Evidence Based National Framework for Undergraduate Nursing Education in Sri Lanka

In Sri Lanka, nursing education is moving from diplomanursing certificate to a university bachelor degree. In thistransitional stage, the development of an evidence based nationallevel framework for undergraduate nursing education is acrucially important step to improve nursing education andnursing service in Sri Lanka. The overall purpose of this PhDresearch study was to develop an evidence-based nationalframework for undergraduate nursing education in Sri Lanka.MethodMy PhD research study has involved conducting criticalreviews of literature, two systematic reviews, developing a draftconceptual framework, testing its appropriateness and feasibilitywith key stakeholders via focus group discussions in Sri Lanka,and formulating the final national framework for nursingeducation in Sri Lanka.ResultsThe systematic reviews revealed that the evidence regardingthe effectiveness and appropriateness of undergraduate nursingcurricula is notably weak and direct transfer of the curriculummodel from one country to another is not appropriate withoutfirst assessing the cultural context of both countries. Theconceptual framework, which was developed using the finding ofsystematic reviews and literature reviews, consists of widelyrecognized nursing concepts in international and local contexts.However, some concepts cannot be directly applicable because ofcultural and economic impediments.DiscussionThis study identified several factors that shape the approachto nursing education in Sri Lanka. These factors include:Western influence; Sri Lanka’s cultural influence; the currenthealthcare system and demand for healthcare; nursing systemsand regulation; medical dominance; financial support; and SriLanka’s education system. All of these factors influence theconceptualization of nursing and educational strategies needed toeffectively and appropriately prepare nurses in Sri Lanka. Thisstudy proposes seven recommendations to support theimplementation of the study findings into practice in Sri Lanka

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

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)