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Results for “Knowledge Management”

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At least 1,207 records · Page 67Linked to original sources

PubMed1994

Asthma knowledge in hospital patients with acute severe asthma.

OBJECTIVES: To assess patient knowledge about asthma management and to assess the risk of asthma-associated morbidity in patients admitted to hospital with acute severe asthma. SUBJECTS AND SETTING: Patients admitted to Fremantle Hospital with a primary diagnosis of acute severe asthma from July to September 1992. RESULTS: Bronchodilator therapy has been used for more than 12 months by all 25 previously diagnosed asthmatics, with 88% knowing that the drug was a bronchodilator. Corticosteroid therapy had been used by 84% of patients but only 52% of these knew that it was anti-inflammatory or "preventive" medication. Sixty per cent of patients did not recall seeing National Asthma Campaign advertisements. Twenty-three patients (88%) were classified as being at high risk of morbidity. CONCLUSIONS: The level of knowledge about asthma management in patients admitted to this hospital is poor. Most patients are at high risk of asthma-associated morbidity.

Acute Disease↗

PubMed1994

Leukemia: management of relapse after allogeneic bone marrow transplantation.

PURPOSE: To review the current state of knowledge regarding the management of leukemic relapse after allogeneic bone marrow transplantation (BMT). PATIENTS AND METHODS: The literature was analyzed using MEDLINE (National Library of Medicine, Bethesda, MD) and reports were identified through review of report bibliographies. Pertinent studies were selected and data synthesized into a review format. RESULTS: Leukemic relapse after allogeneic BMT is an important cause of treatment failure. The risk of leukemic relapse varies from 20% to 60% depending on the diagnosis and phase of disease. Reinduction chemotherapy (CT), second BMT, interferon (IFN) alfa, and donor leukocyte infusions are various options, but none of the approaches is clearly optimal. Approximately 50% of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) patients achieve remission after standard induction CT. However, most patients finally relapse and die of uncontrolled leukemia. Second BMT is successful in 20% to 25% patients and is a reasonable option in patients who relapse more than 6 months after the initial transplant. Young patients with a good performance status and those in remission from initial transplant relapse have a better outcome after second BMT. Venocclusive disease (VOD), interstitial pneumonitis (IP), and acute graft-versus-host disease (GVHD) are the main complications. Therapy with IFN alfa results in cytogenetic complete remission (CR) in 10% to 25% patients with chronic myeloid leukemia (CML). The initial results of leukocyte infusions from the original donor are promising. However, acute GVHD and bone marrow aplasia are associated complications. The correct dose and schedule of donor leukocyte infusions need to be determined in future studies to minimize GVHD while maintaining the graft-versus-leukemia (GVL) effect. CONCLUSION: Identification of patients at increased risk for relapse and use of biologic response modifiers post-transplant to augment the GVL effect in such patients are possible areas of improvement for future studies.

Acute Disease↗

PubMed1993

CEO expectations of the pharmacist materiel manager.

The pharmacist possesses the knowledge and skills required of a materiel manager. The pharmacist must be willing to adapt to the materiel management environment. The resultant loss of certain clinical skills is inevitable. The pharmacist who does not accept this will not succeed. The CEO should expect this.

Education, Pharmacy↗

PubMed2000

Physicians' knowledge and attitudes toward the use of analgesics for cancer pain management: a survey of two medical centers in Taiwan.

The purposes of this study were to examine the attitudes of physicians regarding the optimal use of analgesics for cancer pain management (CPM), to evaluate their knowledge and attitudes toward opioid prescribing, and to comprehend their perceptions of the barriers to optimal CPM. A survey was conducted on 356 physicians with cancer patient care responsibilities practicing in two medical centers in Taiwan. A total of 204 (57%) physicians responded, including internists (28%), surgeons (27%), oncologists (11%), anesthesiologists (10%), and other specialties (24%). The majority of physicians displayed significantly inadequate knowledge and negative attitudes toward the optimal use of analgesics and opioid prescribing. Multivariate analyses showed that the following six categories of physicians would be inclined to have inadequate knowledge of opioid prescribing: 1) those with perception of good medical school training in CPM, 2) those with perception of poor residency or fellowship training in CPM, 3) those with a medical specialty in surgery, medicine, or oncology (vs. anesthesiology), 4) those with limited clinical experience in cancer patient care (number of patients less than 30), 5) those with a limited aim of pain relief, and 6) those with an underestimation of analgesic effect. Additionally, physicians with inadequate knowledge of opioid prescribing and with hesitation to intervene earlier with maximal dose of analgesia would be inclined to have reluctant attitudes toward opioid prescribing. The most important barriers to optimal CPM identified by physicians themselves were physician-related problems, such as inadequate guidance from a pain specialist, inadequate knowledge of CPM, and inadequate pain assessment. The results of this study suggest that active analgesic education programs are urgently needed in Taiwan.

Adult↗

PubMed2004

Nursing home staff characteristics and knowledge gain from a didactic workshop on depression and behavior management.

Depression is a prevalent and serious problem among nursing home residents. Nursing home staff members are gatekeepers for mental health treatment for residents, but may know little about depression and its management. We evaluated a didactic workshop for nursing home staff on depressive symptoms and management. Results for 58 staff participants showed significant gains in knowledge about depression diagnosis and management after the workshop. A regression predicting pre-test knowledge indicated that significant contributors were age (beta = .27; p &#60 .05), education (beta = .28, p = &#60 .05), and experience in long-term care (beta = -.53, p &#60 .01). Results provide preliminary support for didactic training about depression, but suggest that differences in staff knowledge related to experience should be addressed in training.

Adult↗

PubMed1998

Financial management in patients with dementia; their adult children's knowledge and views.

OBJECTIVE: To investigate the awareness of children of dementia patients with regard to financial management options available to their parents. METHODS: Questionnaire survey of the children of 74 consecutive patients referred with dementia and living on their own. SETTING: Catchment area of a district general hospital with a population of 38,000 people over the age of 65. RESULTS: The children of patients with dementia are generally poorly informed as to the legal status of their parents' financial position although all feel they require assistance and most would welcome the help of interested professionals. CONCLUSION: Much needs to and can be done to raise people's awareness of this problem. Means by which this may be accomplished are suggested.

Adult↗

PubMed1998

Practical risk management principles for physicians.

Most medical schools and postgraduate residency programs do not focus adequate attention on risk management and quality management issues. This article will prepare physicians with an adequate working knowledge of risk management and quality management information, which will enable them to practice more effectively in today's litigious and regulatory climate.

Advance Directives↗

PubMed1986

Evaluation of ambulatory care training by graduates of internal medicine residencies.

In 1984, 154 physicians who had completed residencies in internal medicine at 15 major teaching hospitals in 1982 evaluated their residency training in ambulatory care. A majority of the physicians would have liked more experience in practical areas related to career planning and office management, more input from subspecialties such as orthopedics and dermatology, greater knowledge about the management of psychosocial problems, and more information about exercise and nutrition. Although many physicians also wanted more time devoted to several other topics, less than 20 percent recommended spending less time on 26 of the 27 topics being evaluated. Since these recommendations are similar to those reported in evaluation studies published over the past 25 years, it appears that training programs in internal medicine have not been successful in restructuring their curricula to meet many of the needs of practicing physicians.

Ambulatory Care↗

PubMed1997

Essential skills for managed behavioral health care.

Pressure from payers for cost containment and accountability is forcing clinicians to refine existing skills and develop new areas of competence. To adequately address patients' needs in the new health care environment, clinicians must master at least six skill sets and the individual skills within each set. This paper describes six core skill sets-clinical care skills, clinical management skills, clinical knowledge, skills with special populations, administrative competence, and ethical care management-and specific skills within each set. These descriptions are intended to serve as a how-to manual for modern behavioral practice.

Clinical Competence↗

PubMed2002

[A survey of public health nurses regarding their awareness of the abilities, skill and knowledge necessary to fulfill an occupational health nurse's role, and proposal of a new curriculum for occupational nurse specialists at the master level].

The areas of conduct and professional roles in occupational health nursing in Japan has not been defined as yet, even though occupational health nurses have contributed to implementing jobs related to the health examination in workplaces every year. We surveyed public health nurses regarding their awareness of the abilities, skills and knowledge necessary to fulfill an occupational health nurses' role. When answering, they became aware of deficiencies in their abilities, skills and knowledge. This was particularly true in counseling, health assessment skills and management abilities, specialized knowledge of occupational safety and health, ergonomics and environmental health. We propose a curriculum at the master level for occupational health nurse specialists with reference to the core curriculum for occupational and environmental health nursing in the USA.

Curriculum↗

PubMed1995

Does knowledge guide practice? Another look at the management of non-small-cell lung cancer.

PURPOSE: To describe Canadian doctors' beliefs about the appropriate role of chemotherapy and radiotherapy in the management of non-small-cell lung cancer (NSCLC). METHODS: A mail survey of a random sample of Canadian respirologists, thoracic surgeons, radiation oncologists, and medical oncologists was performed. Three cases of NSCLC were described and respondents were asked to estimate the prognosis in each case and to give their treatment recommendations. RESULTS: Responses were obtained from 234 of 330 eligible subjects (74%). Doctors' treatment recommendations varied widely. After a complete resection for stage II NSCLC, 68% recommended no adjuvant treatment, 28% recommended radiotherapy, 1% recommended chemotherapy, and 3% recommended both radiotherapy and chemotherapy. For an asymptomatic patient with stage IIIb NSCLC, 17% recommended no active treatment, 65% recommended radiotherapy alone, 16% recommended radiation and chemotherapy, and 2% recommended chemotherapy alone. For an asymptomatic patient with a stage IV NSCLC, 80% recommended no active treatment and 20% recommended chemotherapy. Doctors' beliefs about the natural history of NSCLC and its response to treatment varied widely. Seventy-five percent of respondents believed that adjuvant radiotherapy did not increase survival in stage II disease, but 25% believed that it did. Thirty percent believed that the addition of chemotherapy to radiotherapy in stage III increased survival, but 70% believed that it did not. Fifty-five percent believed that chemotherapy increased the median survival in stage IV, but 45% believed that it did not. Doctors' beliefs about the efficacy of treatment were strongly associated with their treatment recommendations. CONCLUSION: Personal beliefs, rather than universal knowledge, currently guide the management of NSCLC in Canada.

Aged↗

PubMed1996

Changing the relationship among nurses' knowledge, self-reported behavior, and documented behavior in pain management: does education make a difference?

An educational program designed to change knowledge in order to change pain management practices and patient outcomes was offered to nurses who provide day-to-day care to patients with cancer in communities in a predominantly rural state. A quasi-experimental time-series design was used to measure the effectiveness of the program in changing nurse knowledge, attitude and behavior, and to evaluate the relationships between the outcomes. Data were collected from nurses (N = 29) and patient charts before (N = 209) and after (N = 163) the program. Nurses' knowledge increased, but the change was not statistically significant; the mean percent of correct answers on the three subtests were different and differences persisted throughout the study. Nurses believed that patients should be "pain free." Documentation of behaviors, for example, practice activities, occurred infrequently and showed little change until 6 months after the program. Increase in documentation of pain-intensity ratings, pain location, number of sites of pain, presence of confusion, anxious or depressed mood, sleep, nausea and vomiting, constipation, and general activity were noted. Documentation of the use of a propoxyphene-containing analgesic decreased; increase in the use of hydromorphone methadone and transdermal fentanyl was noted. Analysis of the relationships between correct responses to nurse knowledge questions and documentation of behavior provided interesting, statistically insignificant results that need to be reexamined in future research. Future programs should emphasize analgesic dosing and calculation of equianalgesic doses. Current practices in chart documentation may provide incomplete information regarding change in practice behaviors; more detailed documentation of pain management practices is needed. Nurses who participated in the program anecdotally reported feelings of increased credibility and effectiveness. Although change in behavior is slow to occur, education does make a difference.

Adult↗

PubMed2007

Knowledge of general practitioners dentists about the emergency management of dental avulsion in Curitiba, Brazil.

The prognosis of traumatized teeth in general and of avulsed teeth in particular depends on prompt and appropriate treatment. Management of traumatic injuries may be a challenge to the non-specialized dentist, as they may occur when dentists are least prepared for it. The objective of this research was to investigate the knowledge of general practitioner dentists about the emergency management of dental avulsion in Curitiba, PR, Brazil. A group of 250 professionals were interviewed. The questions were related to knowledge of how to treat traumatic avulsion of teeth. The results suggest that the level of knowledge on the management of dental avulsion of the general practitioners dentists in Curitiba is adequate.

Adult↗

PubMed2005

Clinical management of dental anxiety: what works for whom?

This paper aims to provide an overview of the current knowledge regarding the management of adult dentally anxious patients. Furthermore, an attempt is made to formulate a number of preliminary clinical guidelines, based on the available literature. The findings are discussed in the light of the following four problem areas or types of patients, those with: 1) a mild form of fear or anxiety, 2) a phobia of specific dental procedures or situations, 3) interfering psychiatric symptoms and/or 4) a high treatment need. The literature suggests that particularly the implementation of a high level of predictability during treatment, the training of patients in the use of coping skills, and the application of in vivo exposure to anxiety provoking stimuli are the most appropriate options for the management of anxious dental patients and the reduction of their anxiety level.

Adaptation, Psychological↗

PubMed2003

Achieving strategic consensus in the hospital setting: a middle management perspective.

This study adopts a social network methodology to explore the achievement of strategic consensus in a hospital system. On the basis of responses from 88 middle managers, the authors determined that a manager's (1) knowledge of the internal capabilities and the external environment of an organization and (2) his or her social position in a management structure significantly affect the realization of strategic consensus. Managerial knowledge is essential, and its importance in the consensus-building process is enhanced by a manager's social position.

Consensus↗

PubMedDate not supplied

Do nurses know enough about percutaneous endoscopic gastrostomy?

An audit of nurses in a district general hospital found that there were gaps in their knowledge about the management of percutaneous endoscopic gastrostomy. The author suggests ways in which their knowledge could be updated and patient care improved.

Clinical Competence↗

PubMed2006

Discussing patient management online: the impact of roles on knowledge construction for students interning at the paediatric ward.

The objectives of this study are to explore the use of asynchronous discussion groups during medical students' clinical rotation in paediatrics. In particular, the impact of role assignment on the level of knowledge construction through social negotiation is studied. Case-based asynchronous discussion groups were introduced to enhance reflection and critical thinking on patient management and treatment, and to offer an exercise in evidence-based medical practice. Groups of approximately 4-5 students were asked to discuss 4 authentic cases during clinical rotation in paediatrics. 49 students interning at the paediatric ward participated in this study. With respect to role assignment, differences between groups (1) with a student or an instructor as moderator and (2) with or without a developer of alternatives for patient management were explored. A content analysis was performed to explore the different levels of social construction of knowledge. The results of multilevel logit analyses show a significant difference in knowledge construction through social negotiation between conditions with a student moderator and conditions where the instructor is moderating, but only when a developer of alternatives is involved. No significant difference was revealed between student-moderated and instructor-moderator groups without a developer of alternatives. It can be concluded that when both the moderator and developer role are assigned to students, their contributions are more likely to reflect a high level of knowledge construction.

Adult↗

PubMedDate not supplied

[Beliefs and knowledge of a group of doctors about the nutritional management of the child with acute diarrhea].

OBJECTIVE: To identify the beliefs and knowledge of a group of rural physicians on the dietary management of children under five years of age, with acute diarrhea. Physicians' dietary management was compared with that recommended by the World Health Organization. MATERIAL AND METHODS: A cognitive anthropology study was carried out from July to December 1998, on ten physicians that care for the infant population ascribed to Hospital Rural IMSS-Solidaridad of San Juanito Bocoyna, Chihuahua, Mexico. Data were collected through focus groups, case vignettes, free listing, pile sorting, and a semi-structured questionnaire, and then cross-referred. RESULTS: The physicians recognized the negative impact of diarrhea on the nutritional state of the child, but not all of them evaluated this state. Prevailing interventions were antibiotic therapy, fluid management, and feeding recommendations. Among the latter, the most consistent were breastfeeding, delayed feeding, and gradual feeding. CONCLUSIONS: The obtained information is in conflict with WHO's recommendations, specially with that of sustained feeding. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Acute Disease↗