Educational Webinars Research Articles

A National Survey Evaluating the Impact of the COVID-19 Pandemic on Medical Students Pursuing Careers in Neurosurgery

INTRODUCTIONThe COVID-19 pandemic has significantly disrupted medical students (MSs)' educational experience, and this has unclear implications for those pursuing careers in neurosurgery.METHODSA cross-sectional, online survey was distributed to MSs and foreign medical graduates (FMGs) residing in the United States who are considering or pursuing careers in neurosurgery. Descriptive statistics comparing MS years were performed.RESULTSA total of 379 respondents from 67 medical schools completed the survey. Across all participants, 92% (n = 347) have stopped in-person didactic education, and 43% (n = 161) have experienced basic science and 44% (n = 167) clinical research delays. Sixty percent (n = 227) cite a negative impact on academic productivity. Among first year medical students (MS1s), 18% (n = 17) are less likely to pursue a career in neurosurgery. Over half of MS2s and MS3s are likely to delay taking the United States Medical Licensing Examination (USMLE) Steps I and II. Among MS3s, 77% (n = 91) report indefinite postponement of sub-internships, and 43% (n = 53) are unsatisfied with communication from external programs. Many MS4s (50%, n = 17) are graduating early to participate in COVID-19-related patient care. The top student-requested support activities included access to student-focused educational webinars and studentfocused sessions at upcoming neurosurgical conferences.CONCLUSIONMedical students pursuing careers in neurosurgery have unique academic, career, and personal challenges secondary to the pandemic. These challenges may become opportunities for new initiatives guided by organized neurosurgery and residency programs.

Perception of Neurosurgery Residents and Attendings on Online Webinars During COVID-19 Pandemic and Implications on Future Education

Online education has provided an important tool to continue medical education during the COVID-19 pandemic. Our study aimed to evaluate trainee and attending perceptions of online webinars as an educational tool in neurosurgery. We conducted a cross-sectional survey study. A web-based 19-question survey was distributed to the people who attended the webinar series that was carried out by the Saudi Association of Neurological Surgery from March 29, 2020 to May 31, 2020. Candidates were identified through their registration e-mails. The survey was distributed June 5-8,2020. A total of 156 responses were received (survey response rate: 60%). The overall satisfaction rate among residents and attendings (board-certified neurosurgeons) was similar (>80%). However, only 56.4% of attendings reported they were comfortable with online webinars compared with 81.2% of residents (P value <0.0001). Seventy-five percent of residents found online lectures more useful than traditional in-person lectures compared with 52% of attendings (P value= 0.01). Online educational webinars provide an educational value that can be considered as an adjunct to traditional (in-person) education methods. Among trainees, the satisfaction of neurosurgery webinars was encouraging to consider as an education method. More objective research and progress are required to adopt and refine existing online didactic and neurosurgical teaching tools while creating more engaging future distant learning models.

Feasibility of a community pharmacy antimicrobial stewardship intervention (PAMSI): an innovative approach to improve patients' understanding of their antibiotics.

Community pharmacy staff have an opportunity to play a pivotal role in antimicrobial stewardship (AMS) due to their expertise in medicines and accessibility to patients. To develop and test the feasibility of a pharmacy AMS intervention (PAMSI) to increase community pharmacy staff's capability, opportunity and motivation to check antibiotic appropriateness and provide self-care and adherence advice when dispensing antibiotics. The PAMSI was centred around an Antibiotic Checklist, completed by patients and pharmacy staff, to facilitate personalized advice to the patient, based on their reported knowledge. An educational webinar for staff and patient-facing materials were also developed. Staff and patients completing Antibiotic Checklists were invited to provide feedback via questionnaires. In February 2019, 12 community pharmacies in England trialled the intervention. Forty-three pharmacy staff evaluated the educational webinar and reported increases in their understanding, confidence, commitment and intention to use the tools provided to give adherence and self-care advice. Over 4 weeks, 931 Antibiotic Checklists were completed. Staff reported being more focused on giving advice and able to address patients' knowledge gaps (mainly: likely symptom duration; alcohol and food consumption advice; possible side effects from antibiotics; returning unused antibiotics to the pharmacy), resulting in increased self-reported effective and meaningful conversations. Implementation of a PAMSI is feasible and effectively promotes AMS. Pharmacy staff and commissioners should consider this within their AMS plans. An optional digital format of the Antibiotic Checklist should be explored, for patients who are not collecting their antibiotic prescriptions themselves, and to save printing costs.

SPARC-ing Change—The Maryland Statewide Prevention and Reduction of Clostridioides difficile (SPARC) Collaborative

Background: In 2018, the Maryland Department of Health, in collaboration with the University of Maryland and Johns Hopkins University, created the Statewide Prevention and Reduction of Clostridioides difficile (SPARC) collaborative to reduce C. difficile as specified in Healthy People 2020. Methods: The SPARC collaborative recruited hospitals contributing most cases to statewide C. difficile standardized infection ratio (SIR), according to data reported to the National Healthcare Safety Network (NHSN). SPARC developed intervention bundles around 4 domains: infection prevention, environmental cleaning, and diagnostic and antimicrobial stewardship. Each facility completed a self-assessment followed by an on-site, day-long, peer-to-peer (P2P) evaluation with 8–12 SPARC subject matter experts (SMEs) representing each domain. The SMEs met with hospital executive leadership and then led 4 domain-based group discussions with relevant hospital team leaders. To identify policy and practice gaps, SMEs visited hospital inpatient units for informal interviews with frontline staff. In a closing session, SPARC SMEs, hospital executives, and team leaders reconvened to discuss preliminary findings. This included review of covert observation data (hand hygiene, personal protective equipment compliance, environmental cleaning) obtained by SPARC team 1–2 weeks prior. Final SPARC P2P written recommendations guided development of customized interventions at each hospital. SPARC provided continuous support (follow up phone calls, educational webinars, technical support, didactic training for antimicrobial stewardship pharmacists) to enhance facility-specific implementation. For every quarter, we categorized C. difficile NHSN data for each Maryland hospital into “SPARC” or “non-SPARC” based on participation status. Using negative binomial mixed models, we analyzed difference-in-difference of pre- and postincidence rate ratios (IRRs) for SPARC and non-SPARC hospitals, which allowed estimation of change attributable to SPARC participation independent of other time-varying factors. Results: Overall, 13 of 48 (27%) hospitals in Maryland participated in the intervention. The baseline SIR for all Maryland hospitals was 0.92, and the post-SPARC SIR was 0.67. The SPARC hospitals had a greater reduction in hospital-onset C. difficile incidence; 8.6 and 4.3 events per 10,000 patient days for baseline and most recent quarter, respectively. For non-SPARC hospitals, these hospital-onset C. difficile incidences were 5.1 preintervention and 4.3 postintervention. We found a statistically significant difference-in-difference between SPARC and non-SPARC hospital C. difficile reduction rates (ratio of IRR, 0.63; 95% CI, 0.44−0.89; P = .01). Conclusions: The Maryland SPARC collaborative, a public health-academic partnership, was associated with a 25% reduction in the Maryland C. difficile SIR. Hospitals participating in SPARC demonstrated significantly reduced C. difficile incidences to match that of high-performing hospitals in Maryland.Funding: NoneDisclosure: Aaron Milstone, BD – consulting.

A Statistically Significant Reduction in Hospital Onset Clostridioides difficile Events Using a Learning Collaborative Model

Background: Evidence-based best practices are available for the reduction and prevention of Clostridioides difficile infection (CDI). Often, these practices are not consistently followed in many inpatient care settings. A learning collaborative model resulted in a cost neutral, rapid, sustainable, statistically significant reduction in CDI events across an 88-hospital campus system without requiring hospitals to standardize laboratory methods, increase spending or increase staffing. Methods: In March 2018, a healthcare system with 88 critical access and community hospital campuses across 29 states participated in a harms-reduction learning collaborative. The collaborative format included educational webinars, gap analyses, action plans, and coaching calls facilitated by subject matter experts (SMEs). A collaborative cohort of 11 hospitals (55% rural*) was identified as having significant opportunity for improvement. These facilities participated in 3 monthly coaching calls. The coaching calls supported peer-to-peer sharing of practices and discussions of challenges and successes, and educational materials and presentations were provided by SMEs in pharmacy and infection prevention. Results: Statistically significant changes for the 88-hospital system as a whole: (1) 2018 compared to 2017: P &lt; .001 (statistically significant); (2) 1H2018 compared to 2H2018 (before-and-after collaborative): P = .001; (3) 2019 compared to 2018: P &lt; .001 (statistically significant). Statistically significant changes for the collaborative cohort: (1) 2018 compared to 2017: P &lt; .001; (2) 1H2018 compared to 2H2018 (before-and-after collaborative): P = .002; and (3) 2019 compared to 2018: P &lt; .001. We used 2-proportion, 2-tailed z-test for our analysis. Conclusions: Utilizing a learning collaborative model that included webinars, gap analyses, and interactive coaching calls, a cohort of 11 hospitals was able to induce rapid improvements to adherence of evidence-based practices resulting in a rapid, sustained, statistically significant improvement for both the cohort hospitals and the healthcare system.*2018 American community survey, US Census.Funding: NoneDisclosures: None

A Needs-Assessment Survey of Healthcare Professionals Accountable for Infection Prevention and Control in Hemodialysis Setting

<h3>Background</h3> Little is known about the challenges of infection prevention and control (IPC) program implementation in hemodialysis settings. A survey was conducted to study these challenges and the resources needed to overcome them. <h3>Methods</h3> Outpatient hemodialysis centers (OHC) and hospitals with hemodialysis units were invited to send healthcare professionals (HCPs) accountable for IPC to attend an IPC training program. All attendees were asked to complete an anonymous 11-question IPC program needs-assessment survey during the training. Qualitative and descriptive analyses were used to study the results. <h3>Results</h3> Out of 32 HCPs who responded to the survey, a majority (n=24, 75%) reported working in OHC. Half of the respondents (50%) identified their primary job roles as RN/LPN involved in patient care, 10 (31.3%) as nurse managers/other leadership positions and only 7 (21.9%) as infection preventionists. Many (68.8%) reported >10-year experience. They identified issues related to hand hygiene (66.7%), bloodstream infection (BSI) prevention (38.9%), and cleaning and disinfection (38.9%) as top 3 IPC concerns at their facilities. The top 3 barriers to implementing IPC practices were: high volume of patients/ time constraints (72.4%), lack of staff understanding/motivation/compliance (69%); and lack of patient engagement (34.5%). Educational webinars (68.8%), conferences (68.8%), and having IPC experts available via phone or video-conferencing (53.1%) were reported as potentially helpful in developing and improving IPC programs. Top educational needs identified were hand hygiene (40.6%), preventing BSI (25%), and cleaning and disinfection (21.9%). The preferred methods for receiving educational updates on IPC-related topics were e-mails (87.5%), conferences (78.1%), and webinars (43.8%). <h3>Conclusions</h3> HCPs accountable for IPC in hemodialysis settings usually have other primary job roles. Several barriers were reported in program implementation, which will require significant time commitment to mitigate. Professional organizations and other stakeholders should advocate for protected IPC time for these HCPs, and support IPC program improvement efforts.

X-Rite Offers Color Theory Course and Educational Webinar Series

X-Rite Offers Color Theory Course and Educational Webinar Series

National Institutes of Health StrokeNet During the Time of COVID-19 and Beyond.

National Institutes of Health StrokeNet During the Time of COVID-19 and Beyond.

Twelve tips to present an effective webinar

Educators are increasingly invited to present via webinars rather than in-person. Webinars offer multiple advantages over in-person presentations, including the ability to speak to participants across a wide geographic area and the possibility of reduced financial and time costs for the webinar organizer, speakers, and participants. To capitalize on these advantages, educators need strategies to present effectively using this medium. Here we provide 12 tips for effective webinar presentations based upon best practices identified in the literature and the authors’ experience organizing educational webinars. The 12 tips are: (1) Learn webinar logistics, (2) Conduct a needs assessment, (3) Write specific learning objectives, (4) Attend a webinar, (5) Create clear, engaging slides, (6) Develop interactive learning activities, (7) Familiarize yourself with the technology, (8) Practice your presentation, (9) Be organized, prepared, and energetic, (10) Evaluate participant learning, (11) Learn from feedback, and (12) Share your experience with the organizer. We hope these tips help presenters improve the quality and effectiveness of their webinars.

Reducing Primary Cesarean Births via a Multidisciplinary Learning Collaborative Using Targeted Bundles [32P

INTRODUCTION: The American College of Nurse Midwives Healthy Birth Initiative: Reducing Primary Cesareans is now entering its third year of operation. The initiative focuses on reduction of nulliparous, term, singleton vertex (NTSV) cesareans by engaging multidisciplinary teams from participating hospitals across the United States (U.S.) in a quality collaborative. The multidisciplinary teams participate in quality focused monthly educational webinars augmented by coaching sessions, that include faculty and peer coaches. Each hospital team initiates quality improvement efforts using one of three change bundles; labor progress, comfort and coping or intermittent auscultation which align with the National AIM Reducing Cesareans bundle. METHODS: Teams collect patient level data, and submit aggregated data on key variables to a central registry which produces individual hospital outcomes and process measures and benchmarks for the collaborative. RESULTS: Midwives, obstetricians, nurses and administrators from 25 hospitals around the US have engaged in the project. The hospitals represent public, community and academic medical centers in both urban and rural settings. The majority of the hospitals receive over 40% of their payments from public insurance, with at least one participant having 95% of its payments from public insurance. The decrease from baseline for participating hospitals overall was 7% with a range of 0 to 18% NTSV cesarean rate with no change in the balancing measures. CONCLUSION: A learning collaborative with data registry support for key outcomes and process measures is an effective way to promote reduction of NTSV cesareans and engage all maternity care team members in quality improvement.

Generalist Palliative Care in the California Safety Net: A Structured Assessment to Design Interventions for a Range of Care Settings

To provide high quality care to all patients who have serious illness, health-care systems must develop effective generalist palliative care strategies. To identify palliative care quality gaps within a range of settings in the California safety net and to develop theory-based interventions to address them. Structured assessment using the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines and a Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation intervention planning model-based worksheet, which integrates behavior theories to identify factors that predispose, enable, and reinforce clinicians to perform recommended behaviors. Adviser pairs-one from palliative care and one from a partner service line-from 10 California public health-care systems conducted assessments at their sites. A steering committee provided educational webinars, best practices, and assessment tools. Adviser pairs interviewed at least 6 partner service line stakeholders to identify palliative care quality gaps, behaviors clinicians should perform to close gaps, and factors that predispose, enable, and reinforce those behaviors. Partner service lines were primary care (n = 4), surgery (n = 3), emergency department (n = 2), and radiation oncology (n = 1). Selected gaps were advance care planning and goals of care communication (n = 6), identifying patients with serious illness (n = 3), and pain management (n = 1). All sites designed multiple interventions to address gaps, based on factors that predispose, enable, and reinforce a target audience to perform a target behavior. Advisers reported that the program strengthened relationships between palliative care and the partner service line. This structured assessment helped busy clinicians develop theory-based generalist palliative care interventions.

WEBINAR AS AN INTERACTIVE NETWORK TRAINING LESSON (ON THE EXAMPLE OF THE DISCIPLINE “SPECIALIZATION: INTERNET, TELEVISION”)

The specifics of the educational process in the conditions of distance studying, the specifics of the use of tools, and services that will help to create quality educational content are considered. Emphasis is placed on the autonomy of choice of methods, tools, platforms, interactive technologies for the implementation of a full-fledged educational process and analyzes the possibilities of their use in Ternopil National Pedagogical University named after Volodymyr Hnatyuk. The choice of presentation of individual educational and research tasks in the discipline "Specialization: Internet, Television" of students majoring in "Journalism" in the form of webinars is substantiated. Scientific approaches to understanding the concept of "webinar" are presented. The basic rules of preparation and holding of the webinar are defined. The focus is on the technical features of webinars. Types of webinars are considered: educational webinar, information webinar, webinar-training, consulting webinar (webinar-support), consulting webinar (webinar-support). The activity of participants in the educational process in the online environment is divided into two groups: asynchronous and synchronous. Peculiarities of conducting the author's webinars by fourth-year students of the Department of Journalism of TNPU are determined. The topics of INDZ, the content of reports, features of creation of presentations, and the used technical programs are characterized, the positive and negative parties in carrying out and the organization of webinars by each speaker are allocated. The importance of interactivity between participants of the online lesson is noted. The focus is on the advice and recommendations of higher education students on the use of such forms of education in the educational process. It is stated that in the process of learning with the use of distance technologies the center of gravity moves from the teacher to the student. The role of the teacher as a facilitator who provides support to students helps to solve methodological and methodological problems is outlined. It is determined that learning with the use of distance technologies opens students access to non-traditional sources of information, increases the efficiency of independent work, provides new opportunities for creativity, consolidation of professional skills. Emphasis is placed on the implementation of new forms and methods of teaching to ensure active interaction between participants in the educational process

Abstract P1-20-23: Eliminating postoperative opioids for outpatient breast surgery in a large integrated healthcare system

Abstract Introduction: The epidemic of opioid addiction and overdose has become a public health emergency in the United States. Opioids prescribed for postoperative pain management have contributed significantly to this epidemic. At the Permanente Medical Group (TPMG), reducing postoperative opioid prescriptions has become a priority. A pilot study in 2016 led by TPMG breast surgeons showed that pain after lumpectomy can be managed effectively without opioids. The results of this study were disseminated to all TPMG breast surgeons via a February 2017 webinar. In November 2018, TPMG implemented an outpatient Enhanced Recovery After Surgery (ERAS) initiative that included reducing postoperative opioid prescriptions. The objective of our study was to evaluate self-reported changes in TPMG breast surgeon opioid-prescribing practices after these interventions. Methods: An online survey was created to assess perioperative and postoperative practices. This survey was distributed to TPMG breast surgeons before the 2017 educational webinar about non-opioid regimens, and again in June 2019, more than 6 months after the implementation of the outpatient ERAS initiative. Questions included how surgeons manage patient expectations during the initial consultation, surgeons’ preoperative pain medication regimens, intraoperative pain management including nerve blocks, local anesthetics, ketorolac use, and postoperative pain management. We used a chi-square test to compare differences between the two surveys. Results: We received 13 responses from a group of over 100 TPMG breast surgeons in 2017 and 29 responses from 59 surgeons in 2019. Overall, self-reported non-opioid regimens increased between 2017 and 2019, with only 23% of surgeons using these regimens for lumpectomy in 2017 and 79% in 2019 (p&amp;lt;0.001). TPMG Self-Reported Opioid Prescribing Patterns After Lumpectomy, 2017 vs 2019# Opioid Tablets Prescribed After Lumpectomy% of Surgeons Prescribingp-value2017201902379&amp;lt;0.0011 to 10870.9311 to 201570.3921 to 302330.045&amp;gt;30150NAUnspecified153NA Notably, non-opioid regimens were also reported by 66% of surgeons for lumpectomy with sentinel lymph node biopsy (SLNbx), 41% for mastectomy without reconstruction, and 14% for mastectomy with implant-based reconstruction. 2019 Self-Reported Opioid Prescribing Patterns After Different Types of Breast Operations% of Surgeons Prescribing# Opioid Tablets Prescribed, by Type of OperationLumpectomyLumpectomy With Sentinel Lymph Node BiopsyMastectomy Without ReconstructionMastectomy With Reconstruction0796641141 to 1071021311 to 20717282821-3033710&amp;gt;310007Unspecified3333Per plastics00034 Conclusion: Self-reported postoperative opioid prescribing practices for breast surgery have changed significantly after implementation of TPMG initiatives, with the majority of TPMG breast surgeons prescribing no opioids after lumpectomy with or without SLNbx, and many prescribing no opioids after mastectomy. In future work, we aim to validate the self-reported data using pharmacy prescription data from 2017-2019. We also plan to identify perioperative factors that are predictive of successful non-opioid postoperative pain management such as the use of nerve blocks, non-steroidal anti-inflammatory drugs (NSAIDs), gabapentin, and acetaminophen. Citation Format: Avani R Patel, Gillian E Kuehner, Sharon B. Chang. Eliminating postoperative opioids for outpatient breast surgery in a large integrated healthcare system [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-23.

Knowledge and awareness on novel coronavirus spread among dental fraternities in Visakhapatnam, India: A questionnaire-based survey.

INTRODUCTION:The pandemic caused by novel coronavirus (severe acute respiratory syndrome coronavirus 2) in Wuhan, China, in December 2019 is a highly contagious disease. The World Health Organization has declared the outbreak of coronavirus diseases (COVID-19) as a global public health emergency. Currently, the research on novel coronavirus is still in the primary stage. The aim of this study is to assess the knowledge and awareness on COVID-19 disease and related infection control measures among the dental fraternity in Visakhapatnam – the smart city.METHODS:A total of 808 dentists from the Visakhapatnam region completed a questionnaire-based survey on the knowledge, awareness, and infection control measures related to COVID-19 infection. The questionnaire was tailored from the guidance and information for health-care workers issued by the US Centers for Disease Control and Prevention. Suitable sampling method was used for the collection of data and the distribution of responses was presented as percentages. Explanatory statistics were performed for all groups and subgroups based on the percentage of correct responses. Individual pair-wise comparisons were done using the Chi-square test for the percentage of correct responses.RESULTS:A total of 825 participated in the survey, of which 808 dentists completely answered the survey, and the response rate was 98%. Among the respondents, males and females are 46.8% and 53.2%, respectively. There was a statistically significant difference for all the questions solicited, among age groups (P = 0.001, 0.001) and occupation (P = 0.001, 0.001, 0.004). Private practitioners seem to more awareness compared to teaching faculty, undergraduates, and postgraduates, as they have answered correctly (>70%) for almost all the questions.CONCLUSION:The inputs from the survey help us throw some light and fill up lacunae where required. There is a strong need to implement periodic educational interventions and training programs on infection control practices for COVID-19 among dentists in particular. The information from this survey helps us to make necessary changes in implementing periodic educational webinars and stress on areas where necessary, which is important for the dental fraternity for protecting themselves and shielding our society from COVID-19.

Impact of distance learning during COVID-19 on the anxiety of college students of Almaarefa University

Background: On 8 March, 2020, the Saudi Ministry of Education announced the closure of schools and universities around the Kingdom to control the spread of the coronavirus disease 2019 (COVID-19) as preventive and precautionary measures. On 18 March, 2020, Almaarefa University started the distance learning method for all students, including clinical medical students. This study aimed to assess the anxiety of college students with regard to the distance learning method in Almaarefa University during the COVID-19 pandemic. Methods: This study is a descriptive cross-sectional study. We distributed a closed-ended questionnaire to 149 students of Almaarefa University. The assessment of anxiety was carried out using the Generalized Anxiety Disorder 7-item (GAD-7) Scale. Results: One hundred and forty-nine students responded to an online questionnaire. The anxiety level, using GAD-7 Scale, was found to be moderate in 36.2%, mild in 32.2%, severe in 22.8%, and normal in 8.7%. Clinical phase students had the highest level of anxiety than basic science students and interns. The adaptive coping strategies used by students during COVID-19 were watching shows and movies (70.7%), sports and exercise (49.3%), cooking (48%), drawing (21.3%), developing new skills (38%), and attending educational webinars (36%). Conclusion: The anxiety levels of the 149 students of Almaarefa University were assessed via the GAD-7 Scale, which found that the highest level was the moderate level, followed by mild, severe, and normal levels. The adaptive coping strategies used by students during COVID-19 were mostly watching shows and movies, sports and exercise, and cooking. Future studies with a bigger sample size assessing the depression score are recommended.

Promoting the use of self-management in patients with spine pain managed by chiropractors and chiropractic interns: barriers and design of a theory-based knowledge translation intervention

BackgroundThe literature supports the effectiveness of self-management support (SMS) to improve health outcomes of patients with chronic spine pain. However, patient engagement in SMS programs is suboptimal. The objectives of this study were to: 1) assess participation in self-care (i.e. activation) among patients with spine pain, 2) identify patients’ barriers and enablers to using SMS, and 3) map behaviour change techniques (BCTs) to key barriers to inform the design of a knowledge translation (KT) intervention aimed to increase the use of SMS.MethodsIn summer 2016, we invited 250 patients with spine pain seeking care at the Canadian Memorial Chiropractic College in Ontario, Canada to complete the Patient Activation Measure (PAM) survey to assess the level of participation in self-care. We subsequently conducted individual interviews, in summer 2017, based on the Theoretical Domains Framework (TDF) in a subset of patients to identify potential challenges to using SMS. The interview guide included 20 open-ended questions and accompanying probes. Findings were deductively analysed guided by the TDF. A panel of 7 experts mapped key barriers to BCTs, designed a KT intervention, and selected the modes of delivery.ResultsTwo hundred and twenty-three patients completed the PAM. Approximately 24% of respondents were not actively involved in their care. Interview findings from 13 spine pain patients suggested that the potential barriers to using SMS corresponded to four TDF domains: Environmental Context and Resources; Emotion; Memory, Attention & Decision-Making; and Behavioural Regulation. The proposed theory-based KT intervention includes paper-based educational materials, webinars and videos, summarising and demonstrating the therapeutic recommendations including exercises and other lifestyle changes. In addition, the KT intervention includes Brief Action Planning, a SMS strategy based on motivational interviewing, along with a SMART plan and reminders.ConclusionsAlmost one quarter of study participants were not actively engaged in their spine care. Key barriers likely to influence uptake of SMS among patients were identified and used to inform the design of a theory-based KT intervention to increase their participation level. The proposed multi-component KT intervention may be an effective strategy to optimize the quality of spine pain care and improve patients’ health-outcomes.

UTI Management: It’s All in the Culture

UTI Management: It’s All in the Culture

Abstract 102: The Association of Patient Navigator Program Features and Hospital Strategies with Processes and Outcome Metrics in Acute Myocardial Infarction and Heart Failure

Background: Association between hospital site-led structure, system and process changes, number of site-initiated technologies, the perceived value of program-directed services aimed at promoting quality improvement and process and outcome metrics achieved are unknown after a 2-year acute myocardial infarction and heart failure (AMI-HF) quality program. Methods: After participation in the Patient Navigator Program, hospitals (n=35) completed surveys on the implementation of structure, system and process changes, number of site-initiated technologies, and the perceived value of program directed educational calls and webinars, quality-focused site visits, use of a list-serv that facilitated site coordinator communication and data reports. Univariate analyses assessed the associations of each factor with 30-day unadjusted AMI-HF rehospitalization and in-hospital risk adjusted AMI death and 14 AMI-HF process metrics. Results: When hospital structure, system and process changes were high, sites were more likely to improve 30-day HF re-hospitalization, p =0.014. The number of site-initiated technologies and the value of using a list-serv to communicate with other program sites were not associated with outcome or process metric changes from baseline to 2 years. Sites that rated program-led educational calls and webinars as a high value were more likely to improve AMI-HF self-care education documentation, p =0.049. Sites that rated quality-related site visits as high value were more likely to improve left ventricular systolic dysfunction evaluation, p =0.035 and 30-day unadjusted AMI-HF rehospitalization rates ( p =0.021 and 0.007, respectively). Sites who rated the value of data reports more highly were less likely to improve 30-day unadjusted AMI rehospitalization, p =0.006 and more likely to improve 30-day HF rehospitalization, p =0.033. Conclusion: Hospital-initiated structure-system-process changes and Patient Navigator Program-directed services that were perceived as high value, especially site visits and data reports, were more likely to be associated with improved 30-day HF re-hospitalization rates and some process improvements compared to baseline.

BPI19-017: Clinical Pathway Toward Quality and Efficient Care of Breast Cancer in Women Under 50

Background: Nationally, gaps exist in the timely and appropriate care of young women with breast cancer. Few women receive genetic and fertility counseling, while contralateral prophylactic mastectomy rates rise. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer direct breast cancer treatment and symptom management, but care of young newly diagnosed women requires providers to combine elements of several guidelines and consider an appropriate order of assessments and treatments utilizing multidisciplinary consultation. In Nebraska, fewer than 300 women under age 50 are diagnosed with breast cancer annually. One-third of these women live rurally, miles from the NCCN Member Institution. Thus, rural physicians encounter these patients infrequently and may lack local specialists with whom to consult and refer, thus challenging the provision of the highest quality care. Purpose: To improve the efficacy and efficiency with which rural oncology care providers recognize and address physical, psychosocial, and decision-making needs of young women with breast cancer through development and delivery of education, multidisciplinary consultation, and clinical pathways. Methods: Baseline, 2-year electronic medical record data on surgical, medical, and supportive oncology practice patterns for women with breast cancer under age 50 were collected from the University of Nebraska Medical Center and collaborating rural cancer centers. Records were hand searched for fertility and genetic data. The PROMIS Global Health Survey and Sexual Function Profile, the Brief Subjective Decision Quality Measure, and a project-specific care satisfaction survey were mailed to these patients. Data were entered into SPSS and descriptive statistics used to identify the project’s starting point. Results: To date, clinics (rural and urban) identified a 2-year total of 199 women with breast cancer, ages 21 to 49 years. Cancers were stage 0 (n=21), 1 (n=50), 2 (n=40), 3 (n=19), 4 (n=3), and unavailable (n=66). Eight clinical pathways based on ER, PR, and HER2 status were developed to guide treatment, considerations, evidence-based neoadjuvant and adjuvant therapy, and survivorship care. Pathways, with associated educational webinars and links to NCCN Guidelines, are accessible to providers and patients on the project-derived Pathway to Cure website. Website use and webinar views following program implementation will be reported as will comparison of baseline practice patterns with data at the first 3-month analysis.

The main functions of the moderator as an addressee-repeater in the English educational webinars

The main functions of the moderator as an addressee-repeater in the English educational webinars