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PubMed2006

Structural visualization of expert nursing: Cancer pain management.

Nurses' knowledge and making decisions in Cancer Pain Management contribute much to the improvement of cancer patients' QOL. Based on the practice of a expert nurse involved in Cancer Pain Management, we have developed the algorithm, which clarified that nurses implement much of observations or complicated decision-makings in Cancer Pain Manage Hereafter it is a significant challenge to examine its consistency and validity to develop its system.

Algorithms↗
PubMed2004

Relationship of diabetes-specific knowledge to self-management activities, ambulatory preventive care, and metabolic outcomes.

BACKGROUND: Educational interventions increase diabetes patients' knowledge and self-care activities, but their impact on the use of health services to prevent diabetes complications is unclear. We sought to determine the relationship of patients' diabetes-specific knowledge with self-management behaviors, use of ambulatory preventive care, and metabolic outcomes. METHODS: We surveyed 670 adults with diabetes from three managed care plans to assess diabetes knowledge (using an eight-item scale) and self-management activities. With chart review, we assessed five processes of care--retinal and foot examinations, low-density lipoprotein cholesterol (LDL-C) testing, hemoglobin A1c (HbA1c) testing, and urine microalbumin testing--and three metabolic outcomes--HbA1c < or = 9.5%, LDL-C <130 mg/dL (3.36 mmol/L), and last blood pressure <140/90 mm Hg. RESULTS: In adjusted analyses, a one-point increase on the knowledge scale was associated with following a diabetes diet (OR 1.23, 95% CI 1.10-1.38), blood glucose self-measurement (OR 1.29, 95% CI 1.13-1.48), and regular exercise (OR 1.15, 95% CI 1.03-1.28) but not with processes of care or metabolic outcomes. CONCLUSIONS: Knowledgeable patients were more likely to perform self-management activities but not to receive recommended ambulatory care or reach metabolic outcome goals. Providing patient education about diabetes care processes should be tested as a means of increasing ambulatory care to prevent diabetes complications.

Adult↗
PubMed1997

An instrument for measuring staff's knowledge of behavior management principles (KBMQ) as applied to geropsychiatric clients in long-term care settings.

Direct-care staff in long-term care institutions for the elderly are responsible for implementing behavioral treatment programs for an increasing number of patients with behavioral and psychiatric problems. Because the quality of life for these patients is a function of the quality of care provided, maximizing staff's behavioral competencies could potentially improve patients' quality of life. Behavioral competence requires an understanding of behavioral principles. To assess direct-care staff's knowledge of behavioral principles as applied to geropsychiatric settings the KBMQ, a 30-item multiple choice instrument, was designed. The psychometric properties were tested with 203 staff. Results suggest that the instrument is reliable and valid. Potential uses and limitations are discussed.

Adult↗
PubMedDate not supplied

Medication knowledge and self-management by people with type 2 diabetes.

OBJECTIVE: To explore medication knowledge and self-management practices of people with type 2 diabetes. DESIGN: A one-shot cross sectional study using in-depth interviews and participant observation. SETTING: Diabetes outpatient education centre of a university teaching hospital. SUBJECTS: People with type 2 diabetes, n=30, 17 males and 13 females, age range 33-84, from a range of ethnic groups. OUTCOME MEASURES: Ability to state name, main actions and when to take medicines. Performance of specific medication-related tasks; opening bottles and packs, breaking tablets in half, administering insulin, and testing blood glucose. RESULTS: Average medication use > or = 10years. Respondents were taking 86 different medicines, mean 7 +/- 2.97 SD. Dose frequency included two, three and four times per day. All respondents had > or = 2 diabetic complications +/- other comorbidities. The majority (93%) were informed about how and when to take their medicines, but only 37% were given information about side effects and 17% were given all possible seven items of information. Younger respondents received more information than older respondents. Older respondents had difficulty opening bottles and breaking tablets in half. Twenty percent regularly forgot to take their medicines. Increasing medication costs was one reason for stopping medicines or reducing the dose or dose interval. The majority tested their blood glucose but did not control test their meters and 33% placed used sharps directly into the rubbish. CONCLUSION: Polypharmacy was common. Medication knowledge and self-management were inadequate and could lead to adverse events.

Adult↗
PubMed1997

Nurses' knowledge of pain assessment and management: how much progress have we made?

Undertreatment of pain and lack of knowledge about pain management have been evident for approximately two decades. Because nurses are often the cornerstone of pain management, nurses' knowledge in this area is especially important. This paper explores indications of progress in the level of nursing knowledge about basic aspects of pain management. The literature is reviewed and findings from recent (1995) surveys of nurses' knowledge are compared with results of similar surveys conducted beginning in 1988. Improvements in nurses' knowledge of pain assessment, opioid dosing, and likelihood of addiction seem to have occurred. However, knowledge deficits continue. Fewer than one-half of the nurses surveyed understand that the patient's self report of pain is the single most reliable indicator of pain and that the nurse should increase a previously safe but ineffective dose of opioid. Findings from surveys on addiction reveal that the longer the patient receives opioids the more concerned nurses become about causing addiction. Nevertheless, results of current knowledge surveys of nurses suggest that educational efforts probably have been beneficial and should continue. To maximize the impact of educational efforts, content in basic and continuing education courses should be prioritized and critically evaluated for relevance and accuracy, especially content related to addiction. Early in the education of nurses, responsibility for pain assessment and use of analgesics must be instilled.

Evaluation Studies as Topic↗
PubMed2006

What effect does an educational intervention have on interns' confidence and knowledge regarding acute dyspnea management? A randomized controlled trial.

BACKGROUND: Though acute dyspnea is commonly encountered in hospitalized patients, interns often receive only informal instruction in managing such patients. We hypothesized that formal instruction would improve interns' knowledge and confidence in managing patients with acute dyspnea. METHODS: Twenty-six internal medicine interns were randomized to receive either standard education or standard education plus the educational intervention. The educational intervention included two small-group, case-based discussions on acute dyspnea management. All participants completed pre- and post-intervention surveys over four months that assessed their knowledge and confidence in managing patients with acute dyspnea. RESULTS: Of the 16 interns in the intervention group, 14 attended one of the two small-group sessions while seven attended both sessions. Mean confidence increased by 21.2% in the intervention group and 14.4% in the control group. The trend over time for both groups was significant (P < .001); the effect of the intervention was not (P = .19). Mean knowledge scores increased 7.6% in the intervention group and 5.5% in the control group. Again, the trend over time for both groups was significant (P < .01), but the effect of the intervention was not (P = .65). A per-protocol analysis revealed a trend toward significance with mean scores increasing 15.6% (P = .067). CONCLUSIONS: Our trial found that intern confidence and knowledge about acute dyspnea management increased significantly over time; however, no significant differences between the intervention and control groups were seen. The complete intervention was not administered to the majority of the intervention group, thereby skewing results to the null. The per-protocol analysis suggests attendance at educational sessions may improve knowledge. Future interventions should use a more sensitive testing instrument, a larger sample, and a more powerful intervention.

Clinical Competence↗
PubMed1997

Exchanging clinical knowledge via Internet.

The need for effective and efficient exchange of clinical knowledge is increasing. Paper based methods for managing clinical knowledge are not meeting the demand for knowledge and this has undoubtedly contributed to the widely reported failures of clinical guidelines. Internet affords both opportunities and dangers for clinical knowledge. Systems such as Wax have demonstrated the importance of intuitive structure in the management of knowledge. We report on a new initiative for the global management of clinical knowledge.

Artificial Intelligence↗
PubMed2001

Airway management behaviour, experience and knowledge among Danish anaesthesiologists--room for improvement.

BACKGROUND: Problems with managing the airways in relation to anaesthesia causes severe morbidity and mortality. A large proportion of these adverse respiratory events is preventable. Still patients continue to die from airway disasters related to anaesthesia, also in Scandinavia. The goal of this study is to identify which efforts are likely to improve this situation. METHODS: A questionnaire asking about experience, behaviour and availability of various items of equipment was mailed to all members of the Danish Society of Anaesthesiologists and were returned anonymously. RESULTS: More than 65% of respondents have sufficient access to a flexible fibrescope, but still 17% of specialists have no access and the vast majority (>67%) has little (1-10 times) or no experience in its use for awake intubation. A total of 52-70% knew the basic principles of the ASA difficult airway algorithm, but despite this only 25-50% would perform awake intubation if a difficult intubation was expected. More than 20% of respondents had experienced preventable airway management mishaps. In all, 18-46% did not know how to oxygenate via the cricothyroid membrane. CONCLUSION: There is room for improvement regarding airway management skills among Danish anaesthesiologists. It is likely that airway management can be improved by: A) Better knowledge of an appropriate plan, algorithm, for airway management. B) Awake intubation used more often. C) More experience in fibreoptic intubation. D) All anaesthesiologists accepting that previous difficult intubation is an indicator of future difficulties. E) All anaesthesiologists knowing, and practising on manikins, how to oxygenate via the cricothyroid membrane. F) Always having a laryngeal mask airway immediately available when inducing anaesthesia.

Anesthesia↗
PubMed2003

Knowledge of diarrhea management among rural practitioners.

OBJECTIVE: To determine diarrhea management in rural practitioners. METHODS: This study was conducted among the RMP's of 4 blocks of Aligarh. Pre-coded questionnaire was completed and educational programme followed. 91% were prescribing ORS in various combinations, but only 9.8% were advising ORS and feeding as standard management of diarrhea. Only 12.8% could name a WHO ORS brand and 50% were giving wrong instructions for preparation. 95% were advising inadequate amounts of ORS. Only 43.5% were advising feeding during diarrhea but 86.6% were advising to continue breastfeeding. On an average every 3rd to 4th patient was administered IVF's. 52% felt that drugs should be prescribed. RESULTS: 90% and 55.3% of RMPs could identify diarrhea and key signs of dehydration. CONCLUSION: There is a need for hands on training for the practitioners and education of the masses regarding proper management of diarrhea.

Clinical Competence↗
PubMed1993

Knowledge based lipid management system for general practitioners.

The aim of this system is to provide computer generated interpretative reports with management advice for General Practitioners (GPs). The lipid domain was chosen because of its importance in preventive medicine. Request forms to elicit extra clinical information were designed and distributed to a group of randomly selected GPs. Interpretation of laboratory and clinical data categorizes patients according to risk of coronary heart disease. The management system is rule based and provides advice on lifestyle modifications, diet and drug intervention. Previous clinical and laboratory results are taken into account in determining a management strategy. To date 435 request forms have been processed: 309 (71%) from first visits and 126 (29%) from follow-up visits. Normal lipid profiles were found in 19% of cases. There was 93% agreement between management advice given by the system and the expert. The system has now been modified and further evaluation is under way.

Artificial Intelligence↗
PubMed1989

The principles and prototyping of a knowledge-based diabetes management system.

This paper describes the principles and prototyping of a computer-based system being developed to assist in the management of diabetes mellitus. Unlike other approaches based upon mathematical modelling or the use of computer algorithms, this system adopts one derived from artificial intelligence, seeking to incorporate the dynamics of glucose and insulin in a manner which reflects their clinical importance. The resultant logical model (qualitative algebra) defines the relationships between changes in insulin dose and site and time of injection and glycaemic response. In this manner the computer-based system, implemented in Prolog, can be used to provide advice concerning insulin therapy by means of making qualitative predictions of patient outcome of blood glucose profile resulting from alternative insulin regimens.

Blood Glucose↗
PubMed1999

Comparison of computer-assisted instruction and seminar instruction to acquire psychomotor and cognitive knowledge of epistaxis management.

Epistaxis is a common problem faced by primary care physicians. Typically, first-hand experience with this problem is not obtained in medical school. A computer learning module was developed to address practical management of epistaxis. It was evaluated by use of third-year clerks and compared with an interactive seminar based on the same material. Fifty-eight students doing their required otolaryngology rotations were randomly separated into 3 groups: (1) doing a preinstruction test, (2) using the computer module, and (3) participating in a small-group seminar. All participants were tested with a short written test and a practical test that involved performing anterior nasal pack placement in a model patient. Percentage scores for the 2 groups were compared by use of t tests, and there was no significant difference between the written, practical, or combined scores at a level where P = 0.05. This study shows that basic patient management and a simple procedure can be taught as effectively with a computer module as with a small-group interactive seminar.

Clinical Clerkship↗