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1.
Cody Goessl Paul Estabrooks Wen You Denise Britigan Armando DeAlba Fabio Almeida 《Patient education and counseling》2019,102(5):968-975
Objective
This study evaluates the effectiveness of technology versus in-person, group-initiated diabetes prevention to enhance comprehension of learning objectives between patients with differing health literacy (HL).Methods
Evidence-based content through either a DVD (n?=?217) or in-person, group class (n?=?225) to initiate the intervention. A teach-back call was used to assess comprehension of, and reinforce, learning objectives. Chi-squared was used to determine differences between conditions (DVD vs Class) and HL levels (High n?=?361 vs. Low n?=?81) and regression analyses were used to examine relationships.Results
DVD participants performed significantly better across teach back questions (15.4?±?2.5 v. 14.8?±?2.6, p?<?0.01), demonstrated comprehension in fewer teach-back rounds (1.9?±?0.7 v. 2.1?±?0.7, p?<?0.01), and answered more questions correctly on the first try (4.2?±?1.6 v. 3.4?±?1.8, p?<?0.01). Models for HL levels and modality by HL level were statistically significant (p?<?0.01) favoring the DVD.Conclusion
Initiating a diabetes prevention program with the use of a DVD appears to be a superior option to in-person, class sessions. Teach-back and teach-to-goal strategies enables participants of both high and low health literacy levels to receive and confirm mastery of diabetes prevention objectives.Practice Implications
A teach-back call may improve information uptake increasing the likelihood of health behavior uptake. 相似文献2.
Objectives
Pregnancy options counseling, or nondirective counseling of patients with unintended pregnancy, is a “necessary competency” for medical students according the Association of Professors of Gynecology and Obstetrics. Narrative Medicine (NM) utilizes stories of illness to inform clinical practice and promotes self-reflection in medical education. The authors analyzed the effect of a NM workshop on medical students’ ability to provide pregnancy options counseling.Methods
The authors randomized students in the major clinical year at Columbia University Medical Center (CUMC) to either a 2-hour NM workshop or to a control intervention. The NM group participated in reading and reflective writing exercises addressing varying perspectives on pregnancy. Students then completed a video-taped and numerically-scored OSCE (Objective Structured Clinical Examination) regarding pregnancy options counseling. The authors compared mean OSCE scores between the groups.Results
The study analyzed 103 participants. Overall mean OSCE scores were higher in the NM group (11.9?±?1.5, n?=?51) than the control group (11.3?±?1.6, n?=?52) (p?=?0.049).Conclusions
Students undergoing a NM workshop had higher scores on a pregnancy options counseling OSCE.Practice implications
This brief intervention may aid future physicians in providing nondirective pregnancy options. This novel approach to teaching is an easily shared learning tool. 相似文献3.
Ken Dewitte Marc Claeys Emeline Van Craenenbroeck Koen Monsieurs Hein Heidbuchel Vicky Hoymans Tibor Stoop 《Pathophysiology》2019,26(1):53-59
Aims
We explored the effect of remote ischaemic conditioning (RIC) on endothelial function and on circulating mediators.Methods and results
In 20 healthy male volunteers (mean age 31?±?10 years), flow-mediated dilation (FMD) was measured before and after 20?min of arm ischaemia, followed by reperfusion. Remote ischaemic conditioning (RIC) was performed by applying 3 cycles of 5?min of ischaemia of the leg at the onset of index arm ischaemia. Each volunteer underwent the IR-induced vascular injury protocol with and without RIC in a crossover study design.In the control group, IR significantly reduced FMD (5.9?±?2.9% before IR vs. 2.2?±?3.7% after IR; p?<?0.001). This effect was significantly attenuated by performing RIC (FMD of 5.5?±?3.1% before IR vs. 4.0?±?3.4% % after IR; p for interaction?=?0.01). Serum levels of SOD and ADMA increased significantly whereas MCP-1 and VEGF levels decreased significantly.Only changes in SOD levels were significantly related to the degree of RIC induced protection (r²?=?0.34; p?=?0.018).Conclusion
RIC has protective effects against endothelial IR injury. Our biomarker study suggests that anti-oxidative stress mediators, such as SOD, seem to be more involved in the pathogenesis of RIC-induced protection in humans than angiogenesis factors or chemo-attractant cytokines. 相似文献4.
5.
Jayanthi J. Chandar David A. Ludwig Juan Aguirre Adela Mattiazzi Malgorzata Bielecka Marissa Defreitas Alan M. Delamater 《Patient education and counseling》2019,102(5):1035-1039
Objective
The objective of this study was to facilitate functional health literacy (FHL) with a modified “Teach Back” method. A computer-based program was developed for adolescent and young adult kidney transplant recipients (KTR) to knowledgeably answer questions about their medical condition, medications, and create a simple synopsis of their personal health record with the help of the heath care provider (HCP).Methods
In a pre-post quasi-experimental design, 16 patients received the computer intervention in which they navigated questionnaires and brief informational video clips. Knowledge scores were assessed at baseline and 3 months. The binomial sign test was used to evaluate change in knowledge and purpose of medications.Results
Mean age was 17.3?±?2.4 years and 94% were non-Caucasian. Seven of 16 patients were academically below grade level. Twelve of 16 patients improved their overall knowledge (P?=?0.0002) and purpose of medications (P?=?0.0017).Conclusions
A Modified “Teach Back” during clinic visits was associated with improvements in FHL.Practice Implications
This modified ‘teach back’ program has the potential to improve FHL which could contribute to long-term preservation of kidney transplants. 相似文献6.
Patient knowledge and attitudes toward cervical cancer screening after the 2012 screening guidelines
Jayanti M. Clay Joanne K. Daggy Sunetris Fluellen Brownsyne Tucker Edmonds 《Patient education and counseling》2019,102(3):411-415
Objective
To assess women’s attitudes and preferences related to recent changes in cervical cancer screening guidelines.Methods
We distributed 380 surveys in three University based and Community clinics. Study participants anonymously completed surveys, which included questions related to demographics, cervical cancer, screening practices, risk perception and attitudes towards changing practices.Results
315 women agreed to participate (83%). 60% (185/310) of participants had some college education or higher and 12% (36/305) worked in the medical field. On average, participants answered 4.1 (SD?=?1.3) of the 8 knowledge questions correctly. Knowledge scores significantly increased with education level (Kruskal-Wallis test p-value?<?0.001). The majority (72%, n?=?228) reported that they should be screened annually, and that screening should be initiated with the onset of sexual activity (63%, n?=?197). Participants that were more knowledgeable of current screening practices were more comfortable extending screening intervals (Kruskal-Wallis test p?<?0.001).Conclusion
Even among a relatively highly educated population of women, participants had limited knowledge of cervical cancer and current screening guidelines. Many participants reported discomfort with less frequent screening intervals.Practice implications
This study supports the need for improvement in cervical cancer prevention education especially with regards to the new screening guidelines. 相似文献7.
Binnari Kim Yun-jeong Jang Sujin Park Jung-Il Lee Hong Kwan Kim Joungho Han 《Pathology, research and practice》2019,215(4):807-815
Background
Studies have shown that 30–50% of non-small cell lung cancer (NSCLC) patients develop brain metastasis (BM). Since BM shortens overall survival and decreases the quality of life, early detection and treatment of BM are vital. While data are available for clinical risk factors of NSCLC with BM, histopathological factors are not well understood. Therefore, we evaluated the histopathological related factors which will help early detection and selection of effective treatment options.Materials and methods
A total of 117 surgical lung specimens diagnosed as NSCLC with BM were included as a study group. We included 237 cases without BM as a control group. One pathologist reviewed H&E slides and analyzed the histopathologic factors of all cases.Results
In pulmonary adenocarcinoma, vascular invasion, N stage, micropapillary pattern and necrosis were significantly associated with BM in multivariate analysis (vascular invasion, p?=?0.009; micropapillary pattern, p?=?0.024; others, p?<?0.001). Tumor with extensive necrosis had higher hazard ratio and shorter time to BM (p?<?0.001).Conclusion
Our findings suggest that necrosis is a new predictive factor of BM in pulmonary adenocarcinoma. Short term follow-up is needed especially when extensive necrosis is present. 相似文献8.
Objective
Patient education on high-risk medications such as warfarin is important, and they require quick follow-up after initiation to maximize efficacy and safety. In our Anticoagulation Clinic, two 60-minute new patient appointments are available each day, contributing to prolonged lead-time. We instituted standardized warfarin video education to shorten in-clinic-room visit time, to potentially increase new patient appointments.Methods
Patients viewed the video in the waiting area with a goal to decrease visit times by 15?min (25%), before pharmacists completed their visit. Data collected included time spent in the clinic room, education comprehension, and patient feedback.Results
Ninety patient visits were evaluated in one pre-intervention and two post-intervention phases. Patients who received video education spent less time in the clinic room versus those who had not (52.4 vs 39.4?min, p?=?0.001), and two-thirds of all post-intervention visits achieved 25% reduction in visit time. There were no significant differences in education comprehension and patient satisfaction.Conclusion
Video education significantly decreased in-clinic-room visit time, and most patients achieved a goal of 25% reduction in time spent, without a change in comprehension or patient satisfaction.Practice implications
Implementation of video education can reduce clinic times in many patients without significantly impacting patient satisfaction. 相似文献9.
Aisha T. Langford Binhuan Wang Natasha A. Orzeck-Byrnes Sneha R. Aidasani Lu Hu Melanie Applegate Dana N. Moloney Mary Ann Sevick Erin S. Rogers Natalie K. Levy 《Patient education and counseling》2019,102(3):520-527
Background
Insulin titration is typically done face-to-face with a clinician; however, this can be a burden for patients due to logistical issues associated with in-person clinical care. The Mobile Insulin Titration Intervention (MITI) used basic cell phone technology including text messages and phone calls to help patients with diabetes find their optimal basal insulin dose (OID).Objective
To evaluate sociodemographic and clinical correlates of reaching OID, text message response rate, and days needed to reach OID.Methods
Primary care providers referred patients to MITI and nurses delivered the program. Three multivariable regression models quantified relationships between various correlates and primary outcomes.Results
The sample included 113 patients from 2 ambulatory clinics, with a mean age of 50 years (SD?=?10), 45% female, 79% Hispanic, 43% unemployed, and 46% uninsured. In regression models, baseline fasting blood glucose (FBG) was negatively associated with odds of reaching OID and 100% text responses, and positively associated with days to reach OID, p?<?.05).Conclusions
Patients with higher baseline FBG levels were less successful across outcomes and may need additional supports in future mHealth diabetes programs.Practical Implications
Basic cell phone technology can be used to adjust patients’ insulin remotely, thereby reducing logistical barriers to care. 相似文献10.
A. Folch-Ayora M.I. Orts-Cortés L. Macia-Soler M.V. Andreu-Guillamon J. Moncho 《Patient education and counseling》2019,102(3):511-519
The objective of this study was to assess the effectiveness of an education program and telephone call follow-up at improving the health related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD).
Method
Experimental, controlled, randomized, single blind study, masked data analysis. Duration of 2 years and 3 months. Patients hospitalised for exacerbation. The effectiveness was evaluated by calculating the absolute and relative change (%) of the St. George questionnaire scores (total and by dimensions) before and after the intervention program. Calculation of the effect of the group variable on the absolute and relative changes of the variables, Multiple Analysis of Variance (MANOVA).Results
Completed study of 116 patients. Greater effects on their HRQL reported at admission (48.3?±?SD 20.0 years). Patients in the intervention group improved significantly in their total SGRQ scores (?6.83) in absolute and relative terms and more significantly in their activity dimension (?16.05).Conclusions
The education program was effective at improving global HRQL, especially the activity dimension, in exacerbated COPD patients.Practice implications
This research contributes to clarifying the benefits and contents of education programs for patients with COPD; hospital admission is the suitable moment to contact these patients. 相似文献11.
Karen A. Lindsley 《Patient education and counseling》2019,102(5):944-951
Objective
To develop a patient-centered informed consent and assessment tool written at a 6th grade-level that is multimodal, affordable, transportable, and readily modifiable for protocol updates.Methods
This quality improvement initiative was performed in two phases on an actively-recruiting study at a pediatric diabetes clinic. In phase I, 38 volunteers underwent the standard-paper consent process, a comprehension assessment and provided feedback. Using feedback and the structure of the Plan-Do-Study-Act cycle a multimodal consent and assessment were developed. In phase II, volunteers were randomized to the standard (n?=?25) or the multimodal consent (n?=?25) and all completed the same comprehension assessment via touch-screen tablet. Primary outcomes were comparison of the individual and total comprehension assessment scores.Results
Total comprehension scores were higher in the multimodal versus the standard consent group (p?<? 0.001) and on the elements of benefits (p?<? 0.001), risks (p?<? 0.001), volunteerism (p?<? 0.012), results (p?<? 0.001), confidentiality (p?<? 0.004) and privacy (p < 0.001).Conclusion
A multimodal consent and assessment presented sequentially on a touch-screen tablet were patient-centered enhancements to standard consent.Practice implications
Multimodal standardization of delivery with improved readability may strengthen the informed consent process. 相似文献12.
13.
Daniel Rojas-Bolivar Fitzgerald A. Arroyo-Ramírez Jhesvith Santos Christian Moruquilca Carlos Valdivia 《Educación Médica》2019
Objective
To evaluate medical students perception of the educational environment in the “San Fernando” School of Medicine of the National University of San Marcos of Lima, Peru.Materials and methods
A quantitative and cross-sectional study was performed using the Dundee Ready Educational Environment Measure. A total of 177 medical students from second to sixth year were tested.Results
The scores obtained from the DREEM demonstrate that medical student's perceptions were positive in learning (53.7%), teachers (7.5%), environment (66.1%), and academic situation (66.1%). However, there was a negative perception of their medical school (57.1%). The overall rating of the perception of the educational environment was positive (75.7%).Discussion
The medical student's perception of the medical school educational environment was positive. It is recommended to strengthen the medical student's social environment related to medical school. 相似文献14.
15.
Bin Yu Youming Ding Xiaofeng Liao Changhua Wang Bin Wang Xiaoyan Chen 《Pathology, research and practice》2019,215(5):939-945
Background
TONSL has been suggested to function as an oncogene in lung, esophageal and cervical cancer. This study was aimed to identify the expression of TONSL and its role in hepatocellular carcinoma (HCC).Methods
By data mining in the Cancer Genome Atlas (TCGA) and Human Protein Atlas (HPA) databases, the expression profile of TONSL, its clinical significance, the potential mechanisms of its dysregulation and its underlying biological function in HCC were investigated.Results
TONSL was significantly upregulated in HCC tissues relative to normal liver tissues (P?<?0.05). High TONSL expression was significantly correlated with advanced TNM stage, poorly differentiated tumors, vascular invasion, elevated serum alpha-fetoprotein expression and a worse prognosis (all P?<?0.05). Multivariate analysis further confirmed that TONSL overexpression was an independent risk factor for poor overall survival (OS) and recurrence-free survival (RFS) in HCC (all P?<?0.05). Additionally, 16% of HCC cases (n?=?370) had TONSL DNA amplification. The total methylation level of TONSL was moderately and negatively correlated with its mRNA expression (P?<?0.05). TONSL was predictively targeted by miR-133b, which was downregulated in HCC and negatively related to TONSL mRNA expression (all P?<?0.05). Kaplan-Meier analyses demonstrated that low miR-133b expression was significantly associated with poor OS and RFS (all P?<?0.05). Moreover, gene set enrichment analysis revealed that cases with TONSL overexpression were enriched in cell cycle regulation pathways (all P?<?0.05).Conclusions
TONSL holds promise for serving as a prognostic biomarker for HCC. DNA amplification, hypomethylation and miR-133b downregulation could be the mechanisms associated with TONSL upregulation in HCC. TONSL might function as an oncogene via cell cycle regulation pathways in HCC. 相似文献16.
Nae Yu Kim Jung-Soo Pyo Dong-Wook Kang Seung-Min Yoo 《Pathology, research and practice》2019,215(3):580-585
Objective
The aim of this study was to elucidate the clinicopathological significance and prognostic role of loss of claudin-1 in colorectal cancer (CRC).Methods
The correlations between claudin-1 expression and clinicopathological characteristics, including survival rates, were assessed using immunohistochemistry on 260 archival, paraffin-embedded CRC tissues. In addition, the correlations between cludin-1 and nuclear factor-kappa B (NF-κB), epithelial-mesenchymal transition markers and tumor-infiltrating lymphocytes were investigated.Results
Claudin-1 expression was markedly lost in 42.7% of the 260 CRCs analyzed. Loss of claudin-1 expression significantly correlated with larger tumor size, vascular invasion, higher pT stage, and high metastatic lymph node ratio. In addition, loss of claudin-1 expression significantly correlated with NF-κB activation (P?<?0.001), high SNAI (P?<?0.001), and low E-cadherin (P?<?0.001) expressions. Patients with high immunoscores showed significantly lower rates of claudin-1 expression loss (P?=?0.020). In detail, loss of claudin-1 expression were frequently found in CRCs low CD3- and CD8-positive lymphocytes. There were significant correlations between claudin-1 expression loss and poor overall and recurrence-free survivals (P?<?0.001 and P?<?0.001, respectively).Conclusion
Taken together, our results suggest that the loss of claudin-1 expression significantly correlates with aggressive tumor behaviors, high SNAI expression, lower immunoscore, and poor prognoses. 相似文献17.
Sucharita Kher Hillary Landau Stephanie M. Hon Janis L. Breeze Nadine Al-Naamani Jessica K. Paulus Andrew Martin Rosemary Tsacoyianis 《Patient education and counseling》2019,102(5):932-936
Objective
Identify inhaler use characteristics among English (ESP) and non-English speaking patients (NSP) to develop quality improvement efforts.Methods
Outpatients were surveyed for technique confidence, education, preferences and disease control. We compared characteristics between ESP and NSP.Results
Of 197 respondents, 75% were ESP, 25% were NSP. Compared to NSP, ESP responders were more likely female (57% vs 31%, p?=?0.001), used inhalers for a longer time (10 vs 6 years, p?=?0.008) and had higher rates of metered dose inhaler use (85% vs. 60%, p?<?0.001). Both language groups had similar confidence in inhaler use, after adjustment for age, gender and duration of use. Similar rates of inhaler technique education were reported by ESP and NSP at the initial visit. More NSP reported receiving education at subsequent visits (54% vs. 72%, p?=?0.03). Education for both groups was mostly performed by a clinician. Both language groups reported low internet use for learning proper technique, low interest in a separate education session, preferred an active learning method.Conclusions
These findings will be used to further develop quality inhaler education efforts at our institution.Practical implications
Local patient preferences should be considered when designing inhaler education programs. 相似文献18.
Mingxia Chen Xiaoqing Yang Min Yang Wei Zhang Lei Li Qing Sun 《Pathology, research and practice》2019,215(5):1033-1037
Purpose
To screen novel candidate biomarkers in primary colorectal cancer (CRC), and indentify their clinical valuation in progress of colorectal cancer.Methods
By using antibody microarray, 274 target proteins in tissue samples from primary colorectal cancer patients were detected. Among differently expressed proteins in CRC tissues, As promising candidate biomarker, RANTES/CCL5 was validated by enzyme-linked immunosorbentassay and immunohistochemistry (IHC), and the clinical significance of CCL5 was analyzed.Results
Totally, 25 differentially expressed proteins were indentified between colorectal cancers and matched normal mucosa. CCL5 expression was significantly associated with adverse pathological progress, apt to lymph node metastasis and higher T stage.Conclusions
CCL5 may contribute to promoting tumor growth, and CCL5 is a promising target that may help in understanding the pathogenesis of CRC. 相似文献19.
U. Olivia Kim K. Barnekow S.I. Ahamed S. Dreier C. Jones M. Taylor Md.K. Hasan M.A. Basir 《Patient education and counseling》2019,102(4):701-708
Objective
To develop an educational mobile application (app) for expectant parents diagnosed with risk factors for premature birth.Methods
Parent and medical advisory panels delineated the vision for the app. The app helps prepare for preterm birth. For pilot testing, obstetricians offered the app between 18–22 weeks gestational age to English speaking parents with risk factors for preterm birth. After 4 weeks of use, each participant completed a questionnaire. The software tracked topics accessed and duration of use.Results
For pilot testing, 31 participants were recruited and 28 completed the questionnaire. After app utilization, participants reported heightened awareness of preterm birth (93%), more discussion of pregnancy or prematurity issues with partner (86%), increased questions at clinic visits (43%), and increased anxiety (21%). Participants reported receiving more prematurity information from the app than from their healthcare providers. The 15 participants for whom tracking data was available accessed the app for an average of 8?h.Conclusion
Parents with increased risk for preterm birth may benefit from this mobile app educational program.Practice implications
If the pregnancy results in preterm birth hospitalization, parents would have built a foundation of knowledge to make informed medical care choices. 相似文献20.