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Smith J. Forensic training- bridging the gap between education and workplace. Forensic Sci Int Synerg 2024; 8:100463. [PMID: 38496345 PMCID: PMC10940938 DOI: 10.1016/j.fsisyn.2024.100463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
Outreach initiatives involves mentoring students, university collaboration, and program creation to diversify roles between academia and forensic practitioners. Mixer exercises foster student-forensic scientist interaction. Emphasis is placed on improving understanding of forensic science, particularly in regions like Southern Africa, where media portrayals often distort perceptions. The outreach initiative aims to correct these misconceptions, promote evidence-based forensic education, and address research shortages through collaboration between forensic laboratories and universities. A permanent committee within the Southern Africa Regional Forensic Science Forum is proposed to facilitate cooperation and coordination. By fostering collaboration and encouraging participation in conferences and research publication, the initiative aims to meet the region's forensic scientist needs.
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Affiliation(s)
- J.H. Smith
- School of Criminal Justice, University of South Africa, South Africa
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Wickenheiser R, Cadau A, Muro C, Whitfield S, McGinnis C, Murray L, France M, Niles L, Barron D, Valentin L. The forensic educational outreach initiative - Bridging the gap between education and workplace. Forensic Sci Int Synerg 2023; 8:100448. [PMID: 38229688 PMCID: PMC10788423 DOI: 10.1016/j.fsisyn.2023.100448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024]
Abstract
Skills and knowledge gaps frequently exist between forensic educational programs and practical forensic laboratory needs. An educational outreach project involving three post-secondary academic institutions and a large multidisciplinary forensic laboratory was created to provide lectures to students, enable mentorship with forensic scientists, and provide an interactive experience within the forensic laboratory. Mentorship mixer exercises encouraged meaningful interactions between students and scientists, creating opportunities for practical discussion on employment requirements, optimal class selections based on students' interests and forensic science requirements, and better understanding of the daily tasks and duties of operational forensic scientists. Feedback from students, professors, and forensic mentors have resulted in program improvements which will inform the educational outreach initiative going forward, including broader community outreach.
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Affiliation(s)
| | - Amanda Cadau
- New York State Police Crime Laboratory System, Albany, NY, USA
| | - Claire Muro
- New York State Police Crime Laboratory System, Albany, NY, USA
| | | | - Carrie McGinnis
- New York State Police Crime Laboratory System, Albany, NY, USA
| | - Lola Murray
- New York State Police Crime Laboratory System, Albany, NY, USA
| | - Melissa France
- New York State Police Crime Laboratory System, Albany, NY, USA
| | - Lyn Niles
- New York State Police Crime Laboratory System, Albany, NY, USA
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Reynolds SS, Woltz P, Keating E, Neff J, Elliott J, Hatch D, Yang Q, Granger BB. Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial. Implement Sci 2021; 16:45. [PMID: 33902653 PMCID: PMC8074470 DOI: 10.1186/s13012-021-01112-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor. The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff's compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff's knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates. METHODS A stepped wedged cluster-randomized design was used with units clustered into 4 sequences; each sequence consecutively began the intervention over the course of 4 months. The Grol and Wensing Model of Implementation helped guide selection of the implementation strategies, which included educational outreach visits and audit and feedback. Compliance with the appropriate CHG bathing process and daily CHG bathing documentation were assessed. Outcomes were assessed 12 months after the intervention to assess for sustainability. RESULTS Among the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff's knowledge and perceptions of CHG bathing significantly improved after the intervention (p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates. CONCLUSIONS Using educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices. TRIAL REGISTRATION ClinicalTrials.gov, NCT03898115 , Registered 28 March 2019.
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Affiliation(s)
- Staci S Reynolds
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA.
- Duke University Hospital, 2310 Erwin Road, Durham, NC, 27710, USA.
| | - Patricia Woltz
- WakeMed Health & Hospitals, 3000 New Bern Avenue, Raleigh, NC, 27610, USA
| | - Edward Keating
- Duke University Hospital, 2310 Erwin Road, Durham, NC, 27710, USA
| | - Janice Neff
- WakeMed Health & Hospitals, 3000 New Bern Avenue, Raleigh, NC, 27610, USA
| | - Jennifer Elliott
- WakeMed Health & Hospitals, 3000 New Bern Avenue, Raleigh, NC, 27610, USA
| | - Daniel Hatch
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
| | - Qing Yang
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
| | - Bradi B Granger
- Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, USA
- Duke University Health System, 2310 Erwin Road, Durham, NC, 27710, USA
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Curran R, Murdoch J, Bachmann M, Bateman E, Cornick R, Picken S, Simelane ML, Fairall L. Addressing the quality of paediatric primary care: health worker and caregiver perspectives from a process evaluation of PACK child, a health systems intervention in South Africa. BMC Pediatr 2021; 21:58. [PMID: 33509149 PMCID: PMC7842050 DOI: 10.1186/s12887-021-02512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The WHO’s Integrated Management of Childhood Illness (IMCI) has resulted in progress in addressing infant and child mortality. However, unmet needs of children continue to present a burden upon primary healthcare services. The capacity of services and quality of care offered require greater support to address these needs by extending and integrating curative and preventive care for the child with a long-term health condition and the child older than 5, not prioritised in IMCI. In response to these needs, the PACK Child intervention was developed and piloted in October 2017–February 2019 in the Western Cape Province of South Africa. We report health worker and caregiver perspectives of the existing paediatric primary care context as well as the extent to which PACK Child functions to address perceived problems within the current local healthcare system. Methods This process evaluation involved 52 individual interviews with caregivers, 10 focus group discussions with health workers, 3 individual interviews with trainers, and 31 training observations. Interviews and focus groups explored participants’ experiences of paediatric primary care, perspectives of the PACK Child intervention, and tensions with implementation in each context. Inductive thematic analysis was used to analyse verbatim interview and discussion transcripts. Results Perspectives of caregivers and health workers suggest an institutionalised focus of paediatric primary care to treating children’s symptoms as acute episodic conditions. Health workers’ reports imply that this focus is perpetuated by interactions between contextual features such as, IMCI policy, documentation-driven consultations, overcrowded clinics and verticalised care. Whilst these contextual conditions constrained health workers’ ability to translate skills developed within PACK Child training into practice, the intervention initiated expanded care of children 0–13 years and those with long-term health conditions, enhanced professional competence, improved teamwork and referrals, streamlined triaging, and facilitated probing for psychosocial risk. Conclusion PACK Child appears to be catalysing paediatric primary care to address the broader needs of children, including long-term health conditions and the identification of psychosocial problems. However, to maximise this requires primary care to re-orientate from risk minimisation on the day of attendance towards a view of the child beyond the day of presentation at clinics. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02512-7.
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Affiliation(s)
- Robyn Curran
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Observatory, Cape Town, Western Cape, 7925, South Africa.
| | - Jamie Murdoch
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Max Bachmann
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Eric Bateman
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Sandra Picken
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Makhosazana Lungile Simelane
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Observatory, Cape Town, Western Cape, 7925, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Observatory, Cape Town, Western Cape, 7925, South Africa.,King's Global Health Institute, King's College London, London, SE1 9NH, UK
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Puchalski Ritchie LM, van Lettow M, Makwakwa A, Kip EC, Straus SE, Kawonga H, Hamid JS, Lebovic G, Thorpe KE, Zwarenstein M, Schull MJ, Chan AK, Martiniuk A, van Schoor V. Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial. Implement Sci 2020; 15:107. [PMID: 33308257 PMCID: PMC7731739 DOI: 10.1186/s13012-020-01067-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 12/01/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND With the global shortage of skilled health workers estimated at 7.2 million, outpatient tuberculosis (TB) care is commonly task-shifted to lay health workers (LHWs) in many low- and middle-income countries where the shortages are greatest. While shown to improve access to care and some health outcomes including TB treatment outcomes, lack of training and supervision limit the effectiveness of LHW programs. Our objective was to refine and evaluate an intervention designed to address common causes of non-adherence to TB treatment and LHW knowledge and skills training needs. METHODS We employed a pragmatic cluster randomized controlled trial. Participants included 103 health centres (HCs) providing TB care in four districts in Malawi, randomized 1:1 stratified by district and HC funding (Ministry of Health, non-Ministry funded). At intervention HCs, a TB treatment adherence intervention was implemented using educational outreach, a point-of-care reminder tool, and a peer support network. Clusters in the control arm provided usual care. The primary outcome was the proportion of patients with successful TB treatment (i.e., cure or treatment completion). We used a generalized linear mixed model, with district as a fixed effect and HC as a random effect, to compare proportions of patients with treatment success, among the trial arms, with adjustment for baseline differences. RESULTS We randomized 51 HCs to the intervention group and 52 HCs to the control group. Four intervention and six control HCs accrued no eligible patients, and 371 of 1169 patients had missing outcome, HC, or demographic data, which left 74 HCs and 798 patients for analysis. Randomization group was not related to missing outcome, however, district, age, and TB type were significantly related and included in the primary analysis model. Among the 1153 patients with HC and demographic data, 297/605 (49%) and 348/548 (64%) in the intervention and control arms, respectively, had treatment success. The intervention had no significant effect on treatment success (adjusted odds ratio 1.35 [95% confidence interval 0.93-1.98]). CONCLUSION We found no significant effect of the intervention on TB treatment outcomes with high variability in implementation quality, highlighting important challenges to both scale-up and sustainability. TRIAL REGISTRATION ClinicalTrials.gov NCT02533089 . Registered August 20, 2015.
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Affiliation(s)
- Lisa M. Puchalski Ritchie
- Department of Medicine, University of Toronto, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2 Canada
- Li Ka Shing Knowledge Institute, St. Michaels Hospital, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8 Canada
- Department of Emergency Medicine, University Health Network, Toronto General Hospital, 200 Elizabeth Street, RFE G-480, Toronto, M5G 2C4 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
| | - Monique van Lettow
- Dignitas International, Zomba, Malawi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
| | | | | | - Sharon E. Straus
- Department of Medicine, University of Toronto, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2 Canada
- Li Ka Shing Knowledge Institute, St. Michaels Hospital, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8 Canada
| | | | - Jemila S. Hamid
- School of Epidemiology and Public Health, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa, ON I1G 5Z3 Canada
| | - Gerald Lebovic
- Li Ka Shing Knowledge Institute, St. Michaels Hospital, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
| | - Kevin E. Thorpe
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8 Canada
| | - Merrick Zwarenstein
- Department of Family Medicine, Western University, London, ON Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1 Canada
| | - Michael J. Schull
- Department of Medicine, University of Toronto, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2 Canada
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, c/o H2-66, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
- Dignitas International Toronto, C/O ICES attention Michael Schull, 2075 Bayview Avenue, G106, Toronto, ON M4N 3M5 Canada
| | - Adrienne K. Chan
- Department of Medicine, University of Toronto, 6 Queen’s Park Crescent West, Third Floor, Toronto, ON M5S 3H2 Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
- Dignitas International, Zomba, Malawi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, c/o H2-66, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Alexandra Martiniuk
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, M5T 3M7 Canada
- George Institute for Global Health, Sydney, Australia
- The University of Sydney, Edward Ford Building, Sydney, NSW Australia
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Kunstler BE, Lennox A, Bragge P. Changing prescribing behaviours with educational outreach: an overview of evidence and practice. BMC Med Educ 2019; 19:311. [PMID: 31412928 PMCID: PMC6693161 DOI: 10.1186/s12909-019-1735-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/26/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND General practitioners (GPs), or family practitioners, are tasked with prescribing medications that can be harmful to the community if they are inappropriately prescribed or used (e.g. opioids). Educational programs, such as educational outreach (EO), are designed to change the behaviour of health professionals. The purpose of this study was to identify the efficacy of EO programs at changing the prescribing behaviour of GPs. METHODS This study included an evidence and practice review, comprising a rapid review supplemented by interviews with people who are familiar with EO implementation for regulation purposes. Seven databases were searched using terms related to health professionals and prescribing. Systematic and narrative reviews published in English after 2007 were included. Non-statistical analysis was used to report intervention efficacy. Three government representatives participated in semi-structured interviews to aid in understanding the relevance of review findings to the Victorian context. Interviews were transcribed verbatim and thematically analysed for emerging themes. RESULTS Fourteen reviews were identified for the evidence review. Isolated (e.g. EO program delivered by itself) and multifaceted (e.g. EO program supplemented by other interventions) programs were found to change prescribing behaviours. However, limited evidence suggests that EO can successfully change prescribing behaviours specific to GPs. Isolated EO can successfully change health professional prescribing behaviours, although cheaper alternatives such as letters might be just as effective. Multifaceted EO can also successfully change health professional prescribing behaviours, especially in older adults, but it remains unclear as to what combination of interventions works best. Success factors for EO reported by government representatives included programs having practical rather than didactic foci; making EO compulsory; focussing EO on preventing adverse events; using monetary or professional development incentives; and in-person delivery. CONCLUSIONS Educational outreach can successfully change prescribing behaviours but evidence specific to GPs is lacking. Key characteristics of EO that could optimise success include ensuring the EO program is tailored, involves practical learning and uses incentives that are meaningful to clinicians.
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Affiliation(s)
- Breanne E. Kunstler
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton, Melbourne, VIC 3800 Australia
| | - Alyse Lennox
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton, Melbourne, VIC 3800 Australia
| | - Peter Bragge
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton, Melbourne, VIC 3800 Australia
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Shultz SP, Hughes-Oliver C, Wells D, Sheerin K, Fink PW, Handsfield GG, Hébert-Losier K, Clarke J, Queen RM. Can research align with service? Lessons learned from the Big Experiment and National Biomechanics Day. J Biomech 2019; 87:202-205. [PMID: 30910361 DOI: 10.1016/j.jbiomech.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
Public engagement is an important role for the university academic, but is often neglected due to perceived lack of time and prioritized commitments in research and teaching. Yet, public engagement events offer an untapped opportunity for researchers to collect data from members of the general public who arrive on site at university labs. These engagement events could allow for data collection as part of didactic and demonstrative outreach events to be used in research and science. In this proof of concept study, a collaborative group of international researchers investigated the feasibility of embedding research quality assessment into events surrounding National Biomechanics Day. The Big Experiment collected data on 501 secondary school students (age range: 13 to 18 years) across 9 university sites within a 24-hour period. Data included maximal vertical jump height and self-reported physical activity levels. Vertical jump height was positively correlated to participant height, but not age or body mass. Very physically active students had significantly higher vertical jump heights than individuals who reported being somewhat or not physically active. This feasibility project demonstrates that with substantial preparation and a simple research design, focused research questions can be incorporated into educational outreach initiatives and ultimately provide a rich data source.
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Affiliation(s)
- S P Shultz
- School of Sport and Exercise, Massey University, New Zealand; Kinesiology Department, Seattle University, Seattle, WA, USA.
| | - C Hughes-Oliver
- Kevin P. Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - D Wells
- Sports Performance Research Institute New Zealand (SPRINZ), School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - K Sheerin
- Sports Performance Research Institute New Zealand (SPRINZ), School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - P W Fink
- School of Sport and Exercise, Massey University, New Zealand
| | - G G Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - K Hébert-Losier
- Faculty of Health, Sport and Human Performance, University of Waikato, Adams Centre for High Performance, Tauranga, New Zealand
| | - J Clarke
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - R M Queen
- Kevin P. Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
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Pinto D, Heleno B, Rodrigues DS, Papoila AL, Santos I, Caetano PA. Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing-an 18-month open cluster-randomized trial. Implement Sci 2018; 13:120. [PMID: 30185197 PMCID: PMC6126017 DOI: 10.1186/s13012-018-0810-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/20/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Educational outreach visits are meant to improve the practice of health professionals by promoting face-to-face visits to deliver educational contents. They have been shown to change prescription behavior, but long-term effects are still uncertain. This trial aimed to determine if they improve family physician prescribing compared with passive guideline dissemination. METHODS Parallel, open, superiority, and cluster-randomized trial. National Health Service primary care practices (clusters) were recruited in the Lisbon region-Portugal between March 2013 and January 2014. They could enter if they had at least four family physicians willing to participate and not planning to retire in the follow-up period. Three national guidelines were chosen for dissemination: acid secretion modifiers, non-steroidal anti-inflammatory drugs, and antiplatelets. Physicians in the intervention group received one 15 to 20 min educational outreach visit at their workplace for each guideline. Physicians in the control group had access to guidelines through the Directorate-General for Health's website (passive dissemination). Primary outcomes were the proportion of COX-2 inhibitors prescribed within the NSAID class and the proportion of omeprazole within the PPI class at 18 months after the intervention. A cost-benefit analysis was performed. Practices were randomized by minimization. Data analyses were done at individual physician level using generalized mixed-effects regression models. Participants could not be blinded. RESULTS Thirty-eight practices with 239 physicians were randomized (120 to intervention and 119 to control). Of 360 planned visits, 322 were delivered. No differences were found between physicians in the intervention and control groups regarding the proportion of omeprazole prescribed among PPIs 18 months after the visit (46.28 vs 47.15%, p = 0.971) or the proportion of COX-2 inhibitors among NSAIDs (12.07 vs 13.08%, p = 0.085). All secondary outcome comparisons showed no effect. There was no difference in cumulative drug costs at 18 months (3223.50€/1000 patients in the intervention group and 3143.92€/1000 patients in the control group, p = 0.848). CONCLUSIONS Educational outreach visits were unsuccessful in improving compliance with guideline recommendations among Portuguese family physicians. No effects were observed at 1, 6, and 18 months after the intervention, and there were no associated cost savings. TRIAL REGISTRATION ClinicalTrials.gov NCT01984034 . Registered 7 November 2013.
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Affiliation(s)
- Daniel Pinto
- Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
| | - Bruno Heleno
- Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - David S Rodrigues
- Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Luísa Papoila
- Department of Biostatistics and Informatics, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Isabel Santos
- Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Pedro A Caetano
- Grupo de Investigação Académica Independente - Chronic Diseases Research Center, NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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Glidewell L, Willis TA, Petty D, Lawton R, McEachan RRC, Ingleson E, Heudtlass P, Davies A, Jamieson T, Hunter C, Hartley S, Gray-Burrows K, Clamp S, Carder P, Alderson S, Farrin AJ, Foy R. To what extent can behaviour change techniques be identified within an adaptable implementation package for primary care? A prospective directed content analysis. Implement Sci 2018; 13:32. [PMID: 29452582 PMCID: PMC5816358 DOI: 10.1186/s13012-017-0704-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/26/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Interpreting evaluations of complex interventions can be difficult without sufficient description of key intervention content. We aimed to develop an implementation package for primary care which could be delivered using typically available resources and could be adapted to target determinants of behaviour for each of four quality indicators: diabetes control, blood pressure control, anticoagulation for atrial fibrillation and risky prescribing. We describe the development and prospective verification of behaviour change techniques (BCTs) embedded within the adaptable implementation packages. METHODS We used an over-lapping multi-staged process. We identified evidence-based, candidate delivery mechanisms-mainly audit and feedback, educational outreach and computerised prompts and reminders. We drew upon interviews with primary care professionals using the Theoretical Domains Framework to explore likely determinants of adherence to quality indicators. We linked determinants to candidate BCTs. With input from stakeholder panels, we prioritised likely determinants and intervention content prior to piloting the implementation packages. Our content analysis assessed the extent to which embedded BCTs could be identified within the packages and compared them across the delivery mechanisms and four quality indicators. RESULTS Each implementation package included at least 27 out of 30 potentially applicable BCTs representing 15 of 16 BCT categories. Whilst 23 BCTs were shared across all four implementation packages (e.g. BCTs relating to feedback and comparing behaviour), some BCTs were unique to certain delivery mechanisms (e.g. 'graded tasks' and 'problem solving' for educational outreach). BCTs addressing the determinants 'environmental context' and 'social and professional roles' (e.g. 'restructuring the social and 'physical environment' and 'adding objects to the environment') were indicator specific. We found it challenging to operationalise BCTs targeting 'environmental context', 'social influences' and 'social and professional roles' within our chosen delivery mechanisms. CONCLUSION We have demonstrated a transparent process for selecting, operationalising and verifying the BCT content in implementation packages adapted to target four quality indicators in primary care. There was considerable overlap in BCTs identified across the four indicators suggesting core BCTs can be embedded and verified within delivery mechanisms commonly available to primary care. Whilst feedback reports can include a wide range of BCTs, computerised prompts can deliver BCTs at the time of decision making, and educational outreach can allow for flexibility and individual tailoring in delivery.
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Affiliation(s)
- Liz Glidewell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Thomas A. Willis
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Duncan Petty
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - Emma Ingleson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter Heudtlass
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Andrew Davies
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Tony Jamieson
- Yorkshire and Humber Academic Health Science Network, Wakefield, UK
| | - Cheryl Hunter
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Susan Clamp
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul Carder
- West Yorkshire Research and Development, Bradford Districts Clinical Commissioning Group, Bradford, UK
| | - Sarah Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amanda J. Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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10
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Burnett SM, Mbonye MK, Martin R, Ronald A, Zawedde-Muyanja S, Willis KS, Colebunders R, Manabe YC, Weaver MR. Effect of On-Site Support on Laboratory Practice for Human Immunodeficiency Virus, Tuberculosis, and Malaria Testing. Am J Clin Pathol 2016; 146:469-77. [PMID: 27686173 DOI: 10.1093/ajcp/aqw138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate the effect of on-site support in improving human immunodeficiency virus (HIV) rapid testing, tuberculosis (TB) sputum microscopy, and malaria microscopy among laboratory staff in a low-resource setting. METHODS This cluster randomized trial was conducted at 36 health facilities in Uganda. From April to December 2010, laboratory staff at 18 facilities participated in monthly on-site visits, and 18 served as control facilities. After intervention, 128 laboratory staff were observed performing 587 laboratory tests across three diseases: HIV rapid testing, TB sputum microscopy, and malaria microscopy. Outcomes were the proportion of laboratory procedures correctly completed for the three laboratory tests. RESULTS Laboratory staff in the intervention arm performed significantly better than the control arm in correctly completing laboratory procedures for all three laboratory tests, with an adjusted relative risk (95% confidence interval) of 1.18 (1.10-1.26) for HIV rapid testing, 1.29 (1.21-1.40) for TB sputum microscopy, and 1.19 (1.11-1.27) for malaria microscopy. CONCLUSIONS On-site support significantly improved laboratory practices in conducting HIV rapid testing, TB sputum microscopy, and malaria microscopy. It could be an effective method for improving laboratory practice, without taking limited laboratory staff away from health facilities for training.
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Affiliation(s)
- Sarah M Burnett
- From Accordia Global Health Foundation, Washington, DC Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Martin K Mbonye
- Infectious Diseases Institute, College of Health Sciences, University Research Co, LLC, Kampala, Uganda
| | - Robert Martin
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle
| | - Allan Ronald
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Stella Zawedde-Muyanja
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Robert Colebunders
- Epidemiology for Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marcia R Weaver
- International Training and Education Center for Health (I-TECH), Department of Global Health, University of Washington, Seattle
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11
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Puchalski Ritchie LM, van Lettow M, Makwakwa A, Chan AK, Hamid JS, Kawonga H, Martiniuk ALC, Schull MJ, van Schoor V, Zwarenstein M, Barnsley J, Straus SE. The impact of a knowledge translation intervention employing educational outreach and a point-of-care reminder tool vs standard lay health worker training on tuberculosis treatment completion rates: study protocol for a cluster randomized controlled trial. Trials 2016; 17:439. [PMID: 27604571 PMCID: PMC5015212 DOI: 10.1186/s13063-016-1563-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022] Open
Abstract
Background Despite availability of effective treatment, tuberculosis (TB) remains an important cause of morbidity and mortality globally, with low- and middle-income countries most affected. In many such settings, including Malawi, the high burden of disease and severe shortage of skilled healthcare workers has led to task-shifting of outpatient TB care to lay health workers (LHWs). LHWs improve access to healthcare and some outcomes, including TB completion rates, but lack of training and supervision limit their impact. The goals of this study are to improve TB care provided by LHWs in Malawi by refining, implementing, and evaluating a knowledge translation strategy designed to address a recognized gap in LHWs’ TB and job-specific knowledge and, through this, to improve patient outcomes. Methods/design We are employing a mixed-methods design that includes a pragmatic cluster randomized controlled trial and a process evaluation using qualitative methods. Trial participants will include all health centers providing TB care in four districts in the South East Zone of Malawi. The intervention employs educational outreach, a point-of-care reminder tool, and a peer support network. The primary outcome is proportion of treatment successes, defined as the total of TB patients cured or completing treatment, with outcomes taken from Ministry of Health treatment records. With an alpha of 0.05, power of 0.80, a baseline treatment success of 0.80, intraclass correlation coefficient of 0.1 based on our pilot study, and an estimated 100 clusters (health centers providing TB care), a minimum of 6 patients per cluster is required to detect a clinically significant 0.10 increase in the proportion of treatment successes. Our process evaluation will include interviews with LHWs and patients, and a document analysis of LHW training logs, quarterly peer trainer meetings, and mentorship meeting notes. An estimated 10–15 LHWs and 10–15 patients will be required to reach saturation in each of 2 planned interview periods, for a total of 40–60 interview participants. Discussion This study will directly inform the efforts of knowledge users within TB care and, through extension of the approach, other areas of care provided by LHWs in Malawi and other low- and middle-income countries. Trial registration ClinicalTrials.gov NCT02533089. Registered 20 August 2015. Protocol Date/Version 29 May 2016/Version 2. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1563-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Emergency Medicine, University Health Network, Toronto, ON, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Monique van Lettow
- Dignitas International, P.O. Box 1071, Zomba, Malawi.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Austine Makwakwa
- National Tuberculosis Control Program, Ministry of Health, P.O. Box 30377, Lilongwe, Malawi
| | - Adrienne K Chan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Center, Toronto, ON, Canada.,Dignitas International, 550 Queen Street East, Suite 335, Toronto, ON, Canada
| | - Jemila S Hamid
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Harry Kawonga
- Dignitas International, P.O. Box 1071, Zomba, Malawi
| | - Alexandra L C Martiniuk
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Dignitas International, 550 Queen Street East, Suite 335, Toronto, ON, Canada.,George Institute for Global Health, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Michael J Schull
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Center, Toronto, ON, Canada.,Dignitas International, 550 Queen Street East, Suite 335, Toronto, ON, Canada
| | | | - Merrick Zwarenstein
- Department of Family Medicine, Western University, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Jan Barnsley
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
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12
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Mbonye MK, Burnett SM, Naikoba S, Ronald A, Colebunders R, Van Geertruyden JP, Weaver MR. Effectiveness of educational outreach in infectious diseases management: a cluster randomized trial in Uganda. BMC Public Health 2016; 15:714. [PMID: 27488692 DOI: 10.1186/s12889-016-3375-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 07/26/2016] [Indexed: 11/12/2022] Open
Abstract
Background Integrated Infectious Diseases Capacity Building Evaluation (IDCAP) teams designed and implemented two health worker in-service training approaches: 1) an off-site classroom-based integrated management of infectious diseases (IMID) course with distance learning aspects, and 2) on-site support (OSS), an educational outreach intervention. We tested the effects of OSS on workload and 12 facility performance indicators for emergency triage assessment and treatment, HIV testing, and malaria and pneumonia case management among outpatients by two subgroups: 1) mid-level practitioners (MLP) who attended IMID training (IMID-MLP) and 2) health workers who did not (No-IMID). Methods Thirty-six health facilities participated in the IDCAP trial, with 18 randomly assigned to Arm A and 18 to Arm B. Two MLP in both arms received IMID. All providers at Arm A facilities received nine monthly OSS visits from April to December 2010 while Arm B did not. From November 2009 to December 2010, 777,667 outpatient visits occurred. We analyzed 669,580 (86.1 %) outpatient visits, where provider cadre was reported. Treatment was provided by 64 IMID-MLP and 1,515 No-IMID providers. The effect of OSS was measured by the difference in pre/post changes across arms after controlling for covariates (adjusted ratio of relative risks = a RRR). Results The effect of OSS on patients-per-provider-per-day (workload) among IMID-MLP (aRRR = 1.21; p = 0.48) and No-IMID (aRRR = 0.90; p = 0.44) was not statistically significant. Among IMID-MLP, OSS was effective for three indicators: malaria cases receiving an appropriate antimalarial (aRRR = 1.26, 99 % CI = 1.02-1.56), patients with negative malaria test result prescribed an antimalarial (aRRR = 0.49, 99 % CI = 0.26-0.92), and patients with acid-fast bacilli smear negative result receiving empiric treatment for acute respiratory infection (aRRR = 2.04, 99 % CI = 1.06-3.94). Among No-IMID, OSS was effective for two indicators: emergency and priority patients admitted, detained or referred (aRRR = 2.12, 99 % CI = 1.05-4.28) and emergency patients receiving at least one appropriate treatment (aRRR = 1.98, 99 % CI = 1.21-3.24). Conclusion Effects of OSS on workload were not statistically significant. Significant OSS effects on facility performance across subgroups were heterogeneous. OSS supported MLP who diagnosed and treated patients to apply IMID knowledge. For other providers, OSS supported team work to manage emergency patients. This evidence on OSS effectiveness could inform interventions to improve health workers’ capacity to deliver better quality infectious diseases care. Electronic supplementary material The online version of this article 10.1186/s12889-016-3375-4) contains supplementary material, which is available to authorized users.
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