Majority Of Health Professionals Research Articles

Assessing Risk among Frail Older Adults in Ontario, Canada, during the COVID-19 Pandemic: A Mixed Methods Evaluation of a Telephone Outreach Program

We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been screened as frail or who were identified as vulnerable by their family physician. This study describes the implementation and results of this risk screening protocol and describes patient, caregiver, and health professional perceptions of this outreach initiative. Mixed methods included satisfaction surveys and interviews completed by patients/caregivers (N = 300 and N = 26, respectively) and health professionals (N = 18 and N = 9, respectively). A medical record audit collected information on patient characteristics and screening outcomes. A total of 335 patients were screened in the early weeks of the pandemic, of whom 23% were identified with at least one risk factor, most commonly related to the potential for health destabilization and medication risk. Follow-up referrals were made most frequently to physicians, a pharmacist, and a social worker. The outreach calls were very well received by patients and caregivers who described feeling cared for and valued at a time when they were socially isolated and lonely. The outreach calls provided access to trusted COVID-19 information and reassurance that health care was still available. The majority of health professionals (>86%) were “very” or “extremely” satisfied with the ease of completing the screening via telephone and value for time spent; for 79% the protocol was “very” or “extremely” feasible to implement. Health professional interviews revealed that patients were unaware they could access care during the pandemic lockdown but were reassured that care was available, potential crises were averted, and they supported future implementation. Risk screening provides a significant opportunity to provide information, support, and mitigate potential risks and is an important and feasible component of pandemic planning in primary care.

Health professionals’ role in the transfer of mosaic embryos after preimplantation genetic testing for aneuploidies

Research questionWhat are health professionals’ clinical practices, views and self-rated competencies regarding the transfer of mosaic embryos? DesignThis was a cross-sectional study using surveys. ResultsData were collected from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Fertility Society of Australia and New Zealand. Ninety-five responses were analysed and reported. The results show that most health professionals (n = 62) discussed the transfer of mosaic embryos for different reasons and raised concerns regarding various risks. Although many health professionals were unsure whether mosaic embryos should be transferred, they were more inclined to encourage transfer if the scenario involved segmental losses compared with mosaicism involving duplication of the entire chromosome (i.e. trisomy 21) (e.g. OR = 0.21, P < 0.001; OR = 2.78, P = 0.04). The majority of health professionals would inform patients about the mosaicism to facilitate informed decision making. The factor that health professionals identified as most important when discussing the transfer of mosaic embryos was the specific chromosome involved. Different self-rated competencies were found among health professionals with different backgrounds. Geneticists and genetic counsellors had the highest self-rated competencies. ConclusionsMost health professionals were willing to discuss the mosaicism in the embryo with patients to facilitate informed decision making. However, health professionals’ uncertainty towards the transfer of mosaic embryos indicated a lack of a standardized transfer policy. In addition, obstetricians, gynaecologists and those with multiprofessional backgrounds showed deficiencies in several self-rated competencies, suggesting that education targeted to these groups is needed to optimize the quality of care of women considering transfer of mosaic embryos.

State-wide implementation of patient-reported outcome measures (PROMs) in specialized outpatient palliative care teams (ELSAH): A mixed-methods evaluation and implications for their sustainable use

BackgroundSuch patient-reported outcome measures (PROMs) and patient-centered outcome measures as the Integrated Palliative Care Outcome Scale (IPOS), Phase of Illness, and IPOS Views on Care (IPOS VoC), facilitate patient-centered care and help improve quality. To ensure sustainability, implementation and usage should be adapted according to setting. When settings involve several distinct teams that differ in terms of views and working practices, it is more difficult to integrate outcome measures into daily care. The ELSAH study aimed to learn how health professionals working in specialized outpatient palliative care (SOPC) viewed the use of these outcome measures in daily care, and what they express is needed for successful sustainable, state-wide application.MethodsWe used a parallel mixed-methods design involving three focus groups (n = 14) and an online-survey based on normalization process theory (n = 76). Most participants were nurses and physicians from 19 SOPC-teams in Hesse, Germany. We used a triangulation protocol including convergence coding matrices to triangulate findings.ResultsThe majority of health professionals were able to integrate the outcome measures into their working lives and said that it had become a normal part of their day-to-day work. To ensure their sustainable integration into daily care, the motivation and concerns of health professionals should be taken into consideration. Health professionals must clearly recognize how the measures help improve daily care and quality evaluation.ConclusionsTo implement the outcome measures in a number of teams, it will be necessary to take individual team characteristics into account, because they influence motivation and concerncs. Further, it will be necessary to offer opportunities for them to engage in peer support and share information with other teams. The sustainable use of outcome measures in SOPC will require continuous support within each team as well as across teams. When several distinct teams are working in the same setting, a cross-team coordination unit can help to coordinate their work efficiently.Trial registrationGerman Clinical Trials Register DRKS-ID: DRKS00012421; www.germanctr.de/DRKS00012421

Awareness and opinion of health professionals about various aspects of the implementation of HDSS

Introduction: The lack of appropriate health information obstructs population health assessments, as well as the development and evaluation of healthcare interventions. Surveillance is sometimes used interchangeably with epidemiology in its broadest definition, which is understandable. Surveillance, on the other hand, maybe considered to have evolved into a separate discipline from epidemiology. Objective: To study the Awareness and opinion of health professionals about various aspects of the implementation of HDSS in the defined rural community of district Jammu. Result: The present study was carried out in the Miran Sahib Zone of RS Pura Block, out of which six villages were selected randomly. The study surveyed 20 health professionals' over 3.56 km2 area of rural field practice area out of which 12 HPs had experienced less than 10 years while others had more than 10 years’ experience. The majority of health professionals were aware of various population enumeration methods while a small proportion of health professionals' about 25% considers the data generated by such systems to be useful for policy planning and prioritizing health services in a particular area.

The Perspectives of Health Professionals on Neonatal Genetic Screening

Background: After completing the human genome, the project has created opportunities to improve the diagnosis, prevention, and treatment of disease. However, the limitations in health professionals (HPs), genetic knowledge, technological resources, and a lack of scientific research prevent global genetic screening from being addressed. Objectives: The objective is to evaluate HPs’ knowledge, attitude, and future outlook toward neonatal genetic screening. Methods: The study was carried out in a cross-sectional survey. A simple random sampling technique was used to select health centers and healthcare professionals. Questionnaires were used to assess HPs knowledge, attitude, and future perspectives towards genetic disease screening. Results: Among the total of 384 HPs, 79.7% and 20.3% had good and poor knowledge on the basic idea of genetic screening, respectively. Similarly, 92.4% and 7.6% of HPs had good and poor knowledge, respectively, on the parental history of genetic disease. Besides, 68.8% and 31.3% of HPs had good and poor knowledge on the possibility of treating genetic diseases. Lastly, 81.3% and 18.5% of HPs had a positive and negative attitude towards genetic screening. Conclusion: The majority of HPs had good genetic knowledge and a positive attitude on the basic idea of genetic screening, parental history, and the possibility of treating genetic disease, respectively. However, the practice of genetic screening is not yet addressed in Ethiopia. Genetic HPs and nongenetic HPs have to encourage the concerned bodies, including the governmental system, to implement genetic screening in Ethiopia.

Educating Mental Health Nurse Practitioners on Interprofessional Collaboration and Preparing Them for Collaborative Practice.

Although interprofessional collaboration (IPC) has been discussed for over 40 years, in nursing education as well as the majority of health professionals, education continues to primarily take place in silos with curricula that is discipline specific. Educators need to implement models of education that are linked to collaborative practice and team-based care. To introduce the principles from the Core Competencies for Interprofessional Collaborative Practice, the American Association of Colleges of Nursing Essentials of Doctoral Education for Advanced Nursing Practice and the National Organization of Nurse Practitioners Faculties Nurse Practitioner Core Competencies into the coursework. To demonstrate an application process for incorporating collaboration in their future nurse practitioner roles. Students in the Doctor of Nursing Practice mental health nurse practitioner program participated in a set of assignments to develop essential knowledge and skills for integration of IPC into practice. A pretest-posttest design was used to evaluate student attitudes towards IPC following immersion in IPC subject matter and experiential learning with other healthcare providers working together to coordinate patient care. There were significant findings for six of the 18 survey questions. This project can serve as an example for successful implementation of IPE in the nursing curricula.

Modification of maternal late pregnancy sleep position: a survey evaluation of a New Zealand public health campaign

IntroductionA ‘Sleep-On-Side When Baby’s Inside’ public health campaign was initiated in New Zealand in 2018. This was in response to evidence that maternal supine going-to-sleep position was an independent risk...

Public and Professional Perceptions of the Scope of Practice of Oral and Maxillofacial Surgeons

To investigate and compare the general public's, general dentists', and primary care physicians' level of knowledge of the scope of practice of oral and maxillofacial surgeons (OMSs). We hypothesized that there is a generalized lack of knowledge of the scope of practice of oral-maxillofacial surgery, with the general public being the least informed and the general dentists the most educated. A cross-sectional survey study was conducted via a mail-out survey that was delivered to a random sample of the general public, general dentists, and primary care physicians in Ontario, Canada. A total of 1800 participants were selected. The survey consisted of a demographic screener along with 24 clinical scenarios in which the participants could select all the specialists they thought were capable of completing the treatment. Inferential statistics were computed using a chi-square test to compare responses between the groups and identified any significant differences between subjects for each of the 24 scenarios with P value set at 0.05. Total response rate of 50.1% (n=902) was achieved. The majority of health professionals (100% dentists, 95.5% primary care physicians) have heard of oral-maxillofacial surgery, in contrast to only 73.7% of the general public (P<.001). There was a general lack of awareness of oral-maxillofacial surgery scope of practice by all groups wherein OMSs were selected less than 50% of the time in 10 (general dentists), 14 (primary care physicians), and 16 (general public) of 24 clinical scenarios. Greater than 25% of the general public are unaware of OMS. More concerning, the general public and health professionals as a whole are unfamiliar with the full scope of practice of OMSs. For enhancing access to care by qualified specialists, educational programs highlighting key aspects of oral-maxillofacial surgery should be developed and distributed to all populations.

Attitude, Willingness, and Associated Factors in Organ Donation Among Health Professionals in Gondar, Northwest Ethiopia

BackgroundOrgan transplantation is considered one of the greatest advances of modern science, and it has given many patients a renewed lease on life. The demand for organs far exceeds the supply. Health professionals are fundamental in the process of organ procurement. ObjectiveTo assess the attitude, willingness, and associated factors in organ donation among health professionals of Gondar, Ethiopia. MethodsOur cross-sectional study was conducted among 382 randomly selected health professionals in Gondar using a self-administered questionnaire. Multivariable logistic regression analysis was applied to analyze the data. ResultsAmong health professionals, 79.1% had favorable attitude toward organ donation and 74.6% were willing to donate their organs. After adjusting for covariates, the odds of having a favorable attitude about organ donation were 3.2 and 11.9 times higher in the professions of laboratory technologists and medical doctors, respectively. By keeping all other variables constant, attitude was found to be positively associated with awareness (adjusted odds ratio [aOR] 12.74, 95% confidence interval [CI] 3.71-43.8) and being a member of the Red Cross Association (aOR 5.24, 95% CI 1.46-18.96). Willingness was positively associated with awareness (aOR 6.25, 95% CI 2.0-19.53), a member of the Red Cross Association (aOR 5.09, 95% CI 1.5-17.22), a laboratory technologist (aOR 3.57, 95% CI 1.37-9.29), and a medical doctor (aOR 6.52, 95 % CI 1.93-22.01). ConclusionsThe main findings indicated that the majority of health professionals in Gondar had a favorable attitude toward organ donation and were willing to donate their organs in times of need.

Development and Evaluation of a Tele-Education Program for Neonatal ICU Nurses in Armenia

PurposeNeonatal mortality currently accounts for more than 60% of all infant mortality in Armenia. The majority of health professionals in Neonatal Intensive Care Units (NICU) however, have had no specialized training in neonatology. Local and global agencies have emphasized the need for improvement in the education and skills of NICU health professionals. The objective of this study was to design, implement, and evaluate an innovative tele-education program for NICU nurses in Armenia. Design and methodsSeven online tele-education courses were designed on various neonatal nursing topics using Final Cut Pro and translated professionally to Armenian. The videos were uploaded to YouTube. All NICU nurses employed in two hospitals (n = 35) in Yerevan, Armenia, completed a diagnostic pretest, course viewing, a posttest, and a satisfaction survey for each topic. A difference in knowledge was defined as the number of correct test answers obtained before and after the course. Participant satisfaction was measured using a Likert scale. ResultsThe combined average for completed pre-tests for all courses was 45% and 71% for post-tests, which was statistically significant for each course (p < 0.05). A majority of the nurses either agreed or strongly agreed with all of the satisfaction parameters of the course. ConclusionsThese results support a tele-education model for effectively providing continuing education to NICU nurses in Armenia. A similar platform could be used to establish nationwide certification programs for neonatal nurses. Practice implicationsTele-education technology can be used effectively by nursing educators working in global health as part of international learning collaboratives.

50 Bridging the gap between education and health: What youth need educators to know about chronic pain

Abstract Background Chronic pain is common and affects 20% of children and youth. Those with chronic pain often have a difficult time regularly attending school, with up to 50% of children and youth with chronic pain missing some school. Specific accommodations that benefit youth are unknown. Nearly half of parents of youth with chronic pain report their child’s grades dropped since pain onset. Both parents and youth report “moderate levels of interference” with learning. Most common accommodations include being sent to the nurse, being sent home and receiving extensions on assignments. While these strategies may be helpful for pain conditions expected to resolve, strategies that support staying in and succeeding at school are required for youth with chronic pain. Objectives This study aims to determine what educators need to know to best support youth with chronic pain in the academic setting. More specifically, 1) to determine what youth with chronic pain, parents of youth, educators, and healthcare professionals want educators to know about supporting students with chronic pain, and 2) to describe health professionals’ and educators’ attitudes and knowledge of pediatric chronic pain. Design/Methods Inclusion criteria include youth age 12-25 years with chronic pain and parents, health professionals and educators of youth with chronic pain. The recruitment strategy includes distribution of the survey via the Saskatchewan pediatric chronic pain clinic research contact lists, the Canadian Paediatric Society Section of Community Paediatrics listserve and social media. This online cross-sectional survey includes participant demographics and questions about accommodations noted to be helpful for youth with chronic pain. In addition, educator and health professional surveys include the 26-item Chronic Pain Myth Scale (CPMS). Results The study group includes 87 participants, 26 youth, 18 family/friends, 19 educators, and 24 health professionals. Some suggested school accommodations include: access to technology in class, teachers providing notes for students, education on chronic pain for teachers and students, and improved communication and collaboration between the youth, their healthcare team and educators. The majority of health professionals and educators report some knowledge, positive beliefs and attitudes towards people suffering from chronic pain (M=3.03, SD= .34). Conclusion Chronic pain is common and affects school attendance and achievement. Suggestions for accommodations to help those with chronic pain in the academic setting are made. Educators and health professionals indicated varying levels of knowledge, attitudes and beliefs, with some educators indicating they would like to receive education about chronic pain. Improved communication between school-based pupil support teams and health care teams is warranted.

Knowledge and Attitude of Health Professionals Towards Clinical Pharmacy Services in Selected Hospitals in West Shoa Zone, Ethiopia

Clinical pharmacy services are patient oriented services developed to promote the rational use of medicines by maximizing therapeutic effect of medicines in individual patients. The service is at the infant stage in Ethiopia and there is no adequate information about it in the country. Therefore, the aim of this study was to assess the knowledge, attitude & practice of health professionals towards clinical pharmacy services in selected public hospitals in West Shoa Zone, Oromia Region, Ethiopia. A facility based cross sectional survey was conducted from April 2 to April 16, 2018. The study used a quantitative method of data collection. A total of 150 health professionals were involved in the study; and convenience sampling techniques was used to collect the data. Data was collected using structured and self-administered questionnaires and it was analyzed by using SPSS version 23. Descriptive statistics including frequency, mean, percentage and table was used to present the data. 128 (92.1%) of health professionals were heard about clinical pharmacy services in Ethiopia. 104 (74.8%) strongly agreed & agreed that they appreciated the presence of pharmacist in the ward all the times important for patient care. However, 67 (48.2%) of respondents said the performance of the pharmacists in practicing clinical pharmacy in the hospital was poor. Generally, majority of health professionals had adequate knowledge and positive attitudes towards clinical pharmacy services but their practice with clinical pharmacists was found poor. It is recommended that collaborative working relationship should be established among health professionals in order to optimize and monitor drug use problem in the hospitals.

Factors affecting awareness and practice of primary health care professionals towards interaction of various medications used in systemic conditions, and its effect on periodontal health.

Background:Interaction of various drugs and its effects on gingival and periodontal health is the area of concern; hence the aim of the present study was to explore factors affecting the awareness and practice of primary health care professionals towards the interaction of various medications used for systemic diseases on periodontal health.Materials and Methods:It was a cross-sectional, descriptive, questionnaire study conducted among 203 primary health care professionals which include 94 medical officers and 109 nurses working in primary health centers in rural areas of Udaipur district. The study was conducted in December 2019. Sampling techniques was stratified random sampling technique. A close-ended questionnaire was prepared to conduct an interview schedule.Results:The majority of health professionals had poor awareness (157 [77.33%]) and poor practice (168 [82.75%]) regarding the interaction of various medications used in systemic conditions and periodontal health. Factors that significantly affect awareness and practice of study participants were age (0.01*), degree (0.05*), and number of patients with oral problems seen in a week (0.05*), gender (0.05*), designation (0.05*).Conclusion:From above it was concluded that awareness and practice of primary care health professionals were poor. The factors that affect significantly affect awareness and knowledge of study participants was age, degree and number of patients with oral problems seen in a week, gender, designation, no. of patient attended in a day.

Healthcare Workers’ attitudes towards mandatory influenza vaccination: a systematic review

Abstract Background Influenza affects approximately between 5 to 10% of general population every year, leading to 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths. Healthcare Workers (HCWs) play a crucial role in spreading the infection to patients. Although the strong recommendations provided, influenza vaccination coverage rates among HCWs are globally well below the coverage target set by WHO. The aim of this study is to assess attitudes towards mandatory influenza vaccination programs among HCWs, in order to make a quantitative synthesis of the phenomenon. Methods The present study systematically reviewed published cross-sectional studies investigating attitudes towards compulsory influenza vaccination in Healthcare Workers. PubMed and Scopus scientific databases were searched and 4,198 results were returned. Of these, 23 met the inclusion criteria for the review and 13 were eligible for the meta-analyses. PRISMA statements were followed. Results Thirteen studies were conducted in North America, 4 were conducted in Europe, 3 in Asia, 2 were performed in Australia and one study collected data both from Europe and Asia. According to the assessed studies, the percentage of agreement ranged from 44% to 95% for different compulsory vaccination programs. A combined prevalence of 59.8% (95%CI 50.1-68.8) was found in the meta-analysis. Having been vaccinated against influenza in the previous year increases the likelihood (OR 4.1; 95%CI 2.8-6.1) of being in favour of mandatory vaccination policies. Conclusions Compulsory influenza vaccination programs are generally accepted by the majority of health professionals, especially by those who have already been vaccinated previously. These results could be important to improve European vaccination strategies, in order to increase influenza vaccination rates among Healthcare Workers. Key messages Mandatory influenza vaccination programs are accepted by the majority of Healthcare Workers. Having been previously vaccinated against influenza increases the likelihood of being in favor of a mandatory vaccination policy.

Diabetes care in remote Australia: the antenatal, postpartum and inter-pregnancy period

BackgroundAboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional’s perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care.MethodsHealth professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62).ResultsQualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58).ConclusionThese findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.

Education Matters: Certified health professionals have higher credibility than non health professionals on Instagram

Social media serves as an accessible source of health information and nutrition information. Instagram, an internationally known social media platform with an average of more than 1 billion monthly active users, allows its users to create and share content. However, the credibility of the nutrition content created by users with unknown qualifications may be questionable. The objective of this study is to assess the credibility of content created by nutrition influencers on Instagram by comparing health professionals with non-health professionals.&#x0D; For this study, “influencer” is defined as an Instagram user with at least 15,000 followers who promotes products, services, or ideas and who creates nutrition- or health-related content. For each influencer (n=29), two posts were selected every month from August 2018 to July 2019. Using the “Credible Information Factsheet” from the Dietitians of Canada, a credibility score based on four dichotomous criteria was created. Looking at the 24 posts of each influencer holistically, a credibility score out of 4 was calculated, with 0 being the least credible and 4 being the most credible.&#x0D; Without exception, a greater proportion of health professionals compared to non-health professionals met each criterion from the “Credible Information Factsheet”. 92% of the health professionals met criteria 1 (Miracle Cure) compared to only 31% of non-health professionals. This demonstrates how the vast majority of health professionals would not promise a miracle cure, while most non-health professionals would readily promise a miracle cure. Additionally, 46% of health professionals met criteria 4 (Research-based) compared to only 19% of non-health professionals, which demonstrates how non-health professionals do not support claims with research. When looking at the total credibility scores for health professionals and non-health professionals, not a single health professional scored a total of 0, while not a single non-health professional scored a total of 4. Most importantly, health professionals had an average credibility score of 2.4, which is twice as high as that of non-health professionals (1.2).&#x0D; Overall, health professionals appeared to be more credible than non-health professionals. By viewing nutrition information posted on Instagram by non-health professionals, followers potentially expose themselves to misinformation. Further research should be undertaken to validate the credibility score based on the “Credible Information Factsheet” by determining how adept the factsheet is at differentiating credibility for Instagram content.

Complex regional pain syndrome: An international survey of clinical practice.

Published guidelines promote best practice in complex regional pain syndrome (CRPS) treatment and management; however, these recommendations are not always applied in clinical practice. Understanding existing care internationally will help inform future patient and health professional service delivery, education initiatives and content of clinical guidelines. An e-survey was conducted in order to gain an insight into routine CRPS clinical practice. Health professionals and academics, from the field of CRPS, were recruited from an international population. Quantitative and qualitative data were elicited. Data were mapped onto a framework to identify macro-regional factors. Of the 260 survey respondents, 96% (n=241) provided clinical care for people with CRPS, with academics not involved in patient care also responding. Half of respondents expressed difficulty in recognizing the symptoms of CRPS but treatment aims corresponded with published guidelines. However, a lack of resources and fragmented care were reported as barriers to early intervention. Service constraints were most frequently reported by European respondents. Five themes emerged from the qualitative data: the benefit of interdisciplinary working; the importance of symptom management; need for early diagnosis and intervention; establishing a collaborative partnership with patients; the value of education for patients and health professionals. Our data suggest that more work is required to raise awareness of the Budapest CRPS diagnostic criteria so as to promote early diagnosis and intervention. Future work to optimize clinical effectiveness should consider enhancing interdisciplinary service delivery that encourages a collaborative patient/clinician partnership; includes excellent patient education; and addresses modifiable patient-related factors. Health professionals expressed some level of difficulty recognizing the signs and symptoms of CRPS despite the majority of health professionals having had clinical experience exceeding 6years in the field of CRPS. More work is required to raise awareness amongst clinicians of the Budapest CRPS diagnostic criteria so as to promote early diagnosis and intervention Health professionals' treatment aims reflected the current clinical guidelines however, a lack of resources and fragmented care were frequently cited as barriers to achieving these.

Survey on use of antenatal magnesium sulphate for fetal neuroprotection prior to preterm birth in Australia and New Zealand - Ongoing barriers and enablers.

Clinical practice guidelines recommend the use of antenatal magnesium sulphate for fetal neuroprotection before preterm birth at <30weeks' gestation. This survey assessed the use of antenatal magnesium sulphate for fetal neuroprotection to determine if use has changed since the previous survey in 2012, and to evaluate enablers and barriers to use. A questionnaire was sent to clinical leaders at 29 hospitals with a neonatal intensive care unit in Australia and New Zealand asking at what gestational ages magnesium sulphate was given, if use was audited and any enablers and barriers to use. Responses were received for 24 (83%) hospitals. The use of magnesium sulphate for fetal neuroprotection was reported as 89% (IQR 80-90%), an increase from 80% (IQR 53-90%) from the earlier survey. The majority of health professionals were reported as using magnesium sulphate at <30weeks' gestation. The top enablers for use of magnesium sulphate were availability of pamphlets, posters, case record stickers and PowerPoint presentations. The main reasons as to why eligible women did not receive magnesium sulphate were imminent birth, the hospital being short staffed and the patient declined. The use of antenatal magnesium sulphate has been or is being audited in 11 (46%) of the hospitals. Clinical leaders at institutions in Australia and New Zealand report that uptake in the use of magnesium sulphate for fetal neuroprotection has continued to increase since the earlier, bi-national survey in 2012. Barriers to the use of magnesium sulphate identified have institutional and consumer implications.

The value of interprofessional education in identifying unaddressed primary health-care challenges in a community: a case study from South Africa

ABSTRACTMany countries rely on community health workers (CHWs) at a primary health care (PHC) level to connect individuals with needs to health professionals at health-care facilities, especially in resource-limited environments. The majority of health professionals are centrally based in facilities with little to no interaction with communities or CHWs. Stellenbosch University (South Africa), included interprofessional home visits in collaboration with CHWs as part of students’ contextual PHC exposure in a rural community to identify factors impacting on the health of patients and their families. The aim of this study was to determine the impact of this interprofessional student service-learning initiative on identifying and addressing health-care challenges of households known to CHWs. Active physical, social and attitudinal factors were identified and recorded using a standardized paper case report form. Data were anonymized, captured and categorized for analysis. The frequency and proportion of each type of active problem and referral were calculated. The collaborative team identified many unaddressed health and social issues during their visits. Their exposure to communities at a PHC level offered benefits of experiential learning and provided insight into community needs, as well as offering services to enhance the current health-care system.

Setting up the program ‘PRADO Insuffisance Cardiaque’ (back home program for heart failure patients): Perception by health professionals and patients

Re-hospitalizations and deaths are particularly high during the first month following hospitalization for IC. Thus, several programs have been proposed in recent years, including the ‘Programme d’Accompagnement du Retour à Domicile(PRADO)’. The objectives of this program are to reduce the re-hospitalization and death of IC patients and to improve their quality of life. This is a monocentric observational retrospective study whose main objective was to evaluate the feeling of general practitioners,cardiologists and community nurses in the implementation of the PRADO IC program. The secondary objectives were to determine the impact of the program on the number of re-hospitalizations and deaths within 6 months following hospitalization. It was also to evaluate the feelings of the patients included.60 physicians and 36 community nurses participated in our study as well as 56 patients. The knowledge of the protocol concerned only 28% of general practitioners and 80% of cardiologists (significant difference between specialties). The majority of health professionals seem to favor this program. The 6-month re-hospitalization rate for IC was 21.6%. None of the triggering factors corresponded to a therapeutic break or a difference in diet, suggesting that the therapeutic education sessions of the program have borne fruit. An advanced age,outpatient BNP ≥ 400 pg/mL, and impaired LVEF were correlated with increased risk of re-hospitalization (no statistically significant link). We also found a trend toward shorter re-hospitalizations. Mortality at 6 months was 18.2%. Older age (> 85 years) was statistically associated with a higher risk of cardiovascular mortality. The majority of patients reported having felt a benefit to carry out this program, because it was accessible in its content and easy to set up at home. In conclusion, the low knowledge of the program should allow for new effective dissemination methods for this type of program as the prevalence of HF will continue to grow in the coming years.