Initial Workshop Research Articles

Educational videos for practitioners attending Baby Friendly Hospital Initiative workshops supporting breastfeeding positioning, attachment and hand expression skills: Effects on knowledge and confidence.

UNICEF Baby Friendly Initiative (BFHI) is the global standard for maternity and community services requiring all practitioners to be trained to support mothers in the essential skills of supporting positioning and attachment, and hand expression. These studies aim to rigorously assess knowledge in nurses, midwives, and doctors in these skills, tested before and after watching short videos demonstrating these skills. Practitioners were attending BFHI education, and the video study was additional. In Phase 1 clinicians in England were randomised to one of two videos (practitioner role play or clinical demonstration). The results showed improvements in knowledge and confidence, and a preference for clinical demonstration by mothers and infants. The clinical demonstration video was evaluated in China in Phase 2 where expert trainers viewed the video after completing the BHFI workshop, and in Phase 3 practitioners viewed the video before the BHFI workshop. Phase 2 with expert trainers only showed improvement in knowledge of hand expression but not positioning and attachment. In Phase 3 clinicians showed improved knowledge for both skills. In all Phases there were statistically significant improvements in confidence in practice in both skills. Viewing short videos increased knowledge, particularly about teaching hand expression, and confidence in both skills.

Evaluation of the \u201cFoundations in Knowledge Translation\u201d training initiative: preparing end users to practice KT

BackgroundCurrent knowledge translation (KT) training initiatives are primarily focused on preparing researchers to conduct KT research rather than on teaching KT practice to end users. Furthermore, training initiatives that focus on KT practice have not been rigorously evaluated and have focused on assessing short-term outcomes and participant satisfaction only. Thus, there is a need for longitudinal training evaluations that assess the sustainability of training outcomes and contextual factors that may influence outcomes.MethodsWe evaluated the KT training initiative “Foundations in KT” using a mixed-methods longitudinal design. “Foundations in KT” provided training in KT practice and included three tailored in-person workshops, coaching, and an online platform for training materials and knowledge exchange. Two cohorts were included in the study (62 participants, including 46 “Foundations in KT” participants from 16 project teams and 16 decision-maker partners). Participants completed self-report questionnaires, focus groups, and interviews at baseline and at 6, 12, 18, and 24 months after the first workshop.ResultsParticipant-level outcomes include survey results which indicated that participants’ self-efficacy in evidence-based practice (F(1,8.9) = 23.7, p = 0.001, n = 45), KT activities (F(1,23.9) = 43.2, p < 0.001, n = 45), and using evidence to inform practice increased over time (F(1,11.0) = 6.0, p = 0.03, n = 45). Interviews and focus groups illustrated that participants’ understanding of and confidence in using KT increased from baseline to 24 months after the workshop. Interviews and focus groups suggested that the training initiative helped participants achieve their KT project objectives, plan their projects, and solve problems over time. Contextual factors include teams with high self-reported organizational capacity and commitment to implement at the start of their project had buy-in from upper management that resulted in secured funding and resources for their project. Training initiative outcomes include participants who applied the KT knowledge and skills they learned to other projects by sharing their knowledge informally with coworkers. Sustained spread of KT practice was observed with five teams at 24 months.ConclusionsWe completed a longitudinal evaluation of a KT training initiative. Positive participant outcomes were sustained until 24 months after the initial workshop. Given the emphasis on implementing evidence and the need to train implementers, these findings are promising for future KT training.

‘Real Play Families’: a New Zealand case study

ABSTRACTThis case study examined the experiences of three New Zealand families selected to participate in a four-week ‘Real Play Families’ project. The overall aim of the project was to explore the issues faced when embedding traditional, unstructured, and largely unsupervised play practices in the modern family environment. The project commenced with an initial workshop day, including a two-hour information seminar for parents, real play activities for the children, and a combined debriefing session. Data from parent and child focus group interviews and social media postings were reviewed to generate a comprehensive, triangulated picture of the experiences of each family. The analysis focused on how the families derived meaning and value out of real play, drawing upon their initial perspectives, experiences, challenges, and post-project reflections. Our findings suggest that providing families with appropriate advice and social support around real play can prompt positive and rewarding outcomes for children and parents.

A Standard Nomenclature for Referencing and Authentication of Pluripotent Stem Cells.

Unambiguous cell line authentication is essential to avoid loss of association between data and cells. The risk for loss of references increases with the rapidity that new human pluripotent stem cell (hPSC) lines are generated, exchanged, and implemented. Ideally, a single name should be used as a generally applied reference for each cell line to access and unify cell-related information across publications, cell banks, cell registries, and databases and to ensure scientific reproducibility. We discuss the needs and requirements for such a unique identifier and implement a standard nomenclature for hPSCs, which can be automatically generated and registered by the human pluripotent stem cell registry (hPSCreg). To avoid ambiguities in PSC-line referencing, we strongly urge publishers to demand registration and use of the standard name when publishing research based on hPSC lines.

Assessment of the relationship between a written measure of empathy and an independently rated interview of Motivational Interviewing

Motivational Interviewing (MI) is an evidence-based practice shown to be effective when working with people in treatment for substance use disorders. However, MI is a complex treatment modality optimized by training with feedback. Feedback, assessment and monitoring of treatment fidelity require measurement, which is typically done using audiotaped sessions. The gold standard for such measurement of MI skill has been an audiotaped interview, scored by a rater with a detailed structured instrument such as the Motivational Interviewing Treatment Integrity 2.0 (MITI 2.0) Coding System (Moyers, et al., 2005). The Helpful Responses Questionnaire (HRQ) (Miller, Hedrick, & Orlofsky, 1991) is a pen-and-paper test of empathy (a foundational MI skill) that does not require an audiotaped session. A randomized trial of three different regimens for training counselors in MI (live supervision using Teleconferencing, Tape-based supervision and Workshop only) (Smith et al., 2012) offered the opportunity to evaluate the performance of the HRQ as a measure of MI ability, compared to the several MITI 2.0 global scores and subscales. Participants were counselors (N=97) working at community-based substance use treatment programs, whose MI proficiency was measured at four time points: baseline (before an initial 2-day MI workshop), post-workshop, 8weeks post-workshop (i.e., post-supervision), and 20weeks post-workshop with both MITI 2.0 and HRQ.HRQ total scores correlated significantly with the Reflection to Question Ratio from the MITI 2.0 at post-workshop (r=0.33), week 8 (r=0.34), and week 20 (r=0.38), and with the Spirit (r=0.32) and Empathy (r=0.32) global scores at week 20. Correlations of HRQ with other MITI 2.0 subscales and time points after workshop were small and not significant. As predicted, HRQ scores differed between training conditions (X2(2)=7.88, p=0.02), with counselors assigned to live supervision achieving better HRQ scores than those in Workshop only.In summary, HRQ is a modestly accurate measure, mainly of the Reflection to Question Ratio, considered a core marker of MI skill. It is sensitive to training effects and may help identify counselors needing more intensive supervision. Given its ease of administration and scoring, HRQ may be a useful marker of MI skill during training efforts.

“In Sundry Languages” Pleasure and Disorientation through Multilingual Melange

Now in the development phase of its third iteration, “In Sundry Languages” by Toronto Laboratory Theatre presents the language struggles of both new and established Toronto residents in eight different languages. Following rehearsals on and off throughout its year-long evolution, I have found it fascinating to see the progression from its initial workshop phase to its current period of refinement. The piece is based on the actual immigration or international experiences of its performing members. Each of their stories has contributed to the dramaturgical content of a series of twelve vignettes, which play with linguistic quirks, difficulties, and stereotypes. I initially participated as an actor-dramaturg in the earliest rehearsals (in April 2015) and had the opportunity to dabble in Russian, Cantonese, Mandarin, Persian, Korean, and Portuguese. Due to a scheduling conflict I was only part of the project for the first three weeks of a six-week development stage, which resulted in a public performance on May 15, 16 2015. I later caught up with director Art Babayants for an interview in February 2016 to learn about the second iteration of “In Sundry Languages” scheduled to run in early March, 2017 at the Luella Massey Studio Theatre (Toronto).

Report of the International Stem Cell Banking Initiative Workshop Activity: Current Hurdles and Progress in Seed-Stock Banking of Human Pluripotent Stem Cells.

This article summarizes the recent activity of the International Stem Cell Banking Initiative (ISCBI) held at the California Institute for Regenerative Medicine (CIRM) in California (June 26, 2016) and the Korean National Institutes for Health in Korea (October 19–20, 2016). Through the workshops, ISCBI is endeavoring to support a new paradigm for human medicine using pluripotent stem cells (hPSC) for cell therapies. Priority considerations for ISCBI include ensuring the safety and efficacy of a final cell therapy product and quality assured source materials, such as stem cells and primary donor cells. To these ends, ISCBI aims to promote global harmonization on quality and safety control of stem cells for research and the development of starting materials for cell therapies, with regular workshops involving hPSC banking centers, biologists, and regulatory bodies. Here, we provide a brief overview of two such recent activities, with summaries of key issues raised. Stem Cells Translational Medicine 2017;6:1956–1962

Opioid use in pregnancy and parenting: An Indigenous-based, collaborative framework for Northwestern Ontario.

Opioid use affects up to 30% of pregnancies in Northwestern Ontario. Health care providers in Northwestern Ontario have varying comfort levels providing care to substance-involved pregnant women. Furthermore, health care practitioners, social service agencies and community groups in Northwestern Ontario often work in isolation with little multidisciplinary communication and collaboration. This article describes two workshops that brought together health and social service providers, community organizations, as well as academic institutions and professional organizations involved in the care of substance-involved pregnant and parenting women. The initial workshop presented best practices and local experience in the management of opioid dependence in pregnancy while the second workshop asked participants to apply a local Indigenous worldview to the implementation of clinical, research and program priorities that were identified in the first workshop. Consensus statements developed by workshop participants identified improved transitions in care, facilitated access to buprenorphine treatment, stable funding models for addiction programs and a focus on Indigenous-led programming. Participants identified a critical need for a national strategy to address the effects of opioid use in pregnancy from a culturally safe, trauma-informed perspective that takes into account the health and well-being of the woman, her infant, her family and her community.

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Improvements in the delivery of resuscitation and newborn care after Helping Babies Breathe training.

To evaluate changes in neonatal resuscitation and postnatal care following Helping Babies Breathe (HBB) training at a community hospital in rural Honduras. We hypothesized that HBB training would improve resuscitation and essential newborn care interventions. Direct observation and video recording of delivery room care spanned before and after an initial HBB workshop held in August 2013. Rates of essential newborn care interventions were compared in resuscitations performed by individuals who had and had not received HBB training, and run charts recording performance of newborn care practices over time were developed. Ten percent of deliveries (N=250) were observed over the study period, with 156 newborn resuscitations performed by individuals without HBB training, compared to 94 resuscitations performed by HBB trainees. After HBB training, significant improvements were seen in skin-to-skin care, breastfeeding within 60 min of age, and delayed cord clamping after 1 min (all P<0.01). More babies cared for by HBB trainees received basic neonatal resuscitation such as drying and stimulation. Run charts tracking these practices over time showed significant improvements after HBB training that were sustained during the study period, but remained below ideal goals. With improvement in drying/stimulation practices, fewer babies required bag/mask ventilation. In a rural Honduran community hospital, improvements in basic neonatal resuscitation and postnatal essential newborn care practices can be seen after HBB training. Further improvements in newborn care practices may require focused quality improvement initiatives for hospitals to sustain high quality care.

A cluster randomised controlled trial of a staff-training intervention in residential units for people with long-term mental illness in Portugal: the PromQual trial.

This study aimed to assess the efficacy of a staff-training intervention to improve service users' engagement in activities and quality of care, by means of a cluster randomised controlled trial. All residential units with at least 12-h a day staff support (n=23) were invited to participate. Quality of care was assessed with the Quality Indicator for Rehabilitative Care (QuIRC) filled online by the unit's manager. Half the units (n=12) were randomly assigned to continue providing treatment as usual, and half (n=11) received a staff-training intervention that focused on skills for engaging service users in activities, with trainers working alongside staff to embed this learning in the service. The primary outcome was service users' level of activity (measured with the Time Use Diary), reassessed at 4 and 8 months. Secondary outcomes were the quality of care provided (QuIRC), and service users' quality of life (Manchester Short Assessment of Quality of Life) reassessed at 8 months. Generalized linear mixed effect models were used to assess the difference in outcomes between units in the two trial arms. The trial was registered with Current Controlled Trials (Ref NCT02366117). Knowledge acquired by the staff during the initial workshops increased significantly (p≤0.01). However, the intervention and comparison units did not differ significantly in primary and secondary outcomes at either follow-up. The intervention increased the level of knowledge of staff without leading to an improvement in service users' engagement in activities, quality of life, or quality of care in the units.

“Formulation wars”: a novel formulation curriculum for residents and faculty

Biopsychosocial formulation remains an important skill for both residents and faculty. If it is not taught early and adequately, then residents fail to develop this skill. Despite a number of evidence-based teaching tools, residents continue to voice concern about when and how formulation is being taught in training programs. A survey in Canada showed that residents were dissatisfied with the current “status quo”. Structured teaching was deemed important; as was hearing supervisors formulate. Small group teaching was valued and early exposure was also considered beneficial. The purpose of our paper is to demonstrate a novel technique for teaching biopsychosocial formulation to psychiatry residents of all training levels. We detail a workshop we developed for both residents and faculty that combines faculty formulations with small and large group work. We recognize that this initial workshop was a small first step in changing the culture of formulation teaching. More studies are needed to determine exactly which teaching methods should be employed in a more robust and structured formulation curriculum.

Stimulating Patient Engagement in Medical Device Development in Kidney Disease: A Report of a Kidney Health Initiative Workshop

New technologies challenge current dialysis treatment paradigms as devices become smaller, more portable, and increasingly used outside the dialysis clinic. It is unclear how patients will view this care transition, and it will be important to consider patient and care partner perspectives during all aspects of development for novel dialysis therapies, from design and clinical trials to regulatory approval. To gain insight into this area, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology, the US Food and Drug Administration, and nearly 80 member organizations and companies dedicated to enhancing patient safety and fostering innovation in kidney disease, convened a workshop of patients, care partners, and other kidney community stakeholders. The workshop included background presentations followed by focused small group discussions in 3 areas (device design, clinical trials, and regulatory approval). Participants explored how to involve patients throughout the life cycle of a medical device, including discussions of how patients can influence device design, assist in the planning and implementation of clinical trials, and provide input to affect regulatory decisions. Patients were engaged in the workshop discussion and interested in sharing their perspectives, but they recommended additional efforts around education, communication, and outreach in these areas.

Exploring why a complex intervention piloted in general practices did not result in an increase in chlamydia screening and diagnosis: a qualitative evaluation using the fidelity of implementation model

BackgroundChlamydia trachomatis (chlamydia) is the most commonly diagnosed sexually transmitted infection (STI) in England; approximately 70% of diagnoses are in sexually active young adults aged under 25. To facilitate opportunistic chlamydia screening in general practice, a complex intervention, based on a previously successful Chlamydia Intervention Randomised Trial (CIRT), was piloted in England. The modified intervention (3Cs and HIV) aimed to encourage general practice staff to routinely offer chlamydia testing to all 15–24 year olds regardless of the type of consultation. However, when the 3Cs (chlamydia screening, signposting to contraceptive services, free condoms) and HIV was offered to a large number of general practitioner (GP) surgeries across England, chlamydia screening was not significantly increased. This qualitative evaluation addresses the following aims:Explore why the modified intervention did not increase screening across all general practices.Suggest recommendations for future intervention implementation.MethodsPhone interviews were carried out with 26 practice staff, at least 5 months after their initial educational workshop, exploring their opinions on the workshop and intervention implementation in the real world setting. Interview transcripts were thematically analysed and further examined using the fidelity of implementation model.ResultsParticipants who attended had a positive attitude towards the workshops, but attendee numbers were low. Often, the intervention content, as detailed in the educational workshops, was not adhered to: practice staff were unaware of any on-going trainer support; computer prompts were only added to the female contraception template; patients were not encouraged to complete the test immediately; complete chlamydia kits were not always readily available to the clinicians; and videos and posters were not utilised. Staff reported that financial incentives, themselves, were not a motivator; competing priorities and time were identified as major barriers.ConclusionNot adhering to the exact intervention model may explain the lack of significant increases in chlamydia screening. To increase fidelity of implementation outside of Randomised Controlled Trial (RCT) conditions, and consequently, improve likelihood of increased screening, future public health interventions in general practices need to have: more specific action planning within the educational workshop; computer prompts added to systems and used; all staff attending the workshop; and on-going practice staff support with feedback of progress on screening and diagnosis rates fed back to all staff.

Introduction: Art and Religious Reform in Early Modern Europe

This introduction situates the essays of this special issue within current scholarship on art and religious reform in early modern Europe. The first section considers iconoclasm and the settlements reached in its aftermath, and emphasizes the richness and diversity of the Protestant and Catholic visual cultures that evolved alongside movements for religious reform. The second section considers the individual essays, and draws out common themes: the relationship between image and word; artists’ and patrons’ responses to new understandings of Christian history and soteriology; images’ role in the construction of confessional boundaries, but also their ability to transgress those boundaries. The introduction highlights the plurality of methodological approaches adopted by the contributors, which reminds us that although attention to the social and political contexts in which images were produced and received is an essential part of both historical and art-historical analysis, the power of art can never be fully captured through words.

What are the key elements of cognitive analytic therapy for psychosis? A Delphi study.

ObjectiveThere has been growing interest in the use of cognitive analytic therapy (CAT) with those facing experiences of psychosis. However, there is little research on how CAT is best applied to working with psychosis. This study aimed to identify what the key aspects of CAT for psychosis are or whether this approach requires adaptation when applied to those with experiences of psychosis, drawing on expert opinion.MethodAn adapted Delphi methodology was used. Items were generated during an initial workshop (N = 24) and then rated for agreement or importance via an online survey by a sample of experts with experience of CAT and working clinically with psychosis (N = 14).ResultsFollowing two rounds of ratings, consensus was reached on most items. Additional comments emphasized the need to be flexible with regard to the varying needs of individual clients.ConclusionsResults highlight the specific relational understanding of psychosis provided by CAT as one of the key elements of this approach. Responses emphasized the need for some level of adaptation to work with psychosis, including greater flexibility with regard to the treatment frame.Practitioner Points When working with experiences of psychosis, aspects of the CAT model, such as session length, pacing, and duration of therapy, are open to change and may require modification.When working with experiences of psychosis, narrative reformulation letters and sequential diagrammatic reformulation (SDR) remain essential to the therapy.This Delphi methodology study essentially relies on opinion. Further empirical research could test assumptions about the most important or therapeutically effective components of CAT in psychosis.CAT is still not widely used in the context of psychosis limiting the pool of experts available for the current sample.

Perspectives of Patients, Caregivers and Researchers on Research Priorities in Donation and Transplantation in Canada: A Pilot Workshop.

BackgroundIt is vitally important to seek input from key stakeholders to increase the quality and relevance of health-related research and accelerate its adoption into practice. Patients and caregivers have rarely been involved in setting research priorities in the transplantation and donation field. The objectives of this explorative study are: (i) to discuss research priorities within the Canadian National Transplant Research Program during a priority-setting exercise with patients, caregivers, organ donors and researchers and (ii) to compare the identified priorities with research published in 2 prestigious transplantation journals.MethodsA pilot workshop attended by 10 patients and caregivers and 5 researchers was held in Montréal (Quebec, Canada) in August 2014 to identify research priorities. Priorities were identified using a thematic analysis of the workshop transcription conducted by multiple coders. These priorities were compared with the topics of research articles published in 2 major transplantation journals between 2012 and 2014.ResultsThe themes of the 10 research priorities identified by study participants were related to different research domains: social, cultural, and environmental health factors (4); biomedical or clinical (4); and research about health systems and services (2). 26.7% of the research articles published were related to the identified priorities. Thirteen percent looked at ways to improve graft survival and 8.5% looked at the development of tolerance, 2 priorities identified by participants. Fewer than 5% examined the other 8 research priorities identified as important by workshop participants.ConclusionsThis is the first study reporting patients' and researchers' priorities in the field of transplantation and donation in Canada. There is a discrepancy between topics that key stakeholders find important and research published in 2 major transplantation journals. The research priorities identified during our initial workshop will be validated through a national survey and workshop.

Educational intervention to improve effectiveness in treatment and control of patients with high cardiovascular risk in low-resource settings in Argentina: study protocol of a cluster randomised controlled trial

IntroductionHypercholesterolaemia is estimated to cause 2.6 million deaths annually and one-third of the cases of ischaemic heart disease. In Argentina, the prevalence of hypercholesterolaemia increased between 2005 and 2013 from...

Summer Survival of Translocated Northern Bobwhite in the New Jersey Pine Barrens: Preliminary Results

Northern bobwhite (Colinus virginianus) have declined precipitously since the 1960s, largely due to habitat deterioration and changes in land use; some of the highest declines have been observed in the Mid-Atlantic States. In other regions, attempts to augment bobwhite populations have been relatively successful using translocation. As part of a long-term restocking program, focal areas for translocation in the mid-Atlantic region were identified by biologists at a National Bobwhite Conservation Initiative (NBCI) workshop. The objective of this project is to evaluate translocation to restore bobwhite populations in the New Jersey Pine Barrens, a focal area designated with a high ranking for potential bobwhite recovery. The study site, Pine Island Cranberry Co., is the largest privately owned land tract (>6,000 hectares) in New Jersey, with a mix of shortleaf pine (Pinus echinata), pitch pine (P. rigida), scrub oak (Quercus ilicifolia), and early successional forbes and grasses. For three consecutive years (2015—2017) prior to breeding season, we are translocating eighty radio-collared bobwhite (40 male, 40 female) from wild populations in southwest Georgia. These individuals are radio-located 3-5 times per week, year round. We are collecting microhabitat measurements (e.g., groundcover, understory, and canopy closure) and monitoring nests to characterize habitat use, nest site selection, and nest fate. Survival is estimated using staggered-entry Kaplan-Meier analyses and a Cox proportional hazard model in R to determine covariates of daily mortality. Six of 14 nests were successful in summer 2015 (66 known hatches), and 0 of 12 nests were successful in summer 2016. Snake depredation was the cause of 41.7% of failed nests in 2016. Preliminary analyses produce a five-month adult survival rate of 0.455 (SE = 0.138) for summer 2015 and 0.270 (SE = 0.0516) for 2016. Our planned third summer (2017) of data collection will increase our understanding of these disparate survival estimates.

Armónicos: sólidos platónicos como base de modelo didáctico de iniciación al proyecto en Arquitectura

The teaching of architecture is based on the integral formation of students through the project, in which the teaching learning process begins with an introduction to the form and to the three-dimensional space – to the human scale – as a proper matter of the discipline. In this research-action-teaching, we propose to create the basis for a new educational model for the initial workshop, taking as a reference the experience of two great masters of the 20th century: Frank Lloyd Wright and Le Corbusier, based on the geometry and the primary forms as a common nature of the structure of all things in the universe. For this we propose to strategically introduce an experimental unit where students learn how to get to know and apply fundamental notions of the forms by applying bio-tools and using platonic solids as primary or fundamental forms in the sacred or harmonic geometry, which incorporates the current biological basis and a holistic approach to the process of teaching-learning. After systematizing the experience we concluded that the use of fundamental solids and the development of the geometries of the second order in the project action, which we called game of the harmonics, allow developing progressively more complex actions of perception, manipulation and combination of form, materializing abstract ideas and creating spatial patterns in a particularly way in terms of composition-scale, material-technique and use-functionality. The model also allows that each part of the game of the project refers in a holistic way to the same fundamental structure, favoring in education a reconnection of students with their own nature, conscious of being part of the universal whole. Keywords: teaching, architectural project, initial workshop.