Implementation Of Future Studies Research Articles

Development of a core predictor set of weaning in critically ill patients: a Delphi-based study protocol

IntroductionProlonged mechanical ventilation in intensive care units (ICUs) leads to increased morbidity, higher mortality rates, and elevated healthcare costs. Predicting successful weaning from mechanical ventilation with accuracy is essential for optimizing resource use and improving patient outcomes. The International Classification of Functioning, Disability and Health (ICF) framework offers a holistic perspective on health conditions and can be adapted to identify key predictors of weaning readiness. This study aims to develop a Delphi-based core predictor set for weaning in critically ill patients, utilizing the ICF model.Methods and analysisThe core predictor set development comprises three steps: (1) Literature review and expert consultation to gather weaning predictors, (2) Predictor alignment with ICF categories per established rules, and (3) Three-round Delphi survey with a multidisciplinary team. A systematic review across major databases will be conducted to identify predictors related to weaning predictors in critically ill adults from cohort studies, trials, and reviews. Predictors will then be categorized within ICF domains. A multidisciplinary expert panel will evaluate the relevance of each predictor using a 9-point Likert scale to achieve consensus.DiscussionThis study will contribute to the development of a standardized, evidence-based predictor set for weaning readiness in critically ill patients. Using the ICF framework, this study aims to encompass the complex factors that influence weaning, thereby enabling personalized care plans and improving weaning outcomes. The Delphi methodology guarantees a thorough, iterative process for building consensus by integrating diverse clinical perspectives.ConclusionThe proposed Delphi-based study protocol aims to establish a core set of predictors for weaning in the ICU setting, guided by the ICF model. Successful implementation of this predictor set could enhance decision-making around weaning trials, reduce unnecessary ventilation days, and ultimately improve patient outcomes and healthcare efficiency. Future validation and implementation studies will be essential to confirm the utility and generalizability of this predictor set in clinical practice.

Payment and billing strategies to support methadone take-home medication: Perspectives of financial leaders of opioid treatment program organizations in New York State

IntroductionRecent federal regulatory changes governing the delivery of methadone treatment for opioid use disorder at Opioid Treatment Programs (OTPs) support continued practice changes towards greater and flexible methadone take-home medication. Existing payment models for OTPs were closely tied with onsite medication administration and thus misaligned with the need to conduct more and flexible take-homes. This study aims to understand OTP organizations' experience with the newly created OTP bundled payment model in New York State as an alternative to the pre-existing per-service payment model during 2020–2023 to inform financing strategies to support and sustain practice changes. MethodsThe study conducted semi-structured interviews with financial leaders and staff from OTP organizations in New York State. Snowball sampling supplemented purposeful sampling of OTP organizations based on their billing practices by. Qualitative data from 12 interviews (with 11 OTP organizations and 1 trade organization) were analyzed with an integrated (inductive and deductive) approach to derive themes. ResultsStudy informants recognized that the bundled payment model served to protect revenue in a time when OTPs had to pivot quickly to increase take-home medication to patients. Informants described a wide spectrum of practices to operationalize billing in the alternative payment systems, revealing confusion with the billing rules and significant logistical and technical challenges. Informants expressed concerns regarding the substantial difference between the full bundled rate, paid in weeks with one or more qualifying services, and the medication-only rate, reporting that extended (2 weeks or more) take-homes might not be sustainable under the two-tiered model with the low medication-only rate and advocating for a single bundled rate. Informants believed that increased take-home medication and federal regulatory changes had profound implications for the delivery of counseling services, the counselor workforce, and financial viability for OTPs. ConclusionsOur study of OTP organization experience in New York State provided data on OTP organization perspectives regarding the potential revenue-protecting effects of bundled payments and generated insights to inform future research and policy experimentation to support flexible take-home medication. Future implementation studies are needed to better understand the roles of financing strategies at large in supporting clinical practice changes in substance use disorder treatment.

Virtual Reality for Pediatric Trauma Education - A Preliminary Face and Content Validation Study

PurposePediatric trauma education remains expensive and available only to a few providers worldwide. Innovative educational technologies like virtual reality (VR) can be key to decentralizing trauma education. This preliminary validation study evaluates the face and content validity of a VR software designed to enhance pediatric trauma skills. MethodsPhysicians were invited to test a VR software simulating a child with blunt head and truncal trauma. After the simulation, they filled out surveys assessing the face and content validity of the scenario, including the software's realism, interaction, ease of use, and educational content. Additionally, they completed a cybersickness questionnaire. A descriptive statistical analysis was performed. ResultsEleven physicians from eight different countries tested the VR software. Most found it valuable, and realistic and would prefer using it over high-fidelity mannequins for training. The software received more favorable evaluations for non-technical skills training than for technical skills. Regarding cybersickness most participants reported discomfort during the simulation. ConclusionParticipants agreed that a VR platform for pediatric trauma is realistic and immersive, and they endorsed it for enhancing performance, particularly in non-technical skills. Most participants, however, faced some discomfort with the technology, and efforts to minimize cybersickness should be made in future implementation, feasibility, and effectiveness studies. Level of EvidenceIV.

Barriers and Facilitators to Integrating Acupuncture into the U.S. Health Care System: A Scoping Review.

Background: Acupuncture is a widely practiced complementary and integrative health modality that has multiple clinical applications. The use of acupuncture in the United States is rapidly increasing. Although studies have shown the efficacy and effectiveness of acupuncture for various ailments, the integration of acupuncture into the U.S. health care system remains a challenge. Little is known about the factors affecting this integration. Objective: To provide a systematic review of the barriers and facilitators affecting the integration of acupuncture into the U.S. health care system. Methods: Four electronic databases were searched. Three independent reviewers were involved in the screening and data charting processes. Findings were synthesized and categorized into four levels based on the Social Ecological Model. Results: A total of 22 studies were included in the final review. The barriers and facilitators affecting the integration of acupuncture were mapped into four levels (individual, interpersonal, organizational, and policy). The most frequently reported barriers and facilitators were mapped into the Social Ecological Model constructs within the "Individual" level (i.e., beliefs and attitudes of acupuncture, and practical issues) and the "Organizational" level (i.e., credentialing, space and facility, referral system). Conclusion: This review has identified and synthesized the breadth of evidence on the barriers and facilitators to the integration of acupuncture into the U.S. health care system. Results of this review will guide future implementation studies to develop and test implementation strategies to integrate acupuncture into the U.S. health care system.

Virtual multimodal hub for patients undergoing major gastrointestinal cancer surgery (PRIORITY-CONNECT 2 Pilot) - A pilot randomised type I hybrid effectiveness-implementation trial

BackgroundThe PRIORITY-CONNECT 2 pilot trial will establish the feasibility and acceptability of a virtual multimodal programme following gastrointestinal cancer surgery. The secondary aims are to obtain pilot data on the likely difference in key outcomes, data elements that will guide future implementation studies, and to identify barriers and facilitators that inform the development and execution of a substantive randomised clinical effectiveness trial of teleprehabilitation/rehabilitation. MethodsThis is a multicentre, assessor-blinded, pilot, randomised controlled trial utilising a Hybrid Type I effectiveness-implementation design. 20 participants undergoing major gastrointestinal cancer surgery will be randomised (1:1 allocation) to attend a virtual multimodal prehabilitation-rehabilitation hub (intervention group), delivered before (1–6 weeks) and after (up to 3 months) surgery plus usual care, or to usual care alone (control group). An individualised intervention will be delivered by an experienced multidisciplinary team including a physiotherapist, psychologist, dietitian, nurse, social worker, and a geriatrician. Outcomes will be collected at baseline, 1–2 days before surgery, during the hospital stay, day of discharge from hospital, and 3 months postoperatively. The primary outcomes will be feasibility and acceptability of the virtual multimodal hub. Secondary outcomes assess the rate of postoperative complications within 30 days after surgery, quality of life, the number of days at home within 30 and 90 days after surgery, healthcare use, and implementation outcomes. DiscussionThe PRIORITY-CONNECT 2 pilot trial will generate findings about the feasibility and acceptability of delivering an evidence-based virtual multimodal preoperative (prehabilitation) and postoperative (rehabilitation) intervention targeting patients having major gastrointestinal cancer surgery. Trial registrationThis trial was registered prospectively with the National Library of Medicine ClinicalTrials.gov Registry (NCT06212700) on 8th January 2024.

Dynamic insulation technology in buildings subject to intermittent heating and cooling, Part A: Iraqi case

In harsh climates like Iraq, characterized by extreme temperatures and energy shortages, dynamic insulation technology holds great potential to significantly reduce energy consumption and enhance thermal comfort. Dynamic insulation technology reduces building energy consumption by adjusting thermal conductivity based on climate changes. This article reviews existing literature and numerically evaluates the effectiveness of dynamic insulation technology in buildings subject to harsh climates, specifically focusing on the case of Iraq. The first part of our articles aims to provide a comprehensive overview of dynamic insulation technology and its potential effectiveness in Iraqi structures subject to intermittent heating and cooling. The collected data guides the design and implementation of future studies and experiments. The study predicts the dynamic insulation performance of an office in Baghdad compared to conventional insulation, considering factors such as lighting, number of residents, equipment, and solar gains. The results indicate that applying dynamic insulation techniques in Iraqi buildings can reduce energy consumption by 28% during the heating season and 11% during the cooling season. Implementing this technology can make a significant contribution towards creating a more sustainable and comfortable environment in harsh climates, examined in Iraqi buildings, as a model case. Practical Applications: The study contributes to the evaluation of dynamic insulation technology in Iraqi buildings. Focusing on Iraq's harsh climate provides valuable insights into the effectiveness of this technology. Scientifically based recommendations guide the design of buildings in such environments. In addition, the study investigates the performance of intermittent cooling and heating, ensuring practicality. Overall, it enables professionals to create sustainable and efficient built environments in Iraq.

Abstract PO3-07-02: Radiomics Models for B-mode Breast Ultrasound and Strain Elastography to improve Breast Cancer Diagnosis (INSPiRED 005): An International, Multicenter Analysis

Abstract Background: Breast Elastography, a technique that quantifies tissue stiffness, has been evaluated to objectify and improve the performance of B-mode breast ultrasound. However, large prospective trials showed benefits in BI-RADS 4a breast masses only and a high operator dependency. Modern Artificial Intelligence techniques for automated image processing like radiomics, a technique where quantified features are extracted from images, may overcome these limitations. We aimed to develop and validate radiomics models based on B-mode and Strain Elastography (SE) images for patients with BI-RADS 3 or 4 breast masses and compare their performance to the respective human experts. Methods: This is a secondary analysis of an international, multicenter trial (NCT02638935), evaluating the performance of SE in women with BI-RADS 3 or 4 breast masses. Women were recruited at 12 institutions in 7 countries and underwent B-mode breast ultrasound as well as SE. B-mode images were saved and re-assed by three ultrasound readers ( >10 years of experience), resulting in three independent assessments and a final consensus assessment. SE was interpreted using the E-/B ratio. B-mode and strain images were manually segmented and quantitative radiomics features were extracted using pyradiomics. We used 10-fold cross-validation to build machine learning models (XGBoostTree, MARS) based on data of 11 of 12 study sites. The data of the 12th (largest) study site was used as external validation set. Performance metrics included sensitivity, specificity and area under the receiver operator characteristic curve (AUROC). Results: The study included a total of 1288 patients, 1206 with evaluable B-mode images and 1190 with evaluable Strain images. Mean age was 46.6 years (SD 16.02) and a total number of 29.0% (350 of 1206) and 28.9% (344 of 1190) breast masses were malignant in the B-mode and Strain cohort, respectively. Distribution of BI-RADS categories was 33.0%, 34.5%, 14.5%, and 18.0% for BI-RADS 3, 4a, 4b, and 4c, respectively. In the external validation set (n = 342), the B-mode radiomics model (XGBoostTree) achieved an AUROC of 0.86 (95% CI 0.82 to 0.90), with a sensitivity of 97.4% (95% CI 0.93 to 1.00, 113 of 116) and a specificity of 27.0% (95% CI 0.21 to 0.33, 61 of 226). The model showed equivalent performance compared to the three ultrasound readers (P = 0.133); see also Table 1. In the external validation set (n = 333), the Strain radiomics model (MARS) achieved an AUROC of 0.84 (95% CI 0.79 to 0.88), with a sensitivity of 100% (95% CI 47.0 to 58.0, 115 of 115) and a specificity of 25.5% (95% CI 0.22 to 0.34, 60 of 218). The model showed equivalent performance compared to the three ultrasound readers (P = 0.696) and performed significantly better compared to SE (P = 0.002); see also Table 1. Sensitivity of the strain model was descriptively higher (100% vs. 97.4%, see Table 1). Both models were well-calibrated. Conclusion: This is the largest development and validation study for radiomics models based on B-mode breast ultrasound and SE, to date. The radiomics models performed on par with human readers, with the strain radiomics model showing potential to identify initially missed carcinomas in BI-RADS 3 breast masses. Future implementation studies may evaluate the performance of these image analysis algorithms in clinical routine and their integration into the multi-modal breast cancer diagnostics process, including mammography and MRI. Table 1. Diagnostic performance metrics Citation Format: André Pfob, Tanja He, Lie Cai, Richard G. Barr, Volker Duda, Zaher Alwafai, Corinne Balleyguier, Dirk-André Clevert, Sarah Fastner, Christina Gomez, Manuela Goncalo, Ines Gruber, Markus Hahn, André Hennigs, Panagiotis Kapetas, Sheng-Chieh Lu, Juliane Nees, Ralf Ohlinger, Fabian Riedel, Matthieu Rutten, Benedikt Schaefgen, Anne Stieber, Riku Togawa, Mitsuhiro Tozaki, Sebastian Wojcinski, Cai Xu, Geraldine Rauch, Jörg Heil, Chris Sidey-Gibbons, Michael Golatta. Radiomics Models for B-mode Breast Ultrasound and Strain Elastography to improve Breast Cancer Diagnosis (INSPiRED 005): An International, Multicenter Analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-07-02.

A scoping review of occupational health education programs for music students and teachers

Embedding musicians’ occupational health training in music education curricula is widely recommended due to the well-documented high prevalence of performance-related health problems (PRHPs) among musicians across their lifespan. A scoping review was conducted to examine the range of evidence from implementations of musicians’ health education programs, regarding the maintenance of hearing, musculoskeletal, psychological, and vocal health, as well as injury prevention strategies to minimize the risk of PRHP. Eligible sources of evidence included published and unpublished studies reporting occupational health education programs (which may have incorporated information on physical or psychological health, exercise, or somatic movement training) implemented with pre-tertiary and tertiary music students and teachers. Studies reporting stand-alone psychological health education were excluded. Key characteristics from included studies were extracted and charted. Data charts outline commonalities across the reported results, including physical, psychological, educational, and behavioral change outcome measures. Out of 46 records included for data extraction, 35 reported programs with tertiary-aged music students, seven reported programs with pre-tertiary-aged music students, two reported programs with music teachers, and two reported systematic reviews. Reported benefits from this research with both pre-tertiary and tertiary music students suggest that musicians’ health education and injury prevention strategies reduce self-reported playing-related pain and music performance anxiety. However, future implementation studies need to address identified challenges such as effective behavior change and the enablers and barriers to the long-term adoption of strategies for optimal music performance and health outcomes. This review highlights the need for further research into designing and embedding musicians’ health education into all music training settings, including more implementations with pre-tertiary music students, as well as training to support the professional development needs of instrumental and vocal teachers.

Student and caregiver acceptability of a school-based intervention to improve sugar-sweetened beverage behaviors: a mixed methods study.

Kids SIPsmartER is a 6-month behavioral and health literacy intervention effective at reducing sugar-sweetened beverage (SSB) intake among middle school students and their caregivers in the rural Appalachian region. This exploratory mixed methods study utilized a convergent parallel design to assess participant acceptability of a school-based curriculum for students and a text messaging program for caregivers. Acceptability was assessed using surveys (873 students and 453 caregivers), five focus groups (34 students) and telephone interviews (22 caregivers). Quantitative data were analyzed descriptively, and qualitative data were content coded. On a 5-point scale, average quantitative survey acceptability ratings ranged from 2.7 to 3.3 among three student-rated questions and 4.1 to 4.2 among four caregiver-rated questions. Qualitative focus group findings suggested that students preferred curricular activities that were hands-on and involved social interaction, while caregiver interview results showed high acceptability of the text messaging program's design, including usability, content messages and personalization. Students and caregivers reported similar program benefits: increased knowledge of SSBs and health risks, increased awareness of SSB behaviors and support to make beverage behavior changes. Results from this study can be used to understand Kids SIPsmartER's effectiveness data, communicate the intervention's acceptability with stakeholders and plan for future implementation studies.

Sustainability of enhanced recovery after surgery programmes in gastrointestinal surgery: A scoping review.

Enhanced Recovery After Surgery (ERAS) is an evidence-based intervention that is well-recognised across multiple surgical specialties as having potential to lead to improved patient and hospital outcomes. Little is known about sustainability of ERAS programmes. This review aimed to describe available evidence evaluating sustainability of ERAS programmes in gastrointestinal surgery to understand: (a) how sustainability has been defined; (b) examine determinants of sustainability; (c) identify strategies used to facilitate sustainability; (d) identify adaptations to support sustainability; and (e) examine outcomes measured as indicators of sustainability of ERAS programmes. This scoping review was conducted following the Joanna Briggs Institute's methodology. Research databases (PubMed, Embase, CINHAL) and the grey literature were searched (inception to September 2022) for studies reporting sustainability of ERAS programmes in gastrointestinal surgery. Included articles reported an aspect of sustainability (i.e., definition, determinants, strategies, adaptations, outcomes and ongoing use) at ≥2 years following initial implementation. Aspects of sustainability were categorised according to relevant frameworks to facilitate synthesis. The search strategy yielded 1852 records; first round screening excluded 1749, leaving 103 articles for full text review. Overall, 22 studies were included in this review. Sustainability was poorly conceptualised and inconsistently reported across included studies. Provision of adequate resources was the most frequently identified enabler to sustainability (n/N = 9/12, 75%); however, relatively few studies (n = 4) provided a robust report of determinants, with no study reporting determinants of sustainability and strategies and adaptations to support sustainability alongside patient and service delivery outcomes. Improved reporting, particularly of strategies and adaptations to support sustainability is needed. Refinement of ERAS reporting guidelines should be made to facilitate this, and future implementation studies should plan to document and report changes in context and corresponding programme changes to help researchers and clinicians sustain ERAS programmes locally.

Adaptive Designs in Implementation Science and Practice: Their Promise and the Need for Greater Understanding and Improved Communication.

The promise of adaptation and adaptive designs in implementation science has been hindered by the lack of clarity and precision in defining what it means to adapt, especially regarding the distinction between adaptive study designs and adaptive implementation strategies. To ensure a common language for science and practice, authors reviewed the implementation science literature and found that the term adaptive was used to describe interventions, implementation strategies, and trial designs. To provide clarity and offer recommendations for reporting and strengthening study design, we propose a taxonomy that describes fixed versus adaptive implementation strategies and implementation trial designs. To improve impact, (a) futureimplementation studies should prespecify implementation strategy core functions that in turn can be taught to and replicated by health system/community partners, (b) funders should support exploratory studies that refine and specify implementation strategies, and (c) investigators should systematically address design requirements and ethical considerations (e.g., randomization, blinding/masking) with health system/community partners.

Tailored hybrid microbial water disinfection system using sequentially assembled microbial fuel cells and an ultraviolet C light-emitting diode

An integrated ultraviolet C light-emitting diode (UV-C LED) water disinfection system activated by microbial fuel cells (MFCs) was developed, and optimized via electric circuit and device voltage profiling. The intensity of the renewable energy operated, self-powered UV-C LED for E. coli inactivation was calculated by bio-dosimetry to be 2.4 × 10−2 μW cm−2 using fluence-based rate constant (k) of ∼1.03 (±0.11) cm2/mJ to obtain the reduction equivalent fluence kinetics value. Finally, the first-order rate constant for E. coli inactivation during the tailored hybrid disinfection system was found to be 0.53 (±0.1) cm2/mJ by multiplying intensity with 1.09 (±0.1) × 10−5 s−1 derived from the linear regression of E. coli inactivation as a function of time. Furthermore, selected model microbial consisting of two bacteria (Salmonella sp. and Listeria sp.) and three viruses (MS2 bacteriophage, influenza A virus, and murine norovirus-1) were treated with UV-C LED irradiation under controlled experimental conditions to validate the disinfection efficiency of the system. Consequently, the required to achieve significant removal (i.e., >3-log; 99.9%) UV fluence and dose time were calculated to be 4−7 cm2/mJ and 54–76 h and 33−53 cm2/mJ and 400–622 h for model bacterial and viral, respectively. This study expands the applicability of microbial electrochemical system (MES) for microbial disinfection and could be utilized in future MFCs implementation studies for predicting and measuring the kinetics of microbial elimination using a tailored hybrid water treatment system.

Barriers and enablers to providing evidence-based in-hospital urinary continence care: A cross-sectional survey informed by the Theoretical Domains Framework.

To identify the barriers and enablers perceived by hospital-based clinicians to providing evidence-based continence care to inpatients. This was a cross-sectional study of inpatient clinicians using a questionnaire. Acute care and rehabilitation clinicians from 15 wards that admit patients after stroke at 12 hospitals (NSW = 11, Queensland =1, metropolitan = 4, regional = 8) were invited to complete an online questionnaire. The 58 questions (answered on a 5-point Likert scale) were aligned to 13 of the 14 domains of the Theoretical Domains Framework. Results were dichotomized into 'strongly agree/agree' and 'unsure/disagree/strongly disagree' and proportions were calculated. Data collection occurred between January 2019 and March 2019. The questionnaire was completed by 291 participants with 88% being nurses. Barriers were found in nine domains including knowledge; skills; memory attention and decision making; emotion; environmental context and resources; behavioural regulation; social professional role; intensions, social influences; and beliefs about capabilities. Enablers were found in seven domains including goals; social influences; knowledge; skills; social, professional role and identity; reinforcement and beliefs about consequences. This multi-site, multi-professional study that included predominantly nurses highlights the barriers and enablers to inpatient continence care. Future implementation studies in inpatient continence management should address these identified barriers and enablers to improve effectiveness of implementation of evidence-based care. This study highlights that although there are many barriers to ward nurses providing evidence-based continence care, there are also several enablers. Both should be addressed to improve practice. We adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) (Supplementary File 1). Establishing barriers to practice gives a broader understanding of why practice does not occur and establishes areas where researchers and clinicians need to address in order to change behaviour.

Comparing the effects of inhibitory control training and evaluative conditioning for unhealthy food behaviours

Cognitive Bias Modification (CBM) is hypothesised to reduce unhealthy food preference and consumption through the completion of computerised cognitive training tasks. While there is evidence to suggest that two popular CBM paradigms (Inhibitory Control Training (ICT) and Evaluative Conditioning (EC)) can have a positive influence on food-related outcomes, issues (and inconsistencies) related to task standardisation and control group design make it difficult to evaluate their standalone efficacy. In a pre-registered laboratory study using a mixed experimental design, our aim was to directly compare a single session of ICT and EC on implicit preference, explicit choice and ad-libitum food intake, while ensuring appropriate active control groups were utilised for each training type (in addition to a passive control group). The results revealed that there were no significant differences in terms of implicit preferences, ad-libitum food consumption or food choice. These results provide limited evidence to support the use of CBM as a psychological intervention for unhealthy food choice or consumption. Further work is needed to isolate mechanisms of effect for successful training and identify the most effective CBM protocols for implementation in future studies.

Practitioner perspectives on the use of the experience sampling software in counseling and clinical psychology

ABSTRACT Facilitating the uptake and making better use of technological advances will be pivotal for counseling and clinical psychology to respond to the rising call for more community-based and person-centred care. While the Experience Sampling Method (ESM), a structured self-report digital diary, could help facilitate this transition, it is currently unclear how practitioners envision using ESM in clinical practice. Therefore, we organised focus groups with 36 mental health practitioners (Mage = 39.37, SDage = 12.18, 58.33% female) across Flanders (Belgium). Four broad topics were discussed: (1) how to use ESM, (2) how to visualise clinically relevant information, (3) the software requirements thereof, and (4) barriers and facilitators for implementing ESM in clinical practice. Thematic analysis was conducted and Cohen's Kappa was calculated (κ = .79). Different clinical applications emerged, such as screening, evaluating the effectiveness of therapy, and elucidating determinants of mental health problems in daily life. However, practitioners also expressed difficulty determining how to visualise ESM data, and novel features for use emerged (e.g. integration with electronic health records). Various barriers (e.g. lack of best-practice guidelines) and facilitators (e.g. simplicity) were identified, with the implications of these findings for future clinical implementation studies discussed.

An Adapted Cancer Screening Education Program for Native American Women With Intellectual and Developmental Disabilities and Their Caregivers: Protocol for Feasibility and Acceptability Testing.

Women with intellectual and developmental disabilities (IDD) do not undergo breast and cervical cancer screening at the same rate as women without IDD. IDDs are diagnosed in childhood, are lifelong, and involve difficulties in adaptive behaviors and intellectual functioning. Native American women also experience disparities in breast and cervical cancer screenings. Despite known disparities, women with IDD are often not included in health promotion programs, and there is a need for evidence-based programming for those with intersectional identities, such as Native American women with IDD. This study aims to assess the feasibility and acceptability of My Health My Choice (MHMC), an adaptation of the Women Be Healthy 2 program. There are 2 parts to the study: adaptation of the Women Be Healthy 2 program and feasibility and acceptability testing of MHMC. Individuals aged over 18 years who identify as Native American females with IDD and their caregivers (N=30 women-caregiver dyads) are eligible for the study. Participants, who are affiliated with 2 partnering sites in Arizona (1 rural and 1 urban), complete pre- and postsurveys assessing knowledge, self-efficacy, and screening expectations before and immediately after completing the program. In addition, all participants complete brief satisfaction surveys after each of the 6 educational sessions. A subsample of Native American women with an IDD (n=12), caregivers (n=12), and community health educators (n=2) who participate in the MHMC program will provide semistructured qualitative input regarding the content, delivery, and cultural relevance of the program. The adaptation of the culturally responsive MHMC program was completed in August 2021. In November 2021, the project team began recruitment for feasibility and acceptability studies. Feasibility will be examined using participation metrics, and acceptability will be measured using satisfaction measures. Pre- and postmeasures in cancer screening knowledge, self-efficacy, and screening expectations will examine improvements among participants. The results of feasibility and acceptability testing of MHMC will guide future implementation studies of the program. DERR1-10.2196/37801.

Implementierung einer elektronischen Entscheidungshilfe zur Unterstützung der Behandlungsqualität der COPD in der Hausarztmedizin

BackgroundElectronic clinical decision aids (eCDAs) have the potential to improve the quality of chronic disease management (CDM) and, therefore, patient relevant outcomes. However, eCDAs are only sparsely implemented in primary care for chronic obstructive pulmonary disease (COPD). The aim of this pilot study was to develop and implement of an eCDA for COPD primary care in two Swiss primary care practices. MethodTwo primary care practices, each with five primary care physicians and their assistants, participated in the study. The eCDA was developed in collaboration with one of the two GP practices (Practice 1) following a development cycle encompassing alpha- and beta-testing stages. Long-term testing for one year was conducted in both practices. The implementation of the eCDA was evaluated according to the RE-AIM framework counting occurrences as follows: Reach: the number of patients included in the CDM using the eCDA. Effectiveness: the number of treatment processes initiated per patient. Adoption: practice utilization of the diverse functions featured in the eCDA. Implementation and Maintenance: health care professionals’ attitudes towards the impact of the eCDA on the quality of care and their willingness to continue using the eCDA after long-term testing. Data were collected by the eCDA itself, which was programmed to track user data, and from practice staff using questionnaires. ResultsReach: After the long-term test, the number of patients recorded in the eCDA was 28 in practice 1, and 12 in practice 2. Effectiveness: The number of evidence-based treatment processes per patient was 14 (IQR 6 to 22) in Practice 1 and 6 (IQR 5 to 8) in Practice 2. Adoption: The utilization profiles of the eCDA differed greatly between practices. Implementation and Maintenance: After the long-term test, respondents were more critical of the quality of the CDM for patients with COPD, and attitudes consistent with interprofessional care were more prevalent compared to baseline. Respondents were optimistic regarding both the potential of the eCDA to improve the quality of CDM and their motivation to continue using the eCDA after long-term testing. ConclusionThis pilot study is a roadmap for future projects aiming to develop and implement eCDAs for the CDM of COPD in primary care. Future larger implementation studies in this domain should place greater emphasis on the measurement of structural practice characteristics as potential determinants of patient-relevant outcomes. The modifiable determinants should then be tested for their effects on patient-relevant outcomes in a randomized controlled design.

Taking shared decision making for prostate cancer to the next level: Requirements for a Dutch treatment decision aid with personalized risks on side effects

BackgroundDifferent curative treatment modalities need to be considered in case of localized prostate cancer, all comparable in terms of survival and recurrence though different in side effects. To better inform patients and support shared decision making, the development of a web-based patient decision aid including personalized risk information was proposed. This paper reports on requirements in terms of content of information, visualization of risk profiles, and use in practice. MethodsBased on a Dutch 10-step guide about the setup of a decision aid next to a practice guideline, an iterative and co-creative design process was followed. In collaboration with various groups of experts (health professionals, usability and linguistic experts, patients and the general public), research and development activities were continuously alternated. ResultsContent requirements focused on presenting information only about conventional treatments and main side effects; based on risk group; and including clear explanations about personalized risks. Visual requirements involved presenting general and personalized risks separately; through bar charts or icon arrays; and along with numbers or words, and legends. Organizational requirements included integration into local clinical pathways; agreement about information input and output; and focus on patients' numeracy and graph literacy skills. ConclusionsThe iterative and co-creative development process was challenging, though extremely valuable. The translation of requirements resulted in a decision aid about four conventional treatment options, including general or personalized risks for erection, urinary and intestinal problems that are communicated with icon arrays and numbers. Future implementation and validation studies need to inform about use and value in practice.

Implementing an intervention to enhance care delivery and consistency for people with hip fracture and cognitive impairment in acute hospital wards: a mixed methods process evaluation of a randomised controlled feasibility trial (PERFECTED)

ObjectivesTo determine how, and under what circumstances, the PERFECT-ER intervention was implemented in five acute hospital wards and impacted on staff practices and perceptions.DesignMixed methods process evaluation (undertaken between 2016...

Paramedic supportive discharge programmes to improve health system efficiency and patient outcomes: a scoping review protocol

IntroductionDischarging older adults with frailty home from the emergency department (ED) poses unique challenges due to multiple interacting physical and social problems. Paramedic supportive discharge services help overcome these challenges...