Gerontological educational interventions for student nurses: a systematic review of qualitative findings

OBJECTIVES

This systematic review of qualitative studies explored interventions to improve student nurses' knowledge, attitudes or willingness to work with older people. Student nurses are likely to encounter older people in all health and aged care settings, however, research demonstrates that few have career aspirations in gerontological nursing.

METHODS

Qualitative systematic review method based on the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

Search of Medline, Embase, PsycINFO, EBSCOhost and Scopus yielded 1841 articles which were screened to include primary research about educational interventions to improve student nurses' knowledge, attitudes and/or willingness to work with older people. Data extraction was performed on the 14 included studies, and data were analysed using directed content analysis. The Mixed Methods Appraisal Tool (MMAT) was used the assess the quality of the studies.

CONCLUSIONS

Educational interventions included theory or practice courses, or a combination of theory and practice. While most interventions changed nursing students' negative attitudes towards older people, few increased their willingness to work with them. Practice courses had the most significant impact on willingness to work with older people. Quality assessment revealed methodical limitations. More research is needed to better understand the elements of practice interventions that enhance student nurses' knowledge, attitudes, and willingness to work with older people, so that they can be replicated.

Community Actions and Insights in the Battle against COVID-19 at the Start of the Pandemic: A District Study Observation from Medan, Indonesia

BACKGROUND

As of 17 June 2020, the WHO confirmed 8,061,550 COVID-19 cases globally, with Indonesia reporting 40,400 cases and North Sumatra over 932 cases. The rising infection rates have led to increased deaths, highlighting the urgency for public understanding of virus transmission. Despite information dissemination efforts, North Sumatra has not seen a reduction in cases, emphasizing the need for a unified approach to combat the pandemic.

OBJECTIVE

This study aims to investigate the relationship between public perception and practices regarding COVID-19 prevention in Medan, North Sumatra.

METHODS

A cross-sectional study will be conducted using a combined questionnaire from two previous studies conducted at the start of the pandemic.

RESULTS

Among 200 participants, social media was the favored source for prevention information. Participants exhibited above-average knowledge (67.5%) but predominantly below-average attitudes toward prevention (64.5%). However, most residents practiced correct prevention measures (75.5%).

CONCLUSIONS

Despite possessing adequate knowledge, negative attitudes toward prevention suggest a need for educational interventions to address misconceptions and promote positive behaviors. Such interventions could enhance the community's response to COVID-19 transmission during the pandemic.

"The Things We Carry": Interventions against the cumulative effects of racism in K-12 education

Anti-Black racism in K-12 education settings has long-term impacts on Black students, including negative academic and mental health outcomes. Limited interventions following experiences of racism shape Black students' expectations of K-12 education, accumulating over time into institutional distrust and these mental health outcomes. As such, it is necessary to understand how Black students experience racism within K-12 settings to better inform interventions that can be implemented at the school level. To that end, this study employed the participatory action research (PAR) method of photovoice to understand the impacts of racism in educational settings among 5 Black women undergraduate students. Results highlight the cumulative effects of racism on identity development and early coping. Implications inform future interventions to address the cumulative effects of anti-Black racism in K-12 education.

The assessment of the knowledge and practices of healthcare providers regarding paroxysmal non-epileptic events (PNES) in children: A cross-sectional study

OBJECTIVE

Paroxysmal non-epileptic events (PNEs) are a group of disorders that may be misdiagnosed as epilepsy. This study has aimed to assess the knowledge and practices of family physicians and pediatricians regarding the diagnosis, treatment, and follow-up of PNEs in children.

METHODS

The study was designed as a prospective cross-sectional study that was conducted between March 1, 2022, and June 1, 2022, by reaching pediatric specialists and assistants, family physicians, subspecialty assistants, and subspecialists using a Google questionnaire. The survey consists of 26 questions. The questionnaire used by the researchers was prepared in accordance with the literature search and it included detailed questions on the diagnosis, treatment, and differential diagnosis of PNEs.

RESULTS

A total of 37.3% worked as specialists. Most of the participants (41.3%) have worked in training and research hospitals, and 44.3% have been physicians for 6-10 years. The mean and standard deviation for the total score were 10.1 ± 2.6. The scores of family physicians were statistically lower than those of specialists, subspecialty assistants, and subspecialists. A total of 67.2% left the decision of whether the patient should stop taking their medication to another clinician. 45% of the doctors said that they were uncomfortable with the diagnosis.

SIGNIFICANCE

The study findings emphasized the significant knowledge gap among healthcare providers regarding PNEs in children, highlighting the need for targeted educational interventions to improve their understanding and diagnostic skills in this area.

Promoting Medication Adherence in Children with Attention Deficit Hyperactivity Disorder: A Mixed-Methods Systematic Review with Meta-analysis and Qualitative Comparative Analysis

OBJECTIVE

To evaluate the efficacy of ADHD medication adherence interventions and explore the pathways to effectiveness.

METHODS

A systematic review was conducted using multiple databases to identify relevant randomized controlled trials (RCTs). Pooled effect sizes were calculated for medication adherence and ADHD symptom outcomes. Qualitative Comparative Analysis (QCA) was used to identify pathways to effectiveness.

RESULTS

Six RCTs were included. The interventions significantly improved medication adherence (OR = 2.39, 95% CI [1.19, 4.79]) and ADHD symptoms (Hedges' g = -0.96, 95% CI [-1.38, -0.54]). Multi-regression analysis showed a positive relationship between medication adherence and ADHD symptom reduction. QCA revealed two paths for effectiveness: (1) Presence of ADHD drug education and absence of reminder and (2) Presence of tracking and absence of reminder.

CONCLUSION

ADHD medication adherence interventions have a positive impact on both medication adherence and ADHD symptoms. Interventions should consider including ADHD drug education or tracking to maximize effectiveness.

Assessing Awareness, Knowledge, and Attitude of Saudi Mothers Regarding Shaken Baby Syndrome in the Eastern Province of Saudi Arabia: A Cross-Sectional Prospective Study

Shaken baby syndrome (SBS) is a form of traumatic brain injury. Shaking babies can cause the brain matter to bounce within the cranium causing bruising and bleeding, which can result in permanent brain injury. Understanding the attitudes and knowledge of mothers on SBS would help establish effective interventions to raise awareness and establish preventive measures and education programs to avoid debilitating sequelae from SBS in newborns and infants. This study aimed to explore the awareness and attitude regarding SBS. An observational, cross-sectional study was conducted from April 1st through July 31st, 2023. The study population is comprised of mothers who are residents of the Eastern Province of Saudi Arabia and excluded females with no children and those who refused to participate, in addition to mothers not in the Eastern Province. The final sample size included 403 participants. An online-based validated questionnaire was used in the Arabic language. The questionnaire included demographic information and questions to assess the knowledge and attitude of participants regarding SBS. The chi-square test was used to test for significant associations. The majority of the participants were married (72%), while 15.6% were divorced and 10.2% were widowed. Only 7.4% of the participants were illiterates, 30.5% had primary education only, and 15.9% had postgraduate studies. Of note, 37% of the participants said that they would shake their children to calm them if they started to cry. Only 33% of the participants said that shaking babies is harmful. The most commonly reported complications of shaking babies were intracranial bleeding (48.1%), behavioral changes (23.8%), and learning disability (23.5%). Regarding attitude toward SBS, more than two-thirds (72.5%) of the participants said that they want to know more about SBS. Only the educational level had statistically significant relationship between the awareness and the sociodemographic level of the participants. This study concludes that Saudi mothers' knowledge about SBS is inadequate despite the favorable attitude toward gaining information about it. The awareness level is significantly associated with educational status, which reflects the importance of education programs, especially during the pregnancy period, in raising awareness about SBS and its complications.

The neuroscience basis and educational interventions of mathematical cognitive impairment and anxiety: a systematic literature review

Introduction

Mathematics is a fundamental subject with significant implications in education and neuroscience. Understanding the cognitive processes underlying mathematical cognition is crucial for enhancing educational practices. However, mathematical cognitive impairment and anxiety significantly hinder learning and application in this field. This systematic literature review aims to investigate the neuroscience basis and effective educational interventions for these challenges.

Methods

The review involved a comprehensive screening of 62 research articles that meet the ESSA evidence levels from multiple databases. The selection criteria focused on studies employing various methodologies, including behavioral experiments and neuroimaging techniques, to explore the neuroscience underpinnings and educational interventions related to mathematical cognitive impairment and anxiety.

Results

The review identified key themes and insights into the neuroscience basis of mathematical cognitive impairment and anxiety. It also examined their impact on educational practices, highlighting the interplay between cognitive processes and educational outcomes. The analysis of these studies revealed significant findings on how these impairments and anxieties manifest and can be addressed in educational settings.

Discussion

The review critically analyzes the shortcomings of existing research, noting gaps and limitations in current understanding and methodologies. It emphasizes the need for more comprehensive and diverse studies to better understand these phenomena. The discussion also suggests new directions and potential improvement strategies for future research, aiming to contribute to more effective educational interventions and enhanced learning experiences in mathematics.

Conclusion

This systematic review provides valuable insights into the neuroscience basis of mathematical cognitive impairment and anxiety, offering a foundation for developing more effective educational strategies. It underscores the importance of continued research in this area to improve educational outcomes and support learners facing these challenges.

A Review of Patient Experiences and Provider Education to Improve Transgender Health Inequities in the USA

Transgender individuals are an underserved, vulnerable population. They face many inequities including barriers in both accessing and receiving adequate healthcare. These inequities are proposed here to be rooted in a lack of education about transgender people and their experiences. We begin by exploring the existing transgender healthcare research carried out in the USA, examining client experiences, provider education and attitudes, and the barriers transgender people face to obtaining proper healthcare. Secondly, we look at the previous research on educational interventions implemented with medical students and practitioners in the USA to enhance knowledge about transgender people, and increase sensitivity and awareness, while also increasing the level of comfort in working with these clients. The limitations in these fields of study are discussed in order to understand how to better serve transgender clients in the USA. We will do this through a narrative review to determine evidence-based best practices for educational intervention, uncovering gaps in the literature and highlighting where to focus in future work for researchers and practitioners.

A research synthesis on successful educational practices and student outcomes for physical education in schools

Although successful educational practices (SEPs) in higher education institutions have well-established student outcomes, the vast majority do not meet physical education standards in schools. Despite the promising nature of policy initiatives supporting schools, there is scant evidence of how these SEPs affect student outcomes. This review aimed to determine the status of the literature and the type of evidence regarding school SEPs. Several studies have demonstrated that these SEPs contribute directly or indirectly to improving student outcomes. Three objectives were examined and synthesized in our review of SEP research findings. The first goal is to identify different types of impacts on students in schools. The second goal is to provide educators, principals, and policymakers with a unified and comprehensive framework. Lastly, we provide suggestions for future SEP research. The review identified 45 studies that met our inclusion criteria. Our reviewed studies documented impacts on the individual level. It encompasses both students' instrumental abilities and their sense of self-esteem and motivation. Secondly, improving interpersonal relationships, reducing conflict, and increasing group cohesion are important components at the group level. Finally, there are factors at the community level, including absenteeism reduction, parental involvement, and changes in attitudes toward school. Current research supports the effectiveness of successful school practices. It stresses the importance of implementing policies to maximize student outcomes. Finally, the review concludes by discussing findings implications and future research directions.

Impact of Multimedia Messaging Service Education and Exercise Social Support on Physical Activity Among Patients With Type 2 Diabetes: Quasi-Experimental Study

BACKGROUND

Social support is one of the interpersonal stimuli that define an individual's predisposition to engage in health-promoting behaviors and is considered a facilitator in improving health habits. Patients with type 2 diabetes mellitus (T2DM) can benefit from educating supportive families and friends on self-care management including exercise behavior. Multimedia messaging service (MMS) could also be an effective method for delivering targeted educational interventions that focus on physical activity (PA).

OBJECTIVE

This study aimed to assess the effectiveness of MMS educational interventions and perceived social support for exercise on level of PA of patients with T2DM.

METHODS

A quasi-experimental pretest-posttest design was conducted to recruit 98 patients with T2DM. The intervention group received MMS education aiming to improve exercise social support and PA level for 2 months, and their counterparts in the control group received the usual routine care. We sent 2 to 3 messages daily for 2 weeks from Saturday to Thursday (12 days total). These messages were a combination of videos and texts, and the evidence-based content of these messages was reviewed and approved by the advisory committee. We randomly assigned eligible patients in a 1:1 ratio into the intervention or the control groups. Participants completed a survey in 3 periods.

RESULTS

There were no significant differences in friends' support, family verbal, practical, or emotional support over time in the intervention group (P>.05). Yet, there was a small effect size (Cohen d) in friends' social support (0.389), family practical support (0.271), and moderate activities (0.386). A medium effect size was found in family verbal (0.463) and emotional (0.468) support. Being married increased the likelihood of friends' support by 2.3 times after intervention (P=.04), whereas rarely doing exercise decreased the likelihood of friends' support by 28% (P=.03) and family practical support by 28% (P=.01). Being female and married increased the likelihood of doing moderate activities by 1.6 times (P=.002) and 1.5 times (P=.049) in the intervention group. Being a housewife decreased the likelihood of doing moderate activities by 20% (P=.001). Finally, being a female with a higher educational level decreased the likelihood of doing hard activities by 20% (P=.04) and 15% (P=.002), respectively.

CONCLUSIONS

A theoretically based MMS health education targeting PA levels and social support of family and friends to perform PA seems promising in promoting family and friends' social support and improving PA levels among patients with T2DM. Actively involving family and friends in educational interventions that target PA can have an impact on health-promoting behaviors in patients with diabetes.

Understanding and Addressing Mental Health Stigma Across Cultures for Improving Psychiatric Care: A Narrative Review

Stigma, characterized by negative stereotypes, prejudice, and discrimination, is a significant impediment in psychiatric care, deterring the timely provision of this care and hindering optimal health outcomes. Pervasive in all aspects of psychiatric care, stigma leads to delayed treatment, increased morbidity, and diminished quality of life for those with poor mental health. Hence, better understanding the impact of stigma across different cultural contexts is critically essential, aiming to inform culturally nuanced strategies to minimize its consequences and contribute to a more equitable and effective psychiatric care system. The purpose of the present literature review is twofold (i) to examine the existing research on the stigma surrounding psychiatry across different cultural contexts and (ii) to identify the commonalities and differences in the nature, magnitude, and consequences of this stigma in different cultures in the psychiatry field. In addition, potential strategies for addressing stigma will be proposed. The review covers a range of countries and cultural settings, emphasizing the importance of understanding cultural nuances to combat stigma and promote mental health awareness globally.

Effect of educational interventions on wound healing in patients with venous leg ulceration: A systematic review and meta-analysis

Educational interventions for patients with venous leg ulceration (VLU) may promote adherence and self-management, however, their effect on wound healing is unclear. A systematic literature search was performed and randomised controlled trials with a focus on educational interventions were included. Wound healing was analysed by assessing wound healing rate, ulcer size, and the PUSH Score. Additional outcomes comprised pain, quality of life, and functional ability. The study protocol for this work is registered at PROSPERO 2020 (ID: CRD42021286152). Nine studies were included in this meta-analysis. The odds ratio for wound healing was 1.91 (95% CI, 0.99-3.67, P = .053) in favour of educational interventions compared to usual care. Ulcer size reduction was higher (MD: -7.22; 95% CI, -11.91 to -2.53, P = .003) in patients following educational interventions. Included studies also showed significant effects on pain, quality of life, and functional analysis, though no quantitative synthesis was feasible. The overall risk of bias showed some concerns. Educational interventions aim to actively involve patients in their treatment, thereby appearing to be able to have a positive impact on wound healing within 12 weeks. Consequently, integrating educational approaches to routine wound care may be a promising strategy to improve treatment of VLU.

A rapid evidence assessment of sickle cell disease educational interventions

AIMS AND OBJECTIVES

To assess the impact of educational interventions on the knowledge and attitude of healthcare professionals (HCPs) regarding sickle cell disease (SCD) pain management in the UK.

BACKGROUND

Variations and inadequate pain management due toHCPs' lack of knowledge and negative attitude is still an ongoing global concern for SCD patients despite availability of effective treatment and evidence-based guidelines. Several international studies have implemented interventions aimed at improving knowledge, attitude, and pain management. No review on the effectiveness of these interventions was found. Also, no previous intervention done in the UK was found from the thorough search of research databases. However, there are estimated 240,000 genetic carriers with about 12,500-15,000 estimated people living with SCD in the UK.

DESIGN

Rapid Evidence Assessment of existing evidence.

METHODS

A rapid evidence assessment was conducted between March 2021-January 2022 following the PRISMA 2020 guidelines. Included papers must have an educational intervention about SCD or related symptom management where the learners were HCPs. Excluded papers were those not published in English or before 2010. The following databases were searched: CINAHL, MEDLINE, PubMed America and Europe, Scopus, PsycINFO and Web of Science. Data quality was assessed using the Mixed Methods Assessment Tool (MMAT) and analysed using a narrative approach.

RESULTS

Ten studies were included in the final review. Overall, they reported improved outcomes in six main themes: knowledge, attitude, perception, adoption, satisfaction and efficiency. Five studies reported statistically significant improvement in at least one outcome, four studies reported positive improvement, and two studies reported no significant improvement in knowledge and attitude. These heterogeneous studies were implemented once, and all designs were prone to bias; this makes it difficult to state how effective interventions are for SCD.

CONCLUSION

Current evidence of positive improvement in HCPs' knowledge and attitude is insufficient for generalisation and recommendation for adoption. However, we believe that implementing validated educational interventions remains essential for effective acute SCD pain management and patient-centred care. Further research is needed to find a suitable educational intervention that can be replicated.

RELEVANCE TO CLINICAL PRACTICE

Quality SCD education, timely crisis management and reduced patient stigma are crucial in reducing the risk of rapid clinical decompensation to avoid developing life-threatening complications. Understanding SCD can also support the building of therapeutic relationships between the patient and practitioner.

TRIAL REGISTRATION

This review was not registered.

The importance of reminders and patient preferences to improve inhaler technique in older adults with COPD

Objectives: Medication non-adherence in patients with chronic obstructive pulmonary disease is common. The aim is to evaluate the efficacy of two interventions to improve the inhalation technique (IT) in patients with pulmonary disease is common. Also determine optimal IT reminder time and to test the role of preferences in the intervention selection. Method: 726 pulmonary disease in common patients (consecutive sampling) from two trials: 1) TECEPOC-study (patients' preference trial/comprehensive cohort design) 2) TIEPOC-study (randomised controlled trial). Interventions: intervention-A (ad-hoc leaflet with instructions about correct IT according Spanish Respiratory Society), intervention B (intervention A+ individual training by instructors). Four visits were performed (baseline, 3, 6 and 12 months). Data on IT, sociodemographic and clinical characteristics, quality of life and respiratory drugs were recorded. Analysis under intention to treat principle. Multivariate analysis was conducted to measure the potential modifying factors of improvement in the IT along follow-up. Results: 660 patients (90.9%) did not perform a correct IT at baseline 89.75% with Handihaler, 86.95% with Turbuhaler, 84.75% with Accuhaler and 87.35% with pMDI. At 12 months, 221 patients 29.9% performed correctly the IT; a decrease in the slope of the curve (correct IT) was detected at 3 months follow-up. Intervention B was the most effective in both trials compared to control group or intervention A, regardless of preferences: 1) TECEPOC Study (preference trial): Intervention B versus control group, NNT = 3.22 (IC95%, 2.27-5.52); and versus Intervention A, NNT = 3.57 (CI95%, 2.41-6.8). Preferences improved 6.7% in the correct IT without statistical significance. 2) TIEPOC Study (randomized controlled trial): Intervention B versus control group, NNT = 1.74 (IC95%, 1.47-2.17), and versus intervention A, NNT = 3.33 (CI 95%, 2.43-5.55). No differences were measured between Intervention A and control group. Conclusion: Individual training significantly improves IT. Reminders every 3 months are recommended. Preferences do not influence the intervention effectiveness.

Multidisciplinary Care for the Prevention and Treatment of Venous Thromboembolism in Patients with Cancer-Associated Thrombosis (CAT): Impact of Educational Interventions on CAT-Related Events and on Patients' and Clinicians' Awareness

Cancer is a leading cause of death. Venous thromboembolism (VTE) is an often-overlooked cause of morbidity and mortality in cancer patients that can be readily prevented and treated. Actions are needed to reduce the morbidity and mortality of patients with cancer-associated thrombosis (CAT). There is a need to increase awareness of the impact of CAT on cancer patients' morbidity and mortality, on their quality of life and to understand the importance of more effective preventions and treatments of VTE in cancer patients. Moreover, it is of great importance to systematically assess the risk of VTE in regard to patients, cancer and treatment-related factors. Unfortunately, there are unmet clinical needs in the prevention and treatment of cancer-associated VTE. In this review, we discuss an action plan to ensure an increased awareness of and education on the issues that need to be addressed in order to improve the provision of appropriate prevention, early diagnosis and effective and safe treatment of VTE to all cancer patients and, ultimately, to reduce morbidity and mortality.

International good practices on central venous catheters' placement and daily management in adults and on educational interventions addressed to healthcare professionals or awake/outpatients. Results of a scoping review compared with the existent Italian good practices

This scoping review aims to check the existing international literature related to the placement and management of central venous catheters (CVCs) in adults and compare them with the Good Practices published by the Italian Society of anesthesiology intensive care (hereafter “SIAARTI Good Practices”) and the protocols written by the Italian Expert group on long-term central venous accesses (hereafter “GAVeCeLT Protocols”) and verify the existence of experiences focused on the daily assessment of the implantation site and on educational interventions on awake patients or caregivers to enhance their empowerment. A systematic search approach has been applied. Our composite research question has been primarily defined by the PICO: only patients over 18 years of age with CVC for any clinical reason except for kidney replacement therapy; placement and management of CVCs with procedures recommended by the recent international guidelines/bundles and specific educational interventions are the interventions to be compared with standard CVC placement and management without any educational interventions. In total, two different types of outcomes have been taken into consideration: catheter-related complications rate (A) and patient/caregiver involvement (B). Eligible articles have been limited to Systematic Review OR Meta-analysis OR Guidelines in Human field, focusing on adults, English language only, from January 2015 to December 2020. Searched Medical Subject Headings (MeSHs) Terms were “venous” AND “catheters,” and the correspondence with the designed PICO framework was then checked directly by the authors. A comprehensive search was conducted by two reviewers on 15 February 2021 in four databases, and 32 full-text articles were finally included and qualitatively assessed. The included articles appear to be in line with the indications provided by the available Italian Good Practices and explain the complexity of this procedure. The need to promote the use of bundles and checklists related to CVC placement and dressing procedures comes to light. These organizational technologies can be implemented following the creation of teams dedicated to venous access that are subjected to continuous training. As regards the impact of educational initiatives, implementing paths of health education and proper hospital discharge preparation for both healthcare workers and families increases safety for the patient with CVC.

Educational Interventions to Reduce Prescription and Dispensing of Antibiotics in Primary Care: A Systematic Review of Economic Impact

Antibiotic resistance remains a crucial global public health problem with excessive and inappropriate antibiotic use representing an important driver of this issue. Strategies to improve antibiotic prescription and dispensing are required in primary health care settings. The main purpose of this review is to identify and synthesize available evidence on the economic impact of educational interventions to reduce prescription and dispensing of antibiotics among primary health care professionals. Information about the clinical impact resulting from the implementation of interventions was also gathered. PubMed, Scopus, Web of Science and EMBASE were the scientific databases used to search and identify relevant studies. Of the thirty-three selected articles, most consisted of a simple intervention, such as a guideline implementation, while the others involved multifaceted interventions, and differed regarding study populations, designs and settings. Main findings were grouped either into clinical or cost outcomes. Twenty of the thirty-three articles included studies reporting a reduction in outcome costs, namely in antibiotic cost and associated prescription costs, in part due to an overall improvement in the appropriateness of antibiotic use. The findings of this study show that the implementation of educational interventions is a cost-effective strategy to reduce antibiotic prescription and dispensing among primary healthcare providers.

"Being a team of five strong women… we had to make an impression:" The College Math Academy as an intervention into mathematics education

This paper, a first-person account, describes a community psychology-aligned intervention into a precalculus mathematics class at an Hispanic Serving Research Institution. The intervention was designed because the standard precalculus mathematics class had a high failure rate, especially for Latinx students, which was serving as a barrier for declaration of a Science, Technology, Engineering, or Mathematics major. The high failure rate indicates a structural problem that requires a structural intervention. The paper is coauthored with the teaching team, undergraduates who had taken the course, a graduate student who evaluated the class, and a community psychologist. We describe the ways that the new course, the College Math Academy, transformed the social environment through capacity building, providing access to valued resources for historically marginalized groups, facilitating opportunities to critique dominant power structures, prioritizing perspectives and experiences of people of color, and promoting understanding of how various social forces shape culture and values. The course also decentered white educational norms via adapting decoloniality and liberatory practices. In turn, each person describes their experience of the course. We draw on the first-person accounts to show how they illustrate a transformative, decolonial, and liberatory social environment. We end with implications for how community psychologists can work in their universities to support structural change.

Methodological Proposal for the Accompaniment and Development of Service+Learning Methodology in Universidad de Las Americas in Chile

Service+Learning (S+L) is an active teaching methodology that enables students to participate in their teaching and learning process, being guided by the teacher. This methodology allows the student to show all the skills, abilities, tools and theoretical-practical knowledge since they are placed at the service of the community partner, which in the case of pedagogies translates into pedagogical practice centers. This transfer must be guided and mediated by the teacher, allowing to provide a response to the requirements of the practice center through the "S+L Booklet", developed as a methodological proposal for the intermediate practice subject of the Universidad de Las Américas Physical Education Pedagogy career. This instrument takes 15 weeks of weekly development with the proposal, adjustment, development-implementation, monitoring, evaluation and feedback by the students and the teacher of the subject.

The Effectiveness of Interventions to Evaluate and Reduce Healthcare Costs of Potentially Inappropriate Prescriptions among the Older Adults: A Systematic Review

Potentially inappropriate prescribing (PIP) is associated with an increased risk of adverse drug reactions, recognized as a determinant of adherence and increased healthcare costs. The study's aim was to explore and compare the results of interventions to reduce PIP and its impact on avoidable healthcare costs. A systematic literature review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement guidelines. PubMed and Embase were queried until February 2021. Inclusion criteria followed the PICO model: older patients receiving PIP; Interventions aimed at health professionals, structures, and patients; no/any intervention as a comparator; postintervention costs variations as outcomes. The search strategy produced 274 potentially relevant publications, of which 18 articles met inclusion criteria. Two subgroups were analyzed according to the study design: observational studies assessing PIP frequency and related-avoidable costs (n = 10) and trials, including specific intervention and related outcomes in terms of postintervention effectiveness and avoided costs (n = 8). PIP prevalence ranged from 21 to 79%. Few educational interventions carried out to reduce PIP prevalence and avoidable costs resulted in a slowly improving prescribing practice but not cost effective. Implementing cost-effective strategies for reducing PIP and clinical and economic implications is fundamental to reducing health systems' PIP burden.

Will a preoperative theatre visit reduce anxiety? A randomised controlled trial

To assess the effect of preoperative theatre visit in reducing anxiety and its associated adverse outcomes, a single centre randomised controlled trial was conducted at the Professorial Gynaecology Unit, Colombo South Teaching Hospital, Sri Lanka. 64 patients were randomised. The intervention group had a pre-operative theatre visit with an informative session regarding the surgery. Patients' anxiety before, at the time and after the surgery was assessed using APAIS score. Pre-induction parameters and pain score were also assessed. APAIS anxiety difference before the surgery and on the day of the surgery was -1.937 (±4.641) and -1.781 (±2.586) for the intervention and the control groups respectively (p = 0.643). There was no significant difference in pre-induction parameters between the groups. Pain score at 6 hours after surgery was 5.04 (±2.510) for the intervention group and 6.08 (±2.888) for the control (p = 0.189). Preoperative theatre visit prior to surgery made no significant difference in the patient's anxiety, though a trend in reduction of anxiety and pain was noted.Impact statementWhat is already known on this subject? Patients experience significant anxiety before surgical procedures and high levels of anxiety can lead to adverse outcomes needing high induction doses of aneasthesia, delayed recovery and more postoperative pain. Different methods for preoperative anxiety reduction such as provision of systematic preoperative instructions, cognitive-behavioural interventions had been successful.What do the results of this study add? There are only a limited number of studies conducted assessing the methods of informational interventions to reduce anxiety. Preoperative theatre visit is a simple intervention that can be carried out without any additional preparation.What are the implications of these findings for clinical practice and/or further research? Our study could not show that preoperative theatre visit as an effective intervention in reducing anxiety in patients undergoing elective gynaecological surgery. However, there was a trend towards reduction in anxiety and postoperative pain with the intervention. Future research on providing additional information at the preoperative visit, timing of the visit and larger sample sizes may reveal better outcomes.

Understanding the Role and Uses of Alternative Therapies for Management of Rheumatoid Arthritis

With growing popularity of complementary and alternative medicine (CAM) among the individuals with chronic pain and muscular problems, a number of patients with rheumatoid arthritis (RA) show their interest in CAM interventions for disease improvement. Various reports published on CAM are based on animal model of RA however there is often lack of high quality clinical investigations for explaining the success stories of CAM therapies in patients with RA. CAMs having potential to be used for therapy in patients with RA have been identified, however lack of awareness and scepticism of their efficacy has made the patients reluctant to choose these drug less therapies. In this review, we have summarized the existing evidences which suggest promising efficacy of different alternative therapies in managing RA and providing both physical and mental well being to RA patients.

Undergraduate medical education interventions aimed at managing patients with obesity: A systematic review of educational effectiveness

The growing obesity epidemic requires an evidence-based approach to management of patients with obesity. Two systematic reviews on obesity-management interventions in undergraduate medical education, both published in 2012, reported discrepant findings. This study aimed to build on previous research by identifying, systematically reviewing, and synthesizing current literature on the effectiveness of educational interventions aimed at teaching management of patients with obesity to medical students. A comprehensive search of seven databases was performed with no date or language restrictions. Database search identified 6462 studies; 5373 were screened against title and abstract, 156 full-text articles were retrieved, 31 met eligibility criteria, and 17 were included after critical appraisal of study methodology. Nine cohort-studies, three qualitative, two case-controls, two mixed-methods, and one randomized controlled trial were included. Findings supported the educational effectiveness of brief (<3 h) educational interventions, the value of video-clips to deliver content, and the importance of in-person teaching. Findings also demonstrated an increase in the number of studies describing educational interventions aimed at teaching management of patients with obesity to medical students. These results can be used by medical educators to inform the design of educationally effective curricula focused on the management of patients with obesity in undergraduate medical education.

Effectiveness of Pharmacist-Led Brief Educational Intervention for Adherence to the Antibiotics for Lower Respiratory Tract Infections (EATSA) in Post-Conflict Rural Areas of Pakistan: Study Protocol for a Randomized Controlled Trial

Globally, lower respiratory infections (LRTIs) are one of the most common infectious diseases whichaffect majority of the population and as a result of inappropriate antibiotics practices lead to antibiotic resistance (AR). An individual randomized control trial will be conducted in the post-conflict areas of Swat, Pakistan, through a random sampling method. Patients aged > 18 years will be recruited from five community pharmacies and assigned to equally sized groups to receive either pharmacist-led education interventions or usual care with no intervention. A total of 400 (control = 200, study = 200) patients will be included, with prescriptions comprised of antibiotics for LRTIs. The outcomes measured in both groups will be a combination of treatment cure rate and adherence, which will be assessed using the Morisky Medication Adherence Scale and pill count. The trial comprises pharmacist-led educational interventions to improve treatment outcomes for patients with LRTIs. This study might establish the groundwork for pharmaceutical care of LRTIs patients with antibacterial therapy and the future delivery of a care strategy for the improvement of LRTIs treatment outcomes in post-conflict, remote areas of the third world and LMICs.

Applying empathic communication skills in clinical practice: Medical students' experiences

Background

Studies have demonstrated that empathic communication improves patient outcomes and helps doctors to deliver accurate symptom reports and diagnoses. These benefits emphasise the need for medical students to apply empathic communication skills during their interactions with patients. Focussed empathic communication skill workshops were introduced into the undergraduate medical students’ training at the Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. This study aimed to explore students’ perceptions of applying these empathic communication skills during their clinical practice. We were interested in determining the factors that might influence the development of empathic communication skills. The findings could help curriculum developers to optimise these workshops for inclusion in a formal medical curriculum.

Methods

This study followed a qualitative, descriptive enquiry, exploring the perceptions of medical students through focus-group discussions. The students (N = 18) were selected using convenience sampling techniques. Recordings were transcribed, and the data were thematically analysed.

Results

The two main themes identified relate to the students and the clinical learning environment. The students valued the knowledge and skills they acquired. However, feelings of emotional vulnerability, a lack of language proficiency and inadequate role modelling were highlighted as challenges when applying empathic communication during clinical practice.

Conclusion

The students reported positively on the workshops as these improved both their patient and personal interactions. However, for students to develop these skills further for clinical practice, they need more intentional and supervised opportunities to practise, reflect and receive constructive feedback. These learning opportunities could help medical schools deliver graduates who can competently communicate with their patients in an empathic manner.

Psychological Wellbeing in Physical Education and School Sports: A Systematic Review

Mental health in children and adolescents has become an increasingly important topic in recent years. It is against this backdrop that physical education and school sports play an important role in promoting psychological wellbeing. The aim of this review was to analyse interventions for improving psychological wellbeing in this area. To this end, a literature review was conducted using four databases (WOS, SPORTDiscus, SCOPUS and ERIC) and the following keywords: psychological wellbeing, physical education, and school sports. Twenty-one articles met the inclusion criteria. The results showed that interventions varied greatly in terms of duration and used a wide range of strategies (conventional and non-conventional sports, physical activity, games, etc.) for promoting psychological wellbeing, primarily among secondary school students. There was a lack of consensus as to the conceptualisation of the construct of psychological wellbeing, resulting in a variety of tools and methods for assessing it. Some studies also suggested a link between psychological wellbeing and other variables, such as basic psychological needs and self-determination. Finally, this study provides a definition of psychological wellbeing through physical activity based on our findings.

The Effectiveness of Educational Interventions on Breast Cancer Screening Uptake, Knowledge, and Beliefs among Women: A Systematic Review

There have been various systematic reviews on the significance of educational interventions as necessary components to encourage breast cancer screening (BCS) and reduce the burden of breast cancer (BC). However, only a few studies have attempted to examine these educational interventions comprehensively. This review paper aimed to systematically evaluate the effectiveness of various educational interventions in improving BCS uptake, knowledge, and beliefs among women in different parts of the world. Following the PRISMA guidelines, a comprehensive literature search on four electronic databases, specifically PubMed, Scopus, Web of Science, and ScienceDirect, was performed in May 2019. A total of 22 interventional studies were reviewed. Theory- and language-based multiple intervention strategies, which were mainly performed in community and healthcare settings, were the commonly shared characteristics of the educational interventions. Most of these studies on the effectiveness of interventions showed favorable outcomes in terms of the BCS uptake, knowledge, and beliefs among women. Educational interventions potentially increase BCS among women. The interpretation of the reported findings should be treated with caution due to the heterogeneity of the studies in terms of the characteristics of the participants, research designs, intervention strategies, and outcome measures.

Increasing Human Papillomavirus Vaccination and Cervical Cancer Screening in Nigeria: An Assessment of Community-Based Educational Interventions

We explored the impact of two community-based educational interventions on Nigerian adults' knowledge and intention to take or encourage human papillomavirus (HPV) vaccine and cervical screenings. Face-to-face presentation and printed pamphlet intervention were delivered to 266 men and women aged 18 to 65 years in 12 locations in urban setting. At baseline, the majority (80%) had poor knowledge of HPV, and less than 12% had ever received or have a family member who had received HPV vaccine or cervical screening. Postintervention, there was significant increase (>70%) in the participants knowledge and intention to take or encourage HPV vaccination and cervical screening. In addition, more than half were willing to pay for HPV vaccine and screening even when expensive. Gender-focused and context-specific low-cost community-based educational interventions are effective in increasing HPV vaccine and cervical screening in sub-Saharan Africa.

Impact of Targeted Local Interventions on Tuberculosis Awareness and Screening Among Persons Experiencing Homelessness During a Large Tuberculosis Outbreak in Atlanta, Georgia, 2015-2016

OBJECTIVES

Tuberculosis (TB) outbreaks disproportionately affect persons experiencing homelessness (PEH) in the United States. During 2014-2016, a resurgent TB outbreak occurred among PEH in Atlanta, Georgia. To control the outbreak, citywide policies and educational interventions were implemented in January 2015. Policy changes standardized and enforced TB screening requirements for PEH in homeless shelters. Educational campaigns informed PEH of the outbreak and encouraged TB screening. We evaluated factors associated with, and the effect policy changes and educational interventions had on, TB screening and awareness among PEH in Atlanta.

METHODS

Questions related to TB screening and awareness of the outbreak were added to an annual US Department of Housing and Urban Development survey of PEH in Atlanta in 2015 (n = 296 respondents) and 2016 (n = 1325 respondents). We analyzed the 2016 survey data to determine characteristics associated with outcomes.

RESULTS

From 2015 to 2016, reported TB screening increased from 81% to 86%, and awareness of the TB outbreak increased from 68% to 75%. In 2016, sheltered PEH were significantly more likely than unsheltered PEH to report being evaluated for TB in the previous 6 months (prevalence odds ratio [pOR] = 3.18; 95% confidence interval [CI], 2.28-4.47) and to report being aware of the TB outbreak (pOR = 4.00; 95% CI, 2.89-5.55).

CONCLUSIONS

Implementation of required TB screening and educational interventions may reduce the incidence and severity of TB outbreaks among PEH in other communities. Furthermore, the annual survey of PEH offers an opportunity to collect data to better inform practices and policies.

The Effect of Educational Interventions on Willingness to Work with Older Adults: A Comparison of Students of Social Work and Health Professions

The study examined the effect of an educational intervention on the willingness of Israeli social work students to work with older adults, comparing them to students of nursing, speech therapy, and physiotherapy. A sample of 187 first-year students were divided into two groups: a research group (n=83) exposed to an educational intervention on ageing, and a control group (n=104) that received no intervention of any kind. Following the intervention, ageism among social work students in the research group decreased and positive behavior toward older adults increased. No significant differences were found among students of the health professions following the intervention. In addition, ageism mediated between knowledge of ageing and willingness to work with older adults.Furthermore, the higher the students assessed the contribution of the intervention, the lower their level of ageism, the more positive their behavior toward older adults, and the more willing they were to consider a career in geriatrics. The results suggest that introducing into the curriculum a variety of learning methods aimed at increasing knowledge of ageing and familiarity with the world of older adults is likely to encourage more students of social work and other therapeutic professions to work with the older population.

Efficacy of Nutrition and WASH/Malaria Educational Community-Based Interventions in Reducing Anemia in Preschool Children from Bengo, Angola: Study Protocol of a Randomized Controlled Trial

Angola reports one of the highest infant mortality rates in the world, and anemia represents one of its important causes. Recent studies, in under-five children from the Bengo province of Angola, described high prevalence’s, suggesting malaria, undernutrition and urogenital schistosomiasis as important contributors for the occurrence and spatial variations of anemia. Educational community-based interventions, either in Nutrition and Water, Sanitation, Hygiene and Malaria are recommended to correct anemia. Herein, we designed a cluster-randomized controlled trial to study the efficacy of two educational-plus-therapeutic interventions in the reduction of anemia: one in nutrition and the other in WASH/Malaria. Socioeconomic, nutritional, anthropometric, parasitological and biochemical data will be collected from all willing-to-participate children, aging under four and resident in the Health Research Center of Angola study area. Considering the multifactorial causes of this condition, determining the efficacy of both interventions might help documenting weaknesses and opportunities for planning integrated strategies to reduce anemia.

Wrestling with uncertainty after mild traumatic brain injury: a mixed methods study

Purpose: Our objective was to explore the intersection between mild traumatic brain injury (MTBI) recovery experiences and injury understandings, using both quantitative and qualitative methods.Materials and Methods: The quantitative component was a descriptive case-control study comparing participants (n = 76) who had recovered or not recovered after an MTBI, across demographic and psychological variables. A subset of participants (n = 10) participated in a semi-structured interview to explore experiences of recovery in more detail. We followed threads across the datasets to integrate findings from component methods.Results: The quantitative analyses revealed differences between the two groups in terms of injury recovery understandings and expectations. The qualitative analyses suggested that achieving consistency across information sources was important. By tracing threads back and forth between the component datasets, we identified a super-ordinate meta-theme that captured participants' experiences of wrestling with uncertainty about their recovery and the impacts in terms of heightened anxiety, confusion, and feelings of invalidation.Conclusion: The effectiveness of psychoeducation and reassurance after MTBI may be optimized when content is tailored to the individual. Clinicians are urged to attend both to the subjective interpretations patients make of information gained from formal and informal, internal and external sources, and where information across these sources conflicts and creates uncertainty.Implications for rehabilitationEffectiveness of psychoeducation and reassurance after injury may be optimized when content is tailored to the individual rather than being generic.Effectiveness of such interventions may also be optimized by understanding the subjective interpretations individuals make of injury knowledge gleaned from formal and informal, internal and external sources.Conflicting information from such multiple sources may create uncertainty with associated increased distress as an individual negotiates their recovery from injury. Attending to this uncertainty may be a helpful target for treatment.

Reducing socioeconomic disparities in the STEM pipeline through student emotion regulation

Increasing access to Science, Technology, Engineering, and Math (STEM) fields can create career opportunities. Yet many students, especially those from lower-income backgrounds, find the high-stakes exams in courses necessary for STEM success to be stressful and anxiety provoking. Such experiences of stress can lead to underperformance and compromise students’ ability to advance in STEM. We show that lower-income students given the opportunity to emotionally regulate their worries and reinterpret their arousal go on to perform better on their high school science exams and endorse a more adaptive interpretation of stress. Critically, emotion regulation interventions cut in half the course failure rate for lower-income students. For many students, success is based on more than STEM knowledge—their ability to regulate emotions is important too.

Educational attainment is one lever that can increase opportunity for economically disadvantaged families—especially in Science, Technology, Engineering, and Math (STEM). Unfortunately, students from lower-income backgrounds often perform poorly and fail high school STEM courses, which are a necessary step in pursuing fast-growing and lucrative STEM careers, graduating high school, and matriculating to college. We reasoned that, because high school STEM courses often use high-stakes tests to gauge performance, and such tests can be especially stressful for lower-income students, interventions that help students regulate their negative emotions during tests should reduce the achievement gap between higher- and lower-income students. In a large-scale (n = 1,175) field experiment conducted in ninth grade science classrooms, students were asked to complete a control exercise, or they were given the opportunity to complete an exercise to help them regulate their worries and reinterpret their anxious arousal before their tests. We found significant benefits of emotion regulation activities for lower-income students in terms of their science examination scores, science course passing rate, and students’ attitudes toward examination stress, suggesting that students’ emotions are one factor that impacts performance. For example, 39% of lower-income students failed the course in the control group compared with only 18% of students failing the course if they participated in the emotion regulation interventions—a reduction in course failure rate by half. Our work underscores the crucial importance of targeting students’ emotions during impactful points in their academic trajectories for improving STEM preparedness and enhancing overall academic success.

Empathy and the Development of Affective Skills

Empathy, the most important human attribute that matters in every aspect of life, is essential in health care. Provision of patient-centered care requires empathic health care practitioners. The correlation between empathy of health care providers and improved patient adherence, satisfaction, and treatment outcomes is well-established. Scholarly evidence shows positive correlations between empathy and affective domains and confirms that soft skills are grounded in empathy. Empathic students have stronger affective skills and are capable to acquire, develop, reinforce, and display strong affective behaviors, abilities, and attitudes. As an innate quality, empathy is malleable. The level of empathy can be influenced by educational interventions inculcated into students during the entire curriculum, including both didactic and experiential training. The effectiveness of educational methods may be strengthened by activities that help students enhance empathy and achieve required affective skills. Empathy and the empathy-based affective skills essential in patient-centered care should be routinely and deliberately taught, modelled, and assessed across the continuum of health care curricula.

Teaching Diagnostic Reasoning: A Review of Evidence-Based Interventions

Problem/Background: The ability to accurately diagnose patients based on symptom profiles is a vital yet challenging skill that Nurse Practitioners (NPs) undertake frequently.

PURPOSE

This integrative literature review highlights a variety of evidence based, practical educational strategies that foster the development of diagnostic reasoning.

METHODS

An integrative literature review was conducted in order to identify original research focusing on diagnostic reasoning educational interventions.

RESULTS

Eighteen primary sources met inclusion and exclusion criteria. Results are synthesized in terms of sample and setting, methodological features, interventions, and outcomes. Interventions broadly fit into five educational themes: testing strategies, cognitive biases, simulation programs, course formats, and instructional approaches.

DISCUSSION

Interventions are simple and can be implemented in multiple educational settings. Future research should occur in populations of NP students. Validated, easy-to-use measurement tools as well as more precise diagnostic reasoning concept development should occur.

Actions to increase knowledge about age-related fertility decline in women

OBJECTIVE

There is a strong body of published data corroborating the current lack of awareness of age-related fertility decline (ARFD), but few studies have evaluated specific interventions aimed at increasing ARFD knowledge. Here, we review the literature examining the instruments developed and the educational interventions performed to date.

METHODS

We carried out a narrative review based on a literature search in PubMed, Web of Science, PsycINFO and Scopus between January 2010 and December 2017.

RESULTS

The instruments available comprise websites, paper brochures, slide presentations and tailored information, mainly developed with the input of university students. The eight interventions reviewed include surveys before and/or after a specific intervention, with and without a control group, in randomised and non-randomised designs. Overall, the interventions were effective in increasing ARFD knowledge and lowering the desired age for childbearing in the short term. These results were not always maintained, however, in the long term, possibly due to a lack of perceived risk of future infertility among those studied.

CONCLUSION

Further interventions need to be targeted to both young people and health care providers, and should be as personalised as possible. A greater number of validated instruments are also needed to reliably measure the effectiveness of any intervention.

Interventions Designed to Improve the Learning Environment in the Health Professions: A Scoping Review

This article was migrated. The article was marked as recommended. Purpose: To identify and describe interventions designed to affect the learning environment (LE) in health professions education, summarize factors that influence the LE, and determine gaps that require additional research. The LE can be thought of as a dynamic and complex construct co-created by people in a particular setting. A positive LE represents a welcoming climate for learning, which enhances satisfaction, well-being, academic performance and collaboration, while a negative LE restricts participation and learning, leading to emotional exhaustion, depersonalization and burnout. Method: A six-step scoping review methodology was followed to identify and report on literature that describes interventions affecting the LE in the health professions education: 1. Identify the research question, 2. Identify relevant studies, 3. Select studies to be included, 4. Chart the data, 5. Collate, summarize and report results, and 6. Consult with stakeholders. Results: 2,201 unique citations were identified and reviewed using titles and abstracts. 240 full-text articles were retained for detailed review, resulting in the inclusion of 68 articles. Study results are reported in relation to essential components of the LE: personal, social, organizational, physical and virtual spaces. Results of four different types to the studies of the LE are described: specific interventionsimpacting the LE, comparisonsof perceptions of the LE by two or more different groups, associations with other variable such as well-being with the LE, and descriptivestudies of the LE. Major influences included accreditation regulations, curricular interventions, faculty/staff development grading practices, instructional interventions, placements, physical and virtual spaces, and support services; and are reported along with specific interventions. Conclusion: These results reflect the complexity of the LE and the need for conceptual clarity. Since the quality of the evidence was not evaluated, the identified influences should be viewed as potential opportunities to improve the LE.

The implementation of mindfulness-based interventions and educational interventions to support family caregivers of patients with cancer: A systematic review

PURPOSE

This review aims to determine the effectiveness of mindfulness-based interventions (MBIs) and educational interventions (EIs) as supportive care for family caregivers (FCs) of patients with cancer.

DESIGN AND METHODS

Review was conducted following PRISMA guidelines. The search protocol was performed using EBSCO, Google Scholar, and Science Direct for the studies published between 2007 and 2017.

FINDINGS

Little evidence is available on the usefulness of MBIs among FCs of patients with cancer. However, the available evidence supports that MBIs have the potential to enhance overall well-being and reduce the burden for FCs. EIs have shown positive outcomes on some aspects of well-being and reducing the burden.

PRACTICE IMPLICATIONS

The findings provide preliminary support for effectiveness of MBIs and EIs as a supportive care for FCs.

Preventing "Neurophobia": Remodeling Neurology Education for 21st-Century Medical Students through Effective Pedagogical Strategies for "Neurophilia"

Neurology has a reputation, particularly as a complex "head-to-toe" discipline for undergraduate medical students. Neurophobia syndrome, a global phenomenon, fundamentally stems from pedagogical deficiencies during the undergraduate curriculum, the lack of vertical integration between basic neurosciences and clinical bedside neurology, the lack of clinical reasoning exercises, cognitive heuristics, and clinical problem-solving, errors in diagnostic competence, and hyposkilia. This ultimately results in poor clinical competence and proficiency in clinical neurology and causes attrition in nurturing a passion for learning the neurology discipline. This article explores plausible factors that contribute to the genesis of neurophobia and multifaceted strategies to nurture interest in neurosciences and provide possible solutions to demystify neurology education, especially the need for evidence-based educational interventions. Remodeling neurology education through effective pedagogical strategies and remedial measures, and using the Miller's pyramid, would provide a framework for assessing clinical competence in clinical bedside neurology. Technology-enhanced education and digital classrooms would undoubtedly stamp out neurophobia in medical students of the 21^st century. It will not frighten off another generation of nonneurologist physicians to empower them to hone expertise in order to tackle the increasing burden of neurological disorders in India. Furthermore, promoting neurophilia would facilitate the next generation of medical students in pursuing career options in neurology which would be quintessential not only in closing India's looming neurologist workforce gap but also in fostering interest in research imperatives in the next generation of medical students.

Impact of the Educational Boost Your Brain and Memory Program Among Senior Living Residents

This random assignment waitlist control intervention study examined an implementation of the educational Boost Your Brain and Memory cognitive fitness intervention in 12 senior living organizations. Older adult participants ( n = 166) completed measures of brain health knowledge, use of memory techniques, physical and intellectual activity, and mindfulness, at baseline and after the intervention group's completion of the course. Changes in knowledge scores and in self-reported physical and intellectual activity increased significantly more for intervention participants than for waitlist controls at the conclusion of the course. There were no significant changes between the groups in mindfulness or use of memory techniques. This suggests that in senior living settings Boost Your Brain and Memory is effective in educating participants about brain healthy behaviors and in motivating behavioral change in the areas of physical and intellectual activity.

Effectiveness of Psychological and Educational Interventions to Prevent Depression in Primary Care: A Systematic Review and Meta-Analysis

PURPOSE

Although evidence exists for the efficacy of psychosocial interventions to prevent the onset of depression, little is known about its prevention in primary care. We aimed to evaluate the effectiveness of psychological and educational interventions to prevent depression in primary care.

METHODS

We conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs) examining the effect of psychological and educational interventions to prevent depression in nondepressed primary care attendees. We searched MEDLINE, PsycINFO, Web of Science, OpenGrey Repository, Cochrane Central Register of Controlled Trials, and other sources up to May 2016. At least 2 reviewers independently evaluated the eligibility criteria, extracted data, and assessed the risk of bias. We calculated standardized mean differences (SMD) using random-effects models.

RESULTS

We selected 14 studies (7,365 patients) that met the inclusion criteria, 13 of which were valid to perform a meta-analysis. Most of the interventions had a cognitive-behavioral orientation, and in only 4 RCTs were the intervention clinicians primary care staff. The pooled SMD was -0.163 (95%CI, -0.256 to -0.070; P = .001). The risk of bias and the heterogeneity (I² = 20.6%) were low, and there was no evidence of publication bias. Meta-regression detected no association between SMD and follow-up times or SMD and risk of bias. Subgroup analysis suggested greater effectiveness when the RCTs used care as usual as the comparator compared with those using placebo.

CONCLUSIONS

Psychological and educational interventions to prevent depression had a modest though statistically significant preventive effect in primary care. Further RCTs using placebo or active comparators are needed.

Decreasing antibiotic use through a joint intervention targeting physicians and pharmacists

AIM

To decrease population antibiotic use through an educational intervention targeting primary care physicians' and community pharmacists' attitudes and knowledge.

METHODS

We designed a pragmatic cluster-randomized trial covering all National Health System primary care physicians and all community pharmacists' in a region in the north of Portugal. The study protocol was registered on ClinicalTrials.gov (identifier: NCT02173509).

RESULTS

After adjustment for baseline values and comparison with the control group, the intervention was associated with a significant reduction in overall antibiotic use in the year following the intervention. The effect was most marked for tetracyclines, macrolides and cephalosporins. No statistically significant differences were observed for fluoroquinolone consumption.

CONCLUSION

Multifaceted interventions involving physicians, pharmacists and general public proved effective in reducing antibiotic consumption in the population.

Educational Interventions for Patients With CKD: A Systematic Review

BACKGROUND

Preventing progression from earlier stages of chronic kidney disease (CKD) to end-stage kidney disease and minimizing the risk for cardiovascular events and other complications is central to the management of CKD. Patients' active participation in their own care is critical, but may be limited by their lack of awareness and understanding of CKD. We aimed to evaluate educational interventions for primary and secondary prevention of CKD.

STUDY DESIGN

Systematic review. Electronic databases were searched to December 2015, with study quality assessed using the Cochrane Collaboration risk-of-bias tool.

SETTING & POPULATION

People with CKD stages 1 to 5 in community and hospital settings (studies with only patients with CKD stage 5, kidney transplant recipients irrespective of glomerular filtration rate, or patients receiving dialysis were excluded).

SELECTION CRITERIA FOR STUDIES

Randomized controlled trials and nonrandomized studies of educational interventions.

INTERVENTIONS

Educational strategies in people with CKD.

OUTCOMES

Knowledge, self-management, quality-of-life, and clinical end points.

RESULTS

26 studies (12 trials, 14 observational studies) involving 5,403 participants were included. Risk of bias was high in most studies. Interventions were multifaceted, including face-to-face teaching (26 studies), written information (20 studies), and telephone follow-up (13 studies). 20 studies involved 1-on-1 patient/educator interaction and 14 incorporated group sessions. 9 studies showed improved outcomes for quality of life, knowledge, and self-management; 9 had improved clinical end points; and 2 studies showed improvements in both patient-reported and clinical outcomes. Characteristics of effective interventions included teaching sessions that were interactive and workshops/practical skills (13/15 studies); integrated negotiated goal setting (10/13 studies); involved groups of patients (12/14 studies), their families (4/4 studies), and a multidisciplinary team (6/6 studies); and had frequent (weekly [4/5 studies] or monthly [7/7 studies]) participant/educator encounters.

LIMITATIONS

A meta-analysis was not possible due to heterogeneity of the interventions and outcomes measured.

CONCLUSIONS

Well-designed, interactive, frequent, and multifaceted educational interventions that include both individual and group participation may improve knowledge, self-management, and patient outcomes.

After the Fact: A Brief Educational Program on HIV Postexposure Prophylaxis for Female Detainees in a Local Jail

Women who have been in jail are at increased risk of acquiring HIV when they are in the community. Nonoccupational postexposure prophylaxis (nPEP) reduces HIV transmission following high-risk behaviors and is an effective HIV prevention strategy. The authors designed a 15-minute interactive educational program to increase inmates' knowledge of nPEP. Before the program, participants self-reported high HIV risk yet low risk perception and lack of nPEP awareness. After the program, nPEP knowledge scores increased by 40% regardless of demographic or HIV-risk characteristics. This study demonstrates that a brief, easy-to-deliver educational intervention can be carried out in a jail, is effective at raising awareness of both HIV risk and nPEP, and may be useful for others seeking to increase use of this prevention strategy for high-risk women during incarceration.

Systematic Review: Audiovisual Interventions for Reducing Preoperative Anxiety in Children Undergoing Elective Surgery

OBJECTIVE

To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery.

METHODS

A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children's preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed.

RESULTS

In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies.

CONCLUSIONS

This systematic review suggests that AV interventions can be effective in reducing children's preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice.

Improving treatment adherence in patients with rheumatoid arthritis: what are the options?

Low adherence to therapeutic regimens is a prevalent and persistent healthcare problem, particularly for patients with chronic disorders. Many patients with rheumatoid arthritis (RA) show inadequate therapeutic adherence resulting in poor health outcomes. Reasons for nonadherence can be unintentional or intentional. The characteristics of patient-doctor interactions are also likely to play a role although they have not been well studied for patients with RA. While many educational and cognitive behavioral interventions have been proposed to improve adherence, the few studies that have examined the efficacy of these programs in RA have had disappointing results. Future studies involving the use of mobile technologies have shown promise in other chronic diseases and could prove useful for patients with RA.

Bone care nurses and the evolution of the nurse's educational function: the Guardian Angel(®) research project

Osteoporosis mostly affects females over 50 years old, worldwide. The main osteoporosis complication is fragility fractures that reduce quality of life and cause morbidity and mortality. Most patients who have fragility fractures are treated for the fracture. However, patients' adherence to follow-up treatment plans is poor. Therefore, tailored educational interventions are needed to improve medication adherence and healthy lifestyles. In this context, the role of bone care nurses is important, as they can act at different levels of osteoporosis prevention and fracture liaison services, which are secondary fracture prevention programmes implemented by health care systems to treat osteoporotic patients. In Italy, a research project called Guardian Angel(®) was developed to provide tailored education to osteoporotic women in order to improve their disease management and reduce related complications.

A realist review of educational interventions to improve the delivery of nutrition care by doctors and future doctors

BACKGROUND

Dietary interventions are considered an important aspect of clinical practice, more so in the face of the rising prevalence of obesity, diabetes and cardiovascular diseases globally. Routinely, most doctors do not provide such intervention to their patients, and several barriers, present during both training and clinical practice, have been identified. Educational interventions to improve nutrition care competencies and delivery have been implemented but with variable success, probably, due to the complex nature of such interventions. Using traditional methods only to investigate whether interventions are effective or not could not provide appropriate lessons. It is therefore pertinent to conduct a realist review that investigates how the interventions work. This realist review aims at determining what sort of educational interventions work, how, for whom, and in what circumstances, to improve the delivery of nutrition care by doctors and future doctors.

METHODS/DESIGN

This realist review will be conducted according to Pawson's five practical steps for conducting a realist review: (1) clarifying the scope of the review, (2) determining the search strategy, including adopting broad inclusion/exclusion criteria and purposive snowballing techniques, (3) ensuring proper article selection and study quality assessment using multiple methods, (4) extracting and organising data through the process of note taking, annotation and conceptualization and (5) synthesising the evidence and drawing conclusions through a process of reasoning. This realist review protocol has not been registered in any database before now.

DISCUSSION

Findings will be reported according to the publication criteria outlined by the realist and meta-narrative evidence synthesis (RAMESES) group.