Search

PURPOSE The purpose of this study was to examine differences between urban and rural primary care clinics in the use of colorectal cancer (CRC) screening methods and evidence-based interventions to promote CRC screening. METHODS This was a cross-sectional survey of primary care clinics in Nebraska. Surveys in paper form were sent out and followed up with telephone interviews to nonrespondents. Of the 375 facilities, 263 (70.1%) responded to the survey. FINDINGS Over 30% of urban clinics indicated that 80% or more of their patients were meeting the CRC guidelines compared to 18.3% of rural clinics (P = .03). Rural clinics were more likely than urban clinics to prefer the use of colonoscopy alone or in combination with stool tests (P = .02). The most common interventions for CRC screening included one-on-one patient education and use of computer-based pop-ups to remind providers. CONCLUSIONS In conclusion, we found some important differences between rural and urban primary care clinics in the implementation of CRC screening. Given that there is evidence for differences in preference for CRC screening methods (colonoscopy vs stool-based tests) between rural and urban community members, it is important to assess the effectiveness of different types of CRC screening interventions by comparing rural and urban primary care clinic patient populations.

Discordance between physicians and patients’ health beliefs can impede health communication efforts. However, little research considers physicians’ perceptions of patient beliefs, despite the impor...

Patients with opioid use disorder (OUD) seek care in primary care settings where nurses support the provision of medication-assisted treatment. Office-based opioid treatment (OBOT) that includes buprenorphine hydrochloride administration under the supervision of a nurse for stabilization and maintenance therapy has the potential to improve outcomes for patients with OUD in primary care settings. However, the first step is to determine if OBOT nurses provide nurse-sensitive care, which consists of activities that have been shown to make a difference in patient outcomes. Content analysis of 368 nursing notes from 100 patients enrolled in an OBOT program in an urban hospital-based primary care clinic was conducted. Data were analyzed descriptively according to quantity and qualitatively according to the content. Entries indicative of care coordination and transition management were extracted. Seven content categories within care coordination were identified, including harm reduction, medication management, symptom management, communication between providers, promoting adherence, self-management goal setting, and patient education. Four areas within transition management were identified including supporting connections to resources, referrals for care, medication reconciliation, and communication with other facilities. Care coordination was documented more frequently than transition management. The presence of nurse-sensitive indicators provides evidence for and distinguishes the role of the nurse in OUD care.

Objective: \ud To identify prognostic factors for health outcomes following an eight-week supervised exercise therapy and education program for individuals with knee and hip osteoarthritis (OA) alone or with concomitant hypertension, heart or respiratory disease, diabetes, or depression.\ud \ud Methods: \ud We included individuals with knee and/or hip OA from the Good Life with osteoArthritis in Denmark (GLA:D®). GLA:D® consists of two patient education sessions and 12 supervised exercise therapy sessions. Before GLA:D®, participants self-reported any comorbidities and were categorized in eight comorbidity groups. 21 potential prognostic factors (demographics, clinical data, and performance-based physical function) gathered from participants and clinicians before the program were included. Outcomes were physical function using the 40-m Fast-Paced Walk Test (FPWT), health-related quality of life using the EQ-5D-5L index score, and pain intensity using a visual analogue scale (0-100, VAS) assessed before and immediately after the GLA:D® program. Within each comorbidity group, associations of prognostic factors with outcomes were estimated using multivariable linear regression.\ud \ud Results: \ud Data from 35,496 (40-m FPWT) and 37,576 (EQ-5D-5L and VAS) participants were included in the analyses. Clinically relevant associations were demonstrated between age, self-efficacy, self-rated health, and pain intensity with change in 40-m FPWT, EQ-5D-5L or VAS across comorbidity groups. Furthermore, anxiety, education, physical function, and smoking were associated with outcomes among subgroups having depression or diabetes in addition to OA.\ud \ud Conclusion: \ud Age, self-efficacy, self-rated health, and pain intensity may be prognostic of change in health outcomes following an eight-week exercise therapy and patient education program for individuals with OA, irrespective of comorbidities.

Objectives The Kidney Team at Home program is an educational intervention aimed at patients with chronic kidney disease to assist them in their choice for kidney replacement therapy. Previous studies have shown that the intervention results in an increase in knowledge and communication on kidney replacement therapy, and eventually in an increase in the number of living donor kidney transplantations. The study assesses the cost-effectiveness of the intervention compared to standard care. Methods A dynamic probabilistic Markov model was used to estimate the monetary and health benefits of the intervention in The Netherlands over 10 years. Data on costs and health-related quality of life were derived from the literature. Transition probabilities, prevalence, and incidence rates were calculated using a large national database. An optimistic and a pessimistic implementation scenario were compared to a base case scenario with standard care. Results In both the optimistic and pessimistic scenario, the intervention is cost-effective and dominant compared to standard care: savings were €108,681,985 and €51,770,060 and the benefits were 1382 and 695 QALYs, respectively. Conclusions The superior cost-effectiveness of the intervention is caused by the superior health effects and the reduction of costs associated with transplantation, and the relatively small incremental costs of the intervention. The favorable findings of this implementation project resulted in national uptake of the intervention in The Netherlands as of 2021. This is the first time a psychosocial intervention has been implemented as part of standard care in a kidney replacement therapy program worldwide.

Objectives To evaluate contemporary clinical presentations of priapism, their association with socioeconomic characteristics, and the role of prescribing providers in priapism episodes in a large cohort of patients managed at 3 major academic health systems. Methods We identified all consecutive patients presenting with ischemic priapism to the emergency departments of three major academic health systems (2014 –2019). Demographic characteristics, priapism etiologies, and clinical management were evaluated. Univariable and multivariable analyses were used to assess the contribution of socioeconomic characteristics and the role of prescribing providers in priapism episodes. Results We identified 102 individuals with a total of 181 priapism encounters. Hispanic race, lower income quartile, sickle-cell disease, and illicit drug use were associated with increased risk of recurrent episodes. Of ICI users, 57% received their prescriptions from non-urological medical professionals (NUMPs); the proportion with recurrent episodes was higher for NUMPs compared to urologists (24% vs 0%, P = 0.06) with no demographic differences identified between patients treated by either group. Conclusion Socioeconomic disparities exist among patients presenting with recurrent episodes of priapism, potentially highlighting systemic issues with access to care and patient education. With most patients who developed ischemic priapism from ICI being prescribed these medications by NUMPs, further investigation is required to elucidate the prescribing and counseling patterns of these providers. Increased awareness of disparities and complications may improve patient safety.

Objective People living in rural areas of the United States experience greater health inequality than individuals residing in urban or suburban locations and encounter several barriers to obtaining optimal health care. Health disparities are compounded for patients with rare diseases such as hereditary angioedema (HAE), an autosomal dominant genetic disorder characterized by recurrent, severe abdominal pain and lifethreatening oropharyngeal/laryngeal swelling. The objective of this review is to explore the challenges of managing HAE patients in rural areas and suggest possible improvements for optimizing care. Data Sources PubMed was searched for articles on patient care management, treatment challenges, rural health, and HAE. Study Selections Relevant articles were selected and reviewed. Results Challenges in managing HAE in the rural setting were identified including obtaining a diagnosis of HAE, easy access to a physician with expertise in HAE, continuity of care, availability of telemedicine services, access to approved HAE therapies, patient education, and economic barriers to treatment. Ways to improve HAE patient care in rural areas include health care provider recognition of the undiagnosed HAE patient, development of individualized management plans, expansion of telemedicine, effective care at the local level, appropriate access to HAE medication, and increased awareness of patient support and advocacy groups. Conclusion For HAE patients living in rural areas, optimal care is complicated by health disparities. Given the scarcity with which these topics have been covered in the literature to date, it is intended that this article will serve as the impetus for a range of further initiatives focused on improving access to care.

Long-term treatment with warfarin is recommended for patients with atrial fibrillation at risk of stroke and those with recurrent venous thrombosis or prosthetic heart valves. Patient education before commencing warfarin − regarding signs and symptoms of bleeding, the impact of diet, potential drug interactions and the actions to take if a dose is missed − is pivotal to successful use. Scoring systems such as the CHADS2 score are used to determine if patients with atrial fibrillation are suitable for warfarin treatment. To rapidly achieve stable anticoagulation, use an age-adjusted protocol for starting warfarin. Regular monitoring of the anticoagulant effect is required. Evidence suggests that patients who self-monitor using point-of-care testing have better outcomes than other patients.

PURPOSE: To assess factors that influence adolescent asthma responsibility and how patient- and parent-reported asthma responsibility changes over a 12-month period. METHODS: One hundred sixty-four adolescents and their parents completed questionnaires at baseline and 12 months, including the asthma responsibility questionnaire, in which higher scores indicate greater adolescent responsibility. Multiple linear regression was used to assess how baseline asthma responsibility, self-efficacy, outcome expectations, and demographic characteristics were associated with 12-month asthma responsibility. RESULTS: Asthma responsibility as reported by both adolescents and parents shifted significantly toward the adolescent over the study period (p

Objective To assess the recent trends, acceptability, and effectiveness of digital maternal patient education through summarizing the literature. Methods Articles published in 2010–2020 on patient education, digital tools, and maternal health were searched on PubMed. Abstract and full texts were reviewed to identify eligible studies and extract key information. Results Digital patient education studies covered various topics throughout pregnancy, with the greatest number of studies targeting the prenatal period. Among the 55 studies, 38 (69%) reported significant patient outcomes, with the main benefits of increased knowledge (83.3%), emotional benefits (73.7%), and behavioral changes (60.6%). The number of studies per year increased steadily over the past decade, with frequently utilized formats of texts with images (40%), SMS (30.9%), and videos (25.5%). Video produced the highest rate of positive patient outcomes; however, no statistical significance was found. Conclusion Our study presented evidence supporting the high effectiveness and prevalence of digital tools in maternal patient education, and analyzed the content, platforms, and formats utilized by digital tools of the past decade. Practice implications Digital tools are effective and feasible in conducting maternal patient education. No specific patient education format is found to be superior in improving patient’s health outcomes.

Purpose To evaluate the readability, understandability, and actionability of online patient education materials (OPEM) related to breast cancer risk assessment. Material and methods We queried seven English-language search terms related to breast cancer risk assessment: breast cancer high-risk, breast cancer risk factors, breast cancer family history, BRCA, breast cancer risk assessment, Tyrer-Cuzick, and Gail model. Websites were categorized as: academic/hospital-based, commercial, government, non-profit or academic based on the organization hosting the site. Grade-level readability of qualifying websites and categories was determined using readability metrics and generalized estimating equations based on written content only. Readability scores were compared to the recommended parameters set by the American Medical Association (AMA). Understandability and actionability of OPEM related to breast cancer high-risk were evaluated using the Patient Education Materials Assessment Tool (PEMAT) and compared to criteria set at ≥70%. Descriptive statistics and inter-rater reliability analysis were utilized. Results 343 websites were identified, of which 162 met study inclusion criteria. The average grade readability score was 12.1 across all websites (range 10.8–13.4). No website met the AMA recommendation. Commercial websites demonstrated the highest overall average readability of 13.1. Of the 26 websites related to the search term breast cancer high-risk, the average understandability and actionability scores were 62% and 34% respectively, both below criteria. Conclusions OPEM on breast cancer risk assessment available to the general public do not meet criteria for readability, understandability, or actionability. To ensure patient comprehension of medical information online, future information should be published in simpler, more appropriate terms., Highlights • The average grade readability score of breast cancer risk assessment online education materials was 12.1 • No website met the AMA recommendation of a sixth-grade reading level. • To ensure patient comprehension, future information should be published in simpler, more appropriate terms.

Non-white people are more likely to develop systemic lupus erythematosus (SLE), yet are underrepresented in SLE clinical trials. The efficacy and safety of drugs may be influenced by ancestry, and ancestrally diverse study populations are necessary to optimize treatments across the full spectrum of patients. However, barriers to entry into clinical trials are amplified in non-white populations. To address these issues, a conference was held in Bethesda, Maryland from October 15th -16th , 2019 entitled "Increasing Ancestral Diversity in Systemic Lupus Erythematosus Clinical Studies: Overcoming the Barriers." Participants included people with lupus, lupus physicians, lupus clinical trialists, treatment developers from biotechnology, social scientists, patient advocacy groups, and United States government representatives (the Office of Minority Health, Centers for Disease Control and Prevention, National Institutes of Health, and the Food and Drug Administration). For all of these groups, the organizers purposefully included people of non-white ancestry. Decreased participation of non-white SLE patients in clinical research was evaluated through historical, societal, experiential, and pragmatic perspectives, and several interventional programs to increase non-white patient participation in SLE and non-SLE research were described and discussed. The presentations and discussions highlighted the need for changes at the societal, institutional, research team, referring physician, and patient education levels to achieve equitable ancestral representation in SLE clinical studies.

Despite advances in healthcare and improved chemotherapy, disparities in breast cancer outcomes continue to persist. Our aim was to evaluate socioeconomic factors that may impact timing of treatment for patients receiving chemotherapy in underserved communities.A review of patients with breast cancer who received neoadjuvant or adjuvant chemotherapy from 2015-2019 was conducted at a safety-net hospital. The primary outcomes were times from diagnosis to chemotherapy and surgery. Clinicodemographic factors including race, age, clinical stage, primary language, comorbidities, and median income by zip code were collected. Multivariable regression analysis was performed to evaluate for factors associated with the primary outcomes.One hundred patients were identified. For the neoadjuvant group, median time from diagnosis to chemotherapy and surgery was 52 ± 34 days and 256 ± 59 days, respectively. For the adjuvant group, median time from diagnosis to surgery and chemotherapy was 24.5 ± 18 days and 94.5 ± 53 days, respectively. Non-English language and older age were associated with increased time to chemotherapy in the adjuvant group (p 0.05). Language and age were not associated with increased time to surgery in both groups. Race, age, comorbidities, and income were not associated with delay in treatment in either groups.Older age and non-English language were associated with prolonged time from surgery to adjuvant chemotherapy. Targeted interventions directed at patient education and decreasing language barriers especially post-operatively may decrease delays in treatment and subsequently reduce disparities seen in the breast cancer population.

Background- Sudden unexpected death in epilepsy (SUDEP) is an important concern in patients with epilepsy who are otherwise healthy. Current knowledge of SUDEP and attitudes of neurologists in the Eastern Mediterranean Region (EMR) towards discussing SUDEP with their patients remain unknown. Objective- We aimed at assessing knowledge, attitudes and factors affecting SUDEP discussion practices of neurologists practicing in the EMR. Methodology- An electronic and paper-based survey was sent to 350 neurologists practicing in the EMR. They were questioned about the frequency, timing, and factors affecting their willingness to initiate SUDEP discussion. We also included questions about perceived patient reactions towards SUDEP discussions and neurologists' preferred way to provide SUDEP information to their patients. Results- We received 132 responses from the 350 surveys sent out (response rate 37.7%). Our results showed that only 1.5% of the neurologists discussed SUDEP with “most” of their patients and their caregivers while 55.3% “rarely” or “never” discussed it. Factors such as additional epilepsy training and more years of clinical experience did not significantly affect the frequency of SUDEP discussion (p= 0.329, p= 0.728). A significant negative association between the number of patients seen per year and the frequency of SUDEP discussion was seen (P = 0.046). Based on their selection of known risk factors, 81% of neurologists were considered as having insufficient knowledge of SUDEP. The top three perceived reactions by the neurologists on SUDEP discussion were distress (74.2%), anxiety (70.5%) and depression (65.9%). Most neurologists initiated SUDEP discussion by themselves and preferred brochures/pamphlets, websites and training sessions to provide SUDEP information. Conclusion- Neurologists in the EMR rarely discuss SUDEP, and have limited knowledge about its risk factors. Upon discussing SUDEP, they overwhelmingly receive negative reactions but not always. Based on our findings, we believe an unintended knowledge gap exists on part of the neurologists. This, coupled with a lack of trained epilepsy nurses and patient education material in regional languages can also be attributed to poor SUDEP discussion practices in the EMR.

Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) are at high risk of CKD progression and cardiovascular (CV) disease. Prevalence of CKD in patients with T2D is currently around 40% and continues to grow. The increasing number of people with CKD and T2D will ultimately have a significant impact upon health resource use and costs of care for people with T2D. Management of CKD in patients with T2D aims to preserve kidney function to reduce the risk of end-stage kidney disease, CV events, and mortality. Evidence-based recommendations for the treatment of patients with CKD and T2D are provided by several international and national organizations and recommend several lifestyle and pharmacological approaches to help prevent or delay the progression of CKD in patients with T2D. Guidelines include regular screening of patients with T2D for CKD using spot urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (at least annually and at least twice a year if UACR >300 mg/g). Additionally, assessment of vascular complications, together with interventions designed to improve glycemic control and lipid levels, maintain healthy body weight, and optimize blood pressure should be performed. Medications shown to slow progression of CKD include renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists, and, more recently, selective, non-steroidal mineralocorticoid receptor antagonists. This review highlights the ongoing challenges facing primary care providers in the management of CKD in patients with T2D including the consideration of comorbidities, adoption of new treatment options, and implementation of individualized care. Achieving consensus for optimal treatment of this disease is critical in providing consistent and appropriate care for all patients. Strategies to improve outcomes should also include use of clear referral criteria, use of a multi-disciplinary approach, and patient education.

Background. The chronic complications of diabetes mellitus (DM) result from a wide variety of effects of disease. The correlation between blood sugar level and chronic complications has been demonstrated in various studies. Patient education, risk factor management, and other preventative measures are critical elements in reducing the incidence of diabetes complications such as Diabetic Foot Syndrome (DFS). We purposed to evaluate knowledge and attitudes towards foot care amongst patients with diabetes mellitus; in addition, we investigated the correlation between glycemic control and DFS. Materials and methods. This was a descriptive cross-sectional evaluation of patients who were diagnosed with diabetes mellitus seeking outpatient medical care with data being collected through patient surveys, clinical evaluation, specialty consultation, and biochemical analysis of glycated haemoglobin (HbA1c) serum levels. The population of the study was composed of 90 patients diagnosed with DM. Results. A total of 90 patients, 42 (46.7 %) females and 48 (53.3 %) males were included in the study. The rate of participants who reported completing daily self-evaluations for wounds, cracks, and discoloration on the feet was significantly higher (68.9 %) than those who reported not evaluating on a daily basis (31.1 %). Almost half of the participants were diagnosed with DFS (n = 43; 47.7 %) with the HbA1c levels of patients with DFS being significantly higher compared to the HbA1c levels of patients without DFS (p < 0.05). Conclusions. As a high incidence of DFS was found with a positive and statistically significant correlation between the HbA1c level and DFS presence, our study highlights the importance of close monitoring, education, and treatment given the risk of serious complications of DM such as DFS in setting of poorly controlled DM., Актуальність. Хронічні ускладнення цукрового діабету (ЦД) є наслідком широкого спектра патогенезу захворювання. Кореляція між рівнем цукру в крові та хронічними ускладненнями була продемонстрована в різних дослідженнях. Навчання пацієнтів, управління факторами ризику та інші профілактичні заходи є найважливішими елементами зменшення частоти ускладнень ЦД, зокрема синдрому діабетичної стопи (СДС). Мета дослідження — оцінити рівень знань та ставлення до догляду за ногами серед хворих на цукровий діабет, а також встановити кореляцію між глікемічним контролем та розвитком СДС. Матеріали та методи. Проведене описове перехресне дослідження хворих на цукровий діабет, які зверталися за амбулаторною медичною допомогою. Проведений аналіз даних, зібраних за допомогою опитувань пацієнтів, клінічної оцінки, консультацій суміжних спеціалістів та визначення рівня глікованого гемоглобіну (HbA1c) у сироватці крові. У дослідження включені 90 пацієнтів із діагнозом ЦД. Результати. Із 90 хворих на ЦД, включених у дослідження, під спостереженням перебували 42 (46,7 %) жінки та 48 (53,3 %) чоловіків. Серед учасників дослідження число осіб, які повідомили про щоденне самооцінювання стану ніг (наявність ран, тріщин та зміни кольору шкіри), було вірогідно вищим (68,9 %), ніж тих, хто повідомив, що не проводив оцінку щодня (31,1 %). Майже в половини учасників діагностований СДС (n = 43; 47,7 %), при цьому рівні HbA1c у пацієнтів із СДС були вірогідно вищими порівняно з показниками HbA1c у пацієнтів без СДС (p < 0,05). Висновки. У дослідженні був виявлений високий рівень захворюваності на СДС із позитивною та статистично значущою кореляцією між рівнем HbA1c та наявністю СДС. Проведене дослідження підкреслює важливість ретельного моніторингу, навчання та дотримання рекомендацій лікарів з огляду на ризик серйозних ускладнень ЦД, зокрема СДС, при незадовільно конт­рольованому ЦД.

Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible vision loss. The present consensus provides suggestions on diagnosis, evaluation, treatment, and follow-up strategies for nAMD from a panel of 11 practicing ophthalmologists. The experts suggest that the baseline visit for nAMD management should include a comprehensive ophthalmologic examination via a multimodal approach consisting of visual and anatomical evaluation. Patients diagnosed with nAMD should be subjected to treatment with the goal of maintaining visual function while diminishing anatomical disease activity and minimizing treatment burden. Currently, anti-VEGF therapy is the main treatment strategy for nAMD, and evaluation involving comprehensive ophthalmologic examination within 1 month of completion of the loading phase comprising three monthly injections is recommended to guide subsequent management. Either a treat-and-extend or pro re nata regimen can be considered for the maintenance phase of anti-VEGF therapy, and the regimen should be chosen and adjusted according to disease activity, reimbursement criteria, financial burden, and patient preferences. In the event of inactive nAMD or poor treatment outcomes, after thorough evaluation and patient education, anti-VEGF therapy may be stopped. The consensus provides practical nAMD management guidelines for ophthalmologists and fellow healthcare professionals.

Background: Keratoplasty is a surgical procedure in which part or all of a damaged or diseased cornea is replaced by healthy corneal tissue from a donor. The study aimed to evaluate the effect of a multidisciplinary education course on the health literacy and satisfaction of patients undergoing keratoplasty. This study was carried out at the Ophthalmology department and outpatient clinics at Assiut University hospital. The sample of the study was a purposive sample of 60 adult and elderly patients (30 study group and 30 for the control group) undergoing corneal transplantation surgery. Tools of data collection included four tools, (1) patient’s interview questionnaire sheet, (2) patient's knowledge assessment & observation checklist, (3) health literacy questionnaire, (4) patient satisfaction with nursing care quality questionnaire. The main results of this study revealed the majority of patients in the two groups were diagnosed with keratoconus, performed Full-thickness (penetrating) keratoplasty for optical reasons. There was a highly statistically significant difference between both the study and control of patients regarding health literacy score. Half of the patients in the control group have poor satisfaction level while the majority of the study group patients (83.3%) have a very good satisfaction level post educational course application. There was a positive correlation between patients’ knowledge & health literacy and patient satisfaction (P.

Objective: This study aimed to evaluate inhaled corticosteroid (ICS) adherence and identify factors associated with nonadherence in pediatric asthma patients. Methods: A total of 134 patients aged 8–18 years old were included. At the first visit, patient adherence, asthma knowledge, and outcome expectation data were collected and recorded. Depression, anxiety, and self-esteem were assessed using psychiatric questionnaires. After providing asthma education, reevaluation of adherence and asthma control was performed at one 3- to 6-month follow-up visit. Results: The mean ICS adherence was 75.9 ± 27.5%. Fifty-seven patients (42.5%) were defined as having poor adherence (p > 0.05). Significant improvement in ICS adherence (p = 0.02) and Asthma Control Test scores (p = 0.02) were observed at the follow-up visit. Conclusions: Patient outcome expectations could be predictors of ICS adherence. Patient education regarding the mechanism and nature of asthma should be considered as an intervention for improving pediatric patient adherence. Psychological evaluation is warranted in pediatric patients with asthma.

A major health consequence of climate change is an increased prevalence of vector-borne diseases due to changes in temperatures and the environments in which vectors can survive and carry out transmissible activity. Because of climate change, emerging health challenges related to the warming of the planet have led to an increase in vector-borne diseases in broadening geographic areas. Individuals affected with Lyme disease may present with a variety of symptoms, which highlights the importance of illness recognition to ensure that a patient can receive timely treatment and effective support. Despite the focus on early detection and treatment of acute Lyme disease, chronic health problems associated with Lyme disease are an emerging problem in the 21st century. This article focuses on the role of nurse practitioners and members of the health professional team in the recognition, clinical care, patient education, and management of increasing rates of chronic Lyme disease.

Prediabetes is a high-risk state for diabetes. The study aims to describe routine clinical practice and the views of physicians and pharmacists on prediabetes management.An observational, descriptive, cross-sectional study was conducted using a structured questionnaire.A total of 410 physicians and 393 pharmacists completed the questionnaire. Self-adherence to clinical practice guidelines (CPGs) was reported by 51.5% and 23.2% of physicians and pharmacists, respectively. Less than 60% of participants defined prediabetes according to main CPG. Regarding the use of screening strategies to detect prediabetes (physicians: 96%; pharmacists: 42.1%), reports indicate the opportunistic strategy is widely employed (≥75%) whereas systematic screening is unusual (20%). Changes in lifestyle were deemed essential by almost all participants (≥95%), but in clinical practice only 58.3% of healthcare centers and 28.0% of pharmacies were found to provide awareness-raising/instruction. The role of pharmacists in the prevention of prediabetes/diabetes was judged useful by most participants.Use of CPG, systematic prediabetes screening strategies, and specific strategies for patient education are scarce. The support of community pharmacists in prediabetes management was well valued. Therefore, it is crucial that the lines of action followed by both physicians and pharmacists align with each other and with the CPG.

Malaria is a preventable, mosquito-borne parasitic infection that remains one of the leading causes of imported fever, hospitalization and death in travellers returning from Sub-Saharan Africa. Early symptoms of malaria infection can mimic other common conditions presenting to healthcare settings. A high index of suspicion and early diagnosis and management, alongside patient education and prevention methods, can greatly reduce morbidity and mortality from malaria worldwide. In this article we aim to cover the different types of malaria, individuals at particular risk of malaria acquisition, malaria prevention, treatment and key advances. We will focus on falciparum malaria as this causes the greatest morbidity and mortality.

PURPOSE: To investigate and compare how patients with diabetes mellitus and doctors rate the importance of outcomes used as part of composite endpoints in clinical diabetes trials. Secondly, to compare the ratings of outcomes between patients with low and high education. METHODS: Using a pre-piloted questionnaire, patients with diabetes and doctors working with diabetes were asked to rate the importance of 36 different outcomes commonly used in trials assessing intervention effects in patients with diabetes. The respondents were asked to rate individual outcomes as being either critical, of major importance, of moderate importance, or of minor importance. RESULTS: The study population consisted of 139 patients with a mean age of 56.6 years and an average duration of diabetes for 13.6 years and 45 doctors with a mean time of practice of 19.6 years. There was no difference between patients’ and doctors’ rating of risk of mortality and non-fatal myocardial infarction, and percutaneous coronary intervention (all p-values > 0.34). Non-fatal stroke, admission for heart failure or angina was perceived more severely by patients compared to doctors (all p-values < 0.03). Patients rated risk of foot-ulcers, amputations and quality of life as more important compared to doctors (p-values < 0.01). CONCLUSION: The current study suggest that patients and doctors weigh some diabetic outcomes used as part of composite endpoints in clinical diabetes trials differently. These findings call for more studies on patient reported outcomes and patient education for improved personal care. HIGHLIGHTS: • We performed this study to assess how patients and practicing physicians rate the importance of outcomes commonly used in diabetes trials. • We found that patients and doctors rate the importance of some outcomes used in clinical diabetes trials differently. • These findings suggest that shared decision making is pivotal when taking clinical decisions and that future diabetes studies incorporate end points relevant to both patients and clinicians and do not combine end points which are not equally important.

Precis Patient education and dosing self-efficacy are important factors related to ongoing adherence to glaucoma topical treatment, and patients view their disease management as a shared effort with their provider. Purpose Glaucoma affects nearly 3 million Americans and medication adherence has been reported to be as low as 20% in this patient population; however, key limitations to our understanding of this behavior in adults with glaucoma exist. Patient and methods This research used an electronic survey including validated concepts related to topical medication use and an in-person interview to investigate the influencers of and solutions for challenges to medication adherence in adults with glaucoma. Patient eligibility was determined upon arrival to a regularly-scheduled visit to the Vanderbilt Eye Institute during which they were asked for consent to complete the survey. Responses were captured by tablet and assessed using descriptive and inferential statistics. The primary focus was instrument correlations with the Adherence to Refills and Medications Scale (ARMS) score, and were run between ARMS and the totaled score for each individual questionnaire as well as individual items. Recorded interviews were thematically assessed by multiple study team members. Results Survey results of adults with glaucoma suggested that self-efficacy, forgetfulness, fear of side effects, and dosing ability were all related to self-reported medication adherence. Despite most having glaucoma for several years, discrepancies in disease knowledge were observed. Patient interviews uncovered three overall themes related to glaucoma treatment: (1) glaucoma management as a shared responsibility; (2) the importance of patient education; and (3) specific adherence facilitators and barriers. Conclusion Glaucoma medication adherence interventions may benefit from focusing on developing patient medication-taking self-efficacy, disease-related education, and engagement with their provider.

In this systematic review, the effects of osteoporosis patient education were examined. All studies found an effect on physical function, but for the other themes, the results were inconclusive. The findings indicate a need for further research in this topic. Introduction Osteoporosis is a chronic disease with serious consequences for the individual and major societal costs. With the aim of fracture prevention, many countries offer osteoporosis patient education. The objectives were to examine the effects and mediators of osteoporosis patient education and describe the characteristics of studies with and without an effect. Though, none of the included studies reported mediators, and therefore, we could not examine that. Methods Six databases were searched in October 2020. Two researchers independently conducted title and abstract screening as well as full-text review. Records were included if participants had osteoporosis, and the patient education was group-based, face-to-face, and addressed two or more aspects, e.g., diet, medication, and exercise. The Cochrane Collaboration tools were used for risk of bias assessment. Finally, data were extracted into a standardized form and presented narratively. Results In total, 2934 records were identified, and 13 studies met the inclusion criteria. All six studies examining the effects of patient education on physical function demonstrated improvements. In addition, one out of two RCT studies and one non-randomized study reported improved psychological wellbeing. Just one out of five RCT studies showed improvements regarding physical discomfort and disability. Effects on health-related quality of life, adherence and persistence, and knowledge of osteoporosis were inconclusive. Conclusion There is limited evidence for the effectiveness of osteoporosis patient education. There is a need for high-quality randomized controlled trials, which should describe the characteristics of the interventions and examine the mechanisms of osteoporosis patient education. Prospero registration number CRD42020211930.

Background: Shoulder pain is one of the most frequent complaints of Paraplegia with a prevalence reported to range from 50% to 60%.It has been attributed to the increase in upper extremity (UE) weight bearing following lower extremity paralysis. Purpose of the study: To develop and Evaluate an Evidence Based Patient Education Booklet in Hindi Language for Prevention of Shoulder Pain in Paraplegia along with pictorial presentation. Design: A methodological study Method: It consist of 4 steps. 1) Literature review and informal interview of 2 doctors, 7 physiotherapists, 5 occupational therapists and 10 patients were used to determine the domains of the education booklet. 2) Development of content of the evidence based patient education booklet according to domains found in step 1 and develop a rough draft of booklet in Hindi Language. 3) Evaluation of the evidence based booklet by expert panel using SAM and to modify the booklet to produce the final booklet draft. 4) Pilot study on patients to take their views regarding the booklet developed. Results: The domains found in step 1 were: Education about pain, Education about the treatment options, Ergonomics modifications, Positioning, Wheel chair selection and transfer techniques, Exercises, General precautions. The content was developed in step 2. In step 3 the SAM score is- 88.13% and final booklet was produced after modification. In step 4 the patient rated the booklet easy to read and understand with an overall rating of 9/10 Conclusion: The developed patient education booklet came out to be easy to read and understand and of superior quality according to Suitability assessment of material questionnaire and hence should be made a part of patient education. Keywords: Patient education booklet, Shoulder pain in paraplegia, Suitability assessment of material questionnaire, booklet in Hindi language, Pain prevention and management, Health education material

Prescription opioid analgesics contribute to serious, preventable adverse drug events (ADEs) and despite efforts ranging from regulatory changes to quality improvement initiatives, national studies indicate that opioid-related emergency department visits and hospitalizations are increasing amid the coronavirus disease 2019 (COVID-19) pandemic. Effective pain management is challenging during care transitions, and system imperfections make patients vulnerable to ADEs as they leave one care setting and move to another. Therefore, the Island Peer Review Organization (IPRO) pain management coalition convened a task force to develop resources to guide improvements in opioid-related communication during patient care transitions. Create a consensus list of requisite communication elements (RCEs) that should accompany all patients prescribed opioids as they undergo care transitions. An interprofessional task force of pain management experts was convened and completed a blinded, iterative Delphi process. After four Delphi rounds, the panel reached consensus on a pain management discharge communication (PMDC) List of 24 RCEs across the domains of opioid dosing and pain management (nine elements), factors associated with adverse drug events (nine elements), and patient education and caregiver support (six elements). During transitions of care providers need detailed information on opioid dosing, pain characteristics, risk factors for adverse events, and patient/caregiver capacity to adequately manage symptoms while avoiding potentially fatal ADEs. The PMDC list may guide the development of new clinical tools, quality measures, accreditation standards, and checklists for pharmacists involved in the delivery of opioid stewardship during a care transition. Additional work is needed to design comprehensive, interprofessional opioid stewardship programs to ensure that the requisite communication elements are consistently available at the time of a care transition.

Adherence to prescribed medication is important to the management of all diseases, especially those of chronic nature. Drug effectiveness is substantially compromised by therapy nonadherence. We reviewed the available evidences on the impact of patient preferences for therapy on adherence to a prescribed treatment in chronic diseases requiring long-term treatment. A search on PubMed retrieved 699 publications, leading to a selection of 12 publications: 6 on osteoporosis, 2 on moderate-to-severe asthma, 1 on type 1 diabetes, 1 on type 2 diabetes, 1 on kidney transplantation, and 1 on atrial fibrillation. Overall, 8 studies found a positive association between patient preference and adherence to therapy, while the others found no association. In general, overall adherence was considered to be high in the published studies. The reasons for a positive association included reduced dosing frequency, route of administration, lower costs, and favorable safety profile, which is related to the diverse nature of the pathology and its type and duration of treatment. A literature review suggests that achieving good adherence and persistence to therapy requires evaluation of patient preferences. In a period of increasingly limited resources, more effort is warranted to promote better adherence to therapy, especially when patients must self-manage their disease in the long term. Our results further highlight that insufficient attention has been given to the relationship between patient preference and adherence and point out the complex nature of adherence and the need for adequate patient education. More efforts are also needed to better understand the entity of cost savings for payers for specific treatments and the link with patient preference.

Purpose of Review To summarize the available literature regarding telehealth interventions in the management of pelvic floor disorders. Recent Findings Most Female Pelvic Medicine and Reconstructive Surgery (FPMRS) patients own and feel comfortable operating the technology required to participate in telehealth interventions and would be willing to interact remotely with their providers. Telehealth may be an appropriate and effective tool for patient education about bladder and pelvic physiology and pathophysiology, remote pelvic floor muscle strengthening when in-person physical therapy is not accessible, overactive bladder follow-up and medication management, and for postoperative care following uncomplicated incontinence and prolapse surgery. Summary There is a growing body of literature specific to FPMRS supporting various telehealth interventions that could reasonably be expected to improve access to sub-specialty care while maintaining or improving healthcare quality and reducing costs to the patient and the healthcare system.

Mosaic results obtained through preimplantation genetic testing for aneuploidy pose ongoing challenges to clinical practice. Thorough genetic counseling for patients considering mosaic embryo transfer is consistently recommended by many best-practice statements, and providers are charged with the task of assessing and explaining potential prenatal, neonatal, and long-term risks. However, an increasing amount of outcome data from transferred embryos with mosaic results do not show any evidence of increased risk to ongoing pregnancies or newborns. This article examines how to reconcile these data with the current practices for patient education about preimplantation genetic testing for aneuploidy and mosaic embryo risk assessment, through an evidence-based lens.

Polycystic ovarian syndrome affects between 6% and 18% of women of reproductive age worldwide. This syndrome can lead to female hyperandrogenism, insulin resistance, and female infertility. The Rotterdam criteria is used to improve timely diagnosis and treatment. A detailed physical examination, laboratory testing, and ultrasound imaging help diagnose this condition. Treatment is based on individual needs and should include lifestyle modifications, medication, health screening, and patient education. The goal of care should be to provide an accurate diagnosis of polycystic ovarian syndrome so that a treatment plan can be developed and implemented based on individual needs.

OBJECTIVE To determine the prevalence of anemia with the associated factors in pregnant women and the effect of family medicine practice and antenatal care services provided by family physicians on the prevention of anemia during pregnancy. STUDY DESIGN Community-based cross-sectional study. PLACE AND DURATION OF STUDY Family Health Centres in the Elazig region, Turkey from January to June 2019. METHODOLOGY A total of 495 pregnant women, attending the family health centres, were included. Women were administered a questionnaire related with the anemia and related factors; and hemoglobin values were drawn. Hemoglobin concentration

Purpose: To address demands for timely germline information to guide treatments, we evaluated experiences of patients with ovarian, pancreatic, and prostate cancer with a mainstreaming genetic testing model wherein multigene panel testing was ordered by oncologists with standardized pre-test patient education, and genetic counselors delivered results and post-test genetic counseling via telephone. Methods: Among 1203 eligible patients, we conducted a prospective single-arm study to examine patient uptake and acceptability (via self-report surveys at baseline and three-weeks and three-months following result return) of this mainstreaming model. Results: Only 10% of eligible patients declined participation. Among 1054 tested participants, 10% had pathogenic variants (PV), 16% had variants of uncertain significance (VUS), and 74% had no variant identified (NV). Participants reported high initial acceptability, including high satisfaction with their testing decision. Variability over time in several outcomes existed for participants with PV or NV: Those with NV experienced a temporary increase in depression (pTime

BACKGROUND Every day, more than 190 people in the United States die from opioid overdose. Unused opioid medications pose a risk to the patient and the community as they increase the potential for abuse or misuse. A contributing factor is lack of education on the proper disposal methods of unused opioid medications. PURPOSE The purpose of this quasi-experimental nursing study was to examine whether providing education on proper disposal of opioid medications would increase the proportion of patients who properly dispose of unused opioids. METHODS The study site's mandatory orthopaedic preoperative class was used for consenting patients. The control group did not receive targeted education on opioid disposal, whereas the intervention group did receive targeted education. A total of 86 patients were consented during Months 1 and 2 of the study. Forty-one patients were in the control group and 45 were in the intervention group. Demographic variables such as age, gender, and marital status were collected to determine whether certain demographic factors had an influence over whether or not opioids would be disposed of properly. FINDINGS Those in the intervention group who attended the class were slightly younger than those in the control group (68.2 ± 9.9 years vs. 70.3 ± 10.6 years, p = .5098), primarily male (57.5% vs. 35.0%, p = .0436), and more likely to live with a significant other (94.7% vs. 74.4%, p = .0249). Of those who had medication left over, 62.5% disposed of their unused opioid prescription in the intervention group compared with 40.7% in the control group (p = .1208). In the intervention group, 86.7% of the individuals with leftover medication disposed of it correctly compared with 63.5% in the control group (p = .3478). CONCLUSION Those who received education on appropriate opioid disposal were more likely to dispose of it in general as well as dispose of it correctly. Although not statistically significant, the findings from this study are clinically significant in that they provide direction on the importance of standardized and focused patient education on proper opioid disposal.

Rationale & Objective Education programs are needed for people with advanced chronic kidney disease to understand kidney failure treatment options and participate in shared decision-making (SDM). Little is known about the content and accessibility of current education programs or whether they support SDM. Study Design Stakeholder-engaged, mixed-methods design incorporating qualitative observations and interviews, and a quantitative content analysis of slide presentations. Setting & Participants Four sites located in Boston, Chicago, Portland (Maine), and San Diego. Analytical Approach Thematic analysis based on the Ottawa Framework (observations and interviews) and descriptive statistical analysis (slide presentations). Results Data were collected from observations of 9 education sessions, 5 semistructured interviews with educators, and 133 educational slide presentations. Sites offered group classes or one-on-one sessions. Development, quality, and accuracy of educational materials varied widely. Educators emphasized dialysis (often in-center hemodialysis), with little mention of conservative management. Educators reported patients were often referred too late to education sessions and that some patients become overwhelmed if they learn of the implications of kidney failure in a group setting. Commonly, sessions were general and did not provide opportunities for tailored information most supportive of SDM. Few nephrologists were involved in education sessions or aware of the educational content. Content gaps included prognosis, decision support, mental health and cognition, advance care planning, cost, and diet. Slide presentations used did not consistently reflect best practices related to health literacy. Limitations Findings may not be broadly generalizable. Conclusions Education sessions focused on kidney failure treatment options do not consistently follow best practices related to health literacy or for supporting SDM. To facilitate SDM, the establishment of expectations for kidney failure treatment options should be clearly defined and integrated into the clinical workflow. Addressing content gaps, health literacy, and communication with nephrologists is necessary to improve patient education in the setting of advanced chronic kidney disease.

Background Patient education is essential in Parkinson's disease (PD). However, it is not known which aspects of patient education are associated with an improvement in quality of life (QoL). Objective To identify factors that predicted an improvement in QoL in PD patients that participate in an education program. Methods EduPark is a community-hospital patient education program. PD Patients that had participated in the program between September 2013 and March 2017 were retrospectively included. QoL was prospectively evaluated (using the PDQ-8 questionnaire) before and after the patient's participation. We used mixed linear models (adjusted for the initial value of the PDQ-8) to determine socio-demographic and clinical variables that predicted the change in the PDQ-8 score. Results A total of 181 patients were included (mean ± standard deviation age: 62.9 ± 8.2 years; disease duration: 9.1 ± 5.3 years). 76.7% of the 103 patients having undergone a cognitive evaluation did not display cognitive impairment . We did not identify any factors that predicted the program's impact on the patient's QoL. Participation in the program was associated with a significant decrease (improvement) in the PDQ-8 score (39.4 ± 17.81 before and 35.6 ± 15.9 afterwards, P Conclusion We did not identify any factors that were predictive of the patient education program's impact on QoL in patients with PD. Participation in the program was associated with a significant improvement in QoL. Our results suggest that Patient Education Programs should be more widely prescribed and developed in the management of PD.

Patients highly vulnerable for COVID-19 infection have been proposed to take priority for vaccination. However, vaccine hesitancy is usually more prevalent in these patients. Investigation around modifiable contributors of vaccine hesitancy plays a pivotal role in the formulation of coping strategies. We aimed to evaluate the impact of vaccine misconception in patients with lung cancer or pulmonary ground-glass opacity (GGO). A web-based questionnaire was constructed based on a qualitative interview with 15 patients and reviewed by a multidisciplinary expert panel. Six Likert five-scale questions were used to generate a score of vaccine misconception (SoVM), which ranged from 0 to 24 points, with a higher score indicating a higher level of misconception. A total of 61.6% (324/526) patients responded to our questionnaire. A higher proportion of low willingness patients (n = 173), compared to high willingness patients (n = 151), disagreed that cancer patients should be prioritized for COVID-19 vaccination (82.1% vs. 50.3%, p

To enable patients with rheumatoid arthritis (RA) and their healthcare professionals to choose the optimal treatment, it is crucial to accurately assess the current state of inflammatory activity. The objectives of this study were to (1) investigate the perspective of RA patients on their insight into the current status of their disease, and to (2) investigate the patients’ perspective on the possible added value of a monitoring device based on optical spectral transmission—called the HandScan—that measures the location and severity of joint inflammation. A survey was distributed online among patients with RA in the Netherlands. Four-hundred and eight patients with RA completed the survey. Of these, 298 (73%) felt they have sufficient insight into their current disease status. Most respondents perceived either a large (n = 242; 59%) or small (n = 148; 36%) added value of the HandScan in their monitoring process, mostly because the device provides additional knowledge on the presence of inflammation. This perceived added value was higher for respondents experienced with the device (n = 46; p = .04). Respondents preferred monitoring with the device on every (n = 192; 47%) or most (n = 171; 42%) visits to the outpatient clinic, or even more often than on every visit (n = 17; 4%). Monitoring RA using an optical spectral transmission device is seen by patients as a possibly valuable addition to the monitoring process of inflammatory activity during visits to an outpatient clinic. Their main reason was that the device can increase insight into their current disease status. More insight may support patients in discussing treatment options with their rheumatologist.

© 2021 American Academy of PeriodontologyBackground: Peri-implantitis (PI) is a growing concern in the dental community worldwide. The study aimed to compare U.S. versus European periodontists’ considerations of risk factors, diagnostic criteria, and management of PI. Methods: A total of 393 periodontists from the United States and 100 periodontists from Europe (Germany, Greece, Netherlands) responded to anonymous surveys electronically or by mail. Results: Compared to U.S. periodontists, European respondents were younger, more likely to be female and placed fewer implants per month (9.12 vs 13.90; P = 0.003). Poor oral hygiene, history of periodontitis, and smoking were considered as very important risk factors by both groups (rated > 4 on 5-point scale). European periodontists rated poor oral hygiene (4.64 vs 4.45; P = 0.005) and history of periodontitis (4.36 vs 4.10; P = 0.006) as more important and implant surface (2.91 vs 3.18; P = 0.023), occlusion (2.80 vs 3.75; P < 0.001) and presence of keratinized tissue (3.27 vs 3.77; P < 0.001) as less important than did U.S. periodontists. Both groups rated clinical probing, radiographic bone loss, and presence of bleeding and suppuration as rather important diagnostic criteria. They rated implant exposure/mucosal recession as relatively less important with U.S. periodontists giving higher importance ratings than European periodontists (3.99 vs 3.54; P = 0.001). Both groups nearly always used patient education, plaque control and mechanical debridement when treating PI. U.S. periodontists were more likely to use antibiotics (3.88 vs 3.07; P < 0.001), lasers (2.11 vs 1.68; P = 0.005), allograft (3.39 vs 2.14; P < 0.001) and regenerative approaches (3.57 vs 2.56; P < 0.001), but less likely to use resective surgery (3.09 vs 3.53; P < 0.001) than European periodontists. Conclusions: U.S. and European periodontists’ considerations concerning risk factors, diagnosis and management of PI were evidence-based. Identified differences between the two groups can inform future educational efforts.

European journal of anaesthesiology : EJA 38(12), 1284-1292 (2021). doi:10.1097/EJA.0000000000001616, Published by Ovid, New York, NY

Aim Gout is a common form of inflammatory arthritis with suboptimal management. Management guidelines for gout highlight the importance of both pharmacological and non-pharmacological treatments. Dietitians can potentially assist in improving gout's associated dietary and lifestyle factors, and thereby play a role in improving its management. The aim of this study was to investigate perspectives of Australian community dietitians on whether their role in gout management could be expanded to improve management and treatment of gout. Method A snowballing recruitment strategy was used. Dietitians known to the research team were invited to participate and then they suggested further dietitians. Semi-structured interviews (one-on-one) were conducted with 16 dietitians. The focus was on their experiences of contributing to the management of gout, including any barriers and facilitators experienced. Interviews were transcribed verbatim and independently analyzed by 2 reviewers to identify themes. Results The main reported role of dietitians in gout management was providing patient education. An identified facilitator was dietitians' understanding of gout and its dietary management. Barriers included the emphasis placed on medications for treatment by clinicians and patients, consultation costs, limitations in the evidence for the efficacy of dietary changes and lack of specific training in gout for dietitians. Dietitians predominantly managed the other metabolic conditions commonly associated with gout. Conclusion Currently, the role dietitians play in gout management is limited. However, dietitians have the potential to take on larger roles in gout education and can also indirectly contribute by way of management of commonly associated comorbidities in gout patients.

Introduction: Diabetes mellitus is a disease that requires the patient to strictly adhere to the prescribed treatment throughout his life to prevent the development of various complications of diabetes. The need for repeated daily medication intake, learning knowledge about diabetes, gaining skills of self-monitoring of health indicators (glucose, blood pressure, level of physical activity), visits to healthcare facilities for preventive examinations and treatment is a heavy burden on the patient, reducing the quality of life and motivation to comply with the prescriptions of the attending physician. Objectives: To analyze the level of adherence to drug therapy and its factors in patients with diabetes mellitus. Methods: The survey was carried out over the Internet from November 2020 to February 2021. 434 respondents with diabetes mellitus, aged from 18 to 80, were included into study. Among them there were 221 women (50,92%) and 213 men (49,08%). The proportion of respondents with type 1 diabetes mellitus (T1DM) was 23,96% (n = 104, 95% CI 20,17%–28,22%), with type 2 diabetes mellitus (T2DM) – 76,04% (n = 330, 95% CI 71,78%–79,83%). The survey questionnaire consisted of 2 parts. The first part contained 54 questions related to demographic, socioeconomic, and health status of participants’ along with questions designed to identify respondents’ risk factors, diabetes course and complications, information technology usage in treatment and health management process. The second part of the survey contained 25 questions based on the “Russian universal questionnaire for quantifying adherence to treatment” (KOP-25). The Pearson chi-square test and Cramér's V test of the effect size were used to assess the collected nominal data. Results: A low level of adherence to drug therapy prevailed among all respondents, 38,48% (n = 167). Statistically significant differences in the level of adherence to drug therapy were found among respondents with type 1 diabetes mellitus (p < 0,0001), ones visited the schools of diabetes (p

Background: Patient demand for education and access to the clinical nurse specialists (CNSs) during the rheumatology clinic at one hospital in Ireland was increasing. Alternative methods of providing patient education had to be examined. Aims: To explore the efficacy of video-based outpatient education, and its impact on demand for the CNSs. Methods: A video was produced to play in a rheumatology outpatient department. A representative sample of 240 patients (120 non-exposed and 120 exposed to the video) attending the clinic was selected to complete a questionnaire exploring the effect of the video. Data were analysed using chi-square tests with Yates' continuity correction. Findings: Demand for the CNSs was six times higher in the non-exposed group compared with the exposed group (non-exposed: 25%, exposed: 4.8%) (χ2=15.7, P=0.00007), representing a significant decrease in resource demand. Conclusion: High-quality educational videos on view in the rheumatology outpatient department provide patients with information sufficient to meet their educational needs, thus releasing CNS resources.

PURPOSE The purpose of this study was to evaluate mid-term outcomes of magnetically controlled growing rods (MCGR), evaluate factors associated with unplanned return to the operating room (UPROR) vs achieving full length. Full length was defined as achieving > 85% of the elongating portion of the rod. METHODS IRB approved retrospective single site study. 106 patients underwent MCGR between 2014 and 2020, 58 met inclusion criteria, all genders, ethnicities, and etiologies were included. Patients with 3.5 year follow-up 47% were electively revised, 27% underwent UPROR, 26% were still lengthening, and 3% were being observed. UPROR was associated with male gender and age at implantation was associated with implant-related causes of UPROR. MCGR continues to have high complication rates, better knowledge of MCGR outcomes may improve patient education, surgical timing, and decision-making.

Introduction. The aim of this prospective study was to estimate the perception and popularity of complementary and alternative medicine (CAM) subtypes and the reasons for usage among adult Polish cancer patients. Material and methods. The validated questionnaire was conducted among 310 patients. 24.1% of the patients used CAM during their oncological treatment. Risk factors for CAM usage were: female gender, university degree and radical treatment. The most common reasons for CAM usage were: boosting the immune system (46.1%), improving well-being/ counteracting the ill effects of cancer and its treatment (40.8%). The average level of satisfaction with CAM was high (≥3/5 on a Likert scale). Nearly half of the patients (46.6%) admitted not informing their doctors about their CAM usage. Conclusions. The growing popularity and heterogeneity of CAM methods make it an important issue for patient–doctor relations in Poland and other Central European countries. The results of this study indicate what topics should be covered while introducing patient education programs.

Background The effects of training practices on outcomes of patients receiving peritoneal dialysis (PD) are poorly understood and there is a lack of evidence informing best training practices. This prospective cohort study aims to describe and compare international PD training practices and their association with peritonitis. Methods Adult patients on PD Results A total of 1376 PD patients from 120 facilities across seven countries were included. Training was most commonly performed at the facility (81%) by facility-affiliated nurses (87%) in a 1:1 setting (79%). In the UK, being trained by both facility and third-party nurses was associated with a reduced peritonitis risk [adjusted HR 0.31 (95% confidence interval 0.15–0.62) versus facility nurses only]. However, this training practice was utilized in only 5 of 14 UK facilities. No other training characteristics were convincingly associated with peritonitis risk. Conclusions There was no evidence to support that peritonitis risk was associated with when, where, how or how long PD patients are trained.

To the Editor, Radical Prostatectomy (RP) is one of the preferred treatments for localized prostatic cancer and although surgical complications have been reduced over the years, urinary incontinence and erectile dysfunction are still common and significantly impact the patient’s life. Therefore, adequate patient education and counselling before RP is essential. Informed Consent (IC) is a crucial element of doctor-patient interaction, and it must ensure that patients receive and understand all the information regarding their diseases and treatments. Implicit in providing IC is assessing the patient’s understanding, since accessible communication enables them to make informed decisions consciously and autonomously about their health status [...].

Purpose To identify the reasons for delayed presentation among patients with sight-threatening diabetic retinopathy (STDR) and to assess their knowledge, attitude, and practice (KAP) patterns in context to diabetes mellitus (DM) and diabetic retinopathy (DR). Methods Single-center, cross-sectional, questionnaire-based KAP survey. All consecutive cases of STDR who presented to our tertiary eye care facility from June 2020 to November 2020 were recruited. The KAP scoring survey tool was incorporated into the questionnaire to help evaluate and represent the patient's disease. Results 170 patients with STDR were enrolled in the study. The mean age of patients was 54 ± 9.34 years (Range: 21-70 years); 110 patients (64.7%) were between 41 and 60 years; 131 patients (76%) had DM for more than 5 years. The STDR changes were more prevalent in patients with an educational qualification of high school or less (n = 142; 83.5%). Fifty-two patients (30.6%) had been informed regarding the detrimental effect of diabetes on the eyes and were recommended to consult an ophthalmologist by the treating physician. Of these, 24 (46.15%) patients were educated about retinal changes due to diabetes. Eighty-five (50%) patients in our study had good knowledge about DM; 13 (7.6%) patients had good knowledge about DR. For patients not compliant for follow-ups with the treating physician, the use of "home glucometers for self-monitoring (n = 60, 35.3%) was the most prevalent reason. The main reason for poor compliance for undergoing a dilated fundus examination by the ophthalmologist was "Had good vision, so didn't feel the need" in 143 (90.5%) patients. Conclusion The absence of visual complaints, lack of knowledge, and failure to undergo a dilated fundus examination in the past were the prevalent risk factors in patients presenting with STDR. Knowledge/practice about DR was poor among the patients with STDR. The treating physicians and ophthalmologists were the most common sources for patient education.

Background Chronic anticholinergic medication (ACM) prescribing with antipsychotics when no longer clinically indicated can lead to serious side effects and adversely impact patient quality of life. Objectives Through modifications of previously described deprescribing strategies undertaken in an academic, schizophrenia clinic, this quality improvement (QI) project aimed to bolster ACM deprescription where clinically appropriate among patients with schizophrenia and other psychiatric disorders at a community mental health center. Methods A multidisciplinary team involving clinical pharmacists and psychiatrists created web streaming video medical education accredited modules, supplemented by small groups sessions and case consultations, and provided these to psychiatrists and nurse practitioners at a community mental health center over a one-year period. Electronic medical record reports were also generated, highlighting patients who were receiving one of two ACM used in the clinic: benztropine and/or trihexyphenidyl; these were periodically distributed to support appropriate deprescription. Patient education infographic material focused on ACM were also created and deployed. Results One hundred and twenty-six patients were identified as receiving benztropine or trihexyphenidyl in March 2019. One hundred and six (84%) were on one or both of these medications for at least six months. The mean (±SD) age of the study sample was 53.4 (±12.6) years; a third of the sample was over 60 years. Thirty-seven patients, or 29.4%, had their ACM discontinued or the dosage reduced. Deprescription was not associated with age, sex, race, or diagnosis. Deprescription was not associated with antipsychotic polypharmacy, first versus second generation, or oral versus long acting preparation. Conclusions These results suggest that deprescription of ACM in a community mental health center can occur with prescriber education and support. However, results from previous stages of this QI project, where much higher rates of deprescription were demonstrated, indicate the important benefit of more direct clinical pharmacist support and involvement in the process.