Weaving Evidence into Action for Veterans with Dementia (WEAVE): Evaluation of implementation into long-term care practice.

RATIONALE: Veterans living with dementia in long-term care have complex needs, with variable manifestation of symptoms of dementia that interact with their lived experience. Best practice dementia care prioritises nonpharmacological interventions; of which few have strong evidence. Implementation of evidence is complex, with evaluation of outcomes and processes necessary. AIMS AND OBJECTIVES: This paper details the evaluation of implementation, at veteran and organisational level, of the Weaving Evidence into Action for Veterans with Dementia (WEAVE) programme. METHODS: A Type 2 hybrid effectiveness-implementation design was used, underpinned by the Implementation Framework for Aged Care (IFAC). Programme intervention incorporated music therapy, exercise, reminiscence therapy and/or sensory modulation, offered over a 24-week period. Evaluation components included: (1) programme effectiveness for veterans with dementia for responsive behaviour, physical wellbeing, cognitive status, emotional state, medications and falls (at baseline, 8-week, 16-week and 24-week); and (2) implementation outcomes of reach and adoption, feasibility and acceptability, fidelity (via interviews) and a preliminary cost analysis. RESULTS: Thirty-eight veterans participated in the 24-week programme, with high levels of engagement in interventions of their choice. Statistically significant improvements were seen across all veteran-level outcome measures, for functional capacity and reduced neuro-psychiatric and depressive symptoms. Ten staff members were interviewed, highlighting co-designed core elements were feasible and acceptable, and the momentum generated by resident and staff enthusiasm. Cost analysis included costs of programme set-up and running the 24-week intervention. CONCLUSION: Key components of programme success were the therapeutic leaders, adherence to core elements of programme design, and veterans' choice in meaningful activity. Cost analysis supports deliberations for upscale across further care homes.

Evaluating childsmile, Scotland's National Oral Health Improvement Programme for children.

In the early 2000s, a Scottish Government Oral Health Action Plan identified the need for a national programme to improve child oral health and reduce inequalities. 'Childsmile' aimed to improve child oral health in Scotland, reduce inequalities in outcomes and access to dental services, and to shift the balance of care from treatment to prevention through targeted and universal components in dental practice, community and educational settings. This paper describes how an embedded, theory-based research and evaluation arm with multi-disciplinary input helps determine priorities and provides important strategic direction. Programme theory is articulated in dedicated, dynamic logic models, and evaluation themes are as follows: population-level data linkage; trials and economic evaluations; investigations drawing from behavioural and implementation science; evidence reviews and updates; and applications of systems science. There is also a growing knowledge sharing network internationally. Collaborative working from all stakeholders is necessary to maintain gains and to address areas that may not be working as well, and never more so with the major disruptions to the programme from the COVID-19 pandemic and response. Conclusions are that evaluation and research are synergistic with a complex, dynamic programme like Childsmile. The evidence obtained allows for appraisal of the relative strengths of component interventions and the reach and impact of Childsmile to feed into national policy.

Assessing the impacts of COVID-19 vaccination programme's timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries.

BACKGROUND: The COVID-19 vaccine supply shortage in 2021 constrained roll-out efforts in Africa while populations experienced waves of epidemics. As supply improves, a key question is whether vaccination remains an impactful and cost-effective strategy given changes in the timing of implementation. METHODS: We assessed the impact of vaccination programme timing using an epidemiological and economic model. We fitted an age-specific dynamic transmission model to reported COVID-19 deaths in 27 African countries to approximate existing immunity resulting from infection before substantial vaccine roll-out. We then projected health outcomes (from symptomatic cases to overall disability-adjusted life years (DALYs) averted) for different programme start dates (01 January to 01 December 2021, n = 12) and roll-out rates (slow, medium, fast; 275, 826, and 2066 doses/million population-day, respectively) for viral vector and mRNA vaccines by the end of 2022. Roll-out rates used were derived from observed uptake trajectories in this region. Vaccination programmes were assumed to prioritise those above 60 years before other adults. We collected data on vaccine delivery costs, calculated incremental cost-effectiveness ratios (ICERs) compared to no vaccine use, and compared these ICERs to GDP per capita. We additionally calculated a relative affordability measure of vaccination programmes to assess potential nonmarginal budget impacts. RESULTS: Vaccination programmes with early start dates yielded the most health benefits and lowest ICERs compared to those with late starts. While producing the most health benefits, fast vaccine roll-out did not always result in the lowest ICERs. The highest marginal effectiveness within vaccination programmes was found among older adults. High country income groups, high proportions of populations over 60 years or non-susceptible at the start of vaccination programmes are associated with low ICERs relative to GDP per capita. Most vaccination programmes with small ICERs relative to GDP per capita were also relatively affordable. CONCLUSION: Although ICERs increased significantly as vaccination programmes were delayed, programmes starting late in 2021 may still generate low ICERs and manageable affordability measures. Looking forward, lower vaccine purchasing costs and vaccines with improved efficacies can help increase the economic value of COVID-19 vaccination programmes.

Preparing the Leaders of Tomorrow: Learnings from a Two-Year Community of Practice in Fragility Fractures.

To facilitate the development of leadership competencies in a multidisciplinary group of 18 emerging bone experts from 6 European Countries and Brazil, to face future scenarios in the evolving field of fragility fractures, and to support secondary fracture prevention and improve patient outcomes. Changes brought by the COVID-19 pandemic have further highlighted this need. A 2.5-year community of practice (CoP) programme was established with two senior bone experts acting as mentors. The content was adapted during the COVID-19 pandemic. The education impact of the programme was assessed using an ethics-approved mixed-method design consisting of multiple sources of qualitative and quantitative data collected longitudinally. Quantitative data were analysed descriptively. Qualitative data underwent a thematic analysis. After participating in the programme, participants reported increased interprofessional collaboration and communication skills, better understanding of health economics and negotiation, application of adult learning principles to their work setting, development of competencies to critically appraise guidelines, enhanced abilities to facilitate behaviour change in others, and improved confidence leading their team through crisis situations. Although time was required for some physicians to get accustomed to the CoP concept and develop trust with other members, it was described as a beneficial real-world learning experience. An educational real-world CoP programme was effective in enhancing leadership competencies among future leaders in the bone field to improve care of fragility fracture patients. The results presented could guide the development of other CoPs in fragility fracture care as leadership competencies are increasingly required in that field.

E-Learning Courses Evaluation on the Basis of Trainees’ Feedback on Open Questions Text Analysis

Life-long learning is a necessity associated with the requirements of the fourth industrial revolution. Although distance online education played a major role in the evolution of the modern education system, this share grew dramatically because of the COVID-19 pandemic outbreak and the social distancing measures that were imposed. However, the quick and extensive adoption of online learning tools also highlighted the multidimensional weaknesses of online education and the needs that arise when considering such practices. To this end, the ease of collecting digital data, as well as the overall evolution of data analytics, enables researchers, and by extension educators, to systematically evaluate the pros and cons of such systems. For instance, advanced data mining methods can be used to find potential areas of concern or to confirm elements of excellence. In this work, we used text analysis methods on data that have emerged from participants’ feedback in online lifelong learning programmes for professional development. We analysed 1890 Greek text-based answers of participants to open evaluation questions using standard text analysis processes. We finally produced 7-gram tokens from the words in the texts, from which we constructed meaningful sentences and characterized them as positive or negative. We introduced a new metric, called acceptance grade, to quantitatively evaluate them as far as their positive or negative content for the online courses is concerned. We finally based our evaluation on the top 10 sentences of each category (positive, negative). Validation of the results via two external experts and data triangulation showed an accuracy of 80%. © 2022 by the authors.

Response of fish farmers to aquaculture development program in Segodorejo, Sumobito, Jombang

Segodorejo Village located in Sumobito Subdistric, Jombang Regency, East Java Province. This village is affected by the COVID 19 Pandemic. The economy is experiencing a process of sluggishness as a result of the pandemic. The "doctor serves" program is done to overcome the problems of youth efforts in fishery cultivation. The research aims to analyze the effectiveness and success of the activities of the serving doctor who has been carried out. The research design using survey methods with questionnaire instruments. The data obtained were analyzed descriptively in the form of characteristics of fish farmers to the program. The results showed some aspects of fish farmers observed to be obtained, namely: most are classified as productive age, education is relatively low and moderate with the average education in vocational/high school, the main job is private, on average has run a business with a length of business time between 5-14 months, and most cultivators have two ponds. Furthermore, the cultivator's response to the program was influenced by age, education, occupation, length of effort, time and respondent's number of pools. This study concludes that the activities of the "Doctor of Service" program are responded to well and associated with increased business and economy.