Continuing Medical Education Research Articles

A Survey on Surgical Site Infections Prevention Guidelines Knowledge and Implementation Level of Trauma Centre Healthcare Professionals

Aims/Background Surgical site infections (SSIs) significantly influence patient safety and healthcare quality, particularly in low- and middle-income countries where the burden is most evident. This manuscript aims to evaluate the awareness and adherence to SSI prevention guidelines among healthcare providers at a tertiary trauma centre situated in Tirana, Albania. Methods This cross-sectional survey was conducted among practising surgeons, residents and nurses of Trauma University Hospital, Tirana. The questionnaire explores awareness, attitudes and practices towards SSI prevention in preoperative, perioperative and postoperative phases. Results The participants demonstrated a high level of patient education about SSI risks (91.9%), but lower adherence to individual prevention practices. Conclusion Despite adequate knowledge, there remains a significant gap in the implementation of SSI prevention guidelines. Strengthening continuous medical education is crucial to addressing systemic barriers, improving compliance with guidelines, and decreasing SSI rates.

Development of CytoAcademy: a new web- and mobile-based E-learning platform for cytopathologists and cytotechnologists by the Korean Society for Cytopathology in the post-pandemic era

Since the late 1990s, online e-learning has offered unparalleled convenience and affordability, becoming increasingly popular among pathologists. Traditional learning theories have been successfully applied to web/mobile-based learning systems, with mobile technologies even enhancing conventional offline education. In cytopathology, hands-on microscope training has traditionally been paramount, complemented by real-case presentations and lectures. However, the coronavirus disease 2019 (COVID-19) pandemic disrupted regular academic activities, making online e-learning platforms essential. We designed a web/mobile-based learning platform to enhance continued medical education in cytopathology at various levels, particularly during the era of COVID-19 and beyond. Since 2021, we have integrated curriculum materials, virtual education files, and whole-slide images (WSIs) of cytopathology, submitted from over 200 institutions across Korea, with the support of numerous instructors. We develop a new e-learning platform named “CytoAcademy” composed of a basic session for each organ and level across the range of morphologic findings; on-demand lectures to enhance cytopathologic knowledge; WSI archives that allow users to explore various histologically confirmed cases; and a self-assessment test to help organize diagnostic knowledge acquired through the web/mobile-friendly learning system. The platform provides not just an opportunity to achieve a correct diagnosis, but also a learning experience based on problem-solving point. Members interact, identify their deficiencies, and focus on specific educational materials. In this manner, all participants can actively engage in creating and maintaining knowledge and foster a proactive approach to learning.

Empowering primary care physicians in child and adolescent psychiatry: a needs assessment on collaborative care in Dubai

BackgroundChild and adolescent psychiatric disorders pose significant public health concerns necessitating prompt intervention. Primary care physicians (PCPs) play a critical role as initial points of contact, facilitating early detection, management, and referral of these conditions. In Dubai, integrating mental health services into primary care faces unique challenges, highlighting the need for systemic reforms and enhanced PCP training.ObjectiveThis study investigated perceptions, barriers, and systemic challenges encountered by PCPs in managing child and adolescent psychiatric conditions in Dubai’s primary care setting. It also assessed family physicians’ involvement and preparedness in this domain.MethodsUsing a mixed-methods approach, we conducted a survey among family physicians in Dubai Health facilities and analyzed patient data from family medicine clinics. The survey evaluated formal training, preparedness, encounter frequency, and referral patterns for psychiatric care in young patients. Qualitative insights from open-ended survey questions provided additional understanding of specific challenges.ResultsFindings revealed significant gaps in formal training, with only 33.3% of respondents trained in child and adolescent psychiatry during medical education, and 21.1% participating in Continuing Medical Education (CME). A majority (54.4%) of PCPs felt unprepared to manage psychiatric care in young patients. Patient data analysis showed a predominance of male patients (59.9%) and identified Autism Spectrum Disorder (43.1%) as the most common condition, emphasizing the reliance on specialized care through a high referral rate (63.1%). Major barriers included time constraints, limited psychiatric knowledge, resistance to mental health services, systemic and structural issues, communication challenges, and resource shortages.ConclusionEnhanced training and systemic reforms are urgently needed to integrate mental health services effectively into Dubai’s primary care. Implementing structured collaborative care models, fostering interdisciplinary collaboration, and addressing systemic barriers are crucial for improving child and adolescent psychiatric condition management. These initiatives promise better patient outcomes and more efficient healthcare resource utilization.

Continuing medical education program completion and influencing factors: a cross-sectional study in Sichuan Province, China

ObjectivesThis cross-sectional study was designed to explore the completion of continuing medical education (CME) programs and identify the factors influencing their completion.MethodsThe data for this study were generated from the National CME Program Application and Information Feedback Online System and the Sichuan CME Administrative Platform. The data were processed using descriptive analysis, Chi-square test, and binary logistic regression methods. The completion of each CME program was determined by the research team members according to the criteria created by the Office of the Sichuan CME Commission.ResultsA total of 180 hospitals and 3,622 CME programs were included. Among the 3,622 CME programs, 2,936 (81.1%) were determined to be completed. Comparative analysis showed that in terms of hospital characteristics, specialist hospitals, county hospitals, hospitals with 500–1,000 beds, and hospitals in the regions with government medical expenditure input equal to or more than 3,000 million RMB displayed the highest completion rates. For program attributes, national programs, programs in the field of pharmacy, and programs with 1–3 duration days demonstrated the highest completion rates. The binary logistic regression analysis showed that hospital region with different government medical expenditure input had the strongest positive association with the completion of CME programs [OR = 2.922, 95%CI (1.642–5.198)], while the duration time showed the strongest negative association [OR = 0.235, 95%CI (0.141–0.393)].ConclusionThis is the first study in China to analyze the completion of CME programs and identify its influencing factors at the provincial level. It is recommended that the government in the region should pay great attention to the construction of measures regarding the factors affecting the completion of CME programs. This includes providing more financial support to CME providers to ensure the formal operation of their CME activities, formulating guidelines on the application of CME programs to reasonably allocate and control the distribution of accredited CME programs across different hospital scales and disciplines, especially offering more training support to county hospitals, promulgating administrative documents to raise attention to the completion of CME programs, and special scrutiny on CME programs with longer durations to provide and protect training opportunities for those in need.

Instructions for Obtaining Anesthesiology Continuing Medical Education (CME) Credit

Instructions for Obtaining A<scp>nesthesiology</scp> Continuing Medical Education (CME) Credit

Impact of continuous medical education among Filipino nurses working in Riyadh Saudi Arabia

Impact of continuous medical education among Filipino nurses working in Riyadh Saudi Arabia

Primary care physicians' attitudes, practices, and perceived barriers toward depression screening in older people in the Kingdom of Bahrain

PurposeThis study aimed to explore attitudes, practices, and perceived barriers of primary care physicians (PCPs) toward depression screening in older people.MethodsThis cross-sectional study enrolled PCPs from randomly selected representative primary care centers in Bahrain. A self-administered piloted semi-structured questionnaire was used for data collection.ResultsWe enrolled 248 PCPs in the study (82.3% females, and the mean age = 40 ± 8.7 years). More than half of the participants (54.4%) had a positive attitude toward depression screening in older people. However, only 10.9% of the participants reported systematically screening for this condition without using specific tools for screening in 45.5%. The most reported barriers toward this service are short consultation time (95%), the presence of multiple co-morbidities in this age group (90%), and the absence of guidelines or appropriate training in around 30%. Positive attitudes were significantly higher among older PCPs (p = 0.039), family physician consultants (p = 0.008), those with more than 10 years of work experience (p = 0.024), and those who participated in related educational activities (p = 0.007). Under-screening practice is associated with perceived short consultation time (p = 0.002), insufficient continuous medical education (CME) activities attendance in older people's mental health (p = 0.048) as well as having a general physician's title (p = 0.049). Only the PCPs' job title, Adjusted Odds Ratio (OR) = 3.513, 95 C.I [1.225-10.074] and attendance of CME activities, OR = 1.278, 95 C.I [1.098 – 3.192] remained significant when controlled for age and experience.ConclusionMore training on older people's mental health and provision of screening and management guidelines are priorities to promote older people's mental health in primary care settings.

Online Lifestyle Medicine Continuing Medical Education (CME) Course Completion Predicts Increases in Clinician Knowledge, Confidence, and Practice of Lifestyle Medicine.

Introduction: Despite growing evidence linking lifestyle changes to disease reversal, lifestyle medicine (LM) is not widely practiced. Lack of clinician training and knowledge is cited as a barrier to LM adoption. This study measures changes in LM knowledge, attitudes, confidence, and practice behaviors following completion of a 5.5-h, asynchronous, online continuing medical education (CME) course. Methods: Participants completed a pre- and post-course survey. A repeated-measures linear model tested changes in knowledge, confidence, interest, experience, and practice of LM, after adjusting for age, gender, race, ethnicity, clinical degree/licensure, and presence of a health system value-based care model. Results: Surveys from n = 2954 course participants were analyzed. Overall, statistically significant improvements were observed in self-reported knowledge (+.47 of points) and confidence (+.53 of points) of LM. Participants across the sample reported greater frequency (+.08 of 5 points) and reach (+.10 of 5 points) of LM with their patients (p<.0001 for both). Discussion: This study demonstrated that a brief, scalable, online CME course can improve LM knowledge, confidence, attitudes, and practice. Future research should examine long-term practice changes as well as differences in outcomes across types of healthcare professionals.

Medical school service regions in Canada: exploring graduate retention rates across the medical education training continuum and into professional practice

ABSTRACT Purpose To create medical school service regions and examine national in-region graduate retention patterns across the medical education continuum and into professional practice as one approach to advancing social accountability in medical education. Methods Medical school service regions were created in Canada using publicly available data and mapped using Geographic Information System (GIS) software. Population size and density for each service region were calculated using census data. Retrospective data of medical graduates who completed their medical degrees between 2001–2015 (n = 19,971) were obtained from a centralized data repository and used to analyze in-region retention rates by medical specialty across the training continuum and five years into professional practice. Results Spatial inequities were observed across medical school service regions. Graduate retention patterns also varied across service region groups and medical specialties. Quebec (86.5%) and Ontario (80.4%) had above-average retention rates across the medical education continuum. Family medicine had the highest retention rates from undergraduate to postgraduate training (81.9%), while psychiatry had the highest retention rate across the training continuum and into professional practice (71.2%). The Alberta and British Columbia service region group demonstrated high retention rates across the training continuum and into professional practice and medical specialties, except for retention from undergraduate to postgraduate medical education. Conclusion This study highlights the importance of considering both medical specialty and practice location of graduates when planning and retaining the physician workforce. The observed retention patterns among graduates are a critical aspect of addressing societal needs and represent an intermediate step towards achieving health equity. Furthermore, graduate retention patterns serve as an outcome measure for schools to demonstrate their commitment to social accountability. Tracking and monitoring graduate outcomes may lead schools to actively collaborate with government agencies responsible for healthcare policy, which may ultimately improve physician workforce planning and promote more equitable healthcare access.

Factors Influencing the Skill Level of Primary Healthcare Workers in Managing Paediatric Emergencies

Paediatric emergencies continue to be a significant public health concern in Nigeria, particularly in rural areas where primary healthcare centers (PHCs) often serve as the sole source of medical care. The ability of healthcare workers in these settings to effectively manage paediatric emergencies is crucial for improving child health outcomes. This study aimed to assess the factors influencing the skill level of primary healthcare workers in managing paediatric emergencies in Zaria, Nigeria. A cross-sectional descriptive study was conducted among 139 randomly selected healthcare workers in Sabon Gari and Zaria Local Government Areas. A pre-tested questionnaire was used to collect data on socio-demographic characteristics, work experience, and skills in managing paediatric emergencies. Data were analyzed using SPSS version 21. The results revealed that healthcare workers in PHCs in Zaria exhibited varying levels of skills in managing paediatric emergencies. Several factors were identified as influencing their skill levels. Healthcare workers with higher academic qualifications demonstrated significantly better skills in managing paediatric emergencies. This suggests that formal education plays a crucial role in developing the necessary competencies. While experience can be a valuable asset, the study did not find a strong association between years of experience and skill levels. This may indicate that experience alone is not sufficient for developing the necessary skills, and additional training and support may be required. Healthcare workers who had received recent training or participated in continuing medical education (CME) programs related to paediatric emergency management tended to have higher skill levels. This highlights the importance of ongoing professional development in maintaining and improving skills. The findings of this study suggest that a combination of factors influences the skill level of primary healthcare workers in managing paediatric emergencies. While academic qualifications are important, ongoing training and access to resources are also essential. It is crucial to address these factors through targeted interventions to improve the skills of healthcare workers and enhance the quality of care provided to children in need. This study highlights the critical need for targeted interventions to improve the skills of primary healthcare workers in managing paediatric emergencies in Zaria, Nigeria. By addressing factors such as academic qualifications, training, resource availability, and work environment, policymakers and healthcare providers can significantly enhance the quality of care provided to children in need.

Accessibility factors associated with adherence to healthy timing and spacing of pregnancy among women of reproductive age in Kilifi County, Kenya

Background: Globally, about 25% of births occur with shorter intervals annually with over 12 million underage pregnancies mostly from Sub-Saharan Africa. Kenya records about 20% teenage pregnancies while Kilifi County reported 28.9%. In Kilifi County, 19.6% of births do not adhere to the 24-month birth-interval. The study focused on establishing accessibility factors associated with adherence to healthy timing and spacing of pregnancy (HTSP) among reproductive age women in Kilifi County, Kenya. Methods: A descriptive cross-sectional design was adopted with a sample of 293 respondents. All required approvals and consent were obtained. Quantitative data was collected using questionnaires. Descriptive data was analyzed using SPSS version 22.0 and inferential statistics computed through Chi-square tests. Results: About 60.1% respondents adhered to heathy timing and spacing of pregnancy, 69.4% teenage pregnancies occurred and 67.1% of women adhered to the 24-month inter-birth interval. Availability of family planning (FP) services (p=0.008), experience with providers (p=0.005), cost of accessing FP (p=0.001) and source of information (p=0.002) were associated with HTSP. Conclusions: About 4 out of 10 women of reproductive age in Kilifi County do not adhere to the recommended HTSP. Accessibility factors such as cost and availability of family planning services, source of information and experience with healthcare providers significantly influenced adherence to HTSP. The Ministry of Health and relevant stakeholders should scale up awareness activities, provide mobile clinics and concentrate on regular continuous medical education among healthcare providers to enhance their role in provision of reproductive health services.

Empowering Continuing Medical Education (CME) in India: leveraging Kern’s instructional design model

IntroductionContinuing Medical Education (CME) is vital for healthcare professionals to remain current with advancements and maintain their competence. In India, CME remains in its early stages, lacking a systematic approach. There is a pressing need for a comprehensive framework that addresses needs assessment, program development, accreditation, and credit allocation. Specifically, there is a gap in delivering targeted CME that meets the needs of different medical professionals at appropriate times. The aim of this study is to employ Kern’s six steps of curriculum design to plan and evaluate a faculty development program focused on Entrustable Professional Activities (EPAs) for MD (Doctor of Medicine) Biochemistry professionals.MethodsThis study utilized Kern’s six-step approach to design a training program on Entrustable Professional Activities (EPAs) tailored for MD Biochemistry professionals. Approval was obtained from the Institutional Human Ethics Committee. Following problem identification, a targeted needs assessment was conducted through expert consultations. The goal of the program was established, focusing on the development and delivery of an interactive online CME program. The program was developed, implemented and evaluated using surveys and feedback questionnaires.ResultsA comprehensive literature review revealed a notable gap in EPA-related works for MD Biochemistry program. Expert consultations highlighted significant training needs and barriers, such as limited resources and professional commitments. Consequently, the program’s primary objective was to raise awareness and sensitize participants to EPA development. A 4-h online CME was designed, featuring expert-led sessions and collaborative group activities. The program attracted 152 participants and utilized interactive elements, such as polls and chats, to foster engagement. Group activities allowed participants to apply concepts in EPA validation. Pre- and post-program surveys demonstrated significant improvements in participants’ knowledge and confidence. Feedback highlighted the practical relevance of the content and the interactive, hands-on nature of the sessions.ConclusionKern’s six-step approach provided a structured and effective framework for developing the CME program, addressing identified needs and barriers, and enhancing faculty development in MD Biochemistry. This study underscores the importance of a systematic approach in CME to improve program effectiveness.Trial registrationNot applicable.

Awareness and knowledge about Female Genital Schistosomiasis among European healthcare workers

Abstract Background Female Genital Schistosomiasis (FGS) is a gynaecological manifestation of persistent infection with Schistosoma haematobium, which can lead to severe consequences, such as miscarriage and infertility. It is estimated to affect 56 million women globally, mostly in sub-Saharan Africa (SSA). Most migrants in Europe are female, often from SSA and therefore at risk of FGS, hence healthcare workers (HCWs) knowledge of FGS is essential for the provision of adequate care. This study aims to assess awareness and knowledge of FGS among European HCWs to inform strategies to improve the management of migrant health. Methods In June 2023 - January 2024 we conducted a cross-sectional online survey targeting medical doctors (MDs), nurses and midwives (NMs) working in fields of infectiology, gynaecology, urology, family, travel, internal or occupational medicine. The prevalence of FGS awareness and knowledge was estimated, Poisson regression was used to identify factors associated with MDs’ awareness of FGS. Results Among 922 surveyed HCWs, 43.7% (CI95%: 39.6-47.9) of MDs and 12.0% (CI95%: 8.8-16.0) NMs have heard about FGS. FGS awareness among MDs was associated with work in clinics for migrants (prevalence ratio (PR)=1.33, CI95%: 1.10-1.59) and specialization, being lower for gynaecology (PR = 0.67; CI95%:0.51-0.88), and family medicine (PR = 0.42, CI95%:0.30-0.59). Among MDs, 7.1% (CI95%: 5.1- 9.5) had medium knowledge, while 25.3% (CI95%: 21.8-29.0) had low, and 67.6% (CI95%: 63.7-71.4) no knowledge on symptoms, complications or diagnostic tools for FGS. FGS knowledge was mostly acquired through academic curricula (34.7%), scientific literature (28.4%) and conferences (25.6%). Conclusions The study shows limited awareness of FGS among European MDs and NMs, and highlights that European HCWs may not be adequately prepared to deal with diseases that are gaining relevance on the European continent due to the global connectivity and the dynamic nature of our societies. Key messages • In Europe, the health specialities that are the first point of patient access to the health system show a low level of awareness and knowledge of Female Genital Schistosomiasis. • Rising knowledge of FGS among European HCWs through academic curricula and continuous medical education is important to ensure adequate diagnosis and management of disease in migrant populations.

Restoring trust in vaccination through collective engagement with key populations in Eastern Europe

Abstract Issue/problem COVID-19 vaccination rates remained below 50% in Moldova, North Macedonia, and Serbia, especially among vulnerable populations like pregnant women and those with chronic diseases. This was strengthened by a lack of targeted communication and training for healthcare workers, and COVID-19 fatigue. Strategies to increase vaccine demand and confidence are a global priority, especially among vulnerable populations. Description of the solution From May 2022 to April 2024, the USAID MOMENTUM Routine Immunization Transformation and Equity project employed behavior integration to design a social and behavior change strategy, centering on vaccination as a part of a healthy lifestyle. It was implemented through continuing medical education (CME) and community engagement (CE) workshops with vulnerable populations, supplemented by cross-country learning exchanges. The outcomes provide a framework for public health initiatives aimed at boosting vaccine uptake through innovative, behavior-based methods. Results 1,618 healthcare professionals, able to reach 2.5 to 4.8 million patients, received training in immunization, COVID-19 vaccines, and quality health service, and 99% indicated confidence in applying the knowledge. 265 CE workshops, engaging 4,079 patients, increased awareness and addressed concerns related to vaccination. Of 3,223 patients who were followed up, 47% reported setting an appointment with their doctor regarding vaccination, 27% discussed vaccination with their partners, and 7% proceeded to receive the COVID-19 vaccine. Lessons Behavior Integration helped address key barriers to vaccination and informed the design of strategies (i.e. situating COVID-19 vaccination as part of a healthy lifestyle). Establishing trust with healthcare providers and patients through collective engagement improved health behaviors. Focusing on health as a wider priority helped re-establish the significance of vaccination as part of a healthy lifestyle. Key messages • Behavior science and behavior integration helped identify and address barriers, as well as design tailored interventions to improve vaccination demand and confidence. • Collective engagement, focused on integration of COVID-19 vaccination as part of a healthy lifestyle, achieved results through addressing vaccine hesitance from both sides of the equation.

HIGHER MEDICAL EDUCATION ABROAD IN THE HISTORIOGRAPHY OF UKRAINIAN PEDAGOGICAL COMPARATIVE STUDIES

The relevance of this research is driven by the need for a comprehensive understanding of foreign experiences in the functioning of national higher medical education systems within the context of Ukraine's complex and contradictory processes of integration into the European Higher Education Area. The article aims to conduct a comprehensive analysis of the historiography of Ukrainian pedagogical comparative studies on the development of higher medical education in foreign countries to identify trends, achievements, gaps, and prospects for studying this issue. The research methods include search-heuristic, analysis and synthesis, historiographic, hermeneutic, comparative, and phenomenological. As a result of search-heuristic and scientific research work, about 30 dissertations, monographs, and educational manuals on the issue were identified and analyzed. Based on this, their narrow country-specific focus and the similarity in the formulation of the research subject were identified, as well as the directions, trends, and features of research on the development of higher medical education abroad were outlined. It was shown that the historiography of domestic pedagogical comparative studies on this issue has a pronounced interdisciplinary profile-oriented character. Most of the authors involved in its formation, particularly degree candidates, were mainly professional medics, with their scientific supervisors and consultants being experienced scientist-pedagogues. When studying the body of work on the development of higher medical education abroad, it was found that a significant portion of the monographs, articles, and theses of scientific conferences dedicated to it were prepared based on dissertation materials. Therefore, the focus was on analyzing dissertations, as well as monographs and articles containing original scientific knowledge. The main vector of research related to the training of doctors in specialized higher education institutions in foreign countries was determined. Common and distinctive features of representative dissertations on its development in the USA and certain European countries (Great Britain, Poland, Germany, etc.), as well as on the development of continuous medical education abroad, the establishment of nursing education abroad, the formation of foreign systems of professional training for veterinary doctors, and foreign experience in the organization of military medical education were analyzed.

Development and validation of a training course on proton pump inhibitor deprescription for general practitioners in a rural continuing medical education program: a pilot study

BackgroundDespite being cornerstone medications for managing gastrointestinal disorders, proton pump inhibitors (PPI) have raised concerns due to inappropriate prescribing and overutilization, their potential side effects, and interactions with other medications. General practitioners (GPs) provide long-term patient follow-up and are targets to promote PPI deprescribing to reach the widest possible population. GPs practicing in rural settings encounter unique challenges as their numbers dwindle and their workload increases. Hence, targeted educational interventions are crucial to promote appropriate prescribing practices in such underserved areas.MethodsWe developed a continuing medical education (CME) program focused on PPI deprescribing for GPs in rural settings. The program comprised of an interactive training session featuring clinical cases, an open discussion, and distribution of educational materials. We assessed the program’s effectiveness using a two-level Kirkpatrick model, evaluating participant satisfaction and knowledge levels through pre- and post-course questionnaires.ResultsThirty-three GPs participated, with 61.9% working in semi-rural and 38.1% in rural areas (21 responded to the 1st questionnaire, 14 to the 2nd ). Median medical experience was 6 years, with 61.9% serving as internship supervisors. Despite 95.2% acknowledging PPI overprescription, none had previously participated in dedicated PPI CME programs. The open discussion session provided valuable insights into various topics related to PPI use and gastrointestinal health. Participants expressed high satisfaction with the program (average rating of 9.1/10) and 92.9% reported changes in practice, including increased awareness of inappropriate PPI prescriptions. Indeed, 92.9% of GPs identified inappropriate PPI use following the course. 57.1% of participants utilized the provided educational materials. The main practice changes observed included an increased reassessment rate of PPI indications (71.4% at each renewal after vs. 19% before, 28.6% non-systematically after vs. 66.8% before, 0% rarely after vs. 14.3% before; p = 0.006), the necessity for more than one consultation to deprescribe (64.3% after vs. 23.8% before; p = 0.021), systematic utilization of gradual cessation of PPI (100% vs. 61.9%; p = 0.039) and more frequent use of additional medication (92.9% vs. 57.1%; p = 0.022), primarily antiacids (92.3%).ConclusionsOur study underscores the effectiveness of targeted CME programs in promoting appropriate prescribing practices and enhancing knowledge among GPs in rural settings. Despite the challenges encountered in deprescribing PPI, the program facilitated proactive approaches in managing treatment discontinuation failures. Tailored educational interventions are essential for mitigating medication prescribing challenges and improving patient outcomes in rural primary care settings.Trial registrationsNot applicable.

Urogenital Tuberculosis and Delayed Diagnosis: A Qualitative Study.

To identify the causes of delayed diagnosis of urogenital tuberculosis (UGT) through a qualitative study of patients with contracted bladder due to UGT. Eight patients diagnosed with contracted bladder due to UGT were evaluated. Data were obtained using face-to-face in-depth interviews and supplemented with medical records analysis and personal medical files. The identification of situations of diagnosis delay was coded by 2 urologists after data analyses. Codes were divided into 3 categories related to its causes: (1) health system; (2) disease factors; and (3) medical factors. The 8 interviews produced 220 minutes of audio and 1.3 GB of scanned documents. The most frequent categories were "Medical factors," followed by "Disease factors" and "Health system." The codes "No clinical-laboratory-radiological suspicion" and "No clinical suspicion" were the most frequent, both belonging to "Medical factors." Clinically, tuberculosis simulates other pathologies and lacks specific tests with adequate sensitivity. The low representation of "Health system" codes indicates that access to public and private health services does not influence delayed diagnosis. The lack of clinical and radiological suspicion and the lack of knowledge of UGT features are the main reasons for diagnosis delay. The causes of delayed diagnosis in our sample were related to "Medical factors," followed by "Disease factors." Better understanding UGT features is an important topic in continuous medical education.

Multi-layered factors contribute to irrational use of antibiotics among pediatric patients in Tanzania: ADDO dispensers perspective

BackgroundAntimicrobial resistance (AMR) is a major public health problem affecting both current and future generations. Development of resistance to the commonly available antibiotics has been directly linked to their irrational use. The World Health Organization (WHO) has clearly stated on the Global Strategy on AMR, judicious antibiotic use as well as adequate knowledge and awareness about AMR, as important tools in curbing the existing problem. Therefore, this study aimed to explore the level of knowledge among accredited drug dispensing outlet (ADDO) dispensers on factors contributing to irrational use of antibiotics among Tanzanian pediatric patients.MethodsA qualitative study employing focused group discussions was conducted among 6–10 ADDO dispensers with at least 6 months dispensing experience in 14 regions between July and August 2020. Thematic analysis was used to analyze the data.ResultsFindings from this study indicate that the ADDO dispensers have adequate knowledge on antimicrobial resistance. Participants were aware of the general meaning and the use of antimicrobials. They were aware that antimicrobials are used for treating infections caused by microbes such as bacteria, fungi, and viruses. Participants knew AMR increases health related costs and that the increasing burden of AMR is not an outcome of a specific group of people such as health care providers or patients, rather a contribution of many factors that bring change in microorganism behavior. Despite this knowledge, participants felt that most of the private health care facilities are profit-oriented; they practice polypharmacy to maximize profit rather than focusing on providing quality health services. Participants revealed that dose shortage after symptomatic relief strongly contributes to AMR. Lastly, the ADDO dispensers expressed that continuous medical education and community education to patients is necessary in the efforts to fight against AMR.ConclusionsTo mitigate the increasing AMR burden in our society, integrated interventions must include both communities, ADDOs as first point of contact and other healthcare providers. Periodic refresher training with an emphasis on proper practices is crucial to help the dispensers transform their knowledge into action. Responsible authorities should ensure that ADDOs and other private health care facilities adhere to regulations.

The TELEhealth Shared decision-making COaching and navigation in Primary carE (TELESCOPE) intervention: a study protocol for delivering shared decision-making for lung cancer screening by patient navigators.

Lung cancer screening (LCS) can reduce lung cancer mortality but has potential harms for patients. A shared decision-making (SDM) conversation about LCS is required by the Centers for Medicare & Medicaid Services (CMS) for LCS reimbursement. To overcome barriers to SDM in primary care, this protocol describes a telehealth decision coaching and navigationintervention for LCS in primary care clinics delivered by patient navigators. The objective of the study is to evaluate the effectiveness of the intervention and its implementation potential, compared with an enhanced usual care (EUC) arm. Patients (n = 420) of primary care clinicians (n = 120) are being recruited to a cluster randomized controlled trial. Clinicians are randomly assigned to 1) TELESCOPE intervention: prior to an upcoming non-acute clinic visit, patients participate in a telehealth decision coaching and navigationsession about LCS delivered by trained patient navigators and nurse navigators place a low-dose CT scan (LDCT) order for each TELESCOPE patient wanting LCS, or 2) EUC: patients receive enhanced usual care from a clinician. Usual care is enhanced by providing clinicians in both arms with access to a Continuing Medical Education (CME) webinar about LCS and an LCS discussion guide. Patients complete surveys at baseline and 1-week after the scheduled clinic visit to assess quality of the SDM process. Re-navigation is attempted with TELESCOPE patients who have not completed the LDCT within 3months. One month before being due for an annual screening, TELESCOPE patients whose initial LCS showed low-risk findings are randomly assigned to receive a telehealth decision coaching booster session with a navigator or no booster. Electronic health records are abstracted at 6, 12 and 18months after the initial decision coaching session (TELESCOPE) or clinic visit (EUC) to assess initial and annual LCS uptake, imaging results, follow-up testing for abnormal findings, cancer diagnoses, treatment, and tobacco treatment referrals. This study will evaluate factors that facilitate or interfere with program implementation using mixed methods. We will assess whether a decision coaching and patient navigation intervention can feasibly and effectivelysupport high-quality SDM for LCS and guideline-concordant LCS uptake for patients in busy primary care practices serving diverse patient populations. This study was registered at ClinicalTrials.gov (NCT05491213) on August 4, 2022. Version 1, April 10, 2024.

She said, “Really, you’re just going to have to suffer through it”: The lack of discussion of perimenopause between women and healthcare professionals

Perimenopausal symptoms adversely impacting women’s sexual health are often unacknowledged or even dismissed by healthcare professionals (HCP). Using semi-structured interviews with 23 women experiencing perimenopause, we aimed to understand how HCPs address women’s sexual health needs and concerns during this transition. Thematic data analysis was employed with the reduction of data into themes. Several major themes were identified concerning participants’ experiences with a HCP and sexual health, including insufficient sexual health information and preventative education; the lack of open discussion about sexual health; the need for enhanced support and treatment options; feeling dismissed by a healthcare professional; and sexual pleasure not addressed by healthcare professionals. Additionally, women expressed concerns regarding medical education and training in healthcare professionals on approaching sexual health conversations. There appears to be a need for more formal training, both within medical school and continuing medical education (CME), to address these important aspects of women’s sexual and reproductive health.