Effect of In-Person vs Video Training and Access to All Functions vs a Limited Subset of Functions on Portal Use Among Inpatients: A Randomized Clinical Trial.

Importance: Inpatient portals provide patients with clinical data and information about their care and have the potential to influence patient engagement and experience. Although significant resources have been devoted to implementing these portals, evaluation of their effects has been limited. Objective: To assess the effects of patient training and portal functionality on use of an inpatient portal and on patient satisfaction and involvement with care. Design, Setting, and Participants: This randomized clinical trial was conducted from December 15, 2016, to August 31, 2019, at 6 noncancer hospitals that were part of a single health care system. Patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay were eligible for participation. Data were analyzed from May 1, 2019, to March 15, 2021. Interventions: A 2 × 2 factorial intervention design was used to compare 2 levels of a training intervention (touch intervention, consisting of in-person training vs built-in video tutorial) and 2 levels of portal function availability (tech intervention) within an inpatient portal (all functions operational vs a limited subset of functions). Main Outcomes and Measures: The primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and patients' satisfaction and involvement with their care. Results: Of 2892 participants, 1641 were women (56.7%) with a median age of 47.0 (95% CI, 46.0-48.0) years. Most patients were White (2221 [76.8%]). The median Charlson Comorbidity Index was 1 (95% CI, 1-1) and the median length of stay was 6 (95% CI, 6-7) days. Notably, the in-person training intervention was found to significantly increase inpatient portal use (incidence rate ratio, 1.34 [95% CI, 1.25-1.44]) compared with the video tutorial. Patients who received in-person training had significantly higher odds of being comprehensive portal users than those who received the video tutorial (odds ratio, 20.75 [95% CI, 16.49-26.10]). Among patients who received the full-tech intervention, those who also received the in-person intervention used the portal more frequently (incidence rate ratio, 1.36 [95% CI, 1.25-1.48]) and more comprehensively (odds ratio, 22.52; [95% CI, 17.13-29.62]) than those who received the video tutorial. Patients who received in-person training had higher odds (OR, 2.01 [95% CI, 1.16-3.50]) of reporting being satisfied in the 6-month postdischarge survey. Similarly, patients who received the full-tech intervention had higher odds (OR, 2.06 [95%CI, 1.42-2.99]) of reporting being satisfied in the 6-month postdischarge survey. Conclusions and Relevance: Providing in-person training or robust portal functionality increased inpatient engagement with the portal during the hospital stay. The effects of the training intervention suggest that providing personalized training to support use of this health information technology can be a powerful approach to increase patient engagement via portals. Trial Registration: ClinicalTrials.gov Identifier: NCT02943109.

Feasibility of developing children's Pill School within a UK hospital.

OBJECTIVE: We assessed the feasibility of introducing an intervention (children's Pill School-PS) within a UK hospital to provide swallowing training for children, identified the proportion of children who can be switched from oral liquid medicines to pills and assessed children/parents' opinions about the PS training. METHODS: 30 inpatient children (aged 3-18 years; taking oral liquid medicines; their liquid medications assessed suitable for switching to pills; can (and their parents) speak/understand English were included. Training sessions were delivered using hard sweets of different sizes. RESULTS: 87% (26) of children successfully learnt how to swallow pills after one training session (mean duration 14.5 min), and 92% (24) were discharged on pills. 75 prescribed oral liquid medications were deemed suitable for switching to pills. Of these, 89% (67) were switched successfully. CONCLUSION: Children as young as 3 years were successful in swallowing pills after training. Providing children PS training session within hospital is feasible and acceptable to children and their parents.

Changes in endothelial function during educational hospitalization and the contributor to improvement of endothelial function in type 2 diabetes mellitus.

Only a few reports have examined vascular endothelial function before and after educational hospitalization and the factors that affect it in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to assess vascular endothelial function before and after educational hospitalization and identify factors that affect it. In 65 patients with T2DM who underwent peripheral arterial tonometry (EndoPAT) before and after hospitalization, vascular endothelial function (reactive hyperemia index [RHI]), glucose metabolism, lipid metabolism, and blood pressure were assessed before and after hospitalization. The primary endpoint was hospitalization-induced changes in vascular endothelial function. Educational hospitalization significantly improved the natural logarithmically scaled RHI (L_RHI) from 0.555 ± 0.212 to 0.625 ± 0.245 (p = 0.012). Multivariable logistic regression analysis identified hypoglycemia during hospitalization as the single factor that significantly altered vascular endothelial function (p = 0.019). The odds of achieving normal vascular endothelial function were 0.08 times lower (95% confidence interval, 0.01-0.67) for each episode of hypoglycemia. Furthermore, multivariable analysis identified hypoglycemia during hospitalization as the single factor that worsened L_RHI. Our study showed that educational hospitalization of patients with T2DM improved vascular endothelial function, and that the development of hypoglycemic episodes had a significant negative impact on normalization of vascular endothelial function.

Effectiveness of Virtual vs In-Person Inhaler Education for Hospitalized Patients With Obstructive Lung Disease: A Randomized Clinical Trial.

Importance: Many patients who are hospitalized cannot use inhalers correctly, yet education for their use is often not provided. To address the need for an effective intervention feasible for wide-scale implementation, a virtual teach-to-goal intervention was developed to provide tailored patient-directed education using adaptive learning technology. Objective: To assess whether the virtual teach-to-goal intervention is noninferior to an in-person teach-to-goal intervention for improving inhaler technique. Design, Setting, and Participants: An equivalence and noninferiority randomized clinical trial took place from January 13, 2016, through September 20, 2017, with analyses conducted between October 25, 2017, and September 23, 2019. Adult inpatients with asthma or chronic obstructive pulmonary disease (COPD) admitted to general inpatient wards were eligible. Enrolled participants were randomized to virtual (n = 61) or in-person (n = 60) educational interventions. Investigators and research assistants were masked to interventions. Initial enrollment, study assessments, and delivery of the educational intervention occurred in the hospital; participants returned at 30 days for a follow-up research visit. Interventions: Virtual education was a module delivered via handheld tablet with self-assessment questions before demonstration, narrated video demonstration of the correct technique, and self-assessment questions after demonstration; up to 3 rounds were repeated as needed. In-person education participants received iterative rounds of inhaler technique assessment and education by trained staff. Main Outcomes and Measures: Noninferiority testing of whether virtual vs in-person education achieved an equal percentage with correct inhaler technique after education (>9 of 12 steps correct) against an a priori noninferiority limit of -10%; logistic regression models were used to adjust for differences in baseline technique and health literacy. Results: Among 118 participants (59 in each group), most were black (114 [97%]) and female (76 [64%]), with a mean (SD) age of 54.5 (13.0) years. Correct technique increased similarly before vs after education in virtual (67%; range, 2%-69%) and in-person (66%; range, 17% to 83%) groups, although the difference after intervention exceeded the noninferiority limit (-14%; 95% CI lower bound, -26%). When adjusting for baseline inhaler technique, the difference was equivalent to the noninferiority limit (-10%; 95% CI lower bound, -22%). Conclusions and Relevance: The findings suggest that patient-directed virtual education similarly improved the percentage of participants with correct technique compared with in-person education. Future work should confirm whether virtual teach-to-goal education is noninferior to in-person education and whether it is associated with long-term skills retention, medication adherence, and improved health outcomes. Trial Registration: ClinicalTrials.gov identifier: NCT02611531.

Diabetes Education for Behavioral Health Inpatients: Challenges and Opportunities.

OBJECTIVE: To adapt a diabetes survival skills education (DSSE) program for delivery on inpatient behavioral health units (BHUs) and to evaluate implementation feasibility within nursing unit workflow. METHODS: We employed mixed methods to codesign, implement, and evaluate a DSSE program for inpatient BHUs. The Diabetes to Go core program incorporates linking knowledge deficits to video education content, a companion book on diabetes survival skills, and education for nurses on delivery processes and teaching content. The Diabetes to Go adaptation for BHUs was codesigned in partnership with BHU staff and patients. Implementation evaluation included patient surveys and nursing staff feedback obtained during field observations. RESULTS: A total of 89 patients participated in nine group education sessions among whom 17 (20%) had diabetes. Nursing unit staff and patients expressed willingness to engage in program design. Barriers to implementation were encountered in both groups including lack of standardization of education content by nurse facilitators and difficulty engaging patients for the time required for completion of surveys plus group education. Preferred education media for both nurses and patients was a book. Diabetes knowledge deficits were identified among over two thirds of participants with diabetes. CONCLUSIONS: Group class may not be the optimal delivery model for specialized DSSE on BHUs. It remains to be determined if individual diabetes education alone or a model which combines individual and group sessions is preferable. Translation of standardized approaches for diabetes education on inpatient BHUs will require further redesign to meet the unique needs of this population.

Managing Palliative Patients in Inpatient Rehabilitation Through a Short Stay Family Training Program.

STUDY DESIGN: Retrospective Analysis of a Quality Improvement Program. PURPOSE: To describe the development, implementation, and outcomes of an inpatient rehabilitation-based Short Stay Family Training (SSFT) program for patients with life-limiting conditions. BACKGROUND: Patients with terminal illnesses often have functional limitations that prohibit discharge home after hospitalization, but their condition limits their ability to participate in rehabilitation in an inpatient setting. METHODS AND MEASURES: After a needs assessment, an interdisciplinary team developed an SSFT program to empower patients, caregivers, and family members by giving them the tools to be independent in caring for a patient with a life-limiting condition. Patients qualifying for the program were tracked in terms of acute care physical therapy and occupational therapy discharge recommendations, diagnosis, inpatient rehabilitation unit length of stay (LoS), caregiver involvement, and discharge location. Data were retrospectively analyzed from patients over the first 16 months. RESULTS: Since program implementation, 30 patients and their family members participated in the program. Overall, these patients experienced decreased LoS, increased discharge to home, and increased palliative care involvement in the plan of care. CONCLUSION: Short Stay Family Training is a viable alternative to traditional inpatient rehabilitation to allow patients with life-limiting conditions to discharge home safely with caregiver support.

Factors affecting adherence to rehabilitation in Iranian stroke patients: A qualitative study.

Adherence to rehabilitation has significant effects on patient outcomes. This study aimed to explore factors affecting adherence to rehabilitation in Iranian stroke patients. This is a descriptive, qualitative study. This study was conducted in 2018. Participants were stroke patients, family members, and rehabilitation team members-20 in total. They were purposively recruited from Rofaideh inpatient rehabilitation center in Tehran, and the outpatient physiotherapy center of Poursina hospital in Rasht. Data collection was performed through semistructured interviews and was continued up to data saturation. Data were analyzed by content analysis technique. Factors affecting adherence to rehabilitation in stroke patients were categorized into four main categories, namely patients-related, rehabilitation team, rehabilitation systems, and insurance and social support systems factors. Health care providers can promote patients' adherence to rehabilitation, involvement in the process of treatment, and their quality of life through broadening patients' knowledge about rehabilitation effectiveness, strengthening communication with health care providers, and adequate insurance and social support.

Quasi-Randomized Trial of Effects of Perioperative Oral Hygiene Instruction on Inpatients with Heart Diseases Using a Behavioral Six-Step Method.

The assessor-blinded, parallel-design, quasi-randomized study (alternating allocation) aimed to determine the effects of the six-step method on postoperative numbers of oral bacteria, periodontal status, and atrial fibrillation (AF) among inpatients with heart diseases and periodontitis. Seventy inpatients who received preoperative periodontal treatment were quasi-randomly assigned to intervention and control groups at University Hospital. The intervention group received intensive oral hygiene instruction using a six-step method for 15 minutes per week and the control group received routine oral hygiene instruction. Significantly fewer oral bacteria were identified on the tongue at discharge compared with baseline in the intervention than the control group (ANCOVA) (large effect size, p = 0.02). Changes in scores for self-efficacy, plaque scores, probed pocket depth, and bleeding on probing between baseline and discharge were significantly greater in the intervention, than in the control group (p < 0.05). The period of postoperative AF (days) was significantly shorter in the intervention, than in the control group (p = 0.019). In conclusion, oral hygiene instruction using the six-step method decreased the numbers of oral bacteria on the tongue and improved self-efficacy, oral health behaviors, oral hygiene status, periodontal status, and period of postoperative AF among inpatients with periodontitis and heart diseases.

Randomized clinical trial evaluating the effect of a visual educational leaflet on the preparation of colonoscopies in hospitalized patients.

BACKGROUND: the safety and diagnostic accuracy of colonoscopies depends on the quality of colon cleansing. Several factors have been reported that affect the quality of bowel cleansing, hospitalization being one of them. AIMS: the aim of the study was to investigate whether a visual educational leaflet improved the level of cleanliness achieved in hospitalized patients undergoing a colonoscopy and to identify predictors of a poor bowel preparation. METHODS: a prospective, single-center, endoscopist-blinded, randomized controlled trial was performed. The intervention group was given a visual educational leaflet and both groups received four liters of polyethylene glycol solution. Demographic data, personal history, reason for admission and indication for colonoscopy, work shift during which the procedure was performed and endoscopy findings were collected. The Boston Bowel Preparation Scale (BBPS) was used to assess the bowel preparation. RESULTS: one hundred and thirty-six patients were included in the study; 51.5% were male, with a mean age of 64.3 ± 17.6 years. The educational leaflet did not result in a difference in the total BBPS obtained between the standard group and the intervention group (7 [6-9] vs 6 [5.7-9]; p = 0.17). According to the multivariable analysis, the only factors associated with a poor bowel cleansing were heart disease (OR 3.37 [1.34-8.46]; p = 0.010) and colorectal cancer (OR 3.82 [1.26-11.61]; p = 0.018). CONCLUSION: the use of a visual educational leaflet for the preparation of colonoscopies did not provide a significant improvement in hospitalized patients in our health area. Heart disease was identified as the only predictor of poor preparation for colonoscopy.

Physiotherapist advice to older inpatients about the importance of staying physically active during hospitalisation reduces sedentary time, increases daily steps and preserves mobility: a randomised trial.

QUESTIONS: Does advice from a physiotherapist about the importance of staying physically active during hospitalisation improve activity, mobility, strength, length of stay, and complications in older inpatients? What barriers to physical activity during hospitalisation do older inpatients perceive? DESIGN: Randomised controlled trial with concealed allocation, intention-to-treat analysis, and blinded assessment. PARTICIPANTS: Sixty-eight people who were aged > 60 years and admitted to a university hospital ward. INTERVENTION: In addition to usual hospital care, the experimental group received a booklet with content about the deleterious effects of hospitalisation and the importance of staying active during hospitalisation. The control group received usual hospital care only. OUTCOME MEASURES: The amount of physical activity was measured via accelerometry during the hospital admission. Mobility was assessed using the de Morton Mobility Index (DEMMI), and muscle strength was assessed using a handgrip dynamometer. Length of stay and complications were extracted from hospital records. The barriers to staying active during hospitalisation were investigated via a questionnaire. RESULTS: Accelerometry showed a mean between-group difference of 974 steps/day (95% CI 28 to 1919) in favour of the experimental group. The intervention also increased moderate-intensity physical activity and reduced sedentary time, although these effects might be trivially small. Experimental group participants were about one-fifth as likely to lose mobility during their hospital admission (two of 33) than control group participants (10 of 35), relative risk 0.21 (95% CI 0.05 to 0.90). Effects of the intervention were unclear regarding muscle strength, length of stay and incidence of complications between the groups. Patients reported that the main barriers to remaining active during hospitalisation were dyspnoea, lack of space, and fear of contracting infection. CONCLUSION: In older inpatients, the addition of advice from a physiotherapist about maintaining activity during hospitalisation increases the level of physical activity and prevents loss of mobility. REGISTRATION: ClinicalTrials.govNCT03297567.

Preparing Chinese patients with comorbid heart disease and diabetes for home management: a mixed methods study.

OBJECTIVE: To explore how health education received by patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) influences patients' self-efficacy and self-management and changes in behaviour at, and following, hospital discharge. DESIGN: This study used a convergent mixed methods design. PARTICIPANTS: Twenty-one participants with completed surveys and interviews at discharge and home follow-up were included in the analysis. SETTING: At a coronary care unit of a major hospital in Shanghai, China. RESULTS: Most participants (n=17) did not perceive they had sufficient education or ability to manage both conditions. More concerning was that most participants (n=16) reported low self-efficacy in the management of ACS symptoms. Three major themes were identified: self-management of ACS and T2DM represents a complex interplay between individual self-efficacy, knowledge and skills, as individuals navigate shifting self-management priorities due to perceived condition severity; the social environment is integral to lifestyle and behaviour change and managing multiple health conditions requires body and mind systems' harmony. CONCLUSIONS: The inpatient education received did not enhance participants' confidence to manage either condition on discharge. While an unhealthy lifestyle was embedded within social roles and norms, some social activities, such as square dancing, positively influenced health behaviour. Culturally appropriate education for Chinese people with diabetes and ACS should contain information on maintaining mind and body harmony. Family members should be involved in formal education.

Educating hospital patients to prevent falls: protocol for a scoping review.

INTRODUCTION: Falls prevention in hospitals is an ongoing challenge worldwide. Despite a wide variety of recommended falls mitigation strategies, few have strong evidence for effectiveness in reducing falls and accompanying injuries. Patient education programmes that promote engagement and enable people to understand their heightened falls risk while hospitalised are one approach. The aim of this scoping review is to examine the content, design and outcomes of patient education approaches to hospital falls prevention. As well as critiquing the role of patient education in hospital falls prevention, strategies that can be used in clinical practice shall be recommended. METHODS AND ANALYSIS: The analysis will apply the methodological framework developed by Arksey and O'Malley and refined by the Joanna Briggs Institute. An initial limited search of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed will be completed to identify keywords and index terms. A developed search strategy of Medical Subject Headings and text words will be conducted of PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, PsychINFO, Education Resources Information Center and grey literature databases from January 2008 to current. The reference lists of included articles will be hand searched for additional studies. Two reviewers will screen the titles and abstracts independently and analyse the full text of potential articles based on the inclusion and exclusion criteria. The data will be extracted using a structured data form. Thematic analysis and numerical synthesis of the data will be conducted, and key themes will be identified. ETHICS AND DISSEMINATION: Results of this scoping review will illuminate the designs and outcomes of patient education research for hospital falls prevention in the current literature. It is anticipated that the findings will highlight best-practice educational design to inform the development of future patient-focused education for falls prevention. Study findings will be presented at relevant conferences and public forums, and published in peer-reviewed journals. Ethics approval is not required.

Tai chi for enhanced inpatient mobilization: A feasibility study.

OBJECTIVE: To determine whether utilizing beginner, video-guided tai chi and qigong classes as an adjunct to physical therapy to enhance mobilization among hospitalized patients is feasible and acceptable. DESIGN: Single-arm feasibility study over a 15½-week period. SETTING: Three medical-surgical units at one hospital. INTERVENTIONS: Small-group video-guided beginner-level tai chi and qigong classes supervised by physical therapists occurred three times a week. MAIN OUTCOME MEASURES: The primary outcome was weekly class attendance. Secondary outcomes included patient and staff satisfaction, collected by surveys and semi-structured interviews. Process measures included class duration. Balancing measures included falls. RESULTS: One-hundred and fifty-seven patients were referred for recruitment, 45 gave informed consent, and 38 patients attended at least one class. The number of weekly class attendees increased during the study period. Based on first-class experience, 68% (26/38) of patients reported enjoying the class "quite a bit" or "extremely," 66% (25/38) of patients reported feeling "more mobile" afterward, and 76% (29/38) of patients agreed that the class made them more comfortable going home. Average class duration was 29 minutes. Zero falls occurred during or immediately following class. CONCLUSIONS: Video-guided tai chi and qigong classes are feasible and well-received at our hospital. Future studies of the impact on preserving mobility and function or reducing length of stay are of interest.

"My Family Wants Something Different": Discordance in Perceived Personal and Family Treatment Preference and Its Association With Do-Not-Resuscitate Order Placement.

PURPOSE: Patients make treatment decisions based not only on what they want, but what they think their families want. Discordance in such perceived preferences may therefore pose challenges for advance care planning. This study examines discordance in preference for life-extending care versus comfort-focused care and its association with do-not-resuscitate (DNR) order placement. METHODS: One hundred eighty-nine patients with advanced cancers refractory to at least one chemotherapy regimen were enrolled in a multisite observational study. In structured interviews, patients reported their preference for treatment maximizing either life extension or comfort; patients also indicated their perception of their families' preference. DNR placement was reported by patients and verified using medical records. RESULTS: Approximately 23% of patients (n = 43) perceived discordance between their preference and their families' preference. Patients who perceived discordance were less likely to have completed a DNR compared with those who perceived concordance, even after controlling for relevant confounds (odds ratio = .35; P = .02). Subgroups of discordance and concordance showed varying DNR placement rates (χ2, 19.95; P < .001). DNR placement rate was lowest among discordant subgroups, where there was either a personal (26.7%; four of 15) or family preference for comfort care (28.6%; eight of 28), followed by patients who perceived concordance for wanting life-extending care (34.5%; 29 of 84) and by patients who perceived concordance in wanting comfort-focused care (66.1%; 41 of 62). CONCLUSION: Many patients may perceive discordance between personal and family treatment preferences, posing impediments to advance care planning. Such patients may benefit from additional decision support.

Effects of the frequency of ostomy management reinforcement education on self-care knowledge, self-efficacy, and ability of stoma appliance change among Korean hospitalised ostomates.

Patients who undergo stoma surgery experience difficulties in adapting physically and psychologically. The priority is to support them in learning self-care for successful rehabilitation and psychosocial adaption to a new life. In order to do this, it is important to provide ostomates with repetitive reinforcement education on self-care in a continuous and individual manner, not just to increase knowledge or perform related skills. This study aims to evaluate the effects of ostomy management reinforcement education (OMRE) in ostomates and to identify the optimal frequency of reinforcement education using an equivalent control group post-test design. Participants were 60 ostomates admitted to a university hospital after ostomy formation surgery, and they were randomly assigned to a control and two experimental groups of this study. The OMRE was given to the control group (n = 20), experimental group 1 (n = 20), and experimental group 2 (n = 20) once, twice, and three times, respectively. Participants' self-care knowledge, self-efficacy, and ability of stoma appliance change were evaluated before and after the OMRE. Major results of this study were as follows: the self-care knowledge score of post-test was higher than the pretest in the control, experimental 1, and experimental two groups (P < 0.001). The self-efficacy score of post-test was higher than the pretest in the control, experimental 1, and experimental 2 groups (P < 0.001). The self-care knowledge score according to the frequency of OMRE did not differ among the control, experimental 1, and experimental 2 groups (F = 1.921, P = 0.156). The self-efficacy score according to the frequency of OMRE was significantly different between the control and experimental groups (F = 8.616, P = 0.001), but there was no difference between the experimental 1 and experimental 2 groups (Scheffe's post-hoc analysis: a < b, c). The ability of stoma appliance change score according to the frequency of OMRE was significantly different between the control and experimental groups (F = 49.546, P < 0.001), but there was no difference between the experimental 1 and experimental 2 groups (Scheffe's post-hoc analysis: a < b, c). Results of this study suggested that the OMRE was effective for promoting hospitalised ostomates' self-care knowledge, self-efficacy, and ability of stoma appliance change, and two sessions of the OMRE was the most effective. Findings of this study may be useful in planning education programmes designed to improve self-care ability for hospitalised ostomates.

Improving the Pain Experience for Hospitalized Patients With Cancer.

PURPOSE: To determine the effect of an evidence-based Pain Stoppers bundled intervention on pain management satisfaction scores and actual pain intensity scores of hospitalized patients with cancer, as well as nurses' knowledge and attitudes on pain. PARTICIPANTS & SETTING: Participants and nurses took part in a preintervention group (n = 173 and 11, respectively) and a postintervention group (n = 157 and 9, respectively) at a National Cancer Institute-designated comprehensive cancer center. METHODOLOGIC APPROACH: A pre- and postintervention design was used. Evidence-based strategies included staff education, improved staff communication, adoption of caring behaviors and timely responses, improved patient education, and efforts to maintain patients' analgesic levels. FINDINGS: Patient satisfaction with staff improved from preintervention to postintervention. No statistically significant differences were noted in actual pain intensity scores between the groups; however, fewer patients in the postintervention group received chemotherapy within 30 days, and more were admitted for symptom management versus chemotherapy administration. In addition, no difference was noted between RN group scores, although there was statistically significant improvement on individual questions in the postintervention group. IMPLICATIONS FOR NURSING: Implementation of a Pain Stoppers bundled intervention may be effective in improving the pain experience for hospitalized patients with solid tumor cancers.

Inpatient and outpatient treatment for acute malnutrition in infants under 6 months; a qualitative study from Senegal.

BACKGROUND: Treatment of acute malnutrition in infants under 6 months is a relevant topic regarding the global problem of maternal and child malnutrition. While treatment for older age groups has shifted more towards an outpatient, community based approach, young infants are mostly treated in hospital. This study aims to describe barriers and facilitators for outpatient and inpatient treatment of malnourished infants under 6 months in Senegal. METHODS: This qualitative descriptive study uses in-depth interviews with health workers and focus group discussions with mothers of malnourished infants, conducted from June to September 2015 in two case clinics. In data analysis, Collins' 3 key factors for a successful nutrition program were used as a theoretical framework: access, quality of care and community engagement. RESULTS: Within Collins' 3 key factors, 9 facilitators and barriers have emerged from the data. Key factor access: Outpatient care was perceived as more accessible than inpatient concerning distance and cost, given that there is a milk supplement available. Trust could be more easily generated in an outpatient setting. Key factor quality of care: The cup and spoon re-lactation technique was efficiently used in outpatient setting, but needed close supervision. Basic medical care could be offered to outpatients provided that referral of complicated cases was adequate. Health education was more intensive with inpatients, but could be done with outpatients. Key factor community engagement: The community appeared to play a key role in treating malnourished young infants because of its influence on health seeking behaviour, peer support and breastfeeding practices. CONCLUSIONS: Outpatient care does facilitate access, provided that an affordable milk supplement is available. Quality of care can be guaranteed using an appropriate re-lactation technique and a referral system for complications. The community has the potential to be much engaged, though more attention is required for breastfeeding education. In view of the magnitude of the health problem of young infant malnutrition and its strong relationship with breastfeeding practices, an outpatient community-based treatment approach needs to be considered.

Development and evaluation of a pilot overdose education and naloxone distribution program for hospitalized general medical patients.

Background: Overdose education and naloxone distribution (OEND) to people at risk of witnessing or experiencing an opioid overdose has traditionally been provided through harm reduction agencies. Expanding OEND to inpatient general medical settings may reach at-risk individuals who do not access harm reduction services and have not been trained. An OEND program targeting inpatients was developed, piloted, and evaluated on 2 general medicine floors at Montefiore Medical Center, a large urban academic medical center in Bronx, New York. Methods: The planning committee consisted of 10 resident physicians and 2 faculty mentors. A consult service model was piloted, whereby the primary inpatient care team paged the consult team (consisting of rotating members from the planning committee) for any newly admitted patient who had used any opioid in the year prior to admission. Consult team members assessed patients for eligibility and provided OEND to eligible patients through a short video training. Upon completion, patients received a take-home naloxone kit. To evaluate the program, a retrospective chart review over the first year (April 2016 to March 2017) of the pilot was conducted. Results: Overall, consults on 80 patients were received. Of these, 74 were eligible and the consult team successfully trained 50 (68%). Current opioid analgesic use of ≥50 morphine milligram equivalents daily was the most common eligibility criterion met (38%). Twenty-four percent of patients were admitted for an opioid-related adverse event, the most common being opioid overdose (9%), then opioid withdrawal (8%), skin complication related to injecting (5%), and opioid intoxication (2%). Twenty-five percent had experienced an overdose, 35% had witnessed an overdose in their lifetime, and 83% had never received OEND previously. Conclusions: Integrating OEND into general inpatient medical care is possible and can reach high-risk patients who have not received OEND previously. Future research should identify the optimal way of implementing this service.