Research Team Research Articles

Professional Digital Counselling for Eating Disorders in Germany: Results of the DigiBEssst Project Survey on the Perspectives and Experiences of Health Professionals, Individuals With Eating Disorders, and Carers.

The research project DigiBEssst examines existing digital counselling services for individuals with eating disorders (ED) and carers in Germany. It highlights their experiences with digital counselling as well as those of the expert counsellors involved, aiming to derive quality criteria for digital counselling in ED. A mixed-methods design was adopted. Analysing the websites of 181 professional counselling centers, the research team identified 86 counselling centers for ED that offered online counselling. Initially, 29 centres participated in an online survey. Subsequently, in-depth, semi-structured interviews were conducted with professionals (n=15), individuals with ED (n=13), and carers (n=10). The data were analysed using descriptive statistics and structured content analysis. Less than half of the German counselling facilities offered online counselling. The participants emphasised the need for a specific concept, counsellors' profound expertise in ED and online counselling, sustainable funding, sufficient personnel and time resources, and secure platforms to ensure data protection and quality management. Access to professional services requires informative, user-friendly websites, and social media presence. The identified prerequisites and quality criteria for professional online counselling developed in this project can provide recommendations for the conceptualisation of digital counselling services.

Co-creation of a qualitative fertility research study to understand waiting time experiences through patient engagement

BackgroundInfertility affects an estimated 8 to 12% of the global population and approximately one in six heterosexual couples in Canada. To access fertility services in Newfoundland and Labrador, Canada, individuals with an infertility diagnosis wait for extended periods, and this waiting period has been associated with psychological distress. However, this experience of waiting has not been well studied, and several gaps in fertility research exist. The inclusion of persons with lived experience of infertility in the creation of studies related to infertility may improve research outcomes and create patient empowerment.AimTo collaboratively develop a qualitative research project focused on understanding the waiting experiences of patients seeking fertility services in Newfoundland and Labrador, utilizing patient engagement initiatives and involving individuals with infertility experiences.MethodsThree patient partners who represented individuals awaiting fertility services were recruited to be research team members. Patient partners were eligible to participate as research team members if they identified as either female or non-binary (to effectively represent the female and non-binary target population in the co-produced qualitative study) and had lived experience waiting for fertility services in the province. The research team developed a detailed patient engagement plan following the International Association for Public Participation framework (IAP2). Data from research team discussion groups were documented using a meeting minutes template. Two questionnaires from the Public and Patient Engagement Evaluation Tool were employed to assess patient partners’ impact and satisfaction with the research process.ResultsPatient partner involvement and input helped the co-creation process by refocusing the qualitative study’s research aim to empower patients. To accomplish the new research aim, the patient partners refined the study’s methodology through adjustments to the research design, protocol, interview guide, and participant criteria of the upcoming qualitative study. The PPEET analysis demonstrated high satisfaction with engagement and a high perceived value of patient contributions in the co-creation of the research study. In turn, the PPEET results indicated that patient partners had a comprehensive understanding of their roles for engagement and were satisfied with their involvement in the various research activities.ConclusionsIn conclusion, using patient engagement to co-create a qualitative fertility study to understand patients’ experiences while waiting for fertility services resulted in significant changes to the proposed methodology and research priorities and helped address knowledge gaps in existing fertility research. Most importantly, the patient engagement approach helped foster an inclusive and empowering environment for patient partners to contribute to fertility research.

Components of joint health and wellbeing strategies: a pan-London review of all 33 local authorities

BackgroundIn the UK, Health and Wellbeing Strategies (JHWS) were introduced to identify and help address the health needs of local communities. JHWS translate a borough’s Joint Strategic Needs assessment into actionable outcomes and prioritises areas of focus, but the content and approach of JHWS may vary across different local authorities (LAs) due to demographic and priority differences.ObjectiveCharacterise the key health and wellbeing components of existing and emerging health and wellbeing strategies of 33 local authorities in London.DesignScoping review study with content assessment.MethodsAn online search was conducted to identify JHWS documents. This search was supplemented with outreach to health and wellbeing boards to ensure that the latest documents were retrieved. A set of 62 health and wellbeing themes and words to be captured spanning 13 categories was developed by a team of researchers, and data collection was independently carried out by two researchers. Occurrences of words in the strategy documents were recorded, and a configuration matrix was created and used to determine data trends across the local authorities. A broad search of the context in which the search terms appeared was also performed to understand the trends.ResultsThirty-three JHWS were analysed to identify key search term frequencies. The analysis encompassed strategies from 2015 to 2030, ranging from 7 to 94 pages. Mental health and youth terms emerged as the two top priorities across all strategies. Other frequent terms were related to access to healthcare, inequality, employment, smoking, housing, carers, and elderly individuals. Conversely, terms related to dental health, pollution, nutrition, sexual health, green spaces, breastfeeding, and climate were less cited.ConclusionThis analysis provides insights into regional health priorities and a comprehensive overview of health and wellbeing strategies across London's local authorities. Despite certain limitations, the findings offer valuable insights for local authorities' strategic planning and future research.

Improving Participant Recruitment in Clinical Trials: Comparative Analysis of Innovative Digital Platforms.

Pharmaceutical product development relies on thorough and costly clinical trials. Participant recruitment and monitoring can be challenging. The incorporation of cutting-edge technologies such as blockchain and artificial intelligence has revolutionized clinical research (particularly in the recruitment stage), enhanced secure data storage and analysis, and facilitated participant monitoring while protecting their personal information. This study aims to investigate the use of novel digital platforms and their features, such as e-recruitment, e-consent, and matching, aiming to optimize and expedite clinical research. A review with a systematic approach was conducted encompassing literature from January 2000 to October 2024. The MEDLINE, ScienceDirect, Scopus, and Google Scholar databases were examined thoroughly using a customized search string. Inclusion criteria focused on digital platforms involving clinical trial recruitment phases that were in English and had international presence, scientific validation, regulatory approval, and no geographic limitations. Literature reviews and unvalidated digital platforms were excluded. The selected studies underwent meticulous screening by the research team, ensuring a thorough analysis of novel digital platforms and their use and features for clinical trials. A total of 24 digital platforms were identified that supported clinical trial recruitment phases. In general, most of them (n=22, 80%) are headquartered and operating in the United States, providing a range of functionalities including electronic consent (n=14, 60% of the platforms), participant matching, and monitoring of patients' health status. These supplementary features enhance the overall effectiveness of the platforms in facilitating the recruitment process for clinical trials. The analysis and digital platform findings refer to a specific time frame when the investigation took place, and a notable surge was observed in the adoption of these novel digital tools, particularly following the COVID-19 outbreak. This study underscores the vital role of the identified digital platforms in clinical trials, aiding in recruitment, enhancing patient engagement, accelerating procedures, and personalizing vital sign monitoring. Despite their impact, challenges in accessibility, compatibility, and transparency require careful consideration. Addressing these challenges is crucial for optimizing digital tool integration into clinical research, allowing researchers to harness the benefits while managing the associated risks effectively.

Co-designing a physical activity intervention for low-income mothers of preschool-aged children with community leaders: a qualitative study

BackgroundYoung children from low-income families experience disparities in school readiness that impact short and long-term health. Family physical activity co-participation is an interactive activity that may promote positive health and academic outcomes. The purpose of this study is to describe the process and outcomes of engaging with community leaders to co-design the Families Moving Together intervention for low-income mothers and their preschool-aged children.MethodsFive action planning sessions were conducted with community leaders, experts in physical activity, early learning, or engaging low-income families (i.e., families receiving housing assistance). The PRACTical planning for Implementation and Scale-up (PRACTIS) guide provided a framework for each session to address implementation and sustainability barriers and facilitators. Qualitative data were analyzed using the Framework Analysis method with inductive and deductive coding.ResultsAction planning participants (N = 19) were aged 50 ± 13.4 years, mostly female (89%), and worked across several community organizations serving low-income mothers and children in an urban city in central Kentucky. Three core themes were identified from analyzing the transcripts. First, participants held shared values, such as respect and equity, that informed the intervention design process. Second, these core values provided a foundation for creating collaborative and sustainable solutions to achieve outcomes. Finally, participants described program design elements to remove barriers and increase facilitators. Through the action planning process, participants co-designed the core components of Families Moving Together, which included leading free family movement programs in the community and engaging trusted community members to deliver the intervention. The goal of this 6-month community-level intervention is to increase school readiness and health by engaging families in physical activity together.ConclusionsCommunity experts and the research team used the PRACTIS guide to co-design strategies to increase physical activity and school readiness that they perceived would enhance the likelihood of implementation and sustainability in the community. Participants underscored the importance of the co-design process that centers community representation and collaborative approaches to create, implement, and sustain programs in the local community. Researchers and community leaders serving low-income mothers and children in other settings may be able to replicate the action planning process to facilitate equitable health outcomes.

Client experiences of a task-shifting supported self-management intervention for depression in Vietnam

BackgroundThe global burden of mental illness is substantial, with depression impacting close to 300 million people worldwide. This has been exacerbated within the context of the COVID-19 pandemic. Yet, in many low- and middle-income countries including Vietnam, there is a substantial treatment gap, with many requiring mental health care unable to access it. Task-shifting is an evidence-based approach that seeks to address this gap by utilizing non-specialist providers to provide care. While there is a large body of literature exploring task-shifting, there is little that explores the client experience. This paper describes the facilitators and barriers impacting the client experience of a task-shifting supported self-management (SSM) intervention for depression in Vietnam. SSM involves a client workbook and supportive coaching by non-specialist providers.MethodsThis paper is situated within a randomized controlled trial that demonstrated the effectiveness of the SSM intervention in adult populations across eight provinces in Vietnam. Semi-structured interviews were conducted with a convenience sample of clients (recipients of the intervention) with depression caseness as measured by the Self-Report Questionnaire-20 depression screening measure, and providers (non-specialist “social collaborators”) to explore SSM’s acceptability and factors influencing participation and adherence. This paper presents the qualitative findings from an analysis of the interviews, focusing on the client perspective. Qualitative descriptive methods and thematic analysis were used.ResultsForty-five clients were interviewed. Sub-themes reported for the facilitators and benefits for the client experience of the SSM intervention were client-provider relationship building and family and community connections. Sub-themes reported for the barriers were clients’ responsibilities, clients’ health conditions, and consequences of stigma.ConclusionsDue to challenges with sustaining and scaling up the in-person SSM intervention in Vietnam, the research team has pivoted to delivering the SSM intervention digitally through a smartphone-based app adapted from SSM, with direction from the Government of Vietnam. Findings from this study suggest that while digital interventions may support accessibility and convenience, they may neglect the critical human contact component of mental health care. Ultimately, a model that combines digital delivery with some form of human contact by a support person may be important.

醫學研究倫理審查思考：公共健康倫理學的啟發

LANGUAGE NOTE | Document text in Chinese; abstract also in English. Ethical reviews of medical research are facing challenges similar to those faced by public health ethics, including increasing complexity, diversity and interdisciplinary cooperation; the rapid development of biological and information technology; and the huge impact of these fields on individuals, societies and political and environmental systems. Therefore, models used in research ethics reviews, which are based on traditional bioethics principles and criteria, need to be adjusted. In addition, virtue ethics need to be considered by research teams and institutions. To truly support responsible medical research innovation, all key stakeholders, including researchers, philosophers, sociologists and policy-makers, should be involved in ethical research governance.

The Current Status of and Theoretical Proposals for the English Translation of Foshan Cantonese Opera

Foshan Cantonese opera has now had a profound impact around the world. Yet, it faces some challenges in its further dissemination. To propel the further dissemination of Foshan Cantonese opera in the context of globalization, the translation of Foshan Cantonese opera into English has become an important research topic. The research team investigates the current status in the English translation of Cantonese opera, and conducts a series of theoretical studies concerning the English translation. Based on the investigation of the current situation in the English translation of Foshan Cantonese opera, the research team explores and proposes some effective ways for its translation and dissemination to the foreign countries.

I-RANT: Training session on a novel, scripted, bystander microaggression intervention tool for medical students

BackgroundMicroaggressions, subtle and often unintentional acts of hostility, have been recognized as a significant issue in healthcare, adversely affecting learners’ emotional and physical well-being. Current strategies for addressing microaggressions are broad frameworks without empirical substantiation that leave learners without a clear direction for intervention. This study introduces a novel scripted, succinct, bystander intervention tool to combat microaggressions. The intervention tool developed by the research team, named I-RANT, follows the script of introduction, role naming, affirming the target, negating the microaggression, and transitioning within patient encounters. The study goal was to assess the ability of a training session to impact learners’ recognition of microaggressions, confidence in intervening, and competency in applying the I-RANT tool.MethodsA pre-experimental study was conducted with 97 second-year medical students at a large academic center in the Southeast United States. The I-RANT tool was taught through a 90-minute training session. The session included an introduction lecture, small group discussions, and role-play scenarios. Pre- and post-intervention surveys assessed microaggression recognition via a multiple-choice questionnaire (MCQ) and self-reported confidence in intervening on a Likert scale. Differences were compared via paired T-test. Role-play scenarios were observed by trained faculty and graded for competence using a rubric.ResultsParticipants showed significant improvement in microaggression identification with increase in MCQ score from 4.17 (SD 0.75) pre-intervention to 4.74 (SD 0.42) post-intervention (p < .001) and increased self-reported confidence from 3.2 (SD 1.0) to 4.2 (SD 0.63) (p < .001). Trained faculty evaluated a random sampling of students’ role-play scenarios (n = 30) revealing that 97% of sampled students demonstrated competence in utilizing the I-RANT tool.DiscussionThe I-RANT training session empowered learners to address microaggressions. Learners demonstrated a statistically significant improvement in recognition of microaggressions and confidence in intervening. The majority of learners demonstrated competency in utilizing the I-RANT tool by the end of the training session.ConclusionsThis study supports the effectiveness of our training session in enhancing medical students’ ability to recognize and address microaggressions. I-RANT empowers learners with a tool to intervene against microaggressions within patient encounters.

Application of Youth-Led Participatory Action Research to Examining Adolescent Sexual and Reproductive Health and Rights in Ontario: What Can We Learn?

Engaging adolescents and young people as partners in research is increasingly acknowledged as a vital strategy to ensure diverse voices are heard and to catalyze social change. This article, coauthored by adolescent and adult researchers, presents the methodological approach and outcomes of a youth-led participatory action research (YPAR) study in which three teams of youth researchers developed and implemented projects examining equity-related factors affecting adolescent sexual and reproductive health and rights (ASRHR) in Ontario, Canada. Teams of four assigned-female youth researchers aged 16-19 years were recruited from three priority regions through purposive sampling. Selected youth completed a paid 5-day virtual YPAR training. Each youth team, supported by adult research mentors, identified key ASRHR issues in their region and developed a related research question. Each team then determined their study's design, obtained institutional ethics approval, and conducted data collection, analysis, and interpretation. Based on their findings, teams proposed potential solutions and communicated results to multiple stakeholders. Methodologically, the YPAR process amplified youth voices through a social justice-framed approach to examining ASRHR. Centering the perspectives, values, and experiences of youth positively impacted the youth researchers themselves, while yielding results that were relevant, meaningful, adolescent-responsive, and culturally informed. Results from the youth-led projects identified multiple barriers to accessing sexual and reproductive health services and products. Policy and practice implications encompassed concerns related to geographical accessibility, equity, service provider competence, and content of sexuality education curricula.

Comparison of Three-Bag Method Acetylcysteine Versus Two-Bag Method Acetylcysteine for the Treatment of Acetaminophen Toxicity: An Updated Systematic Review and Meta-Analysis

Background: Acetaminophen is generally considered safe when used according to the recommended guidelines. Consumption in excessive doses can lead to severe liver damage and, in critical cases, may even result in death. To reduce the effects of acetaminophen overdose, N-acetylcysteine (NAC) has been established as the preferred intervention to prevent liver damage. Objectives: The purpose of this updated systematic review and meta-analysis is to evaluate the potential benefits of a two-bag N-acetylcysteine (NAC) dosing regimen compared to the traditional three-bag protocol in the treatment of acetaminophen-induced liver toxicity. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research team utilized the PubMed and Cochrane databases to perform a thorough and comprehensive search of the relevant literature from the inception of these databases up until January 2024. Results: Nine studies were included. The overall use of two-bag NAC was associated with lower anaphylactic reactions and gastrointestinal symptoms compared to the three-bag method. The rate of liver toxicity resolution was the same between the two treatment groups. Conclusions: The two-bag NAC regimen can be considered a safe and effective method for managing acetaminophen toxicity.

An integrated, multidisciplinary management team intervention to improve patient-centeredness, HIV, and maternal-child outcomes in Lesotho: formative research on participatory implementation strategies

BackgroundReducing perinatal HIV transmission and optimizing maternal and child health (MCH) outcomes in high HIV prevalence settings is an urgent, but complex, priority. Extant interventions over-emphasize individual-level provider and patient behaviors, and neglect critical health systems-level changes. The ‘Integrated Management Team to Improve Maternal-Child Outcomes (IMPROVE)’ study implemented a three-part, patient-centered, health-systems-level intervention to improve MCH and HIV outcomes in Lesotho. Ensuring intervention fit within the health systems context is important, but often overlooked. This manuscript describes implementation research conducted to tailor and adapt intervention implementation to optimize appropriateness, acceptability, and feasibility. It identifies resulting implementation variation across study sites and lessons learned.MethodsThe research team reviewed intervention implementation documentation and conducted structured reflections to: 1) assess implementation strategy adaptations, 2) identify facility-specific strategies employed to improve the MCH patient experience, and 3) synthesize lessons.ResultsFacility-based, integrated, multi-disciplinary management teams (MDT) were feasible and acceptable to establish through engagement with facility leadership and facilitation of a participatory training curriculum that established shared values between cadres supporting MCH, and identified facility-specific service delivery gaps and potential solutions. Ongoing MDT meetings provided coordination between facility and community-based MCH service providers to implement early ANC follow-up. Facility-specific improvement strategies included fee, staffing, and patient documentation-based changes. Piloting Positive Health, Dignity, and Prevention-focused counseling approaches resulted in tailored job aids pre-implementation. Leadership involvement was critical for improved coordination while staff turnover and competing donor priorities challenged MDT efforts.ConclusionsIMPROVE created facility-specific adaptation opportunities through participatory intervention implementation practices. The MDTs, benefitting from leadership support, built relationships between HCW cadres, led facility-specific quality improvements, and, importantly, offered HCWs sought-after positive feedback by recognizing HCW efforts. The coordination, monitoring and cross-cadre communication functions of the MDTs supported implementation of other interventions, and may serve as a valuable platform for improving patient-centered care practices in similar settings and for other health services. Trial registration number: NCT04598958, 05 October 2020, retrospectively registered.Trial registrationClinicalTrials.gov, NCT04598958. Registered 05 October 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04598958

The Oxford House Stability Questionnaire: An Effort to Classify Recovery Homes.

Recovery homes are located throughout the United States, with the self-governed Oxford Houses representing one of the largest networks with over 3000 homes. Although there is a growing literature on the characteristics and outcomes of these recovery homes, far less is known about differences among the homes. The current study used a set of characteristics that had been proposed by a leader within the Oxford House recovery movement, and a university research team operationalized them into what is now called the Oxford House Stability Questionnaire. This scale was administered to attendees at their annual convention. Results of a sample of 397 respondents who completed over 95% of the scale validated the notion that there are four different types of Oxford House recovery houses, including Survival, Stable, Successful, and Significant. This scale examined activities that might occur in these homes related to enhancing stability, and we were able to identify mechanisms related to general involvement, social support, and self-help. The findings suggest that these ecological and structural house characteristics are valuable ways to better understand these settings that are providing thousands of people with substance use disorders with distinctive environments for recovery.

Development of a standard set of key work-related outcomes for use in practice for patients with cardiovascular disease: a modified Delphi study

BackgroundTo facilitate the maintenance or resumption of participation in work for patients with cardiovascular disease (CVD), there is a need for high-quality work-focused healthcare. According to the concept of value-based healthcare, quality of care can be enhanced by understanding the outcomes that matter most to patients. However, a major challenge in assessing quality of work-focused healthcare in practice is the lack of consensus on which work-related outcomes should be measured.ObjectiveThe objective of this study was to identify a standard set of key work-related outcomes for patients with CVD to be used in practice of work-focused healthcare in the Netherlands, including standardised outcome measures and associated case mix factors. This standard set is intended to assist occupational and other health professionals in delivering work-focused healthcare that meets a patient’s individual needs regarding work participation, and to enhance patients’ engagement in their own work-focused care process.MethodsA 2-round RAND-modified Delphi process was conducted. The process included literature searches, consecutive research team meetings, and several meetings and rounds of voting by a working group. The working group consisted of patients with CVD (n = 6) and health professionals representing different stakeholders (n = 11) involved in work-focused healthcare for this patient population in the Netherlands. Consensus was reached over four phases: (1) establishing the scope of the standard set and defining the population, (2) prioritising and defining the outcome domains, (3) selecting the outcome measures for the most important domains, including clinical data and patient-reported data, and (4) selecting and defining case mix factors.ResultsA 23-item patient-reported questionnaire was developed, called the Value@WORK-Q23, including questions on nine work-related outcome domains considered most important for patients with CVD: (1) work participation, (2) physical work ability, (3) mental work ability, (4) suitable work, (5) support from the work environment, (6) flexibility of the work environment, (7) communication with the patient, (8) person-centredness, and (9) interdisciplinary communication. In addition, nine case mix variables was selected, comprising demographic-, disease-, and work factors.ConclusionsThe Value@WORK-Q23 provides guidance on measuring the most important work-related outcomes for patients with CVD. Using this work-related set in practice, in addition to existing disease-specific standard sets for CVD may facilitate the provision of high-value work-focused healthcare for this patient population.

Battling time restrictions with collective discourse: collaborative quizzes in a condensed human anatomy course

BackgroundUndergraduate medical education is currently undergoing a remarkable period of transformation. The exponential growth of medical knowledge, accompanied by societal changes and expectations for the upcoming generation of physicians, is placing immense pressure on academic institutions to reform their curricula, particularly foundational courses such as human anatomy. Consequently, instructors are grappling with the challenge of striking a balance between a new curriculum and maintaining the time-honored benchmarks of medical education.MethodsThis study proposes a 9,5-week medical gross anatomy course containing collaborative quizzes to improve the efficacy in a condensed pre-clerkship curriculum. It was hypothesized that the implementation of collaborative quizzes facilitates group learning while ultimately helping students to be better prepared for the NBME (National Board of Medical Examiners) unit examinations used as summative assessment within the course. During the four collaborative quizzes, medical and medical masters student groups rotated through twenty dissected donor stations, each containing a short clinical or anatomy-related multiple-choice question formatted in NBME style. Students individually answered the question first and then collaboratively discussed the question in their group. Success was measured by individual student outcomes of four collaborative quizzes, two NBME anatomy-focused unit examinations, and overall course evaluations.ResultsOverall, all students (n = 203) passed the course and performed well on collaborative quizzes and NBME anatomy-focused unit examinations. Analysis of the quizzes revealed that questions involving tagged structures, blood supply, and nerves resulted in the most answer changes after group discussion. Course evaluations proved the collaborative quizzes to be enjoyable and beneficial to identify lack of knowledge areas.ConclusionsTo address time constraints within the pre-clerkship curricula effectively, it is crucial for educators to explore smaller adjustments to core learning principles. Collaborative quizzes in the gross anatomy laboratory provided students with opportunities to assess their knowledge in a low-stakes setting while simultaneously benefiting from peer learning. The collection and analysis of quiz grades offered a method of identifying struggling students before their first summative examination, enabling timely academic support. In the future, the research team hopes to continue using this assessment and integrate content from various other pre-clerkship courses.

Community perceptions of health accountability meetings with local politicians to improve healthcare quality: a qualitative study in Western Uganda

BackgroundLack of accountability within healthcare systems contributes to suboptimal healthcare quality and ultimately poor health outcomes, especially in low-income countries. In Uganda, our research team implemented a pilot project of quarterly health accountability meetings between community members and their local political leaders to discuss healthcare needs and strategies for quality improvement. In this study, we examine the community members’ understanding and perceptions of the health accountability meetings, as well as the perceived impact of the meetings on local healthcare services and community life.MethodsWe conducted a total of 12 focus group discussions (FGDs), half with men and half with women, in November 2022 across six randomly chosen communities out of the ten communities where health accountability meetings were held. We audio taped, transcribed, and translated all FGDs into English. We collected data on demographics, understanding of the meetings, and perceived changes within healthcare services and the community from 111 participants. Two researchers analyzed the data using an inductive thematic approach, generating five themes.ResultsWe found the following themes: (1) increased inclusivity and promotion of bidirectional communication; (2) increased understanding of patient rights and practicing of collective empowerment by the community; (3) improved provider behavior; (4) enhanced relationships among politicians, community members, and healthcare providers; and (5) identified needs for future improvements.ConclusionThrough this qualitative study, we found that the community members perceived the accountability meetings as beneficial in improving the local healthcare services and community life. The study demonstrates the need to prioritize the voices of local communities in efforts to address the accountability gaps, as well as the potential for utilizing the relationship between community members and politicians to address accountability shortfalls in other governmental functions beyond healthcare.Trial registrationN/A.

Setting the balance of care for older adults at risk of hospitalization and delayed discharge: A mixed-methods research protocol.

Delayed hospital discharge is a persistent care quality issue experienced across health systems worldwide and remains a priority area to be addressed in Canada. Often associated with a decrease in services while waiting to leave the hospital, delayed discharge from hospital can lead to increased frailty, physical and cognitive decline, and caregiver burnout. Optimizing availability of and timely access to community-based health and social care are avenues that could reduce initial admissions to the hospital and length of hospital stay, and facilitate hospital discharges. This research will explore the ways in which community resources could be leveraged to potentially avoid hospitalization and delayed hospital discharge for older adults using sequential mixed-methods including co-design. To better understand the characteristics and needs of older adults, the research team will first identify sub-populations of older adults (65 years old or older) at risk of hospitalization and delayed discharge using comprehensive, longitudinal administrative health data. From these health data, risk profiles and personas will be created and then shared with key partners (e.g., older adults, caregivers, healthcare providers, healthcare decision-makers), who will be engaged to identify, leverage, and create targeted care solutions. The barriers and facilitators to the implementation of these care solutions will then be explored. Delayed hospital discharge has been a critical care quality issue across Canada for decades. The current research will provide health system leaders with an approach to better allocate services to older adults in order to avoid delayed hospital discharge and identify gaps in health and social care resources based on the characteristics, needs, and preferences of older adults, their caregivers, and providers.

Assessing law enforcement officer skills in Crisis Intervention Team (CIT) research: developing and implementing standardized scenarios

This paper outlines the development of standardized scenarios used to assess the efficacy of Crisis Intervention Team (CIT) training in a randomized, controlled trial. The objective was to create scenarios that accurately simulate mental health crisis situations for law enforcement officers, ensuring that each scenario tests specific CIT skills relevant to real-world encounters. Our process involved building an interdisciplinary team and drawing from the knowledge and experience of professionals in law enforcement, mental health, and performance arts to design a set of scenarios that are both realistic and challenging. The scenarios were developed to represent mental health crises that officers frequently encounter, such as mania, psychosis with agitation, and depression with suicidality. Each scenario requires officers to demonstrate CIT-specific skills such as verbal de-escalation, empathy, and critical decision-making. Our structured approach to developing these scenarios provides a replicable model for future studies that aim to assess the real-world effectiveness of mental health training for law enforcement as well as other professional groups.

Technology for Treatment and Reinforcement of Soft Rock Tunnel Floor Using Sealing Material

To maintain the stability of soft rock tunnels, the research team proposed a support scheme involving “floor grouting + floor anchors + sealing material”. This scheme incorporates a new sealing material with excellent mechanical properties, airtightness, and cost-effectiveness. To develop the sealing material, a series of proportioning tests and optimization designs were conducted to investigate how various experimental factors influence material performance. Based on these experiments, a regression prediction model was established to reveal the characteristics of factor interactions and determine the optimal mix ratio. Practical engineering validation confirmed that this support scheme effectively controls floor heave in soft rock tunnels.

Developing a toolkit for building a community hospital clinical research program.

Although health research in Canada is primarily conducted in academic hospitals, most patients receive their care in community hospitals. The benefits of increasing research capacity in community hospitals include improved study recruitment, increased generalizability of results, broader patient access to novel therapies, better patient outcomes, enhanced staff satisfaction, and improved organizational efficiency. Nevertheless, building research programs in community hospitals remains challenging because of a lack of support and expertise. To address this gap, we developed a toolkit to help community hospital professionals build and sustain their community hospital research programs. The toolkit was developed by the Canadian Community Intensive Care Unit Research Network (CCIRNet), a group of clinician-researchers and research staff from community hospitals across Canada who have experience building community hospital research programs. Feedback from a concurrent qualitative study of Canadian community critical care professionals informed the toolkit's design. The CCIRNet toolkit outlines five stages of community hospital clinical research program development: 1) building a research team and gaining support, 2) developing a new research program, 3) choosing a first research study, 4) getting the study up and running, and 5) sustaining a research program. Feedback from qualitative interviews emphasized the need for a step-by-step approach, frequently asked questions, and essential resources. Accordingly, each stage is structured in a question-and-answer format and includes relevant resources for each section. The CCIRNet toolkit is a practical resource for establishing research programs in community hospitals. The toolkit may increase research participation and support clinical research capacity building in community hospitals.