Educational Materials Research Articles

Paving the way for equitable and guaranteed access to vaccination for Newly Arrived Migrants

Abstract Background There is a gap in knowledge on the country-specific access to vaccination for Newly Arrived Migrants (NAM) in Europe, the obstacles encountered, and the resources available to surmount these barriers. The AcToVax4NAM project addresses gaps in the vaccination process of NAM in 8 European countries by developing country-specific, action-oriented flowcharts of the vaccination pathway that identify barriers and provide barrier-specific solutions. The flowcharts are linked to a comprehensive Repository of Tools aimed at providing tools to overcome system barriers and ensuring equitable immunization access for NAM in all consortium countries. Methods Country-specific action-oriented flowcharts group the vaccination pathway for NAM in the five hubs (entitlement, reachability, adherence, achievement, and evaluation) and offer solutions for identified barriers. Participatory research validated these flowcharts via focus group discussions with 84 total professionals FOR health (PFH) involved in NAM immunization. The tools were sourced from all consortium countries, encompass diverse formats and languages, and provide a holistic approach to vaccination promotion. Results The validated instrument was deemed useful, relevant, and easily understandable. Validated barriers included the lack of multi-stakeholder collaboration, culturally competent PFH, tailored educational materials, and language barriers. Meanwhile, the linked Repository includes 359 tools categorized according to the five hubs of the vaccination pathway. These can be filtered by language, country, type of tool, year of issuance, and/or intended target population. Conclusions The flowcharts and the Repository serve as the basis for a pilot intervention aiming to strengthen healthcare system responsiveness to promote NAM immunization. This participatory approach aims to equip PFH with a clear understanding of system-level vaccination barriers and solutions to enhance vaccination uptake among NAMs.

Empowering patients with heart failure: a digital health solution improved self-care and metabolic outcomes in a randomized controlled trial

Abstract Background/Introduction Heart failure is a common cause of morbidity and mortality and poses a significant burden on patients and healthcare providers. Purpose The aim of the study was to evaluate whether a digital health program improves quality of life and clinical outcomes for patients with heart failure. Methods A single-center, randomized controlled trial (RCT) was conducted with patients receiving standard of care (SoC) at a heart failure outpatient clinic. Patients were randomized (1:1) to receive either SoC alone or SoC with an additional six-month digital health program. The program consisted of remote patient monitoring (RPM) with symptom tracking, disease-specific education, and lifestyle coaching, designed to empower patients with heart failure. After the main program concluded, a six-month maintenance program was initiated, consisting of recurrent educational materials, with reduced coaching- and RPM frequency. The primary endpoint was the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) at six months. Secondary endpoints included the European Heart Failure Self-care Behaviour Scale-9 (EHFScB-9), 6-question heart failure knowledge questionnaire, and metabolic outcomes. Here we report on the Intention-to-Treat (ITT) population analysis for the primary and significant secondary endpoints at six and 12 months. Results The ITT included 175 participants, 86 in the program group and 89 in the control. Program group: mean age (SD) 64.7 (13.2), 66.3% male, 87.2% with NYHA stages I-II. Control group: mean age (SD) 66.2 (11.1) years, 69.7% male, 87.6% with NYHA stages I-II. Median compliance with RPM was 93% and in-app retention was 80% at six months. Results for primary and secondary endpoints are presented in Table 1 and Figure 1. No statistical difference was observed in the KCCQ score between groups at six or 12 months. The program group had statistically significant improvements in EHFScB-9 score at six and 12 months and in heart failure knowledge at 12 months compared to the control group. Metabolic outcomes: a significant difference in glucose levels was also observed between groups at six months, and in HbA1c and triglycerides levels at 12 months. Conclusions The difference between groups in the primary endpoint of heart failure symptoms and quality of life, as measured by the KCCQ-12, was not statistically significant. However, significant differences were observed in self-care behaviour and heart failure knowledge, as well as metabolic outcomes at six and 12 months, when compared with standard care alone. These findings, along with good retention and engagement, indicate the value to patients of digital health interventions in the management of heart failure.

Empowering Young Roma Women in matters of health and primary care: an innovative training program

Abstract Background Roma communities are rather diverse groups with different level of knowledge, beliefs and motivations in relation to their health. Raising awareness and self-efficacy of these individuals is a challenging field in the EU public health agenda. Objectives To address this challenge, the program entitled “Empowering Young Roma Women in matters of health, prevention and human rights: a new methodological approach” was developed with the aim to empower Roma women in terms of health and prevention topics pilot testing different educational methods. A two-step co-design approach was performed to determine the training content, tools, methods. The training was implemented in 5 areas throughout Greece (Volos, Chalkida, Thiva, Agia Varvara, Zefyri) in Jan-Oct 2023, including 3 phases: a. Train-the-trainers, b. Training the Roma women and c. Training evaluation. Results The educational material developed for health and prevention included 4 units (gynaecological health issues, vaccinations, smoking and nutrition). Each unit consisted of a theoretical background to develop the material, a presentation for future trainers, a presentation for trainees, a brochure, and a poster. For the training a new methodological approach was tested i.e. a health professional or Roma women (after being trained) to deliver the training. In total, 548 pre-post questionnaires were collected. Most trainees, understood the content of the training, acquired new knowledge and found the information interesting and possible to include in their daily life. 80% trainees expressed their satisfaction with the overall presentation. Regarding knowledge improvement based on the type of trainer only a slightly greater degree of improvement was observed for Roma trainers. Conclusions It is crucial to develop culturally appropriate health interventions by directly working with communities, to understand their particular needs, and to ensure they receive the information needed to make informed decisions. Key messages • Maintaining and promoting health is a decisive factor of social inclusion. • Tailor-made training of ethnic minorities shall be an integral part of the EU public health agenda.

Virtual Children’s Hospital for Learning Pediatric Nursing

Abstract Background In the context of a funded Erasmus+ program, a platform of a Virtual Children’s Hospital for Learning Pediatric Nursing - VLPN is being developed. The education of nurses working with children, adolescents and families, needs to include specialized knowledge, skills, attitudes and behaviors that will empower them to provide optimal and high-quality care. The virtual platform enables the improvement of pediatric nursing competences of the nursing students through interactive and self-paced activities and content. Objectives 1. To develop an immersive and interactive virtual reality learning environment (VRLE), a virtual children’s hospital and new teaching and learning methods and practices, utilizing virtual reality and simulation in teaching. 2. To promote the international collaboration of students and lecturers through the VRLE Results The results are preliminary. 1. The VRLE includes educational materials developed to be integrated in the pediatric nursing studies, easy to access and use by the students and teachers with innovative self-pace learning material i.e. videos, 3D-models, interactive tests. Digital patients can react to the provided care with speech, movement, facial expressions and gestures, something that is not possible with the manikins in the Labs. 2. Nursing students and lecturers from different countries can participate in joint remote seminars or workshops in the VRLE, sharing and comparing their country and culture-specific differences and similarities in the nursing practices. VRLE and digital materials enables synchronous and asynchronous learning. Conclusions VRLE is highly conducive to clinical and procedure-focused training by enabling simulation. VR methods offer nursing students the opportunity to practice skills in a safe and risk-free environment in an immersive way. It can be accessed by multiple students, teachers or nurses at the same time from different locations in different countries. Key messages • New innovative VRLE enhances nursing students’ knowledge and skills that are needed when working with sick children and their families. • International collaboration, interaction and mobilization are enabled by using a virtual platform instead of traveling, thus strengthening the co-operation in European higher educational institutes.

Building the OAChangeMap to improve the service delivery of the New South Wales Osteoarthritis Chronic Care Program: a worked example of using a co-design framework.

The Osteoarthritis Chronic Care Program (OACCP) has been implemented in Australian public hospitals to deliver best-evidence OA care. It is important to ensure that the OACCP continues to deliver evidence-based OA care as intended. We aimed to identify barriers and enablers to delivering the OACCP, prioritise the barriers, and generate strategies to address them. This study provides a worked example of a seven-step theory-informed co-design framework. We invited OACCP coordinators to participate in semi-structured interviews (analysed thematically) and complete a questionnaire to identify barriers and enablers to delivery of the OACCP. We then invited a broader group of stakeholders (OACCP coordinators, health managers, policy makers, consumers, researchers) to prioritise the barriers via a short survey (survey 2). We held five co-design workshops where we mapped the priority barriers to the Theoretical Domains Framework and developed strategies to address them. Sixteen coordinators were interviewed and the main barriers identified were: 1. patients often have beliefs that are inconsistent with best-evidence care; 2. there are aspects of clinical care that are not delivered optimally; and 3. system level factors are a barrier to optimal patient care and sustainability of the OACCP. We co-designed a plan for action with patient educational materials, shared decision-making tools, and health professional education and training. Our worked example of co-design used a theory-based, data driven approach with key stakeholders, identified and prioritised barriers to the delivery of the OACCP, acknowledged enablers, and generated a plan for feasible strategies to improve the program.

Co-creating the intervention ‘MAMAACT’ for improved care for pregnant migrant women in Denmark

Abstract Background The MAMAACT intervention was developed as a response to documentation of ethnic and social inequities in stillbirth in Denmark, despite free and universal access to antenatal care. The MAMAACT intervention aimed to reduce stillbirth in migrant families by improving communication about pregnancy complication during antenatal care. Methods The intervention consisted of a training program for midwives and health education materials. It was implemented at a structural level (training of midwives) and, through strengthened needs-based communication during antenatal care, the aim was to improve the health literacy of the women. 19 of the 20 Danish maternity wards participated in the study in 2018-19 and a comprehensive evaluation was conducted. The intervention was co-created with midwifery managers, midwives, and migrant women. Results The management and selected clinical midwives participated in the design of the midwifery training and the health education material as well as the intervention’s implementation and recruitment strategies for the evaluation. As representatives of the target group, a partnership with the non-profit organization Bydelsmødre was initiated. Bydelsmødre trains migrant mothers living in socially deprived areas to help vulnerable migrant women. Evening sessions were conducted with a specific group of women in their community, where the intervention components, the recruitment to the evaluation, and the interpretation of evaluation findings were discussed. A significant contribution was a video explaining the migrant experiences of becoming a mother in Denmark used in the midwifery training. MAMAACT researchers were invited to present the evaluation at the annual assembly for Bydelsmødre organization in 2019. Conclusions The partnership with Bydelsmødre provided a strong voice for migrant women, enhancing engagement with the intervention, recruitment for the trial, and its real-world relevance.

Improvement in cardiac function but not structure in adults born preterm following a prescribed moderate to high intensity exercise intervention: a randomized clinical trial

Abstract Background People born preterm (<37 weeks’ gestation) have a potentially adverse cardiac phenotype that progresses with blood pressure elevation and may explain their increased risk of early heart failure and cardiovascular-related mortality. It remains unknown whether lifestyle or pharmacological interventions lead to beneficial left ventricle (LV) and right ventricle (RV) structural and/or functional changes in preterm-born adults. Purpose To determine whether preterm-born adults with elevated and stage 1 hypertension exhibit similar cardiac remodelling following a 16-week aerobic exercise intervention as their term-born peers with comparable blood pressures. Methods We conducted an open, parallel, two-arm superiority randomised controlled (1:1) trial in n=203 adults aged 18-35 years old with elevated or stage 1 hypertension. Participants were randomised to a 16-week aerobic exercise intervention targeting three, 60-minute supervised sessions per week at 60-80% peak heart rate (exercise intervention) or sign-posted to educational materials (controls). In a pre-specified cardiovascular magnetic resonance imaging (CMR) sub-study in n=100 individuals, CMR was performed before and after the 16-week intervention. Group differences in outcome variables after the intervention were examined using ANCOVA adjusting for baseline outcome variables, sex, and age. Interactions between birth category and intervention effect were investigated by including an interaction term in the intervention ANCOVA analyses. Results One hundred participants completed CMR scans at baseline and after the 16-week intervention, with n=47 in the exercise intervention group (n=26 term-born; n=21 preterm-born) and n=53 controls (n=32 term-born; n=21 preterm-born). Cardiac structural measures in preterm-born adults did not change following the intervention. However, term-born adults in the exercise intervention group decreased LV mass to end-diastolic volume ratio (adjusted mean difference: -0.03, 95% CI: -0.06,-0.01, interaction term p=0.027) and increased RV stroke volume (adjusted mean difference: 5.53mL/m2, 95% CI: 2.60,8.47, interaction term p=0.076) versus controls. Preterm-born adults in the exercise intervention group increased LV basal- and mid-ventricular circumferential strain versus controls (adjusted mean difference: -1.33%, 95% CI: -2.07,-0.60, interaction term p=0.057 and adjusted mean difference: -1.54%, 95% CI: -2.46,-0.63, interaction term p=0.046, respectively), which was not observed in term-born adults. Similarly, preterm-born adults improved RV longitudinal strain versus controls (adjusted mean difference: -0.51%, 95% CI: -1.49,0.46, interaction term p=0.053), which was also not observed in term-born adults. Conclusions Aerobic exercise training improves myocardial function but not cardiac structure in preterm-born adults. Modified exercise protocols or combination with pharmacological intervention may lead to additional cardiac remodelling benefits.

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.

Enhancing EFL Learning Through Multimodal Integration: The Role of Visual and Auditory Features in Moroccan Textbooks

This study examines the impact of multimodal integration, particularly the combination of visual and auditory elements, on EFL learning through Moroccan textbooks, specifically English Spotlight 1 and English Horizons. It investigates how these educational materials rely on visuals, diagrams, and audio tools to foster comprehension, retention, and engagement among secondary school students in Morocco. Employing a mixed-methods approach that includes both qualitative and quantitative analyses, the study evaluates the effectiveness of these features from the viewpoints of students and teachers. The results indicate that visual components significantly and positively affect vocabulary acquisition and grammatical comprehension, while auditory elements enhance listening skills and pronunciation. The research emphasizes the necessity for more advanced multimodal content in Moroccan EFL education and identifies technological barriers that impede full integration. It recommends an increased emphasis on multimodal resources in textbook development and the improvement of technological infrastructure in educational institutions.

Examinatıon of Assessment and Evaluation Elements in 5th, 6th and 7th Grade Social Studies Middle School Textbooks

Textbooks are the most fundamental educational materials. For these materials to be effectively used, they need to be relevant to the era we live in. In this context, since 2004, the content of textbooks in Turkey has been prepared within the framework of constructivist education, aiming to enhance students’ cognitive, affective, and psychomotor skills. This study examines the assessment and evaluation elements within Social Studies textbooks to determine their alignment with constructivist education and the specific skills they target for students. The research analyzes assessment components found in six different textbooks approved by the Ministry of National Education (MEB). Within these textbooks, the assessment elements related to seven learning approaches—such as preparatory questions, in-text questions, activities, end-of-text evaluations, self-assessment, peer assessment, concept maps, end-of-unit assessment questions, and group self-assessment—are classified and studied from a constructivist perspective. Using a qualitative research design, document analysis is employed to identify assessment elements and link them to skills consistent with constructivist education. Finally, a comparative evaluation reveals differences between textbooks at different educational levels, contributing to the literature on the relationship between assessment elements and constructivist education in Social Studies textbooks.

Pretesting of Printed Information, Education and Communication Materials among Diabetic Patients who are (30 to 80) Years Old in South Kolkata, at Ward no 144, West Bengal

Background: In India, the (IEC) Information, Education & Communication strategy is designed to enhance public awareness and disseminate crucial information about the various benefits offered under the different schemes and programs initiated by the Ministry. This strategy plays a pivotal role in guiding citizens on effectively accessing these benefits, ensuring that the intended population is well-informed and empowered to take advantage of the available resources. A brief study was conducted to pretest the IEC material related to Diabetes Mellitus in a specific ward in Kolkata, West Bengal, India. Following this, we will evaluate and analyse the IEC material.  Methods: A locality‐based cross‐sectional mix method study was conducted in south Kolkata ward no 144, West Bengal from 10/05/2024 to 31/05/2024.A predesigned pretested semi‐structured questionnaire was used to collect quantitative and qualitative variables. Data were collected through personal face-to-face interviews using Epi‐Collect 5 and analysed using EXCEL and SPSS.  Result: Out of 20 study participants, Cent per cent(20) of study participants voted that the IEC material is attractive. The brochure is interesting enough to attract and hold the attention of the target audience, participants like it. several messages attract the most attention. 95%(19)clearly understand, almost comprehensible. Cent per cent(20) of participants accepted that IEC material is not offensive/inappropriate for the individuals or community. The brochure is perceived by individuals in the target audience. They feel that the brochure is made for themselves or made for those who are suffering from diabetic mellitus. Cent per cent(20) of the IEC material is relevant. Cent per cent(20) target audience opined that call to action regarding pretesting IEC material. The target audience is those suffering from diabetic mellitus and complications. Cent per cent(20) of the brochure can convince the study participants to undertake the desired behaviour.25%(5) target audience opined that brochures regarding diabetic mellitus should be improved.  Conclusion: In this short study, we discovered that the use of (Brochure)IEC materials was affected by a variety of factors. Therefore, essential to focus on these IEC materials and strive for enhancements in their quality. Improving the quality of brochures can lead to better comprehension and engagement among the target audience. By addressing the many specific qualitative variables that influence their effectiveness, we can ensure that these materials serve their intended purpose more effectively. This will not only facilitate better communication but also promote a deeper understanding of the information being conveyed. This brochure(IEC) material could be implemented after the improvement of quality in Kolkata 144 no ward, West Bengal.

Technology of creating an innovative textbook for teacher education system

The transformation of education, caused by the constantly changing demands of society and the avalanche growth of information, necessitates the search for new means of training future teachers, focused on the formation of universal qualities of a specialist. The creation of psycho-pedagogical classes requires expanded research into ways to improve pedagogical training with continuity at all levels, starting from school. Considering the focus on professional training, it is important to model the structure and content of educational tools that allow forming not only subject knowledge but also the readiness of future teachers to “learn to teach” adequately to the cognitive characteristics of modern students and the trends in the formation of digital content.The aim of the article is to substantiate the method of creating end-to-end inversion textbooks that allow forming and developing the readiness to learn to teach in students planning their future professional activities in the educational field (by the example of studying the topic of the informatics course “Information and information processes”).The literature analysis allowed us to identify three tools for modeling the format of presentation and structuring of the textbook content: the “inverted” or inversion (question-task) format of the structural composition of educational content; the end-to-end or vertical selection of educational content according to the principle of “vertical lever”, the principle of “transparent” box” based on structural mental diagrams for visualizing all components of educational material (theory, tasks, control methods). Using the example of the topic “Information and information processes”, the article shows the technology of applying these tools in compiling of innovative teaching resources is shown.An expert assessment of the created textbook confirmed the possibility and feasibility of its use in psycho-pedagogical classes and pedagogical universities for training, self-study, and self-control of students.

Assessment of enoxaparin‐related knowledge, administration technique, and self‐reported adherence among women after caesarean section delivery

AbstractBackgroundVenous thromboembolism is among the main causes of maternal morbidity and mortality, with caesarean section (CS) delivery carrying greater risk. Outpatient thromboprophylaxis, such as enoxaparin, is administered subcutaneously and prescribed as an outpatient; raising the issue of medication adherence.AimThis study aimed to evaluate women's adherence to enoxaparin administration after CS delivery, explore the reasons for non‐adherence, and assess the factors associated with patients' adherence to enoxaparin.MethodWomen after CS delivery, who had been given enoxaparin at discharge were included in the study. Eligible patients were contacted via telephone at the middle and the end of the enoxaparin treatment. Syringe count determined the main outcome of adherence during direct telephone interviews with the patient. Optimal adherence was defined as all the doses of enoxaparin being administered and suboptimal adherence was at least one dose not administered. Ethical approval was granted by the Malaysian Registry Ethics Committee belonging to National Medical Research Registry (Reference no: NMRR ID‐22‐02859‐P41) and the study conforms with the Declaration of Helsinki. Informed consent was obtained from all participants through completion of written consent forms, after an explanation of the study was provided by investigators.ResultsOut of 201 women included, the majority (91.5%) were fully adherent to enoxaparin, while 8.5% missed at least one dose. Most patients administering at home missed the dose due to reporting they were unwell (n = 6), busy (n = 4), or forgot to administer (n = 2). Among missed doses in patients administered in a healthcare setting, all participants (n = 5) forgot to bring their medication to the appointment. Only medication knowledge had a significant association with adherence to enoxaparin administration (p = 0.008).ConclusionThe study raised concern about the substantial percentage of patients missing at least one dose of enoxaparin, particularly among patients injecting at home. Initiatives should focus on customised enoxaparin administration counselling and providing educational materials.

Cervical Cancer Screening: Patient Perspectives on Transitioning to Primary High-Risk Human Papillomavirus Testing Alone.

In 2018, the US Preventive Services Task Force updated cervical cancer screening recommendations to allow for screening every 5 years with primary human papillomavirus (HPV) testing in combination with cytology (cotesting) or every 5 years with primary HPV screening alone. Despite these changes, the uptake of primary HPV screening has been lower than expected. The purpose of this study was to evaluate the patient perspective of an integrated health system transition from cotesting to primary HPV testing among a 30- to 65-year-old cohort. Semistructured phone interviews were conducted from July to December 2023 at Kaiser Permanente Colorado with 16 members aged 30-65 years. Interviews asked about reactions to the forthcoming change in cervical cancer screening, personal concern about cervical cancer risk, feedback on patient-facing education materials, and preference on communication timing and modality. Participants reported concerns about cervical cancer screening intervals, primarily the reduction in frequency leading to underdiagnosis of sexually transmitted infections (STIs). Participants recommended defining the rationale for the change to primary HPV testing in the patient education materials. Participants preferred communication about the change in-clinic between practitioner and patient. The interviews identified key themes, including the differentiation between cervical cancer and STI screening methodologies, potential underdiagnosis of STI and cervical cancer, and the rationale supporting primary HPV testing and associated screening intervals. These qualitative findings can inform health systems of potential patient concerns to address when considering the transition from cotesting every 3 years to primary HPV testing every 5 years for cervical cancer screening.

Effectiveness of Eupatorium Perfoliatum 30C in Preventing Dengue Fever-A Prospective, Community-Based, Open Label, Parallel Cohort Study in Delhi, India.

The study was undertaken to evaluate the protective effect of Eupatorium perfoliatum (EP) 30C on the incidence of dengue fever. This study was designed as a prospective, open label, parallel cohort study. Participants were enrolled in two medicine cohort (MC) communities and one control cohort (CC) community. Participants in MC who were more than 5 years of age received four medicated globules and those aged between 1 and 5 years received two medicated globules of EP 30C once a week for 10 weeks. Participants in CC received no medical intervention. Both cohorts received information and educational material regarding dengue. The primary outcome was incidence of dengue cases based on laboratory confirmation or the clinical definition of dengue as per the case definition notified by the National Vector-Borne Disease Control Program, Government of India, during the 14 weeks of intervention and observation. The analysis included 20,607 participants residing in three slums of Delhi, of which MC and CC included 15,298 and 5,309 participants respectively. The overall protective effect of EP 30C in MC against probable/laboratory-confirmed dengue was 59.59% (95% confidence interval [CI], 50.74 to 66.85, p = 0.0001). The overall protective effect of EP 30C against laboratory-confirmed dengue was 72.78% (95% CI, 54.45 to 83.74, p = 0.0001): 26 cases per 15,298 (0.13 per 1,000 person-weeks) in MC versus 33 cases per 5,309 (0.46 per 1,000 person-weeks) in CC. The use of EP 30C was associated with some protection against probable and laboratory-confirmed dengue.

Large language models in internal medicine residency: current use and attitudes among internal medicine residents

BackgroundArtificial intelligence (AI) uses in healthcare changed dramatically with large language models. While work is underway to integrate generative AI safely and effectively into medical practice, little is known about how resident physicians are already using these tools in their work.ObjectivesTo characterize the current usage patterns and attitudes towards large language models among internal medicine residents in North Carolina.MethodsCross-sectional survey-based study of Internal medicine residents in North Carolina.Results152 of 523 total residents completed the survey (29% response rate). Many identified a role for LLMs in both clinical (56%) and non-clinical medicine (72%) today, although only 26% reported current use. More perceived a future role in clinical (71%) and non-clinical (80%) medicine. None had received formal training, but 94% expressed interest in learning more and 87% thought residencies maybe or definitely should have formal curriculum. Top clinical uses include forming a differential diagnosis, researching treatments, and creating educational materials. Top non-clinical uses included self-directed learning, scientific writing, and summarizing literature.ConclusionsMedical educators and administrators should be aware that residents are using generative AI in professional settings. Residents believe in a current and future role for AI in medicine and desire curriculum and learning opportunities during training.

/s/ ideology in twentieth-century educational materials in Finland: on the language-political and sociocultural underpinnings

/s/ ideology in twentieth-century educational materials in Finland: on the language-political and sociocultural underpinnings

Accuracy of natural language processors for patients seeking inguinal hernia information.

NLPs such as ChatGPT are novel sources of online healthcare information that are readily accessible and integrated into internet search tools. The accuracy of NLP-generated responses to health information questions is unknown. We queried four NLPs (ChatGPT 3.5 and 4, Bard, and Claude 2.0) for responses to simulated patient questions about inguinal hernias and their management. Responses were graded on a Likert scale (1 poor to 5 excellent) for relevance, completeness, and accuracy. Responses were compiled and scored collectively for readability using the Flesch-Kincaid score and for educational quality using the DISCERN instrument, a validated tool for evaluating patient information materials. Responses were also compared to two gold-standard educational materials provided by SAGES and the ACS. Evaluations were performed by six hernia surgeons. The average NLP response scores for relevance, completeness, and accuracy were 4.76 (95% CI 4.70-4.80), 4.11 (95% CI 4.02-4.20), and 4.14 (95% CI 4.03-4.24), respectively. ChatGPT4 received higher accuracy scores (mean 4.43 [95% CI 4.37-4.50]) than Bard (mean 4.06 [95% CI 3.88-4.26]) and Claude 2.0 (mean 3.85 [95% CI 3.63-4.08]). The ACS document received the best scores for reading ease (55.2) and grade level (9.2); however, none of the documents achieved the readibility thresholds recommended by the American Medical Association. The ACS document also received the highest DISCERN score of 63.5 (57.0-70.1), and this was significantly higher compared to ChatGPT 4 (50.8 [95% CI 46.2-55.4]) and Claude 2.0 (48 [95% CI 41.6-54.4]). The evaluated NLPs provided relevant responses of reasonable accuracy to questions about inguinal hernia. Compiled NLP responses received relatively low readability and DISCERN scores, although results may improve as NLPs evolve or with adjustments in question wording. As surgical patients expand their use of NLPs for healthcare information, surgeons should be aware of the benefits and limitations of NLPs as patient education tools.

Practices and Barriers in Implementing the Low FODMAP Diet for Irritable Bowel Syndrome Among Malaysian Dietitians: A Qualitative Study

The low fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet (LFD) is a second-line dietary intervention for irritable bowel syndrome (IBS) patients, involving FODMAP restriction, reintroduction, and personalization, and it needs to be delivered by dietitians. However, the application of this diet among Malaysian IBS patients is not well understood. This study aimed to explore the practices and barriers in delivering the LFD among Malaysia dietitians. Semi-structured qualitative interviews were conducted online with practicing dietitians until the data reached saturation. All the interview sessions were audio recorded and transcribed verbatim. Thematic analysis was used to analyze the data. Eleven dietitians were interviewed, with 36.4% (n = 4) having more than 10 years of experience. The following four themes regarding their practices emerged: 1. dietary advice on FODMAP restriction; 2. duration of FODMAP restriction phase; 3. references used to get information about FODMAPs, and 4. strategies on reintroduction. Meanwhile, the following seven barriers were identified: 1. lack of culturally relevant educational materials; 2. limited knowledge about the LFD; 3. inadequate formal training among dietitians; 4. lack of integration in multi-disciplinary care; 5. low health literacy of patients; 6. low compliance rate among patients, and 7. restrictions for certain populations. LFD implementation in Malaysia is not standardized as only experienced dietitians can provide dietary evidence-based advice. Lack of training and culturally specific resources are some of the main barriers that were identified to be limiting the implementation of the diet. Therefore, there is a need for training programs and resource development to support Malaysian dietitians in managing IBS patients.

Physician’s perceived barriers to millet-based diet in clinical practice: A cross-sectional survey

Objectives: This study aimed to investigate the perceived barriers faced by physicians in Maharashtra when recommending a millet-based diet for diabetic patients. The objectives were to identify the challenges physicians encounter in promoting millet consumption, assess their knowledge and beliefs about millet-based diets, and evaluate the current resources and practices used in dietary counseling for diabetes management. Methods: A cross-sectional survey was conducted among 68 physicians specializing in diabetes care in Maharashtra. Participants were recruited using snowball sampling and met the inclusion criteria of having over 10 years of clinical practice and significant experience in diabetes management. Data collection was performed through a pre-tested survey tool distributed through email and Google Forms. The survey included questions on the effectiveness of millet-based diets, patient characteristics influencing dietary recommendations, barriers to providing millet-based food education, and current and desired resources for promoting such diets. Ethical approval was obtained, and informed consent was secured from all participants. Results: The survey revealed that 70.59% of physicians considered a millet-based diet significantly effective for lowering blood sugar levels. However, several barriers were identified, including high comorbidities (82.35%) and low income (54.41%) among patients, which hindered dietary recommendations. In addition, physicians reported a lack of formal training in millet-based nutrition (73.53%), personal skepticism toward millet-based diets (63.23%), and insufficient patient educational resources (55.89%). Current resources used for dietary counseling were primarily verbal education (100%) and electronic resources (97.06%). Conclusion: Despite recognizing the potential benefits of millet-based diets, physicians face substantial barriers in recommending them to diabetic patients. These barriers include factors such as lack of training, time, and educational resources. To overcome these challenges, there is a need for enhanced educational programs for physicians, increased availability of patient-friendly educational materials, and access to trained dietitians. Implementing these measures could improve dietary management strategies and health outcomes for diabetic patients.