EnTraP: A factorial randomised controlled trial embedded within world hip trauma evaluation eight COPAL investigating the effect of an enhanced trainee principal investigator package and digital nudge on recruitment rates

Background Randomised controlled trials (RCTs) often struggle with various aspects of participant recruitment, including engaging clinicians to recruit effectively, and subsequently fail to reach their target sample size. Studies evaluating interventions to improve recruitment aimed specifically at recruiters to the trial are limited in number. The RCTs embedded into the World Hip Trauma Evaluation (WHiTE) cohort study use Trainee Principal Investigators (TPIs) to help manage and drive recruitment at trial sites. No formalised training or support is provided by central trials units to the TPIs. Additionally, trial recruiters receive a generic automated email confirming randomisation to the trial with no other communication to influence or incentivise their behaviour to further recruit. The primary aim of this factorial trial was to evaluate the effectiveness of an educational intervention to TPIs and a positive reinforcement intervention via an email (digital) nudge on increasing recruitment. Secondary aims included feasibility of implementing the interventions and surveying TPIs on the educational package quality of content, delivery and ongoing support. Design This was a multicentre, open, cluster, 2x2 factorial RCT embedded in the WHiTE 8 COPAL RCT, in which research sites were randomised 1:1:1:1 to receive the enhanced TPI package, the digital nudge intervention, both, or neither. Results 1215 patients were recruited to the WHiTE 8 COPAL trial across 20 sites during the SWAT between August 2018 and March 2019. There was a statistically significant interaction between the interventions (IRR 2.09, 95% CI 1.64 to 2.68, p < 0.001). There was a statistically significant benefit on recruitment (IRR 1.23 95% 1.09 to 1.40, p=0.001) from utilizing an enhanced TPI education intervention. The digital nudge intervention had no significant impact on recruitment (IRR 0.89 95% CI 0.79 to 1.01, p=0.07). Within enhanced TPI package sites, the digital nudge had a beneficial effect, while in the standard practice TPI sites it had a detrimental effect. Feasibility analysis showed the median time to site digital nudge and enhanced TPI set up were one day and 17 days, respectively. 353 digital nudges were created taking an average of 12 min to construct, log the activity and then disseminate to recruiters. Median induction time for enhanced TPI was 32 min and 100% of the groups were extremely satisfied with the induction content, delivery and ongoing support. Discussion An education and support programme targeted at surgical TPIs involving a digital education package, 1:1 telephone induction and subsequent support package was effective in increasing recruitment in the first 6 months of trial commencement. There was no evidence for the effectiveness of the digital nudge intervention in isolation, although our results show that when combined with an education programme, it leads to enhanced effectiveness of that programme.

Roadmaps for Reflection: Implementation Drivers to Bridge the Research-to-Practice Gap in Early Childhood Intervention

Training alone will not enable early childhood practitioners to operationalize evidence-based practices. When newly learned practices do not immediately work as intended, the temptation to return to old ways can be great. Moving an innovation from research to practice may require the use of implementation drivers. The field of implementation science informs us of the need for ongoing support during the implementation process. Implementation guides using a flow chart design may assist practitioners to implement evidence-based practices with fidelity immediately after training. This article provides a framework for developing implementation guides to move quickly from knowledge to utilization after a training occurs as well as a means to consider the usefulness of flowcharts for driving implementation efforts.

Explanation of Ancestry Estimation in Forensic Anthropology Textbooks

The way we teach about race and racism can have profound impacts on undergraduate learners, both positive and negative. Textbooks represent a space in which hidden curriculum about race can cement misconceptions and biologically essentialist thinking, leading to the ongoing support of practices that harm racially minoritized populations. In this study, I critically examine five popular introductory level, undergraduate, forensic anthropology textbooks, with attention to chapters on ancestry estimation, and offer recommendations for supplementary or alternative content. Specific coverage of core concepts related to race and ancestry estimation practices in forensic anthropology are evaluated, as well as the order of presentation and consistency of key messages. Though each chapter focuses on distinct examples and approaches, none cover all of the concepts or present a consistent message about ancestry estimation as it pertains to the biological race concept. In particular, messaging within each chapter demonstrates some ambiguity in the distinction between race and ancestry, while also presenting a narrative through which racial typology practices are delineated as “in the past” and distinct from current ancestry estimation practices. These results demonstrate a need, at the undergraduate level, for a more explicit discussion of the biological race myth in lieu of traditional approaches that focus on demonstrating the practicality and validity of such methods. Finally, detailed presentations of ancestry estimation

How to approach childhood obesity

Childhood obesity has a rising prevalence and is associated with significant morbidity, social and psychological consequences. In England, 21% of children aged between 10 and 11 are obese, with the highest rates being among children from lower socioeconomic groups. Primary care is responsible for managing most children who are overweight or obese. Consultations should generate positive conversations about childhood obesity and rule out underlying conditions and co-morbidities. Families may need support to recognise contributing factors and should be encouraged to identify simple, achievable strategies to promote healthier choices. Follow-up is essential, and families should be referred on to appropriate services for ongoing support.

Cognition in Primary Care Community Resource Directory for Individuals, Caregivers, and Providers

A KAER Model recommendation is to refer individuals diagnosed with dementia to resources that help them prepare for the future and services that provide ongoing support. The purpose of this project was to locate local quality services and develop a resource directory for persons with cognitive impairment for use by providers, staff, individuals, families, and caregivers. We worked with a Community Advisory Board and interviewed individuals and caregivers to understand what resources are useful and important to include in the resource directory. We built a web-based resource directory that allows users to query resources based on specific needs. We integrated the resource directory within the electronic health record for providers to include after visit summaries. A resource directory was deployed for community use, with goals of sustainability and longevity after this project is completed.

The perceptions of newly qualified nurses on the guidance by preceptors towards becoming experts in nursing

Background: The new role as professional nurse can be a difficult transition for the new qualified nurses. During this time, factors such as not being well prepared, working without supervision and a lack of guidance can be the result of a difficult transition.Objectives: The purpose of this study is to assess the perceptions of newly qualified nurses on the guidance given by their preceptors towards becoming experts in practice at a Level II regional hospital in the Western Cape.Method: A non-experimental quantitative descriptive design was followed. Collection of data was done by means of a questionnaire, designed by the researcher, using a cross-sectional research method. Non-probability sampling produced a sample of 162 nurses comprising registered nurses (48.2%), enrolled nurses (32.7%), and enrolled nursing auxiliaries (19.1%). Statistical analysis was performed using the Statistical Analysis System (SAS), version 9.3.Results: The results of the research study indicated that respondents had more positive experiences than negative ones. The respondents indicated that for the role and characteristics of the preceptor, expectations were met for knowledgeability, professionalism and contribution to team work. Furthermore, the results indicated that the respondents would recommend preceptorship.Conclusion: Preceptorship is one of the major interventions available to support newly qualified nurses by easing the transition from student to practicing nurse and reducing the theory-practice gap. The findings emphasised the importance of ongoing support programmes for nurses after obtaining a new qualification or/and being a new nurse.

A three-legged stool: Teachers’ views of Junior Cycle Physical Education curriculum change

The purpose of this paper was to examine Irish Physical Education teachers' views on curriculum change at the beginning of its implementation stage, with a particular focus on revision to the Physical Education curriculum and the new Wellbeing programme. In the light of these revisions, teachers were asked to make considerable changes to their beliefs and pedagogical approaches. Teacher change theory provided a lens through which to examine teachers' views. We reimaged the three aspects of teacher change as a triangle or ‘three-legged stool' where the three elements of curriculum materials/resources, pedagogy, and beliefs combine to offer a sense of security to sustain the impending changes. A survey and a series of semi-structured interviews provided data and in total 119 second level Physical Education teachers participated. Analysis was conducted using descriptive statistics of quantitative data and inductive and deductive analysis of qualitative data. Three themes were developed: A Learning Focus, Embracing Change, and Curriculum Enactment. Contrary to recent findings in the change literature, the teachers in this study welcomed curriculum changes as their beliefs aligned with the purpose of the reform of Physical Education. The results indicated that the new curriculum was catching up with teachers’ core beliefs about the purpose of Physical Education. However, in line with recent research, teachers were sceptical about ongoing support for resourcing and continued professional development. In conclusion, the ‘three-legged stool of sustained change has the potential to be unbalanced thereby maintaining teacher buy-in to the new reforms is potentially fragile.

Learning from Graduate and Undergraduate Public Health Virtual Internship Experiences with State Title V Agencies During COVID-19, Summer 2020

Background Since summer 2014, the National MCH Workforce Development Center has placed students from MCH public health graduate (Centers of Excellence and Catalyst) and undergraduate (MCH Pipeline) programs, all funded by the Maternal and Child Health Bureau, in summer internships with state and territorial Title V agencies. In 2020, due to the COVID-19 pandemic the Title V MCH Internship Program was offered virtually. Participants and Methods This manuscript includes quantitative and qualitative data from 2017 to 2020 generated by both Title V MCH Internship student interns (n = 76) and their preceptors (n = 40) with a focus on a comparison between the 2020 virtual year and the 2017–2019 years. Results Evaluation data from the 2017 to 2020 Title V MCH Internship Program from both students and preceptors revealed the implementation of a robust and successful internship program in which students increased their confidence in a variety of team, mentorship, and leadership skills while gaining direct exposure to the daily work of state Title V agencies. However, students and preceptors identified more challenges during 2020 compared to previous years. Conclusions The COVID-19 Pandemic was both a disruption and a catalyst for change in education. While there were clearly some challenges with the pivot to a virtual Title V MCH Internship Program in summer 2020, students were able to participate in meaningful internship experiences. This success can be attributed to the ability of the internship sponsor to engage in best practices, including extensive planning and provision of ongoing support to the students. Going forward, it is recognized that virtual internships may facilitate access to agencies in distant locales, eliminating issues related to housing and transportation. When both virtual and in-person relationships are available, those responsible for internship programs, including the Title V MCH Internship, will need to weigh these type of benefits against the potential missed opportunities students may have when not able to participate in on-site experiences.

The experiences of autistic adults during the COVID-19 pandemic in the UK and implications for autism services development

Purpose COVID-19 has been challenging for many in the UK. This is no different to many with autism spectrum disorder. Based on the experiences and issues raised by a small group of autistic women in an ongoing support group, consideration if this holds true for the wider adult autistic community across further lockdowns and restrictions to public life was explored. Design/methodology/approach An online questionnaire was created based on the issues raised. Participants indicated the degree to which they agreed or disagreed with each statement. Findings Autistic adults experienced an increase in anxiety and poor mental health, which in turn has exacerbated autistic features, such as rigidity. The data indicates that autistic adults can adapt to change provided there is support in maintaining routines. Research limitations/implications The research is limited due to the small number of participants (N = 120), as well as national variations in service provision. Practical implications Our data raises wider questions about the nature of support for autistic adults without cognitive impairments during times of crises and how services can respond and may even be shaped in the future to provide support that is cost-effective and relevant to autistic adults. Social implications To ensure that services have an awareness of how crises impact on autistic adults and how relatively simple changes may avert poor mental health. Originality/value That the creation of local support networks, and the ability to access these, is a key feature of autism-specific support.

Perinatal And Post-Partum Care From Early Pregnancy To Postpartum Period.

Introduction: Despite the fact that just a few researchers have examined the prenatal and postpartum periods, the findings from those few studies suggest an increase in prevalence through out pregnancy and the first six months after delivery. Pregnancy is a pivotal period in a woman’s life, as she experiences significant emotional, physical, hormonal, and social changes. Pregnancy and the first six months after delivery (perinatal phase) can be taxing, leading in sleep deprivation, relationship difficulties, and feelings of isolation. Materials & Methods: Quality of care, perinatal care, India, hospital, intrapartum care, implementation, and still birth for period were searched in the PubMed database using MeSH terms. A narrative summary of the goals and outcomes was completed. Conclusions: This study compiles a list of all prenatal social needs interventions that have been described in the literature to date. The majority of therapies have been for IPV, according to the findings of this study, and interventions that combine counselling or ongoing support have the best likelihood of lowering social risk factors and improving clinical outcomes.