Evaluation of the impact of "speak out" and "human libraries" educational methodologies on nursing students' attitudes toward immigration.

Introduction: Measuring and understanding attitudes toward migrants is crucial in Health Sciences professionals. Nursing students, as future professionals in the healthcare system, must be comprehensively trained and prepared from the undergraduate level to effectively face the challenges of caring for health and disease processes in an increasingly globalized world. Our study aims to determine the level of attitudinal change in nursing students for immigrants, based on a training intervention with sessions of coexistence with immigrants in Spain. Methods: Quasi-experimental controlled and non-randomized study, carried out in 2019 in Nursing School La Fe, Valencia (Spain), with 201 participants (74 intervention group, 127 control group). Instrument: Attitudes toward Immigration Instrument (IAHI) questionnaire. Educational techniques of the training intervention: Speak outs and Human Libraries. Descriptive statistical analysis and comparison of results between groups was performed. Results: The participants in the intervention group showed significant changes in attitude modification, both in the total score of the questionnaire and in 4 of the 5 dimensions (pre-post intervention medition). When comparing the differences between the intervention group and the control group, we observed significant differences in 3 of the 5 dimensions: equality principles and policies, positive favorability, and negative favorability. Conclussion: Sessions involving coexistence, discussion, and reflection with immigrants, as educational intervention methods for nursing students (Speak outs and Human Libraries), are useful and effective tools to promote positive attitudinal changes toward immigrants within the healthcar context in nursing students.

Group physiotherapy and quality of life in parkinsonism: quasi-experimental study

According to systematic reviews, a short-term treatment of aquatic physiotherapy, mind-body therapies and exergame improve quality of life of people with parkinsonism. But few studies examined the group physiotherapy effects on quality of life of people with parkinsonism. Objective: We aimed to investigate the short-term effects of group physiotherapy protocols on the quality of life of people with Parkinson's disease or secondary parkinsonism. Methods: This is a quasi-experimental study, a controlled, non-randomized, unmasked trial, with consecutive arms for one group and parallel to another, with 15 participants with parkinsonism. They were organized in 3 groups: OG-E1wI (n = 9), observed group treated with group physiotherapy once a week; EG-C (n = 6), in the control phase without treatment, concomitant with OG-E1wI; EG-2wI (n = 6), the same subjects as EG-C, they were treated with group physiotherapy twice a week, in a posterior consecutive phase. The PDQ-39 scale was used to assess Quality of Life. Results: The mean differences between OG-E1wI and EG-C and between EG-2wI and EG-C in the various domains of PDQ-39 were not statistically significant. Conclusion: A group physiotherapy protocols performed once or twice a week may not be enough to improve quality of life for people with parkinsonism. The literature suggests that group physiotherapy protocols performed three to five times a week improve quality of life in a short period

Contexto: Revisões sistemáticas sugerem que fisioterapia aquática, terapias corporais complementares e exergame aumentam a qualidade de vida da pessoa com parkinsonismo em tratamento de curto prazo. Porém, os efeitos da fisioterapia em grupo na qualidade de vida da pessoa com parkinsonismo são pouco estudados. Objetivo: Investigar os efeitos em curto prazo de protocolos de fisioterapia grupal sobre a Qualidade de Vida de pessoas com doença de Parkinson e parkinsonismo secundário. Métodos: Estudo quasi-experimental, ensaio controlado não randomizado, sem mascaramento, com braços consecutivos para um grupo e paralelo para outro, com 15 participantes com parkinsonismo. Os participantes foram organizados em 3 grupos: OG-E1wI (n= 9), intervenção de fisioterapia em grupo uma vez por semana; EG-C (n= 6), em fase controle sem tratamento, concomitante ao OG-E1wI; EG-2wI (n=6), os mesmos sujeitos do EG-C, em fase consecutiva com intervenção de fisioterapia em grupo, duas vezes por semana. A escala PDQ-39 foi utilizada para avaliar a Qualidade de Vida. Resultados: As diferenças médias entre OG-E1wI e EG-C e entre EG-2wI e EG-C nos vários domínios da PDQ-39 não são estatisticamente significativas. Conclusão: Protocolos de fisioterapia em grupo com frequência de uma ou duas vezes por semana podem não ser suficiente para promover ganhos na qualidade de vida de pessoas com parkinsonismo. A literatura sugere que protocolos de fisioterapia em grupo feitos três a cinco vezes por semana obtêm ganho de qualidade de vida em um período de curto prazo

Interventions in hypertension: systematic review and meta-analysis of natural and quasi-experiments.

BACKGROUND: Hypertension is an urgent public health problem. Consistent summary from natural and quasi-experiments employed to evaluate interventions that aim at preventing or controlling hypertension is lacking in the current literature. This study aims to summarize the evidence from natural and quasi-experiments that evaluated interventions used to prevent or control hypertension. METHODS: We searched PubMed, Embase and Web of Science for natural and quasi-experiments evaluating interventions used to prevent hypertension, improve blood pressure control or reduce blood pressure levels from January 2008 to November 2018. Descriptions of studies and interventions were systematically summarized, and a meta-analysis was conducted. RESULTS: Thirty studies were identified, and all used quasi-experimental designs including a difference-in-difference, a pre-post with a control group or a propensity score matching design. Education and counseling on lifestyle modifications such as promoting physical activity (PA), promoting a healthy diet and smoking cessation consultations could help prevent hypertension in healthy people. The use of computerized clinical practice guidelines by general practitioners, education and management of hypertension, the screening for cardiovascular disease (CVD) goals and referral could help improve hypertension control in patients with hypertension. The educating and counseling on PA and diet, the monitoring of patients' metabolic factors and chronic diseases, the combination of education on lifestyles with management of hypertension, the screening for economic risk factors, medical needs, and CVD risk factors and referral all could help reduce blood pressure. In the meta-analysis, the largest reduction in blood pressure was seen for interventions which combined education, counseling and management strategies: weighted mean difference in systolic blood pressure was - 5.34 mmHg (95% confidence interval [CI], - 7.35 to - 3.33) and in diastolic blood pressure was - 3.23 mmHg (95% CI, - 5.51 to - 0.96). CONCLUSIONS: Interventions that used education and counseling strategies; those that used management strategies; those that used combined education, counseling and management strategies and those that used screening and referral strategies were beneficial in preventing, controlling hypertension and reducing blood pressure levels. The combination of education, counseling and management strategies appeared to be the most beneficial intervention to reduce blood pressure levels.

The impact of a self-management educational program coordinated through WhatsApp on diabetes control.

BACKGROUND: Social media can effectively mediate digital health interventions and thus, overcome barriers associated with face-to-face interaction. OBJECTIVE: To assess the impact of patient-centered diabetes education program administered through WhatsApp on glycosylated hemoglobin (HbA1c) values, assess the correlation, if any, between health literacy and numeracy on intervention outcomes. METHODS: During an 'intervention phase' spread over six months, target diabetic patients (N=109) received structured education through WhatsApp as per the American Association of Diabetes Educators Self-Care Behaviors recommendations. The control group with an equal number of participants received 'usual care' provided by health professionals void of the social media intervention. Changes in HbA1c levels were recorded thrice (at baseline, 3 and 6 months) for the test group and twice (baseline and 6 months) for the control group. Change in HbA1c values were compared and statistical significance was defined at p<0.05. Baseline health literacy and diabetes numeracy were assessed for both groups (N=218) using the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT), respectively, and values were correlated with HbA1c change p<0.05. Participants' satisfaction with the intervention was also assessed. RESULTS: The average age of respondents was 41.98 (SD 15.05) years, with a diabetes history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively. After six months, a significant drop in HbA1c value was noticed in intervention group (7.7; SD 1.35; p= 0.001); with no significance in the control group (8.4; SD 1.32; p=0.032, paired t-test). Moreover, the reduction in HbA1c was more in the test group (0.7%) than the control group (0.1%) with a difference of 0.6% which is considered clinically significant. There was no significant correlation between LAD score and HbA1c at baseline (r=-0.203, p=0.064), 3 months (r=-0.123, p=0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar result was observed with DNT, where DNT score and HbA1c at baseline, 3 months and 6 months showed no correlation (r=0.112, 0.959 and 0.886; respectively) with HbA1c levels. Eighty percent of the respondents found the social media intervention 'beneficial' and suggested it be used long term. CONCLUSIONS: Diabetes education via WhatsApp showed promising outcomes regardless of the level of patients' health literacy or numeracy.

Development and validation of study filters for identifying controlled non-randomized studies in PubMed and Ovid MEDLINE.

A retrospective analysis published by the German Institute for Quality and Efficiency in Health Care (IQWiG) in 2018 concluded that no filter for non-randomized studies (NRS) achieved sufficient sensitivity (≥92%), a precondition for comprehensive information retrieval. New NRS filters are therefore required, taking into account the challenges related to this study type. Our evaluation focused on the development of study filters for NRS with a control group ("controlled NRS"), as this study type allows the calculation of an effect size. In addition, we assumed that due to the more explicit search syntax, controlled NRS are easier to identify than non-controlled ones, potentially resulting in better performance measures of study filters for controlled NRS. Our aim was to develop study filters for identifying controlled NRS in PubMed and Ovid MEDLINE. We developed two new search filters that can assist clinicians and researchers in identifying controlled NRS in PubMed and Ovid MEDLINE. The reference set was based on 2110 publications in Medline extracted from 271 Cochrane reviews and on 4333 irrelevant references. The first filter maximizes sensitivity (92.42%; specificity 79.67%, precision 68.49%) and should be used when a comprehensive search is needed. The second filter maximizes specificity (92.06%; precision 82.98%, sensitivity 80.94%) and should be used when a more focused search is sufficient.

Visual data: a new tool to improve the presentation of clinical trial results / Dados visuais: uma nova ferramenta para melhorar a interpretação dos resultados de ensaios clínicos

ABSTRACT Randomized controlled trials are known to be the best tool to determine the effects of an intervention; however, most healthcare professionals are not able to adequately understand the results. In this report, concepts, applications, examples, and advantages of using visual data as a complementary tool in the results section of original articles are presented. Visual simplification of data presentation will improve general understanding of clinical research.

RESUMO Ensaios clínicos randomizados são conhecidos por serem a melhor ferramenta para determinar os efeitos de uma intervenção. No entanto, a maioria dos profissionais de saúde não é capaz de compreender os resultados de forma adequada. Neste artigo, são apresentados conceitos, aplicações, exemplos e vantagens do uso de dados visuais como uma ferramenta complementar na seção dos resultados de artigos originais. A simplificação da visualização da apresentação dos dados deve melhorar o entendimento geral de pesquisas clínicas.

Influencing the timing of parenteral nutrition initiation in the pediatric intensive care unit.

BACKGROUND: Lack of benefit and potential harm of early parenteral nutrition (PN) initiation in critically ill children was highlighted in the 2016 published results of a large multicenter, randomized controlled trial. OBJECTIVES: The purpose of this project was to implement a process to delay PN initiation for up to five days after admission to our pediatric intensive care unit (PICU). METHODS: Patients greater than thirty days of age, admitted to the PICU beginning July 1, 2016 were included in the analysis of the healthcare improvement initiative to decrease early PN initiation. A meeting was held with PICU fellows, attending physicians, dietitians, and pharmacists to reach a consensus to delay initiation of parenteral nutrition until PICU day five. The dietitian, with pharmacist support, reiterated recommendations on rounds and in formal notes. RESULTS: A total of 2333 patients were identified in the pre-intervention group and a total of 2491 patients in the post-intervention group. The percentage of patients receiving PN prior to day five within the PICU was 5.5% in the pre-intervention group versus 3.1% in the delayed PN group (p<0.001). PICU patients receiving PN less than or equal to three days decreased from 2.6% pre-intervention to 1.5% post-intervention (p=0.01). For the subset of patients who were initiated on PN after admission to the PICU, median PICU length of stay was 7 days versus 6 days in the pre-intervention versus post-intervention group (p=0.26). CONCLUSIONS: Decrease in PN utilization was seen in the pre and post-intervention groups as assessed by percentage of patients initiated on PN prior to day five of PICU admission. Consensus among practitioners with consistent recommendations from the frontline dietitian and pharmacist, with nutrition support team collaboration, contributed to the evidence based quality initiative results. Delaying PN did not adversely affect length of stay pre versus post-intervention.

Implementing an educational program to improve critical care nurses' enteral nutritional support.

BACKGROUND: Although international nutrition societies recommend enteral nutrition guidelines for patients in intensive care units (ICUs), large gaps exist between these recommendations and actual clinical practice. Education programs designed to improve nurses' knowledge about enteral nutrition are therefore required. In Korea, there are no educational intervention studies about evidence-based guidelines of enteral nutrition for critically ill patients. OBJECTIVES: We aimed to evaluate the effects of an education program to improve critical care nurses' perceptions, knowledge, and practices towards providing enteral nutritional support for ICU patients. METHODS: A quasi-experimental, one-group study with a pre- and post-test design was conducted from March to April 2015. Nurses (N = 205) were recruited from nine ICUs from four tertiary hospitals in South Korea. The education program comprised two sessions of didactic lectures. Data were collected before (pre-test) and 1 month after (post-test) the education program using questionnaires that addressed nurses' perceptions, knowledge, and practices relating to providing enteral nutritional support for ICU patients. RESULTS: After the program, nurses showed a significant improvement in their perceptions and knowledge of enteral nutrition for ICU patients. There was a significant improvement in inspecting nostrils daily, flushing the feeding tube before administration, providing medication that needs to be crushed correctly, changing feeding sets, and adjusting feeding schedules. CONCLUSIONS: The findings indicate that an enteral nutrition education program could be an effective strategy to increase critical care nurses' support for the critically ill. This education program can be incorporated into hospital education or in-service training for critical care nurses to strengthen their perceptions and knowledge of nutritional support in the ICU. This may improve the clinical outcomes of ICU patients.

Focused echocardiography: Dyad versus individual training in an authentic clinical context.

PURPOSE: Echocardiography is increasingly being taught to intensive care unit residents. Current training methods require teachers to closely supervise trainees individually, and are time-intensive. To reduce the time burden, dyad training (training in pairs) under simulation conditions has been shown to be non-inferior to individual training. We aimed to validate these preliminary results for focused subcostal echocardiography (FSE), in an authentic clinical context. MATERIALS AND METHODS: We conducted a quasi-experimental study within a 20-bed medical intensive care unit from June 2016 to March 2017. For supervised practice, residents were divided into individual versus dyad training groups. Residents then performed at least five FSE examinations, which were remotely scored by a blinded observer for image quality and correct interpretation. The main outcome measure was the mean composite image quality and interpretation score for the first five echoes done under indirect supervision (composite score range 1-8). RESULTS: 16 residents received individual training and 17 residents received dyad training. The mean composite score did not differ between the individual and dyad training groups (6.0 ±â€¯0.4 versus 5.9 ±â€¯0.4, 95% CI of difference - 0.2 to 0.4). CONCLUSIONS: Assuming a 1-point non-inferiority threshold for the mean composite score, dyad training for FSE was non-inferior to individual training.

Meniscectomía artroscópica en 100 pacientes / Arthroscopic meniscectomy in 100 patients

Fundamento: las lesiones del menisco en la articulación de la rodilla son una de las enfermedades más frecuentes debido a causas traumáticas y degenerativas, el cuadro clínico se caracteriza por la presencia de síntomas y signos mecánicos y el tratamiento por lo general es quirúrgico por la vía artroscópica que es de gran utilidad. Objetivo: evaluar la efectividad de la meniscectomía por vía artroscópica en un grupo de pacientes con lesión de menisco. Métodos: se realizó un estudio cuasi experimental modalidad antes y después, en 100 pacientes operados por meniscectomía mediante la vía artroscópica, la investigación tiene un nivel de evidencia III, recomendación B y fue realizada en el hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey desde febrero de 2013 a enero de 2017. El universo estuvo compuesto por 158 pacientes de los cuales 100 fueron seleccionados para integrar la muestra no probabilística. Resultados: el promedio de edades fue de 46,95 años, predominó el sexo femenino, la rodilla derecha y el menisco medial. El desgarro de tipo degenerativo se observó en el 50 % de los casos, la plica sinovial se detectó en 41 enfermos y las lesiones de cartílago en 78. El dolor en la línea articular y la maniobra de McMurray presentaron el mayor porcentaje de positividad. La meniscectomía parcial fue el procedimiento quirúrgico más empleado. Se observó significación entre un antes y después al emplear las escalas de WOMET y KOOS abreviada. Conclusiones: la meniscectomía artroscópica es un procedimiento quirúrgico efectivo en pacientes con lesiones de menisco, tanto de causa degenerativa como traumática.

Background: meniscal lesions of the knee due to degenerative and traumatic causes are common. Patients usually complain of mechanical symptoms and signs. Treatment is usually surgical by arthroscopy because of several advantages. Objective: the aim of this study was to evaluate the use of arthroscopic meniscectomy in patients with meniscal lesions. Methods: a quasi experimental study before and after modality with a level of evidence III and recommendation grade B in Manuel Ascunce Domenech hospital in Camaguey city from February 2013 to January 2017 was performed in 158 patients diagnosed with meniscal lesions, but 100 of them were selected as a non-probabilistic sample, based on selected criteria. Results: average age was 46,95 years. Female sex, right knee and medial meniscus prevailed. Degenerative tears were detected in 50 % of the cases. Synovial plica and cartilage lesions were found in 41 and 78 patients respectively. Joint line tenderness and McMurray test were positive in a huge number of patients. Partial arthroscopic meniscectomy was the common used surgical procedure. There were significant statistical differences between before and after while using WOMET and short KOOS scales. Conclusions: arthroscopic meniscectomy is an effective surgical procedure in patients with meniscal lesions.

Immunosuppressive serum levels in allogeneic hematopoietic stem cell transplantation: pharmaceutical care contribution.

BACKGROUND: Cyclosporine and tacrolimus are limited by a narrow therapeutic window. Maintaining immunosuppressive drugs at desired levels may be difficult. Pharmaceutical care emerges as a philosophy of practice that enhances medication use and leads to a better control of serum concentration. OBJECTIVE: This study aims to evaluate the impact of pharmaceutical care in the maintaining of proper serum levels of immunosuppressive medications in patients who have undergone allo-HSCT. METHODS: The study had a quasi-experimental design that included a comparison group. The service model used was pharmacotherapy follow-up, according to an adaptation of the Dader method. The pharmacist consultation was carried out at a day-hospital or at the outpatient hematology clinic as needed. The intervention group consisted of 22 patients seen by a clinical pharmacist. The control group consisted of 44 patients that received standard care. This study aims to evaluate the impact of pharmaceutical care on keeping patient serum levels of cyclosporine and tacrolimus within the desired range. RESULTS: Control group displayed 65% of the proper serum levels of immunosuppressive agents. While In intervention group, the figure was 82% (p = 0.004). CONCLUSION: The role of the pharmacist in the multidisciplinary team may contribute to a greater success in attaining the patients' therapeutic targets with regard to the use of immunosuppressant.