In-hospital Education Program Research Articles

Impact of an in-Hospital Patient Education Program on Choice of Renal Replacement Modality in Unplanned Dialysis Initiation

Background/Aims: Up to 50% patients requiring dialysis receive an urgent, unplanned start (UPS) to renal replacement therapy (RRT). Most of these are initiated with an intravenous catheter and commenced and maintained on hemodialysis (HD). Although peritoneal dialysis (PD) could be an equipotent initial modality for RRT, it is used less frequently as long-term RRT in UPS patients. This multicenter-study aimed to evaluate the impact of a structured, in-hospital education program and factors influencing PD rates, especially in UPS patients. Methods: Three German nephrology departments collaborated to implement an in-hospital education program. Retrospective analysis included 336 subjects and compared the rates of HD and PD in consecutive patients who started RRT 12 months prior (two centers) and for 12 months after (three centers) implementing the education program. Results: PD rates increased significantly (p < 0.05) by 66% in all planned and unplanned dialysis starts after implementation of a structured, patient-centered education program. A highly significant (p < 0.0001) rise in utilization of PD was found, especially in UPS patients. In logistic regression analysis, PD modality choice was significantly influenced by age (p < 0.0001) and gender (p = 0.006). Conclusions: A structured, patient-centered in-hospital education program increases the frequency of PD in patients needing unplanned RRT. PD modality choice is significantly higher in young (p < 0.0001) and male (p = 0.006) patients.

Retrospective study on the efficacy of a low-carbohydrate diet for impaired glucose tolerance.

BackgroundIn recent years, the number of people with impaired glucose tolerance (IGT) has increased steadily worldwide. It is clear that the prevention of diabetes is important from the perspective of public health, medical care, and economics. It was recently reported that a low-carbohydrate diet (LCD) is useful for achieving weight loss and glycemic control, but there is no information about the effects of the LCD on IGT. We designed a 7-day in-hospital educational program focused on the LCD for IGT.MethodsThe subjects were 72 patients with IGT (36 in the LCD group and 36 in the control group) who were enrolled from April 2007–March 2012 and followed for 12 months. We retrospectively compared the LCD group with the control group.ResultsIn 69.4% of the LCD group, blood glucose was normalized at 12 months and the 2-hour plasma glucose level in the oral glucose tolerance test (OGTT) was reduced by 33 mg/dL. In addition, the incidence of diabetes was significantly lower in the LCD group than in the control group at 12 months (0% versus 13.9%, P=0.02). The LCD group showed a significant decrease in fasting plasma glucose, hemoglobin A1c, the homeostasis model of assessment of insulin resistance value, body weight and serum triglycerides (TGs) at 12 months, while there was a significant increase of the serum high-density lipoprotein (HDL) cholesterol level.ConclusionThe LCD is effective for normalizing blood glucose and preventing progression to type 2 diabetes in patients with IGT.

Factors Contributing to Postural Sway in Patients with Diabetes in an In-Hospital Education Program

Objective: We investigated the effect of polyneuropathy, nephropathy, and retinopathy on postural sway in patients with poorly controlled diabetes mellitus (DM) who were hospitalized for DM education. We also investigated the relationship between postural sway and hearing disturbances. Methods: We included 50 subjects who were hospitalized for the purpose of DM education. Mean age was 57.2 years, mean HbA_1c was 9.4%, and mean DM duration was 11.1 years. Renal function, retina condition, and nerve conduction were evaluated in relation to DM complications (nephropathy, retinopathy, and neuropathy). Static posturography was performed to assess DM-related postural sway. Nerve conduction studies were used to obtain information on the condition of peripheral nerves. Pure-tone audiometry was measured. Stepwise multiple linear regression was used to assess DM-related factors that affected postural sway. Results: Deterioration of median nerve compound muscle action potential (CMAP) amplitude, tibial nerve CMAP conduction velocity, and peroneal nerve CMAP latency were associated with deterioration of postural sway. Deterioration of hearing in the worse ear was also associated with postural sway. Conclusion: In patients with poorly controlled DM, postural sway was particularly associated with deterioration of motor nerve conduction study parameters represented by median nerve CMAP amplitude, tibial nerve CMAP conduction velocity, and peroneal nerve CMAP latency. A link between diabetic polyneuropathy, diabetes-related postural sway, and diabetes-related hearing loss was recognized.

Contributing factors to hearing of diabetic patients in an in-hospital education program

Conclusion: In patients with poorly controlled diabetes mellitus (DM), hearing disturbance was associated with renal dysfunction and diabetic neuropathy, represented by decreases in median nerve compound action potential amplitude. Methods: The evaluation was conducted using 43 subjects who were hospitalized for the purpose of DM education. The mean age was 58.1 years (range 21–82 years). The mean HbA1c was 9.5%. The mean DM duration was 11.0 years. Renal function, retina condition, and nerve conduction were evaluated in relation to DM complications (nephropathy, retinopathy, and neuropathy). Nerve conduction studies were used to obtain detailed information on the condition of the peripheral nerves. After otological inspection, pure-tone audiometry, auditory steady-state response (ASSR), and distortion-product otoacoustic emissions (DPOAEs) were measured. Stepwise multiple linear regression was used to analyze the results in the better ear and worse ear. Results: Decreases in median nerve compound action potential amplitude were associated with deterioration in pure-tone audiometry and ASSR. Diabetic neuropathy, creatinine clearance, diabetic nephropathy, and retinopathy were related to hearing in ASSR and/or DPOAEs.

Urinary Protein as a Marker for Systolic Blood Pressure Reduction in Patients with Type 2 Diabetes Mellitus Participating in an In-Hospital Diabetes Education Program

Increased blood pressure (BP) and urinary protein (UP)/microalbuminuria are risk factors for cardiovascular disease in patients with diabetes. Although the management of BP in patients with diabetes should involve a multidisciplinary therapy, there are no reports in which modulators have been identified in an in-hospital diabetes education program. The aim of the present study was to investigate the change in BP levels in patients with type 2 diabetes mellitus (T2DM) during a short-term (2-week) in-hospital education program on lifestyle modifications. A total of 167 patients with T2DM (101 men, 66 women; mean age, 61.1 years; glycated hemoglobin, 9.2%) were divided into 2 groups on the basis of their urinary albumin levels: 1 group without UP (urinary albumin level < 30 mg/day) and 1 group with UP (urinary albumin level ≥ 30 mg/day). We defined efficacy in reducing BP as a 20-mm Hg reduction in systolic BP (SBP) and a 10-mm Hg reduction in diastolic BP, and compared the changes between the 2 groups. Although the group with UP had higher SBP levels than the group without UP at baseline, this difference disappeared at the end of the program. Adjusted multivariate logistic regression analysis showed that UP at baseline was associated with a reduction in SBP (odds ratio, 3.361; 95% confidence interval, 1.29–8.79; P = 0.013). The data suggest that UP may be a marker related to the management of SBP through lifestyle modifications in patients with T2DM.

In-Patient International Normalized Ratio Self-Testing Instruction After Mechanical Heart Valve Implantation

Patient self-testing of the international normalized ratio (INR) has been shown to improve management of anticoagulation with warfarin and reduce risks of thromboembolism and bleeding. Self-testing instruction usually begins several weeks after hospital discharge. We evaluated the feasibility of in-hospital INR self-testing instruction in patients recovering from valve replacement. We instituted an education program on a self-testing device before hospital discharge in 50 adult patients (median age, 54 years; 66% men) undergoing cardiac valve replacement with mechanical prostheses. Patients were monitored for 1 month to assess their ability to self-test and the accuracy of the INR measurements. Self-testing instruction began on postoperative day 4 (range, 1 to 8 days). Each patient had an average of 3.5 teaching sessions; each session lasted approximately 20 minutes. One month after discharge, all patients (98%) but 1 were able to self-test. No patient required interval instruction. One bleeding episode occurred in a patient whose INR exceeded the therapeutic range. Once warfarin doses were stabilized, 5 patients had subtherapeutic INR values on self-testing. The mean INR test result obtained from the coagulometer correlated well with values obtained by laboratory determination (r = 0.79). This evaluation of an in-hospital education program demonstrates that patients are able to learn INR self-testing and that most will continue to use the method without the need for interval instruction. Improved anticoagulation management by early introduction of INR self-testing should reduce thromboembolic and hemorrhagic complications after valve replacement.

Long-Term Glycemic Control after a One Week Hospital Education Program for Inpatients with Type 2 Diabetes

Background: Clinical usefulness of short-term education for long-term glycemic control has been unclear in patients with type 2 diabetes. Objective: To conduct a one week education program, incorporating a clinical path with group education and a team approach, for inpatients with type 2 diabetes and assess the effect of our program on short- and long-term glycemic control in these patients. Methods: Changes in hemoglobin A1c (A1C) values of 29 patients were serially examined for 3 years after discharge at completion of the education program, and findings were compared with those of 22 patients with diabetes who did not participate in the program. Results: A1C values of patients in the education group at the first and third year after discharge were maintained at lower levels than those of patients in the control group. The proportion of patients with A1C values less than 7% was greater in the education group than in the control group during the first and third years. No significant differences in the number of hospital visits were noted over 3 years, and no significant difference between the 2 groups was found in the ratio of patients receiving drug therapy to those supported by a diet/exercise regimen only. Conclusions: Our findings suggest that a one week in-hospital education program contributes to improvement of short- and long-term glycemic control in patients with type 2 diabetes.

Factors Influencing Patient Knowledge of Warfarin Therapy After Mechanical Heart Valve Replacement

Patients with mechanical heart valves must follow lifelong warfarin therapy. Warfarin, however, is a difficult drug to manage because it has a narrow therapeutic window and potentially serious side effects. Successful anticoagulation treatment is dependent upon the patient's knowledge of this drug; however, little is known regarding the determinants of such knowledge. Therefore, the purpose of this study was to determine the influence of both in-hospital teaching practices as well as socioeconomic status and demographic variables on patients' knowledge of warfarin therapy. A telephone survey was conducted among 100 patients 3 to 6 months after mechanical heart valve replacement. A previously validated 20-item questionnaire was used to measure the patient's knowledge of warfarin, its side effects, and vitamin K food sources. Demographic information, socioeconomic status data, and medical education information were also collected. Knowledge scores were compared using the Student t test or one-way analysis of variance. Variables with P < or = .2 on univariate analysis were entered in multiple stepwise regression analysis. Sixty-one percent of participants had scores indicative of insufficient knowledge of warfarin therapy (score < or = 80%). Age was negatively related to warfarin knowledge scores (r = 0.27, P = .007). Patients with family incomes greater than $25,000, who had greater than a grade 8 education, and who were employed or self-employed had significantly higher warfarin knowledge scores (P = .007, P = .002, and P = .001, respectively). Gender, ethnicity, and warfarin therapy before surgery were not related to warfarin knowledge scores. Furthermore, none of the in-hospital teaching practices significantly influenced knowledge scores, whereas receiving postdischarge community counseling significantly improved knowledge scores (P = .001). Multivariate regression analysis revealed that understanding the concept of International Normalized Ratio, knowing the acronym, age, and receiving community counseling after discharge were the strongest predictors of warfarin knowledge. Accessing postdischarge counseling resulted in significantly improved warfarin knowledge scores. Because improved knowledge has been associated with improved compliance and control, our findings support the need to develop a comprehensive postdischarge education program or at least to ensure that patients have access to a community counselor to compliment the in-hospital education program.

Usefulness of a systemic hypertension in-hospital educational program

The effects of an educational program on compliance and blood pressure (BP) control were assessed in 47 hypertensive patients hospitalized for nonhypertension-related diseases. Patients were randomized to receive either a questionnaire and an educational program (group 1, 25) or questionnaire only (grog 11, 22). Baseline clinical characteristics, admission diagnoses and antihypertensive medications were similar between the groups. Antihypertensive medications used by patients before the trial were not changed. Eight weeks after the initial intervention, patients in group I showed a significant reduction in both systolic and diastolic BP ( 37 89 vs 154 98 mm Hg, p = 0.005 and 0.006, respectively) and improved compliance (96 vs 36%, p = 0.04), compared with patients in group II. An education program in patients with high BP is an effective method to improve compliance and BP control in the short-term.