Randomized controlled trials in de-implementation research : a systematic scoping review

Background: Healthcare costs are rising, and a substantial proportion of medical care is of little value. De-implementation of low-value practices is important for improving overall health outcomes and reducing costs. We aimed to identify and synthesize randomized controlled trials (RCTs) on de-implementation interventions and to provide guidance to improve future research. Methods: MEDLINE and Scopus up to May 24, 2021, for individual and cluster RCTs comparing de-implementation interventions to usual care, another intervention, or placebo. We applied independent duplicate assessment of eligibility, study characteristics, outcomes, intervention categories, implementation theories, and risk of bias. Results: Of the 227 eligible trials, 145 (64%) were cluster randomized trials (median 24 clusters; median follow-up time 305 days), and 82 (36%) were individually randomized trials (median follow-up time 274 days). Of the trials, 118 (52%) were published after 2010, 149 (66%) were conducted in a primary care setting, 163 (72%) aimed to reduce the use of drug treatment, 194 (85%) measured the total volume of care, and 64 (28%) low-value care use as outcomes. Of the trials, 48 (21%) described a theoretical basis for the intervention, and 40 (18%) had the study tailored by context-specific factors. Of the de-implementation interventions, 193 (85%) were targeted at physicians, 115 (51%) tested educational sessions, and 152 (67%) multicomponent interventions. Missing data led to high risk of bias in 137 (60%) trials, followed by baseline imbalances in 99 (44%), and deficiencies in allocation concealment in 56 (25%). Conclusions: De-implementation trials were mainly conducted in primary care and typically aimed to reduce low-value drug treatments. Limitations of current de-implementation research may have led to unreliable effect estimates and decreased clinical applicability of studied de-implementation strategies. We identified potential research gaps, including de-implementation in secondary and tertiary care settings, and interventions targeted at other than physicians. Future trials could be improved by favoring simpler intervention designs, better control of potential confounders, larger number of clusters in cluster trials, considering context-specific factors when planning the intervention (tailoring), and using a theoretical basis in intervention design. Registration: OSF Open Science Framework hk4b2.Peer reviewe

Randomized controlled trials in de-implementation research : a systematic scoping review

Background: Healthcare costs are rising, and a substantial proportion of medical care is of little value. De-implementation of low-value practices is important for improving overall health outcomes and reducing costs. We aimed to identify and synthesize randomized controlled trials (RCTs) on de-implementation interventions and to provide guidance to improve future research. Methods: MEDLINE and Scopus up to May 24, 2021, for individual and cluster RCTs comparing de-implementation interventions to usual care, another intervention, or placebo. We applied independent duplicate assessment of eligibility, study characteristics, outcomes, intervention categories, implementation theories, and risk of bias. Results: Of the 227 eligible trials, 145 (64%) were cluster randomized trials (median 24 clusters; median follow-up time 305 days), and 82 (36%) were individually randomized trials (median follow-up time 274 days). Of the trials, 118 (52%) were published after 2010, 149 (66%) were conducted in a primary care setting, 163 (72%) aimed to reduce the use of drug treatment, 194 (85%) measured the total volume of care, and 64 (28%) low-value care use as outcomes. Of the trials, 48 (21%) described a theoretical basis for the intervention, and 40 (18%) had the study tailored by context-specific factors. Of the de-implementation interventions, 193 (85%) were targeted at physicians, 115 (51%) tested educational sessions, and 152 (67%) multicomponent interventions. Missing data led to high risk of bias in 137 (60%) trials, followed by baseline imbalances in 99 (44%), and deficiencies in allocation concealment in 56 (25%). Conclusions: De-implementation trials were mainly conducted in primary care and typically aimed to reduce low-value drug treatments. Limitations of current de-implementation research may have led to unreliable effect estimates and decreased clinical applicability of studied de-implementation strategies. We identified potential research gaps, including de-implementation in secondary and tertiary care settings, and interventions targeted at other than physicians. Future trials could be improved by favoring simpler intervention designs, better control of potential confounders, larger number of clusters in cluster trials, considering context-specific factors when planning the intervention (tailoring), and using a theoretical basis in intervention design. Registration: OSF Open Science Framework hk4b2.Peer reviewe

Randomized controlled trials in de-implementation research : a systematic scoping review

Background: Healthcare costs are rising, and a substantial proportion of medical care is of little value. De-implementation of low-value practices is important for improving overall health outcomes and reducing costs. We aimed to identify and synthesize randomized controlled trials (RCTs) on de-implementation interventions and to provide guidance to improve future research. Methods: MEDLINE and Scopus up to May 24, 2021, for individual and cluster RCTs comparing de-implementation interventions to usual care, another intervention, or placebo. We applied independent duplicate assessment of eligibility, study characteristics, outcomes, intervention categories, implementation theories, and risk of bias. Results: Of the 227 eligible trials, 145 (64%) were cluster randomized trials (median 24 clusters; median follow-up time 305 days), and 82 (36%) were individually randomized trials (median follow-up time 274 days). Of the trials, 118 (52%) were published after 2010, 149 (66%) were conducted in a primary care setting, 163 (72%) aimed to reduce the use of drug treatment, 194 (85%) measured the total volume of care, and 64 (28%) low-value care use as outcomes. Of the trials, 48 (21%) described a theoretical basis for the intervention, and 40 (18%) had the study tailored by context-specific factors. Of the de-implementation interventions, 193 (85%) were targeted at physicians, 115 (51%) tested educational sessions, and 152 (67%) multicomponent interventions. Missing data led to high risk of bias in 137 (60%) trials, followed by baseline imbalances in 99 (44%), and deficiencies in allocation concealment in 56 (25%). Conclusions: De-implementation trials were mainly conducted in primary care and typically aimed to reduce low-value drug treatments. Limitations of current de-implementation research may have led to unreliable effect estimates and decreased clinical applicability of studied de-implementation strategies. We identified potential research gaps, including de-implementation in secondary and tertiary care settings, and interventions targeted at other than physicians. Future trials could be improved by favoring simpler intervention designs, better control of potential confounders, larger number of clusters in cluster trials, considering context-specific factors when planning the intervention (tailoring), and using a theoretical basis in intervention design. Registration: OSF Open Science Framework hk4b2.publishedVersionPeer reviewe

Trans-ancestry meta-analyses identify rare and common variants associated with blood pressure and hypertension

High blood pressure is a major risk factor for cardiovascular disease and premature death. However, there is limited knowledge on specific causal genes and pathways. To better understand the genetics of blood pressure, we genotyped 242,296 rare, low-frequency and common genetic variants in up to ~192,000 individuals, and used ~155,063 samples for independent replication. We identified 31 novel blood pressure or hypertension associated genetic regions in the general population, including three rare missense variants in RBM47, COL21A1 and RRAS with larger effects (>1.5mmHg/allele) than common variants. Multiple rare, nonsense and missense variant associations were found in A2ML1 and a low-frequency nonsense variant in ENPEP was identified. Our data extend the spectrum of allelic variation underlying blood pressure traits and hypertension, provide new insights into the pathophysiology of hypertension and indicate new targets for clinical intervention

Työssäoppimisjaksojen kehittäminen vartijan peruskoulutuksessa Virossa

Kehittämishankkeen tarkoitus oli kehittää Viron vartijan peruskoulutuksen työssäoppimisjaksoja. Tutkimuksen kohdejoukkona olivat Sisekaitseakadeemian vartijan peruskoulutuksen päiväopiskelijat sekä koulutusvankiloiden harjoittelunohjaajat ja aktiiviset perehdyttäjät. Empiirisen tutkimuksen avulla pyrittiin löytämään selkeitä kehittämiskohteita, joiden tehostamisella voitaisiin parantaa työssäoppimisjaksojen laatua ja tukea täydellistä oppimista. Tutkimus oli kvalitatiivinen tutkimus, joka suoritettiin sähköisenä tutkimuslomakekyselynä. Tutkimus sisälsi myös kvantitatiivista aineistoa. Tutkimusotteena oli kehittävän työntutkimus. Teoreettiseen viitekehykseen sisällytettiin pedagogiikan, didaktiikan ja työssäoppimisen teoriaa kognitiivisen oppimiskäsityksen ollessa vallitsevana käsityksenä työssäoppimisprosessin toteutuksessa. Tutkimustuloksiin haettiin selitystä teoriasta sekä aikaisemmista tutkimuksista työssäoppimisesta. Vertailtavina tutkimuksina oli kolme akateemista väitöskirjaa, yksi pro gradu ja yksi alemman ammattikorkeakoulun lopputyö työssäoppimisesta. Samankaltaisia tutkimustuloksia havaittiin aikaisemmissa tutkimuksissa, erityisesti vuonna 2009 Suomessa tehdyssä saman ammattialan tutkimuksessa Työssäoppiminen osana vankeinhoidon perustutkintoa. Tutkimuksen empiirinen osa koostui Sisekaitseakadeemian vartijakoulutuksen päiväopiskelijoille suoritetusta kyselystä (n=8) sekä koulutusvankiloiden harjoittelunohjaajille ja perehdyttäjille (n=18) suoritetusta kyselystä. Nämä yhdessä muodostivat tutkimuksen primaarisen aineiston, joka kerättiin ja analysoitiin Webropolin datan analysointi- ja kyselytyökalulla. Myös kyselyn kirjalliset vastaukset analysoitiin ja luokiteltiin. Tutkimuksen päätavoitteena oli löytää harjoittelujaksoilla työssäoppimisen toteutukseen liittyviä kehittämiskohteita ja saada ne toteutettaviksi mahdollisimman laaja-alaisesti työssäoppimisprosessissa. Keskeisinä tutkimustuloksina voitiin mainita mm. että palautekeskustelujen pitämiseen ja haasteellisten oppimistehtävien luomiseen olisi kiinnitettävä erityistä huomiota. Työssäoppimisprosessia ja siihen liittyviä pedagogisia ja didaktisia ratkaisuja olisi tehtävä tunnetuksi toiminnassa mukana oleville virkamiehille. Tähän liittyen kaivattiin täydennyskoulutusta työssäoppimisjaksojen toteutukseen. Kommunikaatioon vaikuttavina tekijöinä havaittiin mm. perehdyttäjien ja harjoittelunohjaajien aito kiire ja työmäärä virkatöissä sekä osan henkilöstön negatiivinen suhtautuminen harjoittelijaan. Harjoittelijalta kaivattiin enemmän ennakkotietoa tai osaamista perehdytettävästä asiasta; esille nousi venäjän kielen huono taito. Huomioitavana seikkana mainittiin myös arvostuksen puute työssäoppimisprosessia ja sen toteutusta kohtaan. Harjoittelunohjaajat ja perehdyttäjät kaipasivat myös lisää yhteistyötä Sisekaitseakadeemian ja koulutusvankiloiden välille. Kehittämisehdotuksina nostettiin esille mm. perehdytyspassin käyttöönotto, yhtenäisen harjoitteluohjelman laatiminen ja IVA- portaalin laaja-alainen käyttäminen myös harjoittelunohjaajille sekä aktiivisille ja koulutetuille perehdyttäjille. Esille nousi myös perehdytystyöstä maksettava erillinen korvaus ja täydennyskoulutuksen tarjoaminen pedagogiikan ja didaktiikan teorioista sekä työssäoppimisprosessin toteutuksesta.Developing on-the-job learning in basic prison officer training in Estonia The purpose of the development project was to develop the on-the-job learning periods of the basic prison officer training in Estonia. The target groups were the day students in basic prison officer training at Sisekaitseakadeemia (Estonian Academy of Security Sciences) as well as the tutors and instructors in the training prisons. The empirical study aimed at identifying specific areas of development, so that the quality of the on-the-job learning periods could be enhanced and complete learning achieved. The qualitative study was carried out with the help of an electronic questionnaire survey. The research also included literary questions that yielded qualitative data. The adopted approach was developmental work research. The theoretical framework included theories on pedagogy, didactics, and on-the-job training (OJT), with cognitive learning theory governing the OJT learning process. The results were explained through theory and previous studies on OJT learning. We compared three doctorate theses, one university graduate thesis and one university of applied sciences bachelor’s degree thesis on the same area oi research. Previous studies, especially a study carried out in the same field in Finland in 2009, had yielded similar results. The empirical part of the study consisted of the questionnaire surveys directed at the day students in basic prison officer training at Sisekaitseakadeemia (n=8) and the tutors and instructors in the training prisons (n=18). These provided the primary data, gathered and analysed using the Webropol data analysis and survey tool. The literary data was analysed and categorized by us. The main purpose was to reveal areas in the implementation of the OJT learning that needed development and to spread the development throughout the OJT learning process. The main research results were that feedback discussions and creating challenging learning assignments require special attention. The OJT learning process and the pedagogical and didactic solutions thereof need to be better introduced to the personnel involved. Continuing education and training for carrying out the OJT periods was requested. Factors affecting communication, among other things, were the high workloads of the tutors and instructors as well as the negative attitudes some of the personnel had towards the trainees. As concerns the trainees, the tutors and instructors expressed a wish for more preknowledge and skills in prison work, e.g. in the Russian language. The lack of appreciation towards the OJT learning process and its realisation was pointed out. The tutors and instructors also wished for better cooperation between Sisekaitseakadeemia and the training prisons. Ideas for development were implementing a so-called tutoring pass, compiling a uniform training programme, the widespread use of the IVA portal for the tutors and instructors in order to carry out the OJT learning periods, special monetary compensation for tutoring, and available continuous education and training on pedagogy and didactics and the realisation of the OJT learning process

Työssäoppiminen osana vankeinhoidon perustutkintoa

Tehtävänämme oli suorittaa tutkimus, jonka tutkimustulosten pohjalta kirjoitamme Rikosseuraamusalan koulutuskeskukselle perustutkintojen työharjoittelujaksolle harjoittelunohjauksen käsikirjan. Tutkimuksemme tarkoituksena oli selvittää ennen harjoittelunohjauksen käsikirjan kirjoittamista, voidaanko hyvän harjoittelunohjauksen käsikirjan avulla saavuttaa laadukas pedagoginen ja didaktinen taso koulutusvankiloihin toteutettavaksi. Tarkoituksena oli myös selvittää mahdollisia ongelmia ja esteitä, jotka haittaavat laadukasta ja tehokasta oppimista ohjauksen aikana koulutusvankiloissa. Tutkimus oli kvantitatiivinen tutkimus, joka sisälsi myös kvalitatiivisen aineiston analyysia. Tutkimusote oli kehittäväntyön tutkimuksessa. Tutkimuksen teoreettinen viitekehys käsitte-lee yleisimpiä oppimiskäsityksiä ja siinä perehdytään vahvasti pedagogiikan ja didaktiikan kirjallisuuteen. Tutkimusta verrataan kahteen aikaisemmin työssäoppimisesta tehtyyn väitöskirjaan: Petri Pohjonen; Työssäoppiminen tarkasteltuna ammatillisen aikuiskoulutuksen ja työelämän näkökulmasta ja Pentti Väisänen; Työssäoppiminen ammatillisissa perusopinnoissa. Tutkimuksen empiirinen osa muodostui koulutusvankiloiden harjoittelunohjaajille ja perehdyttäjille (n=61) suunnatusta kyselystä, josta saimme primaarisen aineiston työhömme. Sekundaarisena aineistona pidettiin vuosien 2006–2008 perustutkintojen kokelaiden (n=160) antamaa palautetta työharjoittelujaksoilta. Lisäksi käytössämme oli vuoden 2005–2006 koulutusvankiloiden työharjoitteluohjelmat. Primaarinen aineisto käsiteltiin SPSS 13 Base tilastoanalyysiohjelmalla tulosten esiin saamiseksi. Tutkimuksessa keskityttiin tutkimaan työharjoittelujaksolla ilmeneviä ongelmia, opetussuunnitelmaa, kommunikaatiota, oppimista, ammatti-taitoa, palautteen antamista / arviointia, sekä kehittämistä. Tutkimus toi esille niitä epäkohtia, joita koulutusvankiloiden ohjaajat ja perehdyttäjät olivat havainneet työssään. Tarkastellessa Väisäsen ja Pohjosen väitöskirjoissa esille nousseita ongelmia, havaittiin vastaavia esteitä työssäoppimisen ideaalimallille myös vankeinhoitolaitoksessa. Nämä ongelmat tullaan huomioimaan ja niihin pyritään vaikuttamaan harjoittelunohjauksen käsikirjaa kirjoitettaessa. Keskeisinä ongelmina havaittiin mm. ohjaajien työajan puute ja arvostuksen puute tehtävää perehdytystyötä kohtaan. Oppilaan motivaatioon todellisen työn paljastuessa tulee myös kiinnittää erityistä huomiota laadukkaan oppimisprosessin toteutumiseksi. Opetussuunnitelmassa havaittiin laatueroja eri koulutusvankiloiden välillä, jonka vuoksi oppimistehtävien laatuun tulee kiinnittää erityistä huomiota. Työharjoittelujaksolla havaittiin eniten ongelmia kuntoutus- ja muu toimintateemassa, joka kuvastui niin kokelaiden, perehdyttäjien kuin ohjaajienkin palautteista. Tutkimuksen mukaan 82 % vastaajista oli suorittanut Rikosseuraamusalan koulutuskeskuksen täydennyskoulutuksena perehdyttäjäkoulutuksen, joten perehdyttäjien peruskoulutustaso on hyvä. Palautteenantamisessa ja ohjauskeskustelujen suorittamisessa havaittiin puutteita tai ne sekoitettiin keskenään. Harjoittelunohjauksen kehittämisideoina oli noussut esille mm. yhteistyön tehostaminen Rskk:n ja koulutusvankiloiden välillä työharjoittelujakson aikana.On-the-job learning as a part of the Basic Examination in Prison Services The purpose of this thesis was to conduct a piece of research that provides information for a tutor's handbook for the Training Institute for Prison and Probation Services to be used during the on-the-job learning period of the Basic Examination in Prison Services. Before compiling the handbook, it was needed to find out whether a manual could be of help in attaining a good pedagogic and didactic level of on-the-job tutoring in training prisons. Another goal was to map out the possible problems and hindrances preventing efficient and high-quality learning under the tutor's supervision during the on-the-job learning period. The study was quantitative, but also included an analysis of qualitative data and it was based on Developmental Work Research. The theoretical framework of the thesis included the latest concepts of learning, based on pedagogical and didactic literature. This thesis included a comparative analysis with two previously published theses on on-the-job learning, namely Työssäoppiminen tarkasteltuna ammatillisen aikuiskoulutuksen ja työelämän näkökulmasta by Petri Pohjonen and Työssäoppiminen ammatillisissa perusopinnoissa by Pentti Väisänen. The empirical part of the study consisted of a survey directed at tutors and instructors in training prisons (n=61), which provided the primary data. The secondary data consisted of the feedback the trainees of the Basic Examinations on Prison Services of 2006–2008 gave on their on-the-job learning period (n=160). In addition, the available information on the on-the-job learning programmes of 2005–2006 in the training prisons was used. The primary data was analysed using the SPSS 13 Base statistical analysis program. The research concentrated on problems, curriculum, communication, learning, professional skills, feedback / assessment, and development during the on-the-job learning period. The study revealed problems encountered by the tutors and instructors in the training prisons. When looking at the problems presented in the theses by Väisänen and Pohjonen, similar hindrances to the ideal model of on-the-job learning inside prison services were detected. These problems will be acknowledged and possible solutions will be presented in the tutor's handbook. Central problematic issues were the lack of sufficient time and appreciation for tutoring, among other things. Encouraging the motivation of the students when they discover the true nature of the profession is of special importance. The quality of curriculum varied between the training prisons, and the quality of learning assignments should be observed. Most of the problems involved the theme of Rehabilitation and other activities, which were reflected in the feedback given by the trainees, the tutors as well as the instructors. According to the results of this study, 82 % of the respondents had completed the tutor training provided by the continuing education programme at the Training Institute for Prison and Probation Services. Thus, it can be concluded that the tutor’s level of basic training is sufficient. Giving feedback and providing counselling were reported as inadequate or they were confused with one another. Suggestions for the future development of tutoring were intensifying the cooperation with the Training Institute and the training prisons during the on-the-job learning period

A tool for collaborative ontology development for the semantic web

We present a national ontology library development framework ONKI under development in Finland. ONKI’s main goal is to support collaborative development and re-use of interdependent ontologies. It features change management and versioning of ontologies as well as a browser component which provides the ontology search and utilization services as Web Services