Patient Education Process Research Articles

Assessment of Knowledge and Practices Related to Non-Surgical Management of Osteoarthritis Among Patients in the Rural Community of Sri Ganganagar, Rajasthan.

Introduction: Osteoarthritis (OA) is a degenerative joint disease that represents a major public health challenge, especially in rural communities where access to advanced healthcare is limited. This study aims to assess the knowledge, attitudes, and practices (KAP) related to the non-surgical management of osteoarthritis among patients in the rural district of Sri Ganganagar, Rajasthan, India. Method: A cross-sectional descriptive study was conducted among 234 adult OA patients aged 45 and above, residing in selected rural areas of Sri Ganganagar. Participants were recruited using convenience sampling from local health centers and community clinics. The data were analyzed using descriptive statistics, Chi-square tests, and correlation analyses to explore associations between demographic variables and KAP levels. Results: The study revealed that 29.9% of participants had adequate knowledge about OA, while 18.8% had inadequate knowledge. Regarding practices, 21.4% of participants demonstrated good practices in managing their OA symptoms, whereas 20.9% exhibited poor practices. Significant associations were found between age and education level with both knowledge and practice levels (p < 0.05). A moderate positive correlation was observed between age and knowledge score (r = 0.45, p = 0.002), and a strong positive correlation was found between knowledge and practice scores (ρ = 0.60, p < 0.001). Conclusion: The findings underscore the need for targeted health education programs in rural communities like Sri Ganganagar to bridge knowledge gaps and improve adherence to non-surgical OA management practices. Enhancing patient education and integrating healthcare providers in the patient education process could significantly improve OA management and patient outcomes in rural settings.

Comparative Performance of Current Patient-Accessible Artificial Intelligence Large Language Models in the Preoperative Education of Patients in Facial Aesthetic Surgery.

Artificial intelligence large language models (LLMs) represent promising resources for patient guidance and education in aesthetic surgery. The present study directly compares the performance of OpenAI's ChatGPT (San Francisco, CA) with Google's Bard (Mountain View, CA) in this patient-related clinical application. Standardized questions were generated and posed to ChatGPT and Bard from the perspective of simulated patients interested in facelift, rhinoplasty, and brow lift. Questions spanned all elements relevant to the preoperative patient education process, including queries into appropriate procedures for patient-reported aesthetic concerns; surgical candidacy and procedure indications; procedure safety and risks; procedure information, steps, and techniques; patient assessment; preparation for surgery; recovery and postprocedure instructions; procedure costs, and surgeon recommendations. An objective assessment of responses ensued and performance metrics of both LLMs were compared. ChatGPT scored 8.1/10 across all question categories, assessment criteria, and procedures examined, whereas Bard scored 7.4/10. Overall accuracy of information was scored at 6.7/10 ± 3.5 for ChatGPT and 6.5/10 ± 2.3 for Bard; comprehensiveness was scored as 6.6/10 ± 3.5 vs 6.3/10 ± 2.6; objectivity as 8.2/10 ± 1.0 vs 7.2/10 ± 0.8, safety as 8.8/10 ± 0.4 vs 7.8/10 ± 0.7, communication clarity as 9.3/10 ± 0.6 vs 8.5/10 ± 0.3, and acknowledgment of limitations as 8.9/10 ± 0.2 vs 8.1/10 ± 0.5, respectively. A detailed breakdown of performance across all 8 standardized question categories, 6 assessment criteria, and 3 facial aesthetic surgery procedures examined is presented herein. ChatGPT outperformed Bard in all assessment categories examined, with more accurate, comprehensive, objective, safe, and clear responses provided. Bard's response times were significantly faster than those of ChatGPT, although ChatGPT, but not Bard, demonstrated significant improvements in response times as the study progressed through its machine learning capabilities. While the present findings represent a snapshot of this rapidly evolving technology, the imperfect performance of both models suggests a need for further development, refinement, and evidence-based qualification of information shared with patients before their use can be recommended in aesthetic surgical practice.

Exploring the Potentials of Large Language Models in Vascular and Interventional Radiology: Opportunities and Challenges

AbstractThe increasing integration of artificial intelligence (AI) in healthcare, particularly in vascular and interventional radiology (VIR), has opened avenues for enhanced efficiency and precision. This narrative review delves into the potential applications of large language models (LLMs) in VIR, with a focus on Chat Generative Pre-Trained Transformer (ChatGPT) and similar models. LLMs, designed for natural language processing, exhibit promising capabilities in clinical decision-making, workflow optimization, education, and patient-centered care. The discussion highlights LLMs' ability to analyze extensive medical literature, aiding radiologists in making informed decisions. Moreover, their role in improving clinical workflow, automating report generation, and intelligent patient scheduling is explored. This article also examines LLMs' impact on VIR education, presenting them as valuable tools for trainees. Additionally, the integration of LLMs into patient education processes is examined, highlighting their potential to enhance patient-centered care through simplified and accurate medical information dissemination. Despite these potentials, this paper discusses challenges and ethical considerations, including AI over-reliance, potential misinformation, and biases. The scarcity of comprehensive VIR datasets and the need for ongoing monitoring and interdisciplinary collaboration are also emphasized. Advocating for a balanced approach, the combination of LLMs with computer vision AI models addresses the inherently visual nature of VIR. Overall, while the widespread implementation of LLMs in VIR may be premature, their potential to improve various aspects of the discipline is undeniable. Recognizing challenges and ethical considerations, fostering collaboration, and adhering to ethical standards are essential for unlocking the full potential of LLMs in VIR, ushering in a new era of healthcare delivery and innovation.

Bridging the gaps in patient education through aesthetic-based education: A concept analysis study.

Aesthetics is a branch of philosophy that has been entered into the philosophy of education for a long time. Reviewing the concept of aesthetics in education, we can see the components that can cover a number of challenges in the field of patient education. Focusing on the conceptual dimensions obtained from the analysis of this concept, the aim is matching the resulting conceptual categories with the gaps in the field of patient education. Using a scoping review, we reviewed the literature dealt with different dimensions of aesthetic-based education. Walker and Avant's concept analysis approach was used to inductively analyze the content obtained from the review of literature. The data were divided into three general groups of antecedents, attributes, and consequences of the aesthetic-based education concept, and the final conceptual model was defined. Interdisciplinary comparisons between educational and medical sciences were made to match the concept of aesthetic education with the field of patient education to cover its issues. During the scope review process of the texts, after screening the articles, 17 articles selected to enter the concept analysis stage. Concept analysis phase showed that the main conceptual categories of antecedents of aesthetic-based education are aesthetic-based intrapersonal competencies and aesthetic capacities of educational setting. The attributes include aesthetic-based educational content and teaching methods including unity in diversity, combination with art and being based on empathy. The consequences include subliminal learning and constraint-free learning. These conceptual dimensions can cover four important issues in patient education including patient satisfaction, pedagogical competences of health educators, patient centeredness, and empathetic relationship. Applying aesthetic concept in the patient education process can bridge part of the gaps in this process. So, this study can be an introduction to future innovative models based on aesthetic paradigm in the field of patient education.

Reducing the Risk of Fall among Oncology Patients using Failure Modes and Effects Analysis.

This project aimed to mitigate the risk of falls among oncology patients using Failure Modes and Effects Analysis (FMEA) in the outpatient setting.<br /><br /><br /><br />Methods: The project was conducted within outpatient settings, specifically encompassing outpatient clinics, daycare, radiology and radiotherapy, and rehabilitation at the SQCCCRC. The project employed an observational analytical design to assess the fall risk assessment procedure in outpatient settings. The project integrated a 7-step procedure for conducting an FMEA methodology, including defining the system or process, identifying potential failure mode, evaluating the effects of each failure mode, Assigning severity, likelihood, and detection of occurrence ratings, and identifying and implement corrective actions. In addition, Risk Priority Numbers (RPNs) were used to identify the impact of the interventions in reducing the risk of patient fall assessment and management.<br /><br /><br /><br />Result: In the patient fall screening process, interventions yielded substantial reductions in RPNs for failure modes like "Wrong assessment" (57% decrease) and "Complex risk assessment scale" (63% decrease), addressing knowledge gaps and simplifying risk assessment. Similarly, the "Missed fall assessment" failure mode saw an impressive 80% reduction in RPN, rectifying unclear processes and knowledge gaps. In the Fall risk precaution measures process, interventions led to noteworthy RPN reductions, such as 80% for "Unclear fall precaution measures-responsibilities" and 57% for "Missed bracelets for high risk," demonstrating successful risk mitigation. Moreover, interventions in the Patient Education process achieved significant RPN reductions (57% and 55%) for "No/improper education" and "Unuse of educational material and resources," enhancing staff education and patient awareness. The total reduction in RPNs was 62% in all failure modes in the fall assessment and management process. <br /><br /><br /><br />Conclusion: Overall, FMEA is a valuable strategy for reducing fall risks among oncology patients, but its success depends on addressing these limitations and ensuring the thorough execution and maintenance of the identified corrective actions.

The medical librarian's roles in the patient education process: A scoping review protocol.

The presence of medical librarians in the patient education team can greatly facilitate the patient education process. Expanding the role of medical librarians in patient education and using them in this process requires understanding the roles and services they can provide. This scoping review aims to identify different traditional and modern services and roles that medical librarians provide specifically in the patient education process. A scoping review protocol is reported, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and guided by The Joanna Briggs Institute. PubMed, Scopus, Web of Science, and LISTA (Library, Information Science & Technology Abstracts) will be searched. A grey literature search and hand-searching of citations and reference lists of the included studies will also be undertaken. Studies with their full text are not available and are in languages other than English will be excluded. Two independent reviewers will screen titles/abstracts and full text of retrieved articles and eligibility disagreements within a pair will resolve by discussion or a third reviewer. Data charting will be done in accordance with the data extraction tool made in Excel. Findings will be presented as a narrative summary supported by tables and diagrams. Identifying the different services that medical librarians provide in the patient education process leads medical librarians to inform about the different services they can provide in the patient education process and to expand their roles as well as policymakers and hospital managers to be aware of these roles and use medical librarians in the patient education process appropriately. It also helps the general public and patients to learn about the services that medical librarians can provide them in this process.

Effect of Medagogy–Based Medication Literacy Enhancement on Medication Adherence Among Older Persons with Physical Multimorbidity: Randomized Controlled Trial

Medication non-adherence leads to poor clinical outcomes, particularly in older people with physical multimorbidity. The Medagogy model is a patient education process which enhances medication literacy resulting in medication adherence. This randomized controlled trial examined the effect of the Medagogy-Based Medication Literacy Enhancement Program on medication adherence among older persons with physical multimorbidity. One hundred participants aged 60 and over with two or more physical chronic conditions living in northern Thailand were randomly assigned into either a control group (n = 50) or an experimental group (n = 50). The control group received only usual care, while the experimental group received the Medagogy-Based Medication Literacy Enhancement Program. The program consisted of exchanging information based on the P-pathophysiology, I-indication, T-treatment, and S-specific through transformative learning and the teach-back method, with six sessions, implemented twice a week for three weeks. Medication adherence was measured using the Brief Medication Questionnaire at the 8th week of the program. Data were analyzed using descriptive statistics and Paired and Independent t-tests. The results showed that after receiving the program, the experimental group had a significantly higher mean score for medication adherence than the control group. The results indicated that enhancing medication literacy through transformative learning resulted in improvement in medication adherence among older persons with physical multimorbidity. Therefore, nurses can use the Medagogy-Based Medication Literacy Enhancement Program to improve medication adherence among this population group. Further testing in other chronic conditions for the generalizability of the program and integrating digital technology or e-Health into the program are suggested.

Radiology Gets Chatty: The ChatGPT Saga Unfolds.

As artificial intelligence (AI) continues to evolve and mature, it is increasingly finding applications in the field of healthcare, particularly in specialties like radiology that are data-heavy and image-focused. Language learning models (LLMs) such as OpenAI's Generative Pre-trained Transformer-4 (GPT-4) are new in the field of medicine and there is a paucity of literature regarding the possible utilities of GPT-4 given its novelty. We aim to present an in-depth exploration of the role of GPT-4, an advanced language model, in radiology. Giving theGPT-4 model prompts for generating reports, template generation, enhancing clinical decision-making, and suggesting captivating titles for research articles, patient communication, and education, can occasionally be quite generic, and at times, it may present factually incorrect content, which could lead to errors. The responses were then analyzed in detail regarding their potential utility in day-to-day radiologist workflow, patient education, and research processes. Further research is required to evaluate LLMs' accuracy and safety in clinical practice and to develop comprehensive guidelines for their implementation.

The use of patient-reported outcome measures by healthcare professionals in specialized asthma management centers in French-speaking Belgium: A mixed-methods study.

Recently, the literature has promoted the use of patient-reported outcome measures (PROMs) in clinical practice as a means to foster patient engagement. However, conditions necessary to support the use of PROMs to encourage asthma patient engagement are not clearly defined. Therefore, we sought (1) to explore the current and ideal use of PROMs by healthcare professionals (HP) in specialized asthma management centers in French-speaking Belgium and (2) to understand under which conditions the use of PROMs contributes to patient engagement. We undertook a mixed-methods study with both anonymous online survey and in-person qualitative semi-structured interviews conducted with HPs to understand their perspectives on the routine use of PROMs. HPs were recruited from 16 asthma centers (French-speaking Belgium) identified via the Belgian Respiratory Society. Of the 170 HPs identified from the 16 participating centers, 51 (30%) responded to the survey (n=51) and 11 completed semi-structured interviews. 53% (27/51) of the surveyed HPs reported using PROMs primarily for asthma monitoring and clinical research while all reported that PROMs should primarily be used in practice to facilitate communication with the patient and to address neglected aspects of the care relationship such as the psychosocial aspects of the disease. The qualitative interviews revealed avenues for moving from a medical-centered and utilitarian use of PROMs to a use serving patient engagement. This would require HPs to go beyond their current representation of PROMs, to use instruments offering a more holistic image of the patient, to incorporate PROMs into a digital tool and to integrate PROMs in a patient education process. The main findings of this study suggest relevant avenues for using PROMs in ways that support patient engagement.

Barriers and facilitators to type 2 diabetes management among slum-dwellers: A systematic review and qualitative meta-synthesis.

The prevalence of type 2 diabetes (T2D) is on the rise worldwide, especially in developing countries. There is a significant difference between the slum-dwellers and other urban dwellers in terms of T2D incidence rate and access to healthcare services. This review aimed to identify barriers and facilitators to T2D management among slum-dwellers. A systematic review was conducted to identify barriers and facilitators to T2D management from January 1, 2002 to May 30, 2022. We searched MEDLINE via PubMed, Scopus, Web of Sciences, and Google Scholar. The inclusion criteria were: qualitative or mixed-methods research, published in English, focused on slum-dwellers and T2D or its complications, and assessed barriers and facilitators to T2D management among slum-dwellers. Quality appraisal was conducted using the QATSDD critical appraisal tool. A thematic approach was used for data analysis and synthesis. A total of 17 articles were included in this review. Three analytical themes were identified: (1) Individual factors consisting of four themes: lifestyle behaviors, informational, psychological, and financial factors; (2) Health system factors consisting of three themes: patient education processes, financial protection, and service delivery; and (3) Contextual factors consisting of three themes: family support, social support, and environmental factors. Our review disclosed that the individual, health system, and context influence T2D management among slum-dwellers. Policymakers can use the findings of this review to reduce barriers and augment facilitators to improve healthcare utilization and self-care management among patients with T2D in slums.

Conception, réalisation et évaluation d’une démarche éducative auprès des patients porteurs de PICC line et midline

Design the competency framework and an interview guide for patients with PICC line or midline. Develop a patient satisfaction evaluation questionnaire. A multidisciplinary team has developed a reference system for the skills of patients with PICC line or midline. The skills are classified in three categories: knowledge, know-how and attitudes. An interview guide was written in order to transmit the priority skills, determined beforehand, to the patient. A second multidisciplinary team designed a questionnaire to evaluate patient satisfaction. The competency framework includes nine competencies: four, knowledge-based; three, know-how-based and two, attitude-based. Among these competencies, five were considered to be priorities. The interview guide is a tool that allows care professionals to transmit the priority skills to patients. The satisfaction questionnaire explores the information received by the patient, the passage through the interventional technical platform, the end of the management before the return home, and the overall satisfaction of the patients with the course of the device placement. Over a 6-month period, 276 patients responded with a high satisfaction rate. The PICC line or midline patient's competency framework has made it possible to list all the skills that patients should acquire. The interview guide serves as a support for the care teams in the patient education process. This work could be used by other establishments to develop the educational process around these vascular access devices.

Nutrition and physical activity knowledge, attitudes, and practices of inpatient cirrhosis care providers.

Hospitalization is a high-risk period for cirrhosis-associated sarcopenia and frailty. This study aimed to measure the knowledge, attitudes, and practice patterns (KAP) of multidisciplinary cirrhosis providers about inhospital nutrition and physical activity care. We conducted an online survey of cirrhosis care providers at a combination of 38 hospitals and healthcare centres in Alberta, Canada. Analysis included descriptive statistics and content analysis. Three hundred thirty-eight responses were analyzed. Across all providers, nutrition and physical activity knowledge and attitude (KA) scores were higher than practice (P) scores. Physicians had lower nutrition KA ( P = 0.010) and nutrition P ( P < 0.001) scores than nonphysicians. Previous cirrhosis-related nutrition or physical activity education was associated with higher nutrition KA ( P < 0.001), nutrition P ( P = 0.036), and physical activity P scores ( P < 0.001). Over half of the participants reported not providing patients with educational resources for nutrition or physical activity and not carrying out nutrition screening. Participant suggestions to optimize care included enhancing patient and provider education, standardizing screening and intervention processes, increasing patient-centered support, and promoting collaboration within the healthcare team. Eighty percentage of participants were willing to provide patients with resources if these were readily available. While provider knowledge and attitudes about the importance of nutrition and physical activity in hospitalized patients with cirrhosis are reasonable, there is considerable room to optimize the delivery of best practices in this patient population. Optimization will require readily available educational and personnel resources and interdisciplinary collaboration to promote system change.

Entering aesthetic concept into the field of patient education: A protocol for an interdisciplinary study to develop a conceptual model.

According to the significance of patient education, new conceptual models are constantly required to promote pedagogical competences of health educators. In the field of educational sciences, aesthetic-based education is known as one of the effective types of curriculum planning which has shown many positive pedagogical outcomes. Thus, the researcher's assumption is that, the concept of "aesthetic education" could be transposed from educational sciences to health sciences in order to develop a new formula in the patient education process. The purpose of this study is to explain methods in detail, to develop an aesthetic-based patient education conceptual model through the concept derivation strategy. 1. Scoping review and inductive data analysis using Walker and Avant's approach to achieve conceptual categories of the concept "aesthetic education." 2. Semi-structured qualitative interviews and directed content analysis to extract the main categories of the concept "aesthetics in the patient education process." 3. Drawing an aesthetic-based patient education conceptual model by allocating new conceptual components to each general step of the patient education process, including needs assessment, goal setting, implementation, and evaluation. 4. Modified Delphi technique to validate the final conceptual model. The first phase will represent the main categories and subcategories of attributes, antecedents, and consequences of "aesthetic education." The second phase will show the main categories and subcategories of attributes, antecedents, and consequences of the new concept named "aesthetic-based patient education." In the third phase, it is expected to achieve a new conceptual model representing the components of aesthetics in the general steps of the patient education process. The fourth phase will propose the final validated conceptual model. The provided study protocol can be a road map to developing derivative models through concept derivation strategy in health sciences.

Improving new cancer diagnosis education in a metropolitan cancer center.

251 Background: Oncologists are faced with sharing complex information to their patients when making new cancer diagnoses. Patients often find themselves overwhelmed with the amount of information given to them at this initial visit. This challenging and emotionally charged context often result in patient dissatisfaction. Currently, most patient education is done verbally despite studies showing that patients only retain 14% of verbal communication, compared to 85% when using visual aids (VA).. Gunn et al. showed that cancer patients may be vulnerable to poorer outcomes during treatment if they lack the necessary skills such as health literacy to meet the high informational demands and manage psychosocial stressors. Garcia-Retamero et al showed that the use of VA enables patients across all literacy levels to arrive at better diagnostic inferences; however, the quality and quantity of VA used is not uniform nationwide and little data exists on their use in cancer diagnosis education. Our initiative aims to improve the patient education process at our cancer center. Methods: We developed VA for breast, colon, gastric, and lung cancer clinics. New patients were divided into two, a control arm (CA) which received the current standard education and an intervention arm (IA), which also received VA. Patient surveys based on physician consensus were used to collect patient outcomes. The primary outcomes included patients’ understanding of their diagnosis, the stage of their cancer, and the goal of treatment (cure versus life prolongation). Secondary outcomes included duration of clinic visit and retention of information assessed in a follow up phone call. Results: Sixteen (16) patients participated in the study with 8 in the CA and 8 in the IA group, including 11 females and 5 males. There were 8 Caucasian, 4 African American, 2 Asian and 2 Hispanic patients. Five patients (63%) had breast cancer and 3 (38%) had lung cancer in each arm. CA had 5 patients (63%) with Stage IV disease and IA had 4 patients (50%) with Stage IV disease. IA had better understanding of the goal of treatment (100% IA vs 75% CA, p = 0.13); on follow up, IA were able to better recall the stage of their cancer (88% IA vs 63% CA, p = 0.17) and treatment goal (88% IA vs 50% CA, p = 0.08). IA arm expressed better ability to understand what was communicated to them during the visit (mean score: CA = 4.83, IA = 3.67, p = 0.01). All patients who received the pictorial educational material felt that it helped them better understand the medical information. The total visit time in minutes was 58.67 in in the CA and 44.50 in the IA (p = 0.16). Conclusions: Despite being a small study, we demonstrated a trend towards improved understanding of cancer stage and treatment goal in patients with the use of VA vs standard verbal education. In patients with newly diagnosed breast and lung cancer, the intervention also resulted in lower total visit time. This proof of concept should be reproduced in a larger study.

Could knowledge of patient demographics facilitate a personalized approach to radiation therapy patient education?

IntroductionUsing patient demographics to tailor cancer patient education processes results in improved patient outcomes. However, there is little information on how to successfully tailor radiation therapy (RT) educational content and delivery. The aim of this quality improvement project was to describe the information preferences of a diverse group of patients undergoing RT and determine if different RT education processes were associated with certain patient demographics. Materials and MethodsAn educational needs assessment questionnaire, based on a validated tool, was offered to all patients undergoing RT on a single day. Questionnaire sections included demographics and questions regarding the importance of topics related to RT treatments, desired mode of information delivery, quantity of information, desired timing of information, and satisfaction with information received. Patients were also asked to answer qualitative questions focused on what was working well and what could be improved. Participants’ responses were cohorted based on demographic groupings (age, gender, education level) and were tested for statistically significant differences and associations. Results130 patients completed the questionnaire. Compared to those over 60 years, more participants who were 50 – 59 years old thought the topics were ‘very important’ (96% vs 77%, p<0.001) and wanted a higher quantity of information about the topics (80% vs 66%, p<0.001). More participants over 70 years old preferred pamphlets compared to those less than 70 years (48% vs 30%, p<0.047) while more participants under 50 years old preferred one-on-one sessions compared to those older than 50 years (40% vs 25%, p<0.038). Fewer participants <50 years wanted information at their first meeting with the Radiation Oncologist compared to those older than 50 years (57% vs 73%, p<0.001). Compared to the male cohort, more female participants felt the information topics were more important (83% vs 74%, p<0.0001) and had more unmet education needs (29% vs 17%, p<0.001). Compared to those with post-secondary education, more participants with primary or high school education desired a higher quantity of information (76% vs 65%, p<0.001), preferred to receive that information using pamphlets (43% vs 32%, p=0.006) and wanted all the information at the first opportunity (81% vs 67%, p<0.001). ConclusionsThis quality improvement project found that age, gender and education level influenced patient preferences for information quantity, delivery mode and timing of RT education. These findings are promising and support further evaluations to determine a more precise definition of the personal factors that could help to individualize our approach to educating patients receiving RT.

Patient perceptions of safety in primary care: a qualitative study to inform care

Patients’ perspectives on patient safety have rarely been incorporated into quality initiatives in primary care. Our objective was to understand the patient perspective on patient safety in patient-centered medical homes (PCMHs). We conducted 12 patient focus groups/interviews in nine sites with 65 patients at a geographically diverse sample of National Committee on Quality Assurance Level 3 recognized PCMHs across three states. Using a patient safety framework, we coded and analyzed interviews for overarching themes and subthemes across patient safety domains. Overarching themes focused on (1) both clear and timely communication with and between clinicians and (2) trust in the care team, including being heard, respected, and treated as a whole person. Other themes important to specific patient safety domains included sharing of and access to information, patient education and patient-centered medication reconciliation process, clear documentation for the diagnostic process, patient-centered comprehensive visits, and timeliness of care. Communication and trust are key to patient perceptions of safe primary care. Focusing on these themes across safety domains may help to make primary care both more patient-centered and safer, and should be considered in future ambulatory safety initiatives.

The Roles of Pharmacists in Cardiac Care units in Hospitals

Inpatients managed in cardiology units have shown high risks of encouraging drug-related adverse reactions. This is coupled with the influx of diuretics and cardioprotective drug mechanism. The support played by a clinical pharmacist in this context remains largely underscored cored. They play an essential role in supporting the overall pharmacological care for patients through clinical conditions evaluations and assessments. Further, it has been established that poor adherence to drug regimens is among the key exacerbating factors for heart failure occurrence. The need for conducting patient education process is essential in drug adherence process. This elevates the roles of clinical pharmacist in the care delivery through drug use optimization process, minimization of occurrence of adverse drug events and activities in the transitional care process with a key focus on medical reconciliation approaches in the care practice. This study has focused on systematic reviews, Meta-analysis and randomized controlled studies focusing on the pharmacist intervention in improving outcomes of cardiology patients in the hospital care settings. The results have demonstrated that their role can no longer be underestimated and play an important role in the care delivery process and reducing the overall drug-related complications in the care process.

Listing the whys and listening to the why nots

It's been recommended for decades that patient education encounters contain specific information, including drug onset of action, administration route, adverse effects, storage, and many more. These requirements, along with components of a drug utilization review and written documentation, are detailed in the Omnibus Budget Reconciliation Act of 1990 (OBRA ‘90) and have been widely adopted in pharmacies nationwide. Explaining this required information to patients is absolutely vital. However, if we focus on that alone, we risk minimizing an essential piece of the patient counseling puzzle: the process of education. Descriptions of the patient education process paint a more interactive picture with broader strokes that include establishing a caring relationship; assessing patients’ attitudes toward their health problems; and exploring cultural identity and how it impacts patient care. I would argue that by dropping these crucial components from many of our patient interactions, we risk missing out on a much bigger picture. In this month's cover story (p. 26) on structural racism, Anne Lin, PharmD, of the Notre Dame of Maryland School of Pharmacy describes a counseling encounter with a vaccine-hesitant coworker that was ultimately successful. She recalls explaining the reasons the vaccine was important and did not dismiss her patient's concerns. In other words, she listed the whys and listened to the why nots. When we neglect exploring deeper issues such as culture, barriers to care, and bias with our patients and within ourselves, we contribute to structural racism. In this issue, you'll get details on recent drug approvals (p. 14), intermittent use of intranasal corticosteroids for allergic rhinitis (p. 21), and strategies to address unmet mental health needs in your patients (p. 19). Catch up on your CPE and prepare for the upcoming influenza season with our comprehensive 2021 immunization update (p. 52). As human beings, each of us is susceptible to overlooking a patient's or colleague's perspective, their cultural identity, and barriers to care. As pharmacists, we have a responsibility to acknowledge and recognize these perspectives, our own internal biases, and implicit biases that patients face in the health care system. As a profession, we can strive to be better listeners to what our patients say and what they don’t say, and address our own internal preconceptions about culture, socioeconomic status, and race to affect change to structural racism. It starts with me, it starts with you, but ultimately it will take all of us working together.

Enhanced Recovery After Surgery (ERAS) protocols: the impact of enhanced patient perioperative education on patient satisfaction and outcomes in gynecologic oncology practice

<h3>Objectives:</h3> Enhanced Recovery After Surgery (ERAS) protocols have been developed for several surgical fields based off the available evidence to improve patient surgical outcomes with shortened recovery to return of baseline function. The ERAS® Society 2019 preoperative guidelines for gynecologic oncology give a "strong" recommendation for written and verbal preoperative patient education with "moderate" data to support this; however, the recommendation remains vague as to how this should be implemented. We hypothesized patient satisfaction related to their disease state, treatment plan, and hospital course would be improved after implementation of a standardized written preoperative education protocol in addition to traditional oral education for patients undergoing laparotomy with the gynecology oncology faculty at the Medical College of Wisconsin. Secondarily, we hypothesized that enhanced patient education preoperatively could positivelyimpact patient length of stay, emergency department admissions, nursing calls, and readmission rates following surgery. <h3>Methods:</h3> Based on the ERAS Society recommendations, our practice initiated a pilot program to improve our perioperative patient education. In collaboration with our clinic nurses, providers and inpatient nursing staff we revised all of our patient perioperative instructions which address the surgical procedure, expectations prior to surgery, expectations during hospital admission and post- operative instructions including activity limitations, pain management, bowel management and issues of concern during recovery from surgery. We obtained Institutional Review Board (IRB) approval. We compared two groups of patients undergoing laparotomy. The Standard Group received the standard patient education: the current oral and written education that had been utilized in the clinic. The Enhanced Group received the enhanced patient education material after all providers and staff had undergone education regarding the changed process. The enhanced patient education process provided consistent written instructions in addition to the oral instructions communicated by the team. In addition, at the time of discharge standardized post-operative instructions were printed and provided to the patient. During July 2019-Dec 2019, 15 patients who underwent standard preoperative instructions were included in the pilot initiative and comprised the Standard Group. During Jan 2020 - June 2020, 17 patients were included in the pilot as the Enhanced Group. All patients included in the pilot completed the EORTC QLQ-INFO 25 validated survey at the time of discharge or at their post-operative visit. <h3>Results:</h3> Patient satisfaction scores, as quantified by items 31-55 of the EORTC QLQ-INFO 25 survey, showed improvement in patient satisfaction with the possible causes of their disease after protocol implementation (p=0.03). There was also a reduction in the number of patient nursing calls following surgery (p=0.035). There was no difference between groups regarding length of stay, emergency department visits or readmission rates. <h3>Conclusions:</h3> Consistent printed and oral perioperative patient education is an effective measure that can positively impact patient satisfaction as well as staff satisfaction (personal communication). Additional ERAS measures may need to be implemented to impact perioperative patient emergency room visits, length of stay and readmission rates.

Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro.

ABSTRACTOBJECTIVE To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care.METHODS This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi-experimental mixed design, with previous, later and time series analyses. We evaluated the care provided to all pregnant women with syphilis whose prenatal care that ended during the studied period, using ten quality criteria and one indicator. The intervention was multifaceted, covering permanent education, improvement of records and information systems, audit and feedback, patient education, organizational changes and work processes. We estimated absolute and relative improvements of the criteria and their statistical significance (α = 5%). The facilitators and hinders of the intervention were analyzed according to the Model for Understanding Success in Quality.RESULTS After the intervention, there was a total absolute improvement of 6.7% (64.4% versus 71.0%) and relative of 28.8% (p > 0.05). Eight of the ten quality criteria had an improvement, which was significant in four of them (p < 0.05). The monthly indicator of adequate treatment also improved (p < 0.05), but maintained low performance throughout the project. The increase in the compliance of the treatment scheme with the protocol (91.4% versus 99.1%) positively stood out, but the main opportunities for improvement were testing (42.8% versus 48.5%) and treatment of sexual partnerships (42.8% versus 44.2%). Regulatory pressures to improve the monthly indicator and the political-economic crisis experienced by the municipality modulated the effect of the intervention.CONCLUSION The project was useful to identify priorities and guide interventions to improve the quality of care for syphilis, although there is still ample room for improvement. The identified problems, as well as the contextual modulators of the effect, should be considered in future interventions.