[MODERN DATA MANAGEMENT OF MEDICAL BOARD REPORTS].
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Are nurses prepared to manage cancer pain? A national survey of nurses' knowledge about pain control in Taiwan.
Nurses play a crucial role in cancer pain control, but little is known about how well-prepared nurses are to manage cancer pain in Taiwan. The purpose of this study was to examine the level of knowledge about pain management among Taiwanese nurses with different background characteristics and to determine the predictor(s) of nurses' pain management knowledge. Nurse subjects were recruited by a cross-sectional nationwide survey with stratified sampling from nine hospitals distributed in the four major geographic regions of Taiwan. The Nurses' Knowledge and Attitudes Survey-Taiwanese version (NKAS-T) and a background information form were used to collect the data. Of 1900 surveys distributed, 1797 valid questionnaires (94.5%) were analyzed. The average correct response rate was 50.5%, with rates ranging from 7-86% for each survey question. Results from stepwise regression showed that nurses with higher mean correct answer scores had BS or higher degrees, had received pain education at professional conferences, had more prior hours of pain education, had longer clinical care experiences, and always worked with cancer patients. Nurses who worked in intensive care units, however, had significantly lower mean correct scores. The results strongly suggest an urgent need to strengthen pain education in Taiwan. The results also provide the direction for developing pain education.
Data Collection↗
Special aspects of cancer pain management in a Chinese general hospital.
China is still faced with a challenge in cancer pain management. The purposes of this study are to assess the current status of cancer pain management, and physicians' attitudes in China towards cancer pain management. The survey was done in a Chinese general hospital; 427 physicians and 387 cancer pain patients participated. The survey consisted of questionnaires to evaluate cancer pain management and physicians' knowledge of, and attitudes towards, cancer pain management. A total of 43% of patients with cancer pain and 51% with bone pain felt that they had been inadequately treated. The physicians rated the main reason for not using opioid drugs as the strong and difficult to control side-effects. The four main barriers to optimal management of cancer pain were: inadequate pain assessment; excessive state regulation of the prescribing of opioids; inadequate staff knowledge of pain management; and lack of access to powerful analgesics. To conclude: In China, there are some special aspects of cancer pain management, including physicians' concern about using opioid drugs, fear of being unable to manage adverse effects of opioids, and inadequately treated bone pain.
Adolescent↗
Nurses' knowledge about pharmacological and nonpharmacological pain management in children.
The purpose of this study was to investigate the knowledge base and practices of Finnish nurses in the area of children in pain. The convenience sample consisted of 265 nurses working on children's wards in university hospitals. Data were collected using an instrument designed for the study. The results showed that there remain gaps in the knowledge base of nurses with regard to both pharmacological and nonpharmacological pain management in children. The education and the area of expertise were significant influences on knowledge scores. Nurses used a fairly wide range of nonpharmacological pain alleviation methods but most of these were such that the nurse was in an active role and the child was passive. There is a clear need for further education. Nurses should take a more active role in seeking new information and also should be encouraged to use nonpharmacological methods that let the children be active participants in their own care.
Adult↗
Primary healthcare information system--the cornerstone for the next generation healthcare sector in Republic of Croatia.
At no time in the history of medicine has the growth in knowledge and technologies been so profound [Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine (IOM), 2001. ISBN 0-309-07280-8]. However, healthcare delivery systems today are not able to keep up with the pace. Studies have shown that it takes an average of about 17 years for new knowledge generated by randomized trials to be incorporated into practice [B. Andrew, S. Boren, Managing clinical knowledge for health care improvement, in: Yearbook of Medical Informatics, National Library of Medicine, Bethesda, MD, 2000, pp. 65-70]. It is safe to say that today healthcare systems "have the data, but not information". In order to provide highest quality patient care, Republic of Croatia has started the process of introducing enterprise information systems to support business processes in the healthcare domain. Two major requirements are in focus: to provide efficient healthcare related data management in support of decision-making processes; and to support continuous process of healthcare resources spending optimization. The first initiated project refers to Primary Healthcare Information System (PHCIS) that provides domain of primary care with state-of-the-art enterprise information system that connects General Practitioners, Pediatricians and Gynecologists offices with the Croatian Institute for Health Insurance and Public Health Institute. In the years to come, PHCIS will serve as the main integration platform for connecting all other stakeholders and levels of healthcare (e.g. hospitals, pharmacies, laboratories) into single enterprise healthcare network. This article gives an overview of PHCIS, explains challenges that were faced in designing and implementing the system, and elaborates PHCIS role as the cornerstone for the next generation healthcare provisioning in Republic of Croatia.
Croatia↗
A certain art of uncertainty: case presentation and the development of professional identity.
Healthcare professionals use the genre of case presentation to communicate among themselves the salient patient information during treatment and management. In case presentation, many uncertainties surface, regarding, e.g., the reliability of patient reports, the sensitivity of laboratory tests, and the boundaries of scientific knowledge. The management and portrayal of uncertainty is a critical aspect of professional discourse. This paper documents the rhetorical features of certainty and uncertainty in novice case presentations, considering their pragmatic and problematic implications for students' professional socialization. This study was conducted during the third-year inpatient clerkship at a tertiary care, pediatric hospital in hospital in Canada. Data collection included: (1) non-participant observations of 19 student case presentations involving 11 student and 10 faculty participants, and (2) individual interviews with 11 students and 10 faculty participants. A grounded theory approach informed data collection and analysis. Five thematic categories emerged, two of which this paper considers in detail: "Thinking as a Student" and "Thinking as a Doctor". Within these categories, the management and portrayal of uncertainty was a recurrent issue. Teachers modeled central features of a "professional rhetoric of uncertainty", managing uncertainty of six origins: limits of individual knowledge, limits of evidence, limitless possibility, limits of patient's/parent's account, limits of professional agreement, and limits of scientific knowledge. By contrast, students demonstrated a "novice rhetoric of uncertainty", represented by their focus on responding to personal knowledge deficits through the strategies of acknowledgement, argument, and deflection. Some students moved towards the professional rhetoric of uncertainty, suggesting not only advances in communication, but also shifts in attitude towards patients and colleagues, that were interpreted as indications that this rhetoric shapes professional identity and interactions.
Attitude↗
A pilot randomized trial in primary care to investigate and improve knowledge, awareness and self-management among South Asians with diabetes in Manchester.
AIMS: To investigate whether a secondary-primary care partnership education package could improve understanding of diabetes care among South Asians. METHODS: In a pilot randomized controlled trial, in the setting of eight general practices randomized to intervention or control, patients were invited to four or more rotating visits per year by one of a diabetes specialist nurse, dietician or chiropodist working with general practice staff. Participants were from lists of South Asian patients with known Type 2 diabetes in each (general) practice. RESULTS: Patients and practice scores at baseline and 1-year follow-up, from an interview using a questionnaire on knowledge, awareness and self-management of diabetes. Responses were developed into educational packages used during intervention. Of the 411 patients listed at baseline only 211 were traced for interview (refusal only 4%). Mean age was 55.4 years, age of diabetes onset 47.1 years. Fourteen percent were employed and 35% were able to communicate in English fluently. Only 118 could be traced and interviewed at 1 year, although there was no significant difference in demography between those who completed the study and those who did not. Despite a mean of four visits/patient, intervention had no impact on scores for diabetes knowledge, or awareness [score change 0.14, 95% confidence interval (CI) -0.20, 0.49] or self-management (-0.05, 95% CI -0.48, 0.39) between baseline and 1 year. CONCLUSIONS: This form of secondary/primary care support did not transfer information effectively, and we suspect similar problems would arise in other similar communities. Different methods of clinician/patient information exchange need to be developed for diabetes in this South Asian group.
Adult↗
Knowledge of renal histology alters patient management in over 40% of cases.
There is great debate as to whether the benefit gained from the knowledge of renal histology outweighs the risk to the patient from the biopsy procedure. We conducted a prospective study of 276 native renal biopsies performed on 266 patients from a single centre in 1991 to assess the effect of the knowledge of renal histology on patient management. Biopsies were performed under ultrasound guidance using the Trucut biopsy needle. The indications for biopsy were: non-nephrotic proteinuria alone (25), haematuria and proteinuria (28), nephrotic range proteinuria (28), acute renal failure (31), haematuria alone (36), and chronic renal failure (128). Two hundred and sixty-three biopsies were successful. The mean number of glomeruli obtained was 23, range 0-115. Eight patients developed macroscopic haematuria of which two required blood transfusion. The result of the biopsy altered management in 24/28 (86%) of cases of nephrotic range proteinuria, 22/31 (71%) of cases of acute renal failure, 58/128 (45%) of cases of chronic renal failure, 9/28 (32%) of cases with haematuria and proteinuria, 3/25 (12%) of cases with non-nephrotic proteinuria alone, and 1/36 (3%) of cases with haematuria alone. management was altered in 42% of cases overall. These data suggest that knowledge of renal histology is essential in the management of patients with renal disease.
Adolescent↗
Has education about Helicobacter pylori infection been effective? Worldwide survey of primary care physicians.
BACKGROUND: Confusion exists among physicians about the management of Helicobacter pylori (H. pylori) infection. We aimed to survey primary care physicians' (PCP) knowledge and management of H. pylori-related diseases. METHODS: Four-hundred and seventy randomly selected PCP from 29 countries were surveyed. RESULTS: The pathological role of H. pylori was of less concern in South Africa than the rest of the world (63% compared to 93%). The causal relationship between H. pylori and gastric and duodenal ulcers and gastric cancer was accepted by 81%, 85%, and 61% of respondents, respectively. Endoscopy was used by 62% of respondents to diagnose the infection. Histology was used by 61% of European participants for diagnosis compared to 3% in North American and 0% in South Africa. Proton-pump inhibitor (PPI)-based triple therapies were prescribed by 89% of respondents. Physicians in Oceania (35%) and South Africa (45%) were less concerned about bacterial resistance than respondents elsewhere. Sixty-three percent of respondents considered H. pylori relevant to dyspepsia management and 66% treated new dyspepsia empirically, compared to 18% who chose endoscopic diagnosis and 13% who used a H. pylori test and treat strategy. For persistent or recurrent infection, 56% of South African physicians treated with another regimen compared to 33% of PCP from elsewhere. Ninety-one percent of European participants agreed that current information on H. pylori management is helpful and 68% of PCP from other regions considered the information to be adequate. CONCLUSIONS: Current guidelines on the management of H. pylori infection have been useful for PCP worldwide. Contrasting answers to some questions may reflect differences in health care systems, epidemiology and approaches to the management of H. pylori infection between countries.
Anti-Bacterial Agents↗
[An update on the management of Raynaud's phenomenon].
Basic knowledge of clinical management of Raynaud's phenomenon was established and reviewed. Body protection against cold weather and the avoiding of all activities which cause the setting off of the ischemic episodic trigger are the first step in the therapy for this type of patient. Medical treatment includes vasoactive drugs and other drugs which act against the different factors such as plasmapheresis, sympathectomy and electric neurostimulation must be reserved for patients with severe vascular symptoms.
Angiotensin-Converting Enzyme Inhibitors↗
Students' and faculty members' knowledge and attitudes regarding pain management: a descriptive survey.
Many basic nursing programs spend little time educating students about pain management. Between the years of 2000 and 2002, a baccalaureate nursing program at a university in central Virginia surveyed sophomore, junior, and senior nursing students using McCaffery's Pain Knowledge and Attitude Survey at the beginning and end of each academic semester. During the same time period, faculty also completed the survey and answered open-ended questions pertaining to the inclusion of pain management in course content. The purposes of this study were to determine the baseline knowledge and attitudes of nursing students and faculty about the science of pain management and to evaluate the content of pain management material and the extent to which it is integrated into the curriculum.
Analgesia↗
Parents' perceived benefits and barriers of adolescents' diabetes self-management: part 2.
Knowledge is limited about parents' decision making regarding adolescents' assumption of diabetes management. This study's purpose was to identify parents' perceived benefits and barriers about this process. We interviewed 17 parents of adolescents with type I diabetes. Questions were adapted from Janis and Mann's (1977) decisional balance sheet. Interviews were audiotaped and transcribed verbatim. Descriptive expressions were identified and categories inductively generated. Inter-rater agreement was initially 85% and was 100% after discussion of disagreements. Parents' perceived benefits for themselves were relief from burden and knowledge and confidence and/or pride in adolescents' abilities. Their perceived benefits for their sons and daughters were also twofold: knowledge and/or confidence in abilities and freedom, independence, and/or control. Parents perceived barriers for themselves were loss of control, authority, and supervision, dealing with consequences. and expression of lack of barriers. Their perceived barriers for their sons and daughters were burden of responsibility and also lack of barriers. Understanding parents' perceived benefits and barriers would be beneficial to health care professionals when working with parents, because decision making related to the transfer of diabetes management to their adolescent sons and daughters is crucial to the success of its management.
Adolescent↗
Effect of a dementia care management intervention on primary care provider knowledge, attitudes, and perceptions of quality of care.
OBJECTIVES: To evaluate the effect of a multicomponent dementia care management program on primary care provider knowledge, attitudes, and perceptions of quality of dementia care. DESIGN: A clinic-level randomized, controlled trial of a comprehensive care management program for patients with dementia and their nonprofessional caregivers. The program included provider education and protocols for care managers to communicate with patients' medical providers. SETTING: Eighteen clinics (nine intervention, nine [corrected] usual care) in three healthcare systems in San Diego, California. PARTICIPANTS: Two hundred thirty-two medical providers; 129 from nine [corrected] intervention clinics; 103 from nine [corrected] usual-care clinics. MEASUREMENTS: Providers were surveyed 9 months after intervention onset on knowledge (five items on four topics), attitudes about dementia (three items), and perception of quality of dementia care in their practice setting (three items). Multivariable linear and logistic regression models were used to evaluate the differences between intervention and usual-care providers, adjusting for covariate effects across groups and clustering by clinic. RESULTS: One hundred sixty-six of 232 (72%) providers responded. Intervention providers had better knowledge about assessing decision-making capacity than usual-care providers (adjusted difference in percentage correct = 12%; adjusted odds ratio = 2.4, 95% confidence interval = 1.2-4.8). Intervention providers viewed dementia patients as more difficult to manage in primary care than usual-care providers (P = .03). There were no other differences in knowledge, attitudes, or care quality perceptions across intervention and usual-care providers. CONCLUSION: A comprehensive dementia care management model resulted in few differences in provider knowledge or attitudes favorable to dementia care, suggesting that this care model's effects on quality were primarily mediated through other components of the care management program.
Aged↗
Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk.
PURPOSE/OBJECTIVES: To review the literature regarding the incidence, current practice, guideline recommendations, nursing management, and knowledge gaps relevant to vesicant extravasation. DATA SOURCES: Published research articles, books, case reports, and national guidelines. DATA SYNTHESIS: Vesicant extravasation is a relatively rare but significant complication of chemotherapy administration. Extravasation may have a range of consequences that can cause serious physical and quality-of-life effects. Knowledge of risk factors and preventive measures can reduce patient risk. Data-based and empirical management strategies such as immediate local measures (agent withdrawal, comfort measures, and medical interventions) may minimize risk for extravasation, as well as lead to timely recognition and management and decreased morbidity should extravasation occur. CONCLUSIONS: Vesicant extravasation and sequelae constitute a complex patient problem that clinicians should strive to prevent or to minimize injury should it occur. To this end, clinicians must demonstrate awareness of risks and use specialized knowledge while administering vesicant agents. IMPLICATIONS FOR NURSING: Only nurses knowledgeable about extravasation and skilled in associated techniques should assume responsibility for vesicant administration.
Antineoplastic Agents↗
A survey of dietetics professionals' knowledge of and attitudes toward cholesterol management.
Dietetics professionals in Wisconsin (n = 687) were surveyed to assess their knowledge, attitudes, practices, experience, and educational interests regarding cholesterol management. The survey, conducted to guide the development of cholesterol education programming in the state, found that most dietetics professionals are familiar with and support the guidelines of the National Cholesterol Education Program (NCEP). Ninety-three percent of dietetics professionals responding to the survey believe that reducing serum cholesterol levels will reduce the risk of heart disease; the same percentage of respondents were familiar with NCEP guidelines for detecting and treating blood cholesterol levels and knew which cholesterol levels should be treated. Seventy-three percent were familiar with the American Heart Association step 1 diet, and 69% were familiar with the step 2 diet. On average, survey respondents defined a cholesterol level of 6.12 mmol/L as "high risk"; this value is almost identical to the NCEP definition. Respondents were optimistic about patients' ability to reduce their blood cholesterol levels through dietary modifications. Dietetics professionals are interested in education on cholesterol management, although individual educational interests vary depending on the respondent's area of practice.
Aged↗
Does knowledge of drug prescribing predict drug management of standardized patients in office practice?
Drug prescribing for the elderly is an important area of medical knowledge since inappropriate prescribing may lead to significant adverse drug events. The objective of this study was to evaluate the association between knowledge of drug use and quality of drug management by general practitioners in practice. A cross-sectional study design was used to evaluate a sample of 37 GPs in practice. A set of common musculoskeletal problems was chosen to evaluate doctors' knowledge of non-steroidal anti-inflammatory drug use, while performance in practice was assessed using elderly standardized patients. The reliability of knowledge test scores was evaluated using measures of internal consistency. The relationship between knowledge of drug use and quality of therapeutic management in practice was evaluated by rank order and linear correlation analysis. Demographic characteristics of participating and non-participating doctors were similar. The reliability of the knowledge test was 0.55. The reliability of performance scores was 0.66. The correlation between overall performance on the standardized patient cases and total knowledge test score was 0.22 (95% confidence interval = 0-0.63). Knowledge test scores were poorly correlated with quality of therapeutic management in office practice. This indicates that knowledge tests alone cannot predict quality of performance with regard to drug prescribing for the elderly in primary care office practice.
Clinical Competence↗
Treatment of locally advanced prostate cancer: is chemotherapy the next step?
PURPOSE: Management of locally advanced prostate cancer remains controversial. Various single and combination modality approaches have been advocated, but an accepted standard of care remains undefined. The purpose of this review is to define the current knowledge in managing locally advanced prostate cancer and to propose new treatment approaches based on current knowledge. MATERIALS AND METHODS: A MEDLINE search to detect all relevant articles on the management of locally advanced prostate cancer was performed. A review of the staging, natural history, and prognosis of this disease was also performed. RESULTS: The lack of a clearly defined treatment approach to patients with locally advanced prostate cancer stems from multiple factors, including ambiguities in clinical staging, inadequate knowledge of the natural history of the cancer, and a dearth of comparative randomized trials evaluating efficacy of different therapies. Single modality treatment, including radical prostatectomy (RP) or external-beam radiotherapy alone, is associated with high rates of failure. The use of adjuvant hormonal ablation therapy in combination with external-beam radiotherapy has shown improvement in progression-free and overall survival, although similar improvements have not been clearly demonstrated for surgical patients treated with hormonal therapy. New advances in chemotherapy for hormone-refractory prostate cancer suggest that response rates may be as high as 50% or more, and current trials are evaluating the addition of chemotherapy to hormonal ablation in either surgery or radiation therapy in locally advanced prostate cancer. CONCLUSION: Optimal management of locally advanced prostate cancer remains undefined. Standard treatment options include RP, external-beam radiotherapy, or hormonal ablation therapy, alone or in combination. New approaches being tested include improved methods for delivering radiation or combining hormonal ablation with surgery or radiation. It is possible that other forms of systemic therapy, including chemotherapy, may become important components of multimodality treatment. Clinical trials designed to test this hypothesis are ongoing.
Actuarial Analysis↗
Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomized control trial.
BACKGROUND CONTEXT: The process through which new scientific developments are incorporated into clinical practice is referred to as "knowledge transfer" and is currently the subject of great interest in many areas of clinical medicine. Family physicians managing patients with acute low back pain have been shown to have a poor overall rate of concordance with clinical practice guideline-recommended treatments. New methods need to be developed to help physicians bridge the guideline implementation gap. PURPOSE: To determine the efficacy of a knowledge transfer method that communicates clinical practice guidelines to family physicians and their patients using patient-specific, physician-to-physician communications. STUDY DESIGN: A prospective randomized controlled study. PATIENT SAMPLE: 428 patients with acute mechanical low back pain and accepted Workers' Compensation Board claims were studied. OUTCOME MEASURES: Concordance with specific clinical practice guideline-derived history taking items, physical examination procedures and treatment recommendations was determined. METHODS: Patients with acute mechanical back pain of less than 4 weeks duration and accepted Workers' Compensation Board claims were randomly assigned to one of three groups. In Group 1 (control group) neither the patients nor their family physicians received any information concerning the guidelines. In Group 2, family physicians alone or as well as their patients (Group 3) received a summary of clinical practice guidelines at approximately 2 weeks postinjury. In addition, both Groups 2 and 3 received reminders summarizing the recommended guidelines for patients at three specific stages of their clinical course. All guideline correspondence was addressed to a specific family physician or patient, signed by the study physician-investigators, and specified the patient by name. RESULTS: Family physicians in the control and intervention groups demonstrated a high degree of concordance with the guideline-recommended history taking and physical examination procedures, but were generally highly discordant with guideline-recommended treatments. Significant improvement in guideline-concordant treatments was seen only with diminished recommendations of prolonged bed rest and passive therapies and an increase in recommended aerobic exercise. Concordance with guideline recommendations relating to the use of spinal manipulative therapy was poor in all study groups. CONCLUSIONS: A knowledge transfer method that involved patient-specific, physician-to-physician communication to family physicians or their patients at three stages of the patient's clinical course was largely unsuccessful in improving concordance with guideline treatment recommendations.
Acute Disease↗