Development and assessment of a low-health-literacy, pictographic adrenal insufficiency action plan

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Patrick T. Reeves ◽  
Ashley C. Packett ◽  
Carolyn Sullivan Burklow ◽  
Sofia Echelmeyer ◽  
Noelle S. Larson
Keyword(s):  
Patient Education ◽  
Adrenal Insufficiency ◽  
Assessment Tool ◽  
Action Plan ◽  
Consumer Information ◽  
Care Plan ◽  
Endocrine Society ◽  
Readability Score ◽  
Suitability Assessment ◽  
Individualized Care

Abstract Objectives Adrenal insufficiency (AI) is an overall rare disorder characterized by the chronic need for pharmacotherapy to prevent threat to life. The Pediatric Endocrine Society has recommended the use of clinical action tools to improve patient education and help guide acute management of AI. We aimed to develop and assess an easy-to-use, patient-friendly, evidence-based, personalized pictogram-based adrenal insufficiency action plan (AIAP) to aid in the management of AI in children. Methods Patients/caregivers (P/Cs) responded to surveys which measured the concepts of transparency, translucency, and recall in order to assess the pictograms. Readability was assessed using six formulas to generate a composite readability score. Quality was graded by P/Cs using the Consumer Information Rating Form (CIRF) (>80% rating considered acceptable). Understandability and actionability was assessed by medical librarians using the Patient Education Materials Assessment Tool-Printable (PEMAT-P) (>80% rating was acceptable). Suitability was evaluated by clinicians using the Suitability Assessment of Materials (SAM) instrument (>70% rating considered superior). Results All pictograms met criteria for inclusion in the AIAP. Composite readability score=5.4 was consistent with a fifth-grade level. P/Cs (n=120) judged the AIAP to be of high quality with CIRF rating=85.2%. Three medical librarians rated the AIAP to have 100% understandability and 100% actionability. Thirty-three clinicians completing the SAM generated a suitability rating of 90.0%. Conclusions The AIAP visually highlights individualized care plan components to facilitate optimized preventative and acute AI care. Further investigation will determine if AIAP improves clinical outcomes for patients with AI.

Understandability, actionability and suitability of educational videos on dietary management for hypertension

2022 ◽  
pp. 001789692110722
Author(s):  
Mohd Ramadan Ab Hamid ◽  
Nur Dalia Binti Mohd Yusof ◽  
Siti Sabariah Buhari
Keyword(s):  
Patient Education ◽  
Healthcare Professionals ◽  
Assessment Tool ◽  
Dietary Management ◽  
Educational Video ◽  
Lifestyle Modifications ◽  
Educational Tools ◽  
Suitability Assessment ◽  
Educational Videos ◽  
Convenience Sampling

Background: Educational video is a productive means to advocate lifestyle modifications such as changes in the dietary routine. This study assesses the understandability, actionability and suitability of newly developed educational videos aimed at encouraging dietary adjustments among hypertension patients. Method: In all, 183 participants were recruited via convenience sampling and rated the understandability, actionability and suitability of the videos using the Patient Education Materials Assessment Tool for Audio-Visual material (PEMAT-A/V) and the Suitability Assessment of Materials (SAM) scale. Results: Eleven videos were developed from five main topics related to the dietary management of hypertension. Participants agreed that all videos were highly understandable, actionable and suitable for use as educational tools, with scores of more than 85%, 89% and 80%, respectively. Conclusion/Implications: Overall, the newly developed videos gained high scores for understandability, actionability and suitability. This finding reflects positive acceptance of the videos among various healthcare professionals and patients with hypertension.

scholarly journals Change Project Using a Fall Prevention Action Program to Decrease Falls on a Behavioral Health Unit

2021 ◽  
Author(s):  
◽  
Amy Shuptrine
Keyword(s):  
Risk Assessment ◽  
Behavioral Health ◽  
Fall Risk ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Care Plan ◽  
Fall Risk Assessment ◽  
Care Plans ◽  
Individualized Care ◽  
Fall Risks

Practice Problem: Fall rates are increasing in the behavioral health units of the East Texas hospital. Due to the worldwide COVID-19 pandemic, the units are short-staffed, which further supports the urgent need for a targeted intervention to reduce fall risk. PICOT: The PICOT question that guided this project was: “In adult behavioral health patients (P), what is the effect of the Edmonson Psychiatric Fall Risk Assessment Tool (I), compared with previous use of the Morse Fall Risk tool (C), on the fall rate (O), in 8 weeks (T)?” Evidence: Falls are the most reported incidents in acute care hospitals and falls of behavioral health patients are more challenging to mitigate than those of other patients. Evidence suggested that the Edmonson Psychiatric Fall Risk Assessment Tool aided in identifying and mitigating fall risks by tailoring care plans to individual patients. Intervention: The Edmonson Psychiatric Fall Risk Assessment Tool was completed on every patient over the age of 18 years, which was admitted, discharged, falling, or had a change in condition, while on the psychiatric unit. The risk assessment was used to determine the risks and other factors that contribute to the patient falling. Once the contributors were identified, the data was used to put interventions into place and revise each individualized care plan to decrease falls. Outcome: The intended outcome was to identify patients that were at substantial risk for falls using the EPFRAT tool, mitigate some of their risks, and therefore decrease falls. Conclusion: Continued emphasis on the fall risks of behavioral health patients will be paramount in the management and success of the continued improvement in patient outcomes.

scholarly journals Emergency management of adrenal insufficiency in children: advocating for treatment options in outpatient and field settings

2019 ◽  
Vol 68 (1) ◽  
pp. 16-25 ◽  
Author(s):  
Bradley S Miller ◽  
Sandra P Spencer ◽  
Mitchell E Geffner ◽  
Evgenia Gourgari ◽  
Amit Lahoti ◽  
...  
Keyword(s):  
Emergency Management ◽  
Adrenal Insufficiency ◽  
Early Recognition ◽  
Action Plan ◽  
Sodium Succinate ◽  
Urgent Care ◽  
Adrenal Crisis ◽  
Care Providers ◽  
Endocrine Society ◽  
Stress Dose

Adrenal insufficiency (AI) remains a significant cause of morbidity and mortality in children with 1 in 200 episodes of adrenal crisis resulting in death. The goal of this working group of the Pediatric Endocrine Society Drug and Therapeutics Committee was to raise awareness on the importance of early recognition of AI, to advocate for the availability of hydrocortisone sodium succinate (HSS) on emergency medical service (EMS) ambulances or allow EMS personnel to administer patient’s HSS home supply to avoid delay in administration of life-saving stress dosing, and to provide guidance on the emergency management of children in adrenal crisis. Currently, hydrocortisone, or an equivalent synthetic glucocorticoid, is not available on most ambulances for emergency stress dose administration by EMS personnel to a child in adrenal crisis. At the same time, many States have regulations preventing the use of patient’s home HSS supply to be used to treat acute adrenal crisis. In children with known AI, parents and care providers must be made familiar with the administration of maintenance and stress dose glucocorticoid therapy to prevent adrenal crises. Patients with known AI and their families should be provided an Adrenal Insufficiency Action Plan, including stress hydrocortisone dose (both oral and intramuscular/intravenous) to be provided immediately to EMS providers and triage personnel in urgent care and emergency departments. Advocacy efforts to increase the availability of stress dose HSS during EMS transport care and add HSS to weight-based dosing tapes are highly encouraged.

Patient education and steroid replacement regimens in adrenal insufficiency

2014 ◽  
Author(s):  
Zana Ameen ◽  
Sadaf Ulnasah ◽  
Jo Rees ◽  
Lisa Shepherd ◽  
Andrew Bates ◽  
...  
Keyword(s):  
Patient Education ◽  
Adrenal Insufficiency

scholarly journals Utilizing Behavioral Science to Improve Antibiotic Prescribing in Rural Urgent Care Settings

2020 ◽  
Vol 41 (S1) ◽  
pp. s506-s507
Author(s):  
Patricia Cummings ◽  
Rita Alajajian ◽  
Larissa May ◽  
Russel Grant ◽  
Hailey Greer ◽  
...  
Keyword(s):  
Patient Education ◽  
Influenza Season ◽  
Action Plan ◽  
Inappropriate Prescribing ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Intervention Period ◽  
National Action Plan ◽  
Its Analysis ◽  
Urgent Care Centers

Background: The rate of inappropriate antibiotic prescribing for acute respiratory tract infections (ARTIs) is 45% among urgent care centers across the United States. To contribute to the US National Action Plan for Combating Antibiotic-Resistant Bacteria, which aims to decrease rates of inappropriate prescribing, we implemented 2 behavioral nudges using the evidence-based MITIGATE tool kit from urgent-care settings, at 3 high-volume, rural, urgent-care centers. Methods: An interrupted time series (ITS) analysis was conducted comparing a preintervention phase during the 2017–2018 influenza season (October through March) to the intervention phase during the 2018–2019 influenza season. We compared the rate of inappropriate or non–guideline-concordant antibiotic prescribing for ARTIs across 3 urgent-care locations. The 2 intervention behavioral nudges were (1) staff and patient education and (2) peer comparison. Provider education included presentations at staff meetings and grand rounds, and patient education print materials were distributed to the 3 locations coupled with news media and social media. We utilized the CDC “Be Antibiotics Aware” campaign materials, with our hospital’s logo added, and posted them in patient rooms and waiting areas. For the peer comparison behavioral intervention, providers were sent individual feedback e-mails with their prescribing data during the intervention period and a blinded ranking e-mail in which they were ranked in comparison to their peers. In the blinded ranking email, providers were placed into categories of “low prescribers,” those with a ≤23% inappropriate antibiotic prescribing rate based on the US National Action Plan for Combating Antibiotic-Resistance Bacteria 2020 goal, or “high prescribers,” those with a rate greater than the national average (45%) of inappropriate antibiotic prescribing for ARTI. Results: Our results show that fewer inappropriate antibiotic prescriptions were written during the intervention period (58.8%) than during the preintervention period (73.0%), resulting in a 14.5% absolute decrease in rates of inappropriate prescribing among urgent-care locations over a 6-month period (Fig. 1). The largest percentage decline in rates was seen in the month of April (−35.8%) when compared to April of the previous year. The ITS analysis revealed that the rate of inappropriate prescribing was statistically significantly different during the preintervention period compared to the intervention period (95% CI, −4.59 to −0.59; P = .0142). Conclusions: Using interventions outlined in the MITIGATE tool kit, we were able to reduce inappropriate antibiotic prescribing for ARTI in 3 rural, urgent-care locations.Funding: NoneDisclosures: Larissa May repo, Speaking honoraria-Cepheid Research grants-Roche Consultant-BioRad Advisory Board-Qvella Consultant-Nabriva

scholarly journals Telehealth Use in a Home-Based Dementia Care-Coordination Program

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 195-196
Author(s):  
Deirdre Johnston ◽  
Melissa Reuland ◽  
Kelly Marshall ◽  
Inga Antonsdottir ◽  
Morgan Bunting ◽  
...  
Keyword(s):  
Clinical Supervision ◽  
Unmet Need ◽  
Dementia Care ◽  
Care Plan ◽  
Home Setting ◽  
Home Team ◽  
Individualized Care ◽  
Home Based ◽  
Increased Risk ◽  
At Home

Abstract In the coming decades, greater numbers of people will either have Alzheimer’s Disease or a related dementia or will take care of a family member with dementia. The dementia syndromes are associated with increased risk of medical, social, and behavioral complications in both the person with dementia (PWD) and the caregiver (CG), many of which are preventable. These complications, and the dementia itself, can impede access to care and ultimately hasten residential care placement, which can be both undesirable and costly. A nearly universal unmet need in PWD/CG dyads is dementia-specific education. Therefore, it is vital we find ways to support and provide education to CG/PWD dyads to manage dementia in the community and home setting. MIND at Home is a dementia-care model developed and tested at Johns Hopkins University School of Medicine to minimize dementia complications and delay institutionalization by training non-clinical Memory Care Coordinators (MCCs) working under clinical supervision to support and guide PWD/CG dyads in the community. MCCs collaborate with CGs and PWDs in the community using an individualized care plan structured around the dyads’ specific dementia-related needs. This presentation will describe how the MIND at Home team used handheld tablets to connect MCCs to clinicians from participants’ homes, and will report on challenges encountered, strategies to address them, and participant and caregiver satisfaction with the telehealth experience.

Patient education materials assessment tool for laryngectomy health information

Head & Neck ◽  
2017 ◽  
Vol 39 (11) ◽  
pp. 2256-2263 ◽  
Author(s):  
Kevin Wong ◽  
Amir Gilad ◽  
Michael B. Cohen ◽  
Diana N. Kirke ◽  
Scharukh M. Jalisi
Keyword(s):  
Patient Education ◽  
Health Information ◽  
Assessment Tool

National German Audit of Diagnosis, Treatment, and Teaching in Secondary Adrenal Insufficiency

2017 ◽  
Vol 49 (08) ◽  
pp. 580-588 ◽  
Author(s):  
Stephan Petersenn ◽  
Jürgen Honegger ◽  
Marcus Quinkler
Keyword(s):  
Clinical Practice ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Diagnostic Testing ◽  
Treatment Strategies ◽  
Serum Cortisol ◽  
National Audit ◽  
Secondary Adrenal Insufficiency ◽  
Endocrine Society ◽  
Great Heterogeneity

AbstractGreat heterogeneity seems to exist regarding diagnosis, therapy, and teaching of patients with secondary adrenal insufficiency (SAI) across Germany resulting in different diagnosis and treatment strategies. The aim of the work was to present the first national audit on diagnosis, treatment, and patient teaching of SAI reflecting common clinical practice in Germany. A self-designed questionnaire was sent via e-mail to all members of the German Endocrine Society (approx. 120 centers). Returned questionnaires (response rate 38.3%) were checked for duplicity of institutions and analyzed. Diagnostic testing focuses on those patients with relevant risk for adrenal insufficiency. Basal serum cortisol is mostly used as screening test. Short synacthen and CRH tests are the preferred confirmatory tests, however, cut-off values vary due to different assays used. Patients with radiation, second surgery, progressive disease or new symptoms are followed by serial re-testing. Perioperative management and frequency of postoperative re-evaluations differ among centers. Hydrocortisone is the preferred glucocorticoid for replacement therapy, but daily doses vary considerably (10–30 mg/day). Some centers perform hormone measurements for dose adjustment of glucocorticoid replacement therapy whereas others rely on clinical judgement. Patients’ teaching is done in 84% of centers, but only half of the centers include patients’ relatives. Homogeneity exists in patients’ teaching regarding intercurrent illnesses (fever, diarrhoea). Recommendations regarding dose adaptations in situations such as sport-activities, dental-procedures, or coughing are highly variable. This first national audit reveals great heterogeneity among German centers and could improve patients’ care in SAI, for example, by initiating new trials and developing clinical practice guidelines.

scholarly journals EXTENSIVE EXPERTISE IN ENDOCRINOLOGY: Adrenal crisis

2015 ◽  
Vol 172 (3) ◽  
pp. R115-R124 ◽  
Author(s):  
Bruno Allolio
Keyword(s):  
Patient Education ◽  
Adrenal Insufficiency ◽  
Well Being ◽  
Stressful Events ◽  
Major Surgery ◽  
Adrenal Crisis ◽  
Self Administration ◽  
Necrosis Factor Alpha ◽  
Hydrocortisone Administration ◽  
Glucocorticoid Deficiency

Adrenal crisis is a life-threatening emergency contributing to the excess mortality of patients with adrenal insufficiency. Studies in patients on chronic replacement therapy for adrenal insufficiency have revealed an incidence of 5–10 adrenal crises/100 patient years and suggested a mortality rate from adrenal crisis of 0.5/100 patient years. Patients with adrenal crisis typically present with profoundly impaired well-being, hypotension, nausea and vomiting, and fever responding well to parenteral hydrocortisone administration. Infections are the major precipitating causes of adrenal crisis. Lack of increased cortisol concentrations during infection enhances pro-inflammatory cytokine release and sensitivity to the toxic effects of these cytokines (e.g. tumour necrosis factor alpha). Furthermore, pro-inflammatory cytokines may impair glucocorticoid receptor function aggravating glucocorticoid deficiency. Treatment of adrenal crisis is simple and highly effective consisting of i.v. hydrocortisone (initial bolus of 100 mg followed by 200 mg over 24 h as continuous infusion) and 0.9% saline (1000 ml within the first hour). Prevention of adrenal crisis requires appropriate hydrocortisone dose adjustments to stressful medical procedures (e.g. major surgery) and other stressful events (e.g. infection). Patient education is a key for such dose adjustments but current education concepts are not sufficiently effective. Thus, improved education strategies are needed. Every patient should carry an emergency card and should be provided with an emergency kit for parenteral hydrocortisone self-administration. A hydrocortisone pen would hold a great potential to lower the current barriers to hydrocortisone self-injection. Improved patient education and measures to facilitate parenteral hydrocortisone self-administration in impending crisis are expected to significantly reduce morbidity and mortality from adrenal crisis.

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