Continuing Medical Education Programs Research Articles

Risk factors for hepatitis C: A clinical study

Introduction: Hepatitis C is caused by hepatitis C virus (HCV), which is classified into 6 genotypes. It leads to chronic liver disease in majority of cases resulting in morbidity and mortality. Awareness of cause of a disease prevents its progression in the community so knowledge regarding the cause of infection (HCV) is necessary to devise a strategy to prevent its spread. The present study was undertaken to assess the incidence, prevalence, and cause of Hepatitis C among the Malwa region of Punjab, India. Materials and Methods: Seven hundred and forty hepatitis C-positive patients were included in the study. Prevalidated questionnaire was designed to collect their demographic information including age, gender, demographic area, occupation, and clinical information including the history of dental treatment (extraction, root canal treatment, and scaling), blood donation, blood transfusion, surgical intervention, drug abuse (oral or intravenous), and tattooing. Collected data were analyzed by statistical tests. Results: Among the study population, a large number of patients, that is, 84.8% presented with a history of dental treatment indicating that a number of 190 (25.6%) patients had received dental treatment from family dentist and 175 (23.6%) from referral dentist, that is, from the government hospital. A large number of patients 270 (36.5%) had received dental treatment from Quacks in the past. Blood transfusion was received by 8.1% and 17.6% had donated blood in the past. Conclusion: The etiology of HCV is multifactorial with inadequate awareness about the routes of transmission of infection among patients, therefore, knowledge regarding this issue is important. The use of disposable syringes, sterilization protocol, disposal, strictly following biomedical waste management guidelines, and organizing continued medical and dental education programs, and workshops will help in preventing the spread of HCV infection.

The Librarian’s Contribution to Continuing Medical Education

ABSTRACTAt many hospitals, including Robert Wood Johnson (RWJ) University Hospital Rahway, librarians facilitate continuing medical education (CME) programs, sometimes working in that capacity as much as in their traditional librarian functions such as reference, research, cataloging, and bibliographic instruction. This column traces the relationship between the two aspects of the RWJ Rahway’s CME coordinator and health sciences librarian’s job to demonstrate that, because of their duties and skills, medical librarians can meaningfully contribute to hospitals’ CME programs. The worlds of librarianship and CME are further connected by the same goal: the dissemination of information.

Online continuing medical education as a key link for successful noncommunicable disease self-management: the CASALUD™ Model.

PurposeThe purpose of this study is to evaluate how the benefits of online continuing medical education (CME) provided to health care professionals traveled along a patient “educational chain”. In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers.MethodsA total of 422 patients with at least one noncommunicable disease (NCD) treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers.ResultsBetween 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively). Performing self-care activities – including owning and using a glucometer and belonging to a disease support group – saw the highest increase (from 0.65 to 0.75). A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63–68 mmol/mol) (P<0.001), and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg) (P<0.001). The mean levels of other disease biomarkers remained statistically unchanged, despite the improvements seen in the previous “links” of the educational chain.ConclusionOnline CME can effect certain changes in the educational chain linking quality of health care, patient knowledge, and self-management behaviors. However, in order to assure adequate NCD control, the entire health care system must be improved in tandem. Online CME programs, such as CASALUD’s, are feasible strategies for impacting changes in disease self-management at a clinic level throughout a country.

Development and Implementation of a Continuing Medical Education Program in Canada: Knowledge Translation for Renal Cell Carcinoma (KT4RCC).

An in-person multidisciplinary continuing medical education (CME) program was designed to address previously identified knowledge gaps regarding quality indicators of care in kidney cancer. The objective of this study was to develop a CME program and determine if the program was effective for improving participant knowledge. CME programs for clinicians were delivered by local experts (uro-oncologist and medical oncologist) in four Canadian cities. Participants completed knowledge assessment tests pre-CME, immediately post-CME, and 3-month post-CME. Test questions were related to topics covered in the CME program including prognostic factors for advanced disease, surgery for advanced disease, indications for hereditary screening, systemic therapy, and management of small renal masses. Fifty-two participants attended the CME program and completed the pre- and immediate post-CME tests. Participants attended in Ottawa (14; 27%), Toronto (13; 25%), Québec City (18; 35%), and Montréal (7; 13%) and were staff urologists (21; 40%), staff medical oncologists (9; 17%), fellows (5; 10%), residents (16; 31%), and oncology nurses (1; 2%). The mean pre-CME test score was 61% and the mean post-CME test score was 70% (p=0.003). Twenty-one participants (40%) completed the 3-month post-CME test. Of those that completed the post-test, scores remained 10% higher than the pre-test (p value 0.01). Variability in test scores was observed across sites and between French and English test versions. Urologists had the largest specialty-specific increase in knowledge at 13.8% (SD 24.2, p value 0.02). The kidney cancer CME program was moderately effective in improving provider knowledge regarding quality indicators of kidney cancer care. These findings support continued use of this CME program at other sites.

The Leadership Case for Investing in Continuing Professional Development.

Continuing medical education (CME) has the power and capacity to address many challenges in the health care environment, from clinician well-being to national imperatives for better health, better care, and lower cost. Health care leaders who recognize the strategic value of education and engage their people in education can expect a meaningful return on their investment-not only in terms of the quality and safety of their clinicians' work but also in the spirit and cohesiveness of the clinicians who work at their institution. To optimize the benefits of education, clinical leaders need to think of accredited CME as the professional development vehicle that can help them drive change and achieve goals, in consort with quality improvement efforts, patient safety projects, and other systems changes. An empowered CME program, with its multiprofessional scope and educational expertise, can contribute to initiatives focused on both clinical and nonclinical areas, such as quality and safety, professionalism, team communication, and process improvements. In this Invited Commentary, the author describes principles and action steps for aligning leadership and educational strategy and urges institutional leaders to embrace the continuing professional development of their human capital as an organizational responsibility and opportunity and to view engagement in education as an investment in people.

The Intervisions Cliniques Continuing Medical Education Program: A Forum for Exchange and Mutual Knowledge Development between General Practitioners and Psychiatrists

The Intervisions Cliniques Continuing Medical Education Program: A Forum for Exchange and Mutual Knowledge Development between General Practitioners and Psychiatrists

Knowledge of Thyroid Disorders during Pregnancy among General Practitioners in Iran

Background and ObjectivesThyroid disorders during pregnancy are important health problems worldwide. The aim of this study was to assess the knowledge of general practitioners (GPs) about thyroid disorders during pregnancy.MethodsIn this cross sectional study, 120 GPs were randomly selected among participants of a continuous medical education (CME) program, entitled “practical endocrinology”. To assess the knowledge and educational requirements of GPs regarding thyroid disorders during pregnancy, a validated and localized multiple-choice questionnaire was used.ResultsA total of 100 GPs completed the questionnaire. The mean age of the participants was 37.0 years, and 41.4% were men. The mean knowledge score of GPs was 39.9%. On average, the rate of correct response to questions concerning the definition, pathophysiology, diagnosis, complications, and treatment of thyroid disorders was 39.0%, 39.3%, 48.8%, 34.3%, and 44.6%, respectively. There was a significant difference in knowledge among GPs, who had and had not passed the training course on thyroid disorders. In addition, GPs who had passed continuous medical education programs obtained higher knowledge scores regarding diagnosis and treatment (P < 0.05).ConclusionsGPs attending pregnant women in Iran lack sufficient information on the pathophysiology, diagnosis, and management of thyroid disorders during pregnancy. Considering the key role of GPs in the public healthcare system, design of high-quality educational programs and development of specific educational packages about thyroid disorders and pregnancy are necessary.

Effective learning environments - the process of creating and maintaining an online continuing education tool.

Continuing medical education (CME) is an indispensable part of maintaining physicians’ competency. Since attending conferences requires clinical absenteeism and is not universally available, online learning has become popular. The purpose of this study is to conduct a retrospective analysis examining the creation process of an anesthesia website for adherence to the published guidelines and, in turn, provide an illustration of developing accredited online CME. Using Kern’s guide to curriculum development, our website analysis confirmed each of the six steps was met. As well, the technical design features are consistent with the published literature on efficient online educational courses. Analysis of the database from 3937 modules and 1628 site evaluations reveals the site is being used extensively and is effective as demonstrated by the participants’ examination results, content evaluations and reports of improvements in patient management. Utilizing technology to enable distant learning has become a priority for many educators. When creating accredited online CME programs, course developers should understand the educational principles and technical design characteristics that foster effective online programs. This study provides an illustration of incorporating these features. It also demonstrates significant participation in online CME by anesthesiologists and highlights the need for more accredited programs.

Enhancing clinician confidence on the therapeutic management of non-small cell lung cancer (NSCLC) through continuing medical education (CME).

e18271 Background: The evolving strategies to personalize NSCLC treatment have challenged clinicians to remain abreast of and integrate targeted therapy into practice. To address this challenge, 2 CME programs on NSCLC were developed in 2 formats (1-hour cumulative program and a series of 3-1 hour specified programs). Participant responses were compared between the 2 formats to examine differences in learner confidence and competence regarding the management of NSCLC with targeted therapy. Methods: PlatformQ Health developed and executed 2 virtual CME programs in NSCLC. The first program, broadcast in August 2015 and offered for 6 months, attracted 225 learners. This 1 hour program reviewed the latest data of EGFR inhibitors (EGFRi), ALK inhibitors (ALKi), and immunotherapy. In 2016, these 3 topics were divided into a series of 3-1 hour CME programs and offered across the year, which has attracted 371 learners. Survey-based evaluations targeted self-reported clinician data on competence (via patient case studies) and confidence. Results: As of January 2017, learner surveys from EGFR- and ALK-focused education were analyzed. It was observed that learners gained more confidence in managing EGFRi-related toxicities after the 2016 serial education vs the 2015 cumulative education (62% vs 43%, respectively). Learners also felt more confident when evaluating data of available and emerging ALKi (49% vs 35%). Greater competence in management was observed with serial vs cumulative education regarding EGFRi (42% and 15%, respectively) and ALKi (30% and 4%) therapies. Both programs demonstrated a high learner commitment to change in: medical and practice knowledge (93% and 91%, respectively), care attitudes (87% and 87%), practice behavior (85% and 79%), and patient clinical outcomes (86% and 77%). Data analysis on immunotherapy education is ongoing. Conclusions: Overall, education on targeted therapy for NSCLC have demonstrated positive learner outcomes. However, designing education in a serial format that dives deeper into each therapeutic target class affords greater improvements in clinician confidence and learner competence in the therapeutic management of NSCLC.

The impact of continuing medical education (CME) programs in metastatic castration-resistant prostate cancer (CRPC).

e18280 Background: The concurrent development of many CRPC treatments within a short period of time has made prospective data on their sequential use and efficacy complicated, which have challenged clinician confidence, knowledge, and competency. Four hours of CME focused on the therapeutic management of CRPC were developed and participant responses analyzed to determine if these challenges were addressed. Methods: PlatformQ Health developed and executed 4 hours of virtual CME programs in CRPC. The 1st 2-hours, broadcast in May 2015 and offered online for 6 months, attracted a total of 545 learners. The 2nd 2-hours, broadcast in July 2016 and offered for 12 months, attracted a total of 345* learners. Survey-based evaluations targeted self-reported clinician data on satisfaction, clinical practice change and observed patient outcome. Clinician participation data and self-reported patients with CRPC seen per week were used in extrapolations of patients impacted by the CME education per week. Results: Between the 2015 and 2016 CME programs, learners gained confidence in their ability to employ a personalized, sequential approach to treat CRPC (12% vs 35%). Overall, 68% of all learners reported a positive clinical practice impact and 59% reported a positive impact on patient experience and/or outcomes as a result of CME participation. Learner commitment to change was consistently observed in both 2015 and 2016 programs in: medical and practice knowledge (90% and 94%, respectively), care attitudes (83% and 85%), practice behavior (79% and 77%), and their patients’ clinical outcomes (76% and 78%). An estimated 4,066 patients in 2015 and 3,374 patients in 2016 were impacted as a result of the education. Conclusions: Outcomes results of 2 years of education on evolving treatment paradigms of metastatic CRPC demonstrate learner improvements in both clinical practice and patient outcomes. Continuing education in the management of CRPC is recommended, particularly on strategies to appropriately sequence treatments, treatment of bone metastases, keeping abreast of new data, and understanding the rationale for investigational agents. *As of Jan 2017, data collection is ongoing

An Analysis of 2.3 Million Participations in the Continuing Medical Education Program of a General Medical Journal: Suitability, User Characteristics, and Evaluation by Readers.

BackgroundPhysicians frequently use continuing medical education (CME) in journals. However, little is known of the evaluation of journal CME by readers and also user and participation characteristics. Deutsches Ärzteblatt, the journal of the German Medical Association, is distributed to every physician in Germany and regularly offers its readers CME articles. Therefore, it provides a unique opportunity to analyze a journal CME program directed at an entire population of physicians.ObjectiveThe aim is to show key sociodemographic characteristics of participants, frequency and temporal distributions of participations, and to analyze whether the articles are suitable for a general medical audience, how physicians rate the CME articles, how successful they were in answering simple multiple-choice questions, and to detect distinct clusters of participants.MethodsUsing obligatory online evaluation forms and multiple-choice questions, we analyzed all participations of the entire 142 CME articles published between September 2004 and February 2014. We compared demographic characteristics of participants with official figures on those characteristics as provided by the German Medical Association.ResultsA total of 128,398 physicians and therapists (male: 54.64%, 70,155/128,393; median age class 40 to 49 years) participated 2,339,802 times (mean 16,478, SD 6436 participations/article). Depending on the year, between 12.33% (44,064/357,252) and 16.15% (50,259/311,230) of all physicians in the country participated at least once. The CME program was disproportionally popular with physicians in private practice, and many participations took place in the early mornings and evenings (4544.53%, 1,041,931/2,339,802) as well as over the weekend (28.70%, 671,563/2,339,802). Participation by specialty (ranked in descending order) was internal medicine (18.25%, 23,434/128,392), general medicine (16.38%, 21,033/128,392), anesthesiology (10.00%, 12,840/128,392), and surgery (7.06%, 9059/128,392). Participants rated the CME articles as intelligible to a wider medical audience and filling clinically relevant knowledge gaps; 78.57% (1,838,358/2,339,781) of the sample gave the CME articles very good or good marks. Cluster analysis revealed three groups, one comprised of only women, with two-thirds working in private practice.ConclusionsThe CME article series of Deutsches Ärzteblatt is used on a regular basis by a considerable proportion of all physicians in Germany; its multidisciplinary articles are suitable to a broad spectrum of medical specialties. The program seems to be particularly attractive for physicians in private practice and those who want to participate from their homes and on weekends. Although many physicians emphasize that the articles address gaps in knowledge, it remains to be investigated how this impacts professional performance and patient outcomes.

Operational Difficulties in Obese Patients

Background and aim of the work: to give optimal care for obese surgical patients, surgeons and healthcare personnel should be aware about the surgical problems which may be met in obese patient and how to overcome a variety of challenges. In this study the awareness of the surgeons about the obesity as surgical problem would be evaluated from the surgical staff point of view. Patient and methods: a cross-sectional study was done by interviewing the surgeons to fill the questionnaire focusing on their awareness about the prevalence of operational difficulties in obese patients. Results: the study included 82 surgeons most of them practice general surgery. The majority of surgeons found that the main cause of obesity amongst their patients is dietary factors (91.5%). The same percent of surgeons (higher percentage in residents) agreed that obesity might modify the surgical decision. According to the survey, they patients of age between 30-45years represented the majority and most of them were females. Over 89% of surgeons found that the complications are more in obese patients than in average weight patients. All specialties (especially general surgeons) agreed that obesity increases the operative time. Infection was the major problem mentioned by surgeons followed by anesthetic problems and the size of the instrument used. Over 64.6% of surgeons agreed that some operations need to reduce patient weight to be performed. Most of surgeons (42.7%) agreed that surgical error is higher in obese patients; however, 37.8% agreed that surgical errors in obese and average weight patients are equal. The majority of surgeons (68.3%) agreed that experience of the surgeon will differ in theatre. 81.7% of surgeons agreed that obese patient needs more evaluation prior to surgery than average weight patient. 72% agreed that obese patients have prolonged hospital stay. Conclusion: The study revealed a good to excellent awareness of KSA surgeons about surgical problems which may be met in obese patient and how to overcome a variety of challenges reflecting the values of continuous medical education programs applied in their hospitals.

Identification of educational gaps among oncologists who treat patients with pancreatic cancer.

431 Background: Pancreatic ductal adenocarcinoma (PDA) is the fourth-most common cause of cancer-related death in the United States, with only 7.7% of patients surviving beyond 5 years. Given the poor outcomes associated with PDA, it is imperative that patients with PDA receive optimal care. Continuing medical education (CME) offers an effective means to improve physician performance, and CME programs are most effective when they address areas of greatest need. This study was conducted to identify and quantify the educational gaps in PDA management that can potentially be addressed with CME. Methods: A case-vignette survey instrument was developed to assess physicians’ practices related to PDA. Case vignettes are a validated means of assessing healthcare provider practice patterns. The survey instrument included three patient cases: 1) A 50 year-old man with resectable PDA; 2) a 75 year-old man with locally advanced, unresectable PDA; and 3) a 55 year-old woman with metastatic PDA. Each case was followed by a series of questions designed to assess medical decision-making, physician/patient communication, and barriers to optimal practice. Results: Survey responses were collected from 150 US oncologists in July 2016 (19% at academic centers). Several key educational gaps were identified. For Case 1, 44% of oncologists did not select an evidence-based adjuvant chemotherapy regimen from a list of options. For Case 2, in which the patient had developed metastases and neuropathy after first-line therapy, 57% of respondents did not select an evidence-based second-line option, and 35% selected a regimen with oxaliplatin. For Case 3, only 18% of oncologists recommended an initial diagnostic evaluation that included a biopsy, chest imaging, and liver function tests. Finally, for all 3 cases, little emphasis was placed on enrolling patients in clinical trials. Conclusions: This study identified appreciable discrepancies between respondents’ recommendations and standard evidence-based guidelines for treating all stages of PDA. Well-designed CME programs may help bridge the educational gaps among practicing oncologists and ultimately improve adherence to national guidelines.

Medical laboratory professional's perceptions of continuous medical education

Background: Medical laboratory technologists (MLTs) are required to gain credit for continuous professional development for relicensing as well as for their own career-long learning. International studies have shown that MLTs who undertake continuing medical education (CME) have improved productivity, enhanced professional flexibility and high work fulfilment. The time spent on CME is associated with professional competency. Previous national research has shown that attendance at CME programmes in Saudi Arabia is likely affected by demographic factors. The objective of this study was to explore the perceptions of MLTs towards CME activities and to predict factors that affect attendance. Methods: A self-administered questionnaire was given to 103 medical laboratory professionals from the Security Forces Hospital as part of a cross-sectional descriptive study. Data were analysed using SPSS version 21. Results: The overall mean score was 3.88 for the 103 questionnaires, indicating an affirmative perception of the CME programmes. Males in the age group 25-34 years accounted for 61.2% of responses. The preferred delivery modes for CME programmes were short courses and workshops (23%) and higher education relevant courses (20%). For those who had attended CME and those who had not, no significant difference was found in gender, age, field of specialty, education categories or working experience. Conclusion: Most laboratory technicians in our study reported favourable perceptions of CME programmes, feeling that they increased professional confidence and competency. We recommend that core competencies be integrated into credentialing using profession-specific CME in a workplace setting. In addition, MLTs should be involved in designing the programmes as well. Further studies in a multicentre institution are needed to analyse the difference in perception among those who have attended CME and those who have not.

Impractical CME programs: Influential parameters in Iran.

Background: Traditional approaches in Continuing Medical Education (CME) appear to be ineffective in any improvement of the patients’ care, reducing the medical errors, and/or altering physicians' behaviors. However, they are still executed by the CME providers, and are popular among the majority of the physicians. In this study, we aimed to explore the parameters involved in the degree of effectiveness of CME program in Iran. Methods: In this study, 31 participants, consisting of general practitioners, CME experts and providers were recruited to participate in in-depth interviews and field observations concerning experiences with CME. Application was made of the qualitative paradigm along with the qualitative content analysis, using grounded theory data analysis methodology (constant comparative analysis). Results: Based on the participants’ experiences, the insufficient consistency between the training program contents and the demands of GPs, in addition to the non-beneficiary programs for the physicians and the non-comprehensive educational designs, created a negative attitude to the continuing education among physicians. This could be defined by an unrealistic continuing education program, which is the main theme here. Conclusion: Impracticable continuing education has created a negative attitude toward the CME programs among physicians so much that they consider these programs less important, resulting in attending the said programs without any specific aim: they dodge absenteeism just to get the credit points. Evidently, promoting CME programs to improve the performance of the physicians requires factual needs assessment over and above adaptation of the contents to the physicians’ performance.

Awareness and Beliefs of Antimicrobial Resistance among Health Professionals Working at Tikur Anbessa Specialized Hospital, Addis Ababa: Ethiopia

Introduction: Antimicrobial Resistance (AMR) threatens the effective prevention and treatment of an everincreasing range of infections caused by bacteria, parasites, viruses and fungi. In recent years, since the rate at which resistance occurs has outpaced the development of new drug replacements, it has become necessary to use the currently available agents, optimally and appropriately. The aim of this study was to assess the medical staff awareness towards the most common resistant bacteria species, the factors contributing to the lack of awareness, and the possible measures to address the awareness gap. Methods: A structured questionnaire was administered to 205 health care professionals including physicians, pharmacists, and nurses at Tikur Anbessa Specialized Hospitals, Addis Ababa-Ethiopia. Results: The study identified that most of the responding physicians and pharmacists considered Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) as the most frequently encountered resistant bacterial species. However, nurses recognized both MRSA and extended-spectrum β-lactamase producing Gramnegative bacilli (ESBL) as the most prevalent resistant species. Majority of physicians (79.2%) and pharmacists (79.9%) reported prolonged hospitalization as a factor likely to contribute to the increased incidence of bacterial resistance. About 66.0% of pharmacists indicated that the use of antibiotics without prescription as a significant reason for the development of bacterial resistance. Most of the physicians (71.4%) reported that appropriate infection control is the most important measure to reduce bacterial resistance. Conclusion: The findings of this study revealed that there was good awareness of the most common AMR etiologies and their risk factors among the different discipline health professionals. Even though there was a varying level of awareness among the health care professionals. Continuous medical education programs would be desirable to keep the health care professionals updated and diminish the future risk of excessive bacterial resistance.

Assessment of knowledge, attitude, and practice of pharmacovigilance among private practitioners in Southern India: A questionnaire-based study

Background: Pharmacovigilance has constantly gained importance in last 15 years, relating to absolute the amount of adverse drug reactions (ADRs) and to the fact that several hospital admissions are due to ADRs. The success of Pharmacovigilance Programme of India (PVPI) depends on the active involvement of not only the health-care professionals, such as allopathic doctors, dentists, nurses, and pharmacists but also on those doctors who practice alternative systems of medicine. Aims and Objective: To assess the awareness and perception of pharmacovigilance among doctors practicing alternative systems of medicine in Tumkur, Southern India. Materials and Methods: A cross-sectional study was conducted among doctors practicing alternative systems of medicine in Tumkur, Southern India, using a validated questionnaire suitable for assessing the knowledge, attitude, and practice of pharmacovigilance was designed and distributed to the private practitioners. Results: Of 120 doctors who answered the questions, 28.3% reported to have heard the name pharmacovigilance, 14.2% doctors answered that drugs used in alternative systems of medicine cause ADRs whereas 85.8% said they do not. Only 12.5% thought that reporting an ADR with Ayurveda, Siddha and Unani (ASU) drugs is necessary and 9.2% had encountered an ADR with ASU drugs. Only 6.7% have been trained on how to report ADRs, whereas only 1 (0.8%) doctor had reported ADRs. Conclusion: Knowledge of doctors practicing alternative systems of medicine regarding pharmacovigilance is poor as well as their attitude and practice toward it. Sincere efforts should be made to include them under PvPI and to train through continued medical education programs as well as workshops on PvPI.

Assessment of knowledge, attitude, and practice of pharmacovigilance among doctors practicing alternative systems of medicine in Southern India: A questionnaire-based study

Background: Reporting adverse drug reactions (ADRs) are an essence of pharmacovigilance practice. Health-care professionals should know how and where to report an ADR. For Pharmacovigilance Programme of India (PVPI) to be successful, the health-care professionals such as allopathic doctors, nurses, and pharmacists must be actively involved along with the doctors who practice alternative systems of medicine. Aims and Objective: To assess the awareness and perception of pharmacovigilance among doctors practicing alternative systems of medicine in Tumkur, Southern India. Materials and Methods: A cross-sectional study was conducted among doctors practicing alternative systems of medicine in Tumkur, Southern India, using a validated questionnaire suitable for assessing the knowledge, attitude, and practice of pharmacovigilance was designed and distributed to the private practitioners. Results: Of 120 doctors who answered the questions, 28.3% reported to have heard the name pharmacovigilance, 14.2% doctors answered that drugs used in alternative systems of medicine cause ADRs, whereas 85.8% said they do not. Only 12.5% thought that reporting an ADR with Ayurveda, Siddha, and Unani (ASU) drugs is necessary, 9.2% had encountered an ADR with ASU drugs. Only 6.7% have been trained on how to report ADRs, whereas only 1 (0.8%) doctor had reported ADRs. Conclusion: Knowledge of doctors practicing alternative systems of medicine regarding pharmacovigilance is poor as well as their attitude and practice toward it. Sincere efforts should be made to include them under PVPI and to train through continued medical education programs as well as workshops on PVPI.

The Impact of an Educational Program Regarding Total Parenteral Nutrition on Infection Indicators in Neonates Admitted to the Neonatal Intensive Care Unit.

Background:One of the basic care measures for preterm infants is providing nutrition through total parenteral nutrition (TPN) and one of the most important complications of it is infection. Because prevention of nosocomial infections is an important issue for neonate's safety, this study aimed to determine the effects of a continuing medical education (CME) course on TPN for neonatal intensive care unit (NICU) nurses on indicators of infection in newborns.Materials and Methods:This quasi-experimental study was conducted on 127 neonates who fulfilled the inclusion criteria. They were selected through simple convenience sampling method at two stages of before and after the CME program. The inclusion criteria were prescription of TPN by the physician and lack of clinical evidences for infection in newborns before the beginning of TPN. Death of the infant during each stage of the study was considered as the exclusion criteria. The data gathering tool was a data record sheet including clinical signs of infection in the infants and their demographic characteristics. Data were analyzed using Chi-square test, Fisher's exact test, and student's t-test in SPSS software.Results:The results showed the frequency of clinical markers for infection in newborns at the pre-intervention stage (n = 41; 65.10%) was significantly less than at the post-intervention stage (n = 30; 46.90%) (p = 0.04).Conclusions:Nursing educational programs on TPN reduce infection rates among neonates in NICUs.

Knowledge, Attitude, and Practice of Iranian Internists Regarding Diabetes: A Cross Sectional Study.

BackgroundA number of studies investigated the general practitioners' and family physicians' knowledge, attitude, and practice (KAP) on diabetes. However, studies on internists' KAP on diabetes management are limited. This study aimed to investigate the Iranian internists' KAP on diabetes mellitus and its management.MethodsA cross-sectional study was conducted on a random sample of internists who participated in the 26th annual congress of internists in Tehran, Iran. The level of KAP and affecting factor was evaluated by a validated instrument.ResultsOne-hundred internists with the mean age of 41.98±9.26 years were evaluated. Totally, the physicians possessed 66.29%±19.5%, 50.44%±19.39%, and 64.5%±15.3% of the scores in KAP, respectively. The time since graduation in general medicine had significant negative correlation with their knowledge and practice, that was along with the subjects' age (P<0.05). The KAP level had not significant difference between subjects participated in a continuing medical education (CME) program during the last year compared to subjects did not participated (P>0.05). Attitude, and practice scores were significantly higher in physicians who were working at diabetes clinic (P<0.05), and attitude was more in physicians working at teaching hospitals compared to those who were not working (57.82 vs. 47.72, P=0.020).ConclusionAccording to our results, subjects' age and time since graduation in general medicine and specialty were inversely correlated by knowledge and practice. So internists with older age seems to be in priority for educational programs. And holding CME programs in current forms seems to be not suitable to increase the KAP regarding diabetes.