Feasibility Of Implementation Research Articles

The Scholarship of Wellness and Mindfulness to Support First-Year Nursing Students' Response to Stress.

An educational innovation centered on mindfulness was developed to support the well-being of first-year nursing students at a large public university. Students participated in a week-long experiential learning program before their first semester. They then enrolled in a one-credit course that fostered well-being through research and evidence-based mindfulness practices. The course was highly ranked because of the quality of learning, environment, and theories presented, indicating that supportive wellness initiatives are acceptable and feasibility for future implementation.

Adaptive Biking for Assisted Living Memory Care Residents and StaffA Feasibility Study

This study examined the feasibility of implementing an adaptive biking program to concurrently address health and well-being in assisted living memory care residents and staff. Using an intervention protocol designed around the Flourishing Through Leisure Model, resident and staff participants were matched into biking pairs to engage in eight 20-to 30-minute bike rides over four consecutive weeks. The research team assessed (a) recruitment capability and sample characteristics, (b) data collection procedures and outcome measures, (c) acceptability and suitability of the intervention and study procedures (d) resources and ability to manage and implement the study and intervention, and (e) preliminary participant responses to the intervention. Results in each area support the feasibility of implementation on a larger scale and provide insights for program improvements and research opportunities. Given the lack of structured intervention protocols that emphasize multiple domains of health for two populations concurrently, the study also documented a replicable RT adaptive biking protocol designed to meet the needs of both staff and residents. Implications for RT practice include increased awareness of the value of RT services among other health care providers, and new opportunities for interprofessional collaboration.

Integrating Heart Rate Monitoring Into a Camp for Children With Neuromotor Disorders: A Case Series.

This case series investigated the implementation fidelity, feasibility, and effectiveness of integrating continuous heart rate monitoring with visual feedback into an established, intensive physical therapy camp for children with neuromotor disorders. The provision of continuous visual feedback through color-coded, individually calculated heart rate zones was a feasible and effective intervention, encouraging pediatric gait camp participants to exercise at intensities that produced aerobic and functional gains. The use of technology facilitated participation with peers, an outcome equally as important as their endurance and functional improvements. Pediatric physical therapists play a crucial role in enhancing the well-being and physical fitness of children with disabilities. Encouraging regular exercise in a social environment fosters enjoyable, inclusive experiences while promoting overall health. It is important for clinicians in various pediatric rehabilitation settings to establish programs that offer such opportunities for children with neuromotor disorders.

How, when and who should ask about pregnancy intentions in primary care? A qualitative study of primary health care professionals' preferences.

Knowing people's pregnancy intentions would help health care professionals (HCPs) to take a holistic approach to reproductive health, and particularly to providing preconception care. To assess the feasibility of implementation of questions about pregnancy preferences in a range of primary care settings in Great Britain, including digital implementation. Qualitative study using online semi-structured interviews with primary care professionals across Great Britain in 2022. Twelve online interviews were conducted with GPs (n=3), practice nurses (n=3), sexual and reproductive health professionals (n=4) and health visitors (n=2). Framework analysis was conducted in Nvivo, adapting a coding frame from complementary interviews with women. HCPs perceived asking about pregnancy preferences as valuable in meeting patients' reproductive health needs and most suited to women's health consultations, medication and disease reviews, baby checks, or as an addition to lifestyle questions leading to health promotion advice. An introductory, non-discriminatory signposting sentence was well-liked, and the preferred question in a face-to-face clinical encounter was asking how the person would feel about a pregnancy in the next year, in line with women's preference. Guidance and training would give clinicians confidence in knowing how to ask about pregnancy preferences and advise their patients accordingly. Asking about pregnancy intentions is acceptable to women and HCPs and feasible in primary care, but implementation needs to be adapted to the patient and context. Digital options that enable patients to self-manage can reduce the need for HCP input and avoid medicalising a normal process.

Characteristics of Sexual Health Programs for Migrants, Refugees, and Asylum Seekers: A Scoping Review

Background: Social, cultural, and structural determinants of health for migrants, refugees, and asylum seekers can contribute towards poorer sexual health outcomes. People from migrant, refugee, and asylum seeker backgrounds usually use less mainstream sexual healthcare services and have lower levels of sexual health literacy compared with the destination countries’ general population. However, there is little collated knowledge about sexual health programs that have been implemented to improve sexual health among these groups. This study aimed to describe the characteristics of programs for improving sexual health among migrants, refugees, and asylum seekers. Methods: This study was a scoping review in which Scopus and PubMed were searched for peer-reviewed articles published in English since 2010 from countries similar to and including Australia such as New Zealand, the United States of America, Canada, the United Kingdom, and European Union countries). The final search of databases was performed on 26 June 2023, and resultant studies were inputted into Endnote and Covidence systematic review software to remove duplicates before screening. The study utilised a qualitative approach using inductive thematic analysis of the content of the studies to extract and categorise the characteristics of the program. Results: A total of 3044 articles were screened and 20 were included for data extraction. The included studies were conducted in six countries (the United States of America, Australia, France, Italy, Denmark, and Belgium). The key characteristics of sexual health programs identified included consumer consultation and engagement, cultural appropriateness, language support, peer education, self-directed learning, group learning, financial support, and outreach services. the programs had a combination of these characteristics to ensure that they can improve target population engagement with educational materials and decrease barriers to accessing sexual healthcare. Conclusion: Consideration of migrants, refugees, and asylum seekers’ culture, language, socioeconomic characteristics, and access to information and services in the design of the sexual health programs may improve sexual health outcomes among these groups. However, further research is needed to assess the importance and implementation feasibility of the identified characteristics for sexual health programs in specific context.

Recovering from COVID-19 (ReCOV): Feasibility of an Allied-Health-Led Multidisciplinary Outpatient Rehabilitation Service for People with Long COVID.

A multidisciplinary approach is required for the management of long COVID. The aim of this study was to determine the feasibility (demand, implementation, practicality, acceptability, and limited efficacy) of an allied-health-led multidisciplinary symptom management service (ReCOV) for long COVID. A single-group observational cohort feasibility study was conducted to determine demand (referrals), acceptability (survey), implementation (waitlist times, health professions seen), practicality (adverse events), and limited efficacy (admission and discharge scores from the World Health Organization Disability Assessment Scale, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire, and EuroQol 5D-5L). Data are presented as median [interquartile range] or count (percentage). During the study, 143 participants (aged 42.00 [32.00-51.00] years, 68% women) participated in ReCOV. Participants were waitlisted for 3.86 [2.14-9.86] weeks and engaged with 5.00 [3.00-6.00] different health professionals. No adverse events occurred. The thematic analysis revealed that ReCOV was helpful but did not fully meet the needs of all participants. Limited efficacy testing indicated that participants had improved understanding and control (p < 0.001) of symptoms (BIPQ) and a small improvement in EQ VAS score (median difference 5.50 points [0.00-25.00], p = 0.004]). A multidisciplinary service was safe and mostly acceptable to participants for the management of long COVID. Further research should investigate the clinical and cost effectiveness of such a service, including optimal service duration and patient outcomes.

Access strategies in mmWave cell-free network: A matching and auction theory based approach

The mmWave cell-free network is viewed as an energy-efficient and emerging architecture for beyond 5G systems. However, many practical issues should be solved for this system before the benefits are enjoyed, whereof feasible implementation of access strategy is one of the most vital. To this end, the access strategy including user scheduling and bandwidth allocation is investigated in this paper. Firstly, to maximize the defined utility function, the joint optimization problem of user scheduling and bandwidth allocation is formulated as a mixed integer nonlinear programming problem, which is intractable to search for an optimal solution in polynomial time. Secondly, a two-stage matching and sealed-auction-based access strategy is proposed to obtain a sub-optimal solution, where UEs with high-quality channel conditions are scheduled in the first-stage matching as much as possible, and the rest unmatched UEs are scheduled in the second-stage matching with the sealed-auction based bandwidth allocation. Thirdly, a simplified full-matching based access strategy with lower complexity is proposed for the high-dynamic scenario caused by the high-speed movement of UEs, and the complexities and convergence of the two proposed strategies are quantitatively analyzed. Finally, the performance of proposed strategies is evaluated through abundant simulations in different scenarios, and the superiorities of the proposed strategies are demonstrated through the comparison with reference strategies.

Rationale, Design and Baseline Characteristics of a Randomized Controlled Trial of a Cardiovascular Quality Improvement Strategy in India: The C-QIP Trial

BackgroundQuality of chronic care for cardiovascular disease (CVD) remains suboptimal worldwide. The Collaborative Quality ImProvement (C-QIP) trial aims to develop and test the feasibility and clinical effect of a multicomponent strategy among patients with prevalent CVD in India. MethodsThe C-QIP is a clinic-based, open randomized trial of a multicomponent intervention versus usual care that was locally developed and adapted for use in Indian settings through rigorous formative research guided by Consolidated Framework for Implementation Research (CFIR). The C-QIP intervention consisted of 5 components: 1) electronic health records and decision support system for clinicians, 2) trained non-physician health workers (NPHW), 3) text-message based lifestyle reminders, 4) patient education materials, 5) quarterly audit and feedback reports. Patients with CVD (ischemic heart disease, ischemic stroke, or heart failure) attending outpatient CVD clinics were recruited from September 2022 to September 2023 and were randomized to the intervention or usual care arm for at least 12 months follow-up. The co-primary outcomes are implementation feasibility, fidelity (i.e., dose delivered and dose received), acceptability, adoption and appropriateness, measured at multiple levels: patient, provider and clinic site-level, The secondary outcomes include prescription of guideline directed medical therapy (GDMT) (provider-level), and adherence to prescribed therapy, change in mean blood pressure (BP) and LDL-cholesterol between the intervention and control groups (patient-level). In addition, a trial-based process and economic evaluations will be performed using standard guidelines. ResultsWe recruited 410 socio-demographically diverse patients with CVD from four hospitals in India. Mean (SD) age was 57.5 (11.7) years, and 73.0% were males. Self-reported history of hypertension (48.5%) and diabetes (41.5%) was common. At baseline, mean (SD) BP was 127.9 (18.2) /76.2 (11.6) mm Hg, mean (SD) LDLc: 80.3 (37.3) mg/dl and mean (SD) HbA1c: 6.8% (1.6%). At baseline, the GDMT varied from 62.4% for patients with ischemic heart disease, 48.6% for ischemic stroke and 36.1% for heart failure. ConclusionThis study will establish the feasibility of delivering contextually relevant, and evidence-based C-QIP strategy and assess whether it is acceptable to the target populations. The study results will inform a larger scale confirmatory trial of a comprehensive CVD care model in low-resource settings. Trial registrationClinical Trials Registry India: CTRI/2022/04/041847; Clinicaltrials.gov number: NCT05196659

Carbon capture and storage at Malaysia power plants: Evaluation of its feasibility and requisite enablers

Rapidly growing GHG emissions are significantly altering the world climate, necessitating a global decarbonization efforts to avert irreversible catastrophic failure of the world ecosystem. Malaysia is pledging to achieve carbon neutrality by 2050 and has subsequently identified Carbon Capture and Storage (CCS) as one of the solutions for carbon removal from its energy sector by 2050. However, the implementation of CCS presents formidable challenges, encompassing both technical and commercial complexities, especially for a nation like Malaysia, which has limited experience in large-scale CCS deployment. This study evaluates the feasibility of CCS implementation in Malaysia's fossil fuel power plants by conducting a comprehensive techno-economic assessment, taking into considerations the prevailing energy landscape of the country. This assessment is very crucial to demonstrate the feasibility of this plan within the timeframe, considering the limited research have been done to assess a national-scale implementation, as well as to provide the important insights for future policy implication to promote CCS adoption. The CCS scenarios are assessed through an analytical approach, and comparative analyses are conducted between alternative paths. The result shows that a large-scale implementation of CCS at Malaysia's fossil fuel power plant to achieve net-zero emission by 2050 are feasible given a strong enforcement on emission policy and establishment of CCS legal framework. CCS can potentially reduce 60% of Malaysia's energy sector total emissions, and a solar-supported CCS helps to reduce it further. Levelized Cost of Electricity analysis reveals that the implementation of CCS leads to only a minimal increase between pre- and post-CCS LCOE when carbon price is considered. A SWOT-PESTLE analysis was also conducted to identify gaps in regulatory framework, financial and social aspects. It can be concluded that CCS is a techno-economically viable solution, however Malaysia's readiness for CCS implementation is still at a very novice stage, and aggressive actions are needed to enable a successful full-scale implementation.

Implementation of a remote behavioral intervention for older adults with asthma – a pilot study

Objective Older adults with asthma (OAA) have elevated asthma morbidity rates. A six-session intervention based on self-regulation theory was shown to improve outcomes. However, wide-spread implementation was difficult due to the in-person design. Our objective was to determine the feasibility and acceptability of an updated intervention for OAA that is completely remote, includes a physician component, and utilizes shared decision-making (SDM). Methods A pilot study of 12 OAA with uncontrolled asthma and their asthma providers was conducted at three health centers. The remote intervention (titled SOAR) consisted of 4 sessions (2 groups and 2 individual). Asthma providers (both specialists and primary care) were sent updates of progress along with information on how to incorporate SDM into the visit. Implementation (feasibility, acceptability, and appropriateness) and clinical (asthma control, asthma quality of life, perceived control, depression, and self-confidence) outcomes were measured. Results SOAR was found to be feasible, acceptable, and appropriate, with values on validated implementation scales similar to those of in-person behavioral interventions. Asthma providers found the program helpful and intended to change care based on the updates. Asthma control scores improved significantly from baseline (14.2 to 16.8, p = 0.04), as did asthma quality of life (4.2 to 4.9, p = 0.03) and self-confidence to manage asthma (7.1 to 8.5, p = 0.02). There was no change in depression nor perceived control scores. Conclusion A remote behavioral intervention appeared feasible and acceptable for OAA and their health care providers, and can improve outcomes. Larger scale implementation trials are warranted.

Current status of surveillance systems for human respiratory syncytial virus

To conduct timely surveillance of the seasonal characteristics and disease burden of Human Respiratory Syncytial Virus (HRSV) in various geographical regions of China, and further develop more precise and effective prevention and intervention strategies, there is an urgent need for China to establish a nationwide, effective, and stable HRSV surveillance system. Through combining the current status of domestic and international HRSV surveillance systems and the existing surveillance framework in China, this study proposed an HRSV surveillance type applicable to China based on different surveillance purposes, and considering the feasibility of implementation. This article aimed to provide solid scientific and technical support to monitor the dynamic changes of HRSV epidemic timely, carry out a risk assessment and early warning, and further understand the disease burden of HRSV in China. It also helps to improve the diagnosis, prevention, and control of the HRSV diseases research and development, use, and evaluation of HRSV vaccines and drugs in China.

Strategic use of resources to enhance colorectal cancer screening for patients with diabetes (SURE: CRC4D) in federally qualified health centers: a protocol for hybrid type ii effectiveness-implementation trial

BackgroundPersons with diabetes have 27% elevated risk of developing colorectal cancer (CRC) and are disproportionately from priority health disparities populations. Federally qualified health centers (FQHCs) struggle to implement CRC screening programs for average risk patients. Strategies to effectively prioritize and optimize CRC screening for patients with diabetes in the primary care safety-net are needed.MethodsGuided by the Exploration, Preparation, Implementation and Sustainment Framework, we conducted a stakeholder-engaged process to identify multi-level change objectives for implementing optimized CRC screening for patients with diabetes in FQHCs. To identify change objectives, an implementation planning group of stakeholders from FQHCs, safety-net screening programs, and policy implementers were assembled and met over a 7-month period. Depth interviews (n = 18–20) with key implementation actors were conducted to identify and refine the materials, methods and strategies needed to support an implementation plan across different FQHC contexts. The planning group endorsed the following multi-component implementation strategies: identifying clinic champions, development/distribution of patient educational materials, developing and implementing quality monitoring systems, and convening clinical meetings. To support clinic champions during the initial implementation phase, two learning collaboratives and bi-weekly virtual facilitation will be provided. In single group, hybrid type 2 effectiveness-implementation trial, we will implement and evaluate these strategies in a in six safety net clinics (n = 30 patients with diabetes per site). The primary clinical outcomes are: (1) clinic-level colonoscopy uptake and (2) overall CRC screening rates for patients with diabetes assessed at baseline and 12-months post-implementation. Implementation outcomes include provider and staff fidelity to the implementation plan, patient acceptability, and feasibility will be assessed at baseline and 12-months post-implementation.DiscussionStudy findings are poised to inform development of evidence-based implementation strategies to be tested for scalability and sustainability in a future hybrid 2 effectiveness-implementation clinical trial. The research protocol can be adapted as a model to investigate the development of targeted cancer prevention strategies in additional chronically ill priority populations.Trial registrationThis study was registered in ClinicalTrials.gov (NCT05785780) on March 27, 2023 (last updated October 21, 2023).

Sustainable Mobility Guarantee: Developing the concept from a transport planning perspective

In this paper, we develop the concept of a “Sustainable Mobility Guarantee”. We first review existing “Mobility Guarantees”, which are rather motivated by socioeconomic interests than environmental sustainability and classify them. Based on this assessment, we define a Sustainable Mobility Guarantee, which extends existing approaches with environmental interests. It is an emerging concept in policymaking to ensure a certain level of mobility without the need for private cars - particularly in rural areas - but it is still in its infancy and lacks clear definitions. The concept embraces the idea of Classical Mobility Guarantees while seeking to enable and promote the use of non-automobile modes for everyday travels for everyone, not only for specific trip purposes like commuting, nor for specific target groups like the elderly. We then discuss the practical implementation and financial feasibility. Implementation is possible through programmatic or regulatory approaches, which may serve as a potential transitional basis for legal regulation. At least in developed countries, implementing mobility services realizing a Sustainable Mobility Guarantee is deemed financeable, given that financial instruments now subsidizing automobile use are shifted towards implementation of the guarantee, without being detrimental to the economy.

Efficient degradation of p-nitrophenol from water by enhancing dielectric barrier discharge (DBD) plasma through ozone circulation: Optimization, kinetics and mechanism

Non-thermal dielectric barrier discharge (DBD) plasma has received great attention for degradation of persistent organic pollutants such as p-nitrophenol (PNP). However, the feasibility of the DBD implementation is not clear due to its high energy consumption and relatively low degradation efficiency. In this research, a novel strategy was suggested based on re-circulation of the generated O3 in the DBD system to enhance the PNP degradation efficiency and energy yield. The potential mechanism and possible pathway of PNP degradation were studied by EPR, ESR, DFT and GS-MS analytical tests. According to the results, the PNP degradation efficiency and energy yield increased from 57.4% to 94.4% and from 0.52 to 1.18 g kW−1h−1, respectively through ozone circulation into the DBD reactor. This was due to the more release of long-lived and short-lived reactive species (ROS) in the DBD-O3 system by the O3 circulation. The variations in pH (4–10), initial concentration (50–90 mg L−1), and the presence of co-existing substances in the water matrix had minimal impact on the DBD-O3 system, in comparison to the conventional system. The biological toxicity evaluation revealed that the hybrid DBD-O3 system transform PNP to less toxic intermediates. This study proposes a promising strategy to improve the utilization of DBD for the degradation of PNP.

Patient experience in a remote patient monitoring program for hypertension: A qualitative study

Abstract Background Remote patient monitoring (RPM), which includes out-of-office blood pressure (BP) measurement, coupled with interventions including telehealth and team-based care, is recommended for hypertension (HTN) management. We aimed to assess participant experience with RPM for HTN (RPM-HTN) to understand barriers and facilitators to implementing RPM-HTN in a primary care population where health disparities and social inequities are prevalent. Methods This is a qualitative implementation study of participants’ experiences with an RPM-HTN program for primary care patients with uncontrolled HTN at an academic health system. We recruited participants with high and low levels of engagement (≥16 or &amp;lt;16 days of transmitted BP readings per month). Semi-structured interviews were conducted, and descriptive statistics and rapid qualitative analysis were used to identify factors affecting the implementation of RPM-HTN, specifically adoption, acceptability, appropriateness, and feasibility. Results Multiple themes emerged from interviews with 14 participants. A doctor’s recommendation and wanting help with BP management were facilitators for engagement, while work conflicts and forgetfulness were barriers to engagement. Participants enjoyed the format and content of nurse and clinical pharmacist phone calls and forming a relationship with the team; expressed improved understanding of HTN and BP management; and appreciated the convenience of remote monitoring. Conclusions Participants found RPM-HTN acceptable and appropriate, highlighting the team-based and out-of-office approach to care. This study provides actionable targets to overcome feasibility barriers to implementation. In order to increase engagement, RPM policies and procedures should take into account barriers including the quantity of required BP measurements and mechanisms of telehealth communication.

Implementation of long-acting cabotegravir and rilpivirine: primary results from the perspective of staff study participants in the Cabotegravir And Rilpivirine Implementation Study in European Locations.

Cabotegravir plus rilpivirine (CAB + RPV) is the first complete long-acting (LA) regimen recommended for maintaining HIV-1 virological suppression. Cabotegravir And Rilpivirine Implementation Study in European Locations (CARISEL) is an implementation-effectiveness study examining the implementation of CAB+RPV LA administered every 2 months (Q2M) in European HIV centres. We present staff study participant (SSP) perspectives on the administration of CAB+RPV LA over 12 months. Eighteen clinics were randomized to one of two implementation support packages: standard arm (Arm-S) or enhanced arm (Arm-E). Arm-S included video injection training and provider/patient toolkits. Additionally, Arm-E included skilled wrap-around team meetings, face-to-face injection training and continuous quality improvement (CQI) calls. SSPs completed surveys on the acceptability, appropriateness and feasibility of CAB+RPV LA as an intervention and its implementation into their clinics, as well as barriers and facilitators to implementation. All surveys were completed at Month (M)1 (baseline), M5 and M12; data collection was completed by February 2022. Qualitative data were obtained from semi-structured interviews at M1, M5 and M12. The primary objective was assessed via formal statistical comparisons between study arms of the Acceptability of Implementation Measure, Implementation Appropriateness Measure and Feasibility of Implementation Measure surveys (1-5 Likert scale ranging from 1 = "completely disagree" to 5 = "completely agree"). Equivalent measures anchored to CAB+RPV LA as a therapy were also assessed. Seventy SSPs completed surveys and interviews at M1, 68 at M5 and 62 at M12. Mean acceptability/appropriateness/feasibility scores were ≥3.8 (out of 5) at M12 for implementation- and intervention-based measures. An analysis of covariance showed no significant differences between study arms for these outcomes. Although barriers were noted, most SSPs were not overly concerned that these would impact implementation; concern about these anticipated barriers also decreased over time. At M12, 90.3% (n = 56/62) of SSPs held a positive opinion about CAB+RPV LA implementation. Qualitative interviews and CQI calls highlighted three top practices that supported implementation: implementation planning; education about CAB+RPV LA clinical efficacy; and education around administering injections and managing pain/discomfort after injections. CARISEL demonstrated that CAB+RPV LA dosed Q2M was successfully implemented across a range of European locations, with SSPs finding implementation highly acceptable, appropriate and feasible. NCT04399551.

Opportunistic offering of self-sampling to non-attenders within the English cervical screening programme: a pragmatic, multicentre, implementation feasibility trial with randomly allocated cluster intervention start dates (YouScreen)

Opportunistic offering of self-sampling to non-attenders within the English cervical screening programme: a pragmatic, multicentre, implementation feasibility trial with randomly allocated cluster intervention start dates (YouScreen)

The Toxic Cost of Cheap Usernames: Re-Applying Friedman and Resnick's Framework in Competitive Video Game Networks

Toxicity in video games, acting in a rude, abusive, bullying, or deliberately losing manner, ruins competitive team-based video game experiences for everyone involved. Companies are experimenting with the detection, regulation, and bans of toxic players. Regulation attempts are foiled by the ease with which players can switch accounts by creating new profiles to evade consequences. This article applies the framework of Friedman and Resnick (2001), “The Social Cost of Cheap Pseudonyms”, to address the reputational and repetition cost of online pseudonyms in the niche environment of video game toxicity. Four potential solutions are discussed in the context of modern video game regulation: resource-intensive account set-up, paid dues, real-world identification, and a once-in-a-lifetime identification system that creates a permanent, traceable record of toxicity. The article covers the strengths, weaknesses, feasibility, implementation challenges, and player impact of the potential implementation of these solutions in video game networks.

Clinical Implementation of DIGEST as an Evidence-Based Practice Tool for Videofluoroscopy in Oncology: A Six-Year Single Institution Implementation Evaluation.

Clinical implementation of evidence-based practice (EBP) tools is a healthcare priority. The Dynamic Grade of Swallowing Toxicity (DIGEST) is an EBP tool developed in 2016 for videofluoroscopy in head and neck (H&N) oncology with clinical implementation as a goal. We sought to examine: (1) feasibility of clinical implementation of DIGEST in a national comprehensive cancer center, and (2) fidelity of DIGEST adoption in real-world practice. A retrospective implementation evaluation was conducted in accordance with the STARI framework. Electronic health record (EHR) databases were queried for all consecutive modified barium swallow (MBS) studies conducted at MD Anderson Cancer Center from 2016 to 2021. Implementation outcomes included: feasibility as measured by DIGEST reporting in EHR (as a marker of clinical use) and fidelity as measured by accuracy of DIGEST reporting relative to the decision-tree logic (penetration-aspiration scale [PAS], residue, and Safety [S] and Efficiency [E] grades). Contextual factors examined included year, setting, cancer type, MBS indication, and provider. 13,055 MBS were conducted by 29 providers in 7,842 unique patients across the lifespan in diverse oncology populations (69% M; age 1-96 years; 58% H&N cancer; 10% inpatient, 90% outpatient). DIGEST was reported in 12,137/13,088 exams over the 6-year implementation period representing 93% (95% CI: 93-94%) adoption in all exams and 99% (95% CI: 98-99%) of exams excluding the total laryngectomy population (n = 730). DIGEST reporting varied modestly by year, cancer type, and setting/provider (> 91% in all subgroups, p < 0.001). Accuracy of DIGEST reporting was high for overall DIGEST (incorrect SE profile 1.6%, 200/12,137), DIGEST-safety (incorrect PAS 0.4% 51/12,137) and DIGEST-efficiency (incorrect residue 1.2%, 148/12,137). Clinical implementation of DIGEST was feasible with high fidelity in a busy oncology practice across a large number of providers. Adoption of the tool across the lifespan in diverse cancer diagnoses may motivate validation beyond H&N oncology.

Using FRAME to adapt an evidence‐based dyadic intervention program for people living with dementia in residential aged care: A pilot feasibility study

AbstractIntroductionThe purpose of this study was to examine the feasibility of adapting and translating an evidence‐based occupational therapist‐delivered program shown to be effective in the community to residential aged care (RAC). The program aims to improve quality of care and quality of life for people living with dementia and the wellbeing of the family care partner.MethodsThis study took place in a not‐for‐profit RAC home in Adelaide, South Australia. Mixed methods, specifically questionnaires, activity logs, focus group, and one‐on‐one interviews were used to evaluate the feasibility of the program implementation. Staff working in the participating home, occupational therapists trained to deliver the program, and residents and their family carer partners were included. Quantitative data were analysed using proportions, means, and standard deviations. Qualitative data were analysed using a thematic approach.Consumer and Community InvolvementThis study was conducted together with a consumer (person living with dementia) and a carer representative (family member of someone residing in RAC). These representatives provided input towards the study design, interpretation of study data, discussion of results, and recommendations for future consideration.ResultsSmall changes to the program improved feasibility and acceptability for delivery in RAC. While the care home staff required added support during implementation, the intervention therapists felt that the program could be delivered in this setting. Family care partners of residents with dementia felt that the program may be better suited if provided upon entry to RAC or in early stages of dementia.ConclusionAdapting a community‐based dementia care program to RAC can be safe and feasible. Program adaptations are necessary for feasibility. Further adaptations and evaluations of associated outcomes (related to residents with dementia and their family care partners) are needed to assess the program effectiveness in larger scale.Plain language summarySpending quality time with family members in residential aged care is important. However, many struggle to know what to say or do when visiting a family member who lives with dementia. Programs that teach families about how to communicate with people living with dementia, how to support them to take part in important everyday living activities, or how to understand why changes in behaviours may occur have not been available in residential aged care. This paper describes how we adapted one such evidence‐based program from community to residential aged care settings. We consulted with people living with dementia, carers, and families and found that the program could also be valuable in this care setting. Residential aged care staff described how the program is very different to what is usually available in residential aged care, but they were optimistic that with the right support, it could be a valuable way to support residents with dementia and their families. Family members of residents with dementia and therapists delivering the program felt that residents in early stages of living in residential aged care and/or early stages of dementia could benefit the most from these programs. We found that including family members in the intervention process can be useful and empowering for families and residents. Future work should also focus on involving other staff members caring for residents in the process. Communication between staff and families is the key for program delivery and success and treating each person as an individual.