Predictors of Adherence to a Structured Exercise Program and Physical Activity Participation in Community Dwellers after Stroke

Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) took more steps. A model including SF-12, maximal balance range, and 6-min walk accounted for 33% of the variance in average steps/day. Conclusions. The results suggest that better physical functioning and health status are predictors of average steps taken per day in stroke survivors and that predicting adherence to group exercise in this group is difficult

Host Agency Perspectives on Facilitating Community-Based Clinical Experiences for Nursing Students

Nurse educators have developed many innovations for nursing education in response to the current shortage of clinical placements. Nursing programs are increasingly relying on placements in community-based agencies (some of which are not health agencies) and university-agency collaborations are being developed to enhance capacity for student placements. Our interest in this qualitative study was to elicit the perspectives of host agencies in these alternate sites regarding hosting undergraduate student clinical placements. Aims were to gain insight about (1) how community-based host agencies decide to host students, including how the number of students hosted is determined; (2) the nature of agency-university partnerships; and (3) the agency’s experiences of hosting students in relation to benefits and issues that accompany hosting students. Administrators from twenty-five community-based agencies that hosted undergraduate nursing students from the researchers’ university were invited to participate in an online survey or telephone interview, with a final sample size of eighteen respondents. Each participant was given the option of a telephone interview but most elected to complete the online survey because of its flexibility; five participants were interviewed on the phone and 13 completed the open-ended survey questions online. Findings revealed that host agency decisions to host students could have an ad hoc nature to them, and were described as contingent on various explicit and implicit factors such as staff availability, the perceived contribution of students, or a philosophic commitment to contribute to student education. Smaller agencies reported and preferred informal partnerships with the educational institutions because they were perceived to be more flexible, and all sites emphasized the need for increased, improved communication with clinical instructors and more direct supervision of student placements by the educational unit. The benefits of hosting student nurses were described as outweighing the issues and challenges. The study also revealed incongruities between the perspectives of these host agencies and typically-held views of nursing programs, whereby host agencies spoke of the “ideal student” and nursing programs tend to seek an “ideal placement”. Further research is needed to generate knowledge about expanding capacity for clinical placements, enhancing partnerships, and enriching student learning outcomes. Résumé Compte tenu de la pénurie de places de stages cliniques, les professeures en sciences infirmières ont développé plusieurs innovations en formation infirmière. Les programmes de sciences infirmières comptent de plus en plus sur les stages au sein d’organismes communautaires (certains ne sont pas des organismes de santé) et les universités favorisent des partenariats avec ces organismes afin d’accroître la capacité d’accueil de stagiaires. Cette étude qualitative visait à décrire les perspectives d’organismes hôtes dans ces sites alternatifs concernant l’accueil d’étudiantes de premier cycle dans le cadre de stages cliniques. Les objectifs étaient de mieux comprendre : (1) comment les organismes communautaires hôtes prennent la décision d’accueillir des étudiantes dans le cadre de stages cliniques et comment ils déterminent le nombre d’étudiantes qui seront accueillies; (2) la nature des partenariats organisme-université; et (3) les expériences de l’organisme en ce qui concerne l’accueil des étudiantes, plus particulièrement les avantages et les problèmes liés à l’accueil des étudiantes. Des administrateurs de vingt-cinq organismes communautaires, qui ont accueilli des étudiantes en sciences infirmières de l’université d’attache des chercheurs, ont été invités à participer à un sondage en ligne ou à une entrevue téléphonique. La taille de l’échantillon final était de dix-huit participants. La plupart des participants ont opté pour le sondage en ligne à cause de sa flexibilité; cinq participants ont répondu à une entrevue téléphonique et treize ont complété le sondage en ligne qui comportait des questions ouvertes. Les résultats indiquent que les organismes hôtes décident d’accueillir des étudiantes en stage afin de répondre à des besoins spécifiques, et la décision dépend de plusieurs facteurs explicites et implicites, tels que la disponibilité du personnel, la perception de la contribution des étudiantes, ou un engagement philosophique à contribuer à la formation d’étudiantes. Les plus petits organismes ont indiqué qu’ils préfèrent les partenariats informels avec les établissements de formation car ils les perçoivent comme étant plus souples. Tous les sites ont souligné le besoin de communications plus fréquentes et améliorées avec les enseignantes cliniques et de supervision plus directe des stages des étudiantes par l’unité d’enseignement. Les avantages d’accueillir des étudiantes étaient décrits par les organismes hôtes comme dépassant les inconvénients ou les défis. L’étude a aussi révélé des incongruités entre les perspectives des organismes hôtes et celles des programmes de sciences infirmières : les organismes hôtes décrivent ce que serait un « étudiante idéale» et les programmes de sciences infirmières souhaitent trouver le « stage idéal ». D’autres recherches seront nécessaires afin de générer des connaissances sur l’augmentation de la capacité d’accueil de stagiaires, l’amélioration des partenariats, et l’enrichissement des résultats d’apprentissage des étudiantes

Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial

Background: Stroke is the most common disabling neurological condition in adults. Falls and poor mobility are major contributors to stroke-related disability. Falls are more frequent and more likely to result in injury among stroke survivors than among the general older population. Currently there is good evidence that exercise can enhance mobility after stroke, yet ongoing exercise programs for general community-based stroke survivors are not routinely available. This randomised controlled trial will investigate whether exercise can reduce fall rates and increase mobility and physical activity levels in stroke survivors. Methods and design: Three hundred and fifty community dwelling stroke survivors will be recruited. Participants will have no medical contradictions to exercise and be cognitively and physically able to complete the assessments and exercise program. After the completion of the pre-test assessment, participants will be randomly allocated to one of two intervention groups. Both intervention groups will participate in weekly group-based exercises and a home program for twelve months. In the lower limb intervention group, individualised programs of weight-bearing balance and strengthening exercises will be prescribed. The upper limb/cognition group will receive exercises aimed at management and improvement of function of the affected upper limb and cognition carried out in the seated position. The primary outcome measures will be falls (measured with 12 month calendars) and mobility. Secondary outcome measures will be risk of falling, physical activity levels, community participation, quality of life, health service utilisation, upper limb function and cognition. Discussion: This study aims to establish and evaluate community-based sustainable exercise programs for stroke survivors. We will determine the effects of the exercise programs in preventing falls and enhancing mobility among people following stroke. This program, if found to be effective, has the potential to be implemented within existing community services. Trial registration: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12606000479505)

Interventions for improving the design and conduct of scientific research: A scoping review protocol [version 2; peer review: 2 approved]

Background Research waste is prevalent in many scientific fields despite a number of initiatives to improve research practices. Interventions to improve practice are often implemented without evaluating their effectiveness. It is therefore important to identify the interventions that have been evaluated, assess how they have been evaluated and to identify areas where further research is required. Objectives A scoping review will be undertaken to assess what interventions, aimed at researchers or research teams, to improve research design and conduct have been evaluated. This review will also consider when in the research pathway these interventions are implemented; what aspects of research design or conduct are being targeted; and who is implementing these interventions. Methods Interventions which aim to improve the design or conduct of research will be eligible for inclusion. The review will not include interventions aimed at hypothetical research projects or interventions implemented without evaluation. The following sources will be searched: MEDLINE, EMBASE, ERIC, HMIC, EconLit, Social Policy and Practice, ProQuest theses, and MetaArXiv. Hand searching of references and citations of included studies will also be undertaken. Searches will be limited to articles published in the last 10 years. Data extraction will be completed using a data extraction template developed for this review.  Results will be tabulated by type of intervention, research stage, and outcome. A narrative review will also be provided addressing each of the objectives

Physical activity coaching for adults with mobility limitations: protocol for the ComeBACK pragmatic hybrid effectiveness-implementation type 1 randomised controlled trial

INTRODUCTION: Mobility limitation is common and often results from neurological and musculoskeletal health conditions, ageing and/or physical inactivity. In consultation with consumers, clinicians and policymakers, we have developed two affordable and scalable intervention packages designed to enhance physical activity for adults with self-reported mobility limitations. Both are based on behaviour change theories and involve tailored advice from physiotherapists. METHODS AND ANALYSIS: This pragmatic hybrid effectiveness-implementation type 1 randomised control trial (n=600) will be undertaken among adults with self-reported mobility limitations. It aims to estimate the effects on physical activity of: (1) an enhanced 6-month intervention package (one face-to-face physiotherapy assessment, tailored physical activity plan, physical activity phone coaching from a physiotherapist, informational/motivational resources and activity monitors) compared with a less intensive 6-month intervention package (single session of tailored phone advice from a physiotherapist, tailored physical activity plan, unidirectional text messages, informational/motivational resources); (2) the enhanced intervention package compared with no intervention (6-month waiting list control group); and (3) the less intensive intervention package compared with no intervention (waiting list control group). The primary outcome will be average steps per day, measured with the StepWatch Activity Monitor over a 1-week period, 6 months after randomisation. Secondary outcomes include other physical activity measures, measures of health and functioning, individualised mobility goal attainment, mental well-being, quality of life, rate of falls, health utilisation and intervention evaluation. The hybrid effectiveness-implementation design (type 1) will be used to enable the collection of secondary implementation outcomes at the same time as the primary effectiveness outcome. An economic analysis will estimate the cost-effectiveness and cost-utility of the interventions compared with no intervention and to each other. ETHICS AND DISSEMINATION: Ethical approval has been obtained by Sydney Local Health District, Royal Prince Alfred Zone. Dissemination will be via publications, conferences, newsletters, talks and meetings with health managers. TRIAL REGISTRATION NUMBER: ACTRN12618001983291

Discovery and structure-activity relationships of a novel isothiazolone class of bacterial type II topoisomerase inhibitors

There is an urgent and unmet medical need for new antibacterial drugs that tackle infections caused by multidrug-resistant (MDR) pathogens. During the course of our wider efforts to discover and exploit novel mechanism of action antibacterials, we have identified a novel series of isothiazolone based inhibitors of bacterial type II topoisomerase. Compounds from the class displayed excellent activity against both Gram-positive and Gram-negative bacteria with encouraging activity against a panel of MDR clinical Escherichia coli isolates when compared to ciprofloxacin. Representative compounds also displayed a promising in vitro safety profile

WILL (When to Induce Labour to Limit risk in pregnancy hypertension): a multicentre randomised controlled trial - adaptations to deliver a timing-of-birth trial during the COVID-19 international pandemic.

BACKGROUND: As a pragmatic randomised timing-of-birth trial, WILL adapted its trial procedures in response to the COVID-19 pandemic. These are reviewed here to inform post-pandemic trial methodology. METHODS: The trial (internal pilot) paused in March 2020, re-opened in July 2020, and is currently recruiting in 37 UK NHS consultant-led maternity units. We evaluated pandemic adaptations made to WILL processes and surveyed sites for their views of these changes (20 sites, videoconference). RESULTS: Despite 88% of sites favouring an electronic investigator site file (ISF), information technology requirements and clinical trial unit (CTU) operating procedures mandated the ongoing use of paper ISFs; site start-up delays resulted from restricted access to the CTU. Site initiation visits (SIVs) were conducted remotely; 50% of sites preferred remote SIVs and 44% felt that it was trial-dependent, while few preferred SIVs in-person as standard procedure. The Central team felt remote SIVs provided scheduling and attendance flexibility (for sites and trial staff), the option of recording discussions for missing or future staff, improved efficiency by having multiple sites attend, and time and cost savings; the negative impact on rapport-building and interaction was partially mitigated over time with more familiarity with technology and new ways-of-working. Two methods of remote consent were developed and used by 30/37 sites and for 54/156 recruits. Most (86%) sites using remote consenting felt it improved recruitment. For remote data monitoring (5 sites), advantages were primarily for the monitor (e.g. flexibility, no time constraints, reduced cost), and disadvantages primarily for the sites (e.g. document and access preparation, attendance at a follow-up meeting), but 81% of sites desired having the option of remote monitoring post-pandemic. CONCLUSIONS: COVID adaptations to WILL trial processes improved the flexibility of trial delivery, for Central and site staff, and participants. Flexibility to use these strategies should be retained post-pandemic. TRIAL REGISTRATION: ISRCTN77258279. Registered on 05 December 2018