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PubMed1986

House officers' attitudes towards terminal care.

This study examined the change in doctor's knowledge, attitudes and management of the terminally ill during the pre-registration year. There was a slight improvement in the factual knowledge of most house officers, but some showed a deterioration in their understanding of the problems of the terminally ill. There were marked deficits in knowledge of symptom control. The house officers' own experience of serious illness or bereavement did not alter their measured knowledge or attitudes to the patients.

Attitude of Health Personnel↗
PubMed1984

The Japanese management theory jungle.

Many competing hypotheses have been advanced to account for the apparent effectiveness of Japanese management practices. The present review of some of the leading theories attempts to classify and clarify the state of knowledge of Japanese management. Although each theory may be correct as a partial explanation of Japan's success, no single conceptualization has captured the complexity of Japan's managerial achievement. Further development of integrated, internally consistent models is needed.

Group Processes↗
PubMed1988

What anatomy shall we teach medical and dental students in a primary health care curriculum?

The opinions of 142 doctors on the relevance of anatomy to the diagnosis and management of common clinical problems in their current medical and dental practice were analysed. This was in a bid to determine the relevant anatomy course content for the new primary health care oriented medical and dental curriculum of the College of Medicine, University of Lagos. The respondents gave high scores to the relevance of anatomy knowledge to the management of acute abdomen (mean = 3.5), dislocated shoulder (3.3), Colles' fracture (3.2), palmar space abscess (3.2), obstructed labour (3.2), carcinoma of the breast (3.2), ectopic pregnancy (3.1), flail chest (3.1) and upper respiratory obstruction (3.0). They gave minimal scores to helminthiasis (mean = 1.5) common cold and anaemia (1.6), sickle cell disease (1.7), gastroenteritis (1.8), dental abscess (2.0), hypertension (2.2) and asthma (2.2). A basis for selecting relevant anatomy course content is deduced for an undergraduate curriculum in which the responsibilities and competence of the graduates is known. A nationwide extension of the study, especially amongst general practitioners and first-line doctors in rural areas, would be useful for identification of health problems that require little or no knowledge of anatomy and which can be safely managed by lower cadres of health personnel, traditional practitioners and members of the lay community.

Anatomy↗
PubMed1997

The future is no longer what it used to be. Managing health telematics projects.

Future used to mean global progress and convergence of science and technology and society. Today, we observe the decoupling of the two poles of knowledge formation and application (i.e. science and technology, and culture and society, respectively) and also fierce confrontation between them. The key issue to reconcile the two poles is to re-invent the link between them. The new future lies in the development of mental and technical capacities for change and the creation of new forms of solidarity. We propose, as a general attitude, to reactivate and develop the four principles of efficacy-effectiveness-efficiency, hospitality, responsibility and pertinence. Translated into driving forces for the development of health care telematic projects, they amount to the acceptance of and capacity for enterprise-wide solutions, hospitality and capacity to acquire outside knowledge, self-managed, multi-functional team work spirit, reengineering mentality to achieve pertinent technico-cultural solutions.

Attitude↗
PubMed2005

User requirements rating and knowledge-level of general practitioners at the start of CholGate - a lipid management decision support project.

In the CholGate project we performed a preliminary study evaluating user requirements and knowledge level on lipid management in 40 primary care practices in The Netherlands. Practitioners rated speed, usability and completeness as important. We hope to show that the knowledge level of physicians regarding lipid management can be passively increased from its current levels by an integrated decision support system.

Attitude to Computers↗
PubMed1999

Shoulder dystocia: room for improvement?

A questionnaire was completed by 166 midwives and obstetric junior doctors to assess their knowledge of the management of shoulder dystocia and to establish whether mandatory teaching and updating is required. Ninety-six participants (58%) claimed they were confident in the management of shoulder dystocia. However, only six (4%) respondents gained full marks on the scoring system devised to assess their knowledge. Furthermore 36 (22%) of those surveyed suggested rotation of the shoulders to the anterior-posterior position to alleviate the dystocia and 32 (19%) proposed pulling the head hard. Although there are limitations in assessing competence by the use of a questionnaire, the results of this survey suggest that there is considerable room for improvement. We suggest that a shoulder dystocia drill is introduced to all labour wards in the United Kingdom so that birth attendants can develop and memorize a sequence of procedures to use when confronted with this life-threatening emergency.

Journal Article↗
PubMed1998

Management of pain in terminally ill patients: physician reports of knowledge, attitudes, and behavior.

Physician knowledge, attitudes, and reported prescribing behaviors toward pain management in terminally ill patients was surveyed among primary care physicians (PCPs) and oncologists in a southern urban county. Response rates were 64% for PCPs and 100% for oncologists. The effects of knowledge and attitudes on reported behavior were analyzed after accounting for physician demographics, training, and experiences. Oncologists' knowledge and attitudes were close to ideal and behaviors less so. PCPs' knowledge was worse than oncologists, and attitudes and behaviors were even less optimal. Reported behaviors among PCPs correlated somewhat with attitudes, less with background factors, and rarely with knowledge. In multivariate analysis, demographic and experimental factors explained more of selected behaviors than attitudes or knowledge. However, all variables combined left the majority of variation in behaviors unexplained. Physician continuing education will not effect significant behavioral changes in the care of terminally ill patients solely by the traditional approach of attempting to modify knowledge and attitudes.

Health Knowledge, Attitudes, Practice↗
PubMed2006

Management of BRCA1/2 associated breast cancer: a systematic qualitative review of the state of knowledge in 2006.

INTRODUCTION: The optimal clinical management of breast cancer (BC) arising in BRCA1/2 mutations carriers is a difficult issue complicated by the risk of subsequent malignancies and by the potential differences in response to local and systemic therapies. AIM: Systematically review the difference in outcome after breast conservation therapy (BCT) and uni-or bilateral mastectomy in BRCA1/2 related BC. MATERIAL AND METHODS: We selected 20 studies, for which we evaluated the methodology, the characteristics of the populations, biases, confounding risk factors and outcomes. RESULTS: All studies are retrospective, entailed by numerous biases. They varied with respect to patients' number, selection, and confounding factors. Hereditary BC patients carried an increased risk of ipsilateral recurrence in 5/17 studies, a worse survival in 4/14, an increased risk of contralateral BC in 14/16. CONCLUSION: Except for contralateral risk, the presence of a BRCA mutation does not seem to offer additional prognostic information. Large prospective trials, stratified for risk reduction strategies are warranted.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2007

[The epidemiological approach to health inequalities at the local level].

What are the advantages and limitations of epidemiology for decreasing health inequalities at the local level? To answer this question, the current article discusses the role of epidemiology. The hypothesis is that epidemiology produces useful knowledge for local management of interventions aimed at reducing health inequalities, expressed in spaces built by human communities through social and historical processes. Local production of epidemiological knowledge should support action by social actors in specific situations and contexts, thus renewing the appreciation for ecological designs and georeference studies. Such knowledge output and application are also an organizational phenomenon. Organizations can be seen as "conversational networks". In conclusion, strategic and communicative actions by health workers should provide the central thrust for defining new health care and management models committed to decreasing health inequalities, with epidemiology playing a key role.

Epidemiologic Research Design↗
PubMed1999

Successful teaching of pediatric fluid management using computer methods.

OBJECTIVES: To identify and measure differences in knowledge of pediatric fluid management procedures between students taught by computer tutorial and others taught by lecture or seminar. DESIGN: Cohort analytic study. SETTING: Two community-based medical school pediatric teaching services. PARTICIPANTS: Eighty-nine third-year medical students with no prior pediatric fluid management experience. INTERVENTIONS: Forty-eight students at one community campus completed a microcomputer-based tutorial program that replaced all teaching sessions in pediatric fluid management. Forty-one students from a similar community campus were taught identical content by a pediatric critical care specialist using a seminar, reading material, and handouts. MAIN OUTCOME MEASURES: Scores on 2 free-answer problems on treatment of a dehydrated child, which were graded by a single evaluator blinded to the teaching method used, and scores on a 20-item multiple-choice examination. RESULTS: The computer instruction group achieved significantly higher test scores than the seminar group for both the multiple-choice examination (81.1% vs 62.2%; P<.001) and the free-answer test (85.4% vs. 61.0%; P<.001). CONCLUSIONS: The computer tutorial in fluid therapy has been an effective means of meeting the defined objectives of the pediatric clerkship. Compared with traditional methods, students taught using the computer achieved significantly higher scores on tests of both factual knowledge and practical problem solving.

Achievement↗
PubMed2002

Gaps in asthma care of the oldest adults.

OBJECTIVES: To assess the adequacy of asthma care reported by a group of older adults who were subsequently hospitalized for their asthma. DESIGN: Prospective cohort study. SETTING: Fifteen managed care organizations in the United States. PARTICIPANTS: Adults with asthma, enrolled in managed care. MEASUREMENTS: Patient survey of demographics, asthma symptoms, health status, comorbid conditions, asthma treatment, asthma knowledge, and asthma self-management at baseline and 1 year later. RESULTS: Of 254 older adults, 38 (15.0%) reported being hospitalized for asthma at 1-year follow-up. Of these, 22.9% owned a peak flow meter (PFM). Of those with allergies, only about half (56.0%) had been told how to avoid allergens and had been referred for formal allergy testing. Adrenergic drug use was high in some patients. Nearly all (94.6%) used beta-agonist metered-dose inhalers (MDIs); 60.0% reported theophylline; 17.1% reported beta-agonist MDI overuse (>8 puffs per day); 10.5% reported beta-agonist MDI over-use and theophylline; and 13.2% reported both beta-agonist MDI over-use and oral beta-agonist use. Only 18.4% of respondents rated their overall asthma attack knowledge as excellent. Compared with nonhospitalized older adults, the hospitalized group reported care that was more consistent with guidelines, but also higher rates of potentially toxic combinations of adrenergic drugs. Compared with younger hospitalized adults, older hospitalized adults had clear deficiencies, including lower use of PFMs (55.3% vs 22.9%) and worse asthma self-management knowledge. CONCLUSIONS: There are many opportunities to improve both the pharmacologic and non-pharmacologic care of older adults with asthma. Overuse of and potentially toxic combinations of inhaled and oral sympathomimetics should probably be avoided. Older asthmatics may also benefit from increased specialty referral, PFM use, allergy testing, and asthma teaching.

Adult↗
PubMedDate not supplied

Impulse control disorders: clinical characteristics and pharmacological management.

This article reviews the current knowledge of the clinical characteristics and pharmacological management of pathological gambling, kleptomania, and compulsive buying. Specifically, the article summarizes the phenomenology and associated psychopathology of these disorders and presents study results of the various pharmacological agents used to treat these disorders--serotonin reuptake inhibitors, opioid antagonists, mood stabilizers, and atypical antipsychotics.

Anxiety↗
PubMed2006

Evaluation and development of potentially better practices to improve pain management of neonates.

OBJECTIVE: Despite increased knowledge, improved options, and regulatory mandates, pain management of neonates remains inadequate, promoted by the ineffective translation of research data into clinical practice. The Neonatal Intensive Care Quality Improvement Collaborative 2002 was created to provide participating NICUs the tools necessary to translate research, related to prevention and treatment of neonatal pain, into practice. The objective for this study was to use proven quality improvement methods to develop a process to improve neonatal pain management collaboratively. METHODS: Twelve members of the Neonatal Intensive Care Quality Improvement Collaborative 2002 formed an exploratory group to improve neonatal pain management. The exploratory group established group and site-specific goals and outcome measures for this project. Group members crafted a list of potentially better practices on the basis of the available literature, encouraged implementation of the potentially better practices at individual sites, developed a database for sharing information, and measured baseline outcomes. RESULTS: The goal "improve the assessment and management of infants experiencing pain in the NICU" was established. In addition, each site within the group identified local goals for improvement in neonatal pain management. Data from 7 categories of neonates (N = 277) were collected within 48 hours of NICU admission to establish baseline data for clinical practices. Ten potentially better practices were developed for prioritized pain conditions, and 61 potentially better practices were newly implemented at the 12 participating sites. Various methods were used for pain assessment at the participating centers. At baseline, heel sticks were used more frequently than peripheral intravenous insertions or venipunctures, with substantial variability in the number of avoidable procedures between centers. Pain was assessed in only 17% of procedures, and analgesic interventions were performed in 19% of the procedures at baseline. CONCLUSIONS: Collaborative use of quality improvement methods resulted in the creation of self-directed, efficient, and effective processes to improve neonatal pain management. Group establishment of potentially better practices, collective and site-specific goals, and extensive baseline data resulted in accelerated implementation of clinical practices that would not likely occur outside a collaborative setting.

Analgesics, Opioid↗
PubMed2003

Perceptions of first-line nurse managers. What competencies are needed to fulfill this role?

First-line nurse managers have experienced an unprecedented shift in their roles and responsibilities as a result of health care reform. Consequently, there is a need to identify competencies required of first-line nurse managers in a changing health care environment. A descriptive, exploratory study of nurse managers in a western Canadian province was conducted using a combined quantitative and qualitative approach. The research instrument was comprised of three parts: a questionnaire that grouped five categories of competencies (technical, human, conceptual, leadership, and financial management); demographic data; and a critical incident technique that allowed the subjects to elaborate on a specific incident in their practice when they "performed at their best" as a manager. Findings revealed that nurse managers' need for knowledge and understanding was greater than their ability to implement managerial competencies. The exploration of competencies of first-line nurse managers has implications for curriculum development in leadership and management courses in nursing programs, as well as managerial development in health care agencies. Results will assist educators and administrators in addressing the changing needs of current and future nurse managers.

Adult↗
PubMed2000

Impact of a camp experience on phenylalanine levels, knowledge, attitudes, and health beliefs relevant to nutrition management of phenylketonuria in adolescent girls.

OBJECTIVE: To evaluate the effectiveness of an education intervention in a summer camp setting on knowledge, attitudes, and health beliefs regarding metabolic control of phenylketonuria and dietary compliance. DESIGN: An observational study of a weeklong metabolic camp for adolescent girls with phenylketonuria (PKU) who were followed up over the course of 1 year. Observations also were made in 3 subsequent years of camp. INTERVENTION: The camp experience consisted of diet and disease education, sessions on reproductive development, and recreation. Group discussions on attitudes and perceptions about PKU related to dietary compliance were held with nutritionists and a pediatric psychologist. OUTCOME MEASURES: Biochemical and psychological data were collected on the first and last days of the camp to assess short-term effects of the intervention, then at quarterly intervals during the year to determine the long-term impact of the camp. Precamp and Postcamp plasma amino acid data for the subsequent 3 years were also collected. SUBJECTS/SETTING: Analyses were based on 13 adolescent girls with PKU in the first year of a camp at Emory University in Atlanta, Ga, and compared with data from 11 additional campers enrolled the second year, 8 in the third year, and 7 in the fourth year. Mean age +/- standard deviation of first-year campers was 13 +/- 2 years, mean IQ +/- standard deviation was 98 +/- 16, and 9 of 13 girls had menstruated. STATISTICAL ANALYSES PERFORMED: Short-term effects of the intervention were computed by comparing mean levels of response from the baseline period to those from the last day of camp using t tests for dependent samples. Repeated-measures analysis of variance was used to assess the long-term effects of the camp experience over the course of a year at regular quarterly intervals. RESULTS: Short-term effects of the education intervention were significant reductions in dietary phenylalanine intake, plasma phenylalanine levels, and perceived isolation. However, these effects progressively returned to baseline levels over the course of a year. The significant short- and long-term effects of increased knowledge of diet and disease persisted throughout the study period. APPLICATIONS/CONCLUSIONS: Short-term effects of the education intervention resulted in improved metabolic control associated with improved attitudes, increased knowledge of diet and disease, increased perceived support, and decreased barriers to dietary compliance in a camp setting.

Adolescent↗
PubMed2005

Knowledge of risk factors and guidelines for the management of asthma. The educational role of the nurse.

PURPOSE: The aim of the study was to determine the level of knowledge concerning risk factors for the development of asthma and worsening of the course of the disease among patients, as well as achieving a better understanding of the educational role of the nurse in improving the quality of life of patients suffering from the disease. MATERIALS AND METHODS: The study was a questionnaire study involving 100 patients suffering from asthma. 59 of them were diagnosed as having an allergic and 41 a nonallergic asthma. In the main they were patients suffering from moderate to severe asthma, who had attended the outpatient allergology clinic for many years. RESULTS: Analysis of the results obtained demonstrated the significant effects of asthma for the lives and health of the patients questioned. This was reflected in the high number of people registered as unable to work and receiving invalidity benefits, and influenced the activity of the majority patients in various spheres of life. A number of respondents demonstrated poor knowledge of the risk factors for asthma and ways of eliminating the illness. The majority of patients had a good knowledge of the names, doses and ways in which they should take their prescribed medication as well as showing an understanding of the principles of taking additional medicines as necessary. Their knowledge of the principles of anti-inflammatory treatment, which is a basic factor in the treatment of patients with asthma was, however very poor. CONCLUSIONS: Among patients suffering from asthma there is a great need for health information. The majority of respondents expressed a willingness to take part in training sessions to be run by nursing staff. The focus of these educational sessions should be on improving the patients' knowledge about asthma as a chronic inflammatory disease, helping to eliminate and limit risk factors for the disease, treatment principles and avoiding the side-effects of prescribed medication.

Adult↗
PubMed1999

A Web link management tool for optimizing utilization of distributed knowledge in health care applications.

The number of health-related Web sites on the Internet is increasing. Incorporating these sites into clinical decision support systems and other health care applications can significantly enhance the educational and instructional value of such systems. While search engines exist for finding sites and criteria are available for assessing site quality, few tools are available for managing Web-based health care information. Management of Web-based information is particularly challenging because the information is continually changing and new resources are continually being added. In this paper, we describe the development and use of a Web-link manager for health care applications. This system retains search strategies for repeated use, catalogues search results in a search results database, accommodates tracking of site review and use status, and provides periodic checking of link integrity for sites that are used in local applications. The Web-link manager is currently in use to manage the links used in a clinical decision support system that presents clinical practice guidelines interactively to clinicians at the point of care.

Computer Communication Networks↗