Knowledge of home care key for case managers.
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Case Management↗
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[Management of abortion and premature delivery: essential knowledge for general practitioners].
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Abortion, Spontaneous↗
Role of assist devices in managing low cardiac output.
Knowledge of the clinical applicability of short-term LVADs is in the early stages. Intermediate and long-term electrically-actuated devices appear to have the potential of clinical utility in those patients whose low cardiac output states are the result of the complications of atherosclerosis or the final common paths of a group of poorly-understood cardiomyopathies. Finally, the use of LVADs as bridges, alternatives and/or adjuncts to cardiac allografting is not without precedence and attractive possibilities are conceivable. Considerable overlap may exist between short, intermediate and long-term LVAD clinical utilization. The early experience with short-term devices strongly suggests that viable patient populations will emerge who will benefit from implantable devices with portable power sources of longer utility.
Assisted Circulation↗
Knowledge transfer and utilization: implications for home healthcare pain management.
Implementation of research evidence into clinical practice is a complex and dynamic process that has become the subject of investigation in the field of "translation science" or "knowledge utilization." Research shows how individuals, units, and organizations all influence the rate and extent of adoption of research evidence. Environmental factors also play an important role in this process. This article summarizes key lessons from translation science and examines the implications for the organization and delivery of home healthcare. The implementation of pain management guidelines is used as an example.
Health Knowledge, Attitudes, Practice↗
Health perceptions and behaviors of school-age boys and girls.
This study described and compared the health perceptions and behaviors of 83 school-age boys and girls. An age-appropriate interview schedule was designed to collect data related to demographic characteristics, health perceptions, safety, life-style practices, nutrition, dental health, and care of minor injuries. Findings indicated that most boys and girls viewed themselves as healthy and managed their own care fairly well in the areas of seat belt use, exercise, and dental health. Nutrition was identified as an area of concern, with 10% of the children skipping breakfast, and over half eating snacks with empty calories. Generally, children were found to be knowledgeable in the management of simple injuries and how to respond in the event of an emergency. Boys and girls were similar in all areas of health perceptions and behaviors except for dental health, with boys reporting more regular visits to the dentist than did girls. Further research is needed to learn more about the process by which school-age children acquire positive health behaviors to assist nurses to design and implement intervention programs that appropriately address the needs of this age group.
Child↗
The effectiveness of one-on-one nurse education on the outcomes of high-risk adult and pediatric patients with asthma.
The effects of an asthma self-management program on asthma outcomes were evaluated in adult and pediatric patients with asthma who were considered at high risk (i.e., those who were not in control of their disease as determined by resource utilization, medication use, or lack of use). The program consisted of one-on-one nurse-to-patient ("nurse champion") education and subsequent assessment of asthma outcomes using the Asthma Quality Assessment System (AQAS) questionnaire, which measured asthma severity, patient quality of life, asthma awareness and knowledge, confidence in managing asthma, use of peak flow meters, asthma symptoms, medication use, lost work or school days, and affect of asthma. Over the course of six months, nurse champions educated 201 patients from four managed care plans and collected data at baseline and during four follow-up sessions. Adult patients and pediatric patient caregivers reported significant improvements in quality of life, and clinical and process measures. Significant increases in asthma knowledge were observed immediately after patient education, including greater than 89% increase in the proportion of patients who reported that they know "a lot" about the "things that cause asthma symptoms." Significant decreases were also found in work or school days missed, urgent care utilization, and hospital admission rates. Appropriate preventive care visits increased by more than 40%. These results indicate that the nurse champion program was associated with an improvement in asthma outcomes in high-risk adult and pediatric patients and warrant further evaluation in controlled studies. Incorporating one-on-one education programs into asthma management is an effective and rapid means of improving asthma outcomes.
Absenteeism↗
The education of future senior health service managers.
Primarily due to economic forces, health services are being forced into a tight organisational framework of hospitals, clinics and services which need to be managed by educated professional managers. These managers need to be competent general and financial managers, competent planners, knowledgeable about health status, health issues, the Australian health care systems and knowledgeable about society, law and ethics. Assumptions that recruitment of people with such a formidable array of talents would be difficult are incorrect as judged by current experiences. Very talented and experienced candidates are being attracted to graduate education programs in health service management in many Australian universities. Accordingly the future management of Australian health services should be in good hands.
Australia↗
Rheumatology algorithms for primary care physicians.
Primary care physicians were trained on three rheumatology topics to assess the effectiveness of an educational strategy for continuing medical education. Algorithm training was shown to be at least as effective as that based on standard prose monographs. Both training groups improved their knowledge of patient management skills but there were no statistically significant differences between groups in the amount learned. When algorithms were used to design text materials, the designed texts required less study time than did the annotated clinical algorithms alone. That difference was significant for the shoulder pain materials (P less than 0.05) but not for the osteoporosis materials. The ratio of knowledge gained to study time was significantly higher for the algorithm group on the low back pain topic (P less than 0.05) but not for the other topics. Taped interview problems tests were studied as a method for assessing patient management skills related to problem-specific indicator conditions and were found to produce interrater reliability greater than 0.80 on five of the six tests.
Clinical Protocols↗
Food safety practices and readiness to implement HACCP programs in assisted-living facilities in Iowa.
OBJECTIVE: To evaluate current food-handling practices and employee food safety knowledge and attitudes and to provide baseline data for implementing the Hazard Analysis and Critical Control Point (HACCP) program in assisted-living foodservices for elderly persons. DESIGN: Food-handling practices were observed at each assisted-living facility using a structured observation form. A validated questionnaire was used to determine demographic information and employees' attitudes and knowledge about food safety. SUBJECTS/SETTING: A convenience sample of 40 assisted-living facilities in Iowa was recruited from a list obtained from the Iowa Department of Elder Affairs. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to summarize data. One-way analysis of variance was used to assess differences in attitudes and food safety knowledge among the managers, cooks, and other foodservice employees. Multiple linear regression determined the relationship between manager and facility demographics and the food safety practice score. RESULTS: Proper food-handling practices were followed in many assisted-living facilities, but areas in need of improvement were identified. Some HACCP prerequisite programs were found to be inadequate, including a lack of written standard operating procedures, documentation of food safety practices, and training. Temperatures and chemical concentrations need to be checked routinely. Foodservice employees had a significant amount of food safety knowledge (14.6+/-3.0 out of 20 possible points), and employees with food safety certification scored higher than those with no certification (15.6+/-2.6 and 13.9+/-3.1, respectively; P </=.001). CONCLUSIONS: Training programs, both basic food safety and the HACCP program, will support improvement of safe food-handling practices and implementation of prerequisite programs and the HACCP program. Developing prerequisite programs, including sanitation standard operating procedures, will aid assisted-living facilities in moving toward HACCP program implementation.
Adult↗
An exploratory qualitative study of women's perceptions of risk management options for familial ovarian cancer: implications for informed decision making.
OBJECTIVE: Women who are at increased risk of familial ovarian cancer face complex decisions about strategies for managing their risk due to a lack of evidence regarding the benefits of ovarian cancer screening (OCS) and prophylactic surgery. At present, there is a limited understanding of women's attitudes towards these options. METHOD: In-depth interviews were conducted to explore perceptions of ovarian cancer screening and prophylactic oophorectomy (PO) in 10 women who were newly identified as being at increased risk of familial ovarian cancer. RESULTS: The study findings highlight the gaps in women's knowledge about risk management options. Although most women derived considerable reassurance from ovarian screening, many were not aware of the limitations of the screening process or the likelihood of receiving false positive results. Areas in which women's knowledge about prophylactic oophorectomy could be improved include the practicalities of surgery, the risks and benefits of HRT given postsurgically, the limitations of surgery in removing risk, and the absence of concrete information on which to base surgical decisions. In particular, women who were not previously aware of their increased risk may need additional psychological support and preparation. CONCLUSIONS: The present study raises serious questions about the extent to which women are making informed decisions about familial ovarian cancer risk management strategies. Suggestions are made for improving the information and support provided to women and for large-scale prospective research.
Adult↗
Viewpoint: management of malaria--working with the private sector.
Recent reviews have demonstrated that a substantial proportion of cases of malaria are managed in the private sector, and international policy initiatives routinely emphasize the need for malaria control programmes to collaborate with the private sector. However, information on how to develop successful partnerships between the public and private sectors remains limited. This paper reviews the current knowledge about the management of malaria by private providers, considers the potential of different strategies for influencing the quality of care provided, and identifies processes for facilitating public-private sector collaborations. We contend that public sector-led interventions, such as training of private providers or the distribution of prepackaged antimalarials through the private sector, are unlikely to scale up to sustainable national level programmes if they do not take into account a wide range of needs and concerns, represented by private provider organizations and other interest groups, including service users. These groups should be involved at key stages including the design and piloting of interventions, through to the dissemination and implementation of findings. Research priorities are outlined for the development of tools to facilitate public-private partnerships for improving the management of malaria.
Antimalarials↗
Asthma education: what has been its impact?
Despite significant advances in the understanding and therapy of asthma, it is still a disease associated with an important human and socieconomical burden. There is still a gap between what is considered 'optional asthma management' and current care. All recent treatment guidelines indicate that asthma education is one of the main components of asthma management, with patients needing to get actively involved in their own care. Many educational programs have been developed in the past two decades, showing marked differences in approaches, populations involved and capacity to influence asthma outcomes. Published evaluations indicate that these programs generally increase knowledge and self management skills, but only a minority of programs showed a significant reduction in asthma-related morbidity. The most effective programs seem to be those integrated to asthma care, provided by specialized educators, based on behavioral theories and aimed at improving self-management skills. particularly when offered to asthmatic patients with high morbidity. Asthma education programs for both patients and health professionals need to be improved and made widely available. Hopefully, such initiatives will be supported and implemented to provide cost effective educational interventions that will improve quality of life of asthma sufferers and reduce health care costs.
Asthma↗
Case-based independent study for medical students in emergency psychiatry.
OBJECTIVE: Brief cases designed for independent study were developed to allow third-year medical students some exposure to important concepts in emergency psychiatry during their required psychiatry clerkship. METHODS: Five independent study cases were given to University of Michigan third-year medical students during their psychiatry clerkship, and their performance on a pre- and posttest of knowledge of emergency psychiatry management was compared between students who did and did not use the independent study cases. RESULTS: All of the students improved in their knowledge of emergency psychiatric management, but the students who completed the cases had a significantly better performance on the postrotation quiz. CONCLUSIONS: Case-based independent study is an effective method to improve exposure to emergency psychiatry cases during a third-year medical student clerkship.
Clinical Clerkship↗
Working with an Aboriginal community liaison worker.
FPA Health (Family Planning NSW) has conducted two integrated clinical and health promotion projects with Aboriginal communities in western NSW, Australia. The first was in Coonamble, a small rural community which had been selected as a pilot site for the Royal Australian College of General Practitioners Women's Aboriginal and Torres Strait Islander Project and was managed by FPA Health with support from the Dubbo/Plains Division of General Practice and Macquarie Area Health Service. The second was in Dubbo, a regional city where FPA Health had an existing centre and which had funding support from the Rio Tinto Aboriginal Foundation. The aim of this article was to share the learning and knowledge gained in managing these projects and to describe the experience of working with Aboriginal Community Liaison Workers who belong to and are supported by, the local Aboriginal community. The article aimed to illustrate the role and value of utilising these workers within a mainstream health service. The beneficial outcomes include improving service provision to Aboriginal women, adding to community knowledge about reproductive and sexual health issues and increasing the cultural knowledge and competency of a mainstream health service organisation.
Australia↗
An educational intervention to improve the quality of care of diabetic patients.
OBJECTIVE: As few studies have addressed intervention for in-hospital care of diabetes mellitus (DM) patients, we set out to investigate whether an educational intervention targeting doctors could improve the quality of care for diabetic patients. DESIGN: An observational interventional study conducted at Pretoria Academic Hospital, a tertiary care hospital. SUBJECTS: Doctors working in the Department of Internal Medicine were the subjects of two interventional sessions on diabetic care, and all diabetic patients admitted to the wards in the above Department were evaluated. OUTCOME MEASURES: A Diabetes Attitude Scale (DAS-3) and a Diabetes Practice Scale (DPS) were completed by each doctor before and after the interventional educational sessions. Data from diabetic patients in the wards were collected for 5 weeks before and 5 weeks after the interventional training, and these two sets of data were compared to measure the effect of the interventional training. RESULTS: Subscales of the DAS-3 showed an improvement, with a statistically significant improvement in attitude regarding seriousness of DM (P = 0.03), and a trend towards improvement in attitude regarding need for special training and patient autonomy. Most of the items on the DPS improved significantly (P < 0.05). CONCLUSIONS: A short educational intervention resulted in an improvement in attitude, knowledge and clinical management of diabetic patients.
Adult↗
Questionnaire survey on management of spontaneous pneumothorax.
INTRODUCTION: Management of spontaneous pneumothorax (SP) is variable and the initial management of SP is often undertaken by frontline junior medical staff. OBJECTIVES: To assess if medical education in the principles of SP management is adequate and to determine if practice variability exists among different disciplines. METHODS: A validated questionnaire survey on the knowledge and practice of the junior medical staff posted to a general hospital from May to December 1998 was performed. 138 doctors posted to the various departments: medical (n = S9), surgical (n = 46) and emergency (n = 33) were surveyed. RESULTS: The response rate was 95%. 73% surveyed had experience inserting chest tubes (CT). Of the 27% (n = 37) who had never inserted CT, 41% were medical officers. Our results showed adequate knowledge pertaining to initial management of primary SP (PSP). The preferred site and method for CT insertion was the 5th intercostal space, anterior axillary line and open method. There was significant practice variability in the CT size, method of insertion and CT removal sequence among the disciplines (p < 0.05). However a significant proportion of staff (49%) chose to observe or aspirate an acutely breathless patient with a 10% secondary SP (SSP) instead of CT insertion. CONCLUSION: While knowledge in PSP appears adequate, management of SSP and practical training in CT insertion must be emphasized as it is a simple procedure that is potentially life-saving.
Attitude of Health Personnel↗
Managing cancer and noncancer chronic pain in critical care settings. Knowledge and skills every nurse needs to know.
Nurses and physicians caring for people with all types of pain are responsible for providing effective pain management in all clinical settings. Although the principles for managing all types of pain are similar, people with chronic pain have special needs to sustain optimal analgesia in critical care settings. Nursing practice must be guided by national standards, guidelines, and recommendations for managing chronic and acute pain. Pain assessment, reassessment, and follow-up; titration of medications to individual responses; aggressive management of side effects; prevention of pain; and routine evaluation of the effectiveness of the plan are basic skills for all health professionals. Every person's baseline level of pain must be determined, and preexisting interventions for pain relief must be maintained to assure continuity of care. Chronic pain complicates clinical problems and could have a profound effect on patient outcome. Managing chronic pain improves function, outcome, and quality of life. The knowledge, skills, medications, nondrug interventions, and technology are available to manage nearly all types of pain. Pain relief is a responsibility of all health care professionals. Our patients deserve our best efforts to optimize their comfort, and we must be accountable.
Aged↗
Mastery path for developing nurses for management: a conceptual model.
The demand for knowledgeable and skilled nurses in health care management positions highlights the importance of identifying management practices, competencies, and skills of effective managers. Once these attributes are identified, then approaches can be identified for developing nurses for these positions. This article describes a conceptual model, the Mastery Path for Developing Nurses for Management, that serves as a tool for the profession of nursing, health care organizations, and academic institutions to identify and educate nurses in the health care system.
Attitude of Health Personnel↗