Practices Of Care Providers Research Articles

Determinants of continuation on HIV pre-exposure propylaxis among female sex workers at a referral hospital in Uganda: a mixed methods study using COM-B model

BackgroundFemale sex workers (FSWs) have the highest HIV prevalence in Uganda. Pre-exposure prophylaxis (PrEP) has been recommended as a key component of the HIV combination prevention strategy. Although patient initiation of PrEP has improved, continuation rates remain low. This study evaluated PrEP continuation among FSWs and explored potential determinants of PrEP adherence within a public referral hospital in urban Uganda.MethodsWe conducted an explanatory sequential mixed method study at Kiruddu National referral hospital in Uganda. Secondary data on socio demographic characteristics and follow up outcomes of at least one year was collected for all FSWs who were initiated PrEP between May 2020 and April 2021 and data analyzed on July 15,2023. We used Kaplan–Meier survival analysis to evaluate continuation on PrEP from time of initiation and follow-up period. The capability, opportunity, and motivation to change behaviour model was used to explore perspectives and practices of FSWs (n = 24) and health care providers (n = 8) on continuation on PrEP among FSWs, using semi structured interviews. The qualitative data was deductively coded and analyzed thematically, categorizing the themes related to PrEP continuation as facilitators and barriers.ResultsOf the 292 FSWs initiated on PrEP, median age was 26 years (interquartile range, 21–29), 101 (34.6) % were active on PrEP, 137 (46.9%) were lost to follow-up, 45 (15.4%) were no longer eligible to continue PrEP, eight (2.7%) were transferred out and one (0.3%) had died. Median survival time on PrEP was 15 months (Interquartile range IQR, 3–21). The continuation rates on PrEP at six (6) and 12 months were 61.1% and 53.1%, respectively. Facilitators of PrEP continuation included awareness of risk associated with sex work, integration of PrEP with other HIV prevention services, presence of PrEP Peer support and use of Drop-in centers. The barriers included low community awareness about PrEP, high mobility of sex workers, substance abuse, and the unfavorable daytime clinic schedules. However, the quantitative findings from the multivariable Cox Proportional Hazards Model did not align with the reported findings for the qualitative evaluation.ConclusionContinuation on PrEP remains low among FSWs. Interventions for PrEP continuation should address barriers such as low community awareness of PrEP, substance abuse and restrictive health facility policies for scale of the PrEP program among FSWs in Uganda. Integration of PrEP with other services and scale up of community PrEP delivery structures may improve its continuation.

An international survey on the knowledge, aTtitudes and clinical pAtternS of use of medical cannabis for caNcer care: the TASMAN study

BackgroundMedical cannabis (MC) has gained traction in oncology for managing cancer-related symptoms, but its integration faces challenges due to limited evidence, inconsistent guidelines, and varied legal frameworks. MethodsThe TASMAN study aimed to assess the knowledge, attitudes, and practices of oncologists and palliative care providers globally regarding MC use in cancer care. A survey of healthcare providers from diverse regions and income levels was conducted. Resultswe study included 179 participants (response rate: 51.1%), with an equal gender distribution (49.4% female) and a median age of 37 years. Participants were primarily oncologists (71.5%), practicing in university hospitals (40.2%) or cancer centres (32.4%), with over half from low- and middle-income countries. Most respondents (92.7%) were unaware of clinical guidelines for MC. A proportion of 44.1% were familiar with MC use, 78.8% recognized its role in cancer pain, and 34% identified its role in managing cachexia. Awareness of specific products was low, with only 10% familiar with specific cannabis products. Three-quarters of respondents (84.4%) did not prescribe MC routinely. Legal status and regulations were unclear for most participants; 40% noted cannabis as illegal. MC use and patient requests were more common in high-income countries and the EURO region, with palliative care providers demonstrating the highest awareness and prescription rates. ConclusionClearer regulations, standardized guidelines, and targeted education are essential to support the safe integration of MC into oncology and palliative care, ultimately improving the quality of life for cancer patients.

Influence of BI-RADS Breast Density Scores on the Implementation of Supplemental Imaging Modalities in Those With Average Risk and Negative Mammogram by Primary Care Providers in British Columbia.

Introduction: Breast Imaging-Reporting and Data System (BI-RADS) density scores have been included in screening mammography reports in BC since 2018. Despite these density scores being present in screening mammography reports for numerous years, there remains insufficient evidence to guide supplemental testing for patients with dense breasts. Objective: The primary objective of this study was to evaluate how primary care providers in Canada utilize BI-RADS density scores reported on normal screening mammograms of average risk, asymptomatic patients in their clinical practice. The secondary objective of this study was to determine if there are any patterns related to primary care provider demographics and practice settings in BC that could be linked to differences in screening practices for patients based on BI-RADS density scores. Methods: A cross-sectional survey was conducted with family physicians (FPs) and nurse practitioners (NPs) practicing in BC. Descriptive statistics were calculated using percentages and further stratified by participant demographics. P values were derived from Fisher's exact test and results were regarded as statistically significant at P < .05. Results: Ninety-eight participants (85 FPs, 13 NPs) responded to the survey. The percentage of participants who ordered supplemental testing based on BI-RADS density scores alone was 8% for BI-RADS score D, 37% for BI-RADS scores C or D, and 2% for BI-RADS scores B, C, or D. Forty-eight percent of female participants and 45% of male participants would order supplemental testing based on BI-RADS density scores alone (P = 1). Forty-nine percent of FPs and 39% of NPs would order supplemental testing based on BI-RADS density scores (P = .56). Fifty-three percent of participants who had been in practice for more than 10 years, 50% of those who had been in practice for 6 to 10 years, and 36% of those in practice for 5 years or less would order supplemental testing (P = .34). Fifty-seven percent of those practicing in large urban centres, 43% of those practicing in medium-sized communities, and 32% of those in rural or remote communities would order testing (P = .17). Fifty-seven percent of participants were aware of the increased risk of breast cancer with higher breast density. Conclusion: Variations exist in how primary care providers in BC utilize the BI-RADS density scores reported on normal screening mammography of average risk, asymptomatic patients in their clinical practice. Further research in this area is needed to establish clearer clinical guidelines to educate and inform primary care providers on the need for supplemental testing for patients with dense breasts and to improve resources for breast cancer screening in BC.

Perceptions and Practices of Primary Care Providers in Europe and the US in the Diagnosis and Treatment of Irritable Bowel Syndrome: A Multinational Survey.

The knowledge and proficiency of primary care practitioners (PCPs) in diagnosing and managing irritable bowel syndrome (IBS) remain generally low and variable internationally. This variability is partly due to a lack of familiarity with the Rome Foundation diagnostic criteria and treatment guidelines for this condition. We conducted an electronic survey of PCPs in the United States and nine European countries to assess their understanding of IBS pathophysiology; the use of Rome IV criteria in diagnosis, knowledge of and frequency in prescribing various recommended treatments; and the likelihood of referring patients with suspected IBS to subspecialists. Most PCPs in the United States and Europe perceive IBS as a diagnosis of exclusion rather than a definitive diagnosis. They also believe IBS is underdiagnosed in primary care and challenging to diagnose confidently. The majority of PCPs consider diet as a crucial component of IBS management. Notably, US PCPs reported greater confidence than their European counterparts in recommending dietary interventions such as increased dietary fiber, a low FODMAP diet, and gluten restriction. Conversely, both groups exhibited moderate to high confidence in recommending over-the-counter treatments. European PCPs showed greater confidence in treating IBS with antispasmodics and secretagogues, while US PCPs expressed greater confidence in prescribing neuromodulators. Additionally, US PCPs were more likely to refer patients with suspected IBS to a gastroenterologist, whereas both US and European PCPs showed similar referral patterns to dietitians and referred very few patients to mental health providers. Both US and European PCPs reported that IBS is moderately to extremely difficult to treat effectively and emphasized the importance of a strong and longitudinal doctor-patient relationship in managing the condition. Despite the Rome Foundation recommendations and criteria to support a positive diagnosis of IBS, most PCPs still rely on exclusionary investigations such as endoscopy and a serologic workup, while a significant percentage suggest referring patients to gastroenterologists.

Electronic Health Record Alert to Promote Adoption of Limited Transthoracic Echocardiograms in Primary Care and Cardiology Clinics: A Mixed Methods Evaluation.

A limited transthoracic echocardiogram (TTE) can be an appropriate, lower-cost substitute for a full TTE. We assessed the impact of an electronic health record alternative alert promoting the adoption of limited TTEs on the ordering practices of cardiology clinicians and primary care providers and captured their perspectives on the initiative. The alert was deployed in a cardiology clinic and 4 primary care clinics at an academic medical center. The alert provided clinical guidance on the appropriate use of limited TTEs when a clinician selected a full TTE order. We used logistic regression to estimate the change in the proportion of limited versus full TTEs ordered between the baseline and intervention periods in clinics with and without the alert. We also conducted interviews with 24 clinicians (5 cardiologists and 19 primary care providers) to identify implementation barriers and facilitators. Cardiology clinicians ordered 10 654 and 3761 TTEs during the baseline and intervention periods, respectively, for 9100 patients. Primary care providers ordered 723 and 617 TTEs during the baseline and intervention periods for 1273 patients. The model estimated that the percentage of limited TTEs ordered increased by 16.1±2.3 percentage points (P<0.0001) in the cardiology clinic with the alert and by 13.2±1.5 percentage points (P<0.0001) in the primary care clinics with the alert from baseline to post-intervention. Ordering practices did not change in the cardiology (0.7±0.6 percentage points; P=0.24) or primary care (0.7±1.0 percentage points; P=0.52) clinics without the alert. Clinicians viewed the alert as acceptable. Cardiologists appreciated that the alert was concise, whereas primary care providers wanted more information from the alert. An alternative alert providing clinical guidance on the use of limited TTEs at the point of care increased the selection of this lower-cost test in cardiology and primary care clinics. Perspectives on the alert differed between specialists and nonspecialists, highlighting the importance of tailoring intervention design to clinical expertise.

The role of mental health nursing in pediatric hematology/oncology - Part 3: Evaluating feasibility, acceptability, and appreciation.

In February 2022, we introduced the innovative new role of mental health nurse clinician (MHNC) in pediatric hematology/ oncology in a pediatric hospital in Quebec with the aim of better addressing the needs of young cancer patients and their families. In two previous articles, we explained the method used to develop the role, as well as the strategy employed to implement it. In this article, we seek to evaluate the effectiveness of the implementation strategy by measuring role feasibility. We will also examine role acceptability and appreciation 1 year following implementation. We asked three groups of participants (adolescents, parents and care providers) to complete a research questionnaire based on the Theoretical Framework of Acceptability (TFA), with good inter-rater reliability and discriminant validity. The questionnaire, which was made available online, consisted of statements with Likert-scale responses (from 1 to 5), as well as open questions. We performed a standard descriptive analysis and used the responses to the open questions to support or add nuance to the quantitative results. In total, 31 healthcare professionals, 10 adolescent cancer patients and 10 parents of adolescent cancer patients filled out the questionnaire. Between February 2022 and February 2023, the MHNC provided a total of 691 interventions to 112 individuals (patients and parents). Follow-up sessions were offered to 61 individuals, and 99.6% of them accepted. We found a very strong correlation (r = 0.96) between the number of hours worked by the MHNC and the number of interventions provided. The vast majority of participants from all three groups agreed that the role is appropriate, appreciated and necessary, and that it brings much-needed clinical expertise in mental health to the department. Care providers, adolescents, and parents indicated that they would request this service again and would recommend it to others, if it were needed. The results, therefore, demonstrate excellent feasibility and high levels of acceptability and appreciation. Our study shows that the implemented MHNC role helps improve the clinical management of the mental health of adolescents with cancer, as well as their parents. The role brings much-needed expertise in psychiatric nursing care and supports the clinical practice of care providers. Another study will be conducted in the near future to measure the effectiveness of the MHNC's interventions.

Knowledge, Attitudes and Practices of Obstetric Care Providers Regarding Pre-Eclampsia in the Yaoundé IV District

Knowledge, Attitudes and Practices of Obstetric Care Providers Regarding Pre-Eclampsia in the Yaoundé IV District

Knowledge, attitude, and practice of future health care providers about self-medication in a private medical college in Lahore Pakistan

Knowledge, attitude, and practice of future health care providers about self-medication in a private medical college in Lahore Pakistan

Assessment of knowledge, attitude and practice to promote hand hygiene among undergraduate medical and nursing students in a teaching hospital

: A considerable number of epidemiological evidences proved that efficient hand hygiene practices has reduced the risk of infection cross-transmission in hospital facilities. Despite the effortlessness and simplicity of the practice, compliance with hand hygiene among health care workers has been relatively very less. There is a significant lack of evidence regarding infection control training among undergraduate medical and nursing students, hence it becomes essential to re-examine the efficacy of our hand hygiene sessions and conduct programs, CMEs, workshops frequently to keep health care workers sensitized and oriented towards hand hygiene.: The present study was undertaken to assess the overall exposure of medical and nursing students towards basic hand hygiene practices through a knowledge, attitude and practice questionnaire based cross- sectional study. 100 medical and 100 nursing students were grouped into good, moderate and poor categories, based on scores from the questions testing the overall knowledge of hospital acquired infections, attitude towards hand hygiene and actual practice at the field level.: The present study showed poor knowledge among medical and nursing students i.e 41% and 60% of the participants respectively. Nursing staff showed good attitude when compared to medical students (71% and 56%). Regardless of the knowledge, practice of hand hygiene was good in both the groups 59% of medical and 71% of nursing students. On the whole, in comparison nursing population displayed better results compared to undergraduate medical student population. Nevertheless, evidently showing unsatisfactory results among both the study groups in the grounds of knowledge.: Therefore, the study concludes that knowledge and exposure to hand hygiene practices should be improved in undergraduate curriculum for both medical and nursing students which provides an opportunity to correct the bed side hygiene practices of the future health care providers at the foundation level.

“I try to take all the time needed, even if i do not have it!”: Knowledge, attitudes, practices of perinatal care providers in canada about vaccination

ObjectiveSuccessful clinical conversations about vaccination in pregnancy (pertussis, COVID-19, and influenza) are key to improving low uptake rates of both vaccination in pregnancy and infancy. The purpose of this study was to understand Canadian perinatal care providers’ knowledge, attitudes, and practices around vaccination in pregnancy. MethodsQualitative interviews with 49 perinatal care providers (nurse practitioner, general practitioner, registered nurse, registered midwife, obstetrician-gynecologist, and family physicians) in 6 of 13 provinces and territories were deductively coded using directed content analysis [1] and analyzed according to key themes. ResultsParticipants detailed their professional training and experiences, patient community demographics, knowledge of vaccines, views and beliefs about vaccination in pregnancy, and attitudes about vaccine counselling. Providers generally described having a good range of information sources to keep vaccine knowledge up to date. Some providers lacked the necessary logistical setups to administer vaccines within their practice. Responses suggest diverging approaches to vaccine counselling. With merely hesitant patients, some opted to dig in and have more in-depth discussions, while others felt the likelihood of persuading an outright vaccine-refusing patient to vaccinate was too low to be worthwhile. ConclusionProvider knowledge, attitudes, and practices around vaccination varied by professional background. To support perinatal providers’ knowledge and practices, clinical guidelines should detail the importance of vaccination relative to other care priorities, emphasize the positive impact of engaging hesitant patients in vaccine counselling.

Antidepressant Prescribing Practices of Pediatric Palliative Care Providers.

Background: Mental health diagnoses can co-occur with complex medical illness in pediatric patients. Pediatricians may not feel comfortable with managing psychopharmacology for patients and access to child psychiatrists can be limited. Palliative care (PC) providers follow patients with serious illness longitudinally to address burdensome symptoms that affect quality of life and may be responsible for evaluation and treatment of mental health concerns; however, education in managing psychologic distress for pediatric palliative care (PPC) providers is limited. Objective: This study seeks to describe the antidepressant prescribing practices of PPC providers and describe their level of training and comfort in assessing for anxiety and depression and prescribing psychotropic medications. Methods: An electronic survey approved by the American Academy of Hospice and Palliative Medicine was distributed nationally to PPC providers. Results: A total of 58 providers responded to the survey (response rate 12.3%). Most reported prescribing a variety of antidepressants (79%). Very few used formal assessment tools to screen for depression (7%) or anxiety (16%). Less than a third of providers consulted child psychiatry before prescribing antidepressants (29%). More than half of providers (54.5%) had no formal training in assessment and treatment of anxiety and depression in pediatric patients. Despite this, many providers (70%) reported feeling comfortable in prescribing antidepressants while also endorsing interest in more training for behavioral health evaluation and treatment (82.5%). Conclusions: Limited training in assessing mental health concerns, prescribing, and managing psychopharmacology suggests an opportunity for more targeted education for pediatric PC providers regarding antidepressant prescribing practices.

Primary care providers practice patterns regarding female pelvic floor disorders

IntroductionPelvic floor disorders (PFDs) pose substantial physical and psychological burdens for a growing number of women. Given the ubiquity of these conditions and known patient reluctance to seek care, primary...

The impact of severe perinatal events on maternity care providers: a scoping review

BackgroundSevere events during the perinatal period can be experienced as traumatic by pregnant women, their partners or others who are closely involved. This includes maternity care providers who can be affected by being involved in or observing these events. This may have an impact on their personal well-being and professional practice, influencing quality of care. The aim of this study is to map research investigating the impact of severe events during the perinatal period on maternity care providers, and how these experiences affect their well-being and professional practice.MethodA scoping review following the manual of the Joanna Briggs Institute was undertaken. The electronic bibliographic databases included PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX, Cochrane, Scopus, Web of Science and databases for grey literature. Records passing the two-stage screening process were assessed, and their reference lists hand searched. We included primary research papers that presented data from maternity care professionals on the impact of severe perinatal traumatic events. A descriptive content analysis and synthesis was undertaken.ResultsFollowing a detailed systematic search and screening of 1,611 records, 57 papers were included in the scoping review. Results of the analysis identified four categories, which highlighted the impact of traumatic perinatal events on maternity care providers, mainly midwives, obstetricians and nurses: Traumatic events, Impact of traumatic events on care providers, Changes in care providers’ practice and Support for care providers; each including several subcategories.ConclusionThe impact of traumatic perinatal events on maternity care providers ranged from severe negative responses where care providers moved position or resigned from their employment in maternity care, to responses where they felt they became a better clinician. However, a substantial number appeared to be negatively affected by traumatic events without getting adequate support. Given the shortage of maternity staff and the importance of a sustainable workforce for effective maternity care, the impact of traumatic perinatal events requires serious consideration in maintaining their wellbeing and positive engagement when conducting their profession. Future research should explore which maternity care providers are mostly at risk for the impact of traumatic events and which interventions can contribute to prevention.

Abstract WP166: Bleeding Risks Among Hemorrhagic Stroke Patients Started on Serotonergic Antidepressants During Subacute Recovery

Background: Early initiation of antidepressants (ADs) are associated with improved functional recovery, but are associated with an increased risk of major bleeds among hemorrhagic stroke (HS) patients. Our objectives were to determine if increased bleeding risk remained if ADs were initiated during subacute recovery and if bleed risks were comparable between AD classes. Methods: A cohort of AD naive first time HS patients (ICD-10 codes 160-162) were identified from Electronic Medical Records of 70 large healthcare organizations (2003-2023). Patients without AD use were considered “No AD” whereas patients started on ADs during subacute recovery (i.e., at least 3 months after the indexed HS) were grouped as Selective Serotonin/Serotonin &amp; Norepinephrine Reuptake Inhibitors (SSRI/SNRI) or “Other AD” (i.e., Mirtazapine, bupropion, trazodone, or tricyclic ADs). Baseline differences were adjusted for using 1:1 matched propensity score (PS). Outcomes included the 1-year risk of a major bleeding event (e.g., gastrointestinal/intracranial bleed or shock), recurrent HS, fall, ischemic stroke (IS) and death Results: The cohort consisted of n=257,595 patients split into 3 groups: No AD (n=250,103), SSRI/SNRI (n=4,180) or Other AD (n=3,312). Matching resulted in good covariate balance for both the SSRI/SNRI vs. No AD (n=8,250 patients) and Other AD vs. SSRI/SNRI (n=6,380 patients) comparisons. SSRI/SNRIs (vs. No AD) were associated with a 33% increase in the risk of a major bleed (RR: 1.33, 95%CI: 1.22-1.45) and significantly higher risks of recurrent HS, fall, IS and death. There were no significant differences in adverse outcomes between AD classes. Discussion: Increased risk of major bleeds and recurrent HS remains if ADs are started during subacute recovery, a time period which aligns with community-based recovery. Our findings may inform care practices of primary care providers and rehabilitation professionals to decrease preventable adverse outcomes.

Perspectives of primary care providers regarding multicancer early detection panels.

Multicancer early detection panels have recently become available to patients with healthcare provider prescriptions and available funds. These tests utilize circulating tumor DNA (ctDNA) to screen more than 50 cancers using a single blood sample. However, perspectives and data on how the deployment of these tests may impact the practices of primary care providers in terms of implementation, interpretation, documentation, and costs are limited. This study aimed to assess the perspectives of primary care providers regarding the integration of multicancer early detection panels into clinical practice. We used a survey to assess the opinions and perspectives of primary care providers, including physicians, nurse practitioners, and physician assistants, across a multistate, tertiary healthcare system. We used a single form consisting of novel questions on familiarity with multi-cancer early detection panels, cost, healthcare equity, documentation, medicolegal, and other concerns. The subgroup analysis was consistent with stratification based on familiarity with ctDNA-based tests and their roles in clinical practice. Most respondents were unfamiliar with multicancer early detection panels and had not used ctDNA-based tests. Most primary care providers suggested that they would reorder multicancer early detection panel testing at 1- to 5-year intervals and prefer subspecialists for both ordering multicancer early detection panels as well as interpreting their results. Relative concerns differed between physicians and nonphysicians. The integration of multicancer early detection panels into primary care practice requires careful planning and consideration for the management of increased clinical load, interpretation of results, and cost management.

Assessment of Health Care Providers Attitudes and Practices Concerning Medication Errors in Saudi Arabia

Introduction: Medication errors are one of the leading causes of patients’ morbidity and mortality in health care settings&#x0D; Objective: Assess awareness, attitude and practices of health care providers toward medication errors in Saudi Arabia.&#x0D; Methodology: Cross-sectional study design was used in the period of three months, from 01 July to 30th November, 2023. participants were selected randomly. 329 health care providers including physicians, pharmacists and nurses working in different hospitals, primary health care centers and private clinics in different regions of Saudi Arabia, participated in the study. Dat was analyzed using Microsoft excel program.&#x0D; Results: The mean score of good knowledge about medication errors among respondents was 77%, average score of good attitudes toward medication errors among respondents was 72%. 74% of respondents were willing to inform supervisor if they had noticed a medication error. The causes for not reporting medication error were fear of any legal consequences (41%), self-management (23%), busy with work (15%) and did not know whom to inform (21%). Less than half (48%) of study subjects had previously filled an adverse drug reaction form.&#x0D; Conclusion: Medication errors play a significant role role in the quality of health of our patients. Health care providers in Saudi Arabia have good knowledge and positive attitude toward medication errors. However, medication error reporting is still not sufficiently done.

Knowledge, attitude and practices of health care providers in implementing services to HRGs under the TANSACS program

Knowledge, attitude and practices of health care providers in implementing services to HRGs under the TANSACS program

Management of urinary incontinence in females by primary care providers: a systematic review.

To describe primary care provider (PCP) practices for the assessment and management of females with urinary incontinence (UI), and appraise these practices relative to recommendations made in high-quality clinical guidelines. Studies were searched in four databases (MEDLINE, EMBASE, CINAHL, Web of Science) from their respective inception dates to 6 March 2023. All studies describing UI evaluation and management practices used by PCPs for female patients were eligible. Two reviewers independently selected studies assessed their quality and extracted data. A narrative synthesis of included studies was performed to describe practices. Relevant evaluation and management practices were then compared to recommendations that were consistent across current high-quality UI guidelines. Pharmacotherapy, referrals, and follow-ups were reported descriptively only. A total of 3475 articles were retrieved and, among those, 31 were included in the review. The majority reported a poor-moderate adherence to performing a pelvic examination (reported adherence range: 23-76%; based on eight studies), abdominal examination (0-87%; three studies), pelvic floor muscle assessment (9-36%; two studies), and bladder diary (0-92%; nine studies), while there was high adherence to urine analysis (40-97%; nine studies). For the conservative management of UI, studies revealed a poor-moderate adherence to recommendations for pelvic floor muscle training (5-82%; nine studies), bladder training (2-53%; eight studies) and lifestyle interventions (1-71%; six studies). Regarding pharmacotherapy, PCPs predominantly prescribed antimuscarinics (2-46%; nine studies) and oestrogen (2-77%; seven studies). Lastly, PCPs referred those reporting UI to medical specialists (5-37%; 14 studies). Referrals were generally made <30 days after diagnosis with urologists being the most sought out professional to assess and treat UI. This review revealed poor-moderate adherence to clinical practice guideline recommendations. While these findings reflect high variability in reporting, the key message is that most aspects of patient care for female UI provided by PCPs needs to improve.

Comparing the knowledge, attitudes, and practices of pediatric and family medicine clinicians toward atypical anorexia nervosa versus anorexia nervosa.

To investigate the knowledge, attitudes, and current practices of adolescent primary care providers regarding the epidemiology, clinical features, and diagnosis of atypical anorexia nervosa (AN) compared to AN. An online survey was sent to the Pediatric and Family Medicine clinicians who provide medical care to adolescents. Statistical analyses compared differences in responses to questions about atypical AN versus AN. Relative to AN, participants (n = 67) were significantly less familiar with atypical AN, less likely to consider a diagnosis of atypical AN, less comfortable identifying atypical AN, less likely to counsel patients with atypical AN on health risks, less likely to refer patients with atypical AN to a specialist, and less likely to correctly identify atypical AN. Clinicians with more years in medical practice reported a significantly larger gap in familiarity between AN and atypical AN than clinicians with less than 5 years of practice. Providers who care for adolescents appear to be less familiar with and less likely to identify atypical AN compared to AN. This knowledge gap may be more pronounced among clinicians with more years practicing medicine due to the novelty of atypical AN as a diagnosis. Lack of knowledge surrounding atypical AN risk factors may result in delayed diagnosis and associated poor health outcomes. Future research should investigate strategies that improve knowledge and screening of atypical AN in medical and other settings. Pediatric and Family Medicine clinicians are less familiar with atypical anorexia nervosa (AN) and less likely to diagnose a patient with atypical AN relative to AN. Insufficient knowledge about atypical AN may place these individuals at increased risk for worsening restrictive eating and the physical and psychological consequences of malnutrition.

Knowledge and practice of obstetric care providers on prevention of obstetric fistula 2023: an institution-based cross-sectional study

BackgroundObstetric fistula is a preventable devastating condition that is mostly caused by obstructed labour. About 22% of obstructed labor is complicated by obstetric fistula. Skilled birth attendants during delivery are essential for the prevention of obstetric fistula. However, little is known about the status of the knowledge and practice of obstetric fistula prevention in the Gamo zone.ObjectiveWe aimed to assess the knowledge, practice, and associated factors of obstetric caregivers on the prevention of obstetric fistula in public health facilities of the Gamo zone in southwest Ethiopia 2023.MethodA cross-sectional study was employed among 372 obstetric caregivers in selected public health facilities of the Gamo zone in southwest Ethiopia from 1 December 2022 to 30 January 2023. Study participants were selected by a simple random sampling technique, and data were collected by using a pre-tested and self-administered questionnaire. The collected data were coded and entered into Epi-Data version 4.6 computer software and exported to SPSS version 27 for analysis purposes. Bivariable and Multivariable Logistic analyses were applied. The level of significance was declared at aP-value ≤0.05 and a 95% confidence interval.ResultsAbout 57% [95% CI (53.00–62.00)] of participants had good knowledge, and about 55.4% [95% CI (50.00–60.00)] of obstetric caregivers showed good practice for obstetric fistula prevention. The factors significantly associated with knowledge were service year [AOR = 2.50, 95% CI = (1.12–6.73)], types of a health facility [AOR = 1.99, 95% CI = (1.01–3.92)], age [AOR = 2.38, 95% CI = (1.03–5.49)], and in-service training [AOR = 4.61, 95% CI = (2.35–9.05)]. In-service training [AOR = 14.86, 95% CI = (12.75–18.73)], service year [AOR = 3.58, 95% CI = (1.24–10.29)], and knowledge [AOR: 13.24, 95% CI = (6.18–14.34)] were factors which were significantly associated with the practice of obstetric caregivers towards obstetric fistula prevention.ConclusionThe knowledge and practice of obstetric caregivers on the prevention of obstetric fistula was low in public health facilities of the Gamo zone. In this study, practicing at a hospital was a factor significantly associated with the knowledge of obstetric caregivers. Having in-service training, advanced service year, and age were factors significantly associated with the knowledge and practice of obstetric caregivers. Regular in-service training of health professionals can enhance their knowledge and practice of obstetric fistula prevention.