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Pépin JL, Tamisier R, Benjafield AV, Rinder P, Lavergne F, Josseran A, Sinel-Boucher P, Cistulli PA, Malhotra A, Hornus P, Bailly S. CPAP resumption after a first termination and impact on all-cause mortality in France. Eur Respir J 2024; 63:2301171. [PMID: 38135441 PMCID: PMC10831141 DOI: 10.1183/13993003.01171-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Continuation of continuous positive airway pressure (CPAP) therapy after initial prescription has been shown to reduce all-cause mortality versus therapy termination. However, there is a lack of data on the rates and impact of resuming CPAP in patients with obstructive sleep apnoea (OSA). This analysis determined the prevalence of CPAP resumption in the year after termination, characterised determinants of CPAP resumption, and examined the impact of CPAP resumption on all-cause mortality. METHODS French national health insurance reimbursement system data for adults aged ≥18 years were used. CPAP prescription was identified by specific treatment codes. Patients who resumed CPAP after first therapy termination and continued to use CPAP for 1 year were matched with those who resumed CPAP then terminated therapy for a second time. RESULTS Out of 103 091 individuals with a first CPAP termination, 26% resumed CPAP over the next 12 months, and 65% of these were still using CPAP 1 year later. Significant predictors of CPAP continuation after resumption included male sex, hypertension and CPAP prescription by a pulmonologist. In the matched population, the risk of all-cause death was 38% lower in individuals who continued using CPAP after therapy resumption versus those who had a second therapy discontinuation (hazard ratio 0.62, 95% CI 0.48-0.79; p=0.0001). CONCLUSION These data suggest that individuals with OSA who fail initial therapy with CPAP should be offered a second trial with the device to ensure that effective therapy is not withheld from those who might benefit.
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Affiliation(s)
- Jean-Louis Pépin
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | - Renaud Tamisier
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
| | | | | | | | | | | | - Peter A Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University Sydney, Sydney, Australia
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Atul Malhotra
- University of California San Diego, San Diego, CA, USA
| | | | - Sébastien Bailly
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, Grenoble, France
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Thepwongsa I, Muthukumar R, Sripa P, Piterman L. Uptake and effectiveness of online diabetes continuing education: The perspectives of Thai general practitioner trainees. Heliyon 2023; 9:e13355. [PMID: 36755621 PMCID: PMC9900372 DOI: 10.1016/j.heliyon.2023.e13355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Background Despite continuing medical education (CME) programmes on evidence-based diabetes care, evidence-based best practice and actual GP practice remain scant. Online CME offers numerous benefits to general practitioners (GPs), particularly during the coronavirus disease 2019 (COVID-19) pandemic. In Thailand, CME is a voluntary process and is yet to be established as a mandatory requirement. This study examined GP uptake of online diabetes CME and the changes in GPs' attitudes to and knowledge of Type 2 diabetes management. Methods A cross-sectional study and a before-and-after study were employed with 279 GP trainees who voluntarily undertook a newly-developed online diabetes programme. A follow-up survey was conducted six months after the GP trainees completed their training. Results One hundred and twelve out of 279 GP trainees (40.1%) participated in the study, of whom 37 (13.3%) enrolled in the online diabetes programme, and 20 (7.2%) completed the programme. Before enrolling in the programme, the participants' mean diabetes knowledge score was 61.5%. The participants' confidence in effective insulin treatment increased significantly after the programme (95% Confidence interval [CI], -0.51-0.00; P = 0.05), but their knowledge scores before and after the programme were not statistically different (95% CI, -3.93-0.59; P = 0.14). Conclusion Uptake of the online diabetes CME was poor, although appropriate recruitment strategies were employed, and the online educational option was attractive and accessible during the COVID-19 pandemic. This study emphasises the gap between evidence-based practice and actual GP practice and the need for mandatory CME.
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Affiliation(s)
- Isaraporn Thepwongsa
- Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand,Corresponding author. Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen province, 40002, Thailand.
| | | | - Poompong Sripa
- Medicine for the Elderly Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Leon Piterman
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Australia
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Rajan KK, Pandit AS. Comparing computer-assisted learning activities for learning clinical neuroscience: a randomized control trial. BMC MEDICAL EDUCATION 2022; 22:522. [PMID: 35780115 PMCID: PMC9250740 DOI: 10.1186/s12909-022-03578-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Computer-assisted learning has been suggested to improve enjoyment and learning efficacy in medical education and more specifically, in neuroscience. These range from text-based websites to interactive electronic modules (eModules). It remains uncertain how these can best be implemented. To assess the effects of interactivity on learning perceptions and efficacy, we compared the utility of an eModule using virtual clinical cases and graphics against a Wikipedia-like page of matching content to teach clinical neuroscience: fundamentals of stroke and cerebrovascular anatomy. METHODS A randomized control trial of using an interactive eModule versus a Wikipedia-like page without interactivity was performed. Participants remotely accessed their allocated learning activity once, for approximately 30 min. The primary outcome was the difference in perceptions on enjoyability, engagement and usefulness. The secondary outcome was the difference in learning efficacy between the two learning activities. These were assessed using a Likert-scale survey and two knowledge quizzes: one immediately after the learning activity and one repeated eight weeks later. Assessments were analysed using Mann-Whitney U and T-tests respectively. RESULTS Thirty-two medical students participated: allocated evenly between the two groups through randomisation. The eModule was perceived as significantly more engaging (p = 0.0005), useful (p = 0.01) and enjoyable (p = 0.001) by students, with the main contributing factors being interactivity and clinical cases. After both learning activities, there was a significant decrease between the first and second quiz scores for both the eModule group (-16%, p = 0.001) and Wikipedia group (-17%, p = 0.003). There was no significant difference in quiz scores between the eModule and Wikipedia groups immediately afterwards (86% vs 85%, p = 0.8) or after eight weeks (71% vs 68%, p = 0.7). CONCLUSION Our study shows that increased student satisfaction associated with interactive computer-assisted learning in the form of an eModule does not translate into increased learning efficacy as compared to using a Wikipedia-like webpage. This suggests the matched content of the passive webpage provides a similar learning efficacy. Still, eModules can help motivate self-directed learners and overcome the perceived difficulty associated with neuroscience. As computer assisted learning continues to rapidly expand among medical schools, we suggest educators critically evaluate the usage and cost-benefit of eModules.
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Affiliation(s)
- Kiran Kasper Rajan
- Bristol Medical School (PHS), University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- GKT School of Medical Education, King's College London, London, UK.
| | - Anand S Pandit
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
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King S, Damarell R, Schuwirth L, Vakulin A, Chai-Coetzer CL, McEvoy RD. Knowledge to action: a scoping review of approaches to educate primary care providers in the identification and management of routine sleep disorders. JOURNAL OF CLINICAL SLEEP MEDICINE : JCSM : OFFICIAL PUBLICATION OF THE AMERICAN ACADEMY OF SLEEP MEDICINE 2021; 17:2307-2324. [PMID: 33983109 DOI: 10.5664/jcsm.9374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The referral burden on healthcare systems for routine sleep disorders could be alleviated by educating primary care providers (PCPs) to diagnose and manage patients with sleep health issues. This requires effective professional education strategies and resources. This scoping review examined the literature on existing approaches to educate PCPs in sleep health management. METHODS A comprehensive literature search was conducted across eight databases to identify citations describing the education of PCPs in diagnosing and managing sleep disorders, specifically insomnia and sleep apnea. A conceptual framework, developed from the knowledge-to-action cycle, was used to analyze citations from a knowledge translation perspective. RESULTS Searches identified 616 unique citations and after selection criteria were applied, 22 reports were included. Reports spanning 38 years were analyzed using components of the knowledge-to-action cycle to understand how educational interventions were designed, developed, implemented, and evaluated. Interventions involved didactic (32%), active (18%) and blended (41%) approaches, using face-to-face (27%), technology-mediated (45%) and multimodal (5%) delivery. Educational effectiveness was assessed in 73% of reports, most commonly using a pre/post questionnaire (41%). CONCLUSIONS While this scoping review has utility in describing existing educational interventions to upskill PCPs to diagnose and manage sleep disorders, the findings suggest that interventions are often developed without explicitly considering the evidence of best educational practice. Future interventional designs may achieve greater sustained effectiveness by considering characteristics of the target audience, the pedagogical approaches best suited to its needs, and any environmental drivers and barriers that might impede the translation of evidence into practice.
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Affiliation(s)
- Svetlana King
- Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University
| | - Raechel Damarell
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lambert Schuwirth
- Prideaux Centre for Research in Health Professions Education, College of Medicine and Public Health, Flinders University
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute Sleep Health / Adelaide Institute of Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence
| | - Ching Li Chai-Coetzer
- Flinders Health and Medical Research Institute Sleep Health / Adelaide Institute of Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence
| | - R Doug McEvoy
- Flinders Health and Medical Research Institute Sleep Health / Adelaide Institute of Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.,National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence
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Paul CL, Piterman L, Shaw JE, Kirby C, Forshaw KL, Robinson J, Thepwongsa I, Sanson-Fisher RW. Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners. Trials 2017; 18:137. [PMID: 28335809 PMCID: PMC5364574 DOI: 10.1186/s13063-017-1869-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/01/2017] [Indexed: 11/20/2022] Open
Abstract
Background In Australia, rural and remote communities have high rates of diabetes-related death and hospitalisation. General practitioners (GPs) play a major role in diabetes detection and management. Education of GPs could optimise diabetes management and improve patient outcomes at a population level. The study aimed to describe the uptake of a continuing medical education intervention for rural GPs and its impact on the viability of a cluster randomised controlled trial of the effects of continuing medical education on whole-town diabetes monitoring and control. Method Trial design: the cluster randomised controlled trial involved towns as the unit of allocation and analysis with outcomes assessed by de-identified pathology data (not reported here). The intervention programme consisted of an online active learning module, direct electronic access to specialist advice and performance feedback. Multiple rounds of invitation were used to engage GPs with the online intervention content. Evidence-based strategies (e.g. pre-notification, rewards, incentives) were incorporated into the invitations to enrol in the programme. Recruitment to the programme was electronically monitored through the hosting software package during the study intervention period. Results Eleven matched pairs of towns were included in the study. There were 146 GPs in the 11 intervention towns, of whom 34 (23.3%) enrolled in the programme, and 8 (5.5%) completed the online learning module. No town had more than 10% of the resident GPs complete the learning module. There were no contacts made by GPs regarding requests for specialist advice. Consequently, the trial was discontinued. Conclusion There is an ongoing need to engage primary care physicians in improving diabetes monitoring and management in rural areas. Online training options, while notionally attractive and accessible, are not likely to have high levels of uptake, even when evidence-based recruitment strategies are implemented. Trial registration Australian New Zealand Clinical Trials Registry, identifier: ACTRN12611000553976. Retrospectively registered on 31 May 2011.
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Affiliation(s)
- Christine L Paul
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia. .,University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia. .,W4 HMRI Building, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Leon Piterman
- Monash University, School of Rural Health, Churchill, VIC, Australia.,Eastern Victoria General Practice Training, Churchill, VIC, Australia
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Clinical Diabetes and Epidemiology Group, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Catherine Kirby
- Monash University, School of Rural Health, Churchill, VIC, Australia.,Eastern Victoria General Practice Training, Churchill, VIC, Australia
| | - Kristy L Forshaw
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia.,University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia
| | - Jennifer Robinson
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Isaraporn Thepwongsa
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Robert W Sanson-Fisher
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia.,University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia
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