Comparison of students' readiness from six health education programs for interprofessional learning in Vietnam: a cross-sectional study

BACKGROUND

Interprofessional education (IPE) is expected to help prepare undergraduate health profession students to collaborate with other healthcare professionals in realising quality of care. Studies stress the necessity of students' readiness for interprofessional learning (IPL) in view of designing IPE programs. The present study aims to determine students' IPL-readiness and looks at related differences in students enrolled in different programs and at different phases in their educational program.

METHODS

A cross-sectional survey study was set up among 1139 students from six health programs at HueUMP, using the Readiness for Interprofessional Learning Scale (RIPLS). Statistical analysis was performed using Kruskal-Wallis H and Mann-Whitney U tests.

RESULTS

The overall mean RIPLS score was 68.89. RIPLS scores significantly differed between programs and between phases in the educational programs. Medical students presented a lower readiness level for IPL than students from other programs. In contrast to a significant increase in RIPLS scores of students in the clinical phase in Vietnamese traditional medicine, medicine, and pharmacy, a decrease in RIPLS scores was observed in students in the clinical phase in odonto-stomatology.

CONCLUSIONS

The differences could be related to differences in educational programs and the study phases in a particular program. These results offer insights to direct the design and implementation of IPE in health education curricula and especially underscore the need to provide IPE throughout the curriculum.

The Optimal Cut-Off Point of the ADNEX Model for the Prediction of the Ovarian Cancer Risk

OBJECTIVE

This study aimed to assess the effectiveness and determine the optimal cut-off point of the ADNEX model in women presenting with a pelvic or adnexal tumor.

METHOD

All women presented with adnexal mass and were scheduled for operation at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital, Vietnam during June 2019 - May 2021 were included and categorized according to their histopathologic reports into ovarian cancer groups and benign ovarian tumor groups. Multivariable logistic regression was used to explore for potential predictors. The ADNEX model with and without CA125 was used to assess the risk of ovarian cancer preoperative. The goldden standard to evaluate the accuracy of ultrasonography using the ADNEX model was the pathological report. In addition, the accuracy as well as optimum cut-off point of the ADNEX model was estimated with and without CA125.

RESULTS

A total of 461 participants were included in analysis and predictive model development, 65 patients in ovarian cancer group and 361 in benign tumor group. The ADNEX model combined with CA125 proved to be a useful predictor with with an area under ROC of 0.956 (0.933 - 0.973) with Youden's index of 0.8551, p< 0.001. The ADNEX model without CA125 also had high predictive value between benign and malignant tumors, with an area under ROC of 0.956 (0.933 - 0.973). Youden's index J= 0.8551, p< 0.001. Cut-off of the ADNEX with CA125 was 13.5 and without CA125 was 13.1 for sensitivities were 90.8 (81.0 - 96.5) and 93.9 (85.0 - 97.5), specificities 93.2 (90.2 - 95.5) and 91.67 (88.5 - 94.2). The difference in the predictive value of malignancy-risk between the ADNEX model with CA125, without CA125 was not The difference in the predictive value of malignancy-risk between the ADNEX model with CA125, without CA125 was not statistically significant, p=0.4883.

CONCLUSION

The ADNEX model, with or without the combining marker CA 125, provides a valuable predictive value for ovarian tumor malignancy preoperative.

Implementation research to accelerate scale-up of national screen and treat strategies towards the elimination of cervical cancer

BACKGROUND

Cervical cancer is a significant public health problem, with 570,000 new cases and 300,000 deaths of women per year globally, mostly in low- and middle-income countries. In 2018 the WHO Director General made a call to action for the elimination of cervical cancer as a public health problem.

MAIN BODY

New thinking on programmatic approaches to introduce emerging technologies and screening and treatment interventions of cervical precancer at scale is needed to achieve elimination goals. Implementation research (IR) is an important yet underused tool for facilitating scale-up of evidence-based screening and treatment interventions, as most research has focused on developing and evaluating new interventions. It is time for countries to define their specific IR needs to understand acceptability, feasibility, and cost-effectiveness of interventions as to design and ensure effective implementation, scale-up, and sustainability of evidence-based screening and treatment interventions. WHO convened an expert advisory group to identify priority IR questions for HPV-based screening and treatment interventions in population-based programmes. Several international organizations are supporting large scale introduction of screen-and-treat approaches in many countries, providing ideal platforms to evaluate different approaches and strategies in diverse national contexts.

CONCLUSION

For reducing cervical cancer incidence and mortality, the readiness of health systems, the reach and effectiveness of new technologies and algorithms for increasing screening and treatment coverage, and the factors that support sustainability of these programmes need to be better understood. Answering these key IR questions could provide actionable guidance for countries seeking to implement the WHO Global Strategy towards cervical cancer elimination.

Effects of a newborn care education program using ubiquitous learning on exclusive breastfeeding and maternal role confidence of first-time mothers in Vietnam: a quasi-experimental study

Purpose

This study aimed to examine the effect of a newborn care education program using ubiquitous learning (UL-NCEP) on exclusive breastfeeding and maternal role confidence of first-time mothers in Vietnam.

Methods

This quasi-experimental study with a nonequivalent control group design was conducted at a university hospital in Hue city, Vietnam, between June and July 2018. Eligible first-time mothers were conveniently allocated to the experimental (n=27) and the control group (n=25). Mothers in the control group received only routine care, whereas mothers in the experimental group received UL-NCEP through tablet personal computers in addition to routine care in the hospital. Then, the educational content was provided to mothers by their smartphone for reviewing at home. UL-NCEP was developed based on the World Health Organization’s “Essential Newborn Care Course” guidelines. The exclusive breastfeeding rate and maternal role confidence level after birth and at 4 weeks postpartum were assessed in both groups to assess the effect of UL-NCEP.

Results

At 4 weeks postpartum, the experimental group showed a significantly higher level than the control, for exclusive breastfeeding rate (p<.05) as well as mean maternal role confidence (p<.05).

Conclusion

UL-NCEP was a feasible and effective intervention in increasing first-time Vietnamese mothers’ exclusive breastfeeding rate and maternal role confidence level. This program may be integrated into routine care for postpartum mothers to promote mother and infant health among first-time mothers in Vietnam.

Outcome of cesarean scar pregnancy treated with local methotrexate injection

Local injection of methotrexate (MTX) has been widely used for caesarean scar pregnancy (CSP), but the optimal candidate remains undetermined. The aim of this study is to determine the risk factors associated with treatment failure among patients who received a single dose of local MTX. This is a retrospective cohort study. Clinical information was compared between treatment success vs. failure groups. Risk factors related to treatment failure were also investigated with multivariate analysis. Of 47 patients diagnosed with CSP, 30 received local MTX injection. The initial serum ß- human chorionic gonadotropin (hCG) level in the failure group was significantly higher than in the success group (p = 0.048), and the cut-off value was 47,000 mIU/ml. The rate of type 2 position of the gestational sac in the failure group was significantly higher than in the treatment success group (p = 0.031). A high initial serum ß-hCG level (≥ 47,000 mIU/ml) was identified as the independent risk factor for treatment failure (adjusted odds ratio = 21.9; 95% confidence interval = 1.3-383.1). Type 2 gestational sac position and a higher level of ß-hCG at diagnosis appear to be associated with poor outcomes after local injection of a single dose of MTX.

Pelvic Floor and Sexual Dysfunction After Vaginal Birth With Episiotomy in Vietnamese Women

Introduction

Episiotomy has been the most common procedure in obstetrical practice; however, its benefits remain controversial, especially in case of postpartum pelvic floor disorder and sexual dysfunction.

Aim

The aim of this study was to evaluate early complications, pelvic floor, and sexual dysfunction after delivery with episiotomy and their associated factors.

Methods

158 healthy pregnant women at term (38 weeks 0 days to 41 weeks 6 days), aged above 18 years old, who vaginally delivered a singleton baby with cephalic presentation were recruited. The subjects were evaluated through 3 interviews at 1−3 days, 6 weeks, and 3 months after delivery, respectively.

Main Outcome Measure

The evaluations were accomplished primarily by administration of 2 validated questionnaires: the Pelvic Floor Distress Inventory Short-form 20 to evaluate symptoms of pelvic floor dysfunction, and the Female Sexual Function Index to evaluate effects on the women’s sexual life.

Results

Among early complications, pain while sitting (30.4%) was the most prominent trouble, other pelvic disorders, such as urinary incontinence (11.4%), urinary retention (10.8%), or flatus incontinence (8.9%), were also observed in a remarkable number of participants. Average Pelvic Floor Distress Inventory Short-form 20 score was 7.0 ± 10.2 after 3 months. At that time, the prevalence of sexual dysfunction was 40.7%. Trouble occurred commonly in the domains of desire (68.9%) and pain (58.5%). Associated factors of sexual dysfunction were maternal age over 30 years and parity. These factors, in combination with birth weight over 3,500 gram (g), were also associated factors of pelvic floor disorders.

Conclusion

Pelvic pain was the most popular postdelivery complication. Urinary and bowel dysfunction were self-limited complications. Despite being considered a simple technique, episiotomy and its repair must be performed rigorously in order to allow the best recovery of pelvic floor and sexual function.

Huy Quoc NV, Phuc An LS, Phuong LS, et al. Pelvic Floor and Sexual Dysfunction After Vaginal Birth With Episiotomy in Vietnamese Women. Sex Med 2019;7:514–521.

The value of visual inspection with acetic acid and Pap smear in cervical cancer screening program in low resource settings - A population-based study

This study aims to determine the diagnostic values of visual inspection with acetic acid (VIA) and Pap smear in a cervical cancer screening program at a community level in Vietnam. A cross-sectional analysis was obtained, including 1034 women of reproductive age from Thua Thien Hue Province, Vietnam from 09/2012 to 09/2013. Samples were taken from cervixes for Pap smear testing, followed by visual inspection with acetic acid. Subjects with abnormal VIA and/or positive cytology results were invited for colposcopy and biopsy. Histologic confirmed cervical intraepithelial neoplasia (CIN2+) served as gold standards for diagnostic values analysis. Abnormal VIA results were recorded in 87 cases (7.7%). The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of VIA for CIN2+ were 88.8%, 43.8%, 63.4%, 51.2% and 83.3%, respectively. Diagnostic values of Pap smear were 58.0%, 85.2%, 69.9%, 83.3% and 61.3% for its sensitivity, specificity, accuracy, PPV and NPV, respectively. VIA yielded high sensitivity but its accuracy is still limited in pre-cancerous lesions during cervical cancer screening. The Pap smear has acceptable sensitivity and specificity, but its false-negative rate is still high. We recommend a combination of different tests to increase the efficiency of screening in our community.

Serological evidence of human infection with Pteropine orthoreovirus in Central Vietnam

Pteropine orthoreovirus, potentially of bat origin, has been reported to cause respiratory tract infections among human beings in Southeast Asia. Twelve IgG ELISA‐positive cases with antibodies against Pteropine orthoreovirus were detected among 272 human serum samples collected between March and June 2014 from in and around Hue City, Central Vietnam. These 12 cases were IgM ELISA negative. Neutralizing antibodies were also detected among six of these cases with the highest titer of 1:1,280 in 2 cases (both female, 32 and 68 years old, respectively). This is the first report of human infection with Pteropine orthoreovirus in Central Vietnam. These findings indicate the need for surveillance on Pteropine orthoreovirus infections in Southeast Asia to enable prevention and control strategies to be developed should a change in virulence occur. J. Med. Virol. 87:2145–2148, 2015. © 2015 The Authors. Journal of Medical Virology Wiley Periodicals, Inc.