Implementation Of Interventions Research Articles

Refining the Make My Day stroke prevention intervention for primary healthcare through co-creation with stakeholders

ObjectivesTo describe and explore the refinement of a stroke prevention intervention and conditions for implementation in primary healthcare by utilising co-creation with stakeholders.MethodThis was an iterative co-creation process of five collaborative workshops engaging stakeholders; healthcare professionals (HP), and persons at risk for stroke, who participated in or delivered a stroke prevention intervention in primary healthcare.ResultsThrough co-creation with stakeholders key components for revision were identified in the Make My Day intervention. The overall pedagogics, which was recognised as overarching, and three additional key components: the HP education, the intervention sessions, and the digital tool were identified. Moreover, the co-creation process rendered refinements of the prevention program addressing the key components representing stakeholder experiences. Refinements encompass delivering and receiving the Make My Day intervention, material ownership, and the interprofessional team.ConclusionsThe co-creation process revealed the importance of applying a strategic pedagogic approach in a complex intervention. The process underscored the need to augment a sense of material ownership and to improve interprofessional collaboration in primary healthcare, ultimately enhancing the intervention experience and facilitating the change process for individuals at risk of stroke. Utelising a co-creation process in this current intervention allowed for creation of refinements to the intervention optimising conditions for implementation.

Process evaluation of Project Daire: a food environment intervention that impacted food knowledge, wellbeing and dietary habits of primary school children

BackgroundProject DAIRE was a randomised-controlled, factorial design trial which aimed to improve children’s health-related quality of life, wellbeing, food knowledge and dietary habits via two multi-component interventions: Nourish and Engage. Nourish was an intervention aiming to alter the school food environment, provide food-based experiences and expose pupils to locally produced foods. Engage was an age-appropriate cross-curricular food education intervention incorporating food, agriculture, nutrition science and related careers. The purpose of this study was to conduct a process evaluation to evaluate DAIRE implementation, mechanisms of impact (MOI) and context to elucidate trial results, and inform scalable implementation of the DAIRE approach for successful future rollout.MethodsThe Medical Research Council’s (MRC) framework for process evaluation was followed. Formal (questionnaires designed for process evaluation) and informal (researcher records and communications) methods were used to collect quantitative and qualitative data during the DAIRE trial in relation to process evaluation. Quantitative data were analysed using descriptive statistics and qualitative data via thematic analysis to identify key themes.ResultsFifteen schools and 983 pupils (n = 495 6–7 year olds/Year 3 and n = 488 10–11 year olds/Year 7) were recruited for the 6-month DAIRE intervention; a 100% retention rate was observed at the school level and the interventions had a high level of pupil and teacher acceptability. Nourish schools delivered a higher mean dose of intervention elements (61.4%) than Engage (50%) schools but, overall, mixed implementation of both interventions occurred. DAIRE produced change through four key MOI: social learning, experimental learning, interactive engaging content and real-life connections. Lack of time was the main contextual barrier to implementation and lack of financial cost to schools indicated as a potential facilitator.ConclusionsThis process evaluation helped to identify important findings related to implementation, MOI and context. The most effective elements of the interventions which should be maintained include provision of interactive and engaging intervention elements at no financial cost to the school. Findings also identified suggestions for improvement including provision of increased teacher training, support and planning time, content reduction to facilitate easy integration, and implementation across the full academic year. A sustainable funding and resourcing mechanism is required for successful future roll-out across the UK and beyond.Trial registrationsThe original trial referenced in this process evaluation is registered as follows: National Institute of Health (NIH) U.S. National Library of Medicine Clinical Trials.gov (ID: NCT04277312; retrospectively registered 11th February 2020).

Biopolitics at the Nexus of Chronic and Infectious Diseases.

Non-communicable (chronic) and communicable (infectious) diseases constitute the leading causes of death worldwide. They appear to impact populations in developed and developing nations differently with changing trends in the landscape of human conditions. Greater understanding of changing disease burdens should influence the planning of health programmes, the implementation of related interventions, and policymaking efforts on a national and global scale. However, the knowledge of disease burdens does not reflect how states and global health organizations prioritize their efforts in addressing them. This work aims to address the discrepancy in public health priority setting by improving our understanding of how the two disease categories impact the human condition. It reviews two case studies, COVID-19 and type 2 diabetes, as representative cases of an infectious and a chronic disease, respectively, to answer the following question. How does biopolitics, as the governance of human bodies, at the nexus of infectious and chronic disease, impact national and global public health priorities? This work contextualizes and reframes the relationship towards disease categories by focusing on three primary themes: risk, current public health interventions, and funding priorities for each case study analysed. It argues that the politics over life at the nexus of chronic and infectious diseases, best conceived as future-oriented economic optimization, directs the efforts of prioritization in healthcare based on risk and responsibility-based relationship between multiple stakeholders.

Predictive Validity of Hospital-Associated Complications of Older People Identified Using Diagnosis Procedure Combination Data From an Acute Care Hospital in Japan: Observational Study

Background A composite outcome of hospital-associated complications of older people (HAC-OP; comprising functional decline, delirium, incontinence, falls, and pressure injuries) has been proposed as an outcome measure reflecting quality of acute hospital care. Estimating HAC-OP from routinely collected administrative data could facilitate the rapid and standardized evaluation of interventions in the clinical setting, thereby supporting the development, improvement, and wider implementation of effective interventions. Objective This study aimed to create a Diagnosis Procedure Combination (DPC) data version of the HAC-OP measure (HAC-OP-DPC) and demonstrate its predictive validity by assessing its associations with hospital length of stay (LOS) and discharge destination. Methods This retrospective cohort study acquired DPC data (routinely collected administrative data) from a general acute care hospital in Tokyo, Japan. We included data from index hospitalizations for patients aged ≥65 years hospitalized for ≥3 days and discharged between July 2016 and March 2021. HAC-OP-DPC were identified using diagnostic codes for functional decline, incontinence, delirium, pressure injury, and falls occurring during the index hospitalization. Generalized linear regression models were used to examine the associations between HAC-OP-DPC and LOS, and logistic regression models were used to examine the associations between HAC-OP-DPC and discharge to other hospitals and long-term care facilities (LTCFs). Results Among 15,278 patients, 3610 (23.6%) patients had coding evidence of one or more HAC-OP-DPC (1: 18.8% and ≥2: 4.8%). Using “no HAC-OP-DPC” as the reference category, the analysis showed a significant and graded association with longer LOS (adjusted risk ratio for patients with one HAC-OP-DPC 1.29, 95% CI 1.25-1.33; adjusted risk ratio for ≥2 HAC-OP-DPC 1.97, 95% CI 1.87-2.08), discharge to another hospital (adjusted odds ratio [AOR] for one HAC-OP-DPC 2.36, 95% CI 2.10-2.65; AOR for ≥2 HAC-OP-DPC 6.96, 95% CI 5.81-8.35), and discharge to LTCFs (AOR for one HAC-OP-DPC 1.35, 95% CI 1.09-1.67; AOR for ≥2 HAC-OP-DPC 1.68, 95% CI 1.18-2.39). Each individual HAC-OP was also significantly associated with longer LOS and discharge to another hospital, but only delirium was associated with discharge to LTCF. Conclusions This study demonstrated the predictive validity of the HAC-OP-DPC measure for longer LOS and discharge to other hospitals and LTCFs. To attain a more robust understanding of these relationships, additional studies are needed to verify our findings in other hospitals and regions. The clinical implementation of HAC-OP-DPC, which is identified using routinely collected administrative data, could support the evaluation of integrated interventions aimed at optimizing inpatient care for older adults.

Financial Distress Screening and Navigation in Pediatric Oncology Within the National Cancer Institute Community Oncology Research Program

PURPOSE Cancer-related financial hardship is associated with poor quality of life, risk of household material hardship, and psychological distress for families affected by pediatric cancer. Current processes on financial distress screening and financial navigation across the pediatric National Cancer Institute Community Oncology Research Program (NCORP) network remain unknown. METHODS Financial distress screening and financial navigation services among NCORP practices were assessed using two survey items from the 2022 NCORP Landscape Assessment Survey. Practices answering yes to providing oncology care for pediatric patients were included. Univariable models were used to test associations between practice characteristics and financial screening and financial navigation. RESULTS Of the 53 NCORP practices serving pediatric patients with cancer that responded to the survey, 44 (83%) reported routinely conducting financial distress screening. Most of the practices reported that financial screening is completed by social workers (n = 40/44, 91%). One third of practices reported financial screening using a survey completed by patients/caregivers (n = 14/44, 32%). Almost all practices (n = 51/53, 96%) reported responding to financial needs through a social worker. One third of the practices reported having a cancer-specific financial navigator (n = 17/53, 32%) or a nondedicated (not cancer-specific) financial navigator (n = 19/53, 36%). Practices that served a proportion of new patients with cancer at or above the national average of Hispanic individuals in the United States were as likely to screen for financial distress as practices below the national average (odds ratio, 2.42 [95% CI, 0.45 to 13.03]; P = .30). CONCLUSION Most pediatric NCORP practices report screening for financial distress. Fewer groups offer dedicated cancer-specific financial navigation, and practices vary. Further research is needed to explore the development and implementation of standardized financial distress measures and financial navigation interventions within pediatric cancer care.

Injury Patterns and Frequency in Swimming: A Systematic Review

Swimming is a widely practiced sport with significant physical demands, placing athletes at a considerable risk of injury, particularly in the shoulder, due to repetitive high-intensity movements. The aim of this systematic review was to analyze the patterns and frequency of injuries associated with swimming. Methods: A systematic search of the Web of Science, PubMed, Scopus, and SportDiscus databases identified nine relevant studies. Results: The findings revealed a higher incidence of injuries in female swimmers compared to males, with the shoulder being the most frequently affected joint. This disparity is partially attributed to the Female Athlete Triad, a syndrome characterized by low energy availability, menstrual dysfunction, and poor bone health, which increases injury susceptibility. Other commonly affected regions include the knee, often associated with the biomechanical demands of breaststroke, and the lumbar spine, which is impacted by degenerative changes resulting from high training volumes. However, variability in the injury measurement protocols across studies limits their comparability and highlights the need for standardized methods. Conclusions: Based on these findings, professionals in the field can identify injury patterns to enhance diagnosis and treatment, design personalized prevention programs, implement early interventions, and innovate equipment and training methods to improve swimmer safety and performance.

Collaborative Working Relationships Between Community Prevention Coalitions and Their Technical Assistance Providers: A Mixed Methods Approach for the Development of an Innovative Implementation Measure.

Prior research suggests that technical assistance which includes one-on-one, individualized support, guidance, and assistance is necessary to promote high-quality implementation of evidence-based interventions. However, this area lacks measures. This paper uses a mixed methods and community-engaged approach to develop and then evaluate a standardized measure of the collaborative working relationship between technical assistance providers and coalitions/coalition leaders. For measure development, researchers interviewed eight coalition leaders and eight coalition technical assistance providers about their experience providing or receiving technical assistance, using a human-centered design approach. A heat-mapping technique used with the interview data identified 11 themes related to the provision of high-quality technical assistance. Researchers then created survey items through an iterative process. After multiple rounds of revision and feedback with coalition leaders and coalition and technical assistance researchers, the reliability of seven of the constructs was piloted with 52 coalition leaders. The seven constructs included the following: competence and autonomy support, responsiveness, authentic and meaningful participation, co-creation, trust and rapport, compliance, and negative interactions. Researchers used Cronbach's Alphas and correlational analyses to further refine the scales. Empirical results mapped well onto prior theoretical work and suggested that the collaborative working relationship is a multi-dimensional construct. This research moves prevention research methods and measurement development into a more community-engaged, stakeholder-involved approach.

Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot: clinic staff perspectives

IntroductionMedically tailored meals (MTMs) are home-delivered, nutritionally tailored meals for individuals living with complex or advanced diet-sensitive medical conditions. In 2020, Massachusetts Medicaid implemented the Flexible Services Program (FSP) through a Section 1115 Demonstration, which funded novel nutrition programs, including MTMs, for high-risk patients through Accountable Care Organizations (ACOs). Little is known from the practitioners’ perspective regarding the facilitators and barriers to reaching and enrolling patients in MTM programs.MethodsWe interviewed 19 staff across four ACOs that had implemented MTM interventions. Interviews were conducted from Feb to Aug 2023 and included staff who participated in patient screening, referral, or enrollment. The interview guide was informed by the Health Equity Implementation Framework. Interviews were recorded and transcribed and coded using NVivo software. We used directed qualitative content analyses. The study team identified and discussed common themes and presented them back to our ACO partners.ResultsStaff described facilitators of and barriers to reach and enrollment related to several domains of the Health Equity Implementation Framework. For program (innovation) factors, facilitators included perceived positive effects on patient health outcomes and a relative advantage over both the status quo and other nutrition assistance programs; outreach by care team members rather than other staff; the eligibility criteria, which were viewed as appropriate and evidence-based; and the simplicity of the program, which aided communication with patients. Patient-related facilitators included patients being more in need of the program due to more severe illness and being more motivated to change dietary behaviors. Patient-related barriers included lacking a working phone or stable housing and concern about meals meeting taste and cultural food preferences. Staff-related barriers included limited time and especially knowledge about the MTM program.DiscussionThis study highlights the perspectives of front-line staff during the implementation of an MTM program in a state-wide 1,115 Demonstration. Staff may require multiple trainings to gain full knowledge about the program and increase self-efficacy in describing it with sensitivity. These new findings elevate voices from front-line healthcare staff in MTM delivery and can help inform strategies for effective, equitable implementation of MTM programs.

Evaluation of the First Implementation of the Sohanjana Anti-bullying Intervention: Perspectives of the Institutional Staff

Abstract Educational institutions in Pakistan recognize the concerning prevalence of traditional and cyberbullying. However, there are no evidence-based interventions to address this issue in these institutions. The current study examined the outcomes of the first implementation of the Sohanjana Anti-bullying Intervention, a comprehensive approach tailored specifically for Pakistani educational institutions that addresses the urgent need for a socially and culturally appropriate anti-bullying program. It aims to educate and train teachers to effectively address bullying issues among students by identifying, addressing, and intervening appropriately. The current study involved seven participants from four schools, who received 32 h of training and then applied their acquired knowledge. Data were collected at several stages before and after the intervention, and additional data were collected from staff (N = 101) to examine changes in bullying behaviors. The intervention successfully increased teachers’ awareness of bullying control strategies. Data from the experimental group of trained teachers showed a statistically significant decrease in social and verbal bullying in the post-intervention scores. Although decreases in social, verbal, and physical bullying were observed in the post-intervention data collected from staff, statistical significance was not reached, with the exception of one experimental school in a rural region that showed a significant decrease in physical bullying after the intervention. The limitations and implications of the study are discussed.

Evidence-Based Medicine Within Surgical Practice and Training: A Scoping Review.

Evidence-based medicine (EBM) is a fundamental element of modern surgical practice. However, its integration into surgical training remains challenging. Through a scoping review, this study mapped existing evidence on the practice of EBM in surgery, focusing on knowledge, attitudes, barriers, and curricula. The literature was systematically searched through 3 databases and 2 registers. Fifty articles published over a 22-year period (2001-2023) were identified based on predefined eligibility criteria. These were reviewed using Arksey and O'Malley's methodological framework. The review was checked against the PRISMA 2018 checklist for scoping reviews. There is evidence of awareness and appreciation of EBM principles among surgeons and surgical trainees. However, the understanding of EBM terminology is varied. Attitudes toward EBM were predominantly positive yet reliance on clinical experience over evidence-based guidelines was noted. Key barriers to EBM practice included time constraints, lack of structured training, and methodological challenges in surgical research. The review highlighted the lack of validated competency assessment tools and the need for structured EBM curricula. Various educational strategies, such as journal clubs and courses, were found to improve EBM knowledge, albeit with limited evidence on long-term practice change. This scoping review underscores the need for a more detailed understanding of stakeholder views of EBM in surgical practice, the development, implementation, and assessment of educational interventions in this field, and tailored strategies to assess EBM competency in surgery.

Sustained Spread of HIV-1 CRF55_01B in its Place of Origin: Dynamics and Hotspots.

Shenzhen, a city with a substantial mobile population, was identified as the first discovered region of human immunodeficiency virus-1 (HIV-1) CRF55_01B and epicenter of its severe epidemic. During the implementation of venue-based behavioral interventions and the "treat-all" policy, identifying the patterns of spread and transmission hotspots of CRF55_01B is imperative. In this study, 1450 partial pol sequences, with demographic information, were collected from all newly diagnosed CRF55_01B infections in Shenzhen from 2008 to 2020. Molecular networks were constructed using the maximum likelihood and time-resolve phylogenies. Transmission rates, effective reproduction numbers (Re) of clusters, and viral dispersal were evaluated using Bayesian inference. In total, 526 sequences formed 114 clusters, including 7 large clusters. The status and size of clusters were strongly correlated with age, ethnicity, occupation, and CD4+ T-cell counts. The transmission rates of clusters were significantly higher than the national epidemic estimate. Four large clusters had Re exceeding 1 at the end of the sampling period. Immigrants from Guangdong and Hunan, along with local residents, were identified as the transmission hubs, with heterosexual men being the main source and MSM being the main destination. The virus exhibited a high movement frequency from individuals aged 30-49 years toward diverse age groups. This study demonstrated that the hidden CRF55_01B transmissions continued despite current combined interventions in Shenzhen, and at-risk individuals susceptible to infection or transmission were identified, potentially serving as targets for more effective prevention and control of the local epidemic, thereby mitigating cross-regional spread nationwide due to population migration.

Training Parents to Implement Communication Intervention Package in Naturalistic Context Via Telehealth

This study evaluated the effects of behavioral skills training (BST) in training parents to implement communication intervention packages in naturalistic contexts via telehealth. Three parent-child dyads participated in the study. All participants were diagnosed with autism spectrum disorders (ASD) and their age ranged between four and six years. Parents were trained to teach their children augmented and non-augmented requesting skills in a natural context via internet-based service delivery. The findings of the study revealed that parents were successful in implementing communication intervention packages in teaching communication skills to their children with ASD during snack time. Keywords: Autism Spectrum Disorder (ASD), Behavior Skills Training (BST), Telehealth, Naturalistic Context

Determinants of burnout syndrome among undergraduate nursing students in Poland: a cross-sectional study

BackgroundNursing students worldwide are exposed to burnout syndrome resulting from constant academic and clinical stressors. The consequences of student burnout can be related to the student’s mental and physical health. Burnout may affect the learning process, achieving professional skills, and future effectiveness while working with a patient and, eventually, might lead to the decision to quit the job. This study aims to analyze the intensity of burnout syndrome among undergraduate nursing students based on their year of study (1), establishing the impact of stress, anxiety, insomnia, and selected sociodemographic variables on the level of burnout (2) and establishing a student profile predestined to be affected by burnout (3).MethodsA cross-sectional study was conducted among 841 bachelor’s degree nursing students from March 2022 to June 2022. The Maslach Burnout Inventory, Athens Insomnia Scale, Modified Hospital Anxiety and Depression Scale, and Perceived Stress Scale were used.ResultsHigh levels of emotional exhaustion were found in 40.9% and depersonalization in 20.33%, while low personal accomplishment was found in 16.88% of the students. Students of nursing in Year 2 presented the highest levels of emotional exhaustion and depersonalization and achieved significantly higher scores on the Athens Insomnia Scale. The determinants of burnout syndrome identified by the regression analysis were: sociodemographic factors (age, gender, and financial resources), the factors connected with the studying environment (year of studies and clinical and academic stressors), and emotional/mental/interpersonal factors (anxiety, depression, insomnia, and intensity of stress related to life situations).ConclusionThe academic community should be encouraged to create a more supportive environment for students, which will ultimately prevent dropouts and increase the number of nursing professionals in the Polish healthcare system. We recommended carrying out regular screening tests for burnout, insomnia, anxiety, stress, and depression (e.g., once a year) among students. Depending on the results of the tests, implementation of interventions aiming at reducing the negative outcomes of burnout syndrome and promoting well-being and adaptive management mechanisms should be considered.

The Burden of non-Communicable Diseases Attributable to Physical Inactivity in Türkiye

Physical inactivity is a major risk factor for non-communicable diseases (NCDs) globally. In Türkiye, the prevalence of physical inactivity is notably high, ranking third in Europe, with 44.4% of the population classified as physically inactive. This study aims to estimate the population attributable fractions (PAFs) of coronary heart disease, type 2 diabetes (DM), stroke, dementia, depression, and hypertension cases, deaths and disability-adjusted life-years (DALYs) due to physical inactivity in Türkiye. Data on physical inactivity prevalence and NCDs’ incidences, mortalities and DALYs were sourced from recent national surveys and Global Burden of Disease study. Relative risks (RRs) were obtained from global meta-analyses. PAFs were calculated using Levin’s equation. PAFs of physical inactivity were 16.7% for dementia, 11.6% for depression, 9.5% for stroke, 8.8% for CHD, 7.1% for type 2 diabetes and 3.1% for hypertension. Between 3.7% (for hypertension) and 17,5% (for dementia) of NCD deaths and 3.4% (for hypertension) and 17.1% (for dementia) of the DALYs due to NCDs examined in this study were attributable to insufficient physical activity. The burden was more significant among women and older ages.This study emphasizes the need for promoting physical activity and implement interventions focusing particularly on women and the elderly to reduce the burden of NCDs in Türkiye.

PSYCHOEDUCATION TO PREVENT SMARTPHONE ADDICTION THROUGH COMMUNITY BASED INTERVENTION

The prevalence of problematic smartphone usage has become a widespread concern. Excessive smartphone use can develop into an addiction if prompt intervention is not implemented. In order to effectively engage a broader demographic, health cadres play a crucial role in disseminating information to parents regarding strategies for mitigating smartphone addiction in children. The study aimed to examine the effect of psychoeducational interventions to prevent smartphone addiction among children in health cadres. The study employed a quasi-experimental, one-group pre-test and post-test design. The questionnaire comprised ten questions with a reliability coefficient of 0.60. Twenty health cadres from Public Health Center X in Malang were selected as participants. A series of six sessions were done to provide psychoeducation to prevent smartphone addiction. The findings revealed a discernible disparity between the scores obtained before the intervention's implementation and those obtained after completion. The t-test analysis revealed a statistically significant difference between the pre-test and post-test scores, as shown by a significance level of p < 0.001 and a t-value of -9.787. This finding suggests that the intervention increased the knowledge of the health cadres.

The effect of prenatal balanced energy and protein supplementation on gestational weight gain: An individual participant data meta-analysis in low- and middle-income countries.

Understanding the effects of balanced energy and protein (BEP) supplements on gestational weight gain (GWG) and how the effects differ depending on maternal characteristics and the nutritional composition of the supplements will inform the implementation of prenatal BEP interventions. Individual participant data from 11 randomized controlled trials of prenatal BEP supplements (N = 12,549, with 5,693 in the BEP arm and 6,856 in the comparison arm) in low- and middle-income countries were used. The primary outcomes included GWG adequacy (%) and the estimated total GWG at delivery as continuous outcomes, and severely inadequate (<70% adequacy), inadequate GWG (<90% adequacy), and excessive GWG (>125% adequacy) as binary outcomes; all variables were calculated based on the Institute of Medicine recommendations. Linear and log-binomial models were used to estimate study-specific mean differences or risk ratios (RRs), respectively, with 95% confidence intervals (CIs) of the effects of prenatal BEP on the GWG outcomes. The study-specific estimates were pooled using meta-analyses. Subgroup analyses were conducted by individual characteristics. Subgroup analyses and meta-regression were conducted for study-level characteristics. Compared to the comparison group, prenatal BEP led to a 6% greater GWG percent adequacy (95% CI: 2.18, 9.56; p = 0.002), a 0.59 kg greater estimated total GWG at delivery (95% CI, 0.12, 1.05; p = 0.014), a 10% lower risk of severely inadequate GWG (RR: 0.90; 95% CI: 0.83, 0.99; p = 0.025), and a 7% lower risk of inadequate GWG (RR: 0.93; 95% CI: 0.89, 0.97; p = 0.001). The effects of prenatal BEP on GWG outcomes were stronger in studies with a targeted approach, where BEP supplements were provided to participants in the intervention arm under specific criteria such as low body mass index or low GWG, compared to studies with an untargeted approach, where BEP supplements were provided to all participants allocated to the intervention arm. Prenatal BEP supplements are effective in increasing GWG and reducing the risk of inadequate weight gain during pregnancy. BEP supplementation targeted toward pregnant women with undernutrition may be a promising approach to delivering the supplements.

Progressive Retinal Degeneration and Juvenile Nephronophthisis in a Patient with Autosomal Recessive Ciliopathy: A Case Report

Introduction: Inherited retinal diseases (IRDs), particularly ciliopathies, often lead to irreversible blindness and are frequently accompanied by systemic manifestations such as nephronophthisis. Current treatment options are limited, necessitating the exploration of supplementary strategies to slow disease progression. Methods: We present a rare case from a retinal surgery clinic involving a 30-year-old male with autosomal recessive retinitis pigmentosa (ARRP) and juvenile nephronophthisis. Comprehensive ocular and genetic evaluations were conducted, followed by the implementation of nutritional interventions aimed at mitigating multi-systemic effects. Results: Genetic testing revealed pathogenic variants in CEP83, PCARE, and VPS13B genes, confirming the diagnosis of ARRP. Nutritional strategies, including omega-3 fatty acids, antioxidants, and tailored dietary modifications for renal health, were integrated alongside standard medical care. These interventions contributed to the stabilization of retinal degeneration and improved management of end-stage renal disease (ESRD). Conclusions: Integrating personalized nutritional strategies into the management of ciliopathies can enhance patient out-comes by addressing both ocular and systemic manifestations. These findings underscore the need for policy development around nutritional education and support for patients with inherited ciliopathies

Sharpening the gaze, sharpening the pencil: supporting observational drawing in primary education

ABSTRACT This article explores how teachers can support students’ observational drawing skills in the biology classroom. The article is based on classroom data from a collaborative project involving primary school teachers, arts educators, and researchers. Together, we have planned and implemented classroom interventions, aiming to contribute knowledge about the pedagogical potentials of drawing in science. In this article, we analyse one teacher’s way of teaching observational drawing to 8-year-old students. Our analysis reveals two main teaching emphases: (1) the interplay between observing and drawing and (2) the visual characteristics of natural objects, particularly the shape, colour, and specific details of different species. Our findings provide valuable insights for educators who seek to integrate observational drawing into science education. First, we highlight the significance of the teacher’s content knowledge in biology, as it corresponds to the ability to guide students’ attention to specific details in natural objects. Second, we show the pedagogical potential of providing explicit feedback during the drawing process in terms of encouraging students to make detailed and realistic drawings while also making them visually engaging. Lastly, we show that the teacher makes use of verbal, bodily, and visual resources to create a collaborative space for communication around student drawings.

Barriers and facilitators to the implementation of screening and intervention for co-use of opioid medications and alcohol among community pharmacy patients.

A significant risk for overdose among patients prescribed opioid medications is co-use of alcohol. Community pharmacies are underutilized as a resource to prevent and address co-use. The barriers and facilitators that promote or impede the adoption of universal alcohol screening and intervention at point of opioid medication dispensing are unknown. We assessed community pharmacy leaders, pharmacists, and technician's perceptions towards the implementation of a pharmacy-based screening/intervention for the co-use of opioids and alcohol among patients. We conducted a multi-method study that included one-time key informant interviews combined with a close-ended survey to inform our understanding of pharmacy system/practice-level barriers and facilitators for universal screening and intervention. Participants were recruited from Utah and Tennessee and were required to have active employment as pharmacy leaders, pharmacists, or technicians, be English-speaking, and believe they could provide feedback regarding co-use screening and intervention within community pharmacies. Interviews used the Consolidated Framework for Implementation Research and the Organizational Readiness for Implementing Change assessment. Qualitative analysis included both inductive and deductive coding. Themes followed a cycle of open, initial coding whereby codes were derived inductively from the data. Themes from interviews (N=68) included a) emphasizing a need to overcome the stigma associated with patients who engage in co-use and a mindset shift to treat the challenges and risks associated, b) need for corporate-level support, management buy-in, and c) appropriate technology to support the workflow including system-wide changes to support the integration of medication therapy management services within community pharmacies. However, barriers were offset by pharmacists eager to understand their role in screening patients and reiterated a focus on patient-centered care to achieve this goal. From the ORIC assessment, 75% (n=51) of respondents reported that community pharmacy staff wanted to implement the screening and intervention, and 69.1% (n=47) reported motivation to implement the screening and intervention. Finally, 67.6% (n=46) felt that community pharmacies are committed to implementing the screening and intervention, but only 10.3% (n=7) expressed strong support to do "whatever it takes" to implement the screening and intervention. These results provide critical insights into implementation strategies for the adoption of brief intervention by community pharmacists. These data are foundational to developing strategies for a powered trial and possible future system/practice-level implementation of universal alcohol screening and intervention for co-use.

MHealth Intervention for Dementia Prevention through lifestyle Optimisation (MIND-PRO) in a primary care setting: protocol for a randomised controlled trial in people with low SES and/or migration background

IntroductionThe Mobile Health (mHealth) Intervention for Dementia Prevention through lifestyle Optimisation (MIND-PRO) study addresses the increasing prevalence of dementia among populations with lower socio-economic status (SES) and/or a migration background....