Resuscitation status conversations: a short education session improves junior doctors’ confidence

2020 ◽  
pp. bmjspcare-2020-002479
Author(s):  
Lana Ferguson ◽  
Helen Clark ◽  
Wayne de Beer
Keyword(s):  
Educational Intervention ◽  
Postgraduate Education ◽  
Tertiary Hospital ◽  
Perceived Barriers ◽  
Junior Doctors ◽  
Education Session ◽  
Level Of Confidence ◽  
Significant Difference ◽  
Short Education ◽  
Resuscitation Status

AimJunior doctors are frequently required to discuss resuscitation status with patients. They generally lack experience, confidence and skill in having these conversations. However, there is currently no formal postgraduate education requirement to improve or develop in this area. The aim of this educational intervention was to improve junior doctors’ level of confidence and skill in having resuscitation status conversations with patients.MethodAn educational intervention for 27 prevocational postgraduate second and third-year house officers at a tertiary hospital in Hamilton, New Zealand was conducted. A self-administered survey was completed preintervention and postintervention.ResultsFour factors were assessed in the survey (level of confidence having conversations regarding resuscitation status, ability to prognosticate, content of conversations and perceived barriers to having conversations), with a statistically significant difference found with respect to level of confidence having conversations regarding resuscitation status (p=0.001).ConclusionThis study demonstrated that a short education session improves confidence in discussing resuscitation status. It has also identified the need for further postgraduate training in complex communication skills.

scholarly journals P051: Does knowledge of the Canadian CT Head Rules impact the frequency of CT’s ordered?

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S95
Author(s):  
H.C. Duyvewaardt ◽  
M. Ertel ◽  
J. Angel-Mira ◽  
Parker ◽  
N. Kandola ◽  
...  
Keyword(s):  
Decision Rule ◽  
Educational Intervention ◽  
Clinical Decision ◽  
Educational Interventions ◽  
Tertiary Hospital ◽  
Ct Scans ◽  
Control Cohort ◽  
Clinical Decision Rule ◽  
Significant Difference ◽  
Injury Reporting

Introduction: The Canadian Computed Tomography Head Rules (CCTHR) is a validated and well-known head injury clinical decision rule that allows Emergency Room Physicians (ERPs) to determine which patients are most likely to benefit from a diagnostic CT. However, this clinical decision rule is not uniformly adhered to and a number of preventable CT scans are ordered. Choosing Wisely Canada has ranked decreasing unnecessary head CT scans as the number one priority for Emergency Departments (ED). As such, the purpose of this study was to investigate if an educational intervention for ERPs would increase adherence to the CCTHR. Methods: In September 2015 the CCTHR were presented and discussed at three ED departmental meetings at Kelowna General Hospital (KGH) a large tertiary hospital in the interior of British Columbia, Canada. Educational materials were distributed to the ERPS and a CTTHR checklist was made available throughout the ED. Rates of adherence to the CCTHR criteria were calculated from MHI patients that were seen in the four years prior to the educational intervention and were compared to rates of adherence for patients 12 months post educational intervention. Only patients that agreed to participate in the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were included in this analysis. Differences in adherence rates were tested using the chi-squared test. Results: 477 patients were included in the analysis for the pre-education cohort (control) and 257 for the post-education cohort(intervention). In the control cohort, 348 of the 477 (73%) of the patients were managed in accordance to the CCTHR compared to 194 of the 257 (75%) in the intervention cohort. There was no statistically significant difference in rates of adherence (p=0.457).In the control cohort, 44 of the 321 (14%) of patients received a CT that did not meet any CCTHR criteria compared to 15 of the 163 (9%) in the intervention cohort. The overall CT imaging rate was 24% in each patient cohort. Conclusion: Although adherence rates between the two cohorts were not statistically different, a greater proportion of patients had a CTAS of 2 or 3 and met criteria in the intervention cohort suggesting a higher level of acuity. Imaging rates remained constant at 24%, which was lower than expected if there was full adherence to the CCTHR. Further study is required to determine if educational interventions can improve adherence to the CCTHR.

The effect of an educational intervention on junior doctors’ knowledge and practice in detecting and managing elder abuse

2012 ◽  
Vol 24 (9) ◽  
pp. 1447-1453 ◽  
Author(s):  
Claudia Cooper ◽  
Lauren Huzzey ◽  
Gill Livingston
Keyword(s):  
Communication Skills ◽  
Educational Intervention ◽  
Elder Abuse ◽  
Junior Doctors ◽  
Education Session ◽  
Post Intervention ◽  
People With Dementia ◽  
Knowledge And Practice ◽  
First Time

ABSTRACTBackground: Elder abuse is often unreported, undetected, and underestimated by professionals. For the first time, we report the effectiveness of an educational elder abuse intervention over three months and its impact on professionals’ practice.Methods: Forty trainee psychiatrists in two London National Health Service trusts completed the KAMA (Knowledge and Management of Elder Abuse) and CSQ (Caregiver Scenario Questionnaire) measuring knowledge about managing and detecting elder abuse, before and immediately after a brief group education session. We asked how often they considered, asked about, detected, and managed elder abuse and their confidence in doing so, at baseline and three months post-intervention.Results: Compared with baseline, participants scored higher on the KAMA (paired t = 3.4, p = 0.002), and identified more definitely abusive (t = 3.0, p = 0.003) and possibly abusive (t = 2.1, p = 0.043) items immediately post-intervention. At three-month follow up, 24 (60%) participants reported higher confidence in managing abuse (Wilcoxon signed ranks test z = 3.7, p < 0.001) and considered it more frequently (z = 2.8, p = 0.006), but did not ask older people and their carers about abuse more frequently (z = 1.2, p = 0.24). Two (5%, 95% confidence interval 2%–17%) participants detected abuse in the three months before the intervention, compared with 2 (8%, 2%–26%) in the same period afterward.Conclusions: This brief educational intervention increased trainee psychiatrists’ knowledge and vigilance for abuse immediately and after three months. They remained reluctant to ask about abuse for reasons including fear of causing offence or harming the therapeutic relationship and being unsure how to ask people with dementia. We postulate that changing doctors’ behavior may require a more complex intervention, focusing on communication skills.

scholarly journals Effect of Surgical Setting on Hospital-Reported Outcomes for Elective Lumbar Spinal Procedures: Tertiary Versus Community Hospitals

2019 ◽  
Vol 10 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Tristan B. Weir ◽  
Neil Sardesai ◽  
Julio J. Jauregui ◽  
Ehsan Jazini ◽  
Michael J. Sokolow ◽  
...  
Keyword(s):  
Pay For Performance ◽  
Linear Regression Analysis ◽  
Degenerative Spondylolisthesis ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Community Hospitals ◽  
Single Level ◽  
Significant Difference ◽  
Reported Data

Study Design: Retrospective cohort study. Objective: As hospital compensation becomes increasingly dependent on pay-for-performance and bundled payment compensation models, hospitals seek to reduce costs and increase quality. To our knowledge, no reported data compare these measures between hospital settings for elective lumbar procedures. The study compares hospital-reported outcomes and costs for elective lumbar procedures performed at a tertiary hospital (TH) versus community hospitals (CH) within a single health care system. Methods: Retrospective review of a physician-maintained, prospectively collected database consisting of 1 TH and 4 CH for 3 common lumbar surgeries from 2015 to 2016. Patients undergoing primary elective microdiscectomy for disc herniation, laminectomy for spinal stenosis, and laminectomy with fusion for degenerative spondylolisthesis were included. Patients were excluded for traumatic, infectious, or malignant pathology. Comparing hospital settings, outcomes included length of stay (LOS), rates of 30-day readmissions, potentially preventable complications (PPC), and discharge to rehabilitation facility, and hospital costs. Results: A total of 892 patients (n = 217 microdiscectomies, n = 302 laminectomies, and n = 373 laminectomy fusions) were included. The TH served a younger patient population with fewer comorbid conditions and a higher proportion of African Americans. The TH performed more decompressions ( P < .001) per level fused; the CH performed more interbody fusions ( P = .007). Cost of performing microdiscectomy ( P < .001) and laminectomy ( P = .014) was significantly higher at the TH, but there was no significant difference for laminectomy with fusion. In a multivariable stepwise linear regression analysis, the TH was significantly more expensive for single-level microdiscectomy ( P < .001) and laminectomy with single-level fusion ( P < .001), but trended toward significance for laminectomy without fusion ( P = .052). No difference existed for PPC or readmissions rate. Patients undergoing laminectomy without fusion were discharged to a facility more often at the TH ( P = .019). Conclusions: We provide hospital-reported outcomes between a TH and CH. Significant differences in patient characteristics and surgical practices exist between surgical settings. Despite minimal differences in hospital-reported outcomes, the TH was significantly more expensive.

Educational intervention to improve palliative care knowledge among informal caregivers of cognitively impaired older adults

2020 ◽  
pp. 1-9
Author(s):  
Hyunjin Noh ◽  
Lewis H. Lee ◽  
Chorong Won
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Cognitive Impairment ◽  
Educational Intervention ◽  
Test Scores ◽  
Informal Caregivers ◽  
Cognitively Impaired ◽  
Significant Difference ◽  
Post Test ◽  
Seriously Ill

Abstract Objective Lack of palliative care knowledge among caregivers may pose an access barrier for cognitively impaired older adults, who may benefit from the specialized care. Therefore, this study aims to examine the effectiveness of an educational intervention in improving palliative care knowledge among informal caregivers of cognitively impaired older adults. Method Using a one-group, pre- and post-test intervention design, this study implemented an individual, face-to-face educational intervention with an informational brochure for 43 informal caregivers of chronically or seriously ill older adults (50+) with cognitive impairment, recruited from communities in West Alabama. Their level of knowledge about palliative care was assessed by the Palliative Care Knowledge Scale (PaCKS). The pre- and post-test scores were compared by the Wilcoxon signed-ranks test, and the racial subgroup (Whites vs. Blacks) comparison was made by the Mann–Whitney U test. Results There was a statistically significant difference between the pre- and post-test scores (z = 5.38, p < 0.001), indicating a statistically significant effect of the educational intervention in improving palliative care knowledge among participants. There was a significant difference (U = 143, p < 0.05) between Whites and Blacks in the pre-test, which, however, disappeared in the post-test (U = 173.50, p > 0.05), suggesting that the amount of increased PaCKS scores were significantly greater for Blacks (Mdn = 9.50) than for Whites (Mdn = 4.00, U = 130.50, p < 0.05). Significance of results This study demonstrated that a one-time educational intervention can improve the level of palliative care knowledge among informal caregivers of chronically or seriously ill older adults with cognitive impairment, particularly among Black caregivers. Therefore, further educational efforts can be made to promote palliative care knowledge and reduce racial disparities in palliative care knowledge and its use.

scholarly journals Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040361
Author(s):  
Amanda Klinger ◽  
Ariel Mueller ◽  
Tori Sutherland ◽  
Christophe Mpirimbanyi ◽  
Elie Nziyomaze ◽  
...  
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tertiary Hospital ◽  
Early Warning Score ◽  
Receiver Operating Curve ◽  
Predictive Capacity ◽  
Suspected Infection ◽  
Significant Difference

RationaleMortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts.ObjectiveTo determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital.Design, setting, participants and outcome measuresWe prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile.ResultsWe screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores.ConclusionThree scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.

Causes of delayed exploration of the acute scrotum in a regional tertiary centre

2020 ◽  
pp. 205141582098119
Author(s):  
Benjamin Storey ◽  
Nathan Shugg ◽  
Alison Blatt
Keyword(s):  
Retrospective Review ◽  
Testicular Torsion ◽  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
Acute Scrotum ◽  
Tertiary Institution ◽  
Level Of Evidence ◽  
Scrotal Pain ◽  
Surgical Exploration ◽  
Significant Difference

Background: Testicular torsion is an organ-threatening surgical emergency with a limited timeframe for intervention. Objective: To identify the delays to surgical exploration of patients with an acute scrotum in a tertiary hospital to prevent adverse outcomes associated with this time critical emergency. Methods: A retrospective review of medical records for all patients who underwent scrotal exploration for acute scrotal pain in a tertiary hospital in regional New South Wales between January 2008 to December 2018 was performed. Results: Retrospective review identified 242 patients, of whom 161 had testicular torsion and 56 resultant orchidectomies. No statistically significant difference in pre-hospital delays between paediatric or adult populations was found. The average time from presentation to theatre was 4 h 36 min. Patients who were delayed > 6 h from presentation to surgical exploration had significantly increased rates of orchidectomy. Delays that significantly affected rates of orchidectomy were transfer from peripheral sites, late presentation, misdiagnosis and representation after discharge. Conclusion: The most common reason for delay was diagnostic error with the patient later re-presenting to hospital. Patient transfer from the primary hospital to a tertiary institution and subsequent delayed surgical exploration also contributed to significantly higher rates of orchidectomy. Level of Evidence: 3

Sonographic Assessment of Renal Volume in Normotensive Pregnant Women and Women With Pregnancy-Induced Hypertension in Enugu Metropolis

2021 ◽  
pp. 875647932110210
Author(s):  
Idigo Felicitas Ugochinyere ◽  
Nwankwo Sylvia Chiamaka ◽  
Abonyi Everistus Obinna ◽  
Anakwue Angel-Mary Chukwunyelu ◽  
Agbo Julius Amechi
Keyword(s):  
Reference Range ◽  
Interobserver Variability ◽  
Correct Diagnosis ◽  
Negative Relationship ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Renal Volume ◽  
Cross Sectional ◽  
Significant Difference ◽  
Induced Hypertension

Objective: Renal volume (RV) assessment during obstetric sonography is rarely considered in our locality. Understanding the changes in RV in both normotensive pregnant (NP) and pregnancy-induced hypertensive (PIH) women is important in making correct diagnosis regarding pregnancy outcome. This study is aimed at determining the RV in NP and PIH women and correlating RV with fetal gestational age (FGA), body mass index (BMI), and parity in NP women. Materials and Methods: This cross-sectional study involved 450 patients recruited at a Tertiary Hospital. A pilot study was done to determine the interobserver variability in RV measurement. RV was calculated using the following formula: L × W × AP × 0.523. Parity, BMI, and blood pressure were documented, while FGA was calculated as an average of FGAs obtained from the measurements of fetal biometric parameters. Results: Mean RV of PIH women was significantly higher than that of NP women ( P < .05). RV shows a positive significant relationship with BMI and FGA, while it shows a negative relationship with parity in NP ( P < .05). Conclusion: Reference range values of RV were generated for clinical use in our locality, while there is statistically significant difference between RV in NP and PIH women.

scholarly journals Factors associated with physical inactivity among female and male rural adolescents in Borneo – a cross-sectional study

2014 ◽  
Vol 26 (3) ◽  
pp. 447-453 ◽  
Author(s):  
Whye Lian Cheah ◽  
Hazmi Helmy ◽  
Ching Thon Chang
Keyword(s):  
Self Efficacy ◽  
Physical Inactivity ◽  
Cross Sectional Study ◽  
Perceived Barriers ◽  
Anthropometric Measurement ◽  
Rural Adolescents ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Significant Difference

Abstract Rural communities have shown marked increase in metabolic syndrome among young people, with physical inactivity as one of the main contributing factors. This study aimed to determine factors associated with physical inactivity among male and female rural adolescents in a sample of schools in Malaysia. A cross-sectional study was conducted among 145 students aged 13–15 years. Data on socio-demographic, health-related, and psychosocial factors (perceived barriers, self-efficacy, social influences) were collected using a self-administered questionnaire. Anthropometric measurement was taken to generate body mass index (BMI)-for-age, while physical activity (PA) level was assessed using pedometers. The mean steps per day was 6251.37 (SD=3085.31) with males reported as being more active. About 27% of the respondents were either overweight or obese, with more females in this group. There was no significant difference in steps among males and females (p=0.212), and nutritional status (BMI-for-age) (p=0.439). Females consistently scored higher in most items under perceived barriers, but had significantly lower scores in self-efficacy’s items. Males were more influenced by peers in terms of PA (p<0.001) and were more satisfied with their body parts (p=0.047). A significantly higher body size discrepancy score was found among females (p=0.034, CI –0.639, –0.026). PA level was low and almost one-third of the respondents were overweight and obese. Female students faced more barriers and had lower self-efficacy with regards PA. Based on the findings, it is recommended that interventions focus on reducing barriers while increasing support for PA. This is particularly important in improving the health status of the youth, especially among the females.

Evaluation and Quantification of Cytomorphometry in Conjunction with Visual Examination and Exfoliative Cytology in Early Diagnosis of Oral Premalignant and Malignant Lesions

2021 ◽  
pp. 1-7
Author(s):  
Vasudha Singh ◽  
Mudita Bhargava ◽  
Kachnar Varma ◽  
Vatsala Misra ◽  
Richa Singh
Keyword(s):  
Tertiary Hospital ◽  
Accurate Diagnosis ◽  
Exfoliative Cytology ◽  
Visual Examination ◽  
Normal Cytology ◽  
Subjective Analysis ◽  
Oral Epithelial Dysplasia ◽  
Significant Difference ◽  
Potentially Malignant ◽  
Malignant Lesions

<b><i>Introduction:</i></b> Incidence of oral epithelial dysplasia and oral squamous cell carcinoma (SCC) is very high in south Asian countries as compared to western population owing to a greater use of tobacco in these regions. While visual examination and exfoliative cytology are the most common screening and diagnostic modalities at present, it is a subjective analysis. Quantitative analyses such as nuclear size, cell size, and nuclear-to-cytoplasmic ratio may provide an accurate diagnosis and improve reproducibility. The aim of the study was to evaluate the role of morphometry as a diagnostic adjunct to exfoliative cytology and to derive a significant cutoff to identify the population at risk for development of SCC among chronic tobacco users. <b><i>Material and Methods:</i></b> This was an outpatient-based prospective study done in a tertiary hospital over a period of 2 years. Hundred and fifty cases with a history of chronic tobacco use for a minimum period of 5 years were evaluated. Visual inspection using acetic acid was done. Oral scrapes were taken for cytological and morphometric analysis followed by incision biopsy for histopathological evaluation, wherever possible. <b><i>Results:</i></b> On morphometrical analysis, mean nuclear area and nuclear:cytoplasmic (N:C) ratio increased, while the cytoplasmic area decreased from smears with normal cytology to oral dysplasia to SCC. Analysis of variance and post hoc Tukey’s honest significant difference test showed a statistically significant difference among the 3 groups (<i>p</i> value &#x3c;0.05). A cutoff value for a significant N:C ratio was calculated as ≥0.08 using Youden’s index with a sensitivity and a specificity of 88% and 94%, respectively. <b><i>Conclusion:</i></b> In high-risk cases, morphometry can be a useful adjunct to exfoliative cytology and visual examination for an early and accurate diagnosis and timely intervention in oral potentially malignant and malignant lesions, thereby improving the prognosis.

scholarly journals Study of Maternal and Fetal Outcome among Booked and Unbooked Patients at tertiary Hospital

2020 ◽  
Vol 5 (2) ◽  
pp. 1027-1030
Author(s):  
Shanti Sunuwar Subedi ◽  
Rakina Bhansakarya ◽  
Sajjan Kumar Sharma
Keyword(s):  
Sampling Technique ◽  
Secondary Level ◽  
Tertiary Hospital ◽  
Fetal Outcome ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Spontaneous Vaginal Delivery ◽  
Significant Difference ◽  
The Difference

Introduction: To evaluate the maternal and perinatal outcome in booked and unbooked cases. Objectives: To assess the maternal and fetal outcomes in unbooked and booked patients. Methodology: This was a cross-sectional comparative study conducted in the Department of Obstetrics and Gynecology from Augustti2019 to January 2020. Using a convenient sampling technique, 204 samples were taken and cross-sectional study was done. Results: There were total 204 cases in this study;102were booked and 102 were unbooked. In this study, 85(83%) of booked cases were educated up to secondary level as compared toti65 (64%) of unbooked cases. There was no significant difference in Apgar score in 1 and 5 minute between booked and unbooked cases. More babies in the unbooked group were transferred to NICU as compared to the booked group and the difference was significant (9.8%vs 1.9%). Greater proportion of booked cases had spontaneous vaginal delivery (81.3% vs 59.8%) and complications like preterm delivery, anemia, preeclampsia/ eclampsia, complicated labor and puerperal sepsis was also less in the booked group. Conclusions: The study showed that unbooked mothers and their newborns had higher chance of having complications.

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