Training Program Research Articles

Manual wheelchair training approaches and intended training outcomes for adults who are new to wheelchair use: A scoping review.

Wheelchair training is pivotal for safety, independence, and occupational engagement in the community, yet adults coming into wheelchair use often receive insufficient or untailored training. This research aimed to understand the range and type of manual wheelchair training approaches that exist for adults commencing wheelchair use. A systematic scoping review involved searching eight electronic databases and grey literature up to September 2023. Papers relating to manual wheelchair training for adults and their caregivers were included for data extraction. Eighty-seven articles were included in this review. The International Classification of Functioning (ICF) was used to organise and analyse data related to intended training outcomes. Consumer consultation was not included in this review; however, the outcomes suggest that involving consumers in future wheelchair training research is critical to assure community participation outcomes. Data were extracted from 87 papers. Manual wheelchair training was delivered across diverse contexts encompassing varied support structures, trainer backgrounds, and technology and was commonly directed towards wheelchair users with spinal cord injury. Intended training outcomes most frequently mapped to the activity and participation component of the ICF (n= 39), followed by personal factors (n= 27), body structures and functions (n= 18), and environmental factors (n= 3), with limited focus on longer term occupational engagement outcomes. Most existing manual wheelchair training focussed on the acquisition of individual wheelchair skill and may not facilitate generalised and long-term occupational participation outcomes. Further exploration into the contexts that support occupational engagement, particularly for older adults with progressive conditions, is required to support service provision. We looked at what manual wheelchair training approaches exist for adults who need to use a manual wheelchair and what training helps people to do/achieve. We did a scoping review that looked at literature about manual wheelchair training programs for adult wheelchair users. We found 87 research papers and training programs that we included in our review. We recorded and analysed information from all the papers about the wheelchair training programs and outcomes for people who do these programs. We found that manual wheelchair training can be done in structured or ad hoc ways, can have different amounts of training, can be provided face-to-face or online, and can be given by different allied health professionals and other wheelchair users. Most training programs had short-term outcomes like learning manual wheelchair skills, being able to use the wheelchair properly, and feeling confident about using a wheelchair. Some had longer term outcomes about being able to use the manual wheelchair in everyday activities. Most people who did the training programs that we looked at in this review were manual wheelchair users with spinal cord injury. Because not many wheelchair programs have been tried with people who do not have a spinal cord injury, it is hard for occupational therapists to make recommendations about training for other people who use a manual wheelchair. Manual wheelchair training that is done in the community and made to meet the needs of individuals may help people with using their wheelchair for their everyday activities and participate in their community.

Effects of Exergame Training on Executive Function and Heart Rate Variability in Middle-Aged and Older Adults: ARandomized Controlled Study.

Exergame has become widely popular and offers great levels of cognitive demands, thus may facilitate cognitive benefits. In addition, researchers have proposed that cardiac autonomic function, assessed via heart rate variability (HRV), is associated with cognitive executive function. However, few exergame training studies have investigated this relationship. This study aimed to investigate the effects of 10-week exergame training on executive function and HRV in middle-aged and older adults. Ninety-one participants were randomly assigned to either an exergame training group (63.73±4.48years) or a control group (62.46±4.77years). The training program was 50min per session, twice per week for 10weeks. The control group was instructed to maintain their usual lifestyle. All participants completed questionnaires and received assessments of executive functions and electrocardiography at baseline and postintervention. Results revealed significant group-by-time interaction effects for the three indices of the digit span test and the total initiation time of the Tower of London task with better postintervention performances achieved by the exergame group. The 6 min walk test also improved significantly in the exergame group but not in the control group. No significant change in HRV was observed for both groups. There were significant correlations between HRV and digit span test scores. Our results suggest that the 10-week exergame training program was effective in improving executive functions of working memory, inhibitory control, and planning ability as well as aerobic fitness in middle-aged and older adults. Moreover, HRV was associated with improved executive function.

723 Evaluating differences in documentation between residents in different training programs in a pediatric emergency department using a novel grading tool

723 Evaluating differences in documentation between residents in different training programs in a pediatric emergency department using a novel grading tool

Key stakeholder's attitudes towards the professional accountabilities and responsibilities of newly qualified Pharmacist Independent Prescribers (IPs) in England and enablers to implementation at scale?

BackgroundIndependent prescribing is set to expand amongst community pharmacists in the next few years. This study aims to explore the different accountabilities and responsibilities associated with independent prescribing compared to more traditional pharmacist roles. ObjectiveTo inform commissioning frameworks that will allow independent prescribing by community pharmacists to be commissioned safely and appropriately at scale. Design/MethodologyA series of qualitative semi-structured interviews were undertaken with key stakeholders. Interviews were analysed using thematic analysis, and over-arching themes developed from emergent findings. ConclusionsThis study identified three themes, supported by twelve sub-themes, associated with pharmacist independent prescribing being viewed positively. Those three themes were self, environment and competence. Whilst pharmacists are well placed through their initial education and training to undertake a prescribing role, we found that there are perceived differences in responsibility between a prescribing and a non-prescribing role, attitude towards risk and the training and support need to adapt to those changes. These differences are explored leading to a series of overarching themes and recommendations, including that ongoing support is critical and should be built into commissioning frameworks, that newly qualified prescribers need to start prescribing immediately after qualifying and that experiential learning should be built into all training programmes.

A Military-Civilian Training Partnership for Army Nurses.

In 2018, the U.S. Army Surgeon General created the Army Medical Department Military-Civilian Trauma Team Training (AMCT3) program to enhance the clinical proficiency of medical personnel serving on Army trauma teams called forward resuscitative surgical detachments (FRSDs). FRSDs provide resuscitative and surgical care to wounded patients in the deployed environment until they can be medically evacuated to a higher level of care. Through AMCT3, FRSD personnel work at civilian trauma centers while not deployed in order to maintain their combat casualty care competency. This article describes an innovative nursing-specific AMCT3 program model in which Army nurses serving on an FRSD are embedded within a level 1 trauma center for a 3-year assignment. The goal of the program, which was established at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee, is to improve participants' clinical proficiency and skills in preparation for the next major military conflict, with the aim of reducing preventable battlefield deaths. The VUMC Military Affairs Committee, in consultation with Army medical leaders, developed a unique 3-part model for a nursing partnership program at VUMC. This model includes separate tracks for critical care and emergency nurses. The nurses receive training in their specialty, cross-training in the opposite track, and other professional development opportunities. A critical care nurse and an emergency nurse were assigned to the program in January 2022 and September 2022, respectively. Between January 2022 and June 2023, the critical care nurse completed all the required individual critical task lists-specialty-specific clinical skills Army medical personnel must be competent in before deployment-except for 1, obtaining intra-abdominal pressure. The VUMC AMCT3 nursing partnership training model ensures that Army nurses are highly prepared to function as part of the FRSD and to provide superior combat casualty care in a resource-limited environment.

C5 palsy following one- or two-level anterior cervical discectomy and fusion: Incidence and neurological recovery in a retrospective neurosurgical multicenter study.

C5 palsy is a frequent complication following cervical spine surgery, particularly after posterior approaches. Although several risk factors have been proposed, the incidence of C5 palsy after anterior cervical discectomy and fusion (ACDF) remains less well understood. This study aims to elucidate the risk factors and neurological recovery associated with C5 palsy following ACDF. A total of 330 patients who underwent one or two-level ACDF between January 2018 and December 2022 across three institutions within the neurosurgical training program were retrospectively included and analyzed. Demographic, surgical, and radiological data were collected. Sixteen (4.8%) patients developed postoperative C5 palsy, with a significantly high incidence observed in patients exhibiting preoperative symptoms (radiculopathy or radiculomyelopathy) and undergoing two-level ACDF (p-values 0.008 and 0.018, respectively). No other demographic or radiological factors were associated with C5 palsy. Eleven of 16 (68.8%) patients experienced C5 palsy within 1day post-surgery (early-onset group), whereas the remaining five developed symptoms between 4 to 15days post-surgery (late-onset group). At one year post-surgery, the late-onset group demonstrated superior recovery from C5 palsy compared to the recovery noted in the early-onset group (100% vs 44.4%). Surgeons should be cognizant of the potential for C5 palsy following one- or two-level ACDF, despite generally favorable neurological outcomes. The timing of C5 palsy onset post-ACDF, potentially influenced by mechanisms such as direct injury and ischemia-reperfusion injury, could impact the recovery prognosis. Careful surgical procedure might be the key to success.

A Qualitative Study of Attitudes Toward HPV Vaccine Recommendation in Otolaryngology Clinics.

The incidence of human papillomavirus (HPV)-related oropharyngeal cancers has increased such that they are now the most prevalent HPV-related cancer. In 2020, the Food and Drug Administration (FDA) expanded the indication for Gardasil-9 to include the prevention of oropharyngeal and other head and neck cancers caused by selected HPV types, but uptake remains low. Otolaryngology office interactions may provide opportunities to increase uptake, given the relevance of HPV to clinical practice. This study explored the feasibility of recommending HPV vaccination in otolaryngology clinics. Participants were recruited between February to June of 2022 from the alumni of the residency and fellowship training programs at the University of Iowa Hospitals and Clinics. Participant interviews comprised open-ended questions pertaining to otolaryngologists' attitudes toward HPV vaccination recommendation. Interview recordings were transcribed, coded, and analyzed for themes. Participants were willing to respond if patients asked about the HPV vaccine, although a common attitude toward vaccine discussions was that they were a pediatrician's responsibility. One barrier to recommending HPV vaccination was providers' concern that discussing the vaccine when not directly relevant to the patient's chief complaint could result in patient frustration. Nevertheless, participants endorsed the feasibility of discussing the vaccine during follow-up visits after the patient's needs had been addressed or via the distribution of educational materials to patients. Otolaryngologists do not currently identify recommending HPV vaccine uptake as their clinical responsibility. While such recommendations may not be feasible in every patient encounter, there could be a role for this in the appropriate clinical scenario. These findings can be used to inform interventions aimed at recommending the vaccine in otolaryngology clinics.

Evaluating the global landscape of suicide helpline services: a global survey across 105 countries.

Suicide helpline services (SHSs) are viewed as an essential part of suicide prevention. In the context of increased demand experienced by the services through the COVID-19 pandemic, as well as reduced funding, we aimed to evaluate such services to help assess their effectiveness and resilience. This multinational cross-sectional survey, conducted from Sept 1, 2022, to Feb 28, 2023, evaluated SHSs in 150 countries. Local collaborators created an SHS directory, and a 42-question questionnaire was distributed via Survey Monkey through Find A Helpline and local collaborators. A team of experts, including individuals with lived experience, helped shape the research questions and study design. We did descriptive statistical analysis of answers to the questions, and data were further analysed using the Bayesian Model Averaging method to predict managers' or supervisors' low overall satisfaction with the service (MS-LOSS). The study involved 446 responses from 105 countries for descriptive statistics. 354 (79·4%) of 446 services had insufficient funding, 249 (55·8%) had post-COVID-19 budget reductions, and 278 (62·3%) observed a sharp rise in suicide help requests during the COVID-19 pandemic. 420 responses were used for finding the optimal logistic model, which had an area under the curve of 0·679, indicating that pre-service training for volunteers was significantly associated with a reduction in MS-LOSS (odds ratio 0·16 [95% CI 0·07-0·31]; p<0·001), as was having a quality assurance structure (0·15 [0·02-0·70]; p=0·030). Higher MS-LOSS was associated with staff training only every 2-3 years instead of one or more times per year (2·87 [1·23-6·85], p=0.016) and with dilemmas with providing services in severe cases (1·68 [1·06-2·68]; p=0·028). Global SHS reports indicate that both pre-task and ongoing training for volunteers and staff, coupled with a quality assurance structure, could decrease MS-LOSS. Our findings emphasise the need for training for volunteers, continuous training programmes for staff, and on-site support for individuals at risk of suicide. RSTMH Small Grants Award 2021, UK NIHR, and MEXT.

Patient Perspective on Robotic-Assisted Total Joint Arthroplasty.

Robotic-assisted total joint arthroplasty (TJA) has gained popularity in recent years. Despite mixed patient and surgeon perceptions, conflicting evidence regarding efficacy and cost-effectiveness in comparison to manual TJA exists. Patients' beliefs surrounding robotic-assisted TJA remain unclear. This study aims to assess patients' expectations on robotic technology in TJA. A 9-question survey assessing patient understanding and expectations of the use of robotics in TJA was distributed to preoperative and postoperative hip and knee patients of five surgeons at a high-volume academic center. Responses were descriptively analyzed. A total of 498 responses were collected. Of all respondents, 69.1% are aware of robotic usage in TJA, 68.5% are interested but unsure of the benefits, and only 19.5% feel it is superior to manual surgery. Most patients did not consider robotic TJA as minimally invasive surgery, with 61.7% stating they are not the same. In addition, 52.3% were not comfortable with extra or longer incisions for robotic procedures. Regarding surgeon choice, 94.9% did not consider if the surgeon is able to perform robotic TJA, 74.4% wanted their surgeon proficient in manual TJA, and 72.4% felt that surgeons who use robotic technology are not more capable than manual surgeons. Awareness and curiosity of robotic-assisted TJA exists; however, most patients did not appear to acknowledge superiority or benefits over manual surgery. Furthermore, patients appear to prefer surgeon proficiency in manual techniques, which may influence training programs in the future. Surgeons should weigh patient goals, expectations, outcomes, and costs when choosing to perform robotic TJA.

The need for pediatric sleep education to enhance healthcare for children and adolescents: A global perspective from a survey of members of the international pediatric sleep association.

Sleep concerns have become increasingly common over the past few decades. This study outlines the perceived needs and gaps in pediatric sleep education, drawing insights from a diverse international cohort of pediatric sleep health professionals. International Pediatric Sleep Association (IPSA) members were invited to complete an online survey examining a variety of topics related to pediatric sleep education developed by the education committee. There were 111 survey respondents, largely comprised of medical healthcare providers, representing 39 countries. The majority of respondents worked with children and adolescents aged 0-18 years and endorsed the importance of both comprehensive and developmentally appropriate screening for sleep issues in clinical practice, ranging from bedtime behaviors and daytime dysfunction to sleep-related breathing and movement disorder symptoms. Respondents also stressed the importance of including diverse topics in pediatric sleep education, including behavioral sleep issues and sleep in neurodevelopmental disorders, thus underscoring the need for comprehensive training programs. Participants advocated for improved access to screening tools and intervention protocols. There was an identified notable gap in formal sleep education during professional training. Potential barriers identified included time constraints and a lack of resources. Preferences for training online and through professional organization websites underscored the importance of accessible learning platforms. Integrating online resources into education programs could enhance accessibility and engagement. The demand for enhanced sleep education underscores the complexity and significance of pediatric sleep health and highlights an urgent need for tailored and accessible sleep education programs to address the multifaceted challenges in pediatric sleep. Addressing educational needs helps cultivate a skilled workforce to manage pediatric sleep disorders and promote healthy sleep practices. Teaching activities and collaboration play crucial roles in advancing the pediatric sleep community.

Developing and delivering a national training program in the response to sexual violence for frontline practitioners

Developing and delivering a national training program in the response to sexual violence for frontline practitioners

Interprogram Differences in Core General, Core Plastic, and Plastic Surgery-Adjacent Training.

Plastic surgery training continues to evolve with integrated residents spending more time in plastic versus general surgery. Herein, we provide an updated description of interprogram differences in core general, core plastic, and plastic surgery-adjacent training curricula. We obtained rotation schedules from US plastic surgery residency websites or program coordinators for AY2021-2022. Rotation months were recorded and categorized into Core General Surgery, Core Plastic Surgery, and Plastic Surgery-Adjacent. Rotations were compared to American Board of Plastic Surgery (ABPS) and Accreditation Council for Graduate Medical Education (ACGME) standards. Data were analyzed using descriptive statistics (SPSS, IBM Corp., v27.0, Armonk, NY). Of 84 programs, we obtained schedules for 63 (75%). Most offered 2 years of Core General Surgery followed by 4 years of Core Plastic Surgery training (n = 32, 50.8%). From postgraduate years 1-6, programs offered median 52 months [interquartile range (IQR): 47.5, 55] of Core Plastic Surgery, 12 months (IQR: 9, 14) of Core General Surgery, and 8 months (IQR: 6, 10) of Plastic Surgery-Adjacent rotations. Six (9.5%) programs' schedules included rotations specifically addressing all ABPS competency requirements; 1 (1.6%) included rotations addressing all ACGME Core General Surgery competency requirements. Departmental status was not associated with differences in training time. Our results demonstrate that in AY2021-2022, integrated plastic surgery training programs offered 6 months less Core General Surgery, 3 months less Plastic Surgery-Adjacent, and 9 months more Core Plastic Surgery Rotations than in 2012. Very few program schedules include named rotations that specifically addressed all ABPS or ACGME competency requirements.

Unravelling Education Needs for Clinical Practice Guideline Development: A Survey Performed in the Netherlands.

The development of clinical practice guidelines (CPG) has evolved into a rigorous and complex process. There is a need for training of CPG developers including methodologists, panel members and patient representatives. This study explored the educational needs and experiences of CPG developers, with specific attention to the patient perspective and economic considerations. An anonymised mixed-method survey was distributed among CPG developers and panel members in the Netherlands. The survey, developed in collaboration with Dutch CPG development organisations and patient organisations, aimed to capture insights into the developers' roles, training needs, and the incorporation of economic considerations and patient perspectives in CPG development. Data analysis involved qualitative content analysis and descriptive quantitative analysis. A total of 271 responses were analysed. Respondents described role-specific tasks and tasks overlapping between roles. Experience, guidance, and training influenced the respondents' feeling of preparedness for their tasks. Respondents expressed the need for content-related training, including CPG development methodology. They also raised the importance of process-related topics in training, such as the inclusion of different perspectives and responsibilities during CPG development. About half of the respondents (46%) indicated that economic considerations were included in their CPGs, however, there was no uniformity in approach. The patient perspective was included by 89% of the respondents, also in varying manners. Overall, respondents underscored the importance of both topics in CPG development (training) to ensure a future-proof healthcare system. This study underscores the importance of tailored CPG development training programmes addressing the specific competencies required for the different roles in CPG development. Thereby, recognising a holistic approach encompassing both content- and process-related aspects. Addressing economic considerations and the patient perspective in training will contribute to CPGs that support a patient-centred and sustainable healthcare system.

People with spinal cord injury or stroke are able to reach moderate-to-vigorous intensity while exercising on an end-effector robot assisted gait trainer: A pilot study.

Background: Spinal cord injury and stroke are neurological disorders that lead to aerobic deconditioning and increased likelihood of cardiovascular disease. Sessions of at least 20minutes of moderate-to-vigorous intensity exercise is recommended but decreased mobility limits engagement in such exercise. The aim of the study was to assess whether individuals can achieve exercise recommendations with the assistance of an end-effector robot assisted gait trainer (E-RAGT). Methods: We conducted an observational study during which participants were required to complete one exercise session on an E-RAGT. Heart rate, dyspnea, lower limb fatigue and enjoyment were monitored. Based on current guidelines, participants were considered to have reached exercise recommendations if they reached prespecified intensity thresholds for at least 20minutes. Results: Five people with spinal cord injury and ten people with stroke agreed to participate. Every participant was able to reach moderate-to-vigorous exercise intensity and 3 out of 5 participants with spinal cord injury and 4 out of 10 participants with stroke were able to maintain this intensity for at least 20minutes. Overall, participants rated their session as very enjoyable with a median score of 4 out of 5 on a Likert Scale (IQR 3 to 4). Discussion: Individuals with spinal cord injury or stroke who use an E-RAGT can reach moderate-to-vigorous exercise intensity, but not all are able to maintain this intensity of exercise according to disease-specific recommendations. Future research should explore the effectiveness of a training program using an E-RAGT.

The Effectiveness of a Pap Smear Screening Practical Skills Training Program for Nurse-Midwifery Students

Pap smear screenings effectively reduce the incidence of cervical cancer. However, the effectiveness of practical teaching strategies for this procedure is seldom discussed. This study was designed to evaluate the effectiveness of a Pap smear screening training approach using the two strategies of classroom simulation and practical community screening demonstrations. Convenience sampling was used to recruit undergraduate students enrolled between 2021 and 2023 in the nursing midwifery department of a national university. Data were collected between September 2023 and June 2024 and analyzed using a pre-experimental design with a one-group pretest-posttest design. The learning outcomes considered included self-directed learning ability and practical ability performance in cervical smear procedures. Self-directed learning ability was assessed using a self-reported questionnaire, while practical ability performance was separately evaluated by two instructors using direct observation. Fifty-two students were enrolled as participants. Over time, and with the changes in teaching strategies, significant improvements were observed in self-directed learning ability in terms of mean total and subscale scores. In addition, DOPS scores showed a significant increase in practical ability performance. Integrating clinical hands-on training into classroom-based simulation teaching can enhance autonomous learning, improve skill proficiency, and foster future self-directed learning and practical abilities in students to promote women's health.

The Effect of Health Literacy Level of Caregivers of Individuals With Diabetes on Care Activities and Supportive Behaviours.

To determine the effect of the health literacy levels of caregivers of individuals with T2DM on caregiving activities and supportive behaviours. Cross sectional study. The sample for the study comprised of people who provided care for 442 individuals who were diagnosed with diabetes. The data were collected using the Personal Information Form, HLS-14 and D-CASS. Descriptive statistics, Independent samples t test, One-Way ANOVA and multiple linear regression analysis were used to analyse the data. According to the results of the multiple linear regression analysis, the model was found to be statistically significant, and the variables that were incorporated into the model were able to explain 68.1% of the variance. Among the variables included in the model, HLS-14, educational status, employment status, income status and diabetes-related education were found to affect the care activities and supportive behaviours of caregivers of individuals with diabetes. In the research, it was determined that care activities and supportive behaviours were higher in those with higher levels of HL, higher levels of education, those who were not employed, those with higher income levels, and those who received education about diabetes. Nurses should develop training programmes to increase the HL levels of caregivers.

Efficacy of a group-based 8-week multicomponent cognitive training on cognition, mood and activities of daily living among healthy older adults: A two-year follow-up of a randomized controlled trial.

Cognitive training (CT) has been one of the important non-pharmaceutical interventions that could delay cognitive decline. Currently, no definite CT methods are available. Furthermore, little attention has been paid to the effect of CT on mood and instrumental activities of daily living (IADL). To assess the effectiveness of a multicomponent CT using a training program of executive functions, attention, memory and visuospatial functions (TEAM-V Program) on cognition, mood and instrumental ADL. A randomized, single-blinded, treatment-as-usual controlled trial. Geriatric clinic in Bangkok, Thailand. 80 nondemented community-dwelling older adults (mean age 65.7 ± 4.3 years). The CT (TEAM-V) Program or the treatment-as-usual controlled group. The TEAM-V intervention was conducted over 5 sessions, with a 2-week interval between each session. A total of 80 participants were randomized (n = 40 the TEAM-V Program; n = 40 the control group). The Thai version of Montreal Cognitive Assessment (MoCA), The Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Thai version of Hospital Anxiety and Depression Scale (HADS) and The Chula ADL were used to assess at baseline, 6 months, 1 year and 2 years. Compared with the control arm (n = 36), the TEAM-V Program (n = 39) was associated with significantly improved general cognition (MoCA, P = 0.02) at 2 years. Compared with baseline, participants receiving the TEAM-V Program were associated with significantly improved immediate recall (word recall task, P < 0.001), retrieval and retention of memory processes (word recognition task, P = 0.01) and attention (number cancellation part A, P = 0.01) at 2 years. No training effects on anxiety (P = 0.94), depression (P = 0.093) and IADL (P = 0.48) were detected. The TEAM-V Program was effective in improving global cognitive function. Even though, the program did not significantly improve anxiety, depression and IADL compared with the control group, memory and attention improved in the intervention group compared with baseline. Further studies incorporating a larger sample size, longitudinal follow-up and higher-intensity CT should be conducted.

Improving safety in the performance of robotic urinary diversions: a narrative review.

Urinary diversions are performed for a wide variety of indications, including bladder removal for cancer treatment, post-cancer treatment complications, trauma, or bladder pain. The robotic approach has been increasingly used in performing urinary diversions since the introduction of the surgical robot. A PubMed keyword search was performed on September 14, 2023 with the terms: robotic and urinary diversion. A narrative review of the literature was then conducted, with a focus on outcomes and complications following urinary diversion. Studies demonstrated that the robotic approach to cystectomy with urinary diversion was safe and productive, whether the diversion was performed intracorporeally or extracorporeally, and that outcomes are comparable to the open approach. Despite reports of successes and technique improvements, the complication rate following robotic cystectomy with urinary diversion is over 50%. Common complications associated with urinary diversion include bowel complications, ureteroenteric anastomotic strictures, urine leak, urinary tract infections, internal hernias, and parastomal hernias. Many strategies have been developed to improve the complication rate following robotic urinary diversion, including specialized training programs and enhanced recovery after surgery protocols. In conclusion, with the increasing adoption of the robotic approach for urinary diversions, it is important to continue to develop strategies to mitigate surgical risk. Future research should focus on further refinement of training and surgical approaches to prevent and treat complications following robotic urinary diversions.

Intentions to move abroad among medical students: a cross-sectional study to investigate determinants and opinions.

The lack of health professionals and the physicians' migration trend represents a challenging issue for the health systems' sustainability worldwide. The current study aims to evaluate the intentions of Italian medical students to pursue their own careers abroad by investigating the push and pull factors of migration. A cross-sectional study was performed among Italian medical students through a self-administered questionnaire. Primary and secondary outcomes were established as the intention of moving abroad after graduation and knowledge about residency programmes, application, quality training and remuneration in the country of interest. Descriptive analysis for all variables and univariable and multivariable regression for primary and secondary outcomes were performed. Overall, 307 medical students took part in the study. More than half of the sample considered moving abroad after graduation, mainly to find a higher quality training programme. Regression analysis highlighted a significant association between the primary outcome and general personal and professional reasons, as well as previous experiences abroad, whereas bureaucratic procedures were perceived as the main barrier. Perceived better knowledge about residency programmes and quality of training related to sources of information such as the Internet (blogs, forums, websites) and medical associations. Retention policies are necessary to meet the expectations and requests of future generations of doctors by allocating financial resources to offer high-quality training and broad career opportunities, together with appropriate wages, as crucial factors for discouraging the migration of healthcare professionals.

Enhancing capacities for sustainability transition policy design: Lessons from French pesticide reduction plans

CONTEXTReducing pesticide use has become an important policy objective in several countries, yet many have failed to reach their goals. Policies need to be more systemic to address lock-ins hindering pesticide reduction. To do so, policymakers must improve policymaking processes, while ensuring active stakeholder participation. This requires specific policy capacities, which have not yet been characterized. OBJECTIVEThis article aims to identify policy capacities needed to improve the collective elaboration of pesticide reduction policies and integrate a systemic approach. METHODSWe studied the collective elaboration of the French pesticide reduction plans. We built a narration of the policy process organized by policymakers, based on semi-structured interviews and an analysis of grey literature. We then reflected on which policy capacities policymakers needed to better manage the policy design process, using the “management situation” concept. RESULTS AND CONCLUSIONSOur results show that to better design pesticide reduction policies, policymakers lacked four types of interdependent “policy capacities”: capacities to support collective sensemaking about lock-ins, to co-design interdependent and multi-level instruments, to co-design suitable implementation structures and to ensure learning. These results highlight an issue of dynamic capabilities in public organizations. SIGNIFICANCEOur results provide concrete proposals to improve design processes for pesticide reduction policies aiming at systemic transformations: there is a need to develop new methods, tools, analytical resources and training programs for policymakers, to support the development of the policy capacities identified. These results also suggest avenues for future action-research between public management, systemic agronomy, sustainability and design sciences.