Pre-intervention Mean Research Articles

Application of Standardized Antimicrobial Administration Ratio as a Motivational Tool within a Multi-Hospital Healthcare System.

The standardized antimicrobial administration ratio (SAAR) is a novel antimicrobial stewardship metric that compares actual to expected antimicrobial use (AU). This prospective cohort study examines the utility of SAAR reporting and inter-facility comparisons as a motivational tool to improve overall and broad-spectrum AU within a three-hospital healthcare system. Transparent inter-facility comparisons were deployed during system-wide antimicrobial stewardship meetings beginning in October 2017. Stakeholders were advised to interpret the results to foster competition and incorporate SAAR data into focused antimicrobial stewardship interventions. Student’s t-test was used to compare mean SAARs in the pre- (July 2017 through October 2017) and post-intervention periods (November 2017 through June 2019). The mean pre-intervention SAARs for hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Hospital B experienced significant reductions in SAAR for overall AU (from 1.09 to 0.83; p < 0.001), broad-spectrum antimicrobials used for hospital-onset infections (from 1.36 to 0.81; p < 0.001), and agents used for resistant gram-positive infections in the intensive care units (from 1.27 to 0.72; p < 0.001) after the interventions. The alignment of the SAAR across the health-system and sustained reduction in overall and broad-spectrum AU through implementation of inter-facility comparisons demonstrate the utility in the motivational application of this antimicrobial use metric.

Effect of Short Term Resistance and Endurance Exercise Training on Resting Heart Rate and Inflammatory Marker in Young Adults: A Cross-sectional Study

Introduction: In a normal healthy adult, sympathetic and parasympathetic system should be in synergy. Measuring resting heart rate is a one of the methods to assess health condition. It can be affected by different factors such as exercise, mental health, any disease, etc. Normal subjects with reduced heart rate are associated with better cardiovascular health. Physical inactivity is associated with high level of inflammatory markers. Increased inflammatory markers are related to inflammation and chronic diseases. The C-Reactive Protein (CRP) is a biomarker of inflammatory diseases. High CRP level is a potent risk factor for obesity, diabetes, atherosclerosis, etc. Aim: To study the effect of short term resistance and endurance exercise training on resting heart rate in healthy young adults, CRP, Body Mass Index (BMI) and also to compare the changes between two exercise groups. Materials and Methods: A cross-sectional study was conducted from May 2019 to May 2020 in the Department of Physiology at King George’s Medical University, Lucknow, Uttar Pradesh, India. The study included 60 healthy young adults with normal BMI (18.5-24.9 kg/m2) and age between 18-25 years. Subjects were equally divided into Group I- Resistance exercise and Group II endurance groups. Subjects did moderate intensity exercise (based on maximum heart rate) for five days in a week for eight weeks. Endurance group did jogging. Resistance group did push-up, pull-up and squats. Target heart rate during moderate intensity of activities was 64-76% of maximum heart rate. Heart rate measurement was done before the start of exercise and after five to seven minutes of exercise when it reached 64-76% of maximum heart rate. It was measured by pulse oximeter. Follow-up was done after eight weeks of exercise training in both the groups. Evaluation was done by comparing resting heart rate and CRP level before the start of training and after the completion of training programme. Statistical analysis was done using student t-test and paired t-test. Results: Mean age of subjects of group I was found to be higher (19.98±1.26 years) as compared to group II (19.97±0.98 years). Mean pre intervention BMI of both the groups was found to be similar (21.97±1.78 kg/m2). No statistically significant change in resting heart rate was found in both resistance group (p=0.096) and endurance group (p=0.326) after exercise training. Statistically significant increase in CRP was found in resistance group (p&lt;0.001) and endurance group (p&lt;0.001). The increment in CRP was more in endurance group (55.04%) than resistance group (35.34%). Conclusion: Short duration of exercises increase inflammation but no significant effect on resting heart rate was seen.

Dermoscopic Lotus of Learning: Implementation and Dissemination of a Multimodal Dermoscopy Curriculum for Primary Care.

Dermoscopy is a cost-effective tool for detection of skin cancers yet there is limited training available for primary care. The goal of this project was to develop, implement, and disseminate a multimodal curriculum for primary care across a health system based on a previously validated algorithm (Triage Amalgamated Dermoscopic Algorithm; TADA). This cross-sectional study analyzes the dermoscopy workshop intervention of a dermoscopy multimodal curriculum. Volunteers attended one 120-minute dermoscopy workshop on benign and malignant growths using a validated algorithm. Participants took a 30-image pre- and posttest. Survey questions on dermoscopy use, preferences for learning, and skin biopsy performance were included to enhance curriculum development. About 96 participants completed both pre- and postintervention tests. The mean preintervention score (out of 30) was 18.6 and increased to 24.4 on the postintervention evaluation. There was a statistically significant improvement in scores for both benign and malignant skin growths after the intervention (P < .05). Short dermoscopy workshops have a positive intervention effect when training primary care providers to identify images of benign and malignant dermoscopic skin lesions. A multimodal dermoscopy curriculum allows learners to build on initial training using spaced review and blended learning strategies. The “Dermoscopic Lotus of Learning” has the potential to be a model for other primary care residency programs. A healthy partnership between dermatologists and primary care is essential.

Platelet-Rich Plasma for Androgenetic Alopecia in Women: A Single-Center Case Series Study in Qatar

Abstract Objective: Androgenetic alopecia (AA) is a progressive hair loss disorder mediated by systemic androgens and genetic factors. A variety of AA treatments have been investigated. Currently, there is emerging evidence and growing interest in the use of platelet-rich plasma (PRP) for AA. This study describes a single-center experience using PRP to treat AA in women. Methods: A retrospective observational study design was employed. The study cohort comprised 20 women &gt;18 years of age who were diagnosed with AA. PRP was prepared using a commercially available PRP kit. Each patient received six PRP treatment sessions at 4-week intervals. The severity of alopecia tool (SALT) scoring system was used to measure the severity of alopecia, and a paired t-test was used to calculate significance levels. Results: The mean pre-intervention and post-intervention total SALT score was 27.5 ± 6.35 and 9.41 ± 3.71, respectively. The difference in the total mean SALT score was 18.33 ± 1.64 and the effect size was 3.52. The scalp area with the largest effect size was the vertex (Cohen d = 2.53). The effect size was similar across other scalp areas (Cohen d = 1.91–2.09). There were no serious adverse effects of the treatment; only mild transient adverse effects were reported. Conclusion: The present study demonstrated the efficacy and safety of PRP injections in treating AA in women. However, these findings require confirmation in well-designed studies using standardized treatment protocols and evaluation methods.

Reducing Blood Loss by Changing to Small Volume Tubes for Laboratory Testing

ObjectiveTo reduce diagnostic blood loss by using small volume tubes for routine laboratory testing throughout the hospital, as blood loss from laboratory testing can be substantial for patients and may lead to hospital-acquired anemia. Patients and MethodsDiagnostic blood loss was evaluated in hospitalized patients between April 1, 2017, and June 1, 2018. The preintervention, during intervention, and postintervention mean diagnostic blood loss per hospitalized patient was compared across the floors and for each type of tube for hematology, basic metabolic panel, and coagulation tests. Mean hemoglobin levels, blood transfusions per hospitalized patient, and percent redraws were also compared. ResultsThe total volume of blood drawn for all the 3 tests decreased across each implementation phase; however, only patients admitted to the transplant and critical care (T/CC) units had increased hemoglobin levels. In addition, there was a significant reduction in transfusions across implementation phases. The incidence risk ratio for transfusion reduced even more in patients admitted to the T/CC units. Finally, there was no significant difference in the overall percent redraws across all the units. ConclusionThe use of small volume tubes in exchange for standard sized tubes markedly decreased diagnostic blood loss by 25.7% in all the units and 22.9% in the T/CC units. Also, the number of transfusions decreased across units, with the greatest decrease in the T/CC units. An increase in mean hemoglobin levels was observed specifically in patients admitted to the T/CC units, with no corresponding change in percent redraws across all the units.

Adding team-based financial incentives to the Carrot Rewards physical activity app increases daily step count on a population scale: a 24-week matched case control study

BackgroundMobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements.MethodsA 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1–12; intervention: weeks 13–24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week).ResultsThe main analysis included 61,170 users (mean age = 32 yrs.; % female = 64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p < 0.0001; ηp2 = 0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2 = 0.699) with each new STC corresponding to approximately 200 more steps per day.ConclusionDespite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects.

The Influence of Time-dependent Surface Properties on Sprint Running Performance between Male and Female Athletes

Background: The body of research on field based player-surface interaction consists of some contradictory findings and the comparison of male and female physiological responses on different surfaces is limited. Objective: The study investigates the influence of surface properties on sprint running before and after completing a muscle fatiguing intervention. Methodology: Muscle activity was recorded using surface electromyography (EMG). The vastus medialis (VM), biceps femoris (BF), medial head of the gastrocnemius (MG), and the tibialis anterior (TA) sites were selected for analysis. The mechanical properties (MPs) of each field were shown to be different using ASTM F-3189 protocol. Results: A statistically significant three-way repeated measures ANOVA interaction between field properties, sprint trial and muscle groups was determined, F(3,36) = 10.82, p = .006, ηρ2 = .474. Further analyses revealed an interaction effect between field properties and sprint trial, F(1,12) = 26.57, p = .001, ηρ2 = .689, between muscle groups and field properties F(1,12) = 8.78, p = .012, ηρ2 = .422 and between muscle group and sprint trial F(1,12) = 7.29, p = .019, ηρ2 = .378. In addition, pre-intervention mean sprint time was less on the field possessing more energy return by 9.1%. Post-intervention sprint test results show a significant difference for BF peak muscle activity on the field displaying greater force attenuation. Conclusion: Both pre and post intervention sprint results suggest time-dependent properties associated with a sport field could potentially influence muscle activation patterns differently for males and females.

Comparing the Effect of Simulated Patient and Lecture Training Methods in the Clinical Self-Efficacy of Nurses Caring for Patients With Acute Coronary Syndrome

Various training methods can be used to enhance the clinical self-efficacy of nurses caring for patients with the acute coronary syndrome (ACS). The present study aimed at investigating and comparing the effect of simulated patient and lecture training methods in the self-efficacy of nurses' clinical performance caring for ACS patients in 2016. This was a quasi-experimental study. The population consisted of 62 nurses working in cardiac intensive care units (CICU) of associated hospitals with Jahrom University of Medical Sciences. Sampling was done with the conventional method and divided into two groups; "lecture" and "simulated patient" education through random assignment. Data was collected with the Self-efficacy of Nurses' Clinical Performance Questionnaire before and after the intervention. Data analysis was performed with SPSS v16.0 software and paired and independent t-tests. There was a significant difference between pre- and post-intervention self-efficacy mean scores in the two groups (P&lt;0.05). In addition, there was no significant difference between pre-intervention self-efficacy mean scores in the two groups (P&gt;0.05). The simulated patient training method was more effective in enhancing nurses' self-efficacy in caring for ACS patients than the lecture method.

The Impact of a Short-Term Walking Intervention to Decrease Perceived Stress

This study examined a short-term, low-cost walking intervention developed and implemented at a small, private university in the upper Midwest. Results showed a significant decrease in perceived stress (pre-intervention PSQ mean = 0.41 ± 0.16 versus post-intervention PSQ mean = 0.30 ± 0.14, p &lt;0.001), and a significant increase in daily steps (pre-intervention mean = 6,810 ± 2,544 versus post-intervention mean = 9,352 ± 2,825, p &lt; 0.001). These results provide support for the effectiveness of a short-term walking intervention to increase daily steps and decrease perceived stress for university employees.

Effect of a teaching programme on knowledge of postoperative pain management among nurses at Lagos University Teaching Hospital, Nigeria

Background. Postoperative pain management is a way of reducing or eliminating pain and discomfort with minimum side-effects after surgery. Pain is a predictable and expected experience following surgery, and if not well controlled poses a major risk to the patient. Research shows that most patients suffer complications associated with postoperative pain. It is therefore important to develop approaches on how to improve knowledge of postoperative pain management among nurses. Objective. To determine the effectiveness of a teaching programme on the knowledge of postoperative pain management among nurses in the adult surgical ward of Lagos University Teaching Hospital, Nigeria. Methods. A quasi-experimental research design was conducted, and an accidental sampling technique used to select a total of 60 nurses. Probability sampling was used to divide this group into two (control n =30, experimental group n =30). Data were collected using a modified structured questionnaire, the ‘Knowledge and attitudes survey regarding pain’ tool. Ethical clearance was obtained from the hospital before the administration of the questionnaire. Data obtained were coded and analysed using Statistical Package for Social Sciences version 21.0 statistical software, at p =0.05 level of significance. Results. The pre-intervention mean (standard deviation) score on knowledge of postoperative pain management among participants in the control group was 1.05 (0.60) and 1.06 (0.63) in the experimental group, with a mean difference of 0.01. Following intervention, there was a rise in mean score on knowledge of postoperative pain management among the nurses in the experimental group to 1.62 (0.97), while participants in the control group had 1.05 (0.62), with a mean difference of 0.57. There were significant statistical differences between the pre- and post-intervention mean score of participants’ knowledge of postoperative pain management ( t =3.68, p =0.00). Conclusion. The teaching programme was effective in improving participants’ knowledge of postoperative pain management. Therefore continued education on postoperative pain management is recommended for nurses who are involved in the care of postoperative patients.

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.

ROLE OF HYBRID PROCEDURES IN TREATMENT OF CRITICAL LOWER LIMB ISCHEMIA

Background: The lower limb peripheral arterial disease (PAD) is the third-largest atherosclerotic disease site along with heart disease and cerebrovascular disease, a condition that was often overlooked in the past, but which has been a growing cause of Cardiovascular Disability and Mortality, in recent years. Aim of the work: Assessment of the results of hybrid procedures using Endovascular and open techniques for surgery simultaneously, in patients with critical lower limb ischemia caused by arterial multi-level occlusive disease, as regards to patency as well as the complications. Patient and method: This randomized study was conducted on 40 patients attending at Al-Azhar University Hospitals with arterial multisegmental lesions affecting lower limbs. They all treated with hybrid techniques. Results: Technical success in 93.22% (55 of 59) of the procedures. The pre-intervention mean ABPI for the 40 patients was 0.32 ± 0.04, which improved to 0.70 ± 0.15 immediately post-intervention (P<0.01). The primary rate of patency at 12 months was 72.5%. The cumulative limb salvage rate at 12 months was 77.5% (standard error: <10%). It was seven major and ten minor complications in the perioperative period for an overall rate of 27.5%. Mortality occurred in two patients (5%). Conclusion: the hybrid procedures of this high-risk group of patients can simplify the management of multilevel PAD and optimize limb salvage while minimizing total patient risk.

Mitigating Hospital-Onset Clostridioides difficile: Evaluation of a Standardized Environmental Hygiene Program in Eight Hospitals

Background: Despite ongoing efforts over the past 3 decades, hospital-onset Clostridioides difficile infection (HO-CDI) continues to challenge interventions aimed at its prevention and control. We describe the impact of a model environmental services (EVS) program on the incidence of HO-CDI across 8 hospitals that are part of a nationwide integrated health system. Methods: Eight acute-care hospitals with 44–532 beds (mean, 263 beds) in 6 states with stable endemic HO-CDI incidence densities independently implemented identical sporicidal environmental hygiene interventions in 2017. The program combined the use of a hydrogen peroxide/peroxyacetic acid surface disinfectant for all patient-zone hygienic cleaning combined with a structured model EVS cleaning program that included optimized cleaning and disinfection technique, staff training, and auditing with objective performance feedback, which aligned with 2008 HICPAC/CDC categories I and II as well as 2010 CDC Guidance Level II monitoring program recommendations. After a 3-month phase-in, we compared NHSN-reported LabID HO-CDI SIRs for 18 months before and 12 months after implementation of the program. Results were not shared between sites and data were not collated by the authors until a year after the postintervention results were initially available. Multiple possible confounding factors were evaluated and determined not to have identifiably affected the outcome. Results: Mean preintervention HO-CDI SIRs over the 18 months measured ranged from 0.5 to 1.4 (mean, 1.0 for the group). Following the wash-in period, SIRs decreased precipitously in all sites to a mean of 0.42 for the group by the end of 12 months of the intervention. (P &lt; .0001) (Fig. 1). Individual site improvement ranged from 20% to 92% (mean, 57%) (Fig. 2.) Conclusions: Overall, HO-CDI SIRs decreased almost 60% in the study hospitals following daily sporicidal disinfection cleaning of all patient-zone surfaces in association with ongoing programmatic optimization of cleaning practice. As predicted by earlier single-site studies reporting a favorable impact of sporicidal disinfectant cleaning in outbreak settings, this multisite quasi-experimental study has illustrated the substantial potential impact of hospital-wide sporicidal disinfection integrated with objectively sustained optimized thoroughness of cleaning to decrease the incidence of HO-CDI.Funding: NoneDisclosures: None

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.

Assessment of Knowledge Levels Following an Education Program for Parents of Children With Inflammatory Bowel Disease.

Children with inflammatory bowel disease (IBD) and their parents have increasing roles in disease management and require sufficient, appropriate information for communication with their clinical team. Formal education is effective at improving disease knowledge, disease outcomes, and mental health, yet few interventions have been targeted for parents of children with IBD. A two day parent education program was held at the annual residential camp for children with IBD in New Zealand with knowledge levels tested pre and post intervention using a validated assessment tool: IBD-KID2. Thirty parents consented, 25 completed the study, 70% were female and 83% had a child with Crohn's disease. The pre-intervention mean score (maximum fifteen) was 10.6 (SD 2.9), with no associations with independent variables. Knowledge levels increased significantly following the education program to a mean 12.6 (SD 2.0) (p < 0.005). Disease specific knowledge may improve outcomes and should, therefore, be reinforced during clinic encounters, and regarded as an ongoing endeavor.

Effect of Scribes on Efficiency in Academic Ophthalmology Practice

Abstract Objective The aim of the study is to determine the effects of scribes on efficiency in an academic ophthalmology practice. Design This is a quality improvement study conducted by two ophthalmologists at an academic ophthalmology practice at UT Health San Antonio from January 2018 to April 2018. Implementation of scribes in practice was the primary intervention. Session time, patient encounter time, and template time adherence were recorded pre- and post-intervention. A second retrospective arm of the study at the same institution was performed to evaluate long-term effects of scribes on efficiency in ophthalmology practice on session times and patient volume 12 to 18 months after intervention. Main Outcome Measures Primary study outcomes and measures were the effect of scribes in academic ophthalmology practice on physician efficiency in terms of clinic session time, individual encounter time, and amount of patients seen per session, in addition to time adherence based on type of patient encounter. Results Eighty-three patients and 17 half-day clinic sessions and 169 patients and 21 half-day clinic sessions were included in the preintervention and post-intervention datasets, respectively. Number of patients per session was approximately 15 and was kept similar pre- and post-intervention (p = 0.45). Mean preintervention session time was 265.0 ± 31.4 minutes, in contrast to 223.4 ± 19.9 minutes after intervention (p &lt; 0.001). Mean preintervention patient encounter time was 15.0 ± 8.3 minutes, while the mean encounter time after intervention was 10.9 ± 7.0 minutes (p &lt; 0.005). In a retrospective analysis of 20 clinic sessions and 438 patients 12 to 18 months after intervention, session time increased to 266.0 ± 22.0 minutes on average, but the average number of patients per session increased to 21.9 ± 2.8 minutes. Conclusion Utilizing scribes in an ophthalmology practice can increase efficiency, allowing more patients to be seen or allowing time for other activities such as teaching or research.

The Effect Of Percussive Massage Versus Foam Rolling On Recovery Between Two 1000 Meter Runs

Interest in effective methods to reduce recovery time related to athletic performance is an area of interest in competitive sports. Many of the methods purported to enhance recovery and improve repeat performances are unproven. These methods include foam rolling and more recently, percussive massage. PURPOSE: The purpose of this study was to compare repeated running performance under the conditions of no massage (NM), foam rolling (FR) and percussive massage (PM) when implemented during the rest period between two running trials. METHODS: 20 recreationally active college-age students (age: 22.5 ± 2.8 yrs., height: 176.2 ± 8.0 cm, body mass: 70.8 ± 11.1 kg, 11 ♂) volunteered to participate in a randomized, single-blind, crossover design study. Three trials consisting of two repeat 1000m runs separated by 30 minutes of rest were conducted with a minimum of 48 hrs. between trials. The 30 minute recovery was to simulate the time between races in a track event. Finger stick blood lactates were taken three minutes post run, as well as before the second run. During the 30 minute recovery the subjects received one of the three treatments NM, FR, and PM. For PM the treatment was applied bilaterally, for a total of 12 minutes with two minutes per muscle group (calves, hamstrings, and quadriceps). FR trials followed the same protocol. Run time(sec) and lactate values(mmol) were recorded for all trials. RESULTS: Statistical analysis by ANOVA (P<.05) revealed no significant difference in run performance time among all conditions. Mean pre-intervention times were: 245 ± 24, 244 ± 23, and 246 ± 24 and post-invention times were: 246 ± 22, 245 ± 23 sec, and 247 ± 23 for NM, FR, and PM respectively. Blood lactate significantly decreased from post first run: 11.2 ± 2.3, 11.7 ± 2.3, and 10.7 ± 2.0 to the pre-second run with values of 5.1 ± 2.1 mmol, 5.5 ± 2.2mmol, and 5.1 ± 1.7 mmol for NM, FR, and PM respectively, with no significant difference among conditions. CONCLUSION: Although subjects reported enhanced recovery with the interventions, the results of this study suggest that percussive and non-percussive massage do not affect performance time in a 1000m run nor do they alter the time course for blood lactate attenuation. Supported, in part by a grant from Theragun®.