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This is a systematic scoping review protocol which seeks to analyze the evidence base on women’s experiences of stigma due to genital fistula including experiences across stigma domains, the different manifestations and levels of stigma severity, documenting consequences, coping strategies, responses or mechanisms and stigma resistance, and identify areas where additional research is necessary. This review is currently being conducted by the study team listed. Please cite this protocol in any published work resulting from its use.

PurposeThe coronavirus disease 2019 (COVID-19) pandemic highlighted the necessity of practicing Evidence-based Management (EBMgt) as an approach to decision-making in hospital settings. The literature, however, provides limited insight into the process of EBMgt and its contextual nuances. Such insight is critical for better leveraging EBMgt in practice. Therefore, the authors' aim was to integrate the literature on the process of EBMgt in hospital settings, identify the gaps in knowledge and delineate areas for future research.Design/methodology/approachThe authors conducted a systematic scoping review using an innovative methodology that involved two systematic searches. First using EBMgt terminology and second using terminology associated with the EBMgt concept, which the authors derived from the first search.FindingsThe authors identified 218 relevant articles, which using content analysis, they mapped onto the grounded model of the EBMgt process; a novel model of the EBMgt process developed by Sahakian and colleagues. The authors found that the English language literature provides limited insight into the role of managers' perceptions and motives in EBMgt, the practice of EBMgt in Global South countries, and the outcomes of EBMgt. Overall, this study’s findings indicated that aspects of the decision-maker, context and outcomes have been neglected in EBMgt.Originality/valueThe authors contributed to the EBMgt literature by identifying these gaps and proposing future research areas and to the systematic review literature by developing a novel scoping review method.

Pediatric keratoconus (KC) causes progressive deformation of the cornea of children and adolescents, leading to progressive loss of vision and need for rehabilitation(1). Its epidemiology is still poorly understood. However, the need for its reporting is now increased due to new treatments allowing halting of the disease and prevention of the worse outcomes such as the need for penetrating keratoplasty and its associated morbidity and high cost, irreversible loss of vision and amblyopia. There are few systematic reviews on keratoconus, even fewer on pediatric KC(2).Objectives: The authors objective was to perform a systematic review on pediatric KC epidemiology, discuss the studies reporting data on pediatric keratoconus (prevalence, incidence, age distribution) and current diagnostic and screening efforts. The scoping review methodology was favored due to it being the most adequate for summarizing findings from a body of knowledge that is heterogeneous in methods and disciplines (Tricco et al., 2018). The PRISMA-ScR methodology and checklists were used in the elaboration of the manuscript(3). Eligibility Criteria The inclusion criteria are: English language, publication between August 7th 1998 and August 7th 2019 (20 years), studies on the epidemiology of pediatric keratoconus. Sources of evidence The search strategy was performed in the PubMed-MEDLINE database and Cochrane Database of Systematic Reviews and included eight combinations of these MeSH terms: keratoconus; child; incidence; prevalence; pediatrics; adolescent; epidemiology. The included articles were in the English language, with available abstracts, published between August 7th 1998 and August 7th 1998 (20 years) in the PubMed-MEDLINE database. Charting Methods “A flowchart of the article selection process will be provided as per PRISMA-ScR recommendations.” The included studies will be charted in Excel 2019, in order to summarize research methodologies, describe the included populations and demographic characteristics. Expected Results The authors expect to systematically summarize the existing literature, report the methodology of the current epidemiological studies and describe the gathered information. Pediatric keratoconus (KC) is a disease of the eye which causes progressive deformation of the cornea of children and adolescents. KC is bilateral and asymmetric, and its progression may lead to acute corneal hydrops – corneal edema due to breaks in the corneal Descemet membrane with subsequent scarring of the cornea(4). Keratoconus is usually considered to be more severe in the pediatric population (5). Pediatric KC causes a shifting myopic and astigmatic refractive error. Uncorrected refractive error is of severe concern in children due to the possible development of amblyopia, which is an irreversible reduced vision due to inadequate development of the visual brain pathways(Wallace et al., 2007). Traditionally, mild pediatric KC treatment has been based on rehabilitation with glasses and contact lenses. However, severe cases with corneal opacities and highly irregular and curved corneas may require surgery such as intracorneal rings segments, penetrating keratoplasties or deep anterior lamellar keratoplasties(4,7–15). Penetrating keratoplasty (PK) is associated with high costs and brings some morbidity, including the need for reoperations, intraoperative complications, need for visual rehabilitation with glasses and contact lenses, close follow-up visits, and more severe complications such as infectious disease. Furthermore, PK is difficult to be performed in the young due to need of post-operative manipulation, eye rubbing tendencies, poor compliance, increased risk of rejection and increased inflammatory response(7,8,12,16–22). Pediatric KC’s epidemiology has gained importance, due to the possibility of alteration of KC’s natural history through corneal crosslinking(1,23,32,24–31). The development of corneal crosslinking allows for earlier intervention with a possible change in the course of the disease, allowing the prevention of complications and stabilization of corneal anatomy(19,22,32,38–43). In addition, corneal CXL appears to be a cost-effective treatment compared to conventional treatment with PK(44). CXL is based on the application of riboflavin and ultraviolet light on the cornea, which causes strengthening of the cornea due to increase of collagen crosslinks. Pediatric KC is a global healthcare concern and it may be more common than previously reported(19,22,32,38–43). Its epidemiology is still poorly understood, however it is fundamental to policy decisions regarding possible pediatric KC screening programs. Therefore, the authors objective is to conduct a systematic scoping review on pediatric KC: define the disease, describe the studies reporting epidemiological data (prevalence, incidence), its clinical features and screening programs. The authors found that due to the breadth of the purposed review and the significant knowledge gaps, a scoping review was the most appropriate tool to report the information. Methods: The scoping review methodology was favored due to it being the most adequate for summarizing findings from a body of knowledge that is heterogeneous in methods and disciplines (Tricco et al., 2018). The PRISMA-ScR methodology and checklists were used in the elaboration of the manuscript. The scoping review proposal will be included in the OSF database (https://osf.io/), and registration information will be presented in the final manuscript. The eligibility criteria are: English language, publication between 07th of August 7th 1998 and August 7th 2019 (20 years), studies on epidemiological features of pediatric keratoconus, on pediatric KC`s clinical features, and those reporting/proposing screening programs. The information sources are PubMed-MEDLINE database and Cochrane Database of Systematic Reviews and keyword combinations of these MeSH terms: keratoconus; child; incidence; prevalence; pediatrics; adolescent; epidemiology. The included articles will be those in English language, with available abstracts, published in the last twenty years, the last search was conducted on August 7th, 2019. Authors of the included articles will be contacted if needed to clarify information. Pertinent references of the included articles will also be listed in the final references. Duplicate references will be excluded. One reviewer will decide the inclusion of articles based on the title and abstract initially. References out of the scope of the review will be excluded. Two other reviewers will analyze the resulting lists and may propose alterations. In case of divergence, a consensus will be reached to decide inclusion. The included articles will be reviewed in full text and their results charted by one author in Excel 2019, in order to summarize research methodologies, describe the included demographic characteristics. The resulting chart will be reviewed by the other two authors. The proposed data chart will be tested by the team on ten articles before its ample use. The studies will be critically analyzed according to the proposed methodology, corresponding results and risk of bias. A flowchart of the processing of the search results included studies, excluded studies, and reasoning will be provided, following PRISMA-ScR recommendations. Synthesis of the information will be done using the charted data using Excel 2019 software and narrative description, resulting in tables and charts to be presented in the manuscript. References: 1. Godefrooij DA, Soeters N, Imhof SM, Wisse RPL. Corneal Cross-Linking for Pediatric Keratoconus: Long-Term Results. Cornea [Internet]. 2016 [cited 2019 Jul 8];35(7):954–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27027921 2. McAnena L, Doyle F, O’Keefe M. Cross-linking in children with keratoconus: a systematic review and meta-analysis. Acta Ophthalmol [Internet]. 2017;95(3):229–39. Available from: http://files/5281/McAnena et al. - 2017 - Cross-linking in children with keratoconus a syst.pdf 3. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and ExplanationThe PRISMA-ScR Statement. Ann Intern Med [Internet]. 2018 Oct 2;169(7):467–73. Available from: https://doi.org/10.7326/M18-0850 4. Buzzonetti L, Ardia R, Petroni S, Petrocelli G, Valente P, Parrilla R, et al. Four years of corneal keratoplasty in Italian paediatric patients: indications and clinical outcomes. Graefes Arch Clin Exp Ophthalmol. 2016;254(11):2239–45. 5. Naderan M, Jahanrad A, Farjadnia M. Prevalence of Eyelid Laxity and its Association with Ophthalmic Findings and Disease Severity in Patients with Keratoconus. Eur J Ophthalmol. 2017;27(6):670–4. 6. Wallace DK, Chandler DL, Beck RW, Arnold RW, Bacal DA, Birch EE, et al. Treatment of Bilateral Refractive Amblyopia in Children Three to Less Than 10 Years of Age. Am J Ophthalmol [Internet]. 2007;144(4):487–96. Available from: http://dx.doi.org/10.1016/j.ajo.2007.05.040 7. Gabrić N, Dekaris I, Vojniković B, Karaman Z, Mravicić I, Katusić J. Corneal transplantation in children. Coll Antropol [Internet]. 2001 [cited 2019 Jul 8];25 Suppl:17–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11817008 8. Gulias-Cañizo R, Gonzalez-Salinas R, Hernandez-Zimbron LF, Hernandez-Quintela E, Sanchez-Huerta V. Indications and outcomes of pediatric keratoplasty in a tertiary eye care center: A retrospective review. Medicine (Baltimore) [Internet]. 2017 Nov [cited 2019 Jul 8];96(45):e8587. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29137083 9. Buzzonetti L, Petrocelli G, Laborante A. Anterior Lamellar Keratoplasty Assisted by IntralaseTM Femtosecond Laser in a Pediatric Patient. J Pediatr Ophthalmol Strabismus [Internet]. 2010;47 Online:e1-4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21214143 10. Mukhtar S, Ambati BK. Pediatric keratoconus: a review of the literature. Int Ophthalmol [Internet]. 2018 Oct [cited 2019 Jul 8];38(5):2257–66. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28852910 11. El-Khoury S, Abdelmassih Y, Hamade A, Slim E, Cherfan CG, Chelala E, et al. Pediatric Keratoconus in a Tertiary Referral Center: Incidence, Presentation, Risk Factors, and Treatment. J Refract Surg (Thorofare, NJ 1995) [Internet]. 2016 Aug 1 [cited 2019 Jul 8];32(8):534–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27505314 12. Shi W, Jin H, Li S, Liu M, Xie L. Indications of paediatric keratoplasty in north China. Clin Exp Ophthalmol. 2007;35(8):724–7. 13. Bajracharya L, Gurung R, DeMarchis E, Oliva M, Ruit S, Tabin G. Indications for keratoplasty in Nepal: 2005 - 2010. Nepal J Ophthalmol [Internet]. 2013 [cited 2019 Jul 8];5(2):207–14. Available from: http://files/5093/Bajracharya et al. - 2013 - Indications for keratoplasty in Nepal 2005 - 2010.pdf 14. Zaidman GW. The pediatric corneal infiltrate. Curr Opin Ophthalmol [Internet]. 2011 [cited 2019 Jul 8];22(4):261–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21597372 15. Léoni-Mesplié S, Mortemousque B, Touboul D, Malet F, Praud D, Mesplié N, et al. Scalability and severity of keratoconus in children. Am J Ophthalmol. 2012; 16. Rebenitsch RL, Kymes SM, Walline JJ, Gordon MO. The lifetime economic burden of keratoconus: A decision analysis using a markov model. Am J Ophthalmol [Internet]. 2011;151(5):768-773.e2. Available from: http://files/4617/Rebenitsch et al. - 2011 - The lifetime economic burden of keratoconus a dec.pdf 17. Ganekal S, Gangangouda C, Dorairaj S, Jhanji V. Early outcomes of primary pediatric keratoplasty in patients with acquired, atraumatic corneal pathology. J AAPOS [Internet]. 2011 [cited 2019 Jul 8];15(4):353–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21907118 18. Lowe MT, Keane MC, Coster DJ, Williams KA. The outcome of corneal transplantation in infants, children, and adolescents. Ophthalmology [Internet]. 2011 [cited 2019 Jul 8];118(3):492–7. Available from: http://files/5296/Lowe et al. - 2011 - The outcome of corneal transplantation in infants,.pdf 19. Harding SA, Nischal KK, Upponi-Patil A, Fowler DJ. Indications and outcomes of deep anterior lamellar keratoplasty in children. Ophthalmology [Internet]. 2010 [cited 2019 Jul 8];117(11):2191–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20663562 20. Limaiem R, Chebil A, Baba A, Ben Youssef N, Mghaieth F, El Matri L. Pediatric penetrating keratoplasty: Indications and outcomes. Transplant Proc [Internet]. 2011 [cited 2019 Jul 8];43(2):649–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21440785 21. Buzzonetti L, Petrocelli G, Valente P. Amniotic membrane transplantation in corneal melting after anterior lamellar keratoplasty assisted by femtosecond laser in children. Eur J Ophthalmol [Internet]. 2012 [cited 2019 Jul 8];22(3):477–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21971732 22. Majander A, Kivelä TT, Krootila K. Indications and outcomes of keratoplasties in children during a 40-year period. Acta Ophthalmol. 2016;94(6):618–24. 23. Zotta PG, Moschou KA, Diakonis VF, Kymionis GD, Almaliotis DD, Karamitsos AP, et al. Corneal Collagen Cross-linking for Progressive Keratoconus in Pediatric Patients: A Feasibility Study. J Refract Surg [Internet]. 2012 [cited 2019 Jul 8];28(11):793–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23347374 24. Kymionis G, Yoo S, Diakonis V, Kankariya V. Management of pediatric keratoconus - Evolving role of corneal collagen cross-linking: An update. Indian J Ophthalmol [Internet]. 2013 [cited 2019 Jul 8];61(8):435. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23925333 25. Ulusoy DM, Göktaş E, Duru N, Özköse A, Ataş M, Yuvacı İ, et al. Accelerated corneal crosslinking for treatment of progressive keratoconus in pediatric patients. Eur J Ophthalmol [Internet]. 2017 [cited 2019 Jul 8];27(3):319–25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27445064 26. Blackburn BJ, Gu S, Ford MR, de Stefano V, Jenkins MW, Dupps WJ, et al. Noninvasive assessment of corneal crosslinking with phase-decorrelation optical coherence tomography. Investig Ophthalmol Vis Sci [Internet]. 2019;60(1):41–51. Available from: http://files/5293/Blackburn et al. - 2019 - Noninvasive Assessment of Corneal Crosslinking Wit.pdf 27. Soeters N, Van der Lelij A, van der Valk R, Tahzib NG. Corneal Crosslinking for Progressive Keratoconus in Four Children. J Pediatr Ophthalmol Strabismus. 2011; 28. Magli A, Chiariello Vecchio E, Carelli R, Piozzi E, Di Landro F, Troisi S. Pediatric keratoconus and iontophoretic corneal crosslinking: refractive and topographic evidence in patients underwent general and topical anesthesia, 18 months of follow-up. Int Ophthalmol [Internet]. 2016 [cited 2019 Jul 8];36(4):585–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26704375 29. Kalkan Akcay E, Uysal BS, Sarac O, Ugurlu N, Yulek F, Cagil N, et al. The Effect of Corneal Epithelium on Corneal Curvature in Patients with Keratoconus. Semin Ophthalmol. 2015; 30. Viswanathan D, Kumar NL, Males JJ. Outcome of Corneal Collagen Crosslinking for Progressive Keratoconus in Paediatric Patients. Biomed Res Int [Internet]. 2014 [cited 2019 Jul 8];2014:1–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25013757 31. Godefrooij DA, Gans R, Imhof SM, Wisse RPLL. Nationwide reduction in the number of corneal transplantations for keratoconus following the implementation of cross-linking. Acta Ophthalmol. 2016;94(7):675–8. 32. Godefrooij DA, de Wit GA, Uiterwaal CS, Imhof SM, Wisse RPLL. Age-specific Incidence and Prevalence of Keratoconus: A Nationwide Registration Study. Am J Ophthalmol. 2017;175:169–72. 33. Kanavi MR, Javadi MA, Sanagoo M. Indications for Penetrating Keratoplasty in Iran. Cornea [Internet]. 2007 [cited 2019 Jul 8];26(5):561–3. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003226-200706000-00011 34. Downie LE. The Necessity for Ocular Assessment in Atopic Children: Bilateral Corneal Hydrops in an 8 Year Old. Pediatrics [Internet]. 2014 [cited 2019 Jul 8];134(2):e596–601. Available from: http://files/5295/Downie - 2014 - The necessity for ocular assessment in atopic chil.pdf 35. Kaimbo WK. Corneal hydrops associated with vernal conjunctivitis as a presenting sign of keratoconus in a Congolese child. Bull Soc Belge Ophtalmol. 2002; 36. Barsam A, Brennan N, Petrushkin H, Xing W, Quartilho A, Bunce C, et al. Case-control study of risk factors for acute corneal hydrops in keratoconus. Br J Ophthalmol. 2017;101(4):499–502. 37. Sykakis E, Karim R, Evans JR, Bunce C, Amissah-Arthur KN, Patwary S, et al. Corneal collagen cross-linking for treating keratoconus. Cochrane Database Syst Rev [Internet]. 2015 Mar 24 [cited 2019 Sep 13];(3). Available from: http://doi.wiley.com/10.1002/14651858.CD010621.pub2 38. Adachi W, Mitsuishi Y, Terai K, Nakayama C, Hyakutake Y, Yokoyama J, et al. The association of HLA with young-onset keratoconus in Japan. Am J Ophthalmol [Internet]. 2002 Apr [cited 2019 Jul 8];133(4):557–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11931792 39. Reeves SW, Ellwein LB, Kim T, Constantine R, Lee PP. Keratoconus in the Medicare population. Cornea. 2009;28(1):40–2. 40. Gokhale N. Epidemiology of keratoconus. Indian J Ophthalmol. 2013;61(8):382. 41. Torres Netto EA, Al-Otaibi WM, Hafezi NL, Kling S, Al-Farhan HM, Randleman JB, et al. Prevalence of keratoconus in paediatric patients in Riyadh, Saudi Arabia. Br J Ophthalmol. 2018;102(10):1436–41. 42. Fonn D. Concerned Parents and Patients. Eye Contact Lens Sci Clin Pract [Internet]. 2010;36(2):67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20216267 43. Xie L, Qi F, Gao H, Wang T, Shi W, Zhao J. Major shifts in corneal transplantation procedures in north China: 5316 Eyes over 12 years. Br J Ophthalmol. 2009;93(10):1291–5. 44. Leung VC, Pechlivanoglou P, Chew HF, Hatch W. Corneal Collagen Cross-Linking in the Management of Keratoconus in Canada: A Cost-Effectiveness Analysis. In: Ophthalmology. 2017.

A systematic scoping review examining experiential elements and strategies associated with quality participation among children and youth (2- 12 years) with intellectual and developmental disabilities (IDDs).

Introduction: Major depressive disorder (MDD) is a common mental health condition in adolescents. Randomized clinical trials (RCTs) are the gold-standard for assessing the safety and efficacy of interventions in this population. Heterogeneity in the outcomes measured and reported between RCTs limits the ability to compare, contrast, and combine trial results in a clinically meaningful way. There is currently no core outcome set (COS) available for use in RCTs evaluating interventions in adolescents with MDD. We will conduct a systematic scoping review of outcomes reported in adolescent depression RCTs to assess the variability of trial outcomes and to inform the development of a COS for adolescent MDD. Methods and analysis: We will apply methods based on the Joanna Briggs Institute scoping review methods manual. RCTs evaluating any treatment intervention for adolescent MDD published in the last ten years will be located using an electronic bibliographic database search (MEDLINE, PsycINFO, and Cochrane Central Register of Controlled Trials). Title and abstract screening, full-text screening, and data charting of eligible studies will be performed in duplicate. Outcomes identified will be mapped to an outcome domain framework. Data analysis will include summary statistics of the characteristics of the included trials and outcomes. Ethics and dissemination: The results of this review will inform the development of a COS for adolescent MDD. The development and implementation of a COS for RCTs evaluating interventions in adolescents with MDD promises to help reduce variability in trial outcome selection, definition, measurement, and reporting, ultimately facilitating evidence synthesis that will help to identify best treatment practices for adolescents with MDD. Registration details: This protocol was registered prospectively with the Open Science Framework (https://osf.io/xjz9u/).

This project aims to systematically review available guidance on development of clinical practice guidelines (CPG) in the context of management of spinal injuries.

Following acquired brain injury, some patients fail to orient to, attend to, respond to, or report stimuli appearing on the contralesional hemispace, with patients preferring the ipsilesional space despite having intact sensory abilities. Known as unilateral spatial neglect, this disorder is commonplace but highly variable in its symptoms and severity. Although left-sided neglect is diagnosed more frequently than right; left and right-sided neglect are both common. However, as it stands, the current literature predominately focuses on left-sided neglect. Therefore, the potentially different neurological root causes or the behavioural and cognitive consequences of right-sided neglect remains unclear. To our knowledge there has been no systematic review focussing on right-sided neglect. A systematic scoping review can help map the literature specific to right-sided neglect and highlight the characteristics of this disorder. This scoping review aims to map the literature on right-sided neglect following acquired brain injury.

Structured Summary: Limited published literature and media raise serious concerns surrounding atopic dermatitis (AD) and skin infections in both pediatric and adult patients in a Canadian context (Abedi 2019; Asiniwasis et al., 2020; CBC News 2019; Dehaas 2016; Forsey 2014; FNIGC 2012/2018). A retrospective study completed by Jeong et al. (2020) published in BMC identified a high level of antibiotic prescription in adults for skin infections in remote Canadian Indigenous communities, and the authors concluded that, “this population is currently hard to reach and under-represented in standard surveillance systems, and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment, and prevention”. Although Indigenous peoples of North America are unique and diverse in geography, culture and language, they face well documented unique disparities in social determinants of health and health disparity challenges related to social and historical contexts such as residential schools, reserves as legislated segregation, and other government policies (Allan & Smylie, 2015; Waldram, 2006). As a medical dermatologist with an academic interest in dermatology and health disparities, the author (RA) has informally noted a significant gap in inclusion surrounding Indigenous health disparities in skin disease in North American dermatology literature and virtual/in-person continuing medical education events such as conferences, as well as North American clinical trial representation in common inflammatory skin diseases (eg. moderate to severe psoriasis, AD). To date, no unified body of literature exists on North American Indigenous skin disease, thus we chose a systematic scoping review to further explore this topic by providing a ‘lay of the land’. This project involves a systematic scoping review of dermatologic conditions in North American Indigenous peoples using PRISMA-ScR guidelines (Tricco et al., 2018). In keeping with Truth and Reconciliation calls to action (www.trc.ca), our objective is to systematically and formally document dermatologic disease in North American Indigenous peoples, using findings as a launchpoint for discussion, awareness, informing of future research designs, and as a part of the translational research spectrum with the ultimate and hopefully eventual goal of reducing gaps in health disparities. Sources of evidence include a systematic search of North American Indigenous skin disease using MEDLINE, CINAHL, EMBASE, and CENTRAL, with an extended search of guideline repositories of AAD, CDA, AAAI/ACAAI, CSACI, ATS, and CTS and a scoping review of Indigenous representation in Phase II, III, and IV North American clinical trials involving small molecule and biologic therapy in moderate to severe psoriasis and atopic dermatitis. Charting methods include using Rayyan platform and Excel for data entry. Once data is gathered and analyzed, results will be discussed in context of our objectives and research questions. Rationale: We chose a systematic scoping review (ScR) as the topic of North American Indigenous skin disease has not yet been comprehensively reviewed, and includes a sizable, complex and heterogenous nature (TUL, 2021). Other rationales for ScR in this context include detecting gaps in existing literature, clarifying working definitions, and organizing literature from time, location (country and context), and source (Khalil et al., 2016; Temple University Library, 2021). Objectives: To conduct a systematic scoping review using PRISMA-ScR guidelines (Tricco et al., 2018) of North American Indigenous peoples, including all age groups/sex, urban/rural with skin disease. Epidemiological patterns of Indigenous skin disease, co-morbidities and outcomes will be explored. A scoping review of Indigenous representation in North American dermatologic and atopic guidelines and in moderate to severe psoriasis and atopic dermatitis clinical trials in small molecule and biologic therapy will be completed. Research questions include: 1. What is the prevalence/epidemiological patterns of skin disease among North American Indigenous peoples? 2. What kind of research is being done in North American Indigenous Peoples? 3. Frequency of guideline and clinical trial Indigenous representation See detailed attachment for further information. What terminology/language is being used? ADDITIONAL NOTE: Our database search terminology example on MEDLINE is currently being revised as of Feb 2, 2022.

“Patient-Centeredness” (PC) is a theoretical construct made up of a diverse constellation of distinct concepts, processes, practices, and outcomes that have been developed, arranged, and prioritized heterogeneously by different communities of professional healthcare practice, research, and policy. It is bound together by a common ethos that puts the holistic individual at the functional and symbolic center of their care, a quality deemed essential for chronic disease management and health promotion. Several important contributions to the PC research space have adeptly integrated seminal PC conceptualizations to improve conceptual clarity, measurement, implementation, and evaluation in research and practice. This systematic scoping review builds on that work, but with a purpose to explicitly identify, compare, and contrast the seminal PC conceptualizations arising from the different healthcare professional groups. The rationale for this work is that a deeper examination of the underlying development and corresponding assumptions from each respective conceptualization will lead to a more informed understanding of and meaningful contributions to PC research and practice, especially for healthcare professional groups newer to the topic area like pharmacy. The literature search identified four seminal conceptualizations from the healthcare professions of Medicine, Nursing, and Health Policy. A compositional comparison across the seminal conceptualizations revealed a shared ethos but also six distinguishing features: (1) organizational structure; (2) predominant level of care; (3) methodological approach; (4) care setting origin; (5) outcomes of interest; and (6) language. The findings illuminate PC’s stable theoretical foundations and distinctive nuances needed to appropriately understand, apply, and evaluate the construct’s operationalization in contemporary healthcare research and practice. These considerations hold important implications for future research into the fundamental aims of healthcare, how it should look when practiced, and what should reasonably be required of it.

OBJECTIVE: To describe how workload-related exposure variables have been defined in sports injury articles, and to identify the number of workload-related exposure variables included in comparative analyses. U DESIGN: Scoping review. U LITERATURE SEARCH: PubMed, SPORTDiscus, and Scopus were systematically searched on March 13, 2020. Two reviewers independently screened the retrieved literature and selected articles for inclusion. U STUDY SELECTION CRITERIA: Prospective cohort studies using workload-related variables as the primary exposure to sports injury were eligible for inclusion. U DATA SYNTHESIS: The type (eg, distance, balls bowled) and construct of workload-related exposure variables (eg, acute-chronic workload ratio) were extracted and summarized in frequency tables. U RESULTS: A total of 648 articles were identified, and 45 were eligible for inclusion. Workload definition differed greatly, as sports- and workload-related exposure variables could be, but were not limited to, distance, balls bowled, session rating of perceived exertion, accelerations, soreness, and sleep. Within and across articles, authors used different constructs for workload-related exposure variables. For example, distance was represented as total distance, distance per week, distance per 2 weeks, and acute-chronic workload ratio. The number of workload-related exposure variables included in comparative analyses ranged from 1 to 336. U CONCLUSION: Studies used different definitions of workload-related exposure variables. The number of workload-related exposure variables in a single study ranged from 1 to 336. J Orthop Sports Phys Ther 2020;50(10):538-548.

Background Early childhood caries disproportionately affects vulnerable groups and remains a leading cause of preventable hospital admissions for Western Australian children. The Western Australia State Oral Health Plan seeks to improve child oral health through universal and targeted health promotion initiatives with primary caregivers. These initiatives require evidence of primary caregiver oral health knowledge and behaviours and baseline data on early childhood caries. The objective of this systematic scoping review was to understand current oral health knowledge and practices of primary caregivers of children aged 0–4 years, identify influential socioecological determinants, and identify data on early childhood caries in the Western Australian context. Methods A systematic scoping review framework identified articles published between 2010 and 2021, using Scopus, PubMed, Medline, CINAHL, PsycINFO, selected article reference lists, and oral health websites. The lack of Western Australian specific literature prompted the inclusion of Australia-wide articles. Articles were screened via author consensus, with eight selected. Results Western Australia and nation-wide data on early childhood caries are limited and mostly dated. WA data from children aged 2–3 years, collected in 2006, suggests the prevalence is 2.9% in this state, with national data of children from 0 to 3 years, collected from 2006 and 2008, suggesting an early childhood caries prevalence of 3.4–8% of children aged 18 months, rising sharply by 36 months of age. Nationally, fewer than half the primary caregivers reported following evidence-based oral health recommendations for their young children. Perceptions of the role of dental services for young children tends to be focussed on treatment, rather than surveillance and prevention. Knowledge of dietary and oral hygiene practices is inconsistent and awareness of the Child Dental Benefit Schedule low. Young children’s oral health status is clearly associated with socioecological factors, including socioeconomic status. Conclusions Recent early childhood caries data and evidence of primary care-givers’ oral health knowledge and behaviours are unavailable in Western Australia, a similar situation exists nationwide. To realise the Western Australian and National Oral Health Plans, research is required to address this knowledge gap.

Background Molding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum. Methods With a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review. Results The first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF). Conclusions Our systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice.

Within the context of eHealth interventions, a shared understanding of what constitutes engagement in and with eHealth technologies is missing. A clearer understanding of engagement could provide a valuable starting point for guidelines relating to the design and development of eHealth technologies. Given the cross-disciplinary use of the term “engagement,” investigating how engagement (and its components) is conceptualized in different domains could lead to determining common components that are deemed important for eHealth technological design. As such, the aim of this paper was 3-fold: (a) to investigate in which domains engagement features, (b) to determine what constitutes engagement in these different domains, and (c) to determine whether there are any common components that seem to be important. A comprehensive systematic scoping review of the existing literature was conducted in order to identify the domains in which engagement is used, to extract the associated definitions of engagement, and to identify the dimensionality or components thereof. A search of five bibliographic databases yielded 1,231 unique records. All titles, abstracts, and full texts were screened based on specific inclusion and exclusion criteria. This led to 69 articles being included for further analyses. The results showed that engagement is used in seven functional domains, categorized as follows: student (n = 18), customer (n = 12), health (n = 11), society (n = 10), work (n = 9), digital (n = 8), and transdisciplinary (n = 1) domains. It seems that some domains are more mature regarding their conceptualization and theorizing on engagement than others. Further, engagement was found to be predominantly conceptualized as a multidimensional construct with three common components (behavior, cognition, and affective) shared between domains. Although engagement is prolifically used in different disciplines, it is evident that little shared consensus as to its conceptualization within and between domains exists. Despite this, engagement is foremost seen as a state of being engaged in/with something, which is part of, but should not be confused with, the process of engagement. Behavior, cognition, and affect are important components of engagement and should be specified for each new context.

The availability of healthcare data has exponentially grown, both in quantity and complexity. The speed of this evolution has generated new challenges for translating complex data into effective evidence-informed policy. Visual analytics offers new capacity to analyze healthcare systems and support better decision-making. We conducted a systematic scoping review to look for evidence of visual analytics approaches being applied to mental healthcare systems and their use in driving policy. We found 79 relevant studies and categorized them in two ways: by study purpose and by type of visualization. The majority (67.1%) of the studies used geographical maps, and 11% conducted highly complex studies requiring novel visualizations. Significantly, only 15% of the studies provided information indicating high levels of usability for policy and planning. Our findings suggest that while visual analytics continues to evolve rapidly, there is a need to ensure this evolution reflects the practical needs of policy makers.

Optimal delivery of medication via dry powder inhalers, the most commonly prescribed inhaler type, is dependent on a patient achieving a minimum level of inspiratory flow during inhalation. However, measurement of peak inspiratory flow (PIF) against the simulated resistance of a dry powder inhaler is not frequently performed in clinical practice due to time or equipment limitations. Therefore, defining which patient characteristics are associated with lower PIF is critically important to help clinicians optimize their inhaler choice through a more personalized approach to prescribing. The objective of this scoping review was to systematically evaluate patient and disease characteristics determining PIF in patients with chronic obstructive pulmonary disease (COPD). Medline, Cochrane and Embase databases were systematically searched for relevant studies on PIF in patients with COPD published in English between January 2000 and May 2021. The quality of evidence was assessed using a modified Grading of Recommendations Assessment, Development and Evaluation checklist. Of 3382 citations retrieved, 35 publications were included in the review (nine scored as high quality, 13 as moderate, nine as low, and four as very low). Factors correlating with PIF in >70% of papers included both patient characteristics (lower PIF correlated with increased age, female gender, shorter height, decreased handgrip and inspiratory muscle strength, and certain comorbidities) and disease characteristics (lower PIF correlated with markers of lung hyperinflation, lower peak expiratory flow [PEF] and increased disease severity). Other factors correlating with adequate/optimal or improved PIF included education/counseling and exercise/inspiratory muscle training; impaired physical function and errors in inhalation technique/non-adherence were associated with low/suboptimal PIF. In conclusion, clinicians should measure PIF against the simulated resistance of a particular device wherever possible. However, as this often cannot be done due to lack of resources or time, the patient and disease characteristics that influence PIF, as identified in this review, can help clinicians to choose the most appropriate inhaler type for their patients.

Background Research on the integration of artificial intelligence (AI) into community-based primary health care (CBPHC) has highlighted several advantages and disadvantages in practice regarding, for example, facilitating diagnosis and disease management, as well as doubts concerning the unintended harmful effects of this integration. However, there is a lack of evidence about a comprehensive knowledge synthesis that could shed light on AI systems tested or implemented in CBPHC. Objective We intended to identify and evaluate published studies that have tested or implemented AI in CBPHC settings. Methods We conducted a systematic scoping review informed by an earlier study and the Joanna Briggs Institute (JBI) scoping review framework and reported the findings according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Reviews) reporting guidelines. An information specialist performed a comprehensive search from the date of inception until February 2020, in seven bibliographic databases: Cochrane Library, MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ScienceDirect, and IEEE Xplore. The selected studies considered all populations who provide and receive care in CBPHC settings, AI interventions that had been implemented, tested, or both, and assessed outcomes related to patients, health care providers, or CBPHC systems. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Two authors independently screened the titles and abstracts of the identified records, read the selected full texts, and extracted data from the included studies using a validated extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. A third reviewer also validated all the extracted data. Results We retrieved 22,113 documents. After the removal of duplicates, 16,870 documents were screened, and 90 peer-reviewed publications met our inclusion criteria. Machine learning (ML) (41/90, 45%), natural language processing (NLP) (24/90, 27%), and expert systems (17/90, 19%) were the most commonly studied AI interventions. These were primarily implemented for diagnosis, detection, or surveillance purposes. Neural networks (ie, convolutional neural networks and abductive networks) demonstrated the highest accuracy, considering the given database for the given clinical task. The risk of bias in diagnosis or prognosis studies was the lowest in the participant category (4/49, 4%) and the highest in the outcome category (22/49, 45%). Conclusions We observed variabilities in reporting the participants, types of AI methods, analyses, and outcomes, and highlighted the large gap in the effective development and implementation of AI in CBPHC. Further studies are needed to efficiently guide the development and implementation of AI interventions in CBPHC settings.

BackgroundDelirium prevention is crucial, especially in critically ill patients. Nonpharmacological multicomponent interventions for preventing delirium are increasingly recommended and technology-based interventions have been developed to support them. Despite the increasing number and diversity in technology-based interventions, there has been no systematic effort to create an overview of these interventions for in-hospital delirium prevention and reduction.ObjectiveThis systematic scoping review was carried out to answer the following questions: (1) what are the technologies currently used in nonpharmacological technology-based interventions for preventing and reducing delirium? and (2) what are the strategies underlying these currently used technologies?MethodsA systematic search was conducted in Scopus and Embase between 2015 and 2020. A selection was made in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Studies were eligible if they contained any type of technology-based interventions and assessed delirium-/risk factor–related outcome measures in a hospital setting. Data extraction and quality assessment were performed using a predesigned data form.ResultsA total of 31 studies were included and analyzed focusing on the types of technology and the strategies used in the interventions. Our review revealed 8 different technology types and 14 strategies that were categorized into the following 7 pathways: (1) restore circadian rhythm, (2) activate the body, (3) activate the mind, (4) induce relaxation, (5) provide a sense of security, (6) provide a sense of control, and (7) provide a sense of being connected. For all technology types, significant positive effects were found on either or both direct and indirect delirium outcomes. Several similarities were found across effective interventions: using a multicomponent approach or including components comforting the psychological needs of patients (eg, familiarity, distraction, soothing elements).ConclusionsTechnology-based interventions have a high potential when multidimensional needs of patients (eg, physical, cognitive, emotional) are incorporated. The 7 pathways pinpoint starting points for building more effective technology-based interventions. Opportunities were discussed for transforming the intensive care unit into a healing environment as a powerful tool to prevent delirium.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020175874; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=175874

IntroductionHealth-promoting lifestyle behaviours are part of the activities of daily living that influence individual happiness, values and well-being. They play a crucial role in prevention and control of non-communicable diseases (NCDs) among all age groups. Current statistics on mortality, disability and morbidity associated with NCDs are alarming globally. The use of information and communication technology (ICT) for a health-promoting lifestyle behaviour programme enhances health behaviours that are important in the prevention and control of both communicable and non-communicable diseases. Our study aimed to map evidence on the use of ICT in comprehensive health-promoting lifestyle behaviour among healthy adults.MethodsEleven electronic databases were searched for the study. We included studies published in English between January 2007 and December 2018 reporting on healthy adults, ICT and any subscales of the health-promoting lifestyle profile (HPLP). Studies focusing on diseases or disease management and studies that combine monitoring tools in the form of hardware (accelerometer or pedometer) with ICT or computer games were excluded. Data were summarised numerically and thematically.ResultsAll the studies reviewed were conducted in developed countries. Most of the studies reported on physical activity, and findings of one study covered all the subscales of HPLP. The use of ICT for health-promoting lifestyle behaviours was reported to be effective in ensuring health behaviours that can improve physical and mental health.ConclusionOur findings showed that there is a dearth of knowledge on comprehensive health-promoting lifestyle behaviour that can be beneficial for the control and prevention of NCDs. There is a need to carry out primary studies on the use of ICT and comprehensive health-promoting lifestyle, especially among adults in low-income and middle-income countries where there are alarming statistics for mortality and disability associated with NCDs.PROSPERO registration numberCRD42016042568.

BACKGROUND: Substantial investments are being made in health -information -technology (HIT) based on assumptions that these systems will save costs through increased quality, safety and efficiency of care provision. Whilst -short-term -benefits have often proven difficult to demonstrate, there is increasing interest in achieving benefits in the medium and long term through secondary uses of -HIT-derived data.AIMS: We aimed to describe the range of secondary uses of HIT-derived data in the international literature and identify innovative developments of particular relevance to UK policymakers and managers.METHODS: We searched nine electronic databases to conduct a systematic scoping review of the international literature and augmented this by consulting a range of experts in the field.RESULTS: Reviewers independently screened 16,806 titles, resulting in 583 -eligible studies for inclusion. Thematic organisation of reported secondary uses was -validated during expert consultation (n = 23). A primary division was made between patient-identifiable data and datasets in which individuals were not identified. Secondary uses were then categorised under four domain headings of: i) research; ii) quality and safety of care provision; iii) financial management; and iv) healthcare professional education. We found that innovative developments were most -evident in research where, in particular, dataset linkage studies offered important -opportunities for exploitation.CONCLUSIONS: Distinguishing patient-identifiable data from aggregated, de-identified datasets gives greater conceptual clarity in secondary uses of HIT-derived data. Secondary uses research has substantial potential for realising future benefits through generating new medical knowledge from dataset linkage studies, developing precision medicine and enabling cross-sectoral, evidence-based policymaking to benefit population-level well-being.

ObjectiveLate diagnosis of Alzheimer’s disease (AD) may be due to diagnostic uncertainties. We aimed to determine the sequence and timing of the appearance of established early signs and symptoms in people who are subsequently diagnosed with AD.MethodsWe used systematic review methodology to investigate the existing literature. Articles were reviewed in May 2016, using the following databases: MEDLINE, PsycINFO, CINAHL, British Nursing Index, PubMed central and the Cochrane library, with no language restriction. Data from the included articles were extracted independently by two authors and quality assessment was undertaken with the quality assessment and diagnostic accuracy tool-2 (QUADAS tool-2 quality assessment tool).ResultsWe found that depression and cognitive impairment were the first symptoms to appear in 98.5% and 99.1% of individuals in a study with late-onset AD (LOAD) and 9% and 80%, respectively, in early-onset AD (EOAD). Memory loss presented early and was experienced 12 years before the clinically defined AD dementia in the LOAD. However, the rapidly progressive late-onset AD presented predominantly with 35 non-established focal symptoms and signs including myoclonus (75%), disturbed gait (66%) and rigidity. These were misdiagnosed as symptoms of Creutzfeldt-Jacob disease (CJD) in all the cases. The participant with the lowest mini-mental state examination score of 25 remained stable for 2 years, which is consistent with the score of the healthy family members.ConclusionsThe findings of this review suggest that neurological and depressive behaviours are an early occurrence in EOAD with depressive and cognitive symptoms in the measure of semantic memory and conceptual formation in LOAD. Misdiagnosis of rapidly progressive AD as CJD and the familial memory score can be confounding factors while establishing a diagnosis. However, the study was limited by the fact that each one of the findings was based on a single study.