Lessons learned from a pilot implementation of physical activity recommendations in axial spondyloarthritis exercise group therapy

Background The Ankylosing Spondylitis Association of Switzerland (SVMB) aimed to implement physical activity recommendations (PAR) within their exercise groups (EGs). The PAR promote exercise in all fitness dimensions at the correct dose. To implement the PAR within EGs, they were translated into a new EG concept with five key activities: (a) training for supervising physiotherapists (PTs), (b) correctly dosed exercises in all fitness dimensions, (c) exercise counselling, (d) bi-annual fitness assessments, and (e) individual exercise training, in addition to EG. All these activities were realized in close coordination with SVMB management. Objectives To analyse the implementation success by evaluating adherence/fidelity, feasibility, and satisfaction at the patient, PTs, and organisational level. Methods The five key activities of the new EG concept were developed, executed, and assessed after 6 months. The primary outcomes for implementation success were adherence of patients to the recommended exercise behaviour, self-reported by electronic diary; fidelity of PTs to the new concept, self-reported by diary; SVMB organisational changes. Secondary outcomes were feasibility and satisfaction with the new EG concept at all three levels. The tertiary outcome, to evaluate the effectiveness of PAR, was patient fitness, assessed through fitness assessments. Results 30 patients with axSpA (ten women, mean age 58 ± 9 years) and four PTs (three women, mean age 46 ± 9 years) participated. The patients' self-reporting of adherence to the PAR was insufficient (43%), possibly due to technical problems with the electronic dairy. The PTs' fidelity to the new EG concept was satisfactory. On all levels, the new concept was generally perceived as feasible and useful for supporting personalised exercise.The frequency of exercise counselling and the fitness assessments was found by patients and PTs to be too high and rigid. Patients' cardiorespiratory fitness [ES 1.21 (95%CI 0.59, 1.89)] and core strength [ES 0.61 (95%CI 0.18, 1.06)] improved over the 6 months. Conclusions The pilot implementation of PAR showed acceptance and satisfaction to be sufficient, thus confirming the need for evidence-based EGs, provided by a patient organisation in order to support active PA behaviour. However, adaptations are necessary to increase its feasibility for nationwide implementation. Trial Registration: SNCTP, SNCTP000002880. Registered 31 May 2018, https://www.kofam.ch/en/snctp-portal/search/0/study/42491.

Application of MSTAM Methodology in Project Management

Innovation technology development and commercialization are not new, but this is a hot topic in this decade in Hong Kong. The relevant researches are focused on two dimensions from research and development (R&D) technologist perspective (supply-side) and industry user perspective (demand-side). This is a part of the author's engineering doctorate thesis. The thesis title is “An Analysis of the Determinants of Innovation and Technology Fund (ITF) R&D Projects Commercialization in Hong Kong's Logistics and Supply Chain Industries.” A pilot implementation case study has been conducted and tested, and the MSTAM methodology are workable for ITF R&D project deliverables commercialization to the industry.

Development, validation, and pilot implementation of the minimum datasheet for a domestic violence registry system: The case of a developing country

Background Domestic violence (DV) is a universal issue and an important public health priority. Establishing a DV Registry System (DVRS) can help to systematically integrate data from several sources and provide valid and reliable information on the scope and severity of harms. The main objective of this study was to develop, validate, and pilot-test a minimum datasheet for a DVRS to register DV victims in medical facilities. Materials and methods This study was conducted in two main phases. Phase one includes developing the datasheet for registration of DV in the DVRS. In phase two, the datasheet designed in the previous step was used in a pilot implementation of the DVRS for 12 months to find practical challenges. The preliminary datasheet was first developed using information on similar registry programs and guidelines of the World Health Organization (WHO) and then reviewed by four expert panels. Through a two-round Delphi technique, experts evaluated the instrument using the Content Validity Index (CVI) and Content Validity Ratio (CVR). The consistency of the responses was evaluated by test-retest analysis. Finally, two physicians in two forensic medical clinics registered the victims of physical and/or sexual violence perpetrated by a family member. Results Preliminary datasheet consisted of 31 items. In the first round of Delphi, fifteen items had good content validity (I-CVI and CVR) and were kept, and seven items were moved to the next round. Also, in the first round of Delphi, experts suggested adding three items, including history of the violence, custody of the child, and custody of the elderly. All items evaluated in the second round were kept due to good CVR and CVI scores. As a result of Test-retest correlation coefficients for self-reprted items, two items including perpetrator’s alcohol and drug use status were excluded (r(30) = +.43, and +.38, p< .01, two-tailed, respectively). Finally, 24 items were included in the datasheet including 15 items for individuals’ characteristics (victims’ characteristics and perpetrators’ characteristics), eight items for incidents’ characteristics, and one item for past history of violence experience. A total of 369 cases were registered from September 23, 2019, to July 21, 2020. The majority of the reported cases were female (82%) and were 19–40 years old. No physical and/or sexual violence was reported from rural areas, which calls upon researchers to explore how services for detecting and treating the victims can be made accessible to these areas. Conclusion DVRS can show trends in DV by age, sex, the context of the violence, and incidence characteristics at every point in time. This is particularly valuable in planning and prioritizing research areas and interventions for DV prevention. Additionally, DVRS can be linked to other disease registry programs which can contribute to continuity and coordination of care, and major research in the future. Although a DVRS can be a promising initiative in identifying the areas in need of urgent interventions, there is no guarantee for its proper implementation due to limited resources and other challenges.

Creating Comics to Address Well-Being and Resilience During the COVID-19 Pandemic

In this descriptive case series, we detail the theoretical basis, methodology, and impact of a small-scale pilot implementation of graphic medicine workshops as an innovative approach to well-being and resilience in the age of COVID-19 and increasing awareness of racial injustice. The data provided in this article are anecdotal and based on participation in the workshops. Images created during the workshops are also shared as examples of the types of reflection that graphic medicine can enable. The workshops themselves were designed collaboratively and are based on the theoretical principles of graphic medicine, narrative medicine, and racial and social justice. They were conducted as part of a larger wellness initiative and were offered to health care-focused faculty at our academic medical institution. Our findings suggest that this was a beneficial activity which helped participants to reflect and reconsider their experiences with the COVID-19 pandemic and surging awareness of racial injustice. Reflections also showed that drawings were correlated with ProQOL scores and may, in larger numbers, also help to mitigate or bring attention to issues of burnout in frontline providers. Drawings shared show the tremendous impact of COVID-19 and the simultaneous chaos and emptiness of practicing during dual pandemics. Our workshops engaged about 20 frontline health care providers and other health care faculty and highlight the utility of graphic medicine as a tool for building resilience and encouraging self-reflection. Further study is necessary, as is more rigorous analysis of the relationship between the graphics created and the ability to recognize and mitigate burnout.

A Web-based, Provider-driven Mobile App to Enhance Patient Care Coordination between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study (Preprint)

BACKGROUND To fill the communication and care coordination gap between hospitals and dialysis facilities, we piloted a web-based, provider-driven mobile app (“DialysisConnect”). Here, we describe its development and pilot implementation. OBJECTIVE . METHODS DialysisConnect was developed iteratively, with focus group and user testing feedback, and made available to 106 potential users at one hospital [hospitalists, advanced practice providers (APPs), care coordinator] and four affiliated dialysis facilities (nephrologists, APPs, nurses/nurse managers) prior to the start of the pilot (11/1/20-5/31/21). Mid- and end-of-pilot online surveys of potential users were performed. Descriptive statistics were used to describe system usage patterns, ratings on multiple satisfaction items (1=not at all; 3=to a great extent), and provider-selected motivators and barriers to using DialysisConnect. RESULTS The pilot version of DialysisConnect included automatically uploaded clinical information from dialysis facilities, forms for entering critical admission and discharge information, and a direct communications channel. While physicians comprised most of the potential users of DialysisConnect, APPs and dialysis nurses were the most active users. Activity was unevenly distributed: e.g., one hospital-based APP recorded most of the admissions (n=225, 89%) and discharges (n=226, 93%) among patients treated at the pilot dialysis facilities. End-of-pilot ratings of DialysisConnect were generally higher for users vs. non-users: e.g., “I can see the potential value of DialysisConnect for my work with dialysis patients” [mean (SD): 2.8 (0.4) vs 2.3 (0.6), P=0.02]. Providers most commonly selected reduced time and energy spent gathering information as a motivator (42.3%) and lack of time to use the system as a barrier (30.8%). CONCLUSIONS In this pilot, we found that APPs and nurses were most likely to engage with the system. Survey participants generally viewed the system favorably, while identifying substantial barriers to its use. These results inform how best to motivate providers to use this and similar systems and inform future pragmatic research in care coordination in this and other populations.

Organic Oil Recovery - Resident Microbial Enhanced Production Pilot in Bahrain

Tatweer Petroleum has been involved in a Pilot study to determine the efficacy of Organic Oil Recovery (OOR), a unique form of microbial enhanced oil recovery as a means of maximising oil recovery from its Rubble reservoir within the Awali field. OOR harnesses microbial life already present in an oil-bearing reservoir to improve oil recovery through changes in interfacial tensions, which in the case of Rubble will increase the heavy oil's mobility and improve recovery rates and reservoir wettability. These changes could increase recoverable reserves and extend field life through improved oil recovery with negligible topsides modifications. The Pilot injection is implemented by injecting a specific nutrient blend directly at the wellhead with ordinary pumping equipment. The well is then shut-in for an incubation period and thereafter returned to production. In Tatweer Petroleum's Awali field the Rubble reservoir is one of the shallowest oil reservoirs in the Bahrain and the first oil discovery in the Gulf Cooperation Council (GCC) region. The reservoir can be found at depths of around 1400 – 1900 ft. During initial laboratory testing of the Rubble target wells the reservoir showed a diverse and abundant resident ecology which has been proven capable of undergoing the necessary characteristic changes to facilitate enhanced production from the target wells. The Pilot test on one of these wells, called Well (A) within this paper, took place in July 2020 and due to this process, the ecology of this well showed these same changes in characteristics in the reservoir along with an associated oil response. The full method of implementation of the Pilot test will also be discussed in detail and will include any challenges and/or successes in this area. The initial state ecology reports of Well (A) are demonstrated and compared to that of post-Pilot test ecology. We also present the production figures for the well prior to and post the Pilot implementation. A correlation will be demonstrated between changes in ecology and an increase in production.

Development and Pilot Implementation of a Patient Oriented Discharge Summary for Critically Ill Patients (PODS-ICU)

Background - Patients leaving the intensive care unit (ICU) often experience gaps in care due to deficiencies in discharge communication. This study aimed to develop an ICU specific patient-oriented discharge summary tool (PODS-ICU) and pilot test the tool for acceptability and feasibility.Methods - Patient-partners, ICU clinicians, and researchers met to discuss ICU patients’ specific informational needs and design the PODS-ICU through several cycles of iterative revisions. Research team nurses piloted the PODS-ICU with patient and family-caregiver participants in two ICUs in Calgary, Canada. Follow-up surveys on the PODS-ICU and its impact on discharge were administered to participants and ICU nurses.Results – Fifteen patient and family-caregiver participants were administered the PODS-ICU. Most participants felt that their discharge from the ICU was good or better (n=13), and some (n=9) participants reported a good understanding of why the patient was in ICU. Most participants (n=12) reported that they understood ICU events and impacts on the patient’s health. ICU nurses reported that the PODS-ICU was “not reasonable” in their daily clinical workflow due to “time constraint”. Conclusions - PODS-ICU improves patients and family-caregivers’ understanding of ICU events and health-implications but requires better integration with existing care processes to be feasible. Patient or Public Contribution – This work involved patient partners (i.e., individuals with lived experience as patients or family-caregivers) in tool development, study design, participant recruitment, and manuscript preparation.

Feasibility and Acceptability of Engaging Significant Adults in Youth Sexual and Relationship Violence Prevention Work

Relationship and sexual violence (RSV) disproportionately affect youth in immigrant and other marginalized communities yet few prevention initiatives are truly grounded in their experiences. The current study represents a pilot implementation evaluation of youth-led workshops to engage significant adults (parents, grandparents, aunts, adult siblings, community leaders) as RSV prevention partners in diverse communities in a large urban area. The current mixed methods evaluation examined the perceptions of 66 adults and six youth leaders of four, day-long adult training workshops. Results showed high feasibility and acceptability and an important role for significant adults in enhancing RSV prevention.