Training Medical Providers Research Articles

Communicating neurocognitive impacts of childhood cancer: Engaging stakeholders to identify research priorities

ObjectiveSupporting childhood cancer survivors with neurocognitive late effects is critical and requires additional attention in the research arena. This convening project’s aim was to engage parents, healthcare providers, and education stakeholders in order to identify research priorities regarding patient/family-provider communication about neurocognitive impacts associated with childhood cancer. MethodsSpecific components of the Stakeholder Engagement in quEstion Development (SEED) method were combined with an online e-Delphi consensus building approach. Multiple modalities were utilized for engagement including in-person/hybrid meetings, email/Zoom/call communications, targeted-asynchronous learning activities by stakeholders, iterative surveys, and hands-on conceptual modeling. ResultsTwenty-four (parents n = 10, educators n = 5, healthcare providers n = 9) participated in the year-long project, generating 8 research questions in the stakeholder priority domains of training families/caregiver, access of neuropsychological assessment, tools to facilitate communication and training medical providers. ConclusionsThis paper illustrates a successful stakeholder convening process using multi-modal engagement to establish research priorities. The resulting questions can be utilized to guide research projects that will fill gaps to providing optimal care to children with neurocognitive late effects. Practice ImplicationsThis process can be used as a template for tackling other healthcare issues that span across disciplines and domains, where stakeholders have rare opportunities to collaborate.

Improving Safety During Transitions of Care Through the Use of Electronic Referral Loops to Receive and Reconcile Health Information.

Medicare's Promoting Interoperability Program evaluates how often organizations completely reconcile differences between the internal medical record with problems, medications, and allergies received from outside electronic health records (EHRs) during hospitalizations. This quality improvement project sought to increase rates of complete reconciliation of patient problems, medications, and allergies to 80% of hospitalizations for 90 consecutive days at all eight hospitals in an academic medical system by December 31, 2021. Baseline characteristics were determined using monthly reconciliation performance from October 2019 to October 2020. The intervention period occurred from November 2020 to December 2021 and consisted of 26 Plan-Do-Study-Act cycles. Performance was monitored from January 2022 to June 2022 to observe the sustainability of the initiative. Statistical process control charts were used to identify special cause variation in system-level performance. All eight hospitals successfully recorded 90 consecutive days of complete reconciliation above 80% in 2021, and seven of eight hospitals maintained this goal in the sustainability period. Average baseline reconciliation was 22.1%. System-level performance satisfied criteria for baseline shift after PDSA 17, when the average performance was recalculated as 52.4%. Criteria for a second baseline shift were satisfied during the sustainability period, when the average performance was recalculated at 79.9%. Overall performance has remained within the recalculated control limits throughout the sustainability period. An intervention that included enhancing EHR workflows, training medical providers, and communicating division performance was successful in increasing and sustaining complete reconciliation of clinical information in a multihospital medical system.

Assessing service providers’ satisfaction with the chronic diseases package provided through the National Health Insurance Fund in Sudan

Background: The prevalence and burden of chronic diseases is growing significantly with direct impact on health and financial security of population. In Sudan, there is a continuous effort to improve access for good and integrated health services but still the utilization of these services is low. Therefore, there is an urgent need to assess the availability and integration of benefit package to ensure better and effective coverage of services.Aim: This is a descriptive cross sectional based study aimed to assess the opinion of service providers about the chronic diseases package provided through the national health insurance fund.Methods: Form390 participating, data was collected via closed ended standardized questionnaires. Pre testing was done to ensure quality survey instruments and fieldwork procedures were conducted. A structured questionnaire with closed-ended questions was developed based on literature and previous studies. The questionnaire made up of 30 questions and organized in the following sections: background characteristics, medical characteristics, health professionals’ knowledge and practice related to NHIF ’chronic diseases package and perception about NHIF ‘chronic diseases package.Results: Our results showed that despite the existence of a number of issues, the National Health Insurance Fund is rather accepted amongst our respondents. Issues manifested were in regards to health education and supply issues of drugs. Conclusion: Our study concluded that, there is an obvious weakness in both training of providers and implementation of national protocols for chronic diseases. Moreover, despite the challenges of drug availability, 70% of our participants expressed positivity when questioned about the presentation of the drug package, bearing in mind the importance of reviewing the list to ensure its inclusion of new items. There is a need for training medical providers about chronic diseases with more focusing on health promotion and application of national guidelines. Additionally, integration of chronic diseases services in necessary for achieving universal health coverage.
 Keywords: national protocols for chronic diseases, national health insurance fund, health promotion

“We’ll be able to take care of ourselves” – A qualitative study of client attitudes toward implementing buprenorphine treatment at syringe services programs

Background: Syringe services programs (SSPs) complement substance use disorder treatment in providing services that improve the health of people who use drugs (PWUD). Buprenorphine treatment is an effective underutilized opioid use disorder treatment. Regulations allow buprenorphine prescribing from office-based settings, potentially including SSPs although few studies have examined this approach. Our objective was to assess the attitudes among PWUD toward the potential introduction of buprenorphine treatment in an SSP. Methods: In this qualitative study, we recruited 34 participants who were enrolled at a New York City-based SSP to participate in one of seven focus group sessions. The focus group facilitators prompted participants to share their thoughts in five domains: attitudes toward (1) medical clinics; (2) harm reduction in general; (3) SSP-based buprenorphine treatment; (4) potential challenges of SSP-based treatment; and (5) logistical considerations of an SSP-based buprenorphine treatment program. Four researchers analyzed focus group transcripts using thematic analysis. Results: Of the 34 participants, most were white (68%), over the age of 40 years old (56%), and had previously tried buprenorphine (89%). Common themes were: 1) The SSP is a supportive community for people who use drugs; 2) Participants felt less stigmatized at the SSP than in general medical settings; 3) Offering buprenorphine treatment could change the SSP’s culture; and 4) SSP participants receiving buprenorphine may be tempted to divert their medication. Participants offered suggestions for a slow intentional introduction of buprenorphine treatment at the SSP including structured appointments, training medical providers in harm reduction, and program eligibility criteria. Conclusion: Overall, participants expressed enthusiasm for onsite buprenorphine treatment at SSPs. Research on SSP-based buprenorphine treatment should investigate standard buprenorphine treatment outcomes but also any effects on the program itself and medication diversion. Implementation should consider cultural and environmental aspects of the SSP and consult program staff and participants.

A Mixed-Methods Analysis of Barriers to and Facilitators of Human Papillomavirus Vaccination Among Adolescents in Montana.

Human papillomavirus (HPV) vaccination rates among adolescents are lower in rural areas than in urban areas of the United States. The objective of this study was to identify barriers to and facilitators of adolescent HPV vaccination in Montana, a large, primarily rural state. Using a mixed-methods design, we integrated quantitative analyses of Montana's National Immunization Survey-Teen (NIS-Teen) data from 2013-2017 with qualitative data collected at a statewide meeting in October 2018 and from stakeholder interviews conducted from October 2018 through June 2019. Using NIS-Teen data, we identified trends and estimated adjusted prevalence ratios (aPRs) to identify factors associated with vaccine uptake. Using directed content analysis of qualitative data, we identified themes related to vaccine uptake. In Montana, initiation of the HPV vaccine series among adolescents aged 13-17 increased from 34.4% in 2013 to 65.5% in 2017. We identified 6 themes related to HPV vaccination from qualitative analyses, including medical providers' recommendation style as a facilitator of vaccination and parental vaccine hesitancy as a barrier to vaccination. In NIS-Teen 2017 data (n = 326 adolescents), receiving a medical provider recommendation was significantly associated with series initiation (aPR = 2.3; 95% CI, 1.5-3.6). Among parents who did not intend to initiate the vaccine series for their adolescent within 12 months (n = 71), vaccine safety was the top concern (aPR = 24.5%; 95% CI, 12.1%-36.9%). HPV vaccination rates have increased in Montana but remain lower than rates for other adolescent vaccines. Future work should focus on reducing missed opportunities, increasing parents' knowledge of and confidence in vaccination, and training medical providers on addressing common vaccine concerns.

Use of the Progressive Return to Activity Guidelines May Expedite Symptom Resolution After Concussion for Active Duty Military

Background: Clinical recommendations for concussion management encourage reduced cognitive and physical activities immediately after injury, with graded increases in activity as symptoms resolve. Empirical support for the effectiveness of such recommendations is needed. Purpose: To examine whether training medical providers on the Defense and Veterans Brain Injury Center’s Progressive Return to Activity Clinical Recommendation (PRA-CR) for acute concussion improves patient outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: This study was conducted from 2016 to 2018 and compared patient outcomes before and after medical providers received an educational intervention (ie, provider training). Patients, recruited either before or after intervention, were assessed at ≤72 hours, 1 week, 1 month, 3 months, and 6 months after a concussion. The participant population included 38 military medical providers and 106 military servicemembers with a diagnosed concussion and treated by one of the military medical providers: 58 patient participants received care before the intervention (ie, provider training) and 48 received care after intervention. The primary outcome measure was the Neurobehavioral Symptom Inventory. Results: The patients seen before and after the intervention were predominantly male (89.7% and 93.8%, respectively) of military age (mean ± SD, 26.62 ± 6.29 years and 25.08 ± 6.85 years, respectively) and a mean ± SD of 1.92 ± 0.88 days from injury. Compared with patients receiving care before intervention, patients receiving care after intervention had smaller increases in physical activities (difference in mean change; 95% CI, 0.39 to 6.79) and vestibular/balance activities (95% CI, 0.79 to 7.5) during the first week of recovery. Although groups did not differ in symptoms at ≤72 hours of injury (d = 0.22; 95% CI, –2.21 to 8.07), the postintervention group reported fewer symptoms at 1 week (d = 0.61; 95% CI, 0.52 to 10.92). Postintervention patients who completed the 6-month study had improved recovery both at 1 month (d = 1.55; 95% CI, 5.33 to 15.39) and 3 months after injury (d = 1.10; 95% CI, 2.36 to 11.55), but not at 6 months (d = 0.35; 95% CI, 5.34 to 7.59). Conclusion: Training medical providers on the PRA-CR for management of concussion resulted in expedited recovery of patients.

M#1045: Training Course in Focused Assessment with Sonography for HIV/TB in HIV Prevalent Medical Centers in Malawi.

Training medical providers of different backgrounds the "focused assessment with sonography for HIV-associated TB" (FASH) exam to expand the availability of ultrasound for TB diagnosis in resource poor settings in the central region of Malawi. A survey was completed by the 19 eligible participants before and after a 4-day training course regarding the utility of the FASH exam. A six-question quiz was used to assess knowledge of the use of ultrasound in the FASH exam before and after the course. Participants' knowledge of the FASH technique significantly improved after the four-day course with a 32% increase in total quiz questions answered correctly (p<0.001).Ninety-five percent (n= 18) of participants answered that they would "likely" incorporate FASH in their clinical practice. Furthermore, 100% (n=19) of participants agreed that the FASH exam would improve their ability to diagnose TB and 95% (n=18) agreed that FASH would improve patient care in their clinic. After completing a 4-day training course, medical providers were more knowledgeable about the FASH exam and its findings, and felt more comfortable using ultrasound for the diagnosis of TB. Participants were also unanimous in opinion that the FASH ultrasound exam would improve their ability to diagnose TB.

Training medical providers in evidence-based approaches to suicide prevention.

Suicide is a significant issue in the United States and worldwide, and its prevention is a public health imperative. Primary care practices are an important setting for suicide prevention, as primary care providers have more frequent contact with patients at risk for suicide than any other type of health-care provider. The Western Interstate Commission for Higher Education, in partnership with the Suicide Prevention Resource Center, has developed a Suicide Prevention Toolkit and an associated training curriculum. These resources support the education of primary care providers in evidence-based strategies for identifying and treating patients at risk for suicide. The application of this curriculum to post-graduate medical training is presented here.

Injury Patterns at a Large Western United States Ski Resort With and Without Snowboarders

Background: Differences in injury patterns among alpine skiers and snowboarders have previously been recognized, and controversy remains about the safety implications that snowboarding may pose to a ski resort. A change of policy at Taos Ski Valley provides a unique and modern perspective on the effect that snowboarders have on ski resort injuries. Hypothesis: The addition of snowboarders to a large ski resort may result in a significant change in both the rate and pattern of injuries treated. Study Design: Descriptive epidemiology study. Methods: Patient records from the Mogul Medical Clinic at Taos Ski Valley were reviewed from the 2006-2007 ski season through the 2009-2010 season (approximately 2 years before and after snowboarding was allowed) and recorded for age, sex, diagnosis, body region, anatomic location, injury type, and sport (skiing, snowboarding). The total numbers of mountain visits for the time periods with and without snowboarding were used to determine injury rates. Results: The overall rate of persons injured increased from 206.7 per 100,000 mountain visits without snowboarders to 233.8 with snowboarders. The relative risk ratio was 1.131, also represented as a 13.1% increased risk of injury (IRI) (statistically significant; 95% CI, 3.5%-23.6%). Increases were seen in the rate of upper extremity injuries (IRI, 39.1%; 95% CI, 14.3-69.4) and head/neck injuries (IRI 30.8%; not significant), while lower extremity and trunk/pelvis injuries remained relatively constant. Distal radius fractures, closed head injuries, and acromioclavicular separations showed statistically significant increases with the addition of snowboarding. The most frequent injuries among snowboarders were distal radius fractures, wrist sprains, closed head injuries, and acromioclavicular separations. The most frequent injuries among skiers were anterior cruciate ligament tears, knee sprains, closed head injuries, and gastrocnemius tears. The median age of injured persons decreased from 39 years (range, 4-100 years) without snowboarders to 31 years (range, 4-99 years) with snowboarders, and this was significant. Approximately 45% of injured persons were female, and this did not change with the addition of snowboarders. Conclusion: In this study, there was a small but statistically significant increase in the likelihood of injury with the addition of snowboarding to a large ski resort. It is likely that factors such as younger demographic, elevated risk-taking behavior, or increased mountain crowding are involved. The difference in injuries is largely because of a significant increase in distal radius fractures, closed head injuries, and acromioclavicular separations. On mountain safety precautions such as widening of runs and streamlining of high traffic areas, training medical providers to recognize and treat sport-specific injuries, and promoting the use of wrist guards and helmets may be useful in reducing the effect that snowboarders have on ski resort injuries.

O1035 Preventing HIV acquisition with male circumcision: A pilot program training medical providers to perform infant male circumcision in Kisumu, Kenya

O1035 Preventing HIV acquisition with male circumcision: A pilot program training medical providers to perform infant male circumcision in Kisumu, Kenya

Simulation for trauma and combat casualty care

Training medical providers to care for traumatically injured patients is a difficult undertaking and currently used training strategies are often suboptimal. The further strains placed on trauma care in the military environment only add to the challenge. Simulation applications ranging from simple physical models to complex, computer‐based virtual reality systems have either been developed or are being developed to help support and improve trauma care training. Several of these applications have been shown to be as good as or better than the standard training methods they are designed to replace. Simulators are available for training in the treatment of disorders of the airway, difficulty with breathing, and problems dealing with circulation as well as various non‐life‐threatening but disabling injuries. Some of these simulators have already drastically changed how the standard Advanced Trauma Life Support course is taught. Advances in both technology and application of simulators will continue to affect trauma skills training for the foreseeable future.

Training Medical Providers to Conduct Alcohol Screening and Brief Interventions

ABSTRACT Although progress has been made in developing a scientific basis for alcohol screening and brief intervention (SBI), training packages are necessary for its widespread dissemination in primary care settings. This paper evaluates a training package developed for the Cutting Back(r) SBI program. Three groups of medical personnel were compared before and after SBI training: physicians (n = 44), medical students (n = 88), and non-physicians (n = 41). Although the training effects were at times dependent on group membership, all changes were in a direction more conducive to implementing SBI. Physicians and medical students increased confidence in performing screening procedures, and students increased self-confidence in conducting brief interventions. Non-physicians perceived fewer obstacles to screening patients after training. Trained providers reported conducting significantly more SBIs than untrained providers, and these differences were consistent with patients' reports of their providers' clinical activity. Thus, when delivered in the context of a comprehensive SBI implementation program, this training is effective in changing providers' knowledge, attitudes, and practice of SBI for at-risk drinking.