RESUMEN
TOPLINE SUMMARYO_ST_ABSWhat is a Rapid Review?C_ST_ABSOur rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal, and evidence synthesis to answer a specific question and identify key research gaps. They take 1-2 months, depending on the breadth and complexity of the research topic/ question(s), extent of the evidence base, and type of analysis required for synthesis. Background / Aim of Rapid ReviewMany patients were not able to access routine diagnostic care through 2020/21 because of extraordinary pressures on the NHS due to COVID-19 and the UK national lockdowns. For some patients this can have serious short and long-term consequences to their health and life expectancy. The NHS has limited resources and is looking for new ways to meet many demands and patient needs. This Rapid Review Report aims to answer the question "Which innovations can be used to accelerate the patients journey through the endoscopic cancer diagnosis pathway?" The report highlights evidence of innovations and new ways to improve the timeliness of access to endoscopy and to address the backlog of unmet need for patients who have waited a long time for such tests and investigations by selecting those at highest for prioritisation. It does not evaluate in terms of effectiveness on clinical outcomes. Key FindingsO_ST_ABSExtent of the evidence baseC_ST_ABS{blacksquare} Nine papers were included in the rapid review in total. {blacksquare}Two reviews were identified. One review examined the novel colon capsule endoscopy (CCE) procedure and the second review summarised the effects of COVID-19 on colorectal cancer (CRC) screening, the potential long-term? outcomes, and ways to adapt CRC screening during the COVID-19 pandemic. {blacksquare}Seven primary studies assessed innovations for the diagnosis of Gastrointestinal (GI) cancers. Five of these studies examined faecal immunochemical testing (FIT) for prioritising patients for further testing. {blacksquare}Two studies reported pathways/innovations to triage patients e.g. from primary care. These methods of triage used interventions such as Cytosponge for oesophageal symptoms. Recency of the evidence base{blacksquare} Of the primary studies, one was published in 2020 and six were published in 2021. Of the reviews, one was published in 2020 and one in 2021. Evidence of effectiveness{blacksquare} The five studies investigating FIT found that it could help prioritise patients for further testing and improve targeting of high-risk patients. {blacksquare}One review proposed CCE may offer a useful solution for investigating colorectal patients to reduce the need for some endoscopies following the pandemic. {blacksquare}One review found a shift from current CRC screening and surveillance practices towards an individualized approach based on risk factors, could result in the allocation of resources to people with higher risks and prevent inappropriate use of healthcare resources for those with lower risks. Best quality evidence{blacksquare} All studies were quality appraised using the relevant JBI checklist. Five studies were of low to moderate quality. Policy Implications{blacksquare} Increased use of faecal immunochemical testing (FIT) could reduce the endoscopy backlog and save NHS resources if those with low FIT scores can be excluded from further testing. {blacksquare}Policy in Wales supports prioritisation of potential gastrointestinal cancer patients for endoscopy using FIT test scores (NHS Wales 2021) although local implementation currently varies, so it is not yet fully utilised. The FIT test gives results which could be utilised by healthcare professionals to prioritise those who are most in need of urgent diagnosis. The viability of this method to prioritise those in greatest need of being referred for diagnosis through endoscopy is proven (though safety-netting is still required), and the FIT test is part of the diagnostic pathway already in Wales. It will be important to ensure all areas of Wales have equal access to the use of FIT testing for this purpose, and that clinical guidelines are harmonised and adhered to throughout Wales. {blacksquare}Innovations to reduce backlog and speed up time to diagnosis should be explored including: {circ}Triage in primary care settings such as GP surgeries using innovations such as the cytosponge for oesophageal symptoms (e.g. reflux). {circ}Direct referral from primary care settings to specialist investigation, without the need for prior additional referrals in secondary care. Strength of Evidence{blacksquare} The evidence presented in this review is recent, however with small samples (di Pietro et al., 2020), short-term follow up periods (Sagar et al., 2020) and assumptions required for modelling studies (Loveday et al., 2021). This reduces the generalisability and confidence of conclusions. The confidence in the strength of evidence about FIT testing is rated as low-moderate confidence. Cytosponge evidence is rated low confidence. Review team and stakeholder involvementThis Rapid Review is being conducted as part of the Wales COVID-19 Evidence Centre Work Programme. The above question was developed in consultation with Cancer Research UKs identified research gaps and with Professor Tom Crosby OBE. Professor Crosby is a Consultant Oncologist, National Cancer Clinical Director for Wales and Clinical Lead for Transforming Cancer Services and acted as the expert stakeholder for this review. The search questions were identified as a priority during the Cancer/COVID-19 Research Summit hosted by Cancer Research UK (CRUK), Public Health England (PHE) and the National Cancer Research Institute (NCRI). The stakeholder group supporting the review work here is Cancer Research Wales.
RESUMEN
TOPLINE SUMMARYO_ST_ABSWhat is a Rapid Review?C_ST_ABSOur rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal and evidence synthesis to answer a specific question and identify key research gaps. They take one to two months, depending on the breadth and complexity of the research topic/question(s), the extent of the evidence base and type of analysis required for synthesis. Background / Aim of Rapid ReviewThe COVID-19 pandemic has led to differential economic, health and social impacts illuminating prevailing gender inequalities (WEN Wales, 2020). This rapid review investigated evidence for effectiveness of interventions to address gender inequalities across the domains of work, health, living standards, personal security, participation, and education. Key FindingsO_ST_ABSExtent of the evidence baseC_ST_ABSO_LI21 studies were identified: 7 reviews, 6 commentaries and 8 primary studies C_LIO_LILimited evidence for the effectiveness of identified innovations in minority groups C_LIO_LIA lack of evaluation data for educational interventions C_LIO_LIA lack of evidence for cost-effectiveness of the identified interventions C_LIO_LI14 additional articles were identified in the grey literature but not used to inform findings (apart from the Education domain, where there was a lack of peer-reviewed evidence). C_LI Recency of the evidence baseO_LIAll studies were published in 2020-2021 C_LI Summary of findingsSome evidence supported interventions/innovations related to work: O_LIPermanent contracts, full-time hours, and national childcare programmes to increase income for women and thereby decrease the existing gender wage gap. C_LIO_LIMore frequent use of online platforms in the presentation of professional work can reduce gender disparities due to time saved in travel away from home. C_LI Some evidence supported interventions/innovations related to health: O_LILeadership in digital health companies could benefit from women developing gender-friendly technology that meets the health needs of women. C_LIO_LICreate authentic partnerships with black women and female-led organisations to reduce maternal morbidity and mortality (Bray & McLemore, 2021). C_LI Some evidence supported interventions/innovations related to living standards including: O_LIMulti-dimensional care provided to women and their children experiencing homelessness. C_LI Limited evidence supported interventions/innovations related to personal security including: O_LISpecific training of social workers, psychologists and therapists to empower women to use coping strategies and utilise services to gain protection from abusive partners. C_LIO_LIHelplines, virtual safe spaces smart phone applications and online counselling to address issues of violence and abuse for women and girls. C_LI Very limited evidence supported interventions/innovations related to participation including: O_LIUse of online platforms to reduce gender disparities in the presentation of academic/professional work. C_LIO_LIEnsuring equal representation, including women and marginalised persons, in pandemic response and recovery planning and decision-making. C_LI Limited evidence from the grey literature described interventions/innovations related to education including: O_LITeacher training curricula development to empower teachers to understand and challenge gender stereotypes in learning environments. C_LIO_LIEducation for girls to enable participation in STEM. C_LI Policy ImplicationsThis evidence can be used to map against existing policies to identify which are supported by the evidence, which are not in current policy and could be implemented and where further research/evaluation is needed. Further research is needed to evaluate the effectiveness of educational innovations, the effectiveness of the innovations in minority groups and the social value gained from interventions to address gender inequalities. Strength of EvidenceOne systematic review on mobile interventions targeting common mental disorders among pregnant and postpartum women was rated as high quality (Saad et al., 2021). The overall confidence in the strength of evidence was rated as low due to study designs. Searches did not include COVID specific resources or pre-prints. There may be additional interventions/innovations that have been implemented to reduce inequalities experienced by women and girls due to the COVID-19 pandemic but have not been evaluated or published in the literature and are therefore not included here.
RESUMEN
TOPLINE SUMMARYO_ST_ABSWhat is a Rapid Review?C_ST_ABSOur rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal and evidence synthesis to answer a specific question and identify key research gaps. They take 1-2 months, depending on the breadth and complexity of the research topic/question(s), the extent of the evidence base and type of analysis required for synthesis. Background / Aim of Rapid ReviewCare for older and vulnerable people must sustain core infection prevention and control (IPC) practices and remain vigilant for COVID-19 transmission to prevent virus spread and protect residents and healthcare professionals from severe infections, hospitalisations and death. However, these measures could potentially lead to adverse outcomes such as decreased mental wellbeing in patients and staff. A recent publication by Public Health England examines the effectiveness of IPC practices for reducing COVID-19 transmission in care homes (Duval et al., 2021). We explore evidence relating to adverse outcomes from IPC practices to help inform policy recommendations and identify gaps within the literature where further research can be prioritised. Key FindingsO_ST_ABSExtent of the evidence baseC_ST_ABSO_LI15 studies were identified: 14 primary studies and one rapid review C_LI Recency of the evidence baseO_LIOf the primary studies, six were published in 2020 and eight were published in 2021 C_LIO_LIThe rapid review was published in 2021. C_LI Summary of findingsThis rapid review focuses on adverse outcomes resulting from increased IPC measures put in place during the COVID-19 pandemic. Whilst there is some evidence to show that there may be a link between IPC measures and adverse outcomes, causation cannot be assumed. O_LIDuring the COVID-19 restrictions, the cognition, mental wellbeing and behaviour of residents in care homes were negatively affected C_LIO_LIIncreased IPC procedures during the COVID-19 pandemic increased stress and burden among care staff because of increased workload and dilemmas between adhering well to IPC procedures and providing the best care for the care recipients C_LIO_LICOVID-19 IPC procedures were not well developed at the beginning of the COVID-19 pandemic, but evidence from 2021 suggests that good adherence to IPC measures can enable visitations by family members and medical professionals into care homes C_LIO_LIOnly one study investigating domiciliary care was found. Therefore, it is difficult to make conclusions related specifically to this care setting C_LIO_LINo published studies have reported on the costs or cost-effectiveness of IPC measures or have explored the cost implications of adverse outcomes associated with IPC measures C_LI Best quality evidenceOnly one study was deemed as high quality based on the quality appraisal checklist ranking. This was a mixed methods study design (Tulloch et al., 2021). Policy ImplicationsSince March 2020, there have been many changes to government guidelines relating to procedures to keep the population safe from COVID-19 harm. Policies vary according to country, even within the UK. Important issues such as care home visitation policies have changed in such a way that care home staff have felt it difficult to keep up with the changes, which in itself increased the burden on those staff. The following implications were identified from this work: O_LIIPC policies should be clear, concise and tailored to care homes and domiciliary care settings C_LIO_LIIncreased attention to workforce planning is needed to ensure adequate staffing and to reduce individual burden C_LIO_LIRestrictions (e.g. visitation) for care home residents needs to be balanced by additional psychological support C_LIO_LIFurther research with robust methods in this area is urgently needed especially in the domiciliary care setting C_LI Strength of EvidenceOne limitation is the lack of high-quality evidence from the included studies. Confidence in the strength of evidence about adverse outcomes of COVID-19 IPC procedures was rated as low overall. Whilst the majority of studies achieved a moderate score based on the quality appraisal tools used, due to the nature of the methods used, the overall quality of evidence is low.