OBJECTIVE:The objective of this scoping review is to review the body of knowledge on net gain and no net loss (net-outcome) objectives and approaches applicable to health in spatial planning and development policies and practice. INTRODUCTION:There is an established body of academic and gray literature addressing environmental net-outcome objectives, such as biodiversity net gain, in spatial planning policies and practice. A "health net gain" objective has recently been proposed as a driver for health protection and the realization of health. Such an objective and approach are yet to be scoped and defined. INCLUSION CRITERIA:This review will consider sources in the scientific and gray literature that describe health net-outcome objectives that can be implemented in spatial planning and development policies and practice. Source contexts will not be limited to specific countries, geographical areas, or settings. All types of evidence will be considered. METHODS:This review will follow the JBI methodology for scoping reviews. Databases to be searched include PsycINFO, Embase, HMIC Health Management Information Consortium, MEDLINE (Ovid), Scopus, and selected databases from the ProQuest Social Science Premium Collection. Sources of gray literature to be searched include ProQuest Dissertations and Theses, TRIP Pro, and BASE. No language or date restrictions will be applied. Two independent reviewers will retrieve and review full-text studies and extract data. The results will be presented in tabular or diagrammatic format with a narrative summary. REVIEW REGISTRATION:Open Science Framework https://osf.io/4dbcm.

Artificial intelligence (AI) is increasingly being applied in breast cancer care, yet its use across the post-diagnosis phase remains poorly mapped. This scoping review aimed to identify and categorise AI applications in post-diagnosis breast cancer care, encompassing treatment planning, treatment delivery, follow-up and surveillance, survivorship, and palliative care. Following JBI methodology and PRISMA-ScR reporting guidelines, four databases (MEDLINE, EMBASE, CINAHL, and Web of Science) were searched, identifying 3784 records. After screening and full-text assessment, 54 studies published between 2016 and 2024 were included. Machine learning was the predominant technology (81%), followed by generative AI (7%), conversational agents (6%), traditional natural language processing (4%), and data mining (2%). Follow-up and surveillance were the most represented care stage (48%), driven primarily by recurrence prediction models. Most applications were provider-focused (83%), while patient-facing tools accounted for 17% of studies and relied on either conversational agents or generative AI. No studies addressed palliative care. The evidence base was predominantly retrospective (70%) and concentrated in high-income countries (74%). Future research should prioritise prospective evaluation in clinical workflows, address unsupervised patient use of generative AI, and ensure equitable development across diverse populations and care settings.

People who have been detained have a higher prevalence of hepatitis B virus (HBV) than the general population, yet testing uptake remains limited. Improving testing uptake in high-risk settings is essential to the World Health Organization 2030 elimination target. This systematic review examines interventions aimed at increasing hepatitis B testing uptake in prison. MEDLINE, EMBASE, CENTRAL and CINAHL were searched from January 2000 to April 2025. Quantitative interventional studies were included. Quality appraisal was conducted using the JBI critical appraisal tool. A random effects meta-analysis with Freeman-Tukey transformation estimated testing uptake. Subgroup analysis explored heterogeneity by sex, geographical region and the screening approach. Sixteen papers (15 studies) were included. Eleven were post-interventional quasi-experimental studies. Nine were conducted in Europe. The pooled testing uptake was 64% (95% CI 46%-80%; I2 = 98%). Opt-in interventions were associated with a higher testing uptake (77%, 95% CI 59%-91%), in comparison to opt-out testing uptake (33%, 95% CI 17%-52%; p < 0.001), although opt-in screening had enhanced characteristics such as counselling, peer education and culturally tailored approaches. HBV prevalence amongst institutions ranged between 0% and 11.4%. Only one study reports costs. Opt-in programmes were associated with a higher testing uptake in comparison to opt-out programmes, which may reflect the underlying programme characteristics rather than the screening approach alone. Evidence on cost-effectiveness is limited. Most studies were heterogeneous and conducted in high-income countries. Further robust studies are needed to evaluate enhanced screening approaches to determine the most effective and scalable screening programme.

Objective: This scoping review will systematically map and describe evidence on cardiometabolic disease management in and for South Asian tribal (Indigenous) populations and identify key knowledge gaps to inform future studies and interventions. Introduction: South Asia is home to diverse tribal populations facing persistent health inequities due to geographic isolation, socioeconomic disadvantage, and limited access to formal health systems. Cardiometabolic diseases are increasingly reported in these communities, where care involves biomedical services and traditional healing practices. The literature on the management of these diseases in and for tribal populations is fragmented across diverse study designs, health systems, and population groups, with no prior scoping review. Eligibility criteria: Studies on the management of 1 or more cardiometabolic disease—including hypertension, diabetes, dyslipidemia, obesity, and cardiovascular diseases—in or for South Asian tribal populations will be considered. Any community or health care setting will be eligible, and all empirical study designs. Methods: This review will follow the JBI methodology for scoping reviews and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Fifteen databases will be comprehensively searched for published and gray literature, supplemented by Google Scholar searches, reference lists, and forward citation tracking. No date or language restrictions will be applied. Identified studies will be screened by 2 reviewers independently, and data extracted from included studies using a standardized tool. Extracted data will be analyzed using simple descriptive statistics and descriptive content analysis and presented using tables and figures.

BACKGROUND:Type 2 diabetes mellitus (T2DM) is prevalent in Nepal, with many seeking primary care through Ayurveda, a widely practiced traditional system. However, concerns exist about suboptimal care and variability in clinical practice among Ayurvedic practitioners. No evidence-based clinical practice guideline (EB-CPG) is available for managing T2DM. Therefore, an EB-CPG was developed, and a feasibility study was conducted to inform a future cluster randomized controlled trial (RCT) assessing whether EB-CPG improves T2DM management compared with usual practice. METHODS:A two-arm feasibility cluster RCT was conducted in Ayurveda centers. Centers were randomized (1:1) by an independent statistician. Adults with newly diagnosed, treatment-naïve T2DM and glycated hemoglobin (HbA1c) of 6.5%-< 9% were recruited. Data collectors and the analyst were blinded to group allocation. RESULTS:Fourteen Ayurveda centers were approached, all recruited (seven/group) and completed the study. One center withdrew and did not enroll participants. Of 151 potential participants, 121 (80%) were recruited (60 in intervention and 61 in control). Of those, 84% were followed up to 6 months (51/group). The median adherence score to EB-CPG among practitioners was 1-2 (partial to adequate adherence). The median (interquartile range) number of EB-CPG-recommended medicines not consumed by participants and days without consumption was 0 (0-10) and 0 (0-2.5), respectively. No serious adverse events occurred. Preliminary estimates suggest EB-CPG's beneficial effects on HbA1c, fasting plasma glucose, and health-related quality-of-life, though not statistically significant. CONCLUSION:This feasibility trial demonstrated successful recruitment, follow-up, and intervention adherence. A definitive trial is feasible to evaluate the intervention's effectiveness in T2DM management. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov Identifier: NCT05259735; first posted on March 02, 2022.

Objectives:The interval between the 6-8 week and 9-12 month mandated reviews in the Healthy Child Programme is lengthy and may lead to delayed intervention. In Rotherham, northern England, an additional universal 3-4 month review was introduced to support child development and earlier identification of parent and child needs. We aimed to evaluate its reach, acceptability, and association with developmental outcomes. Study design:Mixed methods study using administrative records, qualitative interviews and focus groups with parents (n = 31), nursery nurses (n = 7), and commissioners (n = 4). Methods:The association between uptake and recording of maternal mood by deprivation, ethnicity, maternal age, and parity for babies aged 3-4 months between January 2024 andFebruary 2025 was analysed using mixed-effects logistic regression. Developmental outcomes were compared (Ages and Stages Questionnaire (ASQ-3) scores at 9-12 months) for children eligible for the universal review versus pre-intervention cohort. Qualitative data were analysed using the Consolidated Framework for Implementation Research. Results:Uptake was approximately 80%, around 15% points lower than mandated reviews. Uptake was equitable across deprivation and ethnicity but lower among multiparous mothers (adjusted odds ratio (AOR) 0.29, 95% CI 0.22-0.37). Maternal mood recording was lower for mothers <20 years and for multiparous mothers (AOR 0.78, 95% CI 0.64-0.94). At 9-12 months, eligible children had higher odds of scoring above the close monitoring cut-off for problem solving (AOR 1.41, 95% CI 1.03-1.93), with no significant differences in other ASQ-3 domains. Parents valued reassurance, tailored developmental advice, and local signposting, though some noted inconsistent advice, maternal mood assessment and unclear visit purpose. Staff endorsed the visit's developmental focus but reported capacity pressures. Conclusions:The universal 3-4 month review was broadly acceptable, and associated with higher ASQ-3 problem-solving scores. Communicating visit purpose and consistent mood assessment is required.

IntroductionBrain tumours are a commonly diagnosed solid cancer in children and young adults. Many survivors experience long-term complications. We conducted a systematic review to assess the effectiveness of outpatient rehabilitation interventions in reducing long-term complications following childhood brain tumours.Materials and methodsThree databases were searched to November 2024. Two reviewers independently screened studies, assessed quality, and extracted data. Outcomes were categorised as primary [functional, psychological and Quality of Life (QoL)] and secondary (social, cognitive and sleep disturbance).ResultsEight papers were included. Most studies evaluated physical therapy interventions, assessing changes in functional outcomes, which were associated with the greatest proportion of significant improvements (p ≤ 0.05). Varying effects were seen for psychological, QoL, and social outcomes. Cognitive outcomes did not show significant improvements following cognitive, academic and exercise-based interventions.DiscussionAlthough studies reported positive functional, psychological, QoL and social outcomes, following various interventions, clear conclusions of the long-term effectiveness of rehabilitation interventions cannot be made. Further research is needed with longer-term follow-up, so effective rehabilitation strategies can be determined for this population. Better research could help develop interventions at a health-system level that could improve function, perceived wellbeing, and QoL of children and young people with brain tumours.

Abstract Background/Aims Weight gain is a major concern for patients taking glucocorticoids for their chronic rheumatic diseases, and obesity worsens disease outcomes. These patients desire more support with their weight management. Brief opportunistic interventions used within consultations may be beneficial to promote behaviour changes. The aim of this scoping review was to map peer-reviewed evidence regarding the use of brief interventions to support weight management either in, or applicable to, rheumatology settings. Methods We followed the JBI methodology, conducting a comprehensive search of MEDLINE, Embase and APA PsychINFO from inception to October 2024. We included qualitative and quantitative studies, extracting and summarising the characteristics of the studies, participants and brief interventions. Results Forty-one studies were included in this review. Of these, there were 25 primary studies exploring 22 different brief interventions. The commonest approaches used were verbal advice and paper-based handouts. There was no direct evidence related to the use of brief interventions within rheumatology settings. Of 22 studies reporting setting, 19 took place in primary care or the community. One study discussed the development of future education materials for patients with psoriatic arthritis. None of the studies explored the prevention of weight gain. Many studies included overweight or obese participants only, with outcomes focusing on weight loss rather than maintenance of a healthy weight. Quantitative outcomes assessed in the study included the frequency of brief intervention use and its effects on weight and weight-related risk factors. Qualitative findings focused on exploring the language used in weight-related discussions, the feasibility of brief interventions, and clinician and patient views. These findings suggested that, whilst clinicians are concerned about causing offence, patients considered brief interventions to be appropriate and welcomed these discussions. Barriers to implementing brief interventions included time constraints, stigma and resource practicalities. Conversely, facilitators to implementing brief interventions were their short duration, the availability of guidelines and the existence of long-term doctor-patient relationships. Conclusion Whilst this review highlighted a paucity of research into brief intervention use in rheumatology settings, evidence from other healthcare settings could be transferable. Due to the high visit frequency in rheumatology, it is likely that these long-term relationships between clinicians and patients could act as a facilitator for the use of brief interventions. There remains significant scope to investigate brief interventions for weight loss and the prevention of weight gain in rheumatology patients taking long-term glucocorticoids. Disclosure H.E. Speight: None. J. Leonardi-Bee: None. J.C. Robson: Grants/research support; JCR received a Steroid PRO research start-up grant from Above & Beyond Bristol Hospitals Charity; Steroid PRO research grant from Vifor Pharma; GCA PRO funding from NIHR Research for Patient Benefit, she also received a Steroid PRO cross-condition validation study research grant from Sanofi. F.A. Pearce: Grants/research support; FAP is funded by a National Institute for Health and Care Research Advanced Fellowship [grant number NIHR300863], FAP is also the recipient of a grant from Vifor pharma. Vifor pharma had no influence on the design, conduct or interpretation of this study. S.J. Lax: Grants/research support; SJL is funded by a National Institute for Health and Care Research Advanced Fellowship [grant number NIHR300863].

Music is widely accessed by adolescents and young adults and may contribute to substance-related normative environments. Few studies have examined the longitudinal output of a single artist with such global influence as Taylor Swift. This study aimed to quantify and characterise exposure to alcohol, tobacco, and illicit substances across the lyrics and music videos of Taylor Swift, and to examine patterns relevant to social learning theory and public health. A mixed methods content analysis was conducted of 248 songs and 54 official music videos (2006–2026). Alcohol, tobacco and illicit substance-related exposures were defined and coded as explicit use, implied use, metaphorical reference, or brand-specific reference. Quantitative analyses assessed frequency and exposure rates per hour, and thematic analysis examined the contextual framing. A total of 274 exposures were identified (lyrics: 207; videos: 67), occurring across 96/248 songs (38.7

Objectives Same-day emergency care (SDEC) has been rolled out as a model of care in England with a limited evidence base. This study examined conversion to inpatient admission, 30-day reattendance and 30-day mortality, among adults managed through SDEC compared with those admitted for ≤48 hours, as a proxy for low acuity, over a 4-year period, to assess safety and effectiveness in a real-world operational setting across two acute hospital sites.Design Retrospective cohort study.Setting Two acute hospital sites within one National Health Service (NHS) trust in England, UK.Participants Adults aged ≥18 years attending acute medical services between April 2021 and March 2025, managed via SDEC or admitted for ≤48 hours (n=43 970).Outcome measures Conversion to inpatient admission, 30-day reattendance and 30-day mortality.Results The crude conversion rate from SDEC to inpatient admission was 5.8%. In the multivariable model, increasing age (OR 1.02, 95% CI 1.01 to 1.02), male sex (OR 1.42, 95% CI 1.29 to 1.57) and attendance at the Boston site (OR 1.71, 95% CI 1.55 to 1.90) were associated with higher odds of admission.30-day prefix-concordant reattendance occurred in around 10% of patients in both pathways. After adjustment, SDEC patients had substantially lower odds of reattendance than those admitted for ≤48 hours (OR 0.26, 95% CI 0.19 to 0.36). The effect of SDEC varied by age (interaction OR 1.02, 95% CI 1.01 to 1.02) and site, with a weaker protective effect at Lincoln compared with Boston (interaction OR 2.12, 95% CI 1.74 to 2.60). Age was associated with a reduction in reattendance (OR 0.99 per year increase, 95% CI 0.98 to 0.99).30-day mortality was lower in SDEC than in short-stay admission (0.6% vs 8.2%), with pathway remaining a strong predictor after adjustment (OR 0.05, 95% CI 0.04 to 0.07). Younger age was protective, while male sex was associated with higher mortality. Pathway by sex interaction indicated a less pronounced protective effect of SDEC in men.Conclusions SDEC was associated with very low conversion to inpatient admission and substantially better short-term outcomes than short-stay admission, including markedly reduced diagnosis-concordant reattendance and lower 30-day mortality. These findings indicate that SDEC is a safe and effective model for managing selected acute medical patients. The consistently favourable outcomes among SDEC attenders suggest that patient selection and operational factors within the emergency pathway may be directing lower-risk patients towards SDEC, highlighting the need to review how SDEC capacity is targeted to ensure alignment with its intended clinical role.

Cross-sectional studies are a useful observational study design that provide a snapshot of a population's health status at a specific moment in time. Analytical cross-sectional studies are often included in systematic reviews investigating the etiology or risk of diseases, and descriptive cross-sectional studies are often used to determine the prevalence of a disease. As required of all studies that meet eligibility criteria for a systematic review, analytical cross-sectional studies should be subjected to appropriate critical appraisal of their methodological quality to determine the risk of bias. The JBI Effectiveness Methodology Group is currently undertaking a comprehensive revision of the entire suite of JBI critical appraisal tools to align with recent advances in risk of bias assessment. This paper presents the revised critical appraisal tool for risk of bias assessment of analytical cross-sectional studies. Applying tools such as the revised JBI tools within systematic reviews allows end users to make informed decisions using the evidence. We discuss major changes from the previous iterations of this tool and justify these changes within the context of the broader advancements to risk-of-bias assessment science. We also offer practical guidance for the use of this revised tool, and provide examples for interpreting the results of risk-of-bias assessment for analytical cross-sectional studies to support reviewers including these studies in their systematic reviews.

AIM:The aim of this review is to systematically summarise the evidence on the effectiveness of riboflavin (vitamin B2) or supplements containing riboflavin in preventing paediatric migraines. METHODS:This systematic review followed the Joanna Briggs Institute methodology and is reported to adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched multiple electronic databases on 25 October 2023 to identify potentially relevant studies. Studies were screened, critically appraised and data extracted by two reviewers. Data underwent a narrative synthesis using vote counting based on direction of effect and was presented using harvest plots. RESULTS:Seventeen studies of varying quality were included in the review. Riboflavin or its combination with other natural ingredients was significantly effective in reducing migraine frequency (7/10 comparisons), migraine days (3/4 studies) and use of analgesics (3/4 studies). Mixed findings were found on headache duration in hours (3/5 studies), pain intensity (4/6 studies) and disability (3/5 studies). No negative outcomes and few side effects were reported (five studies). CONCLUSION:Our findings suggest that using riboflavin at different dosages and treatment lengths offers a promising alternative to common medications for paediatric migraine prevention. Future research should explore mechanisms of action, optimal dosing and treatment duration using robust evidence.

INTRODUCTION:Smoking in pregnancy is a preventable cause of detrimental effects on mother and baby, exacerbating socioeconomic health disparities. This study investigates predictors of making a quit attempt and smoking abstinence in pregnancy. METHODS:This study used pooled data from two large UK multicentre smoking cessation intervention trials in pregnancy (N=1409). Baseline predictor variables included demographic, smoking behaviour and quitting belief measures. Percentage of cigarettes cut down in early pregnancy was a novel variable. Outcomes (36 weeks' gestation) were having made a quit attempt (>24 hours) and smoking abstinence (both self-reported). Exploratory logistic regression analyses, with missing smoking outcomes imputed as non-abstinent, involved univariate then multivariable analyses. Sensitivity analyses included complete case analyses, and biochemically validated abstinence. RESULTS:1409 women were included in study analyses. In multivariable analyses, for making a quit attempt, higher intention to quit (OR 1.50, 95% CI 1.26 - 1.79); and higher combined self-efficacy score (OR 1.60, 95% CI 1.30 - 1.96) were statistically significant predictors. For smoking abstinence, higher percentage reduction in number of cigarettes smoked in early pregnancy (OR 1.02, 95% CI 1.01 - 1.02) and longer previous quit attempt (omnibus p =0.001) were statistically significant predictors. CONCLUSIONS:Smoking beliefs, including motivational factors, were statistically significant predictors of making a quit attempt. However, smoking behaviours relating to cutting down the number of cigarettes in early pregnancy and having had a previous period of smoking abstinence > 6 weeks, were predictors of successful smoking abstinence. IMPLICATIONS:This study adds to the evidence that motivational factors are important in initiating a quit attempt whereas positive behavioural changes are associated with smoking abstinence in pregnant women. This information could be used by clinicians designing smoking abstinence support for pregnant women. Women who reduce the number of cigarettes they smoke very early in pregnancy might be more receptive to smoking abstinence support offered at that point.

Introduction Unsupported attempts to quit smoking during pregnancy have a low success rate. Chances of quitting successfully are higher with an interpersonal treatment program but there is low uptake of this in the United Kingdom. Delivering a pregnancy-specific treatment program digitally may provide an alternative treatment route. This study explored pregnant smokers' perceptions of barriers and facilitators to using digital cessation support, along with identifying modes of delivery and engagement enhancers.Aims and Methods Semi-structured interviews were carried out with an ethnically and socioeconomically diverse sample of 25 participants with recent experience of attempting to quit smoking in pregnancy, aged 20-40, from the United Kingdom. An inductive thematic analysis approach was used.Results Digital smoking cessation support, particularly a smartphone app, for pregnancy was felt to overcome many barriers to engaging with interpersonal support, being viewed as more convenient, and nonjudgmental, providing better consistency of advice, and enhancing privacy and autonomy. However, some participants felt that removing access to a human could undermine a digital support package and reduce engagement. Popular engagement enhancers included self-monitoring (eg, digital recording of smoking; smartphone-linked carbon monoxide monitoring), online communities, and remote access to nicotine substitution options. Digital support was viewed as having potential as a stand-alone intervention or working in conjunction with standard interpersonal treatment.Conclusions The findings support the investigation of a digital support package as both a stand-alone and adjunct to standard interpersonal cessation support in pregnancy to increase the proportion of pregnant smokers who make a supported quit attempt.Implications In many countries like the United Kingdom, there are few smoking cessation options routinely available that provide effective support for smoking cessation in pregnancy. To maximize impact, health services need an effective range of strategies to engage with and support quit attempts made by all pregnant smokers, particularly as interpersonal support options are not often well used. Development of a pregnancy-specific digital support package for smoking cessation in pregnancy may represent a means to help address this gap.

BACKGROUND:Tick-borne encephalitis virus (TBEV) is one of the most significant zoonotic diseases in Europe. It primarily spreads through the bites of infected ticks and, less frequently, through consumption of raw milk and dairy products from viremic domestic ruminants. AIMS:Assess the prevalence of TBEV or anti-TBEV antibodies in milk and milk products from domestic ruminants in Europe. MATERIALS AND METHODS:Systematic literature review adhering to the JBI methodology, and reported following the PRISMA framework. RESULTS:From the 16 included scientific articles, we extracted 35 data collections (31 on raw milk and 4 on raw milk cheese); studies focused on cow (n = 15), goat (n = 11) and sheep milk (n = 5), goat (n = 3) and cow/goat cheese (n = 1). Fifteen data collections involved individual milk and 16 bulk milk samples. The estimated prevalence of TBEV in individual raw milk and cheese was 6% and 3%, respectively. TBEV prevalence in bulk milk was very heterogeneous, with most values either 0% or 100%. DISCUSSION:Although published research on TBEV transmission to humans through milk and dairy products in the EU countries is limited, our results highlight the potential infection risk for consumers. The variable prevalence reported in the studies may reflect the focal nature of TBEV. CONCLUSION:Studies on unpasteurised dairy products from domestic ruminants can be valuable for the detection of TBEV presence in a geographic area, even when human cases are not reported. Thanks to the ease of sample collection, their testing could be adopted in monitoring plans on TBEV.

The data extraction stages of reviews are resource-intensive, and researchers may seek to expediate data extraction using online (large language models) LLMs and review protocols. Claude 3.5 Sonnet was used to trial two approaches that used a review protocol to prompt data extraction from 10 evidence sources included in a case study scoping review. A protocol-based approach was also used to review extracted data. Limited performance evaluation was undertaken which found high accuracy for the two extraction approaches (83.3

Objective:The objective of this qualitative review was to identify and synthesize the evidence related to the experiences and perspectives of adolescents with type 1 diabetes (T1D), their parents, and health care providers (HCPs) on the transition from pediatric to adult health care settings.Introduction:Transition to adult health care is one of the challenges facing adolescents with T1D, and unsuccessful transitions can lead to negative health outcomes. Understanding the perspectives of adolescents and young adults, their parents, and health care professionals on the transition is essential to develop effective transition interventions.Eligibility criteria:Studies were considered for inclusion if they explored the experiences and perspectives of adolescents with T1D, their parents, and HCPs on the transition from pediatric to adult health care settings. This review included studies that focused on qualitative data, including designs such as phenomenology, grounded theory, ethnography, and qualitative descriptive.Methods:MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Cochrane Library, and PubMed were searched to identify published studies from inception to May 2024. There was no restriction on the date or language of the publication. The conduct of the review adhered to the JBI methodology for qualitative systematic reviews. The JBI process of meta-aggregation was used to identify categories and synthesize findings.Results:Of 6303 records identified, 25 studies met the eligibility criteria and were included in the review. The included studies represented the perspectives of 486 adolescents and young adults receiving care in either pediatric or adult health care settings, 86 parents, and 81 HCPs working in either pediatric or adult health care settings. In most studies, interviews were used as the method for data collection. A total of 159 findings were extracted and aggregated into 12 categories, based on the similarity of meaning. Five synthesized findings were generated, all with moderate confidence: i) Adolescents and young adults with T1D may be anxious and feel unprepared due to being unaware of the process and a lack of preparation; however, others may be confident and ready for their transition to adult services; ii) Adolescents with T1D face many barriers as they transition from pediatric to adult care, mainly due to challenges of navigating changes in health systems or the burden of living with T1D; iii) A successful transition to adult care for adolescents and young adults with T1D depends on activities to support feeling prepared for the transition, having support networks with a stronger emphasis on peer support, and a structured and coordinated transition between pediatric and adult health care; iv) Parents can struggle with their child's transition where the parents' roles and responsibilities are refined by their children as they approach adulthood, and parents may need support to address their new role during transition; and v) HCPs can be uncertain of the best transition strategy and tend to suggest many activities to improve transition, mainly focusing on coordination between pediatric and adult health care.Conclusion:The findings of this qualitative review offer insight into the perspectives of adolescents with T1D, parents, and HCPs on the transition from pediatric to adult health care settings. The findings highlighted the need for more structured transition processes that empower autonomy and self-management skills of young adults, along with continuous support from parents and HCPs. Review registration:PROSPERO CRD42024557117

PURPOSE:Virtual patients (VPs) are increasingly used in health care professions education to support clinical reasoning (CR) development. However, the extent to which feedback is given across CR components is unknown, and guidance is lacking on how VPs can optimize CR development. This systematic review sought to identify how VPs provide feedback on CR. METHOD:Seven databases (MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, and ProQuest Dissertations) were searched in March 2023 using terms (e.g., medical education , virtual patient , case-based learning , computer simulation ) adapted from a previous systematic review. All studies describing VP use for developing CR in medical professionals and provided feedback on at least 1 CR component were retrieved. Screening, data extraction, and quality assessment were performed. Narrative synthesis was performed to describe the approaches used to measure and provide feedback on CR. RESULTS:A total of 6,526 results were identified from searches, of which 72 met the criteria, but only 35 full-text articles were analyzed because the reporting of interventions in abstracts (n = 37) was insufficient. The most common CR components developed by VPs were leading diagnosis (23 [65.7%]), management or treatment plan (23 [65.7%]), and information gathering (21 [60%]). The CR components were explored by various approaches, from predefined questions to free text and concept maps. CONCLUSIONS:Studies describing VP use for giving CR feedback have mainly focused on easy-to-assess CR components, whereas few studies have described VPs designed for assessing CR components, such as problem representation, hypothesis generation, and diagnostic justification. Despite feedback being essential for learning, few VPs provided information on the learner's use of self-regulated learning processes. Educators designing or selecting VPs for CR use must consider the needs of learner groups and how different CR components can be explored and should make the instructional design of VPs explicit in published work.

Background This scoping review aimed to understand the extent and type of evidence in relation to sexual and reproductive health needs of women with severe mental illness (SMI) in low- and middle-income countries (LMIC) and to summarise those needs. Methods Inclusion criteria were 1) focus on sexual and reproductive health needs 2) women or girls with SMI, professionals, caregivers of women with SMI and community members 3) study set in a LMIC 4) peer reviewed literature (no restriction on study date or design). Studies were identified from comprehensive searches of Medline, EMBASE, CINAHL and PsycINFO (to July 2023). Results The review included 100 papers. Most studies were cross-sectional and set in hospital outpatient departments. Only 20 of 140 LMIC countries were included in this review and only 15 studies were set-in low-income countries (LIC). Included studies often had multiple focus areas and were grouped by frequency of topic into categories of HIV (prevalence, risk behaviour and knowledge), other sexually transmitted infections (STIs), sexual function, contraception use and family planning, sexual violence, fertility, pregnancy and postpartum. Included studies indicated women with SMI have worse outcomes and worse sexual and reproductive health compared to both women without SMI and men with SMI. Women with SMI were shown to have higher rates of HIV and low levels of contraception knowledge and use, with little advice offered by professionals. Conclusions This review highlights the need for a greater diversity of study methodology, robustness of ethical and consensual reporting when researching vulnerable populations and for further research on interventions and models of care aimed at addressing stigma, discrimination and improving the sexual and reproductive health of women with SMI. Future research should better represent the breadth of LMIC, investigate cultural adaptability of interventions and consider sexual health needs across the life course.