Multidisciplinary Education Program Research Articles

Abstract P437: Children First Study II: How An Educational Program In Cardiovascular Prevention At School Can Improve Children Recreational Inactivity

Objective: Evaluate the improvement in recreational inactivity (tv/internet/vieogames) in school age children after a multidisciplinary educational program in cardiovascular prevention (CVP) at school. Methods: Students aging 6 to 10 years old were exposed to two different approaches at two public schools in Sao Paulo, Brazil. For the control school we delivered written educational material (EM) for their parents during the year of 2012 about healthy lifestyle. The intervention school students received the same EM for their parents and the children were exposed to a weekly educational program in CVP with a multidisciplinary heath team during the year 2012. This intervention tried to teach to these children concepts of healthy nutrition, avoidance of tobacco and physical activity. Both at the inclusion in the study and one year later we collect data of parents and their children, including a questionnarie about the time children spent in tv, computes and videogames during the day (recreational inactivity). Results: We studied 262 children. The control group had 136 children (mean age of 8 years) and the intervention group had 126 children (mean age of 8 years). In the intervention group 79.4% of children (100 children) had a reacreational inactivity time (RIT) > 2 hours/day, and in the control group 80.1% of children (109 children) had a RIT > 2 hours/day. After one year of educational intervention 87 children (69.0%) of the intervention group and 107 children (78.6%) of the control group still had a RIT >2 hours/day, p= 0.03923 (Fisher's Exact test Mid p). This represents a 13% reduction in the intervention group and a 1,8% reduction in the control group. Conclusion: An educational program in cardiovascular prevention directed to children at school age can improve recreational inactivity in children contributing for the reduction of obesity and cardiovascular risk.

Contraceptive Awareness, Knowledge and Attitudes Among Adolescent Females Who are HIV Positive in Botswana, Southern Africa

Of people living with HIV/AIDS in the world, 40% of new infections are in young adults and adolescents. Women account for more than half of all adults living with HIV worldwide. The number of children and adolescents living with HIV in Africa continues to escalate despite advances made to prevent vertical transmission. The main objective of this study was to investigate the contraceptive awareness, knowledge and attitude among HIV positive adolescent females in a multidisciplinary educational program.

The Rockefeller University Navigation Program: A Structured Multidisciplinary Protocol Development and Educational Program to Advance Translational Research

The development of translational clinical research protocols is complex. To assist investigators, we developed a structured supportive guidance process (Navigation) to expedite protocol development to the standards of good clinical practice (GCP), focusing on research ethics and integrity. Navigation consists of experienced research coordinators leading investigators through a concerted multistep protocol development process from concept initiation to submission of the final protocol. To assess the effectiveness of Navigation, we collect data on the experience of investigators, the intensity of support required for protocol development, IRB review outcomes, and protocol start and completion dates. One hundred forty-four protocols underwent Navigation and achieved IRB approval since the program began in 2007, including 37 led by trainee investigators, 26 led by MDs, 9 by MD/PhDs, 57 by PhDs, and 12 by investigators with other credentials (e.g., RN, MPH). In every year, more than 50% of Navigated protocols were approved by the IRB within 30 days. For trainees who had more than one protocol navigated, the intensity of Navigation support required decreased over time. Navigation can increase access to translational studies for basic scientists, facilitate GCP training for investigators, and accelerate development and approval of protocols of high ethical and scientific quality.

Simulation Model for Tracheotomy Education for Primary Health-Care Providers

We performed this study to evaluate the competency of health-care providers managing patients with tracheotomies, and assess the need for, and efficacy of, a multidisciplinary educational program incorporating patient simulation. The prospective observational study included 87 subjects who manage patients with tracheotomies within a tertiary-care hospital. The subjects completed self-assessment questionnaires and objective multiple-choice tests before and after attending a comprehensive educational course using patient simulation. The outcome measurements included pre-course and post-course questionnaire and test scores, as well as observational data collected during recorded patient simulation sessions. Before the education and simulation, the subjects reported an average comfort level of 3.3 on a 5-point Likert scale across 10 categories in the questionnaire, which improved to 4.4 after the training (p < 0.0001). The subjects' mean scores improved from 56% on the pre-course test to 91% on the post-course test (p < 0.0001). The specific deficiencies observed during patient simulation scenarios included unfamiliarity with different tracheotomy tube types, misunderstanding of speaking valve physiology, and delayed recognition and treatment of a plugged or dislodged tracheotomy tube. There is a significant need for improved tracheotomy education among primary health-care providers. Incorporating patient simulation into a comprehensive tracheotomy educational program was effective in improving provider confidence, increasing provider knowledge, and teaching the skills necessary for managing patients with a tracheotomy.

Preventing hospital acquired infections: A challenge we must accept

Preventing hospital acquired infections: A challenge we must accept

IPCRG: INTERNATIONAL PRIMARY CARE RESPIRATORY GROUP IPCRG, working locally, collaborating globally

NEW MEMBER COUNTRIESWe are delighted to welcome four new country members to the IPCRG, elected at the recent Annual General Meeting: these are India, Singapore, Slovenia, and Vietnam.THIRD SCIENTIF...

Self‐Critical Perfectionism Predicts Outcome in Multidisciplinary Treatment for Chronic Pain

Self-critical perfectionistic personality features have been shown to influence the onset and perpetuation of pain symptoms. However, no study to date has investigated whether these personality features are associated with treatment response in chronic pain. Using a naturalistic pre-post design, the present study examined the effect of self-critical perfectionism on treatment outcome in terms of self-reported pain. The study was conducted in a sample of 53 chronic non-cancer pain patients who followed Multidisciplinary Pain Education Program (MPEP), a brief, 2-week cognitive-behaviorally based psycho-educational intervention for chronic pain that was recently found to be effective in reducing pain severity. Pre- and post-treatment pain intensity levels were assessed with the visual analog scale of the McGill Pain Questionnaire-Short Form. Pretreatment self-critical perfectionism was significantly associated with negative treatment outcome, even after taking into account pretreatment levels of depression. Results suggest that self-critical perfectionistic personality features may negatively interfere with treatment response in patients with chronic pain. Thus, findings indicate that chronic pain patients with high levels of self-critical perfectionism may benefit less from brief interventions such as MPEP, and therefore may need more intensive and tailored treatment.

Physiotherapeutic approach in early and late post-menopausal Brazilian women

To evaluate changes in joints after physiotherapy in post-menopausal women, specifically to identify clinical responses to the measurements of flexibility, functional capacity and joint pain in early and late post-menopausal women at a multi-disciplinary health education programme. A total of 69 women participated in the Integral Program for the Attention to Climacteric Women at the Department of Gynecology – Federal University of Sao Paulo and were sorted into two groups of early (n = 32) and late (n = 37) post-menopause. The average age of menopause was 47.9 ± 5.6 years. The Blatt Kupperman Menopausal Index scores for the early (baseline = 12.8 ± 6.1) and late (baseline = 14.1 ± 7.7) post-menopausal groups after the programme were 8.4 ± 7.1 and 9.4 ± 8.1, respectively. Both groups presented improvements regarding functional capacity (p < 0.01) and complaints of pain (p < 0.001) after the intervention. The group of early post-menopausal women had better flexibility for hip flexion (p < 0.001), and the late post-menopausal group showed greater improvement in shoulder flexion (p < 0.001), extension (p < 0.001) and elbow flexion (p < 0.001). After multi-disciplinary approach, both early and late post-menopausal groups experienced decrease in intensity of climacteric symptoms, reduction in pain intensity and improvement in functional capacity, but the flexibility was different between both the groups.

PARQVE – project arthritis recovering quality of life by means of education – a pilot study in Brazil

Purpose: The primary objective was to evaluate the improvement of pain and function of patients with knee OA exposed to a multidisciplinary education program. Secondary Objectives were to evaluate patients’ weight loss and increase in physical activity. Methods: Two hundred and twenty-two patients (54 men and 168 women) with knee OA were randomly divided into four groups. Patients underwent pre-assessment and two days of workshops with a multidisciplinary team composed of psychologists; nutritionist; social workers; physiotherapists; occupational therapists and orthopedic surgeons. Patients answered evaluation questionnaires (VAS, WOMAC, LEQUESNE) at inclusion and one year after classes. Three groups participated in two workshops with varying time interval between each workshop (Group 1, 3 months apart; Group 2, 2 months apart; Group 3, 1 month apart. Group 4, control, only received handouts and video as all patients. Patients responded how many times a week they exercised during the year.To compare the means between the groups in the assessments of VAS, WOMAC, Lequesne and BMI, ANOVA was used with repeated measures. To compare the average weekly exercises between groups ANOVA was used. The Tukey test was used for multiple comparisons when significance was found. The data were processed in SPSS V. 18.0 and the significance level used for the tests was α = 0.05. Data are presented as mean (standard deviation) at baseline and after 1 year. Results: Baseline VAS was 53.33 (±27.45) in Group 1, 64.58 (±25.96) in Group 2; 57.81 (±24.91); Group 3; and 55.70 (±26.71) in Group 4. At one year the average VAS was according to groups: 1: 55.81(±22.90); 2: 52.42(±25.93); 3: 52.87(±21.78); 4: 57.27(±24.72). There was a difference between groups after one year (p=0.03) but the Tukey test was not able to verify which group was different. Baseline WOMAC was 1:43.37(±19.15); 2: 46.69(±18.65); 3: 45.33(±18.33); 4:42.33(±18.68) and at one year: 1:43.29(±18.08); 2: 42.33(±20.86); 3: 42.65(±13.67); 4:43.97(±19.43). There was no difference between groups (p=0.53).Baseline LEQUESNE: 1:12.16(6.29); 2: 13.46(9.57); 3: 11.81(4.08); 4: 11.89(4.40) and at one year 1: 11.74(4.05); 2: 11.41(4.63); 3: 11.68(3.62); 4: 11.86(4.30) also showed no difference (p=0.53). Patientes from group 4 exercised less average 1.34(±2.11) times a week than the others: 1: 2.96 (±2.52) p=0.00; 2: 2.75(±2.58); p=0.01; 3: 2.76(±2.95); p=(0.015). BMI was measured at baseline and after a year. There were significant defference between groups: (1 and 4) average =-7.19; CI95%=[-9.94; -4.44]; p=0.00; (2 and 4) average = -4.60; CI95%= [-7.35; -1.849]; p=0.000; (3 and 4) average = -3.55; CI95%= [-6.27; -0.83]; p=0.00. Conclusions: The educational program (handouts, video, and workshops) diminished BMI and increased physical activity of the subjects. Participating in the workshops did not improve functional measures but diminished pain more than just receiving handouts.

Frequency of fear of needles and impact of a multidisciplinary educational approach towards pregnant women with diabetes

To evaluate the frequency of fear of needles and the impact of a multidisciplinary educational program in women with pre-gestational and gestational diabetes taking insulin during pregnancy. The short Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ), composed by two subscales that access fear of self injection (FSI) and fear of self testing (FST), was administered twice during pregnancy to 65 pregnant women with pre-gestational and gestational diabetes: at the first endocrine consult and within the last two weeks of pregnancy or postpartum. An organized multidisciplinary program provided diabetes education during pregnancy. Statistical analysis was carried out by Wilcoxon and McNemar tests and Spearman correlation. A p<0.05 was considered to be significant. Data from the short D-FISQ questionnaire shows that 43.1% of pregnant women were afraid of needles in the first evaluation. There was a significant reduction in scores for FSI and FST subscales between the first and second assessments (first FSI 38.5% compared with second 12.7%, p=0.001; first FST 27.7% compared with second FST 14.3%, p=0.012). The fear of needles is common in pregnant women on insulin therapy and an organized multidisciplinary educational diabetes program applied during pregnancy reduces scores of such fear.

Detoxification in a structured programme is effective for so-called refractory medication-overuse headache

86 of 98 patients completed the 12-month follow-up. Totally, headache frequency was reduced by 39% (p<0.001), medication use by 63% (p<0.001) and 83% remained cured of MOH. Headache frequency was reduced with more than 50% in 42 patients (49%) and 52 (61%) reverted to episodic headache, and with no difference between the groups. Patients in programme B used significantly less symptomatic medication: 6.5 days/ 4 weeks compared with 8.7 days/4 weeks in programme A (p=0.02), and the 56% of patients in programme B who needed prophylactic medication was significantly less than the 80% in programme A (p=0.02). Further, programme B required fewer resources from the staff. Conclusion Structured detoxification with close follow-up by a multidisciplinary team for one year is highly effective in patients with previously treatment-resistant MOH. We recommend a multidisciplinary educational programme for patients in groups due to cost-effectiveness and limited use of medication.

Perspective

Ours is an age of unprecedented levels of environmental alteration and biodiversity loss. Beyond the exposure to environmental hazards, conditions such as environmental degradation, biotic impoverishment, climate change, and the loss of ecosystem services create important health threats by changing the ecology of many pathogens and increasing the incidence and/or severity of certain noncommunicable conditions. They also threaten health in the future by weakening the Earth's life support systems.Although physicians remain one of the most often accessed and most trusted sources of information about the environment, there is currently little emphasis on educating medical professionals about these environmental issues. This lack of training reduces the ability of most physicians to be efficient science-public interfaces and makes them ineffective at contributing to address the fundamental causes of environmental problems or participate in substantive environmental policy discussions. This is an important challenge facing medical education today.To turn medical students into effective physician-citizens, an already-overwhelmed medical school curriculum must make way for a thoughtful exploration of environmental stressors and their impacts on human health. The overarching question before medical educators is how to develop the competencies, standards, and curricula for this educational endeavor. To this end, the authors highlight some of the critical linkages between health and the environment and suggest a subset of key practical issues that need to be addressed in order to create environmental education standards for the physician of the future.

Quel rôle le psychologue peut-il avoir en éducation thérapeutique en néphrologie ? Un exemple en auto-dialyse

This article presents the experience of a psychologist in the development of a multidisciplinary and collective Therapeutic Patient Education program for dialysis patients in out-center (self-dialysis). The role of the psychologist is situated at different levels: construction of the program, animation and co-animation of interventions and evaluation of the program.

239: Effects of a rehabilitation program on large and small artery elasticity, in cardiac patients. Comparison between diabetics and non diabetics patients

Impairment in arterial compliance is associated with diabetes. Arterial stiffness is related to the cardiovascular disease risk. Treatments allowing arterial compliance increase should be relevant to improve prognosis. Previous studies have demonstrated that rehabilitation programs were able to improve arterial compliance in cardiac patients. In the present study, we have assessed the effect of a 6-week rehabilitation program on arterial compliance in diabetic patients (DP) in comparison with non-diabetic patients (NDP) with heart disease. 134 type2 DP and 160 NDP engaged in aerobic training and multidisciplinary educational interventions five days per week. DP and NDP were matched appropriately for age (respectively 57.5 vs 56.5 years), sex ratio (29% vs 25% women) and type of heart disease. Sixty one percent of DP was treated by insulin. Baseline HbA (1c) was greater than 6.6% in 64% of cases. Retinopathy and microalbuminuria were detected in respectively 31% and 36% of subjects. Large (C1) and small artery (C2) elasticity indices were measured using the HDI/PulseWaveTM CR-2000 Research CardioVascular Profiling System (Hypertension Diagnostics TM, Inc) before and after rehabilitation. Before exercise training C2 was lower in DP in comparison with NDP (3.3 vs 3.6 - p<0.02) whereas C1 was similar (15.7 vs 15.3 - p=0.6). After training, significant increases in C1 and C2 were found in the two groups. In diabetic patient a +9% increase in C1 (16.6 - p=0.01) and a 21% increase in C2 (4.2 - p<0.001) were found. This increase was assessed to +7% for C1 (16.7 - p=0.002) and to +18% for C2 (4.3 - p<0.001) in NDP. The percentage of increase in C1 and C2 was not statistically significant between DP and NDP. Small artery elasticity is lower in diabetics compared with non diabetics. A 6-week aerobic training and multidisciplinary educational program improves both large and small artery elasticity in DP and NDP.

The effect of a 12-month multidisciplinary lifestyle education programme on BMI-z score and cardio-metabolic outcomes

Aim: To examine the efficacy of lifestyle intervention on obese children and adolescents (6—16 years) at Princess Margaret Hospital, Western Australia. Strict inclusion criteria exists for this intervention so that participants have significant obesity or obesity with co morbidities. Method: A 12-month group-based multidisciplinary lifestyle programme was attended by 114 subjects (February 2008—May 2011). Anthropometry and cardio-metabolic parameters were assessed at baseline, 10 weeks and 12 months. Non-parametric Wilcoxon signed ranked test was used to test for improvement between pre-treatment and post-treatment parameters. Results: 114 patients were available for analysis (58% female; 44%children <12 years). Pre-treatment BMI z-score (mean± SD) was 2.5± 0.3, systolic blood pressure 119± 14mmHg, fasting insulin 22.4± 38.9mU/l, C-peptide 1.3± 0.5 nmmol/l, triglycerides 1.3± 0.5mmol/l, LDL-cholesterol 2.8± 1.0mmol/l, HDL 1.1± 0.2mmol/l, ALT 27.9± 18.0U/L. Twelve-month follow up was achieved on 90 (78.9%) participants. BMI z-score was reduced at 10 weeks (median± interquartile range) (2.49± 0.32 vs 2.44± 0.34, p < 0.001) with further reduction at 12 months (2.44± 0.34 vs 2.34± 1.0, p = 0.003). Two-hour blood glucose with oral glucose tolerance testing (6.5± 1.9 vs 6.0± 2.0, p = 0.02) and fasting HDL (mean± SD) (1.07± 0.23 vs 1.20± 0.84, p = 0.045) improved at 12 months. No other changes were detected between preand post-treatment. Conclusion: The lifestyle intervention programme for obese children and adolescents is effective in achieving medium term weight loss with maintenance of reductions in BMI-z score 10 months after active intervention phase. HDL and Oral Abstracts

Self-efficacy and health status improve after a wellness program in persons with multiple sclerosis

Purpose: To determine if an intensive wellness program for persons with MS results in improved self-efficacy, quality of life (QOL), or physical activity outcomes. Methods: 129 subjects participated in one of seven 4-day interdisciplinary educational wellness programs throughout the United States. This intervention was based on the philosophy that health management is important to disease management. The program consisted of psychological and physiological evaluations, lectures and workshops. Before the intervention and after at 1, 3 and 6 months, self-efficacy (MS Self-Efficacy Scale, MSSE, control), health related QOL (SF-36) and physical activity (Physical Activity Scale for Persons with Physical Disabilities, PASAID) was assessed. Results: Improvements were noted at 1, 3 and 6 months post-intervention. Those present at 6 months included, MSSE, role physical, vitality and mental health scales of the SF-36. PASAID did not change. Improvements were independent of disability (EDSS). Conclusion: A 4-day multidisciplinary educational wellness program can result in improvement in self-efficacy and health-related QOL in persons with MS and can be stable up to at least 6 months. Improvements do not depend on degree of disability.Implications for RehabilitationMultiple sclerosis is a neurologic disease that can have a significant negative impact on self-efficacy and quality of life.Some wellness based programs have been shown to be effective in improving self-efficacy and quality of life (QOL) in persons with MS.Distance or time could be barriers to access effective wellness programs.An intensive “traveling” 4-day interdisciplinary educational wellness program can result in improvements in self-efficacy and health-related quality of life in persons with MS.Improvements were not dependent on a person’s level of disability (i.e. EDSS).

Detoxification in a structured programme is effective for medication-overuse headache

Abstract Aim To evaluate the long-term efficacy of two different treatment programmes for medication-overuse headache (MOH) in so-called treatment-resistant patients. Methods MOH patients, who had previously been unsuccessfully treated by neurologists, were enrolled in one of 2 structured detoxification programmes in a tertiary headache centre: (A) a one-week withdrawal with restricted analgesics, rescue medications and prophylactics from Day 1 followed by advice of restricted intake of symptomatic medications or (B) a 2-month drug-free period and multidisciplinary education in groups and subsequent initiation of restricted symptomatic medication and prophylactics as required. All patients were closely followed up for a year. Results 86 of 98 patients completed the 12-month follow-up. Totally, headache frequency was reduced by 39% (p &lt;0.001), medication use by 63% (p &lt;0.001) and 83% remained cured of MOH. Headache frequency was reduced with more than 50% in 42 patients (49%) and 52 (61%) reverted to episodic headache, and with no difference between the groups. Patients in programme B used significantly less symptomatic medication: 6.5 days/4 weeks compared with 8.7 days/4 weeks in programme A (p = 0.02), and the 56% of patients in programme B who needed prophylactic medication was significantly less than the 80% in programme A (p = 0.02). Further, programme B required fewer resources from the staff. Conclusion Structured detoxification with close follow-up by a multidisciplinary team for one year is highly effective in patients with previously treatment-resistant MOH. We recommend a multidisciplinary educational programme for patients in groups due to cost-effectiveness and limited use of medication.

Learning about oneself through others: experiences of a group‐based patient education programme about irritable bowel syndrome

People with irritable bowel syndrome (IBS) often experience severe illness-related troubles in their everyday lives. Many persons also perceive their disease-related knowledge to be insufficient, and they feel dissatisfied with their inability to improve well-being. Previous research about patient education and IBS has emphasized biomedical outcomes of symptoms, health-promoting behaviours, coping and health-related quality of life, rather than people's experiences. To explore people's experiences of participating in a multidisciplinary group-based patient education programme about IBS and of the influence of this programme on everyday life with illness. Focus group interviews were performed with 31 persons after their participation in the patient education programme. Interpretive description guided the inductive analysis of data. The study was approved by the local research ethics committee. The analysis revealed four patterns; being part of a safe community, learning about oneself through others, understanding and controlling the body and illness as a whole, and being outside of the community. The pattern of learning about oneself through others can be described as a reciprocal activity of learning by listening to, telling and observing others. Being among similar others had created feelings among most of the focus group participants of being part of a safe community where taboo subjects related to IBS-symptoms could be outspoken. Understanding the body and illness as a whole had enhanced their ability to interpret bodily signals and to handle trouble some situations with greater self-confidence, and this regained their access to the social everyday world. The combination of reciprocal sharing of experiences and the provision of professional scientific knowledge during the patient education programme together contributed to a growing readiness to improve well-being in everyday life, for most of the participating individuals. This was based on new understandings of the body and illness as a whole and of new abilities to make knowledge-based decisions about what strategies to use in overcoming illness-related troubles.

Abstract 288: Secondary Prevention Following Coronary Artery Bypass Surgery: The Need For a Continuum of Care

Purpose: Sustained positive outcomes after coronary artery bypass grafting (CABG) requires risk factor modification and secondary prevention medications. This study assessed the influence of a multidisciplinary educational program on disease understanding, motivation to reduce cardiovascular risk, and secondary prevention medication prescribing following CABG. Methods: Using a prospective, randomized, controlled design, adults undergoing CABG completed surveys at discharge, 3 months, and 12 months, assessing disease understanding and motivation to reduce cardiovascular risk. Four to six weeks after CABG, intervention subjects completed an educational program involving group discussions and individual counseling with pharmacists, dietitians, and a cardiac rehabilitation nurses. The primary endpoint was a composite score of reduced risk factors, medication use among those eligible, and awareness of prescribed medications. Secondary endpoints evaluated survey scores and medication use rates. Wilcoxon Rank Sum and Chi Square tests compared data between specific time points. Generalized estimating equations and linear contrasts of the parameter estimates compared data at the three time points. Results: The final analysis included 98 subjects (I=49, C=49). The composite score was not different between groups (I=12.8±4.5 points, C=12.7±4.9 points, p=0.9405). Improvements were noted in understanding and motivation in the entire cohort, but these changes could not be attributed to our intervention. Medication use declined at 3 and 12 months after CABG without significant differences between the groups. Conclusions: Disease understanding, motivation to reduce risk, and medication use is robust at hospital discharge but declines with time and was not improved by our intervention. These findings are concerning and warrant further study.

Accessing flexible learning opportunities: children’s and young people’s use of laptops in a paediatric hospital

Hospitalised children and young people not only face challenges to their health but also to their continued education and social connections. These challenges can impact on future life trajectories, so it is crucial to maintain learning and socialising. Educational technologies, such as laptops and iPads, are used in the multidisciplinary educational programme provided to patients at the Royal Children’s Hospital, Melbourne. This paper reports on the use of laptops by 71 patients at the hospital, who represented a range of ages, gender, home location and type of hospital admission (short, long, infrequent and frequent). Surveys revealed these technologies were used throughout the hospital with use varying according to the stage of development; however, restrictions to academic and social networking sites were problematic. The results highlight how educational technologies can provide access to flexible learning opportunities and socialising for hospitalised children and young people.