Ongoing Communication Research Articles

NONVERBAL COMMUNICATION BETWEEN THE VILLAGE HEAD AND PEOPLE WITH MENTALLY DISABLED IN KARANGPATIHAN VILLAGE PONOROGO

Abstract: Communication is an important element in the life of society. In everyday, people communicate verbally using language or words, but not all humans are able to interact using only verbal communication. Humans who are less than perfect, such as people with mental disability, find it difficult to receive messages using only language. Mental disability is a mental and intellectual disability disorder below average. As in Karangpatihan Village, Balong District, Ponorogo Regency, where 98 residents are mentally disabled. The village head has an important role in the welfare of its citizens so that the use of signs, symbols and even simple facial expressions can help mentally disabled people more easily understand the ongoing communication. This research was conducted with a descriptive research method with a qualitative approach. Data collection techniques in the form of observation, interviews and documentation. Data analysis technique using Nonverbal Communication Theory according to Paul Ekman. The results of this study are first, the Village Head uses various signs/symbols when communicating with mentally disabled. Namely body language which includes eye gaze, facial expressions, hand gestures and movements, head movements, body posture and foot position, touch and paralanguage. Second, mental disability provides reciprocal responses in the form of nonverbal communication, namely, facial expressions, eye gaze, hand gestures and gestures and paralanguage. The gestures used are self-initiated without referring to sign language books in general.Keywords: Nonverbal Communication, Mental Disability, Paul Ekman's Theory.

The Online Adapted Transformational Leadership and Workforce Innovation within the Software Development Industry

Leadership and workforce innovation are the two most glazed over universal phenomenon across time within the management literature. Despite the status of the buzz words, few researchers studied if there is a link between the online leadership behaviors and the de(in)creasing innovativeness of the followers at work. The current research aimed for offering a viable solution for the online-adapted leadership–workforce innovation equation, by answering to the following research question: is online transformative leadership able, and if so, are its instruments sufficient for increasing followers’ organizational and personal innovativeness within an exclusively online work environment? Research used a two-tailed questionnaire as a research instrument and applied it within the IT&C Industry in Iasi, Romania, namely the software development branch. Results were gathered during the first months of the social lockdown due to the COVID-19 pandemic; therefore, the ongoing communication and online work procedures implementation were captured via the subjects’ responses. Data was analyzed by using SemPLS (v3.2.5.) software; results show that transformational leadership instruments, once shifted within an exclusively online working environment, suffer from losing in importance and designated effects. Research provides information in regards to four general hypotheses that prove to be partially supported, sending the reader to the idea that an exclusively online-adapted work environment does not show expected results in terms on transformational leadership, nor workforce innovation. Therefore, online-based transformational leadership instruments need to be reshaped and adapted so that followers correctly perceive their leaders’ actions and behaviors on all the five dimensionalities.

Engaging community in the translational process: Environmental scan of adaptive capacity and preparedness of Clinical and Translational Science Award Program hubs.

This paper is part of the Environmental Scan of Adaptive Capacity and Preparedness of Clinical and Translational Science Award (CTSA) hubs, illuminating challenges, practices, and lessons learned related to CTSA hubs' efforts of engaging community partners to reduce the spread of the virus, address barriers to COVID-19 testing, identify treatments to improve health outcomes, and advance community participation in research. CTSA researchers, staff, and community partners collaborated to develop evidence-based, inclusive, accessible, and culturally appropriate strategies and resources helping community members stay healthy, informed, and connected during the pandemic. CTSA institutions have used various mechanisms to advance co-learning and co-sharing of knowledge, resources, tools, and experiences between academic professionals, patients, community partners, and other stakeholders. Forward-looking and adaptive decision-making structures are those that prioritize sustained relationships, mutual trust and commitment, ongoing communication, proactive identification of community concerns and needs, shared goals and decision making, as well as ample appreciation of community members and their contributions to translational research. There is a strong need for further community-engaged research and workforce training on how to build our collective and individual adaptive capacity to sustain and improve processes and outcomes of engagement with and by communities-in all aspects of translational science.

NFB-22. Neurofibromatosis Therapeutics Program: Development of a Program

Abstract Neurofibromatosis (NF) therapeutics is a vital field in the care of children with NF. Recent developments in the treatment of plexiform neurofibromas (PN) have increased the numbers of patients seen for therapy. The Neurofibromatosis Therapeutics Program (NTP) provides high quality care to patients receiving therapy for brain tumors and PNs, as well as tumors related to NF2. The program at Children’s Hospital Colorado (CHCO) includes a physician, nurse practitioner, and nurse care coordinator. The team collaborates with other disciplines in the care of the NF patient with plexiform neurofibromas and/or CNS tumors. As the program grew, key players were identified in each subspecialty and educated about the NTP. We have ongoing regular communication with a large number of subspecialists regarding protocols, clinical care pathways, and mutual patients. In addition, an extensive tissue collection study of plexiform neurofibromas and brain tumors enhances NTPs devotion to both clinical and lab research. Weekly clinical care meetings ensure continuity in the care of the nearly 140 patients with NF1 and NF2 under our program. Monthly strategy and vision meetings focus on grant applications, education of primary care providers and subspecialists in our large catchment area, development of new clinical pathways, treatment roadmaps, and growth of our program. Over the last two years of being a formalized program, we have increased research on the epigenetics of plexiform neurofibromas, opened a Phase 2 clinical trial for a Mek inhibitor, and increased our patient volume. The Covid pandemic has increased our ability to manage treatment side effects virtually through telehealth and online patient portals. Future goals of the NTP include completion of a program website, quarterly patient and provider newsletters, educational offerings, collaboration with other centers on Mek inhibitor side effects, adolescent and young adult education on tumor risk, and transition to adult care.

Cross-sector co-creation of a community-based physical activity program for breast cancer survivors in Colombia.

Benefits of physical activity (PA) in breast cancer survivors (BCS) are well established. However, programs to promote PA among BCS tailored to real-world contexts within low- to middle-income countries are limited. Cross-sector co-creation can be key to effective and scalable programs for BCS in these countries. This study aimed to evaluate the networking process to engage multisector stakeholders in the co-creation of a PA program for Colombian BCS called My Body. We employed a mixed-methods design including semistructured interviews, workshops and a social network analysis of centrality measures to assess stakeholders' engagement, resources and skills enabling the collaborative work, challenges, outcomes and lessons learned. The descriptive analysis and the centrality measures of the network revealed that 19 cross-sector stakeholders engaged in the My Body collaborative network. Through ongoing communication and cooperation, My Body built relationships between the academic lead institutions (local and international), and local and national public, private and academic institutions working in public health, sports and recreation, social sciences and engineering fields. The outcomes included the co-creation of the community-based PA program for BCS, its implementation through cross-sector synergies, increased relationships and communications among stakeholders, and successful dissemination of evidence and project results to the collaboration partners and other relevant stakeholders and community members. The mixed-methods assessment enabled understanding of ways to advance cross-sector co-creation of health promotion programs. The findings can help to enable continued development of sustainable cross-sector co-creation processes aimed at advancing PA promotion.

Cyclin-dependent kinase 4/6 inhibitor treatment use in women treated for advanced breast cancer: Integrating ASCO/NCODA patient-centered standards in a community pharmacy.

Outpatients treated with oral anti-cancer drugs, including selective cyclin-dependent kinase 4/6 inhibitors (CDK4/6i), may benefit from a pharmacy practice setting adapted to support proper oral anti-cancer drug monitoring. This real-world study aimed to characterize patient-centered pharmacy practice aligned with American Society of Clinical Oncology (ASCO)/National Community Oncology Dispensing Association (NCODA) standards and to describe its impact on CDK4/6i treatment use. This retrospective study included women with confirmed hormone receptor-positive/human epidermal growth factor 2 negative locally advanced or metastatic breast cancer treated with either palbociclib, abemaciclib or ribociclib combined with letrozole or fulvestrant. Pharmacists collected patient characteristics, clinical activities, and treatment patterns using data from the pharmacy chart. CDK4/6i treatment adherence rates were estimated based on medication claims data. Time-to-treatment discontinuation, a proxy for time-to-event, was assessed using the Kaplan-Meier estimate. Of the 195 patients assessed for eligibility, 65 were included in this study. The median observation duration was 13.6 months. An average of seven pharmaceutical care activities (range 2.8-21.7) per patient was documented for each treatment cycle. The mean proportion of days covered was 89.6%. The median time-to-treatment discontinuation was estimated at 44.2 months in patients treated with CDK4/6i + letrozole and 17.0 months in patients treated with CDK4/6i + fulvestrant. The average relative dose intensity was 85%, and the benefits of treatment were maintained regardless of the relative dose intensity levels. A structured patient-centered pharmacy practice model integrating the ASCO/NCODA patient-centered standards and ongoing communication with patients and healthcare providers ensure timely refills, close monitoring, and allows patients to achieve high adherence and persistence rates comparable to those reported in clinical trials.

Advanced Service Data Provisioning for Real-Time Management of Ongoing Cellular Communication Networks

A new cost-efficient concept to realize real-time management and monitoring of quality-of-service metrics and other service data in 5G and beyond access network using a separate return channel based on a vertical cavity surface emitting laser in the optical injection locked mode that simultaneously operates as a laser source and a resonant cavity enhanced photodetector, is proposed and discussed. The feasibility and efficiency of the proposed approach are investigated and confirmed by a proof-of-concept experiment when optically transceiving high-speed digital signals with multi-position quadrature amplitude modulation of a radio-frequency carrier.

0161 Strategies for Enhancing Recruitment of Adults for Randomized Controlled Trial Among Heterogenous Sample of Cancer Survivors with Insomnia Amid the Covid Pandemic

Abstract Introduction Challenges associated with recruiting participants in a longitudinal research study have been recognized yet remain a major barrier for researchers. The current study details strategies used in recruiting a heterogenous sample of cancer survivors with insomnia from multiple clinical sites, referral sources and outreach. Methods Enrollment goals were 158 participants over 3 years (June 2019 to May 2022). Recruitment strategies included 1) face-to-face (FTF) recruitment at hospital clinics; 2) posting recruitment flyers in clinical settings; 3) completion of insomnia screening instrument at community clinic sites; 4) research registries; 5) institutional social media outreach; 6) community events; 7) PI interview and request for study volunteers in local newspaper; and 8) ongoing engagement and communication with recruited participants. Results 108 of 158 participants have been recruited and completed baseline surveys; 9 participants dropped out. To date, 42 of 49 (85.7%) participants have completed the 12-month study. June 2019 through December 2019 FTF recruitment occurred, where 104 were eligible and 32 (30.76%) were enrolled. Due to changes in study personnel and the COVID pandemic restricting access to in-person recruitment and enrollment, the study pivoted to develop protocols for electronic consent and enrollment using video conferencing. In addition, research databases, institutional social media, community events and local newspaper were utilized, where 76 of 239 (31.79%) interested participants enrolled. The most effective recruitment strategies included on-site FTF recruitment (57.9%) and local newspaper interview (13.88%). The local newspaper interview was the most cost-effective considering personnel costs associated with FTF recruitment. Conclusion Despite the onset of the COVID pandemic during the recruitment phase, we were able to pivot and employ innovative techniques to meet our targeted enrollment goal for the projected study deadline. FTF recruitment, perceived value by clinic staff in benefitting cancer survivors, and participants’ acceptance of video-conferencing were significant contributors. The importance of building and maintaining relationships with providers and nurses in local clinical sites cannot be underestimated. Support (If Any) This research was funded by R01 NR018215 (Dean) by the National Institute of Nursing Research.

Is consent enough? What the research on normative heterosexuality and sexual violence tells us

In this paper, I first critically review previous research on normative heterosexuality and its intersections with sexual violence to demonstrate that the common focus on consent in Western sexual justice politics, sexuality education, and sexual violence prevention is inadequate for defining and promoting ethical sex and preventing sexual violence. In particular, I demonstrate that a consent focus allows men to (a) hold women responsible for communicating (non)consent; (b) define the conditions of sexual interactions; (c) achieve consent through violence and coercion; (d) accept “yes” as unfettered consent; and (e) minimize and justify sexual violence. I then articulate an alternative view of ethical sex that moves beyond consent and centers care, empathy, co-determination, and ongoing communication and attention, and highlight the importance of social norms and gender transformative approaches to sexual violence prevention.

Association Between Surgery Preference and Receipt in Ductal Carcinoma In Situ After Breast Magnetic Resonance Imaging

Guiding treatment decisions for women with ductal carcinoma in situ (DCIS) requires understanding patient preferences and the influence of preoperative magnetic resonance imaging (MRI) and surgeon recommendation. To identify factors associated with surgery preference and surgery receipt among a prospective cohort of women with newly diagnosed DCIS. A prospective cohort study was conducted at 75 participating institutions, including community practices and academic centers, across the US between March 25, 2015, and April 27, 2016. Data were analyzed from August 2 to September 24, 2021. This was an ancillary study of the ECOG-ACRIN Cancer Research Group (E4112). Women with recently diagnosed unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. Participants who had documented surgery and completed the baseline patient-reported outcome questionnaires were included in this substudy. Women received preoperative MRI and surgeon consultation and then underwent wide local excision or mastectomy. Participants will be followed up for recurrence and overall survival for 10 years from the date of surgery. Patient-reported outcome questionnaires assessed treatment goals and concerns and surgery preference before MRI and after MRI and surgeon consultation. Of the 368 participants enrolled 316 (86%) were included in this substudy (median [range] age, 59.5 [34-87] years; 45 women [14%] were Black; 245 [78%] were White; and 26 [8%] were of other race). Pre-MRI, age (odds ratio [OR] per 5-year increment, 0.45; 95% CI, 0.26-0.80; P = .007) and the importance of keeping one's breast (OR, 0.48; 95% CI, 0.31-0.72; P < .001) vs removal of the breast for peace of mind (OR, 1.35; 95% CI, 1.04-1.76; P = .03) were associated with surgery preference for mastectomy. After MRI and surgeon consultation, MRI upstaging (48 of 316 [15%]) was associated with patient preference for mastectomy (OR, 8.09; 95% CI, 2.51-26.06; P < .001). The 2 variables with the highest ORs for initial receipt of mastectomy were MRI upstaging (OR, 12.08; 95% CI, 4.34-33.61; P < .001) and surgeon recommendation (OR, 4.85; 95% CI, 1.99-11.83; P < .001). In this cohort study, change in patient preference for DCIS surgery and surgery received were responsive to MRI results and surgeon recommendation. These data highlight the importance of ensuring adequate information and ongoing communication about the clinical significance of MRI findings and the benefits and risks of available treatment options.

Reducing inequality through institutional action: towards a process framework for student transition and support

PurposeMuch of the existing literature note how students' academic difficulties result from their background and lack of cultural capital. This paper aims to focus on internal structural inequality where people with particular backgrounds are disadvantaged within an institution.Design/methodology/approachThe authors use a case study approach to understand how an in-built faculty programme, Business for Success (B4S), mitigates institutional inequalities.FindingsThe study’s findings demonstrate that students need services to get accustomed to university, settle in and transition to professional work. Student services are both dependent (such as bridging courses, peer mentoring and internships) and independent (such as ongoing communication, resource loans) on the stage of their studies.Originality/valueThis paper contributes to theory and practice by developing a process framework that policymakers could use to design holistic support programmes and improve students' transition to university, learning and professional work.

Painting for a Purpose: A Visual Arts Program as a Method to Promote Engagement, Communication, Cognition, and Quality of Life for Individuals With Dementia.

The arts (e.g., music and painting) have received considerable theoretical and observational support as a cognitive stimulation technique for persons living with dementia (PLWD). However, particularly for visual arts, limited empirical support exists. Therefore, the purpose of this study was to pilot a free-form arts program for PLWD in the context of a cognitive stimulation paradigm and measure subsequent engagement, communication, cognitive-linguistic function, and quality of life. Three PLWD (one each in mild-to-moderate, moderate, and moderate-to-severe stages) were referred for study participation by a local long-term care facility. A single subject across subjects, ABA reversal design was used to assess intervention effects over a period of 8 weeks, in comparison to an active control condition (cooking activity). Cognitive-linguistic function and quality of life were assessed using standardized measures at baseline and follow-up. Engagement and communication were probed regularly across each study phase. Significant changes were seen in participants' engagement and communication during painting sessions compared to the control activity. A nonsignificant positive trend was noted for self-rated quality of life from baseline to follow-up. Pre-post testing revealed nominal change in cognitive-linguistic functions. An arts program led to significant increases in constructive engagement and communication and a trend toward increased self-rated quality of life for the three PLWD. The fact that these changes were not sustained outside intervention sessions (i.e., pre-post testing) is consistent with the need for a larger paradigm shift in which rehabilitation specialists-including speech-language pathologists-better integrate creative, meaningful activities into the everyday lives of PLWD to maximize ongoing engagement, communication, and quality of life.

Mentoring MSMEs through E-Promotion as A Rebranding Strategy Based on Local Wisdom

The pandemic affects Micro, Small, and Medium Enterprises (MSMEs) as an economic sub-sector. MSMEs products have marketing problems, so many unsold products. Traditional marketing strategies can not reach a vast market share, so income significantly declined during the Covid-19 pandemic. In Kejuron Ward, Taman District, the Madiun City, MSMEs actors consist of several industrial sectors such as food and clothing sales. During the COVID-19 pandemic, MSMEs actors in the Kejuron Ward tried to use alternatives to online selling. However, promotions in online selling were still not optimal to attract customers as offline promotions. The target issues were a lack of knowledge in digital marketing and less attractive products. Mentoring MSMEs through e-promotion as a rebranding strategy based on local wisdom was an effort to overcome the partners' problems. The empowerment model used in this community service was participatory assistance through lectures, discussions, and practices methods. There were significant differences in success indicators before and after socialization and practice regarding e-promotion as a local wisdom-based rebranding strategy. The most significant increase was knowledge levels which improved by 50% after the socialization. Thus, this community service could increase innovation and creativity in the target community and solve MSMEs' business problems in Kejuron Ward. In conclusion, mentoring MSMEs through e-promotion as a rebranding strategy based on local wisdom increases partners' knowledge in digital marketing, more attractive products packaging, and updated MSMEs' products with trending products. There should be ongoing assistance and communication to support the sustainability of this program

Perceived stigma and healthcare services in healthcare settings among people living with HIV in Egypt: a qualitative study.

The researchers conducted the current study to explore the perspectives of people living with HIV (PLHIV) on HIV-related discrimination and the delivery of healthcare services in healthcare settings. An exploratory study using a qualitative approach was conducted among 46 PLHIV who were seeking HIV counselling and treatment from two HIV centres in the Cairo governorate using a purposive sampling technique. A thematic content analysis was used to examine the responses. Participants had a combination of positive and negative experiences. Some participants reported staff acceptance and friendliness towards HIV-positive patients on antiretroviral treatment. Most interviewees observed that staff took extra precautions when treating or caring for them. The majority stated that counselling about the effects of the treatment was inadequate and that testing was either too far from their homes or at overcrowded centres with long waiting times. All the interviewees recommended ongoing communication and HIV counselling skills for healthcare providers who are in contact with HIV patients. Most of the study participants were not satisfied with HIV services in the participating centres, as well as experiencing stigma. More investment in enhancing the quality of HIV service delivery and reinforcement of health worker competencies, mainly in HIV counselling, may improve satisfaction, bearing in mind HIV-related stigma in the centres involved.

Community Mobilization Approaches for Large-Scale Public Health Surveys: Experiences from the Population-based HIV Impact Assessment (PHIA) Project.

Community mobilization is an integral process of raising awareness and increasing participation in a specific program. Communities with long-standing mistrust of health research may otherwise be reluctant to participate in surveys originating outside of their locality, particularly when asked to share personal information, provide blood samples, or undergo medical examinations. Here we discuss the community mobilization approaches undertaken by the Population-based HIV Impact Assessment (PHIA) project to optimize participation in surveys across 13 countries of sub-Saharan Africa. The PHIA Project developed a community mobilization strategy to address anticipated community concerns. In each country, a trained cadre of Community Mobilization Coordinators (CMCs) facilitated (1) ongoing communication with leadership and stakeholders at national, provincial/district and local levels; (2) door-to-door visits and group meetings; (3) promotional material dissemination through radio and television jingles and mass social/community media; and (4) the use of public address systems to enhance survey awareness and promote participation. Response rates (RR) were recorded from each survey. The PHIA surveys' mobilization efforts cultivated a receptive environment for data collection. The average household response rate for 13 PHIA surveys was 90.4% and interview RR were consistently over 80%, with women more likely to conduct an interview in all countries except Cote d'Ivoire. 89% of eligible women consented to a blood draw and 81.1% of eligible men consented. The robust and contextualized community mobilization approaches in PHIA were critical for engaging communities in large-scale public health surveys and contributed to high RR in participant interviews and blood draw.

Interventions for pre-school children with co-occurring phonological speech sound disorder and expressive language difficulties: A scoping review.

Recent evidence suggests that pre-school children with co-occurring phonological speech sound disorder (SSD) and expressive language difficulties are at a higher risk of ongoing communication and literacy needs in comparison with children with these difficulties in isolation. However, to date there has been no systematic or scoping review of the literature specific to interventions for children with this dual profile. To explore the evidence regarding interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties, including the content/delivery of such interventions, areas of speech and language targeted, and a broad overview of study quality. A scoping review methodology was used in accordance with the guidance from the Joanna Briggs Institute. Following a systematic search of Ovid Medline, Ovid Emcare, OVID Embase, CINAHL, Psychinfo and ERIC, 11 studies were included in the review. A researcher-developed data extraction form was used to extract specific information about each intervention, with the JBI appraisal tools used to provide a broad overview of the quality of each study. Included papers consisted of six randomized controlled trials (RCTs), two cohort studies, two case studies and one case series. Interventions fell into two main categories: (1) integrated interventions that combined content for both speech and language targets and/or explicitly used the same type of technique to improve both domains; and (2) single-domain interventions that explicitly included content to target speech or language only, but also aimed to improve the other domain indirectly. Study quality varied, with detail on the content, context and delivery of interventions often underspecified, hampering the replication and clinical applicability of findings. Early emerging evidence was identified to support both integrated speech and language interventions as well as single-domain interventions. However, caution should be exercised due to the variation in the quality and level of detail reported for the interventions. Future intervention studies may seek to address this by reporting in accordance with Template for Intervention Description and Replication (TIDieR) reporting guidelines. This approach would enable clinicians to consider the applicability of the intervention to individual children within differing settings. What is already known on the subject Pre-school children with co-occurring phonological SSD and expressive language difficulties frequently present within speech and language therapy services. These children are at a higher risk of long-term communication and literacy difficulties compared with children with these needs in isolation. Some emerging evidence suggests that interventions for children with this co-occurring profile may exist within the literature; however, this evidence may not be known to clinicians in everyday practice. What this paper adds to existing knowledge This review is the first to systematically examine evidence of interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties. The review identified a small number of intervention studies that varied in research quality and level of detail provided regarding the content and delivery of interventions. What are the potential or actual clinical implications of this work? The findings of this study highlight published evidence for interventions for pre-school children with co-occurring phonological SSD and expressive language difficulties. These may take the form of integrating techniques for speech/language into a single intervention, or the explicit targeting of one domain with the aim of also influencing the other. However, there is a need for further high-quality research in this area. Such studies should provide sufficient detail to enable replication. This would enable clinicians to understand the relevance and applicability of such intervention findings to the individual children they see within their clinical practice.

Resident service coordinators as an underutilized resource in the design and development of affordable housing

ABSTRACT Drawing on 20 semi-structured interviews with industry professionals, this study considers whether barriers to collaboration prevent affordable housing developers in the U.S. from collaborating with resident service coordinators when making development decisions. Results suggest executives working in both fields perceive barriers to collaboration to exist, many of which stem from competing interests, financial concerns, and organizational cultures that do not appropriately emphasize the importance of cross-disciplinary cooperation. Recommendations for overcoming these barriers include ongoing communication, a willingness to compromise, and a shared commitment to improving the lives of people who make affordable housing their home.

Investigating the experience of parents who have given their infants enoxaparin at home

IntroductionEnoxaparin is a common anticoagulant used in infants for the prevention and treatment of thrombosis. When administered with the purpose of treating a thrombosis, the duration of treatment is six to twelve weeks. Enoxaparin must be injected subcutaneously, either by direct injection or via an indwelling subcutaneous catheter (Insuflon™). Once discharged from hospital, parents/caregivers of infants and small children take responsibility for the safe preparation and administration of the enoxaparin which can be difficult and confronting. Whilst there is documented evidence about the benefits of targeted education for warfarin anticoagulation and the impact this has on the quality of life for children and their families, this has not been investigated in a cohort of children requiring enoxaparin anticoagulation. We therefore explored the educational needs of parents whose infants require enoxaparin anticoagulation after discharge to inform future practice to optimise delivery of care as well as improve patient safety and outcomes. Materials & methodsA qualitative, descriptive methodology was employed using focus groups to generate rich descriptive data. ResultsOur results show that parents were traumatised by the process of managing their infant's enoxaparin, and that they may benefit from a formal, more structured educational program to facilitate this treatment in the future. ConclusionIt is recognised that enoxaparin therapy in infants may be a traumatic experience for parents and caregivers. The availability of an educational resource for families to refer to once discharged, as well as ongoing communication with the treating medical team is vital.

“It's not something that's really been brought up”: Opportunities and challenges for ongoing advance care planning discussions among individuals living with mechanical circulatory support

BackgroundPeople living with mechanical circulatory support (MCS) are at risk for catastrophic complications that require advance care planning (ACP) as part of the preimplantation work up. Palliative care consultants are a mandatory and essential component of the MCS team tasked to enhance conversations. However, in reality, there is often a serious deficiency of ACP communication after the initial implant counseling. A better understanding of opportunities and challenges in ACP can mobilize intensive care unit and step-down nurses to bridge this gap in crucial communication. ObjectivesTo identify and describe MCS individuals’ perceptions of opportunities and challenges for ongoing ACP communication. MethodsA constructivist grounded theory study was conducted with 24 MCS individuals from 2 medical centers in Southern California. Semi-structured interviews were audio recorded, transcribed, and reviewed for accuracy. The data were systematically analyzed through 3 rounds of coding. ResultsMCS clinicians, supportive others, and peers with MCS were identified as stakeholders in ongoing communication. Four categories of opportunities and challenges for ongoing ACP were synthesized from the narratives: identifying context and timing, sharing information, understanding of ACP, and assessing satisfaction. All participants reported a preference for MCS clinicians, including nurses, to initiate ACP conversations. ConclusionUnderstanding opportunities and challenges is key to facilitating ongoing ACP discussions among MCS patients. MCS-trained nurses are positioned to address the dearth of ongoing ACP by facilitating these sensitive discussions. The personal accounts of this sample serve to guide future research and structure training to prepare MCS clinicians for primary palliative care.

Sustaining interventions in care homes initiated by quality improvement projects: a qualitative study

IntroductionInadequate and varied quality of care in care homes has led to a proliferation of quality improvement (QI) projects. This study examined the sustainability of interventions initiated by such projects.MethodThis...