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PubMed1978

Home management of hyperkinetic children.

Six clinical programs and one controlled, experimental program are described in which parents of hyperkinetic children were trained to alleviate behavior problems in the home. Parents attended educational workshops in which basic general principles of behavior modification were taught. As a result of the training workshops, parents were able to achieve significant reductions in their children's hyperactivity and in the severity of behavioral problems, as well as significant gains in their knowledge of behavior management. All gains were maintained at the time of follow-up assessments. Parent-training workshops are considered to be a useful adjunct to other services provided to the hyperkinetic child and his family.

Adolescent↗
PubMed2004

Management of bipolar disorder during pregnancy and the postpartum period.

OBJECTIVE: Bipolar disorder affects 0.5%-1.5% of individuals in the United States. The typical age at onset is late adolescence or early adulthood, placing women at risk for episodes throughout their reproductive years. General guidelines for the treatment of bipolar disorder are available from the American Psychiatric Association, but additional issues arise when these guidelines are applied in the treatment of peripartum women. The authors summarize knowledge regarding the management of bipolar disorder during pregnancy and the postpartum period, with a focus on managing mania, hypomania, and the psychotic components of the illness. METHOD: An expert panel reviewed articles that address the management of bipolar disorder and the consequences of the use of mood stabilizers during pregnancy, and a consensus document was generated. RESULTS: The treatment of bipolar disorder in pregnant women involves significant challenges. Some mood stabilizers, e.g., sodium valproate and carbamazepine, are human teratogens. On the other hand, the teratogenicity associated with lithium may have been overestimated in the past. CONCLUSIONS: Since treatment can be managed most effectively if pregnancy is planned, clinicians should discuss the issue of pregnancy and its management with every bipolar disorder patient who has childbearing potential, regardless of future reproductive plans. Additional research should address the risks of disturbed sleep to pregnant and postpartum women with bipolar disorder, as well as structural and behavioral consequences to offspring when mood stabilizers are used during pregnancy. Longitudinal and cohort studies can promote these efforts. Given the rate of bipolar disorder in the general population, research efforts will need to be broad based and include multiple collaborating centers.

Adolescent↗
PubMed2005

Framework for measuring adaptive knowledge-rich systems performance.

The universe is non repeatable in nature--most of events cannot be prestated and do not repeat themselves. The only way to create systems that are truly useful is to make them adaptive (able to reason by analogy and learn) and rich in knowledge (including common sense knowledge). Adaptive and knowledge-rich health management could get us closer to errorless health care where small incremental adjustments happen all the time preventing occurrence of an error. In the era of adaptive systems we need to have a way to evaluate their performance. Are they truly adaptive? How adaptive are they? Are they accurate enough? Are they fast enough? Are they cost effective? This chapter presents general framework for measuring adaptive knowledge-rich systems' performance and includes among others definitions of adaptiveness factor, britt (a unit of brittleness) and uso-quant (unit of usefulness of a piece of knowledge). Measuring adaptive knowledge-rich systems performance is one of the most important research areas that can have a big pay-off in healthcare now and in the future.

Artificial Intelligence↗
PubMed2002

Valuing 'voices from below'.

The publication of Commission for Health Improvement (CHI) reports in recent years have revealed that employees attempted to blow the whistle on abuse, corruption or malpractice but were largely ignored by senior members of staff. The CHI report into the North Lakeland National Health Service (NHS) Trust (November 2000), for instance, states that an initial failure among management to listen to the concerns of student nurses led to the sustained abuse of patients. To protect patients from incompetent and unethical practitioners and improve standards of care, an environment needs to be created where health care professionals feel able to express legitimate concerns openly and honestly to senior staff, safe in the knowledge that senior managers will take their concerns seriously and act accordingly. The government has pledged to create an 'open culture' in the NHS to encourage staff with genuine concerns to speak out. This can only be achieved if the current leadership culture characterized by conflict avoidance, blame and hierarchical control is replaced with openness and accountability. To produce the desired changes in culture and attitudes, the NHS needs strong leaders capable of challenging the existing social equilibrium.

Humans↗
PubMed2000

Evaluation of a computer-assisted learning package on the management of traumatised incisors by general dental practitioners.

UNLABELLED: A computer-assisted learning program with a tutorial, self-assessment exercises and an expert system has been developed. Sixty-seven general dental practitioners were requested to evaluate the program. The results from those practitioners who returned the questionnaire showed that 57% found the program generally easy to use with the appropriate level of difficulty of tasks and content of supporting information, which it was felt improved their knowledge of the management of fractured incisors. CONCLUSION: It is worthwhile to develop such programs for the education of general dental practitioners. All users of this program felt that it was better than video, audio tapes, journals or books on the subject.

Adult↗
PubMed2005

Oral health and dental care facilities in Maltese residential homes.

OBJECTIVES: To establish oral health care practices, including the use of dental services, in the residential homes of Malta and Gozo by assessing the knowledge of home managers and assistance of care staff regarding residents' oral health and hygiene; and evaluating the residents' demand for dental treatment and residential home managers response to this demand. SUBJECTS: A total population sample of licensed residential homes (38) in Malta and Gozo was used comprising all home managers in government (seven), church (20), and privately run (11) residential homes. METHOD: A 19-question questionnaire was designed, piloted and sent to the home managers requesting them to report on the dental care provision for their elderly residents. The questionnaire was distributed by post, along with a reply-paid envelope and an explanatory letter. A response deadline of 1 month was included. RESULTS: An 87% response rate was achieved. Whilst the majority of home managers (64%) were aware of domiciliary dental services, there was no code of care practice for oral health. Routine dental check-ups were not organised for residents of most homes. Although home staffs were generally given information about residents' oral health and hygiene, the majority did not assist residents with oral hygiene. Home managers identified the following barriers to the use of dental services by residents: cost, communication problems with dental staff, journey to place of treatment, waiting time at the dental clinic, access to premises/clinic, lack of information on oral health and dental service availability, no one to accompany the person to the clinic, and health problems such as mobility, poor eyesight, hearing impairment and mental health status. CONCLUSION: Although most home managers appreciate the importance of oral health care for their residents, the residents still face many barriers to maintaining adequate oral health care and accessing dental services.

Aged↗
PubMed2002

Home management of febrile convulsion in an African population: a comparison of urban and rural mothers' knowledge attitude and practice.

To determine the knowledge, attitude and practice (KAP) of home management of febrile convulsion (FC), by mothers in the community, focus group discussions (FGD) were conducted in two communities, Uselu (urban) and Evbuomodu village (rural), both in Edo State, Southern Nigeria. The study was conducted between December 2000 and February 2001. Our findings show that 71% of urban mothers compared to 25% of rural mothers attributed the cause of FC to fever (chi(2)=24.17: p<0.001). Seventy-five percent of mothers from rural community and 28.6% of urban mothers attributed the cause to witchcraft and/or evil spirits. Twenty-five percent of rural mothers also attributed abnormality of the spleen as a cause of FC. All the mothers, both urban and rural, were not directly involved in the management of the convulsive episode due to panic and confusion. Ninety-two percent of urban and all the rural mothers permitted the use of traditional medicine while 7.1% of urban mothers employed prayers during convulsion. Twenty percent of urban and twenty-two percent of rural mothers use urine (human and or cow's) for treating FC at home. Other home remedies include kerosene, fuel and crude oil. Mass enlightenment campaign for the community, especially the rural, against use of harmful traditional remedies to treat FC at home is strongly advised.

Attitude to Health↗
PubMedDate not supplied

A joint effort to affect lives. The COPD Wellness Program.

Health care providers can work toward the goal of maintaining quality, dignity, and independence in the elderly when they combine resources with the community to promote wellness and help manage chronic problems. The Chronic Obstructive Pulmonary Disease (COPD) Wellness Program was undertaken for this purpose. The target participants were elderly individuals and their care partners who met the program qualifications: a diagnosis or symptoms of COPD and residency in a certain independent housing facility. The program was designed to help the participants maximize their independence through knowledge and improved management of their disease process.

Activities of Daily Living↗
PubMed2002

Reported management of early-pregnancy bleeding and miscarriage by general practitioners in Victoria.

OBJECTIVES: To describe the management of early-pregnancy bleeding and miscarriage reported by general practitioners in Victoria. DESIGN, SETTING, AND PARTICIPANTS: Self-administered, mailed survey of a stratified random sample of GPs in Victoria. Responses weighted by strata to reflect GP population. MAIN OUTCOME MEASURES: Reported management in referral; investigation (especially ultrasound); expectant versus interventional management; and prevention of rhesus iso-immunisation RESULTS: 382 of 621 eligible GPs responded (response rate, 62%). GPs' reported referral was more likely if the patient had painful bleeding (55%) or if the pregnancy was not viable (77%). Ultrasound strongly influenced the assessment of bleeding. Two-thirds of doctors (262/369; 66%) would routinely order ultrasound for painless bleeding, and 328/369 (84%) for painful bleeding. Expectant management was recommended by 15/353 (4%) for incomplete miscarriage with light bleeding and by 6/351 (2%) when bleeding was heavy. Some GPs are uncertain of the indications for anti-D prophylaxis, including instrumentation of the uterus, for which 261/337 (77%) said they would routinely offer anti-D. There was less agreement about anti-D after threatened miscarriage, for which 213/353 (57%) said they offered the injection. CONCLUSIONS: GPs need a working knowledge of the management of early-pregnancy bleeding, and can probably encourage more rational management. There are significant areas where GPs are uncertain, often reflecting uncertainty elsewhere, and some areas where a minority of GPs are not aware of essential requirements.

Abortion, Spontaneous↗
PubMed2001

Stories as case knowledge: case knowledge as stories.

INTRODUCTION: Every case contains a human story of illness and a medical story of disease, which together cover person management, case management, health system management and self-management. Much of that management can be learned via a thorough set of stories of typical and atypical core cases compiled by clinical teachers. Stories provide a highly flexible framework for illustrating the lessons of experience, the tips and traps for young players, and the dilemmas requiring careful judgement in the trade-offs between benefits and risks. Listening to real stories unfold is much more fun than being lectured (and better remembered). DISCUSSION: Stories illustrate 'what can happen' in a case as a guide to 'what to do'. A story begins with a real world situation with some predicament and a (causal) sequence of events or plot in which things are resolved one way or another. Patients tell their illness story; their clinician translates that into a disease story. Stories sort out what is important in such a predicament, consider the strategy and tactics of what to do, and speak about the outcomes. Each local situation provides relevance, context and circumstantial detail. Stories about case management can encapsulate practical knowledge, logical deduction, judgement and decision making, sharing with the student all the ingredients that develop expertise. Sometimes it is the plot that is important, sometimes the detail, sometimes it is the underlying message, the parable that resonates with the listener's experiences and feelings.1 Stories can also accommodate the complexity of multiple variables and the influence of other stakeholders, the uncertainties and dilemmas within the trade-offs, and the niceties of 'informed judgement'. CONCLUSION: This paper makes four points. First, clinical stories recount pointed examples of 'what happened' that expand our expertise in handling 'a case like that'. Second, cases are the unit of clinical work. Case stories expand the dimensions and details of case knowledge, case-based reasoning and case management. Carefully collated case stories can comprise the 'real life' clinical curriculum. Third, stories provide a framework for 'web' or 'net' thinking that links all the objective and subjective details within the multifaceted complexity of case management. Fourth, personal stories explain how both numerical and non-linear influences determined what decision was actually made in that case.

Anecdotes as Topic↗
PubMed2004

The role of research in a technical assistance agency: the case of the 'German Agency for Technical Co-operation'.

Technical assistance agencies have a sustainable impact on the health systems of the countries they are operating in. As well as policy-makers at the national level, technical assistance agencies see themselves confronted that their interventions should be based on evidence, usually meaning the results of research. This study has the aim to analyse role of research in the implementation of technical assistance. We sent a questionnaire to all health project managers of the 'German Agency for Technical Co-operation' and performed a qualitative case study in one of the health projects. Forty-seven of 80 (58.8%) of the questionnaires were completed and sent back. The managers considered publications of International Organisations (IOs), scientific articles and local research as most important for their work. The case study showed application problems in the daily work. Research use not only depends on the relevance of the data but also on analytical skills, linguistic barriers and technical access to research by the potential users. The role of knowledge and information management has to be clearly defined in an organisation of technical assistance. The specific needs at the different levels have to be analysed so that skills and resources can be allocated adequately.

Cooperative Behavior↗
PubMed2005

Gunshot injuries to the extremities: experience of a U.K. trauma centre.

BACKGROUND: The Metropolitan Police figures suggest an increase in the incidence of injuries related to gun crime. We conducted a retrospective analysis of extremity gunshot injuries over a five-year period. Our aim is to report on our (1) incidence, (2) complications and (3) experience in treating these injuries. METHODS: Over a five-year period (1998-2002), 70 extremity gunshot injuries in 61 patients were identified from a trauma register and case notes reviewed retrospectively. The following were identified and analysed: type of injury (low or high-energy transfer), treatment (early/late), complications, patient demographics and compliance. RESULTS: There was a four-fold increase in incidence. Our incidence correlated well with The Metropolitan Police figures (r = 0.93). One-third of our injuries were managed non-operatively and on an outpatient basis. Complications were as follows: eight wound infections, one fracture non-union, one compartment syndrome, one vascular injury and five nerve injuries. Compliance was excellent for high-energy transfer injuries. CONCLUSION: Extremity gunshot injuries are on an increase in the United Kingdom highlighting the need for trauma surgeons' knowledge of the management of these injuries. Complications can be reduced to a minimum if the basic principles of management are strictly adhered to.

Adolescent↗
PubMed2001

Pelvic and aortic lymphadenectomy.

Pelvic and aortic lymphadenectomy for gynecologic malignancies has changed from a random "picking" of some pelvic and aortic lymph nodes to a well-established technique based on adequate knowledge of the patterns of spread of the primary tumor. The identification of the node groups to remove, the number of nodes to count, and the border of dissection in the different clinical situations make pelvic and aortic lymphadenectomy a reproducible surgical intervention. The large experience accumulated over the years has greatly improved the technique and perioperative and complication management. The improved knowledge of the natural history of gynecologic tumors has refined the indications for lymph node dissection. Today, pelvic and aortic lymphadenectomy is primarily a staging procedure. The therapeutic value of lymphadenectomy is recognized in the surgical treatment of cervical cancer, but it is still under evaluation in ovarian and endometrial tumors.

Aorta, Thoracic↗
PubMed2003

Knowledge systems for sustainable development.

The challenge of meeting human development needs while protecting the earth's life support systems confronts scientists, technologists, policy makers, and communities from local to global levels. Many believe that science and technology (S&T) must play a more central role in sustainable development, yet little systematic scholarship exists on how to create institutions that effectively harness S&T for sustainability. This study suggests that efforts to mobilize S&T for sustainability are more likely to be effective when they manage boundaries between knowledge and action in ways that simultaneously enhance the salience, credibility, and legitimacy of the information they produce. Effective systems apply a variety of institutional mechanisms that facilitate communication, translation and mediation across boundaries.

Agriculture↗
PubMed2000

All the king's horses and all the king's men: pain management from hospital to home.

Pain management in children with cancer continues to be less than adequate in most settings. Children in pain often have multiple caregivers, each imposing a significant risk to adequate pain management if they are uninformed about the principles of pain management and the child's specific pain management regimen. This article reviews current pain management guidelines for children, obstacles to adequate pain management, and the challenges of managing pain across care settings (hospital to home). Using the hospice model of care, case studies are presented that illustrate both threats to adequate pain control and the coordination of care necessary to ensure consistent pain management between the hospital and home. Implications for improvement in pain management between settings and future directions for advancing skills and knowledge related to pain management in children with cancer are provided.

Child↗
PubMedDate not supplied

Alzheimer disease and its management: a review.

Alzheimer disease is a progressive degenerative disorder of the brain characterized by a slow, progressive decline in cognitive function and behavior. As the disease advances, persons with Alzheimer disease have tough time with daily usage of things like using the phone, cooking, handling money, or driving the car. The disease is more common in elder population. It is estimated that Alzheimer disease affects 15 million people worldwide and approximately 4 million Americans. The clinical features of Alzheimer disease overlaps with common signs of aging, and other types of dementia, hence the diagnosis remains difficult. The neuropathologic hallmarks of the disorder are amyloid-rich senile plaques, neurofibrillary tangles, and neuronal degeneration. Drugs approved for treating Alzheimer disease include acetylcholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonist. Caregivers not getting adequate information about Alzheimer disease may believe that nothing can be done to manage its symptoms. Understanding the extent of Alzheimer disease related knowledge can assist disease management that result in improved disease management and reduced care costs. This article attempts to focus on some of the important recent developments in understanding and management of Alzheimer disease.

Alzheimer Disease↗
PubMed1983

Core course in leadership and management skills for allied health professionals.

This article describes the two major purposes of a core course for allied health professionals developed at the University of North Carolina. The purposes of the course are to equip practitioners with practical skills necessary for effective management and to bridge the gap between didactic and clinical knowledge. Emphasizing leadership and management skills, the course has four major sections: Current Health Care Issues, Management and Administrative Skills and Issues, Professional Development Skills, and Clinical Education. Classroom formats, student assignments, and relevant readings are suggested, and participant reactions to the course are described.

Administrative Personnel↗