Periodic Reminders Research Articles

From Insight to Impact: Improving Mesorectal Evaluation Standards through Resident Educational Intervention

Abstract Introduction/Objective The completeness of total mesorectal excision (TME) and involvement of the circumferential radial margin (CRM) significantly impact local recurrence and survival rates in rectal cancer. Accurate gross examination to assess mesorectal status is crucial, not only for patient prognosis but also for evaluating surgical quality. Methods/Case Report We implemented a quality assurance initiative to enhance mesorectal quantification and CRM assessment by pathology trainees. Low anterior resection specimens received between January 2022 and December 2023 were included, with 2022 as the pre-intervention period and 2023 post-intervention. In December 2022, an educational session was conducted, emphasizing rectal resection specimens’ types and the importance of mesorectal and CRM assessment. Periodic reminder emails reinforced these concepts. Results (if a Case Study enter NA) We identified a total of 35 cases in the study: 20 pre-intervention arm and 15 post-intervention arm. Mesorectal quantification and CRM assessment and documentation improved significantly post- education, rising from 70% (14 of 20 cases) to 93% (14 of 15 cases) (p < 0.0001). Conclusion In conclusion, our study underscores the critical role of meticulous gross examination in assessing mesorectal status, serving not only as a prognostic indicator but also in guiding surgical precision and rectal cancer management. Further, our findings emphasize the transformative potential of education-driven interventions in enhancing the quality of mesorectal evaluation, reinforcing the pivotal role of pathologists and pathology trainees in shaping therapeutic strategies and ultimately improving rectal cancer patient care.

Engagement challenges in digital mental health programs: hybrid approaches and user retention of an online self-knowledge journey in Brazil.

Digital mental health interventions (DMHIs) have surged in popularity over the last few years. However, adherence to self-guided interventions remains a major hurdle to overcome. The current study utilized a phased implementation design, incorporating diverse samples and contexts to delve into the engagement challenges faced by a recently launched online mental health platform in Brazil with self-evaluation forms. Employing an iterative mixed-methods approach, including focus groups, online surveys, and think-aloud protocols, the research aims to evaluate user satisfaction, identify barriers to adherence, and explore potential hybrid solutions. Engagement in the platform was evaluated by descriptive statistics of the number of instruments completed, and qualitative interviews that were interpreted thematically. In the fully self-guided mode, 2,145 individuals registered, but a substantial majority (88.9%) engaged with the platform for only 1 day, and merely 3.3% completed all activities. In another sample of 50 participants were given a choice between online-only or a hybrid experience with face-to-face meetings. 40% of individuals from the hybrid group completed all activities, compared to 8% in the online-only format. Time constraints emerged as a significant barrier to engagement, with suggested improvements including app development, periodic reminders, and meetings with healthcare professionals. While the study identified weaknesses in the number and length of instruments, personalized results stood out as a major strength. Overall, the findings indicate high satisfaction with the mental health platform but underscore the need for improvements, emphasizing the promise of personalized mental health information and acknowledging persistent barriers in a digital-only setting.

Evaluation of treatment outcome in extrapulmonary tuberculosis: A mixed method study from Puducherry

BackgroundExtrapulmonary tuberculosis (EPTB) is also a public health problem and involves other parts of the body other than lung. During the quarterly review meeting of State Task Force (STF), Puducherry the members raised concern about the outcome of patients referred from the medical colleges. Even though we receive 60 % feedback of initiation of treatment from the PHI but the treatment outcome of EPTB is not clear. Hence primary agenda of this research was to identify the gap in adherence to diagnostic criteria and treatment. AimTo assess the methods adopted for diagnosis of EPTB and to find out the compliance and outcome of the treatment and to identify the patient and health providers related factors that contribute to the outcome of the treatment. Material and methodStudy design: An explanatory mixed method study. Data collection: The information on methods adopted for diagnosis and category of treatment followed in EPTB was extracted from TB register and patient record sheets from the Medical College. House visits was made to trace the patients and the information related to duration of treatment and the outcome of treatment was found. Free listing was conducted to explore the reasons (facilitating and barriers) contributed to the outcome of the EPTB patients. Data analysis: Using EpiData (version 3.1, EpiData Association, Odense, Denmark), data was entered and analysed. The qualitative data was entered and analysed using Visual Anthropac (Ver_1.0.1.36; Analytic Technologies, Inc., USA) software package. ResultsMore than three-fourth (83.6%) of the patients completed extrapulmonary tuberculosis treatment. The site of EPTB emerged as significant predictor for disease outcome. The most salient facilitating factors and barriers contributed to the outcome of treatment were “periodic reminders and care by the family members” and Side effects such as giddiness, loss of sleep and appetite, discolouration of urine, gastritis, difficulty in breathing and walking, swelling of legs, weight and hair loss and myalgia” respectively. ConclusionThe study found that there is good compliance and outcome in treatment outcome. Efforts should be made to overcome the barriers to the outcome of treatment.

Tsunami at school. An experimental strategy to increase students’ risk perception

We tested a methodology for assessing high school students’ tsunami risk perception and knowledge to improve their tsunami awareness. Our objective was to test whether the use of a structured questionnaire on tsunami risk perception could be used as a tool to assess students’ improvement after a lesson on tsunamis. For this purpose, we involved about 100 students from four classes of a high school (Polo Liceale Statale “Lazzaro Spallanzani”) in the town of Tivoli, in central Italy, about 20 km from Rome and 40 km from the seaside. We administered the questionnaire in three subsequent surveys (to 94, 96, and 109 students, respectively), the first of which without providing any information on which subject they would be dealing with. Students were asked to answer the 31 questions individually, each using her/his mobile phone during science class. After two months, all four classes were trained with a frontal lesson and a discussion on tsunami risk. Afterwards, we administered the questionnaire again and ran the second survey. Finally, we met the students one year later and administered the questionnaire again, then we compared the three survey results. The comparison shows that the students’ risk knowledge and perception, which was generally very low in the first survey, improved significantly after the lesson and the relative discussion. Although this result was somewhat expected, it has been possible to confirm and quantify the improvement. According to studies conducted using similar methods [Gray and Di Loreto, 2016; Ayllón et al., 2019], the active participation of students, the collaborative approach provided by teachers and researchers, and the use of a survey tool such as a questionnaire – which, despite being completed individually, fosters an environment of emotional sharing – all contribute to stimulating students’ curiosity and facilitating their learning in traditional educational settings. We then administered the questionnaire to the same classes one year later. The outputs of the third survey show a partial decrease in students’ awareness that nevertheless remains significantly better than in the first survey. This suggests that the students’ involvement in the learning process through the questionnaire and through an active discussion after watching videos and pictures works well, but also that a periodic reminder by the science teachers is needed to maintain a constant level of risk awareness and perception. We propose to replicate this approach by involving teachers in the survey, providing them with a recorded lesson with all the basic elements, to be shown between the first and second administration of the questionnaire, and with periodic (yearly) reminders.

Factors Affecting Engagement With Portfolio-Based Reflection Among Internal Medicine Trainees: A Survey-Based Study.

Background Contemporary medical education emphasizes that postgraduate clinicians should look at their daily experiences as an opportunity to learn and advance their knowledge and practice of medicine. This is the concept of reflective practice. Internal medicine trainees (IMT) in the UK are encouraged to record written reflections in their electronic portfolios but it is not a mandatory requirement.There is literature suggesting that the level of engagement with these written reflections is varied and that when these are produced, they can be superficial. Thus, the aim of this research was to ascertain what percentage of trainees engaged in written reflections and the factors that affected the likelihood they would reflect. Thereare no studies that have attempted to quantify de novo engagement with reflective practice and to quantify the significance of different theorized barriers to reflection. Methods This study was in the form of a quasi-experimental cross-sectional study. A 15-item survey was sent out to the IMT in the northwest deanery of England (n=592). The survey remained open for approximately three months with periodic reminders sent out to the trainees. The survey was closed to further responses when the number of responses reached the predetermined sample size of 240 (5% margin of error at a confidence interval of 95%). The data were analyzed by chi-square testing and represented using descriptive statistics. Results There were 243 responses to this survey. A total of 81.5% (n=198) wrote reflections in their portfolio and 19.5% (n=45) did not write any reflections. The main content of written reflections were clinical outcomes (positive and negative), teaching, and new learning. Several background factors had a statistically significant influence on the likelihood that trainees would write reflections in their portfolios. These included their stage of training, years practicing medicine, location of primary medical training, first exposure to reflective practice, and whether they have ever been tutored on reflection. Concerns about legal or General Medical Council (GMC) use of reflective notes against trainees also significantly impacted on reflection. The main perceived barriers to written reflections were the fact that trainees felt they had no time to properly reflect and the lack of perceived benefits from reflections. Conclusion Most trainees wrote reflections in their portfolios, but the majority did not perceive any benefits in doing this. The varied backgrounds of trainees seem to have an impact on their likelihood to reflect and strategies to increase engagement would need to address this.

Learning in the wild – exploring interactive notifications to foster organic retention of everyday media content

ABSTRACT The amount of information we consume daily through smartphones has prompted the development of Personal Knowledge Management Systems (PKMS). However, these external memory aids can lead to overreliance and do not help to keep information in our organic memory. This paper presents the design and evaluation of MemoryMate, an app that fosters recall of saved content through interactive notifications. The app's design is based on insights from a focus group (N = 7) that inquired about people's expectations and preferences regarding the notification design. The results of a three-week in-the-wild study (N = 23) of MemoryMate suggest that notifications could trigger engagement with saved content, and two-thirds of participants felt notifications improved their memory and retention. Retrieval practice notifications with interactive tasks performed well and received positive feedback. Content priority and time since the last interaction influenced notification engagement, emphasising the need for periodic reminders to maintain user interest in saved content. We discuss potential implications for the design of PKMSs as a tool for lifelong learning.

ARESEARCH INVESTIGATIONINTO THE UTILIZATIONOF THEPQRSTNURSINGCARESTRATEGY AMONGNURSING PRE-PROFESSIONALS

This study implemented the PQRST (Provoking, Quality, Radiation, Severity, Timing) nursing care strategy to assess how effectively junior nursing students incorporated it into their nursing English conversations. Although all students had been taught the PQRST strategy during their first and second years, they tended to overlook its application in their studies. The research involved two groups: a control group and an experimental group comprising a total of one hundred students. The control group was told to utilize the PQRST nursing strategy while preparing their nursing English scripts, but they did not receive a review lesson on the strategy itself. On the other hand, the experimental group received a list of nursing-patient questions categorized into the sections of the PQRST strategy (refer to Appendix I) and were later guided through a review of the nursing strategy by the instructor. The findings indicated that a significant majority of the experimental groups learners were almost familiar with the PQRST mnemonic, with percentages of 62%, 86%, 60%, 88%, and 94% for the respective components. Overall, 90% of the experimental group successfully implemented the PQRST strategy. The study also identified four scenarios in which the experimental students effectively utilized the PQRST strategy: prior to admission, after an operation, during body assessments when patients experienced pain or discomfort during rehabilitation, and when nurses needed to gather patients medical information. In general, the experimental learners appeared to be confident in their understanding and application of the PQRST nursing strategyhowever, periodic reminders were deemed necessary. Conversely, the control group did not utilize the PQRST nursing strategy at all since they neither received information about it nor were they reviewed on the strategy by the instructor.

Open Source Monitoring and Alarm System for Smart Microgrids Operation and Maintenance Management

Microgrids are becoming increasingly important for improving the dependability, stability, and quality of the electrical system, as well as for integrating renewable technologies. This paper describes a novel monitoring and alarm system that has been developed to optimize the operation and maintenance of microgrids. The system is unique in that it has been developed using open source software, including Node-RED, Home Assistant, Maria DB, and Telegram, and it allows for easy programming of alarms or warnings. Testing of the system has taken place within the CEDER microgrid and is capable of detecting faults in various components of the microgrid, such as generation units, storage systems, and loads. Upon detecting a fault, the system immediately sends a text message to the mobile phones of the microgrid operator or maintenance crew, enabling them to promptly address the problem. The software can also manage preventive maintenance of the microgrid by sending periodic reminders to the maintenance crew regarding necessary tasks.

Increasing pneumococcal vaccine uptake in older adults: a scoping review of interventions in high-income countries

BackgroundThere is low uptake of the pneumococcal vaccination in eligible older adults, even in high-income countries that offer routine and universal vaccination programs.ObjectiveTo systematically characterize interventions aimed at improving pneumococcal vaccine uptake in older adults.DesignWe conducted a scoping review following PRISMA-SCr guidelines of five interdisciplinary databases: Medline-Ovid, Embase, CINAHL, PsychInfo, and Cochrane Library. Databases were searched from January 2015 until April 2020. The interventions were summarized into three pillars according to the European Union Conceptional Framework for Action: information campaigns, prioritization of vaccination schemes, and primary care interventions.ResultsOur scoping review included 39 studies that summarized interventions related to pneumococcal vaccine uptake for older adults, encompassing 2,481,887 study participants (945 healthcare providers and 2,480,942 older adults) across seven countries. Examples of interventions that were associated with increased pneumococcal vaccination rate included periodic health examinations, reminders and decision-making tools built into electronic medical records, inpatient vaccination protocols, preventative health checklists, and multimodal educational interventions. When comparing the three pillars, prioiritization of vaccination schemes had the highest evidence for improved rates of vaccination (n = 14 studies), followed by primary care interventions (n = 8 studies), then information campaigns (n = 5 studies).ConclusionSeveral promising interventions were associated with improved outcomes related to vaccine uptake, although controlled study designs are needed to determine which interventions are most effective.

A Multifaceted Educational Intervention to Reduce Plasma Utilization

Blood transfusion services maintain quality practice through adherence to guidelines but are faced with blood component wastage due to multiple factors. One factor, in particular, is poor ordering and utilization practices followed by physicians who may not be familiar with the indications and the optimal conditions for the handling of blood products. This study evaluates whether an educational intervention would help reduce ordering of plasma and improve wastage rates after thawing. The study followed a quasi-experimental pre-test post-test design. A multifaceted educational intervention was introduced at a tertiary hospital-based combining predisposing, enabling, and reinforcing activities, based on the literature of effective continuous professional development. The activities included a brief survey to evaluate participant knowledge about indications of plasma and its storage condition, a lecture, and periodic reports and reminders sent to all department heads in the hospital. Respondents to the survey and lecture attendees included physicians in adult critical care and anesthesia departments. Monthly plasma utilization and wastage rates were compared before and after introducing the intervention. Sixty physicians participated in the survey. The questions were answered correctly by less than half. After introducing the intervention, monthly plasma transfusion rates decreased; however, wastage rates did not improve. There is a knowledge gap among physicians who order plasma. The educational intervention resulted in lower plasma transfusion rates but did not affect wastage rates. Future interventions would benefit from including physicians in other departments as well as nurses.

Knowledge, Attitude, compliance and barriers of immunization among Parents’ of under-five children

IntroductionImmunization is one of the most substantial contributions from the medical field to human beings as a low-cost intervention to prevent major illnesses that contribute to the mortality of children in developing countries like India. Parent’s knowledge plays a vital role in determining the health status of children. Purpose of the studyTo assess knowledge, attitude, and compliance of immunization, and explore barriers of immunization among parents of under-five children. MethodologyA cross-sectional study was conducted among 200 parents of under-five children at selected government hospitals in Dehradun district. Study participants were selected by consecutive sampling technique, and data were collected using pre-tested, structured questionnaires. The data was analyzed using descriptive and inferential statistics. ResultsOf 200, 39 (19.5%) parents reported that their child was not vaccinated as per schedule. A vast proportion (84.5%) of parents had an average to good level of knowledge regarding under-five immunization. Out of ten components of attitude, most of the parents had agreed in favor of vaccination. The most common barriers of compliance reported by parents were: unaware of the next scheduled doses, illness in family, and absence of vaccine at health centre. ConclusionMost of the parents of the under-five child had basic knowledge and positive attitude regarding immunization, but the compliance rate for immunization was not 100%. We recommend that health agencies must develop multiple education interventions regarding immunization and periodic reminders for scheduled vaccination for their child. Also, concerned authorities should consider feedback and resolve the issues of parents appropriately.

Supportive Periodontal Treatment for the natural dentition and dental implants: a review

Aim: To assess the importance of successful periodontal treatment during long-term supportive periodontal treatment.
 The maintenance phase has been named the "cornerstone" of effective periodontal treatment when a patient is transferred from active treatment to a maintenance phase which is considered the final stage in comprehensive patient care, it takes effort and time from the patient, staff, and the dentist.
 Surgical and non-surgical techniques are used in periodontal therapy; patients should be put on a schedule of periodic reminder visits for supportive care once periodontal therapy is completed to avoid the recurrence of the disease. PD can recur due to poor mouth oral hygiene, insufficient subgingival removal, the microscopic nature of the dentogingival unit healing after periodontal treatment, and other factors. As a result, effective treatment should be provided to prevent disease recurrence.
 Conclusion: The success of periodontal therapy is based on a continuous schedule of periodontal maintenance therapy

Pharmacists' Perceptions of Mental Well-Being and Immunization Safety During COVID-19.

Purpose: To assess pharmacists' mental well-being, perceptions of safety, and willingness to administer vaccines before and during the COVID-19 pandemic. Methods: An electronic survey was administered to a convenient sample of practicing pharmacists working in Alabama, Tennessee and Texas. The 33-item survey examined pharmacists' beliefs about the pandemic's impact on their mental well-being, their perceptions of safety in vaccine administration, and their willingness to vaccinate. Responses were assessed on a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). A recruitment email with the survey link was sent to pharmacists, with periodic reminders over a 4-week period. Descriptive statistics and bivariate analyses were utilized to evaluate survey responses. Results: A total of 387 responses were analyzed, with an estimated response rate of 3.93%. Most respondents were women (65%) and had at least 6 to 10 years of practice experience (28%). Overall, participants felt that the pandemic worsened their mental well-being, with women reporting a more negative mental well-being compared with men (P < .001). They reported having less time during workflow to apply personal protective equipment (PPE) (P = .0074) compared to before the pandemic. They also reported a decrease in willingness to vaccinate adult patients during the pandemic (P < .0001), and that concern about contracting COVID-19 prevented them from giving vaccinations (P < .0001). Conclusions: Pharmacists felt their mental well-being and willingness to vaccinate patients suffered as a result of the COVID-19 pandemic. Future research and initiatives that focus on improving vaccination rates should also consider pharmacists' concerns and well-being.

A smartphone-based self-care application for patients with urinary tract stones: identification of information content and functional capabilities

PurposeThis study aimed to identify and validate the information content and functional capabilities of a smartphone-based application for the self-care of patients with urinary tract stones.Methods and materialsFirst, by reviewing studies and urology-oriented books, studying 214 medical records, and consulting with specialists, the information items and basic capabilities of the application were identified, and in the next stage, a researcher-made questionnaire was designed based on the information obtained from the previous step. Then, experts' opinions were considered to confirm the validity and reliability of the questionnaire; the designed questionnaire was distributed among various participants. Finally, the application's leading information elements, contents, and functional capabilities were explored by analyzing the questionnaire results.ResultsTo conduct the survey, 101 patients with Urinary Stone Diseases (USD), 32 urologists and nephrologists, 11 nurses, and six other specialists were recruited. After analyzing the results of the filled questionnaire, 21 information elements and nine surveyed capabilities that were more important than others were selected to be used in designing the application. Some of the principal information elements that were used in the application design include: the cause of various stones in the body, clinical manifestations, laboratory results, treatments of various stones, the role of environmental factors in the treatment, the role of nutrition in the treatment and formation of stones, and different diagnostic methods. Some of the important features of the application include: medication and fluid intake reminders, laboratory test reminders, radiography and periodic examination reminders, surgical history, and easy access to medical centers for information. The mean score of information elements was 75.07 from the patients' perspective, 65.09 from the physicians' perspective, and 80.09 from the nurses' perspective. Also, the mean score of application capabilities was 31.89 from the patients' perspective, 30.37 from the physicians' perspective, and 35.09 from the nurses' perspective. The difference in the mean scores of the above variables was statistically significant (p < 0.05) in both layers.ConclusionIn this study, informational and functional needs and capabilities were presented for designing a mobile-based application that helps in disease management in patients with urinary tract stones.

Academics’ Intentions to Use Open Educational Resources (OERs) in Professional Development

Academics’ Intentions to Use Open Educational Resources (OERs) in Professional Development

Impact of community masking on COVID-19: A cluster-randomized trial in Bangladesh.

INTRODUCTION:Mask usage remains low across many parts of the world during the COVID-19 pandemic, and strategies to increase mask-wearing remain untested. Our objectives were to identify strategies that can persistently increase mask-wearing and assess the impact of increasing mask-wearing on symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.RATIONALE:We conducted a cluster-randomized trial of community-level mask promotion in rural Bangladesh from November 2020 to April 2021 (N = 600 villages, N = 342,183 adults). We cross-randomized mask promotion strategies at the village and household level, including cloth versus surgical masks. All intervention arms received free masks, information on the importance of masking, role modeling by community leaders, and in-person reminders for 8 weeks. The control group did not receive any interventions. Participants and surveillance staff were not informed of treatment assignments, but project materials were clearly visible. Outcomes included symptomatic SARS-CoV-2 seroprevalence (primary) and prevalence of proper mask-wearing, physical distancing, social distancing, and symptoms consistent with COVID-19 illness (secondary). Mask-wearing and distancing were assessed through direct observation at least weekly at mosques, markets, the main entrance roads to villages, and tea stalls. Individuals were coded as physically distanced if they were at least one arm’s length from the nearest adult; social distancing was measured using the total number of adults observed in public areas. At 5- and 9-week follow-ups, we surveyed all reachable participants about COVID-19–related symptoms. Blood samples collected at 10- to 12-week follow-ups for symptomatic individuals were analyzed for SARS-CoV-2 immunoglobulin G (IgG) antibodies.RESULTS:There were 178,322 individuals in the intervention group and 163,861 individuals in the control group. The intervention increased proper mask-wearing from 13.3% in control villages (N = 806,547 observations) to 42.3% in treatment villages (N = 797,715 observations) (adjusted percentage point difference = 0.29; 95% confidence interval = [0.26, 0.31]). This tripling of mask usage was sustained during the intervention period and for 2 weeks after. Physical distancing increased from 24.1% in control villages to 29.2% in treatment villages (adjusted percentage point difference = 0.05 [0.04, 0.06]). We saw no change in social distancing. After 5 months, the impact of the intervention on mask-wearing waned, but mask-wearing remained 10 percentage points higher in the intervention group. Beyond the core intervention of free distribution and promotion at households, mosques, and markets; leader endorsements; and periodic monitoring and reminders, several elements had no additional effect on mask-wearing, including text reminders, public signage commitments, monetary or nonmonetary incentives, and altruistic messaging or verbal commitments.The proportion of individuals with COVID-19–like symptoms was 7.63% (N = 12,784) in the intervention arm and 8.60% (N = 13,287) in the control arm, an estimated 11.6% reduction after controlling for baseline covariates. Blood samples were collected from consenting, symptomatic adults (N = 10,790). Adjusting for baseline covariates, the intervention reduced symptomatic seroprevalence by 9.5% (adjusted prevalence ratio = 0.91 [0.82, 1.00]; control prevalence = 0.76%; treatment prevalence = 0.68%). We find that surgical masks are particularly effective in reducing symptomatic seroprevalence of SARS-CoV-2. In villages randomized to surgical masks (N = 200), the relative reduction was 11.1% overall (adjusted prevalence ratio = 0.89 [0.78, 1.00]). The effect of the intervention is most concentrated among the elderly population; in surgical mask villages, we observe a 35.3% reduction in symptomatic seroprevalence among individuals ≥60 years old (adjusted prevalence ratio = 0.65 [0.45, 0.85]). We see larger reductions in symptoms and symptomatic seropositivity in villages that experienced larger increases in mask use. No adverse events were reported.CONCLUSION:A randomized-trial of community-level mask promotion in rural Bangladesh during the COVID-19 pandemic shows that the intervention increased mask usage and reduced symptomatic SARS-CoV-2 infections, demonstrating that promoting community mask-wearing can improve public health.

Experience of Using a Mobile App to Improve Adherence to Treatment in Patients with TB/HIV Coinfection

The objective of the study: to summarize experience of using a mobile technology to improve adherence in patients with tuberculosis and HIV infection (TB/HIV) who are psychoactive substance users.Subjects and Methods. A smartphone app was used, it included daily patient inquiries about mood, stress levels, and medication intake; periodic reminders about outpatient appointments; and anonymous chats with the coordinating physician and other patients. Treatment results were evaluated in Group 1 (n = 54) and Group 2 (n = 50), where this technology was used and not used, respectively.Results. The number of patients cured of tuberculosis was not significantly different between Groups 1 and 2 (32/51 vs. 27/48; χ2 = 0.61, p = 0.48). Patients from Group 2 died significantly more often during the follow-up period (14/48 vs. 3/51; χ2 = 7.86, p = 0.006) associated with antiretroviral therapy interruption or withdrawal. Increased CD4 count by 6 months of follow-up was found in both groups, most pronounced among those who started ART (W = 6.0, p = 0.004 – in Group 1 and W = 15.0, p = 0.004 – in Group 2). The total number of patients with viral suppression was greater in Group 1 than in Group 2 (34/47 vs. 20/39; χ2 = 4.05, p = 0.04).Conclusion. The mobile app used is suitable for supporting the outpatient management of patients with TB/HIV coinfection but its direct impact was reflected only in the formation of ART adherence and lower number of deaths.

Facilitators and barriers to medication adherence among stroke survivors in India

Strict compliance with medication and life style modification are integral to secondary stroke prevention. This study was undertaken to find out medication adherence among stroke survivors and factors associated with it. Cross sectional survey among stroke survivors was conducted. Interview based self-reported medication adherence was defined as consumption at least >80% of their medications for last two weeks, based on last prescription. Structured interview using pretested interview schedule was done to collect other data. Sequential step wise logistic regression analysis was done to find out the facilitators and barriers to medication adherence. Two hundred and forty stroke survivors (mean age 58.64 ± 10.96 years; 25.4% females) with a mean post-stroke period of 6.65 ± 3.36 months were participated. Overall medication adherence was 43.8% (n = 105). Medication adherence was 34.3% (n = 134), 52.6% (n = 190) and 56.7% (n = 224) for antidiabetics, antihypertensives and statins respectively and was associated with risk factor control (Diabetes: Odds Ratio (OR) = 4.85; 95% Confidence Interval (CI) 2.12–11.08, Hypertension: OR = 3.42; 95% CI 1.83–6.4, Dyslipidaemia: OR = 3.88; 95% CI 1.96–4.04). Having daily routine (OR = 2.82; 95% CI 1.52–5.25), perceived need of medication (OR = 2.33; 95% CI 1.04–5.2) and perceived poor state of health (OR = 2.65; 95% CI 1.30–5.40) were facilitators. Memory issues (OR = 0.34; 95% CI 0.16–0.71), side effects (OR = 0.24; 95% CI 0.11–0.42) and financial constraints (OR = 0.46; 95% CI 0.24–0.91) were barriers to medication adherence. Establishing daily routines, periodic reminders, financial supports to buy medicines and patient education can enhance medication adherence to prevent future strokes.

Medication Adherence among Stroke Survivors within a Poststroke Period of Three Months to One Year

Strict compliance with medication is integral to secondary stroke prevention. This study was undertaken to fi nd out medication adherence among stroke survivors and factors associated with it. Cross sectional survey among stroke survivors was conducted. Interview based self-reported medication adherence was defi ned as consumption at least more than 80 percent of their medications for last two weeks, based on last prescription. Structured interview using pre-tested interview schedule was done to collect other data; stroke survivors (mean age 58.64 ±10.96 years; 25.4% females) with a mean post-stroke period of 6.65±3.36 months participated. Overall medication adherence was 43.8 percent (n=105). Medication adherence was 34.4 percent (n=134), 52.6 percent (n=190) and 56.7 percent (n=224) for antidiabetics, antihypertensives and statins respectively. People less than 45 years of age, urban residents and those with physical and neurological defi cits were more adherent to medications. Periodic reminders, fi nancial support to buy medicines and patient education can enhance medication adherence to prevent future strokes.

Pengaruh Pendidikan TB Melalui Whatsapp Reminder Berkala Terhadap Tingkat Pengetahuan Remaja di SMA Negeri 2 Denpasar

Tuberculosis that attacks adolescents aged 10-18 years tends to increase. Health education is one way to increase adolescent knowledge about how to prevent tuberculosis, one of the media that can be used for health education is WhatsApp. This study aims to determine the effect of TB education through WhatsApp periodic reminder on the level of knowledge of adolescents in SMA Negeri 2 Denpasar in 2019. The research design used was one-group pre-post test design. The number of samples was 44 people selected by quota sampling technique. The study was conducted in July to August 2019. Data collection used knowledge level questionnaires about TB. The results of this study the average value of knowledge of adolescents before being given health education at 11.68 and after being given health education at 19.02. Hypothesis testing uses paired t-test with p value = 0.001 (p &lt;0.05). The conclusion of this research is the effect of TB education through WhatsApp periodic reminder on the level of knowledge of adolescents, then it is recommended to do health education using WhatsApp media