Pre-assessment Score Research Articles

Teaching Hands-Only CPR (HOCPR) skills to 8th-grade students in urban Bengaluru: Development of a comprehensive Hands-Only CPR programme for high school students.

Background and Aims:Out-of-hospital cardiac arrest is one of the leading causes of death in India. Only 1.3% of these arrests receive bystander cardiopulmonary resuscitation (CPR). Bystander CPR increases a victim's chances of survival; training school children in Hands-Only CPR (HOCPR) is a proven method of increasing bystander CPR rates. Heart Rescue India is an international project working to improve care for cardiovascular diseases, and as a part of it, a ten module Cardiovascular disease (CVD) educational programme, including HOCPR training, was conducted in ten schools in 2017–18. The objective of our study was to assess the effectiveness of HOCPR training for 8th-grade high school students.Methods:Four hundred fourteen of the 530 enroled students from ten schools of Bengaluru participated in the study. The participants attended a one-hour didactic session about the recognition of cardiac arrest and HOCPR in three simple steps. Subsequently, students received hands-on training for HOCPR. The sessions included pre- and post-assessment of knowledge and skills. The results were statistically analysed using paired t-test and the McNemar test.Results:The mean overall pre-assessment score for knowledge was 62.07 ± 28.38%, and the post-assessment score was 72.42 ± 26.58% (P < 0.001). In addition, there was a statistically significant improvement in the post-training scores for HOCPR in all three parameters, namely compressions per minute, depth and chest recoil.Conclusion:The study demonstrated a simple yet effective HOCPR programme for high school children.

Research and Development: Model of Clinical Collaborative Supervision for Scientific Based English Instruction

This research aimed to establish an instructional supervision model for scientific-based English instruction at Islamic Junior Boarding Schools. Research questions were stated as to how was the formulation of the model. This research employed Research and Development with three phases of (1) foundational study seeking the potencies and problems using policy analysis, field study, and theoretical review; (2) design and development study by designing the hypothetical model and developing the model formulation to be validated; and (3) Try out the study by doing one group pre-post experimental and perceptional studies. Finally, the model was established informs of model book and tutorial usage. The model combined principles of clinical Supervision and collaborative orientation to control, which were compatible with the behavioural characteristic of Islamic Boarding Junior High Schools in a pesantren environment. This model obtained score validation of 89 %, categorized as valid, can be used without revision. While the pre-assessment score was 2.60 and the post-assessment score was 3.39with, the t-test was -7.0886on significant 0.05 and t table 2.447. This model was concluded to be practical and applicable to use as a Scientific Based English Instruction Supervision for Islamic Boarding Junior High Schools.

Oh Baby! There's a Pregger in My PACU…

<h3>Background Information</h3> With a trending increase in patient volume and acuity in the Post-Anesthesia Care Unit (PACU)s in a large academic medical center, it was noted that one of the demographics fostering this growth is the Obstetric (OB) population. It is important to note that the OB patients presenting to the PACUs required post-anesthesia care for non-OB procedures and interventions with the exception of OB procedures requiring general anesthesia. Hospital leadership and nursing staff noticed that caring for the OB patient in a non-OB PACU setting offered some distinct challenges related to the special considerations unique to the OB population. Instead of viewing OB patients in the PACU as a quagmire, the PACUs viewed this as an opportunity to collaborate with the OB department, promulgating maternal care in the PACU. <h3>Objectives of Project</h3> The objective was to create a program increasing knowledge related to the care of the OB patient in the PACU. <h3>Process of Implementation</h3> Collaborative gap analyses by the PACU and OB educators revealed that fundamental knowledge, skills, and adherences to professional organization recommendations regarding standards of care were opportunities for improvement. "Special Population Considerations: The OB Patient" was created and added to the existing PACU Residency/ Transition to Practice and PACU Preceptor curriculums which offer didactic and simulation activities to facilitate learning. Topics addressed included OB assessment, fetal monitoring (FM) expectations, postpartum hemorrhage care, and OB emergencies and equipment guided by professional practice guidelines and recommendations. Further, the OB department committed to collaborative care for FM and additional resources as needed, easing the anxiety of PACU nurses. Knowledge assessment was performed pre and post offering to measure changes in knowledge and program evaluation. <h3>Statement of Successful Practice</h3> After completion of the program by five cohorts, the average preassessment score of 30.6% increased to 85.6% post assessment showing an increase in knowledge and program success. Further, 100% of participants found the program beneficial. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> In addition to the new OB curriculum being offered, OB learning enrichment opportunities should be added to unit in-services, yearly skills and drills, and/ or unit-based competencies to ensure that PACU nurses are retaining knowledge regarding the care of the OB patient in the PACU.

Online CME Successful at Improving Awareness, Understanding, and Clinical Use of T2D Treatments

We sought to determine if an online continuing medical education (CME) curriculum could improve the clinical knowledge and competence of endocrinologists and primary care physicians (PCPs) related to knowledge and clinical use of GLP-1 RAs. The online CME curriculum consisted of 3 text- or video-based activities focused on practical tips for utilizing GLP-1 RAs in practice, benefits of GLP-1 RAs over therapeutic classes, and knowledge of oral GLP-1 RAs. The educational effects were assessed using a repeated pre-assessment/post-assessment study design. For all questions combined, a chi-squared test assessed whether the mean post‐assessment score differed from the mean pre‐assessment score (absolute changes reported). P values <.05 are statistically significant. The activities launched between June-August, 2019 and outcomes data were collected through November 2019. After being online and accredited for 1 year, the 3 activities have reached over 15,000 clinicians, over 9,500 of which were physicians. Improved knowledge and competence was demonstrated among the target audiences: • 13% increase in endocrinologists (P<.001) and PCPs (P<.001) who effectively utilized a GLP-1 RA in a practical scenario (competence) • 24% increase in endocrinologists (P<.001) and 21% increase in PCPs (P<.001) who identified the impact of GLP-RA therapy on cardiovascular outcomes (knowledge) • 17% increase in endocrinologists (P<.001) and 14% increase in PCPs (P<.001) who correctly identified cardiovascular impact of an emerging GLP-1 RA (knowledge) Persistent knowledge/competence gaps remain: • 9% of endocrinologists and 38% of PCPs need additional education to improve competence related to clinical use of GLP-1s in practice • 64% of endocrinologists and 62% of PCPs need additional education to improve knowledge on the impact of GLP-1 RAs on cardiovascular outcomes • 64% of endocrinologists and 74% of PCPs need additional education to improve knowledge on the cardiovascular impact of emerging GLP-1 RAs This study demonstrates the success of an online curriculum at improving knowledge and competence of endocrinologists and PCPs related to knowledge and clinical use of GLP-1 RAs. Persistent gaps were identified for future educational targets.

625-P: CME Effectively Improves Physician Knowledge and Competence Related to Hypoglycemia Risk Reduction with Basal Insulin in the Modern Era

We sought to determine if an online continuing medical education (CME) curriculum could improve the clinical knowledge/competence of primary care physicians (PCPs) related to hypoglycemia risk reduction with basal insulin. We also measured education needed for endocrinologists (endos) in this area. The online CME curriculum consisted of 3 text- or video-based activities about reducing hypoglycemia risk with newer basal insulins. Educational effects were assessed using repeated pairs pre-assessment/post-assessment, where individual participants served as his/her own control. For all questions combined, a chi-squared test assessed whether the mean post-assessment score differed from the mean pre-assessment score. P values &amp;lt;.05 are statistically significant. The activities launched in November or December, 2018 and data were collected through November 2019. • 16% of PCPs (P&amp;lt;.01) demonstrated improvement in recognizing the impact of hypoglycemia in patients with diabetes (knowledge) • 11% of PCPs (P=.68) demonstrated improvement in recognizing the link between hypoglycemia and cardiovascular events (knowledge) • 20% of PCPs (P&amp;lt;.001) demonstrated improvement in using newer basal insulins to decrease hypoglycemia risk (competence) Persistent knowledge/competence gaps remain: • 19% of endos and 28% of PCPs need additional education to improve knowledge on the impact of hypoglycemia in patients with diabetes • 66% of endos and 72% of PCPs need additional education to improve knowledge on the link between hypoglycemia and cardiovascular events • 8% of endos and 18% of PCPs need additional education to improve competence related to using newer basal insulins to decrease hypoglycemia risk This study demonstrates the success of an online curriculum at improving knowledge and competence of PCPs related to reduction of hypoglycemia risk with basal insulins. Persistent gaps were identified among PCPs and endos for future educational targets. Disclosure A. Larkin: None. A. Le: None. Funding Novo Nordisk

Incorporating Sex and Gender-based Medical Education Into Residency Curricula.

Emergency medicine (EM) residents do not generally receive sex- and gender-specific education. There will be increasing attention to this gap as undergraduate medical education integrates it within their curriculum. Members of the Sex and Gender in Emergency Medicine (SGEM) Interest Group set out to develop a SGEM toolkit and pilot integrating developed components at multiple residency sites. The curriculum initiative involved a pre- and posttraining assessment that included basic demographics and queries regarding previous training in sex-/gender-based medicine (SGBM). It was administered to PGY-1 to -4 residents who participated in a 3-hour training session that included one small group case-based discussion, two oral board cases, and one simulation and group debriefing. Components of the developed toolkit (https://www.sexandgenderhealth.org) were implemented at four unique SGEM Interest Group member residency programs. Residents (n=82/174, 47%) participated; 64% (n=49) were male and 36% (n=28) were female. Twenty-six percent (n=21) of the residents reported that they had less than 1hour of training in this domain during residency; 59% (n=48) reported they had 1 to 6hours and 16% (n=13) reported they had >6hours. The average preassessment score was 61% and postassessment was 88%. After training, 74% (n=60) felt that their current practice would have benefited from further training in sex-/gender-based topics in medicine during medical school and 83% (n=67) felt their clinical practice would have benefited from further training in this domain during residency. The majority of EM residents who participated in this training program reported that they had limited instruction in this domain in medical school or residency. This initiative demonstrated a method that can be emulated for the incorporation of SGBM educational components into an EM residency training educational day. After training, the majority of residents who participated felt that their current practice would have benefited from further training in sex- and gender-based topics in residency.

Improving knowledge of doctors and paramedics through effective bone procurement workshop: A cognitive approach

BackgroundProcurement of bone allograft must be performed by trained personnel. Improper handling and lack of knowledge during bone procurement will lead to contamination hence jeopardizing quality of the procured bones and expose bone recipients to risks of infection in post-operative phase. Bone procurement workshop is the fundamental training programme to enhance skill among personnel who has been or will be involved in bone procurement. This study evaluated the effectiveness of the workshop contents including teaching materials by assessing the knowledge on bone procurement among the participants before and after the workshop.MethodsBone procurement workshop was held for 2 days for doctors and paramedics. The knowledge on bone procurement was evaluated in pre- and post-assessments by answering self administration questionnaire before and after the workshop, respectively.ResultsA total of 50 participants comprised of doctors and paramedics attended the workshop however only 15 (55.6%) doctors and 12 (44.4%) paramedics completed the assessments. Overall, the mean total score for the post-assessment (61.4%) was significantly higher (p < 0.05) than that of the pre-assessment score (32.2%). The mean values of correct responses for the post-assessment was significantly higher (p < 0.05) than that of the pre-assessment in all five topics given during the workshop. The correct responses for the pre- and the post- assessments in the respective group of the doctors and paramedics were also statistically significant (p < 0.05). In the pre-assessment, the doctors had the highest score in Surgical Approach & Reconstruction (50%) while the paramedics had the highest score in Donor Screening & Selection Criteria (33.3%). In the post-assessment, the doctors had the highest score in Donor Screening & Selection Criteria (70%) while the paramedics in Packaging & Transportation (65.8%).ConclusionsThe assessment managed to show that the workshop contents and teaching materials were effective in improving the cognitive knowledge of the personnel who would get involved in bone procurement under the National Donation Programme.

Developing Sustainable Prehospital Care for NCD Emergencies in Rwanda: A Collaboration between EMS, Ministry of Health of Rwanda, and Virginia Commonwealth University

Introduction:Every year, 71% of all deaths globally are due to NCDs. Over 85% of these deaths occur in low- and middle-income countries (LMICs), with 36% of all reported deaths in Rwanda attributed to NCDs. Approximately 24 million lives are lost each year in LMICs due to emergency medical conditions. The collaboration between VCU and the EMS Rwanda designed and implemented a pre-hospital medical emergencies training course and train-the-trainers program to address the rise of NCDs.Methods:During the course, pre and post 50 assessment questions were administered. Two cohorts participated 25 prehospital staff identified by EMS to form an instructor core and 19 emergency staff from public hospitals who are likely to respond to local emergencies in the community. A two-day EMCC was developed using established best practices. The Instructor core completed EMCC 1 and a one-day educator course and then taught the second cohort (EMCC2). Student’s t-test and matched paired t-tests were used to evaluate the assessments.Results:Mean score on EMCC 1 was 43% (SD: 20) compared to 85% (SD: 5) on post-course assessment. Pre-assessment failure rate was 88%. Mean scores for EMCC 2 were 45% (SD: 14) and 81% (SD: 10) on post-assessment. Pre-assessment score was low (50%). A paired t-test comparing pre-course to post-course assessment means demonstrated an increase by 42% (SD 30) for EMCC 1 (p&lt;0.001) and 37% (SD: 14) for EMCC 2 (p&lt;0.001) with 95% confidence. No items had to be removed from analysis based on the discrimination index (di).Discussion:NCDs often present as emergencies such as myocardial infarction and stroke. Effective management of these in the prehospital setting is essential to optimal outcomes. This study effectively implemented a training program in Kigali, Rwanda and created an instructor core to allow scale-up of effective pre-hospital services across the country.

Successfully Managing IBD in Children: Can Medical Education Improve Knowledge and Competence of Physicians?

Introduction: It is estimated that 25% of patients with IBD are diagnosed within the pediatric age group, and that approximately 50,000 children in the United States have IBD. IBD in children is different than in adults with respect to distribution of disease and thus requires pediatric-specific considerations to confirm diagnosis and select appropriate therapy. This study assessed whether online continuing medical education (CME) - a 15-minute video lecture - can impact knowledge and competence of gastroenterologists and primary care physicians (PCPs) who care for children with IBD. Methods: An online survey was administered to assess the educational effect of the CME program focused on management goals for IBD in children, by comparing the same participant's responses to 4 identical pre- and post-CME assessment questions. A paired 2-tailed t-test was used to assess whether the mean post-assessment score was different from the mean pre-assessment score. McNemar's chi-squared statistic was used to determine statistical significance. Effect size was calculated using Cramer's V by determining the change in proportion of participants who answered questions correctly from pre- to post- assessment. Survey data were collected from September 24 to November 24, 2015. Results: Data were collected for 64 gastroenterologists and 71 PCPs, each of whom answered all assessment questions during the study period. Gastroenterologists who participated in the CME activity demonstrated statistically significant improvements in knowledge/competence (n=64; P<.05; V=0.238, medium educational effect). While 25% answered all 4 questions correctly on preassessment, 63% answered them all correctly on post-CME assessment. PCPs who participated in the CME activity demonstrated statistically significant improvements in knowledge/competence (n=71; P<.05; V=0.245, medium educational effect). While 3% answered all 4 questions correctly on preassessment, 32% answered them all correctly on post-CME assessment. Significant improvements occurred in physicians' ability to recognize epidemiologic differences between pediatric and adult IBD, recognize appropriate approaches to vaccinations, and in knowledge of clinical trial data for pediatric IBD. Conclusion: CME in the format of a video lecture on IBD in children led to improvements in clinicallyrelevant knowledge of gastroenterologists and PCPs, and may be a suitable method for further education of clinicians in this space.

Increasing the Use of Student-Centered Pedagogies from Moderate to High Improves Student Learning and Attitudes about Biology.

Student-centered strategies are being incorporated into undergraduate classrooms in response to a call for reform. We tested whether teaching in an extensively student-centered manner (many active-learning pedagogies, consistent formative assessment, cooperative groups; the Extensive section) was more effective than teaching in a moderately student-centered manner (fewer active-learning pedagogies, less formative assessment, without groups; the Moderate section) in a large-enrollment course. One instructor taught both sections of Biology 101 during the same quarter, covering the same material. Students in the Extensive section had significantly higher mean scores on course exams. They also scored significantly higher on a content postassessment when accounting for preassessment score and student demographics. Item response theory analysis supported these results. Students in the Extensive section had greater changes in postinstruction abilities compared with students in the Moderate section. Finally, students in the Extensive section exhibited a statistically greater expert shift in their views about biology and learning biology. We suggest our results are explained by the greater number of active-learning pedagogies experienced by students in cooperative groups, the consistent use of formative assessment, and the frequent use of explicit metacognition in the Extensive section.

Improving Hematologist/Oncologist Knowledge and Confidence in Managing Hemophilia through Online Educational Interventions

The field of hemophilia has advanced tremendously over the past few decades leading to significant improvements to a patient's life expectancy. However, gaps in clinician's knowledge about appropriate tailored management of hemophilia can result in suboptimal patient outcomes. A study was conducted to determine if a series of online educational interventions on hemophilia could improve the knowledge and confidence of hematologists/oncologists in treating patients with hemophilia.The Perelman School of Medicine at the University of Pennsylvania, Office of CME, the National Hemophilia Foundation and Medscape, LLC, in partnership with an expert steering committee, developed a global, accredited educational curriculum (http://www.medscape.org/sites/advances/hemophilia-management) focused on the advances in the management of hemophilia. Six activities, including text and video formats, within the curriculum were evaluated using a pre-assessment/post-assessment study design comparing participants' responses to knowledge and case-based multiple choice questions before exposure to educational content (pre-assessment measurement) with the same participants' responses after participation in the educational activity (post-assessment measurement). Outcomes assessment questions focused on current evidence-based recommendations for the management of hemophilia. For all questions combined, paired 2-tailed t-test was used to assess whether the mean pre-assessment score was different from the mean post-assessment score. The effect size (Cohen's d) was calculated by comparing pre-assessment means and post-assessment means of linked learners to show the effect of educational intervention. Effect size of >0.8 and 0.4-0.8 are considered a large and medium effect size, respectively.A total of 256 hematologist/oncologist participants who completed all pre- and post- assessment questions for each assessment were included in the evaluation across the 6 interventions. An increase in knowledge and performance was demonstrated as a result of participation in each of the 6 interventions with effect sizes of 0.25, 0.559, 0.618, 0.721, 1.26, and 2.275. Topics that demonstrated the largest statistically significant increases in correct post-assessment compared with pre-assessment answers included: mechanism of action of Fc fusion technology (63% relative increase, p<.001), patient counseling when switching to an extended half-life factor replacement (100%, P=.008), joint health in hemophilia (340% relative increase, P<.05), and incidence of inhibitors (227% relative increase, p<.05).Confidence in when to use prophylaxis increased post-educational exposure (7.3% mean confidence shift using a 7-point Likert scale) as measured in 3 of the 6 activities. Areas where knowledge gaps remained, as evidenced by >15% incorrect answers post-education, included: adherence with prophylaxis, outcomes for children and adults with severe hemophilia A receiving prophylaxis vs episodic treatment, clinical data from recent studies with new extended half-life factor products in terms of efficacy, tolerability, and risk of inhibitor development in persons of different ages and risk settings, and the potential place of extended half-life factor products in the strategy for the care of individuals with hemophilia A and B.This study demonstrates the success of a targeted online hemophilia educational curriculum using text and video formats in improving the knowledge and confidence of hematologists/oncologists who treat patients with hemophilia, while also identifying remaining educational needs for future education. DisclosuresVan Laar:Medscape LLC: Employment. Pipe:CSL Behring: Consultancy; Bayer: Consultancy; American Thrombosis and Hemostasis Network: Other: Chair of the Board of Directors; National Hemophilia Foundation: Other: member of the Medical and Scientific Advisory Committee; Novo Nordisk: Consultancy; Baxter: Consultancy; Biogen Idec Inc: Consultancy.

Success of Online Curriculum-Based Education in the Management of Multiple Myeloma and Continuing Gaps Among Hematologists/Oncologists

Driven by ever-increasing access to diagnostic/prognostic tools and new therapies, the treatment and management of multiple myeloma (MM) is rapidly evolving. This in turn leads to a direct clinical need for updated, timely, and effective education approaches for clinicians to ensure they have access to the latest knowledge, allowing them to provide the best possible care for patients with MM. However, given the time constraints of a busy practice and the large amount of updates in the field, hematologists/oncologists who manage MM often are challenged with integrating new information into clinical practices. A study was conducted to determine if a series of online educational interventions on MM could improve the knowledge and competence of hematologists/oncologists.A series of 9 online continuing medical education interventions targeting US-based hematologists/oncologists was developed to address specific education gaps identified by comprehensive needs assessment in MM (http://www.medscape.org/sites/advances/multiple-myeloma). To assess changes in knowledge and competence, a pre/post outcomes assessment was performed on a subset of 4 video or text-based activities whose focus included: management of transplant-eligible, transplant-ineligible, elderly patients, and differentiating between therapies. The outcomes survey method included knowledge- and case-based, multiple-choice questions focused on current evidence-based recommendations for the management of MM. The effect size (Cohen's d) was calculated by comparing pre-assessment means and post-assessment means of linked learners to show effect of the educational interventions. Effect size of >0.8 and 0.4-0.8 are considered a large and medium effect size, respectively. A Chi square test was used to assess whether the mean pre-assessment score was different from the mean post-assessment score.549 hematologist/oncologist who completed all pre- and post- assessment questions were evaluated. Statistically significant effect on gain in knowledge and competence was demonstrated in each of the 4 interventions (P < .05) with effect sizes of d = 0.4, 0.778, 0.966, and 1.408. Topics that demonstrated significant improvement in learning included: awareness of emerging data/trial design (23% mean increase, 95% CI: 10.4-35.6; P<.001), appropriately tailoring therapy for elderly patients with MM (37% mean increase, 95% CI: 17-57%; P<.001), and use of consolidation/maintenance therapy in MM (35% mean increase, 95% CI: 9.6-59.4%; P<.001). Despite improvements in learning, education gaps remain, as evidenced by the percent of incorrect answers post education, specifically in the areas of: understanding benefits of continuous lenalidomide plus dexamethasone (Rd) therapy (59% incorrect), evaluating clinical trial data for assessing tailored therapy for elderly patients with MM (43% incorrect), and key clinical considerations such as age, performance status, medical history, and comorbidities that could affect treatment of elderly patients with MM (36% incorrect).Knowledge gaps permeate clinical practice specific to MM, with the potential to impact patient outcomes. This study demonstrated the success of a targeted online MM educational curriculum using video and text-based activities as evidenced by improvement in knowledge and competence relative to integrating new clinical trial data, tailoring MM therapy, and supportive care measures. The study also revealed additional areas requiring further education. DisclosuresVan Laar:Medscape LLC: Employment. Landgren:Onyx: Research Funding; International Myeloma Foundation: Research Funding; Onyx: Honoraria; Celgene: Honoraria; Bristol-Myers Squibb: Honoraria; Medscape: Honoraria; BMJ Publishing: Honoraria; Celgene: Consultancy; BMJ Publishing: Consultancy; Medscape: Consultancy; Bristol-Myers Squibb: Consultancy; Onyx: Consultancy.

Optimizing inhaler use by pharmacist-provided education to community-dwelling elderly

ObjectiveTo assess, using a standard observational tool, the ability of patients to demonstrate and maintain proper inhaled medication administration techniques following pharmacist education. DesignSix-month observational study. SettingPatients' homes or adult day health center. ParticipantsPatients in a Program for All-inclusive Care for the Elderly (PACE) prescribed one or more inhaled medications used at least once daily. InterventionInstruction by on-site clinical pharmacist. MeasurementsHickey's Pharmacies Inhaler Technique assessment (score range: 0–20, higher better). ResultsForty-two patients were evaluated at baseline, taught proper techniques for using inhaled medications, assessed immediately following the education, and re-assessed 4–6 weeks later. The mean pre-assessment score was 14 (SD 4.5, range 0–20), the initial post-assessment score increased to 18 (SD 3, range 10–20). The second post-assessment (4–6 weeks later) score mean was 17.7 (SD 3, range 10–20). Both follow-up scores were significantly improved from baseline (p < 0.05). Multivariable analysis indicated the strongest predictors of second post-training score were: score after initial pharmacist training and being subscribed to auto-refill. These characteristics predicted ∼70% of the variance in the second score (p < 0.001). ConclusionsThese results indicate that education by a pharmacist combined with an auto-refill program can improve and sustain appropriate inhaler use by community-dwelling elders in a PACE program. The improved score was maintained 4–6 weeks later indicating a sustained benefit of medication administration education. Optimal inhaler use ensures optimal dosing and supports appropriate inhaler treatment in lieu of oral agents.

GRP-014 An E-Learning Programme on High-Risk Drugs – Does It Actually Increase User Knowledge?

BackgroundHigh-risk drugs are involved in serious medicines errors. Studies have identified a range of contributory factors including lack of training. The MMU Hospital developed a E-learning programme ‘A Guide to...

The importance of the baseline Disease Activity Score 28 in determining responders and non-responders to anti-TNF in UK clinical practice

The NICE re-appraisal of anti-TNF requires demonstration of ongoing response, making the baseline 28-joint Disease Activity Score (DAS28) crucially important. A retrospective analysis of all RA patients on their first anti-TNF determined predictive factors for those classified as non-responders at 6 months according to current NICE guidelines. The patients were divided into responders (DAS28 dropped by >1.2) and non-responders. These groups were compared for demographics, DAS28 at the two pre-assessments 1 month apart and at baseline. Exposure to intramuscular, oral and IA steroids in the 3 months period before the baseline DAS28 was recorded. At 6-month assessment in 256 patients, 82.8% were responders with no demographic differences between them and non-responders. Although the first pre-assessment score was not significantly different (6.8 vs 6.6), the second pre-assessment score (7.1 vs 6.7) and the baseline DAS (7.2 vs 6.3) were lower in the non-responders (P < 0.04 and P < 0.001, respectively). Comparing the differences in DAS28 from the first pre-assessment to baseline, the responders had increased by 0.4, and the non-responders had decreased by 0.4, (P < 0.001). If the first pre-assessment score had been taken as the baseline DAS28, then 9.4% of responders would be re-classified as non-responders, and 31.8% of non-responders would be re-classified as responders. The proportion of patients who had steroid treatment within the 3 months period before the baseline DAS28 did not differ significantly between the responders and non-responders (34% vs 41%, P = 0.38). Baseline DAS28 is critical in classifying responders at the 6-month assessment.