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Illness representations are cognitive structures that individuals rely on to understand and explain their illnesses and associated symptoms. The Representational Approach (RA) to patient education offers a theoretically based, clinically useful model that can support oncology nurses to develop a shared understanding of patients' illness representations to collaboratively develop highly personalized plans for symptom management and other important self-management behaviors. This article discusses theoretical underpinnings, practical applications, challenges, and future directions for incorporating illness representations and the RA in clinical and research endeavors.

PURPOSE The purpose of this study is to summarize the accumulated state of knowledge in the area of diabetes patient education research and highlight important issues that research has left unanswered. METHODS An integrative literature review was conducted on the topic of diabetes patient education between the years 1985 and 1998. Keywords used in the computerized search were diabetes mellitus, patient education, health education, research, and behavior change. The databases searched were MEDLINE, CINAHL, HealthSTAR, EMBASE, and CHID-HE. A total of 78 papers were reviewed. RESULTS Most studies lacked a theoretical framework and the majority of studies were conducted in an outpatient setting. HbA,, was the most frequently employed outcome measure, with little, if any, description of the interventions. CONCLUSIONS Much has been learned in terms of the effectiveness of diabetes education on improving knowledge. However, other topic areas and outcomes need further exploration.

The quality of reported research representing a number of disciplines involved in diabetes patient education was investigated in this study. A rigorous literature search identified 47 studies reported between 1954 and 1986 that met inclusion criteria; 29 were published studies, 18 were unpublished. Quality of the research was measured by Duffy's Research Appraisal Checklist (RAC) and also by coding each study as to the number of threats to internal and external validity present. Overall quality as measured by the RAC ranged from 34 to 95 on a 100-point scale. A statistically significant relationship was found between publication date of the research report and quality, indicating improvement in quality during recent years. Quality of published versus unpublished research reports was not found to differ significantly. Recommendations for improving methodological rigor of future studies include: (a) the use of more rigorous designs, particularly those involving control groups such as randomized clinical trials; (b) reporting of more complete data in research reports; and (c) monitoring of the quality of future studies.

Aptitude x treatment interaction (ATI) has been used only rarely in patient educa tion research. This research paradigm incorporates individual differences (aptitudes) into experimental studies exploring differences in information strategies (treatments). ATI has great potential for applications to patient education research. It identifies patient characteristics and optimal instructional treatments, it is compatible with psychological theories and clinical approaches alike, and it offers a specific method ology for approaching existing problems in a new way. This article presents studies in which ATI has illuminated specific patient needs and treatments, and suggested further applications. Three studies (in addition to those reviewed) are examined in depth. One study determined general guidelines for designing instructional literature to accom pany medication (drug package inserts), that would satisfy the requirements of a group of patients with varied reading ability. Another study examined the effect of patients' "prior knowledge" on their participation in a health education program. A third study explored the interaction between patients' view of self-control over their health and the use of different media for health-care instruction. Guidelines and considerations for conducting further ATI-based research are presented and discussed.

Background and Aims We aimed to investigate a new team-based remote teaching model (TRTM) among M.D and Ph.D. candidates major in nephrology to improve their scientific research training and reduce stresses during the COVID-19 pandemic. Method From February 1 to April 30 in 2020, we set up TRTM (Fig 1) via online conferencing systems as: (i) Plan-Do-Check-Action cycle every two to three days to promote project progress, (ii) weekly lab meetings for sharing experiences and ideas; and (iii) weekly journal clubs for literature reading and knowledge expansion. We recruited nine students in TRTM training, and another 25 students as control group, who arranged their schedule by themselves during the quarantine. Results 1. A survey about the remote teaching 25 mentors and 34 students had received a survey and all believed that teamwork, lab meeting, and short-term academic goals were essential in remote training. Non-scheduled discussion (72.0%,18/25) and regular online lab meetings (60.0%,15/25) were the most common traditional methods. About 85.3% of students and 28.0% of the mentors agreed that “poor self-control” was the main cause of remote-teaching difficulty. 2. The effectiveness of TRTM training Compared to the control group, students in TRTM had more self-reported benefits from “mentors’ feedback”, “team support”, and “team communication” (All P Conclusion Our team-based remote teaching model helped students gain more supports and growth in academics and reduce psychological pressures caused by isolation.

The purpose of the present study was to establish the association between self-efficacy, perception of disease, emotional regulation, and fatigue and the health-related quality of life in older adults living in the departments of Cesar and Atlántico in Colombia and who have been diagnosed with a chronic disease. The participants were 325 older adults of both sexes, with literacy and no presence of cognitive impairment in the Mini-Mental State Examination (MMSE); A non-probabilistic sampling was carried out. We used the MOS-SF-36 questionnaire, the Brief Illness Perception Questionnaire scale for measuring the perception of disease, the Stanford Patient Education Research Center’s Chronic Disease Self self-efficacy questionnaire for chronic patients, the Difficulties in Emotional Regulation Scale, and the Fatigue Severity Questionnaire as measurement instruments. The design was non-experimental cross-sectional with a correlational scope. The results indicate that self-efficacy, disease perception, emotional regulation and severity of fatigue are variables that could impact the physical function of quality of life, confirming that self-efficacy would work as a factor that decreases the probability that a participant score low on this dimension of quality of life. On the other hand, both the perception of the disease and the severity of fatigue were identified as factors that probably negatively influence quality of life.

Purpose of review With social media use continuing to increase in popularity, ophthalmologists use social media daily for interactions with patients, colleagues, and the academic community. Recent findings The potential reach of social media is overwhelmingly encouraging, but academic organizations have much work to do in order to compete for viewership on social media platforms, and users need to remain vigilant of easily spread misinformation. Individual ophthalmology practices can tailor their social media presence to attract and educate patients. Using hashtags to supplement the experience of academic conferences has boosted engagement both of attendees and other interested parties. As an effective indicator of the popularity of different subjects in medicine, new studies are leveraging social media for epidemiological models. Finally, social media is emerging as a powerful tool for patient advocacy in ophthalmology. Summary The accessibility of social media uniquely positions it to educate patients, disseminate public eye health initiatives, and increase the reach of individual physicians. It is also able to enhance the academic experience of conferences, connecting new research colleagues, and is becoming the subject of epidemiologic studies itself. Whether using social media for patient education, research, clinical practice, or patient advocacy, ophthalmologists will find social media an increasingly important workplace contributor.

Introduction:There is a growing concern regarding self-care and chemotherapy side effects. The present study aimed to assess the effectiveness of self-care measures on knowledge, self-efficacy, and performance status among cancer patients undergoing chemotherapy. Methods: A quasi-experimental study was conducted in Dr. Kamatchi Memorial Hospital, India. Using purposive sampling technique, 200 cancer patients were selected. Patients were interviewed using semi-structured knowledge questionnaires, Modified Stanford Patient Education Research Center Self-efficacy scale, deliberate self-efficacy with rating scale under four subheadings, and ECOG Performance Status Scale with 5–point grading scale i.e., dead to fully active. Results:There was adequate knowledge (95%) on self-care measures after the intervention. The mean score was significant, i.e., 21.33 (2.25), which had difference between post-knowledge score in experimental and control was statistically significant at P < 0.001 level. The majority of patients reported a high self-efficacy level (t = 198.60, P < 0.001). In addition, despite self-efficacy and knowledge the performance status observed at each cycle, i.e., 4 cycles had mean score of t = 32.13, P < 0.001, showed high level of performance status. Conclusion: The study revealed that the self-care measures during each cycle had improved the selfefficacy and performance status to high level, which in turn reduced the side effects of chemotherapy to the certain level.

Three-dimensional (3D) imaging has been available for nearly four decades and is regarded as state of the art for visualization of anatomy and pathology and for procedure planning in many clinical fields. Together with 3D image reconstructions in the form of rendered virtual 3D models, it has helped to better perceive complex anatomic and pathologic relations, improved preprocedural measuring and sizing of implants, and nowadays enables even photorealistic quality. However, presentation on 2D displays limits the 3D experience. Novel 3D printing technologies can transfer virtual anatomic models into true 3D space and produce both patient-specific models and medical devices constructed by computer-aided design. Individualized anatomic models hold great potential for medical and patient education, research, device development and testing, procedure training, preoperative planning, and fabrication of individualized instruments and implants. Hand in hand with 3D imaging, medical 3D printing has started to revolutionize medicine in certain fields and new applications are developed and introduced regularly. The demand for medical 3D printing will likely continue to rise, as it is a promising tool for plastic preparation of medical interventions. However, there is ongoing debate on the appropriateness of medical 3D printing and further research on its efficiency is needed. As experts in 3D imaging, radiologists are not only capable of advising on adequate imaging parameters, but should also become adept in 3D printing to participate in on-site 3D printing facilities and randomized controlled trials on the topic, thus contributing to improving patient outcomes via personalized medicine through patient-specific preparation of medical interventions.Die dreidimensionale (3D) Bildgebung steht seit fast vier Jahrzehnten zur Verfügung und gilt als State of the Art für die Visualisierung von Anatomie und Pathologie sowie für die Therapieplanung in vielen klinischen Bereichen. Zusammen mit 3D-Bildrekonstruktionen in Form von gerenderten virtuellen 3D-Modellen hat sie dazu beigetragen, komplexe anatomische und pathologische Zusammenhänge besser zu verstehen und die präprozedurale Vermessung und Größenbestimmung von Implantaten zu verbessern. Heute kann dabei sogar fotorealistische Bildqualität erreicht werden. Die Betrachtung auf 2D-Displays schränkt jedoch die 3D-Perzeption ein. Neuartige 3D-Drucktechnologien können virtuelle anatomische Modelle in den echten 3D-Raum übertragen und erlauben die Herstellung sowohl patientenspezifischer Modelle als auch mittels CAD („computer-aided design“) konstruierter medizinischer Geräte. Individualisierte anatomische Modelle bergen ein großes Potenzial für die medizinische Lehre und Forschung, Patientenaufklärung, Geräteentwicklung und -prüfung, für Operationskurse, präoperative Planung und Herstellung individualisierter Instrumente und Implantate. Zusammen mit der 3D-Bildgebung hat der medizinische 3D-Druck begonnen, die Medizin in bestimmten Bereichen zu revolutionieren, und es werden regelmäßig neue Anwendungen entwickelt und eingeführt. Die Nachfrage nach medizinischem 3D-Druck als ein vielversprechendes Werkzeug für die plastische Vorbereitung von medizinischen Eingriffen wird wahrscheinlich noch steigen. Andererseits wird in der wissenschaftlichen Debatte kritisch hinterfragt, wann medizinischer 3D-Druck angemessen ist, und zur Beurteilung der Effizienz des Verfahrens sind weitere Studien erforderlich. Als Experten auf dem Gebiet der 3D-Bildgebung können Radiologen nicht nur zu adäquaten Bildgebungsparametern beraten und optimale 3D-Bilddaten liefern. Vielmehr sollten sie sich auch selbst mit dem 3D-Druck vertraut machen, um als Partner an lokalen 3D-Druck-Enrichtungen und an randomisierten kontrollierten Studien zu diesem Thema teilzunehmen und so dazu beizutragen, die personalisierte Medizin mittels patientenspezifischer Vorbereitung medizinischer Eingriffe voranzubringen.

PURPOSE: The American College of Sports Medicine exercise guidelines for cancer survivors encourage a combination of 150 minutes of moderate-intensity aerobic activity and 2-3 weekly sessions of strength training. Cancer survivors often experience more barriers to meeting recommended guidelines because of side effects from cancer treatments. Our aim was to measure the cancer survivors’ adherence and barriers with these recommendations. METHODS: Two hundred adult cancer survivors completed surveys (Stanford Patient Education Research Center Exercise Behaviors Survey and an exercise barrier scale) reporting their physical activity, barriers to physical activity, and symptom assessment. RESULTS: A total of 68/200 participants (34%) reported adhering to the recommended physical activity guidelines of 150 minutes or more per week. Those who adhered to the guidelines reported fewer barriers to exercise (mean of 2.44 compared with 4.15 barriers, P < .0001). Female participants ( P = .01), higher number of barriers, and feeling of poor well-being were less likely to report at least 60 or 150 minutes of exercise time. Lack of interest ( P = .003) and self-discipline ( P = .001) were reported as barriers. These participants were more likely to report high symptom burden of pain ( P = .007) and fatigue ( P = .005). Participants who reported < 60 minutes of exercise reported lack of enjoyment ( P = .03), lack of equipment ( P = .01), and symptoms of poor appetite, poor well-being, and increased dyspnea. CONCLUSION: Although recommendations are given for exercise, adherence to recommendations is low. Issues of motivation, including lack of interest and self-discipline, and symptoms of pain and fatigue were some of the main reported barriers to adhering to the recommended exercise guidelines. Therefore, interventions aimed at increasing motivation and treating symptoms could improve cancer survivor adherence to recommended exercise guidelines.

Background: Bellin Health in Wisconsin has pioneered the colocation and integration of physical therapists into primary care pods. Methods: This is an observational study based on one in-person visit and several interviews. Results: For patients with musculoskeletal complaints, providers make warm handoffs to the physical therapist, who is a few steps away. The physical therapist performs most of the visit, providing diagnosis, treatment, and patient education. Research studies show that—compared with physician management—appropriate patients managed by physical therapists have better outcomes, lower costs, and higher patient satisfaction. In a fee-for-service environment, the business case for this innovation requires an increased number of follow-up referrals to the physical therapy department. In the Coronavirus disease 2019 (COVID-19) era, physical therapists can provide video visits with equal quality compared with in-person visits. Conclusion: The Bellin Health program is a blueprint for other primary care practices to integrate physical therapists into primary care teams.

Introduction: An essential component of oropharyngeal dysphagia (OD) management is education of patients and their caregivers. However, clear and precise recommendations are not always present in patient/caregiver education. Objective: The objective of this article is to summarize evidence reported in the literature from 1996 to 2021 for therapeutic patient education (TPE) in OD, with a focus on, the modalities of the interventions, as well as the evaluation of educational interventions for adult patients with OD and their informal caregivers (ICGs). Methods: A search for relevant studies was completed on: Medline (Ovid), PsycINFO (Ovid), and Scopus. Additional searches were performed on Google Scholar, and Open Grey. Data was collected relying on the Patient Education Research Characteristics model. Results-Discussion: In the 17 selected articles, different educational strategies and interventions were used through different modalities. Educational content mostly targeted knowledge about the normal mechanism of swallowing, application of specific rehabilitation exercises, and compensatory strategies. Evaluation of the effectiveness of these educational interventions includes several criteria. Important details are missing in the literature; such as details of the educational strategies amongst others. Conclusion: There is little evidence guiding educational interventions for OD patients and their ICG. Further studies are needed to understand which TPE program would be effective in OD, but first, there is a need to have an agreement on the goals of educational interventions.

The purpose of this study was to (a) describe the development of a culturally appropriate glucose monitoring video using a community-based participatory research approach and (b) assess the cultural appropriateness and effectiveness of the video. The topic of the video—using a glucometer and the importance of performing blood glucose checks—was chosen by Marshallese community stakeholders. The video was produced in Marshallese with English subtitles and disseminated through YouTube. Participants were recruited from August 16, 2016 to September 12, 2016 in a diabetes clinic that serves Marshallese patients in northwest Arkansas. Fifty participants completed a survey at pre- and postintervention, with questions capturing demographic information and questions on glucose monitoring self-efficacy using an adapted version of the Stanford Patient Education Research Center's Diabetes Self-Efficacy Scale. Twenty of those participants who completed the survey also completed semistructured interviews that assessed cultural appropriateness and effectiveness of the video. Participants reported significant increases in self-efficacy related to glucometer use and the importance of performing blood glucose checks ( p

Background The World Health Report (2006) by the World Health Organization conveys that a significant increase is needed in global health care resourcing to meet the current and future demand for health professionals. Electronic learning (e-Learning) presents a possible opportunity to change and optimize training by providing a scalable means for instruction, thus reducing the costs for training health professionals and providing patient education. Research literature often suggests that a benefit of e-Learning is its cost-effectiveness compared with face-to-face instruction, yet there is limited evidence with respect to the comparison of design and production costs with other forms of instruction or the establishment of standards pertaining to budgeting for these costs. Objective To determine the potential cost favorability of e-Learning in contrast to other forms of learning, there must first be an understanding of the components and elements for building an e-Learning course. Without first taking this step, studies lack the essential financial accounting rigor for course planning and have an inconsistent basis for comparison. This study aimed to (1) establish standard ingredients for the cost of e-Learning course production and (2) determine the variance instructional design has on the production costs of e-Learning courses. Methods This study made use of a cross-case method among 3 case studies using mixed methods, including horizontal budget variance calculation and qualitative interpretation of responses from course designers for budget variance using total quality management themes. The different implementation-specific aspects of these cases were used to establish common principles in the composition of budgets in the production and delivery of an applied health professional e-Learning course. Results A total of 2 case studies reported significant negative budget variances caused by issues surrounding underreporting of personnel costs, inaccurate resource task estimation, lack of contingency planning, challenges in third-party resource management, and the need to update health-related materials that became outdated during course production. The third study reported a positive budget variance because of the cost efficiency derived from previous implementation, the strong working relationship of the course project team, and the use of iterative project management methods. Conclusions This research suggests that the delivery costs of an e-Learning course could be underestimated or underreported and identifies factors that could be used to better control budgets. Through consistent management of factors affecting the cost of course production, further research could be undertaken using standard economic evaluation methods to evaluate the advantages of using e-Learning.

Background: The World Health Report (2006) by the World Health Organization conveys that a significant increase is needed in global health care resourcing to meet the current and future demand for health professionals. Electronic learning (e-Learning) presents a possible opportunity to change and optimize training by providing a scalable means for instruction, thus reducing the costs for training health professionals and providing patient education. Research literature often suggests that a benefit of e-Learning is its cost-effectiveness compared with face-to-face instruction, yet there is limited evidence with respect to the comparison of design and production costs with other forms of instruction or the establishment of standards pertaining to budgeting for these costs. Objective: To determine the potential cost favorability of e-Learning in contrast to other forms of learning, there must first be an understanding of the components and elements for building an e-Learning course. Without first taking this step, studies lack the essential financial accounting rigor for course planning and have an inconsistent basis for comparison. This study aimed to (1) establish standard ingredients for the cost of e-Learning course production and (2) determine the variance instructional design has on the production costs of e-Learning courses. Methods: This study made use of a cross-case method among 3 case studies using mixed methods, including horizontal budget variance calculation and qualitative interpretation of responses from course designers for budget variance using total quality management themes. The different implementation-specific aspects of these cases were used to establish common principles in the composition of budgets in the production and delivery of an applied health professional e-Learning course. Results: A total of 2 case studies reported significant negative budget variances caused by issues surrounding underreporting of personnel costs, inaccurate resource task estimation, lack of contingency planning, challenges in third-party resource management, and the need to update health-related materials that became outdated during course production. The third study reported a positive budget variance because of the cost efficiency derived from previous implementation, the strong working relationship of the course project team, and the use of iterative project management methods. Conclusions: This research suggests that the delivery costs of an e-Learning course could be underestimated or underreported and identifies factors that could be used to better control budgets. Through consistent management of factors affecting the cost of course production, further research could be undertaken using standard economic evaluation methods to evaluate the advantages of using e-Learning.

OBJECTIVE The Skills, Confidence, and Preparedness Index (SCPI) is an electronic tool designed to assess three dimensions (knowledge, confidence, and preparedness) in a clinically relevant measure with immediate feedback to guide the individualization of patient education. This study sought to assess the validity and reliability of the final SCPI generation, its relevance to glycemia, and its responsiveness to patient education. RESEARCH DESIGN AND METHODS In Part 1, patients with type 1 and type 2 diabetes were recruited from specialist clinics over a 6-month period and completed the 23-item SCPI using a tablet. In Part 2, participants also underwent a diabetes self-management education (DSME) program. Baseline SCPI score was used to guide the DSME, and SCPI and glycemia were assessed at completion. RESULTS In total, 423 patients met inclusion criteria and 405 had evaluable data. SCPI scores were found to have a high degree of validity, internal consistency, and test-retest reliability, with no floor or ceiling effects. Scoring was negatively correlated with HbA1c (type 1 diabetes: r = −0.26, P = 0.001; type 2 diabetes: r = −0.20, P = 0.004). In 51 participants who underwent a DSME intervention (6.4 ± 0.6 visits over a mean ± SD 3.4 ± 0.8 months), mean HbA1c improvement was 1.2 ± 0.2% (13.1 ± 2.2 mmol/mol, P < 0.0001). Total SCPI score and each subscore improved in parallel. CONCLUSIONS The SCPI tool is a quick and easy-to-use measurement of three domains: skills, confidence, and preparedness. The instant scoring and feedback and its relationship to glycemic control should improve the efficiency and quality of individualizing care in the diabetes clinic.

INTRODUCTION Developing and advancing patient-centered care within neuro-oncology is an essential element of any tertiary brain tumor center. Patient-centered care of neuro-oncology patients requires a holistic approach that integrates oncologic treatment with social and psychological support. OBJECTIVE The aim of this study is to evaluate how a Patient Family Advisory Council can be created within an existing brain tumor center and utilized to improve patient-centered care. METHODS Current patients and caregivers were recruited by brain tumor staff to participate in monthly meetings. All participants underwent screening and training by our Patient Education Research Center team. Discussions focused on current and future brain tumor center initiatives, and participants were encouraged to give feedback from the patient perspective. New ideas to improve the patient experience were solicited. RESULTS A total of 15 participants (female = 57%) were recruited, including 10 with grade 3 or higher brain tumors. Monthly meetings, in-person or virtual, were held for two years. Utilizing participant feedback, the group updated our 80-page patient handbook that contained a variety of patient-caregiver focused resources. Participants also provided feedback on other brain tumor center initiatives such as development of a magnet featuring key phone numbers, an easily accessible website URL for emergencies, and numerous updates to the external website. Additional discussions involved development of neuro-oncology care pathways as we move to a stand-alone cancer center facility and initiation of OncoSTAT and palliative services in this population. CONCLUSION Brain tumor patients require a comprehensive oncologic treatment team as well as a wide variety of support services. A Patient Family Advisory Council is an effective method of advancing patient-centered care and a step toward improving the neuro-oncology patient experience.

Context: Diabetes mellitus along with its complications contribute a significant amount of burden on the society. Lack of awareness has resulted in an increased number of diabetics over the years. Aims: To study the sociodemographic status, complication profile and perception of diabetic patients regarding their illness. Settings and Design: Cross sectional center based study done on 110 type 2 diabetic patients over a period of 5 months at rural health training center. Materials and Methods: Universal sampling technique was used. All old and newly diagnosed diabetic patients were interviewed by Face to Face interview method. Statistical Analysis: Descriptive statistics for sociodemographic factors and morbidity; cross tabulation by using test of significance to find association between different variables were used. Results: 50% patients were illiterate, 91.82% were married and 44.5% were farmers. The perception of self-health was reported GOOD on Stanford patient education research center questionnaire scale in 62.7% patients; these responses were significantly associated with males. 61.81% patient had symptoms of coronary heart disease (CHD). 87.3%, 59.1%, and 58.2% patient had symptoms of neuropathy, nephropathy and retinopathy respectively. Out of 61 patients who were aware of complications only 1/10th were aware with the fact that diabetes can affect eye and heart. Conclusions: Almost half patients were unaware that disease is associated with complications and in remaining halves awareness was negligible for neuropathy and nephropathy. In contrast around 2/3rd patients had symptoms of CHD, nephropathy and retinopathy.

The purpose of this chapter is to consolidate elements from the other guidelines for culturally competent healthcare and illustrate their application at the organizational level. A commitment to cultural competence is needed at the highest administrative level of healthcare institutions, reflected in their mission and vision statements, formation of a diversity committee accountable to leadership, and engaging community members in committees, such as patient education, research and ethics committees. These community members can also help develop culturally appropriate alternatives to unsafe traditional practices. Recruitment of a multicultural workforce and cultural competence training of all the employees are also necessary. Signage in languages of the populations served and interpreters’ services are needed to improve communication and patient education services for those populations not speaking the dominant language. Linking quality of care with equity of care aims to reduce the disparities of health outcomes for our most vulnerable populations.

In the era of modern communication, the physician and patient relationship has evolved to include an entirely new dimension-social media. This new dimension offers several opportunities for patient education, research and its dissemination, and professional development for health care providers; it can also serve as a platform for addressing important public health issues. However, these advantages come with challenges such as threats to patient and professional privacy. In this article, we dissect the benefits and drawbacks of this social evolution on the practicing hematologist-oncologist. We also perform a review of the current literature on the integration of social media in the practice of hematology/oncology; examine available guidelines for information exchange between health care professionals, industry, pharmaceutical companies, advocacy groups, and patients; and offer ways to create its seamless integration into clinical hematology-oncology practice.

Intensive insulin therapy (IIT) has been shown to reduce micro- and macrovascular complications in patients with type 1 diabetes mellitus (T1DM). However, IIT is associated with a significant increase in severe hypoglycemic events, resulting in increased morbidity and mortality. Optimization of glycemic control without hypoglycemia (especially nocturnal) should be the next major goal for subjects on insulin treatment. The use of insulin pumps along with continuous glucose monitors (CGMs) has made it easier but requires significant resources and patient education. Research is ongoing to close the loop by integrating the pump and the CGM using different algorithms. The currently available closed-loop system is the threshold suspend. Steps needed to achieve a near-perfect closed-loop are (1) a control-to-range system that will reduce the incidence and/or severity of hyper- and/or hypoglycemia by adjusting the insulin dose and (2) a control-to-target system, a fully automated or hybrid system that sets target glucose levels to individual needs and maintains glucose levels throughout the day using insulin (unihormonal) alone or with other hormones such as glucagon or possibly pramlintide (bihormonal). Future research is also focusing on better insulin delivery devices (pumps), more accurate CGMs, better predictive algorithms, and ultra-rapid-acting insulin analogs to make the closed-loop system as physiological as possible.

We discuss the evaluation of the Engaging Older Adult Learners as Health Researchers (ENGOAL), a program designed to educate older adults from underserved and underresourced communities about geriatric health and research methods, enabling them to become Research Partners. Quantitative and qualitative data were collected for evaluation from 21 participants aged 53-79. We used All Aspects of Health Literacy Scale (AAHLS, King’s College, London) and an adaptation of Stanford Patient Education Research Center Chronic Disease Self-Efficacy Scale to assess pre-post and follow-up changes, using repeated measures analyses. Results suggest notable increases in self-efficacy, but only small improvements in subjective health literacy. Themes identified through qualitative analysis of interviews with participants included: (1) Finding our Voices (2) Race and Health (3) Faith and Health (4) Communicating with Providers and (5) Sharing and Advocacy. Emerging community leadership of participants are further evidence of confidence gains in our participants.

We discuss the evaluation of the Engaging Older Adult Learners as Health Researchers (ENGOAL), a program designed to educate older adults from underserved and underresourced communities about geriatric health and research methods, enabling them to become Research Partners. Quantitative and qualitative data were collected for evaluation from 21 participants aged 53-79. We used All Aspects of Health Literacy Scale (AAHLS, King’s College, London) and an adaptation of Stanford Patient Education Research Center Chronic Disease Self-Efficacy Scale to assess pre-post and follow-up changes, using repeated measures analyses. Results suggest notable increases in self-efficacy, but only small improvements in subjective health literacy. Themes identified through qualitative analysis of interviews with participants included: (1) Finding our Voices (2) Race and Health (3) Faith and Health (4) Communicating with Providers and (5) Sharing and Advocacy. Emerging community leadership of participants are further evidence of confidence gains in our participants.

Many studies have tested clinical and behavioral approaches for improving glycemic control in people with diabetes. We reviewed studies to identify how blood glucose (BG) values have been used in patient-focused clinical research and interventions. We sought to describe the frequency that BG values have been the focus of patient education research and to characterize the different methods to integrate BG into an intervention, the approaches implemented to support patient education, and behavior change, and the nature of communication about BG values. Thirty-four eligible studies were identified that included patient education using BG values. Information regarding the study and intervention characteristics include: (1) characteristics of the study sample, (2) how BG values were obtained, (3) use of a graphical interface for BG values, (4) use of a BG log, (5) BG interpretation and regimen adjustments, (6) recommended actions to patient, (7) modality of intervention, and (8) intervention communication schedule. The review demonstrated that new BG technologies provide outstanding opportunities for greater access to BG data, and for patient support and intervention. However, it also indicated a need to improve and expand support for people with diabetes in their daily use of BG values to maintain and improve glycemic control. In order to make the most sustainable impact on behavior, generalizable skills such as problem solving need to be integrated into BG education.

Introduction: This review aims to highlight the main characteristics and the recent trends of TPE in obesity through the analysis of the international literature from 2005 to 2010. Method: Several databases were queried using as keywords: obesity, patient education, self management, programs. Data were selected filling in the “patient education research categories” (PERC) model of analysis. Articles really related to patient education in obesity (32 on 237) were considered, among which 24 evaluation studies have been analysed. Results: The selected articles, published in 22 scientific journals, concern TPE for 6483 overweight or obese patients. Delivered in several settings, group education is provided by a multi professional team and represents the most used strategy. A growing development of web-based interventions has been observed particularly for adolescents. The programs in which TPE is an important component beside other interventions and those in which TPE is the main intervention, demonstrate equal clinical effectiveness (weight loss, BMI) especially in short term. Positive outcomes of TPE in patient’s knowledge and self-management skills are particularly important regarding nutrition and physical activity. Conclusion: TPE can improve patients’ health outcomes in obesity. Further researches should focus on which kind of educational interventions is more effective.

Objective The aim of this study is to point out the recent characteristics and developments of therapeutic patient education (TPE) in rheumatoid arthritis through an analysis of the international articles published from 2003 to 2008. Method Studies were selected from major databases, using the following keywords: rheumatoid arthritis, patient education, self-management, programs. Three authors independently reviewed each study and selected the data using the patient education research categories (PERC). Articles consistently related to patient education in rheumatoid arthritis (37 among 109) were included. Results The selected articles have been published in 23 scientific journals. The majority of them concern TPE for adult patients with rheumatoid arthritis. TPE is delivered in several structures and group education represents the most widespread educational strategy mainly provided by a multiprofessional team. There are two types of programs: educational, aiming to make the patient competent in the daily management of his disease and psycho-educational ones, aiming to improve coping and to decrease stress, anxiety and depression. Twenty-eight studies show the effectiveness of TPE on the basis of bio-clinical, educational, psychosocial, economical criteria, but the majority of these positive results are observed in short-term. Barriers to TPE are linked to cultural and socio-economic factors. Conclusion A large number of studies still assess the positive effects of TPE. Nowadays, the problems of short-term efficacy of TPE and the cultural and social barriers to this practice have become a major issue for research.

Bakalaura darba tēma ir „Māsas un pacienta sadarbība ķirurģijas nodaļā”. Darba mērķis ir noskaidrot māsu un pacientu sadarbības modeli ķirurģijas nodaļā un izvirzītā hipotēze ir: māsas un pacienta sadarbības modelis balstīts uz verbālo komunikāciju, kuras mērķis ir pacientu izglītošana. Pētnieciskā darba uzdevumi: 1.Analizēt zinātnisko literatūru par pacientu aprūpi, māsu darbību, saskarsmi, izglītošanu, mācīšanu un sadarbību 2.Analizēt D.Oremas teoriju 3.Izstrādāt anketu, interviju un veikt pilotpētījumu 4.Veikt anketēšanu un intervēšanu 5.Apkopot un analizēt iegūtos rezultātus 6.Izdarīt secinājumus Bakalaura darbā tiek rakstīts par darba organizāciju un galvenājām saslimšanām koloproktoloģijas nodaļā, par māsas un pacientu sadarbību, kurā iekļauts mācīšanas un saskarsmes skaidrojums, par perioperatīvo aprūpi, kura iedalās trīs posmos – pirmsoperāciju periods, ķirurģiskās operācijas periods, pēcoperāciju periods. Savā darbā autore izmantoja Dorotejas Oremas māsu pašaprūpes teoriju. Savā teorijā D. Orema nosaka terapeitiskās pašaprūpes darbību un to, kā māsa ar klientu strādā kopā, lai sasniegtu vēlamos mērķus. Šajā gadījumā, sekmīgu atveseļošanos pēc operācijas. 1.Pētījuma hipotēze ir apstiprinājusies, jo 76% respondentu (pacienti) ir atbildējuši, ka māsas, izglītojot pacientus, vairāk izmanto verbālo saskarsmes veidu un intervijas rezultātos māsas atbildējušas, ka izglītojot pacientus izmanto verbālo saskarsmi un pēc vajadzības pielieto neverbālo saskarsmes veidu. Vēl respondenti (pacienti) ar jautājumu par to, kā viņiem vieglāk uztvert informāciju, ir apstiprinājuši, ka tieši mutiska komunikācija liek vieglāk uztvert informāciju, jo tikai 9% no apjautātajiem respondentiem atbildējuši, ka rakstisku informāciju uztvert ir vieglāk. Var secināt, ka izglītošanas procesā svarīgākais ir mutiska komunikācija, tātad verbāla saskarsme. 2.Autore secina, ka māsas nespēj pietiekami daudz komunicēt un aprūpēt pacientus kvalitatīvi, laika trūkuma dēļ, līdz ar to arī 28% respondentu (pacientu) pētījumā ir atbildējuši, ka māsām vajadzētu vairāk komunicēt ar pacientu. Mainot sadarbības modeli nodaļā uzlabotos aprūpes kvalitāte un komunikācija ar pacientiem pieaugtu. Atslēgvārdi: koloproktoloģija, aprūpe, saskarsme, sadarbība, māsa, pacients, izglītošana, Bachelor's thesis: „Cooperation between patients and nurses in the surgery department”. Pursue of work is to find out nurse and patient cooperation module in surgery department and suggested hypothesis is: Nurse and patients cooperative module based on verbal communication and purpuse of patient education. Research tasks: 1. Analyse scientific literature about patients care, nurse act, communication, education, teaching and cooperation. 2. analyse D. Oremas theory. 3. The questionnaire drawn up, interview, and make pilot study. 4. Take the pool and do interviews. 5. Maintain and analyse the results abstained. 6. Make a conclusion. Bachelor thesis is written about work organization and leading conditions in coloproctology department, about nurse and patient cooperation.Which includes learning and communication explanation about perioperactive care which falls in three episodes - pre operation period, surgery period, after surgery period. Author in her work used Dorathy Oremas nurse self care theory. Theory by Orem down for therapethic act and that, how nurse and costumer work together to reach desired results in this care with successful recovery after operation. 1. Research hypothesis is confirmed that 76% patients have responded, that nurses, educate patients, more verbally and result of interview nurces responded, that educating patients verbally helps a lot. More patients responded on question about, how better perceive information - was verbally. As only 9% patients, who took pool responded that written information is easier. It can be concluded, that the educational process is the most important verbal communication. 2. Author concluding that nurces fail to communicate enaugh and care for patients with hight standards as lack of time don't let them do that. 28% of patient responded that nurces would need communicate more with patients. Changing collaborative model in ward would improve the quality of care and communication with patients will rise. Key words: coloproctology, care, communication, cooperation, nurse, patient, education

This study was designed to test a causality-based model in the context of relationships based on social cognitive theory and the literature for the purpose of examining how self-efficacy directly affects the quality of life of migraine patients through self- disease management skills. The sample of the study consisted of 343 migraine patients selected from a neurology outpatient clinic. The data were collected with self-report method using Self-Disease Management Strategies Scale in Migraine Patients developed by the researcher, the interview form, Quality of Life Scale in Migraine Patients and Self-Efficacy for Managing Chronic Disease 6-Item Scale, SEMCD developed by Stanford Patient Education Research Center. In order to test construct validity of scales, explanatory factor analysis and varimax axis rotation basic component analysis were applied. Cronbach's alpha values were calculated by analyzing the internal consistency for all the items in the scales and each subscale of the scale. The model proposed in the study was tested by using Structural Equation Model (SEM)-path analysis with latent variables in lisrel program. In SEM application, direct effect of self-efficacy on quality of life and indirect effect on self-disease management strategies were found to be statistically significant. Based on these results, self-efficacy can be thought to be a determinant of self-efficacy, quality of life of the patient and the patient’s skills of using self-disease management strategies. In order to improve the quality of life of migraine patients, their self-efficacy on disease management should be assessed and nursing practices should be planned to increase their confidence in the ability of preventing and managing migraine attacks. Extended English abstract is in the end of PDF (TURKISH) file . Ozet Bu arastirma, oz yeterligin migrenli hastalarin yasam kalitesini dogrudan ve kendi kendine hastalik yonetimi becerileri araciligi yoluyla ne kadar etkiledigini incelemek amaciyla, sosyal bilissel teoriden temel alarak ve literature dayali iliskiler baglaminda nedensellik temelli bir modeli test etmek amaciyla planlanmistir. Arastirmanin orneklemini bir noroloji polikliniginden secilen 343 migren hastasi olusturmustur. Veriler, gorusme formu, arastirmaci tarafindan gelistirilen Migrenli Hastalarda Kendi Kendine Hastalik Yonetim Stratejileri Olcegi, Migrenli Hastalarda Yasam Kalitesi Olcegi ve Standford Hasta Egitim Arastirma Merkezi tarafindan gelistirilen [WK1] [Mh2] Kronik Hastaliklari Yonetimde Oz Yeterlik Olcegi (Self-Efficacy for Managing Chronic Disease 6-Item Scale, SEMCD) kullanilarak oz bildirim yontemi ile toplanmistir. Olceklerin yapi gecerliligini test etmek icin aciklayici faktor analizi ve varimaks’ eksen dondurme temel bilesenler analizi uygulanmistir. Olceklerde yer alan maddelerin tamami ve olcegin her bir alt boyutu icin, ic tutarlik analizi yapilarak, Cronbach Alfa degerleri hesaplanmistir. Arastirmada ileri surulen model, lisrel programinda Yapisal Esitlik Modeli (YEM)-ortuk degiskenlerle yol analizi yapilarak test edilmistir. YEM uygulamasinda oz yeterligin yasam kalitesi uzerine dogrudan etkisi ve kendi kendine hastalik yonetim stratejileri uzerinden dolayli etkisi istatiksel olarak anlamli bulunmustur. Bu sonuclara dayanarak; oz yeterlik, hastanin yasam kalitesini, kendi kendine hastalik yonetim stratejilerini kullanma becerisinin bir belirleyicisi olarak dusunulebilir. Migrenli hastalarin yasam kalitesini artirmak icin migrenli hastalarin hastalik yonetimi konusundaki oz yeterlikleri degerlendirilmeli, hemsirelik uygulamalari hastalarin migren atagini onleme ve yonetme becerileri konusundaki kendilerine olan guvenini artiracak sekilde planlanmalidir. // // // //

Participation in eight common types of recreational activities leads annually to more than 2 million medically treated musculoskeletal injuries in children aged 5 to 14 years. Many of these injuries could have been prevented if current safety guidelines and protective equipment had been used. Studies have demonstrated the value of safety education programs in preventing injuries. Parents consider their child's physician an important source of safety education, and orthopaedic surgeons have a unique opportunity to provide injury prevention counseling. The American Academy of Orthopaedic Surgeons recognizes the importance of injury prevention and has developed advocacy programs that are readily available to physicians and the public. Individual orthopaedists should be involved in injury prevention through patient education, research, community programs, and regulatory efforts that promote safe play for children.

Bakalaura darba tēma – Aprūpe un ārstēšanas iespējas pacientiem ar priekškambaru mirgošanu. Priekškambaru mirgošana ir biežākā no nopietnām aritmijām un ir iemesls vienai trešdaļai no visām hospitalizācijām sakarā ar aritmijām. Darba mērķis: noskaidot aprūpi un ārstēšanas iespējas pacientiem ar priekškambaru mirgošanu. Pacienta izglītošana ir apzināta, sistemātiska un mērķtiecīga darbība, kuras mērķis ir ietekmēt pacienta attieksmi pret savu veselību. Pētniecības uzdevumi: izveidot anketu māsām, lai noskaidrotu kādu aprūpi saņem pacienti ar priekškambaru mirgošanu un veikt māsu aptauju. Iegūtie rezultāti tika apstrādati ar datorprogrammu Microsoft Excel 2007 un Microsoft Word 2007 palīdzību. Izvirzīta hipotēze: pacientu ar priekškambaru mirgošanu aprūpe ir vērsta uz medikamentozo terapiju un pacientu izglītošanu. Pētniecības darba metode: kvantitatīvā pētījuma metode (aptauja) ar instrumentu – strukturētu anketu. Pētījuma rezultāti liecina, ka galvenie aprūpes principi pacientiem ar priekškambaru mirgošanu ir medikamentozās terapijas nodrošināšana un pacientu izglītošana par riska faktoru mazināšanu, pareizu medikamentu lietošanu, diētu un tālāko ģimenes ārsta apmeklēšanu. Atslēgas vārdi: priekškambaru mirgošana, aprūpe, ārstēšanas iespējas, izglītošana., The theme of the Bachelor Paper is – Nursing care and treatment’s opportunity for patients with atrial fibrillation. Atrial fibrillation is the most common of the serious arrhythmias and is responsible for one-third of all hospitalizations due to arrhythmias. The aim of the paper is to identify care and treatment’s options for patients with atrial fibrillation. Patient education is a deliberate, systematic and purposeful activity aimed at influencing the patient’s attitude towards health. The objectives of the research are: to create a form for nurses to identify care and treatment’s options for patients with atrial fibrillation and carry out a survey of nurses. The results were processed by computer programms Microsoft Excel 2007 and Microsoft Word 2007 assistance. The hypothesis: patients with atrial fibrillation care is focused on drugs therapy and patient education. Research method: Quantitative research method (survey) with the tool – structured form. The research results show that the main principles of care for patients with atrial fibrillation are providing the drugs therapy and patient education as a risk factor reduction, proper drugs using, diet and a family doctor following in attendance. Key words: atrial fibrillation, care, treatment’s opportunity, education.

Background EULAR recommendations aim to promote the role of the nurse in the management of inflammatory arthritis (IA) (1). A survey among French nurses in 2014–2015 showed a gap between educational needs and reported competences of French nurses regarding IA management (2). Objectives The objective was to investigate competencies in other rheumatic and musculoskeletal conditions (RMD), patient education and research compared with those found in IA. Methods The list of potentially useful competencies for RN was validated by a multidisciplinary group (2). The survey was conducted through 3 on-line quesitionnaires in Dec 2014-Jan 2015 (2) then in Jan-May 2015, including 78, 72, 70 items. For each item, the RN were asked on a 4 point likert scale if they believed they had acquired the competency and considered it of importance. Results All RMD were adressed: rheumatoid arthritis RA, spondyloarthritis SpA, connective tissue diseases (CTD), other RMD e.g osteoarthritis, osteoporosis, low back pain. The cross-functional skills were pain management, patient-nurse communication, patient education, research. Respectively 104, 71 et 64 RN responded the 3 on-line investigations, 92% female, 70% worked full time, 70% in a university hospital; 30–29% declared qualifications in patient education, 9–20% in pain management, 6–17% in research. Reported competencies were very good in DMARDS, analgesics and NSAIDs, good in patient-nurse communication and patient education. In other fields, educational needs are high, particularly for non-pharmacological treatments, CTD, osteoarthritis, low back pain and research (table). Practical skills were less than cognitive skills. Conclusions This multicentric survey provides accurate information on French RN educational needs. They are greater in the management of RMD other than RA and SpA. These results should be considered in elaborating a curriculum to improve RN competencies. References van Eijk-Hustings Y et al. Ann Rheum Dis. 2012;71:13–9. Beauvais Ann Rheum Dis 2015;74(Suppl2):1326. Acknowledgement Members of the committee for the French Rheumatology Nurse educational course Disclosure of Interest None declared

M. Gemma Cherry *, Anne-Linda Frisch , Marij A. Hillen , Valentina Martinelli , Peter F. Pype , Isabelle Scholl , Nete Schwenessen , Kimberly A. Gudzune h Centre for Excellence in Evidence Based Teaching and Learning (CEEBLT), School of Medical Education, University of Liverpool, Liverpool, UK b Institute of Communication and Health (ICH), Department of Communication Sciences, Universita Della Svizzera Italiana, Lugano, Switzerland Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands d Section of Psychiatry, Department of Health Sciences, University of Pavia, Italy Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany g Steno Health Promotion Center, Patient Education Research Team, Gentofte, Denmark Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Patient education research supports the premise that the nurse must consider the patient's perspective before attempting to provide an educational program for implementing the therapeutic regimen. This article describes how a self-care assessment instrument can help the nurse to develop an individualized teaching plan for the cardiac patient.

Background: Bariatric surgery is the most cost-effective treatment for severe obesity, yet less than 1% of U.S. adults undergo bariatric surgery annually. Reasons for low utilization are unclear although previous investigators have found that the most powerful predictor of whether a patient would consider bariatric surgery was if the primary care physician (PCP) recommended it. To better understand how PCPs prioritize the care they provide to their severely obese patients – who often have multiple comorbidities we conducted focus groups with PCPs in Wisconsin. Specifically, we investigated how PCPs approach bariatric surgery as a treatment option and explored the challenges they encounter while providing care. Methods: We conducted three 90-minute focus groups with PCPs in a rural setting (Mauston), mid-sized city (Madison), and large city (Milwaukee) in Wisconsin. PCPs were eligible to participate if they managed adult patients (450% of their practice) and had seen at least five severely obese patients (BMI 435 or higher) in their clinic over the past 6 months. During the focus groups, participants were given a clinical vignette of a severely obese patient with multiple comorbidities and were asked a variety of questions about how they would prioritize treatment. All questions were guided by a focus group script, and the moderator used open-ended follow-up questions to pursue emerging themes. Participants completed a demographic questionnaire prior to completion of the focus group. Sessions were audio-recorded and transcribed. Data were analyzed using a directed approach to content analysis, in which emergent themes were identified and finalized through a process of consensus among three coders. Results: Participants in the three focus groups (n1⁄416) had a mean age of 46 (SD 11), 50% were female, and 94% were white. We identified four general approaches that PCPs use when prioritizing treatment for severely obese patients with multiple comorbidities: 1) Treat the disease that is the “easiest” to address, which is often hypertension or diabetes; 2) Treat the disease that is perceived as the most dangerous; 3) Let the patient set the agenda; 4) Address obesity first because it is the “common denominator” underlying many of the comorbid conditions. Challenges to implementing the plan included patient characteristics (low socioeconomic status, prior weight loss failures, being in denial about their obesity), provider factors (feeling ineffective in their ability to help patients lose weight), and systemic factors, particularly uncertainty regarding insurance coverage for obesity-related services. PCPs rarely – if ever – brought up the idea of bariatric surgery with their patients. This hesitancy stemmed from five main concerns: 1) Wanting to “do no harm”; 2) Questioning the long-term effectiveness of bariatric surgery; 3) Having limited knowledge about bariatric surgery; 4) Not wanting to recommend bariatric surgery “too early”; 5) Not knowing if the patient’s insurance would cover it. Once the PCP and patient agreed to pursue bariatric surgery, challenges to executing the plan during the pre-operative, operative and post-operative phases included meeting the preoperative requirements, living far from a bariatric surgery program, and the need for PCPs to be involved in post-operative care. Conclusions: PCP approaches to prioritizing care are pragmatic and mostly derived from previous experiences with patients. Three of the four prioritization approaches typically place the treatment emphasis on health conditions other than obesity. The five main concerns that PCPs have about bariatric surgery referral can be effectively addressed by provider and patient education, research, policy change, and publicity to highlight the literature regarding safety and effectiveness of bariatric surgery. Given that obesity often underlies many patient comorbidities, future research should focus on providing effective weight management options for PCPs in clinic and health system re-design that supports comprehensive weight management treatment. *This research was conducted as part of a 2014 ASMBS Research Grant award to Dr. Funk

To provide an overview of cancer-related patient-education research to determine future research needs.A literature search of peer-reviewed articles from 1989-1999. Databases that were searched included Medline, CINAHL, HealthStar, ERIC, CancerLit, and PubMed.176 articles were analyzed and synthesized into narrative form.Patients with cancer want and benefit from information, especially when making treatment decisions. Education helps patients manage side effects and improves adherence. Literacy is an important factor in materials development. The efficacy of computer-assisted learning, audio and video programs, and telephone interventions is supported in a variety of patient groups. Pain education can improve pain control, but the impact on fatigue has not been well researched.Patient education is an important component of nursing care. Research has confirmed its impact in many areas but questions still remain.

PURPOSE This article provides an overview of adult learner characteristics, with an emphasis on those characteristics studied in diabetes patient education research. METHODS A selected review of the conceptual and research literature on general adult education and adult learning was conducted, with particular attention to diabetes patient education studies. RESULTS Characteristics reviewed included learning styles, literacy level, age/aging, ethnicity or culture, gender, and knowledge. Studies of the learning style of group vs individual education indicated some positive benefits for group learning; questions remain about optimal size or periodicity. Studies evaluating the benefits of culturally specific interventions for diabetes management have yielded some information. Characteristics related to gender and age have been studied, but often in pilot or feasibility studies without the power to answer the study questions. CONCLUSIONS There continue to be many gaps in knowledge related to adult learner characteristics in diabetes education. Lessons from both general adult learning literature and patient education literature from other chronic diseases should be evaluated and incorporated. The complexities of these learner characteristics create challenges in designing studies. However, evidence to support the need for effective educational interventions is of great importance for implementing change in health care.

PURPOSE In this paper, we examine the nature of vision and the role it plays in helping educators identify and use theories productively. We also discuss the role of theory in diabetes education and provide criteria for selecting appropriate theories. METHODS The vision of diabetes education developed at the Michigan Diabetes Research and Training Center was used to illustrate how our vision has influenced our use of educational and behavioral theories. RESULTS Both our vision and our theoretical assumptions should be articulated, discussed, debated, and studied. CONCLUSIONS Diabetes patient education research can systematically contribute to the development of a sound, coherent, and progressive body of knowledge that will truly serve diabetes patient education.

The North Carolina Department of Health and Human Services, through the Division of Public Health and the Division of Aging and Adult Services, has adopted an evidence-based self-management curriculum called Living Healthy in NC that uses peer-to-peer learning to improve the ability of persons to manage their diseases, including diabetes, and to prevent or slow the progression of chronic conditions. The program is based on Stanford University’s Chronic Disease Self-Management Program (CDSMP) and is being implemented in North Carolina through broad and diverse partnerships within and between multiple systems. Kate Lorig and colleagues at the Stanford Patient Education Research Center created and evaluated the CDSMP in the early 1990s, recognizing that physician care is only part of the disease-management process and that persons with chronic conditions must be good self-managers 24 hours a day, 7 days a week. Workshop sessions with a duration of 2.5 hours take place in community settings once each week for 6 weeks and provide tools and support for becoming positive self-managers. The CDSMP is based on years of research addressing patient self-efficacy and is built on several underlying assumptions, including the following: (1) people can learn skills needed to better manage their diseases; (2) people with chronic conditions have similar challenges, regardless of the type of condition; (3) people with chronic conditions deal not only with their disease(s), but also the impact it has on their lives; (4) laypeople with chronic conditions can, when given a detailed leader’s manual, teach the CDSMP as and perhaps more effectively than can health professionals; and (5) the way in which the CDSMP is taught is as important as the subject matter being conveyed. Research has shown the CDSMP to be effective across socioeconomic and education levels, settings, populations, and chronic conditions. The CDSMP results in statistically significant and measurable improvements in physical and emotional outcomes and in self-rated overall health and health-related quality of life. Whereas people with chronic illnesses are generally expected to make more trips to the emergency department and to have more hospital admissions as their condition worsens, this is not the case for those who have participated in the CDSMP. Participation in CDSMP has been shown to result in reductions in health care expenditures. Many of these health benefits persist over a 3-year period [1]. One or preferably both of the peer leaders who facilitate each workshop have chronic conditions and act as “models” for participants, because participants tend to have a greater sense of trust and understanding when workshops are led by people facing similar challenges and problems. Topics covered include techniques to deal with problems such as frustration, fatigue, pain, and isolation; appropriate exercise for maintaining and improving strength, flexibility, and endurance; appropriate use of medications; communicating effectively with family, friends, and health professionals; nutrition; and how to evaluate new treatments. The peer-to-peer characteristic of the CDSMP was one of the primary reasons the Division of Public Health adopted the program in 2005 as part of an effort to improve disease self-management. At that time, the CDSMP complemented existing programs that used community health workers through the Division of Public Health’s Diabetes Prevention and Control Program. In 2007 and 2010, the Division of Aging and Adult Services received grants from the US Administration on Aging to further disseminate the CDSMP statewide. These grants also made it possible to expand Stanford University’s Diabetes Self-Management Program (known in North Carolina as Living Healthy with Diabetes), the CDSMP’s “sister” program that targets individuals with type 2 diabetes. Together, Living Healthy and Living Healthy with Diabetes are the leading providers of chronic disease self-management services in North Carolina. These programs are supported by 17 regional coordinators in the state’s Area Agencies on Aging, local health departments, Community Care of North Carolina, the North Carolina Cooperative Extension, the University of North Carolina–Chapel Hill Institute on Aging, the American Association of Retired Persons, faith-based organizations, the Associations of the General Baptist State Convention of North Carolina, Strengthening the Black Family, the Eastern Band of Cherokee Indians, and dozens of local community-based organizations. Since 2005, >3,000 people have taken part in one or both of the programs, and >1,500 of those persons have participated in the past 15 months.

Classroom and patient education research both support the premise that allocated instructional time and active learner involvement influence relevant outcomes. Unfortunately, these two common sense variables have not often been applied in either classrooms or health care settings. In this paper, the educational literature supporting the importance of instructional time and active involvement will be briefly reviewed. The application and significance of time-related variables in patient education will then be discussed and suggestions for improving patient education programs offered.

A literature search located 23 evaluations of patient education programs that utilized a randomly selected control group (i.e., an experimental design) or a non- equivalent control group (i.e., a quast experimental design). Meta-analysis pro cedures were used to combine the findings of these studies The effect size for each of 102 dependent variables was derived from the mean of an experimental group and the mean and standard deviation of an untaught control group. The effect size is a z-score that can be converted into the mean percentile rank of taught pattents relative to the untaught controls The mean effect size for all studies was .74, which is equivalent to improving the average taught patient from the fiftieth to the seventy-seventh percentile relative to the untaught patient group Suggestions for improving the usefulness of patient education research design and report content are discussed

This article presents a practical demonstration of a decentralized pharmacy system improving the quality of pharmaceutical services. The authors explain the working system of a satellite pharmacy in one of the pavilions of the Hospital de la Santa Creu i Sant Pau in Barcelona, Spain. Clinical pharmacists working in this satellite become deeply involved in drug information, quality control programs, pharmacokinetics, patient education, research, and teaching activities.

The 120 studies included in this review were grouped in relation to five categories of variables basic to a theory of instruction in patient education. Findings in the studies related to the characteristics of the patient as learner support the following variables as significant for a theory of instruction: demographic characteristics including age, race, duration and type of illness, educational level, and family preparedness. Selected psychological variables are significant as they interact with teaching approaches. Given only two studies in which the characteristics of the nurse as teacher were the main variables, no inferences for a theory of instruction could be drawn. However, the findings from those studies combined with results from studies in which characteristics of the nurse were secondary variables support the importance of this category of variables. The educational preparation, motivation, values, and job description of the nurse implementing patient teaching appear to be significant variables for a theory of instruction. Investigators explored a wide range of teaching strategies in the studies of patient teaching. The setting for teaching, group and individual teaching, and a variety of instructional strategies all prove promising at the operational level. The instructional strategies were too diverse to allow analysis at a level of abstraction beyond the operational. Findings in this review also support characteristics of the health care setting as an important category of variables for a theory of instruction. The organizational structure, a quality assurance framework, and valuing patient teaching appear to be significant variables. Patient education research provides a rich data source for future developments in theory, practice, and research. The effectiveness of patient education as a nursing intervention is clearly established. Furthermore, positive learning outcomes are associated with a broad range of teaching strategies, content areas, and patient populations. Systematic explorations of the characteristics of the patient as learner, the nurse as teacher, and the health care setting as a learning environment are still necessary for developing a theory of instruction for patient education. Future researchers should attend to phenomena unique to patient education rather than to duplicating general educational research. Instead of the investigator-driven research approach that characterizes research to date, replication should be encouraged. Future research should be designed to link theory and research and thereby contribute to the further development of a theory of instruction in patient education.