Types Of Healthcare Professionals Research Articles

Online Lifestyle Medicine Continuing Medical Education (CME) Course Completion Predicts Increases in Clinician Knowledge, Confidence, and Practice of Lifestyle Medicine.

Introduction: Despite growing evidence linking lifestyle changes to disease reversal, lifestyle medicine (LM) is not widely practiced. Lack of clinician training and knowledge is cited as a barrier to LM adoption. This study measures changes in LM knowledge, attitudes, confidence, and practice behaviors following completion of a 5.5-h, asynchronous, online continuing medical education (CME) course. Methods: Participants completed a pre- and post-course survey. A repeated-measures linear model tested changes in knowledge, confidence, interest, experience, and practice of LM, after adjusting for age, gender, race, ethnicity, clinical degree/licensure, and presence of a health system value-based care model. Results: Surveys from n = 2954 course participants were analyzed. Overall, statistically significant improvements were observed in self-reported knowledge (+.47 of points) and confidence (+.53 of points) of LM. Participants across the sample reported greater frequency (+.08 of 5 points) and reach (+.10 of 5 points) of LM with their patients (p<.0001 for both). Discussion: This study demonstrated that a brief, scalable, online CME course can improve LM knowledge, confidence, attitudes, and practice. Future research should examine long-term practice changes as well as differences in outcomes across types of healthcare professionals.

Collaborating for success: empowering medical professionals through interprofessional education

Interprofessional education (IPE) refers to training activities to foster collaborative learning among students from different healthcare professions with the intention to augment the quality of patient care activities. Interprofessional education has been linked with significant impact and accounts for significant benefits that it adds to patient care, healthcare professionals, and even the healthcare delivery system as a whole. Medical institutions that are planning to introduce interprofessional education within their settings must adopt a structured framework to ensure effective delivery of IPE that can train students to develop the required set of skills and competencies that are essential for patient-centered practice. A wide range of challenges has been identified that can impact the implementation of effective IPE in a medical college. There is an immense need to overcome these challenges to facilitate IPE by creating an enabling environment that supports interprofessional collaboration. In conclusion, interprofessional education has a special place in the medical education delivery, as it has the potential to encourage collaborative practice, patient-centered care, and effective teamwork among different types of healthcare professionals. Thus, it is the need of the hour that each medical institution should explore opportunities for interdisciplinary learning and adequately prepare their students for the complexities of modern healthcare.

Exercise in cancer patients: assistance levels and referral pathways-a position statement from the Spanish Society of Medical Oncology.

There is growing evidence about how physical activity can improve cancer care. Unfortunately, exercise is still not widely prescribed to oncology patients, despite the benefit it brings. For this to occur, it is necessary for a multidisciplinary approach involving different types of healthcare professionals, given that each treatment be tailored for each single case. Besides incorporating appropriate infrastructures and referral pathways, we need to integrate exercise into healthcare practice, which ameliorates patients' quality of life and treatment side effects. From the Spanish Society of Medical Oncology (SEOM), and through the Exercise and Cancer Working Group, we indicate considerations, analyze patient care scenarios, and propose a referral pathway algorithm for exercise prescription, taking in account the patient's needs. In later sections of this paper, we describe how this algorithm could be implemented, and how the exercise programs should be built, including the physical activity contents, the settings, and the delivery mode. We conclude that professionals, infrastructures, and organizations should be available at every assistance level to create programs providing adequate exercise training for cancer patients.

Clinical and cost-effectiveness of telemedicine among patients with type 2 diabetes in primary care: A systematic review and meta-analysis.

Telemedicine has been promoted as an effective way of managing type-2 diabetes (T2DM) in primary care. However, the effectiveness of telemedicine is unclear. We investigated the clinical and cost-effectiveness of different telemedicine interventions for people with T2DM, compared to usual care. We searched Medline, Embase, Cochrane, CINHAL, ProQuest and EconLit for randomized controlled trials (RCTs) that examined the effectiveness of telemedicine interventions on clinical outcomes (HbA1c, body mass index [BMI], weight, diastolic blood pressure [DBP], systolic blood pressure [SBP], fasting blood glucose, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, total cholesterol and triglyceride) in adults with T2DM, published in English from inception until 31 December 2022. Meta-analyses were conducted using random-effects models pooling mean differences, heterogeneity was quantified using the I2 statistic. Publication bias was assessed using funnel plots, Egger tests and trim and fill. Subgroup analyses included type of telemedicine intervention, telemedicine mode of delivery and type of healthcare professionals. This study was registered with PROSPERO, CRD 42022375128. Of the 4093 records identified, 21 RCTs, 10,732 participants from seven regions, were included. Reported interventions included telephone (k = 16 studies), internet-based (k = 2), videoconference (k = 2) and telephone and emails (k = 1). We observed no statistically significant differences between synchronous or asynchronous telemedicine interventions compared to usual care for HbA1c (-0.08%(-0.88 mmol/mol); 95% CI: -0.18, 0.02), BMI (0.51 kg/m2; 95% CI: -0.21, 1.22), SBP (-1.48 mmHg; 95% CI: -3.22, 0.26), DBP (3.23 mmHg; 95% CI: -0.89, 7.34), HDL-cholesterol (0.01 mmol/L; 95% CI: -0.03, 0.05), LDL-cholesterol (0.08 mmol/L; 95% CI: -0.22, 0.37), triglycerides (-0.08 mmol/L, 95% CI: -0.31, -0.15), total cholesterol (-0.10 mmol/L; 95% CI: -0.25, 0.04) and weight (-0.50 kg; 95% CI: -1.21, 0.21). Telemedicine was as effective as usual care in improving health outcomes of people with T2DM. They can provide a safe solution in times of rising demands for primary healthcare services, or in extreme events, like a global pandemic. More high-quality RCTs are needed on the cost evaluation of telemedicine.

P074 Diagnostic Journeys of Patients with Hypophosphatasia

Abstract Background/Aims Hypophosphatasia (HPP) is an ultra-rare genetic disorder characterised by low activity of tissue non-specific alkaline phosphatase (TNAP). Due to heterogeneity of clinical presentation and lack of definitive biochemical testing, misdiagnosis and diagnostic delay are common. Methods We used information reported by HPP patients to the Rare and Undiagnosed Diseases Study (RUDY) online registry (www.rudystudy.org). We included patients with a self-reported diagnosis of HPP and information on at least one of our outcomes. We described their diagnostic journey, including diagnostic delays, initial symptoms, incorrect diagnoses and healthcare professionals seen. Results 16 participants with a self-reported diagnosis of HPP were included in the analysis with 14/16 female. Of those reporting the date of initial symptom onset, 9/14 participants had symptom onset before the age of 18, whereas five had symptom onset in adulthood. The median time from symptom onset to HPP final diagnosis was 26.5 years (N = 8, IQR 11.2 to 34.6). From the first GP visit related HPP to final diagnosis the median time was 9.5 years (N = 6, IQR 6.2 to 11.1), and from the first hospital visit related to HPP, the median time to final diagnosis was 3.9 years (N = 10, IQR 0.8 to 10.5). Among participants reporting initial symptoms (N = 13), 16 categories of initial symptom were reported, with a median of two initial symptom categories per participant (IQR 1 to 2). The most prevalent initial symptom was pain (10/13, 77%). Of these 10 participants, four had lower limb pain, one had upper limb pain, one had back pain, and five had pain of unspecified location. Skeletal deformity at birth, dental manifestations, joint swelling, and infantile feeding problems were each present in 2/13 participants (15%). Among participants reporting whether they had received other diagnoses prior to that of HPP (N = 13), nine participants (75%) received at least one other diagnosis, with diagnoses of 10 different conditions reported across the cohort. The most common other diagnosis was fibromyalgia (4/13, 31%), followed by hypermobility (2/13, 15%). 21 different types of healthcare professionals were seen prior to final diagnosis. General Practitioners were the most commonly consulted (9/14, 64%). This was followed by allied health professionals (8/14, 57%). Of the eight participants seeing allied health professionals, all eight saw physiotherapists, and 4 (29% of total) also saw at least one other allied health professional. Other types of healthcare professional seen by multiple responders included orthopaedic surgeons (5/14, 36%), rheumatologists (5/14, 36%), geneticists (4/14, 29%), endocrinologists (3/14, 21%), metabolic specialists (3/14, 21%) and dentists (2/14, 14%). Conclusion Patients typically present with a cluster of symptoms, often including pain, and are often seen by general practitioners and physiotherapists before diagnosis. Increasing awareness of HPP in these professions may improve early recognition of the disease. Disclosure D. Marsden: None. R. Ridley: None.

Stalking in nurses and other health care professionals: Prevalence, consequences, and coping strategies

The aim of this study was to analyze physical and psychological symptoms, anxiety and depression, and coping strategies in a group of Italian Health Care Professional who were victims of stalking. Nurses, who are primarily involved in the physical care of patients, were compared with other types of Health Care Professionals. For research purposes, we queried a database used in previous research between 2014 and 2019. This database was created in collaboration with six hospitals in the Italian territory. 1,971 health professionals between the ages of 18 and 60 who completed an anonymous questionnaire, including 265 self-identified stalking victims (116 nurses), provided the data. The results suggest that Nurses and Health Care Professionals are equally at risk of stalking, with experiences not differing significantly by role. The data collected to date suggests that Nurses are no more likely to be victims than Health Care Professional with other roles. Overall, it appears that all victims suffer from the stalking experience and have negative feelings that affect their ability to deal with the stalker. Health care organizations can assist health care professionals by offering informational courses about the phenomenon. At the same time, strategies could be offered to address potential misconduct that, if not prevented, may lead to an escalation in the number and severity of behaviors.

Holistic Person-Centered Care in Radiotherapy: Protocol for a Scoping Review.

Several types of health care professionals are responsible for the care of patients with cancer throughout their engagement with the health care system. One such type is the radiotherapist. The radiotherapist not only administers treatment but is also directly involved with the patient during treatment. Despite this direct contact with the patient, the narrative tends to focus more on technical tasks than the actual patient. This task-focused interaction is often due to the highly sophisticated equipment and complex radiotherapy treatment processes involved. This often results in not meeting the psychosocial needs of the patient, and patients have acknowledged noncompliance and delayed treatment as a result. The scoping review aims to explore, chart, and map the available literature on holistic person-centered care in radiotherapy and to identify and present key concepts, definitions, methodologies, knowledge gaps, and evidence related to holistic person-centered care in radiotherapy. This protocol was developed using previously described methodological frameworks for scoping studies. The review will include both peer-reviewed and gray literature regarding holistic, person-centered care in radiotherapy. A comprehensive search strategy has been developed for MEDLINE (Ovid), which will be translated into the other included databases: Scopus, CINAHL (EBSCO), MEDLINE (PubMed), Embase (Elsevier), Cochrane Library, and the Directory of Open Access Journals. Gray literature searching will include Google (Google Books and Google Scholar), ProQuest, the WorldWideScience website, the OpenGrey website, and various university dissertation and thesis repositories. The title and abstract screening, full-text review, and relevant data extraction will be performed independently by all 3 reviewers using the Covidence (Veritas Health Innovation) software, which will also be used to guide the resolution of conflicts. Sources selected will be imported into ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) for analysis, which will consist of content analysis, narrative analysis, and descriptive synthesis. Results will be presented using narrative, diagrammatic, and tabular formats. The review is expected to identify research gaps that will inform current and future holistic, person-centered care in radiotherapy. The review commenced in November 2023, and the formal literature search was completed by the end of February 2024. Final results are expected to be published in a peer-reviewed journal by 2025. The findings of this review are expected to provide a wide variety of strategies aimed at providing holistic, person-centered care in radiotherapy, as well as to identify some gaps in the literature. These findings will be used to inform future studies aimed at designing, developing, evaluating, and implementing strategies toward improved holistic, person-centered care in radiotherapy. DERR1-10.2196/51338.

Differences in Care Team Response to Patient Portal Messages by Patient Race and Ethnicity

The COVID-19 pandemic was associated with substantial growth in patient portal messaging. Higher message volumes have largely persisted, reflecting a new normal. Prior work has documented lower message use by patients who belong to minoritized racial and ethnic groups, but research has not examined differences in care team response to messages. Both have substantial ramifications on resource allocation and care access under a new care paradigm with portal messaging as a central channel for patient-care team communication. To examine differences in how care teams respond to patient portal messages sent by patients from different racial and ethnic groups. In a cross-sectional design in a large safety-net health system, response outcomes from medical advice message threads sent from January 1, 2021, through November 24, 2021, from Asian, Black, Hispanic, and White patients were compared, controlling for patient and message thread characteristics. Asian, Black, Hispanic, and White patients with 1 or more adult primary care visits at Boston Medical Center in calendar year 2020 were included. Data analysis was conducted from June 23, 2022, through December 21, 2023. Patient race and ethnicity. Rates at which medical advice request messages were responded to by care teams and the types of health care professionals that responded. A total of 39 043 patients were included in the sample: 2006 were Asian, 21 600 were Black, 7185 were Hispanic, and 8252 were White. A total of 22 744 (58.3%) patients were women and mean (SD) age was 50.4 (16.7) years. In 2021, these patients initiated 57 704 medical advice request message threads. When patients who belong to minoritized racial and ethnic groups sent these messages, the likelihood of receiving any care team response was similar, but the types of health care professionals that responded differed. Black patients were 3.95 percentage points (pp) less likely (95% CI, -5.34 to -2.57 pp; P < .001) to receive a response from an attending physician, and 3.01 pp more likely (95% CI, 1.76-4.27 pp; P < .001) to receive a response from a registered nurse, corresponding to a 17.4% lower attending response rate. Similar, but smaller, differences were observed for Asian and Hispanic patients. The findings of this study suggest lower prioritization of patients who belong to minoritized racial and ethnic groups during triaging. Understanding and addressing these disparities will be important for improving care equity and informing health care delivery support algorithms.

Removing Barriers, Bridging the Gap, and the Changing Role of the Health Care Professional with Automated Insulin Delivery Systems.

As all people with type 1 diabetes (T1D) and some with type 2 diabetes (T2D) require insulin, there is a need to develop management methods that not only achieve glycemic targets but also reduce the burden of living with diabetes. After insulin pumps and continuous glucose monitors, the next step in the evolution of diabetes technology is automated insulin delivery (AID) systems, which have transformed intensive insulin management over the past decade, as these systems address the shortcomings of previous management options. However, AID use remains fairly limited, and access represents a major barrier to use for many people with diabetes, despite these systems being standard of care. Therefore, the future of AID will necessitate addressing barriers related to social determinants of health, finances, and an expansion of the number and type of health care professionals (HCPs) prescribing AID systems. These crucial steps will be essential to ensure that everyone with intensively managed diabetes can use AID systems. The impact of implementing these changes will create a shift in the future of diabetes care that will result in achievement of more targeted glycemia and psychosocial outcomes for all people with diabetes and an expansion of the role of all HCPs in AID-related diabetes care. Even more importantly, by addressing social determinants of health and clinical inertia related to AID, the field can address disparities in outcomes across countries, race, gender, socioeconomic status, and insurance status. Furthermore, the increased use of AID system will provide more time during appointments for a shift in the discussion away from fine tuning insulin dosing and toward a focus on more topics related to behavior and conversations about general health. This will include psychosocial outcomes, and quality of life. In addition, these changes can hopefully allow for time to discuss more general issues, such as cardiovascular health, obesity prevention, diabetes-related complications, and other health-related concerns.

Protocol for the Swiss COhort of Healthcare Professionals and Informal CAregivers (SCOHPICA): Professional trajectories, intention to stay in or leave the job and well-being of healthcare professionals.

Healthcare professionals' shortage, low job satisfaction, high levels of burnout, and excessive staff turnover are some of the challenges health systems face worldwide. In Switzerland, healthcare stakeholders have called to address the health workforce crisis and have pointed out the scarcity of data on the conditions of healthcare professionals (HCPs). Hence, the Swiss Cohort of Healthcare Professionals and Informal Caregivers (SCOHPICA) was developed to study the career trajectories, well-being, intention to stay in or leave the position/profession/health sector, and their determinants, of HCPs and informal caregivers, respectively. This paper describes the protocol for the HCPs cohort of SCOHPICA and discusses its implications. SCOHPICA is a prospective open cohort using an explanatory sequential mixed methods design. All types of HCPs working directly with patients and practicing in Switzerland are eligible, irrespective of their healthcare setting and employment status. Baseline and annual follow-up electronic surveys will take place once a year, featuring both core questions and modules developed according to information needs. While outcome variables are HCPs' trajectories, well-being, intention to stay in or leave the position/profession/health sector, independent variables include organizational, psychosocial, and psychological determinants, as well as occupational (professional) and sociodemographic factors. The qualitative phase will be organized every two years, inviting participants who agreed to take part in this phase. The findings from quantitative analyses, along with the issues raised by healthcare stakeholders in the field, will guide the topics investigated in the qualitative phase. Using innovative methodologies, SCOHPICA will gather nationwide and longitudinal data on HCPs practicing in Switzerland. These data could have numerous implications: promoting the development of research related to HCPs' well-being and retention intentions; supporting the development of policies to improve working conditions and career prospects; contributing to the evolution of training curricula for future or current healthcare professionals; aiding in the development of health systems capable of delivering quality care; and finally, providing the general public and stakeholders with free and open access to the study results through an online dashboard.

Insights of healthcare professionals regarding waterbirths and water immersion during labour: A mixed studies review.

To consolidate healthcare professionals' insights about waterbirths and water immersion during labour. Mixed studies review. Seven electronic databases were searched from their inception dates till June 2023: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest Dissertations and Theses Global. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and Pluye and Hong's mixed studies review framework guided this review. The quality of included studies was evaluated using the Mixed Methods Appraisal Tool. Findings were synthesized using the convergent qualitative synthesis method, and results were thematically analysed using Braun and Clarke's framework. Three main themes were identified from the 22 included studies: (1) believing in waterbirths, (2) opposing forces and (3) plotting the course ahead. Healthcare professionals reported different views about waterbirths and water immersion practices; midwives were most likely to support these practices, followed by nurses and lastly, few physicians supported them. Reasons for opposing waterbirths include insufficient training and support from colleagues as well as concerns about work efficiency, waterbirth safety and litigation issues. The available evidence suggests the need to provide waterbirth training for healthcare professionals, equip healthcare facilities with necessary waterbirth-related infrastructure and develop appropriate waterbirth policies/guidelines. Healthcare professionals could also consider providing antenatal waterbirth education to women and obtain women's feedback to improve current policies/guidelines. Future research should explore the views of different types of healthcare professionals from more diverse cultures. The PRISMA guidelines. Systematic review.

Delivery Strategies for Postpartum Care: A Systematic Review and Meta-analysis.

To systematically review the effects of postpartum health care-delivery strategies on health care utilization and maternal outcomes. We searched Medline, EMBASE, CENTRAL, CINAHL, and ClinicalTrials.gov for studies in the United States or Canada from inception to November 16, 2022. We used duplicate screening for studies comparing health care-delivery strategies for routine postpartum care on health care utilization and maternal outcomes. We selected health care utilization, clinical, and harm outcomes prioritized by stakeholder panels. We found 64 eligible studies (50 randomized controlled trials, 14 nonrandomized comparative studies; N=543,480). For general postpartum care, care location (clinic, at home, by telephone) did not affect depression or anxiety symptoms (low strength of evidence), and care integration (by multiple types of health care professionals) did not affect depression symptoms or substance use (low strength of evidence). Providing contraceptive care earlier (compared with later) was associated with greater implant use at 6 months (summary effect size 1.36, 95% CI 1.13-1.64) (moderate strength of evidence). Location of breastfeeding care did not affect hospitalization, other unplanned care utilization, or mental health symptoms (all low strength of evidence). Peer support was associated with higher rates of any or exclusive breastfeeding at 1 month and any breastfeeding at 3-6 months (summary effect size 1.10-1.22) but not other breastfeeding measures (all moderate strength of evidence). Care by a lactation consultant was associated with higher breastfeeding rates at 6 months (summary effect size 1.43, 95% CI 1.07-1.91) but not exclusive breastfeeding (all moderate strength of evidence). Use and nonuse of information technology for breastfeeding care were associated with comparable rates of breastfeeding (moderate strength of evidence). Testing reminders for screening or preventive care were associated with greater adherence to oral glucose tolerance testing but not random glucose or hemoglobin A 1c testing (moderate strength of evidence). Various strategies have been shown to improve some aspects of postpartum care, but future research is needed on the most effective care delivery strategies to improve postpartum health. PROSPERO, CRD42022309756 .

Causes of Death Among Health Care Professionals in the United States.

Specific causes of mortality among various types of health care professionals (HCPs), including those characterized by age, gender, and race, have not been well described. The National Occupational Mortality Surveillance data for deaths in 26 US states in 1999, 2003-2004, and 2007-2014 were queried to address this question. Proportionate mortality ratios (PMRs) were calculated to compare specific causes of mortality among HCPs compared with those among the general population. HCPs were less likely to die from heart disease (PMR 93, 95% confidence intervals [CI] 92-94), alcoholism (PMR 62, 95% CI 57-68), drugs (PMR 80, 95% CI 70-90), and more likely to die from cerebrovascular disease (PMR 105, 95% CI 104-107) and diabetes (PMR 107, 95% CI 105-109). HCPs aged 18-64 years were more likely to die by suicide (PMR 104, 95% CI 101-107), whereas those aged 65-90 years were less likely to die by suicide (PMR 84, 95% CI 77-91), with physicians (PMR 251, 95% CI 229-275) and other HCPs having high PMR for suicide. Among all HCPs, suicide PMR was similarly increased, whereas heart disease PMRs are similarly decreased among Black compared with those among White HCPs and those among male compared with those among female HCPs. HCPs as a group and specific types of HCPs demonstrate causes of mortality that differ in important ways from the general population. Race and gender-based trends in PMRs for key causes of mortality among HCPs suggest that employment in a health care field may not alter race and gender disparities noted among the general population.

P115 Healthcare professionals' perspectives on integrating predictive and emerging preventive approaches in rheumatoid arthritis care: A qualitative investigation

Abstract Background/Aims There is an increasing interest in treating individuals at risk of rheumatoid arthritis (RA) with preventive drugs and several clinical trials have already reported results. Once developed, a successful predictive and preventive strategy needs to be integrated in the healthcare system. The current research explores the perceptions of health care professionals (HCPs) regarding this, and factors that may affect this integration. Methods We conducted one-to-one semi-structured qualitative interviews (either face-to-face or by telephone) with HCPs based in the West Midlands (UK). Audio recordings of the interviews were transcribed, coded and the data were analysed by thematic analysis facilitated by NVIVO. Results Nineteen HCPs (11 female, 8 male) were interviewed, including ten GPs, six rheumatologists and three rheumatology nurse specialists. The coding and thematic analysis of the transcripts identified four organising themes: Attributes of predictive and preventive approaches; Ethical and psychological concerns; Implementation issues; and Learning from management of other conditions. Theme 1 described necessary attributes of predictive and preventive approaches that interviewees highlighted, including the type and performance of the predictive test, the need for a clear evidence base for preventive approaches and consideration of the risks and benefits associated with the preventive treatment. Theme 2 described the ethical and psycho-social concerns that interviewees raised, including the potential negative economic, financial and psychological effects of risk disclosure for ‘at-risk' individuals and uncertainty around the development of RA and the potential for benefit associated with the treatments being considered. Theme 3 describes the implementation issues HCPs considered, including knowledge and training needs, the costs and resource implications of implementing predictive testing and preventive treatment, the role of different types of HCPs, guidelines and tools needed for implementation and patient characteristics, such as age and family history on appropriateness of prescribing preventive treatments. Theme 4 related to the lessons that could be learned from interviewees’ experiences of prediction and prevention in other disease areas, including relevant knowledge, of how preventive treatment is prescribed, existing guidelines and tools for other diseases which could be adapted for RA prevention and issues relating to risk communication. Conclusion For the successful implementation of predictive and preventative approaches in RA, HCPs across primary and secondary care need appropriate training about predictive tests, test interpretation, communication of results to at-risk individuals, and intervention options. Evidence of cost-efficiency, appropriate resource allocation, adaptation of official guidelines and careful consideration of the at-risk individuals’ psycho-social needs are also needed. Disclosure G. Simons: None. I. Wells: None. J.P. Kanacherril: None. C.D. Mallen: Grants/research support; CM is funded by the NIHR School for Primary Care Research and the NIHR ARC West Midlands. K. Raza: Grants/research support; K.R. is supported by the National Institute for Health Research Birmingham Biomedical Research Centre. M. Falahee: None.

Perceived Knowledge and Confidence for Providing Youth-Specific Type 1 Diabetes Exercise Recommendations amongst Pediatric Diabetes Healthcare Professionals: An International, Cross-Sectional, Online Survey

Background. Managing glycemia around exercise is challenging for individuals with type 1 diabetes (T1D) and their healthcare professionals (HCP). We investigated HCP knowledge and confidence around exercise counseling for youth with T1D worldwide. Objective. To assess HCP familiarity with ISPAD Clinical Practice Consensus Guidelines and confidence to deliver recommendations about T1D and exercise. Methods. A new online survey was developed on strategies and competencies about exercise for youth with T1D, comprising of 64 questions, divided into eight different categories, assessing HCPs perceived exercise knowledge, confidence, training, and barriers to exercise counseling. Results. A total of 125 HCPs mean ± SD age 42 ± 8.2 years (74% female, 73% physicians) completed the survey. The ISPAD exercise guidelines were considered familiar to 68/125 (54%) of responders. Overall, 91/125 (73%) felt confident with giving recommendations about exercise with 47/125 (38%) recommending 45–60 mins/day of physical activity, while 16/125 (13%) recommended &gt;60 mins/day. Several topics related to self-management around exercise were covered by most, but not all responders, and differences were observed in exercise content “confidence” and/or “competence” based on geographic location ( p = 0.048 ). No differences in exercise recommendation dose, confidence, or familiarity with ISPAD guidelines were observed for age, sex, type of HCP, years in practice, or healthcare type. Conclusions. Exercise counseling for youth with T1D remains a challenge in most healthcare settings, globally. In general, the number of physically active minutes per week is under-prescribed for youth with T1D and many HCPs in various settings around the world feel that more professional education is needed to boost confidence around the education of several exercise-related topics.

The Use of Patient-Generated Health Data From Consumer-Grade Mobile Devices in Clinical Workflows: Protocol for a Systematic Review.

With the rapid advancement of mobile technology, the scope of mobile health (mHealth) has expanded to include consumer-grade devices such as smartphones and wearable sensors. These solutions have typically been used for fitness purposes; however, due to their ubiquitous capabilities for data collection, they have the potential to bridge information gaps and supplement data from clinical visits. Patient-generated health data (PGHD) can be derived from mHealth solutions and be used by health care professionals (HCPs) as complementary tools in the care process, yet their integration into clinical workflows presents a myriad of challenges. PGHD might be a new and unfamiliar source of information for most HCPs, and the majority of mHealth solutions have not been designed to be used by HCPs as active reviewers. As mHealth solutions become more available and attractive to patients, HCPs may see an increase in the influx of data and related inquiries from their patients. This mismatch in expectations can result in disruptions to clinical workflows and negatively impact patient-clinician relationships. For PGHD to be integrated into clinical workflows, its use should be proven beneficial for both patients and HCPs. However, so far, only limited research has been done on the concrete experiences of HCPs as active reviewers of PGHD from consumer-grade mobile devices. We aimed to systematically guide the review of existing literature to identify what types of PGHD from consumer-grade mobile devices are currently being used by HCPs as complementary tools in the care process. The PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 was followed for the design of the search, selection, and data synthesis processes. Electronic searches will be done on PubMed, ACM Digital Library, IEEE Xplore, and Scopus. Preliminary searches have been conducted, and previous related systematic and scoping reviews have been found and evaluated. The review is expected to be completed in February 2023. This protocol will guide the review of existing literature on the use of PGHD produced by consumer-grade mobile devices. Although there have been previous reviews related to this topic, our proposed approach seeks to understand the specific opinions and experiences of different types of HCPs who are already using PGHD in their clinical practice and the motives for deeming these data useful and worth reviewing. Depending on the studies that will be included, there may be an opportunity to provide a wider understanding of what types of HCPs trust PGHD, despite the possible challenges that its use might convey, potentially contributing with the knowledge to support the design strategies of mHealth tools that could be integrated into clinical workflows. PRR1-10.2196/39389.

An online randomised controlled trial of prognosticating imminent death in advanced cancer patients: Clinicians give greater weight to advice from a prognostic algorithm than from another clinician with a different profession.

A second opinion or a prognostic algorithm may increase prognostic accuracy. This study assessed the level to which clinicians integrate advice perceived to be coming from another clinician or a prognostic algorithm into their prognostic estimates, and how participant characteristics and nature of advice received affect this. An online double-blind randomised controlled trial was conducted. Palliative doctors, nurses and other types of healthcare professionals were randomised into study arms differing by perceived source of advice (algorithm or another clinician). In fact, the advice was the same in both arms (emanating from the PiPS-B14 prognostic model). Each participant reviewed five patient summaries. For each summary, participants: (1) provided an initial probability estimate of two-week survival (0% 'certain death'-100% 'certain survival'); (2) received advice (another estimate); (3) provided a final estimate. Weight of Advice (WOA) was calculated for each summary (0 '100% advice discounting' - 1 '0% discounting') and multilevel linear regression analyses were conducted. NCT04568629. A total of 283 clinicians were included in the analysis. Clinicians integrated advice from the algorithm more than advice from another clinician (WOA difference=-0.12 [95% CI -0.18, -0.07], p< 0.001). There was no interaction between study arm and participant profession, years of palliative care or overall experience. Advice of intermediate strength (75%) was given a lower WOA (0.31) than advice received at either the 50% (WOA 0.40) or 90% level (WOA 0.43). The overall interaction between strength of advice and study arm on WOA was significant (p< 0.001). Clinicians adjusted their prognostic estimates more when advice was perceived to come from a prognostic algorithm than from another clinician. Research is needed to understand how clinicians make prognostic decisions and how algorithms are used in clinical practice.

Practice Pointer: "My feelings are not on mute - ZOOM and Balint Practice Pointers".

Practice Pointer: "My feelings are not on mute - ZOOM and Balint Practice Pointers".

Burnout and its associated factors among healthcare workers and the general working population in Japan during the COVID-19 pandemic: a nationwide cross-sectional internet-based study

ObjectivesTo examine the prevalence and the associated factors of burnout among both healthcare workers (HCWs) and the general working population, which has not yet been unknown, using large-scale, nationwide data.DesignCross-sectional...

The Spanish and Italian Healthcare Professionals' Contribution to the Safety Attitudes Questionnaire Short Form in the Operating Room: Construct Validity and Reliability.

The aims of the study are to determine the construct validity and reliability of the Spanish and Italian versions of the Safety Attitudes Questionnaire Short Form and to study the capability of this scale of distinguishing between different countries, types of healthcare professionals, and attitudes around patient safety. This was a cross-sectional study of the scale among registered nurses, surgeons, and anesthetists providing direct patient care at surgical inpatient units within public health services in Spain (Sistema Nacional de Salud) and Italy (Servizio Sanitario Nazionale). Construct validity, in both countries, was firstly assessed by exploratory factor analysis. Then, a confirmatory factor analysis was conducted, and finally an assessment was performed by means of hypothesis testing. The reliability of the scale was calculated using Cronbach α coefficient. A total of 499 healthcare professionals completed the questionnaire (Spain, n = 183; Italy, n = 316). The questionnaire showed excellent internal consistency (α = 0.85). An exploratory factor analysis identified a new factor model of the scale. The confirmatory factor analysis performed on this new model reflected the fair dimensionality of the construct (χ2 = 1193.63, root mean square error of approximation &lt; 0.05, standardized root mean square residual &lt; 0.08; nonnormed fit index, comparative fit index, incremental fit index, and goodness of fit index values = 0.90, indicating a good fit). This study provides scientific evidence of the construct validity and reliability of the Safety Attitudes Questionnaire Short Form in both Spain and Italy, showing the capability of this scale of distinguishing between different countries, types of healthcare professionals, and attitudes around patient safety.