Characteristics and Outcomes of Traumatic Cardiac Arrests in the Pan-Asian Resuscitation Outcomes Study.

OBJECTIVE: Little is known about survival outcomes after traumatic cardiac arrest in Asia, or the association of Utstein factors with survival after traumatic cardiac arrests. This study aimed to describe the epidemiology and outcomes of traumatic cardiac arrests in Asia, and analyze Utstein factors associated with survival. METHODS: Traumatic cardiac arrest patients from 13 countries in the Pan-Asian Resuscitation Outcomes Study registry from 2009 to 2018 were analyzed. Multilevel logistic regression was performed to identify factors associated with the primary outcomes of survival to hospital discharge and favorable neurological outcome (Cerebral Performance Category (CPC) 1-2), and the secondary outcome of return of spontaneous circulation (ROSC). RESULTS: There were 207,455 out-of-hospital cardiac arrest cases, of which 13,631 (6.6%) were trauma patients aged 18 years and above with resuscitation attempted and who had survival outcomes reported. The median age was 57 years (interquartile range 39-73), 23.0% received bystander cardiopulmonary resuscitation (CPR), 1750 (12.8%) had ROSC, 461 (3.4%) survived to discharge, and 131 (1.0%) had CPC 1-2. Factors associated with higher rates of survival to discharge and favorable neurological outcome were arrests witnessed by emergency medical services or private ambulances (survival to discharge adjusted odds ratio (aOR) = 2.95, 95% confidence interval (CI) = 1.99-4.38; CPC 1-2 aOR = 2.57, 95% CI = 1.25-5.27), bystander CPR (survival to discharge aOR = 2.16; 95% CI 1.71-2.72; CPC 1-2 aOR = 4.98, 95% CI = 3.27-7.57), and initial shockable rhythm (survival to discharge aOR = 12.00; 95% CI = 6.80-21.17; CPC 1-2 aOR = 33.28, 95% CI = 11.39-97.23) or initial pulseless electrical activity (survival to discharge aOR = 3.98; 95% CI = 2.99-5.30; CPC 1-2 aOR = 5.67, 95% CI = 3.05-10.53) relative to asystole. CONCLUSIONS: In traumatic cardiac arrest, early aggressive resuscitation may not be futile and bystander CPR may improve outcomes.

Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries.

BACKGROUND/PURPOSE: Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. METHODS: A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. RESULTS: Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5%) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5%) cities performed 4 minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR. CONCLUSION: International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.

Characterizing opioid overdose hotspots for place-based overdose prevention and treatment interventions: A geo-spatial analysis of Rhode Island, USA.

OBJECTIVE: Examine differences in neighborhood characteristics and services between overdose hotspot and non-hotspot neighborhoods and identify neighborhood-level population factors associated with increased overdose incidence. METHODS: We conducted a population-based retrospective analysis of Rhode Island, USA residents who had a fatal or non-fatal overdose from 2016 to 2020 using an environmental scan and data from Rhode Island emergency medical services, State Unintentional Drug Overdose Reporting System, and the American Community Survey. We conducted a spatial scan via SaTScan to identify non-fatal and fatal overdose hotspots and compared the characteristics of hotspot and non-hotspot neighborhoods. We identified associations between census block group-level characteristics using a Besag-York-Mollié model specification with a conditional autoregressive spatial random effect. RESULTS: We identified 7 non-fatal and 3 fatal overdose hotspots in Rhode Island during the study period. Hotspot neighborhoods had higher proportions of Black and Latino/a residents, renter-occupied housing, vacant housing, unemployment, and cost-burdened households. A higher proportion of hotspot neighborhoods had a religious organization, a health center, or a police station. Non-fatal overdose risk increased in a dose responsive manner with increasing proportions of residents living in poverty. There was increased relative risk of non-fatal and fatal overdoses in neighborhoods with crowded housing above the mean (RR 1.19 [95 % CI 1.05, 1.34]; RR 1.21 [95 % CI 1.18, 1.38], respectively). CONCLUSION: Neighborhoods with increased prevalence of housing instability and poverty are at highest risk of overdose. The high availability of social services in overdose hotspots presents an opportunity to work with established organizations to prevent overdose deaths.

Recommendations on ambulance cardiopulmonary resuscitation in basic life support systems.

AIM: Cardiopulmonary resuscitation (CPR) during ambulance transport can be a safety risk for providers and can affect CPR quality. In many Asian countries with basic life support (BLS) systems, patients experiencing out-of-hospital cardiac arrest (OHCA) are routinely transported in ambulances in which CPR is performed. This paper aims to make recommendations on best practices for CPR during ambulance transport in BLS systems. METHODS: A panel consisting of 20 experts (including 4 North Americans) in emergency medical services (EMS) and resuscitation science was selected, and met over two days. We performed a literature review and selected 33 candidate issues in five core areas. Using Delphi methodology, the issues were classified into dichotomous (yes/no), multiple choice, and ranking questions. Primary consensus between experts was reached when there was more than 70% agreement. Questions with 60-69% agreement were made more specific and were submitted for a second round of voting. RESULTS: The panel agreed upon 24 consensus statements with more than 70% agreement (2 rounds of voting). The recommendations cover the following: length of time on the scene; advanced airway at the scene; CPR prior to transport; rhythm analysis and defibrillation during transport; prehospital interventions; field termination of resuscitation (TOR); consent for TOR; destination hospital; transport protocol; number of staff members; restraint systems; mechanical CPR; turning off of the engine for rhythm analysis; alternative CPR; and feedback for CPR quality. CONCLUSION: Recommendations for CPR during ambulance transport were developed using the Delphi method. These recommendations should be validated in clinical settings.

Safety attitudes, burnout and well-being among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional study.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. Methods: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR). Results: We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR. Conclusion: Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.

Comparison of emergency medical services systems across Pan-Asian countries: a Web-based survey.

BACKGROUND: There are great variations in out-of-hospital cardiac arrest (OHCA) survival outcomes among different countries and different emergency medical services (EMS) systems. The impact of different systems and their contribution to enhanced survival are poorly understood. This paper compares the EMS systems of several Asian sites making up the Pan-Asian Resuscitation Outcomes Study (PAROS) network. Some preliminary cardiac arrest outcomes are also reported. METHODS: This is a cross-sectional descriptive survey study addressing population demographics, service levels, provider characteristics, system operations, budget and finance, medical direction (leadership), and oversight. RESULTS: Most of the systems are single-tiered. Fire-based EMS systems are predominant. Bangkok and Kuala Lumpur have hospital-based systems. Service level is relatively low, from basic to intermediate in most of the communities. Korea, Japan, Singapore, and Bangkok have intermediate emergency medical technician (EMT) service levels, while Taiwan and Dubai have paramedic service levels. Medical direction and oversight have not been systemically established, except in some communities. Systems are mostly dependent on public funding. We found variations in available resources in terms of ambulances and providers. The number of ambulances is 0.3 to 3.2 per 100,000 population, and most ambulances are basic life support (BLS) vehicles. The number of human resources ranges from 4.0 per 100,000 population in Singapore to 55.7 per 100,000 population in Taipei. Average response times vary between 5.1 minutes (Tainan) and 22.5 minutes (Kuala Lumpur). CONCLUSION: We found substantial variation in 11 communities across the PAROS EMS systems. This study will provide the foundation for understanding subsequent studies arising from the PAROS effort.

Lung Ultrasonography for COVID-19 Patients in Out of Hospital Settings.

PURPOSE: The portability of a hand-held ultrasound allows the health care worker to conduct lung ultrasound in out-of-hospital setting. It is used as a tool to conduct staging and triaging for COVID-19 patients. This study evaluated the utilization of lung ultrasound in an out-of-hospital setting versus chest x-rays in detecting and staging of COVID-19 patients with pneumonia. METHODS: The study was conducted among COVID-19 subjects at an out-of-hospital setting whereby lung ultrasound was done and subsequently chest x-rays were taken after being admitted to the health care facilities. Lung ultrasound findings were reviewed by emergency physicians, while the chest x-rays were reviewed by radiologists. Radiologists were blinded by the patients' lung ultrasound findings and clinical conditions. The analysis of the agreement between the lung ultrasound findings and chest x-rays was conducted. RESULTS: A total of 261 subjects were recruited. LUS detected pulmonary infiltrative changes in more stage 3 COVID-19 subjects in comparison to chest x-rays. Multiple B-lines were the predominant findings at the right lower anterior, posterior and lateral zones. Interstitial consolidations and ground glass opacities were the predominant descriptive findings in chest x-rays. However, there was no agreement between lung ultrasound and chest x-ray findings in detecting COVID-19 pneumonia as the Cohen's Kappa coefficient was 0.08 (95% CI 0.06-0.22, p = 0.16). CONCLUSION: The diagnostic imaging and staging of COVID-19 patients using lung ultrasound in out-of-hospital settings showed LUS detected lung pleural disease more often than CXR for stage 3 COVID-19 patients.

Gender disparities among adult recipients of layperson bystander cardiopulmonary resuscitation by location of cardiac arrest in Pan-Asian communities: A registry-based study.

BACKGROUND: Bystander cardiopulmonary resuscitation (BCPR) is a critical component of the 'chain of survival' in reducing mortality among out-of-hospital cardiac arrest (OHCA) victims. Inconsistent findings on gender disparities among adult recipients of layperson BCPR have been reported in the literature. We aimed to fill this knowledge gap by investigating the extent of gender disparities in a cross-national setting within Pan-Asian communities. METHODS: We utilised data collected from the Pan-Asian Resuscitation Outcomes Study (PAROS), an international, multicentre, prospective study conducted between 2009 and 2018. We included all OHCA cases with non-traumatic arrest aetiology transported by emergency medical services and excluded study sites that did not consistently collect information about the location of cardiac arrest. Logistic regression was used to analyse the association between gender and BCPR, stratified by location. FINDINGS: We analysed a cohort of 56,192 OHCA cases with an overall BCPR rate of 36.2% (20,329/56,192). At public locations, the BCPR rate was 31.2% (631/2022) for female and 36.4% (3235/8892) for male OHCA victims; while at home, the rate was 38.3% (6838/17,842) for females and 35.1% (9625/27,436) for males. Controlling for site differences and several factors in multivariable logistic regression, we found females less likely to receive BCPR than males in public locations (odds ratio [OR]=0.89, 95% confidence interval [CI]: 0.70-0.99), but more likely to receive BCPR at home (OR=1.16, 95% CI: 1.11-1.21). INTERPRETATION: In Pan-Asian communities, gender differences exist in adult recipients of BCPR and differ between home and public locations. Future studies should account for additional information on bystanders and societal factors to identify targets for interventions. FUNDING: The study was supported by grants from the National Medical Research Council (NMRC/CSA/0049/2013) and Laerdal Foundation (20040).

Using Timely Overdose Data to Address a Spike in Nonfatal Overdoses and Inform a Coordinated Community-Level Response in Rhode Island, 2019.

The Rhode Island Department of Health (RIDOH) uses emergency department data to monitor nonfatal opioid overdoses in Rhode Island. In April 2019, RIDOH detected an increase in nonfatal opioid overdoses in Woonsocket, Rhode Island, and sent an alert to state and local partners (eg, fire departments, emergency departments, faith leaders) with guidance on how to respond. To guide community-level, strategic response efforts, RIDOH analyzed surveillance data to identify overdose patterns, populations, and geographic areas most affected. During April-June 2019, nonfatal opioid overdoses in Woonsocket increased 463% (from 13 to 73) when compared with the previous 3 months. Because of the sustained increase in nonfatal opioid overdoses, RIDOH brought together community partners at a meeting in June 2019 to discuss RIDOH opioid overdose data and coordinate next steps. Data analyses were essential to framing the discussion and allowed community partners at the event to identify an unexpected increase in cocaine-involved nonfatal opioid overdoses in Woonsocket. Many patients with cocaine-involved nonfatal overdoses also had fentanyl in their system, and input from community partners suggested that many patients were unaware of using fentanyl. Community response actions included targeting harm reduction services (eg, distribution of naloxone, mobile needle exchange); deploying peer recovery support specialists to overdose hotspots to connect people to treatment and recovery resources; placing harm reduction messaging in high-traffic areas; and targeted social media messaging. After the meeting, nonfatal opioid overdoses returned to pre-outbreak levels. This case study provides an example of how timely opioid overdose data can be effectively used to detect a spike in nonfatal opioid overdoses and inform a strategic, community-level response.

Systematic Review and Meta-Analysis of Diabetes Knowledge among Type 2 Diabetes Patients in Southeast Asia.

OBJECTIVE: Recognition of patient baseline knowledge is important in educating patients with type 2 diabetes mellitus (T2D) to manage their disease effectively. The purpose of this study is to review current evidence on the level of diabetes knowledge among T2D patients and determine factors affecting their knowledge. METHODS: A systematic search of English language articles published between 1990 and June 2019 was conducted using six electronic databases. Only quantitative studies that assessed knowledge of T2D patients in Southeast Asian countries were included. Data were extracted and a meta-analysis was conducted. RESULTS: A total of 6210 articles were retrieved; seven articles met the inclusion criteria, comprising 1,749 T2D patients. The calculated mean knowledge score was 55.6% (95% CI: 7.6 to 103.6). Five types of assessment tools were identified ranging from five to 41 questions that focused on disease specifics, treatment, and nutrition. Age, education level, and glycemic control were the most common factors impacting knowledge. CONCLUSIONS: The level of knowledge among T2D patients in Southeast Asia was unsatisfactory, especially in older patients with low education levels and poor glycemic control. Hence, an appropriate educational plan should be prioritized to these groups.

Experience repatriation of citizens from epicentre using commercial flights during COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, many countries instituted closure of borders from international and local travels. Stranded citizens appeal to their governments to embark on citizen repatriation missions. Between February and April 2020, the Government of Malaysia directed repatriation of its citizens from China, Iran, Italy and Indonesia. We describe the preparation and execution of the repatriation mission using chartered commercial aircraft. The mission objectives were to repatriate as many citizens based on aircraft capacity and prevent onboard transmission of the disease to flight personnel. RESULTS: Five repatriation missions performed was led by the National Agency for Disaster Management (NADMA) with the Ministry of Health providing technical expertise. A total of 432 citizens were repatriated from the missions. The operations were divided into four phases: the pre-boarding screening phase, the boarding and in-flight phase, the reception phase and the quarantine phase. The commercial aircraft used were from two different commercial airlines. Each mission had flight crew members between 10 and 17 people. There were 82 positive cases detected among the repatriated citizens. There was a single positive case of a healthcare worker involved in the mission, based on the sample taken on arrival of the flight. There were no infections involving flight team members. CONCLUSION: Medical flight crew must be familiar with aircraft fittings that differ from one commercial airline to another as it influences infection control practices. A clear understanding of socio-political situation of a country, transmission routes of a pathogen, disease presentation, and knowledge of aviation procedures, aircraft engineering and design is of great importance in preparing for such missions. Our approach of multidiscipline team involvement managed to allow us to provide and execute the operations successfully.

Impact of population aging on the presentation of out-of-hospital cardiac arrest in the Pan Asian Resuscitation Outcomes Study.

AIM: As a population ages, it can impact on the characteristics and outcomes of cardiogenic out-of-hospital cardiac arrest (OHCA) patients. This study aimed to evaluate the relationship between the age incidence of cardiogenic OHCA and population aging. METHODS: This was a post-hoc analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) database. Data on the population old-age dependency ratio (i.e. elderly/non-elderly) were extracted from publicly accessible sources (United Nations and World Health Organization). RESULTS: We analyzed 40,872 OHCA cases from seven PAROS countries over the period 2009 to 2013. We found significant correlation between the population old-age dependency ratio and elderly/non-elderly ratio in OHCA patients (r = 0.92, P = 0.003). There was a significant correlation between the population old-age dependency ratio and risk differences of 30-day survival rates for non-elderly and elderly OHCA patients (r = 0.89, P = 0.007). CONCLUSIONS: Our findings suggest that the proportion of elderly among OHCA patients will increase, and outcomes could increasingly differ between elderly and non-elderly as a society ages progressively. This has implications for planning and delivery of emergency services as a society ages.

Public Hospital Pharmacists' Perceptions and Knowledge of Antibiotic Use and Resistance: A Multicenter Survey.

Antimicrobial Stewardship Program (ASP) has been implemented in major public hospitals in Malaysia, with pharmacists playing a key role in ensuring the appropriate use of antibiotics. This survey aimed to assess the practices, perceptions, and knowledge of public hospital pharmacists on antibiotic use and resistance. A cross-sectional survey involving pharmacists from six public hospitals in Penang was conducted using a self-administered validated questionnaire. The majority of pharmacists perceived that polypharmacy (92%, n = 270) and overuse of broad-spectrum antibiotics (85%, n = 252) can potentially induce resistance of microorganisms and that ensuring the rational use of antibiotics is a shared responsibility between clinicians and pharmacists (94%, n = 278). A large majority of the pharmacists think that formal training in infectious disease should be a pre-requisite for pharmacists in ASP (93%, n = 273). In terms of antibiotic selection, the availability of antibiotics in hospital (81%, n = 234) and patient's clinical condition (68%, n = 196) are more of a concern to the pharmacists. A total of 65% of the respondents (n = 192) demonstrated good levels of knowledge with a mean knowledge score of 10.1 out of 13 (95% CI: 9.95; 10.31). Pharmacists from the managerial level, ward pharmacy, in-patient, and medication therapy adherence clinic (MTAC) unit had better knowledge of antibiotics compared to pharmacists from other units (p < 0.001). Antibiotic knowledge gap had been identified among pharmacists in different work settings, and longer years of service does not warrant good antibiotic knowledge.

Contributing factors to outpatient pharmacy near miss errors: a Malaysian prospective multi-center study.

Background Detecting errors before medication dispensed or 'near misses' is a crucial step to combat the incidence of dispensing error. Despite this, no published evidence available in Malaysia relating to these issues. Objective To determine the incidence of medication labeling and filling errors, frequency of each type of the errors and frequency of the contributing factors at the final stage before dispensing. Setting Six Penang public funded hospitals outpatient pharmacies. Methods A prospective multicentre study, over 8 week's period. Pharmacists identified and recorded the details of either medication labeling and/or filling error at the final stage of counter-checking before dispensing. Besides, the contributing factors for each error were determined and recorded in data collection form. Descriptive analysis was used to explain the study data. Main outcome measure The incidence of near misses. Results A total of 187 errors (near misses) detected, with 59.4% (n = 111) were medication filling errors and 40.6% (n = 76) were labeling errors. Wrong drug (n = 44, 39.6%) was identified as the highest type of filling errors while incorrect dose (n = 34, 44.7%) was identified as the highest type of labeling errors. Distracted and interrupted work environment was reported to lead the highest labeling and filling errors, followed by lack of knowledge and skills for filling errors and high workload for labeling errors. Conclusion The occurrence of near misses related to medication filling and labelling errors is substantial at outpatient pharmacy in Penang public funded hospitals. Further research is warranted to evaluate the intervention strategies needed to reduce the near misses.

What do healthcare providers know about nutrition support? A survey of the knowledge, attitudes, and practice of pharmacists and doctors toward nutrition support in Malaysia.

BACKGROUND AND AIMS: Malnutrition is one of the health problems that can be prevented by appropriate nutrition care provided by healthcare providers. However, this practice is still lacking possibly because of the providers' inadequate knowledge. The aim of this study was to evaluate the self-reported knowledge, attitudes, and practices of pharmacists and doctors toward nutrition support in a tertiary care hospital setting. METHODS: A validated questionnaire was distributed to all the doctors and pharmacists working in a tertiary hospital in Penang, Malaysia. Seven individuals including academics, general surgeons, and pharmacists performed the face and content validity. The questionnaire was piloted using 24 healthcare providers at a different hospital. RESULT: Of 400 surveyed, 158 doctors and 72 pharmacists from various grades completed the questionnaire. More doctors (31.6%) than pharmacists (15.3%) reported adequate knowledge to perform patients' nutrition screening. However, in the knowledge assessment, pharmacists had a higher mean score (6.07 ± 1.77) than the doctors did (4.59 ± 1.87; P < .001), and most (70.4%) of them were grouped in the "average" score range. In addition, both pharmacists and doctors have ambivalent attitudes toward nutrition support. Only 31.3% stated that they perform nutrition screening on admission, and half of them performed nutrition assessment during hospitalization. CONCLUSION: Inappropriate nutrition care might be due to the lack of guidelines and insufficient knowledge among doctors and pharmacists. Special nutrition training and education for both pharmacists and doctors should be established.

Comparison of emergency medical services systems in the pan-Asian resuscitation outcomes study countries: Report from a literature review and survey.

OBJECTIVE: Asia-Pacific countries have unique prehospital emergency care or emergency medical services (EMS) systems, which are different from European or Anglo-American models. We aimed to compare the EMS systems of eight Asia-Pacific countries/regions as part of the Pan Asian Resuscitation Outcomes Study (PAROS), to provide a basis for future comparative studies across systems of care. METHODS: In the first phase, a systematic literature review of EMS system within the eight PAROS countries/regions of interest was conducted. In the second phase, PAROS site directors were surveyed for additional information about the demographics and characteristics of EMS services at their sites. RESULTS: The database and bibliography search identified 25 eligible articles. The survey of EMS systems was completed by seven PAROS directors. By combining information sources from phases 1 and 2, we found that all PAROS EMS systems were single-tiered, and most were public (vs private) and fire-based (Thailand, Malaysia, Singapore, Taiwan, Japan, Korea). Ambulance personnel were primarily emergency medical technicians and paramedics, except for Thailand and Turkey, whose personnel include nurses and physicians. Personnel were trained to use automated external defibrillators and have basic cardiac life support certification. The service capability of each EMS system in terms of dispatch, airway management and medications, for example, varied greatly. CONCLUSION: We found variation in the EMS systems across the eight Asia-Pacific countries/regions studied. The findings will inform the construction of a multinational Asia-Pacific research network for future comparative studies and could serve as a model for international research networks.

A diabetes education multimedia program in the waiting room setting.

INTRODUCTION: This study evaluated the impact of a waiting room-administered, low-literacy, computer multimedia diabetes education program on patient self-management and provider intensification of therapy. METHODS: In this randomized, controlled trial, 129 participants either viewed a computer multimedia education program (intervention group) or read an educational brochure (control group) while in the waiting room. Participants were uninsured, primarily ethnic minority adults with type 2 diabetes receiving care from a county clinic in Chicago, Illinois. Wilcoxon test, t-test, and linear mixed model analyses evaluated changes in diabetes knowledge, self-efficacy, behaviors, medications prescribed, hemoglobin A1c (HbA(1c)), and blood pressure levels over 3 months. RESULTS: During the study period, there was an increase in the number of oral diabetes medications prescribed over three months to multimedia users compared with those in the control group (P=0.017). HbA(1c) declined by 1.5 in the multimedia group versus 0.8 in the control group (P=0.06). There were no differences between groups in changes in blood pressure levels, self-efficacy, and most diabetes-related behaviors. Self-reported exercise increased in the control group compared with the multimedia group (0.9 days/week vs. 0.1 days/week, P=0.016). CONCLUSION: Multimedia users received a greater intensification of diabetes therapy, but demonstrated no difference in self-management in comparison with those receiving educational brochures. The availability of a computer multimedia program in the waiting room appears to be a novel and acceptable approach in providing diabetes education for underserved populations.