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Aims: Surgical Antibiotic Prophylaxis (SAP) in Nigeria is often not evidence based. The aim of this study is to test if the GADSA application can change prescription behaviour of surgeons in Nigeria. In addition, the study aims to identify AMS strategies and policies for the future., Methods: The GADSA gamified decision support app uses WHO and Sanford prescribing guidelines to deliver real-time persuasive technology feedback to surgeons through an interactive mentor. The app can advise on whether clinician's decisions align with SAP recommendations and provides the opportunity for clinicians to make adjustments. Twenty surgeons actively participated in a 6-month pilot study in three hospitals in Nigeria. The surgeons determined the risk of infection of a surgical procedure, and the need, type and duration of SAP. The study used a longitudinal approach to test whether the GADSA app significantly changed prescribing behaviour of participating surgeons by analysing the reported prescription decisions within the app., Results: 321 SAP prescriptions were recorded. Concerning the surgical risk decision, 12% of surgeons changed their decision to be in line with guidelines after app feedback (p < 0.001) and 10% of surgeons changed their decision about the need for SAP (p = 0.0035) to align with guidelines. The change in decision making for SAP use in terms of "type" and "duration" to align with guidelines was similar with 6% and 5% respectively (both p-values < 0.001)., Conclusion: This study suggests that the GADSA app, with its game based and feedback feature, could significantly change prescribing behaviour at the point of care in an African setting, which could help tackle the global challenge of antibiotic resistance., (© 2023. The Author(s).)

Background: In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford)., Objectives: To triangulate three datasets and understand key barriers to implementation using a behavioural science framework., Methods: Surgeons ( N  = 94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup ( N  = 20) piloted a gamified decision support app over the course of 6 months and reported barriers at the point of care., Results: Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries., Conclusions: The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation., (© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Objective: To identify family medicine residents’ barriers to conducting high-quality research for the mandatory family medicine resident scholarly project, as well as to determine possible strategies to encourage research activity among family medicine residents., Design: Descriptive study using an online survey., Setting: Department of Family Medicine at the University of Ottawa in Ontario., Participants: A total of 54 first- and second-year residents., Main Outcome Measures: Family medicine residents’ involvement in research activities, perceived quality of their mandatory scholarly project, intentions for publication and presentation, and attitudes toward potential barriers to and facilitators of conducting high-quality research., Results: Of the 54 residents, 20 (37%) reported that their project was of high quality, 6 (11%) intended to publish their findings, and 2 (4%) intended to present their findings. Respondents indicated that the main barriers to conducting high-quality research were lack of time, interest, and scholarly skills. The proposed solutions to increase participation in scholarly work were to allow full research days to be used in half-day increments and to offer a journal club where residents could learn scholarly activities., Conclusion: Family medicine residents found several factors to be considerable barriers to completing the required family medicine resident scholarly project. This indicates that there is a need to change the current approach to developing scholarly skills in family medicine. Greater allotment of and flexibility in protected research time and more sessions focused on developing scholarly skills might facilitate scholarly activity among family medicine residents.

Purpose: To report survival and longitudinal functional outcomes after radiation or chemoradiation in advanced-stage cancers of the oropharynx., Methods: A population-based cohort of 89 patients with stage III and IV oropharygeal carcinoma treated from 2003 to 2008 with conformal radiation or chemoradiation was followed. Patients were assessed with a standardized prospective clinical functional outcomes protocol pretreatment and at regular intervals posttreatment. The standard clinical functional outcomes protocol followed: performance status (Karnofsky Performance Status [KPS], Eastern Cooperative Oncology Group [ECOG]); swallowing status (performance status scale for head and neck cancer patients [PSS-HN] and Royal Brisbane Hospital Swallowing Scale [RBHOMS]); and speech (PSS-HN and Voice Handicap Index-10 [VHI-10])., Results: The primary site was the base of the tongue in 38 (43%) and tonsil or soft palate in 51 (57%) patients. Chemotherapy was used in 73%. The median follow-up was 3.4 years. At 3 years, overall survival was 72.3% and disease-free survival was 71.8%. Function reached a nadir at 3 months. At 36 months, the KPS was 90 or better in 76% and the ECOG was 0 in 75%. Total or partial feeding tube dependency ranged from 46% at 3 months to 3% at 2 years. Oral diet texture showed prolonged impairment, with 85% of survivors requiring a soft or semisolid diet with fluids at 36 months. Sixty-two percent were able to eat in public without restriction., Conclusions: The majority of patients will have a good functional outcome after radiation or chemoradiation for advanced oropharyngeal carcinoma. We now have a functional benchmark to which we can compare the results of primary surgery and newer treatment techniques, such as intensity-modulated radiation treatment.

Objective: To compare the functional and oncologic outcomes of transoral CO₂ laser microsurgery relative to radiotherapy for early-stage glottic carcinoma., Design: Functional analysis: population-based, prospective, nonrandomized consecutive series of stage 1 and 2 glottic carcinoma treated with laser surgery (n  =  54) or radiotherapy (n  =  25). Oncologic analysis: population-based, historical cohort comparing laser surgery (n  =  54) and radiotherapy (n  =  76)., Setting: Academic cancer centre., Methods and Outcome Measures: Functional results were prospectively collected prior to treatment and at 3, 6, 12, and 24 months following treatment using validated performance scales assessing general level of function, speech, and swallowing. Oncologic results were collected from a larger cohort from the cancer registry of CancerCare MB., Results: Laser surgery resulted in a voice that was less likely to be understood all the time (Performance Status Scale for Head and Neck Cancer Patients: understandability score < 100; OR  =  12.2; p  =  .03) and a higher likelihood of having a Voice Handicap Index (VHI-10) score of 10 or more (OR  =  16.2; p  =  .001). Five-year laryngectomy-free survival rates for laser versus radiation were 87 versus 76% (p  =  .16). Subset analysis revealed that stage 1 5-year laryngeal preservation rates for laser (n  =  51) versus radiation (n  =  46) were 100 versus 86% (p  =  .02)., Conclusions: There is a higher likelihood of hoarseness after laser surgery, but the severity of this handicap is mild in most patients. Laser microsurgery results in excellent laryngeal preservation rates, which may exceed those of radiation.