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Results for “Knowledge Management”

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PubMed1999

Practitioner review: Assessment and management of somatisation in childhood and adolescence: a practical perspective.

The assessment and treatment of somatisation in childhood require explicit recognition that many families frequently hold strong belief in the presence of physical disorders. Engaging the family, recognising and focusing on their beliefs and concerns, and paediatric/psychiatric liaison are usually required. Our knowledge on the management of children with somatisation is largely based on clinical reports but a number of open trials and methodologically increasingly stronger studies show that somatisation can respond to family treatments involving cognitive-behavioural techniques as well as to sensitive, psychologically sound advice by paediatricians. Antidepressants should be considered when there are comorbid mood disorders.

Adolescent↗

PubMed1992

Pediatric pain management.

The management of pediatric pain is a complex, multifaceted subject. By viewing pediatric pain management as a priority, health care providers may diminish children's suffering in hospital settings. Critical care nurses can make a difference by increasing awareness of pain issues, incorporating pain assessment tools into their flow sheet, being knowledgeable about pain management interventions, and collaborating with the other health care team members to cope effectively with each child's individual pain management needs.

Adolescent↗

PubMed1992

Nurses' educational preparation and knowledge concerning continence promotion.

A survey of qualified and learner nurses was carried out in one health district in the Midlands, in England, to establish the level of their educational preparation and knowledge concerning continence management. In spite of considerable advances in the management of urinary incontinence, in recent years, pre- and post-registration education still focused predominantly upon palliative rather than therapeutic or rehabilitative nursing strategies. Results indicated that many nurses, irrespective of grade, appeared to lack sufficient knowledge about incontinence upon which informed nursing practice should be based. The implications of these findings for practice and education are discussed.

Attitude of Health Personnel↗

PubMed1985

Educational factors associated with clinician knowledge about bacterial endocarditis.

This study measured the impact of relatively formal educational experiences (general practice residency and continuing education) and a variety of informal educational opportunities (professional membership activities, dental journals received, patterns of consulting and referral) on a particular body of knowledge (dentists' knowledge about the management of patients at risk for bacterial endocarditis). Data were collected through telephone interviews with 217 dental general practitioners in New York State. Linear regression analyses indicated that age made a significant contribution to the explanation of knowledge level in all models tested. Neither general practice residency experiences nor continuing education exposure in the past year made a significant contribution to the explanation of knowledge. The other more informal educational variables tested sometimes made a significant contribution when controlled for age; however, the explanatory power of these variables often varied according to respondents' locale (urban vs. rural).

Adult↗

PubMed2005

[Evaluation of gastroenterology procedures by general practitioners in the Czech Republic--contribution to interdisciplinary cooperation].

BACKGROUND: The understanding of different management strategies in primary and secondary care is important for cooperation between specialists and general practitioners in clinical practice. The Institut of General Practice at First Faculty of Medicine carried out a survey for gastroenterologists concerning their opinions on general practitioners and their current knowledge, competence and management of GI disorders as a contribution to interdisciplinary communication. METHODS AND RESULTS: Questionnaires were sent to 552 gastroenterologists in the country. There was a response rate of 31% without any reminder, 170 questionnaires were included in a study. The most of gastroenterologists (92%) support practical guidelines development. There is an insufficient confidence that these guidelines are implemented in practice. Four from five gastroenterologists consider knowledge of their colleagues GPs in gastroenterology as average. In particular cases (irritable bowel syndrome, step up and step down approach) are specialists rather sceptic. There is a low support for the increase of GP competence in gastroenterology, as for urea breath test availibility, particularly in private gastroenterologists (p=0,04). CONCLUSIONS: Results of the survey could facilitate the interdisciplinary communication in gastroenterology, contribute to CME programs development and may serve as an example for other specialities.

Adult↗

PubMed2003

[Management of uterine myomas in women of fertile age].

OBJECTIVE: Review of current knowledge about uterine fibroids management in young women. Analysis of possible diagnostic and therapeutic algorithms regarding fertility preserving. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine and the General Faculty Hospital, Charles University, Prague. METHODS: Analysis of the facts in literature (texts in medical journals, monographies, textbooks, internet database Medline and Ovid) and authors' clinical experience. CONCLUSIONS: Alternatives of treatment of infertility in women with uterine fibroids have significantly enlarged in past 10 years. However none of the indicated methods is perfect. Expectation does not exclude the risk of growth of fibroids and abortion. The effect of pharmacological therapy is only temporary. Myomectomy is associated with the risk of surgical complications, fibroids' recurrence and uterine rupture in subsequent gestation. Although uterine artery embolisation (on an average) halves the fibroids volume, the long-term effect of the method on female fertility is still unknown. Nevertheless it seems convenient to advise the active approach to all women planning pregnancy and having significant (submucous or intramural) fibroid even before spontaneous or assisted conception. Most recent studies indicate significant improvement of reproduction outcomes after myomectomy, especially in young women with the absence of other factors of infertility. Only the results of randomized, controlled trials (that are still awaited) will inform us about comparison of the effects and risks of myomectomy and uterine artery embolization in management of infertility.

Adult↗

PubMed1994

Evolutionary trends in the pharmacotherapeutic management of depression.

The past decade has brought an exponential increase in our knowledge of the pharmacotherapeutic management of depression. Much has been learned about the prevalence, risks, and course of depression in the general population, the elderly, and patients with comorbid medical illnesses and about the biological basis of depression. This article reviews evolving trends in the diagnosis and management of depression and evaluates the main classes of antidepressants. Although depression carries a high risk of morbidity and mortality, it is very treatable, and early diagnosis and early treatment are now emphasized. Antidepressant medication is continued after the patients' acute depressive symptoms resolve, sometimes for as long as 1 to 5 years to prevent relapse and recurrence of depression; in addition, full doses, rather than lower doses of antidepressant are prescribed for maintenance therapy. The armamentarium of antidepressants too has changed. In addition to monoamine oxidase inhibitors and tricyclic and tetracyclic antidepressants, the serotonin reuptake inhibitors fluoxetine, sertraline, and paroxetine are now available, as well as a group of antidepressants with atypical mechanisms of action that includes bupropion, trazodone, venlafaxin, and nefazodone. Although comparable in efficacy to the tricyclic antidepressants, these new drugs are safer and better tolerated because they are believed to act selectively on specific neurotransmitter systems.

Adolescent↗

PubMed1987

[Development of a knowledge-based system for aiding therapeutic decision in breast cancer].

The SENEX project has been initiated at the fondation Bergonié in 1985 and is intended for providing physicians in general hospitals with knowledge based systems for the management of cancer treatment protocols. The design and building of a knowledge-based system for the management of breast cancer protocols (SENEX) was the first goal of this project. SENEX has been developed using a commercially available development tool (Personal Consultant Plus, Texas-instruments) derived from EMYCIN. It runs on IBM and compatible microcomputers. The knowledge base embeds the formal knowledge contained in the breast cancer protocols currently in use at the fondation Bergonié, and some judgmental knowledge acquired form breast cancer experts. Production rules and frames allowed us to adequately represent and structure this knowledge and the problem solving processes related to the management of breast cancer. A preliminary informal evaluation of the system has shown that it performs at the expert-level in giving advice for patients included in formal protocols. Its use and acceptability are good. However, we have to add judgmental knowledge into the knowledge base and to interface the system with a temporal data base management system to improve the overall performances of SENEX. Moreover the effectiveness of the system remains to be demonstrated before one can anticipate is routine use in clinical practice.

Breast Neoplasms↗

PubMed1991

Total quality management strategies in mental health systems.

This paper introduces the concept of total quality management (TQM) to top managers of mental health systems. While TQM is a philosophy of management at the cutting edge of U.S. business, it has only recently entered the vocabulary of health care managers. To our knowledge, TQM has yet to be systematically applied to the state mental health service delivery system. After introducing some key concepts and techniques, we develop two extensive examples of how TQM can be integrated into the already existing management structure of the psychiatric hospital.

Hospital Units↗

PubMed1994

The value of the abbreviated ATLS course for accident and emergency nurses.

This study was designed to measure the change in knowledge of Accident and Emergency (A & E) nurses in three key areas of trauma care after attending a half-day course based on Advanced Trauma Life Support (ATLS) teaching, and to detect any correlation between the length of experience of nurses in A & E with their theoretical knowledge of the management of severe injuries. A questionnaire was completed by 27 A & E nurses before and after attending the course on trauma management based on the ATLS system. The questions related to triage, initial management and practical procedures in trauma victims. A statistically significant improvement was observed in the overall result after the course. An unexpected finding was the low score on triage related questions. Abbreviated ATLS based teaching provides improved theoretical knowledge for A & E nurses waiting to attend a full trauma course.

Education, Nursing, Continuing↗

PubMed2005

Analysis of local perspectives on sustainable forest management: an Indonesian case studyThis study was funded through a collaborative project between the University of Illinois and the Center for International Forestry Research (CIFOR). The ideas contained herein are solely of the authors and do not necessarily reflect official views of CIFOR.

Despite widespread acceptance of sustainability as the ultimate goal of forest management, perspectives about its meaning, significance, and relevant indicators may still differ. This paper examines local perspectives on sustainability, and evaluates their similarities and differences. A systematic procedure based on criteria of proximity, pre-existing rights, dependency, knowledge of forest management, forestry spirit, daily activity, and legal rights was used to identify a small group of relevant stakeholders representing different groups, institutions, and organizations. Using participatory action research (PAR), stakeholders were asked to identify relevant indicators of sustainable forest management. The indicators identified by each stakeholder were then compared to a consolidated list assembled by field facilitators with respect to whether relevant indicators are present or not. Based on the resulting presence/absence matrix, a statistical tool called the simple matching coefficient was used to estimate the similarity measures among the stakeholders' perspectives. In addition, cluster analysis was used to classify groups of stakeholders depending on their similarities to each other. Finally, hypotheses related to the 'closeness' of perspectives among local communities, non-governmental organizations, a timber company, and government organizations, as revealed by their selection of indicators, were tested. Results show that: (a) local communities have different perceptions in terms of what they consider to be important indicators compared to the NGOs, (b) there are significantly different perceptions between the government and the timber companies, and (c) there are also different perceptions between urban and field-based personnel of the same organization.

Cluster Analysis↗

PubMed2002

Computer simulations to determine the efficacy of different genome resource banking strategies for maintaining genetic diversity.

Genome resource banks (GRBs) and assisted reproductive techniques are increasingly recognized as useful tools for the management and conservation of biodiversity, including endangered species. Cryotechnology permits long-term storage of valuable genetic material. Although, the actual application to endangered species management requires technical knowledge about sperm freezing and thawing, a systematic understanding of the quantitative impacts of various germ plasm storage and use scenarios is also mandatory. In this study, various GRB strategies were analyzed using the historical data from three managed populations of endangered species with varied pedigrees (Eld's deer, Przewalski's horse, and Sumatran tiger). The following types of sperm banks were assessed: (1) a "Wild Bank" consisting of sperm (i.e., genes) from 5 to 10 males unrelated to the managed population and to each other; and (2) a "Best Male" bank containing sperm from only the most genetically valuable males alive in the ex situ population at the time the bank was established. These different bank types were then used to evaluate the effectiveness of different bank usage frequencies. The efficiency of each scenario was assessed by examining the level of inbreeding and gene diversity in the population. Overall, a sperm usage frequency of five times per year was determined to be the most efficient and "wild banks" were highly successful at enhancing genetic diversity. The value of a GRB established from the ex situ population depends on how closely related the banked males are to future generations. A GRB will have significantly less benefit when banked males also produce many successful offspring, or when donors are already genetically over-represented in the population at the time of establishing the GRB.

Animals↗

PubMed1999

Management of space problems in the primary and mixed dentitions.

BACKGROUND: According to the Third National Health and Nutrition Examination Survey, crowding and irregularity remain a consistent problem for children. Management of space problems continues to play an important role in a dental practice. It also represents an area of major interaction between the primary provider and the specialists. This article attempts to update clinicians on the current knowledge of space management. DESCRIPTION OF CONDITION: Proper management of space in the primary and mixed dentitions can prevent unnecessary loss in arch length. Diagnosing and treating space problems requires an understanding of the etiology of crowding and the development of the dentition to render treatment for the mild, moderate and severe crowding cases. Most crowding problems with less than 4.5 millimeters can be resolved through preservation of the leeway space, regaining space or limited expansion in the late mixed dentition. In cases with 5 to 9 mm of crowding, some can be approached with expansion after thorough diagnosis and treatment planning. Most of these cases will require extraction of permanent teeth to preserve facial esthetics and the integrity of the supporting soft tissue. Serial extraction or guidance of eruption is reserved for treatment of severe tooth-size/arch-size discrepancies. Due to variations in the timing and extraction sequence depending on the diagnosis, serial extraction should be reserved for those who can complete the treatment successfully. CLINICAL IMPLICATIONS: The recommended timing of referring patients with moderate crowding to specialists for treatment is in the late mixed-dentition stage of development. Patients with severe crowding will require earlier evaluation for serial extraction.

Adolescent↗

PubMed1998

Adjuvant therapy for pancreatic cancer: back to the future.

PURPOSE: The role of adjuvant therapy in the management of pancreatic cancer, resected with curative intent, remains controversial. This editorial review updates the status of adjuvant therapy in this context and introduces the first North American co-operative group study in this arena in roughly 20 years. RESULTS: To the extent that there has been a "standard" of care in this context, it has been defined in large part by the early work of the Gastrointestinal Study Group (GITSG). Their trial was activated in the mid 1970's using split course radiation therapy and bolus 5-FU. In the intervening 20 + years the morbidity/mortality of pancreaticoduodenectomy (PDD) has been dramatically reduced; concurrently, understanding of prognostic factors impacting on outcomes for resected patients has been significantly enhanced. In major centers the mortality of PDD is roughly 1% and survival has been shown to correlate with a number of factors including tumor size, nodal involvement, and margin status. With currently available techniques doses of continuous course radiation therapy in the range of 50-55 Gy to sites of pancreatic tumor resection and adjacent lymph node regions have been given in a number of trials with acceptable morbidity. 5-FU sequencing and administration have been advanced and gemcitabine, an agent with clear radiosensitizing properties, has been approved for use against pancreatic cancer. CONCLUSIONS: Following PDD increasing numbers of physiologically intact patients are confronting the survival statistics associated with resected pancreatic cancer. Their interest in improved therapeutic outcomes, combined with the noted improvements in radiation and chemotherapeutic management, has set the stage for renewed and intensified study. Accordingly, the intergroup mechanism of the Cancer Therapy and Evaluation Program (CTEP) of the NCI has designed, approved, and activated a modern Phase III, adjuvant protocol incorporating recently gained knowledge in this management context. Prospective randomization will be utilized to compare gemcitabine and 5-FU as single agents before and after chemoradiotherapy with 5-FU. Successful and timely completion of this newly activated intergroup study, RTOG 97-04, will establish a current, cooperative group experience, data base, and standard in the context of adjuvant therapy for pancreatic cancer and serve to provide momentum for further studies.

Antimetabolites, Antineoplastic↗

PubMed2005

[Feasibility of the programme of focusing on early childhood development in impoverished rural areas in China].

OBJECTIVE: To study the feasibility of the programme "Focusing on early childhood development" in impoverished rural areas in China. METHODS: A questionnaire survey was conducted among 100 mothers, about half with junior middle school education, 18% with grade-school education, and 29% being illiterate, of children aged under two years in 7 villages in Changfeng County, Anhui Province, a native impoverished county, to understand their knowledge and attitudes about child healthcare. Then these mothers were randomly divided into 2 equal groups: experimental group, receiving face-to-face guidance in the practice of early healthcare for children at home with a pamphlet developed by WHO as teaching material; and control group without receiving guidance. Two months later the mothers received the second session of guidance. Six months after the same questionnaire survey was conducted among the 100 mothers to investigate the changes in knowledge and practice and Gesell development test was made to observe the changes in mental development. Two-days' training on the technique of early child healthcare in the form of reading, videotape presenting, and exercise, was given to 29 village doctors. Questionnaire survey was conducted among them before and 1 month after the training to understand the changes of their knowledge and attitudes towards early child healthcare. RESULTS: After the guidance the knowledge and fostering skills in terms of early child healthcare were improved significantly among the mothers of the experimental group in comparison with the mothers of the control group (P < 0.01). After the training most of the village doctors managed put the knowledge they had learned into practice, however, the percentage of those who lacked confidence in the smooth implementation of the programme remained unchanged (38% vs. 41%). Before the experiment the abilities in different fields were not significantly different between the children in these 2 groups. Six months after the implementation of the programme the abilities in fine motion, speech, and interpersonal communication were improved significantly among the children of the experimental group (all P < 0.05). CONCLUSION: Economic, simple, and effective, the programme "Focusing on early childhood development" is suitable for the impoverished rural areas in China.

Child Development↗

PubMedDate not supplied

Health care issues: managing services and people in home care: today's challenge.

This article is the second in a series of three focusing on key management processes in home care. The first article addressed the issue of quality management and the next article looks at financial and information management. This article examines the issues of service and human resource management with an emphasis on service management. It starts by outlining some of the pressures behind the unprecedented demand for home care services and looks at a few of the strategies home care agencies can utilize to manage service demand. It then moves to a discussion of human resources, specifically the case manager. Basic qualifications, knowledge, skills, and attributes are outlined and administrators are encouraged to facilitate the ongoing development of this costly and critical resource.

Canada↗

PubMed2000

Ovarian hyperstimulation syndrome (OHSS): diagnosis and management.

OBJECTIVE: To present our experience and the current knowledge about pathophysiology, diagnosis, and management of the ovarian hyperstimulation syndrome (OHSS). DESIGN: Retrospective study concerning clinical and laboratory findings of severe OHSS. SETTING: General ICU at a maternity-surgical hospital. PATIENTS: Ten patients suffering from severe OHSS. INTERVENTIONS: Supportive and preventive therapeutic measures applied are described. MEASUREMENTS AND RESULTS: Admission and discharge data as well as worst values during disease course were recorded. Clinical and laboratory findings showed third space fluid shift leading to weight gain, generalized tissue edema, ascites, hydrothorax, abdominal distension and pain, chest discomfort, hypovolemia, dehydration, ovaries enlargement, electrolyte disturbances, hypoalbuminemia, high hematocrit, urea, and WBC. CONCLUSIONS: OHSS is an iatrogenic complication of assisted conception of unknown pathogenesis, with potentially life-threatening sequelae due to hemoconcentration such as circulatory shock, ARDS, hepato-renal failure, thromboembolic phenomena, and multi-organ dysfunction syndrome. Gynecologists and intensivists must be aware of the diagnosis and management of the syndrome because of the widely used reproductive techniques for assisted conception.

Adult↗

PubMedDate not supplied

Management engineers help design center.

Drawing on the valuable knowledge and skills at its management engineering department (the Section of Systems and Procedures), the Mayo Clinic recently designed, built, and occupied a highly efficient primary care center for local residents.

Community Health Centers↗