Learning to manage leprosy after 2005: preserving critical knowledge and exploiting new technology.
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Clinical Competence↗
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Results for “Knowledge Management”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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[Management of dental needs in Quebec. Knowledge acquired].
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Delivery of Health Care↗
The role of "knowledge at hand" in the practical management of institutionalized "idiots".
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Adolescent↗
Modelling domain-knowledge: a step toward intelligent data management.
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Database Management Systems↗
Do quality improvement strategies for Medicaid enrollees differ in Medicaid-dominant versus commercial managed care organizations?
OBJECTIVE: To examine whether it matters, in terms of quality improvement initiatives and access to commercial networks, whether states contract with Medicaid-dominant or commercial managed care plans. STUDY DESIGN: A 2001 telephone survey of Medicaid managed care plans in 11 states that together account for about half of the national Medicaid managed care enrollment. METHODS: The survey was developed in consultation with a panel of individuals knowledgeable about Medicaid managed care. Information on plan characteristics and network design was obtained from the plan CEO or person most knowledgeable about the topics. The rest of the data were obtained from the person the CEO named as most knowledgeable about quality improvement initiatives. RESULTS: Surveyed plans reported an extensive array of quality improvement initiatives. Programs are in many ways similar across Medicaid-dominant and commercial plans. Medicaid-dominant plans tend to specialize more in conditions of greatest priority to Medicaid beneficiaries. Commercial plans tend to develop programs for accreditation by the National Committee for Quality Assurance, and to limit measurement specific to the Medicaid population. They draw on their commercial networks to support the Medicaid product line, but how much they expand provider access is not clear. Both types of programs face barriers that limit the effectiveness of the plans' initiatives. CONCLUSION: This study shows extensive development of quality initiatives in Medicaid managed care plans, with limited differences across Medicaid-dominant and commercial plans.
Accreditation↗
Improving medical students' knowledge of systems-based practice.
Systems-based practice is an important aspect of medical education. This study evaluates the effectiveness of an eight-hour intervention on medical students' knowledge of the principles of managed care. A pre-test on basic managed care principles was administered to freshman medical students at Mercer University. After an eight- hour managed care curriculum was presented to these students, a post-test was administered. The pre-test and post-test scores on the material increased a mean score of 9.7 points (p < 0.001). Our conclusion is that providing as little as eight-hours of instruction on managed care topics can significantly improve first-year medical students' knowledge and understanding of systems-based practice.
Adult↗
Problems in the management of medical waste in Thailand.
OBJECTIVES: To identify problems in the management of medical waste in Thailand for future development. MATERIAL AND METHOD: The study was done in 39 hospitals during June and July 2002 by interviewing medical personnel on knowledge and attitude in management of medical waste, observation of practice and checking the amount of medical waste in waste bags. Certain laboratory investigations were done in dustmen. RESULTS: The amount of medical waste was 0.41 kilogram per bed per day. Problems identified were inadequate knowledge in management, improper practices, high incidence of sharp injury at work. Laboratory tests in dustmen showed evidence of pulmonary tuberculosis in 3.4%, parasites and intestinal pathogens in stools 5.1% and positive for HBsAg in 8.5%. CONCLUSION: Improper management of medical waste was present in all hospitals. Risks of exposure and incidence of infection related to the management were at concerned levels. Education and practice guidelines are needed.
Attitude of Health Personnel↗
Effects of participation in the Executive Leadership in Academic Medicine (ELAM) program on women faculty's perceived leadership capabilities.
PURPOSE: This study measured the impact of participation by women academics in the Executive Leadership in Academic Medicine (ELAM) program as part of a robust evaluation agenda. METHOD: The design is a classic pre/post, within-group, self-report study. The survey elicits self-perception about leadership in ten constructs: knowledge of leadership, management, and organizational theory; environmental scanning; financial management; communication; networking and coalition building; conflict management; general leadership; assessment of strengths and weaknesses; acceptance of leadership demands; and career advancement sophistication. The post surveys inquire additionally about perceived program usefulness. Data were collected from 79 participants (1997-98, 1998-99, and 2000-01 classes). Response rates were nearly 100% (pre) and 69% to 76% (post). RESULTS: Statistically significant increases (p <.01) in perceived leadership capabilities were identified across all ten leadership constructs. Gains were large in knowledge of leadership and organizational theory, environmental scanning, financial management, and general leadership. Gains in career building knowledge were large to moderate. More modest were gains in communication, networking, and conflict management. There were significant correlations between each leadership construct and perceived usefulness of the program. CONCLUSIONS: Significant improvements were reported on all leadership constructs, even when participants viewed themselves as already skilled. While it cannot be concluded that participation in ELAM directly and solely caused all improvements, it seems unlikely that midcareer women faculty would improve on all ten constructs in 11 months after program completion by natural maturation alone. Future research will investigate whether the changes are due to ELAM or other factors, and assess whether participants show more rapid advancement into leadership than comparable women not participating in ELAM.
Academic Medical Centers↗
Conservative management of clinically localized prostate cancer.
The purpose of this paper is to review and summarize the current knowledge on conservative management of localized prostate cancer. Deferring treatment for low-grade, clinically localized prostate cancer is an acceptable treatment option for patients with a life expectancy of 10-15 y or less. The outcome of available studies on deferred treatment in selected series cannot be compared with the outcome in register studies where the patients have been managed with noncurative intent, nor can it be directly compared with the outcome of selected series on other treatments. The outcome of different treatments for localized prostate cancer can only be compared in randomized studies.
Journal Article↗
Hospice and hospital oncology unit nurses: a comparative survey of knowledge and attitudes about cancer pain.
PURPOSE/OBJECTIVES: To identify knowledge strengths and weaknesses and misperceptions about cancer pain management between two groups of registered nurses in different settings. DESIGN: Descriptive, comparative survey. SETTING: 11 community-based hospices and 7 inpatient hospital oncology units within an urban county. SAMPLE: A convenience sample of 30 hospice and 34 hospital oncology unit nurses. Sample criteria included registered nurses who had worked for at least the preceding six months exclusively in either a hospice or hospital oncology unit. METHODS: The North Carolina Cancer Pain Initiative survey and a demographic survey were distributed to the work mailboxes of nurses in the participating facilities who met the inclusion criteria. MAIN RESEARCH VARIABLES: Hospice and hospital oncology unit nurses' knowledge and attitudes about basic pharmacologic cancer pain management. FINDINGS: Hospice nurses scored significantly higher than hospital oncology unit nurses regarding overall pain management knowledge, opioids, scheduling, and liberalness. Hospice nurses also reported more pain education and a higher frequency of pain guideline review requirements than hospital oncology unit nurses. CONCLUSIONS: The most prevalent knowledge deficits concerned opioids. Practice setting and pain education may influence knowledge, as well as attitudes, about pain. IMPLICATIONS FOR NURSING PRACTICE: Further research is needed regarding nurses' pain management behavior and outcomes of pain management education in various settings.
Adult↗
Breastfeeding attitudes and knowledge of pediatricians-in-training.
A 15-minute questionnaire was administered to the pediatric housestaff in an academic training program to assess their breastfeeding attitudes, knowledge, and confidence to manage breastfeeding problems. Questionnaires were self-administered and anonymous. The participation rate was 53% (n = 29). Overall, the study participants indicated a supportive attitude toward breastfeeding (2.6 on a 6-point scale where 1 = most supportive and 6 = least supportive). Women agreed more strongly than men that pediatricians should strongly encourage mothers to breastfeed and disagreed more strongly than men that breastfeeding is instinctive. Although supportive of breastfeeding, the housestaff in this study were not knowledgeable regarding breastfeeding management, answering only 53% of the questions correctly. Their self-confidence in this area was appropriately low, with only 14% of the total sample describing themselves as "confident" or "very confident" to manage common breastfeeding problems. Pediatricians-in-training have extremely limited knowledge of breastfeeding management. To be truly supportive of breastfeeding, pediatricians should receive didactic and clinical training in breastfeeding management.
Attitude of Health Personnel↗
Asthma self-management skills and the use of asthma education during pregnancy.
During pregnancy, patients with asthma are at risk of poor outcomes, particularly when asthma is poorly controlled. The aim of this study was to determine the level of asthma self-management skills and knowledge among pregnant subjects and describe the implementation of an asthma education programme delivered in an antenatal clinic setting. Pregnant subjects with asthma were assessed by an asthma educator at 20 (n = 211) and 33 weeks gestation (n = 149). Lung function, symptoms, medication use, adherence, knowledge and inhaler technique were assessed. They were asked whether they had a written asthma action plan, or performed peak flow monitoring. Asthma was classified as mild, moderate or severe. At the first visit with the asthma educator, 40% of females reported nonadherence to inhaled corticosteroids, inhaler technique was assessed as inadequate in 16% and 42% had inadequate medication knowledge. Peak flow monitoring was performed by 3% and 15% had a written action plan. There were significant improvements in all aspects of asthma self-management following education. In females with severe asthma, night symptoms and reliever medication use significantly decreased after education. In conclusion, during pregnancy, patients with asthma have poor asthma knowledge and skills, and may benefit from self-management education as part of their obstetric care.
Adrenal Cortex Hormones↗
Managing recurrent bacterial vaginosis.
Bacterial vaginosis (BV) is the most frequently found condition of the female genital tract. It increases a woman's risk of acquiring HIV, is associated with increased complications in pregnancy, and may be involved in the pathogenesis of pelvic inflammatory disease. Yet there are many unanswered questions about its aetiology, making management of recurrent infection difficult and often idiosyncratic. This paper discusses the current knowledge and possible management of recurrent BV.
Administration, Intravaginal↗
Competition in health care: strategies from other industries.
Health care managers can learn to adjust to competition by observing companies in other deregulated industries. Six basic strategies will separate the winners from the losers: Increase market share. This strategy requires not only increasing the share of current markets but also introducing new products and services into new markets. Scrutinize operations. Managers must be knowledgeable about strategic planning, adept at product line analysis, and skillful in using management information systems. Prune where necessary. Operations must be periodically reviewed to assess whether programs, products, and services continue to be profitable. Increase productivity. Productivity in this labor-intensive industry is essential. Wages may have to be reduced and staffing levels changed in the future to permit better control of labor costs. Increasing the volume of service, investing in nonclinical technology, and encouraging employee ideas also should be considered in seeking higher productivity. Strengthen the balance sheet. Hospitals should avoid incurring both long- and short-term debt, and they should attempt to accelerate repayment of long-term debt. Not-for-profit hospitals should investigate joint ventures, which spread the financial risk among investors, as means to raise capital to expand their operations. Increase cash. Prudent organizations will establish reserve funds, adopt fund-raising programs, and initiate improved cash collection systems. Health care executives also should reflect on how deregulation may affect their employees, the poor, and access to sophisticated medical procedures. The successful health care organization eventually will position itself in line not only with its markets but also with its mission and values.
Economic Competition↗
[Informed consent on pain management].
Informed consent is an essential concern to provide medical services centered on patient's needs. Its significant role is not to avoid legal responsibility but to respect patient's individuality. It emphasizes the necessities for sharing medical information including its uncertainty, listening carefully to a patient about his/her questions and anxieties and being worried with him/her in regard to the best ways coping with sufferings. In this article we describe important aspects concerning informed consent on pain management at clinical situations. It is necessary for physicians not only to have knowledge for pain management but also to get technique for appropriate explanation about analgesics.
Analgesics↗
The presentation and management of victims of chemical and biological agents: a survey of knowledge of UK clinicians.
A survey was conducted among acute specialty clinicians in four centres in the UK to determine their levels of knowledge of the presentation and subsequent management of victims following deliberate release of chemical or biological agents. This revealed significant gaps in knowledge and training. Of the 102 respondents, more than half did not understand the decontamination process. More than a third were unsure of the presenting features of nerve agent release. Only a minority knew the recommended treatment and only one in five have participated in relevant exercises.
Bioterrorism↗
Heterogeneity of physician agreement with recommended therapeutic guidelines for the management of HIV-associated disease.
The aims of this study were to assess the degree of heterogeneity in the knowledge of therapeutic management of HIV infection among HIV-experienced physicians in British Columbia, Canada, and to identify associations between physician characteristics and their agreement with contemporary therapeutic guidelines. A self-administered anonymous questionnaire was mailed to 6500 physician members of the British Columbia Medical Association. The questionnaire provided information about demographic and personal characteristics, including sex, age, medical specialization and practice location; level of experience in treating HIV-infected patients; use of HIV testing procedures; use of preventative vaccinations and tests; and preferred approaches to antiretroviral therapy and the prophylaxis and acute treatment of opportunistic infections. We compared physicians' patterns of knowledge with contemporary recommendations. Logistic regression identified associations between physician characteristics and their agreement with contemporary guidelines. A total of 463 HIV-experienced physicians (a high proportion of the HIV-experienced physicians in British Columbia, Canada) responded to the questionnaire. The agreement with contemporary guidelines about HIV testing and preventative vaccinations and tests among responders ranged from 27% to 71%. For antiretroviral therapy, agreement with the guidelines ranged from 12% to 35%. For the prophylaxis and treatment of opportunistic infections, agreement with the guidelines ranged from 11% to 89% (prophylaxis) and from 46% to 91% (treatment). Regression analysis revealed that physicians actively involved in the care of HIV-infected patients were more likely to agree with the guidelines in all areas of patient care. General practitioners were more likely to agree with the guidelines regarding preventative therapies, and male general practitioners under 45 years old were more likely to agree with the guidelines on antiretroviral therapy. Our data confirm that there is substantial heterogeneity in the management of HIV-associated disease, including some deviations from contemporary guidelines. Concordance with contemporary guidelines increased with the physician's level of HIV-related experience. Our results support the idea that adherence to state-of-the-art practices may be responsible, at least in part, for the recently described association between physician experience and improved survival of HIV-infected individuals.
AIDS-Related Opportunistic Infections↗
Trauma base knowledge and the effect of the trauma evaluation and management program among senior medical students in seven countries.
BACKGROUND: We compared base trauma knowledge and the impact of the Trauma Evaluation and Management (TEAM) program among senior medical students in seven countries. METHODS: We compared pre- and post-TEAM multiple choice question scores of fourth-year students in Jamaica (n = 32), Trinidad (n = 32), Costa Rica (n = 64), Australia (n = 35), United Arab Emirates (n = 68), Toronto (n = 29) and Pennsylvania (n = 34). Means and degree of improvement were compared by analysis of variance (p < 0.05 for statistical significance). Percentage pass (based on 70% or 60% pass mark), student's perception of instruction level, and grading of TEAM (based on the percentage of students grading 1-5 for each category) were assessed by chi2 analysis. [table: see text]. RESULTS: Only 31.4% of students achieved the borderline pass mark of 60%, and 5.4% achieved a clear pass mark of 70%. The performance before and after TEAM was quite variable among medical schools. A grade of > or = 4 was assigned by 74% to 100% for objectives, knowledge improvement, satisfaction, and recommending TEAM for the curriculum. TEAM was rated "just right" by 70.3% to 92.7%, "too simple" by 1.6% to 21.6%, and "too advanced" by 3.3% to 13.5% of students. CONCLUSION: Base trauma knowledge in these students, though variable, was generally very low and improved with TEAM. Our data suggest a need for greater undergraduate emphasis in trauma education.
Analysis of Variance↗