[Morphine and the management of pain. Basic knowledge among the Danish medical staff].
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Analgesics, Opioid↗
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Results for “Knowledge Management”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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[Potential hearing loss caused by loud music. Current status of knowledge and need for management].
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Adolescent↗
Let us extend our knowledge base. Assessment and management of fungating malignant wounds.
Little research has been undertaken on the management of fungating malignant wounds, and current practice relies more upon an exploratory approach than research-based evidence. This article presents a detailed problem-solving framework for the assessment and management of these wounds, and can be used in conjunction with the wallchart outlining the plan enclosed free with this issue.
Bandages↗
Objects and domains for managing medical data and knowledge.
This paper assesses the object-oriented data paradigm, and describes an algebraic approach which permits the generation of data objects from relational data, based on the knowledge captured in a formal Entity-Relationship model, the Structural Model. The advantage is that now objects can be created that satisfy a variety of particular views, as long as the hierarchies represented by the views are subsumed in the network represented by the overall structural model. The disadvantage of creating view-objects dynamically is that the additional layering has performance implications, so that the speedup expected from object-oriented databases versus relational databases, due to their hierarchical object storage, cannot be realized. However, scalability of systems is increased since large systems tend to have multiple objectives, and hence often multiple valid hierarchical views over the data. This approach has been implemented in the Penguin project, and recently some commercial successors are emerging. In truly large systems new problems arise, namely that now not only multiple views will exist, but also that the domains to be covered by the data will be autonomous and hence heterogeneous. One result is that ontologies associated with the multiple domains will differ as well. This paper proposes a knowledge-based algebra over the ontologies, so that the domain knowledge can be partitioned for maintenance. Only the articulation points, where the domains intersect, have to be agreed upon as defined by matching rules which define the shared ontologies.
Artificial Intelligence↗
Consumer Knowledge: the key to managed care success.
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Colorado↗
A multimedia violence prevention program increases pediatric residents' and childcare providers' knowledge about responding to childhood aggression.
A pre-post knowledge test using alternate forms was used to determine if a multimedia violence prevention program can increase knowledge about management of childhood aggression. The participants were pediatric residents and childcare workers who attended lectures about aggression management in young children. The intervention was a presentation of a 30 minute CD-ROM program, Play Nicely, which teaches how to manage aggression in young children ages 1 to 7 years. A pretest and posttest multiple-choice knowledge assessment that focused on the program's most important recommendations was administered. Childcare workers and pediatric residents had significantly increased knowledge scores after viewing the CD-ROM demonstration (F=6.8, p = 0.01). Childcare workers' scores improved by 2.6 points (p< 0.001) and residents' scores by 3.8 points (p< 0.001). A relatively short CD-ROM can improve knowledge about how to manage aggression in young children, indicating its usefulness as a violence prevention resource.
Aggression↗
Women's antenatal knowledge and plans regarding intrapartum pain management at the Royal Hospital for Women.
AIMS: To examine women's knowledge and antenatal plans regarding intrapartum pain management options at Royal Hospital for Women (RHW), Sydney, Australia. METHODS: From October 2002 to January 2003 women aged over 16 who had been in labour were given a questionnaire to complete in the first week post-partum regarding intrapartum pain management. This included questions regarding their antenatal knowledge and predetermined plans. RESULTS: There were 496 participating women (69% response rate). Antenatal pain management information was accessed by 98% of women. Sources most accessed were antenatal classes (55%), multimedia (53%), and friends/relatives (46%). Sixty percent of women felt 'very well informed' antenatally. Women felt better informed antenatally if married/defacto, university educated, privately insured, or receiving birth centre care. Antenatally, 80% planned to use intrapartum pain management: 'natural' methods were most popular (62% planned to use), and pethidine least (49% planned against). The most common determinant against using medical methods was possible maternal side-effects. Intrapartum, 19% used 'unwanted' pain management, mostly (67%) due to increased labour pain. Increased information access was associated with significantly higher use of both 'natural' methods and epidural analgesia, as well as significantly higher satisfaction scores. CONCLUSIONS: Almost all women at RHW access information antenatally about intrapartum pain management, often from informal sources. Demographic factors affected type of information accessed and women's plans. Adequate access to information affected use of, and satisfaction with, pain management.
Australia↗
National school teachers' knowledge of asthma and its management.
Asthma is the most common chronic medical condition that school teachers may encounter among their pupils. However management of asthma in schools and the role school teachers adopt in this condition has only recently been explored. The aim of this study was to determine teachers' knowledge of asthma and its management. A postal questionnaire was circulated to 199 school teachers from 46 schools in Dublin City. A 74 per cent response rate was obtained. The number of children with asthma as identified by teachers was 7.8 per cent which suggests that asthma may be unrecognised in a number of pupils. Knowledge on signs and symptoms of asthma, provoking factors of asthma and the nature of the disease was generally satisfactory. However, knowledge on asthma medications, the purpose of inhalers and teachers' understanding of the treatment and management of asthma was considered poor. Knowledge on exercise-induced asthma was limited. There is a need to provide school teachers with education on asthma and its management. School policies on asthma also need to be developed with particular reference to action necessary in the event of an acute severe attack of asthma.
Adult↗
Negotiating for change. The healthcare manager as catalyst for evidence-based practice: changing the healthcare environment and sharing experience.
This paper addresses the problem of the implementation of both clinical and managerial evidence-based decision-making in healthcare. The lack of implementation of research findings in clinical and management practice has been identified as a key failure in healthcare. Many await the development of better methods of research transfer led by academics and clinicians. Research transfer has become one of the highest priority are as for health services research. In this paper, the authors propose that the healthcare manager is well positioned to advance the research transfer process within the individual healthcare environment through two main mechanisms. First, healthcare managers can align decision-making structures within their own environment to facilitate evidence-based practice. This can occur by managers demonstrating a commitment to processes for the measurement and management of knowledge (identifying knowledge stewards) to the same extent that they demonstrate commitment to the measurement and management of finances. Within such a framework, the healthcare manager can build an environment in which there is an explicit "negotiation" between "knowledge stewards" (usually clinicians) and "financial stewards" (usually administrators) to achieve a common goal. The negotiation is an explicit, documented process that addresses the trade-offs that are made to avoid both financial and quality deficits in the organization (the quality deficit is defined as the gap between knowledge and practice). The second way in which healthcare managers can act as catalysts for promoting evidence-based practice is through cataloguing and reporting, using documented stories, the unique barriers to evidence-based approaches that are peculiar to their specific healthcare environments. It is hypothesized that local contextual circumstances, which can be expressed only through stories, are the most powerful barriers to research transfer within specific organizations. This has implications for what we count as useful knowledge as we try to better understand how rigorous research on the one hand and research and stories on the other contribute to strategies for research transfer at the organizational level.
Decision Making, Organizational↗
Multiple organ failure--the discrepancy between our scientific knowledge and understanding and the management of our patients.
The excitement of molecular biology and of genetic knowledge and their possibilities must be balanced against our limitations in using this information for the care of our patients. There is a great discrepancy between what we know and what we can do. There are many reasons for this. A major one is that science must simplify/reduce the variables in experimentation and then generalize in terms of a specific factor or effect, whereas patients are complex with variables that we do not yet understand completely. This powerful science is now teaching us about the genetic diversity in both susceptibility and outcome of disease, and the diversity in life experiences and antigen exposures. Clinicians have tried to lump together and treat in a similar way many diverse human diseases. This has not worked well. Pancreatitis and perforated diverticulitis both produce inflammation and sepsis, but they are different processes and may both lead to multiple organ failure. This lumping together has contributed to the failure of so-called magic bullets. There are new contributors to organ damage. Gender, lifestyle and prior disease differences also complicate the care of patients. Despite this, we are slowly and gradually improving the care of our surgical patients by careful pre-, intra- and postoperative support and better, simpler and safer operations.
Animals↗
Diabetic retinopathy: management update.
The objective of the study is to review the current knowledge and management of diabetic retinopathy. Current information from multi-centre controlled clinical trials and epidemiological studies in different parts of the world were used to review the epidemiology, pathophysiology, classification, clinical features and management of diabetic retinopathy. Diabetes mellitus affects all ocular tissues. Retinopathy, its most devastating ocular complication, presents with similar clinical picture in both types 1 and 2 diabetes. In Nigeria, diabetic retinopathy has an incidence of 33%; accounts for 16.7% of retinal diseases and leads to bilateral blindness in 22.2% of diabetics. Its incidence depends on both the duration of diabetes and the level of glycaemic control. Hypertension, dyslipaemia, hyperglycaemia and cigarette smoking aggravate retinopathy and adversely affect its response to treatment. Strict blood sugar control delays the onset of retinopathy and retards the progression of established disease. Timely laser and vitrectomy surgeries obviate severe visual loss in diabetic retinopathy. The role of medical therapy for diabetic retinopathy is still experimental. Diabetes occurs worldwide; diabetic retinopathy is increasing in incidence. Developed countries have clear guidelines on the care of diabetes and its complications. The need for similar guidelines in Nigeria is urgent.
Blood Glucose↗
Effects of mental health training and clinical audit on general practitioners' management of common mental disorders.
OBJECTIVE: To evaluate the effects of a seminar-based training program and clinical practice audit on general practitioners' (GPs') knowledge and management of common mental disorders. DESIGN: Survey of GPs' knowledge before and after training, and clinical practice audit and re-audit after feedback. PARTICIPANTS AND SETTING: GP volunteers from around Australia in 1998-1999: 1008 completed the pre-training test, 190 the post-training test, 386 the first audit (33235 patients), and 157 of these the re-audit (13280 patients), with 57 undertaking both audit and training. INTERVENTIONS: Four-seminar, 12-hour training program focused on improving GPs' capacity to identify and manage patients with depression and anxiety; practice audit with patient- and practice-based feedback on diagnosis and treatment of common mental disorders. MAIN OUTCOME MEASURES: Scores on pre- and post-training knowledge tests; self-rated improvements in confidence in managing patients with mental disorders after training; rates of psychological diagnoses and treatment by GPs on first audit and re-audit. RESULTS: GPs' knowledge of pharmacological treatments and clinical management improved after the training program (P<0.001), and 97% of GPs reported increased confidence in their management skills. GPs who undertook training had higher diagnosis rates for common mental disorders in the first audit than those who did not undertake training (36% versus 29%; P<0.001), and their diagnosis rates increased over time (36% to 39%; P<0.01), while those of GPs who did not undertake training were unchanged. Similarly, GPs who undertook training provided more mental health treatments than those who did not (30% versus 27% in the first audit [P<0.001], and 31% versus 24% at reaudit [P<0.001]). They also place greater emphasis on use of nonpharmacological treatments (24% versus 21% at first audit [P<0.001], and 25% versus 19% at re-audit [P<0.001]). CONCLUSION: Clinical audits may heighten awareness of mental disorders, but, on their own, they do not improve mental health practice. A relatively brief but skills-based training program may contribute to better management of patients with common mental disorders by increasing GPs' confidence and competence.
Adult↗
[A dynamic knowledge model for nitrogen and water management of cotton].
Through analyzing and extracting the newest research results on nitrogen and water management of cotton, a dynamic knowledge model for decision-making on total nitrogen and water supply levels and their distribution among main growth stages of cotton under different environments and yield targets was developed, with the principles of nitrogen balance and water demand and by integrating the factors of climate, soil, yield and variety. Case studies on the knowledge model with the experiment data sets of different eco-sites, varieties and soil characters indicated a good model performance in decision-making and applicability.
Fertilizers↗
Terminology-driven literature mining and knowledge acquisition in biomedicine.
In this paper we describe Tagged Information Management System (TIMS), an integrated knowledge management system for the domain of molecular biology and biomedicine, in which terminology-driven literature mining, knowledge acquisition (KA), knowledge integration (KI), and XML-based knowledge retrieval are combined using tag information management and ontology inference. The system integrates automatic terminology acquisition, term variation management, hierarchical term clustering, tag-based information extraction (IE), and ontology-based query expansion. TIMS supports introducing and combining different types of tags (linguistic and domain-specific, manual and automatic). Tag-based interval operations and a query language are introduced in order to facilitate KA and retrieval from XML documents. Through KA examples, we illustrate the way in which literature mining techniques can be utilised for knowledge discovery from documents.
Artificial Intelligence↗
Elderly people's knowledge of and attitudes to pain management.
Pain is a frequent complaint of elderly people in hospitals and in the community, yet it is often not managed effectively. Barriers to effective management have included fear of narcotic addiction, inadequate assessment of pain, and attitudes of health professionals. Attempts have been made to improve the knowledge and attitudes of health-care professionals. This study examined the attitudes and knowledge of acute pain and pain management among well elderly people in rural and urban settings in the southeastern USA in order to identify possible barriers to effective pain management. Questionnaires on knowledge and attitudes towards pain and pain management were given to 62 rural and 63 urban well elderly people aged 65 years and older. Findings demonstrate a lack of knowledge as well as the presence of non-facilitative attitudes about pain and pain management.
Acute Disease↗
Assess your knowledge and attitude regarding pain management.
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Adult↗
A consideration of knowledge and authority in the case seminar.
This paper examines difficulties in the management of knowledge and authority evidenced in some case seminar settings. The author suggests that the traditional model for the case seminar has not kept pace with evolving ideas about authority and knowledge in the psychoanalytic situation. The tension between our current ways of conceptualizing knowledge and authority in psychoanalysis, and the often unwitting idealization and constriction of knowledge and authority in the case seminar format, are explored. Following a review of the literature on the case seminar, three recommendations for change are discussed: (1) differentiation of the goals of the seminar from those of supervision; (2) reconsideration of the way in which the 'failed case" is discussed; and (3) encouragement of the instructor to present clinical material.
Goals↗
Implementing new clinical guidelines: the manager as agent of change.
THIS ARTICLE aims to demonstrate how an increased knowledge of management issues can help improve health care. It focuses on change management, specifically the manager's role in implementing new clinical guidelines on sedation in a paediatric intensive care unit (PICU) setting. An action plan sets out the key stages of the change management process involved in implementing new guidelines (Box 1). There follows a critical analysis of the managerial issues involved in this action plan with a focus on the manager as a change agent.
Attitude of Health Personnel↗