Survey Of Practices Research Articles

A Survey of Rigid Bronchoscopy Practices in India.

A Survey of Rigid Bronchoscopy Practices in India.

Lyme disease in UK primary care: a knowledge, attitude and practice survey.

Lyme disease (LD) cases in the UK most commonly present within the primary care setting. Despite an upward trend of incidence, little is known regarding general practitioner (GP) experience with diagnosis and treatment. This study aims to describe baseline primary care clinician Knowledge, Attitude and Practice (KAP) in Scotland and England. Online KAP survey on Lyme disease for UK based practising GPs. An online KAP questionnaire was developed for use in UK primary care. The survey was distributed through UK based research networks, professional societies and via social media. 191 complete responses were analysed (England n=130, Scotland n=61). The Scotland-based respondent group had more relevant consultations in the previous 3 years. Respondents from Scotland demonstrated a greater awareness that erythema migrans (EM) is pathognomonic for Lyme disease and that serological testing of this patient group is not indicated. Less common cardiac and neurological symptoms were not as well associated with Lyme disease by both respondent groups for the former and England-based respondents for the latter. Prescribing according to the National institute for Health and Care Excellence (NICE) guidance was identified in 70% of Scotland and 42% of England-based GP responses. Targeted resources may improve clinician confidence on exposure risk, symptom recognition, testing limitations and treatment dose and duration. Scotland-based respondents' better survey performance potentially reflects greater clinical exposure and public awareness of the disease, due to high endemicity within the nation.

Understanding the benefits of renin-angiotensin-aldosterone system inhibitors and influence of hyperkalaemia on their prescription: a UK survey of healthcare professionals' views and practice

Abstract Background Renin–angiotensin–aldosterone system inhibitors (RAASi) improve outcomes in heart failure with reduced ejection fraction (HFrEF) and they should be increased to the maximally tolerated dose. However, their use is often hindered by hyperkalaemia leading to discontinuation or down titration. Purpose Assess perceptions of primary and secondary healthcare professionals regarding benefits of RAASi according to indication and, in the context of developing hyperkalaemia, to identify barriers to optimal utilisation, and to explore options for improving management protocols, specifically in HFrEF. Methods An electronic survey was distributed in primary and secondary care setting in Hampshire, UK, to evaluate knowledge about benefits of RAASi, clinical response to varying level of potassium (K+), and decision-making using several clinical scenarios. Hyperkalaemia was graded into mild (serum K+ 5.5 – 5.9 mmol/L), moderate (serum K+ 6.0 – 6.4 mmol/L) or severe (serum K+ ≥ 6.5 mmol/L). Results Between November 2021 and January 2023, 300 questionnaires were completed by 274 (91%) physicians (varying grades of seniority), 22 (7%) non-medical prescribers, and 4 (1%) pharmacists. 80% were working in secondary care across different specialities (31 working in cardiology and 15 in nephrology). The majority were aware of prognostic benefit of angiotensin converting enzyme inhibitors (ACEi) in patients with HFrEF although this was lower for mineralocorticoid receptor antagonists (MRA) (Fig 1). Fewer than 2/3 of respondents were aware of impact of ACEi on symptoms. In the presence of mild hyperkalaemia, 75% and 88% of healthcare professionals would stop or reduce ACEi and MRA, respectively. In moderate or severe hyperkalaemia, this increased to 96% and 97%, respectively (Fig 2A-B). When considering the scenario of a patient with HFrEF who had ACEi stopped due to K+ 5.9 mmol/L, the potassium at which the responder would consider re-starting the ACEi ranged from 77% when potassium level < 5.5 mmol/L to 1% in moderate or severe hyperkalaemia (Fig 2C). 74% of healthcare professionals were familiar with local hyperkalaemia management protocol and 93% supported dedicated training on RAASi dose adjustment and hyperkalaemia management. Conclusion This survey, across a broad range of healthcare professionals, shows uncertainties around knowledge of benefits of RAASi in patients with HFrEF and there is sizeable variation in the prescribing response to degrees of hyperkalaemia. Given the voluntary nature of the survey, it is plausible that these data are biased towards individuals with greater understanding. Regardless, there is a need for continued education with a goal of improving patient-centred care.

Associations Between Testing and Treatment Pathways in a Case of Pediatric Nonlesional Epilepsy: A Census Survey of NAEC Center Directors.

Epilepsy surgery is vital in managing of children with drug-resistant epilepsy. Noninvasive and invasive testing modalities allow for evaluation and treatment of children with drug-resistant epilepsy. Evidence-based algorithms for this process do not exist. This study examines expert response to a vignette of pediatric nonlesional epilepsy to assess associations in evaluation and treatment choices. We analyzed annual report data and an epilepsy practice survey reported in 2020 from 135 pediatric epilepsy center directors in the United States. Characteristics of centers along with noninvasive and invasive testing and surgical treatment strategies were collected. Multivariable logistic regression modeling was performed. The response rate was 100% with 135 responses included in the analyses. Most used noninvasive testing modalities included Neuropsychology evaluation (90%), interictal brain fluorodeoxyglucose-positron emission tomography (85%), and functional magnetic resonance imaging (MRI) (72%) with nearly half obtaining genetic testing. Choosing functional MRI was associated with stereo electroencephalography (EEG) (P = .025) and selecting Wada with subdural grid/strips (P = .038). Directors from pediatric-only centers were more likely to choose stereo EEG as opposed to combined centers (P = .042). Laser interstitial thermal therapy was almost 7 times as likely to be chosen as a treatment modality compared with open resection in dedicated pediatric centers (OR 6.96, P = .002). In a vignette of nonlesional childhood drug-resistant epilepsy, epilepsy center directors' patterns of noninvasive testing, invasive testing, and treatment were examined. Management choices were associated with pediatric versus combined pediatric/adult center characteristics. Expert opinions demonstrated equipoise in evaluation and management of children with drug-resistant epilepsy and the need for evidence-based management strategies.

COVID-19's Effect on Practice Quality Improvement and Transformation Activities: Practice Survey Results.

The Transforming Clinical Practices Initiative (TCPI) was a 4-year, large-scale, collaborative, peer-based learning initiative for physician practices of all specialties with broad goals to improve the quality of patient care, spend health care dollars more wisely, and assist practices in being ready to succeed under value-based payment (VBP). We investigated whether the COVID-19 pandemic had erased or diminished practice transformation progress made during the TCPI program period, through a follow-up survey of participating practices fielded in October 2021. In October 2021 to April 2022, we surveyed a probability sample of 2207 primary care and specialty practices that participated in the TCPI, receiving 610 responses. We asked about practice characteristics, financial and ownership stability, clinical performance, and quality improvement efforts, both now and prior to COVID-19. The COVID-19 content was part of a larger survey. Responses were weighted to account for sample selection, unknown eligibility status, and nonresponse. We generated weighted univariate descriptive statistics representative of practices with clinicians enrolled in TCPI. These estimated percentages have a 95% confidence interval of about ±5%. Multivariate analysis of unweighted data examined associations between practice characteristics and other variables of interest. For all but one of 13 practice transformation activities engaged in prior to the COVID-19 public health emergency, a majority of practices (at least 52%) reported that the progress on these activities were either not hurt or were helped by their COVID-19 experience. Compared to January 2020, only about 7% of practices reported that their quality of care or clinical performance was worse due to COVID-19, and 32% reported that their quality of care was better. More rural than urban practices reported that half or more of their transformation activities were hurt by COVID-19 (29% and 14%, respectively). Physician-owned practices were more likely to report quality is better today than prior to COVID-19 relative to practices with other ownership types such as hospitals or health systems (43% vs 24%). Most practices have been able to recover from the deep stress of the COVID-19 pandemic and continue their efforts to improve patient care and performance to succeed under VBP. These results suggest a high perceived return on investment in value-readiness support along with emergency financial support in times of crisis, as well as room to continue preparation for any future pandemic and the national movement toward increased VBP, especially in rural settings.

A survey on management practices of hypotension in preterm neonates: an Indian perspective

BackgroundHypotension is a common entity in the neonatal intensive care unit (NICU) and is reported in 24%–50% of preterm infants with birth weight less than 1,500 g. Rapid diagnosis and aggressive management is crucial to reduce its detrimental effects on end-organs especially the brain. Physicians often rely on blood pressure alone as a reliable indicator of tissue perfusion, but variations exist in the definition of this crucial parameter. There are also practice variations in the use of diagnostic tools and management modalities among physicians.MethodologyA physician-based cross-sectional survey of management practices of hypotension in preterm neonates in Indian NICUs was conducted using an online survey tool. The questionnaire addressed diagnostic criteria used, utility of echocardiography for the assessment of hypotension, and management strategies used, such as volume expansion, inotropes and steroids.ResultsThree hundred and twenty physicians, working predominantly in Level III NICUs, responded to the survey. The practice of delayed cord clamping was followed in the units of 78% respondents. Only 44% respondents had an institutional written protocol for the management of hypotension. The criteria for the diagnosis of hypotension varied, with 52% using mean blood pressure (BP) less than gestational age as the criteria. Capillary refill time, blood pressure and heart rate were the most common clinical criteria used. 85% respondents used echocardiography in the NICU, but only 73% utilised it for assessment of a hypotensive neonate. Physicians preferred a ‘volume-inotrope-echo-steroid’ strategy, with 85% respondents using volume expansion. Dopamine was the preferred first line inotrope, followed by norepinephrine and low-dose epinephrine.ConclusionThis survey reflects significant variations in practice amongst neonatal physicians in India. Bedside targeted echocardiography needs to be better utilised as a vital tool to determine the pathophysiology of disease and hemodynamic monitoring in the management of hypotension in neonates. While further research is needed on outcome-oriented objectives, awareness and dissemination of already existing guidelines would be useful to standardize clinical practice.

A survey of dysphagia services practice in China.

Dysphagia services have only recently been formalised within Chinese health services. There has been no comprehensive evaluation of all aspects of dysphagia services practice in China. To provide a profile for the dysphagia practice in China by assessing various facets of dysphagia services. This is a survey study carried out from December 2022 to May 2023 online in China. One hundred fifty-nine respondents comprising doctors, nurses or therapists involved in the field of dysphagia rehabilitation completed a questionnaire via Sojump. The questionnaire included dichotomous (e.g., yes/no) and multiple-choice questions related to participants' general information and their provision of dysphagia management services. Results were analysed descriptively and the differences among different levels of hospitals were analysed. Approximately two-thirds of hospitals (67.9%) started dysphagia services within the last 5 years. A significant difference in the initiation of dysphagia rehabilitation was observed across different hospital levels (χ2=32.70;p<0.001). Routine dysphagia screening was a standard practice in most hospitals (71.7%), with the most frequently employed screening method being the water swallow test (95.6%). Clinical swallowing evaluation emerged as the preferred initial assessment method (80.5%) and the most utilised assessment method (91.8%). Video fluoroscopic swallow study and flexible endoscopic evaluation swallowing were used by 22.7% and 12.6% of respondents. A significant difference was observed in the choice of assessment methods across hospitals of different levels (χ2=43.397; p < 0.001). The majority of respondents (53.5%) primarily employed rehabilitation as the main intervention method (76%-100%). Most respondents indicated that they would reevaluate patients after treatment (74.8%) and reported routine follow-up with patients (60.4%). Despite the relatively recent development of dysphagia management in China, the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. However, the use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. There is a need for policy and resource support in the field of dysphagia rehabilitation in China. What is already known on this subject Assessment and treatment methods for dysphagia are various across different patients, medical facilities and settings. There has been no comprehensive evaluation of all aspects of dysphagia rehabilitation practice in China. What this study adds to existing knowledge The study assessed various facets of dysphagia rehabilitation in China through an online survey. We found that the relatively recent development of dysphagia management in China, but the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. Variations in practice patterns between hospitals of different levels may be attributed to resource constraints and patient needs. Besides, while rehabilitation exercises are the primary intervention method for dysphagia in China, the assessment largely centres on clinical swallowing evaluation. The use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. What are the clinical implications of this work? The study assessed various facets of dysphagia rehabilitation in China, and the results indicate that the use of instrumental assessments needs to be improved and there is a need for policy and resource support in the field of dysphagia rehabilitation in China.

Crimean Congo hemorrhagic fever virus exposure among febrile patients, cattle herders, and cattle herds in Cameroon

Problem addressedCrimean Congo hemorrhagic fever (CCHF) is a tick-borne disease with high fatality rates and an expansive geographic distribution, yet disease prevalence data in Cameroon is lacking. ObjectiveThis study aimed to determine CCHF virus (CCHFV) seroprevalence and tick distribution among cattle herders and febrile patients in West and Centre Cameroon. Methods and approachTwo cross-sectional serological studies of human and cattle were conducted from October to December 2021 and from June to July 2022, which included the collection of ticks. Enzyme-linked immunosorbent assay (ELISA) were used to detect anti-CCHFV antibodies, while a knowledge, attitudes, and practice (KAP) survey assessed tick and tickborne disease related knowledge and behaviors among herders. Tick identification used morphological keys. ResultsThe KAP survey showed adequate tick knowledge (94.5 %) among herders but poor understanding of disease transmission, with favorable attitudes towards tick control (24.7 %) but inadequate implementation. Rhipicephalus annulatus (64.1 %) predominated among the 1,296 ticks collected during each rainy season. Among cattle, 27.4 % were seropositive, and seropositivity was associated with specific villages, cattle age (>4 years), and female sex. Herders had a 17.8 % seroprevalence, while febrile patients had 8.3 %, with higher rates in those >20 years old for both groups. Self-reported tick removal by herders after contact and grazing may increase CCHFV exposure. ConclusionsThis study confirms CCHFV circulation in rural West Cameroon and unexpected exposure risk in Yaounde, highlighting the need for active entomological surveillance and preventive measures in transhumance and cattle market activities. Establishing an occupation-based surveillance system can help identify CCHFV hotspots to prevent outbreaks.

Styles, strategies, and challenges of PA leaders nationally: An exploratory qualitative study.

To identify the leadership styles, strengths, strategies, and key factors of PA leaders in healthcare executive, clinical, and academic settings. An exploratory, qualitative study was completed through the American Academy of Physician Associates 2023 Practice Survey to answer seven qualitative questions. Of the 1,423 PAs who responded to the survey invitation, 348 PA leaders in formal and informal roles chose to answer, for a 24.4% response rate. For PA leaders' styles and strengths, collaborative and emotional intelligence emerged as themes. For key factors of PA leadership, balancing expectations and giving and receiving critical feedback emerged as themes. For skills or qualities PA leaders wish they had before starting to lead, project management skills and increased confidence emerged as themes. Leadership development training needs to be in the didactic and clinical curriculum of PA programs for the future of PA leadership. Leadership pathways for PA leaders in healthcare executive, clinical, and academic settings need to be created and established more widely.

The development of a tool for the assessment of oral health program in a pediatric cancer unit

Abstract Background Oral diseases and associated illnesses interfere with cancer treatment, increase morbidity, prolong hospital stay, and increase costs. Oral care of children with cancer is essential to prevent oral diseases and decrease its symptoms. Standardized oral health and hygiene (OHH) practices must be a priority and incorporated as a routine cancer care quality. To improve OHH, baseline information of practices, processes and institutional support are necessary. Here, we report the steps we followed to develop a tool for evaluating OHH practices, support, and resources available in a pediatric cancer unit. Methods We conformed a working group (WG) integrated by healthcare professionals in pediatric, infectious diseases, oncology, and dentistry acquainted with the care of children with cancer. The steps proposed by the WG included: (1) literature review of published surveys in OHH; (2) interviews with practicing healthcare providers regarding OHH in pediatrics; (3) identification, adoption and adaptation of the Hand Hygiene Self-assessment framework (HHSAF), a survey model based on the multimodal improvement strategy (MMIS); (4) building of OHH tool; (5) validation test of OHH tool; and (6) pilot testing in recruited pediatric hematology and oncology centers. Google form version 0.8. Microsoft office excel 2021 (18.0) was used to build the OHH survey and obtain the WG member responses. The final draft of the survey was approved by WG members. We will evaluate survey validity in the pilot test among members of the PRINCIPAL network, a community of pediatric infectious disease experts and preventionists of Latin America. Results We found few reports on OHH practices in children cancer surveys. The WG met virtually and monthly from March to December 2023 to build the OHH survey. Our final survey version was organized following the model of the HHSAF and integrated into five main sections. These sections had items (Q) that requested answers regarding OHH practices and resources and institutional support (6Q); training and education of patients, families, and healthcare providers (6Q); evaluation and feedback of OHH processes in pediatric oncology unit and OHH practices of patients (6Q); reminders of OHH practices in the workplace (3Q); and hospital leadership support (2Q). The survey was made up of multiple choice and Likert scale questions. Each of the answers had a weight, and if all the items were present, the total was 400 points. Based on the total points obtained, we categorized the quality of the OHH practices of the pediatric oncology unit in inadequate (0-100); basic (101-200), intermediate (201-300), advanced (&amp;gt;300). The survey tool must be answered by an assigned team of the pediatric oncology unit oral health including a family member representative, and it could take less than 15 minutes to complete. Conclusion We developed a 21-item OHH practices survey following the WHO recommendations to use a MMIS model. We found that our newly developed tool was comprehensive and potentially helpful to assess OHH practices and identify success factors in best practices in OHH in pediatric oncology units. Our next step is pilot testing to evaluate our survey tool validity and reliability.

Exploring the Clinical Disconnect in Integrated Treatment Pathways for Craniofacial Structural and Functional Anomalies: Collaboration Challenges between Orthopaedic Surgeons, Paediatricians and General Practitioners Referring to Orthodontists

Abstract Introduction: Orthodontic problems extend beyond mere tooth ailments, affecting overall bodily health. Neglecting them can result in severe illnesses, reducing quality of life and lifespan. Physicians must educate patients about the link between orthodontic health and general well-being, stressing the importance of treating dental issues to restore both oral health and smiles. Materials and Methods: This cross-sectional investigation included orthopaedic surgeons, paediatricians and general practitioners working in the government and private sectors. Knowledge, attitude and practice surveys were used for the study. Our analysis included 25 clinicians (n = 75) from each speciality. Results: Among the 25 paediatricians surveyed, only 52% (13) are referring patients to orthodontists, as indicated in the study. Of the 25 general physicians included in the survey, merely 12% (03) are sending patients to orthodontists, with the remaining 88% not making any referrals. Similarly, among the 25 orthopaedic surgeons surveyed, 52% (13) refer patients to orthodontists, while the rest do not refer to orthodontic specialists. Conclusion: A multidisciplinary approach is crucial in bridging the clinical gap among paediatricians, general physicians, orthopaedic surgeons and orthodontists. Integrated care models, through specialised clinics, provide comprehensive evaluations and patient treatment plans. Care coordination mechanisms such as joint consultations and shared decision-making platforms facilitate seamless communication among healthcare providers and empower patients in their care. Continuing education and technological advancements enhance collaboration, fostering teamwork and improving patient outcomes.

Developing a Clinical Service in Interventional Radiology: Results from the 2024 CIRSE Clinical Practice Survey.

Engaging in clinical service development is a prerequisite for Interventional Radiology (IR) to prosper as a full clinical discipline. The CIRSE Clinical Services in IR Task Force conducted a survey of CIRSE members worldwide to assess the current status of their clinical practice and to identify areas of practice requiring further support. An online questionnaire with 63 structured items was sent to 7,501 CIRSE members in November 2023. The survey was closed in January 2024 and a statistical data analysis was performed. A total of 520 complete responses were collected. 49.6% of respondents have an IR outpatient clinic, 34.5% have a dedicated IR day-case ward and 19.8% have dedicated inpatient beds. While 62% of respondents treat patients as the primary consultant responsible for their patients' care, 40.3% of respondents currently without their own beds have admitting rights to the hospital. Clinical practice activities are itemised in the work schedule of 41.3% of respondents and 45% routinely perform ward rounds. A total of 40% feel very positive with their personal clinical practice competency. With half of responding IRs having primary patient access and clinical services in place, the results are encouraging; however further engagement by those who are not yet involved is required. The authors advocate a step-wise approach towards clinical services starting with ward rounds, and subsequently taking increasing responsibility for each step in the IR patient pathway.

Patterns of use of malnutrition risk screening in pediatric populations: A survey of current practice among pediatric hospitals in North America.

Information on the use of validated malnutrition risk screening tools in pediatric facilities to guide malnutrition identification, diagnosis, and treatment is scarce. Therefore, a survey of pediatric healthcare facilities and practitioners to ascertain malnutrition risk screening practices in North America was conducted. A pediatric nutrition screening practices survey was developed and sent to members of the American Society for Parenteral and Enteral Nutrition, the Council for Pediatric Nutrition Professionals and the Academy of Nutrition and Dietetics Pediatric Nutrition Practice Group. Respondents represented 113 pediatric hospitals in the United States and six in Canada, of which 94 were inpatient and 59 were outpatient. Nutrition risk screening was completed in 90% inpatient settings, and 63% used a validated screening tool. Nurses performed most malnutrition risk screens in the inpatient setting. Nutrition risk screening was reported in 51% of outpatient settings, with a validated screening tool being used in 53%. Measured anthropometrics were used in 78% of inpatient settings, whereas 45% used verbally reported anthropometrics. Measured anthropometrics were used in 97% outpatient settings. Nutrition risk screening was completed in the electronic health record in 80% inpatient settings and 81% outpatient settings. Electronic health record positive screen generated an automatic referral in 80% of inpatient and 45% of outpatient settings. In this sample of pediatric healthcare organizations, the results demonstrate variation in pediatric malnutrition risk screening in North America. These inconsistencies justify the need to standardize pediatric malnutrition risk screening using validated pediatric tools and allocate resources to perform screening.

Management of metacarpal shaft fractures: a survey of current UK practice.

Metacarpal shaft fractures (MSF) are common injuries that predominantly affect young, economically active people. However, there is limited evidence to guide their management. The aims of this study were to: evaluate the management of extra-articular MSF of the fingers; assess equipoise for surgical and nonsurgical treatments; and explore factors influencing clinician decision making to inform the design of a randomised controlled trial (RCT) comparing surgical and nonsurgical treatments. A cross-sectional, web-based survey was distributed to UK hand surgeons using membership directories of different professional networks. Practice setting, clinical experience, management strategies, willingness to participate in a RCT and factors affecting suitability for randomisation were recorded. There were 108 responses eligible for analysis. Distribution of clinical experience ranged from <5 to >20 years. A variety of treatments were used for transverse, long oblique/spiral and comminuted MSF. Rotational deformity (90%), step-off deformity (5%) and angulation (5%) were the most important indications for surgical fixation. Acceptable limits of fracture angulation and shortening varied among surgeons. Over 85% expressed interest in participating in a RCT and most showed equipoise and were willing to offer operative or nonoperative treatment as part of a research study. This survey demonstrates that UK hand surgeons have varying views on treatments, acceptable parameters of deformity and indications for surgical fixation of displaced MSF. There is equipoise for surgical and nonsurgical treatments, variability in factors influencing clinical decision making and support for RCTs to investigate best practice.

Pediatric oncology nutritional practices in high-income countries: A survey from the International Society of Paediatric Oncology (SIOP).

Optimal nutrition in pediatric oncology can influence cancer-related outcomes. To establish an understanding of nutrition practice and perceptions of best practice, we queried nutrition providers practicing in pediatric oncology care centers in high-income countries. An electronic, multidisciplinary, cross-sectional survey of nutrition practices was conducted among pediatric oncology nutrition practitioners. Final analysis included 110 surveys from 71 unique institutions and included practitioners from Europe, the United States, Canada, Australia/New Zealand, South America, and the Middle East/Asia. The majority of institutions (97%) reported having dietitians; 72% had designated oncology dietitians. Approximately half of the practitioners (47%) reported feeling their institutions were inadequately staffed. The majority (78%) of institutions completed nutrition risk screening, but there was no consensus on specific screening practices. Half (50%) of the institutions that screened for nutrition risk did so in both inpatient and outpatient settings. The majority (80%) of institutions completed a nutrition assessment close to the time of diagnosis. Those that did not cite lack of staff and/or lack of time, lack of standardized approach, and consult only level of nutritional care as primary barriers. The most common topic of nutrition education provided to patients/families was nutrition-related symptom management (68%). While most institutions reported having pediatric oncology dietitians, we found a lack of standardized practice and perceived inadequate staffing. In addition, what providers perceived to be best practice did not always align with day-to-day clinical practice. Ongoing efforts are needed to develop evidence-based guidelines, including staffing recommendations, to support specialized care in this population.

Assessing disaster mental health preparedness among primary health care physicians of Karnataka, India: Designing and conducting a knowledge, attitude, and practice survey

Background: Disaster mental health is a critical yet neglected aspect in India. Primary care physicians (PCPs) play a crucial role in mitigating mental health challenges following disasters. This study conducted a knowledge, attitude, and practice (KAP) survey among PCPs in Karnataka to assess their disaster mental health preparedness. Methods: A cross-sectional online survey was conducted from February to May 2023 targeting PCPs across 29 districts of Karnataka in a convenient snowball sampling method. The questionnaire review included KAP questions on disaster mental healthcare. A total of 324 PCPs responded. Results: Knowledge scores were moderate (mean: 7.05), attitudes were positive (mean: 9.15), and practices were poor (mean: 0.32). Significant correlations were found between clinical experience and knowledge/attitudes/practices (rho 0.358, P &lt; 0.001; rho 0.147, P = 0.007; rho 0.232, P = 0.003). Conclusion: There is a large gap between theoretical knowledge and practical preparedness in disaster mental health. Training programs and government initiatives are essential to improve preparedness among PCPs.

Assessing capacity for hereditary cancer risk assessment in metro Chicago.

307 Background: Since 2005, the United States Preventive Services Task Force (USPSTF) recommends that primary care (PC) clinicians identify and refer adults with a high-risk cancer family history to cancer genetic services (CGS), yet hereditary cancer risk assessment (HCRA) continues to be underutilized in PC. A population-based approach to HCRA in PC settings can expand access to cancer prevention and early detection to vulnerable populations and reduce disparities in cancer outcomes. The Chicago Cancer Screening and Testing Access Coalition (CCSTAC) is developing strategies to integrate HCRA in PC settings. We conducted an environmental scan to assess current capacity to deliver 1) HRCA in Federally Qualified Health Centers (FQHCs) and 2) follow-up CGS for high risk patients. Methods: In 2023, we administered two surveys to assess HCRA practices in Metro Chicago. We invited 22 FQHCs to complete a 21-item survey of current practices, readiness to implement, and barriers to HCRA. We also invited 21 CGS sites to complete a 25-item survey to understand staffing, utilization, referral patterns, and barriers to access. Surveys were administered electronically via Qualtrics. We conducted a descriptive analysis of survey data. Results: Twenty FQHCs (91%) completed the survey on HCRA in PC; 85% reported familiarity with USPSTF guidelines for HCRA. The majority (75%) reported no plans to implement HCRA. Clinic workflow, paucity of follow-up resources, cost, lack of provider knowledge, and absence of HCRA as a mandatory performance measure were cited as the most significant barriers to implementation. Genetic counselors (GCs) from 19 CGS hospital-based sites (90%) completed the survey on availability of genetic services. CGS were most often located in a cancer center (47%); no CGS were located in PC. Most referrals originated from oncology, surgery, or gastroenterology, with the lowest rate of referrals from community-based PC. Nearly half of CGS clinics (47%) reported capacity for at least a small increase in patient volume. Wait-time at the majority of CGS clinics was less than a month. GCs cited patient logistics (e.g. transportation, time off work), lack of referral information from providers, and systemic racism as significant barriers in patient access to CGS. Conclusions: After almost 20 years of evidence-based guidelines, use of HCRA is still very limited in the community-based PC setting. Our findings point to a need to bridge the gap between hospital-based CGS and FQHCs to ensure patients in vulnerable communities have access to guideline-concordant cancer prevention and screening strategies. Based on these findings, CCSTAC is designing strategies to integrate HCRA in primary care at FQHCs focused on provider education, well-designed clinic workflows, connections with existing CGS, and advocacy to align UDS and HEDIS measures with USPSTF guidelines.

A survey of obstetrical anesthesia health equity practices at academic centers in the United States (US)

BackgroundLimited research has explored obstetrical anesthesiologists' perceptions of healthcare disparities associated with labor and delivery. The objective of this study was to evaluate the perception of obstetrical anesthesia related healthcare disparities, drivers of disparities, and potential solutions. MethodsAn online survey was emailed to division leads at Accreditation Council for Graduate Medical Education (ACGME) accredited obstetrical anesthesiology programs in the United States. The survey included a mixture of yes/no, select all that apply, and free-text questions. Descriptive statistics were used to characterize variable distribution. Free text responses were categorized into themes by selective coding. Results149 surveys were delivered, 74 surveys were conducted (50 %), and 57 were completed entirely (38 %). Fifty-seven percent of participants reported perceived presence of obstetrical/obstetrical anesthesia related healthcare disparities. Most participants reported that they consider a patient's cultural preferences during clinical management, collect race/ethnicity data, implement specific practices to address disparities, and analyze outcome data by social determinants of health. The majority of participants reported using additional relevant practice features, including translator services, quality improvement practices, provider rounds, standardized protocols, and cultural competency or diversity training. Thematic analysis of free text responses into drivers of disparities mapped to 6 themes: language barriers, racism or bias, socioeconomics or social determinants of health, access or quality of care, patient-provider interactions or cultural sensitivity, and individual patient factors. ConclusionMost academic obstetrical anesthesia center division leads reported perceived presence of obstetric anesthesia related health care disparities. Efforts should be made to devise targeted solutions to this multifaceted, pervasive problem.

Managing the Costs of Kidney Paired Donation: A Survey of Contemporary US Practice and Challenges

Managing the Costs of Kidney Paired Donation: A Survey of Contemporary US Practice and Challenges

A survey of enteral feeding tube practice between nurses and pharmacists

A survey of enteral feeding tube practice between nurses and pharmacists