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Exploring the development, evaluation and implementation of complex health interventions to prevent early childhood caries in preschool children: a scoping review protocol

Objective This scoping review aims to identify complex health interventions (CHI’s) to prevent early childhood caries (ECC), explore the level of complexity of the identified CHI’s, and explore the details of their development, evaluation, and implementation. Introduction Many interventions to prevent ECC have multiple interacting components and can be seen as CHI’s. Recent reviews on these interventions have found inconclusive effects, which may be due to differences in the development, evaluation, and implementation of CHI’s. Inclusion criteria This scoping review will consider clinical trials reporting CHI’s to prevent ECC that starts during pregnancy or in the first year of life. Studies in the English language will be included regardless of the country of origin, sociocultural setting, or context. Methods This review will follow the Joanna Briggs Institute methodology for scoping reviews. An initial search of PubMed identified keywords and Medical Subject Headings terms. A second search of PubMed, Embase, Clarivate Analytics/Web of Science Core Collection, ClinicalTrials.gov, and the Wiley/Cochrane Library will follow. Two independent reviewers will perform title and abstract screening, retrieve and review full-text studies, and extract data. The reference lists of all included sources will be screened for additional CHI’s or relevant publications about a specific CHI. Data charting will be utilised based on study characteristics and intervention complexity. A 39-item instrument will be used to explore the details in the description of the CHI’s development, evaluation, and implementation. The results will be presented in tables, visual outputs, and a narrative summary in response to the review questions. Discussion The proposed review will generate evidence which may provide a direction for the future design of studies on CHI’s to prevent ECC and more complete information for those who want to adopt successful interventions to prevent ECC.

Developing a patient decision aid for the treatment of women with early stage breast cancer

Background: A patient decision aid (PtDA) can support shared decision making (SDM) in preference-sensitive care, with more than one clinically applicable treatment option. The development of a PtDA is a complex process, involving several steps, such as designing, developing and testing the draft with all the stakeholders, known as alpha testing. This is followed by testing in ‘real life’ situations, known as beta testing, and then finalising the definite version. Our aim was developing and alpha testing a PtDA for primary treatment of early stage breast cancer, ensuring that the tool is considered relevant, valid and feasible by patients and professionals. Methods: Our qualitative descriptive study applied various methods including face-to-face think-aloud interviews, a focus group and semi-structured telephone interviews. The study population consisted of breast cancer patients facing the choice between breast-conserving therapy with or without preceding neo-adjuvant chemotherapy and mastectomy, and professionals involved in breast cancer care in dedicated multidisciplinary breast cancer teams. Results: A PtDA was developed in four iterative test rounds, taking nearly 2 years, involving 26 patients and 26 professionals. While the research group initially opted for simplicity for the sake of implementation, the clinicians objected that the complexity of the decision could not be ignored. Other topics of concern were the conflicting views of professionals and patients regarding side effects, the amount of information and how to present it. Conclusion: The development was an extensive process, because the professionals rejected the simplifications proposed by the research group. This resulted in the development of a completely new draft PtDA, which took double the expected time and resources. The final version of the PtDA appeared to be well-appreciated by professionals and patients, although its acceptability will only be proven in actual practice (beta testing)

The perceived quality of video consultations in geriatric outpatient care by early adopters

PURPOSE: The COVID-19 pandemic caused rapid implementation and upscaling of video consulting. This study examined the perceived quality of care delivered through video consulting at a geriatric outpatient clinic, and how this related to adoption issues and barriers early adopting professionals found themselves confronted with.METHODS: We performed a qualitative study using semi-structured interviews with healthcare professionals complemented by the views of geriatric patients, family caregivers and medical secretaries. Participants from five academic centers and six teaching hospitals were included. Three researchers conducted the interviews, coded the data, and used thematic analysis.RESULTS: Interviews were conducted with 13 healthcare professionals, 8 patients, 7 family caregivers, and 4 medical secretaries. From these early adopters, we infer five criteria positively contributing to perceived quality of care provided by video consulting: (1) the patient has an intact cognitive function; (2) a family caregiver with digital literacy can be present; (3) doctor and patient already have an established relationship; (4) no immediate need for physical examination or intervention; and (5) the prior availability of a comprehensive and concise medical history. Overall, the uptake of video consulting in geriatric outpatient care appeared to be slow and laborious due to several implementation barriers.CONCLUSION: The implementation of video consulting use among geriatricians and geriatric patients at the geriatric outpatient clinic was slow due to the absence of many facilitating factors, but video consulting might be offered as an alternative to face-to-face follow-up to suitable patients in geriatric outpatient clinics.

Een onderzoek naar het afwegingskader van early adopters in de keuze voor EVV

De pionier als bruggenbouwer

In processen van onderwijsvernieuwing met ict lopen de pioniers vaak zo ver voor de troepen uit dat collega’s afhaken. Nieuwe toepassingen sneuvelen dan al op de tekentafel. Het is deze klassieke ict-kloof die schoolbrede vernieuwing in de weg staat. Pioniers die er echter in slagen die kloof te overbruggen oogsten wél succes. Want wie het verloop van geslaagde schoolbrede innovatieprocessen bestudeert, vindt aan de basis ervan vaak een pionier

Early detection of extremism? The local security professional on assessment of potential threats posed by youth

Frontline professionals such as social workers and civil servants play a crucial role in countering violent extremism.Because of their direct contac twith society,first liners are tasked with detecting individuals that may threaten national security and the democratic rule of law. Preliminary screening takes place during the pre-crime phase. However, without clear evidence or concrete indicators of unlawful action or physical violence, it is challenging to determine when someone poses a threat. There are no set patterns that can be used to identify cognitive radicalization processes that will result in violent extremism. Furthermore, prevention targets ideas and ideologies with no clear framework for assessing terrorism-risk. This article examines how civil servants responsible for public order, security and safety deal with their mandate to engage in early detection, and discusses the side effects that accompany this practice. Based on openinterviews with fifteen local security professionals in the Netherlands, we focus here on the risk assessments made by these professionals. To understand their performance, we used the following two research questions: First, what criteria do local security professionals use to determine whether or not someone forms a potential risk? Second, how do local security professionals substantiate their assessments of the radicalization processes that will develop into violent extremism? We conclude that such initial risk weightings rely strongly on ‘gut feelings’ or intuition. We conclude that this subjectivitymayleadto prejudiceand/oradministrativearbitrariness in relationtopreliminary risk assessment of particular youth.