An Educational Strategy for Treating Chronic,Noncancer Pain With Opioids: A Pilot Test

Chronic pain is common and can be devastating to the patient and challenging to the health care provider. Despite the importance of the topic, pain management curricula are incomplete in health professionals' training. We developed a longitudinal curriculum to teach therapy for chronic noncancer pain over four units and pilot-tested the teaching of one unit (opioids) to internal medicine residents. The educational strategies we used included didactic sessions, write-up of a management plan following a model, case discussions, and role-play group activities. We pilot-tested one unit (opioid therapy) in March 2008. We performed learner evaluations, using a pretest and posttest, a write-up plan following a model, and a learner knowledge questionnaire. Results showed significant improvement in knowledge. Residents found the sessions and educational strategy to be excellent and reported higher confidence levels in managing patients with chronic noncancer pain.     

Needs and Program Strengths: Perceptions of Hospice Volunteers

A state-wide survey was conducted of highly effective hospice volunteers who were questioned about their motivations for becoming a volunteer, training experience and needs, and reasons for continuing in the volunteer role. Needs identified included having a volunteer support group, on-going training opportunities, and opportunities for getting to know other volunteers better. Excellent training, belief in the hospice mission, the relationship with staff, feeling valued, and personal fulfillment were strengths and motivations to continue as a hospice volunteer. Findings from the study will be helpful to hospice staff who recruit, train, and support volunteers. [Article copies available from The Haworth Document Delivery Service: 1-800-342-9678.]     

Developing a Certificate Course for Hospice Nurses: A Delphi Survey of Subject Areas

A Delphi survey of 16 national experts in hospice nursing was conducted to address which subject areas were the most important to include in a certification course for hospice nurses. The three-round survey elicited 70 subject areas which were ranked in order of importance according to the group opinion of the panel of experts. The means, average deviations, standard deviations, and variances for each rank were calculated. The panel showed a high degree of consensus and there was little change in ranking after the second round. The survey produced results that should be of interest to organizations concerned with developing certification courses and examination procedures for hospice nurses.     

Effectiveness of the Wheelchair Skills Training Program: a systematic review and meta-analysis*

Objective: To conduct a systematic review synthesizing the evidence for the effectiveness of the Wheelchair Skills Training Program (WSTP).

Data Sources: We searched PubMed, the Cochrane Library, CINAHL and Embase databases, as well as grey literature, up to 10 October 2017.

Study Selection: Randomized controlled trials (RCTs) assessing the effectiveness of the WSTP.

Data Extraction: Two independent reviewers screened articles and extracted data. Methodological quality was assessed using Cochrane’s Risk of Bias Tool.

Data Synthesis: Meta-analyses (including sub-group analyses) were conducted for the Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores. We qualitatively assessed retention, WST/WST-Q subtotal and individual-skill capacity scores and other identified outcomes. The quality of evidence was determined using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Thirteen articles (581 participants) were included for analysis. The level of evidence was of moderate quality. The WSTP increased the post-training WST/WST-Q total capacity scores by 14.0% (95% CI: 7.4, 20.8; p?Conclusions: There is moderate quality evidence that the WSTP is a safe intervention that has a clinically meaningful effect on WST/WST-Q capacity scores and some other outcomes.

• Implications for rehabilitation

• A systematic review and meta-analysis of 13 randomized controlled trials on a total of 581 participants, using the Wheelchair Skills Training Program (WSTP) as the intervention, found that the WSTP increased Wheelchair Skills Test (WST) and WST Questionnaire (WST-Q) total capacity scores by 21.2% relative to baseline.

• Subgroup analyses showed that training was more effective for new wheelchair users.

• The WSTP was found to have positive effects on some other outcomes and no serious adverse events were reported.

• The WSTP warrants cautious implementation in clinical and educational settings.

     

Emergency management of chronic pain and drug-seeking behavior: an alternate perspective

Pain is one of the most prevalent conditions treated by Emergency Physicians, although it remains contested how to interpret, measure, and treat this condition. In particular, there is controversy over how to identify and treat patients with chronic under-treated pain and those who are potentially malingering (drug-seeking). This article discusses currently accepted paradigms for treating potentially malingering patients, difficulties some communities may have when these paradigms are applied, and the results of implementing pain treatment guidelines that limit opioid use. Systematically limiting opioids via these guidelines was not associated with a decrease in overall patient satisfaction, patient satisfaction with pain management, overall volume, or volume of patients with potential drug-seeking diagnoses. Emergency Physicians' perception of quality of care delivered, as well as job satisfaction, increased after implementation of the guidelines.     

Learning in 360 Degrees: A Pilot Study on the Use of Virtual Reality for Radiation Therapy Patient Education

BackgroundPatient education for external beam radiation therapy (EBRT) is traditionally delivered in verbal and/or written form, which may not provide a full picture of the complex, technical aspects of treatment. The purpose of this pilot study was to create and evaluate a prototype 360-degree virtual reality (VR) video outlining the technical aspects of EBRT to the pelvis as a supplement to traditional education methods.Materials and MethodsA prototype VR video was filmed to simulate the delivery of one fraction of image-guided EBRT to the pelvis. Patients having a radical course of image-guided EBRT to the pelvis were approached while on active treatment to participate in focus groups evaluating the prototype VR video. Focus group discussions were recorded, transcribed, and subjected to thematic analysis.ResultsAll patients were accrued from a single academic cancer centre in a large metropolitan area. In total, seven patients were enrolled to participate in the focus groups. Thematic analysis revealed 71% of participants felt the traditional patient education met their needs. However, 86% mentioned the education did not fully capture the treatment experience. Participants identified potential benefits of VR could include an increased understanding of the treatment process, specifically the spatial and acoustic aspects of treatment, as well as the potential to reduce anxiety in new patients. Timing was also important, with 86% of participants recommending VR video viewing before the first day of treatment. Participants provided feedback such as including two-dimensional elements in the VR video and other changes which could potentially make the viewing experience more realistic.ConclusionsTraditional teaching methods are seen as satisfactory by patients at our institution, but it is recognized that there is a gap in current education methods. An immersive VR education tool has the potential to enhance standard patient education, increasing understanding of treatment and decreasing anxiety.     

Effects of a Mass Media Behavioral Treatment for Chronic Headache: A Pilot Study

This article presents the results of a pilot study evaluating the efficacy of a mass media self-help behavioral treatment program for chronic headache.
The program consisted of a self-help textbook, an exercise book, 10 television programs, 11 radio programs, and 3 audiocassettes with relaxation training. Approximately 15000 headache sufferers purchased the book and relaxation tapes. A random sample of 271 respondents participated in the effect study; the pretraining and posttraining data of 164 subjects were available for analysis.
Multivariate testing of the pretraining and posttraining results showed highly significant reductions in headache activity and medication intake at 4-month follow-up. A reduction of 50% or more in headache parameters and medication intake was achieved by 40% to 60% of the patients. Work absenteeism was significantly reduced. The differences between the diagnostic groups were not significant. Mass media behavioral treatment seems to be a viable treatment alternative for chronic headache and highly promising in terms of gain in quality of life, decrease in economic loss, and cost-effectiveness in health care.     

基于柯氏模型对TeamSTEPPS应用于医疗人员培训后效果维持的系统评价

目的 探讨基于柯氏模型对TeamSTEPPS应用于医疗人员培训后效果维持系统评价。方法 计算机检索中英文数据库关于TeamSTEPPS应用于医疗人员培训的文献,2名研究者根据纳入与排除标准,独立进行文献的筛检、质量评价和资料提取。结果 共纳入9篇自身前后对照试验,结果显示,学员对TeamSTEPPS培训较满意,多数学员能保持较好的团队合作及沟通能力,形成稳定的患者安全文化,但培训后产生的良好患者安全结果,如手术准时开始率、手术周转时间、患者死亡率及并发症发生率等存在差异。结论 TeamSTEPPS培训能有效维持学员良好的团队合作及沟通能力,但对于客观培训结果的维持性,需进一步研究。     

Service User Outcomes of Staff Training in Positive Behaviour Support Using Person‐Focused Training: A Control Group Study

Background Effectively supporting individuals with intellectual disabilities who display challenging behaviours continues to be a priority for service providers. Person‐focused training (PFT) is a model of service delivery which provides staff with skills in functional assessment and intervention development. Existing longitudinal data from a study of 138 cases suggest that implementation of staff‐developed behaviour support plans through PFT is effective in reducing challenging behaviour in approximately 77% of cases [McClean et al.Journal of Intellectual Disability Research (2005) vol. 49, pp. 340–353]. However, no control group was used in this study. Method The current study involves the use of a control group of individuals with challenging behaviours matched against those selected for PFT over a 6‐month period. Groups were matched on type of challenging behaviour, duration of challenging behaviour, gender and level of disability. Information on the frequency, management difficulty and severity of challenging behaviour was collected pre‐ and post‐training using the Checklist of Challenging Behaviours (CCB) for both groups. Observational data were collected for the target group alone. Rates of psychotropic medication were tracked across the training period. Results Significant reductions in the frequency, management difficulty and severity of challenging behaviour were found for service users in the target group but not in the control group after 6 months. No significant changes were found in the use of psychotropic medication for either group over the 6‐month period. Conclusion Overall results suggest that PFT is an effective model for providing support to individuals with challenging behaviours.     

Food on Film: Pilot Test of an Innovative Method for Recording Food Intake of Adults with Intellectual Disabilities Living in the Community

Background Adults with intellectual or developmental disabilities need dietary monitoring but are not likely to be able to provide accurate dietary intake data via traditional methods. Pilot study efforts to meet their support needs with a novel and practical approach to dietary intake data collection are described in this brief report. Materials and Method Still photography kits were used by nine adult volunteer participants with intellectual disabilities who lived in group homes or in semi‐independent living arrangements to capture images of the food they consumed over 24 h. Results Use of photographs during dietary intake interviews improved the reliability of the participants’ responses. Mean reliability ratings improved from ‘Indiscernible/Poor’ (mean range 1.0–1.7) to ‘Good/Excellent’ (mean range 3.6–5.0). Conclusions Our preliminary data imply that Food on Film is an effective and appropriate tool for use in community settings and warrants further testing.     

Systematic Training in Internal Medicine-Pediatrics End of Residency Handoffs: Residency Director Attitudes and Perceived Barriers

Background: It is unclear why systematic training in end-of-residency clinic handoffs is not universal. Purposes: We assessed Internal Medicine-Pediatrics (Med-Peds) residency program directors’ attitudes regarding end-of-residency clinic handoff systems and perceived barriers to their implementation. Methods: We surveyed all Med-Peds program directors in the United States about end-of-residency outpatient handoff systems. Results: Program directors rated systems as important (81.5%), but only 31 programs (46.3%) utilized them. Nearly all programs with (29/31 [93.5%]), and most programs without systems (24/33 [72.7%]) rated them as important. Programs were more likely to have a system if the program director rated it important (p = .049), and less likely if they cited a lack of faculty interest (p = .023) or difficulty identifying residents as primary providers (p = .04). Conclusions: Most program directors believe it important to formally hand off outpatients. Barriers to establishing handoff systems can be overcome with modest curricular and cultural changes.     

Short-Term Effects of Cognitive Training Program for Individuals with Amnestic Mild Cognitive Impairment: A Pilot Study

ABSTRACT

This study examined the effects of a cognitive training program on cognitive function and neurochemistry changes in individuals with amnestic mild cognitive impairment (aMCI). Ten individuals with aMCI were randomly assigned to the experimental (n = 5) and control (n = 5) groups. The experimental group took part in an 18-session cognitive training program over a 6-week period. After completing the cognitive training course, the experimental group demonstrated significant improvement in memory, attention, and executive functions. With respect to the neurochemistry biomarkers, the myoinositol/creatine (mI/Cr) ratio was significantly decreased in the hippocampus, prefrontal cortex, and anterior cingulate cortex of the experimental group after training. Findings demonstrate that the cognitive training program showed promising evidence in improving cognitive functions in individuals with aMCI. The observed cognitive function improvement was accompanied by a decrease of mI levels.     

Pilot Randomized Trial of Integrated Cognitive-Behavioral Therapy and Neuromuscular Training for Juvenile Fibromyalgia: The FIT Teens Program

Cognitive-behavioral therapy (CBT) improves coping and daily functioning in adolescents with juvenile fibromyalgia (JFM), but is less effective in reducing pain. This pilot trial evaluated the efficacy of a novel intervention (Fibromyalgia Integrative Training for Teens; FIT Teens) which integrates CBT with specialized neuromuscular exercise training to enhance the effect of treatment on reducing pain and disability. Forty adolescents with JFM (12–18 years) were randomized to CBT-only or FIT Teens. Treatment was conducted in group-based sessions over 8 weeks with assessments at baseline, post-treatment, and 3-month follow-up (primary end point). Primary outcomes were pain intensity and functional disability. Secondary outcomes were depressive symptoms, fear of movement, and pain catastrophizing. Thirty-six participants (mean age=15.33 years; 90% female) completed the program. Intent to treat analysis was conducted to evaluate differences between the FIT Teens and CBT groups from baseline to 3-month follow-up, controlling for baseline group differences. Participants in the FIT Teens group showed significantly greater decreases in pain than the CBT group. FIT Teens participants also showed significant improvements in disability, but did not differ from CBT-only at the 3-month end point. Results provide preliminary evidence that the FIT Teens intervention provides added benefits beyond CBT in the treatment of JFM, particularly in pain reduction.

Retention of Basic Life Support in Laypeople: Mastery Learning vs. Time-based Education

Objective: To compare the effectiveness of a mastery learning (ML) versus a time-based (TB) BLS course for the acquisition and retention of BLS knowledge and skills in laypeople. Methods: After ethics approval, laypeople were randomized to a ML or TB BLS course based on the American Heart Association (AHA) Heartsaver course. In the ML group, subjects practiced and received feedback at six BLS stations until they reached a pre-determined level of performance. The TB group received a standard AHA six-station BLS course. All participants took the standard in-course BLS skills test at the end of their course. BLS skills and knowledge were tested using a high-fidelity scenario and knowledge questionnaire upon course completion (immediate post-test) and after four months (retention test). Video recorded scenarios were assessed by two blinded, independent raters using the AHA skills checklist. Results: Forty-three subjects were included in analysis (23ML;20TB). For primary outcome, subjects' performance did not change after four months, regardless of the teaching modality (TB from (median[IQR]) 8.0[6.125;8.375] to 8.5[5.625;9.0] vs. ML from 8.0[7.0;9.0] to 7.0[6.0;8.0], p = 0.12 for test phase, p = 0.21 for interaction between effect of teaching modality and test phase). For secondary outcomes, subjects acquired knowledge between pre- and immediate post-tests (p < 0.005), and partially retained the acquired knowledge up to four months (p < 0.005) despite a decrease between immediate post-test and retention test (p = 0.009), irrespectively of the group (p = 0.59) (TB from 63.3[48.3;73.3] to 93.3[81.7;100.0] and then 93.3[81.7;93.3] vs. ML from 60.0[46.7;66.7] to 93.3[80.0;100.0] and then 80.0[73.3;93.3]). Regardless of the group after 4 months, chest compression depth improved (TB from 39.0[35.0;46.0] to 48.5[40.25;58.0] vs. ML from 40.0[37.0;47.0] to 45.0[37.0;52.0]; p = 0.012), but not the rate (TB from 118.0[114.0;125.0] to 120.5[113.0;129.5] vs. ML from 119.0[113.0;130.0] to 123.0[102.0;132.0]; p = 0.70). All subjects passed the in-course BLS skills test. Pass/fail rates were poor in both groups at both the simulated immediate post-test (ML = 1/22;TB = 0/20; p = 0.35) and retention test (ML pass/fail = 1/22, TB pass/fail = 0/20; p = 0.35). The ML course was slightly longer than the TB course (108[94;117] min vs. 95[89;102] min; p = 0.003). Conclusions: There was no major benefit of a ML compared to a TB BLS course for the acquisition and four-month retention of knowledge or skills among laypeople.     

Developing a culture of safety: Exploring students’ perceptions of errors in an interprofessional setting

Abstract

Healthcare has a long tradition of silence around mistakes that cause or have the potential to cause harm to a patient, and there is evidence that this culture may be present from the beginning of a health professional’s training. The purpose of this pilot study was to examine a team of interprofessional students’ interactions with a preceptor in a simulation environment. The debriefing explored the students’ reactions and assisted them with how to manage similar situations in the future to improve patient safety. The results showed that the students felt powerless to stop the simulated preceptor from doing harm to the patient, or to even question the preceptor’s unsafe actions. Recommendations for educators include incorporating discussions and interprofessional training about handling mistakes into the curriculum, in the context of patient safety.     

Nurse-based education: an office-based comparative model for education of migraine patients

BACKGROUND: A person with migraine needs to be prepared to make therapeutic decisions on her own. For this reason, patients often need education to understand the nuisances of managing theirmigraines. In this study an educationalCD-ROM/DVD that described the pathophysiology was utilized by nurses in an office-based primary care setting for patient education. Outcomes from this encounter were measured. OBJECTIVES: (1) Identify educational information that assisted migraine patients feel empowered to more effectively manage migraine; (2) encourage patients to intervene during the mild headache phase of the migraine; (3) measure education related changes in patient satisfaction and confidence regarding management of migraine; (4) measure changes in nurse satisfaction and confidence in educating migraine patients; (5) compare the effectiveness of 3 methods of delivery of nurse-based migraine education. METHODS: One hundred and eighty migraineurs at 21 primary care practices were divided into 4 groups: group A watched the CD-ROM/DVD in the office with a nurse available to answer questions; group B was given the CD-ROM/DVD by a nurse knowledgeable of the content; group C received the educational CD-ROM/DVD from a nurse without comment; group D received no educational material. The 10 nurses in groups A and B participated in a 45-minute teleconference that reviewed the information on the CD-ROM/DVD. Patients and nurses answered a pre- and post-study migraine questionnaire. Patients filled in a treatment diary online within 24 hours of treating a migraine. Nurses completed a satisfaction questionnaire. RESULTS: Of the 17 educational points tested on the pre-test, 75% of patients and nurses already knew about 1/3 of the information. There was significant improvement noted for both patients and nurses on the post-test in groups A, B, and C but not in group D. The percentage of correct responses by patients and nurses was directly and statistically significantly correlated with the involvement of the nurse in the educational effort. As a result of the education, patients felt more confident in their ability to manage and treat migraine. Likewise, nurses gained increased confidence in teaching patients about migraine. Patients did not intervene with acute therapy during the mild headache phase. Overall, 94% of the nurses were very satisfied or satisfied with the format and information provided. CONCLUSIONS: All but objective 2 were met for groups A, B, and C compared to control group D. Patients readily accepted nurse-directed education and assimilated information that increased their confidence to manage migraine. This emphasizes the importance of training nurses about materials used to educate patients.