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We aimed to evaluate the impact of health care vaccine mandates on vaccine uptake and infection risk in a cohort of Canadian health care workers (HCWs). We conduct interrupted time series analysis through a regression discontinuity in time approach to estimate the immediate and delayed impact of the mandate. Multilevel mixed effect modeling fitted with restricted maximum likelihood was used to estimate impact on infection risk. The immediate and sustained effects of the mandate was a 0.19% (P <.05) and a 0.012% (P <.05) increase in the daily proportion of unvaccinated HCWs getting their first dose, respectively. An additional 623 (95% confidence interval: 613-667) HCWs received first doses compared to the predicted uptake absent the mandate. Adjusted test positivity declined by 0.053% (95% confidence interval: 0.035%, 0.069) for every additional day the mandate was in effect. Our results indicate that the mandate was associated with significant increases in vaccine uptake and infection risk reduction in the cohort. Given the benefit that vaccination could bring to HCWs, understanding strategies to enhance uptake is crucial for bolstering health system resilience, but steps must be taken to avert approaches that sacrifice trust, foster animosity, or exacerbate staffing constraints for short-term results. • The mandate was effective in increasing vaccine uptake healthcare workers (HCWS). • Effectiveness was also shown for lowering infection risk. • Impact was greater in subgroups of HCWs including those who work in long-term care. • Context and epidemiology should be considered when utilizing vaccine mandates. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, with many nurses being infected, understanding compliance with standard precautions (SP) among nurses in Kazakhstan is crucial for improving infection prevention and control and preparedness for future emergencies. The study aimed to assess Kazakh nurses' SP compliance amid the COVID-19 pandemic and examine the factors associated with their compliance. Quantitative, cross-sectional design. This research surveyed 241 clinical nurses in Astana, Kazakhstan using a standardized tool from December 2021 to April 2022. This study found 76.0% SP compliance among the nurses. The highest compliance was observed in the dimension "Decontamination of spills and used articles" (86.0% compliance rate), followed by "Use of protective devices" (83.5% compliance rate), "Prevention of cross-infection from person to person" (72.7% compliance rate), "Disposal of sharps" (65.4% compliance rate), and "Disposal of waste" (56.0% compliance rate). Nurses' age and educational qualification influences the nurses' SP compliance. While the nurses' compliance rate in this study was moderate, specific areas warrant more attention, such as their compliance with proper waste and sharps disposal. This study highlighted the experiences of nurses in Kazakhstan on their compliance with SP during the pandemic. • Moderate compliance among nurses highlights the need for targeted waste management and sharp disposal interventions. • Married, older, educated, and experienced nurses had higher compliance levels. • Institutions can enhance compliance through regular infection control training. • Insights into the factors shaping Kazakh nurses' SP compliance can inform effective interventions. [ABSTRACT FROM AUTHOR]

A primer for pediatric providers on understanding stigma in health care, the terminology and types of stigma, the conditions commonly faced with stigma in pediatrics, the components of evidence-based anti-stigma initiatives, and guidance to effect change within a pediatric practice. The authors outline the negative effects of stigma in pediatrics and how to combat the problem at the source, and explore self-stigma, public stigma, and structural stigma and how it applies to weight, diabetes, disability, HIV, mental health, and substance use in pediatrics. [ABSTRACT FROM AUTHOR]

Long-term antidepressant (AD) use, much longer than recommended, is very common and can lead to potential harms. To investigate the existing literature on perspectives of health professionals (HPs) regarding long-term AD treatment, focusing on barriers and facilitators to discontinuation. A systematic review with thematic synthesis. Eight electronic databases were searched until August 2023 including MEDLINE, PubMed, Embase, PsycINFO, CINAHL, AMED, Health Management Information Consortium, and the Networked Digital Library of Theses and Dissertation. Thirteen studies were included in the review. Of these, nine focused on general practitioner perspectives, one on psychiatrist perspectives, and three on a mix of HPs perspectives. Barriers and facilitators to discontinuing long-term ADs emerged within eight themes, ordered chronologically based on HP considerations during an AD review: perception of AD use, fears, HP role and responsibility, HPs' perception of AD discontinuation, HPs' confidence regarding their ability to manage discontinuation, perceived patient readiness to stop, support from patient's trusted people, and support from other HPs. Coding and development of subthemes and themes was performed by one researcher and further developed through discussion within the research team. Deprescribing long-term ADs is a challenging concept for HPs. The review found evidence that the barriers far outweigh the facilitators with fear of relapse as a main barrier. HP education, reassurance and confidence-building is essential to increase the initiation of the discontinuation process. Further research into the perspectives of pharmacists and mental health workers is needed as well as exploring the role of trusted people. • Long-term antidepressant use is common and can lead to potential harms. • The discontinuation of antidepressants is a challenging concept for health care professionals. • Confidence-building is essential to increase the initiation of the discontinuation process. • Further research into pharmacist's and mental health workers' perspective is needed. [ABSTRACT FROM AUTHOR]

Health Care Professionals (HCPs) are the main end-users of digital clinical tools such as electronic prescription systems. For this reason, it is of high importance to include HCPs throughout the design, development and evaluation of a newly introduced system to ensure its usefulness, as well as confirm that it tends to their needs and can be integrated in their everyday clinical practice. In the context of the PrescIT project, an electronic prescription platform with three services was developed (i.e., Prescription Check, Prescription Suggestion, Therapeutic Prescription Monitoring). To allow an iterative process of discovery through user feedback, design and implementation, a two-phase evaluation was carried out, with the participation of HCPs from three hospitals in Northern Greece. The two-phase evaluation included presentations of the platform, followed by think-aloud sessions, individual platform testing and the collection of qualitative as well as quantitative feedback, through standard questionnaires (e.g., SUS, PSSUQ). Twenty one HCPs (8 in the first, 18 in the second phase, and five present in both) participated in the two-phase evaluation. HCPs comprised clinicians varying in their specialty and one pharmacist. Clinicians' feedback during the first evaluation phase already deemed usability as "excellent" (with SUS scores ranging from 75 to 95/100, showing a mean value of 86.6 and SD of 9.2) but also provided additional user requirements, which further shaped and improved the services. In the second evaluation phase, clinicians explored the system's usability, and identified the services' strengths and weaknesses. Clinicians perceived the platform as useful, as it provides information on potential adverse drug reactions, drug-to-drug interactions and suggests medications that are compatible with patients' comorbidities and current medication. The developed PrescIT platform aims to increase overall safety and effectiveness of healthcare services. Therefore, including clinicians in a two-phase evaluation confirmed that the introduced system is useful, tends to the users' needs, does not create fatigue and can be integrated in their everyday clinical practice to support clinical decision and e-prescribing. [ABSTRACT FROM AUTHOR]

• Previous research into the competence of healthcare professionals in the stroke care pathway does not offer a complete picture of the relevant issues. • The overall level of competence of healthcare professionals in the stroke care pathway was good. Multiprofessional and collaboration competence were the strongest areas of competence. In contrast, competence to use evidence-based information was rated as the weakest area of competence. The competence profiles were found to be influenced by healthcare professionals' occupation, and their participation in their organization's expert network. • The results of the study can be used to inform competence development, competence management, and the design of continuing education. Nursing managers can use the results of this study to identify staff competencies and skills gaps. To describe healthcare professionals' self-assessed competence in stroke care pathways based on their self-evaluation and identify the factors associated with competence. A cross-sectional, descriptive explorative study design was used. The data were collected during May and September 2021 through a survey sent to healthcare professionals (N= 1200, n= 215) working in neurological care. Competence in stroke care pathways was measured using the RN-STROKE, PT-STROKE and OT-STROKE instruments defined by four-factor model. The instruments' validity and reliability were confirmed through exploratory factor analysis and Cronbach's alpha. K-means clustering, one-way ANOVA, Chi Square, Mann Whitney U and Kruskal-Wallis were used to analyze the data. The results were reported as frequencies, percentages, mean and standard deviation. The results were reported according to STROBE guidelines. Four main areas of healthcare professionals' competence in stroke care pathways were identified: (1) counseling and interaction competence (2) competence to use evidence-based information, (3) self-management and development competence, and (4) multiprofessional and collaboration competence. The study then identified three competence profiles of healthcare professionals working in the stroke care pathway. Professionals in Profile A evaluated their competence at the highest level, those in Profile B at the average level, and those in Profile C at the lowest level. Healthcare professionals' occupation and participation in their organisation's expert network were found to be associated with competence profiles. The overall competence of healthcare professionals in the stroke care pathway was rated as good, but competence to use evidence-based information in clinical practice, in particular, should be improved. Organisations should, therefore, increase education and training in this area and provide adequate resources to enable the use of evidence-based information in clinical work. The study identifies three profiles relating to healthcare professionals' competence in the stroke care pathway, which can be used to create continuous education and ensure better patient care according to participants' profiles. The study was reported using the STROBE Statement checklist. No patient or public contribution. [ABSTRACT FROM AUTHOR]

This study aimed to develop the inadvertent perioperative hypothermia knowledge test (IPH-KT) for health care professionals and examine its validity and reliability. The methodological and cross-sectional study design was used. The research was carried out with 326 nursing students in Turkey. Data for the study were collected using a demographic information form and the IPH-KT. The item difficulty index and item distinctiveness index of the questions included in the draft form of the 25-item test ranged from 0.03 to 0.81 and from 0.25 to 0.99, respectively. After the analyses, 8 items were excluded from the draft test, and the final version of the test consisted of 17 questions. The item difficulty index of the final test ranged from 0.30 to 0.96, and the item distinctiveness index ranged from 0.33 to 0.81. The reliability of the test was determined using the Kuder-Richardson formula 20 and found to be 0.72, indicating high internal consistency. Therefore, the IPH-KT was accepted as a reliable test. The study revealed that the questions in the IPH-KT had varying difficulty levels and a high ability to discriminate between individuals with knowledge of IPH and those without. The results demonstrated that the test had good content and face validity and showed high reliability for measuring the IPH knowledge of nursing students. [ABSTRACT FROM AUTHOR]

• The model and components of acute care that optimise patient-centred outcomes in injured older patients are not defined. • There is variability in models and components of acute care for injured older patients across Australia and New Zealand. • Opportunity exists to standardise and validate models of care optimising patient-centred outcomes in injured older patients. The epidemiology of injured patients has changed, with an increasing predominance of severe injury and deaths in older (65 years and above) patients after low falls. There is little evidence of the models of care that optimise outcomes for injured older patients. This study aims to describe clinician perspectives of existing models of acute care for injured older patients in Australia and New Zealand. This cross-sectional online survey of healthcare professionals (HCP) managing injured older patients in Australia or New Zealand hospitals was conducted between November 2nd and December 12th, 2020. Recruitment was via survey link and snowball sampling to professional organisations and special interest groups via email and social media. HCP were asked, using a Likert scale, how likely four typical case vignettes were to be admitted to one of twelve options for ongoing care. Additional questions explored usual care components. Participants (n=157) were predominantly Australian medical professionals in a major trauma service (MTS) or metropolitan hospital. The most common age defining "geriatric" was aged 65 years and older (43%). HCP described variability in the models and components of acute care for older injured patients in Australia and New Zealand. As a component of care, cognitive, delirium and frailty screening are occurring (60%, 61%, 46%) with HCP from non-major trauma services (non-MTS) reporting frailty and cognitive impairment screening more likely to occur in the emergency department (ED). Access to an acute pain service was more likely in a MTS. Participants described poor likelihood of a geriatrician (highest 16%) or physician (highest 12%) review in ED Despite a low response rate, HCP in Australia and New Zealand describe variability in acute care pathways for injured older patients. Given the change in epidemiology of injury towards older patients with low force mechanisms, models of acute injury care should be evaluated to define a cost-effective model and components of care that optimise patient-centred outcomes relevant to injured older patients. HCP described some factors they perceive to determine care, and outcomes of variability, offering guidance for future research and resource allocation in the Australia and New Zealand trauma system. [ABSTRACT FROM AUTHOR]

The Danish health care system provides palliative care for terminally ill patients and their family caregivers. However, initiatives to support family caregivers are not systematically organized. We aimed to examine the association between self-reported experience of missing contact to health care professionals involved in palliative care, and symptoms of grief and depression three years post-loss. We conducted a prospective population-based survey of 3635 family caregivers to terminally ill patients. At six months follow-up, the caregivers reported whether they missed contact to the general practitioner, home care nurse, hospital staff, and/or palliative care team. Associations between missing contact and symptoms of prolonged grief (Prolonged-Grief-13) and depression (Beck Depression Inventory-II) three years after bereavement were analyzed with multivariable logistic regression analysis. We found that an experience of missing contact with health care professionals six months after bereavement was significantly associated with symptoms indicative of prolonged grief disorder and depression after three years. The strongest association was found for missing contact with the general practitioner with an adjusted OR = 4.0 (95%CI: 1.9;8.3) for prolonged grief and an adjusted OR = 5.2 (95% CI: 3.4;7.9) for depression. Experiencing missing contact with health care professionals shortly after bereavement was associated with adverse psychological reactions. Family caregivers may benefit from bereavement support to prevent further complications. A proactive approach with assessment of support needs and risk of complications early during the patient's illness trajectory may target support at those who needs it. [ABSTRACT FROM AUTHOR]

To determine the experiences and perceptions of patients who underwent Coronary Artery Bypass Graft (CABG) surgery with perioperative health care professionals. The study used a qualitative research design and was conducted by interviewing eight patients who underwent CABG surgery. Study data were collected between April 24, 2020 and February 25, 2021 via a demographic information form and a semi-structured interview form and analyzed by using Heidegger's phenomenological approach. The participants were between the ages of 51 and 70. They were patients who had undergone CABG surgery 2 months before data collection. Two themes were elicited from the interviews: "If you are bad, I am bad, too", which indicated negative experiences of CABG, and "If you are good, I am safe", which indicated positive patient experiences. In addition, eight sub-themes were determined under these two themes. In the perioperative process, patients may experience feelings of restlessness, fear, vulnerability, insecurity, and threat when ignored by health care professionals. The provision of interaction between the health professional and the patient, along with family support, changes the perceived care positively and makes patients feel cared for, well, and safe. Awareness of health care professionals about patient experiences during the CABG surgery process points to an important aspect of quality health care. [ABSTRACT FROM AUTHOR]

Due to the rise of the nurse practitioner (NP) role in long-term care settings, it is important to understand the underlying structures and processes that influence NP and physician care models. This scoping review aims to answer the question, "What are the structures, processes, and outcomes of care models involving NPs and physicians in long-term care (LTC) homes?" A secondary aim was to describe the structural enablers and barriers across care models. Seven databases were searched. Studies that described NPs and physicians working in LTC were identified and included in the review. We stratified the findings by care model and synthesized using the Donabedian model, which evaluates health care quality based on 3 dimensions: structure, process, and outcome. We then categorized macro, meso, and micro structural enablers and barriers. Sixty papers were included in the review. The main structural influencers within 5 care models included policies on scope of practice, clarity of role description, and workload. A limited number of papers referred to the process of enabling the development of a working relationship. Thirty-five (49%) studies described resident, staff, and health system outcomes. Although structural characteristics of NP and physician care models are described in-depth, there is less detail on the processes that occur within the NP and physician care models. We highlight structural barriers and enablers within the care models, allowing for recognition of the importance of organizational influence on the NP and physician relationship. Future work should focus on the processes of the relationships in the models by identifying the drivers and initiators of collaboration between NPs and physicians and how these relationships influence outcomes. [ABSTRACT FROM AUTHOR]

Doctors and nurses are central in the challenging task of end-of-life (EOL) care, and this study aims to explore and describe doctors' and nurses' experiences of recognition and acknowledgment of the end of life for patients with cancer. A qualitative, explorative research design with individual interviews was carried out based on a semi-open interview guide. A total of 6 doctors and 6 nurses working in medical or surgical departments at a Norwegian University hospital were interviewed. The interviews were analyzed using qualitative content analysis. The study's findings highlight that recognizing and acknowledging patients with cancer as being at end-of-life is a challenging process. Three subthemes emerged from the analysis; the significance of being experienced , the significance of organizational structures, and the significance of having a common understanding. A main theme was analyzed further and abstracted from the subthemes ; Being safe to manage the balancing act of recognizing and acknowledging the end of life. Much is at stake in the EOL setting, and healthcare professionals (HCP) must balance several aspects regarding EOL decisions. Striking the right balance in these situations is challenging. HCPs need a safety net through collaboration with, and support from, colleagues, supporting organizational structures and experience. Strengthening the safety net will have a clear impact on improving clinical practice to reduce futile treatment and provide high-quality EOL care for all dying patients in hospitals. • Recognizing and acknowledging patients as being at the end of life is a challenging process for healthcare professionals. • Healthcare professionals must balance several aspects regarding end-of- life decisions. • Healthcare professionals need a safety net grounded in personal relations, knowledge, experienced-based elements, and support by organizational structures to be able to timely recognize and acknowledge end-of- life. [ABSTRACT FROM AUTHOR]

Background: Understanding the perspective of health care professionals (HCPs) is significant to the implementation of deprescribing in older adults with limited life expectancy (LLE) but a tool to assess this is lacking.Objective: This study aimed to develop and validate a survey tool for assessing HCPs attitudes towards deprescribing (HATD) in older adults with LLE.Methods: An online survey was used to collect data to determine the psychometric properties of a 49-item questionnaire generated from literature review, expert opinion and pretesting. 108 HCPs (doctors, nurses and pharmacists) with experience or interest in palliative care or a member of a palliative care team/organisation completed the survey.Results: Principal component analysis of the participants' data resulted in a 23-item questionnaire structured in five factors, named HATD tool. The factors were related to concerns about deprescribing (7 items), perceived burden of medications on patients (7 items), organisational support for deprescribing (4 items), assurance to deprescribing (2 items) and perceived involvement of patients in medication management (3 items). The HATD tool had valid descriptive statistics (Kaiser-Meyer-Olkin measure: 0.708; Bartlett's test of sphericity: p < 0.001, determinant: 1.35E-5; variance explained: 60.4%; nonredundant residuals with absolute values > 0.05: 39%). The reliability statistics of all the factors were ≥0.750 for both Cronbach's alpha (α) and composite reliability (CR) except for the patient-involvement factor (α = 0.644 but CR = 0.787).Conclusions: The 23-itemed HATD tool is a valid and reliable tool to assess the attitudes and beliefs of HCPs towards deprescribing in older adults with LLE in the Australian setting. [ABSTRACT FROM AUTHOR]

• Most of the participants provided direct health care to COVID-19 patients. • Many health care professionals changed respirators/surgical mask less times than recommended. • Respirators were more prone to adverse effects, when compared to surgical masks. • Average number of errors reported was higher for Mask than for Resp. • The most frequent errors were touching the front while in use and omitting hand hygiene. During COVID-19 pandemic, a shortage of surgical masks (Mask) and respirators (Resp) was experienced worldwide. We aimed to assess its pattern of use, adverse effects and user errors by Portuguese health care professionals (HCP). A cross-sectional study was conducted through snowball convenience sample, collected by email/ social media to health care organizations. Participants answered an online anonymous survey in March 2021. Mean age of 3052 respondents was 42.1 years old, 83.6% were female and 77.8% provided direct health care to COVID-19 patients. Mean time of use per shift was 6-8 hours in 40.8% of the participants. 28.0% reported never changing it during their shift. Resp use (vs Mask) was more associated with discomfort (58.2% vs 26.8%), affecting task performance (41.5 vs 18.9%) and communication (55.0 vs 40.9%), dyspnea (36.0 vs 14.4%), skin rash (37.5 vs 19.4%) and headache (37.5 vs 19.4%). Frequent user errors included touching the front while in use (70.1% Mask vs 66.3% Resp) and omitting hand hygiene before (61.8% Mask vs 55.0% Resp) or after use (61.3% Mask vs 57.0% Resp). Average number of errors was higher for Mask (4.3), than for Resp (3.2) (all: P <.001). Most HCP admitted an extended use of Mask/ Resp. Resp were more prone to adverse effects and Mask more prone to errors. Strategies to reinforce good practices should be considered. [ABSTRACT FROM AUTHOR]

Current follow-up for head and neck cancer (HNC) is ineffective, expensive and fails to address patients' needs. The PETNECK2 trial will compare a new model of patient-initiated follow-up (PIFU) with routine scheduled follow-up. This article reports UK clinicians' views about HNC follow-up and PIFU, to inform the trial design. Online focus groups with surgeons (ear, nose and throat/maxillofacial), oncologists, clinical nurse specialists and allied health professionals. Clinicians were recruited from professional bodies, mailing lists and personal contacts. Focus groups explored views on current follow-up and acceptability of the proposed PIFU intervention and randomised controlled trial design (presented by the study co-chief investigator), preferences, margins of equipoise, potential organisational barriers and thoughts about the content and format of PIFU. Data were interpreted using inductive thematic analysis. Eight focus groups with 34 clinicians were conducted. Clinicians highlighted already known limitations with HNC follow-up – lack of flexibility to address the wide-ranging needs of HNC patients, expense and lack of evidence – and agreed that follow-up needs to change. They were enthusiastic about the PETNECK2 trial to develop and evaluate PIFU but had concerns that PIFU may not suit disengaged patients and may aggravate patient anxiety/fear of recurrence and delay detection of recurrence. Anticipated issues with implementation included ensuring a reliable route back to clinic and workload burden on nurses and allied health professionals. Clinicians supported the evaluation of PIFU but voiced concerns about barriers to help-seeking. An emphasis on patient engagement, psychosocial issues, symptom reporting and reliable, quick routes back to clinic will be important. Certain patient groups may be less suited to PIFU, which will be evaluated in the trial. Early, meaningful, ongoing engagement with clinical teams and managers around the trial rationale and recruitment process will be important to discourage selective recruitment and address risk-averse behaviour and potential workload burden. • Head and neck cancer clinicians agree follow-up regimens need to change. • If proven effective, patient-initiated follow-up may improve patient-centredness. • Clinician concerns include the suitability of patient-initiated follow-up for all. • Patient-initiated follow-up may impose additional burden on some clinicians. • Patient-initiated follow-up may not suit 'disengaged'/high-risk/deprived patients. [ABSTRACT FROM AUTHOR]

Language and communication have an impact on how a clinical condition is treated and experienced, from both the health care professional (HCP) and patient perspective. Malnutrition is prevalent among community-dwelling older adults, yet perceptions of patient understanding of the term malnutrition to date remain underexplored. This qualitative study explored the use and perceptions of the term malnutrition among HCPs and older adults at risk of malnutrition. Semi-structured interviews and focus groups were conducted with HCPs and older adults with a prescription for oral nutritional supplements (ONS) in the community, to explore perspectives. HCPs with experience of working with older adults were recruited in primary care centers, general practitioner practices, community health organizations, and community pharmacies in County Dublin, Ireland, between 2018 and 2019. Older adults, aged ≥60 years, with a current or previous prescription for ONS were recruited from daycare centers. One-to-one interviews were conducted with general practitioners (n = 16) and patients (n = 13), and focus groups were conducted with other HCPs, including dietitians (n = 22), nurses (n = 22), pharmacists (n = 9), physiotherapists (n = 12), occupational therapists (n = 6), and speech and language therapists (n = 4). Data from interviews and focus groups were transcribed verbatim and analyzed using thematic analysis. There was mutual agreement between HCPs and patients on the main theme, "malnutrition is a term to be avoided." There were three subthemes with varying input from the different HCP groups and patients: "Malnutrition is a term a patient doesn't want to hear"—malnutrition has negative connotations that imply neglect and stigma; "malnutrition is a clinical term which patients don't understand"—with perceptions that it is better to substitute the term with simpler motivating messages; and "lack of confidence identifying malnutrition"—expressed by non-dietetics HCPs who believed they had insufficient expertise on malnutrition to communicate effectively with patients. HCPs and patients perceived negative connotations with the term malnutrition, and HCPs used alternatives in practice. Additional consultation with HCPs and patients is recommended to explore appropriate language for conveying health risks associated with malnutrition. Future research should also address how current communication challenges can be addressed as part of strategic management programs or interventions to prevent and treat malnutrition. [ABSTRACT FROM AUTHOR]

Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug resistant organism recognized as major cause of infections ranging from relatively minor skin and soft tissue infections to life-threatening systemic infections. Contact transmission from health care personnel (HCP) to the patients provides the main mode of transmission of MRSA. Screening of HCPs colonized with MRSA may aid in preventing spread of this organism. Two samples were collected from 200 HCP which included sample from anterior nares and web spaces of both hands. Identification of Staphylococcus aureus and MRSA strains were done as per standard operating protocol. Results were compiled, tabulated, and all data were subjected to SPSS, version 17.0 software for analysis. About 25.5% (51 HCPs) were carriers of S aureus and among them 6.5% (13 HCPs) were carriers of MRSA. Among the MRSA carriers, 28.4% were physicians, followed by nursing interns (21.1%), MBBS interns (9%), nurses (5.4%), and others, that is, physiotherapist, housekeeping staff, and helping staff (37.5%). In spite of having infection control policies in place, MRSA carriage rate was 6.5%. This signifies the importance of periodic systematic screening of all HCPs and decolonization, which may help in eliminating the burden of MRSA carrier status and spread of infection in the health care setting. [ABSTRACT FROM AUTHOR]

Background: Thorough investigation of sudden cardiac death (SCD) in those aged 1-40 years commonly reveals a heritable cause, yet access to postmortem genetic testing is variable.Objective: The purpose of this study was to explore practices of postmortem genetic testing and attitudes of health care professionals worldwide.Methods: A survey was administered among health care professionals recruited through professional associations, social media, and networks of researchers. Topics included practices around postmortem genetic testing, level of confidence in health care professionals' ability, and attitudes toward postmortem genetic testing practices.Results: There were 112 respondents, with 93% from North America, Europe, and Australia/New Zealand, and 7% from South America, Asia and Africa. Only 30% reported autopsy as mandatory, and overall practices were largely case by case and not standardized. North American respondents (87%) more often perceived practices as ineffective compared to those from Europe (58%) and Australia/New Zealand (48%; P = .002). Where a heritable cause is suspected, 69% considered postmortem genetic testing and 61% offered genetic counseling to surviving family members. Financial resources varied widely. Half of participants believed practices in their countries perpetuated health inequalities.Conclusion: Postmortem genetic testing is not consistently available in the investigation of young SCD despite being a recommendation in international guidelines. Access to postmortem genetic testing, which is critical in ascertaining a cause of death in many cases, must be guided by well-resourced, multidisciplinary teams. [ABSTRACT FROM AUTHOR]

Context: Drug therapy is an integral part of palliative care but pharmacotherapy can be challenging for health care professionals. Access to information is essential for health care providers to choose the best drug treatment for an individual patient. A drug information service can support health care professionals to obtain appropriate, unbiased information.Objectives: To describe the enquiries to a palliative care drug information service. Objectives are to determine the information needs (including off-label use) of different professional groups and areas of care, to identify subject areas and drug substances for which there is a high need for information.Methods: Retrospective evaluation of all enquiries to a palliative care drug information service within 24 months from July 2017 to June 2019.Results: During the study period, 477 enquiries reached the drug information service, mostly from physicians (59%), followed by pharmacists (31%). Ketamin was the most discussed drug (11%), in general enquiries or corresponding replies mostly contained drugs targeting the nervous system, such as analgesics. Application techniques (26%) was the most relevant category, cancer pain (24%) was the most frequently addressed symptom. About half of the enquiries (48%) dealt with off-label us, regarding an application mode outside the license.Conclusion: The information needs on palliative care pharmacotherapy seem to be particularly high among physicians. The demand for information in the area of application technology is particularly apparent and demonstrates a therapeutic gap in terms of availability of suitable preparations as well as necessary information. [ABSTRACT FROM AUTHOR]

We examined the manifestation of major depressive disorder, generalized anxiety disorder, substance use disorder, post-traumatic stress disorder, and panic attacks among health care professionals during the first COVID-19 wave (n = 6409) by means of mental disorder screening instruments. Logistic regressions were used to gauge individual risk factors; population attributable risk proportions (PARP) were inferred to identify the most important risk factors at the societal level. Data were weighted to represent general profiles of Belgian health care professionals. Lifetime, pre-pandemic emotional problems and work-related factors during the first wave of COVID-19 were strongly associated (mean adjusted odds ratios of 3.79 and 1.47, respectively) with positive screens for current mental disorders (occurrence of 29.3%). Most prominently, the data suggest that disruptions of work-life balance account for more than a quarter of the observed mental health problems due to the combination of widespread occurrence and strong association. [ABSTRACT FROM AUTHOR]

In late 2019, the world saw a viral outbreak of unprecedented scale that sent a significant fraction of humankind into either quarantine or lockdown. Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which was first recognized in Wuhan, China, in December 2019. We created and administered a 17-item questionnaire for health care professionals (HCPs) to assess their level of knowledge towards this ongoing and evolving pandemic. It was disseminated through Web- and mobile-based social networks. The questions were sourced and created from various standard national and international guidelines available at the time of writing. A total of 827 medical personnel participated in the study. Among them, 65.5% scored between 60% and 79%, indicating a moderate level of knowledge. There was no statistically significant difference in the scores of doctors, nursing officers and dental surgeons (p = 0.200). Participants had good knowledge regarding clinical symptoms, mode of transmission and preventive measures. But the study identified some gaps in knowledge in the implementation of management protocols, handling of dead bodies and biomedical waste management of COVID-19 cases. With this understanding, regular training, drills and knowledge dissemination along with skill development through learning correct practices focusing on HCP at all levels are the current needs. [ABSTRACT FROM AUTHOR]

One of the broadly talked about class of medications for their extravagantly expanded abuse is proton pump inhibitors (PPIs). In spite of the fact that, they are known to be profoundly useful, it is accounted for several adverse manifestations. Health care professionals can assume an essential part in controlling its irrational use. The purpose of this study was to explore the knowledge, attitude and behavior of health care professionals of Riyadh region of Saudi Arabia on the use of PPIs by a cross-sectional study design. The study data was obtained through a validated self-administered questionnaire covering knowledge (20 items), attitude (8 items) and behavior (6 items). Furthermore, demographic questions were placed to decide their effect on the intended three domains. The results were analysed by descriptive analysis and affirmed by multinomial regression method using SPSS-IBM 25. Of 414 surveyors, 121 (31%), 182 (44%) and 103 (25%) were doctors, pharmacist and nurses, respectively. Average age of participants' was 33.96 ± 8.37 years. Both doctors and pharmacist showed better degree of information (13.17/20 and 13.25/20) and good attitude (6.66/8 and 6.9/8) towards PPI use compared to nurses. Altogether higher extent of knowledge score showed by highly educated individuals, middle age groups and those with more practicing experience. The reliance on the utilization of PPI is less among pharmacist and nurses when compared to doctors. The outcome of the regression analysis exhibited that the odds of having low knowledge is more in young and bachelor degree holders. Healthcare professionals in the Riyadh area are generally positive about the use of PPIs. However, increasing their level of knowledge and reducing their reliance on PPIs must be strengthened. Frequent professional development programs and trainings for healthcare professionals are needed to minimize widespread PPI overuse. [ABSTRACT FROM AUTHOR]

• Three themes emerged from the data: Risk assessment and planning, innovative evolution of roles and responsibilities, and pandemic response and capacity. • In a rapidly changing landscape of practice protocols and discipline-specific responsibilities, it is important to secure capacity-building resources early on. • Hierarchies seemed to compress during the pandemic, with a leveling of the traditional roles played by different professions. • Clear, concise, and consistent information must be accessible to all staff. Little is known about clinical staff's perspectives on preparedness for a pandemic. The purpose of this study was to obtain various clinical staff perspectives about preparedness to meet the demands for care during the early phase of the SARS-CoV-2 (COVID-19) pandemic. We conducted a qualitative study using semistructured in-person interviews from March 2020 to April 2020 at a large tertiary academic urban hospital center. Interview guides were informed by the Resilience Framework for Public Health Emergency Preparedness and analyzed using a directed content analysis approach. Fifty-five clinical staff participated in the study. Three themes emerged from the data (1) Risk assessment and planning: "The powder keg," (2) Innovative evolution of roles and responsibilities, and (3) Pandemic response and capacity. In the early phases of the pandemic, participants reported varying levels of risks for dying. However, most participants adapted to practice changes and became innovative in their roles over time. Hierarchies were less relevant during care delivery, whereas team collaboration became crucial in managing workforce capacity. As the pandemic progressed, staff preparedness evolved through a trial-and-error approach. The pandemic is evolving as is clinical staff preparedness to meet the demands of a pandemic. In order to get a grasp on the crisis, clinical staff relied on each other and resorted to new workarounds. [ABSTRACT FROM AUTHOR]

• Sick leave during pregnancy is frequent. • Sick leave during pregnancy is associated with working conditions. • Reasons for sick leave are discomfort such as nausea, Braxton Hicks, Low back and pelvic pain. • The literature lacks knowledge on the effect of interventions with-in the workplace. Sick leave during pregnancy is frequent and 36 % of Danish pregnant employees are on sick leave > 14 days. Health care professionals are considered a risk population. This intervention applies preventive sessions including the pregnant employee, her manager and a midwife in addition to usual practice at Aarhus University Hospital, Denmark (AUH). It is hypothesised that pregnant employees who participate in preventive sessions will have less sick leave and report better wellbeing compared to the reference group. All departments at AUH are cluster randomized. A total of 25 and 24 departments are allocated to the intervention and reference group, respectively. The intervention is protocolled with preventive sessions in addition to usual practice. The reference group receives usual practice. The primary outcome is mean number of days on sick leave during pregnancy. Secondary outcomes are wellbeing measured as physical and mental health, general work ability, work-life balance, manager support, and completed work adjustments during pregnancy. Data on sick leave will be collected from the hospital payment system and survey data will be collected at inclusion and follow-up. This study will contribute to limited experimental research aimed to reduce sickness leave during pregnancy. The overall strength is the study design with easy access to study participants within a large hospital. The main limitation of the study is the high complexity of the study. The trial is registered in ClinicalTrials.gov with ID number 29-2019-03. [ABSTRACT FROM AUTHOR]

Health care professionals working in delivery rooms often encounter stressful situations. Understanding their challenges and the support they receive is essential for improving their well-being and consequently patient care. Examining the relationship between burnout, intentions to leave, post-traumatic stress disorder (PTSD) symptoms, and complex PTSD among health care professionals, and identifying their predictors. A mixed methods design, including a survey among 196 midwives and gynecologists assessing burnout, intentions to leave, exposure to negative work experiences and PTSD, as well as 15 semi-structured interviews. Most participants experienced multiple difficult events in the delivery room, reporting insufficient emotional support. Burnout and lack of emotional support were significant predictors of PTSD symptoms. Participants expressed a need for emotional support to cope with complex situations. Burnout among midwives must be addressed through prevention and intervention programs. Emotional support is essential in mitigating PTSD symptoms among midwives and gynecologists, enhancing their resilience and well-being. • Burnout among midwives is a serious problem that needs to be addressed. • Health care institutions can do this by using prevention and intervention programs. • Emotional support has a crucial role in mitigating PTSD symptoms. • The study provides a foundation for the coping of professionals in maternity wards. [ABSTRACT FROM AUTHOR]

• Simulation-based training contributes to individual and collective learning. • Health care professionals not knowing each other impacts negatively on the simulation-based training as a whole. • It was the health care professionals' responsibility to create realism. The aim of the study was to explore health care professionals' experiences of participating in simulation-based training (SBT). Individual semistructured interviews were conducted at two in-house training centres with 23 health care professionals representing different occupations, such as midwives, assistant nurses, registered nurses, and physicians among others. The data were analysed by thematic analysis. Five main themes emerged: Being able to grow in one's professional role, Coming together is fun, isn't it?, Being helped with a structured approach, Learning from feedback , and Creating the best out of (sur)realism. Overall, the health care professionals experienced SBT as positive, valuable, and as providing learning opportunities. Conversely, they expressed difficulties in communication and providing/receiving feedback, in particular when they were not known to the group or were less experienced in SBT. SBT allows health care professionals to improve not only in the SBT process but also prepares them for clinical practice and to develop their communication and teamwork skills. [ABSTRACT FROM AUTHOR]

The purpose was to describe health care professionals' experience of using the World Health Organization (WHO) surgical safety checklist. A descriptive cross-sectional mixed-method study, including health care professionals from two clinics at the same university hospital in the western part of Sweden was conducted. Data were collected from one hundred ninety-six health care professionals using a self-administered questionnaire that contained 12 questions. The Mantel-Haenszel and Pearson χ2 tests were used for ordered and unordered categorical variables. The text analysis was inspired by Malterud. The most statistically significant difference between the clinics related to the responsibility for administering the checklist (P =.0010) and always using the checklist in all emergency situations (P =.045). Among the health care professionals who were educated and trained in using checklists, 63% and 65.5% stated that the checklist was adapted to the department. Sixty four percent stated that the assistant nurses were responsible for implementing the checklist. The health care professionals also mentioned a large number of positive and negative aspects of using the WHO checklist. The health care professionals had difficulties using the WHO checklist in the Swedish health care system. More research is needed to determine why specific items are overlooked and whether these items could form the basis of the further elaboration of a modified checklist. An increased understanding of why the checklist is important, as well as updated knowledge on the content could produce greater compliance and thereby increase patient safety. [ABSTRACT FROM AUTHOR]

Objective: To test whether an intervention consisting of four patient-centered consultations improves glycemic control and self-management skills in patients with poorly regulated type 2 diabetes (T2DM), compared to a control group receiving usual care.Methods: Unblinded parallel randomized controlled trial including 97 adults diagnosed with T2DM ≥ 1 year and hemoglobin A1c (HbA1c) levels ≥ 8.0% (64 mmol/mol). Consultations incorporated tools supporting self-reflection, learning processes, and goal setting. Primary outcome was HbA1c. Secondary outcomes were autonomy support, motivation, self-management skills, and well-being.Results: Average HbA1c decreased slightly in both groups. Autonomy support and frequency of healthy eating were significantly higher in the intervention group. Most participants in the intervention group chose to set goals related to diet and physical exercise. Implementation of the intervention was inconsistent.Conclusion: Despite increased autonomy support and individual goal-setting, the intervention was not superior to usual care in terms of glycemic control. More research is needed on how individual preferences and goals can be supported in practice to achieve sustainable behavior changes.Practice Implications: The intervention promoted participant engagement and supported exploration of participants' challenges and preferences. Further exploration of more flexible use of tools adapted to individual contexts is recommended. [ABSTRACT FROM AUTHOR]

The aim of this review was to analyze the effectiveness of teaching healthcare professionals in perinatal palliative care, methods of evaluating the teaching, and the teaching strategies used. An integrative review. A systematic search was conducted for English language peer reviewed publications of any research design via SCOPUS, Medline/PubMed, EBSCOhost, Science Direct, ERIC, Web of Science, Wiley, Nursing Ovid, and ProQuest databases. Fourteen research papers published between 2002 and 2017 that met the selection criteria were included in the review. All 14 studies considered perinatal bereavement education to be effective. Eight studies reported statistical improvements in knowledge, security/comfort in providing end-of-life care, or increased perceptions of the emotional care needs of bereaved families, after attending an educational program. Questionnaires or interviews were used to evaluate the educational programs. Innovative teaching strategies, in particular, were evaluated positively (e.g., simulation, discussion, and arts-based methods). Perinatal palliative care education is essential in pregradual education for midwives and neonatal nurses. Other research is vital for finding out the effectiveness of this education for pregraduate nursing students. Perinatal palliative care education programs need to be available in postgraduate education for professionals who encounter perinatal death and bereaved families in hospital and community care. [ABSTRACT FROM AUTHOR]

Background: Recent decades have revealed a growing use of medicines for non-disease conditions, especially among university students. The prevalence rates for the use of study drugs (SDs), i.e. prescription stimulants and β-blockers, range from 2 to 20% among students worldwide. However, SD use does not take place in a vacuum. Like any other health-related behavior, medicine use takes place in specific social and cultural contexts, and there is very little scholarly work on these contextual aspects of SD use.Objective: This article aims to explore university students' use of SDs through the perceptions and practices of university counselors, general practitioners (GPs), psychiatrists, and from student polls in Denmark, in order to advocate for a contextual approach to SD use.Methods: The article relies on data from three different data sets involving a total of 18 semi-structured interviews, seven study counselors, nine GPs, and two psychiatrists, as well as votes from eight in-class polls conducted among approximately 300 university students in total. Data were collected between 2012 and 2017 and analyzed through meaning condensation and categorization.Results: The study shows that a great variety of perceptions and practices concerning SDs exists. While study counselors generally do not hear much about SDs from students, except for those seeking help with regard to β-blockers, they link the pressure, competition and perfectionism among students to a more general explanation of why some students may feel the need to use SDs. GPs meet students seeking SDs, but differ significantly in how they align their perceptions with their prescribing practices. The psychiatrists who participated in the study expressed widely different perceptions and practices regarding SDs. Finally, student polls indicate that students' opinions on SDs are also highly divided.Conclusion: The lack of consensus on SDs among professionals in health and education may contribute to students' divided opinions about SDs, just as it provides students with an opportunity to legitimize their use of SDs. [ABSTRACT FROM AUTHOR]

In clinical medicine, shared decision making (SDM) is a well-recognized strategy to enhance engagement of both patients and clinicians in medical decisions. The success of liver-directed gene therapy (GT) to transform severe congenital haemophilia A (HA) from an incurable to a curable disease has launched a shift beyond current standards of treatment. However, GT acceptance remains low in the community of HA persons. We argue for both persons with haemophilia (PWH) and specialists in HA care including clinicians, as needing SDM-oriented educational programs devoted to GT. Here, we provide an ad hoc outline to implement education to SDM and tailor clinician information on GT to individual PWHs. Based on routine key components of SDM: patient priorities; recommendations based on individual risk reduction; adverse effects; drug-drug interactions; alternatives to GT; and ongoing re-assessment of the objectives as risk factors (and individual priorities) change, this approach is finalized to exploit efficacious communication. [ABSTRACT FROM AUTHOR]

Human trafficking is characterized as a violation of human rights that exploits males and females of any age for personal or financial gain. Recently, health care professionals have been identified as feasible change agents in this global issue. However, many health care professionals are not trained in identifying and treating human trafficking victims. Through human trafficking education, health care professionals have the potential to be better equipped to recognize and assist trafficking victims and guide them to the specialized care they need. The purpose of this study was to measure the effect of a trauma-informed human trafficking education intervention and the impact of this training on the self-efficacy of health care professionals in identifying and recognizing human trafficking victims in healthcare settings. The study was a quasi-experimental research design with snowball and convenience recruitment 100 % virtual, online. Health care professionals (N = 30) including Nurse Practitioners, Physician Assistants, Registered Nurses, Licensed Practical Nurses, Certified Medical Assistants, Certified Nursing Assistants, Emergency Medical Technicians, and Paramedics from a variety of healthcare settings. 30 min total program to include Qualtrics pre-intervention Violence Against Women Health Care Provider survey, 20 min educational intervention on YouTube©, and an identical Qualtrics post-intervention survey. Total of 30 sets of paired data. The results showed statistically significant improvement in self-efficacy in all survey questions pre- and post-human trafficking educational intervention (p <.001). An increase in health care professionals' self-efficacy in identifying and treating human trafficking victims yields better patient and health care system outcomes. Trauma-informed human trafficking education for all health care professionals is recommended. • Health care professionals (HCPs) are in strategic positions to care for victims of human trafficking (HT) • HCPs lack training in HT • HT education for HCPs increases their self-efficacy in identifying and treating HT victims • When HCPs' self-efficacy is increased, HT victims have better health outcomes [ABSTRACT FROM AUTHOR]

Objectives: To identify and summarize evidence on interventions to promote the adoption of shared decision-making (SDM) among health care professionals (HCPs) in clinical practice.Methods: Electronic databases including: MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane library were searched to determine eligible peer-reviewed articles. Grey literature was searched for additional interventions. Eligibility screening and data extraction were independently completed. Results are presented as written evidence summaries and tables.Results: Our search yielded 238 articles that met our inclusion criteria. Interventions mostly targeted physicians (46%), had multiple educational modalities (46%), and were administered in group settings (44%) before the clinical encounter (71%). Very few were developed based on the learning needs of targeted HCPs (24%). Many of the SDM outcome tools used for evaluation were developed for the respective study and lacked evidence of validity and reliability (30%).Conclusion: We identified a sizable number of interventions to promote the adoption of SDM, however, these interventions were heterogeneous in their assessments for effectiveness and implementation. Therefore, it is a challenge to infer which strategies and practices are best to promote SDM adoption.Practice Implications: The need for evidence-based standards for developing SDM interventions targeting HCPs and assessing acceptability, effectiveness and implementation is suggested. [ABSTRACT FROM AUTHOR]

The purpose of the study was to explore experiences of older people with cancer in ascertaining the attributes of a person-centred approach in sustaining hope and enabling human flourishing. This was a qualitative study comparing patients and professional experiences and perceptions of care across to ward settings. Methods involved 10 semi-structured interviews conducted with patients and focus groups (n = 6) and 10 semi-structured interviews with health professionals. Three dissemination focus groups (n = 14) were also carried out with professionals to allow further analysis of the data. Two main themes were identified, including 'Emotional adaptations of hope: wants and expectations' and 'Hope through belittling their illness'. Findings highlight the way hope is conveyed and the emphasis' accorded to issues such as societal perceptions, knowledge, expectations of care, life stage, relationships, identity, and emotions. Findings also reinforce the importance of maintaining hope, recognising the different ways hope is used, and enabling patients to flourish. This study highlights how hope is facilitated through the interaction between patients and professionals and that the relational interactive stance. This current study establishes that hope seemed to be temporal, contextual and dynamic in nature, involving an ongoing process. Helping older people with cancer to understand their illness considering the situation of lives and experiences is essential to address expectations and wants. • The study contributes to research of older people with cancer managing hope in relation to their future lives in diverse settings. • Findings demonstrate the importance of the meaning of hope to ensure future expectations are a reality and the importance of relational care. • The study highlights differing types of hope voiced by patients depending on the context of care, 'notion of sameness' and 'comparison to others'. • This study demonstrates that hope is temporal, contextual and dynamic in nature, which involves an iterative process. [ABSTRACT FROM AUTHOR]

Background: Chronic heart failure is a complex and multifaceted syndrome characterised by an unpredictable trajectory, high symptom burden and reduced quality of life. Although palliative care is recommended, patient, provider and system factors limit access.Aim: To examine the knowledge, attitudes and perspectives of health care professionals towards end of life care and palliative care for patients with chronic heart failure.Design: This is an integrative review.Data Sources: CINAHL, Academic Search Complete and SCOPUS were searched. Specific inclusion criteria and search terms were used. The integrative review method entailed analysing data from primary articles using the constant comparison method and then synthesising data.Results: Twenty-six (26) articles were selected that explored health care professionals' perspectives towards end of life care and palliative care. The categories that emerged were grouped into patient, provider and system issues. Most health care professionals involved in providing care to heart failure patients have misperceptions of palliative care, often confusing it with end of life and hospice care. This hinders patients' access to palliative care as determining the end of life period in heart failure is difficult.Conclusions: Exploring health care professionals' perspectives towards the delivery of end of life care and palliative care is important for understanding how their practice influences the delivery of palliative care for heart failure patients. Emphasis on increasing awareness of the principles of palliative care in the health care community, as well as addressing organisational issues will improve the care delivered to these patients. [ABSTRACT FROM AUTHOR]

• Positive patient outcomes result of pharmacists interactions with patients. • Nurses and physicians had positive views of clinical pharmacists' role at a psychiatric hospital. • Advanced practice roles, such as pharmacist-led medication management, were less favored. • Further research to explore which factors are influencing these opinions is needed. With the growing burden of mental disorders, pharmacists are ideally positioned to play an important role in supporting people with a mental illness. However, the value of clinical pharmacists within mental health remains unrecognized by other healthcare professionals. The purpose of this study was to explore the perceptions and expectations of mental health professionals on the provision of clinical pharmacy services (CPS) at a psychiatric hospital. A cross-sectional, self-administered, online survey was administered to physicians and nurses working at a psychiatric hospital. Five-point likert scales were used to measure participant's perceptions and expectations about the CPS provided. Descriptive and inferential statistical analysis were undertaken. Both physicians and nurses reported positive perceptions regarding the CPS provided at the hospital, although physicians agreement with positive statements was higher than those reported by nurses (mean likert scale score 4.76 and 4.45, respectively). There was a statistically significant positive association between participants' years of experience and agreeing that clinical pharmacy services are essential for achieving hospital accreditation (χ2 = 13.11, φ = 0.41, p = 0.04). A statistically significant positive association was noted between the physicians' current position and agreeing that pharmacists assist physicians in selecting more cost effective medication regimens (χ2 = 16.55, φ = 0.62, p = 0.04). Physicians and nurses have mostly positive perceptions and expectations from clinical pharmacists at the psychiatric hospital. However, traditional clinical pharmacy services were more favorably viewed than those associated with advanced clinical roles such as prescribing and pharmacist-led medication management clinics. [ABSTRACT FROM AUTHOR]

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Abstract Child abuse is a global problem and pervades all cultures and socio-economic strata. The effects can be profound and life altering for victims. There is substantial literature from high income countries about signs of abuse, but a dearth of data from low and middle income countries like Pakistan. Healthcare professionals (HCP) are ideally placed to detect abuse, but, to inform interventions, an understanding of their experiences, training needs and cultural beliefs is needed. This study aimed to: (1) Explore the challenges that HCP face when managing cases of abuse; (2) Explore cultural beliefs and understand how these shape practice and (3) Identify training needs. A qualitative study using a phenomenological design was conducted. In-depth interviews were conducted with doctors, nurses and security staff in the emergency department of a large private hospital in Pakistan (n = 15). Interviews were undertaken in Urdu, translated into English and analysed using an inductive thematic approach. Multiple challenges were identified. The process of referral to legal services was poorly understood and further training and guidelines was suggested by participants. As the legal system in Pakistan does not allow HCP to keep potentially abused patients in their custody, they felt restricted in their ability to advocate and concerned about the safety of both the identified children and themselves. HCP have potential to detect abuse early; however, in Pakistan there are numerous challenges. HCP require support through training, as well as clear institutional frameworks and legal support to undertake this role. [ABSTRACT FROM AUTHOR]

Abstract Introduction Bosasso General Hospital is located in Puntland Somalia, an area affected by prolonged civil conflict, terrorism, clan fighting and piracy. International evidence highlights that staff skills and competence may have a significant impact on patient outcomes however there has been little research on emergency education in such an austere and volatile environment. The purpose of this study therefore was to identify current practices and gaps in delivering emergency medicine education in this resource-deprived environment. Methods A mixed methods approach was adopted to inform convergent parallel data collection techniques including questionnaire (n = 16), key informant (n = 5) and focus group interviews (n = 16). Data analysis, following data triangulation, produced descriptive quantitative statistics of themes such as emergency care, educational provision, enablers and barriers. Results The research showed that among health care staff at the hospital, 19% of the nurses felt that visiting nurses offer some knowledge on emergency care, while 38% of knowledge was gained from visiting doctors. Regarding knowledge of emergency medicine, 88.9% of the nurses felt that emergency medicine is basically first aid. Discussion Emergency care was perceived by the majority as essentially 'first aid'. Many indicated that they received little or no regular or formal training on emergency care and related essential topics. In terms of challenges faced in delivering emergency care education demonstrated a common factor in the limited resources available which included lack of teaching materials, reading materials, online resources, health care professionals, equipment and mentors. Conclusions drawn suggest that the knowledge of emergency medicine by front line professionals is limited. Therefore, the development of field curricula, practical and theoretical training by visiting practitioners, provision of additional teaching aids, tools and equipment, integration of multiple disciplines in training and financial resource mobilisation would be beneficial in improving knowledge, attitudes and practices of emergency care. [ABSTRACT FROM AUTHOR]

• Training Con-tAct, a Dutch communication partner training. • Changes in communicative behaviour and experiences in SLT students. • Improved conversation scores in supporting techniques. • SLT students may benefit from Training Con-tAct. • Improved access to health care, especially for communication vulnerable people. This paper describes the changes in communication skills, knowledge and confidence in Speech Language Therapy (SLT) students in conversations with People With Aphasia (PWA) after Training Con-tAct, a Dutch Communication Partner Training. On a voluntary basis, nine SLT students (2nd yr) completed Training Con-tAct, in which People With Aphasia (PWA) were involved as co-workers. A mixed method design with pre- and post-measures was used to analyze the students' communication skills, knowledge and confidence. A quantitative video analysis was used to measure changes in students' communication skills. Besides, a self-report questionnaire was used to measure the changes in students' knowledge and confidence regarding their communication with PWA. To evaluate the perspectives of the students on Training Con-tAct, additionally a focus group interview was held. Regarding students' communication skills the outcomes revealed a significantly higher score on the 'supporting' competence in students who took part in Training Con-tAct. The mean scores for the 'acknowledging' and 'checking information' competences did not improve significantly. The outcomes of the questionnaire showed students gained more knowledge and confidence regarding communication with PWA. The focus group interview provided insights into: motivation for participating in Communication Partner Training, content and structure of the training, feedback in CPT, and learning experiences. The present study suggests that SLT students may benefit from Training Con-tAct as the training leads to better skills, more knowledge about aphasia and more confidence in communicating with PWA. Training Con-tAct could be a valuable addition to the curricula of all healthcare disciplines, and eventually support interprofessional collaboration, resulting in improved access to health care, which is important for communication vulnerable people. Further research with a larger sample size and a control group is required. [ABSTRACT FROM AUTHOR]

Abstract Introduction There is increasing literature suggestive of the positive benefits of 'spirituality' and their links to health and wellbeing. We wished to explore staff’s perceptions of spirituality and spiritual care working in a single district health area in New Zealand. Method A staff survey was undertaken using a questionnaire incorporating the validated 17-item Spirituality and Spiritual Care Rating Scale (SSCRS) and a new 4-item Spiritual Care Confidence Scale (SCCS). Results 635 participants completed the survey (48.4% nurses, 10.7% physicians, 36.6% allied health professionals and administration staff). Participants identifying a religious belief had a higher mean score for spiritual care confidence than staff reporting no religion, t(608) = −3.69, p =.000. Nurses recorded a statistically significant higher SSCRS mean score (x ¯ = 66.36, 95% CI [65.68, 67.05]) compared to allied health professionals (x ¯ = 64.44, 95% CI [63.58, 65.69]) p =.012. Nurses, midwives or physicians had a significantly higher mean score for spiritual care confidence (x ¯ = 15.4.7, SD = 2.2) than allied health professionals (x ¯ = 14.3, SD = 3.1), t(307) = −4.42, p =.000. Formal training (62.7%) and guidance on spirituality and spiritual care (60.5%), communication skills (56.3%) and inclusion on staff induction programs (51.1%) was requested to help staff meet patients’ spiritual care needs. Conclusion This multi-professional survey suggests differences in perceptions of spirituality and confidence in providing spiritual care dependent on religious beliefs and professional role. Results should be used to shape design and delivery of spiritual care education across clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: The primary aim of this study was to investigate midwives’ and obstetricians’ views on how many ultrasound examinations should be part of standard care during pregnancy in Norway. Material and methods: This study is a part of a larger study, the CRO ss- C ountry U ltrasound S tudy (CROCUS), an international investigation of midwives’ and obstetricians’ experiences of and views on the use of ultrasound. We distributed 400 questionnaires to respondents in all five health regions in Norway: 40 to municipal midwives, 180 to midwives working in hospitals and 180 to obstetricians. The questionnaire included specific questions about the appropriate number of examinations during pregnancy, examinations without medical indication, non-medical ultrasound, commercialisation and safety. Results: The response rate was 45%. Of the respondents, 58% reported satisfaction with the offer of one scheduled ultrasound examination during pregnancy, as recommended in the Norwegian guidelines. Health care professionals who used ultrasound themselves were significantly more likely to want to offer more ultrasound examinations: 52% of the ultrasound users wanted to offer two or more ultrasound examinations vs. 16% of the non-users (p < .01). The majority of obstetricians (80%) reported that pregnant women expect to undergo ultrasound examination, even in the absence of medical indication. Conclusion: The majority of Norwegian health care professionals participating in this study supported the national recommendation on ultrasound in pregnancy. Ultrasound users wanted to offer more ultrasound examinations during pregnancy, whereas non-users were generally content with the recommendation. The majority of respondents thought that commercialisation was not a problem at their institution, and reported that ultrasound is often performed without a medical indication. The ultrasound users thought that ultrasound is safe. [ABSTRACT FROM AUTHOR]

Objective This study aimed to explore the health care professional (HCP) experiences of working with interpreters when consulting refugee and migrant women who are not proficient in English around sexual and reproductive health (SRH) issues, in order to identify service and policy implications. Methods Semi-structured interviews were conducted with 21 HCPs, including: nurses (8), general practitioners (GP) (5), health promotion officers (5), sexual therapists (2) and one midwife. Interviews were audio-recorded, professionally transcribed and thematically analysed using socio-ecological theory. Results Overall HCPs stated that language and cultural discordance were barriers to SRH communication with refugee and migrant women. The lack of women interpreters and concerns with the interpreters such as lack of health/SRH knowledge were the main considerations HCPs reported related to working with interpreters when consulting refugee and migrant women. Conclusion Communication barriers in the provision of SRH services to refugee and migrant women may not be avoided despite the use of interpreters. Great attention needs to be paid to the availability of women interpreters and training of interpreters to work in SRH. [ABSTRACT FROM AUTHOR]

Objectives To explore the experiences, needs and coping strategies of families of patients admitted to adult intensive care units. Design and setting A descriptive qualitative research design was chosen using an inductive thematic content analysis approach. Semi-structured interviews were conducted with fourteen family members in three hospitals of Crete. Findings Four main themes were derived from data analysis. Our results showed that family members were in turmoil having to deal with intense and alternating feelings. The protection of patient’s dignity and well-being was of utmost importance mainly by maintaining proximity. Getting comprehensible information and building communication with the healthcare providers was often problematic. Three coping strategies were used: optimism, family support and spirituality. Conclusion This study is a contribution to the understanding of Greek family’s experiences and psychosocial needs during critical illness. A family-inclusive framework should be promoted and implemented in intensive care recognising and supporting family’s role in the patient’s illness and recovery. [ABSTRACT FROM AUTHOR]

Résumé De récentes recherches ont mis en évidence des liens significatifs et positifs entre l’espoir des personnes atteintes de maladie chronique et leur qualité de vie. Dans la continuité de ces recherches, cette étude exploratoire vise à comprendre la structure et la nature de l’espoir des personnes atteintes de maladie chronique, selon l’approche des représentations sociales. Deux cent cinquante-trois individus ( M âge = 37,51 ans ; ET = 16,95 ; 68,80 % de femmes) ont participé à cette étude, répartis selon trois échantillons : patients, soignants et population générale. Les résultats mettent en évidence une représentation de l’espoir spécifique pour les patients. Par ailleurs, ils montrent que l’espoir est assimilable à un mécanisme d’adaptation utilisée par les personnes confrontées à une maladie chronique. Hope has a significant place in many literatures and most recently in health context. Nevertheless, there is still little research describing the distinct concepts and representations of hope in patients’ population. Hope is defined as perceived capability to derive pathways to desired goals, and motivate oneself via agency thinking to use those pathways. The main objective of this study is to explore the representation of hope, in the context of chronic disease, for both patients and health providers. For that purpose, we conducted the present study considering the social representation approach. The sample consisted of 67 chronic disease patients (mean age = 51.13 years; SD = 19.05; 68.70% female), 83 health care professionals (mean age = 35.32 years; SD = 11.49; 74.70% female) and 103 individuals from the general population (mean age = 30.41 years; SD = 13.85; 64.10% female). They completed two free associations task: write “everything that comes into your mind when you think about hope”, one in general and one in disease context. Free associations allowed us to identify shared conceptions of hope as well as intergroup variations in these representations. Associations with the word of hope produced by our respondents were depending on (a) the context (hope in disease or hope in general), and (b) the type of participant (patient, healthcare professionals or individuals from the general population). The results first indicate that hope, for all participants and whatever the context, refers to the beliefs of positive issues and perspectives. Moreover, dealing with a chronic disease seems to create, for the patients, a very specific representation of hope. It appears that when disease becomes serious and persistent, and when patients need to deal with uncertainty, hope is mainly described as a coping strategy, determined by specific objectives and resources. [ABSTRACT FROM AUTHOR]

Businesses marketing unproven stem cell interventions proliferate within the U.S. and in the larger global marketplace. There have been global efforts by scientists, patient advocacy groups, bioethicists, and public policy experts to counteract the uncontrolled and premature commercialization of stem cell interventions. In this commentary, we posit that medical societies and associations of health care professionals have a particular responsibility to be an active partner in such efforts. We review the role medical societies can and should play in this area through patient advocacy and awareness initiatives [ABSTRACT FROM AUTHOR]