Participant Satisfaction Research Articles

Utilizing data platform management to implement “5W” analysis framework for preventing and controlling corruption in grassroots government

In the era of information technology advancement, big data analysis has emerged as a crucial tool for government governance. Despite this, corruption remains a challenge at the grass-roots level, primarily attributed to information asymmetry. To enhance the efficacy of corruption prevention and control in grass-roots government, this study introduces the concept of data platform management and integrates it with the “5W” (Who, What, When, Where, Why) analysis framework. The research is motivated by the observation that existing studies on corruption prevention primarily concentrate on the formulation of laws and regulations, neglecting the potential improvement in actual effectiveness through the utilization of data platforms and analytical frameworks. The research employs methodologies grounded in the Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis framework, the Plan, Do, Check, Act (PDCA) cycle analysis framework, and the 5W analysis framework. Throughout the iterative process of implementing data platform management, various timeframes are established, and the impact of the three models is evaluated using indicators such as public participation and government satisfaction. The research reveals that the SWOT framework can formulate targeted strategies, the PDCA framework continuously optimizes work processes, and the 5W framework profoundly explores the root causes of corruption. The outcomes indicate a 10.76% increase in the public participation level score with the 5W model, rising from 71.67%, and a 23.24% increase in the governance efficiency score, reaching 66.12%. The SWOT model excels in case handling prescription and corruption reporting rate. The synergistic application of the three models demonstrates a positive impact. In conclusion, the amalgamation of data platform management and a multi-model approach effectively enhances the corruption prevention capabilities of grass-roots governments, offering insights for the establishment of transparent and efficient grass-roots governance.

Family Functioning, Community Participation, and Rehabilitation Barriers in the Acquired Brain Injury Community: An Exploratory Analysis

Acquired brain injury (ABI) is the second most common cause of disability in America. Prior research highlights family functioning as an important predictor of psychosocial outcomes in the ABI population; however, there remains limited research aimed at understanding the role of family functioning in predicting rehabilitation progress and community participation. A quantitative, exploratory, descriptive research design was used for this study. A total sample of 49 individuals with mild-to-moderate ABI were recruited from a university medical center and outpatient rehabilitation center. Participants completed measures of demographics, community participation, family functioning, and perceived rehabilitation barriers. Data were analyzed using descriptive statistics and multiple regression (MR) analysis. Two MR models were examined, one with rehabilitation barriers as the dependent variable and one with community participation as the dependent variable. Financial support and perceived rehabilitation barriers contributed significantly to variance in community participation satisfaction, while financial support, family functioning, and community participation satisfaction each accounted for a significant portion of variance in perceived rehabilitation barriers. Overall, the full MR 1 model accounted for 33% of variance in community participation satisfaction, while the full MR 2 model accounted for 51% of variance in perceived rehabilitation barriers. Although more research with larger, more diverse samples is needed, this study provides rehabilitation and counseling professionals with important psychosocial concepts to consider in assessment and treatment and helps clarify the role of family in promoting positive rehabilitation and participation outcomes in the ABI community.

Nurses Taking on Readiness Measures (N-TORM): A nurse-facilitated household emergency preparedness intervention feasibility study.

This research evaluated the effect of a nurse-facilitated intervention on elderly or medically frail community members' level of household emergency preparedness as measured in knowledge, actions taken, and supplies gathered. These community members had access and functional needs that must be accommodated during disasters to mitigate their increased risk of injury, illness, and death because of the disaster. With adequate preparedness, it is plausible these community members may survive the aftermath of a disaster without needing assistance from disaster responders. This was a non-randomized, single group, before-after feasibility study (N = 31) conducted in a one-on-one session with a nurse interventionist in an urban community setting in the United States of America. We used the Household Emergency Preparedness Instrument to measure intervention effectiveness and a Participant Experience Survey to evaluate participant satisfaction with the intervention. The intervention included an educational booklet that provided instruction to participants on how to create a disaster-related evacuation and communication plan and identify community resources. Upon completion of the booklet, participants received a complimentary disaster supply kit. Mean general preparedness scores increased from 5.5 (SD = 4.1) pre-intervention to 20.2 (SD = 3.1) post-intervention (p < .001). Preparedness in all sub-scales also increased significantly (all ps < .001). Study findings provide support for the feasibility of the intervention to increase all measured aspects of emergency preparedness (knowledge, behaviors, and supplies) among elderly and medically frail adults with access and functional needs during disasters.

Feasibility, acceptability, and initial efficacy of a wheelchair exercise training program in persons with multiple sclerosis: study protocol for a parallel group randomized controlled trial

Purpose This study is a randomized controlled trial (RCT) that examines the feasibility, acceptability, and initial efficacy of a home-based, remotely supported and supervised exercise training program that was developed using a three-step community engaged research process for persons with multiple sclerosis (MS) who are wheelchair users. Materials and Methods The study design is a parallel group RCT (NCT05888727). We aim to enroll 24 wheelchair users with MS who will be randomly assigned using REDCap randomization module into exercise training or attention/contact wellness control conditions. The conditions will be delivered remotely over 16 weeks and supported using online, one-onone behavioral coaching. The feasibility outcomes of interest include recruitment and retention rates, and safety outcomes collected throughout the study period. The acceptability outcomes include participant satisfaction and perceptions measured using formative surveys and interviews following the 16-week period. Efficacy outcomes include metabolic health, MS symptoms, and exercise behavior measured before and after the 16-week period. The data analysis will follow intent-to-treat principles using 2 group by 2 time mixed factor ANOVA with estimation of Cohen’s d values as effect sizes. Conclusions The results will guide future research targeting health outcomes using exercise training among wheelchair users with MS who have largely been absent from health promotion research.

Caregiver perceptions of a pediatric produce prescription program during the COVID-19 pandemic.

Produce prescription programs are rapidly expanding as a type of Food is Medicine intervention with prospects for mitigating food insecurity and reducing diet-related health disparities. Gaining insight into participant perspectives on program logistics and perceived impacts is crucial to program success and improvements. Between May and June 2021, we conducted individual and small group interviews with 23 caregivers with children aged 1-5 years who participated in a produce prescription program from 2020 to 2021 in Texas, U.S. They were provided with a gift card to a major national grocery retailer to purchase fresh produce. The card was reloaded $60 monthly for 8 months with automatic roll-over of unused funds to the next month. Participants also received nutrition education in the form of two videos. A deductive analysis approach was employed, and NVivo qualitative data analysis software was used to perform coding and to assist with subsequent analyses. All 23 participants were female, with an average age of 37.5 years, and the majority identified as Hispanic/Latino (83%). About 43% of the families had three or more children. Six themes were generated from interviews. Three of these themes were related to program logistics: (1) ease of program use; (2) participant satisfaction with the incentive; and (3) desire for additional store options. The remaining main themes pertained to program impact: (1) the enhanced ability to purchase produce; (2) the usefulness of the nutrition education; and (3) persistent challenges encountered when preparing the produce for picky eaters and young children. A pediatric produce prescription program was perceived as logistically easy and a helpful source of financial support for accessing fresh produce. Program features such as card-based incentive system and partnership with major grocery retailer were favored by participants. For future program design, it may be beneficial to consider collaborating with multiple grocery outlets and enhancing the intensity and targeting of nutrition education.

Comparison of Conventional Anesthesia Nurse Education and an Artificial Intelligence Chatbot (ChatGPT) Intervention on Preoperative Anxiety: A Randomized Controlled Trial

PurposeThis study aimed to evaluate the effects of an artificial intelligence (AI) chatbot (ChatGPT-3.5, OpenAI, USA) on preoperative anxiety reduction and patient satisfaction in adult patients undergoing surgery under general anesthesia. DesignThe study used a single-blind, randomized controlled trial design. MethodsIn this study, 100 adult patients were enrolled and divided into 2 groups: 50 in the control group, in which patients received standard preoperative information from anesthesia nurses, and 50 in the intervention group, in which patients interacted with ChatGPT. The primary outcome, preoperative anxiety reduction, was measured using the Japanese State-Trait Anxiety Inventory (STAI) self-report questionnaire. The secondary endpoints included participant satisfaction (Q1), comprehension of the treatment process (Q2), and the perception of AI chatbot’s responses as more relevant than those of the nurses (Q3). FindingsOf the 85 participants who completed the study, the STAI scores in the control group remained stable, whereas those in the intervention group decreased. The mixed-effects model showed significant effects of time and group–time interaction on the STAI scores; however, no main group effect was observed. The secondary endpoints revealed mixed results; some patients found that the chatbot’s responses were more relevant, whereas others were dissatisfied or experienced difficulties. ConclusionsThe ChatGPT intervention significantly reduced preoperative anxiety compared with the control group; however, no overall difference in the STAI scores was observed. The mixed secondary endpoint results highlight the need for refining chatbot algorithms and knowledge bases to improve performance and satisfaction. AI chatbots should complement, rather than replace, human healthcare providers. Seamless integration and effective communication among AI chatbots, patients, and healthcare providers are essential for optimizing patient outcomes.

A community-based modified sport program for rural community-dwelling older adults: A pilot study.

With Australia's ageing population, especially in rural regions, promoting physical activity among older adults is crucial. To identify factors influencing participation of older adults (60 years or over) from a rural community in a modified sport program and assess satisfaction with a pilot modified sport program informed by these findings. Insights and ideas from two focus groups exploring community perspectives on a modified sport program informed the development of a six-week pilot modified sport program delivered with the local fitness centre. Post-program surveys assessed participant satisfaction, willingness to continue, and likelihood of recommending the program to others. Nine participants attended the focus groups, highlighting increased social connection, health management, and healthy ageing as key motivators. Joint and health concerns, cost, and time constraints emerged as main barriers. Preferences for the program included weekly sessions, alternating sports, indoor venues, and supporting modifications, but maintaining traditional rules. Thirteen participants participated in the pilot modified sport program. There was strong program attendance (86%). All participants (13/13) rated their satisfaction as very satisfied. They were highly likely to recommend the program to others (8.5/10) and were interested in continuing modified sport after the pilot (7.7/10). This study demonstrates for the first time that modified sport is of interest to older people in the rural setting, and that delivering such a program is feasible in a small community. Rural communities implementing modified sport should consider the availability of suitable facilities and equipment, access to an engaging facilitator and participant cost. Through a strong connection between the health service and community fitness centre, a modified sport program was developed and implemented, well-attended and enjoyed by participants in a rural community.

Monitoring the psychological component of higher education quality using ICT tools

This study examines the use of information and communication technologies (ICT) to monitor the psychological component of higher education quality. A literature review covers the concepts of higher education quality and its monitoring, the psychological factors involved, and the potential of ICT tools, including Google services. The study details a monitoring procedure using Google Forms to assess indicators like relationships between participants, satisfaction levels, and organisational climate. The computer program “Personnel – Ψ” is also presented as a tool for comprehensive psychological diagnostics of teachers. The advantages of using ICT tools for efficient data collection, analysis and management are discussed. The results demonstrate the feasibility and effectiveness of using ICT to improve monitoring of the psychological aspects of educational quality and make evidence-based decisions to enhance the educational environment. The use of user-friendly tools like Google Forms facilitates regular assessment of quality indicators and aids institutions in ensuring participant satisfaction and optimal conditions for learning and growth.

Abstract P233: Leveraging Community-Engaged Research Methods to Improve Recruitment and Retention of Midlife Black Women in Cardiovascular Research

Introduction: Midlife Black women (ages 45-64) are more likely to die of a cardiovascular disease (CVD)-related cause compared to White women of the same age and less likely to be optimally controlled for upstream chronic conditions like hypertension or dyslipidemia. Black women are also 58% less likely than White women to identify heart disease as their greatest health risk. Recruitment and retention of Black women in research trials has been historically difficult, contributing to the paucity of interventions designed to address the unique sociocultural factors that contribute to the existing health disparities. The Midlife Black Women’s Stress Reduction and Wellness intervention (B-SWELL) was created to lower stress and increase CVD awareness and adoption of healthy lifestyle behaviors to lower CVD risk in midlife Black women. Hypothesis We hypothesized that a theoretically based intervention co-developed with midlife Black women from the community would yield a culturally appropriate and appealing intervention, resulting in high retention, low attrition, and high satisfaction. Methods: Mixed methods and community-engaged methods were used in the preliminary research that supported the B-SWELL feasibility trial. Each step (i.e., conceptualization, development, intervention design and delivery) was viewed through a Black Feminist lens, giving voice to midlife Black women. The B-SWELL materials and content were co-developed with an existing community research advisory board (C-RAB) and midlife Black women from the community to produce a culturally tailored and targeted product that was rated highly by experts. A randomized feasibility study was conducted. Recruitment was led by the C-RAB and other community partners. Satisfaction was measured using a 9-item tool ranging from 1 (strongly disagree) to 5 (strongly agree) and a maximum score of 45. Narrative feedback responses were also obtained. Results: Recruitment (N=52) was completed within 30 days and attrition was low (8%). Four participants withdrew prior to the start of the feasibility trial. The remaining 48 participants completed the trial, and none were lost to follow up. Participant satisfaction ratings were high with a mean of 41. Narrative feedback responses were positive. Participant responses indicated an increase in CVD awareness and motivation to adopt healthier behaviors: “Sisterhood is very important to Black women's health." “Never too late in your life to make changes and better choices.” “I need to be a cheerleader and I need to be checked on as well". Conclusions: Theoretically based interventions that employ community-engaged methods have potential to increase recruitment and retention of midlife Black women in research studies. We recommend integration of community-engaged methods at each level of development and for delivery of interventions targeted to at-risk subpopulations like midlife Black women.

A systematic review of the benefits and mechanisms of family-based mind-body therapy programs targeting families of children and adolescents with attention-deficit/hyperactivity disorder

Growing evidence indicates that family-based mind-body therapy programs (FMBTs) act as an important alternative for attention-deficit/hyperactivity disorder (ADHD) treatment in the youth with minimal side-effects. Moreover, FMBTs contribute to improving the family functioning of those affected by ADHD. To summarize and analyze the benefits and mechanisms, an extensive literature search of the EBSCOhost, PubMed, Web of Science, and Scopus databases was conducted to identify eligible studies. Fifteen studies published between 2010–2023 were reviewed. The included FMBTs were implemented with 850 children/adolescents and 996 parents/caregivers, of whom 201 parent couples attended the programs together with their children. All included FMBTs adopted mindfulness/meditation as the core practice to enhance the participants’ mental focus and attention, and were designed for long-term engagement, with six including parent–child joint session(s). Positive changes were observed in both children and adolescents, including improvements in ADHD symptoms, behavioral problems, executive function, and school performance. Additionally, parents experienced positive changes in ADHD traits/symptoms, mental health, and parenting behaviors. Furthermore, FMBTs were found to enhance family functioning by delivering mindful strategies to family, restoring psychological capacity and interpersonal skills in family members, and improving parent–child relationships. The reviewed FMBTs demonstrated high levels of feasibility and participant satisfaction. The factors and issues potentially influencing the effectiveness and feasibility of FMBTs are also discussed. The findings indicate that FMBT holds promise as an ADHD treatment option in home settings. Future efforts may focus on optimizing the design of FMBTs to better address the diverse needs of families in varying circumstances.

Role of Socioeconomic Status in National Health Insurance Ownership in Indonesia's Rural Areas.

National Health Insurance (NHI) is one of the Indonesian Government's policies to increase public access to health services. The study analyzed the role of socioeconomic status in NHI ownership in rural Indonesia. Study Design: A cross-sectional study. The study population included residents of rural Indonesia. The study examined secondary data from the survey entitled "Abilities and Willingness to Pay, Fee, and Participant Satisfaction in Implementing National Health Insurance in Indonesia in 2019", involving 33225 respondents representing Indonesia's rural areas. The study was conducted from March to December 2019. The variables analyzed included NHI, socioeconomic level, age group, gender, education level, employment status, and marital status. In the final step, the study employed binary logistic regression to explain the relationship between socioeconomic status and NHI ownership. The results show that 63.8% of the population in rural Indonesia participated in the NHI. The poorer residents were 1.235 times more likely to have NHI than the most impoverished population (AOR 1.235; 95% CI 1.234-1.237). People with middle wealth status were 1.086 times more likely to have NHI than the poorest (AOR 1.086; 95% CI 1.085-1.087). The richer residents were 1.134 times more likely to have NHI than the poorest (AOR 1.134; 95% CI 1.133-1.136). The richest residents were 1.078 times more likely to have NHI than the poorest residents (AOR 1.078; 95% CI 1.077-1.079). The study concluded that socioeconomic status is related to NHI ownership in rural Indonesia. The analysis indicated that all socioeconomic categories were more likely to become NHI participants than the poorest in Indonesia.

Valuable aspects of digital boons as objects of civil rights of a person

This paper reflects the results of studying the legal nature of digital things and virtual assets as objects of civil rights/ legal relations through the prism of their value component. The aim of the study is to determine the factors (specifically, properties together with characteristics of digital things) that impact the value of these phenomena, thus, enabling their probability to be objects of civil rights/legal relations.&#x0D; The methodological basis of scientific research constitutes the dialectical method of cognition, the application of which made it possible to analyze modern and historical approaches to defining institutions of a digital thing as well as a virtual asset, their legal nature and features. The formal-logical method has been used in order to analyze the norms of legislation that form the legal basis for comprehensive regulation of relevant relations. The method of analysis and synthesis has been applied while studying the practical manifestation of relations to ensure the turnover of digital things along with virtual assets. The comparative-legal method has been used for a comparative analysis of the legal regulation of institutions of digital things together with virtual assets in the latest legislation of the European Union and Ukraine. The logical-legal method has been applied so as to formulate the main conclusions in accordance with the aim of the specified study.&#x0D; The result of the study has been the determination of relevant properties of digital assets as well as virtual ones, which define the value component of the above objects. It has been concluded that neither value nor functionality significantly affect the value of the mentioned phenomena. Specific features along with properties inherent only to these objects come to the fore, to illustrate, adaptability, security of transactions, decentralization, pseudonymity, in addition to availability. Regardless of the fact that the specified properties are basic for comprehanding the nature of digital things and virtual assets, they are subject to significant external influence. In particular, the importance of decentralization together with pseudonymity is levelled due to the rapid and powerful development of legal regulation, aimed at a fairly high level of restrictions as well as regulations. At the same time, the prevalence of the turnover of the above mentioned objects is unlikely to slow down due to exceptional advantages, ensuring a significantly more prompt and accessible satisfaction of market participants’ relevant needs.

Novel Web-Based Drop-In Mindfulness Sessions (Pause-4-Providers) to Enhance Well-Being Among Health Care Workers During the COVID-19 Pandemic: Descriptive and Qualitative Study.

The COVID-19 pandemic exerted extraordinary pressure on health care workers (HCWs), imperiling their well-being and mental health. In response to the urgent demand to provide barrier-free support for the health care workforce, Pause-4-Providers implemented 30-minute live web-based drop-in mindfulness sessions for HCWs. This study aims to evaluate the use, feasibility, satisfaction, and acceptability of a novel mindfulness program aimed at enhancing the well-being of HCWs during the COVID-19 pandemic. Accrual for the study continued throughout the first 3 pandemic waves, and attendees of ≥1 session were invited to participate. The evaluation framework included descriptive characteristics, including participant demographics, resilience at work, and single-item burnout scores; feedback questionnaires on reasons attended, benefits, and satisfaction; qualitative interviews to further understand participant experience, satisfaction, benefits, enablers, and barriers; and the number of participants in each session summarized according to the pandemic wave. We collected descriptive statistics from 50 consenting HCWs. Approximately half of the participants (24/50, 48%) attended >1 session. The study participants were predominantly female individuals (40/50, 80%) and comprised physicians (17/50, 34%), nurses (9/50, 18%), and other HCWs (24/50, 48%), who were largely from Ontario (41/50, 82%). Of 50 attendees, 26 (52%) endorsed feeling burned out. The highest attendance was in May 2020 and January 2021, corresponding to the first and second pandemic waves. The participants endorsed high levels of satisfaction (43/47, 92%). The most cited reasons for attending the program were to relax (38/48, 79%), manage stress or anxiety (36/48, 75%), wish for loving kindness or self-compassion (30/48, 64%), learn mindfulness (30/48, 64%), and seek help with emotional reactivity (25/48, 53%). Qualitative interviews with 15 out of 50 (30%) participants identified positive personal and professional impacts. Personal impacts revealed that participation helped HCWs to relax, manage stress, care for themselves, sleep better, reduce isolation, and feel recognized. Professional impacts included having a toolbox of mindfulness techniques, using mindfulness moments, and being calmer at work. Some participants noted that they shared techniques with their colleagues. The reported barriers included participants' needing time to prioritize themselves, fatigue, forgetting to apply skills on the job, and finding a private place to participate. The Pause-4-Providers participants reported that the web-based groups were accessible; appreciated the format, content, and faculty; and had high levels of satisfaction with the program. Both novel format (eg, drop-in, live, web-based, anonymous, brief, and shared activity with other HCWs) and content (eg, themed mindfulness practices including micropractices, with workplace applications) were enablers to participation. This study of HCW support sessions was limited by the low number of consenting participants and the rolling enrollment project design; however, the findings suggest that a drop-in web-based mindfulness program has the potential to support the well-being of HCWs.

Intervention to promote preventive dental care for older Korean-American Medi-Cal enrollees in Los Angeles

BackgroundIn California, preventive dental care is covered by Medi-Cal (California’s Medicaid program). However, many beneficiaries do not use their dental benefits. Given that a lack of knowledge about oral health and insurance coverage contributes to this underutilization, promoting the use of dental benefits among eligible individuals via an educational program is imperative. Responding to the particular needs of older immigrants with limited English proficiency, we developed a digital oral health intervention for older Korean-American Medi-Cal enrollees in Los Angeles. This educational intervention is designed to be delivered via computers and the Internet. It consists of a 15-min self-running PowerPoint presentation narrated in Korean with links to additional information on the Internet. The slides contain information about the basic etiology of oral diseases, oral hygiene, common myths about oral health and dental care, Medi-Cal coverage of preventive dental care, and how to find a dental clinic.MethodsWe pilot tested the intervention with 12 participants to examine its feasibility and acceptability. We also obtained participants’ qualitative feedback about the intervention.ResultsA post-intervention quantitative assessment yielded high participant satisfaction and improved oral health and dental care knowledge. Participant responses to the intervention yielded four themes: (1) content and structure, (2) linguistic and cultural aspects, (3) delivery mode, and (4) additional concerns and suggestions.ConclusionsOur findings confirm the intervention’s feasibility and acceptability and suggest further refinement.

The Impact of the Emotional Responses of Korean Students Participating in School Sports.

Physical education in schools improves students' health, physical strength, and lifelong physical engagement. Therefore, participation must be encouraged. This study aimed to investigate the relationship between emotional responses and participation satisfaction, word-of-mouth (WOM) praise, and WOM activity in students participating in school sports. Few studies have considered WOM praise and activity separately. This study addresses this gap in the literature. In 2023, a survey of total of 345 students in Gyeonggi-do, Korea, was conducted using convenience sampling. Data processing included factor analysis to verify validity and reliability, correlation analysis, confirmatory factor analysis, and structural equation modeling to test the hypotheses. The results confirmed a relationship between the emotional responses of students and satisfaction with participation. The emotional responses (ventilation [P<0.001], sense of dominance [P<0.001]) significantly affected participation satisfaction, and the latter had a possible causal relationship with WOM praise (P<0.001) and activity (P<0.001). The emotional responses of school sports participants were related to participation satisfaction, WOM praise, and WOM activity. Participation satisfaction significantly affected WOM praise and WOM activity. Therefore, to contribute to students' lifelong health, school sports programs should be developed and implemented to induce positive emotional responses, ensure students' participation in school sports, and improve their future quality of life.

A Staged Defragmented Simultaneous Debriefing Model As Integrated Micro-debriefing Components Inside Online Simulation for Competencies Formation.

Background Currently, there are no separate debriefing models for online simulation training, and existing models simply imitate the traditional models used in on-site simulation training (the physical presence of individuals, such as students or trainees, in a simulation center). This involves hands-on, in-person training within a simulated environment to enhance practical skills and knowledge in a controlled setting. This scenario does not fully meet the requirements and capabilities of distance learning. Objective To develop a staged defragmented debriefing model as integrated micro-debriefing components inside an online simulation to support the development of clinical decision-making andcompetencies formation within medical education and offer recommendations to support the use of this debriefing model as a teaching strategy. Methods This descriptive study was conducted from August 2020 to September 2023. To build a staged defragmented debriefing model as integrated micro-debriefing components inside an online simulation for competencies formation the traditional debriefing model's components for on-site simulation training, simulation type, and structure, modern concepts of e-learning, and classification of the seriousness of medication errors were used. The main focus of this study was on providing a detailed account of the debriefing components for online simulation training, features, and implementation of this new teaching model.A total of 38 participants, healthcare professionals, were recruited for this study. The participants were randomly assigned to two groups: one experiencing the staged defragmented debriefing model (n = 20) and the other control group, which received traditional debriefing following simulation training (n = 18). Results The results allowed us tosuccessfully develop a staged defragmented debriefing model inside the simulation that integrates micro-debriefing components located at different points of the simulation scenarios. This teaching approach was successfully implemented in online clinical case scenarios in the "ClinCaseQuest" Simulation Training Platform for continuous medical education.Additionally, an internal validation experiment comparing the effectiveness of the staged defragmented debriefing model with the traditional debriefing method demonstrated superior learning outcomes and participant satisfaction in the staged debriefing group. Conclusions The staged defragmented debriefing model, when integrated into online simulations, represents a promising strategy for advancing clinical decision-making skills and competencies formation in medical education. Implementation of this debriefing model as a teaching strategy holds promise for enhancing learning outcomes in medical education settings. Further research, validation, and implementation are recommended to maximize the model's potential impact on medical education and training.

Purse-string skin closure versus linear skin closure in people undergoing stoma reversal.

Stoma reversal is associated with a relatively high risk of surgical site infection (SSI), occurring in up to 40% of cases. This may be explained by the presence of microorganisms around the stoma site, and possible contamination with the intestinal contents during the open-end manipulation of the bowel, making the stoma closure site a clean-contaminated wound. The conventional technique for stoma reversal is linear skin closure (LSC). The purse-string skin closure (PSSC) technique (circumferential skin approximation) creates a small opening in the centre of the wound, enabling free drainage of contaminants and serous fluid. This could decrease the risk of SSI compared with LSC. To assess the effects of purse-string skin closure compared with linear skin closure in people undergoing stoma reversal. We searched CENTRAL, MEDLINE, Embase, two other databases, and three trials registers on 21 December 2022. We also checked references, searched for citations, and contacted study authors to identify additional studies. We included all randomised controlled trials (RCTs) comparing PSSC and LSC techniques in people undergoing closure of stoma (loop ileostomy, end ileostomy, loop colostomy, or end colostomy) created for any indication. Two review authors independently selected eligible studies, extracted data, evaluated the methodological quality of the included studies, and conducted the analyses. The most clinically relevant outcomes were SSI, participant satisfaction, incisional hernia, and operative time. We calculated odds ratios (ORs) for dichotomous data and mean differences (MDs) for continuous data, each with its corresponding 95% confidence interval (CI). We used the GRADE approach to rate the certainty of the evidence. Nine RCTs involving 757 participants were eligible for inclusion. Eight studies recruited only adults (aged 18 years and older), and one study included people aged 12 years and older. The participants underwent elective reversal of either ileostomy (82%) or colostomy (18%). We considered all studies at high risk of performance and detection bias (lack of blinding) and four studies at unclear risk of selection bias related to random sequence generation. PSSC compared with LSC likely reduces the risk of SSI (OR 0.17, 95% CI 0.09 to 0.29; I2 = 0%; 9 studies, 757 participants; moderate-certainty evidence). The anticipated absolute risk of SSI is 52 per 1000 people who have PSSC and 243 per 1000 people who have LSC. The likelihood of being very satisfied or satisfied with stoma closure may be higher amongst people who have PSSC compared with people who have LSC (100% vs 89%; OR 20.11, 95% CI 1.09 to 369.88; 2 studies, 122 participants; low-certainty evidence). The results of the analysis suggest that PSSC compared with LSC may have little or no effect on the risk of incisional hernia (OR 0.51, 95% CI 0.07 to 3.70; I2 = 49%; 4 studies, 297 participants; very low-certainty evidence) and operative time (MD -2.67 minutes, 95% CI -8.56 to 3.22; I2 = 65%; 6 studies, 460 participants; very low-certainty evidence). PSSC compared with LSC likely reduces the risk of SSI in people undergoing reversal of stoma. People who have PSSC may be more satisfied with the result compared with people who have LSC. There may be little or no difference between the skin closure techniques in terms of incisional hernia and operative time, though the evidence for these two outcomes is very uncertain.

Centring participant experience: a realist evaluation of a menstruator-friendly facility design project in a refugee settlement, Lebanon

IntroductionMenstrual health in humanitarian contexts is a neglected topic. Its taboo nature presents difficulties for participants in menstrual health projects in these particularly challenging settings. Namely, their experiences may be concealed or overlooked in projects that are typically outcome focused. Realist Evaluation is a useful method to unearth and explore the hidden mechanisms and their causes, which lead to positive or negative participant experiences. The authors have applied this approach to a robust humanitarian menstrual health project to explore how to centre the emotional wellbeing of participants at all stages: prior to, during, and post-participation.Study settingThe project studied was led by the International Federation of Red Cross and Red Crescent Societies who piloted their adaptable manual for menstruator–friendly water, sanitation and hygiene (WaSH) facility design in humanitarian contexts. It was conducted by the Lebanese Red Cross in an informal tented settlement hosting Syrian refugees in Qaa, Lebanon.MethodsThe authors collected interview and focus group data on the contextual factors and processes within the project from nine project staff and 16 settlement inhabitants. They used a realist process of theory development, testing, and consolidation to understand how and under what circumstances the project inputs affected participants’ wellbeing.ResultsThe contextual factors and causal mechanisms promoting participant experience comprised individual (choices influencing and experience during participation), interpersonal (group dynamics and the role of non-menstruators), and organisational (expertise and knowledge, relationship to participants and cultural differences) factors.ImplicationsThe research uses a case study from a renowned humanitarian organisation who provided a well-delivered project in a conducive environment to explore the mechanisms and contexts that can promote wider learning and refine understanding and programming in this under-researched and -theorised space. Specifically, it informs which contextual factors and project inputs must be present within a menstrual health project to ensure participant satisfaction whilst efficiently delivering well-designed menstruator-friendly WaSH facilities.

Effects of paternal involvement in nighttime childcare on child and maternal sleep: exploring the roles of relationship satisfaction and maternal competence about child sleep.

Supportive coparenting between couples has been shown to have positive effects on the dyadic relationship, child development, and parental and child sleep. This study aimed to investigate the association between paternal involvement in nighttime childcare and child and maternal sleep, while exploring relationship satisfaction and maternal competence about child sleep as mediators. The sample consisted of 290 mothers (mean age ± standard deviation = 34.8 ± 4.1) with children (50.7% male) aged 6-36 (mean ± standard deviation = 22.7 ± 8.6) months. Participants reported their paternal involvement in nighttime childcare and completed the following questionnaires: Brief Infant Sleep Questionnaire-Revised, Dyadic Adjustment Scale-4 items, and the Insomnia Severity Index. Path analysis was conducted to examine the impact of paternal involvement on child and maternal sleep through relationship satisfaction and maternal competence. Among the sample, 74.8% responded that paternal participation in nighttime childcare was less than 25%. Path analysis showed that paternal involvement had a significant direct effect on maternal insomnia (β = -.15, P < .05) but not on child sleep. Direct pathways from paternal involvement to relationship satisfaction (β = .17), from relationship satisfaction to maternal competence (β = .19), from maternal competence to child's sleep (β = -.57), and from child sleep to maternal insomnia (β = .48) were significant (P < .01). Relationship satisfaction mediated the associations between paternal involvement and child (β = -.08, P < .05) and maternal (β = -.04, P < .05) sleep. Paternal nighttime childcare involvement was low in South Korea. The results highlight the importance of considering paternal supportive participation and relationship satisfaction in future research on child and maternal sleep. Song J, Jang E, Astbury L, Bei B, Suh S. Effects of paternal involvement in nighttime childcare on child and maternal sleep: exploring the roles of relationship satisfaction and maternal competence about child sleep. J Clin Sleep Med. 2024;20(8):1241-1250.

Relationship Between Social Support and Clinical Outcomes: An Evaluation of Participant-Nominated Treatment Supporters in the HOPE 4 Intervention.

The HOPE 4 trial (Heart Outcomes Prevention and Evaluation 4) investigated the effectiveness of a comprehensive, collaborative model of care, implemented in Colombia and Malaysia, which aimed to reduce cardiovascular disease risk in individuals with hypertension. One component of this intervention was the nomination of a treatment supporter, where participants could select a family member or friend to assist them with their care. The purpose of this study was to investigate the impact of these individuals on participant outcomes, as well as the relationship dynamics between participants and their treatment supporter. Participants in the HOPE 4 intervention group with baseline and 12 months of follow-up were included for analysis. They were divided into Every Visit (n=339) and <Every Visit (n=268) groups based on whether they had a treatment supporter for all 5 or for <5 follow-up visits, respectively. Outcomes were stratified between groups and tested for significance using a generalized linear mixed-effects model. A survey investigating participant satisfaction with their treatment supporter was administered at 12 months. Groups were majority female (53% versus 62%) with a mean age of 63 and 66 years. Country of origin differed between groups (22% versus 86%; Colombia). A 15.5% ([95% CI, 6.2%-24.8%] P=0.004) greater increase in statin medication use was reported in the Every Visit group at 12 months compared with the <Every Visit group. Sixty-one percent versus 48.2% of participants reported high medication adherence at 12 months (P<0.003). The difference in change in systolic blood pressure between groups was not found to be significant at 12 months, though it favored the Every Visit group (-2.3 [95% CI, -6.1 to 1.5]; P=0.045). The majority of survey respondents from either study group strongly agreed that having a treatment supporter positively influenced their health. Long-term support from a nominated treatment supporter was associated with improved adherence, risk factor management, and medication use among individuals with hypertension. URL: https://www.clinicaltrials.gov; Unique identifier: NCT01826019.