ECHO Care of the Elderly: Innovative Learning to Build Capacity in Long-term Care.

BACKGROUND: Older adults are entering long-term care (LTC) homes with more complex care needs than in previous decades, resulting in demands on point-of-care staff to provide additional and specialty services. This study evaluated whether Project ECHO® (Extension for Community Healthcare Outcomes) Care of the Elderly Long-Term Care (COE-LTC)-a case-based online education program-is an effective capacity-building program among interprofessional health-care teams caring for LTC residents. METHODS: A mixed-method, pre-and-post study comprised of satisfaction, knowledge, and self-efficacy surveys and exploration of experience via semi-structured interviews. Participants were interprofessional health-care providers from LTC homes across Ontario. RESULTS: From January-March 2019, 69 providers, nurses/nurse practitioners (42.0%), administrators (26.1%), physicians (24.6%), and allied health professionals (7.3%) participated in 10 weekly, 60-minute online sessions. Overall, weekly session and post-ECHO satisfaction were high across all domains. Both knowledge scores and self-efficacy ratings increased post-ECHO, 3.9% (p = .02) and 9.7 points (p < .001), respectively. Interview findings highlighted participants' appreciation of access to specialists, recognition of educational needs specific to LTC, and reduction of professional isolation. CONCLUSION: We demonstrated that ECHO COE-LTC can be a successful capacity-building educational model for interprofessional health-care providers in LTC, and may alleviate pressures on the health system in delivering care for residents.

Design and Synthesis of Novel Imidazole Derivatives Possessing Triazole Pharmacophore with Potent Anticancer Activity, and In Silico ADMET with GSK-3ß Molecular Docking Investigations.

A library of novel imidazole-1,2,3-triazole hybrids were designed and synthesized based on the hybrid pharmacophore approach. Therefore, copper(I)catalyzed click reaction of thiopropargylated-imidazole 2 with several organoazides yielded two sets of imidazole-1,2,3-triazole hybrids carrying different un/functionalized alkyl/aryl side chains 4a-k and 6a-e. After full spectroscopic characterization using different spectral techniques (IR, 1H, 13C NMR) and elemental analyses, the resulted adducts were screened for their anticancer activity against four cancer cell lines (Caco-2, HCT-116, HeLa, and MCF-7) by the MTT assay and showed significant activity. In-silico molecular docking study was also investigated on one of the prominent cancer target receptors, i.e., glycogen synthase kinase-3ß (GSK-3ß), revealing a good binding interaction with our potent compound, 4k and was in agreement with the in vitro cytotoxic results. In addition, the ADMET profile was assessed for these novel derivatives to get an insight on their pharmacokinetic/dynamic attributes. Finally, this research design and synthesis offered click chemistry products with interesting biological motifs mainly 1,2,3 triazoles linked to phenyl imidazole as promising candidates for further investigation as anticancer drugs.

Building Long-Term Care Staff Capacity During COVID-19 Through Just-in-Time Learning: Evaluation of a Modified ECHO Model.

OBJECTIVES: The onset of the COVID-19 pandemic significantly challenged the capacity of long-term care (LTC) homes in Canada, resulting in new, pressing priorities for leaders and health care providers (HCPs) in the care and safety of LTC residents. This study aimed to determine whether Project ECHO (Extension for Community Healthcare Outcomes) Care of the Elderly Long-Term Care (COE-LTC): COVID-19, a virtual education program, was effective at delivering just-in-time learning and best practices to support LTC teams and residents during the pandemic. DESIGN: Mixed methods evaluation. SETTING AND PARTICIPANTS: Interprofessional HCPs working in LTC homes or deployed to work in LTC homes primarily in Ontario, Canada, who participated in 12 weekly, 60-minute sessions. METHODS: Quantitative and qualitative surveys assessing reach, satisfaction, self-efficacy, practice change, impact on resident care, and knowledge sharing. RESULTS: Of the 252 registrants for ECHO COE-LTC: COVID-19, 160 (63.4%) attended at least 1 weekly session. Nurses and nurse practitioners represented the largest proportion of HCPs (43.8%). Overall, both confidence and comfort level working with residents who were at risk, confirmed, or suspected of having COVID-19 increased after participating in the ECHO sessions (effect sizes ≥ 0.7, Wilcoxon signed rank P < .001). Participants also reported impact on intent to change behavior, resident care, and knowledge sharing. CONCLUSIONS AND IMPLICATIONS: The results demonstrate that ECHO COE-LTC: COVID 19 effectively delivered time-sensitive information and best practices to support LTC teams and residents. It may be a critical platform during this pandemic and in future crises to deliver just-in-time learning during periods of constantly changing information.

Impact of an IEC (Information, Education and Communication) intervention on key family practices of mothers related to child health in Jamshoro, Sindh.

OBJECTIVE: To determine change in practice of mothers having children less than five years of age in five key areas related to child health, growth and development including immunization, feeding during illness, appropriate home treatment for infections and care seeking behavior. METHODS: This was a community based interventional study of Information, Education and Communication (IEC) intervention in the UC Jamshoro, Taluka Kotri, district Jamshoro of 15 months duration from March 2011 to June 2012. Ninety five mothers having children less than five years of age were selected by systematic random sampling for house hold based survey by questionnaire designed by EPP evaluation and health section of UNICEF during baseline and post-intervention phases. Base line data was collected from the interventional area then health education messages were given through written and pictorial material by LHWs for 9 months. To measure the impact helath education messages, data was again collected by same questionnaire are from the same union council during post-intervention phase. RESULTS: During baseline survey except immunization all other key family practices were poor. After 9 months of intervention of repeated heath education sessions through LHW during their routine visits all practices were improved with statistically significant difference. Regarding the comparison of the results between baseline and post-intervention surveys we found that except immunization which was already better, all those practices which requires mother's knowledge and practice were improved after our intervention with significant P-values. CONCLUSIONS: Improving the mother's education level is very important, to empower the first care provider of child in the community. However, in the mean time, health educational messages related to the limited number of key family practices should be disseminated.

Spectrum of heart disease in children under 5 years of age at Liaquat University Hospital, Hyderabad, Pakistan.

OBJECTIVE & METHODOLOGY: This was a descriptive cross sectional study of one year duration conducted in Pediatric department of Liaquat University Hospital, Hyderabad. The objective was to assess the clinical pattern, age distribution and type of heart diseases in children under 5 years of age. In this study 150 children with suspicion of cardiac problem were enrolled. RESULT: Among 150 cardiac patients 55.3% were male and 44.7% were female. Congenital heart diseases (CHD) seen in 89.3% and 10.7% had acquired heart disease. Among CHD 74.6% were Acyanotic lesions while cyanotic lesions were seen in 23.9% and 1.5% were cases of dextrocardia. Ventricular septal defect was the commonest Acyanotic lesion (29.9%) followed by atrial septal defect (25.4%). Among cyanotic heart diseases tetralogy of Fallot was the commonest lesion seen in 11.2% followed by transposition of great arteries and complex heart defect 5.2% and 3% respectively. Among acquired heart disease myocarditis was the commonest disease accounts 94% and pericardial effusion was seen in 6%. CONCLUSION: Regarding the type of congenital heart defect acyanotic defect was more common than cyanotic with ventricular septal defect commonest lesion. Tetralogy of Fallot's was commonest in cyanotic group. Availability of expertise locally will lead to more patients getting surgical treatment at an earlier age thereby reducing morbidity and mortality and improving quality of life for these children.

Role of rapid diagnostic tests for guiding outpatient treatment of febrile illness in Liaquat University Hospital.

OBJECTIVES: To assess the validity /strength of clinical diagnosis of Malaria on the basis of IMNCI algorithm by slide microscopy (gold standard) and to compare the effectiveness of Rapid Diagnostic Test (RDT )against slide microscopy. Methods : It is a descriptive cross sectional study of 6 month duration conducted at Pediatric Outpatient Department LUH Hyderabad from June-Dec. 2010. Sample of 400{the minimum required sample was 385 with malaria prevalence 5% (0.05) with margin of error of 3% (0.03, frequency vary from 2-8 % among different studies)} febrile children under 5 years classified as Suspected Clinical Malaria according to algorithm of IMNCI were included; The operational definition for Suspected Clinical Malaria was; fever for more than 2 days with no runny nose, no measel rash and no other cause of fever. Hyderabad was considered as low risk area. Rapid diagnostic test (RDT) and slide microscopy were done, and only confirmed cases were treated according to current guidelines given by National Malaria Program/updated IMNCI. RESULTS: Total 2000 patients under 5 years presented with fever and were evaluated. From 2000 cases 20% (400) were diagnosed as suspected clinical Malaria according to IMNCI algorithm; and only 40 cases (10%) have shown positive results for malaria parasite on slide microscopy and 38 cases on RDT. Regarding the plasmodium species 70% were vivax and 30% were falciparum. As regards the effectiveness, RDT has shown 95% sensitivity for the detection of plasmodium antigens in the febrile clinically suspected cases of malaria. CONCLUSION: Prompt and accurate diagnosis of malaria is needed for implementation of appropriate treatment to reduce unnecessary anti-malarial prescription. RDT is as effective as slide microscopy for the diagnosis of malaria especially in resource poor countries.

Severe disease in children hospitalized with a diagnosis of Plasmodium vivax in south-eastern Pakistan.

BACKGROUND: Infection by Plasmodium vivax has been considered rarely threatening to life, but recent studies challenge this notion. This study documented the frequency and character of severe illness in paediatric patients admitted to a hospital in south-eastern Pakistan with a laboratory-confirmed diagnosis of vivax malaria. METHODS: An observational study of all 180 paediatric patients admitted with any diagnosis of malaria during 2010 was conducted: 128 P. vivax; 48 Plasmodium falciparum; and four mixed infections of these species. Patients were classified as having severe illness with any of the following indicators: Glascow coma scale <11; ≥2 convulsions; haemoglobin <5g/dL; thrombocytes <50,000/mL; blood glucose <45mg%; >70 breaths/min; or intravenous anti-malarial therapy. Additionally, 64 patients with a diagnosis of vivax malaria were treated during 2009, and the 21 of these having severe illness were included in analyses of the frequency and character of severe illness with that diagnosis. RESULTS: During 2010, 39 (31%) or 37 (77%) patients with a diagnosis of P. vivax or P. falciparum were classified as having severe disease. Including the 2009 records of 64 patients having vivax malaria, a total of 60 (31%) patients with severe illness and a diagnosis of P. vivax were available. Altered mental status (Glascow coma scale score <11; or ≥2 convulsions) dominated at 54% of the 83 indicators of severe illness manifest among the patients with vivax malaria, as was true among the 37 children with a diagnosis of falciparum malaria and being severely ill; 58% of the 72 indicators of severe disease documented among them. No statistically significant difference appeared in frequencies of any other severe disease indicators between patients diagnosed with vivax or falciparum malaria. Despite such similarities, a diagnosis of falciparum malaria nonetheless came with 3.8-fold (95% CI = 1.8-8.1) higher risk of presenting with severe illness, and 8.0-fold (95% CI = 2.1-31) greater likelihood of presenting with three or more severe disease indicators. Two patients did not survive hospitalization, one each with a diagnosis of falciparum or vivax malaria. CONCLUSIONS: Vivax malaria caused a substantial burden of potentially life-threatening morbidity on a paediatric ward in a hospital in south-eastern Pakistan.

To compare the outcome (early) of neonates with birth asphyxia in-relation to place of delivery and age at time of admission.

OBJECTIVE: To determine the frequency of birth asphyxia and short-term (early) outcome in relation to age at admission and place of delivery. METHODS: A descriptive cross-sectional study was conducted in the Paediatric Department, Neonatal Ward of Liaquat University Hospital (LUH) Hyderabad from January to December 2009. All babies were received at our nursery or delivered in LUH with birth asphyxia were included, while babies having major congenital abnormalities, with birth weight < 1800 gm or preterm were excluded. After consent and enrollment their detailed history including peri-natal history, Apgar score, resuscitation measures, problems and outcome were recorded on a pre-designed study proforma. Short-term outcome was measured after 7 hours as clinically improved, developed neurological disability (Hypoxic Ischaemic Encephalopathy stage II or III) or death. RESULTS: The frequency was (n = 600; 25%) of LUMHS born and (n = 310; 61.63%) were received within 6 hours, (n = 272 45% were LUMHS born and n = 7 7% were out born), (n = 37; 38.95%) within 24 hours and (n = 9; 10.3%) after 24 hours. On initial neurological evaluation (n = 90; 15%) were normal while clinical signs of HIE were present in 85%, with (n = 180; 30%) in stage I, (n = 210; 35%) in Stage II and (n = 120; 20%) in stage III of HIE. Outcome was measured after 72 hours, around 53.3% (320) were normal, 31.6% (190) developed neurological disability, while 15% (90) babies expired. Outcome was better in Liaquat University of Medical Health Sciences (LUMHS) born than out-born with statistically significant difference in terms of disability (Chi-square test P-value < 0.0001) but no difference was noted in terms of disability to death. There was a statistically improved outcome for babies received within 6 hours than those after 6 hours of birth (Chi-square test P-value < 0.0255). CONCLUSION: Early recognition of birth asphyxia and timely referral to tertiary center can reduce morbidity and mortality.

Assessment of infant feeding practices at a tertiary care hospital.

OBJECTIVE: To assess the practice and knowledge of mothers regarding breast feeding, complimentary feeding, and to find out socio-economic correlates of feeding practices. METHODS: A cross sectional survey conducted at paediatric department of Liaquat University Hospital (LUH) from Jan-Dec 2008. During that period 500 mothers with children less than 24 months were included. Infant feeding patterns were assessed in relation to recommendations and household socio-economic factors by an Interview Technique. RESULTS: Out of 500 mothers, 8.4% started exclusive breast feeding (EBF) while Pre-lacteal use was seen in 31.6%. Regarding the duration 52.2% mothers continued breast feeding for 2 years. Median duration of EBF was 3.5 months. It was seen that 60% of the 0-5 month-old infants breastfed 8 or more times per day. However, exclusiveness of breast feeding decreased from 60% at (0-2 months) to 40% (3-5 months). Majority 64.2% were poor and 61.5% had no education. There is a statistically significant difference in feeding practices of educated and uneducated (P < 0.0001) and also in poor and middle class mothers (P < 0.0003). Regarding, age of their last born babies, 180 babies were under 6 months, and 320 were 6 to 23 months of age. The knowledge about complimentary feeding (CF) was inadequate. Around 21% of 2-3 months old babies received complementary food and 19% of 6-8 month-olds were only breastfed. In 78% mothers CF was advised by family members while in 23% mothers by doctors. CONCLUSION: Exclusive breastfeeding was not maintained upto recommended age of 6 months. Knowledge about CF was lacking in the mothers. Regarding, mothers' education and socioeconomic conditions, a positive correlation was noted with feeding practices.

Etiological spectrum of pancytopenia based on bone marrow examination in children.

OBJECTIVE: To determine the spectrum of pancytopenia with its frequency, common clinical presentation and etiology on the basis of bone marrow examination in children from 2 months to 15 years. DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Paediatrics, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, from October 2005 to March 2007. PATIENTS AND METHODS: All patients aged 2 months to 15 years having pancytopenia were included. Patients beyond this age limits, already diagnosed cases of aplastic anemia and leukemia, clinical suspicion of genetic or constitutional pancytopenia, history of blood transfusion in recent past, and those not willing for either admission or bone marrow examination were excluded. History, physical and systemic examination and hematological parameters at presentation were recorded. Hematological profile included hemoglobin, total and differential leucocyte count, platelet count, reticulocyte count, peripheral smear and bone marrow aspiration/biopsy. RESULTS: During the study period, out of the 7000 admissions in paediatric ward, 250 patients had pancytopenia on their peripheral blood smear (3.57%). Out of those, 230 patients were finally studied. Cause of pancytopenia was identified in 220 cases on the basis of bone marrow and other supportive investigations, while 10 cases remained undiagnosed. Most common was aplastic anemia (23.9%), megaloblastic anemia (13.04%), leukemia (13.05%), enteric fever (10.8%), malaria (8.69%) and sepsis (8.69%). Common clinical presentations were pallor, fever, petechial hemorrhages, visceromegaly and bleeding from nose and gastrointestinal tract. CONCLUSION: Pancytopenia is a common occurrence in paediatric patients. Though acute leukemia and bone marrow failure were the usual causes of pancytopenia, infections and megaloblastic anemia are easily treatable and reversible.