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PubMed2000

STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers.

BACKGROUND: Prompt treatment of sexually transmitted infections may reduce the incidence of HIV/AIDS infections. With health sector reforms private pharmacies are increasingly the first and only contact with health delivery services. OBJECTIVES: To find out how patients with STDs are treated at private pharmacies in Hanoi, and what drug sellers know about STD management. METHODS: Five simulated clients were taught to adopt a scenario stating that their friend had a urethral discharge. They visited 60 randomly selected private pharmacies in urban Hanoi and noted all questions asked, advice offered, and treatment given. Afterwards interviewers administered a semistructured questionnaire to all people working in the 60 pharmacies. RESULTS: Drug treatment was given in 84% of the 297 encounters averaging 1.5 drugs and 1.2 antibiotics per encounter. Quinolones were given 188 times. No dispensing was adequate for chlamydia or was in accordance with the national guidelines. No questions were asked in 55% of encounters and no advice was given in 61%. Questions on sexual activity were asked in 23% (69) of cases and about the health of the partner twice (1%). Advice to practise safe sex was given in 1% of encounters and for the partner to seek treatment only once. Of 69 questionnaires administered 51% said they would refer to a doctor, 16% said they would ask about the sexual activity 1% said they would ask about the health of the partner, 7% said they would advise using a condom, and 1% advised telling the partner to seek treatment. Even after prompting, 61% would ask no questions and 80% would give no advice. CONCLUSIONS: Even though 74% of pharmacists and drug sellers know that they should not treat STD patients, 84% actually did. None gave syndromically correct treatment. In both the questionnaire and during the simulated client methods, numbers advising on partner notification and condom use were very poor. Educational or peer awareness interventions are urgently needed among private pharmacists in Vietnam.

Community Pharmacy Services↗

PubMed1989

Cholesterol knowledge and practices among patients compared with physician management in a university primary care setting.

Lowering elevated serum cholesterol has been shown to reduce the risk of symptomatic coronary heart disease. The National Institute of Health and National Cholesterol Education Program recommend that all adults obtain a cholesterol screening and state that desirable adult levels are less than 200 mg/dl. This study examined the knowledge and practices regarding cholesterol among patients and physicians in a university-based primary care clinic that serves a large proportion of elderly and indigent patients. One hundred fifty-nine patients were interviewed and their medical records were examined. Twenty-four percent of patients were aware of their elevated cholesterol levels, 60% were aware of the health risks associated with hypercholesterolemia, and 83% were able to state methods of lowering cholesterol levels. Approximately 50% stated that they were making considerable efforts to lower fat and cholesterol consumption. Physicians listed cholesterol as a problem in 29% of patients with elevated values (greater than 200 mg/dl) and counseled 17%. Results indicate a good level of knowledge and interest in cholesterol as a health risk even in this group of patients with the multiple problems associated with low socioeconomic status. Knowledge of personal risk status, however, was poor. Physicians need to improve documentation, counseling, and monitoring of patients with elevated cholesterol levels. Long-term follow-up is needed to evaluate efficacy.

California↗

PubMed2004

Vaccination coverage and epidemiological parameters of the owned-dog population in Thungsong District, Thailand.

Canine rabies vaccination is delivered in Thungsong District, Thailand, as an annual campaign between March 1 and 31, and also at other times through private veterinary clinics, para-veterinarians and health-care staff residing in the villages. The current questionnaire-interview survey was conducted between June 23 and July 18, 2002 to determine: rabies-vaccination coverage amongst the owned-dog population; basic dog-population information; and community awareness about rabies. The modified expand programme on immunization cluster-survey method was used to collect information about dog demography and management characteristics. Household knowledge about rabies and sources of rabies information were assessed. Vaccinated dogs were identified from vaccine certificates or owner reports confirmed by vaccinators. Seventy percent (95%CI 62-78) of 364 eligible owned dogs were vaccinated within the 6 months prior to data collection. Of these 255 vaccinated dogs, 44, 21, 13, 17 and 5% were vaccinated through the annual vaccination campaign, veterinary clinics, para-veterinarians, other vaccinators and owners, respectively. Fifty-four percent of households owned dogs. The sex ratio in dogs was 2 males per female; the dog: human ratio was 1: 4.6 with an average of 0.9 dogs per household (1.7 dogs per dog-owning household). Most dogs roamed freely and these were less likely to be vaccinated compared to dogs being kept on premises or on a leash. Almost all households were aware of rabies and the need for dog rabies vaccination as a control method. Seventy-six percent believed that rabies only occurred in summer. There was little awareness about cat rabies amongst households. Vaccination coverage in the total dog population clearly has not yet reached the 80% target level set by Thailand's official rabies-control programme. Improved effectiveness of the owned-dog rabies-vaccination campaigns in each community is needed-perhaps by more community education about dog management or by better management of ownerless dogs.

Animals↗

PubMed2004

Overview of endpoints in atrial fibrillation studies.

Among the principles for selection of endpoints for trials of arrhythmia management, the most important is that the endpoint be clinically relevant. According to this principle, the endpoint must be closely related to the objective of therapy. In the case of atrial fibrillation, for too long it seems, it has been believed that the primary objective of therapy has been maintenance of sinus rhythm. However, it is important to recognize that maintenance of sinus rhythm is, in fact, a surrogate endpoint and, as the lesson of the Cardiac Arrhythmia Suppression Trial has taught us, arrhythmia suppression is not necessarily a good surrogate for clinical events of importance. The use of clinical events as endpoints is to be encouraged, but the problem is that these events occur with a low frequency in many patients with atrial fibrillation. Symptoms are a primary target of therapy and potentially a good endpoint, but good methodology for quantification of symptoms remains to be developed. Methodology for assessment of patient-perceived quality of life is more highly developed. Surrogate endpoints, such as measurement of sinus rhythm or heart rate control, have the dual problems that they have not been well calibrated with clinical events and they sometimes are overly precise. Other surrogates have not been investigated. Composite endpoints are potentially useful, and cost is an important endpoint. More research on the validity of some of these endpoints is needed if we are to advance our knowledge of the management of atrial fibrillation in a meaningful way.

Atrial Fibrillation↗

PubMed2003

A randomized controlled trial of an educational intervention to improve phosphate levels in hemodialysis patients.

OBJECTIVE: To determine the effect of a dietetic educational intervention on phosphate and calcium levels of hemodialysis patients. DESIGN: Parallel-group randomized controlled trial. SETTING: Teaching hospital hemodialysis unit in London, England. PATIENTS: Fifty-six stable adult hemodialysis patients with hyperphosphatemia. INTERVENTION: An educational intervention and one-to-one teaching session given by a renal dietitian, attempting to improve patients' knowledge of phosphate management and their compliance with diet and medication. OUTCOME MEASUREMENT: Patients' serum phosphate, calcium, and calcium x phosphate products in the 3 months after the intervention, compared with those before the intervention. Results were also compared with a control group that had not undergone the intervention. RESULTS: In the intervention group, serum phosphate was significantly reduced after the education session, as compared with the results previously. In the control group, there was no significant change in serum phosphate level. The improved results were sustained over a period of 3 months. Serum calcium increased in the intervention group, but this result was not significant. There was an improvement in the calcium-phosphate product in the intervention group, but again this was not significant. CONCLUSION: Dietetic educational intervention can favorably alter patients' serum phosphate levels, with potential impact on morbidity and mortality.

Adult↗

PubMedDate not supplied

A study of parent/grandparent education for managing a febrile illness using the CALM approach.

INTRODUCTION: The purpose of this study was to examine the effectiveness of fever management education in increasing knowledge, confidence, comfort, and satisfaction of the parent/grandparent. METHOD: A randomized repeated measures design was used to evaluate the effectiveness of an educational brochure and video. After baseline data were collected on parent/grandparents of children receiving standard care, each site was randomized into two groups: Group 1 parents were given a video and brochure about fever management as they left the clinic/office; Group 2 were shown the video and given the brochure before seeing their health care provider. The parent/grandparents of 216 children, mean age 21.8 months, completed the Fever Management Questionnaire (FMQ) at 48-72 hours, 1, 3, and 6 months post-education. RESULTS: Knowledge scores of parents/grandparents in both CALM groups were significantly higher than those in the control group at 48 hours and 1-month post-visit. By 6 months, the knowledge level of the parent/grandparents in CALM2, those who viewed the video in the office, was significantly different from the other two groups. Satisfaction, comfort, and confidence of all three groups were high at all three points. Parents/grandparents in both CALM groups were highly satisfied with the education they received. DISCUSSION: Educating parent/grandparents about fever management using written and video materials is effective in increasing knowledge about fever management.

Adolescent↗

PubMed2005

Building research administration applications for the academic health center: a case study.

The academic health center information environment is saturated with information of varying quality and overwhelming quantity. The most significant challenge is transforming data and information into knowledge. The University of Cincinnati Medical Center's (UCMC) focus is to develop an information architecture comprising data structures, Web services, and user interfaces that enable individuals to manage the information overload so that they can create new knowledge. UCMC has accomplished much of what is reported in this article with the help of a four-year Integrated Advanced Information Management Systems (IAIMS) operation grant awarded by the National Library of Medicine in 2003. In the UCMC vision for knowledge management, individuals have reliable, secure access to information that is filtered, organized, and highly relevant for specific tasks and personal needs. Current applications and tool sets will evolve to become the next generation knowledge management applications or smart digital services. When smart digital services are implemented, silo applications will disappear. A major focus of UCMC's IAIMS grant is research administration. Testing and building out existing and new research administration applications and digital services is underway. The authors review UCMC's progress and results in developing a software architecture, tools, and services for research administration. Included are sections on the evolution to full integration, the impact of the work at UCMC to date, lessons learned during this research and development process, and future plans and needs.

Academic Medical Centers↗

PubMed2006

The diabetic foot: a plea for the elementary?

The outlook for the diabetic foot today is still not as favourable as it could be. This holds true, despite the progress that has been achieved in the care of both the neuropathic and the neuroischaemic foot. Regrettably, misconceptions abound among the non-specialists. Yet the situation will not be improved, unless every health care provider involved in the management of diabetic patients commands an absolute minimum of knowledge regarding the prevention and management of foot lesions. Indeed, more forceful implementation of elementary knowledge is needed, coupled with continuous education and research, to reduce the number of amputations.

Diabetic Foot↗

PubMedDate not supplied

[Results of a survey on knowledge and habits among hospital doctors concerning primary prevention of venous thromboembolism].

BACKGROUND: The purpose of this study was to analyse the attitudes towards and knowledge of primary prevention of venous thromboembolism (VTE) among hospital doctors in Calabria. METHODS: The survey was based on theoretical knowledge and practical management of hortopedics, surgeons, gynecologists and internists working in 14 hospitals. RESULTS: Out of a total of 340 physicians contacted, 154 (45%) agreed to take part in the survey. 82% of those who responded used VTE prophylaxis on a routine basis. Unfractioned heparin (71%) was the most frequently used methods; early deambulation (55%), low molecular weight heparin (49%) and elastic stocking (49%) were less frequently employed. Surprisingly, one third used aspirin. 75% of those contacted had modified their approach to prevention during the last few years, in particular owing to improvements in pharmacological therapy and increased awareness of the problem. In the survey of clinical practice, 80% of those who took part correctly identified the VTE risk, 86% suggested the best treatment, but only 27% assessed the exact frequency rate of deep venous thrombosis (DVT) and pulmonary embolism (PE) in the absence of prophylaxis. CONCLUSIONS: Most of the doctors contacted showed scant interest in the primary prevention of VTE. The 45% who agreed to be interviewed revealed a good practical approach but were not sufficiently aware of the real incidence of DVT and PE in a clinical risk context without prophylaxis. Although they must be interpreted with caution, these findings allow the real behaviour of hospital physicians in this region to be assessed with regard to the primary prevention of VTE and suggest the need for more correct information about this aspect of venous thromboembolic disease which is not yet sufficiently well known.

Data Collection↗

PubMedDate not supplied

Factors that influence diabetes patient teaching performed by hospital staff nurses.

Hospital staff nurses are frequently expected to teach patients and families with diabetes. A study was conducted to answer the questions: (1) According to nurses' perceptions, what factors influence conducting diabetes education? (2) Do staff nurses have sufficient knowledge to teach diabetes management principles? Thirty-nine staff nurses from adult units of a university hospital completed an investigator-designed survey and a Diabetes Knowledge Test (DKT). Eleven nurses attending a workshop on diabetes patient management were pre- and posttested to determine the workshop's effect on perceptions and knowledge. Perceived factors that interfered with teaching included lack of time, inadequate teaching skills, lack of patient interest in learning, and absence of a physician's order for teaching. The workshop had little influence on perceptions but significantly increased the mean DKT score from 70% to 78% (P = .03). The findings suggest that expecting all staff nurses to adequately educate patients in diabetes management may not be realistic.

Diabetes Mellitus↗

PubMed2003

Do doctors in north-western Somalia follow the national guidelines for tuberculosis management?

A cross-sectional study assessed the knowledge and practices of registered practitioners in management of tuberculosis (TB) in north-western Somalia. Of 100 registered doctors, 53 were interviewed. Of these, 32 (64%) had treated TB patients during the previous year, but only 1 had notified the authorities, 33 (66%) knew the most important symptoms and 32 (64%) identified sputum smear microscopy as the most important diagnostic test. Only 4 doctors prescribed the correct regimen and only 7 advocated direct observation. Suboptimal knowledge was more common among doctors working in private practice (relative risk: 2.1; 95% CI: 1.1-4.3). Patients are being treated in the private sector, but few doctors follow national treatment guidelines. Training in diagnosis and case management is needed to improveTB control in Somalia.

Adult↗

PubMed1997

[Folic acid use for women desiring offspring: the family physician's response].

OBJECTIVE: To establish to what extent general practitioners (GP's) are familiar with the folic acid campaign of the Netherlands Bureau for Food and Nutrition Education, display a positive attitude regarding use of folic acid tablets by women who would like to become pregnant and factually provide information on folic acid. DESIGN: Cross-sectional, descriptive. SETTING: Regions: Central Brabant, Achterhoek, Randstad and Northern Netherlands. METHOD: In 1996 a printed questionnaire was sent to 300 GP's selected at random. It contained questions about knowledge, attitude and management regarding the use of folic acid by women who would like to become pregnant and with a normal risk to have a child with a neural tube defect. RESULTS: The response was high (81%). Most GP's were familiar with the national campaign on folic acid (87%), but 18% considered themselves insufficiently informed about the education campaign and/or the folic acid recommendations. Half the GP's considered use of folic acid tablets by women who would like to become pregnant as important, while two-thirds were of the opinion that it contributed to medicalization of the pregnancy. Most GP's (82%) thought that pregnant women who had not used folic acid tablets might develop feelings of guilt. Nevertheless, 64% recommended use of folic acid tablets and 63% were willing to write a prescription if the woman asked for it. Seventy-five per cent of the GP's reported that they themselves suggested use of folic acid tablets to women who they assumed would like to become pregnant, although most stated they sometimes forgot (58%). The percentages of GP's who sometimes or always suggested folic acid tablets during a contraception advice after delivery or who advised women who would like to become pregnant to switch to a diet rich in folic acid, were much smaller (29 and 37%, respectively). CONCLUSION: Although a large number of the GP's mentioned potential problems, the majority actively cooperated in promoting use of folic acid by women who would like to become pregnant.

Cross-Sectional Studies↗

PubMed2001

The influence of an organizational pain management policy on nurses' pain management practices.

PURPOSE/OBJECTIVES: To examine the influence of a formal organizational pain management policy on nurses' pain management practices. DESIGN: Descriptive correlational. SETTING: Tertiary-care medical center. SAMPLE: 91 nurses providing direct patient care on five study units during a 72-hour study period. METHODS: Off-going nurses completed three self-administered questionnaires one-half hour before the end of each eight-hour work shift. Opioid administration data also were collected. Data were analyzed using correlational, t test, chi-square, and analysis of variance analyses and descriptive statistics. MAIN RESEARCH VARIABLES: Nurses' knowledge of the healthcare organization's chronic pain management policy; nurses' knowledge of pain and pain management; nurses' perceived accountability for pain management activities; the ratio of actual amounts of opioid analgesics administered compared with maximum amounts ordered. FINDINGS: Nurses' knowledge of pain management and their perceived accountability for pain management were significantly related to knowledge of the organization's chronic pain management policy. Correlations were lower than expected, based on theoretical relationships proposed in the open system study framework. CONCLUSIONS: Further research is needed to explore the influence of a high-quality pain management policy on nursing practice and clinical pain management. IMPLICATIONS FOR NURSING PRACTICE: Better understanding of the influence of organizational policy could lead to much needed improvements in pain management.

Adult↗

PubMed2001

The effect of public long-term care insurance plan on care management and care planning in Japanese geriatric hospitals.

Japan, a society facing demographic aging at an incomparable speed, decided to introduce a new public long-term care insurance system to meet the expected need for elders to be cared for in the near future. The purpose of this study was to examine the change in knowledgeability on the side of managers of Japanese geriatric hospitals regarding (1) the concept of care-management as the methodology to supply care services to the elderly smoothly, and (2) comprehensive assessment for the elders as the technical skill in the process of materializing care management. Subjects were interviewed and questioned over the telephone according to a structural questionnaire. Managers (directors and office managers) of geriatric hospitals in 1996 and 1999. In 1996, the rate of knowledgeability for care management on the side of managers of geriatric hospitals was 70.0% (28/40) as a whole, increasing to 97.3% (71/73) in 1999. With regard to MDS-RAPs, the knowledgeability rate increased from 57.5% (23/40) in 1996 to 95.9% (70/73) in 1999. However, regarding care planning, almost all of the hospitals that performed care planning were those in the category required to submit care plans to the municipal government. Geriatric hospitals that were not required to submit such plans did not perform such planning either in 1996 or in 1999. It can be concluded that the decision to introduce a long-term care insurance system in Japan has led to a deeper understanding of the methodology of care management and a comprehensive assessment on the side of managers of geriatric hospitals.

Journal Article↗

PubMed2005

Taming the beast. The challenges for diabetes management.

All professionals involved in the care of individuals with diabetes should know how good blood glucose control is assessed and have at least a basic working knowledge of blood glucose management. Nursing intervention opportunities may be missed, or a well-informed diabetes patient may lose confidence in your ability to provide competent nursing care, when statements or actions reflect knowledge gaps in such basics. This article summarizes the principles of management of diabetes required for, but not limited to, the hospital setting.

Blood Glucose Self-Monitoring↗

PubMed1998

The influence of practice characteristics on the prescribing of benzodiazepines and appetite suppressant drugs.

BACKGROUND: The prescribing volume of benzodiazepines and of appetite suppressant drugs have been suggested as possible indicators of prescribing quality. OBJECTIVE: To investigate the variation among general practices in the prescribing of benzodiazepines and appetite suppressants by examining the contribution to this variation of training status, partnership status, fundholding status and the level of deprivation in the practice population. METHODS: Prescribing data (PACT) were analysed for 350 practices in the former Mersey Regional Health Authority, for the year ending March 1991 and the year ending March 1994. Data were first standardized for variation in practice population demography. Multiple linear regressions were used to investigate the variation among practices in standardized prescribing volume in both years. RESULTS: For benzodiazepines, training status and partnership status contributed to all models and level of deprivation contributed to some (percentage of variation explained for year ending March 1991: 10% to 21%, year ending March 1994: 8% to 20%). For appetite suppressant drugs fundholding status and an interaction between training status and level of deprivation contributed to all models in both years (percentage of variation explained for year ending March 1991: 19% to 20%, year ending March 1994: 20% to 21%). CONCLUSION: The prescribing of benzodiazepines is lower in training practices, in multi-partner practices and in practices serving a less deprived population, while the prescribing of appetite suppressant drugs is lower in training practices and in fundholding practices. Variation in prescribing knowledge, organizational and management capabilities and patient demand may be explanatory factors.

Journal Article↗

PubMed2005

Appropriateness of breast-conserving treatment of breast carcinoma in women with germline mutations in BRCA1 or BRCA2: a clinic-based series.

BACKGROUND: Although BRCA1 and BRCA2 were identified in 1994 and 1995, respectively, to the authors' knowledge the optimal management of women with BRCA-associated breast carcinoma remains incompletely defined. The current study evaluates the appropriateness of breast-conserving therapy (BCT) in women with BRCA mutations. METHODS: Between May 1992 and October 2003, 87 female participants in genetic testing protocols were identified who 1) were found to have deleterious germline BRCA mutations and 2) reported a history of invasive breast carcinoma that was treated with wide local excision and radiation therapy. Clinical records were reviewed and follow-up was updated. RESULTS: The 87 subjects underwent BCT for 95 invasive breast tumors (8 women received BCT for metachronous bilateral tumors). In all 95 treated breasts, the 5-year and 10-year probabilities of metachronous ipsilateral breast carcinoma (MIBC) were 11.2% and 13.6%, respectively. Among the 87 subjects, the 5-year and 10-year probabilities of metachronous contralateral breast carcinoma (CBC) after treatment of the index tumor were 11.9% and 37.6%. No clinical factors were identified that were associated with either MIBC or CBC, including the use of tamoxifen or chemotherapy. CONCLUSIONS: Women with BRCA-associated breast carcinoma who undergo BCT appear to have risks of MIBC that are similar to those reported for young women without known mutations. The indications for unilateral mastectomy in this group of women should be the same as those for women with nonhereditary carcinoma. However, significant risks of CBC and possibly late MIBC may prompt the serious consideration of bilateral mastectomy as a preventive measure.

Adult↗

PubMed1995

Typing and grading breast carcinoma on fine-needle aspiration: is this clinically useful information?

The ability of fine-needle aspiration (FNA) to diagnose breast cancer is beyond question. The established role of cytopathology is to maintain a low benign to malignant biopsy ratio by reducing the number of benign lesions excised. Both typing and grading of breast cancers on FNA have received attention in the cytology literature but how this knowledge can influence management has not been fully explored. Recently we described a method for the cytological grading of breast cancer that compares well with the established Bloom and Richardson grades. In this paper we present our experience of 1,387 breast cancer FNAs reported by us with histological verification. We show that cytologically typing and grading breast cancers are valid exercises that can predict the true nature of the neoplasm. This information may assist in the clinical approach to the malignant breast.

Biopsy, Needle↗