Post-intervention Mean Research Articles

Alternatives to opioid protocols in Colorado emergency departments reduce opioid use without changing reported pain.

ObjectiveThe objective of this study was to determine whether instituting an alternative to opioids (ALTO) protocol significantly reduced opioid use in emergency departments (EDs). The secondary objective was to determine whether patient‐reported pain and satisfaction were affected.MethodsElectronic health records for 10 EDs in Colorado were retrospectively examined for the 6 months before the intervention and for the same 6 months the following year after the intervention, which consisted of systemic and educational initiatives in line with the Colorado American College of Emergency Physicians 2017 Opioid Prescribing and Treatment Guidelines.ResultsOf the total preintervention and postintervention unique patient visits, 47.2% received 1 of the drugs of interest, an opioid or ALTO, while in the ED. In aggregate, the EDs decreased opioid usage, measured in morphine equivalent units per 1000 ED visits, by 37.4% (95% confidence interval, 33.6%–76.2%; P < 0.0001) after the intervention. Statistically significant decreases were seen in every type of opioid. Statistically significant increases in ALTO usage were also noted across all study hospitals. There were no significant changes observed in Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores before and after the intervention in the hospitals with Hospital Consumer Assessment of Healthcare Providers and Systems data (preintervention mean, 3.74; postintervention mean, 3.74; P = 0.637), and there was a small but statistically significant improvement in pain scores (preintervention mean, 3.62; postintervention mean, 3.66; P = 0.002). In a subgroup analysis of patients presenting with chief complaints of long bone fractures and malignant neoplasms, there were no significant reductions in opioid use.ConclusionsThis study demonstrated the feasibility and effectiveness of implementing ALTO protocols to reduce opioid use in the ED setting without an overall reduction in patient perception of pain or satisfaction with care.

Care redesign of pelvic radiotherapy using Design Thinking: An enhanced quality improvement initiative.

246 Background: Cone Beam Computed Tomography(CBCT) is the cornerstone of image guided radiotherapy(IGRT) which is an integral part of pelvic cancers like prostate cancer. Each pelvic radiotherapy (RT) session is preceded by a planned CBCT to ensure target localisation and organ at risk avoidance. When these criteria are not met, an unplanned CBCT is performed until the CBCT is satisfactory. Possible reasons for an unsatisfactory CBCT include an under filled bladder, distended rectum or prostate gland movement. Repeated unplanned CBCT results in unnecessary excess radiation for patients. We aimed to reduce the incidence of unplanned CBCT from a baseline of 21% to 9% over 5 months. Methods: We conducted the project using both conventional quality improvement methodology and the design thinking methodology. In the diagnostic phase up to March 2017, the baseline incidence of CBCT in patients receiving pelvic RT was 21%. We hypothesized that there were reversible factors leading to a higher incidence of unplanned CBCT and sought to identify and rectify these reversible factors to reduce the incidence of unplanned CBCT. Using human centred design, we designed a new process of performing a bladder ultrasound prior to CBCT to ensure a full bladder prior to RT using the steps empathy, define, ideation, prototype, testing, sharing. Results: A total of 97 patients that underwent pelvic radiotherapy were included in this study, 40 patients were pre intervention and 61 patients received the bladder ultrasound intervention implemented from April 2017 onwards. After intervention, incidence of unplanned decreased from 21% to 5.8%. A 2 sample t test was used to compare the unplanned CBCT pre and post intervention. We found the mean pre and post intervention difference in pooled mean incidence of unplanned CBCT to be significantly different by 13.3%. The reduction in unplanned CBCT translated to saving each patient on average equivalent to 3000 chest x rays worth of unnecessary radiation. Conclusions: Design Thinking is a feasible strategy in quality improvement. We report the first design thinking project in radiation oncology quality improvement. An automated ultrasound bladder is a feasible strategy to screen for bladder filling prior to each CBCT to reduce reliance on CBCT and also patient exposure to radiation in IGRT of pelvic cancers.

Effect of Aerobic Exercise on Brain-derived Neurotrophic Factor (BDNF) Serum Level in Stroke Subjects with Cognitive Function Impairment

Background: Cognitive impairment is the most frequent complication of stroke. However, erobic exercise is considered to have potential effect in inhibiting the post-stroke cognitive degradation and increasing cognitive performance through neuroplasticity-influenced long term potentiation in hippocampus.Aim: To determine the effect of aerobic exercise on brain-derived neurotrophic factor (BDNF) serum level in stroke subjects with cognitive function impairment.Material and Methods: Experimental pre-post study on sub-acute stroke male and female, 12 subjects on each group. Intervention group given standard therapy and aerobic exercise using static cycle. Control group treated with standard therapy 30 minutes/session 3x/week, for 6 weeks. Parameter being evaluated was BDNF serum level.Result: No significant difference (p=0.21) in BDNF serum level in both control group (246.03±40.81 pg/ml) and intervention group (280.98±73.53 pg/ml) after treated with treatment. Although there was a significant increase of BDNF serum level in the intervention group (p&lt;0.001) with pre-intervention mean value of 1.96±60.69 pg/ml and post-intervention mean value of 280.98±73.53 pg/ml. Similar to the intervention group, there was a significant increase in BDNF serum level (p&lt;0,001) in control group, with pre-intervention mean value of 136.39±76.32 pg/ml and post-intervention mean value of 246.03±40.81 pg/ml.Conclusion: No significant difference in BDNF serum levels in intervention group after aerobic exercise program with a static cycle and standard therapy 3x/week for 6 weeks, when compared to the control group that only received standard therapy, although both control and intervention groups showed significant difference before and after the intervention.

Effect of Visit Frequency of Pharmacist-Led Diabetes Medication Management Program

Background: Pharmacists have a positive effect on clinical outcomes in chronic disease state management, however, few studies have evaluated the effect that frequency of visits may have on diabetes biomarkers such as hemoglobin A1c and blood pressure readings. Methods: Under the medication management program (MMP), patients with diabetes were seen monthly by pharmacists until early 2015, when time between visits was increased to every 3 months. A retrospective chart review was conducted to evaluate the primary outcome of the percent change in hemoglobin A1c and blood pressure after the change in visit frequency. Results: In the 303 patients enrolled, no statistical difference existed between the pre and post average A1c (p-value = 0.10). The intermediate average A1c was statistically lower from the preintervention mean A1c (p-value = 0.001) but not from the postintervention mean A1c (p-value = 0.30). No statistical differences were seen between systolic blood pressure and diastolic blood pressure. Conclusion: Patients who have been seen by a clinical pharmacist more frequently (every month or every other month) for several years may be able to maintain their reduction in A1c with less-frequent visits (every 3 to 6 months).

Evaluation of Vaccination Training in Pharmacy Curriculum: Preparing Students for Workforce Needs.

Background: To introduce and evaluate a university vaccination training program, preparing final year Bachelor of Pharmacy (BPharm) and Master of Pharmacy (MPharm) students to administer vaccinations to children and adults in community pharmacy and offsite (mobile and outreach) settings. Methods: Final year BPharm and MPharm students were trained to administer intramuscular vaccinations to adults and children. The education program embedded in pharmacy degree curriculum was congruent with the requirements of the Australian National Immunisation Education Framework. The training used a mix of pedagogies including online learning; interactive lectures; and simulation, which included augmented reality and role play. All pharmacy students completing the program in 2019 were required to carry out pre- and post-knowledge assessments. Student skill of vaccination was assessed using an objective structured clinical assessment rubric. Students were invited to complete pre and post questionnaires on confidence. The post questionnaire incorporated student evaluation of learning experience questions. Results: In both cohorts, student vaccination knowledge increased significantly after the completion of the vaccination training program; pre-intervention and post-intervention mean knowledge score (SD) of BPharm and MPharm were (14.3 ± 2.7 vs. 22.7 ± 3.3; p < 0.001) and (15.7 ± 2.9 vs. 21.4 ± 3.2; p < 0.001) respectively. There was no difference between the BPharm and MPharm in the overall knowledge test scores, (p = 0.81; p = 0.95) pre and post scores respectively. Using the OSCA rubric, all students (n = 52) were identified as competent in the skill of injection and could administer an IM deltoid injection to a child and adult mannequin. Students agreed that the training increased their self-confidence to administer injections to both children and adults. Students found value in the use of mixed reality to enhance student understanding of the anatomy of injection sites. Conclusion: The developed vaccination training program improved both student knowledge and confidence. Pharmacy students who complete such training should be able to administer vaccinations to children and adults, improving workforce capability. Mixed reality in the education of pharmacy students can be used to improve student satisfaction and enhance learning.

Evaluation of Physical Activity and Lifestyle Interventions Focused on School Children with Obesity Using Accelerometry: A Systematic Review and Meta-Analysis.

Despite the existence of global recommendations for physical activity and lifestyle to avoid childhood obesity, there are no specific recommendations for school-age children. The aim of this meta-analysis was to measure the effects of current interventions with a physical activity component on body mass index (BMI) Z-score and on the moderate and vigorous physical activity (MVPA) time, measured by accelerometry, and focused on children with obesity. Randomized controlled trial studies (RCTs) based on physical activity interventions focused on children with obesity (6 to 12 years old) from January 1991 to August 2018 were included. The post-intervention mean and standard deviation of the BMI Z-score and MVPA engaged time were extracted to calculate the results using random effects models. Of a total of 229 studies considered potentially eligible, only 10 RCTs met the inclusion criteria. There were improvements in the BMI Z-score for physical activity intervention groups, compared with non-intervention children in addition to a significant increase in time engaged in MVPA. In conclusion, interventions with a physical activity component in school-children with obesity seem to be effective at reducing BMI and producing an increase in time spent engaged in physical activity. Therefore, interventions based on physical activity should be considered one of the main strategies in treating childhood obesity.

Efficacy of a Culture-Specific Dancing Programme to Meet Current Physical Activity Recommendations in Postmenopausal Women.

This study investigated the efficacy of participation in culture-specific dancing to meet current physical activity recommendations and increase cardio-respiratory fitness in postmenopausal women. Sedentary postmenopausal women (n = 24), aged 63 ± 8 years and with BMI of 28 ± 3 kg/m2 completed a 4-week Scottish dancing study. The dancing sessions of approximately 75 min were performed twice a week and each session was based on five Scottish dances performed in 3 sets. Heart rate (HR) measurements were obtained during all dances to evaluate whether the intervention achieves the criteria of moderate to vigorous aerobic exercise intensity. Body composition, waist circumference, and HR during Chester Step test were measured before and after dancing intervention. HR achieved during individual dances ranged from 64 ± 5% to 80 ± 5% of HRmax and the mean HR of the five dances corresponded to 72 ± 7% of HRmax. Post-intervention mean HR was lower throughout Level 2 (Pre, 112 ± 13 bpm; Post, 106 ± 13 bpm; p = 0.005) and Level 3 (Pre, 122 ± 14 bpm; Post, 115 ± 14 bpm; p = 0.006) of the Chester test compared with baseline values. The intervention had no impact on body weight or body fat but reduced waist circumference (Pre, 94 ± 8 cm; Post, 91 ± 9 cm; p = 0.006). Thus, traditional Scottish dancing should be advocated to sedentary postmenopausal women, emphasising its potential in meeting current physical activity recommendations in relation of weekly duration and exercise intensity and improving cardiorespiratory fitness.

Effect of ultrasound and four hourly cryotherapy application in the treatment of bicipital tendinitis- a randomised clinical trial

The purpose of this appraisal was to consider the effect of ultrasound and four hourly cryotherapy application in the treatment of bicipital tendinitis. In this prospective randomized clinical assessment, Thirty individuals were enrolled in the group A, and thirty specific individuals were picked into the get-together B group. In group A, Ultrasound for 7 mins – 2:8 – 1.5 w/cm2 and for group B, Sham Ultrasound for 7 mins – 2:8 – 1.5 w/cm2 with cryotherapy for 20 min 4hourly given. Pain severity, Pressure Pain Threshold and functional disability were assessed in all participants before and after two weeks of treatment. Group A had 12 males, and 15 females and Group B had nine males and 18 females. Pre and post interventional mean and standard deviation for group A was 7.37+1.21 and 7.33+1.30. Whereas pre and post interventional mean and standard deviation for group B was 7.33+1.30 and 1.70+0.60. Pre interventional analysis of data of group A and B showed no significant difference. Whereas post interventional analysis of data showed an extremely significant difference between group A and group B. Results revealed that participants with bicipital tendinitis respond more favourably to ultrasound therapy with cryotherapy for 20min four-hourly than ultrasound alone.

The effect of an emotional support training program on acute stress disorder among mothers of preterm infants hospitalized in neonatal intensive care units

Many mothers experience acute stress disorder after hospitalized their infant in NICU. The objective was to assess the impact of an emotional support training program on acute stress disorder level among mothers of preterm infants admitted to a neonatal intensive care unit. A pretest-posttest experimental randomized controlled trial design using the Stanford Acute Stress Reaction Questionnaire was used on 48 mothers (24 each in two groups) of premature infants in a level III NICU in the largest public teaching hospital in Amman at Jordan. The results revealed statistically significant differences between the interventional and control group for mean post intervention scores [t (23) = 6.07, p = .01], with mean scores of 18.53 (9.33) and, 25.588 (4.99) respectively. Hence, the emotional support training programs effectively reduce acute stress disorder symptoms in mothers of premature infants in neonatal intensive care units.

Fan-on-Face Therapy in Relieving Dyspnea of Adult Terminally Ill Cancer Patients: A Meta-Analysis

Introduction Dyspnea is often encountered in terminally ill cancer patients and is attributed to multiple factors. The use of fan-on-face therapy is a nonpharmacologic adjunct treatment for adult cancer patients suffering from dyspnea at the end-of-life. This study was done to determine if the use of fan-on-face therapy in addition to the standard of care treatment indeed confers clinical benefit to terminally ill adult cancer patients with dyspnea. Materials and Methods A meta-analysis of randomized controlled trials on the use of fan-on-face therapy in relieving dyspnea among terminally ill adult cancer patients was performed. A computerized search was done in MEDLINE, NICE, CENTRAL, Science Direct, and Google Scholar for relevant articles. Other publications were searched, and authors were contacted for additional information. The primary outcome measure was the mean change in dyspnea score, determined by the Modified Borg Scale, Numeric Rating Scale, or Visual Analog Scale. The secondary outcome was the post-intervention mean change in respiratory rate (RR). Results Four eligible randomized controlled trials of low to moderate risk of bias employed a total of 139 cancer patients. Fan-on-face therapy was effective in decreasing mean dyspnea scores (standard mean difference = −1.81, 95% confidence interval [CI]: −3.12, −0.50, p &lt; 0.00001, I2 93%) and improving mean change in RR (mean difference = −0.91, 95% CI: −1.68, −0.15; p = 0.001, I2 = 81%) versus control. Conclusion Fan-on-face therapy, as an adjunct to standard of care, is effective in alleviating dyspnea among adult cancer patients during the end of life.

Effectiveness of an Instructional Program Concerning Healthy Lifestyle on Patients’ Attitudes after Percutaneous Coronary Intervention at Cardiac Centers in Baghdad City

Abstract:&#x0D; Objective: The study’s aim to evaluate the effectiveness of instructional program about healthy lifestyle on patients’ attitudes after undergoing percutaneous coronary intervention.&#x0D; Methodology: Quasi-experimental design/ has been utilized for the current study starting from December 2018 to March 2020 to achieve the objectives of the study. Non-probability (purposive) sample of 60 patients was divided into intervention and control groups. Data were analyzed by the application of descriptive and inferential statistical methods.&#x0D; Results: findings reported that before intervention both study and control groups demonstrated low total mean of score related to their attitudes respectively (1.10±0.24 and 1.12±0.25). Significant post-intervention high mean score compared with pre-intervention concerning attitudes of healthy lifestyle for intervention group. Attitudes mean scores for post-intervention was (20.04±3.59 (while pre-intervention was (14.40±2.93). It can be clearly concluded that applied instructional program was effective to improve the level of attitudes significantly for the intervention group participants based on study findings.&#x0D; &#x0D; Recommendation: The study recommends specifying a cardiac rehabilitation unit at cardiac centers in Baghdad city to promote healthy lifestyle behaviors for patients after undergoing PCI to improve their quality of life.

Effectivnesss of Physiotherapy Interventions on Stress Urinary Incontinence in Female Dancers

Background: Dancing involves high as well as moderate impact activities, interplay between aesthetic and physical demands which collectively increases intra-abdominal pressure responsible for stress urinary incontinence in female dancers. Practicing Kegel’s and Behavioural Intervention therapy can minimize severity of problem. Objectives: To find out effectiveness of Kegel’s exercises, Behavioural intervention therapy and combination of both on stress urinary incontinence in female dancers using IIQ and Pad test Methodology: Permission was taken from institutional ethical committee. 90 female dancers were assessed using QUID and dancers having stress urinary incontinence aged 18-25 years; practicing since 5 years were selected. Pre intervention evaluation was followed by Kegel’s exercise for Group A, behavioral intervention therapy for Group B and combination of Kegel’s exercise along with behavioral intervention therapy for Group C. Post intervention assessment was carried out. Results: Data was statistically analyzed using Wilcoxon test for within the groups and among the groups by using Kruskal-wallis test. IIQ for group A pre-intervention mean was 5.5± 1.45 and post intervention mean was 4.7±1.04 with p &lt;0.00048, For group B pre-intervention mean was 5.8 ± 1.27 and post 5.1± 1.27 with p&lt;0.003 and For group C pre-intervention mean was 5.9±1.18 and post intervention mean was 4.4±0.85 with p&lt;0.0001 which is very significant, while comparing group A B and C IIQ post values p&lt;0.08812 which is not significant. Pad test for group A pre intervention mean7.3±1.78 was and post intervention mean was 6.4±1.4 with p&lt;0.0001, For group B pre intervention mean was7.5±1.48 and post intervention mean was 6.7±1.44 with p&lt;0.0001, For group C pre intervention mean was7.8±1.47 and post intervention mean was 6.2±1.21with p&lt;0.0001 which is significant while comparing group A B and C Pad test post values p&lt;0.08812 which is not significant. Conclusion: Our study concludes the effectiveness of various Physiotherapy interventions within the groups and all interventions being equally effective.

Effect of Kinesiotaping on Diastasis Recti in Post-Partum Women

Background: Diastasis recti is a separation of rectus abdominis muscles in the midline at the linea alba. Diastasis recti may occur in pregnancy as a result of hormonal effects on the connective tissue and the biomechanical changes of pregnancy.The kinesio taping results shows increased fluid flow through an injured area, better control over muscle contractions, reduced pain, and ultimately faster healing. Methodology: Permission was taken from institutional ethical committee. Subjects were selected by convenient sampling method. Patients were evaluated pre and post for diastasis recti using finger-width test and for disability assessed by using modified oswestry disability index. Result: The analyzed data showed that it was not a normal distribution using shapro -Wilk test hence Non parametric test-Wilcoxon sign rank test was performed to analyze the data within the groups. Diastasis recti of group A above umbilicus level pre-intervention mean was 3.040+0.4643 and post-intervention mean was 0.2350+0.3986. At umbilicus level pre-intervention mean was 3.100+0.3482 and post-intervention mean was 0.2950+0.4026and below umbilicus level pre-intervention mean was 2.435+0.4802 and post-intervention mean was 0.035+0.1466. In group B above umbilicus level pre-intervention mean was 2.965+0.5088 and post-intervention mean was 0.365+0.4542. At umbilicus level pre-intervention mean was 3.215+0.4988 and post-intervention mean was 0.4100+0.4626 and below umbilicus level pre-intervention mean was 2.115+0.5461 and post-intervention mean was 0.1350+0.3397. Comparison between the groups was done using Mann-Whitney U Test above umbilicus p value is 0.0059 which is very significant, at umbilicus p value is 0.9072 which is not significant, below umbilicus p value is 0.1124 which is not significant. Conclusion: Our study shows that kinesio taping with exercise shows greater effect on diastasis recti than only exercises in post-partum women.

Environmental change interventions to prevent unintentional home injuries among children in low- and middle-income countries: A systematic review and meta-analysis.

Unintentional home injury is an important cause of death and disability among children, especially those living in low- and middle-income countries (LMICs). This systematic review aimed to synthesize evidence about the effectiveness of environmental interventions to prevent unintentional child injury and/or reduce injury hazards in the home in LMICs. Seven electronic databases were searched for randomized controlled trials (RCTs) and controlled before and after (CBA) studies published up to 1 April 2018. Potentially eligible citations were screened by title and abstract and full texts of studies obtained. Synthesis was reported narratively, and where possible, meta-analysis was conducted. Four studies met the inclusion criteria: One CBA study reported changes in injury incidence, and three RCTs reported changes in frequency of home hazards. In one study, child resistant containers were found effective in reducing the incidence of paraffin ingestion by 47% during and by 50% postintervention. A meta-analysis of two trials found that home inspection, safety education and safety devices reduced postintervention mean scores for poisoning hazards [mean difference (MD) -0.77; 95% CI [-1.36, -0.19]] and burn-related unsafe practices (MD -0.37; 95% CI [-0.66, -0.09]) but not for falls or electrical and paraffin burn hazards. A single trial found that home inspection and safety education reduced the postintervention mean scores for fall hazards (MD -0.5; 95% CI [-0.66, -0.33]) but not for ingestion hazards. There is limited evidence that environmental change interventions reduce child injuries but evidence that they reduce some home hazards. More evidence is needed to determine if altering the physical home environment by removing potential hazards reduces injuries in LMICs.

Improved patient-reported outcomes after interprofessional training in mental health: a nonrandomized intervention study

BackgroundCollaborative interprofessional practices are essential in caring for people with complex mental health problems. Despite the difficulties of demonstrating positive impacts of interprofessional education (IPE), it is believed to enhance interprofessional practices. We aimed to assess impacts on patient satisfaction, self-reported psychological distress and mental health status in a psychiatric ward.MethodsWe conducted a nonrandomized intervention study with patient satisfaction, psychological distress, and health status as outcomes. Mental health inpatients were referred to either an interprofessional training unit (intervention group) or to a conventionally organized ward (comparison group). Outcomes were assessed using the Short Form Health Survey (SF-36), the Kessler Psychological Distress Scale (K10), and the Client Satisfaction Questionnaire (CSQ-8).ResultsThe intervention group included 129 patients, the comparison group 123. The former group reported better mental health status than the latter; the postintervention mean difference between them being 5.30 (95% CI 2.71–7.89; p = 0.001; SF-36), with an effect size of 0.24. The intervention group patients also scored higher on satisfaction (mean difference 1.01; 95% CI 0.06–1.96; p = 0.04), with an effect size of 0.31. The groups’ mean scores of psychological distress were identical.ConclusionOur results support the hypothesized value of interprofessional training: intervention group patients reported higher scores regarding mental health status and satisfaction than did comparison group patients. As IPE interventions have rarely involved patients and fewer have taken place in practice settings, further research into both the processes and the long-term effects of IPE in mental healthcare is needed.Trial registrationThe study was registered in ClinicalTrials.gov: NCT03070977 on March 6, 2017.

"JUMPing into Diabetes Control": A Group-Setting Self-Empowerment Lifestyle Intervention among Diabetes Patients.

We examined the impact of a group-based self-empowerment intervention among diabetes patients, which uses multidisciplinary education, collaborative learning, peer support, and development of diabetes-specific social capital to improve glycemic control and weight management. Thirty-five patients who had primary care established at the Prisma Health Upstate, Internal Medicine Resident clinic and held the diagnosis of diabetes for longer than one year were recruited for our single-arm pilot intervention. Each group intervention session involved one to two internal medicine resident physician facilitators, a clinical diabetic educator, and 5–10 patients. Each session had a framework facilitated by the resident, with most of the discussion being patient-led, aiming to provide a collaborative learning environment and create a support group atmosphere to encourage self-empowerment. Patients’ hemoglobin A1c level and body mass index (BMI) before the intervention and 3 to 6 months after completion were collected from the laboratory results obtained in the participants’ routine clinic visits. All graduates from this three-week intervention were invited to attend monthly maintenance sessions, and we tracked the HgbA1c measures of 29 JUMP graduates one year after the intervention, even though 13 of the 29 chose not to participate in the monthly maintenance sessions. The pre-intervention HgbA1c level averaged 8.84%, whereas the post-intervention HgbA1c level averaged 7.81%. A paired t test showed that this pre–post difference of 1.03 percentage points was statistically significant (p = 0.0007). For BMI, there was an average decline of 0.78 from the pre-intervention mean value of 40.56 to the post-intervention mean value of 39.78 (p = 0.03). Among the 29 participants who agreed to participate in our follow-up measure of their HgbA1c status one year after the intervention, a paired t test showed that there was no significant difference between the post-JUMP measure and the follow-up measure (p = 0.808). There was no statistically significant difference between the HgbA1c level of those participating in the maintenance program and that of those not participating (post-intervention t test of between-group difference: p = 0.271; follow-up t test of between-group difference: p = 0.457). Our single-arm, pilot study of the three-week group intervention of self-empowerment shows promising results in glycemic control and weight loss. The short duration and small number of sessions expected could make it more feasible for implementation and dissemination as compared with popular intervention protocols that require much longer periods of attendance, if the effectiveness of this patient group-based self-empowerment approach can be further established by randomized controlled studies in the future.

No Intern Left Behind: Using a Dedicated Transition to Discipline Block Improves Resident Outcomes.

This article was migrated. The article was marked as recommended. Introduction: A program was developed for incoming PGY-1 residents using the Accreditation Council for Graduate Medical Education milestones ratings. This program detects critical deficiencies and works to correct them as early as possible. Methods: A one month period was used for this transition to discipline block to identify at-risk learners. The block utilized cased-based discussions, interactive lectures, simulations, and clinical core rotations. All activities were tied to milestones measures to recognize deficiencies and provided a goal to correct the individual's progression. Results: Interns that completed the transition to discipline block were compared to the most recent previous class at the same institution. The same number of individuals with critical deficits were found in each class at first milestones rating (4 deficits per class, p value 1.0). The intervention classes had critical deficiencies recognized earlier and all identified deficiencies were extinguished earlier. Medical knowledge as compared by In-Training Examination percentile scores improved (Pre-Intervention Mean Percentile 28.9, Post-Intervention Mean Percentile 49.5, p value 0.005). Discussion: A milestones-based transition to residency block identified critical deficiencies earlier, which allowed for earlier intervention and improvement in resident performance. A similar process may benefit other residency programs.

Comparing Photovoice to Traditional Reflection to Identify Student Learning on a Medical Mission Trip

Objective. To compare the effectiveness of photovoice with traditional reflection as a methodology to identify student learning during an international advanced pharmacy practice experience (APPE). Methods. Over seven years, seven cohorts of two to three pharmacy students completed an APPE in which they participated in a medical mission trip to Guatemala. Cohorts were assigned to use either photovoice or traditional reflection techniques to identify and document their learning. After returning from the mission trip, a focus group was conducted with each cohort of students. Students' comments were audio-recorded and the audio recording was transcribed and the text was qualitatively analyzed. In addition, all students completed the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals (IAPCC-SV) before and after travel. Results. All 18 students who participated in the mission trips, (nine in each group) agreed to participate in the study. Several themes were identified when the transcripts of the focus group sessions were reviewed. Students in both groups emphasized learning about the enhancement of pharmacy skills, cultural appreciation, and self-examination in their reflections. However, students in the photovoice group emphasized three additional areas that were not emphasized by students in the traditional reflection group: emotional impact, critical reflection on privilege, and ethical distribution of health resources. Students' post-intervention mean scores on the IAPCC-SV increased more for the photovoice group (8.5 points) than the reflection group (6.8); however, this difference was not significant. Conclusion. Students who used photovoice focused more on the connection between their learning and emotional or moral experiences than did students who used traditional reflection techniques. Photovoice may represent a promising methodology for deeper reflection into affective learning domains because of students' connection between visual images and their lived experiences.

Implementation of a wound care education project to improve the wound care competency among psychiatric nurses: A quality improvement project and feasibility study.

WHAT IS KNOWN ON THE SUBJECT?: Compared to the general population, people with mental illness die several years prematurely. The prevalence of chronic physical illnesses such as diabetes and cardiovascular disease is higher in people with mental health illnesses, putting them at increased risk of developing skin wounds. The majority of the studies on wound care education and management were carried out in acute care and long-term care settings. A very few addressed the wound care needs for psychiatric patients and the educational needs of nurses in the mental health setting. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study adds to the existing evidence by offering an evidence-based solution to equip Psychiatric and Mental Health Nurses (PMHNs) with the necessary knowledge and skills to provide high-quality wound care to patients. When a lack of wound care competency has been identified, it may be worth the effort to provide education and training to psychiatric nurses on wound care management. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This project has the potential benefit of healthcare cost savings, which can be further investigated in a future study, for instance, a pilot randomized controlled trial to estimate the parameters for a full-trial and cost-effectiveness study. Future mental health nursing practice and research need to focus on finding solutions to help support PMHNs improve their competence in caring for physical illnesses. ABSTRACT: Introduction People with mental illnesses are at increased risk of developing skin wounds. A very few studies addressed the wound care needs for psychiatric patients and the educational needs for psychiatric and mental health nurses (PMHNs). Aim A wound care education-feasibility and quality improvement project-was implemented to improve wound care competence among nurses on the Seniors' Mental Health Units at a psychiatric hospital. Methods A total of 36 nurses participated in wound care knowledge education and completed both the pretest and post-test. Four nurses participated in wound care skills training. Results The post-intervention mean score increase for wound care knowledge was 5.14 (178%) and for skills was 7(75.7%). The results were statistically significant (p<.001). Discussion This study adds to the existing evidence by offering an evidence-based solution to equip PMHNs with the necessary knowledge and skills to provide high-quality wound care to patients. Implications for Practice and Research Future mental health nursing practice and research need to focus on finding evidence-based practical solutions to help support PMHNs improve their ability to care for physical illnesses. A future pilot randomized controlled trial will be needed to estimate the parameters for a full-trial and cost-effectiveness study.

Effect of Comprehensive Pain Management Training Program on Awareness and Attitude of ICU Nurses.

BackgroundPain is one of the main complaints of many patients in intensive care units. However, most nurses and physicians are unable to properly monitor and relieve pain in these patients. Factors such as patients' inability to describe their pain and insufficient knowledge of nurses and physicians have made pain management difficult. Given that the knowledge and attitude of nurses play an important role in the effective implementation of the pain management process, this study aimed to investigate the effect of comprehensive pain management training program on the awareness and attitude of intensive care unit nurses.MethodsThis quasi-experimental single-group study was conducted in two phases (pre and post-intervention) to investigate the awareness and attitude of all nurses employed in the intensive care unit of Tehran Modarres Hospital, based on the determined inclusion and exclusion criteria. In the pre-intervention phase, the awareness and attitudes of the nurses were assessed using a questionnaire. After conducting the pain management training course, an executive program and algorithm were implemented for pain management in ICUs. Then, the nurses’ awareness and attitude toward pain management were assessed again. Finally, changes in the scores of the nurses’ awareness and attitude were analyzed by SPSS V. 22 software in two phases before and after applying the interventions using the Wilcoxon test. The relationship between some demographic variables and the level of awareness and attitude of nurses was also investigated using the Kruskal-Wallis and Mann-Whitney tests.ResultsThe results of this study indicated that the mean score of the nurses’ awareness was significantly different in pre- and post-intervention phases (P < 0.05). Despite an increase in the post-intervention mean score of the nurses’ attitude (71.03), no statistically significant change was observed. Additionally, among the demographic variables, there was only a significant relationship between the nurses' job experience in ICUs and their attitudes.ConclusionsBased on the results of this study, teaching and implementing a comprehensive program for pain management can play an effective role in promoting the nurses’ awareness. Therefore, it is proposed to use pain management models to improve the nurses' knowledge and attitude toward pain management in ICU patients.