René Spijker

Background: Hospitals frequently seek to improve care by copying best practices from high-performing peers, yet comparable outcomes are often not achieved. While implementation science recognises context as a key determinant of success, existing frameworks are generic and unequipped to actively map and compare the unique contextual conditions of both the source and receiving organisations. To bridge this gap, we developed the implementation-oriented Two-Dimensional Practice Context (2DPC) framework capturing the context of best practices in hospital care to support their emulation in other settings. Methods: We developed the 2DPC-framework through a two-phase scoping review and evidence-mapping study. Phase 1 built the framework’s two axes. Searching MEDLINE for publications on the contextual factors that shape best practices in healthcare, we thematically synthesised these factors into distinct domains (Step 1a) and arrayed them against established levels of implementation context (Step 1b). Phase 2 populated the resulting grid. A second MEDLINE search identified empirical studies that implemented or evaluated best practices in hospital settings, and from each we extracted the reported contextual influences, mapped them onto the grid, and thematically analysed the contents of every cell. Results: Phase 1 included 13 publications and yielded six best-practice context domains (Support, Knowledge, Coordination, Resources, Quality monitoring, and Patient-centeredness), organised against established implementation context levels into the 2DPC-framework. Phase 2 included 173 empirical studies, from which 992 contextual extracts were identified, predominantly barriers ( n = 881), and a smaller fraction facilitators ( n = 108). The most populated implementation levels were healthcare professionals ( n = 261), organisational support ( n = 257), and the wider environment ( n = 147). The most populated domains were Knowledge ( n = 271), Resources ( n = 249), Coordination ( n = 199), and Support ( n = 129), while Quality monitoring ( n = 20) and Patient-centeredness ( n = 24) were less frequently represented. Conclusions: Rather than generic solutions, replicating best practices requires a granular alignment between the source and receiving hospital’s context. The 2DPC framework operationalises this, providing an actionable mapping tool for healthcare leaders to evaluate and compare implementation readiness across settings. Furthermore, by exposing a critical deficit in how best practices are documented, this framework challenges both practitioners and researchers to shift from tracking implementation barriers toward actively capturing the enabling conditions that drive success.

Various open science practices have been proposed to improve the reproducibility and replicability of scientific research, but not for all practices, there may be evidence they are indeed effective. Therefore, we conducted a scoping review of the literature on interventions to improve reproducibility. We systematically searched Medline , Embase , Web of Science , PsycINFO , Scopus and Eric , on 18 August 2023. Any study empirically evaluating the effectiveness of interventions aimed at improving the reproducibility or replicability of scientific methods and findings was included. We summarized the retrieved evidence narratively and in evidence gap maps. Of the 105 distinct studies we included, 15 directly measured the effect of an intervention on reproducibility or replicability, while the remainder addressed a proxy outcome that might be expected to increase reproducibility or replicability, such as data sharing, methods transparency or pre-registration. Thirty studies were non-comparative and 27 were comparative but cross-sectional observational designs, precluding any causal inference. Despite studies investigating a range of interventions and addressing various outcomes, our findings indicate that in general the evidence base for which various interventions to improve reproducibility of research remains remarkably limited in many respects.

Background: Functional constipation is common in children and accurate diagnostic methods are essential for early diagnosis and effective management. The diagnostic accuracy of transabdominal ultrasound to diagnose functional constipation is unclear. Objective: To evaluate the diagnostic accuracy of transverse rectal diameter measurement via transabdominal ultrasound in diagnosing children with functional constipation and in identifying fecal impaction. Materials and methods: Electronic databases were searched from inception to March 2023. Original studies investigating the diagnostic accuracy of measuring transverse rectal diameter via transabdominal ultrasound, including children with and without functional constipation, or with and without fecal impaction were included. Data extraction and quality assessment were performed independently by two reviewers. Results: Sixteen studies were included (n = 1,801 children, 0–17 years). Thirteen studies investigated the diagnostic accuracy for functional constipation, and five for fecal impaction. High risk of bias was found across the majority of studies mainly due to un-blinded case–control designs. Cut-off transverse rectal diameter values to diagnose functional constipation ranged from 2.4 cm to 3.8 cm. Meta-analysis (seven studies, n = 509 children) estimated mean sensitivity and specificity to diagnose functional constipation were 0.68 (95% confidence interval (CI) 0.55–0.78) and 0.81 (95% CI 0.71–0.88), respectively. Meta-analysis of diagnostic accuracy of identifying fecal impaction was not feasible. Studies reported a sensitivity and specificity ranging between 68–100% and 83–100%, respectively. Conclusion: Transabdominal ultrasound may be a valuable non-invasive diagnostic tool to diagnose functional constipation by measuring transverse rectal diameter and identifying fecal impaction in children. Heterogeneous study methods and lack of age-dependent normal values impair current clinical recommendations. Future research should focus on separating age groups and developing a standardized protocol. Graphical

Background In many resource-limited settings, understaffed hospitals rely on patients’ families to provide care during admission. These care tasks are often performed informally, untrained and unsupported. The WHO has called for innovative approaches to tackle health worker shortages globally. Family participation interventions could be such an innovation, but current family participation should be understood before implementation. This review explored the barriers and facilitators family caregivers experience participating in resource-limited adult hospital care. Methods For this qualitative systematic review, MEDLINE, Embase, CINAHL and the Global Health Library were searched from inception to 17 February 2023. Studies were included if they described experiences of family caregivers participating in hospital-like environments, were performed in a low- or middle-income country and included qualitative data. Open coding was performed, followed by thematic analysis. The risk of bias was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Results 3099 studies were screened, and 16 were included, involving 466 participants. All studies were published between 2009 and 2023. Three studies were performed in Africa, three in South America and 10 in Asia. 13 main themes were identified, seven for barriers and six for facilitators, including 50 subthemes. The main barriers identified were caregiver burden, a discouraging hospital environment, economic burden, ineffective collaboration with health workers, lack of support, sacrificing personal life to care and unpreparedness for caregiving. The main facilitators identified were a caregiving mindset, competence for caregiving, effective collaboration with health workers, encouraging hospital environment, sufficient financial means and supportive caregiving systems. Discussion This review presents the first overview of barriers and facilitators experienced by family caregivers participating in resource-limited hospital care. Research in more contexts and among other stakeholders is necessary to comprehend family participation holistically. To improve family participation, this review suggests prioritising educational interventions. PROSPERO registration number CRD42023384414.

Background: Inappropriate antimicrobial usage is a key driver of antimicrobial resistance (AMR). Low- and middle-income countries (LMICs) are disproportionately burdened by AMR and young children are especially vulnerable to infections with AMR-bearing pathogens. The impact of antibiotics on the microbiome, selection, persistence, and horizontal spread of AMR genes is insufficiently characterized and understood in children in LMICs. This systematic review aims to collate and evaluate the available literature describing the impact of antibiotics on the infant gut microbiome and resistome in LMICs. Methods and findings: In this systematic review, we searched the online databases MEDLINE (1946 to 28 January 2023), EMBASE (1947 to 28 January 2023), SCOPUS (1945 to 29 January 2023), WHO Global Index Medicus (searched up to 29 January 2023), and SciELO (searched up to 29 January 2023). A total of 4,369 articles were retrieved across the databases. Duplicates were removed resulting in 2,748 unique articles. Screening by title and abstract excluded 2,666 articles, 92 articles were assessed based on the full text, and 10 studies met the eligibility criteria that included human studies conducted in LMICs among children below the age of 2 that reported gut microbiome composition and/or resistome composition (AMR genes) following antibiotic usage. The included studies were all randomized control trials (RCTs) and were assessed for risk of bias using the Cochrane risk-of-bias for randomized studies tool. Overall, antibiotics reduced gut microbiome diversity and increased antibiotic-specific resistance gene abundance in antibiotic treatment groups as compared to the placebo. The most widely tested antibiotic was azithromycin that decreased the diversity of the gut microbiome and significantly increased macrolide resistance as early as 5 days posttreatment. A major limitation of this study was paucity of available studies that cover this subject area. Specifically, the range of antibiotics assessed did not include the most commonly used antibiotics in LMIC populations. Conclusion: In this study, we observed that antibiotics significantly reduce the diversity and alter the composition of the infant gut microbiome in LMICs, while concomitantly selecting for resistance genes whose persistence can last for months following treatment. Considerable heterogeneity in study methodology, timing and duration of sampling, and sequencing methodology in currently available research limit insights into antibiotic impacts on the microbiome and resistome in children in LMICs. More research is urgently needed to fill this gap in order to better understand whether antibiotic-driven reductions in microbiome diversity and selection of AMR genes place LMIC children at risk for adverse health outcomes, including infections with AMR-bearing pathogens.

Delayed cerebral ischemia (DCI) substantially contributes to disability and death in subarachnoid hemorrhage (SAH) patients; however, its pathophysiology is incompletely understood and diagnostic and therapeutic strategies are lacking. Biomarkers may help to elucidate the pathophysiology, optimize early diagnosis, or provide treatment targets. We systematically searched PubMed and Embase on October 13, 2021, for studies that evaluated at least one laboratory biomarker in patients with DCI, using the most up-to-date definition of DCI as proposed by a panel of experts in 2010. Quality of studies was assessed using the Newcastle-Ottawa Scale or Cochrane Collaboration’s risk of bias assessment tool. Biomarkers of clinical and radiological DCI were analyzed separately. Results were meta-analyzed if possible, otherwise narratively reviewed. Biomarkers were classified as significant, inconclusive, or nonsignificant. We defined validated biomarkers as those with significant results in meta-analyses, or in at least two studies using similar methodologies within the same time interval after SAH. The search yielded 209 articles with 724 different biomarkers; 166 studies evaluated 646 biomarkers of clinical DCI, of which 141 were significant and 7 were validated biomarkers (haptoglobulin 2-1 and 2-2, ADAMTS13, vWF, NLR, P-selectin, F2-isoprostane); 78 studies evaluated 165 biomarkers of radiological DCI, of which 63 were significant and 1 was a validated biomarker (LPR). Hence, this review provides a selection of seven biomarkers of clinical DCI and one biomarker of radiological DCI as most promising biomarkers of DCI. Future research should focus on determining the exact predictive, diagnostic, and therapeutic potentials of these biomarkers.

This systematic review aimed to comparatively evaluate the efficacy and safety of maxillomandibular advancement (MMA) and upper airway stimulation (UAS) in obstructive sleep apnea (OSA) treatment. A MEDLINE and Embase database search of articles on MMA and/or UAS for OSA was conducted. Twenty-one MMA studies and nine UAS studies were included. All the MMA studies demonstrated a reduction in apnea hypopnea index (AHI) postoperatively, and success rates ranged from 41.1% to 100%. Ten MMA studies reported pre- and postoperative Epworth sleepiness scale (ESS), and all but one study demonstrated a reduction in ESS. In the UAS studies, all but one demonstrated a reduction in AHI, and success rates ranged from 26.7% to 77.8%. In the eight UAS studies reporting pre- and postoperative ESS, an ESS reduction was demonstrated. No studies reported any deaths related to MMA or UAS. The most common postoperative complications after MMA and UAS were facial paresthesia in the mandibular area and discomfort due to electrical stimulation, respectively. This systematic review suggests that both MMA and UAS are effective and generally safe therapies for OSA. However, due to the limitations of the included studies, there is no evidence yet to directly compare these two procedures in OSA treatment.