Role In Patient Education Research Articles

A Critical Role for Patient Education in Improving Patient-Provider Communication and Treatment Decisions across Rare Hematologic Malignancies

BACKGROUND: The Rare Disease Act of 2002 defined conditions affecting less than 200,000 people in the United States as "rare"; all hematological malignancies qualify. Patients and caregivers often seek out information about rare diseases online. METHODS: We designed 3 online patient and caregiver education programs focused on different rare hematologic malignancies: acute myeloid leukemia (AML) in 2017, hairy cell leukemia (HCL) in 2019, and peripheral T-cell lymphoma (PTCL) in 2020. These programs were each initially launched live-virtually and then made available on demand for up to 1 year. Program features included interactive panels with physicians, other health care professionals (HCPs), patient advocates, and patients; patient-story vignettes; polling and live Q&A. Through survey-based educational evaluations, we assessed the perceived impact of the online programs on patient and caregiver communication skills, shared decision-making (SDM), and health related behaviors, via a mix of qualitative and quantitative questions, all administered online both prior to, immediately post, and 2 months following program participation. RESULTS: As of August 4, 2020, 1,221 individuals had participated in the educational programs via the online platform cancercoachlive.com (AML 262, HCL 725, PTCL 234), and there were 12,237 views of the educational programs via Facebook (AML 8,673, HCL 2,261, PTCL 1,303). 153 patient and caregiver education participants completed the follow-up survey. Prevalent themes at 2 months follow-up across programs included improved communication with HCPs (33%), disease and care related knowledge improvement (30%), behavioral changes (e.g., exercise/diet) (19%), and empowerment and increased shared decision making (15%). Some examples of knowledge improvement included: guidance for better HCP communication, and disease and protocol knowledge. Examples of SDM/communication change included confidence to raise questions, engaging in more treatment decisions, and being honest with HCPs about issues that arise during care. Examples of behavioral impact included increased focus on diet, exercise, and sleep. CONCLUSIONS: Education on rare hematologic malignancies improved patient and caregiver perceived knowledge, communication skills and health-related behaviors. Online education can be a helpful tool to reach individuals living with rare cancers and their caregivers, and assist them in learning how to best engage in a partnership role in managing their health. Disclosures Kreitman: PlatformQ: Honoraria. Steensma:Arena: Current equity holder in publicly-traded company; Onconova: Consultancy; BMS/Celgene: Consultancy; Takeda: Consultancy; H3 Biosciences: Research Funding; Astex Pharmaceuticals, Otsuka: Consultancy; Arrowhead Pharmaceuticals: Current equity holder in publicly-traded company; Aprea Therapeutics: Research Funding; CRISPR: Current equity holder in publicly-traded company. Horwitz:GlaxoSmithKline: Consultancy; Daiichi Sankyo: Research Funding; C4 Therapeutics: Consultancy; Beigene: Consultancy; Portola: Consultancy, Research Funding; Mundipharma: Consultancy; Innate Pharma: Consultancy; Corvus: Consultancy; Trillium: Consultancy, Research Funding; Seattle Genetics: Consultancy, Research Funding; Millenium/Takeda: Consultancy, Research Funding; Kyowa Hakka Kirin: Consultancy, Research Funding; Infinity/Verastem: Research Funding; Forty Seven: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; Aileron: Consultancy, Research Funding; ADCT Therapeutics: Consultancy, Research Funding; Affirmed: Consultancy; Vividion Therapeutics: Consultancy; Verastem: Consultancy, Research Funding; Myeloid Therapeutics: Consultancy; Miragen: Consultancy; Kura Oncology: Consultancy; Janssen: Consultancy; ASTEX: Consultancy.

Perceptions regarding antimicrobial use and resistance among adult hospital patients in Saudi Arabian Ministry of Health (MOH) hospitals

BackgroundEducation, a key strategy within antimicrobial stewardship programmes (ASPs), has been mainly directed towards healthcare professionals and prescribers more than hospitalised patients. AimTo examine patients’ knowledge and perceptions of antibiotic use and resistance, while evaluating the institutional role of patient education on antibiotic use in two Saudi Arabian hospitals, one with an implemented ASP and one without an ASP. MethodA cross-sectional self-administered survey was developed and piloted. A total of 400 surveys were distributed, 200 within the hospital with an ASP and another 200 within the hospital without an ASP. Data were coded and analysed. Ethical approval was obtained before the start of the study. Findings176 patients responded to the survey with 150 surveys completed and analysed. 78% of patients agreed that they should only take an antibiotic when prescribed by the doctor, however they still tended to keep left over antibiotics for future use. 84% of patients were unaware ‘antibiotic resistance’, with 48% believing that antibiotics help them get better quicker when they had a ‘cold’. Information on antibiotic use and resistance were provided to patients in the hospital with an ASP in contrast to the hospital without an ASP. ConclusionOverall there are poor perceptions regarding antibiotic use and resistance among hospital patients in Saudi Arabia. Patients in the hospital with ASP demonstrated greater knowledge during their hospitalisation. ASPs should not only focus on educating healthcare professionals but should involve the patients and seize the opportunity to educate them while hospitalised.

Blind Spots: Gaps in Disease Knowledge and the Role of Patient Education for Canadians With Diabetic Macular Edema

Over a decade ago, anti-vascular endothelial growth factor (anti-VEGF) injections emerged as a viable treatment for diabetic macular edema (DME), the leading cause of new blindness among working-age adults in North America (1). By targeting VEGF, the signal protein that stimulates abnormal blood vessel growth in DME, the injections offered a new approach to managing vision loss resulting from DME, largely replacing vitrectomy and laser surgery as frontline therapy (2,3). Time-release implants have been used in some cases, as well, and show promise (4).

Opinions and Experiences of Patients Receiving Oral Chemotherapy: A Qualitative Study

Aim: This study is a qualitative study aimed to determine the opinions and experiences of patients receiving oral chemotherapy. Methods: The study was conducted in January 2018 with 18 volunteers who applied to oncology polyclinic at a university hospital and received oral chemotherapy. In data collection, a description form and a semi-structured interview form were administered. In data analysis process, transcription after each interview and evaluation steps through thematic content analysis method were employed. Results: The themes obtained in the study are as access to drugs, use of medicine, side effects and control of treatment, approach of health professionals and support of family and relatives. There is a need to ensure the continuity of the treatment follow-up period in order to improve treatment compliance of patients, to monitor side effects of treatment and to ensure safe use of medicines. Conclusion: In this process, it is crucial that nurses take an active role in patient education and counselling among health professionals so that weaknesses in the patient's drug use process and opportunities for improvement could be identified.

Increasing accrual of minority patients in breast cancer clinical trials.

Black and Hispanic patients participate in clinical trials at lower rates than white patients nationally; lack of diversity in clinical trials prevents appropriate safety and efficacy testing of new treatments in these populations. The Oncology Welcomes New Haven into Trials (OWN IT) initiative at the Yale Cancer Center used a multi-tiered approach to improve breast cancer minority clinical trial accrual through community focus groups, ongoing community outreach, institutional executive council representation, grand rounds presentation, and didactic lectures with healthcare providers. Eligibility criteria of breast cancer trials at Smilow Cancer Center were reviewed using clinicaltrials.gov. Also, an anonymous, 5-min survey was conducted at regular visits with Smilow Breast Center patients to gauge awareness of and access to clinical trials. Survey data were compared to the Yale Cancer Center Clinical Trials Office, Connecticut Tumor Registry, and U.S. Census records. Two-tailed Fisher's tests were used for all analyses. There was a significant increase in the number of minority patients who participated in clinical trials at Smilow Cancer Center from 2016 (95/750) to 2018 (155/944) (p = 0.0325). Two hundred patients participated in the survey; response rate 92%. There was no significant difference in the rate at which patients were invited to participate in clinical trials or the rate at which they declined to participate based on race or ethnicity. Black and Hispanic patients were significantly less likely to be aware of clinical trials than white patients (p < .001). The review of eligibility criteria showed that over half of the studies reviewed had restrictions regarding increased liver function tests, and many restricted the participation of patients with other chronic conditions. Low participation in clinical trials among black and Hispanic patients is likely multifaceted. This study indicated that there are likely structural factors at work which can be modified with institutional effort. The role of patient education regarding clinical trials and accrual should be studied further as should eligibility criteria as a potential barrier to participation.

Biosimilars in oncology: key role of nurses in patient education.

Biosimilars have the potential to lower costs and increase patient access to life-saving cancer therapies. However, lack of familiarity with biosimilars can be a barrier to their adoption, limiting their health and economic benefits. As highly trusted healthcare providers, nurses play integral roles in patient education. This review aims to help prepare nurses to respond to potential questions from patients on biosimilars. The regulation, use and potential benefits of biosimilars are discussed, with a focus on biosimilars in oncology. Overall, biosimilars are highly regulated medicines that provide comparable benefits to available biologics. Nurses can influence the adoption of biosimilars through patient education and can impact the future of the field in their expanding roles within health care systems.

The role of demystifying anaesthesia in allaying anxiety and improving post-operative patient satisfaction in a tertiary care centre: A randomised control trial

Preoperative anxiety and stress are inevitable in patients awaiting surgery. However it is known that larger doses of anaesthetics, higher peri- and post-operative requirement of analgesia and longer hospital stay follow higher levels of anxiety. Studies have shown that pre-operative education reduces anxiety symptoms. This studywas undertaken to answer the question: “Does a structured educational intervention to demystify anaesthesia reduce fear and anxiety prior to surgery?” To assess the role of patient education in reducing pre-operative anxiety and fear and improving satisfaction in patients undergoing surgery using the Anesthesia- and Surgery-dependent Preoperative Anxiety Scale (ASPA)and the Visual Analog Scale for fear and the Short Assessment of Patient Satisfaction (SAPS) in patients who have received the structured educational intervention and those who have not.This is aparallel group, single blinded, randomised control trial in 56 consenting patients awaiting abdominal surgery under general anesthesia. The participants were randomized to the interventional and comparator groups and ASPA and VAS were administered. Participants in Group A were given the structured educational intervention to demystify anesthesia. The ASPA and VAS Scales were again administered by a blinded assessor to all participants. The student investigator administered SAPS on the third post-operative day or prior to discharge, whichever was earlier. There was significant reduction in median scores before and after intervention for anxiety (ASPA=2) and fear (VAS=20) in intervention group compared to the comparator group. (p value=&amp;#60;0.001). The median scores for patient satisfaction as measured by SAPS was also higher in the intervention group compared to the comparator group.(p value=0.042).There was a significant reduction of pre-operative fear and anxiety in the intervention group, while the patient satisfaction was also higher in the intervention group.

Risk and Reward: Public Perception of Gluteal Fat Grafting Safety.

This study aims to understand how sociodemographic factors influence perceptions of "Brazilian Butt Lift" (BBL), the cosmetic procedure with the highest reported mortality rate, among adult women. We also investigate whether education about risks changes willingness to receive this procedure. A Qualtrics© survey including education about BBL was administered on Amazon Mechanical Turk, with inclusion criteria of female sex. Survey data from 489 female participants were included. 78.1% of participants found the BBL mortality rate to be higher than expected. 70.1% of the original 177 willing or neutral participants became unwilling to undergo a BBL after education. Multivariate logistic regression indicated that individuals who were more willing to undergo BBL after education were individuals who have a diagnosis of body dysmorphic disorder (OR 60.5, p = 0.02) or have an acquaintance who received a BBL (OR 230.2, p < 0.01). Overall, survey participants were less willing to undergo BBL after learning its risks, indicating the critical role of patient education during informed consent. Additionally, individuals who are unhappy with their body shape, or who feel cultural or social pressure to attain a certain body shape, may accept higher levels of risk to improve their looks, suggesting patient motivation for the procedure may limit even the most effective informed consent process. In light of these findings, the surgical community may consider regulating the BBL procedure and improving safety using evidence-based risk reduction techniques. Ensuring that patients fully understand the risks associated with the BBL procedure is critical for both surgeon and patient. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

MP78-16 PROBABILITY OF SHUNTING FOR ISCHEMIC PRIAPISM BASED ON ETIOLOGY: ROLE FOR PATIENT EDUCATION

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II (MP78)1 Apr 2020MP78-16 PROBABILITY OF SHUNTING FOR ISCHEMIC PRIAPISM BASED ON ETIOLOGY: ROLE FOR PATIENT EDUCATION Ethan Matz*, Rahul Dutta, William Anderson, Kyle Scarberry, and Ryan Terlecki Ethan Matz*Ethan Matz* More articles by this author , Rahul DuttaRahul Dutta More articles by this author , William AndersonWilliam Anderson More articles by this author , Kyle ScarberryKyle Scarberry More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000964.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Refractory ischemic priapism (IP) often requires shunting. We hypothesize cases due to sickle cell (SC) disease or prescribed intracavernosal injection (ICI) may present earlier. We sought to characterize etiology and management for IP to determine likelihood of shunting based on patient parameters. METHODS: An IRB approved database of men seen for IP at our emergency department (ED) since January of 2011 was reviewed. Case data through December 2018 was evaluated for demographics and event details. For patients with recurrent IP, the most recent event was considered. Statistical associations were assessed with chi square and 2-sided t-test, and ROC analysis performed. RESULTS: In total, 110 men were included. Median overall time to presentation (TTP) to ED for IPP was 10 hours (1.5-196). Etiologies included: ICI (24%), idiopathic (16%), trazodone use (16%), SC trait or disease (15%), use of other psychotropic medications (15%). Other etiologies comprised an insignificant number of cases. Median TTP for SC and ICI were not significantly different with median of 6.5 (1.5-22) and 6 (3-120) hours, respectively (p = 0.42).Likelihood of undergoing shunt surgery was highest among cases due to psychotropic medication (59%), followed by trazodone (44%), idiopathic (38%), and ICI (8%). No SC patients required shunting.When compared directly to ICI, the odds of shunting were significantly higher for idiopathic (OR 7.6 CI 1.35, 42.89 p=0.02) or trazodone-related cases (OR 9.6 CI 1.72, 53.4 p=0.0098). ROC analysis yielded a sensitivity of 1 and specificity of 0.9231 for requiring distal shunt using 20 hours to presentation as a cutoff (AUC=0.9904, p<0.0001). No men presenting sooner had distal shunting, while 84% of those seen after were shunted.Grouping SC and ICI cases together (42 men, 38% of cohort), rate of shunting was 4.8% vs 44.1% in others combined (p < 0.001). Median TTP for SC and ICI combined was 6 (1.5-120) hours vs 17 (2-196) hours for others combined (p = 0.001) CONCLUSIONS: Cases of IP presenting to the ED are most commonly due to ICI, and these cases typically present earlier and have a lower incidence of shunting. IP secondary to trazodone or other oral medications presents later with a significantly higher chance of surgery. TTP beyond 20 hours is unlikely to avoid shunting. Analysis for SC and ICI cases suggest lower likelihood of surgery is due to earlier TTP, possibly secondary to better education regarding risk of IP. Prescribers offering trazodone or psychotropic medications associated with IP may need to better educate patients on risk. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1179-e1179 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Matz* More articles by this author Rahul Dutta More articles by this author William Anderson More articles by this author Kyle Scarberry More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement PDF downloadLoading ...

Phakic intraocular lenses: Recent advances and innovations

Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.

Missed nursing care in patient education: A qualitative study of different levels of nurses' perspectives.

To explore the different levels of nurses' perspectives in the delivery of patient education in postoperative care. Patient education is a frequently reported missed nursing care and can lead to postoperative complications and hospital readmissions. Descriptive exploratory qualitative study involving eight focus groups with 35 nurses was conducted in an acute hospital. Interviews were audio-recorded and transcribed verbatim. Data were thematically analysed. The analysis yielded three themes: 'Role ambiguity' between the levels of nurses concerning their roles in patient education; 'Not a priority nursing care' for patient education due to competing work demands and the missing workplace culture to teach; and 'Informal teaching' carried out conversationally during nursing care activities. This study augments the need to develop strategies, including informal teaching, to strengthen the delivery of patient education to avert missed nursing care. Nurse managers and educators are instrumental in establishing role clarity between ward nurses and specialty care nurses for patient education, recognizing patient education as the next nurse-sensitive indicator in reflecting quality of care, fostering positive workplace cultures to teach and providing ward nurses with trainings on communication strategies to provide effective informal teaching at bedside.

Vaccination Perception and Attitude among Undergraduate Medical and Teacher Education Students at Charles University, Prague, Czech Republic.

This cross-sectional comparative study was designed to evaluate different opinions and their impact on vaccine confidence, as perceived by students of two different university programs (medicine and teacher education), as both of them play important roles in patient education, with the latter major shaping the skills of critical thinking. Multi-item, opinion-based, paper-and-pencil anonymous questionnaires were distributed among students of medicine and teacher education. Data were sorted and divided into two sets to be analyzed using logistic regression. Out of a total of 722 respondents, 386 were medical students and 336 were teacher education students. While most respondents said they were not in favor of alternative medicine, a significantly higher number of alternative medicine followers were teacher education students. The positive vaccination perception rate (PVPR) is not dependent on the behavioral factors of student respondents (irrespective of their major) but is largely affected by their attitude to alternative medicine. Fear of infection dramatically increased the PVPR (up to 6.7 times) in those who were versus were not afraid of getting infected or were not quite sure whether to fear it. Fear of side effects of vaccination clearly decreased the PVPR, by at least 84%.

A Mobile App for Thyroid Cancer Patients Aiming to Enhance Their Quality of Life: Protocol for a Quasiexperimental Interventional Pilot Study.

BackgroundThyroid cancer (TC) is one of the fastest growing cancers all over the world. Differentiated thyroid cancer (DTC) is the most frequent subtype of TC. When appropriate treatment is given, the prognosis for the patient is generally excellent. Despite the generally good prognosis of thyroid carcinomas, the symptoms may range from emotional to physical discomfort, depending on the thyroid hormone status, which can severely affect the patient. Moreover, the diagnostic and therapeutic procedures that DTC patients have to undergo, such as thyroidectomy and radioiodine therapy, significantly affect their mental and physical well-being. Often, the physician only addresses the favorable prognosis of DTC compared with other cancer types and neglects to assess issues related to the quality of life (QoL) of the patient; this was the reason we decided to design a mobile app for DTC patients and their caregivers.ObjectiveThe aim of this study is to research the feasibility and applicability of an mHealth app tailored to DTC patients, as reflected in their QoL. The main features of the developed app offer access to useful information about thyroid cancer, diagnostic tests, and the appropriate therapy administered to DTC patients.MethodsBased on the existing literature, we created an up-to-date information platform regarding TC and especially DTC. In order to develop an effective app that can be implemented in current health care, we designed a section where the patient and physician can keep a medical record in an effort to enable access to such information at any time. Finally, we designed a user-friendly notification program, including pill prescription, follow-up tests, and doctor visit reminders in order to equally facilitate the lives of the patient and physician.ResultsHaving developed this mobile app, we aim to conduct a pilot quasiexperimental interventional trial. Our intention is to enroll at least 30 TC patients and assign them to intervention or control groups. Both groups will receive standard care for treating and monitoring TC, and the intervention group will also receive and use the DTC app. TC patients’ QoL will be assessed for both control and intervention groups in order to examine the effectiveness of the DTC app. QoL will be assessed through the QoL core questionnaire European Organisation for Research and Treatment of Cancer (EORTC) QLQ-THY34 in combination with the EORTC QLQ-C30 questionnaire through quantitative statistical analysis.ConclusionsThe use of mHealth apps can play a significant role in patient education, disease self-management, remote monitoring of patients, and QoL improvement. However, the main limitation of the majority of existing studies has been the lack of assessing their usefulness as well as the absence of specific instruments to carry out this assessment. In light of those considerations, we developed a mobile app tailored to the needs of DTC patients. Furthermore, we evaluated its contribution to the QoL of the patients by using the EORTC QLQ-THY34 questionnaire, an accurate and safe instrument for the evaluation of the QoL in TC patients, while supporting future planned endeavors in the field.International Registered Report Identifier (IRRID)PRR1-10.2196/13409

Tooth decay, sugar and obesity

Hazel Coey considers the dental nurse's role in patient education on diet and lifestyle choices

Patient Education and Medication Adherence among Hypertensives in a Tertiary Hospital, South Western Nigeria.

Hypertension is a global health issue among the adult population with high morbidity and mortality rates. Poor adherence to medication is associated with bad outcome of the disease and wastage of health resources. Therefore, this study aims to determine the role of patient education in medication adherence among hypertensives attending tertiary hospitals in Ekiti State, South Western, Nigeria. This is a descriptive cross-sectional study involving 420 participants attending Family Medicine Department Clinic of Federal Medical Centre (FMC), Ido-Ekiti. Relevant data were collected using semi-structured questionnaire. The mean age of respondents was 60.97 ± 11.28 years, and a slight female preponderance (male: female = 1:1.7 over male). Three hundred and forty nine (83.1%) were married, 273(65.0%) were from a monogamous family and 375(89.2%) had family sizes of more than 4. Ninety four (22.4%) had good knowledge about hypertension, and 257(61.2%) were adherent to their medication. Increased medication adherence proportion was observed as knowledge about hypertension improves. The odds of adherence to treatment among subjects with good knowledge is 2 times (OR = 2.320, 95%CI = 1.164, 4.626) higher than among subjects with poor knowledge. The proportion of respondents with good knowledge about hypertension is low. However, the adherence among them to medication is higher and statistically significant. Patient education about the disease and its treatment by primary care physicians can help to improve adherence to medication.

The effect of empowerment program based on the social cognitive theory on the activity of daily living in patients with chronic obstructive pulmonary disease.

OBJECTIVE AND AIM:Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases. The patient's fear and anxiety of shortness of breath and coughing during exercise may lead to a decrease in patients' daily activities. Therefore, the present study aimed to determine the effect of empowerment program based on the social cognitive theory (SCT) on the daily activity of patients with COPD.METHODS:This quasi-experimental study was performed on 70 patients with COPD referred to Kashani and Hajar centers in 2019. Samples were randomly divided into two groups of experimental and control. Data collection tools included demographic information questionnaire and activity of daily living questionnaire, specific for COPD, and a researcher-made questionnaire for measuring SCT constructs. For the experimental group, the training program consisted of four theoretical and practical sessions of 40 min/week. The data were collected at three time points, before, immediately and 3 months after the training are 3 time. The data were analyzed by SPSS software using descriptive and inferential statistics.RESULTS:The difference between the mean scores of behavioral ability, self-efficacy, and empowerment in the three stages was significant only in the experimental group (P < 0.001). The mean daily activity score of patients before, immediately, and 3 months after intervention showed a statistically significant difference between the two groups (52.46 ± 21.98, 63.36 ± 21.95, and 71.34 ± 19.02), respectively, in the intervention group, and (51.79 ± 19.29, 53.70 ± 19.28, and 53.82 ± 19.26), respectively, in the control group (P < 0.001).CONCLUSION:The results of this study showed that empowerment of patients through interventions based on SCT can increase the daily activity of patients with COPD. Because nurses play an important role in patient education and improvement, it is hoped that the findings of this study will be used as a strategy to increase the daily activity and ultimately improve the quality of life in these patients.

Patient and Provider Use of Electronic Care Plans Generated From Patient-Reported Outcomes.

To determine if patients and providers perceived improved care processes through the delivery of personalized, electronic care plans (CPs) generated from the Carevive Care Planning System™. 121 women (51 with gynecologic cancer from Billings Clinic and 70 with breast cancer from Moffit Cancer Center) completed electronic patient-reported outcome assessments and were given electronically generated, personalized supportive CPs tailored to individual symptoms and local healthcare resources. Quantitative instruments evaluated feasibility, usability, acceptability, and satisfaction of the CPs from patient and provider perspectives. Qualitative interviews described patient perceptions of the CPs. Patients with cancer reported the CPs to be useful. Most perceived that CPs improved team communication, helped find needed resources, and helped manage symptoms. Provider satisfaction was highest with the platform's ability to customize patient recommendations. Interviews indicated that patients with cancer used their CP as a resource, preferred delivery at treatment initiation, and valued information to manage symptoms. Nurses play an integral role in patient education and in discussing individual care. Tailored CPs can be used as a teaching tool that patients with cancer can refer to for self-care.

3009 The Role of Patient Education in the Success of Same Day Discharge after Minimally Invasive Gynecologic Surgery

Study Objective To assess the impact of preoperative education success and patient satisfaction for same day discharge after laparoscopic surgery. Design Prospective survey. Setting Academic tertiary referral center. Patients or Participants Twenty-four women undergoing minimally invasive hysterectomy or myomectomy with two surgeons between May 2018 and March 2019 Interventions Patients completed a questionnaire regarding same day surgery before and after an educational video. They also received a phone call four to six weeks postoperative regarding their postoperative experience. Measurements and Main Results Twenty-four patients were enrolled in the study although only twenty patients have currently undergone surgery. Among patients who completed the pre-education questionnaire 15 of 23 (65%) were agreeable to same day discharge and 8 of 23 (35%) were not agreeable. After watching the educational video and completing the post-education questionnaire 17 of 23 (74%) were agreeable to same day discharge and 6 of 23 (26%) were not agreeable. After the educational video among those who were originally not agreeable to same day discharge 3 of 8 (38%) changed to agreeable. Postoperatively 11 of 20 (55%) were discharged same day, 8 of 20 (40%) patients were discharged POD #1 and 1 of 20 (5%) discharged POD #3. Of 9 patients discharged same day, 5 (56%) were happy to be discharged, 3 (33%) were nervous but did well, 7 (78%) felt it was the right to do, 2 (22%) would not do it again and 1 (11%) was not happy to be discharged. Conclusion In this study, the majority of patients were agreeable to same day discharge after undergoing education, which also favorably changed the opinions of some who were not initially agreeable to same day discharge. Postoperatively, the majority of patients were happy to be discharged the same day and felt it was appropriate.

Methotrexate overdose in clinical practice

A folic-acid antagonist, methotrexate, is one of the most commonly prescribed drugs with its expanding use in clinical practice. The drug requires regular monitoring given its wide range of adverse effects including bone marrow suppression, hepatic or renal dysfunction, gastrointestinal distress, mucocutaneous damage, and neurotoxicity. The toxicity usually occurs rapidly and leads to severe neutropenia, sepsis, and advanced renal failure that are difficult to manage. This review is an update for the clinicians to understand the pharmacology, clinical features, laboratory evaluation, and treatment of patients with methotrexate overdose. High-quality literature of the past six decades was collected and reviewed in this article. Several landmark articles were reviewed using PubMed, EMBASE Ovid, and the Cochrane Library, that have important implications in current clinical practice. Methotrexate overdose has complex toxicokinetic and produces myriad clinical features mimicking conditions of lesser severity. Organ dysfunction related to bone marrow, kidney or central nervous system is lifethreatening. The management should focus on high-quality supportive care, antidotal therapy (folinic acid and carboxypeptidase- G2) and plasma alkalization. In accordance with the dictum "prevention is better than cure", the author emphasizes on the role of patient education, regular clinical observation, and laboratory monitoring for prompt recognition and diagnosis of methotrexate overdosing at the earliest stage.

1232 Factors Associated With Treatment Failure in Biopsy Proven Helicobacter pylori Infection in the Rio Grande Valley: A Retrospective Review of 3 Years Data

INTRODUCTION: The 2017 American College of Gastroenterology Clinical guidelines advocate clarithromycin triple therapy (CTT) as first line H. Pylori (HP) treatment. CTT consists of a 14-day course of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole. The national CTT eradication rate (ER) nears 80%. Many well-established factors affect treatment success including therapy duration, compliance, smoking, diabetes mellitus (DM), and local antibiotic resistance rates. Efficacy data on CTT in the Rio Grande Valley (RGV) has not been previously described. It is assumed that local resistance rates parallel those of our neighboring country due to proximity which may influence clinical practice. Aim is to determine the factors that affect biopsy-proven HP treatment failure. METHODS: A retrospective analysis of patients treated for HP in one RGV gastroenterology center between 2015 and 2018 was done. Eradication was defined by either a negative 13C Urea breath test or by a negative HP stool antigen test after treatment. ER was calculated for each regimen and compared against therapy duration, smoking, DM, health insurance status, and socioeconomic level; the latter determined by patient zip codes. We calculated raw ORs (95% CI) and adjusted with Cox and binary logistic regression. RESULTS: Of 544 patients, 71% (384) were females and 97% (526) were Hispanic. Nonsmokers were 79% (425) and diabetics were 32% (174). In total, 56% (305) received CTT and 44% (239) received quadruple therapy (QT) (ie., Tetracycline, metronidazole, bismuth, any PPI). ER was 66% for CTT and 62% for QT. Regarding both therapies, no treatment failure difference was found (P = 0.62) at 10 days, however, treatment failure decreased with 14-day therapy (P &lt; 0.001). Regarding health insurance, 84% (452) had private, 13% (72) had government-issued, and 3% (16) were self-pay. Cox regression found no differences in treatment type. Logistic regression found that females OR 2.25 (95% CI 1.4, 3.5, P &lt; 0.001), income &lt;$40,000/year OR 1.78 (95% CI: 1.1, 2.8, P = 0.013), and smoking OR 1.6 (95% CI 1.03, 2.6, P = 0.034) negatively affected eradication. CONCLUSION: HP therapy efficacy was suboptimal, however, 14-day therapy improved treatment failure. More females were affected with HP. Factors negatively affecting eradication were female gender, smoking, and income &lt;$40,000/year. Further studies are required to determine the role of patient education, HP local antibiotic resistance patterns, and physician practice on HP eradication.