Multimodal Training Program Research Articles

Multimodal Lung and Sternal Ultrasound Education Program for Cardiothoracic Nurses and Physiotherapists

Point-of-Care lung and sternal ultrasound is emerging as an assessment tool that informs timely clinical management within nursing and physiotherapy. We implemented a multimodal training program combining knowledge, simulation, and mentored practice to optimise translation into practice.

The effect of multimodal comprehensive care methodology training on oral health care professionals’ empathy for patients with dementia

AbstractBackgroundThe prevalence of oral diseases in people with dementia has increased, and such patients have worse oral health than do people without dementia. However, in the provision of oral care, they often exhibit care‐resistant behaviours. Empathy is an important element of health care professionals who provide dental care for people with dementia. A study was conducted to assess whether a multimodal comprehensive care methodology training programme is associated with an improvement in empathy for people with dementia among oral health care professionals.MethodsThis research was a pre‐post prospective study. A total of 45 dentists and dental hygienists participated in a 7‐hour multimodal comprehensive care methodology training programme. The empathy of the participants for their patients was evaluated by the Jefferson Scale of Physician Empathy‐Health Professionals Version (JSPE‐HP) before and one month after the training (primary outcome). Each participant listed 3 patients from his or her clinical practice about whom he or she felt that providing dental care to them was difficult due to dementia. The oral health of the 3 patients refusing care provided by each participant was evaluated by the Oral Health Assessment Tool (OHAT) before and one month after the training (secondary outcome).ResultsThe post‐training response rates were 87% (21 dentists, 18 dental hygienists). Over the course of the programme, the multimodal comprehensive care methodology training significantly increased the empathy score from pre‐training to post‐training (from 113.97 to 122.95, P<0.05, effect size=0.9). Regardless of gender, profession and years of clinical experience, all post‐training subgroup scores were higher than the pre‐training subgroup scores. The oral health of patients, as assessed by the OHAT, was significantly improved compared with their oral health before the training (from 6.54 to 5.71, P<0.05).ConclusionsMultimodal comprehensive care methodology training was associated with an improvement in oral health professionals’ empathy for patients with dementia and an improvement in the oral health of their patients.

Training improves the handling of inhaler devices and reduces the severity of symptoms in geriatric patients suffering from chronic-obstructive pulmonary disease

PurposeElderly patients with impaired vision, cognitive decline or motor/sensory disturbances of their fingers suffering from chronic-obstructive pulmonary disease (COPD) encounter difficulties in handling inhaler devices used as the cornerstones of treatment of pulmonary obstruction. Many elderly patients make severe mistakes which impede adequate drug delivery to the bronchioles. This multimodal training program was designed to reduce the number of handling mistakes of inhaler devices.MethodsFrom October 1, 2016 to September 30, 2017, a prospective intervention study was conducted in 38 in-patients > 65 years (median age 79 years) with previously diagnosed COPD. The effect of an 8-day intervention comprising daily counselling and video demonstration according to the recommendations of the German Airway League on the frequency of mistakes during handling of inhaler devices, the forced expiratory volume in 1 s (FEV1), the forced vital capacity (FVC) and the perception of symptoms (COPD Assessment Test, CAT) were studied. Measurements on days 1 and 8 were compared by Wilcoxon signed rank test.ResultsThe number of handling mistakes per patient decreased as a consequence of the intervention from 3.0 (0–7) to 0.5 (0–6) [median (minimum-maximum; p < 0.0001)]. The CAT Score decreased from 19.5 (14/24) to 14.5 (10.75/21) [median (25./75. percentile; p < 0.0001) indicating a substantial reduction of clinical symptoms. Conversely, FEV1 and FVC only slightly increased (difference statistically not significant). At study entry, the number of handling mistakes was inversely correlated with the Mini Mental Status Test (MMST) score (p = 0.01). The reduction of the number of handling mistakes during the intervention was not correlated with the MMST.ConclusionIn COPD, intensive training for 8 days improved the handling of inhalers and reduced clinical symptoms in geriatric patients. Patients with cognitive abnormalities also benefitted from this intervention.Trial registrationGerman Clinical Trials Registry DRKS00023196, date of registration September 29, 2020 (retrospectively registered).

Taking Youth Suicide Prevention to the Schools: Pilot Evaluation of School-Based Clinician Outcomes and Perspectives of a Multi-Modal Program Including Post-Training Online Consultations for Management of Ongoing Suicide Risk

School-based youth-specific suicide prevention and early intervention initiatives are presently underdeveloped. The current study conducted a pilot evaluation of a multi-modal suicide prevention training program for school-based social workers, ‘Management of Youth Suicidality Training for Schools’ (MYSTS). The program comprised a two-day workshop and six fortnightly post-workshop webinar online consultations. Participants were 36 social workers (years’ experience M = 11.23, SD = 8.29) employed by the Department of Education in Tasmania, Australia. Outcomes were self-rated confidence, competence, and knowledge of self-harm in young people, and attitudes toward suicide prevention and suicide-related behaviors. Exploratory quantitative results indicated significant improvements with large effect sizes for participants’ self-reported competence (d = 1.33), and confidence (d = 1.29) to identify and respond therapeutically to youth suicidality following the workshop. Confidence remained significantly higher than baseline following the online consultations (d = 0.90). Qualitative analysis of online supervision consultations indicated key themes of accessibility, communication and information sharing, and clinical management. Participants endorsed the MYSTS package as well-presented, with relevant topics, and effective learning activities. This study highlights the need for continued supervisory or implementation support to practitioners following suicide prevention training initiatives and suggests web-based teleconference technology as a feasible strategy for this. Further evaluation of the MYSTS package, including a suitable comparison or control condition, is indicated.

The effectiveness of two different multimodal training modes on physical performance in elderly.

The study compared the effect of 12-week multimodal training programme performed twice a week at the regular exercise facility (REF) with the 12-week multimodal training programme performed three times per week as a part of the research programme (EX). Additionally, the study analysed how the experimental training programme affect the physical performance of cognitive healthy and mild cognitive impaired elderly (MCI). The REF training group included 19 elderly (65.00±3.62 years). The experimental training programme combined cognitively healthy (EXH: n=16; 66.3±6.42 years) and age-matched individuals with MCI (EXMCI: n=14; 66.00±4.79 years). 10m maximal walking speed (10mMWS), Five Times Sit-to-Stand Test (FTSS), maximal and relative voluntary contraction (MVC & rel. MVC) were analysed. The REF group improved in 10mMWS (t=2.431, p=.026), the MVC (t=-3.528, p=.002) and relative MVC (t=3.553, p=.002). The EXH group improved in FTSS (t=5.210, P=.000), MVC (t=2.771, p=.018) and relative MVC (t=-3.793, p=.004). EXMCI improved in FTSS (t=2.936, p=.012) and MVC (t=-2.276, p=.040). According to results, both training programmes sufficiently improved walking speed and muscle strength in cognitively healthy elderly. Moreover, the experimental training programme improved muscle strength in MCI elderly.

Development and early outcomes of the national training initiative for transanal total mesorectal excision in the UK.

Transanal total mesorectal excision (TaTME) has attracted substantial interest amongst colorectal surgeons but its technical challenges may underlie the early reports of visceral injuries and oncological concerns. The aim of this study was to report on the feasibility, development and the outcome of the national pilot training initiative for TaTME-UK. TaTME-UK was successfully launched in September 2017 in partnership with the healthcare industry and endorsed by the Association of Coloproctology of Great Britain and Ireland. This multi-modal training curriculum consisted of three phases: (i) set-up; (ii) selection of pilot sites; and (iii) formal proctorship programme. Bespoke Global Assessment Scoring (GAS) forms were designed and completed by both trainees and mentors. Data were collected on patient demographics, tumour characteristics and perioperative clinical and histological outcomes. Twenty-four proctored cases were performed by 10 colorectal surgeons from five selected pilot sites. Median operative time was 331±90 (195-610) min which was reduced to 283±62 (195-340) min in the final case. Independent performance (GAS score of 5) was achieved for most operative steps by case 5. There was one conversion (4.2%), but no visceral injuries. Pathological data confirmed no bowel perforation and intact quality of the mesorectal TME specimens with clear distal margin in all cases and circumferential margins in 23/24 cases (96%). This exploratory study demonstrates acceptable early outcomes in a small cohort suggesting that a competency-based multi-modal training programme for TaTME can be feasible and safe to implement at a national level.

An integrated surgical training program for hepatic cystic echinococcosis in Xinjiang of China.

BackgroundHuman cystic echinococcosis (CE) is one of the commonest zoonoses, and it is endemic in many parts of the world including China. Complications and recurrences after the surgical treatment of hepatic CE (HCE) incur a large personal, healthcare, and societal burden. There has been some progress in HCE prevention, diagnosis, and treatment, but there is no “one size fits all” approach, and surgery still remains the cornerstone of treatment for some cyst stages and locations or in areas with little knowledge or access to other treatment modalities. In 2009 we designed and implemented a program to improve surgical outcomes from HCE in Xinjiang province, China.Methodology/Principal findingsA multimodal HCE training program was implemented in eleven primary hospitals in Xinjiang province, China, which provided education and training on HCE clinical knowledge and practice, the application of diagnostic and treatment options, and optimal surgery. The management of HCE cases was analyzed before and after program implementation. Contrast enhanced CT use, application of scoloicidal agents, removal of necrotic cyst wall remnants, appropriate perioperative drug use, and the use of optimal surgical approach increased after program implementation. Further, postoperative recurrences and residual cavity complications creased from 7.4% to 1.3% and 15.2% to 9.0% after program implementation, respectively.Conclusions/SignificanceTis integrated surgical training program is useful for improving outcomes of patients with HCE and can be used in institutions in other endemic areas.

Evaluation of a Multimodal Resuscitation Program and Comparison of Mouth-to-Mouth and Bag-Mask Ventilation by Relatives of Children With Chronic Diseases.

Children with chronic critical illness are at higher risk for cardiopulmonary arrests. Before chronically ill children are discharged from hospital, family members receive training in basic life support at many institutions. We evaluated whether a multimodal training program is able to teach adherence to current resuscitation guidelines and whether laypersons can be trained to perform both bag-mask ventilation and mouth-to-mouth ventilation equally effective in infants. Prospective observational study. Pediatric critical care unit of a tertiary referral center. Relatives of children with chronic illness prior to discharge from hospital. Multimodal emergency and cardiopulmonary resuscitation training program. Following participation in our cardiopulmonary resuscitation training program 56 participants performed 112 simulated cardiopulmonary resuscitations (56 with mouth-to-mouth ventilation, 56 with bag-mask ventilation). Nearly all participants checked for consciousness and breathing. Shouting for help and activation of the emergency response system was only performed in half of the cases. There was almost full adherence to the resuscitation guidelines regarding number of chest compressions, chest compression rate, compression depth, full chest recoil, and duration of interruption of chest compression for rescue breaths. The comparison of mouth-to-mouth ventilation and bag-mask ventilation revealed no significant differences regarding the rate of successful ventilation (mouth-to-mouth ventilation: 77.1% ± 39.6%, bag-mask ventilation: 80.4% ± 38.0%; p = 0.39) and the cardiopulmonary resuscitation performance. A standardized multimodal cardiopulmonary resuscitation training program for family members of chronically ill children is effective to teach good cardiopulmonary resuscitation performance and adherence to resuscitation guidelines. Laypersons could be successfully trained to equally perform mouth-to-mouth and bag-mask ventilation technique.

The Effect of Exercise Timing on Glycemic Control: A Randomized Clinical Trial.

This study sought to determine the effect of diurnal exercise timing on glycemic control in individuals enrolled in a 12-wk supervised multimodal exercise training program. A secondary aim was to determine the effect of diurnal exercise timing on the circadian rhythm of wrist skin temperature. Forty sedentary, overweight adults (mean ± SD, age = 51 ± 13 yr; body mass index = 30.9 ± 4.2 kg·m; women, n = 23) with and without (n = 20) T2D diagnosis were randomly allocated to either a morning (amEX) or an evening (pmEX) exercise training group. The supervised 12-wk (3 d·wk) program, comprised 30 min of moderate-intensity walking and 4 resistance-based exercises (3 sets, 12-18 repetitions each). Glycemic outcomes (glycated hemoglobin, fasting glucose, postprandial glucose) and wrist skin temperature were assessed at baseline and postintervention. Exercise training improved (main effect of time, all P < 0.01) all glycemic outcomes; however, this was independent of allocation to either the amEX (Hedge's g, 0.23-0.90) or the pmEX (Hedge's g, 0.16-0.90) group. Accordingly, the adopted exercise training program did not alter the circadian rhythm of skin temperature. When only T2D individuals were compared, amEX demonstrated greater effects (all Hedge's g) on glycated hemoglobin (amEX, 0.57; pmEX, 0.32), fasting glucose (amEX, 0.91; pmEX, 0.53), and postprandial glucose (amEX, 1.12; pmEX, 0.71) but was not statistically different. Twelve weeks of multimodal exercise training improved glycemic control and postprandial glycemic responses in overweight non-T2D and T2D individuals. However, no distinct glycemic benefits or alterations in circadian rhythm were associated with morning versus evening exercise, when performed three times per week in this cohort.

Study protocol of a randomized controlled trial of home-based computerized executive function training for children with cerebral palsy

BackgroundCerebral palsy (CP) is frequently associated with specific cognitive impairments, such as executive dysfunction which are related to participation and quality of life (QOL). The proposed study will examine whether a computerized executive function (EF) training programme could provide superior benefits for executive functioning, participation, QOL and brain plasticity, as compared to usual care.MethodsA single-blind randomized controlled trial (RCT) design will be performed. Thirty children with CP aged 8 to 12 years will participate in a home-based computerized multi-modal executive training programme (12 weeks, 5 days a week, 30 min a day training, total dose = 30 h). Thirty children with CP matched by age, sex, motor and intelligence quotient (IQ) will compose the waitlist group. Cognitive, behavioural, emotional, participation and QOL measures will be obtained at three time points: before, immediately after and 9 months after completing the training. Additionally, structural and functional (resting state) magnetic resonance images (MRI) will be obtained in a subsample of 15 children from each group. Outcomes between groups will be compared following standard principles for RCTs.DiscussionThe study will test whether the cognitive training programme exerts a positive effect not only on neuropsychological and daily functioning of children with CP but also on other measures such as participation and QOL. We will also use brain MRI to test brain functional and structural changes after the intervention.If this on-line and home-based training programme proves effective, it could be a cost-effective intervention with short- and long-term effects on EF, participation or QOL in CP.Trial registrationClinicalTrials.gov: NCT04025749. Registered 19 July 2019. Retrospectively registered.

A 12-Week Multi-Modal Exercise Program: Feasibility of Combined Exercise and Simplified 8-Style Tai Chi Following Lung Cancer Surgery.

Objective:To assess the feasibility, safety, and preliminary effect of a 12-week multi-modal rehabilitation program targeted at improving health-related quality of life and physical activity levels of patients with lung cancer following treatment.Methods:Patients with stage I to IIIA non-small cell lung cancer were included 6 to 12 weeks following completion of treatment. The intervention comprised of aerobic exercise (brisk walking), resistance training and 8-style Tai Chi. The 12-week program included 2 supervised center-based sessions per week of 90 minutes duration and home-based exercise. The primary outcomes were the feasibility and safety of the intervention. Secondary outcomes (assessed pre and post program) were physical and patient-reported outcomes.Results:Seventy-eight patients were approached during the 6-month recruitment period and 17 (22%) consented to the study. Eight participants (47%) met the definition of adherence to the program (attending at least 70% of supervised sessions). No serious adverse events occurred. A significant reduction in anxiety and depression was observed post-program. In addition, improvements in respiratory function, sleep quality, and some health-related quality of life domains were observed post-program. There were no significant differences in functional capacity or physical activity levels.Conclusion:This multi-modal exercise training program was safe, although the feasibility of the program in its current state is not supported given the low consent rate and low adherence to the intervention.

Specific Health Knowledge and Health Literacy of Patients before and after Bariatric Surgery: A Cross-Sectional Study

Background: It is an important condition for adequate weight loss and prevention of adverse events that bariatric surgery (BS) candidates possess good specific health knowledge. There is a paucity of standardized instruments to evaluate the specific health knowledge of patients before and after BS. Therefore, we developed a 32-item multiple-choice test covering the main aspects of life which are important after BS, and investigated the correlation of specific health knowledge with health literacy, level of depression and anxiety, percentage of excess weight loss, and specific complications of BS in postoperative patients. Methods: Two groups participated in the cross-sectional study: the preoperative group (n = 109) was recruited from candidates for BS (gastric bypass or sleeve gastrectomy), the postoperative group (n = 110) was recruited from patients 12–74 months after BS (average 33 months, SD = 16.5). Both groups had completed a preoperative multimodal training program. Specific health knowledge was assessed with a newly developed knowledge questionnaire. Health literacy was evaluated with the short version of the European Health Literacy Survey (HLS-EU-Q16). The 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Scale (GAD-7) were used to assess the levels of depression and anxiety. Results: The pre- and postoperative group did not differ with regard to the number of correctly answered questions on the knowledge questionnaire, with 75% correct answers in both groups (p = 0.059). No correlations were found with health literacy (p = 0.498) and levels of depression (preoperative group: p = 0.279; postoperative group: p = 0.242) and anxiety (preoperative group: p = 0.866; postoperative group: p = 0.119). In postoperative patients specific health knowledge was not associated with the weight loss achieved (p = 0.437). Conclusion: The newly designed knowledge questionnaire can be useful for screening specific knowledge of BS patients at different time points.

Commentary: Effectiveness of A Multimodal Training Programme to Improve General Practitioners’ Burnout, Job Satisfaction and Psychological Well-Being

Commentary: Effectiveness of A Multimodal Training Programme to Improve General Practitioners’ Burnout, Job Satisfaction and Psychological Well-Being

Effect of a multimodal multidisciplinary training program on pharmacy residents' knowledge and confidence toward research and biostatistics

IntroductionThe optimal method to increase pharmacy resident knowledge and confidence toward research remains unknown. ObjectiveThis study evaluated the impact of a structured curriculum on pharmacy residents' knowledge, confidence and attitude toward biostatistics and research. MethodsThis prospective, multicenter study included pharmacy residents from 2016 to 2017. Residents underwent research training with (1) 60-hours of online modules delivered by multidisciplinary senior faculty (MD, PhD), (2) a 2-day interactive workshop delivered by experienced pharmacy researchers and (3) a mentored longitudinal research experience. Fifteen residents were invited to complete a questionnaire at baseline and again before graduation to measure knowledge, confidence and attitudes about research. Residents were followed for one additional year to measure peer-reviewed publications. ResultsEleven (73%) residents provided complete responses to ≥1survey domain. At baseline, 27% of respondents reported being at least somewhat confident about their biostatistics and research skills (a favorable response for ≥5 of the 9 confidence items). At follow-up, 91% self-reported confidence. Self-reported familiarity with statistical terminology (a score of 4 or 5) increased from 19% at baseline to 82% at follow-up. The mean correct score on the knowledge items at baseline was 15 ± 2.5 (total possible 28) and increased to 20 ± 2.7 after training. By one year after graduation, 53% of residents published at least 1 peer-reviewed manuscript and 20 peer-reviewed publications as first or co-author with a median journal impact factor of 3.16 (IQR: 2.61–4.59). ConclusionThis study provides a framework for sustainable, multidisciplinary, multimodal research education that increased confidence and knowledge among pharmacy residents and resulted in tangible contributions to the scientific literature. Future studies should explore long-term knowledge gained and publications.

Effectiveness of a multimodal training programme to improve general practitioners\u2019 burnout, job satisfaction and psychological well-being

BackgroundThe changes in the models of care for mental disorders towards a community focus and deinstitutionalisation might have risen General practitioners’ (GPs) workload, increasing their mental health concerns and the need for solutions. Pragmatic research into improving GPs’ work-related health and psychological well-being is limited by focusing mainly on stressors and through not providing systematic attention to the development of positive mental health via interventions that develop psychological resources and capacities. The aim of this study was twofold: a) to determine the effectiveness of an intensive multimodal training programme for GPs designed to improve their management of mental-health patients; and b) to ascertain if the program could be also useful to improve the GPs management of their own burnout, job satisfaction and psychological well-being.MethodEighteen GPs constituted a control group that underwent the routine clinical Mental health support programme for primary care. An experimental group (N = 20) additionally received a Multimodal training programme (MTP) with an Integrated Brief Systemic Therapy (IBST) approach. Through questionnaires and a clinical interview, level of burnout, professional satisfaction, psychopathological state and various indicators of the quality of administrative and healthcare management were analysed at baseline and 10 months after the programme.ResultsIn relation to government of mental-health patients indicators, on the one hand MTP group showed statistically significant improvements in certain administrative health parameters, but on the other it did not improve opinions and attitudes towards mental illness. Regarding GPs management of their own burnout, job satisfaction and psychological well-being assessments, the MTP presented better scores on global psychopathological state and better evolution of satisfaction at work; psychopharmacology use dropped in both groups; in contrast, the MTP did not improve burnout levels.ConclusionsFindings of this preliminary study are promising for the MTP (with an IBST approach) practice in primary care. More research evidence is required from larger samples and randomized controlled trials to support both the hypothetical adoption of MTP (with an IBST approach) as a part of a continuing professional-training programme for GPs’ management of mental-health patients and its positive effects on work-related health factors.

Effects of intermittent hypoxia-hyperoxia on mobility and perceived health in geriatric patients performing a multimodal training intervention: a randomized controlled trial

BackgroundAdditional benefits of passive exposures to intermittent hypoxia and hyperoxia on cognitive performance and functional exercise capacity have been demonstrated in geriatric patients who performed a multimodal training program. The main goal of the present study was to evaluate effects of adding intermittent hypoxic-hyperoxic training (IHHT) to a multimodal training intervention (MTI) on mobility and perceived health in old individuals at a Geriatric Day Hospital.MethodsThirty-four patients between 64 and 92 years participated in the double blind, randomized and controlled clinical trial. The elderly patients attended in a 5–7 weeks lasting MTI (strength, endurance, balance, reaction, flexibility, coordination, and cognitive exercises) and performed IHHT (breathing 10–14% oxygen for 4–7 min followed by 2–4 min 30–40% oxygen) in the Hypoxic Group (HG) or placebo treatment with ambient air in the Normoxic Group (NG) in parallel. Before and after all treatments, mobility was assessed by the Tinetti Mobility Test (TMT), the Timed-Up-and-Go Test (TUG) and Barthel-Index, while perceived health was assessed by one part of the EQ-5D Test, the EQ visual analogue scale (EQ VAS).ResultsAfter the MTI plus IHHT or normoxia sessions, results of the TMT, TUG, Barthel Index and EQ-VAS revealed no significant difference between HG and NG (+ 14.9% vs + 15.4%, p = 0.25; − 21% vs − 26.3%, p = 0.51; + 4.2% vs + 3.6%, p = 0.56; + 37.9% vs + 33.9%, p = 0.24;).ConclusionsIHHT added to MTI did not elicit additional improvements in perceived health and mobility compared to MTI alone.

Effect Of Diurnal Exercise Timing On Postprandial Glucose Responses: A Randomized Controlled Trial

PURPOSE: Postprandial exercise has been shown to reduce postprandial glucose (PPG) response to a greater degree than preprandial exercise, suggesting an important yet under-acknowledged role for exercise timing on glycemic control. Whether diurnal timing of exercise imparts additional benefits on PPG responses remains unclear. This study aimed to determine the diurnal effect of exercise timing on PPG response in individuals enrolled into a 12-week supervised multi-modal exercise training program. METHODS: Forty sedentary overweight individuals (17 males, 23 female; age: 51 ± 13 years; BMI: 30.9 ± 4.2 kg/m2) with (n = 20) or without T2DM diagnosis were randomly allocated to either a morning (amEX) or evening (pmEX) exercise training group. All participants completed the 12-week supervised multi-modal exercise training program (3 days per week), which consisted of 30 minutes of aerobic exercise (walking protocol) and 4 resistance-based exercises (3 sets of 12-18 repetitions). The amEX and pmEX training sessions occurred in the postprandial state between 0700-0900h and 1700-1900h, respectively. Changes in postprandial glucose (PPG) and insulin (PPI) responses, during a mixed meal tolerance test (MMTT) were the primary outcome measures of the study assessed at baseline and post-intervention at 12 weeks. All data is displayed as mean differences ± SD. RESULTS: Exercise training reduced (main effect of time, p < 0.01) PPG and PPI concentrations during the MMTT, with no group differences observed (p = 0.69). A significantly greater reduction in PPG-iAUC was observed for the pmEX group (-78.56 mmol/L) when compared to the amEX group (-33.22 mmol/L) at post-intervention (p = 0.03). Reductions in PPI iAUC (main effect of time, p < 0.01) were observed at post-intervention, with no group differences reported (p = 0.18) CONCLUSIONS: Irrespective of the diurnal timing of exercise performance, 12-weeks of multi-modal exercise training significant improved PPG and PPI responses in both overweight non-T2DM and T2DM individuals.

Translation of national guidelines into local practice.

Addressing themes raised by the Royal College of Anaesthetists National Audit Project 4, we introduced new training programmes to improve the knowledge and skills necessary for the management of airway crises. A further large-scale multimodal training programme was introduced to implement guidelines published in 2015 by the Difficult Airway Society (DAS). In 2014, questionnaires were used to assess the knowledge necessary to manage the unanticipated difficult airway before and after high-fidelity simulation sessions. In 2016, surveys assessed knowledge of new DAS guidelines before and 5months after the implementation of a large-scale targeted teaching programme to educate staff. In 2014, 20 anaesthetic teams (75 delegates) attended high-fidelity simulations and demonstrated a significant immediate improvement in knowledge. In 2016, 185 participants attended a targeted teaching programme. Although after the teaching programme an increased number of anaesthetists reported having accessed training, there was a persistent knowledge gap, with some details retained by as few as 15% of participants. Whereas the knowledge of these important guidelines was improved in the immediate aftermath of high-fidelity simulation training, the knowledge retention was disappointing, raising questions as to why knowledge of highly important techniques used in crises was so poor. We ask whether training should be compulsory and how knowledge retention might be improved across all health care disciplines that rely on guidelines for the effective management of rarely occurring but safety-critical events.

A multimodal international collaborative clinical research training program in China

ABSTRACTBackground: There is a strong need to include training of research methods in training programs for physicians. International clinical research training programs (CRTP) that comprehensively introduce the methodology of clinical research and combined with practice should be a priority. However, few studies have reported a multimodal international CRTP that provides clinicians with an introduction to the quantitative and methodological principles of clinical research.Objective: This manuscript is intended to comprehensively describe the development process and the structure of this multimodal training program.Methods: The CRTP was comprised of three distinct, sequential learning components: part 1 – a six-week online eLearning self-study; part 2 – a series of three weekly interactive synchronous webinars conducted between Durham, North Carolina, USA and Beijing, China; and part 3 – a five-day in-person workshop held at Beijing Friendship Hospital, Capital Medical University (BFH-CMU). Self-assessment quiz scores and participation rates were used to evaluate effectiveness of the training program. Participants’ demographic characteristics, research experience, satisfaction and feedback on the program were collected using questionnaires.Results: A total of 50 participants joined the CRTP. Forty-four participants (88%) completed the program satisfaction questionnaires. The average quiz score of the six eLearning units varied from 31% to 73%. Among the three components of the program, the online eLearning self-study was felt to be the most challenging. Thirty-nine (89%) of the surveyed respondents were satisfied with all components of the training program. Among the respondents, 43 (98%) felt the training was helpful in preparing them for future clinical research projects and expressed willingness to recommend the program to other colleagues.Conclusions: We established a multimodal international collaborative training program. The program demonstrated acceptable participation rates and high satisfaction among Chinese clinicians. It provides a model that may be used by others developing similar international clinical research training programs for physicians.

Impact of a training program on the surveillance of Clostridioides difficile infection.

A high degree of vigilance and appropriate diagnostic methods are required to detect Clostridioides difficile infection (CDI). We studied the effectiveness of a multimodal training program for improving CDI surveillance and prevention. Between 2011 and 2016, this program was made available to healthcare staff of acute care hospitals in Catalonia. The program included an online course, two face-to-face workshops and dissemination of recommendations on prevention and diagnosis. Adherence to the recommendations was evaluated through surveys administered to the infection control teams at the 38 participating hospitals. The incidence of CDI increased from 2.20 cases/10 000 patient-days in 2011 to 3.41 in 2016 (P &lt; 0.001). The number of hospitals that applied an optimal diagnostic algorithm rose from 32.0% to 71.1% (P = 0.002). Hospitals that applied an optimal diagnostic algorithm reported a higher overall incidence of CDI (3.62 vs. 1.92, P &lt; 0.001), and hospitals that were more active in searching for cases reported higher rates of hospital-acquired CDI (1.76 vs. 0.84, P &lt; 0.001). The results suggest that the application of a multimodal training strategy was associated with a significant rise in the reporting of CDI, as well as with an increase in the application of the optimal diagnostic algorithm.