Sumayyah Ebrahim, Suman Mewa Kinoo, Maheshwar Naidoo, Jacqueline Marina Van Wyk
The use of household items to support online surgical knot-tying skills training: a mixed methods study
BMC medical education
suspecting urinary tract infection uti nursing home staff contacts physician clinical information behalf resident hence poor understanding uti lack clinical communicative skills cause overtreatment antibiotics investigated whether tailored intervention improves knowledge uti communication skills nursing home staff influences antibiotic prescriptions uti openlabel parallelgroup cluster randomised controlled trial done 22 participating nursing homes denmark patients eligible nursing home residents aged 65 years older nursing home listed permanent address resided living space designated dementia somatic healthcare needs included nursing homes participating uti projects staff present hours using computergenerated random numbers stratification municipality statistician randomised nursing homes 11 receive either interactive educational sessions use dialogue tool continue standard practice statistical analysis blinded staff attended 75 min sessions 8 weeks learn distinguish utis asymptomatic bacteriuria evaluate nonspecific symptoms use dialogue tool primary outcome number antibiotic prescriptions acute uti per resident per days risk defined number days resident present nursing home trial period trial registered clinicaltrialsgov nct03715062 june 1 2017 june 1 2018 22 68 invited nursing homes recruited 22 randomised nursing homes n1625 residents 11 received intervention 770 922 835 allocated residents 11 control group 705 892 790 allocated residents standardised number nursing home staff 572 intervention group 535 control group nursing homes completed trial 65 residents excluded data collection intervention group 85 excluded control group 1470 residents intervention n765 control n705 analysed primary endpoint number antibiotic prescriptions uti per resident 134 per 84 035 days risk intervention group 228 per 77817 days risk control group rate ratio rr receiving antibiotic uti 051 95 ci 037071 unadjusted model 042 031057 adjusted model 140 diary entries suspected utis deaths reported 421 285 1475 residents admitted hospital risk allcause hospitalisation increased intervention group adjusted model rr 128 95 ci 095174 whereas allcause mortality lower intervention group 091 062133 intervention effectively reduced antibiotic prescriptions inappropriate treatments uti without substantially influencing allcause hospitalisations mortality danish ministry health velux foundation