Management of chronic spontaneous urticaria: Real-world Indian perspective

Objectives: There are multiple guidelines for chronic spontaneous urticaria (CSU) by various dermatological associations, but in real-world practice in India, different approaches have been noted. In this paper, we courted to determine these different approaches in CSU management, adherence to various CSU guidelines, and the reasons for deviation from guidelines amidst dermatologists in India. Materials and Methods: A net-based questionnaire was created and validated by five panelists experienced in CSU management and then was circulated to all dermatologists in India in August 2020 for real-world management scenario. Results: We received 880 completed response out of 2235 response. Most of the dermatologists (97%) were aware of some urticaria guidelines. Although many of them follow guidelines about three forth of them reported to deviate from it sometimes. The most common reason for deviation was rely on clinical experience as opted by 53% of respondents. Dermatologists who follow guidelines also investigate routinely in terms of complete blood count, the erythrocyte sedimentation rate, and thyroid-stimulating hormone as compared to those who do not. About 70.5% of the dermatologist prescribe second-generation antihistamine (SGAH) at approved dose as the first line of treatment whereas 63.6% up dose it as second line of treatment. Surprisingly, 68% prescribe first-generation antihistamine in the evening and SGAH in the morning as combination therapy in CSU. Conclusion: From the findings of the present study, it can be strongly implied that guidelines play a vital role in delivering superior attributes of patient care although 75% of dermatologists deviated from it. Main reasons for deviance are reliability on self-clinical proficiency and consideration of economic impediments. Both these factors need to be worked upon by continuous medical education of dermatologists and more pharmaco-economic research.

Position Statement on Religion and Spirituality in Psychiatry: Seven Recommendations

Background: in December 2015 the Executive Committee of the World Psychiatric Association approved a Position Statement on religion, spirituality in psychiatry. Since then, the World Psychiatric Association Section of Religion, Spirituality and Psychiatry has committed to publicizing the Position Statement worldwide. Aim: to bring this statement, especially the seven recommendations, to the attention of the international psychiatric community, in particular the Russian psychiatric community. Method: a narrative review and the seven recommendations in the Position Statement are explained, thus demonstrating its importance. Conclusion: religion and spirituality in psychiatry are part of daily psychiatric practice, scientific research, residency training and continuous medical education, and the political and public realm. With the publication of the Position Statement, the Executive Committee of the World Psychiatric Association has made a major accomplishment that benefits psychiatry around the world.

Twitter as a Medical Media Among French Young Oncologists: Results from a National Survey

Since its launch in 2006, Twitter has become a commonly used platform for sharing medical information, especially in the field of oncology. However, its role and impact on young oncologists’ education remain unclear. Moreover, COVID-19 and congress virtualization is likely to have modified Twitter use by the medical society.We conducted a national survey (27 questions) in France among medical oncology, hematology, and radiation therapy young doctors to help better understand the role played by Twitter on their medical education. One hundred eighty-three young oncologists participated in our survey. A majority does not use Twitter (72.1%), mostly to reduce their time spent on social media. Participants using Twitter (27.9%) often use it more than once a week, mostly by scrolling on their news feed. Interestingly, they rarely express their own opinion on Twitter: a majority of them (75.5%) tweet less than once a month while the rest of them mostly retweet others’ tweets. They mainly follow English-speaking experts, scientific societies, and medical journals. Pharmaceutical laboratories’ accounts are of less significance. Overall Twitter usage seems increasing since COVID-19 pandemic and the consequent digitalization of congresses. No statistical difference was observed between the baseline characteristics of Twitter users and non-users.This survey shows that Twitter is a relevant mean of continuous medical education used by around a third of French young oncologists, especially since COVID-19 pandemic and the virtualization of congresses. This media should be considered and evaluated for its educational advantages or potential biases.

Combining in-situ simulation and live HEMS mission facilitator observation: a flexible learning concept

Background Continuous medical education is essential in Helicopter Emergency Medical Services (HEMS). In-situ simulation training makes it possible to train in a familiar environment. The use of a dedicated facilitator is essential; however, when an in-situ simulation training session is interrupted by a live mission, the efforts invested in the training are left unfulfilled. This study aims to evaluate if HEMS mission observation and debriefing by the simulation facilitator is a feasible alternative to mission-interrupted simulation training, and how this alternative to simulation training is perceived by both facilitators and HEMS crew members. Methods Facilitator observation during live missions and post-mission debriefing was offered as an alternative to mission-interrupted simulation training over a one-year period at three HEMS bases. Immediate feedback was requested from crews and facilitators after each observed live mission on a predefined questionnaire. At the end of the study period, semi-structured interviews were performed with a sample of HEMS crew members and facilitators to further explore the experience with the concept. Numerical data about the sessions were recorded continuously. Results A total of 78 training sessions were attempted, with 46 (59%) of the simulations conducted as planned. Of the remaining, 23 (29%) were not started because the crew had other duties (fatigued crew or crew called for a mission where observation was inappropriate/impossible), and 9 (12%) training sessions were converted to observed live missions. In total, 43 (55%), 16 (21%) and 19 (24%) attempts to facilitate simulation training were undertaken on the three bases, respectively. The facilitators considered mission observation more challenging than simulation. The interviews identified local know-how, clinical skills, and excellent communication skills as important prerequisites for the facilitators to conduct live mission observation successfully. Participating crews and facilitators found simulation both valuable and needed. Being observed was initially perceived as unpleasant but later regarded as a helpful way of learning. Conclusion Live mission observation and debriefing seems a feasible and well-received alternative to an in-situ simulation program in HEMS to maximise invested resources and maintain the learning outcome. Furthermore, additional training of simulation facilitators to handle the context of live mission observation may further improve the learning output.

The management and clinical knowledge of headache disorders among general practitioners in Norway: a questionnaire survey

Background General practitioners (GPs) diagnose and manage a majority of headache patients seeking health care. With the aim to understand the potential for clinical improvement and educational needs, we performed a study to investigate Norwegian GPs knowledge about headache and its clinical management. Methods We invited GPs from a random sample of 130 Norwegian continuous medical education (CME) groups to respond to an anonymous questionnaire survey. Results 367 GPs responded to the survey (73% of invited CME groups, 7.6% of all GPs in Norway). Mean age was 46 (SD 11) years, with an average of 18 (SD 10) years of clinical experience. In general the national treatment recommendations were followed, while the International Classification of Headache Disorders and other international guidelines were rarely used. Overall, 80% (n = 292) of the GPs suggested adequate prophylactic medication for frequent episodic migraine, while 28% (n = 101) suggested adequate prophylactic medication for chronic tension-type headache (CTTH). Half (52%, n = 191)) of the respondents were aware that different types of acute headache medication can lead to medication-overuse headache (MOH), and 59% (n = 217) knew that prophylactic headache medication does not lead to MOH. GPs often used MRI in the diagnostic work-up. GPs reported that lack of good treatment options was a main barrier to more optimized treatment of headache patients. Conclusion The knowledge of management of CTTH and MOH was moderate compared to migraine among Norwegian GPs.

Blood Transfusion Knowledge among Nurses in Malaysia: A University Hospital Experience

Blood transfusion is a fundamental and life-saving procedure where the consequence of errors can be fatal. Nurses’ knowledge plays an essential role in ensuring quality and safety in blood transfusion. The objective of this study was to assess blood transfusion-associated knowledge of tertiary hospital nurses on the east coast of Malaysia. This was a cross-sectional study with 200 registered nurses involved in blood transfusion procedures at Hospital Universiti Sains Malaysia. The knowledge of the nurses was evaluated by using the routine blood transfusion knowledge questionnaire based on five parts, and <50%, 50–74%, or ≥75% of the knowledge was considered as poor, moderate, or high, respectively. Based on the scoring system, the overall knowledge of blood transfusion among Malaysian nurses (33.2 ± 8.4 years) was estimated to be 54.9 ± 7.6%. In individual items, the scoring was 81.0%, 45.4%, 49.2%, 63.0%, and 90.0% in knowledge prior to blood transfusion, on pre-transfusion, on post-transfusion, on complications, and on transfusion policy, respectively. The findings of this study indicated that most of the nurses’ overall knowledge of blood transfusion was at a moderate level; therefore, training courses and continuous medical education are warranted to improve knowledge and skills of the nurses to ensure good practices of blood transfusion.

Awareness and Perceptions Regarding Evidence Based Practice Among Nurses and Midwives in Two Ugandan National Referral Hospitals: A Cross-Sectional Study

Background: Integration of evidence-based practice (EBP) in nursing and midwifery increases patient satisfaction, patient safety and reduced length of hospital stay, which all contribute to better patient outcomes and improved quality of care. Little is known about awareness and perception regarding evidence-based practice among nurses and midwives in Uganda. Objective: This study sought to assess awareness and perceptions regarding evidence-based practice among nurses and midwives.Methods: A descriptive cross-sectional study using self-administered questionnaires was conducted among 384 nurses and midwives in Mulago and Kawempe National Referral Hospitals. The participants were recruited consecutively until when the desired sample size was obtained. Statistical Package for Social Sciences (SPSS) version 26 was used to analyze and summarize data using frequency and percentages. We performed Chi-square test to assess the factors association with awareness and perception. The independent variables with p-value <0.05 were significant. Results: Most of the participants were female (81.8%) and were practicing as nurses (76.2%). The results indicated that less than a half (46.2%, n=138) of participants were aware of EBP. Majority of the participants (96.3%- 97.7%) felt that EBP is highly important, necessary and an obligation in nursing and midwifery practice, although only 68.0% were routinely practicing it in their practice. Awareness was associated with level of education attained (p= 0.000), gender (0.001), going back to school after first qualification (p=0.000), access to learning resources at work place (p=0.000) and attendance of continuous medical education (p= 0.000), whereas, perception was associated with attendance of continuous medical education (0.017).Conclusion: Data show that nurses and midwives’ awareness regarding evidence-based practice was low in this study, however, they possessed positive perceptions regarding evidence-based practice. Moreover, only about two-thirds were practicing EBPs. Therefore, I recommend increased calls for interventions to sensitize nurses and midwives about EBP like continuous medical education (CME) and Continuous professional development (CPD) or refreshing training

Top resources and tools for physician management of chronic pain in the Canadian Armed Forces

LAY SUMMARY Diagnosis and management of chronic pain in Canada by primary care clinicians is a challenging and changing field with new approaches, evidence, and tools emerging in the past few years. For a busy clinician, it is vital to integrate and become aware of new tools that can improve the care delivered to patients. This article summarizes new evidence-based tools, key guidelines and research, algorithms, and simplified prescription practices, in addition to continuous medical education resources that will allow busy clinicians to rapidly be brought up to speed on the latest in chronic pain management in the Canadian military context.