Effects of a structured educational intervention on knowledge and emergency management in patients at risk for anaphylaxis

BackgroundStructured educational programmes for patients at risk for anaphylaxis have not yet been established. Patients and caregivers often lack adequate skills in managing the disease. MethodsTo investigate effects of structured patient education intervention on knowledge, emergency management skills and psychological parameters in patients with previous episodes of anaphylaxis and caregivers of affected children 95 caregivers (11 male, 84 female, mean age 37years) of affected children and 98 patients (32 male, 66 female, mean age 47.5years) were randomly assigned to an intervention (IG) or control group (CG) in a multicentre randomized controlled trial. The IG received two 3-h schooling modules of group education; the CG received standard auto-injector training only. Knowledge of anaphylaxis and emergency management competence in a validated training anaphylaxis situation as main outcome measures as well as secondary psychological parameters were assessed at baseline and 3months after intervention. ResultsIn comparison with controls, the intervention led to significant improvement of knowledge from baseline to 3-month follow-up (caregivers: IG 3.2/13.2 improvement/baseline vs CG 0.7/12.6; P<0.001; patients: IG 3.9/10.8 vs 1.3/12.6; P<0.001). Moreover, emergency management competence was increased after intervention as compared to controls (caregivers: IG 8.6/11.2 vs CG 1.2/10.8; P<0.001; patients: 7.1/11.0 vs 1.1/11.1; P<0.001). Intervention showed significant reduction of caregiver anxiety (-1.9/8.4 vs -0.7/7.5; P<0.05). There were no significant changes in the depression scores. ConclusionStructured patient education programmes may be beneficial in the management of anaphylaxis by increasing patients' empowerment to prevent and treat the disease

Images of weakness and the fall of Rome – an analysis of reputation management’s impact on political history

It will be argued that PR may constitute an interpretative tool when exploring the causes of and reasons for what Peter Heather calls the most dramatic event in ancient history: the decline and ultimate collapse of the Western Roman Empire in 476. The appearance of the Goths at the Danubian border leading to the devastating defeat of the imperial army at Adrianople in 378 was the most visible incident in a chain of events that within a century led to the forced abdication of the last West Roman emperor Romulus Augustulus in 476. This article does not give a detailed and chronological account of events that have been related by historians of antiquity. Instead, it presents the concept of reputation and critiques both its political significance and its potential to offer an alternative answer to the question of why Rome fell