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Results for “knowledge accumulation”

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At least 19 recordsLinked to original sources
PubMed1992

The influence of general practitioners' knowledge about their patients on the clinical decision-making process.

Continuity of care is claimed to be an important and integral part of general practice. A main result of continuity is the doctor's accumulated knowledge about his or her patients. The objective of the present study was to evaluate the modifying effects of this knowledge on the decision-making process that takes place in consultations, as experienced by practitioners. A representative sample of 133 Norwegian general practitioners evaluated a total of 3,918 of their own consultations. The main independent variable was the doctor's own subjectively evaluated knowledge about the patient's medical history, while the major outcome measures included the perceived influence of accumulated knowledge on the consultation process in general, and on the diagnostic and management decisions in particular. In two-thirds of all consultations, or in three out of four in which the doctor had previous knowledge about the patient, this knowledge was considered to be clinically useful. In more than one-third of all consultations with previously unknown patients, this lack of information was felt to be a hindrance. Among patients with new medical problems and when the doctor had prior knowledge about the patient, this knowledge was felt to have significantly more therapeutic than diagnostic impact. Accumulated knowledge was generally felt to be of most help in consultations due to psycho-social problems, and was of special diagnostic value in patients presenting new, unspecific problems such as fatigue, fever, and generalized pain. This study indicates that accumulated knowledge about the patient is felt by the general practitioners to play an important and integral part in their clinical decision-making process.

Continuity of Patient Care↗
PubMed1992

Continuity of care: general practitioners' knowledge about, and sense of responsibility toward their patients.

The aim of the present study was to examine the relations between continuity of care and the general practitioners' accumulated knowledge about their patients. A further objective was to evaluate the link between continuity of care and the doctors' sense of medical responsibility towards the patients. Emphasis was placed on the chronological, or longitudinal component of continuity of care. In a cross-sectional record study a representative sample of 133 Norwegian general practitioners each registered 30 consecutive consultations. Two aspects of longitudinal care were recorded: the duration of the patient-doctor relationship, measured as time from the first visit to the present, and the density, measured as the number of consultations (office or home visits) within the last 12 months. The physicians subjectively evaluated their accumulated knowledge about the patient's medical history, personality, and social network, on multinomic scales. Their sense of medical responsibility was indicated as one of three alternatives. Of 3990 possible recordings, 3918 (98%) were evaluated. In about one-third of all encounters the doctors reported extensive knowledge about their patients. It took at least one, and often 5 years, or at least 4-5 visits last year, to create such an extensive knowledge base. The physician's sense of responsibility increased more rapidly, and to a higher degree with the density of visits, than with duration of the relationship. The findings indicate firm links between longitudinal care and accumulated knowledge, and between longitudinal care and the doctors' sense of responsibility towards their patients.

Continuity of Patient Care↗
PubMed1991

Continuity of care: influence of general practitioners' knowledge about their patients on use of resources in consultations.

OBJECTIVE: To examine the relation between general practitioners' knowledge about their patients and the use of resources in consultations. DESIGN: A cross sectional evaluation of consultations. SETTING AND SUBJECTS: A representative sample of 133 Norwegian general practitioners were each asked to record 30 consecutive consultations. 131 did so, and of 3990 possible registrations, 3918 (98%) were evaluated. MAIN OUTCOME MEASURES: The influence, as assessed by the doctor, of accumulated knowledge on the use of laboratory tests, expectant management, prescriptions, sickness certification, referrals, and time spent in the consultation. RESULTS: Accumulated knowledge was a substantial factor in saving time, especially in consultations with children, the elderly, patients with psychosocial problems, and those with chronic diseases. It also influenced the overall use of laboratory tests, expectant management, sickness certification, and referrals, and to a lesser degree the use of medication. CONCLUSION: The findings imply strong but complex associations between accumulated knowledge and the use of resources in the consultation.

Adolescent↗
PubMed1998

The association of attributes of primary care with the delivery of clinical preventive services.

OBJECTIVES: Evidence is building that primary care is associated with quality of care and cost effectiveness. Still, little is known of the contribution of specific attributes of primary care to important health outcomes, such as the delivery of preventive services. This study tests the association of specific attributes of primary care with a comprehensive measure of the delivery of preventive services. METHODS: A cross-sectional multimethod study design was used to examine 2,889 patient visits to 138 community-based primary care physicians. Four primary care attributes were measured: patient preference for their regular physician, interpersonal communication, physician's accumulated knowledge of the patient, and coordination of care. Delivery of US Preventive Service Task Force-recommended services were based on data collected from direct observation and medical record review. Hierarchical linear regression models (HLM) were used to test the association of each of the primary care attributes with being up to date on screening, immunization, and health habit counseling preventive services. Each regression model was adjusted for patient age, race, health status, and insurance type. RESULTS: Interpersonal communication and coordination of care scale scores were associated with being more up to date on screening services and health habit counseling. Accumulated knowledge and preference for regular physician were associated with being more up to date on immunizations. CONCLUSIONS: The attributes of primary care measured in this study are associated with the receipt of preventive services. Fostering the tenets of primary care may have an impact on the delivery of preventive services and possibly other important health outcomes.

Adolescent↗
PubMed1999

Management forecast: optimizing the use of organizational and individual knowledge.

Knowledge management provides a means for sharing data, lessons learned, and accumulated knowledge throughout an organization or within an entire industry. Gone are the days of hoarding knowledge to ensure job security; today's workers and managers must work together to find new and innovative ways to use what they know and optimize how that knowledge is accessed. Knowledge management's new approach to shared intellectual resources has implications for workers and managers in all fields and promises to redraw the management landscape. But are healthcare organizations setting the stage for reengineering themselves all over again?

Administrative Personnel↗
PubMed1996

Nationally speaking. Life history and narrative research: generating a humanistic knowledge base for occupational therapy.

As a profession, occupational therapists are guided in practice by the accumulated knowledge of occupational therapy. This article demonstrates the contributions of life-history and narrative research to this knowledge base. We are suggesting that in response to our humanistic roots, we must pursue additional knowledge, principles of practice, and ethical philosophies that support practice. We have argued that our ideologic concern for the client must guide our choice of epistemologies to investigate the lived experience to those whom we serve. "What is at stake here is the ethic that is embedded in the epistemology that gives rise to kinds of research" (Brock, 1995, p.157) that meet the societal demands for professionalism and support a humanistic practice.

Ethics, Professional↗
PubMed1995

Child maltreatment as perceived by Arab students of social science in the West Bank.

There is a dearth of knowledge about the problem of child maltreatment in Arab societies. In the West Bank and Gaza Strip, the Palestinians are facing the challenge of establishing their own social welfare system as a result of signing the Declaration of Principles with Israel. In creating services for families and children, the helping professionals in these areas find that one of the main challenges is to integrate and apply knowledge accumulated in Western countries into a different sociocultural context. Another challenge is to develop knowledge on this subject congruent with their own cultural background. Because of this lack of knowledge, a study was conducted among 353 students in the helping professions in the West Bank. An instrument constructed for this study was utilized to examine the following subjects: (a) students' perceptions of situations of child maltreatment; (b) their awareness of signs of maltreated children; (c) their awareness of risk factors which could be related to this problem; and (d) their willingness to report cases of child maltreatment. The results indicate a high level of agreement among students in viewing situations of abuse as well as neglect as maltreatment. Differences were found in their willingness to report situations of maltreatment. A higher tendency was found to report situations of abuse rather than neglect. An inclination was found among students to minimize social and cultural factors as risk factors and to disregard signs that did not contain explicit signals of danger as characteristics of maltreated children. Implications for the development of services in Arab societies are discussed.

Adult↗
PubMed2003

Evidence-based practice in Steeltown: a good start on needed cultural change.

At the Canadian Health Services Research Foundation we talk a lot about the need to improve the 'receptor capacity' for research in the health sector (Canadian Health Services Research Foundation 2000). To create a demand for research as well as a supply of it. To encourage and assist clinicians, managers and policymakers in the health system to pull research from academe with as much fervor as applied researchers now bring to publishing it. Browman, Snider and Ellis have done more than talk about and encourage these things - they have implemented them at their own workplace in Hamilton. Their formula is:1. Design a policy-learning forum (Clinical Policy Committee'), where the use of available research is encouraged and expected 2. Create champions (knowledge stewards') responsible for marshalling and presenting the evidence. 3. Provide rules (negotiation') for the dialogue between the operational implications of the research and its budgetary reality. 4. Use story telling to uncover local implementation barriers and make tacit knowledge explicit. The approach is reminiscent of political scientist Paul Sabatier's description of the circumstances under which policy learning occurs (Sabatier and Jenkins-Smith 1993) and Brown and Duguid's compelling outline of how information permeates corporate structures (Brown and Duguid 2000). Sabatiers advocacy coalition framework highlights the optimal conditions for learning as: balanced coalitions (in this case, of those behind the research and those behind the finances), enough resources for each side to produce a steady flow of information, an organized forum for debate and clear rules of engagement. In 'The Social Life of Information, 'Brown and Duguid highlight the extent to which modern corporations often leave unrecognized and under-utilized their greatest asset - the tacit knowledge accumulated by each employee over his or her career. They, too, recommend storytelling as a way to liberate this knowledge for wider use. Browman and colleagues 'practical realization of Sabatier' advocacy coalition framework and Browns social view of information is refreshing on a number of levels.

Canada↗
PubMed2001

Complementary and alternative medicine: applications and implications for cognitive functioning in elderly populations.

OBJECTIVE: Aged populations in the United States are growing in numbers, and stand to be affected most by the changing shape of healthcare delivery. Within these elderly populations, the problem of decreased cognitive functioning due to dementing disorders is rising. Recent compelling research on complementary and alternative medicine interventions targeted at cognitive deficits in the elderly is reviewed in this survey. DATA SOURCES: A literature review was undertaken to identify original clinical research studies, review articles, chapters, and books on treating cognitive deficits in the elderly. Contact with complementary and alternative medicine researchers provided additional information concerning developments in this field. STUDY SELECTION: Research studies that were methodologically sound were selected for review. More purely clinical studies also were included to provide a thorough overview of the limited amount of accumulated knowledge in this field. DATA SYNTHESIS: A qualitative synthesis of the above data was used to comprehensively present all information accumulated to date in this field. CONCLUSIONS: Although still in the preliminary stages of development, clinical research exploring the benefits of complementary and alternative therapies for cognitive deficits among the elderly shows a significant level of promise that warrants a further investment of resources.

Aged↗
PubMed1994

Reinvention of visual fatigue: accumulation of scientific knowledge or neglect of scientific history?

The development of science is believed to be a continuous accumulation of knowledge, giving rise to the somewhat false idea that the most recent knowledge is the most valid and most appropriate. Neglect of the history of a scientific discipline might therefore lead to reinvention of theories that have already been proposed and experimentally investigated. In the case of visual fatigue the pioneering works of Lucien Howe, Walter Lancaster and others at the beginning of this century are very similar to contemporary work in terms of conceptual definitions, methodological approach, assessment and results. The temporal and dynamic aspects of accommodation and vergence considered important today were intensely studied and discussed by Howe and others.

Asthenopia↗