Confidence In Healthcare Providers Research Articles

Effect of a Standardized Education Program for Interhospital Transport of Critically Ill Patients on Knowledge and Confidence in South Korea: A Pilot Study

Critical care transport (CCT) education and training for health care providers are important for patient safety. In this study, a structured education and training program for CCT was implemented as a pilot in South Korea, and the effects of improving knowledge and confidence among health care providers were evaluated. This retrospective observational study analyzed pre- and post-test scores and survey responses from participants in the education program. The education program consisted of a didactic lecture, skill practice, and simulation for 9 categories lasting 80 hours. The participants included nurses and emergency medical technicians with experience in emergency or critical care. The study consisted of 2 phases, with data collected through web-based evaluation forms and structured questionnaires. The program involved 20 participants across the 2 phases. Posteducation assessments revealed significant improvements in knowledge and confidence in CCT practices. The participants were especially satisfied with their skill in trauma management and advanced CCT simulations. The Korean Critical Care Transport Curriculum education program effectively enhanced the knowledge and confidence of health care providers in CCT. This standardized education model should be considered by policy makers and stakeholders to improve patient safety in emergency medical systems.

Examining How Structural Conditions, Cultural Norms, and Institutional Practices Shape Diagnostic Delays for Women in Ontario: A Critical Qualitative Study

There are a number of diseases and conditions that have notoriously long diagnostic periods. Often associated with a downplaying or dismissal of symptoms and feelings of shame, many of these diseases and conditions disproportionately manifest among women. Endometriosis, for instance, takes on average three to ten years to diagnose, and cardiovascular disease, ADHD, and pain conditions such as fibromyalgia and rheumatoid arthritis represent other common examples. During a diagnostic delay – when the period becomes prolonged between seeking care until the point at which a diagnosis is made – women continue to suffer from symptoms, lose confidence in healthcare providers and systems, and experience interruptions to their lives, relationships, and sense of self. While several investigations have produced descriptive accounts of these reasons, they leave unaddressed women’s embodied experiences of diagnostic delays, socio-political structures and power relations, such as gender, and the interrelationships between these two components. To address this gap, I will draw on critical phenomenology to ask: How are diagnostic delays lived as embodied social practices by women?; What do narratives of diagnostic delay reveal about gendered embodiment during illness? and In what ways do women’s embodied experiences of illness resist, reinforce, and revise the cultural expectations and institutional practices that contribute to diagnostic delays?. In doing so, my research aims to understand how socio-political structures and power relations are intertwined with embodied experiences of diagnostic delay, and the ways the relationship between them serves to support and/or disrupt this phenomenon. Critical phenomenology engages with a wide range of critical disciplines to understand rich subjective experiences and how normalizing structures privilege some experiences and marginalize others. Drawing on this methodology, I will interview women with lived experience of diagnostic delay and clinicians who have experienced delays in diagnosing women. I will also review relevant practice guidelines and organizational policies to further contextualize this phenomenon. By exploring the intertwined nature of women’s embodied experiences of illness with social structures, and how these relationships serve to impact diagnostic delays for women, this project will importantly address the lack of specific and critical discourse on this phenomenon. In doing so, it will not only advance scholarship in this area, but will also support the continued discussion and advocacy that is essential to effecting change to this enduring and wicked problem.

A Qualitative Assessment of Healthcare Providers’ Insights towards Utilization of Symptothermal Method to Ameliorate Unmet Need for Family Planning among Women in Kisumu County, Kenya

Purpose: To attain the Sustainable Development Goals (SDGS) 3- target 3.7, that highlights the need to improve women’s sexual and reproductive health status through means including family planning, information and education, a safer family planning method that could ameliorate unmet need for family planning, is urgently required. Healthcare providers’ knowledge and perception of natural family planning might influence decision of women interested in Symptothermal method (STM). We investigated healthcare providers’ factors influencing utilization of STM as a strategy to ameliorate unmet need for family planning among women in Kisumu County, Kenya. Methodology: Focus group discussion technique was used involving 14 healthcare providers and 8 STM users purposively selected. Phenomenology approach to enquiry which aims to investigate experiences from the perspective of the participants was adopted. Reflexive Thematic analysis was used. Data were transcribed and the thematic codes categorized were applied to assess all focus group transcripts. Dedoose 9.2.005 software was used for the analysis. Findings: Three themes were identified. Disclosure of untapped demand emerged as a significant insight, with healthcare providers admitting their previous oversight of the role of STM as part of other family planning methods. To ensure the successful integration of STM in healthcare facilities, healthcare providers identified training and community awareness as primary strategies. A major challenge identified was limited dissemination of information to clients, with healthcare providers often prioritizing and promoting contraceptive methods in which they are more confident. Unique contribution to theory, practice and policy: Comprehensive training would play a pivotal role in fostering a thorough understanding of STM among service providers. This understanding would instill confidence in healthcare providers, empowering them to effectively convey information to clients with assurance and clarity.

Nonadherence to oral cancer chemotherapy in hepatocellular carcinoma: prevalence and predictive factors in Vietnam

PurposeStandard oral cancer chemotherapy (OCT) or targeted therapy (OTT) has expanded the treatment methods for hepatocellular carcinoma (HCC). However, its principal nonadherence causes a reduction in efficacy. We aimed to evaluate the status of nonadherence and influencing factors among outpatient patients with HCC.Patients and methodsIn 2021, a prospective observational study was conducted on 384 patients with either old or newly diagnosed HCC treated with OTT. Nonadherence to OCT was determined using the eight-item Morisky Medication Adherence Scale, with a score < 6 points. The patients were finished with a six-month follow-up investigation by questionnaires.Results54,8% of HCC outpatients were nonadherent to OCT, with a mean Morisky score of 5.19. They dropped out of the treatment mainly because of drug side effects, such as fatigue (72.4%), hand-foot syndrome (42.7%), diarrhea (38.3%), nausea (25%), insomnia (24.7%), abdominal pain (12%), and anxiety about these adverse events (65.9%). Additionally, financial difficulties and low relative copayments were significantly correlated with the noncompliant treatment of patients (OR = 2.29, 95% CI = 1.32–3.98, P = 0.003; OR = 4.36, 95% CI = 0.95–19.93, P = 0.039, respectively). Moreover, inadequate individual information about the clinical course, the art of treatment, and medication usage instructions were suggestive barriers to adherence to treatment (OR = 1.96, 95% CI = 1.08–3.55, P = 0.024; OR = 1.86, 95% CI = 1.1–3.14, P = 0.02; OR = 2.34, 95% CI = 1.29–4.26, P = 0.004, respectively). Finally, a low level of trust in doctors was an essential factor in nonadherence (Mean of the Anderson Trust in Physician Scale scores counted 38.12 vs. 43.97, respectively for non-adherence vs. adherence, P = 0.00001).ConclusionsThis study suggests a high rate of primary nonadherence to standard oral targeted therapy among HCC outpatient patients because of drug side effects, patient awareness of treatment, and lack of confidence in healthcare providers. Close supervision, proper medication instructions, appropriate dosage reductions, and comprehensive patient counseling might be necessary to control nonadherence.

Exploring young adults' fears related to healthcare and dental procedures.

Fear and anxiety related to dental and healthcare procedures are common among young adults and can negatively impact dental and healthcare consumership, resulting in poor health outcomes. This cross-sectional study aimed to examine young adults' experiences of fear related to dental and healthcare procedures and the potential relationships between the two forms of fear experiences and demographic factors. Young adults (252) were recruited from a large public university and completed a survey about their dental and healthcare fear/anxiety as well as their confidence in healthcare professionals. Descriptive and correlational analyses were completed to describe the experiences of young adults and the relationships between variables. Ten types of fear/anxiety were identified related to healthcare procedures, with the most common being needles and pain. Nine fears/anxieties were identified for dental visits, of which pain and sensory experiences other than pain were most common. Female participants were significantly more likely to report fear/anxiety related to dental procedures, and there was a statistically significant relationship between fear/anxiety related to healthcare procedures and that related to dental procedures. There was also a significant negative relationship found between confidence in healthcare providers and fear/anxiety related to healthcare procedures. Young adults experience fear/anxiety related to healthcare and dentist visits, and this fear/anxiety can impact their confidence in healthcare providers, such as primary physicians. The findings of the current study suggest primary care providers should be aware of potential fears/anxieties and offer patients appropriate supports.

Barriers and facilitators of fetal heart monitoring with a mobile cardiotocograph (iCTG) device in underserved settings: An exploratory qualitative study from Tanzania.

Fetal monitoring in low-resource settings is often inadequate. A mobile cardiotocograph fetal monitoring device is a digital innovation that could ensure the safety of pregnant women at high risk and their fetuses through early detection and management of fetal distress. Research is scarce on factors that affect the implementation of fetal heart monitoring using the mobile cardiotocograph device in low-resource settings, including Tanzania. This study aimed to explore the barriers and facilitators of fetal monitoring with a mobile cardiotocograph device in Tanzania. We adopted an exploratory qualitative study to analyze the barriers and facilitators of fetal monitoring using the mobile cardiotocograph device in primary healthcare facilities. Seventeen face-to-face in-depth interviews with healthcare providers and seven focus group discussions with women were conducted. Braun and Clarke's thematic analysis guided the data analysis. It included the following steps: familiarizing with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. Three themes emerged as barriers: individual-related ones, including inadequate knowledge and skills to use mobile cardiotocograph devices, institutional barriers attributed to limited referral infrastructures and staff shortage, and community-related barriers, such as myths and misconceptions that limit antenatal care checkups. Individual factors, including motives and desires of healthcare providers and community trust in the healthcare system, support systems related to training and mentorship opportunities for healthcare providers, and the availability of community-based health programs in the respective areas, were revealed as facilitators of mobile cardiotocograph devices. Implementing iCTG in primary healthcare facilities is affected by several factors, from individual to institutional level. Providing user-friendly procedure manuals and training on the functions of the iCTG device and cardiotocograph interpretations could serve as potential solutions to improve the competence and confidence of healthcare providers. Moreover, the availability of supportive infrastructure, adequate human resources for health, and community sensitization were good points to start with when addressing institutional and community barriers. Nevertheless, multistakeholder engagement during the design and implementation of fetal monitoring using a mobile cardiotocograph device is warranted.

1140. Impact of an Implementation Science Initiative to Improve Vaccine Confidence for Invasive Meningococcal Disease (IMD) Prevention within American Indian (AI) Communities

Abstract Background Meningococcal vaccine uptake among adolescents remains suboptimal. This project aimed to identify barriers and motivators for vaccination in AI communities. Methods Between 12/2022 and 2/2023, 3 live family education sessions were held within AI communities in WI and ND. Healthcare provider (HCP) participants also attended a workshop to review current vaccine recommendations. Surveys were administered before/after the workshop and family education sessions. Results Surveys were completed by 56 family members. Baseline confidence in vaccine safety, efficacy and benefit was low, which increased after the sessions (Fig. 1). Parent understanding that the vaccine cannot cause disease improved from 51% to 82% (p =.001). Top reported barriers to vaccination were concern for immediate side effects and long-term side effects, and low perceived risk for IMD (34%, 26%, 25%, respectively). Parents identified learning more about IMD (40%), friends/family getting vaccinated (19%), and a local outbreak (12%) as top motivators to seek vaccination. When asked what they thought would motivate families to seek vaccination, HCPs leading the sessions (n=11) identified learning more about IMD (82%) and friends/family getting vaccinated (27%) only. HCP confidence in counseling families was low and improved after the sessions (Fig. 2). HCPs attending the workshop (n=28) reported discomfort contradicting patients/families as the top challenge in addressing vaccine hesitancy, and more HCPs felt confident having conversations to reduce vaccine hesitancy after the workshop (80%) than before (28%). HCP knowledge improved after the workshop, and more HCPs understood that MenACWY booster doses are not needed when initial vaccination occurs at age ≥16 (50%), and correctly identified “provider recommendation” as the top literature-reported factor influencing parental vaccine decisions (50%) compared to baseline (32% and 14%, respectively). HCP action plans for after the sessions prioritized routinely discussing vaccines at well visits (80%), providing written materials (50%) and staying current on new vaccines (50%). Conclusion Parent and provider knowledge and confidence improved after the program and offered insights into community-level motivators and barriers to vaccination. Disclosures All Authors: No reported disclosures

"It's complicated…": Exploring second stage caesarean sections and reasons for non-performance of assisted vaginal births in Kenya: A mixed methods study.

Unnecessary Caesarean Section (CS) can have adverse effects on women and their newborns. Assisted vaginal birth/delivery (AVB/AVD) using a suction device or obstetric forceps is a potential alternative when delays or complications occur in the second stage of labour. Unlike CS, AVB using a suction device does not require regional or general anaesthesia, can often be performed by midwives, and does not scar the uterus, lowering the risk of maternal mortality and morbidity, in this and subsequent pregnancies. This study examined the appropriateness and outcomes of second stage CS (SSCS), and reasons for low levels of AVB use, in Kenya. Using a mixed methods study design, we reviewed case notes from women having SSCS births and AVB, and conducted key informant interviews with healthcare providers, from 8 purposively selected hospitals in Kenya. Randomly selected SSCS and all AVB case notes were reviewed by a panel of four experienced obstetricians, and appropriateness of the procedure assessed. Semi-structured interviews were conducted with obstetricians, medical officers and midwives, and analysed using a thematic approach. Review of 67 SSCS case notes showed 10% might have been conducted as AVBs, with a further 58% unable to be classified due to inadequate/inconsistent record keeping or excessive delay following initial CS decision. Outcomes following SSCS showed perinatal mortality rate of 89.6/1,000 births, with 11% of infants and 9% of mothers experiencing complications. Non-referred cases of AVB showed good outcomes. The findings of the 20 interviews explored the experience and confidence of healthcare providers in performing AVBs, and adequacy of the training they received. Key reasons for non-performance included lack of functioning equipment, lack of trained staff or their rotation to other departments. Reasons for non-performance of AVB were complex and often multiple. Any solutions to these problems will need to address various local, regional and national issues.

Enhancing Pediatric Mental Health Care in an Outpatient Primary Care Setting Using the Keep Your Children/Yourself Safe and Secure (KySS) Program: A Multidisciplinary Quality Improvement Project

This project aimed to enhance access to pediatric mental primary health care. The Keep Your Children/Yourself Safe and Secure (KySS) training was offered to a multidisciplinary team at a Federally Qualified Health Clinic in the Midwest United States. Confidence was measured using the Healthcare Provider Confidence Scale (HPCS). Frequencies of visits and mental health referrals were compared preintervention/postintervention. HPCS scores were compared using Wilcoxon rank-sum and Cohen's d. Referrals in 2022 were greater than in 2020 but less than in 2021 (p=.25). The total number of visits declined from 431 in 2021 to 385 in 2022. HPCS (n=9) scores trended higher following the KySS Program in prescribing and general positive beliefs. Referrals to mental health providers increased, although not significantly. The number of mental health visits varied between 2020-2022. Provider confidence was not significantly affected, whereas beliefs in prescribing did increase significantly. More work is necessary to understand the impact of delivery to a multidisciplinary team.

Healthcare Provider Confidence and Perceived Barriers to Diagnosing Illness Associated with Harmful Algal Blooms

Healthcare Provider Confidence and Perceived Barriers to Diagnosing Illness Associated with Harmful Algal Blooms

Quality of Life and Real-time Patient Experience During Neoadjuvant Therapy: A Prospective Cohort Study.

To use a customized smartphone application to prospectively measure QOL and the real-time patient experience during neoadjuvant therapy (NT). NT is increasingly used for patients with localized gastrointestinal (GI) cancers. There is little data assessing patient experience and quality of life (QOL) during NT for GI cancers. Patients with GI cancers receiving NT were instructed on using a customized smartphone application through which the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, a validated measure of health-related QOL, was administered at baseline, every 30 days, and at the completion of NT. Participants also tracked their moods and symptoms and used free-text journaling functionalities in the application. Mean overall and subsection health-related QOL scores were calculated during NT. Among 104 enrolled patients, the mean age was 60.5 ± 11.5 years and 55% were males. Common cancer diagnoses were colorectal (40%), pancreatic (37%), and esophageal (15%). Mean overall FACT-G scores did not change during NT ( P = 0.987). While functional well-being scores were consistently the lowest and social well-being scores the highest, FACT subscores similarly did not change during NT (all P > 0.01). The most common symptoms reported during NT were fatigue, insomnia, and anxiety (39.3%, 34.5%, and 28.3% of patient entries, respectively). Qualitative analysis of free-text journaling entries identified anxiety, fear, and frustration as the most common themes, but also the importance of social support systems and confidence in health care providers. While patient symptom burden remains high, results of this prospective cohort study suggest QOL is maintained during NT for localized GI cancers.

A Novel Provider Education Module to Enhance Detection of Alpha-1 Antitrypsin Deficiency.

Alpha-1 antitrypsin deficiency (AATD) is the most common genetic risk factor for early-onset emphysema. However, AATD continues to be underrecognized and underdiagnosed. Provider awareness about AATD, concerns with testing costs, and limited understanding about therapeutic options contribute to its underdiagnosis. We hypothesized that provider education would improve awareness of AATD and improve screening. To evaluate the impact of a targeted provider education module on AATD screening. We developed a web-based education module to address barriers to screening for AATD, deployed the education module using the Medscape Education platform, assessed perceived healthcare provider confidence in AATD screening, and conducted a prospective pre and postintervention study of AATD testing practices at a high-volume academic outpatient subspecialty pulmonary clinic. A total of 11,385 healthcare providers, including eight pulmonologists at our institution, completed the web-based education module. Confidence in identifying patients at high risk for AATD improved after completing the module ("not confident" in AATD screening was 7.7% postintervention compared with 19.4% preintervention). The rate of screening patients at high risk for AATD improved more than twofold (AATD screening rate 9.7% preintervention vs. 20.4% postintervention; P = 0.004). Among patients screened for AATD in our cohort, 27.2% had a genotype/phenotype or low alpha-1 antitrypsin concentration consistent with AATD. Targeted healthcare provider education can improve the confidence in testing for AATD. Improvements in provider confidence corresponded to improvements in AATD screening in a subspecialty pulmonary clinic. More than one-fourth of screening tests suggested AATD, underpinning the value of testing in high-risk individuals.

Accelerating digital health literacy for the treatment of growth disorders: The impact of a massive open online course.

Growth hormone deficiency (GHD) is a rare disorder characterized by inadequate secretion of growth hormone (GH) from the anterior pituitary gland. One of the challenges in optimizing GH therapy is improving adherence. Using digital interventions may overcome barriers to optimum treatment delivery. Massive open online courses (MOOCs), first introduced in 2008, are courses made available over the internet without charge to a large number of people. Here, we describe a MOOC aiming to improve digital health literacy among healthcare professionals managing patients with GHD. Based on pre- and post-course assessments, we evaluate the improvement in participants' knowledge upon completion of the MOOC. The MOOC entitled 'Telemedicine: Tools to Support Growth Disorders in a Post-COVID Era' was launched in 2021. It was designed to cover 4 weeks of online learning with an expected commitment of 2 h per week, and with two courses running per year. Learners' knowledge was assessed using pre- and post-course surveys via the FutureLearn platform. Out of 219 learners enrolled in the MOOC, 31 completed both the pre- and post-course assessments. Of the evaluated learners, 74% showed improved scores in the post-course assessment, resulting in a mean score increase of 21.3%. No learner achieved 100% in the pre-course assessment, compared with 12 learners (40%) who achieved 100% in the post-course assessment. The highest score increase comparing the pre- and the post-course assessments was 40%, observed in 16% of learners. There was a statistically significant improvement in post-course assessment scores from 58.1 ± 18.9% to 72.6 ± 22.4% reflecting an improvement of 14.5% (p < 0.0005) compared to the pre-course assessment. This "first-of-its-kind" MOOC can improve digital health literacy in the management of growth disorders. This is a crucial step toward improving the digital capability and confidence of healthcare providers and users, and to prepare them for the technological innovations in the field of growth disorders and growth hormone therapy, with the aim of improving patient care and experience. MOOCs provide an innovative, scalable and ubiquitous solution to train large numbers of healthcare professionals in limited resource settings.

Quality management of the newborn screening network: the Chinese experience.

Quality management of the newborn screening network: the Chinese experience.

Counseling women of reproductive age about emergency preparedness – Provider attitudes and practices

We report healthcare provider attitudes and practices on emergency preparedness counseling for women of reproductive age (WRA), including pregnant, postpartum, and lactating women (PPLW), for disasters and weather emergencies. DocStyles is a web-based panel survey of primary healthcare providers in the United States. During March 17–May 17, 2021, obstetricians-gynecologists, family practitioners, internists, nurse practitioners, and physician assistants were asked about the importance of emergency preparedness counseling, level of confidence, frequency, barriers to providing counseling, and preferred resources to support counseling among WRA and PPLW. We calculated frequencies of provider attitudes and practices, and prevalence ratios with 95% CIs for questions with binary responses. Among 1503 respondents (family practitioners (33%), internists (34%), obstetrician-gynecologists (17%), nurse practitioners (8%), and physician assistants (8%)), 77% thought emergency preparedness was important, and 88% thought counseling was necessary for patient health and safety. However, 45% of respondents did not feel confident providing emergency preparedness counseling, and most (70%) had never talked to PPLW about this topic. Respondents cited not having time during clinical visits (48%) and lack of knowledge (34%) as barriers to providing counseling. Most respondents (79%) stated they would use emergency preparedness educational materials for WRA, and 60% said they were willing to take an emergency preparedness training. Healthcare providers have opportunities to provide emergency preparedness counseling; however, many have not, noting lack of time and knowledge as barriers. Emergency preparedness resources combined with training may improve healthcare provider confidence and increase delivery of emergency preparedness counseling.

Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals

ObjectivesTo explore the experience of caring for children with tracheostomies from the perspectives of parents and health professional caregivers.DesignQualitative semistructured interview study.SettingOne region in England covered by a tertiary care...

Impact of COVID-19 on HIV services and anticipated benefits of vaccination in restoring HIV services in Ethiopia: A qualitative assessment.

HIV services were inevitably disrupted and affected due to COVID-19. There are many challenges in implementing appropriate HIV services, particularly in the provision of health care and the link between people living with HIV/AIDS and retention in care. The study investigated the impact of COVID-19 on HIV services and the anticipated benefit of the COVID-19 vaccination on HIV service restoration in North Shewa, Oromia, Ethiopia. A qualitative descriptive study approach was used to explore how healthcare delivery evolved during the outbreak of COVID-19 in Ethiopia. Sixteen antiretroviral therapy (ART) clinics were selected from 13 districts and one administrative town in Ethiopia. From them, 32 ART providers were purposively selected based on their experience in ART provision. Data were collected from June to July 2021 using in-depth interviews. A thematic analysis approach was used to analyze the data, based on themes and subthemes emerging from the data. ATLAS.ti software was used for coding. Healthcare for people living with HIV was interrupted due to the COVID-19 pandemic. Medical appointments, HIV testing and counseling services, opportunistic infection treatment, medicine supply, and routine viral load and CD4 T-cell count tests were interrupted. Due to a shortage of healthcare staff, outreach testing services and home index testing were discontinued and HIV testing was limited only to hospitals and health centers. This has substantially affected accessibility to HIV testing and reduced the quality of HIV service delivery. Telehealth and less frequent visits to health facilities were used as alternative ways of delivering HIV services. The COVID-19 vaccination campaign is expected to restore healthcare services. Vaccination may also increase the confidence of healthcare providers by changing their attitudes toward COVID-19. The COVID-19 pandemic has substantially impacted HIV services and reduced the quality of HIV care in Ethiopia. Health facilities could not provide routine HIV services as they prioritize the fight against COVID-19, leading to an increase in service discontinuation and poor adherence.

905 Improving Confidence in Plastering Across Specialties: A Hands-on Approach

Abstract Aim Plaster of Paris casts form one the most basic yet effective treatment for acute orthopaedic fractures and often form a permanent treatment methodology. Patients with fractures present at all times of the day to acute services and require prompt stabilisation. Casts however do present some risks including compartment syndrome and skin ulcerations. Our quality improvement aimed to improve confidence in healthcare providers across different specialities in managing plasters. Method Focussed workshops conducted by expert plaster technicians under the supervision of an experienced orthopaedic consultant were conducted for upper and lower limb injuries. Additional workshops encompassing plaster safety and other trauma splints were delivered. Candidates ranged across different grades and included nurse practitioners and qualified doctors. Confidence scores (out of five) measured on a Likert scale were obtained from 25 participants. Results Knowledge about plasters including type of plaster matched to injury improved from a mean score of 3 to 4.5. Confidence in applying upper limb plasters improved from a mean score 3 to 4.7 and applying lower limb plasters improved from a mean score of 3.25 to 4.8. Confidence in plaster safety including acute conditions and safe removal improved from a mean score of 2 to 4.6. Confidence in applying acute splints improved from a mean score of 1.5 to 4.3. Conclusions Our quality improvement project improve the confidence in practitioners managing acute orthopaedic patients with an emphasis on plaster safety and acute splints. It has been formally adopted on a regular basis as a teaching program.

Characteristics of Living Systematic Review for COVID-19.

PurposeThe systematic review aims to analyze and summarize the characteristics of living systematic review (LSR) for coronavirus disease 2019 (COVID-19).MethodsSix databases including Medline, Excerpta Medica (Embase), Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database and China Science, and Technology Journal Database (VIP), were searched as the source of basic information and methodology of LSR. Descriptive analytical methods were used to analyze the included COVID-19 LSRs, and the study characteristics of COVID-19 LSRs were further assessed.ResultsSixty-four COVID-19 LSRs were included. Eighty-nine point one percent of LSRs were published on Science Citation Index (SCI) journals, and 64.1% publication with an impact factor (IF) >5 and 17.2% with an IF >15 among SCI journals. The first unit of the published LSRs for COVID-19 came from 19 countries, with the largest contribution from the UK (17.2%, 11/64). Forty point six percent of LSRs for COVID-19 were related to therapeutics topic which was considered the most concerned perspective for LSRs for COVID-19. Seventy-six point six percent of LSRs focused on the general population, with less attention to children, pregnant women and the elderly. However, the LSR for COVID-19 was reported incomplete on “living” process, including 40.6% of studies without search frequency, 79.7% of studies without screening frequency, 20.3% of studies without update frequency, and 65.6% of studies without the timing or criteria of transitioning LSR out of living mode.ConclusionAlthough researchers in many countries have applied LSRs to COVID-19, most of the LSRs for COVID-19 were incomplete in reporting on the “living” process and less focused on special populations. This could reduce the confidence of health-care providers and policy makers in the results of COVID-19 LSR, thereby hindering the translation of evidence on COVID-19 LSR into clinical practice. It was necessary to explicitly enact preferred reporting items for systematic reviews and meta-analyses (PRISMA) to improve the reporting quality of LSR and support ongoing efforts of therapeutics research for special patients with COVID-19.

Knowledge, attitudes and practices towards malaria diagnostics among healthcare providers and healthcare-seekers in Kondoa district, Tanzania: a multi-methodological situation analysis

BackgroundDespite the large-scale rollout of malaria rapid diagnostic tests (RDTs) in Tanzania, many healthcare providers (HCPs) continue using blood film microscopy (BFM) and clinical examination to diagnose malaria, which can increase the risk of mal-diagnosis and over-prescribing of anti-malarials. Patients disregarding negative test results and self-treating exacerbate the problem. This study explored the knowledge, attitudes and practices of HCPs and healthcare-seekers regarding RDTs in comparison to BFM testing.MethodsA situational analysis was, therefore, conducted in Kondoa District, Dodoma Region, Tanzania. A multi-methodological approach was adopted including (i) a health facility inventory and screening of logbooks from May 2013 to April 2014 with 77,126 patient entries from 33 health facilities; (ii) a survey of 40 HCPs offering malaria services; and iii) a survey of 309 randomly selected household members from the facilities’ catchment area. Surveys took place in April and May 2014.ResultsHealth facility records revealed that out of 77,126 patient entries, 22% (n = 17,235) obtained a malaria diagnosis. Of those, 45% were made with BFM, 33% with RDT and 22% with clinical diagnosis. A higher rate of positive diagnoses was observed with BFM compared with RDT (71% vs 14%). In the HCP survey, 48% preferred using BFM for malaria testing, while 52% preferred RDT. Faced with a negative RDT result for a patient presenting with symptoms typical for malaria, 25% of HCPs stated they would confirm the result with a microscopy test, 70% would advise or perform a clinical diagnosis and 18% would prescribe anti-malarials. Interviews with household members revealed a preference for microscopy testing (58%) over RDT (23%), if presented with malaria symptoms. For participants familiar with both tests, a second opinion was desired in 45% after a negative microscopy result and in 90% after an RDT.ConclusionsNon-adherence to negative diagnostics by HCPs and patients continues to be a concern. Frequent training and supportive supervision for HCPs diagnosing and treating malaria and non-malaria febrile illnesses is essential to offer quality services that can instil confidence in HCPs and patients alike. The introduction of new diagnostic devices should be paired with context-specific behaviour change interventions targeting healthcare-seekers and healthcare providers.