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For seriously mentally ill adults, empowerment is critical to maximizing participation in major life activities. Although studies have identified interventions that have positively impacted empowerment, these interventions may not be applicable or amenable to all adults with serious mental illness. More interventions with other approaches are needed. Therefore, this study evaluated the initial implementation of a movement- and mindfulness-based workshop intervention. Quantitative data were used to examine differences in empowerment before and after the workshop, and qualitative data were used to explore participants’ perceptions of the reasons for empowerment differences. Ten participants completed the intervention, and nine of the ten participants also completed follow-up interviews. Quantitative data were collected via pre- and post-intervention surveys. Qualitative data were collected through follow-up interviews with the participants. Surveys revealed perceptions of optimism and control over the future increased between pre- and post-intervention. Interviews uncovered that increases in optimism and control over the future may have been related to workshop accomplishments and reduced helplessness outside of workshop sessions. Future research would benefit from the creation of a training manual along with a validated system to monitor intervention fidelity.

This version of Core Principles of Group Therapy (2020) is an update of an original manual by Robert Weber called Principles of Group Psychotherapy (2006), itself an update of an earlier manual dev...

PROBLEM Poor knowledge and stigmatizing attitudes of healthcare professionals constitute a significant barrier to child and adolescent mental health care worldwide. This study aimed to determine the effect of a training intervention on the knowledge and attitudes of pediatric nurses to child mental health problems at a Nigerian tertiary hospital. METHODS A two group pretest-posttest study design was undertaken. A total of 156 pediatric nurses were recruited, and participants in the intervention group received a brief child mental health training based on the World Health Organization's mhGAP training manual. Knowledge and attitudes to child mental health problems were obtained at baseline, and post intervention. FINDINGS There were no differences in knowledge or attitudes across the two groups at baseline. Post intervention, there was a significant increase in the mean post knowledge scores of the intervention group compared with the control group (t = 3.8, p

Background: Training needs assessment involves the identification and prioritization of training requirements. The medical practice regulatory authority in Nigeria recommends continuing medical education for physicians. The courses are preplanned and often do not take into consideration the training needs and the preferred method for performance improvement. This study aimed to assess the preferred method for performance improvement among physicians at a tertiary health facility in Southwest Nigeria. Methods: This is a descriptive cross‑sectional survey carried out among 355 doctors employed in the University College Hospital, Ibadan. Sampling was conducted using stratified random sampling with a proportionate allocation to size across different cadres of doctors in various departments/units. The World Health Organization Hennessy‑Hicks Training Needs Analysis Questionnaire was adopted for this study. The self‑administered questionnaire consisted of 33 items (assignments) grouped into five subcategories: clinical assignments, communication/teamwork, research/audit, management/supervisory assignments, and administration. Participants were requested to rate each of the 33 items/assignments along with seven‑point scales (one = not at all important and seven = very important). The Hennessy‑Hicks training manual quadrant chart was adopted for the interpretation of the training needs gap. Results: Three hundred and three (85.4%) of 355 participants responded to the survey. The mean age ± standard deviation of participants was 37.62 ± 6.7 years. About four‑fifths of the participants were resident doctors. Regarding the most important rating, the clinical assignment subcategory was rated (6.3) as the most important to participants’ job, out of the five subcategories. Participants, however, rated their performance best in the communication/teamwork subcategory. The training needs gap was highest (0.82) in the research/audit subcategory and lowest (0.48) in the communication/teamwork category. All subcategories reported a similar score (5.8) on participants’ perception of the organization’s development as a method to bridge the gap in training needs. Participants also rated the training course method as a better method to improve performance in all five subcategories. Conclusion: The research/audit subcategory reported training needs gap that requires close monitoring and possible intervention. This could be done by organizing and sponsorship physicians for training courses. Keywords: Health resources, Nigeria, physicians, training needs assessments

The World Health Organization and United Nations Children’s Fund has introduced Integrated Community Case Management of childhood illness (ICCM) in order to train health workers at community level on how to treat children below 5 years who have pneumonia, diarrhoea and malaria. Since Primary Health Care workers in Benue State are actively involved in caring for sick children at community level, there is every need for them to be trained on ICCM. The objective of this study is to find out if training of primary health care workers in North-West district of Benue State can improve their knowledge on ICCM. The study was carried out in Benue North-west where Gboko Local government was randomly selected out of seven local governments. Health Officers’ in-charge of 38 Primary Health Care Clinics were selected for the study and were trained based on our adapted ICCM training manual. The Pre and Post training assessment test for this study was designed based on the training manual. A paired sample t-test was conducted to find out if there were any significant difference in the knowledge of primary health care workers before and after receiving training. There was significant difference in the pre training scores ( x1 = 136.684, S1 = 37.370) and post-training scores (x2 =177.895, 2 S =14.469) at (t=6.783, P=0.000). This result strongly indicates that the teaching intervention has improved the knowledge of the Primary Health Care workers on ICCM in Gboko Local Government. Keywords: ICCM; Pneumonia; Malaria; Diarrhoea

Sonography provides excellent detection, localization, and characterization of soft‐tissue foreign bodies. Ultrasound guided foreign body removal is a safe and highly successful minimally invasive procedure that facilitates effective treatment and avoidance of complications in patients with soft tissue foreign bodies. Focused laboratory training is critical to successful implementation of a sonographic foreign body management practice.

BACKGROUND Around half of surgical adverse events occur outside the operating room. However the majority of nontechnical skills (NTS) training programs have been developed for the intraoperative environment. Ward rounds are a crucial part of extraoperative care and to date no specific NTS training manual has been developed targeting emergency general surgical ward rounds. AIM To develop a NTS taxonomy for emergency general surgical ward rounds that can be used to improve surgical team members’ NTS and improve outcomes. METHODS A literature review of existing NTS taxonomies was conducted, followed by semistructured interviews and observational data collection, to determine good and poor surgical ward-round behaviors. These behaviors were reviewed by a panel of subject matter experts and categorized into a taxonomy, using the Non-Technical Skills for Surgeons taxonomy framework as a guide. RESULTS The Ward-round Non-Technical Skills for Surgery taxonomy includes examples of good and poor ward–round-specific behaviors, grouped into elements and categories. The taxonomy can be used as both a training and teaching manual for the surgical team. CONCLUSION Ward rounds are a crucial part of extraoperative surgical care. The Ward-round Non-Technical Skills for Surgery taxonomy provides surgical teams with a manual to help them improve their ward-round NTS.

A structured program of manualization and implementation of neurologic upper extremity task-specific training was developed at an inpatient rehabilitation hospital. The study used the Consolidated Framework for Implementation Research and engaged 31 stakeholders in manual refinement and examination of barriers after a year of training and use. Occupational therapists, occupational therapy assistants, and clinical educators provided input for manual revisions until consensus was achieved on usability, applicability, and implementation. Practitioners reported barriers such as intervention complexity, insufficient idea sharing for implementation, and a lack of motivators outside of the organization. The results can inform future implementation research in occupational therapy.Supplemental data for this article is available online at https://doi.org/10.1080/07380577.2021.1938338 .

Procedure induced anxiety affects the majority of children undergoing medical intervention and has been directly linked to behaviour disturbances, psychological trauma, phobias and symptoms of PTSD. Despite this, there is currently no formal training relating to the management of procedure induced anxiety for medical personnel caring for children. A distillation of more than eighty years of research, this textbook examines the nature, prevalence and consequences of anxiety in children, alongside evidence-based strategies for its effective management. Designed as a training manual, it includes a comprehensive account of positive and negative aspects of behaviour that contribute to the successful management of anxious children. Chapters cover topics such as non-verbal and verbal communication, enhanced communication management strategies, support of children with autistic spectrum disorder, ADHD, learning difficulties, the use of premedication and the role that families play. Essential reading for anaesthetists and paediatricians and a valuable resource for any practitioner working with children.

Primary health care facilities offer an entry point to the health care system in Malawi. Challenges experienced by these facilities include limited resources (both material and human), poor or inadequate knowledge, skills and attitudes of health care workers in emergency management, and delay in referral from primary care level to other levels of care. These contribute to poor outcomes including children dying within the first 24 hours of hospital admission. Training of health care workers and support staff in Emergency Triage Assessment and Treatment (ETAT) at primary care levels can help improve care of children with acute and severe illnesses. Health care workers and support staff in the primary care settings were trained in pediatric ETAT. The training package for health care workers was adapted from the Ministry of Health ETAT training for district and tertiary health care. Content for support staff focused on non-technical responsibility for lifesaving in emergency situations. The primary health care facilities were provided with a minimum treatment package comprising emergency equipment, supplies and drugs. Supportive supervisory visits were conducted quarterly. The training manual for health care workers was adapted from the Ministry of Health package and the support staff training manual was developed from the adapted package. Eight hundred and seventy-seven participants were trained (336 health care workers and 541 support staff). Following the training, triaging of patients improved and patients were managed as emergency, priority or non-urgent. This reduced the number of referral cases and children were stabilized before referral. Capacity building of health care workers and support staff in pediatric ETAT and the provision of a basic health center package improved practice at the primary care level. The practice was sustained through institutional mentorship and pre-service and in-service training. The practice of triage and treatment including stabilization of children with dangerous signs at the primary health care facility improves emergency care of patients, reduces the burden of patients on referral hospitals and increases the number of successful referrals.

Introduction This study investigated the current status of the Health Promotion Programme using Traditional Korean Medicine (HaPP-TKM). A survey of public health Traditional Korean Medicine (TKM) doctors asked for suggestions on developing the system and programmes so that TKM public health doctors can practice effectively in different circumstances. Methods TKM public health doctors working in health centres in the Republic Korea were asked about the performance status of HaPP-TKM and their opinions on the programme. The questionnaire took about 20 min to complete and included basic information about the respondent, plus performance status and opinions on HaPP-TKM and the TKM public health doctor system. The survey was administered to 908 doctors through SurveyMonkey. Results The response rate was 96.2% (n = 838) of which 31.1% (n = 236) of respondents were administering HaPP-TKM. The top three programmes that TKM doctors implemented were; stroke (23.1%, n = 61), smoking cessation (20.1%, n = 53), and osteoarthritis (14.8%, n = 39). Over 50% of TKM public health doctors reported that the difficulties performing the programmes were a result of insufficient infrastructure, followed by lack of information and training on TKM health promotion programmes (32.6%, n = 86). Conclusion The study results show that TKM is in high demand and appropriate for stroke, smoking cessation, and osteoarthritis. The activation plan for TKM health promotion programmes are as follows: first, well trained human resources, spaces, facilities, and budget are essential, second, programme development and training manual development should run concurrently and last, it is necessary to consider ways to specialize the health promotion programmes and medical treatment according to specialty areas.

The training manual is based on many years of experience in the practical application of reflexotherapy in outpatient settings. The article presents a structural analysis of diseases of children and adolescents receiving treatment in the reflexology room of a childrens polyclinic, which revealed a high level of pathology of the musculoskeletal system and connective tissue and a steady growth trend of this group of diseases. Pathogenetic justifications, indications and contraindications for the use of reflexotherapy in Pediatrics and in diseases of the musculoskeletal system in particular are given. Principal therapeutic approaches and treatment regimens for patients with obstetric hand paralysis, spastic torticollis, migraine, Perthes disease and traumatic limb injuries are considered. Recommendations on the organization of outpatient use of reflexotherapy in Pediatrics, the methods used and their instrumental support are formulated. The training manual is intended for doctors who specialize in reflexology, already practicing reflexologists, orthopedic traumatologists and physiotherapists.

Background Falls are a common problem among older adults that lead to injury, emergency department (ED) visits, and institutionalization. The Apple Watch can detect falls and alert caregivers and clinicians that help is needed; the device could also be used to objectively collect data on gait, fitness, and falls as part of clinical trials. However, little is known about the ease of use of this technology among older adult ED patients, a population at high risk of recurrent falls. Objective The goal of this study—the Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) II—is to examine the feasibility, acceptability, and usability of the Apple Watch Series 4 paired with the iPhone and our research app Rhode Island FitTest (RIFitTest) among older adult ED patients seeking care for falls. Methods We will conduct field-testing with older adult ED patients (n=25) who sustained a fall and their caregivers (n=5) to determine whether they can use the Apple Watch, iPhone, and app either (1) continuously or (2) periodically, with or without telephone assistance from the research staff, to assess gait, fitness, and/or falls over time. During the initial encounter, participants will receive training in the Apple Watch, iPhone, and our research app. They will receive an illustrated training manual and a number to call if they have questions about the research protocol or device usage. Participants will complete surveys and cognitive and motor assessments on the app during the study period. At the conclusion of the study, we will solicit participant feedback through semistructured interviews. Qualitative data will be summarized using framework matrix analyses. Sensor and survey response data will be analyzed using descriptive statistics. Results Recruitment began in December 2019 and was on pause from April 2020 until September 2020 due to the COVID-19 pandemic. Study recruitment will continue until 30 participants are enrolled. This study has been approved by the Rhode Island Hospital Institutional Review Board (approval 1400781-16). Conclusions GAPcare II will provide insights into the feasibility, acceptability, and usability of the Apple Watch, iPhone, and the RIFitTest app in the population most likely to benefit from the technology: older adults at high risk of recurrent falls. In the future, wearables could be used as part of fall prevention interventions to prevent injury before it occurs. Trial Registration ClinicalTrials.gov NCT04304495; https://clinicaltrials.gov/ct2/show/NCT04304495 International Registered Report Identifier (IRRID) DERR1-10.2196/24455

In Kenya, employment rates for persons with disabilities are very low and those with psychosocial disabilities have even more dismal rates of employment. This situation has negative impact on the individual’s recovery, quality of life, mental and physical health. The systemic exclusion of persons with psychosocial disabilities in work and employment disproportionately affects women. The aim of this study is to test the feasibility of disability inclusion training to improve work and employment opportunities for women with psychosocial disabilities in Tana River County, Kenya. The study will adopt a mixed methods research design using action research approach. A sample of women with psychosocial disabilities will be trained using a researcher designed disability inclusion training manual, while employers and other stakeholders will be trained on inclusive employment. Trainings will be tailored to suit different employers and for different types of psychosocial disabilities. Interactive learning and linking sessions involving the two groups and process evaluations will be conducted at different time points to measure the impact of the intervention. Findings from this pilot study will inform future research on work and employability programs for rural women with psychosocial disabilities. The study protocol was approved by Maseno University Ethics Review Committee (MUERC/00851/20). Findings from this study will be disseminated through conference presentations and scientific publications in peer reviewed journals. &nbsp

Research Objectives To develop a novel exercise training program for persons with multiple sclerosis (MS) who use wheelchairs in partnership with a community advisory board (CAB). Design Community-engaged, qualitative. Setting General Community. Participants Participants (N=10) were recruited to be community advisors from a previous research study and met the following inclusion criteria: 18 years of age or older, MS diagnosis, use of a wheelchair ≥ 50% of the day. The sample had a mean age of 61 years and MS duration of 22 years. Nine participants identified as Caucasian and one participant identified as African American. All participants had progressive MS, 50% were female, and 50% used manual wheelchairs. Interventions The exercise training program developed based on initial qualitative research included a 16-week progressive exercise prescription (resistance and aerobic training), equipment (training manual, cycle ergometer, resistance bands, fitness tracker, and rate of perceived exertion scale), and one-on-one behavioral coaching based on Social Cognitive Theory. Main Outcome Measures Content analysis identified elements that aligned with meeting foci (i.e., prescription, equipment, coaching, and outcomes). Feedback was then divided into categories for refinement of the program, specifically suggestions for modifications and additions, as well as components retained as designed. Results CAB member feedback was very positive wherein most feedback emphasized potential additions to the materials reviewed. The research team proposed modifications based on the CAB member feedback such as adding wrist weights within the equipment options for completing resistance training exercises. Conclusions The CAB feedback overall was invaluable for assessing the appropriateness of the proposed exercise training program prior to feasibility testing. This presentation will provide a model and guidance for other researchers who seek community-engaged research approaches in creating products and interventions. Author(s) Disclosures The authors declare no conflicts.

Background and Significance When hospitals are subject to prolonged surges in patients, such as during the coronavirus disease 2019 (COVID-19) pandemic, additional clinicians may be needed to care for the rapid increase of acutely ill patients. How might we quickly prepare a large number of ambulatory-based clinicians to care for hospitalized patients using the inpatient workflow of the electronic health record (EHR)? Objectives The aim of the study is to create a successful training intervention which prepares ambulatory-based clinicians as they transition to inpatient services. Methods We created a training guide with embedded videos that describes the workflow of an inpatient clinician. We delivered this intervention via an e-mail hyperlink, a static hyperlink inside of the EHR, and an on-demand hyperlink within the EHR. Results In anticipation of the first peak of inpatients with COVID-19 in April 2020, the training manual was accessed 261 times by 167 unique users as clinicians anticipated being called into service. As our institution has not yet needed to deploy ambulatory-based clinicians for inpatient service, usage data of the training document is still pending. Conclusion We intend that our novel implementation of a multimedia, highly accessible onboarding document with access from points inside and outside of the EHR will improve clinician performance and serve as a helpful example to other organizations during the COVID-19 pandemic and beyond.

Background Despite the benefits of physical activity for walking ability, balance, and mood, less than 30% of stroke survivors engage in recommended levels of physical activity with high levels of sedentary behaviour observed. This study aims to assess the feasibility, acceptability and fidelity of a theory- and evidence-based multifaceted behaviour change intervention targeting free-living physical activity and sedentary behaviour after stroke. Methods This study will be set in community stroke services in the North East of England and will assess the feasibility of a behaviour change intervention targeting free-living physical activity and sedentary behaviour of stroke survivors and consultation behaviour of the healthcare professionals to support stroke survivors to make these lifestyle changes. Up to 35 stroke survivors currently receiving stroke rehabilitation within the study catchment area with capacity and no contraindications to increasing physical activity/reducing sedentary behaviour will be recruited. Stroke survivors will receive a supported self-management physical activity/sedentary behaviour programme incorporating provision of information, goal setting, action planning, barrier identification, coping planning, self-monitoring and feedback on physical activity and sedentary behaviour. The programme will be supported by up to 12 healthcare professionals (HCPs) recruited from the community stroke services taking part in the study. The HCPs will deliver at least two face-to-face sessions (baseline, review and subsequent reviews if necessary) and provide a range of personalised tools to support each individual stroke survivor (e.g. workbook, self-monitoring tools, information on local resources). The consultation behaviour of the HCPs will be targeted via a training programme incorporating face-to-face training, a training manual and individual feedback on intervention programme delivery from the study research team. The feasibility, acceptability and fidelity of the study protocol will be assessed. Discussion The most effective methods of supporting stroke survivors to alter physical activity and sedentary behaviour have yet to be established. This study will establish the feasibility of delivering a complex theory- and evidence-based intervention targeting the behaviour of both stroke survivors and HCPs and assess whether it is acceptable to the target populations. Findings will inform the iterative development of the intervention before a larger scale evaluation. Trial registration Trial register: Trial identifier: ISRCTN35516780, date of registration: 24/10/2018

Background Low- and middle-income countries (LMICs) often face significant challenges related to providing effective pre-hospital care services. Barriers to providing care include lack of financial resources, poor road infrastructure, lack of trained first responders and ambulance staff, and issues regarding coordination/communication between different entities involved in Emergency Medical Services. Prior initiatives to characterize and improve the state of pre-hospital care in LMICs have largely focused on improving access to high-quality ambulance services by providing training programs to community first responders and ambulance staff on how to recognize and manage key emergency conditions. In this article, we discuss an alternative strategy for improving pre-hospital care: the creation of a context-specific Emergency Medical Dispatcher (EMD) training curriculum and program. Methods We describe the current pre-hospital care setting in Nepal, the process of creating and piloting the Nepal-specific EMD training manual, and the early impact of its implementation. Results The 30-h EMD training was designed, piloted, and revised in collaboration with the three largest EMS organizations in Nepal. The training is now required for all dispatchers at the Dhulikhel Hospital Dispatch Center, one of the largest ambulance dispatch networks in Nepal. Dispatchers are trained in the following knowledge and skill areas: telecommunication guidelines, triaging and documentation procedures, delivery of Basic Life Support instructions to callers, other medical and trauma-condition specific instructions, and limited resource management. The short-term positive impacts of the training’s implementation include improved documentation procedures, better prioritization of ambulance resources, delivery of Basic Life Support instructions to callers, and improved communication between dispatch, responders, and healthcare facilities. Conclusions Context-specific Emergency Medical Dispatch training programs, which aim to optimize the emergency resources available in resource-limited settings, present a promising low-cost, high-impact interventional strategy to strengthen the pre-hospital care systems in low- and middle-income countries.

ObjectiveTo develop a nationally applicable tool for assessing the quality of informed consent documents for elective procedures.DesignMixed qualitative-quantitative approach.SettingConvened seven meetings with stakeholders to obtain input and feedback on the tool.ParticipantsTeam of physician investigators, measure development experts, and a working group of nine patients and patient advocates (caregivers, advocates for vulnerable populations and patient safety experts) from different regions of the country.InterventionsWith stakeholder input, we identified elements of high-quality informed consent documents, aggregated into three domains: content, presentation and timing. Based on this comprehensive taxonomy of key elements, we convened the working group to offer input on the development of an abstraction tool to assess the quality of informed consent documents in three phases: (1) selecting the highest-priority elements to be operationalised as items in the tool; (2) iteratively refining and testing the tool using a sample of qualifying informed consent documents from eight hospitals; and (3) developing a scoring approach for the tool. Finally, we tested the reliability of the tool in a subsample of 250 informed consent documents from 25 additional hospitals.OutcomesAbstraction tool to evaluate the quality of informed consent documents.ResultsWe identified 53 elements of informed consent quality; of these, 15 were selected as highest priority for inclusion in the abstraction tool and 8 were feasible to measure. After seven cycles of iterative development and testing of survey items, and development and refinement of a training manual, two trained raters achieved high item-level agreement, ranging from 92% to 100%.ConclusionsWe identified key quality elements of an informed consent document and operationalised the highest-priority elements to define a minimum standard for informed consent documents. This tool is a starting point that can enable hospitals and other providers to evaluate and improve the quality of informed consent.

Background Nigeria is estimated to have 25,000 cases of cryptococcal antigenemia (CrAg) annually. CrAg screening with pre-emptive fluconazole treatment is recommended but not yet implemented in Nigeria. Trainings were conducted to improve health-care provider (HCP) awareness and clinical skills in the management and prevention of cryptococcal meningitis (CM). Methods HCPs providing care for people living with HIV were targeted for training at 13 sites from April to November 2018 Course content was adapted from CDC Cryptococcal Screening Program Training Manual and LIFE-website. “Hands-on” training on CrAg testing and lumbar puncture was included. A 14-point pre and post-test assessment instrument was designed to capture the impact of the training and focus group discussions (FGDs) were conducted. Results A total of 761 HCPs were trained. 519 HCPs completed the pre-test evaluation while 470 (90.6%) took part in the post-test evaluation. Post-training, HCPs were significantly more likely to respond correctly to all 14 assessment items, with the mean percentage score rising to 91.0% from a pre-training value of 60.0%. FGDs revealed that many of the HCPs were not aware of the CrAg screening and pre-emptive treatment recommendations in Nigerian guidelines, and reported not having seen or managed a case of CM. Also, they highlighted challenges with routine CrAg screening due to a lack of access to CD4 testing, CrAg test kits, antifungal drugs, as well as the need for similar trainings across all tiers of care in Nigeria. Conclusion Training significantly improved HCPs’ understanding of Nigerian policy on CrAg screening, CM diagnosis and best management practices. This training could be included in routine capacity building efforts for HCPs involved in HIV care in Nigeria.

INTRODUCTION: Compliance with ethical principles is regarded as one of the key components in providing services in midwifery profession. This study was to evaluate the effects of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among midwives working in community health centers in the city of Karaj, Iran. METHODS: this randomized controlled trial (RCT) was conducted in 2018 on a total number of 84 eligible midwives in two intervention and control groups, selected through multistage sampling method. The intervention group took part in six counseling sessions but the control group only received a training manual. Both groups then completed the Self-Reporting Questionnaire of Ethical Codes of Reproductive Health Providers (including 95 items in 14 domains) at three time points (before, immediately, and four weeks after intervention). Finally, the data were analyzed using the IBM SPSS Statistics (version 22) software via descriptive and inferential statistics. RESULTS: the findings showed that level of compliance and applicability rate in all 14 domains of midwifery professional codes of ethics were higher in the intervention group (after intervention) than those in the control group and trend of time changes in mean level of compliance and applicability rate of codes of ethics during the three time points were significantly different between both groups (p < 0.001). CONCLUSION: given the effectiveness of counseling professional ethics principles on midwifery professional codes of ethics compliance and applicability rate among the midwives working in community health centers, designing and applying this counseling approach was recommended to improve quality of reproductive health care services.

Introduction: Hemophilia and other bleeding disorders are underreported and cause significant morbidity and mortality in resource-constrained countries. Training and the creation of awareness among accredited social heath activists (ASHAs) will aid in the early detection of bleeding disorders at the community level. Objective: To develop awareness and skills for the screening and identification of cases with bleeding symptoms among ASHAs in Udupi District, Karnataka, India. Methods: An interventional study was undertaken in Udupi District, which has three taluks and approximately 233 villages. All ASHAs with a current role (586) from rural Udupi were provided a competency-based training program at the community health center using a specifically designed training manual for the identification of cases with bleeding disorders. A pre-test/ post-test evaluation was performed to discover the training outcomes. Results: Sixteen (2.7%) participants had average knowledge in the first post-test, and 570 (92.2%) participants had good knowledge. Thirty-nine (6.6%) participants had average knowledge in second post-test, and 547 (94.3%) participants had good knowledge. The effectiveness of the training program was assessed using Friedman’s two-way test. A significant difference in knowledge scores (χ2 = 955.1) was found at baseline evaluation and end of the training test 1 and at 30 days of training test 2 among the ASHAs. Conclusion: Accredited social heath activists health care workers, who are the most important link between the community and health services, successfully created public awareness concerning the early detection of bleeding disorders.

Background Rapid and precise diagnosis of malaria is an essential element in effective case management and control of malaria. Malaria microscopy is used as the gold standard for malaria diagnosis, however results remain poor as positivity rate in Nigeria is consistently over 90%. The United States President’s Malaria Initiative (PMI) through the Malaria Action Program for States (MAPS) supported selected states in Nigeria to build capacity for malaria microscopy. This study demonstrates the effectiveness of in-service training on malaria microscopy amongst medical laboratory scientists. Method The training was based on the World Health Organization (WHO) basic microscopy training manual. The 10-day training utilized a series of didactic lectures and examination of teaching slides using a CX 21 Olympus binocular microscope. All 108 medical laboratory scientists trained from 2012 to 2015 across five states in Nigeria supported by PMI were included in the study. Evaluation of the training using a pre-and post-test method was based on written test questions; reading photographic slide images of malaria parasites; and prepared slides. Result There was a significant improvement in the mean written pre-and post-tests scores from 37.9% (95% CI 36.2–39.6%) to 70.7% (95% CI 68.4–73.1%) (p

Introduction Delirium is common in Intensive-Care-Unit (ICU) patients but under-recognized by bed-side clinicians when not using validated delirium-screening tools. The Confusion-Assessment-Method for the ICU (CAM-ICU) has demonstrated very good psychometric properties, and has been translated into many different languages though not into French. We undertook this opportunity to describe the translation process. Material and methods The translation was performed following recommended guidelines. The updated method published in 2014 including introduction letters, worksheet and flowsheet for bed-side use, the method itself, case-scenarios for training and Frequently-Asked-Questions (32 pages) was translated into French language by a neuropsychological researcher who was not familiar with the original method. Then, the whole method was back-translated by a native English-French bilingual speaker. The new English version was compared to the original one by the Vanderbilt University ICU-delirium-team. Discrepancies were discussed between the two teams before final approval of the French version. Results The entire process took one year. Among the 3692 words of the back-translated version of the method itself, 18 discrepancies occurred. Eight (44%) lead to changes in the final version. Details of the translation process are provided. Conclusions and relevance The French version of CAM-ICU is now available for French-speaking ICUs. The CAM-ICU is provided with its complete training-manual that was challenging to translate following recommended process. While many such translations have been done for other clinical tools, few have published the details of the process itself. We hope that the availability of such teaching material will now facilitate a large implementation of delirium-screening in French-speaking ICUs.

Background Implementing standard precautions (SP) has been a major challenge for health care workers (HCWs) especially those in developing countries thereby compromising their safety and increasing their exposure to blood-related pathogens. Compliance with safety precautions and occupational accidents among health workers are often unreported. The literature on knowledge and compliance to SP in Ghana is scanty. We report findings of a study that examined knowledge of SP, compliance and barriers to compliance with SP among HCWs in two health facilities in Ghana. Methods This is a facility-based cross-sectional study involving 100 HCWs from two health facilities in the Lower Manya Krobo District of the Eastern region. Statistical analysis summarised data on socio-demographic characteristics of respondents, knowledge of SP and compliance and barriers to SP in frequencies and percentages. Results Most respondents had been working as health staff for 0–5 years (65.0%). Generally, knowledge of the basic concepts of SP was low; only 37.0% of HCWs knew that SP includes hand washing before and after any direct contact with the patient, 39.0% knew about cough etiquettes and 40.0% knew about aseptic techniques which involve infection prevention strategies to minimise the risks of infection. Fifty percent of respondents always protect themselves against BBFs of patients. About a quarter of the respondents do not recap needles after use and 28.0% of respondents sometimes promptly wipe all blood spills. HCWs were of the opinion that wearing PPEs—such as gloves, aprons, gowns and goggles—might cause patients to panic sometimes (63.0%) and complying with SP sometimes interferes with the ability to provide care (38.0%). Sometimes, because of the demands of patient care, HCWs do not have enough time to comply with the rigours of SP (44.0%) and sometimes PPEs are not available. Conclusion Education programmes on the benefits of SP should be organised frequently. The OHS national policy together with the application of the IPC training manual in all health care facilities must be enforced. Communities of practice should be established and sanctions and rewards should be introduced to limit negative behavior and reinforce positive attitudes as regards SP.

Purpose This study examined the effectiveness, feasibility, and satisfaction with implementation of the FOCUS program in two US Cancer Support Community affiliates in Ohio and California as well as the cost to deliver the program. FOCUS is an evidence-based psychoeducational intervention for dyads (cancer patients and caregivers). Methods A pre-post-intervention design was employed. Eleven, five-session Focus programs were delivered by licensed professionals in a small group format (three–four dyads/group) to 36 patient-caregiver dyads. An Implementation Training Manual, a FOCUS Intervention Protocol Manual, and weekly conference calls were used to foster implementation. Participants completed questionnaires prior to and following completion of each five-session FOCUS program to measure primary (emotional distress, quality of life) and secondary outcomes (benefits of illness, self-efficacy, and dyadic communication). Enrollment and retention rates and fidelity to FOCUS were used to measure feasibility. Cost estimates were based on time and median hourly wages. Repeated analysis of variance was used to analyze the effect of FOCUS on outcomes for dyads. Descriptive statistics were used to examine feasibility, satisfaction, and cost estimates. Results FOCUS had positive effects on QOL (p = .014), emotional (p = .012), and functional (p = .049) well-being, emotional distress (p = .002), benefits of illness (p = .013), and self-efficacy (p = .001). Intervention fidelity was 85% with enrollment and retention rates of 71.4 and 90%, respectively. Participants were highly satisfied. Cost for oversight and delivery of the five-session FOCUS program was $168.00 per dyad. Conclusions FOCUS is an economic and effective intervention to decrease distress and improve the quality of life for dyads.

Many horses presumed to be sound by their riders are not. Facial expression ethograms have previously been used to describe pain-related behavior in horses, but there is a need for a ridden horse facial ethogram to facilitate identification of pain in ridden horses. The objectives of this study were to develop and test an ethogram to describe facial expressions in ridden horses and to determine whether individuals could interpret and correctly apply the ethogram, with consistency among assessors. An ethogram was developed by reference to previous publications and photographs of 150 lame and nonlame ridden horses. A training manual was created. Thirteen assessors (veterinarians of variable experience, n = 4; equine technicians, n = 3; equine studies graduates, n = 2; amateur horse owners, n = 2; equine veterinary nurse, n = 1; a British Horse Society Instructor, n = 1) underwent a training session and, with reference to the training manual, evaluated still lateral photographs of 27 training heads. Features were graded as Yes, No, or “Cannot see” (when it was not possible to determine the presence or absence of a feature). The ethogram was adapted, and after further training, the assessors blindly evaluated 30 test heads from nonlame and lame horses. Intraclass correlation (ICC) and free-margin kappa tests were used to assess consensus among assessors. For the training heads, single ICC matrix among observers resulted in an overall ICC of 0.50 (95% confidence intervals, 0.40-0.62). Four assessors consistently scored differently from the others, with ranges of ICC of 0.20-0.50 (mean, 0.41). There was no difference in assessors' scoring related to their professional backgrounds. For the test heads, mean interrater agreement among assessors was 87%. Two assessors still scored consistently differently (0.28-0.50 ICC agreement; mean, 0.40) from the remaining 11 assessors (0.44-0.69 ICC agreement; mean, 0.56). The mean percentage of overall agreement was 80%, and the mean free-marginal kappa value was 0.72, standard deviation (SD) ± 0.22. The large SD was the result of inconsistency in assessments of the eyes and muzzle. It was concluded that the developed ethogram could reliably be utilized to describe facial expressions of ridden horses by people from different professional backgrounds. Future work needs to determine if nonlame and lame horses can be differentiated based on application of the ethogram.

Postoperative delirium (POD) represents an acute brain dysfunction in the postsurgical period. Perioperative physicians caring for the older adults are familiar with the care of dysfunction of organs such as lungs, heart, liver, or kidney in the perioperative setting, but they are less familiar with management of brain dysfunction. As early detection and prompt treatment of inciting factors are utmost important to prevent or minimize the deleterious outcomes of delirium. The purpose of this review is to prepare perioperative physicians with a set of current clinical practice recommendations to provide optimal perioperative care of older adults, with a special focus on specific perioperative interventions that have been shown to prevent POD. On literature search in EMBASE, CINAHL, and PUBMED between January 2000 and September 2015 using search words delirium, POD, acute postoperative confusion, and brain dysfunction resulted in 9710 articles. Among them, 73 articles were chosen for review, in addition, National Institute for Health and Clinical Excellence guidelines, American Geriatric Society guidelines, hospital elderly life program-confusion assessment method training manual, New York geriatric nursing protocols, World Health Organization's International Classification of Diseases, 10th Revision classification of mental disorders, Food and Drug Administration requests boxed warnings on older class of antipsychotic drugs 2008 and delirium in Miller's text book of anesthesia were reviewed and relevant information presented in this article.

Aim: The quality of quantitative analytical measurements is dependent on the quality of the sample collected, and dried blood spots (DBS) are no exception. As the use of DBS has matured into late-stage clinical drug-development studies, it has become apparent that a simple and straightforward approach in a controlled single-site, first-time-into-human clinic, does not always translate into multicenter clinical studies. Using synthetic blood, a method of training and assessing clinical laboratory staff has been developed to ensure the quality of sampling. Methods: A test kit comprising of synthetic blood, a pipetting aid, blank blood spot card, drying rack and training manual was sent to each clinical site for each technician to assess and approve prior to spotting PK samples. Results: The development of a DBS training kit along with a step-by-step guide has been successfully implemented. Conclusion: The training kit has been 100% successful across three large multisite clinical studies.

Introduction Childhood obesity is a public health challenge. There is evidence for associations between parentsâ feeding behaviours and childhood obesity risk. Primary care provides a unique opportunity for delivery of infant feeding interventions for childhood obesity prevention. Implementation strategies are needed to support infant feeding intervention delivery. The Choosing Healthy Eating for Infant Health (CHErIsH) intervention is a complex infant feeding intervention delivered at infant vaccination visits, alongside a healthcare professional (HCP)-level implementation strategy to support delivery.Methods and analysis This protocol provides a description of a non-randomised feasibility study of an infant feeding intervention and implementation strategy, with an embedded process evaluation and economic evaluation. Intervention participants will be parents of infants aged â ¤6 weeks at recruitment, attending a participating HCP in a primary care practice. The intervention will be delivered at the infantâ s 2, 4, 6, 12 and 13â month vaccination visits and involves brief verbal infant feeding messages and additional resources, including a leaflet, magnet, infant bib and sign-posting to an information website. The implementation strategy encompasses a local opinion leader, HCP training delivered prior to intervention delivery, electronic delivery prompts and additional resources, including a training manual, poster and support from the research team. An embedded mixed-methods process evaluation will examine the acceptability and feasibility of the intervention, the implementation strategy and study processes including data collection. Qualitative interviews will explore parent and HCP experiences and perspectives of delivery and receipt of the intervention and implementation strategy. Self-report surveys will examine fidelity of delivery and receipt, and acceptability, suitability and comprehensiveness of the intervention, implementation strategy and study processes. Data from electronic delivery prompts will also be collected to examine implementation of the intervention. A costâ outcome description will be conducted to measure costs of the intervention and the implementation strategy.Ethics and dissemination This study received approval from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study findings will be disseminated via peer-reviewed publications and conference presentations. The authors would like to thank Charlotte Griffin, Lisa Delaney and Jennifer Cooney who worked as research assistants on this project. We would like to thank the staff at the Mallow Primary Healthcare Centre, in particular Ms Ruth Haugh, Mr Carl Beame and Mr Conor Healy. We would like to thank Dr Phil Jennings and Ms Anne Pardy from the HSE National Healthy Childhood Programme, and Ms Joanne O Halloran from the HSE for their assistance in development and refinement of the infant feeding messages. We would like to thank Holly McGrath for her graphic design work on the intervention materials. We would also like to thank all the attendees of the 2018 CHErIsH Steering Committee meeting for their feedback and input on the project. peer-reviewed

Attending college is a major milestone in the lives of students. The transition to college can be a challenging process for new students, particularly first-generation students, impacting their ability to meet the more rigorous academic demands and to integrate socially into the campus community (Prospero & Vohra-Gupta, 2007; RamosSanchez & Nichols, 2007). To ease the transition to college, peer mentoring programs can assist new college students by offering guidance, one-on-one and group sessions, providing information about campus life and resources, and referring them to support services (Ferrari, 2004; Lennox & Leonard, 2007). The project developers collaborated with Dominican University of California to create a peer mentoring program geared specifically for its first-generation student population called Bridging the Gap for First-Generation Students or BG4FGS. We used an occupational therapy lens to help these students succeed in college by addressing areas including academic performance, social participation, occupational balance, stress management, time management, and college finances. The first outcome of this project was the development of a peer mentor training manual. Mentors received their manuals during the training program in mid-August 2012. The second outcome was the creation of group modules that were implemented during one-hour monthly sessions with the mentors and mentees in September, October, and November 2012. Overall, the mentors reported that the training program and manuals were effective in helping them understand the objectives of BG4FGS and adequately prepare them for their roles. This project has demonstrated that occupational therapy plays a vital role in consultation and training to prepare peer mentors for implementing an effective peer mentoring program, in which first-generation students at Dominican University can benefit from.

Background: Patients with axial spondyloarthritis (axSpA) were trained to deliver experience-based workshops to medical students, general practitioners, physiotherapists and other healthcare providers concerning axSpA. The most important aims of these workshops are to improve the early diagnosis and to increase awareness of axSpA in the medical sector. Taking an expert role as a patient however requires an extensive training. Objectives: To describe the training program in detail and to illustrate both the less successful and the optimal implementation steps taken thus far. Methods: In its first iteration, the training program was developed as a resource book including a curriculum, significant amounts of homework, without enough time for practical exercises. This resulted in a drop-out of a large portion of trainees. Thereafter, the training method has been adapted by copying successful parts of the approach of The Patient Partner® Program for Rheumatoid Arthritis (launched in 1999). Also, more concrete training opportunities via a DVD demonstrating the complete course and training materials, as well as offering hands-on trainings during a three day overnight stay were added. Besides creating opportunities for intensive practicing with each other, there was also more time for informal contacts and it allowed for proper group dynamics. So there is a lot of time for sharing among patients with a similar health background. A comfortable environment was created for the candidates, enabling them to go through a complete process and giving them sufficient time to train all the components of the program. Results: On February 22nd 2018, five fresh SpA-patients started the training, all five of them successfully completed the training on June 2nd 2018. On a first evening of familiarization, trainers tried to know more about the motivation of the trainees, while in an individual interview a rheumatologist reassured that the candidates have the correct diagnosis, as their story should be consistent. The selected candidates received part 1 of the training manual by mail and they were invited to profoundly study the terminology and the anatomy, related to their disease. During the first full day of the training, the trainers took time to explain this terminology and anatomy. Later on this constituted the building blocks of the course. The trainers closed this first day demonstrating the history taking and they asked the trainees to study at home their personal medical file. On day 2, the homework of the previous day was first discussed, followed by related exercises. Day 2 finished with the demonstration of the clinical examination. The training program was completed with three days with overnight stay. During these days a lot of practical exercises of the clinical examination were organized, followed by a discussion of the impact of the disease and the importance of active participation. The program ended with a general rehearsal and a written as well as an oral test to evaluate how each trainee had assimilated all this. Conclusion: In the training program PPP SpA, the trainees learn to tell a uniform and academically correct story. This contains an accurate history taking and a correct clinical examination reinforced by the personal history of the Patient Partner. Moreover the whole process helps each Patient Partner to have a better insight in their own illness, a better capacity to cope and to develop more skills in the dialogue with medical practitioners. The experienced positive feedback of the trainees after every course is the best motivation to continue with this approach. Disclosure of Interests: None declared

Background Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children and is generally identified and diagnosed during the preschool years. Preschool learners with ADHD are at risk of developing emergent literacy difficulties, crucial for the development of reading and writing. Many teachers have insufficient training to identify and address barriers to learning, such as ADHD. Aim The aim of this article was to report on the process followed in the development of a specific support programme for Grade R teachers on ADHD and on the piloting of the programme. Method An adapted version of the intervention research model provided the structure and phases for the development, implementation and evaluation of the support programme. Current literature on ADHD training programmes, adult learning principles and Bronfenbrenners’ ecosystemic framework was explored to develop the programme, training material, manual and method of presentation (Phase 1). Workshops were presented to 65 Grade R teachers working in an urban and semi-rural context (Phase 2). Participants were made aware of the symptoms of ADHD, and early identification and management of specific barriers to learning, such as ADHD, in order to reduce the risk of educational complications. Participants provided feedback (Phase 3) on the training, training material and manner of presentation following the workshops. Results The results obtained in phases 1 and 2 of the adapted intervention research model included the compilation of the information presented in the workshops and the training manual, as well as the instructional phase and piloting of the programme. The results obtained for Phase 3 include a summary of the feedback provided by the Grade R teachers on how they experienced the training. Participants’ feedback confirmed that the programme was valued and that their training expectations were met. Conclusion The intervention research model provided a valuable structure for the development and piloting of a specific support programme. This study can be replicated, and may pave the way for future support programmes for teachers. Capacity building of teachers is of the utmost importance in raising education standards in South Africa. Keywords Attention deficit hyperactivity disorder; ADHD; emergent literacy; Grade R teachers; support programme; intervention research model; Bronfenbrenner.

IntroductionSelf-management interventions show promising results on symptom outcomes and self-management behaviours. The Symptom Navi© Programme (SN©P) is a nurse-led intervention supporting patients’ symptom self-management during anticancer treatment. It consists of written patient information (Symptom Navi© Flyers (SN©Flyers)), semistructured consultations and a training manual for nurses.Methods and analysisThis pilot study will evaluate the implementation of the SN©P based on the Reach Effectiveness—Adoption Implementation Maintenance framework at Swiss outpatient cancer centres. We will use a cluster-randomised design and randomise the nine participating centres to the intervention or usual care group. We expect to include 140 adult cancer patients receiving first-line systemic anticancer treatment. Trained nurses at the intervention clusters will provide at least two semistructured consultations with the involvement of SN©Flyers. Outcomes include patients’ accrual and retention rates, patient-reported interference of symptoms with daily functions, symptom burden, perceived self-efficacy, quality of nursing care, nurse-reported facilitators and barriers of adopting the programme, nurses’ fidelity of providing the intervention as intended, and patients’ safety (patients timely reporting of severe symptoms). We will use validated questionnaires for patient-reported outcomes, focus group interviews with nurses and individual interviews with oncologists. Linear mixed models will be used to analyse patient-reported outcomes. Focus group and individual interviews will be analysed by thematic analysis.Ethics and disseminationThe Symptom Navi© Pilot Study has been reviewed and approved by Swiss Ethic Committee Bern (KEK-BE: 2017–00020). Results of the study will be disseminated in peer-reviewed journal and at scientific conferences.Trial registration numberNCT03649984; Pre-results.

The FIGO Fistula Surgery Training Initiative has been developed to build the capacities of fistula surgeons in identified training centres using the Global Competency-Based Fistula Surgery Training Manual. Since the launch of the Training Manual in 2011, the project has evolved, and in the last 4 years, has expanded substantially. Coming from 19 fistula affected countries around the world, there are presently 57 trainee fistula surgeons (‘Fellows’) on the Programme, undergoing training placements in established training centres, as well as receiving coaching visits in their home facilities to progressively build their fistula skills and activities over time. While good progress has been made, FIGO recognises and is ready to address the challenges still facing the Programme, and the next exciting phase will include further expansion, with continued admission of Fellows and fistula care teams from selected, high-need countries, while moving towards programmatic consolidation, by further strengthening the skills and activities of Fellows already on the Programme, so that significantly more affected women have access to high quality, life changing fistula treatment.

AB Purpose: Knowing that motor skills will not develop to their full potential without opportunities to practice in environments that are stimulating and supportive, we evaluated the effect of a physical activity (PA)-based intervention targeting childcare providers on fundamental movement skills (FMS) in preschoolers attending childcare centers. Methods: In this two-arm cluster-randomized controlled trial, six licensed childcare centers in Ottawa, Canada, were randomly allocated into one of two groups (three controls, n = 43; three interventions, n = 40). Participants were between the ages of 3 and 5 yr. Childcare providers in the experimental condition received two 3-h workshops and a training manual at program initiation aimed at increasing PA through active play and several in-center "booster" sessions throughout the 6-month intervention. Control childcare centers implemented their standard curriculum. FMS were measured at baseline and 6 months using the Test of Gross Motor Development-2. Results: Groups did not differ on sociodemographic variables. Compared with control, children in the intervention group demonstrated significantly greater improvement in their standardized gross motor quotient (score, 5.70; 95% confidence interval [95% CI], 0.74-10.67; P = 0.025 and gross motor quotient percentile, 13.33; 95% CI, 2.17-24.49; P = 0.020). Over the 6-month study period, the intervention group showed a significantly greater increase in locomotor skills score (1.20; 95% CI, 0.18-2.22; P = 0.022) than the control group. There was a significant decrease in the object control scores in the control group over the study period. Conclusions: A childcare provider-led PA-based intervention increased the FMS in preschoolers, driven by the change in locomotor skills. The childcare environment may represent a viable public health approach for promoting motor skill development to support future engagement in PA.

Background: Established population based disease registry provides data on incidence, risk factors, determinants and trends of the disease. Population based rural stroke registry was started on a pilot basis with an objective to evaluate the feasibility of establishing population-based stroke registry in Chintamani taluk of Karnataka state, India. Training of health care personnel was undertaken to facilitate reporting of case. The objective of the present communication is to evaluate the training conducted for anganwadi workers by trained investigators in 2012. Methods: Training was conducted using a validated training manual. Among the existing 438 anganwadi workers in the taluk, 405 (92.4%) attended the training. Pre and post-test questionnaire was administered before and after the training session to assess the improvement in the knowledge of stroke. Results: Only 362 (89.38%) with both pre and post-test answered were included for analysis. Overall there was statistical significant improvement in knowledge of anganwadi workers on symptoms, risk factors and prevention of stroke. Regarding Knowledge on symptoms of Stroke, 85 (95.5%) who scored poor, 81 (98.8%) who scored average in pre-test improved to good in post test. It was observed that 94 (100%) and 120 (94.4%) of the workers who scored poor regarding knowledge on prevention and risk factors of stroke respectively improved to good in the post-test. Conclusions: This endeavor substantiates the fact that anganwadi workers can be trained to identify suspects.

Background: Antimicrobial resistance (AMR) is an increasingly critical global public health challenge. An initial step in prevention is the understanding of resistance patterns with accurate surveillance. To improve accurate surveillance and good clinical care, we developed training materials to improve the appropriate collection of clinical culture samples in Ethiopia. Methods: Specimen-collection training materials were initially developed by a team of infectious diseases physicians, a clinical microbiologist, and a monitoring and evaluation specialist using a training of trainers (ToT) platform. Revisions after each training session were provided by Ethiopian attendees including the addition of regional and culturally relevant material. The training format involved didactic presentations, interactive practice sessions with participants providing feedback and training to each other and the entire group as well as assessments of all training activities. Results: Overall, 4 rounds of training were conducted from August 2017 to September 2019. The first 2 rounds of training were conducted by The Ohio State University (OSU) staff, and Ethiopian trainers conducted the last 2 rounds. Initial training was primarily in lecture format outlining use of microbiology laboratory findings in clinical practice and steps for collecting specimens correctly. Appropriate specimen collection was demonstrated and practiced. Essential feedback from this early audience provided input for the final development of the training manual and visual aids. The ToT for master trainers took place in July 2018 and was conducted by OSU staff. In sessions held in February and August 2019, these master trainers provided training to facility trainers, who provide training to personnel directly responsible for specimen collection. In total, 144 healthcare personnel (including physicians, nurses, and laboratory staff), from 12 representative Ethiopian public and academic hospitals participated in the trainings. Participants were satisfied with the quality of the training (typically ranked >4.5 of 5.0) and strongly agreed that the objectives were clearly defined and that the information was relevant to their work. Posttraining scores increased by 23%. Conclusions: Training materials for clinical specimen collection have been developed for use in low- and middle-resource settings and with initial pilot testing and adoption in Ethiopia. The trainings were well accepted, and Ethiopian personnel were able to successfully lead the trainings and improve their knowledge and skills regarding specimen collection. The materials are being finalized in an online format for easier open access dissemination. Further studies are planned to determine the effectiveness of the trainings in improving the quality of clinical specimen submissions to the microbiology laboratory.Funding: NoneDisclosures: None

Introduction Prior to October 2017, our data management team was housed in a separate hospital department that operated from a different site on campus. This made it challenging for the two data managers to ask questions of BMT staff and providers, develop relationships, or understand the transplant process and its accreditation. Furthermore, because none of the leadership in the external department had BMT experience, the data managers were not properly trained, nor was their work sufficiently monitored and audited. To compound these problems, the BMT program was growing rapidly and increasing its transplant numbers by approximately 10-15% each year, thus increasing the CIBMTR reporting burden. These circumstances led to the failure of the 2017 CIBMTR audit, which prompted a complete restructuring of the data management team. Objective Establish an adequately staffed data management team with a team supervisor, implement formal data management training, develop an internal audit process, and collaborate with program leadership and the quality manager to ensure compliance with all CIBMTR requirements and FACT standards. Methods In response to the failed audit, the data managers transferred from the outside department to work directly in the BMT clinic and a data team supervisor was hired. The data supervisor collaborated with the program quality manager to develop a process for monthly internal data management audits. In addition, they created a formal training manual and competency checklist for the data manager role. The program now conducts extensive on-board training for data managers and ongoing weekly Q&A sessions to review results of internal audits, new/revised CIBMTR forms, or provide training, etc. To help with some of the more challenging CIBMTR fields, the team developed several physician worksheets, as well as a reference packet with response criteria and disease status guidelines from the CIBMTR Manual. Utilizing findings from CIBMTR and FACT, internal audits, and the results of CIBMTR's Best Practices Survey, the data supervisor and quality manager worked with the BMT medical director and nurse manager to request an additional data manager position. Working together, we successfully demonstrated the connection between CIBMTR compliance and FACT accreditation, including the potential negative impacts on our hospital if we did not appropriately staff and support our data management team. Results The changes we have made have led to consistently low error rates in internal data management audits. For the 6-month period from March 2019-August 2019, our cumulative critical field error rate was 1.79%, down from 5.3% in our 2017 CIBMTR audit. Conclusion Through a synergistic effort, the data supervisor and quality manager utilized the findings from our failed CIBMTR audit and its potential impact on FACT accreditation to expand and significantly improve our data management team.

Background: Laparoscopic inguinal hernia repair is considered technically difficult. Although a simulation-based curriculum has been developed to help trainees, access to simulation training outside North America is limited. This study aimed to develop an educational system for the transabdominal preperitoneal (TAPP) approach based on the TAPP checklist, an assessment tool we had developed and validated earlier. Material and methods: Consensus within the TAPP education working group consisting of local TAPP experts, hernia experts and a surgical educator to develop educational tools and the educational system based on the TAPP checklist. The system was piloted in several institutes, and participants were surveyed on its efficacy. Results: We systematically developed an educational video and training manual explaining each item of the TAPP checklist and conveying basic knowledge of the procedure. We integrated the training tool with evaluation and feedback to develop an educational system. In a pilot study, seven trainees at five hospitals were trained using this system and found it very useful for mastering the TAPP procedure. Conclusions: We have developed a training system for TAPP procedure and successfully implemented it in several hospitals. Further research will focus on the educational value of this tool.

The quality of education – including the vocational one – depends primarily on its content; and the paper describes the material selection process for designing the curriculum of the «Russian Language and Culture of Speech» course for the medical higher school, based on the theory of level development of educational content by V. V. Klayevsky and I. Y. Lerner. The relevance of the subject for prospective medical specialists is substantiated as it is well-known that this sort of professional activity is lingua-active. Therefore, the high level of linguistic and communicative competence is a necessary prerequisite of the doctor’s professionalism. The main emphasis is on the requirements of the third generation of federal state educational standards for higher vocational training regarding the content of the humanities subjects. The general cultural competences necessary for the graduates specialized in medical treatment and qualified as physicians and pediatricians are enumerated. It is indicated that the objectives, goals and content of the «Russian Language and Culture of Speech» course comply with the above standards. The essence of educational content concerning the curriculum, courseware, textbooks and training manuals is highlighted with the reference to the medical educational establishments. The author believes that the research results along with the printed and electronic educational resource, aimed at developing linguistic and communicative competence, can help prospective specialists in their future professional work.

Electronic portfolios can be used to record user performance and achievements. Currently, clinical learning systems and in-service education systems lack integration of nurses' clinical performance records with their education or training outcomes. For nurses with less than 2 years' work experience (nursing postgraduate year), use of an electronic portfolio is essential. This study aimed to assess the requirements of using electronic portfolios in continuing nursing education for clinical practices. Fifteen nurses were recruited using a qualitative purposive sampling approach between April 2013 and May 2013. After obtaining participants' consent, data were collected in a conference room of the study hospital by one-on-one semistructured in-depth interviews. Through data analyses, the following five main themes related to electronic learning portfolios were identified: instant access to in-service education information, computerized nursing postgraduate year training manual, diversity of system functions and interface designs, need for sufficient computers, and protection of personal documents. Because electronic portfolios are beginning to be used in clinical settings, a well-designed education information system not only can meet the needs of nurses but also can facilitate their learning progress.