Medication Education Research Articles

Final year nursing students' preparedness for medication administration during COVID-19: A multi-site survey study

AimTo examine final-year undergraduate nursing students' characteristics and their perceived preparedness for medication administration across three universities during COVID-19. BackgroundMedication administration is a complex process and medication errors can cause harm to the patient. Nurses are at the frontline of medication administration; therefore, nursing students must be well-prepared to administer medicines safely before graduation. Little is known about final-year undergraduate nursing students' perceived medication administration preparedness during COVID-19. DesignA multi-site study using a cross-sectional survey of student demographics, the ‘Preparedness for Medication Administration’ (Revised) tool and an open-ended question. MethodsThe questionnaire was distributed to nursing students in their final semester of the program in 2022 across two universities in Australia and one in New Zealand. Completed surveys n=214. Descriptive statistics were used to analyse the demographic data. Differences in demographic data and preparedness scores between the three universities were analysed using ranked means, correlation coefficient, Chi-Square, Mann- Whitney U and Kruskal- Wallace H. Directed content analysis was used to analyse the data from the open-ended question. ResultsOverall, students reported high preparedness scores for medication. International students reported significantly higher preparedness scores (Md =119, n=29) compared with domestic students (Md=112.00, n=164), U=1759.50, z=-2.231, p=02, r=.16. Mean ranked scores for each item were above average across the three universities. The impact of COVID-19 on curriculum and students' opportunity to practice may be one explanation for the difference in preparedness scores between universities. International participants reported significantly higher scores on the Preparedness for Medication Administration (Revised) tool than domestic participants. Older students were more confident in applying principles of pharmacology to practice. Students' comments generated three major categories and five subcategories indicating preparedness gaps. ConclusionThis study provides insights into students' medication management preparedness during restrictions and before transitioning to the role of Registered Nurse. It highlights the need to provide integrated and comprehensive medication education and assessments throughout the curriculum and the need for additional support for newly graduated nurses in medication management due to the restrictions.

Knowledge, attitudes, and practices of primary healthcare practitioners regarding pharmacist clinics: a cross-sectional study in Shanghai

BackgroundPharmacist clinics offer professional pharmaceutical services that can improve public health outcomes. However, primary healthcare staff in China face various barriers and challenges in implementing such clinics. To identify existing problems and provide recommendations for the implementation of pharmacist clinics, this study aims to assess the knowledge, attitudes, and practices of pharmacist clinics among primary healthcare providers.MethodsA cross-sectional survey based on the Knowledge-Attitude-Practice (KAP) model, was conducted in community health centers (CHCs) and private hospitals in Shanghai, China in May, 2023. Descriptive analytics and the Pareto principle were used to multiple-answer questions. Chi-square test, Fisher’s exact test, and binary logistic regression models were employed to identify factors associated with the knowledge, attitudes, and practices of pharmacist clinics.ResultsA total of 223 primary practitioners participated in the survey. Our study revealed that most of them had limited knowledge (60.1%, n = 134) but a positive attitude (82.9%, n = 185) towards pharmacist clinics, with only 17.0% (n = 38) having implemented them. The primary goal of pharmacist clinics was to provide comprehensive medication guidance (31.5%, n = 200), with medication education (26.3%, n = 202) being the primary service, and special populations (24.5%, n = 153) identified as key recipients. Logistic regression analysis revealed that education, age, occupation, position, work seniority, and institution significantly influenced their perceptions. Practitioners with bachelor’s degrees, for instance, were more likely than those with less education to recognize the importance of pharmacist clinics in medication guidance (aOR: 7.130, 95%CI: 1.809–28.099, p-value = 0.005) and prescription reviews (aOR: 4.675, 95% CI: 1.548–14.112, p-value = 0.006). Additionally, practitioners expressed positive attitudes but low confidence, with only 33.3% (n = 74) feeling confident in implementation. The confidence levels of male practitioners surpassed those of female practitioners (p-value = 0.037), and practitioners from community health centers (CHCs) exhibited higher confidence compared to their counterparts in private hospitals (p-value = 0.008). Joint physician-pharmacist clinics (36.8%, n = 82) through collaboration with medical institutions (52.0%, n = 116) emerged as the favored modality. Daily sessions were preferred (38.5%, n = 86), and both registration and pharmacy service fees were considered appropriate for payment (42.2%, n = 94). The primary challenge identified was high outpatient workload (30.9%, n = 69).ConclusionsAlthough primary healthcare practitioners held positive attitudes towards pharmacist clinics, limited knowledge, low confidence, and high workload contributed to the scarcity of their implementation. Practitioners with diverse sociodemographic characteristics, such as education, age, and institution, showed varying perceptions and practices regarding pharmacist clinics.

The role of nurses for patients with Parkinson’s disease at home: a scoping review

BackgroundParkinson’s disease is a neurodegenerative disease, and many patients are cared for at home by nurses. Parkinson’s disease nurse specialists have been certified in several countries. This study aimed to provide an overview of what is known about the role of nurses in the care of patients with Parkinson’s disease at home and to determine the differences between nurses and Parkinson’s disease nurse specialists.MethodsA scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were searched (keywords: Parkinson’s disease AND nurse AND [community OR home]) for studies published in English up to September 2023 describing the nurse’s role in caring for patients with Parkinson’s disease at home. Studies without abstracts were removed, along with protocols, systematic reviews, and studies concerned with other diseases or including data that were difficult to distinguish from those of other diseases. Roles were described and organized by category.ResultsA total of 26 studies were included. The nurses’ roles were categorized as overall assessment and support, treatment management, safety assessment regarding falls, care for non-motor symptoms, palliative care, support for caregivers, education for care home staff, multidisciplinary collaboration, and provision of information on social resources. Medication management and education of care home staff were identified as roles of nurse specialists.ConclusionsThis study revealed the role of nurses caring for patients with Parkinson’s disease at home. Because of the complexity of the patients’ medication regimens, nurse specialists provide assistance, especially with medication management and the provision of education to care staff. This study will facilitate the preparation of nurses to acquire the knowledge and skills necessary to help patients with Parkinson’s disease, even in countries where Parkinson’s disease nurse specialists are not officially certified, and will help patients feel comfortable with the care they receive.

Building Medication Profiles in the Elderly: a Qualitative Study Based on Medication Information Literacy in a Long-Term Care Facility.

Long-term care facilities are increasingly challenged with meeting the diverse healthcare needs of the elderly population, particularly concerning medication management. Understanding medication information literacy and behavior among this demographic is imperative. Therefore, this qualitative study aims to explore medication information literacy and develop distinct medication profiles among elderly long-term care residents. In this study, we conducted in-depth semi-structured interviews with 32 participants aged 65 or older residing in a long-term care facility. The interviews were designed to explore participants' understanding of medication information, medication management practices, and experiences with healthcare providers. Thematic analysis was employed to analyze the interview data, allowing for the identification of common patterns and themes related to medication-taking behavior among the elderly residents. The thematic analysis revealed four distinct medication behavior profiles among the elderly long-term care residents: (1) Proactive Health Self-Managers, (2) Medication Information Adherents, (3) Experience-Based Medication Users, and (4) Nonadherent Medication Users. These findings provide valuable insights into the diverse approaches to medication management within long-term care facilities and underscore the importance of tailored interventions to support the specific needs of each profile. This study highlights the necessity for tailored medication education and support to optimize medication management for the elderly. With the aging population expansion, addressing the unique medication challenges within long-term care facilities becomes increasingly critical. This research contributes to ongoing endeavors to enhance healthcare services for the elderly, striving for safer and more effective medication-taking behavior.

Adherence, Burden, and Morbidity in Adults with Chronic Diseases in the Dominican Republic: A Cross-sectional Study in a Tertiary-level Hospital (A-CaMo II)

Introduction: Pharmacological adherence is a key factor in managing chronic non-communicable diseases (NCDs), so its efficacy concerning new therapies emerges as an essential consideration. Despite efforts, adherence rates vary widely, highlighting the complexity of the problem. Non-adherence affects treatment effectiveness and increases patient burden and medical costs. Understanding the interplay between burden, morbidity, and adherence is crucial for adapting health strategies. Objective: This study aims to measure pharmacological adherence, burden, and morbidity among patients with chronic diseases in the Dominican Republic, emphasizing the interplay between these dimensions. Methods: Data were collected using a cross-sectional design at the Centro Médico de Diabetes, Obesidad y Especialidades (CEMDOE) in Santo Domingo during August 2023. Patient interviews were conducted using standardized tools, including the Medication Adherence Reasons Scale (MAR-Scale) and the Disease Burden Morbidity Assessment (DBMA). Nonprobability convenience sampling yielded a sample of 384 patients who met the inclusion criteria. Significant statistical analysis included an ordinal regression analysis correlating medication adherence with disease burden. Results: Among the patients studied, the ordinal regression analysis unveiled a significant correlation (p = 0.001) between nonadherence and disease burden, indicating a 0.29 ± 0.09 unit increase in burden for every one-point decrease in adherence score. Patients with private health insurance and higher education levels exhibited more excellent adherence rates (65.97% and 63.89%, respectively), with a substantial portion also reporting a burden score ≥ 5 (70.07% and 70.42%, respectively). Moreover, the study population experienced a significant burden of multimorbidity (88.8%), with hypertension displaying the lowest burden (1.63 ± 1.13) despite its prevalence (76.76%). Conclusion: Despite the limitations, common reasons for non-adherence were identified, and significant disease burdens were observed, particularly in osteoarthritis, cancer, and rheumatoid arthritis. Notably, a positive association was found between adherence and disease burden, underlining the importance of adherence in chronic disease management. Health disparities affecting access to medication and patient education were observed, highlighting the need for further research and intervention. The combined use of a scale that integrates both the DBMA and the MAR-Scale, in which adherence, burden, and morbidity are investigated simultaneously for each disease, would allow for a more comprehensive approach to all three characteristics regardless of which disease is included in the scales separately.

Exploring healthcare barriers and satisfaction levels among deaf individuals in Ecuador: A video-based survey approach

BackgroundApproximately 80% of Deaf individuals live in low- and middle-income countries, where health systems often overlook their specific needs. This communication gap can result in misdiagnosis and inappropriate treatment, impacting their overall satisfaction with healthcare services. ObjectivesThis study aims to uncover barriers to healthcare access and preferences among the Deaf population in Ecuador, and the role of communication barriers in shaping satisfaction levels with healthcare services. MethodsThe study gathered data from 386 participants through online surveys, focusing on demographic characteristics, healthcare experiences, communication methods, and levels of satisfaction. Descriptive statistics and association analyses were employed to analyze the data. ResultsThe study reveals that nearly all participants possessed an officially recognized disability (95.9%) and 53.9% reported hereditary deafness. Ecuadorian sign language was predominant (60.9%). Communication barriers were evident, with 65.0% having trouble understanding medical instructions, and 66.6% identifying a deficiency of tools for Deaf individuals in healthcare settings. Satisfaction levels were associated with the presence of interpreters during medical care, with 46.6% expressing a preference for interpreters over other communication methods. Additionally, private healthcare facilities were perceived as providing better services, despite being less frequently accessed (38.9%). Dissatisfaction was evident, particularly in aspects of communication and physician courtesy. ConclusionsThis study underscores the importance of tailoring healthcare services to address the unique needs of the Deaf population. Communication barriers emerged as a central obstacle, necessitating the inclusion of sign language interpreters and improvement of resources. The study's implications extend to healthcare equity in developing nations, emphasizing the significance of patient-centered care and inclusive healthcare practices.

Assessing adherence and comprehension of cardiovascular medicines with pharmacist intervention post‐acute myocardial infarction: a pilot study

AbstractBackgroundDue to the addition of multiple new medicines following an acute myocardial infarction (MI), medication non‐adherence occurs frequently. Medication education can improve adherence, comprehension, and health‐related outcomes. There is currently limited literature about individualised pharmacist‐led medication education post‐hospital discharge following an MI.AimTo assess whether individualised, pharmacist‐led education increased patient adherence and comprehension of cardiovascular medicines over a 12‐week period following an MI.MethodAll participants completed the Morisky Medication Assessment Scale (MMAS) of self‐reported adherence at 1 week and 12 weeks post‐hospital discharge. Alongside this, a questionnaire was completed to quantify comprehension of their treatment plan. Participants were randomised to receive individualised pharmacist‐led education directed at their medication regimen at 4–6 weeks post‐discharge. Data were analysed using paired t‐tests and mixed‐design analysis of variance (ANOVA). Ethical approval was granted by the Monash Health Human and Research Ethics Committee (Reference no: RES‐21‐0000234L) and the study conforms to the Australian National Statement on Ethical Conduct in Human Research. Informed consent was obtained from all participants via project information sheets, verbal explanations by recruiting pharmacists with reassurance there would be no difference in standard treatment should patients decline involvement in the project, and written consent forms were completed by all participants.ResultsOf the 29 participants, 15 (51%) received pharmacist‐led education. The intervention group's mean MMAS score increased from 6.7 (moderate adherence) at week 1 to 7.6 (moderate adherence) at week 12 post‐hospital discharge (p = 0.009). At 12 weeks, the intervention group demonstrated a statistically significant and greater mean MMAS score compared to the control group (7.6 moderate adherence and 6.9 moderate adherence respectively, p = 0.003). The intervention group's mean comprehension level increased from 58% at 1 week to 90% at 12 weeks (p < 0.05). The intervention group demonstrated a greater mean comprehension level at 12 weeks compared to the control group (90% and 48.21% respectively, p < 0.001).ConclusionThis pilot study demonstrated that individualised, pharmacist‐led education may improve self‐reported medication adherence and comprehension.

Patient-perceived understanding of home-going medication with transitions of care services at a pediatric institution

BackgroundTransitions of care (TOC) is the coordination and continuity of health care as a patient transfers between different settings. This can include a wide range of services, such as medication reconciliation, patient counseling, bedside delivery of medications, and others that meet individual patient needs. In the pediatric population, patients are at increased risk of potential medication errors and subsequent harm owing to reduced patient and caregiver health literacy, limited dosage form availability, and errors in medication administration. The use of TOC services at the time of hospital discharge in this population has the potential to make a positive impact on patient safety and the treatment of medical conditions. ObjectivesThe primary objective of this study was to determine whether patient-perceived understanding of home-going medications was greater in patients and/or caregivers who received medication bedside delivery and education from a pharmacy-led TOC service at a large pediatric academic medical center. The secondary objective was to determine whether the primary practice area of the pharmacist providing medication education led to changes in understanding of home-going medication(s). MethodsUsing institution-wide, patient satisfaction surveys from January 1, 2021, to December 31, 2021, patient and caregiver responses were queried for 2 questions about home-going medications, relating to the understanding of administration and the potential adverse effects. Patients were divided into 2 groups depending on TOC services received, as documented in the electronic medical record (EMR). Survey responses for each of the 2 questions were categorized as top-box percentage by study group. Hypothesis testing between study groups for the primary and secondary outcomes were conducted using chi-squared tests at an alpha of 0.05. Statistical analyses were conducted using SAS version 9.4. ResultsOf the 1159 patients included in the study, 441 received TOC services, deemed the intervention group, and 718 did not receive TOC services, deemed the control group. When the intervention and control group were asked about understanding of medication administration, 96.37% versus 93.18% of patients (P = 0.007) gave the most favorable response of “yes, definitely,” respectively. Furthermore, 78.51% versus 77.44% of patients (P = 0.053) gave the most favorable response when asked about understanding potential medication adverse effects, respectively. ConclusionPatients receiving TOC services by a member of the pharmacy team had a greater score for understanding of both medication administration and adverse effects. Furthermore, this greater score was consistent among the education provided by the inpatient and outpatient pharmacist.

Acellular dermal matrix-assisted tissue expansion for giant congenital melanocytic nevi of the extremities and trunk in pediatric patients.

Tissue expansion for treating giant congenital melanocytic nevi (GCMN) is a commonly employed surgical method. However, the procedure's efficacy is often hindered by anatomical and histological characteristics as well as blood supply, particularly in the extremities and trunk. Enhancing expansion efficiency while reducing complications is thus a topic to be investigated, especially for pediatric patients undergoing rapid physical and psychological development with higher risks of non-compliance to medical instructions. To explore the effectiveness of expansion in extremities and trunk by immobilizing the acellular dermal matrix (ADM) in the gravitational force zone of inflating expanders. All patients involved in this research underwent ADM-assisted tissue expansion in either the extremities or trunk. ADM was fully flattened, securely fixed to the lower pole of the expander, and subsequently attached to the inner surface of the expanding flap. From 2021 to 2023, a total of nine pediatric patients with GCMN underwent the ADM-assisted tissue expansion. All patients achieved the desired expanding volume without experiencing petechiae, ecchymosis, or skin ulceration in the ADM-covered area. The process was well tolerated by all patients, with no reports of itching, pain, allergic reaction, or fever. During the flap transfer, the ADM was observed to be firmly adhered to the expanding flap with discernible capillary network. ADM-assisted tissue expansion demonstrates promise in augmenting expansion efficiency and reducing the time needed for surgical intervention in the extremities and trunk, thereby presenting significant clinical value for pediatric patients afflicted with GCMN.

CHALLENGES IN TRANSLATING MEDICAL TERMINOLOGY: A COMPREHENSIVE ANALYSIS OF ENGLISH-UKRAINIAN PHARMACEUTICAL TEXTS

The article examines the peculiarities of translating medical instructions from English into Ukrainian. The medical terms in the instructions for medicinal products were analyzed. The article emphasizes the necessity of the translator’s knowledge in the field of medical sciences, in particular, pharmacology, biochemistry, pharmaceutical chemistry. Problems that hinder the correct translation of medical instructions are emphasized, the main of which are difficulties in translating abbreviations, eponyms, synonyms, Latinisms, and Greekisms.

Abstract P256: Rationale, Development, and Implementation of a Multidisciplinary Digital Lifestyle Health Education Program for Older Adults With Cardiovascular Disease and Osteoarthritis

Introduction: Cardiovascular disease (CVD) is the leading cause of death worldwide. Globally, osteoarthritis (OA) affects 654 million. In 2018, of the 1.2 million Australians who had CVD, half also had arthritis, with the most common form in Australia being OA. Ongoing pain and physical limitations from OA can affect lifestyle choices, contributing to the shared risk factor profile of CVD and OA (physical inactivity, overweight/obesity, poor diet, high medication use). This contributes further to the burden of both diseases including reduced 6-minute walk (6MW) performance, which is directly related to increased CVD mortality. This project outlines the rationale for and development of a multidisciplinary digital lifestyle health education program for the treatment and secondary prevention of CVD and its common comorbidity of OA. Methods: This study is a cross-sectional analysis of older adults in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, muscle strength, and 6MW measurements were assessed. Differences between those with and without OA were determined via one-way analysis of variance. Simple linear regressions assessed potential relationships. Results: In a cohort of 532 adults; n=341 (64.1%) had diagnosed CVD; 48.4% of which had OA (mean age 66±12 years; 73.3% female). Socioeconomic index was deemed high. In the OA cohort mean BMI and waist were above healthy heart recommendations according to the World Health Organisation. There were no significant differences between those with OA and those without for cardiovascular risk factors of body weight, BMI, waist measurement, blood pressure, 6MW, or muscle strength. However, in those with CVD and OA, the relationship between age and 6MW was stronger and age accounted for more of the variance in performance (r=-0.44; r 2 =0.19; p<0.001) than those without OA (r=-0.37; r 2 =0.17; p<0.001), indicating a greater reduction in walking ability in those with OA as they get older. Conclusion: With 6MW performance being related to CVD mortality, interventions are needed to improve health and fitness in this cohort. International guidelines for CVD and OA recommend treatment should prioritise lifestyle changes, including a healthy diet, regular physical activity, and interventions that address all risk factors. Lifestyle LIFEMAP will assess the efficacy of a widely translatable multidisciplinary digital evidence-based 10-module lifestyle, food, exercise, medication, and park prescription education program for adults with the comorbidity of CVD and OA. We expect this program to improve knowledge, and healthy lifestyle choices, thereby improving physical activity and health outcomes in this highly vulnerable population.

Managing infectious diarrhea among young children in community pharmacies in Saudi Arabia and the implications for AMR.

Diarrhea remains a major global health issue for children under five, contributing substantially to morbidity and mortality. Community pharmacists play a pivotal role in the management of these children; however, their competence in managing childhood diarrhea in Saudi Arabia is under-researched. This is important to ensure optimal patient care. Simulated patients (SPs) presenting with three pediatric diarrhea scenarios were used to evaluate pharmacists' practice in terms of their counselling, history taking, over-the-counter (OTC) prescribing, medication instructions, diet/fluid advice, and/or information provision. Pharmacists' practice was categorized into adequate, less adequate, and poor. 182 community pharmacists, primarily male and non-Saudi, participated in the study, of which 60% were in chain pharmacies. Only 5% showed adequate practice in currently managing pediatric diarrhea. Of the 182 simulated patient visits, 62% received medication in all three scenarios and 20% were referred to physicians, with 16% of pharmacists failing to provide any form of intervention. The main medications recommended were kaolin (34%), pectin (34%) and metronidazole (11%). While most pharmacists (86%) asked about the patient's identity and age, 15% provided incorrect management information, 16% failed to provide guidance on the prescribed medicines, and 18% dispensed antimicrobials without a valid prescription. A high level of inadequate management of pediatric diarrhea in Saudi Arabia was observed. This highlights the need for extensive training to improve community pharmacists' practice in service delivery including providing counselling and advice on the appropriate management of childhood diarrhea. The latter is particularly important to reduce antimicrobial resistance.

Smartphone Application Versus Standard Instruction for Colonoscopic Preparation: A Randomized Controlled Trial.

To compare smartphone application (Colonoscopic Preparation) instructions versus paper instructions for bowel preparation for colonoscopy. Adhering to bowel preparation instructions is important to ensure a high-quality colonoscopy. This randomized controlled trial included individuals undergoing colonoscopy at a tertiary care hospital. Individuals were randomized (1:1) to receive instructions through a smartphone application or traditional paper instructions. The primary outcome was the quality of the bowel preparation as measured by the Boston Bowel Preparation Score. Secondary outcomes included cecal intubation and polyp detection. Patient satisfaction was assessed using a previously developed questionnaire. A total of 238 individuals were randomized (n = 119 in each group), with 202 available for the intention-to-treat analysis (N = 97 in the app group and 105 in the paper group). The groups had similar demographics, indications for colonoscopy, and type of bowel preparation. The primary outcome (Boston Bowel Preparation Score) demonstrated no difference between groups (Colonoscopic Preparation app mean: 7.26 vs paper mean: 7.28, P = 0.91). There was no difference in cecal intubation (P = 0.37), at least one polyp detected (P = 0.43), or the mean number of polyps removed (P = 0.11). A higher proportion strongly agreed or agreed that they would use the smartphone app compared with paper instructions (89.4% vs 70.1%, P = 0.001). Smartphone instructions performed similarly to traditional paper instructions for those willing to use the application. Local patient preferences need to be considered before making changes in the method of delivery of medical instructions.

A content analysis of medication adherence material in patient educational resources about gout.

This study aimed to investigate how medication adherence is addressed in online gout resources in six countries. We investigated how often adherence was referred to, the strategies suggested to improve patient adherence, and the types of nonadherence that were targeted. We also examined the readability of the adherence material. A content analysis was conducted on 151 online gout resources from medical and health organisations in six predominantly English-speaking countries. Two reviewers coded the content of the websites into categories (kappa 0.80). The analysis involved coding the resources for reasons for nonadherence, and adherence-promoting strategies. Flesch-Kincaid Reading Ease scores and word count were also computed. Out of 151 websites examined, 77 websites discussed medication adherence (51%), with intentional nonadherence being more prevalent than unintentional nonadherence. 67 websites targeted different types of nonadherence, including drug-specific concerns (50%), misconceptions of gout curability and the necessity of medication (16%), forgetfulness (16%), and other practical challenges (5%). Strategies to promote adherence were found in one-third of the websites, with medication education being the most prevalent strategy (17%), followed by healthcare provider engagement (13%) and memory aid strategies (6%). On average, about 11% of the words (89.27, SD = 76.35) in the entire document were focused on adherence. Difficult reading comprehension was found in one-fifth of adherence-related websites. Findings reveal limited medication adherence coverage and narrow strategies in online gout resources. Improved adherence portrayal is needed for effective gout management through comprehensive strategies and clear, understandable information.

Co-design of an intervention to improve patient participation in discharge medication communication.

Patients can experience medication-related harm and hospital readmission because they do not understand or adhere to post-hospital medication instructions. Increasing patient medication literacy and, in turn, participation in medication conversations could be a solution. The purposes of this study were to co-design and test an intervention to enhance patient participation in hospital discharge medication communication. In terms of methods, co-design, a collaborative approach where stakeholders design solutions to problems, was used to develop a prototype medication communication intervention. First, our consumer and healthcare professional stakeholders generated intervention ideas. Next, inpatients, opinion leaders, and academic researchers collaborated to determine the most pertinent and feasible intervention ideas. Finally, the prototype intervention was shown to six intended end-users (i.e. hospital patients) who underwent usability interviews and completed the Theoretical Framework of Acceptability questionnaire. The final intervention comprised of a suite of three websites: (i) a medication search engine; (ii) resources to help patients manage their medications once home; and (iii) a question builder tool. The intervention has been tested with intended end-users and results of the Theoretical Framework of Acceptability questionnaire have shown that the intervention is acceptable. Identified usability issues have been addressed. In conclusion, this co-designed intervention provides patients with trustworthy resources that can help them to understand medication information and ask medication-related questions, thus promoting medication literacy and patient participation. In turn, this intervention could enhance patients' medication self-efficacy and healthcare utilization. Using a co-design approach ensured authentic consumer and other stakeholder engagement, while allowing opinion leaders and researchers to ensure that a feasible intervention was developed.

Compression-Only or Standard Cardiopulmonary Resuscitation for Trained Laypersons in Out-of-Hospital Cardiac Arrest: A Nationwide Randomized Trial in Sweden.

The ongoing TANGO2 (Telephone Assisted CPR. AN evaluation of efficacy amonGst cOmpression only and standard CPR) trial is designed to evaluate whether compression-only cardiopulmonary resuscitation (CPR) by trained laypersons is noninferior to standard CPR in adult out-of-hospital cardiac arrest. This pilot study assesses feasibility, safety, and intermediate clinical outcomes as part of the larger TANGO2 survival trial. Emergency medical dispatch calls of suspected out-of-hospital cardiac arrest were screened for inclusion at 18 dispatch centers in Sweden between January 1, 2017, and March 12, 2020. Inclusion criteria were witnessed event, bystander on the scene with previous CPR training, age above 18 years of age, and no signs of trauma, pregnancy, or intoxication. Cases were randomized 1:1 at the dispatch center to either instructions to perform compression-only CPR (intervention) or instructions to perform standard CPR (control). Feasibility included evaluation of inclusion, randomization, and adherence to protocol. Safety measures were time to emergency medical service dispatch CPR instructions, and to start of CPR, intermediate clinical outcome was defined as 1-day survival. Of 11 838 calls of suspected out-of-hospital cardiac arrest screened for inclusion, 2168 were randomized and 1250 (57.7%) were out-of-hospital cardiac arrests treated by the emergency medical service. Of these, 640 were assigned to intervention and 610 to control. Crossover from intervention to control occurred in 16.3% and from control to intervention in 18.5%. The median time from emergency call to ambulance dispatch was 1 minute and 36 s (interquartile range, 1.1-2.2) in the intervention group and 1 minute and 30 s (interquartile range, 1.1-2.2) in the control group. Survival to 1 day was 28.6% versus 28.4% (P=0.984) for intervention and control, respectively. In this national randomized pilot trial, compression-only CPR versus standard CPR by trained laypersons was feasible. No differences in safety measures or short-term survival were found between the 2 strategies. Efforts to reduce crossover are important and may strengthen the ongoing main trial that will assess differences in long-term survival. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02401633.

Subjectivity study on health conservation of elderly hemodialysis patients

BackgroundHealth conservation enables elderly hemodialysis patients to maintain a positive state of well-being while undergoing treatment and maintenance of disease. This study was to identify the type of perceptions on health conservation of elderly hemodialysis patients and compare the characteristics of perceptions.MethodsThis study used an exploratory study design applying Q methodology, which is designed to research subjectivity. The study determined a population of subjective statements, the concourse, based on the preceding literature and interviews with twenty-five elderly patients over 65 years of age with hemodialysis. We chose a total of 50 statements considered to be representative of the concourse for the Q-sample. The study selected 50 elderly patients over 65 years of age with hemodialysis as the P-set. The participants provided their internal viewpoints by sorting the Q-sample items into a grid. The researchers performed an analysis using PC-QUANL program. Data were collected from June to November, 2019.ResultsType I, ‘support system-based effort’ focused on one’s own effort, positive and proactive attitude, family support, medical instructions, information, and medications. Type II, ‘skeptical life maintaining’ expressed a pessimistic future without hope, strongly negative perception on preserving health, and thus minimal effort and motivation to continue life. Type III, ‘treatment process interest’ is based on an interest in the hemodialysis process; for them, it is important to follow medical staff’s instructions, take regular medications precisely, pay attention to the results of regular monthly blood tests, and control their health. Type IV, ‘positive effort’ accepts hemodialysis positively, lives with hemodialysis, and carries out all daily life activities.ConclusionIn nursing practice, nurses need to pay attention to the perceptions on health conservation of elderly hemodialysis patients. This study can be implied as the evidence of nursing practice based on the perception on health conservation of elderly hemodialysis patients.

Implementation of a pharmacist‐driven chronic obstructive pulmonary disease transitions of care service at a large academic medical center

AbstractIntroductionChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States, and one in five COPD hospitalizations result in a readmission within 30 days. Pharmacists have been identified as key members of interdisciplinary teams to improve transitions of care.ObjectiveThe objective of this study was to develop, implement, and evaluate outcomes for a pharmacist‐driven COPD transitions of care bundle at an academic medical center.MethodsA COPD care bundle was implemented for patients presenting with a COPD exacerbation from December 1, 2021 to February 28, 2022. A historical control group was created from patients who were discharged between December 1, 2020 and February 28, 2021. Patient characteristics, pharmacist‐driven interventions, and time required for the intervention were assessed descriptively. Inhaler technique was assessed before and after pharmacist education utilizing standardized rubrics. The percentage change in inhaler scores was assessed with a Wilcoxon signed‐rank test. Readmission outcomes were analyzed using a chi‐squared test.ResultsThere were 30 patients in the intervention group and 46 in the control group. There were 104 interventions requiring provider collaboration, of which 84 (81%) were accepted. A median (interquartile range, IQR) of 46 (37–55) min was spent per patient in the intervention group. At baseline, patients scored a median of 84.6% (75–100) of steps correctly across all inhaler device types. After pharmacist education, patient scores increased to a median of 100% [92.3–100] (p < 0.0001). There were eight (26.7%) 30‐day all‐cause readmission rates in the intervention group and 15 (32.6%) in the control group (p = 0.58).ConclusionMost pharmacist recommendations were accepted by providers. Medication education led to improved understanding of inhaler technique, but there was no difference in 30‐day readmission rates. Further development of this service is warranted based on these findings.

Multiple Myeloma.

Multiple myeloma (MM) is a cancer that arises from plasma cells in bone marrow. Approximately 35,730 Americans received a new diagnosis and MM will claim the lives of an estimated 12,590 people in 2023. Complications of the disease process include anemia, leukopenia, thrombocytopenia, renal failure, severe pain, bone loss, and hypercalcemia. Patients with MM have a high risk for pathological fractures. For most forms of MM there are effective treatments that may result in long-term remission using multi-drug regimens. Although the medications approved in the United States to treat MM generally produce good outcomes, they have serious, and potentially life-threatening adverse effects. In addition, patients with specific genetic variations are at high risk for relapse. Communication with the oncology team and early intervention in the event of adverse effects of medications, complications of the disease process, or evidence of relapse are important to obtain the best possible outcome. Patients are easily overwhelmed with a three- to four-drug treatment regimen with some drugs given intravenously and/or subcutaneously at the clinic, and others taken orally at home on specific days of each 28-day cycle. Home care nursing is needed to assess for tolerance, adverse effects, and to address patient concerns. Medication management and teaching are very important in guiding patients to safely manage a schedule that changes daily. In addition, the high risk of pathological fractures and serious injury if the patient should fall supports the need for physical and occupational therapy fall prevention and safety education and exercise programs to help avert decline in functional status and combat cancer-related fatigue.

N42 New tool for IBD nurses to support IBD patients

Abstract Background There are about 58000 Inflammatory Bowel Disease (IBD) patients in Finland. The number has doubled in ten years. Over 5500 IBD patients live in the Pirkanmaa region. Patients are treated in three different hospitals and there are eight trained IBD nurses in adult services. Patients can contact a call back-system at any hour of the day. With growing number of patient contacts there is a need for additional contact channels and ways of support for patients care. Methods TaysPolku is an app developed by Buddy HealthCare where IBD patients can see their appointments, upcoming procedures, information packages, medication instructions, videos and questionnaires related to their treatment all in one place. TaysPolku provides automatic reminders and enables them to contact their own care unit directly via message. IBD nurses has been part of creating material for TaysPolku. IBD nurse explains the app and creates TaysPolku for the patient after providing the necessary information. The app is downloaded from app stores, verified by strong authentication. The app works with any face ID or pin number chosen by the patient. Results TaysPolku was introduced in June 2021 and the first users were patients receiving intravenous biologicals. IBD nurses informed about the new service during the infusion visits and provided written material. In the next phase, TaysPolku was set up for biological self-injecting patients. Currently, TaysPolku have been created 299 patients at Tampere University Hospital Tays. The utilization rate of the created TaysPolku is high. Messages on TaysPolku has been send/received 3896 times. The messages feature enables the care unit to reach everyone using TaysPolku simultaneously. It is used in all three hospitals and every IBD nurses take care of it. Satisfaction with TaysPolku has been good for both patients and IBD nurses. Patient questionnaire highlighted the benefits, and the answers highlighted the ease of use of the service. "A well-functioning system " "Reminds me very much of the lab, questions and treatment days. Easy to useand connect. There could also be a connection to other departments when care is taken in other departments as well" Conclusion Different forms of service are needed with the growing number of patients, and a digital app that supports the patient's self-care has been proven to work. Further development is underway to offer a similar service to all IBD patients in the region.