Health sciences librarians' instructional engagement in continuing education: a scoping review.

Objective: Healthcare professionals (HCPs) have an ongoing need for continuing education (CE) while Health Science Librarians (HSLs), accustomed to supporting a range of learning needs in a variety of contexts, are well situated to provide CE that addresses information retrieval, literacy, management, and more. To better understand the extent of HSL delivered CE activities, we undertook a scoping review to determine how HSLs instruct practicing HCPs in support of their CE. Methods: We searched for published and unpublished literature sources including PubMed (NCBI), Embase (Elsevier); Dissertations and Theses Global (ProQuest); CINAHL (EBSCO); Library, Information Science and Technology Abstracts (EBSCO); and Library Literature and Information Science Full Text (EBSCO). To identify unpublished sources, we searched the internet using Google and contacted two health sciences library listservs. We also performed backwards and forwards searching of our included sources. Results: Our database searches yielded 4842 sources, and we retrieved an additional 579 sources through supplementary retrieval methods. After duplicate removal and screening, we included 105 sources in this review. The included sources were published between 1970 to 2021 and covered a range of topics such as searching methods and tools, critical appraisal, and many more. Those related to evidence-based practice (EBP) appeared around 2001 and bibliometrics and bioinformatics arose after 2016. Publications depicting HSLs teaching CE most commonly occurred in academic settings. The most common population taught was nurses, followed by physicians. Most sources did not report using an information literacy framework or instructional design model, undertaking needs assessments, or reporting formal objectives or assessment. Conclusion: While HSLs are active supporters of EBP, we need to apply the same principles to our own professional practice. Formal structure of programming and program assessment combined with clear, detailed reporting can help to build a more robust evidence base to support future CE provision.

Interprofessional collaboration between health professional learners when breaking bad news: a scoping review of teaching approaches.

OBJECTIVE: The objective of this scoping review was to examine teaching approaches used to teach interprofessional health professional learners how to break bad news collaboratively. INTRODUCTION: When breaking bad news, health professionals must be equipped to deliver it skillfully and collaboratively; however, the literature shows that this skill receives little attention in program curricula. Consequently, health professionals can feel inadequately prepared to deliver bad news, which may lead to increased burnout, distress, and compassion fatigue. INCLUSION CRITERIA: Studies that describe teaching approaches used to teach learners how to break bad news collaboratively were considered for inclusion. Studies must have included 2 or more undergraduate and/or postgraduate learners working toward a professional health or social care qualification/degree at a university or college. Studies including lay, complementary and alternative, or non-health/social care learners were excluded. Due to the primary language of the research team, only English articles were included. METHODS: The JBI 3-step process was followed for developing the search. Databases searched included MEDLINE (Ovid), CINAHL (EBSCOhost), Embase, Education Resource Complete (EBSCOhost), and Social Work Abstracts (EBSCOhost). The initial search was conducted on February 11, 2021, and was updated on May 17, 2022. Title and abstract screening and data extraction were completed by 2 independent reviewers. Disagreements were resolved through discussion or with a third reviewer. Results are presented in tabular or diagrammatic format, together with a narrative summary. RESULTS: Thirteen studies were included in the scoping review, with a range of methodologies and designs (pre/post surveys, qualitative, feasibility, mixed methods, cross-sectional, quality improvement, and methodological triangulation). The majority of papers were from the United States (n=8; 61.5%). All but 1 study used simulation-enhanced interprofessional education as the preferred method to teach interprofessional cohorts of learners how to break bad news. The bulk of simulations were face-to-face (n=11; 84.6%). Three studies (23.1%) were reported as high fidelity, while the remainder did not disclose fidelity. All studies that used simulation to teach students how to break bad news utilized simulated participants/patients to portray patients and/or family in the simulations. The academic level of participants varied, with the majority noted as undergraduate (n=7; 53.8%); 3 studies (23.1%) indicated a mix of undergraduate and graduate participants, 2 (15.4%) were graduate only, and 1 (7.7%) was not disclosed. There was a range of health professional programs represented by participants, with medicine and nursing equally in the majority (n=10; 76.9%). CONCLUSIONS: Simulation-enhanced interprofessional education was the most reported teaching approach to teach interprofessional cohorts of students how to break bad news collaboratively. Inconsistencies were noted in the language used to describe bad news, use of breaking bad news and interprofessional competency frameworks, and integration of interprofessional education and simulation best practices. Further research should focus on other interprofessional approaches to teaching how to break bad news, how best to incorporate interprofessional competencies into interprofessional breaking bad news education, whether interprofessional education is enhancing collaborative breaking bad news, and whether what is learned about breaking bad news is being retained over the long-term and incorporated into practice. Future simulation-specific research should explore whether and how the Healthcare Simulation Standards of Best Practice are being implemented and whether simulation is resulting in student satisfaction and enhanced learning.

Experiences of women who have planned unassisted home births in high-resource countries: a qualitative systematic review.

OBJECTIVE: The aim of this review was to identify, appraise, and synthesize the qualitative evidence about the experiences of women in high-resource countries who have planned unassisted home births. INTRODUCTION: Unassisted birth occurs when a woman chooses to give birth without the assistance of health care providers. These births are planned and usually occur in a woman's home. It is difficult to know the prevalence of unassisted birth because it occurs at the margins of health care systems, making data difficult to collect. Based on its lack of visibility in society, we assume that unassisted birth is not a common birth choice. Women who choose planned unassisted birth may face stigma for their decision and their experience of birth, which challenge accepted norms. Synthesizing qualitative evidence about women's experiences of planned unassisted birth can improve our understanding about women's birthing values and provide important clues about aspects of birthing care that may be missing in mainstream birthing services. INCLUSION CRITERIA: Studies that explored the experiences of women who had planned unassisted home births without the support of health care providers in high-resource countries were included. Unassisted home births were defined as those that were planned not to be assisted by health care professionals. Study designs that focused on qualitative data were eligible for inclusion. METHODS: MEDLINE (Ovid), Embase, CINAHL (EBSCO), Scopus, Web of Science, Sociological Abstracts (ProQuest), ProQuest Dissertations and Theses (ProQuest), and Nursing and Allied Health Database (ProQuest) were searched in 2022. Studies published in English since the databases' inception were considered for inclusion. A search of relevant websites for unpublished and gray literature was also undertaken in 2022. Two independent reviewers assessed the methodological quality of papers identified for inclusion. Qualitative research findings were extracted from papers that met the inclusion criteria and critical appraisal standard. Findings were extracted and categorized based on similarity of meaning. The categories were synthesized to create 2 synthesized findings, and the ConQul approach was used to grade the findings to establish confidence in the synthesized findings. RESULTS: Six studies were included in the review. All the studies used interviews for data collection; other methods included surveys, email correspondence, posts on internet discussion boards and forums, and websites. The total sample size for interviews was 103 participants. Total survey sample size for surveys was 87 participants. Total sample size for email correspondence was 5. Internet data sources included more than 100,000 individual and forum posts and 127 birth stories. A total of 17 findings were extracted and grouped into 4 categories. The 4 categories were then synthesized into 2 synthesized findings: i) navigating tensions within self, and between self and systems, and ii) integrating and transcending physical experiences of birth. CONCLUSIONS: More research is needed to better understand the experiences of women who have planned unassisted births. Improving understanding and increasing the awareness of planned unassisted birth are necessary steps for promoting inclusive, relational, and person-centered birthing experiences for everyone. Reflection about the differences between planned unassisted births and mainstream births may support needed reorientations of perinatal services. REVIEW REGISTRATION: PROSPERO CRD42019125242. SUPPLEMENTAL DIGITAL CONTENT: A French-language version of the abstract of this review is available [ http://links.lww.com/SRX/A9 ].

A Systematic Review of Antimicrobial Stewardship Interventions to Improve Management of Bacteriuria in Hospitalized Adults.

OBJECTIVE: To determine whether implementation of antimicrobial stewardship (AMS) interventions improve management of bacteriuria in hospitalized adults. DATA SOURCES: EMBASE, MEDLINE, CINAHL, and Clinical Trials Registries via Cochrane CENTRAL were searched from inception through May 2021. Reference lists of included studies were searched, and Scopus was used to retrieve articles that cited included references. STUDY SELECTION AND DATA EXTRACTION: Randomized and nonrandomized trials, controlled before-after studies, interrupted time-series studies, and repeated measures studies evaluating AMS interventions for hospitalized adult inpatients with bacteriuria were included. Risk of bias was assessed independently by 3 team members and compared. Results were summarized descriptively. DATA SYNTHESIS: The search yielded 5509 articles, of which 13 met inclusion criteria. Most common interventions included education (N = 8) and audit and feedback (N = 5) alone or in combination with other interventions. Where assessed, resource and antimicrobial use primarily decreased and appropriateness of antimicrobial use improved; however, impact on guideline adherence was variable. All studies were rated as having unclear or serious risk of bias. This review summarizes and assesses the quality of evidence for AMS interventions to improve the management of bacteriuria. Results provide guidance to both AMS teams and researchers aiming to develop and/or evaluate AMS interventions for management of bacteriuria. CONCLUSIONS: This review demonstrated benefit of AMS interventions on management of bacteriuria. However, most studies had some risk of bias, and an overall effect across studies is unclear due to heterogeneity in outcome measures.

Children, young people and parent engagement in health intervention design and implementation: A scoping review.

INTRODUCTION: Engaging children and young people (CYP) with and without their parents in health research has the potential to improve the development and implementation of health interventions. However, to our knowledge, the scope of engagement activities used with this population and barriers to their engagement is unknown. The objective of this review was to identify and describe CYP engagement with and without their parents in the development and/or implementation of health interventions. METHODS: This scoping review included any primary research studies reporting on engaging CYP, with or without parents, in the design and/or implementation of health interventions. Healthcare professionals had to be involved over the course of the study and the study had to take place in either community, primary or tertiary care settings. The following databases were searched in May 2017, May 2020 and June 2021: Medline (OVID), CINAHL (EBSCO) and Embase (Elsevier). Two independent reviewers screened titles, abstracts and full-text articles and used a previously piloted extraction form to extract and summarize information from the included articles. RESULTS: Twenty-eight articles discussing twenty-four studies were included. CYP engagement throughout the research cycle was limited. There were no observed differences in the reported presence of engagement, types of interventions or outcomes of engagement between studies engaging CYP or CYP and parents. Studies engaging CYP and parents contained limited information on how these relationships affected outcomes of engagement. Engagement was enabled primarily by the maintenance of resources and relationships among stakeholders. CONCLUSIONS: Although CYP engagement often influenced health intervention and implementation design, they are inconsistently engaged across the research cycle. It is unclear whether parental involvement enhances CYP engagement. Future research should consider reporting guidelines to clarify the level of CYP and/or parent engagement, and enhance CYP engagement by fostering synergistic and sustainable partnerships with key stakeholders. PATIENT OR PUBLIC CONTRIBUTION: A parent partner with codesign experience contributed to the creation of the research questions, screened titles, abstracts and full texts, helped with data extraction and provided feedback on the manuscript.

Black nurses in the nursing profession in Canada: a scoping review.

BACKGROUND: With migration occurring over a series of centuries, dating back to the 1600's, the circumstance regarding Black people in Canada is a complex account. A plethora of social issues and the failure to adequately acknowledge and reconcile historical issues, has resulted in health inequity, disparities and knowledge gaps, related to the Black population in Canada. In nursing, historical records indicate a legacy of discrimination that continues to impact Black nurses. The profession has begun reckoning with anti-Black racism and the residual effects. This scoping review sought to chart the existing evidence on Black nurses in the nursing profession in Canada. METHODS: JBI methodology was used to search peer-reviewed evidence and unpublished gray literature. Sources were considered for inclusion based on criteria outlined in an a priori protocol focusing on: 1) Canada 2) Black nurses and 3) nursing practice. No restrictions were placed on date of publication and language was limited to English and French. All screening and extractions were completed by two independent reviewers. RESULTS: The database search yielded 688 records. After removing duplicates, 600 titles and abstracts were screened for eligibility and 127 advanced to full-text screening. Eighty-two full-text articles were excluded, for a total of 44 sources meeting the inclusion criteria. Seven sources were identified through gray literature search. Subsequently, 31 sources underwent data extraction. Of the 31 sources, 18 are research (n = 18), six are commentaries (n = 6); one report (n = 1) and six are classified as announcements, memoranda or policy statements (n = 6). The review findings are categorized into five conceptual categories: racism (n = 12); historical situatedness (n = 2); leadership and career progression (n = 7); immigration (n = 4); and diversity in the workforce (n = 4). CONCLUSIONS: This review reveals the interconnectedness of the five conceptual categories. Racism was a prominent issue woven throughout the majority of the sources. Additionally, this review captures how racism is exacerbated by intersectional factors such as gender, class and nationality. The findings herein offer insight regarding anti-Black racism and discrimination in nursing as well as suggestions for future research including the use of diverse methodologies in different jurisdictions across the country. Lastly, the implications extend to the nursing workforce in relation to enhancing diversity and addressing the ongoing nursing shortage.

Lifestyle interventions for type 2 diabetes prevention in children and adolescents of African descent in OECD countries: a systematic review protocol.

OBJECTIVES: The objectives of this review are to investigate the effectiveness of lifestyle interventions for type 2 diabetes prevention in children and adolescents of African descent in the Organisation for Economic Co-operation and Development (OECD) member countries and to attempt to ascertain what aspects of these interventions are most effective in this population. INTRODUCTION: Lifestyle interventions have been shown to prevent or delay the onset of type 2 diabetes;however, the extent to which these interventions are effective for children and adolescents of African descent is not well established. The increasing type 2 diabetes incidence and prevalence in children and adolescents of African descent in some OECD member countries underscores the need to pool available evidence to ascertain the effectiveness of lifestyle interventions for type 2 diabetes prevention in this population. INCLUSION CRITERIA: Lifestyle interventions to be considered include individual-or group-based lifestyle or behavioral modification interventions aimed at preventing or delaying the onset of type 2 diabetes in children and adolescents of African descent aged 19 years and under in OECD countries. Randomized controlled trials and non-randomized studies that assess the effectiveness of lifestyle interventions for type 2 diabetes prevention will be considered. METHODS: The databases to be searched include MEDLINE, Embase, CINAHL, PsycINFO, Social Services Abstracts, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations and Theses Global databases. There will be no language or date limits placed on the search. Two independent reviewers will conduct the title, abstract, and full-text screening, followed by critical appraisal and data extraction. Data will undergo meta-analysis where appropriate, and will otherwise be presented as narrative synthesis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021247267.

Exploring parity in female authorship of pharmacoepidemiology articles: A case study of the Canadian Network for Observational Drug Effect Studies and its citing articles.

PURPOSE: The Canadian Network for Observational Drug Effect Studies (CNODES) studies the benefits and risks of post-market drugs and evaluates its research mobilization efforts for accountability, demonstrating value, and learning. As part of these evaluation efforts, and acknowledging gender disparity in authorship across many academic disciplines, CNODES examined the relationship between gender and authorship in its own journal articles and the literature citing them. METHODS: CNODES articles (published 2012-2017) and all citing articles were identified and extracted using Scopus. Scopus author IDs were used to extract full names and a web service (www.genderapi.com) was used to estimate gender, converting all probabilities <80% to "indeterminate." T-tests and visualizations were used to compare the proportion of females between CNODES and the citing literature. RESULTS: Twenty-eight CNODES articles and 463 citing articles were identified. The mean number of authors per article was 9.5 in CNODES articles and 5.7 in the citing literature. CNODES articles had a female authorship rate of 36%, compared to 29% in the citing literature (7% difference, 95% CI: [1%, 13%]). There were no female authors in 14% of CNODES articles versus 36% of the citing literature. Women were first authors in 25% and corresponding authors in 14% of CNODES articles. CONCLUSIONS: This analysis provides a benchmark and method to monitor progress in female parity in pharmacoepidemiology authorship. Further work is needed to determine and address barriers and facilitators to women's recruitment and advancement in the field of pharmacoepidemiology.

Food security in African Canadian communities: a scoping review.

OBJECTIVE: The objective of this review is to chart the evidence relating to food security among African Canadian communities to inform future research and offer insight related to food security in African Canadian communities. INTRODUCTION: Achieving food security is of global importance to meet the United Nations Sustainable Development Goals. As a social determinant of health, food security, which refers to the unrestricted physical, economic, and timely access to safe and nutritious foods, impacts more than 4 million Canadians. Yet, little is known about food security and the differential impacts of food insecurity among African Canadians. This scoping review sought to describe the current state of food security among African Canadians. INCLUSION CRITERIA: Sources were considered for inclusion if they: i) focused on Canada, ii) involved African Canadians, and iii) examined food security. METHODS: This scoping review was conducted in accordance with JBI methodology. Databases and relevant websites containing peer-reviewed, unpublished, and gray literature were searched. Ancestry searching and forward citation tracing were completed. No restrictions were placed on date of publication. Language restrictions were limited to English and French. In instances where articles were unavailable, authors of potential sources were contacted at the full-text review phase to request access to their article. Data were extracted independently by two team members, and are presented narratively and in tabular format. RESULTS: The search of databases yielded a total of 1183 records. Ancestry tracing yielded 287 records. After removing duplicates, 1075 titles and abstracts were screened for eligibility and 80 advanced to full-text screening. Seventy-five full-text articles were excluded for not meeting the inclusion criteria, leaving five articles that underwent data extraction. All five included studies involved African Canadian participants in Canada. All studies focused on adults; one study included women and men participants, while four focused exclusively on women. One study involving women participants included cisgender and transgender women as well as those identifying as queer. Study designs reflected qualitative (n = 2), quantitative (n = 1), and mixed methods (n = 2) designs. CONCLUSIONS: This review begins to fill a gap in understanding the current evidence available on food security as it impacts African Canadians. The findings of this review represent existing research, describing the type of evidence available and methodologies used, before suggesting implications for research and practice. The inclusion of only five studies reveals the limited evidence regarding the current state of food security among African Canadians. Further, included studies were exclusively conducted in urban settings and predominantly in one province. There is a need for further research in rural communities, in other provinces and territories, as well as with younger and older participants. The urgent need to collect race-disaggregated data in Canada is evident.

Women's experiences of living with obesity during pregnancy, birthing, and postpartum: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to explore and understand women's experiences of living with obesity during the perinatal period to support evidence-informed approaches to care. INTRODUCTION: The rising incidence of maternal obesity is a serious global health problem. Qualitative studies exploring the viewpoints of pregnant women living with obesity have shown that some women report negative experiences associated with pregnancy, with some instances of current care management practices being perceived as confronting, judgmental, and generally unhelpful. Synthesizing qualitative findings about the experiences of pregnant and postpartum women who live with obesity can provide important insights into the general needs of this population and current gaps in health care practice. INCLUSION CRITERIA: All settings in which women who live with obesity during their pregnancies and receive health care for pregnancy, birthing, and postpartum care will be considered. Studies published from 1995 onward will be included. The review will consider all studies that present qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, and feminist research. METHODS: The following databases will be searched for this review: CINAHL (EBSCO), Embase (Elsevier), PsycINFO (EBSCO), MEDLINE (Ovid), and Sociological Abstracts (ProQuest). ProQuest Dissertations and Theses will be searched for unpublished studies. Each study will be assessed by two independent reviewers. Any disagreements will be resolved through discussion. Data extraction will be conducted by two independent reviewers. The JBI resources for meta-aggregation will be used to create categories and synthesized findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020214762.

Interprofessional collaboration between health professional learners when breaking bad news: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to examine pedagogies used to teach interprofessional health learners how to break bad news collaboratively. INTRODUCTION: Breaking bad news is a skill health care professionals must be equipped to deliver well, yet literature shows that this skill receives little attention in program curricula. Consequently, health care professionals feel inadequately prepared to deliver bad news, leading to greater burnout, distress, and fatigue. INCLUSION CRITERIA: Studies that describe pedagogies used to teach breaking bad news will be considered for inclusion. Studies must include two or more undergraduate and/or postgraduate learners working towards a professional health or social care qualification or degree at a university or college. Studies including lay, complementary and alternative, or non-health or social care professional learners will be excluded. METHODS: The JBI three-step process will be followed for developing the search. Databases to be searched include MEDLINE, CINAHL, Embase, Education Resource Centre, and Social Work Abstracts. Title and abstract screening through to data extraction will be completed by two independent reviewers and any disagreements will be resolved through discussion, or with a third reviewer. Results will be presented in tabular or diagrammatic form, together with a narrative summary.

Driving performance assessments for benzodiazepine receptor agonist-related impairment: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify, map, and characterize the evidence for assessments that measure driving performance in people taking benzodiazepine receptor agonists. INTRODUCTION: Benzodiazepines and Z-drugs are widely prescribed for the treatment of anxiety disorders and insomnia even though they are not recommended as an initial treatment for these indications. Benzodiazepine and Z-drug use is associated with an elevated risk of traffic accidents, and guidance documents instruct patients to consult with their health care providers for instructions on how to safely operate a motor vehicle while consuming these medications. However, little is known about the assessments that measure driving performance regarding the extent and length of impairment from the consumption of the individual benzodiazepines and Z-drugs. INCLUSION CRITERIA: Eligible studies will include participants who are new, intermittent, or chronic users of benzodiazepines and Z-drugs. No exclusions will be applied regarding the health status of participants or whether their benzodiazepine and Z-drug use is for an approved indication as indicated by government agencies (eg, Health Canada) or practice guidelines. Studies that examine the consumption of a benzodiazepine and Z-drug in association with the operation of a motor vehicle (real or simulated) with direct or indirect objective or standard subjective measures or indicators of impairment while operating a motor vehicle will be considered. METHODS: Embase (Elsevier), MEDLINE (Ovid), and PsycINFO (EBSCO) will be searched as sources of published studies. Only studies published in English will be included, and there will be no limit on dates of publication. After screening the titles and abstracts of identified citations, two independent reviewers will retrieve potentially relevant full-text studies and extract data. Data will be presented in diagrammatic or tabular form accompanied by a narrative summary.

African Canadian nurses in the nursing profession in Canada: a scoping review protocol.

OBJECTIVE: The objective of this review is to synthesize the evidence on African Canadian nurses in the nursing profession in Canada. INTRODUCTION: With approximately 1.2 million people of African descent, Canada has committed to addressing the United Nations' decade for people of African descent. Intergenerational racism continues to result in multisectoral discrimination against African Canadians. Studies suggest that African Canadians are under-represented in nursing, and encountering systemic barriers to entering and advancing in the profession. Additionally, African Canadian nurses experience racism from patients and colleagues, as well as systemic racism through hiring and promotion. INCLUSION CRITERIA: This review will consider sources that include African Canadian nurses who identify as Black or as of African descent. All levels of professional nursing practice will be included (practical nurses, registered nurses, and advanced practice nurses, including nurse practitioners and clinical nurse specialists). Qualitative, quantitative, and mixed methods studies and gray literature will be searched. METHODS: This review will be conducted in accordance with the JBI methodology. Databases to be searched from inception to the present include CINAHL, MEDLINE, Embase, Sociological Abstracts, Gender Studies Database, America: History and Life, PsycINFO, Academic Search Premier, and Scopus. Studies published in English and French will be included. A comprehensive search strategy developed with a librarian will be used to retrieve relevant sources. Two independent screeners will screen titles and abstracts as well as full texts of relevant sources. Data will be extracted by two independent extractors then presented narratively, using appropriate tables and figures. SYSTEMATIC REVIEW REGISTRATION NUMBER: Open Science Framework Preregistration October 3, 2019. Open Science Framework Link for Abstract https://osf.io/6a2fe/?view_only=57d86d5b7c1d464182692d0f4bb9b396.

Deprescribing interventions in primary health care mapped to the Behaviour Change Wheel: A scoping review.

BACKGROUND: Polypharmacy and inappropriate medication use are an increasing concern. Deprescribing may improve medication use through planned and supervised dose reduction or stopping of medications. As most medication management occurs in primary health care, which is generally described as the first point of access for day-to-day care, deprescribing in primary health care is the focus on this review. OBJECTIVE: This scoping review aimed to identify and characterize strategies for deprescribing in primary health care and map the strategies to the Behaviour Change Wheel (BCW). METHODS: A scoping review was conducted that involved searches of six databases (2002-2018) and reference lists of relevant systematic reviews and included studies. Studies that described and evaluated deprescribing strategies in primary health care were eligible. Two independent reviewers screened articles and completed data charting with charting verified by a third. Deprescribing strategies were mapped to the intervention functions of the BCW and linked to specific Behaviour Change Techniques (BCT). RESULTS: Searches yielded 6871 citations of which 43 were included. Nineteen studies were randomized, 24 were non-randomized. Studies evaluated deprescribing in terms of medication changes, feasibility, and prescriber/patient perspectives. Deprescribing strategies involved various professionals (physicians, pharmacists, nurses), as well as patients and were generally multifaceted. A wide range of intervention functions were identified, with 41 BCTs mapped to Environmental restructuring, 38 BCTs mapped to Enablement, and 34 BCTs mapped to Persuasion. CONCLUSIONS: Deprescribing strategies in primary health care have used a variety of BCTs to address individual professionals (e.g. education) as well as strategies that addressed the practice setting, including support from additional team members (e.g. pharmacists, nurses and patients). Further research is warranted to determine comparative effectiveness of different BCTs, which can help facilitate implementation of deprescribing strategies, thereby reducing polypharmacy, in primary health care.

Experiences and perceptions of spousal/partner caregivers providing care for community-dwelling adults with dementia: a qualitative systematic review.

OBJECTIVE: The objective of this review was to synthesize evidence on the experiences and perceptions of spousal/partner caregivers of community-dwelling adults with dementia. INTRODUCTION: Currently 47 million people in the world have a diagnosis of dementia, and this number is predicted to climb to 75 million by 2030. The majority of care is provided by family members, particularly spouses/partners. Quantitative systematic reviews of spouse/partner caregivers demonstrate negative health effects for these caregivers. This review synthesized the qualitative evidence on the experiences of spousal/partner caregivers of people with dementia to further understanding how this care and the context of care contribute to the health and well-being of spousal/partner caregivers. INCLUSION CRITERIA: This review considered qualitative studies that explored the experiences of spousal/partner caregivers providing care for adults with dementia. The focus was on qualitative designs including, but not limited to, phenomenology, grounded theory, ethnography, action research, critical research and feminist research. METHODS: The search strategy used a three-step approach and was aimed at locating both published and unpublished studies. Key databases included MEDLINE, CINAHL, Embase, PsycINFO, Sociological Abstracts, ISI Web of Science, and Dissertation Abstracts International. Gray literature was searched using keywords from the database searches. The databases were searched from inception to February 2017, and a mix of controlled vocabulary (i.e. MeSH, CINAHL headings) and keywords were used to capture all existing qualitative studies related to the experiences and perceptions of spousal/partner caregivers providing unpaid care for adults with dementia. During the title and abstract screening, only English and French articles were included. The recommended JBI approach to study selection, critical appraisal, data extraction and data synthesis was used. Seven of the 10 critical appraisal criteria were deemed essential, with exceptions identified for criteria 1, 6 and 7. RESULTS: Nineteen studies were included in the review. Study designs included phenomenology (eight), grounded theory (five), qualitative description (four), ethnography (one) and narrative inquiry (one). The total number of participants was 248 (164 women and 84 men). The overall quality of the studies was rated as moderate on the ConQual score, with dependability rated as moderate and credibility rated as high. One hundred and fifty-five findings were aggregated into four categories and two synthesized findings. The two synthesized findings were "the expectation to care in the midst of uncertainty and unpredictability" and "the caregiver as hostage". CONCLUSIONS: This review provides a comprehensive understanding that can inform spousal/partner caregiver policies and programs. Evidence is required on the experiences and perceptions of caregivers across the gender continuum. Interventions and interventional research that mobilizes the evidence to date is essential for the future of caregivers. The limitations to this review include the possibility of missed studies, all study participants being in heterosexual relationships, and the majority of participants being Caucasian. Recommendations for practice, policy and research include the need for awareness of the extent of change in the lives of the person with dementia and the spousal/partner caregiver, the importance of support and respite, the need to tangibly recognize the value of the unpaid caregiver in a way that preserves the health and well-being of this group, and research is required that is culturally sensitive and reflects the experiences of the lesbian, gay, bisexual, transgender, transsexual, queer, questioning, intersex, asexual, ally, pansexual populations.

Food security in African Canadian communities: a scoping review protocol.

OBJECTIVE: The objective of this study is to synthesize and describe the evidence relating to food security among African Canadian communities to inform future research and health policy concerning people of African descent. INTRODUCTION: Food security denotes the timely access to nutritionally and culturally appropriate foods by individuals, families, groups, and communities. In Canada, there are vulnerable groups who experience higher rates of food insecurity, including immigrant and senior populations as well as Indigenous communities. While there is evidence describing food security among these vulnerable groups, food security among African Canadian communities remains poorly understood. The African Canadian community is an integral component of the Canadian population, yet there is a limited understanding of food security among this group. INCLUSION CRITERIA: This review will focus on the African Canadian population and food security, which encompasses food access, nutrition, and culturally appropriate foods. Evidence obtained from qualitative, quantitative, mixed methods studies, as well as dissertations and gray literature will be considered for inclusion. METHODS: This scoping review will be conducted in accordance the JBI scoping review methodology. A comprehensive search strategy developed by a librarian scientist will be used to locate and retrieve relevant sources. A screening tool will be used to screen titles and abstracts as well as the full text of included sources. Data will then be extracted by two independent reviewers, synthesized, and presented narratively, including tables and figures where appropriate.

Evaluation of the experiences and needs of users of a drug information resources website.

OBJECTIVE: This article describes the evaluation of the experiences and needs of users of the Drug Information Resources (DIR) website. The DIR website attracts traffic and use from around the world, with the highest number of users in Canada and the United States. METHODS: An online questionnaire was developed through use of a literature review and Google Analytics data. Face validity testing and test-retest reliability were completed prior to releasing the questionnaire. RESULTS: Although the Google Analytics data showed that the site is used internationally, most respondents were Canadian students. They used the site for academic and clinical purposes and reported it was easy to use, was well organized, and included required resources, and they would recommend it to others. CONCLUSION: The DIR website was found to be a valuable resource for educational and clinical use. Future studies will aim to obtain input from international users.

Experiences of women who have planned unassisted home births: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify, appraise and synthesize the qualitative evidence on the experiences of women in high resource countries who have planned unassisted home births. This qualitative review aims to answer the following question: what are the experiences of women who have planned unassisted home births?

The impact of transitional care programs on health services utilization in community-dwelling older adults: a systematic review.

OBJECTIVE: The objective was to identify and synthesize the best available evidence on the impact of transitional care programs on various forms of health services utilization in community-dwelling older adults. INTRODUCTION: There is growing evidence that transitional care programs can help address important challenges facing health care systems and our increasing older adult population in many countries by reducing unnecessary health service utilization. There is a need for a systematic review of the research evaluating the impact of transitional care programs on hospital and other health service usage. INCLUSION CRITERIA: The review included studies on community-dwelling adults age 60 and over with at least one medical diagnosis, and which evaluated the outcomes of transitional care programs on health system utilization of older adults. The outcomes for this review were hospital usage including admissions and readmissions, emergency department usage, primary care/physician usage, nursing home usage, and home health care usage. The review considered experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, and case-control studies. METHODS: A three-step search was utilized to find published and unpublished studies conducted in any country but reported in English. Six electronic databases were searched from inception of the database to May, 2016. A search for unpublished studies was also conducted. Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute critical appraisal checklist for systematic reviews and research synthesis. Quantitative data were extracted from included studies independently by the two reviewers using the standardized Joanna Briggs Institute data extraction tools. Due to the methodological heterogeneity of the included studies, a comprehensive meta-analysis for all outcomes was not possible. Meta-analysis was conducted for rehospitalization at 30, 90 and 180 days. A narrative summary of other quantitative findings was conducted. RESULTS: Twenty-three studies met the inclusion criteria and were included in the review. Nineteen of the studies were randomized controlled trials and four were case control studies, involving 20,997 participants in total with a mean age of 76. Meta-analysis found that transitional care significantly reduced hospital readmission rates at 30 days (odds ratio [OR] 0.75, 95% confidence intervals [CIs] 0.62-0.91, p < 0.01), 90 days (OR 0.77, 95% CIs 0.59-1.02, p = 0.04), and 180 days (OR 0.67, 95% CIs 0.46-0.99, p < 0.01). Narrative synthesis indicated little impact of transitional care on emergency department and nursing home usage, increased use of primary care/physician usage, and decreased home health care usage. CONCLUSIONS: Based on a review of 23 studies conducted in the USA, Hong Kong, Canada, Germany, the Netherlands, Sweden and Switzerland, we identified four major conclusions. First, transitional care reduces rehospitalization rates over time, with the largest effects seen at 30 days. Second, transitional care may increase the utilization of primary care services and thus have a favourable impact on preventative care. Third, transitional care may reduce home health usage. Fourth, transitional care interventions of one month or less appear to be as effective as longer interventions in reducing hospital usage.

Experiences of unpaid family/friend caregivers of community-dwelling adults with dementia: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of the review is to synthesize evidence regarding the experiences of unpaid caregivers of community-dwelling adults with dementia. Specifically, the review question is: What are the experiences and perceptions of unpaid caregivers providing care for community-dwelling adults with dementia?