Developing a synthetic national population to investigate the impact of different cardiovascular disease risk management strategies: A derivation and validation study.

PubMed

Knight, Josh; Wells, Susan; Marshall, Roger; Exeter, Daniel; Jackson, Rod

2017-01-01

Many national cardiovascular disease (CVD) risk factor management guidelines now recommend that drug treatment decisions should be informed primarily by patients' multi-variable predicted risk of CVD, rather than on the basis of single risk factor thresholds. To investigate the potential impact of treatment guidelines based on CVD risk thresholds at a national level requires individual level data representing the multi-variable CVD risk factor profiles for a country's total adult population. As these data are seldom, if ever, available, we aimed to create a synthetic population, representing the joint CVD risk factor distributions of the adult New Zealand population. A synthetic population of 2,451,278 individuals, representing the actual age, gender, ethnicity and social deprivation composition of people aged 30-84 years who completed the 2013 New Zealand census was generated using Monte Carlo sampling. Each 'synthetic' person was then probabilistically assigned values of the remaining cardiovascular disease (CVD) risk factors required for predicting their CVD risk, based on data from the national census national hospitalisation and drug dispensing databases and a large regional cohort study, using Monte Carlo sampling and multiple imputation. Where possible, the synthetic population CVD risk distributions for each non-demographic risk factor were validated against independent New Zealand data sources. We were able to develop a synthetic national population with realistic multi-variable CVD risk characteristics. The construction of this population is the first step in the development of a micro-simulation model intended to investigate the likely impact of a range of national CVD risk management strategies that will inform CVD risk management guideline updates in New Zealand and elsewhere.

Chronic kidney disease risk reduction in a Hispanic population through pharmacist-based disease-state management.

PubMed

Leal, Sandra; Soto, Marisa

2008-04-01

The purpose of this study was to evaluate the ability of a pharmacist-based disease-state management service to improve the care of indigent, predominately Spanish-speaking patients with diabetes mellitus and common comorbid conditions at high risk for the development of chronic kidney disease (CKD). Patients at high risk for developing CKD who have diabetes at a community health center were placed in a pharmacist-based disease state management service for CKD risk reduction. A residency-trained, bilingual, certified diabetes educator, with a PharmD served as the patient's provider using diagnostic, educational, and therapeutic management services under a medical staff approved collaborative practice agreement. Outcomes were assessed by using national standards of care for disease control and prevention screening. The impact on CKD was shown with a mean A1C decrease of 2% and improvement in the proportion of patients at target goals for blood pressure, A1C, and cholesterol levels and receiving aspirin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. A pharmacist-based disease-state management service for CKD risk reduction, care of diabetes, and frequently associated comorbid conditions improved compliance with national standards for diabetes care in a high-risk population.

[The German Disease Management Guideline Asthma: methods and development process].

PubMed

Kopp, Ina; Lelgemann, Monika; Ollenschläger, Günter

2006-01-01

The German National Program for Disease Management Guidelines, which is being operated under the auspices of the German Medical Association (GMA), the Association of the Scientific Medical Societies (AWMF) and the National Association of Statutory Health Insurance Physicians (NASHIP), provides a conceptual basis for the disease management of prioritized healthcare aspects. The main objective of the program is to establish consensus of the medical professions on key recommendations covering all sectors of healthcare provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the scope of this program, the Scientific Medical Societies concerned with the prevention, diagnosis, treatment and rehabilitation of asthma in children, adolescents and adults have reached consensus on the core contents for a National Disease Management Guideline for Asthma. This consensus was reached by applying formal techniques and on the basis of the adaptation of recommendations from existing guidelines with high quality standards in methodology and reporting, and information from evidence reports.

A national surveillance project on chronic kidney disease management in Canadian primary care: a study protocol.

PubMed

Bello, Aminu K; Ronksley, Paul E; Tangri, Navdeep; Singer, Alexander; Grill, Allan; Nitsch, Dorothea; Queenan, John A; Lindeman, Cliff; Soos, Boglarka; Freiheit, Elizabeth; Tuot, Delphine; Mangin, Dee; Drummond, Neil

2017-08-04

Effective chronic disease care is dependent on well-organised quality improvement (QI) strategies that monitor processes of care and outcomes for optimal care delivery. Although healthcare is provincially/territorially structured in Canada, there are national networks such as the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) as important facilitators for national QI-based studies to improve chronic disease care. The goal of our study is to improve the understanding of how patients with chronic kidney disease (CKD) are managed in primary care and the variation across practices and provinces and territories to drive improvements in care delivery. The CPCSSN database contains anonymised health information from the electronic medical records for patients of participating primary care practices (PCPs) across Canada (n=1200). The dataset includes information on patient sociodemographics, medications, laboratory results and comorbidities. Leveraging validated algorithms, case definitions and guidelines will help define CKD and the related processes of care, and these enable us to: (1) determine prevalent CKD burden; (2) ascertain the current practice pattern on risk identification and management of CKD and (3) study variation in care indicators (eg, achievement of blood pressure and proteinuria targets) and referral pattern for specialist kidney care. The process of care outcomes will be stratified across patients' demographics as well as provider and regional (provincial/territorial) characteristics. The prevalence of CKD stages 3-5 will be presented as age-sex standardised prevalence estimates stratified by province and as weighted averages for population rates with 95% CIs using census data. For each PCP, age-sex standardised prevalence will be calculated and compared with expected standardised prevalence estimates. The process-based outcomes will be defined using established methods. The CPCSSN is committed to high ethical standards when dealing with

National Economic Burden Associated with Management of Periodontitis in Malaysia

PubMed Central

Ayob, Rasidah; Abd Muttalib, Khairiyah

2016-01-01

Objectives. The aim of this study is to estimate the economic burden associated with the management of periodontitis in Malaysia from the societal perspective. Methods. We estimated the economic burden of periodontitis by combining the disease prevalence with its treatment costs. We estimated treatment costs (with 2012 value of Malaysian Ringgit) using the cost-of-illness approach and included both direct and indirect costs. We used the National Oral Health Survey for Adults (2010) data to estimate the prevalence of periodontitis and 2010 national census data to estimate the adult population at risk for periodontitis. Results. The economic burden of managing all cases of periodontitis at the national level from the societal perspective was approximately MYR 32.5 billion, accounting for 3.83% of the 2012 Gross Domestic Product of the country. It would cost the nation MYR 18.3 billion to treat patients with moderate periodontitis and MYR 13.7 billion to treat patients with severe periodontitis. Conclusion. The economic burden of periodontitis in Malaysia is substantial and comparable with that of other chronic diseases in the country. This is attributable to its high prevalence and high cost of treatment. Judicious application of promotive, preventive, and curative approaches to periodontitis management is decidedly warranted. PMID:27092180

National Economic Burden Associated with Management of Periodontitis in Malaysia.

PubMed

Mohd Dom, Tuti Ningseh; Ayob, Rasidah; Abd Muttalib, Khairiyah; Aljunid, Syed Mohamed

2016-01-01

Objectives. The aim of this study is to estimate the economic burden associated with the management of periodontitis in Malaysia from the societal perspective. Methods. We estimated the economic burden of periodontitis by combining the disease prevalence with its treatment costs. We estimated treatment costs (with 2012 value of Malaysian Ringgit) using the cost-of-illness approach and included both direct and indirect costs. We used the National Oral Health Survey for Adults (2010) data to estimate the prevalence of periodontitis and 2010 national census data to estimate the adult population at risk for periodontitis. Results. The economic burden of managing all cases of periodontitis at the national level from the societal perspective was approximately MYR 32.5 billion, accounting for 3.83% of the 2012 Gross Domestic Product of the country. It would cost the nation MYR 18.3 billion to treat patients with moderate periodontitis and MYR 13.7 billion to treat patients with severe periodontitis. Conclusion. The economic burden of periodontitis in Malaysia is substantial and comparable with that of other chronic diseases in the country. This is attributable to its high prevalence and high cost of treatment. Judicious application of promotive, preventive, and curative approaches to periodontitis management is decidedly warranted.

[National disease management guidelines (NVL) for chronic CAD : What is new, what is particularly important?].

PubMed

Werdan, K

2016-09-01

Coronary heart disease (CAD) is widespread and affects 1 in 10 of the population in the age group 40-79 years in Germany. The German national management guidelines on chronic CAD comprise evidence and expert-based recommendations for the diagnostics of chronic stable CAD as well as for interdisciplinary/multidisciplinary therapy and care of patients with stable CAD. The focus is on the diagnostics, prevention, medication therapy, revascularization, rehabilitation, general practitioner care and coordination of care. Recommendations for optimizing cooperation between all medical specialties involved as well as the definition of mandatory and appropriate measures are essential aims of the guidelines both to improve the quality of care and to strengthen the position of the patient.

Wildlife mortality investigation and disease research: contributions of the USGS National Wildlife Health Center to endangered species management and recovery

USGS Publications Warehouse

Brand, Christopher J.

2013-01-01

The U.S. Geological Survey—National Wildlife Health Center (NWHC) provides diagnostic services, technical assistance, applied research, and training to federal, state, territorial, and local government agencies and Native American tribes on wildlife diseases and wildlife health issues throughout the United States and its territories, commonwealth, and freely associated states. Since 1975, >16,000 carcasses and specimens from vertebrate species listed under the Endangered Species Act have been submitted to NWHC for determination of causes of morbidity or mortality or assessment of health/disease status. Results from diagnostic investigations, analyses of the diagnostic database, technical assistance and consultation, field investigation of epizootics, and wildlife disease research by NWHC wildlife disease specialists have contributed importantly to the management and recovery of listed species.

Wildlife mortality investigation and disease research: contributions of the USGS National Wildlife Health Center to endangered species management and recovery.

PubMed

Brand, Christopher J

2013-12-01

The U.S. Geological Survey-National Wildlife Health Center (NWHC) provides diagnostic services, technical assistance, applied research, and training to federal, state, territorial, and local government agencies and Native American tribes on wildlife diseases and wildlife health issues throughout the United States and its territories, commonwealth, and freely associated states. Since 1975, >16,000 carcasses and specimens from vertebrate species listed under the Endangered Species Act have been submitted to NWHC for determination of causes of morbidity or mortality or assessment of health/disease status. Results from diagnostic investigations, analyses of the diagnostic database, technical assistance and consultation, field investigation of epizootics, and wildlife disease research by NWHC wildlife disease specialists have contributed importantly to the management and recovery of listed species.

National Study of Chronic Disease Self-Management: Age Comparison of Outcome Findings

ERIC Educational Resources Information Center

Ory, Marcia G.; Smith, Matthew Lee; Ahn, SangNam; Jiang, Luohua; Lorig, Kate; Whitelaw, Nancy

2014-01-01

Introduction: The adult population is increasingly experiencing one or more chronic illnesses and living with such conditions longer. The Chronic Disease Self-Management Program (CDSMP) helps participants cope with chronic disease-related symptomatology and improve their health-related quality of life. Nevertheless, the long-term effectiveness of…

Disease management.

PubMed Central

Hunter, D. J.; Fairfield, G.

1997-01-01

The disease management approach to patient care seeks to coordinate resources across the healthcare delivery system. The growing interest in evidence based medicine and outcomes, and a commitment to integrated care across the primary, secondary, and community care sectors, all contribute to making disease management an attractive idea. A combination of patient education, provider use of practice guidelines, appropriate consultation, and supplies of drugs and ancillary services all come together in the disease management process. But its effectiveness is largely untested, so evaluation is essential. PMID:9233330

Use of the nutrition facts label in chronic disease management: results from the National Health and Nutrition Examination Survey.

PubMed

Post, Robert E; Mainous, Arch G; Diaz, Vanessa A; Matheson, Eric M; Everett, Charles J

2010-04-01

Dietary modifications are common treatment strategies for patients with various chronic diseases, but it is unclear how often these individuals read food labels. The objective of this study was to determine whether patients with chronic disease who are advised to change their eating habits read nutrition labels more than patients who have not been so advised, and whether that impacts their energy and nutrient intake. Analysis of the 2005-2006 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional survey of the United States population, was performed. Adults (20 years of age or older) who participated in the 2005-2006 National Health and Nutrition Examination Survey and who had type 2 diabetes, hypertension, and/or hyperlipidemia were included for analysis. There were 3,748 unweighted participants, which represents 170,958,166 in the US population. Proportions of patients with chronic disease who read nutrition labels were compared by chi(2) analysis, mean values of various components of their diet were compared by the two-sample independent t test, and odds ratios and 95% confidence intervals were determined by logistic regression. Among patients with chronic disease, the odds of reading food labels when told by their doctor or another health professional to reduce calories or weight was 50% higher than in those without physician intervention (odds ratio=1.50, 95% confidence interval: 1.12 to 2.00). Those who read food labels consumed less energy, saturated fat, carbohydrates, and sugar, and more fiber than those who did not. These findings point to the value of dietary counseling in chronic disease management. Copyright (c) 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

State of rare disease management in Southeast Asia.

PubMed

Shafie, Asrul Akmal; Chaiyakunapruk, Nathorn; Supian, Azuwana; Lim, Jeremy; Zafra, Matt; Hassali, Mohamed Azmi Ahmad

2016-08-02

Rare diseases, also referred to as orphan diseases, are characterised by their low prevalence with majority of them are chronically debilitating and life threatening. Given the low prevalence and the widely dispersed but very small patient base for each disease, there may often be a disproportion in the availability of treatments and resources to manage patients, spur research and train experts. This is especially true in Southeast Asian countries that are currently in the process of implementing or revising their universal health coverage schemes. This paper aims to examine the status of rare disease management in Southeast Asian countries. It will serve as the basis for a more active discussion on how countries in the region can address an under-recognised rare disease burden and enhance national and regional capacities. The study consists of literature reviews and key stakeholders interviews in six focus countries, including the Philippines, Singapore, Malaysia, Indonesia, Vietnam, and Thailand and five countries as best practice, comprising of France, Canada, Australia, Taiwan, and South Korea. Rare disease management initiatives across each country were examined based on the World Health Organization's framework for action in strengthening health systems. The results suggest rare disease management remains challenging across Southeast Asia, as many of the focus countries face fundamental issues from basic healthcare systems to funding. Nonetheless, there are substantial improvement opportunities, including leveraging best practices from around the world and organising a multi-stakeholder and regional approach and strategy. Southeast Asian countries have made significant progress in the management of rare disease, but there remain key areas for substantial development opportunities.

Effect of multidisciplinary disease management for hospitalized heart failure under a national health insurance programme.

PubMed

Mao, Chun-Tai; Liu, Min-Hui; Hsu, Kuang-Hung; Fu, Tieh-Cheng; Wang, Jong-Shyan; Huang, Yu-Yen; Yang, Ning-I; Wang, Chao-Hung

2015-09-01

Multidisciplinary disease management programmes (MDPs) for heart failure have been shown to be effective in Western countries. However, it is not known whether they improve outcomes in a high population density country with a national health insurance programme. In total, 349 patients hospitalized because of heart failure were randomized into control and MDP groups. All-cause death and re-hospitalization related to heart failure were analyzed. The median follow-up period was approximately 2 years. Mean patient age was 60 years; 31% were women; and 50% of patients had coronary artery disease. MDP was associated with fewer all-cause deaths [hazard ratio (HR) = 0.49, 95% confidence interval (CI) = 0.27-0.91, P = 0.02] and heart failure-related re-hospitalizations (HR = 0.44, 95% CI = 0.25-0.77, P = 0.004). MDP was still associated with better outcomes for all-cause death (HR = 0.53, 95% CI = 0.29-0.98, P = 0.04) and heart failure-related re-hospitalization (HR = 0.46, 95% CI = 0.26-0.81, P = 0.007), after adjusting for age, diuretics, diabetes mellitus, chronic kidney disease, hypertension, sodium, and albumin. However, MDPs' effect on all-cause mortality and heart failure-related re-hospitalization was significantly attenuated after adjusting for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers or β-blockers. A stratified analysis showed that MDP combined with guideline-based medication had synergistic effects. MDP is effective in lowering all-cause mortality and re-hospitalization rates related to heart failure under a national health insurance programme. MDP synergistically improves the effectiveness of guidelines-based medications for heart failure.

IGEA--a chronic disease management project for people with diabetes.

PubMed

Maggini, Marina

2009-01-01

Chronic diseases can be prevented and controlled using available knowledge. Moreover, the solutions are not only effective but can be highly cost-effective. Chronic care model and disease management have emerged, in the last decades, as new models of care delivery. The two models share the objective of improving the quality of care for people with chronic diseases while optimizing health care expenditure. In Italy, within the National Prevention Plan, the Italian Centre for Disease Prevention and Control of the Ministry of Health, and the Istituto Superiore di Sanità (ISS) are developing the IGEA project, which defines a comprehensive strategy for implementing a chronic disease management intervention for people with diabetes.

National Hansen's Disease (Leprosy) Program

MedlinePlus

... Date Last Reviewed: May 2018 Hansen's Disease Diagnosis & Management Patient Information English (PDF - 109 KB) Portuguese (PDF - 43 KB) ... in the United States - Diagnosis & Treatment Seminar Comprehensive Management of the Neuropathic Foot ... Links Hansen's Disease (Leprosy) (Centers for Disease ...

Genomic and clinical profiling of a national nephrotic syndrome cohort advocates a precision medicine approach to disease management.

PubMed

Bierzynska, Agnieszka; McCarthy, Hugh J; Soderquest, Katrina; Sen, Ethan S; Colby, Elizabeth; Ding, Wen Y; Nabhan, Marwa M; Kerecuk, Larissa; Hegde, Shivram; Hughes, David; Marks, Stephen; Feather, Sally; Jones, Caroline; Webb, Nicholas J A; Ognjanovic, Milos; Christian, Martin; Gilbert, Rodney D; Sinha, Manish D; Lord, Graham M; Simpson, Michael; Koziell, Ania B; Welsh, Gavin I; Saleem, Moin A

2017-04-01

Steroid Resistant Nephrotic Syndrome (SRNS) in children and young adults has differing etiologies with monogenic disease accounting for 2.9-30% in selected series. Using whole exome sequencing we sought to stratify a national population of children with SRNS into monogenic and non-monogenic forms, and further define those groups by detailed phenotypic analysis. Pediatric patients with SRNS were identified via a national United Kingdom Renal Registry. Whole exome sequencing was performed on 187 patients, of which 12% have a positive family history with a focus on the 53 genes currently known to be associated with nephrotic syndrome. Genetic findings were correlated with individual case disease characteristics. Disease causing variants were detected in 26.2% of patients. Most often this occurred in the three most common SRNS-associated genes: NPHS1, NPHS2, and WT1 but also in 14 other genes. The genotype did not always correlate with expected phenotype since mutations in OCRL, COL4A3, and DGKE associated with specific syndromes were detected in patients with isolated renal disease. Analysis by primary/presumed compared with secondary steroid resistance found 30.8% monogenic disease in primary compared with none in secondary SRNS permitting further mechanistic stratification. Genetic SRNS progressed faster to end stage renal failure, with no documented disease recurrence post-transplantation within this cohort. Primary steroid resistance in which no gene mutation was identified had a 47.8% risk of recurrence. In this unbiased pediatric population, whole exome sequencing allowed screening of all current candidate genes. Thus, deep phenotyping combined with whole exome sequencing is an effective tool for early identification of SRNS etiology, yielding an evidence-based algorithm for clinical management. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

space technology and nigerian national challenges in disaster management

NASA Astrophysics Data System (ADS)

O. Akinyede, J., , Dr.; Abdullahi, R.

One of the sustainable development challenges of any nation is the nation s capacity and capabilities to manage its environment and disaster According to Abiodun 2002 the fundamental life support systems are air clean water and food or agricultural resources It also includes wholesome environment shelter and access to energy health and education All of these constitute the basic necessities of life whose provision and preservation should be a pre-occupation of the visionary leaders executive legislative and judiciary of any nation and its people in order to completely eradicate ignorance unemployment poverty and disease and also increase life expectancy Accordingly many societies around the globe including Nigeria are embarking on initiatives and developing agenda that could address redress the threats to the life supporting systems Disaster prevention management and reduction therefore present major challenges that require prompt attention locally nationally regionally and globally Responses to disasters vary from the application of space-derived data for disaster management to the disbursement of relief to the victims and the emplacement of recovery measures The role of space technology in particular in all the phases of disaster management planning against disaster disaster early warning risk reduction preparedness crises and damage assessment response and relief disbursement and recovery and reconstruction cannot be overemphasized Akinyede 2005 Therefore this paper seeks to focus on space

[Disease management programs from a health insurer's point of view].

PubMed

Szymkowiak, Christof; Walkenhorst, Karen; Straub, Christoph

2003-06-01

Disease Management Programmes represent a great challenge to the German statutory health insurance system. According to politicians, disease management programmes are an appropriate tool for increasing the level of care for chronically ill patients significantly, while at the same time they can slow down the cost explosion in health care. The statutory health insurers' point of view yields a more refined picture of the chances and risks involved. The chances are that a medical guideline-based, evidence-based, co-operative care of the chronically ill could be established. But also, there are the risks of misuse of disease management programmes and of misallocation of funds due to the ill-advised linkage with the so-called risk compensation scheme (RSA) balancing the sickness funds' structural deficits through redistribution. The nation-wide introduction of disease management programmes appears to be a gigantic experiment whose aim is to change the care of chronically ill patients and whose outcome is unpredictable.

Chronic disease management: it's time for transformational change!

PubMed

Muttitt, Sarah C; Alvarez, Richard C

2007-01-01

The authors of the lead essay present a compelling case for the development and implementation of a national strategy on chronic disease prevention and management (CDPM). The literature demonstrates that the Chronic Care Model can improve quality and reduce costs. Substantial evidence supports the role of health information technologies such as electronic health records (EHRs) in achieving these goals. However, an interoperable pan-Canadian health infostructure does not exist; funding is required to establish this across the continuum of care. An investment of $350 per capita would provide a robust health technology platform to support a national CDPM strategy. Such an investment would deliver annual benefits of $6-$7.6 billion; this could be leveraged to support national healthcare priorities such as CDPM. EHRs will improve decisions about care, reduce system errors and increase efficiency. They will also improve our ability to measure, assess and manage care. We cannot run a high-performing health system without sound data. This was a key step to enabling progress on wait times management. Leadership is required if a national CDPM strategy is to become reality. The authors made a convincing case for the development of a national strategy; we need to turn their words into actionable events to gain necessary momentum.

Management System of Occupational Diseases in Korea: Statistics, Report and Monitoring System

PubMed Central

Choe, Seong Weon

2010-01-01

The management system of occupational diseases in Korea can be assessed from the perspective of a surveillance system. Workers' compensation insurance reports are used to produce official statistics on occupational diseases in Korea. National working conditions surveys are used to monitor the magnitude of work-related symptoms and signs in the labor force. A health examination program was introduced to detect occupational diseases through both selective and mass screening programs. The Working Environment Measurement Institution assesses workers' exposure to hazards in the workplace. Government regulates that the employer should do health examinations and working conditions measurement through contracted private agencies and following the Occupational Safety and Health Act. It is hoped that these institutions may be able to effectively detect and monitor occupational diseases and hazards in the workplace. In view of this, the occupational management system in Korea is well designed, except for the national survey system. In the future, national surveys for detection of hazards and ill-health outcomes in workers should be developed. The existing surveillance system for occupational disease can be improved by providing more refined information through statistical analysis of surveillance data. PMID:21258584

Management system of occupational diseases in Korea: statistics, report and monitoring system.

PubMed

Rhee, Kyung Yong; Choe, Seong Weon

2010-12-01

The management system of occupational diseases in Korea can be assessed from the perspective of a surveillance system. Workers' compensation insurance reports are used to produce official statistics on occupational diseases in Korea. National working conditions surveys are used to monitor the magnitude of work-related symptoms and signs in the labor force. A health examination program was introduced to detect occupational diseases through both selective and mass screening programs. The Working Environment Measurement Institution assesses workers' exposure to hazards in the workplace. Government regulates that the employer should do health examinations and working conditions measurement through contracted private agencies and following the Occupational Safety and Health Act. It is hoped that these institutions may be able to effectively detect and monitor occupational diseases and hazards in the workplace. In view of this, the occupational management system in Korea is well designed, except for the national survey system. In the future, national surveys for detection of hazards and ill-health outcomes in workers should be developed. The existing surveillance system for occupational disease can be improved by providing more refined information through statistical analysis of surveillance data.

U.S. Geological Survey, National Wildlife Health Center, 2011 report of selected wildlife diseases

USGS Publications Warehouse

Green, David E.; Hines, Megan K.; Russell, Robin E.; Sleeman, Jonathan M.

2012-01-01

The National Wildlife Health Center (NWHC) was founded in 1975 to provide technical assistance in identifying, controlling, and preventing wildlife losses from diseases, conduct research to understand the impact of diseases on wildlife populations, and devise methods to more effectively manage these disease threats. The impetus behind the creation of the NWHC was, in part, the catastrophic loss of tens of thousands of waterfowl as a result of an outbreak of duck plague at the Lake Andes National Wildlife Refuge in South Dakota during January 1973. In 1996, the NWHC, along with other Department of Interior research functions, was transferred from the U.S. Fish and Wildlife Service to the U.S. Geological Survey (USGS), where we remain one of many entities that provide the independent science that forms the bases of the sound management of the Nation’s natural resources. Our mission is to provide national leadership to safeguard wildlife and ecosystem health through dynamic partnerships and exceptional science. The main campus of the NWHC is located in Madison, Wis., where we maintain biological safety level 3 (BSL–3) diagnostic and research facilities purposefully designed for work with wildlife species. The NWHC provides research and technical assistance on wildlife health issues to State, Federal, and international agencies. In addition, since 1992 we have maintained a field station in Hawaii, the Honolulu Field Station, which focuses on marine and terrestrial natural resources throughout the Pacific region. The NWHC conducts diagnostic investigations of unusual wildlife morbidity and mortality events nationwide to detect the presence of wildlife pathogens and determine the cause of death. This is also an important activity for detecting new, emerging and resurging diseases. The NWHC provides this crucial information on the presence of wildlife diseases to wildlife managers to support sound management decisions. The data and information generated also allows

Surgical management of Crohn's disease.

PubMed

Lu, Kim C; Hunt, Steven R

2013-02-01

Although medical management can control symptoms in a recurring incurable disease, such as Crohn's disease, surgical management is reserved for disease complications or those problems refractory to medical management. In this article, we cover general principles for the surgical management of Crohn's disease, ranging from skin tags, abscesses, fistulae, and stenoses to small bowel and extraintestinal disease. Copyright © 2013 Elsevier Inc. All rights reserved.

A framework for a diabetes mellitus disease management system in southern Israel.

PubMed

Fox, Matthew A; Harman-Boehm, Ilana; Weitzman, Shimon; Zelingher, Julian

2002-01-01

Chronic diseases are a significant burden on western healthcare systems and national economies. It has been suggested that automated disease management for chronic disease, like diabetes mellitus (DM), improves the quality of care and reduces inappropriate utilization of diagnostic and therapeutic measures. We have designed a comprehensive DM Disease Management system for the Negev region in southern Israel. This system takes advantage of currently used clinical and administrative information systems. Algorithms for DM disease management have been created based on existing and accepted Israeli guidelines. All data fields and tables in the source information systems have been analyzed, and interfaces for periodic data loads from these systems have been specified. Based on this data, four subsets of decision support algorithms have been developed. The system generates alerts in these domains to multiple end users. We plan to use the products of this information system analysis and disease management specification in the actual development process of such a system shortly.

Disease management: a leap of faith to lower-cost, higher-quality health care.

PubMed

Short, Ashley; Mays, Glen; Mittler, Jessica

2003-10-01

With managed care's promise to reduce costs and improve quality waning, employers and health plans are exploring more targeted ways to control rapidly rising health costs. Disease management programs, which focus on patients with chronic conditions such as asthma and diabetes, are growing in popularity, according to findings from the Center for Studying Health System Change's (HSC) 2002-03 site visits to 12 nationally representative communities. In addition to condition-based disease management programs, some health plans and employers are using intensive case management services to coordinate care for high-risk patients with potentially costly and complex medical conditions. Despite high expectations, evidence of both disease management and case management programs' success in controlling costs and improving quality remains limited.

The management of painful crisis in sickle cell disease.

PubMed

Wright, Josh; Ahmedzai, Sam H

2010-06-01

Until recently management of sickle pain was the province of haematologists. However, a recent National Confidential Enquiry into Patient Outcome and Death report highlighted problems with the management of pain and opioid analgesia in this group and suggested a multiagency approach similar to that used in palliative care. Pain is the most frequent complication of this haemoglobin disorder. Sickle cell disease is very variable with many patients leading full lives with long periods with little or no pain. At the other end of the spectrum there are those who exist in a sea of pain. The mechanisms of sickle pain are poorly understood and evidence for the best treatment modalities sparse. Historically there has been a dearth of clinical trials in sickle cell; however, this is starting to be addressed. In this review we will give a brief overview of the disease and its pathogenesis before examining the epidemiology, management of pain in sickle cell disease. We will also review recent evidence regarding quality of life and discuss the role of opioid hyperalgesia in sickle cell disease.

Integrating a mobile health setup in a chronic disease management network.

PubMed

Ding, Hang; Ireland, Derek; Jayasena, Rajiv; Curmi, Jamie; Karunanithi, Mohan

2013-01-01

Supporting self management of chronic disease in collaboration with primary healthcare has been a national priority in order to mitigate the emerging disease burden on the already strained healthcare system. However, in practice, the uptake of self-management programs and compliance with clinical guidelines remain poor. Time constraints due to work commitments and lack of efficient monitoring tools have been the major barrier to the uptake and compliance. In this paper, we present a newly integrated mobile health system with a clinical chronic disease management network called cdmNet, which has already been validated to facilitate General Practitioners (GPs) to provide collaborative disease management services. The newly integrated solution takes advantage of the latest mobile web and wireless Bluetooth communication techniques to enable patients to record health data entries through ubiquitous mobile phones, and allows the data to be simultaneously shared by multidisciplinary care teams. This integration would enable patients to self-manage their chronic disease conditions in collaboration with GPs and hence, improve the uptake and compliance. Additionally, the proposed integration will provide a useful framework encouraging the translation of innovative mobile health technologies into highly regulated healthcare systems.

Status of adolescent pelvic inflammatory disease management in the United States.

PubMed

Trent, Maria

2013-10-01

Pelvic inflammatory disease (PID) is a common and serious reproductive health disorder and disease rates remain unacceptably high among adolescent girls and young adult women in the United States. Despite data demonstrating that women experience major adverse health outcomes after PID, national recommendations for management of adolescents have become increasingly less cautious in an era of cost-containment. In this review, we take an alternative look at published data on adolescents with PID to frame the next steps for optimizing management for this vulnerable population. Several findings emerge from review of the literature. First, there is limited evidence to guide the best practice strategies for adolescents with PID due to low enrolment of early and middle adolescents in national trials. Second, adolescents and adult women in the United States receive suboptimal treatment regimens per Centers for Disease Control and Prevention (CDC) standards. Third, available evidence suggests that adolescents are at an increased risk for poor adherence to CDC recommendations for self-care, reacquisition of sexually transmitted infections (STIs) and PID, and subsequent adverse reproductive health outcomes. Efforts to develop and integrate adolescent-focused, evidence-based strategies for PID management and prevention of subsequent STIs and recurrent PID are warranted.

[Online continuing medical education based on national disease management guidelines. The e-learning platform leitlinien-wissen.de].

PubMed

Vollmar, H C; Schürer-Maly, C-C; Lelgemann, M; Koneczny, N; Koch, M; Butzlaff, M

2006-05-01

Effective translation of relevant knowledge into clinical practice is essential for modern health care systems. National Disease Management Guidelines (NDMG) are considered relevant instruments to support this transfer. To implement NDMG Internet-based continuing medical education (CME), modules and online case-based learning objects were designed and published. To ensure high quality the contents are based on NDMG and subjected to multi-step review processes. Presentation on the web was realized through a modified content management system. To obtain a CME certificate, completing an online questionnaire using a four-point Likert scale was mandatory. Between June 2003 and April 2005, 3,105 physicians were registered and used the platform: 95% of the physicians expressed positive feedback in the evaluation questionnaire, and 35% actually used the corresponding NDMG in practice. This prompted the development of interactive medical case-based learning objects as a second learning pathway. An Internet platform for CME including case-based learning objects can be a helpful tool to assure the provision of scientific knowledge for patient care.

Effect of Medicaid Disease Management Programs on Emergency Admissions and Inpatient Costs

PubMed Central

Conti, Matthew S

2013-01-01

Objective To determine the impact of state Medicaid diabetes disease management programs on emergency admissions and inpatient costs. Data National InPatient Sample sponsored by the Agency for Healthcare Research and Quality Project for the years from 2000 to 2008 using 18 states. Study Design A difference-in-difference methodology compares costs and number of emergency admissions for Washington, Texas, and Georgia, which implemented disease management programs between 2000 and 2008, to states that did not undergo the transition to managed care (N = 103). Data Extraction Costs and emergency admissions were extracted for diabetic Medicaid enrollees diagnosed in the reform and non-reform states and collapsed into state and year cells. Principal Findings In the three treatment states, the implementation of disease management programs did not have statistically significant impacts on the outcome variables when compared to the control states. Conclusions States that implemented disease management programs did not achieve improvements in costs or the number of emergency of admissions; thus, these programs do not appear to be an effective way to reduce the burden of this chronic disease. PMID:23278435

Effect of Medicaid disease management programs on emergency admissions and inpatient costs.

PubMed

Conti, Matthew S

2013-08-01

To determine the impact of state Medicaid diabetes disease management programs on emergency admissions and inpatient costs. National InPatient Sample sponsored by the Agency for Healthcare Research and Quality Project for the years from 2000 to 2008 using 18 states. A difference-in-difference methodology compares costs and number of emergency admissions for Washington, Texas, and Georgia, which implemented disease management programs between 2000 and 2008, to states that did not undergo the transition to managed care (N = 103). Costs and emergency admissions were extracted for diabetic Medicaid enrollees diagnosed in the reform and non-reform states and collapsed into state and year cells. In the three treatment states, the implementation of disease management programs did not have statistically significant impacts on the outcome variables when compared to the control states. States that implemented disease management programs did not achieve improvements in costs or the number of emergency of admissions; thus, these programs do not appear to be an effective way to reduce the burden of this chronic disease. © Health Research and Educational Trust.

Disease management improves end-stage renal disease outcomes.

PubMed

Sands, Jeffrey J

2006-01-01

Renal disease management organizations have reported achieving significant decreases in mortality and hospitalization in conjunction with cost savings, improved patient satisfaction and quality of life. Disease management organizations strive to fill existing gaps in care delivery through the standardized use of risk assessment, predictive modeling, evidence-based guidelines, and process and outcomes measurement. Patient self-management education and the provision of individual nurse care managers are also key program components. As we more fully measure clinical outcomes and total healthcare costs, including payments from all insurance and government entities, pharmacy costs and out of pocket expenditures, the full implications of disease management can be better defined. The results of this analysis will have a profound influence on United States healthcare policy. At present current data suggest that the promise of disease management, improved care at reduced cost, can and is being realized in end-stage renal disease. Copyright 2006 S. Karger AG, Basel.

Pharmacy workforce to prevent and manage non-communicable diseases in developing nations: The case of Nepal.

PubMed

Khanal, Saval; Nissen, Lisa; Veerman, Lennert; Hollingworth, Samantha

2016-01-01

Non-communicable diseases (NCDs, e.g. cardiovascular diseases, cancer, chronic respiratory diseases and diabetes mellitus) are the main causes of mortality and morbidity in developing countries, including Nepal. Nearly half of the deaths in Nepal are caused by NCDs. Nepal lacks adequate human resources to prevent and manage NCDs, but the skills and expertise of pharmacists in Nepal are underused. There is evidence from many countries that pharmacists can contribute substantially to the prevention and management NCD. We aim to describe the opportunities and challenges for pharmacists to prevent and manage NCDs in Nepal. Pharmacists can contribute by screening and monitoring NCDs; counseling on lifestyle; providing medication therapy management services; promoting public health; and providing other pharmaceutical services. Challenges to the implementation of some of these activities in the current context include inadequate training of pharmacists in NCD prevention and management, the cost of pharmaceutical services to patients and government, and the existing health care service delivery model. There is a need for health services research to determine how pharmacists can be best used to prevent and manage NCDs in Nepal. Copyright © 2015 Elsevier Inc. All rights reserved.

Lysosomal storage diseases: diagnostic confirmation and management of presymptomatic individuals.

PubMed

Wang, Raymond Y; Bodamer, Olaf A; Watson, Michael S; Wilcox, William R

2011-05-01

To develop educational guidelines for the diagnostic confirmation and management of individuals identified by newborn screening, family-based testing after proband identification, or carrier testing in at-risk populations, and subsequent prenatal or postnatal testing of those who are presymptomatic for a lysosomal storage disease. Review of English language literature and discussions in a consensus development panel comprised an international group of experts in the clinical and laboratory diagnosis, treatment and management, newborn screening, and genetic aspects of lysosomal storage diseases. Although clinical trial and longitudinal data were used when available, the evidence in the literature is limited and consequently the recommendations must be considered as expert opinion. Guidelines were developed for Fabry, Gaucher, and Niemann-Pick A/B diseases, glycogen storage type II (Pompe disease), globoid cell leukodystrophy (Krabbe disease), metachromatic leukodystrophy, and mucopolysaccharidoses types I, II, and VI. These guidelines serve as an educational resource for confirmatory testing and subsequent clinical management of presymptomatic individuals suspected to have a lysosomal storage disease; they also help to define a research agenda for longitudinal studies such as the American College of Medical Genetics/National Institutes of Health Newborn Screening Translational Research Network.

Quality management and accreditation of research tissue banks: experience of the National Center for Tumor Diseases (NCT) Heidelberg.

PubMed

Herpel, Esther; Röcken, Christoph; Manke, Heike; Schirmacher, Peter; Flechtenmacher, Christa

2010-12-01

Tissue banks are key resource and technology platforms in biomedical research that address the molecular pathogenesis of diseases as well as disease prevention, diagnosis, and treatment. Due to the central role of tissue banks in standardized collection, storage, and distribution of human tissues and their derivatives, quality management and its external assessment is becoming increasingly relevant for the maintenance, acceptance, and funding of tissue banks. Little experience exists regarding formalized external evaluation of tissue banks, especially regarding certification and accreditation. Based on the accreditation of the National Center of Tumor Diseases (NCT) tissue bank in Heidelberg (Germany), criteria, requirements, processes, and implications were compiled and evaluated. Accreditation formally approved professional competence and performance of the tissue bank in all steps involved in tissue collection, storage, handling as well as macroscopic and histologic examination and final (exit) examination of the tissue and transfer supervised by board-certified competent histopathologists. Thereby, accreditation provides a comprehensive measure to evaluate and document the quality standard of tissue research banks and may play a significant role in the future assessment of tissue banks. Furthermore, accreditation may support harmonization and standardization of tissue banking for biomedical research purposes.

An environmental scan of policies in support of chronic disease self-management in Canada.

PubMed

Liddy, C; Mill, K

2014-02-01

The evidence supporting chronic disease self-management warrants further attention. Our aim was to identify existing policies, strategies and frameworks that support self-management initiatives. This descriptive study was conducted as an environmental scan, consisting of an Internet search of government and other publicly available websites, and interviews with jurisdictional representatives identified through the Health Council of Canada and academic networking. We interviewed 16 representatives from all provinces and territories in Canada and found 30 publicly available and relevant provincial and national documents. Most provinces and territories have policies that incorporate aspects of chronic disease self-management. Alberta and British Columbia have the most detailed policies. Both feature primary care prominently and are not disease specific. Both also have provincial level implementation of chronic disease self-management programming. Canada's northern territories all lacked specific policies supporting chronic disease self-management despite a significant burden of disease. Engaging patients in self-management of their chronic diseases is important and effective. Although most provinces and territories have policies that incorporate aspects of chronic disease self-management, they were often embedded within other initiatives and/or policy documents framed around specific diseases or populations. This approach could limit the potential reach and effect of self-management.

Oncology disease management.

PubMed

Fetterolf, Donald E; Terry, Rachel

2007-02-01

Oncologic conditions are ubiquitous medical illnesses that present a particular challenge for medical management programs designed to address quality and cost issues in patient populations. Disease management strategies represent a reasonable and effective approach for employers and health plans in their arsenal of health management strategies. Multiple reasons exist for the development of specialized disease management programs that deal with cancer patients, some unique to this group of individuals. Health plans and/or employers have solid justification for addressing these issues directly through programs developed specifically to work with cancer patients. Whether developed within a health plan, or "carved out" to an external vendor, proper evaluation of outcomes is essential.

The role of the case manager in a disease management program.

PubMed

Huston, Carol J

2002-01-01

Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.

The role of the case manager in a disease management program.

PubMed

Huston, C J

2001-01-01

Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.

Nonalcoholic Fatty Liver Disease Management: Dietary and Lifestyle Modifications.

PubMed

Nguyen, Vi; George, Jacob

2015-08-01

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of abnormalities that can range from bland liver fat (steatosis), to hepatic inflammation and liver injury (steatohepatitis). It is estimated that NAFLD will become the principal cause of liver disease in Western nations and the leading indication for liver transplantation. Advancements in disease recognition and management are therefore paramount. Although the development of new, reliable drug therapies is vital, lifestyle interventions remain the most effective treatment modality. In addition to weight loss as a primary measure of treatment success, there is growing recognition that other endpoints, including the prevention or delay of diabetes onset, reduced cardiovascular events, prevention of cancer, and improved overall mortality, are equally important outcomes that can be independently modified by lifestyle change. Moreover, NAFLD is inextricably part of a complex, systemic disease process that is linked with deeply entrenched maladaptive lifestyle behaviors. Thus, a holistic, multidisciplinary, and individualized approach to disease management will be the key to achieving any realistic population-level change. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Appropriateness of therapy for fistulizing Crohn's disease: findings from a national inflammatory bowel disease cohort.

PubMed

Pittet, V; Juillerat, P; Michetti, P; Vader, J-P; Burnand, B; Rogler, G; Beglinger, C; Seibold, F; Mottet, C; Felley, C; Gonvers, J-J; Froehlich, F

2010-10-01

About 30-50% of patients with Crohn's disease (CD) develop fistulae, implying significant disease burden and complicated clinical management. To assess appropriate use of therapy for fistulizing CD patients enrolled in the Swiss Inflammatory Bowel Disease Cohort using criteria developed by the European Panel on the Appropriateness of Crohn's disease Therapy. Specific questionnaires were used to gather information on disease and its management. We assessed appropriateness of therapy at enrolment for adult CD patients with one or several fistulae. Two hundred and eighty-eight CD patients had fistulizing disease, of which 80% had complex fistulae and 32% currently had active draining fistulae. Mean age (s.d.) at diagnosis was 27 years (11), 51% males. Of the patients, 78% were judged as having globally an appropriate therapy, which was more often given for complex fistulae (87%) than for simple fistulae (67%). Antibiotics, azathioprine/MP, methotrexate and conservative surgery were almost always appropriate. Anti-tumor necrosis factor α was considered globally appropriate (91%), although most often with an uncertain indication. The 5ASA compounds, steroids and aggressive surgery were most often inappropriate (84%, 58% and 86% respectively). Formal appropriateness criteria for CD therapy were applied to a national cohort of IBD patients. For more than three-quarters of the patients with fistulizing CD, therapy was globally appropriate. © 2010 Blackwell Publishing Ltd.

[Analysis on Research Projects Supported by the National Natural Science Foundation of China at the National Institute of Parasitic Diseases during 2003-2013].

PubMed

Zhou, Xiao-jun; Zheng, Bin; Yi, Feng-yun; Xiong, Yan-hong; Zhang, Min-qi

2015-04-01

The data of the National Natural Science Foundation (NSFC) projests obtained by the National Institute of Parasitic Diseases (NIPD), Chinese Center for Disease Control and Prevention (China CDC) during 2003-2013 were collected from internet-based science information system of NSFC, and NSFC search tool of Dingxiang Garden (http://nsfc.biomart.cn/). The number of funded projects, their subject classification and approved amount were analyzed, and compared with the other institutes of China CDC. Furthermore, the rationalization proposals were given in order to enhance the level of foundation management in the future.

Obesity disease management opportunities and barriers.

PubMed

Sidorov, Jaan E; Fitzner, Karen

2006-04-01

Disease management, a system of coordinated health care interventions and communications for chronically ill populations, relies on patient education and case management to engage individuals in the management of their condition. Disease management also aims to enhance the quality of interactions between doctors and patients and advance evidence-based medicine. Because these programs' interventions frequently include helping individuals who suffer comorbidities associated with obesity to reduce their BMI, adaptation of disease management to populations with obesity seems a viable option. A major barrier for implementing disease management for obesity, however, is the lack of proven return on investment, which limits health plan and disease management organization interest. Purchaser demand may overcome this reluctance. Further research is needed to objectively test whether disease management interventions would be clinically effective for obese populations, produce positive financial outcomes for insurers, and enhance workplace productivity.

The Impact of Nurses on Neglected Tropical Disease Management.

PubMed

Blood-Siegfried, Jane; Zeantoe, G Clinton; Evans, Lauren J; Bondo, John; Forstner, James R; Wood, Kathryn

2015-01-01

Although Neglected Tropical Diseases (NTDs) are largely endemic in the developing nations of Africa, Asia, and South and Central America, they are reemerging with increasing frequency in developed countries. Their diagnosis, treatment, and control are an increasing public health concern that requires a different awareness by health care providers. Neglected tropical diseases (NTDs) are chronic infectious diseases which disproportionately burden poor, rural, and marginalized populations with significant mortality and high morbidity (disability, disfigurement, impaired childhood growth and cognitive development, increased vulnerability to coinfection) that reinforces their poverty. What can we learn from the nurses in developing countries already battling NTD's that could be useful in the developed world? This article provides an overview of distribution, pathophysiology, symptoms, and management of 13 NTDs, with particular attention to the role of nurses in delivering cost-effective integrated interventions. Case studies of schistosomiasis, Chagas disease, and leishmaniasis address recognition and treatment of infected individuals in developed nations where NTD infection is limited primarily to immigrants and travelers. © 2014 Wiley Periodicals, Inc.

76 FR 68615 - National Alzheimer's Disease Awareness Month, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-04

... National Alzheimer's Disease Awareness Month, 2011 By the President of the United States of America A... disease is a pain they know all too well. Alzheimer's disease burdens an increasing number of our Nation's... health. During National Alzheimer's Disease Awareness Month, we stand united in our commitment to improve...

A taxonomy for disease management: a scientific statement from the American Heart Association Disease Management Taxonomy Writing Group.

PubMed

Krumholz, Harlan M; Currie, Peter M; Riegel, Barbara; Phillips, Christopher O; Peterson, Eric D; Smith, Renee; Yancy, Clyde W; Faxon, David P

2006-09-26

Disease management has shown great promise as a means of reorganizing chronic care and optimizing patient outcomes. Nevertheless, disease management programs are widely heterogeneous and lack a shared definition of disease management, which limits our ability to compare and evaluate different programs. To address this problem, the American Heart Association's Disease Management Taxonomy Writing Group developed a system of classification that can be used both to categorize and compare disease management programs and to inform efforts to identify specific factors associated with effectiveness. The AHA Writing Group began with a conceptual model of disease management and its components and subsequently validated this model over a wide range of disease management programs. A systematic MEDLINE search was performed on the terms heart failure, diabetes, and depression, together with disease management, case management, and care management. The search encompassed articles published in English between 1987 and 2005. We then selected studies that incorporated (1) interventions designed to improve outcomes and/or reduce medical resource utilization in patients with heart failure, diabetes, or depression and (2) clearly defined protocols with at least 2 prespecified components traditionally associated with disease management. We analyzed the study protocols and used qualitative research methods to develop a disease management taxonomy with our conceptual model as the organizing framework. The final taxonomy includes the following 8 domains: (1) Patient population is characterized by risk status, demographic profile, and level of comorbidity. (2) Intervention recipient describes the primary targets of disease management intervention and includes patients and caregivers, physicians and allied healthcare providers, and healthcare delivery systems. (3) Intervention content delineates individual components, such as patient education, medication management, peer support, or some

Disease management improves ESRD outcomes.

PubMed

Sands, J J

2006-02-01

Renal disease management organizations have reported achieving significant decreases in mortality and hospitalization in conjunction with cost savings, improved patient satisfaction and quality of life. Disease management organizations strive to fill existing gaps in care delivery through the standardized use of risk assessment, predictive modeling, evidence based guidelines and process and outcomes measurement. Patient self-management education and the provision of individual nurse care managers are also key program components. As we more fully measure clinical outcomes and total health-care costs including payments from all insurance and government entities, pharmacy costs and out-of-pocket expenditures, the full implications of disease management can be better defined. The results of this analysis will have a profound influence on United States healthcare policy. At present, current data suggests that the promise of disease management, improved care at reduced cost, can and is being realized in ESRD.

Management of neurodegenerative disorders: Parkinson's disease and Alzheimer's disease.

PubMed

Pal, P K; Netravathi, M

2005-03-01

Neurodegenerative disorders result from premature progressive degeneration of specific neurons, and manifest as diseases or syndromes with varied combinations of cognitive, motor, sensory and autonomic dysfunctions. The management involves pharmacotherapy as well as non-pharmacological measures and also to lessen the burden of the care-givers. The medications available for medical treatment are: Levodopa, dopamine agonists, amantadine, anticholinergics, enzyme inhibitors, etc. Advanced Parkinson's disease is concerned with management of motor complications and non-motor complications. Recently surgical treatment is a great option for managing motor complication. Orthostatic hypotension, gait distiurbances, emotional and psychiatric problems, sleep disturbances can be managed and had been discussed in brief. Currently there is no medication available for the cure of Alzheimer's disease. The specific medications claimed to improve patient's well being and cognition include cholinesterase inhibitors, N-methyl-D-aspartate receptor antagonist, anti-oxidants, and anti-amyloid therapy. While medical and surgical treatments for Parkinson's disease have revolutionised the management, still drug therapy for Alzheimer's disease is dismal.

Animal disease outbreak control: the use of crisis management tools.

PubMed

Kroschewski, K; Kramer, M; Micklich, A; Staubach, C; Carmanns, R; Conraths, F J

2006-04-01

In this era of globalisation the effective control of animal disease outbreaks requires powerful crisis management tools. In the 1990s software packages for different sectors of the government and agricultural industry began to be developed. In 2004, as a special application for tracking the movement of animals and animal products, the European Union developed the Trade Control and Expert System (TRACES) on the basis of its predecessor, the ANImal MOvement (ANIMO) project. The nationwide use of the ANIMO system by the veterinary authorities in Germany marked the beginning of the development in 1993 of a computerised national animal disease reporting system--the TierSeuchenNachrichten (TSN)--using the ANIMO hardware and software components. In addition to TRACES and TSN the third pillar for the management of animal disease outbreaks and crises in Germany is the national cattle and swine database--called Herkunftssicherungs- und Informationssystem für Tiere. A high degree of standardisation is necessary when integrating the different solutions at all levels of government and with the private sector. In this paper, the authors describe the use of these tools on the basis of their experience and in relation to what we can do now and what we should opt for in the future.

Sickle Cell Disease: Management Options and Challenges in Developing Countries

PubMed Central

Ansong, Daniel; Akoto, Alex Osei; Ocloo, Delaena; Ohene-Frempong, Kwaku

2013-01-01

Sickle Cell Disease (SCD) is the most common genetic disorder of haemoglobin in sub-Saharan Africa. This commentary focuses on the management options available and the challenges that health care professionals in developing countries face in caring for patients with SCD. In a developing countries like Ghana, new-born screening is now about to be implemented on a national scale. Common and important morbidities associated with SCD are vaso-occlusive episodes, infections, Acute Chest Syndrome (ACS), Stroke and hip necrosis. Approaches to the management of these morbidities are far advanced in the developed countries. The differences in setting and resource limitations in developing countries bring challenges that have a major influence in management options in developing countries. Obviously clinicians in developing countries face challenges in managing SCD patients. However understanding the disease, its progression, and instituting the appropriate preventive methods are paramount in its management. Emphasis should be placed on early counselling, new-born screening, anti-microbial prophylaxis, vaccination against infections, and training of healthcare workers, patients and caregivers. These interventions are affordable in developing countries. PMID:24363877

Improving disease management in the United Kingdom: what can be learned from U.S. experience?

PubMed

Florin, Dominique; Lewis, Richard; Rosen, Rebecca

2004-10-01

Chronic diseases are a large and growing burden for health services. The British National Health Service is set up in a way that has many advantages in the management of chronic diseases, but lessons from U.S. managed care plans show that several changes could be implemented to improve the efficiency and effectiveness of care for patients with chronic conditions. These include the introduction of limited market competition; financial incentives, particularly across primary and secondary care; increased patient self-help; and improved clinician-manager relationships.

Diabetes disease management in Medicare Advantage reduces hospitalizations and costs.

PubMed

Rosenzweig, James L; Taitel, Michael S; Norman, Gordon K; Moore, Tim J; Turenne, Wendy; Tang, Pei

2010-07-01

To evaluate the effectiveness of a telephonic diabetes disease management intervention in a Medicare Advantage population with comorbid diabetes and coronary artery disease (CAD). Prospective unequal randomization design of 526 members from a Medicare Advantage segment of one region of a large national health plan from May 2005 through April 2007. High-risk and high-cost patients with diabetes and CAD who were enrolled in telephonic diabetes disease management were compared with a randomly selected comparison group receiving usual care. Wilcoxon signed-rank tests were used to compare the groups on all-cause hospital admissions, diabetes-related hospital admissions, all-cause and diabetes-related emergency department (ED) visits, and all-cause medical costs. Changes in self-reported clinical outcomes also were measured in the intervention group. Patients receiving telephonic diabetes disease management had significantly decreased all-cause hospital admissions and diabetes-related hospital admissions (P <.05). The intervention group had decreased all-cause and diabetes-related ED visits, although the difference was not statistically significant. The comparison group had increased ED utilization. The intervention group decreased their all-cause total medical costs by $984.87 per member per year (PMPY) compared with a $4547.06 PMPY increase in the comparison group (P <.05). All clinical measures significantly improved (P <.05) in the intervention group. A disease management program for high-risk patients with diabetes and CAD was effective in reducing hospital inpatient admission and total costs in a Medicare Advantage population.

Supply chain management of health commodities for reducing global disease burden.

PubMed

Chukwu, Otuto Amarauche; Ezeanochikwa, Valentine Nnaemeka; Eya, Benedict Ejikeme

Reducing global disease burden requires improving access to medicines, thus the need for efficient and effective supply chain management for medicines. The Nigerian government came up with new policies on Mega Drug Distribution Centres and National Drug Distribution Guidelines to improve access to quality medicines with pharmacists having a key role to play. However, pharmacists in Nigeria seem not to be aware and adequately equipped to handle the medicines supply chain. This article aimed at assessing the awareness and readiness of Nigerian pharmacists on supply chain management practices for improving access to medicines. Pharmacists in Nigeria's Capital were randomly sampled. Semi-structured questionnaires were administered. Descriptive statistics was used in data analysis. P values less than 0.05 were considered to be significant. 29.3%, 20.7% and 53.7% were not aware of supply chain management, National Drug Distribution Guidelines and Mega Drug Distribution Centres, respectively. 85.46% do not have a copy of the National Drug Distribution Guidelines. 78% were not aware that Mega Drug Distribution Centres are already operational. 35.4% have never been involved in any supply chain management practice. 69.5% often experience stock out of vital and essential medicines, of which 85.2% were in hospitals. 15.9% were successful in managing their facility's supply chains. 84.1% opined that pharmacists in Nigeria are not yet ready to handle the medicines supply chain. Findings showed limited awareness and readiness on supply chain management of medicines. This may be due to inadequate supply chain management skills and infrastructure, poor financing, lack of accountability and poor management. Tackling these as well as pharmacists showing more interest in the country's health policies and obtaining necessary postgraduate certifications will lead to improvements. This will improve access to quality medicines and thus help in the fight to reduce disease burden both

Remote home management for chronic kidney disease: A systematic review.

PubMed

He, Ting; Liu, Xing; Li, Ying; Wu, Qiaoyu; Liu, Meilin; Yuan, Hong

2017-01-01

Background Remote home management is a new healthcare model that uses information technology to enhance patients' self-management of disease in a home setting. This study is designed to identify the effects of remote home management on patients with chronic kidney disease (CKD). Methods A comprehensive search of PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed in January 2015. The reference listings of the included articles in this review were also manually examined. Randomized controlled trials (RCTs) designed to evaluate the effects of remote home management on patients with CKD were included. Results Eight trials were identified. The results of this study suggest that the quality of life (QOL) enabled by remote home management was higher than typical care in certain dimensions. However, the effects of remote home management on blood pressure (BP) remain inconclusive. The studies that assessed health service utilization demonstrated a significant decrease in hospital readmission, emergency room visits, and number of days in the hospital. Another favorable result of this study is that regardless of their gender, age or nationality, patients tend to comply with remote home management programs and the use of related technologies. Conclusions The available data indicate that remote home management may be a novel and effective disease management strategy for improving CKD patients' QOL and influencing their attitudes and behaviors. And, relatively little is known about BP and cost-effectiveness, so future research should focus on these two aspects for the entire population of patients with CKD.

[The German program for disease management guidelines. Background, methods, and development process].

PubMed

Ollenschläger, Günter; Kopp, Ina; Lelgemann, Monika; Sänger, Sylvia; Heymans, Lothar; Thole, Henning; Trapp, Henrike; Lorenz, Wilfried; Selbmann, Hans-Konrad; Encke, Albrecht

2006-10-15

The Program for National Disease Management Guidelines (German DM-CPG Program) was established in 2002 by the German Medical Association (umbrella organization of the German Chambers of Physicians) and joined by the Association of the Scientific Medical Societies (AWMF; umbrella organization of more than 150 professional societies) and by the National Association of Statutory Health Insurance Physicians (NASHIP) in 2003. The program provides a conceptual basis for disease management, focusing on high-priority health-care topics and aiming at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. It is organized by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network (G-I-N). The main objective of the German DM-CPG Program is to establish consensus of the medical professions on evidence-based key recommendations covering all sectors of health-care provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the last year, DM-CPGs have been published for asthma, chronic obstructive pulmonary disease, type 2 diabetes, and coronary heart disease. In addition, experts from national patient self-help groups have been developing patient guidance based upon the recommendations for health-care providers. The article describes background, methods, and tools of the DM-CPG Program, and is the first of a publication series dealing with innovative recommendations and aspects of the program.

Comparative study on the National Renal Disease Registry in America, England and Iran.

PubMed

Ajami, Sima; Askarianzadeh, Mahdi; Saghaeiannejad-Isfahani, Sakineh; Mortazavi, Mojgan; Ehteshami, Asghar

2014-01-01

A disease registry is a database that includes information about people diagnosed with specific types of diseases. The registry collects information that can be used for capturing, managing, and organizing specific information for patients. The aim of this study was to identify and compare the National Renal Disease Registry (NRDR) in selected countries including the United States, United Kingdom, and Iran. Retrieval of data of the NRDR performed through scholars responsible in related agencies, including the Ministry of Health and Medical Education, and Renal Disease charity, and data registries in the United States, United Kingdom, and Iran. This research was an applied and descriptive, comparative study. The study population consisted of the National Renal Disease Registry of the selected countries including the United States, United Kingdom, and Iran, from which data were collected using forms that were designed according to the study objectives. Sources of data were researchers, scholars responsible in related agencies, including the Ministry of Health and Medical Education, and Renal Disease charity, data registries, articles, books, journals, databases, websites, and related documents. Data were gathered through phone, e-mail, study, observation, and interview. The researchers collected data for each country based on the study objectives and then put them in comparative tables. Data were analyzed by descriptive, comparative, and theoretical methods. There is no NRDR in Iran to report the short- and long-term results of renal disease. Most of the renal transplant teams report their own results as single-center experiences. America and Britain have pre-eminent national registry of renal disease, compared to other countries. The Iranian Society of Nephrology should be actively involved to create a National Renal Registry in Iran. The registry should have representatives from the universities, government, armed forces, and private sectors. Researchers proposed

The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CapSURE), a national disease registry.

PubMed

Cooperberg, Matthew R; Broering, Jeanette M; Litwin, Mark S; Lubeck, Deborah P; Mehta, Shilpa S; Henning, James M; Carroll, Peter R

2004-04-01

The epidemiology and treatment of prostate cancer have changed dramatically in the prostate specific antigen era. A large disease registry facilitates the longitudinal observation of trends in disease presentation, management and outcomes. The Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) is a national disease registry of more than 10000 men with prostate cancer accrued at 31 primarily community based sites across the United States. Demographic, clinical, quality of life and resource use variables are collected on each patient. We reviewed key findings from the data base in the last 8 years in the areas of disease management trends, and oncological and quality of life outcomes. Prostate cancer is increasingly diagnosed with low risk clinical characteristics. With time patients have become less likely to receive pretreatment imaging tests, less likely to pursue watchful waiting and more likely to receive brachytherapy or hormonal therapy. Relatively few patients treated with radical prostatectomy in the database are under graded or under staged before surgery, whereas the surgical margin rate is comparable to that in academic series. CaPSURE data confirm the usefulness of percent positive biopsies in risk assessment and they have further been used to validate multiple preoperative nomograms. CaPSURE results strongly affirm the necessity of patient reported quality of life assessment. Multiple studies have compared the quality of life impact of various treatment options, particularly in terms of urinary and sexual function, and bother. The presentation and management of prostate cancer have changed substantially in the last decade. CaPSURE will continue to track these trends as well as oncological and quality of life outcomes, and will continue to be an invaluable resource for the study of prostate cancer at the national level.

Asthma disease management and the respiratory therapist.

PubMed

Kallstrom, Thomas J; Myers, Timothy R

2008-06-01

The role of the respiratory therapist (RT) is expanding with the growing acceptance and use of the disease-management paradigm for managing chronic diseases. RTs are key members of the asthma disease-management team, in acute-care settings, patients' homes, out-patient clinics, emergency departments, and in the community. Utilizing RTs as disease managers allows patients to be treated faster and more appropriately, discharged to home sooner, and decreases hospital admissions. RT are leaders in the emerging field of asthma disease management.

UK national survey of management of breast lobular carcinoma in situ.

PubMed

Chester, R; Bokinni, O; Ahmed, I; Kasem, A

2015-11-01

There is no national standard treatment for patients with breast lobular carcinoma in situ (LCIS). Association of Breast Surgery guidelines for the management of breast cancer suggest that lesions containing LCIS should be excised for definitive diagnosis and recommend close surveillance after excision biopsy. The aim of this study was to form a picture of the current management of LCIS by UK breast surgeons. A questionnaire about the management of LCIS was sent to 490 UK breast surgeons. Of 490 questionnaires sent out, 173 (35%) were returned. When LCIS is present in a core biopsy, 61% of breast surgeons perform surgical excision, 22% would not excise but would continue follow-up and the remainder perform neither or set no clear management plan. Over half (54%) follow patients up with five years of annual mammography. If classic LCIS were found at the margins of wide local excision, 92% would not re-excise. Conversely, if pleomorphic LCIS were found, 71% would achieve clear margins. Respondents were split evenly regarding management of classic LCIS with a family history as 54% would not alter management whereas 43% would treat the disease more aggressively. Our survey has shown that in cases where LCIS is found at core biopsy, most surgeons follow Association of Breast Surgery guidance, obtaining further histological samples to exclude pleomorphic LCIS, ductal carcinoma in situ or invasive cancer, whereas others opt for annual surveillance and some discharge the patient. This study highlighted the huge variability in LCIS management, and the need for randomised controlled trials and input into national audits such as the Sloane Project to establish evidence-based national standard guidelines.

National Infectious Diseases Surveillance data of South Korea.

PubMed

Park, Sunhee; Cho, Eunhee

2014-01-01

The Korea Centers for Disease Control and Prevention (KCDC) operate infectious disease surveillance systems to monitor national disease incidence. Since 1954, Korea has collected data on various infectious diseases in accordance with the Infectious Disease Control and Prevention Act. All physicians (including those working in Oriental medicine) who diagnose a patient with an infectious disease or conduct a postmortem examination of an infectious disease case are obliged to report the disease to the system. These reported data are incorporated into the database of the National Infectious Disease Surveillance System, which has been providing web-based real-time surveillance data on infectious diseases since 2001. In addition, the KCDC analyzes reported data and publishes the Infectious Disease Surveillance Yearbook annually.

Social workers' role in disease management.

PubMed

Claiborne, N; Vandenburgh, H

2001-11-01

This article discusses social work's participation in a new paradigm for health care delivery, disease management. Attempts to improve health care quality havefocused on evidence-based methods of evaluating health care outcomes as well as quality of life issues with which social workers have been traditionally concerned. The fit between social work's ecological perspective and disease management and the needfor social workers to participate as patient case managers on interdisciplinary disease management teams are discussed. Quality and cost benefits can occur when social workers address such issues as adherence, psychosocialfactors, and depression in terms of the patient's global recovery and concurrent enhancement of quality of life. Potential barriers to disease management implementation with social work participation are discussed.

Mobile technologies and the holistic management of chronic diseases.

PubMed

Mirza, Farhaan; Norris, Tony; Stockdale, Rosemary

2008-12-01

Ageing populations and unhealthy lifestyles have led to some chronic conditions such as diabetes and heart disease reaching epidemic proportions in many developed nations. This paper explores the potential of mobile technologies to improve this situation. The pervasive nature of these technologies can contribute holistically across the whole spectrum of chronic care ranging from public information access and awareness, through monitoring and treatment of chronic disease, to support for patient carers. A related study to determine the perceptions of healthcare providers to m-health confirmed the view that attitudes were likely to be more important barriers to progress than technology. A key finding concerned the importance of seamless and integrated m-health processes across the spectrum of chronic disease management.

Health information management: an introduction to disease classification and coding.

PubMed

Mony, Prem Kumar; Nagaraj, C

2007-01-01

Morbidity and mortality data constitute an important component of a health information system and their coding enables uniform data collation and analysis as well as meaningful comparisons between regions or countries. Strengthening the recording and reporting systems for health monitoring is a basic requirement for an efficient health information management system. Increased advocacy for and awareness of a uniform coding system together with adequate capacity building of physicians, coders and other allied health and information technology personnel would pave the way for a valid and reliable health information management system in India. The core requirements for the implementation of disease coding are: (i) support from national/institutional health administrators, (ii) widespread availability of the ICD-10 material for morbidity and mortality coding; (iii) enhanced human and financial resources; and (iv) optimal use of informatics. We describe the methodology of a disease classification and codification system as also its applications for developing and maintaining an effective health information management system for India.

Is "disease management" the answer to our problems? No! Population health management and (disease) prevention require "management of overall well-being".

PubMed

Cramm, Jane Murray; Nieboer, Anna Petra

2016-09-21

Disease management programs based on the chronic care model have achieved successful and long-term improvement in the quality of chronic care delivery and patients' health behaviors and physical quality of life. However, such programs have not been able to maintain or improve broader self-management abilities or social well-being, which decline over time in chronically ill patients. Disease management efforts, population health management initiatives and innovative primary care solutions are still mainly focused on clinical and functional outcomes and health behaviors (e.g., smoking cessation, exercise, and diet) failing to address individuals' overall quality of life and well-being. Individuals' ability to achieve well-being can be assessed with great specificity through the application of social production function (SPF) theory. This theory asserts that people produce their own well-being by trying to optimize the achievement of instrumental goals (stimulation, comfort, status, behavioral confirmation, affection) that provide the means to achieve the larger, universal goals of physical and social well-being. A shift in focus from the management of physical function, disease limitations, and lifestyle behaviors alone to an approach that fosters self-management abilities such as self-efficacy and resource investment as well as overall quality of life, is urgently needed. Disease management interventions should be aimed at adequately addressing all difficulties chronically ill patients face in life, such as the effects of pain and fatigue on the ability to maintain a job and social life and to participate in activities promoting physical and social well-being. Patients' ability to maintain engagement in stimulating work and social activities with the people who are important to them may be even more important than aspects of disease self-management such as blood pressure or glycemic control. Interventions should aim to make chronically ill patients capable of

NATIONAL ELECTRONIC DISEASE SURVEILLANCE SYSTEM (NEDSS)

EPA Science Inventory

The National Electronic Disease Surveillance System (NEDSS) project is a public health initiative to provide a standard-based, integrated approach to disease surveillance and to connect public health surveillance to the burgeoning clinical information systems infrastructure. NEDS...

Primary immunodeficiency disease: a model for case management of chronic diseases.

PubMed

Burton, Janet; Murphy, Elyse; Riley, Patty

2010-01-01

Patient-centered chronic care management is a new model for the management of rare chronic diseases such as primary immunodeficiency disease (PIDD). This approach emphasizes helping patients become experts on the management of their disease as informed, involved, and interactive partners in healthcare decisions with providers. Because only a few patients are affected by rare illnesses, these patients are forced to become knowledgeable about their disease and therapies and to seek treatment from a healthcare team, which includes physicians and nurse specialists who are equipped to manage the complexity of the disease and its comorbidities. Importantly, therapy for PIDD can be self-administered at home, which has encouraged the transition toward a proactive stance that is at the heart of patient-centered chronic care management. We discuss the evolution of therapy, the issues with the disease, and challenges with its management within the framework of other chronic disease management programs. Suggestions and rationale to move case management of PIDD forward are presented with the intent that sharing our experiences will improve process and better manage outcomes in this patient population. The patient-centered model for the management of PIDD is applicable to the primary care settings, where nurse case managers assist patients through education, support them and their families, and facilitate access to community resources in an approach, which has been described as "guided care." The model also applies specifically to immunology centers where patients receive treatment or instruction on its self-administration at home. Patient-centered management of PIDD, with its emphasis on full involvement of patients in their treatment, has the potential to improve compliance with treatment, and thus patient outcomes, as well as patients' quality of life. The patient-centered model expands the traditional model of chronic disease management, which relies on evidence

Data warehousing in disease management programs.

PubMed

Ramick, D C

2001-01-01

Disease management programs offer the benefits of lower disease occurrence, improved patient care, and lower healthcare costs. In such programs, the key mechanism used to identify individuals at risk for targeted diseases is the data warehouse. This article surveys recent warehousing techniques from HMOs to map out critical issues relating to the preparation, design, and implementation of a successful data warehouse. Discussions of scope, data cleansing, and storage management are included in depicting warehouse preparation and design; data implementation options are contrasted. Examples are provided of data warehouse execution in disease management programs that identify members with preexisting illnesses, as well as those exhibiting high-risk conditions. The proper deployment of successful data warehouses in disease management programs benefits both the organization and the member. Organizations benefit from decreased medical costs; members benefit through an improved quality of life through disease-specific care.

Current management of urethral stricture disease

PubMed Central

Smith, Thomas G.

2016-01-01

Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts. PMID:26941491

Symptom management in Behcets disease.

PubMed

Ozel, Filiz; Tureyen, Aynur Esen; Aykar, Fisun Senuzun

2018-01-01

To determine the symptoms experienced by patients diagnosed with Behcet's Disease and how they cope with them. The qualitative study was conducted from September 2013 to March 2014 at Ege University Medical Faculty Hospital, Turkey, comprising patients having all symptoms of Behcet's Disease. Data was collected through semi-structured focus-group interview form. The findings were assessed using Theory of Unpleasant Symptoms and Symptom Management Theory. SPSS 20 and Nvivo 10 were used for data analysis. Of the 35 patients, 16(45.8%) were female and 19(54.2%) were male. The symptoms affected patients' lives, and the patients used either positive or negative symptom management strategies, leading to either positive or negative results during symptom management. Behcet's Disease patients needed effective symptom management.

77 FR 50985 - National Advisory Committee for Implementation of the National Forest System Land Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-23

... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... implementation of the National Forest System Land Management Rule. The meeting is open to the public. The purpose...

Economic value evaluation in disease management programs.

PubMed

Magnezi, Racheli; Reicher, Sima; Shani, Mordechai

2008-05-01

Chronic disease management has been a rapidly growing entity in the 21st century as a strategy for managing chronic illnesses in large populations. However, experience has shown that disease management programs have not been able to demonstrate their financial value. The objectives of disease management programs are to create quality benchmarks, such as principles and guidelines, and to establish a uniform set of metrics and a standardized methodology for evaluating them. In order to illuminate the essence of disease management and its components, as well as the complexity and the problematic nature of performing economic calculations of their profitability and value, we collected data from several reports that dealt with the economic intervention of disease management programs. The disease management economic evaluation is composed of a series of steps, including the following major categories: data/information technology, information generation, assessment/recommendations, actionable customer plans, and program assessment/reassessment. We demonstrate the elements necessary for economic analysis. Disease management is one of the most innovative tools in the managed care environment and is still in the process of being defined. Therefore, objectives should include the creation of quality measures, such as principles and guidelines, and the establishment of a uniform set of metrics and a standardized methodology for evaluating them.

Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya.

PubMed

Asiki, Gershim; Shao, Shuai; Wainana, Carol; Khayeka-Wandabwa, Christopher; Haregu, Tilahun N; Juma, Pamela A; Mohammed, Shukri; Wambui, David; Gong, Enying; Yan, Lijing L; Kyobutungi, Catherine

2018-05-09

In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya. A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews. A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014-2030), The Kenya Health Sector Strategic and Investment Plan (2014-2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015-2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012-2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents. This review revealed

Disease management, coping, and functional disability in pediatric sickle cell disease.

PubMed

Oliver-Carpenter, Gloria; Barach, Ilana; Crosby, Lori E; Valenzuela, Jessica; Mitchell, Monica J

2011-02-01

Youth with sickle cell disease (SCD) experience chronic symptoms that significantly interfere with physical, academic, and social-emotional functioning. Thus, to effectively manage SCD, youth and caregivers must work collaboratively to ensure optimal functioning. The goal of the current study was to examine the level of involvement in disease management tasks for youth with SCD and their caregivers. The study also examined the relationship between involvement in disease management tasks, daily functioning, and coping skills. The study utilized collaborative care and disease management theoretical frameworks. Youth and caregivers participated in the study during an annual research and education day event. Forty-seven patients with SCD aged 6 to 18 years and their caregivers completed questionnaires examining level of involvement in disease management tasks, youth functional disability, and youth coping strategies. Caregivers also completed a demographic and medical history form. Parents and youth agreed that parents were significantly more involved in disease management tasks than youth, although level of involvement varied by task. Decreased parent involvement was related to greater coping strategies used by patients, including massage, prayer, and positive thinking. Higher functional disability (lower functioning) was related to greater parent involvement in disease management tasks, suggesting that greater impairment may encourage increased parent involvement. Health professionals working with families of youth with SCD should discuss with parents and youth how disease management tasks and roles will be shared and transferred during adolescence. Parents and youth may also benefit from a discussion of these issues within their own families.

Disease Management, Coping, and Functional Disability in Pediatric Sickle Cell Disease

PubMed Central

Oliver-Carpenter, Gloria; Barach, Ilana; Crosby, Lori E.; Valenzuela, Jessica; Mitchell, Monica J.

2016-01-01

Background Youth with sickle cell disease (SCD) experience chronic symptoms that significantly interfere with physical, academic, and social-emotional functioning. Thus, to effectively manage SCD, youth and caregivers must work collaboratively to ensure optimal functioning. The goal of the current study was to examine the level of involvement in disease management tasks for youth with SCD and their caregivers. The study also examined the relationship between involvement in disease management tasks, daily functioning, and coping skills. The study utilized collaborative care and disease management theoretical frameworks. Methods Youth and caregivers participated in the study during an annual research and education day event. Forty-seven patients with SCD aged 6 to 18 years and their caregivers completed questionnaires examining level of involvement in disease management tasks, youth functional disability and youth coping strategies. Caregivers also completed a demographic and medical history form. Results Parents and youth agreed that parents are significantly more involved in disease management tasks than youth, although level of involvement varied by task. Decreased parent involvement was related to greater coping strategies used by patients, including massage, prayer, and positive thinking. Higher functional disability (lower functioning) was related to greater parent involvement in disease management tasks, suggesting that greater impairment may encourage increased parent involvement. Conclusions Health professionals working with families of youth with SCD should discuss with parents and youth how disease management tasks and roles will be shared and transferred during adolescence. Parents and youth may also benefit from a discussion of these issues within their own families. PMID:21443065

Chronic disease management systems registries in rural health care.

PubMed

Skinner, Anne; Fraser-Maginn, Roslyn; Mueller, Keith J

2006-05-01

Health care quality is being addressed from a variety of policy perspectives. The 2001 Institute of Medicine report, Crossing the Quality Chasm, calls for sweeping action involving a five-part strategy for change in the U.S. health care system. This agenda for change includes use of evidence-based approaches to address common conditions, the majority of which are chronic. A Chronic Disease Management System (CDMS), or registry, is a tool that helps providers efficiently collect and analyze patient information to promote quality care for the rural population. CDMSs can provide a technological entry point for the impending use of Electronic Medical Records. A CDMS is a patient-centered electronic database tool that helps providers diagnose, treat, and manage chronic diseases. The purpose of this brief is to discuss the different types of CDMSs used by a sample of 14 state organizations and 19 local rural clinics in Maine, Nebraska, New Mexico, South Carolina, Washington, and Wisconsin. As part of a larger study examining the challenges and innovations in implementing disease management programs in rural areas, we conducted interviews with national, state, and local contacts. During interviews, respondents helped us understand the usefulness and functionalities of commonly used CDMSs in rural facilities. Our focus was on the use of CDMSs in the management of diabetes, a disease prevalent in rural populations. (1) CDMSs are readily available to rural clinics and are being implemented and maintained by clinic staff with minimal expenditures for technology. (2) Use of a standardized system in a collaborative helps provide data comparisons and share costs involved with technical assistance services across the group.

The role of bacillus-based biological control agents in integrated pest management systems: plant diseases.

PubMed

Jacobsen, B J; Zidack, N K; Larson, B J

2004-11-01

ABSTRACT Bacillus-based biological control agents (BCAs) have great potential in integrated pest management (IPM) systems; however, relatively little work has been published on integration with other IPM management tools. Unfortunately, most research has focused on BCAs as alternatives to synthetic chemical fungicides or bactericides and not as part of an integrated management system. IPM has had many definitions and this review will use the national coalition for IPM definition: "A sustainable approach to managing pests by combining biological, cultural, physical and chemical tools in a way that minimizes economic, health and environmental risks." This review will examine the integrated use of Bacillus-based BCAs with disease management tools, including resistant cultivars, fungicides or bactericides, or other BCAs. This integration is important because the consistency and degree of disease control by Bacillus-based BCAs is rarely equal to the control afforded by the best fungicides or bactericides. In theory, integration of several tools brings stability to disease management programs. Integration of BCAs with other disease management tools often provides broader crop adaptation and both more efficacious and consistent levels of disease control. This review will also discuss the use of Bacillus-based BCAs in fungicide resistance management. Work with Bacillus thuringiensis and insect pest management is the exception to the relative paucity of reports but will not be the focus of this review.

Management Strategies for CLN2 Disease.

PubMed

Williams, Ruth E; Adams, Heather R; Blohm, Martin; Cohen-Pfeffer, Jessica L; de Los Reyes, Emily; Denecke, Jonas; Drago, Kristen; Fairhurst, Charlie; Frazier, Margie; Guelbert, Norberto; Kiss, Szilárd; Kofler, Annamaria; Lawson, John A; Lehwald, Lenora; Leung, Mary-Anne; Mikhaylova, Svetlana; Mink, Jonathan W; Nickel, Miriam; Shediac, Renée; Sims, Katherine; Specchio, Nicola; Topcu, Meral; von Löbbecke, Ina; West, Andrea; Zernikow, Boris; Schulz, Angela

2017-04-01

CLN2 disease (neuronal ceroid lipofuscinosis type 2) is a rare, autosomal recessive, pediatric-onset, rapidly progressive neurodegenerative lysosomal storage disorder caused by tripeptidyl peptidase 1 (TPP1) enzyme deficiency, and is characterized by language delay, seizures, rapid cognitive and motor decline, blindness, and early death. No management guidelines exist and there is a paucity of published disease-specific evidence to inform clinical practice, which currently draws upon experience from the field of childhood neurodisability. Twenty-four disease experts were surveyed on CLN2 disease management and a subset met to discuss current practice. Management goals and strategies are consistent among experts globally and are guided by the principles of pediatric palliative care. Goals and interventions evolve as the disease progresses, with a shift in focus from maintenance of function early in the disease to maintenance of quality of life. A multidisciplinary approach is critical for optimal patient care. This work represents an initial step toward the development of consensus-based management guidelines for CLN2 disease. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

The disease management approach to cost containment.

PubMed

Goldstein, R

1998-01-01

Disease management has been around a long time, certainly since Pasteur. Its initial focus was to eliminate or contain epidemics. In the 20th century, American public health scientists and officials have used disease management to address a high-risk, often poor population. Currently, the population-based principles of disease management, including disease prevention activities, are being applied to noninfectious diseases. Two examples of public health disease prevention strategies are vaccinations and chlorination of water. Hospitals are now providing post-hospital disease management programs for selected chronic conditions that account for a high volume of repeat admissions or emergency department visits, such as chronic heart failure, asthma, and cancer. In other words, hospitals are spending money on a program that, if done right, will reduce their inpatient revenues. They are doing so for various reasons (e.g., because they have established at-risk financial partnerships with their physicians, or possibly because other area hospitals are doing it, or possibly because they want to keep the ancillaries [x-rays, laboratory, pharmacy, ambulatory surgery, etc]). Regardless of the reasons, hospital case managers will be charged with referring qualified patients to both hospital-based and provider-based disease management programs.

Chronic Disease Management in Family Practice: Clinical Note.

DTIC Science & Technology

1998-03-01

disease management in the family practice selling. This paper discusses chronic disease management in the family practice selling....Chronic disease management is the process of evaluating and treating a medical condition or disease state which can not be readily cured so as to...minimize it’s negative impact on the individual. Examples of chronic disease management include the treatment of hypertension, diabetes, osteoporosis

Advancing the Science of Behavioral Self-Management of Chronic Disease: The Arc of a Research Trajectory

ERIC Educational Resources Information Center

Allegrante, John P.

2018-01-01

This article describes advances in the behavioral self-management of chronic disease from the perspective of a 25-year trajectory of National Institute of Health-funded research in arthritis and cardiopulmonary diseases that has sought to develop a transdisciplinary understanding of how applied behavioral science can be used to improve health…

Disease and health management in Asian aquaculture.

PubMed

Bondad-Reantaso, Melba G; Subasinghe, Rohana P; Arthur, J Richard; Ogawa, Kazuo; Chinabut, Supranee; Adlard, Robert; Tan, Zilong; Shariff, Mohamed

2005-09-30

Asia contributes more than 90% to the world's aquaculture production. Like other farming systems, aquaculture is plagued with disease problems resulting from its intensification and commercialization. This paper describes the various factors, providing specific examples, which have contributed to the current disease problems faced by what is now the fastest growing food-producing sector globally. These include increased globalization of trade and markets; the intensification of fish-farming practices through the movement of broodstock, postlarvae, fry and fingerlings; the introduction of new species for aquaculture development; the expansion of the ornamental fish trade; the enhancement of marine and coastal areas through the stocking of aquatic animals raised in hatcheries; the unanticipated interactions between cultured and wild populations of aquatic animals; poor or lack of effective biosecurity measures; slow awareness on emerging diseases; the misunderstanding and misuse of specific pathogen free (SPF) stocks; climate change; other human-mediated movements of aquaculture commodities. Data on the socio-economic impacts of aquatic animal diseases are also presented, including estimates of losses in production, direct and indirect income and employment, market access or share of investment, and consumer confidence; food availability; industry failures. Examples of costs of investment in aquatic animal health-related activities, including national strategies, research, surveillance, control and other health management programmes are also provided. Finally, the strategies currently being implemented in the Asian region to deal with transboundary diseases affecting the aquaculture sector are highlighted. These include compliance with international codes, and development and implementation of regional guidelines and national aquatic animal health strategies; new diagnostic and therapeutic techniques and new information technology; new biosecurity measures including

Disease management and medication compliance.

PubMed

Cohen, Joshua; Christensen, Kathyrn; Feldman, Lanna

2012-02-01

Lack of medication compliance is harmful to health care systems from both a clinical and economic perspective. This study examines the methods that disease management organizations employ to identify nonadherent patients and to measure effectiveness of compliance programs for patients with diabetes, hyperlipidemia, and cystic fibrosis. In addition, this study investigates the degree to which disease managers assume risk in their contracts, and whether compliance strategies are being coordinated with payers' use of value-based insurance design, in which patient cost sharing is a function of the relative value of pharmaceuticals. This study's findings suggest that disease management may be falling short in terms of: (a) comprehensive commitment to expert-recommended at-home devices used to self-diagnose and measure health indicators; (b) early adoption of expert-recommended new technologies to measure and improve compliance; (c) intensity of use of standard tests in outpatient clinics; (d) coordination of compliance strategies with payers' use of value-based insurance design; and (e) the proportion of risk assumed in disease management contracts.

Diverticular disease: Epidemiology and management

PubMed Central

Weizman, Adam V; Nguyen, Geoffrey C

2011-01-01

Diverticular disease of the colon is among the most prevalent conditions in western society and is among the leading reasons for outpatient visits and causes of hospitalization. While previously considered to be a disease primarily affecting the elderly, there is increasing incidence among individuals younger than 40 years of age. Diverticular disease most frequently presents as uncomplicated diverticulitis, and the cornerstone of management is antibiotic therapy and bowel rest. Segmental colitis associated with diverticula shares common histopathological features with inflammatory bowel disease and may benefit from treatment with 5-aminosalicylates. Surgical management may be required for patients with recurrent diverticulitis or one of its complications including peridiverticular abscess, perforation, fistulizing disease, and strictures and/or obstruction. PMID:21876861

Overview of Self-Management Resources Used by Canadian Chronic Kidney Disease Clinics: A National Survey

PubMed Central

Donald, Maoliosa; Gil, Sarah; Kahlon, Bhavneet; Beanlands, Heather; Straus, Sharon; Herrington, Gwen; Manns, Braden; Hemmelgarn, Brenda R.

2018-01-01

Background: Chronic kidney disease (CKD) clinics across Canada provide tailored care for patients with CKD with an aim to slow progression and prevent complications. These clinics provide CKD self-management resources; however, there is limited information about what resources are being used by clinics. We undertook a survey of CKD clinics across Canada to identify self-management resources for adults aged 18 years and over with CKD categories 1 to 5 and not requiring dialysis or transplant. Objective: To identify and collate self-management resources (eg, strategies, tools, educational materials) used by CKD clinics across Canada for adults with CKD (categories 1 to 5, not requiring kidney replacement therapy). Design: Self-administered, semistructured electronic survey. Setting, participants: Canadian CKD clinics with previously identified contact information. Methods and measurements: We contacted 57 CKD English-speaking clinics and invited them to complete an online survey. The survey was available from October 2016 to January 2017 and consisted of 17 questions regarding the use and attributes of self-management resources including topic, delivery format, provider, target population, where the intervention was provided, and resource languages. Results: Forty-four clinics (77%) completed the survey. The most common topic was modality education provided in print format, by nurses. The most frequently used resource was the Kidney Foundation of Canada (KFOC) Living With Kidney Disease manual. We also identified that the majority of resources were available in English, targeting both patients and caregivers in the outpatient setting. Limitations: Our survey included Canadian adult CKD clinics, which may not be generalizability to other settings, such as care of people with CKD in primary care. Conclusions: Adult CKD clinics across Canada provide some similar resources, but also provide many different self-management resources. Even though some of the same resources

Overview of Self-Management Resources Used by Canadian Chronic Kidney Disease Clinics: A National Survey.

PubMed

Donald, Maoliosa; Gil, Sarah; Kahlon, Bhavneet; Beanlands, Heather; Straus, Sharon; Herrington, Gwen; Manns, Braden; Hemmelgarn, Brenda R

2018-01-01

Chronic kidney disease (CKD) clinics across Canada provide tailored care for patients with CKD with an aim to slow progression and prevent complications. These clinics provide CKD self-management resources; however, there is limited information about what resources are being used by clinics. We undertook a survey of CKD clinics across Canada to identify self-management resources for adults aged 18 years and over with CKD categories 1 to 5 and not requiring dialysis or transplant. To identify and collate self-management resources (eg, strategies, tools, educational materials) used by CKD clinics across Canada for adults with CKD (categories 1 to 5, not requiring kidney replacement therapy). Self-administered, semistructured electronic survey. Canadian CKD clinics with previously identified contact information. We contacted 57 CKD English-speaking clinics and invited them to complete an online survey. The survey was available from October 2016 to January 2017 and consisted of 17 questions regarding the use and attributes of self-management resources including topic, delivery format, provider, target population, where the intervention was provided, and resource languages. Forty-four clinics (77%) completed the survey. The most common topic was modality education provided in print format, by nurses. The most frequently used resource was the Kidney Foundation of Canada (KFOC) Living With Kidney Disease manual. We also identified that the majority of resources were available in English, targeting both patients and caregivers in the outpatient setting. Our survey included Canadian adult CKD clinics, which may not be generalizability to other settings, such as care of people with CKD in primary care. Adult CKD clinics across Canada provide some similar resources, but also provide many different self-management resources. Even though some of the same resources were used by multiple clinics, the way they were provided them (ie, provider, location, delivery format) varied by

Harnessing Integrated Vector Management for Enhanced Disease Prevention.

PubMed

Chanda, Emmanuel; Ameneshewa, Birkinesh; Bagayoko, Magaran; Govere, John M; Macdonald, Michael B

2017-01-01

The increasing global threat of emerging and re-emerging vector-borne diseases (VBDs) poses a serious health problem. The World Health Organization (WHO) recommends integrated vector management (IVM) strategy for combating VBD transmission. An IVM approach requires entomological knowledge, technical and infrastructure capacity, and systems facilitating stakeholder collaboration. In sub-Saharan Africa, successful operational IVM experience comes from relatively few countries. This article provides an update on the extent to which IVM is official national policy, the degree of IVM implementation, the level of compliance with WHO guidelines, and concordance in the understanding of IVM, and it assesses the operational impact of IVM. The future outlook encompasses rational and sustainable use of effective vector control tools and inherent improved return for investment for disease vector control. Copyright © 2016 Elsevier Ltd. All rights reserved.

Rheumatic diseases and sexuality: Disease impact and self-management strategies.

PubMed

Helland, Ylva; Kjeken, Ingvild; Steen, Eldri; Kvien, Tore K; Hauge, Mona-Iren; Dagfinrud, Hanne

2011-05-01

To explore how intimate relationships and sexuality are influenced by rheumatic diseases and to describe self-management strategies used to manage disease consequences. To ensure that data were grounded in patients' language and experiences, individual and focus group interviews were conducted. Purposeful sampling was used to ensure variation in age, sex, disease duration, diagnosis, and marital status among the informants. Participants were men and women ages 18 years or older, were diagnosed with inflammatory rheumatic disease by a rheumatologist, and had a disease duration of ≥2 years. The mean age of the 23 participants was 44 years, the mean disease duration was 13.6 years, and the mean ± SD modified Health Assessment Questionnaire score was 1.58 ± 0.46. Four key themes summarized the main issues described by the informants: between disease and normality, relational aspects, disease-related sexual challenges, and self-management strategies. The results reveal that the disease constituted a disruption in life, requiring a new orientation of sexual identity and relationship. Participants' experiences of sexuality went beyond specific sexual activity, including aspects such as body image and relational issues, illustrating a multidimensional perception of sexuality. A large inter- and intrapersonal variety of impact and a wide range of management strategies were reported. This study shows that sexuality is a vital area of life for people living with arthritis. It is a source of physical pleasure and intimacy with their partner, but may cause anxiety and distress when affected by rheumatic disease. However, various self-management strategies are applied to enhance intimate relationships and sexual activity. Knowledge and openness concerning sexual issues need to be emphasized as part of the competence of health professionals and researchers. Copyright © 2011 by the American College of Rheumatology.

Operationalizing Surveillance of Chronic Disease Self-Management and Self-Management Support

PubMed Central

Sacks, Jeffrey J.; Terrillion, Albert J.; Colligan, Erin M.

2018-01-01

Sixty percent of US adults have at least one chronic condition, and more than 40% have multiple conditions. Self-management (SM) by the individual, along with self-management support (SMS) by others, are nonpharmacological interventions with few side effects that are critical to optimal chronic disease control. Ruiz and colleagues laid the conceptual groundwork for surveillance of SM/SMS at 5 socio-ecological levels (individual, health system, community, policy, and media). We extend that work by proposing operationalized indicators at each socio-ecologic level and suggest that the indicators be embedded in existing surveillance systems at national, state, and local levels. Without a robust measurement system at the population level, we will not know how far we have to go or how far we have come in making SM and SMS a reality. The data can also be used to facilitate planning and service delivery strategies, monitor temporal changes, and stimulate SM/SMS–related research. PMID:29625631

[Hungarian national plan and strategy for rare diseases].

PubMed

Kosztolányi, György

2014-03-02

The rarity of low prevalence diseases and the lack of information, research, diagnosis, treatment and expert availability may mean that the people affected do not benefit from the health resources and services they need. Rare diseases are considered to have little impact on society as a whole, yet they pose serious difficulties for sufferers and their families. By the end of the last century, two robust achievements in science and technology, i.e. the biotechnological and informatics revolutions, have created a real base for global approach to rare diseases by coordinating the capacities for health care, biomedical research and drug development and pooling the very limited resources available both nationally and transnationally. The European Commission has taken a number of actions which help patients and professionals to share expertise and information across borders with the objective of reducing the number of people suffering from these types of diseases. These actions together form the legal basis of the European Union policy on rare diseases. Orphan or rare diseases are now one of the priorities in the public health programmes in European Union. In 2009, the document "European Union Council Recommendation on an action in the field of rare diseases" was released with the main goal to provide national health authorities with supporting tools for the development and implementation of national plans and strategies for rare diseases by the end of 2013. This recommendation adopted by European Union Member States, allows common policy guidelines to be shared everywhere in Europe. By September 2013 the Hungarian National Plan for Rare Diseases, a health policy strategy until 2020 was finalized. The present report gives a short view on the document.

Recommendations on the diagnosis and management of Niemann-Pick disease type C.

PubMed

Wraith, James E; Baumgartner, Matthias R; Bembi, Bruno; Covanis, Athanasios; Levade, Thierry; Mengel, Eugen; Pineda, Mercè; Sedel, Frédéric; Topçu, Meral; Vanier, Marie T; Widner, Hakan; Wijburg, Frits A; Patterson, Marc C

2009-01-01

Niemann-Pick disease type C (NP-C) is a lysosomal storage disease in which impaired intracellular lipid trafficking leads to excess storage of cholesterol and glycosphingolipids in the brain and other tissues. It is characterized clinically by a variety of progressive, disabling neurological symptoms including clumsiness, limb and gait ataxia, dysarthria, dysphagia and cognitive deterioration (dementia). Until recently, there has been no disease-modifying therapy available for NP-C, with treatment limited to supportive measures. In most countries, NP-C is managed through specialist centers, with non-specialist support provided locally. However, effective patient support is hampered by the absence of national or international clinical management guidelines. In this paper, we seek to address this important gap in the current literature. An expert panel was convened in Paris, France in January 2009 to discuss best care practices for NP-C. This commentary reviews current literature on key aspects of the clinical management of NP-C in children, juveniles and adults, and provides recommendations based on consensus between the experts at the meeting.

Report from the National Institute of Allergy and Infectious Diseases workshop on drug allergy.

PubMed

Wheatley, Lisa M; Plaut, Marshall; Schwaninger, Julie M; Banerji, Aleena; Castells, Mariana; Finkelman, Fred D; Gleich, Gerald J; Guttman-Yassky, Emma; Mallal, Simon A K; Naisbitt, Dean J; Ostrov, David A; Phillips, Elizabeth J; Pichler, Werner J; Platts-Mills, Thomas A E; Roujeau, Jean-Claude; Schwartz, Lawrence B; Trepanier, Lauren A

2015-08-01

Allergic reactions to drugs are a serious public health concern. In 2013, the Division of Allergy, Immunology, and Transplantation of the National Institute of Allergy and Infectious Diseases sponsored a workshop on drug allergy. International experts in the field of drug allergy with backgrounds in allergy, immunology, infectious diseases, dermatology, clinical pharmacology, and pharmacogenomics discussed the current state of drug allergy research. These experts were joined by representatives from several National Institutes of Health institutes and the US Food and Drug Administration. The participants identified important advances that make new research directions feasible and made suggestions for research priorities and for development of infrastructure to advance our knowledge of the mechanisms, diagnosis, management, and prevention of drug allergy. The workshop summary and recommendations are presented herein. Published by Elsevier Inc.

New challenges for grizzly bear management in Yellowstone National Park

USGS Publications Warehouse

van Manen, Frank T.; Gunther, Kerry A.

2016-01-01

A key factor contributing to the success of grizzly bear Ursus arctos conservation in the Greater Yellowstone Ecosystem has been the existence of a large protected area, Yellowstone National Park. We provide an overview of recovery efforts, how demographic parameters changed as the population increased, and how the bear management program in Yellowstone National Park has evolved to address new management challenges over time. Finally, using the management experiences in Yellowstone National Park, we present comparisons and perspectives regarding brown bear management in Shiretoko National Park.

Managing Transnational Education: Does National Culture Really Matter?

ERIC Educational Resources Information Center

Eldridge, Kaye; Cranston, Neil

2009-01-01

This article reports on an exploratory study that examined the effect of national culture upon the management of Australia's provision of transnational higher education in Thailand. In particular, using Hofstede's national cultural value dimensions as an analytical tool, interviews with managers responsible for Australia's provision of…

Several problems in regard to national land management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dong Wenlang

1983-09-21

This article examines several problems with regard to land management in China. National land management is defined as development of the territorial land (including the earth's surface and underground), territorial waters and territorial air space under the jurisdiction of a sovereign country. The Chinese State Council established the Bureau of National Land Management in 1981. Areas of concern include natural resources, or land resources (including continental land, rivers and lakes, territorial waters and what is beneath the waters and the airspace above the waters, also the continental shelves), mineral resources and biological resources; social resources, which include human resources, intellectualmore » resources, social and cultural traditions, and the material and technical foundations of a society. Untapped resources of land, waters, forests, grasslands and minerals are to be developed through reclamation, mining, and engineering projects. Geography and national land economics are the theoretical and applied sciences directly related to national land management.« less

NATIONAL SURVEY ON ENVIRONMENTAL MANAGEMENT OF ASTHMA

EPA Science Inventory

The National Survey on Environmental Management of Asthma is a nation-wide survey on awareness of and existing attitudes toward asthma and its environmental triggers. The survey will generate data which can be used as a benchmark to measure national awareness and action related ...

A comprehensive infectious disease management system.

PubMed

Marcu, Alex; Farley, John D

2009-01-01

An efficient electronic management system is now an essential tool for the successful management and monitoring of those affected by communicable infectious diseases (Human Immunodeficiency Virus - HIV, hepatitis C - HEP C) during the course of the treatment. The current methods which depend heavily on manual collecting, compiling and disseminating treatment information are labor-intensive and time consuming. Clinics specialized in the treatment of infectious diseases use a mix of electronic systems that fail to interact with each other, result in data duplication, and do not support treatment of the patient as a whole. The purpose of the Infectious Disease Management System is to reduce the administrative overhead associated with data collection and analysis while providing correlation abilities and decision support in accordance with defined treatment guidelines. This Infectious Disease Management System was developed to: Ensure cost effectiveness by means of low software licensing costs, Introduce a centralized mechanism of collecting and monitoring all infectious disease management data, Automate electronic retrieval of laboratory findings, Introduce a decision support mechanism as per treatment guidelines, Seamlessly integrate of application modules, Provide comprehensive reporting capabilities, Maintain a high level of user friendliness.

Concordance between Self-Reports and Medicare Claims among Participants in a National Study of Chronic Disease Self-Management Program.

PubMed

Jiang, Luohua; Zhang, Ben; Smith, Matthew Lee; Lorden, Andrea L; Radcliff, Tiffany A; Lorig, Kate; Howell, Benjamin L; Whitelaw, Nancy; Ory, Marcia G

2015-01-01

To evaluate the concordance between self-reported data and variables obtained from Medicare administrative data in terms of chronic conditions and health care utilization. Retrospective observational study. We analyzed data from a sample of Medicare beneficiaries who were part of the National Study of Chronic Disease Self-Management Program (CDSMP) and were eligible for the Centers for Medicare and Medicaid Services (CMS) pilot evaluation of CDSMP (n = 119). Self-reported and Medicare claims-based chronic conditions and health care utilization were examined. Percent of consistent numbers, kappa statistic (κ), and Pearson's correlation coefficient were used to evaluate concordance. The two data sources had substantial agreement for diabetes and chronic obstructive pulmonary disease (COPD) (κ = 0.75 and κ = 0.60, respectively), moderate agreement for cancer and heart disease (κ = 0.50 and κ = 0.47, respectively), and fair agreement for depression (κ = 0.26). With respect to health care utilization, the two data sources had almost perfect or substantial concordance for number of hospitalizations (κ = 0.69-0.79), moderate concordance for ED care utilization (κ = 0.45-0.61), and generally low agreement for number of physician visits (κ ≤ 0.31). Either self-reports or claim-based administrative data for diabetes, COPD, and hospitalizations can be used to analyze Medicare beneficiaries in the US. Yet, caution must be taken when only one data source is available for other types of chronic conditions and health care utilization.

The role of laboratory testing in detection and classification of chronic kidney disease: national recommendations

PubMed Central

Biljak, Vanja Radišić; Honović, Lorena; Matica, Jasminka; Krešić, Branka; Vojak, Sanela Šimić

2017-01-01

Chronic kidney disease (CKD) is a common clinical condition with significant adverse consequences for the patient and it is recognized as a significant public health problem. The role of laboratory medicine in diagnosis and management of CKD is of great importance: the diagnosis and staging are based on estimation of glomerular filtration rate (eGFR) and assessment of albuminuria (or proteinuria). Therefore, the joint working group of the Croatian society of medical biochemistry and laboratory medicine and Croatian chamber of medical biochemists for laboratory diagnostics in CKD issued this national recommendation regarding laboratory diagnostics of CKD.
Key factors for laboratories implementing the national guidelines for the diagnosis and management of CKD are:
1. Ensure good communication between laboratory professionals and clinicians, such as nephrologists or specialists in general/family medicine,
2. Ensure all patients are provided with the same availability of laboratory diagnostics,
3. Ensure creatinine assays are traceable to isotope dilution mass spectrometry (IDMS) method and have minimal bias and acceptable imprecision,
4. Select the appropriate GFR estimating formula. Recommended equation is the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD – EPI) equation,
5. In reporting the key laboratory tests (creatinine, eGFR, urine albumin-to-creatinine ratio, urine protein-to-creatinine ratio) use the appropriate reporting units,
6. Provide adequate information on limitations of creatinine measurement.
The manuscript has been organized to identify critical points in laboratory tests used in basic laboratory diagnostics of CKD and is based on the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. PMID:28392738

Disease management: findings from leading state programs.

PubMed

Wheatley, Ben

2002-12-01

Disease management programs are designed to contain costs by improving health among the chronically ill. More than 20 states are now engaged in developing and implementing Medicaid disease management programs for their primary care case management and fee-for-service populations.

76 FR 39857 - Alaska Coastal Management Program Withdrawal From the National Coastal Management Program Under...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-07

.... SUMMARY: By operation of Alaska State law, the federally approved Alaska Coastal Management Program... partner in the National Coastal Management Program. The ACMP expired by operation of Alaska Statutes 44.66... DEPARTMENT OF COMMERCE National Oceanic Atmospheric Administration Alaska Coastal Management...

Physicians' attitude and practices in sickle cell disease pain management.

PubMed

Labbé, Elise; Herbert, Donald; Haynes, Johnson

2005-01-01

Many physicians believe that patients with sickle cell disease (SCD) are more likely to become addicted to pain medication than are other patient populations. This study hypothesizes that physicians' attitudes towards addiction in patients with SCD affects pain management practices. The Physician Attitudes Survey was sent to 286 physicians at seven National Institutes of Health-funded university-based comprehensive sickle cell centres. The survey assessed demographic information; and physician's attitudes toward and knowledge of pain, pain treatment, and drug addiction and abuse. Significant Pearson product-moment correlations were found between attitudes towards pain and beliefs regarding addiction to prescribed opioids. Physicians reported varied pain management strategies, however, many believe that attitudes toward addiction and to patients in pain crises may result in undertreatment of pain. These results indicate that physicians might benefit from additional education regarding sickle cell disease, addiction to pain medication, the pharmacology of opioids, and the assessment and treatment of pain.

Implementing chronic disease management in the public healthcare sector in Singapore: the role of hospitals.

PubMed

Cheah, J; Heng, B H

2001-01-01

The public health care delivery system in Singapore faces the challenges of a rapidly ageing population, an increasing chronic disease burden, increasing healthcare cost, rising expectations and demand for better health services, and shortage of resources. It is also fragmented, resulting in duplication and lack of coordination between institutions. A disease management approach has been adopted by the National Healthcare Group (NHG) as a critical strategy to provide holistic, cost-effective, seamless and well-coordinated care across the continuum. The framework in the development of the disease management plan included identifying the diseases and defining the target population, organizing a multi-disciplinary team lead by a clinician champion, defining the core components, treatment protocols and evaluation methods, defining the goals, and measuring and managing the outcomes. As disease management and case management for chronic diseases are new approaches adopted in the healthcare delivery system, there is a lack of understanding by healthcare professionals. The leadership and participation of hospital physicians was sought in the planning, design and outcomes monitoring to ensure their 'buy-in' and the successful implementation and effectiveness of the program. The episodic diagnosis related group (DRG)-based framework of funding and subvention for healthcare, and the shortage of step-care care facilities, have been recognized by the Ministry of Health as an impediments to the implementation, and these are currently being addressed.

Respiratory diseases registries in the national registry of rare diseases.

PubMed

Lara Gallego, Beatriz; Abaitua Borda, Ignacio; Galán Gil, Genaro; Castillo Villegas, Diego; Casanova Espinosa, Álvaro; Cano Jiménez, Esteban; Ojanguren Arranz, Iñigo; Posada de la Paz, Manuel

2014-09-01

This report describes the general characteristics, objectives and organizational aspects of the registries of rare respiratory diseases included in the National Registry of Rare Diseases of the Research Institute for Rare Diseases (ISCIII), in order to publicize their existence and encourage the participation of professionals. Information is collected on the following conditions: alpha-1 antitrypsin deficiency, idiopathic tracheal stenosis, adult pulmonary Langerhans' cell histiocytosis, lymphangioleiomyomatosis, alveolar proteinosis, and sarcoidosis. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

Kidney disease management in UK primary care: guidelines, incentives and information technology.

PubMed

Klebe, Bernhard; Farmer, Chris; Cooley, Roger; de Lusignan, Simon; Middleton, Rachel; O'Donoghue, Donal; New, John; Stevens, Paul

2007-09-01

The last few years have seen new developments to understand and tackle the significant public health issue posed by chronic kidney disease (CKD). Established renal disease currently consumes 2% of the UK National Health Service budget and predictions are that this figure will increase significantly due to the rising number of people requiring renal replacement therapy fuelled by the ageing population and the diabetes mellitus epidemic. This paper reviews the scale of CKD and discusses the new developments such as staging, referral guidelines and new Department of Health incentives brought about to improve awareness. The importance of Information Technology in assisting the management of renal disease is also outlined. We identify various types of intervention which might be used to do this: feedback in an educational context, the establishment of computerized decision support and enhancement of the patient journey. Many principles may be extended to the management of any chronic disease. While new developments are necessary to improve care, wider implementation is required to be able to see if improved outcomes are achieved.

[Relevance of medical rehabilitation in disease management programmes].

PubMed

Lüngen, M; Lauterbach, K W

2003-10-01

Disease management programmes will increasingly be introduced in Germany due to the new risk adjustment scheme. The first disease management programmes started in 2003 for breast cancer and diabetes mellitus type II. German rehabilitation will have to face several challenges. Disease management programmes are strongly based on the notion of Evidence so that proof of the efficacy of a care giving task should be present. Verification of the evidence of the specifically German rehabilitation treatments must therefore be given. However, integration of rehabilitation in disease management programmes could lead to changes in the alignment of German rehabilitation. The essence of German rehabilitation, notably its holistic approach, could get lost with integration in disease management programmes.

Crohn Disease: Epidemiology, Diagnosis, and Management.

PubMed

Feuerstein, Joseph D; Cheifetz, Adam S

2017-07-01

Crohn disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. For this review article, we performed a review of articles in PubMed through February 1, 2017, by using the following Medical Subject Heading terms: crohns disease, crohn's disease, crohn disease, inflammatory bowel disease, and inflammatory bowel diseases. Presenting symptoms are often variable and may include diarrhea, abdominal pain, weight loss, nausea, vomiting, and in certain cases fevers or chills. There are 3 main disease phenotypes: inflammatory, structuring, and penetrating. In addition to the underlying disease phenotype, up to a third of patients will develop perianal involvement of their disease. In addition, in some cases, extraintestinal manifestations may develop. The diagnosis is typically made with endoscopic and/or radiologic findings. Disease management is usually with pharmacologic therapy, which is determined on the basis of disease severity and underlying disease phenotype. Although the goal of management is to control the inflammation and induce a clinical remission with pharmacologic therapy, most patients will eventually require surgery for their disease. Unfortunately, surgery is not curative and patients still require ongoing therapy even after surgery for disease recurrence. Importantly, given the risks of complications from both Crohn disease and the medications used to treat the disease process, primary care physicians play an important role in optimizing the preventative care management to reduce the risk of complications. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Heart failure disease management: implementation and outcomes.

PubMed

Whellan, David J

2005-01-01

Millions of dollars are being spent to identify new therapies to improve mortality and morbidity for the growing epidemic of patients sustaining heart failure. However, in clinical practice, these therapies are currently underused. To bridge the gap between proven therapies and clinical practice, the medical community has turned to disease management. Heart failure disease management interventions vary from vital-sign monitoring to multidisciplinary approaches involving a pharmacist, nutritionist, nurse practitioner, and physician. This review attempts to categorize these inventions based on location. We compared the published results from randomized, controlled trials of the following types of heart failure disease management interventions: inpatient, clinic visits, home visits, and telephone follow up. Although research shows an improvement in the quality of care and a decrease in hospitalizations for patients sustaining heart failure, the economic impact of disease management is still unclear. The current reimbursement structure is a disincentive to providers wanting to offer disease management services to patients sustaining heart failure. Additionally, the cost of providing disease management services such as additional clinical visits, patient education materials, or additional personnel time has not been well documented. Most heart failure disease management studies do confirm the concept that providing increased access to healthcare providers for an at-risk group of patients sustaining heart failure does improve outcomes. However, a large-scale randomized, controlled clinical trial based in the United States is needed to prove that this concept can be implemented beyond a single center and to determine how much it will cost patients, providers, healthcare systems, and payers.

76 FR 75860 - National Forest System Invasive Species Management Policy

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-05

..., scope, roles, principles, and responsibilities associated with NFS invasive species management for... threatening the National Forest System. Final Policy or Principles The management of aquatic and terrestrial...-AC77 National Forest System Invasive Species Management Policy AGENCY: Forest Service, USDA. ACTION...

Exploring the use of social network analysis to measure communication between disease programme and district managers at sub-national level in South Africa.

PubMed

Kawonga, Mary; Blaauw, Duane; Fonn, Sharon

2015-06-01

With increasing interest in maximising synergies between disease control programmes (DCP) and general health services (GHS), methods are needed to measure interactions between DCP and GHS actors. In South Africa, administrative integration reforms make GHS managers at decentralised level (district managers) responsible for the oversight of DCP operations within districts, with DCP managers (programme managers) providing specialist support. The reforms necessitate interdependence, but these actors work together ineffectively. Communication is crucial for joint working, but no research to assess communication between these actors has been done. This study explores the use of social network analysis (SNA) to measure the extent to which programme and district managers in South Africa communicate, using HIV monitoring and evaluation (M&E) as an exemplar. Data were collected from fifty one managers in two provinces during 2010-2011, to measure: a) one-on-one task-related communication - talking about the collation (verification, reporting) and use of HIV data for monitoring HIV interventions; and b) group communication through co-participating in management committees where HIV data are used for monitoring HIV interventions in districts. SNA measures were computed to describe actor centrality, network density (cohesion), and communication within and between respective manager groups. Block modelling was applied to identify management committees that connect respective manager groups. Results show HIV programme managers located at higher level communicated largely amongst themselves as a group (homophily), seldom talked to the district managers to whom they are supposed to provide specialist HIV M&E support, and rarely participated with them in management committees. This research demonstrates the utility of SNA as a tool for measuring the extent of communication between DCP and GHS actors at sub-national level. Actions are needed to bridge observed communication gaps in

Integrating disease management into the outpatient delivery system during and after managed care.

PubMed

Villagra, Victor G

2004-01-01

Managed care introduced disease management as a replacement strategy to utilization management. The focus changed from influencing treatment decisions to supporting self-care and compliance. Disease management rendered operational many elements of the chronic care model, but it did so outside the delivery system, thus escaping the financial limitations, cultural barriers, and inertia inherent in effecting radical change from within. Medical management "after managed care" should include the functional and structural integration of disease management with primary care clinics. Such integration would supply the infrastructure that primary care physicians need to coordinate the care of chronically ill patients more effectively.

[Management programs on diabetes among Chinese adults in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases].

PubMed

Jin, R R; Li, J J; Zhang, J; Li, J L; Bian, F; Deng, G J; Ma, S; Su, X W; Zhao, J; Jiang, Y

2018-04-10

Objective: To understand the current situation on management of diabetes mellitus patients aged 35 and above in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases, in China. Methods: Local residents, aged 18 years and above were randomly selected by a complex, multistage, probability sampling method. Face-to-face questionnaire survey was carried out between November and December 2016. Rates regarding prevalence, treatment and management of diabetes were calculated, and influencing factors of diabetes were analyzed by using the non-conditional logistic regression model. Results: A total of 3 213 residents aged ≥35 years were included in this study, of which 11.48% (369/3 213) reported that they had ever been informed by a doctor or other health worker that their blood sugar level was high or being diabetic. The rate of self-reported treatment among the diabetic patients was 83.20% (307/369). Rates on overall management and standardized management were 69.92% (258/369) and 53.66% (198/369), respectively. Higher rates were seen in residents aged 55 to 64 years, 76.32% for overall management and 59.65% for standardized management. Through multiple logistic regression analysis, we found that standardized management for diabetes was much higher in the Demonstration Areas located in the eastern areas ( OR =2.942, 95% CI : 1.547-5.594), or patients with characteristics including high implementation score ( OR =3.499, 95% CI : 1.865-6.563), already signed family doctors ( OR =5.661, 95% CI : 3.237-9.899), or without hypertension ( OR =1.717, 95% CI : 1.010- 2.920). Residents who were living in the first and second batch areas of implementation or responding to the NCDs with positive attitude were more likely to accept standardized management. Conclusion: Prevention and management programs on diabetes had met the requirements set for the Demonstration Areas which had promoted the specific implementation and further

Management of Diverticular Disease in Scandinavia.

PubMed

Schultz, Johannes K; Yaqub, Sheraz; Øresland, Tom

2016-10-01

Throughout the last century, the incidence of diverticular disease of the colon has increased tremendously in industrialized countries; nevertheless, the management of this condition is still controversial. Although several international guidelines for the management of diverticular disease are based on the same evidence, the recommendations differ greatly, emphasizing the lack of high-quality prospective studies. In Scandinavia, official guidelines for the management of diverticular disease exist only in Denmark. However, the treatment policies are quite similar in all Scandinavian countries. Computed tomography is the first choice for imaging of acute diverticulitis and its complications. Furthermore, the use of antibiotics in uncomplicated diverticulitis is nearly abandoned in Scandinavia, whereas several international guidelines still recommend their use. There is a broad consensus that abscesses secondary to acute diverticulitis can safely be managed with percutaneous drainage, which is in line with international recommendations. The surgical management of perforated diverticulitis with peritonitis is still as controversial in Scandinavia as elsewhere. Common surgical options are laparoscopic peritoneal lavage, primary resection with anastomosis, and primary resection with terminal colostomy (Hartmann's procedure). Elective sigmoid resection in patients with diverticular disease seems to be performed less frequently in Scandinavia than in other European countries; the right indications are a current matter of debate. Symptomatic uncomplicated diverticular disease in the absence of diverticulitis has not gained great attention in Scandinavia.

Chronic disease management in general practice: results from a national study.

PubMed

Darker, C; Martin, C; O'Dowd, T; O'Kelly, F; O'Shea, B

2012-04-01

The aim of this study was to provide baseline data on chronic disease management (CDM) provision in Irish general practice (GP). The survey instrument was previously used in a study of primary care physicians in 11 countries, thus allowing international comparisons. The response rate was 72% (380/527).The majority of GPs (240/380; 63%) reported significant changes are needed in our health care system to make CDM work better. Small numbers of routine clinical audits are being performed (95/380; 25%). Irish GPs use evidence based guidelines for treatment of diabetes (267/380; 71%), asthma / COPD (279/380; 74%) and hypertension (297/380; 79%), to the same extent as international counterparts. Barriers to delivering chronic care include increased workload (379/380; 99%), lack of appropriate funding (286/380; 76%), with GPs interested in targeted payments (244/380; 68%). This study provides baseline data to assess future changes in CDM.

75 FR 6700 - National Park Service Concessions Management Advisory Board Reestablishment

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-10

... DEPARTMENT OF THE INTERIOR National Park Service Concessions Management Advisory Board Reestablishment AGENCY: National Park Service, Interior. ACTION: Notice of reestablishment of the National Park... administratively reestablish the National Park Service Concessions Management Advisory Board. This action is...

Rising out-of-pocket costs in disease management programs.

PubMed

Chernew, Michael E; Rosen, Allison B; Fendrick, A Mark

2006-03-01

To document the rise in copayments for patients in disease management programs and to call attention to the inherent conflicts that exist between these 2 approaches to benefit design. Data from 2 large health plans were used to compare cost sharing in disease management programs with cost sharing outside of disease management programs. The copayments charged to participants in disease management programs usually do not differ substantially from those charged to other beneficiaries. Cost sharing and disease management result in conflicting approaches to benefit design. Increasing copayments may lead to underuse of recommended services, thereby decreasing the clinical effectiveness and increasing the overall costs of disease management programs. Policymakers and private purchasers should consider the use of targeted benefit designs when implementing disease management programs or redesigning cost-sharing provisions. Current information systems and health services research are sufficiently advanced to permit these benefit designs.

Applying Science: Opportunities to Inform Disease Management Policy with Cooperative Research within a One Health Framework.

PubMed

Blackburn, Jason K; Kracalik, Ian T; Fair, Jeanne Marie

2015-01-01

The ongoing Ebola outbreak in West Africa and the current saiga antelope die off in Kazakhstan each represent very real and difficult to manage public or veterinary health crises. They also illustrate the importance of stable and funded surveillance and sound policy for intervention or disease control. While these two events highlight extreme cases of infectious disease (Ebola) or (possible) environmental exposure (saiga), diseases such as anthrax, brucellosis, tularemia, and plague are all zoonoses that pose risks and present surveillance challenges at the wildlife-livestock-human interfaces. These four diseases are also considered important actors in the threat of biological terror activities and have a long history as legacy biowarfare pathogens. This paper reviews recent studies done cooperatively between American and institutions within nations of the Former Soviet Union (FSU) focused on spatiotemporal, epidemiological, and ecological patterns of these four zoonoses. We examine recent studies and discuss the possible ways in which techniques, including ecological niche modeling, disease risk modeling, and spatiotemporal cluster analysis, can inform disease surveillance, control efforts, and impact policy. Our focus is to posit ways to apply science to disease management policy and actual management or mitigation practices. Across these examples, we illustrate the value of cooperative studies that bring together modern geospatial and epidemiological analyses to improve our understanding of the distribution of pathogens and diseases in livestock, wildlife, and humans. For example, ecological niche modeling can provide national level maps of pathogen distributions for surveillance planning, while space-time models can identify the timing and location of significant outbreak events for defining active control strategies. We advocate for the need to bring the results and the researchers from cooperative studies into the meeting rooms where policy is negotiated and

Principles of disease management in neonatology.

PubMed

Bowen, F W; Gwiazdowski, S

1998-06-01

This article emphasizes the emerging facets of disease-management practice that impact directly on establishing a measured care system that can produce the information needed to establish a continuous quality improvement program. The areas discussed are risk assessment, clinical management guidelines and carepaths, and the measurement of system output known as clinical outcomes. The remainder of the article details the aspects of risk assessment, guideline function, and outcome assessment, critical in a disease-managed measured care system.

Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have?

PubMed

Mackey, Laura M; Doody, Catherine; Werner, Erik L; Fullen, Brona

2016-08-01

Self-management-based interventions can lead to improved health outcomes in people with chronic diseases, and multiple patient characteristics are associated with the development of self-management behaviors. Low health literacy (HL) has been implicated in poorer self-management behaviors and increased costs to health services. However, the mechanisms behind this relationship remain unclear. Therefore, the aim of the current review is to assess the association between HL and patient characteristics related to self-management behaviors (i.e., disease-related knowledge, beliefs, and self-efficacy). The review comprised 3 phases: 1) database searches, 2) eligibility screening, and 3) study quality assessment and strength of evidence. Inclusion criteria specified that a valid HL screening tool was used, that at least one self-management behavior was assessed, and that patients had a chronic condition. An initial search generated a total of 712 articles, of which 31 studies fulfilled the eligibility criteria. A consistent association was found between low HL and poorer disease-related knowledge in respiratory diseases, diabetes, and multiple disease categories. A significant association between low HL and poorer self-efficacy was reported in cardiovascular diseases, diabetes, human immunodeficiency virus, and multiple disease categories. HL was significantly associated with poorer beliefs in respiratory, musculoskeletal, and cardiovascular diseases. The findings from the current review suggest that low HL may affect behaviors necessary for the development of self-management skills. Given that self-management strategies are core components for effective treatment of a range of chronic diseases, low HL poses a considerable health concern. Further research is needed to understand the mediating influence of HL on disease-related knowledge, self-efficacy, and beliefs. From this, HL-sensitive, self-management interventions ought to be devised and implemented. © The Author

Campsite impact management: A survey of National Park Service backcountry managers

USGS Publications Warehouse

Marion, J.L.; Stubbs, C.J.; Vander Stoep, Gail A.

1993-01-01

Though a central purpose for the creation and management of parks, visitation inevitably affects the natural resources of parks. This is particularly true at campsites, where visitation and its effects are concentrated. This paper presents partial results from a survey of National Park Service managers regarding general strategies and specific actions implemented by park managers to address campsite impact problems.

A national cohesive wildland fire management strategy

Treesearch

Forest Service U.S. Department of Agriculture; Office of Wildland Fire Coordination Department of the Interior

2011-01-01

Addressing wildfire is not simply a fire management, fire operations, or wildland-urban interface problem - it is a larger, more complex land management and societal issue. The vision for the next century is to: Safely and effectively extinguish fire, when needed; use fire where allowable; manage our natural resources; and as a Nation, live with wildland fire. Three...

Knowledge and pharmacological management of Alzheimer's disease by managing community pharmacists: a nationwide study.

PubMed

Zerafa, Natalie; Scerri, Charles

2016-12-01

Background Managing community pharmacists can play a leading role in supporting community dwelling individuals with Alzheimer's disease and their caregivers. Objective The main purpose of this study was to assess knowledge of managing community pharmacists towards Alzheimer's disease and its pharmacological management. Setting Community pharmacies in the Maltese islands. Method A nationwide survey was conducted with full-time managing community pharmacists in possession of a tertiary education degree in pharmacy studies. The level of knowledge was investigated using the Alzheimer's Disease Knowledge Scale and the Alzheimer's Disease Pharmacotherapy Measure. Participants were also asked to rate a number of statements related to disease management. Results Maltese managing community pharmacists (57 % response rate) had inadequate knowledge on risk factors, caregiving issues and pharmacological management of Alzheimer's disease. Age and number of years working in a community pharmacy setting were found to be negatively correlated with increased knowledge. Conclusion The findings highlight the need of providing training and continued educational support to managing community pharmacists in order to provide quality advice to individuals with dementia and their caregivers in the community.

Libyan National Health Services The Need to Move to Management-by-Objectives

PubMed Central

El Taguri, A; Elkhammas, EA; Bakoush, O; Ashammakhi, N; Baccoush, M; Betilmal, I

2008-01-01

In the last four decades, there has been a substantial horizontal expansion of health services in Libya. This resulted in improvement in morbidity and mortality, in particularly those related to infectious disease. However, measures such as the national performance gap indicator reveal an underperforming health system. In this article, we discuss aspects related to the Libyan health system and its current status including areas of weakness. Overcoming current failures and further improvement are unlikely to occur spontaneously without proper planning. Defining community health problems, identifying unmet needs, surveying resources to meet them, establishing SMART (specific, measurable, achievable, and realistic and time specific) objectives, and projecting administrative action to accomplish the proposed programs, are a must. The health system should rely on newer approaches such as management-by-objectives and risk-management rather than the prevailing crisis-management attitude. PMID:21499467

Relevance of Lick Creek ecosystem-based management treatments to National Forest management

Treesearch

Cathy Stewart

1999-01-01

Treatments applied at Lick Creek were the first landscape-scale applications of ecosystem management on the Bitterroot National Forest. The coordinated effort between educators, researchers, resource managers, and the public helped gain acceptance and understanding of new approaches to management, both internally and externally. The longer skidding distances, high...

A model to evaluate quality and effectiveness of disease management.

PubMed

Lemmens, K M M; Nieboer, A P; van Schayck, C P; Asin, J D; Huijsman, R

2008-12-01

Disease management has emerged as a new strategy to enhance quality of care for patients suffering from chronic conditions, and to control healthcare costs. So far, however, the effects of this strategy remain unclear. Although current models define the concept of disease management, they do not provide a systematic development or an explanatory theory of how disease management affects the outcomes of care. The objective of this paper is to present a framework for valid evaluation of disease-management initiatives. The evaluation model is built on two pillars of disease management: patient-related and professional-directed interventions. The effectiveness of these interventions is thought to be affected by the organisational design of the healthcare system. Disease management requires a multifaceted approach; hence disease-management programme evaluations should focus on the effects of multiple interventions, namely patient-related, professional-directed and organisational interventions. The framework has been built upon the conceptualisation of these disease-management interventions. Analysis of the underlying mechanisms of these interventions revealed that learning and behavioural theories support the core assumptions of disease management. The evaluation model can be used to identify the components of disease-management programmes and the mechanisms behind them, making valid comparison feasible. In addition, this model links the programme interventions to indicators that can be used to evaluate the disease-management programme. Consistent use of this framework will enable comparisons among disease-management programmes and outcomes in evaluation research.

Taming wildlife disease: bridging the gap between science and management

USGS Publications Warehouse

Joseph, Maxwell B.; Mihaljevic, Joseph R.; Arellano, Ana Lisette; Kueneman, Jordan G.; Cross, Paul C.; Johnson, Pieter T.J.

2013-01-01

1.Parasites and pathogens of wildlife can threaten biodiversity, infect humans and domestic animals, and cause significant economic losses, providing incentives to manage wildlife diseases. Recent insights from disease ecology have helped transform our understanding of infectious disease dynamics and yielded new strategies to better manage wildlife diseases. Simultaneously, wildlife disease management (WDM) presents opportunities for large-scale empirical tests of disease ecology theory in diverse natural systems. 2.To assess whether the potential complementarity between WDM and disease ecology theory has been realized, we evaluate the extent to which specific concepts in disease ecology theory have been explicitly applied in peer-reviewed WDM literature. 3.While only half of WDM articles published in the past decade incorporated disease ecology theory, theory has been incorporated with increasing frequency over the past 40 years. Contrary to expectations, articles authored by academics were no more likely to apply disease ecology theory, but articles that explain unsuccessful management often do so in terms of theory. 4.Some theoretical concepts such as density-dependent transmission have been commonly applied, whereas emerging concepts such as pathogen evolutionary responses to management, biodiversity–disease relationships and within-host parasite interactions have not yet been fully integrated as management considerations. 5.Synthesis and applications. Theory-based disease management can meet the needs of both academics and managers by testing disease ecology theory and improving disease interventions. Theoretical concepts that have received limited attention to date in wildlife disease management could provide a basis for improving management and advancing disease ecology in the future.

Effect of varying levels of disease management on smoking cessation: a randomized trial.

PubMed

Ellerbeck, Edward F; Mahnken, Jonathan D; Cupertino, A Paula; Cox, Lisa Sanderson; Greiner, K Allen; Mussulman, Laura M; Nazir, Niaman; Shireman, Theresa I; Resnicow, Kenneth; Ahluwalia, Jasjit S

2009-04-07

.43 [95% CI, 1.00 to 2.03]) and among the combined disease management groups than the pharmacotherapy-alone group (OR, 1.47 [CI, 1.08 to 2.00]). Self-reported abstinence at 24 months was 68 of 244 (27.9%) and 56 of 238 (23.5%) participants in the high- and moderate-intensity disease management groups, respectively (OR, 1.33 [CI, 0.88 to 2.02]), and 56 of 244 (23.0%) participants in the pharmacotherapy-alone group (OR, 1.12 [CI, 0.78 to 1.61] for combined disease management vs. pharmacotherapy alone). The effect of pharmacotherapy management cannot be separated from the provision of free pharmacotherapy, and cessation was validated in only 58% of self-reported quitters. Smokers are willing to make repeated pharmacotherapy-assisted quit attempts, leading to progressively greater smoking abstinence. Although point-prevalence abstinence did not differ at 24 months, analyses that incorporated assessments across the full 24 months of treatment suggest that higher-intensity disease management is associated with increased abstinence. National Cancer Institute.

U.S. National forests adapt to climate change through science-management partnerships

Treesearch

Jeremy S. Littell; David L. Peterson; Constance I. Millar; Kathy A. O' Halloran

2011-01-01

Developing appropriate management options for adapting to climate change is a new challenge for land managers, and integration of climate change concepts into operational management and planning on United States national forests is just starting. We established science-management partnerships on the Olympic National Forest (Washington) and Tahoe National Forest (...

Remote patient management: technology-enabled innovation and evolving business models for chronic disease care.

PubMed

Coye, Molly Joel; Haselkorn, Ateret; DeMello, Steven

2009-01-01

Remote patient management (RPM) is a transformative technology that improves chronic care management while reducing net spending for chronic disease. Broadly deployed within the Veterans Health Administration and in many small trials elsewhere, RPM has been shown to support patient self-management, shift responsibilities to non-clinical providers, and reduce the use of emergency department and hospital services. Because transformative technologies offer major opportunities to advance national goals of improved quality and efficiency in health care, it is important to understand their evolution, the experiences of early adopters, and the business models that may support their deployment.

Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations

PubMed Central

Gupta, Dheeraj; Agarwal, Ritesh; Aggarwal, Ashutosh Nath; Maturu, V. N.; Dhooria, Sahajal; Prasad, K. T.; Sehgal, Inderpaul S.; Yenge, Lakshmikant B.; Jindal, Aditya; Singh, Navneet; Ghoshal, A. G.; Khilnani, G. C.; Samaria, J. K.; Gaur, S. N.; Behera, D.

2013-01-01

Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence. PMID:24049265

Policy Guidelines for Effective Inclusion and Reintegration of People with Chronic Diseases in the Workplace: National and European Perspectives.

PubMed

Vlachou, Anastasia; Stavroussi, Panayiota; Roka, Olga; Vasilou, Evdokia; Papadimitriou, Dimitra; Scaratti, Chiara; Kadyrbaeva, Asel; Fheodoroff, Klemens; Brecelj, Valentina; Svestkova, Olga; Tobiasz-Adamczyk, Beata; Finnvold, Jon Erik; Gruber, Sonja; Leonardi, Matilde

2018-03-11

The increasing prevalence of chronic diseases among the European working age population, as well as the implications for the individual and societal level, underline the need for policy guidelines targeting the effective inclusion of persons with chronic diseases in the workplace. The aim of the present paper was to explore the perspectives of European and National-level stakeholders on existing strategies for work re-integration of persons with chronic diseases, and to provide policy guidelines. A highly-structured interview protocol was distributed to 58 National level stakeholders (policy makers, professionals and employers) from seven European countries. Additionally, 20 European organizations concerned with health-related issues and employment completed an online survey. The findings reveal that employment-related challenges remain largely unaddressed. Both national and European stakeholders considered the existing legislative frameworks inadequate and appraised the co-ordination for the implementation of employment re-integration policies as ineffective. Policies targeting at work re-integration of persons with chronic diseases at European and national level should focus on consistent cooperation among all key stakeholders, awareness raising to staff and management, dissemination of effective strategies, developing research and evaluation standards and establishing monitoring systems on inclusive labour markets.

Policy Guidelines for Effective Inclusion and Reintegration of People with Chronic Diseases in the Workplace: National and European Perspectives

PubMed Central

Vlachou, Anastasia; Stavroussi, Panayiota; Roka, Olga; Vasilou, Evdokia; Papadimitriou, Dimitra; Scaratti, Chiara; Kadyrbaeva, Asel; Brecelj, Valentina; Svestkova, Olga; Tobiasz-Adamczyk, Beata; Finnvold, Jon Erik; Gruber, Sonja

2018-01-01

The increasing prevalence of chronic diseases among the European working age population, as well as the implications for the individual and societal level, underline the need for policy guidelines targeting the effective inclusion of persons with chronic diseases in the workplace. The aim of the present paper was to explore the perspectives of European and National-level stakeholders on existing strategies for work re-integration of persons with chronic diseases, and to provide policy guidelines. A highly-structured interview protocol was distributed to 58 National level stakeholders (policy makers, professionals and employers) from seven European countries. Additionally, 20 European organizations concerned with health-related issues and employment completed an online survey. The findings reveal that employment-related challenges remain largely unaddressed. Both national and European stakeholders considered the existing legislative frameworks inadequate and appraised the co-ordination for the implementation of employment re-integration policies as ineffective. Policies targeting at work re-integration of persons with chronic diseases at European and national level should focus on consistent cooperation among all key stakeholders, awareness raising to staff and management, dissemination of effective strategies, developing research and evaluation standards and establishing monitoring systems on inclusive labour markets. PMID:29534484

Recommendations for the management of sickle cell disease in South Africa.

PubMed

Alli, N A; Patel, M; Alli, H D; Bassa, F; Coetzee, M J; Davidson, A; Essop, M R; Lakha, A; Louw, V J; Novitzky, N; Philip, V; Poole, J E; Wainwright, R D

2014-11-01

The spectrum of sickle cell disease (SCD) encompasses a heterogeneous group of disorders that include: (I) homozygous SCD (HbSS), also referred to as sickle cell anaemia; (ii) heterozygous SCD (HbAS), also referred to as sickle cell trait; and (iii) compound heterozygous states such as HbSC disease, HbSβ thalassaemia, etc. Homozygous or compound heterozygous SCD patients manifest with clinical disease of varying severity that is influenced by biological and environmental factors, whereas subject with sickle cell trait are largely asymptomatic. SCD is characterized by vaso-occlusive episodes that result in tissue ischaemia and pain in the affected region. Repeated infarctive episodes cause organ damage and may eventually lead to organ failure. For effective management, regular follow-up with support from a multidisciplinary healthcare team is necessary. The chronic nature of the disease, the steady increase in patient numbers, and relapsing acute episodes have cost implications that are likely to impact on provincial and national health budgets. Limited resources mandate local management protocols for the purposes of consistency and standardisation, which could also facilitate sharing of resources between centres for maximal utility. These recommendations have been developed for the South African setting, and it is intended to update them regularly to meet new demands and challenges.

Ecological modeling for forest management in the Shawnee National Forest

Treesearch

Richard G. Thurau; J.F. Fralish; S. Hupe; B. Fitch; A.D. Carver

2008-01-01

Land managers of the Shawnee National Forest in southern Illinois are challenged to meet the needs of a diverse populace of stakeholders. By classifying National Forest holdings into management units, U.S. Forest Service personnel can spatially allocate resources and services to meet local management objectives. Ecological Classification Systems predict ecological site...

Diabetes disease management results in Hispanic Medicaid patients.

PubMed

Berg, Gregory D; Wadhwa, Sandeep

2009-05-01

To investigate outcomes of a telephonic nursing disease management program for Medicaid patients with diabetes residing in Puerto Rico. A 12-month, matched-cohort study. Four hundred and ninety (490) intervention group members matched to 490 controls. Disease management diabetes program. For those in the intervention group, the disease management program customized a self-management intervention plan. Medical service utilization, including hospitalizations, emergency department visits, physician evaluation and management visits, selected clinical indicators, and financial impact. The intervention group showed significant effects compared with the control group, including a 48% reduction in inpatient bed days, and a 23% increase in ACE inhibitor use, resulting in a return on investment estimate of 3.8:1. The study demonstrates that a nursing disease management program for diabetes can significantly improve hospitalizations, drug compliance, and vaccinations in a Hispanic Medicaid population.

[The German program for disease management guidelines: evaluation by use of quality indicators].

PubMed

Kopp, Ina B; Geraedts, Max; Jäckel, Wilfried H; Altenhofen, Lutz; Thomeczek, Christian; Ollenschläger, Günter

2007-08-15

The Program for National Disease Management Guidelines (German DM-CPG Program) in Germany aims at the implementation of best-practice recommendations for prevention, acute care, rehabilitation and chronic care in the setting of disease management programs and integrated health-care systems. Like other guidelines, DM-CPG need to be assessed regarding their influence on structures, processes and outcomes of care. However, quality assessment in integrated health-care systems is challenging. On the one hand, a multitude of potential domains for measurement, actors and perspectives need to be considered. On the other hand, measures need to be identified that assess the function of the diagnostic and therapeutic chain in terms of cooperation and coordination of care. The article reviews methods and use of quality indicators in the context of the German DM-CPG Program.

Health Technologies for the Improvement of Chronic Disease Management

PubMed Central

Nikitovic, M; Brener, S

2013-01-01

Background As part of ongoing efforts to improve the Ontario health care system, a mega-analysis examining the optimization of chronic disease management in the community was conducted by Evidence Development and Standards, Health Quality Ontario (previously known as the Medical Advisory Secretariat [MAS]). Objective The purpose of this report was to identify health technologies previously evaluated by MAS that may be leveraged in efforts to optimize chronic disease management in the community. Data Sources The Ontario Health Technology Assessment Series and field evaluations conducted by MAS and its partners between January 1, 2006, and December 31, 2011. Review Methods Technologies related to at least 1 of 7 disease areas of interest (type 2 diabetes, coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease, congestive heart failure, stroke, and chronic wounds) or that may greatly impact health services utilization were reviewed. Only technologies with a moderate to high quality of evidence and associated with a clinically or statistically significant improvement in disease management were included. Technologies related to other topics in the mega-analysis on chronic disease management were excluded. Evidence-based analyses were reviewed, and outcomes of interest were extracted. Outcomes of interest included hospital utilization, mortality, health-related quality of life, disease-specific measures, and economic analysis measures. Results Eleven analyses were included and summarized. Technologies fell into 3 categories: those with evidence for the cure of chronic disease, those with evidence for the prevention of chronic disease, and those with evidence for the management of chronic disease. Conclusions The impact on patient outcomes and hospitalization rates of new health technologies in chronic disease management is often overlooked. This analysis demonstrates that health technologies can reduce the burden of illness; improve patient

Disease management: old wine in new bottles?

PubMed

Ritterband, D R

2000-01-01

Disease management is a holistic, patient-focused approach to the treatment of disease across the spectrum of healthcare delivery. In its current form, disease management was created in response to the societal and economic burden that chronic illness contributes. There has recently been rapid growth in the development of disease management programs and sponsors are widespread within the industry, with the largest increase in independent vendors. Although growth has been substantial, the hurdles these programs have encountered have kept them from reaching their full potential. The challenges that exist include clinical, financial, and regulatory issues, and these challenges have significant meaning to healthcare managers. In deciding whether to develop or enhance programs, executives must consider their capability of outcomes measurement, their provider relationships, and the arrangements for program implementation. Ultimately, if programs provide improved health and quality of life for participants, cost savings will follow.

78 FR 34034 - National Advisory Committee for Implementation of the National Forest System Land Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-06

... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... purpose of the Committee is to provide advice and recommendations on the implementation of the National...

Disease management of dairy calves and heifers.

PubMed

McGuirk, Sheila M

2008-03-01

This article focuses on the most important diseases of dairy calves and heifers and presents clinical approaches that can improve detection, diagnosis, and treatment of herd-based problems. A systematic herd investigation strategy is pivotal to define the problems, understand important risk factors, develop a plan, and make recommendations for disease management accurately. A review of records, colostrum and feeding routines, housing and bedding management, routine procedures, vaccination, and treatment protocols begins the investigation and determines which diagnostic procedures and testing strategies are most useful. Disease management is most effective when the problem source is well defined and the exposure can be limited, calf immunity can be enhanced, or a combination of both. Screening examinations performed regularly or done at strategic time points improves detection of disease, can be used to monitor treatment outcomes, and can avoid disease outbreaks.

Disease management programs for CKD patients: the potential and pitfalls.

PubMed

Rocco, Michael V

2009-03-01

Disease management describes the use of a number of approaches to identify and treat patients with chronic health conditions, especially those that are expensive to treat. Disease management programs have grown rapidly in the United States in the past several years. These programs have been established for patients with chronic kidney disease (CKD), but some have been discontinued because of the high cost of the program. Disease management programs for CKD face unique challenges. Identification of patients with CKD is hampered by incomplete use of the International Classification of Diseases, Ninth Revision (ICD-9) codes for CKD by physicians and the less than universal use of estimated glomerular filtration rate from serum creatinine measurements to identify patients with an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2). CKD affects multiple organ systems. Thus, a comprehensive disease management program will need to manage each of these aspects of CKD. These multiple interventions likely will make a CKD disease management program more costly than similar disease management programs designed for patients with diabetes mellitus, congestive heart failure, or other chronic diseases. The lack of data that can be used to develop effective disease management programs in CKD makes it difficult to determine goals for the management of each organ system affected by CKD. Finally, long periods of observation will be needed to determine whether a particular disease management program is effective in not only improving patient outcomes, but also decreasing both resource use and health care dollars. This long-term observation period is contrary to how most disease management contracts are written, which usually are based on meeting goals during a 1- to 3-year period. Until these challenges are resolved, it likely will be difficult to maintain effective disease management programs for CKD.

Lung Cancer Workshop XI: Tobacco-Induced Disease: Advances in Policy, Early Detection and Management.

PubMed

Mulshine, James L; Avila, Rick; Yankelevitz, David; Baer, Thomas M; Estépar, Raul San Jose; Ambrose, Laurie Fenton; Aldigé, Carolyn R

2015-05-01

The Prevent Cancer Foundation Lung Cancer Workshop XI: Tobacco-Induced Disease: Advances in Policy, Early Detection and Management was held in New York, NY on May 16 and 17, 2014. The two goals of the Workshop were to define strategies to drive innovation in precompetitive quantitative research on the use of imaging to assess new therapies for management of early lung cancer and to discuss a process to implement a national program to provide high quality computed tomography imaging for lung cancer and other tobacco-induced disease. With the central importance of computed tomography imaging for both early detection and volumetric lung cancer assessment, strategic issues around the development of imaging and ensuring its quality are critical to ensure continued progress against this most lethal cancer.

Soil health paradigms and implications for disease management.

PubMed

Larkin, Robert P

2015-01-01

Soil health has been defined as the capacity of soil to function as a vital living system to sustain biological productivity, maintain environmental quality, and promote plant, animal, and human health. Building and maintaining soil health are essential to agricultural sustainability and ecosystem function. Management practices that promote soil health, including the use of crop rotations, cover crops and green manures, organic amendments, and conservation tillage, also have generally positive effects on the management of soilborne diseases through a number of potential mechanisms, including increasing soil microbial biomass, activity, and diversity, resulting in greater biological suppression of pathogens and diseases. However, there also may be particular disease issues associated with some soil health management practices. In this review, research and progress made over the past twenty years regarding soil health, sustainability, and soil health management practices, with an emphasis on their implications for and effects on plant disease and disease management strategies, are summarized.

New Directions in Chronic Disease Management.

PubMed

Kim, Hun Sung; Cho, Jae Hyoung; Yoon, Kun Ho

2015-06-01

A worldwide epidemic of chronic disease, and complications thereof, is underway, with no sign of abatement. Healthcare costs have increased tremendously, principally because of the need to treat chronic complications of non-communicable diseases including cardiovascular disease, blindness, end-stage renal disease, and amputation of extremities. Current healthcare systems fail to provide an appropriate quality of care to prevent the development of chronic complications without additional healthcare costs. A new paradigm for prevention and treatment of chronic disease and the complications thereof is urgently required. Several clinical studies have clearly shown that frequent communication between physicians and patients, based on electronic data transmission from medical devices, greatly assists in the management of chronic disease. However, for various reasons, these advantages have not translated effectively into real clinical practice. In the present review, we describe current relevant studies, and trends in the use of information technology for chronic disease management. We also discuss limitations and future directions.

Ecology and management of grapevine leafroll disease.

PubMed

Almeida, Rodrigo P P; Daane, Kent M; Bell, Vaughn A; Blaisdell, G Kai; Cooper, Monica L; Herrbach, Etienne; Pietersen, Gerhard

2013-01-01

Grapevine leafroll disease (GLD) is caused by a complex of vector-borne virus species in the family Closteroviridae. GLD is present in all grape-growing regions of the world, primarily affecting wine grape varieties. The disease has emerged in the last two decades as one of the major factors affecting grape fruit quality, leading to research efforts aimed at reducing its economic impact. Most research has focused on the pathogens themselves, such as improved detection protocols, with limited work directed toward disease ecology and the development of management practices. Here we discuss the ecology and management of GLD, focusing primarily on Grapevine leafroll-associated virus 3, the most important virus species within the complex. We contextualize research done on this system within an ecological framework that forms the backbone of the discussion regarding current and potential GLD management strategies. To reach this goal, we introduce various aspects of GLD biology and ecology, followed by disease management case studies from four different countries and continents (South Africa, New Zealand, California-USA, and France). We review ongoing regional efforts that serve as models for improved strategies to control this economically important and worldwide disease, highlighting scientific gaps that must be filled for the development of knowledge-based sustainable GLD management practices.

Ecology and management of grapevine leafroll disease

PubMed Central

Almeida, Rodrigo P. P.; Daane, Kent M.; Bell, Vaughn A.; Blaisdell, G. Kai; Cooper, Monica L.; Herrbach, Etienne; Pietersen, Gerhard

2013-01-01

Grapevine leafroll disease (GLD) is caused by a complex of vector-borne virus species in the family Closteroviridae. GLD is present in all grape-growing regions of the world, primarily affecting wine grape varieties. The disease has emerged in the last two decades as one of the major factors affecting grape fruit quality, leading to research efforts aimed at reducing its economic impact. Most research has focused on the pathogens themselves, such as improved detection protocols, with limited work directed toward disease ecology and the development of management practices. Here we discuss the ecology and management of GLD, focusing primarily on Grapevine leafroll-associated virus 3, the most important virus species within the complex. We contextualize research done on this system within an ecological framework that forms the backbone of the discussion regarding current and potential GLD management strategies. To reach this goal, we introduce various aspects of GLD biology and ecology, followed by disease management case studies from four different countries and continents (South Africa, New Zealand, California-USA, and France). We review ongoing regional efforts that serve as models for improved strategies to control this economically important and worldwide disease, highlighting scientific gaps that must be filled for the development of knowledge-based sustainable GLD management practices. PMID:23630520

Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial.

PubMed

Rice, Kathryn L; Dewan, Naresh; Bloomfield, Hanna E; Grill, Joseph; Schult, Tamara M; Nelson, David B; Kumari, Sarita; Thomas, Mel; Geist, Lois J; Beaner, Caroline; Caldwell, Michael; Niewoehner, Dennis E

2010-10-01

The effect of disease management for chronic obstructive pulmonary disease (COPD) is not well established. To determine whether a simplified disease management program reduces hospital admissions and emergency department (ED) visits due to COPD. We performed a randomized, adjudicator-blinded, controlled, 1-year trial at five Veterans Affairs medical centers of 743 patients with severe COPD and one or more of the following during the previous year: hospital admission or ED visit for COPD, chronic home oxygen use, or course of systemic corticosteroids for COPD. Control group patients received usual care. Intervention group patients received a single 1- to 1.5-hour education session, an action plan for self-treatment of exacerbations, and monthly follow-up calls from a case manager. We determined the combined number of COPD-related hospitalizations and ED visits per patient. Secondary outcomes included hospitalizations and ED visits for all causes, respiratory medication use, mortality, and change in Saint George's Respiratory Questionnaire. After 1 year, the mean cumulative frequency of COPD-related hospitalizations and ED visits was 0.82 per patient in usual care and 0.48 per patient in disease management (difference, 0.34; 95% confidence interval, 0.15-0.52; P < 0.001). Disease management reduced hospitalizations for cardiac or pulmonary conditions other than COPD by 49%, hospitalizations for all causes by 28%, and ED visits for all causes by 27% (P < 0.05 for all). A relatively simple disease management program reduced hospitalizations and ED visits for COPD. Clinical trial registered with www.clinicaltrials.gov (NCT00126776).

Harnessing collaborative technology to accelerate achievement of chronic disease management objectives for Canada.

PubMed

Thompson, Leslee J; Healey, Lindsay; Falk, Will

2007-01-01

Morgan and colleagues put forth a call to action for the transformation of the Canadian healthcare system through the adoption of a national chronic disease prevention and management (CDPM) strategy. They offer examples of best practices and national solutions including investment in clinical information technologies to help support improved care and outcomes. Although we acknowledge that the authors propose CDPM solutions that are headed in the right direction, more rapid deployment of solutions that harness the potential of advanced collaborative technologies is required. We provide examples of how technologies that exist today can help to accelerate the achievement of some key CDPM objectives.

Collaboration in national forest management

Treesearch

Susan Charnley; Jonathan W. Long; Frank K. Lake

2014-01-01

National forest management efforts have generally moved toward collaborative and participatory approaches at a variety of scales. This includes, at a larger scale, greater public participation in transparent and inclusive democratic processes and, at a smaller scale, more engagement with local communities. Participatory approaches are especially important for an all-...

Ecological and evolutionary approaches to managing honeybee disease.

PubMed

Brosi, Berry J; Delaplane, Keith S; Boots, Michael; de Roode, Jacobus C

2017-09-01

Honeybee declines are a serious threat to global agricultural security and productivity. Although multiple factors contribute to these declines, parasites are a key driver. Disease problems in honeybees have intensified in recent years, despite increasing attention to addressing them. Here we argue that we must focus on the principles of disease ecology and evolution to understand disease dynamics, assess the severity of disease threats, and control these threats via honeybee management. We cover the ecological context of honeybee disease, including both host and parasite factors driving current transmission dynamics, and then discuss evolutionary dynamics including how beekeeping management practices may drive selection for more virulent parasites. We then outline how ecological and evolutionary principles can guide disease mitigation in honeybees, including several practical management suggestions for addressing short- and long-term disease dynamics and consequences.

Management of Annosus Root Disease Caused by Heterobasidion annosum in Coniferous Trees in Yosemite National Park

Treesearch

Lorne West

1989-01-01

Trees affected by the annosus root disease are easily windthrown or fall without visible symptoms that might warn forest recreation managers of impending failure. Some of the treeshave struck cabins or campsites, causing death or destroying vehicles and recreational facilities. To prevent loss of life or property, and to save as many trees as possible for landscaping...

National Communicable Disease Surveillance System: A review on Information and Organizational Structures in Developed Countries.

PubMed

Bagherian, Hossein; Farahbakhsh, Mohammad; Rabiei, Reza; Moghaddasi, Hamid; Asadi, Farkhondeh

2017-12-01

To obtain necessary information for managing communicable diseases, different countries have developed national communicable diseases surveillance systems (NCDSS). Exploiting the lesson learned from the leading countries in development of surveillance systems provides the foundation for developing these systems in other countries. In this study, the information and organizational structure of NCDSS in developed countries were reviewed. The study reviewed publications found on the organizational structure, content and data flow of NCDSS in the United States of America (USA), Australia and Germany that were published in English between 2000 and 2016. The publications were identified by searching the CINAHL, Science Direct, ProQuest, PubMed, Google Scholar databases and the related databases in selected countries. Thirty-four studies were investigated. All of the reviewed countries have implemented the NCDSS. In majority of countries the department of health (DoH) is responsible for managing this system. The reviewed countries have created a minimum data set for reporting communicable diseases data and information. For developing NCDSS, establishing coordinator centers, setting the effective policies and procedures, providing appropriate communication infrastructures for data exchange and defining a communicable diseases minimum data set are essential.

BROOKHAVEN NATIONAL LABORATORY WILDLIFE MANAGEMENT PLAN.

DOE Office of Scientific and Technical Information (OSTI.GOV)

NAIDU,J.R.

2002-10-22

The purpose of the Wildlife Management Plan (WMP) is to promote stewardship of the natural resources found at the Brookhaven National Laboratory (BNL), and to integrate their protection with pursuit of the Laboratory's mission.

Time trends, improvements and national auditing of rectal cancer management over an 18-year period.

PubMed

Kodeda, K; Johansson, R; Zar, N; Birgisson, H; Dahlberg, M; Skullman, S; Lindmark, G; Glimelius, B; Påhlman, L; Martling, A

2015-09-01

The main aims were to explore time trends in the management and outcome of patients with rectal cancer in a national cohort and to evaluate the possible impact of national auditing on overall outcomes. A secondary aim was to provide population-based data for appraisal of external validity in selected patient series. Data from the Swedish ColoRectal Cancer Registry with virtually complete national coverage were utilized in this cohort study on 29 925 patients with rectal cancer diagnosed between 1995 and 2012. Of eligible patients, nine were excluded. During the study period, overall, relative and disease-free survival increased. Postoperative mortality after 30 and 90 days decreased to 1.7% and 2.9%. The 5-year local recurrence rate dropped to 5.0%. Resection margins improved, as did peri-operative blood loss despite more multivisceral resections being performed. Fewer patients underwent palliative resection and the proportion of non-operated patients increased. The proportions of temporary and permanent stoma formation increased. Preoperative radiotherapy and chemoradiotherapy became more common as did multidisciplinary team conferences. Variability in rectal cancer management between healthcare regions diminished over time when new aspects of patient care were audited. There have been substantial changes over time in the management of patients with rectal cancer, reflected in improved outcome. Much indirect evidence indicates that auditing matters, but without a control group it is not possible to draw firm conclusions regarding the possible impact of a quality control registry on faster shifts in time trends, decreased variability and improvements. Registry data were made available for reference. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

Achieving sustainable plant disease management through evolutionary principles.

PubMed

Zhan, Jiasui; Thrall, Peter H; Burdon, Jeremy J

2014-09-01

Plants and their pathogens are engaged in continuous evolutionary battles and sustainable disease management requires novel systems to create environments conducive for short-term and long-term disease control. In this opinion article, we argue that knowledge of the fundamental factors that drive host-pathogen coevolution in wild systems can provide new insights into disease development in agriculture. Such evolutionary principles can be used to guide the formulation of sustainable disease management strategies which can minimize disease epidemics while simultaneously reducing pressure on pathogens to evolve increased infectivity and aggressiveness. To ensure agricultural sustainability, disease management programs that reflect the dynamism of pathogen population structure are essential and evolutionary biologists should play an increasing role in their design. Copyright © 2014 Elsevier Ltd. All rights reserved.

Assessment and management of fracture risk in patients with Parkinson's disease.

PubMed

Lyell, Veronica; Henderson, Emily; Devine, Mark; Gregson, Celia

2015-01-01

Parkinson's disease (PD) is associated with substantially increased fracture risk, particularly hip fracture, which can occur relatively early in the course of PD. Despite this, current national clinical guidelines for PD fail to adequately address fracture risk assessment or the management of bone health. We appraise the evidence supporting bone health management in PD and propose a PD-specific algorithm for the fracture risk assessment and the management of bone health in patients with PD and related movement disorders. The algorithm considers (i) calcium and vitamin D replacement and maintenance, (ii) quantification of prior falls and fractures, (iii) calculation of 10-year major osteoporotic and hip fracture risks using Qfracture, (iv) application of fracture risk thresholds, which if fracture risk is high (v) prompts anti-resorptive treatment, with or without dual X-ray absorptiometry, and if low (vi) prompts re-assessment with FRAX and application of National Osteoporosis Guidelines Group (NOGG) guidance. A range of anti-resorptive agents are now available to treat osteoporosis; we review their use from the specific perspective of a clinician managing a patient population with PD. In conclusion, our current evidence base supports updating of guidelines globally concerning the management of PD, which presently fail to adequately address bone health. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Provision of care for chronic kidney disease by non-nephrologists in a developing nation: a national survey

PubMed Central

Al Shamsi, S; Al Dhanhani, A; Sheek-Hussein, M M

2016-01-01

Objectives The prevalence of chronic kidney disease (CKD) in developing countries has increased dramatically. This study aimed to explore the practice patterns of non-dialysis-dependent CKD care in an affluent developing country. Settings Primary and specialised healthcare facilities of public and private sectors in the United Arab Emirates. Participants 159 non-nephrologist physicians practising in the United Arab Emirates. Interventions A 28-item online self-administered questionnaire based on CKD clinical practice guidelines. Primary and secondary outcome measures The physicians' approach to identifying and managing patients with CKD. Results The survey was completed by 159 non-nephrologists, of whom 135 reported having treated patients with CKD. Almost all the respondents screen patients with hypertension and diabetes for CKD, but one-third of them do not screen patients with cardiovascular disease and elderly patients for CKD. The use of accurate CKD screening tests (estimated glomerular filtration rate and albumin/creatinine ratio) was suboptimal (77% and 59% of physicians used the procedures, respectively). One-third of the physicians do not offer treatment with inhibitors of the renin–angiotensin system to patients with CKD, and only 66% offer antilipid treatment. In general, the primary healthcare physicians are more familiar than secondary healthcare physicians with the diagnosis and management of patients with CKD. Conclusions We identified substantial physician-declared deficiencies in the practice of identifying and managing early CKD. Integration of quality CKD care within the healthcare system is required to face the increasing burden of CKD in the United Arab Emirates and possibly in other developing nations. PMID:27481619

Results From the 2014 National Wilderness Manager Survey

Treesearch

Ramesh Ghimire; Ken Cordell; Alan Watson; Chad Dawson; Gary T. Green

2015-01-01

A national survey of managers was developed to support interagency wilderness strategic planning. The focus was on major challenges, perceived needs for science and training, and accomplishments of 1995 Strategic Plan objectives. The survey was administered to managers at the four federal agencies with wilderness management responsibilities: the Bureau of Land...

National Security Management Correspondence Course.

ERIC Educational Resources Information Center

Industrial Coll. of the Armed Forces (DOD), Washington, DC.

A course of study on the fundamental aspects of the areas of knowledge which are essential to effective management of national security is presented. The course presents the substance of the Industrial College resident curriculum adapted to the correspondence method of study. The subject matter is designed to impart knowledge and understanding of…

78 FR 19523 - General Management Plan, Draft Environmental Impact Statement, Lake Meredith National Recreation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-01

... Management Plan, Draft Environmental Impact Statement, Lake Meredith National Recreation Area and Alibates... Management Plan, Lake Meredith National Recreation Area and Alibates Flint Quarries National Monument, Texas... management alternatives for Lake Meredith National Recreation Area and three management alternatives for...

77 FR 65374 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory... management in the areas of environmental restoration, waste management, and related activities. Tentative...

Distributed Cognition and Process Management Enabling Individualized Translational Research: The NIH Undiagnosed Diseases Program Experience

PubMed Central

Links, Amanda E.; Draper, David; Lee, Elizabeth; Guzman, Jessica; Valivullah, Zaheer; Maduro, Valerie; Lebedev, Vlad; Didenko, Maxim; Tomlin, Garrick; Brudno, Michael; Girdea, Marta; Dumitriu, Sergiu; Haendel, Melissa A.; Mungall, Christopher J.; Smedley, Damian; Hochheiser, Harry; Arnold, Andrew M.; Coessens, Bert; Verhoeven, Steven; Bone, William; Adams, David; Boerkoel, Cornelius F.; Gahl, William A.; Sincan, Murat

2016-01-01

The National Institutes of Health Undiagnosed Diseases Program (NIH UDP) applies translational research systematically to diagnose patients with undiagnosed diseases. The challenge is to implement an information system enabling scalable translational research. The authors hypothesized that similar complex problems are resolvable through process management and the distributed cognition of communities. The team, therefore, built the NIH UDP integrated collaboration system (UDPICS) to form virtual collaborative multidisciplinary research networks or communities. UDPICS supports these communities through integrated process management, ontology-based phenotyping, biospecimen management, cloud-based genomic analysis, and an electronic laboratory notebook. UDPICS provided a mechanism for efficient, transparent, and scalable translational research and thereby addressed many of the complex and diverse research and logistical problems of the NIH UDP. Full definition of the strengths and deficiencies of UDPICS will require formal qualitative and quantitative usability and process improvement measurement. PMID:27785453

Patient-appraised couple emotion management and disease management among Chinese American patients with type 2 diabetes.

PubMed

Fisher, Lawrence; Chesla, Catherine A; Chun, Kevin M; Skaff, Marilyn M; Mullan, Joseph T; Kanter, Richard A; Gardiner, Phillip S

2004-06-01

Family context exerts a strong influence on disease management among patients with chronic disease, but it is not clear which aspects of family life are most influential. This study examined the linkages between patient-appraised couple emotion management (conflict resolution, expressiveness, and respect) and disease management (biological, morale/depression, quality of life, and behavioral) among a relatively understudied group, Chinese American patients with type 2 diabetes. Significant main effects were found between patient-appraised couple emotion management, especially conflict resolution, and the morale component of disease management, but not the biological or behavioral components; both diabetes-specific and general relationship qualities (marital satisfaction) were independently linked to disease management. Acculturation did not qualify the findings. Similarities among ethnic groups in family and disease management relationships may be more common than differences.

National Airspace System interface management plan

DOT National Transportation Integrated Search

1986-01-01

This document is intended to implement Interface Management for interfacing subsystems of the National Airspace System (NAS) and for external NAS interfaces by establishing a process which assures that: Interface requirements are agreed to by interfa...

Disease management as a performance improvement strategy.

PubMed

McClatchey, S

2001-11-01

Disease management is a strategy of organizing care and services for a patient population across the continuum. It is characterized by a population database, interdisciplinary and interagency collaboration, and evidence-based clinical information. The effectiveness of a disease management program has been measured by a combination of clinical, financial, and quality of life outcomes. In early 1997, driven by a strategic planning process that established three Centers of Excellence (COE), we implemented disease management as the foundation for a new approach to performance improvement utilizing five key strategies. The five implementation strategies are outlined, in addition to a review of the key elements in outcome achievement.

Designing patient-centric applications for chronic disease management.

PubMed

Tsalatsanis, Athanasios; Gil-Herrera, Eleazar; Yalcin, Ali; Djulbegovic, Benjamin; Barnes, Laura

2011-01-01

Chronic diseases such as diabetes and heart disease are the leading causes of disability and death in the developed world. Technological interventions such as mobile applications have the ability to facilitate and motivate patients in chronic disease management, but these types of interventions present considerable design challenges. The primary objective of this paper is to present the challenges arising from the design and implementation of software applications aiming to assist patients in chronic disease management. We also outline preliminary results regarding a self-management application currently under development targeting young adults suffering from type 1 diabetes.

e_Disease Management. A system for the management of the chronic conditions.

PubMed

Guillén, Sergio; Meneu, Maria Teresa; Serafin, Riccardo; Arredondo, Maria Teresa; Castellano, Elena; Valdivieso, Bernardo

2010-01-01

Disease Management (DM) is a system of coordinated healthcare intervention and communications for populations with conditions in which patient self-care efforts are significant. e-DM makes reference to processes of DM based on clinical guidelines sustained in the scientific medical evidence and supported by the intervention of Information and Telecommunication Technology (ICT) in all levels where these plans are developed. This paper discusses the design and implementation of a e-DM system which meets the requirements for the integrated chronic disease management following the recommendations of the Disease Management Association and the American Heart Association.

Costs of chronic disease management for newly insured adults.

PubMed

Gilmer, Todd

2011-09-01

Healthcare reform will result in substantial numbers of newly insured, low-income adults with chronic conditions. This paper examines the costs of a chronic disease management program among newly insured adults with diabetes and/or hypertension. Low-income adults with diabetes and/or hypertension were provided County-sponsored health insurance coverage and access to disease management. Health econometric methods were used to compare costs among participants in disease management to nonparticipants, both overall and in comparison between those who were newly insured versus previously insured under an alternative County-sponsored insurance product. Costs were also compared between those who qualified for County-sponsored coverage due to diabetes versus hypertension. Annual inpatient costs were $1260 lower, and outpatient costs were $723 greater, among participants in disease management (P<0.001 each). Participants in disease management without previous County-sponsored coverage had higher pharmacy costs ($154, P=0.002) than nonparticipants; whereas participants with diabetes had marginally significant lower overall costs compared with nonparticipants ($-685, P=0.070). Disease management was successful in increasing the use of outpatient services among participants. The offsetting costs of the program suggest that disease management should be considered for some newly insured populations, especially for adults with diabetes.

How to measure the outcomes of chronic disease management.

PubMed

Lewis, Al

2009-02-01

The fastest-growing methodology for disease management outcomes measurement is valid, transparent, easy to apply, and freely available in the public domain and this article. It measures the actual goal of disease management, which is to reduce the rate of adverse events associated with the disease(s) being managed. Changes in this rate can be translated into a return on investment using some explicit assumptions about comorbidities and episode costs. Outcomes measured in this way show that in the health plan community as a whole, disease management in the broadest sense is working, as measured by the relative stability in the rate of adverse medical events closely associated with common chronic disease during this decade of increasing prevalence of most of the common chronic conditions.

Nursing contributions to chronic disease management in primary care.

PubMed

Lukewich, Julia; Edge, Dana S; VanDenKerkhof, Elizabeth; Tranmer, Joan

2014-02-01

As the prevalence of chronic diseases continues to increase, emphasis is being placed on the development of primary care strategies that enhance healthcare delivery. Innovations include interprofessional healthcare teams and chronic disease management strategies. To determine the roles of nurses working in primary care settings in Ontario and the extent to which chronic disease management strategies have been implemented. We conducted a cross-sectional survey of a random sample of primary care nurses, including registered practical nurses, registered nurses, and nurse practitioners, in Ontario between May and July 2011. Nurses in primary care reported engaging in chronic disease management activities but to different extents depending on their regulatory designation (licensure category). Chronic disease management strategy implementation was not uniform across primary care practices where the nurses worked. There is the potential to optimize and standardize the nursing role within primary care and improve the implementation of chronic disease management strategies.

The interdisciplinary approach to the implementation of a diabetes home care disease management program.

PubMed

Rosa, Mary Ann; Lapides, Shawn; Hayden, Corrine; Santangelo, Roxanne

2014-02-01

Diabetes is a national epidemic and a leading cause of hospitalizations in the United States. Home care agencies need to be able to provide effective Diabetes Disease Management to help prevent avoidable hospitalizations and assist patients to live a good quality of life. This article describes one organization's journey toward providing patients with better diabetes care resulting in an improved quality of life.

76 FR 39080 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory... recommendations to DOE-EM and site management in the areas of environmental restoration, waste management, and...

Values, Ethics, and Attitudes Toward National Forest Management: An Empirical Study

Treesearch

Robert Manning; William Valliere; Ben Minteer

1999-01-01

This study measures environmental values and ethics and explores their relationships to attitudes toward national forest management. The principal research methods were literature review and a survey of Vermont residents concerning management of the Green Mountain National Forest. Descriptive findings suggest respondents (1) favor nonmaterial values of national forests...

Acid suppressants for managing gastro-oesophageal reflux and gastro-oesophageal reflux disease in infants: a national survey.

PubMed

Bell, Jane C; Schneuer, Francisco J; Harrison, Christopher; Trevena, Lyndal; Hiscock, Harriet; Elshaug, Adam G; Nassar, Natasha

2018-02-22

To evaluate the diagnosis and management of reflux and gastro-oesophageal reflux disease (GORD) in infants aged <1 year presenting to general practitioners (GPs). A nationally representative, prospective, cross-sectional survey of GP activity in Australia, 2006-2016 (Bettering the Evaluation And Care of Health Study). Annually, a random sample of around 1000 GPs recorded details for 100 consecutive visits with consenting, unidentified patients. Diagnoses of reflux and GORD and their management including prescribing of acid-suppressant medicines (proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs)) and counselling, advice or education. Of all infants' visits, 512 (2.7%) included a diagnosis of reflux (n=413, 2.2%) or GORD (n=99, 0.5%). From 2006 to 2016, diagnostic rates decreased for reflux and increased for GORD. Prescribing of acid suppressants occurred in 43.6% visits for reflux and 48.5% visits for GORD, similar to rates of counselling, advice or education (reflux: 38.5%, GORD: 43.4% of visits). Prescribing of PPIs increased (statistically significant only for visits for reflux), while prescribing of H2RAs decreased. Overprescribing of acid suppressants to infants may be occurring. In infants, acid-suppressant medicines are no better than placebo and may have significant negative side effects; however, guidelines are inconsistent. Clear, concise and consistent guidance is needed. GPs and parents need to understand what is normal and limitations of medical therapy. We need a greater understanding of the influences on GP prescribing practices, of parents' knowledge and attitudes and of the pressures on parents of infants with these conditions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Asthma disease management: a provider's perspective.

PubMed

Abisheganaden, J

2002-07-01

Asthma is a highly prevalent problem in Singapore, with an increasing societal and economic burden. However, asthma is also an eminently treatable condition, with evidence that integrated education-treatment efforts directed at important patient sub-groups can be cost-effective. What is important is a comprehensive and integrated asthma management programme, aimed at reducing the burden of asthma at all levels of the healthcare system, with the long-term goal of improving asthma care cost-effectively. This refers to asthma disease management. Asthma disease management should focus on identifying deficiencies in asthma management across the population diagnosed with the condition and establish a partnership between the patient, provider and the healthcare system to improve the overall quality of asthma care. The framework for implementing such a programme bridges key concepts and programmes that are already in place in the various institutions. These include patient and physician education, the use of clinical practice guidelines, clinical pathways, outcomes management, quality improvement processes, information technology, case management and existing asthma shared-care programmes and resources. In order to significantly reduce asthma morbidity, an integrated approach is required, involving individuals providing asthma care at various levels of care delivery. There is also a need to co-ordinate the efforts of such individuals and institutions involved so that there is good horizontal and vertical integration of care. The disease management approach described is intended to raise the overall standard of asthma care across a spectrum of patients with asthma.

Challenges in Building Disease-Based National Health Accounts

PubMed Central

Rosen, Allison B.; Cutler, David M.

2012-01-01

Background Measuring spending on diseases is critical to assessing the value of medical care. Objective To review the current state of cost of illness (COI) estimation methods, identifying their strengths, limitations and uses. We briefly describe the current National Health Expenditure Accounts (NHEA), and then go on to discuss the addition of COI estimation to the NHEA. Conclusion Recommendations are made for future research aimed at identifying the best methods for developing and using disease-based national health accounts to optimize the information available to policymakers as they struggle with difficult resource allocation decisions. PMID:19536017

Ecological and evolutionary approaches to managing honey bee disease

PubMed Central

Brosi, Berry J.; Delaplane, Keith S.; Boots, Michael; de Roode, Jacobus C.

2017-01-01

Honey bee declines are a serious threat to global agricultural security and productivity. While multiple factors contribute to these declines, parasites are a key driver. Disease problems in honey bees have intensified in recent years, despite increasing attention to addressing them. Here we argue that we must focus on the principles of disease ecology and evolution to understand disease dynamics, assess the severity of disease threats, and manage these threats via honey bee management. We cover the ecological context of honey bee disease, including both host and parasite factors driving current transmission dynamics, and then discuss evolutionary dynamics including how beekeeping management practices may drive selection for more virulent parasites. We then outline how ecological and evolutionary principles can guide disease mitigation in honey bees, including several practical management suggestions for addressing short- and long-term disease dynamics and consequences. PMID:29046562

Management of ticks and tick-borne diseases

USGS Publications Warehouse

Ginsberg, H.S.; Stafford, K.C.; Goodman, J.L.; Dennis, D.T.; Sonenshine, D .E.

2005-01-01

The mainstays of tick management and protection from tick-borne diseases have traditionally been personal precautions and the application of acaricides. These techniques maintain their value, and current innovations hold considerable promise for future improvement in effective targeting of materials for tick control. Furthermore, an explosion of research in the past few decades has resulted in the development and expansion of several novel and potentially valuable approaches to tick control, including vaccination against tick-borne pathogen transmission and against tick attachment, host management, use of natural enemies (especially entomopathogenic fungi), and pheromone-based techniques. The situations that require tick management are diverse, and occur under varied ecological conditions. Therefore, the likelihood of finding a single ?magic bullet? for tick management is low. In practical terms, the approach to tick management or to management of tick-borne disease must be tailored to the specific conditions at hand. One area that needs increased attention is the decision-making process in applying IPM to tick control. Further development of novel tick control measures, and increased efficiency in their integration and application to achieve desired goals, holds great promise for effective future management of ticks and tick-borne diseases.

Online Health Communities and Chronic Disease Self-Management.

PubMed

Willis, Erin; Royne, Marla B

2017-03-01

This research uses content analysis (N = 1,960) to examine the computer-mediated communication within online health communities for evidence of chronic disease self-management behaviors, including the perceived benefits and perceived barriers to participating in such behaviors. Online health communities act as informal self-management programs led by peers with the same chronic disease through the exchange of health information. Online health communities provide opportunities for health behavior change messages to educate and persuade regarding chronic disease self-management behaviors.

Understanding the economics of succeeding in disease management.

PubMed

Shulkin, D J

1999-04-01

If implemented with the proper resource commitment, disease management can have a significant effect on the health of an organization's patient population. However, it is unlikely that even the noblest of strategic initiatives will survive long without a compelling business imperative. After analyzing the business case, many organizations have committed large amounts of resources to building disease management programs. Yet these issues are still being formulated. The author discusses five issues that are key to understanding the economics of disease management.

Fistulizing Crohn's disease: Diagnosis and management.

PubMed

Gecse, Krisztina; Khanna, Reena; Stoker, Jaap; Jenkins, John T; Gabe, Simon; Hahnloser, Dieter; D'Haens, Geert

2013-06-01

Fistulizing Crohn's disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn's disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery.

77 FR 66519 - National Alzheimer's Disease Awareness Month, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-06

... National Alzheimer's Disease Awareness Month, 2012 By the President of the United States of America A Proclamation Every day, families across our country confront the tragic realities of Alzheimer's disease--an.... As the number of older Americans grows in the coming years, Alzheimer's disease will continue to pose...

78 FR 23219 - National Advisory Committee for Implementation of the National Forest System Land Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-18

... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... Federal Advisory Committee Act. The purpose of the committee is to provide advice and recommendations on...

76 FR 81911 - National Advisory Committee for Implementation of the National Forest System Land Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-29

... National Forest System Land Management Planning Rule AGENCY: USDA Forest Service. ACTION: Notice of intent... intends to establish the National Advisory Committee for Implementation of the National Forest System Land... (FACA), the Committee is being established to provide advice and recommendations on the implementation...

78 FR 9883 - National Advisory Committee for Implementation of the National Forest System Land Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... Advisory Committee Act. The purpose of the committee is to provide advice and recommendations on the...

Primary Care Physicians' Experience with Disease Management Programs

PubMed Central

Fernandez, Alicia; Grumbach, Kevin; Vranizan, Karen; Osmond, Dennis H; Bindman, Andrew B

2001-01-01

OBJECTIVE To examine primary care physicians' perceptions of how disease management programs affect their practices, their relationships with their patients, and overall patient care. DESIGN Cross-sectional mailed survey. SETTING The 13 largest urban counties in California. PARTICIPANTS General internists, general pediatricians, and family physicians. MEASUREMENTS AND MAIN RESULTS Physicians' self-report of the effects of disease management programs on quality of patient care and their own practices. Respondents included 538 (76%) of 708 physicians: 183 (34%) internists, 199 (38%) family practitioners, and 156 (29%) pediatricians. Disease management programs were available 285 to (53%) physicians; 178 had direct experience with the programs. Three quarters of the 178 physicians believed that disease management programs increased the overall quality of patient care and the quality of care for the targeted disease. Eighty-seven percent continued to provide primary care for their patients in these programs, and 70% reported participating in major patient care decisions. Ninety-one percent reported that the programs had no effect on their income, decreased (38%) or had no effect (48%) on their workload, and increased (48%)) their practice satisfaction. CONCLUSIONS Practicing primary care physicians have generally favorable perceptions of the effect of voluntary, primary care-inclusive, disease management programs on their patients and on their own practice satisfaction. PMID:11318911

Idaho National Laboratory Cultural Resource Management Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Julie Braun Williams

As a federal agency, the U.S. Department of Energy has been directed by Congress, the U.S. president, and the American public to provide leadership in the preservation of prehistoric, historic, and other cultural resources on the lands it administers. This mandate to preserve cultural resources in a spirit of stewardship for the future is outlined in various federal preservation laws, regulations, and guidelines such as the National Historic Preservation Act, the Archaeological Resources Protection Act, and the National Environmental Policy Act. The purpose of this Cultural Resource Management Plan is to describe how the Department of Energy, Idaho Operations Officemore » will meet these responsibilities at Idaho National Laboratory in southeastern Idaho. The Idaho National Laboratory is home to a wide variety of important cultural resources representing at least 13,500 years of human occupation in the southeastern Idaho area. These resources are nonrenewable, bear valuable physical and intangible legacies, and yield important information about the past, present, and perhaps the future. There are special challenges associated with balancing the preservation of these sites with the management and ongoing operation of an active scientific laboratory. The Department of Energy, Idaho Operations Office is committed to a cultural resource management program that accepts these challenges in a manner reflecting both the spirit and intent of the legislative mandates. This document is designed for multiple uses and is intended to be flexible and responsive to future changes in law or mission. Document flexibility and responsiveness will be assured through regular reviews and as-needed updates. Document content includes summaries of Laboratory cultural resource philosophy and overall Department of Energy policy; brief contextual overviews of Laboratory missions, environment, and cultural history; and an overview of cultural resource management practices. A series of

76 FR 11501 - National Institute of Diabetes and Digestive and Kidney Diseases

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-02

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Diabetes and Digestive and Kidney Diseases Special Emphasis...

National information network and database system of hazardous waste management in China

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ma Hongchang

1996-12-31

Industries in China generate large volumes of hazardous waste, which makes it essential for the nation to pay more attention to hazardous waste management. National laws and regulations, waste surveys, and manifest tracking and permission systems have been initiated. Some centralized hazardous waste disposal facilities are under construction. China`s National Environmental Protection Agency (NEPA) has also obtained valuable information on hazardous waste management from developed countries. To effectively share this information with local environmental protection bureaus, NEPA developed a national information network and database system for hazardous waste management. This information network will have such functions as information collection, inquiry,more » and connection. The long-term objective is to establish and develop a national and local hazardous waste management information network. This network will significantly help decision makers and researchers because it will be easy to obtain information (e.g., experiences of developed countries in hazardous waste management) to enhance hazardous waste management in China. The information network consists of five parts: technology consulting, import-export management, regulation inquiry, waste survey, and literature inquiry.« less

Case management and adherence to an online disease management system.

PubMed

Robertson, Lucy; Smith, Michael; Tannenbaum, Dennis

2005-01-01

Non-adherence to treatment presents a significant obstacle to achieving favourable health outcomes. We have studied consumers' adherence to an online disease management system for depression, called Recovery Road. Recovery Road was implemented on a pilot basis for mental health care in Western Australia. Recovery Road was available for use by consumers and clinicians to augment usual treatment. One hundred and thirty consumers who had been diagnosed with major depression were enrolled. Consumers who used Recovery Road (n = 98) were provided with education, progress monitoring, e-consultation, e-diary and online evidenced-based therapy. Consumers received either standard, automated adherence reminders by email (n = 69), or case management, which included personalized email and telephone follow-up in response to non-adherence (n = 29). After the first eight sessions, the adherence was 84% in the case management group and 55% in the automatic reminders group. The results suggest that case management increases adherence to online disease management systems.

[Application of "disease management" to the organization and compensation of professionals in the U.S.A., Germany and England: prospects for France].

PubMed

Morin, Ludovic; Christian, Foury; Briot, Pascal; Perrocheau, Antonin; Pascal, Jean

2010-01-01

Disease management, developed in the U.S.A. in the 1990s, is a comprehensive integrated approach that aims to incorporate all phases of chronic disease management from prevention to health education. Its main objective is to optimize patient care services by making patients more responsible for the management of their chronic disease. The specificity of its implementation in different countries is reflected by its translation into various concepts, such as: in the United States by the concept of the "Medical Home", in Germany by establishing contracts that encourage GPs and social security funds to support patients with chronic diseases, and in the United Kingdom through programs with measures that support the delegation of tasks and cooperation between primary care professionals. Disease management is accompanied by the introduction of new forms of payment for doctors and primary care facilities that ensure the effective implementation of the underpinning principles of disease management programs. In France, the development of the disease management approach is being promoted and advocated for integration into primary care, as it is gradually becoming an integral part of the French National Health Insurance Fund's strategy to enhance and improve the quality of care.

Nontimber forest products management on national forests in the United States.

Treesearch

Rebecca J. McLain; Eric T. Jones

2005-01-01

This study provides an overview of nontimber forest products (NTFP) programs on national forests in the United States. We conducted an email survey in 2003 to obtain data on NTFP management activities on national forests across the country. Program characteristics examined in the study included important NTFPs managed on national forests, presence of NTFP coordinators...

78 FR 68811 - National Advisory Committee for Implementation of the National Forest System Land Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-15

... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... (FACA) (Pub. L. 92-463). The purpose of the Committee is to provide advice and recommendations on the...

78 FR 46565 - National Advisory Committee for Implementation of the National Forest System Land Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-01

... National Forest System Land Management Planning Rule AGENCY: Forest Service, USDA. ACTION: Notice of meeting. SUMMARY: The National Advisory Committee for Implementation of the National Forest System Land... Committee Act (FACA) (Pub. L. 92-463). The purpose of the Committee is to provide advice and recommendations...

An architecture model for multiple disease management information systems.

PubMed

Chen, Lichin; Yu, Hui-Chu; Li, Hao-Chun; Wang, Yi-Van; Chen, Huang-Jen; Wang, I-Ching; Wang, Chiou-Shiang; Peng, Hui-Yu; Hsu, Yu-Ling; Chen, Chi-Huang; Chuang, Lee-Ming; Lee, Hung-Chang; Chung, Yufang; Lai, Feipei

2013-04-01

Disease management is a program which attempts to overcome the fragmentation of healthcare system and improve the quality of care. Many studies have proven the effectiveness of disease management. However, the case managers were spending the majority of time in documentation, coordinating the members of the care team. They need a tool to support them with daily practice and optimizing the inefficient workflow. Several discussions have indicated that information technology plays an important role in the era of disease management. Whereas applications have been developed, it is inefficient to develop information system for each disease management program individually. The aim of this research is to support the work of disease management, reform the inefficient workflow, and propose an architecture model that enhance on the reusability and time saving of information system development. The proposed architecture model had been successfully implemented into two disease management information system, and the result was evaluated through reusability analysis, time consumed analysis, pre- and post-implement workflow analysis, and user questionnaire survey. The reusability of the proposed model was high, less than half of the time was consumed, and the workflow had been improved. The overall user aspect is positive. The supportiveness during daily workflow is high. The system empowers the case managers with better information and leads to better decision making.

Integrating palliative care into disease management guidelines.

PubMed

Emanuel, Linda; Alexander, Carla; Arnold, Robert M; Bernstein, Richard; Dart, Richard; Dellasantina, Christopher; Dykstra, Lee; Tulsky, James

2004-12-01

Palliative care should not be reserved for those who are close to dying; as a comprehensive approach to minimizing illness-related suffering, it is appropriate for patients with significant illness from the time of diagnosis on. The American Hospice Foundation Guidelines Committee's initiative aims to provide a practical approach for guideline writers and others to integrate palliative care into disease management and care services whenever it is relevant. A consensus approach was used to design recommendations for upgrading existing disease management and service guidelines to include palliative care. A template is described for identifying stages in disease management guidelines when integration of palliative care is appropriate: (1) Introductory sections to disease management guidelines should include prognosis and other disease consequences; (2) Diagnostic sections should include recommendations for conducting a whole patient assessment; (3) Treatment sections should include discernment of patient goals for care, continuous goal reassessment, palliative care interventions to reduce suffering as needed, and treatment decisions should include discussion of the type of expected improvement. Service guidelines should note the role of interdisciplinary team care as well as palliative care consultative or care services; (4) Sections that conclude the care provided to incurable patients should not end without recommendations on grief and bereavement care, and care during the last hours of living. The American Hospice Foundation Guidelines Committee recommends integration of relevant aspects of palliative care in introductory, diagnostic, treatment, and closing sections of management guidelines for all significant illnesses.

Key outcomes from stakeholder workshops at a symposium to inform the development of an Australian national plan for rare diseases.

PubMed

Molster, Caron; Youngs, Leanne; Hammond, Emma; Dawkins, Hugh

2012-08-10

Calls have been made for governments to adopt a cohesive approach to rare diseases through the development of national plans. At present, Australia does not have a national plan for rare diseases. To progress such a plan an inaugural Australian Rare Diseases Symposium was held in Western Australia in April 2011. This paper describes the key issues identified by symposium attendees for the development of a national plan, compares these to the content of EUROPLAN and national plans elsewhere and discusses how the outcomes might be integrated for national planning. The symposium was comprised of a series of plenary sessions followed by workshops. The topics covered were; 1) Development of national plans for rare diseases; 2) Patient empowerment; 3) Patient care, support and management; 4) Research and translation; 5) Networks, partnerships and collaboration. All stakeholders within the rare diseases community were invited to participate, including: people affected by rare diseases such as patients, carers, and families; clinicians and allied health practitioners; social and disability services; researchers; patient support groups; industry (e.g. pharmaceutical, biotechnology and medical device companies); regulators and policy-makers. All of these stakeholder groups were represented at the symposium. Workshop participants indicated the need for a national plan, a national peak body, a standard definition of 'rare diseases', education campaigns, lobbying of government, research infrastructure, streamlined whole-of-lifetime service provision, case co-ordination, early diagnosis, support for health professionals and dedicated funding. These findings are consistent with frameworks and initiatives being undertaken internationally (such as EUROPLAN), and with national plans in other countries. This implies that the development of an Australian national plan could plausibly draw on frameworks for plan development that have been proposed for use in other jurisdictions. The

[Toward a new model of pharmacy management comprehensive care of patients with chronic kidney disease].

PubMed

Muros-Ortega, M; Ramos, R; Molina, M

2014-07-01

The treatment of chronic kidney disease represents 2.5% of the National Healthcare System budget. Given the panorama of economic crisis, actions aimed at containing the costs in this kind of pathologies should be implemented. Centralization of the management of the medications used for the treatment of chronic kidney disease and its complications aims at reducing the pharmaceutical expenditure. The new contracts of public healthcare administrations with companies of dialysis centers establish a single price by which the contractor takes care of the integral management of the patients, including the dialysis therapy and pharmacological treatment. Drug management at dialysis centers will be handled by specialized pharmacists by means of the creation of pharmacy departments or drug warehouse. these measures aim at improving healthcare of the patient in hemodialysis program, with health benefits at a lower healthcare cost. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Opportunities for improving management of advanced chronic kidney disease.

PubMed

Patwardhan, Meenal B; Matchar, David B; Samsa, Gregory P; Haley, William E

2008-01-01

Evidence suggests that management of advanced chronic kidney disease affects patient outcomes. To identify clinical areas that demand attention from a quality improvement perspective, we sought to examine the extent of conformance to an advanced chronic kidney disease guideline in a range of practices. A total of 237 patient medical records were abstracted from 4 primary care providers and 4 nephrology private practices across the country. In the practices studied, management of advanced chronic kidney disease patients was suboptimal for patients managed by primary care providers as well as those managed by nephrologists (overall conformance 27% and 42%, respectively), specifically for anemia, bone disease, and timing for renal replacement therapy. The current exercise (in conjunction with a literature search and focused and individual interviews with providers and patients) offered valuable information that was used to develop a toolkit for optimizing management of advanced chronic kidney disease.

Toward a national health risk management approach in Australia.

PubMed

O'Donnell, Carol

2002-01-01

There has been increasing international consensus about the importance of competition for achieving national growth and community well-being. The Australian government accordingly has introduced policies to promote such competition. Major legislative review and many public inquiries have assisted implementation of national competition policy and the development of national goals and standards related to international agreements to promote health and sustainable development. Since the 1980s, Australia has had legislation that requires the identification and control of health risks arising at work. The management structures necessary for coordinated delivery of national programs designed for effective identification and control of health risks arising in communities to achieve national health and development goals are still being developed, however. Major difficulties related to this development are discussed. National health development programs should be approached primarily through establishment of regional partnerships between bodies responsible for managing community health, local government, and employment placement, in consultation with other relevant organizations and the community. Related research and evaluation programs are required.

Addison disease - diagnosis and initial management.

PubMed

O'Connell, Susan; Siafarikas, Aris

2010-11-01

Adrenal insufficiency is a rare disease caused by either primary adrenal failure (Addison disease) or by impairment of the hypothalamic-pituitary-adrenal axis. Steroid replacement therapy normalises quality of life, however, adherence can be problematic. This article provides information on adrenal insufficiency focusing on awareness of initial symptoms and on risk scenarios, emergency management and baseline investigations, complete investigations and long term management. Early recognition of adrenal insufficiency is essential to avoid associated morbidity and mortality. Initial diagnosis and decision to treat are based on history and physical examination. Appropriate management includes emergency resuscitation and steroid administration. Initial investigations can include sodium, potassium and blood glucose levels. However, complete investigations can be deferred. Specialist advice should be obtained and long term management includes a Team Care Arrangement. For patients, an emergency plan and emergency identification are essential.

Marketing a national forest: the resource manager's dilemma

Treesearch

Howard A. Clonts; Jeffrey R. Hibbert

1995-01-01

National Forests throughout the United States are facing critical management decisions regarding optimal resource use amidst strong countervailing pressures for access. Visitors to Talladega National Forest in Alabama were surveyed to develop appropriate marketing strategies. Cluster analysis showed that separate homogeneous user groups exist. This information was...

Alzheimer's disease research in the context of the national plan to address Alzheimer's disease.

PubMed

Snyder, Heather M; Hendrix, James; Bain, Lisa J; Carrillo, Maria C

2015-01-01

In 2012, the first National Plan to Address Alzheimer's Disease in the United States (U.S.) was released, a component of the National Alzheimer's Project Act legislation. Since that time, there have been incremental increases in U.S. federal funding for Alzheimer's disease and related dementia research, particularly in the areas of biomarker discovery, genetic link and related biological underpinnings, and prevention studies for Alzheimer's. A central theme in each of these areas has been the emphasis of cross-sector collaboration and private-public partnerships between government, non-profit organizations and for-profit organizations. This paper will highlight multiple private-public partnerships supporting the advancement of Alzheimer's research in the context of the National Plan to Address Alzheimer's. Copyright © 2015 Elsevier Ltd. All rights reserved.

Activating patients with chronic disease for self-management: comparison of self-managing patients with those managing by frequent readmissions to hospital.

PubMed

Kirby, Sue E; Dennis, Sarah M; Bazeley, Pat; Harris, Mark F

2013-01-01

Understanding the factors that activate people to self-manage chronic disease is important in improving uptake levels. If the many frequent hospital users who present with acute exacerbations of chronic disease were to self-manage at home, some hospital admissions would be avoided. Patient interview and demographic, psychological, clinical and service utilisation data were compared for two groups of patients with chronic disease: those attending self-management services and those who managed by using hospital services. Data were analysed to see whether there were differences that might explain the two different approaches to managing their conditions. The two groups were similar in terms of comorbidity, age, sex, home services, home support and educational level. Self-managing patients were activated by their clinician, accepted their disease, changed their identity, confronted emotions and learnt the skills to self-manage and avoid hospital. Patients who frequently used hospital services to manage their chronic disease were often in denial about their chronic disease, hung on to their identity and expressed little emotional response. However, they reported a stronger sense of coherence and rated their health more highly than self-managing patients. This study shed light on the process of patient activation for self-management. A better understanding of the process of patient activation would encourage clinicians who come into contact with frequently readmitted chronic disease patients to be more proactive in supporting self-management.

Using structured decision making to manage disease risk for Montana wildlife

USGS Publications Warehouse

Mitchell, Michael S.; Gude, Justin A.; Anderson, Neil J.; Ramsey, Jennifer M.; Thompson, Michael J.; Sullivan, Mark G.; Edwards, Victoria L.; Gower, Claire N.; Cochrane, Jean Fitts; Irwin, Elise R.; Walshe, Terry

2013-01-01

We used structured decision-making to develop a 2-part framework to assist managers in the proactive management of disease outbreaks in Montana, USA. The first part of the framework is a model to estimate the probability of disease outbreak given field observations available to managers. The second part of the framework is decision analysis that evaluates likely outcomes of management alternatives based on the estimated probability of disease outbreak, and applies managers' values for different objectives to indicate a preferred management strategy. We used pneumonia in bighorn sheep (Ovis canadensis) as a case study for our approach, applying it to 2 populations in Montana that differed in their likelihood of a pneumonia outbreak. The framework provided credible predictions of both probability of disease outbreaks, as well as biological and monetary consequences of management actions. The structured decision-making approach to this problem was valuable for defining the challenges of disease management in a decentralized agency where decisions are generally made at the local level in cooperation with stakeholders. Our approach provides local managers with the ability to tailor management planning for disease outbreaks to local conditions. Further work is needed to refine our disease risk models and decision analysis, including robust prediction of disease outbreaks and improved assessment of management alternatives.

Report from the National Institute of Allergy and Infectious Disease Workshop on Drug Allergy

PubMed Central

Wheatley, Lisa M; Plaut, Marshall; Schwaninger, Julie M; Banerji, Aleena; Castells, Mariana; Finkelman, Fred D.; Gleich, Gerald J.; Guttman-Yassky, Emma; Mallal, Simon A.K.; Naisbitt, Dean J.; Ostrov, David A.; Phillips, Elizabeth J.; Pichler, Werner J.; Platts-Mills, Thomas A. E.; Roujeau, Jean-Claude; Schwartz, Lawrence B.; Trepanier, Lauren A.

2015-01-01

Allergic reactions to drugs are a serious public health concern. In 2013, the National Institute of Allergy and Infectious Diseases, Division of Allergy, Immunology and Transplantation, sponsored a workshop on drug allergy. International experts in the field of drug allergy with backgrounds in allergy, immunology, infectious diseases, dermatology, clinical pharmacology and pharmacogenomics discussed the current state of drug allergy research. These experts were joined by representatives from several NIH Institutes and the U.S. Food and Drug Administration (FDA). The participants identified important advances that make new research directions feasible and made suggestions for research priorities and for development of infrastructure to advance our knowledge of the mechanisms, diagnosis, management, and prevention of drug allergy. The workshop summary and recommendations are presented herein. PMID:26254053

A family medicine training program in the Republic of Georgia: incorporating a model of chronic disease management.

PubMed

Sanders, James

2007-01-01

This study describes a different approach to increase the number of family medicine physicians trained with specific competencies in the management of chronic disease. In 1999 the Republic of Georgia initiated an ambitious program designed to retrain practicing physicians in the specialty of family medicine. At 2 of the implementation sites, the Center for International Health worked with local health authorities to augment the official 940-hour curriculum to include lesson plans, workshops, and practicum experiences emphasizing a model of chronic disease management, giving particular attention to hypertension. The population served by the training sites has benefited in a cost-effective manner by achieving blood pressure control for as little as $8 per year per patient; the physician learners have performed above their peer group on standardized national testing. Family medicine training programs in resource-poor settings can incorporate chronic disease management models into their curriculum and achieve high-quality patient care outcomes.

Integrating Patient Concerns into Parkinson's Disease Management.

PubMed

Lim, Shen-Yang; Tan, Ai Huey; Fox, Susan H; Evans, Andrew H; Low, Soon Chai

2017-01-01

Parkinson's disease (PD) is a complex motor and non-motor disorder and management is often challenging. In this review, we explore emerging approaches to improve the care of patients, drawing from the literature regarding patient-centred care, patient and caregiver perspectives and priorities, gaps in knowledge among patients and caregivers and the need for accurate information, individual variability in disease manifestations, prognostication of disease course, new developments in health technologies and personalized medicine, specialty care, pharmacological and non-pharmacological management, financial burden, lifestyle and work-related issues, support groups and palliative care.

Case Study of American Healthways' Diabetes Disease Management Program

PubMed Central

Pope, James E.; Hudson, Laurel R.; Orr, Patty M.

2005-01-01

Disease management has been defined as a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant (Disease Management Association of America, 2005). The purpose of this article is to provide an overview of the diabetes disease management program offered by American Healthways (AMHC) and highlight recently reported results of this program (Villagra, 2004a; Espinet et al., 2005). PMID:17288077

Long-term disease management of patients with coronary disease by cardiac rehabilitation program staff.

PubMed

Squires, Ray W; Montero-Gomez, Aura; Allison, Thomas G; Thomas, Randal J

2008-01-01

Randomized-clinical trials have demonstrated the benefits of disease management for patients with coronary disease. It is not known if long-term disease management in routine clinical practice provided by cardiac rehabilitation (CR) program staff is possible. The goal of this study was to evaluate the feasibility and clinical benefits of a 3-year disease-management program in the setting of an outpatient CR facility. Consecutive patients (n = 503) referred to CR and who were available for long-term follow-up served as subjects. After a phase II CR program, disease managers assessed secondary-prevention goals every 3 to 6 months via face-to-face meetings with each patient. Outcome measures included use of cardioprotective medications, coronary risk factors, amount of habitual exercise training, and all-cause mortality. At 3 years, aspirin usage was 91%, statin usage 91%, beta-blocker usage 78%, and angiotensin-converting enzyme inhibitor usage 76%. Low-density lipoprotein cholesterol was 90 +/- 23 mg/dL, systolic blood pressure was 126 +/- 19 mm Hg, and body mass index was 29.0 +/- 5.1 kg/m2. Exercise training averaged 139 +/- 123 minutes per week. Annual mortality was 1.9%. There were no differences (P > .05) in medication usage or low-density lipoprotein cholesterol for men versus women, or for age below 65 years versus age 65 years or greater. Long-term disease management of patients with coronary disease in routine clinical practice by CR program staff is feasible and effective in achieving and maintaining secondary-prevention goals. Overweight remains a prevalent and persistent risk factor. We advocate expansion of CR programs into long-term coronary disease-management programs.

[Chronic non-communicable diseases in Brazil: priorities for disease management and research].

PubMed

Duncan, Bruce Bartholow; Chor, Dóra; Aquino, Estela M L; Bensenor, Isabela M; Mill, José Geraldo; Schmidt, Maria Inês; Lotufo, Paulo Andrade; Vigo, Alvaro; Barreto, Sandhi Maria

2012-12-01

Chronic Non-Communicable Diseases are the main source of disease burden in Brazil. In 2011, the Brazilian Ministry of Health launched the Strategic Plan of Action for Management of Chronic Non-Communicable Diseases focusing on population-based interventions to manage cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases mainly through fighting tobacco use, unhealthy diets, physical inactivity and the harmful use of alcohol. Although a significant number of scientific studies on chronic diseases and their risk factors have been undertaken in Brazil, few are of cohort design. In this context, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort study of 15,105 Brazilian public servants reflects the reality of high prevalences of diabetes, hypertension and the main chronic diseases risk factors. The diversity of information that the Study will produce can provide important input to better understand the causes of chronic diseases and to support public policies for fighting them.

75 FR 48977 - National Institute of Allergy and Infectious Diseases; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Notice of Meeting Pursuant to section 10(a) of the Federal Advisory... Diseases Research, National Institutes of Health, HHS) [[Page 48978

Current trends in pharmacy benefit designs: a threat to disease management in chronic complex diseases.

PubMed

Owens, Gary; Emons, Matthew F; Christian-Herman, Jennifer; Lawless, Grant

2007-04-01

With a focus on those patients who are candidates for treatment with biologic agents, we review the impact that current pharmacy benefit trends have on patients with chronic complex diseases and how they affect opportunities for disease management in this unique patient population. Dramatic increases in health care costs have led to a variety of strategies to manage cost. Many of these strategies either limit access to care or increase the patient's responsibility for choosing and paying for care, especially for medications. These strategies have a disproportionate impact on patients with chronic complex diseases, particularly those who require the use of biologic medications. A fundamental prerequisite of disease management has been coverage of disease-modifying therapies. If current pharmacy benefit trends continue, unintended consequences will likely occur including lost opportunities for disease management. Current pharmacy benefit trends could adversely impact disease management, particularly for patients requiring the use of biologic agents. Health plans should consider innovative benefit designs that reflect an appropriate level of cost sharing across all key stake-holders, ensuring appropriate access to needed therapies. Additional research is needed to clarify the value of newer approaches to therapies or benefit design changes.

[The German program for disease management guidelines: type 2 diabetes--diabetic retinopathy/maculopathy guideline 2006. Short review].

PubMed

Ollenschläger, Günter; Kopp, Ina; Thole, Henning; Lelgemann, Monika

2007-02-15

In Germany, the first national consensus between six medical scientific associations on evidence-based recommendations for prevention and therapy of retinopathy/maculopathy in type 2 diabetes was reached in fall 2006. The recommendations' main sources are the NICE Retinopathy Guideline 2002, and existing German guidelines and reviews of recent scientific evidence. The article gives an overview on authors, sources, and key recommendations of the German National Disease Management Guideline Type 2 Diabetes-Retinopathy/Maculopathy 2006 (www.diabetes.versorgungsleitlinien.de).

Coronary artery disease in Brazil: contemporary management and future perspectives.

PubMed

Polanczyk, C A; Ribeiro, J P

2009-06-01

Cardiovascular diseases are responsible for 32% of total mortality in Brazil, mostly due to cerebrovascular and coronary artery disease. Epidemiological and socio-economical factors play a pivotal role on the distribution, severity and management of coronary artery disease, and the burden is greater in the southeast and south regions of the country, with a higher mortality in low-income populations. The Brazilian healthcare structure is divided into two complementary systems-public and private-but 75% of the population is covered exclusively by the public system. Some Brazilian institutions offer state-of-the-art care to patients with acute and chronic coronary artery disease, but regional inequalities in medical care are still significant. National policies will have to be implemented to fight risk factors, to ensure primary prevention strategies, including assistance on drugs with known protective effects, areas to be tackled by both the private and the public health sectors. Finally, large investments will have to be made to improve tertiary care, to reorganise systems of care for acute patients and mainly to ensure prompt access and continuity of cardiac care and secondary prevention strategies for the whole population.

The potential of disease management for neuromuscular hereditary disorders.

PubMed

Chouinard, Maud-Christine; Gagnon, Cynthia; Laberge, Luc; Tremblay, Carmen; Côté, Charlotte; Leclerc, Nadine; Mathieu, Jean

2009-01-01

Neuromuscular hereditary disorders require long-term multidisciplinary rehabilitation management. Although the need for coordinated healthcare management has long been recognized, most neuromuscular disorders are still lacking clinical guidelines about their long-term management and structured evaluation plan with associated services. One of the most prevalent adult-onset neuromuscular disorders, myotonic dystrophy type 1, generally presents several comorbidities and a variable clinical picture, making management a constant challenge. This article presents a healthcare follow-up plan and proposes a nursing case management within a disease management program as an innovative and promising approach. This disease management program and model consists of eight components including population identification processes, evidence-based practice guidelines, collaborative practice, patient self-management education, and process outcomes evaluation (Disease Management Association of America, 2004). It is believed to have the potential to significantly improve healthcare management for neuromuscular hereditary disorders and will prove useful to nurses delivering and organizing services for this population.

National survey of training needs reported by public health professionals in chronic disease programs in state, territorial, and local governments.

PubMed

Wilcox, Lynne S; Majestic, Elizabeth A; Ayele, Missale; Strasser, Sheryl; Weaver, Scott R

2014-01-01

In 2009, the National Association of Chronic Disease Directors published desirable competencies for professionals in public health chronic disease programs. Assessing the training needs of these professionals is an important step toward providing appropriate training programs in chronic disease prevention and control competencies. Conduct a survey of the chronic disease workforce in state and local health departments to identify professional training needs. We conducted a cross-sectional survey of state, territorial, and local public health professionals who work in chronic disease programs to identify their self-reported training needs, using the membership lists of 3 professional organizations that included practitioners in chronic disease public health programs. The survey was national, used a convenience sample, and was conducted in 2011. The survey was developed using an algorithm to select anonymous participants from the membership lists of the National Association of Chronic Disease Directors, the Directors for Health Promotion and Education, and the National Association of County & City Health Officials. The survey included questions about professional background, chronic disease activities, confidence about skills, and needs for training. The survey had 567 responses (38% response ratio). The majority of the respondents were female, non-Hispanic white, and 40 years or older. Respondents were not confident of their skills in health economics (38%) and technology and data management (23%). The most requested training topics were assessing the effects of policies, laws, and regulations (70%) and health economics (66%). This survey included local, territorial, and state public health professionals who work in chronic disease programs. These reported training needs in quantitative measurement methods and policy-related topics suggest key subjects for future training and education curricula.

76 FR 62433 - Delegation of Authority to the Office of Disaster Management and National Security

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-07

... the Office of Disaster Management and National Security AGENCY: Office of the Secretary, HUD. ACTION... Disaster and National Security Officer, Office of Disaster Management and National Security. DATES... and National Security Officer, Office of Disaster Management and National Security, Department of...

Management advisory memorandum on National Airspace System infrastructure management system prototype, Federal Aviation Administration

DOT National Transportation Integrated Search

1997-03-01

This is our Management Advisory Memorandum on the National Airspace : System (NAS) Infrastructure Management System (NIMS) prototype : project in the Federal Aviation Administration (FAA). Our review was : initiated in response to a hotline complaint...

50 CFR 600.320 - National Standard 3-Management Units.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Government, international commissions, foreign nations) are vital to effective management. Where management... scope to that portion of the stock found in U.S. waters; (ii) By estimating MSY for the entire stock and...

50 CFR 600.320 - National Standard 3-Management Units.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Government, international commissions, foreign nations) are vital to effective management. Where management... scope to that portion of the stock found in U.S. waters; (ii) By estimating MSY for the entire stock and...

50 CFR 600.320 - National Standard 3-Management Units.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Government, international commissions, foreign nations) are vital to effective management. Where management... scope to that portion of the stock found in U.S. waters; (ii) By estimating MSY for the entire stock and...

50 CFR 600.320 - National Standard 3-Management Units.

Code of Federal Regulations, 2011 CFR

2011-10-01

... comprehensive approach to fishery management. The geographic scope of the fishery, for planning purposes, should....320 National Standard 3—Management Units. (a) Standard 3. To the extent practicable, an individual... portion of a fishery identified in an FMP as relevant to the FMP's management objectives. (1) Basis. The...

50 CFR 600.320 - National Standard 3-Management Units.

Code of Federal Regulations, 2010 CFR

2010-10-01

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Contribution of Electronic Medical Records to the Management of Rare Diseases

PubMed Central

Bremond-Gignac, Dominique; Lewandowski, Elisabeth; Copin, Henri

2015-01-01

Purpose. Electronic health record systems provide great opportunity to study most diseases. Objective of this study was to determine whether electronic medical records (EMR) in ophthalmology contribute to management of rare eye diseases, isolated or in syndromes. Study was designed to identify and collect patients' data with ophthalmology-specific EMR. Methods. Ophthalmology-specific EMR software (Softalmo software Corilus) was used to acquire ophthalmological ocular consultation data from patients with five rare eye diseases. The rare eye diseases and data were selected and collected regarding expertise of eye center. Results. A total of 135,206 outpatient consultations were performed between 2011 and 2014 in our medical center specialized in rare eye diseases. The search software identified 29 congenital aniridia, 6 Axenfeld/Rieger syndrome, 11 BEPS, 3 Nanophthalmos, and 3 Rubinstein-Taybi syndrome. Discussion. EMR provides advantages for medical care. The use of ophthalmology-specific EMR is reliable and can contribute to a comprehensive ocular visual phenotype useful for clinical research. Conclusion. Routinely EMR acquired with specific software dedicated to ophthalmology provides sufficient detail for rare diseases. These software-collected data appear useful for creating patient cohorts and recording ocular examination, avoiding the time-consuming analysis of paper records and investigation, in a University Hospital linked to a National Reference Rare Center Disease. PMID:26539543

Contribution of Electronic Medical Records to the Management of Rare Diseases.

PubMed

Bremond-Gignac, Dominique; Lewandowski, Elisabeth; Copin, Henri

2015-01-01

Electronic health record systems provide great opportunity to study most diseases. Objective of this study was to determine whether electronic medical records (EMR) in ophthalmology contribute to management of rare eye diseases, isolated or in syndromes. Study was designed to identify and collect patients' data with ophthalmology-specific EMR. Ophthalmology-specific EMR software (Softalmo software Corilus) was used to acquire ophthalmological ocular consultation data from patients with five rare eye diseases. The rare eye diseases and data were selected and collected regarding expertise of eye center. A total of 135,206 outpatient consultations were performed between 2011 and 2014 in our medical center specialized in rare eye diseases. The search software identified 29 congenital aniridia, 6 Axenfeld/Rieger syndrome, 11 BEPS, 3 Nanophthalmos, and 3 Rubinstein-Taybi syndrome. EMR provides advantages for medical care. The use of ophthalmology-specific EMR is reliable and can contribute to a comprehensive ocular visual phenotype useful for clinical research. Routinely EMR acquired with specific software dedicated to ophthalmology provides sufficient detail for rare diseases. These software-collected data appear useful for creating patient cohorts and recording ocular examination, avoiding the time-consuming analysis of paper records and investigation, in a University Hospital linked to a National Reference Rare Center Disease.

Ethnic disparities in coronary heart disease management and pay for performance in the UK.

PubMed

Millett, Christopher; Gray, Jeremy; Wall, Martin; Majeed, Azeem

2009-01-01

Few pay for performance schemes have been subject to rigorous evaluation, and their impact on disparities in chronic disease management is uncertain. To examine disparities in coronary heart disease management and intermediate clinical outcomes within a multiethnic population before and after the introduction of a major pay for performance initiative in April 2004. Comparison of two cross-sectional surveys using electronic general practice records. Thirty-two family practices in south London, United Kingdom (UK). Two thousand eight hundred and ninety-one individuals with coronary heart disease registered with participating practices in 2003 and 3,101 in 2005. Percentage achievement by ethnic group of quality indicators in the management of coronary heart disease The proportion of patients reaching national treatment targets increased significantly for blood pressure (51.2% to 58.9%) and total cholesterol (65.7% to 73.8%) after the implementation of a major pay for performance initiative in April 2004. Improvements in blood pressure control were greater in the black group compared to whites, with disparities evident at baseline being attenuated (black 54.8% vs. white 58.3% reaching target in 2005). Lower recording of blood pressure in the south Asian group evident in 2003 was attenuated in 2005. Statin prescribing remained significantly lower (p < 0.001) in the black group compared with the south Asian and white groups after the implementation of pay for performance (black 74.8%, south Asian 83.8%, white 80.2% in 2005). The introduction of pay for performance incentives in UK primary care has been associated with better and more equitable management of coronary heart disease across ethnic groups.

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Paying for disease management.

PubMed

Levy, Phillip; Nocerini, Robert; Grazier, Kyle

2007-08-01

Disease Management (DM) first appeared in the United States in the early 1990s. Since then its incorporation into health plans has increased dramatically, yet proof of its effectiveness in terms of quality improvement and cost reduction remains to be seen. The following review provides an exploratory analysis of the basic principles of DM, its evolution and differences from traditional managed care, the ways in which programs are currently being used in the private and public sectors, and the challenges to determining a payment structure for incorporating DM into the current health insurance system.

Plant disease management in organic farming systems.

PubMed

van Bruggen, Ariena H C; Gamliel, Abraham; Finckh, Maria R

2016-01-01

Organic farming (OF) has significantly increased in importance in recent decades. Disease management in OF is largely based on the maintenance of biological diversity and soil health by balanced crop rotations, including nitrogen-fixing and cover crops, intercrops, additions of manure and compost and reductions in soil tillage. Most soil-borne diseases are naturally suppressed, while foliar diseases can sometimes be problematic. Only when a severe disease outbreak is expected are pesticides used that are approved for OF. A detailed overview is given of cultural and biological control measures. Attention is also given to regulated pesticides. We conclude that a systems approach to disease management is required, and that interdisciplinary research is needed to solve lingering disease problems, especially for OF in the tropics. Some of the organic regulations are in need of revision in close collaboration with various stakeholders. © 2015 Society of Chemical Industry.

Disease severity is associated with the use of complementary medicine to treat or manage type-2 diabetes: data from the 2002 and 2007 National Health Interview Survey.

PubMed

Nahin, Richard L; Byrd-Clark, Danita; Stussman, Barbara J; Kalyanaraman, Nilesh

2012-10-22

The overall prevalence of complementary medicine (CM) use among adults in the United States with diabetes has been examined both in representative national samples and in more restricted populations. However, none of these earlier studies attempted to identify predictors of CM use to treat diabetes among the populations sampled, nor looked for a relationship between CM use and diabetes severity. Combining data from the 2002 and 2007 National Health Interview Survey (NHIS), we constructed a nationally representative sample of 3,978 U.S. adults aged ≥18 years with self-reported diabetes. Both the 2002 and 2007 NHIS contained extensive questions on the use of CM. We used logistic regression to examine the association between diabetes severity and overall CM use, as well as the use of specific categories of CM. In adults with type-2 diabetes, 30.9% used CM for any reason, but only 3.4% used CM to treat or manage their type-2 diabetes versus 7.1% of those with type-1 diabetes. Among those using CM to treat/manage their type-2 diabetes, 77% used both CM and conventional prescription medicine for their diabetes. The most prevalent types of CM therapies used were diet-based interventions (35.19%, S.E. 5.11) and non-vitamin/non-mineral dietary supplements (33.74%, S.E. 5.07). After controlling for sociodemographic factors, we found that, based on a count of measures of diabetes severity, persons with the most severe diabetes had nearly twice the odds of using CM as those with less severe disease (OR=1.9, 95%CI 1.2-3.01). Persons who had diabetes 10 years or more (OR=1.66, 95%CI 1.04-3.66) and those that had a functional limitation resulting from their diabetes (OR=1.74, 95%CI 1.09-2.8) had greater odds of using CM than those not reporting these measures. No significant associations were observed between overall CM use and other individual measures of diabetes severity: use of diabetic medications, weak or failing kidneys, coronary heart disease, or severe vision problems

Disease severity is associated with the use of complementary medicine to treat or manage type-2 diabetes: data from the 2002 and 2007 National Health Interview Survey

PubMed Central

2012-01-01

Background The overall prevalence of complementary medicine (CM) use among adults in the United States with diabetes has been examined both in representative national samples and in more restricted populations. However, none of these earlier studies attempted to identify predictors of CM use to treat diabetes among the populations sampled, nor looked for a relationship between CM use and diabetes severity. Methods Combining data from the 2002 and 2007 National Health Interview Survey (NHIS), we constructed a nationally representative sample of 3,978 U.S. adults aged ≥18 years with self-reported diabetes. Both the 2002 and 2007 NHIS contained extensive questions on the use of CM. We used logistic regression to examine the association between diabetes severity and overall CM use, as well as the use of specific categories of CM. Results In adults with type-2 diabetes, 30.9% used CM for any reason, but only 3.4% used CM to treat or manage their type-2 diabetes versus 7.1% of those with type-1 diabetes. Among those using CM to treat/manage their type-2 diabetes, 77% used both CM and conventional prescription medicine for their diabetes. The most prevalent types of CM therapies used were diet-based interventions (35.19%, S.E. 5.11) and non-vitamin/non-mineral dietary supplements (33.74%, S.E. 5.07). After controlling for sociodemographic factors, we found that, based on a count of measures of diabetes severity, persons with the most severe diabetes had nearly twice the odds of using CM as those with less severe disease (OR=1.9, 95%CI 1.2-3.01). Persons who had diabetes 10 years or more (OR=1.66, 95%CI 1.04-3.66) and those that had a functional limitation resulting from their diabetes (OR=1.74, 95%CI 1.09-2.8) had greater odds of using CM than those not reporting these measures. No significant associations were observed between overall CM use and other individual measures of diabetes severity: use of diabetic medications, weak or failing kidneys, coronary heart disease

[Disease management for chronic heart failure patient].

PubMed

Bläuer, Cornelia; Pfister, Otmar; Bächtold, Christa; Junker, Therese; Spirig, Rebecca

2011-02-01

Patients with chronic heart failure (HF) are limited in their quality of life, have a poor prognosis and face frequent hospitalisations. Patient self-management was shown to improve quality of life, reduce rehospitalisations and costs in patients with chronic HF. Comprehensive disease management programmes are critical to foster patient self-management. The chronic care model developed by the WHO serves as the basis of such programmes. In order to develop self-management skills a needs orientated training concept is mandatory, as patients need both knowledge of the illness and the ability to use the information to make appropriate decisions according to their individual situation. Switzerland has no established system for the care of patients with chronic diseases in particular those with HF. For this reason a group of Swiss experts for HF designed a model for disease management for HF patients in Switzerland. Since 2009 the Swiss Heart Foundation offers an education programme based on this model. The aim of this programme is to offer education and support for practitioners, patients and families. An initial pilot evaluation of the program showed mixed acceptance by practitioners, whereas patient assessed the program as supportive and in line with their requirements.

Perioperative Management of Patients with Rheumatic Diseases

PubMed Central

Bissar, Lina; Almoallim, Hani; Albazli, Khaled; Alotaibi, Manal; Alwafi, Samar

2013-01-01

This paper aims to explore the assessment of patients with rheumatologic diseases, especially rheumatoid arthritis (RA), before undergoing orthopedic surgery. Perioperative assessment ensures an early diagnosis of the patient's medical condition, overall health, medical co-morbidities, and the assessment of the risk factors associated with the proposed procedures. Perioperative assessment allows for proper postoperative management of complications and of the management of drugs such as disease-modifying anti-rheumatic drugs (DMARD) and anti-platelets, and corticosteroids. The assessment also supports follow up plans, and patient education. Perioperative assessment enables the discussion of the proposed treatment plans and the factors associated with them in each case among the different specialists involved to facilitate an appropriate early decision-making about the assessment and treatment of patients with rheumatologic diseases. It also enables the discussion of both condition and procedure with the patient to ensure a good postoperative care. The article identifies the components of perioperative medical evaluation, discusses perioperative management of co-morbidities and the management of specific clinical problems related to RA, systemic lupus erythematosus, the management of DMARDs, like methotrexate (MTX) and biologic therapies, prophylactic antibiotics, and postoperative follow up, including patient education and rehabilitation PMID:24062860

Management of pilonidal disease.

PubMed

Kallis, Michelle P; Maloney, Caroline; Lipskar, Aaron M

2018-06-01

Pilonidal disease, and the treatment associated with it, can cause significant morbidity and substantial burden to patients' quality of life. Despite the plethora of surgical techniques that have been developed to treat pilonidal disease, discrepancies in technique, recurrence rates, complications, time to return to work/school and patients' aesthetic satisfaction between treatment options have led to controversy over the best approach to this common acquired disease of young adults. The management of pilonidal disease must strike a balance between recurrence and surgical morbidity. The commonly performed wide excision without closure has prolonged recovery, while flap closures speed recovery time and improve aesthetics at the expense of increased wound complications. Less invasive surgical techniques have recently evolved and are straightforward, with minimal morbidity and satisfactory results. As with any surgical intervention, the ideal treatment for pilonidal disease would be simple and cost-effective, cause minimal pain, have a limited hospital stay, low recurrence rate and require minimal time off from school or work. Less invasive procedures for pilonidal disease may be favourable as an initial approach for these patients reserving complex surgical treatment for refractory disease.

Perforated Sigmoid Diverticular Disease: a Management Protocol

PubMed Central

Moin, Thajammul

2008-01-01

Background: To develop an evidence-based protocol for the management of perforated sigmoid diverticular disease. Methods: A search of the literature was undertaken. All publications pertaining to perforated sigmoid diverticular disease were analyzed and then categorized according to their level of evidence. Recommendations were then made on the basis of this. Results: Multiple case reports suggest that primary closure of perforation of sigmoid diverticula is safe in the absence of peritoneal contamination. Conclusions: A 2-stage laparoscopic approach incorporating the principles of damage limitation surgery may be a safe strategy in the management of perforated diverticular disease. PMID:18435896

Identifying management and disease priorities of Canadian dairy industry stakeholders.

PubMed

Bauman, C A; Barkema, H W; Dubuc, J; Keefe, G P; Kelton, D F

2016-12-01

The objective of this study was to identify the key management and disease issues affecting the Canadian dairy industry. An online questionnaire (FluidSurveys, http://fluidsurveys.com/) was conducted between March 1 and May 31, 2014. A total of 1,025 responses were received from across Canada of which 68% (n=698) of respondents were dairy producers, and the remaining respondents represented veterinarians, university researchers, government personnel, and other allied industries. Participants were asked to identify their top 3 management and disease priorities from 2 lists offered. Topics were subsequently ranked from highest to lowest using 3 different ranking methods based on points: 5-3-1 (5 points for first priority, 3 for second, and 1 for first), 3-2-1, and 1-1-1 (equal ranking). The 5-3-1 point system was selected because it minimized the number of duplicate point scores. Stakeholder groups showed general agreement with the top management issue identified as animal welfare and the number one health concern as lameness. Other areas identified as priorities were reproductive health, antibiotic use, bovine viral diarrhea, and Staphylococcus aureus mastitis with these rankings influenced by region, herd size, and stakeholder group. This is the first national comprehensive assessment of priorities undertaken in the Canadian dairy industry and will assist researchers, policymakers, program developers, and funding agencies make future decisions based on direct industry feedback. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Cost effectiveness of a general practice chronic disease management plan for coronary heart disease in Australia.

PubMed

Chew, Derek P; Carter, Robert; Rankin, Bree; Boyden, Andrew; Egan, Helen

2010-05-01

The cost effectiveness of a general practice-based program for managing coronary heart disease (CHD) patients in Australia remains uncertain. We have explored this through an economic model. A secondary prevention program based on initial clinical assessment and 3 monthly review, optimising of pharmacotherapies and lifestyle modification, supported by a disease registry and financial incentives for quality of care and outcomes achieved was assessed in terms of incremental cost effectiveness ratio (ICER), in Australian dollars per disability adjusted life year (DALY) prevented. Based on 2006 estimates, 263 487 DALYs were attributable to CHD in Australia. The proposed program would add $115 650 000 to the annual national heath expenditure. Using an estimated 15% reduction in death and disability and a 40% estimated program uptake, the program's ICER is $8081 per DALY prevented. With more conservative estimates of effectiveness and uptake, estimates of up to $38 316 per DALY are observed in sensitivity analysis. Although innovation in CHD management promises improved future patient outcomes, many therapies and strategies proven to reduce morbidity and mortality are available today. A general practice-based program for the optimal application of current therapies is likely to be cost-effective and provide substantial and sustainable benefits to the Australian community.

Sustainable chronic disease management in remote Australia.

PubMed

Wakerman, John; Chalmers, Elizabeth M; Humphreys, John S; Clarence, Christine L; Bell, Andrew I; Larson, Ann; Lyle, David; Pashen, Dennis R

2005-11-21

The Sharing Health Care Initiative (SHCI) demonstration project, which aimed to improve management of chronic diseases, was implemented in four small remote communities in the Katherine region which are serviced by the Katherine West Health Board, a remote Aboriginal-community-controlled health organisation in the Northern Territory. We reviewed the project proposal, final report, evaluation reports and transitional funding proposal, and supplemented these with in-depth interviews with key individuals. We determined factors critical to the sustainability of the SHCI project in relation to context, community engagement, systems flexibility and adaptability, the availability and effect of information systems, and the human nature of health care and policy. The project had a significant impact on community awareness of chronic disease and an improvement in clinic processes. We found that a number of interrelated factors promoted sustainability, including: An implementation strategy sufficiently flexible to take account of local conditions; A high level of community engagement; Appropriate timeframes, timing and congruence between national policy and local readiness to implement a chronic disease project; Effective communication between participating organisations; Project champions (key individuals) in participating organisations; Effective use of monitoring and evaluation data; and Adequate and ongoing funding. The absence of a number of these factors, such as poor communication, inhibited sustainability. Other factors could both promote and inhibit. For example, the impact of key individuals was important, but could be idiosyncratic and have negative effects.

78 FR 21961 - National Institute of Allergy And Infectious Diseases; Notice of Meeting

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2013-04-12

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy And Infectious Diseases; Notice of Meeting Pursuant to section 10(a) of the Federal Advisory... Infectious Diseases Research, National Institutes of Health, HHS) Dated: April 8, 2013. David Clary, Program...

[Genetic basis for skeletal disease. Dental management of patients with bone diseases].

PubMed

Shintani, Seikou; Ooshima, Takashi

2010-08-01

Malformation of teeth can be found in patients with bone diseases, which was induced when the disease occurred during the tooth formation. The tooth malformation shows typical manifestations of the disease, which may demonstrate the occurrence of the bone disease. In this article, dental management of the patients with bone diseases such as X-linked hypophosphatemic rickets, osteogenesis imperfecta, and hypophosphatasia was presented.

Applying evolutionary concepts to wildlife disease ecology and management

PubMed Central

Vander Wal, Eric; Garant, Dany; Calmé, Sophie; Chapman, Colin A; Festa-Bianchet, Marco; Millien, Virginie; Rioux-Paquette, Sébastien; Pelletier, Fanie

2014-01-01

Existing and emerging infectious diseases are among the most pressing global threats to biodiversity, food safety and human health. The complex interplay between host, pathogen and environment creates a challenge for conserving species, communities and ecosystem functions, while mediating the many known ecological and socio-economic negative effects of disease. Despite the clear ecological and evolutionary contexts of host–pathogen dynamics, approaches to managing wildlife disease remain predominantly reactionary, focusing on surveillance and some attempts at eradication. A few exceptional studies have heeded recent calls for better integration of ecological concepts in the study and management of wildlife disease; however, evolutionary concepts remain underused. Applied evolution consists of four principles: evolutionary history, genetic and phenotypic variation, selection and eco-evolutionary dynamics. In this article, we first update a classical framework for understanding wildlife disease to integrate better these principles. Within this framework, we explore the evolutionary implications of environment–disease interactions. Subsequently, we synthesize areas where applied evolution can be employed in wildlife disease management. Finally, we discuss some future directions and challenges. Here, we underscore that despite some evolutionary principles currently playing an important role in our understanding of disease in wild animals, considerable opportunities remain for fostering the practice of evolutionarily enlightened wildlife disease management. PMID:25469163

Applying evolutionary concepts to wildlife disease ecology and management.

PubMed

Vander Wal, Eric; Garant, Dany; Calmé, Sophie; Chapman, Colin A; Festa-Bianchet, Marco; Millien, Virginie; Rioux-Paquette, Sébastien; Pelletier, Fanie

2014-08-01

Existing and emerging infectious diseases are among the most pressing global threats to biodiversity, food safety and human health. The complex interplay between host, pathogen and environment creates a challenge for conserving species, communities and ecosystem functions, while mediating the many known ecological and socio-economic negative effects of disease. Despite the clear ecological and evolutionary contexts of host-pathogen dynamics, approaches to managing wildlife disease remain predominantly reactionary, focusing on surveillance and some attempts at eradication. A few exceptional studies have heeded recent calls for better integration of ecological concepts in the study and management of wildlife disease; however, evolutionary concepts remain underused. Applied evolution consists of four principles: evolutionary history, genetic and phenotypic variation, selection and eco-evolutionary dynamics. In this article, we first update a classical framework for understanding wildlife disease to integrate better these principles. Within this framework, we explore the evolutionary implications of environment-disease interactions. Subsequently, we synthesize areas where applied evolution can be employed in wildlife disease management. Finally, we discuss some future directions and challenges. Here, we underscore that despite some evolutionary principles currently playing an important role in our understanding of disease in wild animals, considerable opportunities remain for fostering the practice of evolutionarily enlightened wildlife disease management.

National athletic trainers' association position statement: skin diseases.

PubMed

Zinder, Steven M; Basler, Rodney S W; Foley, Jack; Scarlata, Chris; Vasily, David B

2010-01-01

To present recommendations for the prevention, education, and management of skin infections in athletes. Trauma, environmental factors, and infectious agents act together to continually attack the integrity of the skin. Close quarters combined with general poor hygiene practices make athletes particularly vulnerable to contracting skin diseases. An understanding of basic prophylactic measures, clinical features, and swift management of common skin diseases is essential for certified athletic trainers to aid in preventing the spread of infectious agents. These guidelines are intended to provide relevant information on skin infections and to give specific recommendations for certified athletic trainers and others participating in athletic health care.

[Study on the effectiveness of implementation: the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases].

PubMed

Zhang, J; Jin, R R; Li, J J; Li, J L; Su, X W; Deng, G J; Ma, S; Zhao, J; Wang, Y P; Bian, F; Qu, Y M; Shen, Z Z; Jiang, Y; Liu, Y L

2018-04-10

Objective: To assess the implementation and impact of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Methods: Both sociological and epidemiological methods were used to collect qualitative and quantitative data in November and December, 2016 in order to conduct on process and outcome evaluation of the above mentioned objective. In the meantime, case study was also conducted. Results: All the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were found well implemented across the country, with health education and health promotion, surveillance and safeguard measures in particular. A government-led and inter-sector coordination and communication mechanism had been well established, with more than 16 non-health departments actively involved. 28.7% of the residents living in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were aware of the key messages related to chronic diseases. Among the residents, 72.1% of them consumed vegetables and 53.6% consumed fruits daily, with another 86.9% walked at least 10 minutes per day. Over 70% of the patients with hypertension or diabetes reported that they were taken care of by the Community Health Centers, and above 50% of them were under standardized management. Residents, living in the National Demonstration Areas under higher ranking of implementation scores, were more likely to be aware of relevant knowledge on chronic disease control and prevention ( OR =6.591, 95% CI : 5.188-8.373), salt reduction ( OR =1.352, 95% CI : 1.151-1.589), oil reduction ( OR =1.477, 95% CI : 1.249-1.746) and recommendation on physical activities ( OR =1.975, 95% CI : 1.623- 2.403). Conclusion: The implementation of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases had served a local

[The Utilization of Health-Related Applications in Chronic Disease Self-Management].

PubMed

Kao, Chi-Wen; Chuang, Hui-Wan; Chen, Ting-Yu

2017-08-01

The dramatic increase in smartphone usage has spurred the development of many health-related mobile applications (apps). On the other hand, population aging and the associated rise in the incidence of chronic disease is increasing the demand for long-term care. Effective chronic disease self-management has been shown to help patients improve their health condition. Numerous smartphone applications currently support patient self-management of chronic disease, facilitating health management and health promotion. The purpose of the present article was to introduce the definition, contents, and types of health-related apps; to discuss the effectiveness of self-management health-related apps in promoting chronic disease management; and to assess and evaluate these apps. We hope that the present article helps give to healthcare professionals and patients who are willing to manage their diseases a general understanding of health-related apps and their potential to facilitate the self-management of chronic diseases.

The nationalization of a disease: a paradigm?

PubMed

Soviero, D J

1986-01-01

The early history of the Federal involvement in Hansen's Disease reflects the history of the Public Health Service itself. As a young and aggressive institution, the Public Health Service sought out contagious, infectious diseases that threatened the public health. National resources and national coordination were needed to fight the likes of malaria, hookworm, or smallpox. The customary attack would consist of a field study, determination of the etiology, the method of transmission, and, then, perhaps, preventive measures. An eradication campaign would follow. Leprosy fit perfectly into the model--a disease of unknown etiology, an unknown method of transmission, thought to be highly contagious, and no known cure. The United States launched a major investigation in Hawaii, where the disease was prevalent and its victims conveniently segregated. The investigation failed. The Public Health Service then turned toward segregation and isolation as a way to fulfill its public health role. A bureaucracy was established around the idea that victims of leprosy must be incarcerated for the good of the public. The institutionalization of the Public Health Service and the philosophy upon which its treatment of leprosy was based proved difficult to change when researchers in the field made major scientific breakthroughs in the 1940s. The realization that the disease was only feebly contagious, activities of patient organizations, and pressure from the media and the Congress did not achieve as dramatic results as the sulfone drugs did. The Public Health Service moved, but slowly. What are the lessons in all of this?.

The nationalization of a disease: a paradigm?

PubMed Central

Soviero, D J

1986-01-01

The early history of the Federal involvement in Hansen's Disease reflects the history of the Public Health Service itself. As a young and aggressive institution, the Public Health Service sought out contagious, infectious diseases that threatened the public health. National resources and national coordination were needed to fight the likes of malaria, hookworm, or smallpox. The customary attack would consist of a field study, determination of the etiology, the method of transmission, and, then, perhaps, preventive measures. An eradication campaign would follow. Leprosy fit perfectly into the model--a disease of unknown etiology, an unknown method of transmission, thought to be highly contagious, and no known cure. The United States launched a major investigation in Hawaii, where the disease was prevalent and its victims conveniently segregated. The investigation failed. The Public Health Service then turned toward segregation and isolation as a way to fulfill its public health role. A bureaucracy was established around the idea that victims of leprosy must be incarcerated for the good of the public. The institutionalization of the Public Health Service and the philosophy upon which its treatment of leprosy was based proved difficult to change when researchers in the field made major scientific breakthroughs in the 1940s. The realization that the disease was only feebly contagious, activities of patient organizations, and pressure from the media and the Congress did not achieve as dramatic results as the sulfone drugs did. The Public Health Service moved, but slowly. What are the lessons in all of this?. Images p401-a p402-a p403-a PMID:3090606

The Relationship Among Heart Failure Disease Management, Quality of Care, and Hospitalizations.

PubMed

Chung, Eugene S; Bartone, Cheryl; Daly, Kathleen; Menon, Santosh; McDonald, Mark

2015-01-01

Heart failure (HF) affects 5.1 million adult patients, accounting for over 1 million hospitalizations, 1.8 million office visits, and nearly 680,000 emergency department visits annually. HF hospitalizations have been incorporated into a national measure of hospital and provider quality, with associated financial penalties based on the 30-day readmission rate after an index hospitalization for HF. However, it is not clear whether the number of HF-related hospitalizations or 30-day readmissions is consistently related to quality of care. The relationships between various measures of HF care quality and hospitalization rates were evaluated by performing a cohort study of an HF disease management program in a clinical practice setting. Following the statistical analyses assessing outcomes and survival, the conclusion was that an HF disease management program in clinical practice associated with improved utilization of evidence-based medical and device therapies tends to improve ejection fraction and survival, and reduce sex and race disparities, but not with an associated reduction in hospitalizations or total hospital days.

Celiac Disease Diagnosis and Management

PubMed Central

Leffler, Daniel

2012-01-01

Celiac disease is one of the most prevalent autoimmune gastrointestinal disorders but as the case of Ms. J illustrates, diagnosis is often delayed or missed. Based on serology studies, the prevalence of celiac disease in many populations is estimated to be approximately 1% and has been increasing steadily over the last 50 years. Evaluation for celiac disease is generally straightforward, and uses commonly available serologic tests, however the signs and symptoms of celiac disease are nonspecific and highly heterogeneous making diagnosis difficult. While celiac disease is often considered a mild disorder treatable with simple dietary changes, in reality celiac disease imparts considerable risks including reduced bone mineral density, impaired quality of life, and increased overall mortality. In addition, the gluten free diet is highly burdensome and can profoundly affect patients and their families. For these reasons, care of individuals with celiac disease requires prompt diagnosis and ongoing multidisciplinary management. PMID:21990301

Environmental management for dredging sediments - the requirement of developing nations.

PubMed

Manap, Norpadzlihatun; Voulvoulis, Nikolaos

2015-01-01

Scientific research has characterized the effects of dredging, an underwater excavation process for navigational purposes or material extraction, and has shown its association with a number of chemical, physical and biological impacts. Due to this, much environmental management has been applied in the dredging industry in order to manage its detrimental effects. However, developing nations may have different approaches towards their dredging environmental management to compare to their companions with higher economic strength. Moreover, scientific evidence to make an informed decision is often lacking, hence affecting the number of research executed at these nations, limiting their efforts to preserve the environment. This paper reviews the dredging environmental impacts and its two important factors, dredging technology and sediment characteristic, that determine the magnitude of impacts through literature review, and discusses the need for a more integrated dredging environmental management to be developed for developing nations. Copyright © 2014 Elsevier Ltd. All rights reserved.

75 FR 8649 - Evaluation of State Coastal Management Programs and National Estuarine Research Reserves

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-25

... Ocean and Coastal Resource Management (OCRM) announces a rescheduled site visit and time for a public... Management Programs and National Estuarine Research Reserves AGENCY: National Oceanic and Atmospheric Administration (NOAA), Office of Ocean and Coastal Resource Management, National Ocean Service, Commerce. ACTION...

Design and implementation of an inpatient disease management program.

PubMed

Cooper, G S; Armitage, K B; Ashar, B; Costantini, O; Creighton, F A; Raiz, P; Wong, R C; Carlson, M D

2000-07-01

To describe the development and implementation of an inpatient disease management program. Prospective observational study. On the basis of opportunities for improving quality or efficiency of inpatient and emergency department care, 4 diagnoses, including congestive heart failure (CHF), gastrointestinal hemorrhage, community-acquired pneumonia and sickle-cell crisis were selected for implementation of a disease management program. For each diagnosis, a task force assembled a disease management team led by a "physician champion" and nurse care manager and identified opportunities for improvement through medical literature review and interviews with caregivers. A limited number of disease-specific guidelines and corresponding interventions were selected with consensus of the team and disseminated to caregivers. Physician and nurse team leaders were actively involved in patient care to facilitate adherence to guidelines. For quarter 2 to 4 of 1997, there were improvements in angiotensin-converting enzyme inhibitor use, daily weight compliance, assessment of left ventricular function, hospital costs, and length of stay for care-managed patients with CHF. Differences in utilization-related outcomes persisted even after adjustment for severity of illness. For the other 3 diagnoses, the observational period was shorter (quarter 4 only), and hence preliminary data showed similar hospital costs and length of stay for care-managed and noncare-managed patients. An interdisciplinary approach to inpatient disease management resulted in substantial improvements in both quality and efficiency of care for patients with CHF. Additional data are needed to determine the program's impact on outcomes of other targeted diagnoses.

Text messaging as a tool for behavior change in disease prevention and management.

PubMed

Cole-Lewis, Heather; Kershaw, Trace

2010-01-01

Mobile phone text messaging is a potentially powerful tool for behavior change because it is widely available, inexpensive, and instant. This systematic review provides an overview of behavior change interventions for disease management and prevention delivered through text messaging. Evidence on behavior change and clinical outcomes was compiled from randomized or quasi-experimental controlled trials of text message interventions published in peer-reviewed journals by June 2009. Only those interventions using text message as the primary mode of communication were included. Study quality was assessed by using a standardized measure. Seventeen articles representing 12 studies (5 disease prevention and 7 disease management) were included. Intervention length ranged from 3 months to 12 months, none had long-term follow-up, and message frequency varied. Of 9 sufficiently powered studies, 8 found evidence to support text messaging as a tool for behavior change. Effects exist across age, minority status, and nationality. Nine countries are represented in this review, but it is problematic that only one is a developing country, given potential benefits of such a widely accessible, relatively inexpensive tool for health behavior change. Methodological issues and gaps in the literature are highlighted, and recommendations for future studies are provided.

Disparities in Confidence to Manage Chronic Diseases in Men.

PubMed

Elder, Keith; Gilbert, Keon; Hanke, Louise Meret; Dean, Caress; Rice, Shahida; Johns, Marquisha; Piper, Crystal; Wiltshire, Jacqueline; Moore, Tondra; Wang, Jing

2014-01-01

Chronic diseases are highly prevalent among men in the United States and chronic disease management is problematic for men, particularly for racial and ethnic minority men. This study examined the association between health information seeking and confidence to manage chronic diseases among men. Study data were drawn from the 2007 Health Tracking Household Survey and analyzed using multiple binary logistic regressions. The analytical sample included 2,653 men, 18 years and older with a chronic illness. Results: Health information seeking was not associated with confidence to manage chronic illnesses. African-American men had lower odds than White men to agree to take actions to prevent symptoms with their health. Hispanic men had lower odds than White men to agree to tell a doctor concerns they have, even when not asked. Racial and ethnic minority men with a chronic condition appear to be less confident to manage their health compared to white men. Chronic disease management needs greater exploration to understand the best ways to help racial and ethnic minority men successfully manage their chronic condition.

Participation of general practitioners in disease management: experiences from The Netherlands.

PubMed

Steuten, L M G; Vrijhoef, H J M; Spreeuwenberg, C; Van Merode, G G

2002-01-01

To investigate the extent to which GPs in The Netherlands participate in disease management and how personal opinions, impeding and promoting incentives as well as physician characteristics influence their attitude towards disease management. The attitude-model of Fishbein and Ajzen was used to describe the attitude of GPs towards disease management and main influencing factors. After interviewing seventeen representatives of the GPs and testing a questionnaire, the final questionnaire was sent to all GPs in The Netherlands (7680 GPs) barring those involved in the testing of the questionnaire. At least 10.4% of all Dutch GPs are active in disease management. The main factors predicting a positive attitude towards disease management are the following: GPs' opinion that they are improving quality and efficiency of care when executing disease management, presence of a good quality network between actors involved prior to the start of disease management, working in a health centre, and performing sideline activities besides their daily activities as GPs. The main factors predicting a negative attitude are: GPs' opinion that the investment-time is too high, lack of reimbursement for disease management activities, working in a solo practice, and not performing any sideline activities beside their daily activities as GP. The factors predicting a negative attitude of Dutch GPs towards disease management dominate the factors predicting a positive attitude. The arguments in favour of disease management are matters of belief, for example concerning improvements in the quality of care, while arguments against are more concrete barriers e.g. high workload and financial reimbursement. Placed on the innovation timeline, the 10.4% participation might be taken to represent the start of a trend.

Economic effectiveness of disease management programs: a meta-analysis.

PubMed

Krause, David S

2005-04-01

The economic effectiveness of disease management programs, which are designed to improve the clinical and economic outcomes for chronically ill individuals, has been evaluated extensively. A literature search was performed with MEDLINE and other published sources for the period covering January 1995 to September 2003. The search was limited to empirical articles that measured the direct economic outcomes for asthma, diabetes, and heart disease management programs. Of the 360 articles and presentations evaluated, only 67 met the selection criteria for meta-analysis, which included 32,041 subjects. Although some studies contained multiple measurements of direct economic outcomes, only one average effect size per study was included in the meta-analysis. Based on the studies included in the research, a meta-analysis provided a statistically significant answer to the question of whether disease management programs are economically effective. The magnitude of the observed average effect size for equally weighted studies was 0.311 (95% CI = 0.272-0.350). Statistically significant differences of effect sizes by study design, disease type and intensity of disease management program interventions were not found after a moderating variable, disease severity, was taken into consideration. The results suggest that disease management programs are more effective economically with severely ill enrollees and that chronic disease program interventions are most effective when coordinated with the overall level of disease severity. The findings can be generalized, which may assist health care policy makers and practitioners in addressing the issue of providing economically effective care for the growing number of individuals with chronic illness.

The complete "how to" guide for selecting a disease management vendor.

PubMed

Linden, Ariel; Roberts, Nancy; Keck, Kevin

2003-01-01

Decision-makers in health plans, large medical groups, and self-insured employers face many challenges in selecting and implementing disease management programs. One strategy is the "buy" approach, utilizing one or more of the many vendors to provide disease management services for the purchasing organization. As a relatively new field, the disease management vendor landscape is continually changing, uncovering the many uncertainties about demonstrating outcomes, corporate stability, or successful business models. Given the large investment an organization may make in each disease management program (many cost 1 million dollars or more in annual fees for a moderately sized population), careful consideration must be given in selecting a disease management partner. This paper describes, in detail, the specific steps necessary and the issues to consider in achieving a successful contract with a vendor for full-service disease management.

Strategies for job creation through national forest management

Treesearch

Susan Charnley

2014-01-01

This chapter explores the ways in which national forest managers may contribute to community well-being by designing projects that accomplish forest management in ways that not only meet their ecological goals, but also create economic opportunities for nearby communities. The chapter summarizes a number of strategies for enhancing the economic benefits to communities...

Current management of Parkinson's disease.

PubMed

Salawu, F; Olokoba, A; Danburam, A

2010-01-01

Although Parkinson's disease (PD) is still incurable, a large number of different treatments have become available to improve the quality of life and physical and psychological morbidity, and its early treatment is of prime importance. This article reviews the current situation of PD. This review was based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. The subject headings and keywords used were Parkinson's disease and therapeutic advances. Only articles written in English were included.The management of PD has evolved rapidly over the last 10 years with the advent of new drugs and new classes of drugs, but the currently available treatment methods are all symptomatic ones. However, some of these may have marginal disease-modifying effects. Progress in manufacture of newer drugs has markedly improved the treatment of early PD; however, the management of advanced Parkinson's symptoms remains a challenge. Currently no treatment has been proven to slow the progression of PD. Although symptomatic therapy can provide benefit for many years, PD will eventually result in significant morbidity.

Medication therapy disease management: Geisinger's approach to population health management.

PubMed

Jones, Laney K; Greskovic, Gerard; Grassi, Dante M; Graham, Jove; Sun, Haiyan; Gionfriddo, Michael R; Murray, Michael F; Manickam, Kandamurugu; Nathanson, Douglas C; Wright, Eric A; Evans, Michael A

2017-09-15

Pharmacists' involvement in a population health initiative focused on chronic disease management is described. Geisinger Health System has cultivated a culture of innovation in population health management, as highlighted by its ambulatory care pharmacy program, the Medication Therapy Disease Management (MTDM) program. Initiated in 1996, the MTDM program leverages pharmacists' pharmacotherapy expertise to optimize care and improve outcomes. MTDM program pharmacists are trained and credentialed to manage over 16 conditions, including atrial fibrillation (AF) and multiple sclerosis (MS). Over a 15-year period, Geisinger Health Plan (GHP)-insured patients with AF whose warfarin therapy was managed by the MTDM program had, on average, 18% fewer emergency department (ED) visits and 18% fewer hospitalizations per year than GHP enrollees with AF who did not receive MTDM services, with 23% lower annual total care costs. Over a 2-year period, GHP-insured patients with MS whose pharmacotherapy was managed by pharmacists averaged 28% fewer annual ED visits than non-pharmacist-managed patients; however, the mean annual total care cost was 21% higher among MTDM clinic patients. The Geisinger MTDM program has evolved over 20 years from a single pharmacist-run anticoagulation clinic into a large program focused on managing the health of an ever-growing population. Initial challenges in integrating pharmacists into the Geisinger patient care framework as clinical experts were overcome by demonstrating the MTDM program's positive impact on patient outcomes. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Knowledge Insufficient: The Management of Haemoglobin SC Disease

PubMed Central

Pecker, Lydia H.; Schaefer, Beverly A.; Luchtman-Jones, Lori

2016-01-01

Although haemoglobin SC (HbSC) accounts for 30% of sickle cell disease (SCD) in the United States and United Kingdom, evidence-based guidelines for genotype specific management are lacking. The unique pathology of HbSC disease is complex, characterized by erythrocyte dehydration, intracellular sickling and increased blood viscosity. The evaluation and treatment of patients with HbSC is largely inferred from studies of SCD consisting mostly of haemoglobin SS (HbSS) patients. These studies are underpowered to allow definitive conclusions about HbSC. We review the pathophysiology of HbSC disease, including known and potential differences between HbSS and HbSC, and highlight knowledge gaps in HbSC disease management. Clinical and translational research is needed to develop targeted treatments and to validate management recommendations for efficacy, safety and impact on quality of life for people with HbSC. PMID:27982424

Disease management positively affects patient quality of life.

PubMed

Walker, David R; Landis, Darryl L; Stern, Patricia M; Vance, Richard P

2003-04-01

Health care costs are spiraling upward. The population of the United States is aging, and many baby boomers will develop multiple chronic health conditions. Disease management is one method for reducing costs associated with chronic health conditions. Although these programs have been proven effective in improving patient health, detailed information about their effect on patient quality of life has been scarce. This article provides preliminary evidence that disease management programs for coronary artery disease, chronic obstructive pulmonary disease, diabetes, and heart failure lead to improved quality of life, which correlates with a healthier, more satisfied, and less costly patient.

Is disease management relevant in Europe: some evidence from the United Kingdom.

PubMed

Mason, A; Drummond, M; Towse, A

1999-07-01

Actions or approaches by the pharmaceutical industry, going under the general label 'disease management', have become very popular in the USA. However, there appears to be uncertainty about what exactly 'disease management' is and about the extent to which it can be applied in Europe. A postal questionnaire on disease management was sent out to senior personnel in the UK NHS and pharmaceutical industry. The survey aimed to explore the meaning of the term 'disease management' and its relevance to the NHS, assessing how perspectives differed between the two groups of respondents. Views on the barriers to the increase of disease management within the NHS were also sought. Finally, respondents were asked to indicate any involvement in joint disease management ventures. Most respondents agreed that disease management included estimating the total cost of managing a disease (92%) and the devising of clinical guidelines (97%). When asked about the particular role a pharmaceutical company might play, the level of agreement dropped in both groups of respondents, but by a greater degree in the NHS group. In defining disease management for themselves, just 4% of respondents referred to a 'partnership' between the NHS and the pharmaceutical industry. It would seem that, for the majority of respondents, 'joint ventures' are a possible, but not a necessary, means of undertaking disease management. Almost 30% of NHS respondents and 55% of industry respondents indicated that their Authority or company had experience of a joint venture in disease management. The major perceived barrier to an increase in disease management was NHS suspicion of pharmaceutical companies (86% of all respondents), with the difficulty in drawing up contracts coming a close second (79%).

High-impact animal health research conducted at the USDA's National Animal Disease Center.

PubMed

Bannantine, John P; Olsen, Steven C; Kehrli, Marcus E; Stanton, Thad B; Casas, Eduardo; Whipple, Diana L; Zuelke, Kurt A

2013-08-30

Commissioned by President Dwight Eisenhower in 1958 and opened with a dedication ceremony in December 1961, the USDA, Agricultural Research Service (ARS), National Animal Disease Center (NADC) celebrated its 50-year anniversary in November 2011. Over these 50 years, the NADC established itself among the world's premier animal health research centers. Its historic mission has been to conduct basic and applied research on selected endemic diseases of economic importance to the U.S. livestock and poultry industries. Research from NADC has impacted control or management efforts on nearly every major animal disease in the United States since 1961. For example, diagnostic tests and vaccines developed by NADC scientists to detect and prevent hog cholera were integral in the ultimate eradication of this costly swine disease from the U.S. Most major veterinary vaccines for critical diseases such as brucellosis and leptospirosis in cattle, porcine respiratory and reproductive syndrome (PRRS), porcine parvovirus and influenza in swine had their research origins or were developed and tested at the NADC. Additional discoveries made by NADC scientists have also resulted in the development of a nutritional approach and feed additives to prevent milk fever in transition dairy cattle. More recently, NADC's archive of historic swine influenza viruses combined with an established critical mass of influenza research expertise enabled NADC researchers to lead an effective national research response to the pandemic associated with the novel 2009 H1N1 influenza virus. This review commemorates some of the key animal health contributions in NADC's first 50 years, recaps the newly completed modernization of the center into new facilities, and offers highlights of the ongoing research that will define NADC's mission going forward. Published by Elsevier B.V.

Periodontal management of patients with cardiovascular diseases.

PubMed

2002-08-01

Periodontists are often called upon to provide periodontal therapy for patients with a variety of cardiovascular diseases. Safe and effective periodontal treatment requires a general understanding of the underlying cardiovascular diseases, their medical management, and necessary modifications to dental/periodontal therapy that may be required. In this informational paper more common cardiovascular disorders will be discussed and dental management considerations briefly described. This paper is intended for the use of periodontists and members of the dental profession.

Using Data to Effectively Manage a National Screening Program

PubMed Central

Yancy, Brandie; Royalty, Janet E.; Marroulis, Steve; Mattingly, Cindy; Benard, Vicki B.; DeGroff, Amy

2015-01-01

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) is implemented through cooperative agreements with state health departments, US territories, and tribal health organizations (grantees). Grantees typically contract with clinicians and other providers to deliver breast and cervical cancer screening and diagnostic services. As required by the CDC, grantees report biannually a subset of patient and clinical level program data known as the Minimum Data Elements. Rigorous processes are in place to ensure the completeness and quality of program data collection. In this article, the authors describe the NBCCEDP data-collection processes and data management system and discusses how data are used for 1) program monitoring and improvement, 2) evaluation and research, and 3) policy development and analysis. They also provide 2 examples of how grantees use data to improve their performance. PMID:25099900

77 FR 472 - National Advisory Committee for Implementation of the National Forest System Land Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-05

... DEPARTMENT OF AGRICULTURE Forest Service National Advisory Committee for Implementation of the National Forest System Land Management Planning Rule; Correction AGENCY: USDA Forest Service. ACTION... for the deaf (TDD) may call the Federal Information Relay Service (FIRS) at 1 (800) 877-8339 between 8...

Management of coronary artery disease

NASA Astrophysics Data System (ADS)

Safri, Z.

2018-03-01

Coronary Artery Disease (CAD) is associated with significant morbidity and mortality, therefore it’s important to early and accurate detection and appropriate management. Diagnosis of CAD include clinical examination, noninvasive techniques such as biochemical testing, a resting ECG, possibly ambulatory ECG monitoring, resting echocardiography, chest X-ray in selected patients; and catheterization. Managements of CAD patients include lifestyle modification, control of CAD risk factors, pharmacologic therapy, and patient education. Revascularization consists of percutaneous coronary angioplasty and coronary artery bypass grafting. Cardiac rehabilitation should be considered in all patients with CAD. This comprehensive review highlights strategies of management in patients with CAD.

A 21st Century approach to chronic disease management in the United Kingdom: implications for nurse education.

PubMed

Astin, Felicity; Closs, S José; Lascelles, Margaret

2005-12-01

Chronic diseases are the leading cause of death and disability worldwide. An ageing population in prosperous countries has led to an increase in the number of people living with one or more chronic conditions; a trend which is predicted to worsen. Other 'new' epidemics such as obesity, combined with scarce economic resources, have provided impetus for a review of care provision for those living with chronic diseases in the UK. The new 'National Health Service (NHS) and Social Care Long Term Conditions Model' represents a cultural shift as patient and carer are scripted as central in managing their chronic disease, supported rather than directed by a health and social care team. The patient as a passive recipient of care is no longer viable in this approach to care delivery. It has been acknowledged that cultural shift within the NHS is required for these initiatives to be successful. Nurse educators have the potential to play a key role in supporting nurses to fully engage in the modernised chronic disease management initiative. This paper outlines the main features of the contemporary approach to chronic disease management, together with relevant UK policy changes. The implications of these changes for nurse education will be considered.

Managing care.

PubMed

Sandifer, Q D

1997-09-01

The terms 'managed care' and 'disease management' are gaining common usage in the health service but their meaning is not widely understood. Managed care is a generic term describing any health care system that integrates the financing and delivery of medical care. Its growth in the United States has been driven by pressure to control costs, and there is circumstantial evidence that costs are slowing as a result of better management of resources. However, it is not clear how much of this is due to managed care, the selection of more favourable enrollees to health plans or other factors. Research evidence is limited, and that available is constrained by the rapidly changing nature of managed care. In the United States a bewildering variety of managed care arrangements have emerged, although several common characteristics can be identified: limited choice of physician providers; controlled access to secondary care; selective contracting; financial incentives; quality management; and utilization management. All are present in the National Health Service (NHS), which exemplifies a nationalized managed care system. Disease management is an extension of managed care that takes a global approach to patient care by attempting to co-ordinate resources across the entire health care delivery system throughout the life cycle of the disease. This is poorly developed in the NHS, so that the attention of commercial organizations has been attracted. However, concern has been expressed about the implications of commercial involvement: the fragmentation of general medical services; effect of for-profit status; and use of patient-based data. Recent policy developments could allow disease management to develop within the NHS.

Management of inflammatory bowel disease.

PubMed

Nayar, M; Rhodes, J M

2004-04-01

Ulcerative colitis and Crohn's disease result from an interaction between genetic and environmental factors. Only one gene, NOD2/CARD15, has been clearly identified; a minority of people with alteration of this gene develop Crohn's disease. The NOD2/CARD15 protein is thought to be involved in defence against intracellular bacteria. This supports the idea that Crohn's disease and ulcerative colitis result from altered immunological responses to the normal intestinal flora. Life expectancy is normal in ulcerative colitis and nearly so in Crohn's disease, but both conditions cause considerable morbidity. Approximately 80% of patients with Crohn's disease eventually require surgery, and about 25% of patients with ulcerative colitis require colectomy. Treatment of ulcerative colitis is generally by corticosteroids for acute disease and mesalazine for maintenance, but the range of therapies for Crohn's disease is expanding. Alternative therapies include immunosuppressives, enteral nutrition, antibiotics, anti-TNF antibody (infliximab), corticosteroids, and surgery. High dosages of corticosteroids may provide symptomatic relief in Crohn's disease but do not affect the long term natural history of the disease, and management strategies should avoid using steroids whenever possible.

Fistulizing Crohn’s disease: Diagnosis and management

PubMed Central

Gecse, Krisztina; Khanna, Reena; Stoker, Jaap; Jenkins, John T; Gabe, Simon; Hahnloser, Dieter

2013-01-01

Fistulizing Crohn’s disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn’s disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery. PMID:24917961

76 FR 38685 - Draft General Management Plan Amendment/Environmental Impact Statement, Tumacacori National...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

... experience at Tumacacori by developing access to these associated mission resources. A general management... DEPARTMENT OF THE INTERIOR National Park Service Draft General Management Plan Amendment... Management Plan, Tumacacori National Historical Park, in favor of an Environmental Assessment. SUMMARY: The...

Participation of general practitioners in disease management: experiences from the Netherlands

PubMed Central

Steuten, L.M.G.; Vrijhoef, H.J.M.; Spreeuwenberg, C.; Van Merode, G.G.

2002-01-01

Abstract Objective To investigate the extent to which GPs in the Netherlands participate in disease management and how personal opinions, impeding and promoting incentives as well as physician characteristics influence their attitude towards disease management. Methods The attitude-model of Fishbein and Ajzen was used to describe the attitude of GPs towards disease management and main influencing factors. After interviewing seventeen representatives of the GPs and testing a questionnaire, the final questionnaire was sent to all GPs in the Netherlands (7680 GPs) barring those involved in the testing of the questionnaire. Results At least 10.4% of all Dutch GPs are active in disease management. The main factors predicting a positive attitude towards disease management are the following: GPs' opinion that they are improving quality and efficiency of care when executing disease management, presence of a good quality network between actors involved prior to the start of disease management, working in a health centre, and performing sideline activities besides their daily activities as GPs. The main factors predicting a negative attitude are: GPs' opinion that the investment-time is too high, lack of reimbursement for disease management activities, working in a solo practice, and not performing any sideline activities beside their daily activities as GP. Conclusions The factors predicting a negative attitude of Dutch GPs towards disease management dominate the factors predicting a positive attitude. The arguments in favour of disease management are matters of belief, for example concerning improvements in the quality of care, while arguments against are more concrete barriers e.g. high workload and financial reimbursement. Placed on the innovation timeline, the 10.4% participation might be taken to represent the start of a trend. PMID:16896373

National Athletic Trainers' Association Position Statement: Skin Diseases

PubMed Central

Zinder, Steven M.; Basler, Rodney S. W.; Foley, Jack; Scarlata, Chris; Vasily, David B.

2010-01-01

Abstract Objective: To present recommendations for the prevention, education, and management of skin infections in athletes. Background: Trauma, environmental factors, and infectious agents act together to continually attack the integrity of the skin. Close quarters combined with general poor hygiene practices make athletes particularly vulnerable to contracting skin diseases. An understanding of basic prophylactic measures, clinical features, and swift management of common skin diseases is essential for certified athletic trainers to aid in preventing the spread of infectious agents. Recommendations: These guidelines are intended to provide relevant information on skin infections and to give specific recommendations for certified athletic trainers and others participating in athletic health care. PMID:20617918

A randomized trial of an acid-peptic disease management program in a managed care environment.

PubMed

Ofman, Joshua J; Segal, Richard; Russell, Wayne L; Cook, Deborah J; Sandhu, Meenu; Maue, Susan K; Lowenstein, Edward H; Pourfarzib, Ray; Blanchette, Erv; Ellrodt, Gray; Weingarten, Scott R

2003-06-01

To study the effectiveness of a disease management program for patients with acid-related disorders. A cluster-randomized clinical trial of 406 patients comparing a disease management program with "usual practice." Enrolled patients included those presenting with new dyspepsia and chronic users of antisecretory drugs in 8 geographically separate physician offices associated with the Orlando Health Care Group. There were 35 providers in the intervention group and 48 in the control group. The disease management program included evidence-based practice guidelines implemented by using physician champions, academic detailing, and multidisciplinary teams. Processes of care, patient symptoms, quality of life, costs, and work days lost were measured 6 months after patient enrollment. Compared with usual practice, disease management was associated with improvements in Helicobacter pylori testing (61% vs 9%; P = .001), use of recommended H pylori treatment regimens (96% vs 10%; P = .001), and discontinuation rates of proton pump therapy after treatment (70% vs 36%; P = .04). There were few differences in patient quality of life or symptoms between the 2 study groups. Disease management resulted in fewer days of antisecretory therapy (71.7 vs 88.1 days; P = .02) but no difference in total costs. This disease management program for patients with acid-related disorders led to improved processes of care. The effectiveness of such a program in other settings requires further study.

Systems for the management of respiratory disease in primary care--an international series: United Kingdom.

PubMed

Worth, Allison; Pinnock, Hilary; Fletcher, Monica; Hoskins, Gaylor; Levy, Mark L; Sheikh, Aziz

2011-03-01

The UK National Health Service (NHS) is essentially publicly funded through general taxation. Challenges facing the NHS include the rise in prevalence of long-term conditions and financial pressures. NATIONAL POLICY TRENDS: Political devolution within the UK has led to variations in the way services are organised and delivered between the four nations. PRIMARY CARE RESPIRATORY SERVICES IN THE UK: Primary care is the first point of contact with services. Most respiratory conditions are managed here, including prevention, diagnosis, treatment and palliative care. Respiratory disease accounts for more primary care consultations than any other type of illness, with 24 million consultations annually. Equitable access to care is an ongoing challenge: telehealthcare is being tried as a possible solution for monitoring of asthma and COPD. REFERRAL AND ACCESS TO SPECIALIST CARE: Referrals for specialist advice are usually to a secondary care respiratory physician, though respiratory General Practitioners with a Special Interest (GPwSIs) are an option in some localities. Prevalence of asthma and COPD is high. Asthma services are predominantly nurse-led. Self-management strategies are widely promoted but poorly implemented. COPD is high on the policy agenda with a shift in focus to preventive lung health and longterm condition management.

Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review.

PubMed

Ofman, Joshua J; Badamgarav, Enkhe; Henning, James M; Knight, Kevin; Gano, Anacleto D; Levan, Rebecka K; Gur-Arie, Shoval; Richards, Margaret S; Hasselblad, Vic; Weingarten, Scott R

2004-08-01

To assess the clinical and economic effects of disease management in patients with chronic diseases. Electronic databases were searched for English-language articles from 1987 to 2001. Articles were included if they used a systematic approach to care and evaluated patients with chronic disease, reported objective measurements of the processes or outcomes of care, and employed acceptable experimental or quasi-experimental study designs as defined by the Cochrane Effective Practice and Organization of Care Group. Two reviewers evaluated 16,917 titles and identified 102 studies that met the inclusion criteria. Identified studies represented 11 chronic conditions: depression, diabetes, rheumatoid arthritis, chronic pain, coronary artery disease, asthma, heart failure, back pain, chronic obstructive pulmonary disease, hypertension, and hyperlipidemia. Disease management programs for patients with depression had the highest percentage of comparisons (48% [41/86]) showing substantial improvements in patient care, whereas programs for patients with chronic obstructive pulmonary disease (9% [2/22]) or chronic pain (8% [1/12]) appeared to be the least effective. Of the outcomes more frequently studied, disease management appeared to improve patient satisfaction (71% [12/17]), patient adherence (47% [17/36]), and disease control (45% [33/74]) most commonly and cost-related outcomes least frequently (11% to 16%). Disease management programs were associated with marked improvements in many different processes and outcomes of care. Few studies demonstrated a notable reduction in costs. Further research is needed to understand how disease management can most effectively improve the quality and cost of care for patients with chronic diseases.

Integrated disease management: a critical review of foreign and Portuguese experience.

PubMed

Coelho, Anabela; Leone, Cláudia; Ribeiro, Vanessa; Sá Moreira, Pedro; Dussault, Gilles

2014-01-01

The present article reviews findings from empirical evaluations of integrated disease management programmes. The objective is to provide insights on integration levels, priority interventions and their effect on patient outcomes. The literature review identified 1 251 articles, published from 2006 to 2011. Upon a detailed screening 61 articles were selected for bibliometric analysis and critical discussion. Among several findings, it can be noted that United States of America is the country with the highest amount of published evidence on the subject under study. The most frequently referred disease is diabetes mellitus and the main reported issue of integrated disease management is self-management support. The majority of the studies were developed and exclusively managed by managed care organizations, organized family doctors or hospitals. From a total of 360 interventions reported in studies, patient interventions are the most frequently used across all disease groups, followed by professional interventions. To monitor the effectiveness of the disease programmes, the most frequently used outcomes are patient physiological measures, service use and patient health status. Every country has its own way to implement the integrated disease management strategy. The focus of practice lies on patient empowerment, particularly through self-management. Physiological measures and service use are the outcomes with the highest rate of assessment, which are also the indicators that show higher impact among all integrated disease management programmes. The Portuguese health care system still faces challenges in the coordination and integration of care for patients with chronic disease thus improvements at integrated disease management programmes should be incorporate.

AACE/ACE Disease State Clinical Review: Medical Management of Cushing Disease.

PubMed

Hamrahian, Amir H; Yuen, Kevin C J; Hoffman, Andrew R

2014-07-01

To review available medical therapies for patients with Cushing disease and to provide a roadmap for their use in clinical practice. PubMed searches were performed to identify all of the available published data on medical management of Cushing disease. Medical therapy is usually not the first-line treatment for patients with Cushing disease but may be used to improve clinical manifestations of Cushing disease in patients who are not suitable candidates for surgery, following unsuccessful surgery or recurrence, or as a "bridge therapy" in those who have undergone radiotherapy. Medical therapy may also be used in preoperative preparation of patients with severe disease. Current available medical options for patients with Cushing disease include centrally acting agents, steroidogenesis inhibitors, and a glucocorticoid receptor antagonists. At present, there are no head-to-head studies comparing the efficacy, tolerability, and safety of different U.S. Food and Drug Administration (FDA)- and non-FDA-approved drugs in patients with Cushing disease. With the initiation of new studies and the completion of ongoing clinical trials, the number of FDA-approved drugs for medical treatment of Cushing disease is expected to increase. Medical therapy has an important adjunctive role in the management of patients with Cushing disease. The decision to initiate medical treatment depends on many factors, including patient characteristics and preference. Long-term studies are needed to better define the clinical efficacy, safety, and tolerability of medical treatment of Cushing disease, including the role of combination therapies.

77 FR 44144 - National Forest System Land Management Planning; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-27

... Management Planning; Correction AGENCY: Forest Service, USDA. ACTION: Correcting amendments. SUMMARY: The Department of Agriculture (USDA) published a National Forest System land management planning rule in the... document may be sent to the Director, Ecosystem Management Coordination Staff, USDA Forest Service, 1400...

Sandia National Laboratories, California Environmental Management System program manual.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Larsen, Barbara L.

2012-03-01

The Sandia National Laboratories, California (SNL/CA) Environmental Management System (EMS) Program Manual documents the elements of the site EMS Program. The SNL/CA EMS Program conforms to the International Standard on Environmental Management Systems, ISO 14001:2004and Department of Energy (DOE) Order 436.1. Sandia National Laboratories, California (SNL/CA) has maintained functional environmental programs to assist with regulatory compliance for more than 30 years. During 2005, these existing programs were rolled into a formal environmental management system (EMS) that expands beyond the traditional compliance focus to managing and improving environmental performance and stewardship practices for all site activities. An EMS is a setmore » of inter-related elements that represent a continuing cycle of planning, implementing, evaluating, and improving processes and actions undertaken to achieve environmental policy and goals. The SNL/CA EMS Program conforms to the International Standard for Environmental Management Systems, ISO 14001:2004 (ISO 2004). The site first received ISO 14001 certification in September 2006 and recertification in 2009. SNL/CA's EMS Program is applicable to the Sandia, Livermore site only. Although SNL/CA operates as one organizational division of the overall Sandia National Laboratories, the EMS Program is site-specific, with site-specific objectives and targets. SNL/CA (Division 8000) benefits from the organizational structure as it provides corporate level policies, procedures, and standards, and established processes that connect to and support elements of the SNL/CA EMS Program. Additionally, SNL/CA's EMS Program benefits from two corporate functional programs (Facilities Energy and Water Resource Management and Fleet Services programs) that maintain responsibility for energy management and fleet services for all Sandia locations. Each EMS element is further enhanced with site-specific processes and standards. Division 8000 has

Idaho National Laboratory Cultural Resource Management Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lowrey, Diana Lee

As a federal agency, the U.S. Department of Energy has been directed by Congress, the U.S. president, and the American public to provide leadership in the preservation of prehistoric, historic, and other cultural resources on the lands it administers. This mandate to preserve cultural resources in a spirit of stewardship for the future is outlined in various federal preservation laws, regulations, and guidelines such as the National Historic Preservation Act, the Archaeological Resources Protection Act, and the National Environmental Policy Act. The purpose of this Cultural Resource Management Plan is to describe how the Department of Energy, Idaho Operations Officemore » will meet these responsibilities at the Idaho National Laboratory. This Laboratory, which is located in southeastern Idaho, is home to a wide variety of important cultural resources representing at least 13,500 years of human occupation in the southeastern Idaho area. These resources are nonrenewable; bear valuable physical and intangible legacies; and yield important information about the past, present, and perhaps the future. There are special challenges associated with balancing the preservation of these sites with the management and ongoing operation of an active scientific laboratory. The Department of Energy, Idaho Operations Office is committed to a cultural resource management program that accepts these challenges in a manner reflecting both the spirit and intent of the legislative mandates. This document is designed for multiple uses and is intended to be flexible and responsive to future changes in law or mission. Document flexibility and responsiveness will be assured through annual reviews and as-needed updates. Document content includes summaries of Laboratory cultural resource philosophy and overall Department of Energy policy; brief contextual overviews of Laboratory missions, environment, and cultural history; and an overview of cultural resource management practices. A series of

Idaho National Laboratory Cultural Resource Management Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lowrey, Diana Lee

2009-02-01

As a federal agency, the U.S. Department of Energy has been directed by Congress, the U.S. president, and the American public to provide leadership in the preservation of prehistoric, historic, and other cultural resources on the lands it administers. This mandate to preserve cultural resources in a spirit of stewardship for the future is outlined in various federal preservation laws, regulations, and guidelines such as the National Historic Preservation Act, the Archaeological Resources Protection Act, and the National Environmental Policy Act. The purpose of this Cultural Resource Management Plan is to describe how the Department of Energy, Idaho Operations Officemore » will meet these responsibilities at the Idaho National Laboratory. This Laboratory, which is located in southeastern Idaho, is home to a wide variety of important cultural resources representing at least 13,500 years of human occupation in the southeastern Idaho area. These resources are nonrenewable; bear valuable physical and intangible legacies; and yield important information about the past, present, and perhaps the future. There are special challenges associated with balancing the preservation of these sites with the management and ongoing operation of an active scientific laboratory. The Department of Energy, Idaho Operations Office is committed to a cultural resource management program that accepts these challenges in a manner reflecting both the spirit and intent of the legislative mandates. This document is designed for multiple uses and is intended to be flexible and responsive to future changes in law or mission. Document flexibility and responsiveness will be assured through annual reviews and as-needed updates. Document content includes summaries of Laboratory cultural resource philosophy and overall Department of Energy policy; brief contextual overviews of Laboratory missions, environment, and cultural history; and an overview of cultural resource management practices. A series of

Patient satisfaction measurement in the disease management industry.

PubMed

Sen, Shaikat; Fawson, Paul; Cherrington, Graham; Douglas, Kathleen; Friedman, Neal; Maljanian, Rose; Fitzner, Karen; Tang, Pei; Soper, Steven; Wood, Steven

2005-10-01

In mid-2004, the Disease Management Association of America (DMAA) Patient Satisfaction Workgroup in association with J.D. Power and Associates (JDPA) conducted a literature review and a member survey to gain an understanding of the nature of patient satisfaction measurement as it pertains to disease management (DM) programs within the DM industry. A review of the relevant literature indicates that perhaps, with the exception of diabetes disease management, there are no prevalent, systematic, or statistically validated approaches for measuring patient satisfaction within the disease management industry. Most existing studies tend to focus on the effectiveness of a disease management program on clinical outcomes, with patient satisfaction measured only as a part of a battery of "outcome" measures. However, many of these studies do find positive associations between patient satisfaction and clinical outcomes. A majority of the 49 respondents who completed the member feedback survey hold relatively high positions in their organizations. The vast majority of respondents indicate their organizations conduct patient satisfaction surveys that assess overall satisfaction, satisfaction with materials and information provided, and with staff members. Patient satisfaction surveys are most common among the five common chronic diseases: diabetes, asthma, congestive heart failure (CHF), coronary artery disease (CAD), and chronic obstructive pulmonary disease (COPD). More than three in four respondents agree that patient satisfaction measurement is important to the long-term success of their programs. Respondents also indicate that along with intelligence on patients' overall satisfaction with the program, they would also like to gain an understanding of whether or not their programs actually help manage the patient's medical condition. Eight survey instruments currently in use and submitted by study participants were also reviewed. Most of these instruments are relatively short

Drinking Water State Revolving Fund National Information Management System Reports

EPA Pesticide Factsheets

The Drinking Water State Revolving Fund (DWSRF) National Information Management System collects information that provide a record of progress and accountability for the program at both the State and National level.

76 FR 68179 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-03

... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... November 14, 2011, of the Environmental Management Site-Specific Advisory Board, Idaho National Laboratory...: Robert L. Pence, Federal Coordinator, Department of Energy, Idaho Operations Office, 1955 Fremont Avenue...

Knowledge insufficient: the management of haemoglobin SC disease.

PubMed

Pecker, Lydia H; Schaefer, Beverly A; Luchtman-Jones, Lori

2017-02-01

Although haemoglobin SC (HbSC) accounts for 30% of sickle cell disease (SCD) in the United States and United Kingdom, evidence-based guidelines for genotype specific management are lacking. The unique pathology of HbSC disease is complex, characterized by erythrocyte dehydration, intracellular sickling and increased blood viscosity. The evaluation and treatment of patients with HbSC is largely inferred from studies of SCD consisting mostly of haemoglobin SS (HbSS) patients. These studies are underpowered to allow definitive conclusions about HbSC. We review the pathophysiology of HbSC disease, including known and potential differences between HbSS and HbSC, and highlight knowledge gaps in HbSC disease management. Clinical and translational research is needed to develop targeted treatments and to validate management recommendations for efficacy, safety and impact on quality of life for people with HbSC. © 2016 John Wiley & Sons Ltd.

Disease management: panacea, another false hope, or something in between?

PubMed

Geyman, John P

2007-01-01

Disease management is being promulgated by many policy makers, legislators, and a burgeoning new disease management industry as the next major hope, together with information technology and consumer-directed health care, to bring cost containment to runaway costs of health care. Many expect quality improvement as well. The concept is being aggressively marketed to employers, health plans, and government in the wake of managed care's failure to contain costs. There is widespread confusion, however, about what disease management is and what impact it will have on patients, physicians, and the health care system itself. In this article I give a current snapshot of disease management by briefly addressing (1) its rationale and growth, (2) its track record concerning costs and quality of care, and (3) its impacts on primary care.

Disease Management: Panacea, Another False Hope, or Something in Between?

PubMed Central

Geyman, John P.

2007-01-01

Disease management is being promulgated by many policy makers, legislators, and a burgeoning new disease management industry as the next major hope, together with information technology and consumer-directed health care, to bring cost containment to runaway costs of health care. Many expect quality improvement as well. The concept is being aggressively marketed to employers, health plans, and government in the wake of managed care’s failure to contain costs. There is widespread confusion, however, about what disease management is and what impact it will have on patients, physicians, and the health care system itself. In this article I give a current snapshot of disease management by briefly addressing (1) its rationale and growth, (2) its track record concerning costs and quality of care, and (3) its impacts on primary care. PMID:17548854

Communicating the role of silviculture in managing the national forests: Proceedings of the National Silviculture Workshop

Treesearch

Northeastern Forest Experiment Station

1997-01-01

Contains 32 articles on communicating the values and benefits of silviculture in managing the national forests. Specific topics addressed are how communications affect: policymakers, inventory and monitoring, resource management, research, education and demonstration, and partnerships.

75 FR 19408 - National Institute of Allergy and Infectious Diseases; Notice of Closed Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-14

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal..., Immunology, and Transplantation Research; 93.856, Microbiology and Infectious Diseases Research, National...

Wildfire exposure and fuel management on western US national forests.

PubMed

Ager, Alan A; Day, Michelle A; McHugh, Charles W; Short, Karen; Gilbertson-Day, Julie; Finney, Mark A; Calkin, David E

2014-12-01

Substantial investments in fuel management activities on national forests in the western US are part of a national strategy to reduce human and ecological losses from catastrophic wildfire and create fire resilient landscapes. Prioritizing these investments within and among national forests remains a challenge, partly because a comprehensive assessment that establishes the current wildfire risk and exposure does not exist, making it difficult to identify national priorities and target specific areas for fuel management. To gain a broader understanding of wildfire exposure in the national forest system, we analyzed an array of simulated and empirical data on wildfire activity and fuel treatment investments on the 82 western US national forests. We first summarized recent fire data to examine variation among the Forests in ignition frequency and burned area in relation to investments in fuel reduction treatments. We then used simulation modeling to analyze fine-scale spatial variation in burn probability and intensity. We also estimated the probability of a mega-fire event on each of the Forests, and the transmission of fires ignited on national forests to the surrounding urban interface. The analysis showed a good correspondence between recent area burned and predictions from the simulation models. The modeling also illustrated the magnitude of the variation in both burn probability and intensity among and within Forests. Simulated burn probabilities in most instances were lower than historical, reflecting fire exclusion on many national forests. Simulated wildfire transmission from national forests to the urban interface was highly variable among the Forests. We discuss how the results of the study can be used to prioritize investments in hazardous fuel reduction within a comprehensive multi-scale risk management framework. Published by Elsevier Ltd.

75 FR 24685 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory... prior to the meeting. ADDRESSES: Hilton Garden Inn, 700 Lindsay Boulevard, Idaho Falls, Idaho 83402. FOR...

77 FR 38276 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... a meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National... times prior to the meeting. ADDRESSES: Red Lion Hotel, 1555 Pocatello Creek Road, Pocatello, Idaho 83201...

Livestock Disease Management for Trading Across Different Regulatory Regimes.

PubMed

Bate, Andrew M; Jones, Glyn; Kleczkowski, Adam; Naylor, Rebecca; Timmis, Jon; White, Piran C L; Touza, Julia

2018-02-12

The maintenance of livestock health depends on the combined actions of many different actors, both within and across different regulatory frameworks. Prior work recognised that private risk management choices have the ability to reduce the spread of infection to trading partners. We evaluate the efficiency of farmers' alternative biosecurity choices in terms of their own-benefits from unilateral strategies and quantify the impact they may have in filtering the disease externality of trade. We use bovine viral diarrhoea (BVD) in England and Scotland as a case study, since this provides an example of a situation where contrasting strategies for BVD management occur between selling and purchasing farms. We use an agent-based bioeconomic model to assess the payoff dependence of farmers connected by trade but using different BVD management strategies. We compare three disease management actions: test-cull, test-cull with vaccination and vaccination alone. For a two-farm trading situation, all actions carried out by the selling farm provide substantial benefits to the purchasing farm in terms of disease avoided, with the greatest benefit resulting from test-culling with vaccination on the selling farm. Likewise, unilateral disease strategies by purchasers can be effective in reducing disease risks created through trade. We conclude that regulation needs to balance the trade-off between private gains from those bearing the disease management costs and the positive spillover effects on others.

National Priority Setting of Clinical Practice Guidelines Development for Chronic Disease Management.

PubMed

Jo, Heui-Sug; Kim, Dong Ik; Oh, Moo-Kyung

2015-12-01

By November 2013, a total of 125 clinical practice guidelines (CPGs) have been developed in Korea. However, despite the high burden of diseases and the clinical importance of CPGs, most chronic diseases do not have available CPGs. Merely 83 CPGs are related to chronic diseases, and only 40 guidelines had been developed in the last 5 yr. Considering the rate of the production of new evidence in medicine and the worsening burden from chronic diseases, the need for developing CPGs for more chronic diseases is becoming increasingly pressing. Since 2011, the Korean Academy of Medical Sciences and the Korea Centers for Disease Control and Prevention have been jointly developing CPGs for chronic diseases. However, priorities have to be set and resources need to be allocated within the constraint of a limited funding. This study identifies the chronic diseases that should be prioritized for the development of CPGs in Korea. Through an objective assessment by using the analytic hierarchy process and a subjective assessment with a survey of expert opinion, high priorities were placed on ischemic heart disease, cerebrovascular diseases, Alzheimer's disease and other dementias, osteoarthritis, neck pain, chronic kidney disease, and cirrhosis of the liver.

Management of vaccinations in Italy: a national survey after healthcare regionalization.

PubMed

Garattini, Livio; Padula, Anna; Casadei, Gianluigi

2011-01-01

The main aim of this study was to describe the effects of regional organization and performance in managing vaccinations, in the light of the institutional devolution recently introduced in Italy. We analysed (1) the general organization of regions for vaccination programmes, (2) the management of four vaccination programmes (combined measles-rubella-parotitis, varicella for children, influenza, and pneumococcal 23-valent for adults). First, we conducted preliminary face-to-face interviews with 16 regional managers of the infective disease prevention departments. Subsequently, we sent them a standardized questionnaire to obtain comparable information on general organization and on the four specific vaccination programmes considered. In all, 14 regions were eventually included. The survey showed a widespread lack of regional staff involved in the management of vaccinations and a geographical variation in the availability of computerized data collection. We recorded poor coverage for varicella and pneumococcal 23-valent vaccinations compared to MRP and influenza. Prices of the four vaccines varied widely among regions, with only a weak correlation between prices and volumes. The major limitation of the survey was the lack of information available at regional level. The piecemeal diffusion of computerized systems and the widespread lack of sufficient staff should mainly explain this. Economic incentives could be offered to regions that achieve national targets. Such incentives should encourage collaboration between central and regional authorities consistent with institutional trends in regional devolution.

Large-Scale Data Collection Metadata Management at the National Computation Infrastructure

NASA Astrophysics Data System (ADS)

Wang, J.; Evans, B. J. K.; Bastrakova, I.; Ryder, G.; Martin, J.; Duursma, D.; Gohar, K.; Mackey, T.; Paget, M.; Siddeswara, G.

2014-12-01

Data Collection management has become an essential activity at the National Computation Infrastructure (NCI) in Australia. NCI's partners (CSIRO, Bureau of Meteorology, Australian National University, and Geoscience Australia), supported by the Australian Government and Research Data Storage Infrastructure (RDSI), have established a national data resource that is co-located with high-performance computing. This paper addresses the metadata management of these data assets over their lifetime. NCI manages 36 data collections (10+ PB) categorised as earth system sciences, climate and weather model data assets and products, earth and marine observations and products, geosciences, terrestrial ecosystem, water management and hydrology, astronomy, social science and biosciences. The data is largely sourced from NCI partners, the custodians of many of the national scientific records, and major research community organisations. The data is made available in a HPC and data-intensive environment - a ~56000 core supercomputer, virtual labs on a 3000 core cloud system, and data services. By assembling these large national assets, new opportunities have arisen to harmonise the data collections, making a powerful cross-disciplinary resource.To support the overall management, a Data Management Plan (DMP) has been developed to record the workflows, procedures, the key contacts and responsibilities. The DMP has fields that can be exported to the ISO19115 schema and to the collection level catalogue of GeoNetwork. The subset or file level metadata catalogues are linked with the collection level through parent-child relationship definition using UUID. A number of tools have been developed that support interactive metadata management, bulk loading of data, and support for computational workflows or data pipelines. NCI creates persistent identifiers for each of the assets. The data collection is tracked over its lifetime, and the recognition of the data providers, data owners, data

Translating national level forest service goals to local level land management: carbon sequestration

Treesearch

Steven McNulty; Emrys Treasure; Lisa Jennings; David Meriwether; David Harris; Paul Arndt

2017-01-01

The USDA Forest Service has many national level policies related to multiple use management. However, translating national policy to stand level forest management can be difficult. As an example of how a national policy can be put into action, we examined three case studies in which a desired future condition is evaluated at the national, region, and local scale. We...

Exploring National Environmental Policy Act processes across federal land management agencies

Treesearch

Marc J. Stern; Michael J. Mortimer

2009-01-01

Broad discretion is granted at all levels throughout federal land management agencies regarding compliance with the National Environmental Policy Act (NEPA). We explored the diversity of procedures employed in NEPA processes across four agencies, the USDA Forest Service, The USDI National Park Service and Bureau of Land Management, and the U.S. Army Corps of Engineers...

Exploring self-efficacy as a predictor of disease management.

PubMed

Clark, N M; Dodge, J A

1999-02-01

Self-efficacy is posited in social cognitive theory as fundamental to behavior change. Few health behavior studies have examined self-efficacy prospectively, viewed it as part of a reciprocal behavioral process, or compared self-efficacy beliefs in the same population across different behaviors. This article first discusses self-efficacy in its theoretical context and reviews the available prospective studies. Second, it explores self-efficacy as a predictor of disease management behaviors in 570 older women with heart disease. Although the R2 statistics in each case were modest, the construct is shown to be a statistically significant (p<.05) predictor at both 4 and 12 months postbaseline of several disease management behaviors: using medicine as prescribed, getting adequate exercise, managing stress, and following a recommended diet. Building self-efficacy is likely a reasonable starting point for interventions aiming to enhance heart disease management behaviors of mature female patients.

Organizing national responses for rare blood disorders: the Italian experience with sickle cell disease in childhood

PubMed Central

2013-01-01

Background Sickle cell disease (SCD) is the most frequent hemoglobinopathy worldwide but remains a rare blood disorder in most western countries. Recommendations for standard of care have been produced in the United States, the United Kingdom and France, where this disease is relatively frequent because of earlier immigration from Africa. These recommendations have changed the clinical course of SCD but can be difficult to apply in other contexts. The Italian Association of Pediatric Hematology Oncology (AIEOP) decided to develop a common national response to the rising number of SCD patients in Italy with the following objectives: 1) to create a national working group focused on pediatric SCD, and 2) to develop tailored guidelines for the management of SCD that could be accessed and practiced by those involved in the care of children with SCD in Italy. Methods Guidelines, adapted to the Italian social context and health system, were developed by 22 pediatric hematologists representing 54 AIEOP centers across Italy. The group met five times for a total of 128 hours in 22 months; documents and opinions were circulated via web. Results Recommendations regarding the prevention and treatment of the most relevant complications of SCD in childhood adapted to the Italian context and health system were produced. For each topic, a pathway of diagnosis and care is detailed, and a selection of health management issues crucial to Italy or different from other countries is described (i.e., use of alternatives for infection prophylaxis because of the lack of oral penicillin in Italy). Conclusions Creating a network of physicians involved in the day-to-day care of children with SCD is feasible in a country where it remains rare. Providing hematologists, primary and secondary care physicians, and caregivers across the country with web-based guidelines for the management of SCD tailored to the Italian context is the first step in building a sustainable response to a rare but

Wildfire exposure and fuel management on western US national forests

Treesearch

Alan A. Ager; Michelle A. Day; Charles W. McHugh; Karen Short; Julie Gilbertson-Day; Mark A. Finney; David E. Calkin

2014-01-01

Substantial investments in fuel management activities on national forests in the western US are part of a national strategy to reduce human and ecological losses from catastrophic wildfire and create fire resilient landscapes. Prioritizing these investments within and among national forests remains a challenge, partly because a comprehensive assessment that establishes...

Principles for assessing disease management outcomes.

PubMed

Fitzner, Karen; Sidorov, Jaan; Fetterolf, Don; Wennberg, David; Eisenberg, Edward; Cousins, Michael; Hoffman, Joel; Haughton, John; Charlton, Warwick; Krause, David; Woolf, Allen; Mcdonough, Kenneth; Todd, Warren; Fox, Kathe; Plocher, David; Juster, Iver; Stiefel, Matt; Villagra, Victor; Duncan, Ian

2004-01-01

Disease management (DM) is rapidly becoming an important force in the late 20th and early 21st century as a strategy for managing the chronic illness of large populations. Given the increasing visibility of DM programs, the clinical, economic and financial impact of this support are vital to DM program accountability and its acceptance as a solution to the twin challenges of achieving affordable, quality health care. Measuring and reporting outcomes in DM is difficult. DM programs must adapt to local market conditions and customer desires, which in turn limits generalizability, and still account for the overlapping/interlocking/multifaceted nature of the interventions included in any DM program. The Disease Management Association of America convened a Steering Committee to suggest a preferred approach, not a mandated or standardized approach for DM program evaluation. This paper presents the Steering Committee's "Consensus Statement" and "Guiding Principles" for robust evaluation.

Potassium Homeostasis in Health and Disease: A Scientific Workshop Cosponsored by the National Kidney Foundation and the American Society of Hypertension.

PubMed

Kovesdy, Csaba P; Appel, Lawrence J; Grams, Morgan E; Gutekunst, Lisa; McCullough, Peter A; Palmer, Biff F; Pitt, Bertram; Sica, Dominic A; Townsend, Raymond R

2017-12-01

While much emphasis, and some controversy, centers on recommendations for sodium intake, there has been considerably less interest in recommendations for dietary potassium intake, in both the general population and patients with medical conditions, particularly acute and chronic kidney disease. Physiology literature and cohort studies have noted that the relative balance in sodium and potassium intakes is an important determinant of many of the sodium-related outcomes. A noteworthy characteristic of potassium in clinical medicine is the extreme concern shared by many practitioners when confronted by a patient with hyperkalemia. Fear of this often asymptomatic finding limits enthusiasm for recommending potassium intake and often limits the use of renin-angiotensin-aldosterone system blockers in patients with heart failure and chronic kidney diseases. New agents for managing hyperkalemia may alter the long-term management of heart failure and the hypertension, proteinuria, and further function loss in chronic kidney diseases. In this jointly sponsored effort between the American Society of Hypertension and the National Kidney Foundation, 3 panels of researchers and practitioners from various disciplines discussed and summarized current understanding of the role of potassium in health and disease, focusing on cardiovascular, nutritional, and kidney considerations associated with both hypo- and hyperkalemia. Copyright © 2017 Published jointly in American Journal of Kidney Diseases and the Journal of the American society of Hypertension by Elsevier Inc, on behalf of the National Kidney Foundation and the American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

78 FR 13316 - National Forest System Land Management Planning Directives

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-27

... responsibilities. It should be used in conjunction with the FSH. FSH 1909.12--Land Management Planning Handbook... management planning. Forest Service Handbook 1909.15, section 31.12 (57 FR 43208; September 18, 1992... DEPARTMENT OF AGRICULTURE Forest Service RIN 0596-AD06 National Forest System Land Management...

Managing marine disease emergencies in an era of rapid change

PubMed Central

Maynard, Jeffrey; Breyta, Rachel; Carnegie, Ryan B.; Dobson, Andy; Friedman, Carolyn S.; Froelich, Brett; Garren, Melissa; Gulland, Frances M. D.; Heron, Scott F.; Noble, Rachel T.; Revie, Crawford W.; Shields, Jeffrey D.; Vanderstichel, Raphaël; Weil, Ernesto; Wyllie-Echeverria, Sandy; Harvell, C. Drew

2016-01-01

Infectious marine diseases can decimate populations and are increasing among some taxa due to global change and our increasing reliance on marine environments. Marine diseases become emergencies when significant ecological, economic or social impacts occur. We can prepare for and manage these emergencies through improved surveillance, and the development and iterative refinement of approaches to mitigate disease and its impacts. Improving surveillance requires fast, accurate diagnoses, forecasting disease risk and real-time monitoring of disease-promoting environmental conditions. Diversifying impact mitigation involves increasing host resilience to disease, reducing pathogen abundance and managing environmental factors that facilitate disease. Disease surveillance and mitigation can be adaptive if informed by research advances and catalysed by communication among observers, researchers and decision-makers using information-sharing platforms. Recent increases in the awareness of the threats posed by marine diseases may lead to policy frameworks that facilitate the responses and management that marine disease emergencies require. PMID:26880835

Managing marine disease emergencies in an era of rapid change.

PubMed

Groner, Maya L; Maynard, Jeffrey; Breyta, Rachel; Carnegie, Ryan B; Dobson, Andy; Friedman, Carolyn S; Froelich, Brett; Garren, Melissa; Gulland, Frances M D; Heron, Scott F; Noble, Rachel T; Revie, Crawford W; Shields, Jeffrey D; Vanderstichel, Raphaël; Weil, Ernesto; Wyllie-Echeverria, Sandy; Harvell, C Drew

2016-03-05

Infectious marine diseases can decimate populations and are increasing among some taxa due to global change and our increasing reliance on marine environments. Marine diseases become emergencies when significant ecological, economic or social impacts occur. We can prepare for and manage these emergencies through improved surveillance, and the development and iterative refinement of approaches to mitigate disease and its impacts. Improving surveillance requires fast, accurate diagnoses, forecasting disease risk and real-time monitoring of disease-promoting environmental conditions. Diversifying impact mitigation involves increasing host resilience to disease, reducing pathogen abundance and managing environmental factors that facilitate disease. Disease surveillance and mitigation can be adaptive if informed by research advances and catalysed by communication among observers, researchers and decision-makers using information-sharing platforms. Recent increases in the awareness of the threats posed by marine diseases may lead to policy frameworks that facilitate the responses and management that marine disease emergencies require. © 2016 The Author(s).

Medical and surgical management of perianal Crohn’s disease

PubMed Central

Adegbola, Samuel O.; Pisani, Anthea; Sahnan, Kapil; Tozer, Phil; Ellul, Pierre; Warusavitarne, Janindra

2018-01-01

Crohn’s disease is increasingly thought to encompass multiple possible phenotypes. Perianal manifestations account for one such phenotype and represent an independent disease modifier. In its more severe form, perianal Crohn’s disease confers a higher risk of a severe and disabling disease course, relapses, hospital admissions and operations. This, in turn, imposes a considerable burden and disability on patients. Identification of the precise manifestation is important, as management is nuanced, with both medical and surgical components, and is best undertaken in a multidisciplinary setting for both diagnosis and ongoing treatment. The introduction of biologic medication has heralded a significant addition to the management of fistulizing perianal Crohn’s disease in particular, albeit with modest results. It remains a very challenging condition to treat and further work is required to optimize management in this group of patients. PMID:29507460

75 FR 56527 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-16

... DEPARTMENT OF ENERGY Environmental Management Site-Specific Advisory Board, Idaho National... meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory... prior to the meeting. ADDRESSES: Coeur d'Alene Resort, 115 South Second Street, Coeur d'Alene, Idaho...

75 FR 82004 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

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2010-12-29

... Laboratory AGENCY: Department of Energy. ACTION: Notice of open meeting. SUMMARY: This notice announces a meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory...--Radioactive Waste Management. Public Participation: The EM SSAB, Idaho National Laboratory, welcomes the...

78 FR 12747 - Environmental Management Site-Specific Advisory Board, Idaho National Laboratory

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-25

... Laboratory AGENCY: Department of Energy. ACTION: Notice of open meeting. SUMMARY: This notice announces a meeting of the Environmental Management Site-Specific Advisory Board (EM SSAB), Idaho National Laboratory... Management System Public Participation: The EM SSAB, Idaho National Laboratory, welcomes the attendance of...

Return on Investment in Disease Management: A Review

PubMed Central

Goetzel, Ron Z.; Ozminkowski, Ronald J.; Villagra, Victor G.; Duffy, Jennifer

2005-01-01

The results of 44 studies investigating financial impact and return on investment (ROI) from disease management (DM) programs for asthma, congestive heart failure (CHF), diabetes, depression, and multiple illnesses were examined. A positive ROI was found for programs directed at CHF and multiple disease conditions. Some evidence suggests that diabetes programs may save more than they cost, but additional studies are needed. Results are mixed for asthma management programs. Depression management programs cost more than they save in medical expenses, but may save money when considering productivity outcomes. PMID:17288065

Return on investment in disease management: a review.

PubMed

Goetzel, Ron Z; Ozminkowski, Ronald J; Villagra, Victor G; Duffy, Jennifer

2005-01-01

The results of 44 studies investigating financial impact and return on investment (ROI) from disease management (DM) programs for asthma, congestive heart failure (CHF), diabetes, depression, and multiple illnesses were examined. A positive ROI was found for programs directed at CHF and multiple disease conditions. Some evidence suggests that diabetes programs may save more than they cost, but additional studies are needed. Results are mixed for asthma management programs. Depression management programs cost more than they save in medical expenses, but may save money when considering productivity outcomes.

Gene Technology for Papaya Ringspot Virus Disease Management

PubMed Central

Azad, Md. Abul Kalam; Sidik, Nik Marzuki

2014-01-01

Papaya (Carica papaya) is severely damaged by the papaya ringspot virus (PRSV). This review focuses on the development of PRSV resistant transgenic papaya through gene technology. The genetic diversity of PRSV depends upon geographical distribution and the influence of PRSV disease management on a sequence of PRSV isolates. The concept of pathogen-derived resistance has been employed for the development of transgenic papaya, using a coat protein-mediated, RNA-silencing mechanism and replicase gene-mediated transformation for effective PRSV disease management. The development of PRSV-resistant papaya via post-transcriptional gene silencing is a promising technology for PRSV disease management. PRSV-resistant transgenic papaya is environmentally safe and has no harmful effects on human health. Recent studies have revealed that the success of adoption of transgenic papaya depends upon the application, it being a commercially viable product, bio-safety regulatory issues, trade regulations, and the wider social acceptance of the technology. This review discusses the genome and the genetic diversity of PRSV, host range determinants, molecular diagnosis, disease management strategies, the development of transgenic papaya, environmental issues, issues in the adoption of transgenic papaya, and future directions for research. PMID:24757435

Gene technology for papaya ringspot virus disease management.

PubMed

Azad, Md Abul Kalam; Amin, Latifah; Sidik, Nik Marzuki

2014-01-01

Papaya (Carica papaya) is severely damaged by the papaya ringspot virus (PRSV). This review focuses on the development of PRSV resistant transgenic papaya through gene technology. The genetic diversity of PRSV depends upon geographical distribution and the influence of PRSV disease management on a sequence of PRSV isolates. The concept of pathogen-derived resistance has been employed for the development of transgenic papaya, using a coat protein-mediated, RNA-silencing mechanism and replicase gene-mediated transformation for effective PRSV disease management. The development of PRSV-resistant papaya via post-transcriptional gene silencing is a promising technology for PRSV disease management. PRSV-resistant transgenic papaya is environmentally safe and has no harmful effects on human health. Recent studies have revealed that the success of adoption of transgenic papaya depends upon the application, it being a commercially viable product, bio-safety regulatory issues, trade regulations, and the wider social acceptance of the technology. This review discusses the genome and the genetic diversity of PRSV, host range determinants, molecular diagnosis, disease management strategies, the development of transgenic papaya, environmental issues, issues in the adoption of transgenic papaya, and future directions for research.

Chapter 15. Plant pathology and managing wildland plant disease systems

Treesearch

David L. Nelson

2004-01-01

Obtaining specific, reliable knowledge on plant diseases is essential in wildland shrub resource management. However, plant disease is one of the most neglected areas of wildland resources experimental research. This section is a discussion of plant pathology and how to use it in managing plant disease systems.

Multinational corporations and infectious disease: Embracing human rights management techniques.

PubMed

Salcito, Kendyl; Singer, Burton H; Weiss, Mitchell G; Winkler, Mirko S; Krieger, Gary R; Wielga, Mark; Utzinger, Jürg

2014-01-01

Global health institutions have called for governments, international organisations and health practitioners to employ a human rights-based approach to infectious diseases. The motivation for a human rights approach is clear: poverty and inequality create conditions for infectious diseases to thrive, and the diseases, in turn, interact with social-ecological systems to promulgate poverty, inequity and indignity. Governments and intergovernmental organisations should be concerned with the control and elimination of these diseases, as widespread infections delay economic growth and contribute to higher healthcare costs and slower processes for realising universal human rights. These social determinants and economic outcomes associated with infectious diseases should interest multinational companies, partly because they have bearing on corporate productivity and, increasingly, because new global norms impose on companies a responsibility to respect human rights, including the right to health. We reviewed historical and recent developments at the interface of infectious diseases, human rights and multinational corporations. Our investigation was supplemented with field-level insights at corporate capital projects that were developed in areas of high endemicity of infectious diseases, which embraced rights-based disease control strategies. Experience and literature provide a longstanding business case and an emerging social responsibility case for corporations to apply a human rights approach to health programmes at global operations. Indeed, in an increasingly globalised and interconnected world, multinational corporations have an interest, and an important role to play, in advancing rights-based control strategies for infectious diseases. There are new opportunities for governments and international health agencies to enlist corporate business actors in disease control and elimination strategies. Guidance offered by the United Nations in 2011 that is widely embraced

The use and role of predictive systems in disease management.

PubMed

Gent, David H; Mahaffee, Walter F; McRoberts, Neil; Pfender, William F

2013-01-01

Disease predictive systems are intended to be management aids. With a few exceptions, these systems typically do not have direct sustained use by growers. Rather, their impact is mostly pedagogic and indirect, improving recommendations from farm advisers and shaping management concepts. The degree to which a system is consulted depends on the amount of perceived new, actionable information that is consistent with the objectives of the user. Often this involves avoiding risks associated with costly disease outbreaks. Adoption is sensitive to the correspondence between the information a system delivers and the information needed to manage a particular pathosystem at an acceptable financial risk; details of the approach used to predict disease risk are less important. The continuing challenge for researchers is to construct tools relevant to farmers and their advisers that improve upon their current management skill. This goal requires an appreciation of growers' decision calculus in managing disease problems and, more broadly, their overall farm enterprise management.

77 FR 46099 - National Institute of Allergy and Infectious Diseases; Notice of Closed Meetings

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2012-08-02

... Committee: National Institute of Allergy and Infectious Diseases Special Emphasis Panel; NIAID Clinical..., Microbiology and Infectious Diseases Research, National Institutes of Health, HHS) [[Page 46100

A simulation model of hospital management based on cost accounting analysis according to disease.

PubMed

Tanaka, Koji; Sato, Junzo; Guo, Jinqiu; Takada, Akira; Yoshihara, Hiroyuki

2004-12-01

Since a little before 2000, hospital cost accounting has been increasingly performed at Japanese national university hospitals. At Kumamoto University Hospital, for instance, departmental costs have been analyzed since 2000. And, since 2003, the cost balance has been obtained according to certain diseases for the preparation of Diagnosis-Related Groups and Prospective Payment System. On the basis of these experiences, we have constructed a simulation model of hospital management. This program has worked correctly at repeated trials and with satisfactory speed. Although there has been room for improvement of detailed accounts and cost accounting engine, the basic model has proved satisfactory. We have constructed a hospital management model based on the financial data of an existing hospital. We will later improve this program from the viewpoint of construction and using more various data of hospital management. A prospective outlook may be obtained for the practical application of this hospital management model.

78 FR 65344 - National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting

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2013-10-31

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Allergy and Infectious Diseases Special Emphasis Panel, October 30...

78 FR 65343 - National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting

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2013-10-31

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Allergy and Infectious Diseases Special Emphasis Panel, October 15...

78 FR 65348 - National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting

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2013-10-31

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Allergy and Infectious Diseases Special Emphasis Panel, October 31...

78 FR 64962 - National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting

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2013-10-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Allergy and Infectious Diseases Special Emphasis Panel, October 21...

78 FR 64964 - National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting

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2013-10-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Allergy and Infectious Diseases Special Emphasis Panel, October 23...

78 FR 67370 - National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting

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2013-11-12

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Allergy and Infectious Diseases Special Emphasis Panel, October 10...

78 FR 67374 - National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-12

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Amended Notice of Meeting Notice is hereby given of a change in the meeting of the National Institute of Allergy and Infectious Diseases Special Emphasis Panel, October 21...

For what illnesses is a disease management program most effective?

PubMed

Jutkowitz, Eric; Nyman, John A; Michaud, Tzeyu L; Abraham, Jean M; Dowd, Bryan

2015-02-01

We examined the impact of a disease management (DM) program offered at the University of Minnesota for those with various chronic diseases. Differences-in-differences regression equations were estimated to determine the effect of DM participation by chronic condition on expenditures, absenteeism, hospitalizations, and avoidable hospitalizations. Disease management reduced health care expenditures for individuals with asthma, cardiovascular disease, congestive heart failure, depression, musculoskeletal problems, low back pain, and migraines. Disease management reduced hospitalizations for those same conditions except for congestive heart failure and reduced avoidable hospitalizations for individuals with asthma, depression, and low back pain. Disease management did not have any effect for individuals with diabetes, arthritis, or osteoporosis, nor did DM have any effect on absenteeism. Employers should focus on those conditions that generate savings when purchasing DM programs. This study suggests that the University of Minnesota's DM program reduces hospitalizations for individuals with asthma, cardiovascular disease, depression, musculoskeletal problems, low back pain, and migraines. The program also reduced avoidable hospitalizations for individuals with asthma, depression, and low back pain.

Evaluation of the hypertension disease management program in Korea.

PubMed

Kim, Younmi; Lee, Kunsei; Shin, Eunyoung; Kim, Hyeongsu; June, Kyung Ja

2010-07-01

This study evaluated how the Hypertension Disease Management Program (HDMP) affects patient's blood pressure, knowledge, health behaviors, and use of medical services. Evaluation was performed by 2 measures, which were before and after comparison within the management group (n = 210) and comparison between the management group and control group (n = 1050) in 2005. Systolic and diastolic blood pressure of management group significantly decreased from 137.5 and 86.0 mm Hg to 131.2 and 83.8 mm Hg (P < .001, P < .01), respectively. Dieting, snack control, consumption of low-sodium meals, low-cholesterol meals, and fruits or vegetables, regular checking of blood pressure, and stress management techniques significantly increased after HDMP. However, there was no significant difference in the use of medical service between the disease management group and the control group. This study showed that the HDMP improved lifestyle and reduced blood pressure on the disease management group, but changed neither medical costs nor use of medical services. Long-term evaluation should be performed to determine if the HDMP reduce medical costs and use of medical services.

Lake Mead National Recreational Area air tour management plan and planning and National Environmental Policy Act scoping document

DOT National Transportation Integrated Search

2004-04-19

The Federal Aviation Administration (FAA), in cooperation with the National Park Service (NPS), has initiated the development of an Air Tour Management Plan (ATMP) for Lake Mead National Recreation Area (LAME) pursuant to the National Parks Air Tour ...

Medication therapy management: its relationship to patient counseling, disease management, and pharmaceutical care.

PubMed

McGivney, Melissa Somma; Meyer, Susan M; Duncan-Hewitt, Wendy; Hall, Deanne L; Goode, Jean-Venable R; Smith, Randall B

2007-01-01

To delineate the relationship, including similarities and differences, between medication therapy management (MTM) and contemporary pharmacist-provided services, including patient counseling, disease management, and pharmaceutical care, to facilitate the continued evolution of commonly used language and a standard of practice across geographic areas and practice environments. Incorporation of MTM services into the array of Medicare-funded services affords an opportunity for pharmacists to develop direct patient care services in the community. Defining the role of MTM within the scope of pharmacist-provided patient care activities, including patient counseling, disease management, and all currently provided pharmacy services is essential to the delineation of a viable and sustainable practice model for pharmacists. The definitions of each of these services are offered, as well as comparisons and contrasts of the individual services. In addition to Medicare-eligible patients, MTM services are appropriate for anyone with medication-related needs. MTM is offered as an all-encompassing model that incorporates the philosophy of pharmaceutical care, techniques of patient counseling, and disease management in an environment that facilitates the direct collaboration of patients, pharmacists, and other health professionals. Defining the role of MTM within the current patient care models, including patient counseling, disease management, and all who provide pharmacy services, is essential in delineating a viable and sustainable practice model for pharmacists.

Information management and ante-mortem inspection procedures for the emerging diseases control: Experiences acquired in the epidemiological surveillance of bluetongue and lumpy skin disease

PubMed Central

Corradini, Alessandra; Trevisani, Marcello; Dosa, Geremia; Padovani, Anna

2018-01-01

The spread of exotic, emerging and reemerging diseases, has become, in the last years, one of the most important threats to the animal productions and public health, representing a new challenge for the European Community. In a global-market framework, where trade and contacts between countries are simplified, effective and well-developed surveillance systems are necessary. Multiple factors are, in fact, associated with the emergence of new, known or exotic diseases in this new economic panorama and for these reasons controls on animal imports, traceability and timeliness detection of infected animals should be considered the basis of a sound surveillance. In this work, we focused our attention on the management of Bluetongue and on the risk of introduction of the Lumpy Skin Disease in Italy, in order to describe the national and European surveillance systems for these diseases. In particular, we underlined the crucial role of information that reach the Official Veterinarian at the slaughterhouse concerning the epidemiological situation of the sending countries. Information that are important for the management of the ante-mortem inspection and for increasing the awareness of the Veterinary Inspectors of their role in the surveillance. PMID:29732326

Information management and ante-mortem inspection procedures for the emerging diseases control: Experiences acquired in the epidemiological surveillance of bluetongue and lumpy skin disease.

PubMed

Corradini, Alessandra; Trevisani, Marcello; Dosa, Geremia; Padovani, Anna

2018-03-31

The spread of exotic, emerging and reemerging diseases, has become, in the last years, one of the most important threats to the animal productions and public health, representing a new challenge for the European Community. In a global-market framework, where trade and contacts between countries are simplified, effective and well-developed surveillance systems are necessary. Multiple factors are, in fact, associated with the emergence of new, known or exotic diseases in this new economic panorama and for these reasons controls on animal imports, traceability and timeliness detection of infected animals should be considered the basis of a sound surveillance. In this work, we focused our attention on the management of Bluetongue and on the risk of introduction of the Lumpy Skin Disease in Italy, in order to describe the national and European surveillance systems for these diseases. In particular, we underlined the crucial role of information that reach the Official Veterinarian at the slaughterhouse concerning the epidemiological situation of the sending countries. Information that are important for the management of the ante-mortem inspection and for increasing the awareness of the Veterinary Inspectors of their role in the surveillance.

Leveraging the trusted clinician: documenting disease management program enrollment.

PubMed

Frazee, Sharon Glave; Kirkpatrick, Patricia; Fabius, Raymond; Chimera, Joseph

2007-02-01

The objective of this study was to test the hypothesis that an integrated disease management (IDM) protocol (patent-pending), which combines telephonic-delivered disease management (TDM) with a worksite-based primary care center and pharmacy delivery, would yield higher contact and enrollment rates than traditional remote disease management alone. IDM is characterized by the combination of standard TDM with a worksite-based primary care and pharmacy delivery protocol led by trusted clinicians. This prospective cohort study tracks contact and enrollment rates for persons assigned to either IDM or traditional TDM protocols, and compares them on contact and enrollment efficiency. The IDM protocol showed a significant improvement in contact and enrollment rates over traditional TDM. Integrating a worksite-based primary care and pharmacy delivery system led by trusted clinicians with traditional TDM increases contact and enrollment rates, resulting in higher patient engagement. The IDM protocol should be adopted by employers seeking higher returns on their investment in disease management programming.

75 FR 57972 - National Institute of Allergy and Infectious Diseases; Notice of Closed Meeting

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2010-09-23

... Allergy and Infectious Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... conducted by the National Institute of Allergy and Infectious Diseases, including consideration of personnel..., Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Building 31...

78 FR 12769 - National Institute of Allergy and Infectious Diseases; Notice of Closed Meeting

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2013-02-25

... Allergy and Infectious Diseases; Notice of Closed Meeting Pursuant to section 10(d) of the Federal... conducted by the National Institute of Allergy and Infectious Diseases, including consideration of personnel..., Microbiology and Infectious Diseases Research, National Institutes of Health, HHS) Dated: February 19, 2013...

75 FR 15712 - National Institute of Allergy and Infectious Diseases; Notice of Meeting

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2010-03-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Notice of Meeting Pursuant to section 10(a) of the Federal Advisory....855, Allergy, Immunology, and Transplantation Research; 93.856, Microbiology and Infectious Diseases...

77 FR 76058 - National Institute of Allergy and Infectious Diseases; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Notice of Meeting Pursuant to section 10(a) of the Federal Advisory....855, Allergy, Immunology, and Transplantation Research; 93.856, Microbiology and Infectious Diseases...

75 FR 49942 - National Institute of Allergy and Infectious Diseases; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-16

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute of Allergy and Infectious Diseases; Notice of Meeting Pursuant to section 10(a) of the Federal Advisory..., Allergy, Immunology, and Transplantation Research; 93.856, Microbiology and Infectious Diseases Research...

Beliefs and attitudes toward lethal management of deer in Cuyahoga Valley National Park

USGS Publications Warehouse

Fulton, D.C.; Skerl, K.; Shank, E.M.; Lime, D.W.

2004-01-01

We used the theory of reasoned action to help understand attitudes and beliefs about lethal management of deer (Odocoileus virginianus) in Cuyahoga Valley National Park (CVNP), Ohio. We used a mail-back survey to collect data from Ohio residents in the surrounding 9-county area. Two strata were defined: residents <10 km from CVNP (near n = 369) and residents =10 km from CVNP (far n = 312). Respondents indicated that lethal control of deer was acceptable (near 71%??4.7%, far 62%??5.5%) and taking no action to reduce deer populations was unacceptable (near 75%??4.5%, far 72%??5.1%). Beliefs about outcomes of lethal control and evaluation of those outcomes proved to be strong predictors of the acceptability of lethal control of deer in CVNP. Lethal control was more acceptable if it was done to prevent severe consequences for humans (e.g., spread of disease, car collisions) or the natural environment (e.g., maintain a healthy deer herd) than to prevent negative aesthetic impacts or personal property damage. Results from the study can be used to assist managers at CVNP as they make decisions regarding alternatives for deer management in the park and to inform others managing abundant deer populations of socially relevant impacts of management actions.

Disease management and health care reforms in Germany - does more competition lead to less solidarity?

PubMed

Stock, Stephanie Anja Katharina; Redaelli, Marcus; Lauterbach, Karl Wilhelm

2007-01-01

Up to the 1990s German health care legislation was dominated by measures regulating the supply side. Measures, such as budgets, aimed at volume control and sought to confine the increase of health care spending to the growth of the national income. To curb costs more effectively, competitive elements were introduced in the 1990s with free choice of sickness funds (open enrollment). To balance competition and solidarity, a risk compensation scheme (RCS) was implemented two years prior to open enrollment. Since then, balancing competition and solidarity has been a key feature of all consecutive health care reforms. The implementation of disease management programs in the statutory health insurance (SHI) served the dual purpose to promote quality of care and to foster competition. Preliminary experiences suggest, that the aligning of disease management programs with a RCS can greatly aid its implementation and benefit solidarity and competition.

Management of active Crohn disease.