Care Education Research Articles

Provision of palliative care for people with chronic obstructive pulmonary disease: a narrative review.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent and progressive airflow restriction and is the third leading cause of death and disability, globally. People with severe COPD generally experience long-term functional decline punctuated by periods of acute exacerbation. Symptom burden can be severe and debilitating, and typically includes breathlessness, cough, fatigue, pain, anxiety, depression, and overall reduced quality of life. Understanding current palliative care needs and provisions in this group is an essential step to expanding access in future. A narrative review of specialist and generalist (primary) palliative care provisions for people with COPD, with an emphasis on breathlessness symptom management. This paper aims to examine the current landscape of palliative care provision and highlight barriers and facilitators to palliative care access for people with severe COPD. People living with severe COPD, as well as the people who care for them, are routinely under-serviced in best-practice end-of-life care, despite having symptom burden that is comparable to that of people with advanced cancer. Barriers to palliative care in this group include lack of specialist palliative care resources, uncertainty surrounding prognostication, and poor recognition of need from both patients and clinicians. Routine early palliative care involvement, including integration of specialist palliative care into respiratory services and upskilling of other healthcare providers to adopt palliative care principals within usual care (primary palliative care), have been shown to improve outcomes indicative of high-quality end-of-life care in this group, including symptom control, place of death, and legal preparations. Ongoing integration of specialist palliative care and professional education for generalist and non-palliative care specialist healthcare providers in the recognition and management of unmet palliative care needs is required to increase capacity beyond traditional specialist palliative care models. Despite high level of symptom burden, many people with COPD miss out on palliative care. Expanding capacity of traditional specialist palliative care by upskilling generalist healthcare providers and integrating specialist palliative care into existing respiratory services is necessary to improve access for people with COPD.

Assessing nurses’ professional competency: a cross-sectional study in Palestine

BackgroundEvaluating nurses’ professional competence is critical for ensuring high-quality patient care. Therefore, this study aimed to evaluate the nurses’ professional competence level and to identify differences based on demographics in three West Bank hospitals.MethodsA cross-sectional design was used, and a convenient sample of 206 nurses participated in the study. The Nurse Professional Competence (NPC) Scale was used to assess the competency level. The investigator distributed the questionnaire and explained the aim of the research. Consent forms were signed before the data collection.ResultsThe average competency level was 79% (SD = 11.5), with 90% being professionally competent nurses. The average “nursing care” competency was 79% (SD = 12.98), and the competency level in providing value-based care was 80% (SD = 13.35). The average competency level in technical and medical care was 78% (SD = 13.45), whereas 79% (SD = 12.85) was the average competence level in “Care Pedagogics” and “Documentation and Administration “. The average competence level in the development and leadership subscale was 78% (SD = 12.22). Nurses who attended three to five workshops had a higher level of Nursing Care Competency, (H = 11.98, p = 0.003), and were more competent in value-based care (H = 9.29, p = 0.01); in pedagogical care and patient education (H = 15.16, P = 0.001); and in providing medical and technical care (H = 12.37, p = 0.002). Nurses attending more than five workshops were more competent in documentation and administration (H = 12.55, p = 0.002), and in development and leadership subscale ( H = 7.96, p = 0.20).ConclusionThe study revealed that participants lacked development and leadership skills. Engagement in workshops positively impacted the level of competencies among nurses. Notably, those attending more than five workshops exhibited greater competence in documentation, administration, development, and leadership in nursing care.ImplicationsThis study emphasized the role of continuing education in improving nurses’ competencies and highlighted the need to conduct the study at a wider aspect to involve more hospitals with various affiliations to help structure more sensitive professional development and adopt the competencies as an integral part of staff development.

The need for and acceptability of a cancer training course for medical and nursing students in Tanzania: a convergent mixed methods study

BackgroundThe cancer burden in Africa is on the rise. A Cancer Training Course on screening, prevention, care, and community education is crucial for addressing a wide range of cancer health issues. When appropriately educated healthcare providers on cancer provide care, patient care improves, and healthcare costs decrease. However, in Tanzania, doctors and nurses receive little or no training in primary cancer care in their bachelor’s program.AimThis study assessed the need and acceptability of a cancer training course for nursing and medical doctor students at the Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, Tanzania.MethodsThis study was a cross-sectional parallel mixed method study during the 3-month follow-up within the larger study on sexual health training for health professionals. The study was a randomized controlled (RCT), single-blind, parallel trial of sexual health training versus a waitlist control among health students at MUHAS in Tanzania. Descriptive analysis was performed to analyze the participants’ demographic information, need, and acceptability of the cancer training courseto determine the frequencies and percentages of their distribution between disciplines. In addition, inductive thematic analysis was performed for the qualitative data. The RCT study was registered at Clinical Trial.gov (NCT03923582; 01/05/2021).ResultsData were collected from 408 students (272 medical doctors and 136 nursing students). The median age of the participants was 23 years. Most (86.0%) medical and 78.1% of nursing students reported receiving little to no cancer training. On the other hand, most (92.3%) medical and nursing (92.0%) students were interested in receiving cancer training. Furthermore, 94.1% of medical and 92.0% of nursing students needed a cancer training course in their undergraduate program. In addition, participants said a cancer training course would be important because it would help them improve the quality of cancer care and enhance the quality of life for patients by ensuring early diagnosis and treatment.ConclusionA cancer training course is both highly needed and acceptable to medical and nursing students. Implementation of this cancer training course will improve students’ knowledge and skills and eventually improve the quality of cancer care and patients’ quality of life by ensuring early diagnosis and management.

Enhancing foot care education and support strategies in adults with type 2 diabetes.

People with diabetes are susceptible to serious and disabling foot complications, which increase their morbidity and mortality rates. Examining the perspectives of people with diabetes on their foot care routines could help elucidate their beliefs and offer practical ways to prevent foot problems. We explored the perspectives of adults with diabetes on their foot care practices to identify and enhance foot care education and support strategies. Using the Zoom platform, 29 adults with diabetes completed a 3-month telehealth educational program, during which interviews were conducted. This article reports the results of thematic content analysis of the qualitative data. Coded participant statements were organized into categories and reexamined to identify emergent themes. Analysis of participants' perceptions revealed four main themes of influences that facilitated and/or hindered their foot care practices. Foot care behaviors were facilitated by patients' personal knowledge of others with diabetes-related foot consequences (theme 1). Foot care practices were hindered by the emotional impact of living with diabetes (theme 2), and the physical, social, and lifestyle limitations associated with foot care (theme 3). Finally, patients noted that interactions with family could be either a facilitator or hindrance to their foot care routines (theme 4). These findings highlight multiple patient-centered factors related to personal, physical, psychosocial, and cultural influences that affect foot care behaviors. An understanding of how patients manage diabetes-related foot care can help nurse practitioners enhance foot care education and support strategies in this population.

Perceptions of non-disclosure of results in clinical trial designs for multicancer detection tests.

10546 Background: Multi-cancer detection tests (MCDs) are blood-based tests designed to detect multiple cancers. The National Cancer Institute (NCI) is planning a pilot study to ascertain the feasibility of recruitment and the necessary infrastructure, clinical workflow, and diagnostic pathways for conducting a large clinical trial to assess whether cancer screening using MCDs reduces cancer mortality. In preparation for these activities, the NCI conducted a qualitative focus group study with primary care physicians (PCPs) and laypersons to explore the acceptability of alternative MCD trial designs, including the disclosure vs. non-disclosure of MCD test results to study participants. Methods: Focus groups were conducted with convenience samples of PCPs (6 groups, N=45) and laypersons (4 groups, N=88) by a consumer research firm. Interviews used both open-ended questions and specific prompts to explore participants’ perceptions of alternative clinical trial designs. Interviews were audio-recorded and transcribed, and qualitative thematic analysis of interview transcripts was conducted to identify emergent themes. Results: In general, PCPs and laypersons reported a willingness to refer or participate in an MCD trial regardless of design, with the understanding that clear and transparent information would be provided in the consent process. However, both groups expressed concern with a trial design in which patients in the control arm would not receive their MCD test results—a design that would allow a marked reduction in sample size and time necessary to assess a mortality endpoint. PCPs noted that although this design might be ethically acceptable due to current clinical equipoise about MCD testing, they expressed concern about mistrust among patients and medical-legal liability. Laypersons had difficulty understanding the rationale for non-disclosure of MCD test results during a trial, and concerns about the ethics of non-disclosure. Some participants felt more comfortable if return of value with other information was included as part of routine study procedures. Participants were more comfortable with an alternative design involving delayed testing of stored blood samples from the control group after trial completion. PCPs also expressed concern about increased workloads if their patients enrolled. Conclusions: PCPs and laypersons had generally positive reactions to a trial to investigate diagnostic performance, pathways, and outcomes of MCDs. Concerns about study designs involving non-disclosure of results might be managed through return of value strategies, careful education, and clear communication of the benefits and risks of MCDs.

Enhancing foot care education and support strategies in adults with type 2 diabetes: A qualitative study

Enhancing foot care education and support strategies in adults with type 2 diabetes: A qualitative study

Design, Creation, and 13-Month Performance of a Novel, Web-Based Activity for Education in Primary Cardiology Palliative Care

Cardiovascular disease (CVD) clinicians who care for seriously ill patients frequently report that they do not feel confident nor adequately prepared to manage patients’ palliative care (PC) needs. With the goal, therefore, of increasing PC knowledge and skills amongst interprofessional clinicians providing CVD care, the ACC's PC Workgroup designed, developed, and implemented a comprehensive PC online educational activity. This paper describes the process and 13-month performance of this free, online activity for clinicians across disciplines and levels of training, “Palliative Care for the Cardiovascular Clinician” (PCCVC). A key component of PCCVC is that it is tailored to the lifelong learner; users can choose and receive credit for the activities that meet their individual learning needs. This webinar series was well-subscribed, and upon completion of the modules, learners reported better self-perceived abilities related to palliative care competencies. We propose PCCVC as a model for primary PC education for clinicians caring for individuals with other serious or life-shortening illnesses.

Effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy in Port Said City: A pre-post quasi-experimental study.

Emphasizing the pivotal role of caregivers in the cancer care continuum, a program designed to educate caregivers of cancer patients undergoing chemotherapy underscores their significance. The palliative care education initiative strives to cultivate a compassionate and effective care environment, benefiting both patients and caregivers. By imparting education, fostering positive attitudes, offering support, encouraging appropriate behaviors, and providing essential resources, the program aims to enhance the overall caregiving experience and contribute to the well-being of those navigating the challenges of cancer treatment. To evaluate the effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy. The research employed a purposive sample comprising 155 caregivers who were actively present with their cancer patients throughout the pre- and post-test phases within a quasi-experimental research design. The study took place at the outpatient oncology center of Al-Shifa Medical Complex in Port Said City, Egypt. To gather comprehensive data, 4 instruments were utilized: a demographic questionnaire, a nurse knowledge questionnaire, a scale measuring attitudes toward palliative care, and an assessment of reported practices in palliative care. This methodological approach allowed for a thorough exploration of caregiver perspectives, knowledge, attitudes, and practices within the context of a palliative care education program. Before the palliative care education program, only 1.3% of caregivers had a good overall level of knowledge about cancer and palliative care; this increased to 40.6% after the program. Similarly, before the palliative care education program, 32.9% of caregivers had a positive overall attitude, which increased to 72.3% after the program. Similarly, 27.1% of caregivers had an overall appropriate palliative care practice during the pre-test phase, which increased to 93.5% after the palliative care education program. The palliative care education program significantly improved caregivers' knowledge, attitudes, and practice scores. It is strongly recommended that caregivers of cancer patients receive continuing education in palliative care. In addition, it is crucial to conduct further research with a larger sample size in different situations in Egypt.

The potential of artificial intelligence to revolutionize health care delivery, research, and education in cardiac electrophysiology.

The field of electrophysiology (EP) has benefited from numerous seminal innovations and discoveries that have enabled clinicians to deliver therapies and interventions that save lives and promote quality of life. The rapid pace of innovation in EP may be hindered by several challenges including the aging population with increasing morbidity, the availability of multiple costly therapies that, in many instances, confer minor incremental benefit, the limitations of healthcare reimbursement, the lack of response to therapies by some patients, and the complications of the invasive procedures performed. To overcome these challenges and continue on a steadfast path of transformative innovation, the EP community must comprehensively explore how artificial intelligence (AI) can be applied to healthcare delivery, research, and education and consider all opportunities in which AI can catalyze innovation; create workflow, research, and education efficiencies; and improve patient outcomes at a lower cost. In this white paper, we define AI and discuss the potential of AI to revolutionize the EP field. We also address the requirements for implementing, maintaining, and enhancing quality when using AI and consider ethical, operational, and regulatory aspects of AI implementation. This manuscript will be followed by several perspective papers that will expand on some of these topics.

Clinical outcomes, demographics and associative analysis of lung cancer patients with Lambert-Eaton myasthenic syndrome: Insights from the National Inpatient Sample (NIS) database.

e20134 Background: Lambert-Eaton myasthenic syndrome (LEMS) is a rare neuromuscular junction disorder that may present as a paraneoplastic syndrome or a primary autoimmune disorder. Approximately 60% of LEMS patients have an underlying tumor, with the paraneoplastic form predominantly associated with small cell lung cancer (SCLC). Understanding the clinical outcomes and risks associated in lung cancer patients with LEMS is crucial in effective management of such patients. Methods: This retrospective study utilized inpatient hospitalization data from the National Inpatient Sample (NIS) between January 1, 2016, and December 31, 2019. Data of patients with a primary or secondary discharge diagnosis of lung cancer (ICD10-CM codes C34, C78.0, C46.5, D02.2) were obtained. Then, out of this population, we identified Lambert-Eaton myasthenic syndrome with ICD-10 codes (G70.80, G70.81, G73.1). The objective was to run a descriptive analysis of clinical outcomes, risks, demographics and associations of LEMS in patients with lung cancer. Results: A total of 204 cases of lung cancer hospitalizations with LEMS were analyzed. The mean age was 68.23 years, with a slight female (51.72%) preponderance as compared to male (48.28%). Race distribution revealed increased prevalence in White Caucasians (83%), followed by Black (7%), Hispanic (4.5%), Asian or Pacific Islander (3%), Native American (0.5%), and Other (2%). The majority were covered by Medicare (66.33%), followed by private insurance (26.13%). The mortality rate was 8.9%, with a mean length of stay of 10.35 days and mean hospital charges of $118,676. Clinical outcomes and risks were analyzed, with sepsis occurring in 17.6% of cases, pneumonia in 22.5%, and acute respiratory failure in 26.9%. Intubation/mechanical ventilation was necessary in 18.1% of cases. The incidence of urinary tract infection (UTI) was 16.7%, acute kidney injury (AKI) was 17.2%, and venous thromboembolism (VTE) was 6.4%. Additionally, interventions such as intravenous immunoglobulin (IVIG) therapy and blood transfusions were also noted. Conclusions: This study provides insights into the demographic characteristics and clinical outcomes of lung cancer patients with Lambert-Eaton myasthenic syndrome (LEMS). The findings highlight the need for comprehensive management strategies targeting associated complications like acute respiratory failure, intubation and need for mechanical ventilation, pneumonia, UTI, AKI, and VTE to improve patient outcomes, quality of care and effective patient education with regards to their diagnosis of LEMS in lung cancer.

Enhancing thoracic oncology in Armenia: Impact of the implementation of an expert-guided virtual multidisciplinary tumor board.

e13808 Background: The importance of expert-guided multidisciplinary tumor boards (MDTs) in the management of patients with complex malignancies is well established. Modern global telecommunication platforms allow for holding specialized virtual MDT discussions led by international experts even in limited-resource settings. The creation of such a group is of high importance for Armenia given the high incidence and increasing complexity of thoracic malignancies. We describe the initial impact of the implementation of the Thoracic Tumors Working Group (TTWG) of Armenia from August 2022 through January 2024. Methods: The TTWG of Armenia is an MDT comprised of medical oncologists, radiation oncologists, thoracic surgeons, pathologists, and radiologists. The group was formed under the Immune-Oncology Research Institute in August 2022 to discuss the management of patients with complicated thoracic malignancies. For each case, the clinical history, imaging, pathologic findings, and patient management plans are discussed. Updates on treatment paradigms and ongoing clinical trials are also reviewed. The MDTs are held biweekly via the Zoom platform under the supervision of international experts in thoracic oncology. Recordings of MDTs were reviewed to retrospectively identify case characteristics and the impact on patient management. Results: From August 2022 through January 2024, 89 cases were discussed during 33 TTWG MDTs. On average, each MDT was attended by 14 physicians and trainees in Armenia, and by two international experts in thoracic medical and radiation oncology. Median meeting length was 55 minutes with a median of 3 cases presented. Diagnoses included lung adenocarcinoma (n=31, 37.3%), squamous cell lung carcinoma (n=15, 18.0%), neuroendocrine tumors (n=16, 19.3%), small cell lung cancer (n=16, 19.3%), and thymic epithelial tumors (n=6, 7.3%). All disease stages were represented: I 3.7%, II 4.9%, III 31.7%, and IV 47.9%. The male-to-female ratio was 3.6:1 and the median age was 63 years (range: 29-76). Based on MDT discussion, the pre-MDT diagnosis was confirmed in 95.5% (n=85) of patients with down-staging in 3.4% (n=3). The proposed pre-MDT treatment plan was significantly altered in 42.7% (n=38) of patients. Additional studies, mainly PET/CT, bronchoscopy, and broader molecular profiling were recommended for 29.2% (n=26) of patients. Follow-up discussions were held for 7.9% (n=7) of patients based on information arising from prior MDT discussions. The TTWG of Armenia continues to be active. Conclusions: Our initial data suggest that the TTWG of Armenia has had a meaningful influence on patient management by providing access to specialty-expert care and physician education. The impact on patient outcomes will continue to be assessed. The TTWG of Armenia can serve as a model to improve outcomes in other resource-limited settings.

Queensland Trauma Education (QTE): an innovative simulation program that addresses the needs and barriers of interprofessional trauma care education across a complex landscape.

Effective trauma care requires the rapid management of injuries. Rural and remote areas face inequity in trauma care due to time, distance and resource constraints, and experience higher morbidity and mortality rates than urban settings. A training needs analysis (TNA) conducted with stakeholders across Queensland, Australia, revealed a lack of contextual, accessible and interprofessional trauma education for clinicians. The Clinical Skills Development Service and Jamieson Trauma Institute developed the Queensland Trauma Education (QTE) program to address these concerns. QTE comprises a face-to-face training course and open access to online training resources created and reviewed by trauma experts. QTE also supports local training through a statewide simulation network and free access to simulation training equipment. The aim of this article is to review the QTE program and assess the benefits to clinicians in both the delivery of education and the provision of trauma care. To evaluate the QTE program, a desktop review was conducted. This included analyses of website data, course and website content, and facilitator, stakeholder, participant and user feedback. The data were evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, and the program's alignment with the original TNA outcomes was assessed. The results showed that QTE aligns with the identified training needs. Specifically, QTE provides trauma education that is relevant, sustainable, employs best practice, is locally delivered, provides continuous support, is multidisciplinary, multi-platformed, physically accessible and accredited by the Australasian College for Emergency Medicine. The review also highlights how QTE has effectively been reaching its target population, improves knowledge and skills, has become widely adopted, and been implemented and maintained with relative success. The innovative QTE program addresses the previous deficits in trauma education and meets the needs identified in the TNA. The review also reveals further opportunities for continuous improvement and program sustainability.

Transformative Peer Connections: Early Experiences From the ASCO Palliative Care Community of Practice.

The integration of palliative care into routine oncology practice is the standard of care by most leading cancer organizations. Palliative medicine helps to deliver higher quality of care at a lower cost. However, there are barriers to implementing palliative oncology at many institutions for myriad reasons. In this article, we discuss an innovative strategy that ASCO implemented called the Communities of Practice (CoP). We share our experiences as the Palliative Care CoP and how our group seeks to develop processes and structures to collectively promote systemic change and enhance palliative care delivery for people with cancer. Our Palliative Care CoP engages with senior leaders, administrators, and those in power to achieve a shared vision of delivering holistic health care for people with serious illness. We continue to evolve to meet our members' growing needs by addressing eight main domains: (1) increasing palliative care education and resources; (2) creating opportunities for global palliative care research; (3) providing peer mentorship and community building; (4) engaging with patient advocates; (5) supporting and developing interdisciplinary teams; (6) assisting with professional development and identity formation, especially for trainees and early career faculty; (7) extending our outreach through social media; and (8) enhancing the clinical practice of palliative oncology. The ASCO CoP has been a vital forum to realize ASCO's mission of conquering cancer and advancing the Art and Science of Cancer Care: From Comfort to Cure.

Curriculum Research: Disseminating Neuropalliative Care Education Through an Adaptable Curriculum

Curriculum Research: Disseminating Neuropalliative Care Education Through an Adaptable Curriculum

Nurse-led follow-up care versus routine health education and follow-up in diabetes patients: An effectiveness analysis

Nurse-led follow-up care versus routine health education and follow-up in diabetes patients: An effectiveness analysis

Evaluating the Implementation of the Pediatric Acute Care Education (PACE) Program in Northwestern Tanzania: A Mixed-Methods Study Guided by Normalization Process Theory.

Background In low- and -middle-income countries (LMICs) like Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this, we introduced PACE (Pediatric Acute Care Education), an adaptive e-learning program tailored to enhance provider competency in line with Tanzania's national guidelines for managing seriously ill children. Adaptive e-learning presents a promising alternative to traditional in-service education, yet optimal strategies for its implementation in LMIC settings remain to be fully elucidated. Objectives This study aimed to (1) evaluate the initial implementation of PACE in Mwanza, Tanzania, using the constructs of Normalization Process Theory (NPT), and (2) provide insights into its feasibility, acceptability, and scalability potential. Methods A mixed-methods approach was employed across three healthcare settings in Mwanza: a zonal hospital and two health centers. NPT was utilized to navigate the complexities of implementing PACE. Data collection involved a customized NoMAD survey, focus groups and in-depth interviews with healthcare providers. Results The study engaged 82 healthcare providers through the NoMAD survey and 79 in focus groups and interviews. Findings indicated high levels of coherence and cognitive participation, demonstrating that PACE is well-understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practice, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly affecting collective action, were noted. The short duration of the study limited the assessment of reflexive monitoring, though early indicators point towards the potential for PACE's long-term sustainability. Conclusion This study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges is crucial for its successful and sustainable implementation. Furthermore, the study underscores the value of NPT as a framework in guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.

Education Model for Paediatric Palliative Care

Introduction: Meeting the palliative care needs of children and their families is complex and challenging. For countries such as Australia, whose relatively small paediatric palliative care population is dispersed across a very large geographical area, one challenge is maintaining a skilled workforce in regional, rural, and remote areas, where, when compared to major cities, there are fewer resources, and the workforce is often transient. Methods: The Quality of Care Collaborative Australia (QuoCCA) Pop-up Model of Education was used to provide palliative care education to health professionals across three geographical locations and facilities, to facilitate a 2,500-km transfer of a child with complex palliative care needs from a tertiary hospital to the remote family home on Country. Results: Each Pop-Up provided effective education to facilitate the successful transfer of the child to the next hospital location. Over 18 months, three Pop-Ups occurred. Relational learning and real-time problem solving enabled health professionals to build confidence and capacity to successfully transfer the child from the regional hospital to the remote family home. Implications: The QuoCCA Education Pop-up Model is a feasible method to deliver timely access to speciality education. The model can be successfully applied in multiple settings. Keywords: paediatric, palliative care, integrated health care delivery, learning, rural, education models.

Efficacy of a full management model in daytime surgery for gastrointestinal polyps based on WeChat: A study protocol for randomized controlled trials.

The objective of this study is to improve the efficiency of daytime surgery for gastrointestinal polyp and ensure the safety of patients. We tried an information management method based on WeChat platform in patients undergoing daytime gastrointestinal polypectomy and to explore the feasibility and effectiveness of a full management model. Five hundred and ninety-three patients were randomly divided into two groups: the control group was treated with traditional management methods and the experimental group was treated with the whole-process management mode based on the WeChat platform. The WeChat platform-based full management model included establishing a day surgery management WeChat group, developing multidisciplinary, full-management protocols and processes for day surgery, establishing an information-based surgical scheduling system and adopting diverse forms of day surgery education and continuity of care. This feature included illustrated brochures, vivid verbal presentations, WeChat public numbers and Internet management platforms. The treatment time, hospitalization cost and patient satisfaction of the two groups were counted. In the experimental group, 408 patients were enrolled. The preoperative waiting time and patients' length of stay were 3 days and 1 day, respectively. The medical and nursing intake time was 7 min. The procedure cancellation rate and postoperative complications rate was 0.07% and 0.02%. In the control group, 185 patients were enrolled in the study, The preoperative waiting time and patients' length of stay was 7 days and 3 days. The medical and nursing intake time was 28 min. The procedure cancellation rate and postoperative complications rate were 0.13% and 0.05%, respectively. The hospitalization costs were reduced by an average of $140/person and the satisfaction scores were higher than the control group. In summary, the preoperative waiting time, medical reception time, surgical cancellation rate, length of hospital stay and hospitalization cost in the observation group were less than those in the control group (p < 0.05). Patient satisfaction scores were significantly higher than those in the control group (p < 0.05). Through the full management model based on WeChat, the preoperative waiting time, medical reception time, surgical cancellation rate, length of hospital stay and hospitalization cost in the experimental group were less than those in the control group. Patient satisfaction scores were significantly higher than those in the control group and the difference was statistically significant.

Exploring pharmacological treatment for trichotillomania: do we need better education?

Trichotillomania, also known as hair-pulling disorder, is a chronic psychiatric condition with a fluctuating course in which an individual pulls out their hair, leading to visible hair loss and psychosocial sequelae. Due to the unknown pathogenesis, the treatment of this disorder is complex and remains a challenge for dermatologists and psychiatrists. Since guidelines for treating trichotillomania are lacking and, consequently, no common treatment strategy exists, we decided to perform a large-scale, global retrospective cohort study to assess the characterized real-world prescription patterns in treating trichotillomania. The research used the TrinetX database for patients with trichotillomania (ICD 10 - F63.3) within the European and the United States Collaborative Network (EC and UC, respectively). After consulting with a psychodermatology expert, a list of 25 medications was investigated. Data on the prescription drugs of 1,275 patients from the EC and 109,741 patients from the UC were collected. In both the EC and UC cohorts, benzodiazepine derivatives, particularly lorazepam and midazolam, were the most commonly prescribed sedatives/hypnotics. Antipsychotic prescriptions, primarily haloperidol, followed benzodiazepines. After the trichotillomania diagnosis, notable changes in drug prescriptions for the EC cohort, including an increased likelihood of receiving acetylcysteine, haloperidol, quetiapine, sertraline, olanzapine, and risperidone were observed. The UC cohort showed minimal changes. Overall, both cohorts leaned toward benzodiazepine prescriptions (37% UC, 21% EC) and had limited antidepressant usage. Haloperidol (19.3%) and quetiapine (15.1%) were commonly prescribed in both cohorts. The results of our study indicate that the real-world prescription patterns for trichotillomania differ significantly from the expert-proposed therapeutic approach and point toward the necessity of creating standards of pharmacological care and better education.

Embodiment of Pharmacist Intervention in Palliative Care and Augmentation of a Curriculum for Its Assessment

Background Palliative care is the care of patients who have progressive, life-threatening illnesses and who are facing death in the foreseeable future. Since there is a growing need for pharmacist’s intervention in palliative care and there is a gap in the education of palliative care for pharmacy students, this study aims to identify roles and services that have to be performed by palliative care pharmacists in medication-related areas and also to formulate an add-on course to train pharmacy graduates. Materials and Methods A prospective interventional study was done in the palliative care centre in Perinthalmanna, Kerala, India. Relevant data were pooled and analysed for drug-related problems. Necessary interventions were made. Results were interpreted and an add-on course for the training of pharmacy graduates was formulated. Results A total of 88 patients were included in the study. The most prevalent conditions in our palliative setting were kidney disease, liver disease, cancer and stroke. Notably, 38 and 10 cases were found to have drug interactions and drug duplications, respectively. Four patients required dosage adjustments. Fifty cases involved pharmacist intervention which improved the outcome by 80%. At the end of the study, a curriculum was formulated to implement a 3-month add-on course entitled ‘PALLIATIVE PHARMACY’ under the guidance of an Expert committee for training pharmacists and pharmacy students. Conclusion The study identified that there are various roles a pharmacist must undertake in a palliative setup. The involvement of pharmacists in patients’ treatment helps to prevent drug-related problems to a greater extent. The addition of an integrated course for the management of palliative care patients will help to improve the learning as well as practical skills of pharmacists. Incorporating basic and clinical sciences in the therapeutic course is an effective learning plan.