Comprehensive Patient Education Research Articles

Readability of Patient Education Materials From High-Impact Medical Journals: A 20-Year Analysis.

Comprehensive patient education is necessary for shared decision-making. While patient–provider conversations primarily drive patient education, patients also use published materials to enhance their understanding. In this investigation, we evaluated the readability of 2585 patient education materials published in high-impact medical journals from 1998 to 2018 and compared our findings to readability recommendations from national groups. For all materials, mean readability grade levels ranged from 11.2 to 13.8 by various metrics. Fifty-four (2.1%) materials met the American Medical Association recommendation of sixth grade reading level, and 215 (8.2%) met the National Institutes of Health recommendation of eighth grade level. When stratified by journal and material type, general medical education materials from Annals of Internal Medicine were the most readable (P < .001), with 79.8% meeting the eighth grade level. Readability did not differ significantly over time. Efforts to standardize publication practice with the incorporation of readability evaluation during the review process may improve patients’ understanding of their disease processes and treatment options.

Our unique clinical pathway for congestive heart failure cases required admission achieved a dramatic reduction of their hospitalization period and a significant reduction of readmission with heart fa

Abstract Background In recent years, the number of elderly congestive heart failure (CHF) cases has been increasing in Japan with the aging of the population. This tendency is particularly remarkable in rural areas where our facilities are located. After admission with CHF, the hospitalization period (PE) was prolonged due to various complications unique to the elderly, and re-exacerbation of CHF occurred shortly after discharge. Approximately 30% of them were readmitted within one year. From August 2015, for shortening of PE and reduction of CHF readmission through the efficiency of CHF treatment and comprehensive patient education, we had introduced a unique clinical pathway (PATH) that provided the immediate use of Tolvaptan and comprehensive education by multi-disciplinary staff after admission. Purpose In this study, we verified whether the improvement of clinical prognosis were achieved by introduction of PATH. Methods Between April 2014 and July 2019, 635 CHF cases (764 admissions) ware enrolled. We divided them to two groups, N-group before introducing PATH (198 cases, 262 admissions) and P-group applied PATH (437 cases, 502 admission). Between both groups, we compared the various acute care situation, PE and readmission rate with CHF within 1 year after discharge. Results There were no differences between P and N-group in mean age, distribution of underlying illness or daily activity level before admission. There ware not also differences about left ventricle function by echocardiography and various blood test data at admission. The enforcement rate of continuous infusion and the rate of urinary catheter placement were significantly lower in the P-group (71 vs 88%; p&amp;lt;0.0001, 52 vs 63%; p&amp;lt;0.01, respectively). And their enforcement duration was significantly shorter in P-group (4.6±5.3 vs 10.5±9.6 days; p&amp;lt;0.0001, 6.3±7.9 vs 12.8±13.1 days; p&amp;lt;0.0001 respectively). The enforcement rate of cardiac rehabilitation was significantly higher in group P (94 vs 84%; p&amp;lt;0.0001), and the starting time of rehabilitation was significantly earlier (2.9±1.5 vs 6.3±4.8th illness day; p&amp;lt;0.0001). As a result, the average HP was significantly shorter in group P (16.5±13.4 vs 28.6±24.1 days, p&amp;lt;0.0001). The readmission rate with CHF within one year after discharge was significantly lower in group P (23 vs 36%; p&amp;lt;0.001). Conclusion By the introduction of our original clinical pathway for congestive heart failure, the efficiency of medical care was achieved and the mean hospitalization period was widely shortened. In addition, by the through comprehensive patient education by multi-disciplinary staff involved in the pathway, the self-restraint life style after discharge seemed to be maintained and the readmission with worsening of heart failure was significantly suppressed. Funding Acknowledgement Type of funding source: None

Chemotherapy Education and Support: A Model for Use in the Ambulatory Care Setting.

Oncology nurses are challenged to coordinate an effective, evidence-based approach to comprehensive patient education, symptom management, and psychosocial support for patients with pancreatic and colorectal cancers during chemotherapy. The purpose of the study was to develop and evaluate a nurse-led psychoeducational intervention using a multimedia tool. Development and testing of the intervention was grounded in the Science and Practice Aligned Within Nursing model for evidence-based practice implementation. Forty-five participants completed the study (29 with pancreatic cancer and 16 with colorectal cancer). Patient knowledge increased significantly in patients with pancreatic cancer following the intervention (p = 0.05).

Patients and clinicians managing patellofemoral pain should not rely on general web-based information

ObjectiveTo evaluate the credibility and accuracy of PFP-specific web-based content. DesignCross-sectional evaluation of web-based information. MethodsThe study protocol was registered with PROSPERO (CRD42018088671). Two search engines (Google and Bing) were used to search for websites offering information about PFP. Two reviewers assessed the websites for credibility-related and PFP-specific content. PFP-specific content was evaluated according to agreement with current international PFP consensus statements. Based on this, content was rated as (i) Accurate/Clearly described; (ii) Partially accurate/Description lacks clarity; (iii) Inaccurate/Misleading description; or (iv) Not mentioned. ResultsAfter exclusion of duplicates, forty online websites were included in our analyses. 43% of websites did not mention their source of information, and 48% did not mention if the source material was peer-reviewed. Misleading/inaccurate information was most commonly found in the definition of PFP (20% websites) and clinical examination (15%). Twenty-two percent of websites recommended surgery as treatment. The item most frequently rated as accurate/clearly described was PFP terminology (87.5%). ConclusionThis study highlights missing, inaccurate or poorly described web-based PFP information. Due to the commonality of PFP and potential for improving self-management, there is an urgent need to develop more accurate and comprehensive web-based patient education resources for PFP.

Comparison of Health Outcomes in Diabetic and Non-Diabetic Patients Undergoing Maintenance Hemodialysis

Though several studies have assessed Health Related Quality of Life (HRQoL) and factors affecting HRQoL in maintenance haemodialysis (MHD) patients, there are limited data about health outcomes in diabetic and non-diabetic patients on MHD in Indian setup.The study aimed to compare Health Related Quality of Life (HRQoL) in diabetic and non-diabetic patients undergoing maintenance haemodialysis (MHD), to assess the effect of patient education on HRQoL, and factors affecting HRQoL in diabetic and non-diabetic patients undergoing MHD. This eight month prospective interventional study on ambulatory haemodialysis patients assessed HRQoL using the kidney disease quality of life (KDQoLTM-36) questionnaire at baseline, 3 months and 6 months. Comprehensive patient education was provided to patients during study period. Patient responses to questionnaire were compared between baseline and two follow-ups for all patients and between diabetic and nondiabetic patients.89 patients were enrolled into this study and 69 (30 diabetics and 39 non-diabetics) were followed up. The mean age of the study population was 46 ± 12 years. It was observed non-diabetic patients had better HRQoL than diabetic patients undergoing MHD. An improvement in HRQoL from baseline was observed after providing patient education. Male gender (p=0.032), high school education or lesser (p=0.049), smoking history (p=0.031) and dialysis for &lt; three years (p=0.035) were factors with significant influence on HRQoL. Non-diabetic patients had better HRQoL when compared to diabetic patients undergoing MHD. Patient care focussed on factors contributing to lower HRQoL in patients undergoing MHD may improve health outcomes.

Barriers to Blood Transfusions During Post-Partum Hemorrhage in Northern Ethiopia: Preliminary Data [04M

INTRODUCTION: Post-partum hemorrhage (PPH) remains the leading cause of maternal mortality in Ethiopia; the country experiences 412 maternal deaths per 100,000 births, exceeding the global average. Delays in-transit time and inefficient blood transfusions are linked to maternal death. This study aims to evaluate the effects of centralized Ethiopian blood banks on timely blood transfusion and the impact of comprehensive patient education on transfusion refusal. METHODS: As part of a mixed-method study, blood transfusion log books at Ayder Comprehensive Specialized Hospital were analyzed to assess the common reasons for transfusions at tertiary care centers. Focus groups of residents from the Tigray region were conducted to explore the social acceptance of blood transfusions. RESULTS: Focus group data illuminates that women are receptive to receiving blood transfusions, especially in the context of delivery. Hospital transfusion log books show a transfusion rate of 3% for PPH; comprising of 1.95% of total transfusions recorded during our 3-month preliminary data collection period. CONCLUSION: Despite research indicating the average rate of blood transfusions during PPH is 1.4%; Ayder Comprehensive Specialized Hospital has a transfusion rate of 3.0%. Women should be fully counseled on blood transfusions risks and benefits; our data indicates that comprehensive education does not influence women’s transfusion decisions. High transfusion rates may indicate that women are suffering from complications and are being transferred instead of stabilized at general hospitals. Research should focus on exploring the effectiveness of blood distribution and storage in the general hospitals after screening, eliminating the need to transfer women during obstetric emergencies.

Management of toxicity to isoform α-specific PI3K inhibitors.

Alterations in the phosphoinositide 3-kinase (PI3K)/AKT pathway are frequently found in cancer and are especially common in breast cancer, where it is estimated that 70% of tumors have some type of genetic alteration that could lead to pathway hyperactivation. A variety of PI3K pathway inhibitors have been developed in an attempt to target this pathway and improve cancer control. One of the challenges in treating patients with PI3K/AKT pathway inhibitors is the associated toxicity from on-target and off-target effects. Such side-effects are common, but reversible, and include hyperglycemia, rash, stomatitis, diarrhea, nausea, and fatigue. As a result, dose reductions, treatment delays, and treatment discontinuation are frequently reported. This impairs not only patients’ quality of life but also treatment efficacy. Most side-effects are reversible with drug interruption, since these drugs typically have a short half-life and are manageable with early intervention. An interdisciplinary approach with proactive management of patients receiving PI3K pathway inhibitors should include comprehensive education of patients about the range of toxicities, frequent monitoring, early toxicity recognition, active intervention, as well as prophylactic strategies.

Association between low back pain and various everyday performances : Activities of daily living, ability to work and sexual function.

SummaryLow back pain (LBP) is a widely prevalent chronic pain disorder associated with a high burden on individuals and society. In the subjective perception of patients with LBP, probably the most important health outcomes associated with LBP are those that effect everyday performance. Such outcomes include reduction in activities of daily living (ADL), in work ability (WA), and in sexual function. This narrative review aimed to (1) examine the association between LBP and the three mentioned outcomes of everyday performance, (2) to explain possible mediating factors promoting these associations, and (3) to discuss possible implications for treatment and rehabilitation. Studies have shown that LBP can generate anxiety of movement leading to movement avoidance (fear-avoidance beliefs), which may lead to deconditioning and further increasing problems with ADL, WA and decreasing sexual function. Furthermore, common mental disorders, such as depression, anxiety, and stress-related disorders, which also often co-occur with LBP can lead to adverse effects on everyday performance and vice versa, can be the consequence of such problems and aggravate LBP. Although there is no universally accepted treatment modality that fits every patient with LBP, physical training, comprehensive patient education, and workplace or home modifications have been shown to be able to interrupt the mutual influence between LBP and the described mediating factors, and have a beneficial effect on ADL, WA, and sexual function. For this, a multidisciplinary approach is necessary which includes multiprofessional care teams, participation of the patients, and involvement of different settings, such as workplace, home, and physical training facilities.

Complementary therapeutic approaches in asthma

Asthma is defined by The Initiative for Asthma (GINA 2018) as a heterogeneous disease, which include chronic airway inflammation and a history of respiratory symptoms. In the last decades asthma had a rise in prevalence, becoming one of the most frequent diagnosed diseases in the world. The main goals of asthma management are to achieve good symptom control, minimize the risks of exacerbations, decrease rescue medication intake, improve the quality of life by decreasing respiratory system inflammation and ameliorating the patient’s lung function. Beside effective medications, asthma continues to impair quality of life for most patients. Due to the difficulty of controlling symptoms and exacerbations, the need of developing complementary options of treatment is increasing in order to achieve an optimum control and a lower risk of acute episodes or fatal events. Pulmonary rehabilitation is suggested for asthma patients when adequate medical therapy poorly control the symptoms and mental, physical or social consequences of illness persist during the daily life. The following non-drug therapy components are included in the rehabilitation program: physical training, comprehensive smoking cessation program, comprehensive patient education, respiratory physiotherapy, psychosocial support and comprehensive nutritional counseling. These complementary therapies have been proven to improve muscle strength, exercise capacity and symptomatology. Also, it has been associated to fewer exacerbations and a lower use of rescue medication, leading to a better quality of life. Key words: asthma, quality of life, symptomatology, rehabilitation, physiotherapy,

Tools for Community-Based Pharmacist Patient Care Services to Support Optimal Opioid Use

Tools for Community-Based Pharmacist Patient Care Services to Support Optimal Opioid Use

Facilitators and barriers of heart failure care in Kerala, India: A qualitative analysis of health-care providers and administrators

ObjectiveHeart failure is a leading cause of death worldwide and in India, yet the qualitative data regarding heart failure care are limited. To fill this gap, we studied the facilitators and barriers of heart failure care in Kerala, India. Methods and resultsDuring January 2018, we conducted a qualitative study using in-depth, semi-structured interviews with 21 health-care providers and quality administrators from 8 hospitals in Kerala to understand the context, facilitators, and barriers of heart failure care. We developed a theoretical framework using iteratively developed codes from these data to identify 6 key themes of heart failure care in Kerala: (1) need for comprehensive patient and family education on heart failure; (2) gaps between guideline-directed clinical care for heart failure and clinical practice; (3) national hospital accreditation contributing to a culture of systematically improving quality and safety of in-hospital care; (4) limited system-level attention toward improving heart failure care compared with other cardiovascular conditions; (5) application of existing personnel and technology to improve heart failure care; and (6) longitudinal and recurrent costs as barriers for optimal heart failure care. ConclusionsKey themes emerged regarding heart failure care in Kerala in the context of a health system that is increasingly emphasizing health-care quality and safety. Targeted in-hospital quality improvement interventions for heart failure should account for these themes to improve cardiovascular outcomes in the region.

What do the US advanced kidney disease patients want? Comprehensive pre-ESRD Patient Education (CPE) and choice of dialysis modality.

Improvement in Home Dialysis (HoD) utilizations as a mean to improve the patient reported and health services outcomes, has been a long-held goal of the providers and healthcare system in United States. However, measures to improve HoD rates have yielded limited success so far. Lack of patient awareness of chronic kidney disease (CKD) and its management options, is one of the important barriers against patient adoption of HoD. Despite ample evidence that Comprehensive pre-ESERD Patient Education (CPE) improves patient awareness and informed HoD choice, use of CPE among US advanced CKD patients is low. Need for significant resources, lack of validated data showing unequivocal and reproducible benefits, and the lack of validated CPE protocols proven to have consistent efficacy in improving not only patient awareness but also HoD rates in US population, are major limitations deterring adoption of CPE in routine clinical practice. We recently demonstrated that if a structured, protocol based CPE is integrated within the routine nephrology care for patients with advanced CKD, it substantially improves informed HoD choice and utilizations. However, this requires establishing CPE resources within each nephrology practice. Efficacy of a stand-alone CPE model, independent of clinical care, has not been examined till date. In this report we report the efficacy of our structured CPE protocol, delivered outside the realm of routine nephrology care—as a stand-alone patient education program, in a geographically distant region, and show that: when provided opportunity for informed dialysis choice, a majority of advanced CKD patients in US would prefer HoD. We also show that initiating CPE leads to accelerated growth in HoD utilizations and reduces disparities in HoD utilizations, goals for system improvements. Finally, the reproducibility of our structured CPE protocol with consistent efficacy data suggest that initiating such programs at institutional levels has the potential to improve informed dialysis selection and HoD rates across any similar large healthcare institute within US.

Pediatric postoperative opioid prescribing and the opioid crisis

The purpose of this review is to explore the effects of the opioid crisis on pediatric patients in the postoperative setting and provide recommendations for well-tolerated opioid prescribing practices. Opioid overdoses have increased among all age groups, predominantly related to overprescribing and accessibility of opioids in the home. Adverse risks of prescribed opioids include respiratory depression, gastrointestinal distress, accidental ingestion, intentional misuse, new chronic use, diversion to another user, and overdose. Well-tolerated opioid prescribing practices include multimodal pain management; prescribing guided by patient need; risk assessment for potential misuse; and comprehensive patient and family education on risks, safe storage, and disposal practices. Evolving state laws will affect varying institutional policies; thus, providers must ensure their prescribing practices are current and compliant. All age groups have been affected by the opioid crisis, including children and adolescents. When managing postoperative pain, clinicians must balance appropriate pain management with well-tolerated opioid stewardship to minimize harm related to postoperative care.

Prevalence of pain and treatment outcomes among cancer patients in a Malaysian palliative care unit.

Background:Pain remains one of the most common and debilitating symptoms of advanced cancer. To date, there is a lack of studies on pain and its treatment among Malaysian palliative care patients.Objective:This study aimed to explore the prevalence of pain and its treatment outcomes among adult cancer patients admitted to a palliative care unit in Sabah, Malaysia.Methods:Of 327 patients screened (01/09/15-31/12/17), 151 patients with assessed self-reported pain scores based on the numerical rating scale of 0-10 (current, worst and least pain within the past 24 hours) upon admission (baseline), 24, 48 and 72 hours post-admission and discharge were included. Pain severity and pain score reductions were analysed among those who experienced pain upon admission or in the past 24 hours. Treatment adequacy was measured by the Pain Management Index (PMI) among discharged patients. The PMI was constructed upon worst scores categorised as 0 (no pain), 1 (1-4, mild pain), 2 (5-6, moderate pain), or 3 (7-10, severe pain) which is then subtracted from the most potent level of prescribed analgesic drug scored as 0 (no analgesia), 1 (non-opioid), 2 (weak opioid) or 3 (strong opioid). PMI≥0 indicated adequate treatment.Results:Upon admission, 61.1% [95%CI 0.54:0.69] of 151 patients presented with pain. Of 123 patients who experienced pain upon admission or in the past 24 hours, 82.1% had moderate to severe worst pain. Throughout patients’ ward stay until discharge, there was an increased prescribing of analgesics and adjuvants compared to baseline, excluding weak opioids, with strong opioids as the mainstay treatment. For all pain score types (current, worst and least pain within the past 24 hours), means decreased at each time point (24, 48 and 72 hours post-admission and discharge) from baseline, with a significant decrease at 24 hours post-admission (p<0.001). Upon discharge (n=100), treatment adequacy significantly improved (PMI≥0 100% versus 68% upon admission, p<0.001).Conclusions:Accounting for pain’s dynamic nature, there was a high prevalence of pain among cancer patients in the palliative care unit. Continuous efforts incorporating comprehensive pain assessments, evidence-based treatments and patient education are necessary to provide adequate pain relief and end-of-life comfort care.

Best Practices for Long-Term Monitoring and Follow-Up of Alemtuzumab-Treated MS Patients in Real-World Clinical Settings.

Multiple sclerosis (MS) is a chronic autoimmune neurological disease that typically affects young adults, causing irreversible physical disability and cognitive impairment. Alemtuzumab, administered intravenously as 2 initial courses of 12 mg/day (5 consecutive days at baseline, and 3 consecutive days 12 months later), resulted in significantly greater improvements in clinical and MRI outcomes vs. subcutaneous interferon beta-1a over 2 years in patients with active relapsing-remitting MS (RRMS) who were either treatment-naive (CARE-MS I; NCT00530348) or had an inadequate response to prior therapy (CARE-MS II; NCT00548405). Efficacy with alemtuzumab was maintained over 7 years in subsequent extension studies (NCT00930553; NCT02255656), in the absence of continuous treatment and with a consistent safety profile. There is an increased incidence of autoimmune events in patients treated with alemtuzumab (mainly thyroid events, but also immune thrombocytopenia and nephropathy), which imparts a need for mandatory safety monitoring for 4 years following the last treatment. The risk management strategy for alemtuzumab-treated patients includes laboratory monitoring and a comprehensive patient education and support program that enables early detection and effective management of autoimmune events, yielding optimal outcomes for MS patients. Here we provide an overview of tools and techniques that have been implemented in real-world clinical settings to reduce the burden of monitoring for both patients and healthcare providers, including customized educational materials, the use of social media, and interactive online databases for managing healthcare data. Many practices are also enhancing patient outreach efforts through coordination with specialized nursing services and ancillary caregivers. The best practice recommendations for safety monitoring described in this article, based on experiences in real-world clinical settings, may enable early detection and management of autoimmune events, and help with implementation of monitoring requirements while maximizing the benefits of alemtuzumab treatment for MS patients.

Information Gaps in Package Inserts Cause Insufficient Patient Information on Correct Handling of Transdermal Patches

The multi-step administration process of transdermal patches requires sufficient knowledge and skills of patients to prevent administration errors. The package insert is an easily accessible information source that reaches the patient automatically with drug dispensing. However, information gaps potentially limit their suitability as appropriate patient information material. Package inserts of all transdermal patches available on the German drug market were analyzed for medication administration recommendations. In total, 81 package inserts were analyzed including buprenorphine (N = 13), fentanyl (N = 33), granisetron (N = 1), glyceroltrinitrate (N = 2), nicotin (N = 4), oxybutynin (N = 1), rivastigmin (N = 10), rotigotin (N = 2), scopolamin (N = 1), and hormone preparations with estradiol, estradiol hemihydrate, ethinyl estradiol, gestodene, levonorgestrel, norelgestromin, and norethindrone acetate (N = 14). None of the package inserts included all 28 administration recommendations that were previously identified as relevant through a systematic literature search. In particular, information was lacking on transdermal patch-specific characteristics such as mechanism of drug absorption, monitoring, storage, and disposal. The package inserts insufficiently inform patients on correct transdermal patch administration and thus, comprehensive patient education by healthcare professionals is required. In the long-term, regulatory requirements for package inserts should include standardized and dosage form-specific recommendations for correct medication administration.

"If you will counsel properly with love, they will listen": A qualitative analysis of leprosy affected patients' educational needs and caregiver perceptions in Nepal.

BackgroundLeprosy remains a disease of concern in many countries including Nepal. To achieve the target of elimination, the WHO strategy promotes comprehensive education of patients, healthcare workers (HCWs), and the public on leprosy-related issues. However most educational programs are based on the concerns of HCWs and not on patients’ needs. The objective of this paper is to explore the educational needs of leprosy affected patients in Nepal and compare them to the needs perceived by HCWs.Methodology/principal findingsSemi directive interviews were conducted with patients and HCWs. The data was analyzed using the basic interpretative qualitative framework. The study was conducted in two leprosy referral centers, one university hospital and one primary health care center: Lalgadh Leprosy Hospital and Services Centre, Anandaban Hospital and its satellite clinic in Patan, B. P. Koirala Institute of Health Sciences in Dharan, and the Itahari primary health care centre.The results show that there remains a lack of knowledge regarding the disease (origins, manifestations, prevention and treatment) contributing to late care seeking behavior and high levels of stigma, with an important psychological and financial stress for patients. All of the HCWs displayed a good understanding of patients’ difficulties and needs and acknowledged the key role of patient education. However, they expressed several challenges in managing patients due to lack of time, human resources and training in patient education.Conclusions/significanceFurther efforts need to be made to increase patients’ general knowledge of the disease in order to motivate them to seek healthcare earlier and change their perception of the disease to reduce stigma. HCWs need proper training in patient education and counseling for them to acquire the necessary skills required to address the different educational needs of their patients. The use of lay and peer counselors would be an option to address the workload and lack of time expressed by HCWs.

Prevention and Management of Incontinence-Associated Dermatitis in the Pediatric Population: An Integrative Review.

An integrative review was conducted to synthesize evidence on prevention and management of incontinence-associated dermatitis (IAD) in the pediatric population. A 5-step integrative process was used to guide the review. Articles published from January 2000 to April 6, 2017, were identified and retrieved from CINAHL, PubMed, ProQuest (MEDLINE), and Scopus; key terms were associated with IAD, pediatric, prevention, and management. Supplemental and manual searches were carried out to identify other relevant studies. The studies' findings were extracted and summarized in a table of evidence, with their quality evaluated using the Joanna Briggs Institute's Critical Appraisal Checklist. Sixteen articles were included in the review. Articles explored prevention and management strategies including skin cleansing technique, diaper selection, and the application of topical skin care products. Inconsistent and limited evidence was found regarding the benefits of using disposable wipes in preference to water-moistened washcloths in the cleansing process and on the use of superabsorbent polymer diapers with breathable outer lining in IAD prevention. Findings were inconclusive with regard to the best topical skin care product for IAD care. However, the application of skin protectants was encouraged by the authors, as well as promoted in various clinical guidelines. The development of a structured skin care regimen supplemented by a comprehensive patient education program was advised to enhance the prevention and management of IAD.

Perceptions of dietary factors promoting and preventing nephrolithiasis: a cross-sectional survey.

To assess knowledge of both promoting and preventive dietary factors on nephrolithiasis in a diverse patient population. Precipitating factors of kidney stone disease include diet, lifestyle, socioeconomic status, and race/ethnicity. However, patient awareness of these influences is poorly described. A 24-question survey, assessing intake-related risk factors for stone disease, was administered prospectively to 1018 patients. Responses were summarized with frequency and percent. Statistical comparisons were made using a propensity scoring method in order to account for potential confounding variables. Propensity scores were stratified into quintiles. Further analysis with multiple imputation was performed to account for any missing data in the survey. The results of the propensity-adjusted log-binomial regression model are presented as prevalence ratios (PRs) and 95% confidence intervals (CIs). Respondents demonstrated limited knowledge of nutrient factors that influence stone development. However, most study participants (70.3%) reported a willingness to make lifestyle changes aimed at lowering their risk for stone disease. Respondents reporting previous nephrolithiasis education were less likely to report that diet had no effect on kidney stone formation (PR = 0.795, 95% CI 0.65, 0.96, p = 0.01) The type of physician who counseled the respondent had no association with patient knowledge for stone disease (PR = 0.83, 95% CI 0.63, 1.10, p = 0.2). Knowledge of diet-related risk factors for nephrolithiasis is limited among this population. Respondents who received prior education appeared to maintain the knowledge of dietary risk for nephrolithiasis. Participants also expressed a willingness to make requisite dietary changes if that information is provided. Given that most stone formers experience a recurrence, these findings highlight the need for more comprehensive patient education strategies on the modifiable risk factors for nephrolithiasis.

Web-Based Educational Seminars Compare Favorably with In-House Seminars for Bariatric Surgery Patients.

Comprehensive preparative patient education is a key element in bariatric patient success. The primary objective of this study was to compare attrition rates, demographics, and surgery outcomes between patients who participated in the online vs in-house preparative seminars. A retrospective chart review was performed involving patients who chose to participate in online vs in-house educational seminar between July of 2014 and December of 2016. The patients were divided into two groups based on their choice of educational seminar and tracked to see how many made it to an initial visit and to surgery. In those who had bariatric surgery, data was collected on age, type of insurance, length of stay (LOS), longest follow-up, and change in body mass index. Total of 1230 patients were included in this study. There was no difference in attrition rate to initial consultation visit (29.1% vs 29.9%), but there was a statistically higher attrition to surgery in the in-house seminar attendees (72.9%) compared to online participants (66.6%, p < 0.05). Between January 2015 and December 2016, 291 patients underwent primary bariatric surgery. The online group was on average 3years younger which was statistically significant. There were no differences in LOS, longest follow-up, and weight loss at 12months between the groups. When comparing attrition rates and bariatric surgery outcomes, no overall difference was noted between patients who received web- or hospital-based preparative education. Bariatric programs should provide access to online seminars to attract younger population and save resources and cost.