Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial.

BACKGROUND: The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. METHODS: Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. RESULTS: The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3-7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1-6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1-6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9-5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2-9.4). CONCLUSIONS: ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. CLINICAL TRIAL REGISTRATION: ClinicalTrials gov NCT03853824.

Using video calling to simulate arthroscopic surgery in a resource-poor setting.

There is high demand for arthroscopic procedures in the developing world. Simulation allows trainees to develop basic arthroscopic skills away from theatre, where there may be reduced surgical exposure compared with centres with established arthroscopic practice. Smartphones are widely available and accessible throughout the world. We propose a method to create a low-cost, low-fidelity arthroscopic simulator that can be used at home by using the video call function of smartphones. We used readily available materials from a local market. An adequately sized cardboard box was used to house exercises, LED head torch as a light source, bamboo skewers as probes and a smartphone with video call function allowed visualisation without the need to purchase additional equipment. The whole simulator was constructed using less than 50 ZAR (US$3) of new materials. The arthroscopic simulator can be built simply and is easily portable. Established training exercises can be practised and allow development of basic arthroscopic skills. Our home-made simulator is inexpensive, simple to construct and does not require additional hardware (or software) purchases by the trainee. It is a perfect solution for individuals who want to practise their arthroscopic skills, either at home or at the workplace.

Employing newly qualified nurses to work in hospices: A qualitative interview study.

AIM: To establish an understanding of the experiences of newly qualified nurses' working in hospices from the perspective of both newly qualified and senior nurses. DESIGN: A qualitative interview study. METHODS: Semi-structured interviews with six newly qualified nurses and five senior nurses from four UK hospices were conducted between March - July 2017. RESULTS: The hospices involved in this study were among the first to recruit newly qualified nurses. Participants believed that newly qualified nurses coped well with hospice working and received unique opportunities for professional development. Participants identified the value of formal and informal support, however, newly qualified nurses faced negative attitudes from some established staff. Newly qualified nurses expressed concerns about a perceived lack of technical clinical skills training, however, they highlighted gaining end-of-life care and communication skills that would be transferrable to other settings. Participants highlighted the need to allocate more time for education and formal support including preceptorship. Senior staff did not necessarily expect newly qualified nurses to remain in long-term hospice employment suggesting that they could disseminate their hospice learning to future workplaces. CONCLUSION: This study supports recruitment strategies that increasingly target newly qualified nurses to work in hospices with findings suggesting that hospices can be a suitable environment for recent graduates to work in. The senior nurses in this study viewed the employment of newly qualified nurses in a positive light but shared the concerns of newly qualified nurses regarding skills training. IMPACT: At a time when hospices need to expand if they are going to meet demand for their services, they along with most areas of healthcare face difficulties recruiting and retaining registered nurses. To increase the appeal of hospice employment, recruitment campaigns aimed at newly qualified nurses should emphasize the transferability of skills gained in hospice settings.