Evaluation Process Research Articles

Comparative Evaluation of Fenton and Persulfate Processes with UV/H2O2 for Batik Wastewater Treatment: Optimizing Fe2+ and S2O8 2- Ratio by H2O2 for Enhanced Pollutant Degradation

Wastewater generated from industrial processes including the batik industry in Indonesia contains high organic pollutants and dyes. In this study, the advanced oxidation process that will produce hydroxyl radicals was used to degrade pollutants in this batik industry wastewater. This study aims to compare the Fenton and Persulfate processes with the influence of variations in the concentration of Fe2+ and S2O8 2- added. This method is carried out by adding H2O2 as an oxidant which is added to each catalyst, namely Fe2+ and S2O8 2- in the presence of a combination of UV light. Fenton process was carried out in 60 minutes and Persulfate process was carried out in 45 minutes. In this study, there was a tendency to increase the efficiency of COD and color removal along with the increasing concentration of each catalyst added. The highest COD and color removal efficiency occurred at a ratio of H2O2:Fe2+ and H2O2: S2O8 2- of 1: 0.08.

Enhancing service delivery via Work-Integrated Learning (WIL) at uMzimkhulu Local Municipality, South Africa

Municipalities in South Africa face numerous challenges that hinder efficient service delivery. One of these challenges is the lack of implementation of required services, leading to citizen dissatisfaction and protest actions. This study aims to investigate methods for improving service delivery in public institutions in South Africa through the implementation of work-integrated learning (WIL) programmes. Data for this study was collected from the uMzimkhulu local municipality in KwaZulu-Natal, specifically from the Harry Gwala District. A total of 56 participants took part in the study, including 28 WIL students and 28 mentors. This ensured representation from all departments within the municipality. Two separate sets of questionnaires were used to collect data from these two groups. Data analysis was performed using the Statistics Packaging for Social Sciences (SPSS) version 27. The study identified several challenges that currently hinder the effective implementation of WIL programmes within the municipality. As a result, it is recommended that the municipality provide training for WIL students and establish efficient monitoring and evaluation processes for the WIL programmes. Additionally, the municipality should involve students in WIL programmes in matters related to progressive initiatives and provide further support to enhance their ability to handle client services. It is also advised that the municipality prioritise the development of facilities and resources for WIL students to fully engage them in their work.

Protocol for a feasibility registry-based randomised controlled trial investigating a tailored follow-up service for stroke (A-LISTS)

BackgroundStroke affects long-term physical and cognitive function; many survivors report unmet health needs, such as pain or depression. A hospital-led follow-up service designed to address ongoing health problems may avoid unplanned readmissions and improve quality of life.MethodsThis paper outlines the protocol for a registry-based, randomised controlled trial with allocation concealment of participants and outcome assessors. Based on an intention-to-treat analysis, we will evaluate the feasibility, acceptability, potential effectiveness and cost implications of a new tailored, codesigned, hospital-led follow-up service for people within 6–12 months of stroke. Participants (n = 100) from the Australian Stroke Clinical Registry who report extreme health problems on the EuroQol EQ-5D-3L survey between 90 and 180 days after stroke will be randomly assigned (1:1) to intervention (follow-up service) or control (usual care) groups. All participants will be independently assessed at baseline and 12–14-week post-randomisation. Primary outcomes for feasibility are the proportion of participants completing the trial and for intervention participants the proportion that received follow-up services. Acceptability is satisfaction of clinicians and participants involved in the intervention. Secondary outcomes include effectiveness: change in extreme health problems (EQ-5D-3L), unmet needs (Longer-term Unmet Needs questionnaire), unplanned presentations and hospital readmission, functional independence (modified Rankin Scale) and cost implications estimated from self-reported health service utilisation and productivity (e.g. workforce participation). To inform future research or implementation, the design contains a process evaluation including clinical protocol fidelity and an economic evaluation.DiscussionThe results of this study will provide improved knowledge of service design and implementation barriers and facilitators and associated costs and resource implications to inform a future fully powered effectiveness trial of the intervention.Trial registrationACTRN12622001015730pr.Trial sponsorFlorey Institute of Neuroscience and Mental Health, 245 Burgundy Street, Heidelberg, VIC, 3084, PH: +61 3 9035 7032

Value-Able Valuers: Anthropogenic Climate Change and Expanding Community to the “Radically Other”

Anthropogenic climate change creates unique challenges for policy and ethics, but also new opportunities for conceptualizing moral community. Through the lens of valuing, I develop a framework for approaching climate change through the lens of expanding those whom we consider relevant to our own lives and evaluative processes. Distant humans are an important to this expansion, but the ultimate goal includes non-humans in our moral community. In becoming more receptive to the interests of those very unlike ourselves, we create opportunities for greater resilience, both for ourselves and for other organisms and ecosystems.

Evaluation of Seasonal Reservoir Water Treatment Processes in Southwest Florida: Protection of the Caloosahatchee River Estuary

In southwest Florida, the Caloosahatchee River flows from Lake Okeechobee into a biologically productive tidal estuarine system. A combination of excess water during the wet season, insufficient fresh water in the dry season, and poor quality of the river water are damaging the estuarine ecosystem. To better control the quality and quantity of the water entering the estuary, reservoirs are being constructed to store excess, poor quality water during the wet season and return it to the river for discharge into the estuary at an appropriate time. This stored water is enriched in nutrients and organic carbon. Because of the subtropical nature of the climate in southwest Florida and potential increases in temperature in the future, the return flow of water from the reservoirs must be treated before it can be returned to the river. Hence, an experimental water treatment system was developed and operated to compare biological treatment processes consisting of solely wetland plants versus adding some engineered processes, including slow sand filtration and a combination of slow sand filtration and ultraviolet (UV) treatment. These three treatment trains were operated and monitored through a seasonal cycle in 2021–2022. All three treatment methods significantly reduced the concentrations of nutrients and total organic carbon. While the enhanced engineered wetlands’ treatment trains did slightly outperform the wetland train, a comparison of the three process trains showed no statistically significant difference. It was concluded that upscaling of the slow sand filtration and UV process could improve the treatment efficiency, but this change would have to be evaluated within a framework of long-term economic benefits. It was also concluded that the Caloosahatchee River water quality is quite enriched in nutrients so that reservoir storage would increase the organic carbon concentrations, making it imperative that it be treated before being returned to the river. It was also discovered that the green alga Cladophora sp. grew rapidly in the biological treatment tubs and will present a significant challenge for the treatment of the reservoir discharge water using the currently proposed alum treatment.

Adsorption of methane by modified-biochar aiming to improve the gaseous fuels storage/transport capacity: process evaluation and modeling.

The CH4 storage by adsorption on activated carbons for natural gas handling has gained interest due to the appearance of lightweight materials with large surface areas and pore volumes. Consequently, kinetic parameters estimation of the adsorptive process can play a crucial role in understanding and scaling up the system. Concerning its versatility, banana peel (BP) is a biomass with potential for obtaining different products, such as biochar, a solid residue from the biomass' thermal decomposition of difficult disposal, where through an activation process, the material porous features are taken advantage to application as adsorbent of gaseous substances. This research reported data for the CH4 adsorption kinetic modeling by biochar from BP pyrolysis. The activated biochar textural characterization showed particles with fine mesoporous structure (pore diameter ranging between 29.39 and 55.62Å). Adsorption kinetic analysis indicated that a modified pseudo-first-order model was the most suitable to represent the experimental data, with equilibrium adsorption of 28mgg-1 for the samples activated with 20.0% vol wt.-1 of H3PO4 and pyrolysis at 500°C. The equilibrium constant was consistent with the Freundlich isotherm model, suggesting a physisorption mechanism, and led to a non-ideal, reversible, and not limited to monolayer CH4 adsorption.

Acceptability of Four Intervention Components Supporting Medication Adherence in Women with Breast Cancer: a Process Evaluation of a Fractional Factorial Pilot Optimization Trial.

Adjuvant endocrine therapy (AET) reduces mortality in early-stage breast cancer, but adherence is low. We developed a multicomponent intervention to support AET adherence comprising: text messages, information leaflet, acceptance and commitment therapy (ACT), and side-effect website. Guided by the multiphase optimization strategy, the intervention components were tested in the ROSETA pilot optimization trial. Our mixed-methods process evaluation investigated component acceptability. The pilot optimization trial used a 24-1 fractional factorial design. Fifty-two women prescribed AET were randomized to one of eight experimental conditions, containing unique component combinations. An acceptability questionnaire was administered 4months post-randomization, and semi-structured interviews with 20 participants further explored acceptability. Assessments were guided by four constructs of the theoretical framework of acceptability: affective attitude, burden, perceived effectiveness, and coherence. Quantitative and qualitative findings were triangulated to identify agreements/disagreements. There were high overall acceptability scores (median = 14-15/20, range = 11-20). There was agreement between the qualitative and quantitative findings when triangulated. Most participants "liked" or "strongly liked" all components and reported they required low effort to engage in. Between 50% (leaflet) and 65% (SMS) "agreed" or "strongly agreed," it was clear how each component would help adherence. Perceived effectiveness was mixed, with 35.0% (text messages) to 55.6% (ACT) of participants "agreeing" or "strongly agreeing" that each component would improve their adherence. Interview data provided suggestions for improvements. The four components were acceptable to women with breast cancer and will be refined. Mixed-methods and triangulation were useful methodological approaches and could be applied in other optimization trial process evaluations.

Sedaconda ACD-S for Sedation with Volatile Anaesthetics in Intensive Care: A NICE Medical Technologies Guidance.

Intensive care unit (ICU) patients receive highly complex care and often require sedation as part of their management. ICU sedation has traditionally been delivered using intravenous (IV) agents due to the impractical use of anaesthetic machines in this setting, which are used to deliver volatile sedation. Sedaconda anaesthetic conserving device (ACD)-S (previously known as AnaConDa-S) is a device which allows for the delivery of volatile sedation via the majority of mechanical ventilators by being inserted in the breathing circuit where the heat and moisture exchanger is normally placed. The National Institute of Health and Care Excellence (NICE), as part of the Medical Technologies Evaluation Programme, considered the potential benefits of using Sedaconda ACD-S compared to standard IV sedation in ICU patients. Here we describe the evidence evaluation undertaken by NICE on this technology, supported by CEDAR. CEDAR considered the evidence present in 21 publications that compared the clinical outcomes of patients receiving Sedaconda ACD-S-delivered sedation and IV sedation, and critiqued the economic model provided by the manufacturer. Clinical expert input during the evaluation process was used extensively to ensure that the relevant clinical evidence was captured and that the economic model was suitable for the UK setting. Due to the uncertainty of the evidence, sensitivity analysis was carried out on the key economic inputs to ensure the reliability of the results. Economic modelling has shown that Sedaconda ACD-S-delivered isoflurane sedation is cost saving on a 30-day horizon compared to IV sedation by £3833.76 per adult patient and by £2837.41 per paediatric patient. Clinical evidence indicated that Sedaconda ACD-S-delivered isoflurane sedation is associated with faster patient wake-up times than standard of care. Consequently, NICE recommended Sedaconda ACD-S as an option for delivering sedation in the ICU setting, but noted that further research should inform whether Sedaconda ACD-S-delivered sedation is of benefit to any particular subgroup of patients.

Community case management to accelerate access to healthcare in Mali: A realist process evaluation nested within a cluster randomised trial.

The Proactive Community Case Management (ProCCM) trial in Mali reinforced the health system across both arms with user fee removal, professional Community Health Workers (CHWs), and upgraded primary health centres (PHCs)-and randomized village-clusters to receive proactive home visits by CHWs (intervention) or fixed site-based services by passive CHWs (control). Across both arms, sick children's 24-hour treatment and pregnant women's four or more antenatal visits doubled, and under-five mortality halved, over three years compared to baseline. In the intervention arm, proactive CHW home visits had modest effects on children's curative and women's antenatal care utilization, but no effect on under-five mortality, compared to the control arm. We aimed to explain these results by examining implementation, mechanisms, and context in both arms. We conducted a process evaluation with a mixed method convergent design that included 79 in-depth interviews with providers and participants over two time-points, surveys with 195 providers, and secondary analyses of clinical data. We embedded realist approaches in novel ways to test, refine, and consolidate theories about how ProCCM worked, generating three context-intervention-actor-mechanism-outcome nodes that unfolded in a cascade. First, removing user fees and deploying professional CHWs in every cluster enabled participants to seek health sector care promptly and created a context of facilitated access. Second, health systems support to all CHWs and PHCs enabled equitable, respectful, quality healthcare, which motivated increased, rapid utilization. Third, proactive CHW home visits facilitated CHWs and participants to deliver and seek care, and build relationships, trust, and expectations, but these mechanisms were also activated in both arms. Addressing multiple structural barriers to care, user fee removal, professional CHWs, and upgraded clinics interacted with providers' and patients' agency to achieve rapid care and child survival in both arms. Proactive home visits expedited or compounded mechanisms that were activated and changed the context across arms.

Exploration on Innovation Path of Precise Ideological and Political Work in Colleges and Universities Under the Background of Big Data Driving

However, although existing models for evaluating the effectiveness of universities provide a large number of modeling solutions, it is difficult to objectively evaluate dynamic coefficients based on the differences in precision ideological and political work systems of different types of universities in the evaluation process of innovative paths for precision ideological and political work. In this context, this article proposes an innovative path for the precision of ideological and political work in universities under the background of big data driving, and constructs a complex system discrete dynamic modeling technology. This model quantitatively describes the consistency between different precise ideological and political work models, the similarity of research strategies for precise ideological and political work, and expected evaluation indicators using multiple transformation dynamic coefficients. This study provides new ideas and methods for innovative research in the field of ideological and political work in universities.

PENGEMBANGAN EVALUASI PEMBELAJARAN MATEMATIKA BERBASIS WORDWALL PADA MATERI BANGUN RUANG SISI DATAR

In order to maximize the learning interest capacity of class VIII MTSS Al-Washliyah Tembung pupils for the 2023–2024 academic year, this research attempts to deepen the mathematics learning assessment technique utilizing Wordwall on flat-sided geometric material. Students might find the evaluation process more engaging and enjoyable when technology-based assessment formats like Wordwall are used. Using the ADDIE model approach (Analysis, Design, Development, Implementation and assessment), a development study was employed as the research technique to create a Wordwall-based mathematics learning assessment. Observation, surveys, interviews, and documentation are some of the techniques used to collect data. Techniques for analyzing data include validity, usefulness, and effectiveness analysis. The project yielded a Wordwall-based evaluation product for mathematics learning on flat-sided geometric material. Four validators gave this product an average score of 93%, which was used to declare it legitimate. This product received an 88% practicality grade after being provided practically by practitioners. The N-gain test scored 0.66 in the medium group based on the outcomes of the Wordwall-based learning assessment test. In summary, the assessment of Wordwall-based mathematics instruction using flat-sided geometric materials for MTSS Al-Washliyah Tembung's class VIII.

Process evaluation of comprehensive sexuality education programme in Zambia: a focus on contextual factors, mechanisms of impact, quality of development and implementation process

BackgroundComprehensive sexuality education (CSE) is critical in addressing negative sexual and reproductive health (SRH) outcomes among adolescents. Yet in many low- and middle-income countries (LMICs) including Zambia, little is known about the impact, realities of CSE implementation, the quality of teaching and the comprehensiveness of the content covered.MethodsOur approach was informed by a process evaluation incorporating recommendations by the European Expert Group guidance on evaluating sexuality education programmes and the Medical Research Council (MRC) guidelines on process evaluation. The development process and quality of CSE implementation were assessed using eight and six quality criteria respectively. In-depth interviews (IDIs), focus group discussions (FGDs), document analysis and classroom observation were employed to assess contextual factors, implementation process and mechanisms of impact of CSE. In-depth interviews (50) and focus group discussions (2) with seven pupils in each group were conducted among 64 purposefully selected participants. The sample comprised pupils (35), parents (4) and teachers (17) from nine secondary schools (four peri-urban, four urban and one rural), policymakers (4), and religious leaders (4). We employed deductive content analysis to analyse the data.ResultsContextual factors that influenced the implementation of CSE included: (1) piecemeal funding for the CSE programme; (2) lack of monitoring programmes in schools; (3) lack of community engagement; (4) religious and socio-cultural barriers; (5) lack of skills and competency to teach CSE; and (6) insufficient time allocation for CSE. The assessment of the quality of the development of CSE revealed: (1) a lack of sexual diversity; (2) no meaningful participation of pupils in programme implementation; (3) a lack of stakeholder engagement during programme implementation; (4) lack of gender sensitivity; and (5) lack of human rights approach. Assessment of the quality of the implementation of CSE revealed: (1) no evidence of skill-based CSE teaching; (2) no linkage between CSE and SRH services in the communities; and (3) a lack of incorporation of multiple delivery methods during CSE teaching. The mechanisms of impact of CSE were related to the acceptability and positive changes in pupils’ SRH practices.ConclusionThe complex influences of contextual factors during CSE implementation highlight the need for contextual analysis during the interventional design. Co-creation of the CSE programme through stakeholder participation could reduce social opposition and enable a culturally sensitive CSE. Comprehensive teacher training, a guiding curriculum as well as setting of appropriate monitoring tools and indicators are likely to enhance the quality of CSE implementation.

Evidence-based meets community-centred: A new approach to creating informal learning opportunities for children.

Informal learning spaces present ripe opportunities to supplement formal learning experiences. In this paper, we offer a new approach to creating enriching learning activities for public spaces that reflects evidence-based practices rooted in developmental psychology and uses community-centring practices from participatory research approaches. We first argue that extant theory and research supports the use of guided play pedagogy to foster learning. Second, we argue that effective translation of research to practice should incorporate community voices at every stage of the design, implementation and evaluation process. We describe a new initiative called Playful Learning Landscapes that reflects tenets of core developmental theory including constructivism and social learning theories as well as guided play pedagogy. Playful Learning Landscapes also extends the scope and scale of these evidence-backed theories by collaborating with communities to design activities for local community spaces. Taken together, we offer a way of upholding core developmental theory with equitable, culturally inclusive research and intervention practices. Transforming community spaces into hubs for children's learning promises wide-reaching implications for equitable access, school readiness and early childhood education.

How to perform standardized sonographic examination of Cesarean scar pregnancy in the first trimester.

Early diagnosis and appropriate management of Cesarean scar pregnancy (CSP) are crucial to prevent severe complications such as uterine rupture, severe hemorrhage and placenta accreta spectrum disorders. In this article, we provide a step-by-step tutorial for the standardized sonographic evaluation of CSP in the first trimester. Practical steps for performing a standardized transvaginal ultrasound examination to diagnose CSP are outlined, focusing on criteria and techniques essential for accurate identification and classification. Key sonographic markers, including gestational sac location, cardiac activity, placental implantation and myometrial thickness, are detailed. The evaluation process is presented according to assessment of the uterine scar, differential diagnosis, detailed CSP evaluation and CSP classification. This step-by-step tutorial emphasizes the importance of scanning in two planes (sagittal and transverse), utilizing color or power Doppler and differentiating CSP from other low-lying pregnancies. The CSP classification is described in detail and is based on the location of the largest part of the gestational sac relative to the uterine cavity and serosal lines. This descriptive classification is recommended for clinical use to stimulate uniform description and evaluation. Such a standardized sonographic evaluation of CSP in the first trimester is essential for early diagnosis and management, helping to prevent life-threatening complications and to preserve fertility. Training sonographers in detailed evaluation techniques and promoting awareness of CSP are critical. The structured approach to CSP diagnosis presented herein is supported by a free e-learning course available online. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ethical consideration in program evaluation for health professional education programs

Objectives: To explore the ethical considerations and measures of quality assurance during data-collection for programme evaluation in health professional education. Method: The qualitative case study was conducted at Bahria University of Health Sciences, Karachi, from August to November 2023, and comprised faculty members involved in programme evaluation for at least two years having done a minimum two audit cycles. System thinking philosophical framework was used during the data-collection phase. A diverse sample was selected to ensure representation from different sectors and roles within the teams. Data was collected through participant observation, semi-structured interviews and focus group discussions. Data was subjected to thematic analysis. Results: There were 7 faculty members who were interviewed individually twice in addition to 4 focus group discussion. Members of quality assurance team were experts in their respective fields, but were not found to be well-versed in terms of ethical considerations that should guide data-collection. This lack of knowledge may inadvertently lead to ethical lapses in the evaluation process. Another ethical challenge seen was bias in the data-collection phase. Conclusion: Faculty members integral to programme evaluation efforts were found to lack knowledge regarding ethical considerations in data-collection, which can pose significant risks. Key Words: Programme evaluation, Ethics, Health professional education.

Process Evaluation of a Work Stress Prevention Approach in Primary Education: Exploring the Added Value of Real-Time Feedback During Implementation.

Participatory organisational-level interventions carry a risk of implementation failure. The current study evaluates the implementation of a work stress prevention approach in primary education and reflects on the use of real-time feedback as implementation strategy to prevent this risk. The process evaluation was conducted at four primary schools in the Netherlands. A framework for evaluating organisational-level interventions was applied using mixed methods. Results show the implementation level varied between schools and was hindered by the intervention context, school size, and planning of the approach. Management commitment and employee involvement appeared important factors for successful implementation. Real-time feedback appeared valuable to further improve implementation, but not to prevent implementation failure. Collecting data on implementation factors before the active phase of the approach, may provide the possibility to anticipate on implementation problems earlier.

An Investigation of Teaching-Learning Process and Measurement and Evaluation in Elementary English Course Curriculum with the Communicative Language Approach (Teachers’ Views)

This study aimed to determine how teachers use the communicative language approach in the learning-teaching process and measurement-evaluation dimensions while implementing the 2018 Primary English Course (Grades 2-8) Curriculum. Embedded single case study design, one of the qualitative designs, was used in this study. The study group included 14 primary education English language teachers instructing different grades in public schools in Eskişehir, Turkey. Data were collected through semi-structured interviews with teachers and analyzed by content analysis. The findings demonstrated that communicative language approach could not be implemented in the classroom due to physical problems in the teaching-learning process, student reluctance and lack of readiness, teachers' initial failure to analyze the learner goals and styles, the lack of the predominant employment of the target language, partial inclusion of the activities determined by the communicative language approach in the course, preference of grammar instruction, partial utilization of group activities, the lack of using authentic materials, immediate correction of learner mistakes, inability to adopt the communicative language roles such as initialization of communication, providing resources and preference of traditional roles, and inability to measure the four basic language skills due to systemic measurement and evaluation errors.

A novel silicon PIN photodiode device for radiation exposure monitoring in dental CBCT

This paper presents a versatile and cost-effective system for the monitoring of X-ray exposure during dental cone beam computed tomography procedures based on silicon PIN photodiode detectors. The system, developed and implemented at the University of Pisa's School of Engineering, underwent characterization under a range of operational conditions focusing on full field-of-view 3D protocols used in adult patient examinations. This study was facilitated by the Azienda Ospedaliero Universitaria Pisana, which provided access to a Planmeca ProMax 3D Classic scanner for the research. During the investigation, photodiodes were placed both on the surface and inside an Alderson RANDO phantom head to assess the dose delivered to regions near radiation-sensitive areas such as the salivary glands, thyroid, eye lens, and laryngopharynx. The evaluation process spanned a spectrum of tube voltages, ranging from 60 to 90 kVp, and tube currents, extending up to 16 mA, to ensure a broad and thorough analysis. Furthermore, to reinforce the effectiveness of the silicon photodiodes' measurement capabilities, calibrated GR-200 A-type thermoluminescent dosimeters were positioned within the phantom head inserts to serve as a reference point. Complementing this setup, PCXMC Rotation 2.0 simulations were conducted to further the efficacy of the monitoring system, particularly tailored to the specific dental CBCT protocols being investigated. In conclusion, while the research revealed a generally consistent correlation across PCXMC simulations, photodiode readings, and thermoluminescent dosimeter measurements, it is important to note that a direct comparison was not exactly possible due to limitations in the size and positioning of the systems. Variations up to 20–35% were observed, primarily due to the different positioning of the dosimeters and the unique physical and operational traits of the different measurement methods employed. Nevertheless, the development of an affordable, easily deployable, and scalable dosimetry monitoring system may provide a substantial contribution to enhancing patient safety in dental radiology and aid in the optimization of diagnostic X-ray protocols.

Implementation of a fluid balance control strategy in critically ill patients: POINCARE-2 trial process evaluation

BackgroundPOINCARE-2 trial aimed to assess the effectiveness of a strategy designed to tackle fluid overload through daily weighing and subsequent administration of treatments in critically ill patients. Even in highly standardized care settings, such as intensive care units, effectiveness of such a complex intervention depends on its actual efficacy but also on the extent of its implementation. Using a process evaluation, we aimed to provide understanding of the implementation, context, and mechanisms of change of POINCARE-2 strategy during the trial, to gain insight on its effectiveness and inform the decision regarding the dissemination of the intervention.MethodsWe conducted a mixed-method process evaluation following the Medical Research Council guideline. Both quantitative data derived from the trial, and qualitative data from semi-structured interviews with professionals were used to explain implementation, mechanisms of change of the POINCARE-2 strategy, as well as contextual factors potentially influencing implementation of the strategy.ResultsScore of actual exposure to the strategy ranged from 29.1 to 68.2% during the control period, and from 61.9 to 92.3% during the intervention period, suggesting both potential contamination and suboptimal fidelity to the strategy. Lack of appropriate weighing devices, lack of human resources dedicated to research, pre-trial rooted prescription habits, and anticipated knowledge of the strategy have been identified as the main barriers to optimal implementation of the strategy in the trial context.ConclusionsBoth contamination and suboptimal fidelity to POINCARE-2 strategy raised concerns about a potential bias towards the null of intention-to-treat (ITT) analyses. However, optimal fidelity seemed reachable. Consequently, a clinical strategy should not be rejected solely on the basis of the negativity of ITT analyses’ results. Our findings showed that, even in highly standardized care conditions, the implementation of clinical strategies may be hindered by numerous contextual factors, which demonstrates the critical importance of assessing the viability of an intervention, prior to any evaluation of its effectiveness.Trial registrationNumber NCT02765009

A methodological and reporting quality assessment of systematic reviews/meta-analyses on exercise interventions for cognitive function in older adults with mild cognitive impairment.

To assess the methodological quality of meta-analytic literature on exercise interventions for cognitive function in patients with mild cognitive impairment (MCI) and the certainty of evidence for its outcome indicators, and to provide clinicians and researchers with more reliable data for making decisions. Meta-analytic literature related to the effect of exercise intervention on cognitive function in patients with mild cognitive impairment was searched through PubMed, Cochrane Library, Embase, Scopus, Physiotherapy Evidence Database and Web of Science, all with a search period frame of each database until June 1, 2024. The AMSTAR2 scale was used to evaluate the methodological quality of the included studies. Seventeen meta-analyses were included. The AMSTAR2 scale evaluation results showed that there was one medium-quality studies (5.55%), seven low-quality studies (38.88%), and 10 very low-quality studies (55.55%). Methodological deficiencies included failure to prepare a plan and provide a registration number, literature screening, data extraction, reasons for exclusion not described in detail, poor implementation process for systematic evaluation, and failure to describe the source of funding for the included studies or relevant conflicts of interest. The overall methodological quality of the meta-analytic literature is low, and the certainty of evidence is low. We encourage the conduction of high-quality randomized trials to generate stronger evidence. Subsequent systematic reviews can then synthesize this evidence to inform future research and clinical guidelines.