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Nowadays, a ward coordinator should own not only technical knowledge but managements skills as well. Communication is an important tool for organizing work team. The persons are core otherwise of the structure that could be the hardstone otherwise unuseful in case of bad managing. Transitional analysis is a valid mean for whom to ménage interpersonal relationship.
With advanced knowledge of management of hydrocephalus, patients with ventriculoperitoneal shunts are expected to enjoy a longer lifetime. Developments in both instrumentations and surgical techniques have led to increasing popularity of laparoscopic surgery in many surgical subspecialties. Therefore, it is not a surprising event that a patient with a ventriculoperitoneal shunt is scheduled for a laparoscopic surgery under anesthesia. Until now, there is no uniformized protocol for anesthetic management of a patient with a ventriculoperitoneal shunt undergoing laparoscopic surgery. Increased intracranial pressure may occur intraoperatively and be a major concern. We report here our experience in anesthetic management of such a patient and discuss the anesthetic considerations and the potential complications.
Gastrointestinal (GI) cancer includes primary cancers of the esophagus, stomach, small intestine, large intestine, and rectum. This article presents an overview of the current knowledge, medical treatment, and nursing management for each of the identified sites, with a focus on surgical interventions and subsequent nursing care. Acute and long-term postoperative sequelae are addressed in addition to current state-of-the-art chemotherapeutic and radiation treatment modalities. This compilation of information regarding GI malignancies is useful for nursing as a current reference as well as for specific patient care issues.
The study at hand had as an objective the identification and analysis of the production of knowledge in the field of Management of Nursing Services, in the Master and Doctorate Courses of the Graduate Program at the Nursing School of the University of São Paulo. It is an exploratory, descriptive, retrospective and documentary study. The population was constituted of 128 scientific productions, namely, 102 (79.7%) master dissertations and 26 (20.3%) doctorate theses produced between 1977 and March 2004. These works were analyzed according to theme groups in the proposed categories. Results allowed us to visualize the distribution of that production in terms of theme, decade, method and lines of thought adopted in such works. Results also allowed us to make considerations as to the trajectories, needs and perspectives of research in Nursing Management within the Program.
OBJECTIVE: To assess obstetricians' current antenatal screening practices for blood-borne viruses (hepatitis B, hepatitis C and HIV) and how they manage pregnant women infected with a blood-borne virus. DESIGN AND PARTICIPANTS: National cross-sectional survey conducted between September 2002 and January 2003. All obstetricians (n = 767) registered with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) were mailed a questionnaire assessing their antenatal screening practices and knowledge of management of women potentially infected with a blood-borne virus. OUTCOME MEASURES: Concordance of clinical practice with RANZCOG recommendations and current evidence-based guidelines. RESULTS: 523 obstetricians (68% response rate) completed the questionnaire. Fifty-one per cent of respondents said they would always offer HIV screening and 60% would always offer HCV screening. For HIV-infected women, 36% of obstetricians would always recommend elective caesarean section and 33% would always avoid rupture of membranes. Despite a lack of evidence, 34% of obstetricians advise patients that the risk of HBV transmission is increased with breastfeeding, and 47% give the same advice about HCV transmission. CONCLUSION: There is some discordance between the RANZCOG antenatal screening recommendations for HCV and HIV and current practice. Knowledge about the management of HIV-infected women could be improved, and more obstetricians need to be aware that current evidence suggests there is no increased risk of transmission of HBV or HCV with breastfeeding.
BACKGROUND & AIMS: The detection, prevention and treatment of undernutrition in hospitals is often poor. This study assesses the knowledge about undernutrition of staff in a UK teaching hospital. METHODS: Twenty nine doctors, 65 final year medical students, 45 nurses, 11 dietitians, and 11 pharmacists anonymously completed a questionnaire of 20 multiple choice questions. One of five possible answers was considered correct. Twelve questions were about adult nutritional assessment and requirements, five about oral/enteral nutrition and three about parenteral nutrition. RESULTS: Dietitians scored significantly more (median 16) than the other groups (doctors: seven, medical students: eight, nurses: seven and pharmacists: nine) (P < 0.0001). Medical students scored more than doctors (P < 0.001). Examples of areas in which knowledge could be improved are: 67% respondents thought the prevalence of hospital undernutrition to be less than 30%. While 91% of respondents correctly chose a well 70 kg man to need about 2000 kcal/day, only 23% knew that approximately the same amount was needed for a febrile post-operative patient. Sixteen percent knew antibiotic treatment to be the most common reason for enteral feeding-related diarrhoea. CONCLUSIONS: Knowledge about the assessment and management of undernutrition among doctors, medical students, nurses and pharmacists was poor. This questionnaire provides a framework for teaching and auditing the effectiveness of an educational program.
CONTEXT: Emergency department services may be used more appropriately if laypeople's knowledge of managing minor medical problems could be enhanced, especially since Medicaid applies a "prudent layperson" standard for providing access to emergency care. OBJECTIVE: To investigate the effect of mailing a booklet, First Look, that informed Medicaid beneficiaries about care of common nonurgent conditions and encouraged use of alternatives to emergency care including care by office-based physicians, telephonic nursing assistance, and self-care. STUDY DESIGN: A randomized, parallel group study. PATIENTS AND METHODS: Administrative data from 2 health plans serving urban Medicaid populations were used to identify households with a history of emergency department utilization (n = 3101 and n = 3822). Within each health plan, households were randomly assigned to receive First Look. The number of emergency department visits during 6.5 months of follow-up was the primary study endpoint. RESULTS: Compared with controls, 1% fewer members of households that were mailed First Look visited an emergency department in each health plan (23% versus 24% in Plan A; 27% versus 28% in Plan B). The 95% confidence intervals on the observed differences were -3% to 1% and -4% to 1% in Plans A and B, respectively. The proportion of emergency department visits for conditions discussed in First Look was not significantly reduced in households that were mailed the booklet (62% versus 60% in Plan A and 51% versus 48% in Plan B). CONCLUSION: Mailing First Look to Medicaid beneficiaries did not have a significant effect on use of emergency departments. Medicaid programs need to evaluate other, perhaps more multifaceted, interventions to promote appropriate use of emergency departments.
Nurses are recognized as the cornerstone of palliative care. Yet, surveys of nurses' knowledge of cancer pain management reveal serious knowledge deficits that could adversely affect the care of patients with cancer pain. Previous research has explored basic pain management issues such as pain assessment and myths and misconceptions surrounding pain, and principles of analgesic use. Advances in recent years have increased the demand for continuing education that will extend scientific advances in pain to clinical practice. The purpose of this article is to share results from a study which evaluated nurses knowledge regarding three methods of analgesic delivery that have become common in clinical practice: intravenous morphine, extended release morphine, and transdermal fentanyl. Several resources are provided to assist clinicians in the appropriate use of these analgesic methods.
This study assessed first-year doctors' (House Officers) knowledge of asthma at the Korle-Bu Teaching Hospital. Seventy-two out of 80 doctors answered 32 questions on various aspects of asthma. Many of these doctors managed between one to three asthmatics per week. Few, however, did so by acceptable standards. In assessing the severity of asthma, 88% looked for cyanosis, 69% looked for pulsus paradoxicus and 63% looked for a fast pulse rate. Only 63% considered the measurement of peak expiratory flow useful. Ninety-four percent used intravenous aminophylline, 82% intravenous hydrocortisone and 74% oxygen as the drug of choice for acute severe asthma. In moderate forms of acute asthma, 54% used salbutamol inhaler or intravenous aminophylline, 28% oxygen, 15% steroid inhaler and 14% oral prednisolone. Nebulized bronchodilators are not well known for use in either severe or moderate asthma and only 19-21% of doctors had prescribed their use. In chronic asthma, 55-65% of respondents prescribed bronchodilators compared to 19-35% who gave anti-inflammatory drugs. These results reveal insufficient knowledge of the pathophysiology of asthma, the use of standard drugs in asthma therapy and international guidelines for the management of asthma. The results also show that the pragmatic constraints which exist in developing countries preclude the adoption of international guidelines without local modification.
PURPOSE: The University of Utah purchased a 100-clinician, 9-practice multi-specialty primary care network in 1998. The university projected the network to earn a profit the first year of its ownership in a market with growing capitation; however, capitation declined and the network incurred up to a 21 million dollars operating loss per year. This case study describes the financial turnaround of the network. METHODS: In 2001, the university reconfigured the practices for a fee-for-service environment while preserving the group's multidisciplinary clinical and ancillary services. Changes included reorganization under the existing University of Utah Hospitals and Clinics system, new governance and leadership, closure of practices, creation of a billing office, new financial reporting, implementation of electronic health records, revision of physician compensation, capture of referrals, leadership and staff training, and practice reengineering. RESULTS: The network as a whole became profitable in 2004-2005. Its primary care component is projected to become profitable in 2 to 3 years. The network is opening new sites strategically important to the health system. CONCLUSIONS: This turnaround required commitment from senior university leaders, management with knowledge of primary care practice, retention of ancillary revenues, and management and business services specific to the network with support from other units within the university. Culture change within the group was essential. Our experience suggests that an academic health center can successfully operate a primary care network by attending to the unique needs of this challenging business. Doing so can strengthen the institution's overall financial and clinical performance and provide an important setting for teaching and research.
To realize the potential of the Internet as a source of valuable healthcare information, for the general public, patients or practitioners, it is imperative to establish a validation system based on standards of quality. The WRAPIN project (World-wide online Reliable Advice to Patients and Individuals) from the European Community has this ambitious goal. WRAPIN is a federating system for medical information with an editorial policy of intelligently sharing quality and professional information. The WRAPIN project has two main axes: the efficient and intelligent search of information and the assertion of the trustworthiness of content. This article presents the scientific challenges involved in extracting the knowledge from text-based information in order to better manage the knowledge and the rest of the retrieval proc-ess. Our innovative approach is to efficiently extract MeSH terms from the analyzed documents exploiting UMLS knowledge sources. A benefit has been measured when comparing extraction results. Even if the evaluation is made with a limited corpus, this research work proposes heuristics that can be validated to the whole biomedical domain, and possibly enhanced by the adjunction of other methods.
Information derived from Health Technology Assessment (HTA) reports is increasingly used for decision-making in healthcare. The production of HTA reports requires well-qualified interdisciplinarily working specialists who are not yet available in sufficient number. The German HTA Society and the German Network for Evidence Based Medicine have now developed an HTA curriculum which may serve as a basis for training courses for users of HTA information as well as HTA authors. Structure and content of the curriculum were inspired by internationally established training courses. However, the specific aspects of technology regulation and decision-making in the healthcare systems of German-speaking countries are emphasised. The curriculum is subdivided into a total of 11 modules. These include principles of HTA, status and regulation of technologies, priority setting, management of knowledge and information, methods of conducting HTA reports and project management. In the next step, the application of the curriculum into an Internet-based training course is planned.
OBJECTIVE: To measure general practitioners' knowledge of, confidence with and attitudes to the diagnosis and management of dementia in primary care. SETTING: 20 general practices of varying size and prior research experience in Central Scotland, and 16 similarly varied practices in north London. PARTICIPANTS: 127 general practitioners who had volunteered to join a randomised controlled trial of educational interventions about dementia diagnosis and management. METHODS: Self-completion questionnaires covering knowledge, confidence and attitudes were retrieved from practitioners prior to the educational interventions. RESULTS: General practitioners' knowledge of dementia diagnosis and management is good, but poor awareness of its epidemiology leads to an over-estimate of caseload. Knowledge of local diagnostic and support services is less good, and one third of general practitioners expressed limited confidence in their diagnostic skills, whilst two-thirds lacked confidence in management of behaviour and other problems in dementia. The main difficulties identified by general practitioners were talking with patients about the diagnosis, responding to behaviour problems and coordinating support services. General practitioners perceived lack of time and lack of social services support as the major obstacles to good quality care more often than they identified their own unfamiliarity with current management or with local resources. Attitudes to the disclosure of the diagnosis, and to the potential for improving the quality of life of patients and carers varied, but a third of general practitioners believed that dementia care is within a specialist's domain, not that of general practice. More experienced and male general practitioners were more pessimistic about dementia care, as were general practitioners with lower knowledge about dementia. Those reporting greater difficulty with dementia diagnosis and management and those with lower knowledge scores were also less likely to express attitudes endorsing open communication with patient and carer. CONCLUSION: Educational support for general practitioners should concentrate on epidemiological knowledge, disclosure of the diagnosis and management of behaviour problems in dementia. The availability and profile of support services, particularly social care, need to be enhanced, if earlier diagnosis is to be pursued as a policy objective in primary care.
BACKGROUND: Full-scale simulators have been developed in anaesthesia. We aimed at assessing Danish anaesthesia residents' knowledge and management of a standardized difficult airway situation in an advanced airway simulator. The reliability of the assessment was also determined. METHODS: Thirty-six residents answered a questionnaire testing their knowledge on difficult airway management and practice patterns. Secondly, all residents attempted management of a standardized 'cannot ventilate, cannot intubate' airway scenario. Three observers independently assessed a video recording of the performance. RESULTS: Only 17% of the residents passed the written test. Ninety-seven per cent stated that they had difficulties recalling the American Society of Anesthesiologists'(ASA) difficult airway algorithm and 53% did not know how to oxygenate through the cricothyroid membrane. Seventeen per cent had previously been involved in emergency situations with severe complications due to insufficient airway management. In the scenario 75% of the residents established ventilation using a laryngeal mask airway. After establishing ventilation, 26% would continue with surgery without a definitive airway, despite the risk of aspiration. Analysis of the interobserver agreement showed good (Kappa = 0.63) to excellent (Kappa = 0.78) consistency for objective parameters in the scoring scheme. Inter-observer reliability was satisfactory (R = 0.43) for trained Crisis Resource Management evaluators. CONCLUSIONS: Theoretical and practical education in difficult airway management needs to be improved among Danish anaesthesia residents. Simulator assessment should only be performed using well-defined objective parameters and trained assessors.
Knowledge is limited about adolescents' decision making regarding their assumption of diabetes management from parents. This study's purpose was to identify adolescents' perceived benefits and barriers about this process. Sixteen adolescents with type 1 diabetes were interviewed. Questions were adapted from the Janis and Mann (1977) decisional balance sheet. Interviews were audiotaped and transcribed verbatim. Descriptive expressions were identified and categories inductively generated. Adolescents' perceived benefits for themselves were having knowledge of or confidence in self-management abilities, more freedoms, and approval of others. They perceived benefits for parents as relief from responsibility, stress, and worry. Burden of responsibility was perceived as a barrier to adolescents for self-management. Adolescents perceived barriers for parents as worry/guilt and loss of control. Interrater agreement was initially 74%. Categories with disagreements were recategorized by interraters and then there was 100% agreement. Understanding adolescents' perceptions would be beneficial to their health care professionals.
The determinants of frequent visits to the emergency department (ED) for asthma were evaluated in 30 patients who made 2 or more ED visits for asthma (mean, 3.1; range, 2 to 9) over a period of 1 year. They were matched for age, sex, and medication with a control group of asthmatic patients who had made no ED visits within the same period. Evaluation included measurements of expiratory flows (baseline FEV1; PEFR 4 times daily for 3 weeks), airway responsiveness to methacholine, perception of induced bronchoconstriction, and questionnaires on quality of life and knowledge of asthma and its management. In comparison with the control group, the study group showed a trend toward inferior socioeconomic status, education level, and technical abilities (eg, inhaler use). Both groups had similar baseline FEV1, reversibility of airflow obstruction, methacholine-induced changes in expiratory flows, and perception of bronchoconstriction. Diurnal variation in PEFR was slightly increased in the study group. Absenteeism from work or school was higher in the study group but quality of life score was similar to controls. Patients with frequent ED visits showed significantly lesser knowledge of asthma control criteria, as well as an overall trend toward reduced asthma management knowledge and skills. In conclusion, in addition to the previously reported undertreatment of asthma, other factors such as insufficient asthma management knowledge and skills may contribute to frequent ED visits for asthma.
BACKGROUND: Improving asthma knowledge and self-management is a common focus of asthma educational programs, but most programs have had little influence on morbidity outcomes. We developed a novel multiple-component intervention that included the use of an asthma education video game intended to promote adoption of asthma self-management behaviors and appropriate asthma care. OBJECTIVE: To determine the effectiveness of an asthma education video game in reducing morbidity among high-risk, school-aged children with asthma. METHODS: We enrolled 119 children aged 5 to 12 years from low-income, urban areas in and around San Francisco, CA, and San Jose, CA. Children with moderate-to-severe asthma and parental reports of significant asthma health care utilization were randomized to participate in the disease management intervention or to receive their usual care (control group). Patients were evaluated for clinical and quality-of-life outcomes at weeks 8, 32, and 52 of the study. RESULTS: Compared with controls, the intervention group had significant improvements in the physical domain (P = .04 and P = .01 at 32 and 52 weeks, respectively) and social activity domain (P = .02 and P = .05 at 32 and 52 weeks, respectively) of asthma quality of life on the Child Health Survey for Asthma and child (P = .02 at 8 weeks) and parent (P = .04 and .004 at 32 and 52 weeks, respectively) asthma self-management knowledge. There were no significant differences between groups on clinical outcome variables. CONCLUSIONS: A multicomponent educational, behavioral, and medical intervention targeted at high-risk, inner-city children with asthma can improve asthma knowledge and quality of life.
BACKGROUND: Children continue to experience unrelieved moderate to severe pain post-operatively despite the evidence to guide practice being readily available. Previous studies have relied on self-report measures; there is a need to establish exactly how nurses manage children's pain in practice. OBJECTIVES: To ascertain how nurses actually manage post-operative pain in children and whether pain management practices adhere to current best practice guidelines. DESIGN: An observational study was carried out. Structured and unstructured data were collected. SETTING: A children's surgical ward in the English Midlands caring for children from birth to 16 years. PARTICIPANTS: Registered nurses (n=13) took part in the study. METHODS: Each participant was observed continuously for a period of 5 hours per shift for two to four shifts each. The role of the observer as participant was adopted whereby the researcher could shadow the nurse and act primarily as an observer. Data were collected for 36 shifts (185 hours). RESULTS: While nurses administered analgesic drugs when a child complained of pain, in most other areas practices did not conform to current recommendations and are in need of improvement. Nurses did not, for example, routinely assess a child's pain, nor use non-drug methods of pain relief on a regular basis. CONCLUSIONS: The sub-optimal pain management practices may be attributable to several factors. The professional culture of nursing and/or ward culture may result in poor pain management practices being perpetuated. Nurses may not have the requisite theoretical knowledge to manage pain effectively. A lack of priority may also be attributed to pain management. These areas need exploring further.