Abstract P122: An Interactive Intervention to Increase Stroke Knowledge: Results of the SWIFT Study

Introduction: The majority of acute stroke patients do not seek care within the optimal 3 hour time frame. General informational strategies have not increased stroke preparedness, possibly due to a lack of attention to health literacy or cultural tailoring. Several interventions have successfully increased stroke knowledge yet there remains skepticism that knowledge alone can lead to behavior change. The Stroke Warning Information and Faster Treatment (SWIFT) trial is the first intervention to rigorously test whether an interactive educational intervention (II; 2 in-hospital educational sessions and health literate, culturally tailored materials), compared to an enhanced educational intervention (EE; only educational materials) can increase arrival times for stroke/TIA recurrence to the emergency department (ED) in 1193 participants. Aims: SWIFT found large, non-differential increases in the proportion of participants arriving to the ED within 3 hours in both the II and EE group. Here we assess the effect of SWIFT on stroke knowledge (SK), and stroke preparedness (SP), and assess differences by race. Methods: SK was assessed with the 29 item stroke knowledge scale and dichotomized as high/low SK (≥ 23/< 23 correct). SP was dichotomized into those that knew the three important things to tell a health professional after the onset of stroke symptoms and those that identified less than 3 things. These scales were measured at baseline, and one and twelve months after baseline. We fit logit-linear models for high SK and high SP using generalized estimating equations. Results: We observed no difference between groups at baseline in SK (p-value = 0.44) or SP (p-value = 0.36). For SK, we observed statistically significant effect modification such that knowledge increased over time (p-value = 0.02) and the effect was differential by intervention group (p-value = 0.04). At one month the II group had 1.63 (95%CI = 1.23, 2.15) times greater odds of having high SK compared to the EE group but by twelve months there was no difference between groups (OR=1.21; 0.87, 1.67). However, for SP there is not a statistically significant effect of time (p-value = 0.07) but there is a difference in the rate of change by group. The II group had greater odds of having high SP at one month (OR=3.36; 1.86, 6.10) and twelve months (OR=7.64; 2.49, 23.49) compared to the EE group. We did not observe differences in rates of change by race for SK (p-value = 0.21) or SP (p-value = 0.86) but SK (p-value < 0.01) and SP (p-value < 0.01) increased over time for all races. Overall, we find that both II and EE increase SK over 12 months but that only II was able to increase SP. Moreover, this effect was observed for all race ethnic groups. Conclusions: The provision of culturally tailored, health literate information alone was able to increase SK; it did not eliminate racial disparities in SK but did improve SK for all race/ethnic groups studied.

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Effect of a breastfeeding educational intervention: a randomized controlled trial

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.3081.3335 ◽

2020 ◽

Vol 28 ◽

Author(s):

Erdnaxela Fernandes do Carmo Souza ◽

Alfredo Almeida Pina-Oliveira ◽

Antonieta Keiko Kakuda Shimo

Keyword(s):

Randomized Controlled Trial ◽

Educational Intervention ◽

Exclusive Breastfeeding ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

P Value ◽

Postpartum Women ◽

Significance Level ◽

Randomized Controlled

Objective: to assess the effect of a breastfeeding educational intervention on the counseling provided to postpartum women. Method: this is a randomized controlled trial including 104 postpartum women (intervention group = 52 and control group = 52) from a private hospital, whose educational intervention was based on the pragmatic theory and on the use of a soft-hard technology called Breastfeeding Educational Kit (Kit Educativo para Aleitamento Materno, KEAM). Women were followed-up for up to 60 days after childbirth. Chi-Squared Test, Fischer’s Exact Test, and Generalized Estimating Equation were used, with a significance level of 5% (p-value <0.05). The analyses were performed using the Statistical Package for the Social Sciences, version 24. Results: the postpartum women in the intervention group had fewer breastfeeding difficulties and a higher percentage of exclusive breastfeeding at all time points compared with those in the control group. Conclusion: the educational intervention based on active methodologies and stimulating instructional resources was effective in developing greater practical mastery among postpartum women with regard to adherence and maintenance of exclusive breastfeeding. Registry REBEC RBR – 8p9v7v.

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Abstract P255: Decrease in Serum Lipids among 5th Grade CARDIAC Participants, 2002-2012

Circulation ◽

10.1161/circ.127.suppl_12.ap255 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Yohannes Gebremariam ◽

Christa Ice ◽

William Neal

Keyword(s):

Linear Models ◽

Linear Trend ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

P Value ◽

Cross Sectional ◽

Mean Values ◽

Non Linear ◽

Over Time

The presence of multiple cardiovascular risk factors such as elevations in body mass index (BMI), systolic blood pressure (SBP), serum low-density lipoprotein (LDL) cholesterol, and the related non high-density lipoprotein (non-HDL) cholesterol in children is predictive of later cardiovascular disease. LDL and non-HDL have recent decreases in the US adult and youth population despite increases in obesity rates. The purpose of this study was to assess these trends among Appalachian 5 th grade children. Methods: 47,198 children, mostly between 10-11 years old, participated in a cross-sectional statewide CARDIAC (Coronary Artery Risk Detection In Appalachian Communities) screening between 2002-2012 and had a complete fasting lipid profile (FLP). Consistent with state demographics, 92.6% were Caucasian and 53.6% female. LDL (Mean = 92.9, sd = 25.5) and non-HDL (M=111, sd = 28.9) cholesterol levels were normally distributed. Covariates included race, gender, age, SBP and BMI (M = 21.36, sd = 5.2). Generalized Linear Models (GLM) and orthogonal contrast matrices were used to test the hypothesis of a linear (v. non-linear) trend over time for LDL and non-HDL values. Results: Models predicting LDL and non-HDL were significant and fit a linear trend (p-value < 0.0001) attributable to the explanatory variables (race was not significant and excluded from the final models). For LDL, year of screening was significant (p<0.0001) as was gender, age and BMI (all p < 0.0001). For non-HDL, year of screening was also significant (p<0.0001), as was gender (p=0.0194), age (p<0.0001), BMI (p<0.0001), and SBP (p=0.0013). There was a decreasing trend in LDL (dot) and non-HDL (broken line) over time (Figure 1). Although some non-linear trends were also significant (e.g., a quartic trend, p < 0.001), the linear trend provided the best fit for both models. Conclusion: The mean values for LDL and non-HDL of a cross-sectional sample of children in 5 th grade Appalachia has decreased over time even after adjusting for age, BMI, gender, race and SBP.

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Earlier is better when treating rheumatoid arthritis: but can we detect a window of opportunity?

RMD Open ◽

10.1136/rmdopen-2020-001242 ◽

2020 ◽

Vol 6 (1) ◽

pp. e001242 ◽

Cited By ~ 1

Author(s):

Sytske Anne Bergstra ◽

Joy A Van Der Pol ◽

Naghmeh Riyazi ◽

Yvonne P M Goekoop-Ruiterman ◽

Pit J S M Kerstens ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Linear Models ◽

Cox Regression ◽

Absolute Risk ◽

Time Frame ◽

Symptom Duration ◽

Window Of Opportunity ◽

Non Linear ◽

Fast Acting ◽

Over Time

ObjectivesThe window of opportunity (WOO) hypothesis suggests a limited time frame to stop rheumatoid arthritis (RA). We hypothesised that a WOO could either be represented by a hyperbolic (‘curved’) decline in the chance to achieve the outcome sustained drug-free remission (sDFR) over time, after which achieving sDFR is not possible anymore, or by a more gradual linear decline approaching zero chance to achieve sDFR.MethodsPatients with RA (symptom duration <2 years) were included from two randomised trials: BehandelStrategieën (BeSt), n=508 and Induction therapy with Methotrexate and Prednisone in Rheumatoid Or Very Early arthritic Disease (IMPROVED), n=479. Cox-regression was performed to assess the shape of the association between symptom duration and sDFR (Disease Activity Score<1.6, no disease-modifying anti-rheumatic drugs for ≥1 year) for patients starting slow-acting monotherapy (IMPROVED, BeSt) or fast-acting combination therapy (BeSt). Likelihood ratio tests were used to compare the fit of linear and non-linear models in both databases separately. Predictions from the best fitting models were used to assess whether the absolute risk to achieve sDFR approaches zero with increasing symptom duration.ResultsIn BeSt and IMPROVED, 54/226 and 110/421 patients achieved sDFR with fast-acting treatment, and 53/243 (BeSt) with slow-acting treatment. Non-linear models did not fit better than linear models (fast-acting treatment BeSt p=0.743, IMPROVED p=0.337; slow-acting treatment BeSt p=0.609). After slow-acting monotherapy, linear models declined steeper. None of the models approached zero chance to achieve sDFR over time.ConclusionsThe chance to achieve sDFR decreased gradually over time, and decreased fastest in patients starting slow-acting monotherapy. In both treatment groups, we found no evidence for a WOO within 2 years symptom duration.

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Structure and variability in the developmental trajectory of children's externalizing problems: Impact of infant attachment, maternal depressive symptomatology, and child sex

Development and Psychopathology ◽

10.1017/s095457940100205x ◽

2001 ◽

Vol 13 (2) ◽

pp. 277-296 ◽

Cited By ~ 72

Author(s):

JEFFREY A. MUNSON ◽

ROBERT J. MCMAHON ◽

SUSAN J. SPIEKER

Keyword(s):

Adolescent Mothers ◽

Externalizing Problems ◽

Linear Models ◽

Depressive Symptomatology ◽

Rate Of Change ◽

Developmental Trajectory ◽

Infant Attachment ◽

Detailed Assessment ◽

The Impact ◽

Over Time

This study explores the developmental trajectory of externalizing problems in a sample of 101 children of adolescent mothers from preschool through third grade using hierarchical linear models (HLM). First, a detailed assessment of the structure of the developmental trajectory of externalizing problems is provided. Second, the impact of three risk factors (infant attachment, maternal depressive symptomatology, and child sex) on the developmental course of externalizing problems is assessed. Both avoidant and disorganized attachment and higher levels of maternal depressive symptomatology were associated with higher levels of externalizing problems at 9 years of age. Girls also showed higher externalizing problems relative to their same-sex peers than did boys. In addition, maternal depressive symptomatology related to the rate of change in these problems over time; the greater the mother's depression, the faster externalizing problems tended to increase. Although the overall level of maternal depressive symptomatology was related to children's externalizing problems for secure, avoidant, and disorganized groups, changes in maternal depressive symptomatology over time predicted levels of externalizing problems only for children with avoidant insecure attachments.

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Abstract TP242: A Brief Educational Intervention Improves Paramedic Stroke Knowledge

Stroke ◽

10.1161/str.48.suppl_1.tp242 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

John A Oostema ◽

Todd Chassee ◽

Mel Oakley ◽

Mathew J Reeves

Keyword(s):

Educational Intervention ◽

Systems Of Care ◽

Quality Care ◽

Time Frame ◽

Before And After ◽

Baseline Knowledge ◽

On Line ◽

Stroke Systems Of Care ◽

The Impact ◽

Stroke Knowledge

Introduction: Emergency Medical Services (EMS) are an important component of stroke systems of care. EMS transport has been associated with faster emergency department (ED) stroke evaluations and higher t-PA delivery rates, especially among EMS recognized cases with hospital prenotification. However, delivery of high quality care including hospital prenotification requires that paramedics received regular education and training to improve their ability to identify and treat stroke cases. Methods: We identified opportunities for improvement in EMS care of suspect stroke patients through a review of local EMS stroke-related performance data and focus group discussions with paramedics. We then developed a 20-minute online educational module that reviewed basic stroke pathophysiology, discussed acute stroke therapies, and stressed the importance of performing stroke screening examinations and hospital prenotification for suspect stroke cases. The training was provided to all paramedics in a single agency. Scores on 10 item multiple-choice assessment were compared before and after receipt of the online training module using Fisher Exact tests and Wilcoxon Rank Sum Tests. Results: A total of 40 paramedics underwent the training. Overall quiz scores improved from a median of 9 (interquartile range [IQR] 7 to 9) to 10 (IQR 9 to 10, p=0.0002). Prior to training, only 43% of paramedics correctly identified 4.5 hours as the window for t-PA treatment, with 43% choosing 6 hours. Correct t-PA window identification improved significantly following education (43% to 87.5%, p<0.0001). Improvements were also seen for questions regarding the most common presenting complaints among EMS missed strokes (72.5% to 90%) and the recommended time frame for verbal hospital prenotification (80% to 95%), although these differences were not statistically significant. Conclusions: Overall, paramedics demonstrated good baseline knowledge regarding stroke, however important misconceptions regarding the time frame for t-PA eligibility were common. A brief, on-line educational intervention improved stroke knowledge. Further work is needed to determine the impact of stroke education on real world paramedic performance.

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What Skills Really Improve After a Flipped Educational Intervention to Train Medical Students and Residents to Break Bad News?

Journal of Education and Learning ◽

10.5539/jel.v8n3p35 ◽

2019 ◽

Vol 8 (3) ◽

pp. 35 ◽

Cited By ~ 1

Author(s):

Luciana B. Burg ◽

Christof J. Daetwyler ◽

Getúlio R. de Oliveira Filho ◽

Flávia Del Castanhel ◽

Suely Grosseman

Keyword(s):

Factor Analysis ◽

Medical Students ◽

Communication Skills ◽

Educational Intervention ◽

Intervention Group ◽

Bad News ◽

Control Group ◽

Overall Performance ◽

Giving Bad News ◽

Over Time

Breaking bad news (BBN) is necessary in medical practice and requires training. The purpose of this study is to evaluate the efficacy and mainly explore the components involved in medical students’ and residents’ performance after a flipped educational intervention to train them to break bad news. A randomized controlled before-after study was conducted with 43 medical students and residents in the intervention group and 41 in the control group. The intervention combined an online multimedia program (DocCom) with a two-hour workshop. BBN performance was assessed at two clinical stations using Objective Structured Clinical Examination and analyzed using a mixed between-within subject analysis of variance. A factor analysis was conducted to analyze the performance by checklist components. The intervention group improved its overall performance in BBN over time (p = 0.000; Eta2 = 0.38) and when compared to the control group (p = 0.01; Eta2 = 0.12). The factor analysis revealed two main components: Factor 1—“giving bad news and responding with empathy”—and Factor 2—“using general communication skills”. Performance analysis by these components revealed that the improvement occurred mainly in Factor 1 (over time, p = 0.000; Eta2 = 0.48, group x time, p = 0.000; Eta2 = 0.38). The intervention combining DocCom Module 33 and a workshop had a moderate effect on the improvement of medical students’ and medical residents’ BBN overall performance in standardized encounters. This improvement was mainly related to communication skills for giving bad news and responding with empathy, in which the intervention effect was large over time and between groups.

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Effects of Momentary Affect on Satisfaction Judgments

Journal of Individual Differences ◽

10.1027/1614-0001/a000304 ◽

2020 ◽

Vol 41 (2) ◽

pp. 61-67

Author(s):

Marko Tončić ◽

Petra Anić

Keyword(s):

Linear Models ◽

Time Frame ◽

Hierarchical Linear Models ◽

Curvilinear Relationship ◽

Positive And Negative Affect ◽

Transient Events ◽

Time Frames ◽

Events Data ◽

Level Satisfaction ◽

Source Of Information

Abstract. This study aims to examine the effect of affect on satisfaction, both at the between- and the within-person level for momentary assessments. Affect is regarded as an important source of information for life satisfaction judgments. This affective effect on satisfaction is well established at the dispositional level, while at the within-person level it is heavily under-researched. This is true especially for momentary assessments. In this experience sampling study both mood and satisfaction scales were administered five times a day for 7 days via hand-held devices ( N = 74 with 2,122 assessments). Several hierarchical linear models were fitted to the data. Even though the amount of between-person variance was relatively low, both positive and negative affect had substantial effects on momentary satisfaction on the between- and the within-person level as well. The within-person effects of affect on satisfaction appear to be more pronounced than the between-person ones. At the momentary level, the amount of between-person variance is lower than in studies with longer time-frames. The affect-related effects on satisfaction possibly have a curvilinear relationship with the time-frame used, increasing in intensity up to a point and then decreasing again. Such a relationship suggests that, at the momentary level, satisfaction might behave in a more stochastic manner, allowing for transient events/data which are not necessarily affect-related to affect it.

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SUPPORTIVE EDUCATIVE SYSTEM DALAM MENINGKATKAN KEMANDIRIAN MERAWAT KAKI PADA PASIEN DIABETES MELLITUS TIPE II

Jurnal Ilmiah Permas: Jurnal Ilmiah STIKES Kendal ◽

10.32583/pskm.9.2.2019.63-72 ◽

2019 ◽

Vol 9 (2) ◽

pp. 63-72

Author(s):

Nova Nurwinda Sari ◽

Herlina Herlina

Keyword(s):

Diabetes Mellitus ◽

Health Center ◽

Intervention Group ◽

T Test ◽

Control Group ◽

P Value ◽

Type Ii ◽

Foot Care ◽

Control Group Design ◽

Patients With Diabetes

Diabetes mellitus dapat menyebabkan cukup banyak komplikasi seperti kelainan mata, kelainan ginjal, kelainan pembuluh darah dan kelainan pada kaki. Penderita diabetes mellitus yang mengalami komplikasi kronis perlu diberikan upaya preventif untuk mencegah komplikasi, salah satunya adalah kemampuan perawatan kaki. Penelitian ini dilakukan untuk menguji efektivitas supportive educative system dalam meningkatkan kemandirian perawatan kaki pada pasien dengan diabetes mellitus Tipe II di Puskesmas Permata Sukarame, Bandar Lampung. Penelitian ini menggunakan metode quasy eksperimen dengan desain pretest-posttest with control group dengan total masing-masing kelompok sebanyak 18 responden. Pengumpulan data dilakukan dengan menyebarkan kuesioner kepada responden yang memenuhi kriteria inklusi penelitian. Penelitian ini diuji menggunakan analisis univariat, bivariat dan uji T-test. Hasil penelitian menunjukkan bahwa terdapat perbedaan rata-rata dalam kemandirian perawatan kaki pada kelompok intervensi dan kelompok kontrol dengan p-value 0,000. Pendidikan dan praktik perawatan kaki harus diberikan sejak dini sebagai upaya pencegahan untuk komplikasi. Kata kunci : Supportive educative system, kemandirian perawatan kaki SUPPORTIVE EDUCATIVE SYSTEM IN IMPROVING INDEPENDENCE OF FOOT CARE IN PATIENTS WITH DIABETES MELLITUS TYPE II ABSTRACT Diabetes mellitus can cause quite a lot of complications such as eye disorders, kidney disorders, vascular disorders and abnormalities in the legs. Patients with diabetes mellitus who have chronic complications need to be given a preventive effort to prevent complications, one of which is foot care ability. This research was conducted to examine the effectiveness of supportive educative systems in increasing the independence of foot care in patients with Type II diabetes mellitus in the Permata Sukarame Health Center Bandar Lampung Working Area. This study used a quasi-experimental method with pretest-posttest with control group design with a total of 18 respondents each. Data collection is done by distributing questionnaires to respondents who meet the research inclusion criteria. This study was tested using univariate, bivariate, T-Test analysis. The results showed that the mean differences in the independence of foot care in the intervention group and the control group in the Permata Sukarame Community Health Center work area with a p-value of 0,000. Education and practice of foot care should be given early as a preventative effort for complications. Keywords: Supportive educative system, independence of foot care

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The Effectiveness of Using a Mobile Messenger as an Educational Supporting Tool among Nursing Students

Asian Journal of Medicine and Biomedicine ◽

10.37231/ajmb.2020.4.1.333 ◽

2020 ◽

Vol 4 (1) ◽

pp. 67-77

Author(s):

Rohimah Ismail ◽

Chong Mei Chan ◽

Wan Muhammad Azly W. Zulkafli ◽

Hasnah Zani ◽

Zainab Mohd Shafie

Keyword(s):

Nursing Education ◽

Nursing Students ◽

Clinical Decision Making ◽

Intervention Group ◽

Great Influence ◽

Control Group ◽

P Value ◽

Significant Difference ◽

Supporting Tool ◽

Nursing College

The evolution of information technology has exerted great influence on nursing education via new pedagogy of knowledge delivery without time and place restriction. Mobile technology revolutionises nursing education and clinical practice via empowering skills of critical thinking and clinical decision-making through learning. The aim of this study is to evaluate the effectiveness of using mobile messenger (Whatsapp) as an educational supporting tool among nursing students. The study design used is a Cluster Randomized Control Trail. Two nursing colleges were selected. Sample size was 93 participants, 48 from the Kuala Terengganu Nursing College Kuala Terengganu as the intervention group while the control group were recruited among 45 participants from UniSZA Nursing College. There is a significant difference in the level of knowledge between pre and posttest among intervention group (mean difference was -8.70 with a standard deviation 8.42, p-value< 0.001) and 93.8 percent of the respondents perceived the usefulness of using WhatsApp mobile messenger to enhance learning. This demonstrates that learning through mobile messenger (WhatsApp) enhances learning and is well received as a new method of learning by almost all students. Keywords: Mobile learning, WhatsApp messenger, Social Interaction

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The Impact of the Theory-Based Training on Beliefs of Women towards Breast Cancer Screening Behaviors

Current Women s Health Reviews ◽

10.2174/1573404816999200402120836 ◽

2020 ◽

Vol 16 (3) ◽

pp. 229-235

Author(s):

Alireza Didarloo ◽

Leila Mokhtary ◽

Hamid-Reza Khalkhali ◽

Soheila Ahangarzadeh-Rezaei

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Health Beliefs ◽

Educational Intervention ◽

Intervention Group ◽

Health Belief ◽

Control Group ◽

Belief Model ◽

Screening Behaviors

Background: Breast cancer is the most prevalent type of cancer among women that is fatal if not diagnosed and treated in due time. Health beliefs play an important role in people's willingness to engage in health-promoting behaviors. Objective: The aim of the study was to examine the effects of the health belief model (HBM)-based training intervention on women’s health beliefs towards breast cancer screening behaviors. Methods: The study of educational intervention was conducted on women referred to healthcare centers. The sample was selected by convenient sampling and randomly assigned to control and intervention groups of 50 subjects. The intervention group received the theory-based training intervention, but the control group received only the routine care. Champion’s Health Belief Model Scale (CHBMS) was used for collecting the study data. Data analysis was performed using independent t-test, paired t-test, Chi-squared test, and correlation coefficient in SPSS software version 16.00. Results: The mean age of the subjects for control and intervention groups was 39.06±9.78, 38.32±8.27, respectively. Overall, 38%, 12% and 13%of the subjects reported breast selfexamination behavior, mammography and clinical breast examinations, respectively. Before the intervention program, the overall mean score of health beliefs in groups of control and intervention was 160.82±23.28, and 159.14±20.61, respectively. After educational intervention, the overall mean score of beliefs in the intervention group changed from 159.14±20.61 to 195.26±24.42, and it was statistically significant (p<0.001). In the control group, after the intervention, no significant changes were observed in the mean score of total health beliefs and were not statistically significant (p>0.05). Among the variables of the HBM, women's perceived self-efficacy toward breast selfexamination experienced the most positive change after an educational intervention. Conclusion: Our results indicated that HBM-based training significantly improved women’s beliefs toward breast cancer screening behaviors. It is suggested that trainers in the healthcare system use these educational approaches to promote people’s beliefs toward breast cancer and its screening methods.

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