Patient Education Booklet Research Articles

Abstract TP357: Large Five State Health System Standardizes Stroke Patient Education While Significantly Improving Health Literacy

Background: Written stroke patient education materials are instrumental to improving the patient care experience. Since 2010, national certifying bodies recommend written materials at a maximum reading level of 5th grade to meet health literacy needs. In 2016 certified comprehensive and primary stroke centers from a multi-state health system discovered significant variation among stroke patient education booklets (SPEB) developed by separate facilities/states, and in 2018 implemented a standard SPEB by partnering with an external organization (EO). The health system worked with the EO to add information in the SPEB specific to carotid disease and stroke symptoms. Purpose: Compare the health literacy of pre-standardization SPEBs to the updated EO SPEB with and without carotid education. Methods: Readability assessments were used to determine reading grade levels for pre-standardization SPEBs consisting of 7 SPEB among 18 facilities in 5 states, the EO standardized SPEB with and without the additional carotid education, and the carotid education additions alone. Assessments included: 1) Flesch Reading Ease Formula, 2) Flesch-Kincaid Grade Level, 3) Gunning Fog Index Readability Formula, 4) Simple Measure of Gobbledygook (SMOG) Readability Formula, 5) Coleman-Liau Index, 6) Automated Readability Index, and 7) Linsear Write Formula. These assessments were then used to calculate a readability consensus score (RCS), reported as grade levels, using an online tool. Visual Imagery was not included in the assessments. Results: The range of RCS grade levels for pre-standardization materials was 7th to 12th grade. A grade level of 11 - 12 was found for 57.1% of sites. The EO SPEB without carotid education had an RCS grade level of 7 and with the additional information had a grade 8 level. The carotid education alone was at a college graduate level. Utilization of the EO SPEB decreased the health literacy level for 88.9% of sites. Conclusion: A standardized SPEB was implemented for a large five state health system. The health literacy level significantly improved at almost 90% of the participating facilities. The recommended 5 th grade health literacy level was not achieved based on the RCS. More research is needed on the impact visual imagery has on health literacy.

The impact of in hospital patient-education intervention on older people's attitudes and intention to have their benzodiazepines deprescribed: a feasibility study.

Background:Long-term benzodiazepine use in the older population is common and is associated with significant harm. The provision of a patient-educational booklet during hospitalization may encourage patients to discuss review and possible deprescribing of benzodiazepine therapy with their health professionals. The aim of this study was to assess the feasibility and effect of a patient empowerment intervention in hospital inpatients on patient initiation of a discussion about deprescribing benzodiazepines versus usual care.Methods:A feasibility interventional study using a patient-empowerment education intervention was conducted at a Sydney teaching hospital. Patients aged ⩾ 65 years, prescribed a benzodiazepine, and able to provide consent were invited to participate in the study. Participants were randomly allocated to intervention or control group (1:1). Intervention participants received the patient-empowerment booklet and control received usual care. All participants received 1-month follow-up phone interviews to assess medication and attitudinal changes.Results:A total of 42 participants were recruited (20 intervention and 22 control). The average age was 71.5 (interquartile range: 69.0–80.3) and 54.8% were females. There was no difference in baseline characteristics between intervention and control groups (p > 0.05). At baseline, 65.0% of participants (53.0% intervention, 86.0% control) were not concerned about the potential benzodiazepine side effects. Twenty-nine participants (15 intervention and 14 control) completed 1-month follow up; 22 participants (11 intervention and 11 control) were discharged on the benzodiazepine. Among these, 13 (59.1%) had ceased benzodiazepine at 1-month follow up [46.2% (n = 6) intervention; 53.8% (n = 7) control]. In the intervention group, 33.3% (n = 5) of participants had initiated a discussion with their doctor or pharmacist about stopping the benzodiazepine compared with 35.7% (n = 5) in the control group.Conclusion:Cessation of benzodiazepines 1 month following discharge was common. Future larger studies are required to confirm the effectiveness of providing a patient-empowerment booklet on reducing benzodiazepine use and other potentially inappropriate medications.

IMPACT OF A PHARMACIST-LED PATIENT EDUCATION INITIATIVE ON GLYCEMIC CONTROL OF PATIENTS WITH TYPE 2 DIABETES MELLITUS: A SINGLE-CENTER EXPERIENCE IN WEST JAKARTA, INDONESIA

Objective: This study aimed to evaluate the effect of the provision of drug-related information and patient education booklets on the hemoglobin A1c(HbA1c) levels of patients with type 2 diabetes mellitus.Methods: This prospective study was conducted at the Kembangan Health Center, West Jakarta, Indonesia, from March to June 2017. A total of30 patients were divided into two equal groups: In addition to routine treatment, patients in the intervention group received drug-related informationand patient education booklet, while those in the control group received no additional intervention. The provision of drug information was throughdirect education as well as through telephone, short messages, and booklet. HbA1c level was measured as a surrogate measure of treatment adherence.HbA1c concentration was measured at baseline and 11 weeks after the intervention.Results: Mean HbA1c level in the intervention group decreased from 8.05±0.91% at week 0 to 6.92±0.47% at week 11 after intervention (p<0.05).Conclusion: In this study, provision of drug information and patient education booklets helped to improve the patient compliance.

How Does Health Education Given to Lung Cancer Patients Before Thoracotomy Affect Pain, Anxiety, and Respiratory Functions?

In this study, it was aimed to determine how the postoperative pain level, state-trait anxiety level, and respiratory function were affected by the health education given through a patient education booklet to patients with lung cancer, in comparison with control group, before pulmonary resection through thoracotomy. The 60 patients (n = 60) having pulmonary resection indication because of lung cancer were recruited in the present study. The patients were separated as control (n = 30) and experimental groups (n = 30). The patient education was applied to patients in the experimental groups via the education booklet 24h before the surgery. Patients in the control groups received only usual clinical nursing information. The pain was evaluated via visual analog scale (VAS). The State-Trait Anxiety Scale (STAS) was used for evaluating the anxiety level. The evaluated pulmonary functions were peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), and forced expiratory flow 25-75 (FEF25-75). The pain level of the experimental group was statistically lower than control group (p < 0.05). The state anxiety level of experimental group received education was statistically lower than control group (p < 0.05). There was no any statistical difference in trait anxiety levels between control and experimental groups (p > 0.05). The FEV1 and FEF25-75 values in experimental group were statistically higher than control group. A planned health education applied via the thoracotomy patient education booklet has a positive effect on clinical recovery process by affecting postoperative pain, state anxiety, and FEV1 and FEF25-75 values.

Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN trial

BackgroundPain is a common and distressing symptom in people with cancer, but is under-recognised and under-treated. Australian guidelines for ‘Cancer Pain Management in Adults’ are available on the Cancer Council Australia Cancer Guideline Wiki. This study aims to evaluate the effectiveness and cost-effectiveness of a suite of guideline implementation strategies for improving pain outcomes in adults with cancer in oncology and palliative care outpatient settings.MethodsThe study will use a stepped-wedge cluster randomised controlled design, with oncology and palliative care outpatient services as the clusters. Patients will be eligible if they are adults with cancer and pain presenting to participating services during the study period. During an initial control arm, services will routinely screen patients for average and worst pain over the past 24 h using a 0–10 numerical rating scale (NRS) and have unfettered access to online guidelines. During the intervention arm, staff at each service will be encouraged to use: 1) a patient education booklet and self-management resource; 2) an online spaced learning cancer pain education module for clinicians from different disciplines; and 3) audit and feedback of service performance on key indices of cancer pain screening, assessment and management. Service-based clinical change champions will lead implementation of these strategies.The trial’s primary outcome will be the probability that patients initially screened as having moderate-severe (≥5/10 NRS) worst pain experience a clinically important improvement one week later, defined as ≥ 30% reduction. Secondary outcomes will include patient empowerment and quality of life, carer experience, and cost-effectiveness. For the main analysis, linear mixed models will be used, accounting for clustering and the longitudinal design. Eighty-two patients per service at six services (N = 492) will provide > 90% power. A qualitative sub-study and analyses of structural and process factors will explore opportunities for further refinement and tailoring of the intervention.DiscussionThis pragmatic trial will inform implementation of guidelines across a range of oncology and palliative care outpatient service contexts. If found effective, the implementation strategies will be made freely available on the Wiki alongside the guidelines.Trial registrationRegistered 23/01/2015 on the Australian New Zealand Clinical Trials Registry (ACTRN12615000064505).

Direct Oral Anticoagulants in the Real World: Insights into Canadian Health Care Providers’ Understanding of Medication Dosing and Use

Direct Oral Anticoagulants in the Real World: Insights into Canadian Health Care Providers’ Understanding of Medication Dosing and Use

A Theory-Based Educational Booklet Improves Colonoscopy Attendance and Bowel Preparation Quality

Introduction: Patients who “no-show” for colonoscopy or present with poor bowel preparation waste endoscopic resources and do not receive adequate examination for colorectal cancer (CRC) screening. At our VA hospital, which does not use open access endoscopy, the colonoscopy no-show rate is high and inadequate bowel preparation is a common occurrence. To address these issues, we designed a patient education booklet using health behavior theory and evaluated its effect on no-show rates and bowel preparation quality. Methods: We adapted the Health Belief Model for screening/surveillance colonoscopy and identified major targets for intervention. We then designed a 12-page color patient education booklet to target individual perceptions about CRC using simple facts, provide cues to action using graphics to explain the bowel preparation process, and increase likelihood of action by adopting a more palatable low residue diet (Fig 1). We compared the no-show rate over a two month period before and after introduction of the booklet, allowing for a wash-out period during which booklet use was inconsistent. We compared the Boston Bowel Prep Scale (BPPS) in 100 consecutive patients who underwent colonoscopy during each of the two periods.Figure: Select Sections of Patient Education Pamphlet.Results: Baseline characteristics between the two groups were similar, although patients who received the booklet were younger (Table). The no-show rate was significantly lower in patients who received the booklet than those who did not (13% vs. 21%, P=.01). The percentage of patients with adequate bowel prep—defined as BBPS>1 in all segments—increased from 82% to 86% after introduction of the booklet and surpassed the 85% metric recommended US Multi-Society Task Force, although the difference was not statistically significant (P=.44). The proportion of patients with BBPS=9 was significantly higher in the booklet group (Fig 2; 41% vs. 27%, P=.03). There was no difference in adenoma and sessile serrated adenoma detection rates before and after the booklet.Figure: Boston Bowel Preparation Scale Outcomes Before and After Patient Education Booklet.Table: Table. Patient Characteristics and OutcomesConclusion: Using a theory-based patient education intervention, we decreased our colonoscopy noshow rate by 38% and increased our adequate bowel preparation rate above the guideline-recommended 85%. Our adaptation of the Health Belief Model for screening/surveillance colonoscopy may be a useful construct for future health behavioral interventions.

Effect of Education About Oral Mucositis Given to the Cancer Patients Having Chemotherapy on Life Quality.

The study was aimed to determine the effect of education cancer patients receiving chemotherapy for prevention of oral mucositis on the quality of life. A total of 60 patients including 30 patients each in education and control groups were included in this randomized controlled study. On the first day of study, Oral Assessment Guide and EORTC QLQ-C30 Version 3.0 were applied to both groups and also it was trained only the education group for the prevention of oral mucositis and explained Patient Education Booklet. The oral mucosae of both groups were evaluated with Oral Assessment Guide on the 5th, 10th, 15th, and 21st day of chemotherapy. EORTC QLQ-C30 Version 3.0 was again applied to them on the 15th day and on the 21st day of treatment. The frequency of oral mucositis in the education group was less than the control group (p<0.05). The patients' quality of life in the education group in the fields of functional and general health status was higher than the control group and the mean of their symptom score was also lower than control group (p<0.05). The education to be provided training for the patient can have an important role in preventing oral mucositis developed due to chemotherapy.

Early sensory re-education of the hand after peripheral nerve repair based on mirror therapy: a randomized controlled trial

BACKGROUND: Mirror therapy has been used as an alternative stimulus to feed the somatosensory cortex in an attempt to preserve hand cortical representation with better functional results.OBJECTIVE: To analyze the short-term functional outcome of an early re-education program using mirror therapy compared to a late classic sensory program for hand nerve repair.METHOD: This is a randomized controlled trial. We assessed 20 patients with median and ulnar nerve and flexor tendon repair using the Rosen Score combined with the DASH questionnaire. The early phase group using mirror therapy began on the first postoperative week and lasted 5 months. The control group received classic sensory re-education when the protective sensation threshold was restored. All participants received a patient education booklet and were submitted to the modified Duran protocol for flexor tendon repair. The assessments were performed by the same investigator blinded to the allocated treatment. Mann-Whitney Test and Effect Size using Cohen's d score were used for inter-group comparisons at 3 and 6 months after intervention.RESULTS:The primary outcome (Rosen score) values for the Mirror Therapy group and classic therapy control group after 3 and 6 months were 1.68 (SD=0.5); 1.96 (SD=0.56) and 1.65 (SD=0.52); 1.51 (SD=0.62), respectively. No between-group differences were observed.CONCLUSION: Although some clinical improvement was observed, mirror therapy was not shown to be more effective than late sensory re-education in an intermediate phase of nerve repair in the hand. Replication is needed to confirm these findings.

Prospective evaluation of patient satisfaction after the use of brachytherapy specific educational materials for cervical cancer.

Cervical cancer patients are faced with an enormous amount of medical information in a complex oncology field with sophisticated treatments including brachytherapy. We investigated the use of enhanced vs. standard brachytherapy-specific educational materials on patient-reported satisfaction during the informed consent process for intracavitary high-dose-rate brachytherapy. A single-institution, prospective, randomized trial was performed to study patient-reported satisfaction with novel educational materials for high-dose-rate brachytherapy in women undergoing definitive radiation for cervical cancer. Fourteen women receiving informed consent with a customized educational booklet were randomized between no further intervention and take-home educational materials. The weighted average for 10 of 11 survey questions was higher in the intervention arm but ranged between 4 (agree) and 5 (strongly agree) for all questions in both arms. The mean weighted patient satisfaction scores ± standard deviations in the control arm and the intervention arms were 54.3±6.4 and 57.5±2.7, respectively (p= 0.26). Knowledge acquisition is presumed to be part of the coping process for women facing increased stress during a cancer diagnosis. A brachytherapy-specific, visual, patient-educational booklet and take-home materials used to supplement the informed consent process for high-dose-rate brachytherapy resulted in high levels of patient-reported satisfaction among women treated with cervical cancer.

Optimizing adequacy of bowel cleansing for colonoscopy: recommendations from the US Multi-Society Task Force on Colorectal Cancer.

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

Establishing Clinical Research in a Limited Resource Setting, "Acute Lymphoblastic Leukemia Model"

ABSTRACT Aim: One of the most important challenges that face Children's Cancer Hospital-57357 since its start, is establishing on Childhood Acute Lymphoblastic Leukemia (ALL) in a limited resource country like Egypt. Methods: Research Department was established in November-2008. it was the first time in Egypt to introduce the concept of forming team for each disease. A multidisplenary team of was formed. Team is composed of pediatric oncologist, Radiologist, clinical pathologists, flow cytometry specialist, cytogenetics specialist, basic researcher, radiologist, radiotherapist, psychologists, pharmacist, epidemiologist and clinical researchers. In parallel, and with the help of clinical researchers, a database of patients was established. Training curriculum for clinical researchers included 1- Scientific writing workshop, 2- The principles and practice of clinical research course from Harvard medical school, 3- Cancer Registry training. Results: above mentioned steps had a marvelous impact on childhood ALL. Initially, a genetic epidemiology grant in funded by US-NIH was obtained. Based on the results of this grant we applied to another grant on Genome wide Association Study in ALL to get fund and complete our to identify the cause of in Egyptian population and was obtained.The presence of database and statistical analysis of the survival, allow them to 1- hold collaboration with St Jude Research Hospital in special risk protocol that allow both check quality of flow cytometry results, cytogentics results so enhance the quality and allow rapid consultation on complicated cases, 2- the presence of hospital based-cancer registry for ALL,3- Supplying biobank with samples that help in future research, 4- rapid statistics of the number of relapsed and died patients. In addition to Production of patient education booklet. challenges become clear and the future plan to make strategy become mandatory: 1- Identifying the cause of relapse, 2- Route-cause analysis for patient died during induction and in complete remission, 3- plan to make translational and individualized treatment. 4- Using isimple audio-visual materials for education. Conclusions: presence of clinical has an impact on the childhood patients, staff and the institution. Disclosure: All authors have declared no conflicts of interest.

An education booklet to aid cardiac patients' recovery at home

Hospital and home-based cardiac rehabilitation programmes improve the health outcomes of cardiac patients. Both types of programmes include patient education as a core component. However, many patients do not attend cardiac rehabilitation programmes for a variety of reasons. In Singapore, where cardiac rehabilitation is comparatively uncommon, patient education is usually delivered face-to-face by healthcare professionals because educational materials designed specifically for cardiac patients recovering at home are not available. This paper describes the development of a patient education booklet designed to aid recovery at home after a myocardial infarction in Singapore. The conception and development of this evidence-based Heart Recovery Education Booklet was based on patient need and current clinical guidelines pertaining to cardiac rehabilitation and planned in consultation with specialists such as cardiologists, psychiatrists and physiotherapists. The booklet is a patient resource to aid recovery at home after an myocardial infarction. It is interactive, based on identified need and aims to guide and assist the patient in performing their usual activities of daily living and adhering to treatment regimens, including exercise. This booklet is a resource for patients with myocardial infarction and healthcare professionals and its effectiveness in improving health-related quality of life, psychological status and coronary risk profile is to be tested in a randomized controlled trial. Policy makers in health and nursing must find ways of developing and implementing cardiac rehabilitation programmes that aid recovery from myocardial infarction. This education booklet offers one way to do this.

Comparison of Terminology in Patient Education Booklets for Lumbar Surgery

Purpose: To compare the usage of ‘provocative’ terms in two patient education booklets for lumbar surgery. Background: The recently completed FASTER trial failed to support the use of an evidence-based educational booklet to significantly improve postsurgical outcomes over rehabilitation and usual care. The use of a different booklet in another recently completed trial resulted in a significant saving in healthcare utilization; earlier return to work; and greater patient satisfaction with surgery. We propose that the terminology used in these booklets may account for the differing results. Methods: An expert review panel was identified and tasked with identifying and highlight ‘provocative’ words within two patient educational booklets – Booklet A ‘Your Back Operation’ and Booklet B‘Your Nerves are Having Back Surgery’. Reviewers were blinded to title and authorship of the booklets. Data Analysis: Descriptive statistics including means, total scores. Results: Seventeenreviewers from 7 different countries participated and found that Booklet A had almost 3 times as many provocative terms as Booklet B. Booklet A had an average of 67.2 provocative terms per reviewer compared to only 22.6 terms for Booklet B. Conclusions: The findings of this study suggest that use of an educational booklet that minimizes the use of provocative terminology may have the potential to decrease fear, anxiety and patient pain experiences following lumbar surgery. Further research is warranted.

Investigating and comparing the patients’ and staff's perspectives on the usefulness of a head and neck radiotherapy patient education booklet

AbstractIntroductionPrinted patient education material enhances verbal patient teaching. ‘Starting radiation therapy: helpful tips for patients with head and neck cancer’ is a booklet that facilitates head and neck (H&amp;N) cancer patients’ orientation to the study hospital. This study examined and compared patients’ and staff's opinion on the distribution and usefulness of this booklet.MethodsPatients starting radiotherapy treatment to their H&amp;N cancer, and staff involved in their care, were recruited. A survey was designed to collect responses from both cohorts.ResultsOf the patients, 94% received the booklet before their first radiotherapy treatment. Of the staff, 67% referred to this booklet during patient education. Most patients (98%) found that the booklet increased their awareness of hospital and community services. Both groups indicated list of services and telephone number to be the most useful chapter. The staff suggested having this booklet available in different languages.ConclusionThis booklet was useful as an orientation tool for the patients to navigate the hospital system. Patients and staff have similar opinion regarding the most useful sections in the booklet. Further studies needs to be conducted to validate the need of having this booklet available in other languages.

1025 Further Validation of a Novel Patient Educational Booklet to Enhance Colonoscopy Preparation: Benefits in Single-Dose, but Not Split-Dose Preparations

1025 Further Validation of a Novel Patient Educational Booklet to Enhance Colonoscopy Preparation: Benefits in Single-Dose, but Not Split-Dose Preparations

Cancer therapy and heart failure: Successful management through collaborative interdisciplinary practice.

123 Background: Heart failure (HF) is a clinical problem of emerging importance in cancer care. The advances in cancer detection and complex treatment regimens have resulted in increased cancer treatment induced HF. The literature indicates that more than 50% of all patients exposed to anthracyclines will show some degree of cardiac dysfunction either acutely or 10 to 20 years after treatment, and 5% of those patients will develop overt HF. Successful management requires a collaborative, interdisciplinary approach. The purpose of this presentation is to discuss how the “Heart Success Program” (HSP) resulted in cost effective and clinical quality outcomes in patients with cancer and HF. Methods: The HSP was piloted in the emergency center and telemetry units with high volume admission of HF patients. The HSP includes comprehensive education of patients, families, and health care providers regarding HF management in cancer patients. HSP implementation includes a HF order set, patient education booklet, and educational videotape specific for patients with cancer and HF. Weekly interdisciplinary clinical rounds provide a forum for discussion of identified patient’s problems and formulation of solutions. Endpoint outcomes include compliance with the Center for Medicare and Medicaid Services (CMS) core measures for HF, as well as decreasing HF readmissions. Results: The pilot implementation of the HSP resulted in decreased hospital length of stay by 57%, and average hospital admission cost by 60%. Despite multiple co morbid conditions, patients were discharged with improved functional status and compliance with CMS HF core measures. Conclusions: The findings from this quality improvement project showed significant impact in clinical and cost outcomes for patients with cancer and HF. The multidisciplinary team approach that provided support to patients and their families and allowed for patients to continue their cancer treatment resulting in improved outcomes. As we move toward value-based purchasing, the HSP provides an example of how collaboration and standardized process improvement impacts cost and quality in the oncology population.

Development and Validation of a Novel Patient Educational Booklet to Enhance Colonoscopy Preparation

The success of colonoscopy depends on high-quality bowel preparation by patients; yet inadequate preparation is common. We developed and tested an educational booklet to improve bowel preparation quality. We conducted patient cognitive interviews to identify knowledge and belief barriers to colonoscopy preparation. We used these interviews to create an educational booklet to enhance preparatory behaviors. We then prospectively randomized patients scheduled for outpatient colonoscopy at a VA Medical Center to receive usual instructions vs. the booklet before colonoscopy. Patients in both groups received standard pharmacy instructions for single-dose bowel preparation; the protocol did not specify which purgatives to prescribe. The primary outcome was preparation quality based on blinded ratings using the validated Ottawa score. We performed bivariate analyses to compare mean scores between groups using a t-test, and logistic regression to measure the booklet effect on preparation quality, adjusting for potential confounders. A total of 436 patients were randomized between arms. In an intention-to-treat analysis of the primary outcome, mean Ottawa scores were superior in patients allocated to booklet vs. controls (P=0.03). An intention-to-treat analysis of the secondary outcome revealed a "good" preparation in 68 vs. 46% of booklet and control patients, respectively (P=0.054). In a per-protocol analysis limited to patients who actually received the booklet, preparation was good in 76 vs. 46% patients, respectively (P<0.00001). Regression analysis revealed that booklet receipt increased the odds of good preparation by 3.7 times (95% confidence interval=2.3-5.8). Provision of a novel educational booklet considerably improves preparation quality in patients receiving single-dose purgatives. The effect of the booklet on split-dose purgatives remains untested and will be evaluated in future research.

Accurate monitoring leads to effective control and greater learning of patient education materials.

Effective management of chronic diseases (e.g., diabetes) can depend on the extent to which patients can learn and remember disease-relevant information. In two experiments, we explored a technique motivated by theories of self-regulated learning for improving people's learning of information relevant to managing a chronic disease. Materials were passages from patient education booklets on diabetes from NIDDK. Session 1 included an initial study trial, Session 2 included self-regulated restudy, and Session 3 included a final memory test. The key manipulation concerned the kind of support provided for self-regulated learning during Session 2. In Experiment 1, participants either were prompted to self-test and then evaluate their learning before selecting passages to restudy, were shown the prompt questions but did not overtly self-test or evaluate learning prior to selecting passages, or were not shown any prompts and were simply given the menu for selecting passages to restudy. Participants who self-tested and evaluated learning during Session 2 had a small but significant advantage over the other groups on the final test. Secondary analyses provided evidence that the performance advantage may have been modest because of inaccurate monitoring. Experiment 2 included a group who also self-tested but who evaluated their learning using idea-unit judgments (i.e., by checking their responses against a list of key ideas from the correct response). Participants who self-tested and made idea-unit judgments exhibited a sizable advantage on final test performance. Secondary analyses indicated that the performance advantage was attributable in part to more accurate monitoring and more effective self-regulated learning. An important practical implication is that learning of patient education materials can be enhanced by including appropriate support for learners' self-regulatory processes.

Combat casualty care: Lessons learned in Iraq

tients experiencing this surgery, it is critical that they receive comprehensive pre-operative education to ensure the best postoperative experience and achieve successful results. The benefits of pre-admission education are well documented (Kruzik, 2009). Research has also demonstrated that patients often experience problems that health care professionals view as minor but cause considerable distress for the patient and their family (Brumfield et al., 1996; Taylor and Norton, 2000). In order to meet the needs of this specialised patient population, our team developed a preadmission education program that focused on the specific needs of TSA patients. In order to optimise TSA patient care, an interprofessional team approach is essential (Brown, 2008). Our patient education booklet was developed as a starting point for the pre-admission education. To enhance the information provided by our education booklet, a group teaching class was added. The group teaching class includes patients and their families, as well as members from nursing, physiotherapy, and occupational therapy. This presentation will review the development and implementation of a TSA pre-admission education program. Facilitators and barriers to program implementation with a small patient volume will be discussed. Key elements of the education booklet and interprofessional group teaching component will be reviewed. Evaluation data collected pre and post implementationwill also be presented.