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The impact of trauma on the development and educational performance of school children and the benefits of trauma-informed practices have become more evident to both scientists and educators. Creating an effective and sustainable trauma-informed approach in schools, however, proves to be a challenging, time-consuming and complex process. This scoping review examined facilitators and barriers in the implementation of school-wide trauma-informed approaches and school-based trauma-specific interventions by carrying out a thematic analysis and framework synthesis based on 57 sources. The NIRN implementation drivers framework was used to guide the discussion of the findings. Five main themes were established: professional development (competency driver), implementation planning (organizational driver), leadership support, engaging stakeholders (leadership driver) and buy-in. A synthesis of these five themes helps guide the implementation process of trauma-informed approaches in schools. Findings of this review stress the need for identification and concrete operationalization of key elements and activities of trauma-informed educational approaches. Related to this, more empirical research is needed on how and to what extent implementation factors affect implementation success and effectiveness of trauma-informed educational approaches, taking into account implementation fidelity.

Study Question: What are healthcare professionals' barriers and strategies for improvement in female oncofertility care?Summary Answer: Professionals perceived barriers in knowledge, attitude and organization of oncofertility care and suggested strategies to improve oncofertility care.What Is Known Already: The potential loss of fertility is one of the most important undesirable side effects of cancer treatment in women of reproductive age. Unfortunately, despite guideline recommendations, not all patients are informed about their fertility risks and referred for fertility preservation (FP) counselling. Insight into barriers for discussing FP and appropriate referral is necessary before improvements can be made.Study Design, Size, Duration: The aim of this was study was to identify barriers and gather improvement suggestions through semi-structured in-depth interviews conducted with 24 professionals working in oncofertility care. Subsequently, an expert panel meeting was held to reach consensus on a set of improvement strategies.Participants/materials, Setting, Methods: Oncological professionals were recruited from the three Dutch expertise hospitals for female FP and their affiliated hospitals. The expert panel consisted of six healthcare professionals, five survivors and two researchers. In the Dutch setting, financial aspects do not play a role in oncofertility care.Main Results and the Role Of Chance: Barriers were identified and categorized into the patient level (e.g. focus on surviving cancer), the professional level (e.g. lack of awareness, knowledge, time, and attitude), or the organizational level (e.g. unavailable written information, disagreement on who is responsible for discussing infertility risks). The expert panel reached consensus on essential elements for a multifaceted improvement programme: development of information materials (leaflets, online decision aid), education of professionals, a role for specialized oncology nurses in informing patients and patient navigators at the fertility department to facilitate referral and counselling, medical record reminders, standard consultations with a gynaecologist and agreement on responsibility.Limitations, Reasons For Caution: Selection bias could have occurred because it is likely that only professionals with interest in oncofertility care participated. However, this would mean that the barriers were underestimated.Wider Implications Of the Findings: This study forms the basis for the development of a multifaceted oncofertility programme, which is essential to increase adherence to the national clinical guideline.Study Funding/competing Interest(s): This work was supported by the Radboud university medical center. The authors have declared no competing interests. Prof. Dr Braat reports unrestricted grants from Ferring BV, Serono and Goodlife, outside the submitted work.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Study Question: Are the guidelines for the technical aspects of IUI (WHO, 2010) still in accordance with the current literature?Summary Answer: In general, the laboratory guidelines of the World Health Organization (WHO) are a suitable protocol, although the evidence is not always conclusive and some changes are advisable.What Is Known Already: Lack of standardization of the technical procedures required for IUI might result in inter-laboratory variation in pregnancy rates. Most centers still use their own materials and methods even though some guidelines are available.Study Design, Size, Duration: A structural review focusing on the association between pregnancy rates and the procedures of semen collection (e.g. ejaculatory abstinence, collection place), semen processing (e.g. preparation method, temperature during centrifugation/storage), insemination (e.g. timing of IUI, bed rest after IUI) and the equipment used.Participants/materials, Setting, Methods: A literature search was performed in Medline and the Cochrane library. When no adequate studies of the impact of a parameter on pregnancy results were found, its association with sperm parameters was reviewed.Main Results and the Role Of Chance: For most variables, the literature review revealed a low level of evidence, a limited number of studies and/or an inadequate outcome measure. Moreover, the comparison of procedures (i.e. semen preparation technique, time interval between semen, collection, processing and IUI) revealed no consensus about their results. It was not possible to develop an evidence-based, optimal IUI treatment protocol.Limitations, Reasons For Caution: The included studies exhibited a lack of standardization in inclusion criteria and methods used.Wider Implications Of the Findings: This review emphasizes the need for more knowledge about and standardization of assisted reproduction technologies. Our literature search indicates that some of the recommendations in the laboratory guidelines could be adapted to improve standardization, comfort, quality control and to cut costs.Study Funding/competing Interest(s): The Dutch Foundation for Quality Assessment in Medical Laboratories (SKML), Nijmegen, The Netherlands. S.K. and W.N. have no conflicts of interest to disclose. C.B. and A.W. are members of the board of the SKML. With a grant from SKML, L.L. was paid for her time to perform the research and write the publication. D.B. received grants from Merck Serono, Ferring and MSD, outside the submitted work.Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Study Question: What is the effectiveness of a multifaceted implementation strategy compared to usual care on improving the adherence to guideline recommendations on expectant management for couples with unexplained infertility?Summary Answer: The multifaceted implementation strategy did not significantly increase adherence to guideline recommendations on expectant management compared to care as usual.What Is Known Already: Intrauterine insemination (IUI) with or without ovarian hyperstimulation has no beneficial effect compared to no treatment for 6 months after the fertility work-up for couples with unexplained infertility and a good prognosis of natural conception. Therefore, various professionals and policy makers have advocated the use of prognostic profiles and expectant management in guideline recommendations.Study Design, Size, Duration: A cluster randomized controlled trial in 25 clinics in the Netherlands was conducted between March 2013 and May 2014. Clinics were randomized between the implementation strategy (intervention, n = 13) and care as usual (control, n = 12). The effect of the implementation strategy was evaluated by comparing baseline and effect measurement data. Data collection was retrospective and obtained from medical record research and a patient questionnaire.Participants/materials, Setting, Methods: A total of 544 couples were included at baseline and 485 at the effect measurement (247 intervention group/238 control group).Main Results and the Role Of Chance: Guideline adherence increased from 49 to 69% (OR 2.66; 95% CI 1.45-4.89) in the intervention group, and from 49 to 61% (OR 2.03; 95% CI 1.38-3.00) in the control group. Multilevel analysis with case-mix adjustment showed that the difference of 8% was not statistically significant (OR 1.31; 95% CI 0.67-2.59). The ongoing pregnancy rate within six months after fertility work-up did not significantly differ between intervention and control group (25% versus 27%: OR 0.72; 95% CI 0.40-1.27).Limitations Reasons For Caution: There is a possible selection bias, couples included in the study had a higher socio-economic status than non-responders. How this affects guideline adherence is unclear. Furthermore, when powering for this study we did not take into account the unexpected improvement of adherence in the control group.Wider Implications Of the Findings: Generalization of our results to other countries with recommendations on expectant management might be questionable because barriers for expectant management can be very different in other countries. Furthermore, due to a large variation in improved adherence rate in the intervention group it will be interesting to further analyse the process of implementation in each clinic with a process evaluation on professionals and couples' exposure to and experiences with the strategy.Study Funding/competing Interest(s): Supported by Netherlands Organisation for Health Research and Development (ZonMW, project number 171203005). No competing interests.Trial Registration Number: Dutch trial Register, www.trialregister.nl NTR3405.Trial Registration Date: 19 April 2012.Date Of First Patient's Enrolment: 10 July 2012. [ABSTRACT FROM AUTHOR]

Study Question: What is the current guideline adherence by general practitioners (GPs) for work-up and subsequent referral from primary to secondary care for patients suffering from infertility?Summary Answer: Guideline adherence by GPs concerning infertility was 9.2% in couples referred.What Is Known Already: Adherence to recommendations can decrease unnecessary referral, diagnostics and treatments, and consequently result in lower expenditures. Moreover, patients can be saved from unnecessary hospital visits, emotional burden and out of pocket costs.Study Design, Size, and Duration: A retrospective cohort study among 306 patients referred for basic fertility work-up between January 2011 and June 2013 from primary care to a secondary care teaching hospital or a tertiary hospital with IVF facilities.Participants/materials, Setting and Methods: Couples were eligible to participate when there was no previous referral for fertility problems and the duration of the child wish was <2 years. Data to assess guideline adherence were collected from the referral letter and the medical records. A patient questionnaire was used to determine patients' general and fertility-related characteristics.Main Results and the Role Of Chance: The GP performed a Chlamydia Antibody Titre (CAT) testing and semen analysis as recommended in 15.9% and 42.2% of the referred patients, respectively. According to the guideline, 39% of the couples were under referred (i.e. not immediately referred as recommended), 8.8% were unnecessarily referred and the CAT and semen analysis were unnecessarily repeated in secondary care in 80.0% and 57.1% of cases, respectively.Limitations Reasons For Caution: We could not include non-referred patients with expectant management in primary care, an unknown number of whom became pregnant in this period. This may have resulted in an underestimation of primary care performance.Wider Implications Of the Findings: Our findings show that guideline adherence concerning work-up and subsequent referral for fertility problems is low. The influence of patient demands for referral remains largely unknown. Barriers and facilitators for guideline adherence should be determined to develop interventions to improve guideline adherence in the areas of work-up and referral for fertility care and to diminish duplicate tests in secondary care.Study Funding/competing Interest(s): Funded by CZ, a Dutch healthcare insurer (grant number AFVV 11-232). CZ had no role in designing the study, data collection, analysis and interpretation of data or writing of the report. Competing interests: None.Trial Registration Number: Not applicable. [ABSTRACT FROM AUTHOR]