Quasi-experimental Pre-post Study Research Articles

172. Does Passive Reporting of Streptococcus spp Identified by Rapid Molecular Assay Change Antibacterial Prescribing Compared to Gram Stain (GS) Alone?

Abstract Background At University of Virginia Health, the detection of Streptococcus spp via rapid molecular assay from blood cultures (BCx) was not historically reported in the EMR until the isolate was further identified. However this was reconsidered following anecdotal observation of inappropriate vancomycin (VAN) prescribing with GS alone. The purpose of this study was to investigate the impact of implementing passive reporting of Streptococcus spp on antibacterial prescribing patterns with a focus on VAN. Methods This was a single-center, pre-post quasi-experimental study of adult inpatients with non-duplicate Streptococcus spp identified via rapid molecular assay (ePlex®; GenMark Diagnostics) from BCx before (pre-intervention, Jul 2020 – Sep 2021) and after (post-intervention, Oct 2021 - Apr 2022) implementing passive reporting of Streptococcus spp. The primary outcome was any antibacterial switch within 24 hours of GS. VAN days of therapy (DOT) within 7 days and rates of Streptococcus spp deemed contamination by the primary team were also assessed. Results A total of 83 patients were included (58 pre- and 25 post-intervention). Baseline characteristics were similar including immunocompromised status (45% vs 52%), febrile neutropenia (28% vs 28%), and admission to a medical service (90% vs 96%). An antibacterial switch occurred within 24 hours of GS in 59% and 64% of the pre- and post-intervention groups, respectively, and was most commonly the addition of VAN (66% [25/38] vs 40% [8/20]; p=0.09). Fewer post-intervention patients continued VAN beyond 24 hours (66% vs 48%; p=0.15), but this was not statistically significant. The median VAN DOT remained unchanged at 2 days. A non-significant decrease in Streptococcus spp deemed contaminants was noted in the post-intervention arm (28% vs 16%; p=0.16). Finally, a non-streptococcal organism was isolated from concomitant BCx in approximately one-third of patients in each arm. Conclusion Passively reporting Streptococcus spp identified by rapid molecular assay without paired stewardship intervention did not impact antibacterial prescribing. The identification of Streptococcus spp may be characterized by heterogeneous circumstances requiring nuanced real-time stewardship intervention. Disclosures All Authors: No reported disclosures.

Effects of a sexuality education programme on young people’s STI/HIV knowledge, attitudes and risk behaviour in Northeast Nigeria

Objective: The high prevalence of sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) among Nigerian young people has been linked to poor knowledge, attitudes and risk behaviour. This study evaluated the effectiveness of a sexuality education programme (SEP) in improving adolescents’ STI/HIV knowledge and attitudes and reducing risk behaviour. Design: A quasi-experimental pre–post study was conducted. The experimental group ( n = 189) and comparison group ( n = 195) comprised senior secondary school students. Data were collected via a validated self-report questionnaire. A paired t-test, an independent t-test and a one-way between-group analysis of covariance (ANCOVA) were used to analyse the data. Setting: Three hundred eighty-four young people aged 15–20 years at low and high risk for STI/HIV infection participated in the SEP in a school setting in Northeast Nigeria. Results: There were significant post-intervention improvements in students’ knowledge, attitudes and practices in the experimental group ( p < .001). A t-test showed that after the SEP, the mean scores of STI/HIV knowledge (11.25 ± 3.39 vs 8.23 ± 3.60) and attitudes (29.63 ± 6.21 vs 35.38 ± 7.86) were significantly higher in the experimental group than that in the control group. Similarly, the mean risk behaviour score (6.83 ± 2.10 vs 5.64 ± 2.27) was higher in the experimental group than that in the control group post-intervention. Conclusion: The school-based SEP increases STI/HIV knowledge, improves positive attitudes and reduces STI/HIV risk behaviour among school young people in Nigeria.

The effect of catchment based mentorship on quality of maternal and newborn care in primary health care facilities in Tigray Region, Northern Ethiopia: A controlled quasi-experimental study.

In Ethiopia, quality of maternal and newborn care is poor. This situation has persisted, despite the wide implementation of several capacity building-oriented interventions including clinical mentoring for skilled birth attendants that were anticipated to translate in to high-quality maternal and newborn care on each encounter. The effectiveness of mentoring programs is not yet well documented in the research literature. Therefore, we evaluated the effect of a catchment based clinical mentorship in improving the quality of maternal and newborn care in primary level facilities of Tigray, Northern Ethiopia. We conducted a controlled quasi-experimental pre-post study among 19 primary health care facilities, with 10 facilities assigned to the group where the catchment based clinical mentorship program was implemented (intervention group), and 9 facilities to the control group. We assigned the group based on administrative criteria, number of deliveries in each facility, accessibility, and ease of implementation of the intervention. A sample of 1320 women(662 at baseline; 658 at post intervention) and 233 skilled birth attendants(121 at baseline and 112 at end line) were included. We collected data from mothers, skilled birth attendants and facilities. The first round of data collection (baseline) took place two weeks prior the inauguration of the intervention, 05 October to 04 November 2019. The end line data collection occurred from 22 May to 03 July 2020. The primary Outcome was "receipt quality of maternal/newborn care". We analyzed the data using difference in differences (DiD) and logistic regression with Generalized Estimating Equation. The level of significance of predictors was declared at p-value less than 0.05in the multivariable analysis. We deployed a team of local clinical mentors working at primary hospitals to provide clinical mentorship, and direct feedback in routine and emergency obstetrical and newborn care to the mentees (all skilled birth attendants performing maternal and newborn health services) functioning in their catchment rural health centers for duration of six months. While visiting a facility, mentors remain at the facility each lasting at least five to seven days per month, over the course of intervention period. A significantly higher proportion of women at intervention facilities received quality of care services, compared with women at comparison facilities. (DiD = 18.4%, p<0.001). Moreover, following the implementation of the intervention we detected a difference in the occurrences of maternal complication outcome during delivery and immediately after birth. This was decreased by 4.5%, with significant differences between intervention and comparison sites (DiD = 4.5%, p = 0.013). We also found a favorable difference in occurrences of neonatal obstetric complications, with a decrease of 4.8% in the intervention site and almost no change in the comparison site (DiD = 4.8%, p = 0.002). Among the determinants of quality of care, we found that providers' job satisfaction (AoR = 2.95, 95%CI: 1.26 to 6.91), and making case presentation at regular basis(AoR = 1.89, 95%CI: 1.05 to 3.39) were significantly associated to improve the quality of care. However, delivery load(AoR = 0.95, 95%CI: 0.93 to 0.98) was negatively associated with quality of care. We conclude that the catchment based clinical mentorship intervention is effective to improve quality of care and reduce childbirth complications in northern Ethiopia. This finding further elaborated that incorporating maternal and newborn health catchment based clinical mentorship activities into the existing health system strengthening strategies can catalyze improvement processes to quality practice and health systems. This is seen as a necessary step to achieve the effective quality universal health care required to meet the health-related Sustainable Development Goals. Besides, more attention needs to be given to develop interventions and strategies that directly enhance providers' job satisfaction and reduce delivery work load.

Effect of Disaster Preparedness Training on Knowledge Regarding Flood and Landslides Disaster Management among Family with Elderly

Elderly population is among vulnerable populations during disasters. This study aimed to assess the effect of disaster preparedness training on knowledge on flood and landslide disaster preparedness and management in families with elderly. This was a quasi-experimental pre-post study on 30 respondents participating in natural disaster preparedness training. A significant change in general knowledge on disaster, flood, and landslide (12.9, 20, and 12.4 points, respectively). Disaster preparedness practice was good as reflected in actions performed before, during, and after disaster. Before flood occurs, families prepare a disaster preparedness bag for important documents as well as logistics (food) for emergencies and equipment for evacuation while also store valuable goods in a safe place. During flood, families prioritize elderly evacuation while seeking information on the flood through neighbors, handy talky, handphone, television, and radio and ensure the availability of sufficient logistics. After disaster, families clean their properties and house; provide clean water and toilet facilities for the family; check the health of family members that may be impacted by the flood; and make sure that all electrical panels safe. Disaster training affects the knowledge of flood and landslide disaster management in families with elderly.

Effectiveness of Educational Program on Knowledge and Practices of Nurses Regarding Prevention of Diabetic Foot Ulcers at Tertiary Care Hospital, Lahore

Diabetes is a chronic disease that affects 4.2% of the world's population. Nurses effectively prevent foot ulcers and lower limb amputations by providing educational intervention and health care. Objective: To evaluate the effectiveness of a training program on nurses' knowledge and practices related to diabetic foot ulcer prevention. Methods: A quasi-experimental pre-post study was conducted in the diabetes clinic and medical departments of Sir Ganga Ram Hospital in Lahore, Pakistan. A total of 36 nurses were randomly selected. After obtaining informed consent, all female nurses aged 23 to 35 years with inadequate knowledge of diabetic foot ulcer prevention were included in the study. The nurses received a 16-week intervention. Nurses' knowledge was assessed using a validated instrument called the Nurses Knowledge Questionnaire related to Diabetic Foot Management Care and an observation checklist for nurses' practice related to neurovascular assessment of diabetic patients before and after the intervention. Data were entered and analyzed using SPSS version 24.0. Results: The results showed that most of the participants were from 26 to 30 years, 19 (52.8) were single with educational level of nursing diploma (50.0%). Participants were having 2 to 5 years of experience. After the intervention there were 4 (11.1%), 13 (36.1%) and 19 (52.8%) participants having poor, moderate and good knowledge respectively regarding prevention of diabetic foot ulcers. There was a significant difference between pre and post interventional score of practice and knowledge among nurses (p value &lt;0.001). Conclusions: Nurses have poor knowledge and practice regarding diabetic foot care but after the intervention it increases significantly.

MHealth program for patients with advanced cancer receiving treatment in a public health hospital in Brazil.

Previous studies have suggested the benefit of routine screening for biopsychosocial symptoms among patients with cancer. In recognition of the lack of data from low- and middle-income countries, this study sought to test and determine the effect of a mHealth program to screen biopsychological symptoms among patients with advanced breast or gynecological cancer. This was a quasi-experimental pre-post study conducted in a public hospital located in central western Brazil. Patients diagnosed with advanced breast of gynecological cancer who were about to initiate chemotherapy treatment at this institution and had access to Internet by smartphone, computer or tablet were invited to participate. Patients received training on using the app Comfort, a program developed to rate their physical and emotional symptoms during the 6-month of the proposed study. Patients were also asked to complete the EuroQOL 5D (EQ-5D-3L) every month. Mann-Whitney U test was used to determine differences among groups of patients (engaged and non-engaged). RM-ANOVA was used to determine the effect of time on mean visual analog scale (VAS) score. A total of 125 patients were recruited (median age=46.6years old, 41.6% married). Mostly, patients possessed lower levels of education and had relatively low monthly incomes. Notably, 67.2% of patients engaged with the Comfort program, and few patients (4%) withdrew due to lack of engagement with the program or issues with internet connection. In general, patients who engaged with the program reported improvement in physical and emotional symptoms (p<0.01), as well as in their overall quality of life (VAS; p=0.009), compared with patients who did not engage with the program. This is the first mHealth program developed in Brazil for patients in a low resource setting. Our findings suggest that Comfort could be an effective resource to assist patients and health care providers track symptoms and improve patients' quality of life.

Was there any delay in the treatment of breast cancer patients because of the COVID-19 stringency measures?

Abstract Background Healthcare systems across Europe reorganized services to provide attention to COVID-19 patients. In the event of the surge of cases, countries were forced to cancel or postpone non-urgent care. The objective of this work is to investigate whether there were time-to-treatment delays in breast cancer due to April-May 2020 restrictions, and whether the delays were permanent and different across countries. Methods Design: Quasi-experimental pre-post study with a historical control. Population: Virtually the universe of breast cancer patients receiving elective surgery, radiotherapy, hormonal therapy or chemotherapy since January 2017 (until December 2021) in the participant regions - Belgium, Marché (IT), Riga (LV), Portugal, Wales, and Aragon (ES). The main endpoint is the change in the median time-to-treatment before and after an empirical joint-point. The study variables are detailed here https://doi.org/10.5281/zenodo.5148022. Analysis: Distributed generalized additive models using https://cran.r-project.org/package=mgcv. Results Preliminary results show that the impact in March-April 2020 time-to-treatment evolved differently across countries. For instance, while the median time from diagnosis to surgery, as the first treatment, increased from approximately 39 days (2018-2019) to more than 45 days (2020-2021) in Wales, in the Marche region (IT) the median time decreased from 52 days in 2017-2019 to 47 days in 2020. Complete analyses for the rest of the participant countries are currently undergoing. Conclusions We have observed differences in time to treatment in women with breast cancer across countries; however, the magnitude and direction of the effect has been uneven across countries.

A longitudinal and multidesign epidemiological study to analyze the effect of the volcanic eruption of Tajogaite volcano (La Palma, Canary Islands). The ASHES study protocol

IntroductionVolcanic eruptions emit gases and particulate matter into the atmosphere which, if inhaled, can have an impact on health. The eruption of the volcano situated in the Cumbre Vieja Nature Reserve (La Palma, Canary Islands, Spain) affords a unique opportunity to study the effect of such a phenomenon on health. The aim of the proposed study is to assess the short-, medium- and long-term respiratory health effects of exposure to volcanic emissions from the eruption in three different population groups. MethodsWe propose to undertake a multidesign study: an ambispective cohort study to analyze the effect of the eruption on the general population, the highly exposed population, and the childhood population; and a pre-post quasi-experimental study on subjects with previously diagnosed respiratory diseases. The information will be collected using a personal interview, biologic specimens, air pollution data, data from medical records, respiratory tests and imaging tests. The study has an envisaged follow-up of five years, to run from the date of initial recruitment, with annual data-collection. This study has been approved by the Santa Cruz de Tenerife Provincial Research Ethics Committee (Canary Island Health Service) on March 10, 2022. ConclusionsThis study will make it possible to advance our knowledge of the effect a volcano eruption has on population health, both short- and long-term, and to assess the potential respiratory injury attributable to volcanic eruptions. It may serve as a model for future studies of new volcanic eruptions in the coming years.

P33 - Effects of an online education intervention on nursing students’ perceptions towards respectful maternity care

Respectful and dignified care is an essential component of quality midwifery care. The woman-midwife relationship can have a powerful influence on women’s childbirth experiences. Little is known about the effectiveness of education interventions to promote students’ understanding of respectful maternity care (RMC) in low- and middle-income countries (LMICs). To evaluate an online education intervention on nursing students’ perception of respectful maternity care during labour and childbirth. A quasi-experimental pre-post study design was used. Third year students (n = 89; intervention = 40; and control = 49) from three medical colleges in Nepal who had recently completed or were on their midwifery clinical practicum were recruited. Students in both groups completed online pre and post-test (2 weeks post-intervention) surveys. The intervention consisted of an online (synchronous) education module offered for two hours every week for three weeks. Outcome measures included the Students’ Perceptions of Respectful Maternity Care scale and open-ended questions about RMC. Analysis of covariance revealed a significant increase in scores on the Students Perceptions of Respectful Maternity Care scale (F (1, 86) = 28.19, p < 0.001, η p 2 = 0.25). Quantitative findings were complemented by qualitative data. Thematic analysis of the open-ended responses revealed three themes i) empowerment through RMC; ii) motivation to initiate change; and iii) becoming a respectful clinician. This small online education intervention was successful in promoting students’ perceptions towards RMC. This could enhance the culture of respectful care and ultimately improve quality of maternity care services. The online module can be easily integrated into other midwifery and nursing curricula and may be adapted for use as in-service education module for maternity care staff in LMICs.

Usefulness and Safety Evaluation of Chemotherapy Administration Device for Nurses: Experimental Study.

Antineoplastic drugs are considered high risk, and computerized systems favor safe administration. The objective of the study was to test the usefulness and safety of a new mobile device compared to the standard device for administering these antineoplastic treatments. This multicenter, quasi-experimental pre-post study assessed an intervention in two cancer centers in June and July 2020. Nineteen nurses participated by completing 57 questionnaires. The outcome variables were usefulness, ease of use, efficiency, safety, attitudes, and satisfaction with the new mobile device; they were measured by means of the USE questionnaire (Usefulness, Satisfaction, and Ease of use) and the Technology Attitude Survey (TAS). Professionals rated the new device higher than the standard device and showed a favorable attitude toward technology. The tested device was useful, effective, safe, and specific to the antineoplastic treatment administration process, garnering greater satisfaction among professionals than the standard. As new technologies can improve care for patients with cancer, it is essential to develop strategies to improve the experience of professionals for optimal implementation.

Investigating feasibility of 2021 WHO protocol for cervical cancer screening in underscreened populations: PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC)

BackgroundHigh-risk human papillomavirus (hrHPV) testing has been recommended by the World Health Organization as the primary screening test in cervical screening programs. The option of self-sampling for this screening method can potentially increase women’s participation. Designing screening programs to implement this method among underscreened populations will require contextualized evidence.MethodsPREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC) will use a multi-method approach to investigate the feasibility of implementing a cervical cancer screening strategy with hrHPV self-testing as the primary screening test in Bangladesh, India, Slovak Republic and Uganda. The primary outcomes of study include uptake and coverage of the screening program and adherence to follow-up. These outcomes will be evaluated through a pre-post quasi-experimental study design. Secondary objectives of the study include the analysis of client-related factors and health system factors related to cervical cancer screening, a validation study of an artificial intelligence decision support system and an economic evaluation of the screening strategy.DiscussionPRESCRIP-TEC aims to provide evidence regarding hrHPV self-testing and the World Health Organization’s recommendations for cervical cancer screening in a variety of settings, targeting vulnerable groups. The main quantitative findings of the project related to the impact on uptake and coverage of screening will be complemented by qualitative analyses of various determinants of successful implementation of screening. The study will also provide decision-makers with insights into economic aspects of implementing hrHPV self-testing, as well as evaluate the feasibility of using artificial intelligence for task-shifting in visual inspection with acetic acid.Trial registrationClinicalTrials.gov, NCT05234112. Registered 10 February 2022

Effect of Virtual Simulation Practice for Nursing Students: Focusing on Virtual Presence and Virtual Patient Learning System Evaluation (VPLSE)

Purpose: Since the COVID-19 pandemic, virtual simulation practice has been increasingly activated as an alternative to clinical practice in nursing colleges. This study aimed to provide basic data by confirming changes in self-efficacy and nursing knowledge in the virtual simulations of nursing students, and identifying virtual presence, virtual patient learning system evaluation (VPLSE), and practical satisfaction. Methods: This was a single-group pre-post quasi-experimental study. The subjects were 28 third-grade nursing students. Results: Self-efficacy and nursing knowledge increased significantly (p<.001). Virtual presence had a significant positive correlation with VPLSE) (p=.002) and practice satisfaction (p=.011). There was also a significant positive correlation between virtual simulation learning evaluation and practice satisfaction (p<.001). Conclusion: Based on these results, virtual simulation practice can be used with clinical practice as an educational method to improve nursing students' self-efficacy and nursing knowledge in nursing education. Virtual presence was confirmed as a significant variable to improve practice satisfaction and VPLSE. It is necessary to develop a virtual simulation program that can improve virtual presence through collaboration with virtual reality technology experts.

Effect of training provided on knowledge and attitude of reproductive health among adolescent students in Asmara, Eritrea, a quasi-experimental study

Background: The period of adolescence that is between 10 and 19 years of age is the time which largely shapes the future life of boys and girls. Adolescent girls are more likely to experiment sexual practice before they have knowledge of its subsequent consequences. Objective: This study aimed to assess the effect of training on the knowledge and attitude of female adolescent students towards reproductive health and emergency contraceptives. Methods: A school based single group pre-post quasi-experimental study design was employed in four secondary schools in Asmara on 140 female students. Trained data collectors during the pre-test, immediate post-test and three months later used a predesigned and pretested questionnaire to collect data regarding the knowledge and attitude via interview. Repeated measures ANOVA was used to make comparisons in knowledge and attitude scores using SPSS (Version 22). Results: Of all the study participants, a quarter (30.0 %) have heard of the methods of emergency contraceptives at the initial assessment. After training, three quarter (75.7%) of the students were able to have the correct knowledge. Life skill teachers at the school (57.9%) were mentioned as the primary source of information regarding reproductive health. The health education provided to adolescent females resulted in a significant increase on the mean scores of their knowledge from 6.57/13 (SD=2.08) pre-intervention to 9.26/13 (SD=2.14) immediate post intervention. However, the score declined significantly (p &lt;0.001) from immediate after intervention to 3 months’ follow-up by 0.80. Although the score declined, knowledge at 3 months’ follow-up was still significantly greater than that of pre-intervention (p&lt;0.0001). The percentage of participants who believe a girl should carry emergency contraceptives in her bag significantly improved from 52.3% to 86.2% after intervention. The mean (SD) scores of attitudes towards reproductive health significantly increased at three time periods. Mean (SD) scores at time 1 (pre-intervention), time 2 (immediate post) and time 3 (three-month follow-up) were 48.98 (4.68), 51.03 (4.04), and 49.65 (4.01) out of 69 respectively. Attitude score was significantly higher at immediate post intervention than pre-intervention (p&lt;0.001) and immediate post intervention than 3 months’ follow-up (p=0.001), but no significant difference existed between 3 months’ follow-up and pre-intervention (p=0.395). Conclusion: This research has yielded a valuable evidence that educational intervention can bring a significant increase in the knowledge and in introducing positive attitude towards reproductive health and usage of emergency contraceptives among adolescents. Reproductive health education with special emphasis on contraceptives should be part of the structured school curriculum to reach all students in the country with schools playing a leading role in coordinating the efforts of awareness creation.

Impact of End-of-Life Nursing Education Consortium on Palliative Care Knowledge and Attitudes Towards Care of Dying of Nurses in India: A Quasi-Experimental Pre-post Study.

Palliative care (PC) training is conspicuously absent in Indian nursing curricula which is an obstacle to deliver quality end of life care (EOLC). End of life care nursing education consortium (ELNEC) aims to improve nursing staff knowledge and attitudes in PC and EOLC, however its impact on knowledge and attitudes has not been investigated in India. We aimed to assess the impact of ELNEC on the knowledge and attitudes of nurses in India towards PC and care of the dying. This prospective study included 108 registered nurses. A pre- and post-training questionnaire containing Palliative Care Quiz of Nursing (PCQN) and Frommelt Attitude toward Care of the Dying Scale Form B (FATCOD-B) was used to evaluate the PC knowledge and attitudes towards EOLC respectively. Subgroup analysis to delineate association of baseline knowledge and attitudes with gender, educational qualification or professional experience of working with patients with cancer or chronic life limiting illnesses were done. Pre-test FATCOD-B and PCQN scores of 110.81 ± 9.37 and 8.45 ± 1.88 reflect favorable attitudes towards care of dying not backed by sufficient PC knowledge respectively. The mean PCQN and FATCOD-B scores improved from 8.45 ± 1.88 to 10.16 ± 1.89 (P = .0001) and from 110.81 ± 9.37 to 119.47 ± 10.14 (P = .0001) respectively; implying a statistically significant improvement in PC knowledge and a more positive attitudes towards care of the dying. End of life care nursing education consortium is effective in improving practicing nurses' knowledge and attitudes toward PC and care of the dying.

ASSESSMENT OF MULTIPLE CHOICE QUESTIONS TEST ITEM QUALITY AFTER POST EXAM ITEM ANALYSIS

Item analysis is the collection, summarization and utilizing information from students' responses to assess the quality of test items. The item statistics can distinguish between good items and those that need improvement or deletion from question bank. Our aim is to assess the quality of the summative Multiple Choice Questions (MCQs) for all courses of the M.B.B.Ch program before and after staff awareness campaign, College of Medicine, Taibah University, KSA, 2020. This study is a Quasi-experimental pre-post test study design and was conducted in 4 stages, collection of the MCQ exams, conduction of Awareness campaign on how to benet the post-exam item analysis, Re-collection and analysis of the post-exam item analysis and Finally, the results of the post exam item analysis of both academic years were compared to detect any changes in the items quality. showed that there were marked improvement of good quality items after awareness campaign especially in the Pre-clinicalResults courses than clinical ones IN Item analysis when regularly incorporated can help to develop a very useful, valid and a reliable questionConclusion bank by changing awed items either by rectied or deleted from the question bank

Effectiveness of an osteoporosis prevention educational program in Tunisian premenopausal women working in sedentary occupations: a quasi-experimental study.

The main purpose of the study was to evaluate the effectiveness of an osteoporosis prevention educational program on knowledge and perception of self-efficacy in adopting preventive osteoporosis behaviors in Tunisian premenopausal women working in sedentary occupations. A quasi-experimental pre-post intervention study design. Our study population was composed of female employees, aged 35-50years, of a company located in the industrial zone Sousse, situated in the center East of Tunisia. Three data collection methods were used: a questionnaire exploring socio-demographic characteristics and anthropometric measures, the Osteoporosis Knowledge Test, and the Osteoporosis Self-Efficacy Scale. The intervention consisted of an educational program relating to the promotion of calcium intake and physical activity. We are referred to the "Health Belief Model." A survey conducted on 97 women. Only 81 subjects completed the study and are included in data analyses. The total knowledge score regarding osteoporosis improved by + 14.57 which corresponds to percentage of 109% between the pre- (T1) and post-test (T2). This improvement in knowledge was statistically significant (p < 0.001), going from 13.41 ± 3.94 at T1 to 27.98 ± 2.49 at T2. The total osteoporosis self-efficacy score has increased by + 9.56, or a percentage of 15% between the pre- and post-test. This improvement in self-efficacy was statistically significant (p = 0.001), going from 64.18 ± 20.84 at T1 to 73.73 ± 14.35 at T2. It is important to create an appropriate environment for the adoption of favorable behaviors to healthy bones and to promote health education with political commitment and collaboration with different sectors.

Burden of Affected Persons with MRKH Syndrome: Effect of an Intervention to Support Surgical Neovaginal Placement

The diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), a rare variant of female sexual development, is usually made during puberty. The uncertainty in self-image and the impos-sibility of becoming pregnant often lead to considerable stress. Although psychosomatic support is consistently recommended in the literature, there have been only a few studies on the psychological aspects of MRKHS. The aim of the present study is to investigate the quality of life or distress of women with MRKHS undergoing neovaginal surgery and, on the other hand, to evaluate effects of the intervention for support during treatment. Methods In an explorative quasi-experimental pre-post study at a national centre for neovaginal surgery, all patients were offered a psychosomatic intervention (intervention group IG, n=23) and their sexual function (FSFI), psychological distress (PHQ-D) and health-related quality of life (SF-12) were assessed before surgery (t0) and six months after (t1). These were compared with data from a sample collected before and after the intervention period (comparison group VG, n=30). Results While the physical quality of life (SF-12) of both groups was unremarkable at both time points, there was a significant impairment in the psychological quality of life. Both groups (IG, VG) improved from t0 to t1 in their sexual function (FSFI) and showed lower depression scores (PHQ-D). The specific intervention developed was well accepted by those affected and rated as helpful. However, this subjectively perceived effectiveness of the intervention was not reflected by improvement on the quality of life scale (SF-12) and depression scale (PHQ-D). Conclusion Those affected show a clear, clinically relevant distress (SF-12), but this is not reflected in the form of psychological comorbidity (PHQ-D). This apparent discrepancy points to psychologically stable women with acute distress due to the diagnosis of variant sex de-evolution. For them, a low-threshold support service with a supportive character seems to be necessary and helpful during the surgical treatment. The reconstructive therapy for the creation of a neovagina seems to have a positive influence on the psychological quality of life. The fact that pregnancy is still not possible due to the missing uterus could be a reason for not reaching the quality of life of the average population.

Workplace Reintegration Facilitator Training Program for Mental Health Literacy and Workplace Attitudes of Public Safety Personnel: Pre-Post Pilot Cohort Study.

BackgroundPublic safety personnel (PSP) impacted by operational stress injuries can find themselves needing both time off work and support reintegrating back into the workforce. Work reintegration programs have been introduced in PSP organizations to support those who aim to return to work. One such peer-led workplace reintegration program (RP) was created in 2009 by members of the Edmonton Police Service (EPS). The primary goal of the EPSRP is to assist PSP in returning to work as soon as possible following a critical incident, illness, or injury while diminishing the potential for long-term psychological injury. The EPSRP is delivered by peers through 3 interrelated components: (1) the Reintegration Program Facilitator Training (RPFT) Program; (2) a short-term Critical Incident RP; and (3) a long-term RP. There is a dire need for research that incorporates strong study designs to the determine long-term effectiveness of the program on increasing workplace reintegration, improving mental health knowledge, and creating culture change within PSP organizations. Simultaneously, the efficacy, effectiveness, and fidelity of the RPFT in providing the tools, mental health knowledge, and skills the RP peer facilitators will need for the RP must be evaluated.ObjectiveThe purpose of this quasi-experimental pre-post pilot cohort study is to evaluate the effectiveness of the EPSRPFT course on influencing mental health knowledge and attitudes of RPFT attendees who will be future RP peer facilitators.MethodsThis pre-post cohort study collected data via 2 questionnaires from RPFT participants (N=60) which included the Mental Health Knowledge Survey (MAKS) and the Open Minds Survey of Workplace Attitudes (OMSWA). Descriptive, parametric (sample t tests), and nonparametric (Wilcoxon signed rank tests) statistics were used to compare the pre- and post-RPFT results and to analyze results by gender and profession.ResultsStatistically significant changes were observed in pre-post questionnaire scores in the domains of mental health attitudes and knowledge.ConclusionsAlthough results are explorative, the RPFT may facilitate positive changes in workplace mental health attitudes and knowledge among PSP. It is hoped these findings will contribute to a broader evidence base that can inform changes to the program, practices, and policies, and inform decision-making regarding the EPSRP.

Impact of medication therapy management interventions on drug therapy problems, medication adherence and treatment satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia: a one-group pre–post quasi-experimental study

ObjectiveTo determine the impact of medication therapy management interventions on drug therapy problems (DTPs), medication adherence and treatment satisfaction among ambulatory heart failure (HF) patients.Study design, setting and participantsA one-group...

Early Antibiotic Discontinuation or De-escalation in High-Risk Patients With AML With Febrile Neutropenia and Prolonged Neutropenia.

There is minimal data evaluating the safety of antibiotic de-escalation in patients with acute myeloid leukemia (AML) with fever and ongoing neutropenia. Therefore, this study evaluated antibiotic prescribing, infection-related outcomes, and patient outcomes of an antibiotic de-escalation initiative. This pre-post quasiexperimental study included adult patients with AML hospitalized with febrile neutropenia. An antibiotic de-escalation guideline was implemented in January 2017, which promoted de-escalation or discontinuation of intravenous antipseudomonal β-lactams. The primary outcome assessment was the incidence of bacterial infection in a historical control group before guideline implementation compared with an intervention group after guideline implementation. A total of 93 patients were included. Antibiotic de-escalation occurred more frequently in the intervention group (71.7% vs 7.5%; P<.001), which resulted in fewer days of therapy for intravenous antipseudomonal β-lactams (14 vs 25 days; P<.001). Thirty-day all-cause mortality and length of hospitalization were not different between groups. However, the intervention group had significantly fewer episodes of Clostridioides difficile colitis (5.7% vs 27.5%; P=.007). Implementation of an antibiotic de-escalation guideline resulted in decreased use of intravenous antipseudomonal β-lactams and fewer episodes of C difficile colitis, without adversely impacting patient outcomes. Additional studies are needed, preferably in the form of randomized controlled trials, to confirm these results.