Mean Confidence Score Research Articles

Factors influencing the confidence and knowledge of nurses prescribing antiretroviral treatment in a rural and urban district in the Western Cape province.

BackgroundSince the introduction of nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa in 2010, initiation of antiretroviral therapy (ART) in primary care has become the responsibility of nurses. The continued success of this approach is dependent on factors such as adequate training and effective support systems.ObjectivesThis study aimed to investigate factors influencing the knowledge and confidence of professional nurses in managing patients living with human immunodeficiency virus (HIV) in primary healthcare settings in a rural and urban district in the Western Cape.MethodsA cross-sectional survey was conducted amongst 77 NIMART-trained nurses from 29 healthcare facilities to measure demographic details, influencing factors, HIV management confidence and HIV management knowledge.ResultsThe majority of participants had adequate HIV management knowledge and reported being very confident or expert in the HIV management skills or competencies. Participants trained recently on local guidelines (Practical Approach to Care Kit) (3 years ago or less) had significantly higher knowledge scores. Regular feedback about clinic and personal performance was associated with higher HIV management knowledge. Participants who received NIMART mentoring over a period of 2 weeks had a higher mean confidence score compared to other periods of mentoring. A higher caseload of patients living with HIV was also associated with higher knowledge and confidence.ConclusionTraining, mentorship and clinical practice experience are associated with knowledge and confidence. Recommendations include the strengthening of current training and mentoring and ensuring that NIMART-trained nurses are provided with regular updates and sufficient opportunities for clinical practice.

Low-Fidelity, In-Situ Pediatric Resuscitation Simulation Improves RN Competence and Self-Efficacy

ProblemED staff lack adequate exposure to critical pediatric patients to develop competence and confidence in resuscitation scenarios. Simulations of various designs have shown success at increasing health care staff performance and self-efficacy. MethodsWe developed a nurse-led, low-fidelity in situ simulation of a pediatric sepsis scenario. The primary goal was to improve staff adherence to resuscitation guidelines, as measured by the Clinical Performance Tool, a set of checklists designed to measure adherence to Pediatric Advanced Life Support algorithms by multidisciplinary teams during simulations. The secondary goal was to improve staff confidence, measured by the Confidence Scale, a 5-item Likert-type scale that can measure any psychomotor skill. ResultsA total of 43 RNs participated in 12 simulations over a period of 3 months. Mean Clinical Performance score improved by 74%, from 5.3 to 9.2 (P < 0.001). Mean confidence score for RNs improved by 56%, from 2.48 (standard deviation [SD] 0.83) to 3.88 (SD 0.66) (P < 0.001). Several systems issues were identified and addressed by multidisciplinary teams, such as increasing respiratory therapist response to the emergency department and updating of the Broselow cart. DiscussionIn situ low-fidelity simulations led by RNs contributed to significant improvement in adherence to resuscitation guidelines and in staff confidence. The simulation design had minimal impact on staffing and budget and enabled identification and correction of systems issues.

Effectiveness of telemonitoring-enhanced support over structured telephone support in reducing heart failure-related healthcare utilization in a multi-ethnic Asian setting

Aims Our study aimed to compare the effectiveness of telemonitoring over structured telephone support in reducing heart failure-related healthcare utilization. Methods This was a non-randomised controlled study comparing 150 recently discharged heart failure patients enrolled into telemonitoring and 55 patients who only received structured telephone support after rejecting telemonitoring. Patient activation, knowledge and self-management levels were measured at baseline and the one year upon programme completion using the Patient Activation Measure, the Dutch Heart Failure Knowledge Scale and the Self-Care of Heart Failure Index respectively. Differences in heart failure-related and all-cause hospitalization rates, total bed days and mortality rates at 180 days and at one year, knowledge and self-management scores and total cost of care between groups at one year were analysed. Results Average age of telemonitoring was 57.9 years and 63.9 years for structured telephone support. Significant difference in adjusted 180-day all-cause bed days (telemonitoring: five days versus structured telephone support: 9.8 days), heart failure-related bed days (telemonitoring: 1.2 days versus structured telephone support: six days) and adjusted one-year heart failure-related bed days (telemonitoring: 2.2 days versus structured telephone support: 6.6 days) were observed. Telemonitoring was associated with reduced all-cause one-year mortality (hazard ratio 0.32, p = 0.02). Estimated mean maintenance and confidence scores were significantly higher in the telemonitoring group at one year. No differences in all-cause and HF-related readmission rates and knowledge levels were observed. The one-year total cost of care was predicted to be Singapore dollars (SG$) 2774.4 lower (p = 0.07) in telemonitoring. Conclusion In conclusion, telemonitoring was associated with lower all-cause and heart failure-related total bed days at 180 days, lower heart failure-related total bed days and total cost of care at one year as compared with structured telephone support.

1323. Implementation and Effectiveness of the Asia Pacific HIV Practice Course: Building Capacity of Healthcare Workers in the Region

BackgroundBuilding the capacity of healthcare workers (HCW) can positively influence service quality and patient care. Given the limited HIV training opportunities in the Asia Pacific Region, the Asia Pacific HIV Practice Course (APHPC) aims to improve knowledge and skills and encourage patient-centered practice.MethodsThe APHPC is organized by an interprofessional organizing committee. The course was developed based on a needs assessment of HCWs in the region and is run over 4 days. Using didactic and interactive learning approaches, the course covers psychosocial, biomedical and service delivery topics. One hundred HCWs, predominantly nurses, social workers/counselors and, pharmacists have attended the course over 2 years (2016 and 2017). Participants have attended from Singapore, Sri Lanka, Indonesia, Malaysia, Philippines, Bangladesh, Papua New Guinea, Myanmar, and Vietnam. Pre- and post-course evaluations were completed, as well as daily session evaluations and a 3-month post-course evaluation. Participants rated their confidence from 1 to 5 (not confident–very confident). A paired-samples t-test was conducted to compare mean (M) confidence levels pre- and post-course in the various topics covered.ResultsThere was significant improvement in mean confidence scores pre-course (M = 3.40, SD 0.27) and post-course (M = 4.09, SD = 0.13); t(11)= 13.1958, P < 0.0001. This was seen across all topics (figure) with the most marked improvement found in models of care and barriers to care, topics that are not routinely or explicitly covered in the same detail or frequency as HIV basics, testing, treatment and prevention. In the 3-month post-course survey, participants shared the changes they have made to their local practice since attending the APHPC. Changes include, additional staff training, revisions to counseling models and services and the implementation of monitoring and evaluation structures.ConclusionThe APHPC has proven to be an impactful and highly evaluated course. To ensure the course continues to influence and improve practice, the content of the course can be expanded to cover nonstandard topics, and further interactive learning experiences can be incorporated.Disclosures All authors: No reported disclosures.

Effectiveness of PBL methodology in a hybrid dentistry program to enhance students\u2019 knowledge and confidence. (a pilot study)

BackgroundKnowledge and self-confidence are two critical determinants of future success of dental students. The present pilot study was conducted with an objective to simultaneously assess both knowledge and confidence gained by dental undergraduate students in the Head and Neck Anatomy course by employing didactic lecture-based and problem-based learning methods.MethodsA paper-based assessment tool comprising of 30 Multiple choice questions to assess knowledge, followed by a Likert’s scale to assess students’ confidence to answer the given knowledge question was designed. This tool was used in a cohort of first year dental students before the commencement of Head and Neck Anatomy course (Pre-course), immediately after the completion of Head and Neck Anatomy course (Post-course), and again in third year before the same cohort entered their clinical courses (Pre-clinics). The difference in students’ knowledge and confidence through both pedagogies was evaluated by Paired ‘t’ test. Pearson correlation analysis was done to determine the correlation between knowledge scores and self-reported confidence.ResultsA statistically significant increase (p < 0.05) was noted in the mean knowledge and confidence scores in the post-course evaluation, through both didactic lecture-based and problem-based learning methods. On the other hand, a significant decrease (p < 0.05) in the mean knowledge and confidence scores of didactic lecture-based items in comparison to problem-based items was noted in the pre-clinics evaluation.. The post-course evaluation results yielded a Pearson correlation coefficient of r = 0.514, p = 0.002 for lecture-based items and r = 0.495, p = 0.003 for problem-based items, denoting a positive moderate correlation between the knowledge and confidence scores for both lecture-based and problem-based methods.ConclusionA significant improvement in both knowledge and self-reported confidence demonstrated at the end of Head and Neck Anatomy course proves both didactic lectures and problem-based learning methods to be equally effective in a hybrid dentistry program in the short term. However, the non-significant reduction in the pre-clinics knowledge and confidence scores among the PBL lessons proves it to be a potent learning tool for long term retention of knowledge, and sustainability of confidence.

Development and Implementation of an Interprofessional Curriculum for Radiation Oncology Nursing Staff

Radiation oncology nurses play a key role in patient care; however, exposure to radiation oncology in formal training is often inadequate to prepare nurses for their role in an ever more complex practice environment. We sought to create a formalized curriculum for nursing staff to enhance confidence in managing common clinical scenarios. Nursing staff from a single radiation oncology department participated in this study. Participants were initially surveyed to gauge interest level and identify gaps in knowledge. Results of this assessment were used to design a pilot curriculum of 10 30-minute lectures delivered twice monthly. Lectures were devised by the radiation oncology residents and covered the basic elements of radiation therapy, common cancers, toxicity management, and post-treatment monitoring. Pre-, mid-, and post-curriculum surveys were administered to assess engagement and self-reported level of confidence in managing 7 common clinical scenarios, such as answering questions at consultation and managing side effects (scale 1-10; 1=”not confident” and 10=”most confident”). Nurses received continuing education credits for participation. A total of 12 nursing staff participated in the course, with lectures delivered by 8 residents. The majority of participants (58%) attended at least 7 of 10 lectures. At baseline, 58% reported receiving no radiation oncology-related classroom lecture and 75% no clinical experience in formal training. Most common educational sources included hands-on clinical experience (92%) and asking fellow nurses/medical assistants (92%), with 67% citing asking therapists/dosimetrists and 58% asking physicians. The vast majority of participants agreed or strongly agreed that more education about how radiation works (92%), radiation side effects (92%), and commonly treated cancers (92%) would improve their ability to care for patients. On mid-curriculum surveys, 100% of participants found the curriculum to be useful, 100% reported direct impact on clinical work, and 100% requested additional lectures. On post-curriculum surveys, mean confidence scores increased across all domains surveyed. Greatest gain in mean confidence score was seen in managing on-treatment patients (+1.6), while least gain was seen in discussing timing of next follow-up (+1.0). This study suggests there is limited exposure to radiation oncology in formal nursing training and that interprofessional educational interventions may improve patient care. A resident-led curriculum was both of interest to nursing staff and well received. Increases in nursing confidence scores were seen across all patient care domains. Future opportunities include quantitative assessment to evaluate information retention and expansion to staff within other oncology disciplines to foster interdisciplinary fund of knowledge.

Confidence and attitudes of pharmacy students towards suicidal crises: patient simulation using people with a lived experience.

Health care professionals, including pharmacists, have the potential to recognise and assist those at risk of suicide. The primary aim of this study was to assess the impact of utilising people with a lived experience of mental illness as simulated patients on final year pharmacy students' attitudes toward and confidence in caring for people at risk of suicide after first receiving Mental Health First Aid (MHFA) training. A parallel group repeated measures design was used. People with a lived experience of mental illness enacted patients experiencing a mental health crisis, including possible suicidal ideation. Following MHFA training, the first group directly participated in the simulation, the second group observed, and the final group had no exposure to the simulation. Validated surveys measuring student attitudes and confidence were conducted at three time points; pre and post MHFA, and then at 2-4 weeks follow-up. Full datasets of survey responses were received from 34/40 direct participants (85%), 104/146 observers (71%) and 50/66 comparison students (76%). Mean confidence scores significantly improved for all groups post MHFA training (p < 0.05). At follow-up, all 8 confidence items for the direct participant and observer group maintained significance from baseline to post intervention (p < 0.05). Mixed results in relation to attitudes towards suicide were evident at each time point and among each participant group. Utilising people with a lived experience of mental illness as simulated patients has a positive effect on sustaining pharmacy student confidence in discussing suicidal behaviour post MHFA training. The inconsistency in attitudes towards suicide suggests that attitudes are complex in nature, involving multiple dynamic influences.

Assessment of Prelicensure Undergraduate Baccalaureate Nursing Students: Ostomy Knowledge, Skill Experiences, and Confidence in Care

Care of the patient with an ostomy is included in the curriculum of prelicensure nursing programs, but no studies examining student nurses' knowledge about stoma care have been published. The purpose of this project was to examine the ostomy knowledge, experiences, and confidence of nursing students in order to assess and improve the curriculum. At the end of the fall 2016 semester, students enrolled in 3 separate nursing courses in an undergraduate program were asked to participate in a project to examine students' ostomy knowledge, their experiences, and their confidence in providing care. This project was undertaken to explore the college's ostomy curriculum. Participation was voluntary, and no student who was willing to participate was excluded. Students completed a 50-question knowledge test, answered questions about the frequency of performing ostomy-related skills, and rated their confidence in providing ostomy care. Responses were examined with descriptive and inferential statistics. Of 189 possible participants, 138 completed the questionnaires and included mostly women (113, 81.9%); participant mean age was 27.26 ± 6.22 years. The mean number of correct knowledge responses was 35.66 (71.32%); 66 participants (47.8%) reported no experience caring for a patient with an ostomy. The most common skills performed in clinical rotations were emptying (49) and changing (24) the pouch. A scale of 1 to 5 was used to evaluate 6 confidence items, with students having a mean confidence score of 19.54 ± 5.20. They had the most confidence in their ability to empty a pouch and to size and fit the pouching and the least confidence in teaching and community resources. Confidence was related to the number of skills performed in the lab (r = .32; P <.001), the number of skills performed in clinical practice (r = .38; P <.001), and ostomy knowledge scores (r = .23; P <.007). Total correct knowledge scores did not differ significantly by year in the educational program. Based on the results of this survey, it was concluded that students had a beginning knowledge about ostomy care and very limited clinical experience, yet confidence in providing ostomy care was high. Curriculum adjustments were implemented, including strategies for increasing ostomy knowledge, opportunities to provide care, and confidence; these need further investigation in prelicensure undergraduate nursing programs. The effect of curriculum adjustments remains to be evaluated.

Does the British Heart Foundation PocketCPR training application improve confidence in bystanders performing CPR?

Objectives:Out-of-hospital cardiac arrest has poor prognosis and patients rarely survive unless they receive immediate cardiopulmonary resuscitation from bystanders. In 2012, the British Heart Foundation launched its PocketCPR training application to simplify bystander cardiopulmonary resuscitation training and overcome barriers to resuscitation. This study investigates whether the British Heart Foundation PocketCPR training application improves the confidence of bystanders who perform cardiopulmonary resuscitation during simulated resuscitation attempts.Methods:This is a mixed method study using a randomised crossover trial with questionnaire analysis. One hundred and twenty participants were randomised to either perform two minutes of cardiopulmonary resuscitation on a resuscitation manikin using the British Heart Foundation PocketCPR application or perform cardiopulmonary resuscitation without instruction. Participants completed a questionnaire to capture their confidence before completing the opposite arm of the study. Each participant then completed a second questionnaire to allow for comparison of levels of confidence.Results:Participants in this study were more confident in their overall performance of cardio-pulmonary resuscitation using the British Heart Foundation PocketCPR training application compared to performing cardiopulmonary resuscitation without instruction (mean confidence score (0–100): 50.41 with PocketCPR and 43.92 without (p = 0.026)). They were also more confident that the number of chest compressions in this study was correct (mean: 60.39 with PocketCPR vs. 46.10 without (p < 0.001)), and in the delivery of cardiopulmonary resuscitation without having recent cardiopulmonary resuscitation training (mean: 48.67 with PocketCPR vs. 39.79 without (p < 0.002)).Conclusion:The British Heart Foundation PocketCPR training application improved the confidence of bystanders performing cardiopulmonary resuscitation during simulated resuscitation attempts.

Level of Cultural Self-Efficacy of Colombian Nursing Professionals and Related Factors.

To describe the level of cultural self-efficacy of Colombian nursing professionals and determine the main influencing factors. A descriptive, analytical cross-sectional study was conducted in 211 nursing professionals selected by systematic random sampling for a finite population, using the Colombian version of the Cultural Self-Efficacy Scale. After descriptive statistical analysis, nonparametric tests were applied to determine between-variable associations, followed by multiple linear regression analysis. The mean Cultural Self-Efficacy Scale score was 2.58. An association with sex and age ( p < .05) was observed in regression analysis. The mean score for knowledge of cultural concepts was 3.20 and associated with age, years of experience, educational level, and cross-cultural experiences ( p < .05). The mean score for confidence in performing cultural nursing skills was 3.29. The cultural self-efficacy level of this sample of nursing professionals, with their consequent capacity to provide culturally competent care, is moderate and is associated with sex and age. Confidence in knowledge of cultural concepts is affected by age, educational level, years of experience, and cross-cultural experiences. This evidence supports the implementation of changes to improve the cultural knowledge and therefore cultural self-efficacy of these professionals.

Improvement in Confidence Levels for the Management of Paediatric Cardiac Arrests in Medical Students Following a Training Course.

BackgroundNewly qualified doctors lack competency in handling a cardiopulmonary resuscitation. The ability to recall CPR fundamentals have been shown to be inadequate. Of greater concern is that medical students over - estimate their ability to deliver such aid in a real - world setting. As most medical students are only taught adult BLS they are often unskilled and/or unhelpful in managing paediatric specific emergencies. This fact is supported by the poor outcomes demonstrated in delivering successful Paediatric Basic Life Support (PBLS).ObjectivesOur aim was to evaluate the baseline confidence levels of medical students in dealing with a paediatric cardiac arrest (PCA) and the improvement seen following a PBLS training course.MethodsA prospective study was conducted on 51 medical students who attended an established one - day PBLS and first aid course at one UK medical school. Participants were requested to complete a questionnaire directly prior to and after the course.ResultsFollowing the delivery of the training, the cohort reported a statistically significant (P < 0.05) increase in mean confidence with PCA from 2.2/10 (2.2 out of 10) to 7.5/10. A pre - training mean confidence score of 2.6/10 was observed for Year 4 and 5 students who are close to graduating.ConclusionsOur findings clearly demonstrate very poor confidence among medical students with PCA at all stages of their training. We would strongly advocate the inclusion of a PBLS component in medical school curriculums so that future doctors are adequately prepared to deliver PBLS with confidence.

Does the Addition of DWI to Fluid-Sensitive Conventional MRI of the Sacroiliac Joints Improve the Diagnosis of Sacroiliitis?

The purpose of this study was to determine whether adding DWI to conventional MRI of the sacroiliac joints improves the diagnostic performance of MRI readers in the detection of sacroiliitis. MR images of the sacroiliac joints of 63 patients with lower back pain obtained between January 2016 and December 2016 were analyzed retrospectively. Three readers reviewed the MRI studies for bone marrow edema lesions around the sacroiliac joints as a marker of active sacroiliitis and gave a diagnostic confidence score of 0-4 using MRI without DWI and MRI with DWI in separate sessions. The normalized apparent diffusion coefficient mean (nADCmean) was measured. Clinical and radiologic data using the Assessment of Spondyloarthritis International Society criteria were the reference for the diagnosis of sacroiliitis. Diagnostic performance, confidence scores, and interreader agreement for the MRI methods were compared. The nADCmean values of patients with and those without sacroiliitis were compared. The accuracy, sensitivity, and specificity of MRI without DWI were 68.3%, 69.0%, and 67.6% and for MRI with DWI were 74.6%, 69.0%, and 79.4% (accuracy and sensitivity, p > 0.100; specificity, p = 0.039). The mean confidence score for MRI without DWI was 3.60 and for MRI with DWI was 3.67 (p = 0.270). The kappa coefficient for MRI without DWI was 0.28 and for MRI with DWI was 0.46 (p = 0.041). The nADCmean in patients with sacroiliitis was 3.86 and in patients without sacroiliitis was 1.6 (p ≤ 0.001). The nADCmean AUC was 0.758 (95% CI, 0.67-0.83). The addition of DWI to conventional MRI does not significantly improve overall diagnostic performance in terms of accuracy, sensitivity, or confidence in the detection of inflammatory sacroiliitis, but it does have increased specificity and interobserver agreement. ADC threshold values can be used as predictors of sacroiliitis but give no added advantage over MRI with DWI.

Integration of transgender care into a pharmacy therapeutics curriculum

Background and purposeTo examine the impact of a lecture on transgender health given during a special populations therapeutics course on third-year (P3) pharmacy students' knowledge and confidence of transgender care. Educational activity and settingA two-hour lecture that included both cultural sensitivity and pharmacotherapy aspects of care for transgender individuals was added to a required two-credit therapeutics series offered at the end of the P3 year of a doctor of pharmacy curriculum. Following the lecture, students completed a 17-item knowledge-based survey and ranked their confidence with each answer on a 5-point scale. Students in the fourth-year (P4) class, who had not been given the lecture, also completed the survey. FindingsStudents who attended the lecture had a significantly higher mean knowledge score and mean confidence score than students who did not attend. The P3 class had a mean knowledge score of 72.5% while the mean knowledge score for the P4 class was 63.4% (P < 0.01). The P3's mean confidence score was 76.8% and the P4's mean confidence score was 60.6% (P < 0.01). DiscussionTo the authors’ knowledge, this is the first report on incorporating the topic of transgender care to a required disease and therapeutics series in a college of pharmacy curriculum. SummaryStudents who attended a lecture on care of transgender individuals performed significantly better on a knowledge-based assessment and reported having greater confidence in their answers than students who did not attend the lecture.

Factors Influencing Activities-specific Balance Confidence in Community-dwelling Old Adults

Purpose: The purpose of this study is to identify factors influencing activities-specific balance confidence in community- dwelling older adults. Methods: This is secondary analysis of data from an intervention study for improving cognitive function. The data were collected from March 2 to September 30, 2017 at a senior center. Data of 131 older adults were included for this secondary analysis, and were analyzed by using t-test, ANOVA, and multiple regression. Results: The mean score of activities-specific balance confidence is 65.08 out of a possible range of 0-100. The significant factors affecting activities-specific balance confidence among old adults include ‘more than 85 years old’, ‘waist circumference’, ‘depressive symptoms’, ‘activity restriction due to fear of falling’, and ‘self-rated health’ which explained 52.8% of the variance. Conclusion: The study results indicate that psychologic factors as well as physical condition should be considered for interventions to increase activities-specific balance confidence.

Piloting a Sex-Specific, Technology-Enhanced, Active Learning Intervention for Stroke Prevention in Women.

Recent studies reveal deficiencies in stroke awareness and knowledge of risk factors among women. Existing stroke education interventions may not address common and sex-specific risk factors in the population with the highest stroke-related rate of mortality. This pilot study assessed the efficacy of a technology-enhanced, sex-specific educational program ("SISTERS") for women's knowledge of stroke. This was an experimental pretest-posttest design. The sample consisted of 150 women (mean age, 55 years) with at least 1 stroke risk factor. Participants were randomized to either the intervention (n = 75) or control (n = 75) group. Data were collected at baseline and at a 2-week posttest. There was no statistically significant difference in mean knowledge score (P = .67), mean confidence score (P = .77), or mean accuracy score (P = .75) between the intervention and control groups at posttest. Regression analysis revealed that older age was associated with lower knowledge scores (P < .001) and lower confidence scores (P < .001). After controlling for age, the SISTERS program was associated with a statistically significant difference in knowledge (P < .001) and confidence (P < .001). Although no change occurred overall, after controlling for age, there was a statistically significant benefit. Older women may have less comfort with technology and require consideration for cognitive differences.

IP223 Are Patients With Critical Limb Ischemia Ready for Telemedicine?

Patients with critical limb ischemia (CLI) may face numerous barriers to care, including distance and burden of coordinating travel required for multiple inpatient and outpatient visits. We aimed to investigate perceptions and attitudes of patients with CLI to the possibility of providing vascular care through telemedicine. Patients being treated for Rutherford class 5 CLI underwent semistructured interviews with questions focused on current ulcer issues, comfort with current health providers, ability and willingness to see specialists outside of their region, and comfort with health care provided through technology. A mixed-methods approach was used to compare responses and develop themes for a larger patient survey. Eleven patients with a mean age of 60 years (range, 35-79 years) were interviewed. Diabetes mellitus was present in eight patients (73%). Ten of the patients could describe their wound and current treatment regimen. Patients with ulcers due to peripheral artery disease (PAD) were unfamiliar with the terminology but did recall being told they had “bad blood flow.” Patients expressed a mean confidence score of 3.36 of 4 in their current provider. Factors that decreased a patient's confidence included the providers' “ability to hear” the patient's concerns. Seven patients required transport by others, and four drove themselves. All patients were willing to make three or more visits a month to their provider for treatment. Nine patients had Internet at home, and six of these felt comfortable using technology on their own. Eight patients expressed a “lack of trust” regarding seeing an unknown provider over the Internet. Four of these believed an endorsement from their primary care provider could change this perception, but remained “unsure they could form a relationship” with the provider through the Internet. Themes of uncertainty for seeing a provider through the internet centered around “security of personal information,” “ability to maintain confidentiality” of the visit, and limited ability to “get to know” the provider. In this exploratory study of CLI patients, 81% have home Internet and >50% felt comfortable using technology on their own. Primary care provider recommendation can improve patient willingness to use technology for initial specialist consultation, but focused attention must be placed on development of the patient-provider relationship through telemedicine. Using themes developed from this qualitative study, we plan to develop a survey applicable to all patients with CLI to understand their concerns and technological capabilities.

Experiences of patients undergoing pulmonary rehabilitation during an exacerbation of chronic respiratory disease.

Chronic obstructive pulmonary disease (COPD) is characterized in the later stages by acute exacerbations that often require hospitalization. Pulmonary rehabilitation is recommended for patients with COPD to aid symptom control, improve quality of life and increase physical activity. We have previously reported a large intervention trial commenced during a hospital admission. The aim of this sub-study was to evaluate the patients’ experiences of discharge following the hospitalization for an acute exacerbation of COPD. During a programme of early rehabilitation (ER) patient perceptions, experiences and healthcare use were collated during the month that followed their discharge. ER (started during their admission) was comprised of exercise training techniques that were modified to suit the environment of acute illness, together with an education and self-management programme. Each patient was then supported on the programme by telephone contact, following their discharge home, at 48 hours, 2 weeks and 4 weeks. We collected information in relation to the walking and exercise progression; we monitored patient recall of healthcare use, compliance/understanding of medical therapy, as well as their wider perceptions that may have influenced the recovery process. Healthcare use was captured using GP records and data analysis. Of the 100 patients, 47 males, (mean (standard deviation)) 71 (9.3) years, FEV1 1.14 L (0.6), BMI 26.6 (6.9), pack smoked years 45.8 (29.6), ethnicity White British 97%, were discharged home following an acute exacerbation of their respiratory symptoms, to an ER programme. At 48 hours following discharge, a minority (20%) of patients stated their symptoms were ‘feeling better’; 15% highlighted that they found the prescribed ‘exercise difficult’; 44% of patients felt at the end of the month that prescribed exercise programme had a ‘positive effect’ on their recovery from their exacerbation; 38% of patients felt their family had a positive effect on their recovery; 11% felt their family hindered. Patients reported a mean confidence score of 8.21 (2.1) for exercise that did not vary over the three contacts (p = 0.166). A similar mean confidence score of 7.76 (2.6) was reported for walking with a non-statistical change also noted (p = 0.223). When patient recall of primary health care contact was compared with actual use, there was statistical significance shown (p = 0.002); patients underestimated the amount of care they received. The data indicate that patients do recover at home within the support of an early intervention. Patients are positive about the benefit of ER in the process of recovery; however, this is uncontrolled data.

Abstract 24: Helping to Educate Women About the Risk of Stroke (HER-Stroke): Initial Results from a Teaching Intervention

Introduction: Recent studies reveal deficiencies in educating women about stroke. The vast majority of stroke education is presented as gender neutral or with a male bias. This study examined if a computer-based, gender-specific education program (HER-Stroke) increased women’s awareness of stroke signs and symptoms. Methods: This 2-phase prospective study with 2-week follow-up examined gender-specific education based on Knowles’ Theory, enrolled 225 women with at least one stroke risk factor from any inpatient setting or neurology outpatient setting. Phase I, 75 women received standard stroke education (Group A). Phase II, 150 women randomized to standard (Group B) vs HER-Stroke education (Group C). Knowledge is scored as the percent of questions answered correctly; confidence is the percent of questions attempted; and accuracy is percent correct of those attempted. Results: Mean age was similar for Group A, B, C (54.4, 57.9, 52.5 years) respectively. There were no statistically significant differences in mean knowledge scores comparing groups A B and C: (69.4%, 71.6%, 69.0%; p=0.67), mean confidence scores for groups A, B, and C respectively (80.8%, 83.2%, 80.2%; p=0.77), or mean accuracy scores for group A B and C (86.2%, 85.6%, 85.0%; p=0.75). Regression analysis revealed that older age was associated with lower knowledge scores (p&lt;.001) and lower confidence scores (p&lt;.001). After controlling for age, the intervention was associated with a statistically significant difference in knowledge and confidence (p&lt;.001). Conclusions: Enhanced efficacy among younger participants may reflect experience and comfort using technology. While the intervention was not associated with a change in overall scores, after controlling for age there was a statistically significant difference among groups. Further research including unmeasured covariates is needed to explore optimal stroke education formats for older learners.

Healthcare Professionals&amp;apos; Habits of Physical Activity and Their Confidence to Prescribe/Counsel Physical Activity in Hospital Setting, Ethiopia

The purpose of this study is to assess healthcare professionals’ physical activity habits and their confidence to prescribe for chronic (non-communicable) diseases in hospital setting through a cross-sectional survey design. Seven sample hospitals were selected randomly based on the inclusion and exclusion criteria from 12 hospitals. The sample size was determined by using the formula for estimating a single population proportion. The mean score of the participants' confidence was (N = 369, M= 21.7 ± 6.36), indicates that above half of healthcare professionals were had moderate confidence to counsel/prescribe physical activity. The majority of (73.7%) of healthcare professionals reported doing moderate level of physical activity, only 2.8% of participants in the study were categorized as vigorous and 23.5% of the respondents were categorized as low physical activity level. Personal physical activity levels was significantly and positively correlated with confidence of HCPs to prescribe/counsel PA (r_s =.266, p =.00). Hence, the more physically active the participants, they were had a greater confidence to prescribe/counsel about physical activity for their patients.

The undergraduate preparation of dentists: Confidence levels of final year dental students at the School of Dentistry in Cardiff.

Objective To investigate the self-reported confidence and preparedness of final year undergraduate students in undertaking a range of clinical procedures.Methods A questionnaire was distributed to final year dental students at Cardiff University, six months prior to graduation. Respondents rated their confidence in undertaking 39 clinical procedures using a 5-point scale (1 = can undertake on own with confidence, 5 = unable to undertake). Students also responded yes/no to experiencing four difficulties and to three statements about general preparedness.Results 71% (N = 51) responded of which 55% (N = 28) were female. Over half reported being 'anxious that the supervisor was not helping enough' (57%) and 'relying heavily on supervisor for help' (53%). Eighty percent 'felt unprepared for the clinical work presented' and gender differences were most notable here (male: 65% N = 33; females: 93% N = 47). Mean confidence scores were calculated for each clinical procedure (1 = lowest; 5 = highest). Confidence was highest in performing 'simple scale' and 'fissure sealant' (mean-score = 5). Lowest scores were reported for 'surgical extractions involving a flap (mean-score = 2.28)', 'simple surgical procedures' (mean-score = 2.58) and the 'design/fit/adjustment of orthodontic appliances' (mean-score = 2.88).Conclusions As expected complex procedures that were least practised scored the lowest in overall mean confidence. Gender differences were noted in self-reported confidence for carrying out treatment unsupervised and feeling unprepared for clinical work.