Significant Improvement In Knowledge Scores Research Articles

Knowledge on prevention and management of Chronic Obstructive Pulmonary Disease and Asthma among medical officers: a multi-centerpre and post-test study

Background: Despite Chronic Obstructive Pulmonary Disease (COPD) and Asthma being one of the leading causes of morbidity and mortality in India, knowledge about these diseases among healthcare professionals seems inadequate. Aims: This study aimed to assess the knowledge gained by medical and paramedical staff in the prevention and management of COPD and asthma following a two-day training program. Settings and methods: This quasi-experimental (before-after) study was carried out among medical and paramedical staff of public health systems of the government of India in three training centers in Maharashtra. Aquestionnaire was given in the form of a pre-test before a two-day training program. The training was comprised of prevention and management of COPD and asthma. After completion of training, a post-test was given, and scores were calculated. Statistical analysis: A two-tailed paired sample t-test was used to assess knowledge gain. P<0.05 was considered statistically significant. Results: A total of 77 participants completed both pre-test and post-test before and after the training programme. Twenty-Five (32.5%) were female and 52 (67.5%) were male. The mean age of participants was 42.7± 7.9 years. The majority (92.2%) of the participants were medical professionals. Only nine participants (11.7%) had ever attended a training program on COPD or asthma. The mean pre-test score was 14.68±3.88, while the mean post-test score was 25.60±6.52. There was a statistically significant improvement in knowledge scores at all three training centers, among both genders and across all qualifications (p<0.001). Conclusion: Adequate training of medical and para-medical staff in public health systems across the country can result in effective and timely diagnosis, treatment, and referral for patients with COPD and Asthma. This will ensure a reduction in the social and economic burden of disease.

Immunization Simulation Using Actual-Size Infant Manikins for Medical Students in Indonesia

Introduction Manikins are tools used in simulation training for medical students to develop important skills, one of which is immunization. However, conventional manikins often do not resemble the actual size of an infant's arm or leg. This study aimed to determine the impact of using actual-size manikins on students' knowledge and practical skills, evaluate their confidence in immunization practice, and assess students' responses and feedback regarding the practice using actual-size manikins. Methods This was a quasi-experimental study involving medical students at the Faculty of Medicine, Universitas Indonesia, from October 2020 to April 2021. Students in the intervention group used newly developed actual-size infant arm and leg manikins, while the control group used conventional manikins. All students underwent the objective structured clinical examination (OSCE) and the scores were compared between the 2 groups. Within the intervention group, data on pretest and posttest scores, feedback questionnaires, and self-confidence assessments were also obtained and analyzed. Results A total of 205 students were included. Statistically significant difference was found in the OSCE scores between the intervention and control groups (P < 0.01). Students in the intervention group (n = 108) showed significant improvement in knowledge scores after the workshop (P < 0.01). Most students (81.7%) expressed confidence in administering vaccines to live patients after practicing with manikins. In addition, 98.2% of students (n = 107) acknowledged the benefits of practicing with actual-size manikins in accurately determining the injection sites. Conclusions Simulation with the actual-size manikins significantly improved students' knowledge and practical immunization skills, leading to increased confidence and competence in their immunization skills.

The Effect of an Educational Leaflet on Parents' Knowledge, Performance, and Self-Assessment Scores Regarding Oral Health Elements, with a Special Focus on Fluoride

Background: Increasing parental knowledge on dental health is crucial as it has a direct influence on their children's oral health and behavior related to oral care. While most parents exhibit positive attitudes towards preventive dental healthcare, there exists a level of uncertainty regarding several facets of oral care such as fluoride usage, sugar consumption, and more. Consequently, oral health education initiatives should explicitly emphasize various elements encompassing oral health. Objectives: The aim of the present research was to assess the impact of an educational leaflet on parents’ knowledge and performance regarding children’s dental health with a particular emphasis on fluoride. Methods: In this educational experimental study, parents of 124 children were assigned randomly to either a leaflet group (n=61) which received an educational pamphlet, or a control group (n=63) without any pamphlet. All participants were asked to complete a valid and reliable researcher-developed questionnaire both before the distribution of the pamphlet and one month after. The questionnaire consisted of four domains of demographic information, knowledge questions, performance questions and self-assessment questions. The results were analyzed using SPSS 21 via t-test and General linear regression model. Results: The participants' age ranged from 25 to 47 years. By the conclusion of our study, there was a significant improvement in knowledge scores for both groups (p<0.001), with the intervention group showing a more prominent increase compared to the control group (p<0.001) but there was no significant difference between the two groups regarding performance change. There was a statistically significant decrease in the self-assessment scores for both groups (p<0.001), but there was no significant difference between the intervention and control group (p=0.151). Conclusion: The use of the educational leaflet demonstrates effectiveness as a tool for oral health education.

Effects of Nutrition Education Program on Lactating Mothers in Relation to Infant Feeding Practices

Maternal and child health status is profoundly affected by infant feeding practices. In Pakistan, these practices are sub optimal which may lead to adverse outcomes. The initiation of breastfeeding within the first hour of birth, as well as good counseling of lactating mothers regarding infant weaning and introduction of complementary foods to the infants in a hygienic and clean environment, can decrease the risk of malnutrition and infections, leading to a decrease in infant morbidity and mortality. Increasing the awareness of mothers regarding recommended feeding practices is a key to improving this situation, especially in the region of South Asia. The current study was conducted with the aim of assessing the impacts of contextually developed nutrition education sessions on the knowledge and attitudes of women regarding infant feeding. A quasi experiment was conducted for this purpose. A sample of 400 lactating mothers between 20-30 years of age visiting a private post-natal clinic located in Lahore, Pakistan was selected. Half of the sample (200) was included in the experimental group and exposed to 12 weeks of educational intervention based on various audio-visual aids. Pretest and posttest knowledge and attitude scores of the women of both control and experimental groups were recorded. The results showed that women belonging to both control and experimental groups had similar knowledge regarding infant feeding at baseline (pretest). However, experimental group showed significant improvement in knowledge scores after intervention, as compared to control. The results also revealed that simple educational intervention can lead to profound improvements in maternal knowledge and attitudes regarding infant feeding. Increasing awareness is the first step in the translation of knowledge into practice. Therefore, similar interventions may be helpful in improving infant breast and complementary feeding practices. Effective implementation of nutrition education interventions that can improve the breastfeeding rates and also bring about improvement in complementary feeding practices is important for a developing country like Pakistan. This, in turn, may lead to better health outcomes for infants by reducing direct and indirect impacts of undernutrition.

Empowering Nursing Students to Prevent Medication Error-Related Harms: A Step Toward Improving Patient Safety.

Aim: Existing gaps in nursing curriculum particularly related to medication management such as administration and monitoring increase the propensity of nurses to commit medication errors during clinical practice. The present training program was conducted with an aim to sensitize and educate undergraduate nursing students on medication errors' related aspects. Methods: The participants were students pursuing bachelors nursing degree course (second and third year). The training "Medication errors: Role of Nurse practitioners" comprised of blended teaching methods such as theme lectures, hands on training exercises, small group case‑based learning, role plays, and nursing officer's practical experiences. The participants' knowledge and perception about medication errors were assessed at baseline (pre-intervention phase) and 1 week after program (post-intervention phase) with the help of a structured self-administered questionnaire in English language. Results: A total of 110 nursing students participated in the program. Post program there was a consistent increase in the number of correct responses to all knowledge-based questions with a significant improvement in knowledge scores from baseline [Baseline: (mean ± SD) 12.62 ± 2.33; Post-training: 18.52 ± 2.22; P < .001]. There was a positive change in the perception about medication errors among students. The participants rated the overall quality of program as excellent [66 (60%)] or very good [40 (36.4%)]. More than 90% agreed on its applicability in their future practice. Conclusions: The training was quite successful in educating nursing students on medication errors. There is a constant need to educate nurses and other healthcare providers including doctors and pharmacists on medication safety related aspects with an ultimate goal to improve patient safety.

Exploring the Impact of Simulation on Nursing students' Knowledge and Skills during Basic and Advanced Cardiac Life Support Training in Saudi Arabia

Introduction: Basic life support (BLS) and advanced cardiac life support (ACLS) training is crucial for healthcare providers to respond effectively to cardiac emergencies. Simulation-based training has been shown to improve knowledge and skills in nursing students during BLS and ACLS training. Objective: The objective of this study was to review the literature on the impact of simulation-based training on nurses' and nursing students' knowledge and skills during BLS and ACLS training in Arab countries and internationally. Methods: A literature search was conducted in several databases, including PubMed, CINAHL, and Scopus. The search was limited to articles published, written in English, and conducted in Saudi Arabia. Two articles met the inclusion criteria and were included in the review. Results: The reviewed studies reported significant improvements in knowledge scores, ability to respond to cardiac arrest scenarios, and confidence in skills among nursing students who participated in simulation-based training. However, challenges in implementing simulation-based training were reported, including lack of resources, time constraints, and resistance to change. Conclusion: The findings of the reviewed literature suggest that simulation-based training can be an effective tool for improving nurses' and nursing students' knowledge and skills during BLS and ACLS training in both Arab countries and internationally. The use of simulation-based training in nursing education has several advantages, including providing a safe and controlled environment for practicing skills, promoting critical thinking and decision-making, and allowing for repetitive practice. However, challenges in implementing simulation-based training need to be addressed, and strategies for effectively integrating simulation-based training into nursing education programs need to be explored.

Intervention to improve acute care nurses confidence and knowledge in hospital dementia care

ProblemAcute care nurses are the front line of hospital care for persons with dementia (PwD), yet many have inadequate dementia education and lack the confidence to appropriately manage PwD in the hospital setting. ImplementationTwo acute care units with high rates of PwD in a large tertiary-care hospital were provided an education intervention involving interactive case-based discussion of the challenges of inpatient dementia care. ResultsOut of 190 nurses, 171 completed a one-hour virtual educational session, 142 completed pre/post-session confidence surveys, and 123 completed pre/post-session knowledge tests. There was a statistically significant improvement in knowledge scores from 75.8% pre-session to 88.4% post-session (p < 0.001), and pre/post-session dementia care confidence increased from 3.49 to 4.44 ( + 27.22%; p < 0.001) ConclusionAn interactive virtual education intervention improves acute care nurses’ confidence and knowledge in managing PwD in the acute care setting and may improve hospital outcomes for this population.

An educational program on antimicrobial resistance and stewardship for staff nurses in a public tertiary care hospital in India.

Nurses, the largest group among healthcare professionals, hold a pivotal position to positively influence antimicrobial management by virtue of being in constant touch with patients and their widespread engagement in multiple activities relating to antimicrobial use. However, the existing gap in nursing curriculum particularly in areas related to antimicrobial resistance and optimal use of these agents limits the clinical application of nurses' skills and pose barrier to their contribution towards achieving desirable outcomes in patient care. This training program was conducted to increase the nurses' awareness on antimicrobial resistance (AMR) and sensitize them on their role in optimal antimicrobial management and stewardship activities. Training comprised of 4 modules focussing on topics like key concepts on antimicrobials, AMR, infection prevention and control, antibiotic allergy, optimal use of antibiotics and antimicrobial stewardship (AS). The participants' knowledge at baseline and 1 week after program were assessed. 190 nurses participated in the program. Post program there was a consistent increase in the number of correct responses to all knowledge-based questions pertaining to 4 modules. A significant improvement in knowledge scores for all modules from baseline was also seen. The participants rated the overall quality of program as very good and agreed on its applicability in their practice. The training program was quite successful in educating nurses on critical issues related to AMR and AS. Nurses need to be constantly trained and sensitized for their potential contributions in the field of AMR and stewardship.

Lessons Learned from POCUS Instruction in Undergraduate Medicine During the COVID-19 Pandemic.

Point of care Ultrasound (POCUS) has been adopted into clinical practice across many fields of medicine. Undergraduate medical education programs have recognized the need to incorporate POCUS training into their curricula, traditionally done in small groups with in-person sessions. This method is resource intensive and requires sufficient equipment and expertise. These requirements are often cited as barriers for implementation. During the Coronavirus Disease 2019 (COVID-19) pandemic, POCUS education was required to adapt to physical distancing regulations, giving rise to novel teaching methods for POCUS. This article outlines the implementation of a POCUS teaching session before and during the pandemic. It describes how these innovations can scale POCUS teaching and overcome barriers moving forward. A flipped classroom model was implemented for all learners. Learners were given an introductory POCUS module before the scheduled in-person or virtual teaching session. Sixty-nine learners participated in conventional in-person teaching, while twenty-two learners participated in virtual teaching following the pandemic-related restrictions. Learners completed a written test before and following the teaching. In-person learners were assessed using an objective structured assessment of ultrasound skills (OSAUS) pre- and post-learning sessions. A follow-up survey was conducted three years after the teaching sessions were completed. Both in-person and virtual groups demonstrated statistically significant improvement in knowledge scores (p <0.0001). Both groups had similar post-test learning scores (74.2 ± 13.6% vs. 71.8 ± 14.5 %, respectively). On follow-up questionnaires, respondents indicate that they found our online and in-person modes of teaching helpful during their residency. POCUS education continues to face a variety of barriers, including limitations in infrastructure and expertise. This study describes an adapted POCUS teaching model that is scalable, uses minimal infrastructure and retains the interactivity of conventional small-group POCUS teaching. This program can serve as a blueprint for other institutions offering POCUS teaching, especially when conventional teaching methods are limited.

Role Reversal Between Trainees and Surgeons: Improving Autonomy and Confidence in Surgical Residents

IntroductionThere are increasing concerns regarding resident autonomy in the context of efficiency, legal ramifications, patient expectations and patient safety. However, autonomy is necessary to develop competent, independent surgeons. Therefore, educational paradigms that maximize opportunities for entrustability without sacrificing patient safety are necessary to ensure adequate training for surgeons. MethodsThis is a prospective, qualitative study of intraoperative role reversal between surgeons and residents. Using Likert scales and binary questions, preintervention and postintervention surveys were collected, evaluating variables including intraoperative learning, decision making, communication, confidence, autonomy and opportunity for safe struggle. The Mann-Whitney U test was used to analyze results and compare responses between training years. ResultsThirty-six general surgery residents comprising post-graduate year 1, 2, 4, and 5 acted as primary surgeon in a total of 36 cases. Preoperative knowledge scores were significantly higher in more senior residents (P < 0.001), but all residents had significant improvement in knowledge scores postoperatively (P < 0.001). The knowledge improvement was quantitatively larger for junior versus senior residents. Intraoperative decision making significantly improved after the intervention for all training levels (P < 0.001). 25 intraoperative “rescues” were performed by faculty for failure to progress or unsafe conditions (23 for junior residents, 2 for senior residents). Residents indicated that this intraoperative role reversal improved preparation, confidence, autonomy, and intraoperative communication. ConclusionsIntraoperative role reversal between residents and surgeons provides a safe opportunity for maximizing learning and increasing entrustability under direct supervision.

Decision Aid on Orthopedic Virtual Care: Patient Preferences in Orthopedic Hand Clinic.

Introduction: The objectives of this study are to develop a decision aid for orthopedic patients to decide between virtual or in-person care and assess patient preferences for these modalities in hand clinic. Methods: An orthopedic virtual care decision aid was developed alongside orthopedic surgeons and a virtual care expert. Subject participation involved 5 steps: Orientation, Memory, and Concentration Test (OMCT), knowledge pretest, decision aid, postdecision aid questionnaire, and Decisional Conflict Scale (DCS) assessment. Patients presenting to hand clinic were initially provided the OMCT to assess decision-making capacity, with those failing excluded. Subjects were then administered a pretest to assess their understanding of virtual and in-person care. Subsequently, the validated decision aid was provided to patients, after which a postdecision aid questionnaire and DCS assessment were administered. Results: This study enrolled 124 patients. Pre- to postdecision aid knowledge test scores increased by 15.3% (p < 0.0001), and the average patient DCS score was 18.6. After reading the decision aid, 47.6% of patients believed that virtual and in-person care provided similar physician interaction, 46.0% felt little difference in effectiveness between the modalities, and 39.5% had no preference for either. Most patients understood their options (79.8%) and were ready to make a care modality decision (65.4%) following decision aid administration. Conclusion: Significant improvements in knowledge scores, strong DCS scores, and high levels of understanding and decision-making readiness support decision aid validity. Hand patients appear to have no consensus preferences for care modality, emphasizing the need for a decision aid to help determine individual care preferences.

Addressing the Endometriosis Knowledge Gap for Improved Clinical Care—A Cross-Sectional Pre- and Post-Educational-Intervention Study among Pakistani Women

This study explored the baseline knowledge and symptoms associated with endometriosis, educated women about endometriosis, and documented the improvement in endometriosis knowledge. A brief intervention with an educational brochure on endometriosis was administered among 303 female participants. A paired-sample t-test and one-way ANOVA were run to compute endometriosis knowledge scores. In total, 49.5% of the participants had consistent access to annual healthcare, 25.1% were healthcare workers, and 45.2% had an undergraduate education. The entire sample had a pre-test endometriosis knowledge score of 4.2 (SD = 2.48), and the score was 6.3 (SD = 2.3) on the post-test. One-way ANOVA yielded no significant improvement in knowledge scores across the groups with consistent and inconsistent access to annual healthcare, despite a significant overall increase in scores (t = 16.63, df = 302, p < 0.001). We identified a significant improvement in the knowledge concerning endometriosis. Educational strategies among women who are menstruating are essential for addressing diagnostic delays and bridging the endometriosis knowledge gap.

Early Stages of Human Embryology: A Quasi-experimental Study from South Kerala, India

Introduction: Physical models are being used in embryology lectures along with PowerPoint presentations to improve the spatial orientation of students. But the demonstration of the sequence of changes is not possible with commercial models due to nonavailability and high expenses. The latest audio-visual aids including three-dimensional projections like simulation-based screens, or virtual reality enhance the visual-spatial ability of the students but are very costly and not affordable for all institutions. Aim: To compare the effectiveness of hand-made physical models with the PowerPoint presentation mode of teaching in understanding the 3D concept of embryology, among first-year MBBS students and to assess the students’ perception of this model-based teaching. Materials and Methods: The study was conducted using a quasi-experimental study design, on 218 phase 1 medical students of Government Medical College, Thiruvananthapuram, Kerala, India, from February 2020 to August 2020. The students were divided into two equal groups. Group B was taught the topic “Second week of embryonic life” with a PowerPoint lecture session (n=109) and the Group A had in addition a demonstration with the handmade models (n=109). Pretest and post-test were conducted with an internally validated questionnaire. Feedback on the student’s acceptance of teaching/ learning with models were also collected. The improvement of the test scores was analysed using paired t-tests in both the test and control groups. Results: Statistically significant improvement in knowledge score was obtained while comparing the post-test scores of the intervention group (mean score was 4.83±2) with that of the non intervention group (mean score was 3.99±2.06) (student’s t-test, p-value &lt;0.05). It was observed, 99.1% of students were satisfied with this model-assisted teaching, especially with the series of models demonstrating the sequence of events. A 93.1% of students said that they needed such model-assisted lectures in other subjects also. Conclusion: Series of models pertaining to a particular event is beneficial and effective for learning complex concepts of embryology. Also, it’s a long-lasting, innovative mode of teaching which can be done cost-effectively

Effectiveness of an Instructional Module on Knowledge and Anxiety of Caregivers of Children Undergoing Cardiac Catheterization – An Experimental Study

Background: Diagnosis of cardiovascular disorders in children is a very stressful time for the entire family. During this period family caregivers are anxious about their child’s condition. At this time, nurses play an important role to educate the parents or caregivers about the child’s health, procedure that has to be performed, and pre- and post-operative care after procedure. This study was conducted to assess the effectiveness of an “instructional module” on knowledge and anxiety of caregivers of children undergoing cardiac catheterization. Materials and Methods: Caregivers of children with congenital heart disease were randomly enrolled in two groups with 30 caregivers in each control and experimental group. Preoperative knowledge and anxiety in both the groups were assessed by a self-structured questionnaire and the State-Trait Anxiety Inventory. An instructional module in the form of a booklet regarding cardiac catheterization was developed and administered to the experimental group while the control group received routine care instuctions. Caregivers’ postintervention knowledge was assessed by a structured knowledge questionnaire. Results: Median knowledge score was 2 (2–2) in the control group and 2 (1–2) in the experimental group among caregivers of the children during preintervention phase. The median anxiety score of the caregivers of children underwent cardiac catheterization during preintervention phase was 57.50 (47–61) in the control group and 53 (47.75–56) in the experimental group. The results revealed that there was a significant improvement in knowledge score regarding cardiac catheterization procedure and also there was reduction in the level of anxiety among caregivers in the postintervention experimental group (P &lt; 0.001). Conclusion: The study suggests that the “instructional module” is effective in reducing the anxiety and improving the knowledge levels of caregivers regarding the preoperative and postoperative care of children who underwent cardiac catheterization.

Blended Oncology Nursing Training: A Quality Initiative in East Africa

Lack of education and awareness about cancer treatment may result in suboptimal care of patients with cancer. Unlike high-income countries, resource-limited countries lack the standardized training and scope of practice in oncology nursing. This quality improvement project was conducted to assess nurses' knowledge gain, retention of knowledge and clinical skill set, and feasibility of a blended learning approach in the care of adult oncology patients across four hospitals in Kenya and Tanzania. We used a combination of computer-led eLearning sessions and face-to-face interactions over 12 months for cancer education to oncology nurses. Pre- and posttests with each training session were combined with face-to-face clinical skills training at beginning and completion of the course. A comprehensive postassessment was conducted immediately after the training, and at 6, 9, and 12 months to evaluate knowledge gain and retention. Of 21 participants across four sites, there was a statistically significant improvement in knowledge scores for 12 participants (P value < .05). The mean pre- and posttest results found significant differences across 10 sessions individually and cumulatively (P value < .01). Results from a one-way repeated measures analysis of variance (ANOVA) test on comprehensive test results suggested that there was no significant difference in knowledge retention across 9 months (F(2, 30) = 1.648412, P > .05). Blended learning is an effective tool in improving knowledge, skills, and self-efficacy for clinicians practicing in resource-limited countries. Developing a structured oncology training program has implications for bridging knowledge gaps among clinicians in resource-limited countries and promoting international knowledge exchange.

Socio-culturally adapted educational videos increase maternal and newborn health knowledge in pregnant women and female community health volunteers in Nepal's Khotang district.

Objectives:While Nepal has made significant improvements in maternal and newborn health overall, the lack of maternal and newborn health–related knowledge in the more rural parts of the country has led to significant disparities in terms of both maternal and newborn health service utilization and maternal and newborn health outcomes. This study aimed to assess whether viewing culturally adapted maternal and newborn health educational films had a positive impact on (1) the maternal and newborn health knowledge levels among pregnant women and (2) the postpartum hemorrhage–related knowledge levels among Female Community Health Volunteers in rural Nepal.Methods:Four locations were selected for their remoteness and comparatively high number of pregnancies. A convenience sample of 101 pregnant women and 39 Female Community Health Volunteers were enrolled in the study. A pre- and post-test design was employed to assess this intervention. Paired t-tests were used to analyze the change in number of correct responses by knowledge domain for multi-film participants, producing a numeric “mean knowledge score,” and McNemar’s tests were used to calculate the change and significance among select questions grouped into distinct themes, domains, and points of “maternal and newborn health–related knowledge” based on the priorities outlined in Nepal’s maternal and newborn health 2030 goals.Results:There was a significant improvement in knowledge scores on maternal and newborn health issues after watching the educational films for both types of participants. The mean knowledge score for pregnant women improved from 10 to 15 (P < 0.001) for the Understanding Antenatal Care (ANC) film, 3 to 10 (P < 0.001) for the Warning Sign in Pregnancy film, and 6 to 14 (P < 0.001) for the Newborn Care film. For the Female Community Health Volunteers, knowledge also significantly improved (P < 0.05) in all except one category after watching the postpartum hemorrhage film. The percent that correctly answered when to administer misoprostol (80%−95%) was the only variable in which knowledge improvement was not significant (P < 0.057).Conclusion:Using culturally adapted educational films is an effective intervention to improve short-term maternal and newborn health–related knowledge among rural populations with low educational levels. The authors recommend additional larger-scale trials of this type of intervention in Nepal and other low- and middle-income countries to determine the impact on long-term maternal and newborn health knowledge and behaviors among rural populations.

Feasibility of a Novel Real-Time Provider Teaching Intervention in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

BackgroundIt is not known whether an intervention using real-time provider teaching in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) improves provider knowledge and/or patient outcomes.ObjectiveTo pilot the combination of a novel, real-time provider teaching intervention delivered by subspecialists to Internal Medicine trainees with a traditional patient education and medication reconciliation (PEMR) intervention and to assess the impact of these interventions on provider knowledge regarding COPD and patient care.MethodsThis was a single-center, nonrandomized, quality-improvement study. Patients admitted with AECOPD were prospectively identified between June 19 and November 20, 2019. Patients with asthma, lung cancer, or interstitial lung disease were excluded. The primary care team received a novel intervention featuring in-person, real-time teaching, covering Global Initiative on Chronic Obstructive Lung Disease COPD groups and management, including pulmonary rehabilitation referral. Providers completed a knowledge assessment before and after their real-time teaching session. Provider knowledge scores before and after teaching were compared using McNemar’s test. Patients received a traditional PEMR intervention from a nurse practitioner and/or clinical pharmacist. A retrospective chart review was conducted for 50 historical control patients admitted with AECOPD to obtain preintervention rates of discharge on long-acting bronchodilators and referral to pulmonary rehabilitation. The proportions of patients discharged on long-acting bronchodilators and referred to pulmonary rehabilitation in the intervention group were compared with the preintervention historical control patients using chi-square testing.ResultsSeventy-one providers caring for patients with AECOPD received real-time teaching. Postintervention, there was significant improvement in knowledge scores pertaining to Global Initiative on Chronic Obstructive Lung Disease groups and exacerbation risk (81% correct vs. 43% on pretest; P < 0.001) and guideline-directed treatment (83% correct vs. 28% on pretest; P < 0.001). Out of 44 eligible patients, 75% (n = 33 patients) received the PEMR intervention. Ninety percent of patients (n = 40 patients) were discharged on any long-acting inhaler, similar to the group of preintervention control subjects. Pulmonary rehabilitation referrals were made for 50% of patients (n = 22 patients) compared with 6% of preintervention control subjects (n = 3 patients; P < 0.001).ConclusionIn this single-center quality-improvement study, the combination of a novel, real-time provider teaching intervention and a traditional PEMR intervention improved provider knowledge and was associated with increased referrals to pulmonary rehabilitation.

The feasibility and effect of a nurse-led, patient-centered asthma education program in a Nigerian context

Rationale, aims and objectives Insufficient asthma education is an unmet need in Nigeria. We aimed to assess the feasibility of a nurse-led asthma education program and its effect on asthma knowledge and outcomes in Lagos, Nigeria. Methods Using a quasi-experimental study design, we recruited participants ≥12 years with physician diagnosed asthma. We assessed asthma knowledge, asthma control, medication adherence, health related quality of life and inhaler technique and also measured lung function. A trained nurse delivered asthma education sessions during the regular clinic visits and demonstrated correct inhaler technique. All assessments were repeated at 3-month. Data was analyzed with descriptive and inferential statistics. A p-value of <0.05 was considered significant for all associations. Results Of the 80 participants at baseline, 42 (52.5%) completed the follow-up assessment and were included in the outcome analysis. Their ages ranged from 12 to 75 years, 35 (83.3%) were ≥18 years old and 30 (71.4%) were females. There was significant improvement in knowledge score immediately post intervention (15.48 ± 3.05 versus 18.33 ± 2.21, p < 0.001) and at 3 months (17.52 ± 2.63, p < 0.001). Those with uncontrolled asthma (Asthma Control Test score ≤19) had a meaningful (3.8-point) change in ACT score at follow-up. The improvement in the mean score on the Morisky Medication Adherence Scale was significant (p = 0.03), but a change of 0.48 was not considered meaningful. There was significant (p < 0.001) and meaningful (1.08) improvement in Mini Asthma Quality of Life score at 3 months. Pre-bronchodilator FEV1% predicted and scores on the inhaler technique check list for the Diskus and pressurized meter dose inhaler did not significantly change at follow-up (p = 0.38, 0.26 and 0.80 respectively). Conclusion It is practicable for nurses to deliver effective asthma education during regular clinic visits in our practice setting. This training could meaningfully improve asthma control and health related quality of life.

Effect of educational progressive web application on patient's oral and denture knowledge and hygiene: A randomised controlled trial.

This study aimed to evaluate the effect of a novel progressive web application (PWA) on the patient's oral and denture knowledge and hygiene. Fifty-two removable partial denture wearers were randomised to receive education using the PWA, or verbal instructions accompanied by demonstration of hygienic procedures. Changes in the participants' knowledge score, plaque index, gingival index and denture plaque was evaluated during a follow-up period of 3 months. The participants' acceptance of PWA was explored through usage logs and a feedback form. Both groups showed significant improvement in knowledge scores, oral and denture hygiene indices (p < 0.001) after education. The PWA group demonstrated significantly lower gingival index score than control (p = 0.008) at the third month review. In conclusion, there is potential of using mobile application in educating elderly patients and the PWA is a viable option for providing post-denture delivery instructions.

Helping Mothers Survive: Program Evaluation and Early Outcomes of Maternal Care Training in the Dominican Republic.

Introduction: In 2017, approximately 295,000 women died during and immediately following pregnancy and childbirth worldwide, with 94% of these deaths occurring in low-resource settings. The Dominican Republic (DR) exhibits one of the highest maternal mortality ratios in the region of Latin America and the Caribbean despite the fact that 99% of registered births in the country are reportedly attended by a skilled birth attendant. This paradox implies that programs to support healthcare worker knowledge and skills improvement are vital to improving maternal health outcomes in the DR. Helping Mothers Survive (HMS) is a provider training program developed by Jhpiego and global partners. The goal of HMS is to combat maternal mortality by contributing to quality improvement efforts that reinforce maternal health skills of local healthcare workers.Methods: An international, multisectoral group of stakeholders collaborated in the implementation of two HMS curricula, Bleeding After Birth (BAB) and pre-eclampsia & eclampsia (PE&E). Demographic information as well as pre- and post-training knowledge scores were recorded for each participant. Knowledge score improvement was assessed in order to support effectiveness of the program on knowledge acquisition of healthcare workers.Results: Three hundred and twenty healthcare workers participated in the HMS training workshops between October 2016–August 2020. Of the 320 participants, 132 were trained as master trainers. The majority of participants identified as attending physicians, followed by residents/interns, nurses, students, and “other.” A significant improvement in knowledge scores was observed for both the BAB and PE&E curricula, with a 21.24 and 30.25% change in average score (pre- to post-test), respectively. In response to COVID-19 pandemic restrictions, flexibility of the local team led to a PE&E virtual training pilot workshop in August 2020.Discussion/Conclusions: Simulation-based training improved the knowledge levels of healthcare workers for both HMS curricula. These results suggest that simulation-based workshops have an impact on knowledge acquisition and skills of healthcare workers immediately following training. For the PE&E curriculum, no significant difference in knowledge acquisition was observed between in-person and virtual training sessions. The ongoing pandemic poses challenges to program implementation; however, these preliminary results provide evidence that conducting virtual workshops may be a viable alternative to in-person training.