-
BMJ Open Quality May 2024This service evaluation describes the rapid implementation of self-monitoring of blood pressure (SMBP) into maternity care at a tertiary referral centre during the...
BACKGROUND
This service evaluation describes the rapid implementation of self-monitoring of blood pressure (SMBP) into maternity care at a tertiary referral centre during the COVID-19 pandemic. It summarises findings, identifies knowledge gaps and provides recommendations for further research and practice.
INTERVENTION
Pregnant and postpartum women monitored their blood pressure (BP) at home, with instructions on actions to take if their BP exceeded pre-determined thresholds. Some also conducted proteinuria self-testing.
DATA COLLECTION AND ANALYSIS
Maternity records, app data and staff feedback were used in interim evaluations to assess process effectiveness and guide adjustments, employing a Plan-Do-Study-Act and root cause analysis approach.
RESULTS
Between March 2020 and August 2021, a total of 605 women agreed to self-monitor their BP, including 10 women with limited English. 491 registered for telemonitoring (81.2%). 21 (3.5%) took part in urine self-testing. Engagement was high and increased over time with no safety issues. Biggest concerns related to monitor supply and postnatal monitoring. In December 2020, SMBP was integrated into the standard maternity care pathway.
CONCLUSIONS
This project demonstrated successful integration of SMBP into maternity care. Early stakeholder engagement and clear guidance were crucial and community midwifery support essential. Supplying BP monitors throughout pregnancy and post partum could improve the service and fully digitised maternity records would aid data collection. More research is needed on SMBP in the postnatal period and among non-English speakers. These findings support efforts to implement app-supported self-monitoring and guide future research.
Topics: Humans; Female; Pregnancy; COVID-19; Quality Improvement; Adult; United Kingdom; SARS-CoV-2; State Medicine; Blood Pressure Monitoring, Ambulatory; Pandemics; Self Care; Telemedicine
PubMed: 38816006
DOI: 10.1136/bmjoq-2023-002383 -
PloS One 2024Developing web-based education sexual and reproductive health (SRH) programs for immigrant women is crucial. This scoping review aims to provide basic data for... (Review)
Review
Developing web-based education sexual and reproductive health (SRH) programs for immigrant women is crucial. This scoping review aims to provide basic data for developing more advanced programs by examining web-based educational program literature. This review considers web-based SRH education programs for adult immigrant women and focuses on their characteristics, instructional strategies, and outcome evaluations. Data will be extracted following the Minimum Initial Service Package (MISP) and Kirkpatrick level and summarized to show future-oriented results while documenting web-based approach evidence for educating immigrant women on SRH. It is expected to provide information for web-based education programs to meet the MISP and develop various evaluation methods. As such, the findings can be used to determine the direction and level of SRH education.
Topics: Humans; Female; Emigrants and Immigrants; Reproductive Health; Internet; Sexual Health; Sex Education; Health Education
PubMed: 38814976
DOI: 10.1371/journal.pone.0298551 -
PloS One 2024Due to the health consequences arising from climate change, medical students will inevitably interact with affected patients during their training and careers....
INTRODUCTION
Due to the health consequences arising from climate change, medical students will inevitably interact with affected patients during their training and careers. Accordingly, medical schools must incorporate education on the impacts of climate change on health and equity into their curricula. We created a curricular thread called "Climate Change, Health, and Equity" in the first-year preclinical medical program to teach foundational concepts and foster self-reflection and critical consciousness.
METHODS
The authors developed a continuum of practice including administrators, educators and faculty members, students, and community partners to plan and design curricular activities. First-year medical students at Duke University School of Medicine participated in seven mandatory foundational lectures and two experiential learning opportunities in the local community. Following completion of activities, students wrote a critical reflection essay and completed a self-directed learning exercise. Essays were evaluated using the REFLECT rubric to assess if students achieved critical reflection and for thematic analysis by Bloom's Taxonomy.
RESULTS
All students (118) submitted essays. A random sample of 30 (25%) essays underwent analysis. Evaluation by the REFLECT rubric underscored that all students were reflecting or critically reflecting on thread content. Thematic analysis highlighted that all students (30/30, 100%) were adept at identifying new areas of medical knowledge and connecting concepts to individual experiences, institutional practices, and public health and policy. Most students (27/30; 90%) used emotionally laden words, expressing negative feelings like frustration and fear but also positive sentiments of solidarity and hope regarding climate change and effects on health. Many students (24/30; 80%) expressed actionable items at every level including continuing self-directed learning and conversing with patients, minimizing healthcare waste, and advocating for climate-friendly policies.
CONCLUSION
After participating in the curricular thread, most medical students reflected on cognitive, affective, and actionable aspects relating to climate change, health, and equity.
Topics: Humans; Climate Change; Students, Medical; Curriculum; Education, Medical, Undergraduate; Health Equity; Problem-Based Learning; Female; Male
PubMed: 38814920
DOI: 10.1371/journal.pone.0303615 -
JMIR Aging May 2024The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be...
BACKGROUND
The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support-based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated.
OBJECTIVE
This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users.
METHODS
We conducted a nonrandomized controlled trial of older adults aged ≥65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test.
RESULTS
The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels.
CONCLUSIONS
The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials.
Topics: Humans; Aged; Male; Mobile Applications; Female; Exercise; Independent Living; Health Promotion; Peer Group; Feasibility Studies; Aged, 80 and over
PubMed: 38814686
DOI: 10.2196/56184 -
Heliyon May 2024Gangetic old alluvial zone in India has conserved many locally adapted aromatic rice landraces. In order to determine the extent of genetic divergence of ten...
Gangetic old alluvial zone in India has conserved many locally adapted aromatic rice landraces. In order to determine the extent of genetic divergence of ten morphological characters, the study was conducted to examine forty-eight aromatic rice genotypes for six seasons (2016-2021) at the Instructional Farm of Regional Research Station (Old Alluvial Zone), Uttar Banga Krishi Viswavidyalaya, Majhian, West Bengal, India. The experiment was laid out in Randomized Complete Block Design (RCBD) with three replications. A considerable degree of variation was noted for all the traits being investigated. It was found that the total number of tillers per plant, panicle numbers per plant, number of grains per panicle, fertility percentage, test weight, and grain length/breadth ratio had significantly positive correlated with seed yield per plant. Based on D analysis values, all the genotypes were grouped into six clusters. Cluster III (Tulaipanji, Patnai, Basmati 1121, Jugal, and Bahurupi) and Cluster VI (Kanakchur), containing genotypes were found most divergent with maximum inter-cluster distance (6941.51). According to the cluster means, Cluster II had the largest intra-cluster distance (1937.52), and important attributes including test weight, number of grains per panicle, seed yield per plant, and fertility percentage made remarkably significant contributions to this cluster. In terms of principal component analysis, maximum variability was found in PC1 (23.88 %), with high positive loading values for tillers per plant (0.459), panicle number per plant (0.441), seed yield per plant (0.408), fertility percentage (0.364), test weight (0.264), and grain length/breadth (L/B) ratio (0.263). On the basis of biplot analysis, four genotypes, namely Shakbhati, Sugandhi, Bahurupi and Kanakchur, were identified as the most divergent types for the yield-attributing traits of aromatic rice. The diverse genotypes could be used as potential donors in future breeding programmes.
PubMed: 38813207
DOI: 10.1016/j.heliyon.2024.e31232 -
Frontiers in Allergy 2024The concept of pre-diabetes has led to provision of measures to reduce disease progression through identification of subjects at risk of diabetes. We previously... (Review)
Review
The concept of pre-diabetes has led to provision of measures to reduce disease progression through identification of subjects at risk of diabetes. We previously considered the idea of pre-asthma in relation to allergic asthma and considered that, in addition to the need to improve population health via multiple measures, including reduction of exposure to allergens and pollutants and avoidance of obesity, there are several possible specific means to reduce asthma development in those most at risk (pre- asthma). The most obvious is allergen immunotherapy (AIT), which when given for allergic rhinitis (AR) has reasonable evidence to support asthma prevention in children (2) but also needs further study as primary prevention. In this second paper we explore the possibilities for similar actions in late onset eosinophilic asthma.
PubMed: 38812719
DOI: 10.3389/falgy.2024.1404735 -
Turkish Journal of Medical Sciences 2024The shoulder is the most mobile joint in the body, and is frequently exposed to injuries. The applied surgical treatments, protection of the shoulder after surgery, care... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND/AIM
The shoulder is the most mobile joint in the body, and is frequently exposed to injuries. The applied surgical treatments, protection of the shoulder after surgery, care in the use of the shoulder in activities of daily living (ADLs) and gradual exercise programs are all vital to the recovery process. The present study investigates the effect of video-assisted training (VAT) on upper extremity complications and functions after rotator cuff repair (RCR).
MATERIALS AND METHOD
Included in this prospective, parallel two-armed, randomized controlled study were an experimental group (n: 24) that received VAT detailing early postoperative care for RCR and instructions on performing ADLs, and that had access to a 90-day gradual exercise program, and a control group (n: 24) that received routine care. The primary outcomes were upper extremity problems and functions, as assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) and modified Constant-Murley scores (MCM), while secondary outcomes were complications that had developed within the past three months. The outcomes were measured at baseline, after six weeks and at three months.
RESULTS
After 3 months, a statistically significant difference was noted in the DASH-Work (p = 0.001) and MCM ADLs scores (p = 0.003) of the two groups, and significant changes in which the scale scores of both groups when compared to the initial measurement. Only one patient in the VAT group developed complications after RCR at one month; there were no significant differences in the complications of the two groups (p = 0.235).
CONCLUSION
VAT can increase function in RCR patients. Healthcare professionals, especially nurses, can use the VAT method to improve shoulder function in patients after RCR.
Topics: Humans; Male; Female; Middle Aged; Rotator Cuff Injuries; Prospective Studies; Upper Extremity; Exercise Therapy; Adult; Activities of Daily Living; Aged; Treatment Outcome; Rotator Cuff
PubMed: 38812623
DOI: 10.55730/1300-0144.5777 -
Trials May 2024Paediatric convulsive status epilepticus is the most common neurological emergency presenting to emergency departments. Risks of resultant neurological morbidity and...
Seizure control via pH manipulation: a phase II double-blind randomised controlled trial of inhaled carbogen as adjunctive treatment of paediatric convulsive status epilepticus (Carbogen for Status Epilepticus in Children Trial (CRESCENT)).
BACKGROUND
Paediatric convulsive status epilepticus is the most common neurological emergency presenting to emergency departments. Risks of resultant neurological morbidity and mortality increase with seizure duration. If the seizure fails to stop within defined time-windows, standard care follows an algorithm of stepwise escalation to more intensive treatments, ultimately resorting to induction of general anaesthesia and ventilation. Additionally, ventilatory support may also be required to treat respiratory depression, a common unwanted effect of treatment. There is strong pre-clinical evidence that pH (acid-base balance) is an important determinant of seizure commencement and cessation, with seizures tending to start under alkaline conditions and terminate under acidic conditions. These mechanisms may be particularly important in febrile status epilepticus: prolonged fever-related seizures which predominantly affect very young children. This trial will assess whether imposition of mild respiratory acidosis by manipulation of inhaled medical gas improves response rates to first-line medical treatment.
METHODS
A double-blind, placebo-controlled trial of pH manipulation as an adjunct to standard medical treatment of convulsive status epilepticus in children. The control arm receives standard medical management whilst inhaling 100% oxygen; the active arm receives standard medical management whilst inhaling a commercially available mixture of 95% oxygen, 5% carbon dioxide known as 'carbogen'. Due to the urgent need to treat the seizure, deferred consent is used. The primary outcome is success of first-line treatment in seizure cessation. Planned subgroup analyses will be undertaken for febrile and non-febrile seizures. Secondary outcomes include rates of induction of general anaesthesia, admission to intensive care, adverse events, and 30-day mortality.
DISCUSSION
If safe and effective 95% oxygen, 5% carbon dioxide may be an important adjunct in the management of convulsive status epilepticus with potential for pre-hospital use by paramedics, families, and school staff.
TRIAL REGISTRATION
EudraCT: 2021-005367-49. CTA: 17136/0300/001.
ISRCTN
52731862. Registered on July 2022.
Topics: Humans; Status Epilepticus; Double-Blind Method; Hydrogen-Ion Concentration; Randomized Controlled Trials as Topic; Administration, Inhalation; Child; Carbon Dioxide; Child, Preschool; Treatment Outcome; Clinical Trials, Phase II as Topic; Acidosis, Respiratory; Infant; Seizures, Febrile; Acid-Base Equilibrium; Female; Male; Oxygen
PubMed: 38812049
DOI: 10.1186/s13063-024-08188-5 -
BMC Medical Education May 2024Global trends towards the professionalization of Health Professions Education (HPE) have catalyzed the proliferation of degree-awarding programmes in HPE. We apply the...
INTRODUCTION
Global trends towards the professionalization of Health Professions Education (HPE) have catalyzed the proliferation of degree-awarding programmes in HPE. We apply the theoretical lens of threshold concepts to explore the required levels of Master's in HPE (MHPE) learning and teaching, with a view to determining how students might be supported to engage meaningfully with learning.
METHODS
Qualitative data were collected with a series of nominal group discussions. The methodology and data analysis followed a consensus building approach.
RESULTS
Four threshold concepts were identified: Being in the HPE world, the nature of HPE knowledge, the nature of HPE practice and the nature of HPE scholarship. We also mapped the threshold concepts to the World Federation for Medical Education (WFME) master's level academic skills and the Scottish Quality Assurance Agency (QAA) facets of mastersness.
CONCLUSION
It is envisaged that our findings will enhance alignment between the outcomes and assessment in an MHPE programme, form the basis of understanding feedback received from students, and inform teaching and supervisory practices. The findings also complement the WFME and QAA frameworks by clarifying the depth and complexity of academic skills expected at master's level and informing teaching and learning approaches to support the development of the identified threshold concepts.
Topics: Humans; Health Occupations; Qualitative Research; Education, Graduate; Curriculum
PubMed: 38811980
DOI: 10.1186/s12909-024-05500-4 -
BMC Medical Education May 2024Shared decision making (SDM) has been presented as the preferred approach for decisions where there is more than one acceptable option and has been identified a priority...
BACKGROUND
Shared decision making (SDM) has been presented as the preferred approach for decisions where there is more than one acceptable option and has been identified a priority feature of high-quality patient-centered care. Considering the foundation of trust between general practitioners (GPs) and patients and the variety of diseases in primary care, the primary care context can be viewed as roots of SDM. GPs are requesting training programs to improve their SDM skills leading to a more patient-centered care approach. Because of the high number of training programs available, it is important to overview these training interventions specifically for primary care and to explore how these training programs are evaluated.
METHODS
This review was reported in accordance with the PRISMA guideline. Eight different databases were used in December 2022 and updated in September 2023. Risk of bias was assessed using ICROMS. Training effectiveness was analyzed using the Kirkpatrick evaluation model and categorized according to training format (online, live or blended learning).
RESULTS
We identified 29 different SDM training programs for GPs. SDM training has a moderate impact on patient (SMD 0.53 95% CI 0.15-0.90) and observer reported SDM skills (SMD 0.59 95%CI 0.21-0.97). For blended training programs, we found a high impact for quality of life (SMD 1.20 95% CI -0.38-2.78) and patient reported SDM skills (SMD 2.89 95%CI -0.55-6.32).
CONCLUSION
SDM training improves patient and observer reported SDM skills in GPs. Blended learning as learning format for SDM appears to show better effects on learning outcomes than online or live learning formats. This suggests that teaching facilities designing SDM training may want to prioritize blended learning formats. More homogeneity in SDM measurement scales and evaluation approaches and direct comparisons of different types of educational formats are needed to develop the most appropriate and effective SDM training format.
TRIAL REGISTRATION
PROSPERO: A systematic review of shared-decision making training programs in a primary care setting. PROSPERO 2023 CRD42023393385 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023393385 .
Topics: Humans; Decision Making, Shared; General Practitioners; Patient-Centered Care; Primary Health Care; Physician-Patient Relations
PubMed: 38811922
DOI: 10.1186/s12909-024-05557-1