Enhancing education activities for health care trainees and professionals using audience response systems: a systematic review

Introduction: This review examines the effect of incorporating clickers within practice-based education sessions on educational outcomes of health care trainees and professionals. Methods: A systematic literature review was conducted on primary research studies published up until August 2014. Studies were identified by database searching (Ovid MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and PsychInfo), citation searching, and reference list checking. Studies were restricted to those evaluating the use of clickers as part of the provision of postgraduate education or continuing education programs and were evaluated according to Kirkpatrick's four levels of training evaluation (reaction, learning, behavior, and results). Results: Seventeen studies met the eligibility criteria. Twelve studies assessed learner and/or speaker reactions, with feedback overwhelmingly positive in all studies. Reported learner benefits included increased attentiveness, engagement, and enjoyment of presentations. Speakers reported that using clickers engaged the audience and assisted in assessing audience comprehension. Eight studies assessed learning outcomes. Higher level evidence obtained from four randomized studies demonstrated significant improvements in knowledge with the use of clickers compared with traditional didactic presentations, but no differences when clickers were compared with an interactive lecture with integrated questions. No studies adequately assessed higher level educational outcomes (behavior and results). Conclusion: Although the use of clickers improves learning environment and learner satisfaction, the limited high-quality data for improvements in learning and behavior outcomes make it uncertain whether the acceptance and implementation of clickers within routine practice-based education programs are warranted at this stage.Luke E. Grzeskowiak, Alice E. Thomas, Josephine To, Adam J. Phillips, Emily Reev

Trajectories of anxiety and health related quality of life during pregnancy

Published: July 24, 2017Anxiety and health related Quality of Life (HRQoL) have emerged as important mental health measures in obstetric care. Few studies have systematically examined the longitudinal trajectories of anxiety and HRQoL in pregnancy. Using a linear growth modeling strategy, we analyzed the course of State-Trait Anxiety Inventory (STAI)- and Short Form (36) Health Survey (SF-36) scores between the 12th and the 36th week of gestation, in a sample of 355 women. We additionally analyzed the impact of depressive symptoms and a chronic medical condition (asthma), on STAI and SF-36 trajectory curves. STAI scores remained stable throughout pregnancy. A previous history of anxiety increased the overall STAI scores. Asthma and depressive symptoms scores had no impact on the STAI trajectory. Physical SF-36 scores decreased over the course of pregnancy, whereas mental SF-36 trended towards improvement. Asthma reduced physical SF-36 overall. While high depressive symptoms decreased the overall mental SF-36, they were also significantly associated with mental SF-36 improvements over time. Anxiety symptoms are stable during pregnancy and are not modulated by depressive symptoms or asthma. Physical HRQoL declines in pregnancy. In contrast, mental HRQoL appears to improve, particularly in women with high initial levels of depressive symptoms.K. Oliver Schubert, Tracy Air, Scott R. Clark, Luke E. Grzeskowiak, Edward Miller, Gustaaf A. Dekker, Bernhard T. Baune, Vicki L. Clifto

Pharmacoepidemiology and costs of medications dispensed during pregnancy: A retrospective population‐based study

First published: 11 April 2023. OnlinePublObjective: To describe the pharmacoepidemiology and costs associated with medications dispensed during pregnancy. Design: Pharmacoepidemiological study and cost analysis. Setting: Queensland, Australia. Population: All women who gave birth in Queensland between January 2013 and June 2018. Methods: We used a whole-of- population linked administrative dataset, Maternity 1000, to describe medications approved for public subsidy that were dispensed to 255 408 pregnant women. We describe the volume of medications dispensed and their associated costs from a Government and patient perspective. Main outcome measures: Prevalence of medication use; proportion of total dispensings; total medication costs in AUD 2020/21 ($1AUD =$0.67USD/£0.55GBP in December 2022). Results: During pregnancy, 61% (95% CI 60.96–61.29%) of women were dispensed at least one medication approved for public subsidy. The mean number of items dispensed per pregnancy increased from 2.14 (95% CI 2.11–2.17) in 2013 to 2.47 (95% CI 2.44–2.51) in 2017; an increase of 15%. Furthermore, mean Government cost per dispensing increased by 41% from $21.60 (95$20.99–$22.20) in 2013 to$30.44 (95% CI $29.38–$ 31.49) in 2017. These factors influenced the 53% increase in total Government expenditure observed for medication use during pregnancy between 2013 and 2017 ($2,834,227 versus$4,324,377); a disproportionate rise compared with the 17% rise in women's total out-of- pocket expenses observed over the same timeframe ($1,880,961 versus$2,204,415). Conclusions: Prevalence of medication use in pregnancy is rising and is associated with disproportionate and rapidly escalating cost implications for the Government.H. Jackson, L. E. Grzeskowiak, J. Enticott, E. Callande

Strategies towards improving pharmacological management of asthma during pregnancy

Maternal asthma represents a significant burden to individuals and the healthcare system, affecting 1 in 10 pregnancies worldwide. Approximately 50% of asthmatic women experience a deterioration of asthma control at some stage during pregnancy, with a number requiring use of oral corticosteroids for the management of acute exacerbations. The presence of maternal asthma and exacerbations during pregnancy is a noted risk factor for a range of adverse perinatal outcomes including preterm birth, small-for-gestational age, pre-eclampsia, and gestational diabetes. These negative impacts highlight the need for evidence-based approaches for improving asthma management during pregnancy and subsequent perinatal outcomes. Despite this, relatively small progress has been made in enhancing the management of maternal asthma in the clinical setting. A major challenge in improving outcomes of asthmatic pregnancies is that there is no single simplified approach for improving outcomes, but rather the requirement to consider the dynamic relationship between a myriad of interrelated factors that ultimately determine an individual's ability to maintain adequate asthma control. Understanding how these factors are impacted by pregnancy and how they can be addressed through various interventions is therefore important in optimising health outcomes. This review summarises key factors involved in influencing outcomes associated with maternal asthma. This includes an overview of the use of asthma medications in pregnancy, while also considering the impacts of interrelated aspects such as medication adherence, health-seeking behaviours, biological and lifestyle factors, co-morbidities, and asthma self-management strategies on asthma control. Addressing such factors through multidisciplinary approaches towards treatment have potential to improve the health of mothers and their offspring. Optimising asthma control should be a high priority within the antenatal setting, with women advised about the importance of good asthma control, managing asthma actively throughout pregnancy by utilising their asthma medications, and managing exacerbations in a timely and effective manner

Complete Genome Sequences of Four Staphylococcus aureus Sequence Type 398 Isolates from Four Goats with Osteomyelitis

Staphylococcus aureus is the causative agent of multiple infections, including bacteremia, infective endocarditis, osteomyelitis, septic arthritis, and prosthetic device infections. We report here the first whole-genome sequence for four S. aureus sequence type 398 isolates from clinical cases of osteomyelitis in four goats with a history of orthopedic surgery

Antidepressants for depression during pregnancy

The objectives are as follows: To assess the safety of antidepressant use, compared with placebo or psychological therapy, for the treatment of pre-existing and ante-natal depression during pregnancy. To assess the effectiveness of antidepressant use, compared with placebo or psychological therapy, for the treatment of pre-existing and ante-natal depression during pregnancy

Online platforms for prescription and supply of hormonal contraception in Australia: a mapping review

First online 4/4/23 OnlinePublOnline platforms have emerged as a convenient way for individuals to access contraception. However, the extent to which such services exist in Australia and how they operate is currently unknown. We aimed to identify Australian online contraception platforms and evaluate the services they provide to determine the degree to which they may facilitate equitable access to contraception. We conducted an internet search to identify online contraception platforms operating in Australia. Data were extracted from each of the platforms relating to operating policies, services provided and associated payment processes, as well as prescribing and screening processes for assessing user suitability. As of July 2022, eight online contraception platforms operating within Australia were identified. All platforms offered oral contraception, with two also offering the vaginal ring, and one emergency oral contraception. None of the platforms provided access to long-acting reversible contraception. Significant variability existed in product and membership costs across platforms, with only one platform providing access to subsidised medicines. Five platforms restricted services to those already using oral contraception. Overall, online questionnaires were deemed to be adequately screening for important contraindications to using oral contraception. While online contraception platforms may be a valuable option for some individuals who face access barriers and are willing to pay out-of-pocket for to have their contraception sent straight to their home, they do not necessarily ensure that individuals can access their contraceptive method of choice or address recognised financial and structural barriers to contraceptive care.Tahlee B. Stevenson, Alice Rumbold, Emily Callander, Pip Buckingham, Anisa Assifi, Danielle Mazza and Luke E. Grzeskowia

Measuring urban social sustainability:Scale development and validation

Despite the significant role of social sustainability in the sustainable development agenda, there is a lack of research to clearly define and fully operationalise the concept of urban social sustainability. The aim of this study is to contribute to the existing literature by developing a comprehensive measurement scale to assess urban social sustainability at the neighbourhood level. We argue that urban social sustainability is a multidimensional concept that incorporates six main dimensions of social interaction, sense of place, social participation, safety, social equity and neighbourhood satisfaction. Failure to consider each of these dimensions may lead to an incomplete picture of social sustainability. Validity, reliability and dimensionality of the urban social sustainability scale are examined using factor analysis. We also illustrate the application of the urban social sustainability scale by investigating the influence of quality of design, as one of the least studied factors of urban form, on different dimensions of social sustainability. The paper uses data collected from the household questionnaire survey in a sample of 251 respondents from five case study neighbourhoods of Dunedin city, New Zealand. This study provides new evidence on the significance of improving neighbourhood quality of design and its positive and significant relationship with different dimensions of social sustainability and the overall social sustainability

Temporal metabolic profiling of bone healing in a caprine tibia segmental defect model

Bone tissue engineering is an emerging field of regenerative medicine, with a wide array of biomaterial technologies and therapeutics employed. However, it is difficult to objectively compare these various treatments during various stages of tissue response. Metabolomics is rapidly emerging as a powerful analytical tool to establish broad-spectrum metabolic signatures for a target biological system. Developing an effective biomarker panel for bone repair from small molecule data would provide an objective metric to readily assess the efficacy of novel therapeutics in relation to natural healing mechanisms. In this study we utilized a large segmental bone defect in goats to reflect trauma resulting in substantial volumetric bone loss. Characterization of the native repair capacity was then conducted over a period of 12 months through the combination of standard (radiography, computed tomography, histology, biomechanics) data and ultra-high-performance liquid chromatography-high resolution mass spectrometry (UHPLC-HRMS) metabolic profiling. Standard metrics demonstrated that samples formed soft callus structures that later mineralized. Small molecule profiles showed distinct temporal patterns associated with the bone tissue repair process. Specifically, increased lactate and amino acid levels at early time points indicated an environment conducive to osteoblast differentiation and extracellular matrix formation. Citrate and pyruvate abundances increased at later time points indicating increasing mineral content within the defect region. Taurine, shikimate, and pantothenate distribution profiles appeared to represent a shift toward a more homeostatic remodeling environment with the differentiation and activity of osteoclasts offsetting the earlier deposition phases of bone repair. The generation of a comprehensive metabolic reference portfolio offers a potent mechanism for examining novel biomaterials and can serve as guide for the development of new targeted therapeutics to improve the rate, magnitude, and quality of bone regeneration

A randomized controlled trial to assess the clinical and cost effectiveness of a nurse-led Antenatal Asthma Management Service in South Australia (AAMS study)

Background: Pregnancy presents a unique situation for the management of asthma as it can alter the course of asthma severity and its treatment, which in turn can affect pregnancy outcomes. Despite awareness of the substantial adverse effects associated with asthma during pregnancy, little has been done to improve its management and reduce associated perinatal morbidity and mortality. The aim of this randomized controlled trial is to evaluate the clinical and cost effectiveness of an Antenatal Asthma Management Service. Methods/design: Design: Multicentre, randomized controlled trial. Inclusion criteria: Women with physician diagnosed asthma, which is not currently in remission, who are less than 20 weeks gestation with a singleton pregnancy and do not have a chronic medical condition. Trial entry and randomization: Eligible women with asthma, stratified by treatment site, disease severity and parity, will be randomized into either the ‘Standard Care Group’ or the ‘Intervention Group’. Study groups: Both groups will be followed prospectively throughout pregnancy. Women in the ‘Standard Care Group’ will receive routine obstetric care reflecting current clinical practice in Australian hospitals. Women in the ‘Intervention Group’ will receive additional care through the nurse-led Antenatal Asthma Management Service, based in the antenatal outpatient clinic. Women will receive asthma education with a full assessment of their asthma at 18, 24, 30 and 36 weeks gestation. Each antenatal visit will include a 60 min session where asthma management skills are assessed including: medication adherence and knowledge, inhaler device technique, recognition of asthma deterioration and possession of a written asthma action plan. Furthermore, subjects will receive education about asthma control and management skills including trigger avoidance and smoking cessation counseling when appropriate. Primary study outcome: Asthma exacerbations during pregnancy. Sample size: A sample size of 378 women will be sufficient to show an absolute reduction in asthma exacerbations during pregnancy of 20% (alpha 0.05 two-tailed, 90% power, 5% loss to follow-up). Discussion: The integration of an asthma education program within the antenatal clinic setting has the significant potential to improve the participation of pregnant women in the self-management of their asthma, reduce asthma exacerbations and improve perinatal health outcomes.Luke E Grzeskowiak, Gustaaf Dekker, Karen Rivers, Kate Roberts-Thomson, Anil Roy, Brian Smith, Jeffery Bowden, Robert Bryce, Michael Davies, Justin Beilby, Anne Wilson, Philippa Middleton, Richard Ruffin, Jonathan Karnon, Vicki L Clifton and for the AAMS study grou