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PubMed1993

[Diabetic ketoacidosis].

Is the most commun and serious complication of the diabetes mellitus in the childhood and adolescent, the current mortality rate in most tertiary hospitals for children is about 2 percent. Is the metabolic consequence of a deficiency of insulin, it can be precipitating for stress, or inappropriate knowledge of the management and in some cases of subclinical diabetes or it still has not been diagnostic. The majority of instances of diabetic ketoacidosis can be prevented by early recognition of ketosis, and on appropriate ambulatory management.

Acid-Base Imbalance↗

PubMed1993

Response to innovation: behavioral patterns.

An innovation model describes behavior patterns and the specific responses these groups display when introduced to change. These six categories, which are not inclusive, extend along a continuum ranging from eager participation to outright rejection of change. Using this knowledge, the nurse manager can team up with certain group types to smoothly implement innovation into the system.

Adaptation, Psychological↗

PubMed1993

The psychoeducational model of prepared childbirth education.

Prepared, childbirth education classes are designed to teach the expectant mother how to effectively cope with the childbirth experience through active participation, informed decision making, and noninvasive pain management skills. As knowledge and technology increase, it often becomes difficult for the childbirth educator to complete the important task of determining the essential content for each class. The childbirth educator can follow established guidelines for class content with a review the literature or structure the class to meet the needs of the participants. An approach used less often, but a powerful and effective one, is using a conceptual model as a framework for selecting the essential content for classes.

Curriculum↗

PubMed1996

Practice-based research networks: building the infrastructure of primary care research.

Family practice and primary care are rapidly achieving prominence as the foundation of a rapidly changing health care system, driven not by systematic reform but by the rapid advance of managed care. The knowledge base to support primary care practice, however, lags far behind after decades of neglect in the headlong rush toward overspecialization. The success of biomedical research in the United States in the last 50 years is due in large part to the network of tertiary care hospitals, where the specialized care of highly selected patients supports broad programs of teaching and research. There are no comparable laboratories, however, for research on the important content areas of primary care. The emergence and success of practice-based research networks over the past decade provide an important infrastructure for careful study of the health and health care phenomena that comprise primary care. Practice-based research networks have made a great deal of progress in methods development and have begun to contribute important information to the primary care knowledge base. They continue, however, to be underfunded and underdeveloped, existing on large infusions of volunteerism by the participating physicians. The study recently completed by the Institute of Medicine's Committee on the Future of Primary Care will play a critical role in promoting widespread appreciation of the gap in the scientific base necessary to support primary care practice, the need for research in primary care, and the complementary relationship of this body of research and the more traditional biomedical research that has been so well funded.

Family Practice↗

PubMed1996

[Aging brains and the dementias].

Dementia has been defined generally as an acquired persistent impairment of intellectual function caused by organic brain diseases. The rapidly increasing incidence of dementias has been claimed on the basis of epidemic studies in Japan as well as in Western developed countries. These observations are justified by the facts that most dementias are found in people over the age of 65 years, and that the elderly population is increasing rapidly resulting in both absolute numbers and percentage of the population. In Japan, it is estimated that 1.5 million of demented persons are present. The purpose of this paper is to describe clinical manifestations and morphological alterations of aged and demented individuals, diagnostic process to differential diagnosis to provide knowledgeable approach to management, and adequate care of the demented individuals. In aged brain, there are a variety of morphological changes. Some of these are usually observed in aged brains; atrophy of the brains, loss of neurons, accumulations of lipofuscin. Others observed in pathologically aged brains, or accelerated aging brains are Alzheimer's neurofibrillary tangles, senile plaques, and granulovacuolar degeneration. Psychiatric manifestations associated with aging and dementing diseases are described. It should be realized that clinical manifestations of the demented reflect primarily the topography of the organic lesions in the brain, and functional alterations, and are influenced by psychological and socio-environmental factors.

Aging↗

PubMed1996

A study of effect of guggulsterone on hyperlipidemia of secondary glomerulopathy.

Hyperlipidemia in patients of secondary glomerulopathies, a well established entity with very little knowledge of its management modifies its prognosis by predisposing these patients to develop atherosclerosis, coronary artery disease, hypertension cerebro-vascular accidents and also thromboembolic phenomenon leading to renal vein thrombosis and renal failure. Guggulsterone was administered orally in these patients in a daily divided dose of 75 mg for a period of 8 weeks together with supportive measures like high protein diet, diuretics and hematinics. Total serum lipid, total serum cholesterol, triglycerides, phospholipids, HDL, LDL, and VLDL were analysed at 4 and 8 weeks of therapy. Significant reduction was observed in the values of total serum lipid and total serum cholesterol. Other parameters of lipid profile showed downward trend except rise of HDL with insignificant difference. There was no significant side effect throughout the study.

Adolescent↗

PubMed1996

Parental anxiety in febrile convulsions.

Febrile convulsions can cause extreme anxiety to parents. Factors associated with parental anxiety and its relief during and after admission of their child for simple febrile convulsions were studied by questionnaire. Of the 70 parents approached 46 responded (66%), all of whom reported feeling anxiety. Factors directly associated with parental anxiety were lack of knowledge regarding the management of seizures and the performance of a spinal tap or EEG. There was no correlation between a previous seizure in the same child or in a first-degree relative and a decrease in anxiety in the present seizure. Hospital admission of the child yielded no relief of anxiety in 27.3% and some relief in 34.1%. Staff activity was insufficient regarding parental instruction in handling the child in the event of a recurrence. About two-thirds of the parents wished to continue neurologic follow-up after discharge, and about one-half preferred that the child be treated with anticonvulsants. Our findings show that a very intensive effort is required to relieve parental anxiety after febrile convulsions. It is suggested that routine parental preventive education in this area be conducted in well-baby clinics.

Acute Disease↗

PubMed1979

Chemotherapy of disseminated testicular cancer.

Dramatic improvements have been made in recent years in treatment of disseminated testicular cancer. Germ-cell neoplasms, even when advanced, are potentially curable by modern chemotherapy. Although disseminated testicular cancer is a rare disease, it is highly treatable, and primary physicians, internists and urologists should have some knowledge of its management.

Bleomycin↗

PubMedDate not supplied

Determining the cost of care through clinical pathways.

Using the steps from the first approach, the costing of clinical pathways is useful to both the clinical and administrative teams. With knowledge of pathway cost, clinicians can plan cost-effective changes in the pathway or consider cost factors when deliberating on different approaches to care. Using the patient classification system to unbundle the nursing component and using the number of nursing hours per day of care provides an opportunity to describe the intensity of the pathway in its entirety, and by each day of care. One is provided with an opportunity to learn from the cost variances by reviewing the standardized costs for the pathway, and the actual cost of care of patients on the pathway provides an opportunity to learn from the cost variances. This learning, coupled with the clinical variance analysis, can suggest new opportunities for improving care and potential cost savings. Lastly, the cost associated with a pathway is useful knowledge in negotiating managed care contracts.$

Acute Disease↗

PubMed1997

[Methods of investigation in clinical cardiology. X. Studies on the evaluation of diagnostic tests in cardiology].

Diagnosis is a complex cognitive process which is characterised by uncertainty. This uncertainty can be managed through specific knowledge in conjunction with probability theory. Studies evaluating diagnostic tests are the best way of building this knowledge. Studies evaluating diagnostic tests have two essential components: the gold standard and the new test. Both components, gold standard and test, are independent measurement process that can be influenced by diverse sources of variability. The comparison between diagnostic and test is essentially a hierarchical procedure. Diagnostic tests are evaluated by their sensitivity, specificity compared to a definitive gold standard. The predictive values and the likelihood ratio test are also used. Sensitivity (the proportion of true positives) and specificity (the proportion of true negatives) are values obtained from a sample and thereby can be considered as the conditional agreement between gold standard and the new test. Kappa coefficients for sensitivity and specificity are useful tools for adjusting both indices. Sensitivity and specificity are non-poblational values, they are estimates of the true values of the study population and can be affected by random error and systematic errors (bias). Confidence intervals are useful for giving an indication of the precision of the point estimates of sensitivity and specificity. A suitable sound design is required to avoiding a biased estimate of sensitivity, likelihood ratio, and predictive values. Finally a list of potential biases is given with methods for minimising these.

Cardiology↗

PubMedDate not supplied

Medical Grand Rounds: refractory hypertension and renal insufficiency in a patient with renal artery stenosis.

Renal artery stenosis has become increasingly common as a cause of refractory hypertension and renal insufficiency. There is a high prevalence of bilateral disease and the lesions tend to progress over time. Newer, less invasive, imaging modalities such as doppler ultrasound, magnetic resonance angiography, and spiral CT scanning are evolving technologies in the diagnosis of renal artery stenosis. Advances in surgical technique, particularly the development of extra-anatomical procedures such as spleno-renal and hepato-renal by pass, have significantly lowered surgical morbidity and mortality and provides revascularization options for patients with complex vascular disease that would previously not have been considered because of their high surgical risk. Improvements in angioplasty technique and the use of stents are broadening the types of lesions that can be successfully approached with these techniques and may be particularly helpful for patients with more severe cardiac or cerebrovascular disease. The benefits of revascularization may be even greater for preservation of renal function than for control of blood pressure in properly selected patients. It is difficult to predict which patients will benefit from surgical revascularization versus medical management of RAS. Knowledge of the progressive nature of RAS, the high prevalence of bilateral disease, and the clinical characteristics that correlate with progression (e.g., decreasing renal size) are helpful in guiding clinical decisions regarding intervention. Additional studies to determine the predictive value of non-invasive tests such as CRS, doppler ultrasound before and after administration of angiotensin converting enzyme inhibitors, and other tests, are needed to assist the clinician in identifying who will benefit most from revascularization both in terms of renal function and blood pressure control.

Aged↗

PubMedDate not supplied

[New aspects of the Italian health system and the management of medical units and facilities. 3: proposals for the training of personnel for the management of health units and facilities].

In this delicate phase of transformation of the whole health organization and public employment in Italy several training aspects of managers deserve our attention. The target to reach is to achieve in all managers: a standard basic knowledge level in the various essential matters for a modern health structures management; a common language and a common strategic and logistic planning capabilities and solving methodologies of management problems. Plans for pluriprofessional, multidisciplinary, interactive short refresher course and for postgraduate training courses were presented.

Curriculum↗

PubMed2002

Hereditary cancer: family history, diagnosis, molecular genetics, ecogenetics, and management strategies.

The translation of knowledge about hereditary breast cancer and its improved control, as well as prevention through prophylactic surgery, has been significantly accelerated through the veritable explosive discoveries in molecular genetics inclusive of BRCA1 and BRCA2 germline mutations. Needed however, among the physician community, medical geneticists, and genetic counselors, is a raised level of knowledge about hereditary breast cancer syndromes. Particular attention needs to be given to their extant genotypic and phenotypic heterogeneity, their natural history, and foremost, the requirement of a sufficiently detailed family history, with knowledge as to how to interpret its significance so that hereditary cancer syndrome can be diagnosed, should it, in fact, exist in the particular family. Collectively, surveillance and management programs can then be developed for the patient and his or her high-risk relatives. We believe very firmly that this knowledge needs to be extended to the individual patient(s), first- and second-degree relatives so that they can benefit from this knowledge.

Adenomatous Polyposis Coli↗

PubMed2006

HEARTFAID: A knowledge based platform of services for supporting medical-clinical management of heart failure within elderly population.

HEARTFAID is a research and development project aimed at devising, developing and validating an innovative knowledge based platform of services, able to improve early diagnosis and to make more effective the medical-clinical management of heart diseases within elderly population. Chronic Heart Failure is one of the most remarkable health problems for prevalence and morbidity, especially in the developed western countries, with a strong impact in terms of social and economic effects. All these aspects are typically emphasized within the elderly population, with very frequent hospital admissions and a significant increase of medical costs. Recent studies and experiences have demonstrated that accurate heart failure management programs, based on a suitable integration of inpatient and outpatient clinical procedures, might prevent and reduce hospital admissions, improving clinical status and reducing costs. HEARTFAID aims at defining efficient and effective health care delivery organization and management models for the "optimal" management of the care in the field of cardiovascular diseases. The HEARTFAID innovative computerized system will improve the processes of diagnosis, prognosis and therapy provision, providing the following services: * electronic health record for easy and ubiquitous access to heterogeneous patients data;* integrated services for healthcare professionals, including patient telemonitoring, signal and image processing, alert and alarm system;* clinical decision support in the heart failure domain, based on pattern recognition in historical data, knowledge discovery analysis and inferences on patients' clinical data.The formalization of the pre-existing clinical knowledge and the discovery of new elicited knowledge represent the core of the HEARTFAID platform.

Aged↗

PubMed2004

R3-survey of traumatic brain injury management in European Brain IT centres year 2001.

OBJECTIVE: To obtain knowledge about the conditions and management of traumatic brain injury (TBI) in a collaborative network of Brain Information Technology centres. DESIGN: The Brain IT (Brain monitoring with Information Technology) survey comprised two parts: local conditions and policies (part A), and a case study part (part B). The information was gathered by written questionnaires followed by telephone interviews. PARTICIPANTS: Twenty-four Brain IT centres participated (two respondents from 18 sites). RESULTS: The average proportion of agreement between duplicate respondents was 0.79 (range 0.44-1.00). All Brain IT centres monitored ICP. The reported order of treatment for intracranial hypertension was: evacuation of mass-lesions and head elevation (1), increase of sedation and Mannitol scheme (2), hyperventilation (3), ventricular drainage (4), craniectomy and pentothal coma (5), and decompressive lobectomy (6). The respondents were less prone to evacuate expansive contusions in relation to extra cerebral hematomas. The most common suggested interventions (alone or in combination) for treatment of intracranial hypertension without mass lesions was the Mannitol scheme (included in 71% of the suggestions), CSF drainage (included in 56%), hyperventilation (included in 32%), and pentothal coma (included in 22%). CONCLUSIONS: The suggested management of TBI was mainly in accordance with published guidelines, although a minor proportion of the answers deviated to some extent. The suggested order and combinations of different treatment interventions varied. Variation of treatment within the range of prescribed standards provides optimal conditions for an interesting future analysis of treatment and monitoring data as collected prospectively in a Brain IT database.

Adult↗

PubMed2005

The use of Traditional Chinese Medicine in managing oral health--Hong Kong: one country, two systems.

OBJECTIVES: To determine knowledge, use, and interest in traditional methods to manage oral health among Hong Kong adults. DESIGN: A cross sectional epidemiological survey. PARTICIPANTS: A random sample of 500 Hong Kong adults. METHODS: Telephone interviews about Traditional Chinese Medicine (TCM) approaches to mange oral health, employing a battery of 50 questions over a one month period in 2002. RESULTS: Most completed the interview (96%, 481/500). Over half (52%, 250/481) had some knowledge about using TCM to manage oral health. Approximately a third (32%, 155/481) reported using TCM to manage their oral health in the past, most frequently for oral mucosal lesions (65%, 101/155) or for periodontal reasons (62%, 96/155). TCM was used predominately in combination with western dentistry or as a last resort (55%, 86/155). Most (89%, 428/481) expressed an interest in TCM approaches to managing oral health, particularly if administered by their dentist (54%, 259/481), and expressed many reasons for such interest. Socio-demographic variations in knowledge, use and interest in the use of TCM to manage oral health were apparent (p<0.05). CONCLUSION: Knowledge, use and interest in traditional based approaches to managing oral health is widespread in Hong Kong, and is associated with age and educational attainment.

Adolescent↗

PubMed2005

Paediatric fever management: continuing education for clinical nurses.

PURPOSE: This study examined the influence of level of practice, additional paediatric education and length of paediatric and current experience on nurses' knowledge of and beliefs about fever and fever management. METHOD: Fifty-one nurses from medical wards in an Australian metropolitan paediatric hospital completed a self-report descriptive survey. RESULTS: Knowledge of fever management was mediocre (Mean 12.4, SD 2.18 on 20 items). Nurses practicing at a higher level and those with between one and four years paediatric or current experience were more knowledgeable than novices or more experienced nurses. Negative beliefs that would impact nursing practice were identified. Interestingly, beliefs about fever, antipyretic use in fever management and febrile seizures were similar; they were not influenced by nurses' knowledge, experience, education or level of practice. CONCLUSIONS: Paediatric nurses are not expert fever managers. Knowledge deficits and negative attitudes influence their practice irrespective of additional paediatric education, paediatric or current experience or level of practice. Continuing education is therefore needed for all paediatric nurses to ensure the latest clear evidence available in the literature for best practice in fever management is applied.

Analgesics, Non-Narcotic↗

PubMed2006

Use of insulin pumps for diabetes management.

Patients are diagnosed with diabetes mellitus in the United States at increasing rates. Nurses must maintain current knowledge of effective diabetes management strategies. An overview of the use of insulin pumps is provided, including the function, criteria for use, advantages, disadvantages, and nursing management considerations.

Blood Glucose↗

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