Additional Educational Support Research Articles

Academic Integrity: Putting Policy into Practice

On first reading of the University of Dundee’s Policy on Academic Misconduct seems eminently sensible, fair and clear. The Policy classifies plagiarism cases as 1 (very minor), 2 (minor) and 3 (serious), giving examples of each to inform the academic community. There is guidance on how all three should be handled, ranging from additional educational support through written warning through a hearing from a formal academic misconduct panel. As Associate Dean Quality Assurance and Standards at our Medical School I oversee how this policy is both enacted and data collected across the school. This paper outlines how we have operationalised the policy for a distance learning course with a thousand students and over 50 markers, based both within the Centre and globally. The programme is a masters in medical education, with about a third of the students based overseas, about 90% medical doctors, the others being allied health professionals, dentists, nurses and vets. The studies are all online at a distance, and assignments are in the main written. They are submitted, marked ad moderated via Turnitin, and students are encouraged to engage with the similarity report before finalising their submissions. I summarise the policy and identify various issues and how the Centre has sought to solve these. I present the process we have developed so far, our rationale behind each decision made and how going forward we are evaluating this process. I discuss our assessment strategy, including our underpinning pedagogical philosophy and how these have informed the decisions we have taken. I give an overview of both our student and our marker induction and faculty development for our core staff, who as module leads moderate the process. I present some initial statistics on student uptake of the various elements. I describe the development of an efficient and effective reporting process, codeveloped between academics and professional services, and the next stages of this development as we move to the piloting stage. I finish with some current questions we have on how we can support the students further as they navigate through the academic discourse around misconduct, learning and enacting the language, not least the challenges of collaboration versus corroboration and self-plagiarism in a course ending with a capstone assessment.

Patient Interactions With an Automated Conversational Agent Delivering Pretest Genetics Education: Descriptive Study.

BackgroundCancer genetic testing to assess an individual’s cancer risk and to enable genomics-informed cancer treatment has grown exponentially in the past decade. Because of this continued growth and a shortage of health care workers, there is a need for automated strategies that provide high-quality genetics services to patients to reduce the clinical demand for genetics providers. Conversational agents have shown promise in managing mental health, pain, and other chronic conditions and are increasingly being used in cancer genetic services. However, research on how patients interact with these agents to satisfy their information needs is limited.ObjectiveOur primary aim is to assess user interactions with a conversational agent for pretest genetics education.MethodsWe conducted a feasibility study of user interactions with a conversational agent who delivers pretest genetics education to primary care patients without cancer who are eligible for cancer genetic evaluation. The conversational agent provided scripted content similar to that delivered in a pretest genetic counseling visit for cancer genetic testing. Outside of a core set of information delivered to all patients, users were able to navigate within the chat to request additional content in their areas of interest. An artificial intelligence–based preprogrammed library was also established to allow users to ask open-ended questions to the conversational agent. Transcripts of the interactions were recorded. Here, we describe the information selected, time spent to complete the chat, and use of the open-ended question feature. Descriptive statistics were used for quantitative measures, and thematic analyses were used for qualitative responses.ResultsWe invited 103 patients to participate, of which 88.3% (91/103) were offered access to the conversational agent, 39% (36/91) started the chat, and 32% (30/91) completed the chat. Most users who completed the chat indicated that they wanted to continue with genetic testing (21/30, 70%), few were unsure (9/30, 30%), and no patient declined to move forward with testing. Those who decided to test spent an average of 10 (SD 2.57) minutes on the chat, selected an average of 1.87 (SD 1.2) additional pieces of information, and generally did not ask open-ended questions. Those who were unsure spent 4 more minutes on average (mean 14.1, SD 7.41; P=.03) on the chat, selected an average of 3.67 (SD 2.9) additional pieces of information, and asked at least one open-ended question.ConclusionsThe pretest chat provided enough information for most patients to decide on cancer genetic testing, as indicated by the small number of open-ended questions. A subset of participants were still unsure about receiving genetic testing and may require additional education or interpersonal support before making a testing decision. Conversational agents have the potential to become a scalable alternative for pretest genetics education, reducing the clinical demand on genetics providers.

Social and Educational Outcomes in Patients With Biliary Atresia: A Systematic Review.

To systematically review the social outcomes of patients with biliary atresia (BA), including educational, employment and family outcomes. We conducted a systematic review of Medline, EMBASE, Global Health, Maternity and Infant Care Database, supplemented by reference searching. National Heart, Lung and Blood Institute scoring was conducted for quality assessment. The PROSPERO registration ID was CRD42020178846. Fifty-one studies were included (41 cohort, 10 cross-sectional), including 4631 participants across 16 countries. Cohorts were BA post-liver transplant (LT) (18 studies), native liver survivors (NLS) (16 studies), mixed (13 studies) and four other cohorts. Outcomes covered; education (n = 35), employment (n = 16), family outcomes (n = 22), and social functioning (n = 22). BA patients had lower school functioning scores than controls, with no difference between NLS versus post-LT. Between 2% and 48% of children required additional educational support. Between 60% and 100% of adult patients with BA were employed. Pregnancies were described in 17 studies, with small samples, and some noted complications. Social functioning scores were similar to healthy controls in 8 of 11 comparisons. Despite BA being the primary indication for liver transplantation in childhood, social outcomes for children and adolescents are predominantly reported in non-controlled, single-centre survey-based studies. School functioning is lower compared to peer groups, with no evidence of a difference for those having a liver transplant. We recommend routine psychosocial assessment of these patients during follow-up, alongside multi-centre collaborations, to maximise the quality of evidence for future patients.

Implementing a New EMR. How Should We Train the Staff?

Background Information Transitioning from an existing to a new Electronic Medical Record (EMR) while the surgical schedule of a busy perioperative department keeps running as usual can be daunting for nurses and other staff. While user training is part of the EMR implementation process, and crucial to ensure a smooth transition, its content might not be tailored to the role and responsibilities of the nurses involved. Feedback from perioperative nurses on the Virtual Live Training (VLT) provided by the EMR vendor, and its effectiveness to assist nurses documenting patient care on the new EMR, revealed that additional educational support was required. This project focused on the staff education initiative taken by designated unit EMR super-users to ensure Pre and Postoperative nurses’ readiness to document patient care in the new EMR by Go Live day. Objectives of Project • Identify and meet nurses’ learning needs related to the use of the new EMR after the VLT • Ensure training delivery method is effective for all perioperative areas • Ensure perioperative nurses’ readiness to document patient care independently on the new EMR • Ensure a smooth transition from existing to new EMR, while making sure patient care is not compromised Process of Implementation Developed EMR in-person training curriculum to support vendor's virtual live training. Created a training timeline based on goals. Prioritized super-users in-person training. Tailored in-person training sessions to the nurses’ role, pre and postoperative nurses training was conducted separately. Established training schedules, location and staffing. Developed an EMR resource digital folder. Build a Smart Sheet to capture documentation/workflow issues and view solutions. Use patient case scenarios to assess nurses’ competency documenting patient care from admission to discharge in new EMR. Statement of Successful Practice Increased nurses’ satisfaction with to face-to-face training. Postoperative nurses reported increased satisfaction with in-person class content being tailored to postop care. Improved nurses’ performance documenting most aspects of patient care in the new EMR. Improved understanding of new pre/postoperative workflows. Implication for Advancing the Practice of Perianesthesia Nursing Adjusting EMR training based on nurses’ feedback, tailoring training content to nurses’ role, and prioritizing super-user training, have proved to be effective training strategies to assist our perianesthesia nurses to ensure a successful EMR transition. Transitioning from an existing to a new Electronic Medical Record (EMR) while the surgical schedule of a busy perioperative department keeps running as usual can be daunting for nurses and other staff. While user training is part of the EMR implementation process, and crucial to ensure a smooth transition, its content might not be tailored to the role and responsibilities of the nurses involved. Feedback from perioperative nurses on the Virtual Live Training (VLT) provided by the EMR vendor, and its effectiveness to assist nurses documenting patient care on the new EMR, revealed that additional educational support was required. This project focused on the staff education initiative taken by designated unit EMR super-users to ensure Pre and Postoperative nurses’ readiness to document patient care in the new EMR by Go Live day. • Identify and meet nurses’ learning needs related to the use of the new EMR after the VLT • Ensure training delivery method is effective for all perioperative areas • Ensure perioperative nurses’ readiness to document patient care independently on the new EMR • Ensure a smooth transition from existing to new EMR, while making sure patient care is not compromised Developed EMR in-person training curriculum to support vendor's virtual live training. Created a training timeline based on goals. Prioritized super-users in-person training. Tailored in-person training sessions to the nurses’ role, pre and postoperative nurses training was conducted separately. Established training schedules, location and staffing. Developed an EMR resource digital folder. Build a Smart Sheet to capture documentation/workflow issues and view solutions. Use patient case scenarios to assess nurses’ competency documenting patient care from admission to discharge in new EMR. Increased nurses’ satisfaction with to face-to-face training. Postoperative nurses reported increased satisfaction with in-person class content being tailored to postop care. Improved nurses’ performance documenting most aspects of patient care in the new EMR. Improved understanding of new pre/postoperative workflows. Adjusting EMR training based on nurses’ feedback, tailoring training content to nurses’ role, and prioritizing super-user training, have proved to be effective training strategies to assist our perianesthesia nurses to ensure a successful EMR transition.

PMH37 Do Education Costs Matter? A Systematic Literature Review of the Economic Impact of Psychosocial Problems on the Education Sector.

Psychosocial problems lead to costs in the health care sector but also in the education sector among other. As psychosocial problems develop during the critical period of establishing educational trajectories, education costs are particularly relevant in the context of psychosocial problems among children and adolescents. This study aimed to gain insights into the methods used for the inclusion of education costs in health economics studies and into the proportion of the education costs in relation the total costs associated with a condition or an intervention. PubMed, Embase, SSCI, CINAHL, PsycINFO, ERIC, and Econlit were systematically searched for economic evaluations of mental health, psychosocial, and educational interventions and cost-of-illness studies of mental, behavioral and neurodevelopmental disorders, conducted from a societal perspective in the population of children and adolescents. Of 6,248 screened titles and abstracts, 41 articles were included in the analysis. The most common cost items were “special education”, “school absence”, and “additional educational support”. A variety of methods were employed for the identification, measurement and/or valuation of education costs. The proportion of education costs to the total costs of condition/intervention ranged from 0% to 67% with the mean being 18.6%. Since education costs can constitute a significant proportion of the total costs of an intervention or condition, including them in health economics studies might be important in informing optimal resource allocation decisions. Although various methods are available for including education costs in health economics studies, further research is needed to develop evidence-based methods for producing comparable estimates.

INNOVATIVE TECHNOLOGIES OF TEACHING CHILDREN WITH SPECIAL EDUCATIONAL NEEDS

The article is devoted to the problem of obtaining vital competencies in need of additional educational support. It is noted that inclusive education in Ukraine is an innovative educational process and, at the same time, one of the international obligations. Changes in domestic legislation gave a significant impetus to the development of inclusive education in our country. For systemic implementation, the principles of inclusive training the national legislation was brought into line with international norms and standards, however, and for the organization of an inclusive educational environment, it is important for the establishment of appropriate conditions in the institution of education. It has been confirmed that special role in working with children with special educational needs belongs to the innovative technologies. It is determined that technologies of inclusive education are structural elements of a holistic pedagogical system and are divided into technology of individualization of the educational process, technology of joint teaching in the inclusive class, technology of overcoming educational and behavioural difficulties, and technology of adaptation of the educational environment. The introduction of these technologies will provide development and self-development of the student's personality with special educational needs, will contribute to the disclosure of their potential opportunities, attracting all students to one or another type of work during the lesson, diversify the forms and methods of teaching the educational material, the successful implementation of the individual attendance of the student, which requires additional educational support. It is proved that the system of inclusive education is a complex process that requires a society to be patient and aware of importance and common interest. The result of the introduction of this system is the realization of the rights of children to get education and increase the social level of the country as a whole.
 Keywords: inclusion, inclusive education, technologies of inclusive education, children with special educational needs, individualization of educational process, joint teaching in the inclusive class, overcoming educational and behavioural difficulties, adaptation of the educational environment.

Bienveillance filicide. Lecture psychocriminologique du recours à l’acte filicide à la lumière du concept du double dans un contexte de parentalité bienveillante

This paper describes three women who, following acts of filicide and attempted suicide, had been hospitalized to reduce suicidal risk while in detention. À similar event preceded all three homicidal acts: the implementation of an additional medical, educational or paramedical support, or the failure to do so. We questioned their parenting in relation to social discourse around positive parenting. These women described having imagined an “ideal child” which was free of poor transmission and who would restore them in return. In an environment where separation from their romantic conjugal partners was not an option, the women viewed their child as “broken” and resorted to action. This led us to the hypothesis that the mother-child relationship referred to the concept of double; this latter was first reflexive and supporting but disrupted the maternal psyche and its unrecognized obscure zone with the announcement of the child being « broken ».

Patient-Reported Outcomes and Experiences with Population Genetic Testing Offered Through a Primary Care Network.

Aims: To explore patient experiences in a large-scale primary care-based, preemptive genetic testing program.Methods: Patients who received genetic results from the initiative were invited to participate in an online survey 3 weeks postresult disclosure. A 6-month follow-up survey was sent to assess changes over time.Results: The initial survey was completed by 1646 patients, with 544 completing the 6-month follow-up survey. The following outcomes were high overall: patient-reported understanding of results (cancer: 87%; cardiac: 86%); perceived utility (75%); positive emotions (relieved: 66.8%; happy: 62.0%); family result sharing (67.6%); and satisfaction (87%), although analysis by demographic factors identified groups who may benefit from additional education and emotional support. Results-related health behaviors and discussions with providers increased over time (screening procedures 6.1% to 14.2% p < 0.001; provider discussion 10.3% to 25.3%, p < 0.001), and were more likely to take place for patients with positive cancer and/or cardiac results (39.8% vs. 7.6%, p < 0.001). Forty-seven percent of patients reported insurance discrimination concerns, and most (79.4%) were not familiar with privacy and nondiscrimination laws. Concerns regarding discrimination and negative emotions decreased between the two survey time points (privacy issues 44.6% to 35.1% p < 0.001; life insurance discrimination concerns 35.5% to 29.6%, p = 0.001; anxiety 8.1% to 3.3%, p < 0.001; and uncertainty 19.8% to 12.8%, p < 0.001). These findings led to the development and integration of additional patient resources to improve program implementation.Conclusion: Our findings highlight patient experiences with and areas of need in a community-based genomic screening pilot initiative using a mixed primary care/genetics provider model to deliver precision medicine.

Child welfare policies and services during the COVID-19 pandemic in South Korea

ABSTRACT Emergency situations render children vulnerable; hence, this study reviewed child-related policies and services in South Korea during the COVID-19 pandemic. Thus far, the government has proposed online health promotion programmes for children, emergency care services and allowances, and school meal delivery services. Based on these findings, we recommend the establishment of mental health, sexual abuse, and child abuse online messaging services, allocation of additional financial and educational support to low-income families, and prioritisation of childcare services.

Association of asthma severity and educational attainment at age 6–7 years in a birth cohort: population-based record-linkage study

BackgroundThere is conflicting research about the association between asthma and poor educational attainment that may be due to asthma definitions. Our study creates seven categories of current chronic and acute...

Educational attainment trajectories among children and adolescents with depression, and the role of sociodemographic characteristics: longitudinal data-linkage study.

Depression is associated with lower educational attainment, but there has been little investigation of long-term educational trajectories in large cohorts with diagnosed depression. To describe the educational attainment trajectories of children with a depression diagnosis in secondary care, and to investigate whether these trajectories vary by sociodemographic characteristics. We identified new referrals to South London and Maudsley's NHS Foundation Trust between 2007 and 2013 who received a depression diagnosis at under 18 years old. Linking their health records to the National Pupil Database, we standardised their performance on three assessments (typically undertaken at ages 6-7 years (school Year 2), 10-11 (Year 6) and 15-16 (Year 11)) relative to the local reference population in each academic year. We used mixed models for repeated measures to estimate attainment trajectories. In our sample of 1492 children, the median age at depression diagnosis was 15 years (interquartile range = 14-16). Their attainment showed a decline between school Years 6 and 11. Attainment was consistently lower among males and those eligible for free school meals. Black ethnic groups also showed lower attainment than White ethnic groups between Years 2 and 6, but showed a less pronounced drop in attainment at Year 11. Those who receive a depression diagnosis during their school career show a drop in attainment in Year 11. Although this pattern was seen among multiple sociodemographic groups, gender, ethnicity and socioeconomic status predict more vulnerable subgroups within this clinical population who might benefit from additional educational support or more intensive treatment.

&lt;p&gt;Psychosocial Impact and Disease Management in Patients with Congenital Factor VII Deficiency&lt;/p&gt;

PurposeCongenital factor VII (FVII) deficiency is a rare bleeding disorder of variable phenotype with predominantly mucocutaneous bleeding. The aim of this study was to identify the burden of FVII deficiency on patients and caregivers through a better understanding of the management and psychosocial impact of this disease.Materials and MethodsA rare disease specialty recruiter from Comprehensive Health Education Services recruited participants for this online survey, which was conducted from January 31 to March 12, 2019. A moderator-assisted questionnaire was used to collect data on demographics, diagnosis, treatment, and psychosocial impact.ResultsOf the 45 respondents (25 patients and 20 caregivers), the majority were female (56%). Respondents reported a wide variety of initial bleeding symptoms, including bruising (58%), epistaxis (56%), and menorrhagia (36% of females). Because symptoms varied between individuals and were not always severe, diagnosis was often delayed. Mean time to obtain a diagnosis was 6.5 years and mean age at first diagnosis was 12.9 years. One-quarter (24%) of the respondents reported more than 100 bleeds of any severity over the previous year. When treating bleeds, 44% of patients reported using antifibrinolytics, and 42% reported using recombinant activated factor VII. Almost 31% of respondents reported missing schooldays as children, and 16% reported losing or resigning from a job in adulthood as a direct result of their disease. Notably, 29% of caregivers and 10% of their partners had also experienced issues with employment. Forty percent of respondents reported not participating in contact sports during childhood, and 22% continued to avoid contact sports in adulthood.ConclusionOverall, FVII deficiency has a substantial psychosocial impact, but most patients are satisfied with their disease management and are optimistic about their future. Patients desire additional educational, social, and financial support.

Effects of a Web-Based Educational Support Intervention on Total Exercise and Cardiovascular Risk Markers in Adults With Coronary Heart Disease.

eHealth educational programs have proven to be an effective means for health promotion, yet limited studies have been conducted for coronary heart disease (CHD) patients to improve their total physical exercise, self-efficacy for exercise, and cardiovascular risk factor profile. A prospective randomized controlled trial (RCT) was conducted in two cardiac clinics in Hong Kong. Four hundred thirty-eight eligible CHD clients were randomly assigned to either the control or the intervention group. All of the participants received standard care, which consisted of regular medical and nursing care in the cardiac clinic. The intervention group received an additional web-based educational support intervention (eHES), which consisted of a 20-minute individual educational session on the use of the eHES web link. The eHES web link contains a health information platform related to CHD care and an individual member area with records of health measures and physical exercise data for six months. Data were collected at baseline, at three-month and six-month intervals at the cardiac clinic. The primary outcome was the total amount of physical exercise, measured by the Godin-Shephard Leisure-Time Physical Activity Questionnaire. The secondary outcomes were self-efficacy for exercise and cardiovascular disease (CVD) risk markers (body weight, blood pressure, lipid profile). The data were analyzed using a generalized estimating equations model. The intervention group reported a statistically higher amount of physical exercise and a higher HDL-C at 3 and 6months, respectively. There were no statistical differences between the groups in self-efficacy for exercise and other CVD risk markers. The study demonstrated the effectiveness of the eHES in meeting the challenge of boosting the amount of physical exercise and increase HDL-C among CHD patients who engaged for over three months. The results provide insight for eHealth development to support and promote exercise among CHD patients in the community.

Early Adolescent Health Problems, School Performance, and Upper Secondary Educational Pathways: A Counterfactual-Based Mediation Analysis

Abstract Early health problems predict lower educational attainment, but it remains unclear whether this is due to health problems weakening school performance or due to other mechanisms operating above and beyond school performance. We employed counterfactual-based mediation analysis on a register-based sample of Finnish adolescents born in 1988–1993 (n = 73,072) to longitudinally assess the direct (unexplained by school performance, as measured by grade point average) and indirect (pure mediation and mediated interaction via school performance) effects of early adolescent somatic and mental health problems on the noncompletion of upper secondary education and track choice (vocational vs. general). Mental disorders were associated with the largest increases in both noncompletion and choosing the vocational track, but somatic conditions also showed small but robust associations. Weakened school performance mediated up to one-third of the differences in noncompletion and around half of the differences in track choice. When the same analyses were conducted within sibships, the total effects of health problems on educational pathways were weaker, but the contribution of school performance remained similar. In counterfactual simulations that assigned everyone an above-median school performance—that is, eradicating below-median school performance—about 20–40 percent of the effects of mental disorders on educational pathways remained. Our results suggest that while impaired school performance is an important component in health-related selection to education, it does not fully explain the shorter and less academically oriented educational careers of adolescents with health problems. These adolescents may benefit from additional educational support regardless of their formal school performance.

Defining spaces: resource centres, collaboration, and inclusion in Kazakhstan

Recognition and implementation of best practice collaborative partnerships are fundamental to developing inclusive schools and achieving positive outcomes. This is particularly important for those students requiring additional educational supports. In order to develop an individual approach to learning, and implement the necessary adjustments required to assist a student with specific needs, input from parents and other key stakeholders is considered important (Evans, in: Ashman (ed) Education for inclusion and diversity, Pearson, Melbourne, 2015). Azzopardi (Int J Incl Educ 15(1):179–192, 2011) argues that inclusion needs to be viewed as a process that encompasses the culture, policies and practices of a whole school and wider community. Even with the positive intentions from a range of contributors, the purpose and practice of collaborative relationships can vary significantly (Cloninger, in: Orelove, Sobsey, Gillies (eds) Educating students with severe and multiple disabilities: a collaborative approach. Brookes Publishing, Baltimore, 2017). The present study examines the collaborative experiences of key stakeholders at schools that are supported by NGO funded resource centres in Nur-Sultan, Kazakhstan. A descriptive case study research design with a narrative framework explored the lived experiences of 22 teachers, principals, specialists and parents by highlighting the complex factors that are enabling or disabling the success of children with disabilities. The central focus for each semi-structured interview with participants was to describe and understand the current collaborative processes within newly established resource centres at three mainstream government schools in Kazakhstan. The results show how resource centres contribute to developing inclusive practices within the Kazakhstani context of current educational reforms and identify opportunities to enhance and contribute to the development of a successful model of support. The findings of this research have implications for key stakeholders concerning the immediate need for coherent and practical policy that embodies a shared vision and understanding of inclusive practice.

The Influence of Additional Educational Support on Poverty-Stricken Adolescents’ Resilience and Academic Performance

Resilience can be viewed as successful adaptation despite challenging or threatening circumstances (e.g. poverty). This article reports on an investigation of which the primary aim was to establish how additional educational support enhances adolescents’ resilience and academic performance. A quantitative approach was followed using two schools. One was a poverty-stricken school where additional educational support was officially offered, while the other school offered normal required tuition and was located in a middle class suburb. In total, 117 Grade 9 and 10 learners participated in the research. The results indicated that resilience related positively to academic performance and to other factors which are associated with academic performance such as teacher-learner relationships, parental involvement and study methods. Additional educational support to poverty-stricken learners resulted in higher resilience and academic achievement. Amongst the variables used in the investigation, additional educational support explained the largest proportion of the variance in academic achievement, followed by resilience and cognitive development.

Preparing Medical Specialists to Practice Genomic Medicine: Education an Essential Part of a Broader Strategy.

Developing a competent workforce will be crucial to realizing the promise of genomic medicine. The preparedness of medical specialists without specific genetic qualifications to play a role in this workforce has long been questioned, prompting widespread calls for education across the spectrum of medical training. Adult learning theory indicates that for education to be effective, a perceived need to learn must first be established. Medical specialists have to perceive genomic medicine as relevant to their clinical practice. Here, we review what is currently known about medical specialists’ perceptions of genomics, compare these findings to those from the genetics era, and identify areas for future research. Previous studies reveal that medical specialists’ views on the clinical utility of genomic medicine are mixed and are often tempered by several concerns. Specialists generally perceive their confidence and understanding to be lacking; subsequently, they welcome additional educational support, although specific needs are rarely detailed. Similar findings from the genetics era suggest that these challenges are not necessarily new but on a different scale and relevant to more specialties as genomic applications expand. While existing strategies developed for genetic education and training may be suitable for genomic education and training, investigating the educational needs of a wider range of specialties is critically necessary to determine if tailored approaches are needed and, if so, to facilitate these. Other interventions are also required to address some of the additional challenges identified in this review, and we encourage readers to see education as part of a broader implementation strategy.

Two-year persistence with teriparatide improved significantly after introduction of an educational and motivational support program

SummaryThis study evaluated the 2-year persistence with teriparatide in the Netherlands. Analyses showed that the risk of non-persistence was 28% lower in patients who were followed according to an additional educational and motivational support program.IntroductionUntil recently, teriparatide (TPTD) was a third-line treatment option for severe osteoporosis in the Netherlands, which could only be prescribed by medical specialists based on a specific medical statement. We aimed to determine whether an educational and motivational support program (EMSP) increased 2-year treatment persistence with TPTD in patients with severe osteoporosis.MethodsWe evaluated persistence in 1573 Dutch patients treated with TPTD from January 2013 until January 2018. From January 2013 onwards, all patients received a basic support program (BSP) consisting of an educational home visit to initiate TPTD treatment and phone calls (at 1, 2.5 and 8 weeks). Since May 2015, all patients received the EMSP consisting of the BSP extended with evaluation of medication adherence during phone calls, an additional phone call (at 12 months), and motivational letters at 9 and 14 months.ResultsThe EMSP showed a statistically significantly higher 2-year persistence (78%) with TPTD as compared with the BSP (72%). Reasons for treatment discontinuation were comparable between groups, except for the proportion of patients who had stopped TPTD administration due to side effects, which was significantly lower in the EMSP group (8% vs. 15% in BSP, p < 0.001). Overall, the risk of non-persistence was 28% lower in the EMSP compared with the BSP group (HR: 0.72; 95% CI: 0.55–0.93).ConclusionThe introduction of the EMSP has demonstrated to improve the persistence with TPTD, resulting in 78% of the patients being persistent with TPTD during the 2-year treatment period.

Inclusive education reform in Kazakhstan: civil society activism from the bottom-up

ABSTRACT It is a common discourse in Kazakhstan that policy-making is state-driven with weak engagement of civil society. The Ministry of Education and Science of the Republic of Kazakhstan announced a transition to an inclusive education model by 2020. The present study sought to challenge the traditional perspectives on the policy-making process and to investigate to what extent and how civil society in Kazakhstan contributes to inclusive education reform. It employed a qualitative approach, interviewing seven representatives of non-governmental organisations (NGOs) about their contribution to inclusive education reform in Kazakhstan. The findings show that the NGOs actively engage in revising the policies and ensuring their implementation. Furthermore, they facilitate the provision of methodological support to schools and professionals, contribute to promoting cultural change about perceptions of people with special needs, and inform parents, the state, and the public more broadly about the needs of children requiring additional educational supports. These findings give credit to the leadership of NGOs and suggest the need for government and schools to cooperate more closely with civil society organisations, which serve as change-agents in facilitating inclusive education in Kazakhstan.

Hospitalists' Needs Assessment and Perceived Barriers in Wound Care Management: A Quality Improvement Project.

The purpose of this quality improvement project was to determine hospitalists' knowledge, practices, and perspectives related to management of pressure injuries and neuropathic/diabetic foot complications (having a foot ulcer or subsequent development of a foot infection because of a foot ulcer). We also sought to identify resources for and knowledge-based barriers to management of these wounds. This quality improvement effort targeted an interdisciplinary group of 55 hospitalists in internal medicine that consisted of 8 nurse practitioners, 10 physician assistants, and 38 physicians. The site of this initiative was the Johns Hopkins Bayview Medical Center, a 342-bed academic hospital located in the mid-Atlantic United States (Baltimore Maryland). The first phase of our quality improvement project comprised an online survey to identify hospitalists' knowledge, practices, and opinions on inpatient management of pressure injuries and diabetic foot complications. The second phase involved semistructured focus groups attended by hospitalists to identify resource gaps and barriers inferred by survey results. Twenty-nine of 55 (52%) hospitalists responded to the survey; 72% indicated no formal training in wound care. Over 90% had little to no confidence in management of pressure injuries and diabetic foot complications. In a separate ranking section of the survey, respondents selected lack of knowledge/confidence 12 of 29 (41.3%) and resources 9 of 29 (31.0%) as number 1 barriers to wound care. Managing patients with obesity was identified as a second major barrier from 10 of 29 selected options (34.5%). Eighteen of 55 (33%) hospitalists attended focus group sessions acknowledging barriers to wound care that included provider education, information technology, system factors, and interprofessional engagement. Attendees welcomed additional educational and ancillary resource support.