and products. Methods: We undertook a mixed methods case study in South African (SA) primary healthcare (PHC), building on findings from four independent studies. These comprised an overview of international CPG activities; a rapid literature review on international CPG development practices; critical appraisal of 16 purposively-sampled SA PHC CPGs; and additional interrogation of these CPGs regarding how, why and for whom, they had been produced, and how they ‘looked’. Results: Despite a common aim to improve SA PHC healthcare practices, the included CPGs had different, unclear and inconsistent production processes, terminology and evidence presentation styles. None aligned with international quality standards. However many included innovative succinct guidance for end-users (which we classified as evidence-based summary recommendations, patient management tools or protocols). We developed a three-tiered model, a checklist and a glossary of common terms, for more efficient future production of better quality, contextually-relevant, locally-implementable SA PHC CPGs. Tier 1 involves transparent synthesis of existing high quality CPG recommendations; Tier 2 reflects local expertise to layer Tier 1 evidence with local contexts; and Tier 3 comprises tailored locally-relevant end-user guidance. Conclusion: Our model could be relevant for any resource-poor environment. It should reduce effort and costs in finding and synthesising available research evidence, whilst efficiently focusing scant resources on contextually-relevant evidence-based guidance, and implementation. [ABSTRACT FROM AUTHOR]

With recent aging demographic trends, the needs for enhancing geo-spatial analysis capabilities and monitoring the status of accessibilities of its citizens with healthcare services have increased. The accessibility to healthcare is determined not only by geographic distances to service locations, but also includes travel time, available modes of transportation, and departure time. Having access to the latest and accurate information regarding the healthcare accessibility allows the municipal government to plan for improvements, including expansion of healthcare infrastructure, effective labor distribution, alternative healthcare options for the regions with low accessibilities, and redesigning the public transportation routes and schedules. This paper proposes a new method named, Seoul Enhanced 2-Step Floating Catchment Area (SE2SFCA), which is customized for the city of Seoul, where population density is higher and the average distance between healthcare-service locations tends to be shorter than the typical North American or European cities. The proposed method of SE2SFCA is found to be realistic and effective in determining the weak accessibility regions. It resolves the over-estimation issues of the past, arising from the assignment of high healthcare accessibility for the regions with large hospitals and high density of population and hospitals. [ABSTRACT FROM AUTHOR]

Background: Food supplements, and in particular those containing botanicals (plant food supplements, PFS), have in recent decades been of great interest both to consumers and to food/pharmaceutical industries. Objectives: The aim of this paper is to examine replies by Italian consumers to the PlantLIBRA consumers' survey in order to: 1) assess the behaviour of an Italian population with respect to the use of PFS, and to compare it with that of other 5 countries involved in the whole survey; 2) identify different habits in the 4 Italian cities selected according to their geographical distribution; 3) collect independent information on the actual intake of PFS and consumers' behaviour. Subjects/setting: 397 Italian consumers enrolled, 187 males (49.5%) and 191 female (50.5%). The distribution of subjects among the 4 cities included was: Milan 99; Venice 90; Rome 96 and Catania 96. Results: The interest in PFS in Italy is high, the prevalence of "regular" consumers being 22.7%. Some differences were observed between the 4 cities involved: the pattern of use during the year was specific to each city; consumers in Milan reported reasons to use PFS significantly different from those in the whole Italian sample and did not indicate supermarkets as an important place of purchase; respondents from Rome and Catania more frequently used family doctors and pharmacists as a source of recommendation. Some significant difference among cities, sex and age groups were observed when the most frequently used botanicals were ranked. Conclusions: The results provide new insights on the socio-economic characteristics and lifestyle of Italian PFS consumers, on their reasons for and pattern of use, and on their behaviour and expectations. The value of this information is not restricted to the specific country (Italy) but allows for a more general evaluation of the pattern of use, according to habits and geographical area. [ABSTRACT FROM AUTHOR]

Aim: To examine the characteristics of community health workers (CHWs) involved in diabetes prevention programmes (DPPs) and their contributions to expected outcomes. Methods: Electronic databases including PubMed-MEDLINE, EBSCOHost, and SCOPUS/EMBASE were searched for studies published between January 2000 and March 2016. All studies that used CHWs to implement DPP in ≥18-year-old participants without diabetes but at high risk for developing the condition, irrespective of the study design, setting or outcomes measured, were included. Results were synthesized narratively. Results: Forty papers of 30 studies were identified. Studies were mainly community-based and conducted in minority populations in USA. Sample sizes ranged from 20 participants in a single community to 2369 participants in 46 communities. Although CHWs were generally from the local community, their qualifications, work experience and training received differed across studies. Overall the training was culturally sensitive and/or appropriate, covering topics such as the importance of good nutrition and the benefits of increased physical activity, communication and leadership. CHWs delivered a variety of interventions and also screened or recruited participants. The shared culture and language between CHWs and participants likely contributed to better programme implementation and successful outcomes. Conclusions: The complexity of DPPs and the diverse CHW roles preclude attributing specific outcomes to CHW involvement. Nevertheless, documenting potential CHW roles and the relevant training required may optimise CHW contributions and facilitate their involvement in DPPs in the future. [ABSTRACT FROM AUTHOR]

Introduction: A broad range of self-tests (testing for e.g. HIV, cancer, hepatitis B/C) have become available and can be conducted by lay consumers without the help of a health professional. The aims of this study were to (a) investigate the prevalence of self-testing, (b) identify the most frequently used self-tests, and (c) explore the associations between socio-demographic, health-related and individual factors with self-testing. Methods: A face-to-face plus paper-pencil cross-sectional survey was conducted. The sample consisted of 2.527 respondents who were representative of the German population in terms of the age, sex, and residence. Basic descriptive statistics and univariate logistic regression analyses were performed. Results: 8.5% of the participants reported having used one or more self-tests in the past, totalling 363 self-tests, with a mean of 1.7 (min. = 1, max. = 6). The three self-tests most frequently indicated were for detecting diabetes, bowel cancer, and allergies. Self-testers were older (Nagelkerke R2 = .006, p < .01), had a higher BMI (Nagelkerke R2 = .013, p < .001) and displayed more physical and mental fatigue (Nagelkerke R2 = .031, p < .001) than non-testers. Self-testers also reported higher global life satisfaction values (Nagelkerke R2 = .008, p < .01) and a higher educational level (Nagelkerke R2 = .015, p < .01). Conclusions: Self-testing is fairly prevalent in Germany Given the current shortage of physicians in Germany, especially in rural areas, and recent studies on the use of self-medication, the topic of self-testing has a great practical and socio-political relevance. Future studies should investigate further predictors of self-testing (e.g. contextual, situational and individual factors) as well as the emotional consequences of testing as a layperson without the attendance of a health professional. [ABSTRACT FROM AUTHOR]

The 3D convolutional neural network (CNN) is able to make full use of the spatial 3D context information of lung nodules, and the multi-view strategy has been shown to be useful for improving the performance of 2D CNN in classifying lung nodules. In this paper, we explore the classification of lung nodules using the 3D multi-view convolutional neural networks (MV-CNN) with both chain architecture and directed acyclic graph architecture, including 3D Inception and 3D Inception-ResNet. All networks employ the multi-view-one-network strategy. We conduct a binary classification (benign and malignant) and a ternary classification (benign, primary malignant and metastatic malignant) on Computed Tomography (CT) images from and Image Database Resource Initiative database (LIDC-IDRI). All results are obtained via 10-fold cross validation. As regards the MV-CNN with chain architecture, results show that the performance of 3D MV-CNN surpasses that of 2D MV-CNN by a significant margin. Finally, a 3D Inception network achieved an error rate of 4.59% for the binary classification and 7.70% for the ternary classification, both of which represent superior results for the corresponding task. We compare the multi-view-one-network strategy with the one-view-one-network strategy. The results reveal that the multi-view-one-network strategy can achieve a lower error rate than the one-view-one-network strategy. [ABSTRACT FROM AUTHOR]

Objectives: Dutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most important revisions of the costing manual compared to the previous version. Methods: An online survey was sent out to potential users of the costing manual to identify topics for improvement. The costing manual was aligned with contemporary health economic guidelines. All methodology sections and parameter values needed for costing studies, particularly reference prices, were updated. An expert panel of health economists was consulted several times during the review process. The revised manual was reviewed by two members of the expert panel and by reviewers of the Dutch Health Care Institute. Results: The majority of survey respondents was satisfied with content and usability of the existing costing manual. Respondents recommended updating reference prices and adding some particular commonly needed reference prices. Costs categories were adjusted to the international standard: 1) costs within the health care sector; 2) patient and family costs; and 3) costs in other sectors. Reference prices were updated to reflect 2014 values. The methodology chapter was rewritten to match the requirements of the costing manual and preferences of the users. Reference prices for nursing days of specific wards, for diagnostic procedures and nurse practitioners were added. Conclusions: The usability of the costing manual was increased and parameter values were updated. The costing manual became integrated in the new health economic guidelines. [ABSTRACT FROM AUTHOR]

Background: The 16-item Vitamin D Status Predictor (VDSP) questionnaire helps to identify, without resorting to a blood test, older adults with low vitamin D concentrations. Our objective was to determine whether a self-administered VDSP was concordant with the VDSP administered by a physician, and to examine the concordance of every single item of the VDSP. Methods: A total of 349 older in- and outpatients (mean, 83.2±7.2years; 59% female) were consecutively recruited in the geriatric ward of the University Hospital of Angers, France. All participants completed a self-administered VDSP questionnaire (self-VDSP) in paper format composed of 17 items exploring age, gender, general condition, nutrition, vision, mood, cognition, gait and falls, and osteoporosis. All participants underwent subsequently a full clinical examination by a physician exploring the same areas (rater-VDSP). Results: The agreement between the self-VDSP and the rater-VDSP was almost perfect for the probability of having low vitamin D concentrations, regardless of the definition used (i.e., ≤25, ≤50 or ≤75 nmol/L). The agreements between physicians’ and patients’ responses were significant for every single VDSP item. The agreement was fair to perfect for all items, except for cognitive disorders, undernutrition and polymorbidity (poor agreement). Conclusions: Older adults are able to evaluate their own probabilities of severe vitamin D deficiency, deficiency and insufficiency. A self-questionnaire may promote the use of the VDSP tool in this population, and help clinicians in decisions to supplement their patients in a reasoned way. [ABSTRACT FROM AUTHOR]

Background: Myomectomy has potential risks of complications. To reduce these risks, medical pre-treatment can be applied to reduce fibroid size and thereby potentially decrease intra-operative blood loss, the need for blood transfusion and emergency hysterectomy. The aim of this systematic review and meta-analysis is to study the effectiveness of medical pre-treatment with Gonadotropin-releasing hormone agonists (GnRHa) or ulipristal acetate prior to laparoscopic or laparotomic myomectomy on intra-operative and post-operative outcomes. Methods: We performed an extensive search in Embase.com, Wiley/Cochrane Library and PubMed in accordance with the Prisma guidelines. All studies published as full papers in peer reviewed journals using GnRHa or ulipristal acetate as medical pre-treatment independent of route of administration or dosage before laparotomic or laparoscopic myomectomy were included. The primary outcome was duration of surgery. Secondary outcomes were duration of enucleation, blood loss, degree of difficulty of surgery, identification of cleavage planes, proportion of vertical incisions, conversion rate, frequency of blood transfusions, post-operative complications, duration of hospital stay, frequency of recurrence of fibroids, frequency of uterine adhesions, recovery time and quality of life. No language restrictions were applied. Meta-analysis were performed where possible. Findings: Twenty-three studies were included. In laparotomic myomectomy, pre-treatment with GnRHa decreases intra-operative blood loss with 97.39ml (95% CI -111.80 to -82.97) compared to no pre-treatment or placebo. Pre-treatment with GnRHa before laparoscopic myomectomies also shows a reduction in intra-operative blood loss by 23.03ml (95% CI -40.79 to -5.27) and in the frequency of blood transfusions (OR 0.17, 95% CI 0.05 to 0.55) compared to no pre-treatment. Only two retrospective cohort studies reported on pre-treatment with ulipristal acetate compared to no pre-treatment before laparoscopic myomectomy showing a statistically significant reduction in intra-operative blood loss, duration of surgery and frequency of blood transfusions after pre-treatment with ulipristal acetate. Conclusion: Administration of GnRHa prior to laparotomic myomectomy reduces blood loss and might decrease uterine adhesion formation. Pre-treatment with GnRHa before laparoscopic myomectomy reduces blood loss, the frequency of blood transfusions and might increase recurrence rate of fibroids, however it should be taken into account that some results are mainly based on cohort studies. Other pre-treatment agent ulipristal acetate has not been investigated sufficiently for relevant surgical outcomes. [ABSTRACT FROM AUTHOR]

The study investigated two followership behaviors, followers’ active engagement and followers’ independent critical thinking, and their relationship with job satisfaction in a sample of nurses. In addition, the study also considered a number of control variables and classical job demands and job resources—workload and emotional dissonance for job demands, and meaningful work for job resources—which have an impact on well-being at work. A paper-and-pencil questionnaire was administered to 425 nurses in an Italian hospital, and a hierarchical multiple regression was used to test the hypotheses. In addition to the job demands and job resources considered, followers’ active engagement had a significant impact on job satisfaction. Moreover, it showed a significant linear and curvilinear relationship with the outcome variable. Followers’ independent critical thinking has a non significant relationship with job satisfaction, confirming the mixed results obtained in the past for this dimension. These findings bore out the importance of analyzing followers’ behaviors as potential resources that people can use on the job to increase their own well-being. Looking at followers not just as passive recipients but as active and proactive employees can also benefit the organization. [ABSTRACT FROM AUTHOR]

Background: Despite decades of implementation of maternity healthcare programmes, including a focus on increasing the use of antenatal care (ANC) and concomitant birth preparedness and complication readiness (BPCR), the uptake of ANC continues to be below expectations in many developing countries. This has attendant implications for maternal and infant morbidity and mortality rates. Known barriers to ANC use include cost, distance to health care services and forces of various socio-cultural beliefs and practices. As part of a larger study on BPCR in rural Ghana, this paper reflects on the use of ANC in the study areas from rights-based and maternal engagement theoretical perspectives, with a focus on the barriers to ANC use. Methods: Mixed methods approach was adopted to collect data from 8 study communities from individual in-depth interviews with 80 expectant mothers and 13 health care professionals, and 24 focus groups comprising 240 community members. The qualitative data followed a thematic analytical method, while the quantitative data was analysed using descriptive statistics. Results: The average number of ANC visits were 3.34±1.292, and the majority of expectant mothers (71.3%) enrolled for ANC at the 8th week or later, with the longest delay recorded at the 6th month of gestation. Traditional norms significantly influenced this delay. Likewise, overall use of ANC during pregnancy was shaped by cultural factors related to perceptions of pregnancy, gender-based roles and responsibilities and concerns that ANC would result in an overweighed baby and culturally inappropriate delivery at a health care facility. Conclusion: Greater understanding of the sociocultural barriers to ANC is essential if proposed changes in community-specific health education programs are to facilitate early commencement and increased use of ANC. [ABSTRACT FROM AUTHOR]

In this paper we address the problem of automated grading of invasive breast carcinoma through the encoding of histological images as VLAD (Vector of Locally Aggregated Descriptors) representations on the Grassmann manifold. The proposed method considers each image as a set of multidimensional spatially-evolving signals that can be efficiently modeled through a higher-order linear dynamical systems analysis. Subsequently, each H&E (Hematoxylin and Eosin) stained breast cancer histological image is represented as a cloud of points on the Grassmann manifold, while a vector representation approach is applied aiming to aggregate the Grassmannian points based on a locality criterion on the manifold. To evaluate the efficiency of the proposed methodology, two datasets with different characteristics were used. More specifically, we created a new medium-sized dataset consisting of 300 annotated images (collected from 21 patients) of grades 1, 2 and 3, while we also provide experimental results using a large dataset, namely BreaKHis, containing 7,909 breast cancer histological images, collected from 82 patients, of both benign and malignant cases. Experimental results have shown that the proposed method outperforms a number of state of the art approaches providing average classification rates of 95.8% and 91.38% with our dataset and the BreaKHis dataset, respectively. [ABSTRACT FROM AUTHOR]

Background: Mobile health (mHealth) has undergone exponential growth in recent years. Patients and healthcare professionals are increasingly using health-related applications, at the same time as concerns about ethical issues, bias, conflicts of interest and privacy are emerging. The general aim of this paper is to provide an overview of the current state of development of mHealth. Methods and Findings: To exemplify the issues, we made a systematic review of the pain-related apps available in scientific databases (Medline, Web of Science, Gale, Psycinfo, etc.) and the main application shops (App Store, Blackberry App World, Google Play, Nokia Store and Windows Phone Store). Only applications (designed for both patients and clinicians) focused on pain education, assessment and treatment were included. Of the 47 papers published on 34 apps in scientific databases, none were available in the app shops. A total of 283 pain-related apps were found in the five shops searched, but no articles have been published on these apps. The main limitation of this review is that we did not look at all stores in all countries. Conclusions: There is a huge gap between the scientific and commercial faces of mHealth. Specific efforts are needed to facilitate knowledge translation and regulate commercial health-related apps. [ABSTRACT FROM AUTHOR]

Introduction: Globally, life expectancy together with multimorbidity and chronic diseases are increasing. This leads to a growing demand for care and hence for healthcare personnel and nurses. To meet this demand, healthcare workers from abroad are increasingly hired. The nurses’ workplace in general is characterized by physically and psychologically demanding tasks, while that of migrant and minority nurses is additionally characterized by discriminatory practices. The present knowledge about the health of migrant and minority nurses and the terminology in this context are diverse. Thus, the purpose of this review is to systematically identify and synthesize international publications that explicitly focus on migrant nurses’ health. Materials and methods: A systematic review of relevant studies was undertaken using the databases Medline, PsycINFO, CINAHL and Web of Science. The screening process was conducted in several phases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines while the methodological quality assessment of the included papers was performed with the Mixed Method Appraisal Tool (MMAT). Results: Out of 11,599 citations initially obtained, 14 empirical studies were included in the final synthesis. The methodological quality of the empirical studies and reviews was diverse. The majority of the studies were conducted in the US and the nurses under study migrated from countries like the Philippines, India, Europe, and Africa. Among migrant nurses of different origins, there are differences in their physiological responses to stress. Migrant nurses and native nurses differ in reporting work-related injuries. Discussion: Migrant and minority nurses are at high risk of work-related injuries and discrimination than native or majority nurses. However, mixed results were obtained, namely that the reported health of migrant nurses either improves over time or it decreases. This review revealed that discrimination is the leading cause of impaired health amongst migrant and minority nurses. [ABSTRACT FROM AUTHOR]

Pneumonia is the leading cause of infectious disease mortality in children. Currently, health care providers (HCPs) are trained to use World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and manually assess respiratory rate to diagnose pneumonia in low-resource settings (LRS). However, this approach of relying on clinical signs alone has proven problematic. Hypoxemia, a diagnostic indicator of pneumonia severity associated with an increased risk of death, is not assessed because pulse oximetry is often not available in LRS. To improve HCPs’ ability to diagnose, classify, and manage pneumonia and other childhood illnesses, “mPneumonia” was developed. mPneumonia is a mobile health application that integrates a digital version of the IMCI algorithm with a software-based breath counter and a pulse oximeter. A design-stage qualitative pilot study was conducted to assess feasibility, usability, and acceptability of mPneumonia in six health centers and five community-based health planning and services centers in Ghana. Nine health administrators, 30 HCPs, and 30 caregivers were interviewed. Transcribed interview audio recordings were coded and analyzed for common themes. Health administrators reported mPneumonia would be feasible to implement with approval and buy-in from national and regional decision makers. HCPs felt using the mPneumonia application would be feasible to integrate into their work with the potential to improve accurate patient care. They reported it was “easy to use” and provided confidence in diagnosis and treatment recommendations. HCPs and caregivers viewed the pulse oximeter and breath counter favorably. Challenges included electricity requirements for charging and the time needed to complete the application. Some caregivers saw mPneumonia as a sign of modernity, increasing their trust in the care received. Other caregivers were hesitant or confused about the new technology. Overall, this technology was valued by users and is a promising innovation for improving quality of care in frontline health facilities. [ABSTRACT FROM AUTHOR]

Background: Prognostic accuracy in palliative care is valued by patients, carers, and healthcare professionals. Previous reviews suggest clinicians are inaccurate at survival estimates, but have only reported the accuracy of estimates on patients with a cancer diagnosis. Objectives: To examine the accuracy of clinicians’ estimates of survival and to determine if any clinical profession is better at doing so than another. Data Sources: MEDLINE, Embase, CINAHL, and the Cochrane Database of Systematic Reviews and Trials. All databases were searched from the start of the database up to June 2015. Reference lists of eligible articles were also checked. Eligibility Criteria: Inclusion criteria: patients over 18, palliative population and setting, quantifiable estimate based on real patients, full publication written in English. Exclusion criteria: if the estimate was following an intervention, such as surgery, or the patient was artificially ventilated or in intensive care. Study Appraisal and Synthesis Methods: A quality assessment was completed with the QUIPS tool. Data on the reported accuracy of estimates and information about the clinicians were extracted. Studies were grouped by type of estimate: categorical (the clinician had a predetermined list of outcomes to choose from), continuous (open-ended estimate), or probabilistic (likelihood of surviving a particular time frame). Results: 4,642 records were identified; 42 studies fully met the review criteria. Wide variation was shown with categorical estimates (range 23% to 78%) and continuous estimates ranged between an underestimate of 86 days to an overestimate of 93 days. The four papers which used probabilistic estimates tended to show greater accuracy (c-statistics of 0.74–0.78). Information available about the clinicians providing the estimates was limited. Overall, there was no clear “expert” subgroup of clinicians identified. Limitations: High heterogeneity limited the analyses possible and prevented an overall accuracy being reported. Data were extracted using a standardised tool, by one reviewer, which could have introduced bias. Devising search terms for prognostic studies is challenging. Every attempt was made to devise search terms that were sufficiently sensitive to detect all prognostic studies; however, it remains possible that some studies were not identified. Conclusion: Studies of prognostic accuracy in palliative care are heterogeneous, but the evidence suggests that clinicians’ predictions are frequently inaccurate. No sub-group of clinicians was consistently shown to be more accurate than any other. Implications of Key Findings: Further research is needed to understand how clinical predictions are formulated and how their accuracy can be improved. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is highly infectious and one of the leading killers globally. Several studies from sub-Saharan Africa highlight health systems challenges that affect ability to cope with existing disease burden, including TB, although most of these employ survey-type approaches. Consequently, few address community or patient perspectives and experiences. At the same time, understanding of the mechanisms by which the health systems challenges translate into seeking or avoidance of formal health care remains limited. This paper applies the notion of human agency to examine the ways people who have symptoms suggestive of TB respond to and deal with the symptoms vis-à-vis major challenges inherent within health delivery systems. Empirical data were drawn from a qualitative study exploring the ways in which notions of masculinity affect engagement with care, including men’s well-documented tendency to delay in seeking care for TB symptoms. The study was carried out in three high-density locales of urban Blantyre, Malawi. Data were collected in March 2011 –March 2012 using focus group discussions, of which eight (mixed sex = two; female only = three; male only = three) were with 74 ordinary community members, and two (both mixed sex) were with 20 health workers; and in-depth interviews with 20 TB patients (female = 14) and 20 un-investigated chronic coughers (female = eight). The research process employed a modified version of grounded theory. Data were coded using a coding scheme that was initially generated from the study aims and subsequently progressively amended to incorporate concepts emerging during the analysis. Coded data were retrieved, re-read, and broken down and reconnected iteratively to generate themes. A myriad of problems were described for health systems at the primary health care level, centring largely on shortages of resources (human, equipment, and drugs) and unprofessional conduct by health care providers. Participants consistently pointed out how the problems could drive patients from promptly reporting symptoms at primary healthcare centres. The accounts suggest that in responding to illness symptoms including those suggestive of TB, patients navigate their options taking into cognisance past and current experiences with formal health systems. Understanding and factoring in the mediating role of such ‘agency’ is critical when implementing efforts to promote timely response to TB-suggestive symptoms. [ABSTRACT FROM AUTHOR]

Objective: Peer support models, where an individual has a specific illness or lifestyle experience and supports others experiencing similar challenges, have frequently been used in different fields of healthcare to successfully engage hard-to-reach groups. Despite recognition of their value, the impact of these roles on the peer has not been systematically assessed. By synthesising the qualitative literature we sought to review such an impact, providing a foundation for designing future clinical peer models. Methods: Systematic review and qualitative metasynthesis of studies found in Medline, CINAHL or Scopus documenting peer worker experiences. Results: 1,528 papers were found, with 34 meeting the criteria of this study. Findings were synthesised to reveal core constructs of reframing identity through reciprocal relations and the therapeutic use of self, enhancing responsibility. Conclusions: The ability of the Peer Support Worker to actively engage with other marginalised or excluded individuals based on their unique insight into their own experience supports a therapeutic model of care based on appropriately sharing their story. Our findings have key implications for maximising the effectiveness of Peer Support Workers and in contributing their perspective to the development of a therapeutic model of care. [ABSTRACT FROM AUTHOR]

In follow-up studies, interactions are often assessed by including a cross-product term in a (multiplicative) Cox model. However, epidemiologists/clinicians often misinterpret a significant multiplicative interaction as a genuine mechanistic interaction. Though indices specific to mechanistic interactions have been proposed, including the ‘relative excess risk due to interaction’ (RERI) and the ‘peril ratio index of synergy based on multiplicativity’ (PRISM), these indices assume no loss to follow up and no competing death in a study. In this paper, the authors propose a novel ‘mechanistic interaction test’ (MIT) for censored data. Monte-Carlo simulation shows that when the hazard curves are proportional to, non-proportional to, or even crossing over one another, the proposed MIT can maintain reasonably accurate type I error rates for censored data. It has far greater powers than the modified RERI and PRISM tests (modified for censored data scenarios). To test mechanistic interactions in censored data, we recommend using MIT in light of its desirable statistical properties. [ABSTRACT FROM AUTHOR]

Introduction: Bangladesh has a serious shortage of qualified health workforce. The limited numbers of trained service providers are based in urban areas, which limits access to quality healthcare for the rural population. mHealth provides a new opportunity to ensure access to quality services to the population. A recent review suggested that there are 19 mHealth initiatives in the country. This paper reports findings on people's knowledge, perception, use, cost and compliance with advice received from mHealth services from a study carried out during 2012–13 in Chakaria, a rural sub-district in Bangladesh. Methods: A total of 4,915 randomly-chosen respondents aged 18 years and above were interviewed. Results: Household ownership of mobile phones in the study area has increased from 2% in 2004 to 81% in 2012; 45% of the respondents reported that they had mobile phones. Thirty-one percent of the respondents were aware of the use of mobile phones for healthcare. Very few people were aware of the available mHealth services. Males, younger age group, better educated, and those from richer households were more knowledgeable about the existing mHealth services. Among the respondents who sought healthcare in the preceding two weeks of the survey, only 2% used mobile phones for healthcare. Adherence to the advice from the healthcare providers in terms of purchasing and taking the drugs was somewhat similar between the patients who used mobile phone for consultation versus making a physical visit. Conclusions: The high penetration of mobile phones into the society provides a unique opportunity to use the mHealth technology for consulting healthcare providers. Although knowledge of the existence of mHealth services was low, it was encouraging that the compliance with the prescriptions was almost similar for advice received through mobile phone and physical visits. The study revealed clear indications that society is looking forward to embracing the mHealth technology. [ABSTRACT FROM AUTHOR]

Background: Safe Male Circumcision (SMC) is a proven approach for partial protection of men from acquisition of HIV infection. Several sub-Saharan African countries have a target to circumcise 80% of males aged 15 to 49. The use of devices such as PrePex would aid scaling up of SMC. Since most health workers would have no prior experience with use of devices, skills training is needed. This paper explores a skills transfer model at an urban site in Uganda. Objective: To assess the practicability and feasibility of rapid short duration training for safe PrePex device use. Methods: A prospective study, conducted over 8 weeks (August–October 2012) at International Hospital Kampala, an urban Kampala hospital, examining the performance of various health worker cadres after training in the use of a non-surgical device (PrePex). The prospective study obtained approval from the Makerere School of Medicine Research and Ethics Committee and the Uganda National Council of Science and Technology. If eligible, and after the subject signed the informed consent form, they were enrolled into the study. Results: Ten health workers were successfully trained in use of PrePex during a 3 day non-residential on-the-job training course. After the first three days of training, the trained health workers performed 561 placements and 529 device removals successfully. Over all adverse events (AE) rates were below ≤2%; however, there were some differences in AE rates across the cadres trained but not significant (p>0.25 for moderate AEs). Conclusion: Rapid training for safe use of the PrePex device is feasible for the range of health workers available for SMC in resource limited settings, but among those with past SMC experience. [ABSTRACT FROM AUTHOR]