Pre Intervention Research Articles

Prehospital Care in Road Traffic Accident Cases

Abstract Background: Rapid population growth, industrialization and an increase in road vehicles, have led to a drastic increase in the number of Road Traffic Accidents (RTA).Pedestrians, motorized two wheeled vehicle (MTV) users, and cyclists are the most vulnerable road user groups in terms of injuries and fatalities resulting from road traffic crashes in India. At least one-third of potentially preventable deaths occur prior to arrival at hospital and over half occur during the hospital reception and resuscitation phase of care. Prehospital emergency care in India is only beginning to develop. Thirty per cent of emergency patients in India die before they reach a hospital. Persons who shift the victims are usually untrained members of the public. Crash victims are often taken to the nearest hospital, regardless of the hospital’s capabilities for dealing with trauma. The vast majority of ambulances are used for inter-hospital transfer, not for primary response. This highlights the need of urgent steps for establishing good pre-hospital care and trauma services at site in India. Aims and Objectives: The study attempts to know the status of provision of pre hospital care to RTA victims and to suggest measures for improving hospital and pre-hospital care to the same. Methods: The study was conducted on patients of RTI admitted at Trauma Centre of King George’s Medical University UP (KGMU), Lucknow. A semi-structured questionnaire was used gather information about the socio demographic profile of RTA victims and the status of provision of pre hospital care to them. Results: It was seen in the present study that only eight percent cases had some sort of pre-hospital care given, or some interventions done before victim was taken to the hospital. Majority of these interventions were given by the bystanders and included measures like shifting the victim from the accident site (76.5%), water splinting/fanning/water given to drink (8.8%), or wound covered with cloth (5.9%) or medications (8.8%). In 9.7 percent cases, it was not known whether any pre hospital intervention was given. Out of the total cases who died, 66.7 percent had not received any intervention before hospitalization. The proportion of mortality was 2.5 percent in cases where no interventions were given, while there was no mortality in cases where some interventions were given before hospitalization. Conclusion: It was seen that very few cases got some intervention before hospitalization and a number of cases were referred from government health facilities due to unavailability of beds, equipment or medical staff. About thirty percent interviewees were not aware of ambulance emergency number. Lower proportion of mortality was seen in cases that got intervention at a health facility within an hour.

Aplicación de juegos con balón para el desarrollo de la coordinación y control de objetos en escolares de educación general básica media

Introducción Ball games have been used since ancient times, as they provide several benefits for the motor development of children. Nowadays it is important to work on several aspects such as: eye-hand and eye-foot coordination, gross and fine motor skills, spatial development, grasping skills, balance and coordination, where the teacher must implement the necessary activities to improve coordination in the growing stage. Coordination can be defined as orderly and harmonious movements, performed by a person such as: walking, jumping, running, turning, which allows improving different movement skills; motor coordination refers to the use of body movements, in a synchronized manner to develop simple actions to consolidate complex activities. Objetivos To apply ball games for the development of the coordination and control of objects in schoolchildren of General Basic Secondary Education. Método The objective of this research was the development of the coordination and control of objects in students of General Basic Education, an intervention with a series of ball games was applied. The instrument that was applied according to the study variables was the 3JS Motor Coordination test, validated by Cenizo, Ravelo, Morilla, Ramírez, & Fernández (2016) The test allows determining the level of locomotor coordination, object control coordination and motor coordination in general. The population that was considered for the study was made up of 137 schoolchildren from Educación General Básica Media, based on a non-probabilistic sampling by convenience, from which a study sample of 33 students was selected. Principales resultados The analysis by types of object control coordination determined a higher mean score in eye-hand coordination than in eye-foot coordination, the categorization in levels of development of object control coordination determined that the highest percentage of the study sample was in a level considered “low” and a lower percentage, the rest of the sample in a “very low” level. After the application of ball games, the levels of locomotor coordination, object control and general motor coordination, there was a predominance in the normal and good levels. Conclusiones Once the pre and post intervention analysis was implemented, it was possible to determine that significant changes were found when applying the ball games, which allowed a significant improvement in the coordination of object control in the study sample, and thus favored the motor coordination.

Effect of acupressure therapy to reduce chest pain in NSTEMI patients

Introduction: Acute coronary syndrome (ACS) describes the sudden ischemia of the myocardium due to loss of blood flow to the heart muscle, causing a cessation of oxygen supply to heart cells. Non-pharmacological management is needed to be applied instead of intervention or combination in reducing pain intensity. Acupressure is done by applying physical pressure at several points on the surface of the body that are places of energy circulation and balance in cases of pain symptoms. Objective: To reduce chest pain in patients with acute coronary syndrome with NSTEMI by using acupressure therapy. Methods: The method used in this study used case studies with pre and post intervention, patients were given acupressure therapy given at the location of the LI4 point located at the back of the right / left hand between the first and second metacarpal bones and almost along the radial bone. Performed for ± 20 minutes in 10 seconds, pressure is applied according to the tolerance level acceptable to the patient and a rest period of 2 seconds. Results: There was a decrease in pain intensity in patients after acupressure therapy. Conclusion: Pressure therapy with appropriate methods and procedures can be an alternative to reduce chest pain in NStemi patients

SP11.12 Improving Radiology Scan Requests in Acute General Surgery

Abstract Background Junior doctors submit majority of requests for radiological scans in most surgical departments. We aimed to evaluate the accuracy of clinical information entered by referring doctors based on five define parameters recommended by a consultant radiologist in a tertiary hospital. Method All scans requested by clinicians within 48 hours of admission to the acute surgical receiving unit across two weeks were reviewed. Outpatient and ambulatory requests were excluded. The five required parameters were: clinical presentation, relevant past medical history, relevant blood results, clinical examination findings and clinical question. Education, in the form of posters and an online tutorial, were provided with the aim of improving scan requests. Data was collected on Excel and statistical analysis was performed using a paired t-test. Results Over two weeks, majority of 127 scan requests (21% USS, 64% CT scans, 15% MRCP) were made by doctors. Prior to our interventions, 60% of the defined parameters were included in scans request, with 83% of patients receiving their scans within 24 hours. This increased to 80% following delivery of medical education but this did not increase the number of scans performed within 24 hours. A paired t-test demonstrated a statistical significance between pre and post intervention scan requests (p=0.0471), however this did not correlate to shorter scan times. Conclusion Quality of scans improved following medical education in the form of posters and online tutorials. An induction tutorial on submitting quality scan requests would benefit referring clinical and radiologist on highlighting critical information required for timely scans.

Critical care nurses’ knowledge and attitudes toward pressure injury prevention: A pre and post intervention study

ObjectiveTo explore nurses’ knowledge and attitudes towards pressure injury prevention before and after implementing an educational intervention. Design/MethodA pre-and post-intervention study. Pre-intervention data collection involved administering an instrument, including demographic information, the Pressure Ulcer Knowledge Assessment Tool version 2, and the Attitudes towards Pressure Ulcer Prevention instruments. Following the analysis of pre-intervention data, an educational intervention was implemented. Post-intervention data were collected using the same instrument. SettingIntensive care units at three Saudi Arabian hospitals. Main outcome measuresNurses’ knowledge and attitudes towards pressure injury prevention. ResultsThe pre-intervention phase included 190 participants, and the post-intervention phase included 195 participants. Participants completed a paper-based survey at two different time points between June 2021 and March 2022. The mean pre-intervention scores for nurses’ knowledge and attitudes towards pressure injury prevention were 43.22% and 74.77%, respectively. Following the educational intervention, the knowledge and attitude scores increased significantly to 51.22% and 79.02%, respectively. Higher knowledge of pressure injury prevention was positively associated with positive attitudes towards prevention practices. Age, clinical nursing experience, and experience in intensive care units were identified as factors correlated with knowledge of pressure injury prevention. A Bachelor’s qualification or higher predicted better knowledge and attitudes towards pressure injury prevention. ConclusionsNurses’ knowledge and attitudes towards pressure injury prevention greatly improved following tailored, evidence-based education. The educational intervention featured multiple on-site bedside discussions, case studies, small-group presentations, and the provision of printed resources. Implications for Clinical PracticeNurses’ knowledge and attitudes towards pressure injury prevention should be examined, and education provided to ensure evidence-based prevention practices are implemented. Tailored small-group education sessions delivered conveniently could be an effective approach. Efforts should focus on attracting and retaining experienced, highly qualified nurses to ensure the adoption of evidence-based prevention practices.

Acceptability of a shared cancer follow-up model of care between general practitioners and radiation oncologists: A qualitative evaluation.

Facilitators to implement shared cancer follow-up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two-way information sharing and clear follow-up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. Semi-structured interviews were conducted pre- and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. Thirty-two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow-up care, however, patients were concerned about the GPs cancer-specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low-risk, stable patients around 2-3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow-up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. Patients, GPs and ROs felt this shared cancer follow-up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed.

Functional improvement of patients with Parkinson syndromes using a rehabilitation training software.

Individuals with Parkinsonian disorders often face limited access to specialized physiotherapy and movement training due to staff shortages and increasing disease incidence, resulting in a rapid decline in mobility and feelings of despair. Addressing these challenges requires allocating adequate resources and implementing specialized training programs to ensure comprehensive care and support. Regarding these problems, a computer software was invented that might serve as an additional home-based extension to conventional physiotherapy. The trial took place in a rehabilitation center where every patient received equivalent treatment apart from the training program that was set up to be investigated over 3 weeks. Seventy four Patients were included and randomized between two intervention and one control group. Intervention group 1 (IG1) trained with the computer-based system two times a week while Intervention group 2 (IG2) received five training sessions a week. Using the markerless Microsoft Kinect® camera, participants controlled a digital avatar with their own body movements. UPDRS-III and Clinical measurements were performed before and after the three-week period. Patients in all groups improved in UPDRS-III pre and post intervention whereas reduction rates were higher for IG1 (-10.89%) and IG2 (-14.04%) than for CG (-7.74%). Differences between the groups were not significant (value of ps CG/IG1 0.225, CG/IG2 0.347). Growth rates for the arm abduction angle were significantly higher in IG1 (11.6%) and IG2 (9.97%) than in CG (1.87%) (value of ps CG/IG1 0.006 and CG/IG2 0.018), as was the 5-steps-distance (CG 10.86% vs. IG1 24.5% vs. UG2 26.22%, value of ps CG/IG1 0.011 and CG/IG2 0.031). The study shows the beneficial effects of computer-based training and substantiates the assumption of a similar impact in a home-based setting. The utilized software is feasible for such interventions and meets with the patient's approval. Group dynamics seem to have an additional supporting effect for the aspired objective of improving mobility and should be seen as an essential aspect of video games in therapy.

Reducing low-value ED coags across 11 hospitals in a safety net setting

BackgroundProthrombin/international normalized ratio and activated partial thromboplastin time (PT/INR and aPTT) are frequently ordered in emergency departments (EDs), but rarely affect management. They offer limited utility outside of select indications. Several quality improvement initiatives have shown reduction in ED use of PT/INR and aPTT using multifaceted interventions in well-resourced settings. Successful reduction of these low-value tests has not yet been shown using a single intervention across a large hospital system in a safety net setting. This study aims to determine if an intervention of two BPAs is associated with a reduction in PT/INR and aPTT usage across a large safety net system. MethodsThis initiative was set at a large safety net system in the United States with 11 acute care hospitals. Two Best Practice Advisories (BPAs) discouraging inappropriate PT/INR and aPTT use were implemented from March 16, 2022-August 30, 2022. Order rate per 100 ED patients during the pre-intervention period was compared to the post-intervention period on both the system and individual hospital level. Complete blood count (CBC) testing served as a control, and packed red blood cell transfusions served as a balancing measure. An interrupted time series regression analysis was performed to capture immediate and temporal changes in ordering for all tests in the pre and post-intervention periods. ResultsPT/INR tests exhibited an absolute decline of 4.11 tests per 100 ED encounters (95% confidence interval −5.17 to −3.05; relative reduction of 18.9%). aPTT tests exhibited absolute decline of 4.03 tests per 100 ED encounters (95% CI −5.10 to −2.97; relative reduction of 19.8%). The control measure, CBC, did not significantly change (−0.43, 95% CI −2.83 to 1.96). Individual hospitals showed variable response, with absolute reductions from 2.02 to 9.6 tests per 100 ED encounters for PT/INR (relative reduction 12.1%–30.5%) and 2.07 to 10.04 for aPTT (relative reduction 12.1%–31.4%). Regression analysis showed that the intervention caused an immediate 25.7% decline in PT/INR and 24.7% decline in aPTT tests compared to the control measure. The slope differences (rate of order increase pre vs post intervention) did not significantly decline compared to the control. ConclusionsThis BPA intervention reduced PT/INR and aPTT use across 11 EDs in a large, urban, safety net system. Further study is needed in implementation to other non-safety net settings.

Informal caregivers involvement in heart failure self-care: perceived acceptability and contribution to heart failure self-care from a feasibility quasi-experimental study

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): HES-SO University of Applied Sciences and Arts Western Switzerland, Service d’Aide et de Soins à Domicile de la Sarine, Fribourg Background Heart failure (HF) self-care is recommended to reduce HF hospitalisation and mortality. Informal caregivers play a key role in HF self-care support and contribute to outcomes. Uncertainties remain about the acceptability to include informal caregivers to support self-care in people with HF, as well as informal caregivers’ responsiveness of being exposed to an intervention supporting symptom perception in HF, a specific HF self-care process. Purpose We aimed to test an intervention supporting symptom perception in people with HF including among informal caregivers. Methods We used a quasi-experimental feasibility study with a pre-test post-test design. Informal caregivers and people with HF were exposed to an evidence-informed self-care support intervention targeting symptom perception, delivered by trained homecare nurses during one month at people with HF home. We assessed acceptability of informal caregivers involved in HF self-care support using the Treatment Acceptability and Preferences (TAP) Measure adapted for this study (responses from 1=completely disagree to 5=completely agree). We assessed outcome responsiveness regarding contribution to HF self-care using the Caregiver Contribution to Self-care of HF Index version 2 (CC-SCHFI 2), and caregivers’ burden with the Zarit Burden Interview. We used descriptive statistics and calculated effect sizes using Cohen’s d based on mean absolute change between pre and post intervention. Results Seven informal caregivers (mean age 64.7 years, 6/7 women) were exposed to the intervention. All were spouse or child of the people with HF. Mean acceptability score was 4.28. Informal caregivers’ contribution to HF self-care positively responded after intervention exposure. There was a 10-point increase on the CC-SCHFI 2 symptom monitoring and perception post intervention (mean score 69.1) compared to baseline (mean score 58.9) with a large effect size (Cohen’s d=1.37). Contribution to HF self-care maintenance and management also responded positively to the intervention, respectively from 60 to 63.5 for self-care maintenance (Cohen’s d=0.28) and from 49.3 to 52.5 for self-care management (Cohen’s d=0.17). Caregiver burden slightly increased 2-points post intervention from 18.5 to 20.5 with a low effect size (Cohen’s d=0.14). Mean caregiver burden scored high at baseline before intervention exposure, and informal caregivers reported low burden to participate in the intervention (TAP mean item score 4.4). Conclusion Informal caregivers reported the intervention as highly acceptable. Informal caregiver contribution to symptom monitoring and perception was responsive to the intervention, as well as overall contribution to HF self-care. Caregiver burden should be carefully monitored when involved in HF self-care support interventions. Evaluating the effectiveness of including informal caregivers in HF self-care support and in specific symptom perception is needed.Caregivers outcomes responsiveness

A simple dietary intervention to reduce inflammation and oxidative stress in individuals with metabolic syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Approximately 25% of the world's population have metabolic syndrome and those diagnosed have a two-fold risk of developing cardiovascular disease. Inflammation and oxidative stress are responsible for the pathogenesis of metabolic syndrome. Diets with a high intake of vegetables containing carotenoids, a type of antioxidants, are associated with reduced levels of inflammation and oxidative stress, yet interventions to increase vegetable intake have been difficult to adapt. We conducted a randomized controlled trial of a simple dietary antioxidant intervention to reduce the levels of inflammation and oxidative stress. Purpose To examine the effect of a simple dietary antioxidant intervention on levels of inflammation and oxidative stress in persons with metabolic syndrome. Methods A total of 93 individuals with metabolic syndrome (mean age 61 ± 12 years old, 71% female) were enrolled. The intervention group received an 11.5-ounce serving of 100% carotenoid-rich vegetable juice to consume once per day for 30 days. The control group maintained their normal dietary pattern for 30 days. Adherence to the intervention was measured with Veggie Meter®, a validated reflection spectroscopy approach to assess skin carotenoid levels. Inflammation and oxidative stress were measured by plasma levels of high-sensitivity C-reactive protein (CRP) and malondialdehyde (MDA) at baseline and one-month post intervention. Two-way repeated measures analysis of variance was used to compare the group means over time. Log-transformation was applied as necessary for the variables with skewed distribution. Results There was no significant interaction between treatment and time on skin carotenoid levels, (respectively, P=0.214). There was a statistically significant increase of skin carotenoid levels in the intervention group alone (220 vs 264 in pre and post intervention, respectively, P=0.002). Change in mean CRP levels did not differ between control and intervention groups (P=0.520). Similarly, change in mean MDA did not significantly differ between two groups (P = 0.450). Conclusion A simple and easy to adapt, 1-month dietary antioxidant intervention did not change levels of inflammation and oxidative stress in individuals with metabolic syndrome, potentially due to the short-term treatment. Future interventions with dietary antioxidants should be implemented for longer time periods to fully assess the impact on inflammation and oxidative stress.

The effects of music in cardiac surgery patients: early results

Abstract Funding Acknowledgements Type of funding sources: Private hospital(s). Main funding source(s): Sundry fund to Massachusetts General Hospital. Background/Significance Research into the health benefits of music has expanded, driven by a desire to see how it can be better applied in healthcare. There has been an interest in the chemical and biological biomarkers of music. Most studies have focused on physical, and psychological findings. There have been few systematic studies that consider the parallel psychological, physical, and biological effects of music in cardiac surgical patients. Purpose The purpose of this study is to measure psychological, physiological, and biological responses to a music intervention compared to standard of care in cardiac surgical patients. The primary outcome is serum cortisol levels pre and post a 30-minute music intervention compared to the standard of care group. The secondary outcomes are state anxiety, pain, blood pressure, heart rate, respirations, and serum Immunoglobulin A (IgA). Methods This is a randomized, placebo-controlled, pre/post clinical trial to compared responses to the study intervention of music versus standard of care. Psychological responses were measured for anxiety by the Spielberger State Anxiety Scale, and pain by a visual analogy scale, physical responses were measured by blood pressure, heart rate, and respirations, and the biologic markers were measured by serum cortisol and IgA. Results Sixty-three patients were approached, 14 were excluded and 25 declined participation. Most patients who declined stated that they did not feel well enough to participate or did not want more blood samples taken. There were 20 subjects, 15 males and 5 females, mean age of 58.8 years, who did participate. The groups were similar on demographics and pre intervention outcome measures. There was no difference between standard of care and treatment group in the primary outcome, serum cortisol levels (17.8+7.4 vs 15.6+7.6) and no differences in the secondary outcomes post the intervention period. Conclusions This is the early results of a study on use of music as a nursing intervention in cardiac surgery patients. Subject enrollment will continue to provide evidence of the benefits for patients after cardiac surgery. Implications for Nursing Practice Nurses are poised to provide the evidence for non-pharmacological interventions to enhance the patient experience after cardiac surgery.

An evidence-based demand management strategy using a hub and spoke training model reduces waiting time for children's therapy services: An implementation trial.

Waiting lists for community-based paediatric therapy services are common and lead to poorer health outcomes, anxiety and missed opportunities for treatment during crucial developmental stages. The Specific Timely Appointments for Triage (STAT) model has been shown to reduce waiting lists in a range of health settings. To determine whether providing training and support in the STAT model to champions within five community health centres using a remote 'hub and spoke' approach could reduce waiting time from referral to first appointment. Representatives from five community health centres providing paediatric therapy services (speech therapy, occupational therapy and other allied health services) participated in five online workshops over 6months. They were guided sequentially through the steps of the STAT model: understanding supply and demand, reducing backlogs, preserving space for new patients based on demand and redesigning models of care to maintain flow. Waiting time was measured in three consecutive years (pre, during and post intervention) and compared using the Kruskal-Wallis test. Employee satisfaction and perception of the model were explored using surveys. Data from 2564 children (mean age 3.2years, 66% male) showed a 33% reduction in waiting time from the pre-intervention (median 57 days) to the post-intervention period (median 38 days, p< 0.01). The total number of children waiting was observed to reduce from 335 immediately prior to the intervention (mean per centre 67, SD 25.1) to 112 (mean 22, SD 13.6) after implementation (t[8] =3.56, p< 0.01). There was no impact on employee satisfaction or other aspects of service delivery. Waiting lists are a major challenge across the health system. STAT provides a practical, low-cost, data-driven approach to tackling waiting times. This study demonstrates its effectiveness in paediatric therapy services and provides evidence for a 'hub and spoke' approach to facilitate implementation that could be provided at scale.

The effect of nurse-led empowering education on nutrition impact side effects in patients with colorectal cancer undergoing chemotherapy: A randomised trial

ObjectiveThis study assessed the effect of empowering education on patient-reported outcomes and morbidity. MethodsA randomised controlled trial was conducted on adults with colorectal cancer (43 + 40). The intervention consisted of one-hour empowering patient education on nutrition impact side effects. The effect was compared with standard care. The difference between the groups was analysed pre and post intervention. ResultsThe change in malnutrition-related knowledge level was higher in the intervention group compared to control group (median 0.0, IQR 1.00 vs median 0.0, IQR 0.0, p = 0.028). Additional contacts with outpatient clinic were fewer in intervention group (median 0.00, IQR 0.00) compared to control group (median 1.00, IQR 2.00, p < 0.001). We did not find a statistically significant difference in the change in activation level, risk of malnutrition and quality of life between the groups. ConclusionEmpowering education may affect positively on patients’ knowledge level related to malnutrition and reduce the number of additional contacts with health care thus reduce health care costs. Practice implicationsEmpowering education may be used in patients with colorectal cancer to improve knowledge and reduce additional contacts with health care. Further research is needed on the effect of empowering education in self-care.

Effectiveness of health promotion intervention on the knowledge and selected practices related with oral cancer among a group of vulnerable youth in Sri Lanka

BackgroundThere has been a noticeable trend of younger people being diagnosed with oral cancer, particularly among those from low socio-economic backgrounds. Poor knowledge on risk factors toward oral cancer and the growing fashion of using tobacco also identified among younger generation. Present study aimed to assess the effectiveness of a health promotion intervention to improve the knowledge and encourage positive practices associated with oral cancer among a group of vulnerable youth in Sri Lanka.MethodsThe study was a community based quasi experimental study, conducted in urban slums in the district of Colombo, Sri Lanka. Sample size for one group was 120 youth participants aged between 15 and 24 years. Health promotion intervention was implemented to the intervention group and follow up period was 6 months. The control group did not receive the intervention. Awareness of oral cancer and oral potentially malignant disorders, tobacco chewing practice (betel quid chewing and commercially prepared tobacco and areca nut packet (CPTAP) chewing) and self-mouth examination practice were assessed at the beginning and after 6 months in both groups using an interviewer administered questionnaire. Changes in the knowledge, self-mouth examination practice, quit rate and fresh up take rate were computed to determine the effectiveness.ResultsThere was no loss to follow up. No significant difference was observed between the groups in pre intervention assessment regarding the knowledge, tobacco chewing and self-mouth examination practices. Knowledge score was significantly differed between the groups P = 0.000 in the post intervention assessment as well as among females P = 0.001. Quit rate of the tobacco chewing practice, betel chewing practice and CPTAP chewing practice among intervention group was 33%, 70%, and 13% respectively while control group did not have any quitters, P = 0.001. Fresh up take rate of tobacco chewing in the intervention group was 6.7% compared to the 37.5% in the control group, P = 0.001. Practicing self-mouth examination was significantly higher in intervention group in post intervention assessment, P = 0.000.ConclusionMulticomponent health promotion intervention (Advocacy, Interactive discussions, IEC materials and Community mobilization) was significantly effective in enhancing the knowledge, increasing self-mouth examination practice, and reducing tobacco chewing practice among a vulnerable group of youth in Sri Lanka.

Teaching complexity in biology through agent-based simulations: the relationship between students’ knowledge of complex systems and metamodeling knowledge

Real-world complex systems research seeks to understand how systems in the world can follow the same rules of complexity. Scientists have found similarities in processes—such as self-organization, micro-to macro-level emergence, and feedback loops—in seemingly disparate phenomena such as the spread of infectious diseases and how traffic patterns are formed. Our project, BioGraph 2.0, was developed to respond to the issue of students’ disjointed understanding of biology due to the fragmented nature of how high school biology is taught in high school classrooms. We hypothesized that by framing multiple biology concepts through the lens of complexity using dynamic simulations, or models featuring complex systems processes, students would be able to see complex systems as a unifying concept throughout biology. We built a series of units modeling phenomena on biological concepts such as gene regulation, ecology, and evolution using an agent-based modeling tool called StarLogo Nova. While previous research over the last decade of this project has highlighted students’ growth in complex systems understanding, in this study, we explored the relationship between complex systems and agent-based models. We investigated pre and post intervention data from over 300 high school students to determine how their metamodeling knowledge influenced their understanding of complex systems. Through a regression analysis, we demonstrate that growth in students’ modeling understanding significantly predicted growth in complex systems understanding. We further triangulate our findings with interview data from students who highlight the importance of the modeling tool to support their complex systems learning.

Avoiding the Chill Pill- Results from a Simulation-Based Verbal De-escalation Training for Psychiatry Residents in a Community Mental Health Center

Background: Potentially dangerous encounters with uncooperative, belligerent, or even violent patients in the Emergency Department and Psychiatric Inpatient Units require skilled responses and timely management of episodes of acute agitation. Lack of training and knowledge in these scenarios could compromise the safety of both staff and patients. There have been improvements in knowledge and comfort when dealing with acutely agitated patients documented in previous studies that have used simulation training for junior psychiatry residents. Objectives: Understand the existing knowledge and skill gap and attempt to address it through simulation training. Methods: This is an IRB exempt quality improvement project, supported with funds from the Committee of Interns and Residents. The study was conducted over 3 years (2019-2022). All psychiatry residents (N=36) participated in an online module (4hrs, JCAHO and OMH accredited) and simulation training with 3 standardized patients (actors). All residents were blind to the clinical scenarios and observed by faculty. Each incoming class (2019-2022) has been trained yearly since. Pre and post intervention surveys asked questions about knowledge, comfort, perceived competence, prior training, verbal de-escalation skills (APSP-agitated patient simulation project survey) and the validated Management of Aggression and Violence Attitude Scale (MAVAS). Results: Data from pre- and post- intervention APSP responses were analyzed using the student’s paired t-test. Residents felt significantly more comfortable handling verbal de-escalation post training (score of 6 vs. 8, P&lt;0.0001) and more competent evaluating and managing agitated patients (6 vs. 8, p&lt;0.0001). They showed significant (p&lt;0.05) changes in attitudes around seclusion and restrains and causes of agitation on MAVAS. The most used de-escalation interventions were: Explaining the situation and process, Summarizing the content, and Identifying patient’s feelings, wants and needs. Triggering behaviors included interrupting/ talking over the patient, not prioritizing patient’s needs, insisting on using medications. Conclusion: This project showed simulation-based training successfully addressed an important practice and knowledge gap and lent structure to the tailored protocol-based approach for managing agitated patients, especially in busy ER settings. Residents appreciated the simulation-based training with real life scenarios – they found it useful and engaging and they welcomed the interaction with standardized patients (SPs) during the training.

An ultrasound-exclusive non-invasive computational diagnostic framework for personalized cardiology of aortic valve stenosis.

Aortic stenosis (AS) is an acute and chronic cardiovascular disease and If left untreated, 50% of these patients will die within two years of developing symptoms. AS is characterized as the stiffening of the aortic valve leaflets which restricts their motion and prevents the proper opening under transvalvular pressure. Assessments of the valve dynamics, if available, would provide valuable information about the patient's state of cardiac deterioration as well as heart recovery and can have incredible impacts on patient care, planning interventions and making critical clinical decisions with life-threatening risks. Despite remarkable advancements in medical imaging, there are no clinical tools available to quantify valve dynamics invasively or noninvasively. In this study, we developed a highly innovative ultrasound-based non-invasive computational framework that can function as a diagnostic tool to assess valve dynamics (e.g. transient 3-D distribution of stress and displacement, 3-D deformed shape of leaflets, geometric orifice area and angular positions of leaflets) for patients with AS at no risk to the patients. Such a diagnostic tool considers the local valve dynamics and the global circulatory system to provide a platform for testing the intervention scenarios and evaluating their effects. We used clinical data of 12 patients with AS not only to validate the proposed framework but also to demonstrate its diagnostic abilities by providing novel analyses and interpretations of clinical data in both pre and post intervention states. We used transthoracic echocardiogram (TTE) data for the developments and transesophageal echocardiography (TEE) data for validation.

Comparison of efficacy between canagliflozin and teneligliptin as add-on therapy to metformin and glimepiride on plasma glucose levels along with blood pressure and lipid levels in patients with type 2 diabetes mellitus

Abstract Background: Despite of several guidelines metformin and glimepiride remains the first prescribed drug in most people with diabetes. Very often canagliflozin and teneligliptin remain the third prescribed OHA. Efficacy of teneligliptin and canagliflozin as solo drug or in combination with other single OHA’s on glycaemic parameters, lipid profiles &amp; blood pressure is already established. But their efficacy on above parameters when used as third drug next to metformin and sulfonylurea is still not investigated. Aims and objectives: Aim of this study is to compare glycaemic and non-glycemic effects of canagliflozin and teneligliptin as third line drug. Objective is to establish their multiple pleotropic effects at this position. Methods: Subjects with uncontrolled glycaemic parameters with hypertension and diabetic dyslipidaemia already on half maximal doses of metformin and glimepiride were enrolled in the study. Out of 87 selections, 45 were prescribed canagliflozin 100 mg/d and to 42 subjects, teneligliptin 20mg/d, each for 24 weeks. Effects over HbA1c, fasting and post prandial plasma glucose, systolic and diastolic blood pressures, HDL’c and triglycerides were observed pre and post intervention. Results: As a third drug both canagliflozin and teneligliptin show significant reduction in HbA1c (1.5 versus 1.6%), fasting (-20.2 versus -28.8 mg %), and post prandial (-39.9 versus – 58.5mg %). Effects over systolic (4 mmHg versus 1.1 mmHg) and diastolic BP (3.1 mmHg versus 0.2 mmHg) was clinically and statistically significant (p = 0.3 and 0.1) respectively in both groups. A statistically insignificant (9.6 versus 4.1 mg%; p =) reduction in Triglycerides but significant (7.6 versus 1.2; p &lt;0.0001) increase in HDL’c was observed. Conclusion: Canagliflozin and teneligliptin, both retains their glycaemic and non-glycaemic benefits even when used as third OHA for diabetes management. Canagliflozin scores better for comorbid hypertension and diabetic dyslipidaemia.

Effect of health education on knowledge of iso-immunization among pregnant women in selected government hospitals in Lagos State, Nigeria

Objective: to assess the outcome of health education on the knowledge of iso-immunization among pregnant women in selected government hospitals in Lagos state. Method: This was a quasi-experimental study where a semi-structured questionnaire was used to obtain data from 162 pregnant women who were selected by multi-stage Sampling in 3 selected government hospitals in Lagos state. Data collected were analyzed using SPSS version 24 and results were analyzed using frequency tables. An Independent t-test was used to test the mean difference between the two hypotheses. The level of statistical significance was set at a p-value of &lt;0.05. Results: The findings indicated that there were statistically significant differences between the level of knowledge among pregnant women at pre and post-health education intervention on isoimmunisation (Mean difference = 8.204, t(160) = 33.602, p = .000).; and between the level of knowledge of management among pregnant women at pre and post health education intervention on isoimmunisation (Mean difference = 7.191, t(160) = 23.234, p = .000). Conclusion: health education intervention program improved the knowledge of iso-immunization and its management among pregnant women. It was recommended among others that pregnant women should be given health talks about isoimmunisation, its causes, effects, and how it can be managed to improve their knowledge about isoimmunisation.

Effectiveness of acupressure therapy in reducing first trimester hyperemesis Gravidum: Case Study

Nausea and vomiting during pregnancy is a common condition affecting up to 70% of pregnant women. Emergency treatment of Hyperemesis gravidarum will focus on correction of dehydration and/or electrolyte disturbances and control of nausea and vomiting to allow for adequate oral intake. Application of acupressure on the P6 (Nei Guan) meridian point is known to treat vomiting and other stomach problems in traditional Chinese medicine practice Objective: To determine the Effectiveness of Accupresure Therapy in Reducing Hyperemesis Gravidum Trimester I. Methods: The method used in this study used a case study with pre and post intervention with the Pregnancy-Unique Quantification of Emesis questionnaire (PUQE-24). The patient was given accupresure therapy for 15 minutes every day for 3 days. Results: there was a change in the hyperemesis gravidarum score felt by the patient from a score of 10 (moderate level of nausea and vomiting) be 6 (mild level of nausea and vomiting) after being given acupressure therapy. Conclusion: Accupresure therapy with appropriate methods and procedures can be an alternative to reduce Hyperemesis Gravidum in First Trimester Women.