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Stueland, Dean T., John E. McCarty, Peter Stamas, and Paul D. Gunderson. "Evaluation of Agricultural Rescue Course by Providers." Prehospital and Disaster Medicine 11, no. 3 (September 1996): 234–38. http://dx.doi.org/10.1017/s1049023x00043016.
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AbstractStudy objective:To assess the characteristics of rural emergency medical services providers involved in the prehospital care of victims of agricultural injuries and determine which aspects of an agricultural rescue course were perceived as most useful.Design:A questionnaire was sent to participants of a course designed for agricultural prehospital providers who had attended a farm accident rescue course between 1986 and 1993.Setting:A rural referral center in central Wisconsin.Participants:The questionnaire was sent to all persons who had participated in the course. Respondents to the questionnaire characterized their service experience and rated the topic areas in usefulness and whether the subject should be included in future courses.Results:A total of 459 surveys (44% of potential respondents) was returned. Of the respondents, 316 (74.4%) were men, and the mean age was 39.4 years. There were 247 (60.8%) who were volunteers, and an additional 126 (31%) were paid, on-call workers. There were 232 (56.4%) basic providers, and 365 (87.5%) were from a rural area. Many (n = 149; 36.9%) had not responded to farm accidents during the past year. Training course topics rated most useful were machinery extrication, tractor overturn, and enclosed-space rescue.Conclusions:Respondents to an evaluation of an agricultural rescue course primarily were rural, basic providers. Future development of courses for emergency medical technicians involved in agriculture rescue must account for this level of training. Such courses should be short and modular with an emphasis on continuing education, practice, and focus on the identified needs of the participants.
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Queiroz, Elisangela Martins de, Mónica Cecilia De-La-Torre-Ugarte-Guanilo, Kuitéria Ribeiro Ferreira, and Maria Rita Bertolozzi. "Tuberculosis: limitations and strengths of Directly Observed Treatment Short-Course." Revista Latino-Americana de Enfermagem 20, no. 2 (April 2012): 369–77. http://dx.doi.org/10.1590/s0104-11692012000200021.
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This study analyzed the limitations and strengths of the Directly Observed Treatment Short-Course (DOTS) for tuberculosis from the perspective of patients and healthcare providers in a Technical Health Supervision unit in the city of São Paulo, SP, Brazil. Four patients and 17 healthcare providers from nine Primary Care Units were interviewed from April to June 2006, after signing free and informed consent forms. The reports were decoded according to the speech analysis technique. The Theory of the Social Determination of the Health-Disease Process was adopted as the theoretical framework. The strengths were: establishment of bonds between healthcare providers and patients and the introduction of incentives, which promotes treatment adherence. Limitations included: restricted involvement of DOTS' healthcare providers and reconciling patients' working hours with supervision. Treatment adherence goes beyond the biological sphere and healthcare providers should acknowledge patients' needs that go beyond the supervision of medication taken.
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Al-Wathinani, Ahmed, Attila J. Hertelendy, Abdulmajeed M. Mobrad, Riyadh Alhazmi, Saqer Althunayyan, Michael S. Molloy, and Krzysztof Goniewicz. "Emergency Medical Providers’ Knowledge Regarding Disasters during Mass Gatherings in Saudi Arabia." Sustainability 13, no. 6 (March 18, 2021): 3342. http://dx.doi.org/10.3390/su13063342.
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The Hajj is a recurring annual mass gathering event with over three million attendants taking place at the same site for six days. During such events, major incidents and disasters can occur. It is crucial that Emergency Medical Services providers are sufficiently trained regarding disaster preparedness to respond appropriately. EMS-providers of the Saudi Red Crescent Authority who worked during the Hajj in 2016 were asked to complete a web-based survey, utilizing predetermined responses with 5-point Likert scale responses. Seven hundred respondents identified real disasters as the most common source of information about disaster preparedness and also indicated that a disaster management course was the most desired course for improving knowledge. The study has also highlighted a list of Life Support Courses providers feel should be offered as part of a disaster response training package. These findings highlight the importance of continuing education, which may be obtained through short, focused courses, or for small numbers of specialists through higher educational degrees, such as masters or doctorates. This study also examines the importance of media and its impact on increasing knowledge and awareness for EMS-providers. Consideration should be given to pairing novice providers with experienced personnel to disseminate knowledge and practical experience during Hajj missions. Simulated disaster drilling should be considered to introduce novices to the stress of mass casualty disaster response.
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Donati, Maria Anna, Jessica Boncompagni, Giuseppe Iraci Sareri, Sonia Ridolfi, Adriana Iozzi, Valentina Cocci, Alfiero Arena, and Caterina Primi. "Optimizing large-scale gambling prevention with adolescents through the development and evaluation of a training course for health professionals: The case of PRIZE." PLOS ONE 17, no. 5 (May 12, 2022): e0266825. http://dx.doi.org/10.1371/journal.pone.0266825.
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In the field of adolescent gambling prevention, there is a lack of intervention studies reporting and assessing training courses for the intervention providers. The present work fills this gap by realizing a dissemination study inside the PRIZE program aimed at modifying a set of cognitive protective factors and affective risk factors. The purpose of this work was twofold: To develop and evaluate a training course with the intervention providers (Study 1), and to assess the short- and long-term effects of the intervention itself (Study 2). The training course was delivered to 44 health professionals (32 females, Mage = 39.34 years). Results showed a significant increase of correct knowledge about gambling and a significant reduction of their susceptibility to probabilistic reasoning biases. Participants also actually learnt the main competencies to conduct the educational activities, they were satisfied for the training course received, and they felt high levels of self-efficacy. The intervention was implemented with 1894 high school students (61% males; Mage = 15.68 years). In the short term, we found a significant increase of adolescents’ correct gambling knowledge, random events knowledge, and probabilistic reasoning ability, and a significant decrease of superstitious thinking, monetary positive outcome expectation, and gambling-related erroneous thoughts and fallacious behavioral choices. In the long-term, a significant decrease of gambling frequency, gambling versatility, and gambling problem severity was obtained. Overall, this work highlights the importance to train prevention program providers in order to optimize the effectiveness of large-scale gambling intervention programs towards adolescents.
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Loukas, T., V. Stakia, S. Petousis, V. Daikidou, S. Nanoudis, and D. Rigopoulos. "Ability of non-health care providers to perform adequate cardiopulmonary resuscitation after attending a quite short course." Resuscitation 81, no. 2 (December 2010): S105. http://dx.doi.org/10.1016/j.resuscitation.2010.09.427.
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Meeks, Suzanne. "Short-Term Course of Mental Illness in Middle Age and Late Life." International Psychogeriatrics 9, no. 3 (September 1997): 343–58. http://dx.doi.org/10.1017/s1041610297004481.
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The heterogeneity in severe mental illnesses means that although some persons exhibit a chronic course in later life, others may recover for long periods or have episodes throughout the lifespan. The challenge to mental health providers is to identify those people most at risk for a chronic or relapsing course in later life. Data described here come from a prospective study of course and adjustment in severe mental illness for persons over age 40. The sample of 313 people, residing in the community and both in treatment and not in treatment, is unique. Six 8-month course patterns were identified; nearly one third of the participants had course patterns that were unstable, and one third were well across the 8 months. Older participants were more stable and less depressed, but otherwise were very similar to those in middle age. Demographic and history variables that predict long-term outcomes were not useful for predicting short-term recovery or relapse.
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Kirsten, Corinna Lina. "The Impact Of Training Courses On Financial Management Skills Of South African Small-Business Owners." International Business & Economics Research Journal (IBER) 12, no. 7 (July 16, 2013): 825. http://dx.doi.org/10.19030/iber.v12i7.7971.
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Short-term financial management skills are regarded as critical for South African small business owners to effectively manage their businesses so they may survive and grow. These skills can be developed by attending training courses, preferably those specifically designed for the small business environment offered by private sector service providers with the necessary experience and expertise. Record keeping, determining future profitability, managing working capital, measuring past performance, and tax and legal entity compliance are identified as key aspects in which small business owners require training. This study investigates the extent to which a training course, developed and presented by academics from the accounting profession, improved the knowledge of a group of South African small business owners regarding aspects of short-term financial management. A pre-test and post-test single group experimental design was used. In addition, the participants satisfaction with the training course and the trainers was assessed using a post-test design. The results show a significant increase in the participants knowledge of aspects of short-term financial management, as well as overall positive feedbac kregarding the training course and trainers. Challenges relating to language and the duration of the training course were identified. Future research on how such a training course could be combined with other types of interventions to further develop financial management skills is suggested.
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Pinkerton, Mark, Jahnavi Bongu, Aimee James, and Michael Durkin. "1475. Understanding Prescribing Practices for Uncomplicated Urinary Tract Infections (UTIs) in the Primary Care Setting: A Pilot Study." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S538. http://dx.doi.org/10.1093/ofid/ofz360.1339.
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Abstract Background Uncomplicated urinary tract infections (UTIs) should be treated empirically with a short course of narrow-spectrum antibiotics. However, many clinicians order unnecessary tests and treat with long courses of antibiotics. The objective of this study was to understand how internists clinically approach UTIs. Methods We conducted semi-structured qualitative interviews of community primary care providers (n = 15) and internal medicine residents (n = 15) in St. Louis, Missouri from 2018 to 2019 to explore why clinical practices deviate from evidence-based guidelines. Interviews were transcribed, de-identified, and coded by two independent researchers using NVivo qualitative software. A Likert scale was used to evaluate preferences for possible interventions. Results Several common themes emerged. Both providers and residents ordered urine tests to “confirm” presence of urinary tract infections. Antibiotic prescriptions were often based on historical practice and anecdotal experience. Providers were more comfortable treating over the phone than residents and tended to prescribe longer courses of antibiotics. Both providers and residents voiced frustrations with guidelines being difficult to easily incorporate due to length and extraneous information. Preferences for receiving and incorporating guidelines into practice varied. Both groups felt benchmarking would improve prescribing practices, but had reservations about implementation. Pragmatic clinical decision support tools were favored by providers, with residents preferring order sets and attendings preferring nurse triage algorithms. Conclusion Misconceptions regarding urinary tract infection management were common among residents and community primary care providers. Multifaceted interventions that include provider education, synthesis of guidelines, and pragmatic clinical decision support tools are needed to improve antibiotic prescribing and diagnostic testing; optimal interventions to improve UTI management may vary based on provider training level. Disclosures All authors: No reported disclosures.
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Villaseñor, Alberto, Moisés A. Arriaga, Roland D. Eavey, José Ignacio Santos, and Edgar Chissone. "Educational Outcomes of an Otitis Media Workshop for Primary Care Providers in Latin America." Otolaryngology–Head and Neck Surgery 118, no. 3 (March 1998): 394–96. http://dx.doi.org/10.1016/s0194-59989870323-7.
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Otitis media is a prevalent condition that can be diagnosed and treated by primary care providers skilled in otoscopy. Previous analysis demonstrated that brief, intensive instruction at one site in rural Mexico improved the test scores of health care providers and changed long-term practices (Eavey R, et al. Otolaryngol Head Neck Surg 1993;109:895-8). We wanted to confirm these test score findings at other sites. A didactic course on otitis media with a practical otoscopy workshop was conducted at six Mexican locations and in one Venezuelan city by an interdisciplinary group of physicians. The same coded test was given immediately before and after the course. The Wilcoxon test for significance of intra-subject performance before and after intervention was used as a nonparametric assessment. At all seven sites ( n = 190 subjects), test scores demonstrated statistically significant improvement (range = p < 0.001 to p < 0.0001). We conclude that this educational method consistently improved short-term knowledge of otitis media and that further teaching efforts and a longer term practice-impact study are warranted.
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Scott, Lancer A., Layne A. Madden, Amy E. Wahlquist, and Daniel W. Fisher. "Preparing for the Surge: A Half-Day Emergency Preparedness Training Course for the “Second Front”." Disaster Medicine and Public Health Preparedness 12, no. 1 (August 1, 2017): 121–26. http://dx.doi.org/10.1017/dmp.2017.30.
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AbstractPurposeClinical disaster medicine requires providers working collaboratively to care for multiple patients, yet many clinicians lack competency-based training. A 5-hour emergency preparedness training (EPT) curriculum was created using didactics, small group discussion, and scenario-based learning. The goal was to evaluate the effect of a short course on improving clinical-provider knowledge, confidence and skill.MethodsParticipants were enrolled in a medical university between 2011 and 2014. The course consisted of didactic lectures, small group exercises, and live mass-casualty training scenarios. Core competencies and performance objectives were developed by a task force and assessed via facilitator observation, pre- and posttesting, and a course evaluation.ResultsA total of 708 participants were trained, including 49.9% physicians, 31.9% medical students, 7.2% nurses, and 11% allied health personnel. The average percentage of correct answers increased from 39% to 60% (P<0.01). Following didactics, trainees met 73% and 96% of small group performance objectives. Trainees also met 68.5% and 61.1% of the mass-casualty performance objectives. Average trainee self-assessment of disaster-preparedness skill improved from 36 to 73 points out of 100.ConclusionA brief, intensive EPT course can improve the disaster knowledge and comfort level of a diverse group of clinical providers as well as foster disaster-performance skills. (Disaster Med Public Health Preparedness. 2018;12:121–126)
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Glomb, Nicolaus W., Manish I. Shah, Adeola A. Kosoko, Cara B. Doughty, Cafen Galapi, Bushe Laba, and Marideth C. Rus. "Educational impact of a pilot paediatric simulation-based training course in Botswana." BMJ Simulation and Technology Enhanced Learning 6, no. 5 (October 21, 2019): 279–83. http://dx.doi.org/10.1136/bmjstel-2019-000501.
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BackgroundAs emergency medical services (EMS) systems develop globally in resource-limited settings, equipping providers with paediatric training is essential. Low-fidelity simulation-based training is an effective modality for training healthcare workers, though limited data exist on the impact of such training programmes. The objective of this study was to evaluate the paediatric portion of a simulation-based curriculum for prehospital providers in Botswana.MethodsThis was a prospective cohort study of EMS providers from more populated regions of Botswana, who attended a 2-day training that included didactic lectures, hands-on skills stations and low-fidelity simulation training. We collected data on participant self-efficacy with paediatric knowledge and skills and performance on both written and simulation-based tests. Self-efficacy and test data were analysed, and qualitative course feedback was summarised.ResultsThirty-one EMS providers participated in the training. Median self-efficacy levels increased for 13/15 (87%) variables queried. The most notable improvements were observed in airway management, newborn resuscitation and weight estimation. Mean written test scores increased by 10.6%, while mean simulation test scores increased by 21.5% (p<0.0001). One hundred per cent of the participants rated the course as extremely useful or very useful.Discussion/ConclusionWe have demonstrated that a low-fidelity simulation-based training course based on a rigorous needs assessment may enhance short-term paediatric knowledge and skills for providers in a developing EMS system in a limited-resource setting. Future studies should focus on studying larger groups of learners in similar settings, especially with respect to the impact of educational programmes like these on real-world patient outcomes.
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Khan, Ayesha, K. Masek, and A. Ditullio. "Feasibility of using a remote app-based curriculum with short live training course to train mid-level providers in Haiti." Annals of Global Health 82, no. 3 (August 20, 2016): 371. http://dx.doi.org/10.1016/j.aogh.2016.04.105.
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Feldman, Estée C. H., Lindsay K. Durkin, Lindsey Bugno, Kathryn A. Balistreri, W. Hobart Davies, Steven A. Miller, and Rachel Neff Greenley. "Communication About Medication by Providers-Adolescent and Young Adult Version: Confirmatory Factor Analyses." Journal of Pediatric Psychology 46, no. 5 (March 11, 2021): 599–608. http://dx.doi.org/10.1093/jpepsy/jsab009.
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Abstract Objective To replicate the factor structure of a patient-report measure of provider communication about key medication prescription information, the Communication about Medication by Providers-Adolescent and Young Adult (CAMP-AYA) Version. We evaluated whether the 15-item, two-factor structure identified previously could be replicated via confirmatory factor analysis, and we also examined fit of unidimensional and bifactor models. Associations of CAMP-AYA Total and Factor Scores with provider satisfaction and select patient and medication characteristics were also examined. Methods Participants were 739 AYA (ages 18–25) who completed the CAMP-AYA, a provider satisfaction rating, and provided demographic and medication information. Results The bifactor model was best fitting (χ2 [75] = 689.60, p < .0001; root mean squared error of approximation = 0.11, 90% CI [0.10, 0.11]; Comparative Fit Index = 0.98; Tucker–Lewis Index = 0.98; Standardized Root Mean Square Residual Index = 0.02). Internal consistency reliabilities for Total and Factor Scores were high (αs > .89) and Total and Factor Scores were associated with provider satisfaction (ps < .001). CAMP-AYA scores varied as a function of type of prescription (short vs. long term; new vs. refill), with higher scores reported in the context of long term (>30-day course) or refilled prescriptions (ps < .007) in most cases. Conclusions This study provides additional support for the reliability of the CAMP-AYA as a tool to assess AYA perceptions of provider key information coverage about medication prescriptions.
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Lawry, P. "Regional Trends In Hospitality And Tourism Management; Education And Training for Careers In Tourism Management: Implications for New Course Providers." Hospitality Education and Research Journal 12, no. 2 (February 1988): 488–90. http://dx.doi.org/10.1177/109634808801200263.
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Service industries in general and the tourist industry in particular make a significant contribution to the economy of Great Britain. Over 1.1 million people are currently employed either directly or indirectly in the tourist industry and it directly accounts for 4.7 percent of all UK employment. However, the subject of education and training for careers in tourism has been poorly quantified to date and little research has been done in this field of study. Yet any policies to promote the growth of the tourist industry must depend upon adequate numbers of trained people being available at all levels within the industry. If the tourist industry is to be encouraged as a major growth area in the UK economy it is essential that there are sufficient numbers of qualified people to prepare and implement tourism development plans, manage regional and national tourist organizations and staff the many firms which make up the tourist industry. This paper is based on a study carried out for the English Tourist Board, although any views and opinions expressed here are solely those of the author. It has been supplemented by more recent information on courses and course developments since 1985. “Education and training” is taken to mean educational and vocational training courses covering the whole field of further and higher education, from technical colleges through to universities, which are aimed at raising the level of skills and knowledge needed to work in the tourist industry. The study focused on the non-hotel sectors of the tourist industry because it was felt that the hotel and catering sector was well developed. However, it was felt that training in the tourist services sector is in a much earlier stage of development and has quite different manpower and training requirements. The aims of the study was to examine the existing provision of education and training courses in relation to the manpower needs of the industry, to identify shortfalls in provision and to suggest ways of meeting these short falls.
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Vyapari, Sudeep, Robert J. Graves, and Edmund L. Thralls. "(117) A Profile of Landscape Service Providers in West Central Florida." HortScience 40, no. 4 (July 2005): 1080A—1080. http://dx.doi.org/10.21273/hortsci.40.4.1080a.
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A survey of landscape service providers was conducted in conjunction with the 2004 Tree and Landscape Short Course in Tampa, Fla. A greater proportion of participants (56%) provided landscape maintenance services, and 60% of the businesses were independently owned. About 67% of the respondents indicated that their businesses were in operation for over 10 years with 33% of the participants making one million dollars or more in gross sales per year. Although 43% of the respondents indicated that they served only one type of account, at least 29% of the providers served two types of accounts, and 24% served three types. In response to various questions on a Likert scale of 1–5, about 39% of the respondents completely agreed that word-of-mouth is the best marketing method and 41% agreed that an attractive logo on company trucks works as a great marketing tool. Many participants either agreed (27%) or were neutral (27%) when asked if they thought that the customers have no understanding of the costs involved in providing services to them. The survey results show that 73% of the respondents believe the most important factor that impacts and helps retain a customer base at a steady level is quality of work performed followed by professional employees, appearance, and knowledgeable employees. Cheap prices or discounts offered were rated as being low factors in retention of customers. Most service providers (31%) do not communicate with their customers using brochures, newsletters, flyers, emails, or websites. About 61% of service providers promote low water use plants followed by use of Florida native plants.
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Hile, Garrett B., Kaitlin L. Musick, Adam J. Dugan, Abby M. Bailey, and Gavin T. Howington. "Occurrence of Hyperbilirubinemia in Neonates Given a Short-term Course of Ceftriaxone versus Cefotaxime for Sepsis." Journal of Pediatric Pharmacology and Therapeutics 26, no. 1 (January 1, 2021): 99–103. http://dx.doi.org/10.5863/1551-6776-26.1.99.
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OBJECTIVE Ceftriaxone and cefotaxime are appealing options for the treatment of neonatal infections. Guidelines recommend cefotaxime as the cephalosporin of choice in neonates because of ceftriaxone's potential to cause hyperbilirubinemia. Unfortunately, due to cefotaxime discontinuation, providers must choose between alternative antibiotics. Clinicians at our institution adopted a protocol allowing for the utilization of cefepime and ceftriaxone for the management of neonatal sepsis. The objective of this study was to compare the incidence of hyperbilirubinemia between ceftriaxone and cefotaxime in the treatment of neonatal infections beyond the first 14 days of life. METHODS This was a retrospective chart review of patients receiving ceftriaxone or cefotaxime for the treatment of neonatal infections. Patients were 15 to 30 days old at the time of antimicrobial administration and received at least 1 dose of ceftriaxone or cefotaxime during hospital admission. Patient characteristics and bilirubin levels were compared between ceftriaxone and cefotaxime. RESULTS The analysis included 88 patients. There was no statistically significant difference between groups in age, gestational age, weight, and baseline total calcium and bilirubin levels. Normal baseline bilirubin levels increased to an abnormal level after antibiotic administration in 2 patients in the cefotaxime group and 1 patient in the ceftriaxone group. The median number of doses of cefotaxime and ceftriaxone were 3 and 2, respectively. CONCLUSION Patients who received a short-term course of ceftriaxone did not have a higher likelihood of developing hyperbilirubinemia compared with those who received a short-term course of cefotaxime during their hospital stay.
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Zhang, Lane, and David Steckman. "Stroke or side effect? dofetilide associated facial paralysis after direct current cardioversion for atrial fibrillation." BMJ Case Reports 12, no. 1 (January 2019): e227705. http://dx.doi.org/10.1136/bcr-2018-227705.
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Dofetilide is a class III antiarrhythmic drug that has proven efficacious in maintaining sinus rhythm in up to 60% of patients with persistent atrial fibrillation. Dofetilide’s most concerning adverse effect is QT prolongation and polymorphic VT, but providers should be aware of other rare significant side effects. We report a case of dofetilide associated Bell’s palsy masquerading as stroke that developed shortly after a cardioversion. The patient’s facial weakness, a side effect of dofetilide, resolved relatively quickly after discontinuation of the medication and a short course of oral corticosteroids.
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Kennedy, William P., and P. J. R. Delargy. "Shorting the Future? Capital Markets and the Launch of the British Electrical Industry, 1882–1892." Business History Review 94, no. 2 (2020): 287–320. http://dx.doi.org/10.1017/s0007680520000318.
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Although Britain's electrification started with considerable technological and market advantages, it proceeded remarkably slowly and hesitantly. Using share-price data, this study investigates the conventional explanations for this disappointing outcome: notably, perverse regulation and competition from entrenched gas-light providers. It finds that these oft-cited factors had an imperceptible impact on the course of the British electrical industry's turbulent market launch in 1882. However, we show that, owing to the fledgling electrical industry's need for incessant experimentation, short-sighted, self-serving decisions by the management of the early British industry's most prominent firm squandered a well-funded start, with long-lasting adverse consequences.
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Mehegan, Laura, and Chuck Raineville. "NORMALIZING COGNITIVE EVALUATIONS IN ADULTS: GETTING PEOPLE IN THE SCREENING PIPELINE EARLY." Innovation in Aging 6, Supplement_1 (November 1, 2022): 485. http://dx.doi.org/10.1093/geroni/igac059.1871.
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Abstract To understand how adults and healthcare providers perceive a dementia diagnosis and cognitive evaluations, AARP fielded a nationally representative survey of adults aged 40 and older (N=3,022) along with a companion survey of healthcare providers in a position to diagnose dementia (N=500). Like healthcare providers, Americans aged 40 and older understand the benefits of diagnosing dementia at an early stage, 81% agree that early detection would motivate them to engage in healthier behaviors to slow the progression of the disease. Adults look to healthcare providers as authorities to determine when a cognitive evaluation should be triggered with 63% saying they would get an evaluation if their doctor recommended it and 49% of healthcare providers saying evaluations should be done if the doctor feels it is necessary and 39% saying it should be done yearly beginning at age 65. The research also showed that most adults (76%) want to know if they have dementia. Additionally, majorities of adults would engage in healthy behaviors if they knew it’s good for their brain health. Given the desire to prevent and improve outcomes, routine screening for cognitive function should be as commonplace as getting a screening colonoscopy. Unlike a colonoscopy, routine screening for cognitive function is not a normalized process yet. Data from both populations suggest an opportunity for routine evaluation due to a shared understanding of the long and short-term benefits of screening.
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Pound, Catherine M., Jaime McDonald, Ken Tang, Gillian Seidman, Radha Jetty, Sarah Zaidi, and Amy C. Plint. "Dexamethasone versus prednisone for children receiving asthma treatment in the paediatric inpatient population: protocol for a feasibility randomised controlled trial." BMJ Open 8, no. 12 (December 2018): e025630. http://dx.doi.org/10.1136/bmjopen-2018-025630.
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IntroductionAsthma exacerbations are a leading cause of paediatric hospitalisations. Corticosteroids are key in the treatment of asthma exacerbations. Most current corticosteroids treatment regimens for children admitted with asthma exacerbation consist of a 5-day course of prednisone or prednisolone. However, these medications are associated with poor taste and significant vomiting, resulting in poor compliance with the treatment course. While some centres already use a short course of dexamethasone for treating children hospitalised with asthma, there is no evidence to support this practice in the inpatient population.Methods and analysisThis single-site, pragmatic, feasibility randomised controlled trial will determine the feasibility of a non-inferiority trial, comparing two treatment regimens for children admitted to the hospital and receiving asthma treatment. Children 18 months to 17 years presenting to a Canadian tertiary care centre will be randomised to receive either a short course of dexamethasone or a longer course of prednisone/prednisolone once admitted to the inpatient units. The primary clinical outcome for this feasibility study will be readmission to hospital or repeat emergency department visits, or unplanned visits to primary healthcare providers for asthma symptoms within 4 weeks of hospital discharge. Feasibility outcomes will include recruitment and allocation success, compliance with study procedures, retention rate, and safety and tolerability of study medications. We plan on recruiting 51 children, and between-group comparisons of the clinical outcome will be conducted to gain insights on probable effect sizes.Ethics and disseminationResearch Ethics Board approval has been obtained for this study. The results of this study will inform a multisite trial comparing prednisone/prednisolone to dexamethasone in inpatient asthma treatment, which will have the potential to improve the delivery of asthma care, by improving compliance with a mainstay of treatment. Results will be disseminated through peer-reviewed publications, organisations and meetings.Trial registration numberNCT03133897; Pre-results.
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Beriwal, Krishan. "A Review on Supply Chain in Agriculture Sector." International Journal for Research in Applied Science and Engineering Technology 10, no. 7 (July 31, 2022): 3465–70. http://dx.doi.org/10.22214/ijraset.2022.45754.
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Abstract: Furious contest in today's worldwide business sectors, the presentation of items with increasingly short life cycles, and the elevated assumptions for clients have constrained business venture to put resources into and focus consideration around their stockpile chains. This, along with proceeding with propels in correspondences and transportation advancements (e.g., versatile correspondence, Internet, and short-term conveyance), has persuaded the ceaseless development of the production network and of the methods to oversee it. At the point when an organization makes an item with the assistance of parts bought from providers and those fabricated items or merchandise are offered to clients then the entire interaction is known as Supply chain. It is moreover implied as the arranged activities association, containing suppliers which incorporate arrangement of unrefined components, manufacturing centres, stockrooms, course centres, and retail outlets, as well as normal substances, work in process stock, and finished things that stream between the workplaces.
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Henderson, Richard A., Robert Groves, and Sundus Henderson. "The genesis of an Adult Education programme in science." New Directions in the Teaching of Physical Sciences, no. 2 (December 1, 2006): 41–44. http://dx.doi.org/10.29311/ndtps.v0i2.432.
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Science and technology are now part of our everyday lives, and their impact will undoubtedly continue to grow in ever more sophisticated and subtle ways. Inevitably, this will lead to debates and controversy about the ethics and risks that science brings with it; debates in which the general public should be fully engaged. But many adults inevitably feel alienated from any involvement in such a debate because of their lack of scientific knowledge. There is a very urgent need to engage not only young people but also more mature adults in scientific discussion at levels that are both meaningful and serious. In Newcastle we are developing an adult science education programme which brings together local adult education providers, universities and industry to supply a cohesive series of short events which not only allow adults to learn and engage with contemporary science (and how it impacts on their everyday lives), but also offers the opportunity to progress to more advanced courses leading to formal qualifications. In this article we outline the development of this programme which was greatly assisted by the appointment of an ‘Adult Education Fellow’ (funded by The Higher Education Academy Physical Science Centre). Over the course of one year the Fellow established the consortium, identified what the detailed demand was, prepared the course and raised funds ready for its start in 2006.
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Corona, Antonio Gabriel D., and Holly M. Koncicki. "The intersection of oncology, nephrology, and palliative care." Journal of Onco-Nephrology 5, no. 1 (February 2021): 48–56. http://dx.doi.org/10.1177/23993693211001380.
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Onconephrology patients share a common feature: decreased survival. This is where Palliative Care finds a role in managing for these patients. However, during the course of illness and its treatment, providers often overlook the importance of assessing prognosis, predicting disease trajectory, and addressing goals of care discussions with patients and their family. Knowing which factors portend a poor outcome in this population helps bind together the subspecialties of Oncology, Nephrology and Palliative Care and frame interventions within patients’ treatment goals. As the life expectancies of patients suffering from cancer and kidney disease is short, knowledge of these foreboding factors helps initiate end of life planning which has shown to be beneficial for our patients’ quality of life.
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Kunz, Roland. "Neither Last nor Least: Integration of Early Palliative Care Into Standard Oncology Care." healthbook TIMES Oncology Hematology, no. 4 (July 13, 2020): 36–41. http://dx.doi.org/10.36000/hbt.oh.2020.04.014.
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Traditionally, medical oncology has concentrated on the development, implementation, and application of anticancer therapies, therefore in a number of cancers long- and short-term survival has been significantly improved.1 However, for most patients, quality of life is crucial, irrespective of the clinical course of the illness or the duration of survival.2 It is estimated that by 2060, over 16 million people will die from malignant neoplasms and experience serious health-related suffering annually, which is double the number compared with 2016.3 Consequently, building non-specialist palliative care capacity among all healthcare providers by integration of palliative care in the oncological treatment as early as possible is crucial.2,4 But how can we do that?
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Bradley, Jessica, Claire Newhouse, and Nadira Mirza. "Driving social mobility? Competitive collaboration in degree apprenticeship development." Higher Education, Skills and Work-Based Learning 9, no. 2 (May 13, 2019): 164–74. http://dx.doi.org/10.1108/heswbl-07-2018-0077.
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Purpose Apprenticeship reforms have paved the way for higher education (HE) providers, including universities, to become Degree Apprenticeships (DA) training providers, creating new work-based HE routes. The changes aim to generate a new cohort of skilled individuals to support national economic growth, as well as improve levels of social mobility. The purpose of this paper is to focus on an HE partnership project which resulted in a number of collaborative models for development that address these aims. Design/methodology/approach The paper focuses on qualitative interviews undertaken during the process of creating DAs through a consortium of HE providers. It considers the collaborative relationships which were built on and which developed across the course of the short-term project. It assesses the concept of competitive collaboration and its link to social mobility. Findings The paper considers the various manifestations of collaboration which supported the DA developments in a competitive environment: collaboration as embedded; collaboration as negotiation; and collaboration as a driver for social mobility and social equality. Originality/value Working collaboratively across HE providers sought to raise the status of apprenticeships, provide opportunities for the development of new degree apprenticeship curricula and enable practitioners to establish these as a new route into HE. This paper contributes to what is currently limited knowledge about the impact of degree apprenticeships on social mobility and equality.
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Wardell, Hanna, Ana M. Vaughan-Malloy, Courtney Gidengil, Jorge J. Velarde, Zana Khoury, Ramy Yim, Sarah Jones, Mari M. Nakamura, Gabriella S. Lamb, and Gabriella S. Lamb. "1126. Short-Course Therapy and Transition to Enteral Antibiotics for Uncomplicated Bacteremia Due to Enterobacterales Species." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S654. http://dx.doi.org/10.1093/ofid/ofab466.1319.
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Abstract Background Gram-negative bacteremia historically has been treated with 10-14 days of parenteral antibiotics. However, data supporting this practice are lacking, and recent evidence shows equivalent outcomes for short-course (SC) therapy (7 days) and early (by day 5) conversion to highly bioavailable enteral (PO) antibiotics for Enterobacterales bacteremia. Methods Under a QI framework, we used PDSA cycles to reduce treatment duration and increase use of PO levofloxacin or trimethoprim-sulfamethoxazole for uncomplicated Enterobacterales bacteremia among Infectious Diseases (ID) clinicians at a children’s hospital in Boston, MA. We conducted an education session on evidence to support these practices for ID faculty and fellows in October 2020. In December 2020, we implemented standardized recommendations for a 7-day duration and early PO transition for eligible patients (≥ 3-months-old, ≤ 2 days monomicrobial bacteremia, with source control and return to baseline clinical status) that could be inserted automatically into electronic consult notes. In February 2021, we reinforced this practice to ID providers. We collected data before and after these interventions on ID recommendations and on patients’ actual antibiotic management. Results From 11/01/20 to 05/31/21, mean recommended treatment decreased from 10.6 to 9.5 days; however, mean duration received was similar (11.2 vs 11.7 days) (Figure 1). The percentage of patients for whom ID recommended PO conversion and in whom transition to PO agents by day 5 occurred increased from 27% to 37.5%. Figure 1. Change in average duration of antibiotics recommended and received, in days Conclusion Education and creation of automated standardized recommendations led to decreased recommended treatment durations and increased PO conversions for Enterobacterales bacteremia, but only modestly. This quality improvement initiative demonstrates the potential benefits of education and electronic documentation tools to facilitate evidence-based practice changes, but also highlights the difficulty in changing practice even amongst ID clinicians. Further PDSA cycles will be targeted at increasing more consistent awareness among a large ID division in addition to other stakeholders. Disclosures Gabriella S. Lamb, MD, MPH, Nothing to disclose
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Alabiad, Chris R., Kevin J. Moore, David P. Green, Matthew Kofoed, Alex J. Mechaber, and Carol L. Karp. "The Flipped Classroom: An Innovative Approach to Medical Education in Ophthalmology." Journal of Academic Ophthalmology 12, no. 02 (July 2020): e96-e103. http://dx.doi.org/10.1055/s-0040-1713681.
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Abstract Objective The aim of the study is to report the creation of a flipped ophthalmology course and preclinical medical student perceptions and knowledge gains before and after a flipped ophthalmology course. Design The form of the study discussed is an observational study. Subjects The subjects involved in the study are second-year (U.S.) United States medical students at the University of Miami, Miller School of Medicine (n = 401). Methods Second-year medical students participated in a 1-week “flipped classroom” ophthalmology course geared toward primary care providers at the University of Miami, Miller School of Medicine. Eleven hours of traditional classroom lectures were condensed into 4.5 hours of short videos with self-assessment quizzes, small group discussions, and a large group case-based discussion. Fifty-seven short videos (<9 minutes) focused on major ophthalmology topics and common conditions were viewed by the students at their leisure. Students completed a pre- and post-course evaluation on their perceptions and opinions of the flipped classroom approach. Final exam scores in the flipped classroom cohort were compared with the final exam scores in the traditional didactic format used in years prior. Main Outcome Measures The main outcome measures include: student final exam performance; student satisfaction, opinions, and perceptions. Results Over the course of 2 years, 401 second-year U.S. medical students participated in the flipped classroom ophthalmology course. The majority of students enjoyed the flipped classroom experience (75.3%) and expressed interest in using the approach for future lessons (74.6%). The flipped classroom videos were preferred to live lectures (61.2%). Over 90% of students stated the self-assessment quizzes were useful, 79% reported that the small group discussions were an effective way to apply knowledge, and 76% cited the large group case-based discussion as useful. Pre-course knowledge assessment scores averaged 48%. Final examination scores in the flipped group (average ± standard deviation [SD] = 92.1% ± 6.1) were comparable to that of the traditional group when evaluating identical questions (average ± SD = 91.7% ± 5.54), p = 0.34. Conclusion The flipped classroom approach proved to be a well-received and successful approach to preclinical medical education for ophthalmology. This was achieved using 35% less course time than our traditional course. This innovative approach has potential for expansion to other medical schools, medical education abroad, and for other medical school modules.
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Trivedi, Parigna R., and Tejas M. Khakhkhar. "Treatment outcome of tuberculosis patients under directly observed treatment short-course and factors affecting the outcome in tertiary care hospital." International Journal of Basic & Clinical Pharmacology 8, no. 5 (April 23, 2019): 981. http://dx.doi.org/10.18203/2319-2003.ijbcp20191588.
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Background: Revised National Tuberculosis Control Programme (RNTCP) based on Directly Observed Treatment Short-course (DOTS) strategy has been made available in entire country by March 2006. Given high rate of unfavourable treatment outcomes reported in some provinces, there is a need to analyse outcomes and identify possible trends and associated risk factors that can help for improvement in RNTCP.Methods: After getting Institutional Ethics Committee (IEC) approval, total of 76 cases diagnosed and treated for Tuberculosis (TB) under Category I of RNTCP were recruited from January to March 2017. All patients were followed up for six months from date of initiating the treatment. The data was obtained from TB treatment register, by patient visit and regular follow-up. The information collected include age and gender of patient, category of treatment, date of treatment initiation, initial sputum conversion, outcome of treatment and date of outcome.Results: Out of total 76 patients, 64 (84.21%) were cured, 5 (6.57%) were lost to follow-up, 4 (5.26%) were failed to treat, 1 (1.32%) patient was died, 1 (1.32%) patient had completed treatment but status was unknown and 1 (1.32%) patient was not evaluated because of transfer. Overall treatment outcome of TB patients under DOTS was matching goal of RNTCP with cure rate of 84.21%.Conclusions: Efforts by DOT providers, adequate patient education, motivating ones in need can bring positive outcomes. In this region, DOTS center is at good working condition in terms of functionality as well as ethically. Gender, age group, residence and initial culture colony did not significantly affect treatment outcome.
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Powers, Becky. "THE SAGE SYMPOSIUM: A MODEL FOR HANDS-ON INTERACTIVE CONTINUING EDUCATION." Innovation in Aging 3, Supplement_1 (November 2019): S725—S726. http://dx.doi.org/10.1093/geroni/igz038.2658.
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Abstract Current graduate and postgraduate medical education has minimal geriatric and palliative care curricular requirements, leaving Continuing Education (CE) programs poised to fill a critical educational niche. The San Antonio Geriatric and Palliative Education (SAGE) Symposium was a 3 day long interprofessional CE conference for providers caring for older adults. SAGE addressed geriatric knowledge, skill, and attitude deficits in practicing providers by incorporating: 1) a community and provider based needs assessment, 2) active skills sessions culminating in a health fair, and 3) multimedia based reflective exercises. Needs Assessment (Knowledge): A video needs assessments of older adults were performed using a convenience sampling methodology in 13 non-healthcare public locations in each quadrant of the city. 23 respondents were interviewed before reaching thematic saturation with 3 main themes: geriatric syndromes, patient-provider relationships, and support. Content areas for the course were derived from the needs assessment. Skills Sessions (Skills): In addition to standard plenary sessions, multiple active breakout session taught attendees common geriatric skills. On the last day of the conference, attendees applied these skills under supervision at a senior community health fair. Reflective Exercises (Attitudes): Videos, poems, and artwork with themes on aging were displayed during conference breaks. Attendees received CE credit for electronically submitting short reflections to each multimedia piece. Reflections were compiled and reported back to the group at the end of the conference. By changing the traditional CE conference format to an interactive experience, the SAGE Symposium was able to address knowledge, skills, and attitudes towards aging in its attendees.
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Rajeswari Ramasamy, Guru Prasad Mohanta, Shobha Rani R Hiremath, Raman Dang, Chandramouli R, and Manjiri S Gharat. "Assessing the Change of Community Pharmacist’s Knowledge on Tuberculosis and Attitude to practice as a Tuberculosis DOTS provider after an Educational Intervention." International Journal of Research in Pharmaceutical Sciences 11, no. 4 (December 25, 2020): 7593–99. http://dx.doi.org/10.26452/ijrps.v11i4.4008.
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Government of India officially launched Directly Observed Treatment-Short course (DOTS) strategy in 1997 to offer better Tuberculosis (TB) care services under Revised National Tuberculosis Control Program (RNTCP). Under this strategy, DOTS providers need to observe and assist the tuberculosis patient to take their DOTS medicine and document the same after each dosing. As part of Public-Private Mix (PPM) partnership under RNTCP, Community Pharmacists (CPs) needs be trained to observe DOTS.This study was aimed to assess the change of CPs basic knowledge on tuberculosis; and attitude to practice as TB-DOTS provider after an educational intervention. Pretest and post test were carried out for 149 participants, to measure the changes in their TB Knowledge and attitude. The changes in the proportions of choices the subjects were analyzed using inferential statistical tests. It was evident from our study that CPs in spite of their knowledge about the TB and the pathogenesis, they were found largely unaware of the Government DOTS-TB treatment national policy and the role they can play in their private practice setups
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Kruger, Shaul Z., Susan E. Bronskill, Lianne Jeffs, Marilyn Steinberg, Andrew M. Morris, and Chaim M. Bell. "Evaluating and prioritizing antimicrobial stewardship programs for nursing homes: A modified Delphi panel." Infection Control & Hospital Epidemiology 41, no. 9 (June 22, 2020): 1028–34. http://dx.doi.org/10.1017/ice.2020.214.
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AbstractBackground:Antibiotic use in nursing homes is often inappropriate, in terms of overuse and misuse, and it can be linked to adverse events and antimicrobial resistance. Antimicrobial stewardship programs (ASPs) can optimize antibiotic use by minimizing unnecessary prescriptions, treatment cost, and the overall spread of antimicrobial resistance. Nursing home providers and residents are candidates for ASP implementation, yet guidelines for implementation are limited.Objective:To support nursing home providers with the selection and adoption of ASP interventions.Design and Setting:A multiphase modified Delphi method to assess 15 ASP interventions across criteria addressing scientific merit, feasibility, impact, accountability, and importance. This study included surveys supplemented with a 1-day consensus meeting.Participants:A 16-member multidisciplinary panel of experts and resident representatives.Results:From highest to lowest, 6 interventions were prioritized by the panel: (1) guidelines for empiric prescribing, (2) audit and feedback, (3) communication tools, (4) short-course antibiotic therapy, (5) scheduled antibiotic reassessment, and (6) clinical decision support systems. Several interventions were not endorsed: antibiograms, educational interventions, formulary review, and automatic substitution. A lack of nursing home resources was noted, which could impede multifaceted interventions.Conclusions:Nursing home providers should consider 6 key interventions for ASPs. Such interventions may be feasible for nursing home settings and impactful for improving antibiotic use; however, scientific merit supporting each is variable. A multifaceted approach may be necessary for long-term improvement but difficult to implement.
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Mackenzie, Scott C., Kirsten M. Cumming, David Garrell, Doogie Brodie, Lyn Wilson, Salma Mehar, Scott G. Cunningham, Alex Bickerton, and Deborah J. Wake. "Massive open online course for type 2 diabetes self-management: adapting education in the COVID-19 era." BMJ Innovations 7, no. 1 (November 16, 2020): 141–47. http://dx.doi.org/10.1136/bmjinnov-2020-000526.
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IntroductionType 2 diabetes self-management education is an essential component of type 2 diabetes care that is traditionally delivered in a face-to-face setting. In response to the recent COVID-19 pandemic, innovative solutions are urgently needed, allowing provision of self-management education that can be delivered in compliance with social distancing policies. Innovations that are self-service and can deliver education efficiently at low cost are particularly appealing to healthcare providers and commissioners.MethodsWe aimed to evaluate user uptake, dropout, acceptability, satisfaction, perceived short-term knowledge gain and health benefits/behaviour changes in relation to a free massive open online course (MOOC) in diabetes self-management education, created and delivered during the COVID-19 pandemic. This course, focusing on addressing knowledge and self-management needs for people with type 2 diabetes, made use of online interactive content including expert and patient videos, quizzes, moderated discussion boards and live social media that encouraged personal reflection and goal setting. User expectations and experiences were explored via survey-based methods. Here, we present our experience of developing the course and describe users’ experiences.Results1991 users registered interest in the course over a 2-week period, with 976 users starting the course and 640 (65.6%) users completing the course in full. Users engaged well, finding the course educational, user-friendly and motivating, demonstrating high completion rates and user satisfaction. A statistically significant (p<0.001) increase in self-reported self-management ability and health knowledge was observed among participants with type 2 diabetes.DiscussionMOOCs in type 2 diabetes self-management education have great potential for delivering education efficiently at scale and low cost. Although engagement can be limited by digital literacy, benefits include flexible and remote access to up-to-date, evidence-based education delivered by a multidisciplinary team of healthcare professionals.
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Bell, Janice, and Jessica Zitter. "Using Documentary Short Film for Health Impact: An Example for Supporting Family Caregivers." Innovation in Aging 5, Supplement_1 (December 1, 2021): 190. http://dx.doi.org/10.1093/geroni/igab046.725.
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Abstract Storytelling through film is a powerful tool with potential to improve understanding, spark discussion, shape perceptions of health and illness, and influence related behavior. We developed a film discussion guide for the documentary short film Caregiver: A Love Story. The 24-minute film follows the experience of a man who leaves his job to become the primary caregiver of his 59 year-old wife, who opts out of non-beneficial chemotherapy, choosing instead to remain at home with hospice support. The 2-hour program was facilitated by an experienced social worker and offered on five different days/times using Zoom video (n=60 total attendees; 9-15/ session). At each session, we showed the film, discussed self-care and caregiver resources, and fielded a survey to assess satisfaction, format acceptability and session impact (response rates 67-100%/session). Attendees liked the session format (90%); found the film relevant to their situations (80%); intended to look for new professional resources (79%); were motivated to do something different(71%); learned something new (64%); and intended to ask for more help from family or friends (64%). Many commented that they preferred the video meeting format over in-person meetings. The film viewing and discussion format is acceptable and accessible to family caregivers who may otherwise not be able to attend given competing demands. This format also has potential to improve support access to resources. Extensions to this work are planned to tailor the film discussion guide for health care providers and students working with family caregivers across inpatient, outpatient and hospice settings.
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Mariño García, Luisa, and Jordan S. Potash. "Art Therapy as Psychosocial Support for FARC Reincorporation." Journal of Peacebuilding & Development 14, no. 2 (May 21, 2019): 109–24. http://dx.doi.org/10.1177/1542316619842046.
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Psychosocial support programmes are an intrinsic part of a sustainable and successful social reincorporation of ex-combatants in post-conflict situations. Following the end of Colombia’s 50-year civil war, people who were formerly part of the Revolutionary Armed Forces of Colombia (FARC) are currently living in designated spaces for reincorporation into society. This project aimed to identify how the field of art therapy can help advance existing initiatives of psychosocial support and reincorporation. An art therapist collaborated with local treatment providers on a short-term project with former FARC families and individuals. Based on the participants’ narratives and artwork, as well as the art therapist’s observations and field notes, this project identified four functions for art therapy: (1) facilitating communication amongst community members, (2) preserving memories of personal and historical relevance, (3) promoting acceptance, and (4) promoting artistic expression for self-reflection. The findings outline a viable course of action for future art therapists by exemplifying psychosocial supports to individuals, families, communities, and society in reincorporation processes. Open dialogue with community members and on-site service providers is crucial to ensuring art therapy is both adaptive and responsive to changing needs.
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Josephson, Laura, Virgilius Cornea, Bobbi Jo Stoner, and Sami El-Dalati. "Cryoglobulinemic vasculitis in two patients with infective endocarditis: a case series." Therapeutic Advances in Infectious Disease 9 (January 2022): 204993612211134. http://dx.doi.org/10.1177/20499361221113464.
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Cryoglobulins are circulating immune complexes that precipitate at cool temperatures and can induce a small-vessel vasculitis. While patients with endocarditis are well known to have circulating cryoglobulins, cryoglobulinemic vasculitis is a rare complication of infective endocarditis with infrequent publication of reported cases. We present two cases of methicillin-resistant Staphylococcus aureus tricuspid valve infective endocarditis in patients with substance use disorder complicated by cryoglobulinemic cutaneous vasculitis confirmed by skin biopsy, including one patient who developed renal and colonic manifestations of vasculitis. Both patients had symptomatic improvement in their vasculitis with appropriate antimicrobial therapy, including one patient who received a short course of prednisone and another with chronic active hepatitis C that remained untreated. Providers should have a high-index of suspicion for infective endocarditis in patients presenting with new onset cryoglobulinemic vasculitis, particularly if the patients have underlying risk factors for endocarditis.
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Kamaraj, Arunraj, Manish Kumar Goel, Jyoti Khandekar, Khalid Umer Khayyam, and Sanjeev Kumar Rasania. "Delay in diagnosis and treatment among registered TB patients in Directly Observed Treatment Short Course cum Designated Microscopy Centres in South Delhi." Indian Journal of Community Health 33, no. 2 (June 30, 2021): 344–50. http://dx.doi.org/10.47203/ijch.2021.v33i02.021.
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Background: Knowing delays in treatment seeking and subsequent treatment initiation among the TB patients is important and its detailed understanding is crucial in modifying the treatment seeking behaviour which can help in reducing the TB burden and the transmission in the community. Aim & Objective: To study the treatment seeking behaviour including the delays in initiation of treatment along with its determinants; among tuberculosis patients aged > 15 years in Mehrauli area of Delhi. Settings and Design: A longitudinal follow up study conducted in two randomly selected DMC cum DOTS centres in Mehrauli area of Delhi from January 2018 to April 2018. Methods and Material: Patients of both sexes of age > 15 years, registered under RNTCP from January to April 2018 in the randomly selected DOTS centres i.e. Mehrauli DMC cum DOTS and Chattarpur DMC cum DOTS centre were included in the study. Self-designed, pretested interview schedule and records of DMC were used to collect the relevant information. Statistical analysis used: Information collected in the Performa was coded and entered in Statistical Package for Social Sciences (SPSS) version 12. Results: The mean patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 48.91 ± 130.38 days, 91.09 ± 155.97 days, 6.25 ± 6.29 days, 62.72 ± 119.48 days and 97.33 ± 155.06 days respectively. The median patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 15 days, 45 days, 5 days, 35 days and 54 days respectively. Conclusions: The major reasons for patient’s delay were lack of awareness regarding the symptoms of TB and self-medication and for health care system delay it was treatment from private health care providers.
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Kamaraj, Arunraj, Manish Kumar Goel, Jyoti Khandekar, Khalid Umer Khayyam, and Sanjeev Kumar Rasania. "Delay in diagnosis and treatment among registered TB patients in Directly Observed Treatment Short Course cum Designated Microscopy Centres in South Delhi." Indian Journal of Community Health 33, no. 2 (June 30, 2021): 344–50. http://dx.doi.org/10.47203/ijch.2021.v33i02.021.
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Background: Knowing delays in treatment seeking and subsequent treatment initiation among the TB patients is important and its detailed understanding is crucial in modifying the treatment seeking behaviour which can help in reducing the TB burden and the transmission in the community. Aim & Objective: To study the treatment seeking behaviour including the delays in initiation of treatment along with its determinants; among tuberculosis patients aged > 15 years in Mehrauli area of Delhi. Settings and Design: A longitudinal follow up study conducted in two randomly selected DMC cum DOTS centres in Mehrauli area of Delhi from January 2018 to April 2018. Methods and Material: Patients of both sexes of age > 15 years, registered under RNTCP from January to April 2018 in the randomly selected DOTS centres i.e. Mehrauli DMC cum DOTS and Chattarpur DMC cum DOTS centre were included in the study. Self-designed, pretested interview schedule and records of DMC were used to collect the relevant information. Statistical analysis used: Information collected in the Performa was coded and entered in Statistical Package for Social Sciences (SPSS) version 12. Results: The mean patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 48.91 ± 130.38 days, 91.09 ± 155.97 days, 6.25 ± 6.29 days, 62.72 ± 119.48 days and 97.33 ± 155.06 days respectively. The median patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 15 days, 45 days, 5 days, 35 days and 54 days respectively. Conclusions: The major reasons for patient’s delay were lack of awareness regarding the symptoms of TB and self-medication and for health care system delay it was treatment from private health care providers.
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Sims Sanyahumbi, Amy, Craig A. Sable, Melissa Karlsten, Mina C. Hosseinipour, Peter N. Kazembe, Charles G. Minard, and Daniel J. Penny. "Task shifting to clinical officer-led echocardiography screening for detecting rheumatic heart disease in Malawi, Africa." Cardiology in the Young 27, no. 6 (December 19, 2016): 1133–39. http://dx.doi.org/10.1017/s1047951116002511.
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AbstractBackgroundEchocardiographic screening for rheumatic heart disease in asymptomatic children may result in early diagnosis and prevent progression. Physician-led screening is not feasible in Malawi. Task shifting to mid-level providers such as clinical officers may enable more widespread screening.HypothesisWith short-course training, clinical officers can accurately screen for rheumatic heart disease using focussed echocardiography.MethodsA total of eight clinical officers completed three half-days of didactics and 2 days of hands-on echocardiography training. Clinical officers were evaluated by performing screening echocardiograms on 20 children with known rheumatic heart disease status. They indicated whether children should be referred for follow-up. Referral was indicated if mitral regurgitation measured more than 1.5 cm or there was any measurable aortic regurgitation. The κ statistic was calculated to measure referral agreement with a paediatric cardiologist. Sensitivity and specificity were estimated using a generalised linear mixed model, and were calculated on the basis of World Heart Federation diagnostic criteria.ResultsThe mean κ statistic comparing clinical officer referrals with the paediatric cardiologist was 0.72 (95% confidence interval: 0.62, 0.82). The κ value ranged from a minimum of 0.57 to a maximum of 0.90. For rheumatic heart disease diagnosis, sensitivity was 0.91 (95% confidence interval: 0.86, 0.95) and specificity was 0.65 (95% confidence interval: 0.57, 0.72).ConclusionThere was substantial agreement between clinical officers and paediatric cardiologists on whether to refer. Clinical officers had a high sensitivity in detecting rheumatic heart disease. With short-course training, clinical officer-led echo screening for rheumatic heart disease is a viable alternative to physician-led screening in resource-limited settings.
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Veerapu, Nagapraveen, Ravi Kumar Philip Bear, Subbarao Varikuti, and Jayakrishna Kurada. "Pilot testing of sticker tool method for monitoring DOTS providers under revised national tuberculosis control program in Khammam: operational research." International Journal of Advances in Medicine 7, no. 5 (April 23, 2020): 790. http://dx.doi.org/10.18203/2349-3933.ijam20201612.
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Background: Globally, tuberculosis (TB) is one of the leading causes of death. In 2016, 10.4 million people were affected with TB and accounted for 1.7 million deaths. India ranks the first among the seven leading countries that account for 64% of the total burden of TB. To fill the gaps in adherence to therapy and to make the TB Control programs successful, evidence based supplementary low cost effective monitoring tools and techniques are needed. The aims were to determine whether the new sticker tool method acts as supplementary to direct observation component of ‘Directly observed treatment, short course (DOTS) strategy’ used for monitoring adherence to anti-tuberculosis therapy among newly diagnosed sputum positive TB patients; and to compare Sputum smear conversion rate between the intervention group and control group at the end of Intensive phase (IP).Methods: A pragmatic cluster randomized control trial was conducted for a period of 9 months from April 2018 to December 2018 in Rural Khammam district. Data was represented in frequencies and percentages and Means.Results: The delay in sending SMS decreased after field visit (1st week of therapy) but delay again increased as the days passed. The study measured indirectly measured the adherence to the therapy by sputum conversion rate (83.3%). It was noticed that 45.5% stickers did not tally with the date of consumption of TB medications or with the date of sticking on the sticker chart. Conclusions: The study shows self administration is also a good option. There may be other factors that play an important role in adherence to anti tuberculosis treatment (ATT).
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Ajith Kumar G and Saranya P. "A cross sectional study on knowledge, attitude and practice towards tuberculosis among health care workers." International Journal of Research in Pharmaceutical Sciences 10, no. 4 (October 16, 2019): 2632–46. http://dx.doi.org/10.26452/ijrps.v10i4.1521.
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Health care providers play a major role in the management of tuberculosis (TB). The knowledge, attitude and practice towards TB in health care providers will have an impact on the treatment success or failure. Studies have reported that inadequate knowledge of the health care providers led to the delivery of improper counselling content to the recipients. We assessed the knowledge, attitude and practice (KAP) towards tuberculosis among health care workers in and around Chennai. A cross sectional study was conducted among 382 health care workers of the chest and tuberculosis department of government hospitals and directly observed treatment short-course clinics. The principal investigator administered a structured and validated questionnaire to the study participants. Around 500 healthcare workers were approached, and 382 showed interest to sign the informed consent. A majority (70%) of the study participants were between the age group 20-30 years. There was a highly significant difference (P = 0.006) in response to this between participants who had a history of active tuberculosis and undergone treatment for the same, and the participants with no history of TB. There was a significant difference between the study population based on their qualification and profession (P = 0.001 and P = 0.007 respectively) in using the Revised National Tuberculosis Control Program guideline for reference. The knowledge attitude and practice towards TB was good in more than 80% of the respondents, yet there is room to improve. Structured periodic training towards TB will further improve the KAP of health care workers.
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Rajeh, Nisreen, Janet Grant, Jamila Farsi, and Ara Tekian. "Contextual Analysis of Stakeholder Opinion on Management and Leadership Competencies for Undergraduate Medical Education: Informing Course Design." Journal of Medical Education and Curricular Development 7 (January 2020): 238212052094886. http://dx.doi.org/10.1177/2382120520948866.
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Background: The study aimed to conduct a contextual analysis of interviews intended to assist with the future design of a feasible and relevant leadership and management course for undergraduate medical students at King Abdulaziz University (KAU), Saudi Arabia. Methods: This was a cross-sectional study conducted at King Abdulaziz University (KAU), Saudi Arabia, during 2019. An exploratory qualitative approach, utilizing systematic content analysis, was used. Data were collected using semi-structured interviews that were conducted with 10 leaders who were stakeholders at KAU, health service providers at KAU hospital, and stakeholders in the Ministry of Health. Results: This study revealed critical findings that highlighted the areas in which KAU could instill better and adequate leadership and management skills in their undergraduate medical students. Multiple core categories for a leadership and management curriculum emerged with many interrelated themes. Most participants mentioned that leadership can be taught and that early exposure is beneficial for developing skills. Additionally, they stated that leaders should have a vision and the ability to articulate that vision. Conclusions: Different implementation challenges were described in relation to the availability of human resources, the current short supply of suitable teachers, and program design. Teaching methods recommended included simulations, lectures, and a project-based approach. Assessment methods that were recommended included objective structured clinical examination (OSCE), formative and summative assessments, self-assessments, and portfolios.
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Pigoga, Jennifer L., Charmaine Cunningham, Muhumpu Kafwamfwa, and Lee A. Wallis. "Adapting the emergency first aid responder course for Zambia through curriculum mapping and blueprinting." BMJ Open 7, no. 12 (December 2017): e018389. http://dx.doi.org/10.1136/bmjopen-2017-018389.
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ObjectivesCommunity members are often the first to witness and respond to medical and traumatic emergencies, making them an essential first link to emergency care systems. The Emergency First Aid Responder (EFAR) programme is short course originally developed to help South Africans manage emergencies at the community level, pending arrival of formal care providers. EFAR was implemented in two rural regions of Zambia in 2015, but no changes were originally made to tailor the course to the new setting. We undertook this study to identify potential refinements in the original EFAR curriculum, and to adapt it to the local context in Zambia.DesignThe EFAR curriculum was mapped against available chief complaint data. An expert group used information from the map, in tandem with personal knowledge, to rank each course topic for potential impact on patient outcomes and frequency of use in practice. Individual blueprints were compiled to generate a refined EFAR curriculum, the time breakdown of which reflects the relative weight of each topic.SettingThis study was conducted based on data collected in Kasama, a rural region of Zambia’s Northern Province.ParticipantsAn expert group of five physicians practising emergency medicine was selected; all reviewers have expertise in the Zambian context, EFAR programme and/or curriculum development.ResultsThe range of emergencies that Zambian EFARs encounter indicates that the course must be broad in scope. The refined curriculum covers 54 topics (seven new) and 25 practical skills (five new). Practical and didactic time devoted to general patient care and scene management increased significantly, while time devoted to most other clinical, presentation-based categories (eg, trauma care) decreased.ConclusionsDiscrepancies between original and refined curricula highlight a mismatch between the external curriculum and local context. Even with limited data and resources, curriculum mapping and blueprinting are possible means of resolving these contextual issues.
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Koleth, Elsa. "Unsettling the Settler State: The State and Social Outcomes of Temporary Migration in Australia." Migration, Mobility, & Displacement 3, no. 1 (August 24, 2017): 33. http://dx.doi.org/10.18357/mmd31201717072.
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The exponential growth of temporary migration to Australia since the late 1990s has unsettled the model of permanent migration, state supported settlement and multicultural citizenship on which Australia has been built. This article draws attention to the emergence of a gulf between Australia’s immigration policies and social policy frameworks for migrant integration in the course of Australia’s transition from a permanent to a temporary migration paradigm. It does so through an analysis of interviews with migrants, government officials at federal and local levels, and migrant service providers. It argues that the system by which temporary migration has been governed in Australia has enabled the Australian state to strategically divest itself of responsibility for the social welfare of temporary migrants and the long-term outcomes of temporary migration policies. Specifically, this has been achieved through the construction of temporary migrants as disposable, risk-bearing subjects, the exclusion of temporary migrants from social policy frameworks for migrant integration, and the elision of long-term social outcomes of migration policies through a focus on short-term economic outcomes. It concludes by pointing to changes required for instituting a temporal re-orientation of government policies from short-term economic outcomes towards the long-term social outcomes of migration.
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Sharma, Nandini, Anita Nath, Davender Kumar Taneja, and Gopal Krishnan Ingle. "A Qualitative Evaluation of the Information, Education, and Communication Component of the Tuberculosis Control Program in Delhi, India." Asia Pacific Journal of Public Health 21, no. 3 (May 14, 2009): 321–32. http://dx.doi.org/10.1177/1010539509336545.
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Tuberculosis control programs have recognized and addressed those system components in which knowledge and behavior of the patient and the general population are key issues because they have a profound influence on the treatment-seeking behavior and completion of course of treatment. As a part of the Revised National Tuberculosis Control Program, the ongoing information, education, and communication (IEC) efforts in Delhi were further intensified in the form of a multipronged media campaign. The objectives of this study are to evaluate ( a) the impact of the campaign on awareness generation among the target audiences, ( b) their opinion for making the campaign more effective and suited to their needs, and ( c) perceptions of health personnel regarding the campaign. The study follows a descriptive cross-sectional design. The following qualitative methods were used: ( a) focus group discussions of patients and the general population, ( b) 3 key informant interviews of the health care personnel and a defaulter patient, and ( c) in-depth interviews of 20 DOTS (directly observed treatment, short course) providers. The study observed that ( a) different sociocultural segments of the population varied in terms of their observations of IEC messages, ( b) stigma associated with tuberculosis is widely prevalent despite having a campaign, and ( c) television was voted as the most effective IEC medium. IEC strategies should be tailor-made and suited to the needs of a particular subpopulation.
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Powers, Sara, Rachel Cannon, David Bass, Lauren Pongan, Ocean Le, and Nina Darby. "CARING FOR THOSE WHO CARE: EVALUATION OF A COMPREHENSIVE CULTURAL COMPETENCY TRAINING CURRICULUM." Innovation in Aging 6, Supplement_1 (November 1, 2022): 634–35. http://dx.doi.org/10.1093/geroni/igac059.2352.
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Abstract By 2030, nearly 3 in 10 older Americans will identify as a member of a diverse or underrepresented group. To better support diverse, aging communities and help professionals meet the growing needs of family and friend caregivers, the Diverse Elders Coalition developed a comprehensive cultural competency training curriculum that, in the first year of development, engaged over 2,500 healthcare and social service providers. To evaluate the short and long-term impact of the training curriculum, this paper focuses on two types of anonymous evaluations that were electronically distributed to training attendees: 1) Subjective knowledge post-tests (n=162), and 2) 3-month post-training follow-ups (n=232). Majority of participants identified as female, White/Caucasian, and earned at least a college degree. Upon completion of the trainings, participants reported improved subjective knowledge about diverse communities, more confidence and preparedness to meet diverse caregivers’ needs, and also indicated that because of the training they would engage in a variety of diversity related actions (e.g., use more inclusive language, share training resources with colleagues, attend additional diversity trainings). At the 3-month follow-up, 91.8% of respondents reported they engaged in two or more diversity related actions since attending the training. Respondents (73.8%) also indicated that their organization engaged in one or more diversity-related actions since attending the training (e.g., provided staff additional diversity-related trainings, translated materials). Discussion will focus on ways to improve healthcare and social service providers’ advocacy efforts and awareness surrounding the needs of older adults and caregivers from diverse communities.
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Tappen, Ruth, David Newman, Monica Rosselli, and Joshua Coniff. "FIT2DRIVE: DEVELOPMENT AND TESTING OF A PREDICTOR OF DRIVING CAPACITY OF OLDER ADULTS WITH COGNITIVE CONCERNS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 314. http://dx.doi.org/10.1093/geroni/igac059.1243.
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Abstract The decision to stop driving has been reported by caregivers of persons with dementia as one of the most difficult ones they confront. Additionally, primary care providers to whom they often turn for guidance report being unprepared to provide them with evidence-based information. Our aim was to develop and test a predictive model employing 2 or 3 brief, easily administered cognitive tests to predict the individual’s likelihood of passing an on road driving test. Participants were licensed drivers recruited from our Memory Center’s driver evaluation program and the community to obtain a broadly representative sample of older drivers. A total of 357 drivers age 60 to 97 (mean 81) completed an established on-road driving test and battery of short cognitive tests. Two-thirds of the sample were white, non-Hispanic, one third were Black, African American, 59% male and 41% female, mean MMSE score of 24. Employing Receiver Operating curve analysis, the best set of predictors included participant age, MMSE utilizing world spelled backwards (a better predictor than serial 7’s), Trails B time in seconds and participant age yielding 95% AUC (area under the curve). The model was invariant across gender, education and ethnic group. A website with an interactive calculator in which this data is entered and likelihood of passing an on-road driving test prediction is presently under construction and will be available first to providers and later to individuals with a concern about continuing capacity to drive. Funded by Florida Department of Health Ed and Ethel Moore Alzheimer’s Disease Initiative.
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Mittal, Renu, Divya Taneja, and Anil Khurana. "A Cross-Sectional Online Survey of Knowledge, Attitudes and Practices about Tuberculosis among Homoeopathy Practitioners and Students in India." Homœopathic Links 35, no. 01 (March 2022): 010–17. http://dx.doi.org/10.1055/s-0042-1742683.
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Abstract Background Homoeopathy is the second most popular healthcare system in our country with 0.3 million practitioners. Among healthcare providers, homeopathic practitioners (HPs) are also the first contact care providers and often see tuberculosis (TB) patients. To align these practitioners with the National Strategic Plan 2017 to 2025, it is essential that their knowledge and skills about TB is assessed. Objectives The aim of this study was to assess the knowledge, attitude and practice (KAP) of HPs and students in India about TB. Methods An online cross-sectional survey conducted from 3rd to 17th May 2020 identified socio-demographic data, KAP. Descriptive and inferential statistics was performed to analyse differences based on socio-demographic variables. Results Out of 1,784 responses received, 72% were practitioners and 28% were students pursuing homoeopathy course. Eighty per cent respondents were aware of suspected case of TB, miliary, extensive drug-resistant TB and Directly Observed Treatment Short plus regimen for multidrug resistance TB. Knowledge scores significantly differed with qualification, type and years of practice (p = 0.001). Significant differences in attitude of government and private practitioners were noted on issues related to diagnosis and treatment management of TB patients (78.9 vs. 69.3%; p = 0.02). Conclusion The findings could be considered as baseline indicators in relation to the current KAP on TB among HPs. Specific training programmes can be developed for their active involvement in TB diagnosis and management so that TB prevention and care can be improved.
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Anderson, Sharon, and Susan Sklower Brooks. "When the Usual Symptoms Become an Unusual Diagnosis: A Case Report of Trifunctional Protein Complex." Neonatal Network 32, no. 4 (2013): 262–73. http://dx.doi.org/10.1891/0730-0832.32.4.262.
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AbstractDisorders of mitochondrial fatty acid β-oxidation should be considered in any infant who presents with unexplained hypoglycemia and/or myopathy. Although disorders of trifunctional protein (TFP) complex including long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) and mitochondrial TFP deficiencies are extremely rare, the combined incidence of mitochondrial fatty acid disorders is quite frequent. With the expansion of newborn screening, what were once considered uncommon disorders are being identified with increasing frequency in asymptomatic infants. The following case scenario presents an infant who developed symptoms prior to the completion of newborn screening. This fairly routine course for a late-preterm infant reveals an extremely rare inborn error of metabolism, LCHAD deficiency. An overview of TFP complex, the differential diagnoses as the case unfolds, diagnostic test results, acute care management, and short-term patient follow-up is presented.With experience, health care providers often become accustomed to and expect to see common things regularly. This case presents a scenario which, as it unfolds, appears to be quite common. It turns out, however, to be very uncommon.
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Howard, Craig D., Andrew F. Barrett, and Theodore W. Frick. "Anonymity to Promote Peer Feedback: Pre-Service Teachers' Comments in Asynchronous Computer-Mediated Communication." Journal of Educational Computing Research 43, no. 1 (July 2010): 89–112. http://dx.doi.org/10.2190/ec.43.1.f.
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In this quasi-experimental case study, we compared five sections of a basic undergraduate technology course. Within an asynchronous web forum, pre-service teachers wrote short critiques of websites designed by their classmates. This peer feedback was provided anonymously by students in two classes ( n = 35) whereas providers and recipients of peer feedback were identified by their real names in three other classes ( n = 37). Computer-Mediated discourse analysis methods (Herring, 2004) were used to code student written comments according to substance and tone of feedback. Next, we estimated likelihoods of specific feedback patterns through Analysis of Patterns in Time (Frick, 1990). Results indicated that students who were anonymous were approximately five times more likely to provide substantively critical feedback than were those whose identities were known to their recipients. When feedback was given anonymously, students were approximately four times more likely to provide reasons for needed improvement to a website, and then to suggest design alternatives. In light of advantages afforded by this form of pseudonymity, we conclude with a discussion of pedagogical prescriptions for supporting learners' production of feedback.
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Heggart, Keith, and Camille Dickson-Deane. "Microcredentials." Pacific Journal of Technology Enhanced Learning 3, no. 1 (February 16, 2021): 13–14. http://dx.doi.org/10.24135/pjtel.v3i1.87.
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Higher education has faced, and will continue to face, significant challenges in the future (Bradley et al., 2009). Some of these challenges are foreseeable, for example, increasingly diverse student cohorts, many of whom are the ‘first in family’ to come to university. In addition, students today are more likely to have other responsibilities such as multiple jobs or caring duties whilst pursuing their studies (Kift et al., 2010). In addition, students’ expectations about how they will learn at university are changing, with learning technologies playing a bigger role than in the past (Dvoretskaya et al., 2018). These expectations include the use of technology to facilitate learning, more choices in learning approaches and subjects that are directly relevant and immediately translate to career pathways.
In the face of these challenges, institutions are adopting a range of different and innovative measures, including experimenting with the use of technological affordances (Jeong & Hmelo-Silver, 2016) to allow for course restructuring and modifications. While some have long called for these changes (Preston et al, 2010), it could be argued that COVID has provided further stimulus for universities to investigate and trial these new ideas. One such modification is the development and implementation of microcredentials and short courses that exist both as stand-alone courses but also directly feed into terminal degree offerings (Ehlers, 2018). While the notion of microcredentials is not new (DeMonte, 2017), the entry of tertiary institutions into this space is, and is, in part, a response to the offerings of non-higher education providers. However, developing, implementing and advertising these new courses is not without its own challenges including how these might ‘stack’ meaningfully into larger qualifications (Hall-Ellis, 2016).
This presentation describes the innovative development and implementation of eight learning design microcredentials within the Faculty of Arts and Social Sciences at the University of Technology Sydney. The challenges faced by faculty and learning designers responsible for the design and delivery of these microcredentials are analysed, including: multiple entry and exit points for students; the intensity of the short time frame of the courses; the requirement to find the right mix of synchronous and asynchronous delivery; the best way to ensure facilitation throughout the student experience and, most importantly, creating a sense of belonging beyond the bounds of a single microcredential.
This presentation then examines the creative structure and nature of the eight microcredentials, the blended learning theories that underpinned their design, the articulation pathways that they offered, and the design decisions that informed the development of the microcredentials, including the decision to focus on experience over expertise, situate the course close to industry and practice, manage an internship-like experience, and assess students’ achievements through a competency-based portfolio It also describes the way that technology enhanced learning approaches provided the pedagogical basis for the design of the microcredentials. The paper concludes with a summation of the learning design principles that will inform the development of future microcredentials as pathways using innovative program designs into terminal degree opportunities.