Median Number Of Correct Answers Research Articles

Abstract 6131: Increasing self efficacy, self confidence, and genetic knowledge via the Community Genetic Navigation Engagement Specialist Train-the-Trainer program

Abstract Background: Colorectal cancer (CRC) is the second and third leading cause of cancer deaths in US Hispanic/Latino (H/L) men and women, respectively. The Community Genetic Navigation Specialists (CoGENES) train-the-trainer program created a workforce of community health workers (CHWs) to educate H/L individuals about genetic testing, counseling, and research. Methods: The CoGENES three-week program, consisted of six in-person sessions, with a curriculum in both Spanish/English developed and delivered by experts, in Spanish, using presentations and hands-on activities. Acculturation, Latino values, self-efficacy, genetics and tumor testing knowledge, and self-confidence were assessed via pre- and post-training. Differences in scores were analyzed via Wilcoxon matched-pairs signed-rank tests with exact p-values. Results: Median age of the 12 participants was 50 (IQR = 12), 9 were female, 92% were Mexican-born, half completed 1-2 years of college, and 67% were very hispanic oriented. Self-efficacy increased after training, with pre- training median-score = 38.5 (IQR = 3) and post-training score = 39.5 (IQR =2.5) (p = 0.0547). Certainty about understanding tumor testing increased after training (p = 0.0039). The median number of correct answers on the 16-item genetic knowledge scale increased from 6.5 to 9.5 and the median number of “don’t know” responses decreased from 5 to 0 after training. Finally, self-confidence to train future CoGENES was significantly higher (p = 0.0098) at post-test. Conclusion: The CoGENES culturally tailored program led to improved self-efficacy, increased genetic knowledge, and self-confidence in a cohort of Hispanic community health educators. Findings will be shared within COPECC, and other NCI funded programs. Citation Format: Janet Rodriguez, Joel Sanchez Mendez, Yaneth L. Rodriguez, Lourdes Baezconde-Garbanati, Charité Ricker, Rosa Barahona, Bianca Rosales, Daisy Hernandez, Natalia Gutierrez, Julie Culver, Mariana Stern. Increasing self efficacy, self confidence, and genetic knowledge via the Community Genetic Navigation Engagement Specialist Train-the-Trainer program [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6131.

Oral health knowledge and attitude among healthcare professionals of long-term care units: A cross-sectional survey.

This study aims to evaluate the knowledge and the attitude in oral health (OH) of nurses (NUR) and auxiliary health technicians (AHT) belonging to the Long-term Care Units (LTC). Observational cross-sectional study. A survey was applied in five MLTC in Porto (Portugal) to 145 healthcare works (HCW). Data were collected using structured questionnaires with questions about knowledge and attitude regarding oral care. Data analysis comparison was performed using non-parametric tests (α=0.05). Out of a total of 259 HCW, 145 responses were obtained (55.98% response rate). The median number of correct answers was significantly different for NUR and AHT without oral health training (OHT) (p=.035).AHT with OHT had a significantly lower number of correct answers compared to NUR with OHT (7vs. 9, p<.001). There was no significant difference in the number of correct answers in NUR with or without OHT (p=.391) and that the AHT without OHT have a median of correct answers significantly higher than those who they have OHT (8vs. 7, p=.020) CONCLUSIONS: Despite the positive attitude of the HCW, the knowledge is scarce. HCW recognized the urgence to update the protocols. Integrating dentists in the LTC team, implementation of OH protocols and providing OH training should be considered to bridge existing gaps.

A Trial of Practical Training on Online Medication Instructions in Clinical Preparatory Education: Development of Human Resources to Provide New Forms of Medical Care after the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has considerably affected several social services. The Ministry of Health, Labour, and Welfare has partially revised the Pharmaceuticals and Medical Devices Law and established legislations on permanent online medication instructions. Based on these social needs, the development of human resources to provide online medication instructions is vital. Therefore, we developed a training program for providing online medication instructions in preparatory clinical education. Pharmacy students who had conducted medical interviews with standardized patients participated in the training. Educational outcomes were evaluated using an objective multiple-choice test and free description before and after practical training. The median number of correct answers on objective tests on the legislation on online medication instructions increased significantly. Based on the free description analysis, students were able to comprehend the influence of communication environment on the quality of medication instructions. Based on the results of the direct evaluation using objective testing and indirect evaluation by analyzing the free descriptions, they also acquired the skills necessary for providing online medication instructions. Therefore, this training program can contribute to mastering the provision of online medication instructions.

Long-term outcomes of standardized training for caregivers of children with tracheostomies: The IStanbul PAediatric Tracheostomy(ISPAT) project.

We included 32 caregivers (31 children) who had received standardized training a year ago and administered the same theoretical and practical tests 1 year after training completion. We recorded tracheostomy-related complications and the number and reasons for admission to the healthcare centers. All data just before the training and 1 year after training completion were compared. After 1 year of training completion, the median number of correct answers on the theoretical test increased to 16.5 from 12 at pretest (p < 0.001). Compared with pretest, at 1-year post-training practical skills assessment scores, including cannula exchange and aspiration, were significantly higher (both p < 0.001) and mucus plug, bleeding, and stoma infection reduced significantly (p = 0.002, 0.022, and 0.004, respectively). Hands-on-training scores were better than pretest but declined slightly at 1 year compared to testing immediately after training. Emergency admission decreased from 64.5% to 32.3% (p = 0.013). Hospitalization decreased from 61.3% to 35.5% (p = 0.039). Our findings indicate that caregiver training can lead to a persistent increase in knowledge and skill for as long as 1 year, as well as improvements in several measurable outcomes, although a slight decrease in scores warrants annual repetitions of the training program.

Virtual Reality simulation training improves health professionals’ knowledge in STEMI critical care

Abstract Background In Friuli-Venezia Giulia (FVG, Italy, 1.2M inhabitants), the STEMI network has been implemented with a regional educational programme since 2018. However, each step leading to a fast-track reperfusion needs specific interactions between critical care teams on the scene and in hospital that theoretical training cannot provide. Objectives A new educational tool, based on virtual reality (VR), was developed to train emergency nurses and doctors on the STEMI pathway. Each training session consisted of a VR simulation, dynamically driven by an instructor, where a nurse-doctor pair had to provide first aid to a patient with chest pain. A plenary debriefing followed each session. Before and after the training, all participants filled out a questionnaire on the STEMI pathway (21 multiple-choice items on technical and organizational issues) to evaluate the course theoretical effectiveness. This research is part of the EASY-NET program, co-funded by the Ministry of Health and the participating Regions (NET-2016-02364191). Results Between Oct ’22 and Jan ’23, 48 nurses and 14 doctors were trained and filled in both pre- and post-training questionnaires. Before the training, the median number of correct answers was 15 (IQR 13-16), after the course it rose to 16 (IQR 15-17, p &amp;lt; 0.0001); doctors performed better than nurses both at pre- (16, IQR 15-17 and 14.5, IQR 12.5-16, respectively; p = 0.017) and post-test (18, IQR 15-18 vs 16, IQR 15-17; p &amp;lt; 0,0001) but both categories significantly improved their scores (p = 0.019 and p = 0.0001). The main improvement was observed for items concerning the Case Manager's actions after ECG, (right answers: 58 post-test vs 45 pre, p = 0.0016), morphine administration, (37 vs 25, p = 0.0073), and therapy in vagal reaction (46 vs 35, p = 0.0116). Conclusions An innovative VR simulation training improves the theoretical knowledge of the critical care pathway of STEMI in healthcare teams, which may lead to a better approach to this disease. Key messages • A new Virtual Reality simulation tool is useful for the training of doctors and nurses in patients with STEMI. • Simulation tools based on Virtual Reality can improve health professionals’ theoretical knowledge in critical care pathways.

Are pediatricians familiar with hereditary angioedema?

BackgroundHereditary angioedema (HAE) is an autosomal dominant disease characterized by recurrent episodes of subcutaneous or mucosal edema caused by excess bradykinin. The aim of the present study was to assess the knowledge of pediatricians about hereditary angioedema. MethodsAn online survey with 12 HAE-related and 14 demographics-related questions was e-mailed to all pediatricians who were members of the Brazilian Society of Pediatrics (n = 17 145) once a week during the months of June and July 2021. The electronic questionnaire assessed clinical manifestations, diagnosis, and treatment of hereditary angioedema in children and adolescents. ResultsFour hundred and fifty-five pediatricians responded to the questionnaire (2.6%), of whom 55 (12.1%) were board certified in Allergy and Immunology (A/I), while 400 (87.9%) were not (N-A/I). Three hundred and sixty-eight (80.9%) were female, 289 (55.7%) were under 50 years of age, 286 (62.9%) graduated from Medical School more than 10 years previously, 83 (18.2%) held an MSc/PhD degree, and 253 (55.6%) were living in the Southeast Region of Brazil. The median number of correct answers to the questions related to HAE among A/I was 7 out of 12 (58.3%), with median ranging from 4.5 to 8 correct answers, while for N-A/I it was 3 (25%), with median ranging from 2.5 to 4 correct answers (p < 0.001). ConclusionKnowledge about HAE among Brazilian pediatricians, whether board certified in Allergy and Immunology or not, was unsatisfactory. HAE is a rare disease, largely unknown among physicians; therefore, increasing awareness may lead to improvement in diagnosis and treatment.

TRUE-Bolivia: Trauma Responders Unifying to Empower Communities in Santa Cruz, Bolivia.

The aim of this study is to assess the efficacy of the TRUE-Bolivia (Trauma Responders Unifying to Empower Communities Bolivia) trauma first responder course at improving participant confidence in first responder abilities and increasing knowledge of trauma response skills. Participants attended the 4-h TRUE-Bolivia course at the municipal department of urban transportation and universities and medical schools in Santa Cruz, Bolivia and completed a demographic survey and pre- and post-course knowledge assessments. All participants who attended the full course and completed both knowledge assessments were included in the study, with 453 people attending at least one portion of the course and 329 completing the full course and assessments. A majority of participants were men, had completed high school or attended university, and worked or trained in the fields of transportation or medicine. Participant ratings of confidence on a 5-point Likert scale improved from a median of 3 (interquartile range [IQR] 2) before the course to 5 (IQR 1) after the course (P<0.01). The median number of correct answers on the pre-course nine-question knowledge assessment was 3 (IQR 3), improving to 7 (IQR 3) on the post-course assessment (P<0.01). All demographic groups demonstrated improvements in scores from the pre- to post-test. Female gender, higher education level, a background in medicine, and prior training in first aid were associated with higher pre- and post-test scores. The TRUE-Bolivia course increased knowledge of first responder skills and improved confidence in these abilities in participants from a variety of backgrounds. Further study is needed to determine the long-term skill utilization by participants and the course's impact on local trauma morbidity and mortality.

Fertility awareness and attitudes among resident physicians across different specialties.

To evaluate knowledge of age-related fertility decline and oocyte cryopreservation among resident physicians in obstetrics and gynecology (ob-gyn) compared to residents in other specialties. An online survey was sent to the US residency program directors for ob-gyn, internal medicine, emergency medicine, family medicine, general surgery, pediatrics, and psychiatry. They were asked to forward the survey to their respective residents. The survey consisted of three sections: fertility knowledge, oocyte cryopreservation knowledge, and attitudes toward family building and fertility preservation. Multivariable logistic regression models were used to compare outcomes between ob-gyn and non-ob-gyn residents. Of the 2,828 completed surveys, 450 (15.9%) were by ob-gyn residents and 2,378 (84.1%) were by residents in other specialties. 66.3% of respondents were female. The median number of correct answers was 2 out of 5 on the fertility knowledge section and 1 out of 3 on the oocyte cryopreservation knowledge section among both ob-gyn and non-ob-gyn residents. After adjusting for covariates, residents in ob-gyn were no more likely to answer these questions correctly than residents in other specialties (fertility knowledge, adjusted OR .97, 95% CI .88-1.08; oocyte cryopreservation knowledge, adjusted OR 1.05, 95% CI .92-1.19). Ob-gyn residents were significantly more likely than non-ob-gyn residents to feel "somewhat supported" or "very supported" by their program to pursue family building goals (83.5% vs. 75.8%, OR 1.62, 95% CI 1.23-2.14). Resident physicians, regardless of specialty, have limited knowledge of natural fertility decline and the opportunity to cryopreserve oocytes. These data suggest need for improved fertility education.

The ISPAT project: Implementation of a standardized training program for caregivers of children with tracheostomy

Tracheostomy-related morbidity and mortality mainly occur due to decannulation, misplacement, or obstruction of the tube. A standardized training can improve the skills and confidence of the caregivers in tracheostomy care (TC). Our primary aim was to evaluate the efficiency of standardized training program on the knowledge and skills (changing-suctioning the tracheostomy tube) of the participants regarding TC. Sixty-five caregivers of children with tracheostomy were included. First, participants were evaluated with written test about TC and participated in the practical tests. Then, they were asked to participate in a standardized training session, including theoretical and practical parts. Baseline and postintervention assessments were compared through written and practical tests conducted on the same day. A significant improvement was observed in the written test score after the training. The median number of correct answers of the written test including 23 questions increased 26%, from 12 to 18 (p < .001). The median number of correct steps in tracheostomy tube change (from 9 to 16 correct steps out of 16 steps, 44% increase) and suctioning the tracheostomy tube (from 9 to 17 correct steps out of 18 steps, 44% increase) also improved significantly after the training (p < .001, for both). Theoretical courses and practical hands-on-training (HOT) courses are highly effective in improving the practices in TC. A standardized training program including HOT should be implemented before discharge from the hospital. Still there is a need to assess the impact of the program on tracheostomy-related complications, morbidity, and mortality in the long term.

LOW COST SIMULATOR FOR CARDIOPULMONARY RESUSCITATION IN INFANTS

Introduction: The use of realistic simulation methodology is used in several learning scenarios, allowing students to participate directly in the problematization of situations that require immediate professional action. Objective: To develop, validate and validate a low cost simulator for cardiopulmonary resuscitation and resuscitation procedures in infants. Methods: An experimental study carried out with undergraduate students of the 1st year of the Nursing course at a higher education institution in the State of Paraíba, developed a simulator model with dimensions similar to an infant with low cost materials and made possible the use as a prototype for Basic Life Support training. The prototype was developed with the accessories for disengagement and cardiopulmonary resuscitation maneuvers. The data collection instrument was a questionnaire based on the American Hearth Association Basic Life Support guideline to enable and validate the Basic Life Support training instrument. Results: The low-cost prototype for Basic Life Support training was used as a learning object adequately and enabled the teaching-learning process as an accessible resource at low cost. Based on the questionnaire applied, we observed that there was an increase in the median number of correct answers and a reduction in the median of errors, which indicated an improvement in the acquisition of information and improvement in learning, observed through the test of Signal of Related Samples and the test of the Signs of Wilcoxon, (MA) and errors (ME), before and after training where it was found that there was an increase in MA and a reduction in ME with 5% significance (p &lt;0.001). The frequencies of response modifications after training with the simulator were also studied by means of the two-tailed McNemar test where Q1, Q2, Q3, Q4, Q8, Q9, Q13 and Q15 questions showed significant changes (p &lt;0, 05). Conclusion: A prototype was developed that simulated the training activity in Basic Life Support, which made it possible to carry out the procedures appropriately in positioning and simulation of cardiac resuscitation, mouth / nose ventilation, and tapping in the scapular region. Which allowed the validation of disengagement and resuscitation training as a low cost alternative for health education.

Predictors of influenza vaccination uptake among elderly in Croatia

Abstract Background Influenza vaccination (IV) is recommended for elderly but vaccination coverage in this group remains unsatisfactory in Croatia. The aim of this study was to explore IV uptake among elderly from Eastern Croatia and predictors that influence this uptake. Methods This cross-sectional questionnaire study was conducted during 2018/2019 influenza season in convenient sample of older adults aged 65 years or more from Eastern Croatia at the primary health care setting. Results The study sample consisted of 816 subjects (48.0% males and 52.0% females). The median age of all subjects was 73.0 years (interquartile range (IQR) 69.5 - 79.0 years). The overall prevalence of IV uptake was 33.3%. The IV uptake was statistically more frequent among females (P &amp;lt; 0.001) and old-old subgroup (85 years and older) (P &amp;lt; 0.001). There was no statistically significant difference in IV uptake considering marital status of subjects (P &amp;gt; 0.999). The median number of positive attitudes towards IV was 4.0 (IQR 2.0 - 4.0) and the median number of correct answers was 6.0 (IQR 4.0 - 8.0). The study revealed fair positive correlation between attitudes and IV uptake (rho=0.477; P &amp;lt; 0.001) and poor positive correlation between knowledge and IV uptake (rho=0.242; P &amp;lt; 0.001). The study further showed poor positive correlation between presence of comorbidities and IV uptake (rho=0.187; P &amp;lt; 0.001) and moderate positive correlation between previous year vaccination history and IV uptake (rho=0.669; P &amp;lt; 0.001). Conclusions The study showed that observed IV uptake is far below EU target influenza vaccination coverage among elderly of 75%. The study revealed that fairly good predictors of IV uptake in study population were gender, older age group, and previous year vaccination history while attitudes, knowledge and presence of comorbidities were fairly poor predictors. The good predictors of IV uptake among elderly should be taken into account during influenza vaccination popularization strategies development. Key messages Understanding the factors that could improve the acceptance of vaccination is crucial to design effective public health interventions. The structured communication campaigns on influenza and influenza vaccines should be developed and directed specifically to elderly as one of target groups for vaccination.

1285. Impact of an Educational Program on Knowledge, Attitude and Practice to Prevent HIV Infection Among HIV-Negative Heterosexual Partners of HIV-Infected Patients

BackgroundData on knowledge, attitudes, and practices to prevent HIV transmission are limited and effective strategies to improve such knowledge, change attitudes, and reduce risk behaviors are unknown among serodiscordant couples.MethodsA quasi-experimental study was conducted among HIV-negative adult heterosexual partners of HIV-infected patients. The intervention was an educational program consisting of a 1-hour educational session on knowledge about HIV infection and transmission prevention, a condom use teaching session, group discussion and experience sharing, and free HIV testing. Self-administered survey was conducted pre- and post-intervention on the same day to assess effectiveness of the program in improving HIV knowledge and changing attitudes toward HIV prevention. The participants were invited to participate in the program again 6 months later to assess retention of the knowledge and positive attitudes and practices to prevent HIV.ResultsA total of 88 participants were enrolled. The median age was 39 years and 49 (56%) were male. The median number of correct answers to the 30 statements about HIV infection and transmission prevention was significantly higher after the program compared with before the program (28 vs. 21; P < 0.001). After the program, higher proportions of the participants would encourage treatment of their HIV-infected partners (77% vs. 58%), use pre-exposure prophylaxis (59% vs. 38%), have a regular HIV blood test every 6 months (94% vs. 81%) and think that they and their partners can have a baby together safely with the current HIV transmission prevention strategies (48% vs. 17%) compared with before the program (all P < 0.05). Among the 35 participants who participated in the educational program twice, most of the knowledge and positive attitudes were retained. The rates of regular HIV testing every 6 months and consistent condom use had increased from baseline to 6 months later (29% to 74% and 71% to 91%, respectively). None of the participants acquired HIV from their partners.ConclusionThe educational program was shown to be effective in improving HIV knowledge, attitudes, and practices toward HIV prevention among the seronegative partners.Disclosures All authors: No reported disclosures.

Informed decision making (IDM) for prostate cancer (PCa) screening in a high-risk population.

112 Background: PCa incidence and mortality in African Americans (AA) is higher than in Caucasians. Health-education programs and culturally appropriate outreach to high-risk groups in accordance with American Cancer Society IDM guidelines can reduce disparities. Data show that it is hard to provide comprehensive unbiased education about screening to patients (pts). This study aims to examine whether IDM guidelines in a large high risk group setting can improve knowledge on PCa and screening decision, and whether such education program is overall beneficial to pts. Methods: Pts were included in one-day outreach event and were given a 15-question pre and post- test focused on standard informative educational PowerPoint and then were offered screening (PSA + DRE). Components of IDM were reviewed during this educational intervention. Demographics and family history was collected and UCSF 10-year mortality index was assessed to help IDM. Pre- and post- test number of correct answers were compared (Wilcoxon signed rank); pts were surveyed on their opinion on the program. The decision regarding screening after the intervention was tracked as well as the % of PCa diagnosed. Pts were tracked via an established navigation system to ensure follow up care. Results: 106 pts were included in the current analysis. Median number of correct answers at pre and post test was 8 and 11 (p &lt; 0.001). Overall, 86% responded that they wanted screening. Of those, 92% were AA and 21% had family history of PCa; 21 pts had PSA only, 60 had PSA + DRE. 13 pts (16%) had abnormal PSA per NCCN guidelines, 5 (8%) had abnormal DRE. 5 PCa were biopsy-diagnosed, 4 had abnormal DRE + PSA; 1 had only abnormal DRE. Overall, 82% pts favored IDM before screening, 18% would prefer screening without IDM. 75% of all pts found the information “very helpful” in decision-making (within a 5-point Likert scale). Conclusions: Our education-based IDM led to significant improvement in knowledge about PCa screening. Most pts preferred education prior to screening. Our approach paired with the use of navigation program is feasible and was positively received by a large high risk group. Project is ongoing with more pts and follow up, and further validation is pending. Clinical trial information: NCT02419846.

Maternal knowledge of the impact of obesity on complications relevant to obstetric anesthetic care

Background: The number of overweight adults in Australia has more than doubled in 20 years and 50% of pregnant women in Australia are overweight. This study investigated whether pregnant women are aware of the peripartum obstetric and anesthetic risks conferred by obesity. Methods: A sample of 180 antenatal women attending an obstetric tertiary referral hospital were surveyed to identify the level of knowledge about the effect of obesity on medical, obstetric, and anesthetic outcomes, using a 23-item questionnaire. Correct responses were expressed as a percentage and comparisons, based on maternal characteristics including body mass index (BMI), performed using Mann–Whitney and Kruskal–Wallis tests for continuous outcomes and the Chi-square test for categorical outcomes. Logistic regression analysis was conducted to evaluate the maternal characteristics predictive of scores below the 50th percentile. Results: The median percentage of correct answers for all participants was 39% (interquartile range: 30–52%). More correct responses were obtained to questions about medical and obstetric complications. pre-pregnancy BMI ≥ 30 kg/m2, nulliparity, and no tertiary education were significant predictors of scores below the 50th percentile in the survey. Knowledge of the effects of obesity on anesthetic complications did not appear to be influenced by maternal age, ethnicity, or planned mode of delivery. Conclusion: The median number of correct answers was less than half, with women with a BMI < 30 kg/m2 being less knowledgeable. Knowledge about anesthetic problems and risks was less than that about medical and obstetric issues.

Breaking down barriers to communicating complex retinoblastoma information: can graphics be the solution?

ObjectiveTo investigate the impact of a graphical timeline summarizing bilateral retinoblastoma disease and treatment outcomes on parents’ understanding of complex medical information. DesignCross-sectional survey. ParticipantsParents of children with retinoblastoma who were being actively managed at The Hospital for Sick Children were recruited. Forty-five parents from 42 families participated. MethodsAfter a standardized presentation on retinoblastoma and visual tool named Disease-Specific electronic Patient Illustrated Clinical Timeline (DePICT), parents completed a 19-item questionnaire designed to assess their understanding of treatment choices for 2 eyes in bilateral retinoblastoma as communicated using DePICT. SPSS was used to perform statistical analysis. ResultsForty-five parents from 42 families participated (65% female). Median age of participants was 34 years. Median level of participant education was completion of college/trade school. The median level of annual income was $40 000 to $70 000 CDN. Median time since diagnosis of retinoblastoma in their child was 13.5 months. Twenty-three (51%) participants were parents of children with unilateral retinoblastoma, and 22 (49%) were parents of children with bilateral retinoblastoma. Median number of correct answers was 15 of 19, and mean score was 77%. Normal distribution of scores was noted. English as a first language was significantly associated with score (p = 0.01). No significant association was observed between other variables and score in all analyses. ConclusionsThis study builds on the validation of DePICT by demonstrating that parents can achieve good comprehension even when considering choices for treatment for 2 eyes with bilateral retinoblastoma. Clinical application of this tool can enhance the consent process.

Current knowledge of antibiotic prophylaxis guidelines regarding GI open-access endoscopic procedures is inadequate

The American Heart Association (AHA) guidelines from 2007 and the American Society for Gastrointestinal Endoscopy (ASGE) guidelines from 2008 recommended against antibiotic prophylaxis before GI endoscopic procedures to prevent bacterial endocarditis. To determine physician knowledge regarding these guidelines and to identify physician subgroups for which knowledge was suboptimal. A survey questionnaire was developed based on AHA and ASGE guidelines regarding antibiotics before endoscopy. Physicians were queried about 10 theoretical scenarios as to whether or not they would recommend before-procedure antibiotics. The survey was administered at 3 academic medical centers. Attending physicians and trainees in primary care and subspecialties. Survey. Percentage of the survey questions answered correctly and predictors of correct response. The survey was administered to 941 participants of whom 12 declined to participate. Eighty percent (n=740/929) of participants completed the survey. The median number of correct answers was 70% (interquartile range [IQR] 50%-90%) and was similar at each institution (P=.6). A total of 7.3% (n=54) of respondents answered all questions correctly. There was no significant difference in correct responses between attending physicians and trainees or between study centers (median 7, IQR 5-9; P=.75). Gastroenterologists were more likely to answer questions correctly than other subspecialists or primary care physicians (P<.0001). On multivariate analysis, physician knowledge correlated directly with self-reported familiarity with guidelines (0.21; 95% confidence interval [CI], 0.08-0.34; P=.002) and specialty (0.56; 95% CI, 0.30-0.82; P<.001) and inversely with year of medical school graduation (0.22; 95% CI, 0.07-0.37; P=.005). Survey study that used theoretical scenarios. Physician knowledge of guidelines regarding antibiotic use before endoscopy is suboptimal. Further interventions are needed to improve the knowledge of before-procedure guidelines.

Debunking the myth: low knowledge levels of HBV infection among Asian American college students

Objective:To examine the hepatitis B virus (HBV)-related knowledge among Asian American college students and to determine whether there are significant differences in the level of HBV knowledge among Asian American subgroups.Methods:A cross-sectional survey was self-administered to assess a sample of 258 Asian American students’ knowledge about HBV at the campus of the research site.Results:Knowledge regarding transmission and consequences of HBV infection was poor. Of a possible knowledge score of 14, the median number of correct answers was eight. There were no significant differences between the subgroups of Asian American college students in total knowledge of HBV infection.Conclusion:The findings of this study point to the fact that the lack of knowledge and awareness is not limited to community settings only but also includes higher education environment. This finding brings to the forefront the importance of HBV education for Asian American college students.

Validity of direct ophthalmoscopy skill evaluation with ocular fundus examination simulators

ObjectiveWe examined how direct ophthalmoscopy (DO) skills can be evaluated in a clinical setting using a simulator, and determined the appropriate assessment criteria for the DO skills in practical tests such as the Objective Structured Clinical Examination (OSCE). DesignCross-sectional study. ParticipantsMedical students, residents, and attending physicians (73 total participants). MethodsWe selected the following 3 factors that may indicate the ability to perform nonmydriatic direct funduscopy: (i) experience: total number of cases examined (without mydriasis); (ii) frequency: number of cases examined during the previous month; and (iii) range: viewable fundus field range. We used a fundus simulator with 3-level adjustable pupil sizes (2, 3.5, and 5 mm) and created original test slides for use in the simulator. We counted the number of correct answers of each participant for each pupil size using the simulator and test slides. ResultsThere were significant differences in the median number of correct answers for pupil diameters of 2 (p = 0.008) and 3.5 mm (p = 0.007) among groups divided according to the total number of cases examined (without mydriasis). There were no significant differences among groups divided according to the viewable fundus field range (2 mm: p = 0.103, 3.5 mm: p = 0.083, 5 mm: p = 0.347). ConclusionsThe results suggest a possible relation between the surrogate indicators “experience” and “range” and DO skills using a fundus simulator. The surrogate indicator experience showed a strong relation to DO skills using a fundus simulator.

Does Numeracy Correlate With Measures of Health Literacy in the Emergency Department?

The objective was to quantify the correlation between general numeracy and health literacy in an emergency department (ED) setting. This was a prospective cross-sectional convenience sample study of adult patients in an urban, academic ED with 97,000 annual visits. General numeracy was evaluated using four validated questions and health literacy using three commonly used validated screening tools (Short Test of Functional Health Literacy in Adults [S-TOFHLA], Rapid Estimate of Adult Literacy in Medicine-Revised [REALM-R], and the Newest Vital Sign [NVS]). Scores were dichotomized for health literacy tests to limited (low or marginal) versus adequate health literacy, and the proportion of patients answering all numeracy questions correctly was calculated with the mean proportion of correct responses in these groups. The correlation between numeracy scores and scores on the health literacy screening tools was evaluated using Spearman's correlation. A total of 446 patients were enrolled. Performance on questions evaluating general numeracy was universally poor. Only 18 patients (4%) answered all numeracy questions correctly, 88 patients (20%) answered zero questions correctly, and overall the median number of correct answers was one (interquartile range [IQR]= 1 to 2). Among patients with limited health literacy (LHL) by any of the three screening tools used, the mean number of correct numeracy answers was approximately half that of patients with adequate health literacy. However, even among those with adequate health literacy, the average number of correct answers to numeracy questions ranged from 1.6 to 2.4 depending on the screening test used. When dichotomized into those who answered ≤50% versus >50% of numeracy questions correctly, there was a significant difference between those with LHL and those who scored ≤50% on numeracy. Health literacy screening results were correlated with general numeracy in the low to moderate range: S-TOFHLA rs =0.428 (p<0.0001); REALM, rs =0.400 (p<0.0001); and NVS, rs =0.498 (p<0.0001). Correlations between measures of general numeracy and measures of health literacy are in the low to moderate range. Performance on numeracy testing was nearly universally poor, even among patients performing well on health literacy screens, with a substantial proportion of the latter patients unable to answer half of the numeracy items correctly. Insofar as numeracy is considered a subset of health literacy, these results suggest that commonly used health literacy screening tools in ED-based studies inadequately evaluate and overestimate numeracy. This suggests the potential need for separate numeracy screening when these skills are important for health outcomes of interest. Providers should be sensitive to potential numeracy deficits among those who may otherwise have normal health literacy.

A survey of health care practitioners' knowledge of the QT interval.

To assess health care practitioners' ability to correctly measure the QT interval, and to identify factors and medications that may increase the risk of QT-interval prolongation and torsades de pointes. A cross-sectional analysis of a survey administered between April 2002 and March 2003. Health care practitioners attending Grand Rounds Conferences at 6 academic institutions in the United States in internal medicine and psychiatry and at 6 community hospitals in the same geographical areas as the academic institutions. Anonymous, self-administered questionnaire that included 20 questions on the QT interval. Of approximately 826 attendees, 517 (63%) completed the survey. Of about 608 attendees of internal medicine conferences, 371 (61%) responded, and of about 208 attendees of psychiatry conferences, 146 (67%) responded. Of a total number of 20 questions, the median number of correct answers for the whole group was 10 (interquartile range 7-13). The median number of correct answers for internists was 12 (interquartile range 9-13), for psychiatrists 10 (interquartile range 7-13), and for other specialists 10 (interquartile range 5-13). Respondents who graduated between 1990 and 1999 and academicians performed significantly better overall than other respondents. Of the 517 respondents, 224 (43%) measured the QT interval correctly. Physicians in training and academicians were more likely to measure the QT interval correctly. The majority of health care practitioners cannot correctly measure the QT interval and cannot correctly identify factors and medications that can prolong the QT interval. Our findings suggest that greater attention to the QT interval is warranted to ensure safer use of QT prolonging medications.