Patient-selected media and knowledge of risk to kidneys of nonsteroidal anti-inflammatory drugs.

OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause community-acquired acute kidney injury, especially in high-risk populations. Both the U.S. Food and Drug Administration (FDA) medication guide and over-the-counter labeling vaguely describe kidney risks of NSAIDs and do not provide information for patients to evaluate their risk for kidney problems. The purpose of this study was to use a mobile application to evaluate the impact of patient choice of media delivering NSAID avoidance education on patient knowledge about kidney risks associated with NSAIDs. DESIGN: Prospective cohort study. The mobile application was used to deliver either a redesigned FDA medication guide or a video focused on NSAID risks (selected by the patient), followed by patient knowledge questions (PKQs) and a kidney risk assessment. SETTING AND PARTICIPANTS: One hundred fifty adult primary care patients in southeast Michigan. MAIN OUTCOME MEASURES: The primary outcome was the score on 5 NSAID PKQs between the media selected. Secondary outcomes included characterization of media choice among different demographic and NSAID kidney risk groups. The relationship between kidney risk assessment and self-reported NSAID avoidance behavior also was evaluated. RESULTS: The majority of participants (72.7%) chose to review print material. Those that chose print had significantly higher PKQ scores (5 total points) compared with participants who selected the video: mean scores 4.2 ± 0.9 with print and 3.8 ± 1.0 with video (P = 0.034). Older patients (>65 years) had significantly lower PKQ scores compared with other age groups. Forty-four percent of individuals (n = 66) reported current NSAID use, and 65% stated that they would avoid NSAIDs after the selected education material. CONCLUSION: Scores for questions related to NSAID kidney risk knowledge were higher among participants who chose print compared with video education material. Education regarding NSAID kidney risks encouraged patients to limit their use. Targeted education may be beneficial in high-risk (e.g., older) patients and should be further studied.

Professional Skill Builder: Mastering Cardiac Auscultation in Under 4 Hours.

INTRODUCTION: Cardiac auscultation is an important clinical skill used by health care professionals during bedside patient evaluation and management. To support development of this skill in health sciences students, we created a self-paced, interactive program. This program helps develop foundational skills and knowledge so learners can confidently perform basic cardiac auscultation at the bedside. METHODS: For novice learners, this program should be used in conjunction with their initial clinical experiences so they can immediately apply what they have learned in the short course. Advanced learners and health care professionals can use this program to review and improve their cardiac auscultation skills. To achieve these objectives, this multimedia program teaches the eight basic heart cadences and their clinical significance through the use of guided tutorials, a gamified e-learning activity, interactive clinical cases, and a self-assessment. A heart sound and murmur library is also included for comparative listening at the bedside. RESULTS: Course evaluations from the first- and second-year Clinical Foundations of Medicine courses at the University of Michigan Medical School demonstrate the value of the various sections of the program. Additionally, the clinical cases have been shown to be effective in improving cardiac auscultation knowledge and skills among residents. DISCUSSION: All clinical cases in the program are based on authentic clinical problems and were developed by academic cardiologists and internists with expertise in this area. Various sections of this tutorial have been in use at our institution for over 20 years and have been evaluated favorably by our students.