An integrated knowledge translation project to develop, implement, and evaluate a train-the-trainer program at a community rehabilitation program in Tamil Nadu, India.

PURPOSE: This project aimed to develop, implement and evaluate a train-the-trainer initiative for community rehabilitation workers (CRWs) and rehabilitation specialists within a community rehabilitation program for children with delayed development in Tamil Nadu, India. METHODS: Guided by the Knowledge to Action framework, non-governmental and academic partners collaboratively developed two 2-day workshops for (1) rehabilitation specialists and (2) CRWs. Outcomes were evaluated using mixed methods, with pre and 2.5-months post surveys (59 participants) and three focus groups (17 participants) involving trainers and trainees (including rehabilitation specialists and CRWs). RESULTS: There were significant increases in the CRWs' self-perception of their capacity to assess comprehension, provide explanations, respond to questions, adjust teaching, motivate learners, communicate effectively, and provide feedback. Significant changes were noted for rehabilitation specialists in five of seven domains, and for rehabilitation specialist leads in six of seven domains. Participants appreciated the interactive training style, and the use of immersive methods such as role play, though noted challenges when instructions were unclear or when they felt that material was more theoretical. CONCLUSIONS: This collaboratively developed train-the-trainer project demonstrates the value of such an intervention, provides an example of how a tailored program can be developed, and suggests the importance of stakeholder-driven design processes.Implications for RehabilitationThe ability to provide effective training is a core skill set for people engaged in community-based rehabilitation (CBR) programs, yet examples of initiatives to train trainers are lacking, as is their evaluation.This project demonstrates the value of a collaborative and tailored train-the-trainer program to support community rehabilitation workers and rehabilitation specialists in their training roles within a CBR program in India.A stakeholder-driven design process supported by a collaboration between non-governmental organization and academic partners enhanced the capacity to develop, implement and evaluate the train-the-trainer program.

Fixed-dose-rate administration of gemcitabine in cancer-bearing cats: A pilot study.

Gemcitabine is an antimetabolite chemotherapy agent with schedule-dependent metabolism and efficacy. The purpose of this study was to identify the fixed-dose-rate (FDR) of gemcitabine administration in cancer-bearing cats that achieved a target plasma concentration (TPC) of 10 to 20 µM. Fifteen client-owned cats received gemcitabine infusions administered at various FDR for 1 to 6 hours. Plasma gemcitabine and dFdU (2',2'-difluorodeoxyuridine), the major gemcitabine metabolite, were quantitated by high performance liquid chromatography. Cats treated with an FDR less than 2.5 mg/m2 per minute failed to achieve TPC, whereas cats treated with an FDR of 10 mg/m2 per minute quickly exceeded the target range. An FDR of 5 mg/m2 per minute provided the longest duration of exposure without exceeding the upper limit of the TPC. Plasma dFdU concentration mirrored plasma gemcitabine concentrations. These data suggest that in order to maintain TPC of gemcitabine in cats the FDR lies between 2.5 and 5 mg/m2 per minute. A Phase II study to evaluate efficacy and toxicity of this approach is underway.

Administration de gemcitabine à vitesse et à dose fixes chez des chats atteints du cancer : une étude pilote. La gemcitabine est un agent de chimiothérapie antimétabolite ayant un métabolisme et une efficacité qui dépendent du plan thérapeutique. Cette étude visait à identifier la vitesse et la dose fixes (VDF) d'administration de la gemcitabine chez des chats atteints du cancer qui avaient atteints une concentration plasmatique cible (CPC) de 10 à 20 µM. Quinze chats appartenant à des clients ont reçu des infusions de gemcitabine administrées à diverses VDF pendant 1 à 6 heures. La gemcitabine et la dFdU (2',2'-difluorodeoxyuridine) dans le plasma, le métabolite majeur de la gemcitabine, ont été quantifiés par chromatographie liquide à haute performance. Les chats traités à l'aide de VDF de moins de 2,5 mg/m2 par minute n'ont pas réussi à atteindre la CPC, tandis que les chats traités à l'aide de VDF de 10 mg/m2 par minute ont rapidement dépassé la zone cible. Des VDF de 5 mg/m2 par minute ont fourni la durée d'exposition la plus longue sans dépasser la limite supérieure de la CPC. La concentration de dFdU dans le plasma a reflété les concentrations de gemcitabine dans le plasma. Ces données suggèrent qu'fin de maintenir la CPC de la gemcitabine chez les chats, les VDF doivent se situer entre 2,5 et 5 mg/m2 par minute. Une étude de phase II pour évaluer l'efficacité et la toxicité de cette approche est actuellement en cours.(Traduit par Isabelle Vallières).