Provision Of Training Research Articles

How can we improve Comprehensive Geriatric Assessment for older people living with frailty in primary care and community settings? A qualitative study

ObjectiveWith advancing age comes the increasing prevalence of frailty and increased risk of adverse outcomes (eg, hospitalisation). Evidence for comprehensive geriatric assessment (CGA), a multidimensional holistic model of care, is...

Identifying Implementation Strategies to Enhance HIV Pre-Exposure Prophylaxis Uptake Among Black Cisgender Women in New Orleans, Louisiana.

There is an unmet need for HIV prevention among Black cisgender women. From January to November 2020, we conducted formative research to develop locally informed implementation strategies to enhance pre-exposure prophylaxis (PrEP) uptake among Black cisgender women in New Orleans, Louisiana. Following an iterative process, we conducted in-depth interviews (IDIs) with Black women who were not taking PrEP and used those findings to inform IDIs with Black women taking PrEP. We asked about PrEP awareness, social support, PrEP-related norms, medical mistrust, motivation to take PrEP, and potential implementation strategies. Data were analyzed using applied thematic analysis. We established the Black Women and PrEP (BWAP) Task Force-a diverse group of 25 Black female community representatives who reviewed the IDI findings and identified strategies to address these determinants of PrEP uptake. We interviewed 12 Black women who were not taking PrEP and 13 Black women who were taking PrEP. Two main PrEP uptake barriers were identified from the IDI findings and Task Force discussions. First, Black women do not know of other Black women taking PrEP. Women perceived PrEP as a drug for gay men. Most said that testimonials from Black women taking PrEP would make its use more relatable. Second, Black women are not frequently offered PrEP by their providers. Many preferred accessing PrEP through women's health providers. The Task Force identified two strategies to address these barriers: a social media campaign for women and an educational initiative to train providers to discuss and prescribe PrEP. These implementation strategies require further study.

ETHNICITY AND ACADEMIC SUCCESS IN A PRE-REGISTRATION MIDWIFERY EDUCATION PROGRAMME

Equality, diversity and inclusion are core values of both the National Health Service (NHS) and Higher Education healthcare training providers in the UK. It is clear however that there are disparities in course achievement outcomes between students depending on ethnicity.1,2 To what extent midwifery education specifically is impacted has to date not been established. This retrospective cohort observation study looked at the relationship between ethnicity of student midwives, and course outcome in a single higher education midwifery programme in the UK. Findings identify that ethnicity does not impact on course attrition rates but does predict the final degree classification attained.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Structure Principles.

This article is the seventh in a series of eight articles that comprise a special issue on family-centered early intervention for children who are deaf or hard of hearing and their families, or FCEI-DHH. This article, Structure Principles, is the third of three articles (preceded by Foundation Principles and Support Principles) that describe the 10 FCEI-DHH Principles. The Structure Principles include 4 Principles (Principle 7, Principle 8, Principle 9, and Principle 10) that highlight (a) the importance of trained and effective Early Intervention (EI) Providers, (b) the need for FCEI-DHH teams to work collaboratively to support families, (c) the considerations for tracking children's progress through developmental assessment, and (d) the essential role of progress monitoring to continuously improve systems.

Digitalised Welfare-to-work program in Indonesia: A Prelimenary Study of The Pre-Employment Card (PECP) and Job-Loss Insurances (JLI) Programs

Unemployment is a serious challenge facing many countries around the world, including Indonesia. The government plays a crucial role in addressing this issue by implementing effective welfare-to-work (WTW) policies. This study examines the implementation of Welfare-to-Work (WTW) reform in Indonesia through an examination of the Pre-Employment Card Program (PECP) and Job-Loss Insurance (JLI) on unemployment figures. This study examines the use of digitalization in the implementation of the two programs. The study was conducted using qualitative methods with semi-structured interviews with a total of 37 participants (14 policymakers from the Ministry of Manpower and the Coordinating Ministry for Economic Affairs, 17 training providers related to the PECP and 6 participants). Secondary data was collected from previous studies with a total of 846 respondents. This study finds that digitalization can weaken jobseekers' motivation to access the full implementation of the WTW policy. The provision of helpdesks is beneficial for individuals who face difficulties in accessing digital services, especially those living in urban areas. However, digitization may not effectively support those who are geographically marginalized.

Paediatric oncology in the Eastern Mediterranean region (EMR): the current state and challenges.

The WHO Eastern Mediterranean region (EMR) is characterised by highly economically diverse countries, with healthcare systems in various phases of development. Childhood cancer care provision also ranges from that provided in centres able to deliver sophisticated therapy resulting in outcomes comparable to those seen in highly developed nations, to countries with no provision for care of children with cancer. At 10·1 per 100,000 children at risk, the age standardised incidence-rate for cancer in children below 14 years of age is relatively low but may be consequent to poor registration. Shortages in trained care providers were identified in many regional countries, particularly in low and lower-middle income countries, however, implementation of training programs are beginning to counter this deficit. Significant diversity in patient care capacity exists in the region, leading to inequitable access to quality paediatric oncology care. There is strong potential for regional collaboration towards infrastructure and capacity improvement, with facilities available within the EMR for twinning and educational support to those centres and countries that need them. While cancer care coverage is available to citizens of high-income countries, in the lower-income countries out-of-pocket health expenditure can reach 75%. Some relief is achieved through the contribution of multiple charitable foundations working to support childhood cancer care in the region, as well as the provision of care in, often overburdened, public sector hospitals. War and other geo-political turmoil, as well as natural disasters, have negatively impacted healthcare capacity, including childhood cancer care, in several regional countries. Despite all this, the trajectory for change is upward and initiatives such as the WHO Global Initiative for Childhood Cancer are igniting positive change.

MENINGKATKAN NILAI KARAKTER PADA SISWA SEKOLAH DASAR DENGAN MELESTARIKAN BUDAYA GENDANG BELEQ BERBASIS TRI HITA KARANA

Education with low character causes a crisis of national identity among the younger generation. The purpose of this article is an attempt to improve. The method used in the article is to conduct a literature review of various previous studies (literature review). The purpose of writing this article is to analyze various relevant theories, the literature used is research or reviews that have existed in scientific works and are published in journals. The result of this research is implementing Tri Hita Karana in schools through the implementation of Education and Training (Soft Skills and Entrepreneurship) with a cultural content and encouraging students to always explore the knowledge and skills of successful people and collaborate with people who have great intelligence, guide and invites students to have faith and act exemplary by always living cleanly and keeping the environment clean. Implementing Tri Hita Karana in schools through the provision of Education and Training (Soft Skills and Entrepreneurship) with a cultural content and encouraging students to always explore the knowledge and skills of successful people and collaborate with people who have great intelligence, guiding and inviting students to believe and act exemplary by always living cleanly and keeping the environment clean.

Is the UN receiving ethical approval for its research with human participants?

This paper examines the institutional mechanisms supporting the ethical oversight of human participant research conducted by the United Nations (UN). The UN has served an instrumental role in shaping international...

Diagnosis and management of secondary adrenal crisis.

Adrenal crisis (AC) is a life threatening acute adrenal insufficiency (AI) episode which can occur in patients with primary AI but also secondary AI (SAI), tertiary AI (TAI) and iatrogenic AI (IAI). In SAI, TAI and IAI, AC may develop when the HPA axis is unable to mount an adequate glucocorticoid response to severe stress due to pituitary or hypothalamic disruption. It manifests as an acute deterioration in multi-organ homeostasis that, if untreated, leads to shock and death. Despite the availability of effective preventive strategies, its prevalence is increasing in patients with SAI, TAI and IAI due to more frequent exogenous steroid administration, pituitary immune-related effects of immune checkpoint inhibitors and opioid use in pain management. The delayed diagnosis of acute AI which remains infrequently suspected increases the risk of AC. Its main precipitating factors are infections, emotional distress, surgery, cessation or reduction in GC doses, pituitary infarction or surgical cure of endogenous Cushing's syndrome. In patients not known previously to have SAI/TAI/IAI, recognition of its symptoms, signs, and biochemical abnormalities can be challenging and cause delay in proper diagnosis and therapy. Effective therapy of AC is rapid intravenous administration of hydrocortisone (initial bolus of 100mg followed by 200mg/24h as continuous infusion or bolus of 50mg every 6h) and 0.9% saline. In diagnosed patients, preventive education in sick-day rules adjustment of glucocorticoid replacement and hydrocortisone parenteral self-administration must be performed repeatedly by trained health care providers. Strategies to improve the adequate preventive education in patients at risk for secondary AI should be promoted in collaboration with various medical specialist societies and patients support associations.

Optimalisasi Hak Ekonomi Nanas Tangkit Baru Jambi Sebagai Produk Indikasi Geografis

Geographical indication is part of the Intellectual Property regulated in the Law Number 20 of 2016 on Trademarks and Geographic Indications, Tangkit pineapple is a typical Pineapples Village of New Tangit district of Muaro Jambi which must be protected in order to obtain legal protection of Geographic Indication. The aim of this research is to identify and analyze the economic benefits for communal communities that are integrated into the MPIG Nanas New Infection Group. To identify the role of the government in optimizing the utilization of Geographical Indications for the new Infection Society. The basic problems in this research are: 1) How the economic benefit for the communal community that is integrated in the new infection MPIG Group is formed. 2) How the government's role in optimising the use of geographical indications for new infected communities. This research uses empirical methods of jurisprudence with data collection techniques using observations, interviews and documentation. The conclusion of the results of the discussion in the research showed that: 1) The form of economic benefits made by the people of the village of Tangkit New to increase the revenue of the region is to manage UMKM or home industry by processing pineapple fruit into various kinds of processed products. 2) The role of the Muaro Jambi Government in optimizing the use of Geographical Indications is to provide support in the provision of guidance and training as well as facility assistance.

Barriers and enablers of dementia training in healthcare workers in rural and remote Australia: A scoping review to inform future approaches to training.

Dementia is now responsible for the greatest burden of disease of any chronic illness in older Australians. Rural and remote communities bear the impacts of this disproportionately. Additional training and education for healthcare staff to support people living with dementia is needed. The objective of this scoping review was to map and synthesise the evidence related to barriers and enablers of accessing dementia training for Australian healthcare workers located in rural and remote areas. This scoping review systematically searched multiple databases in January 2023 for peer-reviewed literature on the topic. Reviewers used Covidence to screen titles and abstracts of located sources, and to screen full-text articles. From 187 articles screened, seven peer-reviewed journal articles were included in the final data analysis; all were from Australia or Canada. The most common barrier described was low staffing, precluding release of staff for dementia training. Enablers to participation in dementia training were availability of online training programs, as well as training providers collaborating with end users to ensure the training met their learning needs. This review provides evidence of barriers and enablers specific to rural and remote healthcare workers accessing dementia training. It also explores other approaches to training that have been trialled successfully in different settings. Addressing the identified barriers and enablers may assist in developing training approaches appropriate for existing staff, and in meeting training needs for the future workforce.

The Digital Skills Gap – Is it Time to Rethink the Needs of Tourism and Hospitality Organizations in the UK?

ABSTRACT This research investigates digital skill gaps and digital training provision amongst tourism and hospitality organizations in the four nations of the United Kingdom. The results derived from an online survey show that organizations mostly lack skills in emerging technologies such as artificial intelligence and robotics and highlight that key skills gaps relate to social media, online marketing, and communication skills. The skills gaps are considered in the context of specific policies of the four nations together with education barriers and other societal constraints. This is supplemented by a discussion of industry training provision, compounded by issues of time within the management of the business, budget controls and lack of knowledge and resources. These findings add to the growing body of literature on the complexity of skills provision in the tourism and hospitality sector. From a practical perspective, this study helps to identify the key areas for skills development and barriers.

Labor Market Information System: A Review of Some Practices

Accurate and up-to-date labor market information system, which is conducted with the involvement of public decision markers, technical and vocational education and training (TVET) practitioners, employers and their associations, employee associations, training providers and learners, is an essential feature of a successful TVET system. Similarly, engagement of multiple TVET stakeholders is an important component of overall skills development system which leads to developing responsive labor market skill needs, supporting prioritized economic sectors to foster dialogue among the stakeholders to maintain balance demand and supply of labor right. It enhances integration of labor market requirements in the overall training and skills development cycle and ensures that trainees acquire market-relevant skills for their employability and self-employment. In the context of changing labor market conditions, collecting, compiling, analyzing, and disseminating current and future needs from the TVET customers can support better matching for training and employment. As labor markets are constantly evolving and changing, labor market analysis therefore needs to be conducted on a regular basis so that real time labor market information can be obtained. But the active and regular labor market information process is underexplored in a developing country like Nepal. The main objective of the article is to explore the common practices of Nepali labor market information system and the problems faced by the TVET system. Thus, the article addresses the information gap by diving deep into the clear understanding of labor market, practices of labor market information processes in some South Asian countries, including Nepal and issues and challenges facing the Nepali labor market information process.

EXPLORING THE INTEGRATION OF GENDER AND DEVELOPMENT CONTENT AND PEDAGOGY IN LANGUAGE TEACHING THROUGH THE LENS OF ENGLISH TEACHERS: A PHENOMENOLOGY

The purpose of this phenomenological study was to explore into the experiences of teachers on the integration of gender and development content and pedagogy in language teaching. This study was participated by the 13 teachers who were involved in the integration of gender and development in language teaching from the Schools of the Division of Davao de Oro. From the results, it showed that teachers have different lived experiences, coping strategies, and insights on the integration of gender and development content and pedagogy in language teaching. As such, the following themes emerged: using androgynous styles in forming groups; fostering gender-inclusive education; promoting equality and self-discovery through GAD Integration; issues of educating students on gender and development; and problems on gender inclusivity during group activities; utilizing and practicing gender-fair language; integrating GAD activities to teaching; being flexible and adaptive; promoting inclusivity and equality through GAD integration in education; recommending the continuation of GAD integration; and provision of GAD related training and seminar. KEYWORDS: integration of gender and development, language teaching, inclusivity, phenomenology, Davao de Oro

Lesson learned from assessing teachers’ and students’ perspectives regarding the quality of e-learning in medical education during the pandemic: a mixed-methods study

BackgroundThe evaluation of e-learning systems ensures the provision of quality training. The goal was to identify the perspectives of teachers and students on e-learning in medical education during the COVID-19 pandemic at Shiraz University of Medical Sciences (SUMS), Iran.MethodsThis study utilized a convergent mixed methods research design with a two-phase approach to collect and analyze data between June and August 2022. In the first stage, a cross-sectional descriptive study was conducted to evaluate the quality of e-learning systems from the perspective of 400 students. In the second stage, semi-structured interviews were conducted with 10 virtual education professors and 10 student representatives to identify the strengths, weaknesses, opportunities, and threats of virtual education. A validated questionnaire was administered to assess the quality of the e-learning system, and data were analyzed using SPSS-21. Qualitative data were subjected to content analysis.ResultsOur findings revealed that the student support system, the course structure, and the infrastructure and technology subscales’ mean scores were significantly higher than the average level (P < 0.001). However, the professors’ methods of teaching and learning strategies were unsatisfactory. The results of the present study showed that the evaluation mean score was significantly higher among, younger, female, and undergraduate students. Virtual education has strengths and weaknesses, and innovative approaches are needed to enhance student engagement. The lack of appropriate infrastructure and virtual teaching tools for teachers and students is a significant challenge that needs to be addressed. Blended learning is effective in medical education, and the shift from teacher-centered to learner-centered teaching approaches is an opportunity to explore innovative teaching approaches.ConclusionFrom the perspective of students, the quality of eLearning systems at the universities was moderate. Virtual education offers both benefits and drawbacks, and there is a requirement for innovative solutions to enhance student engagement and lessen boredom.

Serious illness communication skills training for emergency physicians and advanced practice providers: a multi-method assessment of the reach and effectiveness of the intervention

BackgroundEM Talk is a communication skills training program designed to improve emergency providers’ serious illness conversational skills. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study aims to assess the reach of EM Talk and its effectiveness.MethodsEM Talk consisted of one 4-h training session during which professional actors used role-plays and active learning to train providers to deliver serious/bad news, express empathy, explore patients’ goals, and formulate care plans. After the training, emergency providers filled out an optional post-intervention survey, which included course reflections. Using a multi-method analytical approach, we analyzed the reach of the intervention quantitatively and the effectiveness of the intervention qualitatively using conceptual content analysis of open-ended responses.ResultsA total of 879 out of 1,029 (85%) EM providers across 33 emergency departments completed the EM Talk training, with the training rate ranging from 63 to 100%. From the 326 reflections, we identified meaning units across the thematic domains of improved knowledge, attitude, and practice. The main subthemes across the three domains were the acquisition of Serious Illness (SI) communication skills, improved attitude toward engaging qualifying patients in SI conversations, and commitment to using these learned skills in clinical practice.ConclusionOur study showed the extensive reach and the effectiveness of the EM Talk training in improving SI conversation. EM Talk, therefore, can potentially improve emergency providers’ knowledge, attitude, and practice of SI communication skills.Trial registrationClinicaltrials.gov: NCT03424109; Registered on January 30, 2018.

Assessment of Trends of Food Crop Vulnerability to Climatic Fluctuations in the Santa Agro-basin of North-West, Cameroon

Santa Subdivision like many highland areas in Cameroon has enormous agricultural potentials. However, climate which plays a vital role in crop production process continues to threaten this agricultural strength through its variability. The study therefore aimed to assess climate variability and its impacts on food crop production in Santa Subdivision. This study used the mixed method and the data collected was both quantitative and qualitative. Rainfall and temperature data for a period of 40 years alongside food crop output data coupled with field observations and interviews were used to assess the link between climatic variations and food crop output in 4 communities. Results showed significant variations in climate with gradual decreasing rainfall trends of -3.7485x and increasing temperature trends of 0.0185x. Regression analysis test showed that there is a direct relationship between climate variability and food crop outputs. This study therefore recommended the provision of climatic data/information and steady early warning systems, development of good techniques to multiply climate variability resistant seeds and the provision of adequate training on sustainable agricultural practices to help farmers cope with climate variability.

Impact of point-of-care ultrasound use on patient referral decisions in rural Kenya: a mixed methods study

BackgroundPoint-of-care ultrasound (POCUS) is recognized as a key imaging modality to bridge the diagnostic imaging gap in Low- and Middle-Income Countries (LMICs). POCUS use has been shown to impact patient management decisions including referral for specialist care. This study explored the impact of POCUS use on referral decisions among trained healthcare providers working in primary rural and peri-urban health facilities in Kenya.MethodsA concurrent mixed methods approach was used, including a locally developed survey (N = 38) and semi-structured interviews of POCUS trained healthcare providers (N = 12). Data from the survey was descriptively analyzed and interviews were evaluated through the framework matrix method.ResultsSurvey results of in-facility access to Xray, Ultrasonography, CT scan and MRI were 49%, 33%, 3% and 0% respectively. Only 54% of the facilities where trainees worked had the capacity to perform cesarean sections, and 38% could perform general surgery. Through a combined inductive and deductive evaluation of interview data, we found that the emerging themes could be organized through the framework of the six domains of healthcare quality as described by the Institute of Medicine: Providers reported that POCUS use allowed them to make referral decisions which were timely, safe, effective, efficient, equitable and patient-centered. Challenges included machine breakdown, poor image quality, practice isolation, lack of institutional support and insufficient feedback on the condition of patients after referral.ConclusionThis study highlighted that in the setting of limited imaging and surgical capacity, POCUS use by trained providers in Kenyan primary health facilities has the potential to improve the patient referral process and to promote key dimensions of healthcare quality. Therefore, there is a need to expand POCUS training programs and to develop context specific POCUS referral algorithms.

Implementing a tobacco-free workplace program at a substance use treatment center: a case study

BackgroundPeople with substance use disorders smoke cigarettes at much higher rates than the general population in the United States and are disproportionately affected by tobacco-related diseases. Many substance use treatment centers do not provide evidence-based tobacco cessation treatment or maintain comprehensive tobacco-free workplace policies. The goal of the current work is to identify barriers and facilitators to a successful and sustainable implementation of a tobacco-free workplace program, which includes a comprehensive tobacco-free policy and evidence-based cessation treatment services, in a substance use treatment center.MethodsThis study is based on an ethnographic approach and uses a qualitative case study design. Data were collected via interviews with staff (n = 6) and clients (n = 16) at the substance use treatment center and site visits (n = 8). Data were analyzed using thematic analysis guided by the extended Normalization Process Theory designed to inform the implementation of innovations in healthcare practice.ResultsStaff at the substance use treatment center supported the implementation of the program and shared a good understanding of the purpose of the intervention and its potential benefits. However, the study identified significant challenges faced by the center during implementation, including widespread tobacco use among clients, contributing to attitudes among staff that tobacco cessation was a low-priority problem due to a perceived lack of interest in quitting and inability to quit among their clients. We identified several factors that contributed to changing this attitude, including provision of tobacco training to staff, active leadership support, low number of staff members who smoked, and access to material resources, including nicotine replacement products. The implementation and active enforcement of a comprehensive tobacco-free workplace program contributed to a gradual change in attitudes and improved the provision of evidence-based tobacco cessation care at the substance use treatment center.ConclusionsSubstance use treatment centers can integrate tobacco cessation practices in their daily operations, despite multiple challenges they face due to the complex behavioral health and socioeconomic needs of their clients. With proper support, substance use treatment centers can provide much needed tobacco cessation care to their clients who are disproportionately affected by tobacco-related health conditions and systemic health inequities.

Use of nonpneumatic anti-shock garment and first response care bundle to improve maternal survival following obstetric hemorrhage in Migori County, Kenya

Background: Despite targeted efforts by the Ministry of Health and nongovernmental organizations, the maternal mortality ratio (MMR) was 673 in 100,000 live births in Migori County, Western Kenya. The first confidential investigation into maternal deaths was a detailed review of half of the maternal deaths reported across Kenya in 2014. Approximately 40% of maternal deaths were due to obstetric hemorrhage (OH), and 90% were attributed to substandard care. Objectives: To evaluate the use of a nonpneumatic anti-shock garment (NASG) and first response bundle in maternal survival following postpartum hemorrhage. Methods: An implementation team trained maternity care staff at 104 participating facilities (responsible for 85% of facility births for the county) to use the first-response bundle, NASG, and uterine balloon tamponade (UBT) combined with NASG for uterine atony. The study had two phases, beginning July 1, 2020, and ending September 30, 2021. Results: 63,580 deliveries were reported, giving an OH rate of 1.32%. Of 838 women with OH, 51.8% showed signs of hypovolemic shock (n=434). NASG was applied per protocol to 56.5% (n=267) of women and preventively to 146 (36.1%) of the 404 women with OH. For most women with OH who did not receive NASG, the provider stated that it was not necessary. In three cases, NASG was not applied due to lack of a trained provider, and in four cases, NASG was not available at the facility. The use of the complete first-response bundle increased from 37.3% to 42.3% over time. For tranexamic acid (TXA), 40.8% of eligible women who received TXA had received the other three interventions. 86 were managed with both the UBT and NASG (22.5%). Conclusion: This study demonstrated that the use of the NASG and PPH first-response bundle is feasible at tertiary and primary health facilities. The limitation to the use of a first-response PPH bundle is whether there is a local commitment to expand the availability of TXA.