Verbal Advice Research Articles

Comparison of the Effect of Structured Lifestyle Changes Versus Verbal Advice Only on Blood Pressure Control Among Hypertensive Adults in a Tertiary Hospital in North Central Nigeria

Background: Results from several clinical trials show that comprehensive behavioral intervention programs improve lifestyle behaviors and lower blood pressure. The study compared the effect of structured lifestyle modification versus verbal advice only on blood pressure control among hypertensive adults presenting in the GOPD of JUTH. Study Design/Setting: The study was a randomized study involving hypertensive adults aged 20 years and above presenting in GOPD of JUTH. Methods: Participants were consecutively selected and randomized into two groups, a structured lifestyle modification group (Group A) and a verbal advice only group (Group B). Group A was offered a structured lifestyle modification counseling while routine advice only was offered to group B. Data was collected about patients’ socio-demographic, medical and lifestyle habits that included dietary and exercise history. Physical examination included blood pressure measurement. Participants were followed up monthly for twelve weeks during which blood pressure measurement was routinely carried out and changes in their lifestyle habits reported. The primary outcome was reduction in BP. The means at 95% confidence intervals of the blood pressure values of the two groups were determined using paired t-test analysis. Data was analyzed on an intention to treat basis. A p-value of <0.05 was considered significant in all analyses. Results: The mean systolic blood pressure reduction in group A was 17 mmHg (8.7, 25.3; 95% CI) after 12 weeks versus 6.67 mmHg (0.47, 12.87, 95% CI) in group B. The mean diastolic pressure reduction after the same period was 8 mmHg (3.5, 12.5; 95% CI) in group A and 5.33 mmHg (1.5, 9.1; 95% CI) in group B. Paired t-test analyses revealed that these reductions were statistically significant in both groups. Conclusion: Findings from the study show that individuals with hypertension can make and sustain, during a period of 12 weeks, multiple lifestyle modifications which can control or reduce blood pressure. There is therefore a need for improved lifestyle intervention programs, including those appropriate for delivery in the clinical setting, that enable individuals with or at risk for hypertension to adopt long-term healthier lifestyles Keywords: Lifestyle modification, Hypertension, Blood pressure

The Effect Of Changes In Lifestyle Measures On Weight And Body Mass Index Among Adult Pre-Hypertensive Patients In A Tertiary Hospital In North Central Nigeria

Background: Results from several clinical trials show that comprehensive behavioral intervention programs improve lifestyle behaviors and lower weight and BMI. The study was undertaken to determine the effect of structured changes in lifestyle measures on weight and BMI among pre-hypertensive adults presenting it the GOPC of JUTH. Study Design/Setting: The study was a randomized controlled experimental study involving pre-hypertensive adults aged 18 years and above presenting in GOPC of JUTH. Methods: Participants were consecutively selected and randomized to a control and an intervention group. The intervention group was offered a structured lifestyle modification counseling while routine advice only was offered to the control group. Data was collected about patients’socio-demographic, medical and lifestyle habits that included dietary and exercise history. Physical examination was done to include height, weight and BMI. Participants were followed up monthly for twelve weeks during which physical examination was routinely carried out and changes in their lifestyle habits reported. The outcome measures were reduction in weight and BMI. The difference in the means of the outcome measures at pre- and post-intervention were determined using the independent and paired student t-tests at 95% confidence interval. Data were analyzed on an intention to treat basis. A p-value of ≤ 0.05 was considered statistically significant in all analyses. Results: On completing the study, independent t-test showed that the mean weight difference between the two study groups was 0.17kg (p=0.96; -5.77, 6.12, 95% CI) and the mean BMI difference was 0.32kg/m2 (p=0.79; - 2.07, 2.71, 95% CI). These were not statistically significant. However, significant improvement in healthy lifestyle habits were notably more in the intervention group. Desirable changes in the mean weight and BMI were more evident among participants of the intervention group after the 12 weeks study, although there were no statistically significant differences in the two groups. Conclusion: Findings from the study showed that although individuals with pre-hypertension can make and sustain, during a period of 12 weeks, multiple lifestyle modifications which can significantly control or reduce weight and BMI, structured changes on lifestyle measures may not be better than routine verbal advice only among pre-hypertensives in the study setting. There is a need for improved lifestyle intervention programs, including those appropriate for delivery in the clinical setting, that enable individuals at risk for hypertension to adopt long-term healthier lifestyles

Traditional Fish Leather Dyeing Methods with Indigenous Arctic Plants

Along the Arctic and sub-Arctic coasts of Alaska, Siberia, north-eastern China, Hokkaido, Scandinavia and Iceland, people have dressed in clothes or worn shoes made of fish skin for millennia. (Within this article, the terms fish skin and fish leather are used to indicate different processes of the same material. Fish skin: Skin indicates the superficial dermis of an animal. Fish skin is referred to as the historical raw material that is tanned following traditional methods such as mechanical, oiling and smoking tanning, using materials such as bark, brain, urine, fish eggs and corn flour. Fish leather is used to refer that the fish skin has passed one or more stages of industrial vegetable or chrome tanning production and is ready to be used to produce leather goods). These items are often decorated with a rich colour palette of natural dyes provided by nature. In this study, minerals and raw materials of plant origin were collected from riverbanks and processed by Arctic seamstresses who operated as designers, biochemists, zoologists, and climatologists simultaneously. During our research, an international team of fashion, tanning and education specialists used local Arctic and sub-Arctic flora from Sweden, Iceland, and Japan to dye fish leather. Several plants were gathered and sampled on a small scale to test the process and determine the colours they generated based on the historical literature and verbal advice from local experts. This paper describes the process and illustrates the historical use of natural dyes by the Arctic groups originally involved in this craft, building on the traditional cultural heritage that has enabled us to develop sustainable dyeing processes. The results are promising and confirm the applicability of these local plants for dyeing fish skins, providing a basis for a range of natural dye colours from local Arctic flora. The aim is to develop a moderate-sized industrial production of fish leather in this colour palette to replace current unsustainable chemical dyeing processes. This project represents an innovation in material design driven by traditional technologies, addressing changes in interactions between humans and with our environment. The results indicate that new materials, processes, and techniques are often the fruitful marriage of fashion and historical research of traditional methods, helping the industry move towards a more sustainable future.

Factors Associated With Tobacco Cessation Advice Recall and Quit Rates in Vascular Surgery Patients. A Single Center Study.

Smoking is an important modifiable risk factor in all vascular diseases and verbal advice from providers has been shown to increase rates of tobacco cessation. We sought to identify factors that will improve tobacco cessation and recall of receiving verbal cessation advice in vascular surgery patients at a single institution. The study is a retrospective cohort study. Patients seen in outpatient vascular surgery clinic who triggered a tobacco Best Practice Advisory (BPA) during their office visits over a 10-month period were contacted post-clinic and administered surveys detailing smoking status, cessation advice recall, and validated scales for nicotine dependence and willingness to quit smoking. This BPA is a "hard stop" that requires providers to document actions taken. Charts were reviewed for tobacco cessation documentation. Nine-digit zip-codes identified the area deprivation index, a measure of socioeconomic status. Univariate analysis was used to identify factors associated with cessation and advice recall. One hundred out of 318 (31.4%) patients responded to the survey. Epic Slicer Dicer found 97 BPA responses. To dismiss the BPA, 89 providers (91.8%) selected "advised tobacco cessation" and "Unable to Advise" otherwise. Of the 318 patients, 115 (36.1%) had cessation intervention documented in their provider notes and 151 (47.5%) received written tobacco cessation advice. Of survey respondents, 70 recalled receiving verbal advice, 27 recalled receiving written advice, 28 reported receiving offers of medication/therapy for cessation. 55 patients reported having tobacco cessation plans, and among those 17 reported having quit tobacco. Recall of receiving written advice (P < .001) and recall of receiving medication/therapy (P = .008) were associated with recall of receiving verbal cessation advice. Providing patients with tobacco cessation medication/therapy and written tobacco cessation education during office visits is associated with increased patients' recall of tobacco cessation advice. Vascular surgeons should continue to provide directed tobacco cessation advice.

Oral and dental health promotion for children's nurses.

Tooth decay remains one of the most common preventable oral health concerns in children. After birth, advice to caregivers predominantly focuses on medical health with little attention paid to dental health. Before discharge from the maternity unit and during future hospital and community appointments, opportunistic dental advice should be provided by midwives, nurses and health visitors where possible, with the aim of preventing early onset dental disease. Registering with a dentist at birth is crucial due to long NHS dental waiting lists. Simple advice on toothbrushing should be offered, including brushing twice a day with a soft toothbrush using an age-appropriate amount of fluoride toothpaste. Mothers should be provided with information on the benefits of breastfeeding for oral health alongside tailored preventive care. Appropriate advice on bottle-feeding and weaning is required, including minimising the use of added sugar, drinking from free-flow cups after six months of age, and discouraging the use of milk bottles at bedtime and in general after one year of age. Written visual summaries can be shared with parents to consolidate verbal advice on oral and dental health.

Effect of iron folic acid with tablet vitamin C compared to iron folic acid with routine verbal advice of vitamin C rich foods on the hemoglobin levels of anemic pregnant women attending a tertiary care hospital in Puducherry: protocol for a pragmatic trial

Background: In routine practice, pregnant women are advised to take iron folic acid (IFA) tablets with vitamin C-rich foods. If vitamin C tablets are given instead, there may be an improvement in the hemoglobin levels of pregnant women. The study aims to find the effectiveness of IFA tablet with vitamin C tablet compared to IFA tablet with verbal advice of vitamin C rich foods, over 6 weeks, on the hemoglobin levels of anemic pregnant women (13-33 weeks) attending a tertiary care hospital in Puducherry. Methods: A pragmatic trial will be conducted in the antenatal OPD of a hospital in Puducherry. Anemic pregnant women will be consecutively recruited until a sample size of 86 is attained. Permuted block randomization and allocation concealment will be used. After eligibility assessment, participants will be randomly assigned two arms. The intervention arm will receive IFA tablets with vitamin C tablets, while the control arm will be advised to take IFA tablets with vitamin C-rich food. Participants will be followed up at 6 weeks. The intention-to-treat approach will be used. Linear regression will be performed followed by multivariable linear regression to adjust for confounding variables. Conclusions: This study protocol is designed to investigate whether the hemoglobin status and control of anemia in anemic mothers can be improved by giving IFA tablets with vitamin C tablets in routine practice, rather than verbal advice to take IFA tablets with vitamin C-rich foods.

Comparing physical activity prescription with verbal advice for general practice patients with cardiovascular risk factors: results from the PEPPER randomised controlled trial

BackgroundRegular physical activity improves health and quality of life for people with cardiovascular risk factors. However, few studies have demonstrated the applicability of strategies in health care to promote physical activity.ObjectiveTo evaluate if a written physical activity prescription combined with pedometer increases physical activity over one year compared with verbal advice in patients with cardiovascular disease risk in primary care.MethodsThe randomised-controlled, interventional, 12-month PEPPER study recruited patients aged 35 to 74 years, having quarterly followed-ups for hypertension, dyslipidaemia, or diabetes, and judged insufficiently active. Seventeen practices randomised patients into either the experimental group, who received a written, personalised prescription for daily step numbers, pedometer and logbook, or control group, who received verbal advice to do at least 15 min of rapid walking or equivalent daily. The primary outcome was the change in total weekly energy expenditure measured using an accelerometer at 3 months. The secondary outcomes were changes in step count, physical activity levels, quality of life, perceived obstacles to physical activity, and biomedical indicators at 3 and 12 months.ResultsOne hundred and twenty-one participants were randomised. Although, weekly energy expenditure did not differ between the prescription and verbal instruction group, the estimated time spent doing moderate-intensity activity was significantly higher in the prescription group than the verbal group by an average of four minutes/week (p = 0.018)(95% CI [0.7 – 7.4]) reaching 48 min after 12 months (95% CI: 8 – 89). Similarly, this was associated with a clinically, higher average step number of 5256 steps/week increase over a year (95% CI: 660 – 9852). Among the most sedentary subgroup, walking less than 5000 steps/day at baseline, an 8868 steps/week (95% CI [2988 – 14700]) increase was observed in the prescription group.ConclusionPrescribing physical activity did not significantly modify total weekly energy expenditure, but slightly increased moderate-intensity activity duration and step counts, particularly among the most sedentary participants. Prescribing personalised physical activity goals encourages sedentary patients to engage in physical activity.Trial registrationThe PEPPER trial is registered in the US National Institutes of Health Clinical Trials Registry under number NCT02317003 (15/12/2014).

PA20 Assessing the value of transition readiness assessment clinics within a dermatology service

Abstract Successful transition of healthcare from paediatric to adult services is a key component of developmentally appropriate healthcare for young people with long-term conditions. Poor preparation for transfer and shifting social roles results in up to 25% of young individuals regularly missing follow-up visits and poor treatment adherence once transferred to adult services. Transition clinics were developed as an intervention to support young people in navigating the journey from paediatric to adult care. The Ready Steady Go (RSG) tool was implemented by Southampton Children’s hospital and endorsed by the Royal College of Paediatrics and Child Health and the National Institute for Health and Care Excellence for use in transition clinics. It considers the developmentally appropriate healthcare domains of self-management of long-term conditions, independence and self-advocacy, sexual health, mental health and emotional wellbeing, and activities of daily living (ADLs). The role and success of the RSG tool in many medical specialties has been documented. However, it has not yet been routinely implemented within dermatology departments. The aim of this project was to assess the additional value of the use of the RSG tool by a paediatrician with expertise in adolescent health, in a transition readiness assessment clinic piloted within a dermatology service. Notes of all patients attending the transition clinic between January and December 2022 were reviewed. Details of any interventions provided during the RSG-guided clinical appointment were compared with interventions previously received by the same patients in their routine dermatology appointments over the preceding 24 months. Intervention types included the assessment of independence, verbal advice, written leaflets, links to websites and direction to self-help services. Sixteen patients were seen in the transition clinic and included in the analysis. All patients were seen without their parents for at least part of the consultation. With the use of the RSG tool, 100% of patients received one or more intervention concerning self-management of their long-term condition, self-advocacy and ADLs vs. 44%, 81% and 75% in their previous clinic attendances for each of these domains, respectively. Eighty-seven per cent of patients received advice on sexual health/family planning, and 87% received information on mental health help with use of the RSG tool in the transition clinic, where 0% and 37% patients, respectively, had received information about these domains at previous dermatology appointments. All patients successfully achieved transition, with 44% having attended their first adult dermatology appointment, while the remaining 56% have their adult appointments still pending at time of writing. This study highlights the value and yield of a transition-readiness assessment for paediatric dermatology patients. During this presentation, we will discuss the RSG tool and the practicalities of implementing its use in dermatology services.

A short survey on GP practices’ approach (structure and process) for managing sepsis

Abstract Introduction Sepsis poses a challenge for general practice, and sepsis awareness raising amongst healthcare professionals is a priority, with general practices expected to have an identified sepsis lead who has updated staff.1 The Royal College of General Practitioners (RCGP) made sepsis a clinical priority to raise awareness of how appropriate GP action could have an impact.2 In September 2020, locality-based prescribing meetings were held focusing on sepsis. For the 2021/22 General Practice Prescribing Quality Scheme it was decided to ascertain what practices had in place to manage suspected sepsis. Aim To assess whether GP practices in Cornwall have the structure and processes in place to manage sepsis. Methods A pre-piloted paper survey, based on a literature review, was delivered to all practices. There were seven questions (mixture of closed questions and questions allowing expanded answers, and a free text comment option). The sepsis lead GP responded on behalf of the practice. Survey completion, along with completion of other elements of the Prescribing Quality Scheme, generated an incentive payment to practices. This service evaluation did not require ethical approval. Results Fifty-one of 57 (89%) surgeries responded. When asked if all practice staff were familiar with the terminology “Red Flag Sepsis’, 36 replied yes, 4 replied only clinical staff, and 11 no. Receptionist training on this topic had occurred in 33 practices, but not in 18. All 51 replied they had the necessary equipment readily available to assess patients with possible sepsis. As regards intravenous antibiotics routinely stocked in the practice, five had none, and for those that kept antibiotics it was a mixture of benzylpenicillin, ceftriaxone, cefotaxime or Tazocin. Thirty-seven were unable to take a blood culture prior to first dose of antibiotics for a patient with Red Flag Sepsis, including one highlighting such a patient would have immediate hospital referral. Fourteen answered yes to this question, including one also highlighting immediate hospital referral. Thirty-five practices had a safety-net resource aligning with NICE guidance3 for giving to adults, parents and carers being managed in the community, whilst ten said no and 5 clarified that they give verbal advice but no written information. Fifteen had implemented change in their practice that they would share with other practices though only 12 provided brief details. Free text comments generated themes around staff training, including administration of IV antibiotics by GPs, and whether practices should be taking blood cultures and associated practical issues. Discussion/Conclusion The RCGP states that ideally all staff in a sepsis aware practice will have had education about sepsis.2 We found this had not occurred in 18/51 (35%) practices, and in 11/51 (22%) practices staff appeared unfamiliar with the terminology “Red Flag Sepsis’. The issue of taking blood cultures (73% said they were unable to do this) generated concerns and further discussion with Microbiology colleagues is needed. Practices have identified actions to be taken subsequent to this survey. We recognise limitations of a small survey from late 2021 conducted in a single centre in England, possibly subject to social-desirability bias.

Analysis of the Audience's Reception on Creativity in the 5 Minute Craft Channel on Youtube

This study aims to describe and explain how the use of audience reception analysis on creativity in the 5 minute craft channel on YouTube. This research is motivated by events whether this channel has no effect on the audience and whether these viewers immediately practice it or not after watching this 5 minute craft youtube channel. This research method uses qualitative. The technique of determining informants uses interview techniques. The results of the interviews that I got were from the viewers I interviewed offline (via WhatsApp), which had various responses. It was concluded that most of the large community was in the dominant hegemonic position, judging that this 5-minute craft youtube channel was very useful for the audience. The negotiating position, as stated by the informant, requires verbal advice not only to practice it so that what is conveyed by the 5-minute craft is clearer. While oppositional, the audience rejects that the audience only enjoys watching it and has difficulty practicing it. The results of these discussions in this case the YouTube mass media are very influential on the audience.

Interventions to reduce lead (Pb) exposure and value of a broad environmental health monitoring capacity

Background and aims In recent years, reports of lead (Pb) contamination have dramatically increased in Georgia. In 2018, 41% of the children who participated in the Multiple Indicator Cluster Surveys (MICS), a nationally representative among 2 to 7 years old children (n=1578), had blood Pb levels (BLL) above 5 microgram/dL. The National Centre for Disease Control and Public Health of Georgia (NCDC&amp;#x26;PH) implemented written and verbal advice on how to reduce Pb exposure, and a state program of clinical follow-up was implemented. A significant reduction of BLL in children over a relatively short period has been documented. We aimed to identify the most relevant sources of Pb exposure contributing to elevated blood Pb in MICS children. Methods In collaboration with UK Health Security Agency, British Geological Survey, and Georgian agencies, NCDC&amp;#x26;PH conducted a Pb isotope ratio study in 36 purposefully selected children from MICS. Environmental samples collected for each included household included dust, soil, paint, spices, milk, drinking water, and toys. Pb isotope ratio analyses were conducted on both blood and environmental samples. Analyses included household level and group level ranking of environmental sources as an explanation of exposure to Pb represented by BILL. Results Preliminary results indicate that drinking water and milk are not among Pb exposure sources of concern, while the precise ranking of other Pb sources varies between children and regions of Georgia. Conclusions It is expected that these data will support the design of more detailed public health interventions to reduce exposure to key sources of Pb, thus leading to further reduction of Pb-induced health effects in Georgia. In addition, this experience will clarify elements of ongoing monitoring of environmental factors such as an Environmental Public Health Tracking system, to support the national capacity to manage the risks to public health. Keywords Lead, intervention, health surveillance

THE RELATIONSHIP BETWEEN PEER EMOTIONAL SUPPORT AND BURNOUT IN STUDENTS : LITERATURE REVIEW

Unrelenting and persistent pressure will cause bad effects such as burnout and changes in self-motivation. Some of the effects of burnout on student include the lecture process becoming less effective, such as reraly doing assignment, depression, cheating and irregular sleep patterns. Emotional support in one form of support provided. This study was conducted whit the aim of knowing the description betweeb peer emotional support and burnout in students : Literature Review. The method used in this study is a literature review research method. Objectivity, authenticity of writing and contributions to research are things that mush be considered in the selection of data sources. In this research, the method used is secondary research methodology in the from of Literature Review whit primary source. The PICO (Population, Intervention, Compare, Outcame) approach is an extraction method used in the data collection process. Based on a review of 8 journals that have been reviewed, the results show that thet most influential support is social support. Social support is the support received by aperson from certain individuals who are in his life and are in a certain social environment, this support consists of support for nonverbal and verbal advice or informations, real assistance provided bu other individuals where this social support refers to actions what other individuals do when they ask for help. The higher the social support from peers, the lower the student experience with burnout, and conversely the less social support, the higher the student experience with burnout

412 Knowledge and Practices for the Prevention of the Diabetic Foot in North Wales

Abstract Aim Diabetes mellitus can result in a wide range of foot complications such as ulceration, infection, and amputation. The National Institute for Health and Care Excellence (NICE) recommend that all diabetic patients should receive verbal and written information relating to their foot care. Here we assess our compliance with the national guidelines and the levels of patient knowledge amongst the diabetic population in the North West of Wales. Method A questionnaire was provided to all adult diabetic patients attending the outpatient podiatry service over the course of three weeks at Ysbyty Gwynedd, North Wales. The survey included compliance and knowledge-based questions regarding foot care. Results A total of 65 patients were recruited and completed questionnaires. The majority of the patients were males (male:female ratio 2:1) and over 70 years and had type II diabetes. 98% of patients admitted to receiving verbal diabetic advice while only 57% received written information. Compliance with daily foot checks was 82%. Regarding patient knowledge, over 90% of patients selected the correct answer to 11 out of the 15 knowledge-based questions. Despite 95% recognising that poor footwear can contribute to diabetic foot complications, only 86% recognised that walking barefoot carries similar risks. Conclusions Diabetic foot knowledge is high within our studied population. Use of patient information leaflets can be further improved to help educate patients in avoiding barefoot walking and to prevent diabetic foot complications and limb loss.

THE RELATIONSHIP BETWEEN KNOWLEDGE OF PREGNANT WOMEN AND FAMILY SUPPORT FOR THE PARTICIPATION OF PREGNANT WOMEN IN TEACHING CLASSES FOR PREGNANT WOMEN IN THE WORK AREA OF UPT PUSKESMAS PANCA MAKMUR

Knowledge is the sensing of object (Arifah E A &amp; Fridayanti W, 2016). Participation is personal involvement (Dwiningrum, 2018). Support is verbal or non-verbal advice, action have emotional benefit. This study aim to show that teaching classes for pregnant women have a good impact on pregnant women, which increase the knowledge and skill of pregnant women in dealing with pregnancy until the parturition process. Teaching class for pregnant women aim to reduce maternal and infant mortality.&#x0D; This study aim to determine the relationship between knowledge of pregnant women and family support on the participation of pregnant women in the Teaching Class for Pregnant Women in the working area of ​​the Panca Makmur Health Center UPT. This type of research is a quantitative study with a descriptive correlational approach. Normality test was carried out using descriptive analytic with a sample size of 36 so that the significant value of Kolmogorov-Smirnov was selected. So the correlation test use rank spearment&#x0D; The results showed that the knowledge of pregnant women was not good enough for 4 respondents (11.1%) and 32 respondents (88.8%). Poor family support 19 respondents (52.7%) and good support 17 respondents (47.2 %). Participation of pregnant women in teaching classes for pregnant women is not good 7 respondents (19.4%) and 29 respondents are good (80.6%). The rank spearment test shows that H1 is rejected, meaning that there is no relationship between knowledge of pregnant women and family support on the participation of pregnant women in teaching classes for pregnant women in the working area of ​​UPT Puskesmas Panca Makmur.&#x0D; Keywords: Knowledge, Support, Participation of pregnant women

Implementation of a chest injury pathway in the emergency department

Rib fractures represent a substantial health burden. Chest injuries contribute to 25% of deaths after trauma and survivors can experience long-standing consequences, such as reduced functional capabilities and loss of...

Implementation of Early Childhood Safety Behavior in Islamic Early Childhood Education Unit

Early childhood is classified as an individual who has not been optimal in taking care of themselves. It is important to inculcate the ability to save oneself in every education unit, not least in the early childhood education (ECE) units. This paper reviews the application of early childhood safety behavior in an Islamic ECE unit. The research, which was conducted at TK ABA Pabelan in 2021, utilized the principal, teachers and children as data sources. Data collection techniques consist of interviews, observation, and documentation. Data were analyzed through data reduction, data display, and inference. Based on an in-depth search, it was found that safety behavior in TK ABA Pabelan was carried out by playing activities with fun learning media, role playing to avoid danger, as well as through verbal advice. All of which were done through a plan prepared in advance by the teacher.

Practical Applications of The Valuation of Illiquid Assets: A Focus on Private Equity and Real Estate

<h3>Background/introduction</h3> Background/introduction: Hepatitis B(HBV) is a sexually transmitted infection commonly diagnosed in GU settings. We routinely test for HBV in high risk patients such as men who have sex with men, sex workers and those from high prevalence areas. <h3>Aim(s)/objectives</h3> A retrospective audit was undertaken assessing whether patients diagnosed with HBV are being managed in accordance with BASHH guidance and whether changes made following a previous audit were implemented successfully. <h3>Methods</h3> Patients newly diagnosed with HBV over an 18 month period up to 31/8/15 had their records reviewed. Data was collected on demographics, investigations, initial management and follow up. <h3>Results</h3> 31 patients were included in the audit and their care compared to the 2008 national auditable standards. Median age was 28(range 16–46). 20 (64.5%) were male and 11 (35.5%) female. 29 (93.5%) identified as heterosexual, 2 (6.5%) as homosexual. 11 (35.5%) were of African descent. Only 6% of patients were provided with written information on HBV transmission and outcomes and 68% had documented partner notification. 95% had liver function tests performed post diagnosis, 97% had clear long term management plans documented and 87% were offered appointments with hepatology(compared to 67% in the previous audit). <h3>Conclusion</h3> Clinicians were failing to provide written information about HBV following diagnosis as information leaflets were not available in clinic. 87% of patients received verbal health advice but this still falls short of national standards. A scheme giving cards with QR codes linking to approved patient information is being trialled. Improved referral pathways have resulted in more patients having specialist review.

Re-Audit of Benzodiazepine and Z-Drug Prescribing in Two Community Treatment Teams in the Cumbria, Northumberland, Tyne and Wear Trust

AimsThis is a re-audit of Benzodiazepine and Z-hypnotic drugs prescriptions in two community treatment teams (CTTs) in the Cumbria Northumberland Tyne and Wear (CNTW) Trust, comparing with previous audits in 2009, 2017 and 2018 to check whether areas of good practice were maintained, and progress was made.MethodsWe reviewed caseloads of four CNTW consultants in the two CTTs which included 554 patient encounters with 60 encounters where benzodiazepines or z-drugs were prescribed. Nine missing data sets brought the total audit sample to 51. For these 51, prescribing information was gathered from RiO and assessed against standards derived from CNTW Trust Policy and BNF prescribing guidance. To be compliant, 90–100% of prescriptions needed to meet the standard.ResultsOverall, the rate of prescribing of benzodiazepines and Z- drugs increased from previous audit (7% in 2018, now 10.8%). Good areas of practice maintained were as follows (all 100%): all teams were compliant in prescribing within BNF limits, refrained from prescribing diazepam in 10 mg formulation, and no pregnant/post-partum women were prescribed these medications.Although non-compliant, there were clear improvements in documenting indicated use (2018: 61.65%, 2021: 80.8%), and providing prescriptions of &lt;4 weeks in duration (2018: 58.2%, 2021: 79.2%)Key areas of concern were as follows: poor documentation of indication, duration of treatment and plans for review/discontinuation (compliance ranged from 31.5% - 81.2% in these areas). There was poor documentation of what verbal advice was given (0–16.9%), and lack of clearly documented tapering/discontinuation plans for those on long-term prescriptions (16.1%). The provision of written advice reduced from previous audit (2018: 10.7%, 2021: 5.8%). As 41/51 encounters were via telephone or video due to COVID-19 pandemic, this may have impacted on results.ConclusionDespite improvement in some areas, there remains scope for ongoing improvement in other areas. To improve these, we plan to produce and distribute an educational email to all prescribers, including the following: information on this audit and its findings, prescribing guidelines, relevant e-links to patient information leaflets as well as the audit proforma used for this audit, to encourage prescribers to undertake self-directed practice. A poster will be distributed, highlighting prescribing guidelines and standards, to be printed and displayed in clinical areas as reminder of prescribing responsibilities and the importance of documentation. Prescribers will be encouraged to participate in a small quiz to test learning. Efficacy of these measures will be assessed with a re-audit in one years’ time.

Monthly Motivational Interview Counseling and Nicotine Replacement Therapy for Smoking Parents of Pediatric Patients: A Randomized Controlled Trial.

BackgroundParental smoking is the dominant source of passive smoke exposure in the pediatric population. The current randomized controlled trial (RCT) study aimed to evaluate the effectiveness of a multi-component smoking reduction intervention in parental smoking reduction and children's environmental tobacco smoke exposure reduction in clinical settings.MethodsA single-blinded, 6-month randomized controlled trial recruited smoking parents (N = 210) of children who attended the pediatric wards or clinics at the Prince of Wales Hospital. Participants allocated to the intervention group (n = 105) received monthly motivational interviews on smoking reduction with emphasis on health hazards related to children's passive smoke exposure, 8-week nicotine replacement therapy, and referral to smoking cessation service if the parents preferred. The control group (n = 105) received simple verbal advice on smoking cessation. Primary outcomes were parental urine cotinine validated and self-reported ≥50% smoking reduction rates at 6 months.ResultsSmoking parents in the intervention group had significantly more biochemically validated ≥50% smoking reduction than the control: 27.1 vs. 10.0% (OR = 3.34, 95% CI: 1.16–9.62, P = 0.02). The rate of self-reported ≥50% smoking reduction was also significantly higher in the intervention group than the control: 51.9 vs. 20.2% (OR = 4.40, 95% CI: 2.38–8.12, P < 0.001). For secondary outcomes, the rate of parental self-reported smoking cessation was higher in the intervention arm: 10.5 vs. 1.0% (OR = 12.17, 95% CI: 1.54–96.07, P < 0.001), however, no differences were detected in biochemically validated cessation and changes in children's passive smoke exposure between the groups.ConclusionMonthly smoking reduction counseling together with nicotine replacement therapy is more effective than simple verbal cessation advice in the smoking reduction for parents of pediatric patients. However, this study did not demonstrate differences in smoking cessation or reduction in children's passive smoke exposure with a 6-month follow-up. Achievement of a smoke-free environment remains challenging.Trial RegistrationClinicaltrials.gov, identifier: NCT03879889.

Nudging physical distancing behaviors during the pandemic: a field experiment on passengers in the subway stations of shiraz, Iran

BackgroundThe possibility of the emergence of new pandemics necessitates further research into using simple strategies to promote social distancing behaviors in public. Most of the current evidence on effectiveness of physical distancing interventions is based on self-report and measure of intention which will not necessarily predict actual behavior.MethodsA field experimental study was conducted in the subway stations of Shiraz, Southern Iran. The interventions were based on intuitions from protection motivation theory and consisted of using environmental nudges to notify the passengers of the pandemic situation (threat appeal) and a verbal advice on keeping a safe physical distance as an effective method of protection against COVID-19 (coping message). Average physical distancing was estimated as the number of steps between two consecutive passengers and was compared between interventions (n = 1045) and the control (n = 855) groups.ResultsA total of 1900 people riding on subway escalators were directly observed during two intervention conditions and the control condition. Under either threat or coping-based interventions, passengers were two times more likely (OR 2.0, 95%CI 1.5–2.7, P < 0.001) to keep a physical distance of at least 1.2 m from the traveler in front compared with those who did receive no intervention. The Kruskal-Wallis test revealed that there was a significant improvement in physical distancing behaviors with coping advice compared with threat appeal and the control conditions (χ2 = 120.84, df = 2, p < 0.001).ConclusionsOur findings suggest that simple and inexpensive theory-based interventions can be used in crowded public spaces to promote physical distancing within the context of the pandemic.