Assent Described: Exploring Perspectives From the Inside

Purpose- The purpose of this study was to describe the informed consent and assent experience for oncology research from the perspective of the participants: adolescents, their parents, and their physician providers. Design & Methods- This descriptive mixed-methods study included the pilot use of the Quality of Informed Consent Questionnaire (QuIC) with an adolescent population and semi-structured interviews with adolescents, their parents, and their physician providers within 48-72 hours of the informed consent and assent discussion for a pediatric oncology clinical trial and again 6-9 weeks later. Results: Adolescents and their parents scored considerably lower on part A of the QuIC than part B indicating a lower level of objective understanding of key elements of informed consent and assent. Qualitative interviews highlight participants\u27 self-reported poor memory or recollection of key details of the informed consent and assent discussion paralleling the QuIC findings for objective understanding. Conclusion- Findings from this pilot descriptive study suggest that adolescents and their parents feel more informed than they actually are. This dichotomy of experience seems to have been mitigated by a strong sense of trust in and connection with their physician provider. Practice Implications- Further exploration of adolescent and parent viewpoints regarding what they value as important in the content of the informed consent and assent and how that content is delivered is warranted. Additionally, understanding the origin of participants\u27 misunderstanding of the key elements of consent and assent may illuminate areas for future intervention-based research focused on improving the overall quality of informed consent and assent discussions

Innovative Collaborative Service-Learning Experience Among Dental Hygiene and Nurse Practitioner Students: A Pediatric Oral Health Pilot Study

Purpose: Preventive oral health behaviors are essential for children during early stages of development. The purpose of this study was to pilot an innovative, collaborative service-learning (ICSL) experience for dental hygiene (DH) and primary care nurse practitioner (NP) students to address pediatric oral health. Methods: A convenience sample of DH and NP students (n=12) participated in the development, planning and delivery of an ICSL activity focusing on pediatric oral health to 44 pre-school aged children. A learning management system was used for the communicating, planning and evaluating the ICSL activity. The interprofessional socialization of the participants was measured using the Interprofessional Socialization and Valuing Scale (ISVS-9A/9/B) survey prior to and following the ICSL experience. Descriptive statistics were used to analyze the data. Results: Twelve students agreed to participate in the ICSL experience (DH= 9 and NP=3) and completed the pre and post ISVS-9A/9B surveys. There was a positive change in interprofessional socialization scales (0.42) after the ICSL experience (p=0.066) for all participants. Marginal statistically significant differences were identified among the DH participants (p=0.058) in their pre and post interprofessional socialization scores. Conclusion: Within the limitations of this pilot study, the ICSL experience had a positive impact on NP and DH students\u27 socialization to interprofessional collaboration. This low resource, service-learning educational project has potential for easy integration within dental hygiene and advanced practice nursing curricula

Telehealth and eHealth in Nurse Practitioner Training: Current Perspectives

Telehealth is becoming a vital process for providing access to cost-effective quality care to patients at a distance. As such, it is important for nurse practitioners, often the primary providers for rural and disadvantaged populations, to develop the knowledge, skills, and attitudes needed to utilize telehealth technologies in practice. In reviewing the literature, very little information was found on programs that addressed nurse practitioner training in telehealth. This article provides an overview of both the topics and the techniques that have been utilized for training nurse practitioners and nurse practitioner students in the delivery of care utilizing telehealth. Specifically, this article focuses on topics including 1) defining telehealth, 2) telehealth etiquette, 3) interprofessional collaboration, 4) regulations, 5) reimbursement, 6) security/Health Insurance Portability and Accountability Act (HIPAA), 7) ethical practice in telehealth, and 8) satisfaction of patients and providers. A multimodal approach based on a review of the literature is presented for providing the training: 1) didactics, 2) simulations including standardized patient encounters, 3) practice immersions, and 4) telehealth projects. Studies found that training using the multimodal approach allowed the students to develop comfort, knowledge, and skills needed to embrace the utilization of telehealth in health care

Nursing, Physical Therapy, and Cytotechnology Graduate and Undergraduate Students\u27 Attitudes Toward Teamwork Before and After Participation in an Interprofessional Education Experience

BACKGROUND Educating health professional (HP) students in environments wherein they can learn about, from, and with each other can prepare them for interprofessional collaborative practice (IPCP), which may positively impact patient safety and satisfaction (Brashers et al., 2015; Health Professions Accreditors Collaborative [HPAC], 2019). IPCP is characterized by effective communication, shared values, respect for diverse disciplines and teamwork among health professionals (IOM, 2015). However, professional silos in practice can foster competition rather than collaboration. Knowledge of HP roles and responsibilities is a primary tenet of IPCP (Interprofessional Educational Collaborative [IPEC], 2011). PURPOSE An interprofessional education (IPE) approach that combined book reading, a presentation by the author of the book, and small group discussion of a case study focused on patient safety was used to introduce students to HP roles and responsibilities and to highlight the benefits of IPCP. Patient safety is an effective platform for engaging students in IPE learning and exposing them to the benefits of teamwork and interprofessional collaboration as demonstrated in this study. METHOD Block randomization was used to assign graduate and undergraduate students (N=167) to interprofessional groups for the IPE learning, including case discussions. There were 20 groups of 8 students and one group with the remaining 7 students. The group compositions were reviewed and it was verified prior to data collection that each group had interprofessional representation of students based on their programs of study. Most students in our sample had two or more prior IPE experiences. Pre- and post-participation attitudes about teamwork were assessed using the Teamwork, Roles, and Responsibilities (TRR) subscale of the Interprofessional Attitudes Scale (IPAS). RESULTS There were significant changes in student attitudes toward teamwork (p \u3c .05) and significant differences in scores based on discipline, prior IPE learning and level (graduate or undergraduate) with moderate to large effect sizes. CONCLUSION This study demonstrates how IPE can be implemented through co-curricular learning to build upon prior IPE learning to improve both graduate and undergraduate students’ attitudes toward teamwork

How to Prepare Interprofessional Teams in Two Weeks: An Innovative Education Program Nested in Telehealth

PROBLEM: Preparing health professional students for interprofessional collaborative practice, especially at a distance where provider shortages prevail remains difficult. APPROACH: A two-week interprofessional education (IPE) immersion experience preparing students from 11 disciplines and four universities was implemented. Week-one, using online technology, students develop/present an interprofessional careplan for a complex patient. Students then meet face-to-face to conduct group interviews with two standardized patient dyads. Week-two, students develop a website for use of the patient dyads. Websites are presented to faculty and fellow students via an online virtual meeting space. OUTCOMES: To date, 594 students have participated demonstrating capacity to: 1.effectively engage in interprofessional care,  2. utilize Telehealth to impact care and break down barriers of isolation, and 3. implement skills to advance healthcare. CONCLUSION: IPE combined with Telehealth technology provides future providers with knowledge and skills for interprofessional care regardless of geographic barriers. Next Step: Integrate more technology using mobile devices and enhance the evaluation process

Expanding Rural Opioid Addictions Treatment: An Inter-institutional, Inter-professional Telehealth Case Study Simulation

Purpose: To determine if inter-institutional collaboration, using telehealth technology, inter-professional education techniques, and case study methodology is a feasible way to teach health professions students how to appropriately address opioid addictions, especially in rural populations with limited health care access. Study subjects: Ten health professions students from four Virginia universities participated. Professions represented included medicine, nursing, physical therapy, social work, nutrition, and psychology at the graduate and undergraduate levels. Methods: Inter-professional faculty from four Virginia universities developed an opioid addiction simulation case study using a standardized patient. Students from different regions engaged in a facilitated patient interview and care planning via secure virtual meeting platform. Faculty observation and feedback, student feedback, and inter-professional education assessments were used to assess this pilot study. Findings: Inter-institutional faculty collaboration and telehealth technology was successfully employed to convene multiple health professions students from different sites; simulation case study methodology using a standardized patient was effective and compelling; students effectively utilized interprofessional competencies and skills to develop a comprehensive and holistic care plan for opioid addiction treatment. Conclusions: Telehealth technology, inter-professional education, and simulation case study methodology can be successfully used to teach health professions students how to collaborate to address the opioid crisis, especially in resource-limited rural areas. Implications: Many resources are necessary to successfully treat opioid addictions. By using telehealth technology combined with inter-professional concepts and skills, resources can be shared between institutions and professions to successfully treat patients with opioid addictions in resource-limited areas

Associations between the built environment and physical activity in public housing residents

Background: Environmental factors may influence the particularly low rates of physical activity in African American and low-income adults. This cross-sectional study investigated how measured environmental factors were related to self-reported walking and vigorous physical activity for residents of low-income public housing developments. Methods: Physical activity data from 452 adult residents residing in 12 low-income housing developments were combined with measured environmental data that examined the neighborhood (800 m radius buffer) around each housing development. Aggregated ecological and multilevel regression models were used for analysis. Results: Participants were predominately female (72.8%), African American (79.6%) and had a high school education or more (59.0%). Overall, physical activity rates were low, with only 21% of participants meeting moderate physical activity guidelines. Ecological models showed that fewer incivilities and greater street connectivity predicted 83% of the variance in days walked per week, p < 0.001, with both gender and connectivity predicting days walked per week in the multi-level analysis, p < 0.05. Greater connectivity and fewer physical activity resources predicted 90% of the variance in meeting moderate physical activity guidelines, p < 0.001, and gender and connectivity were the multi-level predictors, p < 0.05 and 0.01, respectively. Greater resource accessibility predicted 34% of the variance in days per week of vigorous physical activity in the ecological model, p < 0.05, but the multi-level analysis found no significant predictors. Conclusion: These results indicate that the physical activity of low-income residents of public housing is related to modifiable aspects of the built environment. Individuals with greater access to more physical activity resources with few incivilities, as well as, greater street connectivity, are more likely to be physically active

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This study evaluated the effectiveness of nondieting versus dieting treatments for overweight, bingeeating women. Participants (N = 219) were randomly assigned to 1 of 3 groups: diet treatment (DT), nondiet treatment (NDT), or wait-list control (WLC). DT received a balanced-deficit diet reinforced with behavioral strategies. NDT received therapy designed to help participants break out of their dieting cycles. Treatment in both conditions was administered in weekly groups for 6 months, followed by 26 biweekly maintenance meetings, for a total of 18 months of contact. At 6 months posttreatment, DT lost 0.6 kg while NDT gained 1.3 kg. Both treatment groups reduced their Binge Eating Scale scores significantly more than WLC. At 18-month follow-up, both treatment groups experienced weight gain but maintained similar reductions in binge eating. Results indicate that neither intervention was successful in producing short-or long-term weight loss. Therapist biases, which may have affected treatment integrity, and other methodological issues are discussed in relation to the small weight losses achieved. Estimates of binge eating among obese patients range from 20% to 50%, depending on the criteria used and the study population (Bruce &amp; Wilfiey, 1996; It is unclear whether or not binge-eating obese patients experience greater difficulty in treatment programs as a result of these liabilities. Obese binge eaters have been found to respond to weight loss programs similarly to nonbingers, and experience similar or lower attrition rates This research was supported by National Institute of Diabetes and Digestive and Kidney Diseases Grant DK43109 and by a Minority Scientist Development Award from the American Heart Association and its Puerto Rican Affiliate. Correspondence concerning this article should be addressed to G. Ken Goodrick, Behavioral Medicine Research Center, Baylor College of Medicine, 6535 Fannin, Mailstop F-700, Houston, Texas 77030. outcomes Several nondieting therapeutic approaches have been developed for the treatment of obesity The purpose of this prospective, randomized, controlled study was to evaluate the effectiveness of this nondieting approach in the treatment of obese, binge-eating women, compared with a standardized, behavioral dieting treatment and a control group. Method Participants The mean age of participants was 40 years (SD = 6.3, range = 25 to 50 years). Participants&apos; mean pretreatment weight was 88 kg (SD = 9.6, range = 66 to 110 kg). The mean body mass index (BMI) was 33 kg/m 2 (SD = 3.4), with a range of 26 to 43 kg/m 2. The ethnic-racial composition of the sample was 85% White, 8% Black, and 7% Hispanic. Of the total participants, 62% were married, 21% were single or divorced, and 17% were never married. Twenty-four percent of the participants had a college degree, 65% had some college, and 11% had a high school diploma or less. Sixty-nine percent were employed full time, and 9% part time. Procedure Female participants were recruited from Houston and the surrounding area using print and electronic media to publicize the study. Those 36

Weight loss in individuals with metabolic syndrome given DASH diet counseling when provided a low sodium vegetable juice: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Metabolic syndrome, a constellation of metabolic risk factors for type 2 diabetes and cardiovascular disease, is one of the fastest growing disease entities in the world. Weight loss is thought to be a key to improving all aspects of metabolic syndrome. Research studies have suggested benefits from diets rich in vegetables and fruits in helping individuals reach and achieve healthy weights.</p> <p>Objective</p> <p>To evaluate the effects of a ready to serve vegetable juice as part of a calorie-appropriate Dietary Approaches to Stop Hypertension (DASH) diet in an ethnically diverse population of people with Metabolic Syndrome on weight loss and their ability to meet vegetable intake recommendations, and on their clinical characteristics of metabolic syndrome (waist circumference, triglycerides, HDL, fasting blood glucose and blood pressure).</p> <p>A secondary goal was to examine the impact of the vegetable juice on associated parameters, including leptin, vascular adhesion markers, and markers of the oxidative defense system and of oxidative stress.</p> <p>Methods</p> <p>A prospective 12 week, 3 group (0, 8, or 16 fluid ounces of low sodium vegetable juice) parallel arm randomized controlled trial. Participants were requested to limit their calorie intake to 1600 kcals for women and 1800 kcals for men and were educated on the DASH diet. A total of 81 (22 men & 59 women) participants with Metabolic Syndrome were enrolled into the study. Dietary nutrient and vegetable intake, weight, height, leptin, metabolic syndrome clinical characteristics and related markers of endothelial and cardiovascular health were measured at baseline, 6-, and 12-weeks.</p> <p>Results</p> <p>There were significant group by time interactions when aggregating both groups consuming vegetable juice (8 or 16 fluid ounces daily). Those consuming juice lost more weight, consumed more Vitamin C, potassium, and dietary vegetables than individuals who were in the group that only received diet counseling (p < 0.05).</p> <p>Conclusion</p> <p>The incorporation of vegetable juice into the daily diet can be a simple and effective way to increase the number of daily vegetable servings. Data from this study also suggest the potential of using a low sodium vegetable juice in conjunction with a calorie restricted diet to aid in weight loss in overweight individuals with metabolic syndrome.</p