Poor health worker performance is a well-documented obstacle to quality service provision. Due to the increasingly widespread availability of mobile devices, mobile health (mHealth) has received growing attention as a service improvement tool. This pilot study explored feasibility, acceptability and outcomes of an mHealth intervention designed to increase coverage of intermittent preventive treatment of malaria in pregnancy (IPTp) in two districts of West Nile, Uganda. In both districts, selected health workers (N = 48) received classroom training on malaria in pregnancy. All health workers in one district (N = 49) subsequently received 24 text messages reinforcing the training content. The intervention was evaluated using a mixed-methods approach, including four focus group discussions with health workers and three in-depth interviews with district health officials, health worker knowledge assessments one month (N = 90) and six months (N = 89) after the classroom training, and calculation of IPTp coverage from participating health facilities’ (N = 16) antenatal care registers covering six months pre- and post-intervention. Complementing classroom training with text messaging was found to be a feasible, acceptable and inexpensive approach to improving health worker performance. The messages served as reminders to those who had attended the classroom training and helped spread information to those who had not. Health workers in the district where text messages were sent had significantly better knowledge of IPTp, achieving an increased composite knowledge score of 6.00 points (maximum score: 40) compared with those in the district where only classroom training was provided. Average facility coverage of three doses of IPTp was also significantly higher where text messages were sent (85.8%) compared with the district where only classroom training was provided (54.1%). This intervention shows promise for the improvement of health worker performance for delivery of IPTp, and could have significant broader application.

Post–COVID-19 condition is a growing health concern and has been associated with more than 200 possible symptoms. The diverse and varied ways the condition presents clinically creates challenges for developing standard diagnostic criteria, and for health systems aiming to provide effective treatment and management supports for people. To support health care, decision-makers and clinicians understand the different clinical presentations of the condition, we scanned the evidence base to examine early approaches being used to characterize and describe subtypes of post–COVID-19 condition. Subtypes can be developed with many different disease features and patient factors, but for this report we specifically reviewed potential subtypes based on symptoms and clinical presentation. We found that some of the early approaches used to develop subtypes are based on statistical methods that group together patterns of symptoms. These studies are beginning to reveal potential subtypes based on severity of symptoms, type and co-occurrence of symptoms, and symptoms affecting different organ systems. Many reported symptoms of post–COVID-19 condition are similar to previously characterized health conditions. In some cases, subtypes of post–COVID-19 may be manifestations of those other conditions. For example, certain subtypes may present with symptoms similar to myalgic encephalomyelitis/chronic fatigue syndrome or pulmonary fibrosis. It is uncertain whether those subtypes share the same or distinct pathophysiology and whether they may benefit from similar treatments. Early evidence comparing the variant of infection and its association with potential subtypes of post–COVID-19 condition is emerging, but the findings are currently mixed. Some studies suggest that variants such as Delta and Omicron may result in different clinical presentations, while other studies have not found significant differences. Further research assessing the association between variants and subtypes is likely needed. This review provides some implications and considerations for health systems should emerging research further characterize and validate proposed subtypes. These implications may be important for improving the diagnosis, treatment, and management of post–COVID-19 condition. With estimates in Canada suggesting that more than a million people could be affected by the condition, monitoring ongoing research on subtypes may help support the development of effective and tailored treatments, and guide health systems planning across the country.

Low-value tests, treatments, and procedures are an important health care quality problem in Canada and across the world because they provide little clinical benefit, may be harmful for patients, and waste limited resources. Due to the COVID-19 pandemic, health care systems face increased challenges of limited resources, reduced capacity, and a growing backlog of surgeries and other procedures. The pandemic has compelled health care professionals to make challenging decisions to prioritize health care services while coping with increased demand. As Canada emerges from the pandemic and health care systems rebuild and begin to address the backlog of delayed or cancelled services, there is an imperative to introduce lasting changes to reduce low-value care and ensure high-quality care is available to everyone. To help inform efforts for using health care resources wisely and to support decision-making, CADTH and Choosing Wisely Canada convened a 10-member multi-disciplinary panel of clinicians, patient representatives, and health policy experts to review areas of low-value care that can be reduced or limited. This panel reviewed, deliberated, and prioritized 19 recommendations of the more than 400 Choosing Wisely Canada recommendations, the implementation of which can help ensure high-value care after the pandemic. Examples of the 19 recommendations include: Avoiding unnecessary transfers for patients in long-term care to hospitals unless there is an urgent medical need. Limiting blood tests and imaging unless required to answer a specific clinical question or guide treatment. Not transfusing red blood cells for hemodynamically stable patients in the intensive care unit. Not delaying palliative care for patients with serious illness because they are pursuing disease-directed treatment. Moreover, the panel’s discussion highlighted how the selected recommendations can advance key priorities, including improving health equity and access to care, appropriately using limited resources, emphasizing patient-focused care, and addressing challenges the pandemic has presented for long-term care.

Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies; these technologies are identified through the CADTH Horizon Scanning Service as topics of potential interest to health care decision-makers in Canada. This report is not an endorsement or assessment of any test or technology. This Horizon Scan summarizes the available information regarding the emerging technology of liquid biopsy–based, multi-cancer early detection tests for cancer screening. This Horizon Scan focuses specifically on the Galleri (GRAIL Inc.) and CancerSEEK (Exact Sciences) tests, which are further along in the development cycle and are being assessed in different international clinical studies. Multi-cancer early detection technologies aim to provide a new approach to complement traditional cancer screening programs. These tests examine genetic signals within blood samples with next-generation sequencing and computational algorithms to assess the presence and type of different cancers. Research to date has focused on describing results from training and validation studies that have provided initial estimates of test performance and modelling studies estimating the potential impact on cancer incidence. This Horizon Scan also highlights some issues for health care decision-makers to consider about the technology relating to real-world test performance, the potential benefits and harms of screening with multi-cancer early detection tests, and the disruptiveness to health systems they could pose. Ongoing review of clinical trials and the emerging evidence base can help inform health systems in Canada about their potential role within cancer-control initiatives.

Horizon Scan reports provide brief summaries of information regarding new and emerging health technologies; Heath Technology Update articles typically focus on a single device or intervention. This Horizon Scan summarizes the available information regarding emerging comprehensive genomic profiling (CGP) technologies for informing cancer treatments. These technologies are based on next-generation sequencing platforms, which can characterize up to hundreds of genes and other genomic information with a single sample. Emerging tests are also compatible with minimally invasive liquid biopsies that use fluids such as blood samples to support clinical decision-making. CGP could be an alternative or a complement to conventional testing that uses single-biomarker assays or limited gene panels. Some emerging CGP tests available in Canada, the US, and Europe are being considered to inform the treatment of non–small cell lung cancer (NSCLC) because it has the highest number of identified biomarkers. Most identified studies have examined CGP use with NSCLC. The emerging evidence about the clinical and cost-effectiveness of CGP technologies for either NSCLC or other cancer types remains uncertain. Without randomized trials and robust study designs, it is not yet well-established whether the additional costs and technical requirements of CGP may provide better clinical outcomes compared with conventional molecular testing. This Horizon Scan also provides considerations for health systems about testing infrastructure, training for health care professionals, and understanding different patients’ perspectives should CGP or other next-generation sequencing technologies become more widely used in Canada.