Awareness Of Guidelines Research Articles

Storytelling: An Authentic Approach to Patient Safety Nursing Education.

An annual patient safety lecture is offered through a partnership with the local children's hospital. Presentations focus on the personal impact of medical errors, as told by families, patients, and care providers. The human stories of involvement with a medical error expose situations and actions that can lead to adverse clinical events. Nursing education strategies heighten students' awareness of patient safety policies and guidelines but may not assist students to understand the human impact of medical errors and their role in preventing them. Storytelling links course content to actual accounts of lived experiences involving medical errors. It promotes reflective learning by prompting students to examine beliefs, challenge assumptions, transform their understanding of concepts, and connect theory to practice. The annual culture of safety presentation promotes a deeper understanding of the role and responsibility that nurses have in promoting safe clinical practice.

Hyperglycaemia in pregnancy: knowledge and correlates amongst antenatal care providers in healthcare facilities in Jos, Nigeria.

Antenatal healthcare providers' (AHPs) knowledge about hyperglycaemia in pregnancy (HIP) and its screening best practices affect the management of affected pregnant women. We assessed the knowledge of HIP and associated factors amongst first line AHPs. This descriptive cross-sectional study involved 188 Doctors, Nurses and Community Health providers directly involved in providing antenatal care at all levels of health care in Jos, Plateau State, Nigeria, selected through total sampling technique. A total of 103 AHPs (54.8%) were females. The mean knowledge score (SD) score was 17.0+/-5.5 (out of 30). Only 93 (49.5%) had a good knowledge of HIP (Knowledge score ≥18). Only 88 (46.8%) could correctly identify 75g OGTT or 100g OGTT as diagnostic tests for GDM. Gender, category of hospital, level of care of the institution and job designation were significantly associated with knowledge of HIP after bivariate analysis (p < 0.05). After multivariate analysis using logistic regression analysis, only the category of institution and job designation were independently associated with knowledge of HIP. The general level of knowledge of HIP among AHPs is average but awareness of testing and management guidelines is very poor hence the need for regular updates for health professionals.

How are HIV services in the UK currently identifying and managing patients with cognitive impairment? Results of a national survey.

The 2018 British HIV Association (BHIVA) Standards of Care state that people living with HIV should be questioned annually for symptoms of cognitive or memory decline. If symptoms are identified, screening should be considered and services offered if impairment is detected. We examined the availability of services, along with current practices related to the screening and management of cognitive impairment in people living with HIV, in UK HIV services. A survey was distributed via email to all UK HIV services leads on the BHIVA audit mailing list. Questions related to screening practices, referral pathways, and the management of patients with suspected cognitive impairment. Descriptive analyses were conducted on all data returned. In total, 190 surveys were distributed. Of the respondents, 39 (60.6%) stated that they undertook screening for cognitive impairment in their HIV service, and 30 (47.6%) reported not offering a specific service or referral pathway. Awareness of BHIVA screening guidelines was high (49 [84.48%]), yet 15 (30.6%) respondents stated that they were not followed in their service and 41 (71.9%) felt there was a need for training on screening, assessment, and management of cognitive impairment in patients with HIV within their department. Despite no directive, a substantial number of HIV services surveyed are routinely screening patients for cognitive impairment without guidance on when to screen and which screening tools should be used. A UK consensus on screening, along with guidance and training for services, may help to resolve this gap in service provision.

UK physiotherapists delivering physical activity advice: what are the challenges and possible solutions? A qualitative study

ObjectivesDespite the known health benefits of physical activity (PA), PA levels are in decline. Healthcare professionals, including physiotherapists, have been identified as ideal conduits to promote PA, yet their knowledge...

Quality improvement sustainability to decrease utilization drift for therapeutic hypothermia in the NICU.

Therapeutic hypothermia (TH) is now standard of care for the neuroprotection of patients with moderate to severe hypoxic-ischemic encephalopathy (HIE). TH misuse results in increased medical complication rates and high health care resource utilization. Quality improvement (QI) methodology can address drift from clinical guidelines. Assessment of sustainability of any intervention over time is an integral part of the QI methodology. Our prior QI intervention improved medical documentation using an electronic medical record-smart phrase (EMR-SP) and demonstrated special cause variation. This study serves as Epoch 3 and investigates the sustainability of our QI methods to decrease TH misuse. A total of 64 patients met the diagnostic criteria for HIE. Over the study period, 50 patients were treated with TH, and 33 cases (66%) used TH appropriately. The number of appropriate TH cases between cases of misuse increased to an average of 9 in Epoch 3 from 1.9 in Epoch 2. Of the 50 cases, 34 (68%) had EMR-SP documentation included. Length of stay and TH complication rates did not vary between cases of TH misuse and appropriate TH use. Our study confirmed a sustained decrease in TH misuse, despite inconsistent use of EMR-SP. We speculate that culture change involving increased awareness of guidelines through education may have contributed more to a lasting change.

Awareness of Placental Pathologic Examination Criteria and Utilization of Pathology Reports among Obstetricians

Background and Objectives: Several studies have reported a low rate of pathological examination of the placentas and a poor utilization of pathology reports. We assessed Saudi obstetricians' awareness and utilization of the placental pathological examination guidelines of the College of American Pathologists (CAP) and evaluated their understanding of the reports. Materials and Methods: An anonymous survey was distributed to obstetricians registered in the Saudi Commission of Health Specialties database. We examined the association between the participants' level of training or practice as well as their institution type with the surveyed elements. Results: Of 292 respondents, 34.2% were aware of the CAP guidelines. Most of them were practicing in government hospitals. Moreover, 18.2% of them routinely sent the placenta for pathological examination, and approximately 70.5% routinely reviewed the pathology reports and understood the nomenclature used; these percentages were significantly higher among university hospital practitioners. The residents were the least aware of the CAP guidelines and the least likely to review and understand the pathology reports. Regardless of the CAP guidelines awareness, the most common indication for placental pathologic examination was fetal anomalies, followed by medicolegal reasons and infections. Conclusions: Placental pathologic examination appeared uniformly underutilized in Saudi Arabia. Obstetricians are required to generate awareness of the need to comply with the CAP guidelines and to improve the understanding and utilization of pathology reports.

Midwives and service users' perspectives on implementing a dialogue about alcohol use in antenatal care: A qualitative study.

There are barriers to midwives engaging in conversations about alcohol with pregnant women. Our aim was to capture the views of midwives and service users to co-create strategies to address these barriers. Qualitative description. Structured Zoom-based focus group interviews of midwives and service users where we presented known barriers and sought solutions to midwives discussing alcohol use in antenatal settings. Data collection took place between July and August 2021. Fourteen midwives and six service users attended five focus groups. Barriers considered were as follows: (i) lack of awareness of guidelines, (ii) poor skills in difficult conversations, (iii) lack of confidence, (iv) lack of belief in existing evidence, (v) women would not listen to their advice, and (vi) alcohol conversations were not considered part of their role. Five strategies to address barriers to midwives discussing alcohol with pregnant women were identified. These were as follows: Training that included mothers of children with Foetal Alcohol Spectrum Disorder, champion midwives, a service user questionnaire about alcohol for completion before the consultation, questions about alcohol added to the maternity data capture template and a structured appraisal to provide a means of audit and feedback on their alcohol dialogue with women. Co-creation involving providers and users of maternity services yielded theoretically underpinned pragmatic strategies to support midwives to ask advise assist about alcohol during antenatal care. Future research will test if the strategies can be delivered in antenatal care settings, and if they are acceptable to service providers and service users. If these strategies are effective in addressing barriers to midwives discussing alcohol with pregnant women, this could support women to abstain from alcohol during pregnancy, thus reducing alcohol-related maternal and infant harm. Service users were involved in the design and execution of the study, considering data, supporting intervention design and delivery and dissemination.

A survey of patient contact shielding in dental teaching hospitals in the UK

A high volume of dental imaging is carried out each year. In the UK, guidance on the use of patient contact shielding for these investigations is published by the British Institute of Radiology (BIR) and in a document jointly produced by the Faculty of General Dental Practice and Public Health England (FGDP/PHE). Both these sources of guidance have been updated recently and patient contact shielding is no longer recommended for most imaging settings in dental radiology. It is unclear whether radiology departments at dental teaching hospitals in the UK are aware of these sources of guidance, and how this relates to clinical practice within these departments. A survey was carried out exploring the awareness of current guidelines and clinical practice at dental teaching hospitals in the UK. The survey was sent to a representative at 17 different dental teaching hospital radiology departments. Responses were received from 11 departments. The range of intra-oral and extra-oral imaging carried out at these departments was comparable. Ten departments were aware of the existence of national guidelines for patient contact shielding, however only four were specifically aware of the recent BIR guidelines and only four were specifically aware of the FGDP/PHE guidelines. No department was aware of both sets of guidelines. No departments used thyroid protection for bitewing, periapical, lower 45 degree occlusal, panoramic or lateral cephalometric radiographs. Six departments sometimes or always used thyroid protection for upper standard occlusal imaging. Two departments used thyroid protection for cone beam CT imaging. No departments routinely used lead aprons on patients for dental imaging. In conclusion, radiology departments at dental teaching hospitals in the UK do not use patient contact shielding for most imaging situations in dental radiology. There is mixed awareness of current national guidelines, but the reported clinical practice aligns well with the current guidelines.

SPIRIT and CONSORT extensions for early phase dose-finding clinical trials: the DEFINE (DosE-FIndiNg Extensions) study protocol

IntroductionEarly phase dose-finding (EPDF) studies are critical for the development of new treatments, directly influencing whether compounds or interventions can be investigated in further trials to confirm their safety and...

Changes in prostate specific antigen (PSA) “screening” patterns by geographic region and socio-economic status in Australia: Analysis of medicare data in 50–69 year old men

BackgroundWhile it is known that national PSA testing rates have decreased in Australia since 2007, it is not known whether these trends are consistent by broad geographical areas, nor whether previously reported area-specific differences have remained in more recent time periods. MethodsPopulation-based cohort study of Australian men (n = 2793,882) aged 50–69 who received at least one PSA test (Medicare Benefit Schedule item number 66655) during 2002–2018. Outcome measures included age-standardised participation rate, annual percentage change using JoinPoint regression and indirectly standardised participation rate ratio using multivariable Poisson regression. ResultsDuring 2005–09, two thirds (68%) of Australian men aged 50–69 had at least one PSA test, reducing to about half (48%) during 2014–18. In both periods, testing rates were highest among men living in major cities, men aged 50–59 years, and among men living in the most advantaged areas. Nationally, the Australian PSA testing rate increased by 9.2% per year between 2002 and 2007, but then decreased by 5.0% per year to 2018. This pattern was generally consistent across States and Territories, and socio-economic areas, however the magnitude of the trends was less pronounced in remote and very remote areas. ConclusionsThe decreasing trends are consistent with a greater awareness of the current guidelines for clinical practice in Australia, which recommend a PSA test be done only with the informed consent of individual men who understand the potential benefits and risks. However, given there remain substantial geographical disparities in prostate cancer incidence and survival in Australia, along with the equivocal evidence for any benefit from PSA screening, there remains a need for more effective diagnostic strategies for prostate cancer to be implemented consistently regardless of where men live.

Trends in Public Awareness and Knowledge of Drinking Guidelines: a Representative Population Survey in England, 2016-2022.

To examine trends in public awareness and knowledge of drinking guidelines in the UK since their revision in 2016, which had moved from a daily to a weekly guideline, made the guideline the same for men and women, and reduced the guideline for men by around one-third. Data were from a representative, repeat cross-sectional survey. We analysed changes in awareness and knowledge of drinking guidelines among 8168 adult drinkers between 2016 and 2022 and associations with sociodemographic characteristics, smoking status and level of alcohol consumption. The proportion of drinkers aware of guidelines declined from 86.0% (95%CI 84.0-88.0%) in 2016 to 81.7% (79.5-84.0%) in 2019, then increased during the COVID-19 pandemic, peaking at 91.6% (90.1-93.1%) in 2020. The proportion who correctly identified the guideline as a maximum of exactly 14units/week remained at around a quarter from 2016 (25.0%, 22.4-27.5%) to 2018 (25.8%, 23.2-28.3%), whereas the proportion who gave a figure of 14units or fewer rose from 52.1 (49.2-55.0%) to 57.4% (54.6-60.3%). However, by 2022, guideline knowledge had worsened significantly, with these figures falling to 19.7 (17.4-21.9%) and 46.5% (43.6-49.4%), respectively. Changes over time were similar across subgroups. Odds of guideline awareness and knowledge were higher among drinkers who were aged ≥35, female, more educated and from more advantaged social grades. The majority of adult drinkers in the UK are aware of low-risk drinking guidelines. However, 6years since their announcement, knowledge of the revised drinking guidelines remains poor. Less than a quarter know the recommended weekly limit and only around half think it is 14units or less. Inequalities have persisted over time, such that disadvantaged groups remain less likely to know the guidelines.

Understanding influences on the use of professional practice guidelines by pharmacists: A qualitative application of the COM-B model of behaviour

Pharmacy practice in Australia is guided by professional practice guidelines. The guidelines communicate expected pharmacist behaviours to facilitate a consistently high standard of patient care, but are infrequently used by pharmacists and students. It is therefore essential to understand what influences pharmacists’ use of professional practice guidelines and how best to support positive behaviour change towards utilising these guidelines. To explore perceived influences on the use of professional practice guidelines by Australian pharmacists, and to map these influences to the COM-B model of behaviour. Focus group discussions were undertaken with pharmacists (including intern pharmacists) from various practice settings, locations, and with varying years of experience. Audio-recordings from each focus group were de-identified and transcribed verbatim. Transcripts were analysed using the COM-B (‘capability’, ‘opportunity’, ‘motivation’ and ‘behaviour’) model. Nine focus groups with 45 participants were conducted. Limited awareness of professional practice guidelines hindered pharmacists' ‘capability’ to use them. Pharmacists indicated that challenges accessing, and suboptimal content design, limited their ‘opportunity’ to use the guidelines. Pharmacists' professional role and identity (‘motivation’) appeared to inhibit use of the guidelines if they were perceived to not apply to their current role, or if pharmacists believed their experience obviated the need to use them. Motivation to use professional practice guidelines was associated with a belief that the guideline(s) would support pharmacists in their practice. Understanding what influences the use of professional practice guidelines should inform interventions to target and improve pharmacists’ use of the guidelines. The Behaviour Change Wheel offers clear next steps for this process. Awareness, access, and content could be improved in the first instance, and this may also work to improve motivation. Leveraging influences on motivation may serve to ensure that use of professional practice guidelines is embedded in future practice, albeit motivation can be more difficult to target.

Does health literacy moderate the psychological pathways of physical activity from guideline awareness to behavior? A multi-group structural equation modeling

BackgroundAwareness, knowledge, beliefs, and behavioral intentions of physical activity (PA) guidelines may be important mediating factors for promoting PA. However, these pathways of the psychological process to PA behavior have not been examined. These pathways may differ depending on health literacy levels. This study investigated the pathways to PA, from guideline awareness to behavior, and further examined whether they differed by health literacy.MethodsA cross-sectional study was conducted with 7,000 Japanese participants aged 20–69 years. The participants were registered with an Internet survey company. Participants’ awareness, knowledge, beliefs, and behavioral intentions regarding the PA guidelines of Japan, the volume of moderate-to-vigorous intensity PA, activity level, and health literacy were examined through a questionnaire. The PA pathways, from guideline awareness to behavior, were examined by structural equation modeling (SEM), with PA behavior as the dependent variable. Multi-group SEM was conducted to examine the moderating effect of health literacy on PA pathways. Health literacy scores were dichotomized into high and low groups in multi-group modeling by the median split.ResultsSEM revealed that PA guideline awareness directly affects PA behavior and has certain indirect effects through the mediation of knowledge, beliefs, and behavioral intentions. Furthermore, the multi-group SEM showed that the proportion of indirect effects (path coefficient [PC]: 0.11, 95% confidence interval [CI]: 0.10–0.13) was higher than direct effects (PC: 0.07, 95%CI: 0.03–0.11) in the high-health literacy group. In contrast, the proportion of direct effects (PC: 0.22, 95%CI: 0.15–0.30) was higher than indirect effects (PC: 0.06, 95%CI: 0.05–0.07) in the low-health literacy group.ConclusionsPA guideline awareness is both directly and indirectly associated with PA behavior, mediated by psychological pathways of knowledge, beliefs, and behavioral intentions, and influenced by health literacy. These results suggest that health literacy should be considered when implementing PA guideline-based interventions.

Differences in Awareness of Chinese Dietary Guidelines Among Urban and Rural Residents: A Cross-Sectional Survey in Southwest China.

Objectives: This study aimed to compare the awareness of Chinese dietary guidelines (CDGs, 2016) between rural and urban areas in Southwest China and identify the factors that affect CDGs (2016) awareness. Methods: This cross-sectional survey included 8,320 individuals aged 18-75years from Chongqing, Sichuan, Guizhou, and Yunnan, China. Convenience sampling method was adopted to select the survey subjects and face-to-face surveys in each region were conducted to collect data. Descriptive statistics and generalized linear model were used to evaluate differences in awareness of CDGs among urban and rural residents and its influencing factors. Results: Overall CDGs awareness was low in urban and rural areas, although the awareness rate was higher in the former than in the latter (29.1% vs. 19.9%, respectively). Region, education level, Body Mass Index (BMI), gender, income, and age are the influencing factors of CDGs awareness. Urban participants were likely to acquire relevant knowledge from social media, books/magazines, family/friends, and experts. However, rural participants were likely to acquire relevant knowledge from food sales staff (p < 0.05). Conclusion: Rural residents are less aware of CDGs than their urban counterparts in Southwest China. Future dietary education should adopt different strategies for different populations, with considerable focus on rural residents.

Mapping European Association of Urology Guideline Practice Across Europe: An Audit of Androgen Deprivation Therapy Use Before Prostate Cancer Surgery in 6598 Cases in 187 Hospitals Across 31 European Countries

BackgroundEvidence-practice gaps exist in urology. We previously surveyed European Association of Urology (EAU) guidelines for strong recommendations underpinned by high-certainty evidence that impact patient experience for which practice variations were suspected. The recommendation “Do not offer neoadjuvant androgen deprivation therapy (ADT) before surgery for patients with prostate cancer” was prioritised for further investigation. ADT before surgery is neither clinically effective nor cost effective and has serious side effects. The first step in improving implementation problems is to understand their extent. A clear picture of practice regarding ADT before surgery across Europe is not available. ObjectiveTo assess current ADT use before prostate cancer surgery in Europe. Design, setting, and participantsThis was an observational cross-sectional study. We retrospectively audited recent ADT practices in a multicentre international setting. We used nonprobability purposive sampling, aiming for breadth in terms of low- versus high-volume, academic, versus community and public versus private centres. Outcome measurements and statistical analysisOur primary outcome was adherence to the ADT recommendation. Descriptive statistics and a multilevel model were used to investigate differences between countries across different factors (volume, centre type, and funding type). Subgroup analyses were performed for patients with low, intermediate, and high risk, and for those with locally advanced prostate cancer. We also collected reasons for nonadherence. Results and limitationsWe included 6598 patients with prostate cancer from 187 hospitals in 31 countries from January 1, 2017 to May 1, 2020. Overall, nonadherence was 2%, (range 0–32%). Most of the variability was found in the high-risk subgroup, for which nonadherence was 4% (range 0–43%). Reasons for nonadherence included attempts to improve oncological outcomes or preoperative tumour parameters; attempts to control the cancer because of long waiting lists; and patient preference (changing one’s mind from radiotherapy to surgery after neoadjuvant ADT had commenced or feeling that the side effects were intolerable). Although we purposively sampled for variety within countries (public/private, academic/community, high/low-volume), a selection bias toward centres with awareness of guidelines is possible, so adherence rates may be overestimated. ConclusionsEAU guidelines recommend against ADT use before prostate cancer surgery, yet some guideline-discordant ADT use remains at the cost of patient experience and an additional payer and provider burden. Strategies towards discontinuation of inappropriate preoperative ADT use should be pursued. Patient summaryAndrogen deprivation therapy (ADT) is sometimes used in men with prostate cancer who will not benefit from it. ADT causes side effects such as weight gain and emotional changes and increases the risk of cardiovascular disease, diabetes, and osteoporosis. Guidelines strongly recommend that men opting for surgery should not receive ADT, but it is unclear how well the guidance is followed. We asked urologists across Europe how patients in their institutions were treated over the past few years. Most do not use ADT before surgery, but this still happens in some places. More research is needed to help doctors to stop using ADT in patients who will not benefit from it.

Effect of Continuous Medical Education on Awareness of Clinical Imaging Guidelines Among Imaging Referrers in Sub-Saharan Africa

Rationale and objectives: In recent decades, there has been an effort to improve the quality and safety of medical imaging globally. Such, has been promoted through the application of decision aid tools. Clinical Imaging Guidelines (CIGs) are systematically developed statements to assist referrers to make appropriate patient imaging decisions for screening, diagnosis and management of conditions. Awareness of such guidelines prompts their application thus enhancing safety of imaging procedures. There is evidence of low levels of awareness elsewhere but such hasn’t been assessed in Sub-Saharan Africa. The study assessed the CIGs awareness level among imaging referrers before and after giving continuous medical education (CME) and awareness materials. Methods: A pre and post -CME mean score of 18 item questionnaire on awareness on CIGs for 109 referrers from 5 health facilities were compared. A statistical difference in the mean scores for the pre and post intervention assessment was determined using a paired T-test at P > 0.05 and Confidence interval of 95%. Results - At baseline, we found a 47% level of CIGs awareness and after the intervention we found a level of 59%. There was a significant statistical change of 12% level of CIGs awareness from pre-intervention 47% to post intervention 59% at P-value < 0.0001 and 95% confidence interval (7.8-16.4). Conclusion and Recommendation: Routine CMEs are a good to start platforms for enhancing awareness of CIGs and strengthening justification of medical exposures.

Are there differences in perceptions, preferences and attitudes towards disclosure of genetic testing for Stroke? A qualitative study among stroke-free SIREN-SIBS genomics study participants

ObjectiveThis study explored perceptions, preferences and attitudes towards disclosure of genetic testing results for stroke among stroke-free controls (and their family members) in the SIREN-SIBS Genomics Study, healthcare providers and policymakers. Materials and MethodsWe conducted a qualitative thematic analysis of key informant interviews with 61 participants recruited from community advisory boards (30) and health care providers (31) across seven sites in Nigeria and Ghana. ResultsMajor findings illustrate differences in the knowledge of genetic testing with superior knowledge among health care professionals. Relatives and religious leaders were opined as the best to receive the disclosure as they would be able to break the news to the patient in a culturally sensitive manner to reduce the likely resultant emotional outburst. Poor level of awareness of national guidelines for disclosing genetic results exist. Key facilitating factors for disclosure are education, enabling environment, involvement of religious and community leaders, campaigns, and possible treatment options. Disclosure inhibitors include inadequate information, fear of marital break-up or family displacement, fear of stigmatization, fear of isolation, religious beliefs, health worker attitude, and lack of preparedness to accept results. ConclusionsThese necessitate culturally sensitive interventions for continuing education, increased awareness and sustained engagement to equip all stakeholders in genetic testing disclosure process.

Promoting oral and dental health in early childhood - knowledge, views and current practices among paediatricians in Israel.

The aim of this study was to evaluate the knowledge and practice of paediatricians in promoting oral and dental health among young patients (under age 36 months) and their parents. 145 anonymous questionnaires were distributed among paediatricians, 130 of them were 90% or above answered and were suitable for analysis for this study.75% of the questionnaires were distributed during the national convention of the Israeli Association of Clinical Paediatrics, 10% in paediatric ambulatory clinics and 15% in paediatric departments in hospitals. Questionnaires were distributed between 2018 and 2020. The inclusion criteria were physicians specialists in paediatrics or residents in paediatrics, all have Israeli licences to practice in Israel. exclusion criteria were partially filled questionnaires. The questionnaire was validated in a pilot study during the years 2010-2012. In addition to demographic variables that included medical training, post-graduate education and clinical practice the questionnaire included 42 questions. Eleven questions on demographics and amount of dental training during academic and clinical training 31 questions belonged to several sections that referred to the participants' awareness of the AAP guidelines regarding oral and dental health and knowledge of oral health. In each section paediatricians were asked to answer or give an opinion on a specific issue, their answers were coded to scores on a scale of 0-5 and summed per section. Correlations between different variables were analysed. The t-test and Mann-Whitney U test were performed for comparing two variables. For comparing more than two variables, we used the Kruskal-Wallis one-way analysis of variance test or ANOVA. The response rate was 89% (130 questionnaires out of 145). The survey showed that most paediatricians (80%) recognized their role in maintaining the oral and dental health of their young patients. Nevertheless, most admitted that they do not perform simple procedures on a regular basis, like dental examinations (64.6%), or asking parents about feeding habits (59.2%) or teeth brushing (75.4%). Only 21% of the participants expressed adequate knowledge of dental care for children younger than age 3 years. Fifty-eight percent of the participants never had any dental training during their entire paediatric medicine training, including medical school. Paediatricians in private or baby clinics received higher scores in practicing caries prevention, 24.15 ± 5.17 (SD), than paediatricians in hospitals, 2.79 ± 0.54 (SD) (p = 0.006). Caries prevention practice was not found to correlate with paediatricians' knowledge or attitudes regarding oral and dental caries prevention. Oral and dental knowledge should be incorporated into the paediatric medicine curriculum. With their heavy workload, paediatricians generally do not implement dental caries risk assessment and counselling.

Staff perspectives on smoking cessation treatment in German psychiatric hospitals

AimAlthough people with mental illness show a greater severity of nicotine dependence and have a significantly reduced life expectancy because of it, psychiatric staff rarely offer their patients smoking cessation support and are reluctant to encourage patients to quit. In order to improve smoking cessation treatment for psychiatric patients, such staff resistance must be better understood.Subjects and methodsA total of 448 members of staff in eight psychiatric units in Berlin were surveyed in relation to their attitudes towards smoking cessation.ResultsAlthough most participants recognize the importance of smoking cessation in psychiatric patients, they state that they do not adhere to international guidelines which recommend regularly asking patients about their smoking habits and offering cessation support. Staff have little knowledge about how to facilitate smoking cessation treatment and about the influences of smoking on the metabolism of drugs. They also harbor misconceptions about how smoking affects their patients’ mental well-being. Many express concern that a quit attempt might thwart psychiatric treatment and lead to aggressive behavior—assumptions unsupported by scientific evidence. The overwhelming majority does not believe it to be realistic that patients can manage to give up smoking during treatment.ConclusionsStaff training should be directed to heighten awareness of the international guidelines and treatment options for smoking cessation and impart knowledge on how smoking impacts both the physical and mental health of psychiatric patients.

Determinants of Awareness of Clinical Practice Guidelines among Healthcare Users in Japan.

Clinical practice guidelines (CPGs) are used by both healthcare users and providers, so their recognition is important. The present study's purpose was to clarify the features of healthcare users who are aware of the CPGs. A cross-sectional survey was conducted targeting Internet survey panels (n = 6000). The study participants (age range, 20s to 60s) had no medical qualifications and had received medical care in the last 3 months. Multivariate logistic regression analysis was performed to clarify the factors related to the awareness of CPGs. When "I have seen the CPGs" was used as the objective variable, the odds ratios (ORs) were high for "e-health literacy/score 31-40" (OR = 8.72, 95% confidence interval [CI]: 6.51-11.68), "Sources of health information/healthcare workers and professionals" (OR = 2.61, 95% CI: 2.17-3.14), "Age/20s" (OR = 2.38, 95% CI: 1.74-3.23), and "I have been diagnosed and treated for a major illness" (OR = 2.01, 95% CI: 1.52-2.65). These results could be applied to aid the dissemination and utilization of CPGs among healthcare users.