The effect of therapeutic education program on quality of life among type 2 diabetic North-African patients: a randomized controlled trial.

INTRODUCTION: Type 2 Diabetes Mellitus (T2DM) is a chronic non-communicable disease with major impact on health in general and quality of life (QoL) in particular. The ultimate goal of all health interventions is to reduce the burden of this disease. AIM: To evaluate the effect of therapeutic education program on the QoL among patients with T2DM. METHODS: Between May 2021 and July 2022, 320 outpatients were enrolled in a randomized controlled trial in Sfax, Tunisia. The experimental group received the therapeutic education program, whereas the control group received only standard care. For data collection, the Arabic version of the Diabetes Quality of Life (DQoL-Arabic) questionnaire was used. RESULTS: In total, 263 patients completed the intervention, 132 in the experimental group and 131 in the control group. In terms of the main baseline characteristics, the two groups were comparable. After the intervention, there was a significant difference in all domains of QoL scores (median [interquartile]) between the experimental and control groups: satisfaction (3.14 [2.64-3.36] vs. 3.57 [3.43-3.71], p<0.001, respectively), impact (2.09 [1.91-2.36] vs. 2.45 [2.27 2.64], p<0.001, respectively) and worries (2.50 [2.25-2.75] vs. 3.00 [2.75 3.14], p<0.001, respectively). The QoL improves over time in the experimental group (3.01 [2.79-3.17] vs. 2.59 [2.21-2.80], p<0.001, respectively) and remains comparable in the control group (2.99 [2.81-3.14] vs. 3.01 [2.81-3.15], p=0.724, respectively). CONCLUSIONS: The benefits of implementing an educational program among patients with T2DM are observed in terms of all QoL domains.

Health-related quality of life, psychological issues and concerns among sarcoma survivors: a mixed method study.

Purpose: We aimed to explore the health-related quality of life (HRQoL), psychological issues and concerns among sarcoma survivors in India and assess their satisfaction with nursing care. Methods: This study employed a sequential mixed-methods design, enrolling 100 sarcoma survivors from July to December 2021, with data collected using standardised questionnaires for HRQoL, depression, anxiety, stress, cognitive impairment and self-structured satisfaction with nursing care. Qualitative data were gathered through focused group discussions. Results: The mean global health score among sarcoma survivors was 79.48 ± 16.26. A significant number of survivors had symptoms of mild-to-moderate depression (30%), severe anxiety (12%), stress (16%) and mild cognitive impairment (5%). Significant mean rank differences were observed between anxiety and financial difficulty (p < 0.05), emotional functioning (p < 0.001), cognitive functioning (p < 0.001), pain (<0.05), insomnia (p < 0.001), fatigue (p < 0.001), anorexia (p < 0.05) and nausea/vomiting (p < 0.001). Educational qualification had a significant association with depression and anxiety while family history of cancer emerged as a significant factor associated with anxiety and stress among survivors. Qualitative analysis revealed themes related to body image, societal discrimination, socio-economic impact, marriage concerns and fertility issues. Survivor satisfaction with nursing care was good. Conclusion: A substantial number of sarcoma survivors had an average HRQoL and experienced depression, anxiety and stress. Our study emphasizes the importance of holistic survivorship care, involving nurses in post-treatment support, and addressing societal discrimination and psychosocial concerns to enhance their quality of life. Implications for cancer survivors: Our study calls for a holistic approach to sarcoma survivor care and emphasizes the importance of personalised survivorship care plans led by nurses to address the diverse needs of sarcoma survivors in India. Such plans should encompass strategies for managing depression, anxiety and stress, along with addressing body image concerns and social support.

Sexual dysfunction in women with primary Sjögren's syndrome: a systematic review and meta-analysis.

INTRODUCTION: Primary Sjögren's syndrome (pSS) is an inflammatory autoimmune condition affecting the exocrine glands, which can adversely affect the sexual activities of women with pSS. OBJECTIVES: The study sought to evaluate the performance of the Female Sexual Function Index (FSFI) score in women with pSS regarding desire, arousal, orgasm, lubrication, satisfaction, and pain compared with those of healthy individuals. METHODS: A systematic review was conducted by examining studies published up to May 2023 using Embase, Web of Science, Scopus, and PubMed with the search terms "sexual" and "Sjögren's syndrome." RESULTS: Out of the 228 articles retrieved, 9 met the criteria for inclusion in this systematic review. Six of these studies were cross-sectional, involving 229 women with pSS and 303 control subjects. Results from the meta-analysis showed that women with pSS had significantly lower scores in all 6 FSFI subdomains and the total FSFI score compared with healthy individuals. Lubrication showed the largest decrease, followed by pain. In addition, women with pSS exhibited significantly higher standardized mean differences in depression and in anxiety, as assessed by the Hospital Anxiety and Depression Scale, when compared with control subjects. CONCLUSION: This updated meta-analysis underscores the importance of assessing genitourinary atrophy, disease-related psychological changes, and dyspareunia in women with pSS. It also emphasizes the need for customized therapeutic approaches to address these sexual dysfunctions effectively.

The Association Between Well-Being and Empathy in Medical Residents: A Cross-Sectional Survey.

Objective: To evaluate the extent to which personal well-being may be associated with empathy, while controlling for potential confounders. Settings/Location: Residency programs throughout the United States. Subjects: A total of 407 medical residents from residencies including general medicine, surgery, specialized and diagnostic medicine participated in this study. Outcome Measures: Well-being was measured using the modified existential well-being subscale of the spiritual well-being scale. Empathy was measured using the Jefferson Scale of Empathy. Results: Well-being was found to be positively correlated with empathy when adjusted for possible confounders (p < 0.001). In addition to well-being, other factors noted to be statistically significant contributors to higher empathy scores while controlling for the others included age, gender, year in residency, specialty, and work-hours (p < 0.05 for each). After controlling for these factors, a resident's year in residency was not found to be a statistically significant contributor to empathy score. Conclusions: In this study, well-being was associated with empathy in medical and surgical residents. Empathy is a fundamental component of physician competency, and its development is an essential aspect of medical training. These findings suggest that efforts to increase well-being may promote empathy among medical residents.

Survey of Information Acquisition and Satisfaction after Bariatric Surgery at a Tertiary Hospital in Korea.

Background: To determine how patients who underwent bariatric surgery at a tertiary hospital in Korea first considered and then decided to get the surgery and identify information gaps among patients and healthcare professionals. Methods: This study included 21 patients who underwent bariatric surgery to treat morbid obesity (body mass index [BMI] ≥35 or ≥30 kg/m2 together with obesity-related comorbidities) between August 2020 and February 2022. A telephone interview was conducted with the patients after at least 6 months had elapsed since the surgery. We asked how the patients decided to undergo bariatric surgery. We also inquired about their satisfaction with and concerns about the surgery. Results: Seventy-one percent of the patients were introduced to bariatric surgery following a recommendation from healthcare professionals, acquaintances, or social media. Most of the patients (52%) decided to undergo bariatric surgery based on recommendations from healthcare professionals in non-surgical departments. Satisfaction with the information provided differed among the patients. Post-surgical concerns were related to postoperative symptoms, weight regain, and psychological illness. Conclusion: Efforts are needed to raise awareness about bariatric surgery among healthcare professionals and the public. Tailored pre- and postoperative consultation may improve quality of life after bariatric surgery.

EPITRANS. Quality assessment of the epilepsy transition process.

OBJECTIVE: To analyze the differences in clinical management during the epilepsy transition process from pediatric to adult care and to determine the quality of life and degree of satisfaction of patients and caregivers during the transition. METHODS: This is a longitudinal study including patients with epilepsy transferred from pediatric to adult epilepsy care between 2013 and 2017. Patients had a minimum follow-up of 3 years before the transition visit and at least 3 years consulting in the adults section. Clinical characteristics were retrieved from the medical chart. Quality of life and satisfaction questionnaires were administered by online access to patients and caregivers at the end of the adult follow-up period. RESULTS: 99 patients (50.5 % women, mean transition age 16.5 ± 1 years old) were included. Before the transition visit, 90 % of patients received a transition discussion and 88 % had a formal clinical report. In the pediatric period, patients were visited more frequently, had more EEGs and genetic studies, and were seen by the same neuropediatrician (P<0.05). In the adult period, patients underwent a larger number of prolonged video EEGs and were prescribed polytherapy more often (P<0.05). Quality of life remained steady during the entire transition, but satisfaction with the care received was significantly higher during the pediatric period. CONCLUSIONS: Significant differences were seen in epilepsy care during transition from pediatric to adult management, and this had an impact on the degree of satisfaction reported by patients and caregivers. Our results provide evidence of the potential value of development and early implementation of a protocolled transition program.

Effect of Personality and Pain Catastrophizing on Postoperative Analgesia Following Cesarean Section: A Prospective Cohort Study.

Purpose: This study aimed to investigate the effects of different psychological personalities and pain catastrophizing levels on postoperative analgesia in patients undergoing cesarean section. Patients and Methods: Puerperas who underwent cesarean section at our hospital between January and August 2023 were recruited into the study and assessed using the Eysenck Personality Questionnaire-Revised Short Scale (EPQRSC) and Pain Catastrophizing Scale (PCS). Data on the numerical pain intensity at rest and during activity 24 h after surgery, number and dosage of analgesia pumps, and satisfaction with analgesia were recorded. According to the numerical pain score during activity 24 h post-operation, the patients were divided into the analgesia incomplete group (≥4) and control group (<4). Univariate analysis, Spearman correlation analysis, and binary logistic regression analysis were used to evaluate the influence of personality characteristics and PCS on postoperative analgesia. Results: A total of 778 women were included in the study. The incidence of inadequate analgesia was 89.8%. The satisfaction rate of analgesia was 66.8%. Univariate analysis showed that extraversion; neuroticism; PCS; numbers of previous cesarean delivery; ASA; analgesic satisfaction; and 24-h analgesia pump compressions and dosage were associated with postoperative analgesia after cesarean section (P<0.05). Using binary logistic regression analysis, the first cesarean section (odds ratio [OR]=0.056, 95% confidence interval [CI]=1.913-19.174), the number of 24-h analgesic pump compressions (OR=8.464, 95% CI=0.356-0.604), extraversion (OR=0.667, 95% CI=0.513-0.866), neuroticism (OR=1.427, 95% CI=1.104-1.844), and PCS (OR=7.718, 95% CI=0.657-0.783) were factors affecting postoperative analgesia. Conclusion: The incidence of inadequate analgesia after a cesarean section was high (89.8% on the first day after surgery). Formulating accurate analgesia programs for women undergoing cesarean section with extraversion, neuroticism personality characteristics, and pain catastrophizing behaviors is necessary for improving their postoperative analgesia effects and satisfaction and promoting postpartum comfort.

Preference of the patient's family for family-centred care in a paediatric hospital.

Objective: To explore the dimensions of family-centred care preferred by families of paediatric inpatients in a public healthcare setting. METHODS: The qualitative study was conducted at the National Institute of Child Health, Karachi, from October 2021 to August 2022, and comprised family members of the hospitalised children. Data was collected through three focus group discussions that were guided by a semi-structured questionnaire. Using the five-step Fereday and Muir-Cochrane guidelines, data was coded and subjected to thematic analysis. RESULTS: Of the 21 subjects, 13(62%) were males and 8(38%) were females. The overall mean age was 32.24±7.58 years (range: 18-50 years). In terms of relationship with the patient, 9(43%) were fathers and 6(28.6%) were mothers. Each focus group discussion had 7(33.3%) subjects. Thematic analysis showed that the participants perceived family-centred care positively. Eight categories emerged depicting family perception and experience of family-centred care in a tertiary-care setting. Conclusion: The participants perceived family-centred care respectful and empathic towards patients' families, making them integral care team members.

Decisional conflict in parents of children with congenital heart defect: Towards development of a model.

AIM: This study aimed to develop a model to help parents cope with decisional conflict. BACKGROUND: Parents of children with congenital heart defect experience decisional conflict when they are uncertain about treatment decisions for their child, which may lead to delay in seeking care or distress over the decision made. DESIGN: Correlational design with model building and data triangulation was used. METHODS: Data were collected through surveys and interviews with a consecutive sample of 221 parent respondents from June to December 2018. Structural equation modelling and qualitative data analysis were used. RESULTS: Lower decisional conflict was seen in parents with higher income, more nurse support and physician risk communication. Time delay for surgery was correlated with the child's age, social service coverage, and social support. Decisional conflict mediated the influence of income, nurse support and physician risk communication on satisfaction with decision. Based on model fit parameters, the emerging model is a good and parsimonious model of decisional conflict. The overall theme, 'Deciding for Surgery: What Matters Most', described the processes parents went through in making treatment decisions. CONCLUSION: Nurses may help parents feel more certain, less conflicted, and more satisfied with their decision by addressing factors including knowledge gaps, personal values, available support, and resource access.

Does gender still matter in the pursuit of a career in anaesthesia?

A survey sent to fellows of the Australian and New Zealand College of Anaesthetists (ANZCA) aimed to document issues affecting gender equity in the anaesthesia workplace. A response rate of 38% was achieved, with women representing a greater proportion of respondents (64.2%). On average women worked fewer hours than men and spent a larger percentage of time in public practice; however, satisfaction rates were similar between genders. There was a gender pay gap which could not be explained by the number of hours worked or years since achieving fellowship. The rates of bullying and harassment were high among all genders and have not changed in 20 years since the first gender equity survey by Strange Khursandi in 1998. Women perceived that they were more likely to be discriminated against particularly in the presence of other sources of discrimination, and highlighted the importance of the need for diversity and inclusion in anaesthetic workplaces. Furthermore, women reported higher rates of caregiving and unpaid domestic responsibilities, confirming that anaesthetists are not immune to the factors affecting broader society despite our professional status. The overall effect was summarised by half of female respondents reporting that they felt their gender was a barrier to a career in anaesthesia. While unable to be included in statistics due to low numbers, non-binary gendered anaesthetists responded and must be included in all future work. The inequities documented here are evidence that ANZCA's gender equity subcommittee must continue promoting and implementing policies in workplaces across Australia and New Zealand.

A percepção do estudante de medicina sobre a simulação realística em pediatria / The perception of the medical student about realistic simulation in pediatrics

Resumo Introdução: O uso de simulação realística em emergências pediátricas é particularmente valioso, pois permite o treinamento de habilidades técnicas, atitudinais e cognitivas, ajudando a garantir a segurança do paciente. Objetivo: Este estudo tem como objetivo descrever a percepção do aluno sobre o uso da Simulação Realista de Alta Fidelidade nos módulos de emergência pediátrica durante o internato de medicina. Métodos: Estudo observacional, descritivo, com abordagem quantitativa e qualitativa. Um questionário semiestruturado foi aplicado aos estudantes do sexto ano de medicina ao final dos módulos de internato pediátrico, com oito semanas de duração, de agosto a dezembro de 2020. Todos participaram de dois tipos de atividades sobre 14 temas: simulação de alta fidelidade (SRAF) e discussão estruturada de casos clínicos (DCC). Resultados: Dos 33 participantes, 29 responderam ao questionário. A média de idade foi de 24 ± 1,8 anos, sendo 58,6% do sexo feminino. Todos concordaram que a experiência com SRAF contribuiu para um desempenho mais seguro em emergências pediátricas, considerado ótimo por 76% e bom para os demais. A maioria achava que a associação de SRAF e DCC era o método ideal (96%). A análise de conteúdo das respostas sobre a SRAF destacou unidades temáticas em cinco categorias: aprendizagem significativa, contribuição para a formação profissional, habilidades, atitude/comportamento e qualidade da atividade. Conclusões: A reação dos estudantes ao uso da SRAF em emergências pediátricas foi muito positiva, e sua associação com a DCC foi considerada o método de ensino ideal. Conhecer as reações dos alunos ajuda os professores a planejarem suas atividades para melhorar o método de ensino-aprendizagem.

Abstract Introduction: The use of realistic simulation in pediatric emergencies is particularly valuable, as it allows the training of technical, attitudinal, and cognitive skills, helping to ensure patient safety. Objective: This study aims to describe the student's perception of using the High-Fidelity Realistic Simulation in the pediatric emergency modules during the internship. Methods: Observational, descriptive study with a quantitative and qualitative approach. A semi-structured questionnaire was applied to sixth-year medical students at the end of the pediatric internship modules, which lasted eight weeks, from August to December 2020. All of them participated in two types of activities on 14 topics: high-fidelity simulation (HFS) and structured discussion of clinical cases (SDCC). Results: Of the 33 participants, 29 answered the questionnaire. The mean age was 24 ± 1.8 years, and 58.6% were female. All agreed that the experience with HFS contributed to safer performance in pediatric emergencies, considered optimal by 76% and good for the remainder. Most thought the association of HFS and SDCC was the ideal method (96%). The content analysis of the responses on HFS highlighted thematic units in five categories: significant learning, contribution to professional training, skills, attitude/behavior, and quality of the activity. Conclusions: Students' reaction to using HFS in pediatric emergencies was very positive, and its association with SDCC was considered the ideal teaching method. Knowing the students' reactions helps teachers plan their activities to improve the teaching-learning method.

Teaching of sexual medicine and gender issues in medical courses: students' perception

SUMMARY INTRODUCTION: In addition to reproductive purposes, human sexuality and sexual health are matters of great importance in the medical office. Despite this, there is still a deficiency in the training of Brazilian medical students regarding sexual medicine and gender issues. OBJECTIVE: The objective of this study was to analyze the perception of fifth- and sixth-year students in relation to the teaching of sexual medicine and gender issues in medical courses. METHODS: This is a descriptive and cross-sectional study with students from the last 2 years of medical schools in the State of Santa Catarina (internship classes), through the application of a self-administered, semi-structured online questionnaire. RESULTS: A total of 164 students answered the questionnaire, with 83.5% (137/164) saying they had taken classes on sexual medicine and 47% (77/164) saying they had taken classes on gender issues. The participants judged the teaching inadequate in most of the topics addressed, and there was no significant difference between students from public and private schools. Notably, 79.9% (131/164) of the students considered the teaching of sexual medicine insufficient or inadequate, while 87.8% (144/164) considered the teaching of gender issues insufficient or inadequate. CONCLUSION: The vast majority of students consider the teaching of sexual medicine and gender issues insufficient and inadequate.

'Naming and faming' maternity care providers: A mixed-methods study.

BACKGROUND: Positive benchmarking can serve as a catalyst for maternity care improvement. AIM: To retrospectively benchmark Flemish maternity care providers' qualities, based on women's positive care experiences, and to explore which attributes of the different care providers contribute to these experiences. METHODS: A sequential, two-phased mixed-methods study benchmarking the qualities of the community midwife, the hospital midwife, and the obstetrician. An online questionnaire was used to collect the data among pregnant and postpartum women, who rated their care experiences with the various care providers using the Net Promoter Score. Non-parametric and post hoc tests established the differences between types of clinicians and between antenatal, intrapartum, and postpartum Net Promoter Score mean scores. Content analysis was used to construct a final pool of keywords representing attributes of care professionals, accumulated from the promoters' free text responses. Ranks were assigned to each keyword based on its frequency. FINDINGS: A total of 2385 Net Promoter Scale scores and 1856 free-text responses of 1587 responders were included. The community midwife received the overall highest NPS scores (p < .001). The promoters (n = 1015) assigned community midwives the highest NPS scores (9.67), followed by obstetricians (9.57) and hospital-based midwives (9.51). The distinct benchmarking attributes of community midwives were availability (p < .001), supportiveness (p = .04) and personalised care (p < .001). Being honest (p < .001), empathic (p < .001) and inexhaustible (p = .04) benchmarked hospital midwives. Calmness (p < .001), a no-nonsense approach (p < .001), being humane (p = .01) and comforting (p = .02) benchmarked obstetricians. DISCUSSION/CONCLUSION: The findings indicate that all care providers are highly valued, but community midwives are ranked the highest. The distinct differences between the care professionals can serve as exemplary performance for professional development and shape the profiles of maternity care professionals.

Surgical trainee experiences from 2013 to 2023 within the United Kingdom as reported by the General Medical Council National Training Survey.

INTRODUCTION: The General Medical Council (GMC) issues annual surveys to all doctors within the United Kingdom (UK) in a formal postgraduate training scheme. This facilitates the monitoring of experiences for quality assurance purposes. Low job satisfaction has been associated with heightened levels of burnout and staff turnover, alongside deteriorating clinical care and productivity levels. METHODS: We gathered and extracted data from the publicly available online GMC reporting tool. Data ranged from 2013 to 2023 and spanned 12 postgraduate surgical training programmes across all 18 indicators available. In total, 198 individual metrics were recorded, in addition to burnout. We conducted trend analysis and yearly average mean scores for individual metrics, burnout and geographical differences for 141 individual training programmes within the 16 training regions. RESULTS: Of the 198 metrics analysed, 83 (42 â€‹%) were found to have statistically significant negative trends (P â€‹< â€‹0.05), in comparison to 24 (12 â€‹%) with positive trends. 5 specialities had over 50 â€‹% of metrics showing a significant negative trend. Overall satisfaction was negative in all 12 programmes, with eight reaching significance (P â€‹< â€‹0.05). Of 141 individual training programmes, 29 â€‹% showed a significantly negative trend in overall satisfaction, with 1 â€‹% demonstrating a significant positive trend (P â€‹< â€‹0.05). CONCLUSION: Our study is the first to explore long-term trends in trainee reported surgical training experiences within the UK. Our data have revealed widespread worsening trainee reported experiences and dissatisfaction across multiple specialities and geographical regions, especially in key areas of overall satisfaction, self-development, and clinical supervision.

Calidad percibida de la educación a distancia durante la pandemia COVID-19 por estudiantes de posgrado de una facultad de medicina

Introducción. Al decretar el gobierno la cuarentena obligatoria durante la pandemia COVID-19 se inició una nueva forma de ejercer la labor pedagógica de manera sincrónica o asincrónica. Objetivos. Conocer a través de los niveles de insatisfacción, la calidad percibida de la educación a distancia durante la pandemia COVID-19 por los estudiantes del posgrado. Métodos. Se realizó un estudio descriptivo observacional. La población estuvo conformada por 403 estudiantes, las variables fueron calidad percibida y educación a distancia. Se aplicó el análisis de la estadística descriptiva y el análisis univariado. Resultados. El nivel de satisfacción de la calidad percibida de la educación a distancia de los 413 estudiantes fue de indiferencia en el 45,7%, en el 12,5% fue de insatisfacción y en el 41,8% fue de satisfacción. El nivel de satisfacción de la calidad percibida le correspondió mayoritariamente al entorno del aprendizaje virtual e información recibida y contenido del aula virtual, mientras que el mayor nivel de indiferencia le correspondió a la educación a distancia (78,0%), neuropedagogía (51,1%) y docente (45,8%). Conclusiones. La satisfacción respondió al entorno, a la información y materiales, mientras la insatisfacción a la adaptación de estrategias pedagógicas y materiales a la virtualidad.

Introduction. When the government decreed the mandatory quarantine during the COVID-19 pandemic, a new way of exercising the pedagogical work in a synchronous or asynchronous way was initiated. Objectives. To know through the levels of dissatisfaction the perceived quality of distance education during the COVID-19 pandemic by postgraduate students. Methods. A descriptive observational study was carried out. The population consisted of 403 students, the variables were perceived quality and distance education. Descriptive statistics analysis and univariate analysis were applied. Results. Level of satisfaction with the perceived quality of distance education of the 413 students was indifference in 45.7%, dissatisfaction in 12.5% and satisfaction in 41.8%. The level of satisfaction of perceived quality corresponded mostly to the virtual learning environment and information received and content of the virtual classroom, while the highest level of indifference corresponded to distance education (78%), neuropedagogy (51.1%) and teacher (45.8%). Conclusions. Satisfaction responded to the environment, information, and materials, while dissatisfaction to the adaptation of pedagogical strategies and materials to virtuality.

Women's Satisfaction with Breastfeeding and Risk of Exclusive Breastfeeding Interruption.

This prospective cohort study was conducted to evaluate the association between women's satisfaction with breastfeeding at 1 month post-partum and the risk of exclusive breastfeeding (EBF) interruption before 6 months. 287 mother-infant dyads randomly selected from two maternity hospitals were followed from birth to 24 months of infant's age. Women's satisfaction with breastfeeding was assessed using the Maternal Breastfeeding Evaluation Scale (MBFES) at 1 month. The association between women's satisfaction with breastfeeding and risk of EBF interruption before 6 months was estimated using Cox proportional hazards model. Kaplan-Meier survival curves for EBF were compared between women with lower satisfaction with breastfeeding (MBFES score < median 124) and those with higher satisfaction (MBFES score ≥ 124). Median EBF duration in women with higher satisfaction was 120 days (95%CI 109-131), vs. 26 days (95%CI 19-33) in less satisfied women. Each additional point on MBFES promoted a reduction of 2.0% in the risk of EBF interruption. Among women with satisfaction scores < 124, the risk of EBF interruption was 86% higher when compared with those ≥ 124 (adjusted hazard ratio 1.86; 95%CI 1.41-2.46). Lower maternal satisfaction with breastfeeding in the first month post-partum is associated with a higher risk of EBF interruption before 6 months.

A satisfação dos estudantes de enfermagem com as práticas clínicas simuladas / Nursing students' satisfaction with simulated clinical experiences / Satisfacción de los estudiantes de enfermería con las prácticas clínicas simuladas

Resumo Enquadramento: As práticas clínicas simuladas, designadas por experiências clínicas simuladas ou simulação, são um processo formativo dinâmico e desafiador que decorre em ambiente controlado com recurso a cenários que recriam a realidade clínica. Objetivo: Estudar a satisfação dos estudantes de enfermagem com as práticas clínicas simuladas. Metodologia: Estudo descritivo-correlacional de abordagem quantitativa, com uma amostra de 223 estudantes de enfermagem. Aplicada a Escala de Satisfação com as Experiências Clínicas Simuladas (ESECS), constituída pelas dimensões: prática, cognitiva e realismo. Resultados: A satisfação média global com as práticas clínicas simuladas, foi de 7,501 na escala de 1-10. As características sociodemográficas, ano curricular e conteúdos, não foram preditivos da satisfação. Os estudantes apresentam-se em média mais satisfeitos na dimensão cognitiva e menos satisfeitos na dimensão realismo. Conclusão: Os estudantes apresentam-se satisfeitos com as práticas clínicas simuladas percecionando a sua importância para a aprendizagem, na aquisição de competências e maior capacidade de resposta no ensino clínico em contexto real. Tal reforça a pertinência do investimento, teórico, científico e prático, nesta estratégia de ensino.

Abstract Background: Simulated clinical experiences, also known as simulated clinical practices or simulation, are dynamic and challenging training activities that occur in a controlled environment using scenarios that recreate real-life clinical practice. Objective: To examine nursing students' satisfaction with simulated clinical experiences. Methodology: This quantitative descriptive-correlational study was conducted with 223 nursing students, using the Escala de Satisfação com as Experiências Clínicas Simuladas (ESECS; Satisfaction with Simulated Clinical Experiences Scale), which includes the Practical, Cognitive, and Realism dimensions. Results: The total mean of global satisfaction with the simulated clinical experiences was 7.501 on a scale of 1 to 10. The socio-demographic characteristics and course year and contents were not predictors of satisfaction. On average, students were more satisfied with the Cognitive dimension and less satisfied with the Realism dimension. Conclusion: Students are satisfied with simulated clinical experiences and understand their importance for acquiring skills and improving their ability to respond during clinical teachings in real-life contexts. For this reason, the theoretical, scientific, and practical investment in this teaching strategy is highly relevant.

Resumen Marco contextual: Las prácticas clínicas simuladas, denominadas experiencias clínicas simuladas o simulación, son un proceso de formación dinámico y desafiante que tiene lugar en un entorno controlado y que utiliza escenarios que recrean la realidad clínica. Objetivo: Estudiar la satisfacción de los estudiantes de enfermería con las prácticas clínicas simuladas. Metodología: Estudio descriptivo-correlacional con enfoque cuantitativo, con una muestra de 223 estudiantes de enfermería. Se aplicó la Escala de Satisfacción con las Experiencias Clínicas Simuladas (ESECS), que consta de las siguientes dimensiones: práctica, cognitiva y realismo. Resultados: La satisfacción global media con las prácticas clínicas simuladas fue de 7,501 en una escala del 1 al 10. Las características sociodemográficas, el año de estudio y los contenidos no predijeron la satisfacción. De media, los estudiantes se mostraron más satisfechos en la dimensión cognitiva y menos satisfechos en la dimensión realismo. Conclusión: Los estudiantes se muestran satisfechos con las prácticas clínicas simuladas y son conscientes de su importancia para el aprendizaje, la adquisición de habilidades y una mayor capacidad de respuesta en la enseñanza clínica en un contexto real. Esto refuerza la pertinencia de la inversión teórica, científica y práctica en esta estrategia pedagógica.

The effectiveness of simulation-based education combined with peer-assisted learning on clinical performance of first-year medical residents: a case-control study.

BACKGROUND: Simulation-based education and peer-assisted learning (PAL) are both known as useful educational methods. Previous research has reported that combining these two methods are effective for training medical residents in short-term evaluation. This study was aimed to evaluate the middle- to long-term effects of simulation-based education combined with PAL on the performance of medical residents during emergency department duties. METHODS: This study was designed as a case-control study and conducted over three years at Okayama University Hospital in Japan. Postgraduate-year-one medical residents were assigned to three groups: a simulation group that received simulation-based education, a lecture group that received traditional lecture-based education, and a control group that received no such prior trainings. Prior training in emergency department duties using PAL was performed as an educational intervention for the simulation and lecture groups during the clinical orientation period. The residents' medical knowledge was assessed by written examinations before and after the orientation. The performance of residents during their emergency department duties was assessed by self-evaluation questionnaires and objective-assessment checklists, following up with the residents for three months after the orientation period and collecting data on their 1st, 2nd, and 3rd emergency department duties. All the datasets collected were statistically analyzed and compared by their mean values among the three groups. RESULTS: A total of 75 residents were included in the comparative study: 27 in the simulation group, 24 in the lecture group, and 24 in the control group. The simulation and lecture groups obtained significantly higher written examination scores than the control group. From the self-evaluation questionnaires, the simulation group reported significantly higher satisfaction in their prior training than the lecture group. No significant differences were found in the emergency department performance of the residents among the three groups. However, when evaluating the improvement rate of performance over time, all three groups showed improvement in the subjective evaluation, and only the simulation and lecture groups showed improvement in the objective evaluation. CONCLUSION: Simulation-based education combined with PAL is effective in improving the knowledge and satisfaction of medical residents, suggesting the possibility of improving work performance during their emergency department duties.

Perception, satisfaction, and self-regulation in a blended learning environment during COVID-19 pandemic among health sciences students: A cross-sectional survey.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has severely impacted the health status of the people and the education of the students affecting their learning process and performance in examinations. Blended learning (hybrid learning) has evolved as one of the convenient and innovative methods of using technologies with the integration of traditional methods, significantly when face-to-face interaction is compromised. This study aimed to assess perception, satisfaction, and self-regulatory learning behaviors among undergraduate health sciences students. METHODS AND MATERIAL: A descriptive cross-sectional survey was carried out among 550 undergraduate students. The tools used for data collection were demographic proforma, perception scale, satisfaction questionnaire, and self-regulation learning scale, which were self-report questionnaires. The data were analyzed using Spearman's rank correlation and Chi-square test. RESULTS: About 378 (68.7%) out of 550 students preferred traditional face-to-face learning before the COVID-19 pandemic, whereas 276 (50.2%) students chose blended learning after the pandemic. About 424 (77.1%) perceived blended learning positively, 267 (48.5%) were moderately satisfied, and 377 (68.5%) of the students had moderate self-regulation in blended learning. The study revealed a strong, positive relationship, between perception (r = 0.817, P < 0.001), satisfaction (r = 0.710, P < 0.001), and self-regulation (r = 0.722, P < 0.001) in the blended mode of learning. Age, course, year of study, and preference of learning mode were significantly associated with perception, satisfaction, and self-regulation in blended learning at P < 0.05. However, perception, satisfaction, and self-regulation among students did not differ according to gender and students' previous exposure to a blended mode of learning at P > 0.05. CONCLUSIONS: To implement innovative pedagogical techniques using improvised technological assistance in teaching and learning, building up an effective blended learning environment within every institution is essential.

Stroke survivors' long-term participation in paid employment.

BACKGROUND: Knowledge on long-term participation is scarce for patients with paid employment at the time of stroke. OBJECTIVE: Describe the characteristics and the course of participation (paid employment and overall participation) in patients who did and did not remain in paid employment. METHODS: Patients with paid employment at the time of stroke completed questions on work up to 30 months after starting rehabilitation, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P, Frequency, Restrictions and Satisfaction scales) up to 24 months. Baseline characteristics of patients with and without paid employment at 30 months were compared using Fisher's Exact Tests and Mann-Whitney U Tests. USER-P scores over time were analysed using Linear Mixed Models. RESULTS: Of the 170 included patients (median age 54.2 interquartile range 11.2 years; 40% women) 50.6% reported paid employment at 30 months. Those returning to work reported at baseline more working hours, better quality of life and communication, were more often self-employed and in an office job. The USER-P scores did not change statistically significantly over time. CONCLUSION: About half of the stroke patients remained in paid employment. Optimizing interventions for returning to work and achieving meaningful participation outside of employment seem desirable.