Posttest Period Research Articles

Effect of a dementia education intervention on the confidence and attitudes of general practitioners in Australia: a pretest post-test study

ObjectivesThis study assessed the impact of a Dementia Education Workshop on the confidence and attitudes of general practitioner (GP) registrars (GPR) and GP supervisors (GPS) in relation to the early...

Effectiveness of Spirituality Therapy on Social Stigma and Worry in the Mothers of the Children with Autism

Background: The children’s acute and chronic psychological and physical diseases cause their mothers’ mental health. Therefore, the objective of the present study was to investigate the effect of spirituality therapy on social stigma and worry in the mothers of the children with autism. Methods: It was a quasi-experimental study with pretest, posttest, control group and two-month follow-up period design. The statistical population included the mothers of the children with autism visiting the autism centers in the city of Isfahan in the last three months of the lunar year 1396. Convenient sampling method and random replacement were used in the present study in a way that 40 mothers were selected from the ones with children with autism and they were randomly replaced into experimental and control groups (20 in each group). The experimental group received eight ninety-minute sessions of spirituality therapy interventions during two months. The applied questionnaires included Social Stigma Questionnaire and Worry Questionnaire. The data of the study were analyzed through repeated measures ANOVA and SPSS 23. Results: Results showed that spirituality therapy has influenced social stigma (f = 18.81, P < 0.0001) and worry (f = 24.84, P < 0.0001) in the mothers of the children with autism. Conclusion: According to the findings of the present study, it can be concluded that spirituality therapy using techniques such as knowing values and deep belief in God can decrease social stigma and worry in the mothers of the children with autism.

The Daily Mile: 15 Minutes Running Improves the Physical Fitness of Italian Primary School Children.

The Daily Mile™ is an innovative school-based intervention that requires children to run or jog outside for 15 min at a self-selected pace during class time. Today, only one study has investigated the efficacy of The Daily Mile on physical fitness, which was conducted with Scottish children. Thus, we aimed to evaluate the feasibility and effectiveness of The Daily Mile in Italian primary schools. A total of 486 children participated in The Daily Mile for 3 months (experimental group), whereas 309 children continued their daily school routine (control group). The 6-min run test, standing long jump, body mass index, and waist-to-height ratio were assessed. Their teachers completed surveys for assessing the intervention acceptability. After correction for age and gender, significant group × time interactions were observed in the 6-min run test and standing long jump results. In the post-test period, the experimental group showed improvement in the 6-min run test and standing long jump results. Overall, the teachers were satisfied with the program and found it suitable for their school context and easy to implement. The Daily Mile was successfully implemented and smoothly accepted in the day routine of Italian primary schools.

EP.85Exploring the trainability of working memory and learning in Duchenne muscular dystrophy using computerized memory training

Duchenne muscular dystrophy (DMD) is an X-linked recessive disease caused by gene mutations, leading to an absence of dystrophin protein isoforms in various tissues including the brain. A lack of dystrophin isoforms in the brain is hold responsible for the cognitive abnormalities in DMD. Especially, working memory problems and learning difficulties are frequently described in DMD, and these are known to have a major influence on academic achievement throughout childhood and adolescence. Previous research in the general population suggests that working memory problems and learning difficulties are trainable by memory programs. Positive and long-lasting results have been described particularly for the computerized Jungle memory program in children and adolescents with ADHD or learning difficulties. The current study aimed to assess the trainability of the dystrophin-associated working memory problems and learning difficulties in five male patients (age range = 10 – 16 years) with DMD, using the computerized Jungle memory program. A single case experimental design (SCED) with an A (non-intervention) B (intervention) A (non-intervention) withdrawal method was used. The study consisted of distinct phases. At baseline (week 0 to 3), patients underwent a short neuropsychological assessment and received psycho-education on working memory problems. Hereafter, the intervention program commenced based on randomization outcomes. At post-test (1 to 3 weeks after the intervention), and at 3 and 8 months follow-up patients repeated the baseline neuropsychological battery. Additionally, a weekly questionnaire on working memory problems was completed by parents throughout the baseline, intervention, and post-test period. Weekly administration outcomes of parents will be assessed by Tau-U analyses for SCED and outcomes of the neuropsychological assessments by reliable change index analyses (RCI). Preliminary results will be presented.

Effect of different recovery periods during a high Intensity Training (HIT) session on some hematologic factors and Muscle Damage in active males

Background: Recovery periods during intense exercise cause changes in blood flow, such as hematologic factors and Muscle Damage. The aim of present study was to evaluate the effect of different recovery in an high intensity training session changes of platelets, white blood cells and creatine kinase serum before, immediately after and two hours after exhaustive exercise in healthy active men. Methods: In this stude, 24 healthy men (Age: 21/07± 1/57, weight: 68/41± 11/75, body fat percentage: 15/93± 6/11 and VO2max: 41/83± 5/87) were selected and randomly divided into three groups including: control, aerobic and stretching PNF recovery were studied. The blood samples were collected from anticubital venous in at pre-test, post-test and follow up. To measure the platelets and white blood cells values, Flowcytometry and equipment Mindray BC-5800 and to measure creatine kinase serum values ELISA technique was used. And to identify significant the data for the analysis of variance with repeated measures with Bonferroni post hoc tests at a significance level of α=0.05 was used. Results: There was a significant difference about the amount of platelets, white blood cells and creatine kinase serum in different periods of pre-test, post-test and follow-up revealed(P<0.001). The Bonferroni Post-hoc test results showed a significant difference in the control group between post-test and follow-up(P<0.05), in the PNF group between pre-test and post-test(P<0.05) and post-test and follow-up(P<0.01) and in the aerobic group between pre-test and post-test(P<0.001) and post-test and follow-up periods(P<0.01). Bonferroni post hoc test creatine kinase serum results, showed significant differences between the control group post-test and follow-up(P<0.05), PNF group between pre-test and post-test periods(P<0.05) and post-test and follow-up (P<0.01). Conclusion: There was no effect of aerobic recovery and PNF stretching at rest in a HIT training session on platelets, white blood cells and creatine kinase is, but a change in values before and after training in each group. The advantage of active and passive recovery for changes in some hematological values and no Muscle Damage after an intense training. Keyword: PNF Stretching, Exercises HIT, Platelets, White Blood Cell, Creatine Kinase Serum, Active Males

Effects of Physical Exercise on Body Composition and Resting Blood Pressure among Patients with Uncontrolled Hypertension

Background: Hypertension is one of the major public health challenges worldwide because of its high prevalence and concomitant risk of cardiovascular and cerebrovascular morbidity and mortality. Different studies indicate that majority of the peoples died in sub-Saharan Africa with heart failure and stroke as the result of high blood pressure. Excess body fat, especially upper body fat is associated with enhancing the frequency of hypertension occurrence. The aim of this study was to evaluate the outcomes of physical activity on changes of body composition and resting blood pressure among sedentary hypertensive patients, as an effective non-pharmacological alternative means of control and prevention of hypertension. Methods: Experimental design was employed to measure the effects of physical activity on body composition among sedentary hypertensive patients. Thirty (30) hypertensive adult participants were selected. Before and after the intervention, participants’ mean arterial pressure, body weight, percentage of body fat, waist and hip circumferences were measured for each subject in experimental and control group. Results: The current findings demonstrated a greater change of body weight, percentage of body fat, and mean arterial pressure between pre and post measurements in the experimental group (Body weight pre 87.0 + 7.26 kg, Body weight post 83.73 + 7.74 kg; Mean arterial pressure pre 123.7 + 3.76 mm Hg, Mean arterial pressure post 120.2 + 4.39mm Hg; and Body fat percentage pre 40.16 + 1.13 %, Body fat percentage post 38.44 + 1.15 %). Among the control group however, all these measurements spontaneously increased significantly (p&lt;0.0005) from pre to posttest period. Conclusion: The results of this experimental study revealed that regular physical exercise is an effective alternative control of hypertension among sedentary hypertensive patients, as evidenced by significant decrease in body composition parameters and resting blood pressure from baseline (pretest) to post intervention period.

Structured teaching programme enhances the knowledge of mothers to take care of children with leukaemia

We assumed that the parents of children who are undergoing treatment for leukaemia experience practical challenges in taking care of the side effects of chemotherapy. In this study, the effectiveness of a structured teaching programme on knowledge about home management of chemotherapy side effects among parents is determined. Furthermore, the study also aimed at finding an association between the pre-test knowledge score of parents and selected baseline information of subjects as well as children. A quantitative, experimental research approach was used to assess the effectiveness of a structured teaching programme on enhancement of mothers’ knowledge about childcare for leukaemic children in the Cancer Research Institute, Sri Raghvendra Hospital, India. A teaching intervention was given, and in the post-test period the same structured knowledge questionnaire was used. Practise was assessed using the interview method by direct observation. Post-intervention, the education of the mother and sex of the child were significantly associated with the knowledge and practise of mothers regarding their care of children with leukaemia. Before the intervention, many more mothers had inadequate and moderate knowledge than had adequate knowledge. The study found that the total number of mothers with moderate and adequate knowledge increased significantly. Overall, the mean knowledge score increased significantly to 18.75 after the intervention. From the study results, it can be concluded that a structured teaching programme on knowledge about home management of chemotherapy side effects was found to be effective in increasing the knowledge among parents of children who receive chemotherapy.

The Effect of Nurse-Led Diet and Physical Activity Program for Health on Diet and Physical Activity Behavior of Children.

Many health problems encountered in childhood, adolescence, and adulthood periods arise from problematic eating behavior, an unhealthy dietary approach, and inactive lifestyles. The aim of this study was to determine the effect of the Diet and Physical Activity Program for Health, under the leadership of a nurse, on the dietary and physical activity behaviors of children. This study was planned in a quasi-experimental design with pretesting, posttesting, follow-up testing, and a control group. The study was conducted with 114 students in 2 schools. A total of 12 hours of training was given to the experimental group for 6 weeks. Institutional permission required for performing the study and an ethical consent from the commission for clinical trials of Marmara University institute of health sciences were received. The results of the study reveal that Diet and Physical Activity Program for Health in posttest and follow-up periods was effective in improving dietary and physical activity behaviors of children within the program. However, the program's effect on dietary and physical activity self-efficacy was limited. The results of the study indicate that this program was effective in development of children's behavior regarding diet and physical activity.

The Effect Of Comprehensive Coordination Training On Children's Cognitive Function

PURPOSE: The aim of this study was to investigate the impact of comprehensive coordination training on children's cognitive function by adding two extracurricular exercises per week. METHODS: A sample of 120 children aged 7-9 years old who participated in the "MQ101" program were randomly divided into two groups. The experimental group consisted of 58 people and the control group of 62 people. The experimental group participated in extracurricular comprehensive coordination training for 12 weeks, 2 times a week, and 1 hour each time. The control group did not participate in specialized training courses (not limiting students' self-exercise). The height, weight, 50-meter run, Body Comprehensive Coordination Test (BCCT) and the Eriksen Flanker test were tested in the pre-post experiment. The independent sample T-test and factor analysis were used to analyze the change values between the experimental group and the control group. RESULTS: The two groups had no significant demographic differences in age, gender, height, weight, physical fitness tests or BCCT before the experiment. After the experiment, height, weight, and 50-meters-run had significantly changed in two groups (p<0.05). However, regarding a body comprehensive coordination test, only the experimental group has significant differences before (29.75± 6.75) and after (32.80± 5.21) the experiment (p<0.05).The results of Flanker test indicated that the post-test period had a higher accuracy rate in both congruent (95.27 % ± 9.76) and incongruent (91.03 % ± 6.97) trials compared with those in the pre-test period (84.7% ± 10.29 and 73.69 % ± 7.79, respectively) in the experimental group. Additionally, no significant differences were found in the reaction time between the experimental group and the control group. CONCLUSIONS: Comprehensive coordination training has a great impact on the development of children's coordination skills. In addition, behavioral testing results also suggest that coordinative training may specifically benefit prefrontal-dependent tasks in the immature brain state of children aged 7-9 years old by increasing the allocation of attention resources and enhancing the efficiency of neurocognitive processing. (This study was supported by NPOPSS Grant 15CTY011.)

Incorporating Perioperative Point-of-Care Ultrasound as Part of the Anesthesia Residency Curriculum

The purposes of this study were to establish whether implementing a curriculum of perioperative point-of-care ultrasound (POCUS) of the heart and lungs for current in-training anesthesia residents during their required month of cardiac anesthesia was feasible and whether an evaluation tool would demonstrate improvement in the residents' baseline knowledge of POCUS. Single-center, prospective, cohort, and observational study. A tertiary-care, university-affiliated hospital. The study comprised 16 anesthesia residents on their third postgraduate training year during their required cardiac anesthesia rotation. The implementation of a curriculum to educate anesthesia residents in perioperative POCUS of the heart and lungs on patients undergoing elective cardiothoracic procedures that included both theoretical and practical approaches. A 21-question, multiple-choice, electronic-generated test was developed to gauge performance improvement from before ("pretest") to after ("posttest") the 4-week period. Of the 16 residents, 13 (81.3%) showed improved scores between the pretest and posttest periods after the 4-week rotation. The difference between pretest and posttest mean score was 5 (p = 0.001). This study demonstrates that integrating a curriculum dedicated to perioperative POCUS of the heart and lungs as part of the goals and objectives during the rotation of cardiac anesthesia is feasible and that anesthesia residents who received the training proposed by the authors improved their cognitive and technical skills.

Behavioral indicators associated with experimental pain in schizophrenia or major depression: A pilot study

Background and objectivesPain is a subjective experience which is assessed verbally. However, the quality of verbal expression is often questioned and/or altered for subjects with a psychiatric disorder, thus complicating access to care and pain relief with a deny of their pain. Our aim was to search for obvious behavioral signs of pain feeling in subjects with schizophrenia (SC) or major depression (MD). MethodsSixteen MD, 17 SC, and16 disease-free participants were video-recorded during an experimental session comprised of an interview (baseline), pain test, and post-test period. Several non-verbal behavioral indicators were analyzed during the session and compared between the disease and control groups. ResultsSome behavioral indicators were more frequent during the pain tests than during the other periods, independently from the group. ConclusionHetero-evaluation scales for conventional pain rating should be completed by the observation of these discreet behavioral indicators of pain during painful situations. Their observation during medical examination of painful points will ensure the feeling of pain, and avoid a deny of the pain feeling for psychiatric patients.

Implementation of a nurse-driven ventilation weaning protocol in critically ill children: Can it improve patient outcome?

BackgroundCritically ill children treated with invasive mechanical ventilation in a paediatric intensive care unit (PICU) may suffer from complications leading to prolonged duration of ventilation and PICU stay. ObjectiveThe objective of this study is to find out if the use of a nurse-driven ventilation weaning protocol in a PICU can shorten the duration of mechanical ventilation. MethodsIn a prospective, pretest–posttest implementation study, we implemented a nurse-driven ventilation weaning protocol and compared its outcomes with those of the usual physician-driven weaning. In the posttest period, nurses weaned the patients until extubation as per this protocol. The primary outcome was duration of ventilation. The secondary outcomes were length of PICU stay, reintubation rate, and compliance with the protocol (measured by use of the prescribed support mode). ResultsIn total, 424 patients aged from 0 to 18 years (212 pretest and 212 posttest) were included; in both groups, the median age was 3 months. The median duration of ventilation did not differ significantly between the pretest and posttest periods: 42.5 h. (interquartile range, IQR 14.3–121.3) vs. 44.5 h (IQR 12.3–107.0), respectively; p = 0.589. In the posttest period, the PICU stay was nonsignificantly shorter: 5.5 days (IQR 2–11) vs. 7 days (IQR 3–14) in the pretest period; p = 0.432. Compliance with the prescribed support mode was significantly higher in the posttest period: 69.9% vs. 55.7% in the pretest period; p = 0.005. The reintubation rate was not significantly different between the pretest and posttest periods (5% vs. 7%, respectively; p = 0.418). The extubation rate during nights was higher in the posttest period but not significantly different (p = 0.097). ConclusionsImplementation of a nurse-driven weaning protocol did not result in a significantly shorter duration of invasive mechanical ventilation but was safe and successful. The reintubation rate did not significantly increase compared with usual care.

Effectiveness of Positive Psychology in Improving the Quality of Married Women’s Life: Spiritual Intelligence as a Moderator

The objective of this study was to investigate the effect of training in positive psychology on quality of married women’s life referring to family centers in Isfahan, Iran. It was also taken into account the moderating effect of spiritual intelligence using a quasi-experimental method by selecting two groups (an experimental group and a control one) with pretest, post-test, and a follow-up stage. The population of interest comprised of all married women seeking family counseling throughout the Isfahan city. Thirty (30) people from the above population were selected using the convenience sampling method. Then these people were randomly divided into two groups of fifteen (15), which one was called experimental and the other one control group. The research tools used for this study included the WHO’s 26-question questionnaire on quality of life (1998) and King’s 24-question questionnaire on spiritual intelligence (2008). A training course on positive psychology was held for the experimental group. This course consisted of ten sessions by weekly and each session was 90-minutes. The control group did not participate in any training sessions. Findings from covariance analysis revealed that training for positive psychology had significant effect on increasing married women’s quality of life in the post-test period (p < .05). However, this observation was not seen during follow-up period. Likewise, the spiritual intelligence as a moderating variable was found to increase the degree at which conducting training on positive psychology affected the quality of life among married women within post-test and follow-up stages (p < .05).

Effects of a moderate-intensity aerobic exercise programme on the cognitive function and quality of life of community-dwelling elderly people with mild cognitive impairment: A randomised controlled trial

BackgroundIndividuals with mild cognitive impairment have a heightened risk of developing dementia. Physical exercise, especially moderate-intensity aerobic exercise, is a promising lifestyle intervention to improve the cognitive function of this patient group. However, the mechanisms underlying the exercise–cognition relationship are not fully understood. Whether the cognitive benefits of physical exercise can improve the overall well-being of this group remains unknown. This study aims to address these research gaps in the under-researched Chinese population. ObjectivesThis study aimed to evaluate the effects of a moderate-intensity aerobic exercise programme on the cognitive function and health-related quality of life of Chinese elderly with mild cognitive impairment and to explore the mediating roles of depressive mood and sleep quality in the exercise–cognition relationship. DesignA single-blinded randomised controlled trial. Settings and participantsThis study was conducted in two urban community healthcare centres in Hangzhou City, China. Elderly people aged over 60 years screened with mild cognitive impairment were included. MethodsA total of 120 eligible participants were randomly assigned to receive either the group-based moderate-intensity aerobic exercise programme or the health education programme (as attention–placebo control). Montreal Cognitive Assessment, Quality of Life-Alzheimer’s Disease, Geriatric Depression Scale and Pittsburgh Sleep Quality Index were administered at baseline before randomisation and immediately after the completion of the interventions. Analysis followed the intention-to-treat principle. Generalised estimating equation was used to compare the changes in the cognitive function and health-related quality of life over the pre-test and post-test periods between the groups. The mediating roles of depressive mood and sleep quality in the exercise–cognition relationship were examined with the PROCESS macro. ResultsParticipants in the intervention group had a significantly greater improvement in terms of cognitive function (β = 1.895; 95% confidential interval [CI] = 1.421, 2.368; p < 0.001) and health-related quality of life (β= 0.605; 95% CI= 0.295, 0.914; p < 0.001) compared with the control group over the pre-test and post-test periods. The exercise–cognition relationship was significantly mediated by reduced depressive symptoms (indirect effect: β= −0.705; 95% CI: −1.028, −0.382) and improved sleep quality (indirect effect: β=−0.205; 95% CI: −0.122, 0.831). ConclusionsThis study revealed the benefits and outlined the underlying mediating mechanism of an aerobic exercise programme to the cognitive function and health-related quality of life of Chinese elderly people with mild cognitive impairment. The findings provided insights into the development of public health initiatives to promote brain health amongst the elderly with mild cognitive impairment.

Do family health conversations impact patients with glioblastoma multiforme and their family members?

To assess the impact of family health conversations (FamHC) as a supplement to conventional care on health-related quality of life (HRQoL), family functioning (FFSS) and family hardiness or resilience (FHI) 4 and 14weeks postoperatively among patients with glioblastoma multiforme and their family members. There is a lack of knowledge about the efficiency of FamHC among families experiencing glioblastoma multiforme. A quasi-experimental pre- and post-test design adhering to the STROBE (Strengthening the reporting of observational studies in epidemiology) guidelines for case-control studies. Patients and family members were included consecutively in the pretest period from November 2013-December 2014 for the control group (offered traditional care only), and in the post-test period from January 2015-December 2015 for the intervention group (offered traditional care and FamHC). For both groups, 4 and 14weeks postoperative measurement were obtained. Differences in outcomes were assessed using a difference-in-difference regression analysis approach measuring difference across pre and post groups and across 4 and 14weeks measurements. The study does not reveal significant effects of FamHC (all p-values larger than 0.05) as measured by the three instruments WHOQOL-BREF, FFSS and FHI. The present study was not able to show significant effects of FamHC. However, it cannot be left out that the intervention might be helpful and supportive at a later state of the illness trajectory. The study adds to the growing evidence-based knowledge on FamHC by questioning their potential use in different cultural contexts among families experiencing critical illness. Oncological nurses need to adapt this information to support their daily care for the patients and their close relatives. For future studies, it is recommended that the families themselves choose when the conversations should take place during the course of the illness.

Virtual offender: a pilot project on nurturing social work students’ capacity to work with offenders

ABSTRACTAlthough considerable literature conducted in the context of Western societies has concluded that the use of virtual reality (VR) technology can facilitate students’ learning, the applicability of this learning approach to nurturing social work students in the Chinese context remains uncertain. This pilot study empirically tests the effectiveness of VR technology in enhancing social work students’ perceived creativity and competence in working with offenders. The study uses mixed methods that include qualitative and quantitative procedures in a complementary manner. Survey data that capture the responses of 41 social work students collected in the pre-and post-test periods indicate a positive change in self-perceived confidence in handling offenders following the VR training session. The qualitative data generated from the focus groups echo the survey findings and provide insights into the use of VR technology in social work education. Issues and implications for innovative education in the social work profession are discussed.

The impact of maximal strength training on quality of life among women with breast cancer undergoing treatment.

55BC patients with disease stage I-III were randomized into a training group and control group. The training group performed maximal strength training twice a week for 3months, whereas the control group followed prescribed treatment without strength training. Overall quality of life was measured by The European Organization for Research and Treatment of Cancer Core Quality of life Questionnaire-C30 and additional BC module BR23before and after the intervention. The results obtained from pre-tests and those obtained after 3months of intervention revealed that patients in the training group significantly increased one repetion maximum, by 20.4kg (20%) (p=0.001, d=0.9). Simultaneously, statistically significant alterations were observed in this variable for the control group, one repetition maximum decreased by 8.9kg (9%) (p = 0.001, d = 0.5). The overall quality of life improved significantly by 13% for the training group with large effect (p = 0.002, d = 0.6), but no relevant changes were observed in the control group (p = 0.44, d=0.2). Results revealed remarkable changes in overall quality of life after 3-month post-test period between the two groups with large effect (p = 0.002, d = 0.9). The training sessions had helped in diminishing the sense of fatigue by 24% (p = 0.03, d = 0.6), while it had got worse by 25% (p = 0.02, d = 0.4) for the control group. Again, the data on large effect were noticed to differ between the groups (p = 0.01, d = 0.6). Maximal strength training for BC patients was well tolerated, safe and feasible and showed strength improvements that led to improved muscle strength and improved overall quality of life. These data certainly support the therapeutic role for maximal strength training in the treatment of BC.

Mapping and Sustaining Leadership Development: An Innovation Academic Service Partnership.

To improve leadership competency, academic and clinical partners planned and implemented a 2-day facilitated workshop that actively engaged nurse leaders in preparing for their current and future careers by focusing on "The Leader Within." We anticipated that an emphasis on this particular dimension of leadership, that is, knowing oneself, would lead to improvements in the science and the art of leadership among nurse managers (NMs) and assistant NMs (ANMs). Using the Nurse Manager Skills Inventory (NMSI), we conducted precompetency and 8-month postcompetency surveys and interviews. Although 41 nurses completed the pretest, only 17 completed the posttest. The sample of 50% NMs and 50% ANMs had an average age of 38.4 (SD, 8.2) years' and 8.2 (SD, 6.3) years' experience. Self-rated leadership competency scores were improved at the 8-month posttest period on all NMSI sections: the Science, the Art, and the Leader Within. Actively cultivating "The Leader Within" facilitates reflective practice that may lead to more deliberate leadership competency attainment and career planning.

Passive standing tests for the office diagnosis of postural tachycardia syndrome: New methodological considerations

ABSTRACT Background: Passive standing tests are a first-line, practical means of assessing individuals with chronic orthostatic symptoms. Purpose: To identify the proportion reaching heart rate (HR) criteria for postural tachycardia syndrome (POTS) during a 10-minute passive standing test (PST) if measurement of the lowest supine HR incorporated a 2-minute period of post-test monitoring, rather than being restricted to the 5-minute pre-test values only, and to determine the proportion whose POTS would be missed by shorter periods upright. Methods: Consecutive individuals ≥ 12 years from 2008 to 2017 who presented with chronic fatigue or lightheadedness and whose PST met criteria for POTS. Results: Of the 93 enrolled (70% female, median age 17 years), the mean (SD) HR was higher in the 5 min supine before the 10 min upright than in the 2 min supine afterwards (67.6 [10.0] vs. 65.7 [10.9]; P = 0.01). Thirteen (14%; 95% CI, 7–21%) satisfied HR criteria for POTS using the supine HR from only the post-test period. The median time to reaching the HR criteria for POTS was 3 min. Of those reaching HR criteria, 53% (95% CI, 43–63%) would be missed by a 2-minute and 27% (95% CI, 19–37%) by a 5-minute test. Interpretation: More adolescents and young adults are diagnosed with POTS during a 10-minute PST when the definition of their lowest supine HR includes a 2-minute post-test measurement along with the conventional pre-test measure. A full 10 min of standing is required to avoid underdiagnosing POTS in both clinical and epidemiologic studies.

Evaluation of a multimodal teaching method on essential newborn care among health providers at a tertiary care hospital

BackgroundThere is an unmet need for in-service training of health providers for essential new-born care. This study evaluated the ability of a multi-modal training workshop on new-born care to improve the knowledge and skills of health providers. MethodsThis was an intervention based pre-and post-study on 54 students who attended a two-day workshop on essential new-born care. The teaching used self-directed learning, demonstration, videos, webinars, podcasts, group discussion, role-play and individual feedback. Knowledge was assessed by a set of 25 peer-reviewed multiple-choice questions (MCQs), both pre-and post-test and skills by 3 peer-reviewed and validated objective structured clinical examination (OSCE) stations in the post-test period. Follow-up assessment after 10 months was also done for 30 students. ResultsThere was a significant improvement in the knowledge scores on MCQs after the workshop [16.65 ± 1.84 vs 12 ± 2.98, mean difference 4.65, 95%CI (3.85 to 5.44); p value < 0.0001]. The skill scores assessed by the OSCE were 92.35%, 83.50% and 78.86% of the expected scores respectively with a composite OSCE stations score of 83.90% of the expected score (100%). Follow-up assessment after 10 months showed a significant decline in knowledge scores, though skill scores were retained. ConclusionAn essential new-born care workshop using multi-modal teaching methods resulted in an improvement in knowledge and skill scores among a diverse mix of nurses and doctors. This model of learning was acceptable and can be adapted for future training of health providers. There is a need for regular refresher training to maintain knowledge and skills.