Educational Outreach Research Articles

The Inception and Progression of a True Partnership: How to Make It Work for at Least 20 Years

ABSTRACT A cancer partnership was established between the University of the District of Columbia (UDC) and the Lombardi Comprehensive Cancer Center (LCCC) Georgetown University Medical Center in 2000 to focus on Cancer Prevention and Control. The major goal of the Partnership was cancer research, education, and cancer outreach. African American populations in the District of Columbia were the focus of this Partnership. This Partnership began with a planning grant (P20) from the National Cancer Institute/National Institutes of Health (NCI/NIH) and two years later it received additional funding in the form of a U56 grant from NCI/NIH. Stemming from this Partnership has been new undergraduate courses in cancer prevention, new cancer outreach activities, collaborative projects between UDC and LCCC faculty researchers, a Cancer Academy for both graduate and undergraduate students, a Bridges to the Doctorate Program for graduate students, and the designing and implementation of a UDC/LCCC jointly taught and administered Master’s Program in Cancer Biology, Prevention and Control. It is hoped that many more activities will stem from this continuing Partnership, which is twenty years old. A description of the planning activities, policies to include or avoid, and outcomes will be detailed in this article.

Evaluating the effectiveness of let's talk period's high school educational outreach program: A pilot study.

Menorrhagia impacts ~40% of adolescent females, with about half having an underlying bleeding disorder, most commonly von Willebrand Disease (VWD). VWD affects ~1 in 1000 individuals, though many are unaware of their condition. Let's Talk Period (LTP) is an online knowledge translation platform aimed at increasing awareness of bleeding disorders symptoms, with a validated self-administered bleeding assessment tool (Self-BAT). To evaluate the effectiveness of the LTP high school outreach program in Grade 9 girls' health classes quantitatively, using baseline, post-presentation, and follow-up quiz scores, and qualitatively, with student and teacher feedback forms. The 75-minute in-class presentations, developed in alignment with the 2015 Ontario Curriculum for Grade 9 Health and Physical Activity, were led by a haemophilia nurse, clinical research assistant, and undergraduate student from the LTP team. Students completed baseline, post-presentation, and 4-6-week follow-up Kahoot quizzes featuring the same nine questions to evaluate change in knowledge levels and retention. Both student and teacher feedback were collected. There was a significant increase (p<0.001) from baseline to post-presentation scores, with a significant gain in knowledge, for all questions (p<0.01). Students found content related to the basics and management of menstruation to be most interesting. Many had constructive feedback on how the presentation method could be improved. On average, the presentations were rated an 8.6 of 10 by students and 8.75 of 10 by teachers. The LTP high school outreach program effectively increases student knowledge of menorrhagia and bleeding disorders. It was well-received by students and staff alike.

Is it possible to influence ability, willingness and understanding among nursing home care staff to implement nutritional guidelines? A comparison of a facilitated and an educational strategy.

Translating nutrition knowledge into care practice is challenging since multiple factors can affect the implementation process. This study examined the impact of two implementation strategies, that is external facilitation (EF) and educational outreach visits (EOVs), on the organisational context and individual factors when implementing nutritional guidelines in a nursing home (NH) setting. The EF strategy was a one-year, multifaceted (including support, guidance, a practice audit and feedback) intervention given to four NH units. The EOV strategy was a three-hour lecture about the nutritional guidelines given to four other NH units. Both strategies were directed at selected NH teams, consisting of a unit manager, a nurse and 5-10 care staff. A questionnaire was distributed, before and after the interventions, to evaluate the prerequisites for the staff to use the guidelines. Three conditions were used to examine the organisational context and the individual factors: the staff's ability and willingness to implement the nutritional guidelines and their understanding of them. Confirmatory factor analysis and structural equation models were used for the data analysis. The results indicated that on average, there was a significant increase in the staff's ability to implement the nutritional guidelines in the EF group. The staff exposed to the EF strategy experienced better resources to implement the guidelines in terms of time, tools and support from leadership and a clearer assignment of responsibility regarding nutrition procedures. There was no change in staff's willingness and understanding of the guidelines in the EF group. On average, no significant changes were observed for the staff's ability, willingness or understanding in the EOV group. A long-term, active and flexible implementation strategy (i.e. EF) affected the care staff's ability to implement the nutritional guidelines in an NH setting. No such impact was observed for the more passive, educational approach (i.e. EOV).

Academic detailing with ambulatory pharmacists to support naloxone counseling

BackgroundPharmacists are critical to public health in supporting safe use of prescription opioids by ensuring that all patients are offered and counseled on naloxone. Academic detailing may be an effective educational outreach strategy for improving pharmacists’ knowledge and behavior related to naloxone. ObjectiveTo describe an academic detailing program to pharmacists on the topic of counseling and promoting naloxone to patients. MethodsPharmacists were recruited by convenience sampling. Three pharmacists who were experienced with academic detailing techniques provided the education. Survey data were collected to evaluate the program. ResultsThirty-three pharmacists participated, including 16 sessions that were delivered virtually. The pharmacists worked in a variety of ambulatory settings, including chain or corporate-owned pharmacies (58%), hospital-owned specialty pharmacies (15%), hospital-owned community pharmacies (15%), and independently owned or other pharmacies (12%). Twenty-eight pharmacists (85%) completed an immediate post-session evaluation survey. Twenty-seven pharmacists (96%) indicated they felt the information presented will impact their practice or patient care. Eleven pharmacists (33%) completed a second post-session survey, self-reporting improvements related to counseling patients about naloxone. Conclusion: Participating in academic detailing supports community pharmacists’ providing patient counseling about naloxone. Further study, particularly related to virtual academic detailing, is necessary to understand the full potential of academic detailing to pharmacists.

Incidence and cost of radical prostatectomy for NCCN low-risk prostate cancer in Utah.

232 Background: Guidelines Support active surveillance (AS) as the preferred treatment for men with NCCN low-risk prostate cancer (Gleason 3+3, prostate-specific antigen [PSA] &lt;10 ng/ml, ≤T2a). Recent work from Mahal BA et al. (JAMA 2019) reports AS rates are increasing, but only 42.1% of men with low-risk prostate cancer underwent AS in 2015. Low-risk prostate cancer accounted for 30.1% of diagnoses. The majority of Utah residents treated for prostate cancer receive therapy at either The Huntsman Cancer Institute or Intermountain Healthcare facilities. We modeled the costs associated with the presumptive overtreatment of men with low-risk disease treated in 2017-2019. Methods: Data from The Huntsman Cancer Institute and Intermountain Healthcare cancer databases from 2017 to 2019 were retrospectively analyzed. Men with available pathologic, laboratory and clinical data who had undergone prostatectomy were stratified by having NCCN low, intermediate, and high-risk disease. Rates of radical prostatectomy by year and institution were analyzed. The cost of prostatectomy compared to AS was estimated to be $14,453 from recent work by Trogdon JG et al. (JAMA Oncol 2019). Results: Data was available for 1,155 Utahn men (Table). Of the 1155 surgeries performed, 69 (6%) were in low-risk patients. The total costs of care that might have been avoided over these three years are estimated to be $1 million. Conclusions: Approximately 6% of prostatectomies performed in Utah are in men with NCCN low-risk prostate cancer. While these rates are lower than the national average, we estimate approximately $1 million in medical costs and toxicities could be deferred had these patients opted for AS. Work is ongoing to characterize clinical toxicity of treatment in these men, and a multi-institutional collaborative education outreach program to reduce overtreatment is in development. [Table: see text]

Deprescribing medications that may increase the risk of hepatic encephalopathy: A qualitative study of patients with cirrhosis and their doctors.

Background and AimsMultiple medications are associated with an increased risk of incident hepatic encephalopathy. Despite this known risk, medications such as opioids, benzodiazepines, gabapentin/pregabalin, and/or proton pump inhibitors are increasingly prescribed to persons with cirrhosis. Deprescribing is a promising intervention to reduce the burden of hepatic encephalopathy. Given that deprescribing has not been trialed in cirrhosis, we evaluated the barriers and facilitators to safe and successful deprescribing in cirrhosis.MethodsWe conducted, transcribed, and analyzed semi‐structured interviews using qualitative methodology with 22 subjects. This included eight patients with cirrhosis and recent use of opiates, benzodiazepines, gabapentin/Lyrica, and/or proton pump inhibitors as well as 14 providers (primary care, transplant surgery, transplant hepatology). Interviews explored opinions, behaviors, and understanding surrounding the risks and benefits of deprescribing.ResultsMajor provider‐specific barriers included deferred responsibility of the deprescribing process, knowledge gaps regarding the risk of hepatic encephalopathy associated with medications (e.g., proton pump inhibitors) as well as the safe method of deprescription (i.e., benzodiazepines), and time constraints. Patient‐specific barriers included knowledge gaps regarding the cirrhosis‐specific risks of their medications and anxiety about the recurrence of symptoms after medication discontinuation. Patients uniformly reported trust in their provider's opinions on risks and wished for more comprehensive education during or after visits. Providers uniformly reported support for deprescription resources including pharmacist or nurse outreach.ConclusionGiven knowledge of medication risks related to hepatic encephalopathy in patients with cirrhosis, deprescribing is universally seen as important. Knowledge gaps, inaction, and uncertainty regarding feasible alternatives prevent meaningful implementation of deprescription. Trials of protocolized pharmacy‐based deprescribing outreach and patient‐facing education on risks are warranted.

Patient factors associated with oral generic olanzapine initiation and substitution among Medicaid beneficiaries: a new user cohort study

Objective Generic drugs typically are less expensive than branded products; however, several factors can limit generic drug utilization. This study assesses the associations of patient factors with generic olanzapine initiation and substitution. Methods A retrospective new user cohort study was conducted using the 2011–2012 Medicaid administrative claims data. Beneficiaries continuously enrolled during the 6 month washout period prior to their initial oral brand or generic olanzapine prescription were included and followed up to 12 months. Among brand olanzapine new users, time to generic substitution and competing risk outcomes was estimated using the Fine–Gray cumulative incidence function. Patient demographic and health service utilization factors were assessed in the multivariate cause-specific hazards model. Results Among olanzapine new users, 70.7% patients initiated generic treatment. Beneficiaries aged ≥21, and living in the Midwest and West regions were more likely to initiate generic olanzapine. Among brand new users, 28.2% switched to generic olanzapine, 23.6% switched to an alternative atypical antipsychotic treatment and 38.0% discontinued within 12 months. Beneficiaries who resided in urban areas (adjusted hazard ratio [AHR) = 0.53, 95% CI = 0.37–0.75) and had prior hospitalizations (AHR = 0.85, 95% CI = 0.75–0.96) had lower rates of generic substitution, whereas those with emergency department (ED) visits (AHR = 1.06, 95% CI = 1.02–1.10) had a higher rate of generic substitution. In addition, beneficiaries in different age subgroups also had different rates of generic substitution in different regions. Conclusion Medicaid beneficiaries’ age, geographic region, prior hospitalization and ED utilization were associated with generic olanzapine initiation and substitution. Tailored educational outreach targeting these patient subgroups might improve generic olanzapine utilization.

Leveraging library technology resources for internal projects, outreach, and engagement: A case study of Overleaf, LaTeX, and the KiltHub Institutional Repository Service at Carnegie Mellon University Libraries

Academic libraries offer educational outreach surrounding their technology services available to users. When using those same technology services for internal projects, librarians can better understand the mechanisms behind these technologies, allowing for meaningful outreach efforts in which librarians serve as both primary users and facilitators of use. This paper highlights a case study of leveraging an institutional license to Overleaf, a collaborative LaTeX editor, to rebuild documentation on the use of KiltHub, an institutional repository. This requires a complex mix of text, images, tables, and even videos, and presented a tremendous challenge to format in Microsoft Word and Google Docs. In leveraging the library’s own technologies, the KiltHub team gained a greater understanding of how to use and teach with these platforms, ultimately better serving campus users.

An Analysis of Computed Tomography-Related Radiation Exposure in Pediatric Trauma Patients.

To compare radiation doses used for pediatric computed tomography (CT) scans at community-based referring facilities (RF) to those at a designated pediatric trauma center (PTC) to assess the consistency of radiation exposure. In this retrospective study, patients 0 to 18 years of age with CT imaging performed either at a RF or at a PTC from January 1, 2015, to January 5, 2016, were identified. Data about patients, CT radiation dose, and characteristics of the RFs were compared. We identified 502 patients (156 RF, 346 PTC) with 281 head CTs (79 RF, 202 PTC) and 86 abdominal/pelvis CTs (28 RF, 58 PTC). The radiation dose (measured in mean dose-length product [DLP] ± 1 standard deviation) was significantly higher for RF scans compared with PTC scans (head, RF DLP = 545 ± 334 vs PTC DLP = 438 ± 186 (P < 0.001); abdomen/pelvis, RF DLP = 279 ± 160 vs PTC DLP = 181 ± 201 [P = 0.027]). There was a nonsignificant trend toward lower head CT radiation dosages at RFs with a dedicated pediatric emergency department compared with RFs without a pediatric emergency department. Our data suggest that CT scans performed at RFs expose pediatric patients to significantly higher doses of radiation when compared with a PTC. These data support further study to identify factors associated with increased radiation and educational outreach to RFs.

Working within the System: The Effects of Standardized Testing on Education Outreach and Community Writing

This snapshot describes and reflects upon two case studies of community writing projects between Emerson College and Boston Public Schools. Emerson College students were asked to tutor 10th grade BPS students for the English Language Arts portion of the state standardized assessment. Through both quantitative results and qualitative reflection, this paper suggests that approaching such standardized tests as a distinct genre of writing can not only help students to gain awareness for multiple genres, but also to recognize their own writing as an empowered and meaningful political form of social action.

Considering the Potential Benefits of Over-the-Counter Naloxone.

Since 1999, annual opioid-related overdose (ORO) mortality has increased more than six-fold. In response to this crisis, the US Department of Health and Human Services outlined a 5-point strategy to reduce ORO mortality which included the widespread distribution of naloxone, an opioid antagonist that can rapidly reverse an opioid overdose. Increased distribution has been facilitated by the implementation of naloxone access laws in each US state aimed at increasing community access to naloxone. While these laws differ from state-to-state, most contain mechanisms to enable pharmacists to dispense naloxone without a patient-specific prescription. These laws have enhanced community naloxone distribution, both from pharmacies and overdose education and naloxone distribution programs, and produced positive effects on ORO mortality. However, a growing body of evidence has revealed that significant barriers to naloxone access from pharmacies remain, and annual ORO deaths have continued to climb. Given these concerns, there has been a push among some clinicians and policymakers for the US Food and Drug Administration to re-classify naloxone as an over-the-counter (OTC) medication as a means to further increase its accessibility. If an OTC transition occurs, educational outreach and funding for clinical innovations will continue to be crucial given the important role of health professionals in recommending naloxone to people at risk for experiencing or witnessing an ORO. Recognizing the severity of the ORO public health crisis, we believe transitioning formulations of naloxone approved for layperson use to OTC status would result in a net benefit through increased access. However, such a change should be combined with measures to ensure affordability.

General practitioners’ views and experiences in caring for patients after sepsis: a qualitative interview study

BackgroundPatients surviving critical illnesses, such as sepsis, often suffer from long-term complications. After discharge from hospital, most patients are treated in primary care. Little is known how general practitioners (GPs)...

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Improving Prone Positioning for Severe Acute Respiratory Distress Syndrome during the COVID-19 Pandemic. An Implementation-Mapping Approach.

Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress syndrome (ARDS), a feature of severe coronavirus disease 2019 (COVID-19). Despite this, most patients with ARDS do not receive this lifesaving therapy.Objectives: To identify determinants of prone-positioning use, to develop specific implementation strategies, and to incorporate strategies into an overarching response to the COVID-19 crisis.Methods: We used an implementation-mapping approach guided by implementation-science frameworks. We conducted semistructured interviews with 30 intensive care unit (ICU) clinicians who staffed 12 ICUs within the Penn Medicine Health System and the University of Michigan Medical Center. We performed thematic analysis using the Consolidated Framework for Implementation Research. We then conducted three focus groups with a task force of ICU leaders to develop an implementation menu, using the Expert Recommendations for Implementing Change framework. The implementation strategies were adapted as part of the Penn Medicine COVID-19 pandemic response.Results: We identified five broad themes of determinants of prone positioning, including knowledge, resources, alternative therapies, team culture, and patient factors, which collectively spanned all five Consolidated Framework for Implementation Research domains. The task force developed five specific implementation strategies, including educational outreach, learning collaborative, clinical protocol, prone-positioning team, and automated alerting, elements of which were rapidly implemented at Penn Medicine.Conclusions: We identified five broad themes of determinants of evidence-based use of prone positioning for severe ARDS and several specific strategies to address these themes. These strategies may be feasible for rapid implementation to increase use of prone positioning for severe ARDS with COVID-19.

Sociodemographic Factors Associated with Request for Labor Epidural Analgesia in a Tertiary Obstetric Hospital in Vietnam.

This study is aimed at examining the sociodemographic factors associated with the utilization of labor epidural analgesia at a large obstetric and gynecology hospital in Vietnam. This was a cross-sectional study of women who underwent vaginal delivery in September 2018 at the Hanoi Obstetrics and Gynecology Hospital. The utilization of epidural analgesia during labor was determined. Univariate and multivariate regression models were applied to evaluate the association between patient demographic and socioeconomic factors and request for labor epidural analgesia. A total of 417 women had vaginal deliveries during the study period. 207 women utilized epidural analgesia for pain relief during labor, and 210 did not. Parturients older than 35 years of age (OR 2.84, 95% CI 1.11-8.17), multiparous women (OR 2.8 95% CI 1.85-4.25), women living from an urban area, women with higher income (OR 6.47, 95% CI 2.59-19.23), and women with higher level of education were more likely to utilize labor epidurals. Factors related to a parturient request for epidural analgesia during labor at our tertiary obstetric hospital included age greater than 35 years, multiparity, and high income and education levels. Educational outreach to women about the benefits of epidural analgesia can target women who do not share these demographic characteristics.

If you build it, promote it, and they trust you, then they will come: Diffusion strategies for science gateways and cyberinfrastructure adoption to harness big data in the science, technology, engineering, and mathematics (STEM) community

AbstractIn the big data era, for science gateways (SG) and cyberinfrastructure (CI) projects to have the greatest impacts, they need to be widely adopted in the scientific community. However, diffusion activities, or activities aimed to spread SG/CI in the science, technology, engineering, and mathematics community, are often an afterthought in projects. We warn against the fallacy of “If You Build It, They Will Come.” Projects could be intentional in promoting tool adoption. Based on an analysis of 83 interviews with 66 administrators, developers, scientists/users, and outreach educators of SG/CI, we identified seven external communication practices—raising awareness, personalizing demonstrations, providing online and offline training, networking with the community, building relationships with trust, stimulating word‐of‐mouth persuasion, and keeping reliable documentation. With these strategies, we revised the pop culture line to “If You Build It, Promote It, and They Trust You, Then They Will Come.” We also observed the beliefs that external communication is mainly necessary when seeking continuous funding, and it belongs to the skillset of nontechnical staff. These two beliefs may explain why external communication is underemphasized in many SG/CI projects. The article serves as evidence to justify a bigger budget in funding proposals for diffusion strategies to increase adoption and broader impacts.

Needs Assessment to Inform and Improve Educational Practices Surrounding Omega-3 Consumption during Pregnancy.

Adequate dietary consumption of long chain omega-3 fatty acids (n-3 LCPUFA) during pregnancy has been associated with better maternal and infant health outcomes. Given that the primary source of n-3 LCPUFA is fish and fish oils, concerns surrounding contamination and uncertainty of safe fish intake guidelines have negatively affected consumption of fish during pregnancy. Although obstetric healthcare providers are in a unique position to influence dietary intake patterns, a gap exists in their understanding the knowledge and practices surrounding n-3 LCPUFA. This needs assessment investigation evaluated knowledge, attitudes and prescribing/recommending practices of obstetric practitioners surrounding n-3 LCPUFA consumption and/or supplementation to generate evidence supporting the development of targeted educational initiatives. A cross-sectional, needs assessment was conducted using anonymous online-survey of affiliate members of the American College of Nurse Midwives (N = 105). A 24-item, previously validated (α = 0.86) needs assessment survey (Obstetric Clinicians Omega-3 Survey, OCOS) was used to assess attitudes, knowledge, and prescribing practices surrounding n-3 LCPUFA. The total OCOS score representing attitudes, knowledge and prescribing patterns collectively was 69.48% (Mean = 79.90(± 12.44), score range = 24-115). Scores for the sub-domains included attitude 68.33% (Mean = 20.50(± 3.64), score range = 6-30); knowledge 71.40% (Mean = 30.70(± 5.43), score range = 9-43); and prescribing patterns 68.31% (Mean = 28.69(± 5.39), score range = 9-42). Although the majority of respondents had fair-moderate n-3 LCPUFA knowledge, attitudes and prescribing/recommending, our results highlight an opportunity for additional research and educational outreach targeting improved n-3 LCPUFA knowledge and practices. Specific areas of educational interest included associated health outcomes, dosing and safe consumption guidelines.

The Importance of Public Education and Interpretation in the Conservation of Toba Caldera Geoheritage

This article discusses the importance of local community involvement and their appreciation concerning geotourism. The Toba Caldera is an interesting area that forms a unique, spectacular landscape and is a popular international tourist destination. This caldera has become an important Indonesian tourism icon, and a plan is being developed with respect to sustainable development within the vicinity. The authors prepared an educational outreach event consisting of class and field presentations to residents of the Lake Toba area. The course covered the evolution of the Toba Caldera and its relationship to Samosir Island, part of a resurgent dome complex (Chesner 2011). A comprehensive survey indicated that approximately 67% of the local residents and students in the course understood the geological implications of the Toba area. This number indicates a very rapid increase, when compared to 11% of those individuals who understood the volcanic geology aspect before they entered the education program. Fortunately, soon after learning the material, the residents and the students demonstrated an eagerness to preserve the Toba Caldera geoheritage site (i.e., to protect the fossil geosites and/or become involved as geotourism guides). This attitude can be considered as the key factor for the success of Toba’s geoheritage preservation, which is dependent on the awareness of local communities and their appreciation towards geoconservation, especially at fossil outcrop locations. Fossil outcrops are so important because of their limited distribution and they usually were preserved in a soft rock/formation. Another finding of this study is that 53% of the participants (most of them are young boys) became interested in geotourism guide services after learning the evolution of the Toba Caldera, citing a desire to be involved in the Toba caldera geopark program’s success. In response to the positive impact the program had on the participants, the authors assisted them in developing a responsibility to protect the geoheritage of Toba Caldera from any disrupters. In addition to the study, the authors produced a geoheritage map that displays 36 geosites. Moreover, for further advancement of public education programs, some written materials will be prepared, such as leaflets, posters, and geotourism guidelines.

Lessons Learned From LMICs (Low and Middle Income Countries): COVID-19 Health Education and Community Outreach Best Practices for Gaza

Purpose of Review To survey successful COVID–19 interventions of low– and middle–income countries (LMIC) that are transferable to Gaza, Palestine. Recent Findings As the COVID–19 pandemic ravages globally, low– and middle–income countries (LMIC) showed success in education–based intervention approaches. This paper compiled the COVID responses in 7 LMIC: Vietnam, Ethiopia, Bangladesh, Somalia, Afghanistan, Yemen, and Syria. The authors outlined the most successful and effective of these public health strategies, such as outreach through local leadership and the use of social media campaigning. Ineffective public outreach attributed to the shortcomings of some of the countries’ public health responses. This paper identifies the successful techniques of one LMIC and how similar strategies may be applicable in assisting Gaza in curbing COVID–19 infection rates. Summary Gaza, a community under conflict with little resources, must implement proven strategies to improve its healthcare framework and COVID–19 response. Of the 7 LMIC reviewed, 3 are nations actively in conflict: Afghanistan, Yemen, and Syria. Assessing their ability to respond to COVID despite unstable infrastructure and low–income status provides an important example of successful health education and community outreach techniques. Based on the education–based and community–oriented best practices discovered, appropriate recommendations are proposed for Gaza’s growth and benefit.

Tax Filing and Take-Up: Experimental Evidence on Tax Preparation Outreach and EITC Participation

Governments and non-profits devote substantial resources to increasing take-up of the Earned Income Tax Credit (EITC) through educational outreach. We study a different approach: policies that encourage tax filing. In a large field experiment, we find that IRS letters about free tax preparation modestly increased filing, with a large share of the new filers claiming the EITC. The results suggest policies that increase filing can be an effective way to increase take-up of tax-administered social benefits, even policies that do not raise awareness or directly target the benefit in other ways.