Proportion Of Health Care Providers Research Articles

Immediate postnatal care guidelines implementation and associated factors among healthcare providers in East Shewa zone public health facilities, Oromia, Ethiopia, 2022: a multicentre cross-sectional study

ObjectivesImmediate postnatal care is a critical intervention to reduce maternal and neonatal morbidity and mortality; however, many women and newborns receive inadequate postnatal care timely and effectively during the first...

What do healthcare providers think of the quality of uterotonics? A mixed-methods systematic review

ObjectivesTo synthesise evidence on the perceptions of healthcare providers (HCPs) about the quality of oxytocin and misoprostol available in their settings, and their actions as a result of these perceptions.DesignMixed-methods...

The Effect of the COVID-19 Pandemic on the Management and Telehealth Care of Spontaneous Abortions [ID: 1378351

INTRODUCTION: The purpose of this study was to explore the influence of the COVID-19 pandemic on the management of early pregnancy loss. Additionally, we aimed to identify differences in the use of virtual health care for the management of spontaneous abortions (SABs) before and after the COVID-19 pandemic. METHODS: Retrospective cohort study was conducted of patients aged 18–40 receiving obstetric care at Cleveland Clinic hospitals between March 2019 and September 2019 (pre-COVID-19), and between March 2020 and September 2020 (post-COVID-19). SABs were defined as spontaneous pregnancy losses occurring before the 20th week of pregnancy, excluding induced abortions and ectopic pregnancies. Baseline demographic information, medical history, type of SAB management, and use of virtual visits were compared between the pre-COVID-19 and post-COVID-19 groups. RESULTS: Two thousand two hundred eleven patients met inclusion criteria, 1,159 with SAB pre-COVID-19 and 1,052 with SAB post-COVID-19. Demographic factors including race (P=.64) and age (P=.46) did not differ between the two groups. Overall management of SAB differed between the two cohorts, with a higher proportion of post-COVID-19 patients opting for expectant management (49.9%) compared to only 38.1% choosing expectant management in the pre-COVID-19 group (P<.001). Virtual visits for consultation and management of SAB were more prevalent in the post-COVID period with 11.1% of patients choosing to utilize telehealth compared to only 0.09% of patients in the pre-COVID-19 cohort (P<.001). CONCLUSION: The COVID-19 pandemic affected many aspects of the delivery of health care, and women's health is no exception. Our study shows that the pandemic changed the way SABs were managed, with a higher proportion of health care providers and patients opting for expectant management as compared to the pre-pandemic time period. We also saw a change in the way health care was delivered with virtual appointments becoming more popular post-COVID-19, emphasizing the growing role of telehealth in women's health care and in the management of SAB.

Knowledge and skills of pre-eclampsia management among healthcare providers working in antenatal clinics in Zanzibar

BackgroundPre-eclampsia and eclampsia are the leading causes of perinatal morbidity and mortality worldwide. Early detection and treatment of preeclampsia is lifesaving; however, evidence suggests that the majority of women in low and middle income-countries are not routinely screened for high blood pressure during antenatal care, that those with severe and mild pre-eclampsia are not monitored for blood pressure and proteinuria as needed, and the magnesium sulphate is not administered as needed. The purpose of this study was therefore to assess knowledge and skills in pre-eclampsia and eclampsia management and their associated factors among healthcare providers working in antenatal clinics in Zanzibar.MethodsThis was a cross-sectional analytical study conducted in all levels of healthcare facilities in Zanzibar. The study involved 176 healthcare providers (nurses and doctors) who were randomly selected. A self-administered questionnaire was used to collect data and descriptive and inferential statistics were used in the analysis whereby logistic regression models were employed. The Chi-square coefficient, odds ratio, and 95% confidence intervals were reported, and the level of significance was set at p < 0.05.ResultsThe mean age of healthcare providers was 35.94 (SD ± 7.83) years. The proportion of healthcare providers with adequate knowledge was 49.0%, and 47% had adequate skills. Knowledge level was predicted by working in higher healthcare facility levels (AOR: 3.28, 95% CI: 1.29–8.29), and having attended on-the-job training on pre-eclampsia (AOR: 7.8, 95% CI: 2.74 − 22.75). Skills were predicted by having attended on-job training (AOR: 8.6, 95% CI: 2.45 − 30.16), having working experience of five years or above in antenatal care units (AOR: 27.89, 95% CI: 5.28 − 148.89) and being a medical doctor or assistant medical doctor (AOR: 18.9, 95% CI: 2.1–166).ConclusionApproximately half of Zanzibar’s ANC healthcare workers demonstrated inadequate knowledge and skills in preeclampsia care, indicating a critical need for targeted interventions to reduce maternal morbidity and mortality. Knowledge is predicted by attending on-the-job training and working in higher healthcare facility level, while skills is predicted by attending on job training, more years of working experience in antenatal care units and being a medical doctor or assistant medical doctor The study recommends the healthcare facility institutions to provide on-the-job training to for the healthcare providers working in lower healthcare facility levels.

Lessons learned from an outbreak of COVID-19 in the head and neck surgery ward of a Japanese cancer center during the sixth wave by Omicron

IntroductionWe describe a coronavirus disease (COVID-19) outbreak in a cancer center's head and neck surgery ward and the interventions to halt ongoing exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers and patients with cancer. MethodsCase definition included all healthcare workers and all patients associated to the ward from January 27 to January 31, 2022 with a positive SARS-COV-2 antigen test. This retrospective descriptive study was conducted between January 27, 2022, and February 14, 2022. ResultsFrom January 28, 2022, to February 9, 2022, 84 cases (36 healthcare workers, 48 patients) were screened, and 26 (12 healthcare workers, 14 patients) were identified as SARS-CoV-2-positive. The proportion of healthcare providers who performed aerosol generating procedures on positive patients was 91% for positive cases and 49% for non-cases. Room sharing with patients with COVID-19 was 64% for positive cases and 21% for non-cases (57% vs. 21% with positive tracheostomy patients; 43% vs. 9% with positive cases using a nebulizer; 50% vs. 15% with positive cases requiring sputum suctioning, respectively). Compliance with the universal masking policy for patients was 36% of positive cases and 79% of non-cases. ConclusionsThis is the first report of a nosocomial outbreak of COVID-19 in a head and neck surgery ward during the Omicron pandemic. Notably, there were a high number of positive cases among healthcare workers who performed aerosol generating procedures for positive patients and patients who shared the room with a patient with COVID-19 with the potential to generate aerosols.

Accelerating Virtual Health Implementation Following the COVID-19 Pandemic: Questionnaire Study.

BackgroundThe COVID-19 pandemic accelerated drivers for virtual health adoption and triggered the US federal government to implement regulatory changes to reduce barriers to virtual health implementation. Consequently, virtual health solutions have been increasingly adopted, and health systems in the United States have been reorganizing their care delivery process with unprecedented speed.ObjectiveThis study aimed to assess and make recommendations on the strategy, business model, implementation, and future considerations for scaling and sustaining virtual health solutions based on the views of executives from the largest health systems in the United States.MethodsIn September 2020 and October 2020, the Health Management Academy conducted 29 quantitative surveys and 23 qualitative interviews involving 58 executives from 41 of the largest health systems in the United States. Participating health systems were approximately equally distributed across size categories (small, medium, and large, defined as annual total operating revenue US $2-3 billion, $3-6 billion, and >$6 billion, respectively) and US Census Bureau regions (Northeast, Midwest, South, and West).ResultsBased on the Health Management Academy’s assessment of approaches to governance, financing, data infrastructure, and clinical integration of virtual health, most participating health systems (13/24, 54%) had a mid-stage level of maturity in virtual health implementation. Executives reported the pandemic is forcing health systems to re-examine strategic priorities; the most commonly raised key impacts were increased access (15/21, 71%) and flexibility (10/21, 48%) as well as lower costs of care delivery (9/21, 43%). Most executives (16/28, 57%) reported their organization had a defined budget for virtual health, and many noted that virtual health is best supported through value-based payment models. Irrespective of health system maturity, reimbursement was consistently rated as a key challenge to virtual health scaling, along with patient access to and understanding of virtual health technology. The success of virtual health implementation was most commonly measured by patient satisfaction, health care provider engagement, and proportion of health care providers using virtual health solutions (reported by 7/8, 88%; 6/8, 75%; and 7/8, 75% of information technology executives, respectively). Almost all health systems (27/29, 93%) expect to continue growing their virtual health offerings for the foreseeable future, with user-friendliness and ease of integration into the electronic medical record as key factors in making go-forward decisions on virtual health solutions (each selected by 9/10, 90% executives).ConclusionsThe increased demand for virtual health solutions during the COVID-19 pandemic is expected to continue postpandemic. Consequently, health systems are re-evaluating their current platforms, processes, and strategy to develop a sustainable, long-term approach to virtual health. To ensure future success, health system leaders need to proactively build on their virtual health solutions; advocate for payment, site flexibility, and reimbursement parity for virtual health; and demonstrate continued engagement and boldness to evolve care beyond established models.

WOMEN'S HEALTH RIGHTS IN UKRAINE

Introduction: Women’s health, due to their biological characteristics and fertility function, as well as their role, their focus on family and community health care is different from that of men and is of particular importance. According to the World Health Organization, women are at greater risk of poverty, hunger and malnutrition due to their diverse roles in the family and society, which undergo various physiological courses such as puberty, menstruation, pregnancy, childbirth and menopause. And sex discrimination is a high-risk group. Women's health is vulnerable for various reasons, and in addition to biological features, the impact of cultural, social, economic and political factors. The first condition for a healthy and dynamic society and health is stability and strengthening the family, and women guarantee health and strengthening family. The family is the foundation and cornerstone of the social institution, given that the upbringing of the next generation is the responsibility of women. Dynamics is the result of the existence of healthy and knowledgeable women, which shows the importance of women's right to health. Unfortunately, despite international, regional organizations and groups working on women's rights, we still see discrimination and lack of access to women's rights today, and this lack of access seems to be due to ignorance and recognition of women's rights and lack of state support. in practice to facilitate women's access to health. Women's health is very vulnerable in most countries, and this is considered to be one of the features of the development of countries, with the main emphasis on promoting and strengthening the role of women in achieving good health and promoting their position in the system. Women develop education and a culture of health. Women Both recipients and main health care providers are part of the health care system and, in part, make up a large proportion of health care providers in the formal health care sector. This article examines the state of health rights in Ukraine, the history of women's health rights, laws on women's health care since Ukraine's independence, current laws on the advancement of women, and all international and global partnerships to promote health. women.

862. A Survey of HIV PrEP Prescribing Practices at an Academic Medical Center in the Northwest United States

Abstract Background The prescribing of pre-exposure prophylaxis (PrEP) remains a major means of reducing the incidence of HIV infection in the United States. Many individuals are unaware of their HIV status until further symptom progression has ensued or continue to engage in high-risk behavior despite awareness of the risk of HIV transmission. Primary care providers are instrumental in identifying patients who are at high risk of HIV acquisition and prescribing PrEP with appropriate counseling and monitoring. Methods In order to identify existing barriers to prescribing HIV PrEP at a single academic medical center, a voluntary 14-question de-identified survey was administered electronically to ambulatory care providers in the following departments: family medicine, internal medicine and geriatrics, adolescent and young adult health, student health, and women’s health clinics. Results Following survey dissemination, the response rate was 28% (82/286). The results are displayed in Tables 1-3. Notably, though 74% of survey respondents reported being familiar with CDC 2017 and USTPF 2019 clinical practice guidelines for PrEP prescribing, only 36% (22/61) were able to correctly identify the clinical scenarios in the survey whereby an individual is eligible for HIV PrEP. 57% (47/82) reported that they discuss HIV PrEP with less than 25% of eligible patients. Conclusion A significant proportion of healthcare providers at a major regional academic medical center are either not familiar with HIV PrEP prescribing clinical practice guidelines or are unable to appropriately identify situations whereby an individual meets eligibility for PrEP. In addition, a significant proportion do not discuss HIV PrEP with eligible patients. As such, data from the conducted survey will be used to inform the creation of clinical decision support tool to identify risk factors for HIV acquisition in patients, educate providers on guideline-based indications, and provide the option of a telePrEP referral service. Downstream effects anticipated from this intervention include increased HIV/STI testing, case identification, and increased rates of PrEP counseling and prescribing. Disclosures All Authors: No reported disclosures

Enablers and perceived risks of Covid-19 vaccine uptake among health care providers in Nigeria

Vaccines found to be highly effective will enable uptake than those with low effectiveness. Health care providers in Nigeria aged 18 years and above participated in this study. The study was conducted to assess the enablers and perceived risks of Covid-19 vaccination among healthcare providers in Nigeria. A snowball sampling technique was relied upon in the distribution of the online questionnaires sent in the form of a link through social media outlets such as Whatsapp, Face book and emails within four weeks interval. The analysis was performed using the Statistical Software Package SPSS version 22.0.Four Hundred and forty-five respondents filled the questionnaire from the six geopolitical zones of the country. It was observed that safety of the vaccine, proven efficacy and good knowledge of the vaccine were enablers to the Covid-19 vaccine uptake. This finding shows that a higher proportion of health care providers was in support of the covid-19 vaccine under the presumption that the vaccine was proven effective. 243(54.6%) perceived that a clinical sequalae may result later after they take the Covid-19 vaccine, 207(46.5%) perceived that the clinical trial of the Covid-19 vaccine was inadequate and 187(42.0%) perceived that a new virus strain may emerge and therefore, bring about another vaccine. In addition, 180(40.4%) respondents perceived that the Covid-19 vaccine might worsen their co-morbidities and 61(13.7%) showed concerns as they think the Covid-19 vaccine may affect their immune systems and make them more susceptible to new viral strains. Proven vaccine safety, proven efficacy and good knowledge were identified as enablers of the covid-19 vaccine while clinical sequalae and inadequate trials were noted as the perceived risks of covid-19 vaccine uptake among health care providers.

Health Care Provider Utilization of Prescription Monitoring Programs: A Systematic Review and Meta-Analysis.

ObjectiveTo synthesize the literature on the proportion of health care providers who access and use prescription monitoring program data in their practice, as well as associated barriers to the use of such data.DesignWe performed a systematic review using a standard systematic review method with meta-analysis and qualitative meta-summary. We included full-published peer-reviewed reports of study data, as well as theses and dissertations.MethodsWe identified relevant quantitative and qualitative studies. We synthesized outcomes related to prescription monitoring program data use (i.e., ever used, frequency of use). We pooled the proportion of health care providers who had ever used prescription monitoring program data by using random effects models, and we used meta-summary methodology to identify prescription monitoring program use barriers.ResultsFifty-three studies were included in our review, all from the United States. Of these, 46 reported on prescription monitoring program use and 32 reported on barriers. The pooled proportion of health care providers who had ever used prescription monitoring program data was 0.57 (95% confidence interval: 0.48–0.66). Common barriers to prescription monitoring program data use included time constraints and administrative burdens, low perceived value of prescription monitoring program data, and problems with prescription monitoring program system usability.ConclusionsOur study found that health care providers underutilize prescription monitoring program data and that many barriers exist to prescription monitoring program data use.

Predictors of presumptive treatment of uncomplicated malaria among children in private retail outlets in Kenya: mixed effects logistic regression modelling

Background: The health seeking behavior in Kenya raises concerns in malaria case management at the private sector. Adherence to the national guidelines for the diagnosis, treatment and prevention of malaria is key in management of the disease. Presumptive treatment remains a major challenge in Kenya, especially in the private sector, with major gaps in literature identified on predictors of this treatment. Mixed-effects regression modelling considers county clustering, is more accurate in prediction and is more efficient and flexible. Methods: The study design was a cross-sectional, nationally representative, retail outlet survey secondary data analysis. The study populations included the health care providers in the retail outlets sampled randomly in both the rural and urban settings in Kenya. The primary outcome of interest was the proportion of health care providers who treated patients presumptively. Multivariable analysis was conducted for the significant variables, adjusting for clustering at the county level to determine the predictors of presumptive treatment. The best fitting model was examined using the Akaike Information Criterion (AIC). Results: Out of the 333 health care providers who treated patients, 190 (57%) treated patients presumptively. From the mixed effects logistic regression model, the predictors of presumptive treatment of uncomplicated malaria were case management training (AOR = 0.44; 95% CI = (0.18 – 1.09)), asked signs or symptoms (AOR = 0.19; 95% CI = (0.10 - 0.37)) and results presented (AOR = 0.08 95% CI = (0.03 - 0.19)). Conclusions: Presumptive treatment of uncomplicated malaria remains a challenge in the private retail sector. Malaria case management training and health care providers asking of signs and symptoms and results presented predicts presumptive treatment. To address the issue of presumptive treatment of Malaria, strengthening of malaria case management training is key for health care providers in the private sector.

Infection prevention knowledge, practice, and its associated factors among healthcare providers in primary healthcare unit of Wogdie District, Northeast Ethiopia, 2019: a cross-sectional study

BackgroundAdequate knowledge and safe practice of infection prevention among healthcare providers are vital to prevent nosocomial infections. Thus, this study aimed to assess the level of knowledge and practices of healthcare providers towards infection prevention and its associated factors in the health facilities of Wogdie District, Northern Ethiopia.MethodsInstitution based cross-sectional study was conducted among 171 healthcare providers who were selected by a simple random sampling technique. Data were collected using interviewer-administered questionnaire. Multivariable logistic regression was performed to identify factors associated with knowledge and practice of infection prevention.ResultAbout 70.8 and 55.0% of healthcare providers had adequate knowledge and safe practice of infection prevention respectively. Having infection prevention guideline (AOR = 3.65, 95% CI; 1.26, 10.54), taking infection prevention training (AOR = 2.2, 95% CI; 1.01, 4.75), having five years or more work experience (AOR = 1.52:95%CI; 1.13, 4.51), and working in maternity unit (AOR = 1.67:95%CI; 1.38–5.23) were positively associated with adequate knowledge of infection prevention. The odds of safe practice were higher in participants who received infection prevention training (AOR: 2.4; 95% CI; 1.01, 4.75) but lower among healthcare providers who are working in the facility which has no continuous water supply (AOR = 0.48:95% CI; 0.21, 0.83).ConclusionA significant proportion of healthcare providers had inadequate knowledge and unsafe practice of infection prevention. To improve healthcare worker’s knowledge of infection prevention, adequate pre-service as well as on job training should be given.

PTSD in those who care for the injured

BackgroundPost Traumatic Stress Disorder (PTSD) has become a focus for the care of trauma victims, but the incidence of PTSD in those who care for injured patients has not been well studied. Our hypothesis was that a significant proportion of health care providers involved with trauma care are at risk of developing PTSD. MethodsA system-wide survey was applied using a modified version of the Primary Care PTSD Screen [PC-PTSD], a validated PTSD screening tool currently being used by the VA to screen veterans for PTSD. Pre-hospital and in-hospital care providers including paramedics, nurses, trauma surgeons, emergency medicine physicians, and residents were invited to participate in the survey. The survey questionnaire was anonymously and voluntarily performed online using the Qualtrix system. Providers screened positive if they affirmatively answered any three or more of the four screening questions and negative if they answered less than three questions with a positive answer. Respondents were grouped by age, gender, region, and profession. Results546 providers answered all of the survey questions. The screening was positive in 180 (33%) and negative in 366 (67%) of the responders. There were no differences observed in screen positivity for gender, region, or age. Pre-hospital providers were significantly more likely to screen positive for PTSD compared to the in-hospital providers (42% vs. 21%, P<0.001). Only 55% of respondents had ever received any information or education about PTSD and only 13% of respondents ever sought treatment for PTSD. ConclusionThe results of this survey are alarming, with high proportions of healthcare workers at risk for PTSD across all professional groups. PTSD is a vastly underreported entity in those who care for the injured and could potentially represent a major problem for both pre-hospital and in-hospital providers. A larger, national study is warranted to verify these regional results.

Organizational factors associated with Health Care Provider (HCP) influenza campaigns in the Veterans health care system: a qualitative study.

BackgroundIt is an important goal to vaccinate a high proportion of health care providers (HCPs) against influenza, to prevent transmission to patients. Different aspects of how a HCP vaccination campaign is conducted may be linked to different vaccination rates. We sought to characterize organizational factors and practices that were associated with vaccination campaign success among six sites within the Veterans Health Administration, where receipt of flu-vaccination is voluntary.MethodWe conducted a total of 31 telephone interviews with key informants who were involved with HCP flu vaccination campaigns at three sites with high-vaccination rates and three sites with low-vaccination rates. We compared the organization and management of the six sites’ campaigns using constant comparison methods, characterzing themes and analyzing data iteratively.ResultsThree factors distinguished sites with high flu vaccination rates from those with low vaccination rates. 1) High levels of executive leadership involvement: demonstrating visible support, fostering new ideas, facilitating resources, and empowering flu team members; 2) Positive flu team characteristics: high levels of collaboration, sense of campaign ownership, sense of empowerment to meet challenges, and adequate time and staffing dedicated to the campaign; and 3) Several concrete strong practices emerged: advance planning, easy access to the vaccine, ability to track employee vaccination status, use of innovative methods to educate staff, and use of audit and feedback to promote targeted efforts to reach unvaccinated employees.ConclusionSuccessful HCP flu campaigns shared several recognizable characteristics, many of which are amenable to adoption or emulation by programs hoping to improve their vaccination rates.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1462-y) contains supplementary material, which is available to authorized users.

Is the Front Line Prepared for the Changing Faces of Patients? Predictors of Cross-Cultural Preparedness Among Clinical Nurses and Resident Physicians in Lausanne, Switzerland

Phenomenon: Assuring quality medical care for all persons requires that healthcare providers understand how sociocultural factors affect a patient's health beliefs/behaviors. Switzerland's changing demographics highlight the importance of provider cross-cultural preparedness for all patients—especially those at risk for social/health precarity. We evaluated healthcare provider cross-cultural preparedness for commonly encountered vulnerable patient profiles. Approach: A survey on cross-cultural care was mailed to Lausanne University hospital's “front-line healthcare providers”: clinical nurses and resident physicians at our institution. Preparedness items asked “How prepared do you feel to care for … ?” (referring to example patient profiles) on an ascending 5-point Likert scale. We examined proportions of “4 – well/5 – very well prepared” and the mean composite score for preparedness. We used linear regression to examine the adjusted effect of demographics, work context, cultural-competence training, and cross-cultural care problem awareness, on preparedness. Findings: Of 885 questionnaires, 368 (41.2%) were returned: 124 (33.6%) physicians and 244 (66.4%) nurses. Mean preparedness composite was 3.30 (SD = 0.70), with the lowest proportion of healthcare providers feeling prepared for patients “whose religious beliefs affect treatment” (22%). After adjustment, working in a sensitized department (β = 0.21, p = .01), training on the history/culture of a specific group (β = 0.25, p = .03), and awareness regarding (a) a lack of practical experience caring for diverse populations (β = 0.25, p = .004) and (b) inadequate cross-cultural training (β = 0.18, p = .04) were associated with higher preparedness. Speaking French as a dominant language and physician role (vs. nurse) were negatively associated with preparedness (β = −0.26, p = .01; β = −0.22, p = .01). Insights: The state of cross-cultural care preparedness among Lausanne's front-line healthcare providers leaves room for improvement. Our study points toward institutional strategies to improve preparedness: notably, making sure departments are sensitized to cross-cultural care resources and increasing provider diversity to reflect the changing Swiss demographic.

Do frontline health care providers know enough about artemisinin-based combination therapy to rationally treat malaria? A cross-sectional survey in Gezira State, Sudan.

BackgroundIn 2004, artemisinin-based combination therapy (ACT) was introduced in Sudan for the treatment of malaria. The role of health care providers working in first-level health care facilities is central for the effective implementation of this revised malaria treatment policy. However, information about their level of ACT knowledge is inadequate. This study sought to describe frontline health care providers’ knowledge about the formulations and dose regimens of nationally recommended ACT in Sudan.MethodsThis cross-sectional study took place in Gezira State, Sudan. Data were gathered from five localities comprising forty primary health care facilities. A total of 119 health care providers participated in the study (72 prescribers and 47 dispensers). The primary outcome was the proportion of health care providers who were ACT knowledgeable, a composite indicator of health care providers’ ability to (1) define what combination therapy is; (2) identify the recommended first- and second-line treatments; and (3) correctly state the dose regimens for each.ResultsAll prescribers and 95.7% (46/47) of dispensers were aware of the new national malaria treatment policy. However, 93.1% (67/72) of prescribers compared to 87.2% (41/47) of dispensers recognized artesunate-sulphadoxine/pyrimethamine as the recommended first-line treatment in Sudan. Only a small number of prescribers and dispensers (9.4% and 13.6%, respectively) were able to correctly define the meaning of a combination therapy. Overall, only 22% (26/119, 95% CI 14.6-29.4) of health care providers were found to be ACT knowledgeable with no statistically significant difference between prescribers and dispensers.ConclusionOverall, ACT knowledge among frontline health care providers is very poor. This finding suggests that efforts are needed to improve knowledge of prescribers and dispensers working in first-level health care facilities, perhaps through implementing focused, provider-oriented training programmes. Additionally, a system for regularly monitoring and evaluating the quality of in-service training may be beneficial to ensure its responsiveness to the needs of the target health care providers.

Characteristics of US Health Care Providers Who Counsel Adolescents on Sports and Energy Drink Consumption.

Objective. To examine the proportion of health care providers who counsel adolescent patients on sports and energy drink (SED) consumption and the association with provider characteristics. Methods. This is a cross-sectional analysis of a survey of providers who see patients ≤17 years old. The proportion providing regular counseling on sports drinks (SDs), energy drinks (EDs), or both was assessed. Chi-square analyses examined differences in counseling based on provider characteristics. Multivariate logistic regression calculated adjusted odds ratios (aOR) for characteristics independently associated with SED counseling. Results. Overall, 34% of health care providers regularly counseled on both SEDs, with 41% regularly counseling on SDs and 55% regularly counseling on EDs. On adjusted modeling regular SED counseling was associated with the female sex (aOR: 1.44 [95% CI: 1.07–1.93]), high fruit/vegetable intake (aOR: 2.05 [95% CI: 1.54–2.73]), family/general practitioners (aOR: 0.58 [95% CI: 0.41–0.82]) and internists (aOR: 0.37 [95% CI: 0.20–0.70]) versus pediatricians, and group versus individual practices (aOR: 0.59 [95% CI: 0.42–0.84]). Modeling for SD- and ED-specific counseling found similar associations with provider characteristics. Conclusion. The prevalence of regular SED counseling is low overall and varies. Provider education on the significance of SED counseling and consumption is important.

Alternative returns: On ‘costs’ and ‘outcomes’ in market-medicine

Despite significant improvements in the treatment of many pathologic processes witnessed over the past century, some particularly difficult medical problems persist, which are characterized by unclear underlying etiologies and less than desirable outcomes of treatment in spite of considerable intellectual and financial investment and escalating costs. Accordingly, physicians (as well as scientists, governmental officials, insurance companies, the media, ... etc.) have recently begun grappling with the following question: If our aim is to achieve the best outcome as measured by symptom relief/control and a return to functional activities; and if we are generally aware that the connections between assessment, diagnosis, treatment, and outcome for these problems are loose, at best; then why do a large proportion of health care providers continue to treat patients 'as-if' these connections were tight? In what follows, we hypothesize that the persistence and acceptance of this 'as-if' program is linked to its success in achieving outcomes that differ from those currently measured by physicians and patients and payers-and that physicians, patients, and citizens who understand these 'alternative outcomes' and their consequences should take the next step and consider the repercussions and the available options.

Knowledge, attitudes and practices of healthcare providers towards prenatal HIV screening and prevention of mother -to-child transmission in nigeria

TOWARDS PRENATAL HIV SCREENING AND PREVENTION OF MOTHER -TO-CHILD TRANSMISSION IN NIGERIA L. NNEKA MOBISSON, DONNA NEALE (F), University of Pennsylvania, Pediatrics, Philadelphia, Pennsylvania, Yale University, Maternal-Fetal Medicine, New Haven, Connecticut OBJECTIVE: Over 3.5 million people in Nigeria are living with HIV/AIDS; consequently, the risk of perinatal transmisson is great. The purpose of this study was to assess the knowledge, attitudes and practices of healthcare providers regarding prenatal HIV screening and the use of antiretroviral drugs in the prevention of mother-to-child transmission of HIV in Nigerian pregnant women. STUDY DESIGN: A cross sectional survey using self-administered questionnaires among 150 healthcare providers (physicians and nurses) was conducted at four healthcare facilities in Nigeria from June August 2000. Three of these healthcare facilities are designated pilot centers for the national prevention of mother-to-child transmission (PMTCT) program. Differences in responses between physicians and nurses were compared for each category and at each hospital. RESULTS: Of 150 self-administered questionnaires that were fielded, 86 healthcare providers responded, representing 57% of physicians and nurses. Less than two-thirds of respondents had correct knowledge regarding the use of antiretroviral drugs in mother-to-child transmission with physicians being more knowledgeable than nurses. Despite the difference in knowledge levels, more nurses than physicians acknowledged the importance of screening pregnant women for HIV (93% vs. 70.91%; p = 0.04). In addition, a significantly larger proportion of nurses routinely inquire about the HIV status of pregnant women (60% vs. 38%). CONCLUSION: Current healthcare providers have limited knowledge levels regarding the use of antiretroviral drugs in the prevention of mother-to child transmission. In addition, a significant proportion of healthcare providers do not have attitudes or practices conducive to the prevention of perinatal transmission. This may negatively impact on the success of the PMTCT programs in Nigeria. This study highlights the need for continuous and comprehensive training of healthcare providers at government and private healthcare facilities to increase the likelihood of achieving the objectives of PMTCT programs.

Saudi Women's Consent for Invasive Radiological Procedures

Saudi Women's Consent for Invasive Radiological Procedures