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Trabeculectomy as an introduction to intraocular surgery in an ophthalmic training program.

Ninety seven trabeculectomies for open-angle glaucoma performed by either consultants (senior surgeons) or surgeons in training (resident junior staff) were retrospectively analyzed with reference to the outcome of surgery and the complication rate. The results obtained by the trainees were comparable with those obtained by experienced surgeons, suggesting that trabeculectomy is a suitable operation to be performed by surgeons in training.

Evaluation Studies as Topic↗

[Implementation and assessment of an HIV treatment training program (2000-2001) for patients in Casablanca (Morocco)].

An educational program to improve the management of HIV patients was introduced in the department of infectious diseases of Ibn Rochd hospital, Casablanca, Morocco in January 2000. The project, funded by the GlaxoSmithKline Foundation, began by training ward physicians as well as volunteers from the ALLOCS (Association de lutte contre le sida) in pedagogy and patient education techniques (four-day course). Other sessions reviewed HIV management and treatment. Treatment training sessions were offered to all patients receiving antiretroviral treatment when the program began. All had been taking medication for at least two months and gave their informed consent to participation in the project. Each patient's sessions took place just after his or her medical consultation, in a room set aside for this purpose in the hospital. During the first session the educator established an educational diagnosis and defined educational objectives according to the individual patient's needs. Objectives were related to patients' knowledge about HIV transmission prevention and treatment management (including problem-solving for mild adverse events, delays, forgetting, vacations etc.). Trainers used several educational tools, including therapeutic planning (planning card with self-adhesive stickers showing the treatment medication); a folder of drawings depicting HIV transmission, prevention, and natural history, as well as the aims of antiretroviral therapy; decks of cards illustrating symptoms and psycho-sociological problems. Each patient had to attend at least 3 educational sessions. The program was evaluated at the end of one year. Patients' attendance, treatment adherence, laboratory test results (CD4 count, viral load), satisfaction about patient-staff relationships and knowledge about HIV disease and treatment were assessed on an on-going basis with various questionnaires and data collection systems. In all, 96 patients attended classes, with a mean of 14 sessions per patient per year. After 6 and 12 months of training, patients' CD4 cell counts increased, and the proportion with viral loads below the detection level rose, as did adherence scores. Patients' knowledge appeared to have improved at 6 months but regressed somewhat at 12 months. This may be explained by program timing: most educational sessions take place during the first 6 months of patient enrolment in the program. Patient satisfaction about the program and their care reveals that they acquired autonomy in managing their disease and treatment. Their satisfaction at 12 months, however, was lower than it was at 6 months. One explanation may be that more educated patients are more demanding, but another is the staff turnover in the program. New staff may have required more support and training than was then available. This pilot program allowed us to draft guidelines for setting up educational programs for HIV patients in relatively poor countries.

Adult↗

Neonatal resuscitation in community hospitals. A regional-based, team-oriented training program coordinated by the tertiary center.

Neonatal resuscitation in community hospitals is problematic because of the lack of on-site personnel with adequate training and experience. Even when efforts are made to transport high-risk mothers to tertiary care centers, the most complex resuscitations must occasionally be performed in all obstetric services. This dilemma can result in increased neonatal morbidity and mortality, and is reflected in the obstetric malpractice crisis. We present an approach to the problem in which a tertiary center actively intervenes to assist regional community hospitals to develop and implement resuscitation team capabilities. Key aspects of the system are training and implementation of hospital shift "Code Pink" teams composed of nonphysician professionals, a regional neonatal resuscitation protocol used by all participants, "mock code" resuscitation drills to maintain skills, and extensive quality assurance both at the local hospital and regional levels.

Clinical Protocols↗

A controlled prospective case control study of a prevention training program in female team handball players: the German experience.

BACKGROUND: Few authors have investigated the effectiveness of preventive intervention in European team handball. PURPOSE: The aim of the present study was to evaluate the effects of a prevention program on the incidence of injuries in female European team handball players. STUDY DESIGN: Prospective controlled study. METHODS: Ten female handball teams (134 players) took part in the prevention program (1. Information about injury mechanism, 2. Balance-board exercises, 3. Jump training) while 10 other teams (142 players) were instructed to train as usual. Over one season all injuries were documented weekly. RESULTS: Ankle sprain was the most frequent diagnosis in both groups with 11 ankle sprains in the control group and 7 ankle sprains in the intervention group (Odds ratio: 0.55, 95% confidence interval: 0.22-1.43). The knee was the second frequent injury site. In the control group 5 of all knee injuries were anterior cruciate ligament (ACL) ruptures (incidence: 0.21 per 1000 h) in comparison with one in the intervention group (incidence: 0.04 per 1000 h). Odds ratio was 0.17 with 95% confidence interval of 0.02-1.5. CONCLUSIONS: This study confirms that proprioceptive and neuromuscular training is appropriate for the prevention of knee and ankle injuries among female European team handball players.

Adult↗