A growth of knowledge in pain management.
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Improving caretakers' knowledge of fever management in preschool children: is it possible?
INTRODUCTION: The purpose of this study was to investigate caretakers' knowledge of the implications of fever, the appropriate method of fever management, and the effectiveness of an educational intervention directed toward improving caretakers' ability to manage their child's fever. METHOD: A descriptive, comparative study was conducted with a convenience sample of 86 caretakers. Follow-up data were obtained for 50 caretakers. Data were collected with an investigator-developed open-ended questionnaire. RESULTS: A fever of 104 degrees F was considered to be harmful by 31 subjects. However, fever as low as 100 degrees F was perceived to be harmful by eight subjects. Administration of acetaminophen was the most frequent method of treatment (84 [98%] of 86). No significant improvement in caretaker knowledge in terms of the level of fever at which to administer medication was demonstrated (chi-squared analysis, .012; df, 1; p = 0.91). Accuracy of antipyretic medication dosage was improved (chi-squared analysis, 13.13; df, 6; p = 0.04). DISCUSSION: Caretakers continue to perceive even marginal fevers can cause harm. Improvement was noted in dose accuracy after the intervention. The lack of significant improvement in caretaker knowledge regarding some aspects of fever management after the educational intervention suggests that more than a one-time educational intervention is required.
Acetaminophen↗
How patients with Parkinson's disease retrieve and manage cognitive event knowledge.
Several studies have pointed out that basal ganglia are involved in adaptive control of action at both motor and cognitive level. This study aimed to investigate how basal ganglia retrieve and manage script event knowledge required in planning behavior. Script event knowledge was investigated in patients with Parkinson's Disease using three kinds of activity that differed in familiarity. Unlike patients with prefrontal lesions, patients with Parkinson's Disease were able to order events in a typical sequence and obeyed the boundaries and hierarchies between events. In contrast, patients with Parkinson's Disease were impaired in evaluating how important each script event was within the context of goal-oriented planning activity. Our findings indicate that the prefrontal cortex and the basal ganglia are differentially involved in planning. The role of the basal ganglia might consist in providing a feedback about the goodness of each action while building up meaningful sequences of events during learning.
Adult↗
Danish dentists' knowledge, attitudes and management of procedural dental pain in children: association with demographic characteristics, structural factors, perceived stress during the administration of local analgesia and their tolerance towards pain.
OBJECTIVE: The aim of the present study was to describe Danish dentists' knowledge of, attitudes towards and management of procedural pain during paediatric dental care, and to assess the importance of demographic characteristics, structural factors, perceived stress during administration of local analgesia and the dentists' own tolerance towards procedural dental pain. DESIGN: A cross-sectional questionnaire study was conducted in Denmark in May 2001. SUBJECTS AND METHODS: The subjects were a random sample of 30% of Danish dentists treating children. Usable information was obtained from 327 (80.3%) of the dentists in the sample. RESULTS: One-quarter of the respondents answered that a 3-5-year-old child could report pain only with uncertainty. More than 80% of the dentists stated that they never compromised on painlessness. Very few agreed to the statement that children forget pain faster than adults. One-third agreed to, or were neutral to, the statement that all restorative care in primary teeth could be performed painlessly using N2O-O2 sedation alone. The majority of the respondents reported using three or more methods to assess the effect of their pain control methods. Almost 90% reported using local analgesia for restorative work 'always' or 'often'. A similar proportion reported using topical analgesia before injection 'always' or 'often'. Administering a mandibular block to preschool children was the procedure perceived as the most stressful (33.6%) pain control method. Demographic factors (gender), structural factors (always working alone and treating 3-5-year-old children daily), perceived stress during the administration of a mandibular block in preschool children and the dentists' own willingness to accept potentially painful dental treatment without local analgesia were associated with knowledge of, attitudes towards and management of procedural dental pain in children. CONCLUSIONS: Danish dentists treating children demonstrate concern about procedural dental pain in children. Factors amenable to change via training and reorganization into larger clinical units seem to determine their knowledge of, attitudes towards and management of procedural dental pain in children.
Adult↗
Improving egg production in two indigenous communities through the adaptation of management practices and local knowledge. The results of participative research.
Free-ranging poultry (FRP) are known to be efficient in the recycling of residues of agroforestry systems. The objective of this paper is to present the results of participative applied research on the improvement of egg production in two indigenous communities in Costa Rica. This involved a dialectic process of adaptation between indigenous knowledge and introduced management practices. We report an increase in egg production through the use of nests and improved diets.
Animal Feed↗
Physicians' knowledge about pharmacological management of cancer pain--with special reference on their prescribing responses to simulated patients with cancer pain.
BACKGROUND: Cancer pain control is unsatisfactory in Taiwan. Insufficient knowledge about cancer pain on the part of physicians is an important factor responsible for ineffective cancer pain relief. Therefore, this study was to explore the knowledge deficits of physicians on the specific aspects of pharmacological management of cancer pain (PMCP) and their influences on the prescriptions to simulated patients in a southern medical center in Taiwan. METHODS: A set of self-designed questions was delivered to 234 licensed physicians with the responsibility to care for cancer patients and 111 (47.4%) questionnaires were completed and returned anonymously. RESULTS: Most of the physicians showed inadequate knowledge of the pharmacological management of cancer pain (3.34 +/- 0.49; range 1-5), which included the principle subscale (3.38 +/- 0.67) and the practice subscale (3.32 +/- 0.46). Crucial knowledge deficits of principle were identified in the preferential analgesic route and schedule. The severe practice knowledge deficits were on the meperidine, transdermal fentanyl, equianalgesic dose-conversion as well as analgesics for different pain types. Furthermore, physicians' knowledge deficits in the practice subscale, but not the principle subscale, correlated with their correct prescription of opioids to the simulated hepatoma cases. The correlates of physicians' PMCP knowledge deficits were: clinical specialty of medicine or surgery, less than 5 years or more than 10 years from medical school graduation, with limited volume of cancer pain patients being cared, and with personal unusual pain. CONCLUSIONS: The PMCP knowledge deficits were prevalent in physicians and thus influenced their prescription of opioids for the simulated cases. An active continuing education program on both the international guidelines and the essential practice skills should be implemented and intensified specifically upon subgroup physicians, to correct their misconceptions and consolidate their PMCP knowledge.
Adult↗
The relationship between knowledge of recent HbA1c values and diabetes care understanding and self-management.
OBJECTIVE: Knowledge of one's actual and target health outcomes (such as HbA(1c) values) is hypothesized to be a prerequisite for effective patient involvement in managing chronic diseases such as diabetes. We examined 1) the frequency and correlates of knowing one's most recent HbA(1c) test result and 2) whether knowing one's HbA(1c) value is associated with a more accurate assessment of diabetes control and better diabetes self-care understanding, self-efficacy, and behaviors related to glycemic control. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional survey of a sample of 686 U.S. adults with type 2 diabetes in five health systems who had HbA(1c) checked in the previous 6 months. Independent variables included patient characteristics, health care provider communication, and health system type. We examined bivariate and multivariate associations between each variable and the respondents' knowledge of their last HbA(1c) values and assessed whether knowledge of HbA(1c) was associated with key diabetes care attitudes and behaviors. RESULTS: Of the respondents, 66% reported that they did not know their last HbA(1c) value and only 25% accurately reported that value. In multivariate analyses, more years of formal education and high evaluations of provider thoroughness of communication were independently associated with HbA(1c) knowledge. Respondents who knew their last HbA(1c) value had higher odds of accurately assessing their diabetes control (adjusted odds ratio 1.59, 95% CI 1.05-2.42) and better reported understanding of their diabetes care (P < 0.001). HbA(1c) knowledge was not associated with respondents' diabetes care self-efficacy or reported self-management behaviors. CONCLUSIONS: Respondents who knew their HbA(1c) values reported better diabetes care understanding and assessment of their glycemic control than those who did not. Knowledge of one's HbA(1c) level alone, however, was not sufficient to translate increased understanding of diabetes care into the increased confidence and motivation necessary to improve patients' diabetes self-management. Strategies to provide information to patients must be combined with other behavioral strategies to motivate and help patients effectively manage their diabetes.
Adult↗
Physicians' attitudes toward managed care: assessment and potential effects on practice behaviors.
This study was designed to identify the key components of physicians' attitudes toward managed care and develop a tool to assess these components. We developed a questionnaire based on physicians' reactions to managed care, as reflected in the published literature. We mailed this questionnaire to a sample of 753 community physicians in the greater Sacramento area. A factor analysis of these data (n = 315) identified five unifactorial scales, which we labeled managed care quality, need to adapt to managed care, cost-containment effectiveness of managed care, personal knowledge of managed care, and inevitability of managed care. Physicians were most negative about the quality of managed care and most in agreement about the need to adapt to it. Correlations among these five scales, while statistically significant, were modest in size, suggesting that these physicians were quite discriminating in their evaluations. In comparison with medical/surgical specialists, primary care physicians rated the quality of managed care, their knowledge of it, and the inevitability of a national transition to managed care more positively. These measures predicted the physicians' intentions to alter their medical behaviors to comply with managed care practices.
Attitude of Health Personnel↗
The nurse as the knowledge worker. A management challenge.
The purpose of health care institutions is to provide quality patient care. Who renders quality patient care for these institutions? Nurses do. Without nurses, health care institutions would be unable to provide essential services; therefore, administrators need to attract and retain nurses who are knowledge workers and manage their environments effectively.
Administrative Personnel↗
A study of the level of knowledge about diabetes management of low-income persons with diabetes.
Diabetes education has proven to be an effective intervention for the management of diabetes. Persons with lower education levels, the majority of whom have low incomes, receive less diabetes self-management education (DSME) than their peers. This study compared the diabetes knowledge level of low-income adults who did not have a high school diploma or general equivalency diploma with those who did. We conducted a survey among residents of 4 low-income neighborhoods in Cincinnati, Ohio, using a cross-sectional descriptive design. Surveys included information related to diabetes self-management and level of education. The only questions for which there was a significant difference between the 2 groups were those pertaining to the causes and treatment of hypoglycemia. Survey results were used to validate the need for a DSME program for low-income adults in Cincinnati, Ohio. A DSME program was developed specifically for persons with low literacy.
Adult↗
The internet-based knowledge acquisition and management method to construct large-scale distributed medical expert systems.
The Internet offers an unprecedented opportunity to construct powerful large-scale medical expert systems (MES). In these systems, a cost-effective medical knowledge acquisition (KA) and management scheme is highly desirable to handle the large quantities of, often conflicting, medical information collected from medical experts in different medical fields and from different geographical regions. In this paper, we demonstrate that a medical KA/management system can be built upon a three-tier distributed client/server architecture. The knowledge in the system is stored/managed in three knowledge bases. The maturity of the medical know-how controls the knowledge flow through these knowledge bases. In addition, to facilitate the knowledge representation and application in these knowledge bases as well as information retrieval across the Internet, an 8-digit numeric coding scheme with a weight value system is proposed. At present, a medical KA and management system based on the proposed method is being tested in clinics. Current results have showed that the method is a viable solution to construct, modify, and expand a distributed MES through the Internet.
Computer Systems↗
Mechanical equipment injuries in small manufacturing businesses. Knowledge, behavioural, and management issues.
This paper presents findings from an extensive study into factors that impact upon the high rate of injuries due to mechanical equipment, especially in small manufacturing firms. Issues relating to knowledge of health and safety issues and to management practices have been shown to be extremely important with regards to safety in small businesses. Knowledge and awareness of hazards were found to be relatively low and few respondents, especially managers, had received adequate safety training. Managers did not regard the identification and control of risks as a priority. Workplaces generally lacked effective safety management procedures such as safety rules and regulations, procedures for recording and learning from accidents, and clearly defined responsibilities for safety. Some issues requiring further investigation, and some recommendations for improving safety in small businesses, are presented.
Accidents, Occupational↗
Investigation of lay knowledge of the management of avulsed permanent incisors.
The prognosis of replanted avulsed permanent incisors depends largely on prompt and appropriate emergency management. The aim of this study was to investigate lay knowledge and attitudes in this respect. Postal questionnaires were sent to all physical education teachers, school nurses and secretaries, attendants in swimming baths and leisure centres and to 220 parents of teenage children in a defined area of North West England. The overall questionnaire response rate was 86.9%. Knowledge of methods of dealing with this problem was generally inadequate in both parents and the other groups. Although 53.6% of respondents claimed to have received first aid training only 3.1% could remember dental injuries being included. There was evidence that dental health education in this field can be effective, since the highest mean knowledge score was found in the 11.5% of respondents who recalled receiving advice from sources such as posters, magazines and newspapers. More than 80% of the respondents stated that they would not want to replant an avulsed incisor themselves, the main reason being lack of knowledge and training. It is suggested that there is a need for potentially effective dental health education in relation to this problem.
Caregivers↗
Knowledge, self-management, compliance and quality of life in asthma: a cross-sectional study of the French version of the Asthma Quality of Life Questionnaire.
The Asthma Quality of Life Questionnaire (AQLQ) is a well-validated instrument. Our objectives were to explore the cross-sectional validity of the French version, using usual outcomes of asthma, as well as assessment of knowledge of asthma, self-management and compliance. A self-administered version of the AQLQ was given to 124 consecutive patients recruited from two out-patient clinics and an emergency room in order to reflect a wide range of asthma severity. The other outcomes of asthma measured were the FEV1, patient-perceived asthma severity using a visual analogue scale, compliance, knowledge of asthma condition and self-management autonomy. Correlations were predicted before analysis ( r > 0.5, strong correlation, ++ r = 0.35-0.5, moderate correlation and + r = 0.20-0.35, fair correlation). The AQLQ scores correlated moderately to strongly with asthma severity and fairly with the pulmonary function results. Of the behavioural outcomes assessed, only knowledge of asthma correlated fairly with the AQLQ scores, as expected. This study of the French version of the AQLQ, while showing similar cross-sectional correlations with functional assessment and asthma severity to those observed with the original English version, suggested in addition a positive association between quality of life and knowledge of asthma.
Adult↗
Village health care providers in Matlab, Bangladesh: a study of their knowledge in the management of childhood diarrhoea.
This study was conducted among village health care providers in Matlab, Bangladesh in 1987. The objectives were to assess their knowledge of childhood diarrhoea and methods of management. All types of health care providers considered diarrhoea as a major childhood disease and opined that treatment should be initiated in case of four or more loose motions a day. Slightly more than half of the allopaths were aware of the scientific causes of diarrhoea; homeopaths and traditional healers in large proportions related diarrhoeal diseases with certain types of food, and 'evil eyes'. Eighty per cent of the allopaths reported use of oral rehydration solution in treating watery diarrhoea against 20% of the others. Prescription of antibiotics in treating dysentery was higher among allopaths than others. Allopaths were also less restrictive regarding continuation of breastfeeding and intake of food during diarrhoea among children.
Adult↗
Knowledge, assessment and management of pain related to nursing procedures used with premature babies: questionnaire study for caregivers.
The aim of the study was to discover how much Finnish nursing staff know about the pain experienced by premature babies and about pain assessment. The types of helping methods used by caregivers in the nursing of premature babies were also studied. A semistructured questionnaire was sent in autumn 1995 to all registered nurses, practical children's nurses and medical laboratory technologists who take heel blood samples (n = 280) working in paediatric intensive care units in all Finnish university hospitals. The response rate was 70.4%. The structured questions were processed quantitatively at Kuopio University with the SPSS/PC+ data processing program (SPSS, Chicago, IL, USA), and the open questions were processed using quantitative content analysis. The results indicate that the respondents have rather extensive knowledge about the pain experienced by premature babies, pain assessment, pain management and about nursing and helping methods. Pain was assessed mostly on the basis of behaviour and physiological changes, and only infrequently on the basis of biochemical changes. The respondents described the helping methods they use in considerable detail. The most common was to increase the baby's feeling of security. The answers to the open questions revealed that the actions used by the respondents in pain assessment and pain management were not completely consistent with their knowledge. The results demonstrate that caregivers do not use their knowledge adequately in their pain management practices. Future studies should observe the three groups of caregivers in order to discover how they treat premature babies' pain.
Caregivers↗
[Effects of biophysical index, knowledge, and self management compliance of patients with primary hypertension by a self management compliance promotion program].
PURPOSE: This study was to develop and prove the effects of a self management compliance promotion program for primary hypertension patients who reside in rural communities. METHOD: The content of the self management compliance promotion program developed by this study was as follows: A leader trains patients as a group or individually, in walking, education and green tea therapy from the first to twelfth week. From the thirteenth to twenty fourth week, the patients should perform walking and green tea therapy by themselves. One hundred twenty subjects volunteered to participate in the study, who were among those registered as hypertension patients in the 14 community health clinics located in Chungcheongbuk-do. RESULT: Systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, triglyceride, step width, and degree of obesity decreased significantly. High-density lipoprotein cholesterol, step length, knowledge of hypertension, and self management compliance significantly increased. CONCLUSION: A self management compliance promotion program for primary hypertensive patients enhances biophysical index and knowledge on hypertension, thus ultimately suggesting a nursing intervention for promoting self management compliance.
Adult↗
Management of weight problems and obesity: knowledge, attitudes and current practice of general practitioners.
A postal questionnaire was used to assess general practitioners' knowledge, attitudes and current practice of treatment regarding obesity and weight problems. Overall, 299 responses (75%) were received from general practitioners randomly selected from family practitioner committee lists in Portsmouth and Norwich. Currently 27% of the doctors were overweight and a further 3% obese. Many doctors (69%) had tried to lose weight at some time and 40% had been overweight and a further 12% obese in the past. The most popular methods used to educate overweight and obese patients were one to one counselling and giving out diet sheets and leaflets on healthy eating. The treatment advice to patients from the majority of doctors was to eat less in general (78%) (specifically to eat fewer calories 75%); to exercise (77%); or to attend a slimmers group (54%). Doctors thought that they were less effective than the media or the family in persuading overweight patients to lose weight. Doctors said they were prepared to counsel on weight reduction but felt they had little success in achieving weight loss in patients. Experience was ranked as the most important contributor to knowledge about managing obesity, and medical school was rated as least important. Further study is needed to discover how different practices and attitudes affect patient management and which ones are associated with greatest success. Medical schools and postgraduate centres could play a more important role in educating doctors about nutrition.
Adult↗