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PubMed2001

Achieving consensus about pain content for child branch curricula.

AIM: The aim of the study was to identify nurse educators' and nurse managers' perceptions of the educational needs of children's nurses in relation to pain management. RATIONALE: Children continue to suffer unnecessary pain during hospitalization. This has been attributed, in part, to inadequate education among paediatric nurses with a number of studies demonstrating that nursing curricula need re-evaluating with respect to the content relating to pain management. In order to equip nurses to manage pain within clinical practice nurse education needs to provide them with the knowledge and skills required. It is apparent that nurse education is currently failing students in this regard. In order to evaluate nursing curricula with respect to pain management it is necessary for there to be a degree of consensus, among paediatric nurses, regarding appropriate content. METHODOLOGY: A two-round Delphi study was used to ascertain the appropriate pain content for pre-registration child branch courses. When undertaking a Delphi study a number of 'experts' in the field are identified, who complete a series of questionnaires. The first round is used to generate ideas, which are reconsidered in subsequent rounds (Hicks 1999, Reid 1988). Following analysis of the responses to each questionnaire anonymous feedback is sent to the respondents together with the next questionnaire (Walker 1994). Participants were either senior nurse educators or senior nurse managers. RESULTS: Positive correlations were found within the two groups as well as between the educators' and managers' rankings for the 14 categories identified. CONCLUSIONS: The results of this study suggest that nurse educators and nurse managers have similar views about the pain management knowledge they would expect a newly qualified child branch nurse to have. The list of appropriate pain content derived from the results of this study provides a useful tool with which to evaluate the content of child branch curricula.

Curriculum↗

PubMed1999

Management of childhood diarrhea and use of oral rehydration salts in a suburban West African community.

In a household survey in Guinea-Bissau, 319 episodes of diarrhea in children were followed by interviews every second day with the aim of investigating perceived morbidity and subsequent actions taken. The majority of the mothers had good knowledge of oral rehydration salts (ORS). However, only 58% of the episodes were treated with ORS and the amount given was insufficient. Mothers with no knowledge of ORS did not use it during the observed attack of diarrhea regardless of contact with a health center, which suggests that maternal knowledge is an important determinant of whether health personnel provide ORS. Children with diarrhea considered to be caused by teething were less likely to receive ORS in the acute phase (risk ratio = 0.6, 95% confidence interval [CI] = 0.5-0.9). Univariate analyses showed that the use of ORS was related to number of reported symptoms, the mother being the care taker, consultations, previous use of ORS, good knowledge of ORS, and having ORS sachets at home. Multivariate Cox regression analyses showed that the presence of ORS sachets at home at the onset of diarrhea was the strongest predictor of use (hazard ratio = 3.3, 95% CI = 1.9-3.6). Improved health education should focus more on the quantity of ORS needed, early signs of dehydration, treatment of teething diarrhea, and breast feeding, and address mothers who have no prior knowledge of ORS. Management of diarrhea may be improved by a more liberal distribution of ORS sachets.

Administration, Oral↗

PubMed1996

Employee misconduct: discipline or prevention.

Discipline is something that can only be imposed after an act of misconduct has already occurred, but managers can use strategies to prevent misconduct before it occurs. When an act of employee misconduct does occur, supervisors should know how to deal with the situation effectively. Management training and knowledge of appropriate administration of discipline will greatly enhance the probability that undesirable behaviors are changed and that when termination of employment becomes necessary, arbitration and litigation will not suspend, reduce, or reverse management's decisions.

Employee Discipline↗

PubMed1998

How the principles of geriatric assessment are shaping managed care.

In traditional geriatric medicine, comprehensive assessment is considered crucial to the care of frail older patients. The principles of geriatric assessment--identifying high-risk patients and targeting them for preventive interventions--are also practiced by managed care organizations (MCOs). Self-reported health surveys and administrative data are two methods used by MCOs to identify members at high risk for adverse health outcomes and functional decline who may benefit from geriatric case management. For a successful partnership with primary care physicians, it is very important that geriatric care managers should be knowledgeable in the principles of geriatric medicine.

Activities of Daily Living↗

PubMed2004

Midwives' knowledge of newborn feeding ability and reported practice managing the first breastfeed.

Continuous uninterrupted skin-to-skin contact is known to facilitate newborn transition to extrauterine life, the ability to actively find the nipple and establishment of effective breastfeeding but is not promoted consistently in practice. The Newborn Feeding Ability Questionnaire (NFAQ) was developed to measure midwives' knowledge and practice in supporting the first breastfeed. The NFAQ was administered to 3 500 midwives in Australia through a mailed survey. A response rate of 31.6% (n=1 105) was achieved and the sample was representative of the national midwifery population for age sex, education and experience. Mean total score for knowledge was 85.94 (range 40-110 out of 110), SD=10.55) and mean practice score was 95.89 (range 57-117 out of 120), SD=9.19). Knowledge of newborn feeding ability was consistently associated with best practice in managing the first breastfeed. Almost all midwives reported that skin-to-skin contact for newborn infants immediately after birth was important, but few understood the significance of 'continuous uninterrupted' skin-to-skin contact to facilitate correct attachment and effective suckling. One-third reported separting mother and baby for routine interventions before allowing the opportunity to demonstrate pre-feeding behaviour or actually breastfeed. Although midwives attempt to ensure the first breastfeed is facilitated soon after birth, the practice of continuous uninterrupted skin-to-skin contact seems poorly understood and not uniformly practised. Further research is needed to investigate how midwives teach mothers' positioning and attachment for the first breastfeed. Education of midwives so they can optimally facilitate the first breastfeed is required to improve breastfeeding initiation rates.

Australia↗

PubMed2004

Emergency ventilation of the tracheostomy patient, Part I: Knowledge assessment of healthcare professionals.

A nurse-driven investigation, using a convenience sample and comparative descriptive design, was conducted within a large medical center to identify healthcare professionals' (N=885) knowledge of emergency ventilation strategies for the tracheostomy patient. Registered nurses and physicians comprised the majority of survey respondents (n=587) who answered a three-item questionnaire to assess specific knowledge. Findings focused primarily on differences in knowledge among subgroups of nurses, including those in critical care and noncritical acute care settings. Although increasing knowledge levels are documented since the mid 1980's, concern for the knowledge available to manage the emergency ventilation of tracheostomy patients is voiced. Less than half of nurses and physicians in this sample were able to answer correctly all three questions asked regarding emergency strategies. Recommendations address this knowledge deficit.

Academic Medical Centers↗

PubMed2003

[Opioid therapy in chronic non-malignant pain].

In long-term treatment opioids seem to have only minimal side-effects compared with other analgesics and co-analgesics.Nevertheless, some risks have to be considered. While immunosuppression, neurotoxicity, teratogenity, tolerance and addiction are clinically not relevant or very rare, cognitive impairment, sedation and obstipation may have a clinical impact.However, these symptoms can usually be managed by adjuvant medication and patient education. Treatment of non-malignant pain with opioids can only be considered on an individual basis. Scientific evidence for general treatment with opioids, treatment of specific pain syndromes or treatment with certain opioids is not available. In conclusion, only recommendations regarding opioid treatment for certain chronic pain syndromes can be made. In only a minority of patients can a long-term analgesic effect be expected.Therefore, careful evaluation of alternative options of pain management is necessary before opioid therapy is started. With standardized documentation responders may be distinguished from non-responders. For clinical practice of long-term opioid therapy in non-malignant pain a specialized knowledge in pain management is a prerequisite. Future studies with more sophisticated methodology will be necessary to advocate more precise guidelines.However, the therapeutic recommendations from the DGSS consensus conference allow a safer,well structured and validated use of opioids for chronic non-malignant pain.

Analgesics, Opioid↗

PubMed2005

An educational intervention can prevent delirium on acute medical wards.

BACKGROUND: Delirium is a common disorder in hospitalised older people and established cases may have a poor outcome that is not readily improved by intervention. Prevention of cases through education of medical and nursing staff has not been fully studied. OBJECTIVES: To test the hypothesis that an educational package for medical and nursing staff would both reduce the number of incident cases of delirium and increase recognition of cases of delirium within an acute medical admissions ward. DESIGN: Single-blind case-control study. SETTING: Two acute admissions wards in a busy inner-city teaching hospital. SUBJECTS: 250 acute admissions over the age of 70 years. METHODS: An educational package for staff on one ward consisting of a 1 hour formal presentation and group discussion, written management guidelines and follow-up sessions. The follow-up sessions, which were based on one-to-one and group discussions, aimed at providing continuous support of staff through emphasising learning and testing knowledge. Diagnosis and management of some discharged delirium patients were also discussed to allow staff to learn from previous experience. The main outcome measures are point prevalence of delirium established by researchers, and recognition and case-note documentation of delirium by clinical staff. RESULTS: The point prevalence of delirium was significantly reduced on the intervention compared to the control ward (9.8% versus 19.5%, P < 0.05) and clinical staff recognised significantly more delirium cases that had been detected by research staff on the ward where the educational package had been delivered. CONCLUSION: A focused and inexpensive educational programme can decrease the prevalence of delirium among older inpatients.

Acute Disease↗

PubMed1999

[Training of local health managers: process of identification of strategic actions].

In Brazil, in recent years, as a result of the increasing participation of county authorities in health care, a need for tools which would contribute to the better preparation of local administrators, complementary to the activities of a more academic nature, has been recognized. One of the possible alternatives is the exploitation of experiences, regarded as successful, in local health care planning and administration, by using them as material for "case studies" in activities with selected groups of health care administrators thus, stimulating the identification of those elements which contributed to the favorable results attained, and their interactions, in the quest for analogies which would facilitate the identification of new perspectives for their own situations. In this article an experience of a "case studies" development, in response to a demand from UNICEF, based on 8 counties in from the North and Northeast, which were successful in using a "focus approach" in their organization of data and their utilisation in a seminar with 21 local managers from both regions, is presented. During the seminar the local health managers attained greater knowledge of the strategies implemented and identified feasible intervention alternatives. The methodological proposition of teaching on the basis of case studies, using a conceptual strategy of grouping experiences according to specific dimensions enabled local health managers to learn from their practical experiences.

Brazil↗

PubMed1992

Factors related to successful goal attainment in case management.

Goal planning is fundamental to the case management process. Manager and client identify specific long-term goals and then systematically break them down into the incremental behaviors needed to be accomplished to achieve each goal. The goal-setting process may fail as a result of four types of factors: (1) behavioral, (2) cognitive, (3) affective, and (4) environmental. To decrease the likelihood of failure, case managers must be knowledgeable about goal planning. They must help the client set goals that are expressed positively, that are client focused, realistic and achievable, measurable, and easily understood, with one observable outcome per goal. For both case manager and client, setting and attaining goals must be viewed as part of a continuing learning process, rather than a success-failure dichotomy.

Goals↗

PubMed1990

Obstetrical risk management: establishing documents of defense.

The practice of obstetrics is high risk for the obstetrician. We are the target for plaintiffs and their attorneys for any outcome--maternal or neonatal--that is less than perfect. Thus obstetricians should learn how to practice inexpensive, high-quality defensive medicine by increasing knowledge of risk management and improving charting skills. This article attempts to achieve these objectives, thus reducing the obstetrician's vulnerability to being a legal "sitting duck"!

Humans↗

PubMed1984

Exercise programs for asthmatic children.

The role of exercise in the management of the asthmatic child is now understood to be essential for the child's overall health. With the medications available today, a child, even with complicating EIA, can expect to perform as well as his nonasthmatic peers. In fact, with appropriately set expectations, adequate medical management, and supportive parents, coaches and teachers, the asthmatic child can hope to achieve a physical fitness level compatible with a high quality of life. The physician's role is a key one requiring basic knowledge of medical management, as well as supervising the overall effort. One cannot overlook the satisfaction a doctor experiences when assisting the patient in functioning normally, despite underlying disease.

Adolescent↗

PubMedDate not supplied

[Intelligence or relevant knowledge as a prerequisite for strategies in environmental management in old age].

The theoretical part discusses implications of changes in intelligence and cognitive structure for the behavior of adults and elderly individuals. The theory is proposed that knowledge pertaining to the actual environment, rather than intelligence, is the determining factor for the "ability to adapt". Deviations in behavior displayed by elderly individuals are not mainly attributed to an--insignificant--reduction in intelligence, but rather are related to changes in basic knowledge. In a second, empirical part, it is examined whether knowledge of relevant changes in the environment is related to mastery of developmental tasks in old age. A cross-sectional study brought forth results demonstrating that knowledge of change is more significantly related to "mastery of life" than is intelligence. In addition to this, it could be observed that the examined sample succeeded in mastering life outstanding, with alltogether only a minor decrease in knowledge of change, despite a considerable lag in measured fluid intelligence.

Adaptation, Psychological↗

PubMed1981

Rehabilitation recommendations for institutionalized motor-disabled patients.

Consultation reports on 142 profoundly retarded and severely motor-disabled patients in a state residential care facility who were seen by physiatrists from an academic department of physical medicine and rehabilitation (PM&R) were reviewed. In all, 168 reasons for consultation were listed: 117 for specific identification or management of disabilities related to gross-motor or fine-motor function, 37 for surgical problems, and 10 for medical problems. The consultants made 314 recommendations altogether: 100 suggested the evaluation or treatment of gross-motor disabilities by a physical therapist, 43 suggested occupational therapy evaluation or treatment, and an additional 73 suggested adaptive equipment involving an orthotist. The recommendations also involved the following problems: medical-33; surgical-37; behavioral-27; further rehabilitation-1. The skills of a consultant knowledgeable in the management of multiply handicapped people include the coordination of medical, surgical, physical and behavioral care. Such knowledge is also a useful adjunct to overall patient care in complex cases with motor involvement. The preliminary association during which these consultations were done served as the basis of a growing affiliation between the state institution and the department of PM&R.

Adolescent↗

PubMed2006

Pharmacokinetic drug interactions between opioid agonist therapy and antiretroviral medications: implications and management for clinical practice.

BACKGROUND: Opioid dependence and HIV/AIDS are 2 of the most serious yet treatable diseases worldwide. Global access to opioid agonist therapy and HIV treatment is expanding but when concurrently used, problematic pharmacokinetic drug interactions can occur. METHODS: We reviewed English, Spanish, French, and Italian language articles from 1966 to 2005 in Medline using the following keywords: HIV, AIDS, HIV therapy, antiretroviral therapy, HAART, drug interactions, methadone, and buprenorphine. Additionally, we reviewed abstracts from national and international meetings and conference proceedings. Selected references from these articles were reviewed as well. RESULTS: Clinical case series and carefully controlled pharmacokinetic interaction studies have been conducted between methadone and most approved antiretroviral therapies. Important pharmacokinetic drug interactions have been demonstrated within each class of agents, affecting either methadone or antiretroviral agents. Few studies, however, have been conducted with buprenorphine. The metabolism of both therapies, description of the known interactions, and clinical implications and management of these interactions are reviewed. CONCLUSIONS: Certain interactions between methadone and antiretroviral medications are known and may have important clinical consequences. To optimize care, clinicians must be alert to these interactions and have a basic knowledge regarding their management.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Cardiovascular dysfunction. A rationale for characterization and a guide to therapy.

Traditional clinical assessment of cardiac function has relied on the indirect measurement of systemic blood pressure, heart rate and rhythm, and central venous pressure. However, because the circulation comprises complex interactions between flow and impedance in two hydraulic systems coupled in series, the usual assumptions drawn from the measurement of only a representative sample of this system can lead to serious errors in interpretation. This is particularly significant in conditions leading to physiologic distortions. Patients undergoing major surgery, or with suspected cardiac dysfunction, can only be adequately managed with a knowledge of both right and left heart pressures, together with the measurement of cardiac output. This report presents a rationale for the use of a simple method for interpreting these data and a guide to optimizing management. For those patients with heart failure who are unable to be sustained with conventional pharmacology, criteria are suggested that may help the clinician decide when more aggressive intervention, such as mechanical assist, is required.

Biometry↗

PubMed2003

Is there a role for adjuvant high-dose interferon-alpha-2b in the management of melanoma?

The knowledge that melanoma is susceptible to attack by the host's immune system has resulted in the testing of a variety of immunotherapies. Interferon-alpha-2b, which has several anti-tumour mechanisms including an antiproliferative effect, an anti-angiogenesis effect, the enhancement of natural-killer cell activity and the upregulation of tumour antigen presentation, has shown tremendous potential. Early trials using low-dose and intermediate-dose regimens demonstrated no benefit to survival. However, the Eastern Cooperative Oncology Group trial EST 1684, showed that a high-dose regimen involving an induction phase of intravenous interferon-alpha-2b 20 MU/m(2) 5 days a week for 4 weeks, followed by a maintenance phase of subcutaneous 10 MU/m(2) 3 days a week for the remainder of a year, led to significant improvements in both disease-free and overall survival compared with observation. On the basis of these results, the US FDA approved high-dose interferon-alpha-2b for the post-surgical adjuvant therapy of high-risk melanoma. Unfortunately, the results of subsequent trials involving high-dose interferon-alpha-2b have not been as clear, and its role in the adjuvant treatment of melanoma remains controversial. Concerns remain regarding the design and interpretation of the clinical trials, the cost and toxicity of treatment, and the appropriate selection of patients who should be treated. This article reviews the existing data and attempt to address the arguments for and against a role for adjuvant high-dose interferon-alpha-2b in the management of melanoma.

Antineoplastic Agents↗

PubMed2006

Knowledge, attitude and practices of mothers regarding home management of acute diarrhoea in Sunsari, Nepal.

In Nepal, 45,000 children less than five years age die due to diarrhoea annually. Home management of diarrhoea is the hallmark of control of diarrhoeal diseases program in Nepal, which also aims to increase the correct use of Oral Rehydration Solution (ORS) by mothers, so mothers play a great role in the reducing the morbidity and mortality of children. The aim of the study was to assess knowledge, attitude and practices of the mother regarding home management of acute diarrhea in their children. The list of 330 children on Plan 'A' treatment was prepared at 11 peripheral health institutions of Sunsari district. Their identification data were recorded by health workers. The mothers were interviewed by the same health worker at the time of home visit after 24 hrs to know the improvement in the child and also preparation and use of ORS. Majority (97.6%) of the mother had information about ORS and also its usefulness in the management of dehydration due to diarrhea. Fifty percent mothers could make ORS properly and gave ORS to their children ideally (after each stool). The correct preparation and ideal use of ORS have not reached in proper way to the mothers of Sunsari district. Use of ORS definitely lowers the mortality due to dehydration, an effect that can clearly be seen in the short term. Intervention such as increasing women's literacy, improving basic sanitation and health care services, and raising the general nutritional status of the population can only be expected to decrease the diarrhoeal diseases morbidity and mortality in long term.

Acute Disease↗