Clinical competency of nurses trained in competency-based versus objective-based education in the Democratic Republic of the Congo: a qualitative study.

BACKGROUND: Designing competency-based education (CBE) programmes is a priority in global nursing education for better nursing care for the population. In the Democratic Republic of the Congo (DRC), object-based education (OBE) remains mainstream in pre-service nursing education programmes. Recently, the Ministry of Health developed a self-assessment tool and quantitatively compared the clinical competency of CBE- and OBE-trained nurses. This study aimed to qualitatively triangulate the results of self-evaluation by exploring perception of supervisors, incumbent CBE-, and OBE-trained nurses in comparison with the competence of the two types of nurses, and to identify influential factors or barriers to their competence in clinical settings. METHODS: A qualitative descriptive approach with conventional content analysis was applied. Twenty interviews with clinical supervisors who oversaw both CBE- and OBE-trained nurses, 22 focus group discussions (FGDs) with CBE-trained nurses, and 21 FGDs with OBA-trained nurses currently working in health facilities were conducted. Participants of the FGDs were selected from the participants of the DRC self-assessment competency comparison study where there was no statistically significance between CBE- and OBE-trained nurses in the demographic characteristics. Data were analysed in terms of the competencies identified by the Ministry of Health. RESULTS: The supervisors recognised that the CBE-trained nurses had stronger competencies in professional communication, making decisions about health problems, and engaging in professional development, but were weak in clinical skills. This study identified challenges for supervisors in assuring standardised care in health facilities with OBE- and CBE-trained nurses, as well as barriers for CBE-trained nurses as a minority in the workplace in demonstrating their competencies. CONCLUSIONS: The study results support the Ministry of Health's policy to expand CBE in pre-service education programmes but reveal that its slow implementation impedes full utilisation of the acquired competencies at health facilities. Implementation could be accelerated by strengthening cooperation among the Ministry of Health's three human resource departments, and developing and implementing a well-planned, legally binding, long-term CBE reform strategy, including an approach to the Continuing Professional Development system.

Comparison of the clinical competency of nurses trained in competency-based and object-based approaches in the Democratic Republic of the Congo: A cross-sectional study.

In the Democratic Republic of the Congo (DRC), the object-based approach (OBA) still remains mainstream in the basic nursing education program, despite the intention of the Ministry of Public Health to expand the competency-based approach (CBA) nationwide. This study aimed to compare the clinical competency of nurses trained with CBA and OBA. A cross-sectional, mixed study was conducted. We developed a self-assessment questionnaire consisting of an individual demographic information, a clinical competency assessment scale and the General Self-efficacy Scale. Nurses trained with CBA or OBA and currently working in health facilities with two to five years of clinical experience were purposively selected from ten cities across nine provinces in the DRC. We also conducted key informant interviews with the clinical supervisors at health facilities. In a comparison of 160 nurses trained with CBA and 153 with OBA, 3 competency domains ("establishing professional communication", "making decisions about health problems", and "performing nursing interventions") of the 5 domains required for nurses had significantly higher scores in the CBA group. The key informant interviews supported these results while revealing various issues in the basic nursing education program. The results support the strategic direction of the Ministry of Public Health in the DRC to expand CBA. Collaboration among education institutions, health facilities, and administrative bodies is crucial for clinical nurses to fully engage their competencies for the population. Other low- and middle-income countries with scarce resources can refer to the developed and implemented competency assessment method applied in this study.

A phase III, 52-week, open-label study to evaluate the safety and efficacy of 5% sofpironium bromide (BBI-4000) gel in Japanese patients with primary axillary hyperhidrosis.

A long-term study was conducted in Japanese patients with primary axillary hyperhidrosis who completed the preceding 6-week phase III, confirmatory study of 5% sofpironium bromide gel (hereinafter referred to as sofpironium) to evaluate the safety and efficacy of 52-week treatment with sofpironium. In the long-term study, 185 patients who completed the confirmatory study (94 and 91 patients in the vehicle and sofpironium groups, respectively) started to receive sofpironium (switching and extension groups, respectively), and all these patients were included in both the full analysis set (FAS) and the safety analysis set (SAF). In the FAS, there were more females than males (73.0% vs. 27.0%), and median age was 38.0 years. A total of 161 patients (86 and 75 patients in the switching and extension groups, respectively) completed the study at week 52. The proportions of patients with hyperhidrosis disease severity score of 1 or 2 and a 50% or more reduction in total gravimetric weight of sweat were 57.4% in the switching group and 58.2% in the extension group at week 52. The proportions of patients who achieved this efficacy end-point in the long-term study were similar to that (53.9%) in the sofpironium group in the confirmatory study. In the SAF, the incidences of adverse events (AEs) were 80.9% in the switching group and 83.5% in the extension group, and the incidences of adverse drug reactions were 39.4% and 45.1%, respectively. AEs that occurred in at least 20% of patients in both treatment groups were application site dermatitis (25.5% and 33.0%, respectively) and nasopharyngitis (31.9% and 23.1%, respectively). Reported AEs were generally mild, and there were no deaths. Serious AEs occurred in three patients, but none were considered related to the study drug. In this study, the efficacy of sofpironium was maintained during 52-week treatment, and no new safety risk was observed.

Enhancing the use of computed tomography and cardiac catheterization angiography in Zambia: A project report on a global extension of medical technology in Japan.

Cardiovascular disease (CVD) is one of the leading causes of death in adults in Zambia among the non-communicable diseases. The Government of the Republic of Zambia through the Ministry of Health procured Japanese radiological systems, computed tomography, and angiography for the University Teaching Hospitals (UTHs) - Adult in 2015. However, the operation of these diagnostic systems has not been optimal due to lack of a proper maintenance service plan, lack of competent health professionals, and erratic supply of medical consumables. In this study, we report our experiences of providing intensive training to multidisciplinary healthcare teams of the radiology department at UTHs - Adult from 2017 to 2019 to strengthen the quality management system of the radiological equipment so as to provide effective healthcare services. However, the COVID-19 pandemic has had enormous negative impact on essential healthcare. Long-term support through continuous hands-on training must be provided to establish sustainable healthcare services.

A phase 3, multicenter, randomized, double-blind, vehicle-controlled, parallel-group study of 5% sofpironium bromide (BBI-4000) gel in Japanese patients with primary axillary hyperhidrosis.

A phase 3 study was conducted to verify the efficacy and safety of 5% sofpironium bromide (BBI-4000) gel (hereinafter referred to as sofpironium) administrated for 6 weeks in Japanese patients with primary axillary hyperhidrosis. The primary efficacy end-point was the proportion of patients who satisfied both criteria of a Hyperhidrosis Disease Severity Score (HDSS) of 1 or 2 at the end of 6-week treatment and a 50% or more reduction in total gravimetric weight of sweat at the end of treatment relative to baseline. A total of 281 patients were randomized to receive 5% sofpironium (141 patients) or vehicle (140 patients), and all patients were included in the full analysis set (FAS). In the FAS, 70.1% of patients were female, and the median age was 35.0 years. The proportion of patients who achieved the primary efficacy end-point was 53.9% in the sofpironium group and 36.4% in the vehicle group, with a statistically significant difference of 17.5% (95% confidence interval, 6.02-28.93) between these two groups (P = 0.003). The incidence of adverse events was 44.0% in the sofpironium group and 30.7% in the vehicle group, and the incidence of adverse drug reactions was 16.3% in the sofpironium group and 5.0% in the vehicle group. Reported adverse events were generally mild or moderate in severity. In the sofpironium group, common events (incidence, ≥5%) were nasopharyngitis (14.2%) and dermatitis/erythema at the application site (8.5%/5.7%), with no serious adverse events reported. This study demonstrated the efficacy and safety of 5% sofpironium.

Can we apply lessons learned from Ebola experience in West Africa for COVID-19 in lower income countries?

The COVID-19 affects vulnerable groups disproportionally in a society where inequities are long-standing issue. Weak health system, especially the shortage and maldistribution of capable health workforce will be the main challenge in lower income countries to fight against the COVID-19. Applying the lesson learned and success from the Ebola outbreak in West Africa is important. International collaboration with already well functioned local mechanisms, such as the Network of Managers of Health Workforce in Francophone Africa is the key to provide prompt support. This approach contributes not only to the short-term COVID-19 control but also long-term strengthening of the sustainable and resilient health system in the lower income countries.