Disease Management Skills Research Articles

Electronic Health Self-Management Interventions for Patients With Chronic Kidney Disease: Systematic Review of Quantitative and Qualitative Evidence.

BackgroundChronic kidney disease (CKD) poses a major challenge to public health. In CKD patients, adequate disease self-management has been shown to improve both proximal and distal outcomes. Currently, electronic health (eHealth) interventions are increasingly used to optimize patients’ self-management skills.ObjectiveThis study aimed to systematically review the existing evidence regarding the implementation and effectiveness of eHealth self-management interventions for patients with CKD.MethodsFollowing a search in 8 databases (up to November 2017), quantitative and qualitative data on process and effect outcomes were extracted from relevant studies. Quality was appraised using the Crowe Critical Appraisal Tool; narrative synthesis was performed to analyze the data extracted.ResultsOf the 3307 articles retrieved, 24 (comprising 23 studies) were included in this review; of these, almost half were appraised to be of low to moderate quality. There was considerable heterogeneity in the types of interventions used and the outcomes measured. A total of 10 effect and 9 process outcome indicators were identified. The most frequently reported effect outcome indicators were specific laboratory tests and blood pressure (BP), whereas satisfaction was the most frequently reported process outcome indicator. Positive effects were found for proximal outcomes (eg, BP control and medication adherence), and mixed effects were found for more distal outcomes (eg, quality of life). High feasibility, usability, and acceptability of and satisfaction with eHealth self-management interventions were reported. The determinant ability of health care professionals to monitor and, if necessary, anticipate on patient measurements online was mostly cited to influence patients’ adherence to interventions.ConclusionseHealth self-management interventions have the potential to improve disease management and health outcomes. To broaden the evidence base and facilitate intervention upscaling, more detailed descriptions and thorough analysis of the intervention components used are required. In addition, our review reveals that outcomes closely related to the scope and duration of the intervention implemented are most likely to be impacted. For instance, if a 4-week Web-based training to optimize disease management skills is implemented, the outcome perceived control would more likely be affected than kidney function. Although this seems obvious, most studies evaluate only distal outcomes and thereby fail to capture intervention effects that might contribute to long-term health improvement. We advise future researchers to carefully consider their choice of outcomes based on their sensitivity for change. In this way, we ensure that relevant effects are captured and legitimate conclusions are drawn.

Substance Use in Adolescents and Young Adults With Inflammatory Bowel Diseases: An Exploratory Cluster Analysis.

Adolescents and young adults (AYAs) with chronic illnesses use substances at similar, if not greater, rates compared to healthy peers. The present study aimed to examine rates and patterns of tobacco use, marijuana use, and binge drinking in AYAs with inflammatory bowel diseases. We expected that substance use would be associated with poorer physical health, psychosocial functioning, and disease management. One hundred thirty-two AYAs completed a single set of surveys assessing demographics, disease activity, healthcare utilization, health-related quality of life (HRQoL), inflammatory bowel disease-specific self-efficacy, adherence barriers, disease management skills, and substance use in the last 30 days (eg, tobacco use, marijuana use, binge drinking). Exploratory cluster analyses, followed by chi-square tests and analyses of variance examined patterns of substance use and correlates of cluster membership. Four patterns emerged from the sample: Global Users (n = 17), Marijuana Users Engaging in Binge Drinking (n = 18), Exclusive Binge Drinkers (n = 21), and Global Abstainers (n = 76). Groups differed by age, gender, disease activity, healthcare utilization, HRQoL, self-efficacy, and adherence barriers with medium and large effect sizes (P < .05). Older age, male gender, active disease, at least 1 hospitalization in the past year, low self-efficacy, low HRQoL, and high adherence barriers were significantly more likely for those reporting multisubstance use. In addition, all those reporting both marijuana use and binge drinking also reported tobacco use. Future research ought to examine these associations longitudinally and throughout the transition to adult care.

Analysis of the Health Information Needs of Diabetics in China.

According to the latest statistics of the China National Health Protection Commission, the prevalence of adult diabetics in China has reached 11.6%, and the number of patients has exceeded 114 million. Understanding the needs of diabetics and what kind of problems they are anxious about are crucial for doctors, hospitals and other health care providers, which can be used to ameliorate patient education services and help patients to improve their disease management skills. Hence we have conducted a study to analyze the questions about diabetes collected from a Chinese health website; the number of which is 151,589. We have divided these questions into 9 categories using a convolutional neural network. The shocking results showed that the questions about prevention only account for 1.23%. And a Chinese patented drug Xiaoke pill, the main component of which is glibenclamide, ranks fourth among the drugs the user cares most about due to the cheap price. However, patients know very little about its side effects.

Nursing Consultation in a Public Bathhouse: A Community Resource for the Vulnerable Population in a European Capital

Background: In Portugal’s capital, Lisbon, there are 19 public showers (PS) attended by a vulnerable population.Aim: To describe the assessment and interventions performed during nursing consultations.Method: This is a quantitative, observational, and cross-sectional study.Findings: In a convenience sample of 77 users, 52% are females, 43% are single, 52% do not possess any economic resources, 87% have mental health issues, and 32% are homeless. The main nursing focuses found were: arterial hypertension, disease management skills, and emotional suffering. The most used nursing intervention is listening, followed by the expression of feelings, valuing the individual and his/her story, analyzing causes, providing support, and comforting.Conclusions: This study shows that the main focus of the nursing care in these facilities is the human being. The respect for individuality and dignity was the primary concern, in an attempt to empower the individual to better manage his/her health and illness processes.

Preparation for and Implementation of Shared Medical Appointments to Improve Self-Management, Knowledge, and Care Quality Among Patients With Atrial Fibrillation.

Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults and is associated with an increased risk of stroke, heart failure, and death. Therapy for this pervasive arrhythmia is complex, involving multiple options that chiefly manage symptoms and prevent stroke. Current therapeutic strategies are also of limited efficacy, and can present potentially life-threatening side effects and/or complications. Emerging research suggests that the burden of AF can be reduced by improving patient understanding of the arrhythmia and teaching patients to adopt and maintain lifestyle and behavior changes. Shared medical appointments (SMAs) have been successfully used to deliver education and develop patient coping and disease management skills for patients with complex needs, but there is a paucity of studies examining the use of SMAs for managing AF. Moreover, few studies have examined strategies for implementing SMAs into routine clinical care. We detail our approach for (1) adapting a patient-centered SMA curriculum; (2) designing an evaluation comparing SMAs to routine care on patient outcomes; and (3) implementing SMAs into routine clinical practice. We conclude that evaluation and implementation of SMAs into routine clinical practice requires considerable planning and continuous engagement from committed key stakeholders, including patients, family members, schedulers, clinical staff, nurse educators, administrators, and billing specialists.

Review of Alzheimer’s Disease Focused Mobile Applications

Background: As of 2017, an estimated 5.5 million Americans are living with Alzheimer’s disease and related dementias (ADRD). Information and support for individuals with ADRD and their caregivers are critically needed. Technological advancements have provided patients and caregivers with tools that can provide information and education in areas such as improving awareness about the disease, disease management, and caregiving skills training. Mobile applications (apps) are an example of these tools. Studies have been conducted to assess the content of mobile apps focused on other health issues such as diabetes, weight management, and cancer; however, little is known about ADRD-related mobile apps. To our knowledge, this is the first comprehensive review of apps focused on ADRD. Objective: The objective of this study was to review the content of ADRD-related mobile apps. Methods: ADRD-related mobile apps were searched using keywords such as “Alzheimer”, “Alzheimer’s Disease” and “Dementia” in the App store for iOS-supported apps and Google Play Store for Android-supported apps. Apps were included for final review based on description, and inclusion and exclusion criteria. Three reviewers coded characteristics of the app (e.g. developer, version, number of installations, user ratings), target users, purpose, content of information provided, and technical aspects. Descriptive statistics, including frequencies and percentages, were used to analyze the data. Results: A total of 38 apps were included in the review (16 were only available in iOS; 9 were only available in Android; 13 apps were available in both operating systems). IT companies developed 36.8% of the apps reviewed, followed by non-profit organizations (18.4%), and health-consulting organizations (10.5%). Very few apps were developed by government agencies (5.3%) or pharmaceutical companies (5.3%). Most apps were intended for caregivers of individuals with ADRD (63.2%), followed by the general population (44.7%). The main purpose of the apps was for disease management (55.3%), skills training (42.1%), disease and treatment information (34.2%), and to improve disease awareness (29.0%). Very few apps had a goal of providing peer support (2.6%). Most of the content was focused on caregiving (63.2%) and disease management (50.0%). Other information frequently presented included signs and symptoms of ADRD (34.2%), types of ADRD (31.6%), financial and legal issues (29.0%), resources for supporting patients (29.0%), and healthy lifestyle for ADRD prevention (29.0%). Few apps contained information about differences between typical aging and ADRD symptoms (13.2%), and health insurance option for ADRD patients (10.5%). Few apps had video (23.7%) or audio (2.6%) lectures or tutorials. Interactive features were limited; few apps had a function of sharing (18.4%), an app community (10.5%), or sending reminders (7.9%). Conclusions: ADRD mobile apps that provide caregiving information can potentially benefit individuals who are supporting ADRD patients. Most ADRD mobile apps reviewed did not cover certain aspects related to ADRD, such as how to differentiate ADRD symptoms from typical aging. In addition, information provided by the apps was mainly presented in the form of text with limited audio/video options. There are opportunities for further development of ADRD apps with respect to content and format. [iproc 2017;3(1):e44]

Enhancing Pediatric Asthma Care and Nursing Education Through an Academic Practice Partnership

BackgroundHome environmental assessments and interventions delivered via academic practice partnerships (APP) between clinics and schools of nursing may be a low or no cost delivery model of pediatric asthma care and professional education. Patients receive enhanced clinical resources that can improve self-management and healthcare utilization. Additionally, students can practice chronic disease management skills in actual patient encounters. ObjectiveTo describe outcomes of the implementation of an APP between a school of nursing and a pediatric asthma specialty clinic (PASC) to deliver a home visit program (HVP). The HVP was designed to reduce emergency department visits and asthma related hospitalizations in PASC patients and provide clinical experiences for nursing students. MethodsPASC referred patients to the HVP based on their level of asthma control. Students provided an individualized number of home visits to 17 participants over a nine month period. A 12-month pre- and post-HVP comparison of emergency department visits and asthma related hospitalizations was conducted. Additional information was gathered from stakeholders via an online survey, and interviews with APP partners and HVP families. OutcomesChildren had fewer asthma related hospitalizations post HVP. Findings suggest a reduction in exposure to environmental triggers, improved patient and family management of asthma, and increased PASC knowledge of asthma triggers in the home and increased student knowledge and skills related to asthma management. ConclusionsMultiple clinical and educational benefits may be realized through the development of APPs as an infrastructure supporting targeted interventions in home visits to pediatric asthma patients and their families.

Utilization of simulated patients to assess diabetes and asthma counseling practices among community pharmacists in Qatar.

Background Patient counseling is one of the most important services a pharmacist can provide to patients. Studies have shown that counseling provided by pharmacists may prevent medication related problems and improve adherence to medication therapy. Objective To explore counseling practices among community pharmacists using simulated patients and to determine if patient, pharmacist, and pharmacy characteristics influence the counseling provided by community pharmacists. Setting Private community pharmacies within Qatar. Method This is a randomized, cross sectional study where simulated patients visited community pharmacies and presented the pharmacist with a new prescription or requested a refill for either a diabetes or asthma medication. Pharmacists completed a questionnaire at the end of the simulated interaction, which was utilized to determine if patient, pharmacist, or pharmacy characteristics had any influence on the counseling provided to patients. A scoring system was devised to assess the pharmacist's counseling practices. Main outcome measure To evaluate the type of information provided by community pharmacists to the simulated patient regarding diabetes and asthma. Results One hundred and twenty-nine pharmacists were enrolled in the study. Eighty one percent of pharmacists had a score <35%. Medication name (95%), directions (47%), indication (43%), and dose (41%) were the most frequently counseled components by pharmacists during the simulated interaction. Male patients received better counseling compared to the female patients (t=6.177; p<0.0001). Pharmacists with a master of pharmacy degree provided significantly better counseling (f=3.261; p=0.042). Many pharmacists (65%) provided hypoglycemia management to patients, however, 63% referred the patient to the physician when the patient experienced hypoglycemia from inappropriate medication administration. Only 2 (7%) pharmacists correctly counseled the patient on all 8 inhaler administration steps. Majority of pharmacists (50%) educated on the role of the rescue and controller therapy in asthma, however, 33% referred the patient to the physician when the patient inquired about controller therapy use. Conclusion Patient counseling was substandard with the majority of community pharmacists focusing on the name of the medication. Pharmacists rarely assessed patient's medical history or medication use. Disease management and problem solving skills of pharmacists were suboptimal with many referring patients back to the physician.

Abortion and various associated risk factors in small ruminants in Algeria

Identification of the causes of abortion among the huge population of small ruminants in Algeria (≈31 millions heads), is an important task for the control of livestock productivity and viability scourges to the small ruminants industry. Optimal production and utilization is constrained by a number of factors: disease, poor feeding and low management skills. Therefore, in the present study the prevalence of abortion in Algerian small ruminant’s flocks was estimated and its possible association was correlated with infectious (PPR, BT and Brucellosis seropositivity) and managerial (flock size, grazing system, type of farming, and contact with other flocks) risk factors. The present study showed an overall flock prevalence of small ruminant’s abortion as 75.33% (113/150) [95% CI 71.72–78.94%]. The risk factor analysis using multivariable logistic regression recognized the north-western and the steppe region as well as PPR positivity as a risk factor for abortion in Algerian small ruminant’s flocks. The odds of flock abortion was 11.47 [95% CI 2.39–54.88; P=0.002] and 10.31 [95% CI 1.28–82.88; P=0.028] times higher in north-western and steppe regions respectively compared to other region. Also the presence of PPRV infection in small ruminant flocks amplified the odds by 6 times [95% CI 2.221–17.427; P=0.001].Surprisingly, the univariate analysis for the other risk factors associated with abortions in Algerian small ruminant flocks indicated no statistically significant links with bluetongue (P=1.000) and brucellosis seropositivity (P=0.334). Flock size (P=0.574), type of farming (P=0.443), grazing system (P=0.117) and contact with other flocks (P=0.245) was also not statistically significant. Our results revealed that abortion in small ruminants is a challenge to farmers and PPR was chiefly linked to it. Therefore an effective vaccination and control programme is advocated for small ruminants in Algeria.

PC-FACS

PC-FACS

Feasibility of a Group-Based Self-Management Program for Ethnically Diverse People With HIV/AIDS in Hawaii

HIV/AIDS has transformed from a terminal to a chronic health condition affecting individuals for decades rather than years. Yet the development of care models that enhance client-focused HIV disease management skills is still in progress, especially in HIV resource-poor locales. This pilot study tested the feasibility of implementing the group-based Positive Self-Management Program (PSMP) to participants recruited from Oahu, Hawaii. The PSMP is a self-management program developed at Stanford University. A paucity of data exists on the efficacy of implementing the specialized PSMP that addresses unique needs of persons living with HIV. With a focus on enhancing self-efficacy beliefs, examples of topics addressed during seven weekly 2-hr group sessions include managing the physiological and psychological aspects of HIV, adherence to treatment regimes, symptom management, and fostering healthy lifestyle behaviors. Using a randomized waitlist control design, participants were recruited via convenience sampling and active outreach. The manualized PSMP was delivered by trained seropositive lay leaders. The completion rate for those who attended any sessions was 93.5%. The average attendance rate was 85%. The majority of participants reported being comfortable in the PSMP group setting and very satisfied with program activities. Almost all participants reported that the PSMP was a useful and easy method to learn new ways of managing their illness. The majority (93.8%) were most satisfied with skill development in goal setting and action planning. Implementation of the program for persons living with HIV in Hawaii was feasible. Lessons learned for future research and application to practice are discussed.

Abstract W P356: Neuroscience ICU Advanced Practice Provider Competency Model

Background: A large community based stroke program began utilizing advanced practice providers (APPs) 24/7 in the 18-bed Neuroscience ICU. The nurses needed 24/7 in-house support in managing these complex patients. Literature shows that APPs impact the length of stay and health care cost. This practice change led to an evaluation of the process of educating and ensuring competency to the APPs. Purpose: The goal was to ensure competency of APPs demonstrated by complete understanding of complex disease management and ongoing skills to manage critical neuro patients. Methods: Core Competency models were designed and used as a framework to aid in critical care specialization. Advanced classes, applicable clinical rotations, and procedure based skills lab were utilized to train the APPs. Initial measures to evaluate efficacy of the model included 14-item knowledge tests administered before and after a critical care symposium. Two versions of the test were administered using a crossover design, and changes in test scores were examined using analysis of variance. Additional competency measures included procedure and skill check-off competencies, neuro-monitoring utilization, provider sign-offs and one-on-one education by system educators. Results: APPs scored significantly higher on the post-test than the pre-test (mean difference = 19.71%, CI:14.3%-25.2%; p-value &lt;0.0001), suggesting the symposium advanced their neuroscience knowledge. There was no difference in scores between the two versions of the test (p=0.98). Strict adherence to integration of current evidence based practices combined with an in-depth orientation is critical to ensuring clinical competence. Program focus includes facilitating ongoing education in a variety of neuroscience topics via lecture and clinical experiences to advance knowledge to the highest level within their Scope of Practice. Conclusions: Utilizing a combination of specially trained critical care physicians, 24/7 accessible neurologists, neurosurgeons and neuro interventionalists on the training of the APPs for this complex patient population is the key to the success of the neurocritical care APP competency model.

Family caregivers and physicians caring for cancer patients: on-the-job training for all.

I am writing from the bedside of a family member who recently underwent pancreaticoduodenectomy. After participating in two brief training sessions and watching nurses do their jobs, I learned how to administer total parenteral nutrition, flush a pancreatic drain, and handle other caregiving tasks. I am not alone. More than 40 million Americans serve as unpaid caregivers for a family member who is 50 years of age or older. Given the psychological burdens of caregiving and the need for on-the-job training, family-directed interventions have been mounted.1 As Griffin et al.2 (this issue) note, an “implicit assumption” of these interventions is that “the patient will also benefit.” The authors do not unpack these assumptions, but the credibility of their argument, and its relevance for clinical practice and policy, require the identification of plausible mechanisms. There are at least three. First, interventions might improve communication and decision-making at the point-of-care, thereby, for example, decreasing patient exposure to treatments that do more harm than good. Such was the case in a study3 that was excluded from the review because it was conducted outside the United States. In that study, an intervention for family members of patients dying in intensive care units both decreased patient exposure to futile treatments and improved caregiver bereavement outcomes. Second, caregivers might be taught disease management skills (e.g., pain, nutrition) that directly benefit the patient. Third, intervention-induced improvements in caregiver quality of life (QOL) could be transmitted to the patient via psychological processes (e.g., empathy, conditioning, social learning) that are facilitated by commonalities (due to genetics, homophily or living in a shared environment) between patient and caregiver. By virtue of the same psychological processes that account for increased physical resemblance among older spouses4 and increased caregiver morbidity after exposure to patient suffering,5 patients might benefit from improved caregiver quality of life. Despite the presence of plausible mechanisms, the authors “found little evidence” that patients’ outcomes “were more effectively addressed by a family-involved intervention.” Nonetheless, they encourage more research on this topic. Observing that all but two of the 27 trials were of poor or fair quality, they call for increased methodological rigor. Rigor is needed, but so is greater stakeholder involvement in the research process. Community psychologists have long recognized that a project’s societal impact is proportional to the diversity of perspectives represented.6 Only recently has this principle earned the imprimatur of federal policy, with government agencies now requiring community-based participatory research and stakeholder involvement throughout the research process.6 As a caregiver, I can personally attest to the need for stakeholder involvement. Despite co-authoring a meta-analysis on caregiver interventions,1 I had seriously underestimated the skills and knowledge required for effective caregiving. Patients, caregivers, physicians, nurses and other members of care teams have an insider’s understanding of cancer care and its aftermath that is unavailable to researchers with no first-hand cancer experience.

A Virtual Patient Software Program to Improve Pharmacy Student Learning in a Comprehensive Disease Management Course

To implement and assess the impact of a virtual patient pilot program on pharmacy students' clinical competence skills. Pharmacy students completed interactive software-based patient case scenarios embedded with drug-therapy problems as part of a course requirement at the end of their third year. Assessments included drug-therapy problem competency achievement, performance on a pretest and posttest, and pilot evaluation survey instrument. Significant improvements in students' posttest scores demonstrated advancement of clinical skills involving drug-therapy problem solving. Students agreed that completing the pilot program improved their chronic disease management skills and the program summarized the course series well. Using virtual patient technology allowed for assessment of student competencies and improved learning outcomes.

Task shifting of HIV management from doctors to nurses in Africa: Clinical outcomes and evidence on nurse self-efficacy and job satisfaction

With 24% global disease burden and 3% global health workforce, the World Health Organization (WHO) designates the African region a critical workforce shortage area. Task shifting is a WHO-recommended strategy for countries with severe health worker shortages. It involves redistribution of healthcare tasks to make efficient use of available workers. Severe physician shortages, increasing HIV disease burden, and the need for improved access to antiretroviral treatment (ART) posed serious challenges for Africa. Shifting ART management from physicians to nurses was adopted by many countries to increase access to treatment. Growing evidence from Africa supports this model of care but little is known about its impact on African nurses. A PubMed literature search was conducted for most recent task-shifting studies in Africa between January 2009 and August 2012. Thirty-four studies were identified but 11 met criteria for “task shifting from physicians to nurses in HIV settings.” The methodologies and findings related to patient outcome, nurses' perceived self-efficacy, and job satisfaction were summarized. Patient outcomes were measured in 10 of the studies and all demonstrated comparable results. Seven of eight studies showed no difference in mortality while five found better retention and lower client loss to follow-up in nurse-managed groups. Four studies showed that nurses built on existing nursing and HIV knowledge; improved HIV and other disease management skills; and had increased comfort levels with using treatment guidelines. Results of job satisfaction from three studies showed that nurses expressed “feelings of emotional rewards, accomplishment, prestige, and improved morale.” In six studies, nurse-managed care was acceptable to patients in five studies, nurses in two studies, and majority of physicians and program managers in one study. Nurse-managed care had comparable outcomes and retained more patients but only two studies “directly” assessed nurses' perceptions. Research exploring nurses' response, self-efficacy, and job satisfaction are critically to sustainability.

Teaching family medicine: a longitudinal and modular competency-based approach

What problems were addressed? Our graduate medical school is located in Singapore. It runs a 4-year curriculum which closely follows the curriculum at Duke University (Durham, NC, USA). Basic sciences are taught during Year 1; clinical clerkships and electives are held in Years 2 and 4, and Year 3 is dedicated to research. The challenge was to design an innovative clerkship that complements the school’s unique curriculum. We abandoned the 4-week programme in Year 2 as taught at Duke University and adopted a modular competency-based approach. We created a year-long programme, allowing our students to experience care continuity and patient-centredness in the community. The first cohort of students completed the year-long clerkship in 2010 with encouraging results. What was tried? The family medicine clerkship is taught in three modules. The first is a knowledge foundation module, which is completed in the first 2 weeks of Year 3. Knowledge and skills learned during Year 2 clerkships are consolidated. Students learn to translate them to a family medicine setting, using team-based learning and clinical scenarios. These are supplemented with lectures and smallgroup discussions on conceptual topics in family medicine. Topics include family medicine principles, organisation of primary care, chronic disease management, preventative care and consultation skills. This is followed by two other modules, which are conducted in the community over the rest of the year. The continuity clinic module focuses on professionalism, patient care and system-based learning. Students are placed under the tutelage of two preceptors in community clinics. They complete a minimum of 20 clinic sessions distributed over a 1-year period. They are required to record their reflections after each session, using an electronic log book. In the patient-centred care module, students follow up two patients with chronic health issues, whom they encountered in their Year 2 clerkships. Students work in small groups of up to six and are supervised by a faculty member. Students make home visits and are encouraged to discover the perspectives of the patients and their caregivers as they cope with their illnesses. Students are encouraged to study system issues as they follow their patients’ journeys through the health care system. They are required to reflect on the impact of illness on the patients’ lives. Students ‘blog’ their reflections in their personalised web logs. We use a closed-access network which is shared only with team-mates and assigned faculty staff to maintain confidentiality. Students and teachers are encouraged to comment and interact with one another as they share experiences. What lessons were learned? An extended clerkship in which students are dispersed in the community is logistically challenging. Use of information technology, such as a web-based personal journal and electronic log books, is helpful. The programme was well accepted by faculty staff and students. On a scale of 0–5, the clerkship achieved a score of 4.21 in the students’ evaluation of the programme’s ability to achieve the goals and objectives of the rotation. Overall, 29.0% of students in the class gave the programme a score of 5 and 62.5% gave it a score of 4.

WS4.5 Knowledge and skills in managing CF: Data from the I Change Adherence and Raise Expectations (iCARE) study

Objectives: Knowledge of disease management and treatment skills are necessary, but not sufficient, to improve adherence. This study examined: 1. gaps in knowledge of disease management, 2. deficits in treatment skills, 3. impact of age and gender, and 4. convergence between teen and parent knowledge. Methods: Knowledge of Disease Management (KDM-CF) in four domains, General Health, Lung Health, Nutrition, and Treatments, and the Skills Checklist (scored as percent correct) were administered to 571 teens (M = 14.6 years, SD = 2.6; 307 girls) and 249 parents in iCARE at 18 CF centers in the US. Results: Significant gaps in knowledge were observed, with lowest scores on the Nutrition Scale (M = 68.9 [15.4]). Skills were best for enzymes (M = 94.5 [12.00]) and worst for MDIs (M = 68.8 [18.8]) and acapella (M = 69.9 [23.1]). Age was positively correlated with Knowledge Scores (r = 0.46, p< 0.001) but not Skills. Older teens had higher KDM-CF Total Scores (M = 82.4 [9.5]) than younger teens (M = 71.8 [13.4], p< 0.001). Knowledge scores did not differ by gender, but girls (M = 82.8 [17.7]) had significantly higher Nebulizer Skills than boys (M = 79.4 [19.2], p< 0.05). Parents had higher KDM-CF Total Scores (M = 84.7 [7.5]) than adolescents (M = 75.1 [14.2]), and paired t-tests revealed significant differences in KDM scores by dyads (p< 0.001). Conclusions: Remediating gaps in knowledge of disease management and skill deficits are critical targets for intervention and should be assessed annually. These measures provide individual teen and parent data to focus teaching and retraining. Acknowledgements: Novartis Pharmaceuticals, Genentech, Inc. & Cystic Fibrosis Foundation. WS4.6 The psychometric properties of CF-specific measures of health beliefs and motivation to adhere K.A. Riekert1, D. Rand-Giovannetti1, B. Borrelli2, A. Green1, M.N. Eakin1. 1Johns Hopkins University, Medicine, Baltimore, United States; 2Brown University, Psychiatry & Human Behavior, Providence, United States

Medical students' perceptions of an emergency medicine clerkship: an analysis of self-assessment surveys.

BackgroundNo studies have been performed that evaluate the perceptions of medical students completing an emergency medicine (EM) clerkship. Given the variability of exposure to EM in medical schools nationwide, assessment of the student rotation may inform the structure and content of new and existing clerkships, particularly in relation to student’s acquisition of the core competencies.ObjectivesTo investigate whether undergraduate medical students rotating through an EM clerkship improved their understanding and abilities in core content areas and common procedural skills; to evaluate whether improvement was affected by rotation length.MethodsAll students participating in an EM clerkship over a 12-month period were asked to complete an anonymous voluntary pre- and post-rotation survey. Confidence with patient assessment, diagnosis, and management plans; trauma and medical resuscitations; formal and informal presentations; basic procedure skills and understanding of the modern practice of EM were self assessed using a Likert scale. Group mean scores on each question on the pre- and post-clerkship surveys were calculated and compared. The mean scores on each survey item, both pre- and post-clerkship, were compared between 2- and 4-week clerkship rotation groups.ResultsTwo hundred thirty-nine students participated in the rotation during the 12 months of the study. One hundred sixty-one (161), or 67.4%, completed the pre-rotation survey, and 96 (40.2%) completed the post-rotation survey. Overall, students showed significant mean gains in confidence with initial patient assessment, diagnosis, and management plans (p < 0.01, 0.02, <0.01) and with basic procedure skills (p < 0.01 for all). Students completing a 2-week rotation did not differ significantly from f4week rotators in confidence levels, except in the area of formal presentation skills (p = 0.01), where the 4-week students demonstrated a statistically significant advantage. The 2-week clerkship participants were significantly less confident in all procedures except EKG interpretation, splinting, and venipuncture (p = 0.28, 0.22, 0.05). Regardless of rotation length, students generally felt they had sufficient exposure to patients and opportunities for hands-on learning and practice, and overwhelmingly would recommend the EM clerkship to a fellow student, regardless of their chosen specialty.ConclusionsMedical students show significant gains in confidence with acute care knowledge, disease management, and procedure skills after completion of an EM clerkship. Although a 4-week clerkship may be preferable to expose students to the widest variety of patients and procedures, all students can benefit and improve in core competencies after an EM undergraduate experience.

A Meta-Analysis on the Impact of Disease-Specific Education Programs on Health Outcomes for Patients with Chronic Obstructive Pulmonary Disease

Disease-specific education programs have become an important factor in the treatment and care of chronic conditions, such as heart failure and diabetes mellitus. However, the effectiveness of these educational methods on chronic obstructive pulmonary disease (COPD) remains unclear. The objective of this meta-analysis was to evaluate whether disease-specific education programs were beneficial to health-related quality of life (HRQoL) variables and other long-term health outcomes in patients with COPD. Using electronic databases (PubMed, Cochrane Library, Science Direct, Chinese Biomedical Data System, China National Knowledge Infrastructure, and Wanfang Database) and individual searches (published and unpublished Chinese studies), we identified 12 randomized controlled trials (RCTs; English and/or Chinese) from 1991 to 2011. A meta-analysis on these studies revealed a positive relationship between disease-specific education programs and HRQoL scores (as measured by the St. George's Respiratory Questionnaire). Moreover, educational programs were associated with increased knowledge about COPD, improved disease management skills, inhaler adherence, and decreased COPD-related emergency department visits and hospital admissions, as well as long-term effects on improving COPD patients' health outcomes. Although significant effects were not detected across all HRQoL variables and health measures, our findings suggest that education programs have the potential to be a valuable intervention for COPD patients. Our results provide a foundation for future research in this area, which we recommend as including more rigorously designed, large, randomized studies.

Social networking for adolescents with severe haemophilia

Access to modern treatments allows adolescents with haemophilia to manage their haemophilia at home, with improved treatment outcomes and quality of life, but has reduced peer support and the potential for experiential learning from older peers. Social networking, aided by modern communication technologies, may offer health benefits through peer support. We sought to assess whether or not disease-specific social networking could benefit adolescents with severe haemophilia. A total of 150 adolescents (aged 10-18) with severe haemophilia A or B from 11 UK treatment centres or those who had attended focus groups to explore the potential for a social network designed specifically for their use were surveyed. Teenage boys with severe haemophilia in the UK who responded to an online and paper questionnaire (n = 47; 31% response rate) rarely knew of or socialized with others with haemophilia outside their families. Two-thirds of respondents said they would like to meet others. For 70% of boys, parents were the major source of information about haemophilia, yet more than half said they often had trouble finding answers to their questions. These boys frequently used online social networks to chat with friends. Adolescents with severe haemophilia frequently have limited contact with others and many wish to have greater contact. They may benefit from peer support and experiential learning gained through online social networking. The SixVibe restricted access social network is to be launched in 2011. It includes features designed to promote and facilitate the development of peer-to peer disease management skills for adolescents with severe haemophilia.