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PubMedDate not supplied

Medication management in primary and secondary schools.

OBJECTIVE: To summarize present knowledge about medication management in primary and secondary schools; to place this knowledge in its drug use and organizational contexts; and to provide a foundation for studying the problem and developing policy- and practice-level interventions aimed at alleviating it. To offer recommendations for practitioners, policy makers, and health professions educators aimed at improving the situation. DATA SOURCES: MEDLINE database (1966-1998); International Pharmaceutical Abstracts database (1977-1998); complete Medscape full-text search; contents of the Journal of School Nursing and the Journal of School Health (1966-present). STUDY SELECTION: We reviewed 95% of all articles, books, and reports identified using the search terms elementary school, middle school, junior high school, high school, primary school, secondary school, school nurse, school health, and schoolchildren. DATA EXTRACTION: The literature on this topic includes background material describing the nature of the problem and its political and organizational context and implying its significance; summaries of regulations, guidelines, and recommendations regarding medication management in the schools; and empirical studies. Few articles address pharmacist involvement in medication management in schools. DATA SYNTHESIS: Although approaches to this important problem vary widely, a set of core medication management guidelines is identifiable. Formal research is sparse, but it shows that medication use is widespread in schools and carries significant therapeutic and safety consequences. CONCLUSION: Pharmacists and school nurses must cross professional borders if they wish to play a role in solving this important drug therapy problem. Pharmacists can provide therapeutic and contextual perspectives on the problem, while school nurses can implement solutions within the schools.

Child↗

PubMed1999

Public knowledge of dental registration and management of common dental problems.

The government has recently changed its policy on dental registration. There is now a requirement to attend a dentist within 15 months of the previous appointment or dental registration will lapse. The authors of this article undertook a survey of the patients attending for dental treatment at the accident and emergency department of their hospital to ascertain whether inappropriate attendance was due to ignorance about general dental services. Of the 501 respondents 14% had not seen their general dental practitioner within the last 15 months and were therefore no longer registered--only 21% realized that they had to keep regular appointments or dental registration would lapse. A proportion (30%) had tried to contact the dentist outside normal working hours; 27% of these were unhappy with the outcome. Telephone calls were unanswered in 38% of those expressing dissatisfaction and 45% subsequently attended hospital for treatment.

Dental Care↗

PubMed2005

Inadequate community knowledge about sickle cell disease among African-American women.

BACKGROUND: Federal legislation was passed in 1972 initiating genetic screening and community education about sickle cell disease (SCD). Few assessments have examined the impact of these programs. The aim of this study is to assess existing knowledge about SCD among African-American women in St. Louis, MO. METHODS: We conducted a cross-sectional telephone survey of African-American women, 18-30 years of age. Participants were recruited through random-digit dialing in six ZIP codes with greater than 75% African-American residents. The survey contained questions exploring four content domains about SCD: general knowledge, genetics, management and educational resources. RESULTS: A total of 264 women were contacted; 30% were unable to complete the survey and participate further because they were unaware of SCD. One-hundred-sixty-two women met eligibility criteria, agreed to be surveyed and were included in the study. Ninety-one percent of the participants believed that SCD was a hereditary blood disorder, but only 9.3% understood the inheritance pattern. Eleven percent of the women were unaware of their sickle cell trait status. Most women recognized pain (94%), infections (80%) and strokes (40%) as complications of SCD. CONCLUSION: New strategies are needed to enhance awareness of SCD among African-American women of childbearing age.

Adult↗

PubMed1990

Survey of community health aides in Jamaica (1987-1988).

The Community Health Aide (CHA) programme was initiated in 1967, and, by the early 1980s, 1,328 CHAs had been trained and over 1,100 remained in the service. The aim of the programme was to train CHAs to assist in the delivery of basic health care. During the restructuring of the health services in 1985-1986, many CHAs were made redundant. As part of a large study aimed at assessing the current status of the CHA programme, this paper reports results of interviews with 415 CHAs still in service in 1987-1988 and 134 CHAs no longer employed in the programme at that time. The survey of CHAs still employed as such showed that they continued to perform duties in the community and in health centres with emphasis on the maternal and child health services and the management of diabetics and hypertensives. The survey of CHAs no longer employed as such showed that the majority remained unemployed through many continued to use their skills on a voluntary basis. These CHAs felt that home visiting had been reduced and environmental health was being neglected since they left, and that problems were not being regularly reported to the professionals at the health centres. It was recommended that all CHAs be offered training in the taking of blood pressure levels and in the giving of insulin injections to diabetics. Recommendations included improved methods of selection, longer training, greater community outreach, especially to the elderly, post-training evaluation, regular assessment of the CHAs' performance, and improved upward mobility opportunities and job security.

Adult↗

PubMed2002

Measuring Gene Flow in the Cultivation of Transgenic Barley.

Genetic engineering is becoming a useful tool in the improvement of plants and plant-based raw materials. Varieties with value-added traits are developed for nonfood use in industrial and medical production, and different production lines must be kept separate. For good management practices, knowledge of relevant gene flow parameters is required. In the present study, pollen-mediated dispersal of transgenes via cross-fertilization was examined. A transgenic barley (Hordeum vulgare L.) line carrying a marker gene coding for neomycin phosphotransferase II (nptII) was used as a pollen donor. For maximum resolution, a cytoplasmically male-sterile barley line was utilized as recipient and the flow of nptII transgene was monitored at distances of 1, 2, 3, 6, 12, 25, 50, and 100 m from the donor plots of 225 and 2000 m(2). Male-fertile plots at a distance of 1 m were included to measure the transgene flow in normal barley. The number of seeds obtained from male-sterile heads diminished rapidly with distance and only a few seeds were found at distances of 50 and 100 m. Molecular genetic analysis (polymerase chain reaction-PCR) revealed that all seeds obtained from male-sterile heads at a distance of 1 m were transgenic, as anticipated. However, only 3% of the distant seeds (50 m) actually carried the transgene, whereas most of them resulted from fertilization with nontransgenic background pollen. This background pollen was mainly due to pollen leakage in some male-sterile heads. In normal male-fertile barley, the cross-fertilization frequency with transgenic pollen varied from 0 to 7% at a distance of 1 m, depending on weather conditions on the heading day. We conclude that, because of competing self-produced and nontransgenic background pollen, the possibility of cross-pollination is very low between a transgenic barley field and an adjacent field cultivated with normal barley. However, adequate isolation distances and best management practices are needed for cultivation of transgenic barley.

Journal Article↗

PubMed2005

Web content management by self-organization.

We present a new method for content management and knowledge discovery using a topology-preserving neural network. The method, termed topological organization of content (TOC), can generate a taxonomy of topics from a set of unannotated, unstructured documents. The TOC consists of a hierarchy of self-organizing growing chains (GCs), each of which can develop independently in terms of size and topics. The dynamic development process is validated continuously using a proposed entropy-based Bayesian information criterion (BIC). Each chain meeting the criterion spans child chains, with reduced vocabularies and increased specializations. This results in a topological tree hierarchy, which can be browsed like a table of contents directory or web portal. A brief review is given on existing methods for document clustering and organization, and clustering validation measures. The proposed approach has been tested and compared with several existing methods on real world web page datasets. The results have clearly demonstrated the advantages and efficiency in content organization of the proposed method in terms of computational cost and representation. The TOC can be easily adapted for large-scale applications. The topology provides a unique, additional feature for retrieving related topics and confining the search space.

Abstracting and Indexing↗

PubMed1991

Acute toxicology of components of vegetation smoke.

Only in recent times, systematic attention has been paid to the occupational health of forest firefighters and workers who manage prescribed fire. Two parts of the effort to learn the impact on worker health are medical observation of those workers, and study of occupational hygiene. It is also necessary to learn what components of smoke are most likely to affect firefighters, and to learn something of the manner in which those substances might compromise health; this review is a step toward that end. The number of possible products of vegetation combustion is almost limitless, and every fuel and condition of burning produces a unique pattern. Nonetheless, it is possible and practical to select a limited number of products that are most likely to be involved in the acute toxicity of smoke. Two products that are almost certainly important are formaldehyde and acrolein. Both appear to occur in all smoke. The toxicology of both is well studied; in particular both are powerful mucosal irritants. Estimates of exposure suggest strongly that concentrations are high enough in smoke to contribute some or all of the irritant activity. There seems to be a reasonable prospect that free radical precursors with half-lives in the tens of minutes are produced when cellulosic materials burn. If so, they will reach the respiratory tract, and liberate free radicals that react immediately on or in pulmonary cells. Ozone is not produced in the fire, but the various hydrocarbons of smoke are substrates for reactions that eventually produce ozone, and that production may continue for miles down-plume. Some measured plume concentrations approach the threshold for human health effects. The effects of the best known component, the particulate material, are unknown in isolation from all of the other substances in smoke. In spite of that ignorance, particulate loading is the principal index of smoke pollution for regulatory purposes, and sometimes is incorrectly used to represent smoke emissions regardless of source. The need to understand health impacts of these components of smoke seems obvious. Perhaps less obvious is the need to use such knowledge in management of both prescribed burning and wildfire. To some extent, it is possible to either manage fire itself to alter emission patterns, or control exposures in certain situations. Whether that should be done to protect worker health can only be judged if enough is known about health effects to direct the management decisions.

Acrolein↗

PubMed2002

Teaching residents humanistic skills in a colposcopy clinic.

OBJECTIVE: The aim of this project is to add formal training and evaluation of humanistic skills for residents in a colposcopy clinic. Medical education of residents in office procedures has generally focused on proficiency in a particular technical skill and acquisition of clinical knowledge regarding management options. The literature supports assessing pattern recognition with visual images and observing a specific number of procedures to achieve proficiency. Little attention has been given to training residents to demonstrate sensitivity during procedures. However, we believe this is a key element, as the procedure involves anxious patients who are fearful of cancer and fearful of pain in their most private body parts. Further, women who have painful or unpleasant colposcopy procedures are less likely to follow up for further evaluation of treatment and may be at higher risk to develop cervical cancer. DESCRIPTION: Colposcopy training for gynecology residents, family medicine residents, medical students, and emergency room sexual assault nurses is provided at a colposcopy clinic that performs more than 400 procedures per year. The majority of women are referred for colposcopy from outside clinics, and more than one third are non-English-speaking. We have added to our traditional didactics and case instruction curriculum a session dedicated to training residents in humanistic skills related to performing colposcopy. Topics of discussion include (1) how to ask sensitive questions regarding risk factors for cervical dysplasia, (2) how to explain the procedure and obtain consent, especially with non-English-speaking women, (3) how to educate patients about human papilloma virus (HPV) and prevention of cervical cancer, (4) how to speak to the patient and the attending physician during the procedure to reduce rather than increase anxiety, (5) how to provide comfort measures during colposcopy (e.g., using a warm speculum, using local anesthesia, hiding instruments from patient view), and (6) how to review findings during and after procedures. The discussion includes errors that previous residents have made and approaches that create effective, culturally sensitive role models. The training session participants are given feedback regarding statements or actions that may make patients anxious or less comfortable during and following clinical procedures. Residents are evaluated at the end of each rotation by faculty who rate their technical skills, visual pattern recognition, knowledge on the subject, and humanistic qualities. DISCUSSION: The training session participants have responded favorably to feedback about observed interactions with patients during procedures. Indications are that this training may improve the quality of care given by providers during colposcopy and other sensitive procedures. To document the curriculum's effect on patient satisfaction and care, we plan to pilot the use of a patient survey regarding physicians' humanistic qualities.

Colposcopy↗

PubMed2003

Physician knowledge of the diagnosis and management of Rocky Mountain spotted fever: Mississippi, 2002.

Rocky Mountain spotted fever (RMSF), a tick-borne illness that has its highest incidence in the south central and southeastern United States, is often a diagnostic challenge, as patients frequently present with nonspecific symptoms during the early stages of illness. RMSF has a high case fatality rate among untreated individuals, and the median time from onset of symptoms to death is only eight days, making early recognition and treatment of RMSF crucial. In two Mississippi public health districts, 148 primary care physicians were randomly selected and mailed surveys regarding RMSF diagnosis, treatment, and prevention. Eighty-four of the 148 (57%) physicians responded. Responses from different specialties and different health districts were compared using chi square statistics. Almost all (99%) physicians correctly identified doxycycline as the antibiotic agent of choice for treating adults and adolescents. However, only 21% of family practice physicians, and 25% of emergency medicine physicians correctly identified the antibiotic of choice for treating children with RMSF. Twenty-three percent of physicians responded that waiting for the development of a rash before prescribing antibiotics is an appropriate treatment strategy. The current standard of care-doxycycline as the agent of choice among children 8 years of age or younger with suspected RMSF-has not been effectively communicated to all physicians caring for children. Also, many physicians are not familiar with the rationale underlying initiation of antibiotic therapy prior to the development of rash in patients with suspected RMSF. Continuing education efforts should focus on antibiotic selection in pediatric patients and initiation of therapy prior to the onset of rash in appropriate patients.

Animals↗

PubMed2002

[Indicators of structural quality in palliative care for cancer pain patients in Lower-Saxony].

INTRODUCTION: Palliative care in Germany fails to reach established standards. To improve this situation the Chamber of Physicians of Lower-Saxony initiated SUPPORT in 1995. Prior to interventions structural quality of care was evaluated, specifically the rate of availability of opioid-prescription-forms and the ability to treat chronic pain (defined as a construct of knowledge, attitudes and skills) were examined. METHODS: The survey was carried out using a standardized questionnaire mailed to a representative stratified sample of 1200 physicians. RESULTS: Out of 865 answering physicians (response rate 72.1%) only 36.9% had their own opioid-prescription-forms. Differentiations regarding to specialty, working place (clinic vs. private practice) and treatment of cancer pain patients during the last three months shows a better result for GPs (84.6%), internists (48.6%), gynecologists (51%) and pain specialists (66.7%). Only 33.1% of respondents claimed knowledge of the WHO-3-step-analgesic-ladder. Again the aforementioned differentiations yield somewhat better results for GPs (49.2%), internists (51.5%), gynecologists (34.7%) and pain specialists (55.6%), however only two thirds of these physicians were able to identify the correct number of steps of the WHO-algorithm. CONCLUSIONS: These results verify an insufficient structural quality in palliative care in Lower-Saxony. In the authors' opinion effective improvements can only be achieved by implementing a parallel strategy:improvement of basic knowledge in pain management with sufficient transfer of this knowledge into practice as well as raising the rate of availability of opioid-prescription-forms,and, on the other hand, establishing local palliative-care-teams with nursing and medical expertise with 24/7 on-demand availability to optimize palliative care.

Adult↗

PubMed2005

[Pre-hospital airway management in trauma].

Knowledge of trauma is as old as mankind and survived a long way to reach new technologic developments. Being a multisystemic disease, trauma is an important social and financial problem especially in developing countries. Anesthesists possess important roles in the multisystemic management of trauma patients. In our country prehospital life support for trauma victims is primarily realized and arranged by the emergency help and rescue team 112 which belonged to the Ministry of Health. Several courses are arranged for the team especially about endotracheal intubation and resuscitation in the field. Acute major airway injuries require an early diagnosis and a prompt treatment to improve their outcomes. Typical injuries causing alterations in oxygenation or ventilation are head, spinal cord and thoracic traumas. The use of cuffed tracheal tube remains the definitive 'gold standard' for airway control. Tracheal tube placement requires experience and high degree of skill. The laryngeal mask airway, intubating laryngeal mask airway and oesophageal-tracheal combitube are also indicated in maintaining control of airway during emergency trauma patients in the field. A probable occurrence of cervical spine fracture must be assumed while maintaining airway patency. On-site airway aspiration, and monitoring of carbon dioxide must be realized in trauma victims.

Airway Obstruction↗

PubMed1994

Self-management of cystic fibrosis: a structural model for educational and behavioral variables.

One hundred and ninety-nine patients and their primary caregivers at two metropolitan cystic fibrosis centers participated in a clinical trial to evaluate the effectiveness of a health education program designed to help improve self-management skills for the care of CF. The baseline data from the study was used to test a structural model that hypothesized the relationship between educational, behavioral, and health status variables. Controlling for the effects of all other variables, including demographic, self-efficacy (confidence in being able to perform a behavior) was the most important educational factor predicting self-management behavior for monitoring and treating respiratory problems. Knowledge about the management of CF was only related to the ability of caretakers to apply coping skills to problems associated with CF. The more caretakers reported performing monitoring behaviors the more likely they were to report performing self-management treatment behaviors. The findings suggest that educational interventions that focus on increased knowledge alone are not likely to be effective in improving self-management behavior for CF. Based on the structural model analyses, it is recommended that educational programs for CF patients and families address increased self-efficacy and improved monitoring skills to influence the improvement of self-management treatment for CF.

Adaptation, Psychological↗

PubMed1988

Programmatic intent of IAIMS--past and future. The National Library of Medicine's IAIMS grant program: experiences and futures.

The National Library of Medicine awards grants for the planning and development of integrated Academic Information Management Systems (IAIMS). The goal is to create mechanisms in health institutions and organizations to more effectively manage the knowledge of medicine. A background and description of the IAIMS Grant Program is given with emphasis on the planning phase. General observations and comments are made about IAIMS activities to date. A brief discussion about IAIMS futures is also included.

Academic Medical Centers↗

PubMed1993

Adrenal incidentaloma.

Improvements in ultrasonography and computed tomography have led to the problem of 'adrenal incidentaloma', an asymptomatic adrenal mass discovered during investigation of some other problem. In the light of current knowledge a management rationale for patients with such an adrenal abnormality is proposed.

Adrenal Cortex Hormones↗

PubMed1991

Knowledge-based approach to the management of serious arrhythmia in the CCU.

An expert system (SETA) for the management of patients in the CCU environment has been developed. SETA suggests therapeutic actions for the treatment of serious arrhythmias that complicate the pathophysiological state of patients recovering from acute and suspected myocardial infarction. The prototype begins by reasoning from the arrhythmia, diagnosed from the ECG signal, and progresses through its inference process by considering ECG changes (i.e. heart rate, QRS width), patient clinical data, patient history and therapeutic drug data, to reach the most appropriate actions for each particular patient. The system was implemented on production rules using M1 as a development tool. SETA uses a multiknowledge base (KB) architecture, one for each particular arrhythmia and relevant complication, and a decision board that controls the firing of the KBs and keeps track of patient status through time. The system takes into consideration aspects that are very important for the human expert, e.g. sequence of arrhythmia appearance, drug contraindications and priority in the case of simultaneous arrhythmia. The development of this system has given insight into the management of critical CCU patients, that should influence the specification and design of intelligent instruments for this clinical environment.

Arrhythmias, Cardiac↗

PubMed2000

Recent advances in the diagnosis and treatment of precocious puberty.

In the last two decades, the diagnosis and treatment of precocious puberty has undergone important changes. The use of supersensitive assays to determine gonadotropins and gonadal hormones has increased the sensitivity and decreased the number of blood samples required to assess the diagnosis. The introduction of gonadotropin-releasing hormone (GnRH) agonists produced a revolution in the diagnosis and treatment of this disorder. Recently, the use of long acting GnRH agonists improved the adherence of patients to medical treatment and decreased the need for uncomfortable repeated doses. The medications in the treatment of the GnRH independent causes of precocious puberty, and the important revelations in the pathophysiology of these disorders, have advanced our knowledge and management of the affected children.

Adolescent↗

PubMedDate not supplied

Diabetes education for the family, patient and paramedical staff.

Diabetes education should fulfill definable objectives and be provided in an orderly way to match the child and family's ability and readiness to learn. The main aims of education are (1) gaining an understanding of diabetes (2) developing practical skills in care (3) acquiring attitudes of optimism and self-confidence (4) acquiring detailed knowledge of management and (5) developing the ability to make management decisions. Families can respond to education as they overcome their initial shock and grief. Their ability to learn is enhanced by professional support in the anxious task of assuming responsible care for their child. It is helpful to involve all the family and both parents so they can support each other, share responsibility and enjoy the satisfaction of contributing to their child's good health. The child after infancy, should participate in care as much as he is able, and is consistent with his developmental stage. People learn in different ways and it is helpful to have different teaching methods available: individual learning, group discussion, reading material, visual aids and seminars. For the older child and teenager, camps enhance self-esteem and reinforce learning and allow the family to profit by their own experience. Paramedical staff should meet regularly to maintain their competence and ensure that teaching is consistent.

Adolescent↗

PubMed1998

The primary interpretation workstation: information beyond image data.

With the advent of picture archival and communication systems (PACS), the importance of design surrounding primary review workstations has become apparent. To help acceptance of filmless medical imaging, workstations must be developed that serve the needs of both radiologists and referring clinicians. This report will discuss integral requirements of workstation design, including information creation, medical management, medical knowledge, and enabling technologies.

Data Display↗