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Arinda A, Ouma S, Kalani K, Ramasubramanian P, Johnson T, Charles A, Newson C, Ratliff O, Kakooza-Mwesige A, Njeru P, Kaddumukasa M, Kaddumukasa M, Kolls B, Husain A, Tchapyjnikov D, Haglund M, Fuller A, Prose N, Koltai D. Evaluation of a tailored epilepsy training program for healthcare providers in Uganda. Epilepsy Behav 2023; 138:108977. [PMID: 36446268 DOI: 10.1016/j.yebeh.2022.108977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/29/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study evaluated an epilepsy training program for healthcare workers that was designed to improve their knowledge of epilepsy, its treatment, and its psychosocial effects. METHODS This single group, before and after survey was conducted in three regional referral hospitals in Uganda. Healthcare workers participated in a 3-day epilepsy training program and were assessed immediately prior to and following the program using a 39-item epilepsy knowledge questionnaire. Pretest to posttest changes and acceptability ratings were analyzed. RESULTS Twenty healthcare workers from each of our three study hospitals (N = 60) participated in the study. The average age of the participants was 39.9 years (SD = 9.6). Female participants constituted 45% of the study population. There was a significant improvement in the knowledge of healthcare workers about epilepsy following the training (t = 7.15, p < 0.001). Improvement was seen across the three sub-scores of general knowledge about epilepsy, assessment and diagnosis of epilepsy, and management of epilepsy. Subgroup analysis showed that both high and low baseline scorers showed significant training gains. CONCLUSIONS The study suggested that our training program was effective in improving the knowledge of health workers about epilepsy and that participants had favorable impressions of the program. Further work is needed to determine if the knowledge is retained over time and if the change in knowledge translates into a change in clinical practice.
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Affiliation(s)
- Anita Arinda
- Midmay Uganda, P.O. Box 24985, Kampala, Uganda; School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Simple Ouma
- The AIDS support Organization (TASO) Uganda, P.O. Box 10443, Kampala, Uganda
| | | | | | - Tyler Johnson
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | | | - Colby Newson
- University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Olivia Ratliff
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Angelina Kakooza-Mwesige
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda; Department of Pediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Paula Njeru
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Martin Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda; Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda
| | - Bradley Kolls
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Clinical Research Institute, Neuroscience Medicine, 300 W Morgan St, Durham, NC 27701, USA; Duke University School of Medicine, Department of Neurology, Durham, NC 27704, USA
| | - Aatif Husain
- Duke University School of Medicine, Department of Neurology, Durham, NC 27704, USA; Veterans Affairs Medical Center, 299B Hanes House, 315 Trent Drive, P.O. Box 102350, Durham, NC 27710, USA
| | - Dmitry Tchapyjnikov
- Duke University School of Medicine, Department of Neurology, Durham, NC 27704, USA; Duke University School of Medicine, Department of Pediatrics, Durham, NC 27710, USA
| | - Michael Haglund
- Duke University School of Medicine, Durham, NC 27710, USA; Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Anthony Fuller
- Duke University School of Medicine, Durham, NC 27710, USA; Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Neil Prose
- Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Department of Dermatology and Pediatrics, Duke University Medical Center, Durham, NC 27710, USA
| | - Deborah Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC 27704, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC, Box 3119, Trent Drive, Durham, NC 27710, USA.
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Le Pichon JB, Horton S, Abdelmoity O, Hoffman MA, Cramer E, Kishk N, Hamada S, Abdelmoity A. The use of virtual tools in narrowing the impact of health disparities in neurology. Front Pediatr 2022; 10:1028833. [PMID: 36313873 PMCID: PMC9614345 DOI: 10.3389/fped.2022.1028833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
The concept of Epilepsy Treatment Gap (ETG) refers to the proportion of people with epilepsy who are not being appropriately treated. The ETG in the USA approaches 10%, with historically underserved populations and rural populations disproportionately affected. The ETG in Low-and Middle-Income Countries (LMIC) is reported to be 5-10 times higher than in high-income countries. The growing availability of reliable internet access offers a unique opportunity to provide better care to children and adults with epilepsy. In this paper we explore various telehealth (TH) initiatives that have leveraged the availability of easy and free access to an internet connection in reducing the ETG in underserved regions of the world. We describe several interventions targeted to reach patients and providers in rural areas of the United States and in LMIC. First, we examine initiatives that were developed to improve patient access to coordinated care and education regarding epilepsy and seizures. Next, we describe an intervention designed to improve knowledge of epilepsy diagnosis and treatment for providers in LMIC. We conclude with a brief overview of the use of virtual tools in diminishing the ETG.
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Affiliation(s)
- Jean-Baptiste Le Pichon
- Division of Neurology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States
| | - Stephanie Horton
- Division of Neurology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States
| | - Omar Abdelmoity
- Washington University at St. Louis, Saint Louis, MO, United States
| | - Mark A Hoffman
- Department of Pediatrics, Children's Mercy Research Institute, Kansas City, MO, United States
| | - Emily Cramer
- Division of Health Services / Outcomes Research, Children's Mercy Research Institute, Kansas City, MO, United States
| | - Nirmeen Kishk
- Department of Neurology, Cairo University, Giza, Egypt
| | - Salah Hamada
- Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Ahmed Abdelmoity
- Division of Neurology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, United States
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Shawahna R. Using a mixed method to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs. BMC MEDICAL EDUCATION 2021; 21:572. [PMID: 34772401 PMCID: PMC8588674 DOI: 10.1186/s12909-021-03001-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Knowledge deficits with regard to epilepsy have been reported among healthcare professionals. This study was conducted to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs. METHODS A mixed method which combined a thorough search of literature, the nominal group technique, the Delphi technique, and survey of students' agreement was used. The databases MEDLINE/PUBMED, EMBASE, COCHRANE, CInAHL/EBESCO, SCOPUS, Google Scholar, Google Books, and Amazon were searched to identify potential aims, topics/contents, intended learning outcomes, teaching, and evaluation methods. Discussions and deliberations in serial meetings based on the nominal group technique were attended by educators/academicians (n = 12), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 2), and students in postgraduate and continuing education programs (n = 7) to supplement and refine the data collected from the literature. The qualitative data were analyzed using RQDA tool for R. The Delphi technique was used among educators/academicians (n = 15), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 3), and students in postgraduate and continuing education programs (n = 8) to achieve formal consensus. RESULTS Consensus was achieved on 6 aims, 16 intended learning outcomes, and 27 topics in the course. Of the topics, 13 were relevant to nature of epilepsy and seizures, 2 were relevant to the impact of epilepsy and seizures on different life aspects of patients with epilepsy, 4 were relevant to advocating for the patients and supporting their choices, 5 were relevant to educating patients and their caregivers, and 3 were relevant to assessments and services. CONCLUSION Consensus-based aims, topics/contents, intended learning outcomes, teaching, and evaluation methods of a course on epilepsy for postgraduate or continuing education in community health nursing programs were developed. Consensus-based courses could bridge knowledge gaps and improve educating community health nursing programs on epilepsy. Further studies are needed to determine if such consensus-based courses could promote care of patients with epilepsy.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, New Campus, Building: 19, Office: 1340, P.O. Box 7, Nablus, Palestine.
- An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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Kaggwa MM, Acai A, Rukundo GZ, Harms S, Ashaba S. Patients' perspectives on the experience of absconding from a psychiatric hospital: a qualitative study. BMC Psychiatry 2021; 21:371. [PMID: 34311731 PMCID: PMC8311958 DOI: 10.1186/s12888-021-03382-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Absconding (i.e., escaping) is common among patients with mental illness admitted to psychiatric hospitals. Patients use various strategies to make absconding successful due to the experiences faced during admission. We conducted a study to identify patients' perspectives on the experience of absconding from the psychiatry facility. METHODS We conducted 10 in-depth interviews with patients with a history of absconding from the hospital who were accessing care at the Mbarara Regional Referral Hospital in Mbarara city Uganda. Interviews were audio-recorded, translated when required, transcribed into English, and analyzed thematically to identify relevant themes. RESULTS Participants ranged in age from 18 to 55 and the majority (n = 9) were male. Most had absconded at least twice from a psychiatric facility. We identified different experiences that influenced patients' engagement in absconding from the psychiatry hospital ward. These included: (1) stigma, (2) experiences with caregivers: mixed emotions, (3) poor resources and services, and (4) the influence of mental illness symptoms. The loneliness of stigma, negative emotions associated with the loss of important roles given the nature and framework of caregiving on the psychiatric ward, as well as the stress of limited resources were a salient part of the patient experience as it relates to absconding. CONCLUSION Our findings indicate that absconding is a symptom of a larger problem with a mental health system that perpetuates stigma in its design, isolates patients and makes them feel lonely, and forces patients to rely on caregivers who infantilize them and take away all their freedom in a facility with no basic services. For many patients, this makes absconding the only option. Within such a system, all stakeholders (policymakers, health-care providers, caregivers, and patients) should be involved in rethinking how psychiatric facilities should be operated to make the journey of patient recovery more positive.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Anita Acai
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Sheila Harms
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
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