Simple Educational Intervention Research Articles

Boosting the Understanding and Approval of Anti-Corona Measures-Reducing Exponential Growth Bias and its Effects through Educational Nudges.

One major problem of compliance with anti‐coronavirus measures originates from the so‐called exponential growth bias, i.e. the cognitive distortion of systematically underestimating exponential growth and its consequences. We replicate an Amazon MTurk experiment regarding the spread of SARS‐CoV‐2 that was conducted in the general US population during the first wave of the pandemic in March 2020 dealing with this bias. Using a least‐likely‐design‐approach, we find a similarly strong bias in our sample of German students in November 2020. Nevertheless, this bias can be reduced by one simple educational intervention. Furthermore, participants who received these educational nudges showed a considerably higher approval rating for contact restrictions. This effect is robust to different analytical techniques and the inclusion of controls. Complementing political statements about the exponential spread of the virus – which often only mention the name of the phenomenon – with simple educational nudges could help the public better understand the need for encroachments on personal liberties.

Impact of implementing a Choosing Wisely educational intervention into clinical practice: The CW-SIMI study (a multicenter-controlled study)

To evaluate the impact of an educational intervention based on the Italian Society of Internal Medicine Choosing Wisely (CW-SIMI) recommendations. Multicenter, interventional, controlled study. Twenty-three acute-care hospital wards in Italy. 303 Physicians working in internal medicine wards. An online educational course. The rate of proton pump inhibitor (PPI) prescriptions, the number of days of central venous catheter (CVC) usage, and the duration of intravenous (IV) antibiotic prescriptions evaluated at one month (T1) and at six months (T2) after course completion. Patients admitted and discharged during a 30-day period before the educational intervention (T0, one year before T2) were considered the comparison group. A total of 232 physicians completed the course, while 71 did not attend the course. Data from 608, 662, and 555 patients were analyzed at T0, T1, and T2, respectively. The rate of PPI prescriptions declined at one month (RR: 0.67, 95% CI: 0.52-0.87, p=0.0005) and at six months (RR: 0.62, 95% CI: 0.46-0.84, p=0.003), and the number of days of CVC usage was reduced at six months (9.13 days at T0 vs. 5.52 days at T2, p=0.007). The duration of IV antibiotic prescriptions displayed a decreasing trend (7.94 days at T0 vs. 7.42 days at T2, p=0.081). A simple online educational intervention based on the CW-SIMI recommendations was associated with a clinically relevant reduction in the usage of PPIs and CVCs. Further studies are needed to confirm these findings and a possible benefit on patients' outcomes.

Accessing the potential impact of education about cancer screening programs: a pilot before and after study

Introduction In the context of the Public Health curricular unit, students were requested to choose a relevant theme within the scope of public health and to develop a field study involving the community and ideally draw an intervention impacting on their well-being. We identified breast, cervical and colorectal cancer as a priority [1]. Our aim was to evaluate the citizens’ knowledge about screening and then subsequently to raise their awareness of the importance of screening. Our ultimate goal was to increase knowledge by providing written information on the theme. Materials and methods We conducted a pilot before and after study aiming to involve 10% of the estimated sample (700 adult individuals; for an 11% increase [2], 5% Type I and 20% type II errors using Sample Size Calculator) living in the municipalities of Almada, Santarém and Lisboa. To evaluate their knowledge, we developed a 20-item questionnaire containing statements to be rated using a 4 point Likert scale, scored for a maximum of 80 points. We assessed knowledge at baseline and 48 h following the intervention. The intervention consisted of the delivery of a flyer containing general information on cervical cancer, breast cancer and colorectal cancer prevention and early detection means. Data analysis resorted to paired samples t-test using IBM SPSS Statistics, version 25.0, considering a 95% confidence interval. Results The sample included 70 people aged between 23 and 70 years, 73% female, with 56% having university education. Most respondents considered important to engage in screening programs, at both time points (70%); however, only 56% knew where these could be sought, as opposed to 68% following intervention. Mean baseline knowledge was 63.27 points, increasing to 73.54 post intervention, i.e. 10.27 points corresponding to a significant increase of 12.37% (p-value ≤ .05). Discussion and conclusions Our data suggests that through a very simple educational intervention it is possible to improve the population’s knowledge about cancer screening programs, with impacts exceeding previously reported studies [2]. We should acknowledge our sample is limited (10%) and probably biased as educational levels reported were quite high. This apparent limitation, however, suggests we may even produce greater differences targeting our intervention at lower literate individuals. Future studies should focus on the link between knowledge and behaviour as the literature suggests intention may have a role in mediating this association [3].

A Single Educational Intervention Improves Pregnancy-Related Knowledge and Emotional Health Among Women With IBD Who Are Pregnant or Wish to Conceive.

There is considerable interest in improving the education and care of women with inflammatory bowel disease (IBD) to improve pregnancy outcomes. Despite increased awareness, not all women with IBD have access to pregnancy-related education and the quality of counseling is variable. We aimed to assess the effectiveness of a simple educational intervention for improving pregnancy-related knowledge and to evaluate the effect of education on patient outcomes including anxiety, depression, and quality of life in women with IBD. This prospective study of women with IBD who were pregnant or planning a pregnancy evaluated the effectiveness of a single gastroenterologist-led educational intervention in improving pregnancy-related knowledge, measured using the Crohn's and Colitis Pregnancy Knowledge score 1 month postintervention. Secondary outcomes included the effect on anxiety and depression, quality of life, medication adherence, and patient satisfaction. One hundred women with IBD were recruited. Fifty percent were pregnant at the time of the intervention. Baseline knowledge scores were similar independent of the patients' pregnancy status or whether they had previously received counseling from their gastroenterologist. Median Crohn's and Colitis Pregnancy Knowledge scores postintervention (n = 82) were higher than preintervention scores (14/17 vs 10/17; P < 0.001). In addition, 32% of patients had poor knowledge at baseline (score ≤7/17), compared to only 5% after the intervention (P < 0.001). There was a significant improvement in total anxiety and depression and quality of life scores postintervention. Medication adherence and patient satisfaction were excellent. Uptake of this gastroenterologist-led educational intervention has the potential to improve pregnancy knowledge, promote medication adherence, and enhance quality of life for women with IBD globally.

Early Stroke Detection in Perioperative Patients: A Simple Educational Intervention and Feasibility Study

Background: Perioperative stroke is uncommon. However, it carries high morbidity and mortality. Unfortunately, the diagnosis is usually delayed resulting in reduced possibility for therapeutic intervention. Objective: To develop a protocol directed at shortening the time to detect neurological deficits in postoperative patients. Materials and Methods: By using a pre-post intervention design to evaluate the time to stroke recognition in post-open heart surgery patients. The intervention consisted of 1) A new protocol to evaluate new neurological deficits within 14 days after surgery, composed of six items of simple neurological assessment applied by CVT nurses during routine vital sign measurement. 2) An educational program for nurses, patients, and family focusing on postoperative stroke complications. Results: Between January 2014 and October 2015, the authors retrospectively reviewed 27 consecutive patients with acute neurological deficit within 14 days after surgery as the pre-intervention population. Twenty-seven consecutive patients with postoperative neurological deficits were enrolled during a post-intervention period, which was between November 2015 and September 2016. Comparing pre- and post-intervention periods, the authors found that stroke fast track activation was significantly increased from 4/27 (14.80%) to 15/27 (55.60%) (p=0.002). The median (min-max) duration from time last seen normal to first neurological deficit detection was reduced from 690 (19 to 9,190) to 130 (5 to 5,935) minutes (p=0.003). The number needed to treat for early detection when the protocol was used was 2.94. There was an increasing trend to endovascular treatment. Conclusion: Perioperative stroke is rare. However, it has negative impact to postoperative patients’ outcome. A simple protocol for postoperative neurological assessment after cardiac surgery is feasible to detect perioperative stroke. Keywords: Postoperative, In-hospital, Detection, Recognition, Stroke

Improving Knowledge of Lactation Compatibility of Antirheumatic Medications Among Providers Who Care for Patients With Rheumatic Disease.

ObjectiveWe sought to evaluate and improve knowledge of lactation compatibility of medications commonly used to treat rheumatic diseases among rheumatology, obstetric, and newborn providers practicing at an academic safety net hospital.MethodsBaseline knowledge of rheumatic disease medication compatibility with lactation among 49 providers was obtained via a multiple‐choice questionnaire. Following initial evaluation, providers were given a rheumatic diseases and lactation information card. The questionnaire was readministered at the time of card distribution and 5 months later.ResultsAt baseline, more rheumatology providers correctly identified a higher number of lactation‐compatible and noncompatible medications than nonrheumatology providers (78% and 65% vs 31% and 46%, respectively; P < 0.0001). After the intervention, rheumatology providers correctly identified lactation‐compatible and noncompatible medications 98% and 100% of the time, compared with 78% and 65% of the time before the intervention (P < 0.0001 and P < 0.0001). This improvement was durable because rheumatology providers correctly identified lactation‐compatible and noncompatible medications 96% and 98% of the time 5 months following the initial intervention (P = 0.0021 and P < 0.0001). Nonrheumatology providers correctly identified lactation‐compatible and noncompatible medications 31% and 46% of the time before the intervention and 95% and 100% of the time after the intervention (P < 0.0001 and P < 0.0001).ConclusionRheumatology providers had better baseline knowledge than obstetric and newborn providers of the breastfeeding compatibility of medications used to treat rheumatic diseases. However, all providers had knowledge gaps. After a simple educational intervention, the knowledge gap was significantly narrowed in all provider groups. This improvement was durable because repeat testing of the rheumatology provider subset 5 months post intervention continued to show significant improvement.

The effectiveness of a simple antimicrobial stewardship intervention in general practice in Australia: a pilot study

BackgroundInappropriate and excessive antimicrobial prescribing can lead to antimicrobial resistance. Antimicrobial Stewardship (AMS) principles are not well established in general practice in Australia despite the relatively high rate of community antimicrobial prescribing. Few interventions have been implemented that have resulted in a significant reduction or improvement in antimicrobial prescribing by General Practitioners (GPs). This study was therefore conducted to assess the impact of a novel GP educational intervention on the appropriateness of antimicrobial prescriptions as well as GP compliance with antimicrobial prescription guidelines.MethodsIn 2018, a simple GP educational intervention was rolled out in a large clinic with the aim of improving antimicrobial prescribing. It included face-to-face education sessions with GPs on AMS principles, antimicrobial resistance, current prescribing guidelines and microbiological testing. An antibiotic appropriateness audit on prescribing practice before and after the educational intervention was conducted. Data were summarised using percentages and compared across time points using Chi-squared tests and Poisson regression (results reported as risk ratios (RR) with 95% confidence intervals (CI)).ResultsData from 376 and 369 prescriptions in July 2016 and July 2018, respectively, were extracted. There were significant improvements in appropriate antimicrobial selection (73.9% vs 92.8%, RR = 1.26; 95% CI = 1.18–1.34), appropriate duration (53.1% vs 87.7%, RR = 1.65; 95% CI = 1.49–1.83) and compliance with guidelines (42.2% vs 58.5%, RR = 1.39, 95% CI = 1.19–1.61) post- intervention. Documentation of antimicrobial duration directions, patient follow-up as well as patient weight significantly increased after the intervention (p < 0.001). There was significant reduction in; prescriptions without a listed indication for antimicrobial therapy, prescriptions without appropriate accompanying microbiological tests and the provision of unnecessary repeat prescriptions (p < 0.001). Inappropriate antimicrobial prescriptions observed pre-intervention for medical termination of pregnancy ceased post-intervention.ConclusionsAuditing GP antimicrobial prescriptions identified prescribing practices inconsistent with Australian guidelines. However, implementation of a simple education program led to significantly improved antimicrobial prescribing by GPs. These findings indicate the important role of AMS and continued antimicrobial education within general practice.

Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections

Introduction In relation to wrist imaging, the accepted requirement is two orthogonal projections obtained at 90°, each with the wrist in neutral position. However, the literature and anecdotal experience suggests that this principle is not universally applied. Method This multiphase study was undertaken across eight different hospitals sites. Compliance with standard UK technique was confirmed if there was a change in ulna orientation between the dorsi-palmar (DP) and lateral wrist projections. A baseline evaluation for three days was randomly identified from the preceding three months. An educational intervention was implemented using a poster to demonstrate standard positioning. To measure the impact of the intervention, further evaluation took place at two weeks (early) and three months (late). Results Across the study phases, only a minority of radiographs demonstrated compliance with the standard technique, with an identical anatomical appearance of the distal ulna across the projections. Initial compliance was 16.8% ( n = 40/238), and this improved to 47.8% ( n = 77/161) post-intervention, but declined to 32.8% ( n = 41/125) within three months. The presence of pathology appeared to influence practice, with a greater proportion of those with an abnormal radiographic examination demonstrating a change in ulna appearances in the baseline cohort ( p &lt; 0.001) and the late post-intervention group ( p = 0.002) but not in the examinations performed two weeks after staff education ( p = 0.239). Conclusion Assessment of image quality is critical for diagnosis and treatment monitoring. Yet poor compliance with standard anatomical principles was evident. A simple educational intervention resulted in a transient improvement in wrist positioning, but the impact was not sustained over time.

Pilot Educational Intervention to Promote Safe Pesticide Use Practices Among Farmworkers in Nepal.

The misuse of pesticides among farmworkers in Nepal is commonplace. To address this, we implemented a pilot educational intervention (three modules delivered over 3 days and lasting approximately 3 h each) in Kavre District of Nepal. Modules included: (i) health and environmental effects of pesticides, (ii) use of personal protective equipment, and (iii) label literacy and behavioral factors that influence pesticide exposure. In addition, 10 posters with key messages from each of the modules were hung throughout communities. Surveys were administered to cross-sectional convenience samples of farmworkers at baseline (n = 106) and 1 year later (n = 98). Practices relating to pesticides at baseline and endline were compared using multivariable logistic regression to adjust for differences in demographic and socioeconomic characteristics between the samples. Compared with the baseline sample, farmworkers in the endline sample were significantly more likely to report: getting information regarding the amount of pesticides to use from experts or pesticide labels (versus personal judgment); wearing gloves while mixing pesticides; wearing boots while working in the field; using personal hygiene practices after handling pesticides such as bathing or washing hands and feet; changing clothes after handling pesticides; checking the wind direction before spraying; and delaying entry for a longer period of time after spraying. These results suggest that a simple educational intervention can improve pesticide handling practices among farmworkers in Nepal. Future research should explore the impact of such interventions on pesticide exposure levels and health outcomes, and the potential to scale up these programs nationally.

Inpatient Adherence to Topical Glaucoma Medications before and after an Educational Intervention

To assess the inpatient adherence rate and factors associated with adherence to topical glaucoma medications (TGMs) at a single academic institution throughout hospitalization before and after an educational intervention. Nonrandomized, comparative, retrospective study. Inpatients 18 years of age and older admitted to a single academic hospital from January 2014 through June 2019 with a diagnosis of glaucoma who also received TGMs. The medication administration record during admission was examined closely to determine if the TGMs were reconciled and administered correctly before and after an educational intervention with inpatient providers. A simple intervention reached various health care providers through an educational e-mail, communication in a weekly newsletter, and a morning report presentation. Adherence was defined as administration of more than 75% of recommended doses during the inpatient stay. Other collected variables included length of stay and primary diagnosis on admission. Adherence rate to inpatient administration of TGMs. One hundred eighty-four patients (n= 142 before intervention; n= 42 after intervention) were included. The preintervention group had a total of 275 TGMs, of which 207 (75.3%) were administered in accordance with the adherence definition of this study. After the intervention phase, 49 of 56 (87.5%) TGMs were administered with appropriate adherence (P= 0.047). Adherence was associated significantly with a known outpatient medication regimen (P= 0.006) and correct admission reconciliation (P < 0.001). When glaucoma patients requiring topical treatment are admitted, approximately one quarter of patients seem to not receive their medications appropriately. In this study, a simple educational intervention was able to improve adherence. To prevent daily fluctuations in intraocular pressure for vulnerable glaucoma patients, inpatient adherence to appropriate medication administration should be stressed continuously. While in the care of health care providers, inpatients should be afforded at least the opportunity to maintain adequate adherence, just as is carried out for other medications related to other chronic medical conditions.

Audit changes practice-a simple education intervention can lead to better outcome in ankle fracture surgery

BackgroundUnstable ankle fractures are common, and majority requires open reduction and internal fixation (ORIF). There is emerging evidence that the rate of malreduction has remained high despite advances in surgical techniques and implants. Malreduced ankle is a prominent cause of post-traumatic ankle arthritis leading to poor patient reported outcome. The aim of this study was to investigate the quality of anatomical reduction and surgical fixation of ankle fractures and the impact of simple education intervention on the quality of reduction of these fractures. MethodologyAn audit cycle was completed in two phases; retrospective review (phase 1) of 114 cases operated prior to an education intervention using infographic posters and then a prospective (phase 2) review of 96 consecutive cases operated after the education intervention. Data including age, fracture morphology, time to surgery, and the quality of reduction were assessed. The quality of anatomical reduction was evaluated using radiological parameters described by Pettrone. Paediatric, Weber A, pathological and open fractures were excluded. Education interventions included regional teaching and dissemination of infographic posters. Mann- Whitney U test and Chi-squared test were used to compare continuous and categorical data between phase 1 and 2 respectively. P value < 0.05 was considered significant. ResultsPhase one cohort showed malreduced fixation in 25% of cases. Inadequate restoration of fibular length was the most common type of malreduction. After implementation of education intervention, malreduction rate reduced to 9.4% in phase 2 (p = 0.015). There were no significant differences between age, gender, and time to surgery between phase one and two. ConclusionThis study demonstrates that simple education intervention can lead to better understanding of fixation and decrease the rate of malreduction of these fractures. We recommend that using Pettrone’s radiological criteria in correction of corresponding anatomy of ankle fracture is a useful tool to avoid malreduction.

Substantial and sustained improvement of serrated polyp detection after a simple educational intervention: results from a prospective controlled trial

ObjectiveSerrated polyps (SPs) are an important cause of postcolonoscopy colorectal cancers (PCCRCs), which is likely the result of suboptimal SP detection during colonoscopy. We assessed the long-term effect of a...

Foundation doctor knowledge of wounds and dressings is improved by a simple intervention: An audit cycle-based quality improvement study.

BackgroundMany foundation year 1 and 2 doctors (FYs) have limited knowledge experience in wound management. Wound dressing formularies exist in many NHS Trusts, though awareness of and adherence to them by FYs is not known. This quality improvement study described baseline FY knowledge of wound management, and investigated whether this could be improved through educational intervention.MethodsA single-centre, prospective, baseline audit was conducted following local approval. This assessed knowledge of wound types and appropriate dressings alongside individual confidence providing wound care. The educational intervention involved the distribution of an ID-badge sized quick reference guide that could be attached to the FYs' lanyards, and an introduction to the formulary during routine teaching. The audit loop was closed by repeating the questionnaire.ResultsPre- (n = 43) and post- (n = 35) intervention questions were completed by FYs. The mean score post-intervention was significantly higher than the pre-intervention score across all knowledge questions (from 32% correct to 71% correct, p < 0.0001). There was no change in participant confidence, which remained low.ConclusionFYs lack confidence and knowledge about wounds and dressings. The latter can be improved through a simple and practical educational intervention that could be deployed nationally.

Effects of an educational intervention on heart failure knowledge, self-care behaviors, and health-related quality of life of patients with heart failure: Exploring the role of depression

ObjectivesTo test effects of an educational intervention on patient-reported outcomes among rural heart failure (HF) patients and to examine whether effects differed between patients with and without depression. MethodsPatients (N = 614) were randomized to usual care (UC) or 1 of 2 intervention groups. Both intervention groups received face-to-face education, followed by either 2 phone calls (LITE) or biweekly calls until they demonstrated content competency (PLUS). Follow-up lasted 24 months. Statistical analyses included linear mixed models and subgroup analyses by depression status. ResultsBoth intervention groups showed improvement in HF knowledge at 3 months (LITE–UC, p = 0.003; PLUS–UC, p < 0.001). Improvement lasted 24 months only in the PLUS group. Compared to UC, both intervention groups exhibited better self-care at 3 months (LITE–UC, p < 0.001; PLUS–UC, p < 0.001) and 12 months (LITE–UC, p = 0.001; PLUS–UC, p = 0.002). There were no differences in health-related quality of life (HRQOL) among groups. In subgroup analyses, similar effects were found among non-depressed, but not among depressed patients. ConclusionThe educational intervention improved HF knowledge and self-care, but not HRQOL. No intervention effects were observed in patients with depressive symptoms. Practice ImplicationsThe simple educational intervention is promising to improve HF knowledge and self-care. Additional strategies are needed for depressed patients.

Hypertension and Health-Related Quality of Life: A Community Based Epidemiological Study in an Egyptian Village

Background: High blood pressure is the most important modifiable risk factor for stroke, associated with 54% episodes of stroke worldwide and 45% of Ischemic Heart Disease deaths are attributable to high systolic blood pressure. Aim of the work: To identify the prevalence rate of hypertension among adult inhabitants of Badaway village, Al-Mansoura District, Al-Dakahlia Governorate, to identify the epidemiological characteristics and risk factors of hypertension compared to non-hypertension individuals, to assess the (HRQOL) among hypertensive patients compared to non- hypertension individuals, and to evaluate the effect of an educational health program on health-related quality of life (HRQOL) among hypertensive patients. Subjects and methods: A study was conducted on 1100 of adult populations aged 30 years and older living at the studied village, A cross sectional study using questionnaire to assess the participant's HRQOL by SF-36 questionnaire, and interventional study included application of intervention program on hypertension group. Results: The total prevalence of hypertension was 28.2% of the total studied sample. The important predictor's factors were overweight, obese, older age, unmarried status, employment, and high socioeconomic level. The mean of Physical Component Summary and Mental Component Summary and their items of HRQOL were statistically higher among the normal group compared with hypertension group. The intervention program has a significant effect on improving means of PCS and MCS of HRQOL. Conclusion: Application of simple health education intervention program can lead to significant positive impact on knowledge, behaviors and HRQOL of hypertension patients.

Extended Follow-up of an Educational Intervention Encouraging Appropriate Use of Blood Transfusions

Introduction: A restrictive transfusion strategy of packed red blood cells (PRBCs) has been associated with at least non-inferior patient outcomes in a variety of clinical settings. In December 2014, we conducted an educational intervention which consisted of an oral presentation and computerized notifications at a single tertiary medical center. Objective: The aim of this study was to examine the long-term effects of a simple and low-cost educational intervention aimed to promote awareness to transfusion guidelines. Methods: We retrospectively analyzed all PRBC transfusions ordered between 2014 and 2017. The primary end point was defined as the percentage of PRBC transfused to patients with hemoglobin (Hb) ≥8 g/dL. Results: Between 2014 and 2017, a total of 27,475 PRBCs were transfused in our medical center. There was a continuous reduction in the percentage of PRBCs transfused at a Hb level ≥8 g/dL between 2014 and 2017, with a matching increase in the PRBC percentage trans­fused at Hb <7 g/dL (OR reduction of 42%, 95% CI 0.54–0.62 and OR increase of 68% [95% CI 1.56–1.81], respec­tively). Conclusion: A simple educational intervention likely contributed to sustained improvement in the appropriateness of PRBC transfusions.

Randomised controlled trial of an intervention to improve parental knowledge and management practices of fever

BackgroundWe know that parents require resources which can assist them to improve fever knowledge and management practices. The purpose of this study, using an RCT, was to examine the effectiveness of an information leaflet at increasing parental knowledge of fever, specifically temperature definition.MethodsA prospective, multi-centre, randomised, two-parallel arm, controlled trial with blinded outcome ascertainment was conducted. Parents presenting at purposively selected healthcare facilities who had a child aged ≤5 years of age were invited to participate. An information leaflet for use in the trial was designed based on previous studies with parents. Parents in the intervention arm read an information leaflet on fever and management of fever in children, completed a short questionnaire at Time 1 (T1) and again 2 weeks after randomisation at Time 2 (T2). Parents in the control arm did not receive the fever information leaflet but completed the same questionnaire as the intervention arm at T1 and againat T2. The primary outcome was the correct definition of fever (higher than ≥38 °C).ResultsA total of 100 parents participated in the study at T1. A greater proportion of the intervention group (76%) than the control group (28%) selected the correct temperature (≥38 °C) at T1. 76% of the intervention arm correctly identified “higher than ≥38°C” as the temperature at which a fever is said to be present compared to 28% of the control arm. After 2 weeks, there was an increase of 6% of parents in the intervention arm (increase to 82.4%) who gave the correct temperature compared to just a 2.8% increase in the control arm (increase to 30.8%). Univariate logistic regression showed that parents in the intervention arm were significantly more likely to give the correct answer at both time-points (T1: OR 8.1; CI 95% 3.3–19.9: p < 0.01; T2: OR 10.5; CI 95% 3.4–32.0: p < 0.01).ConclusionsOur RCT of this simple educational intervention has been shown to improve parental understanding of fever knowledge and correct management strategies. Education interventions providing simple, clear information is a key step to decreasing parental mismanagement of fever and febrile illness in children.Trial registrationClinicalTrials.gov NCT02903342, September 16, 2016, Retrospectively registered.

Effect of a quality improvement intervention to reduce the length of stay in appendicitis

AimDetermine the effect of an intervention to reduce the length of stay (LOS) in appendectomies. MethodsA four-quarter quality improvement initiative was developed after approval by the facility Quality Management Department, including educational sessions about the best practices regarding the hospital care for patients with appendicitis and recommendations to limit the LOS for no complicated appendicitis unless associated conditions were present, monitoring of the LOS and feedback to the staff and leaders. Results692 appendectomies were performed, 365 (52.7%)) of them during the intervention. The mean LOS was 3.94 days with a decreasing trend during the study period. The complicated appendicitis had a mean LOS of 6.42 days (SD, 3.85) during the baseline and 5.27 days (SD 2.50) during the intervention (p=0.03), representing a 17.9% reduction. The not complicated appendicitis during baseline had LOS of 3.82 days (SD 4.17) with a subsequent reduction to 2.95 days (SD 1.53) in the intervention. The total saving bed days during the intervention were 338.04 days, which 254.04 days (75.2%) were in non complicated appendectomies. One patient required readmission during the intervention because of an organ space surgical site infection, with proper recovery after antibiotic treatment. ConclusionOur study provides evidence about the possibility to optimize the bed use with a simple educational intervention, and should be considered a step to achieve additional reductions in the hospital stay of patients who undergo laparoscopic appendectomies.

An educational intervention to implement skin-to-skin contact and early breastfeeding in a rural hospital in Mexico

BackgroundEarly skin-to-skin contact promotes infant physiologic stability, provides warmth and makes breast milk readily available. Despite the known benefits of early skin-to-skin contact, this practice is not included within standard care in the Mexican public healthcare system. After birth, newborns are usually taken to an incubator in the nursery where they transition to extrauterine life and receive either dextrose 5% or infant formula for their first feed. The aim of this study was to assess if a dual educational intervention in a rural hospital in Mexico could modify current practice and accomplish early skin-to-skin contact and early breastfeeding.MethodsA two-step educational intervention was designed. The first step was to educate the labor and birthing staff of the hospital, and the second step was to educate all pregnant women with uncomplicated pregnancies at 36 weeks’ gestation. The educational intervention explored the benefits, implications and steps of early skin-to-skin contact and early breastfeeding. All births were registered for the three month period following the intervention. The time of onset of skin-to-skin (SSC) contact, its duration and time of initiation of breastfeeding were recorded and analyzed using ANOVA testing.ResultsA total of 142 births met our inclusion criteria, from those, 77% (n = 109) received skin-to-skin contact and early breastfeeding. The average time of initiation of skin-to-skin contact in the first and last month of the study was 18.5 (± 2.2) and 9.6 (± 2.2) minutes of life, respectively (p < 0.001). The average duration of SSC in the first and last month was 22 (± 10.9) and 40.9 (± 17.4) minutes, respectively (p < 0.001). The average time of onset of breastfeeding in the first and last month was 48.9 (± 15) and 34.4 (± 16.7) minutes of life, respectively (p < 0.001).ConclusionsA simple and low-cost educational intervention achieved the inclusion of skin-to-skin contact and early breastfeeding as part of standard care in a rural hospital. Further studies could replicate our intervention in similar settings to test the generalizability of the findings.

The effect of nutritional education and continuous monitoring on clinical symptoms, knowledge, and quality of life in patients with cirrhosis.

In this study, we aimed to evaluate the effectiveness of an educational intervention in patients with liver cirrhosis. Liver cirrhosis is end stage of liver diseases with many complications that affects quality of life and nutritional status in cirrhotic patients. Today, educational intervention and nutritional counseling is a key factor for preventing disease process and improving quality of life in patients with chronic diseases. This quasi-experimental, non-randomized, pre and post intervention were conducted as a pilot study on cirrhotic patients. Educational intervention and nutritional counseling were performed in clinical visits and via guide booklet. Chronic liver disease questionnaire (CLDQ) and knowledge questionnaire were used to assess patients' quality of life and knowledge. Blood samples were taken before and after intervention for assessment of laboratory outcomes. One hundred and seven patients referred to Research Center for enrolling in the trial. Twenty-eight did not meet inclusion criteria and seven patients were excluded from the study for lack of proper follow-up. Final analyses were done on 72 patients. Quality of life and knowledge of cirrhotic patients improved significantly after educational intervention (P < 0.0001). Biochemical characteristics were not changed significantly. Ascites and edema were improved significantly (P = 0.005 and P = 0.002, respectively). There was significant difference before and after intervention in the days of hospitalization (P = 0.001). We concluded a simple educational intervention and continuous monitoring for 6 months can affect clinical outcomes, quality of life, hospital admissions days, and knowledge of patients with cirrhosis.