Low awareness of nonalcoholic fatty liver disease among patients at high metabolic risk.

GOALS: To assess awareness of nonalcoholic fatty liver disease (NAFLD) as a disease entity among individuals with and without metabolic risk factors in an outpatient clinical setting, and to evaluate interest in patient-centered education on NAFLD. BACKGROUND: NAFLD is the most common chronic liver disease in the United States with up to 30% of the adult population affected. Individuals with metabolic risk factors, particularly, insulin resistance, diabetes, and overweight/obesity, have a high prevalence of NAFLD estimated up to 70%, yet little is known about the understanding and perceptions of NAFLD in these high-risk patients. STUDY: A self-administered paper questionnaire was given to 368 adult patients presenting to an outpatient endocrinology clinic from February 2012 to October 2012. RESULTS: A total of 302 surveys were completed for a response rate of 82%. Overall, 18% of all respondents reported awareness of NAFLD. Even among patients with self-reported major risk factors for NAFLD (overweight/obese, insulin resistant, or both overweight/obese and insulin resistant), the rates of awareness of NAFLD were low (19%, 23%, and 24%, respectively). A majority of survey respondents expressed interest in receiving patient-centered education on NAFLD (73%). CONCLUSIONS: Among high metabolic risk individuals there is low awareness of NAFLD. The majority of those surveyed expressed interest in learning about NAFLD. These findings suggest opportunities to raise public awareness of NAFLD, particularly among patients at high metabolic risk, and to provide education to high-risk individuals with the goal of implementing early prevention strategies and optimizing care.

Reducing asthma attacks in disadvantaged school children with asthma: study protocol for a type 2 hybrid implementation-effectiveness trial (Better Asthma Control for Kids, BACK).

BACKGROUND: Asthma is a leading cause of children's hospitalizations, emergency department visits, and missed school days. Our school-based asthma intervention has reduced asthma exacerbations for children experiencing health disparities in the Denver Metropolitan Area, due partly to addressing care coordination for asthma and social determinants of health (SDOH), such as access to healthcare and medications. Limited dissemination of school-based asthma programs has occurred in other metropolitan and rural areas of Colorado. We formed and engaged community advisory boards in socioeconomically diverse regions of Colorado to develop two implementation strategy packages for delivering our school-based asthma intervention - now termed "Better Asthma Control for Kids (BACK)" - with tailoring to regional priorities, needs and resources. METHODS: In this proposed type 2 hybrid implementation-effectiveness trial, where the primary goal is equitable reach to families to reduce asthma disparities, we will compare two different packages of implementation strategies to deliver BACK across four Colorado regions. The two implementation packages to be compared are: 1) standard set of implementation strategies including Tailor and Adapt to context, Facilitation and Training termed, BACK-Standard (BACK-S); 2) BACK-S plus an enhanced implementation strategy, that incorporates network weaving with community partners and consumer engagement with school families, termed BACK-Enhanced (BACK-E). Our evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, including its Pragmatic Robust Implementation Sustainability Model (PRISM) determinants of implementation outcomes. Our central hypothesis is that our BACK-E implementation strategy will have significantly greater reach to eligible children/families than BACK-S (primary outcome) and that both BACK-E and BACK-S groups will have significantly reduced asthma exacerbation rates ("attacks") and improved asthma control as compared to usual care. DISCUSSION: We expect both the BACK-S and BACK-E strategy packages will accelerate dissemination of our BACK program across the state - the comparative impact of BACK-S vs. BACK-E on reach and other RE-AIM outcomes may inform strategy selection for scaling BACK and other effective school-based programs to address chronic illness disparities. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT06003569, registered on August 22, 2023, https://classic. CLINICALTRIALS: gov/ct2/show/NCT06003569 .

Self-care approaches to managing chronic obstructive pulmonary disease: a provincial survey.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory condition associated with considerable personal and social burden yet little is known about how patients manage their condition. PURPOSE: The purpose of this study was to identify, from the perspective of individuals living with COPD, their management approaches. METHODS: A mailed survey was conducted with individuals living in Ontario with physician confirmed COPD who experienced daily respiratory symptoms. Potential participants were identified through existing databases. Questionnaire development was based on focus groups and pilot testing. RESULTS: Completed questionnaires were received from 353 of the 452 eligible participants, representing a 78% response rate. The mean age of responders was 68 +/- 12 years (sd) with 52% male, 85% ex-smokers, 52% with moderate COPD (self-report) and 52% treated by a family physician. Common strategies used by participants included inhaled bronchodilators (100%), annual influenza vaccination (90%), aerobic types of activity (75%), regular physician visits (72%), breathing exercises (69%) and inhaled steroids (67%). Forty-four percent of participants had scores indicative of depression. Participants (68%) reported using a shared decision-making model for management decisions and were satisfied with their interactions with the health care team (physician and non-physician). CONCLUSION: Most individuals with COPD use several strategies to manage their disease. Health care professionals have an important role in ensuring that evidence-based guidelines for COPD are translated to patients.

Developing, Implementing, and Evaluating a School-Centered Asthma Program: Step-Up Asthma Program.

BACKGROUND: Asthma is a significant health problem among children: 9.3% of children in the United States suffer from asthma. Children with persistent asthma in inner cities have increased health care utilization, worse health care outcomes, increased school absences, and worse academic performance. OBJECTIVE: We sought to create and evaluate a school-centered asthma program to reduce asthma morbidity and create asthma-friendly schools. METHODS: We developed, implemented, and evaluated the Step-Up Asthma Program, a multidisciplinary school-centered asthma program. The program was designed as an outreach program with asthma counselors as a bridge between subspecialty asthma care, primary care providers, school nurses, and children with asthma. The core components of the program involve identifying children with asthma, providing evidence-based asthma education, and case management. Students' asthma knowledge, inhaler technique, and number of asthma exacerbations were evaluated over a 2-year period (2010-2012) as a pre-post study. RESULTS: A total of 252 students enrolled in the Step-Up Asthma Program over a 2-year period. Significant improvements were noted in number of asthma action plans, rescue medications at school, and asthma controllers. Program participants had significant improvements in asthma knowledge scores (P < .001) and inhaler technique (P < .0001). There were significant reductions in asthma exacerbations defined as oral steroid courses, urgent care visits, and missed school days (P < .05) that persisted over time. CONCLUSIONS: A guideline-based school-centered asthma program can significantly reduce asthma morbidity. The asthma counselor is the cornerstone of the program, providing asthma education and care coordination. The Step-Up Asthma Program is in its 10th year, and we believe the key elements of this program can be implemented in other school systems.

Bringing it home: expanding the local reach of dissemination and implementation training via a university-based workshop.

BACKGROUND: Currently, national training programs do not have the capacity to meet the growing demand for dissemination and implementation (D&I) workforce education and development. The Colorado Research in Implementation Science Program (CRISP) developed and delivered an introductory D&I workshop adapted from national programs to extend training reach and foster a local learning community for D&I. METHODS: To gauge interest and assess learning needs, a pre-registration survey was administered. Based on feedback, a 1.5-day workshop was designed. Day 1 introduced D&I frameworks, strategies, and evaluation principles. Local and national D&I experts provided ignite-style talks on key lessons followed by panel discussion. Breakout sessions discussed community engagement and applying for D&I grants. A workbook was developed to enhance the training and provided exercises for application to an individual's projects. Day 2 offered expert-led mentoring sessions with selected participants who desired advanced instruction. Two follow-up surveys (immediate post-workshop, 6 months) assessed knowledge gained from participation and utilization of workshop content. RESULTS: Ninety-three workshop registrants completed an assessment survey to inform workshop objectives and curriculum design; 43 % were new and 54 % reported a basic understanding of the D&I field. Pre-registrants intended to use the training to "apply for a D&I grant" (73 %); "incorporate D&I into existing projects" (76 %), and for quality improvement (51 %). Sixty-eight individuals attended Day 1; 11 also attended Day 2 mentoring sessions. In the 1-week post-workshop survey (n = 34), 100 % strongly agreed they were satisfied with the training; 97 % strongly agreed the workshop workbook was a valuable resource. All Day 2 participants strongly agreed that working closely with faculty and experts increased their overall confidence. In the 6-month follow-up evaluation (n = 23), evidence of new D&I-related manuscripts and grant proposals was found. Training materials were published online ( www.ucdenver.edu/implementation/workshops ) and disseminated via the National Institutes of Health (NIH) Clinical and Translational Science Awards Consortium. To sustain reach, CRISP adapted the materials into an interactive e-book ( www.CRISPebooks.org ) and launched a new graduate course. CONCLUSIONS: Local D&I training workshops can extend the reach of national training programs.

Advances in development and evaluation of asthma education programs.

PURPOSE OF REVIEW: Effective asthma education requires more than merely providing information on asthma. Behavior change and learning principles must be incorporated into educational programs. However, there remains much debate and research about the most effective strategies to educate people to deal effectively with their asthma. This article focuses on recent advances in theoretical and practical strategies and examines core elements of successful asthma education programs. RECENT FINDINGS: Asthma education has improved in recent years as a result of application of evidence-based, theoretical principles that guide learning and behavior modification. Many studies show a refreshing focus on how to teach and have made substantial contributions to testing educational theories and making meaningful improvements to those with asthma. Successful asthma education programs include behavior change strategies, shared care practices and communication skills, a clear educational process, tailoring to client needs and influencing factors, multiple teaching formats, and a continuum of care. SUMMARY: An array of effective and innovative asthma education programs have been developed and tested. However, numerous areas in asthma education require improvement and further research, such as real-world models, sensitivities to underserved populations or venues, innovative partnerships, continuum of care, and patient incentive/participation.

Biological markers in diagnosing, monitoring, and treating asthma: a focus on noninvasive measurements.

Asthma is a major concern for society, healthcare professionals, and individuals and families directly affected by asthma due to rising morbidity rates and costs associated with the disease. The pathological hallmark of asthma is airway inflammation that is considered to be a major cause of exacerbations and persistent structural alterations of the airways. Assessing airway inflammation is important for investigating the underlying mechanisms of the disease and possibly for following the progression and resolution of the disease. The presence and type of airway inflammation can be difficult to detect clinically, and may result in delays in initiating appropriate therapy. The purpose of this article is to review noninvasive methods for assessing biological markers of airway inflammation and their potential role in the future for diagnosing, monitoring, and treating asthma. The article reviews the noninvasive measurements of induced sputum and exhaled nitric oxide as indicators of airway inflammation.