Multifaceted Training Program Research Articles

Effectiveness of a low-threshold physical activity intervention in residential aged care--results of a randomized controlled trial.

PurposeResearch on effectiveness of low-threshold mobility interventions that are viable for users of residential aged care is scarce. Low-threshold is defined as keeping demands on organizations (staff skills, costs) and participants (health status, discipline) rather low. The study explored the effectiveness of a multi-faceted, low-threshold physical activity program in three residential aged-care facilities in Austria. Main goals were enhancement of mobility by conducting a multi-faceted training program to foster occupational performance and thus improve different aspects of health-related quality of life (QoL).Participants and methodsThe program consisted of a weekly session of 60 minutes over a period of 20 weeks. A standardized assessment of mobility status and health-related QoL was applied before and after the intervention. A total of 222 of 276 participants completed the randomized controlled trial study (intervention group n=104, control group n=118; average age 84 years, 88% female).ResultsSubjective health status (EuroQoL-5 dimensions: P=0.001, d=0.36) improved significantly in the intervention group, and there were also positive trends in occupational performance (Canadian Occupational Performance Measure). No clear effects were found concerning the functional and cognitive measures applied.ConclusionThus, the low-threshold approach turned out to be effective primarily on subjective health-related QoL. This outcome could be a useful asset for organizations offering low-threshold physical activity interventions.

Feasibility and acceptability of a resilience training program for intensive care unit nurses.

The critical nursing shortage is particularly apparent in specialty areas such as intensive care units (ICUs). Some nurses develop resilient coping strategies and adapt to stressful work experiences, mitigating the development of common maladaptive psychological symptoms. To determine if a multimodal resilience training program for ICU nurses was feasible to perform and acceptable to the study participants. In a randomized and controlled 12-week intervention study, treatment and control groups completed demographic questions and measures of resilience, anxiety, depression, posttraumatic stress disorder (PTSD), and burnout syndrome before and after the intervention. The intervention included a 2-day educational workshop, written exposure sessions, event-triggered counseling sessions, mindfulness-based stress reduction exercises, and a protocolized aerobic exercise regimen. Nurses in the intervention arm also completed satisfaction surveys for each component of the intervention. This mulitmodal resilience training program was feasible to conduct and acceptable to ICU nurses. Both nurses randomized to the treatment group and nurses randomized to the control group showed a significant decrease in PTSD symptom score after the intervention. A multifaceted resilience training program for ICU nurses was both feasible and acceptable. A sufficiently powered, randomized clinical trial is needed to assess the effect of the intervention on improving individuals' level of resilience and improving psychological outcomes such as symptoms of anxiety, depression, burnout syndrome, and PTSD.

Integrative Approach to High-Performance Evaluation and Training: Illustrative Data of a Professional Boxer

This article describes a specific and unique performance enhancement training paradigm for an elite heavyweight boxer currently competitive and successful in his sport. The athlete was a 27-year-old male professional boxer. He participated in our multifaceted training program beginning in 2009, though he still actively participates to date. Extensive nutritional, sport psychology, and cortical functioning assessments were conducted at baseline. The results from the training program, as judged by objective data and self-report at posttraining evaluations, are discussed here. Among the many nutritional advantages he gained, the athlete was able to decrease his risk for coronary artery disease, increase lean mass, decrease unnecessary immune system strains, and decrease body fat percentage by 6%. With regard to his mental skills, the athlete offered self-report that he is able to narrow his focus to the objective at hand and stay in a calm frame of mind both before and during his competitive rounds. His brai...

Changes in insurance physicians' attitudes, self-efficacy, intention, and knowledge and skills regarding the guidelines for depression, following an implementation strategy.

Introduction To improve guideline adherence by insurance physicians (IPs), an implementation strategy was developed and investigated in a randomized controlled trial. This implementation strategy involved a multifaceted training programme for a group of IPs in applying the guidelines for depression. In this study we report the impact of the implementation strategy on the physicians’ attitude, intention, self-efficacy, and knowledge and skills as behavioural determinants of guideline adherence. Any links between these self-reported behavioural determinants and levels of guideline adherence were also determined. Methods Just before and 3 months after the implementation of the multifaceted training, a questionnaire designed to measure behavioural determinants on the basis of the ASE (attitude, social norm, self-efficacy) model was completed by the intervention (n = 21) and the control group (n = 19). Items of the questionnaire were grouped to form scales of ASE determinants. Internal consistency of the scales was calculated using Cronbach’s alphas. Differences between groups concerning changes in ASE determinants, and the association of these changes with improvements in guideline adherence, were analyzed using analysis of covariance. Results The internal consistency of the scales of ASE determinants proved to be sufficiently reliable, with Cronbach’s alphas of at least 0.70. At follow-up after 3 months, the IPs given the implementation strategy showed significant improvement over the IPs in the control group for all ASE determinants investigated. Changes in knowledge and skills were only weakly associated with improvements in guideline adherence. Conclusions The implementation strategy developed for insurance physicians can increase their attitude, intention, self-efficacy, and knowledge and skills when applying the guidelines for depression. These changes in behavioural determinants might indicate positive changes in IPs’ behaviour towards the use of the guidelines for depression. However, only changes in knowledge and skills related to the use of the guidelines were associated with improvements in IPs’ actual performance when applying the guidelines.Electronic supplementary materialThe online version of this article (doi:10.1007/s10926-012-9378-9) contains supplementary material, which is available to authorized users.

Effectiveness of a Multifaceted Cognitive Training Programme for People with Mild Cognitive Impairment: A One-Group Pre- and Posttest Design

Objectives The effectiveness of a cognitive training programme in enhancing the functional abilities of elderly persons with mild cognitive impairments was tested in an integrated home and institutional training programme focused on performing daily tasks. Methods Twenty elderly participants were taught cognitive stimulation and memory encoding strategies for 10 weeks by an occupational therapist, or by nonprofessionals and community caregivers. The programme consisted of attention and memory stimulation, association-based and imagery-based strategies. Functional assessment (Chinese version of the disability assessment for dementia instrument and the instrumental activities of daily living scale) and neuropsychological tests (digit span forward test, word list memory subtest of the neuropsychological test battery developed by the Consortium to Establish a Registry for Alzheimer's Disease, Cognistat) were administered before and after the programme. Results After the 10-week programme the participants showed significant improvements in average attention and memory. The participants showed improved memory (word list memory: p ≤ .001) and other cognitive function as measured by the naming (p ≤ .001), construction (p ≤ .001), memory (p ≤ .001) and similarities (p ≤ .001) subtests of the Cognistat. Conclusion These results provide initial evidence supporting the use of daily tasks as the context in teaching cognitive stimulation and memory encoding strategies to mildly impaired elderly people.

Impact of a multi‐faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute‐care geriatric wards and physical rehabilitation units

To assess the impact of a multi-faceted training program on the compliance with hand hygiene and gloving practices. Hand hygiene is considered as the cornerstone of the prevention of hospital-acquired infections. Several studies have enhanced the poor effectiveness of training programs in improving hand hygiene compliance. A before-after evaluation study. The study was conducted in four healthcare settings before and after an intervention program which included the performance feedback of the first evaluation phase, three six-h training sessions, the assessment of hand hygiene performance with teaching boxes and the organisation of one full-day session devoted to institutional communication around hand hygiene in each setting. Hand hygiene compliance and quality of hand rubbing were evaluated. Hand hygiene opportunities were differentiated into extra-series opportunities (before or after a single contact and before the first contact or after the last contact of a series of consecutive contacts) and intra-series opportunities (from the opportunity following the first contact to the opportunity preceding the last in the same series). Overall, 969 contacts corresponding to 1,470 hand hygiene opportunities (760 during the first phase and 710 during the second) were observed. A significant improvement of observed practices was recorded for the hand hygiene compliance in intra-series opportunities (39·0% vs. 19·0%; p < 10(-5) ), the proportion of gloves worn if indicated (71·4% vs. 52·0%; p < 0·001) and the quality of hand rubbing (85·0% vs. 71·9%; p < 10(-5) ). Some of the performances measured for both hand hygiene and gloving practices were improved. We plan to extend this investigation by performing a qualitative study with experts in behavioural sciences to try improving practices for which adherence was still weak after the training program such as hand hygiene in intra-series opportunities. This study underscored the usefulness of implementing contextualised training programs, while more traditional courses have shown little impact.

Facilitators and barriers for implementation of an easy, care-based Dementia Training Programme for general practitioners and primary care nurses: A qualitative study

Dementia is under-diagnosed in primary care. To overcome this problem, we designed a multi-faceted Dementia Training Programme (DTP) for dyads of general practitioners (GPs) and primary care nurses (PCNs), aimed at the implementation of Dutch national dementia guidelines. The objective of this study is to identify successful elements of the DTP and barriers for its implementation. The DTP consisted of two workshops, individual coaching on real-life cases, access to an internet forum, and a computerized clinical decision support system. Two independent researchers interviewed a selected sample of 10 GPs and 12 nurses who participated in the DTP. Interviews were analysed using the grounded theory approach. Analysis revealed three important successful elements of the DTP: learning based on real-life cases, structured protocols and collaboration. Learning based on real-life cases facilitated knowledge and skills sinking in. It made participants understand the importance of early dementia diagnosis and adequate disclosure. Furthermore, it increased awareness to signals of possible dementia and generated insight into possible therapeutic options for dementia patients and their caregivers, thereby reducing the feeling of therapeutic nihilism. The structured diagnostic protocols provided in the DTP, made GPs feel competent to diagnose dementia. Nurses appreciated the fact the protocols gave them a role in diagnostic workup. When collaborating, GPs and nurses felt that they obtained an overall picture of both patient and caregiver, learning from each others views and skills, which improved the quality of the diagnostic and care process. Most GPs stated that they could not perform adequate diagnostic work-up and management without the help of a nurse. Barriers for implementation of primary care dementia guidelines, using the DTP, were the time consuming nature of dementia care, the lack of adequate financial compensation by insurance companies for the care provided and the lack of interdisciplinary collaboration with other health care providers. The DTP's successful elements, learning based on real-life cases, structured protocols, and collaboration, seem to change attitudes, diagnosis and management in primary dementia care. Barriers to implementation of dementia guidelines are lack of time, of financial compensation and of interdisciplinary collaboration. Policy makers could play an important role in overcoming these barriers.

Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial

BackgroundEarly diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP) aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses.MethodsThe DTP is a complex educational intervention that consists of two workshops, a coaching program, access to an internet forum, and a Computerized Clinical Decision Support System on dementia diagnostics. One hundred duos of GPs and nurses will be recruited, from which 2/3 will be allocated to the intervention group and 1/3 to the control group. The effects of implementation of the DTP will be studied in a cluster-randomised controlled trial. Primary outcomes will be the number of cognitive assessments and dementia diagnoses in a period of 9 months following workshop participation. Secondary outcomes are measured on GP and nurse level: adherence to national guidelines for dementia, attitude, confidence and knowledge regarding dementia diagnosis and management; on patient level: number of emergency calls, visits and consultations and patient satisfaction; and on caregiver level: informal caregiver burden and satisfaction. Data will be collected from GPs' electronic medical records, self-registration forms and questionnaires. Statistical analysis will be performed using the MANOVA-method. Also, exploratory analyses will be performed, in order to gain insight into barriers and facilitators for implementation and the possible causal relations between the rate of success of the intervention components and the outcomes.DiscussionWe developed multifaceted dementia training programme. Novelties in this programme are the training in fixed collaborative duos and the inclusion of an individual coaching program. The intervention is designed according to international guidelines and educational standards. Exploratory analysis will reveal its successful elements. Selection bias and contamination may be threats to the reliability of future results of this trial. Nevertheless, the results of this trial may provide useful information for policy makers and developers of continuing medical education.Trial registrationClinicalTrials.gov ID NCT00459784

Routine HIV testing in the context of syndromic management of sexually transmitted infections: outcomes of the first phase of a training programme in Botswana

Objective:In 2004, the Ministry of Health adopted revised protocols for the syndromic management of sexually transmitted infections (STI) that included routine HIV testing. A training programme for providers was developed...

A knowledge environment for the biodiversity and ecological sciences

The Science Environment for Ecological Knowledge (SEEK) is a knowledge environment that is being developed to address many of the current challenges associated with data accessibility and integration in the biodiversity and ecological sciences. The SEEK information technology infrastructure encompasses three integrated systems: (1) EcoGrid--an open architecture for data access; (2) a Semantic Mediation System based on domain-specific ontologies; and (3) an Analysis and Modeling System that supports semantically integrated analytical workflows. Multidisciplinary scientists and programmers from multiple institutions comprise the core development team. SEEK design and development are informed by three multidisciplinary teams of scientists organized in Working Groups. The Biodiversity and Ecological Analysis and Modeling Working Group informs development through evaluation of SEEK efficacy in addressing biodiversity and ecological questions. The Knowledge Representation Working Group provides knowledge representation requirements from the domain sciences and develops the corresponding knowledge representations (ontologies) to support the assembly of analytical workflows in the Analysis and Modeling System, and the intelligent data and service discovery in the EcoGrid. A Biological Classification and Nomenclature Working Group investigates solutions to mediating among multiple taxonomies for naming organisms. A multifaceted education, outreach and training program ensures that the SEEK research products, software, and information technology infrastructure optimally benefit the target communities.

Asian Tobacco Education and Cancer Awareness Research Special Population Network

Asian Americans are the fastest growing and the second largest foreign-born ethnic group in the United States. Cancer is a leading cause of death among Asian Americans. The Asian Tobacco Education and Cancer Awareness Research (ATECAR) Special Population Network, Center for Asian Health, aimed to reduce or eliminate cancer health disparities in these diverse, underserved populations in Pennsylvania, New Jersey, Delaware, and New York. The ATECAR logic model was adapted from a variety of conceptual frameworks to develop and implement the network's multifaceted cancer health disparities research, training, awareness, and outreach programs. The model was the basis for the developmental phases of the network that included (1) needs assessment, infrastructure, and partnership building; (2) intervention research, training, and mentorship; and (3) evaluation, dissemination, and diffusion. Community involvement occurred at every operational level to ensure program and network sustainability. Between 2000 and 2005, the ATECAR network consisted of 88 partners, representing a cross-section of Asian communities, academia, cancer centers, and health service agencies, ensuring a viable infrastructure for the network's multidimensional cancer health disparities programs. ATECAR's research covered tobacco control, cancer prevention and intervention, and clinical trials. More than 22 research projects were conducted and their results disseminated in peer-reviewed journals. ATECAR also trained 76 junior researchers and special population investigators and 1014 community professionals in disparity issues. ATECAR's multimedia cancer awareness education program reached over 116,000 Asians. The ATECAR network's achievements have had a profound impact on Asian Americans and established a trend toward reducing cancer health disparities, especially among underserved Asian Americans. Cancer 2006. (c) 2006 American Cancer Society.

Emergency Preparedness Volunteer Training Program

The Vermont Department of Health (VDH) does not have sufficient personnel to fully staff a mass prophylaxis or vaccination clinic in response to a natural or man-made disease outbreak. Therefore, the VDH developed an emergency preparedness volunteer training program with three primary goals: to include both background information about public health and emergency preparedness and a hands-on training for clinic volunteers; to be adaptable for both community and healthcare professional volunteers; and to examine local emergencies and the VDH public health response to these events. Major components of the training program include basic public health goals and capacities; an introduction to emergency preparedness; a role-playing exercise using Job Action Sheets to simulate "just-in-time" training; and guidance for personal and family preparedness. The VDH has experienced difficulty finding and recruiting volunteers. To increase the potential volunteer pool, it will be implementing a multifaceted training program (on-line, through the mail, in person) to most effectively engage volunteers with varying interests and learning styles. The VDH must also develop a system to maintain regular contact with volunteers and clarify regulations regarding their scope of practice and liability.

A randomised controlled trial of brief training in assessment and treatment of somatisation: effects on GPs' attitudes

Somatising patients frequently present in primary care but GPs often express frustration in dealing with them. A negative attitude may result in missed diagnoses and ineffective treatment. This study aimed to evaluate the effect of a novel, multifaceted training programme on GPs' attitudes towards somatisation. The study was performed as a cluster randomised controlled trial with practices as randomisation unit and with a follow-up period of 12 months. Forty-three GPs from 27 practices in Vejle County, Denmark participated. The intervention consisted of a cognitive-oriented educational programme on assessment, treatment and management of somatisation (The Extended Reattribution and Management Model). Outcome measures were GPs' attitudes toward somatoform disorder and somatisation in general measured by the means of questionnaires at baseline and follow-up. The primary outcome was a change in response. Baseline values confirmed previous findings that GPs find it difficult to deal with somatising patients. Compared with the control doctors, intervention doctors' attitudes towards patients with somatoform disorders had changed significantly 12 months after training on the parameters enjoyment (P = 0.008) and anxiety (P = 0.002). Doctors also felt more comfortable in dealing with somatising patients in general (P = 0.002). Attitudes about other parameters related to the doctors feelings, aetiology and course of somatisation changed in the expected direction, but these changes were not statistically significant. A brief multifaceted training programme focussing on somatisation was accompanied by a significant change in GPs' attitude towards patients with somatoform disorders.

Sensory and Cognitive Factors Influencing Functional Ability in Older Adults

Background: Age-related sensory and cognitive impairments have been related to functional performance in older adults. With regard to cognitive abilities, processing speed in particular may be strongly related to older adults’ abilities to perform everyday tasks. Identifying and comparing cognitive correlates of functional performance is particularly important in order to design interventions to promote independence and prevent functional disability. Objective: The present study examined the relative importance of cognitive (specifically, speeded and nonspeeded) and sensory factors in relation to older adults’ functional abilities. Functional abilities included measures of mobility and performance of everyday activities. Methods: A cross-sectional study design was employed. Five hundred and thirty adults between the ages of 62 and 94 completed measures of sensory, cognitive (including processing speed, attention, memory, intelligence) and functional abilities. Results: Overall, functional performance was most strongly associated with cognitive speed performance, but nonspeeded cognitive and sensory abilities also accounted for significant amounts of variance in functional performance. Age explained a small but statistically significant amount of additional variance in some functional abilities, but no additional variance in self-reported mobility measures. Conclusion: These findings point to the potential impact of multifaceted training programs, targeting both sensory and cognitive abilities for maintaining functional abilities.

Integrated Obstetric Curriculum for Obstetrics and Gynecology Residency, Radiology Residency and Maternal-Fetal Medicine Fellowship program at an accredited American Institute of Ultrasound in Medicine Diagnostic Ultrasound Center.

The purpose of this work was to demonstrate the approach to developing an integrated curriculum for obstetric ultrasound training by utilizing an accredited American Institute of Ultrasound in Medicine teaching platform. During the 1996-98 academic years, the American College of Obstetricians and Gynecologists and American Institute of Ultrasound in Medicine guidelines for ultrasound performance and training were integrated into a multifaceted training program for obstetric and radiological residents and maternal-fetal medicine fellows consisting of a structured reading program, self study of a 35-mm slide program of normal/abnormal anatomy, a basic ultrasound and fetal echocardiography interactive CD program, hands-on supervised scanning program and practical and certificate-bearing fetal echocardiography courses for fellows. All obstetric residents were given pretests and post-tests to measure learning performance in the program. The results from these tests were analyzed for statistical significance. Thirteen obstetric residents completed the training program. The locally developed pretest showed a mean of 16/40 correct questions with an SD of 1.85. After completing the training, the mean obstetric resident scores on the post-test were 32/40 with an SD of 5.9. This difference was statistically significantly different, P < 0.009. Radiology residents showed an improvement from no residents passing the obstetric ultrasound portion on the 1996 Radiology Boards to 100% pass rate in 1997 (four residents per year) after completing the course. Maternal-fetal medicine fellows progressed from inability to perform acceptable fetal echocardiography to full ability to perform fetal echocardiographic examinations. An integrated approach to obstetric ultrasound training for obstetric and radiologic residents and maternal-fetal medicine fellows with multifaceted learning methods is easily achieved with available guidance from the American College of Obstetricians and Gynecologists and American Institute of Ultrasound in Medicine.

Practical training for postgraduate year 1 surgery residents

Background: Surgical interns accept significant patient care responsibilities with minimal orientation. We have developed a multifaceted training program for incoming surgical interns in which learning in a simulated environment plays a key role. The purpose of this study was to evaluate resident perceptions of simulated clinical calls as an educational modality and to measure the effect on self-ratings of confidence. Methods: A multidisciplinary team compiled 15 clinical scenarios. Simulated nurse-to-resident clinical call sessions were held on 3 separate days. Daily course evaluation surveys and identical precourse and postcourse confidence surveys were completed. Results: The resident confidence measure increased significantly postcourse (6.73 versus 8.35, P <0.03). The evaluation survey score averaged 4.35 out of 5. Conclusions: Simulated clinical call sessions were well received and resulted in a significant increase in resident confidence levels. Based on this modality’s apparent efficacy and ease of implementation, we offer it as a useful educational tool for incoming postgraduate year-1 surgical residents.

Review of social–cognitive problem-solving interventions with children.

This article critically reviews training studies of interpersonal problem solving, family problem solving, verbally mediated self-control applied to social behavior, and social perspective taking with children. Treatment procedures are described, and the outcome data are examined. Although some encouraging results have been reported, the need for assessments of behavioral adjustment, for better control group procedures, and for more long-term follow-up reports are particularly noted. The discussion also considers the need to examine specific deficits in social-cognit ive abilities, the similarities across different training programs, and the need for analysis of the active treatment ingredients in multifaceted training programs. Although it seems reasonable to assert that a child's positive mental health is related to the way he or she resolves the social/interpersonal problems that arise in day-to-day living, there has been surprisingly little systematic research into the processes concerning how children think when confronted with personal and interpersonal problems. Until recently, research into human problem-solv