Mixed-methods evaluation of family medicine research training and peer mentorship in Lesotho

Background: Strengthening primary care research capacity is a priority globally. Family medicine training programmes in sub-Saharan Africa represent an important opportunity to build primary care research; however, they are often limited by insufficient research training and mentorship. Peers can be used to extend research mentorship capacity, but have not been evaluated in this context. Aim: The aim of this study was to evaluate one family medicine training programme's research capacity building efforts through a blended research curriculum and peer mentorship. Setting: Lesotho is a landlocked country within South Africa of approximately two million people. The Family Medicine Specialty Training Programme (FMSTP) is the only accredited postgraduate medical education programme in Lesotho. Methods: This two-year mixed-methods evaluation used: (1) Likert-scale surveys measuring trainee research confidence, (2) written evaluations by trainees, peers, programme faculty and administrators and (3) in-depth, semi-structured interviews. Survey data were analysed using Friedman and sign tests. Interview and written data were analysed thematically via a mixed inductive-deductive approach using Cooke's framework. Results: Family Medicine Specialty Training Programme trainees (n = 8) experienced moderate increases in research confidence that were statistically significant. Skill-building occurred primarily via experiential learning. Research was grounded in trainees' clinical practice and locally relevant. A positive research culture was created, promising for sustainability. We identified infrastructure gaps, including funding and protected time. Peer research mentorship supported trainees' motivation and provided a safe space for questions. Conclusion: The FMSTP research curriculum and peer mentorship programme were successful in positively impacting a number of Cooke's research capacity domains. This evaluation identified improvements that are now being implemented

A Placebo-controlled Trial of Folate with B12 in Patients with Schizophrenia with Residual Symptoms in Ethiopia Using a Sequential Parallel Comparison Design.

Background: Approximately 30% of patients with schizophrenia suffer from treatmentresistant psychotic symptoms, which can produce substantial distress, result in hospitalization and disrupt school or work functioning. Studies have found low blood folate concentrations in psychiatric populations and recent reports have consistently linked schizophrenia to low folate levels. We aim to examine the efficacy of a four-month trial of folate with B12 supplementation for reducing symptoms of schizophrenia. Methods: This study is a randomized, sequential parallel comparison design (SPCD) for double-blind phase fixed dose, 4-month trial of folate plus B12 as add-on therapy to reduce symptoms of schizophrenia. Participants will be adults (ages 18 to 65 years) diagnosed with schizophrenia, any subtype, who are psychiatrically and medically stable, but have residual positive or negative symptoms of moderate or greater intensity, despite antipsychotic treatment. The study is divided into 2 double-blind phases of 56 days each. Two hundred total participants will be randomized to adjunctive treatment with either folate with vitamin B12 (n=50) or placebo (n=150), with a 2:3:3 ratio for random assignment to the treatment sequences drug/drug (DD; n=50), placebo/placebo (PP; n=75), and placebo/drug (PD; n=75), while all continue to receive their current antipsychotic agent for the duration of the study. Diagnosis will be established using the Structured Clinical Interview for DSM-IV for clinical trials (SCID-CT). The primary outcome measure will be change in symptom severity measured by the change from baseline in Positive and Negative Syndrome Scale (PANSS) total score. Secondary outcome measures will include change in severity of psychotic symptoms as measured by the PANSS psychosis subscale score; and change in severity of negative symptoms as measured by the modified Scale for Assessment of Negative Symptoms (SANS) total score. Key assessments for primary and secondary outcomes will be conducted at baseline, week 8, and week 16. Trial Registration: Clinicaltrials.gov identifier: NCT01724476.