Self-rated Improvement Research Articles

Back pain exercise therapy remodels human epigenetic profiles in buccal and human peripheral blood mononuclear cells: an exploratory study in young male participants.

With its high and increasing lifetime prevalence, back pain represents a contemporary challenge for patients and healthcare providers. Monitored exercise therapy is a commonly prescribed treatment to relieve pain and functional limitations. However, the benefits of exercise are often gradual, subtle, and evaluated by subjective self-reported scores. Back pain pathogenesis is interlinked with epigenetically mediated processes that modify gene expression without altering the DNA sequence. Therefore, we hypothesize that therapy effects can be objectively evaluated by measurable epigenetic histone posttranslational modifications and proteome expression. Because epigenetic modifications are dynamic and responsive to environmental exposure, lifestyle choices-such as physical activity-can alter epigenetic profiles, subsequent gene expression, and health traits. Instead of invasive sampling (e.g., muscle biopsy), we collect easily accessible buccal swabs and plasma. The plasma proteome provides a systemic understanding of a person's current health state and is an ideal snapshot of downstream, epigenetically regulated, changes upon therapy. This study investigates how molecular profiles evolve in response to standardized sport therapy and non-controlled lifestyle choices. We report that the therapy improves agility, attenuates back pain, and triggers healthier habits. We find that a subset of participants' histone methylation and acetylation profiles cluster samples according to their therapy status, before or after therapy. Integrating epigenetic reprogramming of both buccal cells and peripheral blood mononuclear cells (PBMCs) reveals that these concomitant changes are concordant with higher levels of self-rated back pain improvement and agility gain. Additionally, epigenetic changes correlate with changes in immune response plasma factors, reflecting their comparable ability to rate therapy effects at the molecular level. We also performed an exploratory analysis to confirm the usability of molecular profiles in (1) mapping lifestyle choices and (2) evaluating the distance of a given participant to an optimal health state. This pre-post cohort study highlights the potential of integrated molecular profiles to score therapy efficiency. Our findings reflect the complex interplay of an individual's background and lifestyle upon therapeutic exposure. Future studies are needed to provide mechanistic insights into back pain pathogenesis and lifestyle-based epigenetic reprogramming upon sport therapy intervention to maintain therapeutic effects in the long run.

Assessing and enhancing legal literacy in cancer care: A nationwide analysis of a training intervention for healthcare workers.

6 Background: We previously showed the significant extent to which legal barriers requiring appropriate navigation are encountered by patients with cancer and their caregivers. Despite this, structured training on legal topics is not offered for healthcare workers (HCW). We performed a nationwide analysis to ascertain baseline legal knowledge in HCWs, and investigate the impact of a training program aimed at improving knowledge gaps in legal, financial, and social services navigation. Methods: This is a retrospective analysis of HCWs participating in legal and financial training sessions from 2021-2023 led by attorneys from Triage Cancer, a nonprofit organization providing free education on legal issues that impact individuals with cancer. Pre-training surveys assessed baseline knowledge, comfort, and frequency with which HCWs counseled patients with cancer, on legal barriers. Impact of training was evaluated via surveys at 1 week and 6 months post-training. Survey scores were descriptively analyzed to summarize changes in knowledge compared to baseline. Paired t-tests evaluated self-rated competence before and after legal training. Results: The pre-intervention survey was completed by 2141 HCWs who were primarily White (63.9%), female (89.8%), and social workers (39.3%) during the most recent survey year. HCWs served patients of ≥20 cancer types including breast (33.4%), hematologic (12.7%), and lung (6.9%), and reported assisting patients with health insurance options (82.6%), financial navigation (53.3%), and disability insurance claims (46.5%). Only few HCWs reported feeling “comfortable” or “very comfortable” assisting patients with health insurance (22.1%), finances (17.2%), or disability insurance (9.5%). The 1-week and 6-month post-intervention surveys were completed by 852 and 211 individuals, respectively, and standardized questionnaire scores demonstrated improvement in tested knowledge from baseline (26% questions correct) to 1-week (67.5%) and 6-month (35%) follow-up. Self-rated improvement in HCW competence following intervention at 1-week (surveyed using 10-point scale, mean improvement 3.14, 95% CI [3.05, 3.25]) and 6-months (corrected mean improvement 2.52 [2.29, 2.75]) were significant (p < 0.001 for both). At 6-month follow-up, 90.5% of surveyed HCWs reported changing behavior or practice based on the training, noting the education facilitated patient care through navigation of health and disability insurance and appeals; reducing financial burden, stress, and anxiety; and improving quality of life (Likert scales ranged 3.17-3.41 with 3 for Agree and 4 for Strongly Agree). Conclusions: This study showcases the necessity, success, and practicality of implementing a legal training for HCWs who note high frequency of legal concerns from their patients, but lack the comfort or expertise in appropriately navigating these.

Going virtual: mixed methods evaluation of online versus in-person learning in the NIH mixed methods research training program retreat

BackgroundDespite the central role of mixed methods in health research, studies evaluating online methods training in the health sciences are nonexistent. The focused goal was to evaluate online training by comparing the self-rated skills of scholars who experienced an in-person retreat to scholars in an online retreat in specific domains of mixed methods research for the health sciences from 2015–2023.MethodsThe authors administered a scholar Mixed Methods Skills Self-Assessment instrument based on an educational competency scale that included domains on: “research questions,” “design/approach,” “sampling,” “analysis,” and “dissemination” to participants of the Mixed Methods Research Training Program for the Health Sciences (MMRTP). Self-ratings on confidence on domains were compared before and after retreat participation within cohorts who attended in person (n = 73) or online (n = 57) as well as comparing across in-person to online cohorts. Responses to open-ended questions about experiences with the retreat were analyzed.ResultsScholars in an interactive program to improve mixed methods skills reported significantly increased confidence in ability to define or explain concepts and in ability to apply the concepts to practical problems, whether the program was attended in-person or synchronously online. Scholars in the online retreat had self-rated skill improvements as good or better than scholars who participated in person. With the possible exception of networking, scholars found the online format was associated with advantages such as accessibility and reduced burden of travel and finding childcare. No differences in difficulty of learning concepts was described.ConclusionsKeeping in mind that the retreat is only one component of the MMRTP, this study provides evidence that mixed methods training online was associated with the same increases in self-rated skills as persons attending online and can be a key component to increasing the capacity for mixed methods research in the health sciences.

Dynamic Visual Acuity, Vestibulo-Ocular Reflex, and Visual Field in National Football League (NFL) Officiating: Physiology and Visualization Engineering for 3D Virtual On-Field Training.

The ability to make on-field, split-second decisions is critical for National Football League (NFL) game officials. Multiple principles in visual function are critical for accuracy and precision of these play calls, including foveation time and unobstructed line of sight, static visual acuity, dynamic visual acuity, vestibulo-ocular reflex, and sufficient visual field. Prior research has shown that a standardized curriculum in these neuro-ophthalmic principles have demonstrated validity and self-rated improvements in understanding, confidence, and likelihood of future utilization by NFL game officials to maximize visual performance during officiating. Virtual reality technology may also be able to help optimize understandings of specific neuro-ophthalmic principles and simulate real-life gameplay. Personal communication between authors and NFL officials and leadership have indicated that there is high interest in 3D virtual on-field training for NFL officiating. In this manuscript, we review the current and past research in this space regarding a neuro-ophthalmic curriculum for NFL officials. We then provide an overview our current visualization engineering process in taking real-life NFL gameplay 2D data and creating 3D environments for virtual reality gameplay training for football officials to practice plays that highlight neuro-ophthalmic principles. We then review in-depth the physiology behind these principles and discuss strategies to implement these principles into virtual reality for football officiating.

Results of a Pilot Virtual Microsurgery Course for Plastic Surgeons in LMICs.

The Plastic Surgery Foundation's Surgeons in Humanitarian Alliance for Reconstruction, Research and Education (SHARE) program seeks to expand surgical capacity worldwide through mentorship and training for local plastic surgeons. This study aims to define the need for microsurgery training among SHARE global fellows and describe results of a pilot course. Ten participants of the SHARE Virtual Microsurgical Skills Course were asked to complete an anonymous survey. Pre- and post-course response rates were 100% and 50.0%, respectively. There was a high incidence of microsurgical problems encountered in the clinical setting. Resource availability was varied, with high access to loupes (100%), yet limited access to microsurgery instruments (50%), medications (40%), operating microscope (20%), skilled nursing (0%) and appropriate peri-operative care settings (0%). Participants identified vessel preparation, instrument selection, and suture handling as priority learning objectives for a microsurgery skills course. Post-course satisfaction with learning objectives was high (60% "very good," 40% "excellent"). Participants reported high levels of improvement in suture handling (Likert 4.60±0.55), end-to-end anastomosis (4.40±0.55), instrument selection (4.20±0.45), vessel preparation (4.20±0.45), and economy of motion (4.20±0.45). This study demonstrates a high frequency of reconstructive problems encountered by global fellows yet low access to appropriate resources to perform microsurgical procedures. Initial results from a pilot virtual microsurgery course demonstrate very high satisfaction and high self-rated improvement in key microsurgical skills. The virtual course is an effective and accessible format for training surgeons in basic microsurgery skills and can be augmented by providing longitudinal opportunities for remote feedback.

PAVING the path to wellness: Lifestyle medicine to improve outcomes in breast cancer survivors.

e24053 Background: Lifestyle medicine emphasizes the role of 6 pillars in preventing chronic disease and improving health: nutrition, physical activity, sleep, stress management, social connection, and avoiding risky substance use. While most oncologists are aware of the role of these factors in reducing risk of recurrence and improving outcomes, there are numerous barriers to addressing these lifestyle factors during clinic visits. The PAVING the Path to Wellness for Breast Cancer Survivors program (PAVING) is a 12-week lifestyle medicine group intervention designed to deliver lifestyle medicine guidelines and practices to cancer survivors in a supportive setting. This study assessed short-term impacts of PAVING on behavioral and psychological outcomes. Methods: 101 women who completed PAVING since 2019 were invited to complete a survey. Inclusion criteria were primary oncology treatment at Massachusetts General Hospital, age > 22, diagnosis of invasive breast cancer (Stages I-III) within past 5 years, ECOG score 0-1, and English fluency. 16 enrolled in the study, 13 of whom fully completed the survey. The REDCap survey included the REAP-S and EHQ nutrition scales, IPAQ-SQ physical activity measure, COPE Inventory for coping skills, Psychological Wellbeing Scale, PROMIS-QOL scale, and ratings of the impact of the program on well-being. Statistical analysis was completed in SPSS. Results: The participants, N = 16, were women above the age of 22 with a primary diagnosis of breast cancer. Analysis found while ASCO recommends a minimum of 150 min/week of moderate-vigorous exercise, PAVING participants achieved a median of 255 min/week (120 to 420). A Spearman’s rank correlation found a significant positive relationship between fruit intake and self-rated dietary improvement due to PAVING, r(13) = .764, p = .002. A significant positive relationship also existed between PAVING-attributed emotional well-being improvements and general mental health, r(13) = .615, p = .025. Participants strongly agreed PAVING improved their confidence in their ability to cope (M = 1.9, SD = .76) and set goals (M = 1.92, SD = .862). Participants agreed their quality of life (QOL) improved since completing PAVING (M = 2, SD = .816); QOL ratings (M = 1.69, SD = .751) reflect very good-to-excellent QOL in the average PAVING participant. Conclusions: PAVING Participants report positive lifestyle practices, many attributed to the program, supporting further investigation of this program for patients with cancer. Mental well-being, QOL, and fruit intake were all positively correlated with self-rated growth resulting from PAVING. Participants exceeded guidelines for physical activity, which has been shown to reduce risk of breast cancer recurrence. PAVING is an effective lifestyle-medicine intervention for breast cancer survivors, and expansion will enable a broader population to improve outcomes following diagnosis and treatment.

Quality of life in patients treated for COVID-19-associated mucormycosis at a tertiary care hospital.

Coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) has emerged as a formidable infection in patients with COVID-19. The aggressive management of CAM affects quality of life (QOL); thus, this study was designed to assess the QOL in patients with CAM at a tertiary healthcare institution. This cross-sectional study of 57 patients with CAM was conducted over 6 months using a semi-structured standard questionnaire (the abbreviated World Health Organization Quality of Life questionnaire [WHO-BREF]) and a self-rated improvement (SRI) scale ranging from 0 to 9. Cut-off values of ≤52 and <7 were considered to indicate poor QOL and poor improvement, respectively. The correlations of QOL and SRI scores were evaluated using Spearman rho values. In total, 27 patients (47.4%; 95% confidence interval [CI], 34.9%-60.1%) and 26 patients (45.6%; 95% CI, 33.4%-58.4%) had poor QOL and poor SRI scores, respectively. The overall median (interquartile range) QOL score was 52 (41-63). Headache (adjusted B, -12.3), localized facial puffiness (adjusted B , -16.4), facial discoloration (adjusted B, -23.4), loosening of teeth (adjusted B, -18.7), and facial palsy (adjusted B, -38.5) wer e significantly associated with the QOL score in patients with CAM. Approximately 1 in 2 patients with CAM had poor QOL and poor improvement. Various CAM symptoms were associated with QOL in these patients. Early recognition is the key to optimal treatment, improved outcomes, and improved QOL in patients with CAM.

Rituximab as an adjunctive treatment for schizophrenia spectrum disorder or obsessive-compulsive disorder: Two open-label pilot studies on treatment-resistant patients

In this explorative study, we investigated if an adjunctive treatment with one single dose of the monoclonal antibody rituximab would improve symptoms and function in treatment-resistant patients with schizophrenia spectrum disorder (SSD, n = 9) or obsessive-compulsive disorder (OCD, n = 10), based on the inflammatory hypothesis for mental disorders. Patients were followed for one year. Disability was measured with the Personal and Social Performance score (PSP). At baseline, the mean PANSS score in the SSD group was 99 ± 32 and the mean Y-BOCS score in the OCD group was 27.5 ± 7. Mean PSP scores were 32 ± 10.2 and 42.5 ± 9.9 in the SSD and OCD groups, respectively. Seven had Paediatric Acute-Onset Neuropsychiatric Syndrome (PANS) in retrospect, and 3 SSD patients had schizo-obsessive subtype. 4/8 SSD patients showed a ≥40% reduction in PANSS at endpoint I week 20, however, 7/9 were similarly improved already at week 12. Among the OCD patients, 2/10 showed a ≥35% reduction in Y-BOCS at week 20. Disability was significantly improved only in the SSD group. The percentual decrease of PANSS scores in SSD patients was associated with the increase in immunoglobulin levels week 20 (n = 8: IgG r = 0.85, p = .007; IgA r = 0.79, p = .019; IgM r = 0.73, p = .038).Rituximab was generally well tolerated in these patients. Self-rated improvements since baseline were reported for psychic (p = .021), neurological (p = .059), and autonomic (p < .001) side effects (UKU-SERS-Pat side-effect scale). Anxiety was commonly reported by OCD patients, while an initial increase in psychotic symptoms was seen in a few SSD patients. An RCT is underway to evaluate rituximab in SSD.

Patient’s satisfaction in physiotherapy outpatient departments of Amhara regional comprehensive specialized hospitals, Ethiopia

BackgroundSatisfaction is basically the state of being gratified and act of fulfilling one's need or desires. Nowadays, evidence-based practice concept is prevailing and there has been a growing interest in the measurement of patient satisfaction in healthcare research. Patient satisfaction surveys provide several benefits for healthcare professionals. Assessing patient’s satisfaction with physiotherapy service could generate knowledge that can utilized for improving or maintaining quality service. Although a wide coverage and high emphasis givens to patient satisfaction studies in developed counties, there are few research’s done in Africa. This study aimed to assess satisfaction in physiotherapy service and identify predictors that affect satisfaction among patient treated in physiotherapy outpatient department.ObjectivesTo assess satisfaction in physiotherapy service and identify associated factors among patients in physiotherapy outpatient department in Amhara regional state comprehensive specialized hospitals.MethodInstitution based cross-sectional study was conducted among physiotherapy outpatients from April to June 2021, at three selected Comprehensive specialized hospitals. Data were collected by interviewing participants using semi-structured questionnaire. Patient satisfaction was determined by using Medrisk tool. Data were analyzed by using descriptive statistics and bivariate and multivariable logistic regression method were used to identify predictor factors.ResultA total of 409 participants with a response rate of 95% were included in this study. The overall satisfaction among physiotherapy outpatient attendee was 50.1% with 95% CI (46.2–55.7). Pain level (AOR = 5.59 95%CI (2.58–12.1), longitudinal continuity of care (AOR = 3.02 95%CI (1.46–6.62) and self-rated health improvement (AOR = 3.76, 95% CI (1.78–7.94) were significantly associated factors.ConclusionThe overall satisfaction in this study were found to be low in Amhara regional state comprehensive specialized hospitals. pain level, self-rated health improvement and longitudinal continuity of care were significantly associated factors.

The Effectiveness of a Mindfulness Training Program on Selected Psychological Indices and Sports Performance of Sub-Elite Squash Athletes.

Mindfulness Acceptance Commitment (MAC) programs have garnered much support in enhancing sport performance through present-moment focus and non-judgmental thoughts. Expanding on previous studies conducted in collegiate and professional settings, the current study investigates the application of MAC amongst national sub-elite athletes. The study was conducted utilizing a single case A-B design, with a total of six sub-elite Malaysian Squash athletes (2 males, 3 females; Mage = 15 ± 2 years) purposively sampled from the Malaysian national squash team. Participants underwent 6 weeks of baseline testing, 7 weeks of program intervention, and a retention test 4 weeks post-intervention. The intervention consisted of psycho-education, centering and cognitive defusion among other aspects as purported in MAC programs. Changes in proficiency of mindful practice was observed through the Mindfulness Awareness Acceptance Scale (MAAS), experiential avoidance through the Acceptance Action Questionnaire (AAQ-II), stress levels through the Perceived Stress Scale (PSS), and sport performance through both coach- and self-rated scales. Overall, visual analysis revealed improvements in MAAS levels (M = 1.15 ± 0.15), with no marked changes in AAQ-II (M = –0.002 ± 1.12) and PSS (M = 0.7 ± 0.93) after 7 weeks of intervention. Coach-rated sport performance also improved across the phases (M = 0.86 ± 0.93), with mixed responses for self-rated improvements (M = 0.01 ± 1.19). Overall, the benefits of MAC program were well-maintained past the post-intervention phase. The current study supported the implementation of an MAC program for sub-elite athletes in real-world settings.

Establishing thresholds for meaningful within-individual change using longitudinal item response theory

PurposeThresholds for meaningful within-individual change (MWIC) are useful for interpreting patient-reported outcome measures (PROM). Transition ratings (TR) have been recommended as anchors to establish MWIC. Traditional statistical methods for analyzing MWIC such as mean change analysis, receiver operating characteristic (ROC) analysis, and predictive modeling ignore problems of floor/ceiling effects and measurement error in the PROM scores and the TR item. We present a novel approach to MWIC estimation for multi-item scales using longitudinal item response theory (LIRT).MethodsA Graded Response LIRT model for baseline and follow-up PROM data was expanded to include a TR item measuring latent change. The LIRT threshold parameter for the TR established the MWIC threshold on the latent metric, from which the observed PROM score MWIC threshold was estimated. We compared the LIRT approach and traditional methods using an example data set with baseline and three follow-up assessments differing by magnitude of score improvement, variance of score improvement, and baseline-follow-up score correlation.ResultsThe LIRT model provided good fit to the data. LIRT estimates of observed PROM MWIC varied between 3 and 4 points score improvement. In contrast, results from traditional methods varied from 2 to 10 points—strongly associated with proportion of self-rated improvement. Best agreement between methods was seen when approximately 50% rated their health as improved.ConclusionResults from traditional analyses of anchor-based MWIC are impacted by study conditions. LIRT constitutes a promising and more robust analytic approach to identifying thresholds for MWIC.

Alzheimer’s Disease Risk Reduction: An Evidence-Based, Multi-Component Lifestyle Program, Pre- &amp; Intra-Covid-19

As dementia is widely under-detected, a predictive model using electronic health records (EHR) could provide a method for early screening to implement preventive strategies. There is limited research on using EHR to identify persons with Alzheimer’s disease (AD) and related dementias (RD). In a data-driven approach, we used all ICD-9 diagnosis and CPT procedure codes from statewide inpatient, ambulatory surgery, and Medicare records, in addition to age at baseline and gender, to detect AD/RD from the Cache County Study on Memory in Aging (1995–2009). After removing participants diagnosed with dementia at baseline (n=335), 3882 (82%) Cache County Study participants could be linked to inpatient, ambulatory surgery, and/or Medicare EHR records; 484 (12.5%) of these 3882 had incident all-cause dementia, with 308 (7.9%) having AD/AD comorbid with RD; and 176 (4.5%) having RD without AD. We removed participant’s ICD-9 codes occurring after first AD/RD diagnoses. EHR features (~2000) along with gold-standard diagnoses as class labels were then used to train and detect AD and/or RD using a Gradient Boosting Trees machine learning algorithm. Models evaluated with nested cross-validation yielded AUCs of 0.70 for all-cause dementia, 0.69 for AD/AD comorbid with RD, and 0.67 for RD without AD. Key factors detecting AD/RD included age at enrollment, cardiovascular, metabolic, and kidney disease, and sleep disturbances, with feature importance varying by record type and time frame prior to dementia onset. Our findings suggest that a patient’s health status up to 12 years prior may be useful in identifying individuals at-risk for dementia development.

Efficacy and safety comparison between 1927\xa0nm thulium laser and 2940\xa0nm Er:YAG laser in the treatment of facial atrophic acne scarring: a prospective, simultaneous spilt-face clinical trial

Acne scarring is a common disfiguring complication of acne, and fractional lasers are widely applied in improving it. This study is to compare the efficacy and safety of fractional non-ablative 1927 nm thulium laser (FTL) and fractional ablative 2940 nm Er:YAG laser (FEL) in the treatment of acne scarring. Subjects with moderate or severe atrophic facial acne scarring received 3 sessions of FTL on the left side of face and FEL on the right side of face at an average interval of 4–6 weeks. Major assessments included Goodman&Baron quantitative global scarring grading system (GBS), self-rated improvement and satisfaction score. Twenty-seven subjects completed the study; for FTL side, average GBS decreased from 11.15 ± 5.04 at baseline to 7.07 ± 4.87 with an improvement percent of 36.54%; for FEL side, average GBS decreased from 10.81 ± 4.46 to 7.00 ± 4.07 with an improvement percent of 35.27%. Adverse effects include transient pain, erythema, edema, and increase of acne. No significant difference was found between two lasers. Both FTL and FEL improved atrophic acne scarring and were well-tolerated. Increase of acne during laser treatment may have a negative impact on efficacy. Trial registration number was NCT04813419 and date of registration was 19th, March, 2021, retrospectively registered.

A structured Endoscopic Ultrasound training program in Germany improves knowledge and competence.

Limited evidence on how to organize pre-patient training in Endoscopic Ultrasound (EUS) and how to evaluate its effect on knowledge and skills are available. The aim of our study was to assess the impact of a structured multi-site training program on EUS competence in Germany. In a prospective study design, evaluation of 64 trainees was conducted during four three-day training courses with equal curricula at three sites. Participants completed a structured pre- and post-test questionnaire consisting of 4 items to evaluate the relevance and acceptance of the training components (theoretical teaching, video sessions, live demonstration, hands-on experience) on a 5-point Likert scale, as well as a Likert scale to judge the self-rated improvement in EUS competence. To assess knowledge, 12 multiple choice (MC) questions had to be answered by all participants in a pre- and a post-test design. Also differences between beginners and advanced learners were analysed. Overall evaluation on acceptance received above-average results with a median of 4 or 5 (IQR 1-2) on Likert scale (1=completely disagree, 5=completely agree). In the post-test self-rated EUS skills improved from 4 to 2 on the Likert scale (IQR=1, p=0.001, 1=excellent EUS skills, 5=no EUS skills). Results of the MC-test of all trainees showed significant improvement in theoretical knowledge from 7.9±1.9 to 8.8±1.9 points (mean±SD, p=0.001). Our study provides arguments for the usefulness of a structured EUS training program resulting in a positive acceptance and high self-rated EUS competence by the participants and significant improvements in knowledge.

Improving drug prescription in general practice using a novel quality improvement model

Introduction Quality improvement (QI) clusters have been established in many countries to improve healthcare using the Breakthrough Series’ collaboration model. We investigated the effect of a novel QI approach based on this model of performed medication reviews and drug prescription in a Norwegian municipality. Methods All 27 General Practitioners (GPs) in a mid-size Norwegian municipality were invited to join the intervention, consisting of three peer group meetings during a period of 7–8 months. Participants learned practical QI skills by planning and following up QI projects within drug prescription practice. Evaluation forms were used to assess participants’ self-rated improvement, reported medication review reimbursement codes (MRRCs) were used as a process measure, and defined daily doses (DDDs) of potentially inappropriate drugs (PIDs) dispensed to patients aged 65 years or older were used as outcome measures. Results Of the invited GPs, 25 completed the intervention. Of these, 76% self-reported improved QI skills and 67% reported improved drug prescription practices. Statistical process control revealed a non-random increase in the number of MRRCs lasting at least 7 months after intervention end. Compared with national average data, we found a significant reduction in dispensed DDDs in the intervention municipality for benzodiazepine derivates, benzodiazepine-related drugs, drugs for urinary frequency and incontinence and non-steroid anti-inflammatory and antirheumatic medications. Conclusion Intervention increased the frequency of medication reviews, resulting in fewer potentially inappropriate prescriptions. Moreover, there was self-reported improvement in QI skills in general, which may affect other practice areas as well. Intervention required relatively little absence from clinical practice compared with more traditional QI interventions and could, therefore, be easier to implement. KEY POINT The current study investigated to what extent a novel model based on the Breakthrough Series’ collaborative model affects GP improvement skills in general practice and changes their drug prescription. KEY FINDINGS Most participants reported better improvement skills and improved prescription practice. The number of dispensed potentially inappropriate drugs decreased significantly in the intervention municipality compared with the national average. The model seemed to lead to sustained changes after the end of the intervention.

Building Emotional Intelligence for Student Success: A Pilot Study

Purpose Nationwide, upward trends exist in student issues with anxiety, stress, depression, and lowered classroom performance. As emotional awareness and emotional regulation skills are typically not addressed in professional discipline-specific courses, students experience challenges in their academic performance. This pilot research explored the effect of brief targeted classroom practices within an empowerment-based framework on domains of emotional intelligence. Method Twenty-two students in an undergraduate speech-language pathology class received a 13-week, biweekly, 15-min session of empowerment-based worksheet exercises to develop increased self-esteem, emotional awareness and regulation, and communication. Assessments of self-esteem, emotional intelligence, communication competence, and communication apprehension were conducted using validated scales, namely, the Rosenberg Self-Esteem Scale ( Rosenberg, 1965 ), the Quick Emotional Intelligence Self-Assessment ( Mohapel, 2015 ), the Self-Perceived Communication Competence Scale ( McCroskey &amp; McCroskey, 2013 ), and the Personal Report of Communication Apprehension ( McCroskey, 1982 ), respectively. Midsemester and semester-end student reflections were collected. Results Paired t tests were significant in self-esteem and emotional quotient, including subdomains of emotional awareness, emotional management, social emotional awareness, and relational management. Significance was noted in communication competence in the subdomains of dyad interaction, stranger interaction, and acquaintance. Students' reflection showed significant improvement in empowerment and self-rated improvements in confidence, communication, connections with peers, and trust with instructor. Conclusion Preliminary evidence demonstrates positive outcomes with integration of intentional classroom exercises to build emotional intelligence (including emotional awareness and regulation), self-esteem, and communication. This empowerment model may assist faculty in developing effective pedagogical strategies to build students' self-resiliency.

Effectiveness of a Comprehensive Health Literacy Consultation Skills Training for Undergraduate Medical Students: A Randomized Controlled Trial.

Comprehensible communication by itself is not sufficient to overcome health literacy related problems. Future doctors need a larger scope of capacities in order to strengthen a patient’s autonomy, participation, and self-management abilities. To date, such comprehensive training-interventions are rarely embedded in curricula, nor systematically evaluated. We assessed whether comprehensive training increased these health literacy competencies, in a randomized controlled trial (RCT), with a waiting list condition. Participants were international undergraduate medical students of a Dutch medical faculty (intervention: 39; control: 40). The 11-h-training-intervention encompassed a health literacy lecture and five interactive small-group sessions to practise gathering information and providing comprehensible information, shared decision-making, and enabling of self-management using role-play and videotaped conversations. We assessed self-reported competencies (knowledge and awareness of health literacy, attitude, self-efficacy, and ability to use patient-centred communication techniques) at baseline, after a five and ten-week follow-up. We compared students’ competencies using multi-level analysis, adjusted for baseline. As validation, we evaluated demonstrated skills in videotaped consultations for a subsample. The group of students who received the training intervention reported significantly greater health literacy competencies, which persisted up to five weeks afterwards. Increase was greatest for providing comprehensible information (B: 1.50; 95% confidence interval, CI 1.15 to 1.84), shared decision-making (B: 1.08; 95% CI 0.60 to 1.55), and self-management (B: 1.21; 95% CI 0.61 to 1.80). Effects regarding demonstrated skills confirmed self-rated competency improvement. This training enhanced a larger scope of health literacy competences and was well received by medical students. Implementation and further evaluation of this training in education and clinical practice can support sustainable health literacy capacity building of future doctors and contribute to better patient empowerment and outcomes of consultations.

An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation.

BackgroundWhiplash is a health and economic burden worldwide. Contributing to this burden is poor guideline adherence and variable management by health care professionals (HCPs). Web-based tools that facilitate clinical pathways of care are an innovative solution to improve management.ObjectiveThe study aimed to develop, implement, and evaluate a Web-based tool to support whiplash management following a robust process.MethodsThis study followed the first 3 processes of a research translation framework (idea generation, feasibility, and efficacy) to inform the development, implementation, and evaluation of a website that supports HCPs in whiplash management. Development followed the idea generation and feasibility processes to inform the content, design, features, and functionality of the website. This involved stakeholder (eg, industry partners, website developers, and HCPs) consultations through face-to-face meetings, surveys, and focus group discussions. Implementation followed the feasibility process to determine the practicality of the website for clinical use and the most effective strategy to promote wider uptake. Implementation strategies included classroom education, educational meetings, educational outreach, reminders, and direct phone contact. The analysis of website use and practicality of implementation involved collection of website metrics. Evaluation followed the feasibility and efficacy processes to investigate the acceptability and extent to which the website assisted HCPs in gaining knowledge about whiplash management. Surveys were conducted among student, primary, and specialist HCPs to explore ease of access, use, and satisfaction with the website, as well as self-rated improvements in knowledge of risk assessment, management, and communication between HCPs. Website logs of specialist management decisions (eg, shared care, specialist care, and referred care) were also obtained to determine actual practice.ResultsThe development process delivered an interactive, user-friendly, and acceptable website, My Whiplash Navigator, tailored to the needs of HCPs. A total of 260 registrations were recorded from June 2016 to March 2018, including 175 student, 65 primary, and 20 specialist HCPs. The most effective implementation strategies were classroom education for students (81% uptake, 175/215) and educational meetings for primary HCPs (43% uptake, 47/110). Popular pages visited included advice and exercises and risk assessment. Most HCPs agreed that their knowledge about risk management (79/97, 81%) and exercises (85/97, 88%) improved. The specialists’ most common management decision was shared care, an improvement from a previous cohort. Areas to improve were navigation and access to outcome measures.ConclusionsA robust process resulted in an innovative, interactive, user-friendly, and acceptable website, the My Whiplash Navigator. Implementation with HCPs was best achieved through classroom education and educational meetings. Evaluation of the website showed improved knowledge and practice to be more consistent with a risk-based clinical care pathway for whiplash. The positive results provide sufficient evidence to scale implementation nationally and involve other target markets such as people with whiplash, insurers, and insurance regulators.

Design, implementation, and evaluation of educational workshop on management of Parkinson's and Alzheimer's disease patients for third-year pharmacy students

Background and purposeIncreasing aging populations in the United States means an increasing number of persons with Parkinson's disease (PD) and Alzheimer's disease (AD) requiring competent pharmaceutical care. The workshop was designed and implemented to integrate pharmacology and therapeutics in management of PD and AD, and evaluate efficacy of students’ high-cognitive thinking, and self-rated knowledge improvement, confidence, and interest in the subject. Education activity and settingThird-year pharmacy students participated in a three-hour workshop comprised of a foundational knowledge quiz from pathophysiology, pharmacology and therapeutics, performance on high-cognitive thinking in clinical scenarios, and hands-on activities in pharmacology and therapeutics related to PD and AD care. Pre- and post-education, Likert-style questions assessed students’ self-rated confidence, interest and knowledge improvement. Descriptive statistics, paired t-test, and chi-square analyses were performed using Stata 10.1 statistical software (College Station, TX: Stata Corp LP). FindingsEighty-four of 93 students (90.3%) completed all workshop activities. Students’ ability to apply knowledge in complex case mediation problems was not associated with performance on baseline quiz questions (Pearson r: 0.03–0.17). Completion of structured, hands-on active learning integrating clinical pharmacology and therapeutics had measurable immediate benefit solving high-cognitive order problems in clinical scenarios (p < 0.05). Hands-on activity also increased mean self-rated confidence (p < 0.01). Students (85.6%) reported knowledge improved “somewhat” or “very much” after the activity. Mean scores before and after hands-on activity were not associated with interest in the topic. SummaryStructured, hands-on workshops can aid comprehension of taught/lectured material and its application to PD and AD, and is a way for instructors to close gaps between didactic lecture and clinical practice.

A simplified ultrasonography-guided approach for neurotoxin injection into the obliquus capitis inferior muscle in spasmodic torticollis

The obliquus capitis inferior (OCI) muscle may be crucially involved in generating the tremulous component of spasmodic torticollis. This study was undertaken to evaluate the efficacy of a simplified ultrasonography-guided approach of botulinum neurotoxin injection into the OCI in the management of spasmodic torticollis. Here, a novel off-plane technique of ultrasonography-guided botulinum neurotoxin injection into the OCI is demonstrated on video. We investigated its effect in five patients with tremulous torticollis with only partial response to conventional injection technique not injecting OCI. On ultrasonography the OCI and its neighboring structures (greater occipital nerve, vertebrae C1 and C2) were clearly displayed. Unlike the previously proposed approach with axial OCI imaging and in-plane medio-lateral needle insertion, we applied here an off-plane needle insertion technique. With this, the ultrasonography guidance of needle insertion was easier using the sagittal imaging plane rather than the axial plane. Compared to botulinum neurotoxin injection into more superficial neck muscles only, additional ultrasonography-guided botulinum neurotoxin injection into the OCI led to a higher benefit (self-rated improvement of cervical dystonia, p=0.026, Mann-Whitney test), especially of the tremulous component (p=0.007), even though the total botulinum neurotoxin dose was not changed. We conclude that selected patients with tremulous torticollis may benefit from botulinum neurotoxin injection into the OCI.