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PubMed1995

Case management quality assessment in rural areas of Papua New Guinea.

A study was carried out to assess the quality of case management of malaria, malnutrition, diarrhoea and acute respiratory tract infections in children in rural primary health services in Papua New Guinea. In particular, the study focused on the knowledge and skills of different categories of rural health workers (HW) in history taking, examination, diagnosis, treatment and patient education. Quality criteria were defined and health centre (HCW) and aidpost workers' (APWs) knowledge and practices were assessed. Primary health workers' (PHW) knowledge of case management was weak, but in all cases better than their actual practice. History taking and examination practices were rudimentary. HWs tended not to make or record diagnoses. Treatment knowledge was often incorrect, with inappropriate or insufficient drugs prescribed, being worst at aidpost level. These findings raise serious questions about the effectiveness of providing health services through small, isolated health units. Far greater attention must now be directed to focus on the institutionalization of problem-based training, continuous supportive supervision and maintenance of clinical skills and provision of essential drugs, supplies and equipment to ensure that rural health workers (RHW) can provide sound care.

Child↗

PubMed1995

A preliminary study of factors that influence children's sense of competence to manage their asthma.

This study identifies several factors that appear to influence children's sense of competence to manage their asthma. The study examined a consecutive series of 62 children and adolescents who had been admitted to hospital for management of their asthma. Self-reports rating their sense of competence to manage their asthma were obtained from all the children. In addition, reports were obtained of the children's motivation to achieve healthy functioning, their sense of control over their health, and parental knowledge of childhood asthma management. Results from the study suggest that older children, children who are more intrinsically motivated to achieve healthy functioning, and children with parents who are knowledgeable about asthma management feel more competent to manage their asthma. It is suggested that the effectiveness of asthma self-management programs for children may be improved if there is a better understanding of the psychological factors that influence children's sense of competence to manage their asthma.

Adolescent↗

PubMed1985

Continuing education in management: a survey of practitioners' perceived needs, knowledge and interest.

A survey of 519 Georgia pharmacists' was conducted to determine pharmacists perceived need for knowledge, their perceived knowledge, and their interest in continuing education programs in a wide range of managerial areas. The 269 usable responses indicated that pharmacists felt they needed to know at least a moderate amount about all topics listed. They perceived a greater need to know about basic management than about marketing or finance. Respondents felt they knew less than they needed to about most topics. However, they were not overly interested in attending continuing education programs. As a group, they reported moderate interest in programs in management and less interest in programs in marketing and finance. Managers, directors and owners were more interested in continuing education programs in all areas than pharmacists in other positions.

Data Collection↗

PubMed2000

How effective is syndromic management of STDs?: A review of current studies.

BACKGROUND: Studies of the accuracy of syndromic management have demonstrated widely varying results depending upon gender, location of infection, risk group, organisms, among other factors. GOAL: To review current knowledge about syndromic management of sexually transmitted diseases (STDs) and to make recommendations about the strengths and weaknesses of different syndromic management algorithms. STUDY DESIGN: The authors identified articles and abstracts about the syndromic management of STDs. Evaluation of the effectiveness of algorithms for urethral discharge, genital ulcer disease, and vaginal discharge was based primarily on published sensitivity and specificity data. RESULTS: Overall, algorithms for the diagnosis and treatment of urethral discharge and genital ulcer disease in men had high sensitivities or cure rates (urethral discharge, 87-99%; genital ulcer disease, 68-98%). The sensitivities for the algorithms for vaginal discharge ranged from 73% to 93% among women presenting with symptoms of vaginal discharge, and from 29% to 86% among women not presenting with symptoms. Vaginal discharge was not found to be an effective indicator of cervical infection and, therefore, is not an independently effective screening tool to detect women with cervical infection, especially in low-risk or asymptomatic populations. Incorporating risk scores can improve the accuracy of algorithms to detect cervical infection. CONCLUSIONS: Algorithms for urethral discharge and genital ulcer disease can be effective in STDs. The current algorithms for vaginal discharge are not highly effective in detecting gonorrhea and chlamydia in women; risk scores can improve their efficacy, but must be tailored to reflect community risks. Without attention to the qualitative aspects of STD syndromic management, these methods will likely have even less accuracy than the studies reviewed above. There remains an urgent need for the development of an affordable, rapid, and effective diagnostic technique that will improve STD detection in resource-poor settings.

Adolescent↗

PubMed2005

Training pain resource nurses: changes in their knowledge and attitudes.

PURPOSE/OBJECTIVES: To determine the changes in knowledge and attitudes of pain resource nurses (PRNs) as a result of an intensive pain management course. DESIGN: Pre- and post-test design. SETTING: A Veterans Administration hospital in the southeastern United States. SAMPLE: 18 RNs from multiple units where care is provided for veterans with cancer. METHODS: The PRNs were tested before and after a 32-hour intensive pain management course. MAIN RESEARCH VARIABLES: Knowledge about pain management, attitudes toward pain management, and attitudes toward patients in pain. FINDINGS: Significant improvements were found in pain knowledge and attitudes toward patients in pain. Improvements in attitudes toward pain management approached significance. CONCLUSIONS: The improvements in scores not only supported the effectiveness of the course but also provided additional evidence of the validity of the assessment instruments. IMPLICATIONS FOR NURSING: Courses such as this should be offered in other settings to encourage practicing nurses to provide better care to patients in pain and to serve as role models for their peers.

Adult↗

PubMed1992

Pharmacological management of cancer pain. A guide for the health care professional.

Cancer pain continues to remain a significant problem for oncology patients treated in both the university and the community setting. Nursing knowledge regarding pain management has advanced significantly in recent years. This article provides health care professionals with current factual information on cancer pain management. The information focuses on the emotional aspects of cancer pain, specific principles of analgesic management, opioid equianalgesics, multiple approaches to opioid administration, management of unwanted side effects, and a description of inappropriate drug therapies.

Analgesia, Patient-Controlled↗

PubMedDate not supplied

Initiation and management of insulin pump therapy.

Insulin infusion pump therapy is a treatment option that facilitates achieving improved blood glucose control and lifestyle flexibility. These advantages are derived from the physiologic mode of insulin delivery and the pharmacologic advantages of using rapid-acting insulin. Patients who are sufficiently motivated and capable can learn to use the pump so that insulin adjustments can be made to compensate for changing circumstances. Although there are potential risks and side effects of using an insulin pump, these can be avoided through proper education and surveillance. The health care provider should be knowledgeable about the management of infusion pump therapy, including assessment of patient capabilities and practices, education, insulin adjustment, and techniques of use. The knowledge assists the health care provider in counseling patients to consider pump therapy and to manage patients already employing this mode of insulin delivery.

Blood Glucose Self-Monitoring↗

PubMed2003

Radiation risk and human space exploration.

Radiation protection is essential to enable humans to live and work safely in space. Predictions about the nature and magnitude of the risks posed by space radiation are subject to very large uncertainties. Prudent use of worst-case scenarios may impose unacceptable constraints on shielding mass for spacecraft or habitats, tours of duty of crews on Space Station, and on the radius and duration of sorties on planetary surfaces. The NASA Space Radiation Health Program has been devised to develop the knowledge required to accurately predict and to efficiently manage radiation risk. The knowledge will be acquired by means of a peer-reviewed, largely ground-based and investigator-initiated, basic science research program. The NASA Strategic Plan to accomplish these objectives in a manner consistent with the high priority assigned to the protection and health maintenance of crews will be presented.

Aerospace Medicine↗

PubMed2001

The longitudinal case study: from Schön's model to self-directed learning.

BACKGROUND: Rapid changes observed in information technologies, medical practice, and learning methods encourage physicians to develop new updating strategies. To test its feasibility and to help physicians devise new learning and updating strategies, the knowing-in-action model developed by Schön was applied in planning and evaluating an interactive workshop. Acquisition of knowledge was tested. METHODS: The office and hospital charts of a family physician were reviewed. They were used to prepare a longitudinal case study, based on the real-life story of a hypertensive patient followed by her doctor over a period of 15 years. The clinician's approach to solving clinical problems was triangulated for credibility with general practitioners, specialists, and the information available in the literature. This longitudinal case study was used to develop an interactive educational workshop. The workshop was presented to physicians who had registered in an accredited continuing medical education event. Changes in pre- and postevent knowledge among the participants were assessed using touch pad technology to evaluate the effectiveness of this approach on the acquisition of knowledge related to management of arterial hypertension and associated clinical problems. RESULTS: A comparison of pre- and post-test data showed a significant improvement in knowledge for participants who answered all questions on both questionnaires (n = 8/37). The average score of these participants increased from 5.5 of 10 before the workshop to 8.3 of 10 after the workshop (p < .05). Participants reported a high satisfaction rate for the event. FINDINGS: A workshop using the longitudinal case study enables physicians to perceive their daily practice through a continuing education activity in which they experience the processes of reflection in action and reflection on action described by Schön. It also increases awareness of the gap between current practice and experts' recommendations and provides an opportunity to evaluate the means for bridging or closing this gap. It sensitizes the physician to patients' changing needs and prompts the clinician to reflect on the who, what, when, where, and how of learning.

Education, Medical, Continuing↗

PubMed1997

Issues complicating the implementation of postexposure prophylaxis.

Occupational exposures to blood-borne pathogens occur regularly in diverse settings and involve multiple groups of healthcare workers. Current compliance of healthcare workers with behavioral controls is poor, and additional engineering and work-practice controls for exposure prevention are inadequate and/or underutilized. Barriers to effective postexposure management include deficient knowledge and fear and denial among healthcare workers, the diverse risks associated with different exposures, the costs and personnel necessary for providing exposure management 24 hours a day, variable levels of expertise in postexposure prophylaxis strategies, and administrative requirements for standardized policies and procedures. In the current environment, healthcare institutions are largely ill equipped to provide timely and effective postexposure prophylaxis. Widespread worker education, simplified reporting mechanisms, and availability of prompt source and worker testing along with timely, free postexposure prophylaxis is central to an institution's postexposure program. Postexposure management programs should be comprehensive and provide standardized procedures, expand workers' access to postexposure prophylaxis by establishing responsible parties in diverse areas, disseminate program information to all workers, and ensure confidentiality in the care and follow-up of exposed workers. To implement such programs, it may be necessary to merge resources and link local management of exposures with regional expertise to provide up-to-date counseling in a rapidly changing field. Careful surveillance of occupational exposures is essential to evaluate program efficacy, direct prevention efforts, and to determine necessary resources to ensure continued successful delivery of postexposure prophylaxis.

Anti-HIV Agents↗

PubMed1994

Intravenous contrast media reactions: how do radiologists react?

Following the publication of the Royal College of Radiologists guidelines for the management of reactions to intravenous contrast media we assessed radiologists' understanding of intravenous contrast media reactions and their management of specific adverse reactions. A confidential questionnaire was sent to all radiologists in the Northern Region. Responses were received from 61/101 (60%). Knowledge of minor contrast media reactions was generally good but the understanding of treatment of severe reactions was poor. Knowledge of optimal management was inversely related to radiological seniority. This study suggests a poor understanding of severe contrast media reaction management amongst radiologists. Simplified treatment guidelines based on the Royal College document and aimed at severe reactions are suggested.

Anaphylaxis↗

PubMed2006

A comparison of pharmacy students' confidence and test performance.

OBJECTIVES: The objectives of this study were to estimate student retention of knowledge regarding the management of patients with hypertension and dyslipidemia, measure student clinical confidence, and identify the relationship between clinical confidence and actual performance on a knowledge assessment test. METHODS: This was a sequential cross-sectional study to evaluate knowledge retention and clinical confidence of second-year pharmacy students. To measure student clinical confidence, a 12-item clinical confidence questionnaire was administered. To measure student retention of knowledge, a 21-question knowledge assessment test was administered. At least 1 test question was related to each question asked in the clinical confidence questionnaire. RESULTS: One hundred eight students completed the study. The percentage of students correctly answering test questions decreased from a baseline of 70.4% +/- 5.8% to 60.9% +/- 5.8% four months later (p = 0.02) in spite of the students rating their clinical confidence from moderate to high in all areas. The proportion of students answering questions correctly was similar across the different levels of confidence. CONCLUSION: Overall, retention of knowledge appears to decline over a 4-month period of time. Furthermore, while students perceived moderate to high confidence, student knowledge did not match perceived confidence.

Clinical Competence↗

PubMedDate not supplied

Healthcare managers' roles, competencies, and outputs in organizational performance improvement.

Healthcare CEOs recognize that managers are under increasing pressure to work smarter and more efficiently with fewer available resources. Jobs in the healthcare industry are in a constant state of change, requiring a workforce that is not only prepared to adjust quickly to the changing environment but to simultaneously maintain or improve overall organizational performance. Traditionally, trainers were viewed as the people with the primary responsibility for improving organizational performance. Today some CEOs believe healthcare managers should own that responsibility, and other CEOs believe the responsibility should be shared among healthcare managers and trainers. This shift in how accountability is viewed poses at least two important questions. Are managers aware of the various roles they need to enact to achieve successful organizational performance improvement? Do managers possess the competencies associated with those roles? The seven most contemporary trainer roles, now referred to as workplace learning and performance roles, are examined in this article to help managers increase their knowledge of the roles, competencies, and outputs expected of them. Based on findings of a study conducted to examine CEO's perceptions of managers' roles in the performance improvement process, this article provides theoretical backgrounds, includes verbatim study comments, and offers practical recommendations or tips for managers.

Attitude of Health Personnel↗

PubMed2002

Urinary incontinence in Canada. National survey of family physicians' knowledge, attitudes, and practices.

OBJECTIVE: To determine current knowledge, attitudes, and management of urinary incontinence among family physicians in Canada. DESIGN: Cross-sectional mailed survey. SETTING: Family physicians in Canada. PARTICIPANTS: A random sample of 1500 members of the College of Family Physicians of Canada. MAIN OUTCOME MEASURES: Self-assessed knowledge, self-reported attitudes, and rating of various tests and treatments in the investigation and management of incontinence. RESULTS: The overall unadjusted response rate was 43.3% (650/1500). Although most respondents reported that urinary incontinence was common in their practices, less than half (46.0%, 284/617) indicated that they clearly understood incontinence and just 37.9% (232/612) had an organized plan for incontinence problems. Only 35.0% (214/612) of respondents felt very comfortable dealing with incontinence. Physical examination, urodynamic studies, urinalysis, and testing blood sugar levels were all considered important investigations by more than 90% of respondents. CONCLUSION: There are wide variations in knowledge, attitudes, practices, and comfort level among family physicians dealing with urinary incontinence.

Adult↗

PubMed1998

Perioperative pain management: a gate control perspective.

The assessment and management of perioperative pain are critical skills for the surgical nurse, hence, the subjective nature of pain should be reflected in their approach to pain control. Unfortunately, many studies (Seers 1987, Kuhns et al 1990, Royal College of Surgeons and Royal College of Anaesthetists 1990, Closs 1992 and Field 1996) suggest that the nurse's knowledge of perioperative management is inadequate. However, as Carr (1997) reported, nurses are not the only group of health care professionals who demonstrate a lack of 'expertise' in providing analgesic relief. Carr reviewed the survey of 27 medical schools by Marcer and Deighton in 1988 which revealed that 4 schools undertook no formal teaching on pain control, and the remainder averaged only 3.5 hours during a four year course. Clearly, perioperative pain management remains a major problem! We have suggested that surgical nurses must have a sound knowledge of the neurophysiology associated with this subjective phenomenon (Clancy and McVicar 1998) since such an understanding is paramount in assisting the decision making process which underpins effective individualised perioperative pain management.

Analgesics↗

PubMed2005

A telephone survey to measure communication, education, self-management, and health status for patients with heart failure: the Improving Chronic Illness Care Evaluation (ICICE).

BACKGROUND: Many aspects of quality of care for heart failure cannot be reliably obtained by chart review. METHODS AND RESULTS: We created and tested a telephone survey to measure provider-patient communication; satisfaction; patient education, knowledge, and self-management; and health status for the Improving Chronic Illness Care Evaluation. A total of 781 patients participated in the survey; 62% were age 65 or older, 66% had a history of coronary artery disease, and 59% were cared for by a cardiologist. The measures of communication, satisfaction, patient education, knowledge, and self-management performed very well with low rates of missing values and good psychometric properties. The self-efficacy scale had acceptable reliability (Cronbach's alpha 0.69); however, it was weakly correlated with objective measures of knowledge about self-management. The Heart Failure Symptom Scale (HFSS) showed high reliability (Cronbach's alpha 0.88) and good correlation with the SF-12 Physical Health Summary Scale (r=0.63); the HFSS was also moderately correlated with measures of mental health. CONCLUSIONS: Reliable information about processes of care and health outcomes that cannot be reliably assessed by chart can be obtained by telephone. This tool should be useful for measuring quality of care for large patient populations and determining the effectiveness of quality improvement activities.

Aged↗

PubMed1992

Management considerations in heifer development and puberty.

Management of replacement beef heifers should focus on factors that enhance physiological processes that promote puberty. Age at puberty is important as a production trait when heifers are bred to calve as 2-yr-olds and in systems that impose restricted breeding periods. Calving by 24 mo of age is necessary to obtain maximum lifetime productivity. Because the reproductive system is the last major organ system to mature, factors that influence puberty are critical. The influence of environment on the sequence of events leading to puberty in the heifer is dictated largely by the nutritional status of the animal and related effects on growth rate and development. Management strategies have been designed to ensure that heifers reach a prebreeding target weight that supports optimum reproductive performance, and consequences of inadequate or excessive development have been evaluated. Those strategies are based on evidence linking postweaning nutritional development with key reproductive events that include age at puberty and first breeding, conception, pregnancy loss, incidence and severity of dystocia, and postpartum interval to estrus. Management alternatives that ultimately affect lifetime productivity and reproductive performance of heifers begin at birth and include decisions that involve growth-promoting implants, creep-feeding, breed type and(or) species, birth date and weaning weight, social interaction, sire selection, and exogenous hormonal treatments to synchronize or induce estrus. Basic and applied future research efforts should converge to match in a realistic manner the production potential of the animal with available resources. Strategies that incorporate consideration of nutrition, genetics, and emerging management techniques will need to be tested to enable producers to make decisions that result in profit. This review evaluates the current status of knowledge relating to management of the replacement beef heifer and serves to stimulate research needed to enhance management techniques to ensure puberty at an optimal age.

Animal Feed↗

PubMed2006

Emotional intelligence instruction in a pharmacy communications course.

OBJECTIVES: To determine the benefits of incorporating emotional intelligence instruction into a required pharmacy communications course. DESIGN: Specific learning objectives were developed based upon the emotional intelligence framework and how it can be applied to pharmacy practice. Qualitative data on student perceptions were collected and analyzed using theme analysis. ASSESSMENT: Students found instruction on emotional intelligence to be a positive experience. Students reported learning the taxonomy of emotional intelligence--a concept that previously was difficult for them to articulate or describe, and could use this knowledge in future pharmacy management situations. Students also recognized that their new knowledge of emotional intelligence would lead to better patient outcomes. CONCLUSION: Students had positive perceptions of the importance of emotional intelligence. They valued its inclusion in the pharmacy curriculum and saw practical applications of emotional intelligence to the practice of pharmacy.

Communication↗