Examine Health Care Professionals Research Articles

All Else Being Equal: Examining Treatment Bias and Stereotypes Based on Patient Ethnicity and Socioeconomic Status With In-Hospital Cardiac Arrest Clinical Vignettes

BackgroundResearch on ethnic and socioeconomic treatment differences following in-hospital cardiac arrest (IHCA) largely draws on register data. Due to the correlational nature of such data, it cannot be concluded whether detected differences reflect treatment bias/discrimination – whereby otherwise identical patients are treated differently solely due to sociodemographic factors. To be able to establish discrimination, experimental research is needed. ObjectiveThe primary aim of this experimental study was to examine whether simulated IHCA patients receive different treatment recommendations based on ethnicity and socioeconomic status (SES), holding all other factors (e.g., health status) constant. Another aim was to examine health care professionals’ (HCP) stereotypical beliefs about these groups. MethodsHCP (N = 235) working in acute care made anonymous treatment recommendations while reading IHCA clinical vignettes wherein the patient's ethnicity (Swedish vs. Middle Eastern) and SES had been manipulated. Afterwards they estimated to what extent hospital staff associate these patient groups with certain traits (stereotypes). ResultsNo significant differences in treatment recommendations for Swedish versus Middle Eastern or high versus low SES patients were found. Reported stereotypes about Middle Eastern patients were uniformly negative. SES-related stereotypes, however, were mixed. High SES patients were believed to be more competent (e.g., respected), but less warm (e.g., friendly) than low SES patients. ConclusionsSwedish HCP do not seem to discriminate against patients with Middle Eastern or low SES backgrounds when recommending treatment for simulated IHCA cases, despite the existence of negative stereotypes about these groups. Implications for health care equality and quality are discussed.

55-LB: “Older patients manifest it differently”—HCP Perspectives of People Aging with Type 1 Diabetes

In the last decade, people with type 1 diabetes (T1D) are living longer due to advancements in diabetes technology. However, there is little research on treating this population. This study examined health care professionals’ (HCPs) experiences in treating older adults with T1D to identify clinical and practical differences. Participants were recruited from T1D Exchange (an online diabetes community) and 11 HCPs (average time in practice: 21.5 years) were interviewed. Interview questions focused on their clinical experiences, challenges that older people experienced, and needs of this aging population that might be different from other age groups. The interviews were recorded, transcribed, independently coded by 2 coders and thematically analyzed. Themes included treatment recommendations for older adults with T1D, diabetes education, post-severe hypoglycemic event recommendations, fear of hypoglycemia, insurance, and polypharmacy. As older adults with diabetes continue to live longer, new recommendations for this age group should be considered. Specifically, treatment recommendations amongst older adults differ in glycemic target goals and HbA1c range. These recommendations are made to combat any severe hypoglycemic episodes prone to this population. There is a greater degree of neurocognitive decline which poses a greater risk for life threatening emergencies, not only in older adults but also older adults with T1D. It is the HCPs duty to prepare this population for the risks of developing certain complications associated with T1D as well as the possible dangers if the more emergent situations are not addressed promptly. Disclosure K. Uddin: None. H. L. Stuckey: Consultant; Eli Lilly and Company. A. Hughes: None.

The perceived impact of pediatric food allergy on mental health care needs and supports: Apilot study.

Evidence suggests a mental health impact of food allergy on affected children and their families; however, little is known about health care professionals' understanding of these impacts and the resources available to patients and their families. Our aim was to conduct a pilot study examining health care professionals' perceptions of the psychosocial and financial burden of food allergy to identify gaps in education and resources and thus better support families with food allergy moving forward. Between February 20 and November 19, 2020, we conducted audiorecorded interviews (n= 6) and profession-specific focus groups (n= 2 [representing 7 individuals]). The participants included pediatric allergists, allergy nurse educators, and clinical dietitians who were directly involved in pediatric food allergy care. The interviews were recorded and transcribed verbatim. Thematic analysis was subsequently applied to identify the main themes. Our study consisted of an interdisciplinary group of Manitoban health care providers (N= 13) who were directly involved with pediatric food allergy care. We identified 3 main themes from these interviews: anxiety among families with food allergy, which is a common comorbidity; limited resources available within current public infrastructure; and empowerment through education. These themes describe issues surrounding access to information and resources and how this can affect anxiety and parenting styles among families with food allergy. Health care professionals perceive that many families experience anxiety as a result of their child's food allergy. They further advocate that access to information and suitability of public resources be considered when planning forrelated programs.

Attitudes of Health Care Professionals Toward Older Adults' Abilities to Use Digital Technology: Questionnaire Study.

BackgroundDigital technologies (DTs) for older adults focus mainly on health care and are considered to have the potential to improve the well-being of older adults. However, adoption rates of these DTs are considered low. Although previous research has investigated possible reasons for adoption and acceptance of DT, age-based stereotypes (eg, those held by health care professionals) toward the abilities of older adults to use DTs have yet to be considered as possible barriers to adoption.ObjectiveThe aim of this study was to investigate the influencing role of ageism in the context of health care professionals attitudes toward older adults’ abilities to use health care DT. A further goal was to examine if social comparison and stereotype activation affect and moderate this association.MethodsA new measurement to assess health care professionals’ attitudes toward older adults using technology (ATOAUT-10) was developed and used in 2 studies. Study 1 involved the development of the ATOAUT-10 scale using a principal component analysis and further examined health care professionals’ attitudes toward the use of health care DTs and correlations with ageism. Study 2 further explored the correlation between ageism and ATOAUT in an experimental design with health care professionals.ResultsIn study 1, physiotherapists (N=97) rated older adults as young as 50 years as less able to use health care DT compared to younger adults (P<.001). A multiple regression analysis revealed that higher levels of ageism, beyond other predictors, were predictive of more negative ATOAUT, (β=.36; t=3.73; P<.001). In study 2, the salience of age was manipulated. Health care professionals (N=93) were randomly assigned to rate the abilities of a young or old person to use health care DT. Old age salience moderated the correlation between ageism and ATOAUT (R2=0.19; F6,85=3.35; P=.005), such that higher levels of ageism correlated with more negative ATOAUT in the old age salient condition, but not the young condition. Stereotype activation accounted for health care professionals’ attitudes more than did the experience of working with older patients or the professionals’ age.ConclusionsNegative and ageist attitudes of health care professionals can potentially affect how older adults are viewed in relation to DT and consequently might influence actual use and adoption of technology-based treatment. Future studies should broaden the validation of the ATOAUT-10 scale on more diverse samples and focus on the discriminatory aspect of ageism and self-ageism of older adults. This study calls for a focus on ageism as a determinant of adoption of DT.

Invisible Moral Wounds of the COVID-19 Pandemic: Are We Experiencing Moral Injury?

Invisible Moral Wounds of the COVID-19 Pandemic: Are We Experiencing Moral Injury?

Burnout and compassion fatigue among organ donation coordinators: a scoping review protocol.

The objective of this review is to develop a comprehensive description of burnout and compassion fatigue, including risk/protective factors, among organ and tissue donation coordinators worldwide. Research on turnover rates among organ and tissue donation coordinators has shown that job tenure generally lasts less than three years, a possible consequence of burnout and compassion fatigue. Increased turnover rates of organ and tissue donation coordinators have significant impact on the ability of ODOs to optimize organ donation. This current scoping review will help inform understanding of the nature of burnout and compassion fatigue in this population as well as the available strategies for managing it. Articles examining health care professionals working as organ and tissue donation coordinators, with the main concepts of interest being burnout and/or compassion fatigue, will be considered. Articles within the context of organ and tissue donation coordinators in acute care settings at any part of the organ donation process will also be considered for inclusion in this review. Quantitative and qualitative studies, text and opinion papers, unpublished material (eg, unpublished research data, reports, institutional protocols, government documents) provided by researchers in the organ donation field worldwide will also be examined for possible inclusion. The scoping review will be performed in accordance with JBI methodology. Published and unpublished papers from 1980 to the present will be searched. Databases will include MEDLINE (Ovid), CINAHL, Embase, LILACS, PsycINFO, and PTSDpubs, while appropriate gray literature will be searched. Two reviewers will screen the papers according to predefined inclusion and exclusion criteria, extract data for specific variables, and perform descriptive examination.

Barriers and Facilitators to Aerobic Exercise Implementation in Stroke Rehabilitation: A Scoping Review

Aerobic exercise is a recommended part of stroke best practices; yet, access to aerobic exercise programs within stroke rehabilitation remains limited and inconsistent. The purpose of this scoping review was to describe the nature and extent of barriers and facilitators to aerobic exercise implementation with adults post-stroke as reported by health care professionals. MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, and AMED Allied and Complementary Medicine were searched from inception to October 16, 2019. Research studies that examined health care professionals' barriers and facilitators to aerobic exercise implementation in adults post-stroke were included. Two reviewers independently conducted title and abstract screening, full-text evaluation, data extraction, and quality appraisal. The Theoretical Domains Framework was used to map the identified barriers or facilitators and to analyze and interpret the results. Four studies were included in the review. All studies involved surveys conducted among physical therapists and reported barriers related to "environmental context and resources" (eg, lack of equipment, time, staff), insufficient "knowledge" and "skills" (eg, safe aerobic exercise prescription and implementation), "beliefs about capabilities" (eg, uncertainty about exercise intensity and screening tools), and professional role and identity (eg, aerobic exercise not a priority). Access to and continued education in structured aerobic exercise programs and safety monitoring were identified facilitators. Some of the identified barriers could be overcome with modeling and training in best practice, while others may require interventions targeting organizational environment and leadership. Future knowledge translation interventions should target the identified barriers and facilitators to implementing aerobic exercise.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A312).

Palliative care in chronic heart failure: a theoretically guided, qualitative meta-synthesis of decision-making

International clinical practice guidelines recommend that patients with chronic heart failure receive timely and high-quality palliative care. However, integrating palliative care is highly variable and dependent on decision-making and care models. This meta-synthesis aimed to examine health care professionals' decision-making processes and explore factors impacting decisions to refer or deliver palliative care in chronic heart failure. The electronic databases SCOPUS, CINAHL, and Medline were searched. Included studies were those that reported health care professionals' perceptions of palliative care in chronic heart failure through qualitative data collection, were written in English, and were peer-reviewed articles. Included articles were analysed using Thomas and Harden's approach. The dual-process theory was used and applied a priori to organise the findings. The perception of palliative care as a transition and active treatment failure fit within the intuitive system of thinking in the dual-process theory. The theme that overlapped into both intuitive and analytical systems of thinking was acquiring patient and illness information themes reflecting the analytical system of thinking were professional role and experience, pre-existing decision pathways, and balancing viewpoints. This meta-synthesis identified factors influencing the decision-making process in referring patients with chronic heart failure to palliative care. The findings from this review highlight the need for further development of decision-making tools or facilitate guidelines to assist health care professionals' shared decision-making to improve patient outcomes.

Productivity Standards and the Impact on Quality of Care: A National Survey of Inpatient Rehabilitation Professionals

Background: Skyrocketing health care costs have resulted in significant changes to reimbursement rates in health care. The result has increased pressure to be as efficient as possible while maintaining high-quality care. The purpose of this exploratory study was to examine health care professionals’ perceptions on whether and how productivity pressures have impacted the quality of care in therapy practice.

Factors Affecting Attitudes Toward Organ Donation in Health Care Professionals

BackgroundHealth care professionals can affect attitudes toward organ donation in society. The aim of this study was to examine health care professionals’ attitudes toward and the affecting factors of organ donation. Materials and methodsThis descriptive and cross-sectional study was conducted between June and September in 2018. The sample consisted of 220 health professionals (nurses and physicians) who worked in the University Hospital and Family Health Centers located in Northern Turkey. The data were collected by using a sociodemographic form, an organ donation questionnaire, and the Organ Donation Attitudes Scale. Descriptive statistics (means, standard deviations, and ratios), independent t test, Kruskal-Wallis test, and correlation analyses were used. ResultsThe mean age of the participants was 36.05 ± 7.52 years (range, 20–52 years). The mean score of the participants was 100.98 ± 13.18 for the positive dimension and 46.81 ± 17.61 for the negative dimension of the scale. It was found that nurses and health care professionals working in university hospitals and intensive care units have higher negative organ donation attitudes (P < .01). It was found that negative attitudes toward organ donation decreased as age increased (r = 0.146; P = .016). Overall, 17.7% of the participants had a donor card. ConclusionBecause the negative attitudes of nurses are higher in this study, the results reflect the need for intervention studies to determine the sensitivity to organ donation. It is striking that health care professionals who work in intensive care units have high negative attitudes toward organ donation. It can be recommended that interventional studies be performed with intensive care health care professionals.

Palliative care for persons with Parkinson\u2019s disease: a qualitative study on the experiences of health care professionals

BackgroundParkinson’s disease (PD) is a chronic and neurodegenerative disease associated with a wide variety of symptoms. The risk of complications increases with progression of the disease. These complications have a tremendous impact on the quality of life of people with PD. The aim of this study was to examine health care professionals’ experiences of potential barriers and facilitators in providing palliative care for people with PD in the Netherlands.MethodsThis was a qualitative descriptive study. The data were collected from 10 individual in-depth interviews and three focus groups (n = 29) with health care professionals. Health care professionals were selected based on a positive answer to the question: “In the past 2 years, did you treat or support a person with PD who subsequently died?” The data were analyzed by thematic text analysis.ResultsHealth care professionals supported the development of a palliative care system for PD but needed to better understand the essence of palliative care. In daily practice, they struggled to identify persons’ needs due to interfering PD-specific symptoms such as cognitive decline and communication deficits. Timely addressing the personal preferences for providing palliative care was identified as an important facilitator. Health care professionals acknowledged being aware of their lack of knowledge and of their little competence in managing complex PD. Findings indicate a perceived lack of care continuity, fragmentation of services, time pressure and information discontinuity.ConclusionsHealth care professionals experienced several facilitators and barriers to the provision of palliative care to people with PD. There is a need to improve the knowledge on complex PD and the continuity of information, as well as optimize coordination and deliver care based on a persons’ preferences. Additional training can help to become more knowledgeable and confident.

Genomic information and a person's right not to know: A closer look at variations in hypothetical informational preferences in a German sample.

In clinical practice and in research, there is an ongoing debate on how to return incidental and secondary findings of genetic tests to patients and research participants. Previous investigations have found that most of the people most of the time are in favor of full disclosure of results. Yet, the option to reject disclosure, based on the so-called right not to know, can be valuable especially for some vulnerable subgroups of recipients. In the present study we investigated variations in informational preferences in the context of genetic testing in a large and diverse German sample. This survey examined health care professionals, patients, participants of genetic counseling sessions and members of the general population (N = 518). Survey participants were assessed regarding their openness to learning about findings under various hypothetical scenarios, as well as their attitudes about the doctor-patient-relationship in a disclosure situation and about informational transfer to third parties. While the majority of participants wanted to learn about their findings, the extent of support of disclosure varied with features of the hypothetical diagnostic scenarios (e.g., controllability of disease; abstract vs. concrete scenario description) and demographic characteristics of the subjects. For example, subjects with higher levels of education were more selective with regards to the kind of information they want to receive than those with lower levels of education. We discuss implications of these findings for the debate about the right not to know and for the clinical practice of informed consent procedures.

Health care professionals\u2019 attitudes towards population-based genetic testing and risk-stratification for ovarian cancer: a cross-sectional survey

BackgroundOvarian cancer is usually diagnosed at a late stage when outcomes are poor. Personalised ovarian cancer risk prediction, based on genetic and epidemiological information and risk stratified management in adult women could improve outcomes. Examining health care professionals’ (HCP) attitudes to ovarian cancer risk stratified management, willingness to support women, self-efficacy (belief in one’s own ability to successfully complete a task), and knowledge about ovarian cancer will help identify training needs in anticipation of personalised ovarian cancer risk prediction being introduced.MethodsAn anonymous survey was distributed online to HCPs via relevant professional organisations in the UK. Kruskal-Wallis tests and pairwise comparisons were used to compare knowledge and self-efficacy scores between different types of HCPs, and attitudes toward population-based genetic testing and risk stratified management were described. Content analysis was undertaken of free text responses concerning HCPs willingness to discuss risk management options with women.ResultsOne hundred forty-six eligible HCPs completed the survey: oncologists (31%); genetics clinicians (30%); general practitioners (22%); gynaecologists (10%); nurses (4%); and ‘others’. Scores for knowledge of ovarian cancer and genetics, and self-efficacy in conducting a cancer risk consultation were generally high but significantly lower for general practitioners compared to genetics clinicians, oncologists, and gynaecologists. Support for population-based genetic testing was not high (<50%). Attitudes towards ovarian cancer risk stratification were mixed, although the majority of participants indicated a willingness to discuss management options with patients.ConclusionsLarger samples are required to investigate attitudes to population-based genetic testing for ovarian cancer risk and to establish why some HCPs are hesitant to offer testing to all adult female patients. If ovarian cancer risk assessment using genetic testing and non-genetic information including epidemiological information is rolled out on a population basis, training will be needed for HCPs in primary care to enable them to provide appropriate support to women at each stage of the process.

Barriers in the Uptake and Delivery of Preconception Care: Exploring the Views of Care Providers

Objectives To examine health care professionals’ views of their role and responsibilities in providing preconception care and identify barriers that affect the delivery and uptake of preconception care. Methods Twenty health care professionals who provide preconception care on a regular basis were interviewed using semi-structured interviews. Results We interviewed twelve community midwives, three General Practitioners, three obstetricians, one cardiologist specialized in congenital heart diseases and one gastroenterologist.We identified four barriers affecting the uptake and delivery of preconception care (PCC): (1) lack of a comprehensive preconception care program; (2) limited awareness of most future parents about the benefits of preconception care, hesitance of GP’s about the necessity and effectiveness of PCC; (3) poor coordination and organization of preconception care; (4) conflicting views of health care professionals on pregnancy, reproductive autonomy of patients and professional responsibility. Conclusion We have identified four barriers in the uptake and delivery of preconception care. Our findings support the timely implementation of a comprehensive program of PCC (already advocated by the Health Council of the Netherlands) and increasing awareness and knowledge of PCC from care providers and future parents. We emphasize the need for further research on how organizational barriers lead to suboptimal PCC and how interdisciplinary collaboration and referral can lead to optimally tailored intervention approaches.

Concern about the Expanding Prescription Drug Epidemic: A Survey of Licensed Prescribers and Dispensers

Background: Prescription drug misuse and abuse has reached epidemic levels in the U.S., and stands as a leading cause of death. As the primary gatekeepers to the medications contributing to this epidemic, it is critical to understand the views of licensed health care professionals. Objective: In this study, we examine health care professionals’ concern regarding prescription drug abuse in their communities and the impact their concern has had on their prescribing and dispensing practices. Study Design: An online survey of licensed health care providers. Setting: Conducted in Indiana. Methods: This study was a state-wide evaluation of Indiana’s prescription drug monitoring program. The questionnaire asked respondents how concerned they were about prescription drug abuse in their community. Variation in the level of concern was examined using ordinary least squares regression and information about the respondents’ demographic background and clinical experience. In addition, we used logistic regression to examine whether concern was associated with changing prescribing and/or dispensing behavior. Results: The majority of providers indicated they were “moderately” or “extremely concerned” about prescription drug abuse in their communities. The level of concern, however, varied significantly by profession, with pharmacists, physicians, nurse practitioners/physician assistants being more concerned than dentists. Additional analyses indicate that providers with higher levels of concern were those who also reported recently changing their prescribing and/ or dispensing behavior. Limitations: The voluntary nature and geographical focus of the study limits the generalizability of the findings. Conclusion: Concern about prescription drug abuse is generally high across the major health care professions; however, a significant minority of providers, particularly among dentists, expressed little or no concern about the epidemic. Increasing health care providers’ general level of concern about prescription drug abuse may be an effective public health tool for encouraging voluntary reductions in prescribing and/or dispensing controlled substances. Key words: Attitudes of physicians, nurse practitioners, physician assistants, and dentists; prescription drug misuse and abuse; prescribing practices; dispensing practices

Health care professionals` experiences with the implementation of The Coordination Reform at a University Hospital in Norway. A qualitative study

Introduction: The Norwegian Coordination Reform was implemented January 1. 2012 with a changed distribution of tasks and responsibility between primary and specialist health care. For the specialist health care the aim was to concentrate to a greater extent on their specialized tasks. Aim: The aim of this study was to examine how health care professionals in a university hospital have experienced the implementation of the Coordination Reform. Method: A qualitative study with three focus group interviews and 3 individual interviews with nurses, physicians and hospital managers. Results: Lack of information within the hospital concerning the Coordination Reform made the informants feel unprepared for the changes that followed, especially in terms of the new guidelines for notifying the municipalities about patients in need of municipal follow-up after discharge. The informants experienced an increased focus on economy, because errors in the notification process led to less income for the hospital. The impression among the informants was that patients without complex care needs were faster received by the larger municipalities, unlike those with complex care needs. According to the informants this affected their work in relation to use of resources and lead to poorer communication. Discussion: Other studies on implementation of the implementation of the Norwegian Coordination reform in primary care have found that their main focus is on their ability to receive patients ready for discharge. The reason is that they have to pay the hospital more than $600 per day if there is a delayed discharge. Both the findings in this and the other studies indicates that the organisations focus is on this topic rather than other aspect of the coordination reform like treating more patients in primary care, health promotion and competency transfer. Conclusion: The key findings was that the aim for the specialist health care to focus more on their specialist competence and an improved coordination with the primary health care has not yet been achieved according to the informants in this study. Lessons learned: The economic incentives to reduce the number of patients ready for discharge in the hospitals have overshadowed other central aspects of the Norwegian Coordination reform. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116611– http://www.ijic.org/ Limitations: The sample only included informants from one large department at one university hospital. Suggestions for future research: This study indicates that there is a further need for examining health care professionals in relation to the implementation of the Coordination Reform. One interesting aspect concerns the hospitals and specialization – more specialization or are they specialized enough. Another aspect is the work with developing patient pathways and ICTsolutions what are the effects on communication between the hospitals and the municipalities?

Excellence in Transitional Care of Older Adults and Pay-for-Performance: Perspectives of Health Care Professionals

Article-at-a-Glance Background: Care transitions across health care settings are common and can result in adverse outcomes for older adults. Few studies have examined health care professionals' perspectives on important process measures or pay-for-performance (P4P) strategies related to transitional care. A study was conducted to characterize health care professionals' perspectives on (1) successful transitional care of older adults (age 65 years and older), (2) suggestions for improvement, and (3) P4P strategies related to transitional care. In a qualitative study, one-hour semistructured in-depth interviews were conducted in an acute care hospital, a skilled nursing facility, two community-based primary care practices, and one home health care agency with 20 health care professionals (18 physicians and 2 home health care administrators) with direct experience in care transitions of older adults and who were likely to be affected by P4P strategies. Findings were organized into three thematic domains: (1) components and markers of effective transitional care, (2) difficulties in design and implementation of P4P strategies, and (3) health care professionals' concerns and unmet needs related to delivering optimal care during transitions. A conceptual framework was developed on the basis of the findings to guide design and implementation of P4P strategies for improving transitional care. In characterizing health care professionals' perspectives, specific care processes to target, challenges to address in the design of P4P strategies, and unmet needs to consider regarding education and feedback for health care professionals were described. Future investigations could evaluate whether performance targets, educational interventions, and implementation strategies based on this conceptual framework improve quality of transitional care.

Adolescent anemia screening during ambulatory pediatric visits in the United States.

The Centers for Disease Control and Prevention recommends anemia screening for reproductive age women every 5-10 years and annually for those with risk factors. Due to the lower risk of anemia among males, screening for men is recommended only if risk factors exist. The study objective was to examine health care professionals' current anemia screening patterns for male and female adolescents. Data are from the 2001 -2004 National Ambulatory Medical Care Survey, a nationally representative sample of ambulatory visits to primary care practices. The frequency of anemia screening during preventive care visits by 12-21-year-olds was estimated by sex using a reported hemoglobin/hematocrit or complete blood count as an indicator of screening. Multivariable logistic regression identified patient, provider and practice-level factors associated with screening. During the study period, 1,263 preventive care visits occurred for 12-21 year-olds. In bivariate analysis, higher odds of anemia screening were observed for both younger females (OR 1.85; 95 % CI 1.09-3.14) and older males [1.83 (1.02-3.26)] compared to older females (≥ 16 years). In the multivariable model, odds of screening increased with non-white race [3.29 (1.84-5.88)], tobacco use [3.57 (1.94-6.58)], longer visit length [1.03 (1.01-1.06)], and practice site acceptance of managed care plans [2.08 (1.04-4.14)]. Patient sex and age were not statistically significant predictors of screening. Although anemia is more prevalent among older adolescent females, they were not more likely to be screened. This suggests providers are not targeting groups at highest risk of anemia for screening.

Palliative care for severely affected patients with multiple sclerosis: when and why? Results of a Delphi survey of health care professionals.

Patients severely affected by multiple sclerosis (MS) present with complex symptoms and needs requiring an interdisciplinary care approach. Analysis of when and why specialized palliative care integration would be beneficial via examining health care professionals' attitudes. A two-round online Delphi study and expert workshop were undertaken and analyzed descriptively. Following an extensive online search, 164 professionals with expertise in treating and caring for severely affected patients with MS were contacted. Professionals included neurologists, urologists, general practitioners, MS nurses, speech therapists, physiotherapists, psychologists, and palliative care physicians. Forty-six consented to participate: 33 of 46 (71.4%) and 15 of 33 (45.5%) experts responded in the first and second round, respectively. Consensus was reached among all respondents (100%) defining the term "severely affected": 78.8% and 86.7%, respectively, thought that specialized palliative care should begin once the disease has progressed (Expanded Disability Status Scale [EDSS]>6 and nursing care required). When the need exists for communication about disease progression (93.3%), psychological support (93.3%), relatives support (93.3%), and pain medication (86.7%) specialized palliative care should be consulted. Specialized palliative homecare was rated (93.3%) "very important." The workshop documented the paucity of home visits and specialized MS care in nursing homes. Our results clearly identified specific areas in which palliative care will likely prove to be a valuable asset in the treatment course of MS. This information should serve clinicians, indicating when to consider palliative care services and help further reduce or eliminate uncertainty about how palliative care can be integrated in the course of MS.

Health care workers—part of the system or part of the public? Ambivalent risk perception in health care workers

The emergence of the avian influenza A (H7N9) in China during 2013 illustrates the importance of health care professionals as a mediating channel between health agencies and the public. Our study examined health care professionals' risk perceptions considering their unique position as representing the health care system and yet also being part of the public, hence a risk group. Recent studies have examined the role of health professionals' personal risk perceptions and attitudes regarding compliance of the general public with vaccination. Our study examined how risk perception affects their risk analysis. We employed an online survey of Israeli health care professionals and the general public in Israel (N = 240). When risk perception is relatively low, health care professionals tend to base their attitudes toward vaccines on analytical knowledge (Rc = 0.315; P < .05), whereas in situations with high risk perception, the results did not indicate any significant difference between Israeli health professionals and the Israeli general public, hence both groups base their attitudes more on emotions and personal experience than on analytical knowledge. Public health organizations must consider the fact that health professionals are a group that cannot be automatically treated as an extension of the organization. When the risk is tangible and relevant, health care workers behave and act like everybody else. Our study contributes to understanding health care professionals' perceptions about vaccines and the thinking processes underlying such perceptions.