Frontline Healthcare Providers Research Articles

629. Evaluation of Neurocysticercosis Healthcare Provider Diagnostic Practices in Houston, Texas

Abstract Background Neurocysticercosis (NCC) is a neglected tropical disease caused by infection with the pork tapeworm Taenia solium that affects 2-8 million people globally and is responsible for ∼30% of epilepsy cases in endemic countries. Based on case series data, > 4,000 new NCC cases are estimated to occur annually in the US. The gold standard for NCC diagnosis as outlined in the Infectious Disease Society of America (IDSA) guidelines is neuroimaging with computed tomography (CT: to detect calcifications) and magnetic resonance imaging (MRI: to detect viable disease), followed by confirmatory serologic testing with the enzyme-linked immunoelectrotransfer blot (EITB) or other reliable assay. Our study aims to describe healthcare provider diagnostic practices at a public healthcare system serving at-risk patients in Texas. Methods We retrospectively identified patients ≥ 18 years old tested for NCC in the Harris Health System [HHS] between 2017-2021, systematically extracted variables from the patients’ electronic medical records, and recorded this data via a REDCap instrument. We classified NCC patients by NCC type and performed descriptive statistics. Results We identified 113 patients with NCC (Table 1). Family medicine (n=44, 39%) or internal medicine (n=29, 26%) providers evaluated most patients in their first diagnostic encounter. Presenting signs/symptoms included seizure (n=75, 66%) and chronic headaches (n=77, 68%). 77% of patients with calcified disease and 88% with viable disease were diagnosed within 5 years after symptom onset. Only 63% of patients had both CT and MRI completed. Zero initial providers ordered EITB confirmatory serologic testing; n=4, 3% ordered other types of serologic testing. Only five patients ultimately had EITB sent; of those, two tested positive. While 47% of initial providers referred patients to neurology and 18% referred to neurosurgery, only 35% referred to tropical medicine or infectious diseases specialties. Conclusion Improved education of frontline healthcare providers on NCC presentation and diagnosis may reduce time to NCC diagnosis. Future work should target the need for structured education and standardization of diagnostic practices especially amongst frontline healthcare providers serving at-risk communities in the US. Disclosures All Authors: No reported disclosures

A perinatal psychiatry access program to address rural and medically underserved populations using telemedicine

BackgroundAlthough highly prevalent, most perinatal mental health and substance use disorders often go unrecognized, undiagnosed, and untreated. Perinatal Psychiatry Access Programs have emerged as a successful model to increase the capacity of front-line maternal health care providers to address perinatal mental health conditions through education, consultation, and increased resources and referrals.MethodsThis model has been adapted in South Carolina to include direct access to mental health treatment in response to inadequate maternity care and mental health services, including a large proportion of rural, Medically Underserved Areas in Primary Care and Mental Health Healthcare Provider Shortage Areas throughout the state. Moms IMPACTT [Improving Access to Perinatal Mental Health and Substance Use Disorder Care Through Telehealth and Tele-mentoring] leverages statewide partnerships and a virtual care model to provide: 1) people who are pregnant or within 1 year postpartum with immediate access by phone or internet to a clinician trained in perinatal psychiatric care coordination to assess and refer to an appropriate level of perinatal psychiatry services; 2) communication and care coordination with the person’s healthcare provider, as appropriate; and 3) healthcare provider training and real-time psychiatric consultation for the management and treatment of perinatal mental health and substance use disorders. Adaptations to this care model have demonstrated benefit including increase access to care for patients with perinatal mental health and substance use disorders and support for frontline health providers serving this population.ResultsWithin the first 12 months, the Mom’s IMPACTT program served people from 45 of the 46 counties in South Carolina. There were 938 encounters, 96% of which resulted in telehealth or teleconsultation with a care coordinator or program psychiatrist. Treatment was provided to 881 perinatal patients (54.6% White, 26.1% Black, 6.2% Hispanic) of whom 51.8% were insured by Medicaid, 89.7% resided in counties designed as fully Medically Underserved Areas, and 38.9% lived in counties designed as fully rural. Most calls were received directly from perinatal patients, with 60.7% (548/903) of patients requesting mental health support. Additionally, the program completed 22 consultations, and trainings with 443 healthcare providers throughout the state.ConclusionsAdaptations made to psychiatry access program evident in Moms IMPACTT appear to be successful in meeting the specific needs of birthing people in the state of South Carolina. Suggestions and considerations are included to replicate the success of Moms IMPACTT program elsewhere.

Development and Evaluation of an Automated Multimodal Mobile Detection of Oral Cancer (mDOC) Imaging System to Aid in Risk-based Management of Oral Mucosal Lesions.

Oral cancer is a major global health problem. It is commonly diagnosed at an advanced stage although often preceded by clinically visible oral mucosal lesions, termed oral potentially malignant disorders associated with an increased risk for oral cancer development. There is an unmet clinical need for effective screening tools to assist front-line healthcare providers to determine which patients should be referred to an oral cancer specialist for evaluation. This study reports the development and evaluation of the mobile Detection of Oral Cancer (mDOC) imaging system and an automated algorithm that generates a referral recommendation from mDOC images. mDOC is a smartphone-based autofluorescence and white light imaging tool that captures images of the oral cavity. Data were collected with mDOC from a total of 332 oral sites in a study of 29 healthy volunteers and 120 patients seeking care for an oral mucosal lesion. A multimodal image classification algorithm was developed to generate a recommendation of "Refer" or "Do Not Refer" from mDOC images, using expert clinical referral decision as the ground truth label. A referral algorithm was developed using cross-validation methods on 80% of the dataset, then retrained and evaluated on a separate holdout test set. Referral decisions generated in the holdout test set had a sensitivity of 93.9% and a specificity of 79.3% with respect to expert clinical referral decisions. The mDOC system has the potential to be utilized in community physicians' and dentists' offices to help identify patients who need further evaluation by an oral cancer specialist.

Psilocybin-Assisted Group Psychotherapy + Mindfulness Based Stress Reduction (MBSR) for Frontline Healthcare Provider COVID-19 Related Depression and Burnout: A Randomized Clinical Trial.

This clinical trial sought to evaluate the safety and preliminary efficacy of psilocybin and MBSR for frontline healthcare providers with symptoms of depression and burnout related to the COVID-19 pandemic. This was a randomized controlled trial that enrolled physicians and nurses with frontline clinical work during the COVID-19 pandemic and symptoms of depression and burnout. Participants were randomized in a 1:1 ratio to either an 8-week MBSR curriculum alone or an 8-week MBSR curriculum plus group psilocybin-assisted psychotherapy (PAP) with 25mg psilocybin. Symptoms of depression and burnout were assessed at baseline, and 2-weeks and 6-months post intervention utilizing the Quick Inventory of Depressive Symptoms (QIDS-SR-16) and Maslach Burnout Inventory Human Services Survey for Medical Professionals (MBI-HSS-MP), respectively. Secondary outcome measures included the Demoralization Scale (DS-II) and the Watt's Connectedness Scale (WCS). Adverse events and suicidality were assessed through 6-month follow-up. 25 participants were enrolled and randomized. There were 12 study-related AEs recorded that were Grade 1-2 and no serious AEs. There was larger decrease in QIDS score for the MBSR+PAP arm compared to MBSR-only from baseline to 2-weeks post-intervention and significant between-group differences favoring MBSR+PAP on subscales of the MBI-HSS-MP as well as the DS-II and WCS. Group psilocybin-assisted therapy plus MBSR was associated with clinically significant improvement in depressive symptoms without serious adverse events and with greater reduction in symptoms than MBSR alone. Study findings suggest that integrating psilocybin with mindfulness training may represent a promising treatment for depression and burnout among physicians and nurses.

Exploring Barriers and Bridging Gaps: Perspectives of Nurses, Midwives, and Lady Health Workers in the Implementation of Emergency Obstetric Care.

Maternal mortality is a global concern primarily due to preventable obstetric complications. Challenges in implementing Emergency Obstetric Care (EmOC) in developing nations hinder effective reduction of these deaths. Our objective was to identify key challenges in EmOC practices among frontline healthcare providers, assess the severity and frequency of these barriers, and evaluate gaps in resources, training, and institutional support needed for effective resolution. This cross-sectional study assessed EmOC knowledge, practical skills, and challenges among Nurses, Lady Health Visitors (LHVs), and Lady Health Workers (LHWs) in Khyber Pakhtunkhwa, Pakistan from July 2017-June 2020. Participants were conveniently sampled from hospitals across eight districts, with data collected through a questionnaire on EmOC knowledge, practical interventions, and challenges faced. Although most participants (91% of nurses, 90.2% of LHVs, 92.3% of LHWs, and 83.3% of midwives) expressed satisfaction with course content, important gaps emerged in the practical application of specific EmOC interventions. Nurses displayed 79% knowledge of the Partogram with only 60% utilization, while LHVs showed 80.5% knowledge but just 50.2% utilization. Assisted delivery knowledge and practice were particularly low among nurses (32% & 7%) & LHVs (17.1% & 2.4%) respectively. Significant gaps were found in retained placenta removal and manual vacuum aspiration, with only 12% of nurses and 3% of LHVs practicing the latter, with no utilization among LHWs or midwives. Key barriers included insufficient training and restrictive institutional policies. Despite high course content satisfaction, disparities in EmOC knowledge and practice persist among frontline healthcare-providers, with barriers like insufficient training and institutional limitations impacting maternal outcomes.

The Experiences of Midwives in the Management of Obstetric Emergencies: A Phenomenological Study in the Kwahu West Municipality, Ghana

Introduction Obstetric emergencies are sudden, unexpected life-threatening medical conditions that occur during pregnancy, labour, delivery or puerperium and are challenging moments because of frightening and traumatic experiences. Obstetric emergencies, which threaten the well-being of the woman and the unborn child, account for the majority of causes of maternal death. Objective The study sought to explore Midwives’ experiences in obstetric emergencies in the Kwahu West Municipality of Ghana Methods A phenomenological study design with a qualitative approach was employed to explore the midwives’ experiences in the management of obstetrics. Participants were selected using purposive sampling. The sample size of 13 was reached upon data saturation. A semi-structured interview guide was used to interview midwives who have experienced and managed obstetric emergencies. The obtained data was transcribed and analysed using a thematic analysis approach. Results Overall, five themes and 13 subthemes emerged. The emerging themes encompass factors influencing midwives’ experiences in managing obstetric emergencies, Reactions of midwives during obstetric emergencies, Challenges of midwives in managing obstetric emergencies, Healthcare challenging factors, and Client-centred limitations. Conclusion It is evident that midwives play a critical role in addressing obstetric emergencies, often being the frontline healthcare providers in such situations. Their experiences shed light on both the challenges they face and the strategies they employ to provide effective care under demanding circumstances. The findings highlight the need for further investment in training and resources for midwives, particularly in rural areas where access to healthcare services may be limited.

Postnatal foot length measurement as a proxy to identify low birth weight for frontline health workers in rural Sindh Province, Pakistan: a diagnostic accuracy study

ObjectiveTo assess the diagnostic accuracy of postnatal foot length (FL) measurements as a proxy to identify low birth weight (LBW) for frontline healthcare workers in rural Sindh Province, Pakistan.DesignA community-based...

Future Nurses in a Changing Climate: Exploring the Relationship Between Environmental Literacy and Climate Anxiety.

Climate change significantly impacts public health, increasing the prevalence of respiratory, cardiovascular and mental health issues. Nurses, as frontline healthcare providers, need strong environmental literacy to manage these health challenges. This study explores how environmental literacy among nursing students relates to climate anxiety, aiming to improve educational strategies and mental health support for future nurses. Is to investigate how environmental literacy among nursing students affects their levels of climate anxiety. A cross-sectional survey was utilised on a representative sample of 620 nursing students from each academic year. Climate anxiety scale and the environmental literacy scale for adults were used to collect data. Environmental literacy and its components were positively linked to cognitive-emotional and functional impairments and climate anxiety. Gender differences were observed, with females experiencing higher climate anxiety. Increased environmental literacy generally reduced climate anxiety, particularly in females, emphasising gender differences in environmental literacy's impact on climate anxiety. Despite the model's low explanatory power (R2 = 0.026), the findings highlight the importance of gender differences in the relationship between environmental literacy and climate anxiety. Nursing students show promise in their environmental knowledge but face significant climate anxiety. Gender differences in anxiety levels warrant attention. Addressing these concerns is crucial for preparing nurses to effectively address climate change's health effects and ensuring a resilient healthcare system. The study underscores the importance of integrating environmental literacy into nursing education and promoting pro-environmental behaviours among nursing students and professionals. It highlights the crucial role of mental health support services, policy advocacy and ongoing research in addressing climate anxiety and preparing nurses to tackle the health impacts of climate change. No patient or public involvement.

Knowledge and Attitude regarding Cardio Pulmonary Resuscitation (CPR) among Nurses in Bangladesh

Cardiac arrest remains a leading cause of mortality worldwide. The effective management of cardiac arrest requires a thorough understanding of cardiopulmonary resuscitation (CPR) techniques. As frontline healthcare providers, nurses are pivotal in identifying cardiac arrest and initiating CPR. This study aimed to evaluate the level of knowledge and attitude regarding CPR among nurses at Chittagong Medical College Hospital (CMCH), Bangladesh. A descriptive cross-sectional study was conducted involving government-registered nurses employed at CMCH. A convenience sampling method was employed to select participants. Data were collected using self-administered semi-structured questionnaires. The study found that 68.1% of the nurses had a diploma in nursing and limited experience in CCU/ICU and emergency departments. Furthermore, 76% of the nurses had not received CPR training. Only 1.4% of the participants exhibited good knowledge of CPR, 37.2% had an average level of knowledge, and 61.5% demonstrated poor knowledge. Regarding attitudes towards CPR, 24% of the nurses had a good attitude, while 76% had an average attitude. The findings indicate that nurses at CMCH possess inadequate knowledge of CPR despite a moderate attitude towards its practice. This study provides foundational data that could guide efforts to enhance CPR training and knowledge among nurses in Bangladesh.

Public health communication and multi-disciplinary NHS workload relating to Group A Streptococcus: a retrospective observational study

BackgroundBy December 2nd, 2022, five child deaths in England were linked to invasive Group A Streptococcus (iGAS) and cases were higher than average, prompting the UK Health Security Agency (UKHSA) to release public health advice for parents. This study aims to describe the relationship between public health messaging and Streptococcus A-related NHS activity in children aged 0–14-years in England. MethodsA retrospective observational study was conducted using GAS-related internet search analytics, NHS and GP surveillance, and UKHSA notifications. FindingsIn the week following the first public health announcement, GP pharyngitis appointments rose by 111% compared to any previous peak observed since 2017. Strep throat and peritonsillar GP attendances rose by 1742%, and Penicillin V prescriptions by 134% compared to mean winter levels. Emergency department attendances for paediatric respiratory infections rose by 68%, 111 calls and online submissions for children with fevers increased by 20% and 311% respectively, and sore throats by 397% and 748%. For each paediatric invasive GAS case, 2250 111 contacts for sore throat or fever and nearly 1200 GP appointments for pharyngitis or scarlet fever occurred. InterpretationThis study highlights the significant impact of Streptococcus A-related workload on the healthcare system during the winter of 2022. Strengthening interdisciplinary collaboration between public health bodies and frontline healthcare providers could help to optimise the content and targeting of messaging and prepare the system for future outbreaks. The findings also point to the necessity of establishing mechanisms for scaling healthcare capacity during periods of increased demand. FundingNone.

Infertility Prevention and Health Promotion: The Role of Nurses in Public Health Initiatives.

Infertility is a growing public health concern, affecting millions of individuals and couples worldwide. Despite advancements in medical treatments, prevention remains a critical strategy for reducing the burden of infertility. Nurses, as frontline healthcare providers, play a pivotal role in infertility prevention and health promotion, particularly through public health initiatives. This review aims to explore the diverse roles of nurses in infertility prevention and their contributions to public health strategies. A review of existing literature was conducted to examine the epidemiology of infertility, key risk factors, and the preventive measures that can be employed by nursing professionals. Emphasis is placed on the role of nurses in health education, screening, early detection, and community-based interventions, which are essential in reducing infertility rates. In addition, this review identifies barriers that impede effective nurse-led infertility prevention, such as disparities in access to care, cultural sensitivity challenges, and policy constraints. Evidence suggests that nurses are well-positioned to lead public health campaigns, conduct reproductive health counseling, and advocate for policy reforms to improve infertility prevention. The review concludes with recommendations for future research, suggesting enhanced nursing education and training, as well as the need for stronger integration of nurses into public health policy-making. This study underscores the critical role of nurses in promoting reproductive health and preventing infertility, advocating for their inclusion in comprehensive public health strategies aimed at addressing infertility on a global scale.

Pharmacists' Knowledge, Perception, and Prescribing Practice of Probiotics in the UAE: A Cross-Sectional Study.

The human body is a complex and interconnected system where trillions of microorganisms, collectively known as the gut microbiota, coexist with these cells. Besides maintaining digestive health, this relationship also impacts well-being, including immune function, metabolism, and mental health. As frontline healthcare providers, pharmacists are pivotal in promoting the benefits of probiotics for immune support. This study explored pharmacists' knowledge, perception, and practice behavior in the UAE towards the implication of probiotic application beyond digestive health, such as cardiovascular and mental health impacts and their diverse dosage forms. An online self-administered survey was distributed among pharmacists in the UAE. Data were collected through personal visits to pharmacies, where pharmacists were approached and asked to complete the questionnaire. The sample size included 407 pharmacists, determined using the formula for proportions with a 95% confidence level and a 5% margin of error. Statistical analysis was performed using SPSS version 29. Descriptive statistics were used to summarize demographic characteristics and survey responses. The knowledge levels were categorized into poor, moderate, and good. Chi-square analysis was employed to investigate associations between demographic factors and knowledge levels, with a significance level set at p < 0.05, enhancing the robustness of the study's findings. This study included 407 completed eligible responses. About 63.56% of participants were female, with 52.1% employed in pharmacy chains. While 91.2% of pharmacists recognized probiotics' role in immune support, only 30% were aware of their cardiovascular benefits. Moreover, chewing gum was the least known dosage form of probiotics, recognized by only 16.7% of respondents. Additionally, only 57% of the participants recognized liposomes as a dosage form. In practice, most pharmacists recommended storing probiotics at room temperature, accounting for 66.6%. The most prevalent misconception encountered in the pharmacy setting was the belief that probiotics are primarily intended for gastrointestinal tract problems, at 79.1% of the respondents. Regarding perception, the agreement was observed regarding the safety of probiotics for all ages. Perceived barriers included the high cost of probiotics, with the majority (86.5%) indicating this as a significant obstacle, while lack of demand was identified as the minor barrier by 64.6%. Additionally, an association was found at a significance level of p < 0.05 with knowledge, gender, educational level, type and location of pharmacy, and source of information. The study highlights knowledge gaps in pharmacists' understanding of probiotic applications beyond digestive health, particularly cardiovascular health and depression. Targeted educational interventions are necessary to address these gaps. The findings underscore the importance of ongoing professional development for pharmacists, enhancing their role in patient education and the promotion of probiotics for overall health.

Empowering nurses to support Greener NHS policy

Climate change is a significant global health threat, projected to cause over 250000 deaths annually by 2050, as a result of factors such as extreme heat, flooding and poor air quality caused by pollution. The NHS, as a major healthcare provider, contributes around 4% of the UK's total emissions and in October 2020, became the world's first health service to commit to reaching net zero carbon, in response to the profound and growing threat to health posed by climate change. Nurses, as frontline healthcare providers, are uniquely positioned to drive sustainability initiatives within healthcare settings, reducing environmental impact while improving patient outcomes. Sue Thomas explores how nurses can make a difference in line with the Greener NHS policy.

The psychological impact of COVID-19 on front-line healthcare providers in the United Arab Emirates: A cross-sectional study.

The COVID-19 pandemic has significantly impacted the psychological well-being of healthcare providers (HCPs) worldwide. Understanding the prevalence and associated factors of depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) among these providers is crucial. Assess the prevalence of major depression, GAD, and PTSD symptoms among HCPs in the United Arab Emirates (UAE) during the COVID-19 pandemic. Additionally, this study sought to identify demographic, work-related, and health-related factors associated with these psychological symptoms. A cross-sectional survey involving 992 HCPs across various healthcare institutions in the UAE was conducted. Participants were administered standardized assessment tools, including the Patient Health Questionnaire-9 (PHQ-9) for depression, the GAD-7) for GAD, and the Impact of Event Scale-Revised (IES-R) for PTSD. Independent t-tests and one-way analysis of variance (ANOVA) were employed to assess the prevalence and associated factors. The findings revealed that approximately 19% of the participants exhibited significant symptoms of major depression (PHQ-9 ≥10), while 57.1% reported no significant anxiety symptoms, and 54.4% displayed minimal or no significant PTSD symptoms. Participants with COVID-19, family infections, and work overload showed higher depression, GAD, and PTSD symptoms. Married in-hospital workers significantly differed from single prehospital workers in psychological symptoms. Occupation, level of education, working department, and age significantly influenced the perceived severity of depression, GAD, and PTSD symptoms. Specifically, the ANOVA test revealed significant differences in depression (F = 3.01, P < 0.05), GAD (F = 11.4, P < 0.001), and PTSD symptoms (F = 3.6, P < 0.05) based on occupation. Nurses had higher depression (5.8 ± 7.4) and GAD (7.4 ± 6.6) scores, while physicians had elevated PTSD symptoms (22.4 ± 21.0). Participants with a bachelor's degree had significantly higher depression (7.0 ± 8.4), GAD (7.2 ± 7.4), and PTSD symptoms (22.9 ± 24.6) than those with diplomas or postgraduate degrees. In the intensive care unit (ICU), higher levels of depression (9.3 ± 9.1), GAD (7.6 ± 7.5), and PTSD symptoms (24.7 ± 25.4) were reported. Participants at the screening center had higher depression (5.4 ± 4.7) and PTSD symptoms (15.2 ± 16.8) than those in other prehospital departments. However, participants in PHCs reported higher levels of GAD symptoms (5.8 ± 7.1) compared to those at screening centers, and EMTs. Concerning age groups, participants between 50 and 60 years old experienced more depressive symptoms (8.3 ± 6.7), while those aged 40-49 reported higher GAD (8.5 ± 7.3) and PTSD symptoms (27.0 ± 19.0). This study underscores the importance of proactive mental health support and tailored interventions for HCPs. It highlights the need for workload management and work-life balance, as well as personalized support for those directly affected by COVID-19. Moreover, it emphasizes the significance of pandemic preparedness and comprehensive training for HCPs. The study findings contribute to a deeper understanding of the diverse factors influencing the psychological well-being of HCPs during public health crises.

Mental Health Effects of COVID-19 Among Health Care Providers: A Case Study of Kalulushi General Hospital in Kalulushi District, Zambia

Coronavirus disease 2019 is an infectious disease which was first identified in Wuhan a City in the Peoples Republic of China in December 2019. The aim of this study was to establish the mental health effects of COVID 19 on the frontline health care providers at Kalulushi General Hospital in Kalulushi district of Zambia. A descriptive cross-sectional study was employed to assess the mental health effects of COVID 19 on the frontline health care providers at Kalulushi General Hospital in Zambia. The study used simple random sampling technique to select 122 respondents to participate in the study. Data was collected from study participants using structured questionnaire. The collected data was analyzed using SPSS version 25 and MS excel and was presented using tables, bar charts and pie charts. Multivariate logistic regression analysis was used to examine the relationships between socio-demographic characteristics and mental health effects of COVID-19 parameters. The ethical approval was gotten from Lusaka Apex Medical University Biomedical Research Ethics Committee, Kalulushi General Hospital and Kalulushi District Health Office respectively. The study revealed that, most of the respondents (31%) were afraid of contracting COVID-19, while 27% of study participants claimed that COVID 19 was a propaganda and that no one knew when it would end. The study also found that, a small proportion of study participants reported a decline in work morale (17%), likely associated with witnessing numerous deaths (19%) and the added stress of inadequate personal protective equipment (PPE) experienced by 15%. The study further demonstrated that 58% of the respondents accepted that working in a COVID-19 environment affected their mental health while 42% of the respondents did not accept that working in the COVID-19 environment did affect mental health of frontline healthcare providers. The study further revealed that, most of the respondents were using handwashing or sanitizers, facemasks and protective clothing (27%) to cope with COVID-19 pandemic. The study also showed that, a few respondents were practicing social distancing (22%), and having healthy diet (19%) in order to cope with COVID-19. Marital status and religion were found to have significant association with copying strategies of frontline healthcare providers against COVID-19 pandemic at Kalulushi General Hospital in Kalulushi District of Zambia (P &amp;lt; 0.05). WHO, CDC, and Zambian Ministry of Health should prioritize implementing Critical Incident Stress Management protocols, develop culturally sensitive mobile applications to offer self-guided interventions, and promote healthy coping mechanisms among frontline healthcare providers.

Factors Affecting Standing and Walking Outcomes for Individuals with Spinal Cord Injury during In-patient Rehabilitation: a Qualitative Study on the Perspectives of Physiotherapists

Purpose: Standing and walking outcomes following spinal cord injury (SCI) vary across rehabilitation centres and therapists. Much of this variation has been attributed to individual patient characteristics. However, insight from frontline health care providers, as well as exploration of comprehensive contributing factors, have been under investigated. This study aimed to explore the perspectives of physiotherapists on factors affecting standing and walking recovery and outcomes during in-patient SCI rehabilitation. Methods: An exploratory qualitative study was conducted using semi-structured focus group interviews. Our qualitative approach was grounded in interpretive description and used reflexive thematic analysis. Results: Ten physiotherapy representatives of seven different in-patient SCI rehabilitation sites across Canada participated. Dosage, organizational culture, length of stay, staffing, equipment, relationships, atmosphere, and mindset were the key factors identified. Our findings also highlight that how factors impact a site may differ, but perspectives on which factors influence standing and walking outcomes were similar. Factors beyond the individual and the relationship of these factors on training dosage were emphasized. Conclusion: Future work is needed to better understand the role of institutional culture, to design and implement potential ways to address key contributing factors, and to evaluate if such initiatives lead to improvements in standing and walking outcomes.

A low-cost approach to upskilling tutors in frontline health care worker production value chain.

Nigeria, like many countries, struggles with a shortage of healthcare professionals including frontline healthcare providers at the primary healthcare (PHC) level. While the country is pitched towards producing more healthcare professionals, the existing infrastructure to produce them is inadequate. Producing healthcare professional with the required skills to deliver quality services is impeded by several factors including the use of outdated curricula for their training, low application of technology in teaching, and weak tutor capacity that is worsened by the paucity and high cost of opportunities for tutor continuing professional development. To address these issues, the Health Workforce Management Activity (HWM), an initiative of the United States Agency for International Development (USAID), in 2023 designed and implemented a low-cost programme called TutorConnect that offered low-cost continuing professional development to tutors. TutorConnect is a Zoom-based monthly training programme that is facilitated by subject matter experts. The programme offered topics spanning effective learning, enhanced instructional design, and improved student engagement in the 14 months of its operation with over 700 tutors from more than 10 states in Nigeria that benefited from it. Utilising WhatsApp for additional support and peer-to-peer learning was crucial to providing more hands-on support, and institution-specific solutions. This low-cost approach to build competencies enabled access to continuing professional development by tutors, limiting effects of location and finances as barriers to continuing professional development. Developing the teaching capacity of tutors is pivotal to enhancing the quality of frontline healthcare worker training.

Assessing Healthcare Providers’ Preparedness for Managing COVID-19 Patients: A Mixed-methods Study

Objectives: Globally, the preparedness of frontline healthcare providers (HCPs) to deliver timely and appropriate medical care has emerged as a significant concern. The training of HCPs in containment measures is considered pivotal in elevating the quality of care for COVID-19 patients while simultaneously mitigating the risk of viral transmission to both fellow patients and HCPs. This study investigates the impact of training on HCPs readiness to manage COVID-19 patients in a tertiary hospital in Oman. Methods: Employing a mixed-method design, we extended invitations to HCPs at the Royal Hospital in Muscat using electronic forms. We collected data about HCPs demographics, their comprehension of the hospital’s core objectives and protocols, and any knowledge acquired through official training or self-directed study. Our analytical approach encompassed descriptive and univariate statistical methods, complemented by thematic analysis for the qualitative component. Results: Our survey acquired responses from a total of 241 individuals. Among the respondents, 67.6% were female nurses, and 49.8% were aged between 31–40 years old. Significant differences were observed concerning gender (p =0.018 and p =0.001) and profession (p &lt; 0.001 and p&lt; 0.001) with the total score in awareness and knowledge, respectively. Stress and fear of handling confirmed or potentially contagious patients negatively impacted nearly half of the HCPs, with doctors and nurses reporting this effect significantly. Remarkably, 61.0% of HCPs expressed that their confidence in managing COVID-19 cases was positively influenced by their faith in national pandemic plans. Conclusions: While the hospital’s protocols and procedures were well comprehended, the lack of preparedness and skills training for managing highly contagious patients resulted in diminished confidence and heightened stress. To fortify their ability to respond to future outbreaks and work with resilience and confidence, HCPs require ongoing, comprehensive, and hands-on training.

A national survey of pandemic fear and cyberchondria after ending zero-COVID policy: The chain mediating role of alexithymia and psychological distress

BackgroundMore than half the domestic population in China were infected with COVID-19 in two months after ending “zero-infection policy”, which severely overwhelmed frontline healthcare providers with stress and fear. However, there is no study to date investigating the associations between nurses' fear of pandemic and cyberchondria. This study aimed to 1) investigate the correlations between fear pandemic and cyberchondria among frontline nurses, and 2) discover its potential mechanism. MethodsA cross-sectional sample of frontline nurses (N = 8161) was recruited from 98 hospitals across China in February 2023. Participants were invited to complete an online, self-rated standardized questionnaire focused on pandemic fear, alexithymia, psychological distress, and cyberchondria. Environmental, clinical and socioeconomic information were collected for adjustment while conducting chain mediation analysis. ResultsWhen other covariates were controlled, it was found that fear of the pandemic significantly contributed to cyberchondria (b = 0.58, 95%CI [0.56, 0.60], p < .001). The chain mediation model suggested that both alexithymia and psychological distress were mediating factors between pandemic fear and cyberchondria. ConclusionsThe higher the perceived fear, the greater the cyberchondria, which suggests that reducing fear about the pandemic and providing adequate support could reduce the incidence of cyberchondria. As alexithymia and psychological distress may be transdiagnostic mechanisms between fear and cyberchondria, targeted interventions focused on expression dysregulation and emotional identification could be useful.

Management of iron deficiency anemia during pregnancy: a midwife-led continuity of care model

BackgroundGlobally, 36.5% of pregnancies are affected by anemia, particularly in low-and middle-income countries, posing significant risks to maternal and perinatal health. In rural Pakistan, 44.3% of pregnant women suffer from iron deficiency, contributing to the high prevalence of anemia. Limited accessibility to antenatal care exacerbates the challenge, necessitating innovative solutions. This study assessed a midwife-led continuity of care model, utilizing intravenous (IV) iron therapy for the management of anemia in Karachi, Pakistan.MethodsWe performed a retrospective analysis of data from a prospective cohort study conducted in two primary healthcare facilities, which employed a community midwife (CMW)-led continuity of care model for antenatal care, including IV iron therapy. We extracted data from February 2021 to March 2022 for women who were diagnosed with anemia based on hemoglobin (Hb) levels, categorized as mild (10.0 to 10.9 g/dL), moderate (7.0 to 9.9 g/dL), or severe (less than 7.0 g/dL). Assessment occurred at the initial antenatal care (ANC) visit to establish baseline anemia severity, and approximately 2 weeks after intravenous (IV) iron therapy administration to evaluate post-treatment changes were considered.ResultsWe enrolled 114 pregnant women, where the majority presented with moderate (88.6%) anemia. After IV iron treatment, 48.5% improved to normal-mild levels, while 50% remained unchanged. Severe anemia affected 10.5% at baseline; 42% shifted to moderate and 50% to normal-mild post-treatment, with one remaining unchanged (p &amp;lt; 0.001). Among women enrolled in the first and second trimesters, severe anemia improved to normal-mild (50%) and moderate levels (50%) (pre-treatment: n = 10, post-treatment: n = 0), and moderate anemia decreased by 48% (pre-treatment: n = 92, post-treatment: n = 47).ConclusionOur midwife-led model of care demonstrated an improvement in iron levels among pregnant women. The model addressed the challenges of anemia prevalence in Pakistan and underscored the significance of empowering front-line healthcare providers, such as community midwives (CMWs) for managing these common conditions.