Provision Of Training Research Articles

Exercise for patients with neuromuscular diseases

Background: Neuromuscular diseases (NMD) vary widely with regard to their onset, progression, and symptoms, which include muscle weakness, sensory loss, pain, fatigue, and joint contractures. Owing to this diversity, creation of a unified exercise therapy approach is challenging.Current Concepts: Exercise recommendations for patients with NMD prioritize maintenance of patients’ current functional status, prevention of further decline, and provision of compensatory training. Conventionally, highintensity exercises are not recommended owing to the risks of overwork weakness and muscle injury. Recent studies indicate that tailored aerobic exercises can improve endurance, cardiovascular function, and overall health without worsening muscle injury. Flexibility exercises are essential to prevent joint contractures. Resistance training should focus on avoidance of high-intensity and eccentric exercises and on maintenance of rather than an increase in muscle strength.Discussion and Conclusion: Evidence regarding the benefits of exercise in patients with NMD is inconsistent. Aerobic exercise is usually safe and may help maintain function and increase maximal oxygen uptake; however, low-intensity exercise is preferred to avoid fatigue and muscle injury. Resistance training may help preserve muscle strength in some patients; however, high-intensity workouts are not should be avoided to mitigate the risk of muscle overload and injury. Tailored exercise programs designed according to disease characteristics are essential.. Further well-designed, large-scale studies are necessary to establish effective and safe exercise guidelines for patients with NMD.

Gamification approach to addiction education for internal medicine residents

Background: People with a substance use disorder (SUD) outnumber the trained provider workforce. The Accreditation Council for Graduate Medical Education (ACGME) recognized this gap in 2022 and now requires addiction education for internal medicine (IM) residents. However, traditional lecture formats struggle to deliver education on this stigmatized condition with meaningful retention and changes in attitudes. Gamification is an evidence-based educational strategy with positive outcomes in graduate medical education, but to our knowledge, has not been used for an entire addiction curriculum. Intervention: This six session IM-focused, stigma-free, interactive curriculum used published physician competencies for content selection. Games were matched to topics based on complexity and need for skill practice. Each hourly session included 10 minutes on introduction, 45 minutes on gameplay, and 5 minutes on feedback. This addiction curriculum was incorporated into existing didactics for IM residents where participants’ comfort, psychological safety, and learning expectations were pre-established. Methods: Sixteen IM residents participated in the curriculum. Curriculum evaluation was conducted using Kirkpatrick’s four levels of evaluation. Resident feedback was obtained via online survey software at the conclusion of each session and behavior impact through an anonymous single question prompt. We used descriptive statistics and summative content analysis to evaluate findings, respectively. Results: All residents were highly satisfied with the curriculum design and use of gamification. Residents reported high levels of engagement and learning, despite use of various games. Findings support an increase in medication prescribing and utilization of harm reduction strategies following curriculum implementation. Conclusion: Gamification may be a preferred educational strategy for addiction curriculum for IM residents. We plan to distribute our curriculum widely for further evaluation in health professions’ programs.

Enhancing patient-oriented research training: participant perceptions of an online course

BackgroundPatient-oriented research is now widely regarded as key to improving health systems and patient outcomes. This shift toward meaningful patient involvement in health research has sparked a growing interest in patient-oriented research training across Canada. Yet some barriers to participation, including distance and scheduling constraints, may impede the provision of in-person patient-oriented research training. Virtual course delivery options may help surmount those barriers, as well as offer unique pedagogical advantages.ObjectiveTo help increase patient-oriented research training uptake, the research team adapted the Canadian Institutes of Health Research’s (CIHR) Strategy for Patient-Oriented Research’s Foundations for Patient-Oriented Research course to a virtual format. The course consists of three modules, which focus respectively on patient-oriented research, health research methods, and teamwork skills. The current evaluation of this virtual delivery examines how a diverse set of participants received the online course.MethodsCourse participants from a variety of professional backgrounds, including researchers, patients, clinicians, and policy decision-makers, were recruited from across Canada to participate in the adapted course. Participant and facilitator feedback was solicited via online surveys that were distributed shortly after the delivery of each module.ResultsOver the span of the current project, the online course was delivered seven times across Canada. A total of 189 learners and 12 facilitators participated in the course. We received 89 completed feedback surveys in total. These included a total of 78 responses from learners, with 22 on Module 1, 32 on Module 2, and 24 on Module 3, in addition to 11 responses from facilitators. Overall, participants and facilitators were very satisfied with the course, indicating a successful adaptation from traditional to online delivery. Survey respondents were especially pleased with the course’s co-learning elements, which exposed them to fresh perspectives and real patient voices, as well as ample opportunity for discussion. Some participants offered recommendations for minor course revisions. Future iterations of the course will reflect participant and facilitator feedback to enhance accessibility via minor changes to course format (e.g., shorter live sessions), content (e.g., more concrete examples), and workload (e.g., reduced pre-work requirements).ConclusionsSustainable and effective health care depends on health research that includes active partnerships across diverse populations. These collaborative relationships are fostered by strong capacity in patient-oriented research, which in turn hinges on widely accessible training opportunities. This online course overcomes common barriers to face-to-face training and offers the accessible, inclusive training environment required for sustained progress in patient-oriented research.

Effectiveness of the modified WHO labour care guide to detect prolonged and obstructed labour among women admitted at publicly funded facilities in rural Mbarara district, Southwestern Uganda: an ambispective cohort study.

Obstructed labour, a sequel of prolonged labour, remains a significant contributor to maternal and perinatal deaths in low- and middle-income countries. We evaluated the modified World Health Organization (WHO) Labour Care Guide (LCG) in detecting prolonged and or obstructed labour, and other delivery outcomes compared with a traditional partograph at publicly-funded maternity centers of rural Mbarara district and City, Southwestern Uganda. Since November 2023, we deployed the LCG for use in monitoring labour by trained healthcare providers across all maternity centers in Mbarara district/City. We systematically randomized a total of six health center IIIs (HCIIIs) out of 11, and all health center IVs (HCIVs), reviewed all their patient labour monitoring records for their first quarter of 2024 (LCG-intervention) and 2023 (partograph-before LCG introduction). Our primary outcome was the proportion of women diagnosed with prolonged and or obstructed labour. Our secondary outcomes included; tool completion, mode of delivery, labour augmentation, stillbirths, maternal deaths, Apgar score, uterine rupture, postpartum haemorrhage (PPH). Data was collected in RedCap and analyzed using STATA version 17. Statistical significance was considered at p<0.05. A total of 2,011 women were registered; 991 (49.3%) monitored using the LCG, and 1,020 (50.7%) using a partograph, 87% (1,741/2011) delivered from HCIVs and 270/2011 (13%) from HCIIIs. Mean maternal age (25.9; SD=5.6) and mean gestation age (39.4; SD=1.8) were similar between the two groups. A total of 120 (12.4%) cases of prolonged/obstructed labour were diagnosed (100 for LCG versus 20 for partograph), with the LCG having six times higher odds to detect/diagnose prolonged/obstructed labour compared to the partograph (aOR=5.94; CI 95% 3.63-9.73, P<0.001). Detection of obstructed labour alone increased to 12-fold with the LCG compared to the partograph (aOR=11.74; CI 95% 3.55-38.74, P<0.001). We also observed increased Caesarean section rates (aOR=6.12; CI 4.32-8.67, P<0.001), augmentation of labour (aOR=3.11; CI 95% 1.81-5.35, P<0.001), and better Apgar Score at 5 minutes (aOR=2.29; CI 95% 1.11-5.77, P=0.025). The tool completion rate was better for LCG compared to (58.5% versus 46.3%), aOR=2.11; CI 95% 1.08-5.44, P<0.001. We observed no differences in stillbirths, maternal deaths, post-partum haemorrhage (PPH) and uterine rupture. Our data shows that LCG diagnosed more cases of prolonged and or obstructed labour compared to the partograph among women delivering at rural publicly funded facilities in Mbarara city/district. We also observed increased C-sections, labour augmentation, and 5-minute Apgar scores. There were no differences in stillbirths, maternal deaths, PPH and uterine rupture. More controlled and powered studies should evaluate the two tools for other delivery outcomes, in different sub-populations.Trial registration number NCT05979194 clinical trials.gov.

A survey of the training experiences and needs on Wellcome Trust PhD programmes

Background Training for PhD researchers was previously identified by the Wellcome Trust funded Emerging Research Cultures project as an area for further investigation to ensure an inclusive culture which enables PhD students to become well-rounded researchers. Methods The Taskforce on Training conducted a survey of 35 Wellcome Trust funded PhD students and 10 programme administrators to evaluate the provision of training in eight key areas. This survey examined a number of issues, such as availability and knowledge of training, potential gaps in training, and the perceived usefulness of training. Results PhD students reported that training was generally useful and viewed as important; with technical training being particularly highly valued. However, the survey identified that students desired additional training in project management and personal development. Surveying programme administrators highlighted the wide variety in training availability for students across different Wellcome Trust programmes currently running in the UK. Conclusion In response to these findings, several recommendations were suggested. Examples include; promotion of peer mentoring for PhD students, and alternative methods for delivery of wellbeing training. However, this report only explores the views of a small number of Wellcome Trust funded PhD students and would benefit from further research into the experiences of PhD students, programme administrators, and PhD supervisors.

Implementation of a Virtual Point-of-Care Ultrasound Curriculum at Black Lion Hospital, Ethiopia.

Introduction In low- and middle-income countries (LMICs), the availability of formal point-of-care ultrasound (POCUS) training remains limited, and there is limited data on how to train providers in these countries to use POCUS. This study aimed to describe a virtual training workshop for physicians in Ethiopia, with the intention of serving as a model that could guide similar initiatives. Methods The authors developed and implemented a three-day virtual workshop in 2022 for physicians in the Department of Medicine at Addis Ababa University in Ethiopia. Participants in the workshop completed pre-workshop and post-workshop surveys, as well as knowledge assessments. The authors examined POCUS use prior to the workshop, the impact of the workshop on ratings of comfort level in performing POCUS, and the change in scores on a knowledge assessment before and after the workshop. Results We found that very few of the participants had prior formal POCUS training. Participants reported a significantly higher level of comfort in using POCUS for the assessment of patients (p < 0.001) and for procedural guidance (p < 0.001) after attending the workshop, compared to before. Scores on the post-test knowledge assessment were significantly higher than scores on the pre-test knowledge assessment (p < 0.001). Conclusion Our POCUS workshop was successfully implemented and delivered virtually to a group of physicians in Ethiopia, and it increased comfort levels in performing POCUS and POCUS knowledge. We hope that similar workshops can be implemented in other LMICs.

Establishing Quality Indicators and Implementation Priorities for Post-Stroke Aphasia Services Through End-User Involvement.

Currently, there are no agreed quality standards for post-stroke aphasia services. Therefore, it is unknown if care reflects best practices or meets the expectations of people living with aphasia. We aimed to (1) shortlist, (2) operationaliseand (3) prioritise best practice recommendations for post-stroke aphasia care. Three phases of research were conducted. In Phase 1, recommendations with strong evidence and/or known to be important to people with lived experience of aphasia were identified. People with lived experience and health professionals rated the importance of each recommendation througha two-round e-Delphi exercise. Recommendations were then ranked for importance and feasibility and analysed using a graph theory-based voting system. In Phase 2,shortlisted recommendations from Phase 1 were converted into quality indicators for appraisal and voting in consensus meetings. In Phase 3,priorities for implementation were established by people with lived experience and health professionals following discussion and anonymous voting. In Phase 1, 23 best practice recommendations were identified and rated by people with lived experience (n = 26) and health professionals (n = 81). Ten recommendations were shortlisted. In Phase 2,people with lived experience (n = 4) and health professionals (n = 17) reached a consensus on 11 quality indicators, relating toassessment (n = 2), information provision (n = 3),communication partner training (n = 3),goal setting (n = 1),person and family-centred care (n = 1)and provision of treatment (n = 1). In Phase 3,people with lived experience (n = 5) and health professionals (n = 7) identified three implementation priorities: assessment of aphasia,provision of aphasia-friendly informationand provision of therapy. Our 11 quality indicators and 3 implementation priorities are the first step to enabling systematic, efficientand person-centred measurement and quality improvement in post-stroke aphasia services. Quality indicators will be embedded in routine data collection systems, and strategies will be developed to address implementation priorities. Protocol development was informed by our previous research, which exploredthe perspectives of 23 people living with aphasia about best practice aphasia services. Individuals with lived experience of aphasia participated as expert panel members in our three consensus meetings. Wereceived support from consumer advisory networks associated with the Centre for Research Excellence in Aphasia Rehabilitation and Recovery and the Queensland Aphasia Research Centre.

Factors Influencing Education Development in West Pokot County, Kenya

The Pokot community is conservative and has resisted change in its culture from any quarter, including government policies, which have had little impact in the region since the colonial period to date. This situation has militated against school enrolment witnessed in many schools of the County and reluctance to use modern technologies in farming and SME activities. Political power has lacked recognition among the Pokots and, consequently, has had no impact on the region's social, economic, and technological developments. The purpose of this study was to establish factors influencing education development among the Pokot people of West Pokot County. The research was guided by four objectives, which included: To determine the influence of schooling on education development in West Pokot County, Kenya To investigate the influence of religion on education development in West Pokot County, Kenya To examine the influence of population explosion on education development in West Pokot County, Kenya, and To assess the influence of devolved government on education development in West Pokot County, Kenya This study was guided by the Human Capital Theory propounded by Theodore W. Schultz in 1960, who believed education and training enable the acquisition of knowledge, skills and abilities, which increase human value. The target population was 200,000, which is the number of people in active life who are creating wealth for their families in West Pokot County. A sample of 400 respondents was used to provide data, 100 from each constituency, namely: Kapenguria, North Pokot, South Pokot and Central Pokot. Stratified and purposive sampling techniques were used to select the respondents. Interview schedules were used to collect data, and the test-retest technique was used to test the validity and reliability of the instruments. Data collected was analyzed, and relationships between the independent and the dependent variables were established. The findings established that high levels of poverty were prevalent, and the bulk of the population was illiterate with no innovative or entrepreneurial skills. The study established that traditional education was designed to encompass control of livelihood in the region, making it difficult for new forms of education and ideas to be accepted. The study made four recommendations: The county government should expand social facilities such as schools and health units in the region The county government should abolish repugnant cultural practices The county government should provide credit facilities to the active population in the county for entrepreneurial activities, and The government and non-governmental organizations should make provision for training selected groups of the community population on micro, small and medium-sized enterprises to boost wealth creation for education development

Originalarbeiten / Original Articles. Prävention sexualisierter Gewalt an Kindern und Jugendlichen: Präventionsmaßnahmen und Schutzkonzepte in den Bereichen Sport, Musik und Kirche

Prevention of Child Sexual Abuse: Prevention Programs and Safeguarding Concepts in the Context of Sports, Musical Education, and Religious Organizations Prevalence rates of child sexual abuse by caregivers in private and non-public institutions underscore the need for implementing safeguarding concepts. However, factors driving the implementation of prevention and safeguarding in the field are not well understood. What supportive and inhibiting factors can be identified in the implementation of safeguarding concepts and prevention programs? Content analysis of semi-structured interviews with professional and volunteer staff in clubs and institutions (n = 10, 69 % female) as well as with individuals who experienced child sexual abuse during their childhood (n = 3, 66 % female). Safeguarding concepts in clubs or religious institutions were primarily initiated by umbrella organizations. Current incidents of child maltreatment, public pressure, and media attention substantially increased the need for preventive actions. The provision of training, resources, and networking structures by umbrella organizations further facilitated their implementation. Main implementation challenges included limited personnel and time resources, lack of expertise, insufficient training opportunities, and absence of guidelines and support from umbrella organizations. Due to club leaders' limited knowledge and resources an independent implementation of safeguarding concepts is largely lacking without concrete guidelines and support from umbrella organizations. To upscale safeguarding, public policies or incentive systems such as state-funded child protection certifications are thus paramount.

Contraceptive counseling training experiences and behaviors among obstetrics and gynecology residents in California and Florida

ObjectiveTo describe experiences with contraception counseling training and provision of obstetrics and gynecology residents training in California and Florida. Study designWe conducted a mixed-methods study of obstetrics and gynecology residents training across 19 programs (with approximately 428 residents) in California and Florida from September 2022 through February 2023. We asked participants how often they use tiered-effectiveness counseling, their satisfaction with contraception counseling practices, and experiences with witnessing and recognizing contraception coercion. We asked about personal disappointment when patients decline long-acting reversible contraception (LARC) and pressure from faculty to prescribe LARC. To further explore resident contraception counseling education and behaviors, we conducted semi-structured telephone interviews with a subset of 20 survey volunteers. ResultsWe received survey responses from 155 (36.2%) participants. Most (n = 113 [76.4%]) often or always reported using tiered-effectiveness counseling. While few participants (n = 17 [11.3%]) reported feeling pressure from faculty to convince a patient to keep a LARC, some (n = 34 [22.1%]) reported they often or always feel disappointed when a patient chooses LARC removal, with more Florida participants reporting disappointment (n = 19 [37.3%]) compared to California (n = 15 [14.6%], p = 0.01). We identified two main themes from the telephone interviews. First, residents feel they have limited formal education on how to provide contraceptive counseling and commonly learn these practices by emulating supervising faculty or peer counseling styles. Second, residents are informally taught, through feedback and interactions with supervising faculty and peers, that successful contraception counseling is the ability to convince patients to use highly effective contraception. ConclusionWhen residents lack formalized contraception counseling education, they adopt counseling behaviors that may not be patient centered. ImplicationsWhen obstetrics and gynecology residents lack formalized contraception counseling education, they learn practices that may lead to coercive counseling behaviors during training. Resident education should include recognition and mitigation of contraception coercion and patient-centered counseling both through a formalized curriculum and socialization of trainees during their medical education.

Upper gastrointestinal training in the UK and Ireland: a Roux Group Study.

Surgical training programmes in the United Kingdom and Ireland (UK&I) are in a state of flux. This study aims to report the contemporary opinions of trainee and consultant surgeons on the current upper gastrointestinal (UGI) training model in the UK&I. A questionnaire was developed and distributed via national UGI societies. Questions pertained to demographics, current training evaluation, perceived requirements and availability. A total of 241 responses were received with representation from all UK&I postgraduate training regions. The biggest discrepancies between rotation demand and national availability related to advanced/therapeutic endoscopy and robotic surgery, with 91.7% of respondents stating they would welcome greater geographical flexibility in training. The median suggested academic targets were 3-5 publications (trainee vs consultant <3 vs 3-5, p<0.001); <3 presentations (<3 vs 3-5, p=0.002); and 3-5 audits/quality improvement projects (<3 vs 3-5, p<0.001). Current operative requirements were considered achievable (87.6%) but inadequate for day one consultant practice (74.7%). Reassuringly, 76.3% deemed there was role for on-the-job operative training following consultant appointment. Proficiency in diagnostic endoscopy was considered a minimum requirement for Certificate of Completion of Training (CCT) yet the majority regarded therapeutic endoscopy competency as non-essential. The median numbers of index UGI operations suggested were comparable with the current curriculum requirements. Post-CCT fellowships were not considered necessary; however, the majority (73.6%) recognised their advantage. Current CCT requirements are largely consistent with the opinions of the UGI community. Areas for improvement include flexibility in geographical working and increasing national provisions for high-quality endoscopy training.

O44 LOW ADHERENCE TO HYPERTENSION MANAGEMENT IN THE COLOMBIAN COMMUNITY IMPLEMENTATION RE-HOPE STUDY

Background and objective: Uncontrolled hypertension is a leading cause of death worldwide, and it's associated with a high socioeconomic burden. Demographic, social, behavioral, and health system-related factors contribute to low adherence to hypertension management. Recognizing adherence rates is a mainstay for improving hypertension control. This study examined the level of adherence to hypertension management and control in the participants belonging to the implementation, integration, and institutionalization of a community-based care strategy to reduce the risk of cardiovascular disease in Santander (ReHOPE) study. Methods This cross-sectional analysis was conducted in 12 municipalities of Santander, Colombia, from May to December 2023. Participants over 18 with hypertension, not in a cardiovascular risk program, were included. Data were collected door-to-door by trained community health providers using standardized questionnaires for socio-demographic information, medication use, lifestyle details, and hypertension knowledge. Physical exams provided anthropometric and blood pressure values. Medication adherence was assessed with the Morisky 4-item scale. Continuous variables are presented as central tendency measures, and categorical variables as frequencies and proportions. Analysis was performed using R software. Results: A total of 2,617 participants were included. The mean age was 65.09 (SD 12.09), and 64.3% were women. The mean systolic blood pressure was 133.94 mmHg (SD 16.53). The median waist-to-hip ratio (WHR) was 0.96 (IQR 0.92-1.00) in men and 0.91 (IQR 0.87-0.96) in women. Among participants, 33.9% had uncontrolled hypertension, 28.5% were not aware of their condition, and 69.2% reported no physical activity. High WHR was found in 84.8% of the participants. Antihypertensive monotherapy use was reported in half of the participants (53.8%). The most frequently used pharmacological group was angiotensin-converting enzyme inhibitors (81.8%). Hypertension control was observed in 66.1%, and 12.6% had high adherence. Conclusions: Low medication adherence was observed, only 12.6% of participants reported high adherence and nearly 40% had uncontrolled hypertension. Additionally, nearly 30% were undetected by the healthcare system. Thus, improving medication adherence and healthcare strategies is essential to enhance health outcomes.

Abstract P107: Training for home blood pressure monitoring among women with a diagnosis or risk factors for hypertensive disorders of pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP) are leading causes of morbidity and mortality among pregnant women. Despite the potential benefits of home blood pressure monitoring (HBPM) for early diagnosis and monitoring of patients with HDP, its utilization is limited by inconsistent training by healthcare providers. This study sought to examine the use of and training for HBPM in those at risk for HDP. Methods: Pregnant women, aged 20-50 (N = 103), diagnosed with either hypertension, HDP, or risk factors for HDP, were recruited from a large academic medical center to complete a survey on HBPM practices from June 2020 to January 2024. Thisincluded questions about HBPM, frequency of HBPM, and prior HBPM training provision by providers. Statistical analysis was performed using STATA/BE 18.0. Results: Of the 103 participants, 41 (39.8%) did HBPM and the most common frequency was daily (70.7%). Of those who did HBPM, 36.6% had received training from their healthcare providers and 31.7% had their BP monitors calibrated in the clinic. There was a trend towards Hispanic women being less likely to receive training compared to white women ( p =0.07). There were no significant differences in training across categories of education and location of residence. Conclusion: In this sample where nearly 40% of pregnant women used HBPM, we observed that only 1 in 3 received training for HBPM with little difference observed across demographic categories. Given the time constraints in clinic visits hindering appropriate training for HBPM, exploring alternative methods of HBPM training such as leveraging mobile health applications may be beneficial to ensure that pregnant women receive necessary training to effectively conduct HBPM.

Psychosocial support for counselors working with HIV-Serodiscordant couples

ABSTRACT Living in HIV serodiscordant relationship poses psychosocial challenges to couples. These necessitate proper counseling. This paper explored the psychosocial support for counselors working with HIV-serodiscordant couples at a regional hospital. The study used descriptive and exploratory approaches, underpinned by an interpretative phenomenological analysis design (IPA). Participants were selected using a non-probability snowball sampling technique. A total of nine participants took part in the study. Data were collected using an in-depth interview guide and analyzed using an interpretive phenomenological analysis framework. Three themes emanated: knowledge deficiency on serodiscordancy among the counselors, limited/lack of support and ways to recommend HIV-serodiscordant couples services. The findings indicates that there is need to enhance, strengthen, and provide comprehensive psychosocial support services to discordant couples. To support and improve the knowledge, confidence and skills of counselors, the following should be implemented: provision of training, introducing debriefing sessions to reflect on discordant cases, follow-up on discordant couple’s post diagnosis to offer psychosocial support services, and establishment and strengthening of the support groups.

Late complications following infant male circumcision using Plastibell technique: Experience from a single facility in Pakistan

BackgroundGlobally, millions of circumcisions are performed annually by both medical and non-medical providers, with minor and major adverse outcomes. Short-term outcomes are well documented but there are limited reports of long-term, group-based assessments after Plastibell circumcision of infants. Through this study, we aim to assess the rate and types of late complications in the group of boys circumcised as part of Safe Circumcision Program (SCP) in Karachi, Pakistan, to document the safety of our technique and approach in the long-term. MethodsThis cross-sectional study was conducted on male infants circumcised via Plastibell technique as part of the SCP from June 2016 to May 2021. A sample size of 602 was calculated using OpenEpi. After obtaining consent, telephone interviews of parents/guardians were conducted by health workers using a structured questionnaire. All complications reported by parents and identified by health workers were documented, and the babies were then referred to a pediatric surgeon for review. ResultsParents of 46 (7.5%) children reported a total of 81 concerns. After health worker assessment, 20 babies were referred to a specialist for in-person review and complications were documented in four (adhesion, inclusion cyst, skin bridge and meatal stenosis); thus, a late complication rate of 0.7% was recorded. ConclusionThe long-term complication rate for Plastibell circumcisions performed by trained providers is less than 1% with all reported complications minor and amenable to surgical correction.

Post Natal Mothers Satisfied and Happy with the Outcomes of their Deliveries after Individualized Precision Maternal Monitoring using 3D-Printing Technology in a Maternity Unit in the Developing World - A Case Study of Jaramogi Oginga Odinga Teaching and Referral Hospital in Western Kenya

Background: In the low and middle income countries’ healthcare system for medicine and surgery training and service provision, the use of computing technologies would be of great help in creating faster and transformational solutions by creating software applications and hardware fabrications for faster diagnosis, which are absent currently, hence leading to efficient treatment interventions in the developing world. Objective: The objective of this study was to assess the potential of using computing innovation of 3-D printing technology in producing medical solutions using 3-D printing of fetoscopes to solve the challenge of the frequency of monitoring fetal heart rates in the maternity department. Methodology: A randomized case-control study was used to analyze the impact of having one fetoscope per mother on shortening the frequency of monitoring of fetal heart rates and promptly intervening in case of non-reassuring fetal status. This was done by 3-D printing fetoscopes increasing the numbers at the Maternity department of Jaramogi Oginga Odinga Teaching and Referral Hospital. Findings: The frequency of monitoring heart rates increased to hourly instead of 3 hourly in 24 hours, leading to timely interventions, as compared to previous days when there was only one fetoscope serving the whole unit. Mothers with a 3-D printed Fetoscope reported a lower proportion of emergency caesarean section done compared to mothers who were sharing a 3-D printed Fetoscope (13% vs. 38%, p = 0.021). No fetal death was reported among mothers with a 3-D printed Fetoscope each, while maternal satisfaction was higher among mothers with a 3-D printed Fetoscope as compared to those who were sharing (94% vs. 63%, p = 0.002). Conclusion: We concluded that computing technology is useful in designing and fabricating medical equipment and parts, which help save lives in the maternity, emergency room and the operating room in low and middle income countries.

A qualitative study identifying implementation strategies using the i-PARIHS framework to increase access to pre-exposure prophylaxis at federally qualified health centers in Mississippi

BackgroundMississippi (MS) experiences disproportionally high rates of new HIV infections and limited availability of pre-exposure prophylaxis (PrEP). Federally Qualified Health Centers (FQHCs) are poised to increase access to PrEP. However, little is known about the implementation strategies needed to successfully integrate PrEP services into FQHCs in MS.PurposeThe study had two objectives: identify barriers and facilitators to PrEP use and to develop tailored implementation strategies for FQHCs.MethodsSemi-structured interviews were conducted with 19 staff and 17 PrEP-eligible patients in MS FQHCs between April 2021 and March 2022. The interview was guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework which covered PrEP facilitators and barriers. Interviews were coded according to the i-PARIHS domains of context, innovation, and recipients, followed by thematic analysis of these codes. Identified implementation strategies were presented to 9 FQHC staff for feedback.ResultsData suggested that PrEP use at FQHCs is influenced by patient and clinic staff knowledge with higher levels of knowledge reflecting more PrEP use. Perceived side effects are the most significant barrier to PrEP use for patients, but participants also identified several other barriers including low HIV risk perception and untrained providers. Despite these barriers, patients also expressed a strong motivation to protect themselves, their partners, and their communities from HIV. Implementation strategies included education and provider training which were perceived as acceptable and appropriate.ConclusionsThough patients are motivated to increase protection against HIV, multiple barriers threaten uptake of PrEP within FQHCs in MS. Educating patients and providers, as well as training providers, are promising implementation strategies to overcome these barriers.

Training Needs Assessment for managers of Technical and Vocational Education and training providers in Namibia

Training Needs Assessment for managers of Technical and Vocational Education and training providers in Namibia

The long-term effects of job training on labor market and skills outcomes in Chile

Job training programs can be an effective policy for improving productivity and labor market outcomes in low- and middle-income countries. We report medium- and long-term impacts of a job training program for vulnerable workers in Chile on labor market and skill outcomes using experimental and administrative data. We estimate intention-to-treat effects, accounting for potential non-compliance by training providers in the assignment process, as well as local average treatment effects due to noncompliance with the assigned treatment status. Overall, the program shows limited effectiveness. While we find some positive impacts on labor income, the program fails to improve most labor outcomes. A detailed investigation of heterogenous effects by course-type, training provider and course quality, and gender reveals that the positive income effects are more likely to be realized for males and participants in courses that were offered by high-quality providers. Evidence on mechanisms indicates that the program's limited impact on labor outcomes could, at least partly, be due to its limited effect on workers’ skills.

Building a solid foundation: advancing evidence synthesis in agri-food systems science

Enhancing the reliability of literature reviews and evidence synthesis is crucial for advancing the transformation of agriculture and food (agri-food) systems as well as for informed decisions and policy making. In this perspective, we argue that evidence syntheses in the field of agri-food systems research often suffer from a suite of methodological limitations that substantially increase the risk of bias, i.e., publication and selection bias, resulting in unreliable and potentially flawed conclusions and, consequently, poor decisions (e.g., policy direction, investment, research foci). We assessed 926 articles from the Collaboration for Environmental Evidence Database of Evidence Reviews (CEEDER) and recent examples from agri-food systems research to support our reasoning. The analysis of articles from CEEDER (n = 926) specifically indicates poor quality (Red) in measures to minimize subjectivity during critical appraisal (98% of all reviews), application of the eligibility criteria (97%), cross-checking of extracted data by more than one reviewer (97%), critical appraisal of studies (88%), establishment of an a priori method/protocol (86%), and transparent reporting of eligibility decisions (65%). Additionally, deficiencies (Amber) were found in most articles (&amp;gt;50%) regarding the investigation and discussion of variability in study findings (89%), comprehensiveness of the search (78%), definition of eligibility criteria (72%), search approach (64%), reporting of extracted data for each study (59%), consideration and discussion of the limitations of the synthesis (56%), documentation of data extraction (54%) and regarding the statistical approach (52%). To enhance the quality of evidence synthesis in agri-food science, review authors should use tried-and-tested methodologies and publish peer-reviewed a priori protocols. Training in evidence synthesis methods should be scaled, with universities playing a crucial role. It is the shared duty of research authors, training providers, supervisors, reviewers, and editors to ensure that rigorous and robust evidence syntheses are made available to decision-makers. We argue that all these actors should be cognizant of these common mistakes to avoid publishing unreliable syntheses. Only by thinking as a community can we ensure that reliable evidence is provided to support appropriate decision-making in agri-food systems science.