Knowledge Of Guidelines Research Articles

INTENSIVE CARE NURSES' KNOWLEDGE, PRACTICE AND ATTITUDE IN PREVENTION OF CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION (CLABSI)

Central line-associated bloodstream infections (CLABSI) are mainly preventable with evidence-based guidelines. However, it needs to be made clear how well these guidelines are followed in critical care units in Malaysia. Therefore, this study evaluates critical care nurses’ knowledge, practices, and attitude toward evidence-based guidelines for preventing CLABSIs issued by the Centers for Disease Control and Prevention and the Malaysia Ministry of Health. This study aims to identify the level of knowledge, practice, and attitudes regarding preventing CLABSI among critical care nurses in a teaching hospital. A cross-sectional descriptive study was carried out among 203 nurses working in seven units consisting of the Intensive Care Unit (ICU), Coronary Care Unit (CCU), Intermediate Dependency care Unit (IDCU), Neonatal Intensive Care Unit (NICU), Neurosurgery Intensive Care Unit (Neuro ICU), Cardiac Intensive Care Unit (CICU), and Pediatric Intensive Care Unit (PICU) in University Malaya Medical Center in Kuala Lumpur. Nurses completed online questionnaires regarding their demographic characteristics, knowledge, practices, and attitudes toward evidence-based guidelines for preventing CLABSIs from December 2022 to January 2023. The data was analyzed using T-Test, ANOVA, and Fisher’s Exact Test. 203 ICU nurses completed the questionnaire, and none correctly answered all the knowledge-related questions. The response rate of the correct answer regarding the knowledge question was only 49.7%. Mean scores for 11 questions regarding knowledge of evidence-based guidelines for preventing CLABSI were low, 5.85 (± 1.29). Meanwhile, individual total scores were significantly associated with time spent as a nurse in the ICU (2–4 years). The mean score for eight questions related to CLABSI prevention was 4.19 (± 0.50), which was acceptable for the compliance score. There was an association between nurses’ gender (p-value: 0.01) and their duration of working experiences in the ICU (p-value: 0.04) with the practice regarding the prevention of CLABSI. The overall mean score for nurses’ attitudes toward the guidelines was high; 8.63 (± 1.37). However, there was no association between the demographic characteristic and attitude regarding preventing CLABSI. The knowledge and practice of ICU nurses need to be improved. Regular training with the implementation of available guidelines and protocols was essential to improve the knowledge and compliance on preventing CLABSIs in ICUs.

Perceptions and drivers of healthcare provider and drug dispenser practices for the treatment of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study

BackgroundEmergence of Plasmodium falciparum resistance to artemether-lumefantrine in Africa prompted the pilot introduction of multiple first-line therapies (MFT) against malaria in Kenya, potentially exposing women-of-childbearing-age (WOCBAs) to anti-malarials with unknown safety profiles in the first trimester. This qualitative study explored knowledge and perceptions among healthcare providers providing malaria treatment to WOCBAs and pregnant women.MethodsIn-depth interviews were conducted with purposively selected public and private health facility (HF) and drug outlet (DO) providers within and outside the pilot-MFT area. County health managers were interviewed about their knowledge of the national treatment guidelines. Transcripts were coded by content analysis using the World Health Organization health system building blocks (leadership/governance, financing, health workforce, health information systems, access to medicines, and service delivery).ResultsThirty providers (HF:21, DO:9) and three health managers were interviewed. Eighteen providers were from HFs in the pilot-MFT area; the remaining three and all nine DOs were outside the pilot-MFT area. The analysis revealed that providers had not been trained in malaria case management in the previous twelve months. DO providers were unfamiliar with national treatment guidelines in pregnancy and reported having no pregnancy tests. Health managers were unable to supervise DOs due to resource limitations. Providers from HFs and DOs noted poor sensitivity of malaria rapid diagnostic tests (RDTs) and hesitancy among patients who associated malaria-RDTs with HIV testing. Almost all providers reported anti-malarial stock-outs, with quinine most affected. Patient preference was a major factor in prescribing anti-malarials. Providers in HFs and DOs reported preferentially using artemether-lumefantrine in the first trimester due to the side effects and unavailability of quinine.ConclusionKnowledge of malaria case management in drug outlets and health facilities remains poor. Improved regulation of DO providers is warranted. Optimizing treatment of malaria in pregnancy requires training, availability of malaria commodities, and pregnancy tests.

O.2.1-5 Knowledge, use and confidence in physical activity guidelines and assessment in recently graduated doctors from Irish medical schools: a cross sectional survey

Abstract Purpose Approximately 54% of the adult population in Ireland do not meet National Physical Activity Guidelines. Doctors play a key role in supporting people to be more active but may lack knowledge, skills and confidence to promote physical activity. The aim of this study was to explore knowledge and confidence in relation to physical activity counselling in recent medical graduates in Ireland. Methods Medical doctors who graduated from Irish medical programmes in the past 5 years and currently had patient contact were asked to complete an online survey between April and November 2022. The survey was shared with medical graduates through social media, alumni groups, and relevant professional and social networks. The survey included a minimal number of questions about participant demographics and education, questions relating to participants' knowledge and confidence of physical activity guidelines and counselling, and questions relating to education and training on physical activity. The responses were downloaded to Excel and data such as mean, standard deviation, frequency and percentage, were analyzed to summarize participant responses. Results Among the 95 responses, the majority were from graduates of Direct Entry Medicine Programmes who were currently working as Senior House Officers in either Ireland or Australia. Key findings indicated that 76% of participants were unaware of the Irish Physical Activity Guidelines and 60.76% are unaware of the Making Every Contact Count Framework. The majority wanted to receive training on physical activity at undergraduate level (73%) and postgraduate level (61%). With regards to physical activity knowledge for counselling, a majority of responders rated their knowledge between 5,6 and 7 out of 10. Similarly, a majority of responders rated their confidence in prescribing between 4,5, and 6 out of 10 (1 being not confident and 10 being extremely confident). The top three subjects participants wanted training on were: Physical Activity Guidelines, Counselling, and Assessment. Conclusions Findings indicate a gap in the teaching and assessment of physical activity in undergraduate medical curricula in Ireland. However, there is demand among recent graduates for training on physical activity. Future studies should be done among a larger sample in order to strengthen confidence in our findings.

Healthcare provider and drug dispenser knowledge and adherence to guidelines for the case management of malaria in pregnancy in the context of multiple first-line artemisinin-based combination therapy in western Kenya

BackgroundConcerns about emerging resistance to artemether-lumefantrine (AL) in Africa prompted the pilot introduction of multiple first-line therapies (MFT) in Western Kenya, potentially exposing women-of-childbearing-age (WOCBA) to anti-malarials with unknown safety profiles in the first trimester. The study assessed healthcare provider knowledge and adherence to national guidelines for managing malaria in pregnancy in the context of the MFT pilot.MethodsFrom March to April 2022, a cross-sectional study was conducted in 50 health facilities (HF) and 40 drug outlets (DO) using structured questionnaires to assess pregnancy detection, malaria diagnosis, and treatment choices by trimester. Differences between HF and DO providers and between MFT and non-MFT HFs were assessed using Chi-square tests.ResultsOf 174 providers (77% HF, 23% DO), 56% were from MFT pilot facilities. Most providers had tertiary education; 5% HF and 20% DO had only primary or secondary education. More HF than DO providers had knowledge of malaria treatment guidelines (62% vs. 40%, p = 0.023), received training in malaria in pregnancy (49% vs. 20%, p = 0.002), and reported assessing for pregnancy in WOCBA (98% vs. 78%, p < 0.001). Most providers insisted on parasitological diagnosis, with 59% HF using microscopy and 85% DO using rapid diagnostic tests. More HF than DO providers could correctly name the drugs for treating uncomplicated malaria in the first trimester (oral quinine, or AL if quinine is unavailable) (90% vs. 58%, p < 0.001), second and third trimesters (artemisinin-based combination therapy) (84% vs. 70%, p = 0.07), and for severe malaria (parenteral artesunate/artemether) (94% vs. 60%, p < 0.001). Among HF providers, those in the MFT pilot had more knowledge of malaria treatment guidelines (67% vs. 49%, p = 0.08) and had received training on treatment of malaria in pregnancy (56% vs. 32%, p = 0.03). Few providers (10% HF and 12% DO) had adequate knowledge of malaria treatment in pregnancy, defined as the correct drug and dose for uncomplicated and severe malaria in all trimesters.ConclusionsKnowledge of national malaria in pregnancy treatment guidelines among providers in Western Kenya is suboptimal. Robust training on appropriate anti-malarial and dosage is needed, particularly given the recent change in recommendation for artemether-lumefantrine use in the first trimester. Supervision of DO and HF practices is essential for correct treatment of malaria in pregnancy in the context of MFT programmes.

Real-world physician practices on the diagnosis and management of allergic rhinitis in the Philippine setting.

Physician awareness and adherence to guidelines varies among countries and between types of physician practice. Identifying the needs of the physician and patient is essential to improve patient outcome. Data on physician diagnosis and management of allergic rhinitis (AR) in the Philippines is currently limited. Study objectives are to assess awareness and use of guidelines, practices on diagnosis and management of intermittent and persistent AR, reasons for choice of therapy, and familiarity with immunotherapy. A cross-section of 590 specialist and 223 subspecialist physicians from 17 regions of the Philippines were surveyed from October 2021 to July 2022. Survey consisted of a 12-point validated online questionnaire on knowledge and use of guidelines for diagnosis and treatment, use of diagnostic tests, preferred pharmacologic treatment, preferred adjuvant therapy, reasons for treatment choice, and familiarity with immunotherapy. Seventy-seven percent of respondents used Allergic Rhinitis and its Impact on Asthma guidelines for diagnosis and management of AR. Three-fifths of respondents "always" routinely evaluated AR patients' history and performed a physical examination for asthma; 57% of respondents "always" routinely evaluated asthma patients' history and performed a physical examination for AR. Allergy testing was "sometimes" recommended by 62.2%. Oral second-generation antihistamines were the preferred choice for the treatment of intermittent AR. Intranasal steroids were the preferred treatment for persistent AR. Top reasons for choice of treatment were guideline recommendations, efficacy, onset of action, cost, and availability of treatment. Filipino specialists and subspecialists are aware and use guidelines in diagnosis and management of AR. Clinical history and physical examination are the cornerstone of diagnosis. Management practices for intermittent and persistent AR are similar for both groups. Recognizing the role of patient treatment preferences and allergen-specific immunotherapy remains to be a gap in the management of AR by Filipino physicians.

1246 High Output Stoma Management Audit

Abstract Aim High output stomas lead to a myriad of complications for patients including dehydration, electrolyte imbalances, poor skin integrity &amp; altered bowel function. However, this issue is not well recognised amongst junior doctors. This audit’s aim was to improve awareness of high output stomas including their implications and management according to the Association of Stoma Care Nurses’ (ASCN) national guidelines amongst junior doctors. Method An electronic survey was distributed to 20 junior doctors working in General Surgery at Southend University Hospital, assessing their knowledge on recognition and management of high output stomas. A checklist summarising the ASCN guidelines was then created. A post-intervention survey was then distributed to assess for improvement in knowledge and application of ASCN guidelines as well as use of the checklist. Results Overall, 51% answers were correct in the first survey compared to 72% answers correct in the post-intervention survey, and 83% of participants used the checklist. There was improvement in use of IV fluids (50% to 100%), monitoring fluid balance (80% to 91%), fibre restriction (37% to 70%), fluid restriction (50% to 70%), checking &amp; replacing Mg (65% to 87%) &amp; use of regular codeine (70% to 77%), as well as moderate improvement in appropriate doses of loperamide being given (5% to 30%). Conclusions The above audit resulted in an improvement of knowledge and application of evidence-based guidance provided by ASCN, with ultimate intent to improve patient outcomes. Further work includes distribution of the checklists throughout the hospital and to other hospitals.

LEVEL OF KNOWLEDGE AND PRACTICE OF ORTHOTICS IN THE DIABETIC FOOT MANAGEMENT IN NIGERIA

Orthotists are trained to have the specialist skill and ability to make prescriptions as well as fabricate devices to achieve these offloading goals in the management of the diabetic foot. The IWGDF has been promoting sound guidelines for efficient management (offloading) of the DF and has been updating these from time to time since 1999. These guidelines could also be used as a yardstick to measure the level of knowledge and orthotic practice as well as an appraisal tool of same among group or groups of orthotic practitioners. For an efficient care of the DF, a multidisciplinary teamwork is necessary and can include the following: Diabetologist/Endocrinologist, Surgeons, specialized Nurse, Podiatrist, Orthotist (Pedortist), Physiotherapist, etc. The cross-sectional descriptive research design was adopted for the present study in describing the level of Knowledge and practise of orthotic-conservative management of DF/DFU in Nigeria. Participants included Orthotists working in Nigerian healthcare institutions whether or not they are engaged in the conservative/offloading management of DF/DFUs. Out of 50 questionnaire mailed out, 30 responses were obtained. More than 70% of the responding Orthotists were working in centres without a Diabetic Foot Management Team (DFMT). Only 7% of the Orthotists were well-informed of their role as spelt out in the IWGDF Guidelines. 33% were not aware of the guideline but know to an extent the orthotic roles in the DF management while 60% were not. There was no implementation of the digital technologies in the processes of diabetic foot management. Analysis showed that knowledge and awareness of the offloading guidelines was an important factor influencing the practice. Having diabetic foot management teams in our health institutions is important to the enhancement of the skill, knowledge and success of the management of the diabetic foot. Utilization of digital technologies in the healthcare sector including orthotics could help Orthotist in Nigeria to improve the success of their offloading practices as well as generate researches in this area.

Clinical Practice Guideline Recommendations in Pediatric Orthopaedic Injury: A Systematic Review.

Lack of adherence to recommendations on pediatric orthopaedic injury care may be driven by lack of knowledge of clinical practice guidelines (CPGs), heterogeneity in recommendations or concerns about their quality. We aimed to identify CPGs for pediatric orthopaedic injury care, appraise their quality, and synthesize the quality of evidence and the strength of associated recommendations. We searched Medline, Embase, Cochrane CENTRAL, Web of Science and websites of clinical organizations. CPGs including at least one recommendation targeting pediatric orthopaedic injury populations on any diagnostic or therapeutic intervention developed in the last 15 years were eligible. Pairs of reviewers independently extracted data and evaluated CPG quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. We synthesized recommendations from high-quality CPGs using a recommendations matrix based on the GRADE Evidence-to-Decision framework. We included 13 eligible CPGs, of which 7 were rated high quality. Lack of stakeholder involvement and applicability (i.e., implementation strategies) were identified as weaknesses. We extracted 53 recommendations of which 19 were based on moderate or high-quality evidence. We provide a synthesis of recommendations from high-quality CPGs that can be used by clinicians to guide treatment decisions. Future CPGs should aim to use a partnership approach with all key stakeholders and provide strategies to facilitate implementation. This study also highlights the need for more rigorous research on pediatric orthopaedic trauma. Level II-therapeutic study.

Knowledge of computed tomography dose optimisation and justification among CT users and referring physicians: A single hospital study

IntroductionRadiation dose associated with computed tomography (CT) remains a concern, and radiation risk does not receive the needed attention, especially in low and middle-income countries. This because the frequency of this high-dose examination is rapidly growing and systems for protocol optimisation and dose justification are yet to be provided in CT imaging. ObjectiveTo determine radiographers’ and radiologists’ awareness and knowledge of CT dose optimisation. We also determined knowledge of dose justification and use of the referral guidelines amongst the referring physicians. MethodsRadiographers and radiologists were invited to complete a web-based questionnaire whilst the referring physicians completed a self-administered questionnaire. The returned questionnaires were analysed and a significant difference was determined using Yates corrected Chi-square, and a p-value of 0.05 was considered at the 95% confidence interval. ResultsThe response rates were 50% (17 out 34) and 35% (16 out 46) for radiographers and radiologists respectively while referring physicians had a response rate of 84% (92 out of 110). Overall, more radiographers (47.1%) than radiologists (18.8%) had good knowledge of CT doses and image quality, however, the difference in knowledge was not found to be significant (p = 0.167). In addition, knowledge of diagnostic reference levels (DRLs) was significantly (p = 0.033) higher amongst radiographers (52.9%) as compared to radiologists (12.5%). Meanwhile, physicians understood the principles of dose justification. However, their knowledge of referral guidelines was limited. ConclusionThe study revealed that radiographers were more knowledgeable on matters relating to radiation dose and image quality as well as DRLs when compared to radiologists. Meanwhile, the concept of dose justification was understood among physicians, however, they had limited awareness and knowledge of referral guidelines.

Nurses’ Knowledge, Attitudes and Practices regarding COVID-19 National Guidelines in Selected Palestine Public Hospitals

The front line of healthcare professionals that could be at high risk for COVID-19 is nursing personnel. In Palestine, there is a lack of data on nurses’ knowledge, attitudes, and practices (KAP) regarding COVID-19 national guidelines. Undeniably, nurses’ adherence to control measures is affected by KAP. The study’s goal was to assess nurses’ KAP toward prescribed COVID-19 hospital guidelines. A cross-sectional, quantitative and descriptive design was used in this research involving a total of 340 nurses working in hospitals and health care centres in Palestine. The survey was conducted between May and July 2021 by means of a computerised survey questionnaire. Four portions of the questionnaire included sociodemographic data, nurses’ knowledge, attitudes, and practices regarding COVID-19 national guidelines. Results showed that a total of 248 (73.0%) nurses demonstrated good knowledge of COVID-19 national guidelines, 207 (61.0%) displayed positive attitudes, and 226 (66.6%) complied with prescribed COVID-19 guidelines as evidenced through observations of their daily nursing care practices. Increasing knowledge and training for improving attitudes and practices among frontline nurses is paramount for controlling the transmission of COVID-19. Nurses and other healthcare professionals who have direct or indirect contact with COVID-19 patients should be protected from infection by policies and education, which should be implemented.

Health care–associated Clostridioides difficile infection: Learning the perspectives of health care workers to build successful strategies

Clostridioides difficile (C difficile) is one of the most common health care-associated infections that negatively impact patient care and health care costs. This study takes a unique approach to C difficile infection (CDI) control by investigating key prevention obstacles through the perspectives of Stanford health care (SHC) frontline health care personnel. An anonymous qualitative survey was distributed at SHC, focusing on knowledge and practice of CDI prevention guidelines, as well as education, communication, and perspectives regarding CDI at SHC. 112 survey responses were analyzed. Our findings unveiled gaps in personnel's knowledge of C difficile diagnostic guidelines and revealed a need for targeted communication and guideline-focused education. Health care staff shared preferences and recommendations, with the majority recommending enhanced communication of guidelines and information as a strategy for reducing CDI rates. The findings were then used to design and propose internal recommendations for SHC to mitigate the gaps found. Many guidelines and improvement strategies are based on strong scientific and medical foundations; however, it is important to ask whether these guidelines are effectively translated into practice. Frontline health care workers hold empirical perspectives that could be key in infection control. Our findings emphasize the importance of including frontline health care personnel in infection prevention decision-making processes and the strategies presented here can be applied to mitigating infections in different health care settings.

Understanding advanced practice registered nurse perspectives on providing care to people with a history of breast cancer.

People with a history of breast cancer (PHBC) face a lifelong risk of treatment-related sequelae affecting their quality of life. Stakeholders advocate for improving breast cancer survivorship outcomes by increasing clinicians' knowledge of cancer survivorship issues. In Missouri, advanced practice registered nurses (APRNs) in nononcology settings provide routine survivorship care to PHBC; however, little is known about how they approach survivorship care planning for PHBC. Examine perspectives of Missouri APRNs practicing in nononcology settings about providing survivorship care to PHBC. A combination of grounded theory and thematic analysis techniques was used for focus groups and semistructured interviews. The interviews were audio-recorded, transcribed, and analyzed using grounded theory coding methods. Nineteen nononcology Missouri-based APRNs (18 NPs, 1 CNS/DNP) shared their perspectives about managing care for PHBC. We identified four major themes. Our participants (1) attuned their baseline assessment techniques to a history of breast cancer; (2) were prepared to order additional evaluations; (3) were willing to proactively figure out next best steps for PHBC beyond theneed for breast cancer recurrence surveillance; and (4) suggest that streamlining cancer survivorship care resources would benefit both clinicians and PHBC. Our findings shed light on how APRNs approach care planning for PHBC and the needs of nononcology APRNs for managing PHBC. Advanced practice registered nurses are well-positioned to improve cancer survivorship care. Increasing knowledge of cancer survivorship care guidelines could improve long-term health outcomes of PHBC. Access to cancer survivorship resources or experts via telehealth/technology for both APRNs and patients could improve survivorship care and overall health of PHBC.

Awareness and Knowledge of the Physical Activity Guidelines for Americans, 2nd Edition.

Assessing awareness and knowledge of the Physical Activity Guidelines for Americans, 2nd edition (Guidelines), released in 2018, is important for monitoring factors that contribute to increasing physical activity. We estimated prevalence of awareness and knowledge of the adult aerobic guideline (≥150min/wk of moderate-intensity equivalent aerobic physical activity preferably spread out over a week) among adults (n = 3471) and of the youth aerobic guideline (≥60min/d of mostly moderate- to vigorous-intensity aerobic physical activity) among a subset of parents (n = 744) from a nationwide sample of US adults in the 2019 FallStyles survey. We estimated odds ratios using logistic regression, adjusting for demographic and other characteristics. Approximately 1 in 10 US adults and parents reported being aware of the Guidelines. Only 3% of adults knew the correct adult aerobic guideline. The most common responses were "don't know/not sure" (44%) and "30minutes a day, 5 or more days a week" (28%). Among parents, 15% knew the youth aerobic guideline. Awareness and knowledge tended to be lower with lower education and income. Limited awareness and knowledge of the Guidelines suggest communication about the Guidelines could be strengthened, especially among adults with low income or education.

Assessment of Knowledge, Attitude, and Adherence to National Guidelines for Preventing Central Line-Associated Bloodstream Infections Among ICU Nurses of Adult Patients in Jeddah, Saudi Arabia: A Cross-Sectional Survey.

Central line-associated bloodstream infections (CLABSIs) pose a significant burden on patient outcomes in intensive care units (ICUs). Adherence to evidence-based guidelines for CLABSI prevention is crucial in reducing healthcare-associated infections. This study aimed to assess the knowledge, attitude, and practice adherence to national guidelines for preventing CLABSIs among adult ICU nurses in Ministry of Health (MOH) hospitals in Jeddah, Saudi Arabia. Methods: This cross-sectional survey included all adult ICU nurses with a minimum of one year of experience from the four major MOH hospitals in Jeddah with operational adult ICUs. A self-administered online questionnaire was utilized for data collection. Descriptive statistics, t-tests, ANOVA, and Pearson correlation were employed for data analysis. Results:A total of 203 nurses completed the questionnaire (response rate: 91.5%). The overall knowledge score was 71%. Only 20% of nurses answered over 90% of the knowledge questions correctly, and merely 8% answered all questions correctly. Higher knowledge levels were significantly associated with older age, longer ICU nursing experience, higher education, holding a head nurse position, and attending educational courses on CLABSI prevention. Regarding attitudes, 58% of respondents had a positive perception of guideline utility for CLABSI prevention. In terms of adherence, the overall score was 65%, with only 5% reporting complete adherenceto evidence-based practices for preventing CLABSIs. Conclusion: This study highlights knowledge gaps, suboptimal adherence, and the need for targeted interventions to enhance nurses' understanding of and adherence to evidence-based guidelines for preventing CLABSIs among adult ICU nurses in Jeddah's MOH hospitals. Enhancing knowledge, attitudes, and practice adherence is crucial for reducing CLABSI risks and improving patient outcomes. Further research investigating the factors influencing nurses' knowledge, acceptance, and application of evidence-based guidelines is warranted to inform the development of tailored interventions and educational strategies.

Healthy Eating in the Australian Coal Mining Industry: Assessing the Efficacy of the 'Out of the Box' Workplace Health Promotion Program.

Noncommunicable diseases are the world's leading cause of death. To curb the global rise in these diseases, using the workplace as a front to disseminate health communication messages and resources has been suggested. This study aimed to assess the efficacy of a workplace health promotion program, 'Out of the Box', that targeted nutrition outcomes and nutrition guideline knowledge. A 6-month workplace health promotion program was implemented within a coal mine site. Over the 6 months, there were four wellness focus areas, lasting 1 month each, including fruits, vegetables and portion controlling, label reading, alcohol awareness, and hydration promotion. The study utilized a quasi-experimental pre-test-post-test design, with measurements via self-reported paper-based surveys. At baseline there were 163 responses, and 106 at follow-up. At the 6-month follow-up, respondents had increased odds of recalling the current fruit (OR 1.29, p = 0.032) and vegetable (OR 1.76, p < 0.001) guidelines. Being male was associated with lower vegetable intake (B: -0.28), although this did not reach statistical significance. A nutrition-focused workplace health promotion program can be an efficacious strategy in improving knowledge of fruit and vegetable guidelines. Further research is needed to evaluate the effectiveness of these programs over time.

Knowledge regarding the accurate measurement of blood pressure among intern medical officers practising at three teaching hospitals in Sri Lanka: A cross-sectional analysis

Introduction: Hypertension is a major risk factor for cardiovascular and renal diseases. Accurate measurement of blood pressure as per existing guidelines is of paramount importance in the management of hypertension.Objective: To describe knowledge of current guidelines regarding the accurate measurement of blood pressure by an auscultatory method with a manual sphygmomanometer among Intern Medical Officers practising at the National Hospital of Sri Lanka, Teaching Hospital, Kandy and Teaching Hospital, Jaffna.Methods: A cross-sectional survey was carried out among newly qualified doctors, practicing at the National Hospital of Sri Lanka, Teaching Hospital, Kandy and Teaching Hospital, Jaffna. A self-administered questionnaire was used to collect data. Data were analyzed using SPSS 28.Results: Of 79 newly qualified doctors who partici-pated, the majority (64.6%) were males, and mean age was 28.24 (range of 24-32) years. A significant proportion (45.6%) answered less than 8 (8=median) questions correctly, out of 15 ques-tions intended to assess knowledge regarding accurate blood pressure measurement.Conclusions: Knowledge regarding accurate measurement of blood pressure among newly qualified doctors was suboptimal. Junior doctors should be motivated to improve their knowledge and skills of blood pressure measurement through regular in-service training.

Medical nutrition therapy during intensive remission-induction treatment and hematopoietic stem cell transplantation in acute myeloid leukemia patients: Hematologists’ experiences and perspectives

The European Societies for Clinical Nutrition and Metabolism (ESPEN) and Blood and Marrow Transplantation (EBMT) recommend enteral nutrition (EN) as the first-choice medical nutrition therapy in acute myeloid leukemia (AML) patients undergoing intensive treatments, including high-dose remission-induction chemotherapy and hematopoietic stem cell transplantation (HSCT). However, parenteral nutrition (PN) remains the preferred method of nutrition support in current clinical practice. The aim of this qualitative study was to gain insight into hematologists' experiences and perspectives regarding the choice and ESPEN/EBMT recommendations on EN versus PN. Online semi-structured interviews were conducted with one hematologist from each of the 21 hospitals offering intensive AML treatments in the Netherlands, using Microsoft Teams. Interviews were audio-recorded, transcribed verbatim and thematically analyzed using Atlas. ti. One hundred nineteen hematologists working in the same hospitals were invited to complete a short online questionnaire survey (SurveyMonkey®) regarding their knowledge and opinion on the ESPEN/EBMT guidelines recommending EN over PN during intensive AML treatments. The results of this survey are presented in a descriptive way. Fifty-nine hematologists participated in this study (42% overall response rate), of which 21 in the semi-structured interviews (response rate 100%) and 38 in the online survey (response rate 32%). Hematologists considered medical nutrition therapy important for prevention and treatment of malnutrition and associated adverse outcomes in AML patients undergoing intensive remission-induction treatment and HSCT. However, opposed to the ESPEN/EBMT guidelines, the vast majority of hematologists were hesitant or reluctant to use EN instead of PN as the first-choice medical nutrition therapy in these patients. The most frequently cited barriers to use EN were the expected low feasibility and tolerance of EN, feeding tube-related discomfort and bleeding risk, and patient refusal. Other barriers to follow the guidelines on EN were related to personal factors, including hematologists' knowledge (lack of awareness and familiarity) and attitude (lack of agreement, outcome expectancy, experience, success, motivation, and learning culture), guideline-related factors (lack of evidence and applicability), and external factors (lack of collaboration and resources). Facilitators included strategies for nutrition education and dissemination of nutritional guidelines, interprofessional and patient collaboration, availability of feeding tubes that can be inserted without endoscopy and stronger scientific evidence. Hematologists recognized the importance of medical nutrition therapy for reducing malnutrition and related negative outcomes during intensive AML treatments. However, contrary to the ESPEN/EBMT guidelines, they preferred PN instead of EN as the medical nutrition therapy of first choice. To reduce compliance barriers, interventions should focus on improving hematologists' knowledge of medical nutrition therapy and dietary guidelines, enhancing success rates of EN by adequately triaging patients eligible for EN and inserting duodenal feeding tubes using an electromagnetic sensing device without endoscopy, developing decision aids and multidisciplinary guidelines and care pathways. Furthermore, future trials should focus on the feasibility and benefits of EN versus PN both during remission-induction treatment and HSCT.

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study.

To examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings. A qualitative descriptive study. Data were collected via semi-structured interviews. In March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized. Six themes and 20 sub-themes were identified. Non-validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed. Introduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness. The findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post-cardiac event counselling. Adherence to COREQ guidelines was maintained. No Patient or Public Contribution as this study explored health professionals' experiences only.

Influence of social determinants of health on breastfeeding intent in the United States.

Breastfeeding rates in the United States are suboptimal despite public health recommendations that infants are fed breastmilk for their first year of life. This study aimed to characterize the influence of social determinants of health on intended breastfeeding duration. This case-control study analyzed breastfeeding intent in 421 postpartum women. Data on social determinants and medical history were obtained from medical records and participant self-report. Logistic regression estimated the influence of demographic factors and social determinants on intent to breastfeed for durations of <6 months, 6-12 months, and at least 1 year. Thirty-five percent of mothers intended to breastfeed for at least 6 months, and 15% for 1 year. Social determinants that negatively predicted breastfeeding intent included not owning transportation and living in a dangerous neighborhood (p < 0.05). Women were more likely to intend to breastfeed for 12 months if they had knowledge of breastfeeding recommendations (adjusted odds ratio [aOR] 6.19, 95% confidence interval [CI 2.67-14.34]), an identifiable medical provider (aOR 2.64 [CI 1.22-5.72]), familial support (aOR 2.80 [CI 1.01-7.80]), or were married (aOR 2.55 [CI 1.01-6.46]). Sociodemographic factors that negatively influenced breastfeeding intent included non-Hispanic Black race, no high school diploma, cigarette use, income below $20,000, fewer than five prenatal visits, and WIC or Medicaid enrollment (p < 0.05). Women who lack familial support, an identifiable healthcare provider, or knowledge of breastfeeding guidelines are less likely to intend to breastfeed. Public health initiatives should address these determinants to improve breastfeeding and infant outcomes.

Assessing awareness and compliance with fish consumption advisories on the upper Hudson River: Implications for risk management of the Hudson River Superfund site

Polychlorinated biphenyls (PCBs) are a common environmental contaminant. The NYS Department of Health (DOH) issues fish consumption advisories to limit consumption of PCB-contaminated fish. Fish consumption advisories are utilized as institutional controls within the Hudson River Superfund site to limit exposure to PCBs. There is a “Do Not Eat” advisory for all species caught in the upper Hudson River, from Glens Falls, NY to Troy, NY. The section of the river below Bakers Falls also has a catch-and-release regulation issued by the NYS Department of Environmental Conservation. There is limited research on the effectiveness of these advisories in preventing consumption of contaminated fish in the context of Superfund site risk management. We surveyed individuals actively fishing on the upper Hudson River in the area with a “Do Not Eat” advisory, specifically between Hudson Falls and the Federal Dam in Troy, NY. The goal of the survey was to assess knowledge of the consumption guidelines, and if the guidelines are effectively preventing exposure to PCBs. A subset of individuals continue to consume fish caught from the upper Hudson River Superfund site. Awareness of advisories was inversely related to fish consumption from the Superfund site. Age, race, and possession of a fishing license were associated with overall awareness of fish consumption guidelines; age and possession of a license were associated with awareness of the “Do Not Eat” advisory. While institutional controls appear to have a beneficial impact, there is incomplete awareness and compliance with advisories and regulations aimed at preventing exposure to PCBs from fish consumption. Risk assessment and management strategies for contaminated fisheries should consider imperfect adherence to fish consumption guidelines.