Hypertension (HTN) is highly prevalent globally among low- and middle-income countries (LMICs). By 2020, cardiovascular disease (CVD) deaths related to HTN in LMICs are projected to increase by 75%. HTN control in LMICs is hindered by an acute shortage of physicians, limited diagnostic medical equipment, and a dearth of disease management resources. Despite the increasing prevalence of HTN in LMICs, scalable, evidence-based interventions to reduce morbidity and mortality attributed to HTN are rarely applied in these settings. The TAsk-Shifting Strategy for Hypertension (TASSH), a 5-year cluster-randomized controlled trial that has been implemented in community health centers in the Ashanti region of Ghana, is an evidence-based example of a scalable intervention strategy for LMICs that can effectively control HTN. The aims of this study were to: (a) conduct a systematic review of interventions for HTN control implemented in LMICs and assess the effect on blood pressure control as demonstrated in RCTs that stated “scale-up”; (b) identify the WHO/ExpandNet scale-up components (i.e., Inputs, Outputs, Outcomes, Impact, Cost effectiveness, Equity, Embedded within current health organization policy, Monitoring and evaluation, Sustainability); and (c) investigate the community health nurse stakeholders’ (n = 27) perceptions of the evidence-based TASSH cluster-randomized controlled trial in Ghana. Twenty-nine randomized-controlled trials describing potentially scalable HTN control intervention strategies and WHO/ExpandNet components were identified. Studies reported clinically significant differences in blood pressure, with 16 studies reporting statistically significant mean differences in BP (p < 0.05). Multicomponent interventions, including drug therapy and health education, provided the most benefit to participants. However, there was limited reporting on translation into existing institutional policy, cost effectiveness, stakeholder engagement, and sustainability. Patient goal setting, leadership engagement, and availability of resources, all of which were mentioned by TASSH nurses as important for successful implementation and eventual TASSH scale-up, emerged as major themes. LMICs need context-specific metrics and indicators to effectively evaluate and standardize the reporting of scale-up components and processes. In addition, infrastructure development, including capacity building at the individual, institutional, and systems levels, as well as stakeholder engagement (i.e., leadership), are necessary to address HTN-related morbidity and mortality and other diseases.

<p> This study investigated the use of deliberate practice theory as a technique to improve hand hygiene performance (HHP) of first-semester associate degree nursing program students. Proper HHP at specific intervals during patient care prevents the spread of healthcare-associated infections. HHP consistently falls below industry expectations and this gap exists worldwide. Modifying established HHP behaviors of professionals in the health care setting is resource intensive, yet novice health care professionals such as nursing students are uniquely positioned to acquire optimal hand hygiene habits as they enter professional practice. The research question for this study was as follows: Is there a performance difference between a group of nursing students using a routine practice approach and a group using deliberate practice theory as a technique for the task of hand hygiene in the nursing skills laboratory setting? The research design was a multiple-measures pretest/posttest nonrandomized quasi-experimental design using a convenience sample. The target population was prelicensure first-semester associate degree nursing students in the United States and a sample of 47 nursing students was obtained from an intact cohort of first-semester associate degree nursing students. The method of data analysis was an independent-samples <i> t</i> test to determine if a statistically significant performance difference existed between the control and experimental groups. The experimental group using deliberate practice theory as a technique for HHP had higher performance scores (<i>M</i> = 97.10, <i>SD</i> = 9.60) than the control group using a routine approach (<i>M</i> = 91.67, <i>SD</i> = 14.74); however, it was not statistically significant, with <i>t</i>(39.73) = &ndash;1.503, <i>p</i> = .141. An additional analysis was conducted to determine hand hygiene compliance rates. The control group dropped 4.16% for hand hygiene compliance from the pretest to the posttest whereas the experimental group dropped only 0.72%. The most impressive findings from this alternative examination of the findings is that the control group had two (8.33%) of its participants with one hand hygiene omission during the pretest and the experimental group had one (4.35%). For the posttest, the control group had six (25%) of its participants with one hand hygiene omission and the experimental group had two (8.69%). The number of individuals in the experimental group with hand hygiene omissions doubled from the pretest to the posttest whereas the number of individuals with hand hygiene omissions tripled for the control group. This additional analysis indicates that deliberate practice theory as a technique to improve HHP may have important clinical implications.</p><p>

<p> Challenges regarding patient safety, limited clinical instruction time, and competitive clinical placements are factors that continue to contribute to the growing interest in the use of simulation in nursing education programs across the nation (Kaddoura, 2010). While there is an abundance of literature supporting the use of high-fidelity simulation in baccalaureate and associate degree registered nurse programs, there is limited literature addressing the effects of its use in practical nursing programs. The overarching question for this study is: <i>What is the relationship between high-fidelity simulation and perceived efficacy as it relates to practical nursing education? </i> Building upon this premise, the relationship between the following subscales comprising high-fidelity simulation were examined: knowledge, clinical judgment, and technical skills. Practical nursing students&rsquo; perceptions of benefits and challenges related to participation in high-fidelity simulation were studied along with their perceptions of self and collective efficacy. These culminated with the faculty focus groups feedback regarding practical nursing students&rsquo; progression from novice toward advanced beginner.</p><p>

<p> Climate change has become responsible for substantial mortality and morbidity around the world. These numbers are said to rise, as climate change will continue to have both direct and indirect effects on human health, as well as threaten the determinants of health. Some health effects include asthma, respiratory disease, cancer, cardiovascular disease, stroke, health-related illness, human developmental effects, mental illness, neurological disease, vector-borne disease, waterborne disease, and more. Given the implications it carries on human health, climate change should be of fundamental relevance to doctors and future doctors alike. The aim of this thesis is to explore the importance of preparing doctors and student doctors for a climate-changing world. This includes developing skills and insights necessary in a clinical practice and a public health role. The research methods in this thesis is sought to identify if future doctors are being prepared and are willing to take action against climate change and the health implications it poses. The focus is also to identify the perceptions of doctors on climate change and its health risks, as little is known about this. Through theoretical and quantitative evidence, the goal is to provide insight on the role future doctors, who are both prepared and willing to take actions, can play in influencing patients to participate in climate change mitigation.</p><p>

<p> The number of cases of elderly people in Spain who may be suffering from some type of mistreatment is increasing. Some elder abuse victims are unaware they are being abused. When they are aware of the abuse, they often do not seek help due to lack of awareness about available resources and fear of consequence for themselves or caregivers. Socially isolated older adults are at greater risk of ill-treatment and abuse. </p><p> Neighborhood watch volunteers are in an excellent position for detecting at-risk elders and reporting suspected abuse to police and social services. The Radars Project in Barcelona, a neighborhood watch organization, includes neighbors and local business working together to prevent social isolation. However, these volunteers do not receive formal training to detect and monitor seniors at risk of abuse. The purpose of this project was to develop an educational curriculum that will provide training to neighborhood watch volunteers in Catalonia, Spain to help improve recognition and reporting of elders at risk of abuse and neglect.</p><p>

<p> <b>Background:</b> Attachment selection in removable partial dentures (RPD) design is considered one of the most challenging treatment modalities in dentistry. Any error that occur during attachment selection due to lack of proper knowledge, overwhelming number of attachments, mistreatment, multiple adjustments and repairs could result in adverse clinical consequences, and significant inconvenience to the patient as well as financial implication to both patient and provider. Attachment selection is indeed very challenging for several reasons. Firstly, the topic itself has not been widely researched and published in dental literature, and therefore the best attachment selection still remains an area prone to high error rates in decision-making. Secondly, the complexity of the topic and lack of proper knowledge that requires sound knowledge of attachment principle, which spans multiple dental displaces of endodontic, orthodontics, periodontics and prosthodontics. Furthermore, now there are an over whelming number of attachments available in the market due to high patient demand for cosmetic and aesthetic dental enhancements. It is therefore extremely difficult for dental practitioners to readily recall an extensive list of factors that determine an appropriate attachment for RPD design. This is more as for dental education students, especially for students, residents, and less experienced clinician who may not possess the adequate education, training and competencies. Although clinical experts in the area of RPD design and attachment experience and skills may be able to assist with knowledge and years of experience they may not always be around or readily available. To address this problem and gab in the education and training of dental students, residents and practitioners seeking continuing education, we have developed a clinical support and training system for RPD attachment design and implementation based on dental experts&rsquo; knowledge and literature evidence-based clinical and practice guidelines. </p><p> <b>Methodology:</b> The RPD attachment clinical decision support system was developed using Exsys Corvid Core software. The knowledge based of the system was setup using dental experts&rsquo; and literature evidence-based practice guidelines. In all the knowledge base was successfully loaded with more than 100 rules representing many different clinical scenarios for variable types of attachment selection in RPD. For any new input attachment case, based on the information entered by the user, the system comes up with an appropriate evidence-based recommendation and treatment plan. To ensure that the clinical decision support and training system was indeed fully capable of training and educating dental students and residents it was validated by nine expert prosthodontics using a survey style questionnaire on the various aspects of the setup and functionality of the system. The questionnaire results were statistically evaluated using Cronbach&rsquo;s Alpha Coefficient Test. </p><p> <b>Results:</b> The Cronbach&rsquo;s Alpha reliability coefficient was 0.893, which represent a good internal consistency and indicates an overall agreement among the prosthodontic experts as to the need and viability of the system for training dental students and residents in the area of RPD attachment design. Likewise, the results of the validation questionnaire showed that all prosthodontics agreed that the system contained all of the most relevant factors for attachment selection in RPD design ensuring its utility for training and education in a real-world practice. </p><p> <b>Conclusion:</b> The clinical decision support and training system for RPD attachment design was successfully developed using Exsys Corvid Core software. Expert prosthodontists concurred that the system can be effectively employed for training dental student, inexperienced dentists and residents to select an appropriate attachment for RPD. It can be used to complement traditional teaching methods even in the absence of patients as part of a dental degree curriculum.</p><p>

<p> A projected deficit in the perioperative workforce of 32,000 perioperative nurses retiring by 2024, creates an inability to meet the nursing needs of the United States population. The need for experienced perioperative nurses has been increasing while the availability of nurses with perioperative education has been decreasing. The purpose of this phenomenological study was to explore the lived experience of post-licensure nurses who participated in a perioperative clinical rotation within their baccalaureate nursing program and did that experiential experience affect the recruitment and employment for perioperative nursing to halt the impending shortage. The integrations of Kolb&rsquo;s experiential learning theory and Bandura&rsquo;s theory of self-efficacy model was the framework that supported the study. Thirteen interviews were conducted using van Manen&rsquo;s (1990) method for researching the lived experience. The two themes emerging from the data were value and attitude. Subthemes under value are gaining knowledge and skill set and a different type of nursing. Subthemes under attitude are (a) communication with the medical team and advocacy for families and patients. The experiential perioperative clinical rotation affected the study participants&rsquo; interest for working in the operating room (OR). Most had a highlighted interest in the specialty, and those participants&rsquo; not choosing the OR as their choice of employment expressed that the experience positively affected the type of nurse they are today. Experiential learning can build the fundamental knowledge necessary to understand the novice perioperative nurse&rsquo;s role as a career choice.</p><p>

Childhood obesity is a growing epidemic that calls for more effective, school-based interventions. As such, the aim of the present study was to systematically describe the steps in the development of and conduct a formative evaluation for Food, Health & Choices (FHC), an innovative approach to reducing childhood that incorporates curriculum with classroom wellness policy and parental supports. The formative evaluation includes both process and outcome evaluations. The purpose of evaluating the formative stage of research was to learn about ways to strengthen and improve the quality of program implementation and the appropriateness of study instruments in anticipation of the full intervention year. Results from the process evaluation revealed key factors to include in formative studies for school-based interventions, particularly for maximizing a program's ability to change behavior and the ability for evaluation instruments to detect any changes. Recommendations include shortening and simplifying lesson content, adding more visuals and hands-on activities to lessons, modifying the goal-setting process, making the physical activity component more engaging, rallying teacher support of the program, providing teachers with on-going support, and obtaining regular teacher feedback. The process instruments found to be most useful were the mid-intervention PD sessions, lesson observation forms, unit summary sheets, teacher interviews, and student interviews. Results from the outcome evaluation demonstrated that students successfully made changes in some of the targeted behaviors and are sufficiently promising to proceed with the full trial contingent upon program improvements being made.

Childhood obesity is a growing epidemic that calls for more effective, school-based interventions. As such, the aim of the present study was to systematically describe the steps in the development of and conduct a formative evaluation for Food, Health and Choices (FHC), an innovative approach to reducing childhood that incorporates curriculum with classroom wellness policy and parental supports. The formative evaluation includes both process and outcome evaluations. The purpose of evaluating the formative stage of research was to learn about ways to strengthen and improve the quality of program implementation and the appropriateness of study instruments in anticipation of the full intervention year. Results from the process evaluation revealed key factors to include in formative studies for school-based interventions, particularly for maximizing a program's ability to change behavior and the ability for evaluation instruments to detect any changes. Recommendations include shortening and simplifying lesson content, adding more visuals and hands-on activities to lessons, modifying the goal-setting process, making the physical activity component more engaging, rallying teacher support of the program, providing teachers with on-going support, and obtaining regular teacher feedback. The process instruments found to be most useful were the mid-intervention PD sessions, lesson observation forms, unit summary sheets, teacher interviews, and student interviews. Results from the outcome evaluation demonstrated that students successfully made changes in some of the targeted behaviors and are sufficiently promising to proceed with the full trial contingent upon program improvements being made.

Childhood obesity is an important societal problem for reasons of justice, economy, and well-being; therefore, significant resources are expended on childhood obesity prevention interventions. We need strong evaluations to ensure that we use these resources efficiently and effectively. While randomized controlled trials are focused on internal validity, process evaluations can be focused on more generative evaluation questions and can be a powerful compliment to a randomized controlled trial if they employ methodological pluralism and methodological rigor. In this dissertation, a systematic framework for a Comprehensive Approach to Process Evaluation is presented. The Comprehensive Approach to Process Evaluation was developed based on a review of 17 process evaluation and similar studies and emphasizes the examination of both implementation and contextual factors together in a process evaluation. The Comprehensive Approach to Process Evaluation is applied in this dissertation to the Food, Health & Choices childhood obesity prevention cluster randomized trial, which was implemented in 20 high-need NYC public elementary schools and included 1,358 students in 55 5th grade classes. The Comprehensive Approach to Process Evaluation was used to evaluate Food, Health & Choices in three articles. The first used hierarchical linear modeling to examine relationships among implementation factors, contextual factors, and behavioral outcomes, while accounting for the clustering of these variables at both the classroom and school levels. Important findings were that student reception of the intervention was related to outcome behaviors; class engagement was related to curriculum recall; and teacher interest was related to delivery of the wellness intervention, the only aspect of Food, Health & Choices that depended on classroom teachers for implementation. Additionally, student responses to behavior items on questionnaires were grouped as three logical factors, which not only increased statistical power but also provided insight into how students think about energy balance related behavior. The second article used mixed methods to examine the relationship between intervention delivery and reception, energy balance related behavior, and intrapersonal and external contexts by comparing classrooms with high and low buy-in based on measures of classroom context. This comparison led to the finding that there were quantitative differences in energy balance related behavior in high buy-in and low buy-in classes at baseline and posttest, but no other constructs. A qualitative comparison of student perceptions of supports and barriers to maintaining energy balance uncovered neighborhood environment as a universal barrier, preferences as a more salient barrier for students in low buy-in classes, and more awareness of the home environment as both a support and barrier among students in high buy-in classes. The third article used qualitative methods to examine the relationship between energy balance related behavior and intrapersonal and external contexts. Findings were that four patterns of behavior adoption existed among the interviewees and that corresponding intrapersonal and external contextual factors facilitated and hindered energy balance related behavior adoption in each of these groups. In all, the Comprehensive Approach to Process Evaluation proved to be a useful and rigorous compliment to the Food, Health & Choices randomized controlled trial outcome evaluation and provided a more nuanced explanation of what happened during Food, Health & Choices. A synthesis of findings across the three studies highlights both implementation and contextual factors that were important during the intervention, including: 1) Intervention reception – satisfaction and recall of Food, Health & Choices were associated with energy balance related behaviors; 2) Intervention delivery – using trained nutrition educators seemed to positively influence the completion of the intervention; 3) Intrapersonal context – students responded differently to the intervention based on prior experiences and personality; 4) External context – neighborhood environments were powerful in influencing energy balance related behaviors. This has implications for intervention sustainability and improvement as well as research, practice, and policy in childhood obesity prevention. Research should be conducted to clarify the relationship between intervention satisfaction and behavioral outcomes; practice should consider the value of trained nutrition educators versus classroom teacher professional development, the importance of parent education about exposure to fruits and vegetables in early childhood, and how interventions might be tailored for different student energy balance related behavior adoption profiles; and policies that support children in choosing healthy food outside of school should be adopted. The Comprehensive Approach to Process Evaluation should be tested in other interventions to determine if it is recommended as an approach to process evaluation across school-based childhood obesity prevention interventions.