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At least 1,099 records · Page 61Linked to original sources
PubMed1997

Positron emission tomography and brain tumours.

The first applications of positron emission tomography (PET) for the study of brain tumours appeared early in the development of this technology. New trends in these particular PET applications tend to take into account the histological heterogeneity of these tumours and the necessity to integrate PET data in their surgical management. Better knowledge on PET tracers behavior in brain tumours should lead to new clinical uses, in particular in the promising field of cancer treatment evaluation.

Brain Neoplasms↗
PubMed1998

Resolved: A pulmonary artery catheter should be used in the management of the critically ill patient. Pro.

Selected studies showing both positive and negative outcomes with the use of pulmonary artery catheters (PACs) are reviewed. Indications for use of a PAC are controversial, although clearly the "red cap syndrome" is an indication for its insertion. There are sufficient data as well as personal experience to suggest that PACs do make a difference in the management of critically ill patients. Attention is focused on the level of physician expertise in interpreting data provided by PAC monitoring as the most critical limitation on the physician's ability to make appropriate clinical decisions. Studies are reviewed that addressed physician level of expertise related to PAC insertion, complications, data and waveform interpretation, and management. User knowledge clearly is suboptimal. Before attempting to draw conclusions from outcome studies, criteria for appropriate use need to be developed and clinician knowledge needs to be significantly improved.

Cardiac Output↗
PubMed1999

Preparing adult branch students for their management role as staff nurses: an action research project.

AIM: This action research project aimed to investigate students', newly qualified staff nurses' and ward managers' views about the management skills and knowledge required by staff nurses, and how best students could be prepared for their management role. BACKGROUND: The importance of the staff nurse's management role is increasingly being recognized but the literature highlights the difficulties in preparing students for management, and personal experience confirmed this. METHODS: Focus group interviews were held with senior students and newly qualified staff nurses. A questionnaire was then developed which was completed by 23 ward managers. FINDINGS: A good insight into the management skills and knowledge expected of newly qualified staff nurses, and useful ideas about preparation for the role emerged. An extra 2 weeks in practice, supernumerary and with specific management learning outcomes, was implemented and evaluated well. CONCLUSIONS: Preparation of students for their management role as staff nurses benefits from being closely linked to practical experience, with clear learning outcomes and supportive clinical staff. Using an action research approach to investigate the problem and develop a strategy was found to be an appropriate methodology.

Adult↗
PubMed1976

Medical management of urolithiasis.

Knowledge of the crystalline structure of the calculus provides the basis of the therapeutic plan. Laboratory evaluation depends heavily upon routine urinalysis. Assessment of renal function, serum calcium, phosphorus, uric acid and, in some cases electrolytes is usually indicated, as is urography. General principles of management include maintenance of an ample urine volume, eradication of infection and correction of any obstructing lesions or metabolic abnormalities. Specific antistone regimens are indicated for patients with recurrent urolithiasis.

Anti-Bacterial Agents↗
PubMed1991

A community-based study of diabetes-related skills and knowledge in elderly people with insulin-requiring diabetes.

An open cross-sectional study of elderly (age greater than 65 yr) patients with insulin-requiring diabetes mellitus (n = 57) was undertaken to audit safety of self-management. Levels of knowledge and management skills of hypoglycaemia, hyperglycaemia, and foot care were determined. The prevalence of hypoglycaemia, visual impairment, and at-risk feet and the ability to perform practical procedures (insulin injection and self-monitoring) were assessed. Drawing up insulin and self-injection was correct in 84% and 76% of patients, but 53% of self-monitored urine or blood tests were performed incorrectly. Twenty-six per cent experienced hypoglycaemia at least monthly and 25% had been seen at the hospital with hypoglycaemia in the last year. Eighteen per cent did not know what action to take with hypoglycaemia. Forty-six per cent did not know any hyperglycaemic symptoms or signs. Prompted with symptoms, 35% still did not know what to do and 21% would take inappropriate action when self-monitored tests read high. Fifty-one per cent had impaired vision, 61% peripheral neuropathy and 24% peripheral vascular disease, with the result that 78% had at-risk feet. Fifteen percent inspected or washed their feet infrequently, 40% walked barefoot occasionally, and 47% would take potentially dangerous action in the event of foot injury. This study demonstrates serious deficiencies in the basic education and management skills in our elderly insulin-requiring diabetic population that could result in morbidity and mortality. Greater effort and vigilance by health care professionals must be directed towards this group.

Aged↗
PubMedDate not supplied

Evaluation of a cancer pain education module.

PURPOSE/OBJECTIVES: To assess whether a case-based cancer pain education module would lead to acquisition and retention of knowledge and attitudes at the graduate nursing student level. DESIGN: Quasi-experimental pretest, post-test, and follow-up. SETTING: Three nursing schools in the New England area. SAMPLE: 92 graduate nursing students. METHODS: An oncology nurse specialist delivered seven two- to four-hour seminars integrated in existing pharmacology, primary care, or adult health courses. Participants' cancer pain knowledge was assessed at four time points with a paper-and-pencil test: before the seminar, immediately after, and approximately 6 and 24 months after the seminar. MAIN RESEARCH VARIABLE: Cancer pain knowledge. FINDINGS: The intervention was effective in improving students' knowledge of cancer pain management and assessment (p = 0.0001), and the effect was retained at 6 and 24 months (p = 0.0001 and p = 0.0024, respectively). CONCLUSIONS: Policymakers, clinicians, and professional organizations have recommended providing cancer pain education during professional training to overcome the continuing problem of the undertreatment of cancer pain. The education module used was effective in changing students' knowledge of cancer pain management, and the results suggest that this knowledge is lasting. IMPLICATIONS FOR NURSING: Early cancer pain education for nurses may play an important role in improving pain control for patients with cancer. Although this study did not evaluate the application of cancer pain knowledge to clinical practice, the results support the notion that advanced practice nurses can improve their cancer pain management knowledge and attitudes while in training. One implication is that this shift in attitudes and knowledge will translate to effective management of pain in varied healthcare settings.

Education, Nursing, Graduate↗
PubMed1999

Knowledge workers and knowledge-intense organizations, Part 2: Designing and managing for productivity.

Our economy is shifting from a hard goods and material products base to one in which knowledge is the primary mode of production. Organizations are experimenting with designs that support knowledge work by clustering individuals with different but complementary skills in focused teams. The goal is to increase applied knowledge that furthers the organization's strategic intent. The team-based knowledge work model holds promise for healthcare organizations that are under pressure to use knowledge to improve clinical care, integrate care across disciplines and settings, and accept accountability for costs. However, the shift from the traditional bureaucratic model to the flexible team-based design mandates changes in the design of the organization, the role of leadership, and the attributes of the teams and team members. In Part 2 of this three-part series, the authors explore the necessary design changes and the new roles for leadership, teams, and their members. Additionally, implications for healthcare clinicians, particularly nurses, are discussed.

Efficiency, Organizational↗
PubMed2005

Knowledge about sexually transmitted diseases in women among primary care physicians.

OBJECTIVES: Little is known about sexually transmitted disease (STD) knowledge of primary care providers. The objectives of this study were to determine the knowledge about the management of STDs among primary care physicians and to identify physician characteristics associated with possession of STD knowledge. STUDY: A self-administered questionnaire was mailed to a random sample of 1600 obstetrician/gynecologists, pediatricians, family physicians, and internists practicing in Pennsylvania. Information on physician and patient demographics was gathered, and we assessed knowledge and practice patterns concerning the management of STDs in young women. RESULTS: Physician knowledge regarding the evaluation and management of women with or at risk for STDs was associated with female gender (odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.2), age < or =40 (OR: 2.3; 95% CI: 1.4-3.6), and metropolitan practice location (OR: 1.7; 95% CI: 1.1-2.6). Familiarity with the Center for Disease Control and Prevention's (CDC's) STD treatment guidelines was independently associated with STD knowledge (OR: 2.0; 95% CI: 1.2, 3.3). Physicians with good STD knowledge were more likely to report routinely screening at-risk women for Chlamydia trachomatis (OR: 3.9; 95% CI: 2.3-6.8). CONCLUSIONS: Inadequacies in physician knowledge may serve as a barrier to the appropriate diagnosis and treatment of STDs. Interventions to improve STD management practices should include continuing medical education and distribution of CDC's STD treatment guidelines to primary care providers.

Adult↗
PubMed1995

Introduction of knowledge bases in patient's data management system: role of the user interface.

As the number of signals and data to be handled grows in intensive care unit, it is necessary to design more powerful computing systems that integrate and summarize all this information. The manual input of data as e.g. clinical signs and drug prescription and the synthetic representation of these data requires an ever more sophisticated user interface. The introduction of knowledge bases in the data management allows to conceive contextual interfaces. The objective of this paper is to show the importance of the design of the user interface, in the daily use of clinical information system. Then we describe a methodology that uses the man-machine interaction to capture the clinician knowledge during the clinical practice. The different steps are the audit of the user's actions, the elaboration of statistic models allowing the definition of new knowledge, and the validation that is performed before complete integration. A part of this knowledge can be used to improve the user interface. Finally, we describe the implementation of these concepts on a UNIX platform using OSF/MOTIF graphical interface.

Algorithms↗
PubMed2000

Asthma management in five European countries: doctors' knowledge, attitudes and prescribing behaviour. Drug Education Project (DEP) group.

The aim of the study was to examine the relationship between guideline recommendations on asthma management, and the performance of doctors in five different European health care contexts. Knowledge, attitudes and prescribing behaviour of doctors recruited to an educational project was investigated. A total of 698 general practitioners from Germany, The Netherlands, Norway and Sweden, and 94 specialists from the Slovak Republic participated. A questionnaire was used to assess their knowledge and attitudes. Antiasthmatic drugs dispensed to their patients reflected their prescribing behaviour. In response to questions on how to treat chronic asthma, most doctors were in agreement with guideline recommendations. In practice, however, the proportion of asthma patients receiving inhaled steroids varied almost twofold, ranging 31% in Germany to 58% in The Netherlands. On questions related to exacerbation of asthma, German and Slovakian doctors often preferred treatment with antibiotics to steroids. They also more often associated yellow-green sputum with bacterial infection. In conclusion, although many doctors in different health care contexts have accepted the recommendations given in guidelines, the proportion of their patients treated accordingly differed. German and Slovakian doctors seem to attach less importance to the inflammatory features of asthma than the doctors from the other three European countries.

Adolescent↗
PubMed2004

[Exploring the knowledge of asthma, attitude and self-management behaviors of school age children with asthma in the Ping-Tung area].

The present correlational research was aimed at: exploring asthmatic children's knowledge of their disease, their attitude towards it, and their self-management behavior. Convenient sampling was used to recruit subjects. One hundred and sixty eight asthmatic children from 7 to 12 years old were recruited from 14 elementary schools in the Pintung area, Taiwan. The results showed: (1) a moderate-leveled standardized score of 57.26 for knowledge of the disease; a positive-leveled standardized score of 86.27 for attitude toward the disease; a moderate high-leveled standardized score of 69.34 for self-management behaviors; (2) no significant relationship between demographic information and self-management behavior; (3) a significant correlation between asthmatic knowledge and self-management behavior; (4) a significant correlation between attitude towards asthma and self-management behavior; and (5) knowledge of the disease and attitude towards the disease as important predictors of self-management behavior, together accounting for 23.9% of the total variance. Results of the present study could serve as a basis for future studies.

Asthma↗
PubMed2004

Learning management systems: technology to measure the medical knowledge competency of the ACGME.

AIMS: We report how the learning management system (LMS) Web Course Tools (WebCT) was used to design, implement and evaluate the web-based course "Principles of Ambulatory Paediatrics", taken by paediatric residents during an ambulatory block rotation. This report also illustrates how WebCT can be used to measure the medical knowledge competency required by the Accreditation Council for Graduate Medical Education (ACGME). METHODS: Eighty paediatric residents completed a 1-month outpatient rotation between July 1, 2001 and June 30, 2002. During this rotation residents were required to complete 4 modules in asthma, otitis media, gastroenteritis and fever, respectively. Each module was evaluated using a standard questionnaire. RESULTS: Completion rates for the required modules ranged from 64-72%. Residents in all 3 years of training showed improvement between the pre- and post-test scores for each module, except for postgraduate Year 2 residents in the asthma module. Most residents somewhat agreed, agreed or strongly agreed that the module components were useful and that the experience of completing the modules would improve their ability to take care of patients. CONCLUSIONS: The LMS WebCT is an innovative and adaptable approach for designing a web-based course for primary care education in paediatrics. The LMS addresses the educational needs of both a clinical division and a residency programme. The LMS also provides an information technology infrastructure to measure the medical knowledge competency required by the ACGME.

Accreditation↗
PubMedDate not supplied

Management options for the child with spastic cerebral palsy.

Knowledge of spasticity management for the child with cerebral palsy begins with understanding how cerebral palsy and spasticity are defined and related. The next step is learning what the treatment options are and how they can impact the child. There are many strategies for managing spasticity. This article focuses on pharmacologic and surgical approaches. Pharmacologic is further subdivided into medications taken by mouth, given through an injection (Botox) or delivered by a pump (baclofen). Surgery includes neurosurgical and orthopaedic procedures. Each treatment is reviewed using rationale, patient selection, delivery methodology, and management technique citing the advantages and disadvantages of each modality.

Baclofen↗
PubMed1998

A conceptual framework for nursing management of pain.

The development of specific nursing-based conceptual frameworks help to define and link ideas when performing studies involving a number of different concepts. Through the use of nursing models and frameworks, knowledge gained from nursing research can be more readily disseminated into nursing practice. The present framework encompasses nurses' knowledge and attitudes about pain management and incorporates the work of many theorists, the most prominent being that of Brenda Conrad. This pain management scheme expresses the belief that nurses have a unique and pivotal role in supporting and promoting optimum health states and providing quality life. It generates overall goals related to nurse assistance of the patient in the areas of recovery, independence, adjustment and treatment, and emphasises that to meet the patient's needs, nurses must possess adequate pain assessment and management knowledge as well as supportive attitudes to provide efficient quality care provision. The major supposition emphasised throughout this conceptual framework is that underlying nursing care is a grounded knowledge base fostering genuine care and concern for the welfare of the holistic patient.

Health Knowledge, Attitudes, Practice↗
PubMed2003

Influence of seminar and mailed guidelines on knowledge of school teachers regarding emergency treatment for dental injuries.

OBJECTIVE: To evaluate the influence of two different modes for delivering guidelines on school teachers' knowledge on emergency treatment for dental injuries. DESIGN: Cross sectional questionnaire study. SETTING: Primary schools in Dar es Salaam city council in Tanzania. PARTICIPANTS: Primary school teachers. INTERVENTION: Provision of guidelines by mail or through seminar or no guidelines (control). MAIN OUTCOME MEASURES: Knowledge on emergency management of dental injuries RESULTS: The teachers did not have adequate knowledge on the emergency management of traumatised teeth. Significant differences were observed between the study groups. Teachers from the seminar group were likely to re-implant an avulsed tooth (five times more likely than the control group) or otherwise would transport it in the recommended medium. No significant differences were observed between the groups on their willingness to take the avulsed tooth to a doctor or dentist or on the method or liquid they would use to clean a dirty avulsed tooth. CONCLUSION: Compared to provision of information through mailed guidelines, seminar discussions better improved the school teachers' knowledge regarding emergency treatment for dental injuries.

Cross-Sectional Studies↗
PubMed1988

Shin splints. Diagnosis, management, prevention.

Our knowledge of the etiology of shin splints is incomplete. Biomechanical abnormalities are likely to be major factors in predisposing certain persons to such injury. Also, training errors are major etiologic factors. Because shin splints result from mechanical overload of various elements of the musculoskeletal system of the leg that exceed their adaptive remodeling capacity, rest and recovery should be emphasized as an important aspect of sports training. Accurate and prompt diagnosis reduces the severity and duration of the injury. Management should consist of measures to reduce inflammation and pain and to identify possible biomechanical factors that may be correctable by strengthening and flexibility exercises or by the use of an orthotic device.

Athletic Injuries↗