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Microneurosurgical techniques remain crucial for managing neurosurgical diseases, especially in low- and middle-income countries (LMICs) where other advanced treatment modalities are not available. The global distribution of these techniques is uneven due to disparities in infrastructure, equipment, and training. Medical professionals from LMICs face barriers in reaching training centers in high-income countries, as well as in accessing microsurgical techniques. To address these disparities in microsurgery training, we offer free and accessible microsurgery training model by combining the donations of microsurgery kits with a comprehensive support system that includes live-streamed, offline, and in-person assistance within LMICs.
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Países en Desarrollo , Microcirugia , Humanos , Microcirugia/educación , Microcirugia/métodos , Procedimientos Neuroquirúrgicos/educación , Procedimientos Neuroquirúrgicos/métodos , Competencia Clínica , Educación a Distancia/métodos , Neurocirugia/educaciónRESUMEN
BACKGROUND: Sentinel lymph node mapping is a minimally invasive surgical staging procedure that allows identification of macro- and micrometastases. The implementation of sentinel lymph node mapping to women with low-grade endometrial cancer allows detection of lymph node metastases and avoids the morbidity of radical pelvic lymphadenectomy. The extent of myometrial invasion is highly predictive of lymph node metastases but is hard to determine precisely preoperatively. The exact rate of lymph node metastases in the large group of women with <50% myometrial invasion is low but unknown. The benefit of detecting metastases in this group should balance the risk of lymphedema. There is limited knowledge of early and late lymphedema and its impact on the quality of life in women with low-grade endometrial cancer following sentinel lymph node mapping. OBJECTIVE: The primary objective was to investigate the risk of patient-reported lymphedema after SLN mapping in women with low-grade endometrial cancer. In addition, we aimed to evaluate risk factors for lymphedema and the condition-specific quality of life (QoL) among women who reported lymphedema 12 months after surgery. STUDY DESIGN: Women with presumed stage I low-grade endometrial cancer were included in a national prospective cohort study on SLN mapping from March 2017-February 2022. Women completed a package of validated patient-reported outcome measures (PROMs) before surgery, three and 12 months after surgery. The primary outcome was the leg lymphedema domain score from the European Organisation for Research and Treatment of Cancer endometrial cancer-specific module (EORTC QLQ-EN24). The lymphedema assessment was further supplemented by seven validated single items from the EORTC item library addressing lymphedema of legs, genitals, and groin. The disease-specific QoL was assessed using the validated Lymphedema quality of life tool (LYMQOL). Scores were linearly transformed to 0-100. A change from baseline of 8 points in leg lymphedema sum-score was considered clinically important. Mean difference scores over time with 95% CI were estimated. Multiple linear regression models evaluated baseline predictors associated with the 12 month postoperative lymphedema score, and if early lymphedema predicted lymphedema at 12 months after surgery. Lymphedema condition-specific QoL was evaluated for women with lymphedema. RESULTS: Seventy-nine % (486/617) completed PROMs at baseline and 12 months. The mean difference score of leg lymphedema from baseline to 12 months was 5.0, CI [3.3, 6.8], i.e., below the threshold for clinical importance. Baseline leg lymphedema score and BMI were positively associated with the leg lymphedema score at 12 months. The leg lymphedema score at three months was associated with a higher 12-month score. High scores of lymphedema at 12 months were negatively associated with the women's daily activities, appearance, emotional functioning, and global QoL and increased their subjective symptom burden. CONCLUSIONS: Women with low-grade endometrial cancer have a low risk of lymphedema after SLN mapping. Leg swelling at baseline and BMI predicted more lymphedema at 12 months after surgery. Early lymphedema at three months predicted persistent lymphedema. A high leg lymphedema score at 12 months is associated with impairment in several aspects of QoL.
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BACKGROUND: The digital transformation in health care requires training nursing and health professionals in the digitally competent use of digital assistive technologies (DAT). The continuing education training "Beratende für digitale Gesundheitsversorgung" ("Consultant for Digital Healthcare") was developed to fill this gap. The effectiveness of the training program will be assessed in this study. OBJECTIVE: The primary objective is to record and measure the participants' learning success. We will assess whether the previously defined teaching intentions, learning objectives, competencies, and participants' expectations have been achieved and whether a transfer of learning occurred. The secondary objective is participant satisfaction and feasibility of the training. The tertiary objective is the successful transfer of DAT by participants in their institutions. METHODS: Approximately 65 nursing and health care professionals will participate in the pilot phase of the further training and evaluation process, which is planned in a mixed methods design in a nonsequential manner. The different methods will be combined in the interpretation of the results to achieve a synaptic view of the training program. We plan to conduct pre-post surveys in the form of participant self-assessments about dealing with DAT and content-related knowledge levels. Exploratory individual interviews will also be conducted to build theory, to examine whether and to what extent competence (cognition) has increased, and whether dealing (affect) with DAT has changed. Furthermore, an interim evaluation within the framework of the Teaching Analysis Poll (TAP) will occur. The knowledge thereby gained will be used to revise and adapt the modules for future courses. To assess the transfer success, the participants create a practical project, which is carried out within the training framework, observed by the lecturers, and subsequently evaluated and adapted. RESULTS: We expect that the learning objectives for the continuing education training will be met. The attendees are expected to increase their level of digital competence in different skills areas: (1) theoretical knowledge, (2) hands-on skills for planning the application and practical use of DAT, (3) reflective skills and applying ethical and legal considerations in their use, (4) applying all that in a structured process of technology implementation within their practical sphere of work. CONCLUSIONS: The aim of this study and appropriate further training program are to educate nursing and health care professionals in the use of DAT, thereby empowering them for a structured change process toward digitally aided care. This focus gives rise to the following research questions: First, how should further training programs be developed, and which focus is appropriate for addressee-appropriate learning goals, course structure, and general curriculum? Second, how should a training program with this specific content and area be evaluated? Third, what are the conditions to offer a continued program? INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/57860.
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Educación Continua , Humanos , Educación Continua/métodos , Evaluación de Programas y Proyectos de Salud , Personal de Salud/educación , Encuestas y CuestionariosRESUMEN
OBJECTIVES: The objective of this study was to establish normative data and cut-off scores for the Children Voice Handicap Index-10 (CVHI-10) and the Children Voice Handicap Index-10 for Parents (CVHI-10-P) METHODS: For normative data, CVHI-10 and CVHI-10-P questionnaires originally developed in the Italian language were completed by 201 children without dysphonia and with no history of voice disorders, and by 1 of their parents. The results were analyzed for mean, standard deviation (SD), and standard error of the mean (SEM) for both questionnaires. For cut-off values determination, data from 49 dysphonic children and from 1 of their parents were also used. This analysis was based on the sensitivity and specificity indicators of the questionnaires using the "receiver operating characteristic" (ROC) curve. RESULTS: Analysis of the questionnaires related to healthy children revealed a mean of 0.26 (SD 0.74; SEM 0.06) for CVHI-10 and a mean of 0.15 (SD 0.49; SEM 0.04) for CVHI-10-P for the normative values. ROC curve analysis allowed us to establish the cut-off scores of 2.5 for CVHI-10 and 1.5 for CVHI-10-P. CONCLUSIONS: This study offers normative data for CVHI-10 and CVHI-10-P and provides cut-off values for both questionnaires to distinguish healthy and pathologic responders.
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Introduction: Despite growing efforts to increase diversity in recruitment and to teach principles of diversity, equity, and inclusion (DEI), representation of individuals underrepresented in medicine continues to fall short. This demonstrates a need for efforts that target the work environment and culture to increase retention alongside existing recruitment initiatives. We designed this interactive allyship workshop with a focus on building skills necessary for being an ally that has been missing in existing allyship curricula. Methods: This workshop was led by multidepartmental faculty with experience in DEI training. Participants engaged in a number of interactive activities to reflect on their own identities and privilege and practiced ways to engage in difficult conversations. Prior to the workshop, participants completed a survey that was repeated at the workshop's completion to evaluate their perspective change and understanding of allyship. We also collected responses to a self-reflective exercise during the workshop. Results: Participants included 68 anesthesia and surgery attendees, 53 of whom (78%) completed the postsurvey. Participants strongly agreed that this workshop was important to the workplace and medical training. Themes from the self-reflective exercises included endorsement of sponsorship and mentorship activities, community support, and advocacy. Discussion: Interactive skill-building activities are important and effective at helping trainees develop as allies. Long-term follow-up is needed to assess longitudinal knowledge retention and translation into behavioral change to create a more inclusive and supportive work environment.
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Curriculum , Educación , Humanos , Educación/métodos , Encuestas y Cuestionarios , Diversidad Cultural , MentoresRESUMEN
BACKGROUND AND OBJECTIVE: Competency-based education is recognized for evaluating dental students' knowledge and skills. However, practical management training, which is the hands-on education and experience in managing operations and patient interactions, does not align fully with this framework. This study aims to assess professional competence and related factors among dental students using self-assessment, contributing to dental education literature, and identifying areas for improvement. METHODS: A cross-sectional study included 50 total senior dental students from a top-ranked dental school. With a response rate of 100%, data were collected using a structured questionnaire with three sections: personal information, self-assessment of professional competency, and factors influencing competency. Statistical analysis, including descriptive statistics and tests like Chi-square and ANOVA, analyzed the data. RESULTS: The average self-reported professional competence score was 71.15 with a standard deviation of 3.05. Associations between age, gender, grade point average (GPA), and self-reported professional competence were assessed, with no significant links found (p > 0.05). Influential factors included interaction with clinical instructors (69.24%) and interest in dentistry (67.03%). No significant differences in self-reported professional competence were observed among students residing on-campus versus off-campus. CONCLUSION: Age, gender, and GPA do not significantly impact dental students' self-reported professional competence. Positive interaction with instructors and interest in dentistry contribute to skill development. Practical experience and effective educational relationships are crucial. Dental education institutions should improve clinical competence by fostering strong student-instructor relationships, increasing hands-on clinical training, and fostering student interest in dentistry.
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INTRODUCTION: The aim of this study was to assess the implementation of safe medication practices in hospital emergency services, in order to understand the points of greatest risk as well as the safety challenges faced by these departments, and to plan collaboratively improvement initiatives. METHOD: Multicentric and descriptive study based on completion of the "Medication safety self-assessment of emergency services" from 5/16/2023 to 11/16/2023, at voluntarily participating emergency services. The survey contained 93 items grouped into 10 key elements. Mean score and mean percentages based on the maximum possible values for the overall survey, for the key elements and for each individual item of evaluation, were assessed. RESULTS: A total of 72 emergency services completed the questionnaire. The mean score obtained for the overall questionnaire was 428.3 points (51.1% of the maximum score). Results showed a large variation among the scores of the participating services (range: 164-620.5). Four key elements had values below 50%, corresponding to competence and training of professionals in safety practices (38.4%); incorporation of pharmacists in emergency departments (42.1%), availability and accessibility of information about patients (43.1%), and patient education (48.1%). The highest values corresponded to labeling, packaging, and naming of medications (69.2%) and communication of prescriptions and other medication information (64%). No differences were found between emergency services in the key elements according to the dependency or size of the hospital, or the type of service, except for the item referring to the incorporation of pharmacists in the emergency service, where differences were observed between hospitals with less than 200 beds (28.9%) and those with more than 500 (52.2%). CONCLUSION: The application of the specific self-assessment questionnaire has made it possible to identify safety practices that are insufficiently implemented into emergency services in our country and to identify critical points for improvement for which planning collaborative initiatives to reduce medication errors in these departments should become a priority.
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BACKGROUND: Partial thickness rotator cuff tears significantly affect physical and psychosocial well-being. This study aimed to compare the efficacy of physiotherapist-supervised exercise and physiotherapist-prescribed home exercise programs on physical and psychosocial health measures in partial thickness rotator cuff tears. METHODS: Seventy patients with partial thickness rotator cuff tears (44 female; mean age, 50.1 ± 5.2 years) were divided into 2 groups. Both the physiotherapist-supervised exercise group (group 1, n = 35) and physiotherapist-prescribed home exercise group (group 2, n = 35) received a program consisting of glenohumeral joint range of motion, stretching, and strengthening exercises (twice a week for eight weeks). The primary outcome measures were the modified Constant-Murley Score (mCMS) and the Hospital Depression and Anxiety Scale. Secondary outcome measures were the visual analog scale, active range of motion (AROM), Pain Catastrophizing Scale, Pittsburg Sleep Quality Index, Short Form-12, and Global Rating of Change Scale. Patients were assessed at baseline and the end of the treatment. The significance level was adjusted to 0.025 after the Bonferroni correction. RESULTS: Both groups showed significant improvements in all measures after treatment. There were no statistically significant group-by-time interactions for the mCMS (F = 12.47, P = .03) and the Hospital Depression and Anxiety Scale (F = 0.89, P = .14 for depression; F = 0.73, P = .44 for anxiety). However, the improvement in the mCMS was clinically meaningful in both groups. The overall group-by-time interaction was significant for the visual analog scale activity (P = .004), shoulder flexion (P = .01) and abduction (P = .02) AROM, and Pain Catastrophizing Scale (P = .005) in favor of group 1. CONCLUSION: Exercise effectively improves physical and psychosocial health measures in partial thickness rotator cuff tears when delivered in the clinic or at home. However, exercise is more effective for activity pain, AROM, and pain catastrophizing when delivered in the clinic, highlighting the effectiveness of the physiotherapist-supervised exercise program.
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Genome Resources Banks (GRBs) represent vital repositories for the systematic collection, storage, and management of genetic material across various taxa, with a primary objective of safeguarding genetic diversity for research and practical applications. Alongside the development of assisted reproductive techniques (ART), GRBs have evolved into indispensable tools in conservation, offering opportunities for species preservation, mitigating inbreeding risks, and facilitating genetic management across fragmented populations. By preserving genetic information in a suspended state, GRBs serve as backups against population vulnerabilities, potentially aiding in the restoration of endangered species and extending their genetic lifespan. While evidence demonstrates the efficacy of GRBs, ethical considerations surrounding biobanking procedures for wildlife conservation remain largely unexplored. In this article, we will discuss possible ethical issues related to GRBs and the need to ethically monitor biobanking procedures in wildlife conservation. We will then propose a methodological tool, ETHAS, already in use for the ethical self-assessment of assisted reproduction techniques, to assess also biobanking procedures. ETHAS can make it possible to monitor a GRB from its design phase to its actual operation, helping to build biobanking procedures that meet high ethical standards.
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The World Health Organization emphasizes the importance of providing integrated care for older people. Taiwan is the fastest aging country in the world. In 2016, Taiwan implemented the Long-Term Care Plan 2.0 (TLTCP 2.0), aimed at providing integrated long-term care (LTC) services in communities. However, LTC service agencies have not been able to evaluate the level of integrated care they provide due to the lack of an effective assessment tool. To address this need, this study sets out to develop an integration assessment tool, namely the Self-Assessment for Service Integration in Long-Term Care (SASI-LTC), which will allow LTC agencies to self-evaluate their current level of integration from multiple perspectives. The SASI-LTC was developed based on Evashwick's framework, underwent two rounds of Delphi panels with twenty-six experts, and a pilot test with 243 valid questionnaires from administrators of Tier A agencies who are responsible for integrating LTC. The Delphi experts assessed the content with high levels of agreement using medians, the scale content validity index (SCVI) and item content validity index (ICVI). The SASI-LTC included four domains (inter-entity organization and management, integrated care coordination, integrated resources, and integrated information systems) with thirty items. The SASI-LTC showed good reliability (Cronbach's α = 0.94) and good validity, and a confirmatory factor analysis showed a good model fit index [χ2/df = 1.38; RMSEA = 0.040; CFI = 0.963; SRMR = 0.049] in pilot testing. While the SASI-LTC is a useful and feasible tool for Taiwan's LTC service agencies to evaluate their level of integration in providing LTC services, it could also be used in other countries with minor adjustments to localization of items related to financial integration.
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Prestación Integrada de Atención de Salud , Técnica Delphi , Cuidados a Largo Plazo , Autoevaluación (Psicología) , Cuidados a Largo Plazo/organización & administración , Humanos , Taiwán , Prestación Integrada de Atención de Salud/organización & administración , Reproducibilidad de los Resultados , Anciano , Encuestas y Cuestionarios , FemeninoRESUMEN
BACKGROUND: Evaluating the psychometric and clinical performances of the RM-18, the shorter version of the Roland Morris Disability Questionnaire (RMQ), in Italian people with non-specific low back pain (NSLBP) as a time-saving and clinically useful method of assessing disability. METHODS: This cross-sectional study included 74 people (52 females and 22 males, 53.03 ± 15.25 years old) with NSLBP. The RM-18, the RMQ, the Oswestry Disability Index (ODI), and a pain intensity numerical rating scale (NRS) were administered. Psychometric testing included reliability by internal consistency (Cronbach's alpha) and test-retest measurement (Intraclass Correlation Coefficient, ICC2.1), and concurrent validity by comparing the RM-18 with the RMQ and the ODI (Pearson's r correlation). Two separate regression analyses were performed to investigate the different impact of RM-18 and RMQ on NRS. RESULTS: Cronbach's α of RM-18 was 0.92 and ICC (2,1) = 0.96. Strong correlations were found with the RMQ and the ODI (r = 0.98; r = 0.78, respectively). The regression models showed that the RM-18 and the RMQ similarly impacted the NRS (p < 0.001). CONCLUSION: The RM-18 showed satisfactory psychometric testing and similarly impacted the NRS when compared to the RMQ. It can be recommended for clinical and research purposes in Italian people with NSLBP.
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(1) Background: The COVID-19 pandemic has brought about a change in the concept of teaching with the introduction of online lectures and "distance learning." The aim of this study was to determine the impact of the COVID-19 pandemic on the confidence and both theoretical and practical knowledge of dental students regarding the courses in conservative dentistry and endodontics. (2) Methods: The study was conducted using an originally created online questionnaire consisting of 30 questions that the students used to make a subjective assessment of their confidence in performing both endodontic and conservative procedures using numerical scales. They were divided into two groups, a non-COVID group of students, who attended classes before the outbreak of the pandemic, and a COVID group, whose classes were suspended due to the lockdown. The data were processed in the SPSS statistic 25 program, with statistical significance p < 0.05. (3) Results: The comparison of the self-assessment of 96 students from the COVID group and 91 students from the non-COVID group revealed significant results. Compared with the COVID group, the non-COVID students felt more confident in the application of anesthesia in both the maxilla and mandible, in the initial treatment of patients in pain, as well as in all the steps of the endodontic treatment. Both groups felt equally confident in diagnostic and conservative procedures, and the level of theoretical knowledge acquired in the courses. (4) Conclusions: Changes in teaching due to the COVID-19 pandemic had an unfavorable effect on students' self-confidence in performing routine dental interventions, especially in the endodontic field. The lack of confidence in the COVID group regarding the anesthetic and endodontic procedures appears due to their inability to do any of these procedures during the COVID period; we organized summer practical school under the supervision of teachers, and they gained the necessary knowledge and self-confidence for these procedures.
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BACKGROUND: The ever-evolving healthcare system of today demands physicians who steer their roles as treatment providers, managers and collaborators. Professionals are highly interdependent due to increased complexity of health problems and risk of errors increases with transitions in care. In hospitals, the main workforce is postgraduate residents; therefore, intraprofessional collaboration amongst residents is essential. Several instruments are available to evaluate interprofessional collaboration amongst physicians, nurses and hospital teams but none specifically assessed intra-professional collaborative practices amongst residents working in tertiary care hospitals in multi-disciplinary teams. This study intends to develop and validate an instrument to self-assess intraprofessional collaborative practices in postgraduate residents undergoing residency in multiple specialties at tertiary care hospitals. APPROACH: This study on Instrument Development employed mixed method study design executed in two phases. In phase 1, six domains of intraprofessional collaborative practices were identified from literature and 35 items were developed. Fifteen experts participated in qualitative content validation and provided comments. To establish content validity in phase 2, content validity index (CVI) and content clarity average (CCA) were assessed by seventeen experts. Response process validity was established by cognitive interviewing of 5 postgraduate residents. Pilot testing was done on a sample of 407 residents. Cronbach's alpha was determined, and confirmatory factor analysis established construct validity. RESULTS: During phase 1, items were modified based on qualitative feedback from 15 experts. In round 2, CVI and CCA were determined based on responses of 17 experts. The items having an I-CVI greater than 0.90 were accepted and six items underwent modifications as their I-CVI fell between 0.78 and 0.90. Similarly, four items with a CCA of less than 2.4 were modified to increase clarity. Cognitive interviews of participants on 30 items resulted in the deletion of 1 item and changes in 5 items. The final instrument had 29 items categorized under six constructs. All items had good factor loadings during CFA, so none was deleted. Cronbach's Alpha α was 0.937. CONCLUSION: Intraprofessional collaborative practices in residents is a valid and reliable self-assessment tool comprising 29 items measuring six constructs. It may be used by residents to assess their collaborative practices and incorporated in curricula to help develop collaborative practices and their assessment during training of postgraduate residents.
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Conducta Cooperativa , Internado y Residencia , Autoevaluación (Psicología) , Centros de Atención Terciaria , Humanos , Relaciones Interprofesionales , Reproducibilidad de los Resultados , Educación de Postgrado en Medicina , Femenino , Masculino , Encuestas y Cuestionarios , Grupo de Atención al PacienteRESUMEN
Background: Most neovascular age-related macular degeneration treatments involve long-term follow-up of disease activity. Home monitoring would reduce the burden on patients and those they depend on for transport, and release clinic appointments for other patients. The study aimed to evaluate three home-monitoring tests for patients to use to detect active neovascular age-related macular degeneration compared with diagnosing active neovascular age-related macular degeneration by hospital follow-up. Objectives: There were five objectives: Estimate the accuracy of three home-monitoring tests to detect active neovascular age-related macular degeneration. Determine the acceptability of home monitoring to patients and carers and adherence to home monitoring. Explore whether inequalities exist in recruitment, participants' ability to self-test and their adherence to weekly testing during follow-up. Provide pilot data about the accuracy of home monitoring to detect conversion to neovascular age-related macular degeneration in fellow eyes of patients with unilateral neovascular age-related macular degeneration. Describe challenges experienced when implementing home-monitoring tests. Design: Diagnostic test accuracy cohort study, stratified by time since starting treatment. Setting: Six United Kingdom Hospital Eye Service macular clinics (Belfast, Liverpool, Moorfields, James Paget, Southampton, Gloucester). Participants: Patients with at least one study eye being monitored by hospital follow-up. Reference standard: Detection of active neovascular age-related macular degeneration by an ophthalmologist at hospital follow-up. Index tests: KeepSight Journal: paper-based near-vision tests presented as word puzzles. MyVisionTrack®: electronic test, viewed on a tablet device. MultiBit: electronic test, viewed on a tablet device. Participants provided test scores weekly. Raw scores between hospital follow-ups were summarised as averages. Results: Two hundred and ninety-seven patients (mean age 74.9 years) took part. At least one hospital follow-up was available for 317 study eyes, including 9 second eyes that became eligible during follow-up, in 261 participants (1549 complete visits). Median testing frequency was three times/month. Estimated areas under receiver operating curves were < 0.6 for all index tests, and only KeepSight Journal summary score was significantly associated with the lesion activity (odds ratioâ =â 3.48, 95% confidence interval 1.09 to 11.13, pâ =â 0.036). Older age and worse deprivation for home address were associated with lower participation (χ2â =â 50.5 and 24.3, respectively, pâ <â 0.001) but not ability or adherence to self-testing. Areas under receiver operating curves appeared higher for conversion of fellow eyes to neovascular age-related macular degeneration (0.85 for KeepSight Journal) but were estimated with less precision. Almost half of participants called a study helpline, most often due to inability to test electronically. Limitations: Pre-specified sample size not met; participants' difficulties using the devices; electronic tests not always available. Conclusions: No index test provided adequate test accuracy to identify lesion diagnosed as active in follow-up clinics. If used to detect conversion, patients would still need to be monitored at hospital. Associations of older age and worse deprivation with study participation highlight the potential for inequities with such interventions. Provision of reliable electronic testing was challenging. Future work: Future studies evaluating similar technologies should consider: Independent monitoring with clear stopping rules based on test performance. Deployment of apps on patients' own devices since providing devices did not reduce inequalities in participation and complicated home testing. Alternative methods to summarise multiple scores over the period preceding a follow-up. Trial registration: This trial is registered as ISRCTN79058224. Funding: This award was funded by the National Institute of Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/97/02) and is published in full in Health Technology Assessment; Vol. 28, No. 32. See the NIHR Funding and Awards website for further award information.
Treatment for neovascular age-related macular degeneration, the most common cause of sight loss in those over 50 years, involves regular eye injections and frequent follow-up appointments. This is inconvenient for patients and causes capacity issues in the hospital eye service. Finding tests that could be undertaken at home that could detect if a further injection and hospital appointment was required or not would increase capacity to see those at highest risk of sight loss and also reduce the burden on patients and their carers. We investigated three different visual function tests, one paper-based and two applications on an iPod TouchTM tablet (Apple, Cupertino, CA, USA). We wanted to see if they could detect an increase in disease activity that would require treatment, compared to the decision by a retinal specialist at a traditional hospital eye outpatient visit based on clinical examination and retinal imaging. To encourage those without a smartphone or home internet to participate, we provided both an iPod Touch and Mobile Wireless-Fidelity device with a mobile contract. None of the tests performed well enough to safely monitor patients at home. Those who were willing to participate tended to be younger, had previous experience of using smartphones, sending e-mail and internet access and were more well-off than those who chose not to participate. Some participants also experienced difficulties with the devices provided and successfully uploading the data which were not related to the extent of previous information technology experience. There were also significant technical challenges for the research team. The study helpline was used heavily, considerably more than we anticipated. These tests are not ready to be used in this context. Future studies involving mobile health technology need to carefully consider how to reach those unlikely to participate and provide sufficient technical support to support long-term follow-up.
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Degeneración Macular , Humanos , Reino Unido , Anciano , Masculino , Femenino , Anciano de 80 o más Años , Degeneración Macular/diagnóstico , Agudeza Visual , Evaluación de la Tecnología BiomédicaRESUMEN
OBJECTIVE: To assess the effect of the toothbrush handle on video-observed toothbrushing behaviour and toothbrushing effectiveness. METHODS: This is a randomized counterbalanced cross-over study. N = 50 university students and employees brushed their teeth at two occasions, one week apart, using either a commercial ergonomically designed manual toothbrush (MT) or Brushalyze V1 (BV1), a manual toothbrush with a thick cylindrical handle without any specific ergonomic features. Brushing behaviour was video-analysed. Plaque was assessed at the second occasion immediately after brushing. Participants also rated their self-perceived oral cleanliness and directly compared the two brushes regarding their handling and compared them to the brushed they used at home. RESULTS: The study participants found the BV1 significantly more cumbersome than the M1 or their brush at home. (p < 0.05). However, correlation analyses revealed a strong consistency of brushing behavior with the two brushes (0.71 < r < 0.91). Means differed only slightly (all d < 0.36). These differences became statistically significant only for the brushing time at inner surfaces (d = 0.31 p = 0.03) and horizontal movements at inner surfaces (d = 0.35, p = 0.02). Plaque levels at the gingival margins did not differ while slightly more plaque persisted at the more coronal aspects of the crown after brushing with BV1 (d = 0.592; p 0.042). DISCUSSION: The results of the study indicate that the brushing handle does not play a major role in brushing behavior or brushing effectiveness.
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Estudios Cruzados , Cepillado Dental , Humanos , Cepillado Dental/instrumentación , Masculino , Femenino , Adulto , Adulto Joven , Diseño de Equipo , Placa Dental , Grabación en Video , Hábitos , Índice de Placa Dental , Ergonomía , Persona de Mediana Edad , Dispositivos para el Autocuidado Bucal , Higiene Bucal , Factores de TiempoRESUMEN
BACKGROUND: The high prevalence of osteoporosis has increased the economic burden on the health system globally. The burden of osteoporosis and its associated factors have not been adequately assessed in community settings in the Nepalese context thus far. Therefore, this study aimed to assess the prevalence of osteoporosis and its associated factors, lifestyle behaviors, and dietary calcium intake. METHODS: A community-based cross-sectional study was conducted among 395 people aged 50 years and older in the Madhesh Province of Nepal between July 2022 and August 2023. The Osteoporosis Self-assessment Tools for Asians (OSTA) index was used to measure osteoporosis. A structured questionnaire was used to collect sociodemographic information, anthropometric data, lifestyle behavior, daily dietary calcium intake, and frequency of calcium-rich food consumption. A food frequency questionnaire and 24-hour recall methods were used to assess dietary intake. The chi-square test, binary logistic regression and MannâWhitney U test were applied to measure the association between predictors and the outcome of interest. RESULTS: The prevalence of no risk, moderate risk and high risk of osteoporosis were 38.7%, 39%, and 22.3% respectively. The risk of osteoporosis was higher in females (aOR = 5.18, CI: 2.10-12.75, p < 0.001) and increased risk with advancing age (aOR = 32.49, CI: 14.02-75.28, p < 0.001). Similarly, underweight was associated with increased odds of having osteoporosis (aOR = 13.42, CI = 4.58-39.30, p < 0.001). The incidence of osteoporosis was strongly associated with daily calcium intake of 225 mg (100, 386). CONCLUSION: This study revealed a high prevalence of osteoporosis among people aged 50 years and older due to the combined effect of being underweight and having inadequate calcium intake. Nutritional counselling services encourage people to consume sufficient calcium-rich food and adopt an appropriate lifestyle behaviours to maintain healthy body weight so that osteoporosis and osteoporotic fractures could be prevented. Further research can explore the impact of socioeconomic status and medical comorbidities on a large scale.
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Calcio de la Dieta , Estilo de Vida , Osteoporosis , Humanos , Femenino , Masculino , Nepal/epidemiología , Estudios Transversales , Osteoporosis/epidemiología , Persona de Mediana Edad , Prevalencia , Anciano , Calcio de la Dieta/administración & dosificación , Factores de Riesgo , Encuestas y Cuestionarios , Anciano de 80 o más AñosRESUMEN
Objectives. Self-assessment of health is one of the most important factors determining manifestations in care for health, expressed in health-promoting behaviours. The way a person takes care of their health affects not only their health but also their well-being, quality of life and work ability. This study aimed to present results regarding self-assessment of health and care for health and the relationship with work ability in a group of working men aged 20-65 years. Methods. The sample of 600 men were assessed using a survey. The work ability index was used to measure work ability. An original survey was developed, which included questions about self-assessment of health and taking care of health, motives for taking care of health, physical activity, healthy eating and smoking. Results. Most men rated their health well and declared that they took care of it. Low health scores were obtained among overweight men, men without physical activity, men with unhealthy nutrition and smokers. High self-rated health was associated with good work ability. Conclusions. There is a constant need to make men of all ages aware of the role of individual health care in maintaining good health and high work ability.
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Autoevaluación (Psicología) , Humanos , Masculino , Polonia , Adulto , Persona de Mediana Edad , Anciano , Estado de Salud , Conductas Relacionadas con la Salud , Ejercicio Físico , Encuestas y Cuestionarios , Fumar/epidemiología , Adulto Joven , Calidad de Vida , MotivaciónRESUMEN
Background: Presently, dental hygiene education is primarily divided into classroom lectures, simulation labs, and clinical experiences. Although the recent surge of curriculum renovation in dental and medical schools centres around enhancing student engagement and active learning, classroom teaching remains teacher-focussed, involving students mainly as passive learners. H5P is an open platform for creating and sharing interactive HTML5 learning content. A large set of H5P content was created and provided to students through the learning management system as supplementary material for an oral biology course in the dental hygiene program at a Canadian university. This study was conducted to evaluate the impact of this interactive H5P content on the students' learning experiences. Methods: The third-year dental hygiene students enrolled in the oral biology course were invited to participate in the study. Anonymised student performance data from the summative exam were analysed, and a survey regarding the student experience with the supplementary H5P content was administered. Results: Students performed better on questions for which H5P supplements were provided. The results from the survey showed satisfaction and perceived benefit of using H5P as supplementary content in didactic lectures. Discussion: The H5P content allowed students to apply knowledge and reproduce understanding, promoting active learning in the didactic oral biology course. Students appreciated the content's interactive nature and expressed willingness to have similar experiences in other courses. Conclusion: Using H5P, interactive learning content can promote self-directed and personalized learning. This open learning platform has the potential to redefine didactic teaching by fostering an active learning environment.
Contexte: À l'heure actuelle, la formation en hygiène dentaire s'appuie principalement sur des exposés en classe, des simulations en laboratoire et des expériences cliniques. Bien que la récente vague de révision des programmes d'études des écoles dentaires et de médecine soit axée sur le renforcement de l'engagement des étudiants et de l'apprentissage actif, le travail en classe reste axé sur l'enseignement par un enseignant : dans ce contexte, les étudiants sont principalement des apprenants passifs. H5P est une plateforme ouverte pour la création et le partage de contenu d'apprentissage interactif au format HTML5. Un vaste ensemble de contenu H5P a été créé et fourni aux étudiants, par l'entremise du système de gestion de l'apprentissage, à titre de matériel supplémentaire pour un cours de biologie buccale dans le cadre du programme d'hygiène dentaire d'une université canadienne. Cette étude a été effectuée pour évaluer les effets de ce contenu H5P interactif sur les expériences d'apprentissage des étudiants. Méthodes: Les étudiants en hygiène dentaire de troisième année inscrits au cours de biologie buccale ont été invités à participer à l'étude. Des données anonymisées sur le rendement des étudiants provenant de l'examen sommatif ont été analysées, et un sondage sur l'expérience des étudiants avec le contenu H5P supplémentaire a été mené. Résultats: Les résultats des étudiants étaient meilleurs pour les questions pour lesquelles du contenu H5P supplémentaire a été fourni. Les résultats de l'enquête ont révélé les avantages perçus de l'utilisation du contenu H5P supplémentaire dans les cours didactiques, ainsi que la satisfaction en la matière. Discussion: Le contenu H5P a permis aux étudiants d'appliquer les connaissances et de reproduire la compréhension, favorisant ainsi l'apprentissage actif dans le cadre des cours didactiques de biologie buccale. Les étudiants ont apprécié la nature interactive du contenu et se sont dits prêts à répéter l'expérience dans le cadre d'autres cours. Conclusion: Grâce à H5P, le contenu d'apprentissage interactif peut favoriser l'apprentissage autodirigé et personnalisé. Cette plateforme d'apprentissage ouverte a le potentiel de redéfinir l'enseignement didactique en favorisant un environnement d'apprentissage actif.
Asunto(s)
Curriculum , Higienistas Dentales , Aprendizaje Basado en Problemas , Humanos , Higienistas Dentales/educación , Aprendizaje Basado en Problemas/métodos , Evaluación Educacional , Instrucción por Computador/métodos , Enseñanza , CanadáRESUMEN
In this study, we developed and validated the Clinical Student Version of the Japanese Interprofessional Competency Self-Assessment Scale (C-JASSIC) for healthcare students in their clinical practice phase. Data obtained from 331 students (medical, 98; nursing, 99; pharmacy, 134) during orientation for interprofessional education (pre-IPE) and from 319 students (medical, 94; nursing, 93; pharmacy, 132) within a week following IPE (post-IPE) were analyzed. Exploratory pre-IPE and Confirmatory post-IPE factor analyses revealed a consistent 6-factor structure aligning with the Japanese Interprofessional Competency domains. The scale exhibited strong internal consistency, with Cronbach's α values exceeding 0.8 for all factors both pre- and post-IPE. Scores for overall competency and individual domains increased post-IPE in 234 matched cases. A notable significant pre vs post difference concerned "Understanding of Others," indicating enhanced interprofessional comprehension after clinical practice. There was a weak but significant positive correlation between IPE satisfaction and difference in pre- and post-IPE scores. However, no significant differences were observed among medical, nursing, and pharmacy students. Despite its strengths, such as its competency-based design and cultural relevance to Japan, a limitation of the study may be potential self-reporting bias. Nonetheless, C-JASSIC represents a valuable tool for seamless competency evaluations from student to professional stages, with implications for broader Asian contexts.
Asunto(s)
Relaciones Interprofesionales , Autoevaluación (Psicología) , Humanos , Competencia Clínica , Pueblos del Este de Asia , Japón , Psicometría , Reproducibilidad de los Resultados , Estudiantes del Área de la Salud/psicologíaRESUMEN
Purpose: This study aimed to reveal the association between the osteoporosis self-assessment tool for Asians (OSTA) and airflow limitation (AL) in post-menopausal Japanese women. Participants and Methods: This cross-sectional study included 1580 participants undergoing a comprehensive health examination using spirometry and dual-energy X-ray absorptiometry. The OSTA was calculated by subtracting the age in years from the body weight (BW) in kilograms, and the result was multiplied by 0.2. The OSTA risk level was defined as low (>-1), moderate (-4 to -1), or high (<-4). AL was defined as forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) <0.7. The association between the OSTA and AL was assessed using logistic regression analysis. Results: The prevalence of AL was significantly higher in the high OSTA group (15.3%) than in the low OSTA group (3.1%) (p<0.001). In multiple linear regression analysis, the OSTA was independently associated with FEV1/FVC. In logistic regression models adjusted for smoking status, alcohol consumption, current use of medication for diabetes, hyperglycemia, rheumatoid arthritis, second-hand smoke, and ovary removal showed a significantly higher risk of AL (odds ratio: 5.48; 95% confidence interval: 2.90-10.37; p<0.001) in participants with OSTA high risk than in those with OSTA low risk. Conclusion: These results suggest that the OSTA high risk indicates reduced BMD at the femoral neck and presence of AL in Japanese post-menopausal women aged ≥45 years.