Mean Improvement In Score Research Articles

The effect of food safety training program on food safety knowledge and practices in hotels’ and hospitals’ food services

Food Safety Knowledge (FSK) among Food Handlers (FHS) in the food services in both hotels and hospitals has a crucial role in food protection and combating against foodborne diseases. The aim is to check the food safety (FS) training program upon FSK in the Jordanian hotels’ and hospitals’ food services. A pre-test-post-test design was used. A convenience sample of 412 food handlers from randomly selected hotels and hospitals were recruited. Data were collected using 118-questions Food Safety Knowledge Questionnaire (FSKQ); 40- questions tool for FS Practices. A significant improvement in FSK mean scores in the post-test (85.48±17.07/118 points corresponded to 72.44%) compared with the pretest (78.50±13.69/118 points, corresponding to 66.66%). The overall mean FSK score was considered to be “moderate” in pre and post-tests. FS Practice level mean was 26.86±4.38/40 points (67.14%), regarded as “moderate” in the pre-test and continued to be “moderate” after the training despite a significant increase in the post-test scores (27.92±4.45/40 point, corresponded to 69.80%, P=0.000). FHS worked in organizations where HACCP principles are implemented, possessed higher FSK and better FS practices. Although continued to be “moderate”, FSK and FS Practices among FHS in the Jordanian hotels and hospitals have been significantly improved after the FS Training Program.

Impact of Pharmacist-Led Diabetes Self-Care Education on Patients With Type 2 Diabetes in Pakistan: A Randomized Controlled Trial.

Introduction: There is a little evidence on efficacy of pharmacy-based interventions on clinical outcomes of type 2 diabetes mellitus (T2DM) patients in Pakistan. Objective: To appraise the impact of pharmacist-led self-care education on glycemic control, self-care practices and disease knowledge of T2DM patients with poor glycemic control (HbA1c ≥ 7%). Methods: In this 6-months, randomized controlled trial (RCT), n = 75, T2DM patients seeking care at a diabetes clinic were randomized in to two groups. Intervention group (n = 38) received two face-to-face educational sessions (at enrollment and on week 12), whereas control group (n = 37) received usual care. Outcome measures such as glycemic control, self-care practices and disease knowledge were assessed at the time of enrollment and after 6-months in both groups. Results: Thirty-three intervention and thirty-three participants from the control group completed the study. Mean glycated hemoglobin (% HbA1c) significantly reduced in the intervention group from 9.00 ± 1.43 to 8.09 ± 1.16 (p < .01). However, no significant change was observed in the control group (9.20 ± 1.24 to 8.93 ± .97; p = .06). Cohen’s d effect size of the intervention on HbA1c was .78. Percentage of participants achieving glycemic control (HbA1c < 7%) were significantly higher (p < .05) in the intervention group as compared to the control group (twenty-four vs. six), after 6 months of the trial. A significant (p < .01) improvement in mean scores for disease knowledge and self-care activities was also observed in the intervention group participants, whereas no significant improvements (p > .05) were observed in the control group. Conclusion: The study demonstrated an improvement in glycemic control, disease knowledge and self-care activities of T2DM patients who received pharmacist-led educational intervention. The study findings support clinical significance of integrating pharmacy-based interventions in diabetes management.

Impact of Cervical Disc Arthroplasty vs Anterior Cervical Discectomy and Fusion on Driving Disability: Post Hoc Analysis of a Randomized Controlled Trial With 10-Year Follow-Up

Driving an automobile requires the ability to turn the neck laterally. Anecdotally, patients with multilevel fusions often complain about restricted turning motion. The purpose of this study was to compare the effectiveness of cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion (ACDF) on driving disability improvement at 10-year follow-up after a 2-level procedure. In the original randomized controlled trial, patients with cervical radiculopathy or myelopathy at 2 levels underwent CDA or ACDF. The driving disability question from the Neck Disability Index was rated from 0 to 5 years preoperatively and up to 10 years postoperatively. Severity of driving disability was categorized into "none" (score 0), "mild" (1 or 2), and "severe" (3, 4, or 5). Score and severity were compared between groups. Out of 397 patients, 148 CDA and 118 ACDF patients had 10-year follow-up. Driving disability scores were not different between the groups preoperatively (CDA: 2.65; ACDF: 2.71, P = 0.699). Postoperatively, the scores in the CDA group were significantly lower than those in the ACDF group at 5 (0.60 vs 1.08, P ≤ 0.001) and 10 years (0.66 vs 1.07, P = 0.001). Mean score improvement in the CDA group was significantly greater than the ACDF group at 10-year follow-up (-1.94 vs -1.63, P = 0.003). The majority of patients reported severe driving disability (CDA: 56.9%, ACDF: 58.0%, P = 0.968) before surgery. After surgery, a greater proportion of patients in the CDA group had neck pain-free driving compared with the ACDF group at 5 (63.3% vs 41.8%, P < 0.001) and 10 years (61.8% vs 41.2%, P = 0.003). In patients with cervical radiculopathy/myelopathy and 2-level disease, CDA provided greater improvements in driving disability as compared with ACDF at 10-year follow-up. This is the first report of its kind. This finding may be attributable to preservation of motion associated with CDA. This study provides valuable information regarding the improvement of driving disability after both CDA and ACDF. It demonstrates that both procedures result in significant improvements, with CDA resulting in even better improvements than ACDF, up to 10 year follow-up.

Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study

BackgroundKnee osteoarthritis (OA) is a debilitating condition affecting human body biomechanics and quality of life. Current standard care for knee OA leads to trivial improvement and entails multiple adverse effects or complications. Recently, investigational cell therapies injected intra-articularly, such as bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), have shown safety and therapeutic potency providing patients with pain relief. In the current retrospective comparative study, we investigated the differences in pain and functional improvements in patients with symptomatic knee OA receiving intra-articular injections of BMAC vs PRP.MethodsPain and functionality scores were measured at baseline and at different time points post-injection over 12 months, using 3 self-administered, clinically validated questionnaires: the visual analogue scale (VAS) for assessing pain intensity, the knee injury and osteoarthritis outcome score (KOOS) for evaluating functionality and knee-related quality of life, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) for evaluating physical function. The repeated-measures general linear model with Sidak test for pairwise comparisons was used to investigate the influence of the treatment on the score evolution within groups (between baseline and each time point) and between groups (overall).ResultsThe BMAC group (n = 26 knees) significantly improved in VAS, KOOS, and WOMAC scores between baseline and 12 months (57.4, 75.88, and 73.95% mean score improvement, respectively). In contrast, the PRP group (n = 13 knees) witnessed nonsignificant improvement in all scores. BMAC, in comparison to PRP, induced significant improvement in outcomes by 29.38% on the VAS scale, 53.89% on the KOOS scale, and 51.71% on the WOMAC scale (P < .002, P < .01, P < .011, respectively).ConclusionsIntra-articular autologous BMAC injections are safe, effective in treating pain, and ameliorate functionality in patients with symptomatic knee OA to a greater extent than PRP injections.Graphical abstractIntra-articular autologous BMAC therapy is safe and provides more relief to patients with symptomatic knee osteoarthritis compared to PRP therapy.

The effect of the socioeconomic status on the measurement of asthma control.

Background: The Asthma Control Test (ACT) is a commonly used scoring system for evaluation of asthma control in the pediatric and adult populations. Asthma control has been deemed poor in those economically disadvantaged. Objective: To study whether the ACT is affected by socioeconomic status (SES) as evaluated by the percentage of the federal poverty level and the education level. Methods: This was a cross-sectional study (N = 307), in which the patients were surveyed for demographics data and underwent ACT scoring, spirometry (forced expiratory volume in the first second of expiration) and fractional concentration of exhaled nitric oxide testing. Results: There was a positive correlation of improved mean score on the ACT (p < 0.001) with higher education status and higher federal poverty level status. Conclusion: SES plays a factor in the way patients perceived their asthma control, and therefore affected how they scored on the ACT.

From Office-Based Treatment to Telehealth: Comparing Clinical Outcomes and Patient Participation in a Psychiatric Intensive Outpatient Program with a Large Transdiagnostic Sample.

Introduction: Patient participation and clinical outcomes of a precoronavirus disease 2019 (COVID-19) office-based transdiagnostic psychiatric intensive outpatient program (IOP) were compared with those of telehealth IOP during COVID-19. Materials and Methods: Weeks of enrollment, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessments, and sociodemographic and clinical factors (including group track and diagnosis) were collected during pre-COVID-19 (n = 191) and during COVID-19 (n = 200). Continuous and categorical measures of GAD-7 and PHQ-9 were analyzed; potential sociodemographic and clinical covariates to scores were also explored. Results: There were no statistically significant differences in participation between time periods. Associations were observed between PHQ-9/GAD-7 score improvement and number of assessments. Significant score reductions occurred in both periods, and differences in change scores were not significant. Sociodemographic and clinical factors were not significantly different between time periods. Patients with commercial insurance had significantly higher improvement in both mean and categorical PHQ-9 scores (t = 2.77, p = 0.006; χ2 = 10.47, df = 1, p = 0.001) and GAD-7 scores (t = 2.29, p = 0.023; χ2 = 8.58, df = 1, p = 0.003) than those with public insurance. Patients with anxiety disorders had significantly greater improvements (F = 4.49, p = 0.004; χ2 = 9.15, df = 3, p = 0.027) in GAD-7 during COVID-19. Discussion: Significant improvements in PHQ-9/GAD-7 scores and measures of participation were not significantly different between telehealth and office-based IOP, nor were they greatly influenced by clinical or sociodemographic factors. Further study is needed of possible care disparities for publicly insured patients. Conclusion: Despite some limitations, telehealth IOP appears to be a clinically appropriate option for a diverse sociodemographic and diagnostically heterogeneous psychiatric population.

Effectiveness of Therapy for the Treatment of Accommodative Insufficiency: An Open Pilot Study

Background: To evaluate improvements in clinical measures and symptoms in children and young adults with accommodative insufficiency in an open trial of office-based vergence and accommodative therapy. Methods: Major eligibility requirements included ages 9 to 30 years and amplitude of accommodation (AA) ≥2 diopters (D) below Hoffstetter’s minimum. Participants completed 8 weekly, 1-hour sessions of office-based vergence and accommodative therapy. Therapy procedures followed the Convergence Insufficiency Treatment Trial (CITT) therapy protocol with emphasis on accommodative procedures. Clinical measures of accommodation and symptoms (Convergence Insufficiency Symptom Survey [CISS]) were assessed at baseline and after therapy. Results were evaluated using the Student’s t test and Kruskal-Wallis test. Repeatability of CISS scores at baseline was assessed using Bland Altman 95% Limits of Agreement (LoA) and Interclass Correlation Coefficient (ICC). Results: Eighteen participants (mean age 17.4 ± 8.0 years) were enrolled; sixteen completed the study. The mean AA improved significantly from 5.5D OD and OS at baseline to 12.4D OD and 12.8D OS at outcome (p&lt;0.001). Mean monocular accommodative facility (AF) also increased significantly in both eyes from 6.6 cycles per min (cpm) OD and 7.4cpm OS at baseline to 14.2cpm OD and OS at outcome (p≤0.0009). Amplitude-scaled monocular AF also showed significant improvements (p≤0.034 for both). Mean CISS score improved 10.50 points (p=0.0003). Significantly greater improvements in AA were observed in children (9.0D) than in adults (4.3D) in the right eye (p=0.007 for both comparisons). Conversely mean improvement in CISS score was significantly greater in adults than in children (p=0.039). Repeated CISS scores differed by, on average,1.47 points (95% limits of agreement:-5.19, 8.13; p=0.12). The ICC was 0.95 with a 95% confidence interval of 0.87 to 0.98. Conclusion: Eight weekly sessions of office-based accommodative vergence therapy combined with homebased- reinforcement therapy resulted in improvements of symptoms and clinical measures of accommodation in children and young adults with accommodative insufficiency.

A Programmatic Evaluation of School Preparedness for Latinx Children and Families: A Partnership Program.

Introduction: Latinx children are the fastest-growing ethnic minority of children under the age of 5 years in a tri-county area in the Southeastern United States (US Census, 2018). There are limited culturally and linguistically appropriate school preparedness initiatives in this geographic region. Methods: A cultural and linguistic appropriate program was developed in coordination with the state's largest Latinx advocacy organization and two patient-centered pediatric medical homes (PCPMHs) after securing extramural grant funding for an evidenced-based home visitation program using skilled community health workers (CHWs) aimed at Latinx children at the age of 0-5 years and their caregivers. The program includes developmental screenings using the Ages & Stages Questionnaires®, Third Edition (ASQ®-3), CHW role modeling of developmentally appropriate play, early literacy, connection to resources, oral health, nutrition, and physical activity. Results: Of the 103 unique children represented in this programmatic evaluation that received an initial and follow-up ASQ®-3 developmental screening, paired t-tests indicate statistically significant improvement in mean scores from the first to second ASQ®-3 in all five major developmental domains with the largest gains represented in the communication and fine motor skill domains. Conclusion: This evaluation suggests that low-frequency home visits from skilled CHWs can have a beneficial effect on development in early childhood. PPCMHs can serve as a hub for these community-based programs.

Effect of Tele-nursing on Burden and Coping Strategies among Family Caregivers of Confirmed COVID- 19 Patients

Background: Coronavirus or COVID-19 disease is not only disrupt patients' lives, but they also affect their family caregivers. Aim of the study was to evaluate the effect of tele-nursing on burden and coping strategies among family caregivers of confirmed COVID-19 patients. Methods: Research design in this study: A Quasi- experimental research design was used to conduct the current study. Setting: The study was carried out at family health center of Mastay village followed Quesna district, Menoufia governorate. Subjects: A convenient sample of 90 family caregivers of patients with confirmed COVID-19 were taken and divided randomly into study group and control group. Tools: The tools of this study used were (1) An interviewing questionnaire included four parts; I- Sociodemographic data and medical history for patients and their family caregivers. (2)- COVID-19 knowledge questionnaire (3) Zarit Burden Interview Scale. (4) Coping Inventory for stressful situation scale. Results: The study revealed that 41.4% of the studied family caregivers were among age group 41-50 years old, 53.3% main family caregivers were female, 64.4% of them were married. After application of tele-nursing intervention, there was statistical significance improvement in the total mean score of knowledge about COVID-19 among study group than the control group at (p <0.001). Also, there were a statistical significance differences among both group on total score of burden at (p <0.001). Finally, there were highly statistical significance differences among two group on the total score of coping strategies at (p <0.001). Conclusions: Using of tele- nursing was effective in decreasing burden, improving knowledge about COVID-19 disease and improving coping strategies among family caregivers of patients with confirmed COVID - 19 .Recommendation: Continuous providing of knowledge and skills about family caregivers’ burden and effective coping strategies in the crisis of COVID-19 should be a part of the nursing care.

Development of a Single-Institution Virtual Internal Medicine Subinternship With Near-Peer Teaching in Response to the COVID-19 Pandemic.

In March 2020, medical students at the University of Washington School of Medicine were removed from clinical settings in response to the COVID-19 pandemic. As subinternships are required for graduation and an important way to prepare for internship, a virtual subinternship was created to include practical elements of in-person learning and to address limited teaching faculty from COVID-19 inpatient surges. A virtual, interactive subinternship was developed with case-based teaching sessions, communication and critical literature evaluation skill building, professional development, and creation of independent learning plans. Near-peer teachers (NPTs) were selected from graduating senior medical students who matched into internal medicine. In addition to teaching topics from the Clerkship Directors of Internal Medicine curriculum, NPTs engaged in course development, recruited teaching faculty, gathered feedback, and facilitated small groups. Participating students completed pre- and postcourse surveys. The 10 students (100%) enrolled in the course who completed both surveys indicated significant improvement in mean scores across 4 domains: evaluating medical literature (3.1/5 to 4.5/5; +1.4, P < .001); developing individual learning plans (3.6/5 to 4.7/5; +1.1, P = .001); perceived ability to efficiently evaluate patients with common internal medicine concerns (3.7/5 to 4.6/5; +0.9, P = .004); and formulating initial diagnostic and therapeutic plans (3.6/5 to 4.6/5; +1.0, P < .001). Themes extracted from open-ended responses included initial skepticism of an online format, the course exceeding expectations, and feeling prepared for internship. Although a virtual subinternship lacks direct patient care, students reported improvement in all 4 domains studied. Future courses would benefit from greater use of simulation and role-playing scenarios for practical skills. The experience with NPTs was encouraging, aiding in the success of the subinternship. The role of NPTs should be cultivated to fill gaps in content delivery and enhance the development of students as educators.

O16 THE TOR-CONCEPT (TRAINING-OPERATION-REHABILITATION) APPLIED TO A COHORT OF POST-PARTUM WOMEN WITH SYMPTOMATIC DRA (DIASTASIS RECTI ABDOMINIS). EVALUATION OF PHYSICAL FUNCTION AND QUALITY OF LIFE ONE YEAR AFTER SURGERY

Abstract Aim Management of diastasis recti abdominis (DRA) differs regarding core training, surgical repair methods and post-operative rehabilitation. The purpose of this prospective cohort study was to evaluate the effect of a novel concept of treatment for DRA, the TOR-concept (Training, Operation and Rehabilitation). The concept includes preoperative evaluation of symptoms and instructed abdominal core training; tailored surgical repair of the DRA; and an individualized postoperative rehabilitation program. Material and Methods A cohort of seventy-five post-partum women with diagnosed DRA and training resistant core dysfunctions were evaluated and included to the study during 2018-2020. After surgery, all participants underwent an individualized supervised rehabilitation program with progressive increasing load for four months. Physical function was registered preoperatively and one year after surgery with the disability rating index (DRI) questionnaire. Quality of life (QoL) was assessed with the SF-36 questionnaire. The DRA and the surgical result were assessed with ultrasonography before and one year after surgery. Results Sixty-nine participants, 92%, completed the study. There were no DRA-recurrences at the 1-year follow-up. Early results shows that self-reported physical function, (DRI), improved in 88.8 % of patients, with a mean score improvement of 78.5 %. Quality of life, (SF-36), improved significantly compared with the preoperative scores, and reached a level similar to, or higher than, the normative Swedish female population. Conclusions In this cohort of post-partum women with DRA combined with core instability symptoms resistant to training, surgical reconstruction within the TOR-concept resulted in a significant improvement of physical function and QoL.

A Resident-as-Leader Curriculum for Managing Inpatient Teams

Problem Leading inpatient teams is a foundational clinical responsibility of resident physicians and leadership is a core competency for inpatient physicians, yet few training programs have formal leadership curricula to realize this clinical skill. Intervention We implemented a 4-module curriculum for PGY1 internal medicine residents. The program focused on the managerial skills necessary for daily clinical leadership, followed by clinical coaching. Interns were first introduced to foundational concepts and then given the opportunity to apply those concepts to real-world practice followed by clinical coaching. Context Using direct-observations and a previously published checklist for rounds leadership, this study sought to evaluate the workplace behavior change for novice residents leading inpatient teams for the first time. We conducted a prospective cohort study (March 2016 and August 2018) of internal medicine residents at a large tertiary academic medical center in Boston, MA. Trained faculty raters performed direct observations of clinical rounding experiences using the checklist and compared the findings to historical and internal controls. Questionnaires were distributed pre- and post- curriculum to assess satisfaction and readiness to lead a team. Impact We trained 65 PGY1 residents and raters conducted 140 direct observations − 36 in the intervention group and 104 among historical controls. The unadjusted mean score in rounds leadership skills for the intervention group was 19.0 (SD = 5.1) compared to 16.2 (SD = 6.2) for historical controls. Adjusting for repeated measures, we found significant improvement in mean scores for behaviors linked to the curricular objectives (p = 0.008) but not for general behaviors not covered by the curriculum (p = 0.2). Lessons Learned A formal curriculum to train residents as leaders led to behavior change in the workplace in domains essential to rounds leadership. We also found that the curriculum was highly regarded in that all interns indicated they would recommend the curriculum to a peer. Moreover, the program may have assuaged some anxiety during the transition to junior year as 90% of interns surveyed felt more ready to start PGY2 year than historical trainings. We learned that while a robust, multi-faceted modular curriculum and clinical coaching successfully resulted in behavior change, the resources required to manage this program are significant and difficult to sustain. Future iterations could include asynchronous material and potentially peer-observation of rounds leadership to reduce the burden on faculty and program curricular time.

The effect of ISBARR on knowledge of and attitudes about interprofessional communication skills among Chinese undergraduate nursing students

BackgroundInterprofessional communication is essential for the coordination and collaboration of healthcare team members during patient care, especially in critical situations. Therefore, nursing students must learn and practice interprofessional communication skills throughout their education and clinical training. Previous studies evaluating standardized communication frameworks in the United States (e.g., ISBARR [identify, situation, background, assessment, recommendation, and repeat]) suggest that nursing students feel more confident about interprofessional communication and collaboration through familiarity with these frameworks. ObjectiveTo evaluate the effect of an ISBARR workshop on knowledge of and attitude about effective communication among Chinese undergraduate students. DesignA pre- and posttest quasi-experimental study. ParticipantsA convenience sample of 90 undergraduate nursing students at a vocational health college in China. MethodThe two-part ISBARR workshop featured a lecture and a video-simulation exercise. Differences in students' knowledge of and attitudes about interprofessional communication skills using ISBARR were compared pre- and post-workshop. ResultsWe observed a statistically significant (p < 0.001) improvement in overall mean scores of students' knowledge of and attitudes about utilizing ISBARR post-workshop. We also observed a statistically significant (p < 0.001) improvement in the overall mean scores of students' knowledge of and attitudes about ISBARR after the video-simulation exercise. ConclusionThe ISBARR workshop improved Chinese nursing students' knowledge and attitudes about interprofessional communication. Incorporating ISBARR into the nursing healthcare team eventually can lead to improved patient safety. Subsequent studies should target nursing faculty and clinical instructors to evaluate their knowledge and attitudes about teaching ISBARR and interprofessional education. Improving these attitudes can help establish a positive interprofessional communication learning environment for nursing students in China and other cultural contexts worldwide.

Effect of an evidence-based poster on the knowledge of delirium and its prevention in student nurses: A quasi-experimental study

Background A major barrier to nurses adopting evidence-based practice (EBP) has been the limited awareness of evidence underpinning clinical practice, often due to poor access and understanding of the literature base. To address this, we piloted the development of educational posters summarizing the evidence base around clinical practices to see if they help nurses better understand the rationale behind their care. Our first poster focused on the evidence supporting the management of delirium in older persons, specifically delirium identification and its prevention. Objective To examine the effect of an evidence-based poster education on the delirium knowledge of student nurses. Design A prospective two-armed quasi-experimental study. Methods 188 student nurses were recruited in December 2017. Participants were alternated to receive either an evidence-based poster education session or a reflective education session as a control. Both groups were assessed on their general knowledge on delirium, knowledge on delirium detection and knowledge on delirium prevention. This was conducted both before exposure to either the intervention or control, and one week after exposure. Unpaired t-tests with 95% confidence intervals (CI) were applied to compare the mean change in pre-test and post-test delirium knowledge. We used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist to report our methods and findings. Results Students in the poster education group reported greater improvements in mean scores of delirium identification (Mean increase = 1.0, p = 0.007, 95% CI: 0.3-1.6), delirium prevention (Mean increase = 1.6, p < 0.001, 9% CI: 1.0-2.2) and overall delirium knowledge (Mean increase = 2.7, p < 0.001, 95% CI: 1.5-3.8) than students in the control. Conclusion Summarised research evidence within a poster format can increase student nurses’ access to the evidence base. This has shown to increase their knowledge to guide their clinical practice. Impact statement Exposure to poster summaries of research evidence underpinning delirium care increases student nurses’ clinical knowledge of delirium identification and prevention.

Evaluation the Effectiveness of Abridged IMNCI (7-Day) Course v Standard (11-Day) Course in Pakistan

BackgroundThe conventional IMCI training for healthcare providers is delivered in 11 days, which can be expensive and disruptive to the normal clinical routines of the providers. An equally effective, shorter training course may address these challenges.MethodsWe conducted a quasi-experimental study in two provinces (Sindh and Punjab) of Pakistan. 104 healthcare providers were conveniently selected to receive either the abridged (7-day) or the standard (11-day) training. Knowledge and clinical skills of the participants were assessed before, immediately on conclusion of, and six months after the training.ResultsThe improvement in mean knowledge scores of the 7-day and 11-day training groups was 31.6 (95% CI 24.3, 38.8) and 29.4 (95% CI 23.9, 34.9) respectively, p = 0.630 while the improvement in mean clinical skills scores of the 7-day and 11-day training groups was 23.8 (95% CI: 19.3, 28.2) and 23.0 (95% CI 18.9, 27.0) respectively, p = 0.784. The decline in mean knowledge scores six months after the training was − 12.4 (95% CI − 18.5, − 6.4) and − 6.4 (95% CI − 10.5, − 2.3) in the 7-day and 11-day groups respectively, p = 0.094. The decline in mean clinical skills scores six months after the training was − 6.3 (95% CI − 11.3, − 1.3) in the 7-day training group and − 9.1 (95% CI − 11.5, − 6.6) in the 11-day group, p = 0.308.ConclusionAn abridged IMNCI training is equally effective as the standard training. However, training for certain illnesses may be better delivered by the standard course.

777 Changing Student Perceptions of Surgical Careers

Abstract Aim Increasing student interest in pursuing a surgical career at an undergraduate level. Background Data suggests that interest in surgical specialties may be declining, even from as early on as medical school. However, studies suggest that engagement with extra-curricular activities influences their likelihood to pursue surgical careers. Our study aimed to assess changes in student perception towards surgical careers following participation in a three-week surgical course. Method Students on placement at St Peter’s Hospital, Chertsey were invited to a course of 3 one-hour sessions covering practical surgical skills and lectures. Participants were tutored by Foundation-Year-Two doctors, with oversight of a surgical clinical teaching fellow and senior consultant. Students completed pre- and post-course surveys focusing on surgical interest, surgical skill confidence, placement-participation, and career preparation. The course was delivered through two cycles. Results Cycle one showed statistically significant improvements in suturing-confidence (mean increase 4.05 out of 10, p = 0.001), confidence in hand-ties (3.63 out of 10, p = 0.015) and understanding of developing a surgical portfolio (mean increase 1.95 out of 10, p = 0.005). After a second cycle, including the introduction of a surgical portfolio development lecture, students demonstrated a statistically significant improvement in mean scores across all areas. Notably, interest in pursuing a surgical career increased from mean 5.85/10 to 8.8/10 (p = 0.028). Conclusions We demonstrate that a short and easily accessible course can significantly improve student interest and understanding of a surgical career; equipping them with fundamental skills to pursue engagement at the undergraduate level.

514 F1-taught Orthopaedic Teaching for Students (FOTS)

IntroductionF1 doctors, despite being expected to teach, have had reduced opportunity to do so during COVID-19. Medical students have also become increasingly concerned for upcoming exams due to time away from placements. A national orthopaedic teaching programme was designed to provide F1 doctors with opportunities to develop their teaching skills and synergistically improve students’ confidence in performing clinical orthopaedic examinations.MethodA University Trauma & Orthopaedics society coordinated the teaching programme consisting of 6-weekly online sessions on each joint examination (shoulder, hip, knee, hand, ankle and lumbar spine). Each session was delivered by two F1 tutors. Pre- and post-session MCQs were provided to students to assess improvement in knowledge. Anonymous feedback forms were also disseminated.ResultsFrom the 341 students that attended, 87.1% provided feedback. 86.2% felt that they had de-skilled due to time off, with a mean 15 weeks off from placement. Based on a 5-point Likert scale, students displayed a mean improvement in confidence (1.9±1.1, p < 0.001) and MCQ scores (1.4±1.3, p < 0.001) before and after the sessions. 91.6% of students agreed that the use of online teaching increased attendance. Of the 10 tutors, all reported improvement in confidence to teach and teaching skills.ConclusionsWe demonstrate that online delivery of clinical orthopaedic examinations is effective and present our findings to encourage similar teaching programmes to be adopted at other locations and specialities.

Outcomes of a National, Cross-Sector Antimicrobial Stewardship Training Initiative for Pharmacists in England.

(1) Background: Pharmacists play a pivotal role in tackling Antimicrobial resistance through antimicrobial stewardship (AMS) and are well placed to lead behaviour change interventions across the healthcare system; (2) Methods: A cross-sector AMS training initiative for pharmacists was implemented across England, with three cohorts between 2019–2021. Each cohort took part in an introductory workshop, followed- by a workplace-based quality improvement project supported by peer-assisted learning sessions. Completion of training was determined by an end of training assessment after three to four months. Outcome data and learner survey results were collated, anonymised, and analysed by the training provider. (3) Results: In total, 118 pharmacists participated in the introductory workshop, 70% of these subsequently undertook an improvement project, and 48% engaged workplace stakeholders in the process. Interventions were designed by 57% of learners and 18% completed a at least one Plan-Do-Study-Act cycle. Approximately a quarter of learners met the requirements for a Certificate of Completion. Knowledge quiz scores were obtained from 115 learners pre-training and 28 learners post-training. Paired t-tests conducted for 28 learners showed a statistically significant improvement in mean score from 67.7% to 81.1% (p < 0.0001). Sixty-two learner survey responses were received during the training and 21 follow-up survey responses 6 to 12 months post training. Of the 21 responses to the follow-up survey, ongoing quality improvement work and improvement outcomes were reported by nine and six learners, respectively. (4) Conclusions: The delivery of workplace-based training at scale can be challenging, however this study demonstrates that coupling learning with workplace implementation and peer support can promote behaviour change in learners. Further study into the impact of providing pharmacists across sectors and geographies with access to this type of training will help inform ongoing workforce development interventions.

Effect of Concomitant Meniscal Lesions and Meniscal Surgery in ACL Reconstruction With 5-Year Follow-Up: A Nationwide Prospective Cohort Study From Norway and Sweden of 8408 Patients.

Background:Increased knowledge of the factors predicting outcome after anterior cruciate ligament reconstruction (ACLR) is needed.Purpose:To determine the effect of concomitant meniscal lesions, and the surgical management thereof, on patient-reported outcomes 5 years after ACLR.Study Design:Prospective cohort study; Level of evidence, 2.Methods:A total of 15,706 patients who underwent primary unilateral ACLR between 2005 and 2008 were enrolled prospectively and evaluated longitudinally. All patients were part of the Norwegian and Swedish national knee ligament registries. Outcomes at 5-year follow-up were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS). A multivariable linear regression model was used to assess possible effects on prognosis, as measured by KOOS, of a concomitant meniscal lesion and its associated surgical treatment.Results:At a mean follow-up of 5.1 ± 0.2 years, KOOS data were available from 8408 patients: 4774 (57%) patients with no and 3634 (43%) patients with concomitant meniscal lesions (mean patient age, 33.8 ± 10.7 years). Patients with concomitant meniscal lesions reported equal crude mean scores compared with patients without meniscal lesions in all KOOS subscales 5 years after ACLR. The mean improvement in scores from preoperative to the 5-year follow-up was greater for patients with a concomitant meniscal lesion for the KOOS Pain, Activities of Daily Living (ADL), and Sport and Recreation subscales. In the adjusted regression analyses, using patients without concomitant meniscal lesions as the reference, neither no treatment nor resection or repair of medial meniscal lesions were significantly associated with KOOS scores 5 years after ACLR. Except for the ADL subscale, in which a repaired lateral meniscal lesion was associated with better outcome, no significant associations between any of the lateral meniscal lesion treatment categories and KOOS outcome at 5-year follow-up were identified.Conclusion:Concomitant meniscal lesions at the time of ACLR conferred no negative effects on patient-reported outcomes 5 years after ACLR. The improvement in selected KOOS subscales from preoperative to the 5-year follow-up was significantly greater for patients with concomitant meniscal lesions than for patients without such lesions.

Oral Health-related Quality of Life (OHRQoL) Following Surgical Extraction of Impacted Mandibular Third Molars: Preliminary Observations in a Saudi Arabian Subpopulation.

Introduction:OHQoL is crucial for the best preoperative assessment and development of suitable indications for mandibular third molar surgical extraction. The current study hopes to report QoL after surgical extraction of impacted mandibular third molars. Materials and Methods:This was a prospective study conducted in the Department of Oral and Maxillofacial Surgery, between January 2020 and April 2020. After consenting to partake in the study, patients’ baseline demographics, indication for seeking third molar removal and laterality of impaction were recorded. All the surgical extractions were performed by the same surgeon. Pain was assessed pre and postoperatively with the numerical pain rating scale while QoL was assessed pre and postoperatively using the validated Arabic version of the 16 item United Kingdom Oral Health Related Quality of Life measure (UK-OHQoL).Results:A total of 92 patients were recruited. There are 41 (44.6%) males and 51 (55.4%) females with M:F of 1:1.2. Age range was between 18 and 48 years with a mean of (31.2 ± 6.6) years. Age group 20–29 years constitutes the highest number of patients. Subscales: eating, appearance, sleep, mood and work revealed more percentage complaints (42.9%, 23.4%, 24.7%, 28.6%, and 16.9%, respectively). Regarding mean domain and overall QoL scores, it was observed that there was gradual improvement in mean scores from the Pre-op values and the review periods with best mean QoL reported at POD 14Conclusion:Improvement in overall mean QoL scores during the review periods as compared with the preoperative score was observed. Eating, appearance, sleep, mood and work subscales revealed more percentage complaints.