Time for change in practice of in-patient oxygen therapy: a period-limited, multidimensional approach to improve oxygen prescription compliance: quality improvement project at Hamad General Hospital, Qatar

Prescription of oxygen therapy has traditionally poor compliance across the globe and mostly given to patients on verbal orders leading to under or overuse. The British Thoracic Society (BTS) guidelines (2017) recommend that oxygen therapy must be prescribed. Our study aimed to assess the prescription practice of oxygen therapy for patients admitted to acute medical assessment unit and general medical wards at Hamad General Hospital, Qatar and to achieve 80% compliance of valid oxygen therapy prescription implementing the quality improvement model against the BTS guidelines.The prescription practice of oxygen therapy was audited between April 2019 and August 2019. Using a Plan, Do, Study, Act (PDSA) model of improvement and multiple interventions was performed in the eight PDSA cycles, including (1) educational sessions for residents/fellows/nurses, (2) introduction of electronic prescription, (3) emails, posters/flyers, (4) nurse-led reminders and (5) re-enforced teaching for new residents. Data were then collected using a questionnaire assessing electronic prescriptions and documentation. Our baseline study regarding oxygen therapy showed limited awareness of BTS guidelines regarding the documentation of initiation and further adjustment of oxygen therapy. There was a lack of compliance with oxygen prescription; none of the patients had a valid prescription on our computer-based prescription (Cerner). The duration, target range and indications of Oxygen therapy were documented in 25% (18/72), 45.8% (33/72) and 42% (30/72) patients, respectively. Oxygen was initiated by communication order only. In a total of 16 weeks period, the repeated PDSA cycles showed significant improvement in safe oxygen prescription practices. Following intervention, oxygen electronic prescription, documentation of indications for oxygen therapy, target oxygen saturation and wean-off plan improved to 93%, 85%, 86 % and 80 %, respectively.We concluded that poor compliance to oxygen therapy Orders is a universal issue, which can be successfully managed using small-scale PDSA cycles to ensure sustained improvement through multidimensional interventions, continuous reinforcement and frequent reassessments.

Exercise prescription for non-communicable diseases: Knowledge and practice among healthcare providers

Background: Exercise prescription (EP) use as medicine is an effective. It is the cornerstone to prevent and manage NCDs. The main aim of the study was to investigate the knowledge and confidence, practice of HCPs towards NCDs pertaining to EP in West Gojjam Zone hospitals, Amhara region, Ethiopia.Methods: The target population was 487 HCPs (medical doctors, nurses and midwiferies).Cross sectional research design was carried out in hospital setting from HCPs to collect data, Self-administered questionnaires were used from 7 governmental hospitals and 353 HCPs (Medical doctors=107, 30.3%, Nurses=157, 44.5% and Midwiferies=89, 25.2%) was selected through whole, strata and random sampling methods. The data was collected and analyzed from March, 2021- June, 2012. It was analyzed through descriptive (mean, frequency, percentage, cross tabulation and standard deviation) and inferential statics(chi-square, Kruskal-Wallis test of analysis, Mann-Whitney U test to examine difference and spearman’s rank to examine correlation). All assumptions for conducting non-parametric tests were used before decided to use the type of statistical data.Results: The HCPs reported that; majority of 80.6% respondents had poor EPP regarding to written prescription for their patients. 62.5% of HCPs were agreed they had not knowledge on WHO and ACSM recommendations to prescribe exercise for NCD patents. Male HCPs were had better exercise prescription practice ( x2 = 228.756, df = 15, p =0.000 ). HCPs knowledge and confidence was had a significance difference regarding to profession (Medical doctors: Mean rank =198.71, Nurses: Mean rank =171.96 and Midwifery: Mean rank =159.78, x2 = 7.773, df = 2, p =0.021). Exercise prescription practice (EPP) was significantly and positively correlated with Knowledge and Confidence (rho=0.292, p= 0.000). EPP was had a positive and significant correlation with all main variables of the study.Conclusion: Exercise prescriptions practice, knowledge and confidence of majority of HCPs regarding to prescribe exercise for NCDs were poor. The HCPs educational curriculums should include sufficiently about physical exercise as a strategy how to prevent and manage NCDs. Exercise is medicine Ethiopia (EIME) initiative should established and Exercise Prescription (EP) also established in organizational structure as a unit in healthcare setting. There should be a standardized recommendation guidelines, prepared at a national level to prescribe exercise used as a bench mark for healthcare providers for every healthcare settings. There will be also design a continuous training program for HCPs to be a role model or how to prescribe physical activity or exercise to prevent and manage NCD from their patients.

Emergency Contraceptives: Knowledge, Attitude and Prescription Practice of Primary Healthcare workers in Sokoto Metropolis, Northwest Nigeria.

Background: Emergency contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. About thirty percent of all pregnancies, and 61% of all unintended pregnancies, ended in an induced abortion in Nigeria, and many women with unwanted pregnancies decide to end them by abortion. Healthcare providers' knowledge and attitude towards emergency contraception is very important for dissemination of awareness, consumer acceptance and use of contraceptives, as health care workers interact with large numbers of women and are reliable sources of information. This study aimed to assess healthcare workers' emergency contraception knowledge, attitude and prescription practice. Materials and Methods: The study was a cross-sectional study. Healthcare workers providing services in Primary Health care facilities of Sokoto metropolis were studied. Using formula for sample size estimation for crosssectional study, a total of 419 respondents were recruited into the study using systematic sampling technique. The instrument of data collection was a structured interviewer administered questionnaire and data was collected by means of Open Data Kit for android App and analysed using IBM SPSS statistical software package version 23. Univariate and bivariate analysis were conducted; level of significance was set at 5%. Results: Few (39.9%) respondents knew that Intra uterine contraceptive devices can be used for emergency contraception, only 15.4% knew how emergency contraceptives work. Most (75.4%) believed that emergency contraceptives should be available only on prescription; and 30.5% felt that emergency contraceptive pills promote irresponsible behaviour. More than half of the respondents (56.5%) had prescribed within the last one month, 48.7% of them prescribed less than 5 times within the month. Only 27(8.0%) have ever prescribed emergency contraceptive pills in advance of need. Conclusion: The study respondents had good knowledge of emergency contraceptives, albeit, with some misconceptions, they also demonstrated good attitude, however, the prescription practice was fair.

Knowledge, Attitude and Prescription Practice on Antimicrobials Use among Physicians: A Cross-sectional Study in Zhejiang, China

Introduction: Over-prescription of antimicrobials for patients is a major driver of bacterial resistance. The aim of the present study was to assess the knowledge, attitude and prescription in relation to antimicrobials among physicians in the Zhejiang province in China, and identify the determining factors. Methods: A total of 600 physicians in public county hospitals and township health institutions were surveyed cross-sectionally using a structured electronic questionnaire. Results: The questionnaire was completed by 580 physicians and accordingly, the response rate was 96.67%. The mean score of 11 terms related to antimicrobial knowledge was 6.81, and that an average of 32.1% of patients with upper respiratory tract infections (URIs) would be prescribed antimicrobials. Multivariate analysis indicated that young general practitioners with less training are more likely to contribute to high antimicrobial prescriptions (P<0.05). Older physicians with more trainings are more willing to provide patients with the correct knowledge regarding antimicrobials and less likely to prescribe antimicrobial s to URIs. The results of the correlation analysis showed that a positive connection was found between the doctor’s knowledge, attitude and prescription practice (P<0.05). Conclusion: Proper prescription of antimicrobials depends on adequate knowledge and regular training programs for physicians.

Factors associated with zinc prescription practice among children with diarrhea who visited public health facilities in Addis Ababa, Ethiopia: A cross sectional study

Background: Diarrhea and nutrient deficiency worsen each other, and zinc is recommended to be included in clinical management of diarrhea. Therefore, this investigation was done to assess zinc prescription practice to children with diarrhea, identify factors associated with zinc prescription, and assess caregivers’ zinc’s perceived cost and willingness to pay for. Methods: A health institution based cross-sectional study was done. Caretakers of 609 children with diarrhea attending health centers in Addis Ababa were included. Logistic regression was applied to identify variables associated with zinc prescription. Results: Zinc was prescribed to 62.1% of children. About 74.9% of the caregivers were willing to pay for zinc. Previous use of zinc (AOR = 2.3; 95% CI: 1.34-4.01), exposure to zinc related message (AOR = 2.6, 95% CI: 1.53-4.60) and willingness to pay for zinc (AOR = 6.9; 95% CI: 3.84-12.66) were associated with zinc prescription. Conclusion: Zinc was not administered to considerable proportion of children with diarrhea. Previous use of zinc, exposure to zinc related message and willingness to pay for positively contributed to zinc prescription. Health care workers shall be encouraged on zinc prescription. Intervention to increase willingness to pay for zinc and zinc benefit communication shall be strengthened in parallel with operational researches.

Knowledge, Attitude, and Prescription Practice on Antimicrobials Use Among Physicians: A Cross-Sectional Study in Eastern China

Over-prescription of antimicrobials for patients is a major driver of bacterial resistance. The aim of the present study was to assess the knowledge, attitude, and prescription practices regarding antimicrobials among physicians in the Zhejiang province in China, and identify the determining factors. A total of 600 physicians in public county hospitals and township health institutions were surveyed cross-sectionally using a structured electronic questionnaire. The questionnaire was completed by 580 physicians and the response rate was 96.67%. The mean score of 11 terms related to antimicrobial knowledge was 6.81, and an average of 32.1% of patients with upper respiratory tract infections (URTIs) were prescribed antimicrobials. Multivariate analysis indicated that young general practitioners with less training are more likely to contribute to more frequent antimicrobial prescriptions ( P < .05). In contrast, older physicians with more training are more willing to provide patients with the correct knowledge regarding antimicrobials and less likely to prescribe antimicrobials for URTIs. Correlation analysis showed that the level of physician's knowledge, attitude, and prescription practice is related ( P < .05). In conclusion, proper prescription of antimicrobials depends on adequate knowledge and regular training programs for physicians.

Art on prescription: Practice and evidence

The following chapter constitutes an overview of the literature on art on prescription, where people are referred to a programme of art workshops (visual arts), by health care professionals, with the aim of improving psychosocial health and wellbeing.