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Background: Twenty percent of Americans live in rural areas where most of their health care is provided in critical-access hospitals (CAHs). It is unknown how frequently obstacle and helpful behavior items occur in end-of-life (EOL) care in CAHs. Objectives: The aims of this study were to determine the frequency of occurrence scores of obstacle and helpful behavior items in providing EOL care in CAHs and to also determine which obstacles and helpful behaviors have the greatest or least impact on EOL care based on the magnitude scores. Methods: A questionnaire was sent to nurses working in 39 CAHs in the United States. Nurse participants were asked to rate obstacle and helpful behavior items by size and frequency of occurrence. Data were analyzed to quantify the impact of obstacle and helpful behavior items on EOL care in CAHs by multiplying the mean size by the mean frequency of items to determine mean magnitude scores. Results: Items with the highest and lowest frequency were determined. In addition, obstacle and helpful behavior item magnitude scores were calculated. Seven of the top 10 obstacles were related to patients' families. Seven of the top 10 helpful behaviors involved nurses ensuring families had positive experiences. Conclusion: Nurses in CAHs perceived issues around patient family members as significant obstacles to EOL care. Nurses work to ensure that families have positive experiences. Visiting hour issues seemed to be irrelevant. The use of technology, such as telehealth, seemed to provide little benefit in EOL care in CAHs. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to promote exercise prehabilitation in patients with end-stage liver disease during their waiting period for liver transplantation. Introduction: End-stage liver disease indirectly contributes to the development of sarcopenia and affects survival after liver transplantation because of low physiological reserves and insufficient aerobic capacity while awaiting transplantation. Exercise prehabilitation could reduce postoperative complications and promote postoperative recovery. Methods: Following the JBI Practical Application of Clinical Evidence System, this study used six audit criteria derived from the JBI Evidence Summary. A baseline audit of six patients and nine nurses was conducted, analyzed barriers, established a prehabilitation process and improved interventions, followed by the implementation of exercise prehabilitation and follow-up audit. Results: In the baseline audit, the results of the six criteria [(1) multimodal prehabilitation that includes exercise and other interventions where appropriate is offered to patients scheduled for abdominal surgery; (2) prior to the commencement of an exercise program an assessment of exercise contraindications, health status, treatments, physical activity level, functional capacity and quality of life is completed; (3) exercise programs are designed by appropriately qualified personnel; (4) exercise is delivered and supervised by appropriately qualified personnel; (5) exercise prescription is tailored to each individual patient; and (6) patient response to exercise is monitored throughout prehabilitation] were 0–22%. After implementing the best-practice strategies, all six criteria were set to 100%. Patients were aware of and had high compliance with exercise prehabilitation, nurses' and patients' knowledge of exercise rehabilitation improved, and nurses' implementation rate was significantly higher than before implementation (P  < 0.05). The differences in the 6 min walking distance and Borg Fatigue Score between the preimplementation and postimplementation were statistically significant (all P  < 0.05). Conclusions: This best-practice implementation project is feasible. These results indicate that exercise prehabilitation could improve the preoperative walking capacity and fatigue of patients with end-stage liver disease. Ongoing best practices will be expected to develop in the future. [ABSTRACT FROM AUTHOR]

Introduction: There is an enormous need for pain education among all health care professions before and after licensure. The study goal was to explore generic and chronic pain–specific factors that influenced uptake of a continuous education program for chronic pain, the Project Extension for Community Health Outcomes (ECHO) CHUM Douleur chronique. Methods: The study team conducted 20 semistructured virtual interviews among participants of the program. Interviews were transcribed verbatim, and two analysts used a reflexive thematic analysis approach to generate study themes. Results: Five aspects facilitating engagement, continued participation, and uptake of the Project ECHO were identified: rapid access to reliable information, appraising one's knowledge, cultivating meaningful relationships, breaking the silos of learning and practice, and exponential possibilities of treatment orchestrations for a complex condition with no cure. Although participants' experiences of the program was positive overall, some obstacles to engagement and continued participation were identified: heterogeneity of participants' profiles, feelings of powerlessness and discouragement in the face of complex incurable pain conditions, challenges in applying recommendations, medical hierarchy, and missed opportunity for advocacy. Discussion: Many disease-specific and contextual factors contributed to an increased motivation to participate in the ECHO program. Some elements, such as the complexity of diagnosis and treatment, and the multidisciplinary requirements to manage cases were identified as elements motivating one's participation in the program but also acting as a barrier to knowledge uptake. These must be understood in the broader systemic challenges of the current health care system and lack of resources to access allied health care. [ABSTRACT FROM AUTHOR]

Aim: Integrated knowledge translation (IKT) is an increasingly recommended collaborative approach to minimize knowledge translation gap. Still, few studies have documented the impact of IKT to optimize knowledge uptake in healthcare settings. An IKT-based clinical algorithm (Algo) was deployed in Quebec (Canada) homecare services to support skill mix for selecting bathing equipment for community-dwelling adults. The objective of this study was to document the characteristics related to Algo's IKT process. Methods: A multiple-case study with a nested concurrent mixed design was conducted in provincial homecare services. Based on Knott and Wildavsky's seven-stage classification and the integrated- Promoting Action on Research Implementation in Health Services model, Innovation , Recipients , and Context , characteristics related to Algo's levels of utilization were documented. Quantitative (electronic questionnaire) and qualitative (semistructured interviews and focus groups) data were collected for each case (i.e. homecare service). Descriptive statistics and thematic analysis were performed to describe each case through a mixed methods matrix, for intra/intercase analyses. Results: Knowledge translation characteristics of five Algo's levels of utilization were documented: reception, cognition, reference, effort, and impact. Innovation characteristics (e.g. underlying knowledge) were found to facilitate its dissemination and its use. However, the Recipients (e.g. unclear mechanisms to implement change) and Context (e.g. organizational mandates nonaligned with skill mix) characteristics hampered its application through intermediate and advanced levels of utilization. Conclusion: The knowledge translation analysis of Algo allowed for documenting the IKT-based benefits in terms of utilization in healthcare settings. Although an IKT approach appears to be a strong facilitator for initiating the implementation process, additional characteristics should be considered for promoting and sustaining its use on local, organizational, and external levels of context. Facilitation strategies should document the administrative benefits related to Algo's utilization and contextualize it according to homecare services' characteristics. Key points * The IKT approach used for developing Algo facilitated the initiation of its application but seems insufficient in its actual form to support its implementation accordingly to contextual characteristics (e.g. policies). * Ulterior IKT initiatives should embrace additional stakeholders and contextual characteristics to better align the codevelopment of scientific knowledge with priorities and mandates of the healthcare system. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The study examined relationships between nurses' perceptions of implicit rationing of nursing care and leadership style in the nursing work environment. BACKGROUND: Nurses' perceptions of higher amounts of implicit rationing of nursing care relate to perceptions of lower quality of care and poorer patient outcomes. This study was the 1st to examine leadership style and implicit rationing of nursing care. METHODS: Using a cross-sectional survey study design, 35 039 RNs were randomly sampled during September 2017 to March 2018. RESULTS: Findings support an association between nurses' perceptions of an emotionally intelligent leadership style and lower amounts of implicit rationing of nursing care. CONCLUSION: Implicit rationing of nursing care in the nursing work environment is significantly associated with emotionally intelligent leadership style. Nurse executives, and nursing faculty in administrative-focused graduate programs, can provide development and education in emotionally intelligent leadership skills. [ABSTRACT FROM AUTHOR]

Objective: The objective of the research was to screen male and female adolescent athletes on their concussion educational histories and preferred future methods of education in terms of educational messenger, modality, and concussion-related areas of interest. Design: Cross-sectional survey. Setting: Examination setting within the classroom. Participants: Adolescent male (n = 1854) and female (n = 590) athletes aged 12 to 18 years. Main Outcome Measures: To explore the concussion educational histories and preferred future methods of education in Irish male and female adolescent athletes. Results: 19.7% (n = 482) of the sample received education in the past 12 months. Male athletes had a significantly higher rate of previous education than female athletes (41% vs 17%). The methods used in previous educational interventions are failing to match the interests of the athletes. Sex played a significant role in the preferred educational methods, as male and female athletes had significant differences in their choice of educational messenger, modality, and concussion-related areas of interest. Conclusions: The current disparity in previous concussion education rates between male and female adolescent athletes should be addressed. Forthcoming research should explore the efficacy of tailoring knowledge translation strategies to match the specific needs of the recipient. [ABSTRACT FROM AUTHOR]

Introduction: Mentors are in short supply at academic health centers (AHCs). The effectiveness of training mentors (without preselection for their research skills) to support faculty mentees in scholarly activities at AHCs is not well known. Methods: The University of New Mexico Health Sciences Center has a two-component program to develop effective mentors for scholarship for faculty mentees. It has an online component supplemented by an optional face-to-face (F2F) component. Study outcomes included changes in self-reported knowledge scores for online users and Mentoring Competency Assessment scores for F2F users. Results: One hundred five mentors, mostly women associate professors, used the online program. Online users demonstrated improvement in self-reported knowledge scores. Thirty-eight users additionally completed the F2F program--63% on a clinician--educator track and none with a National Institutes of Health--funded K-award mentee. The self-reported Mentoring Competency Assessment composite score rose from 4.3 ± 1.0 to 5.5 ± 0.8 (paired t = 7.37, df = 37, P < .001) for the F2F participants, with similar improvement noted in the clinician--educator subgroup. Discussion: Users of the online and F2F components of the program improved their self-assessed knowledge and mentoring skill, respectively, demonstrating the effectiveness of the program. Such programs may help AHCs enhance the scholarship and the diversity of their scientific and clinician--educator workforce. [ABSTRACT FROM AUTHOR]

The US homeless population is predisposed to serious complications of influenza with increased likelihood of hospitalization and death. This quality improvement project sought to increase infl uenza vaccination in the homeless population of a rural area in the Midwest and improve provider knowledge of risks and preventive care responsibilities. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study examined the cognitive, behavioral, and environmental factors that facilitate publication by clinical nurses in Magnet® hospitals. BACKGROUND: The culture promoted by the Magnet Recognition Program® promotes nurses practicing in those settings to use, generate, and disseminate best practices. Successful and promising models of care and nursing practice are rarely disseminated beyond the organization where they are practiced. The questions persist: what barriers to writing for publication exist for clinical nurses, and how do we overcome them to advance emergent evidence? METHODS: A focused ethnographic, multiple-case study design examined 5 well-published nurses with high levels of dissemination occurring outside the Magnet organization where they were employed. RESULTS: Nurses in this study most often credited cognitive and behavioral factors for promoting publication. Although the organization encouraged peer-reviewed publication, there were limited environmental efforts to support efforts to publish in peer-reviewed journals by clinical nurses. CONCLUSIONS: The results of this case study call for more research on the multifaceted factors that promote publication by clinical nurses in the practice environment. Publication of research in peer-reviewed journals was supported by environmental influences of time to write, collaborative writing opportunities, and supportive and accurate guidance from editors. [ABSTRACT FROM AUTHOR]

Introduction: Individuals using a lower-limb prosthesis need knowledge about many aspects of management to maximize use and comfort and minimize secondary complications. Knowledge assessments are used in other health fields, yet no assessment has been published in prosthetics. Therefore, a knowledge assessment was developed for international use and pilot tested in the United States and East Africa. Materials and Methods: The assessment contained 36 questions and was written at a 4.7-grade reading level. Content was based on professional input and literature. The assessment was pilot tested with 16 prosthetic users in the United States, 19 prosthetic users in East Africa, and 24 nonprosthetic users in the United States. Assessment scores were analyzed across questions, between prosthetic users and nonprosthetic users, and correlated with patient demographics. Results: We found the assessment was understandable among all subject groups. United States prosthesis users scored higher than nonprosthesis users. Prosthetic experience was positively correlated with assessment scores in the United States and negatively correlated with assessment scores in East Africa. Conclusions: Clinicians can use this knowledge assessment to identify gaps or misunderstanding and track progress in comprehension with their patients. Clinicians can adapt questions to their local context, individual needs and componentry, and time constraints. [ABSTRACT FROM AUTHOR]

Objective: The primary objective of this study was to examine the proportion of US college coaches who receive annual concussion education from their institution and to describe the content and delivery modalities of this education. This study also tested the hypothesis that coaches receiving concussion education from their institution will have greater knowledge about concussions independent of other individual and institutional characteristics. Design: Cross-sectional online survey. Setting: US college sport. Participants: College coaches in National Collegiate Athletic Association Division I, II, and III (n = 1818). Independent Variables: Self-reported receipt of education from institution, sex, sport coached, division of competition. Main Outcome Measures: Concussion identification and management knowledge. Results: Two-thirds of coaches reported receiving informational materials about concussion from their institution. The content of the education most frequently referred to symptoms of a concussion and information about proper management of a concussion. Coaches who received educational materials from their institution were better able to identify symptoms and had more conservative responses to concussion management scenarios. Male coaches of male contact or collision teams less frequently endorsed safe or correct response as compared with female coaches of noncontact or collision teams. Conclusions: Not all US college coaches receive concussion education from their institution. Male Division I coaches of male contact/collision sport are a population for whom targeted educational outreach may be particularly valuable. Clinical Relevance: Education for coaches, delivered by clinicians at many institutions, is an important component of ensuring that coaches are prepared to be informed partners in supporting concussion safety. [ABSTRACT FROM AUTHOR]

Objective: The primary aim was to assess experience and knowledge of adult concussion among international, professional and semiprofessional players, coaches, medical staff, and referees within Rugby Union. The secondary aim was to identify preferred education dissemination routes. Design: Questionnaires devised specifically for players, coaches, medical staff, and referees. Setting and Participants: A total of 370 players, 44 coaches, 40 medical staff, and 33 referees from within Wales were surveyed. Main Outcome Measures: Knowledge of the signs and symptoms of concussion, return to play guidelines and consequences of concussion were investigated along with experiences of, and attitudes towards, concussion. Results: The respondents had extensive experience of sustaining or witnessing rugby-related concussion. Medical staff had the greatest level of concussion knowledge, with coaches having the least. Players and coaches exhibited a disconnection between being "knocked-out" and practically applying this when managing concussion. Almost half of the players and coaches did not indicate concussion could impair performance. Eighty percent of medical staff had felt pressured to clear a concussed player. Most players (82%), coaches (66%), and referees (64%) incorrectly believed protective equipment prevents concussion. Players and coaches prefer concussion education from medical staff, whereas medical staff and referees prefer such education from governing body Web sites or training courses. Conclusions: Several role-specific misconceptions and deficiencies in concussion knowledge were identified and should be targeted through education. Medical staff had the highest level of concussion knowledge and were the preferred sources of education for players and coaches. Therefore, they are encouraged to play a greater role in providing concussion education. [ABSTRACT FROM AUTHOR]

Background: Previous studies have evaluated the competency of newly graduated nurses and nurses. However, most of the instruments used include a large number of items that make completing them a time-consuming process. A brief instrument may be more acceptable and feasible for use in these evaluations. Purpose: This study was designed to develop the brief capstone core competency (CCC or 3C) scale and validate its effectiveness in evaluating the academic and practical performance of nursing students enrolled in a bachelor's degree program. Methods: A cross-sectional study was conducted. The 3C scale was developed in two phases. In Phase I, the items were summed from literature reviews, an expert panel, known-groups validity, test–retest reliability, internal consistency reliability, and exploratory factor analysis. In Phase II, the efficacy of the instrument was confirmed using confirmative factor analysis. Five hundred ninety-six participants participated in the first phase, and 520 participants participated in the second phase. The study period was 2016–2017. Results: The 3C scale includes 24 items distinguished into a three-component structure that accounts for 67.85% of the total variance. The three components include nursing intelligence, nursing humanity, and nursing career. The 3C scale was found to have high levels of internal consistency reliability (.97) and test–retest stability reliability (r =.97). A significant statistical difference in the performance level was examined between senior and junior nursing students. The hypothesized three-factor model fit index showed χ2/ df = 1338.25/249, p <.001, goodness-of-fit index =.82, comparative fit index =.90, root mean square error of approximation =.09, and standardized root mean square residual =.06. The participants were found to have excellent nursing humanity competency. Conclusions: The developed 3C scale exhibited satisfactory reliability and validity for use with nursing students. The 3C scale may be used to evaluate the performance of nursing students during their learning process, and the results may be used to evaluate changes in educational outcomes. [ABSTRACT FROM AUTHOR]

Objective: Certain dietary supplements (DSs) used by military populations pose a threat to overall readiness. This study assessed members of the American Medical Society for Sports Medicine (AMSSM) regarding their knowledge of DS use among their patients and reporting of suspected adverse events. Design: A thirteen-question retrospective, cross-sectional, Web-based survey sought data on practices regarding DSs and adverse event reporting. Setting: Anonymous Web-based survey. Participants: Military and civilian sports medicine physicians. Main Outcome Measures: The primary finding of the study was how frequently practitioners report adverse events associated with DS use. Results: A total of 311 physicians responded to the survey. Only 51% of respondents had a reliable source for information on DS safety and 58% routinely discussed DS use with their patients. Although a majority (71%) of respondents had encountered adverse events associated with DS use, few of those (10%) confirmed reporting such events. Reasons that physicians did not report adverse events were lack of knowledge regarding where to report (68%), how to report (61%), and availability of time (9%). Conclusions: Our results indicate that some AMSSM physicians are familiar with DSs and have encountered adverse events associated with their use. However, reporting of these adverse events to the appropriate agency is minimal at best. The significant gaps in physician knowledge regarding how and where to report such events indicate a need to educate physicians on this subject. Clinical Relevance: The findings of this survey indicate the need for provider education on reporting adverse events associated with DS use. Although reporting of adverse events is essential for removing harmful DSs from the market, a majority of physicians have limited knowledge on this issue. Moreover, the survey provides insight into the barriers to physician reporting of adverse events. [ABSTRACT FROM AUTHOR]

Objective: To investigate knowledge, attitude, and awareness of appropriate mouthguard use, as well as the management of traumatic dental injuries (TDIs). Design: Cross-sectional survey. Setting: Community survey. Participants: Four hundred ninety-four junior rugby league players and their coaches in the Gold Coast, Australia. Interventions: Data were collected anonymously during training sessions by means of a survey questionnaire, followed by a presentation on mouthguards and the management of TDIs. Main Outcome Measures: Descriptive statistics on the frequency distribution of the demographic characteristics, knowledge, and use of mouthguards as well as the relationships between the type of mouthguard worn and questions related to mouthguard use. Results: The majority of players surveyed reported wearing a mouthguard (68.2%). Cost (40.1%) and not believing that they work (35.7%) were listed as the main reasons for not doing so. The boil-and-bite type was the most used by players (64.7%). Almost 44% of coaches and 50% of players responded that only a dentist can manage an avulsed tooth, that a tooth had to be reinserted within 15 minutes (40.6% and 21.9%, respectively), and that either water or milk can be used to transport an avulsed tooth to the dentist (100% and 82.2%, respectively). Conclusions: Education related to the correct use of mouthguards and the management of TDIs should be ongoing for players, their caregivers, and their coaches and should be required as part of the training of coaches to prevent injury in rugby league. Clinical Relevance: This study found that although the overwhelming majority of junior rugby league coaches encourage the wearing of mouthguards, only two-thirds of the players do so. Players' compliance to wear mouthguards is largely influenced by their perception of efficacy and its comfort. Educational campaigns with involvement of dental practitioners, related to the correct use of mouthguards and the management of TDIs, should be ongoing for players, their caregivers, and their coaches and should also be required as part of the training of coaches. [ABSTRACT FROM AUTHOR]

Objective: To investigate concussion rates and reporting frequencies in high school and collegiate athletes in 2013, compare results to those obtained from 1999 to 2002, and examine to what extent the 2012 Wisconsin state concussion law affected reporting in 2013. Design: Retrospective 2013 survey compared with prior survey. Setting: High schools and colleges in the Milwaukee, Wisconsin, area. Participants: Athletes (N = 784) from multiple sports were surveyed in 2013. Football players (N = 1532) from 1999 to 2002 completed the same measure. Main Outcome Measures: Both surveys assessed concussion history, concussion incidence during the current season, whether incident concussions were reported, who concussions were reported to, and reasons for not reporting. The 2013 survey also assessed awareness of the Wisconsin state law and its effect on reporting. Results: Rates of concussion in the surveyed season were comparable to previous findings from 1999 to 2002 (16.6% vs 15.3%, P = 0.558). Notably, athletes were significantly more likely to report their concussions in 2013 (70.6% vs 47.3% previously, P = 0.011). Among high school athletes surveyed, 59.5% were aware of the Wisconsin state law, with 55.1% stating it would make them more likely to report a concussion. Conclusions: Rates of concussion for 1 sport season have not changed significantly over the past 14 years. The percentage of concussions that are reported to someone has increased significantly. Awareness of the Wisconsin state law does not fully account for the increase in concussion reporting. Clinical Relevance: Given the finite amount of knowledge regarding the influence of concussion-related cultural and legal changes, these findings will help to inform clinicians of the current concussion milieu from the perspective of athletes. It will inform practitioners involved in concussion management to what extent athletes are aware of and report concussions. [ABSTRACT FROM AUTHOR]

Objectives: Many patients with diabetes and their care providers are unaware of the presence of the disease. Dysglycemia encompassing hyperglycemia, hypoglycemia, and glucose variability is common in the ICU in patients with and without diabetes. The purpose of this study was to determine the impact of unknown diabetes on glycemic control in the ICU.Design: Prospective observational study.Setting: Nine ICUs in an academic, tertiary hospital and a hybrid academic/community hospital.Patients: Hemoglobin A1c levels were ordered at all ICU admissions from March 1, 2011 to September 30, 2013. Electronic medical records were examined for a history of antihyperglycemic medications or International Classification of Diseases, 9th Edition diagnosis of diabetes. Patients were categorized as having unknown diabetes (hemoglobin A1c > 6.5%, without history of diabetes), no diabetes (hemoglobin A1c < 6.5%, without history of diabetes), controlled known diabetes (hemoglobin A1c < 6.5%, with documented history of diabetes), and uncontrolled known diabetes (hemoglobin A1c > 6.5%, with documented history of diabetes).Interventions: None.Measurements and Main Results: A total of 15,737 patients had an hemoglobin A1c and medical record evaluable for the history of diabetes, and 5,635 patients had diabetes diagnosed by either medical history or an elevated hemoglobin A1c in the ICU. Of these, 1,460 patients had unknown diabetes, accounting for 26.0% of all patients with diabetes. This represented 41.0% of patients with an hemoglobin A1c > 6.5% and 9.3% of all ICU patients. Compared with patients without diabetes, patients with unknown diabetes had a higher likelihood of requiring an insulin infusion (44.3% vs 29.3%; p < 0.0001), a higher average blood glucose (172 vs 126 mg/dL; p < 0.0001), an increased percentage of hyperglycemia (19.7% vs 7.0%; blood glucose > 180 mg/dL; p < 0.0001) and hypoglycemia (8.9% vs 2.5%; blood glucose < 70 mg/dL; p < 0.0001), higher glycemic variability (55.6 vs 28.8, average of patient SD of glucose; p < 0.0001), and increased mortality (13.8% vs 11.4%; p = 0.01).Conclusions: Patients with unknown diabetes represent a significant percentage of ICU admissions. Measurement of hemoglobin A1c at admission can prospectively identify a population that are not known to have diabetes but have significant challenges in glycemic control in the ICU. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate whether preseason concussion knowledge and reporting intention predicted in-season concussion reporting behavior. Design: Prospective cohort study. Setting: Collegiate athletic facility of each participating team. Participants: National Collegiate Athletic Association Division I men's ice hockey players in 1 conference of competition (n = 116). Independent Variables: Intention to report symptoms of a "minor" concussion and concussion knowledge were assessed at preseason. Main Outcome Measures: Postseason recall of non-report of postimpact symptoms. Results: Preseason concussion knowledge was not significantly associated with in-season reporting behavior. Intention to report concussion symptoms was significantly related to in-season reporting behavior. There was a significant interaction between the number of different symptoms experienced and both preseason reporting intention and in-season reporting behavior. Conclusions: Evaluations of concussion education programs tend to measure concussion knowledge. The present findings suggest that reporting intention may be more strongly predictive of reporting behavior than concussion knowledge and should be included in evaluations of concussion effectiveness. New concussion education initiatives should consider targeting psychosocial constructs that increase reporting intention. Clinical Relevance: Sports medicine clinicians who are involved in evaluating concussion education programs should measure constructs other than just concussion knowledge. Intention, to report symptoms or to continue play while experiencing symptoms of a concussion, seems to be an important and feasible construct to include as part of proximal evaluations of education effectiveness. [ABSTRACT FROM AUTHOR]

Introduction The relationship among an individual's sense of self-efficacy, motivation to change, barriers to change, and the implementation of improvement programs has been reported. This research reports the relationship among self-efficacy, motivation to change, and the acquisition of knowledge in a continuing medical education (CME) activity. Methods The measure of individual sense of self-efficacy was a 4-item scale. The measure of motivation was a 6-item scale following on the work of Prochaska and colleagues. The knowledge acquisition was measured in a simple post measure. The participants were enrolled in a CME activity focused on HIV. Results The CME activities had a significant effect on knowledge. Preliminary analysis demonstrates a relationship among the self-efficacy measure, the motivation to change measure, and global intent to change. Specifically, as reported earlier, the sense of efficacy in effecting change in the practice environment is predictive of a high level of motivation to change that, in turn, is predictive of formation of intent to change practice patterns. Interestingly, there were also relationships among the self-efficacy measure, the motivation to change measure, and knowledge acquisition. Finally, as expected, there was a significant relationship between knowledge and intent to change practice. Discussion Further inspection of the motivation to change construct suggests that it mediates the self-efficacy constructs' effect on intent as well as its effect on knowledge acquisition. This new finding suggests that the proximal construct motivation completely masks an important underlying causal relationship that appears to contribute to practice change as well as learning following CME-self-efficacy. [ABSTRACT FROM AUTHOR]

Introduction Maintenance of Certification (MOC) for Family Physicians (MC-FP) includes clinical Self-Assessment Modules (SAMs). Whether family physicians choose SAMs that reflect their aptitudes or knowledge gaps has not been studied. Method Secondary analysis of demographic data, 2009 certification examination scores, and 2009-2012 SAM participation data. We computed disease-specific scores for asthma, diabetes, and hypertension from the examination. We ran unadjusted logistic and adjusted conditional logistic regression models of score quintiles, matched on the number of SAMs completed and controlling for physician demographics and area-level social deprivation. Results In 2009, 9 610 physicians passed the exam. Mean scores were 591.4 (SD ± 308.5) for asthma, 558.6 (SD ± 216.1) for diabetes, and 533.3 (± 226.7) for hypertension. Average scores on hypertension and diabetes were higher for physicians who subsequently completed related SAMs but not for those who completed the asthma SAM. The percentage of physicians in each quintile of scaled score who completed each SAM increased for diabetes (32.3%-40.9%) and hypertension (33.0%-36.9%). For asthma, logistic regression analyses found no statistically significant associations. For diabetes, there was a consistent association in both models between higher score quintile and likelihood of taking the SAM. For hypertension, an association of higher score and higher likelihood of taking the SAM was significant only in the third quintile (OR = 1.20 (1.03, 1.39)). Discussion We found inconsistent relationships between physician knowledge and SAM selection. For MOC to better impact quality, boards should consider directing physicians toward MOC activities that fill knowledge gaps rather than areas of strength. [ABSTRACT FROM AUTHOR]

Objective: To explore use and attitudes toward drugs and dietary supplements (DS) and knowledge concerning doping in cycling. Design: Retrospective cross-sectional study. Setting: Professional cycling. Participants: Elite under-23 male cyclists. Intervention: Anonymous semistructured questionnaire administered during race periods. Main Outcome Measures: Use and attitudes toward DS and drugs, and doping knowledge. Results: Forty cyclists aged 19 to 23 years and practicing for 14 to 30 h/wk were interviewed. Previous use (last 3 months) of drugs or DS occurred in 33 of 40 (82.5%) and 39 of 40 (97.5%) cyclists, respectively. Almost all the subjects named at least 1 doping agent (range, 1-10). Within a fixed list of 18 substances (among which only 14 were doping agents), participants recognized 3 to 18 of them as doping agents. They recognized tramadol and sildenafil as doping agents, which are not doping agents, and failed to recognize probenecid and albumin, which actually are. Doping knowledge correlated with drug use (r2 = 0.1614; P = 0.01). Participants deemed doping prevalence high among cyclists in general but not in their own team (P < 0.0001). Conclusions: Use of prescription drugs and DS was a common occurrence. Doping knowledge was poor and biased, and its relationship with drug use deserves consideration. Educational interventions are needed to improve knowledge and awareness about prescription drugs and DS use, as well as about doping. [ABSTRACT FROM AUTHOR]

Objectives: Self-efficacy is defined as a person's beliefs in his or her abilities to successfully complete a task, and has been shown to influence student motivation and academic achievement. The purpose of this study was to evaluate the impact of a new European teaching module in occupational medicine on undergraduate students' self-efficacy and knowledge in the subject matter. Methods: Pre-, in-between, and posttraining tests were used to assess self-efficacy and knowledge building of 261 third-year medical students on occupational health issues. Determinants of self-efficacy and knowledge were also identified. Repeated measurement data were analyzed with multilevel statistical procedures. Results: The level of self-efficacy and knowledge in occupational medicine increased after the training. Students who frequently attended the lectures scored significantly higher than sporadic attendees. There was no relation between the level of self-efficacy and the final knowledge score. Conclusions: Teaching with the new occupational medicine module was effective. Lecture attendance is an important determinant of self-efficacy and performance. Self-efficacy was not associated with knowledge score. Encouraging classroom participation may enhance student achievement. [ABSTRACT FROM AUTHOR]

The article discusses research into the correlation between cognitive expertise and amount of training in adolescent volleyball players. The study measured weekly training hours and attainment of declarative knowledge and procedural knowledge. Statistical univariate analysis of variance indicated that training time quantity was associated with evidence of cognitive improvements.

The article discusses a study conducted on Hispanic farm workers to determine the association between pesticide safety training and knowledge about pesticides and use of personal protective equipment (PPE). Language barriers and socioeconomic status make it difficult for migrant farm workers to follow US Environmental Protection Agency (EPA) and Worker Protection Standards (WPS) regulations. It concludes that the current regulations and safety programs need reassessing and amending.

The article discusses a study examining the effectiveness of the Sport Legacy Institute Community Educator (SLICE) curriculum on recognition and appropriate response to concussions, for student athletes. The SLICE concussions education program was conducted, which provided interactive demonstration, discussions, and case studies of athletes. Evaluation of the outcomes revealed that there was a significant improvement in the concussion knowledge quiz after the presentation.

The article presents a study conducted to determine the attitude of the American Medical Society for Sports Medicine (AMSSM) members toward the new policy implemented by the National Collegiate Athletic Association (NCAA) that requires screening of athletes for sickle cell trait (SCT). It relates that the study utilized a cross-sectional survey as its research design. It mentions that most respondent believed that discrimination exist during selection of athletes.

We are attending a vertiginous growth of the implantation of personal training (PT) services in Spain. However, there´s a great confusion on what type of knowledge, skills and abilities (KSAs) should PT have due to it´s width and fast implementation, together with the absence of professional regulation. The aim of this study is to determine the relative importance that several international certifications, accredited by National Commission For Certifying Agencies (NCCA) as of December 2008, grant to different knowledge fields. Contents of 10 PT certifications programs were analyzed: NSCA, ACSM, NASM, ACE, IFPA, NCSF, NETA, NESTA, NFPT and The Cooper Institute. Distribution of the contents in 8 categories that include all KSAs that should have a PT, according to these organizations. A international panel of experts validated the election and definition of the categories, afterwards we distributed the contents of each certification in these categories. When any content didn't agree exactly with those owned to this study, an interpretation was carried out, assigning the relative importance based on panel of experts criteria. Statistical analysis used measures of central tendency (mean and standard deviations), as well as coefficient of variability (C.V.), using SPSS software (v.15.0; SPSS, Inc. Chicago, IL). The categories resulted from the analysis are (Table 1): exercise programming and prescription (EPP), applied sciences (AS), physical fitness testing and interpretation (PFT), exercises technique (ET), nutrition (N), marketing and business applications (MB), safety and emergency management (SEM), legal issues (LI). The most relevant category is EEP, with an average of importance among all certifications of 24,8%. It´s followed by AS (22,5%), PFT (19%), and ET (17,3%). Resting categories (N, MB, SEM and LI), have an importance average lower than 10%. The relevance of the MB category is the most heterogeneous, data that indicates a great disagreement among the studied certifications in relation to this aspect of PT competence. EPP is the most important content, followed by AS, PFT and ET. On the other hand, N, MB, SEM and LI are the categories considered as less relevant. PT educational programs should distribute their contents and load assigned to them in a similar way to the results obtained in this study.Table 1. Personal training certification programs contents and measurements of central tendency. [ABSTRACT FROM AUTHOR]