Improvement In Overall Knowledge Research Articles

Bridging nursing professional development and Healthcare Simulation Standards of Best Practice™

BackgroundBoth the faculty shortage and limited clinical placement opportunities for students impact the use of simulation in nursing programs. Despite widespread use, many nursing faculty do not have training in simulation best practices and have limited skills and confidence in the use of simulation. MethodAs part of a Texas Higher Education Coordinating Board Grant, a Simulation Series was developed for nurse educators and graduate nurse educator students with the objective of increasing knowledge, confidence and skill as a nurse educator utilizing simulation as a teaching strategy. The series was developed based on the Healthcare Simulation Standards of Best Practice™. The education was designed to be a four-part Simulation Series combining both in person and virtual components. Completion of the series provided 20 contact hours of Nursing Professional Development (NPD). ResultsTwelve participants completed all 4 modules in the series, limiting the generalizability of the data. However, data suggest an overall improvement in knowledge, confidence, and skills. ConclusionsDevelopment of clinically and technologically relevant simulation education based on set standards can challenge nurse educators. Nursing professional development can be a tool to close the knowledge, skills, and practice gap.

Educating and empowering health care teams who present to the hospital to recognize and intervene on cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) in patients on bispecific t-cell engager therapy (BiTEs): A quality improvement study.

e23212 Background: Treatment of oncologic disease with Bispecific T-Cell Engager antibodies (BiTEs) are an emerging novel immunotherapy with demonstrated efficacy in multiple hematologic malignancies. Notable side effects of BiTE therapy include cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which can be life-threatening and must be rapidly identified. We aim to fill knowledge gaps surrounding CRS and ICANS for medical providers, particularly considering increased use of BiTE therapy. We hope that educating providers will allow faster recognition and treatment and will improve patient outcomes. Methods: Our study focused on the impact of educational presentations on awareness and identification of CRS/ICANS. Our intervention targeted the residents and attendings in the emergency department and the nurses, advanced practice providers, and hospitalists in the bone marrow transplant (BMT) unit at Stony Brook University Hospital. Anonymous surveys consisting of 9 multiple choice questions were conducted to assess baseline foundational knowledge of CRS/ICANS. QI consisted of a 15-minute educational presentation for both groups. The same surveys were repeated following the presentations to assess improvement in overall knowledge of CRS/ICANS. A two tailed independent T test was used to calculate significance. Results: The average pre-survey score for the emergency department (N = 37) was 39%. The average presurvey score for the BMT department (N = 13) was 45%. Significant improvements in scores after intervention were shown in both the emergency department (39% vs 66%, p = 0.0001) and the BMT department (45% vs 68%, p = 0.0006). Conclusions: Education among emergency department and hospitalist providers is essential in improving management of CRS and ICANS in patients treated with BiTEs. This quality improvement initiative confirmed a knowledge gap in CRS and ICANS amongst our healthcare teams. By providing educational resources to both departments, there was a significant improvement in this gap. Future directions for continued improvement in the detection and management of CRS/ICANS include patient medication identification cards, a central repository of treatment protocols, algorithms, and toxicities associated with BiTEs, and expanding our educational curriculum which are all currently under development at Stony Brook University Hospital.

The Impact of an Intern's Clinical Guidebook on Easing the Transition of New Interns Into the United States Healthcare System.

This study explores the efficacy of an intern's clinical guidebook in facilitating the transition of categorical internal medicine interns into the United States healthcare system. New interns, particularly foreign medical graduates, face multifaceted challenges during their initial year of residency. The research, conducted at Ascension Saint Joseph Hospital in Chicago, employed a quasi-experimental pre-post design involving 20 interns. Participants were provided with an intern's clinical guidebook, and their knowledge was assessed through pre and post exams. Results demonstrated a statistically significant improvement in overall knowledge, with mean scores increasing from 65% to 77.37%. Subgroup analysis revealed similar improvements among both male and female interns. Data confidentiality and ethical considerations were prioritized, with participant data anonymized and stored securely. Despite limitations, this study highlights the guidebook's potential to enhance intern education and improve the quality of care provided during the crucial transition period. Further research is recommended to validate and extend these findings.

Neurosurgical Education in Tanzania: The Dar es Salaam Global Neurosurgery Course

Postgraduate neurosurgical training is essential to develop a neurosurgical workforce with the skills and knowledge to address patient needs for neurosurgical care. In Tanzania, the number of neurosurgeons and neurosurgical services offered have expanded in the past 40 years. Training opportunities within the country, however, are not sufficient to meet the needs of residents, specialists, and nurses in neurosurgery, forcing many to train outside the country incurring associated costs and burdens. We report on the Dar es Salaam Global Neurosurgery Course, which aims to provide local training to neurosurgical health care providers in Tanzania and surrounding countries. We report the experience of the Global Neurosurgery Course held in March 2023 in Dar es Salaam, Tanzania. We describe the funding, planning, organization, and teaching methods along with participant and faculty feedback. The course trained 121 participants with 63 faculty-42 from Tanzania and 21 international faculty. Training methods included lectures, hands-on surgical teaching, webinars, case discussions, surgical simulation, virtual reality, and bedside teaching. Although there were challenges with equipment and Internet connectivity, participant feedback was positive, with overall improvement in knowledge reported in all topics taught during the course. International collaboration can be successful in delivering topic-specific training that aims to address the everyday needs of surgeons in their local setting. Suggestions for future courses include increasing training on allied topics to neurosurgery and neurosurgical subspecialty topics, reflecting the growth in neurosurgical capacity and services offered in Tanzania.

Changing perioperative practice in the time of climate crisis

BackgroundTo reduce the healthcare sector's contribution to carbon emissions, many hospitals have advocated avoiding inhaled anesthetic agents with high greenhouse gas potential, such as desflurane and nitrous oxide; using low gas flows; and adopting alternative anesthetic techniques. However, limited evidence is available on how to implement these changes, which require both organizational and individual adjustment. We engaged our healthcare workers on the topic of climate change, and reviewed any change in their knowledge and attitudes towards environment-friendly use of inhaled anesthetic agents. MethodsWe sent out a survey via email to our anesthetic staff to assess their baseline knowledge and opinions regarding inhaled anesthetic agents and climate change. We then provided an online education session, followed by a debate on whether to remove desflurane from use. The session was recorded and emailed to all staff. The impact of the intervention was subsequently assessed by repeating the knowledge and attitude survey. ResultsOf the 101 anesthetic staff members, 76 completed the initial survey and 54 completed the post-intervention survey. Using a pre-determined generated code, we matched 44 pairs of datasets for analysis (response rate 44%). We demonstrated an overall improvement in knowledge on the topic, and showed a positive attitude towards reducing the use of nitrous oxide. There was minimal attitude change on desflurane use, a considerable concern about risk shifting and limited support for total intravenous anesthesia as the default technique. ConclusionsAs an initial step of a practice change process, this study raised climate change awareness and enabled our staff with differing opinions to feel involved and prepared for change. However, additional strategies may be required before initiating organizational changes, with the aim to provide environmentally sustainable practice while maintaining safe and high-quality perioperative patient care.

Effect of an information booklet on nephrotic syndrome regarding knowledge and attitude of caregivers towards care of children with nephrotic syndrome in tertiary level centre of Bihar

Nephrotic syndrome, the most common renal disease in pediatric age group, is responsible for frequent hospitalization of children. As parents are the most responsible person for care of their children, it is necessary for them to be aware and have knowledge regarding strict adherence to therapeutic regimen, about the disease recurrence and measures for adequate care of their child’s health. An information booklet on nephrotic syndrome can help the caregivers in understanding the disease process and in maintaing their child’s health. Effect of an information booklet on nephrotic syndrome regarding knowledge and attitude of caregivers towards care of children with nephrotic syndrome in tertiary level centre of BiharThis cross sectional study was carried out on admitted patients in Indira Gandhi Institute of Medical Science, Bihar from January 2021 to December 2021. An information booklet on nephrotic syndrome was given to caregivers of children diagnosed with nephrotic syndrome. About 50 parents/caregivers were interviewed with a preformed structured questionnaire before and after reading the information booklet.Of 50 respondents, an overall improvement in knowledge increased from 18% in pretest to 80% in post test. This result proves that the information booklet helped in improving the knowledge of caregivers towards care of their children. The present study concluded that there was significant improvement in knowledge of caregivers after administrating information booklet.

Development and Assessment of Simulation-Based Point-of-Care Ultrasound Curriculum in Undergraduate Medical Education.

Implementation barriers and lack of standardized point-of-care ultrasound (POCUS) curricula make the development of effective POCUS curricula and methods of assessment challenging. The authors aim to develop a longitudinal POCUS curriculum through staged intervention. In the first stage, the authors hypothesized that the use of high-fidelity ultrasound simulation during the Internal Medicine clerkship would improve POCUS confidence and knowledge among medical students, minimizing the need for trained faculty. A quasi-experimental study of third-year students on the Internal Medicine clerkship at a large academic medical center in the United States was performed assessing the efficacy of ultrasound simulation use. The control group consisted of students who received baseline POCUS education during teaching rounds but did not have access to the ultrasound simulator. The experimental group consisted of students who, in addition to baseline POCUS education, had access to a high-fidelity ultrasound simulator throughout the clerkship for a minimum of 1 hour per week. Students in both the control and experimental groups completed a pre- and post-intervention confidence survey and knowledge-based examination. Eighty-two percent (50/61) of students completed pre- and post-tests, with the control group demonstrating no significant difference in POCUS confidence or knowledge. After exposure to the ultrasound simulator, the experimental group demonstrated statistically significant improvement in POCUS confidence and overall POCUS knowledge (p < .01). The use of high-fidelity ultrasound simulation can improve POCUS confidence and knowledge among medical students while addressing common barriers to the implementation of a POCUS curriculum. Despite showing statistically significant improvement in overall knowledge, the results did not appear to hold educational significance. Additional POCUS educational methods are necessary to overcome cognitive bias and potential overconfidence. The next stage of curriculum development will include resident-led POCUS workshops to supplement simulation.

A study to assess the impact of appropriate intervention/s on compliance w.r.t. key hospital infection control parameters in dialysis unit of a tertiary healthcare teaching institute in India

Aim: The aim of this study was to assess the impact of appropriate interventions on key infection control parameters subsequent to baseline assessment in dialysis unit with objectives to ascertain the current status of knowledge, attitude, and practice for key hospital infection control (HIC) parameters, to develop and execute appropriate interventions, to assess the impact of interventions, and to recommend an evidence-based HIC module.Methodology: An interventional, longitudinal study was conducted from April 2018 to May 2019 in dialysis unit of SGPGI. Study samples were nurses and technicians. The questionnaire was designed to assess knowledge and attitude. To evaluate practices, a checklist was drafted and graduated by scoring from 0 to 10. Interventions made were on-site training and workshop, IEC, and placement of alcohol-based hand rub. Data analysis was done by SPSS 23. For normally distributed data of the study, Descriptive Statistics was presented in the form of mean ± 2 standard deviation. Paired Sample t-test was used to compare the mean score and Chi Square test was used to compare the Knowledge between pre and post-intervention.Results: The overall improvement in knowledge was from 55% to 70% (P = 0.017–0.000). For attitude, the mean scores changed from 4.61 ± 0.562, 4.63 ± 0.582, 4.40 ± 0.756, and 4.36 ± 0.889 to 69 ± 0.493, 4.76 ± 0.428, 4.73 ± 0.449, and 4.64 ± 0.621. Regarding practices, prior to intervention, the mean scores were 20.49 ± 5.699, 48.75 ± 18.185, 63.25 ± 22.376, and 23.03 ± 10.036, and following intervention, it was found to be 22.98 ± 6.614 (2.49% increase, t = −2.990; P = 0.004), 52.81 ± 19.074 (4.06% increase, t = −1.473; P = 0.145), 68.00 ± 21.955 (4.75% increase, t = −1.472; P = 0.145), and 31.06 ± 13.400 (8.03% increase, t = −4.270; P = 0.000).Conclusions: Hemodialysis patients are vulnerable to severe infections for many reasons in dialysis setting including the failure to comply with appropriate hand hygiene, contamination of the instrument, or improper disinfection practices.

Trainee Headache Education and Management Enhancement (THEME) Study.

We investigated the association between clinical rotation at a specialized headache center and headache knowledge of resident trainees. Using standardized pre- and post-questionnaires, change in self-reported knowledge of headache disorders and management in 31 participants undertaking clinical rotations were evaluated. There was a statistically significant improvement in self-reported measures of headache disorder knowledge post-rotation [mean score (SD), 3.19(0.543), p < 0.001] and significant improvement in overall knowledge measured using case-based questionnaires pre- vs. post-rotation [7.1(1.4) vs. 7.9(1.5), p = 0.003]. Rotation at a specialized headache center improved trainees' self-reported knowledge and test-based scores, suggesting that such rotation should be included in postgraduate curriculum.

Impact of Pharmacist Mediated Education on Knowledge, Attitude, and Practices of Rural Adolescent Girls Towards Menstrual Hygiene

A prospective interventional study is conducted to study the influence of pharmacist-provided education on knowledge, attitude, and practices (KAP) of school-going adolescent girls towards menstrual hygiene practices in rural Suryapet, Telangana. After obtaining permission from the school, adolescent girls meeting the study criteria were included in the study. A 13 item KAP questionnaire was designed, validated, and administered to girls. A structured education was given about menstrual hygiene management to them. Post-education, the KAP questionnaire was readministered and results were analyzed. A total of 206 students were enrolled in the study, and 90(43.0%) students were in the age group of 14. Knowledge about menstruation was 27.18% in pretest and it was 94.68% after posttest showing a significant (p &lt; 0.01) improvement. After the education, the respondents have changed their opinion from “menstruation as a curse from God” (63.59%) to “as a natural process (95.63%). Mother was named as the main information source about menstruation, followed by teachers and friends. Post-education increased the attitude of maintaining regular genital hygiene from 86.40% to 96.60%. Proper discard of menstrual waste to refuse bin increased from 54.85% to 95.15% indicating the overall improvement in knowledge, attitude, and practice regarding menstrual hygiene among adolescent girls.

Developing a digitally innovative ethics and professionalism curriculum for neonatal-perinatal medicine fellows: a 3-year multicenter pilot study.

The purpose of this study was to develop and regionally pilot a digitally innovative curriculum in ethics and professionalism in neonatology and study the effects on trainee knowledge and confidence. We developed 13 modules in ethics for neonatology fellows and piloted them at three academic institutions utilizing a flipped-classroom approach. Baseline surveys in ethics knowledge and confidence in approaching ethical dilemmas were compared with repeat surveys after curriculum completion. Pre- and post-tests were also administered for all 13 modules. Forty-four of 49 eligible fellows participated (90% response rate). Pre/post comparisons demonstrated significant improvements in overall knowledge and in 8/13 modules, as well as improvement in overall confidence and individually when navigating 16/22 ethical dilemmas. After completing this curriculum, participants' knowledge scores and reported confidence in approaching ethical challenges significantly improved. Future steps include assessing the effects of this innovative curriculum via an ongoing international pilot.

Improving knowledge and confidence in the acute management of eating disorders and resulting complications

AimsThis project aimed to improve the knowledge and confidence of doctors at all levels when managing patients with eating disorders while on call.BackgroundA recent survey found just 1% of doctors have the opportunity for clinical experience on eating disorders. Anecdotally, a number of junior doctors within our trust had mentioned that they felt unsure when asked to manage patients with eating disorders during their out of hours shifts.MethodThis project aimed to ascertain levels of confidence with managing patients with eating disorders, and to collect suggestions to improve this. This was achieved using a survey sent out to 97 doctors working in a Mental Health Trust.We then utilised two of the suggestions to improve the identified areas of concern. The first method involved direct lectures. This was followed up with the creation of a poster highlighting the pertinent information which was displayed in key clinical areas. The second avenue was the creation of an information booklet covering key clinical information that is available to all on call doctors.ResultThe response rate for the survey was 37.11%. The survey found that doctors lacked confidence in the management of common conditions that arise in patients admitted with eating disorders. Refeeding syndrome was identified as the greatest area of concern by responding doctors.To assess the impact of the lectures, MCQs were given out before and after the presentation. The results were compared, and showed a clear improvement in overall knowledge, with results going from an average score of 56.6% to 80%.ConclusionBy using multiple methods to improve doctors confidence, (lectures, written information and visual posters), this quality improvement project achieved its aims in improving doctors knowledge, and through having easy access to important information, will have long term positive effects on patient care.

Abstract A028: Exploring Asian Indian and Pakistani views about cancer and participation in research: An evaluation of a culturally tailored educational intervention

Abstract Background: Asian Indians and Pakistanis (AIP) are a growing population in the United States (US), and cancer is a leading cause of mortality in this population. Cancer screening rates among AIP populations in the US remain low compared to other racial and ethnic groups. In addition, AIP adults have been historically under-represented in clinical research and reasons are largely unexplored. Methods: We delivered a culturally tailored educational intervention to improve knowledge, attitudes, and perceptions about cancer risk and preventive screening measures to AIP adults in the Philadelphia area. Participants of AIP descent, ages 18 and older, were recruited during an evening celebration at a local community center. The intervention, an oral presentation, was delivered by a physician of AIP descent with expertise in clinical cancer genetics. The presentation focused on screening measures and applicable genetic tests for breast, prostate, and colon cancers based on family history and individualized risk factors. Participants were assessed before (pre), immediately after (post), and 1 month following the presentation (follow-up) for changes in knowledge, attitudes, and perceptions of cancer risk and risk assessments. Data were analyzed for means, frequencies, and differences in means from baseline to endpoint and baseline to follow-up using SPSS. Only those who completed all three assessments were included in analysis. Results: Twenty-three participants, 12 female and 10 male participants (1 not reported) of AIP descent, averaging 46 years of age, completed the study. All participants were born in India and had been living in the US for an average of 20 years. Most (n=13) preferred the English language when discussing medical material, while a few (n=3) preferred another language. While there was no significant improvement in overall knowledge or knowledge of screening timelines for prostate and colon cancers, participants showed a significant change in understanding of when screening for breast cancer should begin (p&amp;lt;0.05). Pre- to post-intervention knowledge regarding genetic mutations (p&amp;lt;0.05) and genetic testing (p&amp;lt;0.05) was also improved. Lastly, participants were more willing to talk to their family members about cancer (p&amp;lt;0.05), participate in a medical research study (p&amp;lt;0.01), and undergo genetic testing for cancer risk assessment (p&amp;lt;0.001) after exposure to the intervention. Discussion: The intervention increased specific aspects of knowledge, willingness to participate in cancer research and risk assessments, and willingness to talk about cancer among AIP adults. This suggests that culturally tailored educational interventions, delivered in community settings, can be influential for this population. The efficacy of this research could be tested in a future randomized controlled trial with longer-term follow-up for sustained impact along with the collection of data regarding the uptake of cancer screening services post-intervention. Citation Format: Veda N. Giri, Preethi Selvan, Salini Mohanty, Ray Lum, Samantha Serrao, Amy E. Leader. Exploring Asian Indian and Pakistani views about cancer and participation in research: An evaluation of a culturally tailored educational intervention [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A028.

Readiness for the epidemic: The adult nonalcoholic fatty liver disease toolkit for primary care nurse practitioners.

Nonalcoholic fatty liver disease (NAFLD) prevalence has reached epidemic proportions, and the severe form, nonalcoholic steatohepatitis, can result in cirrhosis and liver failure. The growing prevalence requires primary care (PC) providers to be adept at recognition and management; however, they experience significant knowledge gaps that can result in delayed access to interventions that could improve outcomes. This study's aim was to develop and evaluate a toolkit to improve knowledge gaps and support evidence-based practice (EBP) among PC nurse practitioners caring for patients with NAFLD in a midwestern state. The Adult NAFLD Toolkit was designed using the Knowledge to Action framework and guidelines from the Agency for Healthcare Research and Quality. The success of the toolkit was evaluated by administering the NAFLD survey for general practitioners in a pre-post evaluation design. Pre-post survey scores (N = 11) were compared for statistically significant change using the Wilcoxon signed rank test for matched pairs and showed improvement in overall knowledge (p = .011), perceived preparedness to care for NAFLD (p = .007), intention to recommend weight loss for management (p = .008), and intention to use the NAFLD fibrosis score for patient monitoring (p = .008). The results of this pilot study demonstrate successful implementation and positive outcomes of an EBP toolkit and support its expanded use. Continued evaluation on a larger scale is needed. Health care providers can use the process described in this article to develop and implement toolkits to support EBP of other PC issues.

Interprofessional education: A controlled trial of a shared-learning skills simulation between RN &amp; OT students

Abstract Background Interprofessional education (IPE) in healthcare aims to enhance collaborative, evidence-based care. Case-based IPE scenarios incorporating clinical evidence and professional role information may enhance knowledge. Purpose This study compared transfers, mobility, and positioning knowledge, professional role knowledge, and IPE readiness between registered nurse (RN) and occupational therapy (OT) students who participated in either case-based IPE simulation or separate profession-specific education. Method Pre/post knowledge tests and Readiness for Interprofessional Learning Scale (RIPLS) surveys were used. Discussion The IPE group had statistically significant improvement in overall knowledge (p = .0478) and 12 of 19 readiness items, but not role knowledge (p = .2714), versus control group. Statistical significance was noted for overall knowledge between RN and OT groups (p = .0311) and within the RN group (RN intervention versus RN control) (p = .0039), and for role knowledge in the same groups (p = .0303 and p = .0126, respectively). Conclusions The results provide evidence for case-based, shared learning with RN and OT students in simulation.

Implementation of a Renal Replacement Therapy Simulation to Strengthen Essential Pharmacist Skills

Objective. To assess third-year pharmacy students' knowledge and application of renal pharmacotherapy using a renal replacement therapy (RRT) simulation. Methods. A simulation was developed that involved three stations related to RRT: peritoneal dialysis, continuous renal replacement therapy (CRRT), and hemodialysis. Stations involved demonstration of each modality, literature searches for drug information questions related to renal dosing with written recommendations, and utilization of an electronic medical record (EMR) to develop a verbal Situation, Background, Assessment, Recommendation (SBAR) for a patient with chronic kidney disease (CKD). Pre- and post-simulation assessments regarding therapeutic knowledge of RRT was used. Results. All 174 students completed the pre- and post-simulation assessments over the course of two years. Student performance indicated significant improvement in overall knowledge based on the assessments with significant overall differences in questions relating to indications for RRT, type of RRT indicated for hemodynamic instability, and agents used to maintain circuit patency. Overall inter-class differences were also identified at baseline and specifically for the questions regarding indications for RRT and agents used to maintain circuit patency. Both classes showed significant improvement in overall knowledge based on the post-simulation assessments. Debrief sessions and course evaluations indicated student satisfaction with the simulation experience. Students reported that the experience met the simulation objectives. Conclusion. Participation in an RRT simulation allowed pharmacy students to apply knowledge and skills learned didactically related to renal pharmacotherapy.

Health education on diabetes at a South African national science festival

Background. Diabetes is one of the non-communicable diseases with a major negative impact on the health and development of South Africans. Empowering the population’s understanding of the condition, with health-literacy appropriate approaches, is one of the interventions that allows discussions around the prevention of diabetes. Objective. To determine the effects of a health education programme on increasing knowledge about diabetes and encouraging preventive measures. Method. A public health education exhibition was held by a pharmacy student at a national science festival. It incorporated presentations, posters, health models, word-search games, information leaflets and a computer-based quiz consisting of pre- and post-intervention questions. Results. Junior and senior school learners participated in the computer-based quiz. Results from the junior school pre-intervention phase showed that learners had a fair prior knowledge of diabetes, with an overall score of 52.8%. Improvement in their overall mean score at the 5% significance level was noted ( p =0.020). There was a significant difference in the mean score after the intervention at the 1% level (government schools: 65.5 (standard error (SE) 3.1)%, independent schools: 45.9 (6.2)%; p =0.006). Of the senior learners 53.7% ( n =137) indicated that they use computers at school, while 118 (46.3%) did not have access to computers. The improvement in overall knowledge of the senior participants after the intervention was significant at the 0.1% level ( p <0.001). Conclusion. The health education offered by the pharmacy student's project was interactive and used an interdisciplinary approach to improve health literacy and raise awareness of diabetes. This is a tested intervention that may be adopted for improving health literacy among schoolchildren.

Knowledge of venomous snakes, snakebite first aid, treatment, and prevention among clinicians in northern Nigeria: a cross-sectional multicentre study.

Snakebite envenoming causes considerable morbidity and mortality in northern Nigeria. The clinician's knowledge of snakebite impacts outcome. We assessed clinicians' knowledge of snakebite envenoming to highlight knowledge and practice gaps for possible intervention to improve snakebite outcomes. This was a cross-sectional multicentre study of 374 doctors selected from the accident and emergency, internal medicine, family medicine/general outpatient, paediatrics and surgery departments of nine tertiary hospitals in northern Nigeria using a multistage sampling technique. A self-administered questionnaire was used to assess their sociodemographics, knowledge of common venomous snakes, snakebite first aid, snake antivenom treatment and prevention. The respondents' mean age was 35.6±5.8 y. They were predominantly males (70.6%) from urban hospitals (71.9%), from the northwest region (35.3%), in family medicine/general outpatient departments (33.4%), of <10 years working experience (66.3%) and had previous experience in snakebite management (78.3%). Although their mean overall knowledge score was 70.2±12.6%, only 52.9% had an adequate overall knowledge score. Most had adequate knowledge of snakebite clinical features (62.3%), first aid (75.7%) and preventive measures (97.1%), but only 50.8% and 25.1% had adequate knowledge of snake species that caused most injuries/deaths and anti-snake venom treatment, respectively. Overall knowledge predictors were ≥10 y working experience (odd ratio [OR] 1.72 [95% confidence interval {CI} 1.07 to 2.76]), urban hospital setting (OR 0.58 [95% CI 0.35 to 0.96]), surgery department (OR 0.44 [95% CI 0.24 to 0.81]), northwest/north-central region (OR 2.36 [95% CI 1.46 to 3.82]) and previous experience in snakebite management (OR 2.55 [95% CI 1.49 to 4.36]). Overall knowledge was low. Improvements in overall knowledge may require clinicians' exposure to snakebite management and training of accident and emergency clinicians in the region.

English

Pain is subjective and it can only be described by the individual experiencing it. It is the main reason why people seek medical help. Nurses play a major role in the management of pain; hence they must be highly knowledgeable to ensure their practices are of high quality. The aim of this study was to evaluate the impact of Nurses’ Pain Educational Program (NPEP) on nurses’ knowledge of pain management. The quantitative design was employed in the study; five lectures on the Nurses Pain Educational Program (NPEP) were conducted for 500 nurses. All participants were given 15 items questionnaires in a pre and post test design. The study location was the University College Hospital Ibadan and the duration of the study was between March to December, 2015. The pre and post-test on nurses’ knowledge were analyzed using descriptive and inferential statistics and the overall improvement in knowledge and management of pain was analyzed using the student t-test. The participants were divided into groups; each group was trained for two days in a week using the Nurses Pain Educational Program Package (NPEP). Findings revealed an improvement in knowledge which was found to be statistically significant (P < 0.000). This was evident by the results of the pre-test and post-test values; pre-test mean score was 2.6 ± 0.05 while that of the post test score was 4.0 ± 0.04. This indicated that knowledge was impacted. The Nurses Pain Educational Program had a positive effect on nurses' knowledge of pain assessment and pain management. Key words: Nurses’ Pain Education Program (NPEP), nursing, pain management.

IMPACT OF PHARMACIST LED ANTICOAGULATION MONITORING AND PATIENT EDUCATION ON ORAL ANTICOAGULATION THERAPY WITH ACENOCOUMAROL

Objective: Acenocoumarol is anoral anticoagulant with narrow therapeutic index, and the ideal dose of anticoagulation lies between International normalized ratio (INR) values of 2.0 and 3.5. Lack of monitoring and knowledge on acenocoumarol therapy may compromise patient’s safety resulting in under- or over-anticoagulation. A study was conducted to monitor for the safety of anticoagulation therapy, achievement of goal INR levels and to assess the impact of pharmacist led anticoagulation monitoring and patient education on the rational use of acenocoumarol in patients admitted in cardiology wards with thromboembolic disorders.Methods: The study was conducted in 70 patients; data collection was done, prescriptions were analyzed for drug-drug interactions and adverse drug reactions (ADRs). Patients’ knowledge on acenocoumarol therapy was assessed using a self-developed questionnaire at the baseline, then were subjected to a detailed patient education and on an average each patient received three sessions of education. They were again made to answer the same questionnaire on the day of discharge. The mean score of the responses before and after education was compared statistically using Wilcoxon signed rank test and McNemar test.Results: There were 60% patients under anticoagulated with the INR range of &gt;2.0. 123 drug interactions were observed in 58 patients, on an average of 2 interactions per prescription, but no ADRs were observed. 59 patients (84.3%) showed significant overall improvement in knowledge on anticoagulation therapy following education.Conclusion: This study implies the role of clinical pharmacists in achieving better clinical outcomes in patients receiving oral anticoagulation therapy with acenocoumarol.