Impact of Continuing Education on Clinicians' Self- Reported Knowledge of Tobacco Dependence and Tobacco Control Interventions

Purpose: To assess a tobacco cessation continuing education (CE) program for Indiana dental and medical providers. Methods: A 26-item immediate post-CE survey and a 19-item 3-month follow-up survey assessed changes in participants’ self-reported knowledge of tobacco dependence and tobacco control interventions. De-identified data were analyzed using descriptive statistics, Spearman correlation coefficients, and Mantel- Haenszel chi-square tests. Results: Participants totaled 252 across 6 programs statewide. Immediate post-CE course survey response was 98.4% (N=248): dental assistants (2%), dental hygienists (83%), dentists (8.5%), and other healthcare professionals (6.45%). Participants reported less knowledge before than immediately after CE (p< .0001) and 3 months after (p<.0001). Reported knowledge at 3 months was less than after CE (p< .002). Participants reported on their intention to apply program communication strategies (99%), implement brief tobacco interventions (85%), and refer patients to local cessation resources (95%), Indiana Quitline (96%). Follow-up survey response rate was 54% (N=136). Participants reported active engagement in tobacco interventions (48%, 78), applying CE communication strategies (85%, 109), and implementing brief interventions (71%, 90). Participants reported referring few patients to local or state quitline counselors. Conclusion:Tobacco dependence CE may enhance health care practitioners’ knowledge and willingness to integrate tobacco interventions in their healthcare settings but it does not ensure a change in clinical tobacco control intervention

Assessing the Depiction of Electronic Cigarettes in YouTube Videos

poster abstractObjective: Use of electronic cigarettes is an emerging phenomenon with unknown health implications. YouTube videos of e-cigarettes are abundant, easily accessible, and possess the potential to promote e-cigarette use through the increased visibility of user-generated content and novel marketing strategies. As there are no published studies examining the content of e-cigarette videos, this study aimed to assess the depiction of e-cigarettes in terms of content and viewing qualities. Methods: Two calibrated reviewers conducted 4 searches for e-cigarette English language YouTube videos between August 2, 2013 and November 26, 2013. Based on a Google Insights analysis, the sample was selected from the top 20 search results for the terms “electronic cigarette,” and “e-cig”. Two searches were performed for each term using the filters “Relevance” and “View Count”. The initial sample included a total of 80 short-length videos from which duplicates were removed, leaving a final sample of 63 unique videos. Data collected included: title; uploader alias; length; number of views, “likes”, “dislikes”, comments and actor demographics. Videos were rated independently by the two reviewers for content theme and connotation. Inter-rater reliability was good (k=.70). Reviewer ratings were compared; consensus was reached on any discrepancies. Data was coded and recorded into an electronic database for statistical analysis. Results: The sample of assessed videos (N=63), generated the following means: video length, 135 seconds; views, 199,311; “likes”, 21.5; “dislikes”, 98.2; and posted comments, 244. Of the actors shown, 49.2% were male, 61.9% were Caucasian, and 33.3%, the largest segment, were coded as young (i.e. < 40 years). The most commonly mentioned brand was Blu. Video content connotation was coded as follows: positive (76.1%); neutral (17.4%); and negative (6.3%). Videos were categorized into one of the following seven content themes: Advertisement (33%); Instructional/how-to (17.4%); news clip/story (19.0%); product review (12.7%); entertainment (11.1%); public health/educational (3.1%); and personal testimonial (3.1%). Conclusions: YouTube videos of electronic cigarettes primarily feature young, male, Caucasian actors and depict e-cigarettes in a positive manner. Most videos were non-traditional advertisements

Analyzing Medication Documentation in Electronic Health Records: Dental Students’ Self-Reported Behaviors and Charting Practices

The aim of this two-part study was to assess third- and fourth-year dental students’ perceptions, self-reported behaviors, and actual charting practices regarding medication documentation in axiUm, the electronic health record (EHR) system. In part one of the study, in fall 2015, all 125 third- and 85 fourth-year dental students at one U.S. dental school were invited to complete a ten-item anonymous survey on medication history-taking. In part two of the study, the EHRs of 519 recent dental school patients were randomly chosen via axiUm query based on age >21 years and the presence of at least one documented medication. Documentation completeness was assessed per EHR and each medication based on proper medication name, classification, dose/frequency, indication, potential oral effects, and correct medication spelling. Consistency was evaluated by identifying the presence/absence of a medical reason for each medication. The survey response rate was 90.6% (N=187). In total, 64.5% of responding students reported that taking a complete medication history is important and useful in enhancing pharmacology knowledge; 90.4% perceived it helped improve their understanding of patients’ medical conditions. The fourth-year students were more likely than the third-year students to value the latter (p=0.0236). Overall, 48.6% reported reviewing patient medications with clinic faculty 76-100% of the time. The respondents’ most frequently cited perceived barriers to medication documentation were patients’ not knowing their medications (68.5%) and, to a much lesser degree, axiUm limitations (14%). Proper medication name was most often recorded (93.6%), and potential oral effects were recorded the least (3.0%). Medication/medical condition consistency was 70.6%. In this study, most of the students perceived patient medication documentation as important; however, many did not appreciate the importance of all elements of a complete medication history, and complete medication documentation was low

Impact of a Tobacco CE Program for Indiana Healthcare Providers.

PosterPurpose: To assess an evidence-based continuing education (CE) program for Indiana healthcare practitioners focusing on tobacco use and dependence which emphasized team-based tobacco dependence treatment. Methods: Program impact was assessed by changes in participants’ self-reported knowledge and clinical application of course concepts and strategies via a 26-item immediate post- CE survey and a 19 -item 3-month follow-up survey. Surveys included multiple-choice and 5-point Likert-style scaled items. The three month follow-up surveys were mailed / delivered electronically to participants; non-responders were sent two reminders. De-identified data were analyzed in aggregate using descriptive statistics, Spearman correlation coefficients, and Mantel-Haenszel chi-square tests. Results: CE programs were held in Tell City, Madison, Lafayette, Goshen, Richmond and Vincennes with a total of 252 participants. Initial survey response was 98.4% (n=248): dental assistants (2%), dental hygienists (83%), dentists (8.5%), and other healthcare professionals (6.45%). Overall, participants reported less knowledge before than immediately after (p<.0001) and 3 months after (p<.0001) the CE program. Reported knowledge at 3 months was less than immediately after the program (p<.002). Participants planned to apply CE program communication strategies (99%), implement brief tobacco intervention strategies (85%), and refer patients to local cessation resources (95%) or the Indiana Quitline (96%). Response rate for the 3 month survey was 54% (n=136). Respondents reported currently playing an active role in team-based tobacco cessation (48%,78), applying CE communication strategies (85%,109), and implementing brief tobacco interventions (71%,90). Sixty-eight respondents reported referring patients to local counselors; eighty-three referred to the Indiana Quitline. Conclusion: Tobacco dependence CE may be beneficial to enhance health care practitioners’ knowledge and willingness to integrate tobacco interventions in their healthcare settings. However, this does not assure that they will change their practice behaviors by utilizing the learned concepts and tobacco interventions with patients. (Funded by the Indiana State Dept. of Health

The Use of Simulation in Pre-doctoral Medical Emergencies Training

poster abstractObjective: This purpose of this study was to determine the level and method of teaching medical emergencies management in U.S. pre-doctoral programs, particularly the extent to which patient simulation techniques are employed for instruction and /or assessment. Methods: In the fall of 2013, a 22- item survey instrument was developed, piloted with a small cohort of oral and maxillofacial surgery faculty, and modified based on feedback. Survey items assessed curriculum content and teaching methods used for medical emergencies training, and program demographics. A link to the survey was sent to the institutional email of the Academic Dean and Oral and Maxillofacial Surgery Department Chair at each U.S. dental school. The internet-based survey platform Qualtrics was used to record responses and track non-responders. Two follow-up reminders were sent via email to non-responders. Response data were de-identified and statistical analyses were conducted. Results: Completed surveys were returned by respondents from 40 schools (62.5% response rate). Of responding schools, 95% (38) offered medical emergencies training; teaching methods included lecture, seminar, and small group learning. Median instruction time was 12 hours. Of responding schools, 12 reported providing management of medical emergencies instruction via high fidelity patient simulation (HFPS), 16 used role playing, 5 employed computer-based programs, and 6 utilized standardized patients. While 6 schools reported employing HFPS for 3-5 yrs., no school reported using it for > 5 yrs.; however, 4 schools reported utilizing role-playing for > 5 yrs. While class size was not significantly associated with use of HFPS, cost was significantly associated with non-use of HFPS (p=0.0274). Conclusions: Although the vast majority of pre-doctoral dental programs educate students in the management of medical emergencies, few programs utilize simulation as an instructional method

Gender Differences: Smokers With and Without Substance Abuse History

poster abstractPrevious research suggests that individuals with chemical dependence history experience more intense nicotine addiction, and during smoking cessation may be more likely to demonstrate increased negative affect and unfavorable scores on psychometric assessments. It is unknown how men and women may differ in their susceptibilities to such undesirable outcomes. From 1992-2004, The Indiana University Nicotine Dependence Program (IUNDP) treated over 1200 patients using a Mayo Clinic-based protocol which assesses the behavioral, social, and physiological aspects of nicotine dependence. The IUNDP was instituted at Fairbanks Hospital’s addictions center to address tobacco use among the patients and staff. Charts of individuals who completed nicotine dependence treatment (1992-2011) were selected from IU School of Dentistry and Fairbanks Hospital for retrospective analysis. Chart selection criteria consisted of the availability of complete pre-and post quit measures for a minimum of four total appointments and two post-quit appointments. Reviewed were 107 charts from patients without a history of chemical dependence (ND) and 123 from those with a chemical dependence history (CD), including 120 men and 110 women. Student researchers used a standardized protocol to capture 16 tobacco use and demographic variables and 12 post-quit measures. Comparisons between CD and ND groups were made using Pearson chi-square tests for binary data, Wilcoxon rank sum tests for all other data, and Wilcoxon signed rank tests for changes between time periods. Despite similarities among CD and ND smokers, males and females appear to face distinct challenges. Results suggest CD males are significantly more negative in mood, and are more likely to have increased withdrawal symptoms at the end of treatment. Males were also more likely to experience adverse events with NRT. Both CD males and females experienced more increased appetite than their ND counterparts. Females scored higher on addiction-related sensorimotor manipulation and may have increased propensity for psychological dependence

Biomarkers of genotoxicity, immunotoxicity and oxidative stress on Caiman latirostris (Broad-snouted caiman) hatchlings exposed to pesticide formulations and mixtures widely used in agriculture

Pesticide formulations are currently considered as one of the main factors responsible for environmental contamination worldwide. Consequently, several wild species can be affected by the over use of pesticides related to agriculture activity. The aim of this study was to evaluate genotoxicity, immunotoxicity and oxidative stress on Caiman latirostris hatchlings exposed in vivo to sub-lethal concentrations of three insecticide formulations: Endosulfan (END)-, Cypermethrin (CYP)-, and Chlorpyrifos (CPF)- based formulations, two Glyphosate (GLY)- based herbicide formulations and two different ternary complex mixtures of them. C. latirostris hatchlings, 20 days old were exposed in plastics containers with pesticide solutions (by voluntary immersion) during two months, with a progressive decrease in pesticide concentrations through time, in order to simulate their degradation in water under natural conditions. After exposure, blood samples were taken to all animals for the analysis of genotoxicity (Comet assay, Micronucleus and other nuclear abnormalities) immunotoxicity (Total and differential white blood cell counts) and oxidative stress (Lipoperoxidation and the antioxidant enzymes Catalase and Superoxide dismutase). Results indicated that the five formulations tested, as well as the complex mixtures of them, induced genotoxicity, alteration in white blood cell counts and oxidative stress at environmentally relevant concentrations. Mixtures showed different interactions depending of the biomarker analyzed. This study constitutes an integral evaluation of the effect of five pesticide formulations and two possible complex ternary mixtures widely used in soybean crops in Argentina, on different endpoints on a native reptile species, C. latirostris.Fil: López González, Evelyn Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Ciencias Veterinarias del Litoral. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias. Instituto de Ciencias Veterinarias del Litoral; Argentina. Universidad Nacional del Litoral. Facultad de Humanidades y Ciencias. Departamento de Ciencias Naturales. Laboratorio de Zoología Aplicada: Anexo Vertebrados (FHUC-UNL/MASPyMA); ArgentinaFil: Romito, María Laura. Universidad Nacional del Litoral. Facultad de Humanidades y Ciencias. Departamento de Ciencias Naturales. Laboratorio de Zoología Aplicada: Anexo Vertebrados (FHUC-UNL/MASPyMA); ArgentinaFil: Latorre, María Agustina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Universidad Nacional del Litoral. Facultad de Humanidades y Ciencias. Departamento de Ciencias Naturales. Laboratorio de Zoología Aplicada: Anexo Vertebrados (FHUC-UNL/MASPyMA); ArgentinaFil: Siroski, Pablo Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Ciencias Veterinarias del Litoral. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias. Instituto de Ciencias Veterinarias del Litoral; Argentina. Universidad Nacional del Litoral. Facultad de Humanidades y Ciencias. Departamento de Ciencias Naturales. Laboratorio de Zoología Aplicada: Anexo Vertebrados (FHUC-UNL/MASPyMA); ArgentinaFil: Poletta, Gisela Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe; Argentina. Universidad Nacional del Litoral. Facultad de Bioquímica y Ciencias Biológicas. Cátedra de Toxicología y Bioquímica Legal; Argentina. Universidad Nacional del Litoral. Facultad de Humanidades y Ciencias. Departamento de Ciencias Naturales. Laboratorio de Zoología Aplicada: Anexo Vertebrados (FHUC-UNL/MASPyMA); Argentin

Retail promotions and perceptions of R.J. Reynolds' novel dissolvable tobacco in a US test market

<p>Abstract</p> <p>Background</p> <p>With declining cigarette sales, tobacco manufacturers have been developing and marketing new smokeless products, such as R. J. Reynolds' dissolvable tobacco, Camel Sticks, Strips and Orbs. This study assessed the availability, price and point-of-purchase promotional strategies for Camel Dissolvables, and investigated consumer awareness, interest and perception of these products in the Indiana test market.</p> <p>Methods</p> <p>An exploratory retail audit of point-of-purchase promotions was conducted in a random sample of retailers from 6 store categories (n = 81) in the test market area. Data included: store type, location, product placement, forms/flavors carried, price, types and locations of advertisements and promotions, and ad messages. An Awareness-Attitude-Usage (AAU) survey was used to gauge consumer awareness and knowledge of tobacco products including Camel Dissolvables. Respondents were shown promotional materials from a package onsert and perceptions and interest in the Camel Dissolvables were assessed. An Intended Target Survey (ITS) compared subjects' perceptions of ad targets for several non-tobacco products, as well as Camel Snus, Camel No. 9 and Camel Dissolvables. Respondents were asked to identify each ad's intended target category, perceived targetedness, and purchase intent.</p> <p>Results</p> <p>The products were carried by 46% of stores, most frequently gas stations (100%) and convenience stores (75%). They were shelved near smokeless tobacco (70%), cigarettes (25%) or candy (5%). Prices ranged from $3.59 -$4.19 per package; most stores carried at least 1 promotional item. Ad messages included: "Dissolvable Tobacco" (60%). "Free Trial" (24%), "Special Price" (24%), "What's Your Style?" (22%). At 14% of stores, free trial packs of Camel Dissolvables were offered with another Camel purchase. Awareness was reported by 42% of respondents (n = 243), and trial by 3%. Consumer interest was very low, but younger respondents (< 40 years) were more familiar with Camel Dissolvables (60% vs. 45% for those > 40 years, p < .01). Males, as well as current and former smokers had higher rates of interest and trial; only 1% of never smokers reported trial. In the ITS, only for the 3 tobacco product ads, was perceived targetedness for smokers significantly higher than for non-smokers. Smokers and nonsmokers perceived that the ads targeted smokers.</p> <p>Conclusions</p> <p>Current retail promotional strategies for Camel Sticks, Strips & Orbs appear to be targeting a select audience, primarily current smokers. Overall, consumer awareness, interest and trial were low.</p

Initial Efforts to Manage IPE during the COVID-19 Pandemic: Reports from the Big Ten Academic Alliance

Purpose: The COVID-19 pandemic required higher education institutions to quickly transition to a virtual platform. This was challenging for those involved in interprofessional education (IPE), given the goal that students from two or more professions learn about, from, and with one another. The Big Ten IPE Alliance is a subgroup of the larger Big Ten Academic Alliance. The purpose of this paper is to share the collective experiences of multiple large, research intensive universities in addressing the challenge of implementing IPE programs under the conditions established by the COVID-19 pandemic. Methods: To better understand how the Big Ten schools dealt with the transition to virtual learning for didactic and clinical IPE given the COVID-19 pandemic, a subset of representatives from the Big Ten IPE Alliance met to discuss best practices for virtual learning in the IPE realm. Each participating university completed an electronic 14 question survey related to their IPE curriculum during the COVID-19 pandemic from March 2020 thru August 2020 and the responses were analyzed. Results: Four categories were identified as needing to be addressed to develop and implement successful interprofessional didactic and clinical experiences. The categories identified included content/assessment, virtual technologies, faculty and facilitators, and learners. Conclusions/Recommendations: Consider including authentic and innovative mechanisms to deliver IPE experiences that meet the learning needs and accreditation requirements. Interinstitutional collaborations such as within the Big Ten IPE Alliance can be beneficial in assessing current and future best practices in IPE