Majority Of Health Care Providers Research Articles

Igniting Awareness: Assessing Healthcare Providers' Understanding of Firefighter Cancer Risks

Firefighters are at increased risk for skin cancer from exposure to fireground carcinogens, UV radiation, and other occupational hazards. Despite known risk factors, agencies such as the US Preventive Services Task Force (USPSTF) do not include recommendations for routine skin cancer screenings in their general guidelines. Moreover, limited provider understanding of the unique health challenges firefighters encounter has resulted in a lack of awareness in the healthcare community regarding these increased skin cancer threats. This raises concern as providers are crucial in conducting skin cancer screenings and advocating for preventive measures for patients, especially firefighters. To better understand healthcare provider perspectives, the San Antonio Fire Department (SAFD) administered a questionnaire assessing healthcare providers’ knowledge of firefighter cancer, including rates, risks, and policies, to healthcare providers attending the second annual SAFD “Firefighter Cancer Prevention and Wellness Fair” in January and February 2024, sharing de-identified results with the research team. The results indicate a majority of healthcare providers have limited knowledge about skin cancer in firefighters and are unaware of the major risks affecting members of this occupation. Approximately 70 healthcare providers participated in the questionnaire; of those, 4% passed the basic firefighter cancer knowledge quiz (>70% correct answers) and 18% scored higher than 50%. The mean score was 34%. While the SAFD skin cancer screenings revealed a smoldering knowledge gap among providers in understanding firefighter cancer risk, this study underscores the necessity of educating more healthcare professionals about the men and women who dedicate their lives to keeping ours safe.

Exploring Effective Approaches: Integrating Mental Health Services into HIV Clinics in Northern Uganda.

Integrating mental health services into HIV clinics is recognized as a promising strategy. However, the literature reveals gaps, particularly in the unique context of Northern Uganda, where factors such as historical conflict, stigma, and limited resources pose potential barriers. This qualitative study, conducted between October and November 2023, employed a phenomenological design. The study involved primary healthcare facilities across diverse urban and rural settings, focusing on healthcare providers, village health teams, and service users. A purposive sampling approach ensured diverse demographics and perspectives. In-depth interviews and focus group discussions were conducted, with healthcare providers and service users participating individually, and village health teams engaged in group discussions. Thematic analysis was employed during data analysis. Findings revealed a predominance of females among healthcare providers (18 of 30) and service users (16 of 25), as well as in VHTs. Average ages were 33.4 (healthcare providers), 38.5 (service users), and 35.1 (VHTs). Most healthcare providers (15) held diplomas, while 12 service users and 4 VHTs had certificates. The majority of healthcare providers (n=20) and 4 VHTs had 6-10 years of experience. Thematic analysis highlighted three key themes: benefits of integrated mental health services, implementation challenges, and the role of community engagement and cultural sensitivity. This study contributes valuable insights into the integration of mental health services into HIV clinics in Northern Uganda. The perceived benefits, challenges, and importance of cultural sensitivity and community engagement should guide future interventions, fostering a holistic approach that enhances the overall well-being of individuals living with HIV/AIDS in the region. Policymakers can use this information to advocate for resource allocation, training programs, and policy changes that support the integration of mental health services into HIV clinics in a way that addresses the identified challenges.

Preferences and attitudes of healthcare providers towards pneumococcal vaccines for adults in the United States.

It is important to assess healthcare providers (HCPs) knowledge, attitudes, perceptions, and preferences towards new pneumococcal vaccines for adults. HCPs who met eligibility criteria completed an online survey between March - May 2024 that included a discrete choice experiment (DCE) to elicit preferences. Among 340 participating HCPs, the average age was 44.9 years old, and the majority were male (55.6%), and White (85.3%). Most HCPs reported that they would support (90.3%) and implement (91.5%) a lower age-based recommendation for pneumococcal vaccines (from adults 65+ years to adults 50+ years). A majority of HCPs would offer a supplemental dose of a pneumococcal vaccine to high-risk adults 19-49 years, at-risk or high-risk adults 50-64 years, and adults 65+ years regardless of risk status to increase protection after completing the recommended series. DCE results showed that coverage of pneumococcal pneumonia and invasive pneumococcal disease (IPD) in adults 65+ years were the two most important attributes in evaluating pneumococcal vaccines. HCPs preferred a pneumococcal vaccine with increased coverage against pneumococcal pneumonia and IPD, and they supported lowering the age recommendation for pneumococcal vaccination as well as a supplemental vaccine dose to provide additional coverage for adults.

Simultaneous determination of amphotericin B, tobramycin and vancomycin in rabbit ocular biofluids and tissues by LC-MS/MS: An antimicrobial therapy for keratitis and its PK-PD application

A rationale poly-microbial keratitis (PMK) therapy requires quick identification of pathogen (bacteria and fungi) and their efficient treatment. However, majority of healthcare providers are still having trouble finding an effective medicine to treat PMK due to constraints such as antimicrobial resistance, dose and dosing schedule. Thus, a broad spectrum anti-fungal and antibacterial having less resistance in community involving combination therapy such as amphotericin B (AmB), tobramycin (TBR) and vancomycin (VCM) is required. Hence, to characterize the pharmacokinetic (PK) and PK-pharmacodynamic (PD) indices, a rapid and sensitive simultaneous LC-MS/MS bioanalytical method was developed and validated for the quantification of AmB, TBR and VCM in rabbit ocular biofluids and tissues. Chromatographic resolution was achieved on a Zorbax C18 column with a mobile phase composed of acetonitrile and 0.4 % formic acid in deionized water using a gradient mode of elution. The calibration curves showed good linearity over the concentration range of 1.95–500 ng/mL for AmB and TBR, 3.9–800 ng/mL for VCM, respectively. The lower limit of quantification (LLOQ) was found to be 1.95 ng/mL for AmB and TBR, and 4.5 ng/mL for VCM. Analyte extraction was performed by simple protein precipitation method with minimal sample volume of 10 µL. Finally, the developed method was validated for selectivity, linearity (r2 > 0.99), precision, accuracy, matrix effects, and stability. The ocular pharmacokinetic profile of commercial AmB, TBR, and VCM formulations was further assessed using the validated method and the PK-PD indices along with dosing frequency was predicted by PK-PD modelling using Phoenix WinNonlin Software.

Improving outcomes for hospitalised First Nations peoples through greater cultural safety and better communication: the Communicate Study Partnership study protocol

BackgroundThe Communicate Study is a partnership project which aims to transform the culture of healthcare systems to achieve excellence in culturally safe care for First Nations people. It responds to the ongoing impact of colonisation which results in First Nations peoples experiencing adverse outcomes of hospitalisation in Australia’s Northern Territory. In this setting, the majority of healthcare users are First Nations peoples, but the majority of healthcare providers are not. Our hypotheses are that strategies to ensure cultural safety can be effectively taught, systems can become culturally safe and that the provision of culturally safe healthcare in first languages will improve experiences and outcomes of hospitalisation.MethodsWe will implement a multicomponent intervention at three hospitals over 4 years. The main intervention components are as follows: cultural safety training called ‘Ask the Specialist Plus’ which incorporates a locally developed, purpose-built podcast, developing a community of practice in cultural safety and improving access to and uptake of Aboriginal language interpreters. Intervention components are informed by the ‘behaviour change wheel’ and address a supply–demand model for interpreters. The philosophical underpinnings are critical race theory, Freirean pedagogy and cultural safety. There are co-primary qualitative and quantitative outcome measures: cultural safety, as experienced by First Nations peoples at participating hospitals, and proportion of admitted First Nations patients who self-discharge. Qualitative measures of patient and provider experience, and patient-provider interactions, will be examined through interviews and observational data. Quantitative outcomes (documentation of language, uptake of interpreters (booked and completed), proportion of admissions ending in self-discharge, unplanned readmission, hospital length of stay, costs and cost benefits of interpreter use) will be measured using time-series analysis. Continuous quality improvement will use data in a participatory way to motivate change. Programme evaluation will assess Reach, Effectiveness, Adoption, Implementation and Maintenance (‘RE-AIM’).DiscussionThe intervention components are innovative, sustainable and have been successfully piloted. Refinement and scale-up through this project have the potential to transform First Nations patients’ experiences of care and health outcomes.Trial registrationRegistered with ClinicalTrials.gov Protocol Record 2008644

Health care provider and hospital decision-maker perceptions and beliefs on global environmental sustainability in the operating room.

e18832 Background: Human health is intrinsically linked to the environment’s health; therefore, it is essential for the surgical oncology community, healthcare providers (HCPs) and hospital leadership alike, to incorporate environmentally sustainable practices, while continuing to provide high quality care. Hospital operating rooms (ORs) have a serious environmental impact due to a high rate of greenhouse gas (GHG) emissions, medical waste generation, and energy consumption. An evidence-based understanding of the environmental impact of ORs, as well as sustainability initiatives undertaken to decrease this impact, are crucial for generating and implementing appropriate policies and guidelines. This systematic literature review (SLR) aimed to determine the perceptions and beliefs of HCPs and decision-makers related to environmental sustainability in OR settings globally. Methods: An SLR was conducted following the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines. Embase and PubMed searches were conducted to identify relevant studies published between January 2011 and November 2022. Results: The analysis incorporated thirty-four studies focused on the perceptions and beliefs of OR HCPs and decision-makers on sustainability initiatives. The majority of HCPs across all studies indicated a willingness to engage in these sustainability initiatives such as recycling, while noting frequent barriers that prevent participation, such as lack of awareness and education, hospital funding, facilities to carry out recycling processes, and guidance at the hospital level. One study noted that robotic and laparoscopic procedures, when compared to open procedures, generate greater quantities of waste and GHG emissions. In a survey of 400 anesthesiologists, the lack of support from the hospital and inadequate education were identified as the main barriers to OR recycling by more than 60% of respondents. Common sustainability initiatives suggested by HCPs included creating a sustainability steering committee, reducing overall OR waste via recycling and waste segregation, education and training dedicated to environmental sustainability and enforcement of rules and mandates for sustainability initiatives. Conclusions: HCPs are aware of potential opportunities to make ORs more environmentally sustainable and HCPs are willing, but not necessarily able, to participate in these efforts. Existing literature shows that HCPs have suggestions for how to minimize the environmental impact of the OR. Oncologists interested in adopting more sustainable practices can use this research as a guide for key themes and barriers to acknowledge when designing and implementing their own initiatives. More research is needed on the implementation and impact of sustainability initiatives on the environment.

Best practice implementation on reporting of coronavirus disease 2019 vaccine adverse events following immunization in Uasin Gishu County, Kenya.

This project's aim was to implement vaccine safety surveillance best practices to improve reporting of adverse events following immunization (AEFI) during coronavirus disease 2019 (COVID-19) vaccination roll out in Uasin Gishu County. Weak vaccine safety surveillance systems in developing countries has contributed to underreporting of AEFIs undermining public confidence in immunization efforts, contributing to low uptake of vaccines critical in the fight against communicable diseases. The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in healthcare practice was utilized. Preimplementation and postimplementation audit cycles carried out utilized six best practice recommendations. Context-specific strategies and resources were used to address the gaps identified. Less than half of the AEFIs reported were in accordance with the local policy recommendation, and most of the AEFIs reported were submitted in a timely manner in the baseline and follow-up cycle. Slight improvement was recorded in the number of health facilities with AEFIs reporting forms. An improvement of 33.7% was recorded in the number of health workers providing COVID-19 vaccination services who had received education and practical training on vaccine pharmacovigilance. Underreporting and delayed submission of COVID-19 vaccine AEFI was evident among the healthcare providers offering COVID-19 vaccination services, the majority of healthcare providers had received training on vaccine pharmacovigilance, and AEFI hard copy reporting forms were not adequate in the health facilities. Public education on vaccine safety before administration of vaccine needs emphasis in order to improve reporting of AEFI.

Knowledge, attitude, and practice of healthcare providers towards chest physiotherapy for COVID-19 patients at Al Baha, Saudi Arabia

Background: The knowledge, attitude, and practice of health professionals in Covid-19 medical centers are considered as the cornerstone for improvement of Covid-19 patients. This study aimed to assess the knowledge, attitude, and practice of the healthcare professionals in chest physiotherapy for COVID-19 patients. Methods: This is a descriptive cross-sectional study; it was conducted among healthcare professionals working at ICUs at King Fahad Hospital and Prince Meshari Hospital, in Al-Baha Region, Saudi Arabia. A convenient sampling technique was used to collect data using a questionnaire about knowledge attitude and practice toward chest physiotherapy for COVID-19 patients which was adopted from a previously validated questionnaire. A specific coding for knowledge, attitude and practice was used to calculate the overall scores. Data was analyzed using SPSS software. Results: Among 34 of healthcare providers working at King Fahad Hospital (44.1%) and Prince Meshari Hospital (55.9%), it was shown that 82.4% of healthcare providers have adequate knowledge, 91.2% have positive attitude and 70.6% have appropriate practice towards COVID-19 physiotherapy in ICUs. A significant relationship was reported between marital status of healthcare providers and adequate knowledge (p=0.39), where singles and divorced participants have 100% adequate knowledge compared to married workers. It was also reported that knowledge significantly enhances levels of attitude and practice of healthcare providers by 0.609 and 0.61 respectively. Furthermore, their attitude affects positively the level of practice by 0.572. Conclusions: This study highlighted that majority of healthcare providers (physiotherapists, nurses or medical) are knowledgeable; they also have positive attitude and appropriate practices about COVID-19 physiotherapy management in ICUs at Al-Baha governmental hospitals. Keywords: knowledge, attitude, practice, healthcare professionals, COVID-19, physiotherapy.

Clinician Experience with Using Hypoallergenic Formulas to Treat Infants with Suspected Cow's Milk Protein Allergy: A Secondary Analysis of a Prospective Survey Cohort.

Cow's milk protein allergy (CMPA) is a common condition in infants, but little is known about healthcare providers' clinical experience treating infants with CMPA. To address this gap, we analyzed prospectively collected data from healthcare providers (HCPs) who treated infants under six months old with suspected CMPA using hypoallergenic formulas. The study focused on a commercial extensively hydrolyzed formula containing Lactobacillus rhamnosus GG (ATCC53103) (eHF-LGG) or a commercial amino acid formula (AAF). In this secondary analysis of prospectively collected survey data, 52 HCPs treated 329 infants under six months old with suspected CMPA using hypoallergenic formulas. A series of two de-identified surveys per patient were collected by HCPs to assess short-term symptom relief in the patients and HCP's satisfaction with the management strategies. The initial survey was completed at the initiation of treatment of CMPA, and the second survey was completed at a follow-up visit. The majority of HCPs (87%) in the study were general pediatricians, and most saw 2 to 10 CMPA patients weekly. Results showed that clinicians reported satisfaction with treatment in 95% of patients in the EHF cohort and 97% of patients in the AAF cohort and achieved expected clinical results in 93% and 97% of patients using eHF and AAF, respectively. Furthermore, few patients were switched from the hypoallergenic formula once initiated. The study provides new insights into HCP perspectives on treating infants with CMPA and supports using hypoallergenic formulas to manage this condition. However, additional prospective controlled studies are needed to confirm these initial findings.

Willingness, Attitude, and Associated Factors towards Adverse Drug Reaction Reporting among Healthcare Providers in Mizan Tepi University Teaching Hospital, Southwest Ethiopia.

An adverse drug reaction (ADR) is harm that arises from the use of a drug. Adverse drug reactions have a huge impact on the health system since they result in drug-related morbidity and mortality as well as indirect costs such as loss of productivity at work. Reporting of adverse drug reactions to a relevant authority is one of the methods of enhancing medication safety; however, underreporting of adverse drug reactions by health workers is a major challenge in enhancing medicines safety. The aim of this study was to assess the willingness, attitude, and associated factors of healthcare providers towards ADRs reporting at Mizan Tepi University Teaching Hospital (MTUTH). A cross-sectional mixed method was conducted among healthcare providers working in Mizan Tepi University Teaching Hospital from August to September 2021. A total of 190 healthcare providers and five key informants were participated in the study. The quantitative data were collected using self-administered structured questionnaires, and for the qualitative study, data from the key informant interviews were collected using a semistructured questionnaire containing open-ended questions. The collected data were coded, entered, and analyzed using a Statistical Package for Social Sciences (SPSS, version 21). Furthermore, the logistic regression model was fitted to see the association between attitude items and demographic characteristics. Variables with P value <0.05 were considered as statistically significant. Analysis of the qualitative data was done by sorting the data into categories and examining the emerging themes. The majority of individuals in the study (81.6%) were willing to report adverse drug reactions. High percent (57.9%) of the study participants knew how to report ADR to responsible body and 66 (34.7%) of the study participants believe that ADR reporting is the responsibility of all healthcare professionals. 86 (45.3%) of respondents encountered ADR cases during their professional career. It was found that the majority of participants (53.7%) had a positive attitude toward ADR reporting. The professional distribution and work experiences of healthcare professionals had a significant impact on their attitude toward ADR reporting (P < 0.05). A large percentage of study subjects were willing to report adverse drug reactions to the appropriate authorities. The majority of healthcare providers were found to have a good attitude towards ADR reporting. Professional distribution and work experiences were significantly associated with attitude of healthcare providers towards ADR reporting. In order to improve the ADR reporting practices of the healthcare professionals and increase the ADR reporting load at the national level, the national regulatory body should collaborate with health facilities.

Barriers to and recommendations for integrating the age-friendly 4-Ms framework into electronic health records.

The Institute for Healthcare Improvement's 4-Ms framework of care for older adults recommends a multidisciplinary assessment of a patient's Medications, Mentation, Mobility, and What Matters Most. Electronic health record (EHR) systems were developed prior to this emphasis on the 4-Ms. We sought to understand how healthcare providers across the healthcare system perceive their EHRs and to identify any current best practices and ideas for improvement regarding integration of the 4-Ms. Anonymous survey of healthcare providers who care for older adults. The survey aimed to evaluate efficiency, error tolerance, and satisfaction (usefulness and likeability). The survey was distributed through organizational list serves that focus on the care of older adults and through social media. Sixty-six respondents from all geographic segments of the U.S. (n=62) and non-U.S. practices (n=4) responded. Most (82%) were physicians. Respondents used a range of EHRs and 82% had >5 years of experience with their current EHR. Over half of respondents agreed that their EHR had easy to find contact information (56%) and advance directives. Finding a patient's prior cognitive status (26% agreement), goals of care (24%), functional status (14%), and multidisciplinary geriatric assessments (27%) was more difficult. Only 3% were satisfied with how their EHR handles geriatric syndromes. In free text responses, respondents (79%) described three areas that the EHR assists in the care of older adults: screening tied to actions or orders; advance care planning, and medication alerts or review. Common suggestions on how to improve the EHR included incorporating geriatric assessments in notes, establishing a unified place to review the 4-Ms, and creating age-specific best practice alerts. The majority of healthcare providers were not satisfied with how their EHR handles multidisciplinary geriatric assessment and geriatric care. EHR modifications would aide in reporting, communicating, and tracking the 4-Ms in EHRs.

Duty to Work During the COVID-19 Pandemic: A Cross-Sectional Study of Perceptions of Health Care Providers in Jordan

IntroductionThis study aimed to assess perceptions of duty to work among health care providers during the coronavirus disease 2019 response and to identify factors that may influence their perceptions. MethodsThis was a cross-sectional study conducted from April 1, 2020, to April 20, 2020, using an online survey distributed to health care providers in Jordan. Descriptive statistics were used, as well as chi-square test for independence to assess relationships between variables. ResultsA total of 302 questionnaires were included. Commitment to serve the community was the primary reason for coming to work (36%), followed by commitment to faith (29.6%). The major perceived barriers for coming to work were lack of appropriate personal protective equipment and appropriate training (62.6% and 53.5%, respectively). Males perceived higher work obligations than females in all potential barriers (P < .05), except for the lack of appropriate training. Nurses perceived higher work obligations than other health care providers despite the lack of appropriate training (χ2 = 11.83, P = .005), lack of effective vaccine or treatment (χ2 = 21.76, P < .001), or reported infection among coworkers (χ2 = 10.18, P = .03). DiscussionWhile the majority of health care providers perceive an obligation to work during the coronavirus disease 2019 pandemic, specific conditions, mainly lack of protective gear and training, may significantly alter their perception of work obligation. Providing training and proper personal protective equipment are among the vital measures that could improve the work environment and work obligation during pandemic conditions.

Knowledge, attitude, and practice of preconception care and associated factors among obstetric care providers working in public health facilities of West Shoa Zone, Ethiopia: A cross-sectional study.

Preconception care is biomedical, social, and behavioural care provided for a woman or couple before conception occurs or throughout their reproductive year. In Ethiopia, it's reported that the majority of health care providers had poor knowledge and practice of preconception care. The institution-based cross-sectional study was conducted among 359 obstetric care providers to assess knowledge, attitude, and practice of preconception care in West Shoa Zone, Ethiopia. A stratified, simple random sampling technique selected five hospitals, 46 health centers, and study participants. Pretested and structured questionnaires were used to collect data. Data were entered into Epidata and exported to SPSS for analysis. Bivariate and multivariate logistic regressions were employed to identify an association between the independent predictors and the outcome variables. In this study, 173(48.2%) and 124(34.5%) of the obstetric care providers had good knowledge and practice of preconception care, respectively. Two-thirds 255(71%) of providers had a favorable attitude toward preconception care. The odds of having good knowledge were higher among Midwives' providers [AOR: 2.03, 95%CI: 1.09-3.77] and had training on HIV testing [AOR: 3.5, 95%CI: 1.9-6.4]. The presence of a library [AOR: 1.7, 95%CI: 1.04-2.85] and internet access [AOR: 3.4, 95%CI: 2.0-5.8] in working health facility had a higher odds of good knowledge about preconception. Degree and above holders [AOR: 3.1, 95%CI: 1.5-6.1] also had higher odds of good preconception knowledge than diploma holders. Similarly, the odds of having good practice of preconception care were higher among health care providers: who did screening for reproductive life plans [AOR: 3.7, 95%CI:1.8-7.4], worked in maternity and child health unit [AOR:4.2,95%CI:2.0-8.6], perceive all health facilities should give preconception care services [AOR:2.3,95%CI:1.2-4.3], and perceive all health care providers should provide preconception services [AOR:3.0, 95%CI: 1.7-5.5]. This study found that more than half of obstetric care providers' had poor knowledge, favorable attitude, and poor practice of preconception care. Provision of training, carrier development, and installation of internet and library services should be enhanced.

Evaluating patient`s satisfaction and quality perception towards health services rendered at JTH, a major referral Hospital mostly depending on external Donners, Juba / South Sudan

Patient satisfaction is the perception of patient towards health care services, has been considered a mandatory barometer to evaluate how well a healthcare system is working in a number of advanced countries such as France and Germany, however, it receives limited attention in developing countries,1 Improved patient care has become a priority for all health care service providers with the optimum objective of achieving a high degree of patient satisfaction, therefore is the state of pleasure or happiness that the patients experience while using a health services.2 According to Emmanuel K Mpinga3 has moved from theoretical essence to more technical and operational approach, corresponds to expression of patient’s judgment on the quality of care, is an indicator and the voice of the patient, on other hand6 found that socio - demographic characteristics contribute minimally to patient satisfaction, patient who is anxious will not comprehend information clearly. In South Sudan generally, is perceived that there is a gap in needs of patients despite external donor`s efforts, hence patients seek healthcare in private health centers. Improving the quality of health care service offered at JTH will improve the service offered Nationwide directly or indirectly. This study is a cross-sectional studies, exploratory based on qualitative interviews one - to one investigator and patient, while structured questionnaire are given to Doctors and Nurses, the Study population aged 15 to 55yrs old, males and females, regardless of occupation and educational levels from all departments, Simple random samples were attained from the period between1st Oct 2012- 14th Jan2013 from various wards to reached 50 patients, 20 doctors and 30 nurses were given structured questionnaires which they filled. Followed by extensive discussions and analysis was done using MS Excel &amp;MS Word, data presentation is in the form of plain text, tables, graphs and pie charts. Results &amp; conclusions: The general performance of doctors and nurses is positive, despite the minority are dissatisfied, 22% of patients residing outside Capital Juba while 78% in Juba City. In regards to education level only 12% had tertiary education, while secondary level with 36% the remaining 52% had none or minimal education, the age group 15-24 had the highest unemployment rate while age 45-54 the least, 78% of the participants agreed that there was no language barrier, only 22% who had communication difficulty, South Sudan is a multi-ethnic country in which some patients speak their mother tongues or dialects only, 72% of the patients felt that privacy was observed while 28% contrary, because consultation rooms usually overcrowded with medical students, patients are examined in front of students and co-patients, Patients tend to hide information when they feel their privacy is at stake, leads to patients’ dissatisfaction. follow up of patients scored high when doctors’ performance was evaluated, However, some slight deviation could be due to doctors working in shifts, swift clinical examinations, impoliteness to colleagues, most doctors are interns and so their competency is always being questioned. JTH is under equipped and it has few Specialists, and the management of chronic cases almost futile attempt. Majority of health care providers at JTH have good attitude towards patients. few answered negatively. The breaches were in the areas of drugs administration, 70% of doctors felt that nurses don’t administer drugs with right doses and timely as prescribed, only 30% believe contrary, 90% of nurses feel they over worked, hindering the quality of care services, in JTH nurses working in strenuous shifts and high patient to nurse ratio with no allowance’s payments, and luck of in service training or luck of capacity building. Inadequate facilities hamper health services in our exploratory studies and investigations, all agreed that improvement of facilities need urgency with 35% agreed for Lab,78.2% agreed for OPD, while 54.2% wards need improvement, 51.6% for pharmacy. high patients to doctor’s ratio resulting in patients taking long to see doctors and their investigation results done. Patients share beds in the emergency wards; others sleep on the floor and outside the ward receiving the treatment this deteriorates patient`s dissatisfaction towards the capacity of the hospital to deliver services. Paradoxically, many patients still prefer JTH as a final resort, Therefore, JTH should rise the capacity of OPD, increase the healthcare workers and increase incentives and motivation, create good working environment. Medical students should be trained basic medical emergency on triage in order to handle growing number of patients. The laboratory should be modernized, and the management of Hospital should be given to who holds administrative and managerial skills.

Sexual and Reproductive Health Needs and Priorities of the Adolescents in Northern Pakistan: A Formative Evaluation

The vast majority (90%) of the world’s young people aged 10–24 years live in low and middle-income countries (LMICs). Pakistan has one of the world’s largest populations under 30 years. Adolescents’ access to basic sexual and reproductive health (SRH) services, such as family planning and sexuality education, remains low, especially in rural areas such as the Gilgit-Baltistan (GB) province of Northern Pakistan. This study addressed these gaps by exploring the SRH priorities and health information needs of adolescents living in GB. A cross-sectional survey was conducted with adolescents and healthcare providers. A total of 216 adolescents and 22 healthcare providers completed the survey forms. The findings pointed out that adolescents in GB have unmet SRH needs and are more interested in learning about SRH, human immunodeficiency virus (HIV) and sexually transmitted infections (STIs), and sexual abuse. The majority of the participants highlighted that their age, fear of being judged/stigmatized, and society’s attitude toward sex hinder them from opting for SRH services. The majority of healthcare providers reported that they are not well-equipped to tackle SRH-related issues and require training to better serve the adolescent SRH needs. The findings from this study have highlighted that there is a need to formulate robust interventions and strategies to raise knowledge and awareness about SRH needs among adolescents.

Assessing Implementation of Helping Babies Breathe Program Through Observing Immediate Care of Neonates at Time of Delivery

BackgroundTraining in neonatal resuscitation has been shown to reduce deaths related to intrapartum asphyxia. Helping Babies Breathe (HBB) is a simulation-based program focusing on training healthcare providers (HCPs) in immediate neonatal care including stimulation, initiating bag mask ventilation (BMV) in the absence of breathing by 1 min of life, and delayed (30–60 s after birth) umbilical cord clamping (DCC). Data on implementation of HBB posttraining are limited.ObjectiveTo determine time from birth to spontaneous breathing, cord clamping, and initiation of BMV in a setting where the majority of HCPs are HBB trained.MethodsTwo research nurses observed deliveries conducted in two referral hospitals. Timing included the onset of breathing, cord clamping, and initiation of BMV. Deliveries were grouped according to the mode of delivery.ResultsIn total, 496 neonates were observed; 410 (82.7%) neonates cried or had spontaneous breathing (median time 17 s) soon after birth, 25/86 (29%) of neonates not breathing responded to stimulation, 61 (12.3%) neonates required BMV, and 2 (0.4%) neonates required chest compression and/or adrenalin. Neonates delivered by cesarean section (CS) took longer to initiate first breath than those delivered vaginally (median time 19 vs. 14 s; p = 0.009). Complete data were available in 58/61 (95%) neonates receiving BMV, which was initiated in 54/58 (93%) cases within 60 s of life (the “Golden Minute”). Median time to cord clamping was 74 s, with 414 (83.5%) and 313 (63.0%) having cord clamped at ≥ 30 and ≥ 60 s, respectively. Factors associated with BMV were CS delivery [odds ratio (OR) 29.9; 95% CI 3.37–229], low birth weight (LBW) (birthweight < 2,500 g) (OR 2.47; 95% CI 1.93–5.91), and 1 min Apgar score < 7 (OR 149; 95% CI 49.3–5,021). DCC (≥ 60 s) was less likely following CS delivery (OR 0.14; 95% CI 0.02–0.99) and being LBW (OR 0.43; 95% CI 0.24–0.77).ConclusionApproximately 83% of neonates initiated spontaneous breathing soon after birth and 29% of neonates not breathing responded to physical stimulation. BMV was initiated within the Golden Minute in most neonates, but under two-thirds had DCC (≥60 s). HBB implementation followed guidelines, suggesting that knowledge and skills taught from HBB are retained and applied by HCP.

Enhancing Patient Care II: The Clinical Impact of Medical Information Services

BackgroundUnderstanding the ways that healthcare providers (HCPs) utilize medical information received from the pharmaceutical industry is important so that the information can be tailored and customized to meet the HCPs needs. Additionally, this understanding supports the value of the information provided. The purpose of this study was to collect opinions of HCPs who recently requested information from a manufacturer’s Medical Information (Med Info) Service. HCPs provided their opinions on the perceived quality, relevance, impact on patient care, and intended usage of information.MethodsHCPs who recently requested medical information from one of eight participating companies received a Survey Monkey link in the information response. Data collected included demographics, perceived quality, relevance, impact on patient care, and intended usage of the information. Data were analyzed via descriptive statistics.ResultsOver a 14-month period, 246 HCPs responded to the survey. Eight companies participated in the survey. Customer responses to the survey ranged from 2 to 97 per company. A total of 99 pharmacists, 68 physicians, 22 registered nurses, 21 nurse practitioners, 8 physician assistants, and 28 others participated in the survey. Most HCPs (208/227, 92%) contacted the company Med Info Group 1–5 times in the last six months and 67% (159/238) had been in practice greater than 10 years. Most HCPs rated the following quality areas as a 4 or 5 on a 5-point Likert scale: timeliness (195/225, 87%), trustworthiness (189/221, 86%), conciseness (185/221, 84%), clarity (180/222, 81%), relevance (178/223, 80%), and completeness (173/222, 78%). The most common reason for contacting Med Info Services was to advance knowledge or education (110/228, 48%). Additional reasons were at the point of care (60/228, 26%), for a specific patient (not at point of care) (60/228, 26%), and to reflect on a treatment decision (59/228, 26%). The relevance of the information provided was utilized for the HCPs own education (99/226, 44%), shared with peers (91/226, 40%), or used for future treatment decisions (88/226, 39%). The information provided enhanced patient care by enabling the HCPs to educate patients more effectively (86/222, 39%), efficacy of treatment regimen was enhanced (70/222, 32%), or other positive impact (65/222, 29%).ConclusionThe opinions of HCPs who are using Medical Information Services are overall positive. All the quality indicators were rated as a 4 or 5 by the majority of HCPs, with the lowest in completeness (173/222, 78%) and the highest in timeliness (195/225, 87%). Medical Information Services were utilized to advance knowledge/education of the HCP, followed closely by the care of a current or future patient. However, when queried on the relevant use of the information in their practice, the most common answers were for their own education or to share with peers. The impact on patient care was focused on enabling the HCP to educate patients more effectively. The value of medical information is difficult to quantify. Understanding the quality assessment, utilization, and the impact on patient care by HCPs can provide a broad descriptor of value. This study supports the value of the medical information responses provided by pharmaceutical companies to HCPs in their practice(s).

Prescriptions patterns and appropriateness of usage of antibiotics in non-teaching community hospitals in South Korea: a multicentre retrospective study

BackgroundAlthough non-teaching community hospitals form the majority of healthcare providers in South Korea, there is limited data on antibiotic usage in them. To evaluate the pattern of antibiotic usage and its appropriateness in hospitals with < 400 beds in South Korea.MethodsA multicentre retrospective study was conducted in 10 hospitals (six long-term care hospitals, three acute care hospitals, and one orthopaedic hospital), with < 400 beds in South Korea. We analysed patterns of antibiotic prescription in 2019, and their appropriateness in the participating hospitals. For the evaluation of the appropriateness of the prescription, 25 patients under antibiotic therapy were randomly selected at each hospital, over two separate periods. Due to the heterogeneity of their characteristics, the orthopaedics hospital was excluded from the analysis.ResultsThe most commonly prescribed antibiotics in long-term care hospitals was fluoroquinolone, followed by beta-lactam/beta-lactamase inhibitor (anti-pseudomonal). In acute care hospitals, these were third generation cephalosporin, followed by first generation cephalosporin, and second generation cephalosporin. The major antibiotics that were prescribed in the orthopedics hospital was first generation cephalosporin Only 2.3% of the antibiotics were administered inappropriately. In comparison, 15.3% of patients were prescribed an inappropriate dose. The proportion of inappropriate antibiotic prescriptions was 30.6% of the total antibiotic prescriptions.ConclusionsThe antibiotic usage patterns vary between non-teaching community hospitals in South Korea. The proportion of inappropriate prescriptions exceeded 30% of the total antibiotic prescriptions.

Knowledge on Newborn Life Support among the Healthcare Providers in a Tertiary Care Maternity Hospital in the Southern Province, Sri Lanka.

Introduction The newborn life support (NLS) is a set of educational guidelines established by the academies of Paediatrics that outline the proper procedures for resuscitation of a newborn. The objective of this study was to determine the knowledge on NLS among the healthcare providers (HCPs) in a tertiary care maternity hospital in the Southern Province, Sri Lanka. Methods A hospital-based cross-sectional study was carried out among doctors, nurses, and midwives, using a self-administered questionnaire. Comparison of knowledge among different categories was made using the chi-square test. Total sample of 191 consisted of 118 (61.8%) nurses, 33 (17.3%) midwives, and 36 (18.8%) doctors. The majority of HCPs (76.7%) had good knowledge of NLS; however, following guidelines on NLS among HCPs was poor (33%). According to the category, 91% of doctors and 78% of nurses had good knowledge, whereas only 48% of midwives had good knowledge. The difference of knowledge on NLS among different categories of HCPs was statistically significant (p < 0.001). Only 33% of HCPs had good knowledge of following NLS guidelines. Of them, 52% were doctors, 31% were nurses, and only 18% were midwives. The difference in adherence to NLS guidelines among different categories of HCPs was highly significant statistically (p=0.003). Conclusion The majority of the healthcare providers had good knowledge of NLS. There was a significant difference in the level of knowledge on NLS among different categories of HCPs. Gaps in the knowledge in following guidelines of NLS were noted in the majority. Newborn resuscitation has to be included in nursing and midwifery curricula, and training on NLS is essential in the orientation programs for newly recruited HCPs in maternity hospitals.

Promoting adolescent health through integrated human papillomavirus vaccination programs: The experience of Togo

The introduction of the Human papillomavirus (HPV) vaccine has shown potential to not only prevent cervical cancer but also drive adolescents’ access to other health care services, even in low-income countries. Few studies have been conducted to date to identify best practices and estimate the acceptance, operational challenges and benefits of including broader adolescent health interventions into immunization efforts, knowledge which is essential to supporting widespread integration. In this paper we review the efforts undertaken by the government of Togo to integrate adolescent health programming with the HPV vaccination roll out. With the support of partners (GAVI, WHO, UNFPA and UNICEF), the country successfully completed, in 2017, two years of an HPV vaccine demonstration project, which entailed vaccinating 10-year-old girls against HPV in two selected districts of the country and integrating a health education component focused on puberty education / menstrual hygiene and hand washing practice. Our study is a post-implementation program evaluation, using mixed methods to assess key questions of feasibility and acceptability of an integrated adolescent package of care. It showed that the HPV vaccination in conjunction with the health education sessions was well received by the majority of health care providers, teachers and parents. Our study confirmed that in Togo it proved feasible to combine education and HPV vaccination in school-based service delivery. However, more operational research is neded to understand how to increase the impact and sustainability of the co-delivery of interventions. We did not analyze the health impact and cost implications of the intervention, which will be an important consideration for scaling up such integration efforts alongside routine immunization.