Measuring and Improving Physician Knowledge of Safety Risks Using Traditional and Online Methods in Pharmacovigilance.

BACKGROUND: Traditional methods for assessing prescriber knowledge can take several years to deliver results. This study was undertaken to obtain insights into the potential for using existing online communities to educate prescribers on therapy-related safety risks. OBJECTIVE: The aim of this study was to describe approaches to measuring prescribers' knowledge of safety risk (osteonecrosis of the jaw) outlined in the European Medicine Agency's summary of product characteristics for denosumab (XGEVA®). METHODS: Short multiple-choice online instruments were administered as (1) a two-round cross-sectional survey fielded in January 2013-May 2015 (traditional, nine European countries, study duration: 3 years), (2) a survey targeting the online Medscape community (seven European countries, study duration: 3 weeks), and (3) a continuing medical education module with pre-/post-assessment in an online Medscape community (Medscape Education, USA). All respondents were oncologists; treated five or more patients with bone metastases from solid tumours in the previous 3 months; and prescribed denosumab within the previous 12 months. Medscape (a WebMD company, New York, NY, USA) is the leading online medical information resource, serving approximately 3 million physicians worldwide and 400,000 within Europe. RESULTS: In the traditional 29-month study, 420 (n = 210 per round; 14% of screened physicians) individuals participated. Knowledge levels exceeded 75% correct on five questions (incidence of osteonecrosis of the jaw, concomitant risk factors and prevention of osteonecrosis of the jaw during denosumab treatment, importance of ensuring oral hygiene, and care for patients who have or develop osteonecrosis of the jaw) with less awareness of optimal osteonecrosis of the jaw treatment. The Medscape survey (n = 207; 32.1% of 645 eligible) provided similar results in a 3-week post-survey launch. The Medscape Education study (n = 264) documented knowledge acquisition. CONCLUSIONS: Assessments that target physicians through online platforms where they seek information about drug-related safety risks may result in increased efficiencies, informing regulators about prescribers' knowledge of safe use within weeks rather than years. Online communities or professional societies may provide venues in which to implement knowledge-acquisition surveys tied to training/education modules that address safety topics.

Discharging patients from acute care hospitals.

Planning for patient discharge is an essential element of any admission to an acute setting, but may often be left until the patient is almost ready to leave hospital. This article emphasises why discharge planning is important and lists the essential principles that should be addressed to ensure that patients leave at an optimum time, feeling confident and safe to do so. Early assessment, early planning and co-ordination of all the teams involved in the patient's care are essential. Effective communication between the various teams and with the patient and their family or carer(s) is necessary. Patients should leave hospital with all the information, medications and equipment they require. Appropriate plans should have been developed and communicated to the receiving community or non-acute team. When patient discharge is effective, complications as a result of extended lengths of hospital stay are prevented, hospital beds are used efficiently and readmissions are reduced.

The effect of heart failure nurse consultations on heart failure patients' illness beliefs, mood and quality of life over a six-month period.

AIMS AND OBJECTIVES: To explore the effect contact with a heart failure nurse can have on patients' illness beliefs, mood and quality of life. BACKGROUND: There is growing interest in patients' illness beliefs and the part they play in a patients understanding of chronic disease. DESIGN: Secondary analysis on two independent datasets. Patients were recruited from five UK hospitals, four in London and one in Sussex. Patients were recruited from an inpatient and outpatient setting. The first dataset recruited 174 patients with newly diagnosed heart failure, whilst the second dataset recruited 88 patients with an existing diagnosis of heart failure. METHODS: Patients completed the Minnesota Living with Heart Failure Questionnaire, Hospital Anxiety and Depression Scale, Illness Perception Questionnaire and the Treatment Representations Inventory at baseline and six months. We used a linear regression model to assess the association that contact with a heart failure nurse had on mood, illness beliefs and quality of life over a six-month period. RESULTS: Patients who had contact with a heart failure nurse were more satisfied with their treatment and more likely to believe that their heart failure was treatable. Contact with a heart failure nurse did not make a statistically significant difference to mood or quality of life. CONCLUSIONS: This study has shown that contact with a heart failure nurse can improve patient satisfaction with treatment decisions but has less influence on a patient's beliefs about their personal control, treatment control and treatment concerns. With appropriate support, skills and training, heart failure nurses could play an important role in addressing individual patient's beliefs. There is a need to further investigate this. RELEVANCE TO CLINICAL PRACTICE: Exploring patients' illness beliefs and mood could help to enhance person-centred care. Heart failure nurses would need additional training in the techniques used.

Illness perception, self-care behaviour and quality of life of heart failure patients: a longitudinal questionnaire survey.

OBJECTIVES: To examine the associations between illness perception, self-care behaviour, and quality of life in patients admitted to hospital with a primary diagnosis of heart failure (HF), and the changes in these at 2 and 6 months after discharge. DESIGN: Longitudinal questionnaire-based study. SETTING: Three London hospitals with specialist heart failure services. PARTICIPANTS: A convenience sample of 88 patients (70% male, mean age 70) admitted to hospital with a primary diagnosis of heart failure were recruited prior to discharge. Participants were over the age of 18, able to understand English, and with the cognitive ability to complete the questionnaires. Thirty-eight patients did not provide follow-up data: 21 (24%) died during the 6-month follow-up period, and 17 (19%) did not return their post-discharge questionnaires. METHODS: The Revised Illness Perception Questionnaire, the Self-Care Heart Failure Index, Hospital Anxiety and Depression scale, and the Minnesota Living with Heart Failure (MLHF) Questionnaires were completed prior to discharge from hospital, and 2 and 6 months after discharge. RESULTS: HF symptoms improved over time (MLHF score co-efficient [95%CI] -0.915 [-1.581, -0.250], P<0.001). Patients appeared to believe that many of the causes of their illness were outside their control. Although self-care maintenance (e.g. weighing daily) improved over time, this did not translate into increased involvement in self-care management (e.g. adjusting diuretic dose) or the ability to act on changes in symptoms. Self-care confidence was lower in those who reported a more negative emotional impact of their illness, but was higher in those who had high scores on illness coherence. CONCLUSIONS: Six months following hospital discharge, patients' symptom control had improved. Many continued to believe that their illness was outside their control, and although self-care maintenance improved this was not associated with greater self-care management, particularly if the patient's emotional state was negative, and their understanding of their condition was poor. Our data suggest that a more participative person-centred approach, tailoring the disease management programme to address the patient's illness beliefs and emotional state, assisting the individual to identify barriers and solutions, may help increase self-care confidence and management.

Patient and staff perspective of a nurse-led support programme for patients waiting for cardiac surgery: participant perspective of a cardiac support programme.

BACKGROUND: A nurse-led support and education programme for patients waiting for coronary artery bypass surgery was evaluated in a randomised controlled trial of 188 patients at a tertiary centre in the UK. AIM: To add a qualitative perspective to the evaluation by exploring patients' experience while taking part in the trial and staff views of the patients' experience and the intervention. METHODS: A purposive sample of 19 patients was interviewed and the transcriptions read to staff during focus groups. They discussed what they learned from the stories and their own experience of the programme. RESULTS: The patients appreciated support from the nurses but felt communication and physical assessment could be improved. The patients varied in their understanding of the programme and their degree of motivation to improve their health. The staff varied in their approach to preparing patients for surgery. External factors influencing the intervention's impact were length of time on the waiting list and the increasing contribution of local rehabilitation services. CONCLUSION: Staff need to improve communication both between themselves and with the patients. Patients appreciate physical and psychological preparation for surgery, but the waiting period is not the optimal time to address their risk factors for coronary disease.

A randomised controlled trial to evaluate a nurse-led programme of support and lifestyle management for patients awaiting cardiac surgery 'Fit for surgery: Fit for life' study.

BACKGROUND: The 'Fit For Surgery' programme was based on previous studies suggesting improvement in risk factors contributing to coronary disease while patients wait for cardiac surgery. AIM: To evaluate our nurse-led programme in a randomised controlled trial with 188 patients. METHODS: Patients listed for coronary artery bypass surgery with at least one poorly controlled risk factor were randomised to standard care or the intervention which provided lifestyle counselling and preparation for surgery at monthly intervals. Primary outcome measurements were anxiety, blood pressure, cholesterol, length of stay and body mass index. Costs of the intervention were also collected. RESULTS: For both groups blood pressure and total cholesterol improved (Blood pressure mm Hg (Control -9.11 (CI -4.89, -13.33); Intervention -13.02 (CI -8.76, -U17.29) both p<0.01); total cholesterol (Control -0.20 (CI -0.03, -0.37) p=0.02, Intervention -0.18 (CI -0.02, -0.34) p=0.03). However there were no significant differences between the groups. Cost minimization analysis showed that the total costs were less in the intervention group due to fewer admissions (total costs pounds 10,754 (3746) v pounds 13,047 (5835), CI -3743, -843; p=0.002). CONCLUSIONS: The nurse-led programme did not appear to reduce risk factors prior to coronary artery bypass surgery. However, the intervention appears to reduce overall healthcare utilization.

A pilot study using a newly devised manual in a programme of education and support for patients waiting for coronary artery bypass surgery.

BACKGROUND: Cardiac rehabilitation programmes are widely accepted as being of benefit to patients with cardiac disease. The time spent waiting for cardiac surgery can be extremely stressful but can be used to address risk factors and provide information to reduce anxiety and prepare the patient for surgery. AIMS: To pilot the usefulness of a manual for pre-operative cardiac surgical patients, and assess the feasibility and usefulness to both nurses and patients of a monthly education and support programme for patients waiting for cardiac surgery. METHODS: A pilot study of 42 patients followed up for 3 months. Research tools included patient questionnaires and telephone interviews, risk factor measurements and nurse focus groups. RESULTS: Nurses and patients evaluated the manual and overall programme favourably, although the nurses found it was very labour intensive. Changes to risk factors made during the study were small but patients valued the opportunity to raise questions which fell into the categories of medical concerns, hospital procedure and risk factors. CONCLUSION: The manual is a useful tool for patients waiting for cardiac surgery. The programme is useful and feasible but could be targeted more specifically to patients with raised risk factors.

The psychosocial impacts on families of low-incidence, complex conditions in children: the case of craniopharyngioma.

This paper reports qualitative data from a multidisciplinary, multimethod Craniopharyngioma Child and Family Impact Study conducted at the Royal Children's Hospital, Melbourne. The study aimed to assess the psychosocial impact on children and their families of a childhood craniopharyngioma, a congenital non-hereditary brain tumour that is 'benign' by histology, but often locally invasive. The condition may result in significant morbidity and mortality due to location in the brain, which tends to precipitate multisystemic abnormalities either at the time of presentation, or in conjunction with treatment. The condition has a high survival rate with approximately 90 percent of children alive ten years after diagnosis and although the diagnosis and treatment of craniopharyngioma may result in severe physical and emotional burden for the child and family, there have been few studies to date on the psychosocial impact of this multifaceted condition. Interviews incorporating a purpose-designed Craniopharyngioma Symptom and Treatment Impact Scale were held with 13 families. Impacts on both the family and the children were identified as well as information about the child's coping capacity; parents' fear, uncertainty and trust; family managing and mastery; the experience of hospital; service use and illness specific support. Implications for social work practice are discussed.