Dataset Information

Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial.

ABSTRACT:

Background

Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings.

Objective

We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling.

Design

Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India.

Participants

Eligibility criteria included age 18-70 years, active admission to the hospital, and current smoking.

Intervention

A medical student-guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge.

Main measures

The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training.

Key results

Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24-2.26; p < 0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (± 0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (± 0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3-4.3; p < 0.001).

Conclusions

Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates.

Trial registration

URL: http://www.

Clinicaltrials

gov . Unique identifier: NCT03521466.

SUBMITTER: Satish P

PROVIDER: S-EPMC10247264 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial.

Satish Priyanka P Khetan Aditya A Shah Dharav D Srinivasan Shuba S Balakrishnan Rojith R Padmanandan Arun A Hejjaji Vittal V Hull Leland L Samuel Reema R Josephson Richard R

Journal of general internal medicine 20230607 14

<h4>Background</h4>Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings.<h4>Objective</h4>We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling ...[more]

PMID: 37286774

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Project description:BackgroundMore than 8.5 million Germans suffer from chronic diseases attributable to smoking. Education Against Tobacco (EAT) is a multinational network of medical students who volunteer for school-based prevention in the classroom setting, amongst other activities. EAT has been implemented in 28 medical schools in Germany and is present in 13 additional countries around the globe. A recent quasi-experimental study showed significant short-term smoking cessation effects on 11-to-15-year-old adolescents.ObjectiveThe aim of this study was to provide the first randomized long-term evaluation of the optimized 2014 EAT curriculum involving a photoaging software for its effectiveness in reducing the smoking prevalence among 11-to-15-year-old pupils in German secondary schools.MethodsA randomized controlled trial was undertaken with 1504 adolescents from 9 German secondary schools, aged 11-15 years in grades 6-8, of which 718 (47.74%) were identifiable for the prospective sample at the 12-month follow-up. The experimental study design included measurements at baseline (t1), 6 months (t2), and 12 months postintervention (t3), via questionnaire. The study groups consisted of 40 randomized classes that received the standardized EAT intervention (two medical student-led interactive modules taking 120 minutes total) and 34 control classes within the same schools (no intervention). The primary endpoint was the difference in smoking prevalence from t1 to t3 in the control group versus the difference from t1 to t3 in the intervention group. The differences in smoking behavior (smoking onset, quitting) between the two groups, as well as gender-specific effects, were studied as secondary outcomes.ResultsNone of the effects were significant due to a high loss-to-follow-up effect (52.26%, 786/1504). From baseline to the two follow-up time points, the prevalence of smoking increased from 3.1% to 5.2% to 7.2% in the control group and from 3.0% to 5.4% to 5.8% in the intervention group (number needed to treat [NNT]=68). Notable differences were observed between the groups for the female gender (4.2% to 9.5% for control vs 4.0% to 5.2% for intervention; NNT=24 for females vs NNT=207 for males), low educational background (7.3% to 12% for control vs 6.1% to 8.7% for intervention; NNT=30), and migrational background (students who claimed that at least one parent was not born in Germany) at the 12-month follow-up. The intervention appears to prevent smoking onset (NNT=63) but does not appear to initiate quitting.ConclusionsThe intervention appears to prevent smoking, especially in females and students with a low educational background.

Project description:BackgroundMedical education in resource-constrained settings such as Pakistan faces significant challenges, including large class sizes, limited resources, and reliance on traditional teacher-centered pedagogies. These factors hinder effective learning and fail to equip students with the critical thinking and practical skills essential for modern medical practice. Educators play a fundamental role in shaping student experiences but often struggle to adopt student-centred methodologies due to insufficient training, resource limitations, and institutional constraints. This study aimed to explore medical educators' teaching approaches, their perceptions of their effectiveness, and the challenges they face in implementing modern pedagogical techniques.MethodsA sequential explanatory mixed-method study was conducted. First, the Approaches to Teaching Inventory (ATI) was administered to 130 medical and dental educators in Karachi, Pakistan (71% response rate, n = 93), assessing teacher-centered (Information Transmission/Teacher-Focused, ITTF) versus student-centered (Conceptual Change/Student-Focused, CCSF) approaches. Second, semi-structured interviews were conducted with 25 educators purposively selected from the initial sample. Quantitative data were analysed using SPSS and Mann-Whitney U tests. Qualitative data were subjected to thematic analysis to identify key themes.ResultsThe quantitative results demonstrated that educators often use a blended teaching approach. No significant gender differences were found in teaching experience or teacher-centric scores; however, female educators scored higher on the student-centric approach (p = 0.001). Qualitative analysis identified themes: (1) teachers as catalysts for student transformation, emphasising mentorship and practical learning; (2) curriculum challenges and the need for faculty development, highlighting dissatisfaction with outdated curricula and assessments focused on rote memorisation; and (3) teaching practices advocating for interactive methods and continuous assessment aligned with practical clinical skills. Educators expressed a desire for faculty development programs to support student-centered learning.ConclusionsMedical educators recognise the importance of student-centred approaches but face significant challenges due to institutional pressures, outdated curricula, and inadequate assessment methods. There is a critical need for curriculum reform, adoption of continuous formative assessments, and faculty development programs to enhance teaching effectiveness. Institutions should promote environments that value pedagogical excellence and support innovative teaching practices. Aligning educators' perceptions with actual teaching practices is essential to improve medical education and prepare students for professional practice.

Project description:BackgroundChat-based counseling services are popular for the low-threshold provision of mental health support to youth. In addition, they are particularly suitable for the utilization of natural language processing (NLP) for improved provision of care.ObjectiveConsequently, this paper evaluates the feasibility of such a use case, namely, the NLP-based automated evaluation of satisfaction with the chat interaction. This preregistered approach could be used for evaluation and quality control procedures, as it is particularly relevant for those services.MethodsThe consultations of 2609 young chatters (around 140,000 messages) and corresponding feedback were used to train and evaluate classifiers to predict whether a chat was perceived as helpful or not. On the one hand, we trained a word vectorizer in combination with an extreme gradient boosting (XGBoost) classifier, applying cross-validation and extensive hyperparameter tuning. On the other hand, we trained several transformer-based models, comparing model types, preprocessing, and over- and undersampling techniques. For both model types, we selected the best-performing approach on the training set for a final performance evaluation on the 522 users in the final test set.ResultsThe fine-tuned XGBoost classifier achieved an area under the receiver operating characteristic score of 0.69 (P<.001), as well as a Matthews correlation coefficient of 0.25 on the previously unseen test set. The selected Longformer-based model did not outperform this baseline, scoring 0.68 (P=.69). A Shapley additive explanations explainability approach suggested that help seekers rating a consultation as helpful commonly expressed their satisfaction already within the conversation. In contrast, the rejection of offered exercises predicted perceived unhelpfulness.ConclusionsChat conversations include relevant information regarding the perceived quality of an interaction that can be used by NLP-based prediction approaches. However, to determine if the moderate predictive performance translates into meaningful service improvements requires randomized trials. Further, our results highlight the relevance of contrasting pretrained models with simpler baselines to avoid the implementation of unnecessarily complex models.Trial registrationOpen Science Framework SR4Q9; https://osf.io/sr4q9.

Project description:BackgroundDuring the COVID-19 pandemic, we identified a gap in adequate discharge counseling for COVID-19 patients in the Emergency Department. This was due to high patient volumes and lack of patient education regarding a novel disease. Medical students were also restricted from clinical areas due to safety concerns, compromising their clinical experience. We piloted a novel program in which medical students served as virtual discharge counselors for COVID-19 patients via teleconference. We aimed to demonstrate an impact on patient care by examining the patient bounce back rate as well as assessing medical student education and experience.MethodsThis program was piloted in a tertiary care Emergency Department. Medical student volunteers served as virtual discharge counselors. Students were trained in discharge counseling with a standardized protocol and a discharge script. Eligible patients for virtual discharge counseling were 18 years old or greater with a diagnosis of confirmed or suspected COVID-19 and no impediment precluding them from participating in a telemedicine encounter. Counseling was provided via secure teleconference in the patient's preferred language. Counseling included diagnosis, supportive care with medication dosing, quarantine instructions, return precautions, follow up, and time to ask questions. Duration of counseling was recorded and medical students were anonymously surveyed regarding their experience.ResultsOver an 18-week period, 45 patients were counseled for a median of 20 min. The 72-hr ED revisit rate was 0%, versus 4.2% in similarly-matched, not counseled COVID-19 patients. 90% of medical students believed this project increased their confidence when speaking with patients while 80% indicated this was their first telemedicine experience.ConclusionOur pilot discharge program provided patients with an extensive discharge counseling experience that would not otherwise be possible in an urban ED setting and demonstrated benefit to patient care. Medical students received a safe clinical experience that improved their communication skills.

Project description:BackgroundDecreases in smoking prevalence from recent decades have slowed, and national goals to reduce tobacco use remain unmet. Healthcare providers, including those in physician and dental teams, have access to evidence-based guidelines to help patients quit smoking. Translation of those guidelines into practice, however, remains low. Approaches that involve screening for drug use, brief intervention, and referral to treatment (SBIRT) are a promising, practical solution.PurposeThis study examined whether dentists and dental hygienists would assess interest in quitting, deliver a brief tobacco intervention, and refer to a tobacco quitline more frequently as reported by patients if given computer-assisted guidance in an electronic patient record versus a control group providing usual care.DesignA blocked, group-randomized trial was conducted from November 2010 to April 2011. Randomization was conducted at the clinic level. Patients nested within clinics represented the lowest-level unit of observation.Setting/participantsParticipants were patients in HealthPartners dental clinics.InterventionIntervention clinics were given a computer-assisted tool that suggested scripts for patient discussions. Usual care clinics provided care without the tool.Main outcome measuresPrimary outcomes were post-appointment patient reports of the provider assessing interest in quitting, delivering a brief intervention, and referring them to a quitline.ResultsPatient telephone surveys (72% response rate) indicated that providers assessed interest in quitting (control 70% vs intervention 87%, p=0.0006); discussed specific strategies for quitting (control 26% vs intervention 47%, p=0.003); and referred the patient to a tobacco quitline (control 17% vs intervention 37%, p=0.007) more frequently with the support of a computer-assisted tool integrated into the electronic health record.ConclusionsClinical decision support embedded in electronic health records can effectively help providers deliver tobacco interventions. These results build on evidence in medical settings supporting this approach to improve provider-delivered tobacco cessation.Trial registrationThis study is registered at ClinicalTrials.govNCT01584882.

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Dataset Information

Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial.

Background

Objective

Design

Participants

Intervention

Main measures

Key results

Conclusions

Trial registration

Clinicaltrials

Publications

Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial.

Similar Datasets

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