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Biomedical subjects

R Gagnayre

Publications and source records attributed to R Gagnayre.

At least 19 recordsLinked to original sources
PubMed2006

Educating diabetic patients about insulin use: changes over time in certainty and correctness of knowledge.

AIM: Diabetic patients should understand their disease correctly and be sure of what they know, but certainty is rarely considered by educators. Furthermore little is known about how certainty changes with time after an educational intervention. To clarify this, in 38 patients with type 1 diabetes (0.3-36 years duration) we analysed the effect of a course on insulin use by administering a questionnaire before the course, after the course and 1 and 3 years later. METHODS: Answers, accompanied by a subjective estimate of the degree of certainty, were assigned to mastered knowledge (certainty>or=90%, correctness>or=90%), hazardous knowledge (certainty>or=90%, correctness or=90%) and residual knowledge (total-[mastered+hazardous+uncertain]). Answers were then counted and changes in distribution among areas were analysed by the chi2 test. We also followed the fate of wrong answers. RESULTS: The course increased mastered knowledge, while other types of knowledge decreased. With time mastered knowledge decreased, patients losing both correctness and certainty. The loss affected declarative knowledge, based purely on theory, more than procedural knowledge, which concerns the way things are done. Wrong answers, mostly given with high degree of certainty, were heterogeneous since some became correct after the course, some remained wrong, some became wrong after the course, some became mistaken after having been corrected earlier. CONCLUSIONS: The analysis of certainty helps in evaluating patient's knowledge; programmes tending to improve procedural knowledge are more likely to have long lasting effects; wrong answers need to be considered on a individual basis.

Diabetes Mellitus, Type 1↗
PubMed2005

[Written asthma action plans: a useful tool for self-management].

Written action plans for asthma have been recommended for many years. However, despite the fact that their effectiveness has been demonstrated, they are not used enough. The plans that we propose are serviceable and the method that we suggest makes them easy to use in the treatment of asthmatic children. These plans are made for patients who do not use a peak-flow meter (plans based on symptoms) and those who control this tool (plans based on peak expiratory flow).

Asthma↗
PubMed2004

The use of concept mapping to enlighten the knowledge networks of diabetic children: a pilot study.

OBJECTIVE: The value of concept mapping in enlightening nature and organization of knowledge was shown with adult diabetic or obese patients. Our objectives were to ascertain the relevance and feasability of concept mapping in diabetic children during an educational program. METHOD: This qualitative research was performed in 5 children from 8 to 13 years. Concept maps were drawn at the beginning (Phase 1) and at the end (Phase 2) of an educational program. During the interview each child was invited to express himself starting from the central concept: "diabetes", and to express his/her knowledge, representations, and life experience. RESULTS: The ten maps analysis shows: an increase of knowledge between phase 1 and phase 2 (+34%), towards a deepening of initial knowledge and an addition of new knowledge (43% and 41% of the added knowledge); a decrease of inaccurate knowledge in phase 2; an enrichment of the knowledge networks (+16 cross links); an increase of knowledge related to the ways to behave knowledge (+42%). CONCLUSION: This preliminary report demonstrated that concept maps were feasible, useful and relevant in therapeutic education of children. This method allowed us to show how every child connected his knowledge and how it was modified by an educational intervention. Concept maps therefore contributed to individual educational diagnosis and assessment of new knowledge integration.

Adolescent↗
PubMed2004

[Nursing practice in the context of geographic isolation: implications for training].

A survey on the characteristics of the unique working context of nursing practice in remote areas of French Polynesia and semi-remote areas of northern Quebec demonstrates the importance of a specific training to best prepare the professionals who find themselves in this type of setting. Twenty professionals were interviewed: six nurses practicing in isolated stations in French Polynesia (Tuamotu Archipelago, Marquesas Islands and Austral Islands), six nurses practicing in semi-remote areas within northern Quebec (namely among the Algonquins, the Crees and the Attikameks), four officials of the French Polynesian Health Directorate and four training programme designers from Quebec who were encountered during an expedition to Montreal, Mistissini and Trois-Rivieres. The authors identified ten characteristics which were then regrouped into two categories for both of the practice contexts: first, those inherently linked to professional practice in an isolated context (including the characteristics of nursing practice, the working conditions, the community's health problems, their forms of socio-professional relations, their way of life, and their perception and responses to isolation); and second, those pertaining to the social and natural environment, the economic conditions and the community's cultural specificities. All of the results strongly demonstrate that the specificities of the skills utilised by these nurses are indeed very different than those which they received in their initial preparatory training. If a training programme specific to nursing practice in isolated settings seems essential for these nurses, their individual predisposition to practice in such a complex environment and the acknowledgement of their professional competencies are equally to be considered within the perspective of human resources management.

Adult↗
PubMed2002

[The use of telephone for counseling diabetic patients: a descriptive and pedagogic approach].

This descriptive study of telephone interviews, conducted between the staff of a diabetes unit and patients, is intended to clarify a professional manner in which the telephone should be used as part of patient care. Having examined simulated calls from diabetic patients, analysis of the interviews conducted by the doctors, nurses and members of the office staff in a hospital unit demonstrates wide differences in the content, the quality of the content, and the interview strategy. An interpretation of the results signals the importance of the manner in which the staff member answers, a knowledge of patients' genuine needs, and an ability to adequately acknowledge the emotional state of the patient. Structuring telephone conversations, allowing sufficient time for patient responses, avoids over-long interviews. The decisions taken by the staff member answering the call, in terms of advice and suggestions of actions to take, must be systematically backed-up by ensuring that the patient has properly understood what has been said. The study poses a number of questions, notably concerning the specific requirements demanded by these new remote-care services in the organization of care within a hospital unit, and the professional approach to the use of the telephone as part of the relationship with patients. Recommendations are given concerning the general principles governing a telephone interview and the definition of training objectives for healthcare professionals.

Counseling↗
PubMed2002

[Analysis of preliminary conditions for the implementation of health training programs within the framework of humanitarian aid].

NGOs must be able to ensure the appropriate design and quality of their training programmes for health workers implemented in developing countries. It is a question of empowering those countries to become more autonomous, and the purpose of this study is to identify factors that can improve the sustainable management of the population's health through the long-term training of competent health workers. A literature review validated by experts distinguished three main characteristics necessary for the success of such programmes; relevance, feasibility and functionality from an educational perspective. Moreover, in addition to the three aforementioned criteria, a fourth transversal attribute was noted: sustainability. The objective of the programme designer is to assess the presence of these conditions in order to decide whether or not the training programme should be implemented.

Delivery of Health Care↗
PubMed2002

[Role of patient associations in the development of therapeutic education in France].

The aim of this survey conducted among patient associations is to define the role and the position that they have with regard to the development of therapeutic education in France. 124 associations were solicited (out of over 500 existing), and 68 replied. 17 indicated that the survey was not relevant for them. 51 answered the 43 questions related to the conception and implementation of educational programmes, their goals and objectives, the choice and selection of educational activities, the target audiences and pedagogical principles of reference. The results obtained demonstrate the predominance of informational activities and psychological support. The responding associations declared that sometimes they conduct educational activities which rather resemble informational activities. Only three associations declared having Implemented and managed formalised educational programmes based on pedagogical methods. The aims and objectives most frequently targeted were focused on increasing the patients' knowledge on their disease and its treatment. These educational programmes are usually delivered by members of the association's office staff. However, overall most of the responding associations indicated that it is relatively difficult to provide precise data on the pedagogical methods of the activities undertaken. In light of the results, it is therefore necessary to consider the totality of the activities conducted by the associations as a mechanism for building educational resources in which the place of formalised educational programmes remains marginal, even quasi-absent, for the moment. Associations believe that patient education is an important issue for their development. It is highly likely that the emergence of such programmes will only be possible if the associations show some degree of autonomy in relation to the health care sector and assert a point of view specific to patients, above and beyond that of health care users.

France↗
PubMed2001

Difficulties of diabetic patients in learning about their illness.

The aim of this report is to shed light on the difficulties experienced by diabetic patients in learning about their illness. One hundred and thirty-eight diabetic people (97 IDD and 41 NIDD) were questioned at two survey locations, one national (63) and one regional (75), by means of a closed answer questionnaire. One hundred and four (75%) had attended a formal programme of diabetes education. They were asked which points in their diabetes education they had best understood and which they had least understood. The main results show that, globally, they easily acquire the manual skills. Conversely, numerous learning difficulties are associated with the skills required to solve problems and make decisions, such as adaptation of doses of insulin. These results are comparable to those obtained in a previous study in which professional carers were asked about their difficulties in educating their patients.

Adolescent↗
PubMed2001

[Analysis methods for educational needs assessment for family caregivers of HIV positive or AIDS patients in Thailand].

Identification of educational needs of natural helpers for the home-based care of persons living with HIV or AIDS. Surin, Thailand. The very significant increase in the number of persons living with aids in Thailand, (1995: 20,154 notified cases; 1996: 23,309 cases; 1997: 25,064 cases), and the insufficiency of medical care for patients within Thailand's health structures, have driven Médecins Sans Frontières (MSF) to put in place since 1996 a home-based care project in Surin province (North-Eastern Thailand). In Thai culture, the sick are commonly cared for by one family member, known as the natural helper. An evaluation of the health situation showed that natural helpers who took care of a family member living with HIV or aids were not prepared for this situation. In order to better define the tasks that they ought to perform, we carried out a needs assessment in three interdependent steps: a records analysis of the activities delegated to natural helpers by nurses; an enquiry on the acceptability of natural helpers to carry out these cares and on the perceived usefulness of being trained; an expert consensus on the cares to be carried out by the natural helpers, obtained by the Delphi method. Twenty seven cares were identified as being able to be provided by natural helpers. They constitute as a list of reference for the training for natural helpers. This work has shown a social coherence between the different actors of the project. At no stage was the role of the natural helpers questioned. On the contrary, natural helpers have a privileged place within the family and in the home-based care programme. Natural helpers will allow continuity of care between the health structures and the patient's home.

Adult↗
PubMed2000

An analysis of the teaching techniques used in diabetic specialist consultations.

We attempted to explore the teaching practices of 11 senior diabetic specialists consulting in a out-patient hospital setting and known to have a strong commitment to patient education. The survey consisted of a questionnaire dealing with the duration and distribution of speaking time, the classification of questions, the type of oral questions asked of patients, written materials, teaching aids, demonstrations, if any, care techniques used, and whether or not information was summarized. Our study of 44 consultations showed an average consultation time of 26 +/- 10 min and a balanced sharing of speaking time. The percentage of consultations during which no questions were asked depended on the type and classification of test questions, i.e. oral questions to check knowledge (13.6%), open-ended problem-solving questions (27.3%) or problems involving written materials (54.5%). One to two problems involving open-ended questions were set during 36.4% of the consultations and one to two problems involving written materials were set in 20.5% of the cases; visual aids prepared in advance took a back seat to sketches made during the consultation itself. Information was summed up by the caregiver 75% of the time, and 50% with the patient's help. Our results indicate a patient education orientation during consultations and help to design a standard model formation combined teaching/treatment consultations.

Consultants↗
PubMed2000

[Education of health personnel in the design of humanitarian actions; the experiences of a non-governmental organization].

The aim of this study is to ascertain the importance that a Non-Governmental Organisation (NGO) such as the French section of Doctors Without Borders, (MSF Médecins Sans Frontières), gives to the education of health staff within for humanitarian aid interventions. The study was carried out at the headquarters of this NGO and consisted in classifying educational activities, analyzing assignment reports and conducting interviews with the staff at the headquarters of the organization. Accordingly, an educational activity can be identified in 85% of the 41 assignments listed in 1998. Nearly half of these were carried out in geographical areas that are classified as stable. The qualitative study of educational activities underlines the importance of the stages preceding the implementation of the actual educational program (needs analysis, feasibility study). During interviews with staff at the MSF headquarters, the majority of the 22 interviewees stated that educational activities contribute to the quality of aid activities in situ. Nearly a third of the interviewees, however, felt that educational methods used were too useless. It would seem, therefore, that the degree of importance attached to education and the actual educational methods practiced differ totally for each of the association's standard forms humanitarian interventions (urgency, post-urgency, development for technical assistance).

Altruism↗
PubMed1999

An initial experiment in haematology instruction using the problem-based learning method in third-year medical training in France.

We present an initial experiment in the teaching of haematology using the problem-based learning technique in the third year of medicine at the Bobigny Faculty of Medicine (Université Paris-Nord). This new approach to the clinical and bioclinical teaching of medicine is used in several hundred medical faculties throughout the world. It is based on students' integrated learning of concepts (scientific, clinical, psycho-social) through patient problems. The method alternates group meetings with a tutor and individual learning. Sixty-eight students with no previous training in haematology and eight tutors (eight groups) took part in this experiment, which lasted five weeks (with no other teaching) and enabled them to study ten patient problems representing the bulk of the objectives pursued in this discipline. The preparation of students and teachers for this experiment is described, as well as its conduct and the results obtained. These show that the problem-based learning students performed better in their clinical problem-solving examinations than did students from a previous year who had been taught using traditional methods for the same period of time. The comparison does not indicate, however, that problem-based learning students had any advantage in the acquisition of factual information. The high degree of satisfaction of the students beginning their third year and of tutors in respect of this experiment constitutes a very favourable point. The limitations of the experiment and the teaching method itself are also discussed.

Analysis of Variance↗
PubMed1999

[Training missions in Cambodia: impact on the anesthesiologists and intensive care workers who carried out these missions].

OBJECTIVES: 1) To analyse the incentives and the significance of the participation of anaesthesiologists in training missions for male nurse anaesthetists in Cambodia; 2) to assess the professional and private impact of these missions on them; 3) to evaluate the level of contribution of hospital administration. STUDY DESIGN: Retrospective survey. PERSONS AND METHOD: Twelve anaesthesiologists, mainly males, mean age 44 +/- 6 years, with some expertise in missions in developing countries complete anonymously a written questionnaire including standardized answers and open questions. RESULTS: The mean reason for participating was the wish to transmit knowledge and expertise. For most of them the mission was an extension of their clinical activity. The reverse effects were a change of their mind on medical practice, on teaching and training, assistance projects for developing countries. For the latter, all considered that the health care institutions in association with Faculties of medicine should be involved in these missions. DISCUSSION: Initially, these missions expressed a need of self-sacrifice and appraisal of professional expertise. However the educational goal of the mission, the difference of cultural environment, determined a change in links with other persons. As a result, they wished to share expertise with other colleagues, in modifying the procedures for education and their participation in future assistance projects for development. However these intentions remained without professional impact as these educational actions were not included in a real institutional project. CONCLUSION: Every international assistance project for development build by hospital doctors should be examined not only by staff members of the department, but also by the hospital administration.

Adult↗
PubMed1999

Design and implementation of a training programme for general practitioners in emergency surgery and obstetrics in precarious situations in Ethiopia.

Médecins Sans Frontières (MSF) has been implementing medical assistance programs in Ethiopia since 1994, including the rehabilitation of health structures and the supply of drugs and medical equipment. In 1995, the serious shortage of surgeons in Ethiopia prompted MSF to add a programme to train general practitioners to perform surgery in the Woldya region. The results of the relevant feasibility study were encouraging. The programme's design is based on recent educational data and MSF's experience with introducing transcultural training in countries where unstable conditions prevail. The training programme is currently being studied by the Ethiopian Health Ministry for use as a model for training general practitioners in surgery throughout the country.

Developing Countries↗
PubMed1998

Learning difficulties of diabetic patients: a survey of educators.

This study was designed to shed light on the learning difficulties of diabetic patients. An open-ended questionnaire was sent to 85 health care professionals working in the field of diabetes and nutrition who had been trained in patient education techniques. They were asked to describe the skills that were the easiest to teach patients and those that patients mastered the best, as well as the skills they found hardest to teach patients, those that patients mastered the least and those that gave rise to errors persisting after the patients education was completed. On the whole, the results showed that the educators found it easy to teach techniques: patients mastered procedures well and made few mistakes. In contrast, diabetic patients seem to have problems learning skills, such as insulin dose adjustment, that require complex problem-solving (involving multiple variables). Based on these findings, the authors discuss the notions of learning complexity and the time needed for successful patient education.

Attitude of Health Personnel↗
PubMed1998

[Evaluation of professional development of Cambodian male nurses specializing in anesthesia and intensive care, trained through humanitarian care programs].

OBJECTIVES: To assess the working conditions of Cambodian male nurses specialised in anaesthesia and intensive care (NSAIs), degree of satisfaction, whether training was suited to the Cambodian needs and practical application of training. STUDY DESIGN: Prospective survey. PERSONS: Two training years including 30 NSAIs. METHOD: External assessors evaluated working conditions, practice of anaesthesia, analysed logbooks and theatre reports, organised semi-directive interviews and examinations using clinical cases. RESULTS: Out of the 30 NSAIs, 28 had an appointment, mainly in anaesthesia (80% of their activity) and three-quarters of them felt that their skills were appreciated by their superiors. Seventeen had some form of responsibility in the management of a department. For the administration of an anaesthetic, 13 NSAIs of the second year had achieved an acceptable level of performance and resolved effectively 85% of the submitted cases. Twenty-two NSAIs reported difficulty in applying techniques learned during their training to real working conditions. The causes were poor equipment, poor organisation and poor relations with the hierarchy. The latter cause decreased the capacity to take appropriate decisions, which was the most common error made by the second year NSAIs. Finally, as their wages remained unchanged, 19 out of the 28 NSAIs were obliged to look for an additional source of income. CONCLUSION: This survey shows the medium-term effectiveness of an NSAI training programme basing on teaching and public health principles and organised in the humanitarian aid sector.

Cambodia↗