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The Life-saving Instruction for Emergencies (LIFE) is a 3D simulation training app for smartphones that teaches healthcare workers how to manage medical emergencies. LIFE is a scenario-based mobile and virtual reality (VR) gaming platform that teaches healthcare workers to identify and manage medical emergencies using game-like training techniques to reinforce the key steps that need to be performed in order to save lives.
Factors Influencing Health Workers' Acceptance of Guideline-Based Clinical Decision Support Systems for Preventive Services in Thailand: Questionnaire-Based Study.
BACKGROUND: A guideline-based clinical decision support system (CDSS) is a knowledge-based system designed to collect crucial data from electronic medical records to generate decision-making based on system data requirements and inputs from standard guidelines. Despite the potential to enhance health care delivery, the adoption rate of CDSSs in clinical practice remains suboptimal. OBJECTIVE: This study aimed to evaluate the determinants influencing the intention to use a new CDSS in preventive care within clinical practice. METHODS: A single-center, questionnaire-based, cross-sectional study was conducted among physicians and medical students responsible for providing comprehensive preventive services at the Continuity of Care Clinic, Siriraj Hospital, Thailand. RESULTS: In total, 89 participants were enrolled. Relationships between factors impacting the adoption of CDSSs were analyzed using correlation and regression analysis. We found that physicians' intentions to adopt the CDSS for preventive care were high, with 79% (70/89) of participants expressing their intention to use the system. According to the study's conceptual framework, modified from the original unified theory of acceptance and use of technology model, physicians' positive attitudes toward CDSS use in preventive services and a high level of effort expectancy emerged as crucial factors influencing the intention to use the new CDSS. The odds ratios for these factors were 5.44 (95% CI 1.62-18.34, P=.006) and 7.60 (95% CI 1.55-31.37, P=.01), respectively. Similar results were observed for medical students and for physicians who had graduated. The most prevalent barriers to CDSS implementation were related to physicians' attitudes, followed by issues such as the accuracy and burden of data input, time constraints for clinicians, and the risk of workflow disruption. CONCLUSIONS: There was a high intention to adopt the CDSS in preventive care. Positive physician attitudes toward CDSS use in preventive services and effort expectancy were found to be critical factors influencing the intention to use the new CDSS.
Communication Between Anaesthesia Providers for Clinical and Professional Purposes: A Scoping Review
Background: Anaesthesia providers in all contexts need to be able to communicate with colleagues to meet a variety of clinical and professional needs, including physical help, advice and support as well as learning, supervision and mentorship. Such communication can be regarded as a ‘social resource’ which underpins anaesthesia providers’ practice, but which has not itself been extensively studied. The objective of this scoping review is to provide an overview of the literature related to communication among anaesthesia providers to meet clinical and professional goals, focusing on the modalities, contexts and purposes or outcomes of such communication, as well as which providers are involved.Methods: We conducted a scoping review using the JBI methodology to examine the current literature available, searching the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL and Google Scholar. Papers were eligible for inclusion where they primarily addressed the subject of communication between trained anaesthesia providers for any clinical or professional purpose (excluding purely social interactions). Data were charted for the location and cadre of providers represented, means of communication and the situation, purposes and outcomes of communication.Results: 3872 records were identified for screening, and 225 papers were ultimately included. Communication was reported both as a variable influencing a wide range of clinical and nonclinical outcomes and as an outcome in itself which might be modified by other factors. It was also considered in a smaller group of studies as a resource with varying availability to anaesthesia providers. Physician providers were well represented in included documents, but nurse anaesthetists, clinical officers and other nonphysician, nonnurse anaesthetists were far less commonly included. The majority of identified studies on communication between anaesthesia providers originated from and related to high‐income countries.Conclusion: Communication between anaesthesia providers affects all aspects of their practice and has implications for both patient outcomes and workforce capacity. More research is necessary to understand how the availability of communication as a resource affects patient care and health worker well‐being, particularly in low‐ and middle‐income contexts and among nonphysician anaesthesia providers.
Core collections: Essential titles for health libraries.
Core collections have been produced by CILIP's Health Libraries Group, then called the Library Association's Medical Section, since 1952. Maintained by a Working Group of health librarians based in the UK NHS, higher education and specialist libraries, the collections provide an up-to-date curated list of reliable titles essential to health libraries. The core collections currently include nursing, midwifery, medicine and dentistry. The newest core collection is being developed in collaboration with the African Hospital Libraries to provide a list of key resources relevant to sub-Saharan Africa. Expressions of interest to help develop this latest collection are invited.
The global scope and components of family-centred care for preterm infants: An umbrella review.
Preterm birth is the leading cause of under-five mortality. Family-centred care (FCC) interventions may improve outcomes related to prematurity and may be used to address this issue to achieve the Sustainable Development Goals. We aimed to consolidate the scope of evidence and components of FCC interventions for preterm infants globally and see its relevance for low-resource settings. We conducted an umbrella review informed by the Joanna Briggs Institute (JBI) guidelines. Systematic literature reviews evaluating FCC in the preterm or high-risk infant population and their families were identified from six databases. Keywords included "family-centred care", "premature infants", "neonatal intensive care unit", and their relevant synonyms. Quality appraisal was conducted using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses and data extraction performed to an agreed table. Thematic analysis was carried out to categorise the components of FCC interventions. Forty-four reviews were included in the umbrella review. Outcomes were observed on the parents in 40 studies, the infant in 19, the health care provider in 13, and the health system in 7. Most studies focused on inpatient settings (79.6%) and were conducted primarily in high-income countries (92.3%). The components identified were general FCC, health system design, parent support, partnership in care, and information and communication. Overall, FCC interventions have a positive impact on parental, infant, and health system outcomes, with consistent reporting of FCC impact on parental well-being and satisfaction, infant length of stay, feeding and growth, and hospital readmission rates. FCC interventions have the potential to improve preterm infant health system outcomes. To maximise impact, FCC interventions need to be further explored in low-resource and post-discharge settings, where the burden of premature infant morbidity and mortality is highest. Evidence in both these settings is scarce. Future research efforts should aim to close these evidence gaps.
Characterisation of between-cluster heterogeneity in malaria cluster randomised trials to inform future sample size calculations.
Cluster randomised trials (CRTs) are important tools for evaluating the community-wide effect of malaria interventions. During the design stage, CRT sample sizes need to be inflated to account for the cluster heterogeneity in measured outcomes. The coefficient of variation (k), a measure of such heterogeneity, is typically used in malaria CRTs yet is often predicted without prior data. Underestimation of k decreases study power, thus increases the probability of generating null results. In this meta-analysis of cluster-summary data from 24 malaria CRTs, we calculate true prevalence and incidence k values using methods-of-moments and regression modelling approaches. Using random effects regression modelling, we investigate the impact of empirical k values on original trial power and explore factors associated with elevated k. Results show empirical estimates of k often exceed those used in sample size calculations, which reduces study power and effect size precision. Elevated k values are associated with incidence outcomes (compared to prevalence), lower endemicity settings, and uneven intervention coverage across clusters. Study findings can enhance the robustness of future malaria CRT sample size calculations by providing informed k estimates based on expected prevalence or incidence, in the absence of cluster-level data.
Prevalence and risk factors for murine typhus, scrub typhus and spotted fever group rickettsioses among adolescent and adult patients presenting to Yangon General Hospital, Yangon, Myanmar.
ObjectivesTo inform patient management and disease prevention, we sought to estimate the prevalence of, and identify risk factors for, scrub typhus, murine typhus, and spotted fever group rickettsioses (SFGR) among febrile patients presenting to hospital in Myanmar.MethodsWe recruited patients ≥12 years old with fever ≥38°C among those seeking care at Yangon General Hospital from 5 October 2015 through 4 October 2016. Standardised clinical and risk factor assessments were conducted. Confirmed scrub typhus, murine typhus, and SFGR infections were defined as a positive polymerase chain reaction or ≥4-fold rise in immunofluorescence assay antibody titre to Orientia tsutsugamushi, Rickettsia typhi or Rickettsia honei or Rickettsia conorii, respectively. Probable infection was defined as IgM titre ≥1:400 to O. tsutsugamushi, an IgM titre of ≥1:800 or IgG ≥1:1600 to R. typhi or an IgG titre of ≥1:200 to R. honeii or R. conorii. Univariate and multivariable logistic regression was used to identify associations.ResultsAmong 944 participants, the median (range) age was 37 (12-94) years, 444 (47.0%) were female, and 704 (74.6%) resided in rural areas. Among participants, 63 (6.7%) had confirmed or probable scrub typhus and 15 (1.6%) had confirmed or probable murine typhus. No SFGR infections were identified. The odds of confirmed or probable scrub typhus were lower among females than males (adjusted odds ratio [aOR] 0.5, p = 0.014), lower among those earning >300,000 Kyat per month compared with those earning less than 100,000 Kyat per month (aOR 0.28, p = 0.039), and higher among agricultural workers compared with others (aOR 2.9, p = 0.004).ConclusionScrub typhus was common among patients presenting with fever in Yangon, murine typhus was uncommon, and SFGR was not found. Empiric treatment of severe febrile illness should include an antimicrobial with activity against rickettsial diseases. Public health campaigns targeting agricultural workers are recommended.
Strengthening respectful communication with patients and colleagues in neonatal units — developing and evaluating a communication and emotional competence training for nurse managers in Kenya
Introduction: Effective communication is essential to delivering compassionate, high-quality nursing care. The intensive, stressful and technical environment of a new-born unit (NBU) in a low-resource setting presents communication-related challenges for nurses, with negative implications for nurse well-being, team relationships and patient care. We adapted a pre-existing communication and emotional competence course with NBU nurse managers working in Kenya, explored its’ value to participants and developed a theory of change to evaluate its’ potential impact. Methods 18 neonatal nurse managers from 14 county referral hospitals helped adapt and participated in a nine-month participatory training process. Training involved guided ‘on the job’ self-observation and reflection to build self-awareness, and two face-to-face skills-building workshops. The course and potential for future scale up was assessed using written responses from participant nurses (baseline questionnaires, reflective assignments, pre and post workshop questionnaires), workshop observation notes, two group discussions and nine individual in-depth interviews. Results Participants were extremely positive about the course, with many emphasizing its direct relevance and applicability to their daily work. Increased self-awareness and ability to recognize their own, colleagues’ and patients’ emotional triggers, together with new knowledge and practical skills, reportedly inspired nurses to change; in turn influencing their ability to provide respectful care, improving their confidence and relationships and giving them a stronger sense of professional identity. Conclusion Providing respectful care is a major challenge in low-resource, high-pressure clinical settings but there are few strategies to address this problem. The participatory training process examined addresses this challenge and has potential for positive impacts for families, individual workers and teams, including worker well-being. We present an initial theory of change to support future evaluations aimed at exploring if and how positive gains can be sustained and spread within the wider system.
Trends in inpatient antibiotic use in Indonesia and the Philippines during the COVID-19 pandemic.
ObjectiveIncreased antibiotic use (AU) has been reported globally during the COVID-19 pandemic despite low rates of bacterial co-infection. We assessed changes in AU during the COVID-19 pandemic in Indonesia and the Philippines.MethodsWe evaluated hospital-wide AU over 36 months in six hospitals, 3 in Indonesia and 3 in the Philippines. Intravenous antibiotics commonly used for respiratory conditions were selected and grouped for analysis. AU rates were calculated as monthly defined daily dose per 1000 patient-days or patient discharges. Median AU rates were compared from the pre-pandemic (March 2018-February 2020) and pandemic periods (March 2020-February 2021) using quantile regression to assess for statistical significance. Changes in AU during the COVID-19 pandemic were analyzed using interrupted time series analysis.ResultsSignificant increases were noted in the median AU rate from the pre-pandemic to pandemic period of all antibiotics combined in 3/6 hospitals (percentage change, Δ, 12.5%-63.6%) and anti-pseudomonal antibiotics in 3/6 hospitals (Δ 51.5%-161.5%). In the interrupted time series analysis, an immediate increase (range: 125.40-1762) in the use of all included antibiotics combined was observed in 3/6 hospitals at the onset of the COVID-19 pandemic. One of these 3 hospitals experienced a statistically significant sustained increase, while another experienced a decrease over time.ConclusionsWe observed significant increases in facility-wide inpatient AU during the COVID-19 pandemic in our participating hospitals in Indonesia and the Philippines. These findings reinforce the importance of antibiotic stewardship practices to optimize AU, especially during infectious disease pandemics.
Exploring early childhood development programming in Kenya’s arid and semi-arid lands
Background: Promoting high-quality early childhood development (ECD) is vital for individuals’ physical and social well-being and yields significant societal returns. However, children in marginalised regions like Kenya’s arid and semi-arid lands (ASALs) face significant barriers to accessing quality ECD services. Aim: This study aimed to document existing ECD services in Kenya’s ASAL areas, including their availability, types and key characteristics; identify gaps in their provision and propose solutions to enhance access and quality. Setting: This qualitative study was conducted in 10 ASAL counties in Kenya. Methods: Using purposive and snowball sampling techniques, 103 key informants, including pre-primary teachers, parents, healthcare workers, religious leaders and county ECD coordinators, were interviewed. The interviews were audio-recorded, transcribed verbatim and analysed thematically. Results: The study found that while diverse ECD programmes exist in ASAL regions, their quality and effectiveness are hindered by challenges such as inadequate funding, insecurity, extreme weather events, food insecurity, poor infrastructure, inadequate healthcare access and limited early learning opportunities. Recommendations include increasing ECD funding, improving healthcare, enhancing early learning opportunities, promoting livelihood diversification and addressing security and food insecurity. Conclusion: Despite investments in ECD programmes, significant challenges persist, underscoring the need to provide children with high-quality services that foster nurturing care and mitigate risks to their development. This study highlights the urgency of adopting a multi-sectoral approach to strengthen ECD programmes and services in Kenya’s ASAL. Contribution: This article contributes to the scarce literature on ECD programming in Kenya’s ASALs by documenting existing ECD services, identifying critical gaps in their provision and offering actionable recommendations to address barriers to programme quality and effectiveness.
Metagenomic exploration of antimicrobial resistance genes in marine bacteria ecosystem
Background: Antibiotic resistance (AMR) is a crucial threat to human health and challenges the effectiveness of clinical interventions. Antibiotic resistance is often perpetuated by the indiscriminate use of antibiotics leading to selection pressure and the transfer of the resistance genes between humans, domestic animals, and the environment. Being the ultimate recipient of runoffs and effluents, the marine environment is a potential reservoir of Antimicrobial Resistance Genes (ARGs). Terrestrial input from anthropogenic activities such as the indiscriminate use of antibiotics drives the accumulation of ARGs in the marine environment. The dissemination of these genes in the marine environment is aided by Horizontal Gene Transfer (HGT) using Mobile Genetic elements (MGEs). Despite the reported evidence on the presence of ARGs in world oceans, antimicrobial resistance monitoring in the African marine environment remains limited. Methods This exploratory study conducted a bioinformatics-based screening for Antimicrobial Resistance Genes (ARGs) using secondary data from the European Nucleotide Archive (ENA). Antimicrobial Resistance Gene screening was done using the Resistance Gene Identifier and AMRFinderPlus tools. Results We found 38 different Antimicrobial Resistance Genes (ARGs) classified into 10 drug classes from the analyzed marine metagenomes. The most abundant genes identified include vanT and vanY belonging to the glycopeptide class, adeF in fluoroquinolone and tetracycline, bla OXA and bla SGM in the b-lactam class, and qacG in the small multidrug resistance group. Conclusion These findings underscore the crucial role of the marine environment in harbouring resistance genes, particularly in the African region, highlighting the urgent need to integrate environmental screening in the surveillance and monitoring programs of AMR.