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Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Training helps to maintain and improve sufficient muscle function, body control, and body coordination. These are important to reduce the risk of fracture incidents caused by falls, especially for the elderly or people recovering from injury. Virtual reality training can offer a cost-effective and individualized training experience. We present an application for the HoloLens 2 to enable musculoskeletal training for elderly and impaired persons to allow for autonomous training and automatic progress evaluation. We designed a virtual downhill skiing scenario that is controlled by body movement to stimulate balance and body control. By adapting the parameters of the ski slope, we can tailor the intensity of the training to individual users. In this work, we evaluate whether the movement data of the HoloLens 2 alone is sufficient to control and predict body movement and joint angles during musculoskeletal training.We record the movements of 10 healthy volunteers with external tracking cameras and track a set of body and joint angles of the participant during training. We estimate correlation coefficients and systematically analyze whether whole body movement can be derived from the movement data of the HoloLens 2. No participant reports movement sickness effects and all were able to quickly interact and control their movement during skiing. Our results show a high correlation between HoloLens 2 movement data and the external tracking of the upper body movement and joint angles of the lower limbs. [ABSTRACT FROM AUTHOR]

Aim: the objective of this study was to describe the results of the implementation of a home parenteral nutrition (HPN) care programme (Nutrihome©) in a cohort of patients treated at a tertiary hospital. Methods: retrospective study of the patients included in Nutrihome© at Hospital General Universitario Gregorio Marañón, Madrid, Spain. Nutrihome consists of different modules including pre-discharge nursing hospital visits and nursing home visits, deliveries of the infusion pump, consumables and parenteral nutrition bags, patient training, weekly scheduled nursing home visits, scheduled nursing phone calls, stock control phone calls and 24-hour on-call line manned by the nurses. Results: the study included 8 (75 % women) and 10 (70 % women) patients in the Nutrihome© pilot and Nutrihome© programme, respectively. A total 37 adverse events were reported during Nutrihome© pilot, 26 of which were technical, 9 clinical, 1 was catheter-related and 1 other event. Nutrihome© programme registered a total of 107 adverse events reported, 57 of which were technical, 21 clinical, 16 were catheter-related and 13 were other events. A total of 99 % of these events were solved by Nutrihome© via phone calls or home visits. Conclusions: Nutrihome© programme has been extremely useful during this pandemic, facilitating both the start of HPN and training at the patient home without the need for hospitalisation. Additionally, the adverse events reported and solved by Nutrihome© not only reduced the physicians’ burden during those tough times and the patients´ stress of being hospitalised during a pandemic, but supported the entire healthcare system. [ABSTRACT FROM AUTHOR]

This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion catheter and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN. [ABSTRACT FROM AUTHOR]

Type 2 diabetes is one of the most common chronic diseases worldwide. It also has a high risk of morbidity and mortality in the covid 19 pandemic. Due to pandemic measures, disruptions have emerged in the care treatments of patients with type 2 diabetes. The present study aimed to determine the effects of telehealth monitoring and patient training on the symptoms and metabolic outcomes in the patients with type 2 diabetes who are at risk of COVID-19. The current study is in the design of a single-blind randomized controlled trial. Patients were randomized into intervention group (n=41) and control group (n = 44). The patients in the intervention group received diabetes training once a week for the first 4 weeks and every other week for weeks 5–12. No training was given to the control group. The data was collected using the socio-demographic information form, the questionnaire of diabetes treatment, the form of metabolic control variables, and the Diabetes Symptoms Checklist. The data was analyzed with Chi-square, independent samples t-test, and paired sample t-test. The mean age of the patients in the control group was 56.86 ± 9.40, and the mean age of those in the intervention group was 54.12 ± 8.32. After the training, a statistically significant difference was found between the checklist averages of the groups in the subscale of hyperglycemia. However, a statistically significant difference was found between the subscales of neurology, cardiology, cognition, hyperglycemia, and the total checklist averages in the intervention group before and after the training (p < 0.05). In the control group, there was a statistically significant difference between the subscale of hyperglycemia and the total checklist averages at the beginning and 3 months later (p < 0.05). It has been determined that the disease training given to the patients with diabetes via telehealth monitoring during the COVID-19 process has a positive effect on the diabetes control of the patients. Health education through telehealth methods can be an effective and cost-effective strategy to support patients with diabetes. • The patients with diabetes via telephone during the COVID-19 process has given education. • The patients with type 2 diabetes during the pandemic process was controlled glycemic level. • The holistic care principles should maintained with telehealth monitoring in diabetes patient. [ABSTRACT FROM AUTHOR]

Introduction. Arterial hypertension (AH) is one of the important high-risk factors for the development of heart diseases, but its diagnosis and treatment does not require high technologies and substantial costs. However, the asymptomatic course of AH combined with a low level of medical literacy contributes to low adherence to treatment.Aim. To study the indirect impact of remote blood pressure monitoring (RBPM), the introduction of educational materials (EMs) in comparison with self-monitoring of blood pressure (SMBP) on adherence of patients with AH to outpatient treatment.Materials and methods. 60 subjects with an established fact of partial or complete refusal to use antihypertensive therapy were enrolled in the study and randomized into four equal and comparable groups: 1 – SMBP, 2 – RBPM, 3 – SMBP + EMs, 4 – RBPM + EMs. The impact of using RBPM was assessed by comparing blood pressure values in groups 1 and 2; the impact of EM – by comparing the results of questionnaire surveys in groups 1 and 2 and groups 3 and 4.Results and discussion. Additional training of patients with AH contributed to a twofold increase in adherence in using SCAD and RBPM. The average systolic blood pressure in groups 1 and 2 was 134 mm Hg, in groups 3 and 4 – 129 mm Hg; diastolic blood pressure in groups 1 and 2 – 78.5 mm Hg, in groups 3 and 4 – 77.5 mm Hg.Conclusion. The maximum impact on adherence to AH treatment can be achieved with the introduction of a set of measures. However, the introduction of RBPM has a number of limitations associated with the additional economic burden and the lack of an approved methodology. However, the provision of treatment and prevention facilities with EMs does not require additional development of methodology and is significantly cheaper than the cost of modern blood pressure monitors.

Background: Patient-controlled analgesia (PCA) is a well-established form of postoperative pain management. One form of administration is patient-controlled regional analgesia (PCRA), where local anesthetics are administered via peripheral regional catheters; however, a prerequisite is that the patients are instructed on its use. A multitude of sources recommend that these instructions are given before surgery as preoperative training on pain management procedures has been shown to significantly reduce patients' postoperative pain and increase their well-being., Objective: The aim was to assess the effect of guideline-assisted preoperative patient education for PCRA on postoperative pain in patients undergoing orthopedic surgery compared to unstructured postoperative standard instructions., Material and Methods: A controlled study with two randomized samples and a postinterventional survey was conducted. Overall, 73 patients with PCRA catheters for orthopedic surgery were enrolled in the study. The 37 participants in the interventional group (IG) received guideline-based structured instructions on PCRA use as well as a handout immediately before the surgical intervention. The 36 patients in the control group (CG) received postoperative instructions in the anesthesia recovery room. Pain was documented according to the numerical rating scale (NRS) at 2h (t1), 6h (t2), and 24h (t3) after surgery., Results: There were no statistically significant differences in the average pain scores between the two groups; however, there were lower mean pain scores in the IG at t1 and t3., Conclusion: A significant reduction of pain in the IG could not be shown. Further studies concerning this topic with larger samples and adapted points in time are recommended., (© 2023. The Author(s).)

Background: Effective peritoneal dialysis (PD) training is essential for performing dialysis at home and reducing the risk of peritonitis and other PD-related infections. Virtual reality (VR) is an innovative learning tool that is able to combine theoretical information, interactivity, and behavioral instructions while offering a playful learning environment. To improve patient training for PD, Fresenius Medical Care launched the stay•safe MyTraining VR, a novel educational program based on the use of a VR headset and a handheld controller., Objective: This qualitative assessment aims to investigate opinions toward the new tool among the health care professionals (HCPs) who were responsible for implementing the VR application., Methods: We recruited nursing staff and nephrologists who have gained practical experience with the stay•safe MyTraining VR within pilot dialysis centers. Predetermined open-ended questions were administered during individual and group video interviews., Results: We interviewed 7 HCPs who have 2 to 20 years of experience in PD training. The number of patients trained with the stay•safe MyTraining VR ranged from 2 to 5 for each professional. The stay•safe MyTraining VR was well accepted and perceived as a valuable supplementary tool for PD training. From the respondents' perspective, the technology improved patients' learning experience by facilitating the internalization of both medical information and procedural skills. HCPs highlighted that the opportunity offered by VR to reiterate training activities in a positive and safe learning environment, according to each patient's needs, can facilitate error correction and implement a standardized training curriculum. However, VR had limited use in the final phase of the patient PD training program, where learners need to get familiar with the handling of the materials. Moreover, the traditional PD training was still considered essential to manage the emotional and motivational aspects and address any patient-specific application-oriented questions. In addition to its use within PD training, VR was perceived as a useful tool to support the decision-making process of patients and train other HCPs. Moreover, VR introduction was associated with increased efficiency and productivity of HCPs because it enabled them to perform other activities while the patient was practicing with the device. As for patients' acceptance of the new tool, interviewees reported positive feedback, including that of older adults. Limited use with patients experiencing dementia or severe visual impairment or lacking sensomotoric competence was mentioned., Conclusions: The stay•safe MyTraining VR is suggested to improve training efficiency and efficacy and thus could have a positive impact in the PD training scenario. Our study offers a process proposal that can serve as a guide to the implementation of a VR-based PD training program within other dialysis centers. Dedicated research is needed to assess the operational benefits and the consequences on patient management., (©Caterina Lonati, Marie Wellhausen, Stefan Pennig, Thomas Röhrßen, Fatih Kircelli, Svenja Arendt, Ulrich Tschulena. Originally published in JMIR Medical Education (https://mededu.jmir.org), 06.08.2024.)

Purpose: The aim of the studywas to incorporate the perspectives of both patients and providers into the development of training to improve the exchange of secure messages through a patient portal as well as to identify management strategies that support patient engagement. Methodology: Three patient focus groups (17 patients) and interviews with 21 ambulatory physicians across 17 outpatient clinics at a large Midwestern academic medical center using Epic MyChart were performed. Rigorous thematic analysis was guided by the Systems Engineering Initiative for Patient Safety 2.0 framework adapted to patient portal implementation. Results: Patients and physicians identified strategies at the patient, portal, physician, and health system levels that could help each group navigate the portal to communicate via secure messages more efficiently. Patient-focused training strategies included multimodal materials addressing how to navigate portal features and direction on when, what, and how to message. Changes to the format of the messaging feature and pop-ups with communication tips were also frequently mentioned. Physician and clinic-level strategies focused on how the clinic and health system management could enhance physician training on the patient-facing portal features and on how to manage patient care within the portal. Physicians also requested that the health system administration standardize physician and care team work processes related to secure messages within the portal and communicate clear management expectations of physician portal management. Conclusion: As communication via securemessaging has becomemore common, our study identified patient, physician, portal and health system-level management and training strategies to enhance patient portal use. Practice Implications: Health system administrators and outpatient clinic management could implement these strategies to clarify the rules of engagement in the collaborative work of incorporating a patient portal into the primary care workflow and facilitating provider and patient use. [ABSTRACT FROM AUTHOR]

Objective: to evaluate the effectiveness of an educational program for teaching self-control skills for patients with rheumatoid arthritis (RA).Subjects and methods. Examinations were made in 85 patients: 38 of them underwent a training program for mastering self-control skills; 47 patients constituted a control group. The serum levels of rheumatoid factor (RF), C-reactive protein (CRP), anti-cyclic citrullinated peptide (anti-CCP) antibodies and DAS28 were determined at baseline and after 2 months.Results and discussion. After training in self-control skills, the study group showed a significant reduction of DAS28 on an average from 5.2±4.9 to 3.2±3.0 and in the number of tender and swollen joints, erythrocyte sedimentation rate (ESR), and the levels of CRP, RF, and anti-CCP antibodies. At the same time, the level of hemoglobin, the number of red and white blood cells did not change substantially. There was a decrease in ESR and CRP levels in the control group.Conclusion. Teaching the patients in self-control methods can reduce the activity of the inflammatory process.

Home hemodialysis requires total autonomy from the patient, who punctures himself. To this end, the vascular approach must be of good quality and the puncture technic should be easy to handle. A recognized approach is the "Buttonhole" technique. An easy technique, it encourages patients to continue their dialysis at home. But the risk of arterio-venous fistula (AVF) infection related to the puncture of the "Buttonhole" is very high. However, this technique has many positive points for the AVF itself, for the patients and for the caring teams. We looked for ways to improve this technique and eliminate as much as possible the risk of infection and to maintain the functionality of the fistula. We present our experience in this field.

This guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home parenteral nutrition (HPN) providers, as well as healthcare administrators and policy makers, about appropriate and safe HPN provision. This guideline will also inform patients requiring HPN. The guideline is based on previous published guidelines and provides an update of current evidence and expert opinion; it consists of 71 recommendations that address the indications for HPN, central venous access device (CVAD) and infusion pump, infusion line and CVAD site care, nutritional admixtures, program monitoring and management. Meta-analyses, systematic reviews and single clinical trials based on clinical questions were searched according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing Scottish Intercollegiate Guidelines Network methodology. The guideline was commissioned and financially supported by ESPEN and members of the guideline group were selected by ESPEN. [ABSTRACT FROM AUTHOR]

Background: This study was designed as a randomized experimental study to determine the effect of web-based training on anxiety and depression levels in patients who previously underwent myocardial infarction (MI). Methodology: The study was carried out between January and December 2016 with individuals who applied to two hospitals affiliated to the Ministry of Health because of MI. 65 individuals were randomly assigned to the experimental group and the control group separately. Data were collected with Patient Information Form and Hospital Anxiety Depression Scale and Patient Follow-up Form. While patients in the control group received routine patient notification, a web-based distance education program was applied to the experimental group. Both groups were reevaluated after 3 months. Results: The attitude of the individuals included in the study to exhibit health behaviors, and thus their compliance to treatment, was significantly higher in the experimental group compared to the control group (P < 0.001). The mean anxiety and depression scores of the experimental group were 6.74 ± 3.36 and 6.26 ± 3.16, whereas the mean scores of the control group were 9.66 ± 3.85 and 9.28 ± 3.49, respectively. A significant difference was found between the groups (P < 0.001). Similarly, 20% and 52.3% of the experimental group and 49.2% and 81.5% of the control group had anxiety and depression scores above the threshold, respectively. Conclusion: Web-based remote training is effective in decreasing the anxiety and depression levels in individuals who previously underwent MI. Web-based remote training can be recommended as an effective training method in dealing with life-threatening situations. [ABSTRACT FROM AUTHOR]

Objective: Spacer and metered-dose inhaler use is widespread especially among pediatric population. In children, training in medication use is provided both for the family and the child. The aim of the present study was to investigate whether this training is well comprehended and which training method is more effective to achieve that goal. Methods: This study included patients presenting to our outpatient clinic who were in need of spacer and metereddose inhaler use. The study subjects had an age range of 2-16 years. The patients were randomized into two groups. The first group was trained on metered-dose inhaler use by video demonstration. The second group was trained by applied verbal training. They asked to use spacer and metered-dose inhaler, and they were rated from 0 to 6, as in previous studies. Errors and deficiencies of use were re-explained. They were informed about their scores and were told that they would be rated again in the next follow-up appointment. They were asked again to use spacer and metered-dose inhaler and rated between 0 and 6 at the second-month control visit. Results: The intra-group analysis of the video group showed a significant difference between the first-month and second-month total scores (p<0,01). The intra-group analysis of the verbal training group also showed a significant difference between the first-month and second-month total scores (p<0,01). Conclusion: In conclusion, we demonstrated the positive effect of actively inclusion of patients with asthma into the training about spacer and metered-dose inhaler use. We ensured active participation by exam motivation. Here in we aimed to contribute to the existing literature. [ABSTRACT FROM AUTHOR]

The influence of group self-monitoring and self-care training of 204 patients with chronic heart failure of II-IV functional class according to NYHA (average age - 58.7 ± 12.9 years) on functional status, quality of life, exercise tolerance, echocardiography indices, rate of adverse events development was studied. The duration of follow-up period was 6 months. Self-monitoring and self-care training of patients with CHF contributed to functional status improvement, quality of life improvement and exercise tolerance. The following results were noted: therapy high compliance maintenance, rate and risk of repeated admissions associated with CHF decompensation reduction, left ventricular ejection fraction increase in group training group. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to assess the knowledge and skill of clinical residents in Tabriz University of Medical Sciences, northwestern Iran, (as the future specialists), as well as their attitudes on the necessity of patient education, and the practice and responsibility of the residents in this field. Methods: Knowledge, attitudes, and practices of a random selection of 380 clinical residents at Tabriz University of Medical Sciences were assessed in 2011 through a comprehensive questionnaire about education. The data were analyzed using SPSS software.Results: There was no significant relationship between the two variables of sex and study period and the knowledge variable during the residency. However, there was a significant positive correlation between knowledge and age variables (P

Copyright of dentalTarget is the property of dentalTarget and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Se realizó un estudio cuasiexperimental para valorar la influencia de una intervención educativa en el desarrollo de conocimientos, habilidades y destrezas en pacientes con diabetes mellitus 2, en Cárdenas, ingresados en el Centro de Atención a Pacientes Diabéticos, durante el segundo semestre de 2007 y el primero de 2008. La muestra estuvo conformada por 90 pacientes que asistieron al centro durante los meses de julio a diciembre del año 2007 (grupo de intervención) y 90 pacientes diabéticos de la Atención Primaria (grupo control). La intervención educativa constó de 2 etapas. Para ambos grupos al finalizar la primera etapa se aplicó un cuestionario, mientras que la segunda etapa consistió en actividades de profundización de conocimientos e integración del grupo de intervención, y al mismo tiempo se buscó igual información en el grupo control. Al final de la intervención los participantes en el Curso de Información Básica aumentaron sus conocimientos sobre diabetes mellitus, y mostraron diferencias significativas en cuanto a conocimientos sobre la enfermedad con relación al control. El Curso de Información Básica resulta efectivo para el desarrollo de conocimientos sobre diabetes mellitus. Los pacientes del grupo de intervención mostraron un adecuado control metabólico a los 6 meses de la intervención.A quasi experimental study was conducted to value the influence of an educational intervention in knowledges, abilities and dexterities development in patients presenting with typo II diabetes mellitus in Cárdenas municipality, admitted in Care Center for Diabetes Patients during the second semester of 2007 and during the first one of 2008. Sample included 90 patients seen in such center from July to December, 2007 (intervention group), and 90 diabetic patients from Primary Care (control group). Educational intervention had 2 stages. In both groups at the end of the first stage we applied a questionnaire, whereas the second one included knowledge deepening activities and group intervention, and at the same time we search for information in control group. At the end of intervention, participants in Basic Information Course increased their knowledges on diabetes mellitus and showed significant differences as regards the knowledges on the disease in relation to control group. The above mentioned course is effective to develop the knowledges on diabetes mellitus. Patients of intervention group showed a appropriate metabolic control at 6 months from the intervention.

Background: Training Patients is one of the fundamental principles of nursing profession Nurses have to do this training task in order to provide patients satisfaction speed up patients recovery and reduce rate of readmission Objective: To determine training performance of nurses working in Kerman University of Medical Sciences from the point of view patients discharging from Medical – Surgical wards in 2006 Methods: In this descriptive analytic study the sample size base on a pilot study was determined 396 patients and subjects were selected consecutivly A researcher – made questionnaire was used to collect data The questionnaire included two parts of demographic features and evaluating training performance of nurses in 6 domains Data were analyzed by using central and distributional indices and Mann – Withny U kruskal Wallis Freedman tests and Spearman coefficient correlation Results: According to the results the majority of samples were males (62/1%) married (66/4) over 50 years of age (30/55%) illiterate (3055%) and with no history of previous hospitalization (40/7%) In regard to the performance of nurses in training patients the results showed that in the domains of disease nature 19% disease complications 23% medicines 43% physical activity 3207% nutrition 428% and other items 413% had received complete or relative training considering nurses total training performance score based on demographic features of patients significant differences were observed in terms of sex hospital and educational level ) P < 0/05) That is nurses training performance score was higher from the point of view of female patients patients with higher educational levels and patients in hospital C comparing to male patients patients with lower educational levels and patients in hospitals other than hospital C Conclusion : The obtained percentages for nurses performance in training patients show their poor performance in this regard Therefore improving nurses knowledge about the importance of training patients is highly recommended

Objective: Hyperbaric oxygen therapy (HBOT) is applied for various diseases. It is generally considered safe but has some benign complications and adverse effects. The most common complication is middle ear barotrauma. The aim of this study was to collect data about middle ear and cranial sinus barotraumas in our department and to evaluate factors affecting the occurrence of barotrauma. Material and methods: Files of patients who had undergone hyperbaric oxygen therapy between June 1st, 2004, and April 30th, 2012, and HBOT log books for the same period were searched for barotraumas. Patients who were intubated and unconscious were excluded. Data about demographics and medical history of conscious patients with barotrauma (BT) were collected and evaluated retrospectively. Results: It was found that over eight years and 23,645 sessions, 39 of a total 896 patients had BT; thus, the general BT incidence of our department was 4.4%. The barotrauma incidence was significantly less in the multiplace chamber (3.1% vs. 8.7%) where a health professional attended the therapies. Most barotraumas were seen during early sessions and were generally mild. A significant accumulation according to treatment indications was not determined. Conclusion: It was thought that the low barotrauma incidence was related to the slow compression rate as well as training patients thoroughly and monitoring them carefully. It can be said that when applied in these conditions, HBOT is safe for ears and cranial sinuses. [ABSTRACT FROM AUTHOR]

Aims and objectives This study was to determine the effect of preoperative patient training on the concern level of patients who would be undergoing cataract surgery. Background Cataract is one of the main causes of blindness in the world. Cataract surgery is located among the quite frequently performed surgeries today. Design This study was an experimental study. Methods The subject pool for this research consisted of patients admitted to the Eskisehir Osmangazi University Medical Faculty Hospital Ophthalmology Department for cataract surgery. The sampling consisted of volunteers who were able to communicate and were deemed suitable patients within the limitations of this study (a total of 100 patients; control group = 50, experimental group = 50). Patient identification forms and the State Trait Anxiety Inventory I-II scale were used as data collection tools. Results The mean State Trait Anxiety Inventory pretest score for the experimental group was significantly higher than the mean final test score (53·30 ± 7·02 and 27·54 ± 3·25, respectively, p < 0·05). The mean State Trait Anxiety Inventory pretest score of the control group was 53·82 ± 7·42 and the mean final test score was 49·22 ± 13·17; there was no significant difference between these average scores ( p > 0·05). However, the mean final test scores of the experimental and control groups were significantly different ( p < 0·05). Conclusions In the experimental group in this study, informative, educational and planned nursing care had a significant impact on anxiety levels in patients who had cataract surgery. Relevance to clinical practice Although it is not implemented in most hospitals, and implementation in some hospitals is unplanned, systematically planned preoperative education should take place as part of standard nursing practices. [ABSTRACT FROM AUTHOR]

Background: The amount of drug aerosol from an inhaler that can pass through an in vitro model of the mouth and throat (MT) during a realistic breath or inhalation flow rate vs. time profile (IP) is designated the total lung dose in vitro, or TLDin vitro. This article describes a clinical study that enabled us to recommend a general method of selecting IPs for use with powder inhalers of known airflow resistance (R) provided subjects followed written instructions either alone or in combination with formal training. Methods: In a drug-free clinical trial, inhaler-naïve, nonsmoking healthy adult human volunteers were screened for normal pulmonary function. IPs were collected from each volunteer inhaling through different air flow resistances after different levels of training. IPs were analyzed to determine the distribution of inhalation variables across the population and their dependence on training and airflow resistance. Results: Equations for IP simulation are presented that describe the data including confidence limits at each resistance and training condition. Realistic IPs at upper (90%), median (50%), and lower (10%) confidence limits were functions of R and training. Peak inspiratory flow rates (PIFR) were inversely proportional to R so that if R was assigned, values for PIFR could be calculated. The time of PIFR, TPIFR, and the total inhaled volume (V) were unrelated to R, but dependent on training. Once R was assigned for a powder inhaler to be tested, a range of simulated IPs could be generated for the different training scenarios. Values for flow rate acceleration and depth of inspiration could also be varied within the population limits of TPIFR and V. Conclusions: The use of simulated IPs, in concert with realistic in vitro testing, should improve the DPI design process and the confidence with which clinical testing may be initiated for a chosen device. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to test the effects of a generic transition-oriented patient education program on adolescents' health service participation and quality of life (QoL).Methods: We conducted a controlled trial comparing participants of 29 transition workshops with treatment as usual in 274 adolescents (16.8 mean age, SD=1.76) diagnosed with type I diabetes (DM), cystic fibrosis (CF) or inflammatory bowel disease (IBD). A two-day transition workshop was carried out at 12 sites in Germany, focusing in standardized modules on adjustment to adult care settings, organization of future disease management, career choices and partnership. Study outcomes were health-related transition competence, self-efficacy, satisfaction with care, patient activation and QoL. Measures were assessed at baseline and six-month follow-up.Results: Repeated-measurement covariance analysis using age as a covariate showed that the transition workshop significantly affected transition competence, self-efficacy and satisfaction with school care six months post intervention. The intervention did not significantly affect patient activation and QoL. However, post-hoc analysis suggested different effects across conditions.Conclusion: The program has a positive effect on the competence of adolescents in the transition phase.Practice Implications: The study demonstrates that an intervention can be effective in preparing adolescents with chronic conditions for transitions. [ABSTRACT FROM AUTHOR]

Kinematic computed tomography (CT) allows identification of fine positional anomalies of bones during motion and under stress and has a potential role in the evaluation of dynamic joint diseases. The increasing width of CT detector systems has made kinematic CT clinically available. Information on acquisition protocol, patient preparation, and the influence of motion on image quality is scarce in the literature despite the obvious importance for the clinical application of this technique. In this article we review the current knowledge on the relation between motion and artifacts, recommendations for the acquisition protocol, as well as current indications for kinematic CT. [ABSTRACT FROM AUTHOR]

Background: Patients' knowledge was found to be a key contributor to the success of therapy. Many efforts have been made to educate patients in their disease. However, research found that many patients still lack knowledge regarding their disease. Integrating patient education into social media platforms can bring materials closer to recipients.Objective: The aim of this study is to test the effectiveness of patient education via Instagram.Methods: A randomized controlled trial was conducted to test the effectiveness of patient education via Instagram among patients with inflammatory bowel disease. Participants were recruited online from the open Instagram page of a patient organization. The intervention group was educated via Instagram for 5 weeks by the research team; the control group did not receive any educational intervention. The knowledge about their disease was measured pre- and postintervention using the Inflammatory Bowel Disease Knowledge questionnaire. Data were analyzed by comparing mean knowledge scores and by regression analysis. The trial was purely web based.Results: In total, 49 participants filled out both questionnaires. The intervention group included 25 participants, and the control group included 24 participants. The preintervention knowledge level of the intervention group was reflected as a score of 18.67 out of 24 points; this improved by 3 points to 21.67 postintervention. The postintervention difference between the control and intervention groups was 3.59 points and was statistically significant (t32.88=-4.56, 95% CI 1.98-5.19; P<.001). Results of the regression analysis, accounting for preintervention knowledge and group heterogeneity, indicated an increase of 3.33 points that was explained by the intervention (P<.001).Conclusions: Patient education via Instagram is an effective way to increase disease-related knowledge. Future studies are needed to assess the effects in other conditions and to compare different means of patient education.Trial Registration: German Clinical Trials Register DRKS00022935; https://tinyurl.com/bed4bzvh. [ABSTRACT FROM AUTHOR]

Background: Simulation has been associated with positive educational benefits in the training of healthcare professionals. It is unknown whether the use of simulation to supplement patient training for home hemodialysis (HHD) will assist in improving a patient's transition to home. We aim to assess the impact of simulation training on home visits, retraining and technique failure. Methods: Since February 2013, patients training for HHD are required to dialyze independently in a dedicated training room (innovation room) which simulates a patient's home prior to graduation from the program. We performed a single-center retrospective, observational, cohort study comparing patients who completed training using the innovation room(n = 28) versus historical control (n = 21). The outcome measures were number of home visits, retraining visits and technique failure. Results: Groups were matched for age, gender, race, body mass index and comorbidities. Compared with controls, significantly more cases had a permanent vascular access at the commencement of training (57.1 versus 28.6%, χ² P = 0.04). Cases spent a median of 2 days [IQR (1.75)] in the innovation room. Training duration was not statistically different between groups {cases: median 10.0 weeks [IQR (6.0)] versus controls: 11.0 [IQR (4.0)]}. Compared with controls, cases showed a trend towards needing less home visits with no difference in the number of re-training session or technique failure. Conclusions: Simulation-based teaching in NHHD training is associated with a trend to a reduction in the number of home visits but had no effect on the number of re-training sessions or proportion of patients with technique failure. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to assess the knowledge and skill of clinical residents in Tabriz University of Medical Sciences, northwestern Iran, (as the future specialists), as well as their attitudes on the necessity of patient education, and the practice and responsibility of the residents in this field. Methods: Knowledge, attitudes, and practices of a random selection of 380 clinical residents at Tabriz University of Medical Sciences were assessed in 2011 through a comprehensive questionnaire about education. The data were analyzed using SPSS software. Results: There was no significant relationship between the two variables of sex and study period and the knowledge variable during the residency. However, there was a significant positive correlation between knowledge and age variables (P<0.05). The level of knowledge rose with aging because the amount of the model significance was less than 0.05. Besides, the coefficient of sex was positive by regression analysis. There was no significant relationship between the previous variables and attitude variable. No significant relationship was seen between the previous variables and practice variable. Conclusion: The influence of age, sex, and year of study was apparent in the knowledge of the residents, but no considerable influence was shown in their practices and attitudes. Some educational strategies are needed to improve the practices and attitudes of the training group. [ABSTRACT FROM AUTHOR]

We present the evolution of patient-centered care (PCC) and shared decision-making (SDM) in France since 2017, highlighting advantages and drawbacks of their implementation at the macro level. We then focus on several key policy and legislative milestones that are aimed to develop PCC and SDM. These milestones underline the importance of patient movements to support and fund the development of research and practice in the field. We shall conclude by presenting the growing research agenda and selected key topics. These key topics notably include the increase in both patient and healthcare professional trainings on PCC and SDM provided by healthcare users' and patients' representatives. PCC and SDM continue to be central preoccupations at the macro level, supported by public health policies and patients/healthcare users' actions. This overview, however, suggests that although implementation initiatives have increased since 2017, implementation remains scarce in routine clinical practice. Funding, not only for research projects, but for the implementation of PCC and SDM in real-life settings (e-decision aids, clinical guidelines integrating PCC/SDM, human resources dedicated to PCC/SDM, etc.) are needed to promote sustained adoption. More systematic training for both healthcare professionals and patients is also warranted for a true acculturation to occur., (Copyright © 2022. Published by Elsevier GmbH.)

Introduction: The prevalence of chronic kidney disease has increased globally (8-16%), mainly due to the incidence of type 2 diabetes mellitus (DM2) and hypertension (HT). Education or training programs for patients with chronic diseases is considered a fundamental tool to prevent their worsening., Objectives: (1) To determine whether attendance at training for patients with HT and/or diabetes affects the progression of the deterioration of renal function. (2) To assess the association of renal function with HT, DM2 and the occurrence of cardiovascular events, analyzing the influence of the control degree of blood pressure (BP) and glycated hemoglobin (HbA1c). (3) To study the occurrence of cardiovascular events., Material and Methods: Retrospective analytical observational cohort study carried out in a Primary Care Center in Leganés, Madrid, using databases of patients with HT, diabetes and both pathologies simultaneously (n = 200), attending or not to the training of the medical team during the years 2017-2019., Results: 120 of 200 patients received training (60% women). Only in these patients, an improvement of renal function was observed. This was accompanied by a reduction in BP and HbA1c levels, being more prominent in patients with a single pathology, especially hypertensive patients., Conclusions: Training of patients was beneficial to prevent the deterioration of renal function, by means of the reduction of the BP and HbA1c. It was more evident in those who started from a worse control of both parameters. Association of renal function evolution with HT and DM2 was demonstrated., (Copyright © 2021 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To assess physician needs for patient-centered communication training for medical consultations and to develop an updated patient training curriculum. Methods: An online needs assessment was distributed through physician email listserves at the University of Florida College of Medicine. Frequency tabulation and content analyses were conducted to assess patient communication themes. Results: Responses were received from 336 physicians. Physicians reported that patients are reluctant to ask questions when they do not understand information related to their medical condition, treatment plan, or medical advice. Furthermore, physicians reported that a lack of patient negotiation inhibits patient-centered communication and may negatively influence patient adherence and compliance. Based on these results the AGENDA model was created for patient training and consists of (1) agenda setting; (2) goals for health; (3) expressing concerns, questions, and negotiations; (4) navigating health literacy issues; (5) disclosing detailed information; and (6) active types of listening. Conclusion: This study supports revisiting patient communication training and tailoring future training interventions to specific communities. Practice implications: The AGENDA model can be used to train patients to enhance patient-centered communication with physicians. Additionally, patient communication training could help to address the barriers to care identified by the physicians in our study. [Copyright &y& Elsevier]

There are approximately 100 000 people in the UK who have been diagnosed with multiple sclerosis (MS). Long-term adherence by patients to the widely used treatment disease modifying therapies (DMTs) can be a challenge. The aim of this survey was to understand the critical points of contact where homecare support could impact adherence and provide suggestions to improve the homecare support services provided to MS patients. Homecare support is defined as any sponsored patient support programme from a homecare company. Surveys were sent to 5 025 MS patients and 150 MS nurses working within the NHS. Completed survey responses were obtained from 1 868 MS patients (37%) and 42 MS nurses (28%). Patients and specialist nurses reported that training and support in the early stages of treatment could influence adherence, particularly when that training is tailored specifically to the patients' requirements and unlimited by time and resources. [ABSTRACT FROM AUTHOR]

Ozcan H, Findik UY, Sut N. International Journal of Nursing Practice 2010; 16: 289–294 Information level of patients in discharge training given by nurses following open heart surgery Providing discharge information following a surgery is one of the most common nursing approaches. Patients should be given discharge training after open heart surgery in order to eliminate or reduce physical and emotional problems. The study aims to assess the information level of patients in discharge training provided by nurses following open heart surgery. The study is a prospective study including 50 patients who underwent open heart surgery. The information level of patients who received discharge training was assessed before training and 1 month after the training. Data were collected using the personal information form, and pretest and post-test questionnaires. Data were assessed by using percentage, McNemar chi-squared, Wilcoxon signed ranks and stepwise linear regression analysis tests. Results indicated that patients were well informed following discharge training ( Z = −6.166, P < 0.05), and that age and marriage variables affected the information level ( P = 0.032, P = 0.045, respectively). Discharge training following open heart surgery increases the knowledge of patients and should be given to patients in a planned manner. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing coronary artery bypass graft surgery (CABGS) may fail to adhere to their treatment regimen for many reasons. Among these, one of the most important reasons for nonadherence is the inadequate training of such patients or training using inappropriate methods. Objective: This study aimed to compare the effect of gamification and teach-back training methods on adherence to a therapeutic regimen in patients after CABGS. Methods: This randomized clinical trial was conducted on 123 patients undergoing CABGS in Tehran, Iran, in 2019. Training was provided to the teach-back group individually. In the gamification group, an app developed for the purpose was installed on each patient's smartphone, with training given via this device. The control group received usual care, or routine training. Adherence to the therapeutic regimen was assessed using a questionnaire on adherence to a therapeutic regimen (physical activity and dietary regimen) and an adherence scale as a pretest and a 1-month posttest. Results: One-way analysis of variance (ANOVA) for comparing the mean scores of teach-back and gamification training methods showed that the mean normalized scores for the dietary regimen (P <.001, F =71.80), movement regimen (P <.001, F =124.53), and medication regimen (P <.001, F =9.66) before and after intervention were significantly different between the teach-back, gamification, and control groups. In addition, the results of the Dunnett test showed that the teach-back and gamification groups were significantly different from the control group in all three treatment regimen methods. There was no statistically significant difference in adherence to the therapeutic regimen between the teach-back and control groups. Conclusions: Based on the results of this study, the use of teach-back and gamification training approaches may be suggested for patients after CABGS to facilitate adherence to the therapeutic regimen. Trial Registration: Iranian Registry of Clinical Trials IRCT20111203008286N8; https://en.irct.ir/trial/41507 J Med Internet Res 2021;23(12):e22557 doi:10.2196/22557 [ABSTRACT FROM AUTHOR]

Abstract: Standard guidelines for cancer pain treatment routinely recommend training patients to reduce barriers to pain relief, use medications appropriately, and communicate their pain-related needs. Methods are needed to reduce professional time required while achieving sustained intervention effectiveness. In a multisite, randomized controlled trial, this study tested a pain training method versus a nutrition control. At six oncology clinics, physicians (N =22) and nurses (N =23) enrolled patients (N =93) who were over 18years of age , with cancer diagnoses, pain, and a life expectancy of at least 6months. Pain training and control interventions were matched for materials and method. Patients watched a video followed by about 20min of manual-standardized training with an oncology nurse focused on reviewing the printed material and adapted to individual concerns of patients. A follow-up phone call after 72h addressed individualized treatment content and pain communication. Assessments at baseline, one, three, and 6months included barriers, the Brief Pain Inventory, opioid use, and physician and nurse ratings of their patients’ pain. Trained versus control patients reported reduced barriers to pain relief (P <.001), lower usual pain (P =.03), and greater opioid use (P <.001). No pain training patients reported severe pain (>6 on a 0–10 scale) at 1-month outcomes (P =.03). Physician and nurse ratings were closer to patients’ ratings of pain for trained versus nutrition groups (P =.04 and <.001, respectively). Training efficacy was not modified by patient characteristics. Using video and print materials, with brief individualized training, effectively improved pain management over time for cancer patients of varying diagnostic and demographic groups. [Copyright &y& Elsevier]

Brain-computer interfaces based on fMRI enable real-time feedback of circumscribed brain regions to learn volitional regulation of those regions. This is an emerging field of intense research, with potential for multiple applications in neuroscientific research in brain plasticity and reorganization, movement restoration due to stroke, clinical rehabilitation of emotional disorders, quality assurance of fMRI experiments, and teaching functional imaging. This article presents a general architecture of an fMRI-BCI, with descriptions of each of its subsystems, and factors influencing their performance. The study has attempted to describe and compare a variety of approaches toward signal acquisition, preprocessing, analysis, and feedback. Technological advancement in higher-field MRI scanners, data acquisition sequences and image reconstruction techniques, preprocessing algorithms to correct for artifacts, more intelligent and robust analysis and interpretation methods, and faster feedback and visualization technology are anticipated to make fMRI-BCI widely applicable. FMRI-BCI could potentially be used for training patients to learn self-regulation of specific brain areas for transferring them later on to a more portable EEG-BCI system. FMRI-BCI has the potential of establishing itself as a tool for neuroscientific research and experimentation and also as an aid for psychophysiological treatment. [ABSTRACT FROM PUBLISHER]

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Respiratory gating is used to counter the effects of organ motion during radiotherapy for chest tumors. The effects of variations in patient breathing patterns during a single treatment and from day to day are unknown. We evaluated the feasibility of using patient training tools and their effect on the breathing cycle regularity and reproducibility during respiratory-gated radiotherapy. To monitor respiratory patterns, we used a component of a commercially available respiratory-gated radiotherapy system (Real Time Position Management (RPM) System, Varian Oncology Systems, Palo Alto, CA 94304). This passive marker video tracking system consists of reflective markers placed on the patient’s chest or abdomen, which are detected by a wall-mounted video camera. Software installed on a PC interfaced to this camera detects the marker motion digitally and records it. The marker position as a function of time serves as the motion signal that may be used to trigger imaging or treatment. The training tools used were audio prompting and visual feedback, with free breathing as a control. The audio prompting method used instructions to “breathe in” or “breathe out” at periodic intervals deduced from patients’ own breathing patterns. In the visual feedback method, patients were shown a real-time trace of their abdominal wall motion due to breathing. Using this, they were asked to maintain a constant amplitude of motion. Motion traces of the abdominal wall were recorded for each patient for various maneuvers. Free breathing showed a variable amplitude and frequency. Audio prompting resulted in a reproducible frequency; however, the variability and the magnitude of amplitude increased. Visual feedback gave a better control over the amplitude but showed minor variations in frequency. We concluded that training improves the reproducibility of amplitude and frequency of patient breathing cycles. This may increase the accuracy of respiratory-gated radiation therapy. [Copyright &y& Elsevier]

Background: Allergic rhinitis is an inflammatory disease often associated with bronchial asthma. Intranasal corticosteroids and oral antihistamines are the first-choice drugs. Patient training is relevant to asthma management, but little is known about its impact on rhinitis. We evaluated the role of patient training in the treatment of allergic rhinitis and its effects on nasal and bronchial symptoms. Methods: One hundred and one patients (M/F=62/39, age range 12–62 years) with pollen-induced rhinitis (32 with concomitant mild asthma) were enrolled. They were randomized into three groups: A (n=30) with drug therapy alone, B (n=35) with drug therapy plus training on the use of nasal spray, and C (n=36) the same as B plus a lesson on rhinitis and asthma. All patients received mometasone furoate nasal spray for 8 weeks as regular therapy, plus rescue medications on demand. Symptoms and drug consumption were evaluated during the pollen season. Results: The rate of noncompliance/dropout was highest in the untrained patients (P=0.001). No difference in nasal symptoms was seen among the three groups. On the other hand, group C had significantly fewer asthma symptoms (P=0.02) and less albuterol use (P=0.005) than group A. Moreover, the trained group globally used less rescue medication than the other groups (P=0.02). Conclusions: Detailed training of patients seems to improve compliance with treatment, reduce concomitant asthma symptoms, and reduce the use of symptomatic drugs. [ABSTRACT FROM AUTHOR]