Instruction Sheet Research Articles

GPT-4 performance on querying scientific publications: reproducibility, accuracy, and impact of an instruction sheet

BackgroundLarge language models (LLMs) that can efficiently screen and identify studies meeting specific criteria would streamline literature reviews. Additionally, those capable of extracting data from publications would enhance knowledge discovery by reducing the burden on human reviewers.MethodsWe created an automated pipeline utilizing OpenAI GPT-4 32 K API version “2023–05-15” to evaluate the accuracy of the LLM GPT-4 responses to queries about published papers on HIV drug resistance (HIVDR) with and without an instruction sheet. The instruction sheet contained specialized knowledge designed to assist a person trying to answer questions about an HIVDR paper. We designed 60 questions pertaining to HIVDR and created markdown versions of 60 published HIVDR papers in PubMed. We presented the 60 papers to GPT-4 in four configurations: (1) all 60 questions simultaneously; (2) all 60 questions simultaneously with the instruction sheet; (3) each of the 60 questions individually; and (4) each of the 60 questions individually with the instruction sheet.ResultsGPT-4 achieved a mean accuracy of 86.9% – 24.0% higher than when the answers to papers were permuted. The overall recall and precision were 72.5% and 87.4%, respectively. The standard deviation of three replicates for the 60 questions ranged from 0 to 5.3% with a median of 1.2%. The instruction sheet did not significantly increase GPT-4’s accuracy, recall, or precision. GPT-4 was more likely to provide false positive answers when the 60 questions were submitted individually compared to when they were submitted together.ConclusionsGPT-4 reproducibly answered 3600 questions about 60 papers on HIVDR with moderately high accuracy, recall, and precision. The instruction sheet's failure to improve these metrics suggests that more sophisticated approaches are necessary. Either enhanced prompt engineering or finetuning an open-source model could further improve an LLM's ability to answer questions about highly specialized HIVDR papers.

Verifying a novel bile cytology scoring system.

The scoring system for bile cytology (SSBC) aims to improve bile cytology diagnostic accuracy. Here, the practicality of SSBC was verified by multiple cytotechnologists. Bile cytological specimens were evaluated by 24 cytotechnologists using SSBC. The samples were assessed before using the SSBC (first-time assessment) according to three categories: benign, indeterminate, and malignant. A first scoring evaluation (FSE) was then performed using SSBC; each item in the scoring system was classified as present or absent. After distributing an instruction sheet with diagnostic criteria, a second scoring evaluation (SSE) was performed using SSBC. Each method was evaluated using diagnostic accuracy and interobserver and intraobserver agreement. Several samples were assessed as indeterminate in the first-time assessment. Although the specificity of the SSE improved, the sensitivity and accuracy decreased compared with those of the FSE. The overall interobserver agreement was fair for all parameters, including abnormal chromatin, irregular internuclear distances, irregularly overlapped nuclei, irregular cluster margins, and final evaluation in the FSE and SSE. The final evaluation by histological type exhibited slight agreement for well-differentiated tubular adenocarcinoma and almost perfect agreement for poorly differentiated tubular adenocarcinoma in the FSE and SSE. For moderately differentiated tubular adenocarcinoma, agreement was moderate in the FSE and fair in the SSE. For cholangitis, a slight agreement was observed in the FSE, which improved to fair in the SSE. Although the SSBC is expected to improve specificity, there exists ambiguity regarding SSBC criteria and interindividual assessment differences. Therefore, the objective assessment method should be revised.

109 Age-Friendly Research Tools to Enhance Inclusion of Older Adults in Research

OBJECTIVES/GOALS: Older adults are often underrepresented in research due to recruitment and retention barriers, among others. Frameworks have been developed to address these barriers but have not been disseminated to research teams without aging expertise. We aimed to test Age-Friendly tools among non-aging-trained research teams. METHODS/STUDY POPULATION: Our team developed and/or adapted seven Age-Friendly research tools to improve inclusion of older adults in research. Tools included a communication guide, Age-Friendly research checklist, knowledge consent check, and condolence card template, among others. Non-aging-trained research team members (n= 21) were invited to pilot test them and share strengths, limitations, and areas for improvement for each tool. Feedback was collected for up to 4 months using REDCap surveys and analyzed for common themes. Participants provided written informed consent and received a stipend of $1000 upon the completion of the surveys. RESULTS/ANTICIPATED RESULTS: Sixteen participants (76%) from primarily cancer and neurology departments completed at least one survey. The communication guide, research checklist, and knowledge check were implemented the most within the participants' study populations. Participants shared that the tools were user-friendly, easy to access, and well-explained through webinar trainings (offered separately) or instruction sheets. The most frequently reported barriers were lack of time, industry-sponsored trial restrictions, and lack of age-appropriate study populations. DISCUSSION/SIGNIFICANCE: Age-Friendly tools were acceptable and valuable among non-aging-trained research members. Dissemination of these tools could improve the experience for research teams and older adults and help align demographics of enrolled study populations with demographics of the condition being studied.

Structure, Agency, and Structural Reform: The Case of the European Central Bank

Monetary and financial integration has been shown to increase the pressure on states to liberalize social and labor market policies. If structures do not come with instruction sheets, how do monetary regime pressures translate into policy? Through a case study of the euro area, we show that central banks play an underappreciated role in this process. Using mixed methods to analyze a large amount of data, including the complete corpus of speeches, we trace the evolution of the European Central Bank’s advocacy for structural reforms between 1999 and 2019. To explain the ECB’s activism in a policy area beyond its mandate, we theorize the ECB as navigating a dilemma between governability and legitimacy. Handed a monetary regime under which flexible labor markets were seen as a condition for governability, the ECB saw no alternative but to push governments toward structural reforms, despite the reputational risks. The ECB ended its advocacy when increasing political backlash coincided with a structural regime shift from an inflationary to a deflationary environment.

Engaging Neural Plasticity in Senior High School Students: The Impact of Guided Discovery Teaching Method on Achievement in Circle Theorems

Purpose: The study's objective was to ascertain how circle theorem achievement in SHS students was affected by the guided discovery teaching method, a student-centered approach associated with improved neural plasticity.
 Materials and Methods: Two Form 2 classes from various Wa Municipal schools were chosen for the study using convenient, purposeful, and straightforward random sampling techniques. The study adopted a non-equivalent quasi-experimental design to compare students who are taught with the guided discovery method and the traditional method of teaching circle theorems concepts. The sample size was composed of 164 students. Using a separate t-test and descriptive statistics, the Geometry Achievement test was investigated. A pre-test was given before the experiment (post-test) began. The students who engaged in guided discovery instruction outperformed than those who did not when teaching and learning Circle theorems.
 Findings: The findings suggested that student-centered methods like guided discovery can greatly improve students’ achievement in the study of circle theorems. One of the implications derived from the study indicated that guided discovery teaching approach offers students the chance to put a method of learning into practice after they have used it. This was done by using illustrations of diagrams on cardboard. This must be considered in the planning of educators and subject-matter experts. For pre-tertiary education, the government must make it mandatory to use cardboard, mathematical instruments, and instructional sheets as teaching aids. Since visual representations of Euclidean Geometry diagrams bring reality to teaching and learning through pictures and diagrams, the importance of visualization and experimentation in learning circle theorems should not be underestimated by teachers or students. This will improve their conceptual understanding.
 Implications to Theory, Practice and Policy: One can recommend that in order to enhance the performance of SHS students, it will be most advantageous to introduce guided discovery teaching methods to pre- and in-service teachers, through promotion by Ghana Education Service and/or other stakeholders in the education sector. This introduction may be distributed through workshops and seminars for mathematics teachers' instructional techniques and skills will improve as a result. This study has added a lot to our understanding of the world. The guided discovery teaching method approach to teaching circle theorems has been strengthened and expanded as a result of this research, first and foremost. This thesis thus makes a substantial enhancement of the body of knowledge. The research also explains and backs up the notion that guided discovery methods aid students' academic endeavors. This shows that the teaching process engages students' attention and improves their capacity for memory and recall.

Health Literacy–Informed Communication to Reduce Discharge Medication Errors in Hospitalized Children

Inadequate communication between caregivers and clinicians at hospital discharge contributes to medication dosing errors in children. Health literacy-informed communication strategies during medication counseling can reduce dosing errors but have not been tested in the pediatric hospital setting. To test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. This parallel, randomized clinical trial was performed from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Permuted block (n = 4) randomization (1:1) to a health literacy-informed discharge medication communication bundle (n = 99) compared with standard counseling (n = 99). A study team member delivered the intervention consisting of a written, pictogram-based medication instruction sheet, teach back (caregivers state information taught), and demonstration of dosing with show back (caregivers show how they would draw the liquid medication in the syringe). Observed dosing errors, assessed using a caregiver-submitted photograph of their child's medication-filled syringe and expressed as the percentage difference from the prescribed dose. Secondary outcomes included caregiver-reported medication knowledge. Outcome measurements were blinded to participant group assignment. Among 198 caregivers randomized (mean [SD] age, 31.4 [6.5] years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 [95% CI, 1.0-3.6] percentage points; P < .001). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group (P = .003). The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]; P = .03), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%]; P = .04), and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]; P < .001). There were no differences in knowledge of medication name, indication, frequency, or storage. A health literacy-informed discharge medication communication bundle reduced home liquid medication administration errors and enhanced caregiver medication knowledge compared with standard counseling. Routine use of these standardized strategies can promote patient safety following hospital discharge. ClinicalTrials.gov Identifier: NCT05143047.

Contextualized Instructional Sheet (CIS) as Intervention Material in Mathematics 8 to Improve Students’ Academic Performance

This quasi-experimental study investigated the effectiveness of Contextualized Instructional Sheets (CIS) as an intervention material in improving the academic performance of eighth-grade learners in Mathematics. Two groups of eighth-grade learners participated in the study, with one group as the control group and the other as the experimental group. The control group did not have exposure to CIS, while the experimental group used CIS. Data were collected through a researcher-made survey questionnaire and a 40-item pre-test and post-test based on the third quarter’s most essential learning competencies (MELCs). The perception of the respondents regarding CIS was analyzed using mean and standard deviation, while the pre-test and post-test scores were analyzed using frequency and percentage. The dependent t-test was used to determine the significant difference between the pre-test and post-test scores of the two groups, while the independent t-test was used to compare the pre-test scores of the two groups and the post-test scores of the two groups. The use of CIS had a significant impact on the academic performance of the learners which was indicated in a statistically significant difference between the pre-test and post-test scores of the control group, with the post-test scores being significantly higher. These findings suggest that CIS can be an effective intervention material for improving the academic performance of eighth-grade learners in Mathematics. The study recommends the wider implementation of CIS based on its positive impact on learners’ academic achievement.

Effectiveness of the ABCDEF method for developing an institution-specific pain management clinical resource

Introduction Comprehensive treatment strategies improve pain management in hospitalized patients, but no conclusive algorithm is currently available. The Audience, Blueprint, Collaborators, Dissemination, Education, Feedback method for pain management resource development (ABCDEF method) has been proposed as an “executable template” for developing clinical resources customized to local practice environments. Methods The ABCDEF method was used to develop a proposal for a pain management pamphlet. Thereafter, a “Pocket Resource: Evidence-Based Pain Management and Responsible Opioid Prescribing” was developed according to the proposal. Qualitative retrospective analysis was performed to determine executability of the ABCDEF method for developing this institution-specific pain management resource. Results Twelve elements of the ABCDEF method were analyzed. Ten were completed according to the ABCDEF method instruction sheet. Of those, the expected outcome was different than actual outcome for four elements. All outcomes that were different than expected expanded either the overall impact or the information incorporated into the finished resource. Conclusions This qualitative retrospective analysis demonstrates executability of the ABCDEF method to successfully develop an institution-specific pain management resource. This template adds to the resources available to create evidence-based care consistency individualized to local practice environments. Study limitations include the retrospective analysis and a lack of generalizability for the results.

Exploring digital signal processing using an interactive Jupyter notebook and smartphone accelerometer data

Digital signal processing is a valuable practical skill for the contemporary physicist, yet in physics curricula, its central concepts are often introduced either in method courses in a highly abstract and mathematics-oriented manner or in lab work with little explicit attention. In this paper, we present an experimental task in which we focus on a practical implementation of the discrete Fourier transform (DFT) in an everyday context of vibration analysis using data collected by a smartphone accelerometer. Students are accompanied in the experiment by a Jupyter Notebook Companion, which serves as an interactive instruction sheet and a tool for data analysis. The task is suitable for beyond-first-year university physics students with some prior experience in uncertainty analysis, data representation, and data analysis. Based on our observations the experiment is very engaging. Students have consistently reported interest in the experiment and they have found it a good demonstration of the DFT method.

Fostering Secondary School Science Students’ Intrinsic Motivation by Inquiry-based Learning

Abstract Background Intrinsic motivation plays a unique mediating role in student academic performance. An inquiry-based learning (IBL) physics practical is studied in terms of effects on secondary school students’ intrinsic motivation towards performing science practicals. Results After performing IBL experiments on ionizing radiation, 38 secondary school physics students were interviewed and expressed their need for support in two main areas: the inquiry process and non-salient tasks, i.e., operating the equipment. The IBL experiments were revised accordingly, providing scaffolding through revised worksheets and videos on the use of the equipment. Subsequently, a quasi-experiment was carried out. One experimental group received both a revised worksheet and a video (N = 88), the other only received the worksheet (N = 67). Students performing the same practical on the basis of a step-by-step instruction sheet were used as a control group (N = 87). Five subscales of the intrinsic motivation inventory were used as a pre- and post-test for all three groups. Results show significant gains in the Interest/Enjoyment as well as Effort/Importance subscales favouring both IBL groups. With an instructional video, all five subscales show a significant increase as compared to the control group. Conclusions The results point to the advantages of using an IBL approach for practicals, provided appropriate scaffolding is used in terms of equipment operation and inquiry process.

Development and Evaluation of Task Instructional Sheets for Teaching Electricity/Electronics Skills in Nigerian Colleges of Education

The study was conducted to develop and evaluate task instructional sheets for teaching Electricity/Electronics students in Colleges of Education in Nigeria. Four research questions were formulated guided the study. A pretest and posttest non-equivalent control group design was adopted for the study. A sample of 320 Electricity/Electronics and final year students drawn using random sampling technique from four Colleges of Education in South-South, Nigeria was used for the study. Two schools each were randomly assigned to experimental and control groups and the available data showed that each Electricity/Electronic final year class of each school contains an average of 80 students. The experimental and control groups were taught the (TEE 313) Electricity/Electronics devices and measurement by their regular Electricity/Electronics lecturers. An instrument, the Electricity/Electronics Achievement test (EEAT) was developed by the researchers, validated by three experts and used for date collection. The reliability coefficient of the instrument was 0.85. The research hypotheses were tested at .05 using analysis of covariance (ANCOVA). The results of data analysis showed that the task instructional sheets were superior to the expository method and high ability level.

Accessible exercise for wheelchair users: comparing the usability of two adapted exercise machines

Introduction Exercise is an important occupation for wheelchair users. Limited access to adapted aerobic exercise equipment in the community and lack of knowledge on how to exercise are barriers to exercise participation among wheelchair users. To address these barriers, the adapted rower (aROW) and adapted skier (aSKI) exercise machines and educational materials were created. Purpose 1) To compare wheelchair users’ perspectives of the effectiveness and usability of the aROW and aSKI. 2) To explore perceptions of educational materials to support use of the machines. Materials and Methods A sequential, mixed-methods study design was used. Six wheelchair users trialled the machines, and completed an interview and two usability questionnaires. Qualitative data were analysed using thematic and conventional content analysis. Usability scores of both machines were compared using the Wilcoxon Signed Ranks Test. Results Data show high usability of the aROW and aSKI. More set up challenges were reported for the aROW than the aSKI. Participants perceived both machines provided effective cardiovascular workouts, and each met their exercise goals differently. Participants preferred the instructional videos over instructional sheets and provided suggestions for improving both. The Wilcoxon Signed Ranks Test showed no statistically significant difference in usability between the aROW and aSKI. Conclusion Implementing the aROW and aSKI in the community may address some equity issues that wheelchair users face by providing more aerobic exercise options. Results will inform educational material revisions to support use of the machines.

Impact of Online Preparation Modules on Students Engagement and Interactions in Face-to-Face Fluid Mechanics Laboratories

The transformation of laboratory activities to better embed the development of essential personal attributes and the attainment of specific learning outcomes in the engineering curriculum has been supported by the integration of online preparation modules. Beyond the widely demonstrated effectiveness of multimedia pre-laboratory activities in strengthening students’ engagement and preparedness for the execution of experimental tasks, this study also focuses on the effect of these online modules on student-student and student-instructor interactions in face-to-face fluid mechanics laboratories. Survey data show that students with a mid-level of academic performance were more likely to adopt the new resources but that most students perceived them as a valuable complement to, or replacement for, the traditional instruction sheet. While students’ self-assurance in conducting the laboratory tasks and appreciation of the instructor’s support appear unaffected by the completion of the modules, observations suggest these modules can strengthen students’ autonomy and engagement within their group during the conduct of the laboratory activities. Indeed, the introduction of the modules appears to facilitate a transition of the instructor’s role from directing the laboratory to guiding students in peer-learning.

Development of Real-world Data-based Medication Instruction Sheet for Acute Myeloid Leukemia Patients Receiving High-dose Cytarabine Consolidation Therapy.

For quick and accurate monitoring of potential adverse events (AEs) during concurrent chemotherapy, we had previously developed innovative medication instruction sheets (MIS) for a variety of chemotherapy regimens. However, it is still unclear whether these sheets correctly predict the type and time course of the onset and recovery of AEs. Therefore, we monitored AEs in patients with acute myeloid leukemia (AML) receiving high-dose cytarabine (HD-AraC) using the original MIS. Patients who received HD-AraC following remission induction chemotherapy were included in this study. Data obtained from AE monitoring were evaluated, and the original MIS was modified as appropriate. Among 41 patients, a total of 203 AEs (139 non-hematological and 64 hematological) were observed after chemotherapy. By contrast, all but one patient (97.6%) experienced 102 AEs (43 non-hematological and 59 hematological) before chemotherapy. The AEs that appeared after chemotherapy were all predicted items described in the original MIS; however, their onset and duration were not consistent with the predicted data, in which the prediction accuracy was 69.1% for non-hematological AEs and 1.6% for hematological events. Based on these monitoring data, the original MIS was revised, which led to an increase in the prediction accuracy to 94.2% for nonhematological events and 100% for hematological events. Preexisting AEs should be considered when preparing MIS for consolidation therapy with HD-AraC. The modified MIS based on AE monitoring exhibited a sufficiently high prediction accuracy.

Exercise combined with lysine-inositol vitamin B12 promotes height growth in children with idiopathic short stature

ObjectiveThis study was aimed to systematically determine the effect of exercise combined with lysine-inositol vitamin B12 (VB12) therapy on the height of children with idiopathic short stature (ISS). MethodsSixty children with ISS were randomly divided into observation and control groups (N = 30). Each group was given lysine-inositol VB12 oral solution (10 mL bid). Simultaneously, the observation group exercised following the “ISS exercise instruction sheet”. The height (H), growth velocity (GV), height standard deviation score (HtSDS) and other indicators were compared after 6 and 12 months of intervention, respectively. After 12 months of intervention, the biochemical indicators of the two groups, together with the correlation between the average days of exercise per week and average minutes of exercise per day, GV and serum growth hormone were analyzed. ResultsAfter 6 and 12 months of treatment, the GV, serum GHRH, GHBP, GH, IGF-1, and IGFBP-3 levels in the observation group were significantly higher than those in the control group, and HtSDS was significantly lower than that in the control group (P<0.01). After 12 months of treatment, the height of the observation group was significantly higher than that of the control group (P<0.05). There was no significant difference in the biochemical indicators between two groups (P>0.05). Average days of exercise per week and average minutes of exercise per day were positively correlated with GV and GHBP levels. Serum GHRH, GH, IGF-1, and IGFBP-3 levels were negatively correlated. Average minutes of exercise per day were negatively correlated with GV and GHBP levels. Serum GHRH, GH, IGF-1, and IGFBP-3 levels were positively correlated. ConclusionRegular and moderate stretching exercises combined with lysine-inositol VB12 can effectively promote height growth of children with ISS, which is clinically safe. The mechanism promotes serum GHRH, GHBP, GH, IGF-1, and IGFBP-3 levels.

Eudora Welty Collection: Mississippi Department of Archives and History

Eudora Welty Collection:Mississippi Department of Archives and History Elisabeth Cambonga The materials transferred to the Archives and Records Services Division (A&RS) from the Museum Division since March 2011, along with those transferred to the Mississippi Department of Archives and History (MDAH) upon the settlement of Eudora Welty's estate, continue to be incorporated into the Eudora Welty Collection. Any newly acquired collections of Welty-related material not donated to MDAH by Eudora Welty or her heirs are established as collections unto themselves, in accordance with archival rules of provenance, and are not added to the Eudora Welty Collection proper. In 2019, the National Endowment for the Humanities awarded an implementation grant to MDAH to support the preservation, digitization, and enhancement of access to the papers and photographs of Eudora Welty. The Eudora Welty Foundation matched MDAH's contribution to the grant. Although scheduled to be completed in May 2022, project revisions related to Covid-19 delayed progress and MDAH received a second grant extension from NEH. The project aimed to professionally conserve and scan selected items in the Eudora Welty Collection. The preparation and digitization of items necessitated the closure of selected series during scanning and quality control review. The grant was completed in January 2023 and can now be accessed via the digital archives on MDAH's website by visiting https://da.mdah.ms.gov/series/welty. The Welty Family Papers, Series 45, has been processed and is open as of April 2022; a new subseries, the Garden Papers of Chestina Welty, will open in April 2023. Series 33, Works on Welty, was opened in January 2023, and Series 34, Dramatizations of Welty's Fiction, is scheduled to be opened in 2023. The preparation of items may necessitate the temporary closure of this series. [End Page 199] We suggest researchers contact MDAH, refdesk@mdah.ms.gov, to verify the availability of series that are of particular interest to them prior to visiting the archives. Researchers are invited to visit the MDAH website where the home page https://www.mdah.ms.gov/ features Welty information with some regularity and provides a portal to the online catalog where new series and series revisions may be posted. The A&RS division continues to use Koha, a recently updated open source system, for its online catalog. An instruction sheet, The Eudora Welty Collection: Collection Research and Access via the Online Catalog, has been prepared to aid researchers in readily locating catalog records for the Eudora Welty Collection and other Welty-related materials in the division's holdings. The instruction sheet now includes information on accessing the Eudora Welty Digital Archives and concludes with a current series list. Researchers interested in obtaining publication rights for, and/or reproductions of, material in the Eudora Welty Collection may benefit from information provided in The Eudora Welty Collection: Contacts for Use Permission and Reprographic Services. The 2023 Eudora Welty Research Fellowship co-sponsored by the Eudora Welty Foundation and the Mississippi Department of Archives and History will be awarded in April. On-site research at the William F. Winter Archives and History Building, supported by the stipend of $5,000, will be conducted during the summer. The 2022 Fellow was Pamela J. Merryman, a PhD candidate in Liberal Studies at Southern Methodist University. Ms. Forrest Galey, who served as the curator of the Eudora Welty Collection since 1997 retired in December 2022 after more than thirty-seven years of outstanding service to MDAH and the state of Mississippi. Galey joined MDAH in 1985 as an archivist and Graphic Records Collection curator of Special Collections. She then served as the Archival Program Supervisor and later as Special Projects Officer. In 2012, she received the Public Humanities Award for Special Recognition presented by the Mississippi Humanities Council. During her tenure, Galey was instrumental in the multi-year construction planning of the William F. Winter Archives & History Building and the move from the Charlotte Capers Building, the former home of the archives and library. Galey also led the grant project Sharing the Literary and Photographic Legacy of Eudora Welty, supported by the National Endowment for the Humanities, the Eudora Welty Foundation, and MDAH, involving the improved conservation and...

Implementation and Assessment of No Opioid Prescription Strategy at Discharge After Major Urologic Cancer Surgery

Postoperative opioid prescriptions are associated with delayed recovery, perioperative complications, opioid use disorder, and diversion of overprescribed opioids, which places the community at risk of opioid misuse or addiction. To assess a protocol for eliminating postdischarge opioid prescriptions after major urologic cancer surgery. This cohort study of the no opioid prescriptions at discharge after surgery (NOPIOIDS) protocol was conducted between May 2017 and June 2021 at a tertiary referral center. Patients undergoing open or minimally invasive radical cystectomy, radical or partial nephrectomy, and radical prostatectomy were sorted into the control group (usual opioids), the lead-in group (reduced opioids), and the NOPIOIDS group (no opioid prescriptions). The NOPIOIDS group received a preadmission educational handout, postdischarge instructions for using nonopioid analgesics, and no routine opioid prescriptions. The lead-in group received a postdischarge instruction sheet and reduced opioid prescriptions at prescribers' discretion. The control group received opioid prescriptions at prescribers' discretion. Primary outcome measures included rate and dose of opioid prescriptions at discharge and for 30 days postdischarge. Additional outcome measures included patient-reported pain and satisfaction level, unplanned health care utilization, and postoperative complications. Of 647 opioid-naive patients (mean [SD] age, 63.6 [10.0] years; 478 [73.9%] male; 586 [90.6%] White), the rate of opioid prescriptions at discharge for the control, the lead-in, and the NOPIOIDS groups was 80.9% (157 of 194), 57.9% (55 of 95), and 2.2% (8 of 358) (Kruskal-Wallis test of medians: P < .001), and the overall median (IQR) tablets prescribed was 14 (10-20), 4 (0-5.3), and 0 (0-0) per patient in the control, lead-in, and NOPIOIDS groups, respectively (Kruskal-Wallis test of medians: P < .001). In the NOPIOIDS group, median and mean opioid dose was 0 tablets for all procedure types, with the exception of kidney procedures (mean [SD], 0.5 [1.7] tablets). Patient-reported pain surveys were received from 358 patients (72.6%) in the NOPIOIDS group, demonstrating low pain scores (mean [SD], 2.5 [0.86]) and high satisfaction scores (mean [SD], 86.6 [3.8]). There was no increase in postoperative complications in the group with no opioid prescriptions. This perioperative protocol, with emphasis on nonopioid alternatives and patient instructions, may be safe and effective in nearly eliminating the need for opioid prescriptions after major abdominopelvic cancer surgery without adversely affecting pain control, complications, or recovery.

Usefulness of a Medication Instruction Sheet for Patients Receiving Cytarabine and Idarubicin Induction Therapy for Acute Myeloid Leukemia.

To monitor adverse events rapidly and accurately during combination chemotherapy, we established an innovative medication instruction sheet (MIS) including cytarabine and idarubicin induction therapy. However, it is unclear whether this MIS allows for the accurate prediction of adverse events and their onset timing in a clinically significant manner. We therefore evaluated the clinical usefulness of our MIS for monitoring adverse events. Patients who received cytarabine and idarubicin induction therapy for acute myeloid leukemia (AML) at the Department of Hematology, Kyushu University Hospital between January 2013 and February 2022 were included. The real-world clinical data were compared to the MIS to determine the accuracy of the MIS for predicting the onset and duration of adverse events in patients with AML during induction chemotherapy. Thirty-nine patients with AML were included in this study. Overall, 294 adverse events were noted, all of which were predicted items in the MIS. Among the 192 non-hematological adverse events, 131 (68.2%) occurred during a similar period as that listed in the MIS, whereas among the 102 hematological adverse events, 98 (96.1%) appeared earlier than expected. For the non-hematological events, the onset and duration of elevated aspartate aminotransferase levels and nausea/vomiting coincided well with those listed in the MIS, whereas the predictive accuracy for rashes was the lowest. Hematological toxicity was not predicted because of the bone marrow failure associated with AML. Our MIS was useful for rapidly monitoring non-hematological adverse events in patients with AML receiving cytarabine and idarubicin induction therapy.

Evaluation of Fundamental Instructional Design Skill: The Quality of PPG Program In-Service Teachers

Program Pensiswazahan Guru (PPG) is a targeted degree program catered for those in-service teachers mention above. PPG is conducted using a distance learning mod and the duration is 4 years. In-service teachers will attend the courses during the weekend and only five times face-to-face meetings with the lecturers. However, there is no comprehensive research has been conducted towards PPG students’ mastery skills in fundamental instructional design. Therefore, this study aimed to evaluate the fundamental instructional design skill level among PPG students and to determine the differences in fundamental instructional design skills among three groups of PPG students (Primary School, Secondary School, and Vocational College). This study employed a tracer study survey as the research design by using a set of questionnaires on the Needham Model-based instructional design skill assessment sheet. A total number of 276 respondents were involved in this study. The collected data will be analysed by using descriptive statistics and the One-Way ANOVA Test. Results show that most of the in-service teachers tend to have high scores in fundamental instructional design skills, namely orientation, idea generation, idea restructuring, application of the idea, and reflection. Vocational college teachers were champions in all four phases of instructional design skills except the reflection phase. The reflection phase was championed by teachers from primary school. Meanwhile, secondary school teachers tend to achieve middle level across all instructional design skills. In conclusion, the PPG programme conducted by the university can enhance the in-service teacher’s instructional design skills.

Reduction of Central-line-Associated Bloodstream Infections in a Tertiary Neonatal Intensive Care Unit through Simulation Education.

Critically ill neonates and those with complex medical conditions frequently require the use of central venous lines. Unfortunately, central line-associated bloodstream infections (CLABSIs) result in significant morbidity and mortality, and the cost and increased length of stay burden the healthcare system. Previous studies have demonstrated that standardized care bundles can decrease CLABSI rates, but achieving sustained improvement has proven difficult. All patients admitted to the Neonatal Intensive Care Unit between 2014 and 2020 who had a CVL were included in this study. First, we recorded all CLABSI events and total CVL days according to defined criteria. Then, in late 2016, we instituted simulation-based nursing training for CVL care. Job Instruction Sheets were initially introduced to Neonatal Intensive Care Unit nursing staff simultaneously with one-on-one teaching sessions between instructors and bedside nurses. Intermittent performance audits and re-education for identified deficiencies did not improve the CLABSI rate per 1000 line days. After instituting simulation-based CVL training in 2016, there was a decreased rate of CLABSI events per 1000 line days sustained over time (x = 0.692). Standardized care bundles and Hospital-acquired Condition interactor audits were insufficient to reduce the CLABSI rate. However, combining care bundles and education with simulation-based training significantly decreased CLABSI rates. One-on-one intensive training and continued ongoing monitoring were critical to producing a sustained reduction. This experience demonstrates that supervised, interactive education combined with simulation can significantly impact patient outcomes.