Medication Gaps and Antipsychotic Polypharmacy in Previously Hospitalized Schizophrenia Patients: An Electronic Cohort Study in Three Canadian Provinces.

Background: Real world evidence about antipsychotics focuses on rehospitalization. Modeling the time course of pharmacotherapy would show patients' adherence to medications and physicians' adherence to medication guidelines. We aimed to calculate the cumulative time spent in second generation antipsychotics (SGAs), gaps, antipsychotic polypharmacy, and clozapine in discharged schizophrenia patients. Methods: Hospitalization and pharmacy dispensing data from 2008-2018 in Manitoba, Saskatchewan, and British Columbia were linked and an electronic cohort (N = 2,997) was created (mean follow-up: 49 months, SD = 38). Cohort members were required to have a minimum of 6 weeks medicated with aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, or ziprasidone. Results: The multistate model predicted that schizophrenia patients accumulated 44 months in SGA monotherapy, 4 months in polypharmacy, 11 months in medication gaps and 17 days in clozapine over a 5-year period. The majority of transitions were between SGA and medication gap. Accumulated time in medication gaps was seven times as much as in clozapine. Each 10% delay in SGA initiation post-discharge was associated with a 2, 1, and 6% higher risk for polypharmacy (95% CI: 1.01-1.02), gap (95% CI: 1.01-1.01), and clozapine (95% CI: 1.04-1.08), respectively. Interpretation: Schizophrenia patients accumulated more time unmedicated and in polypharmacy compared to clozapine. Either treatment guidelines for schizophrenia are not followed, or real-world challenges hamper their implementation.

Improving preparation for scalp cooling: Learning from women undergoing chemotherapy for early-stage breast cancer-The COOL study.

AIMS AND OBJECTIVES: This study set out to understand the experiences and expectations of scalp cooling among women with early-stage breast cancer. The objective was to develop patient co-produced information resources to better inform and prepare women considering scalp cooling during chemotherapy. BACKGROUND: Treatment-induced alopecia is a common concern among women preparing for chemotherapy. Evidence indicates that many women feel inadequately prepared for scalp cooling, resulting in potentially mitigable distress and disappointment. DESIGN: A single-site, sequential, explanatory mixed-methods design was used. Participants included women with early-stage breast cancer who had previously or were currently using, scalp cooling. Women completed an online survey exploring scalp cooling experiences and expectations and self-selecting participants took part in one semi-structured, audio-recorded interview. Guidelines for Good Reporting of a Mixed Methods Study were followed. RESULTS: Forty-nine women (69%) consented to take part in the survey and 23 took part in an interview. Most women described losing more hair than they expected. Many described feeling inadequately prepared for the discomfort of scalp cooling; the additional time needed to accommodate scalp cooling during treatment and, that they lacked information about self- care to help minimise hair loss. Importantly, several participants described variability in nurses' knowledge and practical skills regarding scalp cooling. CONCLUSIONS: To optimise experience of scalp cooling, women need comprehensive preparatory information about variability in efficacy of scalp cooling; time needed to accommodate scalp cooling; hair care during treatment, and the potential discomfort associated with it. They also need nurses to be confident and well informed about scalp cooling processes. RELEVANCE TO CLINICAL PRACTICE: Our study led to the development of online, patient co-produced resources to help prepare and inform women considering using scalp cooling; and an online scalp cooling training module and checklist for nurses. Links to the resources are included in the manuscript.

"It's Embedded in What We Do for Every Child": A Qualitative Exploration of Early Childhood Educators' Perspectives on Supporting Children's Social and Emotional Learning.

Early childhood educators play an important role in supporting children's social and emotional development. While a growing body of research has examined the impact of curriculum-based social and emotional learning (SEL) programs on child outcomes, the approaches educators use to strengthen children's social and emotional functioning through their everyday practices are less defined. This study explored Australian early childhood educators' perspectives on children's social and emotional development, the approaches educators use to encourage children's social and emotional skills, the enablers and barriers to SEL within the preschool environment, and the additional support needed. Thirty Early Childhood Education and Care professionals participated in semi-structured interviews and focus group discussions. Findings suggest children's social-emotional development is at the forefront of educator planning, practice, and reflection. Participants described utilising various approaches to support children's social and emotional skills, embedded within interactions and relationships with children and families. Specifically, strategies could be grouped into four broad categories: a nurturing and responsive educator-child relationship; supporting SEL through everyday interactions and practice; utilising the physical environment to encourage SEL; and working in partnership with caregivers. There was, however, inconsistency in the variety and type of approaches identified. Time constraints, group size, educator confidence and capability, high staff turnover, and limited guidance regarding high-quality social and emotional pedagogy were identified as key barriers. Participants sought practical strategies that could be embedded into daily practice to build upon current knowledge.

Do Curriculum-Based Social and Emotional Learning Programs in Early Childhood Education and Care Strengthen Teacher Outcomes? A Systematic Literature Review.

There is growing awareness of the benefits of curriculum-based social and emotional learning (SEL) programs in Early Childhood Education and Care settings for children's social, emotional, and cognitive development. While many SEL programs aim to strengthen teachers' capacity and capability to foster children's social and emotional skills, research effort has focused on understanding the impact on child outcomes, with less emphasis on improvement in teaching quality. This systematic literature review examined the effectiveness of universal curriculum-based SEL programs on teacher outcomes. Fifteen studies met inclusion criteria, capturing ten distinct SEL interventions. The findings suggest SEL programs may strengthen teaching quality, particularly the provision of responsive and nurturing teacher-child interactions and effective classroom management. Data were insufficient to ascertain whether participation improved teachers' knowledge, self-efficacy, or social-emotional wellbeing. The potential pathways between SEL intervention, teaching quality and children's developmental outcomes are discussed.

Integrating Health and Educational Perspectives to Promote Preschoolers' Social and Emotional Learning: Development of a Multi-Faceted Program Using an Intervention Mapping Approach.

High-quality early childhood education and care (ECEC) can strengthen the social and emotional skills that are crucial for children's ongoing development. With research highlighting an increasing prevalence of emotional and behavioural challenges in young children, there is emphasis on embedding teaching practices and pedagogies to support social and emotional skills within early learning programs. A growing body of research has examined the impact of social and emotional learning programs in ECEC; however, few studies describe the intervention development process, or how educators and other professionals were engaged to increase the relevance and feasibility of the program. The current paper describes the development of the Cheshire Social-Emotional Engagement and Development (SEED) Educational Program, an online learning tool to support early childhood educators to foster children's positive mental health. Cheshire SEED was designed using five steps of the Intervention Mapping methodology: (i) comprehensive needs assessment to create a logic model of the problem; (ii) creation of program outcomes and change objectives mapped against determinants of educator behaviour; (iii) co-design of theory-based methods and practical strategies; (iv) program development; and (v) adoption and implementation planning. The process and decisions at each step of the IM protocol are presented, and the strengths and limitations of the approach to develop a mental health intervention for ECEC settings are discussed.

Using an iPad for Basic Communication Between Spanish-Speaking Families and Nurses in Pediatric Acute Care: A Feasibility Pilot Study.

The growing number of Spanish speakers in the United States poses communication challenges for healthcare providers. Language barriers in pediatric acute care have been associated with an increased risk for adverse events, longer hospital stays, and decreased quality of care. In addition, clinicians' usage of interpreter services is inconsistent. In fact, nurses often lack interpreter support during daily bedside care. Nursing staff at a pediatric children's hospital in the southeastern United States identified bedside communication with Spanish-speaking patients and families as a clinical challenge. To address this challenge, a basic communication interface, UTalk version 1.0 (the author is the owner and proprietor), supported by an Apple iPad, was developed by the researcher with input from nursing staff, a certified medical interpreter, and Spanish-speaking community members. A feasibility pilot study of the interface's usability and engagement was conducted on the hospital's pediatric medical-surgical unit through qualitative interviews with nurse-family dyads. Three themes emerged from the data: UTalk-facilitated communication, UTalk needs improvement, and interpreter miscommunication. These findings indicate that a mobile digital device interface is a feasible method for augmenting bedside communication with Spanish-speaking patients and families. These results also may serve as a reference for the development of similar mobile device interfaces. Further research with a larger sample size is needed.