Individualized Patient Education Research Articles

Food Insecurity Status and Health Care Utilization Among COPD Patients: A Retrospective Study.

Government programs-targeting chronic disease patients with high health care costs-focus on clinical conditions, factors internal to the health care system, and individual patient education, not on addressing modifiable social determinants of health to reduce health care utilization. To evaluate differences in sociodemographic variables and health care utilization between patients with chronic obstructive pulmonary disease (COPD) who reported food insecurity and those who did not. This descriptive retrospective cross-sectional study used data from the electronic health records of a convenience sample of 854 participants with a discharge diagnosis of COPD or COPD with acute exacerbation, admitted via the emergency department of participating hospitals in Southern California. Chi-square (or Fisher's exact) tests and t tests were used to evaluate group differences, and multivariate (or Firth) logistic regression to identify factors that increased the odds of emergency department visits and hospitalizations. Significant differences between groups were identified for food insecurity (sometimes or often vs never insecure) and age (P < .001), race (P = .022), medical insurance (P < .001), zip code (P = .022), homeless status (P < .001), smoking status (P < .001), and emergency department visits (P = .033). No significant differences were found for food insecurity and hospitalizations (P = .592). This study contributes to the growing body of research supporting the association of upstream social factors (food insecurity, homelessness, zip code) and downstream health outcomes (repeated emergency room visits), and how existing programs can be effectively utilized to impact downstream health outcomes such as health care utilization.

Therapeutic patient education and treatment intensification of diabetes and hypertension in subjects with newly diagnosed type 2 diabetes mellitus: a longitudinal study.

The aim of this study is to prospectively evaluate whether individual and group Therapeutic Patient Education (TPE) can reduce the need to intensify treatment of diabetes and hypertension in newly diagnosed type 2 diabetic patients. A total of 937 patients were recruited and followed-up for 42.7 ± 21.5 months. TPE was a structured comprehensive education delivered by trained nurses: 322 patients received individual TPE (ITPE), 291 underwent group TPE (GTPE), and 324 were in Usual Care (UC). The primary endpoints were intensification of diabetes treatment and intensification of hypertension treatment. The rate of diabetes treatment intensification was 40.1% in patients receiving ITPE, 47.8% in patients undergoing GTPE, and 64.2% in patients in UC (p < 0.001). The rate of hypertension treatment intensification was 24.2% in patients following ITPE, 31.3% in patients receiving GTPE, and 41.0% in patients in UC (p < 0.001). Multivariate analysis showed that both ITPE and GTPE were associated with reduced intensification of diabetes (ITPE: HR:0.51; 95% IC:0.40-0.64; p < 0.001 - GTPE: HR:0.46; 95% IC:0.44-0.70; p < 0.001) and hypertension medication (ITPE: HR:0.45; 95% IC:0.34-0.61; p < 0.001 - GTPE: HR:0.49; 95% IC:0.38-0.65; p < 0.001). The association was independent of age, sex, BMI, HbA1c, and presence of hypertension at baseline. TPE, delivered as both individual and group sessions, represents an effective tool to reduce the need to intensify treatment of both diabetes and hypertension. Therefore, it can ensure better control of diabetes and hypertension with fewer medications. This could reduce adverse effects and costs and improve quality of life and medication taking in patients with type 2 diabetes.

Full-body skin examination in screening for cutaneous malignancy: a focus on concealed sites and the practices of Australian dermatologists.

Full-body skin examination (FSE) is a vital practice in the diagnosis of cutaneous malignancy. Precisely how FSE should be conducted with respect to concealed site inclusion remains poorly elucidated. To establish the approach of Australian dermatologists to concealed site examination (CSE). A cross-sectional study was performed consisting of an online self-administered 11-question survey delivered to fellows of the Australasian College of Dermatologists. There were 237 respondents. Anogenitalia was the least often examined concealed site (4.6%), and 59.9, 32.9, and 14.3% reported always examining the scalp, breasts, and oral mucosa, respectively. Patient concern was the most frequently cited factor prompting examination, while many cited low incidence of pathology and limited chaperone availability as the main barriers to routine examination of these sites. Most Australian dermatologists do not routinely examine breasts, oral mucosal, or anogenital sites as part of an FSE. Emphasis should be made on identifying individual patient risk factors and education regarding self-examination of sensitive sites. Aconsensus approach to the conduct of the FSE, including concealed sites, is needed to better delineate clinician responsibilities and address medicolegal implications.

Inpatient psychiatry patient medication education groups: A retrospective observational case series evaluating education provided on prescribed psychiatric medications at discharge and documentation practices

AbstractIntroductionPatient medication education groups (PMEGs) during inpatient psychiatric hospitalizations have occurred for over 40 years. It is unknown to what degree patients are educated on their prescribed medications following PMEGs, or, pharmacist PMEG documentation practices.ObjectivesThe primary objective was to determine the percentage of patients educated on their newly prescribed or continued psychiatric medications at hospital discharge during daily pharmacy‐delivered education sessions at an inpatient psychiatric hospital.MethodsThis single‐center, six‐month, retrospective observational case series of PMEGs and individual education occurred during acute inpatient psychiatric hospitalization. Educational content was adapted by the board‐certified psychiatric pharmacist (BCPP) to emphasize medications that attendees wished to discuss. Data collection included demographics, medications prescribed at discharge, educational content provided, and documentation by pharmacy staff regarding attendees' behaviors and shared medication experiences. The chi‐square test was used to determine differences in percentages of patients educated on psychiatric medication classes.ResultsA total of 87 PMEGs and 90 individual patient education were performed, reaching 230 unique patients. The average patient attended two PMEGs. Patients prescribed the following scheduled medication classes at discharge were educated on them: antipsychotics (76.3%), antidepressants (67.3%), antiepileptic drugs (66.7%), substance use disorder medications (63.6%), lithium (60%), and non‐antidepressant anti‐anxiety medications (58.6%). Education was provided more frequently on newly prescribed medication classes (79%) compared to continued medication classes at discharge (58.3%) (p = 0.00001). Individual patient interactions during educational sessions documented behavioral or psychiatric symptoms (68%), patient‐sharing experience with medications (39%), medication‐related concerns (28%), medication efficacy comments (18%), and interest in pharmacotherapy modification (14%).ConclusionNearly 80% of patients who attended PMEG or met individually with the BCPP were educated on newly prescribed scheduled psychiatric medications. Additional research is needed to determine patient preference of how education is delivered, and how PMEGs impact pharmacist interventions, medication adherence, and hospital readmission rates.

Survey of adolescents’ needs and parents’ views on sexual health in juvenile idiopathic arthritis

BackgroundAlthough the advent of new therapeutics for juvenile idiopathic arthritis (JIA) patients has considerably lessened the impact of the disease and reduced its sequelae, the outcomes of JIA remain important in their lives. Disease repercussions and side effects of treatments may affect sexual health and cause psychological distress. This aim of the study was to determine the expectations of adolescent JIA patients and the perceptions of their parents regarding knowledge and communication with healthcare providers (HCPs) in the field of sexual health (SH).MethodsIn France, from September 2021 to April 2022, a survey was conducted, using anonymous self-administered questionnaires, among JIA patients (adults (aged 18–45 years) to provide insights from their recollection of their adolescence) and their parents in nine rheumatology centers and three patient associations.ResultsThe responses to the 76 patient questionnaires and 43 parent questionnaires that were collected were analyzed. Half of the patients thought JIA impacted their romantic relationships, but the results were less clear-cut for their sexual activity; and 58.7% of the patients said they would be comfortable discussing the subject with HCPs, but only 26.3% had done so, mainly regarding biomedical issues. The patients and their parents thought that ideally, the topic should be addressed in an individual patient education session at the hospital (51.3% and 34.9%, respectively), in a regular consultation (47.4% and 53.5%), or in a dedicated consultation requested by the adolescent without the adolescent’s parents being informed (38.2% and 20.9%). Most of the respondents thought HCPs should be proactive in SH (77.6% of the patients and 69.8% of their parents). More patients than parents said the following digital information tools must be used: videos (29.0% vs. 9.3%, p = 0.0127) and smartphone applications (25.0% vs. 9.3%, p = 0.0372).ConclusionHCPs should consider addressing the unmet need for SH discussions during their patient encounters. To meet this need, we propose concrete actions in line with the wishes of patients and parents.Clinical trial registration numberNCT04791189.

Workshop (Clinical/Best Practice Implementation) ID 2001167

Background Hamilton’s Spinal Cord Injury (SCI) Regional Rehabilitation Program in collaboration with SCI Consortium is implementing tissue integrity monitoring for pressure injury (PI) prevention. An increased prevalence of PI was found in 2021 - 2022 compared to 2020 on Hamilton’s SCI Rehabilitation Unit. To address this finding, the clinical team introduced a staff and patient education program focused on PI prevention. Upon completion of this workshop, the attendees will be aware of the CQI methodology used to implement the best practices related to tissue integrity and appreciate the education pathway for both staff and patients. Methods Using a Continuous Quality Improvement model, a systematic approach was used to enhance the education model for staff and patients on skin assessment and appropriate interventions. A process map was created outlining steps for each discipline involved in skin assessment, intervention, and patient education. Education plan included Skin &amp; Wound Management workshop, individual and group patient education, daily skin check calendar for patient/staff use. The workshop will be delivered in a lecture format, ending with discussion time. Results Preliminary data post partial implementation of the education program showed a decrease of 12% in the prevalence of PIs in the patients discharged from the program between July 2022 and March 2023 compared to January 2021 – June 2022. Conclusion Preliminary results are encouraging in demonstrating that implementation of a comprehensive education plan for staff and patients using a structured framework is effective in reducing the prevalence of pressure injuries in the inpatient SCI rehab unit.

Implementation of patient education for patients with atrial fibrillation: nationwide cross-sectional survey and one-year follow-up.

Clinical practice guidelines recommend patient education for patients with atrial fibrillation (AF) as a part of holistic care, however, clinical guidelines lack detailed specification on the content, structure, and delivery of AF education programmes. To examine the implementation of education for patients with AF in Denmark in relation to coverage, organization, and content. A cross-sectional survey was conducted from February to May 2021. The survey contained questions on the organization, delivery, and content of education for patients with AF from all 29 AF outpatient hospital sites in Denmark. The survey was conducted by email and telephone. One-year follow-up was done in May 2022 by email. Patient education was provided by healthcare professionals in 16 (55%) hospitals. Nurse workforce issues, management, non-prioritization, and lack of guidance for implementation were reasons for the absence of patient education in 13 (45%) hospitals. The structure of patient education differed in relation to group or individual teaching methods and six different education models were used. Content of the AF disease education was generally similar. At 1-year follow-up, another four hospitals reported offering patient education (69% in total). Initially, almost half of the hospitals did not provide patient education, but at 1-year follow-up, 69% of hospitals delivered patient education. Patient education was heterogeneous in relation to delivery, frequency, and duration. Future research should address individualized patient education that may demonstrate superiority in relation to quality of life, less hospital admissions, and increased longevity.

"I feel I have been taken seriously" Women's experience of greater trochanteric pain syndrome treatment-A nested qualitative study.

Women experiencing greater trochanteric pain syndrome (GTPS) report high levels of pain and reduced quality of life. Exploring how they manage GTPS in a daily life context can provide important knowledge about individual coping strategies. Education, extracorporeal shockwave therapy (ESWT) and exercise have good group level evidence for efficacy in clinical trials and are increasingly used in routine care for patients with GTPS. Exploring women's experiences of such treatment may help understand the mechanisms underpinning these positive results and inform treatment strategies. We therefore aimed to explore how women with GTPS experience and manage their daily life, and their experience of the combined treatment of education, ESWT and exercises. This qualitative study was nested within a cohort study based in a hospital outpatient clinic and a physiotherapy clinic in Denmark assessing the combined treatment of education, ESWT and exercises. Data was collected from eleven women using in-person, individual, semi-structured interviews which were audio recorded. Transcripts were coded and analysed using an inductive thematic analysis approach. Five themes were identified: (1) Daily life was controlled and structured by pain; (2) The condition was acknowledged and taken seriously by treating professionals; (3) The participants´ experiences of the intervention-information is key; (4) Improved capability and autonomy in pain management and (5) The women´s perspectives on improving and expanding the intervention. Learning how to manage pain was experienced as the most important element of the program to the women to be able to minimize pain and manage daily life. Exploration of how women with greater trochanteric pain syndrome experienced and managed daily hip pain, and how they experienced and adapted to treatment are important novel findings that will inform clinical practice. This new knowledge may be used to inform an individualized patient education, treatment and evaluation strategy for women with the painful and debilitating condition of GTPS.

Patients successfully lose body weight after primary total knee arthroplasty but not more than a matched general population

IntroductionHigh BMI is associated with increased risk for knee osteoarthritis, ultimately necessitating total knee arthroplasty (TKA). The aim of this retrospective study was to (1) analyse the amount of postoperative long-term weight loss as reflected by BMI change in TKA patients, (2) identify factors associated with increased change in BMI, and to (3) compare changes with BMI trends of a general population.Materials and methodsOverall, 298 TKA patients [198 females; mean age: 65.1 ± 7.9 years, median follow-up 8.8 (interquartile range: 5.9–10.8 years)] were included in the final evaluation and compared with an age group-matched control group from the general population regarding weight trends between 2006 and 2014. Main variable of interest in both cohorts was body mass index (BMI). Linear regression analyses were performed to assess changes in weight and BMI over time between TKA patients and the general population. Furthermore, mixed linear-effects models were constructed to analyse the potential change in BMI independent from age and gender.ResultsIn TKA patients, a significant drop in BMI by 0.8 ± 3.2 points from postoperative to final follow-up was observed (p < 0.001), with reduction being significant independently from age (p = 0.382), gender (p = 0.310), or revision surgery (p = 0.195). In the general population, likewise a significant BMI-decrease by 0.7 ± 6.1 points was observed between 2006 and 2014, with younger people (p = 0.004) and females (p < 0.001) being more likely to reduce BMI. Yet, BMI-decrease between TKA patients and the general population over time was comparable (p = 0.734). Notably, patients with initially higher BMI were significantly more likely to lose weight postoperatively than normal-weight patients (p < 0.001).ConclusionsOur results point against the notion that TKA patients lose a considerable amount of weight in comparison to the general population as soon as improved joint function and pain relief have been achieved. Thus, individualized patient education programmes should be reinforced, promoting a healthy lifestyle.

Impact of Individualized Patient Education Material on Patients' Cancer Care Experiences

Background Patient education materials (PEMs) empower patients to have an understanding of their health and treatment options. PEMs that currently exist in Radiation Oncology are available primarily as text heavy resources, or multiple-click web-based Internet resources, exceeding the national readability recommendation of a 6th grade reading level. A health literacy level appropriate PEM that simplifies the complexity of a cancer diagnosis and treatment options may be a reasonable option to facilitate patient-provider communication in Oncology. Methods We are developing a multidisciplinary, health literacy appropriate thoracic oncology PEM at Rush University Medical Center (RUMC) in Chicago, IL, which serves a diverse patient population with varying health literacy levels. This new PEM, part of an ongoing study, aims to address the knowledge translation gap. The primary outcome is to assess the mean difference in patient satisfaction between control and study groups. The secondary outcome is to assess an interaction effect between health literacy and the overall effect of the PEM on patient satisfaction. Results This prospective randomized control trial with IRB approval is ongoing. The PEM was developed collaboration with media designers and the RUMC Patient Education Committee. Readability of the PEM was assessed with ten common readability assessment scales, represented through a mean score. All English or Spanish speaking adults scheduled for a new patient consult during Comprehensive Lung Clinic will be included. The control group will receive the standard of care (physician encounter without the PEM), while the intervention group will receive standard of care and the PEM. All patients will complete an anonymized validated survey that measures health literacy levels, sociodemographic factors, and satisfaction of the encounter. A cumulative anonymized health-care provider survey will gather descriptive data about health-care providers' experiences using the PEM. Descriptive statistics will characterize the control and study group. Patient satisfaction will be measured on a 5-point scale. A two-sample t-test with a one-sided alternative will measure the difference of mean score of patient satisfaction between the control and study group. We will apply interaction tests to determine the differential impact of health literacy on the correlation of the PEM and patient satisfaction. Multiple linear regression modeling will be done to determine the correlation of the PEM and patient satisfaction after adjusting for other socio-demographic variables. Discussion If received well, we will explore expanding this study to other treatment sites, with the overall goal of improving health literacy appropriate PEMs in Radiation Oncology. Patient education materials (PEMs) empower patients to have an understanding of their health and treatment options. PEMs that currently exist in Radiation Oncology are available primarily as text heavy resources, or multiple-click web-based Internet resources, exceeding the national readability recommendation of a 6th grade reading level. A health literacy level appropriate PEM that simplifies the complexity of a cancer diagnosis and treatment options may be a reasonable option to facilitate patient-provider communication in Oncology. We are developing a multidisciplinary, health literacy appropriate thoracic oncology PEM at Rush University Medical Center (RUMC) in Chicago, IL, which serves a diverse patient population with varying health literacy levels. This new PEM, part of an ongoing study, aims to address the knowledge translation gap. The primary outcome is to assess the mean difference in patient satisfaction between control and study groups. The secondary outcome is to assess an interaction effect between health literacy and the overall effect of the PEM on patient satisfaction. This prospective randomized control trial with IRB approval is ongoing. The PEM was developed collaboration with media designers and the RUMC Patient Education Committee. Readability of the PEM was assessed with ten common readability assessment scales, represented through a mean score. All English or Spanish speaking adults scheduled for a new patient consult during Comprehensive Lung Clinic will be included. The control group will receive the standard of care (physician encounter without the PEM), while the intervention group will receive standard of care and the PEM. All patients will complete an anonymized validated survey that measures health literacy levels, sociodemographic factors, and satisfaction of the encounter. A cumulative anonymized health-care provider survey will gather descriptive data about health-care providers' experiences using the PEM. Descriptive statistics will characterize the control and study group. Patient satisfaction will be measured on a 5-point scale. A two-sample t-test with a one-sided alternative will measure the difference of mean score of patient satisfaction between the control and study group. We will apply interaction tests to determine the differential impact of health literacy on the correlation of the PEM and patient satisfaction. Multiple linear regression modeling will be done to determine the correlation of the PEM and patient satisfaction after adjusting for other socio-demographic variables. If received well, we will explore expanding this study to other treatment sites, with the overall goal of improving health literacy appropriate PEMs in Radiation Oncology.

Individual Patient Education for Managing Acute and/or Subacute Low Back Pain: Little Additional Benefit for Pain and Function Compared to Placebo. A Systematic Review With Meta-analysis of Randomized Controlled Trials.

To evaluate the effects of individual patient education for managing acute and/or subacute low back pain (LBP), compared to no intervention/placebo education, noneducational interventions, or other type of education. Systematic review with meta-analysis of randomized trials. PubMed, CINAHL, PEDro, Embase, Scopus, and CENTRAL (up to September 30, 2020); reference lists of previous systematic reviews. Randomized controlled trials (RCTs) evaluating individual education for patients with acute and/or subacute LBP. Random-effects meta-analysis for clinically homogeneous RCTs. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. We included 13 RCTs. There was moderate certainty evidence that individual patient education was more effective than placebo education for pain at medium term (mean difference [MD], -0.79; 95% confidence interval [CI]: -1.52, -0.07) and physical function at short term (standardized mean difference [SMD], -0.25; 95% CI: -0.47, -0.02) and medium term (SMD, -0.26; 95% CI: -0.48, -0.04), but with no clinically relevant effects. There was low-to-moderate certainty evidence that individual patient education was superior to noneducational interventions on short-term quality of life (MD, -12.00; 95% CI: -20.05, -3.95) and medium-term sick leave (odds ratio = 0.32; 95% CI: 0.11, 0.88). We found no clinically relevant between-group effects for any other comparison (low-to-high certainty of evidence) at any follow-up. One or 2 hours of individual patient education probably makes little to no difference in pain and functional outcomes compared with placebo for patients with acute and/or subacute LBP. Considering its effects on other outcomes (eg, reassurance) and patients' desire for information about their condition, it is reasonable to retain patient education as part of a first-line approach when managing acute and subacute LBP. J Orthop Sports Phys Ther 2022;52(7):432-445. Epub: 18 May 2022. doi:10.2519/jospt.2022.10698.

Home administration of needle injections for children with rheumatic diseases: A qualitative study on nurses’ perception of their educational role

PurposeTo explore nurses' perceptions of their educational role, pedagogical competence, and practice in teaching children with rheumatic diseases and their parents to manage subcutaneous injections at home. Design and methodsIn this qualitative study, we used thematic analysis to analyze data from three focus groups with 14 nurses responsible for patient education at one pediatric ward and two outpatient clinics. ResultsWe identified three main themes capturing nurses' perceptions of their educational role: myriad expectations, awareness of own competence, and facilitation and prioritization of patient education. Nurses perceived patient education as an expected but challenging duty of their work. They described a lack of pedagogical competence, insecurity in managing parents' and children's fears and worries, and limited organizational structures guiding their educational role. Nurses who worked in outpatient clinics felt freer to individualize education compared to ward nurses. ConclusionsNurses perceive their educational role as significant in enabling children and parents to manage subcutaneous injections at home; however, they require pedagogical competence integrated with daily practice to provide high-quality care. Short-term admissions require a different organization of patient education than before. Practical implicationsNurses need increased training in communication and management of children's pain and fear during needle injections. Competence development should include opportunities for reflection and guidance in clinical practice. Pediatric specialist nurses at outpatient clinics seem to have better competence to provide individual patient education for these families. The potential advantage of web-based solutions for nurses' patient education is a promising avenue for future research.

Commentary on “Remote Advance Care Planning in the Emergency Department During COVID-19 Disaster: Program Development and Initial Evaluation”

Commentary on “Remote Advance Care Planning in the Emergency Department During COVID-19 Disaster: Program Development and Initial Evaluation”

The Effect of Education Based on Kolb's Learning Style on Selfcare Behaviors of the Elderly with Type II Diabetes: A Randomized, Clinical Trial.

Individualized patient education can help older people with diabetes to improve their self-care behaviors and effectively manage their disease. Identifying patients' preferred learning style can be a useful way to optimize learning opportunities. The aim of this study was to investigate the effect of education based on Kolb's learning style on selfcare behaviors of older people with type II diabetes. This randomized clinical trial was conducted on 62 older adults with type II diabetes referred to the diabetes center of Imam Reza Hospital in Bojnourd, Iran, from May to November 2020. Participants who met the inclusion criteria were randomly allocated into two groups of intervention (n=34) and control (n=28). Participants in intervention group received the educational intervention based on their learning style (described by Kolb as accommodating, diverging, converging and assimilating) in four 45 minutes-sessions (two sessions per week). In the control group, the same educational content was presented with a lecture and a booklet. Participants in both groups completed the self-care questionnaires before and one month after the intervention. The mean self-care scores of the older adult patients with type II diabetes based on Kolb's learning style after the educational intervention in the intervention and control groups were 58.15 (SD=10.71) and 44.7 (SD=12.12), respectively (P<0.001). Accommodating Kolb's learning style-based education was most effective in improving self-care practice in older adult patients with type II diabetes (P<0.001). Education based on Kolb's learning style is effective in improving self-care behaviors of older people with type II diabetes. Therefore, it is suggested to consider Kolb's learning style in the educational process of older adults with type II diabetes to improve self-care practice in these patients.

THE OUTCOMES OF A MCKENZIE-BASED APPROACH COMBINED WITH OTHER INTERVENTIONS FOR A PATIENT WITH LOW BACK PAIN AND PIVD

Low backache is the most common health condition among adults which leads to pain and disability. Radiculopathy is a impaired condition that causes low back pain that radiates to the lower extremity. The aim of this case study is to establish a comprehensive physical therapy plan for a patient who has chronic low back pain and PIVD. The patient was a 30-year-old female with a one month history of LBP. The pain further radiated to both legs. Further magnetic resonance imaging (MRI) was done, which indicated PIVD at the level ofL4-L5The patient's main concern about her condition was that she was unable to work, engage in her once-loved hobbies, and function without pain or discomfort, and pain has disrupted her sleep. After eight weeks the pain level on the Numerical Pain Rating Scale had reduced from 7/10 at worst to 2/10. The patient said that aggravating pain is reduced. Capacity to function has been restored and sleeping has also been improved. A detailed physical therapy program that included a patient with chronic low back pain and PIVD are McKenzie extension exercise, therapeutic exercise, electrical stimulation, individualized patient education, manual techniques, superficial heat and home exercise program.

Validation of the Chinese Version of the Coronary Artery Disease Education Questionnaire - Short Version: A Tool to Evaluate Knowledge of Cardiac Rehabilitation Components.

Background:Patient education is the first step in implementing a cardiac rehabilitation (CR) program and a powerful tool for promoting behavioral changes in cardiac patients. In China, the clinical workload is so heavy that a short and reliable tool for assessing disease-related knowledge is needed for targeted patient education.Objective:The aim of this study was to translate, adapt and validate the Chinese version of the Coronary Artery Disease Education Questionnaire – Short Version (CADE-Q SV).Methods:The CADE-Q SV was translated to simplified Chinese and culturally adapted to the Chinese context. The translated version was reviewed by a committee of seven experts in cardiovascular disease, and the content validity of the questionnaire was established. The psychometric properties of the questionnaire were analyzed considering the responses of 240 CR patients. The Kuder-Richardson-20 (KR-20) coefficient and Cronbach’s alpha were used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to assess test-retest reliability. The criterion-related validity was evaluated by determining whether there were differences in the total scores of patients with different educational levels. Confirmatory factor analysis (CFA) was used to assess the factor structure.Results:Three items from the original version were adapted to reflect Chinese culture. The content validity index was 0.94. The KR-20 score was 0.856. All ICC values were > 0.70. The knowledge scores of patients with different educational levels were significantly different, indicating that the criterion-related validity of the Chinese CADE-Q-SV was acceptable. CFA validated the five-factor structure of the Chinese CADE-Q-SV.Conclusion:The Chinese CADE-Q SV questionnaire has good reliability and validity. This short, efficient tool can be completed quickly, assess disease-related knowledge in cardiovascular patients and serve as a reference for individualized patient education in China. It can also be used to evaluate the effectiveness of CR-related patient education interventions.

Distinctions in the Management, Patient Impact, and Clinical Profiles of Pachyonychia Congenita Subtypes

Introduction: Pachyonychia congenita (PC) is a rare dermatosis that confers lifelong physical and emotional morbidities in affected patients. However, the clinical findings, treatments, and psychosocial impact of this disease have not been adequately described. The International PC Research Registry (IPCRR), a multinational initiative to collect data on PC patients, has allowed an opportunity to distinguish the salient features of this disease. We aimed to characterize the breadth and extent of nail disease, treatments, and quality of life in PC patients, and to describe any significant differences in clinical presentation or treatment of PC subtypes. Methods: The most recent IPCRR patient survey data consisting of an 857-response questionnaire and a 102-response addendum were analyzed in a retrospective analysis. The survey data were collected as part of a multinational, multicenter initiative and comprise the largest representative population of PC to date. Participants (survey respondents) were included in the study based on questionnaire responses and a genetic confirmation of having a PC subtype. Results: A total of 857 survey responses were collected. Genetic variations among PC subtypes influence nail disease onset and severity of symptoms. Nail disease negatively impacts patients’ emotional health, especially during the adolescent and young adult years. Nail treatment tools vary little in terms of effectiveness and acquired infection rates. Conclusion and Discussion: Patients with different PC subtypes have distinct clinical nail presentations and psychosocial impact. Genetic testing should be used to confirm PC diagnoses. Further characterization of PC, especially the rarer subtypes, may allow for more individualized patient education.

Structured Blood Glucose Monitoring in Primary Care: A Practical, Evidence-Based Approach.

Comprehensive care of diabetes requires satisfactory stewardship of an underutilized prescription in diabetes management: the prescription for structured blood glucose monitoring (BGM). Structured BGM is a recommended schedule of actionable blood glucose measurements taken at specific times with the intent of using the data for individualized patient education and therapeutic intervention. The utility of different BGM protocols is logically dictated by a patient’s therapeutic regimen. This article reviews the prescription for structured BGM in the setting of intensive insulin, nonintensive basal insulin, and noninsulin treatment regimens. Evidence-based prescriptions of structured 5- to 7-point BGM profiles in diabetes provide essential information for productive clinician- and patient-directed therapeutic interventions. The effective implementation of structured BGM aids clinicians in achieving the desired goal of A1C reduction while bolstering patient education and empowering self-management.

Physical Therapist Management of Anterior Knee Pain.

Anterior knee pain is a common musculoskeletal complaint among people of all ages and activity levels. Non-operative approaches with an emphasis on physical therapy management are the recommended initial course of care. The purpose of this review is to describe the current evidence for physical therapist management of anterior knee pain with consideration of biomechanical and psychosocial factors. The latest research suggests anterior knee pain is a combination of biomechanical, neuromuscular, behavioral, and psychological factors. Education strategies to improve the patient's understanding of the condition and manage pain are supported by research. Strong evidence continues to support the primary role of exercise therapy and load progression to achieve long-term improvements in pain and function. Preliminary studies suggest blood flow restriction therapy and movement retraining may be useful adjunct techniques but require further well-designed studies. Anterior knee pain includes multiple conditions with patellofemoral pain being the most common. An insidious onset is typical and often attributed to changes in activity and underlying neuromuscular impairments. A thorough clinical history and physical examination aim to identify the patient's pain beliefs and behaviors, movement faults, and muscle performance that will guide treatment recommendations. Successful physical therapist management involves a combination of individualized patient education, pain management, and load control and progression, with an emphasis on exercise therapy.

Enhancing adult immunization care by community pharmacists: A qualitative analysis of Project VACCINATE

BackgroundProject VACCINATE was a 1-year demonstration project conducted in 70 community pharmacies in Washington from September 1, 2016 to August 31, 2017 aimed at increasing adult vaccination and documentation in the state immunization information system (IIS). Key intervention features aligned with the Standards for Adult Immunization Practices and included incorporation of an immunization interface to facilitate proactive immunization screenings, patient engagement regarding vaccine needs, and vaccine documentation in the IIS as enhancements to the vaccination workflow. ObjectiveThe objective of this qualitative study, a subanalysis of Project VACCINATE, was to identify community pharmacy staff members’ perceptions of work system factors that influenced the implementation of key intervention features. MethodsPharmacy staff at all Project VACCINATE locations were eligible to participate and were recruited by e-mail. Key informant interviews lasting 15-30 minutes were conducted by telephone using a semistructured interview guide. Interview transcripts were thematically analyzed using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model of work systems. ResultsA total of 7 interviews were conducted with pharmacists from different pharmacy locations from September to December 2017. Nine factors emerged across all domains of the SEIPS 2.0 model regarding the implementation of the key intervention features. These factors were pharmacist-patient relationships, team culture, individualized patient education, technician involvement, electronic access to vaccine records, pharmacy layout, staff training, immunization documentation in other care settings, and insurance coverage. ConclusionsSeveral key factors were identified that, when addressed, can enable the incorporation of proactive immunization screenings, patient engagement, and vaccine documentation as enhancements to the community pharmacy–based vaccination process. Community pharmacy organizations should consider incorporating the described factors into existing immunization programs when assessing the unique dynamics of their work system.