Assessing the feasibility and acceptability of a diabetes-specific nurse-led multicomponent smoking cessation intervention in diabetes education: study protocol for an open-label pragmatic randomised controlled trial.

INTRODUCTION: Smoking cessation is an essential, but often overlooked aspect of diabetes management. Despite the need for tailored smoking cessation support for individuals with diabetes, evidence of effective interventions for this cohort is limited. Additionally, individuals with diabetes do not easily adopt such interventions, resulting in low uptake and abstinence rates. This protocol describes a study that aims to assess the feasibility and acceptability of a unique smoking cessation intervention, based on the best evidence, theory and the needs of individuals with diabetes, among patients and service providers, the diabetes nurse educators. METHODS AND ANALYSIS: This is an open-label pragmatic randomised controlled trial. Between 80 and 100 individuals with type 1 or type 2 diabetes who smoke will be recruited from the diabetes outpatients at the main acute public hospital in Malta, starting in August 2023. Participants will be randomly assigned (1:1 ratio) to the intervention or control arm for 12 weeks. The experimental intervention will consist of three to four smoking cessation behavioural support sessions based on the 5As (Ask, Advise, Assess, Assist and Arrange) algorithm, and a 6-week supply of nicotine replacement therapy. The control intervention will consist of an active referral to the Maltese National Health Service's one-to-one smoking cessation support service, which is based on motivational interviewing. The primary feasibility and acceptability outcomes include the recruitment and participation rates, resources used, problems identified by the nurses, the nurses' perceived challenges and facilitators to implementation and the nurses' and patients' acceptability of the study intervention. Data analyses will be descriptive, with quantitative feasibility and acceptability outcomes reported with 95% confidence intervals. ETHICS AND DISSEMINATION: Ethical clearance was obtained from the Faculty of Health Sciences Research Ethics Committee, University of Malta. The study results will be disseminated through conference presentations and a publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT05920096.

Acceptability measures for evaluating smoking cessation interventions among individuals with diabetes.

Background: The literature indicates that individuals with diabetes do not easily adopt smoking cessation interventions. Given that the success of such interventions depends on patient involvement and attitudes, assessing intervention acceptability, including patient satisfaction and perceived usefulness, is crucial before implementing a smoking cessation intervention. This paper reports the preliminary validation of the satisfaction and perceived usefulness questionnaires for evaluating smoking cessation interventions among individuals with diabetes. Study design: Validity study. Methods: The satisfaction questionnaire contained eight statements while the perceived usefulness questionnaire had fourteen; both rated on a 5-point Likert scale. Content validation involved five tobacco cessation facilitators rating item relevance using a 4-point ordinal rating scale, suggesting improvements. The questionnaires were also translated into Maltese for local use and assessed for translation validity using a similar scale. Unanimous agreement among experts was required for item relevance and equivalence. Thirty-four individuals with type 1 or type 2 diabetes, attending a diabetes-specific smoking cessation intervention, received either the Maltese or English versions of the questionnaires. Internal consistency was measured using Cronbach's alpha. Results: After two rounds of content validation, the experts unanimously agreed on item relevance and conceptual equivalence. Fifteen and sixteen participants completed the Maltese and English versions of the questionnaires, respectively. Both questionnaires' versions were found to have a high internal consistency (>0.8). Conclusions: These findings provide the initial validation of these instruments for assessing the acceptability of smoking cessation interventions among individuals with diabetes. Further validation in different settings using a larger sample is suggested.

Exploring the smoking cessation needs of individuals with diabetes using the Information-Motivation-Behavior Skills model.

INTRODUCTION: Smoking cessation is an important aspect of diabetes management. Despite the increased risk for diabetes complications when smoking, evidence suggests that people living with type 1 and type 2 diabetes are less likely to quit smoking when compared to those without diabetes. Guided by the Information-Motivation-Behavioral Skills model, this study aimed to identify the needs of individuals living with type 1 and type 2 diabetes to quit smoking. METHODS: A qualitative descriptive design was adopted. Semi-structured telephone interviews were held between April and June 2021, with 20 former and current Maltese smokers living with type 1 or type 2 diabetes, recruited from the diabetic clinics within the two main acute public hospitals. The interview transcriptions were analyzed using applied thematic analysis. RESULTS: Individuals with diabetes need more information on the effects of smoking on diabetes to encourage cessation. Preventing diabetic complications was reported as a motivator to quit smoking. However, having diabetes was identified as a challenge to quitting. Participants welcomed the provision of health professional support for quitting smoking, identifying the need to provide smoking cessation support within diabetic clinics. The provision of information on tobacco-associated diabetic complications, by using video messages featuring former smokers' stories was also suggested. CONCLUSIONS: To promote smoking cessation among individuals with diabetes, they need to be informed about how smoking affects their condition. Utilizing video messages featuring real-life stories of former smokers with diabetes who experienced tobacco-associated diabetic complications may be influential. Additionally, providing diabetes-specific intensive smoking cessation support is crucial to help them quit.

Feasibility and acceptability of a culturally adapted psychological first aid training intervention (Preparing Me) to support the mental health and well-being of front-line healthcare workers in China: a feasibility randomized controlled trial.

Background: Psychological first aid (PFA) training helps to prepare healthcare workers (HCWs) to manage trauma and stress during healthcare emergencies, yet evidence regarding its effectiveness and implementation is lacking.Method: A two-arm feasibility randomized controlled trial design was conducted in a Chinese tertiary hospital. Participants were randomly allocated to receive either a culturally adapted PFA training (the intervention arm) or psychoeducation (the control arm). Feasibility indicators and selected outcomes were collected.Results: In total, 215 workers who expressed an interest in participating in the trial were screened for eligibility, resulting in 96 eligible participants being randomly allocated to the intervention arm (n = 48) and control arm (n = 48). There was a higher retention rate for the face-to-face PFA training session than for the four online group PFA sessions. Participants rated the PFA training as very helpful (86%), with a satisfaction rate of 74.25%, and 47% reported being able to apply their PFA skills in responding to public health emergencies or providing front-line clinical care. Positive outcome changes were observed in PFA knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth. Their scores on depression, anxiety, stress, and burnout measures all declined. Most of these changes were sustained over 3 months (p < .05). Repeated measures analysis of variance found statistically significant interaction effects on depression (F2,232 = 2.874, p = .046, ηp2 = .031) and burnout (F2,211 = 3.729, p = .018, ηp2 = .037), indicating a greater reduction in symptoms of depression and burnout with PFA compared to psychoeducation training.Conclusion: This culturally adapted PFA training intervention was highly acceptable among Chinese HCWs and was feasible in a front-line care setting. Preliminary findings indicated positive changes for the PFA training intervention on knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth, especially a reduction of depression and burnout. Further modifications are recommended and a fully powered evaluation of PFA training is warranted.

Psychological first aid (PFA) training was culturally adapted and evaluated to help prepare healthcare workers to manage trauma and stress during healthcare emergencies.This culturally adapted PFA training was highly acceptable among Chinese healthcare workers and was feasible in a front-line care setting.Preliminary findings show positive changes for the PFA training intervention on knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth, especially a reduction of depression and burnout.

The Effectiveness and Implementation of Psychological First Aid as a Therapeutic Intervention After Trauma: An Integrative Review.

Psychological First Aid (PFA) is known to be an initial early intervention following traumatic exposure, yet little is known about its optimal implementation and effectiveness. This review aims to examine the evidence for the effectiveness of PFA interventions and how PFA interventions have been designed, implemented, and experienced. MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsychINFO, Embase, Web of Science, PILOTS, and China National Knowledge Infrastructure (in Chinese) databases were searched. Twenty studies from 4,735 records were included and quality rated, followed by an integrative synthesis of quantitative and qualitative evidence. PFA intervention following trauma exposure shows a positive effect for reducing anxiety and facilitating adaptive functioning in the immediate and intermediate term, yet the evidence for reducing Post-traumatic stress disorder/depressive symptoms is less compelling. Furthermore, commonalities in the components and techniques across different PFA approaches identified tend to align with four of Hobfoll's five essential elements: safety, calm, efficacy, and connectedness (as reflected among 7/11 PFA protocols), whereas the "hope" element was less developed. These commonalities include active listening, relaxation/stabilization, problem-solving/practical assistance, and social connection/referral. Intensive techniques such as cognitive reconstruction have also been incorporated, intensifying PFA delivery. The substantial variation observed in PFA format, timing, and duration, coupled with inadequate documentation of fidelity of implementation and adaptation, further constrains the ability to inform best practices for PFA. This is concerning for lay frontline providers, vital in early trauma response, who report implementation challenges despite valuing PFA as a time-sensitive, supportive, and practical approach.

Llamamiento a adoptar medidas urgentes para limitar los aumentos de temperatura en el mundo, restablecer la diversidad biológica y proteger la salud

[Extract]. En septiembre del 2021, la Asamblea General de las Naciones Unidas reunirá a los países en un momento crucial para orga-nizar la acción colectiva con el propósito de hacer frente a la crisis medioambiental mundial. Se reunirán una vez más en la Conferencia de las Naciones Unidas sobre la Diversidad Bioló-gica, en Kunming (China) y en la Conferencia de las Naciones Unidas sobre el Cambio Climático (CP26), en Glasgow (Escocia). Antes de la celebración de estas reuniones trascendenta-les, nosotros —los editores de revistas sobre salud de todo el mundo— exigimos medidas urgentes para mantener los aumen-tos promedio de la temperatura a nivel mundial por debajo de 1,5 °C, detener la destrucción de la naturaleza y proteger la salud.

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

[EXTRACT]. The UN General Assembly in September 2021 will bring coun-tries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (COP26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature, and protect health.Health is already being harmed by global temperature increa-ses and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1The science is unequivocal; a global increase of 1.5°C above the pre-industrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2,3Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions.Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recogni-sing that only fundamental and equitable changes to societies will reverse our current trajectory.

An online mindfulness intervention to enhance compassion in nursing practice: A feasibility and acceptability study with nursing students.

Background: Compassion is an important component of nursing care, but public enquiries into care failures have noted that it is not always evident. Mindfulness interventions have the potential to support compassion. However, the feasibility of delivering a mindfulness intervention at scale to nursing students has not been established. Objectives: To develop and test the feasibility and acceptability of a tailored mindfulness based online intervention to foster compassion in nursing students within clinical practice. Design: A randomised feasibility study with a waiting list control. Setting: A UK nursing faculty within a large university. Participants: Post-graduate, post-registration and pre-registration nursing students (N = 77). Methods: An online five module mindfulness based intervention (Mindful Nursing Online) was developed and tailored to support compassion in clinical nursing. The feasibility study comprised 77 participants randomised in a 2:1 ratio into an immediate access group (intervention, n = 50) or a delayed access group (waiting list control, n = 27). Data on feasibility through completion, attrition and practice rates, were collected through follow-up questionnaires at post-intervention, and 14 and 20 weeks after baseline. Acceptability data was collected through semi-structured interviews with 12 participants. Results: Non-completion rates were high with all five modules completed by only 28% (n = 14) of participants, and three modules completed by only 46% (n = 23). The most commonly cited reason for non-completion was lack of time. However, the interview data suggested those who completed the intervention were using mindfulness techniques in practice. They described feeling less stressed on the ward, having an increased focus on patients and a greater appreciation of the importance of self-care. Evaluative feedback therefore showed that the intervention was perceived to be effective at promoting mindfulness skills and was relevant to nursing work. Conclusion: Minimising attrition and enhancing engagement with the intervention should be the key objectives of a future study. Feedback from participants who completed the intervention indicates that a brief mindfulness intervention delivered online may support the delivery of compassionate nursing care.

Adaptação transcultural e validação da Readiness for Interprofessional Learning Scale no Brasil / Adaptación transcultural y validación de la Readiness for Interprofessional Learning Scale en Brasil / Cross-cultural adaptation of the Readiness for Interprofessional Learning Scale in Brazil

RESUMO Objetivo Realizar a adaptação transcultural e a validação da versão de 29-itens daReadiness for Interprofessional Learning Scale (RIPLS) para língua portuguesa falada no Brasil. Método Foram adotadas cinco etapas: três traduções, síntese, três retrotraduções, avaliação por especialistas e pré-teste. A validação contou com 327 estudantes de 13 cursos de graduação de uma universidade pública. Foram realizadas análises paralelas com o software R e a análise fatorial utilizando Modelagem de Equações Estruturais. Resultados A análise fatorial resultou em uma escala de 27 itens e três fatores: Fator 1 - Trabalho em equipe e colaboração com 14 itens (1-9, 12-16), Fator 2 - Identidade profissional, oito itens (10, 11, 17, 19, 21-24), e Fator 3 - Atenção à saúde centrada no paciente, cinco itens (25-29). Alfa de Cronbach dos três fatores foi respectivamente: 0,90; 0,66; 0,75. Análise de variância mostrou diferenças significativas nas médias dos fatores dos grupos profissionais. Conclusão Foram identificadas evidências de validação da versão em português da RIPLS em sua aplicação no contexto nacional.

RESUMEN Objetivo Realizar la adaptación transcultural y la validación de la versión de 29 ítems de la Readiness for Interprofessional Learning Scale(RIPLS) para el portugués hablado en Brasil. Método Adoptado cinco etapas: tres traducciones, síntesis, tres retro-traducciones, evaluación de expertos y pretest. Validación consistió de 327 alumnos de 13 cursos de formación de grado en una universidad pública. Análisis paralelos con el software R y análisis factorial utilizando Modelo de Ecuaciones Estructurales fueron realizados. Resultados El análisis factorial resultó en una escala de 27 ítems y tres factores: Factor 1 - Trabajo en equipo y colaboración con 14 ítems (1-9, 12-16), Factor 2 - Identidad Profesional ocho ítems (10, 11, 17, 19, 21-24) y Factor 3 - Atención a la salud centrada en el paciente, cinco ítems (25- 29). El Alfa de Cronbach de los tres factores fueron, respectivamente: 0,90; 0,66; 0.75. Análisis de varianza mostró diferencias significativas en los promedios de los grupos profesionales. Conclusión Se identificaron evidencias de validación de la versión en portugués de RIPLS en su aplicación en el contexto nacional.

ABSTRACT Objective Conduct a cross-cultural adaptation of the expanded version of the 29-items Readiness for Interprofessional Learning Scale (RIPLS) into Brazilian Portuguese. Method Five steps were adopted: three translations, synthesis, three back-translations, assessment by an expert committee, and pre-test. Validation comprised 327 students from 13 undergraduate health courses from a public university. Parallel analyses were conducted using the R software and factor analysis using Exploratory Structural Equation Modeling. Results 1 9 12 16 10 11 17 19 21 24 25 29 Conclusion Evidences were found relating to the validity of the RIPLS version in Brazilian Portuguese in its application in the national context.

Educacao interprofissional: formacao de profissionais de saude para o trabalho em equipe com foco nos usuarios / Educacion interprofesional: la formacion de profesionales de la salud para el trabajo en equipo con enfoque en los usuarios / Interprofessional education: training for healthcare professionals for teamwork focusing on users

São analisados os constructos teóricos da educação interprofissional com base em duas revisões de literatura, considerado o contexto da formação dos profissionais de saúde no Brasil. Identificam-se três tipos de formação: uniprofissional, multiprofissional e interprofissional, com predomínio da primeira, que ocorre entre estudantes de uma mesma profissão de forma isolada; a segunda, entre estudantes de duas ou mais profissões de forma paralela, sem haver interação, e na terceira há aprendizagem compartilhada, com interação entre estudantes e/ou profissionais de diferentes áreas. Destaca-se a distinção entre interprofissionalidade e interdisciplinaridade, referidas, respectivamente, como a integração das práticas profissionais e das disciplinas ou áreas de conhecimento. Mediante a análise apresentada, conclui-se que no contexto brasileiro, a educação interprofissional, base para o trabalho em equipe colaborativo, ainda está restrita a iniciativas recentes, que merecem estudo.

Fueron analizados los constructos teóricos de la educación interprofesional basado en dos revisiones de la literatura, considerando el contexto de la formación de los profesionales de salud en Brasil. Se identificaron tres tipos de formación: uniprofesional, multiprofesional e interprofesional, con predominio de la primera, que se produce entre los estudiantes de una misma profesión de forma aislada; la segunda, entre los estudiantes de dos o más profesiones de forma paralela, sin existir interacción y, en la tercera existe un aprendizaje compartido, con interacción entre los estudiantes y/o profesionales de diferentes áreas. Se destaca la diferencia entre interprofesionalidad e interdisciplinariedad referidas, respectivamente, como la integración de las prácticas profesionales y de las disciplinas o áreas de conocimiento. A partir del análisis se concluye que en el contexto brasileño, la educación interprofesional base para el trabajo en equipo colaborativo, todavía está restringido a iniciativas recientes, que merecen estudio.

The theoretical constructs of interprofessional education (IPE) are analyzed based on two reviews of the literature, taking the context of training for healthcare professionals in Brazil into consideration. Three types of training are identified: uniprofessional, multiprofessional and interprofessional, with predominance of the first type. The first occurs among students of the same profession, in isolation; the second occurs among students of two or more professions, in parallel without interaction; and the third involves shared learning, with interaction between students and/or professionals from different fields. The distinction between interprofessionalism and interdisciplinarity is highlighted: these refer to integration, respectively, of professional practices and disciplines or fields of knowledge. Through the analysis presented, it is concluded that in the Brazilian context, IPE (the basis for collaborative teamwork) is still limited to some recent initiatives, which deserve to be investigated.