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PubMed2005

Cardiopulmonary complications of pregnancy.

OBJECTIVES: To provide an up-to-date review of the literature on the assessment and management of pulmonary and cardiac conditions that may affect women during pregnancy and the postpartum period. DESIGN: A review of the current literature was performed. RESULTS: Pregnancy may be complicated by a variety of pregnancy-specific and other cardiopulmonary complications. Management requires knowledge of the cardiopulmonary physiologic changes occurring in pregnancy, the pregnancy-specific conditions that may occur, and the effect of a fetus on maternal care. CONCLUSIONS: Admission of the pregnant or postpartum woman to the intensive care unit is uncommon but may require specialized knowledge for successful management.

Cardiopulmonary Resuscitation↗
PubMed2006

Application of current knowledge to the management of bleeding events during immune tolerance induction.

The development of inhibitors to factor VIII is the most serious adverse event associated with the treatment of haemophilia A, predisposing patients to uncontrollable haemorrhage, disability and premature death. Eradication of inhibitors via immune tolerance induction (ITI) is effective in the majority of patients, but may require months to years to achieve success. In the interim, the treatment and prevention of acute bleeding episodes are primary foci of care. Regrettably, there is a paucity of information regarding management of bleeding episodes in inhibitor patients undergoing tolerization. Until specific data from ongoing clinical trials are available to provide more guidance in this patient group, it is reasonable and useful to rely on the broader base of medical literature pertaining to patients not being tolerized to deduce strategies for controlling acute and perioperative bleeding episodes in inhibitor patients during ITI.

Blood Coagulation Factors↗
PubMed1995

Environmental risk factors of childhood asthma in urban centers.

Asthma morbidity and mortality are disproportionately high in urban centers, and minority children are especially vulnerable. Factors that contribute to this dilemma include inadequate preventive medical care for asthma management, inadequate asthma knowledge and management skills among children and their families, psychosocial factors, and environmental exposure to allergens or irritants. Living in substandard housing often constitutes excess exposure to indoor allergens and pollutants. Allergens associated with dust mites (DM) and cockroaches (CR) are probably important in both onset and worsening of asthma symptoms for children who are chronically exposed to these agents. Young children spend a great deal of time on or near the floor where these allergens are concentrated in dust. Of children (2 to 10 years of age) living in metropolitan Washington, DC, 60% were found to be sensitive to CR and 72% were allergic to DM. Exposure to tobacco smoke contributes to onset of asthma earlier in life and is a risk factor for asthma morbidity. Since disparity of asthma mortality and morbidity among minority children in urban centers is closely linked to socioeconomic status and poverty, measures to reduce exposure to environmental allergens and irritants and to eliminate barriers to access to health care are likely to have a major positive impact. Interventions for children in urban centers must focus on prevention of asthma symptoms and promotion of wellness.

Air Pollution, Indoor↗
PubMed2000

Assessing nurses' knowledge of wound management.

An understanding of the principles and theories of wound healing and management is vital for the delivery of high-quality care. This literature review suggests that wound management is often undertaken by health-care professionals who have not received sufficient training in this specialty.

Clinical Competence↗
PubMed1994

Knowledge-based information management: implications for information services.

The 1994 Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) standards for information management will change the way health care librarians respond to JCAHO accreditation surveys and may affect the way libraries are managed. This article will highlight the changes in the standards and the new opportunities they offer. Implications for library operations and the challenges inherent in working with the new Accreditation Manual for Hospitals (AMH) are also explored. The long-awaited 1994 Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) Accreditation Manual for Hospitals (AMH) is now on most hospital library shelves. As expected, librarians will find that the section on Professional Library Services (the PR chapter) has disappeared and that the standards previously in that section are now incorporated in part into the new Management of Information, or IM chapter. Although this method of grouping standards may be new to many health sciences librarians, the incorporation of library services into IM may actually provide many more opportunities for librarians than the previous method of addressing library services separately.

Accreditation↗
PubMed2000

An analysis of managerial skills for the current and future health care environment.

A survey questioned 503 experienced practitioners about managerial tasks and responsibilities of senior professionals in four allied health fields: physiotherapy, speech-language pathology, occupational therapy, and medical radiation science. Participants worked in a range of settings, including the private and public sectors, small and large departments/units, and community and hospital-based work sites. Factor analysis identified eight managerial areas of functioning: department running, staff relations management, legislative knowledge, career path management, implementation and change, quality assurance, management of future planning, and prioritizing work. The professional field of the practitioner influenced the importances attached to these areas, while work setting and gender of practitioner had minimal impact. Level of involvement in managerial tasks had no bearing on the importance attached to competency areas. Open-ended comments added depth to the results of the factor analysis. The findings are discussed with respect to the changing requirements being placed upon health service personnel.

Administrative Personnel↗
PubMed1988

Issues in airway management--1988.

Knowledge of the airway is expanding. New conditions, modern management strategies, and a more complete understanding of the interaction between the airway and fluid flux in the lung are presented.

Acute Disease↗
PubMed2000

Managed care organization authorization denials: lack of patient knowledge and timely alternative ambulatory care.

STUDY OBJECTIVE: To assess patient knowledge of managed care organization (MCO) regulations, availability of alternative ambulatory care, and patient outcome after MCO insurance authorization denial for an emergency department visit. METHODS: A medical screening examination and a follow-up structured interview were conducted with patients denied authorization for ED visits. The study was conducted at a large urban hospital with 36,000 annual ED visits and 40% MCO patients. RESULTS: During a 7-month period, 151 patients did not receive MCO authorization for ED care. The interview response rate was 75% (104/138) with 13 patients excluded. Eighty-three percent (86/104) of respondents came to the ED because they believed their problem was an emergency. Four percent (4/104) of the respondents had been instructed to go to the ED but were later denied authorization, whereas 85.6% (89/104) did not know that the MCO could deny payment. Only 37% (38/104) of the respondents reported having received instruction on the MCO preauthorization process, whereas of the 19% who contacted their MCO as instructed, all resulted in scheduling difficulties. Although 57% (59/104) received follow-up within 24 hours, 11% (11/104) of the respondents had a subsequent return visit to the ED with a subsequent admission rate of 4% (4/104). CONCLUSION: Few patients are aware of the need for MCO preauthorization for ED care, and almost half do not receive alternative care within 24 hours. A significant number of patients (11%) returned to the ED with an admission rate of 4%.

Adolescent↗
PubMed1997

Assessment of knowledge about cancer pain management by physicians in training.

This survey assessed the knowledge of physicians in training about the pharmacology of opioid analgesics and the benefits of palliative radiation therapy in the management of cancer pain. Eighty-one trainees at the Washington University Medical Center completed a questionnaire that addressed the palliative care of a hypothetical patient with metastatic non-small cell lung cancer. The questions addressed were 1) opioid selection, 2) conversion of parenteral to oral morphine, 3) management of opioid toxicities, 4) opioid addiction, and 5) efficacy of radiation therapy. The results demonstrated that few physicians in training were familiar with the stepwise progression of analgesic selection outlined in the World Health Organization (WHO) guidelines. When asked to convert a parenteral dose of morphine to an equivalent dose of a controlled-release preparation, 75% calculated a dose that was less than one-third the correct dose; only four (5%) calculated the dose correctly. Trainees were familiar with the management of opioid toxicities. They were unfamiliar with the palliative benefits of radiation therapy. Although 41% recognized that complete relief of pain could be achieved in 50%-60% of patients, most (70%) predicted that maximum pain relief would be seen within the first month, and 98% predicted maximum benefit by 12 weeks. Although cancer pain management has been highlighted in the lay and medical literature, physicians in training still demonstrate deficiencies in their knowledge about the pharmacology and bioequivalency of the opioid and the benefits of radiation therapy. Published guidelines for the management of cancer pain need to be disseminated to all medical personnel caring for patients with cancer.

Analgesics, Opioid↗
PubMed2007

Improving paediatric nurses' knowledge and attitudes in childhood fever management.

AIM: This paper reports an evaluation of the effectiveness of a peer education programme in developing paediatric nurses' evidence-based knowledge and attitudes towards fever management and the sustainability of these changes. BACKGROUND: In general, paediatric nurses' fever management knowledge seems to be mediocre. They believe fever to be harmful, causing febrile convulsions and brain damage. Antipyretics are administered to prevent febrile convulsions and alternate antipyretics are given when temperatures are not reduced. METHOD: A quasi-experiment was conducted from August 2002 to March 2003. An experimental group of Registered Nurses received the peer education programme and peer support and education were promoted for those unable to attend the sessions. A control group continued its normal practices. Seventy-seven nurses were eligible to attend the programme; 74.0% attended at least one session, 52% two or more. Questionnaire data were collected 1 month before and 1 and 4 months after the peer education programme from 56.3% to 77.8% of eligible experimental and 40.9% to 51.6% of eligible control group nurses. FINDINGS: Interaction effects between group and time were found in overall knowledge (P = 0.01), specifically knowledge of the physiology of fever (P = 0.001), and attitudes towards evidence-based fever management (P = 0.05). In addition, experimental group nurses demonstrated statistically significantly more knowledge of general fever management principles at 4 months after the intervention than control group nurses (P = 0.01), and compared with their own knowledge at baseline (P < 0.001). CONCLUSIONS: Educational programmes targeting practice change must be theoretically based and target knowledge, attitudes and barriers to change. The programme tested here, which incorporated peer education and support and facilitated group change, is adaptable to other practices, groups and settings.

Adult↗
PubMed1986

Robots in food systems: a review and assessment of potential uses.

Management personnel in foodservice, food processing, and robot industries were surveyed to evaluate potential job functions for robots in the food industry. The survey instrument listed 64 different food-related job functions that participants were asked to assess as appropriate or not appropriate for robotic implementation. Demographic data were collected from each participant to determine any positive or negative influence on job function responses. The survey responses were statistically evaluated using frequencies and the chi-square test of significance. Sixteen of the 64 job functions were identified as appropriate for robot implementation in food industries by both robot manufacturing and food managers. The study indicated, first, that food managers lack knowledge about robots and robot manufacturing managers lack knowledge about food industries. Second, robots are not currently being used to any extent in the food industry. Third, analysis of the demographic data in relation to the 16 identified job functions showed no significant differences in responses.

Adult↗
PubMed2002

Essential components of a medical student curriculum on chronic pain management in older adults: results of a modified delphi process.

OBJECTIVE: The purpose of this study was to develop expert-based guidelines for a medical student curriculum on chronic pain evaluation and management in older adults. METHODS: A modified Delphi approach was used to survey an interdisciplinary panel (N = 12) with expertise in pain assessment, pharmacological and nonpharmacological pain management, and medical student education. A list of core knowledge/attitudes/skills (KAS) competency items was developed based upon a comprehensive literature review and clinical experience. The expert panel was then asked to consider the degree to which each item should be included in a pain education curriculum, using a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree with inclusion of item). Items with a mean>4.0 (agree) and a standard deviation (SD) <1 were retained, while others were discarded. Retained items were refined, and new items were added based upon panel suggestions. The new KAS list was again scored by the expert panel, and items with a mean <4.0 and SD <1 were discarded. RESULTS: The original KAS list contained eight pain assessment knowledge, seven pain management knowledge, 12 pain attitudes, and 14 skills/abilities items. The final list, presented in this paper, consisted of 11 pain assessment knowledge, seven pain management knowledge, 12 pain attitudes, and 12 skills/abilities items. DISCUSSION: We have developed curriculum content guidelines for educating medical students about the evaluation and management of chronic pain in older adults. Once curricula are developed, their efficacy, in particular their influence on patient outcomes, must be evaluated.

Journal Article↗
PubMed2004

The PRO-SELF pain control program improves patients' knowledge of cancer pain management.

PURPOSE/OBJECTIVES: To evaluate the effectiveness of a psychoeducational program (i.e., PRO-SELF Pain Control Program) compared to standard care in increasing patients' knowledge regarding cancer pain management. DESIGN: Randomized clinical trial. SETTING: Seven outpatient settings in northern California. SAMPLE: 174 outpatients with cancer and pain from bone metastasis. METHODS: Following randomization into either the PRO-SELF or standard care group, patients completed the Pain Experience Scale (PES) prior to and at the completion of the intervention. MAIN RESEARCH VARIABLES: Total and individual item scores on the PES. FINDINGS: Total PES knowledge scores increased significantly in the PRO-SELF group (21%) compared to the standard care group (0.5%). Significant improvements in knowledge scores for patients in the PRO-SELF group were found on five of the nine PES items when compared to baseline scores. CONCLUSIONS: The PRO-SELF Pain Control Program was an effective approach to increase patients' knowledge of cancer pain management. IMPLICATIONS FOR NURSING: The use of a structured paper-and-pencil questionnaire, such as the PES, as part of a psychoeducational intervention provides an effective foundation for patient education in cancer pain management. Oncology nurses can use patients' responses to this type of questionnaire to individualize the teaching and to spend more time on the identified knowledge deficits. This individualized approach to education about pain management may save staff time and improve patient outcomes.

Female↗
PubMed1992

[Epidemiology and natural history of biliary calculi. Implication for clinical management].

The knowledge of the epidemiology of cholesterol gallstones is mainly descriptive in Chile. Prevalence data has been gathered from several autopsy studies. The prevalence in these studies is similar to the prevalence determined in a cholecystographic study in a sample of the population of Santiago: 51% of women and 17% of men harbor gallstones, or have been cholecystectomized. The risk factors of the disease are well known and include sex, age, obesity, pregnancy, female sex hormones and hypotriglyceridemic drugs, there is scarce data on the natural history of gallstone disease. In this article we review the present knowledge of both the epidemiology and natural history of gallstones. In addition, we present some specific questions related to the potential identification of environmental and genetic risk factors in epidemiological studies. It is stressed that the knowledge of the natural history of gallstone disease is critical for the appropriate rational management of silent gallstones.

Cholelithiasis↗