Educational Handout Research Articles

Respiratory Syncytial Virus (RSV): Independent Community Pharmacy Impact in Promoting Prevention Through Immunization.

Respiratory syncytial virus (RSV) typically results in mild cold-like symptoms; however, it can lead to severe complications and hospitalization in patients who are 60 years of age and older with long-term health conditions. The aim of this study was to assess patient knowledge about RSV and to provide patients with information about the virus and the vaccination. A multisite cross-sectional pilot study was conducted from September 12, 2023, to March 11, 2024, in the independent community pharmacy setting. Included were all patients aged 60 years and older who consented to filling out the 14-question survey. Excluded were patients who declined to take the survey. Patients completed the survey either on paper or electronically, and the survey included initial consent, demographic information, past medical history, knowledge of RSV, consent to vaccine administration, and reasons for refusal, if applicable. At the end of the survey, patients could consent to vaccine administration onsite and were provided with an educational handout. The primary outcome revealed that 78% of participants had not received any education from their healthcare provider about RSV. Additionally, 70% correctly identified ways RSV might spread, 60% reported knowing how to protect themselves, and 58% correctly indicated that a previous RSV infection does not provide immunity. As for the secondary outcomes, 63% of participants consented to receive the vaccine on the day of the survey. The study underscores the critical role of community pharmacies in healthcare delivery and the need for enhanced educational efforts to support vaccination programs.

The Effects of Sexual Education on Function and Quality of Life of Women Who Underwent Total Hip Arthroplasty: A Randomized Controlled Trial

BackgroundThis study aimed to determine the effect of sexual education on sexual function and quality of activity after total hip arthroplasty (THA). MethodsThere were 31 patients who underwent THA who were randomly assigned to the education (n = 15) and the control (n = 16) groups in this randomized controlled trial. A sexual education session and an educational handout were provided to the study group after THA prior to discharge. Patients were evaluated 4 times throughout the study: preoperatively, at 1, 3, and 6 months after surgery. The data were collected by using the sociodemographic and medical data form, the Index of Female Sexual Function, the Sexual Quality of Life-Female (SQoL-F) Questionnaire, the visual analog scale (VAS) of the Fear of Sexual Activity, and the VAS of Satisfaction with Sexual Activity scales. ResultsThe mean sexual activity satisfaction score of the education group was higher in the second (95% confidence interval [Cl] [0.67 to 3.08]) and third follow-up (95% Cl [0.19 to 3.03]) (P < 0.05). Over time, the mean satisfaction scores of both groups increased (P < 0.05). The mean VAS fear of sexual activity scores at the first (95% CI [−2.81 to −0.48]), second (95% CI [−4.71 to −2.80]), and third (95% CI [−3.80 to −1.55]) follow-ups of the education group were significantly lower. Over time, the mean fear scores of both groups decreased (P < 0.05). The education group had higher mean SQoL-F scores at the first (95% CI [4.90 to 33.11], second (95% CI [7.62 to 34.31]), and third (95% CI [5.23 to 35.79]) follow-ups (P < 0.05). For the mean SQoL-F score, the difference between groups (F = 6.64), the change over time in both groups (F = 29.16), and the change over time between groups (F = 13.74) were statistically significant (P < 0.05). For the mean Index of Female Sexual Function score, it was found that the change over time was significantly different for both groups (F = 69.64, P < 0.05). ConclusionsSexual education after THA may improve satisfaction with sexual activity and quality of life.

Improving vaccination counseling rates in first time patients with cancer: A multi-disciplinary approach.

315 Background: ASCO guidelines 2024 recommend that “clinicians determine vaccination status and ensure that adults newly diagnosed with cancer about to initiate treatment are up to date on seasonal vaccines as well as age- and risk-based vaccines.” Prior to the study, Baylor Scott and White Hematology Oncology Round Rock (BSWHRR) clinic lacked a formalized process for vaccine education. The primary aim of this study was to increase vaccination counseling for first-time cancer patients with solid tumors or hematologic malignancies. The secondary endpoint was to optimize vaccination status for this group of patients. Methods: Inclusion criteria were patients 18 years or older with initial diagnosis of solid tumor or hematologic malignancy, receiving chemotherapy and/or immunotherapy for the first time, and treated within BSWHRR. Exclusion criteria were patients with subsequent malignancy, malignancy requiring second line chemotherapy and/or immunotherapy, or deceased. Patients meeting these criteria n=57 were collected during the pre-intervention period October 15-December 15. Post-intervention data n=52 was collected 6 weeks following the initiation of the intervention from February 18 – April 18. The intervention included a 2-sided handout containing current recommendations for vaccination schedules in immunocompromised adults. These handouts were provided along with counseling at 2 separate encounters (during the initial consult and during chemotherapy education). The handout included instructions for scheduling vaccines with the Baylor Scott and White Pharmacy and/or their PCP. This multi-disciplinary approach included nurse navigators, triage nurses, pharmacists, and physicians. A standardized documentation process was initiated and utilized for both consult and chemotherapy education encounters. Results: Following the introduction of vaccine education handouts and standardized documentation, vaccine counseling rates during the consult visit improved from 0% to 49%. Vaccine counseling rates during chemotherapy education visits increased from 0% to 71%. Overall, the number of patients that attended and were counseled during at least one of these visits increased from 0% to 70%. The secondary endpoint of increasing vaccination rates showed that non-seasonal vaccination rates improved. Pneumococcal vaccination rates improved from 33% to 42%, a 27% increase. Shingles coverage improved from 16% to 25%, a 56% increase. Conclusions: This study showed that a multidisciplinary approach, utilization of patient/physician education handouts, and standardization of documentation was effective in achieving a substantial increase in vaccination counseling rates for patients with newly diagnosed malignancy. The intervention was also effective in achieving the secondary endpoint of increasing pneumococcal and shingles vaccinations.

Comparison of two implementation strategies for anterior cruciate ligament injury prevention in amateur girls’ youth soccer: a prospective cohort study

ObjectivesTo compare two implementation strategies, an educational handout and a knowledge-to-action (KTA) intervention, for promoting anterior cruciate ligament (ACL) injury prevention programme (ACL-IPP) implementation in amateur youth girls’ soccer. The...

A case of severe opioid and methamphetamine use disorder in a 14 year old

We present the case of a 14-year-old who established care at our primary care clinic after hospitalization for unintentional fentanyl overdose. They were diagnosed with severe opioid use disorder (OUD) and stimulant use disorder (StUD) and initiated buprenorphine while inpatient. They were then transitioned to the only known outpatient primary care clinic in her county who was actively providing medications for opioid use disorder (MOUD) in adolescents.At the first visit, they reported a history of 20 overdoses, struggling with adherence to buprenorphine and continued opioid cravings. An overdose safety plan was reviewed with them and their parent including providing them naloxone kits, fentanyl test strips, and education handout sheets. Due to their significant overdose history and adherence challenges with sublingual buprenorphine, they were started on long-acting injectable buprenorphine (LAIB) with weekly provider visits and urine toxicology screening. In collaboration with the treatment team, they initiated behavioral treatment with contingency management (CM), with incentives for appointment completion, expected urine results, and successful medication administration. Over the next 19 months, and to date, they have increasingly engaged with care and have remained abstinent. LAIB may be an appealing alternative for adolescents with OUD to improve adherence and reduce risk of recurrent use and overdose. Adjunctive treatment with CM may improve retention in MOUD and have the benefit of treating StUD. There is a need for further research to explore innovative, community-based treatment for youth with OUD.

First Aid Curriculum for Second Year Medical Students.

This small-group workshop is designed for pre-clinical medical students. The workshop can also be offered to other medical students looking to review first aid in the community setting. First aid training in medical students varies based on each student's previous experience. Because of this, medical students in their pre-clinical years have expressed a desire for further training in first aid.1 While most bystanders in an emergency situation do not have a medical background, medical students have received additional training that can provide the skillset to process and respond to emergency situations in a different capacity. Most medical schools have not adopted a universal curriculum in teaching medical students first aid.2 Incorporating first aid into a medical school curriculum can enhance medical students' confidence in emergent situations and lead to better outcomes for patients requiring immediate on-site care. The goal of this workshop was to improve the confidence of medical students in handling emergencies in the community with the use of first aid while also giving them a standard approach to emergencies using an airway, breathing, and circulation approach. The curriculum was evaluated through student-perceived self-efficacy and confidence in handling the provided scenarios, performance on relevant multiple choice questions, and general appeal of the first aid sessions. By the end of this workshop, students will be able to define the goals of "first aid" and first responder actions, describe clinical signs and symptoms suggestive of an airway, breathing, or circulation emergency in the setting of selected medical emergencies, and demonstrate immediate care steps in the setting of selected medical emergencies, specifically the Heimlich maneuver on adults and infants, direct pressure, wound packing, tourniquet application for external bleeding, epinephrine auto-injector administration, and the recovery position for obtunded or unconscious patients. Small group activities were performed with a focus on case-based scenarios combined with hands-on instruction. The four scenarios were choking, seizure, anaphylaxis, and bleeding which were taught by an educator who was either faculty, an emergency medicine resident, or an upper-level medical student. Facilitators were provided an educational handout specific to their station to guide them through the teaching session. A PowerPoint presentation was also provided complete with supporting images and videos to share with the students each session. Students were asked to complete a pre-test and post-test survey to assess knowledge outcome, self-efficacy in first aid, and overall appeal of the workshop. The multiple-choice knowledge outcome data was scored for percent correct on each question as well as overall performance on questions grouped by content. Students were also asked to provide feedback and comments on their overall experience in the workshop. Overall, medical students reported increased knowledge and confidence in responding to various first-aid situations. There was overall improvement in pre-test and post-test evaluations. The appeal of the event as a whole and its usefulness was overwhelmingly viewed as positive. Some participants noted they wanted similar workshops with more first-aid topics. Participants also noted they felt better prepared to respond to the various emergencies included in the workshop. A workshop directed at teaching first aid to medical students increased their confidence and knowledge in responding to various emergencies and can successfully be accomplished through a focused large group didactic session and multiple clinically relevant small group teaching sessions. First aid, airway, breathing, circulation, medical students, choking, seizures, bleeding, anaphylaxis.

(040) EVALUATING CHATGPT AS A SOURCE OF PATIENT EDUCATION MATERIALS ON DYSPAREUNIA

Abstract Introduction Dyspareunia, or female sexual pain, has an estimated prevalence of up to 18% worldwide. It is a complex condition with various physical and psychological etiologies, making it a challenge for patients to understand. Physicians spend significant time on patient education and providing educational materials to patients. ChatGPT is an artificial intelligence (AI) language model that generates human-like conversational text. Objective The aim of our study is to evaluate the understandability, quality, and readability of written patient educational material on topics related to dyspareunia generated by ChatGPT in English. Methods Five existing and accessible patient education handouts related to the topic of dyspareunia were identified and used as reference material. We prompted ChatGPT to create patient education leaflets on dyspareunia, female sexual dysfunction, vaginismus, and vulvodynia. The DISCERN instrument and Patient Education Materials Assessment (PEMAT) were used to assess each leaflet’s quality, understandability, and actionability. Readability of the patient education materials was assessed with the Flesch-Kincaid Grade (FKG) level. Results ChatGPT created four different patient education materials. The document created on “dyspareunia” scored 90% on understandability 75% on actionability, 42 on DISCERN, and 14.4 FKG level compared to the UpToDate (88%, 50%, 50, and 7.6) and the International Urogynecologic Association (IUGA) (100%, 0%, 80, and 13.6) on the same subject. The ChatGPT handout on “female sexual dysfunction” scored 70% on understandability, 50% on actionability, 37 on DISCERN, and 12.9 FKG Level compared to the American Urogynecologic Society (AUGS) (90%, 50%, 52, and 13) handout on the same subject. The ChatGPT handout on “vaginismus” scored 81% on understandability, 25% on actionability, 41 on DISCERN, and 11.3 FKG Level compared to the International Society for the Study of Vulvovaginal Disease (ISSVD) (90%, 0%, 44, 11.4) handout on the same subject. The ChatGPT handout on “vulvodynia” scored 81% on understandability, 25% on actionability, 36 on DISCERN, and 11.5 FKG Level compared to the ISSVD (90%, 25%, 46, 10.5) handout on the same subject. Conclusions The average PEMAT understandability scores suggest that the reference handouts (91.6%) are more understandable than the AI-generated materials (80.5%). The ChatGPT-generated handouts also fell short in quality according to the average DISCERN scores (39 vs. 54.4). The average FKG level for the AI-generated information was 12.525 compared to 11.22 for the reference patient education materials. Overall, ChatGPT was not able to create patient education handouts on topics related to dyspareunia that were as understandable or readable as the existing handouts. The ChatGPT-generated handouts did, however, score higher in actionability on average (50) than the reference handouts (25), which may give patients a false sense of trust in these AI-generated materials. Our study indicates that ChatGPT is not yet an ideal tool for the creation of patient education materials, nor is it a reliable information source for patients. Disclosure No.

Survey Says! Programming in a Cancer Hospital Library

ABSTRACT Library staff at a large cancer center decided to restart in-person programming after three years of having programming shut down by the hospital’s COVID-19 restrictions. This effort began by conducting a survey of the library’s users on what types of programming was desired, along with best format of program, most preferred day of the week and time of day. Once the survey was completed, the results guided staff to begin a weekly program consisting of educational handouts and giveaways. A second, follow-up survey sought to obtain any further ideas or comments by users. Programming began with passive display tables stocked with information and giveaways. Active, scheduled programming began in late 2023.

Mobilizing exercise recommendations for people with bone metastases: An experience-based co-design approach.

e23241 Background: People with bone metastases have historically been advised to limit exercise due to potential risks, such as fractures. Although published exercise recommendations by the International Bone Metastases Exercise Working Group emphasize regular exercise may benefit people with bone metastases, adopting guidelines into clinical practice remains challenging. Our study aims to use an experience-based co-design (EBCD) approach to collaborate with knowledge users (KUs) to develop knowledge mobilization (KM) products and a dissemination plan to promote the adoption of exercise recommendations for people with bone metastases. Methods: Three KU groups participated in EBCD: patient/family partners, oncology healthcare providers (e.g., physicians, nurses, allied health), and community-based exercise professionals (e.g., physiotherapists, exercise physiologists). Through four facilitated meetings, KM products were co-created and a dissemination strategy was planned. A survey of exercise professionals was used to collect further information on professional development (PD) preferences. Results: Twenty-nine KUs from five Canadian provinces participated (n = 10 patient/family partners, n = 9 healthcare providers, and n = 10 exercise professionals). KM products prioritized for co-development were: 1) a patient education handout; 2) patient education videos; 3) a clinical communication tool; and 4) PD resources for exercise professionals and healthcare providers. Finalized KM products will be presented at the meeting. A total of 183 international exercise professionals completed the PD survey, with 80% indicating that more PD resources were needed for bone metastases, focusing on exercise safety, feasibility, and prescription considerations. The dissemination plan will involve partnerships with Canadian and international organizations. Conclusions: Collaborating with KUs through EBCD may enhance KM product development and maximize utility and acceptability compared to researcher-designed products. Our KM products, tailored to support people with bone metastases to exercise safely, may also increase healthcare providers' and exercise professionals' satisfaction by improving the quality of information they can offer patients. A fulsome evaluation is planned to assess the reach, use, and partnership indicators of the KM products and dissemination plan.

Assessing the Application of Large Language Models in Generating Dermatologic Patient Education Materials According to Reading Level: Qualitative Study.

Dermatologic patient education materials (PEMs) are often written above the national average seventh- to eighth-grade reading level. ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT are large language models (LLMs) that are responsive to user prompts. Our project assesses their use in generating dermatologic PEMs at specified reading levels. This study aims to assess the ability of select LLMs to generate PEMs for common and rare dermatologic conditions at unspecified and specified reading levels. Further, the study aims to assess the preservation of meaning across such LLM-generated PEMs, as assessed by dermatology resident trainees. The Flesch-Kincaid reading level (FKRL) of current American Academy of Dermatology PEMs was evaluated for 4 common (atopic dermatitis, acne vulgaris, psoriasis, and herpes zoster) and 4 rare (epidermolysis bullosa, bullous pemphigoid, lamellar ichthyosis, and lichen planus) dermatologic conditions. We prompted ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT to "Create a patient education handout about [condition] at a [FKRL]" to iteratively generate 10 PEMs per condition at unspecified fifth- and seventh-grade FKRLs, evaluated with Microsoft Word readability statistics. The preservation of meaning across LLMs was assessed by 2 dermatology resident trainees. The current American Academy of Dermatology PEMs had an average (SD) FKRL of 9.35 (1.26) and 9.50 (2.3) for common and rare diseases, respectively. For common diseases, the FKRLs of LLM-produced PEMs ranged between 9.8 and 11.21 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). For rare diseases, the FKRLs of LLM-produced PEMs ranged between 9.85 and 11.45 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). At the fifth-grade reading level, GPT-4 was better at producing PEMs for both common and rare conditions than ChatGPT-3.5 (P=.001 and P=.01, respectively), DermGPT (P<.001 and P=.03, respectively), and DocsGPT (P<.001 and P=.02, respectively). At the seventh-grade reading level, no significant difference was found between ChatGPT-3.5, GPT-4, DocsGPT, or DermGPT in producing PEMs for common conditions (all P>.05); however, for rare conditions, ChatGPT-3.5 and DocsGPT outperformed GPT-4 (P=.003 and P<.001, respectively). The preservation of meaning analysis revealed that for common conditions, DermGPT ranked the highest for overall ease of reading, patient understandability, and accuracy (14.75/15, 98%); for rare conditions, handouts generated by GPT-4 ranked the highest (14.5/15, 97%). GPT-4 appeared to outperform ChatGPT-3.5, DocsGPT, and DermGPT at the fifth-grade FKRL for both common and rare conditions, although both ChatGPT-3.5 and DocsGPT performed better than GPT-4 at the seventh-grade FKRL for rare conditions. LLM-produced PEMs may reliably meet seventh-grade FKRLs for select common and rare dermatologic conditions and are easy to read, understandable for patients, and mostly accurate. LLMs may play a role in enhancing health literacy and disseminating accessible, understandable PEMs in dermatology.

Comment on: Utility of ChatGPT for Automated Creation of Patient Education Handouts: An Application in Neuro-Ophthalmology.

Comment on: Utility of ChatGPT for Automated Creation of Patient Education Handouts: An Application in Neuro-Ophthalmology.

Public Perceptions of Rotator Cuff Tears.

(1) Background: Full-thickness rotator cuff tears (RCTs) impact 25% of those over 60 and 50% over 80; however, minimal data exists on public understanding; (2) Methods: The primary outcome was to determine the public's baseline understanding of RCTs utilizing a 36-question survey regarding anatomy and function, risk factors, diagnosis and treatment options, and expectations. Secondarily, we evaluated the effect of an educational video and informational handout created by the authors to improve understanding. Participants ≥ 18 years were recruited from the senior author's clinic and online discussion platforms over a 5-month period; (3) Results: Baseline surveys were completed by 382 individuals: 56% men, 64% Caucasian, 27% with at least a master's degree, and 56% with very little or no RCT knowledge. Mean correct answer scores improved from 47% to 68% posteducational intervention (p < 0.001). Males, higher education level, healthcare experience, and a higher self-rated understanding of RCTs were significantly correlated with higher survey performance (p < 0.001); (4) Conclusions: The public's knowledge of RCTs at baseline was poor, with demographic factors correlating with survey performance. The educational intervention effectively enhanced participants' understanding. By focusing on common misconceptions, this data can help clinicians align patient expectations and enhance patient outcomes.

A pilot randomized controlled trial of an online intervention for Hodgkin lymphoma survivors to increase knowledge about late effects and recommended screening.

Hodgkin lymphoma (HL) survivors who received chest radiotherapy are at risk for breast cancer and cardiovascular disease, but screening adherence is low. We assessed the acceptability/feasibility of a web-based educational intervention and its impact on knowledge of health risks and screening. HL survivors were randomized to either an interactive online educational intervention or handouts only. Surveys were completed at baseline and 3months post-intervention. We described the acceptability/feasibility of the intervention and compared knowledge between groups. Fifty-two HL survivors participated; 27 in the intervention group and 25 in the control group. Eighteen (66%) intervention participants completed the intervention and reported high acceptability (89-100%). At baseline, adherence to breast cancer screening was low across all participants. Post-intervention, those in the intervention group more often than controls correctly identified breast cancer and echocardiogram screening guidelines (35% vs. 28%, P = 0.02 and 82% vs. 52%, P = 0.04) and reported knowing how to address potential complications from cancer treatments (87% vs. 64%, P = 0.03). We detected no increase in screening behavior post-intervention. Online education modules for high-risk HL survivors are an acceptable method to improve knowledge of health risks and screening guidelines. Future interventions should focus on improving screening uptake in this population. Web-based learning can be useful in increasing cancer survivor knowledge of their unique risks and screening recommendations but does not necessarily change patient behavior. Involvement in a cancer survivorship program can help assess individual barriers and monitor uptake of screening.

Prescription writing quality of psychotropic agents in MBBS interns in a private medical college hospital in Mangaluru.

Rational prescription writing is an important skill to master during internship. This Quality Improvement (QI) project aimed to understand the state of prescription writing among interns posted in the Department of Psychiatry, analyze the causes responsible for errors in prescription writing and bring about a change in the current practice. The MBBS interns are posted in the Department of Psychiatry for 15 days. During day 1 to day 5 of their posting, a pre intervention phase was conducted wherein prescriptions written by interns in the Department of Psychiatry were collected. The prescriptions were scored based on 14 criteria which were selected based on World Health Organization (WHO) guidelines and Medical Council of India (MCI) ideal prescription format. During PDSA (Plan Do Study Act) Cycle 1, an educational handout was distributed to the interns containing the MCI ideal prescription format and WHO guidelines regarding prescription writing. The brochure was also verbally explained to the interns. From day 7 to day 15 of their posting, prescriptions written by the interns were collected. The prescriptions were scored using the same criteria. During the pre intervention phase the mean total score of prescriptions was 9.54 ± 1.003. There was a significant improvement in the mean total score to 10.26 ± 0.746. There was a 7.54% improvement. There was also a significant improvement in several individual criteria. The first PDSA cycle was successful in improving the quality of prescription writing among interns posted in the Department of Psychiatry. There is a need to implement more PDSA cycles to improve the quality still further.

The National Kidney Diet, Part 2: Patient Education Handout, the Food Label and CKD

The National Kidney Diet, Part 2: Patient Education Handout, the Food Label and CKD

Using Behavioral Economics to Reduce Low-Value Care Among Older Adults

Use of low-value care is common among older adults. It is unclear how to best engage clinicians and older patients to decrease use of low-value services. To test whether the Committing to Choose Wisely behavioral economic intervention could engage primary care clinicians and older patients to reduce low-value care. Stepped-wedge cluster randomized clinical trial conducted at 8 primary care clinics of an academic health system and a private group practice between December 12, 2017, and September 4, 2019. Participants were primary care clinicians and older adult patients who had diabetes, insomnia, or anxiety or were eligible for prostate cancer screening. Data analysis was performed from October 2019 to November 2023. Clinicians were invited to commit in writing to Choosing Wisely recommendations for older patients to avoid use of hypoglycemic medications to achieve tight glycemic control, sedative-hypnotic medications for insomnia or anxiety, and prostate-specific antigen tests to screen for prostate cancer. Committed clinicians had their photographs displayed on clinic posters and received weekly emails with alternatives to these low-value services. Educational handouts were mailed to applicable patients before scheduled visits and available at the point of care. Patient-months with a low-value service across conditions (primary outcome) and separately for each condition (secondary outcomes). For patients with diabetes, or insomnia or anxiety, secondary outcomes were patient-months in which targeted medications were decreased or stopped (ie, deintensified). The study included 81 primary care clinicians and 8030 older adult patients (mean [SD] age, 75.1 [7.2] years; 4076 men [50.8%] and 3954 women [49.2%]). Across conditions, a low-value service was used in 7627 of the 37 116 control patient-months (20.5%) and 7416 of the 46 381 intervention patient-months (16.0%) (adjusted odds ratio, 0.79; 95% CI, 0.65-0.97). For each individual condition, there were no significant differences between the control and intervention periods in the odds of patient-months with a low-value service. The intervention increased the odds of deintensification of hypoglycemic medications for diabetes (adjusted odds ratio, 1.85; 95% CI, 1.06-3.24) but not sedative-hypnotic medications for insomnia or anxiety. In this stepped-wedge cluster randomized clinical trial, the Committing to Choose Wisely behavioral economic intervention reduced low-value care across 3 common clinical situations and increased deintensification of hypoglycemic medications for diabetes. Use of scalable interventions that nudge patients and clinicians to achieve greater value while preserving autonomy in decision-making should be explored more broadly. ClinicalTrials.gov Identifier: NCT03411525.

Evaluating the Implementation of the Connect for Health Pediatric Weight Management Program

Adoption of primary care interventions to reduce childhood obesity is limited. Progress in reducing obesity prevalence and eliminating disparities can be achieved by implementing effective childhood obesity management interventions in primary care settings. To examine the extent to which implementation strategies supported the uptake of research evidence and implementation of the Connect for Health pediatric weight management program. This quality improvement study took place at 3 geographically and demographically diverse health care organizations with substantially high numbers of children living in low-income communities in Denver, Colorado; Boston, Massachusetts; and Greenville, South Carolina, from November 2019 to April 2022. Participants included pediatric primary care clinicians and staff and families with children aged 2 to 12 years with a body mass index (BMI) in the 85th percentile or higher. Pediatric weight management program with clinician-facing tools (ie, clinical decision support tools) and family-facing tools (ie, educational handouts, text messaging program, community resource guide) along with implementation strategies (ie, training and feedback, technical assistance, virtual learning community, aligning with hospital performance metrics) to support the uptake. Primary outcomes were constructs from the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework examined through parent, clinician, and leadership surveys and electronic health record data to understand the number of children screened and identified, use of the clinical decision support tools, program acceptability, fidelity to the intervention and implementation strategies, and program sustainability. The program screened and identified 18 333 children across 3 organizations (Denver Health, 8480 children [46.3%]; mean [SD] age, 7.97 [3.31] years; 3863 [45.5%] female; Massachusetts General Hospital (MGH), 6190 children [33.8%]; mean [SD] age, 7.49 [3.19] years; 2920 [47.2%] female; Prisma Health, 3663 children [20.0%]; mean [SD] age, 7.33 [3.15] years; 1692 [46.2%] female) as having an elevated BMI. The actionable flagging system was used for 8718 children (48%). The reach was equitable, with 7843 children (92.4%) from Denver Health, 4071 children (65.8%) from MGH, and 1720 children (47%) from Prisma Health being from racially and ethnically minoritized groups. The sites had high fidelity to the program and 6 implementation strategies, with 4 strategies (67%) used consistently at Denver Health, 6 (100%) at MGH, and 5 (83%) at Prisma Health. A high program acceptability was found across the 3 health care organizations; for example, the mean (SD) Acceptability of Intervention Measure score was 3.72 (0.84) at Denver Health, 3.82 (0.86) at MGH, and 4.28 (0.68) at Prisma Health. The implementation strategies were associated with 7091 (39%) uses of the clinical decision support tool. The mean (SD) program sustainability scores were 4.46 (1.61) at Denver Health, 5.63 (1.28) at MGH, and 5.54 (0.92) at Prisma Health. These findings suggest that by understanding what strategies enable the adoption of scalable and implementation-ready programs by other health care organizations, it is feasible to improve the screening, identification, and management of children with overweight or obesity and mitigate existing disparities.

Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients With COPD, Heart Failure, or Interstitial Lung Disease

Many patients with chronic obstructive pulmonary disease (COPD), heart failure (HF), and interstitial lung disease (ILD) endure poor quality of life despite conventional therapy. Palliative care approaches may benefit this population prior to end of life. Determine the effect of a nurse and social worker palliative telecare team on quality of life in outpatients with COPD, HF, or ILD compared with usual care. Single-blind, 2-group, multisite randomized clinical trial with accrual between October 27, 2016, and April 2, 2020, in 2 Veterans Administration health care systems (Colorado and Washington), and including community-based outpatient clinics. Outpatients with COPD, HF, or ILD at high risk of hospitalization or death who reported poor quality of life participated. The intervention involved 6 phone calls with a nurse to help with symptom management and 6 phone calls with a social worker to provide psychosocial care. The nurse and social worker met weekly with a study primary care and palliative care physician and as needed, a pulmonologist, and cardiologist. Usual care included an educational handout developed for the study that outlined self-care for COPD, ILD, or HF. Patients in both groups received care at the discretion of their clinicians, which could include care from nurses and social workers, and specialists in cardiology, pulmonology, palliative care, and mental health. The primary outcome was difference in change in quality of life from baseline to 6 months between the intervention and usual care groups (FACT-G score range, 0-100, with higher scores indicating better quality of life, clinically meaningful change ≥4 points). Secondary quality-of-life outcomes at 6 months included disease-specific health status (Clinical COPD Questionnaire; Kansas City Cardiomyopathy Questionnaire-12), depression (Patient Health Questionnaire-8) and anxiety (Generalized Anxiety Disorder-7) symptoms. Among 306 randomized patients (mean [SD] age, 68.9 [7.7] years; 276 male [90.2%], 30 female [9.8%]; 245 White [80.1%]), 177 (57.8%) had COPD, 67 (21.9%) HF, 49 (16%) both COPD and HF, and 13 (4.2%) ILD. Baseline FACT-G scores were similar (intervention, 52.9; usual care, 52.7). FACT-G completion was 76% (intervention, 117 of 154; usual care, 116 of 152) at 6 months for both groups. Mean (SD) length of intervention was 115.1 (33.4) days and included a mean of 10.4 (3.3) intervention calls per patient. In the intervention group, 112 of 154 (73%) patients received the intervention as randomized. At 6 months, mean FACT-G score improved 6.0 points in the intervention group and 1.4 points in the usual care group (difference, 4.6 points [95% CI, 1.8-7.4]; P = .001; standardized mean difference, 0.41). The intervention also improved COPD health status (standardized mean difference, 0.44; P = .04), HF health status (standardized mean difference, 0.41; P = .01), depression (standardized mean difference, -0.50; P < .001), and anxiety (standardized mean difference, -0.51; P < .001) at 6 months. For adults with COPD, HF, or ILD who were at high risk of death and had poor quality of life, a nurse and social worker palliative telecare team produced clinically meaningful improvements in quality of life at 6 months compared with usual care. ClinicalTrials.gov Identifier: NCT02713347.

Utility of ChatGPT for Automated Creation of Patient Education Handouts: An Application in Neuro-Ophthalmology.

Patient education in ophthalmology poses a challenge for physicians because of time and resource limitations. ChatGPT (OpenAI, San Francisco) may assist with automating production of patient handouts on common neuro-ophthalmic diseases. We queried ChatGPT-3.5 to generate 51 patient education handouts across 17 conditions. We devised the "Quality of Generated Language Outputs for Patients" (QGLOP) tool to assess handouts on the domains of accuracy/comprehensiveness, bias, currency, and tone, each scored out of 4 for a total of 16. A fellowship-trained neuro-ophthalmologist scored each passage. Handout readability was assessed using the Simple Measure of Gobbledygook (SMOG), which estimates years of education required to understand a text. The QGLOP scores for accuracy, bias, currency, and tone were found to be 2.43, 3, 3.43, and 3.02 respectively. The mean QGLOP score was 11.9 [95% CI 8.98, 14.8] out of 16 points, indicating a performance of 74.4% [95% CI 56.1%, 92.5%]. The mean SMOG across responses as 10.9 [95% CI 9.36, 12.4] years of education. The mean QGLOP score suggests that a fellowship-trained ophthalmologist may have at-least a moderate level of satisfaction with the write-up quality conferred by ChatGPT. This still requires a final review and editing before dissemination. Comparatively, the rarer 5% of responses collectively on either extreme would require very mild or extensive revision. Also, the mean SMOG score exceeded the accepted upper limits of grade 8 reading level for health-related patient handouts. In its current iteration, ChatGPT should be used as an efficiency tool to generate an initial draft for the neuro-ophthalmologist, who may then refine the accuracy and readability for a lay readership.

Reducing central line-associated bloodstream infection with a dedicated CLABSI prevention registered nurse role

Following a 200% increase in the central line-associated bloodstream infection (CLABSI) standardized infection ratio in a private teaching hospital between 2019 and 2020, a program with the utilization of a CLABSI Prevention Registered Nurse was implemented to reduce CLABSIs through a variety of focused prevention efforts and education. The CLABSI P-RN project consisted of a dedicated team of RNs that performed interventions that included an audit of all central lines daily, real-time education and remediation, bi-weekly educational handouts, and assistance with 2-person dressing changes. Audit data were utilized to identify trends in gaps in compliance with the CLABSI bundle (ie, daily bathing, dressing integrity). The CLABSI rate/1,000 central line days were tracked in preintervention, intervention, and postintervention time periods. During the intervention, the CLABSI rate decreased from 1.4 during the preintervention time period, to 0.4 during the intervention time period (P-value .04). Additionally, daily bathing compliance improved from 84.3% during the preintervention time period, to 90.8% during the intervention time period (P-value .004). The implementation of the CLABSI P-RN was beneficial in reducing CLABSIs. An expert-trained role dedicated to central line management reduces CLABSI occurrences, reduces health care costs, and improves patient outcomes.