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PubMed2004

Knowledge About Recommended Treatment and Management of Major Depressive Disorder, Panic Disorder, and Generalized Anxiety Disorder Among Family Physicians.

BACKGROUND: Concerns have been raised about whether primary care physicians appropriately manage mental disorders. We assessed family physicians' knowledge of appropriate management of major depressive disorder (MDD), panic disorder, and generalized anxiety disorder (GAD). METHOD: Active members of the Texas Academy of Family Physicians (N = 3553) were mailed a questionnaire in 2002 asking them to indicate which treatments they felt were effective for MDD, panic disorder, and GAD and also to indicate how they had treated their last patient with each disorder. Their treatment strategies were then compared with current guidelines. RESULTS: 574 physicians (16%) responded. The percentage of respondents scoring at or above 80% for knowledge of effective treatments was 88.3% for MDD, 16.8% for panic disorder, and 12.5% for GAD (p <.001 for MDD vs. panic disorder or GAD). Only 0.3% of MDD patients, 1.4% of panic disorder patients, and 4.0% of GAD patients were not prescribed at least 1 of the effective treatments. Referral rates to mental health providers were high for all 3 conditions. CONCLUSIONS: There were significant gaps in physician knowledge of current guidelines on treating panic disorder and GAD, but not MDD. However, most patients with one of the disorders were either referred to a mental health provider or treated with an effective modality.

Journal Article↗
PubMed1998

Radiotherapy residents' knowledge of and attitudes toward management of cancer pain.

PURPOSE: To evaluate the fund of knowledge of and attitudes toward cancer pain management of radiotherapy residents across the nation. METHODS: Radiotherapy (XRT) residents who had completed at least a year of training were surveyed by questionnaire. Residents (n = 10) from a training program who had been given instructional resources in cancer pain management skills were compared with residents from across the nation (n = 61). A validated survey used in national Cancer Pain Initiative Role Model Programs was administered by mail. The survey contained 30 questions that evaluated attitude alone (A), knowledge alone (K), and how attitude affects the application of knowledge (A/K). RESULTS: The residents from the training program scored significantly higher in K (p < 0.005) and A/K (p < 0.04) than did the residents across the nation. No difference in scores evaluating A were detected (p = 0.26). Compared with the baseline knowledge of physicians in practice who had attended a workshop on cancer pain management, the national XRT residents had significantly lower scores in A (p < 0.006) and K (p < 0.001); however, no difference was found in A/K scores. After the workshop, the physicians in practice had significant gains in cancer pain management skills (p < 0.006). When the post-instruction survey was compared with the national XRT resident scores, there were marked differences in A (p < 0.00001), K (p < 0.00001) and A/K (p < 0.01). CONCLUSIONS: XRT residents in the United States are empathetic, but knowledge of cancer pain management is lacking. Instruction in the principles of cancer pain management can make a profound difference in knowledge and attitude. There is a need to recognize cancer pain management as a significant aspect of radiotherapeutic practice.

Attitude of Health Personnel↗
PubMed2004

School nurses' knowledge and beliefs about the management of children with ADD.

The purpose of this study was to examine school nurses' knowledge and beliefs about the management of children with attention deficit disorder (ADD). Seven hundred eighty-six school nurses responded to mailed surveys regarding their attitudes and knowledge about the management of children with attention deficit disorder. Surveys were mailed to school nurses randomly selected from the membership of the National Association of School Nurses. School nurses' knowledge of school management of ADD and their attitudes about physicians' participation as part of a team effort in this care were explored. School nurses responded that physicians should increase their efforts to educate children and parents about ADD. Recommendations for school nurses in the management of children with ADD are offered.

Attention Deficit Disorder with Hyperactivity↗
PubMed1984

The role of physicians' knowledge and attitudes in effective diabetes management.

We examined the role of physicians' knowledge and attitudes in effective diabetes management among internal medicine house staff. We examined the extent to which (1) knowledge of common diabetes management strategies and (2) beliefs about the efficacy of, and intentions to engage in, such strategies predict success in their management of patients with diabetes. Successful managers are those house staff whose ambulatory diabetes patients' fasting blood sugar levels were lower than the clinic median. Knowledge was assessed with a written case simulation of an obese noninsulin-dependent woman; beliefs and intentions were surveyed through a self-administered questionnaire. The data suggest that knowledge was unable to discriminate physicians who are relatively successful in controlling their patient's blood sugar levels from those who are less successful. However using intentions related to initial and follow-up management strategies and beliefs about the benefits of achieving euglycemia, there was discrimination between the two physician groups (P less than 0.001). These findings suggest that beliefs are important in understanding why some physicians are successful managers. Further, if beliefs are mutable, continuing medical education courses could be more effective by fostering critical beliefs rather than depending solely upon the transfer of new medical information.

Adult↗
PubMed2006

Beneficiary knowledge of original Medicare and Medicare managed care.

BACKGROUND: Previous research on beneficiary knowledge of the Medicare program has shown that the beneficiary population is not well informed about Medicare. The Centers for Medicare & Medicaid Services (CMS) implemented the National Medicare Education Program in 1998 to educate Medicare beneficiaries about program benefits; choices, rights, responsibilities and protections, and health behaviors. OBJECTIVES: We sought to measure beneficiary knowledge of the Medicare program and to assess how knowledge varies by beneficiary subgroups and topic areas. RESEARCH DESIGN: We conducted psychometric analyses of survey data from Round 36 of the Medicare Current Beneficiary Survey to construct knowledge indices and estimated regression models with each knowledge index as the dependent variable, controlling for sociodemographic characteristics, self-reported health status, and insurance. SUBJECTS: The study sample included 2634 noninstitutionalized Medicare beneficiaries. MEASURES: There were 2 separate knowledge indices representing the 2 primary avenues for receiving Medicare benefits: Original Medicare and Medicare managed care. RESULTS: Beneficiaries ages 75 or older, nonwhite, with lower incomes, lower education levels, and public insurance had lower levels of knowledge on both indices. Enrollment in Medicare managed care was positively associated with knowledge about Medicare managed care but negatively associated with knowledge about Original Medicare. Areas of low program knowledge included coverage and benefits, enrollment/disenrollment, and plan choice. CONCLUSIONS: Our findings suggest the need to develop educational campaigns targeting vulnerable beneficiaries who have continued to demonstrate low levels of Medicare program knowledge.

Aged↗
PubMed2005

School-based interventions to enhance knowledge and improve case management of schistosomiasis: a case study from Hunan, China.

This paper discusses an intersectoral health-related intervention, using cartoons and video-recording, print materials and face-to-face educational methods, to increase children's knowledge of schistosomiasis, which in turn might improve the case management of early diagnosis and treatment. The main components of the project were (i) the collaboration between the departments of public health and education and (ii) a randomized, controlled, school-based field trial conducted in the Dongting Lake region, China. Children in the experimental group (n=604) and their parents participated in the educational programme. Control children (n=527) received a 2 hour lecture about the disease. All participants were pre-tested, and retested five months after the conduct of the educational intervention. The results show significant changes among children and their parents in the experimental group related to knowledge about schistosomiasis and beliefs towards screening and treatment of the disease. Children in the experimental group also had better compliance than children in the control group for regular screening for schistosomiasis. These findings indicate that carefully designed education programmes are useful for providing both children and their families with information about the prevention and treatment of schistosomiasis. Intersectoral collaboration holds promise to deliver research-based interventions for enhanced knowledge of schistosomiasis and improved case management.

Adolescent↗
PubMed2003

Ultrasonographically-guided fine-needle aspiration of axillary lymph nodes: role in breast cancer management.

The knowledge of the status of axillary lymph nodes (LN) of patients with breast cancer is a fundamental prerequisite in the therapeutic decision. In the present work, we evaluated the impact of fine-needle aspiration cytology (FNAC) of ultrasonographically (US) selected axillary LN in the diagnosis of LN metastases and subsequently in the treatment of patients with breast cancer. Axillary US was performed in 298 patients with diagnosed breast cancer (267 invasive carcinomas and 31 ductal carcinoma in situ DCIS), and in 95 patients it was followed by FNAC of US suspicious LN. Smears were examined by routine cytological staining. Cases of uncertain diagnosis were stained in immunocytochemistry (ICC) with a combination of anticytokeratin and anti-HMFG2 antibodies. Eighty-five FNAC were informative (49 LN were positive for metastases, 36 were negative). In 49 of 267 patients with invasive breast carcinoma (18%), a preoperative diagnosis of metastatic LN in the axilla could be confirmed. These patients could proceed directly to axillary dissection. In addition, US-guided FNAC presurgically scored 49 out of 88 (55%) metastatic LN. Of all others, with nonsuspicious LN on US (203 cases including 31 DCIS), in which no FNAC examination was performed, 28 invasive carcinomas (16%) turned out to be LN positive on histological examination. Based on these data, US examination should be performed in all patients with breast cancer adding ICC-supported FNAC only on US-suspect LN. This presurgical protocol is reliable for screening patients with LN metastases that should proceed directly to axillary dissection or adjuvant chemotherapy, thus avoiding sentinel lymph node biopsy.

Axilla↗
PubMed2004

Evaluating the effects of an educational symposium on knowledge, impact, and self-management of older african americans living with osteoarthritis.

The purpose of the study1 was to determine the effects of a 1-day educational symposium on knowledge, impact, and self-management of older African Americans living with osteoarthritis (OA). A 1-group pre- and posttest design was employed. The educational symposium was the intervention variable. Speakers were experts in the field of arthritis care. Participants were recruited from a community senior center. Participants completed the Short Form of the Arthritis Impact Management Scales (AIMS2-SF), the Summary of Arthritis Management Methods (SAMMS), and a 6-question Knowledge Test about OA before the symposium. The knowledge test was administered again at the completion of the program. Posttesting of the AIMS2-SF and SAMMS occurred 3 months later to assess changes in arthritis impact and self-management strategies. Knowledge scores increased significantly immediately following the symposium. The AIMS2-SF subscales of Affect, Symptom, and Physical Function decreased significantly 3 months after the symposium indicating that arthritis had less impact on participants after the conference. Participants also reported using more self-management methods 3 months after the event. The results of this pilot study indicate that this symposium was effective in increasing participants' knowledge of OA, improving self-management, and decreasing the impact of OA on daily function. The small sample size and preexperimental design limit generalizability.

Black or African American↗
PubMedDate not supplied

Tapping into hospital champions--strategic middle managers.

A social network analysis of eighty-nine midlevel health care professionals showed that middle managers' strategic knowledge is positively associated with championing alternative ideas and synthesizing new information for upper management. In addition, the relationship between knowledge and middle management strategic activities in informal networks is moderated by the manager's social position.

Catholicism↗
PubMedDate not supplied

Impact of a management-oriented course on knowledge and leadership skills exhibited by baccalaureate nursing students.

This study evaluated the impact of a one-month management concept course on 80 senior baccalaureate nursing students. Findings revealed that leadership values held by nursing students did not affect their leadership behaviors. Nursing students who took the course demonstrated significantly more leadership behaviors and knowledge of leadership concepts than students who did not take the course. Reasons for the findings are discussed.

Curriculum↗
PubMed1994

Active management of labour: current knowledge and research issues.

OBJECTIVES: To review the evidence that the package of labour interventions collectively called "active management"--namely, strict diagnostic criteria for labour, early amniotomy, early use of oxytocin, and continuous professional support--reduce rates of caesarean sections and operative vaginal delivery in first labours. DESIGN: Review of observational data, supplemented by evidence from four separate overviews of relevant randomised trials previously published as part of the Cochrane Collaboration pregnancy and childbirth database. RESULTS: Observational data do not permit a clear conclusion. There have been no randomised trials of the total package of active management or of the use of strict diagnostic criteria alone, but trials of early amniotomy, early oxytocin, and these interventions combined do not suggest that these interventions are effective in reducing rates of caesarean sections or operative vaginal deliveries. In contrast, the provision of continuous professional support in labour seems to reduce both types of operative delivery, although the effect on caesarean sections is confined to those settings where non-professional companions are not normally present in labour. CONCLUSIONS: Delivery units should endeavour to provide continuous professional support in labour, but routine use of amniotomy and early oxytocin is not recommended.

Amnion↗
PubMedDate not supplied

Understanding pain, part 1: physiology of pain.

This article is the first in a two-part series which explores pain and its management from a physiological perspective. Pain is a common experience which is often inadequately managed in hospital and community settings. While nurses are in a key position to contribute to successful pain management there are frequent accounts in the literature that nurses lack knowledge about pain management. Knowledge of pain physiology is fundamental to its successful management. This article introduces nurses to the components in the pain pathway and describes nociceptors which respond to pain stimuli and identifies pain fibres which carry pain information to the spinal cord. The processing of pain in the spinal cord is explained and the role of the brain in the manifestation of the pain experience is also explored. The gate control theory of pain and the more recent neuromatrix theory are discussed.

Analgesia↗
PubMedDate not supplied

Nurses' knowledge of prevention and management of constipation.

Constipation is often a preventable problem in health care; therefore health professionals must have the appropriate knowledge to help patients prevent this common complaint occurring. The purpose of this study was to assess nurses' knowledge of constipation in a teaching hospital in Northern Ireland. A knowledge questionnaire on constipation was obtained and adapted for use in this study using a non-experimental survey design to assess a convenience sample of nurses (n = 131) within various hospital specialities. The results demonstrated gaps in nurses' knowledge of constipation and also indicated that knowledge varied between specialties and between nursing grades. Educational initiatives must not allow bowel care, often labelled 'basic nursing care', to be neglected in postregistration education and training.

Career Mobility↗
PubMed1996

Keys to career success in managed care.

Given the prominence that managed care will have in the future U.S. healthcare system, financial managers who want to advance their careers must take steps to hone their managed care knowledge and skills, become accomplished managed care strategists, and identify opportunities to gain expertise in the managed care field. Healthcare Financial Management interviewed a number of managed care experts to obtain their views on how healthcare financial managers can prepare for a career in managed care organizations. The experts agree that one of the keys to future success lies in financial managers' willingness to assume more and different types of responsibility than before as the shift to managed care continues.

Administrative Personnel↗
PubMed2006

Health and clinical management - comparing the clinical outcome of computerized strategies. Findings from the Section on Health and Clinical Management.

OBJECTIVES: To summarize current excellent research in the field of health and clinical management. METHODS: Synopsis of the articles selected for the IMIA Yearbook 2006. RESULTS: Current research in the field of health and clinical management analyses impact and patient outcome of both established and recently presented approaches. Usability and effects of extracting data from computerized medical records for preventive care and surveillance issues are a topic as well as strategies for detecting adverse events. CONCLUSIONS: The best paper selection in the field of health and clinical management shows examples of excellent research on assessment, strategies and concepts for computerized health information management approaches. The articles emphasize the necessity of carefully considering health information systems regarding their outcome and compatibility with clinical routine. A concerted management of knowledge about evaluated health information management approaches will advance this trend and should lead to a more evidence-based design of the underlying systems.

Awards and Prizes↗
PubMedDate not supplied

Patients' knowledge of and attitudes toward the management of cancer pain.

PURPOSE/OBJECTIVES: To examine patients' knowledge of and attitudes toward the management of cancer pain and to identify, from the patients' perspectives, factors contributing to effective and ineffective pain relief. DESIGN: Descriptive, correlational. SETTING: Ambulatory care oncology facility in Canada. SAMPLE: Convenience sample of 42 patients receiving oral pain medication for chronic cancer-related pain. METHODS: Participants completed a modified version of the Patient Pain Questionnaire and a demographic questionnaire and responded to two open-ended questions. MAIN RESEARCH VARIABLES: Patients' knowledge of and attitudes toward cancer pain management and their perceptions of factors contributing to effective and ineffective pain relief. FINDINGS: Many patients locked knowledge of the principles involved in effective cancer pain management and had unrealistic concerns about taking pain medications. Significant negative relationships were found between pain intensity ratings and factors such as patients' knowledge of pain management, their level of satisfaction with pain relief, and their perception of the goal of pain management. Patients identified a number of impediments to effective pain relief, including concerns about addiction and various side effects to pain medications. CONCLUSIONS: Many patients have inadequate knowledge about the management of cancers pain and have unrealistic concerns about taking pain medications, both of which have been identified in the literature as barriers to effective cancer pain management. IMPLICATIONS FOR NURSING PRACTICE: A need exists for patient education that addresses patients' misconceptions and concerns about using pain medications and the principles involved in effective cancer pain management.

Adult↗