Michael Anders

Training health care providers in the treatment of tobacco use and dependence: pre- and post-training results

RATIONALE Health care providers have an extended reach into the population of tobacco users. Increasing the number and variety of health care providers that deliver the evidence-based, brief interventions for tobacco use prescribed by the Public Health Service Clinical Practice Guideline is likely to result in more tobacco users exposed to evidence-based treatments and more successful quit attempts. Effective training is key to increasing provider performance and proficiency in this regard. METHOD A 1-hour didactic training was delivered to 1286 health care providers (185 physicians, 359 nurses, 75 dental providers and 667 other health-related professions). Pre- and post-training tests assessed provider attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. Analysis of variance was used to test for significant differences among professional groups. RESULTS Prior to training, physicians engaged in more interventions and reported more knowledge and more positive attitudes towards treating tobacco use than the other professions. Post-training, differences among physicians, nurses and dental providers were minimal. All professions reported significantly more knowledge and more positive attitudes on nearly all measures. CONCLUSIONS A large potential benefit can be garnered from a brief, targeted, 1-hour training in the brief, evidence-based interventions for treating tobacco use and dependence. Increases in perceived knowledge and positive attitudes towards treatment among the professional groups suggest that trainees will perform interventions at higher frequency post-training. Overall gains were highest for dental providers and nurses.

Training Nurses in the Treatment of Tobacco Use and Dependence: Pre- and Post-Training Results

AIM This paper is a report of a study conducted to examine the effects of a brief training in the treatment of tobacco use and dependence on the tobacco use intervention-related knowledge and attitudes of nurses. BACKGROUND   Nurses are the largest group of healthcare providers and they have an extended reach into the population of tobacco users. Thus, increasing the number of nurses who deliver brief evidence-based interventions for tobacco use and dependence, such as that prescribed by the Public Health Service Clinical Practice Guideline in the United States of America, is likely to expose more tobacco users to evidence-based treatments and lead to more successful quit attempts. Effective training is key to improving provider proficiency in delivering evidence-based interventions for tobacco use and dependence. METHOD   A 1-hour didactic training was delivered to 359 nurses from 2006 to 2007, including 54 Advanced Practice Nurses, 250 Registered Nurses and 55 Licensed Practical Nurses. Pre- and post-training tests assessed attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. RESULTS   Statistically significant increases on nearly all measures were achieved, with Registered Nurses and Licensed Practical Nurses realizing the largest gains. CONCLUSION   Given the overwhelming impact of tobacco use on patients, all nurses should be provided with training in the delivery of brief, evidence-based interventions for tobacco use. As the most trusted healthcare provider group with an extended reach into the tobacco using population, nurses have a large potential impact on the prevalence of tobacco use.

Emergency Department-Initiated Tobacco Dependence Treatment

OBJECTIVE To examine the feasibility of a fax referral program to increase enrollment in tobacco dependence treatment in emergency department (ED) patients. METHODS The control group received quit advice and printed information; the intervention group also received a faxed referral that generated telephone contacts. RESULTS Treatment enrollment was higher in the intervention group (13.5% vs 2.7%). Only the faxed referral was associated with treatment enrollment. CONCLUSIONS An ED intervention is feasible. Faxed referral resulted in a 5-fold increase in tobacco treatment enrollment. The ED may be an opportune setting to facilitate smoking-cessation behavior change among lower income, underserved patients.

Audiology Students’ Perception of Hybrid Simulation Experiences: Qualitative Evaluation of Debriefing Sessions

Simulation-based research is still new in the audiology field and requires more research to better understand students’ perspectives on standardized patients/parents (SPs) and manikins use. There is also limited research about debriefing practices in audiology. This qualitative study used a baby simulator and SPs to evaluate audiology students’ reflection during three debriefing sessions conducted at the University of Arkansas for Medical Science (UAMS) Simulation Center. Seventeen Doctor of Audiology (AuD) students participated in the simulation event, and the data were collected using the transcripts of videotaped debriefing sessions. The qualitative content analysis of the transcripts revealed eight sub-themes: support, compassion, respect, teamwork, limited academic knowledge and practice, insufficient communication skills, low self-confidence, and undesirable emotional reactions. These items, in turn, fell under two main themes of Qualification and Lack of Preparation. Both main themes were included in one core category named Professional Dispositions and Competencies. Study findings indicated that audiology students demonstrated both promising professional dispositions and competencies as well as characteristics that may hinder students from developing their professional abilities. Thus, audiology programs will benefit from simulation use, including debriefing sessions, to emphasize professional efficiency.

Comparison of total resistive work of breathing in two generations of ventilators in an animal model

Spontaneous breathing through an endotracheal tube and ventilator circuit is associated with an increased work of breathing (WOB). Recently, pediatric ventilators have introduced improved features to optimize patient‐ventilator interactions. We performed an experiment utilizing an animal model to compare total resistive WOB of two widely used ventilators, the Siemens Servo Ventilator 300 (SV300) with patient‐optimized features, such as flow‐triggering and rapid response time, and the Siemens 900C (S900C) without those features. A total of 120 experiments of 10 minutes duration each were performed in 6 anesthetized, intubated lambs. In each experiment, the animal was randomized to either pressure support ventilation (PSV) of 5 cm H2O, or continuous positive airway pressure (CPAP) with 0 cmH2O end expiratory pressure (ZEEP) while supported by the SV300 or the S900C. Each animal was used as its own control. WOB was measured with a Bicore monitoring device as WOB of the animal (WOBp), WOB of the ventilator (WOBv), and the pressure time product (PTP) for each breath during the experiment. Oxygen consumption (VO2) of the animal was measured using breath‐by‐breath gas analysis with a customized metabolic monitoring system. A Wilcoxon signed rank sum test was used for analysis. All comparisons between the ventilators for both CPAP and PSV showed a statistically significant difference (p < 0.001). WOBp was reduced by 47% during pressure support ventilation (PSV) and by 47% during CPAP when the SV300 was used compared to the S900C. We conclude that WOB is significantly lower in animals ventilated with the SV300 than with the S900C ventilator, and we speculate that ventilators with the features of the SV300 may offer advantages in ventilating pediatric patients. Pediatr Pulmonol. 1996; 22:58–66.

Simulating Four Essential Conversations with Hematology/Oncology Trainees: a Qualitative Evaluation.

Hematologists/oncologists have a crucial responsibility to effectively communicate with patients. However, they have been criticized for ineffective communication with patients. To develop effective communication behaviors that meet the needs of patients and families, trainees need practice and feedback about their performance. Medical faculties frequently teach communication skills using simulation-based curricula; however, they often include only general communication skills, without tailored approaches for specialties. This study examined Hematology/Oncology trainees’ qualitative perceptions about the value of and techniques used for simulations of specialty specific, essential conversations with patients and families, and debriefing sessions. Results demonstrate a highly effective curriculum and positive learner experiences. While most reports on this topic take place within major academic cancer centers, outcomes from a mid-sized Hematology/Oncology training program are unknown. The study confirms feasibility for implementing a simulation-based communications program in a mid-sized Hematology/Oncology program and describes simulation techniques that were effective.

Evaluation of Clinical Decision Rules for Bone Mineral Density Testing among White Women

Background. Osteoporosis is a devastating, insidious disease that causes skeletal fragility. Half of women will suffer osteoporotic fractures during their lifetimes. Many fractures occur needlessly, because of inattentiveness to assessment, diagnosis, prevention, and treatment of osteoporosis. Study Purpose. Study Purpose. To evaluate the discriminatory performance of clinical decision rules to determine the need to undergo bone mineral density testing. Methods. A nationally representative sample from the Third National Health and Nutrition Examination Survey consisted of 14,060 subjects who completed surveys, physical examinations, laboratory tests, and bone mineral density exams. Multivariable linear regression tested the correlation of covariates that composed the clinical decision rules with bone mineral density. Results. Increased age and decreased weight were variables in the final regression models for each gender and race/ethnicity. Among the indices, the Osteoporosis Self-Assessment Tool, which is composed of age and weight, performed best for White women. Study Implications. These results have implications for the prevention, assessment, diagnosis, and treatment of osteoporosis. The Osteoporosis Self-Assessment Tool performed best and is inexpensive and the least time consuming to implement.

Use of decision rules for osteoporosis prevention and treatment: Implications for nurse practitioners

Purpose: To describe the current literature regarding the benefits of bone mineral density (BMD) screening and to discuss clinical decision rules for BMD screening. Data sources: Extensive review of the scientific literature regarding osteoporosis, BMD screening, and current clinical decision rules. Conclusions: Osteoporosis is a disease characterized by deterioration of bone and increased susceptibility to fractures, crippling, and disfigurement. BMD testing is the best predictor for osteoporosis and associated fractures; however, routine global BMD testing is cost‐prohibitive. A need exists for a selective and practical clinical decision rule for referral for testing. Implications for practice: Several effective clinical decision rules are presented, and their uses and applications are described. The osteoporosis self‐assessment tool is recommended by the authors because of its predictive power and ease of use.