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Knowledge and diabetes self-management.

This paper discusses the role of knowledge in the self-management of diabetes mellitus and addresses limitations in the measurement of knowledge in studies which have been undertaken. In addition, the findings of a recent investigation related to knowledge of diabetes in young adults with the condition are reported. The results showed high levels of knowledge and glycosylated haemoglobin values which were acceptable when length of time with diabetes was considered. However, no relationship between knowledge and level of glycaemic control was demonstrated. In the light of recent research confirming the need for tighter metabolic control, the implications of these findings in relation to future research and the education of health care professionals are considered. Although this paper related to diabetes mellitus many of the issues raised are equally applicable to the wider forum of chronic illness management.

Adolescent↗

Local cultural knowledge and water resource management: the Wind River Indian Reservation.

Ecology and culture comprise interacting components of landscapes. Understanding the integrative nature of the landscape is essential to establish methods for sustainable management. This research takes as a unifying theme the idea that ecological and cultural issues can be incorporated through management. As a first step in developing integrative management strategies, information must be collected that compares and contrasts ecological and cultural issues to identify their areas of intersection. Specifically how can local cultural knowledge enable water resource management that reflects cultural and ecological values? This research examines Native American cultural knowledge for setting water resource management priorities in the Wind River Indian Reservation in central Wyoming. A cross-cultural approach is adopted to assess the relationship between indigenous cultural knowledge and Euro-American perspectives through a comparative examination of the Wind River Water Code and Wyoming Water Law. This research indicates that cultural perspectives provide a rich arena in which to examine management issues. Understanding and identifying cultural practices may be an important first step in collaborative resource management between different cultural groups to prevent conflict and lengthy resolution in court.

Conflict, Psychological↗

Diarrhoea in children of Nigerian market women: prevalence, knowledge of causes, and management.

A cross-sectional survey was carried out among mothers of children aged less than five years in two markets in Ibadan, one with poor environmental sanitation and the other clean and well maintained. The study took place between September 1996 and March 1997. The questionnaire used for this survey sought information about the occurrence of diarrhoea among children aged less than five years, their mothers' knowledge about the management of diarrhoea and their practices, including care-seeking practices, and the use of oral rehydration solutions. Two hundred and sixty-six mothers were interviewed in the first market (Bodija) and 260 in the other (Gbagi). Thirty-seven percent of the children in the cleaner market (Gbagi) were said to have had diarrhoea within the last 3 months compared to 33% of the children in the unhygienic Bodija market (p > 0.05). These results suggest that environmental sanitation may not be a major determinant of diarrhoea among children of the two groups of market women. When their children had diarrhoea, 44% (Bodija) and 40% (Gbagi) of the mothers attended health centres, 33% (Bodija) and 32% (Gbagi) gave ORT at home, and 12% (Bodija) and 19% (Gbagi) purchased drugs at a chemist. The study further showed that, while only one-third of all respondents resorted to home-treatment of diarrhoea with ORS, more than 80% of them knew the components and composition of ORS solution. There is a need to continue to encourage mothers to use ORS and, thus, bridge the knowledge-practice gap in mothers' management of diarrhoea at home.

Adult↗

Knowledge and perceptions of residents regarding case management of acute diarrhea.

The knowledge and perceptions about case management of acute diarrhea were studied amongst 330 resident doctors working in Pediatric Departments of various Medical Colleges in the country. Our observations highlight the inadequacies in the medical curriculum and deficient clinical training in the management of acute diarrhea in the teaching institutions. Knowledge of signs of dehydration was correctly perceived by only 79.8% interns, 80.9% house physicians and 81.1% postgraduate students. It was appalling to observe that despite spending 1-3 years in pediatric wards, the knowledge and perceptions of postgraduate students had not significantly improved. On the contrary, the responses of postgraduate students were poorer as compared to interns in their perceptions of use of ORT in moderate dehydration (p less than 0.005) and in presence of vomiting (p less than 0.05). Adequate thrust on diarrhea and its management during undergraduate as well as during postgraduate teaching and proper training in diarrhea case management with "hands on training" needs to be viewed as a priority in the teaching institutions.

Acute Disease↗

Promoting continuing education in diabetes management.

Diabetes knowledge among hospital nurses is suboptimal. Studies that measured basic diabetes knowledge among nurses in a variety of clinical settings have consistently reported poor understanding of hemoglobin A1C, medication usage and side effects, and self-care diabetes management. Although diabetes is a common diagnosis among hospitalized patients, many nurses report they have never attended an update on diabetes management. To promote advances in glycemic control within the hospital setting, the nursing staff must be better educated in the theoretical framework and clinical practice guidelines for diabetes management. The methods used to promote continuing education in diabetes among staff nurses need to be cost-effective as well as flexible to accommodate work shifts and learning needs. Because many hospitals are facing staff shortages and increased patient acuity, staff development needs may not be a high priority. To be successful, updating diabetes knowledge must be a collaborative effort involving clinical care, research, and education. Mentoring and peer support also are useful methods for improving glycemia in the hospital setting.

Diabetes Mellitus↗

Attitudes, knowledge and blood glucose control.

The hypothesis that management-related diabetes knowledge and attitudes may be more directly related to diabetic control than general knowledge of or general attitude towards diabetes is examined. Sixty Type 1 diabetic patients were studied using an itemized knowledge questionnaire and an attitude scale measuring a general attitude to diabetes but containing a previously defined subgroup of items concerned with attitudes to management. A significant linear correlation was found between management-related knowledge (r = -0.39; p less than 0.01) and HbA1c. However, knowledge of insulin, diet, footcare, and glucose monitoring were not significantly correlated with HbA1c, poor control being associated with both very low and very high knowledge status. A significant linear correlation was found between management-related attitudes (but not general attitude) and HbA1c (r = -0.47; p less than 0.01). The multiple regression correlation between HbA1c and both management knowledge and attitudes was -0.51. Most (63%) of the association between knowledge and HbA1c was attributable to attitude. This study provides support for education strategies based upon achieving improved patient attitudes and motivation rather than comprehensive knowledge as the most effective way of improving patient diabetic control.

Adolescent↗

Epilepsy education in schools.

The objective of this study was to assess the effect of an epilepsy education initiative on the management of epilepsy in Southampton schools. A self-completion questionnaire survey was undertaken of staff in 19 Southampton primary schools and ten secondary schools. Changes in knowledge and management of seizures in children with epilepsy were measured following an education session and a recommended implementation of an individual seizure protocol for children with epilepsy. There were significant changes in some areas of seizure management and knowledge. Only a small number (three) of primary schools had a protocol in place. Two primary and four secondary schools were in the process of putting the protocol in place. An improvement in knowledge and seizure management has been demonstrated. Further work is needed to implement an individual seizure protocol for all children with epilepsy.

Child↗

The effects of a pain management education program on the knowledge level and attitudes of clinical staff.

Two of the most important variables in effective pain management are the knowledge level and attitudes of the clinical staff at the bedside. Gaps in knowledge or uninformed attitudes can prevent optimal pain management. A baseline survey of staff knowledge and attitudes can guide educational and other process improvement efforts. Improvements can then be quantified. A multidisciplinary and multifaceted approach to pain management can improve the knowledge and attitudes of bedside clinicians.

Data Collection↗

Knowledge and perceived competence of home care nurses in pain management: a national survey.

This national mail survey assessed pain-related knowledge and subjective competence of a random sample of home care nurses across the United States. Other study objectives were to examine the relationship between nurse characteristics, knowledge and perceived competence, and assess continuing education practices. On average, the 1236 nurses scored only 56% of the items correctly, demonstrating stronger knowledge in pain assessment than treatment. Respondents reported most confidence in patient and family communication, discussion of advance directives and pain assessment. The lowest competence was reported in sophisticated pain treatment techniques. The relationship between knowledge and subjective competence was found to be highly significant. Sixty-three percent of the sample displayed a realistic assessment of their pain management knowledge, while 37% under- or overestimated what they knew. It is challenging to engage the latter group who overestimate their competence but score low on pain management knowledge. Educational strategies need to differentiate these two groups and target the audience appropriately.

Advance Directives↗

Lingual displacement of an entire lower third molar. Report of a case with suggestions for prevention and management.

Perfect knowledge of regional anatomy is the main factor in the prevention of tooth displacement during lower third molar extraction. Some technical expedients should be used to avoid the occurrence of this accident and to manage it if it anyway happens. The patient was seen just 2 days after his left lower third molar was lingually displaced during surgical extraction. Two mucoperiosteal flaps were made under general anaesthesia, one on each side of the mandible, to obtain good exposure of the previous bone access and to retrieve the tooth. No further complications occurred. Lower third molar extraction becomes complicated if tooth displacement happens. Predisposing factors of this accident are analyzed and the rules to minimize the risk of its occurrence and to simplify the retrieval of the displaced tooth are discussed.

Adult↗

Peripheral arterial disease--Part II: Management.

While knowledge about peripheral arterial disease (PAD) appears well disseminated, the condition still goes largely undiagnosed and untreated. In PART 1 of this paper, we summarized the diagnosis, epidemiology and risk factors for PAD. Non-invasive treatment involves management of risk factors and targeted drug therapy. Invasive strategies include angioplasty, angiogenesis and surgery. Dealing with both the structural factors (physical plaque morphology) and functional ones (endothelial function) are important in effectively managing PAD. This paper (PART 2) deals with the management (medical and surgical) of PAD.

Angioplasty↗

Future cancer management with stem cell knowledge and technology.

Cancer has been proposed as a result of abnormal control of growth and development of stem cells for more than century. This is the "cancer stem cell hypothesis". Both cancer and stem cells share many common especial properties. They are immortal and have good differentiation potential. In addition, organogenesis and carcinogenesis are very similar processes. Recently, more evidence and convincing data from stem cell biology research are supporting this concept. Furthermore, the research provides new promising approaches for cancer diagnosis and treatment based on stem cell knowledge and technology. Upcoming data and evidence may revolutionize cancer management, making it more effective and safer.

Forecasting↗

Community exchange and training in the Suid Bokkeveld: a UNCCD pilot project to enhance livelihoods and natural resource management.

Community knowledge exchanges have played a key role in developmental processes in the Suid Bokkeveld community of South Africa. Two exchange visits were undertaken with the support of the Department of Agriculture and an NGO, the Environmental Monitoring Group, which have led to local economic development and enhanced capacity to manage natural resources in a sustainable manner. These pilot projects were undertaken within the framework of the Community Exchange and Training Programme of the Global Mechanism of the United Nations Convention to Combat Desertification (UNCCD). The methodology applied included facilitation to develop a community-based vision for development, in terms of which the community exchange process was designed. A Facilitation Team of service providers conducted preparatory workshops, and identified potential partner communities. Two exchange visits were carried out, one focused on Rooibos production and marketing, and the other on community-based eco-tourism. Following report-back and planning workshops, emerging community-driven initiatives were supported through their formative stages. The initiatives have not only resulted in enhanced livelihoods, but the methodology has also been applied widely in a number of different contexts.

Community Participation↗

Essential activities and knowledge domains of case management: new insights from the CCMC role and functions study.

The Commission for Case Manager Certification (CCMC) defines case management (CM) as "a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs. [Case management] uses communication and available resources to promote quality, cost-effective outcomes." The practice of CM spans the entire health-care spectrum, including pre-acute, acute, and post-acute settings, and the involvement of varied care providers, such as nurses, social workers, rehabilitation counselors, physicians, and other allied health professionals. So what does it mean to practice as a case manager? What roles and job functions are performed and what knowledge is required of a professional in the field for effective practice? These highly relevant questions reflect the thinking of the CCMC commissioners when the latest Case Manager Role and Functions study was undertaken. The primary purpose of this research, which is conducted every 5 years by the CCMC, is to capture the current state of CM practice. This type of in-depth research is required to support an evidence-based certification examination such as the one offered by CCMC-the certified case manager (CCM) credential. Moreover, as the first and largest nationally accredited organization to certify US case managers, the CCMC recognizes its responsibility to undertake and promote scientifically conducted research in the field of CM.

Case Management↗

Knowledge of and reported asthma management among South Australian general practitioners.

AIM: This study, carried out in 1989, set out to assess general practitioners' knowledge of asthma management and their reported management practices. METHOD: Of 153 randomly selected South Australian general practitioners 127 (83%) completed a questionnaire designed to explore issues relating to the management of asthma. RESULTS: The survey revealed substantial differences between general practitioners in their knowledge and management practices including the assessment of the severity of asthma, the need for objective monitoring, that is by the use of spirometry and peak flow meters, and the use of medication. Overall, the sampled general practitioners believed that patient-related factors were the main barriers to effective treatment of asthma. CONCLUSION: The findings of this study suggest that ideal asthma management was not being attained. More research is required to ascertain why such variability among practitioners exists and how best to remedy these differences.

Adult↗

Videotape increases parental knowledge about pediatric pain management.

UNLABELLED: Pediatric pain management often depends on parents recognition and assessment of their child's pain and their beliefs as to whether the pain should be treated. Parental misconceptions concerning pain assessment and pain management may therefore result in inadequate pain treatment, particularly in patients who are too young or too developmentally handicapped to self-report their pain. We hypothesized that viewing a concise, educational videotape would provide parents with instructive information that could correct misconceptions concerning pain and pain management in children. To do this, we evaluated the impact of an educational videotape on parental responses to a questionnaire about pediatric pain management. Parents of children scheduled for inpatient, postoperative hospital care were studied. After answering 30 questions, parents were randomly assigned to either view (Group 1) or not view (Group 2) a 19-min educational videotape. Immediately after viewing the videotape (Group 1), or 30 min after taking the first test (Group 2), parents were asked to answer the same questionnaire a second time. The effect of seeing the videotape was assessed by comparing post-pre test score differences using paired t-test. One-hundred parents were studied. Randomization was effective in assigning equitable groups. Initial scores of percent answers correct in each group were not different ([mean +/- SD] Group 1 [n = 50]: 68.7% +/- 18.8% vs Group 2 [n = 50]: 61.5% +/- 22.7%; P = 0.09). Viewing the videotape effectively increased test scores: paired t-test within groups demonstrated a significant difference in Group 1 (22.4% +/- 16.5%, P < 0.0001), whereas Group 2 scores changed to a much lesser degree (2.7% +/- 8.3%, P = 0.0271). All parents who viewed the videotape stated that it was informative regarding their understanding of their child's pain management. This study demonstrates the effectiveness of an educational videotape in changing parental knowledge concerning postoperative pediatric pain. This effective and efficient teaching medium may be useful in improving pain management in postoperative pediatric surgical patients. IMPLICATIONS: Pediatric pain management often depends on parents recognition and assessment of their child's pain and their beliefs as to whether the pain should be treated. This prospective, randomized, controlled study demonstrated the effectiveness of an educational videotape in changing parental knowledge concerning postoperative pediatric pain. This effective and efficient teaching medium may be useful in preventing inadequate pain management in postoperative pediatric surgical patients.

Adult↗

Knowledge jobs--how to manage without burnout?

The working world is progressing from the industrial era to the era of knowledge. The critical factor of success in work is shifting from machines to the human mind. All work that essentially uses and produces knowledge during and as a result of the work process can be defined as knowledge work. Knowledge jobs involve many health-promoting features, but stress and burnout may be caused by the rapid increase in the knowledge-intensity of work, new job demands, and emerging new professional subcultures emphasizing excessive commitment to work. Very little empirical evidence is available on these developments. Much more research is needed to understand the essential features of knowledge work, the change in organizational cultures, and the values guiding this process from the point of view of human resources. Research is also needed to develop organizational strategies for the prevention of stress and burnout in knowledge jobs.

Administrative Personnel↗