Supplemental Educational Materials Research Articles

Creation of an advancing adult and pediatric neurology resident EEG curriculum

BackgroundThe Accreditation Council for Graduate Medical Education (ACGME) milestones state that neurology residents should be able to “interpret common EEG abnormalities, recognize normal EEG variants, and create a report.” Yet, recent studies have shown that only 43% of neurology residents express confidence in interpreting EEG without supervision and can recognize less than half of normal and abnormal EEG patterns. Our objective was to create a curriculum to improve both confidence and competence in reading EEGs. MethodsAt Vanderbilt University Medical Center (VUMC), adult and pediatric neurology residents have required EEG rotations in their first and second years of neurology residency and can choose an EEG elective in their third year. A curriculum consisting of specific learning objectives, self-directed modules, EEG lectures, epilepsy-related conferences, supplemental educational material, and tests was created for each of the three years of training. ResultsSince the implementation of an EEG curriculum at VUMC from September 2019 until November 2022, 12 adult and 21 pediatric neurology residents completed pre- and post-rotation tests. Among the 33 residents, there was a statistically significant improvement in post-rotation test scores, with a mean score improvement of 17% (60.0 ± 12.9 to 77.9 ± 11.8, n = 33, p < 0.0001). When differentiated by training, the mean improvement of 18.8% in the adult cohort was slightly higher than in the pediatric cohort, 17.3%, though it was not significantly different. Overall improvement was significantly increased in the junior resident cohort with a 22.6% improvement in contrast to 11.5% in the senior resident cohort (p = 0.0097 by Student’s t-test, n = 14 junior residents and 15 senior residents). DiscussionWith the creation of an EEG curriculum specific to each year of neurology residency, adult and pediatric neurology residents demonstrated a statistically significant mean improvement between pre- and post-rotation test scores. The improvement was significantly higher in junior residents in contrast to senior residents. Our structured and comprehensive EEG curriculum objectively improved EEG knowledge in all neurology residents at our institution. The findings may suggest a model which other neurology training programs may consider for the implementation of a similar curriculum to both standardize and address gaps in resident EEG education.

Evaluation of YouTube videos as a patient education source for novel surgical techniques in thyroid surgery.

Patients and physicians are increasingly utilizing online video sharing sites such as YouTube for obtaining and disseminating health-related information in multimedia format; however, due to its free, open-access platform, YouTube videos fall short in providing validated, up-to-date medical information, and may even convey unintended messages to patients who are seeking additional information on surgeries. We evaluated the relevance, reliability, and quality of YouTube videos on novel surgical techniques in thyroid surgery. The top 50 indexed YouTube videos for the queries, "robotic thyroid surgery" and "transoral thyroid surgery", were assessed by two independent reviewers for video quality and reliability for patient understanding. Videos were scored using Global Quality Score (GQS), a scale for video quality, and DISCERN Scoring, a questionnaire for reliability and quality measures of information presented. The mean ± standard deviation (SD) duration of the videos (n=50) was 8.1±3.7 minutes. Total views were 261,440 and the mean ± SD time since upload was 3.6±2.6 years. The median and interquartile range of video power index (VPI) was 1.9 (0.5-3.7), GQS was 3.0 (2.0-4.0), and DISCERN score was 2.8 (2.3-3.2). Most videos were uploaded by physicians (75.8%) and the highest number of videos (63.6%) uploaded were from the United States (US). Videos with higher quality and reliability scores were uploaded by academic professionals, and included videos of physicians who described procedural information, perioperative instructions, and possible postoperative complications (P<0.05). Adequate medical information on the procedure and discussion of complications in YouTube videos were independent predictors of advanced educational quality and reliability. Clinical information on new surgical techniques such as transoral and robotic thyroid surgeries in YouTube videos scored low on quality and reliability as a source of patient education. Physicians should provide supplemental educational material online and offline to aid patient understanding of novel procedures.

The East Side Table Make-at-Home Meal-Kit Program is feasible and acceptable: A pilot study

Drawing from marketing literature, shopper solutions and food bundles (that group items to be used together) can promote purchase intention, efficacy, and related outcomes. Similarly, meal kits boxes (food bundles with step-by-step instructions to prepare home-cooked meals) have potential to be an accessible intervention to facilitate healthy, at-home food preparation and intake. This manuscript describes the feasibility, acceptability, and preliminary outcomes of a community-designed and -led program promoting healthy food skills, accessibility, and intake through meal kits. This pilot study was designed using community-based participatory research principles and 60 participants enrolled in the study. Participating families received a free meal kit weekly during the 10-week program. Meal-kit boxes also included language-appropriate recipe cards, step-by-step instructions, and supplemental educational material including links to videos with related food preparation tips and fact sheets about the meal. Data were collected at baseline, post-program, and follow-up (3 months post-program). Specifically, validated measures were used to assess food insecurity, food availability, cooking preparation techniques, self-efficacy, and fruit/vegetable intake. Process data were also collected. Descriptive statistics, paired t-tests, and Wilcoxon sign-ranked tests were used to describe data and evaluate outcomes. Content analysis was used to code open-ended survey responses into categories. Study findings indicated retention rates were high (≥90%); 83% made eight or more meal kits. At post-program, significant increases were observed in cooking/meal preparation self-efficacy, cooking techniques, and healthy food availability. At follow-up, only healthy food availability remained significantly higher. Findings suggest that meal-kit programs are feasible and acceptable, and there is a potential for these programs to influence factors important to increasing healthy home-cooked meals and dietary intake. Future research should use more rigorous designs and explore meal-kit dosage.

Just Because (Most) Hospitals Are Publishing Charges Does Not Mean Prices Are More Transparent.

BackgroundThe Centers for Medicare and Medicaid Services (CMS) recently mandated that all hospitals publish their charge description masters (CDMs) online, in a machine-readable format, by January 1, 2019. In addition, CMS recommended that CDM data be made available in a manner that was consumer friendly and accessible to patients.ObjectiveThis study aimed to (1) examine all hospitals across the state of Pennsylvania to understand policy compliance and (2) use established metrics to measure accessibility and consumer friendliness of posted CDM data.MethodsA cross-sectional analysis was conducted to quantify hospital website compliance with the recent CMS policies requiring hospitals to publish their CDM. Data were collected from all Pennsylvania hospital websites. Consumer friendliness was assessed based on searchability, number of website clicks to data, and supplemental educational materials accompanying CDMs such as videos or text.ResultsMost hospitals (189/234, 80.1%) were compliant, but significant variation in data presentation was observed. The mean number of website clicks to the CDM was 3.7 (SD 1.3; range: 1-8). A total of 23.1% of compliant hospitals provided no supplemental educational material with their CDM.ConclusionsAlthough disclosure of charges has improved, the data may not be sufficient to meaningfully influence patient decision making.

Comparison of Traditional and Web-Based Medical Student Teaching by Radiology Residents

PurposeWeb-based learning tools are increasingly available for use and have been described in the pedagogical literature. However, rigorous comparisons between traditional learning methods and newer collaborative online tools have not been performed. Herein, we describe a web-based curriculum hosted on the collaborative Radiopaedia.org website. This curriculum was compared with traditional learning tools in a randomized, controlled fashion. Materials and MethodsMedical students rotating through inpatient pediatrics were offered a 1-hour case-based learning session led by radiology residents. Students were randomized to receive online (Radiopaedia.org) versus traditional supplemental educational materials (reading material covering the same content) for review before the in-class session. A 15-point questionnaire was administered at two different points during the rotation: at the beginning of the clinical rotation and at the end of the classroom session. ResultsFifty-eight students were approached for enrollment and a total of 47 (81%) consented to participation and completed the study requirements. Students who completed the web-based module had higher mean knowledge scores (74%) compared with those who were provided the traditional learning material (68%) (P = .06). Specifically, they demonstrated increased knowledge of the ACR Appropriateness Criteria and the “silhouette sign.” ConclusionsA randomized, controlled, nonblinded evaluation of a novel radiology curriculum intervention hosted on Radiopaedia.org demonstrates improved test scores compared with traditional teaching methods.

Establishing Pulmonary and Critical Care Medicine in China: 2016 Report on Implementation and Government Recognition: Joint Statement of the Chinese Association of Chest Physicians and the American College of Chest Physicians

This article provides an update on progress toward establishing pulmonary and critical care medicine (PCCM) fellowship training as one of the first four subspecialties to be recognized and supported by the Chinese government. Designed and implemented throughout 2013 and 2014 by a collaborative effort of the Chinese Thoracic Society (CTS) and the American College of Chest Physicians (CHEST), 12 leading Chinese hospitals enrolled a total of 64 fellows into standardized PCCM training programs with common curricula, educational activities, and assessment measures. Supplemental educational materials, online assessment tools, and institutional site visits designed to evaluate and provide feedback on the programs' progress are being provided by CHEST. As a result of this initial progress, the Chinese government, through the Chinese Medical Doctor's Association, endorsed the concept of subspecialty fellowship training in China, with PCCM as one of the four pilot subspecialties to be operationalized nationwide in 2016, followed by implementation across other subspecialties by 2020. This article also reflects on the achievements of the training sites and the challenges they face and outlines plans to enhance and expand PCCM training and practice in China.

Extension and Community Resilience: Improving Community Disaster Preparedness Using Online Resources

As Extension agents work to improve the quality of life in their communities, they must increase the capacity to respond to disasters, especially in high risk areas (which includes most of coastal Florida). Community Resiliency is a community’s ability to quickly recover from adversity and it can be enhanced through planning and adaptation using easily available online resources. This 4-page fact sheet describes supplemental educational materials that can be added to community resiliency training, offering background information and specific tools for disaster preparation. Written by Emily Ott, Paul Monaghan, and Timothy Fogarty, and published by the UF Department of Agricultural Education and Communication, October 2014. (UF/IFAS photo by Milt Putnam)

Recommendations for Implementation of Community Consultation and Public Disclosure Under the Food and Drug Administration’s “Exception From Informed Consent Requirements for Emergency Research”

In addition to the usual requirement of appropriate study design and institutional review board (IRB) approval, research studies performed under the Food and Drug Administration (FDA) and Department of Health and Human Services regulations regarding “Informed Consent and Waiver of Informed Consent Requirements in Certain Emergency Research” (21 CFR §50.24)1 require community consultation and public disclosure. This special report discusses the general issues related to consent in emergency circumstances and provides a template to help IRBs implement community consultation and public disclosure appropriately. A portion of the material in this special report was presented as testimony by Dr Halperin on October 11, 2006, at the FDA’s public hearing on “Draft Guidance for Institutional Review Boards, Clinical Investigators, and Sponsors: Exception From Informed Consent Requirements for Emergency Research.” More than 300 000 Americans die each year due to catastrophic medical and surgical emergencies.2,3 New interventions based on sound research could save lives. These research studies must be done within an ethical framework that traditionally includes obtaining prospective informed consent from the research subject. The ethical framework for the conduct of human research began with the development of the Nuremberg Code4,5 in 1949. This code states that (1) informed consent of volunteers must be obtained without coercion of any form, (2) human experiments should be based on prior animal experiments, (3) the anticipated scientific results should justify the experiment, (4) only qualified scientists should conduct medical research, (5) physical and mental suffering should be avoided, and (6) no expectation of death or disabling injury should be expected from the research study. The Declaration of Helsinki6 was issued in 1964 and defines rules for clinical research. It repeats the ethical concerns stated in the Nuremberg Code but also gives a provision for enrolling certain patients in clinical research without …

Community Pharmacist Practices in Hypertension Management

Objective: To determine the current practices of community pharmacists in the management of hypertension. Methods: This was a cross-sectional, observational study of pharmacist practice using unannounced standardized patients (SPs) with hypertension visiting a random stratified sample of 101 community pharmacies in Edmonton, Alberta. Consent was not obtained from pharmacists. Results: Knowledge of current blood pressure guidelines and target values: Of the 101 community pharmacists who were visited by the SPs, 69% offered a general blood pressure target value (&lt;120/80 mm Hg); only 7% stated the correct target blood pressure value for the SPs' particular scenario (&lt;140/90 mm Hg). Only 14% requested enough patient history to properly determine target blood pressure. Review of medical history: Few pharmacists questioned the SPs about their medical history (7%), medication profile (16%), family history of cardiovascular disease (19%), previous elevated blood pressure readings (20%), or previous diagnosis of hypertension (22%). Accuracy/confirmation of blood pressure reading: 53% of pharmacists inquired about the conditions under which the blood pressure reading had been taken; 39% of pharmacists offered to retake the patient's blood pressure. Patient education: Pharmacists discussed how hypertension is diagnosed (76%), what hypertension is (46%), how to take a blood pressure reading properly (46%), and the impact of lifestyle measures on blood pressure (60%); they also gave supplemental educational materials (29%). Referral: 83% of pharmacists advised the SPs to make an appointment to see a physician. Conclusions: Pharmacists took reasonable steps to determine the accuracy of the blood pressure measurement, explain the diagnosis of hypertension, and refer to a physician. Major deficiencies were observed in assessment of target blood pressure and review of medical history. Pharmacists, alone or in collaboration with other health professionals, are urgently needed to play a major role in identifying, screening, and managing individuals with hypertension. Can Pharm J 2006;139(5):38–44.

Family visitation

After reading Protocols for Practice Update 2003 in the October issue, my brain would not let go of the subject matter. The adult critical care unit I work in has very liberal visiting policies. This fact has led us to consider limiting our access, not increasing it.Critical care nurses are increasingly looked at as the coordinator of care as well as the provider of direct patient care. When an RN is charged with the care of 2 critically ill adults, it is near impossible to meet your patients’ needs, when you are constantly bombarded with family questions, comments, chit-chat, and family psychosocial needs. Most nurses have seen that patients and families don’t always want 24-hour access. Nurses who are new to the profession need to concentrate on patient assessment and what they are doing for the patient, and these frequent interruptions lead to more errors and high frustration. I know this is one of the reasons many nurses have left the bedside. A nurse can not be all things to all involved and still meet his or her patient’s needs first.I would hope that as we move forward with research in this area, we look seriously at not only patient and family needs, but to the bedside nurse and how we can best support their mission. Heaven knows we need to mentor and support the nurses we have left!Nurses do indeed have many demands on their time during their work. A proactive approach to meeting family needs will reduce the workload over the long haul. There are a few interventions that nurses can use proactively to prevent nurses and families stress. One approach is to meet families’ needs as a team, which can be done a number of ways. Develop a group of senior nurses to be “experts” in meeting family needs. These senior staff can be role models and troubleshoot for less experienced nurses. The group of “family experts” can develop orientation materials and a competency to build the expertise of other nurses.Nurses can also supplement their support for families by working with their advanced practice nurses, nurse managers, social worker, chaplain, and others within their organization. Ask these services to meet with the nurses to identify how to best collaborate and plan regular “rounds” on the patient unit and in the visitor’s lounge. Consider posting a sign to advertise a weekly family support meeting facilitated by the advanced practice nurse and social worker as a team. If families have particularly extensive educational needs, consider including the advanced practice nurse in obtaining or developing supplemental educational materials on routinely used equipment and procedures. Direct families to the hospital library and thus access to written and internet resources.Consider contracting with families. Helping the family anticipate availability up front is also an important intervention to meet their needs and respect the availability of nurses. When a patient’s family first visits and is being oriented to the unit, it may be helpful for the unit to identify times when families may be asked to leave the unit. When you explain that these requests will be limited and may not be related to their own family members illness or recovery, but help focus nursing care to best meet the patient’s needs, families will be prepared up front and will usually cooperate with these requests. Begin the first discussion of the shift with the family by introducing yourself, updating the patient’s progress, answer any immediate questions, and outline when you will or will not be available to them. Remind families that they need to take breaks and take care of themselves with plenty of sleep and rest, nutritious meals, etc, to help them “be there for the long haul” during their loved one’s recovery. Again, anticipating and communicating with families the times when nurses must concentrate on meeting patient’s needs and contracting will allow nurses and families to work together.A proactive approach to meeting family needs will pay off in the long run. If the patient’s stay begins with family support and education, nurses build rapport that will facilitate positive and timely decision making later in the patient’s illness.

The impact of worksite-based health risk appraisal programs on observed safety belt use

This study assessed the effectiveness of worksite-based health risk appraisal (HRA) programs, with and without supplemental educational materials on safety belt use, for increasing obvserved belt use of program participants. HRA programs were offered by county public health departments to employees of four manufacturing plants in two states, one with mandatory safety belt use laws, the other without such laws. Two additional worksites served as no-treatment controls. Treatment consisted of either HRA only, in which participants completed a questionnaire and later attended a group counseling session, or HRA + education, which included the same questionnaire and counseling components plus the presentation of educational materials on habit change, emphasizing safety belt use, designed specifically for this study. Direct observations of safety belt use were made by trained observers in the worksite parking lots at four times: baseline, post-HRA screening, post-counseling, and follow-up 2–3 months later. Analyses of changes in observed safety belt use showed that all HRA treatment groups significantly increased their rates of use, with improvements ranging from 48 to 124% over baseline. Use of the supplemental educational materials did not produce additional improvements. There was no significant difference between safety belt use increases in states with and without mandatory use laws. The observed rates