Lotty Hooft

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.

Overweight and obesity are closely linked to diseases such as type 2 diabetes, coronary heart disease, and stroke and have been shown to increase mortality risk. To conduct a living systematic review of pharmacologic treatments for weight management in overweight or obesity in adults. MEDLINE and Cochrane Central Register of Controlled Trials until October 2025. Randomized controlled trials that compared pharmacologic treatments for weight management (dulaglutide, exenatide, liraglutide, lixisenatide, naltrexone-bupropion, orforglipron, phentermine, phentermine-topiramate, retatrutide, semaglutide, semaglutide-cagrilintide, tirzepatide, or any combination with or without lifestyle intervention [LI]) for overweight or obesity (body mass index ≥25 kg/m²) in adults for outcomes such as mortality, weight loss, and quality of life. One reviewer extracted data and assessed risk of bias and certainty of the evidence; a second reviewer verified these data. The review included 69 studies with a total of 112 511 participants. Thirty-seven studies were at low risk of bias. In meta-analyses, nearly all studied interventions were more effective than placebo and/or LI in reducing weight, but more discontinuations due to adverse events were observed. Semaglutide probably reduced mortality and major adverse cardiovascular events (MACE), and both semaglutide and tirzepatide led to the greatest weight loss compared with placebo and/or LI in pairwise and network meta-analyses. Evidence for outcomes such as mortality, MACE, and serious adverse events was limited. Direct head-to-head comparisons of different treatments were limited. Nearly all studied interventions were more effective than placebo and/or LI in reducing weight. Semaglutide and tirzepatide showed the most favorable results across outcomes. American College of Physicians. (PROSPERO: CRD42023491646).

A comprehensive overview of the cost-effectiveness of pharmacologic treatments for overweight or obesity is lacking. This systematic review, which was conducted to inform a clinical guideline from ... Background: A comprehensive overview of the cost-effectiveness of pharmacologic treatments for overweight or obesity is lacking. Purpose: To evaluate cost-effectiveness of pharmacologic treatments ...

Well reported systematic reviews of health interventions provide valuable information for making therapeutic decisions, informing policies, and identifying research priorities. When reporting a systematic review of interventions used in paediatrics, addressing the heterogeneity of people aged 0-19 years pertaining to the biological, pharmacological, and psychological variabilities during child development (ontogeny) is essential. To enable reporting the essential detail on treatment effects related to age and developmental stages in these systematic reviews, an extension to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was developed: PRISMA-Children and Adolescents (PRISMA-C) 2026. The extension comprises a checklist, explanations, and examples of good reporting for seven main checklist items and four abstract items, and present paediatric examples of good reporting for 10 PRISMA 2020 items to which the ontogeny statement applies. All new items were deemed relevant by evidence end users, including family caregivers. Adherence to the PRISMA-C 2026 extension should improve the reporting of key paediatric specific details that enhance the understandability and interpretability of the evidence on interventions for children and adolescents.

Background: Digital health technologies (DHTs) are increasingly implemented to improve efficiency, quality, and patient experience. However, conditions that could influence the impact on well-being of healthcare professionals (HCPs) are rarely assessed. Objective: To develop a tool to support policymakers, hospital administrators, and implementation teams in considering workforce experience and well-being implications of DHTs on HCPs. Methods: A mixed-methods study was conducted in three Dutch university medical centres. First, we re-analysed a scoping review on DHT-implementation, applying criteria focusing on HCP-related determinants and thematically analysing these within a modified Work-System model and Quintuple Aim framework. Second, we conducted a prioritisation survey using the Reweighted Priority-Setting tool to rank themes related to Care-team well-being , one of the Quintuple Aim domains. Third, we explored the highest-ranked themes in focus-groups and interviews with HCPs and stakeholders. Finally, we synthesised findings into a tool. Results: From 73 eligible studies we extracted determinants, generating themes and subthemes, of which 44 mapped to Care-team well-being , and were used as survey items. Twelve respondents (eight HCPs and four policy-staff) prioritised these. Top-ranked themes included perceived benefits, acceptance, involvement in development and implementation, ‘champions’, training and skills, communication, and role clarity. Analysis of two focus-groups and three interviews yielded six domains: acceptance, champions, process and development, role of the professional, communication, and training. These informed a 14-item checklist for use during DHT-implementation. Conclusion: We developed a reflective checklist to support structured consideration of conditions shaping workforce experience in DHT-implementation. The tool offers a starting point for embedding workforce conditions in DHT-governance.

Randomized controlled trials (RCTs) represent the gold standard for establishing the efficacy of new interventions. Yet, RCTs are often conducted in selected populations, not representative of those at risk for or living with the disease. This lack of representativeness has raised concerns about the generalizability of RCT results to those populations not (adequately) represented in RCTs, in particular in the absence of evidence on potential differences in treatment effects across population subgroups. In the field of cardiovascular disease, women are often underrepresented in RCTs relative to disease burden. The present paper seeks to define representative participation of women in RCTs. Trial data from two cardiovascular trials, the ADVANCE trial and the LoDoCo2 trial, are used to illustrate sample size requirements for (i) achieving representative participation, (ii) achieving representative contribution to knowledge gained, and (iii) assessing whether treatment effects are the same or different in men and women (i.e. sex * treatment interactions). Achieving representative participation and representative contribution to knowledge gained requires relatively small increases in sample size and is mainly driven by sex differences in disease rates. However, sample size requirements for RCTs powered to assess sex differences in treatment effects are unfeasibly large. Hence, while efforts to enhance representative trial participation should continue, as RCTs provide the cornerstone for guideline recommendations and clinical decision-making, these should be complemented by mechanistic studies to provide insights in possible treatment interactions and inform optimal treatment for both women and men.