OBJECTIVE: Educational approaches for training physicians in clinical communications vary, and whether physicians apply the communication skills they learn or find them useful in the clinic is not well known. The aim of this study was to determine how first-year residents who received explicit instruction in 7 communication strategies would apply them in a simulation exercise and in clinical practice.
METHODS: First-year Internal Medicine residents at an urban teaching hospital received instruction in 7 systematic communication strategies: Ask-Tell-Ask, Teach-back, open-ended questioning, NURSE, open body language, pausing, and plain language. Residents were evaluated on their use of specific communication behaviors associated with the 7 strategies during a simulation exercise of disclosing a medical error to a standardized patient. Control group residents who did the simulation before attending the training program and training group residents who did the simulation after the training were compared. Residents were queried 6 months after the training program on their use of communication strategies during clinical practice.
RESULTS: A total of 27 residents participated (n = 13 control group; n = 14 training group). The training group performed behaviors for \"establishing patient understanding\" significantly more often than the control group. Both groups used non-verbal communication and behaviors for addressing patient emotions at similar levels. Of the 24 residents who responded to the 6-month follow-up questionnaire, 24 (100%) reported using Ask-Tell-Ask, open-ended questioning, and Teach-back, and 22 (92%) reported using NURSE statements and non-verbal communication. Most respondents reported using the strategies in clinical practice often or very often (79%) and found the strategies useful or very useful (96%).
CONCLUSIONS: Providing explicit instruction in systematic communication strategies, particularly those focused on establishing patient understanding, may be an efficient approach for helping early career physicians develop effective communication skills that can be readily implemented during clinical training and practice.

BACKGROUND: The CAST Grid has been developed to evaluate the use of closed-loop communication (CLC) in the trauma bay.
METHODS: The CAST Grid and two validated non-technical team performance assessment tools (the TEAM and T-NOTECHS grids) were completed by 2 independent reviewers based on trauma care simulation videos from a French Level 1 trauma center. Intra- and inter-rater agreements were evaluated for CLC parameters and non-technical performance, and correlations between these parameters were analyzed.
RESULTS: The study analyzed 11 videos. The intra- and inter-rater agreement for the number of CLC per minute (CLC/min) was moderate and good, respectively, based on Lin\'s concordance correlation coefficient [95%CI] (0.57 [-0.40;0.94] and 0.77 [0.33;0.94]). However, the agreement was poor for the percentage of CLC (0.37 [-0.58;0.89] and -0.36 [-0.71;0.14], respectively). The study found that a lower number of CLC/min was correlated with an increased duration of the simulation (r = -0.75 [-0.93; -0.25]).
CONCLUSIONS: The CAST Grid showed a relatively good inter-rater agreement to quantify the number of CLC/min which was inversely correlated with the duration of care. This tool opens up the possibility of quantifying CLC and allows for new analyses of team functioning and interactions.

Assess the effects of feedback reports and implementing a closed-loop communication system on rates of recommendations for additional imaging (RAIs) in thoracic radiology reports.
In this retrospective, institutional review board-approved study at an academic quaternary care hospital, we analyzed 176,498 thoracic radiology reports during a pre-intervention (baseline) period from April 1, 2018, to November 30, 2018; a feedback report only period from December 1, 2018, to September 30, 2019; and a closed-loop communication system plus feedback report (IT intervention) period from October 1, 2019, to December 31, 2020, promoting explicit documentation of rationale, time frame, and imaging modality for RAI, defined as complete RAI. A previously validated natural language processing tool was used to classify reports with an RAI. Primary outcome of rate of RAI was compared using a control chart. Multivariable logistic regression determined factors associated with likelihood of RAI. We also estimated the completeness of RAI in reports comparing IT intervention to baseline using χ2 statistic.
The natural language processing tool classified 3.2% (5,682 of 176,498) reports as having an RAI; 3.5% (1,783 of 51,323) during the pre-intervention period, 3.8% (2,147 of 56,722) during the feedback report only period (odds ratio: 1.1, P = .03), and 2.6% (1,752 of 68,453) during the IT intervention period (odds ratio: 0.60, P < .001). In subanalysis, the proportion of incomplete RAI decreased from 84.0% (79 of 94) during the pre-intervention period to 48.5% (47 of 97) during the IT intervention period (P < .001).
Feedback reports alone increased RAI rates, and an IT intervention promoting documentation of complete RAI in addition to feedback reports led to significant reductions in RAI rate, incomplete RAI, and improved overall completeness of the radiology recommendations.

BACKGROUND: Education is an essential component in optimising chronic disease self-management. Teach-back is a robust approach in patient education, which is suitable for varying health literacy although its effectiveness in chronic kidney disease patient education is unknown.
OBJECTIVE: To evaluate the impact of teach-back method in health education for improving self-management and adherence to treatment regimens in chronic kidney disease.
METHODS: Systematic review.
METHODS: Adults with any chronic kidney disease grade or treatment modality.
METHODS: A comprehensive search was undertaken in MEDLINE, CINHAL, EMBASE, Cochrane library, PsychINFO, Web of Science, ERIC, JBI library and WHO International Clinical Trial Registry to identify published studies from September 2013 to December 2022. The methodological quality of studies was assessed using Joanna Briggs Institute guidelines.
RESULTS: Six studies involving 520 participants were retrieved for this review. A meta-analysis could not be conducted due to substantial heterogeneity between studies. Nevertheless, there was some evidence that teach-back could improve self-management, self-efficacy and knowledge. There was limited evidence on improvement in psychological outcomes or health-related quality of life.
CONCLUSIONS: Teach-back seems to improve both objective and patient-reported outcomes, although further studies are needed. Using teach-back can improve both understanding of health information and the development of skills. Kidney care teams could use teach-back for all patients as it takes account of varying patient health literacy abilities. Teach-back assists with communicating important health information to improve patients\' knowledge, confidence and skills in self-managing this disease and its treatment.

BACKGROUND: Heart failure is one of the most common causes of hospital readmission. Self-care is an essential but challenging task for patients with heart failure, and inadequate self-care is closely related to unplanned readmission and unnecessary health expenditure. Patient-centered education using the teach-back method emerged as a key strategy to prevent patients\' adverse events by improving self-care.
OBJECTIVE: To evaluate the effects of discharge education using the teach-back method on self-care, self-care efficacy, symptoms of heart failure, caregiver dependency, and unplanned healthcare resource utilization among patients with heart failure.
METHODS: A prospective, two-arm randomized controlled trial.
METHODS: Four adult cardiology units at a tertiary hospital in Seoul, South Korea.
METHODS: A total of 100 patients diagnosed with heart failure and scheduled to be discharged to their homes.
METHODS: The intervention group received the HEART program® in addition to the usual discharge education by a trained nurse before discharge, while the control group received usual discharge education only. The discharge education included the definition of heart failure, medication, symptom management, diet, physical activity, and other precautions. Data on self-care (self-care maintenance; symptom-perception; self-care management), self-care efficacy, symptoms of heart failure, and caregiver dependency were measured at 7-days after discharge (T1), and unplanned healthcare resource utilization (including readmission, emergency room visit, and healthcare professional contacts) was assessed at 1-month after discharge (T2). Outcomes were analyzed with ANCOVA.
RESULTS: A total of 94 patients (intervention group = 45, control group = 49) completed outcome measurements at the three-time points. Participants in the intervention group showed a significant improvement in self-care maintenance (F = 11.597, p = 0.001), symptom perception (F = 20.173, p < 0.001), self-care management (F = 7.205, p = 0.009), and self-care efficacy (F = 4.210, p = 0.043) compared to the control group. However, there were no statistically significant differences in symptoms of heart failure, caregiver dependency, and unplanned healthcare resource utilization between the two groups (all ps > 0.05).
CONCLUSIONS: The findings demonstrated that discharge education using the teach-back method is an effective educational strategy to improve self-care and self-care efficacy in patients with heart failure. We recommend nurses implement discharge education using the teach-back method for patients with heart failure.
BACKGROUND: This study was registered at the Clinical Research Information Service (KCT0004444) on November 15, 2019, and the participant recruitment was initiated in June 2020.

Communication failure is one of the most common causes of adverse events in hospitals and poses a direct threat to patient safety. Research recommends the use of closed-loop communication in interprofessional emergency teams to prevent such events. Multiple studies have examined closed-loop communication during simulation training, but few have investigated its use in clinical practice. The aim of the study was to explore the use of closed-loop communication by anesthesia personnel in real-life interprofessional emergency teams.
This study had a descriptive, cross-sectional design where structured field observations were used to assess anesthesia personnel\'s use of closed-loop communication in real-life interprofessional emergency teams. A total of 60 interprofessional teams were observed, including 120 anesthesia personnel at a hospital in South-Eastern Norway. Data were analyzed using descriptive statistics.
A total of 1626 call outs were registered, in which closed-loop communication was applied in 45%. Closed-loop communication was used more frequently when call outs were directed using eye contact and when the call outs were medication orders. There was no difference in the use of closed-loop communication between nurse anesthetists and anesthesiologists. Closed-loop communication was used more frequently in cardiac arrest teams than in trauma teams.
The findings in this study have contributed knowledge about anesthesia personnel\'s use of closed-loop communication in real-life interprofessional emergency teams and indicate a potential for improvement. Further research is needed about real-life interprofessional emergency teams\' communication patterns and potential barriers from using closed-loop communication, with the aim to improve patient safety.

BACKGROUND: Adopting a healthy lifestyle is necessary to maintain and promote health. The aim of this study was to determine the effect of teach-back method on improving the lifestyle of health ambassadors in Urmia.
METHODS: In this quasi-experimental study, 200 health ambassadors were participated. The research sample was obtained using simple random sampling method. Data collection tool was a questionnaire including demographic characteristics and lifestyle standard. The educational intervention was performed in 4 sessions of 45 min based on the teach-back method. Data were collected through a lifestyle questionnaire before and 3 months after the educational intervention. Then, the data were analyzed by mean and standard deviation, independent t-test, paired t-test, and Chi-square test through SPSS 19.
RESULTS: The results showed that 24% of the control group and 21% of the intervention group had a good lifestyle before the educational intervention. After the educational intervention 27% of the control group and 54% of the intervention group were in good lifestyle. The results also showed that the mean score of total lifestyle and all its dimensions in the intervention group increased compared to the control group after the educational intervention and the difference between the mean score of total lifestyle and all its dimensions in the intervention group after the intervention was significant (P < 0.05).
CONCLUSIONS: Among health ambassadors, teach-back communication is more effective in improving the lifestyle. Therefore, it is suggested that this method must be used in designing training programs for health ambassadors.

BACKGROUND. Patients with adverse social determinants of health may be at increased risk of not completing clinically necessary follow-up imaging. OBJECTIVE. The purpose of this study was to use an automated closed-loop communication and tracking tool to identify patient-, referrer-, and imaging-related factors associated with lack of completion of radiologist-recommended follow-up imaging. METHODS. This retrospective study was performed at a single academic health system. A tool for automated communication and tracking of radiologist-recommended follow-up imaging was embedded in the PACS and electronic health record. The tool prompted referrers to record whether they deemed recommendations to be clinically necessary and assessed whether clinically necessary follow-up imaging was pursued. If imaging was not performed within 1 month after the intended completion date, the tool prompted a safety net team to conduct further patient and referrer follow-up. The study included patients for whom a follow-up imaging recommendation deemed clinically necessary by the referrer was entered with the tool from October 21, 2019, through June 30, 2021. The electronic health record was reviewed for documentation of eventual completion of the recommended imaging at the study institution or an outside institution. Multivariable logistic regression analysis was performed to identify factors associated with completion of follow-up imaging. RESULTS. Of 5856 recommendations entered during the study period, the referrer agreed with 4881 recommendations in 4599 patients (2929 women, 1670 men; mean age, 61.3 ± 15.6 years), who formed the study sample. Follow-up was completed for 74.8% (3651/4881) of recommendations. Independent predictors of lower likelihood of completing follow-up imaging included living in a socioeconomically disadvantaged neighborhood according to the area deprivation index (odds ratio [OR], 0.67 [95% CI, 0.54-0.84]), inpatient (OR, 0.25 [95% CI, 0.20-0.32]) or emergency department (OR, 0.09 [95% CI, 0.05-0.15]) care setting, and referrer surgical specialty (OR, 0.70 [95% CI, 0.58-0.84]). Patient age, race and ethnicity, primary language, and insurance status were not independent predictors of completing follow-up (p > .05). CONCLUSION. Socioeconomically disadvantaged patients are at increased risk of not completing recommended follow-up imaging that referrers deem clinically necessary. CLINICAL IMPACT. Initiatives for ensuring completion of follow-up imaging should be aimed at the identified patient groups to reduce disparities in missed and delayed diagnoses.

Describe the effect the teach back method on promoting the health literacy of health ambassadors in Urmia County in 2020.
In the present quasi-experiment, 200 persons over 14 years old participated. They were divided into two research groups, a control (n=100) and an intervention (n=100). The sampling method was simple randomization and the data collection instrument was a questionnaire comprised of demographic information and health literacy (HELIA). The educational intervention took 4 sessions each 45 minutes in length following the teach back method. The questionnaire-based data were collected once before the intervention and once again three months after the intervention.
The present findings showed that 54% of the control group and 50% of the intervention group had a good or very good level of health literacy before the intervention(p>0.05). However, after the intervention, 52% of the control and 78% of the intervention group had a good or very good level of health literacy. The present findings revealed that the mean scores of health literacy dimensions (access to information, reading, understanding, appraisal, decision-making) and the overall health literacy score were significantly higher in the intervention group than the control (after the intervention). Wilcoxon\'s test results showed that the mean difference of the overall health literacy scores and the dimensions before and after the intervention were statistically significant (p<0.001).
In the light of the present findings, we can conclude that participatory methods and the teach back method can improve health literacy, acquire reliable information and adopt healthy behaviors.

To investigate the effect of teach-back education on patient asthma control and family care pressure of patients with asthma.
The present study is a clinical trial and the study population was patients referred to Shahid Faghihi and Shahid Motahhari clinics in Shiraz, Iran. 58 patients with asthma and their caregivers were randomly assigned to the intervention and control groups, for a total of 29 subjects in each group. In the intervention group: the teach-back method was delivered individually to the patient and his or her primary caregiver in three sessions of approximately 60 minutes at one-day intervals. each session included presentations, practical techniques and a booklet. In this study, patients and caregivers in the control group were not trained. Before the intervention, 4 and 8 weeks after the intervention, asthma control test and spirometry test were performed to evaluate asthma control; Also, before the intervention and 8 weeks after the intervention, Zarit test was performed to evaluate the care burden.
The findings of repeated measures tests showed that, compared to the control group, the intervention group obtained a greater increase in the vital capacity index (p=0.028) and in the disease control score (p=0.001), as well as a reduction in the burden of care on family members (p<0.001).
The present study showed that teaching asthma related topics to the patient and her caregiver along with the follow-up and supervision of the nurse improves the asthma control of the patient and also reduces the caregiver pressure.