Early Lessons Research Articles

Putin’s Last War: Narratives, Counternarratives, and Early Lessons Learned

Putin’s Last War: Narratives, Counternarratives, and Early Lessons Learned

P53 The Early Lessons of COVID-19: The Need for a Broader Health-Economic Perspective

The current COVID-19 pandemic caused ∼20,000 deaths and ∼50,000 hospital admissions in the Netherlands. Efforts to manage this communicable disease and its impact on the health-care system without prior development of specific vaccines have put a strain on the fiscal budget. This study aims to indicatively quantify the impact of COVID-19 on the Dutch government’s fiscal position, simultaneously indicating the value of preventive vaccines from a payer perspective.

(Un)precedented: Reflecting on the Early Lessons of the COVID-19 Pandemic

(Un)precedented: Reflecting on the Early Lessons of the COVID-19 Pandemic

Clinical and radiological outcomes of robotic-assisted unicompartmental knee arthroplasty: Early lessons from the first 100 consecutive knees in 85 patients

IntroductionRobotic-assisted unicompartmental knee arthroplasty (UKA) is associated with improved component positioning and comparable short- and mid-term implant survivorship with manual UKA. This study aims to evaluate clinical and radiological outcomes following robotic-assisted UKA as well as any potential learning-curves associated with the introduction of such new technology. MethodsProspective study of patients undergoing robotic-assisted UKA. Outcome measures were patient-reported outcome measures (PROMs) including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS) and Oxford Knee Score (OKS), complications, implant survivorship, component positioning and learning curve. ResultsEighty-five patients comprising 100 knees were recruited and followed up for 21.0 ± 4.3 months. At two years, there were significant and sustained improvements in PROMs and 100% implant survivorship rate. A high degree of implant accuracy was achieved with the robotic system. A cumulative learning curve of 20 cases was noted. ConclusionRobotic-assisted UKA achieves excellent implant accuracy and clinical outcomes in the short-term. Long-term follow up is needed to evaluate this relationship.

My biochemical journey from a Cambridge undergraduate to the discovery of phosphotyrosine

The most notable moment in my career as a biochemist was the discovery of phosphotyrosine, a somewhat serendipitous finding that turned out to have some very important consequences, notably, in human cancer. My career as a biochemist which has spanned nearly 60 years, began when I was 16. At the time, I was in the sixth form at Felsted School, a boarding school in Essex England, and my biology master, David Sturdy, elected to teach me some extracurricular biochemistry, giving me one-on-one tutorials on glycolysis and the TCA cycle. These early biochemistry lessons turned out to be invaluable because I was able to regurgitate them to answer a question in the University of Cambridge scholarship exam in the autumn of 1960. As a result, I was lucky enough to be awarded an Exhibition at Gonville and Caius College, the college where my father had studied for a medical degree during World War II. When I arrived in Cambridge in October 1962 to read natural sciences (see Figure 1), it was a natural choice to take biochemistry as one of my three required first-year courses. The Part I biochemistry course was taught by a series of excellent lecturers, including Philip Randle (a prominent diabetes researcher who described the Randle Cycle), Brian Chappell (who discovered mitochondrial transporters) and Asher Korner (a pioneer of cell free systems to study protein synthesis). It quickly became clear that biochemistry was an exciting subject, and Brian Chappell, my biochemistry supervisor at Caius, made supervisions a lot of fun. I also took Part I courses in invertebrate zoology and, importantly, organic chemistry, which gave me insights into how the metabolites we were learning about in biochemistry worked as chemicals.

The Contribution of Artificial Intelligence in Achieving the Sustainable Development Goals (SDGs): What Can Eye Health Can Learn From Commercial Industry and Early Lessons From the Application of Machine Learning in Eye Health Programmes.

Achieving The United Nations sustainable developments goals by 2030 will be a challenge. Researchers around the world are working toward this aim across the breadth of healthcare. Technology, and more especially artificial intelligence, has the ability to propel us forwards and support these goals but requires careful application. Artificial intelligence shows promise within healthcare and there has been fast development in ophthalmology, cardiology, diabetes, and oncology. Healthcare is starting to learn from commercial industry leaders who utilize fast and continuous testing algorithms to gain efficiency and find the optimum solutions. This article provides examples of how commercial industry is benefitting from utilizing AI and improving service delivery. The article then provides a specific example in eye health on how machine learning algorithms can be purposed to drive service delivery in a resource-limited setting by utilizing the novel study designs in response adaptive randomization. We then aim to provide six key considerations for researchers who wish to begin working with AI technology which include collaboration, adopting a fast-fail culture and developing a capacity in ethics and data science.

Nutrition Capacity Building to Meet National Priorities: Lessons Learned in Developing and Implementing Malawi's First Dietetics Program.

The current nutrition situation in Malawi, characterized by high rates of malnutrition in communities and hospitals and a rapidly increasing burden of overweight/obesity and diet-related noncommunicable diseases, highlights the urgent need for registered dietitians, who have a proven track record in the prevention and management of all forms of malnutrition and improving patient outcomes. However, dietetics practice has been described as underdeveloped and fragmented in many parts of Africa, exacerbated by a severe and chronic shortage of dietetics professionals and a lack of nutrition and dietetic education programs in most African countries.We share early lessons learned in the development and implementation of the first dietetics program in Malawi. Within 6 years, the program produced 10 graduate dietitians who have filled the first clinical dietitian posts in Malawian public hospitals. This early success can be attributed to the model used to develop and implement the program, which included early stakeholder engagement to define the priority skills and competencies of a Malawian dietitian, the use of internationally recognized training standards, and the development of strategic institutional partnerships that brought together complementary skills and expertise. Furthermore, using existing resources and recruiting students with a nutrition and health background accelerated implementation. The current dietetics curriculum responds to the national nutrition and health policy direction and strategic objectives. Early and sustained government engagement was crucial in creating demand and securing career prospects for graduates. Although still in its infancy, dietitians in Malawi are poised to contribute significantly to alleviating the country's complex nutrition challenges.

Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review.

BackgroundHealth systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities.ObjectiveThis paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities.MethodsA systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O’Malley Scoping Review Framework and focused on PCORI’s active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study.ResultsPCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI’s priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information.ConclusionsEarly PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.

Early Lessons From The EU/UK Brexit Negotiations: Implications For Ireland

Early Lessons From The EU/UK Brexit Negotiations: Implications For Ireland

Maintain Your Brain trial: Early findings and lessons learned from adherence and compliance data

AbstractBackgroundTechnology and web‐based approaches potentially provide scalable population‐based interventions to reduce modifiable risk factors for dementia. Key issues in online interventions are recruitment and retention. To devise strategies to improve population reach We investigated which factors influence recruiting and maintaining participants in such an intervention, the in‐progress Maintain Your Brain trial.MethodInvitations were sent to people aged 55‐77 years from the 45 and Up study, a population‐based cohort study of one in ten people aged 45 years and older in New South Wales, Australia (n = 267,000). For MYB, participants were required to be eligible for at least one of four modules to be enrolled (physical activity, nutrition, brain training and mental wellbeing). All participants received modules based on their risks and were randomly allocated to either personalised coaching (intervention) or static information (control). Associations between participant characteristics (listed Table 1) and likelihood of completing set assessment tasks was assessed at two key stages – end of baseline and end of 12‐month follow‐up using stepwise (forward) regression.ResultsOf 96,418 people invited, 12,281 (13%) participants started baseline and completed a mean of 6.2 (SD 4.3) of ten assessments. Of these, 6,236 (6%) were enrolled in the trial. At 12‐months participants completed a mean of 5.0 of 8 assessments (SD = 3.8). Completion rate of the primary outcome (two tasks) was 62% (3,869). In the final regression model for baseline (Table1), overall associations were weak even though statistically significant, with only years of education not entered in the final model. The follow‐up model included retirement status, gender, baseline dementia risk and baseline wellbeing. However, this model (df1 = 1, df2 =6231; R2 = .01) accounted for even less variation than baseline model (R2 = .04).ConclusionOverall, regression models of participant characteristics accounted for a low amount of variation in task completion rates at both baseline and follow‐up. Participants were less likely to complete baseline tasks if they were older, male, not living with a spouse or alone and not retired or had lower dementia risk score and more psychological distress.

Procurement and commissioning during COVID-19: reflections and (early) lessons

This commentary reflects on some common themes that are starting to emerge in the early analysis of the healthcare procurement and commissioning response to the COVID-19 pandemic. Although it largely results from the observation of the situation in the English NHS, the most salient issues are common to procurement in other EU healthcare systems, as well as more broadly across areas of the public sector that have strongly relied on the extremely urgent procurement exception in the aftermath of the first wave of the pandemic. Given the disfunction and abuse of ‘unregulated procurement’ in the context of COVID-19, the commentary reflects on the longer term need for suitable procurement rules to face impending challenges, such as Brexit and, more importantly, climate change.

HIV pre-exposure prophylaxis implementation in Africa: some early lessons

Since antiretrovirals were first shown to prevent sexual transmission of HIV,1 numerous randomised trials have reported that oral pre-exposure prophylaxis (PrEP) is efficacious in preventing HIV infection in a range of settings and populations.2 However, there can be a substantial gap between efficacy in controlled clinical trial settings and effectiveness in real-world implementation, generally referred to as the efficacy-effectiveness gap. For example, three large HIV test-and-treatment implementation trials failed to demonstrate effectiveness in community settings, even though the initial individual treatment trial reported very high efficacy.

Early Lessons Learned with the Independent IR Residency Selection Process: Similarities and Differences From the Vascular and Interventional Radiology Fellowship

Over the last two decades, there has been a concerted push by interventional radiologists (IR) to revamp the IR training paradigm (1). The single year Vascular and Interventional Radiology (VIR) fellowship was suboptimal in providing adequate training in the increasingly complex procedural and nonprocedural patient care aspects of IR (2). In 2012, the American Board of Medical Specialties (ABMS) recognized Interventional Radiology (IR) as a primary specialty and programs began receiving accreditation in 2014 by the ACGME (3).

Building-Back-Better in Post-Disaster Recovery: Lessons Learnt from Cyclone Idai-Induced Floods in Zimbabwe

This study evaluated the build-back-better considerations in post-disaster recovery, following the devastation of Chipinge and Chimanimani communities by Cyclone Idai-induced floods in 2019. Conducted in 2020, the study assessed the impact of Cyclone Idai-induced floods on communities in Chipinge and Chimanimani Districts of Zimbabwe; evaluated the build-back-better considerations; and analyzed the lessons learned. Based on a qualitative approach and case study design, the study depended on focus group discussions, interviews, and researcher observations to gather data from 85 participants. The findings indicate that Cyclone Idai-induced floods seriously impacted human lives, infrastructure, and livelihoods of communities that had been living with flood risk and vulnerability. Build-back-better considerations were absent in much of the post-disaster recovery effort to address the cyclone disaster impact. There are important early lessons for both practitioners and community members to learn from the Cyclone Idai event. These lessons still can inform policy and disaster risk reduction practice in the medium and long term. Build-back-better should be a mandatory objective in the recovery from any disaster impact. Continuous training is also recommended to improve the disaster knowledge of stakeholders and increase local ability to cope with future disaster events.

Early Lessons Learned in Designing an Adaptive Shared Reading Intervention for Preschoolers With Autism

Project START (Students and Teachers Actively Reading Together) is an adaptive shared reading intervention designed to address the varied learning needs of preschool children with autism spectrum disorder (ASD). This report summarizes procedures and results of the developmental year of the project, which focused primarily on evaluating implementation fidelity and social validity of the intervention. The final sample consisted of four classrooms with 10 students with ASD ( Mage = 4.32 years) and their teachers ( N = 4). Classrooms were randomized to either a 4- or an 8-week first-stage small-group dialogic reading condition. Children who were early responders continued with the initial intervention; those who were slower to respond were randomized to one of two intensified reading conditions. Results indicate that teachers perceived the intervention as feasible and child outcomes as acceptable. Implementation fidelity was low during initial weeks (33%–50%), improving to 67% to 83% by the last weeks of the study. Neither children’s engagement nor vocabulary growth differed between treatment levels or conditions. We discuss lessons learned from the study’s developmental year and changes that will be made in subsequent years to improve implementation and feasibility.

Implementation of a non-communicable disease clinic in rural Sierra Leone: early experiences and lessons learned

This study is an evaluation of the first cohort of patients enrolled in an outpatient non-communicable disease clinic in Kono, Sierra Leone. In the first year, the clinic enrolled 916 patients. Eight months after the enrollment of the last patient, 53% were still active in care, 43% had been lost to follow-up (LTFU) and 4% had defaulted. Of the LTFU patients, 47% only came for the initial enrollment visit and never returned. Treatment outcomes of three patient groups [HTN only (n = 720), DM only (n = 51), and HTN/DM (n = 96)] were analyzed through a retrospective chart review. On average, all groups experienced reductions in blood pressure and/or blood glucose of approximately 10% and 20%, respectively. The proportions of patients with their condition controlled also increased. As NCDs remain underfunded and under-prioritized in low-income countries, the integrated program in Kono demonstrates the possibility of improving outpatient NCD care in Sierra Leone and similar settings.

Emergency Medical Services (EMS) Calls During COVID-19: Early Lessons Learned for Systems Planning (A Narrative Review).

BackgroundOver the course of the COVID-19 progress, reports from many locations around the world indicated major increases in EMS call volume, which imposed great pressure on EMS dispatch centers (EMSDC) globally. No studies yet have been done to examine this phenomenon.ObjectiveThis paper examines the interrelated effects of the unprecedented global increase of EMS call, the effect of the COVID-19 crisis on responding to non-COVID-19 emergencies, and the concurrent effects of having overwhelmed dispatch centers. It tries to explain the current evidence of the bottleneck of EMS calls during the early phase of the worldwide pandemic.Eligibility CriteriaWe examine the numbers of EMS calls internationally between March and June 2020, derived from published literature and news media. Only articles in English were selected, with certain keywords related to EMS calls, ambulance delay, stroke and cardiac arrest.Source of EvidenceGoogle Scholar was the main searching source.ResultsAfter applying the selection criteria, a total of 29 citations were chosen, and a pattern of knowledge resulted in the emergence of five themes: EMS calls during COVID-19, Reduced EMS operator response time, Ambulance response delays, Collateral mortality and morbidity among non-COVID-19 cases, and Total ambulance call time.ConclusionOver the course of COVID-19 progress, there was a global phenomenon of exponential increases in EMS calls, which is expected to impose a great pressure on EMS dispatch centers. Several factors contributing to the bottleneck of EMS calls are identified and explained.

Re-engaging in Aging and Mobility Research in the COVID-19 Era: Early Lessons from Pivoting a Large-Scale, Interdisciplinary Study amidst a Pandemic

Abstract In the wake of the COVID-19 pandemic, those planning and conducting research involving older adults have faced many challenges, in part because of the public health measures in place. This article details the early steps and corresponding strategies implemented by our multidisciplinary team to pivot our large-scale aging and mobility study. Based on the premise that all current and emerging research in aging has been impacted by the pandemic, we propose a continuum approach whereby the research question, analysis, and interpretation are situated in accordance with the stage of the pandemic. Using examples from our own study, we outline potential ways to partner with older adults and other stakeholders as well as to encourage collaboration beyond disciplinary silos even under the current circumstances. Finally, we suggest the formation of a Canadian-led consortium that leverages cross-disciplinary expertise to address the complexities of our aging population in the COVID-19 era and beyond.

50 Years Ago in TheJournalofPediatrics: Early Lessons about Infectious Diseases and Vaccines in Children with Cancer

50 Years Ago in TheJournalofPediatrics: Early Lessons about Infectious Diseases and Vaccines in Children with Cancer

Deployment of combined technologies to smallholder farmers in Kenya: TAAT Clearinghouse technical report series 002

Deployment of combined technologies to smallholder farmers in Kenya: TAAT Clearinghouse technical report series 002