ChatGPT vs. sleep disorder specialist responses to common sleep queries: Ratings by experts and laypeople.

BACKGROUND: Many individuals use the Internet, including generative artificial intelligence like ChatGPT, for sleep-related information before consulting medical professionals. This study compared responses from sleep disorder specialists and ChatGPT to common sleep queries, with experts and laypersons evaluating the responses' accuracy and clarity. METHODS: We assessed responses from sleep medicine specialists and ChatGPT-4 to 140 sleep-related questions from the Korean Sleep Research Society's website. In a blinded study design, sleep disorder experts and laypersons rated the medical helpfulness, emotional supportiveness, and sentence comprehensibility of the responses on a 1-5 scale. RESULTS: Laypersons rated ChatGPT higher for medical helpfulness (3.79 ± 0.90 vs. 3.44 ± 0.99, p < .001), emotional supportiveness (3.48 ± 0.79 vs. 3.12 ± 0.98, p < .001), and sentence comprehensibility (4.24 ± 0.79 vs. 4.14 ± 0.96, p = .028). Experts also rated ChatGPT higher for emotional supportiveness (3.33 ± 0.62 vs. 3.01 ± 0.67, p < .001) but preferred specialists' responses for sentence comprehensibility (4.15 ± 0.74 vs. 3.94 ± 0.90, p < .001). When it comes to medical helpfulness, the experts rated the specialists' answers slightly higher than the laypersons did (3.70 ± 0.84 vs. 3.63 ± 0.87, p = .109). Experts slightly preferred specialist responses overall (56.0%), while laypersons favored ChatGPT (54.3%; p < .001). ChatGPT's responses were significantly longer (186.76 ± 39.04 vs. 113.16 ± 95.77 words, p < .001). DISCUSSION: Generative artificial intelligence like ChatGPT may help disseminate sleep-related medical information online. Laypersons appear to prefer ChatGPT's detailed, emotionally supportive responses over those from sleep disorder specialists.

Comparing modalities of opioid education in patients undergoing total knee arthroplasty: a randomized pilot trial.

BACKGROUND: Patients undergoing total knee arthroplasty (TKA) experience significant postoperative pain and routinely require opioids, yet they often lack knowledge regarding appropriate use and handling of these medications. Evidence suggests that educational interventions in various formats may help reinforce proper usage and improve postoperative pain control. The aim of this study is to compare the institution standard of care (webinar) with two novel educational interventions-one in-person and the other a video recording-that focus specifically on the use of opioids and pain control. METHODS: This prospective, randomized pilot study included 42 patients undergoing TKA. Patients were randomized into one of three groups: (1) webinar: 50 min virtual session standard of care at Hospital for Special Surgery (HSS), (2) in-person education, or (3) video education. The primary outcomes of this study were the number of opioid refill requests through postoperative day (POD) 30 and POD 60. The secondary outcomes evaluated Numerical Rating Scale (NRS) pain scores, opioid consumption in oral morphine equivalents (OME), surveys on medication usage and opioid knowledge, reported medication storage and disposal. We hypothesize that the novel educational interventions, presented either in-person or by video, will lead to a decrease in opioid refills within 60 days compared with current education delivered through virtual webinar. RESULTS: No significant differences were found among groups in the number of opioid refill requests, average NRS pain score, or OME consumption at any time point. Opioid refill requests ranged from 0% to 16.7% at POD 30 (Fisher's exact test, p=0.625) and from 0% to 8.3% at POD 60 (p=1.000). The median opioid refill request was zero requests per group from POD 21 to 60 (webinar 0 (0.0, 0.0), in-person 0 (0.0, 0.0), video 0 (0.0, 0.0), Kruskal-Wallis test, p=0.381). Average NRS pain scores were 5 or below for all groups on POD 1, 7 and 14. By POD 7, all groups had an average daily intake OME of 14 or below. CONCLUSIONS: Overall, patients in each group did well with postoperative pain management after TKA and had minimal opioid refill requests. There were no statistically significant differences in outcomes of NRS pain scores or opioid usage among groups suggesting that educational interventions were similarly effective. As a pilot trial, study demonstrated successful recruitment and retention of participants, and important feedback was elicited from patients regarding education, as well. Of note, this was a pilot study and was likely underpowered to detect a difference. TRIAL REGISTRATION NUMBER: NCT05593341.

Perceived factors influencing the success of pain neuroscience education in chronic musculoskeletal pain: a meta-synthesis of qualitative studies.

PURPOSE: We aimed to identify the factors influencing the success of Pain Neuroscience Education (PNE) in chronic musculoskeletal (MSK) pain from the perspective of those experiencing PNE first-hand. MATERIALS AND METHODS: We conducted a meta-synthesis of qualitative studies. Articles were found on MEDLINE via Pubmed, EMBASE, Cochrane Library, CINHAL, and PsycINFO up to April 2023. Eligible qualitative studies focussed on adults (>16 years old) with a diagnosis of chronic primary or secondary MSK pain who performed PNE. Thematic synthesis by Thomas and Harden was followed. The Critical Appraisal Skills Programme (CASP) tool ensured the quality of the studies, while the Confidence in Evidence from the Reviews of Qualitative Research (CERQual) approach facilitated data confidence assessment. RESULTS: Nine studies were included (188 participants). Three analytical themes were developed: (i) "Efficient Communication of Information", emphasising the importance of accurate content transmission; (ii) "Emotional Support and Well-being", recognising emotional aspects as integral to treatment; and (iii) "Empowerment Promotion", focusing on information retention and personal transformation. The studies showed good quality, with moderate confidence in the evidence. CONCLUSIONS: The perceived factors influencing the success of PNE are intricately related to the domain of communication, the emotional dimension of personal experience, and the capacity to be empowered.

Tailoring interventions to pain experiences, preferences, and emotions is key for the success of pain neuroscience education;A personalised approach is crucial for effective pain neuroscience education, emphasising the need to understand and address the specific aspects of each patient's pain journey.

Contents and delivery methods of pain neuroscience education in pediatrics: A scoping review.

BACKGROUND: Pain is prevalent among children and adolescents. The development and implementation of Pain Neuroscience Education (PNE) strategies tailored to this population remains overlooked in contrast to the adult population. OBJECTIVE: This study sought to identify the content, delivery methods, and dosage of PNE for children and adolescents available in the literature. METHOD: We systematically searched PubMed, EMBASE, Physiotherapy Evidence Database, Scopus, Web of Science, Cochrane Library, PsycINFO, and clinical trial registration databases. Inclusion criteria consisted of studies that involved children submitted to a PNE program in community, school, clinics, hospitals or child development centers. We considered studies that included children with and without pain who received PNE strategies associated or not with self-motivational interventions. Studies focusing on psychological interventions were excluded. We extracted data on authors, publication year, country, sample characteristics, health condition, PNE content, study design, context, outcomes, duration, follow-up, main results, dropout, and adverse effects. Data extracted were qualitatively organized. RESULTS: A total of 805 studies were initially reviewed. The final sample comprised 17 studies. Common PNE topics included pain neurophysiology, biopsychosocial influences, pain concepts, self-management, and coping strategies. Delivery methods ranged from slideshows and videos to booklets, with sessions lasting 8-60 min. Schools were the most common setting for these interventions. CONCLUSION: Our review demonstrates the diversity in PNE content, delivery methods, and intervention dosages among the included studies. Most studies occurred in school settings, potentially limiting its generalizability for clinical contexts.

Evaluating the impact of differing completion rates of a face-to-face DIABETES self-management education programme on Patient Reported Outcome measures (DIABETES PRO): A feasibility trial protocol.

INTRODUCTION: Structured diabetes self-management education (DSME) is internationally recommended for people with type 2 diabetes to support self-management and to prevent associated long-term complications. 'Attendance' at DSME is currently benchmarked as having completed a registration form and at least one active engagement with programme content, and 'completion' measured against ≥60% completion, despite landmark trials reporting outcomes based on the full completion of a programme. Little is known about the effectiveness of DSME on the psychological and emotional health of people with diabetes who complete less than the full DSME programme. We report a protocol for a single-centre randomised feasibility study to assess the impact of differing completion rates of a face-to-face DSME programme on patient reported outcomes of self-care, diabetes distress and quality of life in people with type 2 diabetes. METHODS: A randomised feasibility study in 120 people with type 2 diabetes due to attend a secondary care diabetes clinic in the North West UK for DSME. Participants will be randomised into one of the four groups: Group 1 full DSME programme, Group 2 60%, Group 3 10% and Group 4 0% (delayed education). Psychometric questionnaire scores will be evaluated at baseline and 3-4 months post-intervention. Measures of feasibility (eligibility, recruitment and retention rates) will be reported. ETHICS AND DISSEMINATION: The DIABETES-PRO study was approved by the London-Surrey Borders Research Ethics Committee (24/LO/0235). Results will be shared with study participants and published in peer-reviewed journals. TRIAL REGISTRATION: Clinicaltrials.gov NCT06419907.

Digital Health and Self-Management in Idiopathic Inflammatory Myopathies: A Missed Opportunity?

PURPOSE OF REVIEW: This paper explored the potential of digital health in idiopathic inflammatory myopathies (IIMs), with a focus on self-management. Digital self-management technology includes tailored treatment plans, symptom tracking, educational resources, enhanced communication, and support for long-term planning. RECENT FINDINGS: After arguing the importance of digital health in IIMs management, from diagnosis until treatment, our literature review revealed a notable gap in research focusing on the efficacy of digital self-management interventions for individuals with IIMs, with no randomised controlled trials or observational studies addressing this topic. Our review further highlighted the significant unmet need for research in self-management interventions for individuals with IIMs. The absence of studies underscores the necessity for collaborative efforts to address this gap and develop personalised, effective strategies for managing IIMs using digital technology. Individuals with IIMs deserve tailored self-management approaches akin to those available for other rheumatic and musculoskeletal diseases.

A cross-sectional time series of cardiometabolic health education format preferences across sociodemographic groups.

AIMS: Health education is integral to cardiometabolic disease (CMD) management. This study aimed to assess whether and how education preferences have changed over time, and whether trends differ by sociodemographic characteristics (education status, age, ethnicity, and sex). METHODS: A cross-sectional questionnaire was deployed across five counties in the East Midlands, UK between 2017 and 2022 to adults with CMD (type 2 diabetes, cardiovascular disease or cerebrovascular disease). Respondent demographic data were collected alongside health education preferences. Statistical analyses ascertained whether demographic characteristics influenced preferences. The distribution of preferences over time was charted to identify trends. RESULTS: A total of 4301 eligible responses were collected. Face-to-face one-to-one education was preferred (first choice for 75.1% of participants) but popularity waned over the five-year period. Trends were similar amongst demographic groups. Online education showed a U-shaped trend: In 2017, 44% of respondents ranked it as acceptable, peaking at 53% in 2019, but declining again, to below base line, 43%, by 2022. This modality was more popular with participants aged younger than 65 years, but popularity in people older than 65 years increased over the study period. The popularity of printed information also declined over time across all demographic groups except those of South Asian ethnicity, for whom it remained static. CONCLUSIONS: The overwhelming preference for face-to-face one-to-one health education from a doctor or nurse highlights the importance of preserving access to this modality, even in the face of current NHS pressures and trends towards digitalisation. Trends are changing, and should continue to be monitored, including between different sociodemographic groups.

Air Pollution and Stroke: What Nurses Need to Know.

Air pollution exposure is linked to an increased risk of stroke. Elevated levels of pollution (carbon monoxide, carbon dioxide, nitrous oxide, sulfur dioxide, coarse particulate matter [PM10], and especially fine particulate matter [PM2.5]) cause systemic inflammation after the particles are inhaled and lodge into lung tissue, causing an increased incidence of stroke, hospitalizations for stroke, and stroke mortality. Until air pollution levels are remediated, assessing Air Quality Index (AQI) and following the guidelines to decrease illness from exposure is imperative. AQI levels are reported hourly, identifying ambient PM2.5 and ozone levels. When AQI levels are low, the risk of exposure to PM2.5 is low. As the AQI increases, there is more risk. It is important to take steps to decrease exposure to PM2.5, especially for those with cardiovascular comorbidities such as diabetes and those with previous stroke events. This is important information for nurses to understand and share with their patients as a risk reduction strategy.

Evaluating the effectiveness of a tailored online educational video on the contraceptive knowledge and decision making of young women from culturally and linguistically diverse backgrounds: findings from the EXTEND-PREFER study.

BACKGROUND: Young Australian women from culturally and linguistically diverse (CALD) backgrounds are vulnerable to unwanted pregnancy. We aimed to assess whether an online educational video, co-designed with young CALD women, can increase their contraceptive knowledge, preference for and uptake of long-acting reversible contraception (LARC). METHODS: Online advertising was used to recruit young CALD women aged 16-25 years. Participants completed the pre-video survey (S1), watched the 13-min co-designed video, then completed a survey immediately afterwards (S2) and 6 months later (S3). Outcomes were analysed using McNemar tests and multivariate logistic regression. RESULTS: A total of 160 participants watched the video, completed S1 and S2, and 57% of those completed S3. At S1 only 14% rated their knowledge about every contraceptive method as high. Knowledge improved at S2 for all methods (aOR 3.2, 95% CI 2.0 to 5.0) and LARC (aOR 4.7, 95% CI 2.9 to 7.5). Overall method preference for LARC increased from 2.5% (n=4) at S1 to 51% (n=82) at S2. Likelihood of using a LARC increased at S2 (aOR 3.8, 95% CI 2.6 to 5.6). The overall proportion of participants using a LARC increased from 8% at S1 to 11% at S3; however, this increase was not significant (p=0.7). CONCLUSIONS: The significant increase in knowledge, likelihood of use, and preference for LARC underscores the potential of online video-based contraceptive education to address contraceptive knowledge gaps and challenge misconceptions about LARC held by young women. Combining contraceptive education with supports to LARC access is crucial for empowering young CALD women to make informed contraceptive decisions.

Communicative competence of generative artificial intelligence in responding to patient queries about colorectal cancer surgery.

PURPOSE: To examine the ability of generative artificial intelligence (GAI) to answer patients' questions regarding colorectal cancer (CRC). METHODS: Ten clinically relevant questions about CRC were selected from top-rated hospitals' websites and patient surveys and presented to three GAI tools (Chatbot Generative Pre-Trained Transformer [GPT-4], Google Bard, and CLOVA X). Their responses were compared with answers from the CRC information book. Response evaluation was performed by two groups, each consisting of five healthcare professionals (HCP) and patients. Each question was scored on a 1-5 Likert scale based on four evaluation criteria (maximum score, 20 points/question). RESULTS: In an analysis including only HCPs, the information book scored 11.8 ± 1.2, GPT-4 scored 13.5 ± 1.1, Google Bard scored 11.5 ± 0.7, and CLOVA X scored 12.2 ± 1.4 (P = 0.001). The score of GPT-4 was significantly higher than those of the information book (P = 0.020) and Google Bard (P = 0.001). In an analysis including only patients, the information book scored 14.1 ± 1.4, GPT-4 scored 15.2 ± 1.8, Google Bard scored 15.5 ± 1.8, and CLOVA X scored 14.4 ± 1.8, without significant differences (P = 0.234). When both groups of evaluators were included, the information book scored 13.0 ± 0.9, GPT-4 scored 14.4 ± 1.2, Google Bard scored 13.5 ± 1.0, and CLOVA X scored 13.3 ± 1.5 (P = 0.070). CONCLUSION: The three GAIs demonstrated similar or better communicative competence than the information book regarding questions related to CRC surgery in Korean. If high-quality medical information provided by GAI is supervised properly by HCPs and published as an information book, it could be helpful for patients to obtain accurate information and make informed decisions.

Application and challenges of using a Constructivist Grounded Theory methodology to address an undertheorized clinical challenge: A discussion paper.

Background: The benefits of nurse-led therapeutic patient education regarding wound healing and the prevention of recurrences for individuals living with a venous leg ulcer remain unclear. Obtaining the individuals perspective could offer an in depth understanding of why and how they engage or not, in self-management strategies following nurse-led patient education. Despite strong evidence indicating the need for further investigation into the benefits of therapeutic patient education in this population there is a lack of research into how individuals cope with chronic venous insufficiency or resulting ulceration. With this discussion paper we therefore explore the challenges associated with employing a Constructivist Grounded Theory methodology to gain a deeper insight into the experiences of patients with venous leg ulcers receiving individualized nurse-led patient education programs focused on the self-management of their condition. Objective: To identify and analyse the specific methodological and practical challenges encountered when applying a Constructivist Grounded Theory methodology to gain a better understanding of how patients with venous leg ulcer experience an individualised nurse-led patient education programme concerning the self-management of their condition. Design: discussion paper. Results and Discussion: The constructivist approach to Grounded Theory methodology allows for the investigation of understudied phenomena such as nurse-led patient education for individuals living with venous leg ulcers. This methodology values the co-construction of a theory taking into consideration the inherent value of participants' and researchers' experiences. However, the specificities of constructivist epistemology challenge certain methodological aspects of Grounded Theory methods, such as how and when to use existing literature, conduct interviews to generate data and engage in the coding and theoretical sampling process for conceptualizing and proposing a theory. Conclusions: The constructivist paradigm of grounded theory methodolgy resonates with the art and science of nursing through its collaborative 'real-world' reflective approach, offering a unique way to explore understudied complex clinical nursing practice. Registration: This methodological paper is derived from a PhD study embedded in a clinical trial (NCT04019340) were the recruitment started on February 2020, approved by ethical committee of Geneva (CCER: 2019-01964). Tweetable abstract: Constructivist Grounded Theory Methodologies could support an in depth understanding of the impact of nursing interventions.

Participatory Development of an Integrated, eHealth-Supported, Educational Care Pathway (Diabetes Box) for People With Type 2 Diabetes: Development and Usability Study.

BACKGROUND: Type 2 diabetes (T2D) tremendously affects patient health and health care globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioral, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change their health behavior and improve glucose regulation. Digital tools are effective in areas of self-management and have great potential to support patient self-management due to low costs, 24/7 availability, and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and use a structured approach to guide the development team in planning, coordinating, and executing the development process. OBJECTIVE: The aim of this study is to develop an integrated, eHealth-supported, educational care pathway for patients with T2D. METHODS: The educational care pathway was developed using the first 3 phases of the Center for eHealth and Wellbeing Research roadmap: the contextual inquiry, the value specification, and the design phase. Following this roadmap, we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with health care professionals (HCPs), and a patient panel to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box (Leiden University Medical Center) and consists of personalized education, digital educational material, self-measurements of glucose, blood pressure, activity, and sleep, and a smartphone app to bring it all together. RESULTS: The scoping review highlights the importance of self-management education and the potential of telemonitoring and mobile apps for blood glucose regulation in patients with T2D. Focus groups with HCPs revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualization, and that insulin use should be incorporated into the app. Both patients and HCPs stressed the importance of direct automated feedback in the Diabetes Box. CONCLUSIONS: After developing the Diabetes Box prototype using the Center for eHealth and Wellbeing Research roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible and that direct automated feedback and education on stress and sleep are essential. A pilot study is planned to assess feasibility, acceptability, and usefulness in more detail.

Evaluating online health information utilisation and its psychosocial implications among breast cancer survivors: Qualitative explorations.

Background: This study investigated the online information-seeking behaviours of breast cancer patients at Jordan University Hospital, focusing on their dissatisfaction with available online health resources and its impact on their well-being and anxiety levels. Methods: Employing descriptive phenomenology and convenience sampling, we conducted five Skype-based focus groups with 4-6 breast cancer survivors each, from March to July 2020. Data analysis was performed using NVivo, following Braun and Clark's inductive thematic analysis framework. Results: The thematic analysis revealed critical insights into survivors' interactions with online cancer resources, identifying key subthemes such as the quality of online information, cyberchondriasis, health literacy and search strategies, the distress caused by counterproductive searches, and the tendency to avoid internet searches. Conclusion: The study underscores the challenges breast cancer survivors face in accessing online health information, especially in Arabic. It highlights the need to improve the quality and accessibility of these resources. Enhancing the cultural relevance of online materials and educating patients on effective information evaluation are crucial. These measures can significantly boost health literacy, mitigate anxiety, and provide better support for breast cancer survivors.

The exercise-app Axia for axial spondyloarthritis enhances the home-based exercise frequency in axial spondyloarthritis patients - A cross-sectional survey.

BACKGROUND: Patients with axial spondyloarthritis (axSpA) benefit from regular home-based exercise (HbE). In spite of recommendations, a relevant proportion of German axSpA patients does not adhere to recommended HbE practices. To enhance HbE care, we developed the novel digital therapeutic (DTx) "Axia" compliant with the European medical device regulation (MDR). Axia offers a modern app-based HbE solution with patient educative content and further integrated features. OBJECTIVE: We aimed to assess Axia's efficacy, attractiveness, and functionality through a survey among axSpA-patients involved in the first user tests. METHODS: A mixed-method online questionnaire with 38 items was administered to 37 axSpA volunteers after using Axia. Numeric rating scales (NRS) and likelihood scales were primarily used. RESULTS: HbE frequency significantly increased from a median of 1 day/week to 6 days/week (p < 0.001) by using Axia. Existing HbE practitioners also increased their frequency (median of 4 days/week before, 6 days/week with Axia, p < 0.05). Axia received a median rating of 5 out of 5 stars. On NRS scales, Axia scored a median of 9 for intuitiveness and design, and a median of 8 for entertainment. 64.9% reported improved range of motion, 43.2% reported reduced pain, and 93.6% enhanced disease-specific knowledge. All users recommended Axia to other patients. CONCLUSION: Axia increases axSpA patients HbE frequency, possibly due to its good intuitiveness and design, leading to reduction in pain and subjective improvement of range of motion. This warrants further investigation in large randomized controlled interventional trials to establish its efficacy conclusively and patients adherence to HbE.

Barriers and facilitators to nutritional recommendations identified by participants of a cardiovascular rehabilitation program in a low resource context in Brazil.

OBJECTIVES: Nutritional recommendations, a core component of cardiovascular rehabilitation, play a vital role in managing cardiovascular diseases. However, adherence to these recommendations is complex, particularly in low-resource settings. This study explored the barriers and facilitators influencing adherence to nutritional recommendations among participants in a low-resource cardiovascular rehabilitation program in Brazil. METHODS: A mixed-methods approach was employed. Sociodemographic data, the Mediterranean diet score, scale for assessing nutrition, and open-ended questions on adherence were collected. Those who completed the questionnaires (phase 1) were invited to participate in one focus group session (phase 2). The participants were characterized according to the responses provided in phase 1 (Mediterranean diet score and scale for assessing nutrition) in low adherence or high adherence to dietary practice. Descriptive statistics and thematic content analysis within the context of the theory of planned behavior were employed. RESULTS: Seventy-four participants completed phase 1, with 41.9% classified into low adherence and 27.0% in high adherence; of those, 17 participated in phase 2. Focus group findings revealed 9 themes/29 subthemes. Barriers included food prices, income, knowledge, routine, food access, family patterns, disease, work, anxiety, eating habits, and food planning. Facilitators included affordable food, health considerations, taste preferences, knowledge, family/professional support, government assistance, personal willpower, income stability, easy food access, media influence, and a quiet eating place. CONCLUSIONS: The study findings underscore the need for targeted interventions, including individualized meal planning, community engagement, and enhanced access to healthcare professionals, to optimize dietary adherence and improve cardiovascular outcomes.

Effects of a comprehensive structured patient education intervention on disease-related knowledge and behaviour change among people living with type 2 diabetes in the Philippines.

Introduction: Addressing the ongoing needs of individuals with diabetes, particularly in low- and middle-income countries like the Philippines, requires a focus on regular follow-ups with healthcare teams, adherence to healthy behaviors, and effective patient education to prevent long-term complications. The aim of this study was to ascertain the impact of a comprehensive educational program for those living with diabetes in the Philippines. Methods: In a prospective study, a convenience sample of patients living with diabetes attending a cardiac rehabilitation or an outpatient diabetes clinic in the Philippines received a 12-week education intervention. Participants completed surveys at pre- and post-intervention assessing disease-related knowledge, health literacy, dietary habits, and tobacco use. Physical activity was measured by steps taken per day using wearable devices and by self-report of minutes of moderate or vigorous-intensity exercise per week. Satisfaction with the educational materials was also evaluated by a survey composed of Likert-type scale and open-ended questions. Descriptive statistics, paired t-tests or chi-square were used for data analysis. Results: Overall, 184 individuals living with diabetes type 2 (mean age = 54.4 ± 12.4, 32% female) completed both assessments. There was significant improvement in disease-related knowledge (p < 0.001), daily steps measured by a wearable device and self-reported minutes of moderate/vigorous-intensity exercise (p < 0.001), and the number of fruit and vegetable servings consumed per day (p = 0.001). No significant changes were observed in health literacy levels. One participant stopped using tobacco at post-education. Educational materials were highly satisfactory to participants. Lack of time, family responsibilities, and poor internet access were the main barriers to learning reported by participants. Suggestions to improve the education provided included assessment of information needs at the start of the education, having short summaries about the topics, follow-ups post-intervention, and inviting family members to sessions. Discussion: Results of this study demonstrated the positive effects a comprehensive structured patient education intervention on disease-related knowledge and behaviour changes among people living with type 2 diabetes in the Philippines.

Parents' perspectives on dental team as advisors to promote HPV vaccination among Spanish adolescents.

PURPOSE: Human papillomavirus (HPV) is a prevalent sexually transmitted infection responsible for many anogenital and oropharyngeal cancers. Dental care providers have the potential to influence vaccine uptake, yet little is known about how patients perceive their role in HPV education and prevention. METHODS: Parents of adolescents aged 9 to 17 years (n = 375) were recruited from Valdeorras District Hospital (Galicia, Spain) to investigate parents' attitudes concerning the involvement of dental care providers in discussions related to HPV. A survey was distributed to the participants, and 343 (91.5%) were included in the analysis. RESULTS: In general, nearly half of the parents reported feeling comfortable regarding discussing HPV with their dentist. Participants described more comfort with dentists than with dental hygienists. Parents' comfort levels were influenced by various social determinants of health, including education level, marital status, geographic origin, and child vaccination status (p > 0.05). CONCLUSION: Parents reported varying comfort levels when discussing HPV and its vaccine with dental professionals, displaying a preference for dentists. Dental settings have the potential to promote vaccination, but the existence of ongoing barriers needs to be addressed.

Association Between Nurse-Led Multidisciplinary Education and Cardiac Events in Patients With Heart Failure: A Retrospective Chart Review.

PURPOSE: This study examined the modifiable factors, including nurse-led multidisciplinary education and in/out-of-hospital rehabilitation, to predict cardiac events in patients with heart failure (HF) in South Korea. METHODS: A retrospective review of the medical records was conducted using data of patients admitted for HF between June 2021 and April 2022. A total of 342 patients were included in this study. Information related to HF education, cardiac rehabilitation, and demographic and clinical characteristics were collected. Cardiac events, including emergency department visits, readmissions, and deaths, were defined as a composite of events. After adjusting for covariates, a multivariate Cox proportional hazard regression model was used to explore the association between modifiable factors and cardiac events in patients with HF. RESULTS: During the follow-up period (median, 823 days), 123 patients (36.0%) experienced at least one cardiac event. In the Cox regression model, patients who received nurse-led multidisciplinary HF education during hospitalization were less likely to experience cardiac events (hazard ratio: 0.487; 95% confidence interval [CI]:0.239-0.993). Additionally, high NT-pro BNP levels were associated with an increased risk of cardiac events. CONCLUSIONS: The education led by nurses on HF was a factor that reduced adverse prognoses in patients with HF. Our results highlight the importance of a nurse-led multidisciplinary approach during hospitalization.

Acceptability and feasibility of virtual reality to promote health literacy in primary care from the health professional's view: A qualitative study.

OBJECTIVE: The development of health literacy is important in the management of chronic pain and virtual reality may be an effective medium for its development. This study aims to understand the usability and acceptability of a virtual reality-based pain education system for the facilitation of health literacy. METHODS: Semi-structured interviews were conducted with health professionals who had used a VR-based pain education system within their clinical practice, to explore perceptions of feasibility. Data collection and analyses were informed by the Unified Theory of Acceptance and Use of Technology and the Integrated Model of Health Literacy. RESULTS: From 10 participants, the VR-based system was considered feasible in providing immersive experiential learning which addressed patient understanding and health-related communication. CONCLUSION: VR appears to be perceived as an acceptable and feasible technology to support the development of health literacy in people with chronic pain. Its largest perceived benefit was its capacity to provide an immersive and entertaining alternative to conventional methods of pain education. PRACTICE IMPLICATIONS: Virtual reality is considered as a feasible method of facilitating patient understanding and health-related communication related to chronic pain. Feasibility of such a tool relies clinically on time available, social expectations of VR, and the role of immersive and experiential learning within the management of chronic pain.

A Systematic Quality Assessment of Online Resources on Eyelid Ptosis Using the Modified Ensuring Quality Information for Patients (mEQIP) Tool.

BACKGROUND: Eyelid ptosis is an underestimated pathology deeply affecting patients' quality of life. Internet has increasingly become the major source of information regarding health care, and patients often browse on websites to acquire an initial knowledge on the subject. However, there is lack of data concerning the quality of available information focusing on the eyelid ptosis and its treatment. We systematically evaluated online information quality on eyelid ptosis by using the "Ensuring Quality Information for Patients" (EQIP) scale. MATERIALS AND METHODS: Google, Yahoo and Bing have been searched for the keywords "Eyelid ptosis," "Eyelid ptosis surgery" and "Blepharoptosis." The first 50 hits were included, evaluating the quality of information with the expanded EQIP tool. Websites in English and intended for general non-medical public use were included. Irrelevant documents, videos, pictures, blogs and articles with no access were excluded. RESULTS: Out of 138 eligible websites, 79 (57,7%) addressed more than 20 EQIP items, with an overall median score of 20,2. Only 2% discussed procedure complication rates. The majority fail to disclose severe complications and quantifying risks, fewer than 18% clarified the potential need for additional treatments. Surgical procedure details were lacking, and there was insufficient information about pre-/postoperative precautions for patients. Currently, online quality information has not improved since COVID-19 pandemic. CONCLUSIONS: This study highlights the urgent requirement for improved patient-oriented websites adhering to international standards for plastic and oculoplastic surgery. Healthcare providers should effectively guide their patients in finding trustworthy and reliable eyelid ptosis correction information. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .