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Background: Randomised controlled trials (RCTs) are considered the gold standard design to determine the effectiveness of an intervention, as the only method of decreasing section bias and minimising random error. However, participant recruitment to randomised controlled trials is a major challenge, with many trials failing to recruit the targeted sample size accordingly to the planned protocol. Thus, the aim of this review is to detail the recruitment challenges of preoperative exercise clinical trials. Methods: A comprehensive search was performed on MEDLINE, Embase, The Cochrane Library, CINAHL, AMED and PsycINFO from inception to July 2021. Randomised controlled trials investigating the effectiveness of preoperative exercise on postoperative complication and/or length of hospital stay in adult cancer patients were included. Main outcomes included recruitment rate, retention rate, number of days needed to screen and recruit one patient and trial recruitment duration. Descriptive statistics were used to summarise outcomes of interest. Results: A total of 27 trials were identified, including 3656 patients screened (N = 21) and 1414 randomised (median recruitment rate (interquartile range) = 53.6% (25.2%–67.6%), N = 21). The sample size of the included trials ranged from 19 to 270 (median = 48.0; interquartile range = 40.0–85.0) and the duration of trial recruitment ranged from 3 to 50 months (median = 19.0 months; interquartile range = 10.5–34.0). Overall, a median of 3.6 days was needed to screen one patient, whereas 13.7 days were needed to randomise one participant. Over the trials duration, the median dropout rate was 7.9%. Variations in recruitment outcomes were observed across trials of different cancer types but were not statistically significant. Conclusion: The recruitment of participants to preoperative exercise randomised controlled trials is challenging, but patient retention appears to be less of a problem. Future trials investigating the effectiveness of a preoperative exercise programme following cancer surgery should consider the time taken to recruit patients. Strategies associated with improved recruitment should be investigated in future studies. [ABSTRACT FROM AUTHOR]

The aims of this small-scale study were to explore the feasibility and outcomes of a parent-implemented intervention for two-year-olds at risk of language difficulties, and to explore the implications for the public health model of speech and language therapy (SLT). This adds to limited research into targeted SLT public health interventions. It is the first study to investigate early language intervention delivered by trained therapy assistants (TAs) rather than clinicians. Nine children aged between 26 and 31 months took part. Seven (78%) completed the six-session intervention. The outcome measure was the Words subscale of the Language Use Inventory. The gross motor subscale of the Ages and Stages Questionnaire was used as a control measure. Children's skills were assessed twice before intervention and once afterwards. At baseline, six participants had expressive language delay and no wider speech, language and communication needs (SLCNs). Five of this subgroup showed language use skills within the typical range following intervention. At baseline, three participants had expressive language delay and previously undetected receptive language and/or social interaction difficulties. None of this sub-group showed improved age-adjusted language use skills following intervention. All nine participants had gross motor skills in the typical range at each time point. These exploratory findings suggest this targeted intervention is feasible. This study presents no evidence of short-term impact of this intervention for two-year-olds with expressive language delay and wider SLCNs. These findings suggest this targeted language intervention for two-year-olds may be associated with accelerated language development for some two-year-olds at risk of language difficulties because of expressive language delay; and may help identify two-year-olds with previously undetected wider SLCNs, and therefore facilitate early access to specialist support. We highlight limitations in the study size, design and outcome measures, and identify how these preliminary findings can inform future research.

Background: Health literacy (HL) comprises skills and knowledge required to understand, access, and make decisions about healthcare. Our aim was to examine associations between patient HL and time intervals (defined in the Aarhus statement) along the pathway to treatment of head and neck cancer (HNC). Methods: A prospective cohort study was conducted from October 2018 to March 2020. Participants completed the Health Literacy Questionnaire (HLQ®) and described key events and dates along the pathway to treatment using validated questionnaires. Correlations between six diagnostic time intervals and domains of HL were explored, and factors predicting exceeding maximum acceptable timeframes were assessed using logistic regression. Results: One hundred patients with a diagnosis of HNC within the preceding 6 months were recruited. HLQ® Domain 2 (sufficient information to manage health) was significantly negatively associated with four intervals: the patient interval (first symptom to first presentation), primary care interval (first presentation to referral to secondary care), diagnostic interval (first presentation to diagnosis), and total interval (first symptom to treatment onset); correlation coefficients −0.25 to −0.27 (P < 0.05). Domain 8 (ability to find good information) was significantly negatively associated with three intervals (primary care interval, diagnostic interval, and total interval; correlation coefficients −0.23 to −0.34; P < 0.05). Higher education, age, and comorbidity levels were associated with shorter patient and diagnostic intervals. Conclusions: HL may be a potential target to improve timeliness of HNC diagnosis and reduce disparities in outcomes. [ABSTRACT FROM AUTHOR]

Objective. Lung cancer is commonly diagnosed and is the leading cause of cancer-related death, morbidity, and burden of disease globally. There is an ongoing need to ensure patients receive optimal evidence-based care and to identify and reduce unwarranted clinical variation to achieve best possible outcomes. The EnRICH program has developed evidence-based clinical quality indicators to measure processes and outcomes of lung cancer care, and a feedback dashboard to report comparative performance data, which highlight variation in both care and outcomes. The aims of this study were to evaluate the acceptability and utility of the quality indicators and feedback dashboard and identify benchmarks for performance monitoring and priorities for future quality improvement interventions to address observed clinical variation. Method. Clinicians from lung cancer multidisciplinary teams (MDTs) at six tertiary clinical sites across regional and metropolitan NSW were invited to participate in evaluation interviews. Interviews were conducted via videoconference and recorded with consent. Data were analysed thematically using framework methods. Results. Thirteen clinicians participated in interviews, with representation from each clinical site and specialty. All participants considered the quality indicators to be clinically meaningful. Three main themes were identified: (i) the importance of timely, local, quality data; (ii) implementable versus nonimplementable clinical practice changes; and (iii) the need for ongoing performance monitoring. Clinicians prioritised two areas of unwarranted clinical variation that could be immediately addressed through easily implementable quality improvement interventions to positively impact patient care: (i) a process to ensure that all stage III patients are discussed by a multidisciplinary team prior to commencing treatment; (ii) a referral pathway to palliative care within eight weeks for patients diagnosed with stage IV disease. The importance of lung cancer nurse specialists for improved care coordination was highlighted. Conclusion. Clinicians would like to continue to receive close-to-real-time quality data for ongoing performance monitoring to identify and address unwarranted clinical variation. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the trends in UC surgery in New South Wales (NSW) at a population level. Methods: A retrospective data linkage study of the NSW population was performed. Patients of any age with a diagnosis of UC who underwent a total abdominal colectomy (TAC) ± proctectomy between Jul‐2001 and Jun‐2019 were included. The age adjusted population rate was calculated using Australian Bureau of Statistics data. Multivariable linear regression modelled the trend of TAC rates, and assessed the effect of infliximab (listed on the Pharmaceutical Benefits Scheme for UC in Apr‐2014). Results: A total of 1365 patients underwent a TAC ± proctectomy (mean age 47.0 years (±18.6), 59% Male). Controlling for differences between age groups, the annual rate of UC TACs decreased by 2.4% each year (95% CI 1.4%–3.4%) over the 18‐year period from 1.30/100000 (2002) to 0.84/100000 (2019). An additional incremental decrease in the rate of TACs was observed after 2014 (OR 0.83, 95% CI 0.69–1.00). There was no change in the proportion of TACs performed emergently over the study period (OR 1.02, 95% CI 0.998–1.04). The odds of experiencing any perioperative surgical complication (aOR 1.54, 95% CI 1.01–2.33, P = 0.043), and requiring ICU admission (aOR 1.85, 95% CI 1.24–2.76, P = 0.003) significantly increased in 2014–2019 compared to 2002–2007. Conclusions: The rate of TACs for UC has declined over the past two decades. This rate decrease may have been further influenced by the introduction of biologics. Higher rates of complications and ICU admissions in the biologic era may indicate poorer patient physiological status at the time of surgery. [ABSTRACT FROM AUTHOR]

Background: Ileal pouch‐anal anastomosis (IPAA) is considered the gold standard reconstructive option in ulcerative colitis (UC). Recent efforts to improve pouch outcomes have seen a push towards centralisation of surgery. This study aimed to document outcomes following pouch surgery at a population level within New South Wales (NSW), and identify factors associated with, and temporal trends of these outcomes. Methods: A retrospective data linkage study of the NSW population over a 19‐year period was performed. The primary outcome was pouch failure in patients with UC who underwent IPAA. The influence of hospital level factors (including annual volume) and patient demographic variables on this outcome were assessed using Cox proportional hazards modelling. Temporal trends in annual volume and evidence for centralisation over the studied period were assessed using Poisson regression analysis. Results: The annual volume of UC pouches reduced over the study period. The pouch failure rates were 8.6% (95% CI 6.3–10.8%) and 10.6% (95% CI 8.0–13.1%) at 5‐ and 10‐years, respectively. Increasing age and non‐elective admission were associated with higher failure rates. One‐third of UC pouches (31.6%) were performed in a single institution, which averaged 6.5 pouches/year throughout the study period. Three‐quarters (19/25) of NSW public hospitals who performed pouches performed less than one UC pouch annually. Conclusions: The outcomes following UC pouch surgery in NSW are comparable with global standards. Concentrating IBD pouch surgery with the aim of producing specialist surgical teams may be a reasonable way forward in NSW and would ensure equity of access and facilitate research and training collaboration. [ABSTRACT FROM AUTHOR]

Intensive Speech and Language Therapy (SLT) training courses for Early Childhood Educators (ECEs) can have a positive effect on their use of interaction strategies that support children's communication skills. The impact of brief SLT training courses is not yet clearly understood. The aims of these two studies were to assess the impact of a brief SLT training course on ECEs' interaction behaviour, and to explore ECEs' views and experiences of the course. In Study 1, eight ECEs took part in a multiple-baseline study of a brief SLT training course. Video-recordings of interactions with children were used to evaluate ECEs' interaction behaviour using the Conversational Responsiveness Assessment and Fidelity Tool. In Study 2, seven ECEs took part in semi-structured interviews about this training course. Template analysis was used to identify key themes. In Study 1, the group of trained ECEs showed a statistically significant increase in their use of one communication-facilitating strategy (using comments to cue turn-taking) and a statistically significant decrease in their use of one conversation-hindering behaviour (asking yes/no, testing or rhetorical questions). Analysis at the individual level showed a modest increase in some ECEs' use of language-modelling strategies and a more generalized decrease in conversation-hindering behaviours. In Study 2, ECEs more consistently reported learning and using communication-facilitating strategies than language-modelling strategies. ECEs identified several features of the training course that facilitated learning: the practical, interactive nature of the group training sessions, the use of video feedback, and the repetition of key strategies in several training sessions. We conclude that brief SLT training for ECEs can lead to increased use of some interaction strategies that help children's communication skills develop. Further research is needed to evaluate brief SLT training more thoroughly.

In a survey of career awareness among high school seniors in Northern California, almost all students agreed that career is an important consideration for them, and about two-thirds reported that they had decided on an occupational field. However, only about half reported that they were comfortable with their current career decision-making, had a clear idea of their own interests and abilities, or had sufficient knowledge about potential occupations. Minority students tended to express greater needs with regard to career exploration than white students. Compared to other groups, significantly fewer Latino males had made an occupational decision. Part-time work during the students’ senior year did not appear to hinder school grades or school engagement. In fact, working was associated with generally higher levels of career awareness, especially regarding the importance of career planning. However, part-time work was associated with increases in reported stress levels.