Group Education Sessions Research Articles

Decreasing Vancomycin Utilization in the NICU by Optimizing Treatment Decisions in Suspected Late Onset Sepsis

BackgroundLate Onset Sepsis (LOS) is frequently suspected in NICU patients in the setting of nonspecific clinical symptoms. Based on institutional antibiogram data, empiric treatment of LOS in our NICU is vancomycin and amikacin with a plan to deescalate or discontinue based on culture results and symptomatology. Baseline data in our NICU revealed vancomycin overuse where vancomycin was continued past 48 hours of culture negativity, after Gram-negative urinary tract infection (UTI) was diagnosed, or for urine cultures reported with multiple organisms or < 10,000 CFU/mL. Our objective was to eliminate inappropriately prolonged empiric use of vancomycin for suspected LOS or UTI.MethodsTo institute timely discontinuation of vancomycin when cultures are negative at 48 hours, group education sessions were conducted for physicians, nurse practitioners, and nurses that included evidence-based criteria for diagnosing “true UTI”. Vancomycin indication for use and duration were added to the rounding script for the night shift.ResultsAt baseline over a 6 month period, extra vancomycin doses were administered in 39% of LOS courses, typically because late-night doses (past 48 hours culture negativity) preceded the decision to discontinue empiric therapy on morning rounds. After intervention, during a 6 month period, extra vancomycin doses were reduced to 3%. A baseline anonymous survey revealed that some prescribers advocated continuing vancomycin in the setting of urine cultures with < 10,000 CFU/mL (18%) or for Gram-negative UTI until sensitivities are reported (24%). After intervention, these were both reduced to 7%. At baseline over a 9 month review of UTI data, the use of vancomycin past 48 hours occurred in 86% of patients with negative or contaminated urine cultures (< 10,000 CFU/mL or > 1 organism) and in 48% of patients with Gram-negative UTI. In the post intervention phase, this occurred in 0% and 50% (N = 2) of cases respectively.ConclusionA high incidence of overtreatment with vancomycin was found to be related to inconsistent system processes and knowledge deficiencies. Through improved documentation, staff education and creation of evidence based guidelines for the diagnosis and management of UTI, we successfully minimized vancomycin overutilization for suspected LOS and UTI in the NICU.Disclosures All authors: No reported disclosures.

Time to question diabetes self-management support for Arabic-speaking migrants: exploring a new model of care.

The objective of this study was to explore a new model for diabetes self-management support in Arabic-speaking migrants. Two qualitative methods were used: face-to-face semi-structured individual interviews and focus groups. Interviews were audio-taped, transcribed verbatim and coded thematically. Arabic-speaking migrants with Type 2 diabetes were recruited from several primary, secondary and tertiary healthcare settings in metropolitan Melbourne, Australia. These settings were purposefully selected to obtain a diverse group of participants. Data collection continued until saturation was reached. This is the first study that involved members of Arabic-speaking communities in Australia in a formal process of consumer and public involvement to inform research design and recruitment in order to provide evidence for a new model of diabetes self-management for Arabic-speaking migrants. No self-management support was offered to Arabic-speaking migrants beyond the initial diagnosis period. Significant knowledge gaps and skills deficits in all self-management domains were evident. The provision of tailored self-management support was considered crucial. When asked about preferred structure and delivery modalities, a strong preference was reported for face-to-face storytelling interactions over telephone- or internet-based interventions. Gender-specific group education and self-management support sessions delivered by Arabic-speaking diabetes health professionals, lay peers or social workers trained in diabetes self-management were highly regarded. A patient and public involvement approach allows genuine engagement with Arabic-speaking migrants with diabetes. There is urgent need for a new model for self-management support among Arabic-speaking migrants. Findings yielded new recommendations for diabetes health professionals working with these migrant communities to support behaviour change.

A social cognitive theory-based programme for eating patterns and sedentary activity among overweight adolescents in Makassar, South Sulawesi : a cluster randomised controlled trial.

Social cognitive theory provides the opportunity for program development to enhance healthy personal behvioural characteristics. We devised study to employ social cognitive theory to reduce snacking habits and sedentary activity among overweight adolescents . Eight junior high schools in Makassar city were randomly assigned as intervention and control schools. A total of 238 overweight students aged 11-15 years (BMI z-score >=1 SD, according to a 2007 report from the WHO) were recruited. Adolescents from the intervention schools attended 12 weekly 75-min nutrition education group sessions, which focused on behavioural modification assisted by trained facilitators; furthermore, their parents received weekly nutrition education leaflets. Adolescents from the control schools, but not their parents, received leaflets on evidenced-based nutrition information. The BMI z-scores, waist circumference, snacking habits, sedentary activity, and the adolescents' self-efficacy data were assessed prior to and after 3 months of intervention. The outcomes were analysed on an intent-to-treat basis. Compared with the control group, the intervention group showed a higher reduction in BMI z-scores (-0.08; p<0.05) and waist circumference (-1.5; p<0.05) at 3 months. Significant between-group differences were also observed for decreased snacking habits, but not for sedentary activity. Additionally, the programme improved self-efficacy for reducing these behaviours. Mean compliance and satisfaction with the programme were 95% and 92%, respectively. These high reduction rates suggest that the programme is promising and may address the problem of overweightness in adolescents. Additional studies are required to develop the programme in community settings.

Understanding and supporting women with polycystic ovary syndrome: a qualitative study in an ethnically diverse UK sample

Objective Polycystic ovary syndrome (PCOS) is a lifelong condition. Its symptoms have been linked with psychological consequences, but less attention has been given to the daily implications of living with PCOS. We aimed to explore women's experiences living with PCOS, and the potential acceptability of group education sessions for this target group. Methods Women with PCOS were recruited from an ethnically diverse UK community. Twelve semi-structured interviews were conducted. Analysis was underpinned by the constant comparative approach and involved the identification and exploration of key themes. Results Participants reported a range of symptoms linked with PCOS, including problems relating to menstruation and weight difficulties. Hirsutism was reported as the most distressing symptom. Emergent themes included perceptions about symptoms and delays in receiving a diagnosis; psychological distress; practical implications of living with the condition; coping with PCOS and perceived support needs. Some findings were specific to cultural backgrounds. Participants were supportive of the idea of group education for women with PCOS and suggested a need to provide education within the community and health care providers. Discussion Women with PCOS experience high psychological distress and difficulties with coping with their condition. Suggested strategies to reduce the negative psychological impact include education at various levels.

Educational interventions to empower nursing home residents: a systematic literature review.

Purpose of the studyHealth education is essential to improve health care behavior and self-management. However, educating frail, older nursing home residents about their health is challenging. Focusing on empowerment may be the key to educating nursing home residents effectively. This paper examines educational interventions that can be used to empower nursing home residents.MethodsA systematic literature search was performed of the databases PubMed, CINAHL, CENTRAL, PsycINFO, and Embase, screening for clinical trials that dealt with resident education and outcomes in terms of their ability to empower residents. An additional, manual search of the reference lists and searches with SIGLE and Google Scholar were conducted to identify gray literature. Two authors independently appraised the quality of the studies found and assigned levels to the evidence reported. The results of the studies were grouped according to their main empowering outcomes and described narratively.ResultsOut of 427 identified articles, ten intervention studies that addressed the research question were identified. The main educational interventions used were group education sessions, motivational and encouragement strategies, goal setting with residents, and the development of plans to meet defined goals. Significant effects on self-efficacy and self-care behavior were reported as a result of the interventions, which included group education and individual counseling based on resident needs and preferences. In addition, self-care behavior was observed to significantly increase in response to function-focused care and reasoning exercises. Perceptions and expectations were not improved by using educational interventions with older nursing home residents.ConclusionIndividually tailored, interactive, continuously applied, and structured educational strategies, including motivational and encouraging techniques, are promising interventions that can help nursing home residents become more empowered. Empowering strategies used by nurses can support residents in their growth and facilitate their self-determination. Further research on the empowerment of residents using empowerment scales is needed.

Rehabilitation and auto-exercises protocol in patients with chronic lateral epicondylitis: 6 months follow-up

The chronic lateral epicondylitis is a common pathology with an economic impact. Actually, many costly therapies are prescribed without evidence of their effectiveness. Physical therapies seem to be neglected. However, they can correct actions at risk and involve the patient in his rehabilitation. This study evaluated the effectiveness of a standardized 2 month rehabilitation program composed of: an outpatient group education session, 18 liberal physical therapy sessions with correction of the posture of the trunk and shoulder, eccentric strengthening of the supinator muscles and the wrist extensor muscles, stretching, and some self daily exercises (transverse friction massage and stretching) according to Pernot-Comtet protocol. Patients were evaluated at 3 and 6 months follow-up. Twenty-three patients aged from 18 to 65 years old, who had failed an initial treatment, without physiotherapy recently, were enrolled. In total, 71% of patients reported being restored by this protocol. At 3 months, the mean VAS decreased 6.2 ± 1.84 to 4.26 ± 2.68 and was maintained at 6 months (4 ± 2.84), P = 0.0005. The Pain Free Grip Test evaluated on Jamar dynamometer had increased significantly at 3 months: 26.12 kg ± 12.3 versus 21.29 kg ± 8.94 initially ( P = 0.027). This effect was maintained at 6 months (24.3 kg ± 10.14, P = 0.17). The significant improvement of the score “Patient Rated Tennis Elbow Evaluation Functional Capacity” reflects a functional gain at 3 months (26.7 ± 10.5 initially versus 19.32 ± 14.46, P = 0.0035), maintained at 6 months (20.21 ± 14.25, P = 0.017). Half of the patients initially on sick leave restarted working at 6 months. The rate of active population has about tripled from 25% to 70%. An initial Pain Free Grip Test superior to 21 kg predicted to succeed in this protocol (sensibility 73%, sensitivity 83%). These results argue for efficiency of an appropriate physical therapy, which had no side effect. However, this pilot study should be confirmed by methodology with a higher level of evidence.

Piloting an Integrated, Interprofessional Programme for People Living with Type II Diabetes: Outcomes and Experiences

This paper reports quantitative and descriptive qualitative findings from a mixed-methods study exploring and evaluating the outcomes and experiences of clients, staff and students piloting an integrated interprofessional programme for community members with type II diabetes. The one-day per week, eight-week programme included interprofessional appointments, group education sessions and case conferences led by students from exercise and nutrition, health promotion, nursing, occupational therapy, oral health, physiotherapy, podiatry and counselling psychology. Participants shared their experiences in individual interviews or focus groups. Client outcomes were evaluated using basic clinical indicators and the Canadian Occupational Performance Measure (COPM) that assesses client goal satisfaction and performance. While only small expected changes to clinical indicators were noted, there were moderate increases in mean COPM scores for performance and satisfaction. Descriptive qualitative analysis identified enjoyment from working as a team, better client outcomes and new knowledge or learning as the most frequent experiences. Findings suggested increased self-management empowerment for clients and their support people, while students and staff experienced both learning from, appreciating and educating each other about their own and others’ roles, and better collaboration. The success of the pilot programme has led to its continuation; however, timing and resourcing challenges noted by participants could threaten sustainability and accommodation of more clients and students.

Efficacy of a self-management plan in exacerbations for patients with advanced COPD.

BackgroundSelf-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD.MethodsMulticenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E) department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD. The intervention consisted of a group education session on the main characteristics of the disease, an individual training session on inhalation techniques, at the start and during the 3rd month, and a written action plan containing instructions for physical activity and treatment for stable phases and exacerbations. We determined the combined number of COPD-related hospitalizations and emergency visits per patient per year. Secondary endpoints were number of patients with visits to A&E and the number of patients hospitalized because of exacerbations, use of antibiotics and corticosteroids, length of hospital stay, and all-cause mortality.ResultsAfter 1 year, the rate of COPD exacerbations with visits to A&E or hospitalization had decreased from 1.37 to 0.89 (P=0.04) and the number of exacerbations dropped from 52 to 42 in the group of patients who received the intervention. The numbers of patients hospitalized, at 19 (40.4%) versus 20 (52.6%) (P=0.26), and those who went to A&E, at 9 (19.1%) versus 14 (36.8%) (P=0.06), due to exacerbation of COPD were also lower in this group. Intake of antibiotics was higher in the intervention group, whereas use of glucocorticoids was slightly lower, though there were no significant differences (P=0.30). There were also no differences between groups in the length of hospital stay (P=0.154) or overall mortality (P=0.191).ConclusionThe implementation of a self-management program for patients with advanced COPD reduced exacerbations that required hospital care.

Input Subject Diversity Enhances Early Grammatical Growth: Evidence from a Parent-Implemented Intervention

ABSTRACTPurpose: The current study used an intervention design to test the hypothesis that parent input sentences with diverse lexical noun phrase (NP) subjects would accelerate growth in children’s sentence diversity.Method: Child growth in third person sentence diversity was modeled from 21–30 months (n = 38) in conversational language samples obtained at 21, 24, 27, and 30 months. Treatment parents (n = 19) received instruction on strategies designed to increase lexical NP subjects (e.g., The baby is sleeping.). Instruction consisted of one group education session and two individual coaching sessions which took place when children were approximately 22–23 months of age.Results: Treatment substantially increased parents’ lexical NP subject tokens and types (ηp2 ≥ .45) compared to controls. Children’s number of different words was a significant predictor of sentence diversity in the analyses of group treatment effects and individual input effects. Treatment condition was not a significant predictor of treatment effects on children’s sentence diversity, but parents’ lexical NP subject types was a significant predictor of children’s sentence diversity growth, even after controlling for children’s number of different words over time.Conclusions: These findings establish a link between subject diversity in parent input and children’s early grammatical growth, and the feasibility of using relatively simple strategies to alter this specific grammatical property of parent language input.

The FAV-S Pilot Study.

The 2012 FAV-S pilot study was developed as a dietary intervention program for low-income Somali mothers grounded in the health belief model. The intervention was geared toward increasing fruit and vegetable intake among participants' children. The purpose of this analysis was to determine the impact of the FAV-S program on participants' (1) self-efficacy in ability to serve more fruits and vegetables, (2) knowledge and beliefs about healthy eating, and (3) perceived barriers to accessing healthy foods. Furthermore, this study assessed change in fruit and vegetable intake among participants and their children. The intervention consisted of two small group education sessions addressing nutrition, serving size, and label reading; a cooking session incorporating fruits and vegetables into traditional Somali dishes; and a grocery store session demonstrating best purchasing practices. Self-efficacy, knowledge and beliefs, and perceived barriers were assessed via surveys administered verbally in Somali pre- and postintervention. Paired t tests were used to compare pre- and postintervention survey responses. Twenty-five women participated in the pilot study; mean age was 43.6 years ( SD = 12.4). Self-efficacy significantly increased among participants postintervention ( p = .01), though there were no significant changes in knowledge and beliefs or perceived barriers. Following intervention, daily servings of fruits and vegetables significantly increased among both women and children ( p = .01 to p < .01). Findings suggest that a multistage, culturally tailored, approach is effective at increasing self-efficacy and fruit and vegetable intake in the Somali community. Continued and expanded research is needed to further develop culturally focused dietary interventions.

Involvement of informal caregivers in supporting patients with COPD: a review of intervention studies.

Caregivers of individuals with COPD have a key role in maintaining patient adherence and optimizing patient function. However, no systematic review has examined how the caregiver role has been operationalized in interventions to improve outcomes of individuals with COPD or the quality or effectiveness of these interventions. The aims of this review were to 1) determine whether caregivers have been involved as part of interventions to improve outcomes of individuals with COPD; 2) determine the risk of bias within included intervention studies; and 3) examine the effectiveness of interventions that have involved caregivers in improving outcomes of individuals with COPD. The electronic databases of Medline, Embase, PsycINFO, and Cochrane Library were searched from January 2000 to November 2015. Experimental studies testing interventions that involved a caregiver to improve COPD patient outcomes were eligible. Nine studies involving caregivers met inclusion criteria. No studies reported any intervention components targeted solely at caregivers, with most instead including caregivers in dyadic or group education sessions about COPD delivered by health care professionals. The risk of bias identified in included studies was mixed. Seven of the nine studies were effective in improving a broad range of outcomes. These findings highlight that there is an urgent need for methodologically rigorous interventions to examine the effectiveness of strategies to assist caregivers to provide direct care, encourage adherence to health care provider recommendations, act as a health care advocate, and provide emotional and psychosocial support to individuals with COPD.

Effectiveness of Shared Medical Appointments Versus Traditional Clinic Visits for Adolescents With Type 1 Diabetes.

Shared medical appointments began in the United States in 1996 to advance quality of care and enhance patients' ability to self-manage. Group visits gather patients with the same diagnosis for individual examinations followed by group education sessions taught by the provider. This leads to the opportunity to learn from the experiences of others. The Cleveland Clinic Department of Pediatric Endocrinology offers a shared medical appointment group for pediatric patients with type 1 diabetes called the ESCALAIT clinic (Enrichment Services and Care for Adolescents Living with Autoimmune Insulin Dependent Type 1 Diabetes). The objective of this study was to compare the effectiveness of traditional clinic visits with shared medical appointments for adolescents with type 1 diabetes in terms of hemoglobin A1c (HbA1c) improvement. Eighty ESCALAIT patients, aged 11 to 19 years were compared with 516 clinic controls of the same age. Visits were approximately 3 months apart for both patient groups. Changes in HbA1c between groups were calculated from the first to fourth visits. There was a statistically significant difference between the ESCALAIT clinic patients and the control patients. Our results revealed that the group visit patients had less improvement in HbA1c values at the last visit approximately 1 year later, but we would argue that the difference is not clinically significant. However, there were many benefits to shared medical appointment visits including increased access to care as well as peer support. Shared medical appointments are therefore a valid alternative to traditional clinic visits in this patient population.

Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey.

This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was conducted by repeated point prevalence survey (PPS) to audit the quality of documentation on antibiotic therapy in the medical records before and after a combined intervention strategy (implementation of guidelines, distribution of educational materials, educational outreach visits, group educational interactive sessions) from the antimicrobial stewardship team (AST) in the academic teaching hospital (CHU) of Liège, Belgium. The primary outcome measure was the documentation rate on three quality indicators in the computerized medical records: (1) indication for treatment, (2) antibiotics prescribed, and (3) duration or review date. Segmented regression analysis was used to analyze the ITS. The medical records of 2306 patients receiving antibiotics for an infection (1177 in the pre-intervention period and 1129 in the post-intervention period) were analyzed. A significant increase in mean percentages in the post-intervention period was observed as compared with the pre-intervention period for the three quality indicators (indication documented 83.4 ± 10.4% vs. 90.3 ± 6.6%, p = 0.0013; antibiotics documented 87.9 ± 9.0% vs. 95.6 ± 5.1%, p < 0.0001; and duration or review date documented 31.9 ± 15.4% vs. 67.7 ± 15.2%, p < 0.0001). The study demonstrated the successful implementation of a combined intervention strategy from the AST. This strategy was associated with significant changes in the documentation rate in the computerized medical records for the three quality indicators.

The effect of nutrition education on nutrition‐related health outcomes of Aboriginal and Torres Strait Islander people: a systematic review

Objective:To determine the effectiveness of nutrition education on improving nutrition‐related health outcomes in Aboriginal and Torres Strait Islander people. Methods:Databases Medline, Cinahl, Scopus, ProQuest and ATSI Health were searched in September 2013 to identify nutrition education intervention studies in Indigenous Australian populations. Peer‐reviewed and grey literature with nutrition‐related biochemical or anthropometrical health outcomes were included in a qualitative comparative analysis. Results:Of 1,162 studies identified from the search, six met inclusion criteria. Three studies were from a remote setting and three from an urban setting. Four of the six education interventions were shown to improve body mass index (BMI) and/or nutritional biochemical indicators. Components of the nutrition education interventions showing greatest effect included cooking skills workshops, group education sessions and store interventions. Community involvement in the program design was most strongly associated with a positive effect on BMI. Conclusion:Nutrition education had some effect in reducing biochemical and anthropometric risk factors for chronic disease in Indigenous Australians. Implications:Nutrition education can be considered as part of a range of strategies to improve nutrition‐related health for Aboriginal and Torres Strait Islander people. Further evidence is needed to strengthen this recommendation.

Habit reversal training and educational group treatments for children with tourette syndrome: A preliminary randomised controlled trial

Quality of life of children with Tourette Syndrome (TS) is impacted greatly by its symptoms and their social consequences. Habit Reversal Training (HRT) is effective but has not, until now, been empirically evaluated in groups.This randomised controlled trial evaluated feasibility and preliminary efficacy of eight HRT group sessions compared to eight Education group sessions. Thirty-three children aged 9–13 years with TS or Chronic Tic Disorder took part. Outcomes evaluated were tic severity and quality of life (QoL).Tic severity improvements were found in both groups. Motor tic severity (Yale Global Tic Severity Scale) showed greatest improvements in the HRT group. Both groups showed a strong tendency toward improvements in patient reported QoL.In conclusion, group-based treatments for TS are feasible and exposure to other children with tics did not increase tic expression. HRT led to greater reductions in tic severity than Education. Implications, such as cost-effectiveness of treatment delivery, are discussed.

Abstract A29: Efficacy study of a group-based promotora intervention to increase cervical cancer screening among immigrant Latina women

Abstract Background: This study evaluates the feasibility and efficacy of a promotora-led, Spanish-language educational group session on cervical cancer screening (Pap tests), self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among Latina immigrants compared to a control condition. Methods: The group-based promotora intervention, Salud es Vida, consisted of a toolkit of materials which includes a curriculum guide, a brochure, a flipchart, a short animated video, and in-class activities. Data from baseline and follow-up/post-intervention surveys were used to assess differences in obtaining a Pap test using the Chi-square test of independence and in self-efficacy and knowledge scores using t-tests. Results: We recruited 38 women to the intervention and 52 women to the control who were due for Pap test screening. After an average of 8 months until the follow-up assessment, twelve (32%) intervention participants received the Pap test and 10 (19%) control participants received the Pap test (p = .178). At follow-up, the intervention group participants had higher total cervical cancer knowledge and higher self-efficacy scores, adjusting for the posttest scores, respectively (p's &amp;lt; .05). Conclusions: The findings from this feasibility study using a group intervention approach suggest intervention efficacy for increasing cervical cancer knowledge and self-efficacy; however, these secondary outcomes alone were not sufficient to increase cervical cancer screening rates in this Latina immigrant population during the study period. Citation Format: John S. Luque, Yelena N. Tarasenko, Moya L. Alfonso, Claudia Reyes-Garcia, Laura Rebing, Daron G. Ferris. Efficacy study of a group-based promotora intervention to increase cervical cancer screening among immigrant Latina women. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A29.

Do You See What I See? Standardized Imaging Education for Therapists

care clinic structure. Method/Process: The DRCC CSRT began in April 2015 working with three out of eight Radiation Oncologists (ROs). The CSRT attends the RO’s clinics for patients being seen for potential palliative radiation treatments. The RO and CSRT discuss the case, and review relevant imaging, correlating the diagnostic information with the clinical picture (patient’s symptoms). After simulation, the CSRT contours the target and places treatment fields, subsequently reviewing this with the RO before planning commences. Results/Benefits/Challenges: Palliative patients enter the system through various pathways for consult at DRCC, which impacts the CSRT’s ability to track when/where these patients are seen. Working with three ROs has allowed the CSRT to learn from a diverse knowledge and experience base; however this has also meant adapting to differences in clinical preferences and teaching styles. Due to peripheral clinics, the CSRT is unable to see all patients in consult, however will still work on the plan for these patients. The difficulty of correlating the clinical picture (patient’s symptoms) with the diagnostic information and treatment decisions was apparent if a patient was not physically seen in clinic by the CSRT. Conclusion/Impact/Outcomes: Measures have been established to monitor the CSRT’s progress and include conducting concordance activities with the ROs with respect to prescription decisions, target contouring and field placements. A process change has been implemented to streamline the notification system of palliative consults in the clinical information system. The CSRT is continuing to expand her clinical role by including an additional RO. She is increasing her profile by gaining trust and proving oneself to her colleagues and patient through the collection of evidence regarding performance of the relevant clinical tasks outlined in the CSRT job description.

Short-term effects of a peer co-led educational programme delivered before mental health treatment: A randomised controlled trial

ObjectiveTo investigate the 1-month effects of an educational programme co-led by peers delivered before treatment on treatment preferences, self-management knowledge and motivation in comparison to usual care. MethodsAdults referred to a community mental health centre were randomised to either a control group (n=48) or a peer co-led educational programme (intervention group, n=45). The programme consisted of an 8-hour group education session followed by an individual pretreatment planning session. The main topics of the educational programme were treatment options, patients’ rights, self-management, the importance of patient activation and participation. ResultsAt 1-month follow-up, a significantly larger proportion of the patients in the intervention group knew which type of treatment they preferred (76.7% vs. 32.5%, p<0.001). The intervention group had significantly higher self-management knowledge (p<0.001). There was no effect on treatment motivation (p=0.543). ConclusionAt 1-month following the delivery of a pretreatment educational programme, we found that participants’ knowledge of treatment preferences and self-management had improved. Practice implicationsEducational interventions co-led by peers can optimise the process of informing and educating outpatients, thereby helping patients to clarify their treatment preferences

Clinical Application of the Food Insulin Index for Mealtime Insulin Dosing in Adults with Type 1 Diabetes: A Randomized Controlled Trial.

The Food Insulin Index (FII) is a novel algorithm for ranking foods based on their insulin demand relative to an isoenergetic reference food. We compared the effect of carbohydrate counting (CC) versus the FII algorithm for estimating insulin dosage on glycemic control in type 1 diabetes. In a randomized, controlled trial, adults (n = 26) using insulin pump therapy were assigned to using either traditional CC or the novel Food Insulin Demand (FID) counting for 12 weeks. Subjects participated in group education and individual sessions. At baseline and on completion of the trial, glycated hemoglobin A1c (HbA1c), day-long glycemia (6-day continuous glucose monitoring), fasting lipids, and C-reactive protein were determined. Changes in HbA1c from baseline to 12 weeks were small and not significant in both groups (mean ± SEM; FII vs. CC, -0.1 ± 0.1% vs. -0.3 ± 0.2%; P = 0.855). The incremental area under the curve following breakfast declined significantly among the FID counters with no change in the CC group (FID vs. CC, -93 ± 41 mmol/L/min [P = 0.043] vs. 4 ± 50 mmol/L/min [P = 0.938]; between groups, P = 0.143). The mean amplitude of the glycemic excursion (MAGE) was significantly reduced among the FID counters (FID vs. CC, -6.1 ± 1.0 vs. -1.3 ± 1.0 mmol/L; P = 0.003), and only the FID counters experienced a trend (-44% vs. +11%; P = 0.057) to reduced hypoglycemia. In a 12-week pilot study, MAGE and postprandial glycemia following breakfast were significantly improved with FII counting versus CC, despite no significant differences in HbA1c.

Utilization of sexual health and pelvic floor physiotherapy services in Vancouver’s Prostate Cancer Supportive Care (PCSC) Program.

163 Background: The Vancouver Prostate Centre established PCSC in January 2013 to provide education and clinical services to men with prostate cancer (pts) and their partners. The program includes a dedicated sexual health (SH) clinician and physiotherapist (PT) with expertise in male pelvic floor anatomy and physiology. Educational and clinical services are available to pts without charge. We examined the use of the SH and PT services in PCSC to better understand how the services are utilized. Methods: Pts who are pre-treatment or within 6 months of surgery or radiation are offered a group educational (ED) session regarding sexual rehabilitation with the option of visits to the SH clinic. Those who were &gt; 6 months from surgery or radiation were offered evaluation in the SH clinic. Pts who are about to undergo surgery or who have postoperative incontinence are offered attendance at a group ED session and/or 3 visits with the PT clinician. We gathered data from PCSC logs, clinic schedules, and patient records to assess utilization of SH and PT services. Results: SH and PT ED sessions and clinics (CLIN) were initiated in July and October 2013 respectively. Of 802 pts oriented to PCSC, 400 pts, median age 64 (42-92), participated in the SH module and 229, median age 66 (range 42-88) in the PT module. 90% of patients in each module had been treated with surgery; 10% were on ADT. Details of utilization of the ED and CLIN components by pts for both modules are shown in the table below. There was a total of 781 SH clinic visits: 141 pts had one visit, the remainder had a median of 3 visits (range 2-8). For PT, there were 334 visits, with a median of 2 (range 1-4) per pt. 37% of pts who were seen by SH were also seen by PT and 65% of those seen in PT were seen in SH. Conclusions: Sexual dysfunction and urinary incontinence can be significant problems, and often occur together. The PCSC Program offers both educational and clinical services to address these issues, and continues to modify its programs to best serve patient and partner needs at various time points after therapy. [Table: see text]