Developing participatory methods that meet the needs of rural communities: the Rural ECOH study

The international literature is replete with case studies of community participation in healthcare planning. Many have not been systematically or robustly evaluated. The Rural ECOH study, across six Australian communities, was designed to robustly evaluate the usefulness of 'Remote Service Futures', an evidence-based method of community participation. Using oral health as a focus, the theory was that services and local people would come together for evidenced-based discussions about oral health and would design costed strategies to address oral health challenges. Whilst 'Remote Service Futures' has been successfully used in the United Kingdom, in the Australian context, its translation has not been easy. Our findings reflect the dilemma of whether local organisations really want to delegate decision-making power to communities, and whether people want to participate in structured ways. We discuss the challenges that we encountered, and provide examples of the approaches that we have used to engage all stakeholders, including modifications to ethics processes, using social media, community conversations, working with existing community and social groups, and extensive work with community champions. Our findings have implications for policy and practice. Whilst internationally, policy promotes the active engagement of citizens and health service providers in health planning, service design and evaluation, there is little guidance on how this can be achieved. Our recommendations provide clear direction for enacting participation policy at a service and community level

A mixed-methods feasibility study of a new digital health support package for people after stroke : The Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention

Background Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. Methods We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. Results Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. Conclusion The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-723

A hierarchical and modular approach to the discovery of robust associations in genome-wide association studies from pooled DNA samples

[Background] One of the challenges of the analysis of pooling-based genome wide association studies is to identify authentic associations among potentially thousands of false positive associations. [Results] We present a hierarchical and modular approach to the analysis of genome wide genotype data that incorporates quality control, linkage disequilibrium, physical distance and gene ontology to identify authentic associations among those found by statistical association tests. The method is developed for the allelic association analysis of pooled DNA samples, but it can be easily generalized to the analysis of individually genotyped samples. We evaluate the approach using data sets from diverse genome wide association studies including fetal hemoglobin levels in sickle cell anemia and a sample of centenarians and show that the approach is highly reproducible and allows for discovery at different levels of synthesis. [Conclusion] Results from the integration of Bayesian tests and other machine learning techniques with linkage disequilibrium data suggest that we do not need to use too stringent thresholds to reduce the number of false positive associations. This method yields increased power even with relatively small samples. In fact, our evaluation shows that the method can reach almost 70% sensitivity with samples of only 100 subjects.Supported by NHLBI grants R21 HL080463 (PS); R01 HL68970 (MHS); K-24, AG025727 (TP); K23 AG026754 (D.T.)

The motivations for the adoption of management innovation by local governments and its performance effects

This article analyses the economic, political and institutional antecedents and performance effects of the adoption of shared Senior Management Teams (SMTs) – a management innovation (MI) that occurs when a team of senior managers oversees two or more public organizations. Findings from statistical analysis of 201 English local governments and interviews with organizational leaders reveal that shared SMTs are adopted to develop organisational capacity in resource‐challenged, politically risk‐averse governments, and in response to coercive and mimetic institutional pressures. Importantly, sharing SMTs may reduce rather than enhance efficiency and effectiveness due to redundancy costs and the political transaction costs associated with diverting resources away from a high‐performing partner to support their lower‐performing counterpart

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Developing participatory methods that meet the needs of rural communities: the Rural ECOH study

The international literature is replete with case studies of community participation in healthcare planning. Many have not been systematically or robustly evaluated. The Rural ECOH study, across six Australian communities, was designed to robustly evaluate the usefulness of 'Remote Service Futures', an evidence-based method of community participation. Using oral health as a focus, the theory was that services and local people would come together for evidenced-based discussions about oral health and would design costed strategies to address oral health challenges. Whilst 'Remote Service Futures' has been successfully used in the United Kingdom, in the Australian context, its translation has not been easy. Our findings reflect the dilemma of whether local organisations really want to delegate decision-making power to communities, and whether people want to participate in structured ways. We discuss the challenges that we encountered, and provide examples of the approaches that we have used to engage all stakeholders, including modifications to ethics processes, using social media, community conversations, working with existing community and social groups, and extensive work with community champions. Our findings have implications for policy and practice. Whilst internationally, policy promotes the active engagement of citizens and health service providers in health planning, service design and evaluation, there is little guidance on how this can be achieved. Our recommendations provide clear direction for enacting participation policy at a service and community level

Data for: Enhancing the Seeking Safety Group Intervention with Trauma-Sensitive Yoga Practice: A Program Evaluation

Seeking Safety is an evidence-based manualized group counseling intervention designed to address trauma and addiction as co-occurring conditions. This qualitative utilization-focused program evaluation analyzed the effectiveness of enhancing Seeking Safety with a Trauma-Sensitive (TA) yoga practice integrated into the Seeking Safety group intervention. Data were generated from key informant interviews, and focus groups. A research team then analyzed all data sources using narrative analysis of transcripts and documents to assess the efficacy of Seek-ing Safety with the yoga enhanced intervention. Implications and recommendations for further research on the use of TS yoga with Seeking Safety are discussed. Code books, subjectivity statements and memos are included in the data set