Continuing Education Lectures Research Articles

Learn Intestinal Failure Tele-ECHO Project: An innovative online telementoring and case-based learning clinic.

Intestinal failure (IF) is a rare chronic disease requiring intravenous (IV) fluids or parenteral nutrition (PN) dependency for optimal patient health and sustenance. The complex care is best managed by specialized multidisciplinary teams. Patients who have limited access to intestinal rehabilitation centers often receive IV/PN care from clinicians lacking specialty expertise. An innovative videoconferencing project was launched in May 2019 to provide online telementoring and case-based learning in IF. The Extension for Community Healthcare Outcomes (ECHO) model was adopted to provide education and virtual support via the Learn Intestinal Failure Tele-ECHO (LIFT-ECHO) project. Online clinics include patient case presentations, moderated discussion, best-practice recommendations, and didactic continuing education lectures on IF- and PN-related topics. Participation is interprofessional and international. Via knowledge dissemination and specialty mentorship, LIFT-ECHO is expected to improve healthcare for patients with IF and transform care delivery by overcoming the limitations in access to expertise.

Learner behaviors in synchronous online prosthodontic education during the 2020 COVID-19 pandemic

Statement of problemSynchronous online prosthodontic courses became a popular learning mode during the 2020 COVID-19 pandemic crisis. Nonetheless, the extent of learner participation and completion of these courses remains unknown. PurposeThe purpose of this study was to assess learner behaviors in synchronous online prosthodontic continuing education lectures in China during the 2020 COVID-19 pandemic. Material and methodsAll live online prosthodontic courses held by an online dental school in China from February to May 2020 were retrieved. The no-cost lectures could be accessed anonymously and viewed repeatedly on the day of broadcast. Learning behavior data (teacher speaking time, audience total, timing of first visit to the online classroom, viewing time, and completion rate) were obtained. Learning progress was calculated by dividing viewing time by teacher speaking time. When a learner progressed through 95% of a lecture, the lecture was considered completed. ResultsA total of 41 781 learners participated in 18 online prosthodontic courses, which had a mean duration of 77.2 ±15.8 minutes. For each lecture, 2321 ±1454 participants attended, with 510 ±404 participants completing each session. There were 13 098 participants (31.35%) who viewed the lectures for less than 1 minute. Approximately half of the participants viewed the lectures for less than 10 minutes, with their learning progress failing to pass 10%. The average completion rate was 21.97%, with variation in completion rate dependent on when a learner first visited the online classroom. Significant differences were found among the lecture completion rates and the timing of the first visit to the online classroom (P<.001). ConclusionsSynchronous online prosthodontic education courses in China had a high number of participants but low learning progress and completion rates during the 2020 COVID-19 pandemic.

Assessment of Nurses knowledge toward prevention of Complications related Valvular Replacement Surgery at Surgical Department in AL-Nasiriyah Heart Center

Objectives: The study aims to assess the nurses knowledge toward prevention of complications related to valvular replacement surgery and to find out the relationship between nurses knowledge and their demographic and occupational characteristic's Which as (Age, gender, level of education ,years of experience in Surgical Department , and training sessions)&#x0D; &#x0D; Methodology: A descriptive design (a cross-sectional study ) was carried out from December 2017 to May 2018 in order to assess nurses' knowledge of preventing complications Valvular Replacement Surgery at Surgical Department in Nasiriyah Heart Center on a purposive (non-probability) sample was used in this study that composed of (70) nurses of the morning and night shifts. Data were collected by using the technique of self-report questionnaire which designed and constructed by the researchers from previous related studies and consisted of two Part one included ' socio-demographic characteristics for the nurses, Part two : knowledge items related to anatomy , physiology heart valve , heart valve replacement and complication heart valve replacement. and nursing care . The validity of the questionnaire was determined by presenting the questionnaire to (13) specialized experts. The reliability of the internal consistency was achieved by applying the alpha correlation Coefficient (r=0.85) which was statistically acceptable. The data were analyzed by applying descriptive and inferential statistics .&#x0D; Results: The results showed that most of the participants in the research of nurses at age group (20-29) years, and the study revealed that the nurses have a moderate knowledge towards the prevention of complications of valve replacement surgery by significant level among all items of the scale. The study concluded that most nurses did not have sufficient experience in work in the surgical department and most of them did not train well . &#x0D; Recommendations: The study recommended spreading awareness among nurses regarding the prevention of complications of valves replacement surgery through instructional sessions and continuing education lectures to increase awareness of nurse's in ways of preventing complications of heart valve replacement.

Effectiveness of a pharmacy teaching certificate program offered to practicing pharmacists

IntroductionRegardless of the practice setting, pharmacists' roles often expand beyond patient-centered services and into health-related educational roles for patients, healthcare providers, and student pharmacists. Teaching roles of a clinical pharmacist can include providing invited presentations (such as continuing education lectures), teaching colleagues about new clinical initiatives, precepting students during advanced pharmacy practice experiences (APPEs) and introductory pharmacy practice experiences (IPPEs), and precepting residents on rotations. This program was designed to evaluate the effect of a university-affiliated pharmacy teaching certificate program on participant knowledge and perceived confidence in specific areas of academic pharmacy and preceptor development. MethodsA 10-month program consisting of four live modules with associated continuing education (CE) credit was offered to pharmacy residents and practicing pharmacists in the surrounding area. The program format utilized didactic and active learning strategies with “at home” assignments to reinforce material presented. Content knowledge was measured with written summative assessments provided at the start and end of each module. Perceived confidence was assessed through online surveys provided at the start and end of the program. All results were evaluated using paired t-tests. ResultsData were obtained from 14 participants in the first cohort and 18 participants in the second cohort. For each of the four modules, there was a significant difference in pre- and post-knowledge assessments. Confidence data was also significantly increased regarding topics in each module. ConclusionKnowledge assessments and perception surveys suggest that this university-affiliated teaching certificate program improved both knowledge and perceived confidence for program participants.

Association of Phantom Vibration and Ringing Syndrome and Job-Related Stress among Nurses in Al-Nasiriyah City

Objectives: The study aims to: (1) assess the prevalence of phantom vibration and ringing syndrome amongnurses, (2) determine the level of job-related stress among those nurses who are working at teaching hospitals inAl- Nasiriyah city, and (3) identify the association between job-related stress and experience of phantomvibration and ringing syndrome.Methodology: : A descriptive design, cross-sectional study was used for the present study was carried outfrom 4th December, 2017 to the 4th April, 2018 in order to determine the association of PhantomVibration and Ringing Syndrome with Job - Related Stress among nurses at Teaching Hospitals in AlNasiriyahCity , on a purposive (non-probability) sample was used in this study that composed of (600) nurseswho are working in the morning and night shifts . Data were collected by using the technique of self –administrative report was consisted of four parts: ' socio-demographic characteristics for the nurses, factorsthat are related to mobile use among the nurses , phantom vibration and ringing syndrome scale and job –related stress scale . The validity of the questionnaire was obtained through a panel of experts and theinternal consistency reliability was achieved through the application of Alpha Correlation Coefficient (r=0.76)which was statistically acceptable.Results: The finding of the study revealed that phantom vibration and ringing syndrome are experiencedmoderately among nurses evidenced by significant level among all items of the scale, there were nosignificant association between phantom vibration \ ringing syndrome and job- related stress among nurses.Recommendations: The study recommended spreading awareness among nurses regarding the risks of mobileuse through instructional sessions and continuing education lectures and the necessary conducting of furthersimilar studies for exploring the factors that influence the job-related stress in order to apply the management forsuch factors

Media reporting of ProtecT: a disconnect in information dissemination?

Given the central role of the media in disseminating information to the public, we analyzed news coverage of the recent publication from ProtecT to assess views on treatment, the level of detail presented and degree of bias. We applied a predefined search strategy to identify all news articles reporting on ProtecT within 30 days of its publication. Articles were independently assessed by two urologists and two lay persons using five-point Likert scales. Descriptive statistics and analysis of variance were used. Of 33 unique articles identified, 20 (61%) conveyed negative views on definitive treatment for localized prostate cancer (PCa), while 29 (88%) expressed favorable views of active surveillance/monitoring (AM). Nevertheless, fewer than half of the articles described what AM entails (n=15; 46%) or the rate of treatment in the AM arm (n=12; 36%). Moreover, while 32 (97%) articles highlighted the absence of a difference in cancer-specific mortality at 10 years, only 17 (52%) mentioned the need for longer follow-up. A total of 17 (52%) articles had a notable degree of perceived bias (⩾4/5 on Likert scale), with shorter articles (P=0.02), articles covering few content areas (P=0.03) and articles that did not detail what AM entails (P=0.003) containing significantly increased bias. The majority of news articles regarding ProtecT presented an adverse view of definitive treatment for localized PCa relative to AM, but failed to highlight key nuances of the trial. Healthcare professionals and the lay public should be cautious in acquiring medical news through the general media. Additionally, the urologic community must continue to improve the quality of disseminated information, for example, through proactively engaging with the media, through social media and/or through participation in continuing education lecture series, so as to guide the knowledge translation process, especially upon publication of such potentially influential studies.

Anesthesia Lost in Translation: Perspective and Comprehension

Care of non-English speaking patients poses a unique challenge to the anesthesiologist in the perioperative setting. Communication limitations can be frustrating to both the patient and provider, and at times can compromise the quality of care, resulting in health care disparities. An often overlooked, but critical component is the interaction between the anesthesia provider and the interpreter. The goal of our study was to identify misconceptions regarding anesthesia and determine common knowledge gaps amongst medical interpreters. A survey inquiring about past perioperative experiences, level of training, and barriers to effective communication was sent to the Department of Interpreter Services (IS). Concurrently, a survey was sent to the Department of Anesthesia, about their experiences with interpreters in the perioperative setting. Our survey had 29 respondents from IS and 42 respondents from Anesthesia. 85% of interpreters had >5 years experience, but 96% denied having anesthesia specific training. Additionally, 42.5% of our interpreters felt that less than half of their patients were sufficiently literate to read and consent in their native language. Anesthesia providers were primarily concerned about the fidelity of the interpretation. Misunderstanding one another's field appears to play a significant role in the communication issues surrounding interpretation for anesthesia. Educating both departments may prove beneficial to resolving misconceptions, improving perioperative interactions and ultimately improving patient care. Based on the gathered information, a continuing education lecture was created by the Anesthesia Department in order to improve our interpreters' understanding of anesthesia, associated procedures and vocabulary.

Implementation and Outcomes of a Live Continuing Education Program on Pharmacogenomics

This study evaluated the implementation and outcomes of a pharmacogenomics education program among pharmacists. Continuing education lectures were presented at local, state and national pharmacy conferences. Six hundred and seventy three pharmacist participants (mean ± standard deviation: 45 ± 14 years of age with 19 ± 13 years of practice experience) completed program evaluations. Participants' knowledge and overall ability to address pharmacogenomics testing significantly improved (p < 0.001). More than 50% rated self-efficacy for putting pharmacogenomics knowledge into clinical practice to be likely or very likely. Attitudes toward increasing the number of patients to educate, updating pharmacogenomics knowledge, and providing advice were 39, 76 and 64%, respectively. Participants rated program components to be useful or very useful, and the quality of the program format, program content and audience response system as good, very good or excellent. Through live continuing education presentations at pharmacy conferences, participants showed significant increases in knowledge and their overall ability to address pharmacogenomics testing with patients.

BONDING TO FLUOROSED TOOTH STRUCTURE

In many continuing education lectures, I frequently have been asked the question “When bonding to fluorosed teeth, should I do anything differently?” As the prevalence of fluorosis has increased, this question has become more and more clinically relevant. Unfortunately, there has not been extensive research in this area, but there has been some. Recent Ask the Expert pieces in the Journal have addressed the issue, and this Critical Appraisal covers the recent research on bonding of resin‐based materials to fluorosed enamel and dentin in greater detail.

WE‐A‐BRD‐01: Locating and Targeting Moving Tumors with Radiation Beams

The current climate of rapid technological evolution is reflected in newer and better methods to modulate and direct radiation beams for cancer therapy. This Continuing Education lecture focuses on one aspect of this evolution, locating and targeting moving tumors. The two processes — locating and targeting tumors— are somewhat independent and in principle different implementations of these processes can be interchanged. Advanced localization and targeting methods have an impact on treatment planning, and also present new challenges for quality assurance (QA), that of verifying real‐time delivery. Some methods to locate and target moving tumors with radiation beams are currently FDA approved for clinical use — and this availability and implementation will increase with time. Extensions of current capabilities will be the integration of higher order dimensionality into the estimate of the patient pose and real‐time reoptimization and adaption of delivery to the dynamically changing anatomy of cancer patients.Learning Objectives:1. To describe the technology available to determine real‐time target position2. To review the systems for real‐time target‐beam alignment3. To discuss the practical considerations of real‐time target tracking systemsResearch sponsored by Accuray, Calypso, Cyberheart, GE, NIH/NCI, Philips and Varian.

TH‐C‐352‐04: Acceptance Testing, Commissioning, Data Entry, and QA for Brachytherapy Treatment Planning Systems

Clinical medical physicists are compelled to concern with accuracy of brachytherapy treatment planning systems as the basis for treatment delivery. The role of the medical physicist in brachytherapy is key — close interactions with physicians are needed, and often a radiation therapist may not be present. In comparison to external beam, dose gradients are steeper, record‐and‐verify is not typically used, and treatment fraction dose is usually higher. Thus, the importance of our input. The role of brachytherapy for cancer treatment has expanded in recent years. Many of these new modalities push the limits of the conventional brachytherapy treatment planning dose calculation algorithm. A solid understanding of these systems and their clinical role is crucial towards ensuring success. This tenet holds true for both the newer modalities and the more established brachytherapy procedures.This continuing education lecture will provide a quasi‐chronological overview of the resources and actions required of a clinical medical physicistEducational Objectives:1. Acceptance Testing and Commissioning recommendations.2. Data Entry of brachytherapy dosimetry parameters based on AAPM‐, manufacturer‐, and user‐provided data.3. Quality Assurance, including startup and on‐going efforts, towards ensuring a safe and accurate environment.

Arkansas pharmacists' perceptions toward emergency contraception and nonprescription Plan B.

This study describes Arkansas pharmacists' knowledge, attitudes, and beliefs regarding emergency contraception. A cross-sectional survey was conducted among a convenience sample of pharmacists prior to a continuing education lecture. The 16-item survey included multiple choice and true/false questions to assess knowledge in addition to Likert-type scale questions regarding attitudes and beliefs. Frequency and descriptive statistics were calculated for all variables. Eighty-eight pharmacists completed the survey. A majority (73%) knew that Plan B had been FDA-approved for nonprescription use yet 42% believed that it works by disrupting a newly implanted ovum. On a scale from 1-5 where 5=strongly agree, the mean item score was 3.2 for whether emergency contraception should be available for nonprescription use with counseling and 1.6 for nonprescription use without counseling. When asked what they would do if presented with a request for emergency contraception, 45.8% indicated they would dispense the drug, 22.9% would refer the patient to another pharmacist or pharmacy, 3.6% would refuse to dispense, and 27.7% were not sure. Almost half (48.6%) did not believe they were competent instructing patients on the use of emergency contraception. The results show that pharmacists could benefit from additional training on emergency contraception.

Physician Assistants in Oncology

To the Editor: We would like to comment on the efforts of the American Society of Clinical Oncology (ASCO) in identifying the challenges and demands of treating patients with cancer, and in naming physician assistants (PA) and nurse practitioners (NP) as part of the solution.1 At the same time, we are disappointed with two articles published in the May 2007 issue of the Journal of Oncology Practice (JOP), which slight the PA profession. The first article, written by Dr Yu, describes how NPs will have an increased role in the oncology workforce, yet the role of the PA is noticeably omitted.2 In the second article, a biased communication, Dr Cohen expresses his concerns over PAs in oncology.3 We cannot ignore that the section heading for the article by Dr Yu is the “Voice of ASCO.” I can only hope that Dr Yu will follow his current report with a discussion of the role of PAs in oncology. Certainly, an article dedicated to describing the positive impact that PAs can have in caring for patients with cancer is warranted. Or does ASCO not have a voice for PAs? I do not believe this is the case. A liaison to ASCO was created in conjunction with the American Academy of Physician Assistants (AAPA) to represent PAs in oncology at ASCO events. In addition, a new educational symposium made its debut at the ASCO Annual Meeting in 2006. In conjunction with the AAPA, ASCO, and Oncology Nursing Society, the symposium addressed challenges that NPs and PAs face when evaluating patients. Dr Cohen's letter deserves attention as well. PAs are educated, motivated, and caring health care providers. The University of Texas M.D. Anderson Cancer Center (MDACC) employs over 160 PAs and relies on their skills, knowledge, and expertise to ensure the highest quality of care. The office of Physician Assistant Programs at MDACC developed a PA journal club, a PA continuing education lecture series, and a postgraduate PA program in oncology. In gastrointestinal medical oncology at MDACC, PAs have had a significant impact on oncology research, publishing original research articles and giving presentations at international oncology meetings.4–10 Other departments at MDACC have equally successful PAs. We admire Dr Cohen's engagement with his patients. We also suggest that a PA might allow him to work part-time in his practice or see more patients as a full-time clinician. Dr Erikson et al reported that oncologists who work with NPs or PAs have higher weekly visit rates, and productivity is highest when NPs or PAs are used for advanced activities.1 In addition, PAs provide quality care when working in non–primary care settings. For example, PAs and NPs working in specialty HIV clinics had performance ratings similar to or better than physician ratings for eight quality measures.11 PAs should not diminish the role of the patient-physician relationship in oncology, but rather provide high patient satisfaction, increased revenue, and more forgiving work schedules for their supervising physicians.

The Difference Between Knowing and Applying

As the complexity of physical therapy interventions grows and the options for examination and evaluation increase, the knowledge that practitioners must obtain and carry with them threatens to reach unmanageable levels. Therefore, like other members of the health care team, we are highly dependent on our literature and our ability to quickly and in a clinically practical manner extract salient information for the management of our patients. But this challenge—the retrieval of evidence for everyday practice—is only one part of the daunting task we face. In dialogues about evidence-based practice, we often forget that most proponents of this approach believe in something more than the application of data in a vacuum. As Sackett et al1 state, Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values. Clinical expertise and patient values are critical to the way we care for our patients and how we relate to them as partners in care. “Clinical expertise” is a difficult term to operationally define. Too often, clinical expertise is viewed as something that gurus and masters of the continuing education lecture circuit have, but in reality they have not yet demonstrated that they can be any more effective than anyone else. Clinical expertise is a property that is held by all physical therapists who practice effectively; though they might not be able to define “clinical expertise,” they can demonstrate it. Among the characteristics of the clinical …

Are emergency medical technician–basics able to use a selective immobilization of the cervical spine protocol?: A preliminary report

Objective To be a first step in determining whether emergency medicine technician (EMT)–Basics are capable of using a protocol that allows for selective immobilization of the cervical spine. Such protocols are coming into use at an advanced life support level and could be beneficial when used by basic life support providers. Method A convenience sample of participants ( n = 95) from 11 emergency medical services agencies and one college class participated in the study. All participants evaluated six patients in written scenarios and decided which should be placed into spinal precautions according to a selective spinal immobilization protocol. Systems without an existing selective spinal immobilization protocol received a one-hour continuing education lecture regarding the topic. College students received a similar lecture written so laypersons could understand the protocol. Results All participants showed proficiency when applying a selective immobilization protocol to patients in paper-based scenarios. Furthermore, EMT-Basics performed at the same level as paramedics when following the protocol. Statistical analysis revealed no significant differences between EMT-Basics and paramedics. A follow-up group of college students (added to have a non-EMS comparison group) also performed as well as paramedics when making decisions to use spinal precautions. Differences between college students and paramedics were also statistically insignificant. Conclusions The results suggest that EMT-Basics are as accurate as paramedics when making decisions regarding selective immobilization of the cervical spine during paper-based scenarios. That laypersons are also proficient when using the protocol could indicate that it is extremely simple to follow. This study is a first step toward the necessary additional studies evaluating the efficacy of EMT-Basics using selective immobilization as a regular practice.

ARE EMERGENCY MEDICAL TECHNICIAN–BASICS ABLE TO USE A SELECTIVE IMMOBILIZATION OF THE CERVICAL SPINE PROTOCOL? A PRELIMINARY REPORT

Objective. To be a first step in determining whether emergency medicine technician (EMT)–Basics are capable of using a protocol that allows for selective immobilization of the cervical spine. Such protocols are coming into use at an advanced life support level and could be beneficial when used by basic life support providers. Method. A convenience sample of participants (n = 95) from 11 emergency medical services agencies and one college class participated in the study. All participants evaluated six patients in written scenarios and decided which should be placed into spinal precautions according to a selective spinal immobilization protocol. Systems without an existing selective spinal immobilization protocol received a one-hour continuing education lecture regarding the topic. College students received a similar lecture written so laypersons could understand the protocol. Results. All participants showed proficiency when applying a selective immobilization protocol to patients in paper-based scenarios. Furthermore, EMT-Basics performed at the same level as paramedics when following the protocol. Statistical analysis revealed no significant differences between EMT-Basics and paramedics. A follow-up group of college students (added to have a non-EMS comparison group) also performed as well as paramedics when making decisions to use spinal precautions. Differences between college students and paramedics were also statistically insignificant. Conclusions. The results suggest that EMT-Basics are as accurate as paramedics when making decisions regarding selective immobilization of the cervical spine during paper-based scenarios. That laypersons are also proficient when using the protocol could indicate that it is extremely simple to follow. This study is a first step toward the necessary additional studies evaluating the efficacy of EMT-Basics using selective immobilization as a regular practice.

Teaching information mastery: creating informed consumers of medical information.

The concepts of evidence-based medicine are permeating all specialties, including family practice. This article describes a curriculum to teach residents the principles and practices of information mastery, a derivation of evidence-based medicine that is more relevant to family physicians. The curriculum is a 2-year longitudinal experience consisting mainly of didactic presentations and demonstrations in the first year followed by small-group sessions in the second year. Residents are taught the concepts of the previously described approach of information mastery and the application of these concepts to the variety of information resources available to them. Specifically, residents are taught how to find, evaluate, and apply information available from original research literature, review articles, meta-analyses, translation (controlled-circulation) journals, continuing education lectures, experts and colleagues, pharmaceutical representatives, and clinical experience. Using a before-after design at two institutions, the curriculum improved residents' attitudes, confidence regarding the medical literature, their perceptions of their ability to evaluate the published literature, and their use of information sources. Offering a structured curriculum to family practice residents creates dynamic, confident, and independent clinicians skilled in the art of information mastery.

Continuing Education Lectures, Conferences, Seminars

Continuing Education Lectures, Conferences, Seminars