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PubMed1999

New strategies in the management of cancer.

The developing knowledge of cancer is paving the way for a new era of management of this disease. New scientific knowledge has enabled different and exciting modes of cancer therapy to be tested in the clinical setting. These innovations will lead to the availability of novel cytotoxic agents in the near future. In addition to such agents, the last few years has seen the emergence of new radiotherapy and surgical techniques that have the potential to radically change nursing practice. Such developments require a knowledgeable nursing workforce who can provide anticipatory care in tandem with supportive care strategies to facilitate optimal patient outcomes. This article considers potential future developments in cancer management and raises the issue of nursing being integral to the treatment process.

Humans↗
PubMed2004

[Impact of a brochure on pain destined for thoracic oncology patients].

OBJECTIVE: To assess the impact of a brochure supplied on pain and analgesic treatment on the knowledge, attitude, belief and perception of patients consulting oncology departments. METHOD: A prospective, comparative, study on patients consulting a thoracic oncology and a general oncology department, suffering from pain and motivating a treatment level > or = to 2 (WHO scale). A group of patients having been given a brochure (case) was compared with a group who had not been given the brochure (controls). The assessment questionnaire, developed according to the KABP (Knowledge, Attitudes, Belief, Practice) method, was distributed to the 2 groups. A second assessment was made 4 weeks after the patients having received the brochure. Visual analog scales (VAS) followed the intensity of the pain. RESULTS: Twenty-one cases and 33 controls were assessed. There was no modification in their belief (risk of addiction) but an improvement in their knowledge (duration of action of morphine agents, management of treatment, multi-disciplinary management). This improvement in knowledge was accompanied by improved control of pain: 2/3 of the patients exhibited a VAS < 1 at the time of the second assessment versus 1/3 during the initial assessment. CONCLUSION: Improvement, if only partial, in the patients' knowledge of pain and its treatment using a brochure, is one of the routes for optimising the management of pain.

Female↗
PubMedDate not supplied

Knowledge acquisition and evaluation of an expert system for managing disorders of the outer eye.

The aim of the current study was to develop and evaluate an expert system for diagnosing outer eye disorders, intended to support family physicians and nurse practitioners in the management of patients with minor eye complaints. The knowledge in the program was gathered from the scientific literature and from 6 experienced ophthalmologists and 6 ophthalmic nurses. Fourteen diagnoses must be considered, and the differential diagnosis is dependent upon 32 signs and symptoms. The program calculates the most likely diagnosis, presents photographs of the typical ocular findings, and provides information regarding management and treatment. The program's output was compared with the diagnosis made by 8 other ophthalmologists at a Swedish university clinic, based on data from 157 patients with disorders of the outer eye, who visited the emergency ward during a one-week period. The concordance between the diagnosis made by the ophthalmologists and the program was 96%. In conclusion, the expert system for disorders of the outer eye provided essentially the same diagnostic information as an examination by an ophthalmologist. Support from the program would make it possible for family physicians and nurse practitioners to manage most of these patients.

Diagnosis, Computer-Assisted↗
PubMed2006

Training and attitudes about contraceptive management across primary care specialties: a survey of graduating residents.

PURPOSE: Little is known about how physicians' attitudes and knowledge of contraception could impact the unintended pregnancy rate in the United States. The objective of this study was to analyze survey data from physicians in primary care training programs in Pittsburgh, PA. METHODS: A cross-sectional survey was administered to primary care medical residents in Allegheny County, PA. Descriptive statistics were used to illustrate training, attitudes and knowledge regarding contraceptive management. A multivariable analysis was performed to elucidate associations between training, attitudes and behavior. RESULTS: Of 143 residents surveyed, 74 (52%) responded. The mean score on contraceptive knowledge assessment was 54%. Obstetrics/gynecology residents performed consistently better on the knowledge index (p<.01). Among nonobstetrics/gynecology residents, formal training in contraception, female gender, ability to insert an intrauterine device and not being a family practitioner were independently associated with improved knowledge (p<.05). CONCLUSIONS: Most of the responding graduating residents view contraception as an important component of primary care. However, young physicians have a contraceptive knowledge base that is inconsistent across primary care specialties. Improvement in this area might improve the unintended pregnancy rate in the United States.

Adult↗
PubMed2004

Management and outcome of extremity soft tissue sarcomas.

OBJECTIVE: To analyze the results of various treatment modalities applied to soft tissue sarcomas of the extremity. DESIGN: An analytical study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Rawalpindi during the period January 1994 - January 1996. SUBJECTS AND METHODS: Data was collected from 32 patients. It included age, gender, presentation, diagnostic work-up, treatment instituted followed by evaluation of management. All patients were followed up for 24 months. RESULTS: Seventeen (53%) were males and 15 (46%) were females. Mean age of presentation for males was 50 years and for females 40 years. Most common presentation was a lump on proximal part of the limbs. Surgery was the primary treatment modality in 20 (62.5%) patients followed by adjuvant radio-chemotherapy, whereas in 12 (37.5%) only radiotherapy was employed to local site. In this latter group, 6 (18.75%) were subjected to chemotherapy as well, due to metastatic disease. CONCLUSION: The management of soft tissue sarcomas of the extremity carried out in our set up was not satisfactory leading to increased incidence of local recurrence and mortality. Appropriate management requires updated knowledge and its application by health professionals. Preferably these tumours should be managed by a dedicated multi-disciplinary team.

Adult↗
PubMed2005

HL7 ontology and mobile agents for interoperability in heterogeneous medical information systems.

Modern medical information management is a knowledge intensive activity requiring a high degree of interoperability across various health management entities. Ontology-based multi-agent systems provide a framework for interactions in a distributed medical systems environment without the limitations of a more traditional client server approach. In this paper, we describe electronic Medical Agent System (eMAGS) a multi-agent system with an ontology based on an accepted public health message standard, Health Level Seven (HL7), to facilitate the flow of patient information across a whole healthcare organisation.

Computer Communication Networks↗
PubMed2003

A retail and consumer phase model for exposure assessment of Bacillus cereus.

An exposure assessment is conducted for psychrotrophic and mesophilic Bacillus cereus in a cooked chilled vegetable product. A model is constructed that covers the retail and consumer phase of the food pathway, using the output of a similar model on the industrial process as input. Microbial growth is the predominant process in the model. Variability in time and temperature during transport and storage is included in the model and different domestic refrigerator temperature distributions are compared. As an end point, probable levels of B. cereus colony forming units (cfu) in packages of vegetable purée are predicted at the moment the consumer takes the product from its refrigerator, that is prior to a cooking process. The psychrotrophic strain is predicted to end up above a threshold level of 10(5) cfu/g in 0.9% to 6.3% of the vegetable purée packages, depending on domestic refrigerator temperature. Accounting for spoilage this reduces to 0.3% to 2.4%. Even if the purée is stored at 4 degrees C in the domestic refrigerator and use-by-date (UBD) is respected, the threshold level may be passed. For the mesophilic strain the threshold level is rarely passed, but in contrast to the total viable count, the spore load at the end point is predicted to be higher than in the psychrotrophic strain. Our study illustrates how an exposure assessment model, which may be used in quantitative risk assessment, can integrate expertise in modelling, food processing and microbiology over the food pathway, and thus evaluate food safety, identify gaps in knowledge and compare risk management measures. As important gaps in knowledge, the lack of sporulation and germination models and data, validated non-isothermal growth models and a spoilage model useful for risk assessment are identified. Knowledge of the dose-response relationship is limited and does not allow a full risk assessment. It is shown that exposure can be lowered by lowering domestic refrigerator temperatures, and less so much by monitoring and withdrawing contaminated products at the end of industrial processing.

Bacillus cereus↗
PubMed2002

Acute care nurses' perceptions of barriers to using research information in clinical decision-making.

AIM: To examine the barriers that nurses feel prevent them from using research in the decisions they make. BACKGROUND: A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self-reported utilization behaviour; poor response rates and small, nonrandom sampling strategies. DESIGN: Cross-case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%). RESULTS: Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, 'academic' and overly statistical; (2) Nurses who felt confident with research-based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research-based practice, rather than becoming directly involved themselves. CONCLUSIONS: Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy-makers and the research community.

Adult↗
PubMed2003

Cultural childbirth practices and beliefs in Zambia.

BACKGROUND: Zambia, one of the world's poorest countries, also has one of the highest maternal mortality rates in the world. Most pregnant women in Zambia (96%) attend antenatal care, while 53% deliver at home. This may be related to socio-economic and cultural factors, but cultural childbirth practices and beliefs in Zambia have been little documented. AIM: The aim of this study was to explore cultural childbirth practices and beliefs in Zambia as related by women accompanying labouring women to maternity units. These social support women were also interviewed about their views on providing companionship to labouring women. METHODS: Thirty-six women accompanying labouring women to urban and rural maternity units in Zambia were interviewed A thematic guide with closed and open-ended questions was used. EPI INFO, an epidemiological statistical software package, was used to analyse the quantitative data; qualitative data were analysed using content analysis. FINDINGS: Eighteen of the women considered themselves to be mbusas, or traditional birth assistants and the rest said that they followed labouring women to maternity units. Those who considered themselves traditional birth assistants advised childbearing women on appropriate cultural childbirth practices and assisted with deliveries at home. They also advised women on the use of traditional medicine, for example, to widen the birth canal and to precipitate labour. If something went wrong during labour, they relied on traditional beliefs and witchcraft to explain the mishap and expected the woman in labour to confess her purported 'bad' behaviour. Twelve of the women were in favour of providing support to labouring women in maternity units and learning about childbirth care from midwives. CONCLUSION: These social support women, including those who considered themselves as mbusas, lacked understanding of the causes of obstetric complications during childbirth, and had inadequate knowledge of the appropriate management of labour. Culturally-specific knowledge from this study should be used to guide policy-makers and health planners in the future development of safe motherhood initiatives in developing countries. Midwives have a unique opportunity to ensure that care given during childbirth is clinically safe and culturally sensitive.

Adolescent↗
PubMed2006

Application of knowledge-driven spatial modelling approaches and uncertainty management to a study of Rift Valley fever in Africa.

BACKGROUND: There are few studies that have investigated uncertainties surrounding the scientific community's knowledge of the geographical distribution of major animal diseases. This is particularly relevant to Rift Valley fever (RVF), a zoonotic disease causing destructive outbreaks in livestock and man, as the geographical range of the disease is widening to involve previously unaffected regions. In the current study we investigate the application of methods developed in the decision sciences: multiple criteria decision making using weighted linear combination and ordered weighted averages, and Dempster-Shafer theory, implemented within the geographical information system IDRISI, to obtain a greater understanding of uncertainty related to the geographical distribution of RVF. The focus is on presenting alternate methods where extensive field data are not available and traditional, model-based approaches to disease mapping are impossible to conduct. RESULTS: Using a compensatory multiple criteria decision making model based on weighted linear combination, most of sub-Saharan Africa was suitable for endemic circulation of RVF. In contrast, areas where rivers and lakes traversed semi-arid regions, such as those bordering the Sahara, were highly suitable for RVF epidemics and wet, tropical areas of central Africa had low suitability. Using a moderately non-compensatory model based on ordered weighted averages, the areas considered suitable for endemic and epidemic RVF were more restricted. Varying the relative weights of the different factors in the models did not affect suitability estimates to a large degree, but variations in model structure had a large impact on our suitability estimates. Our Dempster-Shafer analysis supported the belief that a range of semi-arid areas were suitable for RVF epidemics and the plausibility that many other areas of the continent were suitable. Areas where high levels of uncertainty were highlighted included the Ethiopian Highlands, southwest Kenya and parts of West Africa. CONCLUSION: We have demonstrated the potential of methods developed in the decision sciences to improve our understanding of uncertainties surrounding the geographical distribution of animal diseases, particularly where information is sparse, and encourage wider application of the decision science methodology in the field of animal health.

Africa South of the Sahara↗
PubMed2002

A shotgun wedding: business decision support meets clinical decision support.

By effectively closing the loop between the data, analytics, processes, and methods supporting business and clinical decision making, a healthcare organization closes the loop between its knowledge generation activities and its actions at the bedside: knowledge guiding actions, actions generating knowledge.

Database Management Systems↗