Training Of Healthcare Professionals Research Articles

Driving sustainability in enteral tube feeding through virtual training of healthcare professionals

Driving sustainability in enteral tube feeding through virtual training of healthcare professionals

Rollout of a statewide Australian telestroke network including virtual reality training is associated with improved hyperacute stroke workflow metrics and thrombolysis rate

BackgroundTelestroke networks aim to address variability in both quality and access to stroke care in rural areas, by providing remote access to expert stroke neurologists. Implementation of telestroke requires adaptation of workflow processes and education. We previously developed virtual reality (VR) workflow training and documented acceptability, utility and feasibility. The effects on acute stroke treatment metrics have not been previously described.AimsThe overall aim was to improve hyperacute stroke metrics and shorten the time-to-reperfusion therapy administration in rural settings.MethodsThis study applies a natural experiment approach, collecting stroke metric data during transition from a pre-existing pilot to a statewide telestroke service at five rural hospitals. Pre- and post-intervention data included baseline patient demographics and assessment, diagnosis, and treatment delivery metrics. The primary study outcome was door-to-decision time (thrombolysis and endovascular thrombectomy). Secondary outcomes included door-to-computerized tomography time, door-to-thrombolysis time and proportion of patients receiving thrombolysis or thrombectomy treatment. Usage data relating to the VR stroke workflow training of interprofessional healthcare professionals was automatically captured via Wi-Fi. Statistical comparisons of clinical metrics between the pre- and post-intervention time periods, defined as the timeframes before and after VR deployment, were performed.ResultsA total of 2,683 patients were included (April 2013–December 2022); 1910 pre- and 773 post-intervention. All acute stroke time metrics significantly improved post-intervention. The primary outcome, door-to-decision time, decreased from 80 min [56–118] to 54 min [40–76; P < 0.001]. Secondary outcomes also improved, including door-to-thrombolysis time (90 min [68–114] vs. 68.5 min [54–90]; P < 0.001) and proportion of patients thrombolysed (11 vs. 16%; P < 0.001). The proportion of patients transferred for thrombectomy was unchanged (6 vs. 7%; P = 0.69). Seventy VR sessions totaling 15 h 39 min of training time were logged. VR training usage varied across sites (3–31 sessions per site).ConclusionsDelivery of a multi-factorial intervention including infrastructure, funding, education and training (with VR workflow training) as part of a state-wide telestroke rollout was associated with improved acute stroke treatment metrics. Additional work is required to identify the contribution of each intervention component on clinical outcomes and to increase training uptake and sustainment.

Using co-design methods to develop new personalised support for people living with Long Covid: The 'LISTEN' intervention.

Many Covid-19 survivors are living with unresolved, relapsingand remitting symptoms and no 'one size' of treatment is likely to be effective for everyone. Supported self-management for the varied symptoms of Long Covid (LC) is recommended by the National Institute for Health and Care Excellence in the United Kingdom. We aimed to develop a new personalised support intervention for people living with LC using a structured co-design framework to guide replication and evaluation. We used the improvement methodology, Experience-Based Co-Design, in an accelerated form to harness the collective experiences of people with LC. Incorporating evidence from 'Bridges Self-Management' (Bridges) an approach in which healthcare professionals (HCPs)are trained to support knowledge, confidence and skills of individuals living with long term conditions. Co-designed resources are also central to Bridges. Adults who self-identified as living with or recovered from LC, from England or Wales, aged 18 years and over were recruited, and HCPs, with experience of supporting people with LC. Participants took part in a series of small co-design group meetings and larger mixed meetings to agree priorities, core principles and generate resources and intervention content. People with LC (n = 28), and HCPs (n = 9) supported co-design of a book (hard-copy and digital form) to be used in 1:1 support sessions with a trained HCP. Co-design stages prioritised stories about physical symptoms first, and psychological and social challenges which followed, nonlinear journeys and reconceptualising stability as progress, rich descriptions of strategiesand links to reputable advice and support for navigating healthcare services. Co-design enabled formulation of eight core intervention principles which underpinned the training and language used by HCPs and fidelity assessments. We have developed a new personalised support intervention, with core principles to be used in one-to-one sessions delivered by trained HCPs, with a new co-designed book as a prompt to build personalised strategies and plans using narratives, ideas, and solutions from other people with LC. Effectiveness and cost effectiveness of the 'LISTEN' intervention will be evaluated in a randomised controlled trial set within the context of the updated Framework for Developing and Evaluating Complex Interventions. The LISTEN Public and Patient Involvement (PPI) group comprised seven people living with LC. They all contributed to the design of this study and five members were part of a larger co-design community described in this paper. They have contributed to this paper by interpreting stages of intervention design and analysis of results. Three members of our PPI group are co-authors of this paper.

Challenges to Alzheimer Care in Pakistan

Madam, Alzheimer's, the prime culprit behind Dementia, is a neurodegenerative disorder that gradually erases memory and cognition, affecting daily tasks 1. Symptoms often emerge in later years, and in Pakistan, where a rising aging population and middle-income status prevail, the risk amplifies. By 2030, global dementia cases can soar to 1.3 million from 850,000 in 2015, surging to 3.6 million by 2050 without preventive action 2. Urgent attention beckons. Yet, challenges abound. With Pakistan’s depleting literacy rate currently of 58.9% in 2023, misconceptions are likely 3. Stigma, cultural norms, and language barriers shroud the path to treatment. Moreover, mental health issues like depression, an Alzheimer’s symptom, are seen as taboo, deterring help-seeking. Till date, the lack of national databases stifles research progress, and a shortage of neurologists-just less than 150 for millions of people-worsens with scarce training programs4. Private caretakers in this developing country may be limited. As this chronic Alzheimer's has no cure, high drug costs hinder adherence, while the affordability of the new "Leqembi" drug, if approved, raises concerns. Additionally, access to MRI and CT scanning equipment in Pakistan is not widespread and their procurement along with testing entail significant costs. Furthermore, government policies and funding for Alzheimer's treatment and research might be insufficient with the rising aging population. NGOs in Pakistan related to Alzheimers are very limited- “Alzheimers Pakistan” the one and only centered in just three regions across this vast country. Solutions for these challenges emerge as vibrant threads. How can we aid patients and families in Alzheimer education? Imagine engaging workshops and media partnerships with prominent figures like the UNICEF Goodwill ambassadors thereby igniting a good community-healthcare bond, and envision ‘Alzheimer homes’ for patients lacking caregivers. Besides, a national database involving stakeholders, from NGOs to healthcare providers, can not only pave the way for easy data accessibility but also to proper treatment plans and protocols. Engaging these stakeholders could also lead to initiatives for more affordable medicines. For the shortage of neurologists, medical tourism initiatives that attract foreign neurologists to work temporarily in the country, sharing their expertise and contributing to healthcare delivery can be deployed. Targeted training for healthcare professionals and collaborating with international organizations for increased research, clinical trial participation and even in machinery purchase hold a promise to resolving this issue. Conclusively, emphasizing these concerns holds utmost significance in the pursuit of discovering effective interventions for this incurable ailment.

Effectively teaching cultural competence in a pre-professional healthcare curriculum

BackgroundThere has been research documenting the rising numbers of racial and ethnic minority groups in the United States. With this rise, there is increasing concern over the health disparities that often affect these populations. Attention has turned to how clinicians can improve health outcomes and how the need exists to educate healthcare professionals on the practice of cultural competence. Here we present one successful approach for teaching cultural competence in the healthcare curriculum with the development of an educational session on cultural competence consisting of case-based, role-play exercises, class group discussions, online discussion boards, and a lecture PowerPoint presentation.MethodsCultural competence sessions were delivered in a pre-dental master’s program to 178 students between 2017 and 2020. From 2017 to 2019, the sessions were implemented as in-person, case-based, role-play exercises. In 2020, due to in-person limitations caused by the COVID-19 pandemic, students were asked to read the role-play cases and provide a reflection response using the online Blackboard Learn discussion board platform. Evaluation of each session was performed using post-session survey data.ResultsSelf-reported results from 2017 to 2020 revealed that the role-play exercises improved participant’s understanding of components of cultural competence such as communication in patient encounters (95%), building rapport with patients (94%), improving patient interview skills (95%), and recognition of students own cultural biases when working with patients (93%).ConclusionsStudents were able to expand their cultural awareness and humility after completion of both iterations of the course session from 2017 to 2019 and 2020. This session can be an effective method for training healthcare professionals on cultural competence.

Optimizing ventilatory support in ARDS: A comprehensive guide for ICU nurses on patient care

The emergence of COVID-19 as a global pandemic has placed an unprecedented strain on healthcare systems worldwide, highlighting a critical shortage of trained healthcare professionals equipped to manage such a crisis. This deficit poses a significant challenge to the delivery of healthcare services, particularly in the context of intensive care units (ICUs) where the use of advanced medical technologies, such as ventilators, is paramount. For nurses with limited experience in ICU settings, navigating the complexities of invasive positive pressure ventilation (IPPV), a principal method of mechanical ventilation for critically ill patients can be daunting. This article aims to serve as a comprehensive guide for nurses less familiar with the intricacies of managing patients on IPPV, offering insights and strategies to enhance their competence and confidence in this critical aspect of patient care.

Implementation of the MiNDToolkit intervention for the management of behavioral symptoms in MND by healthcare professionals: a mixed-methods process evaluation

Objective MiNDToolkit is a novel psychoeducational intervention for carers to support management of behavioral symptoms in people living with motor neuron disease (PlwMND). Implementation of MiNDToolkit involves delivery of an online intervention to carers, which is reinforced by trained healthcare professionals (HCPs). Methods A mixed-methods process evaluation of the MiNDToolkit feasibility trial was conducted, focusing on reinforcement of the intervention by HCPs. Quantitative data, descriptively analyzed, were included from platform analytics, questionnaire, and 10 semi-structured interviews with HCPs. Interviews were transcribed verbatim; data were inductively analyzed using Reflective Thematic Analysis. Results The MiNDToolkit training and platform is a beneficial and acceptable resource for HCPs with potential to increase knowledge and confidence in identifying and managing behavioral symptoms in MND. Implementation barriers included HCPs’ perceptions that highlighting behavior changes would be burdensome to carers and assumptions that carers would take the initiative to ask for support from clinicians. Degree of intervention reinforcement varied, with most HCPs delegating intervention delivery solely to the online platform. Conclusions Implementation of the MiNDToolkit was viewed to be feasible and the platform thought to increase accessibility of support to carers. The flexible approach to delivery (online platform and optional HCP reinforcement) is acceptable as an intervention for supporting carers of PlwMND with behavioral symptoms. However, MiNDToolkit should not negate HCP involvement in providing medical and practical information to PlwMND and families. Future research should explore ways to incorporate support for carers in the management of PlwMND alongside standard care, alongside tools such as the MiNDToolkit.

Barriers and facilitators to health professionals' engagement in quality improvement initiatives: a mixed-methods systematic review.

Quality improvement (QI) initiatives in healthcare are crucial for enhancing service quality and healthcare outcomes. The success of these initiatives depends on the active engagement of healthcare professionals, which can be influenced by several factors within the healthcare system. This systematic review synthesized the factors influencing healthcare professionals' engagement in QI projects, focusing on identifying both barriers and facilitators. A mixed methods systematic review (MMSR) was conducted using the JBI methodology for MMSR. Databases such as MEDLINE, CINAHL, Scopus, and Embase were searched for studies that explored barriers and facilitators to QI engagement of health professionals in the clinical setting. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). The extracted data were synthesized using the JBI convergent integrated approach to MMSR. Eighteen studies (seven qualitative, nine quantitative, and two mixed-methods) published between 2007 and 2023 were included in the review. The analysis revealed barriers and facilitators to engagement in QI initiatives at different levels of the health system. At the QI program level, the engagement of health professionals to QI was influenced by the approach to QI, evidence underpinning the QI initiative, QI knowledge and training, and access to QI specialists. At the health professional level, barriers and facilitators were related to their organizational role, motivation, perceptions about QI, and collaborations with individuals and groups. At the organizational level, factors related to culture and climate, leadership, available resources (including human resource and workload, infrastructure, and incentives), and institutional priorities influenced health professionals' participation in QI. This review highlights the complex interplay of organizational, individual, and QI program level factors that influence the engagement of healthcare professionals in QI. Overcoming these complex barriers and leveraging facilitators is crucial for enhancing participation in QI efforts. The findings underscore the need for a multi-level strategy that focuses on creating a conducive organizational culture, providing robust leadership, and ensuring adequate resources and training for healthcare professionals. Such strategies hold the potential to enhance the effectiveness and sustainability of QI initiatives in healthcare settings.

Empowering Sustainable Healthcare: The Role of Health Literacy

The imperative of sustainability in healthcare is becoming more pressing due to global health crises, climate change, and the rising burden of chronic diseases. Sustainability in healthcare involves social, economic, and environmental dimensions, each important for equitable and robust healthcare delivery. Health literacy may play a central role in embracing all three dimensions, bridging the gap between complex health information and individuals’ capability to understand and use it effectively: In fact, as a factor influencing the link between adverse social and economic conditions and subsequent health issues, health literacy could represent a practical target for mitigating health disparities within various demographic groups, thereby enhancing social sustainability. Furthermore, when people possess a solid understanding of their health conditions and the necessary steps for health management, they can contribute to a reduction in generated healthcare costs. Finally, health literacy and environmental health literacy equips individuals and communities with the knowledge and skills to understand how environmental factors affect health and empowers them to take proactive measures to protect the environment, potentially reducing the environmental impact of healthcare services. Therefore, integrating health literacy into education curricula and healthcare professional training is crucial for promoting sustainability. Despite some known barriers to the advancement and improvement of health literacy, such as limited awareness of its importance, the collaboration between academia, healthcare institutions, and community organizations is a path to follow to overcome these challenges.

The psychosocial health of sexual and gender minority people with anal and colorectal cancer: a mixed methods study.

Sexual and gender minority (SGM) cancer survivors have poorer psychosocial health than their heterosexual cisgender counterparts. Nevertheless, most research has focused on breast and prostate survivors. It is unknown how different gastrointestinal (GI) cancers affect the psychosocial well-being of SGM individuals. We (1) described the psychosocial health of SGM people with GI cancers and (2) identified differences in psychosocial health outcomes by cancer type. We conducted a concurrent mixed-methods secondary analysis with identical samples (n = 295) using data from "OUT: The National Cancer Survey." Likert-type and open-ended questions about demographics, satisfaction with care, social support, and access to mental health resources were included in the analysis. Poor mental health was the primary outcome. Quantitative (linear regression) and qualitative (thematic analysis) data were independently analyzed, then integrated through the narrative, weaving approach. Three concepts emerged after data integration, (1) positive and negative influences on the psychological well-being of the participants; (2) social adaptations with the participants' friends, partners, and family members; and (3) additional factors affecting the psychosocial well-being during and after cancer, particularly interactions with providers, comorbidities, and treatment side effects. Clinical characteristics, demographic factors, and culturally responsive care influenced the psychosocial health of SGM survivors of GI cancers. Participants developed their own coping strategies and advocated for the SGM community. Interventions promoting peer support and self-esteem are a priority for this population. Healthcare professional training should incorporate historical trauma awareness and assess the delivery of culturally responsive care.

Can the spirit of motivational interviewing be taught online? A comparative study in general practitioners.

ObjectiveMotivational Interviewing (MI) is an evidence-based approach to enhance patients' motivation and is increasingly in demand in medical practice. Online teaching methods offer advantages to train health care professionals, but only very few studies examined whether MI-specific interviewing skills (""MI-skills""), and especially MIspecific attitudes (the "MI-spirit"), can be taught online and whether learning gains differ from those in face-to-face courses. This study compared the effects of 7 h of basic training for experienced general practitioners (GP) in either an online or a traditional face-to-face format with a non-trained control group. Methods"MI-skills" and "MI-spirit" were measured in a prospective analysis in 49 experienced GPs before and one week after training ResultsAn ANOVA on gain-scores demonstrated significant differences between groups in both MI-specific skills (VASE-R, p = 0.006) and "MIspirit" (MIKAT, p = 0.029; HRQ, p < 0.001) from pre- to posttest. Post-hoc comparisons revealed significant improvement only in the training groups (VASE-R, p < 0.001; MIKAT, p = 0.014 for online, p = 0.003 for face-to-face; HRQ, p < 0.001). ConclusionThe results suggest similar effects of both online and face-to-face training of "MI-skills" and "MI-spirit" to GPs. Practice Implication: Online learning opportunities should be integrated in MIT programs for general practitioners where appropriate.

Geriatric health care in rural India: HR issues and public policy constraints

Purpose The purpose of this paper is to emphasize the need for holistic geriatric health care in rural India. Many older people in Indian villages suffer from chronic ailments without any relief or intervention because of inaccessible and unaffordable health-care services. This paper explores how holistic health care can be assured for older people in Indian villages. Design/methodology/approach This paper is based on reflections of the authors who have had experiences as caregivers to older persons within their respective families rooted in the Indian villages. Besides, they interacted with 30 older persons (18 males and 12 females in the age group of 60–80 years) living in the villages in three states of India, namely, Haryana, Rajasthan and Madhya Pradesh to develop a comprehensive viewpoint on the need of geriatric health care in rural India. Relevant reports, newspaper articles and research papers were also reviewed while developing viewpoints on such an important topic. Findings Geriatric health-care facilities in rural India are abysmal. The older people in the villages cannot leverage health-care facilities that are generally inaccessible, inadequate and unaffordable. Even the government support for medical treatment is minuscule. Furthermore, there is lack of trained health-care professionals at all levels, namely, doctors, nurses and paramedic personnel. Training opportunities in geriatrics are also negligible. The scenario vis-à-vis geriatric health care in rural India can be upturned by increasing public spending on health-care infrastructure, increasing numbers of health-care professionals and expanding training programmes in geriatrics. Originality/value This paper is based on the critical reflections of the authors as well as their informal interactions with some of the older people in the Indian villages.

Enhancing stroke care in Ghana: A systematic review of stroke rehabilitation services

ObjectiveIn Ghana, the shifting demographics of stroke incidence towards young adults have prompted the expansion of stroke care and rehabilitation efforts. Nevertheless, the precise impact of stroke rehabilitation remains unclear. We conducted a systematic review to explore the landscape and effects of stroke rehabilitation in Ghana. MethodWe identified articles on stroke rehabilitation services in Ghana through searches of PubMed, Scopus, Embase, and Web of Science from inception until February 2024. The Critical Appraisal Skills Programme (CASP) Qualitative Checklist was employed to assess the risk of bias in the included studies, supplemented by qualitative synthesis. ResultsAmong the 213 articles screened, 8 were deemed suitable for review. These studies primarily focused on two groups: stroke survivors (n = 335) and healthcare professionals (HCPs) (n = 257). Many stroke survivors reported significant benefits from telerehabilitation, with increased participation in rehabilitation activities correlating with improved physical and cognitive outcomes. The findings also underscored a lack of knowledge about stroke rehabilitation among HCPs, alongside variations in the availability of protocols and guidelines for stroke management across different hospital levels. ConclusionsThe review reveals several challenges in stroke rehabilitation in Ghana, including disparities in HCPs' perceptions and utilization of rehabilitation services. The findings emphasize the need for comprehensive, patient-centered approaches, standardized training for HCPs, improved resource allocation, and the integration of telehealth to overcome barriers and enhance stroke rehabilitation in Ghana. These insights hold significance not only for Ghana but also for guiding strategies in similar contexts worldwide, aiming to improve stroke rehabilitation outcomes.

Evaluation of treatment and long-term management of anaphylaxis in pediatric departments of Greece: a 2-year nationwide survey.

Anaphylaxis proportions of incidence are increasing globally. However, limited data are available regarding anaphylaxis in the pediatric population of Greece. The aim of the study was to evaluate management of anaphylaxis in Greek pediatric departments. We performed a questionnaire-based study of children aged less than 16 years presenting with anaphylaxis in 10 national pediatric hospitals over a period of 2 years. Management of anaphylaxis was assessed prior to and after an informative intervention. In all, 127 cases of anaphylaxis were identified. Epinephrine was administered in almost half of all cases (51.2%), predominantly through intramuscular route (88.5%), while the majority of anaphylaxis patients were treated with antihistamines (92.9%) and corticosteroids (70.1%). Epinephrine was more likely administered by physicians if the elicitor was a drug (P < 0.003). Regarding long-term management, an epinephrine auto-injector was prescribed in 66.9% of patients. Follow-up information was available for most of the patients (92.9%), the majority of whom (76.3%) were referred to an allergist. More than half of these patients (63.6%) had a documented allergy follow-up, which identified a causative allergen in 53.3% of cases. No statistically significant differences were recorded prior to and after the intervention regarding management of anaphylaxis. This nationwide study highlighted the necessity of further improvement in terms of anaphylaxis treatment and secondary prevention measures. This presupposes appropriate education and training of healthcare professionals, thus contributing to proper and comprehensive care of the pediatric population.

Technology-Mediated Learning in Higher Education Physiology Classes: The Use of MeGli App to Teach Glycemic Control

Glycemic control is a fundamental physiological concept in diabetes and obesity. Proper training of healthcare professionals in this content is essential for disease prevention and management. Active learning methods, including technology-mediated learning (TML), are important for effective education and student engagement. Given the complexity of physiology, educational technology can facilitate the visualization of its dynamic processes. Thus, we've developed the MeGli smartphone application as an educational tool to teach glycemic control and related conditions, aimed at undergraduate students in health and biological courses. Our hypothesis is that the use of MeGli in Physiology classes promotes student learning and satisfaction. MeGli ( https://t.ly/crEwT ) is a didactic simulator for glycemic metabolism, allowing users to observe postprandial and fasting events, interact with objects, and explore cellular processes. The aim of this study was to conduct and evaluate a TML class using the app and its impact on students' outcomes in Biological Sciences Physiology classes at University of Campinas (n = 23). We analyzed pretest-posttest knowledge questionnaires using the Wilcoxon matched-pairs signed rank test (p ≤ 0.05) due to non-normal data (Shapiro-Wilk normality test). Additionally, we applied a Likert scale opinion survey. Prior to the intervention, students provided informed consent, ensuring anonymous participation. The use of MeGli in a non-expository class, where students consulted the app in an active-learning process for answering and discussing questions, led to a significant improvement in their performance on the topic of glucose metabolism and diabetes (pretest mean 5,739± 0,3784 versus 8,652± 0,2142 on posttest; p &lt; 0.0001). In terms of student feedback, opinion questionnaire results were overwhelmingly positive. All students agreed that the app was useful for learning and helped in their understanding of diabetes mechanisms. 87% understood the importance of healthy eating and physical exercise through the app. 91.3% reported a higher acquisition of knowledge due to the app's use and found the app-integrated class more stimulating and engaging. These findings strongly support the effectiveness of the MeGli application in facilitating physiology education, leading to a more motivating educational experience. Consequently, this study is significant in introducing an innovative tool that mediates active learning with technology, enhancing physiology teaching strategies and improving the education of future healthcare professionals. CNPq (441028/2020-9), FAPESP (2018/26080-4), CEPID (2013/07607-8). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Chinese Healthcare Workers' Knowledge, Attitudes, and Practices in Diabetic Kidney Management: A Multi-Centered Cross-Sectional Study.

Given the importance of diabetic kidney disease (DKD) management, this study aims to explore the knowledge, attitudes, and practices in disease management demonstrated by healthcare workers from the nephrology department. This study is a multi-centered cross-sectional study, and adopts snowball sampling, with 530 healthcare workers being recruited to complete a questionnaire covering areas such as demographic characteristics, knowledge, attitude, and practices (KAP) of DKD management. This data was analyzed using descriptive statistics and binary logistics analysis. In this study, 530 healthcare workers were studied, including 94 doctors and 436 nurses. The participants were mainly from general tertiary hospitals in 14 provinces. For Chinese nurse, the results indicate that both poor knowledge level (Odds Ratio (OR) =0.63, 95% Confidence Interval (CI): 0.42-0.94) and having experience in further medical training in nephrology (OR=1.92, 95% CI: 1.20-3.08) are associated with the practice levels. For Chinese doctors, having not experience in further medical training in nephrology (OR=0.36, 95% CI: 0.15-0.83) are associated with their practice levels. In summary, Chinese doctors and nurses in this study showed positive attitudes towards DKD management, but their knowledge and practical skills were lacking. This underscores a notable gap in achieving optimal DKD care. Notably, nurses' knowledge influenced their management practices, and additional nephrology training correlated with better engagement. To improve patient care, enhancing nephrology healthcare professional training and addressing knowledge-practice disparities are recommended.

PREVALENCE OF VESICO VAGINAL FISTULA AND COPING STRATEGIES OF WOMEN IN KEBBI STATE, NIGERIA

Vesico-Vaginal Fistula (VVF) poses a significant challenge for women, particularly in Kebbi State, Nigeria, where a VVF Centre operates to provide surgical repair and healthcare professional training. Despite this, research on VVF prevalence and coping strategies in Kebbi State remains limited, warranting further investigation to address knowledge gaps. This study investigates the prevalence and coping strategies associated with Vesicovaginal Fistula (VVF) among women in Kebbi State. Employing purposive sampling, 49 questionnaires were distributed to women aged 15 years and above. Data analysis involved descriptive statistics, including frequency, and inferential statistics, with Spearman rank correlation analyzing variable associations. Results indicate that the mean age of marriage is 16, with the highest frequencies of married (35.9%) and divorced (27.4%) respondents. Occupation-wise, 33.4% are housewives, revealing low-income earners, especially among casual laborers (28.9%) and farmers (26.9%). VVF prevalence is concentrated among ages 14–19 (30.7%), and overall prevalence is 29.3 per 1000 deliveries. The disease exhibits an increasing trend, with the years 2011-2012 having the least frequency (17%) and a mean score of 5.1. Yearly variations are noted in documented VVF cases from Gesse VVF Centre in Birnin Kebbi (2011-2020). Knowledge of VVF prevalence is highest (100.0%) among age groups 30-34 and 40 and above, contrasting sharply with the smaller proportion (15-30 age group). Coping mechanisms predominantly involve accepting fate. Recommendations include implementing comprehensive health education, targeting girls and women to address early marriage and reproductive health, facilitated by government and health workers.

Established and emerging theatre pharmacy services: a scoping review

Abstract Introduction Guidelines recommend that pharmacists contribute to perioperative patient care.[1,2] Expansion of perioperative pharmacy services was considered in Tallaght University Hospital following the appointment of a Critical Care &amp; Anaesthesia Chief II Pharmacist. Preliminary research indicated that activities at surgical pre-assessment clinics, in critical care and on inpatient wards are well-documented, while theatre pharmacy services appear comparatively under-developed. Pharmacists are well-placed to promote the safe and cost-effective use of medicines in this high-risk environment. An understanding of the evidence base could provide a foundation on which pharmacy departments seeking to expand their clinical services can build. Aim To determine the range, extent and nature of theatre pharmacy services internationally, and to describe any reported outcomes of these services. Methods This scoping review was conducted and reported as per the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR checklist. The review protocol was registered on Open Science Framework. A search was conducted across electronic (Ovid® MEDLINE, Embase, CINAHL and PsycInfo) and grey literature databases (Google Scholar, BASE, CADTH, and Google) without limitations on date of publication, study type or language (where English translation available). A manual search of the citation lists of all included publications supplemented the electronic search. One reviewer screened titles and abstracts and carried out data extraction, with a 10% sample screened by a second reviewer. Two reviewers evaluated full texts. Critical appraisal was performed using the Mixed Methods Appraisal Tool where appropriate. A narrative approach to evidence synthesis was employed. Extracted data about the type of pharmacy service(s) and associated outcomes were studied to inform development of key concepts through which results were presented. Results Ninety-two publications were included from 3924 results. Fifty-seven were primary research articles. Most publications were descriptive in nature. Over half of the included publications described services in the United States; the remainder were from Australia, several European countries, Egypt, Morocco, Japan, China and Taiwan. The majority of theatre pharmacy services involved medication management, i.e. procurement, spending, storage, formulary development and distribution of medicines. Clinical services incorporated provision of medicines information, protocol and guideline development, antimicrobial stewardship, education and training of healthcare professionals, engagement with health informatics and medication safety projects, practice-based research and intraoperative emergency support. Reported outcomes included financial savings, improved accountability of controlled substances, improved patient safety and staff satisfaction with the service. Many publications highlighted improved inter-departmental relationships between pharmacy and anaesthesiology. Of the 57 primary research articles, 48 lacked a clear research question and so did not satisfy the MMAT screening criteria. Of the nine assessed, adherence to quality criteria ranged from 40-100%. Conclusion Evidence for theatre pharmacy services is extensive and varied. Empirical research of high methodological quality is required to assess the outcomes of these services. Strengths of this review include the use of reporting guidelines and quality appraisal of the evidence. This review may have been limited by the exclusion of non-English language publications. This review collates practical guidance on the development of theatre pharmacy services and highlights facilitators of successful service establishment.

Dementia U-Care: Comprehensive Cognitive Screening Application for Seniors

The prevalence of cognitive impairment increases with age, particularly impacting seniors as it advances to severe dementia. These conditions pose significant challenges for afflicted individuals and their caregivers, manifesting as profound impacts on daily life and imposing considerable emotional and financial burdens on families. Mild cognitive impairment (MCI) denotes an intermediate stage between normal cognitive function and dementia, signifying a decline in cognitive abilities while maintaining normal daily life activities. Identifying MCI early in seniors within the community is pivotal to preventing further cognitive decline.In response to the challenge of traditional cognitive function assessments, which require trained healthcare professionals and take 20-30 minutes per case, we introduce "Dementia U-Care," an innovative app designed to assist community health workers in screening, monitoring, and collecting cognitive data. Accessible on mobile devices, it allows seniors to respond through drawing and writing, simplifying data collection compared to paper forms. Dementia U-Care streamlines preliminary assessments, empowering professionals and reducing fatigue and errors. This tool enables prompt screening, minimizing test-related stress, with an average testing time of 13.06 minutes, ranging from 9 to 20 minutes. The evaluation indicates high satisfaction with Dementia U-Care, with a mean score of 9.37±1.12. Users are generally pleased with its quality and user experience, demonstrating its effectiveness in meeting their needs and providing a positive experience.

P010 To establish compliance with British Society for paediatric and adolescent rheumatology (BSPAR) and the Royal College of Ophthalmology (RCOphth) guidelines for screening for uveitis in juvenile idiopathic arthritis (JIA) at a District General Hospital: a retrospective audit

Abstract Background/Aims JIA associated Uveitis (JIA-U) is most common extra-articular manifestation of JIA. The prevalence of uveitis in JIA is approximately 8-30%, but may be as high as 45-57% in young patients with oligoarticular disease. Uveitis is predominantly asymptomatic and requires slit-lamp examination for diagnosis. Up to 67% of JIA-U cases develop ocular complications such as cataracts (20%), glaucoma (19%), band keratopathy (16%), macular oedema and irreversible permanent visual impairment. The primary objective of our audit was to establish compliance of our service with BSPAR/RCOphth 2006 uveitis screening guidelines and therefore reduce the risk of visual complications in children with JIA. Methods A retrospective review of clinical records of children with rheumatological conditions attending our clinic was performed over five-year period. A total of 42 patients with JIA were identified. Data was collated using excel sheet audit tool. Results Results were analysed in accordance with the four major guideline domains as below. 1. Initial Screening exam within 6 weeks of referral: 40 out of 42 children screened within six weeks with 95% compliance rate. 2. Symptomatic patients seen within one week of referral: 4 out of 13 children seen in time with 30% compliance. 70% non-compliance was due to non-availability of ophthalmology appointment. 3. Uveitis may flare on stopping Methotrexate/DMARD’s. Patients should get screened two monthly for six months: 9 out of 13 children were screened with 70% compliance. 15% non-compliance was due to non-availability of ophthalmology appointment. 4. Ongoing screening at two-monthly intervals from onset of arthritis for six months, then 3-4 monthly: 15 out of 20 children screened with 75% compliance. 20% non-compliance was due to non-availability of ophthalmology appointment. Conclusion Practice at our centre as judged against the BSPAR/RCOphth guidelines was suboptimal. The main cause of non-compliance was due to staffing issue, rather than lack of healthcare professional training, delay in onward referral or non-attendance of patients. Non-availability of regular ophthalmology cover with cross-site commitment stretched the uveitis screening service at our centre. We presented this audit in our trust paediatric governance meeting. As a result of this audit, the frequency of paediatric ophthalmology clinics was increased to one a week. The paediatric nurse specialist facilitated liaison with the ophthalmology department and improved compliance with attendance. Patient database on shared drive was regularly updated with separate column for ophthalmology follow-up. The ophthalmologists were granted access to this database detailing clinic attendance and diagnosis. Parent education, reinforced with appropriate literature and a child friendly clinic environment improved awareness and reduces non-attendance. Combined clinics with ophthalmology are being explored. We plan to re-audit the service in near future to assess the impact after above remedial measures. A similar multi-site nation-wide audit may help identify and address local and national concerns. Disclosure K.K. Garg: None. T. Walton: None. A. Holliday: None.