Patient safety awareness and attitude among interns of a tertiary care hospital

Background: Patient Safety (PS) emerging as global health problem. PS attitudes are being assessed worldwide but behaviors and attitudes in young doctors have not been studied in great depth. Aim: To assess knowledge and attitude towards PS in Foundation Year Trainees (Interns) in a tertiary care hospital. Method: A cross sectional Survey was applied to 126 Interns of Combined Military Hospital Lahore using Questionnaire (APSQ) in December 2019. The survey was kept anonymous. Statistical analysis was by utilizing SPSS Version 23. Results: Interns had PS knowledge. Highest domain score was “Attitude to medical error reporting” (53.34 + 7.62) followed by “PS knowledge” (50.88 + 6.85). The lowest domain score was “Attitude to PS Skills” (16.34 + 3.46). Pearson correlations revealed significant correlation between domains. Conclusion: The study showed that there was prevalence of PS knowledge among interns but limited understanding requiring training. KEYWORDS: Attitude, patient safety, medical errors, interns Continuous...

Exploring Providers’ Perception to Naloxone Education for Opioid Overdose After Receiving Academic Detailing at the U.S. Department of Veterans Affairs

Introduction The U.S. Department of Veterans Affairs (VA), in partnership with the Opioid Overdose Education and Naloxone Distribution (OEND) Program, implemented the National Academic Detailing Service to deliver naloxone education to providers with patients at-risk for opioid-related overdose. Methods We administered a 26-item online survey to VA providers to explore their perceptions about prescribing naloxone for opioid overdose emergencies and their experience with academic detailing between August 2017 and April 2018. Responses were analyzed using descriptive statistics to (1) explore their current perceptions of naloxone prescribing and their experience with academic detailing, (2) identify differences across provider types [primary care providers (PCP), specialists, and others], and (3) assess perceived naloxone prescribing behavior change after an academic detailing visit. Results Providers (N = 137) indicated that they were practicing at a level that was consistent with VA goals to promote take-home naloxone to reverse opioid-related overdose events. Average domain scores were similar across PCP, specialist, and other provider types. Specialists reported a higher average attitude domain score (+.56, P = .011) and perceived barriers domain score (+.82, P = .009) than PCPs. Most providers agreed that they prescribed naloxone more frequently due to academic detailing (53%) and indicated that they synthesized information from the academic detailer to change their naloxone prescribing practice (60%). Discussion VA providers’ perceptions of take-home naloxone were aligned with current evidence-based practice. Moreover, providers reported increasing their naloxone prescribing and synthesizing OEND-related information after an academic detailing interaction. Understanding providers’ perceptions can be used to improve and enhance the academic detailing program’s effectiveness.

Impact of Testosterone Therapy on hypogonadal patients unresponsive to phosphodiesterase-5 inhibitors alone: A systematic review and a meta-analysis

Background Phosphodiesterase-5 inhibitors as the first-line treatment for erectile dysfunction, when patients with hypogonadism fail to respond to phosphodiesterase-5 inhibitors, the beneficial of addition testosterone therapy is a major concern for clinicians. The objective of this study was to collect and summarize the evidence that evaluated the benefit of addition testosterone therapy in hypogonadism fail to respond to phosphodiesterase-5 inhibitors. Methods Electronic literature searches of Cochrane Library, PubMed, MEDLINE and EMBASE databases were conducted up to October 2020 and included randomized controlled trials. Specifically, we were looking for papers where Erectile Function Domain Score differences between pre and post-treatment were used as the primary outcome after treatment of testosterone therapy alone, phosphodiesterase-5 inhibitors therapy alone, or a dual treatment of both testosterone therapy and phosphodiesterase-5 inhibitors. Secondary outcomes included the number of phosphodiesterase-5 inhibitors non-responders who subsequently reported a satisfactory treatment of dual treatment with testosterone therapy and phosphodiesterase-5 inhibitors. Results A total of 4 studies that met our criteria, consisting of 326 patients. The Erectile Function Domain Score was significantly higher after treatment of testosterone combine with phosphodiesterase-5 inhibitors(4.88[4.18–5.57]), phosphodiesterase-5 inhibitors with placebo(3.15[1.82–4.47]), and testosterone monotherapy (2.04[0.38–3.71]) compared with baseline. Dual treatment with testosterone and phosphodiesterase-5 inhibitors significantly improved Erectile Function Domain Score when compared with testosterone monotherapy (3.16, 95% CI: 1.79–4.53), Of 41.7% patients in the dual treatment group reported an improvement, compared to only 33.0% in phosphodiesterase-5 inhibitors treatment group. Conclusions Combination therapy of testosterone and phosphodiesterase-5 inhibitors seems most effective in men with both erectile dysfunction and hypogonadism who initial unrespond to phosphodiesterase-5 inhibitors.

The association of social frailty with intrinsic capacity in community-dwelling older adults: a prospective cohort study

Background Social frailty is associated with poor health outcomes; however, its effects on healthy aging indicators have not been adequately investigated. This study assessed the longitudinal association between social frailty and the intrinsic capacity of community-dwelling older adults. Methods A total of 663 participants (56.7% women) aged ≥60 years from in Nagoya, Japan, were included in the study. The first measurement occurred in 2014, and annual follow-ups occurred until 2017. Social frailty was determined based on four items: financial difficulty, household status, social activity, and regular contact with others. A deficit score of 0 represented social robustness, 1 represented social prefrailty, and ≥ 2 represented social frailty. Intrinsic capacity was evaluated by the locomotion, cognition, psychological function, vitality, and sensory function domains. The longitudinal association was analyzed using generalized estimating equations. Results The prevalence of social prefrailty and social frailty at baseline was 31.2 and 6.3%, respectively. The social prefrailty group (β = − 0.132, P < 0.001) and social frailty group (β = − 0.258, P < 0.001) were associated with a greater reduction in the composite intrinsic capacity scores than the social robustness group, especially in the cognition, psychological function, and vitality domains. Men with social prefrailty/social frailty demonstrated a greater decrease in the psychological function domain score (− 0.512 vs. − 0.278) than women. Additionally, the cognition domain score only decreased in men in the social prefrailty/social frailty group (β = − 0.122, P = 0.016). Conclusions Social frailty was associated with intrinsic capacity and its subdomains longitudinally. Men with social frailty were more vulnerable than women to a decline in their psychological function and cognition domains. Therefore, the advanced management of social frailty is necessary to facilitate healthy aging.

Combination of white matter hyperintensities and Aβ burden is related to cognitive composites domain scores in subjective cognitive decline: the FACEHBI cohort

Background To explore whether the combination of white matter hyperintensities (WMHs) and amyloid-beta (Aβ) deposition is associated with worse cognitive performance on cognitive composites (CCs) domain scores in individuals with subjective cognitive decline (SCD). Methods Two hundred participants from the FACEHBI cohort underwent structural magnetic resonance imaging (MRI), 18F-florbetaben positron emission tomography (FBB-PET), and neuropsychological assessment. WMHs were addressed through the Fazekas scale, the Age-Related White Matter Changes (ARWMC) scale, and the FreeSurfer pipeline. Eight CCs domain scores were created using the principal component analysis (PCA). Age, sex, education, and apolipoprotein E (APOE) were used as adjusting variables. Results Adjusted multiple linear regression models showed that FreeSurfer (B − .245; 95% CI − .1.676, − .393, p = .016) and β burden (SUVR) (B − .180; 95% CI − 2.140, − .292; p = .070) were associated with face–name associative memory CCs domain score, although the latest one was not statistically significant after correction for multiple testing (p = .070). There was non-significant interaction of these two factors on this same CCs domain score (p = .54). However, its cumulative effects on face–name associative performance indicated that those individuals with either higher WMH load or higher Aβ burden showed the worst performance on the face–name associative memory CCs domain score. Conclusions Our results suggest that increased WMH load and increased Aβ are independently associated with poorer episodic memory performance in SCD individuals, indicating a cumulative effect of the combination of these two pathological conditions in promoting lower cognitive performance, an aspect that could help in terms of treatment and prevention.

O-131 The effect of time since surgical diagnosis of endometriosis on treatment outcomes with relugolix combination therapy in women with endometriosis-associated pain: SPIRIT program

Study question To assess the efficacy of Relugolix-CT vs placebo in women who were surgically diagnosed with endometriosis &lt;5 and &gt; = 5 years ago. Summary answer Treatment outcomes did not differ for dysmenorrhea and daily functioning between subgroups of patients with &lt;5 years or ≥ 5 years since surgical diagnosis. What is known already Time since clinical manifestation and diagnosis of endometriosis may influence the treatment success of patients with endometriosis-associated pain. SPIRIT 1 and 2 were randomized, double-blind, placebo-controlled Phase 3 studies of Relugolix-CT (relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) in premenopausal women (age 18–50 years) with surgically diagnosed endometriosis and a history of moderate-to-severe dysmenorrhea and non-menstrual pelvic pain (NMPP). These studies previously demonstrated that Relugolix-CT significantly reduced dysmenorrhea and NMPP, and improved daily functioning measured by the Endometriosis Health Profile-30 (EHP-30) pain domain score vs placebo over 24 weeks. Study design, size, duration Premenopausal women with surgically diagnosed endometriosis and moderate-to-severe dysmenorrhea and NMPP at baseline were randomized 1:1:1 to 24 weeks of treatment with once daily oral Relugolix-CT, delayed Relugolix-CT (relugolix 40 mg monotherapy for 12 weeks followed by Relugolix-CT for 12 weeks), or placebo. The proportion of dysmenorrhea and NMPP responders at Week 24/End-of-Treatment (EoT), based on daily Numerical Rating Scale (NRS), and analgesic use status were co-primary endpoints. Participants/materials, setting, methods Pooled SPIRIT 1 and 2 data of patients who received 24 weeks of treatment with once daily Relugolix-CT (N = 418) or placebo (N = 416) are presented. Outcomes for the delayed Relugolix-CT group were only for the safety assessment and therefore not reported here. Analyses of NRS scores for dysmenorrhea, NMPP, and EHP-30 pain domain score were carried out in the subgroups of patients with time since diagnosis of &lt; 5 years (N = 579) and ≥5 years (N = 255). Main results and the role of chance Baseline demographics and clinical characteristics were comparable between the time since diagnosis subgroups except for a numerically higher mean age in the ≥5-years subgroup. Mean time since diagnosis (standard deviation) was 2.1 (1.5) years with both Relugolix-CT and placebo for &lt;5-years subgroup, and 8.0 (2.8) and 7.8 (2.3) years, respectively, for ≥5-years subgroup. In Relugolix-CT-treated patients, mean NRS score for dysmenorrhea decreased from 7.5 (severe) to 1.8 (mild) in the &lt;5-years subgroup and from 6.9 (moderate) to 1.8 (mild) in the ≥5-years subgroup with a significant difference to placebo (p &lt; 0.0001, both subgroups), and demonstrating 74.8% and 72.7% reduction in pain from baseline to Week 24/EoT, respectively. Mean NRS score for NMPP decreased from 6.0 (moderate) to 3.0 (mild) with a significant difference compared with placebo (p &lt; 0.0001), equating to 48.8% pain reduction in the &lt;5-years subgroup, and from 5.6 (moderate) to 2.7 (mild) equating to 51.5% pain reduction (p = 0.089) in the ≥5-years subgroup. Improvement of daily functioning as measured by EHP-30 pain domain score was significantly greater with Relugolix-CT vs placebo in both subgroups, with decrease in EHP-30 pain score from 59.1 to 24.0 in the &lt;5-years subgroup, and from 57.4 to 21.1 in the ≥5-years subgroup (p &lt; 0.0001, both subgroups). Limitations, reasons for caution A lower number of patients were included into the subgroup with ≥5-years since surgically diagnosed endometriosis. Five-year dichotomy was close to the mean time since surgical diagnosis in the studies and to certain extent is arbitrary. Furthermore, time since surgical diagnosis is not the same as time since symptom onset. Wider implications of the findings In women with endometriosis-associated pain, Relugolix-CT vs placebo significantly reduced dysmenorrhea and improved daily functioning in both groups: with surgical diagnosis of &lt; 5 years or ≥ 5 years. Substantial decrease in NMPP was also observed and was significantly different to placebo in the &lt;5-years subgroup. Trial registration number NCT03204318 and NCT03204331

Depression, its correlates and quality of life of undergraduate medical students in the Kumaon region of Uttarakhand state, India

Background: Medical students are future health care providers and experience a lot of stress during their training years. They are more likely to suffer depressive disorders than the general population and have a poorer quality of life. Objectives: To determine the prevalence of depressive disorder, its correlates and quality of life of medical students studying at a medical college in North India. Methods and material: It was a cross sectional study which included all the students enrolled at the study medical college. Data was collected using pre-validated questionnaires namely - 20 item ‘Center for Epidemiologic Studies Depression Scale (CES-D)’, WHO Quality of life (QoL) – BREF questionnaire and ‘Smartphone Addition Scale - Short version’ (SAS-SV) questionnaire to assess for depression, quality of life and smartphone addiction respectively which was distributed in the classroom to be filled. Multivariate logistic regression was employed to ascertain association between depression and the other variables. Results: The study had an effective response rate of 79%. Using a score of 16 or above as cut-off on CES-D scale145 study participants (36.7%) were found to be depressed. Participants who negatively compared themselves with their peers/friends and also those who were addicted to smartphone were significantly more likely to be depressed [1.85(1.12-3.05) and 1.96 (1.29-2.97) respectively]. We report a statistically significant negative relationship between physical domain score [0.97(0.95-0.99)], psychological domain score [0.95(0.93-0.97)] and social relationship domain score [0.97(0.95-0.99)] on BREF Quality of life questionnaire and the presence of depression among the study participants. Conclusion: The prevalence of depression among medical students was high and those with depression have significantly poor quality of life.

Educational Value of Endoscopic Versus Microscopic Ear Surgery

Objective: To compare the educational value of endoscopic ear surgery versus microscopic ear surgery among medical students. Methods: Medical students anonymously completed a cross-sectional survey immediately after observing endoscopic or microscopic ear surgery. A Likert scale (1 = worst, 5 = best) was used to analyze variables across 3 domains including: (1) area of interest visibility, (2) optical quality, (3) education and understanding. The Mann–Whitney U-test and multivariable linear regression were used to compare mean scores of individual items and domain means between endoscopic and microscopic groups. Results: Forty-four surveys were analyzed (20 endoscopic and 24 microscopic ear surgeries). Across domains, the endoscope was superior to the microscope (adjusted P < .05) for visibility of the area of interest (mean ± SD: 4.74 ± 0.26 vs 4.28 ± 0.50), optical quality (4.78 ± 0.38 vs 4.28 ± 0.64), and education and understanding (4.70 ± 0.47 vs 4.13 ± 0.61). In multivariable linear regression, the mean domain score for visibility of the area of interest was 1.23 (95% CI = 0.56, 1.90; adjusted P < .01) points higher for the endoscopic group, compared to the microscopic group, adjusting for surgeon, procedure, and student type. The mean domain score for education and understanding was 1.19 (95% CI = 0.49. 1.90; adjusted P < 0.01) points higher for the endoscopic group, compared to the microscopic group, adjusting for the same confounders. Conclusions: Among medical students, endoscopic ear surgery was superior to microscopic ear surgery for several visual quality indicators and perceived educational benefit. These findings have implications for medical student education and surgical training.

Integrating approaches for quality guideline development in LactaMap, an online lactation care support system

Background Health professionals caring for women and infants experiencing difficulty with breastfeeding have reported deficiencies in evidence-based lactation knowledge. LactaMap is an online lactation care support system with more than 100 clinical practice guidelines to support breastfeeding care. Clinical practice guidelines support medical decision-making by summarising scientific evidence into systematically developed statements for specific clinical circumstances. Both common-sense and theory-based approaches have been used for guideline development and debate continues regarding which is superior. LactaMap clinical practice guidelines were created over the course of 5 years using a common-sense approach that was refined inductively. The aim of this study was to incorporate a theory-based framework approach into the methodology for ongoing update and review of LactaMap clinical practice guidelines. Methods The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was chosen as the framework-based approach to appraise LactaMap guideline quality. The study was conducted in two phases. The first phase appraised all 103 original LactaMap guidelines. The second phase appraised a subset of 15 updated LactaMap guidelines using improved methodology guided by phase 1, as well as 15 corresponding original (un-updated) guidelines. Results Mean Domain scores for 103 LactaMap original guidelines were above 75% in 3 of the 6 AGREE II quality Domains and no mean Domain score rated poorly. Update of guideline methodology was guided by phase 1 appraisals. Improved documentation of methods relating to questions in the Rigour of Development Domain resulted in improvement in mean Domain score from 39 to 72%. Conclusions This study showed that a theory-based approach to guideline development methodology can be readily integrated with a common-sense approach. Factors identified by AGREE II theory-based framework provided practical guidance for changes in methodology that were integrated prior to LactaMap website publication. Demonstration of high quality in LactaMap clinical practice guideline methodology ensures clinicians and the public can have trust that the content founded on them is robust, scientific and of highest possible quality.