Increase Health Care Providers Research Articles

Healthcare providers' perceived support from their organization is associated with lower burnout and anxiety amid the COVID-19 pandemic.

Professional burnout represents a significant threat to the American healthcare system. Organizational and individual factors may increase healthcare providers' susceptibility or resistance to burnout. We hypothesized that during the COVID-19 pandemic, 1) higher levels of perceived organizational support (POS) are associated with lower risk for burnout and anxiety, and 2) anxiety mediates the association between POS and burnout. In this longitudinal prospective study, we surveyed healthcare providers employed full-time at a large, multihospital healthcare system monthly over 6 months (April to November 2020). Participants were randomized using a 1:1 allocation stratified by provider type, gender, and academic hospital status to receive one of two versions of the survey instrument formulated with different ordering of the measures to minimize response bias due to context effects. The exposure of interest was POS measured using the validated 8-item Survey of POS (SPOS) scale. Primary outcomes of interest were anxiety and risk for burnout as measured by the validated 10-item Burnout scale from the Professional Quality (Pro-QOL) instrument and 4-item Emotional Distress-Anxiety short form of the Patient Reported Outcome Measurement Information System (PROMIS) scale, respectively. Linear mixed models evaluated the associations between POS and both burnout and anxiety. A mediation analysis evaluated whether anxiety mediated the POS-burnout association. Of the 538 participants recruited, 402 (75%) were included in the primary analysis. 55% of participants were physicians, 73% 25-44 years of age, 73% female, 83% White, and 44% had ≥1 dependent. Higher POS was significantly associated with a lower risk for burnout (-0.23; 95% CI -0.26, -0.21; p<0.001) and lower degree of anxiety (-0.07; 95% CI -0.09, -0.06; p = 0.010). Anxiety mediated the associated between POS and burnout (direct effect -0.17; 95% CI -0.21, -0.13; p<0.001; total effect -0.23; 95% CI -0.28, -0.19; p<0.001). During a health crisis, increasing the organizational support perceived by healthcare employees may reduce the risk for burnout through a reduction in anxiety. Improving the relationship between healthcare organizations and the individuals they employ may reduce detrimental effects of psychological distress among healthcare providers and ultimately improve patient care.

Developing Innovative Virtual Reality Simulations to Increase Health Care Providers' Understanding of Social Determinants of Health.

Health care providers (HCPs) who work primarily with Medicaid patients must be competent in identifying and addressing social determinants of health (SDH). A curricular gap exists between promoting an understanding of SDH and teaching HCPs how to recognize and increase empathy to manage them. The project aim was to develop two virtual reality simulations (VRSs) as innovative methods to teach HCPs to identify and manage SDH. A secondary aim was to decrease unconscious bias and increase empathy by experiencing SDH from their patients' perspective. Scripts for two VRSs were created by two HCP educators and clinicians. Scripts were evaluated by experts using an index of content validity (CVI). An advisory panel critiqued the scripts for appropriateness for VRSs, adequacy of evidence-based practice, and use of VRS equipment and software. The panel participated in a focus group and completed a final evaluation. The VRSs then were pilot tested with five HCPs who assessed content and utility and participated in interviews. This led to iterative improvements. Qualitative data were analyzed using a content analysis approach. The VRS scripts demonstrated adequate content-related validity evidence with CVI scores of 0.81 and 0.75. The expert panel found the VRS easy to use, useful as an educational tool, while promoting empathy for patients. Overall, participants were satisfied with using the VRS as an educational experience. Through VRS technology, this project addresses a curricular gap in HCP training on SDH. VRS can be a useful tool to increase HCPs' understanding of SDH and, potentially, their empathy for patients.

Diagnostic Criteria and Treatment Modalities of Ectopic Pregnancies: A Literature Review

Background: Ruptured ectopic or extrauterine pregnancy (EP) is responsible for 6% of maternal deaths in the first trimester. This review was designed to summarise the diagnostic criteria and treatment modalities of EPs. Methods: Recent guidelines of the international societies of obstetrics and gynaecology, including the Royal College of Obstetricians and Gynaecologists (RCOG), the American College of Obstetricians and Gynecologists (ACOG), and the European Society of Human Reproduction and Embryology (ESHRE), were reviewed to summarise the diagnostic criteria and treatment modalities of EPs. Results: A minimum β-human chorionic gonadotropin (β-hCG) rise of ≥35% in 48 hours was suggested to diagnose intrauterine pregnancy. A β-hCG rise &lt;35% in 48 hours has 96.2% positive predictive value, 69.7% negative predictive value, and 80.2% overall accuracy in predicting EPs. The blob sign has &gt;90% positive predictive value in diagnosing EPs in symptomatic females with positive β-hCG and no definite intrauterine gestational sac by transvaginal sonography. The interstitial ectopic pregnancy and cornual pregnancy are two separate entities of EPs. Interstitial line sign has 80% sensitivity and 98% specificity in diagnosing interstitial ectopic pregnancy. A meta-analysis reported 89% overall success rate for methotrexate in treatment of EPs; the multi-dose regimen was significantly more successful than the single-dose regimen. Conclusion: Institutes and healthcare providers should follow clear guidelines and/or protocols for the management of EPs. Institutes should implement competency-directed training programmes to increase healthcare providers’ skills to diagnose and treat EP variants using different modalities.

A Review on Human Orf: A Neglected Viral Zoonosis.

Orf virus (ORFV) is the etiologic agent of Orf or ecthyma contagiosum in humans but primarily affects different domestic and wild animals. The disease mostly affects sheep, goats and other small wild ruminants and spreads to humans through direct contact with infected animals or by way of contaminated fomites worldwide. ORFV is taxonomically classified as a member of the genus Parapoxvirus. It is known to have tolerance to inactivation in a drier environment, and it has been recovered from crusts after several months to years. Among immunocompetent people, the lesions usually resolve by its natural course within a maximum of 8 weeks. In immunosuppressed patients, however, it needs the use of various approaches including antiviral, immune modifier or minor surgical excisions. The virus through its association with divergent host ranges helps to develop a mechanism to evade the immune system. The relative emergence of Orf, diagnosed on clinical ground among human cases, in unusual frequencies in southwest Ethiopia between October 2019 and May 2020, was the driver to write this review. The objective was to increase health care providers’ diagnostic curiosity and to bring the attentiveness of public health advisors for prevention, control and the development of schemes for surveillance of Orf zoonosis in a similar setting like Ethiopia.

A Concept Analysis of Oral Anticancer Agent Self-management.

The rapid development and adoption of oral anticancer agents (OAAs) for cancer management have shifted patients' roles from recipient to owner of their care delivery, assuming their responsibilities for self-managing their OAA treatments at home, while the concept of oral anticancer agent self-management (OAA-SM) has not been well clarified and defined. This study was to clarify the concept of OAA-SM and identify major components, influential factors, and consequences of OAA-SM, as well as propose a representative conceptual model of OAA-SM. A literature review was conducted concerning the concept and application of OAA-SM. The Walker and Avant method for concept analysis was utilized to guide the examination of OAA-SM. OAA-SM is a multifaceted and dynamic process that requires continuous adaptation by patients as multiple self-management challenges can emerge throughout OAA treatments. The defining attributes of OAA-SM include OAA adherence, adverse-effect self-management, patient-provider communication, and OAA safe storage, handling, and administration practices. Oral anticancer agent-SM is potentially influenced by a variety of patient-related, OAA-related, and healthcare system factors. Effective OAA-SM is associated with better patient and healthcare outcomes. The clarification of the concept of OAA-SM and the identification of attributes of OAA-SM and their interrelationships contribute to the body of knowledge in OAA-SM. This concept analysis provides the foundation to increase healthcare providers' understanding of patients' needs for OAA-SM support and guides the development of patient-centered interventions to empower and engage patients and their families in effective OAA-SM, and improve patients' quality of life and care.

Untact Visit Service Development Based on an Application Reflecting the Circumstances during COVID-19: Focusing on Utilization in the Pediatric Intensive Care Units

This study aimed to develop an untact visit service based on an application that can be utilized in the pediatric intensive care unit (PICU) during COVID-19. This study adopted the double diamond process of service design comprising the discovery, defining, and development stages. We developed an untact visit service based on an application that considered the child's status, schedule, photo, and video messages, and so on. Moreover, we derived a service flow regarding the required roles and the type of flow shown between each stakeholder. Considering the ongoing pandemic, the untact visit service is designed to increase rapport and participation of parents, share the child's information in real-time, and provide one-stop service without increasing healthcare providers' work. It will be a useful visit service that can be applied and evaluated in various hospital settings and the PICU.

Hypoglycemic Effects of Turmeric (Curcuma longa Linn.) on Bio-chemical Profile in Alloxan Monohydrate Induced Type-1 Diabetes in Albino Rats

Background: Type 1 diabetes is increasing by approximately 3% each year globally. Type 1 diabetes can manifest at any stage during the human life cycle, but particularly demanding when it present in a child. The diagnosis in a child can cause parental distress and anxiety, the effects of which can be long lasting. The diagnosis of a T1D affects not only the parents but the whole child family. Objectives: To determine impacts on the family living with child having T1D. Method: Cross sectional study conducted on 138 families in Sana’a city. Convenience sampling used to select parents of diabetic children aged 6-14 years. Structured questionnaire was completed using face to face interview. Results: In the current study. Parents in relationship of to the participate to the child was father (49.2%), mother was (50.8%). The mean age of parents was 37 ± 10 years. Most of the parents were illiterate or had basic education. The mean age of parents at diagnosed of diabetes was (33 ± 10years). The diabetic children aged 6-14 years old. The mean age of the children was 11 ± 2.6 years. More than half of them were female. The majority of the children 92% in basic school level. Mean duration of diabetes was 4 ± 3 years. The greatest portions were diagnosed at age group 5-8 years. The mean age of diagnosed of diabetes was 7 ± 3.2 years. Diabetes duration was 1-4 years for most of the diabetic children. Most of families had one child with T1D. Conclusion: Further studies on impact of T1D are needed. Protective health behavior education efforts are made to increase health care provider knowledge about T1D and promote family and T1D child life.

Trends in sickle cell trait and disease screening in the Republic of Uganda, 2014-2019.

Sickle cell disease is an important public health issue that is increasingly recognised as a substantial contributor to morbidity and early childhood mortality in sub-Saharan Africa. We aimed to provide information from large-scale, long-term sickle cell screening efforts in Africa. We used nationally representative data from the centralised public health laboratory database in Uganda to examine epidemiological trends in sickle cell screening over a five-year period, comparing age and geographic adjustments to prevalence among different testing cohorts of children aged 0-24months, and calculating screening coverage within high-burden districts. A total of 324356 children aged 0-24months were screened for sickle cell trait and disease from February 2014 to March 2019. A high national burden of sickle cell disease (0.9%) was confirmed among a cohort of samples co-tested with HIV. In the cohort of samples referred specifically for sickle cell testing, the overall prevalence of sickle cell disease was 9.7% and particularly elevated in high-burden districts where focused screening occurred. The majority of children were screened before age 4months, but the sickle-specific cohort had a larger proportion of affected children tested between age 5-9months, coincident with onset of disease signs and symptoms. Successful screening coverage of sickle cell disease births was achieved in several high-burden districts. Examination and analysis of national sickle cell screening trends in Uganda documents the successes of focused screening strategies as an important step towards universal screening. With this evidence and increased healthcare provider knowledge, Uganda can optimise sickle cell diagnosis and management across the country.

The Health Sciences and Technology Academy (HSTA): Providing 26 Years of Academic and Social Support to Appalachian Youth in West Virginia.

The Health Sciences and Technology Academy's, (HSTA) goals are to increase college attendance of African American, financially disadvantaged, first generation college and rural Appalachian youth and increase health-care providers and STEM professionals in underserved communities. Students enter in the 9th grade and remain in HSTA four years. They engage in a rigorous academic program within the nurturing environment of small after-school clubs punctuated by yearly summer camps on multiple college campuses. A distinctive piece of HSTA is its students' development of research projects under the mentorship of teachers and researchers that examine and address health issues faced by their communities. The projects help HSTA students to understand the health dynamics in their local community, transforming them into community advocates who address health and social issues at home as they prepare to move on to college and beyond. Substantial in-state tuition waivers inspire 99% of the 3,021 HSTA graduates to attend college versus 56% of WV high school graduates. Approximately 85% of matriculating HSTA students graduate with a four-year degree or higher versus less than 50% of all college entrants. To date, 57% of HSTA students go into health and other STEM majors, much higher than the state and national figures.

The Educational Program for Healthcare Providers Regarding Fertility Preservation for Cancer Patients: a Systematic Review.

The emerging discipline of oncofertility advocates for the timely provision of fertility preservation (FP) to all cancer patients of childbearing age by healthcare providers. A lack of practice due to limited FP-related knowledge was found among healthcare providers. A systematic review was undertaken on the educational programs on FP for healthcare providers. An initial search was performed in MEDLINE, PsycINFO, CINAHL, Web of Science, PubMed, and Scopus databases in October 2019. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Among the 160 articles that were identified, five relevant articles published between 2009 and 2019 were reviewed. Of the five studies, three were quantitative nonrandomized studies, one was a randomized controlled trial, and one was a qualitative study. Three programs were relevant to oncology nurses, one was relevant to social workers as well as nurses, and one was relevant to oncology fellows and residents. The four programs significantly increased healthcare providers' knowledge about FP, but clinical practice was only improved in the Educating Nurses about Reproductive Issues in Cancer Healthcare program (P < 0.01). Nevertheless, most of the studies used a self-made questionnaire or tool to assess the effects of the training programs. The educational programs improved the FP-related knowledge of healthcare providers but lacked the high-quality randomized controlled trials needed to provide robust evidence on the effectiveness of training programs using standard tools. More training projects should be developed based on learning theories or models to improve oncofertility care in clinical practice.

Taking Care of the Puerto Rican Patient: Historical Perspectives, Health Status, and Health Care Access.

IntroductionHispanics are the largest minority group in the US at 18% of the population, of which Puerto Ricans are the second largest subgroup. Puerto Ricans have poorer health status than other US Hispanic and non-Hispanic populations. Thus, health care providers need to know about and distinguish the health care problems of Puerto Ricans to improve their health. Although there are some published curricula addressing how to provide health care to Hispanic populations, none address the specific needs of Puerto Ricans.MethodsWe developed a 60-minute interactive workshop consisting of a PowerPoint presentation and case discussion aimed at increasing health care providers' knowledge and understanding of the historical perspective that led to Puerto Rican identity, health issues and disparities, and the health care access problems of mainland and islander Puerto Ricans. Evaluation consisted of pre- and postworkshop questionnaires.ResultsThere were a total of 64 participants with diverse ethnoracial identities including medical students, residents, faculty, physicians, researchers, administrators, and students/faculty from nursing, occupational therapy, genetic counseling, biomedical sciences, and social work programs. A comparison of pre- and postworkshop data showed a statistically significant increase in participants' confidence in meeting all learning objectives. Participants positively commented on the interactive nature of the workshop, the case discussion, and the historical perspective provided.DiscussionWith the increasing migration of Puerto Ricans to the US mainland this module can uniquely improve the preparation of current and future health care providers to provide competent care to Puerto Rican patients.

Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives.

IntroductionPersons with vulvodynia (a chronic vulvar pain condition) suffer many barriers to diagnosis and treatment, several of which may be exacerbated by the sociocultural and geographical context in which they live.AimWe drew on the experiences of patients with vulvodynia who were living in small urban and rural communities to learn what they perceived as the major barriers to diagnosis and treatment as well as to probe for possible solutions.MethodsFor this qualitative case study, we conducted 3 focus groups with a total of 10 participants, drawn from patients seen at our academic tertiary referral center, with a goal of understanding their lived experience with vulvodynia.Main Outcome MeasuresThe patient dialogue was coded into themes and temporally grouped to illustrate struggles and victories in diagnosis and treatment.ResultsParticipants confirmed that healthcare provider knowledge and attitudes as well as system challenges (specialist and allied healthcare provider availability) are major barriers to timely diagnosis. Of novel interest are other factors that exacerbate distress and delay diagnosis such as patients’ inadequate knowledge of sexual functioning and sociocultural messages regarding “normal” sexual activity. Our work suggests that a disease prevention framework that includes comprehensive sexual education before or at the onset of sexual activity may be of benefit in reducing the burden of vulvodynia when added to strategies to increase healthcare provider knowledge and improve access to effective treatments.ConclusionWhile healthcare provider knowledge and attitudes are often at the forefront of barriers to diagnosis, our study suggests that to minimize patient distress and expedite diagnosis, resources must also be directed to promoting comprehensive sexual health education.Webber V, Miller ME, Gustafson DL, et al. Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives. Sex Med 2020;8:757–766.

PARC report: a health-systems focus on reimbursement and patient access to pharmacogenomics testing.

Pharmacogenomics test coverage and reimbursement are major obstacles to clinical uptake. Several early adopter programs have been successfully initiated through dedicated investments by federal and institutional research funding. As a result of research endeavors, evidence has grown sufficiently to support development of pharmacogenomics guidelines. However, clinical uptake is still limited. Third-party payer support plays an important role inincreasing adoption, which to date has been limited to reactive single-gene testing. Access to and interest in direct-to-consumer genetic testing are driving demand for increasing healthcare providersand third-party awareness of this burgeoning field. Pharmacogenomics implementation models developed by early adopters promise to expand patient access and options, as testing continues to increase due to growing consumer interest and falling test prices.

‘Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)’: protocol of community-based intervention development and a non-randomised multisite pilot study with pre–post test design in Canada

IntroductionEducational workshops are a promising strategy to increase healthcare providers’ ability to provide gender-affirming care for transgender (trans) people. This strategy may also reduce healthcare providers’ stigma towards trans people...

Reducing physical restraints by older adults in home care: development of an evidence-based guideline

BackgroundRestraint use is a complex and challenging issue in home care. Due to socio-demographic trends, worldwide home healthcare providers are faced with an increasing demand for restraint use from informal caregivers, patients and healthcare providers, resulting in the use of various types of restraints in home care. Awareness and knowledge of restraint use in home care, its implications and the ethical challenges surrounding it are of crucial importance to its reduction. This research aimed to describe the development process of an evidence-based practice guideline to support caregivers to optimize home care.MethodThe practice guideline was developed according to the framework of the Belgian Centre for Evidence-Based Medicine and AGREE II. The guideline was developed over several stages: (1) determination of the target population and scope, (2) literature search, (3) drafting and (4) validation. A multidisciplinary working group determined the proposed purpose, target group, and six clinical questions for the guideline. A consensus procedure and consultation by experts were used to develop the guideline.ResultsThe guideline provides an answer to six clinical questions and contains ten key recommendations based on the classification of GRADE, with the objective of increasing healthcare providers’ awareness, knowledge and competence to adequately deal with situations or questions related to restraint use. The guideline also includes a flowchart for dealing with complex situations where the use of restraints is requested, already present or considered.ConclusionsThe guideline was validated by the Belgian Centre for Evidence-Based Medicine. Increasing competence, awareness and knowledge related to restraint use are key objectives of the guideline for reducing restraint use in home care. A multicomponent intervention to support healthcare workers in implementing the guideline in clinical practice needs to be developed.

Lyndsay Orr Pamela Houghton Paul Holyoke Deena Lala

This quasi-experimental design study aimed to determine whether an educational program could improve health care providers' knowledge and attitudes regarding the use of E-Stim for treating PrIs in community-dwelling individuals with spinal cord injury living in 1 region of Ontario, Canada. An educational intervention based on a university-level continuing education program was developed as part of a multifaceted knowledge mobilization project. Health care providers (eg, nurses, physicians, and allied health professionals) from multiple agencies were invited to participate. The instructional series included 8 online modules on background theory and knowledge and a hands-on workshop that familiarized participants with the equipment necessary to deliver E-Stim. Knowledge (percentage of correct answers using a knowledge test developed by the research team) and attitudes (assessed using the E-Stim Attitude Survey in which items were scored using a 5-point Likert scale (where 0 indicated a negative attitude and 5 a positive attitude) were evaluated 3 times (pre-education, post-online, and post-workshop). Data were aggregated into unit-weighted averaged composites of 3 attitude subscales (resources, evidence-based practice, and education), which were compared before and after educational sessions using a linear mixed effect model. Among the 83 participants, a significant increase in knowledge scores was noted from pre-education (55.9%) to post-online (78.4%) and post-workshop (78.0%) (X² [2] = 89.34; P <.001). A significant increase in attitude scores was noted across time points (resources: X² [2] = 27.32, P <.0001; evidence-based practice: X² [2] = 38.93, P <.0001; and education: X² [2] = 92.88, P <.0001). For the evidence-based practice subscale, attitude increased significantly post-online (t[127] = 6.03, P <.0001). For the resources subscale, a significant increase was detected after post-workshop (t[113] = 5.23, P <.001]. Online education increased health care providers' knowledge about E-Stim; however, hands-on workshops were required to change certain attitudes about the use of E-Stim for wound healing. Further research is required to evaluate 1) whether a change in knowledge and attitude scores translates to a practice change for health care providers and 2) the potential importance of ongoing coaching and mentorship for a sustainable change in the clinical setting.

Developing Resources for American Indian/Alaska Native Transgender and Two-Spirit Youth, Their Relatives, and Healthcare Providers.

American Indian and Alaska Native (AI/AN) youth disproportionately face barriers accessing healthcare, including lack of access to culturally specific resources. This article details the creation of a culturally-specific Toolkit for AI/AN transgender and Two-Spirit youth, their relatives, and their healthcare providers across the United States. The Toolkit aims to 1) deliver culturally grounded resources to youth with diverse gender identities, 2) provide resources for families, and 3) increase healthcare provider awareness. A culturally appropriate Toolkit, "Celebrating Our Magic," was created from continual engagement with community partners over a 6-month period to address identified needs. The Toolkit has been shared regionally with partners who helped with its creation and nationally with Indian Health Service, Tribal, and Urban clinics serving AI/AN youth. This Toolkit creation process could be applied to manuals or guides for work in other underserved communities.

Barriers to chronic Hepatitis B treatment and care in Ghana: A qualitative study with people with Hepatitis B and healthcare providers.

BackgroundHepatitis B viral (HBV) infection remains an important public health concern particularly in Africa. Between 1990 and 2013, Hepatitis B mortality increased by 63%. In recent times, effective antiviral agents against HBV such as Nucleos(t)ide analogs (NAs) are available. These drugs are capable of suppressing HBV replication, preventing progression of chronic Hepatitis B to cirrhosis, and reducing the risk of hepatocellular carcinoma and liver-related death. Notwithstanding, these treatments are underused despite their effectiveness in managing Hepatitis B. This study sought to explore barriers to treatment and care for people with Hepatitis B (PWHB) in Ghana, paying particular attention to beliefs about aetiology that can act as a barrier to care for PWHB.MethodsWe used an exploratory qualitative design with a purposive sampling technique. Face-to-face interviews were conducted for 18 persons with Hepatitis B (PWHB) and 15 healthcare providers (HCP; physicians, nurses, and midwives). In addition, four focus group discussions (FGD) with a composition of eight HCPs in each group were done. Participants were recruited from one tertiary and one regional hospital in Ghana. Data were processed using QSR Nvivo version 10.0 and analysed using the procedure of inductive thematic analysis. Participants were recruited from one tertiary and one regional hospital in Ghana.ResultsThree main cultural beliefs regarding the aetiology of chronic Hepatitis B that act as barriers to care and treatment were identified. These were: (1) the belief that chronic Hepatitis B is a punishment from the gods to those who touch dead bodies without permission from their landlords, (2) the belief that bewitchment contributes to chronic Hepatitis B, and (3) the belief that chronic Hepatitis B is caused by spiritual poison. Furthermore, individual level barriers were identified. These were the absence of chronic Hepatitis B signs and symptoms, perceived efficacy of traditional herbal medicine, and PWHB’s perception that formal care does not meet their expectations. Health system-related barriers included high cost of hospital-based care and inadequate Hepatitis B education for patients from HCPs.ConclusionGiven that high cost of hospital based care was considered an important barrier to engagement in care for PWHB, we recommend including the required Hepatitis B laboratory investigations such as viral load, and the recommended treatment in the National Health Insurance Scheme (NHIS). Also, we recommend increasing health care providers and PWHB Hepatitis B knowledge and capacity in a culturally sensitive fashion, discuss with patients (1) myths about aetiology and the lack of efficacy of traditional herbal medicines, and (2) patients’ expectations of care and the need to monitor even in the absence of symptoms.

A Media Campaign to Increase Health Care Provider Assistance for Patients Who Smoke Cigarettes.

Although most smokers visit a health care provider annually, only half report being provided evidence-based assistance with quitting, defined as brief counseling and an offer of medication. The New York State Department of Health designed a provider-targeted media campaign to increase provider-assisted quitting, which was implemented in 2016. Messaging focused on the addictive nature of tobacco products and evidence-based interventions. Online surveys of 400 New York State health care providers measured advertising awareness, associations between awareness and assistance with quit attempts, and perceptions that patients expect providers to assist with quitting. Forty-three percent of providers were aware of at least 1 advertisement, and providers who had seen an advertisement were more likely to provide evidence-based assistance (AOR = 2.55, P = .01), which includes recommending or prescribing cessation medications. Provider-targeted media is a promising approach to reach health care providers and encourage evidence-based smoking cessation treatment.

Practice and factors associated with active management of third stage of labor among obstetric care providers in Amhara region referral hospitals, North Ethiopia, 2018: A cross sectional study.

Active management of third stage of labor is the most indispensable intervention to avert post-partum hemorrhage which is one of the typical causes of maternal morbidity and mortality. Therefore, the aim of the study was to assess practice and factors associated with active management of third stage of labor among obstetric care providers in referral hospitals. Institution based cross-sectional study design was conducted from April 1-30, 2018. Simple random sampling technique was used to select a total of 356 obstetric care providers. Data were collected using pretested, structured and self-administered questionnaires. Data were entered to Epi data version 3.1 statistical software and exported to SPSS 23 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify associated factors. P value <0.05 with 95% confidence level were used to declare statistical significance. This study revealed that practice of active management of third stage of labor was 61.2%. Age group of 20-30 years [AOR = 1.95 (95%CI;1.13-3.38)], Being male obstetric care provider [AOR = 1.74 (95%CI;1.03-2.94)], having work experience ≥2 years [AOR = 1.95(95%CI;1.13-3.38)], availability of oxytocin [AOR = 5.46 (95%CI; 2.41-12.3)], having exposure to manage third stage of labor [AOR = 2.91(95%CI; 1.55-5.48)], and having good knowledge [AOR = 2.67 (95%CI; 1.46-4.90)], were the factors associated with practice. This study showed that practice of active management of third stage of labor was high. Age group between 20-30 years, being a male obstetric care provider, having ≥2years work experience, availability of oxytocin, exposure to third stage management and having good knowledge were factors associated with practice. Therefore, all referral hospitals and concerned bodies need efforts to focus on providing training to increase health care provider's knowledge so as to sustain good practice through appropriate interventions.