Impact of a Formal Breastfeeding Education Program [E-learning about dementia: a randomized study]. Updating Systematic Reviews: An International Survey Perception and practice of malaria prophylaxis in pregnancy among health care providers in Ibadan. Improving Informed Consent of Surgical Patients Using a Multimedia-Based Program?: Results of a Prospective Randomized Multicenter Study of Patients Before Cholecystectomy Positioning of stroke patients: evaluation of a teaching intervention with nurses. Effects of a Computer-based Nursing Documentation System on the Quality of Nursing Documentation Computer visualisation of patient safety in primary care: a systems approach adapted from management science and engineering. Professional responses to innovation in clinical method: diabetes care and negotiating skills. Laparoscopic Simulators : Are They Useful! A randomized psychosocial intervention study on the effect of home visits on the well-being of Danish colorectal cancer patients--the INCA Project. Improving support for family carers: Key implications for research, policy and practice The Effect of a Disease Management Intervention on Quality and Outcomes of Dementia Care Knowledge retention from preoperative patient information Learning not to take it seriously: junior doctors' accounts of error. The Effect of a Multimedia Health Educational Program on the Postoperative Recovery of Patients undergoing Laparoscopic Cholecystectomy Measuring operative performance after laparoscopic skills training: edited videotape versus direct observation. The efficacy of a computer-assisted preoperative tutorial for clinical clerks. A randomised controlled trial evaluating family mediated exercise (FAME) therapy following stroke Promoting physical activity: issues in primary health care. RECODE: Design and baseline results of a cluster randomized trial on cost-effectiveness of integrated COPD management in primary care Internet Skills Performance Tests: Are People Ready for eHealth? Effects of extended preoperative information on perioperative stress: an anaesthetic nurse intervention for patients with breast cancer and total hip replacement.
Purpose To investigate whether implementation of a formal breastfeeding education program including a breastfeeding protocol , a re source guide , and educational presentations would have an impact on knowledge , comfort level , and attitudes toward breastfeeding among healthcare providers , and on amount of exclusive breastfeeding at our hospital . Design and Methods Quasi-experimental study that included a survey to obtain a preintervention baseline measurement and a postintervention measurement 6 months after the implementation of the formal breastfeeding education program . The sample was obstetricians , pediatricians , and nurses who interact with breastfeeding mothers at our hospital . Additionally , we surveyed breastfeeding mothers who gave birth at our hospital to determine the impact on the nurse observation of breastfeeding , exclusivity of breastfeeding , and nighttime feedings . Results Healthcare providers showed increased levels of knowledge and comfort dealing with breastfeeding issues after the education program . Knowledge scores were significantly improved ( pre- vs. postimplementation scores were 20.2 vs. 22.2 , p < .05 ) . Comfort level scores were also significantly improved ( pre- vs. postimplementation scores were 20.7 vs. 29.4 , p < .05 ) . There was no statistically significant change in attitude toward breastfeeding ( preimplementation score = 43.8 , postimplementation score = 43.4 , p = .075 ) . For the mothers , the preintervention group reported exclusive breastfeeding 55 % of the time versus 63 % ( p = .046 ) in the postintervention group . There was an increase in nurse observation of breastfeeding after the intervention : 84 % versus 92 % ( p = .046 ) , and breastfeeding patients reported an increase in nighttime breastfeeding after the intervention ( 55 % vs. 71 % , p = 0.001 ) , with a result ing decrease in formula supplementation in the nursery at night ( 28 % vs. 21 % , p = .006 ) . Clinical Implication sThis study shows how an educational program and adherence to protocol s can increase exclusive breastfeeding as well as improve healthcare provider knowledge , comfort level , and attitudes about breastfeeding . Our interventions also result ed in an increase in nurse observation of breastfeeding , nighttime breastfeeding , and a decrease in the use of formula supplementation at night . This study suggests that positive changes can be made with an educational program and protocol BACKGROUND Curricular medical training on dementia at the Department of Psychiatry and Psychotherapy at the University of Erlangen comprises of a traditional lecture . This setting was compared with two different E-Learning formats using a r and omized study design . METHODS 104 students ( average age 26.3 + /- 3.6 years ) were r and omized into 3 groups : Interactive e-Learning ; virtual lecture ( slides and audio ) and st and ard lecture ( control group ; 90 minutes ) . RESULTS Overall , the response rate was 40.4 % . Assessment of formal knowledge using a multiple-choice test yielded no differences between the three groups . In the students ' evaluation , the interactive e-learning showed the best results ( 1.86 + /- 0.69 ) , followed by the st and ard lecture ( 2.0 + /- 0.71 ) and the virtual lecture ( 2.6 + /- 0.8 ) . Nevertheless , the students would not prefer e-learning to the st and ard lecture when both methods are directly compared . CONCLUSION Our findings suggest that e-learning is equivalent to a st and ard lecture when formal knowledge is assessed . Evaluation results are best for interactive e-learning formats . The detailed reasons for the preference of different learning styles should be further investigated Background Systematic review s ( SRs ) should be up to date to maintain their importance in informing healthcare policy and practice . However , little guidance is available about when and how to up date SRs . Moreover , the updating policies and practice s of organizations that commission or produce SRs are unclear . Methodology /Principal Findings The objective was to describe the updating practice s and policies of agencies that sponsor or conduct SRs . An Internet-based survey was administered to a purposive non-r and om sample of 195 healthcare organizations within the international SR community . Survey results were analyzed using descriptive statistics . The completed response rate was 58 % ( n = 114 ) from across 26 countries with 70 % ( 75/107 ) of participants identified as producers of SRs . Among responders , 79 % ( 84/107 ) characterized the importance of updating as high or very-high and 57 % ( 60/106 ) of organizations reported to have a formal policy for updating . However , only 29 % ( 35/106 ) of organizations made reference to a written policy document . Several groups ( 62/105 ; 59 % ) reported updating practice s as irregular , and over half ( 53/103 ) of organizational respondents estimated that more than 50 % of their respective SRs were likely out of date . Authors of the original SR ( 42/106 ; 40 % ) were most often deemed responsible for ensuring SRs were current . Barriers to updating included re source constraints , review er motivation , lack of academic credit , and limited publishing formats . Most respondents ( 70/100 ; 70 % ) indicated that they supported central ization of updating efforts across institutions or agencies . Furthermore , 84 % ( 83/99 ) of respondents indicated they favoured the development of a central registry of SRs , analogous to efforts within the clinical trials community . Conclusions / Significance Most organizations that sponsor and /or carry out SRs consider updating important . Despite this recognition , updating practice s are not regular , and many organizations lack a formal written policy for updating SRs . This research marks the first baseline data available on updating from an organizational perspective The study assessed knowledge and practice of health care providers on current concepts on  malaria prophylaxis in pregnancy . 497 r and omly selected respondents at the three levels of care in two local governments in Ibadan , South western Nigeria were interviewed using a self-administered question naire . Respondents were selected from 45 health facilities : 48 ( 9.7 % ) community health extension workers ( CHEWS ) , 139 ( 28.9 % ) auxiliary nurses , 220 ( 44.3 % ) formally trained nurses and 90 ( 18.10 % ) medical doctors . Only 57 ( 11.5 % ) respondents were knowledgeable about current WHO strategies for malaria prevention in pregnancy . Three hundred and eighty six respondents ( 77.7 % ) were aware of  intermittent preventive treatment ( IPT ) . Awareness about IPT  was highest among CHEWS ( 95.8 % ) .  Pyrimethamine  was prescribed mainly by healthcare providers in the secondary ( 60.6 % ) and primary ( 60.3 % ) levels of care ( chi2 = 11.54 , p < 0.01 ) .  Chloroquine  was prescribed by 42.5 % of respondents .  Sulfadoxine-pyrimethamine  was significantly more commonly prescribed by primary health care providers than in other levels of care ( chi2 = 15.07 , p < 0.01 ) . Prescription for insecticide treated nets was high . Respondents ' practice of anti-malarial chemoprophylaxis  was influenced by the cadre of the health care provider and level of practice . There are several knowledge gaps on current malaria prevention strategies in pregnancy among healthcare providers . Multiple strategies are required to improve health care workers ' knowledge and practice of malaria prevention during pregnancy Objective : The term “ informed consent ” explains the process by which a patient , before treatment , is provided comprehensive and impartial information regarding a planned operative procedure so that he/she underst and s the implication s of the procedure before consenting . The goal of the current study was to investigate whether st and ard methods of consenting can be improved using a multimedia-based information program ( MM-IP ) . Patients and Methods : In a prospect i ve multicenter study , 80 patients undergoing laparoscopic cholecystectomy went through the st and ard informed consent process . One group of patients was also given access to a MM-IP . Question naires were completed before surgery . These evaluated how patients perceived their own underst and ing of important aspects of their illness ( ie , disease , therapeutic alternatives , operation , risks ) and satisfaction with the consenting process . Patients ’ anxiety levels were also assessed . These question naires were used to evaluate the effectiveness of the MM-IP for improving the consent process . Results : Seventy-six patients ( 47 women , 29 men , median age 54 years ) were included . There was no significant age or gender variation between the groups ( st and ard n = 41 and MM-IP n = 35 ) . Eighty-two percent of all respondents were satisfied with the st and ard informed consent process . However , perceived underst and ing of the material was significantly improved in the MM-IP group ( P < 0.001 ) . Patients with less formal education profited particularly from the MM-IP .  Preoperative anxiety did not vary between the groups . Conclusion : Use of the multimedia-based program was positively evaluated by patients , and significantly improved patients ’ perceived underst and ing of their disease and its treatment . It is , therefore , valuable in the informed consent process BACKGROUND AND PURPOSE There is agreement , although little evidence , that consistently positioning stroke patients in allegedly reflex-inhibiting positions is therapeutic and will enhance functional recovery . The nursing staff , therefore , needs to know and implement these postures and underst and their potential underlying value . We examined nurses ' knowledge of and practice in positioning stroke patients before and after a formal teaching intervention . METHODS In a quasi-experimental study , 38 stroke patients and 59 nursing staff members ( 44 trained nurses and 15 healthcare assistants ) from 6 wards were studied . The wards were r and omly allocated to experimental or control status . Patients were assessed on entry into the study by use of a range of measures to establish group equivalence . Nineteen aspects of their position were documented at intervals throughout their stay with a previously developed observational tool . One thous and sets of observations of patient position were made . Using 2 question naires , the nurses ' knowledge of the terminology used to denote posture and of issues relating to the moving and positioning of stroke patients was assessed before , immediately after , and 3 months after a package of formal teaching was implemented on the experimental wards . Nurse knowledge and patient position were used as the main outcome measures . RESULTS Immediately after teaching , nurses in the experimental group scored significantly higher than those in the control group on the terminology question naire ( P < 0.05 ) and the moving and positioning question naire ( P < 0.001 ) . Three months later , the experimental group scored higher on the latter question naire only ( P < 0.005 ) . The positioning of patients in the experimental group was improved overall after the teaching ( P < 0.0005 ) , and improvements to specific parts of the body were noted . CONCLUSIONS It was possible to effect a degree of change in the nurses ' knowledge of and practice in the positioning of stroke patients . However , the quality of patient positioning remained variable . More effective ways of improving positioning need to be developed . Only then can the effects of recommended positioning be evaluated Nursing documentation is an important part of clinical documentation . However , documentation of the nursing process is frequently lacking quality . There are high expectations that computer support in nursing documentation will help improve documentation quality . This study aim ed to examine whether the introduction of a computer based nursing documentation system can improve documentation quality . A prospect i ve intervention study was conducted on 4 wards of the University Medical Center Heidelberg over a period of 18 months . Two wards in the Psychiatric University Medical Center Heidelberg were involved in the research study , as well as a dermatological and a pediatric ward . The results of the study show a significant improvement of documentation quantity and quality on three of the four wards . Positive aspects include completeness of documentation on the nursing process , formal aspects and subjective quality improvement by the nurses . Negative aspects were mainly associated with the contents of the care plans Patient safety and medical errors in ambulatory primary care are receiving increasing attention from policy makers , accreditation bodies and research ers , as well as by practising family physicians and their patients . While a great deal of progress has been made in underst and ing errors in hospital setting s , it is important to recognise that ambulatory setting s pose a very large and different set of challenges and that the types of hazards that exist and the strategies required to reduce them are very different . What is needed is a logical theoretical model for underst and ing the causes of errors in primary care , the role of healthcare systems in contributing to errors , the propagation of errors through complex systems and , importantly , for underst and ing ambulatory primary care in the context of the larger healthcare system . The authors have developed such a model using a formal ' systems engineering ' approach borrowed from the management sciences and engineering . This approach has not previously been formally described in the medical literature .This paper outlines the formal systems approach , presents our visual model of the system , and describes some experiences with and potential applications of the model for monitoring and improving safety . Applications include providing a framework to help focus research efforts , creation of new ( visual ) error reporting and taxonomy systems , furnishing a common and unambiguous vision for the healthcare team , and facilitating retrospective and prospect i ve analyses of errors and adverse events . It is aim ed at system re design for safety improvement through a computer-based patient-centred safety enhancement and monitoring instrument ( SEMI-P ) . This model can be integrated with electronic medical records ( EMRs ) OBJECTIVE To describe the responses of family doctors and nurses to applying an innovative clinical technique and technology in the context of a r and omised controlled trial . DESIGN Multi-faceted descriptive analysis of professional responses in the experimental arm of the trial . SUBJECTS AND SETTING 29 family practice s involving 30 doctors and 33 nurses over a 3-year time scale and 200 patients with type II diabetes . INTERVENTION A new visual agenda- setting technology and other visual aids applied using the techniques of negotiation and motivational interviewing . OUTCOME MEASURES Uptake of training , use of the method , group discussion s , willingness to accept consultation recordings . RESULTS 100 % of clinicians welcomed two or more formal training sessions . The agenda- setting technology was used frequently by 71 % of clinicians and occasionally by a further 22 % . High levels of engagement with the method occurred among nurses but many doctors also reported benefits . CONCLUSIONS Family doctors and nurses in Wales have found a new technology to facilitate negotiation in diabetes consultation acceptable and useful . Analysis of outcome is now awaited BACKGROUND Laparoscopic surgery has changed the face of medical care forever . The benefits of laparoscopic open surgery have been demonstrated in virtually all major abdominal surgical procedures . Laparoscopy has introduced a new skill set that must be mastered and requires dedicated training . The teaching of laparoscopic operative skills in the clinical setting is constrained by the complexity of procedures , medicolegal and ethical concerns , fiscal and time limitations . This has created the need for formal training outside the operating room . Simulator-based training holds great promise in enhancing surgical education and providing a safe , cost-effective means for practicing techniques prior to their use in the operating room . METHODS The surgical residents of two batches were recruited for the study . The residents were r and omized to either a group that received training on a simulator or a controlled group that did not receive the training or to a group that received training twice . RESULT The residents who received training on a simulator demonstrated better psychomotor skills in the operation theatre than those who did not . Training in simulator environment can contribute to the development of technical skills relevant to the performance of laparoscopic surgery in vivo . Training at regular intervals will benefit the residents in gaining significant improvement of their psychomotor skills . CONCLUSION Laparoscopic trainer is a promising tool for training in laparoscopic surgery Home visits by health care professionals may constitute a formalized social relationship in which cancer patients can be given emotional and informational support . We aim ed at study ing the effect of home visits on the well-being of colorectal cancer patients . A total of 249 Danish colorectal cancer patients undergoing abdominal surgery were r and omly assigned to a control group or to an intervention group . The intervention group received 10 home visits carried out by a project nurse or a medical doctor during the first 2 years after discharge . Participants were interviewed 3 , 6 , 12 , and 24 months after discharge in order to assess well-being . Using a linear mixed model , we found no overall effect of the intervention on well-being . We recommend that future psychosocial intervention studies include baseline screening for distress and recommend testing the effect of shorter but intensive interventions carried out by trained therapists The aim of this editorial is to highlight several research priorities and key implication s for policy and practice that inform an agenda to improve family carer support . The development of systematic approaches to identify carers who are at risk of poor psychosocial outcomes  is a priority . Family caregiving should not be pathologised as an inherently negative experience ; however , it would be a breach of care if more than 40 % of carers who appear to meet the criteria for psychological distress1 are not offered suitable supports . Related to this is the urgent need for greater investment in bereavement research ; while bereavement support is integral to palliative care , it is typically under-re source d , under-investigated and not systematic ally applied . We know that routine intervention for all bereaved carers is not warranted . The challenge is to discern those carers who are ‘ at risk ’ prior to the death of the patient and to identify suitable evidence -based strategies to assist them . Research indicates that carer re sources , rather than patient diagnosis or illness severity , are the primary predictors of carer burden and other carer outcomes . This implies that although the specific content may need to vary to suit the context , the core elements of family carer interventions may be relevant across disease groups . It is also apparent that the perceived quality of social support is more important than the size of the social network in improving carer outcomes .2 Current indications are that palliative care providers should assist carers by targeting social support and re sources and provide education that focuses on coping strategies and preparation for the carer role . In many countries , family carers are well prepared for the beginning of life when , for example , prospect i ve parents are routinely offered parenting classes . It is also not uncommon to assist carers prepare for and support relatives having major heart surgery . However , preparation for supporting a relative/ friend at the end of their life is not routinely offered . Carers typically want to know what the role entails , how to manage symptoms , signs of imminent death and re sources and strategies to sustain their own well-being . Given the majority of patients want to be cared for in their home environment , initiatives that assist carers to achieve this are needed . The period of time most people receive palliative care services is typically quite short ; hence , the challenge is to design interventions that are as brief as possible , readily accessible and easily delivered . The significant number of carers who support patients in the hospital/hospice setting should also not be neglected ; their needs are often hidden . Other valuable insights regarding how we deliver interventions are surfacing . For example , the conception that face-to-face carer support is the gold st and ard is being challenged . Emerging evidence suggests that telephone and video phone support may be equally effective in some circumstances.1,3 Emphasis on the development of a strategic , coordinated and priority-driven family carer research agenda is also important.4 The role of formal research collaborations may be a vehicle to foster this . Much of the carer research seems to be first-world centric . More attention needs to be directed towards family caregiving in under-re source d countries and in other under-represented population s such as ethnic minority groups . Several important policy and clinical matters warrant consideration if palliative care is to foster improved carer support . One of the core questions for policymakers and clinicians is whether or not it is feasible for palliative care to be expected to meet the needs of the patients ’ entire family . It has been recommended that given re source constraints , the focus should be on the primary family carer ( as identified by the patient ) and where possible extended to other family members.5 Consideration might also be given to revising expectations about the goal of family support . The current World Health Organization definition of palliative care advocates that families ’ quality of life be improved ; perhaps a more realistic objective may be to aim to reduce the psychosocial burden of primary family carers . A related question is how to effectively legitimise family carer support . Most family carers do not want to discuss their needs and concerns in front of their relative ; they therefore need one-to-one time with healthcare and socialcare professionals . It is also clear that many healthcare workers find supporting carers challenging . Hence , where pertinent , consideration should be given to the potential merits of officially recognising family carers as ‘ care recipients ’ ; therefore , they are formally acknowledged as ‘ worthy ’ within the healthcare system . This may help justify much needed re sources and allow healthcare workers to allocate time and where pertinent offer interventions . In 488855 PMJ27710.1177/0269216313488855Palliative MedicineEditorial Context Dementia is an incurable chronic disease , but assistance to caregivers can reduce the severity of patients ' symptoms and delay institutionalization . Because this assistance requires provision of multiple health care and social services , patients and caregivers might benefit from a coordinated system of care . Contribution The investigators r and omly assigned patients with dementia and their caregivers to usual care or to a coordinated system of care . In the coordinated system , care managers regularly assessed patient and caregiver pairs and coordinated guideline -recommended provision of services by health care providers and community agencies using computerized information systems . The study found that pairs cared for in the coordinated system received higher- quality health care and more needed assistance than those who received usual care . Caution s The study focused on a relatively homogeneous population of white , well-educated , otherwise healthy , noninstitutionalized patients with health insurance . The findings might not apply to other population s. Implication s The quality of care for patients with dementia and their caregivers can be improved with a model of care in which services provided by the health system and community agencies are coordinated by a care manager . The Editors Dementia has enormous health and financial consequences for affected individuals , their family caregivers , and society ( 15 ) . Although most dementia is currently neither preventable nor reversible , existing practice guidelines reflect evidence from r and omized , controlled trials that caregiver assistance and support can delay institutionalization ( 68 ) , and nonpharmacologic management of problem behaviors and depression can reduce symptom severity and improve patient health ( 9 , 10 ) . Yet , adherence to published dementia care guidelines ( 1114 ) is poor ( 15 ) , including inappropriate use of psychoactive medications for initial management of agitation ( 16 ) ; low referral rates to community agencies ( 17 , 18 ) ; and underdetection of elder abuse , for which cognitive impairment is a risk factor ( 19 ) , and of depression ( 20 ) , a common comorbid condition ( 21 ) . There are few controlled trials of improvement interventions for dementia care . An opinion leader intervention improved neurologists ' reported adherence to dementia care guidelines ( 18 ) , and a recent trial using advanced practice nurses within primary care improved care quality ( 22 ) ; other trials reported limited impacts ( 23 , 24 ) . All studies were conducted primarily within or outside of health care delivery systems ; to date , trials of comprehensive , guideline -based dementia care interventions that incorporate all chronic care model components , including substantive collaboration between health systems and community agencies ( 25 , 26 ) , have not been reported . Yet , this would seem to be a well-suited approach because of the multifaceted nature of dementia care management and the need for coordinated efforts across health care delivery systems and community agencies to provide recommended medical , behavioral , and social services and support . To address gaps in care quality for persons with dementia , we design ed and tested a guideline -based , comprehensive dementia care management intervention in a clinic-level , cluster r and omized , controlled trial ( 27 ) . Intervention components were based on the chronic care model and emphasized linkages with community re sources and multiagency coordination ( 25 , 26 , 28 ) . Key components included dementia care managers , formal procedures for communication within and between organizations and agencies , Internet-based care management , collaborative care planning with caregivers , caregiver self-management support , ongoing follow-up , and provider education . We hypothesized that patient and caregiver dyads in intervention clinics would receive care in higher accordance with guidelines ; receive more community re sources and services ; have fewer unmet caregiving assistance needs ; and have better patient and caregiver health and caregiving quality , social support , and perceived care quality than dyads receiving usual care . Methods The institutional review boards of the University of California , Los Angeles , and all participating health care organizations approved the study procedures . All enrolled patient and caregiver dyads provided written informed consent . Three health care organizations ( Kaiser Permanente San Diego , Scripps Clinic , University of California , San Diego , Healthcare ) and 3 community agencies ( Alzheimer 's AssociationSan Diego Chapter , Southern Caregiver Re source Center , Meals on WheelsGreater San Diego ) providing services for persons with dementia and their informal caregivers in the San Diego metropolitan area participated . Private group practice , academic group practice , and health maintenance organization practice types were represented by the 3 health care organizations . Study Participants The study included 18 clinics from the participating health care organizations ( 4 to 8 per organization ) ( Table 1 ) . The inclusion criterion was that these be primary care clinics . Table 1 . Characteristics of Participating Health Care Organizations * Patients with dementia who were age 65 years or older and receiving Medicare were identified by querying health care organization administrative data bases for occurrence during the previous year of a dementia diagnosis code ( 29 ) at an outpatient visit or hospitalization or a cholinesterase inhibitor prescription . Patient lists were grouped by primary provider and were circulated to those providers for confirmation of dementia diagnosis and identification of additional potential participants from his or her practice ( generating < 5 % of the sample ) . Patients had to have an informal caregiver ( age 18 years ) . Patients were recruited by mail with English- and Spanish- language letters from their physician and an opt-out postcard , followed by up to 3 mailings of a patient consent or assent form ( depending on the physician 's design ation of the patient 's ability to provide consent ) , a caregiver consent form ( containing a proxy consent for the patient if he or she was judged unable to provide consent ) , and a baseline caregiver survey . R and omization was conducted at the clinic level , based on the clinic-focused design of the care management intervention . Within each health care organization , we paired clinics by patient volume ; within each pair , we r and omly assigned 1 clinic to the intervention and the other clinic to usual care using a computerized r and om-number generator operated by a study statistician . Participants were unaware of clinic r and omization status at enrollment and at completion of the baseline survey and were not reminded of r and omization status at follow-up . Intervention A steering committee that included a physician from each health care organization , a leader from each community agency , a community caregiver , and investigators used a formal method ( 30 ) to identify 23 existing dementia guideline recommendations as care goals ( 11 , 12 , 14 ) . They also design ed a structured assessment , algorithms linking specific care management actions to assessment results , and interorganization care coordination and referral protocol s. A key intervention element was health care organization and community agencybased dementia care managers ( primarily social workers ) who received formal training and used an Internet-based care management software system for care planning and coordination ( 25 , 26 , 28 ) . Every enrolled patient and caregiver dyad in the intervention group was assigned 1 health care organization care manager , who contacted them to schedule a structured home assessment . Assessment responses were entered into the software system , generating a preliminary problem list and guides to care-plan actions . The care manager collaborated with the caregiver to prioritize problem areas ; teach problem-solving skills ; initiate care plan actions ; and send an assessment summary , a problem list , and selected recommendations to the patient 's primary care physician and other design ated providers . A menu of potential care plan actions ( for example , referral for respite care services ) was documented in a comprehensive care management manual . The care management protocol included ongoing follow-up , usually by telephone , with frequency based on need and a formal in-home re assessment every 6 months to assess the need for major care-plan revisions . The software system had a feature to enable efficient tracking of multiple cases and tasks . Referrals to a particular community agency were guided by flagged problem areas . With patient and caregiver consent , referrals were communicated through the software system to that agency , whose design ated care manager subsequently received system access to the assessment , problem list , and care plan . Each dyad could have 1 or more community agency care managers . Care managers from the health care organizations and community agencies received the same formal education and training program , which was conducted jointly , and met monthly to refine care coordination procedures . Care management began within a month after enrollment of the first dyads and was active throughout the study follow-up unless a case was closed , for example , because a patient moved out of the study area and no longer was enrolled in the health care organization . At each intervention clinic , more than 90 minutes of st and ardized , interactive seminars ( in up to 5 sessions ) on relevant care issues , including  evaluation of acute behavioral changes , depression management  , and determination of decision-making capacity  ( 31 ) , were offered to primary care providers . Selected intervention tools and documents with more detailed descriptions can be accessed at www.adc.ucla.edu/access/access.swf . Patients , caregivers , and providers in the usual care group were not offered study interventions . Outcome Measures Primary Outcome The study 's primary outcome was Background Preoperative education is a common feature of the preoperative preparation for many surgical procedures . It is anticipated that this education will result in beneficial outcomes for the patient . Many studies have evaluated the effectiveness of different formats used to deliver the information , and the effect of this information on a variety of outcomes . While there has been substantial research and several meta‐analyses undertaken on different aspects of preoperative education , there has been no previous attempt to summarise this body of research to evaluate its impact on knowledge and underst and ing of patients . Objective The objective of this review was to present the best available evidence related to knowledge retention and /or correct performance of postoperative activities after preoperative patient education . Review method This review considered all studies that included adults in a hospital setting , either as in patients or same day surgical patients , and who received some form of information and /or instruction before an operative procedure . Interventions were the methods of preoperative patient education , instruction or teaching , and included evaluations of the effectiveness of different presentations such as : written information ; audio‐visual aids ; computer‐assisted instruction ; learning packages in either group or individual formats , at either pre‐admission or post‐admission . The primary outcomes were those associated with the underst and ing of the information related to the operative or postoperative period that were provided in the intervention and included : increased knowledge ; ability to perform postoperative activities ; time to teach skills . This review considered r and omised controlled trials that evaluated forms of preoperative patient education and their effect on patient underst and ing , knowledge and ability to perform postoperative activities . Results The findings of this review support the use of pamphlets to inform patients and to improve their skills . The role of videos as a preoperative instruction tool has not been rigorously evaluated . However , existing studies support the use of preoperative videos to improve patient knowledge and skill . The data suggest that the instructional method , the act of educating a patient by delivering directions for actions or behaviour is useful for improving patients ' knowledge of their treatment and their ability to perform and comply with required exercises . However , instruction is likely to be more effective if provided before admission . If teaching is to be done after admission , using a group format has been shown to be equally as effective as individual instruction . Conclusions Although numerous studies have been performed on many aspects of preoperative education , little high‐ quality research has assessed the effectiveness of this information on patient knowledge and ability to perform specific skills such as exercises . Further research is required to examine : ( i ) the effectiveness of pamphlets and other written material for people with English as a second language or limited literary skills ; ( ii ) the accuracy of information provided in preoperative pamphlets ;  ( iii ) the effectiveness of pamphlets  on  general population s ; ( iv ) the role of videos and learning packages ;  ( v ) the effectiveness of preoperative instruction ; and ( vi ) the changes in patient misconceptions with the provision of preoperative information OBJECTIVES We aim ed to investigate experiences of , and responses to , medical error amongst junior doctors and to examine the challenges junior doctors face and the support they receive . METHODS We carried out a qualitative study of 38 r and omly selected pre- registration house officers ( PRHOs ) in 10 hospitals . All 38 had graduated in 2000 or 2001 from a single medical school . RESULTS Errors were common and sometimes serious . In relation to disclosure and learning from error , four main themes emerged : a norm of selective disclosure ; the effects of the team ; individualised blame and responsibility , and the ' learning moment ' . Trainees reported disclosing errors informally , particularly when teams were seen as supportive , but were reluctant to criticize colleagues . Formal reports and disclosure to patients were very rare . Patient care was compromised when juniors did not access senior help , often when working outside their usual team environment . Lack of cooperation between teams and poor continuity of care also contributed to errors . Learning was maximised when errors were formally discussed and constructive feedback offered . However , both blame and the prioritization of reassurance over learning and structured feedback appeared to inhibit reflection on the experience of error . CONCLUSIONS Junior doctors need help to reflect on their experiences and to recognise where they may have made mistakes , particularly in the context s of shift-work and fragmented teams . Formal reporting systems alone will not facilitate learning from error . Juniors require individual clinical supervision from seniors with appropriate training . Such expertise may benefit the whole team and the training environment Aim of this study is the evaluation of the impact of preoperative informative session using a Multimedia Health Educational Program ( MHEP ) on patients undergoing elective Laparoscopic Cholecystectomy ( LC ) for cholelithiasis , preoperative anxiety and postoperative pain and nausea . Sixty consecutive patients scheduled for elective LC were considered for enrollment in the trial . Patients were assigned r and omly to four groups : Group A included 15 patients , preoperatively informed regarding LC through the MHEP presented by a Registered Nurse ( RN ) . Group B included 15 patients  preoperatively informed through a leaflet ( design ed and developed using the exact contents of the MHEP ) . In Group C , there were 15 patients who were being informed verbally from the RN . Finally , the control Group D included 15 patients , who had the conventional preoperative information about the operation and postoperative course by the attending surgeon and anesthesiologist , as every other patient included in groups A , B , C. Preoperative assessment of patient 's knowledge about cholelithiasis and LC was performed after informative session , and was based on a specifically developed " closed , true-false " question naire . Preliminary results suggest that conventional information provided by the attending surgeon ( Group D ) is inadequate . Specifically developed informative sessions with the contribution of MHEP seems to be effective on reducing preoperative anxiety and postoperative pain , in patients undergoing elective LC BACKGROUND AND PURPOSE Global assessment by direct observation has been vali date d for evaluating operative performance of surgery residents after formal skills training but is time-consuming . The purpose of this study was to compare global assessment performed from edited videotape with scores from direct observation . MATERIAL S AND METHODS Junior surgery residents ( N = 22 ) were r and omized to 2 weeks of formal videotrainer skills training or a control group . Laparoscopic cholecystectomy was performed at the beginning and end of the rotation , and global assessment scores were compared for the training and control groups . Laparoscopic videotapes were edited : initial ( 2 minutes ) , cystic duct/artery ( 6 minutes ) , and fossa dissection ( 2 minutes ) . Two independent raters performed both direct observation and videotape assessment s , and scores were compared for each rater and for interrater reliability using a Spearman correlation . RESULTS Correlation coefficients for videotape versus direct observation for five global assessment criteria were < 0.33 for both raters ( NS for all values ) . The correlation coefficient for interrater reliability for the overall score was 0.57 ( P = 0.01 ) for direct observation v 0.28 ( NS ) for videotape . The trained group had significantly better overall performance than the control group according to the assessment by direct observation ( P = 0.02 ) but not by videotape assessment ( NS ) . CONCLUSIONS Direct observation demonstrated improved overall performance of junior residents after formal skills training on a videotrainer . Global assessment from an edited 10-minute videotape did not correlate with direct observation and had poor interrater reliability . Efficient and valid methods of evaluating operative performance await development OBJECTIVE To assess the effectiveness of computer-assisted preoperative tutorials on human anatomy in improving the operating-room learning experience  for clinical clerks . DESIGN Crossover trials with immediate assessment and approximately 1-week delay between trials . SETTING General surgery operating room of a university teaching hospital . SUBJECTS Eight 4th-year clinical clerks on a single 8-week surgical rotation . MAIN OUTCOME MEASURES The senior surgeon 's assessment of the clerk 's knowledge and underst and ing of the operation , according to a six-item question naire , and the clerk 's own assessment of the experience in the operating room , according to an eight-item question naire . RESULTS Surgeons rated the clerks ' performances in the operating room as better when they had received the preoperative tutorial ( mean [ and st and ard deviation ] , 3.7 [ 0.4 ] ) than when they had not received the preoperative tutorial ( 3.0 [ 0.3 ] ) . The difference ( 0.7 [ 0.6 ] ) was statistically significant ( t7 = 3.3 , p < 0.01 ) . Similarly , clerks rated their own experience more positively when they had received the tutorial ( 4.0 [ 0.2 ] ) than when they had not ( 3.1 [ 0.3 ] ) , with the difference ( 0.9 [ 0.5 ] ) being statistically significant ( t7 = 4.9 , p < 0.001 ) . CONCLUSIONS Short , preoperative , computer-assisted tutorials on human anatomy can have a positive impact on the clerk 's level of knowledge and confidence in the operating room . Further research is warranted into the extent to which students spontaneously make use of these tutorials Background Stroke is a leading cause of disability among adults worldwide . Evidence suggests that increased duration of exercise therapy following stroke has a positive impact on functional outcome following stroke . The main objective of this r and omised controlled trial is to evaluate the impact of additional family assisted exercise therapy in people with acute stroke . Methods / Design A prospect i ve multi-centre single blind r and omised controlled trial will be conducted . Forty patients with acute stroke will be r and omised into either an experimental or control group . The experimental group will receive routine therapy and additional lower limb exercise therapy in the form of family assisted exercises . The control group will receive routine therapy with no additional formal input from their family members . Participants will be assessed at baseline , post intervention and followed up at three months using a series of st and ardised outcome measures . A secondary aim of the project is to evaluate the impact of the family mediated exercise programme on the person with stroke and the individual(s ) assisting in the delivery of exercises using a qualitative methodology . The study has gained ethical approval from the Research Ethics Committees of each of the clinical sites involved in the study . Discussion This study will evaluate a structured programme of exercises that can be delivered to people with stroke by their ' family members/friends ' . Given that the progressive increase in the population of older people is likely to lead to an increased prevalence of stroke in the future , it is important to reduce the burden of this illness on the individual , the family and society . Family mediated exercises can maximise the carry over outside formal physiotherapy sessions , giving patients the opportunity for informal practice .Trial Registration The protocol for this study is registered with the US NIH Clinical trials registry ( NCT00666744 In the past few years , alliances between primary care and leisure services have become a popular strategy for exercise promotion in the Engl and . ' GP Referral Schemes ' typically involve referral to a local leisure centre by a General Practitioner ( GP ) , whereupon patients are inducted into a 10 - 12 week exercise programme at a reduced fee . Referred patients are usually white , middle aged and apparently healthy women , with the main reason for referral being overweight . The schemes are characterised by their lack of formal evaluation , making conclusions about effectiveness impossible . In the US , physicians advice to exercise has been the focus of interventions to date . Two controlled trials , one r and omised , have provided some evidence that exercise behaviour can be changed , at least in the short term . The ability to recruit sufficient numbers of patients , who have potentially the most to gain from increased physical activity , is the biggest barrier to primary care based interventions . One contributing factor to this problem , may be doctors and nurses ' knowledge about the benefits of physical activity Background Favorable effects of formal pulmonary rehabilitation in selected moderate to severe COPD patients are well established . Few data are available on the effects and costs of integrated disease management ( IDM ) programs on quality of care and health status of COPD patients in primary care , representing a much larger group of COPD patients . Therefore , the RECODE trial assesses the long-term clinical and cost-effectiveness of IDM in primary care . Methods / design RECODE is a cluster r and omized trial with two years of follow-up , during which 40 clusters of primary care teams ( including 1086 COPD patients ) are r and omized to IDM or usual care . The intervention started with a 2-day multidisciplinary course in which healthcare providers are trained as a team in essential components of effective COPD IDM in primary care . During the course , the team re design s the care process and defines responsibilities of different caregivers . They are trained in how to use feedback on process and outcome data to guide implement guideline -driven integrated healthcare . Practice -tailored feedback reports are provided at baseline , and at 6 and 12 months . The team learns the details of an ICT program that supports recording of process and outcome measures . Afterwards , the team design s a time-contingent individual practice plan , agreeing on steps to be taken in order to integrate a COPD IDM program into daily practice . After 6 and 12 months , there is a refresher course for all teams simultaneously to enable them to learn from each other ’s experience . Health status of patients at 12 months is the primary outcome , measured by the Clinical COPD Question naire ( CCQ ) . Secondary outcomes include effects on quality of care , disease-specific and generic health-related quality of life , COPD exacerbations , dyspnea , costs of healthcare utilization , and productivity loss . Discussion This article presents the protocol and baseline results of the RECODE trial . This study will allow to evaluate whether IDM implemented in primary care can positively influence quality of life and quality of care in mild to moderate COPD patients , thereby making the benefits of multidisciplinary rehabilitation applicable to a substantial part of the COPD population .Trial registration Netherl and s Trial Register ( NTR ) : Background Despite the amount of online health information , there are several barriers that limit the Internet ’s adoption as a source of health information . One of these barriers is highlighted in conceptualizations of the digital divide which include the differential possession of Internet skills , or “ eHealth literacy ” . Most measures of Internet skills among population s at large use self- assessment s. The research discussed here applies a multifaceted definition of Internet skills and uses actual performance tests . Objective The purpose of this study was to assess how ready a sample of the general population is for eHealth . More specifically , four types of Internet skills were measured in a performance test in which subjects had to complete health-related assignments on the Internet . Methods From November 1 , 2009 , through February 28 , 2010 , 88 subjects participated in the study . Subjects were r and omly selected from a telephone directory . A selective quota sample was used divided over equal sub sample s of gender , age , and education . Each subject had to accomplish assignments on the Internet . The Internet skills accounted for were categorized as operational ( basic skills to use the Internet ) , formal ( navigation and orientation ) , information ( finding information ) , and strategic ( using the information for personal benefits ) . The tests took approximately 1.5 hours and were conducted in a University office , making the setting equally new for all . Successful completion and time spent on the assignments — the two main outcomes —were directly measured by the test leader . Results The subjects successfully completed an average of 73 % ( 5.8/8 ) of the operational Internet skill tasks and an average of 73 % ( 2.9/4 ) of the formal Internet skill tasks . Of the information Internet skills tasks , an average of 50 % ( 1.5/3 ) was completed successfully and , of the strategic Internet skills tasks , 35 % ( 0.7/2 ) . Only 28 % ( 25/88 ) of the subjects were able to successfully complete all operational skills tasks , 39 % ( 34/88 ) all formal skills tasks , 13 % ( 11/88 ) all information skills tasks , and 20 % ( 18/88 ) both the strategic skill tasks . The time spent on the assignments varied substantially . Age and education were the most important contributors to the operational and formal Internet skills . Regarding the formal Internet skills , years of Internet experience also had some influence . Educational level of attainment was the most important contributor to the information and strategic Internet skills . Conclusions Although the amount of online health-related information and services is consistently growing , it appears that the general population lacks the skills to keep up . Most problematic appear to be the lack of information and strategic Internet skills , which , in the context of health , are very important . The lack of these skills is also problematic for members of younger generations , who are often considered skilled Internet users . This primarily seems to account for the operational and formal Internet skills . The results of the study strongly call for policies to increase the level of Internet skills An anaesthetic nurse intervention was performed in order to evaluate the effects of extended preoperative information , given by anaesthetic nurses , on perioperative stress in patients operated on for breast cancer or total hip replacement ( THR ) . Forty-six consecutive patients scheduled for surgery for breast cancer , and 55 for THR , were r and omized into two groups which were given different modes of preoperative information . Patients in the control group were informed about pre- and postoperative routines by a ward nurse . Patients in the intervention group were given extended formalized information by an anaesthetic nurse .  Wilcoxon rank sum test was used to show relations between variables . There were no significant differences between the intervention group and control group for patients with breast cancer or for patients with THR . Breast cancer patients in the intervention group were significantly more anxious than THR patients in the intervention group ( P < 0.01 ) . Breast cancer patients in the intervention group showed the highest anxiety scores on the Hospital Anxiety and Depression Scale ( HADS ) scale on the day of surgery . This information may reflect an increased level of anxiety due to the extended information given preoperatively . The information may thus have had a negative effect on breast cancer patients , result ing in an increased state of anxiety . The result indicates a need for individualized modes of information to provide a proper balance between enough and too much information
Due to the very low quality of the current evidence , the effects of formal patient education provided in addition to the st and ard information provided by doctors to patients compared with st and ard care remain uncertain .
BACKGROUND Generally , before being operated on , patients will be given informal information by the healthcare providers involved in the care of the patients ( doctors , nurses , ward clerks , or healthcare assistants ) .
This information can also be provided formally in different formats including written information , formal lectures , or audio-visual recorded information .
OBJECTIVES To compare the benefits and harms of formal preoperative patient education for patients undergoing laparoscopic cholecystectomy .