Warfarin knowledge in patients with atrial fibrillation: implications for safety, efficacy, and education strategies.

BACKGROUND: Multiple factors influence warfarin metabolism and can significantly affect the risk of adverse events. The extent to which patients understand the modifiable factors that impact on warfarin safety and efficacy is unclear. METHODS: A 52-item questionnaire related to knowledge of warfarin was administered to patients with atrial fibrillation in a face-to-face interview with a dietitian. Results were compiled based on five categories: general warfarin knowledge, compliance, drug interactions, herbal or vitamin interactions, and diet. RESULTS: 100 patients were surveyed. Stroke risk factors included hypertension (57%), heart failure (36%), age >75 years (33%), diabetes (22%), and prior stroke/transient ischemic attack (29%). The majority were either high-school (49%) or college graduates (27%). Ten (10%) had a stroke while on warfarin, 11 (11%) had a blood transfusion, and 26 (26%) had at least one fall. The percentages correct for questionnaire items in the five categories were as follows: general knowledge (62%), compliance (71%), drug interactions (17%), herbal or vitamin interactions (7%), and diet (23%). Neither education level nor duration of therapy correlated with warfarin knowledge. Patients at highest risk of stroke had very low knowledge scores in general. DISCUSSION: Patients on warfarin have a poor general understanding of the medication, particularly those at highest risk of stroke.

Providing nutrition education to recently resettled refugees: piloting a collaborative model and evaluation methods.

Resettled refugees experience high levels of food insecurity because of low English proficiency, limited job skills, and lack of understanding of the United States food system. This study evaluated integrating Supplemental Nutrition Assistance Program Education (SNAP-Ed) into English as Second Language (ESL) classes taught at a worksite- training program for recently resettled refugees and the feasibility of using food purchase receipts. A convenience sample of resettled refugees participated in SNAP-Ed one hour for 12 weeks during ESL classes. Food purchase receipts were collected for purchases one week prior to, first three weeks, last three weeks, and one week after classes. Participants were from 17 countries and 50% completed 12 lessons. Fifty-nine participants turned in receipts and 93% used SNAP funds. By integrating SNAP-Ed into ESL classes at a worksite-training center a hard-to-reach eligible population was reached. Further validation is needed to use food purchase receipts.

Alternate site glucose testing: a crossover design.

A crossover design study was conducted to determine if reducing pain, by using alternative sites off the finger tip, would increase testing frequency and improve clinical outcome as measured by hemoglobin A1c (HbA1c). Subjects with type 1 and type 2 diabetes tested with the FreeStyle meter (group 1) or tested with their original meter (group 2). After three months the subjects used the alternate meter. Testing frequency and blood glucose concentrations were recorded for the month before the study began and monthly thereafter. HbA1c was tested initially, at the crossover point, and at study conclusion. Insulin users increased testing frequency from 2.4 to 3.0 tests/day. Testing frequency for non-insulin users remained the same at 1.5 tests/day. Testing frequency was the same with the FreeStyle and the original meters. The average HbA1c was 7.4% (SD 1.5%) initially, 7.3% (SD 1.5%) at the crossover point, and 6.9% (SD 1.1%) at study conclusion. There was no significant difference in HbA1c measurements between meter types. Preference rankings were 76% for FreeStyle, 20% for their original meter, and 4% preferred both meters equally. This population tended to be in good glycemic control with 70% having HbA1c at < or = 8.0 at study initiation. Subjects preferred testing with the FreeStyle meter (76%), but did not increase testing frequency. Study participants tended to be in good testing compliance and glycemic control with little room for improvement. A population in poor glucose control might show differences in outcome with off site monitoring.

Developing an online certification program for nutrition education assistants.

OBJECTIVE: To develop an online certification program for nutrition education paraprofessionals to increase knowledge and confidence and to overcome training barriers of programming time and travel expenses. DESIGN: An online interactive certification course based on Supplemental Nutrition Assistance Program-Education and Expanded Food and Nutrition Education Program core competencies was delivered to employees of both programs. Traditional vs online training was compared. Course content validity was determined through expert review by registered dietitians. Parameters studied included increase of nutrition knowledge and teaching technique/ability, educator satisfaction, and programming costs related to training. SETTING: Utah State University Extension. PARTICIPANTS: Twenty-two Supplemental Nutrition Assistance Program-Education and Expanded Food and Nutrition Education Program educators in Utah. MAIN OUTCOME MEASURES: Knowledge and skills were measured using pre/posttest statistics. Participant satisfaction was measured with a survey. ANALYSIS: Paired t test; satisfaction survey. RESULTS: The change in paraprofessional knowledge score was statistically significant (P < .001). Forty percent of paraprofessionals strongly agreed and 60% agreed they were better prepared as nutrition educators because of the training. An estimated $16,000 was saved by providing the training online as compared to a face-to-face training. CONCLUSIONS AND IMPLICATIONS: This interactive online program is a cost-effective way to increase paraprofessional knowledge and job satisfaction.