OBJECTIVE: To describe barriers to the successful use of the 1997 National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines. METHODS: We conducted 3 focus groups to understand barriers to the use of 4 recommendations within the NHLBI guidelines (prescription of inhaled corticosteroids, recommendation of daily peak flowmeter use, smoking cessation screening and counseling, and allergen exposure counseling). PARTICIPANTS: Twenty-one pediatricians and 1 nurse practitioner, who each followed an average of 47 patients with asthma, participated. Six participants (27%) had a faculty or adjunct appointment at a medical school. Nineteen (90%) of the 21 pediatricians were board certified. RESULTS: We identified 171 comments about barriers to adherence. Type of recommendation and physician year of graduation from medical school were related to which barrier was prominent. For corticosteroid prescription, senior physicians mentioned lack of agreement, whereas younger physicians described lack of confidence in dosing or recognizing contraindications. For peak flow-meter use, senior physicians emphasized lack of training. Only senior physicians described the inertia of previous practice as a barrier. All groups mentioned time limitations. CONCLUSIONS: Efforts to improve adherence to asthma guidelines should consider the range of barriers that pediatricians face, such as lack of awareness, familiarity, or agreement, and external barriers owing to environmental, guideline, or patient factors. In addition, this study documents barriers not previously considered, such as lack of self-efficacy, lack of outcome expectancy, and inertia of previous practice, that prevent adherence. Because type of recommendation and physician demographics are related to which barriers are prominent, interventions to improve NHLBI guideline adherence should be tailored to these factors.

Diette, G. B., E. A. Skinner, et al. (2001). "Consistency of care with national guidelines for children with asthma in managed care." Journal of Pediatrics 138(1): 59-64.

OBJECTIVE: To evaluate the consistency of pediatric asthma care with the National Asthma Education and Prevention Program Guidelines. DESIGN: Cross-sectional survey at 2 managed care organizations in the United States (winter 1997-1998). The participants were parents of children (n = 318) age 5 to 17 years with asthma. There were no interventions. The outcome measures were indicators of care in 4 domains: (1) periodic physiologic assessment, (2) proper use of medications, (3) patient education, and (4) control of factors contributing to asthma severity. RESULTS: Of 533 eligible patients with asthma, 318 (60%) parents responded; 59% of children were male, 76% were white, and 60% were aged 5 to 10 years. Deficiencies in care were identified in all care domains including, for patients with moderate and severe persistent symptoms, only 55% used long-term control medication daily, 49% had written instructions for handling asthma attacks, 44% had instructions for adjustment of medication before exposures, 56% had undergone allergy testing, and 54% had undergone pulmonary function testing. CONCLUSIONS: There are significant opportunities to improve the quality of care for children with asthma enrolled in managed care. A comprehensive approach to improving care may be necessary to address multiple aspects of care where opportunities exist.

Dionne, R. R. (1998). "What works. Software enhances patient education for pediatrician." Health Management Technology 19(7): 49.

Hait, E., J. H. Arnold, et al. (2006). "Educate, communicate, anticipate-practical recommendations for transitioning adolescents with IBD to adult health care." Inflammatory Bowel Diseases 12(1): 70-3.

The cyclical nature of chronic illness requires that children with inflammatory bowel disease be transitioned to the adult medical system with as much continuity of care as possible. Transition from pediatric to adult medical care continues to present significant barriers. The philosophy of transition centers on a process, with the actual transfer to adult care as a point along this clinical pathway. Concrete steps can be taken to help patients prepare for new responsibilities. The aim of this review is to propose a clinical and developmental timeline for both patients and their medical team, including specific responsibilities for both, so that the partnership can best promote a successful transition.

Heaman, M. (2002). "Smoking cessation in pregnancy: are we doing enough?" Journal of Obstetrics & Gynaecology Canada: JOGC 24(8): 611-3.

McClung, H. J., R. D. Murray, et al. (1998). "The Internet as a source for current patient information." Pediatrics 101(6): E2.

OBJECTIVE: The purpose of this study was to assess the quality of information a lay person could obtain from Internet (Net) sources regarding the treatment of childhood diarrhea. It also afforded an opportunity to evaluate the awareness and compliance of the general medical community with the American Academy of Pediatrics (AAP) guidelines on the management of acute diarrhea. METHODS: This was a prospective, open, observational, literature review performed with a computer workstation and medical library. The AAP practice parameter on the management of acute gastroenteritis in young children was selected as the current standard by which to judge all other documents. The Net was searched, and all documents retrievable from the first 300 references were evaluated for compliance with current recommendations on the management of diarrhea in children. RESULTS: Of 60 articles published by traditional medical sources, only 12 (20%) conformed to current AAP recommendations for treatment of children. The source of the information, even if from a major academic medical center, did not improve the likelihood of compliance. CONCLUSIONS: As demonstrated by information supplied on World Wide Web sites by traditional medical sources, recommendations for the treatment of acute diarrhea show a low percentage of concurrence with the AAP guidelines. Major medical institutions, schools, and hospitals need to devise ways to carefully monitor and establish quality control of what is being distributed from their home pages. Patients must be warned about the voluminous misinformation available on medical subjects on the Net.

Mosca, L., A. H. Linfante, et al. (2005). "National study of physician awareness and adherence to cardiovascular disease prevention guidelines." Circulation 111(4): 499-510.

BACKGROUND: Few data have evaluated physician adherence to cardiovascular disease (CVD) prevention guidelines according to physician specialty or patient characteristics, particularly gender. METHODS AND RESULTS: An online study of 500 randomly selected physicians (300 primary care physicians, 100 obstetricians/gynecologists, and 100 cardiologists) used a standardized questionnaire to assess awareness of, adoption of, and barriers to national CVD prevention guidelines by specialty. An experimental case study design tested physician accuracy and determinants of CVD risk level assignment and application of guidelines among high-, intermediate-, or low-risk patients. Intermediate-risk women, as assessed by the Framingham risk score, were significantly more likely to be assigned to a lower-risk category by primary care physicians than men with identical risk profiles (P<0.0001), and trends were similar for obstetricians/gynecologists and cardiologists. Assignment of risk level significantly predicted recommendations for lifestyle and preventive pharmacotherapy. After adjustment for risk assignment, the impact of patient gender on preventive care was not significant except for less aspirin (P<0.01) and more weight management recommended (P<0.04) for intermediate-risk women. Physicians did not rate themselves as very effective in their ability to help patients prevent CVD. Fewer than 1 in 5 physicians knew that more women than men die each year from CVD. CONCLUSIONS: Perception of risk was the primary factor associated with CVD preventive recommendations. Gender disparities in recommendations for preventive therapy were explained largely by the lower perceived risk despite similar calculated risk for women versus men. Educational interventions for physicians are needed to improve the quality of CVD preventive care and lower morbidity and mortality from CVD for men and women.

Peterson-Sweeney, K., A. McMullen, et al. (2007). "Impact of asthma education received from health care providers on parental illness representation in childhood asthma." Research in Nursing & Health 30(2): 203-12.

The burden of asthma has increased dramatically despite increased understanding of asthma and new medication regimens. Data reported here are part of a larger study investigating factors that influence parental asthma illness representation and the impact of this representation on treatment outcomes, including the parent/health care provider relationship. We investigated the influence of asthma related education provided by health care providers on these outcomes. After interviewing 228 parents of children with asthma, we found that asthma education received from the child's health care providers positively influenced parental belief systems, especially attitudes towards anti-inflammatory medications and facts about asthma. Parents who reported receiving more education also reported stronger partnerships with their child's health care provider. (c) 2007 Wiley Periodicals, Inc.

Skinner, R., W. H. Wallace, et al. (2006). "Long-term follow-up of people who have survived cancer during childhood." Lancet Oncology 7(6): 489-98.

Substantial improvements in survival after treatment for malignant disease in childhood are leading to a rapidly increasing number of long-term survivors, many of whom are now adults. However, late chronic adverse effects of treatment are common, and have potentially severe effects on survivors' future physical, cognitive, or psychosocial health. The aim of long-term follow-up is to facilitate timely diagnosis and appropriate management of late adverse effects, thereby reducing the frequency of severe complications. Although the delivery of long-term follow-up care varies substantially--particularly in terms of who provides it, where, and how--recognition of the importance of appropriate multidisciplinary care and cross-speciality care is increasing, especially for adolescent and adult survivors of cancer during childhood. Several models of long-term follow-up care have been developed to address this need. This review discusses the present provision of long-term follow-up, and summarises information that might facilitate design and implementation of future models of long-term follow-up care.

Trent, M., J. M. Ellen, et al. (2005). "Pelvic inflammatory disease in adolescents: care delivery in pediatric ambulatory settings." Pediatric Emergency Care 21(7): 431-6.

OBJECTIVES: To evaluate care delivery patterns in patients treated for pelvic inflammatory disease in pediatric outpatient settings and to determine the effect of practice type on care delivery. DESIGN/SETTING: Retrospective review of medical records for patients treated as outpatients in an urban academic pediatric facility. Care patterns were evaluated according to the Centers for Disease Control sexually transmitted disease guidelines. PARTICIPANTS: Fifty-six adolescent patients who were diagnosed with pelvic inflammatory disease in pediatric ambulatory settings between January 1, 2002, and December 31, 2002. MAIN OUTCOME MEASURES: Demographic information, documented patient history and examination, laboratory data, and discharge instructions. RESULTS: Forty percent of patients were prescribed inadequate courses of medications. Patients who were seen in the pediatric emergency department were less likely to receive a standard medication regimen than those seen in the ambulatory setting. Most patients did not receive adequate instruction for self-care on review of written discharge instructions, and there were no differences based on location of care. CONCLUSIONS: Many adolescents treated as outpatients for pelvic inflammatory disease may not receive adequate medications and instructions for self-care at discharge in pediatric ambulatory settings. This study suggests a need for aggressive quality improvement measures to enhance the care of adolescents with pelvic inflammatory disease in pediatric outpatient settings.

van den Berg, N. J., W. H. of ten Have, et al. (2005). "What general practitioners and paediatricians think about their patients' asthma." Patient Education & Counseling 59(2): 182-5.

The Asthma Insight and Reality in Europe (AIRE) study showed that the current management and treatment of asthma in Europe falls short of the goals set in the GINA guidelines. Patient care may be negatively influenced by the physicians' underestimation of their patients' disease state, and overestimation of their patients' knowledge of asthma management. We interviewed 118 paediatricians and 152 general practitioners (response rate 70 and 86%, respectively) in order to get an insight into the physicians view on his patients' asthma management. A questionnaire containing similar items to those used in the AIRE study was used. Dutch physicians believe that the asthma of the majority of their patients is well controlled and underestimate the prevalence of daytime symptoms. They believe that their patients are aware of the differences between reliever medication and maintenance medication and overestimate the number of patients in possession of a written action plan. Dutch paediatricians and general practitioners underestimate the severity of their patients' disease state and overestimate their patients' knowledge of disease management.

白丽琼, 肖. 谢. 杨. 汪. (2003). "湖南省部分医学院校毕业生结核病知识、实践能力及相关因素调查." 中华结核和呼吸杂志(08).

目的　评价医学院校毕业生对结核病知识的掌握情况及其实践能力。方法　运用自制调查问卷 ,在湖南省 3所医学院校采取随机整群抽样方法抽查临床、预防专业应届毕业生 ,进行结核病知识、实践能力及相关因素的调查。结果　 4 5 0名调查对象中 ,4 39人 (97 6 % )对所有调查内容作了有效回答。其中男性 2 5 7人 (5 8 5 % ) ,女性 182人 (41 5 % ) ;平均年龄 2 3岁 (2 0～ 2 6岁 )。在结核病知识方面 ,大多数学生对结核病的临床症状较为熟悉 ,但仅 2 5 5 %的受试者知道卡介苗接种的作用 ;只有 6 2 %的学生知道我国传染性肺结核的现患率 ;33 5 %了解结核病需归口管理 ,5 8 8%知道直接面视下短程治疗 (dots)的定义。经分析 ,12个结核病知识条目中有 6条在不同学校或专业或性别中差异有显著性。在临床实践方面 ,334名曾管治过结核患者的受试者写出了 80余种化疗方案 ,其中正确者仅占 16 8% ;33 4 %在治疗结核患者时作了痰检复查 ;4 5 %执行了结核病归口管理。结论　应届医学院校毕业生对结核病知识掌握不够 ,临床实际能力欠缺。需加强结核病流行病学、预防和国家结核病控制规划等知识的培训。医学教育应将结核病规划纳入教育课程

毕银花 (2000). "精神疾病患者的健康教育实践." 当代护士(02).

提出了对精神疾病患者健康教育的实施步骤、教育形式,并将1996年6月入院的符合ccmd-2诊断标准的首次发病的精神分裂症患者按年龄、性别等随机分为两组进行统计学分析,结果表明按整体护理实施健康教育组优于按传统法护理组。

陈晶琦, 李. 王. (2003). "高中学生2062名预防艾滋病健康教育需求评价." 中国学校卫生(04).

目的 了解高中学生预防艾滋病知识、态度和行为状况,为开展艾滋病健康教育提供科学依据。方法 以不记名问卷调查方式,对北京、阜新4所中学的2062名高一、高二学生进行调查。结果 57.5％的学生知道艾滋病病毒可通过男性与男性之间的性接触传播,52.9％的学生知道正确使用避孕套可降低感染艾滋病病毒的危险性;有关预防艾滋病和性传播疾病(aids/std)知识,男生得分高于女生。学生的预防艾滋病知识和性健康知识主要来自大众传媒;有82.9的学生想了解预防aids基本知识;46.6的学生同意与感染hiv的人继续做朋友;有3.6％的学生报告曾有过性交行为。结论 学校预防aids健康教育工作应该得到加强,在教育中应注意培训学生正确的性道德观念,培养学生不歧视艾滋病病毒(hiv)感染者及aids患者。

陈青山, 严. 梁. 刘. 陈. 尹. 何. (2004). "艾滋病防治知识讲座对某高校大学生知·信·行影响." 中国学校卫生(03).

目的　评价艾滋病防治知识讲座对大学生有关艾滋病的知识、态度与行为的影响 ,以探讨在高校学生中预防艾滋病 /性病的有效方法。方法　采用整群抽样的方法 ,对广东某高校参加艾滋病防治知识讲座的在校二年级大学生 462名进行教育前、后的问卷调查及统计分析。结果　健康教育后大学生对艾滋病相关知识的知晓率显著提高 ,对待艾滋病患者态度的正确率有所提高。结论　在大学生中开展艾滋病健康知识讲座的近期效果明显 ,建议今后应当长期、深入、广泛地开展大学生预防艾滋病的健康教育和行为干预

黄丽雯, 张雪宝, et al. (2007). "珠海市中学生的防病知识状况及健康教育效果评价." 华南预防医学(04).

目的了解珠海市中学生结核病、艾滋病、夏季常见皮肤病的知识、态度和行为,并评价进行健康干预的效果。方法采用分层整群随机抽样的方法,对珠海市3所中学新入学军训学生进行基线调查,随后通过举办健康知识讲座和发放宣传资料等途径进行健康教育干预,评价干预前后学生防病知识水平。结果健康教育干预前后分别有效回收问卷575份和557份,有效回收率分别为99.14%、96.03%。军训学生对肺结核主要传播途径、肺结核确诊知识的知晓率干预前分别为47.0%、36.1%,干预后分别为65.9%、52.3%,差异有统计学意义(p<0.01);对艾滋病知识的知晓率干预前为66.6%~87.5%,干预后为79.0%~92.3%,差异均有统计学意义(p<0.05或p<0.01);对夏季常见皮肤病知识的知晓率干预前为12.9%~83.7%,干预后为28.7%~89.2%。结论珠海市军训学生已经具备一定的结核病、艾滋病以及夏季常见皮肤病的防病知识,普及率较高,但不全面,不系统。通过健康教育干预能提高学生的防病知识水平。

霍丽莉, 王娜, et al. (2006). "健康教育个体化对预防急性冠脉综合征的应用研究." 现代护理(05).

目的研究健康教育预防急性冠脉综合征(Acs)的临床治疗效果。方法将62例老年acs患者分为a组(常规教育)和b组(个体化教育),b组通过指导患者制定合适的活动度、掌握缓解疼痛的方式、改善遵医行为、减少冠心病强危险因素以及改变a型行为等方法对患者进行个体化健康教育;a组分小组实施教育。对2组患者康复效果进行对照比较。结果2组患者的康复有效率:a组低于b组,经统计学分析差异有显著性。结论在acs患者的诊疗过程中,实施个体化教育对促进患者恢复,减少危险因素的发生具有重要辅助作用。

戚以勤, 陈超刚, et al. (2006). "烹饪实践课对糖尿病患者饮食控制的效果分析." 中华护理杂志(02).

目的观察烹饪实践课对糖尿病患者饮食控制的影响,以及患者对营养知识的掌握程度。方法已确诊的2型糖尿病患者125例,随机分成对照组和实验组,对照组进行门诊课堂教育或个别的糖尿病饮食理论教育,实验组进行烹饪实践课学习。两组患者教育前后均进行营养知识评分以及空腹血糖(FBG)、餐后2h血糖(PBG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等检查。结果实验组患者对糖尿病营养知识的掌握较好,其FBG,PBG,HbA1c,TG,TC,HDL-C,LDL-C的控制也比对照组理想。结论烹饪实践课有利于糖尿病患者掌握饮食控制的原则和方法,达到更好地控制糖尿病的目的。

王红伟, 杨月欣, et al. (2007). "糖尿病患者对食物血糖生成指数知识的接受性及膳食调整(英文)." 中国组织工程研究与临床康复(52).

背景: 血糖生成指数是含碳水化合物食物的生理学特征性指数, 食物血糖生成指数在糖尿病、心血管病和肥胖等慢性病的预防控制中具有重要的应用价值和实际意义。目的: 了解与传统的食物交换表为主要宣传材料的教育方法相比较, 糖尿病患者对食物血糖生成指数知识的接受性和实际意义。设计: 对比观察实验。单位: 中国疾病预防控制中心营养与食品安全所。对象: 选择 2000- 10/2002- 02 在北京市第六医院内分泌科就诊的糖尿病患者 72 例, 年龄 18～70 岁, 平均 58 岁, 男女各半。方法: 将 72 例糖尿病患者随机分为 2 组: ①血糖生成指数组: 以不同食物的血糖生成指数为主要教育材料。②食物交换表组: 以传统的食物交换表为主要教育材料。采用课堂讲座、个别辅导、电话咨询等方式教育 5个月。观察教育前后糖尿病患者对所授知识的知晓率、食物选择和血糖变化等。主要观察指标: 教育前后营养教育知识知晓率、空腹血糖及餐后 2 h 血糖变化。结果: 纳入糖尿病患者 72 例, 均进入结果分析。①患者教育后对各个问题的正确回答率明显高于教育前(P < 0.01)。教育前, 血糖生成指数组对血糖生成指数问题正确回答率低于食物交换表组对食物交换表问题的正确回答率(0, 6.5%, P < 0.01); 教育后, 血糖生成指数组对血糖生成指数问题正确回答率高于食物交换表组对食物交换表问题的正确回答率(92.2%, 79.4%, P < 0.01)。而对相同问题的平均正确回答率, 两组间差异不明显(P > 0.05)。在谷类食物的种类及制作方法、水果类、豆类及其制品的选择上, 血糖生成指数组均优于食物交换表组(P < 0.01) 。②两组教育后空腹血糖和餐后 2 h 血糖均低于教育前(P < 0.01) , 但组间比较, 差异不明显(P > 0.05) 。结论: 在糖尿病营养教育中, 患者对血糖生成指数知识的接受性优于食物交换表知识。

王金枝, 杨. (2004). "糖尿病健康教育的临床实践." 现代护理(07).

目的　了解通过糖尿病健康教育的临床实践对糖尿病患者提高疾病知识和自我管理的能力的作用。方法　因时、因地、因需要灵活掌握。采用集体教育、小组教育、个别教育等方法者。结果　通过糖尿病知识培训前后测试评分 ,培训后的知识总评分比培训前明显提高 (P <0 .0 1 )。结论　糖尿病健康教育为糖尿病患者提供了系统的糖尿病知识 ,通过不同形式的教育 ,可使患者最佳利用健康教育的信息资料获得最好的生活质量

魏常胜 and 梁杰雄 (2007). "教学医院应加强医学生与患者沟通能力的培训." 首都医科大学学报(社科版)(00).

素质教育是医学教育改革的重点,在医疗实践的过程中,作者意识到对医学生的培养要逐步从医学理论知识占据主导位置向医生综合素质和能力的培养转变,医学院校和教学医院要加强医学生和患者沟通能力的培养。作者从语言表达能力的培训、了解患者的心理变化、积极参与医疗实践全部过程以及注意学习医疗常规和医疗卫生相关的法律文献等方面展开讨论,阐述了医科院校基本教育阶段强化医学生沟通能力的学习和训练、加强与患者沟通能力培训的重要性。

于淑梅, 孟. 朱. (2005). "健康教育在结核性胸膜炎患者自理能力中的作用." 中国全科医学(01).

目的　探索应用健康教育提高结核性胸膜炎患者自理能力的方法。方法　对 2 0 0 2年 1月～ 2 0 0 4年 6月住院的结核性胸膜炎患者进行健康教育 ,并以Orem自理理论为框架 ,自行设计自理能力评估量表评价其效果。结果　健康教育后结核性胸膜炎患者自理能力提高 ,与教育前相比差异有显著性意义 (P <0 0 1)。结论　良好的健康教育 ,可满足患者的自理需要 ,提高其自理能力 ,从而提高治疗效果与护理质量

张思明, 李松柏, et al. (2006). "宜春市农村初三学生艾滋病知识与态度调查." 中国学校卫生(10).

目的了解农村欠发达地区初中学生艾滋病(AIDS)认知状况,以指导农村中学开展AIDS健康教育。方法整群随机抽取宜春市袁州区农村初三学生1 305名进行问卷调查。结果学生获得AIDS知识的主要途径是电视(平均为80.61%);仅有19.39%和14.60%的学生分别回答愿意接触艾滋病患者和愿意与艾滋病患者同班上课;对AIDS传播途径的正确回答率平均为9.33%,有关艾滋病传播途径知识平均得分为(3.81±1.41)(满分为8分),男生平均得分为(3.92±1.46),女生平均得分为(3.68±1.32),差异有统计学意义(t=3.093,P<0.05)。结论应尽快在农村中学开展AIDS健康教育。