Providing Patient Education Research Articles

Remote Management of Osteoporosis.

Purpose of ReviewOsteoporosis management has evolved significantly over the past decade, with telehealth emerging as an effective tool to manage bone health in a growing patient population. This review explores the advantages and disadvantages of telehealth use for osteoporosis management while highlighting recent studies of clinical importance.Recent FindingsA wide variety of telehealth approaches are used today, from phone or video telemedicine appointments with physicians and advanced practice providers, to electronic systems for triage and consultation with osteoporosis specialists. Contemporary studies show that telehealth can facilitate health care access to underserved communities and enhance physician–patient communication, as well as provide patient education. However, barriers such as inexperience or lack of access to technology, suboptimal patient-clinician relationship building process, and difficulties with follow-up have limited the use of telehealth to certain situations.SummaryTelehealth has proven to be an effective resource for managing and treating osteoporosis patients. As its use continues to grow, important limitations must be accounted for to avoid lapses in care. Further research should keep these factors in mind as the use of this technology progresses.

Abstract P089: Health Facility Readiness For Hypertension Management In Ghana, West Africa

Background: Hypertension continues to be a growing health burden in Sub-Saharan Africa (SSA). The health systems in SSA are ill-equipped to manage patients with hypertension. The current study explored hypertension service readiness at the health facilities in Kumasi, Ghana. Methods: We purposively recruited 11 (out of over 200) health facilities that provide hypertension services in Kumasi, Ghana. At each facility, we administered the Hypertension Service Availability and Readiness tool. The main outcome of interest was hypertension service readiness regarding the availability of hypertension guidelines, provider and their training, equipment, diagnostics, and anti-hypertensive medications. We used descriptive analysis and reported counts (%) and median (Interquartile Range). Results: Five facilities (46%) were of medium size with 50-100 bed-capacity, four (36%) were government-owned, five (46%) treated patients with hypertension in a hypertension clinic while the rest managed them in the general outpatient department (Table). At least one provider had received cardiovascular disease training at 7 (64%) facilities. Hypertension-related patient education materials and treatment guidelines were available in 6 (54%) and 8 (72%) facilities, respectively. Also, 7 (64%) had all of the first-line anti-hypertensive medications (as stipulated in Ghana Standard Treatment Guidelines) available. Conclusion: We identified gaps in provider training, patient education, and first-line medication availability related to hypertension in Ghana. This study calls for policy changes to improve hypertension management and prevention of cardiovascular diseases.

Assessment of chemotherapy-related educational needs of colorectal cancer patients.

Aim of our study was to evaluate cancer patients' knowledge about their chemotherapy regimens in order to assess educational needs of patients. Study was conducted on 58 colorectal carcinoma patients who were treated in an outpatient chemotherapy unit. These patients had received a 2-page information pamphlet about their chemotherapy treatments before the commencement of treatment. During the first interview with patients, pharmacist collected demographic data and evaluated patients' knowledge about their medications using a standardized questionnaire. Mean age of the patients was 59.6 ± 1.3 years; 65.5% were male. Majority (77.6%) of patients were graduates of primary school. Sixty-four percent of these had at least one comorbid disease. Median number of chemotherapy courses already received by patients was 4 (1-9). Fifty-nine percent reported that they did not receive any patient education and 43.1% reported that they did not receive any informative document. Twenty-nine percent of patients did not know what actions to take in case of nausea-vomiting; while 53.4% did not know how to react if their body temperature exceeded 38 °C and 25.9% had no idea about dietary necessities. About one-third of patients did not pay attention to oral care. Our study showed that patients did not understand (or remember) the basic points about their chemotherapy sufficiently, but remembered the adverse effects they experienced occasionally. Pharmacists will have the chance to increase the level of knowledge of the patients receiving chemotherapy by providing patient education and follow-up.

Increasing incidence of anterior cruciate ligament reconstruction: a 17-year population-based study.

Anterior cruciate ligament (ACL) injuries are one of the most frequently studied injuries in orthopedic care and research. However, limited epidemiological data are available in Canada regarding trend and distribution of anterior cruciate ligament reconstruction (ACLR). In this paper, our purpose was to assess trends of ACLR between 2002/03 and 2018/19 by age, sex, season of surgery, and location (inpatient vs outpatient) of surgery. In this descriptive epidemiological study of retrospective data available from Alberta Ministry of Health, we report annual incidence of ACLR between 2002/03 until 2018/19 among Albertans aged 10years and older. Information was collected by authors from physician claims database for primary ACLR and revision ACLR and linked with other databases. Incidence proportions (number of ACLR/100,000 population) were calculated and compared by age category and gender over the study period. A total of 28,401 primary ACLR and 2085 revision ACLR were identified during the study period. Age-standardized annual incidence of primary ACLR increased from 40.6 to 51.2 per 100,000 population aged 10years and older. Average annual increase in ACLR incidence was higher among females (1.8% per years) compared to males (0.96% per year). The overall peak incidence and peak incidence among males was observed in 20-29year age group, whereas peak incidence in females was observed in 10-19years of age. The number of ACLR in females outnumbers those among males for 10-19year age group. Generally, a lower proportion of ACLR were conducted in summer compared to other seasons. Primary ACLR conducted in outpatient setting increased from 72% in 2002/03 to 97% in 2018/19. The incidence of ACLR is increasing in Alberta, especially among females and among younger cohorts under 20years of age. This information can help clinicians to provide patient education and policy-makers to design and implement targeted ACL injury prevention programs. Level III.

Retention of students' knowledge of immunizations following a one-day or a five-week course

IntroductionThe American Pharmacists Association (APhA) Pharmacy-Based Immunization Delivery Certificate Program is commonly used by schools of pharmacy to train student pharmacists in immunizations. This study compared student pharmacists' knowledge retention of immunization content when the live seminar of the APhA Program was delivered as a one-day co-curricular activity or as a five-week required course. The impact of immunization experience on students' knowledge retention was a secondary objective. MethodsA 45-question knowledge assessment about immunizations was administered to second and third-year student pharmacists eight months after completing either a five-week course (second-year students) or a one-day seminar (third-year students). Students were also asked about their experience providing patient education, screening, and administering immunizations. ResultsKnowledge assessment scores declined by an average of 26.3% from the initial to the eight-month assessment, and declines were similar for second and third-year students. However, students who reported immunizing over 50 patients had significantly higher knowledge retention than those who reported never immunizing. ConclusionsA live immunization training given over one day or five weeks did not impact the retention of immunization knowledge eight months later. However, students who immunized >50 patients had greater knowledge retention. These findings indicate the importance of including the application of immunization knowledge in pharmacy curricula to enhance long-term knowledge retention.

Emergency Preparedness for the COVID-19 Pandemic: Social Determinants Predicting the Community Pharmacists' Preparedness and Perceived Response in Malaysia.

Background: Pandemic preparedness of healthcare providers helps to mitigate future threats such as spread and fatality rates, as well as the management of the disease. Pharmacists are key partners with public health agencies, and the role of community pharmacists is becoming increasingly recognised in this COVID-19 pandemic. The study aimed to explore the emergency preparedness of community pharmacists (CPs) for COVID-19. Methods: A cross-sectional study was performed among community pharmacists using cluster sampling followed by convenient sampling. A self-administered questionnaire was formulated using references from the previous literature and the WHO preparedness checklist. Descriptive analysis was undertaken for the participants’ socio-demographic characteristics. All the data collected were entered into the Statistical Package for Social Sciences version 24 (SPSS V.24), (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp.) for analysis. Results: Most of the CPs had five or fewer years of practice experience, and they had all the mandatory information relating to the needs of their communities regarding the disease. The participants knew where to acquire these resources whenever needed. They were able to recognise the signs and symptoms of the disease. Most participants felt that they were confident to provide patient education and carry out their duties during these challenging times. There was a strong position correlation between preparedness and the perceived response of the participants. Conclusion: The community pharmacists in Malaysia are prepared enough for COVID-19 pandemic management and perceive that they can respond during any unprecedented situations, such as COVID-19. Community pharmacists were aware of the challenges that they need to face in their community regarding COVID-19.

A mixed-methods feasibility study of a comorbidity-adapted exercise program for low back pain in older adults (COMEBACK): a protocol

BackgroundThe prevalence of low back pain increases with age and has a profound impact on physical and psychosocial health. With increasing age comes increasing comorbidity, and this also has pronounced health consequences. Whilst exercise is beneficial for a range of health conditions, trials of exercise for low back pain management often exclude older adults. It is currently unknown whether an exercise program for older adults with low back pain, tailored for the presence of comorbidities, is acceptable for participants and primary healthcare providers (PHCPs). Therefore, this mixed-methods study will assess the feasibility of an 8-week comorbidity-adapted exercise program for older people with low back pain and comorbid conditions.MethodsThe 3-phased feasibility study will be performed in a primary healthcare setting. PHCPs will be trained to deliver a comorbidity-adapted exercise program for older people with low back pain and comorbidities. Healthcare-seeking adults > 65 will be screened for eligibility over telephone, with a recruitment target of 24 participants. Eligible participants will attend an initial appointment (diagnostic phase). During this initial appointment, a research assistant will collect patient demographics, self-reported outcome measurement data, and perform a physical and functional examination to determine contraindications and restrictions to an exercise program. During the development phase, PHCPs will adapt the exercise program to the individual and provide patient education. During the intervention phase, there will be two supervised exercise sessions per week, over 8 weeks (total of 16 exercise sessions). Each exercise session will be approximately 60 min in duration. A qualitative evaluation after the last exercise program session will explore the feasibility of the exercise program for participants and PHCPs. Progression criteria will determine the suitability for a fully powered randomised controlled trial.DiscussionThis mixed-methods feasibility study will assess an exercise program for older adults with low back pain and comorbidities. Once assessed for feasibility, the exercise program may be tested for effectiveness in a larger, fully powered randomised controlled trial. This information will add to the sparse evidence base on appropriate options for managing back pain in older adults.Trial registrationAustralian and New Zealand Clinical Trials Registry registration number: ACTRN12621000379819p (06/04/2021; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000379819p).Trial sponsorMacquarie University, Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia.

Sudanese Medical Doctors' Perceptions, Expectations, Experiences and Perceived Barriers Towards the Roles of Clinical Pharmacists: A Cross-Sectional Study.

PurposeInterprofessional collaboration between physicians and clinical pharmacists has been shown to improve patients’ outcome by reduce medical errors, costs and patient adherence. Thus, the purpose of this study was to investigate the medical doctors’ perceptions, expectations, experiences, and perceived barriers regarding clinical pharmacists in Wad Medani.MethodsA cross-sectional study was conducted at five major hospitals in Wad Medani, between April and June 2021 using a self-administered questionnaire. The questionnaire was distributed among 178 physicians. The questionnaire consists of four sections, in addition to a demographic section. These four sections measure physicians’ perceptions, expectations, experience, and perceived barriers.ResultsA total of 178 physicians were enrolled in the study. Physicians were comfortable with clinical pharmacists detecting and preventing prescription errors (55.1%); providing patient education (56.3%). Generally, physicians had high expectations with agreement rate of all the items ranged from 51.7% to 85.4%. Most physicians (79.8%) agreed that clinical pharmacists were a reliable source of general and clinical drug information. 64.0% and 59.0% of physicians perceive the unclear responsibility of clinical pharmacists and the lack of physicians’ experience with clinical pharmacists were barriers that can hinder clinical pharmacists’ contributions, respectively.ConclusionPhysicians had positive perceptions, expectations, and experiences with clinical pharmacists, and pointed out some barriers clinical pharmacists face. It was suggested that hospitals should recruit more clinical pharmacists to cover each unit within the hospital with clear job description and provide them CPD.

Practical Screening for Islet Autoantibodies: The Time Has Come.

The increasing prevalence of type 1 diabetes (T1D) suggests family physicians will regularly see first-degree relatives of patients with T1D with the genetic propensity for developing T1D. T1D autoantibody screening by family clinicians addresses an important need to identify at-risk individuals early and achieve short- and long-term health benefits. Multiple T1D screening options and programs are available to clinicians that provide patient education, testing, result analysis, follow-up, and opportunity for participation in T1D prevention trials. The provider-patient relationship in family medicine places clinicians in a unique position to provide monitoring and followup crucial to family members with positive autoantibody results.

Addressing Challenges of Undergraduate Medical Education in India Through Massive Open Online Courses (MOOCs)

Context: Massive open online courses (MOOCs) have much potential in higher education, including medical education. This paper explores the challenges and potential solutions through planning, developing, and integrating MOOCs into the medical curriculum. Evidence Acquisition: A non-systematic review study was conducted in March and April 2021. A comprehensive literature search was done on Pubmed, Scopus, Web of Science, Google Scholar, and websites to retrieve articles on MOOCs and medical education using relevant search terms. Results: With their wide availability, open access, and affordability, MOOCs have attracted the attention of several educationalists and learners. Indian medical undergraduates face several problems, such as introducing the new competency-based curriculum, information overload, the COVID-19 pandemic, and increased health care demand. The advantages of MOOCs can be leveraged to solve some of the problems in medical education. They can be effectively used to educate and empower the general public and provide patient education and continuous professional development. Conclusions: With embedded advanced interactive tools, MOOCs have the potential to reshape medical education. Sustained commitment, promotion competition, and collaboration can help overcome the common barriers to MOOC development and integration into the undergraduate medical curriculum.

Assessing Use of Gender Diverse Language in Patient Education Materials on Breast Reconstruction.

Background:Utilizing inclusive terminology in patient education materials is an increasing area of focus in plastic surgery. Over 300,000 cases of breast cancer were diagnosed in 2020, affecting cisgender and gender diverse patients alike. Both cisgender and gender diverse patients may choose to undergo breast reconstruction. This study aims to assess the use of inclusive language in online patient education materials on reconstruction after breast cancer.Methods:Materials were collected from all academic hospitals with a plastic surgery integrated and/or independent residency program, 97 in total. Programs were further classified by the presence of a comprehensive gender program. Materials were analyzed for gender diverse terminology outlined by the National LGBTQIA+ Health Education Center. A chi-square test evaluated for statistical significance of inclusive terminology based on the presence or absence of a comprehensive gender program.Results:The majority (75%) of programs referenced cis women alone, with 25% referring to both men and women or using gender neutral terms such as “patients.” Although most (85%) programs wrote in second person (“you”), 15% used she/her/hers pronouns alone, and no programs utilized gender diverse language outlined by the National LGBTQIA+ Health Education Center. The presence or absence of a comprehensive gender program was not predictive of the use of inclusive terminology (P = 0.32).Conclusions:This study found that only 25% of breast reconstruction materials contained inclusive gender terminology. Plastic surgeons should provide patient education materials with language that supports members of a gender diverse population to facilitate a safe, inclusive space and conversation.

Effects of patient education on the oral behavior of patients with temporomandibular degenerative joint disease: a prospective case series study

ABSTRACT Objective To evaluate the effects of patient education and related factors on oral behaviors (OBs) in patients with temporomandibular joint degenerative diseases. Methods Sixty-three patients were included. Temporomandibular joint specialists conducted clinical examinations, provided patient education, and administered the Oral Behavior Checklist (OBC) questionnaire at baseline. Patients were followed up at 6 months. Results Eight OBs showed a high incidence among patients. At the 6-month follow-up, the incidence of 6 of the OBs decreased, all of which were high incidence OBs. The frequency of 9 OBs decreased, of which 8 were high incidence OBs. The average OBC score decreased from 22.97 ± 9.30 to 17.90 ± 9.28. Age, education level, and original OBC score had a significant effect on OB improvement. Conclusion Patient education and the corresponding treatment are conducive to OB improvement. The related factors affecting the improvement in patients’ OBs were age, education level, and OB severity.

Assessing acceptability and identifying barriers and facilitators to implementation of the EULAR recommendations for patient education in inflammatory arthritis: a mixed-methods study with rheumatology professionals in 23 European and Asian countries

ObjectivesTo disseminate and assess the level of acceptability and applicability of the European Alliance of Associations for Rheumatology (EULAR) recommendations for patient education among professionals in rheumatology across Europe and...

Applying a User-Centric Design Approach to Develop a Mobile Application for Management and Treatment of Gestational Diabetes in Nepal

ObjectivesMobile apps can aid with the management of Gestational Diabetes Mellitus (GDM) by providing patient education, and reinforcing daily glucose monitoring and diet/lifestyle modification. Here we describe our process of applying a user-centered design approach in developing a culturally-appropriate app (GDM-DH) to support the management of GDM among patients in Dhulikhel Hospital, Nepal.MethodsA multidisciplinary team including experts in GDM, mHealth, and behavior and implementation sciences, as well as health providers and patients at Dhulikhel Hospital, contributed to the development of the GDM-DH app. After finalizing the app's content and features, we created the app's wireframe, which illustrated the app's proposed interface, navigation sequences, and features and functions. This was followed by key informant interviews with healthcare providers (n = 5), focus groups, and in-depth interviews with GDM patients (n = 12) in which they were asked to provide feedback on the features and functions of the wireframe. Incorporating their input, we built the minimum viable product, which was user-tested with 6 GDM patients, and further refined for the final version of the GDM-DH app.ResultsQualitative findings from the user research affirmed the potential utility and usability of our target app and provided insight into app features and design elements that needed to be added or modified. Consistent with the Social Cognitive Theory, the final version of the GDM-DH app supports GDM self-management by providing health education and allowing patients to record and self-monitor blood glucose levels, carbohydrate intake, physical activity, and gestational weight gain. The app uses innovative features to minimize the self-monitoring burden and uses automatic feedback and data visualizations. Healthcare providers can use the web-based admin portal of the GDM-DH app to enter/review glucose readings, track patient progress, and guide treatment and counseling accordingly.ConclusionsTo our knowledge, this is the first mHealth platform for GDM developed for a low-income country, and the first one containing a feature to aid with carbohydrate estimation in meals. A pilot clinical trial is currently underway to explore the clinical utility of the GDM-DH app.Funding SourcesNIH/FIC.

1055-P: Low Rate of Preconception Counseling and Near Absence of Contraception Provision by Endocrinologists for Women with Diabetes

Preconception counseling for reproductive-age women with type 1 and type 2 DM improves maternal-fetal outcomes. Endocrinologists are in a unique position to provide such important counseling and contraception or applicable referrals. In response to an increasing number of women referred to our prenatal clinic with poor glycemic control and unplanned pregnancies, we instituted a quality improvement initiative to improve preconception care at our academic center. We conducted a chart review of 96 women of reproductive age with at least one in-person visit for DM from July 2020-Oct 2021. Patients who were pregnant or had undergone sterilization were excluded. Fifty patients (mean age 34.5+/-6.7 yrs) met inclusion criteria. Of these, 66% had T1DM, 32% had T2DM and 26% had a HgbA1c ≤6.5%, recommended for pregnancy. Each woman had a mean of 2.1+/-1.2 visits with an endocrinology provider during these 15 mos. Only 4% had contraception specifically documented during a visit, although medical staff or other providers had documented contraception use in 56% of cases. No women received a contraception prescription. Endocrinologists did not document provision of preconception counseling to any of these women, although 14% had previously undergone counseling with a maternal fetal medicine provider. No women were referred to an OB-Gyn provider. Our data suggest that endocrinology providers infrequently provide preconception or contraception counseling or referrals for women with diabetes and underscores the striking need for a QI initiative. To this end, we are implementing a multifaceted intervention to educate providers on key aspects of preconception counseling and contraception provision, facilitate specialist referrals, simplify documentation, and provide patient education materials. We will assess the efficacy of our intervention with the ultimate goal of improving outcomes for this rapidly growing population of women with diabetes and their offspring. Disclosure R.Jeffers: None. L.Sayres: None. L.Abushamat: None. C.Nielsen: None. A.Zaman: None. L.A.Barbour: None.

MO927: The Impact of Medication Therapy Management on Medication Burden Quality of Life Among Haemodialysis Patients in Egypt: An Intervention Study

Abstract BACKGROUND AND AIMS End-stage kidney disease (ESKD) is a rapidly increasing global health burden. Renal replacement therapy is essential to save the lives of ESKD patients and is done either through kidney transplantation, peritoneal dialysis or hemodialysis (HD). Patients on HD are subjected to polypharmacy, increase in drug-related problems (DRPs), adverse effects, impaired drug adherence and consequently poor medication burden quality of life (MBQoL). Medication therapy management (MTM) plays an essential role in resolving those problems. The MTM involves performing a medication review, selecting, modifying or administering medication therapy, evaluating the patient’s response to therapy, identifying and resolving any DRPs and providing patient education to enhance the patient’s understanding and adherence to the treatment plan. These pharmaceutical services have shown a positive impact on dialysis patients regarding the economic, humanistic and clinical aspects. We therefore aimed to evaluate the impact of the application of MTM on MBQoL and determine its predictors. METHOD We collected baseline data (sociodemographic, clinical, hemodialysis vintage, hospital admission, drug adverse effects and laboratory) in a pre–post one-group intervention study from all adults on regular maintenance dialysis for >3 months at Alexandria University Hospital. The MBQoL was assessed using the patient-reported outcomes measure of the pharmaceutical therapy (PROMPT) questionnaire after being translated and validated into Arabic. Data on drug adherence was collected by comparing prescribed doses to the actually administered by patients. A structured checklist instrument was used to identify adverse effects. The MTM intervention was applied (medication therapy review, developing a personalized medication record, participating in the medication-related action plan, and patient education sessions). All haemodialysis patients were re-assessed after 3 months. Construct validity was assessed using exploratory factor analysis and reliability was determined using Cronbach's alpha and intraclass correlation coefficient (ICC). Multiple linear regression was used to determine the predictors of the post-MBQoL and change in MBQoL from pre- to post MTM after adjusting for variables with P < 0.10 in bivariate analysis. RESULTS The study included 130 patients who were on average 52 year old (±13), 53.1% were males, 25.8% were smokers, 64.6% had cardiovascular diseases, 26.9% had hepatitis C virus and 14.6% were diabetics. The median (interquartile range) of the dialysis vintage was 5 (2–15) years. The validation of the PROMPT questionnaire was done on an additional 80 haemodialysis patients with similar baseline criteria as the study sample. Exploratory factor analysis revealed that items of the PROMPT were distributed on five domains. Cronbach's alpha was >0.70 for all domains except for ‘impact on patient's life’ (0.52). The ICC was significant (P < 0.01) for all items of the PROMPT questionnaire. The application of MTM had significant effects on the overall PROMPT score (50.74 ± 9.68 versus 59.3 ± 9.86; P < .001), the total number of DRPs (1245 versus 794; P < .001), and calcium level in mg/dL (9.13 ± 0.95 versus 8.77 ± 1.05; P = 0.002). There was a statistically significant reduction in the reported proportion of dry mouth, change of appetite, nausea and vomiting, stomach pain and dyspepsia, diarrhea, constipation and flatulence (P < 0.05). Calcium level (mg/dL) was significantly declined after the MTM application (9.13 ± 0.95 versus 8.77 ± 1.05; P = 0.002). The total number of DRPs was the only significant predictor for change in MBQoL, while university graduates and the a total number of DRPs were the predictors for the post-score of MBQoL. CONCLUSION There is a potentially relevant impact of MTM provision by a clinical pharmacist on medication burden, quality of life, drug-related problems and adverse events among haemodialysis patients.

Preliminary Study on the Establishment of Dental Treatment and Follow-up Management System under General Anesthesia for Patients With Autism

이 연구는 ASD 환자를 대상으로 전신마취 하 치과치료의 필요성을 밝히고 환자의 구강관리 행동 변화의 가능성과 향후 치료 계획에 시사점을 제공하고자 한다. A 권역장애인구강진료센터에서 전신마취 하 치과치료를 받은 53명의 ASD 환자 대상의 후향적 연구이며, 대상자는 높은 구강방어로 인해 불량한 구강 상태였고, 이를 개선하기 위해 전신마취 하치과치료를 하였다. 전신마취 하 치과치료 후 재내원에서 협조도가 단계가 증가하는 경향을 보였지만, 요인 간 상관관계를 확인하기 위해서는 후속 연구가 필요하다. 연구의 결론은 다음과 같다. 첫째, 의료적 위험과 보호자의 전신마취에 대한 부정적 인식에도 ASD 환자의 고통을 개선하기 위해 전신마취 하 치과치료는 필요하다. 둘째, 전신마취 하 치과치료 후 사후관리는 환자의 협도조가 향상되는 행동 개선에 기여한다. 셋째, 전신마취 하 치과치료 후 사후관리는 환자교육을 하고, 구강관리 역량을 환자 스스로 키울 수 있도록 유도하는 절차이다.This study aimed to reveal the need for dental treatment under general anesthesia for ASD patients and provides implications for the possibility of changing patient oral care behaviors and future treatment plans. This retrospective study included 53 patients with ASD who underwent dental treatment under general anesthesia at the Oral Treatment Center for the Disabled in Area A. Because the patients had poor oral conditions due to high oral defense, dental treatment under general anesthesia was performed to improve their conditions. Although the degree of cooperation tended to increase during hospital visits after dental treatment performed under general anesthesia, a follow-up study was needed to confirm the correlation between the two factors. The conclusions of the study were as follows. First, dental treatment performed under general anesthesia was necessary to reduce pain in patients with ASD despite the medical risks and negative perceptions of caregivers regarding general anesthesia. Second, follow-up care contributed to the improvement of the patient’s cooperative behavior. Lastly, follow-up care was found to be a procedure that provided patient education and encouraged patients to independently develop oral care competency.

Effectiveness of patient education on total knee arthroplasty: A systematic review and meta-analysis.

This study was designed to examine the contents and methods of patient educational interventions about total knee arthroplasty (TKA) and their effectiveness in reducing postoperative pain and enhancing range of motion (ROM) in the literature. Patient education has been provided to facilitate recovery after TKA; however, little is known about the contents and methods of the interventions and their effectiveness in reducing postoperative pain and enhancing ROM. This is a systematic review and meta-analysis of randomised controlled trials (RCTs). Published studies from June 1998-June 2021 were identified from electronic databases. Two independent investigators assessed the quality of the studies by using the revised Cochrane risk-of-bias tool. Meta-analyses with random-effects models were conducted to assess the effectiveness of the interventions using the Comprehensive Meta-Analysis Software. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Among 12 articles that met the inclusion criteria, three interventions provided education on pain management and mobility/exercises. The most common educational methods were the combinations of oral explanation, written materials, and audiovisual materials, group discussion, while four studies used information technology (IT) devices. The meta-analysis demonstrated that the educational interventions using IT devices were effective in improving pain and ROM, but not the interventions that did not use IT devices. Structured education for pain management, communication and/or exercise support programs utilising diverse methods have been provided to patients undergoing TKA. Using IT devices could successfully enhance the effectiveness of educational interventions for patients undergoing TKA. Integration of postoperative pain management and mobility/exercises with the use of IT devices should be actively considered in providing patient education in clinical nursing practice.

Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians\u2019 perspectives

BackgroundThere is a lack of understanding of the team processes and factors that influence teamwork and medication management practices in the care of patients with type 2 diabetes mellitus (T2DM). The purpose of the study was to explore physicians’ perspectives of barriers and facilitators to interprofessional care of patients with T2DM within team-based family practice settings.MethodsThis was a qualitative, descriptive study. Participants included physicians affiliated with a primary care network providing care to patients with T2DM in an interprofessional team-based primary care setting in Edmonton, Alberta, Canada. Participants’ contact information was obtained from the publicly available College of Physicians and Surgeons of Alberta and respective primary care network websites. Interview questions addressed physicians’ perspectives on factors or processes that facilitated and hindered the care and medication management of adult patients with T2DM in primary care team-based clinical practice. Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis and a constant comparative approach.ResultsA total of 15 family physicians participated in individual interviews. Family physicians identified facilitators of interprofessional team-based care and medication management of patients with T2DM in three theme areas—access to team members and programs, knowledgeable and skilled health professionals, and provision of patient education by other health professionals. Two themes emerged as barriers to interprofessional care – lack of provider continuity and the loss of skills from delegation of tasks.ConclusionFamily physicians perceive both benefits and risks to interprofessional team-based care in caring for patients with T2DM. Successful functioning of team-based care in family practice will require overcoming traditional professional roles.

Multidisciplinary Project to Prevent Postoperative Urinary Tract Infection.

Postoperative urinary tract infections (UTIs) are associated with increased lengths of stay, inpatient costs, and mortality. Review of institutional data from the American College of Surgeons (ACS) NSQIP revealed opportunities to improve practices with respect to urinary catheter (Foley) insertion, catheter care, adherence to diagnosis and prevention protocols, and ACS NSQIP reporting. A multidisciplinary quality improvement team convened and implemented interventions based on a literature review and analysis of institutional drivers of postoperative UTI. The team educated the ACS NSQIP surgical clinical reviewers and clinical teams about UTI diagnostic criteria and prevention, trained staff in proper catheterization technique, and provided performance feedback. The team also developed kits with supplies and instructions for patients who were discharged home with catheters, along with an instructional video. The investigators evaluated project effectiveness by comparing pre- and postintervention process measures and rates of postoperative UTI. After interventions, compliance rates improved for hand hygiene (62% to 83%, p = 0.04), precleansing of the periurethral area (66% to 97%, p = 0.001), and catheter positioning (41% to 93%, p < 0.001), and the composite performance (10% to 73%, p < 0.001). Surgery residents' scores on a UTI knowledge assessment improved from 71% to 81% (p = 0.005). The majority of residents and staff strongly agreed that the training sessions would change their practice (57% and 69%, respectively). The unadjusted rate of postoperative UTIs at our institution decreased from 1.55% to 0.69% (p = 0.016), corresponding to an improvement in the ACS NSQIP odds ratio from 1.51 to 0.86. A series of interventions, including provider training, patient education, and audits of practice with performance feedback, are associated with improvements in both practice and the incidence of postoperative UTI.