Nonphysician Health Care Providers Research Articles

Knowledge and Perception of Rural Non-Physician Healthcare Providers towards Full Practice Authority for APRNs

Knowledge and Perception of Rural Non-Physician Healthcare Providers towards Full Practice Authority for APRNs

Exploring perspectives on vaccinations delivered in complementary nonclinical settings and by nonphysician health professionals: A qualitative interview study

BackgroundAlthough vaccines are an effective solution for preventing infectious disease, some vaccination rates remain below national targets, creating a need to increase vaccination access and uptake. A potential solution to improve vaccination rates is the implementation of policies that allow for more convenient vaccination access, such as the expansion of vaccination delivery by nonphysician healthcare providers (NPHPs) outside of traditional clinical settings. ObjectiveTo understand perspectives on vaccine administration at complementary sites (such as pharmacies, mobile clinics, and pop-up clinics) by NPHPs, and the barriers surrounding administration. MethodsWe performed interviews with healthcare providers and vaccination policy experts to elicit perspectives on including vaccination program scope, facilitators and barriers to NPHPs administering vaccines, and recommendations for improvement of vaccine administration. Eligible participants were required to either work directly in vaccination administration or work in vaccination policy. ResultsThirty-eight participants completed interviews. Participants reported that U.S. individuals have a positive view of vaccination at complementary sites and by NPHPs, especially since the COVID-19 pandemic, where vaccination was often performed by NPHPs at complementary sites. Concerns expressed by participants included language barriers, out-of-pocket costs, and mistrust among marginalized communities. Participants described the complexity of state and local regulations, particularly scope of practice laws, as a barrier to implementation of NPHP vaccination programs at complementary sites. ConclusionNPHPs and vaccination advocates report that complementary sites represent a potentially important step to ensuring broader, more equitable vaccination service in the United States.

Effectiveness of team-based care interventions in improving blood pressure outcomes among adults with hypertension in Africa: a systematic review and meta-analysis

ObjectiveWe evaluated the effectiveness of team-based care interventions in improving blood pressure (BP) outcomes among adults with hypertension in Africa.DesignSystematic review and meta-analysis.Data sourcePubMed, CINAHL, EMBASE, Cochrane Library, HINARI and...

Impact of baseline cardiovascular risk on the outcomes of intensive blood pressure intervention: a post hoc analysis of the China rural hypertension control project

BackgroundThe 2018/2023 ESC/ESH Guidelines underlined a gap how baseline cardiovascular disease (CVD) risk predicted blood pressure (BP) lowering benefits. Further, 2017 ACC/AHA Guideline and 2021 WHO Guideline recommended implementation studies about intensive BP control. Now, to bridge these guideline gaps, we conducted a post hoc analysis to validate whether the baseline CVD risk influences the effectiveness of the intensive BP control strategy, which was designed by China Rural Hypertension Control Project (CRHCP).MethodsThis is a post hoc analysis of CRHCP, among which participants were enrolled except those having CVD history, over 80 years old, or missing data. Subjects were stratified into quartiles by baseline estimated CVD risk and then grouped into intervention and usual care group according to original assignment in CRHCP. Participants in the intervention group received an integrated, multi-faceted treatment strategy, executed by trained non-physician community health-care providers, aiming to achieve a BP target of < 130/80 mmHg. Cox proportional-hazards models were used to estimate the hazard ratios of outcomes for intervention in each quartile, while interaction effect between intervention and estimated CVD risk quartiles was additionally assessed. The primary outcome comprised myocardial infarction, stroke, hospitalization for heart failure, or CVD deaths.ResultsSignificant lower rates of primary outcomes for intervention group compared with usual care for each estimated CVD risk quartile were reported. The hazard ratios (95% confidence interval) in the four quartiles (from Q1 to Q4) were 0.59 (0.40, 0.87), 0.54 (0.40, 0.72), 0.72 (0.57, 0.91) and 0.65 (0.53, 0.80), respectively (all Ps < 0.01). There’s no significant difference of hazard ratios by intervention across risk quartiles (P for interaction = 0.370). Only the relative risk of hypotension, not symptomatic hypotension, was elevated in the intervention group among upper three quartiles.ConclusionsIntensive BP lowering strategy designed by CRHCP group was effective and safe in preventing cardiovascular events independent of baseline CVD risk.Trial registrationThe trial is registered with ClinicalTrials.gov, NCT03527719.

Impact of medical innovations on quality of care in low income settings

Access to high-quality healthcare remains a challenge in low-income settings, primarily due to resource constraints and limited access to medical innovations. This systematic review examines the impact of medical innovations on the quality of care in low-income settings. Through a comprehensive analysis of relevant literature, this paper highlights the various medical innovations that have been implemented in low-income settings and evaluates their effectiveness in improving healthcare outcomes and patient satisfaction. The review identifies three broad categories of medical innovations: technological innovations, innovative healthcare delivery models, and novel treatment modalities. Technological innovations encompass a wide range of advancements, including telemedicine, mobile health (mHealth) applications, and point-of-care diagnostics. These innovations have shown promise in improving access to healthcare services, enhancing diagnostic accuracy, and facilitating remote monitoring and follow-up care in low-resource settings. Innovative healthcare delivery models, such as community health worker programs, task shifting, and mobile clinics, have also been implemented to overcome barriers to healthcare access in low-income settings. These models prioritize community engagement, decentralization of services, and task delegation to non-physician healthcare providers to expand coverage and reach underserved populations. Furthermore, novel treatment modalities, including affordable and portable medical devices, point-of-care testing kits, and low-cost medications, have been developed to address the specific healthcare needs of low-income populations. These innovations aim to improve treatment efficacy, reduce treatment costs, and minimize the burden of disease in resource-limited settings. The review synthesizes evidence from a diverse range of studies to assess the impact of these medical innovations on healthcare outcomes and patient satisfaction. Key findings suggest that while medical innovations hold promise in enhancing quality of care, several challenges including limited resources, infrastructure constraints, and training requirements need to be addressed to maximize their impact. The paper concludes by emphasizing the importance of tailored approaches and sustainable strategies for implementing medical innovations in low-income settings. By fostering partnerships, leveraging existing infrastructure, and investing in capacity building initiatives, stakeholders can effectively integrate medical innovations into healthcare delivery systems and improve access to high-quality care for underserved populations. This systematic review contributes to the growing body of literature on healthcare innovation and provides valuable insights for policymakers, healthcare providers, and researchers seeking to address the healthcare needs of low-income populations and achieve health equity on a global scale.

Psychometric properties of the Persian version of Conners Early Childhood ADHD Questionnaire-Parents’ Form in Iranian children aged 3-6 years

Background. Attention deficient-hyperactivity disorder (ADHD) is the most prevalent psychiatric diagnosis in preschool children. The present study aimed to translate and determine the validity and reliability of the Persian version of Conners Early Childhood Attention Deficit-Hyperactivity Disorder Questionnaire–Parents’ Form in Iranian children aged 3-6 years. Methods. We included 1,013 pediatrics aged &lt;6 years in 2017-18 in Tabriz, Iran. In the first step, the questionnaire was translated into Persian using the re-translation method. Then, the content validity of the questionnaire was evaluated by ten specialists. Finally, the concurrent validity of the questionnaire was simultaneously compared with the children’s Strengths and Difficulties Questionnaire (SDQ). ROC curve was used to determine the best cut-off point, and sensitivity and specificity were measured to determine the questionnaire’s diagnostic value compared to the clinical psychiatric interview. The test-retest method was used to determine reproducibility using the intra-class correlation coefficient (ICC). The internal consistency was also evaluated with Cronbach’s alpha test. Results. Of all the 1,013 participants, 569 (56.2%) were female. The overall modified kappa agreement and concurrent validity coefficients were 0.76 and 0.70, respectively. The sensitivity and specificity of the questionnaire was estimated 86.8% and 79.4%, respectively. The ICC was calculated at 0.90, and the questionnaire’s internal consistency was calculated at an overall Cronbach’s alpha coefficient of 0.88. Conclusion. The Persian version of Conners Early Childhood Attention Deficit-Hyperactivity Disorder Questionnaire–Parents’ Form exhibited proper reliability and validity for screening the Iranian pediatric population. Practical Implications. The emerged validated tool from the present study can be used in the first-line health system in the public and private sectors for physician and non-physician healthcare providers, especially family physicians in primary health care.

Evaluation of satisfaction with and relief vs. workload by ageneral practitioner-centered dementia care project: early information and support in dementia (FIDEM) in Göttingen, Germany

Early information and support in dementia (FIDEM) is across-sectoral, general practitioner-centered network model for the improvement of community-based care of people with dementia and their caregivers by systematically assigning them to non-physician healthcare providers. To describe the implementation of FIDEM in Göttingen, Germany and to exploratorily evaluate satisfaction and relief vs. additional workload. FIDEM was established in Göttingen in 2017. Community-based and district-based networks consisted of medical (general practitioners) and non-medical cooperation partners (occupational therapists, care counselling, other non-medical care providers) and were instructed to efficiently share information. During biannual network meetings from August 2017 to October 2019, aself-developed questionnaire for quality management and evaluation of the aspects of the project described above was filled out by participants attending the meetings. Consecutive recruitment resulted in 7 networks by October 2019, with participation of 29 general practitioners and 46 non-medical care providers, serving as cooperation partners. Quantitative evaluation of 80 FIDEM cooperation partners revealed high satisfaction ratings with all aspects of the model (Mfrom 7.22 to 7.87 out of possible "10"), with partially higher ratings on the part of primary care physicians. Furthermore, all participants reported areduction in workload due to participation, which was significantly higher for primary care physicians across all scales (all p-values < 0.001). FIDEM has been implemented in Göttingen beyond afunded pilot project phase. High satisfaction ratings and considerable relief in workload suggest the continuation of FIDEM along with afull evaluation and, provided positive results, its consolidation of and transfer to other regions in Germany.

Exploring virtual care clinical experience from non-physician healthcare providers (VCAPE)

COVID-19 has caused an urgent implementation of virtual care (VC). Most research has focused on patient and physician experience with virtual care. Non-physician healthcare providers have played an active role in transitioning to virtual care, yet little is known about their experiences. This study explored their lived experiences in caring for patients virtually. Forty non-physician healthcare providers from local hospitals, community, and home care settings in Kingston, ON, Canada, participated and included nurse practitioners, occupational therapists, physiotherapists, psychologists, registered dietitians, social workers, and speech-language pathologists. Data were collected using semi-structured interviews between February and July 2021 and were analyzed thematically. The study was guided by organizational change theory. Four themes were identified from the data: 1) Quality of care, 2) Resources and training, 3) Healthcare system efficiency, and 4) Health equity and access for patients. Providers suggested that VC increased patient-centredness and had clear benefits for patients. Participants had little to no training in conducting patient care, virtually stating this as a key challenge. They believed that VC increased the efficiency of the healthcare system and was more proactive. Despite concerns regarding inequities across healthcare, participants reported that VC could improve equity as long as patients had access to technology. The study highlights the urgent need to support all healthcare providers in delivering optimal patient-centred care. We should leverage some of the advantages offered by VC to improve the efficiency of healthcare delivery, reduce provider burnout, and increase capacity across organizational systems.

An Analysis of Cosmetic Facial Injectable Treatment Content on TikTok.

TikTok (Culver City, CA) is a powerful and popular source of patient education. However, the lack of content regulation allows for the potential spread of medical misinformation. Analyze the source, content, quality, and reliability of TikTok posts regarding non-surgical cosmetic facial injectable treatments including Botox and fillers. The TikTok application was queried using 14 popular hashtags related to non-surgical facial injectable treatments. The top 25 search result videos from each hashtag were included in the analysis. Videos were categorized based on content creator and video type and descriptive metrics collected for each result. Educational videos were further analyzed for content quality using the validated modified DISCERN (mDISCERN) score and the Patient Education Materials Assessment Tool (PEMAT) scales. Univariate and linear regression models were utilized for content analysis between groups. The included 340 videos totaled 306,552,644 views, 22,715,689 likes, 220,072 comments, and 352,614 shares. Most videos were uploaded by non-physician healthcare providers (n = 126, 37.1%), and patient experience (n = 130, 38.2%) was the most common video category. Healthcare team content creators had significantly lower median views, likes, comments, shares, and engagement when compared to non-healthcare team content (p<0.001). DISCERN scores for information reliability were significantly higher in physician-created videos than non-physician and non-physician health care provider created videos (2 vs. 1.5, p<0.001, 2 vs. 1.5 p=0.001 respectively). The overall quality of TikTok videos regarding non-surgical cosmetic facial injectable treatments was low, which may stem from a lack of content from physician content creators.

Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial

Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention on cardiovascular disease has not been established. We aimed to test the effectiveness of such an intervention compared with usual care on risk of cardiovascular disease and all-cause death among individuals with hypertension. In this open-label, blinded-endpoint, cluster-randomised trial, we recruited individuals aged at least 40 years with an untreated systolic blood pressure of at least 140 mm Hg or a diastolic blood pressure of at least 90 mm Hg (≥130 mm Hg and ≥80 mm Hg for those at high risk for cardiovascular disease or if currently taking antihypertensive medication). We randomly assigned (1:1) 326 villages to a non-physician community health-care provider-led intervention or usual care, stratified by provinces, counties, and townships. In the intervention group, trained non-physician community health-care providers initiated and titrated antihypertensive medications according to a simple stepped-care protocol to achieve a systolic blood pressure goal of less than 130 mm Hg and diastolic blood pressure goal of less than 80 mm Hg with supervision from primary care physicians. They also delivered discounted or free antihypertensive medications and health coaching for patients. The primary effectiveness outcome was a composite outcome of myocardial infarction, stroke, heart failure requiring hospitalisation, and cardiovascular disease death during the 36-month follow-up in the study participants. Safety was assessed every 6 months. This trial is registered with ClinicalTrials.gov, NCT03527719. Between May 8 and Nov 28, 2018, we enrolled 163 villages per group with 33 995 participants. Over 36 months, the net group difference in systolic blood pressure reduction was -23·1 mm Hg (95% CI -24·4 to -21·9; p<0·0001) and in diastolic blood pressure reduction, it was -9·9 mm Hg (-10·6 to -9·3; p<0·0001). Fewer patients in the intervention group than the usual care group had a primary outcome (1·62% vs 2·40% per year; hazard ratio [HR] 0·67, 95% CI 0·61-0·73; p<0·0001). Secondary outcomes were also reduced in the intervention group: myocardial infarction (HR 0·77, 95% CI 0·60-0·98; p=0·037), stroke (0·66, 0·60-0·73; p<0·0001), heart failure (0·58, 0·42-0·81; p=0·0016), cardiovascular disease death (0·70, 0·58-0·83; p<0·0001), and all-cause death (0·85, 0·76-0·95; p=0·0037). The risk reduction of the primary outcome was consistent across subgroups of age, sex, education, antihypertensive medication use, and baseline cardiovascular disease risk. Hypotension was higher in the intervention than in the usual care group (1·75% vs 0·89%; p<0·0001). The non-physician community health-care provider-led intensive blood pressure intervention is effective in reducing cardiovascular disease and death. The Ministry of Science and Technology of China and the Science and Technology Program of Liaoning Province, China.

Non-physician and physician preceptors in Landscapes of Practice: a mixed-methods study exploring learning for 1st-year medical students in clinical experiences

ABSTRACT Medical education has traditionally relied on physician educators. With expanding Health Systems Science competencies, non-physician healthcare providers are required. To investigate preceptor-role types, communication frequency, and importance of preceptors in value-added patient navigator roles (PN) and clinical preceptorships (CP). Using a mixed-methods approach, medical students participating in PN and CP during the first year of medical school (n=191) identified individuals with whom they communicated and communication frequency (1=never, 7=frequently), and importance of preceptors to work/education (1=not important, 7=extremely important; open-ended responses). Quantitative data were analyzed via repeated measures using a mixed-effects model and McNemar’s test; effect size was calculated via Cohen’s d or Cohen’s h; qualitative data was analyzed using thematic analysis. Comparing ratings for non-physicians to physician healthcare professionals in PN, communication frequency (5.54 vs 3.65; p<0.001, d=1.18), importance to work (5.77 vs 4.28, p<0.001, d=0.89) and education (5.02 vs 4.12, p<0.001; d=0.49) were higher for non-physician educators. Comparing ratings for non-physicians to physician healthcare professionals in CP, communication frequency (4.93 vs. 6.48, p<0.001, d=1.33), importance to work (5.12 vs 6.61 vs, p<0.001, d=1.29) and education (4.32 vs 6.55, p<0.001, d=1.89) were higher for physician educators. Qualitative analysis indicated that non-physician healthcare providers in PN focused on Health Systems Science concepts, including social determinants of health and healthcare delivery. In PN, students observed collaboration from the perspective of multiple providers. In CP, healthcare providers, mainly physicians, focused on physician-centric clinical skills and interprofessional collaboration from the physician’s perspective. Educational benefits of non-physician healthcare professionals related to Health Systems Science in work-based clinical settings – or Landscapes of Practice – can help students understand systems-based concepts such as social determinants of health, healthcare delivery systems, and interprofessional collaboration. Differences in the educational value of non-physician healthcare educators perceived by students should be further explored.

Effect of intensive care provided by nurse practitioners for postoperative patients: A retrospective observational before-and-after study.

Nurse practitioners are increasingly now members of intensive care teams in Japan, but no data exist about their effect on the outcomes for critically ill patients. This study aimed to compare the outcomes of postoperative patients on mechanical ventilators before and after the participation of nurse practitioners in intensive care teams. We retrospectively identified 387 patients who underwent postoperative mechanical ventilation at a University Hospital in Japan, using data from medical records from 1 April 2015 to 31 March 2017. We extracted data and compared patients’ length of stay in the intensive care unit and the hospital, mechanical ventilation days, postoperative rehabilitation start date, rehabilitation prescription, intensive care unit and hospital mortality, and intensive care unit readmission. Multiple regression analysis was used to analyze the factors affecting length of stay in the intensive care unit. Patients who received care from nurse practitioners and physicians had significantly shorter stays in intensive care (4.8 ± 4.8 days versus 6.7 ± 10.3 days, p < 0.021). Mechanical ventilation days, total length of hospital stay, rehabilitation prescription, mortality in intensive care and hospital, and readmission to intensive care were all similar to those who received care only from physicians. The multiple regression analysis suggests that participation of nurse practitioners in intensive care reduced the length of stay in the unit by 2.6 days (p = 0.003). These findings could help to increase use of non-physician healthcare providers in intensive care. Our results demonstrated that it is both effective and safe for nurse practitioners to participate in intensive care teams that provide care for postoperative patients receiving mechanical ventilation.

Gender-Based Discrimination and Sexual Harassment Among Academic Internal Medicine Hospitalists.

Gender-based discrimination and sexual harassment, both implicit and overt, have been reported in academic medicine. This study examines experiences of academic hospitalists regarding gender-based discrimination and sexual harassment. A survey was distributed to Internal Medicine hospitalists at university-based academic institutions in the United States. Questions assessed experiences regarding gender-based discrimination and sexual harassment in their interactions with patients, as well as with other healthcare providers (HCPs). Eighteen institutions participated in the survey, resulting in 336 individual responses. Female hospitalists more frequently reported inappropriate touch, sexual remarks, gestures, and suggestive looks by patients compared with male peers both over their careers (P < .001) and in the last 30 days (P < .001). Similarly, females more frequently reported being referred to with inappropriate terms of endearment (eg, "dear," "honey," "sweetheart") by patients both over their careers (P < .001) and in the last 30 days (P < .001). Almost 100% of females reported being mistaken by patients for nonphysician HCPs over their careers, compared with 29% of males (P < .001) (76% vs 10%, in the last 30 days; P < .001). Similarly, females more frequently reported sexual harassment over their careers (P < .05) and being mistaken for nonphysician HCPs by colleagues both over their careers (P < .001) and in the last 30 days (P < .001). Females rated their sense of respect both by patients (P < .001) and colleagues (P < .001) lower than males (P < .001). More females than males reported that gender negatively impacted their career opportunities (P < .001). This survey demonstrates that gender-based discrimination and sexual harassment are commonly encountered by academic hospitalists, with a significantly higher number of females reporting these experiences.

Findings from Optometrists' Practices in Advising about Lifestyle Study.

Lifestyle influences eye health and other chronic diseases. All health care providers, not just primary care physicians, should have the necessary information and training to advise and refer patients on lifestyle to take advantage of opportunities to provide such advice. The extent to which optometrists offer lifestyle advice to their patients is largely unknown. The Optometrists' Practices in Advising about Lifestyle (OPAL) study aimed to examine lifestyle advice that optometrists offer, to whom such advice is offered, and reasons for not offering this advice. We developed and administered a mail-in survey to 140 optometrists in Western New York. Five surveys were returned because of death, retirement, and relocation. Of the 135 remaining eligible participants, 46 of the optometrists contacted responded to our survey; however, only 42 (31%) provided signed consent forms. Of these, more than 93% report offering advice on smoking, dietary supplements, and diet, and >59% reported offering on physical activity and alcohol use. Eighty-three percent offer advice to only those with unhealthy behaviors or certain conditions. Most advice consisted of mentioning the lifestyle factor's influence on eye or overall health. Reasons for not offering advice included lack of knowledge or training or the belief that advice would not change behaviors. Optometrists reported offering advice primarily to those with unhealthy lifestyle behaviors or pre-existing health conditions. Future studies should address low response rates, include nonphysician health care providers in addition to optometrists, and also examine patients' perceptions and understanding of the advice offered to better understand whether this advice is received as the provider envisioned.

Using Social Media for Rapid Information Dissemination in a Pandemic: #PedsICU and Coronavirus Disease 2019.

To describe the impact of a strategy for international collaboration and rapid information dissemination on Twitter among the pediatric critical care community during a global pandemic. Analysis of #PedsICU and coronavirus disease 2019 Twitter data in the Symplur Signals Database between February 1, 2020, and May 1, 2020. Social media platform Twitter. None. Promotion of the joint usage of #PedsICU and #COVID19 throughout the international pediatric critical care community in tweets relevant to the coronavirus disease 2019 pandemic and pediatric critical care. We collected data on all tweets containing the hashtag #PedsICU in addition to those containing both #PedsICU and coronavirus disease 2019 hashtags. Tweets including #PedsICU were shared 49,865 times on six continents between February 1, 2020, and May 1, 2020; between February 1 and March 13, only 8% of #PedsICU tweets included a coronavirus disease 2019 hashtag. After a sharp rise during the week of March 14, 2020, coronavirus disease 2019 content has dominated the #PedsICU conversation on Twitter, comprising 69% of both #PedsICU tweets and impressions (p < 0.001). The most commonly used coronavirus disease 2019 hashtag over the study period was #COVID19 (69%). Proportionately, a greater percentage of #PedsICU tweets including the coronavirus disease 2019 hashtag (vs not) had images or videos (45% vs 41%; p < 0.001). In addition, non-physician healthcare providers were the largest group of users (46%) of the combination of #PedsICU and coronavirus disease 2019 hashtags. The most popular tweets shared on Twitter were open-access resources, including links for updated literature, narrative reviews, and educational videos relevant to coronavirus disease 2019 clinical care. Concurrent hashtags and words in tweets containing #PedsICU and coronavirus disease 2019 hashtags spanned several different disciplines and topics in pediatric critical care. Twitter has been used widely for real-time information sharing and collaboration among the international pediatric critical care community during the coronavirus disease 2019 pandemic. Targeted use of #PedsICU and #COVID19 for engagement on Twitter is a conduit to combat misinformation and optimize reach to pediatric critical care stakeholders across the globe when rapid dissemination is needed.

Blood Pressure Screening by Outpatient Physical Therapists: A Call to Action and Clinical Recommendations.

Hypertension (HTN) is among the leading global preventable risk factors for cardiovascular disease and premature mortality. Early detection and effective management of HTN have demonstrated significant reductions in mortality, morbidity rate, and health care costs. Furthermore, screening for HTN by nonphysician health care providers improves detection rates and medical management. As physical therapist practice advances to a more independent care model, physical therapists may serve as the first point of contact into the health care system, thereby necessitating a need for routine blood pressure (BP) monitoring. This is especially relevant in the outpatient physical therapist practice setting, where there is evidence for elevated BP measures among patients, yet omission of routine screening in this setting is well documented. Leading physical therapy professional organizations include statements in their guidelines that suggest that physical therapists have a duty to provide a standard of care that protects the safety and optimizes the overall health of patients under their care. Therefore, it is imperative not only that physical therapists include BP examination into routine practice protocols but that the knowledge and skills to accurately measure and interpret BP at rest and during exercise be integrated into the standard of care. The authors suggest that the profession of physical therapy proactively embrace their potential to address the national and worldwide HTN epidemic through routine assessment of BP, appropriate referral for elevated BP measures, and exploration of HTN management by physical therapists.

YouTube as a Source of Information About the Posterior Cruciate Ligament: A Content-Quality and Reliability Analysis

PurposeThe purpose of this study was to evaluate the reliability and educational content of YouTube videos concerning injuries to the posterior cruciate ligament (PCL) of the knee.MethodsThe first 50 videos specific to the PCL identified through the YouTube query posterior cruciate ligament were evaluated by a method of video selection demonstrated to be feasible in prior YouTube studies. Videos were classified by content and upload source. Video reliability was assessed using the Journal of the American Medical Association (JAMA) benchmark criteria (score range 0-5). Video educational content was assessed using the Global Quality Score (GQS) (range 0-4) and the PCL Score (PCLS) (score range 0-18). Analysis of variance was used to determine differences in video reliability and educational content quality based on video content and upload source. Multivariate linear regressions were used to identify predictors of video reliability and educational content quality.ResultsThe mean number of views per video was 50,477.9 ± 15,036. Collectively, the 50 videos were viewed 14,141,285 times. Video content was classified primarily as information about disease (62.0%). The most common upload sources were physicians (24.0%) and nonphysician health care providers (26.0%). Significant between-group interactions were found between video source and the JAMA score, with physicians and medical sources having significantly higher mean JAMA scores (P = 0.037). Videos uploaded by physicians were an independent positive predictor of greater JAMA scores (β:1.27; P = 0.008). Videos uploaded by a medical source (β:2.06; P = 0.038) were an independent positive predictor of a greater GQS. There were no independent associations between video content category or upload source and the PCLS.ConclusionsVideos concerning the PCL were frequently viewed on YouTube, but the educational quality and reliability of these videos were low.Clinical RelevancePhysicians and health care providers treating PCL pathology should take the initiative to counsel patients about which outside resources are reliable to better inform patients about their treatment decisions. With regard to YouTube videos specifically, providers should caution their patients that this source of information may be unreliable.

A Content Analysis of Multidimensional Support Needs Regarding Fertility Among Cancer Patients: How Can Nonphysician Health Care Providers Support?

This study aimed to identify support needs among young cancer patients regarding fertility-related issues to describe multidimensional support provided by nonphysician health care providers. Participants were cancer patients and their families who contacted the Hotline for Cancer Treatment and Reproduction at National Cancer Center Hospital in Japan. Medical charts were analyzed through content analysis. A total of 51 participants met the inclusion criteria, of which 32 cases (63%) involved patients themselves, 13 (25%) patients' family members, and 6 (12%) both patients and their families. About patients' demographic status, 40% of the patients were female and 28% were in their thirties. Gynecological and breast cancer patients were the majority, and 24 patients (47%) had not yet started cancer treatment. As a result of content analysis regarding support needs, 9 categories and 55 codes were extracted. The categories included information about risk of infertility, information about means to maintain reproductive function, referral to specialists, support for economic burden, support for worry about cancer progression, support for psychological distress upon facing the risk of infertility, support for communication with oncologists, support for family relationships, and decisional aid. This study suggests that nonphysician health care providers should acquire knowledge about fertility preservation and provide psychological support within their specialties.

Knowledge, Practice Behaviors, and Perceived Barriers to Fertility Care Among Providers of Transgender Healthcare

PurposeTransgender individuals may experience impaired fertility due to gender-affirming hormonal interventions (e.g., pubertal suppression treatment and/or exogenous hormones). Clinical practice guidelines recommend providers discuss fertility implications and options for fertility preservation. The goal of this study was to examine fertility knowledge, practice behaviors, and perceived barriers to fertility care among multidisciplinary providers who care for transgender pediatric and/or adult patients. MethodsA 46-item survey was distributed to relevant listservs and at conferences with a focus on transgender health. ResultsTwo hundred two providers completed the survey: (1) physicians (n = 87), (2) psychologists (n = 51), (3) Master (MA)-level mental health providers (n = 39), and (4) nonphysician healthcare providers, comprising advanced practice nurses, registered nurses, and physician assistants (n = 25). Overall knowledge was high (M = 3.64, SD = 1.61). Significant differences were identified in knowledge by provider type (p <.001) but not patient age group (p = .693). Physicians had significantly greater knowledge than MA-level mental health providers (p = .005). Variables associated with fertility discussion included provider-related barriers [b = –.42, p < .001], and perceived patient-related barriers, including perceptions that patients are unwilling to delay treatment [b = .12, p = .011] or are unable to afford fertility preservation (FP) [b = .12, p = .029]. ConclusionsWhile overall fertility-related knowledge was high, there was variability in domains of knowledge, as well as provider practice behaviors related to fertility counseling and referral for FP. Findings related to perceived barriers to fertility counseling and fertility preservation warrant further investigation; qualitative studies may be particularly helpful in understanding how specific provider- and patient-related barriers impact counseling and referral for fertility-related care.

Novel educational program improves readiness to manage intimate partner violence within the fracture clinic: a pretest-posttest study.

Intimate partner violence (IPV) is prevalent among female patients at fracture clinics; however, previous research suggests health care providers (HCPs) are unprepared to identify victims and provide appropriate support. To address this gap in care, we developed an IPV educational program and conducted a study to measure the impact of this program on HCPs' IPV-related knowledge, attitudes, beliefs and self-reported behaviours. We enrolled 140 participants (orthopedic surgeons, surgical trainees, nonphysician HCPs and research and administrative staff) from 7 fracture clinics in North America who completed the 2-hour educational program. We used a pretest-posttest study design to assess knowledge, attitudes, beliefs and self-reported behaviours. We administered the Physician Readiness to Manage IPV Survey before, immediately after and 3 months after training and generated scores for each of the 10 subscales. Our primary outcome was change in score for the actual knowledge subscale from before training to 3 months after training. We used linear regression to conduct all analyses. We found significant improvement on the actual knowledge subscale 3 months after the training (mean difference [MD] 2.44, 95% confidence interval [CI] 1.79 to 3.09). We found statistically significant improvements on 7 additional subscales 3 months after training (perceived preparation [MD 1.96, 95% CI 1.79 to 2.13], perceived knowledge [MD 2.05, 95% CI 1.88 to 2.23], practice issues [MD 6.10, 95% CI 4.98 to 7.23], preparation [MD 1.06, 95% CI 0.89 to 1.22], legal requirements [MD 1.50, 95% CI 1.30 to 1.70], workplace issues [MD 1.11, 95% CI 0.97 to 1.26] and self-efficacy [MD 0.54, 95% CI 0.45 to 0.63]) and on all 10 subscales immediately after training (actual knowledge [MD 3.35, 95% CI 2.77 to 3.94], perceived preparation [MD 2.06, 95% CI 1.88 to 2.23], perceived knowledge [MD 2.14, 95% CI 1.98 to 2.30], practice issues [MD 4.08, 95% CI 3.35 to 4.82], preparation [MD 1.04, 95% CI 0.89 to 1.20], legal requirements [MD 1.66, 95% CI 1.47 to 1.85], workplace issues [MD 1.08, 95% CI 0.96 to 1.20], self-efficacy [MD 0.56, 95% CI 0.49 to 0.63], alcohol/drugs [MD 0.20, 95% CI 0.10 to 0.30] and victim understanding [MD 0.15, 95% CI 0.04 to 0.25]). Our educational program led to significant improvements in participants' readiness to manage IPV. This finding suggests HCPs are better prepared to help patients who experience IPV; however, future research should aim to investigate the impact of this program directly on patients.