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1

Choice and privatisation in Swedish primary care.  

PubMed

In 2007, a new wave of local reforms involving choice for the population and privatisation of providers was initiated in Swedish primary care. Important objectives behind reforms were to strengthen the role of primary care and to improve performance in terms of access and responsiveness. The purpose of this article was to compare the characteristics of the new models and to discuss changes in financial incentives for providers and challenges regarding governance from the part of county councils. A majority of the models being introduced across the 21 county councils can best be described as innovative combinations between a comprehensive responsibility for providers and significant degrees of freedom regarding choice for the population. Key financial characteristics of fixed payment and comprehensive financial responsibility for providers may create financial incentives to under-provide care. Informed choices by the population, in combination with reasonably low barriers for providers to enter the primary care market, should theoretically counterbalance such incentives. To facilitate such competition is indeed a challenge, not only because of difficulties in implementing informed choices but also because the new models favour large and/or horizontally integrated providers. To prevent monopolistic behaviour, county councils may have to accept more competition as well as more governance over clinical practice than initially intended. PMID:20701829

Anell, Anders

2011-10-01

2

Facility Manager Primary Purpose  

E-print Network

and working environment for our students, employees and others associated with the STM community. Nature. The Facility Manager is responsible for the work of supervising others, recruiting, providing training health and safety requirements; d. ensuring that employees receive training in occupational health

Saskatchewan, University of

3

Managing Depression in Primary Care  

Microsoft Academic Search

\\u000a The need to manage depression more effectively in primary care is well established. Major depressive disorder is a common,\\u000a chronic but episodic and costly condition for which primary care physicians provide the majority of care (1). Among nonpsychotic\\u000a patients, symptom composition and severity differs little from adults presenting to psychiatrists (2). Patients who have chronic\\u000a medical conditions such as diabetes

Larry Culpepper; Peggy Johnson

4

Choice Based Revenue Management for Parallel Flights  

E-print Network

Mar 5, 2014 ... The inputs of the stochastic models include booking arrival rates, competitor assortment selection, ..... choice models, where “dynamic” refers to the chosen assortments being a function of time. 3. ...... Model validation and test.

2014-03-05

5

Knowledge Management Technology: Making Good Choices.  

ERIC Educational Resources Information Center

Discusses the reliability of technology products that support knowledge management, particularly in higher education. Presents a conceptual framework for knowledge management technology, evaluates available software products, concludes that most products perform poorly, and offers recommendations for knowledge management strategies. (LRW)

Chapman, Linda D. R.; Coukos, Eleni D.; Pisapia, John

2001-01-01

6

Factors Influencing Career Choice of Management Students in India  

ERIC Educational Resources Information Center

Purpose: This paper aims to explore the influence of a range of factors on the career choice of management students in India. The importance of different individuals in the family and at work in making career choices among these students is also to be explored. In addition, the study seeks to address the relationship of the cultural values of…

Agarwala, Tanuja

2008-01-01

7

Choice Criteria in Final Selection of a Management Consultancy Service  

Microsoft Academic Search

A survey of 142 client organizations provided data on the choice criteria used in the final selection of a wide range of management consultancy services. A consultancy's reputation, their experience in the client's industry, and cost (fees) were the most important choice criteria. Significant differences were found between first time (new) and previous clients, and between clients experienced and inexperienced

Paul Patterson

1995-01-01

8

Children as Researchers in Primary Schools: Choice, Voice and Participation  

ERIC Educational Resources Information Center

"Children as Researchers in Primary Schools" is an innovative and unique resource for practitioners supporting children to become "real world" researchers in the primary classroom. It will supply you with the skills and ideas you need to implement a "children as researchers" framework in your school that can be adapted for different ages and…

Bucknall, Sue

2012-01-01

9

Choice.  

PubMed

Understanding how and why analysands make the choices they do is central to both the clinical and the theoretical projects of psychoanalysis. And yet we know very little about the process of choice or about the relationship between choices and motives. A striking parallel is to be found between the ways choice is narrated in ancient Greek texts and the experience of analysts as they observe patients making choices in everyday clinical work. Pursuing this convergence of classical and contemporary sensibilities will illuminate crucial elements of the various meanings of choice, and of the way that these meanings change over the course of psychoanalytic treatment. PMID:18802123

Greenberg, Jay

2008-09-01

10

Career Choice in Management: Findings from US MBA Students  

ERIC Educational Resources Information Center

Purpose: This research aims to explore the role of values, family, and non-family influences on career choice in management among a sample of US MBA students. Design/methodology/approach: Data were collected using self-reported questionnaires from 109 students in a mid-sized university located on the west coast of the USA. The respondents were in…

Ng, Eddy S. W.; Burke, Ronald J.; Fiksenbaum, Lisa

2008-01-01

11

Underwriter choice and earnings management: evidence from seasoned equity offerings  

Microsoft Academic Search

Using a sample of seasoned equity offerings (SEOs), this paper examines the association between the choice of financial intermediary\\u000a and earnings management. We contend that with more stringent standards for certification and intense monitoring, highly prestigious\\u000a underwriters restrict firms’ incentives for earnings management to protect their reputation and to avoid potential litigation\\u000a risks, while firms with greater incentives for earnings

Hoje Jo; Yongtae Kim; Myung Seok Park

2007-01-01

12

Managing coastal area resources by stated choice experiments  

NASA Astrophysics Data System (ADS)

In many coastal regions, oil spills can be considered as one of the most important and certainly the most noticeable forms of marine pollution. Efficient contingency management responding to oil spills on waters, which aims at minimizing pollution effects on coastal resources, turns out to be critically important. Such a decision making highly depends on the importance attributed to different coastal economic and ecological resources. Economic uses can, in principal, be addressed by standard measures such as value added. However, there is a missing of market in the real world for natural goods. Coastal resources such as waters and beach cannot be directly measured in money terms, which increases the risk of being neglected in a decision making process. This paper evaluates these natural goods of coastal environment in a hypothetical market by employing stated choice experiments. Oil spill management practice in German North Sea is used as an example. Results from a pilot survey show that during a combat process, beach and eider ducks are of key concerns for households. An environmental friendly combat option has to be a minor cost for households. Moreover, households with less children, higher monthly income and a membership of environmental organization are more likely to state that they are willing to pay for combat option to prevent coastal resources from an oil pollution. Despite that choice experiments require knowledge of designing questionnaire and statistical skills to deal with discrete choices and conducting a survey is time consumed, the results have important implications for oil spill contingency management. Overall, such a stated preference method can offer useful information for decision makers to consider coastal resources into a decision making process and can further contribute to finding a cost-effective oil preventive measure, also has a wide application potential in the field of Integrated Coastal Zone Management (ICZM).

Liu, Xin; Wirtz, Kai W.

2010-02-01

13

Safer medicines management in primary care.  

PubMed Central

Errors in the medicines management process represent an important source of iatrogenic harm in primary care. Most errors result from underlying systems-based problems that are amenable to intervention and potentially preventable. In this paper, we seek to identify the frequency of medication-related morbidity in primary care, understand the underlying systemic reasons that increase risk of medication-related errors and iatrogenic harm, and suggest strategies for improving the safety of medicines management. PMID:12389765

Avery, Anthony J; Sheikh, Aziz; Hurwitz, Brian; Smeaton, Lesley; Chen, Yen-Fu; Howard, Rachel; Cantrill, Judy; Royal, Simon

2002-01-01

14

Valuing Choice as an Alternative to Fixed-Ability Thinking and Teaching in Primary Mathematics  

ERIC Educational Resources Information Center

This article offers a personal account of a primary mathematics teacher's current practice and how it developed through participation in a professional development programme. This alternative to fixed-ability teaching is based on creating opportunities for learners to exercise choice and on an understanding of mathematics as connected. Key…

Milik, Amy; Boylan, Mark

2013-01-01

15

42 CFR 440.168 - Primary care case management services.  

...2014-10-01 2014-10-01 false Primary care case management services. 440.168...PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case...

2014-10-01

16

Choice of primary care provider: results from a population survey in three Swedish counties.  

PubMed

Recent reforms in Swedish primary care have involved choice of provider for the population combined with freedom of establishment and privatisation of providers. This study focus to what extent individuals feel they have exercised a choice of provider, why they exercise choice and where they search for information, based on a population survey in three Swedish counties. The design of the study enabled for studying behaviour with respect to differences in time since introduction of the reform and differences in number of alternative providers and establishments of new providers in connection with the reform. About 60% of the population in the three counties felt that they had made a choice of provider in connection with or after the introduction of a reform focusing on choice and privatisation. Establishments of new providers and having enough information increased the likelihood whereas preferences for direct access to a specialist decreased the likelihood of making a choice. The data further suggests that individuals were rather passive in their search for information and tended to choose providers that they previously had been in contact with. This is in line with results from previous studies and poses challenges for county councils governance of reforms. PMID:21703712

Glenngård, Anna H; Anell, Anders; Beckman, Anders

2011-11-01

17

Why Undergraduates Students Choose Sport Management As A Major: Factors Influencing College Choice Decisions  

Microsoft Academic Search

The purpose of this study was to explore and determine relevant college choice factors among undergraduate Sport Management students, along with collecting specific demographic information from the respondents. Since little was known about college choice factors for undergraduate Sport Management students, this study will be exploratory in nature, and will employ a non-experimental design. College choice has been a topic

Sarah Singleton Crockett

2005-01-01

18

Managing dyspepsia in primary care.  

PubMed

NICE recommends immediate referral for patients with dyspepsia and significant acute GI bleeding and urgent specialist referral for investigation if any of the following alarm symptoms are present: progressive difficulty swallowing; chronic GI bleeding; unintentional weight loss; persistent vomiting; abdominal mass; iron deficiency anaemia; suspicious findings on barium meal. Patients aged > 55 with unexplained and persistent dyspepsia, despite H. pylori testing and acid suppression therapy, should also be considered for endoscopy, as should those with previous gastric ulcer or surgery, continuing need for NSAIDs or raised risk of gastric cancer. Patients with uninvestigated dyspepsia should be managed by empirical treatment with a PPI or testing for and treating H. pylori if present. Testing by urea breath test, stool antigen test, or locally validated lab-based serology is suggested. H. pylori eradication is usually given as triple therapy, for seven days, involving a PPI, clarithromycin and either amoxicillin or metronidazole. It is important to take a thorough history and to enquire about any medication the patient is taking. Drugs that are common culprits for dyspepsia include: NSAIDs; calcium antagonists; bisphosphonates; steroids; theophyllines; nitrates. NSAIDs can also cause GI bleeding. Absence of dyspepsia in patients taking NSAIDs does not indicate a reduced risk of bleeding. Peptic ulcers fall into three categories: H. pylori associated ulcers; drug-induced ulcers (particularly NSAIDs); and ulcers in H. pylori-negative patients not taking causative medication. H. pylori is associated with both gastric and duodenal ulcer disease but it is in the duodenum where the closest relationship exists. In any 6-12 month period, 20-40% of healthy people, more commonly men, will experience symptoms of heartburn. Oesophageal reflux can progress to more serious disease such as erosive oesophagitis, stricture or Barrett's oesophagus. PMID:19938559

Summers, Andrew; Khan, Zubair

2009-10-01

19

Primary urban energy-management-planning methodology  

SciTech Connect

Metropolitan Dade County, Florida, developed a pragmatic, transferable methodology to assist local governments in attempts to develop and implement energy management plans. A summary of that work is presented and suggestions are provided to guide the application and refinement of a Primary Urban Energy Management Planning Methodology. The methodology provides local governments with the systematic approach for dealing with short and intermediate-term urban energy management problems while at the same time laying the groundwork for the formulation of long-term energy management activities. The five tasks of the methodology summarized are: organizing for the PEP process; performing an energy use and supply inventory; formulating energy management goals and objectives; developing strategies to achieve the energy management objectives; and monitoring and evaluation. (MCW)

None

1980-11-01

20

Management of primary spinal cord tumors  

Microsoft Academic Search

The literature is scarce on surgical and\\/or radiotherapeutic management of primary neoplasms of the spinal cord, a rare form of tumor. We have reviewed retrospectively the records of all patients with spinal cord tumor who were treated at the University of California, San Francisco, from 1950 to 1975, a total of 34 patients. Patients were treated with megavoltage equipment to

J. G. Schwade; W. M. Wara; G. E. Sheline; S. Sorgen; C. B. Wilson

1978-01-01

21

Risk preferences in strategic wildfire decision making: a choice experiment with U.S. wildfire managers.  

PubMed

Federal policy has embraced risa management as an appropriate paradigm for wildfire management. Economic theory suggests that over repeated wildfire events, potential economic costs and risas of ecological damage are optimally balanced when management decisions are free from biases, risa aversion, and risa seeking. Of primary concern in this article is how managers respond to wildfire risa, including the potential effect of wildfires (on ecological values, structures, and safety) and the likelihood of different fire outcomes. We use responses to a choice experiment questionnaire of U.S. federal wildfire managers to measure attitudes toward several components of wildfire risa and to test whether observed risa attitudes are consistent with the efficient allocation of wildfire suppression resources. Our results indicate that fire managers' decisions are consistent with nonexpected utility theories of decisions under risa. Managers may overallocate firefighting resources when the likelihood or potential magnitude of damage from fires is low, and sensitivity to changes in the probability of fire outcomes depends on whether probabilities are close to one or zero and the magnitude of the potential harm. PMID:23078036

Wibbenmeyer, Matthew J; Hand, Michael S; Calkin, David E; Venn, Tyron J; Thompson, Matthew P

2013-06-01

22

Choice set as an indicator for choice behavior when lanes are managed with value pricing  

E-print Network

represents the primary motivation for this study: 1. A given decision maker either does or does not consider ridesharing to be personally feasible, 2. A given decision maker either does or not consider shoulder-period travel to be personally feasible... represents the primary motivation for this study: 1. A given decision maker either does or does not consider ridesharing to be personally feasible, 2. A given decision maker either does or not consider shoulder-period travel to be personally feasible...

Mastako, Kimberley Allen

2005-02-17

23

Exercise as medicine: Role in the management of primary hypertension.  

PubMed

Primary hypertension affects ?1 in 5 Canadians and significantly increases the risk of myocardial infarction, stroke, heart failure, and early mortality. Guidelines for the management of hypertension recommend lifestyle modifications (e.g., increased physical activity, smoking cessation, moderate alcohol consumption, improved dietary choices) as the frontline strategy to prevent and manage high blood pressure (BP). In particular, acute and chronic aerobic exercise has consistently been shown to reduce resting and ambulatory BP, with the largest effects in hypertensive patients. Current guidelines recommend 30-60 min of moderate- to vigorous-intensity aerobic exercise 4-7 days per week, in addition to activities of daily living. The role of resistance training in the management of hypertension is less clear, although available data suggests resistance exercise can be performed safely without risk of increasing BP or adverse events. Presently, resistance exercise (8-10 exercises, 1-2 set(s) of 10-15 repetitions, 2-3 days/week) is advocated only as an adjunct exercise modality. Patients desiring to begin an exercise program should complete the Physical Activity Readiness Questionnaire (PAR-Q or PAR-Q+) or as required, the Electronic Physical Activity Readiness Medical Examination (ePARmed-X) or Physician Clearance Form in consultation with their clinician and (or) trained exercise professional. A greater emphasis on utilizing exercise as medicine will produce positive nonpharmacologic benefits for hypertensive patients and improve overall cardiovascular risk profiles. PMID:24773307

Millar, Philip J; Goodman, Jack M

2014-07-01

24

Free Choice of Learning Management Systems: Do Student Habits Override Inherent System Quality?  

ERIC Educational Resources Information Center

Purpose: Although multiple studies examine institutional transitions of learning management systems (LMS) or compare their merits, studies examining students' free choice of access on parallel LMSs for the same course are absent from the literature. In order to investigate usage in a free-choice situation, identical content was posted at the…

Porter, Gavin W.

2013-01-01

25

Women in construction management: Creating a theory of career choice and development  

NASA Astrophysics Data System (ADS)

The purpose of this study was to create a theory of women's career choice and development in the context of the construction industry. Focused on female constructors, or those engaged in the management of construction projects or companies, this study investigated the relevant factors, processes, and experiences of women who choose to enter the construction industry through construction management degree programs. The goal was to communicate as a theoretically and practically grounded theory of career choice and development an understanding of who female constructors are and those factors which led them to the construction industry and those influencing their career development. As a grounded theory research design, qualitative research methods were employed as the primary means of collecting and analyzing data. Purposive and snowball sampling were used to garner a sample of 24 women who had graduated within a ten year period and were actively employed as constructors. Participants' views and experiences, captured through small focus group interviews, were analyzed with quantitative data of demographics, education, construction experience, self-efficacy, personality, and career satisfaction and commitment gathered from a written questionnaire, to create a profile of female constructors used in this theory. The profiles completed from these data are complex, providing for an extensive understanding of their career choice and development process. The strongest common characteristic in the career development of these women was a mentor. This influence in cannot be overlooked, especially in light of the rather constant sense of isolation many of these women expressed as a significant minority in every facet of their careers. Recommendations for academia and industry are in many ways related to these findings. Recommendations for recruitment center on educating youth and those able to influence the career choice making process of youth about the career paths available within the construction industry. Suggestions for retention centered on: (a) the need for mentoring programs and support networks, and (b) modification of industry demands to allow for a better work-family balance. In all, this study provides insights and recommendations for those focused on attracting, hiring, and retaining the employees necessary to meet ever-increasing staffing demands.

Moore, Jennifer Dawn

26

Management of hypertension in primary aldosteronism  

PubMed Central

Hypertension causes significant morbidity and mortality worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldosteronism (PA) is the most common cause of reversible hypertension, affecting 5%-18% of adults with hypertension. PA is estimated to result from bilateral adrenal hyperplasia in two-thirds of patients, and from unilateral aldosterone-secreting adenoma in approximately one-third. Suspected cases are initially screened by measurement of the plasma aldosterone-renin-ratio, and may be confirmed by additional noninvasive tests. Localization of aldostosterone hypersecretion is then determined by computed tomography imaging, and in selective cases with adrenal vein sampling. Solitary adenomas are managed by laparoscopic or robotic resection, while bilateral hyperplasia is treated with mineralocorticoid antagonists. Biochemical cure following adrenalectomy occurs in 99% of patients, and hemodynamic improvement is seen in over 90%, prompting a reduction in quantity of anti-hypertensive medications in most patients. End-organ damage secondary to hypertension and excess aldosterone is significantly improved by both surgical and medical treatment, as manifested by decreased left ventricular hypertrophy, arterial stiffness, and proteinuria, highlighting the importance of proper diagnosis and treatment of primary hyperaldosteronism. Although numerous independent predictors of resolution of hypertension after adrenalectomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifactorial model convenient for use in daily clinical practice. PMID:24944753

Aronova, Anna; III, Thomas J Fahey; Zarnegar, Rasa

2014-01-01

27

Impact of comorbidity on the individual's choice of primary health care provider  

PubMed Central

Objective This study examined whether age, gender, and comorbidity were of importance for an individual's choice of listing with either a public or a private primary health care (PHC) practice. Design and setting The study was a register-based closed cohort study in one private and one public PHC practice in Blekinge County in southern Sweden. Subjects A cohort (12 696 individuals) was studied comprising all those listed with the public or private PHC practice on 1 October 2005 who were also listed with the public PHC practice on 1 October 2004. Main outcome measures The listing/re-listing behaviour of the population in this cohort was studied at two points in time, 1 October 2005 and 1 October 2006, with respect to age, gender, and comorbidity level as measured by the ACG Case-Mix system. Results Individuals listed with the public practice both on 1 October 2005 and one year later were significantly older, were more often females, and had a higher comorbidity level than individuals listed with the private practice. Individuals with a higher comorbidity level were more likely to re-list or to stay listed with the public practice. Conclusions This study shows that the probability of choosing a public instead of private PHC provider increased with higher age and comorbidity level of the individuals. It is suggested that using a measure of comorbidity can help us understand more about the chronically ill individual's choice of health care provider. This would be of importance when health care policy-makers decide on reimbursement system or organization of PHC. PMID:21413840

Zielinski, Andrzej; Håkansson, Anders; Beckman, Anders; Halling, Anders

2011-01-01

28

Better Choices: Evaluating the Effectiveness of Behavior Management Programs  

ERIC Educational Resources Information Center

Managing student behavior is often looked upon as a sidebar in teaching. The lack of formal classroom management training in teacher education programs reveals the low importance placed on this skill. As a result, teachers are often very well prepared to instruct, but in terms of effectively understanding the behavior of students--particularly…

Acuna, Miguel T.

2011-01-01

29

The management of primary nonparasitic splenic cysts.  

PubMed

Primary nonparasitic splenic cysts (PNSC) are rare and their management in children has been controversial. We conducted this study to discuss various treatment modalities. The medical records of patients with PNSC (1991-2008) were evaluated retrospectively, including age, sex, history of trauma, presenting symptoms, physical examination and radiological findings, therapeutic approaches, and outcomes. Six patients, between 3 to 12 years of age with a male/female ratio of 2, were included. The presenting symptom was abdominal pain in all but one asymptomatic patient. Physical examination findings were unremarkable in all except for palpable spleen in two patients. Cyst sizes ranged from 3 x 4 cm to 10 x 12 cm. The patients were treated with aspiration-sclerotherapy (n=2), total splenectomy (n=2), partial splenectomy (n=1), and cyst excision (n=1). The pathological diagnoses were epidermoid cyst (n=5) and lymphangioma (n=1). The postoperative course was uneventful except for postsplenectomy fever (n=1), recurrence (n=1) and residual cyst (n=1). PNSC larger than 5 cm in diameter or those that are symptomatic should be treated surgically. Total splenectomy should not be done in children to avoid infectious postsplenectomy problems unless there is a mandatory condition like intraoperative bleeding. Aspiration-sclerosis is not recommended because of recurrence. PMID:21434535

Boybeyi, Ozlem; Karnak, Ibrahim; Tanyel, F Cahit; Ciftçi, Arbay O; Senocak, M Emin

2010-01-01

30

Using choice experiments to design wetland management programmes: The case of Severn Estuary Wetland, UK  

Microsoft Academic Search

This paper reports the results of a pilot valuation study, which was undertaken to investigate whether the public located around the Severn Estuary derive positive economic values from its sustainable management. One hundred members of the public took part in a choice experiment, the results of which indicate that overall the public derives positive and significant values from sustainable management

Ekin Birol; Victoria Cox

2007-01-01

31

Factors that Influence Students' Choice of Careers in Construction Management  

Microsoft Academic Search

The goal of this study was to explore the demographics and career influences (in terms of experiences and relationships) of students currently enrolled in accredited Construction Management (CM) programs in one Midwestern state. It was limited to one state due to the regional differences in construction shown by a 1996 Business Roundtable (BRT) study (The Business Roundtable, 2000). Numerous factors

Daphene Cyr Koch; James Greenan; Kathryne Newton

2009-01-01

32

Primary umbilical endometriosis. Case report and discussion on management options?  

PubMed Central

INTRODUCTION We report a recently observed case of primary umbilical endometriosis (UE), with the main aim to discuss the management of this rare condition. PRESENTATION OF CASE A 24-year-old woman complained of a painful nodule on her umbilical region, bleeding with her menstrual cycle. Ultrasonography showed a hypoechoic superficial mass in the umbilicus and no signs of intra-abdominal endometriosis. Excision of the nodule under local anesthesia was performed. Histopathological analysis confirmed the diagnosis of umbilical endometriosis. Neither symptoms nor signs of local recurrence have been observed after 24 months. DISCUSSION UE should be taken into account in differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. Although there is a substantial agreement about the necessity of surgery, treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis. CONCLUSION Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions. PMID:24291679

Fancellu, Alessandro; Pinna, Antonio; Manca, Alessandra; Capobianco, Giampiero; Porcu, Alberto

2013-01-01

33

Institutional Choice, Community, and Struggle: A Case Study of Forest Co-Management in Mexico  

Microsoft Academic Search

Change in the commons remains poorly understood. This essay analyzes a comparative case study of community forestry in Mexico. In a primary case study, corruption in a community-owned logging business legitimates timber smuggling, and this situation contrasts with several forestry communities having internally-legitimate social institutions able to control such problems. A discussion assesses the institutional choice model for understanding change

Daniel Klooster

2000-01-01

34

School Management Information Systems in Primary Schools  

ERIC Educational Resources Information Center

Developments in information technologies have been impacting upon educational organizations. Principals have been using management information systems to improve the efficiency of administrative services. The aim of this research is to explore principals' perceptions about management information systems and how school management information…

Demir, Kamile

2006-01-01

35

The health plan choices of retirees under managed competition.  

PubMed Central

OBJECTIVE: To investigate the effect of price on the health insurance decisions of Medicare-eligible retirees in a managed competition setting. DATA SOURCE: The study is based on four years of administrative data from the University of California (UC) Retiree Health Benefits Program, which closely resembles the managed competition model upon which several leading Medicare reform proposals are based. STUDY DESIGN: A change in UC's premium contribution policy between 1993 and 1994 created a unique natural experiment for investigating the effect of price on retirees' health insurance decisions. This study consists of two related analyses. First, I estimate the effect of changes in out-of-pocket premiums between 1993 and 1994 on the decision to switch plans during open enrollment. Second, using data from 1993 to 1996, I examine the extent to which rising premiums for fee-for-service Medigap coverage increased HMO enrollment among Medicare-eligible UC retirees. PRINCIPLE FINDINGS: Price is a significant factor affecting the health plan decisions of Medicare-eligible UC retirees. However, these retirees are substantially less price sensitive than active UC employees and the non-elderly in other similar programs. This result is likely attributable to higher nonpecuniary switching costs facing older individuals. CONCLUSIONS: Although it is not clear exactly how price sensitive enrollees must be in order to generate price competition among health plans, the behavioral differences between retirees and active employees suggest that caution should be taken in extrapolating from research on the non-elderly to the Medicare program. PMID:11130806

Buchmueller, T C

2000-01-01

36

Rational Treatment Choices for Non-major Depressions in Primary Care  

PubMed Central

OBJECTIVE This review synthesizes available evidence for managing clinically significant dysphoric symptoms encountered in primary care, when formal criteria for major depression or dysthymia are not met. Discussion is focused on premenstrual dysphoric disorder (PMDD) and minor depression because of their significant prevalence in the primary care setting and the lack of clear practice guidelines for addressing each illness. DESIGN English language literature from prior systematic reviews was supplemented by searching medline, embase, the Cochrane Controlled Trials Registry, the Agency for Healthcare Research and Quality National Guideline Clearinghouse, and bibliographies of selected papers. Studies addressing the natural history or treatment of minor depression or PMDD were selected for review. Data were abstracted by 1 of 2 independent reviewers and studies were synthesized qualitatively. RESULTS Five individual studies that compared antidepressant or psychological treatments to placebo in patients with minor depression suggest short-term improvements in depressive symptoms with paroxetine, problem-solving therapy, and cognitive behavioral therapy, but not with amitryptiline. Modest benefits on mental health function were reported with paroxetine and with problem-solving therapy, but only in patients with severe functional impairment at baseline. Twenty-four controlled trials were identified that compared antidepressant or psychological treatments to placebo in patients with premenstrual dysphoric disorder. Pooled results from a recent systematic review of 15 randomized controlled trials and one additional trial abstract provide strong evidence for a significantly greater improvement in physical and psychological symptoms with serotonin-selective reuptake inhibitor medications when compared with placebo. Individual trials also suggest significantly greater improvements in symptom scores with venlafaxine, but not with tricyclic antidepressants. CONCLUSIONS The limited evidence base for minor depression provides only mixed support for a small to moderate benefit for few antidepressant medications and psychological treatments tested. For the treatment of severe psychological or physical symptoms causing functional impairment in patients with PMDD, sertraline and fluoxetine are clearly beneficial in carefully selected patients. PMID:11972726

Ackermann, Ronald T; Williams, John W

2002-01-01

37

Kid's Choice Program improves weight management behaviors and weight status in school children  

Microsoft Academic Search

The present study examined the effectiveness of the Kid's Choice Program (KCP) for increasing children's weight management behaviors, and decreasing body mass index percentile (BMI%) for overweight and average-weight children. It also evaluated KCP characteristics relevant to long-term application in schools. Participants included 382 children assigned to two groups: a KCP group that received token rewards for three “Good Health

Helen M. Hendy; Keith E. Williams; Thomas S. Camise

2011-01-01

38

The role of culture and gender in the choice of a career in management  

Microsoft Academic Search

Purpose – The paper addresses the influence of culture and gender on the choice of a management career among men and women MBA students in Israel, the USA, the UK, Turkey, Cyprus, Hungary and India. The culture by gender comparison enabled an examination of five theories: two that focused on culture (Hofstede's and an application of Schneider's ASA model) and

Ayala Malach-Pines; Oshrit Kaspi-Baruch

2008-01-01

39

How Leaders Foster Self-Managing Team Effectiveness: Design Choices Versus Hands-on Coaching  

Microsoft Academic Search

This multi-method field study examines the relative effects of two kinds of leader behaviors—design choices and hands-on coaching—on the effectiveness of self-managing teams. Find- ings show that how leaders design their teams and the quality of their hands-on coaching both influence team self- management, the quality of member relationships, and member satisfaction, but only leaders' design activities affect team task

Ruth Wageman

2001-01-01

40

Crisis Management in a Primary School  

ERIC Educational Resources Information Center

Dunblane Primary School, Scotland, and Columbine High School, USA. Two headline tragedies that have led to trauma for their pupils and staff. Trauma that could be devastating because of the psychological impact and the practical requirements a crisis brings. Children's social and personal development can be negatively affected, their academic…

Barclay, Colette

2004-01-01

41

Improving the Primary School. Educational Management Series.  

ERIC Educational Resources Information Center

This book offers suggestions to primary schools about how they can improve their work in preparing children for a rapidly changing world. Chapter 1 sets the stage by considering various definitions of educational improvement, efficacy, and goals. Chapter 2 assesses research on school effectiveness and critically considers components of school…

Dean, Joan

42

Primary healthcare in transition - a qualitative study of how managers perceived a system change  

PubMed Central

Background Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. Methods In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. Results The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. Conclusions This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager’s perspective. This suggests a need for improved follow-up and control in order to monitor and govern system changes and ensure development towards a more effective and sustainable primary healthcare system. PMID:24090138

2013-01-01

43

Pooling and segmentation to improve primary care prescription management  

E-print Network

Analyses of schedule history and medical records for large primary care medical practice are combined with time studies to develop a quantitative network flow model of the prescription management process, including metrics ...

Sanderson, Thomas Daniel

2014-01-01

44

The management of primary sclerosing cholangitis  

Microsoft Academic Search

Primary sclerosing cholangitis (PSC) is a chronic cholestatic hepatobiliary disease that usually progresses to biliary cirrhosis\\u000a and liver failure; it also predisposes to cholangiocarcinoma. The cause of PSC is unknown, although evidence suggests that\\u000a the tissue damage is mediated by the immune system. There is an unexplained close association between PSC and inflammatory\\u000a bowel disease, particularly in ulcerative colitis, which

Roger W. Chapman

2003-01-01

45

Primary resection and anastomosis in the management of perforation of diverticulitis of the sigmoid flexure and diffuse peritonitis  

Microsoft Academic Search

Summary  Twenty-six patients with perforation of sigmoidal diverticulitis and acute diffuse peritonitis were managed surgically by\\u000a onestage and multistaged procedures. Based on comparative results revealed in this study (Table 6), it is believed that primary\\u000a resection and anastomosis should be the procedure of choice in the management of this condition. Occasionally, a proximal\\u000a colostomy may be performed if the integrity of

N. V. Dandekar; W. J. McCann

1969-01-01

46

Influencing dressing choice and supporting wound management using remote 'tele-wound care'.  

PubMed

This article describes a local involvement in a project to evaluate a remote system of wound management, incorporating the use of digital and mobile technology. It outlines how this involvement influenced the current system of 'tele wound care' (remote wound management) in a large community organisation. The system allows remote wound assessment, management advice and ongoing monitoring of wounds to ensure that the dressing choice remains appropriate and that timely wound care support can be provided to community nurses, practice nurses and GPs. PMID:24912832

King, Brenda

2014-06-01

47

Impacts of electric demand-side management programs on fuel choice: A case study  

SciTech Connect

Information, rebates, and technical assistance associated with utility demand-side management (DSM) programs can alter consumer behavior. Such programs may unintentionally affect consumer fuel choices. This study addresses fuel choice effects of a unique Pacific Northwest DSM program: (1) it is directed at new manufactured homes only, (2) it is an acquisition program -- utilities make $2,500 payments directly to manufacturers for each electrically heated, energy-efficient home built, (3) it has rapidly penetrated nearly 100% of the potential market, and (4) over 90% of the affected homes in the participating region have traditionally used electricity for space heating. Heating equipment data for all manufactured homes built in the region since 1987 were sampled and regression analysis was used to examine the relationship between the DSM program and fuel shares. The quantitative data were supplemented with interview data to better understand the relationship between the program and fuel choice. The results should be useful for program design and evaluation.

Lee, A.D.; Kavanaugh, D.C.; Sandahl, L.J. [Pacific Northwest Lab., Richland, WA (United States); Vinnard, A.B. [USDOE Bonneville Power Administration, Portland, OR (United States)

1994-04-01

48

Diagnosis and management of primary ciliary dyskinesia.  

PubMed

Primary ciliary dyskinesia (PCD) is an inherited autosomal-recessive disorder of motile cilia characterised by chronic lung disease, rhinosinusitis, hearing impairment and subfertility. Nasal symptoms and respiratory distress usually start soon after birth, and by adulthood bronchiectasis is invariable. Organ laterality defects, usually situs inversus, occur in ?50% of cases. The estimated prevalence of PCD is up to ?1 per 10,000 births, but it is more common in populations where consanguinity is common. This review examines who to refer for diagnostic testing. It describes the limitations surrounding diagnosis using currently available techniques and considers whether recent advances to genotype patients with PCD will lead to genetic testing and screening to aid diagnosis in the near future. It discusses the challenges of monitoring and treating respiratory and ENT disease in children with PCD. PMID:24771309

Lucas, Jane S; Burgess, Andrea; Mitchison, Hannah M; Moya, Eduardo; Williamson, Michael; Hogg, Claire

2014-09-01

49

Diagnosis and management of primary ciliary dyskinesia  

PubMed Central

Primary ciliary dyskinesia (PCD) is an inherited autosomal-recessive disorder of motile cilia characterised by chronic lung disease, rhinosinusitis, hearing impairment and subfertility. Nasal symptoms and respiratory distress usually start soon after birth, and by adulthood bronchiectasis is invariable. Organ laterality defects, usually situs inversus, occur in ?50% of cases. The estimated prevalence of PCD is up to ?1 per 10?000 births, but it is more common in populations where consanguinity is common. This review examines who to refer for diagnostic testing. It describes the limitations surrounding diagnosis using currently available techniques and considers whether recent advances to genotype patients with PCD will lead to genetic testing and screening to aid diagnosis in the near future. It discusses the challenges of monitoring and treating respiratory and ENT disease in children with PCD. PMID:24771309

Lucas, Jane S; Burgess, Andrea; Mitchison, Hannah M; Moya, Eduardo; Williamson, Michael; Hogg, Claire

2014-01-01

50

NHS direct: managing demand for primary care?  

PubMed

This paper considers how NHS Direct is affecting demand for primary care in particular out-of-hours services from GPs. This is reviewed through a 3-year study of NHS Direct and HARMONI, the integrated telephone health helpline based in West London. It describes the policy background and development of the services on the site, and some of the outcomes of the HARMONI commissioned research to answer the question 'Has NHS Direct increased the workload for HARMONI doctors?'. The research adopted both a qualitative and quantitative approach using cross-sectional and longitudinal analysis of the data collected. The analysis of the data reveals the issues as both complex and dynamic in nature. The research shows that while there has been no significant change to the total volume of activity, changes within patient groups notably the elderly and children, and in individual GP practices may be significant. In addition, the changes in organizational arrangements may influence significant changes in referral patterns such as GP out-of-hours visits. This was confirmed in the interview data indicating a link between the change in nurses' role from gatekeeper to patient advocate, which happened when they ceased to be employees of the part-time co-op and began to work instead for the 24 hours, 7 days a week NHS Direct service. The conclusions drawn are that behavioural and organizational changes are at least as significant as the evidence-based computerized decision support software in changing the demand for primary care. Further evidence cited is that a different demand pattern of calls was experienced by those local GPs not integrated into out-of-hours provision at NHS Direct West London at the time of the study. PMID:15061291

Mark, Annabelle L; Shepherd, Ifan D H

2004-01-01

51

Recovery and self-management support following primary cancer treatment  

Microsoft Academic Search

Background:Around 2 million people are living with or beyond cancer in the UK. However, experiences and needs following primary treatment are relatively neglected. Following treatment, survivors may feel particularly vulnerable and face threats to their identity. We present a conceptual framework to inform areas of self-management support to facilitate recovery of health and well-being following primary cancer treatment.Methods:To explain the

C Foster; D Fenlon

2011-01-01

52

Management of fulminant ulcerative colitis by primary restorative proctocolectomy  

Microsoft Academic Search

Severe acute ulcerative colitis unresponsive to medical management is characterized by multiple associated risk factors including anemia, hypoproteinemia, and high steroid requirements when urgent surgery is required. Current surgical options include use of primary ileal pouch-anal anastomosis (IPAA)vs.historic trends favoring colectomy with ileostomy. PURPOSE: To evaluate the efficacy of primary IPAA in patients with severe colitis, we reviewed our own

Bruce A. Harms; Gregory A. Myers; David J. Rosenfeld; James R. Starling

1994-01-01

53

Consumer choice over living environment, case management, and mental health treatment in supported housing and its relation to outcomes.  

PubMed

Choice and empowerment is commonly discussed as important for mental health consumers. Greater specificity is needed in identifying domains of consumer choice related to outcomes in supported housing. Using data from 534 chronically homeless adults participating in a supported housing initiative, mixed model regressions were used to test the predictive association between three factor-analytically derived domains of consumer choice (choice over living environment, case management, and mental health treatment) and housing and mental health outcomes. Controlling for sociodemographic characteristics, homeless history, and incarceration history, domains of consumer choice assessed at three months were not predictive of housing outcomes at six or 12 months. However, choice over living environment at three months was weakly predictive of psychological well-being and subjective quality of life at six and 12 months. Policy and clinical efforts to enhance consumer choice over housing and living options deserve support, although the magnitude of beneficial effects may be small. PMID:23698681

Tsai, Jack; Rosenheck, Robert A

2012-11-01

54

A Framework for Fibromyalgia Management for Primary Care Providers  

PubMed Central

Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary care providers through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting. PMID:22560527

Arnold, Lesley M.; Clauw, Daniel J.; Dunegan, L. Jean; Turk, Dennis C.

2012-01-01

55

Managed Care Quality of Care and Plan Choice in New York SCHIP  

PubMed Central

Objective To examine whether low-income parents of children enrolled in the New York State Children's Health Insurance Program (SCHIP) choose managed care plans with better quality of care. Data Sources 2001 New York SCHIP evaluation data; 2001 New York State Managed Care Plan Performance Report; 2000 New York State Managed Care Enrollment Report. Study Design Each market was defined as a county. A final sample of 2,325 new enrollees was analyzed after excluding those in markets with only one SCHIP plan. Plan quality was measured using seven Consumer Assessment of Health Plans Survey (CAHPS) and three Health Plan Employer Data and Information Set (HEDIS) scores. A conditional logit model was applied with plan and individual/family characteristics as covariates. Principle Findings There were 30 plans in the 45 defined markets. The choice probability increased 2.5 percentage points for each unit increase in the average CAHPS score, and the association was significantly larger in children with special health care needs. However, HEDIS did not show any statistically significant association with plan choice. Conclusions Low-income parents do choose managed care plans with higher CAHPS scores for their newly enrolled children, suggesting that overall quality could improve over time because of the dynamics of enrollment. PMID:19208091

Liu, Hangsheng; Phelps, Charles E; Veazie, Peter J; Dick, Andrew W; Klein, Jonathan D; Shone, Laura P; Noyes, Katia; Szilagyi, Peter G

2009-01-01

56

[Professional autonomy in the choice and management of therapy. Medicolegal aspects].  

PubMed

Any discussion of the delicate subject of a doctor's autonomy in the choice and management of therapy entails addressing the intimate question of professional and ethical conduct. The professional freedom to choose which therapy to use continues to be the most quintessential expression of the medical professional and, in respect of the primary purpose of safeguarding health, must be aligned with: the choices of the informed patient or his/her legal representatives, existing guidelines and the equitable allocation of resources. On these grounds, the author sets out brief considerations regarding a number of issues frequently raised in the everyday work of the pediatrician and neonatologist: from the doctor's autonomy to adopt a diagnostic-therapeutic approach, with special reference to the prescription of drugs and the subtle differences compared to pharmacological trials, to the promotion and protection of breastfeeding, with explicit reference to the Ministry of Health's recent Circular no. 16 of 24.10.2000 ("Promotion and protection of breastfeeding") which, following a cursory reading of the text, appears to highlight restrictions to the pediatrician's decision-making autonomy. Special emphasis is also given to the medicolegal problems of caring for high-risk neonates. The clinical practice of neonatology often places the doctor in "critical" decision-making situations, with far from negligible ethical and moral implications, not to mention juridical and forensic ones. The author sets out a number of decision-making parameters for use as guidelines: the statistical criterion, the legal criterion and the clinical criterion, the only one capable of adjusting to scientific progress and to the specific technical and professional resources of the medical centre where the doctor is required to intervene in order to preserve even the simple "possibility" of autonomous life for the fetus. From this point of view, the so-called chronological vitality and scientifically proven statistics form part of the numerous criteria available for clinical evaluation. If the clinical criterion is not met, namely if the product of conception is not vital and has never been fully alive in the biologically complete sense of the term, then the omission of therapeutic support is not particularly important in professional and juridical terms. On the contrary, it would show an obstinate persistence of therapy, which would be both ethically and professionally incorrect. Lastly, even during the final stages of life, the doctor must play a participatory role not only by providing palliative treatment but also, and above all, offering moral assistance to sanction the ineluctable end of the therapeutic alliance, that "feeling together" which is the most literal and profound meaning of the word "consent", indicating both "information" but to an even greater extent "discussion" and "empathy" with the patient and his/her family. PMID:11862168

Bolino, G; Alfano, C

2002-02-01

57

Managing the Primary Curriculum: Policy into Practice in England  

ERIC Educational Resources Information Center

This paper reports on research into how effective non-statutory guidance has been in managing the primary science curriculum in England. A small-scale qualitative study was used to elicit the views of teachers, local education authority advisors, an Ofsted inspector and a policy-maker. The findings indicate that the guidance is influencing the…

Gillard, Linda; Whitby, Virginia

2007-01-01

58

Medicare's Chronic Care Management Payment - Payment Reform for Primary Care.  

PubMed

In 2015, the Centers for Medicare and Medicaid Services will introduce a non-visit-based payment for chronic care management. The new policy reflects an investment in primary care that may contribute to the development of a value-oriented health system. PMID:25427110

Edwards, Samuel T; Landon, Bruce E

2014-11-27

59

Total Quality Management Practices in Turkish Primary Schools  

ERIC Educational Resources Information Center

Purpose: The purpose of this paper is to determine the extent of total quality management (TQM) practices in primary schools based on teachers' perceptions, and how their perceptions are related to different variables. Design/methodology/approach: In this study, a survey based descriptive scanning model was used. This study was carried out in…

Toremen, Fatih; Karakus, Mehmet; Yasan, Tezcan

2009-01-01

60

The management of new primary care organizations: an international perspective.  

PubMed

Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles. The research, based on a two-year fieldwork programme, indicates that at the meso-level of management planning and practice, there is a considerable potential for exchange and transferable learning between previously unconnected countries. The effectiveness of management strategies abroad, for example, in contexts where for the first time alternative but comparable new primary care organizations are exercising responsibilities for local resource utilization, may be understood through the application of stakeholder analyses, such as those employed to promote parity of relationships in NHS primary care trusts. PMID:16848957

Meads, Geoffrey; Wild, Andrea; Griffiths, Frances; Iwami, Michiyo; Moore, Phillipa

2006-08-01

61

Nonlethal Techniques for Managing Predation: Primary and Secondary Repellents  

Microsoft Academic Search

Conservation biology requires the development of practical tools and techniques to minimize con- flicts arising from human modification of ecosystems. We applied behavioral theory of primary and secondary repellents to predator management by using aversive stimulus devices (electronic training collars) and dis- ruptive stimulus devices (behavior-contingent audio and visual repellents) in a multipredator ( Canis lupus, Haliaeetus leucocephalus, Ursus spp.)

JOHN A. SHIVIK; ADRIAN TREVES; PEGGY CALLAHAN

2003-01-01

62

Sigmoid Volvulus Complicating Pregnancy Managed by Resection and Primary Anastomosis  

PubMed Central

Sigmoid volvulus is an extremely rare cause of intestinal obstruction in pregnancy. The rarity of the condition and the fact that pregnancy itself clouds the clinical picture invariably leads to a delay in diagnosis with an increased risk of gangrene of the gut. The majority of these patients would then require resection and colostomy. However, an early diagnosis and intervention as in our patient, which would require a high index of clinical suspicion, could significantly improve the outcome of the foetus and the mother. A case of sigmoid volvulus in pregnancy is reported which was managed by resection and primary anastomosis. A review of literature revealed no previous reports of sigmoid volvulus in pregnancy managed by primary anastomosis following resection of the sigmoid volvulus. The literature is also reviewed regarding predisposing factors, management options and the outcome of sigmoid volvulus complicating pregnancy. PMID:21509281

Machado, Norman O; Machado, Lovina S M

2009-01-01

63

Technology crossing borders: the choice, transfer, and management of international technology flows  

SciTech Connect

The empirical work in this book examines three issues in the transfer of technology: 1) how managers, public and private, choose the kinds of technology they import or export; 2) how multinational enterprises decide on the channels through which they transfer technology and how that choice affects the recipient firm abroad; and 3) how multinational enterprises manage certain of their relationships with overseas affiliates that import, use, modify, and generate technology. This book makes no attempt to summarize all the literature in the fields on which it reports; rather, it presents a group of clearly related empirical studies that draw on a common set of concepts. On some points the studies are in agreement with the conventional literature; on others, they depart strikingly from the more commonly accepted theories.

Stobaugh, R.; Wells, L.T. Jr. (eds.)

1984-01-01

64

Primary cutaneous melanoma: surgical management and other treatment options  

Microsoft Academic Search

Opinion statement  The incidence of primary cutaneous melanoma continues to increase and is a growing public health problem. By virtue of its\\u000a metastatic potential, melanoma accounts for most of the deaths from cutaneous malignancies. Management of cutaneous melanoma\\u000a has undergone a paradigm shift in recent years. Clinical studies have furthered our understanding of the biology of this disease\\u000a and have changed

Jeffrey D. Wagner; Debra Bergman

2003-01-01

65

Potential benefits of integrated COPD management in primary care.  

PubMed

Chronic obstructive pulmonary disease (COPD) represents a major and progressive cause of morbidity and mortality worldwide, resulting in an important financial and health burden in coming decades. Pulmonary rehabilitation (PR) has been proven to be the most effective treatment in all patients in whom respiratory symptoms are associated with diminished functional capacity or reduced quality of life. Nevertheless, despite wide recommendation and proven efficacy, the use of PR is limited in daily practice. Reasons for these include low accessibility and availability, high costs, and lack of motivation to continue a healthy life style after treatment. By contrast, it has been demonstrated that primary care patients can be reactivated by formulating personal targets and designing individualized treatment plans in collaboration with their general practitioner or practice nurse. Based on these personal plans and targets, specific education must be provided and development of self management skills should be actively encouraged. Ideally, elements of pulmonary rehabilitation are tailored into a comprehensive primary care integrated disease management program. In that way, the benefits of PR can be extended to a substantially larger part of the COPD population, to reach even those with milder stages of disease. Favorable long-term effects on exercise tolerance and quality of life in a number of studies have been demonstrated in recent years, but broad introduction in the primary care setting still needs further justification in the form of a proper cost effectiveness analysis. PMID:21214043

Kruis, A L; Chavannes, N H

2010-09-01

66

Optimal management of older patients with chronic lymphocytic leukemia: some facts and principles guiding therapeutic choices.  

PubMed

Chronic lymphocytic leukemia (CLL) is a disease of older patients and median age at diagnosis is 72 years. This older group is under-represented in clinical trials, (median age 58-62 years). Here we review background data on incidence, survival, definitions of older age, fitness criteria, frailty and co-morbidities. Issues influencing the choice of therapy in older patients are also addressed and different therapeutic options are highlighted based on recent available data. Fit older patients with less co-morbidities benefit most from the very effective chemoimmunotherapy (FC-R) given for younger patients today, but whether other novel drug combinations or new agents are more suitable for less fit patients is still unsettled. Based on careful evaluation of published data from larger clinical trials and major referral centers we present our concept of therapy as a guide to optimal management for subgroups of older patients with CLL. PMID:21955980

Tadmor, Tamar; Polliack, Aaron

2012-01-01

67

[The effect of some factors on medical student specialty choice of non-primary care--a synthesis of the literature].  

PubMed

The paper analyses the literature on non-primary care specialty choice. The motives for studying medicine and influences on medical student career choice have been presented. The stability of this selection has also been examined. Several predictors of specialty choice such as: demographics, academic performance, income, social status and personality attributes have been identified. Moreover, the influence of prestige, intellectual content, ability to provide sophisticated technology on preferences of non-primary care specialty has been analyzed. Association between empathy and medical specialty choice has been evaluated. What is more, it is presented that internal medicine residents are more likely to be introverted, attentive, to have deeper intellectual curiosity, higher aspiration levels and to be interested in mental stimulations. Furthermore, the surgery residents are more likely to be interested in modern technology, prestige, higher income and to be assertive and extroversive. In addition, students attracted to gynecology like contact with (mostly healthy) patients and express strong believes on reproductive issues. Besides, psychiatry students seem to be sensitive, unstable and impulsive. The analyses of Polish students' attitudes to non-primary care specialties are also presented. There is a positive perception of non-primary care and hospital medicine specialties. The specialties are more attractive because of foreseeable higher income, prestige, opportunities for research and possibilities for mastering skills and knowledge. PMID:17874633

Pawe?czyk, Agnieszka; Pawe?czyk, Tomasz; Bielecki, Jan

2007-06-01

68

Managing Suicide Attempts: Guidelines for the Primary Care Physician  

PubMed Central

The management of patients who have made suicide attempts is a responsibility that frequently falls to the primary care physician. For this reason, it is important that the physician have a clear strategy for dealing with the suicidal patient in the office, hospital, and emergency room. In the acute situation, the first priority is to stabilize the patient and ensure his or her medical safety. Once this is accomplished, history and circumstances of the attempt can be assessed, along with likelihood of recurrence of the attempt. This article reviews guidelines for evaluating suicide risk. The importance of the patient-physician relationship is noted, particularly in regard to prevention of future suicide attempts. With a focused, thorough approach to the suicidal patient, which incorporates both medical and psychiatric considerations, the primary care physician can ameliorate the patient's acute situation and facilitate the coordination of care with appropriate psychiatric resources. PMID:15213779

Carrigan, Catherine Goertemiller; Lynch, Denis J.

2003-01-01

69

Current Management of Primary Central Nervous System Lymphoma  

SciTech Connect

Primary central nervous cell lymphoma (PCNSL) is an uncommon neoplasm of the brain, leptomeninges, and rarely the spinal cord. Initially thought to be characteristically associated with congenital, iatrogenic, or acquired immunosuppression, PCNSL is now recognized with increasing frequency in immunocompetent individuals. The role of surgery is limited to establishing diagnosis, as PCNSL is often multifocal with a propensity to involve the subarachnoid space. A whole-brain radiation volume has empirically been used to adequately address the multifocal tumor frequently encountered at the time of PCNSL diagnosis. Despite high rates of response after whole-brain radiotherapy (WBRT), rapid recurrence is common and long-term survival is the exception. Chemotherapy alone or in combination with WBRT has more recently become the treatment of choice. Most effective regimens contain high-dose methotrexate and or other agents that are capable of penetrating the blood-brain barrier. High response rates and improved survival with the use of chemotherapy has led to treatment strategies that defer or eliminate WBRT in hopes of lessening the risk of neurotoxicity attributed to WBRT. Unfortunately, elimination of WBRT is also associated with a higher rate of relapse. Combined chemotherapy and WBRT regimens are now being explored that use lower total doses of radiation and altered fractionation schedules with the aim of maintaining high rates of tumor control while minimizing neurotoxicity. Pretreatment, multifactor prognostic indices have recently been described that may allow selection of treatment regimens that strike an appropriate balance of risk and benefit for the individual PCNSL patient.

Schultz, Christopher J. [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Bovi, Joseph, E-mail: jbovi@mcw.ed [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)

2010-03-01

70

Gastroschisis--primary fascial closure. The goal for optimal management.  

PubMed Central

Since Raffensperger and Jona reported an 80% success rate with primary skin closure including a 16% rate of complete fascial closure in 24 patients with gastroschisis in 1974, primary fascial closure has been the author's preferred method. It has been possible to achieve complete fascial and skin closure in 17 of the last 21 patients (81%). Four infants in this series, one of whom was initially managed by another surgeon, were treated with brief application of a silon prosthesis with subsequent reduction and closure. The two keys to success of this method are thorough wash out of the meconium from the entire intestine and vigorous stretching of the abdominal wall. Assisted ventilation may be needed for 24 to 48 hours after operation and has been well tolerated. Transposition of an umbilical artery for cannulation and blood gas monitoring has been an important adjunct. The one death (5% mortality) resulted from prolonged bowel dysfunction and liver failure three months after operation. Other complications have been few and mild. Since some recent reports have indicated that primary closure is not being widely used in the treatment of gastroschisis, this series is presented to emphasize that this method can be used in most infants and with a very low complication rate. Images Fig. 1. PMID:6219639

Filston, H C

1983-01-01

71

The impact of group-oriented values on choice of conflict management styles and outcomes: an empirical study in Turkey  

Microsoft Academic Search

Globalization has led to increased attention to cultural diversity in workforces and its influences on organizational practice. This study examines group-oriented values and their impact on choice of conflict management styles as well as on conflict resolution outcomes in Turkey. Using a sample of 315 managerial personnel from various public and private organizations, this study shows that norms of subordination

Zhenzhong Ma; Dapeng Liang; Ahmet Erkus; Akif Tabak

2012-01-01

72

The organizational choice of human resource management practices: a study of Chinese enterprises in three cities in the PRC  

Microsoft Academic Search

This study examined the effects of an organization's contextual variables on the choice of human resource management (HRM) practices to secure, nurture, reward and retain managerial employees. The contextual variables included organizational characteristics (ownership, age and size), on the one hand, and its competitive strategies (innovation, quality and cost) and the strategic role of the human resource function, on the

Daniel Z. Ding; Syed Akhtar

2001-01-01

73

Using focus groups to design a choice modelling questionnaire for estimating natural resource management benefits in NSW  

Microsoft Academic Search

In this study, focus group discussions were used to design a choice modelling (CM) questionnaire to estimate community wide values for the environmental and social benefits provided by natural resource management changes in the Namoi, Lachlan and Hawkesbury-Nepean catchments. This report describes the logistics of the focus groups and outlines the main conclusions drawn from the discussions. The research team

Kasia Mazur; Jeffrey W. Bennett

2008-01-01

74

Changes in health care utilisation following a reform involving choice and privatisation in Swedish primary care: a five-year follow-up of GP-visits  

PubMed Central

Background The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an equity perspective, in subgroups defined by age, gender and family income. Methods The study is based on register data years 2007 – 2011 from the Skåne Regional Council (population 1.2 million) regarding individual health care utilisation in the form of visits to general practitioner (GP). Health utilisation data was matched with data about individual’s age, gender and family income provided by Statistics Sweden. Multilevel, logistic regression models were constructed to analyse changes in health utilisation in different subgroups and the probability of a GP-visit before and after reform. Results Health care utilisation in terms of both number of individuals that had visited a GP and number of GP-visits per capita increased in all defined subgroups, but to a varying degree. Multilevel logistic regression showed that individuals of both genders aged above 64 and belonging to a family with an income above median had more advantage of the reform, OR 1.25-1.29. Conclusions Reforms involving choice and privatisation in Swedish primary health care improved access to GP-visits generally, but more so for individuals belonging to a family with income above the median. PMID:24171894

2013-01-01

75

Multiprofessional training for breastfeeding management in primary care in the UK  

PubMed Central

Background Increasing breastfeeding initiation and duration rates is one of the UK Department of Health national targets for improving the health of the population. One reason contributing to the high rates of breastfeeding discontinuation may be that primary care teams may not have sufficient knowledge to help mothers overcome problems experienced in the early days and may also give conflicting advice. Previous studies have shown that general practitioners are happy to participate in practice-based educational sessions and have expressed a need for breastfeeding education. This study was carried out as part of the training to achieve 'UNICEF UK Baby Friendly Initiative in a community health care setting' status. It aimed to improve the breastfeeding expertise and advice about the management of breastfeeding problems within the primary care team using a CD-ROM breastfeeding learning package, and to assess the usefulness and acceptability of this educational intervention. Methods Six UK general practitioner (GP) practices were involved in a questionnaire survey of multiprofessional groups before and after an interactive training session. This focussed on managing and solving problems, particularly mastitis and nipple thrush. The questionnaire included 20 questions on attitudes to and knowledge of breastfeeding, and eight multiple-choice questions on breastfeeding management. Non-parametric statistics (Mann-Whitney, Kruskal-Wallis and Wilcoxon tests) were used to compare the groups and to explore changes in knowledge after training. Results Fifty primary care health professionals (29 GPs, 18 health visitors, 3 midwives) attended the sessions. There was an increase in scores relating to knowledge about breastfeeding after training, especially for the GPs and for those who did not have their own children. Health visitors improved their scores on recognition of the symptoms of poor attachment at the breast, and GPs showed greatest improvement in resolving sore nipples and recognising nipple thrush. Changes in practice were reported and positive comments made about involving GPs and health visitors together in practice-based education. Conclusion Using an electronic teaching resource is feasible for updating the knowledge of the primary care team. It can help to improve breastfeeding expertise and advice about breastfeeding problem management. PMID:16722540

Ingram, Jennifer

2006-01-01

76

Biodiversity informatics: managing and applying primary biodiversity data.  

PubMed

Recently, advances in information technology and an increased willingness to share primary biodiversity data are enabling unprecedented access to it. By combining presences of species data with electronic cartography via a number of algorithms, estimating niches of species and their areas of distribution becomes feasible at resolutions one to three orders of magnitude higher than it was possible a few years ago. Some examples of the power of that technique are presented. For the method to work, limitations such as lack of high-quality taxonomic determination, precise georeferencing of the data and availability of high-quality and updated taxonomic treatments of the groups must be overcome. These are discussed, together with comments on the potential of these biodiversity informatics techniques not only for fundamental studies but also as a way for developing countries to apply state of the art bioinformatic methods and large quantities of data, in practical ways, to tackle issues of biodiversity management. PMID:15253354

Soberón, Jorge; Peterson, A Townsend

2004-04-29

77

Biodiversity informatics: managing and applying primary biodiversity data.  

PubMed Central

Recently, advances in information technology and an increased willingness to share primary biodiversity data are enabling unprecedented access to it. By combining presences of species data with electronic cartography via a number of algorithms, estimating niches of species and their areas of distribution becomes feasible at resolutions one to three orders of magnitude higher than it was possible a few years ago. Some examples of the power of that technique are presented. For the method to work, limitations such as lack of high-quality taxonomic determination, precise georeferencing of the data and availability of high-quality and updated taxonomic treatments of the groups must be overcome. These are discussed, together with comments on the potential of these biodiversity informatics techniques not only for fundamental studies but also as a way for developing countries to apply state of the art bioinformatic methods and large quantities of data, in practical ways, to tackle issues of biodiversity management. PMID:15253354

Soberon, Jorge; Peterson, A Townsend

2004-01-01

78

Parental choice of schools and parents’ perceptions of multicultural and co?existence education: the case of the Israeli Palestinian–Jewish bilingual primary schools  

Microsoft Academic Search

The present research effort aims to better understand parental choice of the Israeli Palestinian–Jewish bilingual primary schools and its implications in contributing (or not) to fostering multicultural and co?existence educational efforts in conflict?ridden societies. The manuscript offers a short description of the educational initiative under examination and the socio?political contexts within which it has evolved. The research was conducted using

Zvi Bekerman; Moshe Tatar

2009-01-01

79

Diagnosis and management of primary aldosteronism: an updated review.  

PubMed

Primary aldosteronism (PA) is the most common secondary form of arterial hypertension, with a particularly high prevalence among patients with resistant hypertension. Aldosterone has been found to be associated with cardiovascular toxicity. Prolonged aldosteronism leads to higher incidence of cardiac events, glomerular hyperfiltration, and potentially bone/metabolic sequels. The wider application of aldosterone/renin ratio as screening test has substantially contributed to increasing diagnosis of PA. Diagnosis of PA consists of two phases: screening and confirmatory testing. Adrenal imaging is often inaccurate for differentiation between an adenoma and hyperplasia, and adrenal venous sampling is essential for selecting the appropriate treatment modality. The etiologies of PA have two main subtypes: unilateral (aldosterone-producing adenoma) and bilateral (micro- or macronodular hyperplasia). Aldosterone-producing adenoma is typically managed with unilateral adrenalectomy, while bilateral adrenal hyperplasia is amenable to pharmacological approaches using mineralocorticoid antagonists. Short-term treatment outcome following surgery is determined by factors such as preoperative blood pressure level and hypertension duration, but evidence regarding long-term treatment outcome is still lacking. However, directed treatments comprising of unilateral adrenalectomy or mineralocorticoid antagonists still potentially reduce the toxicities of aldosterone. Utilizing a physician-centered approach, we intend to provide up-dated information on the etiology, diagnosis, and the management of PA. PMID:23701121

Chao, Chia-Ter; Wu, Vin-Cent; Kuo, Chin-Chi; Lin, Yen-Hung; Chang, Chin-Chen; Chueh, S Jeff; Wu, Kwan-Dun; Pimenta, Eduardo; Stowasser, Michael

2013-06-01

80

Introducing innovation in a management development programme for a UK primary care organisation  

Microsoft Academic Search

Purpose – The aim of this paper is to examine the introduction of innovation as part of a management development programme at a primary care organisation, a legal form known as a Primary Care Trust (PCT), in the UK. Design\\/methodology\\/approach – The paper draws on experience of managing a successful management development programme for a PCT. The report of the

Paul Smith; Libby Hampson; Jonathan Scott; Karen Bower

2011-01-01

81

Current approaches to obesity management in UK Primary Care: the Counterweight Programme  

Microsoft Academic Search

Background\\/Aims Primary care is expected to develop strategies to manage obese patients as part of coronary heart disease and diabetes national service frameworks. Little is known about current manage- ment practices for obesity in this setting. The aim of this study is to examine current approaches to obesity management in UK primary care and to identify potential gaps in care.

Rachel Laws

2004-01-01

82

Managed Care and the Primary-Specialty Care Interface. Abstract, Executive Summary, and Final Report.  

National Technical Information Service (NTIS)

This study examined how managed care influences the occurrence and content of referrals that primary care physicians make to specialty care. During 1997-1999 survey data were collected prospectively in the practices of 155 primary care physicians located ...

A. W. Riley

2000-01-01

83

Approach to the diagnosis and management of suspected exercise-induced bronchoconstriction by primary care physicians  

PubMed Central

Background Exercise-related respiratory symptoms in the diagnosis of exercise-induced bronchoconstriction (EIB) have poor predictive value. The aim of this study was to evaluate how athletes presenting with these symptoms are diagnosed and managed in primary care. Methods An electronic survey was distributed to a random selection of family practitioners in England. The survey was designed to assess the frequency with which family practitioners encounter adults with exercise-related respiratory symptoms and how they would approach diagnostic work-up and management. The survey also evaluated awareness of and access to diagnostic tests in this setting and general knowledge of prescribing asthma treatments to competitive athletes. Results 257 family practitioners completed the online survey. One-third of respondents indicated they encountered individuals with this problem at a frequency of more than one case per month. Over two-thirds of family practitioners chose investigation as an initial management strategy, while one-quarter would initiate treatment based on clinical information alone. PEFR pre- and post-exercise was the most commonly selected test for investigation (44%), followed by resting spirometry pre- and post-bronchodilator (35%). Short-acting ?2-agonists were the most frequently selected choice of treatment indicated by respondents (90%). Conclusion Family practitioners encounter individuals with exercise-related respiratory symptoms commonly and although objective testing is often employed in diagnostic work-up, the tests most frequently utilised are not the most accurate for diagnosis of EIB. This diagnostic approach may be dictated by the reported lack of access to more precise testing methods, or may reflect a lack of dissemination or awareness of current evidence. Overall the findings have implications both for the management and hence welfare of athletes presenting with this problem to family practitioners and also for the competitive athletes requiring therapeutic use exemption. PMID:19527498

Hull, James H; Hull, Peter J; Parsons, Jonathan P; Dickinson, John W; Ansley, Les

2009-01-01

84

Primary cicatricial alopecia: recent advances in understanding and management.  

PubMed

Primary cicatricial alopecias (PCA) are a rare group of disorders, in which the hair follicle is the main target of destructive inflammation resulting in irreversible hair loss with scarring of affected lesions. The most typical clinical manifestation of PCA is the loss of visible follicular ostia. The histopathological hallmark of a fully developed lesion is the replacement of the hair follicle structure by fibrous tissue. PCA could share similar clinical manifestations and eventually lead to "burn-out" alopecia. Some subsets are hardly distinguishable histopathologically and the mechanisms that elicit such a destructive reaction have not been fully elucidated. Thus, the management of PCA represents one of the most challenging clinical problems for dermatologists. The aim of this review is to provide a concise and comprehensive summary of recent advances in PCA management, especially focusing on novel methodologies to aid diagnosis, and updates on our understanding of the etiopathogenesis. Dermoscopy, a new pathological preparation technique and direct immunofluorescence analysis enable more accurate clinicopathological diagnosis of PCA. Microarray analysis may be beneficial to distinguish PCA subtypes. Currently suggested mechanisms underlying PCA include loss of immune protection of stem cells, impaired stem cell self-maintenance, enhanced autoimmunity by pro-inflammatory cytokines and environmental/genetic predispositions. Interestingly, recent data indicates the association between lipid metabolism dysregulation and PCA development, implying an important role of the sebaceous gland dysfunction in the etiopathogenesis. Based on that hypothesis and observations, novel therapeutic approaches have been proposed, including the use of peroxisome proliferator-activated receptor-? agonist for lichen planopilaris. PMID:22097924

Ohyama, Manabu

2012-01-01

85

Primary care by desire or default? Specialty choices of minority graduates of US medical schools in 1983.  

PubMed Central

This study was undertaken to determine if US medical school students of different racial/ethnic backgrounds demonstrate similar patterns of evolution of specialty choice between their senior year of medical school and their third postgraduate year. The study identified the specialty choices of US medical school seniors in 1983 through their responses to the Association of American Medical Colleges Graduating Medical Student Questionnaire (GQ). The cohort was classified into three groups: underrepresented minorities, non-underrepresented minorities, and whites. Using these AAMC data as baseline, each racial/ethnic background group was tracked through their third residency year. Comparisons were made between anticipated specialty choices as senior medical students and actual specialties as revealed through residency tracking. The study found that more than 95% of the cohort began residencies in specialties compatible with their GQ choices. Unexpectedly, almost 20% of blacks, Commonwealth Puerto Ricans, and other Hispanics were not in graduate medical education in their third postgraduate year. This group needs to be studied further in order to learn the proportion of these physicians who subsequently completed residency training and the reason(s) for attrition in physicians who did not fulfill minimum training requirements for board certification. PMID:8064901

Babbott, D.; Weaver, S. O.; Baldwin, D. C.

1994-01-01

86

Managing Time. Supervising: Technical Aspects of Supervision. The Choice Series #42. A Self Learning Opportunity.  

ERIC Educational Resources Information Center

This student guide is intended to teach persons employed as supervisors how to manage time. Discussed in the first three sections are the following topics: the importance of managing time (managing time, becoming a better time manager, crisis management, beck and call, the treadmill, and the activity trap); techniques of deciding how to use time…

Boak, George

87

International Primary Care Respiratory Group (IPCRG) Guidelines: integrating diagnostic guidelines for managing chronic respiratory diseases in primary care.  

PubMed

This is the first of the IPCRG Guideline papers. The IPCRG took on the task of producing an integrated guideline for the management of chronic respiratory diseases in primary care. This included some original work aimed at developing questionnaires suitable for improving the diagnosis and recognition of respiratory diseases in the primary care setting. This paper provides the background evidence and rationale for the integrated diagnostic section of the IPCRG Guideline. It focuses on identifying the unique challenges in respiratory disease diagnosis in primary care, the use of epidemiology to build a co-ordinated diagnostic framework, and the development of tools to support guideline implementation. PMID:16701755

Halbert, Ron J; Isonaka, Sharon

2006-02-01

88

International Primary Care Respiratory Group (IPCRG) Guidelines: Management of Chronic Obstructive Pulmonary Disease (COPD)  

Microsoft Academic Search

COPD is a common and under-diagnosed disease which is increasing in prevalence worldwide. A more aggressive and optimistic approach must be adopted towards its management in primary care. This IPCRG Guideline on the management of COPD in primary care is fully consistent with GOLD guidelines. It highlights the goals of COPD treatment and the need for spirometric testing to make

David Bellamy; Jacques Bouchard; Svein Henrichsen; Gunnar Johansson; Arnulf Langhammer; Jim Reid; Chris van Weel; Sonia Buist

2006-01-01

89

Ongoing pregnancy qualifies best as the primary outcome measure of choice in trials in reproductive medicine: an opinion paper.  

PubMed

The most appropriate primary outcome measure for reproductive medicine has been discussed frequently. In 2003 the European Society for Human Reproduction and Embryology recommended that the outcome measure of assisted reproductive technology (ART) and non-ART should be singleton live birth. Although live birth is indeed the aim of clinical practice, and there is no discussion that it should be reported in infertility trials, we hereby provide arguments that plead for using ongoing pregnancy as the primary outcome in such trials. We feel that ongoing pregnancy best serves the many purposes of a primary outcome and best reflects the effectiveness of a treatment. PMID:24786739

Braakhekke, Miriam; Kamphuis, Esme I; Dancet, Eline A; Mol, Femke; van der Veen, Fulco; Mol, Ben W

2014-05-01

90

Working capital management, corporate performance, and strategic choices of the wholesale and retail industry in China.  

PubMed

We examine the influence of strategic choice on working capital configurations and observe how the relationship between working capital ratio and operational performance differs depending on strategy. By clustering the strategic factors of the wholesale and retail industry, we find three categories of strategies: terminal market strategy, middle market strategy, and hybrid strategy. Using the panel data of the listed companies of the wholesale and retail industry as our sample, we analyze the differences in the ways companies configure working capital, the speed with which working capital adjusts to its target, and the effects of working capital on performance for companies that make different strategic choices. The empirical results suggest that working capital is configured and adjusted to its target in different ways under different competitive strategic choices. This effect is finally transferred to influence the relationship between working capital configuration and operational performance. PMID:25121141

Li, Chuan-guo; Dong, Hui-min; Chen, Shou; Yang, Yan

2014-01-01

91

Working Capital Management, Corporate Performance, and Strategic Choices of the Wholesale and Retail Industry in China  

PubMed Central

We examine the influence of strategic choice on working capital configurations and observe how the relationship between working capital ratio and operational performance differs depending on strategy. By clustering the strategic factors of the wholesale and retail industry, we find three categories of strategies: terminal market strategy, middle market strategy, and hybrid strategy. Using the panel data of the listed companies of the wholesale and retail industry as our sample, we analyze the differences in the ways companies configure working capital, the speed with which working capital adjusts to its target, and the effects of working capital on performance for companies that make different strategic choices. The empirical results suggest that working capital is configured and adjusted to its target in different ways under different competitive strategic choices. This effect is finally transferred to influence the relationship between working capital configuration and operational performance. PMID:25121141

Li, Chuan-guo; Dong, Hui-min; Chen, Shou; Yang, Yan

2014-01-01

92

Questionable methods of cancer management: the Committee for Freedom of Choice in Medicine, Inc.  

PubMed

The Committee for Freedom of Choice in Medicine is the political arm of several interlocking corporations promoting and/or marketing questionable remedies for cancer and other serious diseases. Operating during the 1970s as the Committee for Freedom of Choice in Cancer Therapy, the organization fought for legalization of laetrile and claimed to have many members. Today the Committee appears to be a small group whose principal activities are speeches and press conferences by its leaders, protests to government agencies, and publication of a small-circulation newsletter. PMID:8382548

1993-01-01

93

Physical activity, food choice, and weight management goals and practices among U.S. college students  

Microsoft Academic Search

Introduction: Physical activity and a healthy diet have been recommended to help reverse the increasing prevalence of overweight among adolescents and adults in the United States.Methods: Data is from the 1995 National College Health Risk Behavior Survey. A representative sample of US undergraduate college students (n = 4609) were analyzed to examine associations of physical activity and food choice with

Richard Lowry; Deborah A Galuska; Janet E Fulton; Howell Wechsler; Laura Kann; Janet L Collins

2000-01-01

94

Health services management in primary schools (Elazig city sample)  

Microsoft Academic Search

Primary school children have low resistance to diseases. In order to live a healthy life, they should be equipped with health literacy skills. Effective primary school health services can only be achieved with the collaboration of related parties. Turkish schools generally do not employ permanent health personnel, and school health services are generally taken to be synonymous with health screening.

I. Bak?r Arabaci

2009-01-01

95

Integrated Natural Disaster Risk Management: Comprehensive and Integrated model and Chinese Strategy Choice  

Microsoft Academic Search

The integrated natural disaster risk management (INDRM) has become an important strategy and model in contemporary disaster management. It is a comprehensive and integrated approach that embraces the management of all types of natural disasters and all phases of the disaster management cycle, focuses on disaster hazard and vulnerability, i.e. the underlying conditions of disasters, and emphasizes a multi-level, multi-dimensional,

Jiquan Zhang; Norio Okada; Hirokazu Tatano

96

Newcomers Navigating Language Choice and Seeking Voice: Peer Talk in a Multilingual Primary School Classroom in Finland  

ERIC Educational Resources Information Center

This article investigates how two young newcomers navigate an institutional policy of "English only" in a Finnish primary school and how this policy impacts opportunities for voice. From a discourse analytic and sociolinguistic perspective, the analysis takes an ethnographic path to a focal event of language conflict in the classroom. The analysis…

Mokkonen, Alicia Copp

2013-01-01

97

Cancer Pain Management in Prisons: A Survey of Primary Care Practitioners and Inmates  

Microsoft Academic Search

Cancer pain management among prison inmates is an emerging problem. To examine the obstacles to cancer pain management in inmates, surveys of inmates with cancer pain (IPs) (n=102) and primary care practitioners (PCPs) (n=74) in Texas state prisons were conducted. IPs were assessed using the Brief Pain Inventory and Pain Management Index (PMI). PCPs were assessed with a modified Clinic

James T. Lin; Paul Mathew

2005-01-01

98

Knowledge Management, Value Chain Modelling and Simulation as Primary Tools for  

E-print Network

Knowledge Management, Value Chain Modelling and Simulation as Primary Tools for Mass Customization of the company's value chain. Knowledge management is a tool that assures this collaboration by better capturing presents Knowledge management, value chain modelling and simulation as tools for MC implementation, applied

Paris-Sud XI, Université de

99

Patient Self-management of Chronic Disease in Primary Care  

Microsoft Academic Search

Patients with chronic conditions make day-to-day decisions about—self- manage—their illnesses. This reality introduces a new chronic disease para- digm: the patient-professional partnership, involving collaborative care and self-management education. Self-management education complements tra- ditional patient education in supporting patients to live the best possible quality of life with their chronic condition. Whereas traditional patient edu- cation offers information and technical skills,

Thomas Bodenheimer; Kate Lorig; Halsted Holman; Kevin Grumbach

2005-01-01

100

Managing the new primary care: the new skills that will be needed.  

PubMed

Developing new models of primary care will demand a level of managerial expertise that few of today's primary care physicians possess. Yet medical schools continue to focus on the basic sciences, to the exclusion of such managerial topics as running effective teams. The approach to executing reform appears to assume that practice managers and entrepreneurs can undertake the managerial work of transforming primary care, while physicians stick with practicing medicine. This essay argues that physicians currently in practice could be equipped over time with the management skills necessary to develop and implement new models of primary care. PMID:20439899

Bohmer, Richard M J

2010-05-01

101

Values, Increasing Autonomy and Managing the Primary School.  

ERIC Educational Resources Information Center

Since 1988, education deregulation policies in the Netherlands have granted more autonomy to schools. This paper presents findings of a study that analyzed the changing role of school managers that has resulted from such policies. The study identified underlying values in the attitudes of school leaders toward their changing roles as managers of…

Hooge, Edith

102

School Management Related Knowledge Levels of Primary School Teachers  

ERIC Educational Resources Information Center

The knowledge levels of the teachers affect the qualifications of operations and transactions in schools. School management related knowledge of the teachers is an essential tool to reach the targets of the school. The objective of this study was to determine the school management related knowledge levels of the teachers. Qualitative and…

Ugurlu, Celal Teyyar

2013-01-01

103

A review of the literature informing affordable, available wound management choices for rural areas of tropical developing countries.  

PubMed

Health professionals are often absent in rural areas of tropical developing countries. Current wound management in this environment is costly and largely ineffective. Achieving effective wound management in this setting will require educating the lay health providers who manage wounds in villages. Two extensive literature searches were conducted using CINAHL and Medline with no date, geographic, or language restrictions. The question, "What is the evidence base for topical wound treatments and dressings that are affordable and available in developing countries?" was addressed by critically evaluating all 18 identified clinical studies and reviews. The results suggest that a moist wound environment can be maintained using improvised dressings such as banana leaves, saline-soaked furniture foam, and food wrap, and that these choices are superior to many commercial dressings. Some varieties of honey, papaya pulp, EUSOL, and lubricating jelly are effective, affordable substances for treating and debriding wounds. Papaya pulp can be unsafe if not very closely monitored. No studies addressing the second question, "What are the topical wound management interventions currently being used in rural areas of tropical developing countries?" were found. However, 13 articles that could guide the design of research studies in this field were identified and are reviewed here. This literature describes a wide variety of wound prevention and management methods, some known to be deleterious for healing. These two literature reviews reveal the large gaps in the evidence base on available and affordable wound treatment options for rural patients in developing countries. Future research should address these gaps. PMID:24106254

Benskin, Linda L L

2013-10-01

104

Impact of an informed choice invitation on uptake of screening for diabetes in primary care (DICISION): trial protocol  

E-print Network

letters are sent from participants' GPs and screening takes place at the surgery. An opt-out method of seeking consent to measure attendance is used. An opt-in method of consent to participate in the remainder of the trial is used after the primary outcome... : UKPDS 38. BMJ 1998, 317:703-713. 26. Bekker H, Thornton JG, Airey CM, Connelly JB, Hewison J, Robinson MB, Lilleyman J, MacIntosh M, Maule AJ, Michie S: Informed deci- sion making: an annotated bibliography and systematic review. Health Technology...

Mann, Eleanor; Prevost, A Toby; Griffin, Simon J; Kellar, Ian; Sutton, Stephen; Parker, Michael; Sanderson, Simon; Kinmonth, Ann Louise; Marteau, Theresa M

2009-02-20

105

Impact of chronic disease self-management programs on type 2 diabetes management in primary care  

PubMed Central

AIM: To assess the effectiveness of the Chronic Disease Self-Management Program (CDSMP) on glycated hemoglobin A1c (HbA1c) and selected self-reported measures. METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls who received usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life (HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects. RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6% (P < 0.0001), but the reductions did not differ significantly between the two groups (P = 0.885). Few significant differences were observed in participants’ diabetes self-care activities. No significant differences were observed in the participants’ HRQOL, pain, or fatigue measures. CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations. PMID:24936263

Forjuoh, Samuel N; Ory, Marcia G; Jiang, Luohua; Vuong, Ann M; Bolin, Jane N

2014-01-01

106

The role of primary care providers in managing falls.  

PubMed

Falls threaten the ability of older adults to live independently in the community. Fortunately, national and state organizations have created tools that allow primary care providers to easily assess fall risk, and small changes in practice patterns can provide patients with the resources necessary to prevent falls, thus helping to reverse a costly, deadly epidemic. PMID:25237872

Demons, Jamehl L; Duncan, Pamela W

2014-01-01

107

Adolescent Substance Use: Prevention and Management by Primary Care Clinicians  

Microsoft Academic Search

Substance use by adolescents is a major public health problem in the United States, with users at increased risk for adverse social consequences, injury, and death. Despite published guidelines for screening, assess- ment, and intervention in primary care settings, signifi- cant barriers limit clinician adherence with recommen- dations. Cited barriers include physician discomfort with the topic, lack of time, poor

Brigid L. Vaughan; Sharon Levy; John R. Knight

108

Principals' and Teachers' Perceptions of Quality Management in Hong Kong Primary Schools  

ERIC Educational Resources Information Center

Purpose: The purpose of this paper is to examine the perceptions of a sample of Hong Kong principals and teachers of the extent to which quality management (QM) has been effectively implemented in primary schools. The features of QM improvement implemented in Hong Kong primary schools include: values and duties, systems and teams(ST) resources and…

Cheng, Alison Lai Fong; Yau, Hon Keung

2011-01-01

109

Nurse Managed Center: Access to Primary Health Care for Urban Native Americans  

Microsoft Academic Search

Urban Native Americans represent a small, diverse minority with unique health needs. The purposes of this descriptive retrospective study were to describe (a) the characteristics and primary health problems of urban Native Americans who receive primary health care at an urban nurse managed center (NMC) and (b) the nursing interventions provided at an urban NMC to urban Native Americans. A

Donna Felber Neff; Elizabeth S. Kinion; Christen Cardina

2007-01-01

110

Risk-Adjusted Primary Cesarean Delivery Rates for Managed Care Plans in New York State, 1998  

Microsoft Academic Search

Objective: To demonstrate the effect of risk adjustment methodologies compared to crude rates in evaluating the rate of primary cesarean deliveries in managed care plans, after accounting for known demographic and clinical factors. Risk adjustment allows for a more accurate comparison of primary cesarean delivery rates among plans, eliminating potential confounding factors that could influence rates. Methods: Data was collected

Patrick J. Roohan; Raina E. Josberger; Foster C. Gesten

2001-01-01

111

Expatriate assignments vs localization of management in China : Staffing choices of Australian and German companies  

Microsoft Academic Search

Purpose – The purpose of this paper is to explore the specific difficulties that senior managers face when employing expatriate, Chinese and local-hired foreign managers in China-based subsidiaries of Western multinational companies (MNCs). Furthermore, it aims to examine the resultant coping strategies to overcome identified weaknesses. Design\\/methodology\\/approach – This research adopts a qualitative approach, using semi-structured interviews with key-informants from

Torsten Kühlmann; Kate Hutchings

2010-01-01

112

Primary care management of otitis media among Australian children  

Microsoft Academic Search

Acute otitis media (AOM) is diagnosed on the basis of acute onset of pain and fever; a red, bulging tympanic membrane; and middle ear effusion. AOM is managed with analgesia (paracetamol or non-steroidal anti-inflammatory drugs). Antibiotic therapy is minimally effective for most patients; it is most effective for children < 2 years with bilateral otitis media and for children with

Hasantha Gunasekera; Tony E O’Connor; Shyan Vijayasekaran; Chris B. Del Mar

2009-01-01

113

Riverine threat indices to assess watershed condition and identify primary management capacity of agriculture natural resource management agencies.  

PubMed

Managers can improve conservation of lotic systems over large geographies if they have tools to assess total watershed conditions for individual stream segments and can identify segments where conservation practices are most likely to be successful (i.e., primary management capacity). The goal of this research was to develop a suite of threat indices to help agriculture resource management agencies select and prioritize watersheds across Missouri River basin in which to implement agriculture conservation practices. We quantified watershed percentages or densities of 17 threat metrics that represent major sources of ecological stress to stream communities into five threat indices: agriculture, urban, point-source pollution, infrastructure, and all non-agriculture threats. We identified stream segments where agriculture management agencies had primary management capacity. Agriculture watershed condition differed by ecoregion and considerable local variation was observed among stream segments in ecoregions of high agriculture threats. Stream segments with high non-agriculture threats were most concentrated near urban areas, but showed high local variability. 60 % of stream segments in the basin were classified as under U.S. Department of Agriculture's Natural Resources Conservation Service (NRCS) primary management capacity and most segments were in regions of high agricultural threats. NRCS primary management capacity was locally variable which highlights the importance of assessing total watershed condition for multiple threats. Our threat indices can be used by agriculture resource management agencies to prioritize conservation actions and investments based on: (a) relative severity of all threats, (b) relative severity of agricultural threats, and (c) and degree of primary management capacity. PMID:24390081

Fore, Jeffrey D; Sowa, Scott P; Galat, David L; Annis, Gust M; Diamond, David D; Rewa, Charles

2014-03-01

114

Delayed choice without choice  

E-print Network

A critical note on some of the existing proposals for performing the "delayed choice" experiment is placed. By abandoning the original idea and intention, some modern theoretical proposals and experimental evidence are simply incorrectly understood/interpreted. In effect, the Complementarity principle remains practically intact.

M. Dugic

2012-11-07

115

Teacher perceptions of classroom management and problematic behaviors in primary schools  

Microsoft Academic Search

The aim of this research is to determine and evaluate the problematic behaviors teachers that work in primary schools encounter in classroom management, the reasons of these behaviors and the methods, activities they use to cope with these behaviors, and their ideas and thoughts regarding classroom management. The interview method which is one of the qualitative research methods has been

Semra Demir

2009-01-01

116

Case management by nurses in primary care: analysis of 73 'success stories'  

Microsoft Academic Search

BACKGROUND: There is interest as to whether case management reduces unplanned patient admission to hospital. However, very little is known about how the intervention is delivered and what the most salient outcome measures are. DESIGN: Qualitative study embedded in a wider evaluation. SETTING: Primary health care. METHOD: Analysis of case manager case reports in a service innovation evaluation study. RESULTS:

G. Elwyn; M. Williams; C. Roberts; R. G. Newcombe; J. Vincent

2008-01-01

117

Primary Care Management of Chronic Nonmalignant Pain in Veterans: A Qualitative Study  

ERIC Educational Resources Information Center

Clinicians managing older patients with chronic pain play an important role. This paper explores the attitudes of primary care clinicians (PCPs) toward chronic nonmalignant pain management and their experiences using a clinical decision support system. Our investigation followed a qualitative approach based on grounded theory. Twenty-one PCPs…

Ruiz, Jorge G.; Qadri, S. Sobiya; Nader, Samir; Wang, Jia; Lawler, Timothy; Hagenlocker, Brian; Roos, Bernard A.

2010-01-01

118

An investigation of paradigm choice in Australian international human resource management research  

Microsoft Academic Search

This paper addresses the question of whether Australian international human resource management (IHRM) research is dominated by either a universalist or contextualist paradigm. Using a systematic review approach, 82 peer reviewed papers were analysed using a basic extraction tool to record publication and research design details. The universalist\\/contextualist distinction decision was based on the point at which theory became evident

Cathy Sheehan; Marilyn Fenwick; Peter J. Dowling

2010-01-01

119

A Collaborative Approach to Diabetes Management: The Choice Made for Colorado Schools  

ERIC Educational Resources Information Center

Students with diabetes deserve a school nurse who can effectively manage the disease. Tensions between the school and families sometimes emerge when a child with diabetes goes to school. To resolve these tensions in Colorado, stakeholders collaborated to implement a statewide program to meet the needs of students with diabetes. Colorado school…

Bobo, Nichole; Wyckoff, Leah; Patrick, Kathleen; White, Cathy; Glass, Sue; Carlson, Jessie Parker; Perreault, Christine

2011-01-01

120

Avoidance as the First Choice of Default Management: Challenges in Overseas Korean Organizations  

Microsoft Academic Search

Avoidance becomes the default management style for dealing with cross-cultural conflict in overseas Korean organizations rather than a collaborative style. We argue in this conceptual paper, this is due to the absence of personalized informal social ties that are utilized in domestic Korean organizations to progress information sharing and conflict resolution, and to the absence of a structured and transparent

Inju Yang; Aidan Kelly

2008-01-01

121

The role of culture and personality in choice of conflict management strategy  

Microsoft Academic Search

Globalization has led to an increased emphasis on cultural diversity and its influences on personal, social, and organizational practices. As the world becomes a smaller place, the potential for conflict in our daily interactions is increasing. Research investigating the influence of culture on conflict management and resolution behaviors has demonstrated that individualism and collectivism do indeed influence a person's style

Ritu Kaushal; Catherine T. Kwantes

2006-01-01

122

Food choice as a key management strategy for functional gastrointestinal symptoms.  

PubMed

Recognition of food components that induce functional gut symptoms in patient's functional bowel disorders (FBD) has been challenging. Food directly or indirectly provides considerable afferent input into the enteric nervous system. There is an altered relationship between the afferent input and perception/efferent response in FBD. Defining the nature of food-related stimuli may provide a means of minimizing such an input and gut symptoms. Using this premise, reducing the intake of FODMAPs (fermentable oligo-, di-, and mono-saccharides and polyols)--poorly absorbed short-chain carbohydrates that, by virtue of their small molecular size and rapid fermentability, will distend the intestinal lumen with liquid and gas--improves symptoms in the majority of patients. Well-developed methodologies to deliver the diet via dietician-led education are available. Another abundant source of afferent input is natural and added food chemicals (such as salicylates, amines, and glutamates). Studies are needed to assess the efficacy of the low food chemical dietary approach. A recent placebo-controlled trial of FODMAP-poor gluten provided the first valid evidence that non-celiac gluten intolerance might actually exist, but its prevalence and underlying mechanisms require elucidation. Food choice via the low FODMAP and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for functional gut symptoms. PMID:22488077

Gibson, Peter R; Shepherd, Susan J

2012-05-01

123

Making a technological choice for disaster management and poverty alleviation in India.  

PubMed

The right mix of policy, institutional arrangements and use of technology provides the framework for a country's approach to disaster mitigation. Worldwide, there has been a shift away from a strictly 'top-down' approach relying on government alone, to a combination of 'top-down' and 'bottom-up' approaches. The aim is to enhance the indigenous coping mechanisms of vulnerable communities; draw on their cooperative spirit and energy; and empower them through appropriate information and contextual knowledge to mitigate natural disasters. In light of this, the paper examines India's use of space technology in its disaster management efforts. Poverty alleviation and disaster management are almost inseparable in many parts of the country, as vulnerability to natural disasters is closely aligned with poverty. Addressing these issues together requires integrated knowledge systems. The paper examines how knowledge inputs from space technology have strengthened the national resolve to combat natural disasters in conjunction with alleviating rural poverty. PMID:18498370

Srivastava, Sanjay K

2009-03-01

124

Breaking Silence: Tactical Choices Women Managers Make in Speaking Up About Gender-Equity Issues  

Microsoft Academic Search

This study examines female managers' assessments of how to speak up about the treatment of women in their organizations. Qualitative data from 172 women provide an in-depth look at their theories about the right way to sell this issue. In addition, inductive exploration of the tactics chosen by 985 other women to address gender-equity concerns yields four clusters of issue-selling

Sandy Kristin Piderit; Susan J. Ashford

2003-01-01

125

Management of trade-offs in geoengineering through optimal choice of non-uniform radiative forcing  

NASA Astrophysics Data System (ADS)

Solar radiation management could be used to offset some or all anthropogenic radiative forcing, with the goal of reducing some of the associated climatic change. However, the degree of compensation will vary, with residual climate changes larger in some regions than others. Similarly, the insolation reduction that best compensates climate changes in one region may not be the same as for another, leading to concerns about equity. Here we show that optimizing the latitudinal and seasonal distribution of solar reduction can improve the fidelity with which solar radiation management offsets anthropogenic climate change. Using the HadCM3L general circulation model, we explore several trade-offs. First, residual temperature and precipitation changes in the worst-off region can be reduced by 30% relative to uniform solar reduction, with only a modest impact on global root-mean-square changes; this has implications for moderating regional inequalities. Second, the same root-mean-square residual climate changes can be obtained with up to 30% less insolation reduction, implying that it may be possible to reduce solar radiation management side-effects and risks (for example, ozone depletion if stratospheric sulphate aerosols are used). Finally, allowing spatial and temporal variability increases the range of trade-offs to be considered, raising the question of how to weight different objectives.

MacMartin, Douglas G.; Keith, David W.; Kravitz, Ben; Caldeira, Ken

2013-04-01

126

Optimal management of primary retroperitoneal sarcoma: an update.  

PubMed

Soft tissue sarcomas are a group of heterogeneous neoplasms with more than 50 histological subtypes exhibiting major differences in terms of pathogenesis, genetic alterations and clinical behavior. Sarcomas represent approximately 1% of malignancies with retroperitoneal sarcomas representing 10-15% of all soft tissue sarcomas. Surgery is currently the only modality which offers the chance of cure. Surgery for retroperitoneal sarcomas presents specific challenges due their location in a complex space surrounded by vital structures and visceral organs often prohibiting resection with wide margins. Furthermore, even after complete resection local recurrence is common and the leading cause of death. In this article the authors describe the initial investigations, prognostic factors and optimal surgical management. The evidence and current research as regards the role of multimodality treatment is reviewed and discussed. PMID:24524274

Miah, Aisha B; Hannay, Jonathan; Benson, Charlotte; Thway, Khin; Messiou, Christina; Hayes, Andrew J; Strauss, Dirk C

2014-05-01

127

Primary hepatic lymphoma: dilemmas in diagnostic approach and therapeutic management.  

PubMed

Primary hepatic lymphoma (PHL) is a very rare malignancy and is characterized by liver involvement at presentation with no affectation of the spleen, lymph nodes, peripheral blood, bone marrow, or other tissues until at least 6 months after diagnosis. PHL should be considered in the differential diagnosis in a patient with space-occupying liver lesions and normal levels of alpha-fetoprotein and CEA. A computed tomography (CT) scan is the commonly used modality for staging lymphomas. The widespread use of positron emission tomography/CT results in the improvement in the accuracy of detecting the extent of disease, response evaluation, and prognostication. The liver biopsy, due to its pleomorphic appearances in the needle biopsy specimen, can be very challenging. Current literature favors the combination of chemotherapy as the frontline treatment for its least invasiveness and improved survival. Favorable prognosis of PHL can be obtained by early surgery combined with chemotherapy in strictly selected patients. However, the optimal therapy is still unclear and the outcomes are uncertain. PMID:25114399

Mastoraki, Aikaterini; Stefanou, Maria Ioanna; Chatzoglou, Evangelos; Danias, Nikolaos; Kyriazi, Maria; Arkadopoulos, Nikolaos; Smyrniotis, Vasilios

2014-09-01

128

Created versus natural coastal islands: Atlantic waterbird populations, habitat choices, and management implications  

USGS Publications Warehouse

Nesting colonial waterbirds along the Atlantic Coast of the United States face a number of landscape-level threats including human disturbance, mammalian predator expansion, and habitat alteration. There have been changes from 1977 to the mid-1990s in use of nesting habitats and populations of a number of seabird species of concern in the region, including black skimmers Rynchops niger Linnaeaus, common terns Sterna hirundo Linnaeaus, gull-billed terns Sterna nilotica Linnaeaus, least terns Sterna antillarum Lesson, royal terns Sterna maxima Boddaert, and sandwich terns Sterna sandvicensis Cabot. These species form colonies primarily on the following habitat types: large, sandy barrier or shoal islands, natural estuarine or bay islands (mostly marsh), man-made islands of dredged deposition materials (from navigation channels), and the mainland. Significant changes in the use of the dredged material islands have occurred for these species in New Jersey and North Carolina, but not in Virginia. Population declines and changes in bird habitat use appear to be at least partially associated with the conditions and management of the existing dredged material islands, coastal policy changes associated with creating new dredged material islands, and competing demands for sand for beach augmentation by coastal communities. As these and other coastal habitats become less suitable for colonial waterbirds, other manmade sites, such as bridges and buildings have become increasingly more important. In regions with intense recreational demands, coastal wildlife managers need to take a more aggressive role in managing natural and man-made habitats areas and as stakeholders in the decision-making process involving dredged materials and beach sand allocation.

Erwin, R.M.; Allen, D.H.; Jenkins, D.

2003-01-01

129

Management of temporomandibular joint ankylosis type III: lateral arthroplasty as a treatment of choice.  

PubMed

Many surgical techniques for the management of temporomandibular joint (TMJ) ankylosis have been described in the literature. The purpose of this study was to report our experience using a lateral arthroplasty technique in the management of type III ankylosis. The records of 15 patients treated for TMJ ankylosis at our institution between 2007 and 2011 were reviewed. Pre- and postoperative information collected included age, gender, aetiology, ankylosis type/classification, existing facial asymmetry, maximum pre- and postoperative mouth opening, complications, and recurrence of ankylosis. The mean maximum inter-incisal opening in the preoperative period was 12.9 mm and in the postoperative period was 36.2mm. No major complication was observed in any patient. No recurrence was noted in any patient. Our working hypothesis was that for patients with ankylosis type III, the medially displaced condyle and disc can fulfil their role in mandibular function and growth after extirpation of the ankylozed mass. Although they are located in an awkward medial position, they should function exactly as they would after a properly treated, displaced condylar fracture. PMID:24100155

Singh, V; Bhagol, A; Dhingra, R; Kumar, P; Sharma, N; Singhal, R

2014-04-01

130

Endoscopic Management of a Primary Duodenal Carcinoid Tumor  

PubMed Central

Carcinoids are rare, slow-growing tumors originating from a variety of different neuroendocrine cell types. They are identified histologically by their affinity for silver salts and by positive reactions to neuroendocrine markers such as neuron-specific enolase, synaptophysin and chromogranin. They can present with various clinical symptoms and are difficult to diagnose. We present the case of a 43-year-old woman who was referred for evaluation of anemia. Upper endoscopy showed a duodenal bulb mass around 1 cm in size. Histopathological and immunohistochemistry staining were consistent with the diagnosis of a carcinoid tumor. Further imaging and endoscopic studies showed no other synchronous carcinoid lesions. Endoscopic ultrasound (EUS) revealed a 1 cm lesion confined to the mucosa and no local lymphadenopathy. Successful endoscopic mucosal resection of the mass was performed. Follow-up surveillance 6 months later with EUS and Octreoscan revealed no new lesions suggestive of recurrence. No consensus guidelines exist for the endoscopic management of duodenal carcinoid tumors. However, endoscopic resection is safe and preferred for tumors measuring 1 cm or less with no evidence of invasion of the muscularis layer. PMID:22679400

Abraham, Albin; Singh, Jaspreet; Siddiqui, Ghulam; Prasad, Apsara; Rashid, Sadat; Vardaros, Magdalene; Garg, Vikas; Rizvon, Kaleem; Subramani, Krishnaiyer; Mustacchia, Paul

2012-01-01

131

Primary School Managers' Knowledge of and Attitude towards Epilepsy among Children in Erbil City, Iraq  

PubMed Central

Objectives: This study aimed to determine the knowledge and attitudes of primary school managers regarding epilepsy among school children in Erbil City, Iraq. Methods: A cross-sectional study was conducted in primary schools between 18 June and 18 August 2013. A total of 80 primary school managers were selected to answer a questionnaire covering three domains: socio-demographical characteristics, knowledge of epilepsy and attitudes towards epilepsy. Results: More than half of the participants (55%) had spent less than 10 years in school administration. More than one-third (37.5%) of the participants believed that epilepsy was an infectious disease, and over half of the respondents (53.75%) stated that epilepsy cannot be treated or prevented. Conclusion: Although the respondents’ attitudes towards pupils with epilepsy were generally positive, their knowledge of epilepsy was imperfect; thus, an epilepsy education campaign is required. This should focus on the causes of epilepsy and its management. PMID:24790745

Abdulla, Salih A.

2014-01-01

132

Carbon--making the right choice for waste management in developing countries.  

PubMed

Due to initiatives such as the clean development mechanism (CDM), reducing greenhouse gas emissions for a developing country can offer an important route to attracting investment in a variety of qualifying project areas, including waste management. To date CDM projects have been largely confined to schemes that control emission from landfill, but projects that avoid landfilling are beginning to be submitted. In considering the waste options which might be suitable for developing countries certain ones, such as energy from waste, have been discounted for a range of reasons related primarily to the lack of technical and other support services required for these more sophisticated process trains. The paper focuses on six options: the base case of open dumping; three options for landfill (passive venting, gas capture with flaring, and gas capture with energy production), composting and anaerobic digestion with electricity production and composting of the digestate. A range of assumptions were necessary for making the comparisons based on the effective carbon emissions, and these assumptions will change from project to project. The highest impact in terms of carbon emissions was from using a sanitary landfill without either gas flaring or electricity production; this was worse than the baseline case using open dumpsites. Landfills with either flaring or energy production from the collected gas both produced similar positive carbon emissions, but these were substantially lower than both open dumping and sanitary landfill without flaring or energy production. Composting or anaerobic digestion with energy production and composting of the digestate were the two best options with composting being neutral in terms of carbon emissions and anaerobic digestion being carbon negative. These generic conclusions were tested for sensitivity by modifying the input waste composition and were found to be robust, suggesting that subject to local study to confirm assumptions made, the opportunity for developing CDM projects to attract investment to improved waste management infrastructure is significant. Kyoto credits in excess of 1 tCO2e/t of waste could be realised. PMID:18053701

Barton, J R; Issaias, I; Stentiford, E I

2008-01-01

133

The art and science of managing traumatic injuries to primary teeth.  

PubMed

The selection of an appropriate treatment protocol and the rendering of treatment to children with traumatic injuries of their primary teeth are often more challenging than doing so for the permanent teeth of older individuals. This article discusses general considerations involving patient, parent, dentist, dental anatomy and occlusion that are responsible for the differences between the treatment protocols for the management of traumatic dental injuries to primary teeth and those for permanent teeth. PMID:21535401

Needleman, Howard L

2011-08-01

134

Managing Attention-Deficit\\/Hyperactivity Disorder in Primary Care: A Systematic Analysis of Roles and Challenges  

Microsoft Academic Search

OBJECTIVE.This study was designed to investigate the perceptions of primary care providers about their roles and the challenges of managing attention-deficit\\/hyper- activity disorder and to evaluate differences between providers who serve families primarily from urban versus suburban settings. METHODS.The ADHD Questionnaire was developed to assess primary care provider views about the extent to which clinical activities that are involved in

Thomas J. Power; Jennifer A. Mautone; Patricia H. Manz; Leslee Frye; Nathan J. Blum

2010-01-01

135

Recognition and management of overweight and obesity in primary care in Germany  

Microsoft Academic Search

BACKGROUND: In contrast to the well-documented high prevalence of overweight and obesity in the general population, the prevalence, recognition rates and management by primary care physicians—as the core gatekeeper in the health care system—remains poorly studied.PURPOSE OF THE STUDY: To examine (1) the point prevalence of overweight (BMI 25.0–29.9 kg\\/m2) and obesity (BMI?30 kg\\/m2) in primary care patients, (2) prevalence

P Bramlage; H-U Wittchen; D Pittrow; W Kirch; P Krause; H Lehnert; T Unger; M Höfler; B Küpper; S Dahm; S Böhler; A M Sharma

2004-01-01

136

Managing tradeoffs in geoengineering through optimal choice of non-uniform radiative forcing  

NASA Astrophysics Data System (ADS)

Solar radiation management (SRM) could be used to offset some or all anthropogenic radiative forcing, with the goal of reducing some of the associated climatic change. However, the degree of compensation will vary, with residual climate changes larger in some regions than others. Similarly, the insolation reduction that best compensates climate changes in one region may not be the same as for another, leading to concerns about equity. We show that optimizing the latitudinal and seasonal distribution of insolation reduction can improve the fidelity with which SRM offsets anthropogenic climate change. Using the HadCM3L general circulation model, we consider three trade-offs: the trade-off between minimizing global rms climate changes and minimizing residual changes at the worst-off location, the trade-off between minimizing global rms climate changes and the average solar reduction required to do so, and the trade-off between minimizing global rms climate changes and maximizing Northern Hemisphere September sea ice, for a given average solar reduction. First, the residual temperature and precipitation changes in the worst-off region can be reduced by 30% relative to uniform insolation reduction, with only a modest impact on global root-mean-square (rms) changes; this has implications for managing regional inequalities. Second, the same rms residual climate changes can be obtained with up to 30% less insolation reduction than with a uniform distribution, implying that it may be possible to reduce side effects and risks of SRM (e.g., ozone depletion from sulfate). Finally, allowing spatial and temporal variability increases the range of trade-offs to be considered, such as the relative importance of restoring Northern Hemisphere sea ice versus minimizing overall climate impacts, or the relative weighting between temperature and precipitation residuals. This raises the question of how to weight different objectives. In summary, decisions involving SRM do not need to be reduced to a single "global thermostat"The trade-off between minimizing the global-rms normalized temperature and precipitation changes, and minimizing the worst-case change over any grid-cell, both expressed in number of standard deviations of inter-annual variability. Curves are plotted for uniform and non-uniform solar insolation reduction (SIR).

MacMartin, D. G.; Keith, D.; Kravitz, B.; Caldeira, K.

2012-12-01

137

Passengers' Airport Choice  

Microsoft Academic Search

Modelling airport choice of passengers has been a subject of interest for air transport scientists and airport managers already for a while. Wilken, Berster and Gelhausen have reported of a market segment specific model approach to airport choice in Germany in a paper entitled \\

Marc Christopher Gelhausen

2007-01-01

138

25 CFR 558.3 - Procedures for forwarding applications and reports for key employees and primary management...  

Code of Federal Regulations, 2010 CFR

...Section 558.3 Indians NATIONAL INDIAN GAMING COMMISSION, DEPARTMENT OF THE INTERIOR GAMING LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY...

2010-04-01

139

Case management of arthritis patients in primary care: a cluster-randomized controlled trial  

Microsoft Academic Search

OBJECTIVE: To assess whether providing information on arthritis self-management through general practitioners (GPs) increases the quality of life in patients with osteoarthritis and whether additional case management provided by practice nurses shows better results. METHODS: We conducted a pragmatic, cluster-randomized, controlled, 3-arm trial that included 1,021 patients from 75 primary care practices in Germany. GPs were randomized to intervention group

Thomas Rosemann; Stefanie Joos; Gunter Laux; Jochen Gensichen; Joachim Szecsenyi

2007-01-01

140

Work Values and Their Relationships With Career Choice: A Segment?Based Approach to Understanding Hospitality and Tourism Management Students in China  

Microsoft Academic Search

Focusing on the work values of Chinese hospitality and tourism management (HTM) undergraduate students, this article aims to identify any segment existing among HTM students in China based on work values, as well as to investigate any relationship between work values and career choice intention across the derived student segments. Work values were measured by a self?administered questionnaire based on

Jing Liu

2009-01-01

141

Impact of a Simple Inexpensive Quality Assurance Effort on Physician's Choice of Thrombolytic Agents and Door-to-Needle Time: Implication for Costs of Management  

Microsoft Academic Search

The objective of this study were to assess the impact of a quality assurance effort on the door-to-needle time and the choice of thrombolytic agent for the management of acute myocardial infarction in the emergency department. The study design involved a prospective collection of data on a series of consecutive patients who received a thrombolytic agent for a presumed acute

Ursula A. Guidry; Sumita D. Paul; Jose Vega; Cathie Harris; Rahul Chaturvedi; Patrick T. O'Gara; Kim A. Eagle

1998-01-01

142

Investigations with large-scale forest lysimeter research of the lowlands of Northeast Germany - Results and consequences for the choice of tree species and forest management  

Microsoft Academic Search

Investigations with large-scale forest lysimeter research of the lowlands of Northeast Germany - Results and consequences for the choice of tree species and forest management Introduction At present about 28 % - i.e. 1.9 million hectares - of the Northeast German Lowlands are covered with forests. The Lowlands are among the driest and at the same time the most densely

J. Müller

2009-01-01

143

Changing Climate, Challenging Choices: Identifying and Evaluating Climate Change Adaptation Options for Protected Areas Management in Ontario, Canada  

NASA Astrophysics Data System (ADS)

Climate change will pose increasingly significant challenges to managers of parks and other forms of protected areas around the world. Over the past two decades, numerous scientific publications have identified potential adaptations, but their suitability from legal, policy, financial, internal capacity, and other management perspectives has not been evaluated for any protected area agency or organization. In this study, a panel of protected area experts applied a Policy Delphi methodology to identify and evaluate climate change adaptation options across the primary management areas of a protected area agency in Canada. The panel identified and evaluated one hundred and sixty five (165) adaptation options for their perceived desirability and feasibility. While the results revealed a high level of agreement with respect to the desirability of adaptation options and a moderate level of capacity pertaining to policy formulation and management direction, a perception of low capacity for implementation in most other program areas was identified. A separate panel of senior park agency decision-makers used a multiple criterion decision-facilitation matrix to further evaluate the institutional feasibility of the 56 most desirable adaptation options identified by the initial expert panel and to prioritize them for consideration in a climate change action plan. Critically, only two of the 56 adaptation options evaluated by senior decision-makers were deemed definitely implementable, due largely to fiscal and internal capacity limitations. These challenges are common to protected area agencies in developed countries and pervade those in developing countries, revealing that limited adaptive capacity represents a substantive barrier to biodiversity conservation and other protected area management objectives in an era of rapid climate change.

Lemieux, Christopher J.; Scott, Daniel J.

2011-10-01

144

Centralized care management support for "high utilizers" in primary care practices at an academic medical center.  

PubMed

Although evidence of effectiveness is limited, care management based outside primary care practices or hospitals is receiving increased attention. The University of Michigan (UM) Complex Care Management Program (CCMP) provides care management for uninsured and underinsured, high-utilizing patients in multiple primary care practices. To inform development of optimal care management models, we describe the CCMP model and characteristics and health care utilization patterns of its patients. Of a consecutive series of 49 patients enrolled at CCMP in 2011, the mean (SD) age was 48 (+/- 14); 23 (47%) were women; and 29 (59%) were White. Twenty-eight (57%) had two or more chronic medical conditions, 39 (80%) had one or more psychiatric condition, 28 (57%) had a substance abuse disorder, and 11 (22%) were homeless. Through phone, e-mail, and face-to-face contact with patients and primary care providers (PCPs), care managers coordinated health and social services and facilitated access to medical and mental health care. Patients had a mean (SD) number of hospitalizations and emergency room (ER) visits in 6 months prior to enrollment of2.2 (2.5) and 4.2 (4.3), respectively, with a nonstatistically significant decrease in hospitalizations, hospital days, and emergency room visits in 6 months following enrollment in CCMP. Centralized care management support for primary care practices engages high-utilizing patients with complex medical and behavioral conditions in care management that would be difficult to provide through individual practices and may decrease health care utilization by these patients. PMID:24761538

Williams, Brent C; Paik, Jamie L; Haley, Laura L; Grammatico, Gina M

2014-01-01

145

The Perceptions of Senior Management Teams' (SMTs) Dominant Leadership Styles in Selected Botswana Primary Schools  

ERIC Educational Resources Information Center

This study, which was funded by the office of research and development (ORD) in the University of Botswana, surveyed 65 primary schools in South Central region in Botswana, which aimed at establishing the perceptions of senior management teams dominant leadership style. The study was done in three phases; the first phase started in June 2008 to…

Mhozya, C. M.

2010-01-01

146

Importance of the Primary Radioactivity Standard Laboratory and Implementation of its Quality Management  

SciTech Connect

The paper presents some specific aspects of the implementation of the quality management in the Radionuclide Metrology Laboratory, from IFIN-HH, the owner of the primary Romanian standard in radioactivity. The description of the accreditation, according to the EN ISO/IEC 17025:2005, is presented.

Sahagia, Maria; Razdolescu, Anamaria Cristina; Luca, Aurelian; Ivan, Constantin ['Horia Hulubei' National Institute of Physics and Nuclear Engineering (IFIN-HH), 407 Atomistilor Street, PO Box MG-6, Magurele, Ilfov County, RO-077125 (Romania)

2007-04-23

147

Diagnosis and management of bipolar disorder in primary care: a DSM-5 update.  

PubMed

This review discusses the diagnosis and detection of bipolar disorder in the primary care population with recent changes introduced by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the pharmacotherapy and psychosocial management of this psychiatric condition. PMID:25134871

Brenner, Carolyn J; Shyn, Stanley I

2014-09-01

148

Computer-based Decision Support in the Management of Primary Gastric non-Hodgkin  

E-print Network

lymphoma. 1 Introduction Primary non-Hodgkin lymphoma (NHL) of the stomach is a relatively rare malignant disorder, accounting for about 5% of gastric tumours. Until recently, the aetiology of gastric NHL in the clinical manage- ment of patients with NHL [7], NHL of the stomach included [8]. Therapy selection

Utrecht, Universiteit

149

Patients' views on improving sickle cell disease management in primary care: focus group discussion  

PubMed Central

Objectives To assess sickle cell disease (SCD) patient and carer perspectives on the primary care services related to SCD that they receive from their general practitioner (GP). Design A focus group discussion was used to elicit the views of patients about the quality of care they receive from their primary health-care providers and what they thought was the role of primary care in SCD management. The focus group discussion was video recorded. The recording was then examined by the project team and recurring themes were identified. A comparison was made with notes made by two scribes also present at the discussion. Setting Sickle Cell Society in Brent, UK. Participants Ten participants with SCD or caring for someone with SCD from Northwest London, UK. Main outcome measures Patients' perceptions about the primary care services they received, and a list of key themes and suggestions. Results Patients and carers often bypassed GPs for acute problems but felt that GPs had an important role to play around repeat prescriptions and general health care. These service users believed SCD is often ignored and deemed unimportant by GPs. Conclusion Participants wanted the health service to support primary health-care providers to improve their knowledge and understanding of SCD. Key themes and suggestions from this focus group have been used to help develop an educational intervention for general practice services that will be used to improve SCD management in primary care. PMID:23476727

AlJuburi, Ghida; Phekoo, Karen J; Okoye, NV Ogo; Anie, Kofie; Green, Stuart A; Nkohkwo, Asaah; Ojeer, Patrick; Ndive, Comfort; Banarsee, Ricky; Oni, Lola; Majeed, Azeem

2012-01-01

150

Prevention and management of chronic obstructive pulmonary disease (COPD) in primary care: position paper of the European Forum for Primary Care  

Microsoft Academic Search

Chronic obstructive pulmonary disease (COPD) is a smoking-related, progressive lung disease that represents a substantial individual, societal and economic burden. Primary care professionals have an important role in healthcare provision for patients with COPD. In this position paper we summarise the current knowledge about, and management of patients with COPD. Next, we describe the role general practitioners and other primary

Tjard Schermer; C. van Weel; F. Barten; J. Buffels; N. Chavannes; P. Kardas; A. Ostrem; A. Schneider; H. Yaman

2008-01-01

151

Management of primary aldosteronism: its complications and their outcomes after treatment.  

PubMed

Primary aldosteronism is the most common cause of secondary hypertension, accounting for about 10% of all forms of high blood pressure. Life-time pharmacological therapy is the treatment of choice for primary aldosteronism due to idiopathic adrenal hyperplasia (IHA), while adrenalectomy is effective in curing most patients with an aldosterone producing adenoma (APA). Far from being a benign form of hypertension, primary aldosteronism is characterized by the development of cardiovascular renal and metabolic complications, including left ventricular hypertrophy, myocardial infarction, atrial fibrillation and stroke, microalbuminuria, renal cysts as well as metabolic syndrome, glucose impairment and diabetes mellitus. We review recent clinical experience with the above mentioned complications and long-term outcomes of blood pressure normalization and cardiac, renal and gluco-metabolic complications in patients with primary aldosteronism, after medical treatment with mineralocorticoid receptor antagonists and surgical treatment. We conclude that removal of adrenal adenoma results in normalization of the renin-angiotensin-aldosterone system (RAAS) and of kalaemia and improvement of blood pressure levels in all patients. Complete resolution of hypertension is achieved in nearly half of treated patients. Moreover, unilateral adrenalectomy is the best treatment to have the regression of cardiovascular, renal and metabolic complications in patients with APA. On the other hand, targeted medical treatment with aldosterone antagonists improves blood pressure control and appears able to prevent the progression of cardiac and metabolic complications in patients with IHA. PMID:19356005

Giacchetti, Gilberta; Turchi, Federica; Boscaro, Marco; Ronconi, Vanessa

2009-04-01

152

Primary health care practitioner perspectives on the management of insomnia: a pilot study.  

PubMed

This paper reports a qualitative pilot study exploring primary care health practitioners' perspectives on the management of insomnia following the extensive media coverage on the adverse effects of zolpidem in 2007-08. General practitioners and community pharmacists were recruited throughout metropolitan Sydney, New South Wales using a convenience sampling and snowballing technique. Demographic information was collected from each participant followed by a semistructured interview. In total 22 participants were interviewed, including eight general practitioners and 14 community pharmacists. Interview transcripts were analysed using 'framework analysis'. Participants' responses illuminated some of the key issues facing primary care practitioners in the management of insomnia. Practitioners perceived there to be an overreliance on pharmacotherapy among insomnia patients and inadequate support for directing patients to alternative treatment pathways if they require or prefer non-pharmacological management. Current prescribing trends appear to favour older benzodiazepines in new cases of insomnia whereas some successful sporadic users of zolpidem have continued to use zolpidem after the media coverage in 2007-08. The findings of this pilot study suggest the need to address the limitations in the management of insomnia within the current health care system, to revise and disseminate updated insomnia guidelines and to provide educational opportunities and resources to primary care practitioners concerning management options. PMID:24200195

Cheung, Janet M Y; Atternäs, Kristina; Melchior, Madeleine; Marshall, Nathaniel S; Fois, Romano A; Saini, Bandana

2014-01-01

153

Sigmoid Volvulus Complicating Pregnancy Managed by Resection and Primary Anastomosis: Case report with literature review.  

PubMed

Sigmoid volvulus is an extremely rare cause of intestinal obstruction in pregnancy. The rarity of the condition and the fact that pregnancy itself clouds the clinical picture invariably leads to a delay in diagnosis with an increased risk of gangrene of the gut. The majority of these patients would then require resection and colostomy. However, an early diagnosis and intervention as in our patient, which would require a high index of clinical suspicion, could significantly improve the outcome of the foetus and the mother. A case of sigmoid volvulus in pregnancy is reported which was managed by resection and primary anastomosis. A review of literature revealed no previous reports of sigmoid volvulus in pregnancy managed by primary anastomosis following resection of the sigmoid volvulus. The literature is also reviewed regarding predisposing factors, management options and the outcome of sigmoid volvulus complicating pregnancy. PMID:21509281

Machado, Norman O; Machado, Lovina S M

2009-04-01

154

Do referral-management schemes reduce hospital outpatient attendances? Time-series evaluation of primary care referral management  

PubMed Central

Background Ninety-one per cent of primary care trusts were using some form of referral management in 2009, although evidence for its effectiveness is limited. Aim To assess the impact of three referral-management centres (RMCs) and two internal peer-review approaches to referral management on hospital outpatient attendance rates. Design and setting A retrospective time-series analysis of 376 000 outpatient attendances over 3 years from 85 practices divided into five groups, with 714 000 registered patients in one English primary care trust. Method The age-standardised GP-referred first outpatient monthly attendance rate was calculated for each group from April 2009 to March 2012. This was divided by the equivalent monthly England rate, to derive a rate ratio. Linear regression tested for association between the introduction of referral management and change in the outpatient attendance rate and rate ratio. Annual group budgets for referral management were obtained. Results Referral management was not associated with a reduction in the outpatient attendance rate in any group. There was a statistically significant increase in attendance rate in one group (a RMC), which had an increase of 1.05 attendances per 1000 persons per month (95% confidence interval = 0.46 to 1.64; attendance rate ratio increase of 0.07) after adjustment for autocorrelation. Mean annual budgets ranged from £0.55 to £6.23 per registered patient in 2011/2012. RMCs were more expensive (mean annual budget £5.18 per registered patient) than internal peer-review approaches (mean annual budget £0.97 per registered patient). Conclusion Referral-management schemes did not reduce outpatient attendance rates. RMCs were more expensive than internal peer review. PMID:23735409

Cox, Jonathan MS; Steel, Nicholas; Clark, Allan B; Kumaravel, Bharathy; Bachmann, Max O

2013-01-01

155

Clinical practice guidelines for the medical and surgical management of primary intracerebral hemorrhage in Korea.  

PubMed

The purpose of this clinical practice guideline (CPG) is to provide current and comprehensive recommendations for the medical and surgical management of primary intracerebral hemorrhage (ICH). Since the release of the first Korean CPGs for stroke, evidence has been accumulated in the management of ICH, such as intracranial pressure control and minimally invasive surgery, and it needs to be reflected in the updated version. The Quality Control Committee at the Korean Society of cerebrovascular Surgeons and the Writing Group at the Clinical Research Center for Stroke (CRCS) systematically reviewed relevant literature and major published guidelines between June 2007 and June 2013. Based on the published evidence, recommendations were synthesized, and the level of evidence and the grade of the recommendation were determined using the methods adapted from CRCS. A draft guideline was scrutinized by expert peer reviewers and also discussed at an expert consensus meeting until final agreement was achieved. CPGs based on scientific evidence are presented for the medical and surgical management of patients presenting with primary ICH. This CPG describes the current pertinent recommendations and suggests Korean recommendations for the medical and surgical management of a patient with primary ICH. PMID:25368758

Kim, Jeong Eun; Ko, Sang-Bae; Kang, Hyun-Seung; Seo, Dae-Hee; Park, Sukh-Que; Sheen, Seung Hun; Park, Hyun Sun; Kang, Sung Don; Kim, Jae Min; Oh, Chang Wan; Hong, Keun-Sik; Yu, Kyung-Ho; Heo, Ji Hoe; Kwon, Sun-Uck; Bae, Hee-Joon; Lee, Byung-Chul; Yoon, Byung-Woo; Park, In Sung; Rha, Joung-Ho

2014-09-01

156

Clinical Practice Guidelines for the Medical and Surgical Management of Primary Intracerebral Hemorrhage in Korea  

PubMed Central

The purpose of this clinical practice guideline (CPG) is to provide current and comprehensive recommendations for the medical and surgical management of primary intracerebral hemorrhage (ICH). Since the release of the first Korean CPGs for stroke, evidence has been accumulated in the management of ICH, such as intracranial pressure control and minimally invasive surgery, and it needs to be reflected in the updated version. The Quality Control Committee at the Korean Society of cerebrovascular Surgeons and the Writing Group at the Clinical Research Center for Stroke (CRCS) systematically reviewed relevant literature and major published guidelines between June 2007 and June 2013. Based on the published evidence, recommendations were synthesized, and the level of evidence and the grade of the recommendation were determined using the methods adapted from CRCS. A draft guideline was scrutinized by expert peer reviewers and also discussed at an expert consensus meeting until final agreement was achieved. CPGs based on scientific evidence are presented for the medical and surgical management of patients presenting with primary ICH. This CPG describes the current pertinent recommendations and suggests Korean recommendations for the medical and surgical management of a patient with primary ICH. PMID:25368758

Kim, Jeong Eun; Kang, Hyun-Seung; Seo, Dae-Hee; Park, Sukh-Que; Sheen, Seung Hun; Park, Hyun Sun; Kang, Sung Don; Kim, Jae Min; Oh, Chang Wan; Hong, Keun-Sik; Yu, Kyung-Ho; Heo, Ji Hoe; Kwon, Sun-Uck; Bae, Hee-Joon; Lee, Byung-Chul; Yoon, Byung-Woo; Park, In Sung; Rha, Joung-Ho

2014-01-01

157

Empirical research on accounting choice  

Microsoft Academic Search

We review research from the 1990s that examines the determinants and consequences of accounting choice, structuring our analysis around the three types of market imperfections that influence managerschoices: agency costs, information asymmetries, and externalities affecting non-contracting parties. We conclude that research in the 1990s made limited progress in expanding our understanding of accounting choice because of limitations in research

Thomas D Fields; Thomas Z Lys; Linda Vincent

2001-01-01

158

Blood management strategies in primary and revision total knee arthroplasty for Jehovah's Witness patients.  

PubMed

Primary or revision total knee arthroplasties (TKAs) may be associated with a marked amount of intraoperative or postoperative blood loss that potentially may lead to the need for blood transfusions. However, Jehovah's Witnesses usually refuse blood transfusions because of their religious beliefs. This may create clinical or ethical challenges for the treating physicians. Therefore, following established blood management protocols specifically designed for these patients may be beneficial for the performance of safe and transfusion-free procedures with minimal complications. In this report, we provide an overview of various potential preoperative, intraoperative, and postoperative blood management measures that may be used for the care of Jehovah's Witnesses who undergo knee arthroplasty procedures. In addition, we review reported outcomes of primary and revision TKAs in these patients. PMID:23955185

Issa, Kimona; Banerjee, Samik; Rifai, Aiman; Kapadia, Bhaveen H; Harwin, Steven F; McInerney, Vincent K; Mont, Michael A

2013-12-01

159

Practical Suicide-Risk Management for the Busy Primary Care Physician  

PubMed Central

Suicide is a public health problem and a leading cause of death. The number of people thinking seriously about suicide, making plans, and attempting suicide is surprisingly high. In total, primary care clinicians write more prescriptions for antidepressants than mental health clinicians and see patients more often in the month before their death by suicide. Treatment of depression by primary care physicians is improving, but opportunities remain in addressing suicide-related treatment variables. Collaborative care models for treating depression have the potential both to improve depression outcomes and decrease suicide risk. Alcohol use disorders and anxiety symptoms are important comorbid conditions to identify and treat. Management of suicide risk includes understanding the difference between risk factors and warning signs, developing a suicide risk assessment, and practically managing suicidal crises. PMID:21709131

McDowell, Anna K.; Lineberry, Timothy W.; Bostwick, J. Michael

2011-01-01

160

Esthetic management of a primary double tooth using a silicone putty guide: a case report.  

PubMed

The term double tooth is often used to describe fusion and gemination. The development of isolated large or joined teeth is not rare, but the literature is confusing when the appropriate terminology is presented. The objective of this paper is to present a case of a primary double tooth in a 5-year-old girl with a history of trauma. The tooth was endodontically treated and esthetic management was carried out using a silicone putty guide. PMID:23600163

Agarwal, Ravi; Chaudhry, Kalpna; Yeluri, Ramakrishna; Munshi, Autar Krishen

2013-03-01

161

Management of terminal cancer patients: attitudes and training needs of primary health care doctors and nurses  

Microsoft Academic Search

The objective of the study was to ascertain the attitudes and training needs of primary health care (PHC) professionals regarding\\u000a the management of terminal cancer patients. A cross-sectional study involving 30 PHC teams (15 urban and 15 rural) in the\\u000a health district of Majorca (Spain) was carried out. Out of the 224 doctors and 186 nurses initially included, 157 and

Magdalena Esteva Cantó; Joan Llobera Cánaves; Jerónima Miralles Xamena; M. de Lluch Bauzá Amengual

2000-01-01

162

Do ideological and political motives really matter in  the public choice of local services management? Evidence from urban water services in Spain  

Microsoft Academic Search

This paper studies the influence of ideology and political motives on the choice of management for urban water services. Our\\u000a contribution is two-fold. Firstly, we use a considerably more detailed set of variables to represent ideological and political\\u000a motives than previous research. Secondly, the variables that explain local politicians’ decisions are observed at the time\\u000a decision-making occurs, rather than at

Andrés J Picazo-Tadeo; Francisco González-Gómez; Jorge Guardiola Wanden-Berghe; Alberto Ruiz-Villaverde

2012-01-01

163

Management of primary chronic headache in the general population: the Akershus study of chronic headache.  

PubMed

Primary chronic headaches cause more disability and necessitate high utilisation of health care. Our knowledge is based on selected populations, while information from the general population is largely lacking. An age and gender-stratified cross-sectional epidemiological survey included 30,000 persons aged 30-44 years. Respondents with self-reported chronic headache were interviewed by physicians. The International Classification of Headache Disorders was used. Of all primary chronic headache sufferers, 80% had consulted their general practitioner (GP), of these 19% had also consulted a neurologist and 4% had been hospitalised. Co-occurrence of migraine increased the probability of contact with a physician. A high Severity of Dependence Scale score increased the probability for contact with a physician. Complementary and alternative medicine (CAM) was used by 62%, most often physiotherapy, acupuncture and chiropractic. Contact with a physician increased the probability of use of CAM. Acute headache medications were taken by 87%, while only 3% used prophylactic medication. GPs manage the majority of those with primary chronic headache, 1/5 never consults a physician for their headache, while approximately 1/5 is referred to a neurologist or hospitalised. Acute headache medication was frequently overused, while prophylactic medication was rarely used. Thus, avoidance of acute headache medication overuse and increased use of prophylactic medication may improve the management of primary chronic headaches in the future. PMID:21993986

Kristoffersen, Espen Saxhaug; Grande, Ragnhild Berling; Aaseth, Kjersti; Lundqvist, Christofer; Russell, Michael Bjørn

2012-03-01

164

User Choice.  

ERIC Educational Resources Information Center

In vocational education and training (VET), user choice is a means of achieving a more client-responsive training system by allowing clients to have greater choice over how their training needs are met. Funding arrangements linked in some direct way to the expressed demands of individual clients are essential for effective operation of a user…

Smith, Joy Selby

165

Adolescence and asthma management: the perspective of adolescents receiving primary health care?  

PubMed Central

Objective: To study the influence of adolescence characteristics on asthma management. Methods: This was a qualitative study conducted in the city of Divinópolis, Minas Gerais, Southeast Brazil. Data were collected through semistructured interviews guided by a questionnaire with seven asthmatic adolescents followed-up in the primary public health care service of the city. Results: Using content analysis, three thematic categories were observed in the adolescents' responses: 1) family relationships in the treatment of asthma in adolescence; 2) the asthmatic adolescents and their peers; and 3) the role of the school for the asthmatic adolescents. Conclusions: The results demonstrated that peers, family, and school should be more valued by health professionals and by health care services when treating asthmatic adolescents, as these social relationships are closely associated with the adolescent and have an important role in asthma management. Attempts to meet the demands of adolescents contribute to improve asthma management.

Araújo, Alisson; Rocha, Regina Lunardi; Alvim, Cristina Gonçalves

2014-01-01

166

Vaccination Management and Vaccination Errors: A Representative Online-Survey among Primary Care Physicians  

PubMed Central

Background Effective immunizations require a thorough, multi-step process, yet few studies comprehensively addressed issues around vaccination management. Objectives To assess variations in vaccination management and vaccination errors in primary care. Methods A cross sectional, web-based questionnaire survey was performed among 1157 primary physicians from North Rhine-Westphalia, Germany: a representative 10% random sample of general practitioners (n?=?946) and all teaching physicians from the University Duisburg-Essen (n?=?211). Four quality aspects with three items each were included: patient-related quality (patient information, patient consent, strategies to increase immunization rates), vaccine-related quality (practice vaccine spectrum, vaccine pre-selection, vaccination documentation), personnel-related quality (recommendation of vaccinations, vaccine application, personnel qualification) and storage-related quality (storage device, temperature log, vaccine storage control). For each of the four quality aspects, “good quality” was reached if all three criteria per quality aspect were fulfilled. Good vaccination management was defined as fulfilling all twelve items. Additionally, physicians’ experiences with errors and nearby-errors in vaccination management were obtained. Results More than 20% of the physicians participated in the survey. Good vaccination management was reached by 19% of the practices. Patient-related quality was good in 69% of the practices, vaccine-related quality in 73%, personnel-related quality in 59% and storage-related quality in 41% of the practices. No predictors for error reporting and good vaccination management were identified. Conclusions We identified good results for vaccine- and patient-related quality but need to improve issues that revolve around vaccine storage. PMID:25118779

Weltermann, Birgitta M.; Markic, Marta; Thielmann, Anika; Gesenhues, Stefan; Hermann, Martin

2014-01-01

167

The management of HIV- and AIDS-related pain in a primary health clinic in Tshwane, South Africa.  

PubMed

Pain has been recognized as an important, highly prevalent, and debilitating symptom of HIV and AIDS. In South Africa, many people living with HIV and AIDS utilize primary health clinics for pain management. Primary health clinics are nurse led and face a variety of challenges pertaining to pain management. The purpose of this study was to explore if HIV and AIDS pain is effectively managed in a primary health clinic in Tshwane, South Africa. The study aimed to explore the level and characteristics of HIV- and AIDS-related pain, the pain-related experiences of patients and if pain was managed according to the applicable guidelines of the Department of Health. A quantitative survey was conducted. The target population was HIV and AIDS patients who had been using the primary health clinic for chronic pain management. The sampling method was convenience (n = 500). Data were gathered by means of structured interviews and structured observation. The data were analyzed using the SSPS 15 program and open coding. The study provided evidence that HIV- and AIDS-related pain is not managed effectively. Despite repeated visits to the primary health clinic, the overwhelming majority of patients still experienced pain. Nurses added to the suffering, because they lacked knowledge of pain and pain management. It is recommended that nurses practicing in primary health clinics should be trained and supervised to effectively manage the pain of people living with HIV and AIDS. PMID:23688363

Maree, Johanna Elizabeth; Dreyer Wright, Susanna Catharina; Makua, Mogalagadi Rachel

2013-06-01

168

Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials  

PubMed Central

Background Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have potential for improving outcomes. This manuscript describes two ongoing randomized clinical trials being conducted in two different health care systems, examining patient-based and provider-based interventions for managing hip and knee OA in primary care. Methods / Design One study is being conducted within the Department of Veterans Affairs (VA) health care system and will compare a Combined Patient and Provider intervention relative to usual care among n?=?300 patients (10 from each of 30 primary care providers). Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only, Provider Only, and Combined (Patient + Provider) interventions relative to usual care among n?=?560 patients across 10 clinics. Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis, are overweight, and do not meet current physical activity guidelines. The 12-month, telephone-based patient intervention focuses on physical activity, weight management, and cognitive behavioral pain management. The provider intervention involves provision of patient-specific recommendations for care (e.g., referral to physical therapy, knee brace, joint injection), based on evidence-based guidelines. Outcomes are collected at baseline, 6-months, and 12-months. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and secondary outcomes are the Short Physical Performance Test Protocol (objective physical function) and the Patient Health Questionnaire-8 (depressive symptoms). Cost effectiveness of the interventions will also be assessed. Discussion Results of these two studies will further our understanding of the most effective strategies for improving hip and knee OA outcomes in primary care settings. Trial registration NCT01130740 (VA); NCT 01435109 (NIH) PMID:22530979

2012-01-01

169

Evaluation of computerized health management information system for primary health care in rural India  

PubMed Central

Background The Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS), New Delhi has a computerized Health Management Information System (HMIS) since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a computerized Health Management Information System in rural health system in India. Methods The data for evaluation were collected by in-depth interviews of the stakeholders i.e. program managers (authors) and health workers. Health Workers from AIIMS and Non-AIIMS Primary Health Centers were interviewed to compare the manual with computerized HMIS. A cost comparison between the two methods was carried out based on market costs. The resource utilization for both manual and computerized HMIS was identified based on workers' interviews. Results There have been no major hardware problems in use of computerized HMIS. More than 95% of data was found to be accurate. Health workers acknowledge the usefulness of HMIS in service delivery, data storage, generation of workplans and reports. For program managers, it provides a better tool for monitoring and supervision and data management. The initial cost incurred in computerization of two Primary Health Centers was estimated to be Indian National Rupee (INR) 1674,217 (USD 35,622). Equivalent annual incremental cost of capital items was estimated as INR 198,017 (USD 4213). The annual savings is around INR 894,283 (USD 11,924). Conclusion The major advantage of computerization has been in saving of time of health workers in record keeping and report generation. The initial capital costs of computerization can be recovered within two years of implementation if the system is fully operational. Computerization has enabled implementation of a good system for service delivery, monitoring and supervision. PMID:21078203

2010-01-01

170

Self-management practices among primary care patients with musculoskeletal pain and depression.  

PubMed

The objective of this study was to assess the effect of clinical depression on pain self-management practices. We employed a cross-sectional analysis of baseline data from the Stepped Care for Affective disorders and Musculoskeletal Pain (SCAMP) study. Participants included 250 patients with pain and comorbid depression and 250 patients with pain only and were enrolled from urban university and VA primary care clinics. Musculoskeletal pain was defined as low back, hip or knee pain present >or=3 months and with at least a moderate, Brief Pain Inventory severity score >or=5. Depression was defined as a PHQ-9 score >or=10. We used multiple logistic and Poisson regression to assess the relationship between individual and combined effects of depression and pain severity on two core pain self-management skills: exercise duration and cognitive strategies. Depressed patients exercised less per week than did nondepressed patients but showed a trend towards more frequent use of cognitive strategies. On multivariable analysis, depression severity substantially decreased the use of exercise as a pain self-management strategy. In contrast, depression and pain severity interacted to increase the use of cognitive strategies. Depression and pain severity have differential effects on self-management practices. Understanding the differences between preferential strategies of pain patients with and without depression may be useful in tailoring pain self-management programs. PMID:18553130

Damush, Teresa M; Wu, Jingwei; Bair, Matthew J; Sutherland, Jason M; Kroenke, Kurt

2008-08-01

171

Managing schizophrenia in primary care: the utility of remission criteria as outcome indicators  

PubMed Central

The shared management of patients with schizophrenia in primary care can only succeed if underpinned by valid, easily administered and clinically relevant outcome measures. While conditions such as depression and anxiety lend themselves to this approach through the development, over a number of years, of patient- and observer-rated scales, schizophrenia still lacks the capacity for meaningful outcome measures. Recently, two international working groups have developed the concept of remission in schizophrenia and recommended a simple, brief and clinically valid measure based upon improvement in key symptoms over a specified time period. The authors consider this concept and its application to primary care both as a commissioning tool and to facilitate shared care of this chronic medical condition. PMID:22477899

2009-01-01

172

The Impact of Blood Management on Length of Stay After Primary Total Knee Arthroplasty  

PubMed Central

The current study investigates the impact of patient factors, surgical factors, and blood management on postoperative length of stay (LOS) in 516 patients who underwent primary total knee arthroplasty. Age, gender, type of anticoagulation, but not body mass index (BMI) were found to be highly significant predictors of an increased LOS. Allogeneic transfusion and the number of allogeneic units significantly increased LOS, whereas donation and/or transfusion of autologous blood did not. Hemoglobin levels preoperatively until 48 hours postoperatively were negatively correlated with LOS. After adjusting for confounding factors through Poisson regression, age (p = 0.001) and allogeneic blood transfusion (p = 0.002) were the most significant determinants of LOS. Avoiding allogeneic blood plays an essential role in reducing the overall length of stay after primary total knee arthroplasty. PMID:24894715

Monsef, Jad B; Della Valle, Alejandro G; Mayman, David J; Marx, Robert G; Ranawat, Amar S; Boettner, Friedrich

2014-01-01

173

Providing diabetes self-management support in rural primary care clinics with nurse partners.  

PubMed

This study examined the roles and effectiveness of nurse partner-provided diabetes self-management (DSM) support in five rural primary care clinics. There were two to nine providers and one nurse partner in each clinic; nurses were licensed practical nurses (LPNs) in all but one clinic. Interviews with providers and observations of patient interactions assessed nurse roles, clinic processes, and communication patterns. Using immersion-crystallization methods, three major themes explained nurse partner role variation: "gatekeeper" role of providers, compression of time and space within clinic work flow, and nurses' educational background and experience. While nurses' education and experience were important, clinics where providers facilitated nurse participation in DSM support through focused communication and commitment of time and space most effectively integrated DSM support into their practice. Some quantitative measures improved; notably glycated hemoglobin level and patients' frequency of blood glucose measurement. Study findings provide guidance on using nurses in primary care clinics to provide DSM. PMID:22309990

Vetter-Smith, Molly; Lemaster, Joseph; Olsberg, Joshua; Kruse, Robin; Day, Tamara; Mehr, David

2012-12-01

174

Going native can be a smart choice for Michigan landscapes Joy Landis, MSU Integrated Pest Management Program  

E-print Network

. Getting smart around your home Home landscaping and flower gardens can be designed with native perennialGoing native can be a smart choice for Michigan landscapes Joy Landis, MSU Integrated Pest. They offer extensive information at their website, www.nwf.org. Smart shorelines According to the Michigan

175

Management of chest pain: a prospective study from Norwegian out-of-hours primary care  

PubMed Central

Background Chest pain is a common diagnostic challenge in primary care and diagnostic measures are often aimed at confirming or ruling out acute ischaemic heart disease. The aim of this study was to investigate management of patients with chest pain out-of-hours, including the use of ECG and laboratory tests, assessment of severity of illness, and the physicians’ decisions on treatment and admittance to hospital. Methods Data were registered prospectively from four Norwegian casualty clinics. Data from structured telephone interviews with 100 physicians shortly after a consultation with a patient presenting at the casualty clinic with “chest pain” were analysed. Results A total of 832 patients with chest pain were registered. The first 100 patients (corresponding doctor-patient pairs) were included in the study according to the predefined inclusion criteria. Median age of included patients was 46 years, men constituted 58%. An ECG was taken in 92 of the patients. Of the 24 patients categorised to acute level of response, 15 had a NACA-score indicating a potentially or definitely life-threatening medical situation. 50 of the patients were admitted to a hospital for further management, of which 43 were thought to have ischaemic heart disease. Musculoskeletal pain was the second most common cause of pain (n?=?22). Otherwise the patients were thought to have a variety of conditions, most of them managed at a primary care level. Conclusions Patients with chest pain presenting at out-of-hours services in Norway are investigated for acute heart disease, but less than half are admitted to hospital for probable acute coronary syndrome, and only a minority is given emergency treatment for acute coronary syndrome. A wide variety of other diagnoses are suggested by the doctors for patients presenting with chest pain. Deciding the appropriate level of response for such patients is a difficult task, and both over- and under-triage probably occur in out-of-hours primary care. PMID:24661903

2014-01-01

176

Current management of atrial fibrillation: an observational study in NHS primary care  

PubMed Central

Objective To describe National Health Service (NHS) resource use and pharmacological management of atrial fibrillation (AF) in routine UK primary care. Design Multicentre retrospective study. Setting Seven primary care practices in England, one in Wales. Patients Patients with AF were identified and approached for consent. Data were collected on the first 12?weeks post-diagnosis (‘initiation’) and, for established patients, up to the most recent 3?years of management (‘maintenance’). Results Data collected on 825 patients with AF, 56% men. Mean age (at diagnosis) 70.5?years. Mean 2.4 (SD 2.2) visits to primary care per patient during the initiation phase; 1.5 (SD 1.8) per patient-year during the maintenance phase. Mean 0.4 (SD 0.6) inpatient admissions for AF per patient during the initiation phase and 0.1 (SD 0.3) per patient-year during the maintenance phase. The mean length of hospital stay per admitted patient was 5.6?days during initiation and 6.4?days per patient-year during maintenance. During the initiation phase, 46.1% (143/310) patients received a ?-blocker and 97 (31.3%) received no rate/rhythm control. Only 234 (75.5%) patients received thromboprophylaxis in the 12?weeks postdiagnosis and 674 (87.7%) in the maintenance phase. 440 (57.2%) patients were deemed to be at high risk of stroke at the end of the maintenance phase; 55% (242/440) of these were receiving appropriate anticoagulation therapy. Conclusions The results suggest that there are opportunities for optimisation of treatment and there is significant NHS resource associated with AF management, the details of which are invaluable for future healthcare planning and policy development in this area. PMID:24271019

Kassianos, George; Arden, Chris; Hogan, Simon; Dew, Robert; Fuat, Ahmet

2013-01-01

177

Primary malignant bone tumors and solitary metastases of the thoracolumbar spine: results by management with total en bloc spondylectomy  

Microsoft Academic Search

Primary malignant spinal tumors and solitary vertebral metastases of selected tumor entities in the thoracolumbar spine are\\u000a indications for total en bloc spondylectomy (TES). This study aimed to describe our oncological and surgical management and\\u000a to analyze the treatment results by management with TES for extra- and intracompartmental solitary spinal metastases and primary\\u000a malignant vertebral bone tumors. In 15 patients

Ingo Melcher; Alexander C. Disch; Cyrus Khodadadyan-Klostermann; Stefan Tohtz; Mirko Smolny; Ulrich Stöckle; Norbert P. Haas; Klaus-Dieter Schaser

2007-01-01

178

Evaluating the integration of chronic disease prevention and management services into primary health care  

PubMed Central

Background The increasing number of patients with chronic diseases represents a challenge for health care systems. The Chronic Care Model suggests a multi-component remodelling of chronic disease services to improve patient outcomes. To meet the complex and ongoing needs of patients, chronic disease prevention and management (CDPM) has been advocated as a key feature of primary care producing better outcomes, greater effectiveness and improved access to services compared to other sectors. The objective of this study is to evaluate the adaptation and implementation of an intervention involving the integration of chronic disease prevention and management (CDPM) services into primary health care. Methods/Design The implementation of the intervention will be evaluated using descriptive qualitative methods to collect data from various stakeholders (decision-makers, primary care professionals, CDPM professionals and patients) before, during and after the implementation. The evaluation of the effects will be based on a combination of experimental designs: a randomized trial using a delayed intervention arm (n = 326), a before-and-after design with repeated measures (n = 163), and a quasi-experimental design using a comparative cohort (n = 326). This evaluation will utilize self-report questionnaires measuring self-efficacy, empowerment, comorbidity, health behaviour, functional health status, quality of life, psychological well-being, patient characteristics and co-interventions. The study will take place in eight primary care practices of the Saguenay region of Quebec (Canada). To be included, patients will have to be referred by their primary care provider and present at least one of the following conditions (or their risk factors): diabetes, cardiovascular diseases, chronic obstructive pulmonary disease, asthma. Patients presenting serious cognitive problems will be excluded. Discussion In the short-term, improved patient self-efficacy and empowerment are expected. In the mid-term, we expect to observe an improvement in health behaviour, functional health status, quality of life and psychological well-being. At the organizational level, the project should lead to coordinated service delivery, improved patient follow-up mechanisms and enhanced interprofessional collaboration. Integration of CDPM services at the point of care in primary care practices is a promising innovation in care delivery that needs to be thoroughly evaluated. Trial registration ClinicalTrials.gov Identifier: NCT01319656 PMID:23565674

2013-01-01

179

Managed care and the delivery of primary care to the elderly and the chronically ill.  

PubMed Central

OBJECTIVE: To analyze primary care staffing in HMOs and to review the literature on primary care organization and performance in managed care organizations, with an emphasis on the delivery of primary care to the elderly and chronically ill. DATA SOURCES/STUDY SETTING: Analysis of primary care staffing: InterStudy HMO census data on primary care (n = 1,956) and specialist (n = 1,777) physician staffing levels from 1991 through 1995. Primary care organization and performance for the chronically ill and elderly were analyzed using a review of published research. STUDY DESIGN: For the staffing-level models, the number of primary care and specialist physicians per 100,000 enrollees was regressed on HMO characteristics (HMO type [group, staff, network, mixed], HMO enrollment, federal qualification, profit status, national affiliation) and community characteristics (per capita income, population density, service area size, HMO competition). For the review of organization and performance, literature published was summarized in a tabular format. PRINCIPAL FINDINGS: The analysis of physician staffing shows that group and staff HMOs have fewer primary care and specialist physicians per 100,000 enrollees than do network and mixed HMOs, which have fewer than IPAs. Larger HMOs use fewer physicians per 100,000 enrollees than smaller HMOs. Federally qualified HMOs have fewer primary care and specialist physicians per 100,000 enrollees. For-profit, nationally affiliated, and Blue Cross HMOs have more primary care and specialist physicians than do local HMOs. HMOs in areas with high per capita income have more PCPs per 100,000 and a greater proportion of PCPs in the panel. HMO penetration decreases the use of specialists, but the number of HMOs increases the use of primary care and specialist physicians in highly competitive markets. Under very competitive conditions, HMOs appear to compete by increasing access to both PCPs and specialists, with a greater emphasis on access to specialists. The review of research on HMO performance suggests that access to PCPs is better in MCOs. But access to specialists and hospitals is lower and more difficult in MCOs than FFS. Data do not suggest that processes of care, given access, are different in MCOs and FFS. MCO enrollees are more satisfied with financial aspects of a health plan and less satisfied with other aspects of health plan organization. There are potential problems with outcomes, with some studies finding greater declines among the chronically ill in MCOs than FFS. We found a variety of innovative care programs for the elderly, based on two fundamentally different approaches: organization around primary care or organizing around specialty care. Differences between the performance of the two approaches cannot be evaluated because of the small amount of research done. It is difficult to say how well particular programs perform and if they can be replicated. The innovative programs described in the literature tend to be benchmark programs developed by HMOs with a strong positive reputation. PMID:9618674

Wholey, D R; Burns, L R; Lavizzo-Mourey, R

1998-01-01

180

Recommendations for Modernization of Solid Waste Management Practices in Class -I Cities -Suggestions on Choice of Technology in Indian Context  

E-print Network

filled in a scientific manner. Integrated Plant Nutrient Management or IPNM, where composted urban wasteRecommendations for Modernization of Solid Waste Management Practices in Class - I Cities. 61') Preamble The Supreme Court Committee for Solid Waste Management in Class-1 Cities in India

Columbia University

181

Choice Plans: A Glossary.  

ERIC Educational Resources Information Center

Choice plans include private schools (voucher plans, tax credits and deductions, and contract services and charter plans) and public schools (intradistrict choice, interdistrict choice, and statewide choice). Issues spanning both areas are those of curricular choice and residential choice. (SLD)

Heleen, Owen

1992-01-01

182

The role of public relations activities in hospital choice.  

PubMed

Public relations activities for all organizations can have an important effect on consumer decision-making when buying goods or services. This study examines the effect that public relations activities can have regarding consumer decisions and choice. To explore exemplify this relationship a questionnaire was given to 971 patients within public, university and private hospitals in Ankara, Turkey. Study results show that public relations activities were a crucial factor in determining consumer hospital choice. The majority of respondents reported that the behaviors and attitude of personnel as public relations activities that support the hospital's reputation within the public were the primary variables in hospital choice. Health care managers can use these findings to further understand how patients make informed choices related to usage of a health care facility and to develop and/or improve public relations activities. PMID:19042526

Tengilimoglu, Dilaver; Yesiltas, Mehmet; Kisa, Adnan; Dziegielewski, Sophia F

2007-01-01

183

Managing obesity in primary care practice: an overview with perspective from the POWER-UP study.  

PubMed

Primary care practitioners (PCPs) have been encouraged to screen all adults for obesity and to offer behavioral weight loss counseling to the affected individuals. However, there is limited research and guidance on how to provide such intervention in primary care settings. This led the National Heart, Lung and Blood Institute in 2005 to issue a request for applications to investigate the management of obesity in routine clinical care. Three institutions were funded under a cooperative agreement to undertake the practice-based opportunities for weight reduction (POWER) trials. The present article reviews selected randomized controlled trials, published before the initiation of POWER, and then provides a detailed overview of the rationale, methods and results of the POWER trial conducted at the University of Pennsylvania (POWER-UP). POWER-UP's findings are briefly compared with those from the two other POWER trials, conducted at Johns Hopkins University and Harvard University/Washington University. The methods of delivering behavioral weight loss counseling differed markedly across the three trials, as captured by an algorithm presented in the article. Delivery methods ranged from having medical assistants and PCPs from the practices provide counseling to using a commercially available call center, coordinated with an interactive website. Evaluation of the efficacy of primary care-based weight loss interventions must be considered in light of costs, as discussed in relation to the recent treatment model proposed by the Centers for Medicare and Medicaid Services. PMID:23921779

Wadden, T A; Volger, S; Tsai, A G; Sarwer, D B; Berkowitz, R I; Diewald, L K; Carvajal, R; Moran, C H; Vetter, M

2013-08-01

184

Managing Obesity in Primary Care Practice: An Overview and Perspective from the POWER-UP Study  

PubMed Central

Primary care practitioners (PCPs) have been encouraged to screen all adults for obesity and to offer behavioral weight loss counseling to affected individuals. However, there is limited research and guidance on how to provide such intervention in primary care settings. This led the National Heart, Lung, and Blood Institute (NHLBI) in 2005 to issue a request for applications to investigate the management of obesity in routine clinical care. Three institutions were funded under a cooperative agreement to undertake the Practice-based Opportunities for Weight Reduction (POWER) trials. The present article reviews selected randomized controlled trials, published prior to the initiation of POWER, and then provides a detailed overview of the rationale, methods, and results of the POWER trial conducted at the University of Pennsylvania (POWER-UP). POWER-UP’s findings are briefly compared with those from the two other POWER Trials, conducted at Johns Hopkins University and Harvard University/Washington University. The methods of delivering behavioral weight loss counseling differed markedly across the three trials, as captured by an algorithm presented in the article. Delivery methods ranged from having medical assistants and PCPs from the practices provide counseling to using a commercially-available call center, coordinated with an interactive web-site. Evaluation of the efficacy of primary care-based weight loss interventions must be considered in light of costs, as discussed in relation to the recent treatment model proposed by the Centers for Medicare and Medicaid Services. PMID:23921779

Wadden, Thomas A.; Volger, Sheri; Tsai, Adam G.; Sarwer, David B.; Berkowitz, Robert I.; Diewald, Lisa; Carvajal, Raymond; Moran, Caroline H.; Vetter, Marion

2013-01-01

185

The role of radiotherapy and chemoradiation in the management of primary liver tumours.  

PubMed

Due to advances in technical radiotherapy delivery over the past two decades there has been a rapid increase in the use of radiotherapy for intrahepatic malignancies. This overview provides a succinct summary of the current evidence for external beam radiotherapy in the management of primary liver tumours, highlighting areas for future research. Internationally, hepatocellular carcinoma is a leading cause of cancer death and UK incidence rates are rising rapidly. The main risk factor is chronic liver disease and, as a result, most patients will be unsuitable for curative surgical modalities of treatment. Conformal radiotherapy may be used in patients with localised disease who are unsuitable for alternative local therapies. It may also be used in patients with portal venous thrombosis or for palliation in advanced disease. Caution should be used in patients with pre-existent liver dysfunction (Childs Pugh B or C) due to increased rates of toxicity. Stereotactic body radiotherapy has been used for early stage disease, with promising long-term local control rates and a favourable toxicity profile. Stereotactic body radiotherapy has also been investigated as a 'bridge to transplant'. Charged particle therapy may be used for patients with more advanced liver dysfunction, or as a means of dose escalation, and warrants further investigation in early stage disease. Cholangiocarcinoma is a rare but aggressive primary liver malignancy in which only a minority of patients will be suitable for resection. Conformal radiotherapy and stereotactic body radiotherapy have been used in both the adjuvant and locally advanced settings, although small patient numbers and a lack of prospective trial data limit interpretation of their role. To fully define the role of radiotherapy in the management pathway for primary liver tumours, prospective randomised studies are required. PMID:24951335

Aitken, K L; Hawkins, M A

2014-09-01

186

Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians  

PubMed Central

Background Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. Methods The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In different settings, 521 practitioners (448 GPs and 73 residents/vocational trainees) were questioned using a validated questionnaire. Results The knowledge about multimorbidity, a main consequence of obesity was balanced. Only 51% of the GPs were aware of the diagnostic threshold for obesity; awareness being higher in cities (60%) and the highest among residents (90%). They also considered obesity an illness rather than an aesthetic issue. There were wider differences regarding attitudes and practice, influenced by the the doctors’ age, gender, known BMI, previous qualification, less by working location. GPs with qualification in family medicine alone considered obesity management as higher professional satisfaction, compared to physicians who had previously other board qualification (77% vs 68%). They measured their patients’ waist circumference and waist/hip ratio (72% vs 62%) more frequently, provided the obese with dietary advice more often, while this service was less frequent among capital-based doctors who accepted the self-reported body weight dates by patients more commonly. Similar reduced activity and weight-measurement in outdoor clothing were more typical among older doctors. Diagnosis based on BMI alone was the highest in cities (85%). Consultations were significantly shorter in practices with a higher number of enrolled patients and were longer by female providers who consulted longer with patients about the suspected causes of developing obesity (65% vs 44%) and offered dietary records for patients significantly more frequently (65% vs 52%). Most of the younger doctors agreed that obesity management was a primary care issue. Doctors in the normal BMI range were unanimous that they should be a model for their patients (94% vs 81%). Conclusion More education of primary care physicians, available practical guidelines and higher community involvement are needed to improve the obesity management in Hungary. PMID:24138355

2013-01-01

187

Patterns of disease presentation and management in Egyptian primary care: findings from a survey of 2458 primary care patient consultations  

PubMed Central

Background The Egyptian government is considering embarking on a new wave of health sector reform. Although primary care is seen as central to the anticipated reforms, little is known about the current morbidity and utilization patterns in Egyptian publicly funded primary care. We conducted this survey study of patient encounters to describe the demographic characteristics of patients attending publicly-funded primary care practices, the relative frequency of conditions encountered in these practices, and the rates of drug prescription, investigation and referral. Method Cross-sectional survey of twelve primary care practices and 2458 patient consultations. Additional secondary data were collected from five of the twelve practices for preventive services provided at these practices i.e. immunizations, family planning and ante-natal care. Results 54% of the attendances were for people below the age of twenty, of which 54% were females. In patients above the age of twenty, women accounted for 73% of consultations. Upper respiratory tract infection was the most common reason for encounter, accounting for 24% of the presentations, followed by gastroenteritis (10%), intestinal parasites (5%), and lower respiratory tract infections (5%). Over 97% of patients were prescribed at least one drug, whereas investigation and referral rates were low (15% and 5% respectively). When the analysis was repeated for practices where data on both curative and preventive services were available (5 practices and 2146 consultations), substantial proportions of patients were found to seek care for immunizations (25%), family planning (12%), and ante-natal care (11%). Conclusion Most patients utilizing primary care practices in Egypt seek care for minor and preventive services with relatively few consultations for more serious conditions. There is also a pattern of prescribing drugs to most primary care patients which may reflect over-prescribing by primary care doctors. PMID:24148873

2013-01-01

188

How do patients referred to neurologists for headache differ from those managed in primary care?  

PubMed Central

Background Headache is the neurological symptom most frequently presented to GPs and referred to neurologists, but little is known about how referred patients differ from patients managed by GPs. Aim To describe and compare headache patients managed in primary care with those referred to neurologists. Design of study Prospective study. Setting Eighteen general practices in south-east England. Method This study examined 488 eligible patients consulting GPs with primary headache over 7 weeks and 81 patients referred to neurologists over 1 year. Headache disability was measured by the Migraine Disability Assessment Score, headache impact by the Headache Impact Test, emotional distress by the Hospital Anxiety and Depression Scale and illness perception was assessed using the Illness Perception Questionnaire. Results Participants were 303 patients who agreed to participate. Both groups reported severe disability and very severe impact on functioning. Referred patients consulted more frequently than those not referred in the 3 months before referral (P = 0.003). There was no significant difference between GP-managed and referred groups in mean headache disability, impact, anxiety, depression, or satisfaction with care. The referred group were more likely to link an increased number of symptoms to their headaches (P = 0.01), to have stronger emotional representations of their headaches (P = 0.006), to worry more (P = 0.001), and were made anxious by their headache symptoms (P = 0.044). Conclusion Patients who consult for headache experience severe disability and impact, and up to a third report anxiety and/or depression. Referral is not related to clinical severity of headaches, but is associated with higher consultation frequency and patients' anxiety and concern about their headache symptoms. PMID:17504590

Ridsdale, Leone; Clark, Lucy V; Dowson, Andrew J; Goldstein, Laura H; Jenkins, Linda; McCrone, Paul; Morgan, Myfanwy; Seed, Paul T

2007-01-01

189

Evaluating and Managing Acute Low Back Pain in the Primary Care Setting  

PubMed Central

Acute low back pain is a common reason for patient calls or visits to a primary care clinician. Despite a large differential diagnosis, the precise etiology is rarely identified, although musculoligamentous processes are usually suspected. For most patients, back symptoms are nonspecific, meaning that there is no evidence for radicular symptoms or underlying systemic disease. Because episodes of acute, nonspecific low back pain are usually self-limited, many patients treat themselves without contacting their primary care clinician. When patients do call or schedule a visit, evaluation and management by primary care clinicians is appropriate. The history and physical examination usually provide clues to the rare but potentially serious causes of low back pain, as well as to identify patients at risk for prolonged recovery. Diagnostic testing, including plain x-rays, is often unnecessary during the initial evaluation. For patients with acute, nonspecific low back pain, the primary emphasis of treatment should be conservative care, time, reassurance, and education. Current recommendations focus on activity as tolerated (though not active exercise while pain is severe) and minimal if any bed rest. Referral for physical treatments is most appropriate for patients whose symptoms are not improving over 2 to 4 weeks. Specialty referral should be considered for patients with a progressive neurologic deficit, failure of conservative therapy, or an uncertain or serious diagnosis. The prognosis for most patients is good, although recurrence is common. Thus, educating patients about the natural history of acute low back pain and how to prevent future episodes can help ensure reasonable expectations. PMID:11251764

Atlas, Steven J; Deyo, Richard A

2001-01-01

190

Using an established telehealth model to train urban primary care providers on hypertension management.  

PubMed

The objective of this study was to determine whether a videoconference-based telehealth network can increase hypertension management knowledge and self-assessed competency among primary care providers (PCPs) working in urban Federally Qualified Health Centers (FQHCs). We created a telehealth network among 6 urban FQHCs and our institution to support a 12-session educational program designed to teach state-of-the-art hypertension management. Each 1-hour session included a brief lecture by a university-based hypertension specialist, case presentations by PCPs, and interactive discussions among the specialist and PCPs. Twelve PCPs (9 intervention and 3 controls) were surveyed at baseline and immediately following the curriculum. The mean number of correct answers on the 26-item hypertension knowledge questionnaire increased in the intervention group (13.11 [standard deviation (SD)]=3.06) to 17.44 [SD=1.59], P<.01) but not among controls (14.33 [SD=3.21] to 13.00 [SD=3.46], P=.06). Similarly, the mean score on a 7-item hypertension management self-assessed competency scale increased in the intervention group (4.68 [SD=0.94] to 5.41 [SD=0.89], P<.01) but not among controls (5.28 [SD=0.43] to 5.62 [SD=0.67], P=.64). This model holds promise for enhancing hypertension care provided by urban FQHC providers. PMID:22235823

Masi, Christopher; Hamlish, Tamara; Davis, Andrew; Bordenave, Kristine; Brown, Stephen; Perea, Brenda; Aduana, Glen; Wolfe, Marcus; Bakris, George; Johnson, Daniel

2012-01-01

191

Angelina's choice  

PubMed Central

This is an opinion piece on how a celebrity’s personal choice to undergo prophylactic mastectomy on discovery of an aberrant gene, when publicly promoted, carries in itself the power to influence and impact healthcare trends and decisions. When celebrities advocate causes that are universally and uniformly acceptable and indisputable as the best in the realm of healthcare and cure (e.g. no smoking), it creates well-being and awareness in society at large. But those which are personal choices made out of a repertoire of other available and effective options may, because of celebrity preference, don the mantle of a norm. They thus run the danger of being blindly replicated by others without proper awareness and knowledge of the true potential of disease, risk factors, and other existing remedial or risk-reducing measures. Society should thus be encouraged to question, debate, and understand the validity, authenticity, and reason of the choices, especially those with a medical basis. This tempering of information with intelligence and rationale and making informed choices based on facts will serve humanity as a whole. PMID:24455660

Goel, Nishu Singh

2013-01-01

192

Choice Matters.  

ERIC Educational Resources Information Center

Describes how the author allows the children to make choices about their art and writing, enabling them to make connections between their own lives and work. Suggests that educators need to provide doorways to the things that give students ideas: books, music, objects, pictures, smells, sounds, and textures. (SG)

Hicks, Darcy

2001-01-01

193

Supporting Family Choice  

Microsoft Academic Search

Supporting family choice in the decision-making process is recommended practice in the field of early childhood and early\\u000a childhood special education. These decisions may relate to the medical, educational, social, recreational, therapeutic\\/rehabilitative,\\u000a and community aspects of the child's disability. Although this practice conveys the message that families are the primary\\u000a decision-makers for their children, families are not always adequately supported

Mary M. Murray; Kimberly A. Christensen; Gardner T. Umbarger; Karin C. Rade; Kathryn Aldridge; Judith A. Niemeyer

2007-01-01

194

[Management of sudden neurosensory hearing loss in a Primary Care Centre].  

PubMed

Sudden hearing loss is a rapid loss of neurosensory hearing that may occur within hours or days in an apparently healthy patient. Its origins are variable and multifactorial. Most patients do not recover hearing if not treated, and some even develop cophosis (deafness) in the affected ear. It is an otological emergency, as early therapeutic management offers a better hearing prognosis. As there is limited knowledge on this condition, it may be underdiagnosed in Primary Health Care Centers. It should be suspected in patients with abrupt hearing loss or tinnitus. Sophisticated instruments are not required for its diagnosis, just a detailed history, basic otoscopy, and proper interpretation of the hearing test. In this way, an accurate diagnosis is achieved in most cases, which is confirmed by audiometry. PMID:24071487

Muñoz-Proto, F; Carnevale, C; Bejarano-Panadés, N; Ferrán-de la Cierva, L; Mas-Mercant, S; Sarría-Echegaray, P

2014-04-01

195

School Choice for the Poor? The Limits of Marketisation of Primary Education in Rural India. CREATE Pathways to Access. Research Monograph No. 23  

ERIC Educational Resources Information Center

In recent years India has seen an explosion in low-fee private (LFP) schooling aimed at the poorer strata of society. This marketisation of primary education is a reaction to the well-documented failings of the government system. This paper looks at LFP schooling in one rural district of Uttar Pradesh, and compares government to low cost private…

Harma, Joanna

2010-01-01

196

[Assessment of municipal management of oral health in primary care: data collection instrument accuracy].  

PubMed

This validation study seeks to check the accuracy of an evaluation model. In an evaluation, it is necessary to validate the precision and reliability of the data collection instrument. In this study, the Management Assessment of Oral Health in Primary Care in Santa Catarina was used as a benchmark to calculate the indicators. Its model analyzes primary data, collected via an electronic form, and secondary data, available in the Unified Health System (SUS) database. For this study, the form was applied in the cities of Santa Catarina's Coal Region at two different moments to check its reproducibility, followed by a discussion over the answers with the researcher. The results obtained were analyzed and debated in a consensus workshop with specialists in the field, detecting inaccuracies relating to the concept, the source used and the profile of the respondents themselves. The gross agreement rate in the two data collections was 87%, and the inaccuracies amounted to 36% of the answers. Preferential source suggestions, question modifications and guidelines for the correct filling out of the form were some of the proposed changes, improving the original matrix and the data collection instrument. PMID:25351318

Pires, Diego Anselmi; Colussi, Claudia Flemming; Calvo, Maria Cristina Marino

2014-11-01

197

Management strategies in geriatric depression by primary care physicians and factors associated with the use of psychiatric services: A naturalistic study  

Microsoft Academic Search

Approximately 10% of elderly patients in primary care have depression yet it is often under-diagnosed and under-treated. It is unclear exactly how patients are being managed in primary care or what factors are associated with referral to psychiatric services. This study aimed to establish in a naturalistic setting how older depressed patients are managed in primary care; to determine which

S. P. Dearman; W. Waheed; V. Nathoo; R. C. Baldwin

2006-01-01

198

Child diet and healthy growth in the context of rural poverty in the peruvian andes: what influences primary caregivers' opportunities and choices?  

PubMed

This study explored opportunities and choices related to child feeding among women living in a remote and low-income district in the Andean highlands. Data were collected through in-depth interviews with mothers (N = 7) with reputations for providing good child care, and who participated in an NGO-run social and health programme. The aim of this study was to learn about women's positive experience with child feeding, in the context of living in low-income communities. Such knowledge could be of substantial practical value to health promotion practitioners, in illuminating existing local circumstances and practices that produce good child nutrition. The women who were most knowledgeable about child health and diet were better educated and had relatively higher social positions in the community. Regarding contextual factors related to child feeding, numerous references were made to the extensive use of own crops and food stuffs, seen to provide a better diet than that available in cities where people buy their food. In discussing food and meal preparation habits, there were clear references to child welfare and health as motivating factors in the choices that were made. The NGO programme was not mentioned by the interviewer, to avoid prompting, yet the respondents referred to it explicitly, and attributed improved health-related knowledge and skills to the NGO education interventions (e.g. education about nutritious meal preparation, child care skills, and sanitation practices). It is concluded that the women were concerned about providing a good diet to their children, they were aware of the impact of feeding practices on child health, and that education about health and diet helped them to improved feeding practices. PMID:23986377

Urke, Helga B; Bull, Torill; Mittelmark, Maurice B

2013-09-01

199

Choosing health, constrained choices.  

PubMed

In parallel with the neo-liberal retrenchment of the welfarist state, an increasing emphasis on the responsibility of individuals in managing their own affairs and their well-being has been evident. In the health arena for instance, this was a major theme permeating the UK government's White Paper Choosing Health: Making Healthy Choices Easier (2004), which appealed to an ethos of autonomy and self-actualization through activity and consumption which merited esteem. As a counterpoint to this growing trend of informed responsibilization, constrained choices (constrained agency) provides a useful framework for a judicious balance and sense of proportion between an individual behavioural focus and a focus on societal, systemic, and structural determinants of health and well-being. Constrained choices is also a conceptual bridge between responsibilization and population health which could be further developed within an integrative biosocial perspective one might refer to as the social ecology of health and disease. PMID:20028669

Chee Khoon Chan

2009-12-01

200

Attitudes toward School Choice in South Carolina.  

ERIC Educational Resources Information Center

School choice is the right of parents to decide where their children will attend school, regardless of residential school district boundaries. According to E. Marciniak (1989), the primary reason for advocating school choice was lack of progress in public school reform during the 1980s. The rationale for school choice is based on two assumptions:…

Wilson, W. C.; And Others

201

Sustainable Forest Management Preferences of Interest Groups in Three Regions with Different Levels of Industrial Forestry: An Exploratory Attribute-Based Choice Experiment  

NASA Astrophysics Data System (ADS)

The challenge of sustainable forest management is to integrate diverse and sometimes conflicting management objectives. In order to achieve this goal, we need a better understanding of the aspects influencing the preferences of diverse groups and how these groups make trade-offs between different attributes of SFM. We compare the SFM preferences of interest groups in regions with different forest use histories based on the reasoning that the condition of the forest reflects the forest use history of the area. The condition of the forest also shapes an individual’s forest values and attitudes. These held values and attitudes are thought to influence SFM preferences. We tested whether the SFM preferences vary amongst the different interest groups within and across regions. We collected data from 252 persons using a choice experiment approach, where participants chose multiple times among different options described by a combination of attributes that are assigned different levels. The novelty of our approach was the use of choice experiments in the assessment of regional preference differences. Given the complexity of inter-regional comparison and the small sample size, this was an exploratory study based on a purposive rather than random sample. Nevertheless, our results suggest that the aggregation of preferences of all individuals within a region does not reveal all information necessary for forest management planning since opposing viewpoints could cancel each other out and lead to an interpretation that does not reflect possibly polarised views. Although based on a small sample size, the preferences of interest groups within a region are generally statistically significantly different from each other; however preferences of interest groups across regions are also significantly different. This illustrates the potential importance of assessing heterogeneity by region and by group.

Berninger, Kati; Adamowicz, Wiktor; Kneeshaw, Daniel; Messier, Christian

2010-07-01

202

Managing boundaries in primary care service improvement: A developmental approach to communities of practice  

PubMed Central

Background Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. Methods The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester—a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010–2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. Findings The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors, competition and strong organisational identification. Manipulated emergence of multi-organisational CoPs in the context of primary care may thus be problematic. Conclusions In cases when manipulated emergence of new CoPs is problematic, boundary issues could be addressed by adopting a developmental perspective on CoPs, which provides an alternative to the analytical and instrumental perspectives previously described in the CoP literature. This perspective implies a pragmatic, situational approach to mapping existing CoPs and their characteristics and potentially modifying them in the process of service improvement through the combination of internal and external facilitation. PMID:23068016

2012-01-01

203

Diagnosis and management of the primary headache disorders in the emergency department setting  

PubMed Central

Headache continues to be a frequent cause of emergency department (ED) use, accounting for 2% of all visits. The majority of these headaches prove to be benign but painful exacerbations of chronic headache disorders, such as migraine, tension-type, and cluster. The goal of ED management is to provide rapid and quick relief of benign headache, without causing undue side effects, as well as recognizing headaches with malignant course. Though these headaches have distinct epidemiologies and clinical phenotypes, there is overlapping response to therapy: non-steroidals, triptans, dihydroergotamine, and the anti-emetic dopamine-antagonists may play a therapeutic role for each of these acute headaches. Because these headaches often recur over the days and months following ED discharge, the responsibility of the emergency physician includes identifying as yet unmet treatment needs and ensuring successful transition of care of these patients to an outpatient healthcare provider. Herein, we review the diagnostic criteria and management strategies for the primary headache disorders. PMID:19218020

Friedman, Benjamin Wolkin; Grosberg, Brian Mitchell

2009-01-01

204

Review of experimental studies in social psychology of small groups when an optimal choice exists and application to operating room management decision-making.  

PubMed

Because operating room (OR) management decisions with optimal choices are made with ubiquitous biases, decisions are improved with decision-support systems. We reviewed experimental social-psychology studies to explore what an OR leader can do when working with stakeholders lacking interest in learning the OR management science but expressing opinions about decisions, nonetheless. We considered shared information to include the rules-of-thumb (heuristics) that make intuitive sense and often seem "close enough" (e.g., staffing is planned based on the average workload). We considered unshared information to include the relevant mathematics (e.g., staffing calculations). Multiple studies have shown that group discussions focus more on shared than unshared information. Quality decisions are more likely when all group participants share knowledge (e.g., have taken a course in OR management science). Several biases in OR management are caused by humans' limited abilities to estimate tails of probability distributions in their heads. Groups are more susceptible to analogous biases than are educated individuals. Since optimal solutions are not demonstrable without groups sharing common language, only with education of most group members can a knowledgeable individual influence the group. The appropriate model of decision-making is autocratic, with information obtained from stakeholders. Although such decisions are good quality, the leaders often are disliked and the decisions considered unjust. In conclusion, leaders will find the most success if they do not bring OR management operational decisions to groups, but instead act autocratically while obtaining necessary information in 1:1 conversations. The only known route for the leader making such decisions to be considered likable and for the decisions to be considered fair is through colleagues and subordinates learning the management science. PMID:24108254

Prahl, Andrew; Dexter, Franklin; Braun, Michael T; Van Swol, Lyn

2013-11-01

205

Management of menorrhagia in primary care—impact on referral and hysterectomy: data from the Somerset Morbidity Project  

Microsoft Academic Search

OBJECTIVETo investigate the management of menorrhagia in primary care and its impact on referral and hysterectomy rates.DESIGNProspective observational study.SETTING11 general practices from the Somerset Morbidity Project.SUBJECTS885 women consulting their general practitioner with menorrhagia over four years.MAIN OUTCOME MEASURESProportions of these women investigated and treated with drugs in primary care, referred to a gynaecologist and undergoing operative procedures. The relation between

Clare Grant; Lesley Gallier; Tom Fahey; Nicky Pearson; Joyshri Sarangi

2000-01-01

206

Application of Information Technology: The Development and Evaluation of an Integrated Electronic Prescribing and Drug Management System for Primary Care  

Microsoft Academic Search

ObjectiveTo develop and evaluate the acceptability and use of an integrated electronic prescribing and drug management system (MOXXI) for primary care physicians.DesignA 20-month follow-up study of MOXXI (Medical Office of the XXIst Century) implementation in 28 primary care physicians and 13,515 consenting patients.MeasurementMOXXI was developed to enhance patient safety by integrating patient demographics, retrieving active drugs from pharmacy systems, generating

Robyn Tamblyn; Allen Huang; Yuko Kawasumi; Gillian Bartlett; Roland M. Grad; André Jacques; Martin Dawes; Michal Abrahamowicz; Robert Perreault; Laurel Taylor; Nancy Winslade; Lise Poissant; Alain Pinsonneault

2006-01-01

207

Non-pharmacological management of primary and secondary insomnia among older people: review of assessment tools and treatments  

Microsoft Academic Search

Background: primary and secondary insomnia, especially among older adults, is frequently encountered by family physicians. Pharmacological interventions, although effective in some circumstances, can be detrimental in others. Non-pharmacological management of insomnia may allow the patients to self-administer the treatment. Objectives: review of published literature of assessment tools and treatments for primary and secondary insomnia. Results: two frequently used self-reporting methods

LYNDAL PETIT; F.-A. SARAZAN; N. Azad

2003-01-01

208

Practice nurse involvement in primary care depression management: an observational cost-effectiveness analysis  

PubMed Central

Background Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the management of diabetes and obesity. This paper reports on their value in the management of depression. Methods General practices were assigned to a low or high model of care based on observed levels of practice nurse involvement in clinical-based activities for the management of depression (i.e. percentage of depression patients seen, percentage of consultation time spent on clinical-based activities). Linked, routinely collected data was used to determine patient level depression outcomes (proportion of depression-free days) and health service usage costs. Standardised depression assessment tools were not routinely used, therefore a classification framework to determine the patient’s depressive state was developed using proxy measures (e.g. symptoms, medications, referrals, hospitalisations and suicide attempts). Regression analyses of costs and depression outcomes were conducted, using propensity weighting to control for potential confounders. Results Capacity to determine depressive state using the classification framework was dependent upon the level of detail provided in medical records. While antidepressant medication prescriptions were a strong indicator of depressive state, they could not be relied upon as the sole measure. Propensity score weighted analyses of total depression-related costs and depression outcomes, found that the high level model of care cost more (95% CI: -$314.76 to $584) and resulted in 5% less depression-free days (95% CI: -0.15 to 0.05), compared to the low level model. However, this result was highly uncertain, as shown by the confidence intervals. Conclusions Classification of patients’ depressive state was feasible, but time consuming, using the classification framework proposed. Further validation of the framework is required. Unlike the analyses of diabetes and obesity management, no significant differences in the proportion of depression-free days or health service costs were found between the alternative levels of practice nurse involvement. PMID:24422622

2014-01-01

209

Primary care-based, targeted screening programme to promote sustained weight management  

PubMed Central

Abstract Objective. To identify overweight and obese subjects at increased cardiovascular risk in the community, and provide them with lifestyle counselling that is possible to implement in real life. Design. Longitudinal cohort study. Setting. The communities of Harjavalta and Kokemäki in south-western Finland. Subjects. A tape for measurement of waist and a risk factor questionnaire was mailed to home-dwelling inhabitants aged 45–70 years (n = 6013). Of the 4421 respondents, 2752 with at least one cardiovascular risk factor were examined by a public health nurse. For the subjects with high cardiovascular risk (n = 1950), an appointment with a physician was scheduled. The main goal of lifestyle counselling for the 1608 high-risk subjects with BMI ? 25 kg/m2 was weight reduction of at least 5%. Among these, 906 had completed self-administrated questionnaires at baseline and form the present study population. Main outcome measure. Success in weight management. Results. At the three-year follow-up visit, 18% of subjects had lost ? 5% of their initial weight and 70% had stabilized their weight, while 12% had gained weight ? 5%. Newly diagnosed glucose disorder (OR 1.37 [95% CI 1.02–1.84]) predicted success in weight management, whereas depressive symptoms (OR 0.61 [95% CI 0.42–0.90]), excess alcohol use (OR 0.63 [95% CI 0.44–0.90]), and number of drugs used (OR 0.91 [95% CI 0.83–0.99]) at baseline predicted poor outcome. Conclusions. A primary care screening programme to identify overweight or obese individuals can promote sustained weight management. Psychological factors, especially depressive symptoms, are a critical component to consider before attempts to change the lifestyle of an individual. PMID:24592894

Jarvenpaa, Salme; Kautiainen, Hannu

2014-01-01

210

Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease  

PubMed Central

Background The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD) in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1) improvement in the rational utilization of health-care services and 2) benefits reflected in improved health status and quality of life for patients. Methods/Design A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients) and the other the control group (n = 32,114 patients). The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. Discussion The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of complex cases. PMID:19239679

Bolibar, Ignasi; Plaza, Vicente; Llauger, Mariantonia; Amado, Ester; Anton, Pedro A; Espinosa, Ana; Dominguez, Leandra; Fraga, Mar; Freixas, Montserrat; de la Fuente, Josep A; Liguerre, Iskra; Medrano, Casimira; Peiro, Meritxell; Pou, Mariantonia; Sanchis, Joaquin; Solanes, Ingrid; Valero, Carles; Valverde, Pepi

2009-01-01

211

Challenges and controversies in the medical management of primary and antithrombotic-related intracerebral hemorrhage  

PubMed Central

Intracerebral hemorrhage (ICH) represents 10–15% of all cerebrovascular events, and is associated with substantial morbidity and mortality. In contrast to ischemic cerebrovascular disease in which acute therapies have proven beneficial, ICH remains a more elusive condition to treat, and no surgical procedure has proven to be beneficial. Aspects pertinent to medical ICH management include cessation or minimization of hematoma enlargement, prevention of intraventricular extension, and treatment of edema and mass effect. Therapies focusing on these aspects include prothrombotic (hemostatic) agents, antihypertensive strategies, and antiedema therapies. Therapies directed towards the reversal of antithrombosis caused by antiplatelet and anticoagulant agents are frequently based on limited data, allowing for diverse opinions and practice styles. Several newer anticoagulants that act by direct thrombin or factor Xa inhibition have no natural antidote, and are being increasingly used for various prophylactic and therapeutic indications. As such, these new anticoagulants will inevitably pose major challenges in the treatment of patients with ICH. Ongoing issues in the management of patients with ICH include the need for effective treatments that not only limit hematoma expansion but also result in improved clinical outcomes, the identification of patients at greatest risk for continued hemorrhage who may most benefit from treatment, and the initiation of therapies during the hyperacute period of most active hemorrhage. Defining hematoma volume increases at various anatomical locations that translate into clinically meaningful outcomes will also aid in directing future trials for this disease. The focus of this review is to underline and discuss the various controversies and challenges involved in the medical management of patients with primary and antithrombotic-related ICH. PMID:22276075

2012-01-01

212

Survey of pharmacist-managed primary care clinics using healthcare failure mode and effect analysis  

PubMed Central

Objective The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement. Methods The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments. Data were analyzed with a method adapted from HFMEA. Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are doing a poor job. A score greater than or equal to ten was used to identify areas for improvement. Results Seventy-one patients completed surveys. Thirteen components were assessed and no item achieved a mean product greater than or equal to ten. The survey item with the highest mean product pertained to discussion of potential medication side effects (mean: 7.06; interquartile range: 5-10). Analysis of each survey item found that all survey items had multiple individual responses that provided a product score of greater than or equal to ten. The survey items most frequently listed in the overall population as being most valued were “Told you the name of each of your medicines and what they are used for”, “Answered your questions fully,” and “Explained what your medicines do”. Conclusions Educational components provided during pharmacist-managed clinic appointments are aligned with patients’ needs and are successfully incorporating the components that patients value highly in a patient-healthcare provider interaction. The HFMEA model can be an important teaching tool to identify specific processes in need of improvement and to help enhance pharmacists’ self-efficacy, which may further improve patient care. PMID:24367459

Vincent, Ashley H.; Gonzalvo, Jasmine D.; Ramsey, Darin C.; Walton, Alison M.; Weber, Zachary A.; Wilhoite, Jessica E.

213

The Influence of Individual and Situational Factors on Children's Choice of a Conflict Management Strategy  

ERIC Educational Resources Information Center

Research Findings: The aim of the present study was to investigate the influence of individual and situational factors on nursery school children's conflict management strategies. This observational study of triadic interaction was carried out among 69 children whose mean age was 48 months. The video-recorded data were coded for the type of…

Tamm, Anni; Tõugu, Pirko; Tulviste, Tiia

2014-01-01

214

The effect of health and nutrition management classes on nutrition choices: a case study on diabetics in huntsville, alabama, United States.  

PubMed

This study evaluated the effectiveness of a one-day nutrition education seminar utilizing a sample of 26 confirmed diabetics who had at least once before, participated in nutrition classes. The participants were exposed to a seminar that promoted, evaluated, and rewarded good nutrition choices in an effort to educate this group about coping with diabetes through nutrition management. A 24-hour food recall was used as a pre-test, meal plans constructed by trained graduate-level diet interns were used as the standard by which proper nutrition was judged, and participants' choices were used as the post-test evaluation. Significant differences were found between the 24-hour recall and the ideal meal plans in all of the three nutrient measured (energy, protein and fat). Participants showed a preference for personally constructed meal plans as opposed to those constructed by the interns. However, significant diet adjustments were shown in the short term. Discussion focused on the need for repeated involvement in diet interventions, and the challenges faced in changing diet habits of a group of middle-aged individuals who are even slightly obese. PMID:22691752

Cort, Malcolm A; Sovyanhadi, Marta

2007-09-01

215

Dyspepsia Management in Primary Care in The Netherlands: To What Extent Is Helicobacter pylori Diagnosis and Treatment Incorporated?  

Microsoft Academic Search

Background: Many guidelines on the management of Helicobacter pylori (HP)-related dyspepsia have been launched over the past decade. The suggested policies in these guidelines are often more consensus- than evidence-based (test-and-treat policy, test and endoscope), which may cause confusion among primary-care physicians. Aim: To determine the current management of HP-related dyspepsia by Dutch general practitioners (GPs). Methods: A random sample

Catherine F. Weijnen; Niek J. de Wit; Mattijs E. Numans; A. Otto Quartero; Theo J. M. Verheij

2001-01-01

216

Specialized Nursing Practice for Chronic Disease Management in the Primary Care Setting  

PubMed Central

Background In response to the increasing demand for better chronic disease management and improved health care efficiency in Ontario, nursing roles have expanded in the primary health care setting. Objectives To determine the effectiveness of specialized nurses who have a clinical role in patient care in optimizing chronic disease management among adults in the primary health care setting. Data Sources and Review Methods A literature search was performed using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database. Results were limited to randomized controlled trials and systematic reviews and were divided into 2 models: Model 1 (nurse alone versus physician alone) and Model 2 (nurse and physician versus physician alone). Effectiveness was determined by comparable outcomes between groups in Model 1, or improved outcomes or efficiency in Model 2. Results Six studies were included. In Model 1, there were no significant differences in health resource use, disease-specific measures, quality of life, or patient satisfaction. In Model 2, there was a reduction in hospitalizations and improved management of blood pressure and lipids among patients with coronary artery disease. Among patients with diabetes, there was a reduction in hemoglobin A1c but no difference in other disease-specific measures. There was a trend toward improved process measures, including medication prescribing and clinical assessments. Results related to quality of life were inconsistent, but patient satisfaction with the nurse-physician team was improved. Overall, there were more and longer visits to the nurse, and physician workload did not change. Limitations There was heterogeneity across patient populations, and in the titles, roles, and scope of practice of the specialized nurses. Conclusions Specialized nurses with an autonomous role in patient care had comparable outcomes to physicians alone (Model 1) based on moderate quality evidence, with consistent results among a subgroup analysis of patients with diabetes based on low quality evidence. Model 2 showed an overall improvement in appropriate process measures, disease-specific measures, and patient satisfaction based on low to moderate quality evidence. There was low quality evidence that nurses working under Model 2 may reduce hospitalizations for patients with coronary artery disease. The specific role of the nurse in supplementing or substituting physician care was unclear, making it difficult to determine the impact on efficiency. Plain Language Summary Nurses with additional skills, training, or scope of practice may help improve the primary care of patients with chronic diseases. This review found that specialized nurses working on their own could achieve health outcomes that were similar to those of doctors. It also found that specialized nurses who worked with doctors could reduce hospital visits and improve certain patient outcomes related to diabetes, coronary artery disease, or heart failure. Patients who had nurse-led care were more satisfied and tended to receive more tests and medications. It is unclear whether specialized nurses improve quality of life or doctor workload. PMID:24194798

2013-01-01

217

Managing patients with multimorbidity: systematic review of interventions in primary care and community settings  

PubMed Central

Objective To determine the effectiveness of interventions designed to improve outcomes in patients with multimorbidity in primary care and community settings. Design Systematic review. Data sources Medline, Embase, CINAHL, CAB Health, Cochrane central register of controlled trials, the database of abstracts of reviews of effectiveness, and the Cochrane EPOC (effective practice and organisation of care) register (searches updated in April 2011). Eligibility criteria Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses reporting on interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. Outcomes included any validated measure of physical or mental health and psychosocial status, including quality of life outcomes, wellbeing, and measures of disability or functional status. Also included were measures of patient and provider behaviour, including drug adherence, utilisation of health services, acceptability of services, and costs. Data selection Two reviewers independently assessed studies for eligibility, extracted data, and assessed study quality. As meta-analysis of results was not possible owing to heterogeneity in participants and interventions, a narrative synthesis of the results from the included studies was carried out. Results 10 studies examining a range of complex interventions totalling 3407 patients with multimorbidity were identified. All were randomised controlled trials with a low risk of bias. Two studies described interventions for patients with specific comorbidities. The remaining eight studies focused on multimorbidity, generally in older patients. Consideration of the impact of socioeconomic deprivation was minimal. All studies involved complex interventions with multiple components. In six of the 10 studies the predominant component was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In the remaining four studies, intervention components were predominantly patient oriented. Overall the results were mixed, with a trend towards improved prescribing and drug adherence. The results indicated that it is difficult to improve outcomes in this population but that interventions focusing on particular risk factors in comorbid conditions or functional difficulties in multimorbidity may be more effective. No economic analyses were included, although the improvements in prescribing and risk factor management in some studies could provide potentially important cost savings. Conclusions Evidence on the care of patients with multimorbidity is limited, despite the prevalence of multimorbidity and its impact on patients and healthcare systems. Interventions to date have had mixed effects, although are likely to be more effective if targeted at risk factors or specific functional difficulties. A need exists to clearly identify patients with multimorbidity and to develop cost effective and specifically targeted interventions that can improve health outcomes. PMID:22945950

2012-01-01

218

Comparison of primary health-care models in the management of chronic kidney disease  

PubMed Central

Negative lifestyle habits (potential risks for chronic kidney disease, CKD) are rarely modified by physicians in a conventional health-care model (CHCM). Multidisciplinary strategies may have better results; however, there is no information on their application in the early stages of CKD. Thus, the aim of this study was to compare a multiple intervention model versus CHCM on lifestyle and renal function in patients with type 2 diabetes mellitus and CKD stage 1–2. In a prospective cohort study, a family medicine unit (FMU) was assigned a multiple intervention model (MIM) and another continued with conventional health-care model (CHCM). MIM patients received an educational intervention guided by a multidisciplinary team (family physician (FP), social worker, dietitian, physical trainer); self-help groups functioned with free activities throughout the study. CHCM patients were managed only by the FP, who decided if patients needed referral to other professionals. Thirty-nine patients were studied in each cohort. According to a lifestyle questionnaire, no baseline differences were found between cohorts, but results reflected an unhealthy lifestyle. After 6 months of follow-up, both cohorts showed significant improvement in their dietary habits. Compared to CHCM diet, exercise, emotional management, knowledge of disease, and adherence to treatment showed greater improvement in the MIM. Blood pressure decreased in both cohorts, but body mass index, waist circumference, and HbA1C significantly decreased only in MIM. Glomerular filtration rate (GFR) was maintained equally in both cohorts, but albuminuria significantly decreased only in MIM. In conclusion, MIM achieves better control of lifestyle-related variables and CKD risk factors in type 2 diabetes mellitus (DM2) patients with CKD stage 1–2. Broadly, implementation of a MIM in primary health care may produce superior results that might assist in preventing the progression of CKD. PMID:25018986

Cueto-Manzano, Alfonso M; Martinez-Ramirez, Hector R; Cortes-Sanabria, Laura

2013-01-01

219

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 2. Results: Primary care management and community orientation.  

PubMed

At the WONCA Europe conference 2009 the recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' was presented. It is a background paper and reference manual, providing advocacy of general practice/family medicine (GP/FM) in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In this second article, the results for the core competencies 'primary care management' and 'community orientation' are presented. Though there is a large body of research on various aspects of 'primary care management', it represents a very scattered rather than a meta view. Many studies focus on care for specific diseases, the primary/secondary care interface, or the implications of electronic patient records. Cost efficiency or process indicators of quality are current outcomes. Current literature on community orientation is mainly descriptive, and focuses on either care for specific diseases, or specific patient populations, or on the uptake of preventive services. Most papers correspond poorly to the WONCA concept. For both core competencies, there is a lack of research with a longitudinal perspective and/or relevant health or quality of life outcomes as well as research on patients' preferences and education for organizational aspects of GP/FM. PMID:20100109

Hummers-Pradier, Eva; Beyer, Martin; Chevallier, Patrick; Eilat-Tsanani, Sophia; Lionis, Christos; Peremans, Lieve; Petek, Davorina; Rurik, Imre; Soler, Jean Karl; Stoffers, Henri Ejh; Topsever, Pinar; Ungan, Mehmet; van Royen, Paul

2010-03-01

220

Organisational quality, nurse staffing and the quality of chronic disease management in primary care: Observational study using routinely collected data  

Microsoft Academic Search

Background An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as

Peter Griffiths; Jill Maben; Trevor Murrells

2011-01-01

221

Role of chemotherapy in the management of primary rectal lymphoma: a case report and review of the literature  

PubMed Central

Introduction Primary rectal lymphoma is a rare disease. In this paper we present an unusual case of primary rectal lymphoma which was managed with chemotherapy and discussed by a thorough review of the related literature. Cases presentation An 85-years-male patient was diagnosed in Sidi Mohammed Ben Abdellah Hospital as having diffuse large B-cell lymphoma of the rectum at a bulky stage two. This patient was managed successfully with 8 treatment cycles of Cyclophosphamide 750 mg/m2 at day 1 of each cycle, Doxorubicin (50 mg/m2 in the first 4 cycles and 25 mg/m2 in the subsequent cycles) at day 1 of each cycle, Vincristine 1.4 mg/m2 at day 1 of each cycle, and prednisone 50 mg/m2 at day 1 to 5 of each cycle. Conclusion The optimal treatment of primary rectal lymphoma needs more research studying to be achieved. PMID:20062547

2009-01-01

222

Enhancing the Primary Care Team to Provide Redesigned Care: The Roles of Practice Facilitators and Care Managers  

PubMed Central

ABSTRACT Efforts to redesign primary care require multiple supports. Two potential members of the primary care team—practice facilitator and care manager—can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities—reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care. PMID:23319510

Taylor, Erin Fries; Machta, Rachel M.; Meyers, David S.; Genevro, Janice; Peikes, Deborah N.

2013-01-01

223

Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.  

PubMed

Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care. PMID:23319510

Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N

2013-01-01

224

Molecular aetiology of primary hyperoxaluria and its implications for clinical management.  

PubMed

The primary hyperoxalurias type 1 (PH1) and type 2 (PH2) are autosomal recessive calcium oxalate kidney stone diseases caused by deficiencies of the metabolic enzymes alanine:glyoxylate aminotransferase (AGT) and glyoxylate/hydroxypyruvate reductase (GR/HPR), respectively. Over 50 mutations have been identified in the AGXT gene (encoding AGT) in PH1, associated with a wide variety of effects on AGT, including loss of catalytic activity, aggregation, accelerated degradation, and peroxisome-to-mitochondrion mistargeting. Some of these mutations segregate and interact synergistically with a common polymorphism. Over a dozen mutations have been found in the GRHPR gene (encoding GR/HPR) in PH2, all associated with complete loss of glyoxylate reductase enzyme activity and immunoreactive protein. The crystal structure of human AGT, but not human GR/HPR, has been solved, allowing the effects of many of the mutations in PH1 to be rationalised in structural terms. Detailed analysis of the molecular aetiology of PH1 and PH2 has led to significant improvements in all aspects of their clinical management. Enzyme replacement therapy by liver transplantation can provide a metabolic cure for PH1, but it has yet to be tried for PH2. New treatments that aim to counter the effects of specific mutations on the properties of the enzymes could be feasible in the not-too-distant future. PMID:14987413

Danpure, Christopher J; Rumsby, Gill

2004-01-01

225

Female genital cutting: an evidence-based approach to clinical management for the primary care physician.  

PubMed

The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue. PMID:23726401

Hearst, Adelaide A; Molnar, Alexandra M

2013-06-01

226

Conservation Reserve Program (CRP) contributions to wildlife habitat, management issues, challenges and policy choices--an annotated bibliography  

USGS Publications Warehouse

The following bibliography presents brief summaries of documents relevant to Conservation Reserve Program relations to wildlife habitat, habitat management in agriculturally dominated landscapes, and conservation policies potentially affecting wildlife habitats in agricultural ecosystems. Because the literature summaries furnished provide only sweeping overviews, users are urged to obtain and evaluate those papers appearing useful to obtain a more complete understanding of study findings and their implications to conservation in agricultural ecosystems. The bibliography contains references to reports that reach beyond topics that directly relate to the Conservation Reserve Program. Sections addressing grassland management and landowner surveys/opinions, for example, furnish information useful for enhancing development and administration of conservation policies affecting lands beyond those enrolled in conservation programs. Some sections of the bibliography (for example, agricultural conservation policy, economics, soils) are far from inclusive of all relevant material written on the subject. Hopefully, these sections will serve as fundamental introductions to related issues. In a few instances, references may be presented in more than one section of the bibliography. For example, individual papers specifically addressing both non-game and game birds are included in respective sections of the bibliography. Duplication of citations and associated notes has, however, been kept to a minimum.

Allen, Arthur W.; Vandever, Mark W.

2012-01-01

227

Attitudes and Practices of Primary Care Physicians in the Management of Overweight and Obesity in Eastern Saudi Arabia  

PubMed Central

Background Obesity is a global world-wide health problem in both developing and developed countries. In Saudi Arabia, this problem becomes an alarming disease both during childhood and adulthood among males and females. Primary health care physicians are identified as the first line of defense and contributor to cost-effective for the management and prevention of the disease; they are expected to normalize the weights in the community. Objective The aim of this study was to determine attitudes and practice by physician working in primary health care centers regarding management of obesity in the cities of Dammam and Al-Khobar in the Eastern Province of Saudi Arabia. Methods This study is a cross-sectional study that took place from December 2009 to March 2010. A specially made questionnaire with a Cronbach alpha reliability of 0.86 and content validity by 5 experts was used to measure the attitudes and practices from several different aspects of care provided at primary health care centers to obesity were distributed and collected from 76 physicians working in primary health centers in Dammam and 73 in Al-Khobar in Saudi Arabia. One hundred thirty physicians responded (12.8% non-response rate) and became the sample. Results Eighty-three per cent of physicians has negative attitude toward the concept of obesity, and more than two-thirds of primary care physicians see themselves play a key role in the management of obesity; The mean attitude scores of studied nurses was ranged from 2.95±1.06 to 4.34 ±0.82 with an agreement that obesity is considered as a disease and the role of the primary health care physician is not only to refer obese patients to other specialized care as well as difficulties in counseling for weight reduction. However, the majority of physicians gave their obese patients advice on dietary habits and physical activities and also they are sometimes referred obese people to dieticians. Moreover, half of physicians provide educational materials as part of the management and above two third of the studied physicians never use medications in weight reduction. Only one third of them believe that they are well prepared for the treatment of obesity. Conclusion There exist gaps in attitudes contradictory for the management of obesity which indicates Physicians in Eastern Saudi Arabia showed a reasonable level of interest in participating in obesity prevention and management. Accordingly, they need for more education and training in management and prevention of obesity, and should continue education from medical school till post-graduate.

Alshammari (Al-Shammari YF), Yousef Fadhel Fahad

2014-01-01

228

Caries management strategies for primary molars: 1-yr randomized control trial results.  

PubMed

Minimal invasive approaches to managing caries, such as partial caries removal techniques, are showing increasing evidence of improved outcomes over the conventional complete caries removal. There is also increasing interest in techniques where no caries is removed. We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars: conventional restorations (CR; complete caries removal and compomer restoration), Hall technique (HT; no caries removal, sealing in with stainless steel crowns), and nonrestorative caries treatment (NRCT; no caries removal, opening up the cavity, teaching brushing and fluoride application). In sum, 169 children (3-8 yr old; mean, 5.56 ± 1.45 yr) were enrolled in this secondary care-based, 3-arm, parallel-group, randomized clinical trial. Treatments were carried out by specialist pediatric dentists or postgraduate trainees. One lesion per child received CR, HT, or NRCT. Outcome measures were clinical failure rates, grouped as minor failure (restoration loss/need for replacement, reversible pulpitis, caries progression, etc.) and major failure (irreversible pulpitis, abscess, etc.). There were 148 children (87.6%) with a minimum follow-up of 11 mo (mean, 12.23 ± 0.98 mo). Twenty teeth were recorded as having at least 1 minor failure: NRCT, n = 8 (5%); CR, n = 11 (7%); HT, n = 1 (1%) (p = .002, 95% CI = 0.001 to 0.003). Only the comparison between NRCT and CR showed no significant difference (p = .79, 95% CI = 0.78 to 0.80). Nine (6%) experienced at least 1 major failure: NRCT, n = 4 (2%); CR, n = 5 (3%); HT, n = 0 (0%) (p = .002, 95% CI = 0.001 to 0.003). Individual comparison of NRCT and CR showed no statistically significant difference in major failures (p = .75, 95% CI = 0.73 to 0.76). Success and failure rates were not significantly affected by pediatric dentists' level of experience (p = .13, 95% CI = 0.12 to 0.14). The HT was significantly more successful clinically than NRCT and CR after 1 yr, while pairwise analyses showed comparable results for treatment success between NRCT and CR (ClinicalTrials.gov NCT01797458). PMID:25216660

Santamaria, R M; Innes, N P T; Machiulskiene, V; Evans, D J P; Splieth, C H

2014-11-01

229

Improving equity in the provision of primary health care: lessons from decentralized planning and management in Namibia.  

PubMed Central

This paper draws lessons from a review of primary health care services in Windhoek, the capital of Namibia, undertaken by a regional health management team. The review was carried out because of perceived increases in workload and inadequate staffing levels, arising from the rapid expansion of the city associated with inward migration. A survey of the utilization of government clinics was used to develop a more equitable allocation of primary health care services between localities. The survey revealed disparities between patterns of utilization of the services and the allocation of staff: the poorer localities were relatively underprovided. Decisions made centrally on resource allocation had reinforced the inequities. On the basis of the results of the review, the regional health management team redistributed nursing and medical staff and argued for a shift in the allocation of capital expenditure towards the poorer communities. The review demonstrates the potential for regional and provincial health management teams to make effective assessments of the needs of their populations and to promote the equitable delivery of primary health care services. In order to achieve this they need not only to become effective managers, but also to develop population-based planning skills and the confidence and authority to influence the allocation of resources between and within their regions and provinces. PMID:12219160

Bell, Ruth; Ithindi, Taathi; Low, Anne

2002-01-01

230

Iron Chelation Therapy with Deferasirox in the Management of Iron Overload in Primary Myelofibrosis  

PubMed Central

Deferasirox (DSX) is the principal option currently available for iron-chelation-therapy (ICT), principally in the management of myelodysplastic syndromes (MDS), while in primary myelofibrosis (PMF) the expertise is limited. We analyzed our experience in 10 PMF with transfusion-dependent anemia, treated with DSX from September 2010 to December 2013. The median dose tolerated of DSX was 750 mg/day (10 mg/kg/day), with 3 transient interruption of treatment for drug-related adverse events (AEs) and 3 definitive discontinuation for grade 3/4 AEs. According to IWG 2006 criteria, erythroid responses with DSX were observed in 4/10 patients (40%), 2 of them (20%) obtaining transfusion independence. Absolute changes in median serum ferritin levels (Delta ferritin) were greater in hematologic responder (HR) compared with non-responder (NR) patients, already at 6 months of ICT respect to baseline. Our preliminary data open new insights regarding the benefit of ICT not only in MDS, but also in PMF with the possibility to obtain an erythroid response, overall in 40 % of patients. HR patients receiving DSX seem to have a better survival and a lower incidence of leukemic transformation (PMF-BP). Delta ferritin evaluation at 6 months could represent a significant predictor for a different survival and PMF-BP. However, the tolerability of the drug seems to be lower compared to MDS, both in terms of lower median tolerated dose and for higher frequency of discontinuation for AEs. The biological mechanism of action of DSX in chronic myeloproliferative setting through an independent NF-?B inhibition could be involved, but further investigations are required. PMID:24959339

Elli, Elena Maria; Belotti, Angelo; Aroldi, Andrea; Parma, Matteo; Pioltelli, Pietro; Pogliani, Enrico Maria

2014-01-01

231

Empirical research on accounting choice  

Microsoft Academic Search

Abstract We review research from the 1990s that examines,the determinants,and consequences of accounting choice, structuring our analysis around the three types of market imperfections that influence managerschoices: agency costs, information asymmetries, and,externalities affecting non-contracting,parties.We conclude,that research in the 1990s made,limited progress,in expanding,our,understanding,of accounting,choice because,of limitations in research,design,and,a focus on,replication rather than extension of current knowledge.We discuss opportunities for future

Thomas D. Fields; Thomas Z. Lys; Linda Vincent

2001-01-01

232

Drinking Water Management: Health Risk Perceptions and Choices in First Nations and Non-First Nations Communities in Canada  

PubMed Central

The relationship between tap water and health has been a topic of public concern and calls for better management in Canada since well-publicized contamination events in two provinces (Ontario and Saskatchewan) in 2000–2001. This study reports the perspectives on health risks from tap water and corresponding use of, and spending on, bottled water in a number of different communities in Canada. In 2009–2010, four First Nations communities (three from Ontario and one from Saskatchewan) and a geographically diverse sample of non-First Nations Canadians were surveyed about their beliefs concerning health risks from tap water and their spending practices for bottled water as a substitute. Responses to five identical questions were examined, revealing that survey respondents from Ontario First Nations communities were more likely than non-First Nations Canadians to believe bottled water is safer than tap water (OR 1.6); more likely to report someone became ill from tap water (OR 3.6); more likely to express water and health concerns related to tap water consumption (OR 2.4); and more likely to spend more on bottled water (OR 4.9). On the other hand, participants from one Saskatchewan First Nations community were less likely than non-First Nations Canadians to believe that someone had become ill from drinking tap water (OR 3.8), less likely to believe bottled water is safer than tap (OR 2.0), and less likely to have health concerns with tap water (OR 1.5). These differences, however, did not translate into differences in the likelihood of high bottled water expenditures or being a 100% bottled water consumer. The paper discusses how the differences observed may be related to water supply and regulation, trust, perceived control, cultural background, location, and past experience. PMID:24886757

Dupont, Diane; Waldner, Cheryl; Bharadwaj, Lalita; Plummer, Ryan; Carter, Blair; Cave, Kate; Zagozewski, Rebecca

2014-01-01

233

Drinking water management: health risk perceptions and choices in First Nations and non-First Nations communities in Canada.  

PubMed

The relationship between tap water and health has been a topic of public concern and calls for better management in Canada since well-publicized contamination events in two provinces (Ontario and Saskatchewan) in 2000-2001. This study reports the perspectives on health risks from tap water and corresponding use of, and spending on, bottled water in a number of different communities in Canada. In 2009-2010, four First Nations communities (three from Ontario and one from Saskatchewan) and a geographically diverse sample of non-First Nations Canadians were surveyed about their beliefs concerning health risks from tap water and their spending practices for bottled water as a substitute. Responses to five identical questions were examined, revealing that survey respondents from Ontario First Nations communities were more likely than non-First Nations Canadians to believe bottled water is safer than tap water (OR 1.6); more likely to report someone became ill from tap water (OR 3.6); more likely to express water and health concerns related to tap water consumption (OR 2.4); and more likely to spend more on bottled water (OR 4.9). On the other hand, participants from one Saskatchewan First Nations community were less likely than non-First Nations Canadians to believe that someone had become ill from drinking tap water (OR 3.8), less likely to believe bottled water is safer than tap (OR 2.0), and less likely to have health concerns with tap water (OR 1.5). These differences, however, did not translate into differences in the likelihood of high bottled water expenditures or being a 100% bottled water consumer. The paper discusses how the differences observed may be related to water supply and regulation, trust, perceived control, cultural background, location, and past experience. PMID:24886757

Dupont, Diane; Waldner, Cheryl; Bharadwaj, Lalita; Plummer, Ryan; Carter, Blair; Cave, Kate; Zagozewski, Rebecca

2014-06-01

234

Opportunities and limitations of patient choice: the case of the Russian Federation.  

PubMed

While many countries have increased the opportunities for patient choice of provider, there is debate to what extent this has had positive effects on efficiency and quality of healthcare provision. First, some conditions should be met to exercise such choice, of which the most important is the provision of reliable data on providers' performance to both patients and physicians as their agents, as well as increasing primary health care (PHC) providers' involvement in realization of patient choice. Second, expanding patient choice does not always lead to efficient allocation of resources in a healthcare system. This article explores these controversial developments by using empirical evidence from the Russian Federation. It shows that choice indeed has value for patients, but there are many areas of inefficient choice, which leads to misallocation of healthcare recourses. Thus, health policy in this area should be designed to ensure a reasonable balance between objectives of expanding choice and promoting more efficient organization of healthcare provision. Political rhetoric about unlimited patient choice may be useless and even risky unless supported by well-balanced programmes of supporting and managing choice. PMID:23619777

Sheiman, Igor; Shishkin, Sergey; Markelova, Helen

2014-01-01

235

On Being in Charge: A Guide for Middle-Level Management in Primary Health Care.  

ERIC Educational Resources Information Center

Intended for middle-level health workers with managerial responsibilities, this guide aims to help improve their efficiency in the support and supervision of community health workers and in the organization and continuous support of primary health care programs. It is a sequel to "The Primary Health Worker," available separately--see note. The…

McMahon, Rosemary; And Others

236

The Primary School in Changing Times: The Australian Experience. Educational Management Series.  

ERIC Educational Resources Information Center

Following substantial changes throughout the Australian education system, primary schools are no longer in the protected position of having a regulated flow of clients, a predetermined curriculum, and marginal levels of staff development. This book reviews the impact of this change on Australian primary schools, the people who are involved with…

Townsend, Tony, Ed.

237

Dementia Diagnosis and Management in Primary CareDeveloping and testing educational models  

Microsoft Academic Search

Dementia presents a challenge for primary care and the advent of new therapeutic options has highlighted the need to improve its detection so that early decisions about medication use can be made. Efforts at earlier diagnosis should be targeted at primary care as the gateway to specialist health and social services. There is, however, evidence that dementia remains under-detected and

Steve Iliffe; Jane Wilcock; Tony Austin; Kate Walters; Greta Rait; Stephen Turner; Michelle Bryans; Murna Downs

2002-01-01

238

A Self-Study Guide for Managers and Staff of Primary Support Programs for Young People.  

ERIC Educational Resources Information Center

Identifying the voluntary activities, programs, and services that children and families use during students' out-of-school time as primary supports, this self-study guide provides a framework for developing primary support programs that allow school-aged children and adolescents to develop physical, cognitive, social, and emotional skills. The…

Costello, Joan; Barker, Gary; Pickens, Lisa Marie; Cassaniga, Neide; Merry, Sheila; Falcon, Adrienne

239

Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients  

ERIC Educational Resources Information Center

Context: Federally qualified health centers across the country are adopting depression disease management programs following federally mandated training; however, little is known about the relative effectiveness of depression disease management in rural versus urban patient populations. Purpose: To explore whether a depression disease management

Adams, Scott J.; Xu, Stanley; Dong, Fran; Fortney, John; Rost, Kathryn

2006-01-01

240

Depression care management for late-life depression in China primary care: Protocol for a randomized controlled trial  

Microsoft Academic Search

Background  As a major public health issue in China and worldwide, late-life depression is associated with physical limitations, greater\\u000a functional impairment, increased utilization and cost of health care, and suicide. Like other chronic diseases in elders such\\u000a as hypertension and diabetes, depression is a chronic disease that the new National Health Policy of China indicates should\\u000a be managed in primary care

Shulin Chen; Yeates Conwell; Baihua Xu; Helen Chiu; Xin Tu; Yan Ma

2011-01-01

241

Psychosocial Factors Associated with Successful Transition into HIV Case Management for those without Primary Care in an Urban Area  

Microsoft Academic Search

The purpose of this study was to identify the psychosocial factors which influence transitioning HIV positive clients without\\u000a primary medical care to a case management agency within 6 weeks by a city brokerage agency. People living with HIV who reported\\u000a being in a social support group and those who requested assistance with meeting their basic needs were significantly more\\u000a likely to

Derek Johnson; Marcia Polansky; Marlene Matosky; Michelle Teti

2010-01-01

242

How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol  

PubMed Central

Background Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues—such as IPV management—get integrated into health systems, and that focuses on healthcare teams’ learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. Methods This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Discussion Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in terms of how to trigger such learning and how team learning is connected with changes in organizational culture and values, and in service delivery. This realist evaluation protocol aims to contribute to this knowledge by conducting this project in a country, Spain, where great endeavours have been made towards the integration of IPV management within the health system. PMID:23522404

2013-01-01

243

Developing a toolkit for panel management: improving hypertension and smoking cessation outcomes in primary care at the VA  

PubMed Central

Background As primary care practices evolve into medical homes, there is an increasing need for effective models to shift from visit-based to population-based strategies for care. However, most medical teams lack tools and training to manage panels of patients. As part of a study comparing different approaches to panel management at the Manhattan and Brooklyn campuses of the VA New York Harbor Healthcare System, we created a toolkit of strategies that non-clinician panel management assistants (PMAs) can use to enhance panel-wide outcomes in smoking cessation and hypertension. Methods We created the toolkit using: 1) literature review and consultation with outside experts, 2) key informant interviews with staff identified using snowball sampling, 3) pilot testing for feasibility and acceptability, and 4) further revision based on a survey of primary care providers and nurses. These steps resulted in progressively refined strategies for the PMAs to support the primary care team. Results Literature review and expert consultation resulted in an extensive list of potentially useful strategies. Key informant interviews and staff surveys identified several areas of need for assistance, including help to manage the most challenging patients, providing care outside of the visit, connecting patients with existing resources, and providing additional patient education. The strategies identified were then grouped into 5 areas – continuous connection to care, education and connection to clinical resources, targeted behavior change counseling, adherence support, and patients with special needs. Conclusions Although panel management is a central aspect of patient-centered medical homes, providers and health care systems have little guidance or evidence as to how teams should accomplish this objective. We created a toolkit to help PMAs support the clinical care team for patients with hypertension or tobacco use. This toolkit development process could readily be adapted to other behaviors or conditions. Trial registration ClinicalTrials.gov, NCT01677533 PMID:24261337

2013-01-01

244

Optimizing pain management through collaborations with behavioral and addiction medicine in primary care.  

PubMed

Chronic noncancer pain (CNCP) affects many primary care patients, and carries a large human and economic burden. In response to the widespread perception that pain is underdiagnosed and undertreated, regulatory bodies have encouraged more comprehensive services to address pain syndromes. Significant hurdles exist in treating CNCP in primary care settings, and interventional therapies and pharmacotherapy often do not provide complete symptomatic relief. This article describes a multidimensional and interdisciplinary approach to the treatment of CNCP. The utility of collaborations with behavioral and addiction medicine specialists optimizes care and advances models of patient treatment within a primary care patient-centered medical home. PMID:23148959

Brensilver, Matthew; Tariq, Shabana; Shoptaw, Steven

2012-12-01

245

Parental Choice Options.  

ERIC Educational Resources Information Center

Reviews the many dramatically different forms of school choice proposals, warning against implementing sharply limited and regulated school choice plans and arguing that if the failure of school choice is wrongly attributed to too much choice rather than too little, broader and freer experiments in choice could be politically doomed. Focuses on…

Merrifield, John D.

2000-01-01

246

Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network  

PubMed Central

Background This study aimed to examine the prevalence, risk factors, detection rates and management of primary care depression in Hong Kong. Methods A cross-sectional survey containing the PHQ-9 instrument was conducted on waiting room patients of 59 primary care doctors. Doctors blinded to the PHQ-9 scores reported whether they thought their patients had depression and their management. Results 10,179 patients completed the survey (response rate 81%). The prevalence of PHQ-9 positive screening was 10.7% (95% CI: 9.7%-11.7%). Using multivariate analysis, risk factors for being PHQ-9 positive included: being female; aged ?34 years; being unmarried; unemployed, a student or a homemaker; having a monthly household income < HKD$30,000 (USD$3,800); being a current smoker; having no regular exercise; consulted a doctor or Chinese medical practitioner within the last month; having ? two co-morbidities; having a family history of mental illness; and having a past history of depression or other mental illness. Overall, 23.1% of patients who screened PHQ-9 positive received a diagnosis of depression by the doctor. Predictors for receiving a diagnosis of depression included: having higher PHQ-9 scores; a past history of depression or other mental health problem; being female; aged ?35 years; being retired or a homemaker; being non-Chinese; having no regular exercise; consulted a doctor within the last month; having a family history of mental health problems; and consulted a doctor in private practice. In patients diagnosed with depression, 43% were prescribed antidepressants, 11% were prescribed benzodiazepines, 42% were provided with counseling and 9% were referred, most commonly to a counselor. Conclusion About one in ten primary care patients screen positive for depression, of which doctors diagnose depression in approximately one in four. At greatest risk for depression are patients with a past history of depression, who are unemployed, or who have multiple illnesses. Patients most likely to receive a diagnosis of depression by a doctor are those with a past history of depression or who have severe symptoms of depression. Chinese patients are half as likely to be diagnosed with depression as non-Chinese patients. Over half of all patients diagnosed with depression are treated with medications. PMID:24521526

2014-01-01

247

A Review of Barriers and Enablers to Diagnosis and Management of Persons with Dementia in Primary Care  

PubMed Central

Background With the rise in the prevalence of dementia disorders and the growing critical impact of dementia on health-care resources, the provision of dementia care has increasingly come under scrutiny, with primary care physicians (PCP) being at the centre of such attention. Purpose To critically examine barriers and enablers to timely diagnosis and optimal management of community living persons with dementia (PWD) in primary care. Methods An interpretive scoping review was used to synthesize and analyze an extensive body of heterogeneous Western literature published over the past decade. Results The current primary care systems in many Western countries, including Canada, face many challenges in providing responsive, comprehensive, safe, and cost-effective dementia care. This paper has identified a multitude of highly inter-related obstacles to optimal primary dementia care, including challenges related to: a) the complex biomedical, psychosocial, and ethical nature of the condition; b) the gaps in knowledge, skills, attitudes, and resources of PWD/caregivers and their primary care providers; and c) the broader systemic and structural barriers negatively affecting the context of dementia care. Conclusions Further progress will require a coordinated campaign and significantly increased levels of commitment and effort, which should be ideally orchestrated by national dementia strategies focusing on the barriers and enablers identified in this paper. PMID:23259021

Aminzadeh, Faranak; Molnar, Frank J.; Dalziel, William B.; Ayotte, Debbie

2012-01-01

248

Managing the 'seamless service': Primary Care Groups in the new NHS.  

PubMed

This paper reports on empirical work examining the consequences for the development of the role of Primary Care Groups of the shift from competition (in the internal market) to relationships based on collaboration and partnership. Previous work (Conway and Willcocks, 1998; Willcocks and Conway, 1999) firstly developed a conceptual framework emphasizing the development of relationships between Primary Care Groups and their key stakeholders (for example, Health Authorities, Local Authorities and Trusts) and, secondly, sought to test this framework empirically through case study analysis of two Primary Care Groups in the north of England. This paper takes the research further and focuses on one of these Primary Care Groups, providing an in-depth analysis of particular issues such as the rationale for the particular configuration of this organization and the chosen working arrangements, the role and function of the Board and individual members, and the problems encountered in the first year of operation. PMID:12028799

Willcocks, S; Conway, A

2002-05-01

249

Primary databases for forest ecosystem management-examples from Ontario and possibilities for Canada: NatGRID.  

PubMed

This paper identifies some scientific impediments to ecosystem management and describes bio-physical databases required to help systematically and empirically address the ecological sustainability challenge. Examples are drawn from ongoing work in Ontario. This work has implications for efforts in ecological land classification, landscape ecology, more efficient locating of research and monitoring plots, wildlife management and ultimately trade-off analyses. We conclude with the recommendation that the key primary databases, as currently evolving for Ontario, could and should be developed nationally, thereby creating a "NatGRID database", i.e., Nationally Georeferenced Resource Information for Decision-making. NatGRID could be used to help address, in a more quantitative manner, fundamental questions regarding ecological sustainability and trade-offs in forest management. PMID:24198019

McKenney, D W; Mackey, B G; Sims, R A

1996-01-01

250

School Choice vs. School Choice. Policy Backgrounder.  

ERIC Educational Resources Information Center

This paper recommends replacing the existing U.S. school choice system, which relies on the housing market to ration educational opportunity, with one that creates a level playing field upon which schools compete for students, and students and their parents exercise choice. Section 1 describes the current school choice system, which works well for…

Goodman, John C.; Moore, Matt

251

Splenic trauma. Choice of management.  

PubMed Central

The modern era for splenic surgery for injury began in 1892 when Riegner reported a splenectomy in a 14-year-old construction worker who fell from a height and presented with abdominal pain, distension, tachycardia, and oliguria. This report set the stage for routine splenectomy, which was performed for all splenic injury in the next two generations. Despite early reports by Pearce and by Morris and Bullock that splenectomy in animals caused impaired defenses against infection, little challenge to routine splenectomy was made until King and Schumacker in 1952 reported a syndrome of "overwhelming postsplenectomy infection" (OPSI). Many studies have since demonstrated the importance of the spleen in preventing infections, particularly from the encapsulated organisms. Overwhelming postsplenectomy infection occurs in about 0.6% of children and 0.3% of adults. Intraoperative splenic salvage has become more popular and can be achieved safely in most patients by delivering the spleen with the pancreas to the incision, carefully repairing the spleen under direct vision, and using the many adjuncts to suture repair, including hemostatic agents and splenic wrapping. Intraoperative splenic salvage is not indicated in patients actively bleeding from other organs or in the presence of alcoholic cirrhosis. The role of splenic replantation in those patients requiring operative splenectomy needs further study but may provide significant long-term splenic function. Although nonoperative splenic salvage was first suggested more than 100 years ago by Billroth, this modality did not become popular in children until the 1960s or in adults until the latter 1980s. Patients with intrasplenic hematomas or with splenic fractures that do not extend to the hilum as judged by computed tomography usually can be observed successfully without operative intervention and without blood transfusion. Nonoperative splenic salvage is less likely with fractures that involve the splenic hilum and with the severely shattered spleen; these patients usually are treated best by early operative intervention. Following splenectomy for injury, polyvalent pneumococcal vaccine decreases the likelihood of OPSI and should be used routinely. The role of prophylactic penicillin is uncertain but the use of antibiotics for minor infectious problems is indicated after splenectomy. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. Fig. 8. Fig. 9. Fig. 10. Fig. 11. Fig. 12. PMID:1992948

Lucas, C E

1991-01-01

252

Factors Influencing Teaching Choice in Turkey  

ERIC Educational Resources Information Center

Why choose to become a teacher in Turkey? The authors examined motivations and perceptions among preservice teachers (N = 1577) encompassing early childhood, primary and secondary education. The Factors Influencing Teaching Choice (FIT-Choice) instrument was translated into Turkish and its construct validity and reliability assessed. Altruistic…

Kilinc, Ahmet; Watt, Helen M. G.; Richardson, Paul W.

2012-01-01

253

Management of the early and late presentations of rheumatoid arthritis: a survey of Ontario primary care physicians.  

PubMed Central

OBJECTIVE: To examine primary care physicians' management of rheumatoid arthritis, ascertain the determinants of management and compare management with that recommended by a current practice panel. DESIGN: Mail survey (self-administered questionnaire). SETTING: Ontario. PARTICIPANTS: A stratified computer-generated random sample of 798 members of the College of Family Physicians of Canada. OUTCOME MEASURES: Proportions of respondents who chose various items in the management of two hypothetical patients, one with early rheumatoid arthritis and one with late rheumatoid arthritis. Scores for investigations, interventions and referrals for each scenario were generated by summing the recommended items chosen by respondents and then dividing by the total number of items recommended in that category. The scores were examined for their association with physician and practice characteristics and physician attitudes. RESULTS: The response rate was 68.3% (529/775 eligible physicians). Recommended investigations were chosen by more than two thirds of the respondents for both scenarios. Referrals to physiotherapy, occupational therapy and rheumatology, all recommended by the panel, were chosen by 206 (38.9%), 72 (13.6%) and 309 (58.4%) physicians respectively for early rheumatoid arthritis. These proportions were significantly higher for late rheumatoid arthritis (p < 0.01). In multiple regression analysis, for early rheumatoid arthritis, internship or residency training in rheumatology was associated with higher investigation and intervention scores, for late rheumatoid arthritis, older physicians had higher intervention scores and female physicians had higher referral scores. CONCLUSIONS: Primary care physicians' investigation of rheumatoid arthritis was in accord with panel recommendations. However, rates of referral to rheumatologists and other health care professionals were very low, especially for the early presentation of rheumatoid arthritis. More exposure to rheumatology and to the role of physiotherapy, occupational therapy and social work during primary care training is strongly recommended. PMID:8823213

Glazier, R H; Dalby, D M; Badley, E M; Hawker, G A; Bell, M J; Buchbinder, R; Lineker, S C

1996-01-01

254

The Effects of a Classroom Management Teacher Training Primary Prevention Program on Fifth-Grade Students.  

ERIC Educational Resources Information Center

Effective Classroom Management II-Elementary (ECM), an in-service teacher training course, was evaluated. Grade 5 teachers were taught techniques in communication, classroom management, and self-esteem enhancement. The goals were to make classroom environments more responsive to students' affective and cognitive needs, thereby fostering positive…

Moskowitz, Joel M.; And Others

255

A new method of discovering primary management history: two examples where “little things mean a lot”  

Microsoft Academic Search

Outlines a new method of discovering original documents related to management history. Uses seemingly insignificant statements in books, articles or original documents to locate documents not listed on any computer database or public archive records, but which are undiscovered in attics or basements. The method involves the use of sources not commonly used by management scholars: obituaries, wills, cemetery records,

Charles D. Wrege; Ronald G. Greenwood; Regina Greenwood

1997-01-01

256

A recommendation for the management of lesions of unknown malignancy in multiple primary malignant neoplasm patients: A case report  

PubMed Central

In numerous patients with multiple primary malignant neoplasms, it is difficult to determine whether the mass is benign or malignant, and the method to treat these lesions is controversial. For patients with a history of cancer, a point of high-risk for the development of a second primary tumor occurs following a 10-year gap. To the best of our knowledge, to date, there has been no large clinical trial to observe the appropriate method to manage the lesions in patients with multiple primary malignant neoplasms. The present study reports the case of a patient who was initially diagnosed with rectal cancer, treated with Dixon’s rectectomy and post-operative chemotherapy. The patient’s disease was evaluated as complete response following these treatments. However, the patient then presented with bladder cancer and underwent transurethral resection of the bladder tumor, again achieving a complete response. The patient more recently presented with hepatocellular carcinoma, which developed from an unexplained mass in the liver. The patient underwent partial liver resection and to date, has achieved a complete response. The management of masses of unknown malignancy is also discussed. The current case provides useful insight for future research in this field. PMID:25364458

XIA, XIANGYU; CUI, KAIJUN

2014-01-01

257

The development of quality indicators for the prevention and management of postpartum haemorrhage in primary midwifery care in the Netherlands  

PubMed Central

Background At present, there are no guidelines on prevention and management of postpartum haemorrhage in primary midwifery care in the Netherlands. The first step towards implementing guidelines is the development of a set of quality indicators for prevention and management of postpartum haemorrhage for primary midwifery supervised (home) birth in the Netherlands. Methods A RAND modified Delphi procedure was applied. This method consists of five steps: (1) composing an expert panel (2) literature research and collection of possible quality indicators, (3) digital questionnaire, (4) consensus meeting and (5) critical evaluation. A multidisciplinary expert panel consisting of five midwives, seven obstetricians and an ambulance paramedic was assembled after applying pre-specified criteria concerning expertise in various domains relating to primary midwifery care, secondary obstetric care, emergency transportation, maternal morbidity or mortality audit, quality indicator development or clinical guidelines development and representatives of professional organisations. Results After literature review, 79 recommendations were selected for assessment by the expert panel. After a digital questionnaire to the expert panel seven indicators were added, resulting in 86 possible indicators. After excluding 41 indicators that panel members unanimously found invalid, 45 possible indicators were assessed at the consensus meeting. During critical evaluation 18 potential indicators were found to be overlapping and two were discarded due to lack of measurability. Conclusions A set of 25 quality indicators was considered valid for testing in practice. PMID:24139411

2013-01-01

258

Management of Tibial Bony Defect with Metal Block in Primary Total Knee Replacement Arthroplasty  

PubMed Central

Purpose To analyze minimum 2-year clinical and radiological follow-up results of primary total knee replacement arthroplasty (TKRA) with metal block augmentation for tibial bony defect. Materials and Methods We analyzed 67 cases (52 patients) of primary TKRA with metal block augmentation for tibial bony defects from March 1999 and March 2008. Clinical results were evaluated using the Knee Society clinical rating system and the Western Ontario and McMaster University (WOMAC) score. Radiologic results were evaluated using the Knee Society roentgenographic evaluation system. Results The mean knee score and function score improved from 42.0 and 45.6 preoperatively to 94.5 and 85.4 postoperatively. At last follow-up, the mean WOMAC score was 16.8. The incidence of radiolucent lines was 10% (7 cases) during the follow-up period, but there was no case of progression. There were no statistically significant differences between the groups divided according to the block size (below 5 mm and over 8 mm) and between the stem and no-stem groups for all parameters. Conclusions Primary TKRA with a metal block produced satisfactory results for the minimum 2-year follow-up and can be considered as a simple and effective method for the treatment of tibial bony defect in primary TKRA. PMID:23508525

Baek, Seung-Wook; Kim, Chul-Woong

2013-01-01

259

Management of understorey to reduce the primary inoculum of Botrytis cinerea: Enhancing ecosystem services in vineyards  

Microsoft Academic Search

Botrytis bunch rot, caused by Botrytis cinerea (Pers.: Fr) is an important disease of grapevines that causes worldwide crop losses and reductions in wine quality. The pathogen predominantly overwinters on vine debris on the vineyard floor. In the current work, organic mulches were used to enhance biological degradation of vine debris to reduce levels of B. cinerea primary inoculum the

M. A. Jacometti; S. D. Wratten; M. Walter

2007-01-01

260

Management of chronic pain among older patients: Inside primary care in the US  

Microsoft Academic Search

Under-treatment of pain is a worldwide problem. We examine how often pain was addressed and the factors that influence how much time was spent on treating pain.We analyzed 385 videotapes of routine office visits in several primary care practices in the Southwest and Midwest regions of the United States. We coded the visit contents and the time spent on pain

Ming Tai-Seale; Jane Bolin; Xiaoming Bao

2011-01-01

261

Investigating Students Misbehavior in Classroom Management in State and Private Primary Schools with a Comparative Approach  

ERIC Educational Resources Information Center

The research aims to showing the students misbehaviors in formal and private primary schools according to the perceptions of class teachers working in Kayseri in 2006-2007 academic year The data has been collected with the questionnaire developed by the researcher based on review survey and expert ideas. Questionnaire is applied to 245 teachers in…

Durmuscelebi, Mustafa

2010-01-01

262

Maintenance Matters: Maintenance and Minor Works in Primary Schools. A Manual for Boards of Management.  

ERIC Educational Resources Information Center

This manual provides guidance in the maintenance requirements of primary education schools in Ireland, covering: roofing; floors and walls; doors and windows; external and internal finishes; heating, plumbing, and drainage; electrical installations; paved and grassed surfaces; and furniture and loose equipment. The basic considerations are covered…

Department of Education and Science, Dublin (Ireland).

263

Can primary care groups learn how to manage demand from fundholders? A study of fundholders in Nottingham.  

PubMed Central

BACKGROUND: Primary care groups (PCGs) will commission care for their patients and may be increasingly required to manage clearly defined resources. Existing general practice fundholders already operate in this environment, but can PCGs learn from the experience of fundholders in managing demand? AIM: To explore how general practice fundholders manage demand for hospital and community health services, and for prescribing. METHOD: A general practitioner (GP), and a fundholding manager from each of 26 practices were invited to take part. Questionnaires were developed, with structured and semi-structured components, and piloted in three practices. Interviews were conducted between October 1996 and February 1997 by the same interviewer (MDT). RESULTS: All practices stated that they were monitoring their waiting lists and giving priority to patients whose problems had become worse, but eight of the 23 GPs felt that they were unable to manage demand. Eight of the 15 fundholders who had developed in-house services actively managed the waiting list for these clinics. All fundholders had identified areas of unmet demand. Widely differing methods for increasing supply to meet demand were identified, and are described. Formularies were used by 12 out of the 23 fundholders. Guidelines were only considered useful by eight of the 23 practices; fundholders from later waves were less likely to find guidelines useful than fundholders from earlier waves (odds ratio [OR] = 0.11; 95% confidence interval [CI] = 0 to 0.96). Private specialist surgery was less likely to be accessed by later wave fundholders using the fund than by early wave fundholders (OR = 0.10; 95% CI = 0.09 to 0.97). CONCLUSION: Fundholders in Nottingham had not developed consistent approaches to managing demand within limited resources. Given the apparent diversity of attitudes and practices, the larger PCGs will require strong support to develop the intended commissioning function. PMID:10736907

Tobin, M D; Packham, C J

1999-01-01

264

Diabetes Self-Management and Education of People Living with Diabetes: A Survey in Primary Health Care in Muscat Oman  

PubMed Central

Background Although the prevalence of type 2 diabetes in Oman is high and rising, information on how people were self-managing their disease has been lacking. The objective of this study was therefore to assess diabetes self-management and education (DSME) among people living with type 2 diabetes in Oman. Methods A questionnaire survey was conducted in public primary health care centres in Muscat. Diabetes self-management and education was assessed by asking how patients recognized and responded to hypo- and hyperglycaemia, and if they had developed strategies to maintain stable blood glucose levels. Patients' demographic information, self-treatment behaviours, awareness of potential long-term complications, and attitudes concerning diabetes management were also recorded. Associations between these factors and diabetes self-management and education were analysed. Results In total, 309 patients were surveyed. A quarter (26%, n?=?83) were unaware how to recognize hypoglycaemia or respond to it (26%, n?=?81). Around half (49%, n?=?151), could not recognize hyperglycaemia and more than half could not respond to it (60%, n?=?184). Twelve percent (n?=?37) of the patients did not have any strategies to stabilize their blood glucose levels. Patients with formal education generally had more diabetes self-management and education than those without (p<0.001), as had patients with longer durations of diabetes (p<0.01). Self-monitoring of blood glucose was practiced by 38% (n?=?117) of the patients, and insulin was used by 22% (n?=?67), of which about one third independently adjusted dosages. Patients were most often aware of complications concerning loss of vision, renal failure and cardiac problems. Many patients desired further health education. Conclusions Many patients displayed dangerous diabetes self-management and education knowledge gaps. The findings suggest a need for improving knowledge transfer to people living with diabetes in the Omani clinical setting. PMID:23451219

Al-Maniri, Abdullah A.; Al-Shafaee, Mohammed A.; Wahlstrom, Rolf

2013-01-01

265

System Factors Affect the Recognition and Management of Post-Traumatic Stress Disorder by Primary Care Clinicians  

PubMed Central

Background Post-traumatic stress disorder (PTSD) is common with an estimated prevalence of 8% in the general population and up to 17% in primary care patients. Yet, little is known about what determines primary care clinician’s (PCC) provision of PTSD care. Objective To describe PCC’s reported recognition and management of PTSD and identify how system factors affect the likelihood of performing clinical actions with regard to patients with PTSD or “PTSD treatment proclivity.” Design Linked cross-sectional surveys of medical directors and PCCs. Participants Forty-six medical directors and 154 PCCs in community health centers (CHCs) within a practice-based research network in New York and New Jersey. Measurements Two system factors (degree of integration between primary care and mental health services, and existence of linkages with other community, social, and legal services) as reported by medical directors, and PCC reports of self-confidence, perceived barriers, and PTSD treatment proclivity. Results Surveys from 47 (of 58) medical directors (81% response rate) and 154 PCCs (86% response rate). PCCs from CHCs with better mental health integration reported greater confidence, fewer barriers, and higher PTSD treatment proclivity (all p<.05). PCCs in CHCs with better community linkages reported greater confidence, fewer barriers, higher PTSD treatment proclivity, and lower proclivity to refer patients to mental health specialists or to use a “watch and wait” approach (all p<.05). Conclusion System factors play an important role in PCC PTSD management. Interventions are needed that restructure primary care practices by making mental health services more integrated and community linkages stronger. PMID:19433999

Meredith, Lisa S; Eisenman, David P; Green, Bonnie L; Basurto-Davila, Ricardo; Cassells, Andrea; Tobin, Jonathan

2009-01-01

266

Primary hyperoxaluria.  

PubMed

Primary hyperoxaluria (PH) occurs due to an autosomal recessive hereditary disorder of the metabolism of glyoxylate, which causes excessive oxalate production. The most frequent and serious disorder is due to enzyme deficit of alanine-glyoxylate aminotransferase (PH type I) specific to hepatic peroxisome. As oxalate is not metabolised in humans and is excreted through the kidneys, the kidney is the first organ affected, causing recurrent lithiasis, nephrocalcinosis and early renal failure. With advance of renal failure, particularly in patients on haemodialysis (HD), calcium oxalate is massively deposited in tissues, which is known as oxalosis. Diagnosis is based on family history, the presence of urolithiasis and/or nephrocalcinosis, hyperoxaluria, oxalate deposits in tissue forming granulomas, molecular analysis of DNA and enzyme analysis if applicable. High diagnostic suspicion is required; therefore, unfortunately, in many cases it is diagnosed after its recurrence following kidney transplantation. Conservative management of this disease (high liquid intake, pyridoxine and crystallisation inhibitors) needs to be adopted early in order to delay kidney damage. Treatment by dialysis is ineffective in treating excess oxalate. After the kidney transplant, we normally observe a rapid appearance of oxalate deposits in the graft and the results of this technique are discouraging, with very few exceptions. Pre-emptive liver transplantation, or simultaneous liver and kidney transplants when there is already irreversible damage to the kidney, is the treatment of choice to treat the underlying disease and suppress oxalate overproduction. Given its condition as a rare disease and its genetic and clinical heterogeneity, it is not possible to gain evidence through randomised clinical trials. As a result, the recommendations are established by groups of experts based on publications of renowned scientific rigour. In this regard, a group of European experts (OxalEurope) has drawn up recommendations for diagnosis and treatment, which were published in 2012. PMID:24798559

Lorenzo, Víctor; Torres, Armando; Salido, Eduardo

2014-05-21

267

Management of adult attention deficit hyperactivity disorder in UK primary care: a survey of general practitioners  

PubMed Central

Background Compared to existing literature on childhood attention deficit hyperactivity disorder (ADHD), little published adult data are available, particularly outside of the United States. Using General Practitioner (GP) questionnaires from the United Kingdom, this study aimed to examine a number of issues related to ADHD in adults, across three cohorts of patients, adults who received ADHD drug treatment in childhood/adolescence but stopped prior to adulthood; adults who received ADHD drug treatment in childhood/adolescence and continued treatment into adulthood and adults who started ADHD drug treatment in adulthood. Methods Patients with a diagnosis of ADHD and prescribed methylphenidate, dexamfetamine or atomoxetine were identified using data from The Health Improvement Network (THIN). Dates when these drugs started and stopped were used to classify patients into the three cohorts. From each cohort, 50 patients were randomly selected and questionnaires were sent via THIN to their GPs. GPs returned completed questionnaires to THIN who forwarded anonymised copies to the researchers. Datasets were analysed using descriptive statistics. Results Overall response rate was 89% (133/150). GPs stated that in 19 cases, the patient did not meet the criteria of that group; the number of valid questionnaires returned was 114 (76%). The following broad trends were observed: 1) GPs were not aware of the reason for treatment cessation in 43% of cases, 2) patient choice was the most common reason for discontinuation (56%), 3) 7% of patients who stopped pharmacological treatment subsequently reported experiencing ADHD symptoms, 4) 58% of patients who started pharmacological treatment for ADHD in adulthood received pharmacological treatment for other mental health conditions prior to the ADHD being diagnosed. Conclusion This study presents some key findings relating to ADHD; GPs were often not aware of the reason for patients stopping ADHD treatment in childhood or adolescence. Patient choice was identified as the most common reason for treatment cessation. For patients who started pharmacological treatment in adulthood, many patients received pharmacological treatment for comorbidities before a diagnosis of ADHD was made. PMID:23432851

2013-01-01

268

Excellence in Primary Care Physician (PCP) and Geriatrics Community-Based Practice: Meeting the Institute of Medicine’s Care Management Standards  

Microsoft Academic Search

The community-based internist and geriatric primary care physicians (PCPs) or medical doctors (MDs) have long been the most prevalent providers of primary care to populations who have chronic illness and\\/or are elderly in the United States. This article addresses the strategies for disease management (DM) that physicians in nonmature health care markets are utilizing to address unmet needs and suggestions

Maureen Dailey; Geraldine Lanman

2006-01-01

269

The Need for Quality Management in Primary Health Care in Cyprus: Results From a Medical Audit for Patients With Type 2 Diabetes Mellitus  

Microsoft Academic Search

Objectives: To assess the quality of clinical management regarding metabolic and blood pressure control in a cohort of patients with type 2 diabetes in the primary health care setting of Cyprus. Subjects and Methods: Medical care, received by 296 patients with type 2 diabetes from 4 primary care health centers in Cyprus, was assessed for 1 year. Data were collected

Theodora Zachariadou; Loukia Makri; Henri E. J. H. Stoffers; Anastasios Philalithis; Christos Lionis

270

Primary care management for optimized antithrombotic treatment [PICANT]: study protocol for a cluster-randomized controlled trial  

PubMed Central

Background Antithrombotic treatment is a continuous therapy that is often performed in general practice and requires careful safety management. The aim of this study is to investigate whether a best-practice model that applies major elements of case management and patient education, can improve antithrombotic management in primary healthcare in terms of reducing major thromboembolic and bleeding events. Methods This 24-month cluster-randomized trial will be performed with 690 adult patients from 46 practices. The trial intervention will be a complex intervention involving general practitioners, healthcare assistants, and patients with an indication for oral anticoagulation. To assess adherence to medication and symptoms in patients, as well as to detect complications early, healthcare assistants will be trained in case management and will use the Coagulation-Monitoring List (Co-MoL) to regularly monitor patients. Patients will receive information (leaflets and a video), treatment monitoring via the Co-MoL and be motivated to perform self-management. Patients in the control group will continue to receive treatment as usual from their general practitioners. The primary endpoint is the combined endpoint of all thromboembolic events requiring hospitalization and all major bleeding complications. Secondary endpoints are mortality, hospitalization, strokes, major bleeding and thromboembolic complications, severe treatment interactions, the number of adverse events, quality of anticoagulation, health-related quality of life, and costs. Further secondary objectives will be investigated to explain the mechanism by which the intervention is effective: patients’ assessment of chronic illness care, self-reported adherence to medication, general practitioners’ and healthcare assistants’ knowledge, and patients’ knowledge and satisfaction with shared decision making. Practice recruitment is expected to take place between July and December 2012. Recruitment of eligible patients will start in July 2012. Assessment will occur at three time points: baseline and follow-up after 12 months and after 24 months. Discussion The efficacy and effectiveness of individual elements of the intervention, such as antithrombotic interventions, self-management concepts in orally anticoagulated patients, and the methodological tool of case management, have already been extensively demonstrated. This project foresees the combination of several proven instruments, as a result of which we expect to profit from a reduction in the major complications associated with antithrombotic treatment. Trial registration Current Controlled Trials ISRCTN41847489 PMID:22929015

2012-01-01

271

The Changing Face of Chronic Illness Management in Primary Care: A Qualitative Study of Underlying Influences and Unintended Outcomes  

PubMed Central

PURPOSE Recently, there has been dramatic increase in the diagnosis and pharmaceutical management of common chronic illnesses. Using qualitative data collected in primary care clinics, we assessed how these trends play out in clinical care. METHODS This qualitative study focused on management of type 2 diabetes and hypertension in 44 primary care clinics in Michigan and was based on interviews with 58 clinicians and 70 of their patients, and observations of 107 clinical consultations. We assessed clinicians’ treatment strategies and discussions of factors influencing treatment decisions, and patients’ understandings and experiences in managing these illnesses. RESULTS Clinicians focused on helping patients achieve test results recommended by national guidelines, and most reported combining 2 or more medications per condition to reach targets. Medication selection and management was the central focus of the consultations we observed. Polypharmacy was common among patients, with more than one-half taking 5 or more medications. Patient interviews indicated that heavy reliance on pharmaceuticals presents challenges to patient well-being, including financial costs and experiences of adverse health effects. CONCLUSIONS Factors promoting heavy use of pharmaceuticals include lower diagnostic and treatment thresholds, clinician-auditing and reward systems, and the prescribing cascade, whereby more medications are prescribed to control the effects of already-prescribed medications. We present a conceptual model, the inverse benefit law, to provide insight into the impact of pharmaceutical marketing efforts on the observed trends. We make recommendations about limiting the influence of the pharmaceutical industry on clinical practice, toward improving the well-being of patients with chronic illness. PMID:22966109

Hunt, Linda M.; Kreiner, Meta; Brody, Howard

2012-01-01

272

A Primary Care Approach to the Diagnosis and Management of Peripheral Arterial Disease  

NASA Technical Reports Server (NTRS)

The objectives of this work are: (1) Be able to recognize characteristic symptoms of intermittent claudication (2) Diagnose PAD on the basis of history, physical exam, and simple limb blood pressure measurements (3) Recognize the significance of peripheral artery disease as a marker for coronary or cerebrovascular atherosclerosis (4) Provide appropriate medical management of atherosclerosis risk factors-- including use of antiplatelet therapy to reduce risk of myocardial infarction, stroke and death (5) Manage symptoms of intermittent claudication with program of smoking cessation, exercise, and medication The diagnosis of intermittent claudication secondary to peripheral artery disease (PAD) can often be made on the basis of history and physical examination. Additional evaluation of PAD is multi-modal and the techniques used will vary depending on the nature and severity of the patient's presenting problem. Most patients can be appropriately managed without referral for specialized diagnostic services or interventions.

Dawson, David L.

2000-01-01

273

Integration of Systemic Chemotherapy in the Management of Primary Breast Cancer  

Microsoft Academic Search

Breast cancer cells can metastasize early in the devel- opment of primary tumors. Adjuvant chemotherapy improves disease-free survival and overall survival (OS) in patients with early-stage breast cancer, both in pre- menopausal and postmenopausal women. Tamoxifen improves OS in patients whose tumors are estrogen-recep- tor-positive, regardless of age. Although the relative risk reduction with these interventions is the same for

FRANCISCO J. ESTEVA; G ABRIEL N. HORTOBAGYI

274

Alternative approach to management of early loss of second primary molar: a clinical case report.  

PubMed

Preservation of space after premature loss of the second primary molar is essential to prevent mesial drifting of the permanent first molar. Various modifications of distal shoe space maintainers, which have been documented, are all nonfunctional in nature. This paper describes an innovative design of a functional distal shoe space maintainer that is intended to overcome the disadvantages of conventional non-functional space maintainers and that does not hamper the periodontal status of the abutment tooth. PMID:25087351

Agarwal, Ravi; Chaudhry, Kalpna; Yeluri, Ramakrishna; Singh, Chanchal; Munshi, Autar K

2014-05-01

275

Primary Extradural Tumors of the Spine - Case Review with Evidence-guided Management  

PubMed Central

Background: Primary extradural tumors of the spine comprise only a small percentage of all spinal tumors. However, given their relative radioresistance and their typical malignant, invasive nature, surgery may be associated with fairly high morbidity and mortality rates. Furthermore, it may be especially difficult to achieve gross total resections with tumor-free margins. Case Descriptions: We present two cases and review the literature regarding the presentation, diagnosis, and evidence-based guidance/treatment of primary extradural spinal tumors. The first patient with an L1 chordoma presented with cauda equina syndrome. Following surgery, the second patient, with a giant cell tumor of the cervicothoracic junction, responded well to the novel drug denosumab, a monoclonal antibody to the RANK ligand. Conclusion: Primary extradural spine tumors pose significant challenges to surgeons as the aim is to achieve satisfactory surgical outcomes with clean tumor margins (e.g, thus avoid recurrence) while minimizing morbidity. Improvements in radiotherapy, chemotherapy, and novel molecular drugs may increase survival rates and improve overall outcomes.

Lam, Fred C.; Arle, Jeffrey E.; Glazer, Paul A.; Kasper, Ekkehard M.

2014-01-01

276

Management of lymph node metastases from an unknown primary site to the head and neck (Review)  

PubMed Central

Cancer of unknown primary site (CUP) is an intriguing clinical phenomenon found in ~3–9% of all head and neck cancers. It has not yet been determined whether CUP forms a distinct biological entity with specific genetic and phenotypic characteristics, or whether it is the clinical presentation of metastasis in patients with an undetected primary tumor and no visible clinical signs. The treatment of patients with cervical lymph node metastases from CUP remains controversial, due to the lack of randomized clinical trials comparing different treatment options. Consequently, treatment is currently based on non-randomized data and institutional policy. In the present review, the range and limitations of diagnostic procedures are summarized and an optimal diagnostic work-up is recommended. The initial preferred diagnostic procedures include fine-needle aspiration biopsy (FNAB) and imaging. Although neck dissection followed by postoperative radiotherapy is the the most generally accepted approach, other curative options may be used in certain patients, such as neck dissection alone, nodal excision followed by postoperative radiotherapy, or radiotherapy alone. There remains controversy regarding target radiation volumes, ranging from ipsilateral neck irradiation to prophylactic irradiation of all the potential mucosal sites and both sides of the neck. When no primary lesion is identified with imaging and endoscopy in patients without history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus and/or Epstein-Barr virus is required.

ZHUANG, SHI MIN; WU, XI-FU; LI, JING-JIA; ZHANG, GE-HUA

2014-01-01

277

National survey addressing the information needs of primary care physicians: Side effect management of patients on androgen deprivation therapy  

PubMed Central

Objective: Androgen deprivation therapy (ADT) is a common treatment for prostate cancer with numerous side effects. We assess primary care physicians’ (PCPs) knowledge of ADT side effects and their interest in increasing their knowledge in this area. Methods: A list of active Canadian PCPs was obtained using the Canadian Medical Directory. A cross-sectional survey was distributed to 600 randomly selected physicians. We collected PCPs’ demographic information, experience with ADT management, knowledge regarding ADT side effects and desired sources for obtaining knowledge on ADT management. Results: In total, we received 103 completed questionnaires. Of these, 89% of PCPs had patients on ADT. One-third of respondents prescribed ADT and over half of them administered ADT annually. Thirty-eight percent felt their knowledge of ADT side effects was inadequate and 50% felt uncomfortable counselling patients on ADT. Many PCPs were less familiar with the incidence of functional side effects of ADT (i.e., hot flashes, fatigue and erectile dysfunction) compared to life-threatening side effects (i.e., cardiovascular events, metabolic syndrome, fractures). In terms of increasing their knowledge of ADT side effects, 82% of PCPs would use educational resources if they were available (52% and 32% preferred continued medical education [CME] events and educational pamphlets, respectively). Conclusions: PCPs play an important role in managing ADT side effects. There is poor awareness of the prevalence of ADT side effects, and many are uncomfortable in managing these side effects. These areas may be addressed through CME programs and educational pamphlets. PMID:24839488

Soeyonggo, Tony; Locke, Jennifer; Giudice, Maria Elizabeth Del; Alibhai, Shabbir; Fleshner, Neil Eric; Warde, Padraig

2014-01-01

278

Dietary Management in Gastrointestinal Diseases. Nutrition in Primary Care Series, Number 13.  

ERIC Educational Resources Information Center

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Stein, Joan Z.; Gallagher-Allred, Charlette R.

279

On Being in Charge: A Guide to Management in Primary Health Care. Second Edition.  

ERIC Educational Resources Information Center

This revised training guide is designed to help health workers, including nurses, midwives, and medical assistants, improve managerial skills. The book is divided into four main parts, each dealing with a different aspect of management. An opening exercise helps readers diagnose managerial weaknesses and turn to appropriate chapters for study.…

McMahon, Rosemary; And Others

280

Primary and Secondary Contamination Mechanisms in ASR Modeling and Design of Practical Management  

EPA Science Inventory

Aquifer storage and recovery (ASR) is a useful water resource management option for water storage and reuse. Its increased use is recognized in adaptation to the ever increasing problem of water availability, both in timing and flow. Challenges in the ASR process may arise from...

281

Primary and Secondary Contamination Mechanisms for Consideration in ASR Modeling and Practical Management  

EPA Science Inventory

Aquifer storage and recovery (ASR) is a useful water resource management option for water storage and reuse. Its increased use is recognized in adaptation to the ever increasing problem of water availability, both in timing and flow. Challenges in the ASR process may arise from...

282

Identification, Evaluation, and Management of Obesity in an Academic Primary Care Center  

Microsoft Academic Search

Background. The rapidly increasing prevalence of obesity among children is one of the most challenging dilemmas facing pediatricians today. While the medical community struggles to develop effective strategies for the treatment of this epidemic, timely iden- tification of obesity by pediatric health care providers remains the crucial initial step in the management of obesity. Objective. Direct assessment of pediatric clinicians'

Sarah Harvey O'Brien; Richard Holubkov; Evelyn Cohen Reis

2010-01-01

283

Dietary Management in Hyperlipidemia. Nutrition in Primary Care Series, Number 12.  

ERIC Educational Resources Information Center

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Gallagher-Allred, Charlette R.; Townley, Nancy A.

284

Dietary Management for Alcoholic Patients. Nutrition in Primary Care Series, Number 14.  

ERIC Educational Resources Information Center

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Hurley, Roberta Smith; Gallagher-Allred, Charlette R.

285

Computer-based Decision Support in the Management of Primary Gastric non-Hodgkin  

E-print Network

-Hodgkin lymphoma (NHL) of the stomach is a relatively rare malignant disorder, accounting for about 5% of gastric tumours. Until recently, the aetiology of gastric NHL was unknown; it is now generally believed researchers have recognised the need for decision support in the clinical manage- ment of patients with NHL [7

Lucas, Peter

286

Dietary Management in Hypertension. Nutrition in Primary Care Series, Number 11.  

ERIC Educational Resources Information Center

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Molleson, Ann L.; Gallagher-Allred, Charlette R.

287

Evaluation of computerized health management information system for primary health care in rural India  

Microsoft Academic Search

BACKGROUND: The Comprehensive Rural Health Services Project Ballabgarh, run by All India Institute of Medical Sciences (AIIMS), New Delhi has a computerized Health Management Information System (HMIS) since 1988. The HMIS at Ballabgarh has undergone evolution and is currently in its third version which uses generic and open source software. This study was conducted to evaluate the effectiveness of a

Anand Krishnan; Baridalyne Nongkynrih; Kapil Yadav; Satyavir Singh; Vivek Gupta

2010-01-01

288

Dietary Management in Diabetes Mellitus. Nutrition in Primary Care Series, Number 10.  

ERIC Educational Resources Information Center

Nutrition is well-recognized as a necessary component of educational programs for physicians. This is to be valued in that of all factors affecting health in the United States, none is more important than nutrition. This can be argued from various perspectives, including health promotion, disease prevention, and therapeutic management. In all…

Bossetti, Brenda; Gallagher-Allred, Charlette R.

289

Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage.  

PubMed

Numerous forecasts have predicted shortages of primary care providers, particularly in light of an expected increase in patient demand resulting from the Affordable Care Act. Yet these forecasts could be inaccurate because they generally do not allow for changes in the way primary care is delivered. We analyzed the impact of two emerging models of care--the patient-centered medical home and the nurse-managed health center--both of which use a provider mix that is richer in nurse practitioners and physician assistants than today's predominant models of care delivery. We found that projected physician shortages were substantially reduced in plausible scenarios that envisioned greater reliance on these new models, even without increases in the supply of physicians. Some less plausible scenarios even eliminated the shortage. All of these scenarios, however, may require additional changes, such as liberalized scope-of-practice laws; a larger supply of medical assistants, licensed practical nurses, and aides; and payment changes that reward providers for population health management. PMID:24191083

Auerbach, David I; Chen, Peggy G; Friedberg, Mark W; Reid, Rachel; Lau, Christopher; Buerhaus, Peter I; Mehrotra, Ateev

2013-11-01

290

Extracranial aneurysms of the distal posterior inferior cerebellar artery: Resection and primary reanastomosis as the preferred management approach  

PubMed Central

Background: Extracranial aneurysms of the posterior inferior cerebellar artery (PICA) are rare, with only 22 reported cases in the English literature. For saccular extracranial distal PICA aneurysms not amenable to coiling, a surgically placed clip is not protected by the cranium postoperatively, and can be subject to movement in the mobile cervical region. Furthermore, fusiform or complex aneurysms cannot be clipped primarily. Resection and primary reanastomosis is a useful surgical approach not previously described for these extracranial lesions. Case Description: We report three cases of extracranially located distal PICA aneurysms successfully treated with this surgical strategy at our center. One patient harboring a broad necked saccular aneurysm originally underwent successful primary clipping of the aneurysm but sustained a second subarachnoid hemorrhage (SAH) on postoperative day 25 due to clip dislodgement from vigorous neck movement. The other two patients were found to have fusiform and complex aneurysms, respectively. All three patients were ultimately treated with resection and end-to-end PICA anastomosis, which successfully obliterated their aneurysms. Conclusions: Resection and primary reanastomosis of extracranial distal PICA aneurysms averts the risk of clip dislodgement due to neck movement and/or compression by soft tissues in the upper cervical region. It is a safe and efficacious technique, which we propose as the preferred management strategy for these rare vascular lesions. PMID:24381793

Chwajol, Markus; Hage, Ziad A.; Amin-Hanjani, Sepideh; Charbel, Fady T.

2013-01-01

291

Obesity and asthma: Pathophysiology and implications for diagnosis and management in primary care.  

PubMed

The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly recognized; however, the underlying pathophysiology of this association is poorly understood. Mainstream clinical practice has yet to adopt aggressive management of obesity as a modifiable risk factor in asthma care, as is the case with a risk factor like tobacco or allergen exposure. This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. Our review suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly using patient-centered approaches such as shared decision making. There is a need for research to better understand the mechanisms of asthma in the obese patient and to develop new therapies specifically targeted to this unique patient population. PMID:24719380

Mohanan, Sveta; Tapp, Hazel; McWilliams, Andrew; Dulin, Michael

2014-11-01

292

Obesity and asthma: Pathophysiology and implications for diagnosis and management in primary care  

PubMed Central

The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly recognized; however, the underlying pathophysiology of this association is poorly understood. Mainstream clinical practice has yet to adopt aggressive management of obesity as a modifiable risk factor in asthma care, as is the case with a risk factor like tobacco or allergen exposure. This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. Our review suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly using patient-centered approaches such as shared decision making. There is a need for research to better understand the mechanisms of asthma in the obese patient and to develop new therapies specifically targeted to this unique patient population. PMID:24719380

Mohanan, Sveta; McWilliams, Andrew; Dulin, Michael

2014-01-01

293

Implementation of a care management model for depression at two primary care clinics.  

PubMed

The Mayo clinic participated in the Depression Improvement Across Minnesota, Offering a New Direction model at two Mayo Family Clinics, that is, the Rochester Northwest and Northeast sites. Although the Northwest and Northeast clinics demonstrated the best 6-month remission rates in the state during the first year of implementation, they were retrospectively found to differ on several process issues and on measures related to the populations served. Six-month remission rates were significantly better at Northwest clinic; yet, Northeast clinic had more patient contacts. Differences in rates of activation into care management, care management accessibility, and differences in maintaining contact with patients at 6 months may explain some of these results. PMID:21415614

Williams, Mark; Angstman, Kurt; Johnson, Isaac; Katzelnick, David

2011-01-01

294

Self-management support in primary care: enactments, disruptions, and conversational consequences.  

PubMed

A common refrain in chronic disease management is that patients and clinicians need to enact new roles: patients as their own caregivers; clinicians as professional supporters of patient self-management activities. These roles are central to self-management support (SMS), an approach that emphasizes a clinical partnership, and promotes patient identification and achievement of realistic and short-term behavioral goals. With SMS, behavior change is the desired end, not the means to a desired biomedical end. Shifting SMS concepts into clinical practice has proven to be difficult and inconsistent, creating potential, unknown risks or harms to patients. We completed a discourse analysis of 16 clinical dialogues between diabetic patients and clinicians, collected during a study of six Ontario Family Health Teams, to explore the questions of risks and harms relating to SMS implementation. We observed varying degrees of incomplete implementation of SMS, as well as interactions that actively negated the core principles. Contrary to SMS principles, clinicians tended to emphasize behavioral changes as means to achieve biomedical ends, though to varying degrees. We present two appointments in detail, highlighting how linking behavior change closely with biomedical measures often elicited face-saving defenses from patients. The subsequent dialogue shifted attention away from problem solving and behavior change into active negotiation of responsibility and identity. Interactions that oriented more to SMS concepts elicited fewer defensive maneuvers from patients. Our analysis helps explicate one additional mechanism by which self-management talk threatens the clinical relationship, and highlights a promising method to mitigate this threat. PMID:24632054

Thille, Patricia; Ward, Natalie; Russell, Grant

2014-05-01

295

Bronchial Artery and Systemic Artery Embolization in the Management of Primary Lung Cancer Patients with Hemoptysis  

SciTech Connect

Purpose. To assess the safety and effectiveness of arterial embolization in lung cancer patients with hemoptysis. Methods. Nineteen primary lung cancer patients with hemoptysis underwent bronchial artery and systemic artery embolization from April 2002 to March 2005. There were 17 men and 2 women, with a mean age of 59 years. Histologic analysis revealed squamous cell carcinoma in 10 patients and poorly differentiated adenocarcinoma in 9 patients. The amount of hemoptysis was bleeding of 25-50 ml within 24 hr in 8 patients, recurrent blood-tinged sputum in 6, and bleeding of 100 ml or more per 24 hr in 5. Embolization was done with a superselective technique using a microcatheter and polyvinyl alcohol particles to occlude the affected vessels. Results. Arterial embolization was technically successful in all patients and clinically successful in 15 patients (79%). The average number of arteries embolized was 1.2. Bronchial arteriography revealed staining (all patients), dilatation of the artery or hypervascularity (10 patients), and bronchopulmonary shunt (6 patients). The recurrence rate was 33% (5/15) and 11 patients were alive with a mean follow-up time of 148 days (30-349 days). Conclusion. Arterial embolotherapy for hemoptysis in patients with primary lung cancer is an effective, safe therapeutic modality despite the fact the vascular changes are subtle on angiography.

Park, Hong Suk, E-mail: hpark@ncc.re.kr; Kim, Young Il; Kim, Hyae Young; Zo, Jae-Ill; Lee, Joo Hyuk; Lee, Jin Soo [Research Institute and Hospital, National Cancer Center Korea (Korea, Republic of)

2007-07-15

296

Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model  

PubMed Central

Background The purpose of this study was to examine factors associated with the implementation of case management (CM) interventions in primary health care (PHC) and to develop strategies to enhance its adoption by PHC practices. Methods This study was designed as a systematic mixed studies review (including quantitative and qualitative studies) with synthesis based on the diffusion of innovation model. A literature search was performed using MEDLINE, PsycInfo, EMBASE, and the Cochrane Database (1995 to August 2012) to identify quantitative (randomized controlled and nonrandomized) and qualitative studies describing the conditions limiting and facilitating successful CM implementation in PHC. The methodological quality of each included study was assessed using the validated Mixed Methods Appraisal Tool. Results Twenty-three studies (eleven quantitative and 12 qualitative) were included. The characteristics of CM that negatively influence implementation are low CM intensity (eg, infrequent follow-up), large caseload (more than 60 patients per full-time case manager), and approach, ie, reactive rather than proactive. Case managers need specific skills to perform their role (eg, good communication skills) and their responsibilities in PHC need to be clearly delineated. Conclusion Our systematic review supports a better understanding of factors that can explain inconsistent evidence with regard to the outcomes of dementia CM in PHC. Lastly, strategies are proposed to enhance implementation of dementia CM in PHC. PMID:24959072

Khanassov, Vladimir; Vedel, Isabelle; Pluye, Pierre

2014-01-01

297

Efficacy of a systematic depression management program in high utilizers of primary care: a randomized trial  

PubMed Central

Background Approximately 25% of so-called high utilizers of medical care are estimated to suffer from depression. A large proportion of these individuals remain undiagnosed and untreated. This study aims to examine the effects of a systematic screening and collaborative treatment program on depression severity in small primary care practices of the German outpatient health care system. Method High utilizers of primary care who screened positive for depressive symptoms on the Brief Psychiatric Health Questionnaire (B-PHQ) were further diagnosed using the DIA-X, a standardized diagnostic interview, performed by trained and supervised interviewers. Patients with major depression were randomized (cluster randomization by practice) to (a) a six-month treatment program of pharmacotherapy, standardized patient and provider education, and physician and patient counseling or (b) six months of usual medical care. All subjects were followed for a 12-month observation period using the 17-item Hamilton Depression Rating scale (HAMD-17) rated by the treating physicians and the B-PHQ-9 rated by the patients. Results A total of 63 high utilizer patients were included in the trial (17 male, 46 female), 19 randomized to intervention, 44 to usual care. The mean age was 49.7 (SD 13.8). Most patients had one or more somatic co-morbidities. There was no significant difference in response (defined as a decrease in the HAMD-17 sum score of at least 50%) after six months of treatment (50% vs. 42%, p = 0.961, all analyses adjusted for age) and after 12 months of treatment (83% vs. 54%, p = 0.282) between groups. Using patient self-rating assessments with the B-PHQ-9 questionnaire the intervention was superior to treatment as usual at six months (83% vs. 16%, p = 0.000). There was no significant difference in HAMD-17 depression severity at six months between the groups (10.5 (SD 7.6) vs. 12.3 (SD 7.8), p = 0.718), but a trend at 12 months (4.7 (SD 8.0) vs. 11.2 (SD 7.4), p = 0.083). Again, using B-PHQ-9 sum scores depression severity was significantly lower in the intervention group than in the treatment as usual group after six months (6.4 (SD 5.2) vs. 11.5 (SD 5.8), p = 0.020), but not at 12 months (7.9 (SD 8.7) vs. 9.0 (SD 5.2), p = 0.858). Conclusion A systematic collaborating treatment program for depression in high utilizers in primary care showed superiority to treatment as usual only in terms of patients´ self-assessment but not according to physicians´ assessment. The advance of the intervention group at 6 months was lost after 12 months of follow-up. Overall, positive results from similar trials in the US health care systems could not be confirmed in a German primary care setting. PMID:22943609

2012-01-01

298

Prevalence and Burden of Breathlessness in Patients with Chronic Obstructive Pulmonary Disease Managed in Primary Care  

PubMed Central

Background & Aims Breathlessness is a primary clinical feature of chronic obstructive pulmonary disease (COPD). We aimed to describe the frequency of and factors associated with breathlessness in a cohort of COPD patients identified from the Clinical Practice Research Datalink (CPRD), a general practice electronic medical records database. Methods Patients with a record of COPD diagnosis after January 1 2008 were identified in the CPRD. Breathlessness was assessed using the Medical Research Council (MRC) dyspnoea scale, with scoring ranging from 1–5, which has been routinely administered as a part of the regular assessment of patients with COPD in the general practice since April 2009. Stepwise multivariate logistic regression estimated independent associations with dyspnoea. Negative binomial regression evaluated a relationship between breathlessness and exacerbation rate during follow-up. Results The total cohort comprised 49,438 patients diagnosed with COPD; 40,425 (82%) had any MRC dyspnoea grade recorded. Of those, 22,770 (46%) had moderate-to-severe dyspnoea (MRC?3). Breathlessness increased with increasing airflow limitation; however, moderate-to-severe dyspnoea was also observed in 32% of patients with mild airflow obstruction. Other factors associated with increased dyspnoea grade included female gender, older age (?70 years), obesity (BMI ?30), history of moderate-to-severe COPD exacerbations, and frequent visits to the general practitioner. Patients with worse breathlessness were at higher risk of COPD exacerbations during follow-up. Conclusions Moderate-to-severe dyspnoea was reported by >40% of patients diagnosed with COPD in primary care. Presence of dyspnoea, including even a perception of mild dyspnoea (MRC?=?2), was associated with increased disease severity and a higher risk of COPD exacerbations during follow-up. PMID:24427316

Mullerova, Hana; Lu, Chao; Li, Hao; Tabberer, Maggie

2014-01-01

299

Transileocolic venous balloon dilatation for the management of primary and recurrent portal venous stenosis after living donor liver transplantation in children  

Microsoft Academic Search

Portal venous stenosis is relatively a rare complication after liver transplantation in children and it sometimes leads to\\u000a life threatening event due to gastrointestinal bleeding or graft failure. Recently, balloon dilatation has been widely accepted\\u000a as a treatment of choice for the management of portal venous stenosis. The purpose of this study was to evaluate the feasibility\\u000a of transileocolic venous

Ryo Hotta; Ken Hoshino; Seishi Nakatsuka; Shioko Nakao; Jun Okamura; Yohei Yamada; Koji Komori; Yasushi Fuchimoto; Hideaki Obara; Shigeyuki Kawachi; Minoru Tanabe; Yasuhide Morikawa; Subaru Hashimoto; Masaki Kitajima

2007-01-01

300

Trauma bleeding management: the concept of goal-directed primary care.  

PubMed

The early and aggressive high-volume administration of fresh frozen plasma, platelet concentrates, and red blood cells (RBCs), using ratio-driven massive transfusion protocols, has been adopted by many for the treatment of trauma-induced coagulopathy and hemorrhagic shock. However, the optimal ratio of RBC: fresh frozen plasma and RBC:platelet concentrate is still under investigation. In some European trauma centers, hemostatic agents such as fibrinogen concentrate, prothrombin complex concentrates, and antifibrinolytics are integral parts of goal-directed massive transfusion protocols. Both a ratio-driven coagulation therapy and a point-of-care-guided coagulation management based on coagulation factor concentrates aim for the same target-the rapid prevention and treatment of shock and coagulopathy to prevent death from traumatic hemorrhage. In this review, we compare the evidence relating to the effectiveness and safety of the ratio-driven and goal-directed approaches to trauma-induced coagulopathy to draw attention to the potential benefits and drawbacks associated with these management strategies. PMID:23757468

Schöchl, Herbert; Schlimp, Christoph J

2014-11-01

301

Management of normal tissue toxicity associated with chemoradiation (primary skin, esophagus, and lung).  

PubMed

Nearly one quarter of patients with lung cancer present with locally advanced disease where concurrent chemoradiotherapy is the current standard of care for patients with good performance status. Cisplatin-based concurrent chemoradiotherapy consistently showed an improvement in survival compared with sequential chemoradiotherapy, at the expense of an increase in the toxicity profile. Over the past decades, several encouraging biomarkers such as transforming growth factor-beta and radioprotective agents such as amifostine were studied but without reaching approval for patient care. We reviewed the prevalence and risk factors for different adverse effects associated with the combined chemoradiotherapy modality, especially dermatitis, mucositis, esophagitis, and pneumonitis. These adverse effects can further be divided into acute, subacute, and chronic. Dermatitis is usually rare and responds well to topical steroids and usual skin care. Acute esophagitis occurs in 30% of patients and is treated with proton pump inhibitors, promotility agents, local anesthetic, and dietary changes. Radiation pneumonitis is a subacute complication seen in 15% of patients and is usually managed with steroids. Chronic adverse effects such as radiation fibrosis and esophageal stricture occur approximately 6 months after completion of radiation therapy and are usually permanent. In this review, complications of chemoradiotherapy for patients with locally advanced lung cancer are delineated, and approaches to their management are described. Given that treatment interruption is associated with a worse outcome, patients are aggressively treated with a curative intent. Therefore, planning for treatment adverse effects improves patient tolerance, compliance, and outcome. PMID:23708070

Yazbeck, Victor Y; Villaruz, Liza; Haley, Marsha; Socinski, Mark A

2013-01-01

302

Your Genes, Your Choices  

MedlinePLUS

Your Genes, Your Choices describes the Human Genome Project, the science behind it, and the ethical, legal, and social ... Nothing could be further from the truth. Your Genes, Your Choices points out how the progress of ...

303

Pediatricians’ and health visitors’ views towards detection and management of maternal depression in the context of a weak primary health care system: a qualitative study  

PubMed Central

Background The present study’s aim has been to investigate, identify and interpret the views of pediatric primary healthcare providers on the recognition and management of maternal depression in the context of a weak primary healthcare system. Methods Twenty six pediatricians and health visitors were selected by using purposive sampling. Face to face in-depth interviews of approximately 45 minutes duration were conducted. The data were analyzed by using the framework analysis approach which includes five main steps: familiarization, identifying a thematic framework, indexing, charting, mapping and interpretation. Results Fear of stigmatization came across as a key barrier for detection and management of maternal depression. Pediatric primary health care providers linked their hesitation to start a conversation about depression with stigma. They highlighted that mothers were not receptive to discussing depression and accepting a referral. It was also revealed that the fragmented primary health care system and the lack of collaboration between health and mental health services have resulted in an unfavorable situation towards maternal mental health. Conclusions Even though pediatricians and health visitors are aware about maternal depression and the importance of maternal mental health, however they fail to implement detection and management practices successfully. The inefficiently decentralized psychiatric services but also stigmatization and misconceptions about maternal depression have impeded the integration of maternal mental health into primary care and prevent pediatric primary health care providers from implementing detection and management practices. PMID:24725738

2014-01-01

304

Ethnic differences in primary care management of diabetes and cardiovascular disease in people with serious mental illness  

PubMed Central

Background Patients with serious mental illness (SMI) have high rates of cardiovascular disease (CVD). In contrast to widespread perception, their access to effective chronic disease management is as high as for the general population. However, previous studies have not included analysis by ethnicity. Aim To identify differences in CVD and diabetes management, by ethnicity, among people with SMI. Design and setting Three inner east London primary care trusts with an ethnically diverse and socially deprived population. Data were obtained from 147 of 151 general practices. Method Coded demographic and clinical data were obtained from GP electronic health records using EMIS Web. The sample used was the GP registered population on diabetes or CVD registers (52 620); of these, 1223 also had SMI. Results The population prevalence of CVD and diabetes is 7.2%; this rises to 18% among those with SMI. People with SMI and CVD or diabetes were found to be as likely to achieve clinical targets as those without SMI. Blood pressure control was significantly better in people with SMI; however, they were more likely to smoke and have a body mass index above 30 kg/m2. Ethnic differences in care were identified, with south Asian individuals achieving better cholesterol control and black African or Caribbean groups achieving poorer blood pressure control. Conclusion Risk factor management for those with SMI shows better control of blood pressure and glycosylated haemoglobin than the general population. However, smoking and obesity rates remain high and should be the target of public health programmes. Ethnic differences in management mirror those in the general population. Ethnic monitoring for vulnerable groups provides evidence to support schemes to reduce health inequalities. PMID:22867683

Mathur, Rohini; Hull, Sally A; Boomla, Kambiz; Robson, John

2012-01-01

305

Privatization and Educational Choice.  

ERIC Educational Resources Information Center

This book describes how and why educational choice movements will affect public education. It uses a public-choice approach to argue that both the supporters and opponents of private and school choice have failed to address several critical issues. Following an introductory chapter, chapter 2 is devoted to the rationale for contracting out…

Lieberman, Myron

306

Office-based nursing staff management of hypertension in primary care.  

PubMed

A family medicine practice in a large multi-specialty clinic undertook a quality improvement initiative focusing on blood pressure control. Current rooming procedures were reviewed, including obtaining accurate and reliable blood pressures. All rooming staff were instructed how to take an accurate blood pressure and were observed at random over a 3-month period to ensure continued accuracy. Rooming staff (medical assistants and licensed practical nurses) were engaged to give patient education and to arrange a standard 2-week follow-up with a rooming staff team member (nurse visit) if the patient's blood pressure was elevated. Clinicians were educated briefly about the importance of managing hypertension regardless of reason for visit. Blood pressure control (<140/90) in patients age 18-85 without diabetes improved from 68.4% to 75.8% in 3 months. PMID:22970534

Gindlesberger, Danielle R

2012-08-01

307

Management of the primary malignant mediastinal germ cell tumors: experience with 54 patients  

PubMed Central

Background Primary malignant mediastinal germ cell tumor (PMMGCT) is rare and sometimes the prognosis of the patients with PMMGCT is not very satisfactory. Methods A total of 54 patients with PMMGCT in a follow-up from 1990 to 2009. We evaluated the role of the surgical treatment and the effect of multimodality treatment strategy for patients with PMMGCT. Results Fifty-two patients underwent surgical resections, while the other two patients just received chemoradiotherapy. Among the 52 patients, 28 cases received preoperative adjuvant therapy and 24 cases underwent surgery as initial treatment; 30 cases with complete resections, 18 cases with partial resections and 4 cases with only biopsies. There was no perioperative mortality. Histopathologic results revealed 18 cases of seminomas and 36 cases of nonseminomatous germ cell tumors (NSGCT). The last follow-up showed that 17 patients were alive, including 11 patients with seminoma and 6 patients with NSGCT. The 5-year overall survival rate of patients with seminomas was 87.7%. The 3-year and 5-year overall survival rates of patients with NSGCT were 47.4% and 23.0%, respectively. Conclusions It could be concluded that a complete surgical resection of PMMGCT after chemoradiotherapy showed favorable long-term survival. Patients with pure seminomas have a better prognosis compared with that with NSGCT. Virtual slides The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1676987232116837. PMID:24552239

2014-01-01

308

[Implementation of a protocol of management of chronic kidney disease between Nephrology and Primary Health Care. Preliminary results].  

PubMed

During the last years there has been an important advance in the knowledge of chronic kidney disease (CKD). In order to adapt our clinical practice to these new data, a protocol of management of CKD between Nephrology and Primary Health Care has been developed. The protocol includes several items like cardiac and renal protection strategies, diagnosis and treatment of complications, use of drugs and clear derivation criteria. Implementation of the protocol has been only partial and has implied, for the Renal Unit, an increase in the number of patients,specially the oldest ones, but a clear improve in the quality of the information too,and a first positive step in the right way to face the challenge of CKD. In view of analysed data we propose some modifications for the protocol. PMID:17564560

Torregrosa, I; Solís, M; Pascual, B; Ramos, B; González, M; Ramos, C; Puchades, M J; García, R; Pons, S; Abarca, A; Mahiques, E; Alcocer, H; Sanmartín, A; Navarro, J; Miguel, A

2007-01-01

309

Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis.  

PubMed

The aim of this up-to-date meta-analysis was to compare the effects of surgical versus non-surgical treatment of patients following primary patellar dislocation and to provide the best evidence currently available. A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane Registry of Clinical Trials. All databases were searched from the earliest records to May 2013. Eligible studies were selected, and data were extracted by two independent investigators. The primary outcome variable was the frequency of recurrent patellar dislocation. The other outcomes included knee function scores, patient-rated outcomes, and radiographic examination. If appropriate, meta-analysis of these variables was performed. Nine independent trials were found to match the inclusion criteria. The pooled results demonstrated that the incidence of recurrent patellar dislocation and Hughston visual analog scale was significantly lower in the surgical treatment group than that in the non-surgical treatment group (P < 0.05). There was no statistically significant difference between the two treatment groups in frequency of subsequent surgical interventions, percentage of excellent or good subjective opinion, Kujala score, pain score on visual analog scale, and severity of patellofemoral joint osteoarthrosis (P > 0.05). This up-to-date meta-analysis indicates that surgical treatment was associated with a lower risk of recurrent patellar dislocation, but a lower Hughston VAS than non-surgical treatment for primary patellar dislocation. More large high-quality trials and further studies are needed to overcome the limitations of small sample sizes, and varieties of different surgical procedures or non-surgical management strategies adopted in the included trials. PMID:24390042

Zheng, Xiaozuo; Kang, Kai; Li, Tong; Lu, Bo; Dong, Jiangtao; Gao, Shijun

2014-12-01

310

COPD management in primary care: is an educational plan for GPs useful?  

PubMed

BACKGROUND: GPs currently deal with COPD. The aim of this study was to review COPD management, data collection in medical records, and adherence to GOLD guidelines of 12 GPs from rural areas of Northern Italy and to assess changes after an educational program (EP). METHODS: From 2004 to 2008 medical records of patients, defined as COPD by GPs, were analyzed. Data collection in terms of tests prescription, Forced Expiratory Volume at first second (FEV1), smoking habits and actual drug treatment were reviewed at baseline and 1 year after EP. RESULTS: 437 patients were defined as COPD. GPs prescribed more chest X-rays than spirometry (99% vs. 74%, p<0.001), FEV1 was registered only in 50% of the population. GPs prescribed "correct" or "doubtful" (not related to FEV1) therapy in 38% and 56% of patients, respectively. Only smoking habit registration increased significantly (p<0.05) after EP. CONCLUSIONS: Adherence to COPD Guidelines is suboptimal and data collection is poor. The EP did not change significantly GPs' practice: i) COPD diagnosis is largely clinical, ii) usage of spirometry is poor, GPs prescribe more chest X-rays iii) a small proportion of patients receive respiratory therapy, iv) therapy is often incorrect or not related to FEV1, v) correct clinical practice is influenced by the number of COPD patients and number of dedicated visits. PMID:23509969

Bertella, Enrica; Zadra, Alessandro; Vitacca, Michele

2013-01-01

311

42 CFR 431.51 - Free choice of providers.  

...of the Act provides that a beneficiary enrolled in a primary care case management system or Medicaid managed care organization...prepayment basis. (2) A beneficiary enrolled in a primary care case-management system, a Medicaid MCO, or...

2014-10-01

312

Management of primary headaches in adult Emergency Departments: a literature review, the Parma ED experience and a therapy flow chart proposal  

Microsoft Academic Search

Adults seeking treatment at hospitals’ Emergency Departments (EDs) because of headache represent a major health-care issue.\\u000a To date, there are no special guidelines for management of primary headache in adults seen at EDs and therapeutic approaches\\u000a are often inconsistent. This review describes the therapeutic strategies that are most frequently used to treat primary headache\\u000a in adult ED patients and their

Paola Torelli; Valentina Campana; Gianfranco Cervellin; Gian Camillo Manzoni

2010-01-01

313

Developing an educational intervention on dementia diagnosis and management in primary care for the EVIDEM-ED trial  

PubMed Central

Background Dementia syndromes are under-diagnosed and under-treated in primary care. Earlier recognition of and response to dementia syndrome is likely to enhance the quality of life of people with dementia, but general practitioners consistently report limited skills and confidence in diagnosis and management of this condition. Changing clinical practice is difficult, and the challenge for those seeking change it is to find ways of working with the grain of professional knowledge and practice. Assessment of educational needs in a practice has the potential to accommodate variations in individual understanding and competence, learning preferences and skill mix. Educational prescriptions identify questions that need to be answered in order to address a clinical problem. This paper reports the development of an educational needs assessment tool to guide tailored educational interventions designed to enhance early diagnosis and management of dementia in primary care, in the Evidence Based Interventions in Dementia in the Community – Early Diagnosis trial. Methods A multidisciplinary team, including a lay researcher, used an iterative technology development approach to create an educational needs assessment tool, from which educational prescriptions could be written. Workplace learning was tailored to each practice using the educational prescription, and the method was field-tested in five pilot practices. Results The educational prescriptions appeared acceptable and useful in volunteer practices. The time commitment (no more than four hours, spread out at the practice’s discretion) appeared manageable. The pilot group of practices prioritised diagnosis, assessment of carers’ needs, quality markers for dementia care in general practice, and the implications of the Mental Capacity Act (2005) for their clinical practice. The content of the educational needs assessment tool seemed to be comprehensive, in that no new topics were identified by practices in the field trial. Conclusions The educational needs assessment tool took into account practitioners’ knowledge of the local health and social care systems, reflected the complexity of the diagnostic and care processes for people with dementia, and acknowledged the complexity of the disease process itself. PMID:22913431

2012-01-01

314

The non-anticoagulation costs of atrial fibrillation management: findings from an observational study in NHS Primary Care  

PubMed Central

Background: Atrial fibrillation (AF) management represents a significant burden on the UK NHS. Understanding this burden will be important in informing future health care planning and policy development. Aim: To describe the non-anticoagulation costs associated with AF management in routine UK clinical practice. Materials, patients and methods: A retrospective observational study of 825 patients with AF undertaken in eight UK primary care practices. Data collected from routine clinical and prescribing records of all eligible, consenting patients, for a period of up to 3 years. The first 12 weeks following diagnosis was defined as the ‘initiation phase’; the period after week 12 was defined as the ‘maintenance phase’. Results: Mean (SD) total cost of AF management was £941 (£1094) per patient in the initiation phase and £426 (£597) per patient-year in the maintenance phase. AF-related inpatient admissions contributed most to total costs; the mean (SD) total cost per patient in the initiation phase was £2285 (£900) for admitted and £278 (£252) for non-admitted patients. Mean maintenance phase costs per year were £1323 (£755) and £168 (£234), respectively, for admitted and non-admitted patients. Significant patient variables contributing to high cost in the initiation phase were hypertension and younger patient age, although only accounting for 6% of cost variability. Significant variables in the maintenance phase (18% of cost variability) were the presence of congestive heart failure, structural heart disease or diabetes and the frequency of day case admissions, ECGs and hospitalisations in the initiation phase. Conclusions: Inpatient admissions contributed most to total AF management costs. Given the burden of hospital care, future work should focus on evaluating the appropriateness and reasons for hospitalisation in patients with AF and the factors affecting length of stay, with the aim of identifying opportunities to safely reduce inpatient costs. A number of significant patient characteristics and initiation phase variables were identified, which accounted for 18% of the variability in total maintenance phase costs. However, none of these could adequately predict high maintenance phase costs. PMID:24744805

Kassianos, George; Arden, Chris; Hogan, Simon; Baldock, Laura; Fuat, Ahmet

2014-01-01

315

Effect of adding a diagnostic aid to best practice to manage suspicious pigmented lesions in primary care: randomised controlled trial  

PubMed Central

Objectives To assess whether adding a novel computerised diagnostic tool, the MoleMate system (SIAscopy with primary care scoring algorithm), to current best practice results in more appropriate referrals of suspicious pigmented lesions to secondary care, and to assess its impact on clinicians and patients. Design Randomised controlled trial. Setting 15 general practices in eastern England. Participants 1297 adults with pigmented skin lesions not immediately diagnosed as benign. Interventions Patients were assessed by trained primary care clinicians using best practice (clinical history, naked eye examination, seven point checklist) either alone (control group) or with the MoleMate system (intervention group). Main outcome measures Appropriateness of referral, defined as the proportion of referred lesions that were biopsied or monitored. Secondary outcomes related to the clinicians (diagnostic performance, confidence, learning effects) and patients (satisfaction, anxiety). Economic evaluation, diagnostic performance of the seven point checklist, and five year follow-up of melanoma incidence were also secondary outcomes and will be reported later. Results 1297 participants with 1580 lesions were randomised: 643 participants with 788 lesions to the intervention group and 654 participants with 792 lesions to the control group. The appropriateness of referral did not differ significantly between the intervention or control groups: 56.8% (130/229) v 64.5% (111/172); difference ?8.1% (95% confidence interval ?18.0% to 1.8%). The proportion of benign lesions appropriately managed in primary care did not differ (intervention 99.6% v control 99.2%, P=0.46), neither did the percentage agreement with an expert decision to biopsy or monitor (intervention 98.5% v control 95.7%, P=0.26). The percentage agreement with expert assessment that the lesion was benign was significantly lower with MoleMate (intervention 84.4% v control 90.6%, P<0.001), and a higher proportion of lesions were referred (intervention 29.8% v control 22.4%, P=0.001). Thirty six histologically confirmed melanomas were diagnosed: 18/18 were appropriately referred in the intervention group and 17/18 in the control group. Clinicians in both groups were confident, and there was no evidence of learning effects, and therefore contamination, between groups. Patients in the intervention group ranked their consultations higher for thoroughness and reassuring care, although anxiety scores were similar between the groups. Conclusions We found no evidence that the MoleMate system improved appropriateness of referral. The systematic application of best practice guidelines alone was more accurate than the MoleMate system, and both performed better than reports of current practice. Therefore the systematic application of best practice guidelines (including the seven point checklist) should be the paradigm for management of suspicious skin lesions in primary care. Trial registration Current Controlled Trials ISRCTN79932379. PMID:22763392

2012-01-01

316

Issues in word choice  

Microsoft Academic Search

This paper discusses word choice for natural language generation. It examines 11 issues, the solutions that have been proposed for them, and their implications for design. The issues are:How are appropriate words chosen?How is conciseness ensured?When does choice stop?How are patterns of lexicalization respected?How are interactions among choices handrled?How are the correct parts of speech chosen?How are words chosen to

Nigel Ward

1988-01-01

317

How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study  

PubMed Central

Background There is much description in the literature of how patients with chronic obstructive pulmonary disease (COPD) manage their breathlessness and engage in self-care activities; however, little of this is from the perspective of those with less severe disease, who are primarily managed in primary care. This study aimed to understand the self-care experiences of patients with COPD who are primarily managed in primary care, and to examine the challenges of engaging in such behaviors. Methods Semistructured interviews were carried out with 15 patients with COPD as part of a larger project evaluating a self-management intervention. Thematic analysis was supported by NVivo software (version 8, QSR International, Melbourne, Australia). Results Three main themes are described, ie, experiencing and understanding symptoms of COPD, current self-care activities, and the importance of family perceptions in managing COPD. Conclusion Self-care activities evolved spontaneously as participants experienced symptoms of COPD. However, there was a lack of awareness about whether these strategies would impact upon symptoms. Perceptions of COPD by family members posed a challenge to self-care for some participants. Health care professionals should elicit patients’ prior disease experiences and utilize spontaneous attempts at disease management in future self-management. These findings have implications for promoting self-management and enhancing quality of life. PMID:24600218

Apps, Lindsay D; Harrison, Samantha L; Williams, Johanna EA; Hudson, Nicky; Steiner, Michael; Morgan, Mike D; Singh, Sally J

2014-01-01

318

Primary repair of colon injuries: clinical study of nonselective approach  

PubMed Central

Background This study was designed to determine the role of primary repair and to investigate the possibility of expanding indications for primary repair of colon injuries using nonselective approach. Methods Two groups of patients were analyzed. Retrospective (RS) group included 30 patients managed by primary repair or two stage surgical procedure according to criteria published by Stone (S/F) and Flint (Fl). In this group 18 patients were managed by primary repair. Prospective (PR) group included 33 patients with primary repair as a first choice procedure. In this group, primary repair was performed in 30 cases. Results Groups were comparable regarding age, sex, and indexes of trauma severity. Time between injury and surgery was shorter in PR group, (1.3 vs. 3.1 hours). Stab wounds were more frequent in PR group (9:2), and iatrogenic lesions in RS group (6:2). Associated injuries were similar, as well as segmental distribution of colon injuries. S/F criteria and Flint grading were similar. In RS group 15 primary repairs were successful, while in two cases relaparotomy and colostomy was performed due to anastomotic leakage. One patient died. In PR group, 25 primary repairs were successful, with 2 immediate and 3 postoperative (7-10 days) deaths, with no evidence of anastomotic leakage. Conclusions Results of this study justify more liberal use of primary repair in early management of colon injuries. Trial registration Current Controlled Trials ISRCTN94682396 PMID:21126337

2010-01-01

319

Geographic and Temporal Trends in the Management of Occult Primary Breast Cancer: A Systematic Review and Meta-Analysis  

PubMed Central

Background Management of occult primary breast cancer (OPBC), including the role of magnetic resonance imaging (MRI), is controversial. We conducted a pooled analysis of OPBC patients and a meta-analysis of MRI accuracy in OPBC in order to elucidate current practices. Methods A literature search yielded 201 studies. Patient-level data for clinically/mammographically OPBC from studies published after 1993 and from our institution were pooled; logistic regression examined associations between patient/study data and outcomes, including treatments and recurrence. We report adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI) significant at 2-tailed p<0.05. Meta-analysis included data for patients who received MRIs for workup of clinically/mammographically OPBC. We report pooled sensitivity and specificity with 95 % CIs. Results The pooled analysis included 92 patients (15 studies [n = 85] plus our institution [n = 7]). Patients from Asia were more likely to receive breast surgery (OR = 5.98, 95 % CI = 2.02–17.65) but not chemotherapy (OR = 0.32, 95 % CI = 0.13–0.82); patients from the United States were more likely to receive chemotherapy (OR = 13.08, 95 % CI = 2.64–64.78). Patients from studies published after 2003 were more likely to receive radiotherapy (OR = 3.86, 95 % CI = 1.41–10.55). Chemotherapy recipients were more likely to have distant recurrence (OR = 9.77, 95 % CI = 1.10–87.21). More patients with positive MRIs received chemotherapy than patients with negative MRIs (10 of 12 [83.3 %] vs 5 of 13 [38.5 %]; p = 0.0414). In the MRI-accuracy meta-analysis (10 studies, n = 262), pooled sensitivity and specificity were 96 % (95 % CI = 91–98 %) and 63 % (95 % CI = 42–81 %), respectively. Conclusions OPBC management varied geographically and over time. We recommend establishing an international OPBC patient registry to facilitate longitudinal study and develop global treatment standards. PMID:23975301

Fayanju, Oluwadamilola M.; Stoll, Carolyn R. T.; Fowler, Susan; Colditz, Graham A.; Jeffe, Donna B.; Margenthaler, Julie A.

2013-01-01

320

Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey  

PubMed Central

Context Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system. Methods Between June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use. Findings Of 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patient's next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications. Conclusions Despite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere. PMID:23268489

Singh, Hardeep; Spitzmueller, Christiane; Petersen, Nancy J; Sawhney, Mona K; Smith, Michael W; Murphy, Daniel R; Espadas, Donna; Laxmisan, Archana; Sittig, Dean F

2013-01-01

321

The Changing Nature of the Role of Principals in Primary and Junior Secondary Schools in South Australia Following the Introduction Local School Management (Partnerships 21)  

ERIC Educational Resources Information Center

This paper discusses the changing nature of the role of principals following the introduction of local school management (Partnerships 21) in South Australia. The study reports the series of interviews with primary and junior secondary principals with regard to their roles in several areas namely; instructional leadership, teachers' professional…

Sahid, Abdul

2004-01-01

322

Evidence-Based Classroom and Behaviour Management Content in Australian Pre-Service Primary Teachers' Coursework: Wherefore Art Thou?  

ERIC Educational Resources Information Center

Beginning teachers often report feeling less than adequately prepared by their teacher education programs in the area of classroom and behaviour management (CBM). This article reports the prevalence of evidence-based practices in the coursework content on offer in Australian undergraduate primary teacher education programs. First a set of CBM…

O'Neill, Sue C.; Stephenson, Jennifer

2014-01-01

323

Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial  

Microsoft Academic Search

BACKGROUND: Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in

M. Perry; I. Draskovic; T. van Achterberg; G. F. Borm; M. I. J. van Eijken; PL Lucassen; M. J. F. J. Vernooij-Dassen; M. G. M. Olde Rikkert

2008-01-01

324

Development and Implementation of Nonpharmacologic Protocols for the Management of Patients with Alzheimer's Disease and Their Families in a Multiracial Primary Care Setting  

ERIC Educational Resources Information Center

Purpose. Most patients and families with dementia are cared for in primary care clinics. These clinics are seldom designed to provide the necessary comprehensive care. The purpose of this article is to describe nonpharmacologic protocols for the management of patients with Alzheimer's disease and their families that are administered as part of a…

Austrom, Mary Guerriero; Damush, Teresa M.; Hartwell, Cora West; Perkins, Tony; Unverzagt, Frederick; Boustani, Malaz; Hendrie, Hugh C.; Callahan, Christopher M.

2004-01-01

325

Cholgate - A Randomized Controlled Trial Comparing The Effect Of Automated And On-Demand Decision Support On The Management Of Cardiovascular Disease Factors In Primary Care  

PubMed Central

Automated and on-demand decision support systems integrated into an electronic medical record have proven to be an effective implementation strategy for guidelines. Cholgate is a randomized controlled trial comparing the effect of automated and on-demand decision support on the management of cardiovascular disease factors in primary care. PMID:14728543

van Wyk, Jacobus T.; van Wijk, Marc A.; Moorman, Peter W.; Mosseveld, Mees; van der Lei, Johan

2003-01-01

326

Concurrent analysis of choice and control in childbirth  

PubMed Central

Background This paper reports original research on choice and control in childbirth. Eight women were interviewed as part of a wider investigation into locus of control in women with pre-labour rupture of membranes at term (PROM) [1]. Methods The following study uses concurrent analysis to sample and analyse narrative aspects of relevant literature along with these interviews in order to synthesise a generalisable analysis of the pertinent issues. The original PROM study had found that women experienced a higher degree of control in hospital, a finding that appeared at odds with contemporary notions of choice. However, this paper contextualises this finding by presenting narratives that lucidly subscribe to the dominant discourse of hospital as the safest place to give birth, under the premise of assuring a live healthy baby irrespective of their management type. Results This complex narrative is composed of the following themes: 'perceiving risk', 'being prepared', 'reflecting on experience', maintaining control' and relinquishing control'. These themes are constructed within and around the medical, foetocentric, risk averse cultural context. Primary data are presented throughout to show the origins and interconnected nature of these themes. Conclusions Within this context it is clear that there is a highly valued role for competent health professionals that respect, understand and are capable of facilitating genuine choice for women. PMID:21631910

2011-01-01

327

Evaluation of Academic Detailing Programme on Childhood Diarrhoea Management by Primary Healthcare Providers in Banke District of Nepal  

PubMed Central

Academic detailing is rarely practised in developing countries. A randomized control trial on healthcare service was conducted to evaluate the impact of academic detailing programme on the adherence of primary healthcare providers in Banke district, Nepal, to childhood diarrhoea treatment guidelines recommended by World Health Organization/United Nations Children's Fund (WHO/UNICEF). The participants (N=209) were systematically divided into control and intervention groups. Four different academic detailing sessions on childhood diarrhoea management were given to participants in the intervention group. At baseline, 6% of the participants in the control and 8.3% in the intervention group were adhering to the treatment guidelines which significantly (p<0.05) increased among participants in the intervention (65.1%) than in the control group (16.0%) at the first follow-up. At the second follow-up, 69.7% of participants in the intervention group were adhering to the guidelines, which was significantly (p<0.05) greater than those in the control group (19.0%). Data also showed significant improvement in prescribing pattern of the participants in the intervention group compared to the control group. Therefore, academic detailing can be used for promoting adherence to treatment guidelines in developing countries, like Nepal. PMID:23930342

Ibrahim, Mohamed Izham b. Mohamed; Shankar, Pathiyil Ravi; Palaian, Subish; Mishra, Pranaya

2013-01-01

328

42 CFR 438.52 - Choice of MCOs, PIHPs, PAHPs, and PCCMs.  

...seeks. (D) The beneficiary's primary care provider or other provider determines...HIO has a choice of at least two primary care providers within the entity. (d) Limitations on changes between primary care providers. For an...

2014-10-01

329

42 CFR 438.52 - Choice of MCOs, PIHPs, PAHPs, and PCCMs.  

Code of Federal Regulations, 2011 CFR

...seeks. (D) The recipient's primary care provider or other provider determines...HIO has a choice of at least two primary care providers within the entity. (d) Limitations on changes between primary care providers. For an...

2011-10-01

330

42 CFR 438.52 - Choice of MCOs, PIHPs, PAHPs, and PCCMs.  

Code of Federal Regulations, 2013 CFR

...seeks. (D) The beneficiary's primary care provider or other provider determines...HIO has a choice of at least two primary care providers within the entity. (d) Limitations on changes between primary care providers. For an...

2013-10-01

331

42 CFR 438.52 - Choice of MCOs, PIHPs, PAHPs, and PCCMs.  

Code of Federal Regulations, 2012 CFR

...seeks. (D) The beneficiary's primary care provider or other provider determines...HIO has a choice of at least two primary care providers within the entity. (d) Limitations on changes between primary care providers. For an...

2012-10-01

332

Initial Choices and Final Outcomes in Lower Urinary Tract Symptoms  

Microsoft Academic Search

Management of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) requires careful thought so that the most appropriate treatment can be targeted to each individual patient. Initial choices in the management of LUTS\\/BPH include watchful waiting, medical therapies and surgical interventions. A decision on treatment choice should be taken together with the patient. It should be based

Mark J. Speakman

2001-01-01

333

The Choice Controversy.  

ERIC Educational Resources Information Center

Issues in school choice--constitutionality, feasibility, equity, and educational productivity--are examined in this book. The controversy requires an ongoing analysis of the origins of the school-choice movement, the kinds of plans proposed and implemented, their educational and social consequences, and the philosophical assumptions underlying the…

Cookson, Peter W., Jr., Ed.

334

School Choice Slandered.  

ERIC Educational Resources Information Center

Critiques the criticism leveled at Milwaukee's (Wisconsin) four-year-old Parental Choice Program, a program designed to open private school choice through a voucher program. It discusses John Witte's reports which criticize the program and how these reports are flawed and inaccurate depictions of the program's progress and impact. (GLR)

McGroarty, Daniel

1994-01-01

335

Comparing Your Treatment Choices  

Cancer.gov

The charts below list 9 common questions and answers for the 3 treatment choices discussed in this booklet. As mentioned before, most men will need more information than found in this booklet to reach their decisions. You may use the questions in these charts as a guide for talking with your doctor or learning more about your choices.

336

Attention in risky choice.  

PubMed

Previous research on the processes involved in risky decisions has rarely linked process data to choice directly. We used a simple measure based on the relative amount of attentional deployment to different components (gains/losses and their probabilities) of a risky gamble during the choice process, and we related this measure to the actual choice. In an experiment we recorded the decisions, decision times, and eye movements of 80 participants who made decisions on 11 choice problems. We used the number of eye fixations and fixation transitions to trace the deployment of attention during the choice process and obtained the following main results. First, different components of a gamble attracted different amounts of attention depending on participants' actual choice. This was reflected in both the number of fixations and the fixation transitions. Second, the last-fixated gamble but not the last-fixated reason predicted participants' choices. Third, a comparison of data obtained with eye tracking and data obtained with verbal protocols from a previous study showed a large degree of convergence regarding the process of risky choice. Together these findings tend to support dimensional decision strategies such as the priority heuristic. PMID:25226548

Brandstätter, Eduard; Körner, Christof

2014-10-01

337

More Choice, Less Crime  

ERIC Educational Resources Information Center

Previous research debates whether public school choice improves students' academic outcomes, but there is little examination of its effects on their nonacademic outcomes. We use data from a nationally representative sample of high school students, a previously developed Tiebout choice measure, and metropolitan-level data on teenage arrest rates to…

Dills, Angela K.; Hernandez-Julian, Rey

2011-01-01

338

Tense Choices in Citations.  

ERIC Educational Resources Information Center

Examines tense, aspect, and voice choices in the reporting verbs in a corpus of research articles from the "Journal of Psychosomatic Medicine." Investigates how such choices correlate with other syntactic elements in the citations, as well as with the discourse functions of the citations in their contexts. (TB)

Hawes, Thomas; Thomas, Sarah

1997-01-01

339

Evaluation of a Chronic Disease Management System for the Treatment and Management of Diabetes in Primary Health Care Practices in Ontario  

PubMed Central

Background Computerized chronic disease management systems (CDMSs), when aligned with clinical practice guidelines, have the potential to effectively impact diabetes care. Objective The objective was to measure the difference between optimal diabetes care and actual diabetes care before and after the introduction of a computerized CDMS. Methods This 1-year, prospective, observational, pre/post study evaluated the use of a CDMS with a diabetes patient registry and tracker in family practices using patient enrolment models. Aggregate practice-level data from all rostered diabetes patients were analyzed. The primary outcome measure was the change in proportion of patients with up-to-date “ABC” monitoring frequency (i.e., hemoglobin A1c, blood pressure, and cholesterol). Changes in the frequency of other practice care and treatment elements (e.g., retinopathy screening) were also determined. Usability and satisfaction with the CDMS were measured. Results Nine sites, 38 health care providers, and 2,320 diabetes patients were included. The proportion of patients with up-to-date ABC (12%), hemoglobin A1c (45%), and cholesterol (38%) monitoring did not change over the duration of the study. The proportion of patients with up-to-date blood pressure monitoring improved, from 16% to 20%. Data on foot examinations, retinopathy screening, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, and documentation of self-management goals were not available or not up to date at baseline for 98% of patients. By the end of the study, attitudes of health care providers were more negative on the Training, Usefulness, Daily Practice, and Support from the Service Provider domains of the CDMS, but more positive on the Learning, Using, Practice Planning, CDMS, and Satisfaction domains. Limitations Few practitioners used the CDMS, so it was difficult to draw conclusions about its efficacy. Simply giving health care providers a potentially useful technology will not ensure its use. Conclusions This real-world evaluation of a web-based CDMS for diabetes failed to impact physician practice due to limited use of the system. Plain Language Summary Patients and health care providers need timely access to information to ensure proper diabetes care. This study looked at whether a computer-based system at the doctor’s office could improve diabetes management. However, few clinics and health care providers used the system, so no improvement in diabetes care was seen. PMID:24748911

DJ, O'Reilly; JM, Bowen; RJ, Sebaldt; A, Petrie; RB, Hopkins; N, Assasi; C, MacDougald; E, Nunes; R, Goeree

2014-01-01

340

Haptic choice blindness  

PubMed Central

Choice blindness is the failure to notice a mismatch between intention and outcome when making decisions. It is unknown whether choice blindness occurs when participants have extended interaction with real objects. Here, we examined the case when objects could be touched but not seen. Participants examined pairs of common, everyday objects inside a specially constructed box where a silent turntable was used to switch objects between initial choice and later justification. For similar pairs of objects, we found detection rates of around 22%, consistent with previous studies of choice blindness. For pairs consisting of more distinctive exemplars, the detection rate rose to 70%. Our results indicate that choice blindness does occur after haptic interaction with real objects, but is strongly modulated by similarity. PMID:23799197

Steenfeldt-Kristensen, Catherine; Thornton, Ian M.

2013-01-01

341

Choice and reinforcement delay  

SciTech Connect

Previous studies of choice between two delayed reinforcers have indicated that the relative immediacy of the reinforcer is a major determinant of the relative frequency of responding. Parallel studies of choice between two interresponse times have found exceptions to this generality. The present study looked at the choice by pigeons between two delays, one of which was always four times longer than the other, but whose absolute durations were varied across conditions. The results indicated that choice is not uniquely determined by the relative immediacy of reinforcement, but that absolute delays are also involved. Models for concurrent chained schedules appear to be more applicable to the present data than the matching relation; however, these too failed to predict choice for long delays.

Gentry, G.D.; Marr, M.J.

1980-01-01

342

Coordination and management of chronic conditions in Europe: the role of primary care – position paper of the European Forum for Primary Care  

Microsoft Academic Search

Healthcare systems in Europe struggle with inadequate co-ordination of care for people with chronic conditions. Moreover, there is a considerable evidence gap in the treatment of chronic conditions, lack of self-management, variation in quality of care, lack of preventive care, increasing costs for chronic care, and inefficient use of resources. In order to overcome these problems, several approaches to improve

S. Gress; C. A. Baan; M. Calnan; T. Dedeu; P. Groenewegen; H. Howson; L. Maroy; E. Nolte; M. Redaèlli; O. Saarelma; N. Schmacke; K. Schumacher; E. J. van Lente; B. Vrijhoef

2009-01-01

343

Choices: Learning about Changing Sex Roles.  

ERIC Educational Resources Information Center

Maintaining that sexism wastes talents by limiting an individual's choices, the document presents activities for elementary school students to increase awareness of sex roles and a set of inservice materials for training school personnel to teach about sexism. Activities are presented on two levels. Activities for primary grades deal with…

Wangen, Nancy Register; Wagner, Sherri

344

Choice, freedom, and freedom of choice  

Microsoft Academic Search

This paper argues in favour of a distinction between ‘freedom’ and ‘freedom of choice’ – a distinction that economists and political philosophers have so far either ignored or drawn wrongly. Drawing the distinction correctly may help to resolve a number of disputes in contemporary political philosophy and non-welfarist normative economics regarding the so-called ‘preference-based’ account of freedom and the relevance,

Ian Carter; Strada Nuova

2004-01-01

345

Risk stratification in very old adults: how to best gauge risk as the basis of management choices for patients aged over 80.  

PubMed

Cardiovascular disease (CVD) is the leading cause of mortality in older adults, however, in the elderly accurate stratification of CVD risk to guide management decisions is challenging due to the heterogeneity of the population. Conventional assessment of CVD and therapeutic risk is based on extrapolation of guidelines developed from evidence demonstrated in younger individuals and fails to weight the increased burden of complications and multimorbidity. Using a comprehensive geriatric based assessment of older adults with CVD that includes an estimation of complexity of multimorbidity as well as traditional risk assessment provides a patient centered approach that allows for management decisions congruent with patient preferences. This review examines the complexity of risk stratification in adults over 80, assessment methods to augment current tools and the basis of management decisions to optimize patient and family centered goals. PMID:25216619

Bell, Susan P; Saraf, Avantika

2014-01-01

346

Risk stratification in very old adults: How to best gauge risk as the basis of management choices for patients aged over 80  

PubMed Central

Cardiovascular disease (CVD) is the leading cause of mortality in older adults, however, in the elderly accurate stratification of CVD risk to guide management decisions is challenging due to the heterogeneity of the population. Conventional assessment of CVD and therapeutic risk is based on extrapolation of guidelines developed from evidence demonstrated in younger individuals and fails to weight the increased burden of complications and multimorbidity. Using a comprehensive geriatric based assessment of older adults with CVD that includes an estimation of complexity of multimorbidity as well as traditional risk assessment provides a patient centered approach that allows for management decisions congruent with patient preferences. This review examines the complexity of risk stratification in adults over 80, assessment methods to augment current tools and the basis of management decisions to optimize patient and family centered goals. PMID:25216619

Bell, Susan P.; Saraf, Avantika

2014-01-01

347

Poor glycemic control in younger women attending Malaysian public primary care clinics: findings from adults diabetes control and management registry  

PubMed Central

Background Women of reproductive age are a group of particular concern as diabetes may affect their pregnancy outcome as well as long-term morbidity and mortality. This study aimed to compare the clinical profiles and glycemic control of reproductive and non-reproductive age women with type 2 diabetes (T2D) in primary care settings, and to determine the associated factors of poor glycemic control in the reproductive age group women. Methods This was a cross-sectional study using cases reported by public primary care clinics to the Adult Diabetes Control and Management registry from 1st January to 31st December 2009. All Malaysian women aged 18 years old and above and diagnosed with T2D for at least 1 year were included in the analysis. The target for glycemic control (HbA1c < 6.5%) is in accordance to the recommended national guidelines. Both univariate and multivariate approaches of logistic regression were applied to determine whether reproductive age women have an association with poor glycemic control. Results Data from a total of 30,427 women were analyzed and 21.8% (6,622) were of reproductive age. There were 12.5% of reproductive age women and 18.0% of non-reproductive age women that achieved glycemic control. Reproductive age group women were associated with poorer glycemic control (OR = 1.5, 95% CI = 1.2-1.8). The risk factors associated with poor glycemic control in the reproductive age women were being of Malay and Indian race, longer duration of diabetes, patients on anti-diabetic agents, and those who had not achieved the target total cholesterol and triglycerides. Conclusion Women with T2D have poor glycemic control, but being of reproductive age was associated with even poorer control. Health care providers need to pay more attention to this group of patients especially for those with risk factors. More aggressive therapeutic strategies to improve their cardiometabolic control and pregnancy outcome are warranted. PMID:24325794

2013-01-01

348

PSYCHOPATHOLOGY AND SOCIOMETRIC CHOICE  

E-print Network

Previous research has suggested that except for paranoid schizophrenics, similarity in diagnostic category has little effect on sociometric choice among patients. A sociometric study was conducted employing MMPI scales as well as diagnostic categories on 84 hospitalized psychiatric patients. When diagnostic labels from the patients ' charts were used, results showed no relationship between sociometric choice and diagnosis. However, patients classified by highest MMPI scale or by MMPI code type made positive sociometric choices among themselves. Psychopathology has been related to difficulties in interpersonal relationships (Ansbacher

Russell Eisenman

349

Possibility of the most cost efficient choice: A divided process approach to method and location selection for municipal solid waste management.  

PubMed

As studies on municipal solid waste management increased in recent years, many new mathematical models and approaches with a focus on determining the best treatment and disposal scenario were developed and applied. In this study, a mixed integer linear programming model was developed to be used as a facilitative tool for the cost minimisation of municipal solid waste management practices. Since municipal solid waste mass is a mixed composition of various types of waste components with different physical and chemical properties, the model was designed to include all the suitable treatment and disposal methods for these different waste components. The method alternatives with multiple waste inputs, such as aerobic biological treatment and the thermal processes, were divided into a number of inputs to remove their non-linear structures. This way, linear programming could be used, and the linear cost function could be minimised over a set of linear constraints with integer variables. The model was applied to the city of Kocaeli, which will require a new waste management application in the future, beginning from 2015. The results obtained for different haul distance constraints in the study area were presented and assessed. The results showed that all the information required for a comprehensive management task could be modelled by a linear optimisation model with a divided processes approach easily. PMID:25245295

Korucu, M Kemal; Cihan, Ahmet; Alkan, Atakan; Ozbay, Ismail; Karademir, Aykan; Aladag, Zerrin

2014-11-01

350

Media Choice in Environmental Information Dissemination for Solid Waste Management among Policy Formulators and Implementors: A Case Study of Oyo State, Nigeria  

ERIC Educational Resources Information Center

Environmental information has been described as central to the issues of solid waste management and disposal. This study investigated the availability and accessibility of environmental information to the solid waste policy formulators and implementors with regard to the media/channels used for disseminating environmental information to the…

Akintola, B. A.; Temowo, O. O.; Ajiboye, J. O.

2009-01-01

351

Use of primary corticosteroid injection in the management of plantar fasciopathy: is it time to challenge existing practice?  

PubMed

Plantar fasciopathy (PF) is characterized by degeneration of the fascia at the calcaneal enthesis. It is a common cause of foot pain, accounting for 90% of clinical presentations of heel pathology. In 2009-2010, 9.3 million working days were lost in England due to musculoskeletal disorders, with 2.4 million of those attributable to lower-limb disorders, averaging 16.3 lost working days per case. Numerous studies have attempted to establish the short- and long-term clinical efficacy of corticosteroid injections in the management of PF. Earlier studies have not informed clinical practice. As the research base has developed, evidence has emerged supporting clinical efficacy. With diverse opinions surrounding the etiology and efficacy debate, there does not seem to be a consensus of opinion on a common treatment pathway. For example, in England, the National Institute for Clinical Health and Excellence does not publish strategic guidance for clinical practice. Herein, we review and evaluate core literature that examines the clinical efficacy of corticosteroid injection as a treatment for PF. Outcome measures were wide ranging but largely yielded results supportive of the short- and long-term benefits of this modality. The analysis also looked to establish, where possible, "proof of concept." This article provides evidence supporting the clinical efficacy of corticosteroid injections, in particular those guided by imaging technology. The evidence challenges existing orthodoxy, which marginalizes this treatment as a secondary option. This challenge is supported by recently revised guidelines published by the American College of Foot and Ankle Surgeons advocating corticosteroid injection as a primary treatment option. PMID:24072372

Kirkland, Paul; Beeson, Paul

2013-01-01

352

How Happiness Affects Choice  

E-print Network

Consumers want to be happy, and marketers are increasingly trying to appeal to consumers’ pursuit of happiness. However, the results of six studies reveal that what happiness means varies, and consumers’ choices reflect ...

Mogilner, Cassie

353

Reflections on Public Choice  

Microsoft Academic Search

My 2002 presidential address to the PublicChoice Society consisted of three parts.The first had to do with the business ofthe Society's 2002 meeting and plans forthe Nashville meeting, and has beenomitted. This essay begins with the secondsection of that talk, in which I identifywhat I call the classic books ofPublic Choice, and then discuss what I viewas common misconceptions about

Bernard Grofman

2004-01-01

354

Countable choice and compactness  

Microsoft Academic Search

We work in set-theory without choice ZF. Denoting by AC(N) the countable axiom of choice, we show in ZF+AC(N) that the closed unit ball of a uniformly convex Banach space is compact in the convex topology (an alternative to the weak topology in ZF). We prove that this ball is (closely) convex-compact in the convex topology. Given a set I,

Marianne Morillon

2008-01-01

355

Blue Choice New EnglandSM Summary of Benefits  

E-print Network

Blue Choice New EnglandSM Summary of Benefits Williams College An Association of Independent Blue Cross and Blue Shield Plans This health plan meets Minimum Creditable Coverage Standards Reform Law. #12;Your Care Your Primary Care Provider. When you enroll in Blue Choice New England, you

Aalberts, Daniel P.

356

A Policy-into-Practice Intervention to Increase the Uptake of Evidence-Based Management of Low Back Pain in Primary Care: A Prospective Cohort Study  

Microsoft Academic Search

BackgroundPersistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs).MethodsTo encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical

Helen Slater; Stephanie Joy Davies; Richard Parsons; John Louis Quintner; Stephan Alexander Schug

2012-01-01

357

Setting-up nurse-led pilot clinics for the management of non-communicable diseases at primary health care level in resource-limited settings of Africa  

Microsoft Academic Search

Background: This article describes the setting-up process for nurse-led pilot clinics for the management of four chronic diseases: asthma, type 2 diabetes mellitus, epilepsy and hypertension at the primary health care level in urban and rural Cameroon. Methods: The Biyem-Assi urban and the Bafut rural health districts in Cameroon served as settings for this study. International and local guidelines were

Andre Pascal Kengne; Eugene Sobngwi; Leopold Fezeu; Paschal Kum Awah; Claude Mbanya

358

[Quality management systems are compulsory: clinics have the choice. Comparison of the systems DIN EN ISO 9000 ff, KTQ and EFQM].  

PubMed

According to §§135-137 SGB V (German Civil Code), German hospitals are required to introduce and develop an institutional quality management (QM) system. They are, however, currently not obliged to undergo a certification. The prime responsibility to introduce a QM system lies with the top management. The aim is to continuously monitor and improve the quality of the processes and practices in the hospital. QM systems are one of the major constituents which influence the prosperity of an enterprise. Hospitals are able to improve the quality of their processes without significantly increasing the costs. The Excellence Barometer® Health Care (ExBa) of the Fraunhofer Institute has shown that deficits are usually not identified in the professional competence of the medical personnel but rather in respect to leadership abilities, communication and motivation. The introduction of QM in a hospital requires an in-depth familiarity with the various QM systems to select an appropriate model for the own institution. The systems most commonly in use in German hospitals are DIN EN ISO ff, EFQM and KTQ®. The article illustrates and compares the layout, requirements and assessment criteria of the various systems. PMID:21901554

Steinbrucker, S

2011-10-01

359

Individual Determinants of Media Choice for Deception  

Microsoft Academic Search

Recent research has found that deceivers are extremely difficult to detect in computer-mediated work settings. However, it is unclear which individuals are likely to use computer systems for deception in these settings. This study looked at how 172 upper-level business students’ political skill, social skill, and tendency to use impression management was related to their deception media choice in a

Gabriel Giordano; Christopher Furner

2007-01-01

360

Multiple-Choice Computer Diagnostic Test Designs.  

ERIC Educational Resources Information Center

Discusses factors that should be considered when designing multiple-choice diagnostic tests for use with microcomputer systems. Item content and characteristics are described, presentation of feedback and results are examined, database management functions are discussed, and benefits for students with learning problems and physically disabled…

Burns, Edward

1990-01-01

361

Choice of initial therapy  

PubMed Central

Current international and national treatment guidelines such as EACS, BHIVA, DHHS or IAS update regularly recommendations on the choice of initial combination antiretroviral treatment (cART) regimens. Preferred cART regimens include a backbone with two nucleoside (nucleotide) reverse transcriptase inhibitors combined either with one non-nucleoside reverse transcriptase inhibitor or one ritonavir boosted protease inhibitor or more recently one integrase inhibitor. Response rates according to viral load measurements increased in recent years, in particular due to better tolerability. The choice of initial therapy is flexible and influenced by several factors such as height of viral load, genotypic resistance testing, CD4 cell count, co-morbidities, interactions, potential adverse events, (potential for) pregnancy, convenience, adherence, costs as well as physician's and patient's preferences. Diverse highly potent initial cART regimens exist. Following the many possibilities, the choice of a regimen is based on a mixture of evidence-informed data and individualized concepts, some of the latter only partly supported by strong evidence. For example, different perceptions and personal experiences exist about boosted protease inhibitors compared to non-nucleoside reverse transcriptase inhibitors or integrase inhibitors and vice versa which may influence the initial choice. This lecture will discuss choices of initial cART in view of international guidelines and the evidence for individualization of initial HIV therapy.

Battegay, Manuel

2014-01-01

362

Causes and consequences of lexicographic choices in stated choice studies  

Microsoft Academic Search

Stated Choice (SC) methods, and other choice experiments, are now becoming increasingly popular for the valuation of environmental goods. This paper shows that lexicographic choices (LCs) in an SC task, or other types of choice experiments, do not imply that the respondent has lexicographic preferences. LCs may be a result of (i) study designs where differences between the alternatives are

Kjartan Saelensminde

2006-01-01

363

[Conceptions and typology of conflicts between workers and managers in the context of primary healthcare in the Brazilian Unified National Health System (SUS)].  

PubMed

This study aimed to analyze perceptions of conflict between workers and managers in primary healthcare units and to present a typology of conflicts on the job. This was a comprehensive interpretive case study with a critical hermeneutic approach. Data collection techniques included: focus group with managers, workplace observation, and worker interviews, conducted from April to November 2011. The results were triangulated and indicated the coexistence of distinct concepts of conflict, typified in six modalities: lack of collaboration at work; disrespect resulting from asymmetrical relations between workers; problematic employee behavior; personal problems; asymmetry with other management levels; and inadequate work infrastructure. The relevance of (non)mutual recognition, as proposed by Axel Honneth, stood out in the interpretation of the causes and practical implications of these conflicts. PMID:25166942

Carvalho, Brígida Gimenez; Peduzzi, Marina; Ayres, José Ricardo de Carvalho Mesquita

2014-07-01

364

Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies  

PubMed Central

Background The NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition. Methods A meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum. Results Twenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care. Conclusions In order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input. PMID:24606913

2014-01-01

365

Special Issue Topic: School Choice.  

ERIC Educational Resources Information Center

Includes "The Choice Movement" (Brogan); "Choice in American Education" (Witte); "Role of Parents in Education" (Mawdsley); "As Arrows in the Hand" (Coons); "Vouchers in Wisconsin" (Underwood); "Milwaukee Parental Choice Program (MPCP)" (Grover); "Civil Liberties and the MPCP" (Bolick); "Comments on School Choice" (Jauch); "Two Classes of…

Brogan, Bernard R.; And Others

1991-01-01

366

More rigorous protocol adherence to intensive structured management improves blood pressure control in primary care: results from the Valsartan Intensified Primary carE Reduction of Blood Pressure study  

PubMed Central

Objective: To examine protocol adherence to structured intensive management in the Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) study involving 119 primary care clinics and 1562 randomized participants. Methods: Prospective criteria for assessing adherence to treatment prescription, uptitration, and visit attendance at 6, 10, 14, and 18 weeks postrandomization were applied to 1038 intervention participants. Protocol adherence scores of 1–5 (least to most adherent) were compared to blood pressure (BP) control during 26 weeks of follow-up. Results: Mean age was 59.3?±?12.0 years, 963 (62%) were men, and 1045 (67%) had longstanding hypertension. Clinic attendance dropped from 91 (week 6) to 83% (week 26) and pharmacological instructions were followed for 93% (baseline) to 61% at week 14 (uptitration failures commonly representing protocol deviations). Overall, 26-week BP levels and BP target attainment ranged from 132?±?14/79?±?9 and 51% to 141?±?15/83?±?11?mmHg and 19% in those participants subject to the highest (n?=?270, 26%) versus least (n?=?148, 14%) per protocol adherence, respectively; adjusted relative risk (RR) 1.22 per unit protocol adherence score, 95% confidence interval (CI) 1.15–1.31; for achieving BP target (P?management to improve BP control in primary care, especially when optimally applied. PMID:24759125

Stewart, Simon; Stocks, Nigel P.; Burrell, Louise M.; de Looze, Ferdinandus J.; Esterman, Adrian; Harris, Mark; Hung, Joseph; Swemmer, Carla H.; Kurstjens, Nicol P.; Jennings, Garry L.; Carrington, Melinda J.

2014-01-01

367

Diagnosis and management of a patient with primary pulmonary diffuse large B-cell lymphoma: A case report and review of the literature  

PubMed Central

Primary pulmonary lymphoma (PPL) is an uncommon type of non-Hodgkin’s lymphoma. The majority of PPLs are of low-grade, mucosa-associated lymphoid tissue type. Primary pulmonary diffuse large B-cell lymphoma (DLBCL) is extremely rare, and prompt diagnosis may be challenging since its clinical symptoms and signs are nonspecific. Although the clinical features, diagnostic procedures, optimal management and prognostic factors of this disease have not yet been well defined, open thoracotomy and chest computed tomography (CT)-guided percutaneous biopsy are the preferred methods used in previous studies. In the present case report, the diagnosis and management of a patient with primary pulmonary DLBCL is reported. A 68-year-old patient was admitted to hospital in May 2013, with complaints of shortness of breath and intermittent wheezing and a cough associated with the production of small amounts of phlegm. Following admission, chest CT scans revealed a mass in the right middle lobe with ground-glass opacities at the lesion margins, as well as air bronchograms in the areas of consolidation. Bronchoscopy was performed and revealed an endobronchial lesion and partial stenosis in the distal end of the middle segment bronchus. Transbronchial needle aspiration (TBNA) of the right hilar lymph node, as well as endobronchial biopsy, was performed. The patient was diagnosed with primary pulmonary DLBCL by subsequent histopathological and immunohistochemical analysis of biopsy specimens collected via TBNA. Following the final diagnosis, standard treatment with CHOP chemotherapy resulted in significant clinical and radiological response and the patient remained in remission 8 months later. These results indicate that TBNA may be an effective method for the diagnosis of primary pulmonary DLBCL. PMID:25120602

JIANG, AI-GUI; GAO, XIAO-YAN; LU, HUI-YU

2014-01-01

368

Implementing clinical practice guidelines while taking account of changing evidence: ATHENA DSS, an easily modifiable decision-support system for managing hypertension in primary care.  

PubMed Central

This paper describes the ATHENA Decision Support System (DSS), which operationalizes guidelines for hypertension using the EON architecture. ATHENA DSS encourages blood pressure control and recommends guideline-concordant choice of drug therapy in relation to comorbid diseases. ATHENA DSS has an easily modifiable knowledge base that specifies eligibility criteria, risk stratification, blood pressure targets, relevant comorbid diseases, guideline-recommended drug classes for patients with comorbid disease, preferred drugs within each drug class, and clinical messages. Because evidence for best management of hypertension evolves continually, ATHENA DSS is designed to allow clinical experts to customize the knowledge base to incorporate new evidence or to reflect local interpretations of guideline ambiguities. Together with its database mediator Athenaeum, ATHENA DSS has physical and logical data independence from the legacy Computerized Patient Record System (CPRS) supplying the patient data, so it can be integrated into a variety of electronic medical record systems. PMID:11079893

Goldstein, M. K.; Hoffman, B. B.; Coleman, R. W.; Musen, M. A.; Tu, S. W.; Advani, A.; Shankar, R.; O'Connor, M.

2000-01-01

369

The role of the General Practitioner in weight management in primary care – a cross sectional study in General Practice  

Microsoft Academic Search

BACKGROUND: Obesity has become a global pandemic, considered the sixth leading cause of mortality by the WHO. As gatekeepers to the health system, General Practitioners are placed in an ideal position to manage obesity. Yet, very few consultations address weight management. This study aims to explore reasons why patients attending General Practice appointments are not engaging with their General Practitioner

Marlene Tham; Doris Young

2008-01-01

370

NBNews Editor's Choice Awards  

NSDL National Science Digital Library

An online newsletter, NBNews Editor's Choice Awards, an annotated listing of new Internet sites that is issued every ten days, has been added to the Internet Publications--Internet Webzines section of the Scout Toolkit. In addition, about one third of all the annotations in the Toolkit have been revised and updated in the last two weeks.

371

Reason-based choice  

Microsoft Academic Search

This paper considers the role of reasons and arguments in the making of decisions. It is proposed that, when faced with the need to choose, decision makers often seek and construct reasons in order to resolve the conflict and fustify their choice, to themselves and to others. Experiments that explore and manipulate the role of reasons are reviewed, and other

Eldar Shafir; Itamar Simonson; Amos Tversky

1993-01-01

372

Choices, frameworks and refinement  

Microsoft Academic Search

Presents a method for designing operating systems using object-oriented frameworks. A framework can be refined into subframeworks. Constraints specify the interactions between the subframeworks. The authors describe how they used object-oriented frameworks to design Choices, an object-oriented operating system

Roy H. Campbell; Nayeem Islam; Ralph Johnson; Panos Kougiouris; Peter Madany

1991-01-01

373

Choices, Frameworks and Refinement  

NASA Technical Reports Server (NTRS)

In this paper we present a method for designing operating systems using object-oriented frameworks. A framework can be refined into subframeworks. Constraints specify the interactions between the subframeworks. We describe how we used object-oriented frameworks to design Choices, an object-oriented operating system.

Campbell, Roy H.; Islam, Nayeem; Johnson, Ralph; Kougiouris, Panos; Madany, Peter

1991-01-01

374

RESEARCH BRIEF School Choice  

E-print Network

research on school choice in all its forms Since the first charter school opened in 1992, the number of charter schools has grown to more than 4,000 in 40 states. Given the priorities of the Obama administration and recent changes in state education policies, charter schools are expected to see further growth

Palmeri, Thomas

375

ARPProgram Choices OPERSfor Staff  

E-print Network

Ohio Public Employees Retirement System Enrollment Deadline: 120 Days #12;2 ·Retirement Program Choices Retirement Plan (ARP) · Ohio Public Employees Retirement System (OPERS) Ohio State employees do to Medicare. Instead, employees are required to participate in the Ohio state retirement system

376

ARPProgram Choices OPERSfor Staff  

E-print Network

Ohio Public Employees Retirement System Enrollment Deadline: 120 Days #12;Retirement Program Choices Alternative Retirement Plan (ARP) · Ohio Public Employees Retirement System (OPERS) Ohio State employees do to participate in the Ohio state retirement system. In recognition of the diverse retirement needs of employees

377

A Matter of Choice  

ERIC Educational Resources Information Center

Since the goal of helping the client make wise decisions is at the core of counseling, it is suggested that existentialism as a state of mind may give the contemporary counselor an outlook most conducive to achieving that goal. The entire role of choice must be dealt with by the counselor in light of the reality of current events. (Author)

Vriend, John

1973-01-01

378

Choice for America's Poor.  

ERIC Educational Resources Information Center

Argues that school choice should be provided to give low-income parents control of their lives and opportunities for their children's futures through access to superior educational resources. Describes the successes of two small private schools, the Sheenway School in Los Angeles and the Holy Angels School in South Chicago. (MAB)

Roggeveen, Dirk G.

1993-01-01

379

Multiple Choice Test  

NSDL National Science Digital Library

This site presents a guide to developing and deploying effective multiple choice tests. The site also discusses the costs and benefits of this method, as well as the philosophy of this commonly used assessment method. Links to more detailed information are included as well.

Parkes, Jay; Guide, Field-Tested L.

380

Supporting Family Choice  

ERIC Educational Resources Information Center

Supporting family choice in the decision-making process is recommended practice in the field of early childhood and early childhood special education. These decisions may relate to the medical, educational, social, recreational, therapeutic/rehabilitative, and community aspects of the child's disability. Although this practice conveys the message…

Murray, Mary M.; Christensen, Kimberly A.; Umbarger, Gardner T.; Rade, Karin C.; Aldridge, Kathryn; Niemeyer, Judith A.

2007-01-01

381

STOCKING UNDER DYNAMIC CHOICE  

Microsoft Academic Search

It is well known that consumers, when faced with limited choices or temporary stock-outs, will often chose different sizes, colors or brands rather than go home empty handed. Intuitively, a firm's decisions about the level of variety they offer and the quantity of inventory they stock ought to account for such behavior. In this talk, we present recent work on

Garett van Ryzin; Siddarth Mahajan

2000-01-01

382

Green Lighting Choices  

NSDL National Science Digital Library

This brief article looks at sustainable choices in home and commercial lighting. The author discusses the energy use of several different types of bulbs, and their appropriate uses. The suggestions the author includes in the article are intended to be both environmentally responsible and have an appearance similar to other lighting projects. This document may be downloaded in Microsoft Word Doc file format.

Benya, James R.

2011-11-29

383

School Choice Today.  

ERIC Educational Resources Information Center

With the increasing demand for better schools, states and communities are providing more options to families. By doing so, they are not only improving educational opportunity for those children, but also having a dramatic impact on how schools operate in their communities. The most important options are full school-choice programs, charter…

DeSchryver, Dave

384

Choice: Panacea or Pandora's Box for California Public Education.  

ERIC Educational Resources Information Center

Disenchantment with 1980s school reform progress has produced school choice--the get-tough, marketplace approach to school improvement. Choice proposals in California fit two categories: interdistrict plans and intradistrict plans. The latter is already a common option featuring open enrollment and management and continuation schools. Two sidebars…

Speich, Don

1989-01-01

385

Primary Versus Specialty Care Outcomes for Depressed Outpatients Managed with Measurement-Based Care: Results from STAR*D  

Microsoft Academic Search

Background  Whether the acute outcomes of major depressive disorder (MDD) treated in primary (PC) or specialty care (SC) settings are\\u000a different is unknown.\\u000a \\u000a \\u000a \\u000a Objective  To compare the treatment and outcomes for depressed outpatients treated in primary versus specialty settings with citalopram\\u000a in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (www.star-d.org), a broadly inclusive effectiveness\\u000a trial.\\u000a \\u000a \\u000a \\u000a Design  Open clinical trial with citalopram

Bradley N. Gaynes; A. John Rush; Madhukar H. Trivedi; Stephen R. Wisniewski; G. K. Balasubramani; Patrick J. McGrath; Michael E. Thase; Michael Klinkman; Andrew A. Nierenberg; William R. Yates; Maurizio Fava

2008-01-01

386

[Institutional support as a fundamental aspect for joint management in primary health care: the experience of a program in Rio de Janeiro, Brazil].  

PubMed

This article presents reflections regarding the concepts and praxis of a new feature for health care and management, namely institutional support. It is seen as a management tool for enhancing quality of care, which has the potential to reformulate the hierarchical and authoritarian practices of health coordination and planning. Institutional support is a trigger for change that can enhance the autonomy, accountability, collective practices and new relationships between managers, professionals and users of the health system. These assumptions are aligned with the concepts of comprehensive and participatory Primary Health Care (PHC), which lead us to the conclusion that matricial and institutional support are processes that generate new models of health care and management. To appreciate the modus operandi of this feature, the Teias Escola Manguinhos/ENSP/Fiocruz experience is presented as a case study, one of the main pillars of which is the adoption of institutional support as a strategy for joint accountability and participative management of PHC in a community in the city of Rio de Janeiro. PMID:25351308

Casanova, Angela Oliveira; Teixeira, Mirna Barros; Montenegro, Elyne

2014-11-01

387

Understanding Predisposition in College Choice: Toward an Integrated Model of College Choice and Theory of Reasoned Action  

ERIC Educational Resources Information Center

This article seeks to improve traditional models of college choice that draw from recruitment and enrollment management paradigms. In adopting a consumer approach to college choice, this article seeks to build upon consumer-related research, which centers on behavior and reasoning. More specifically, this article seeks to move inquiry beyond the…

Pitre, Paul E.; Johnson, Todd E.; Pitre, Charisse Cowan

2006-01-01

388

Intercultural Communication in the Malaysian Vision Schools: Implications for the Management and Leadership in a Multicultural Primary School  

ERIC Educational Resources Information Center

This article discusses intercultural communication in Vision Schools in Malaysia. It also elaborates the extent to which the Vision Schools foster racial interaction across the three major ethnic groups: Malays, Chinese, and Indians. A total of 887 primary school students were surveyed across the Vision Schools. It was found that the intercultural…

Othman, Azam; Ruslan, Norbaiduri; Ahmad, Ismail Sheikh

2012-01-01

389

Principals as Middle Managers: School Leadership during the Implementation of Primary Class Size Reduction Policy in Ontario  

ERIC Educational Resources Information Center

Previous work on policy implementation has often suggested that schools leave their "thumbprints" on policies received from above. During the implementation of Primary Class Size Reduction (PCS) Initiative in Ontario, Canada, however, school principals spoke with remarkable uniformity about the ways PCS affected their work. This article reports…

Flessa, Joseph J.

2012-01-01

390

Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review  

Microsoft Academic Search

BACKGROUND: The diagnosis of dementia in primary care is perceived as a problem across countries and systems, resulting in delayed recognition and adverse outcomes for patients and their carers. Improving its early detection is an area identified for development in the English National Dementia Strategy 2009; there are thought to be multiple benefits to the patient, family, and resources by

Tamar Koch; Steve Iliffe

2010-01-01

391

Confidence and quality in managing CKD compared with other cardiovascular diseases and diabetes mellitus: a linked study of questionnaire and routine primary care data  

PubMed Central

Background Much of chronic disease is managed in primary care and chronic kidney disease (CKD) is a recent addition. We are conducting a cluster randomised study of quality improvement interventions in CKD (QICKD) - Clinical Trials Registration: ISRCTN56023731. CKD registers have a lower than expected prevalence and an initial focus group study suggested variable levels of confidence in managing CKD. Our objective is to compare practitioner confidence and achievement of quality indicators for CKD with hypertension and diabetes. Method We validated a new questionnaire to test confidence. We compared confidence with achievement of pay-for-performance indicators (P4P) and implementation of evidence-based guidance. We achieved a 74% (148/201) response rate. Results 87% (n = 128) of respondents are confident in managing hypertension (HT) compared with 59% (n = 87) in managing HT in CKD (HT+CKD); and with 61% (n = 90) in HT, CKD and diabetes (CKD+HT+DM). 85.2% (P4P) and 62.5% (National targets) of patients with hypertension are at target; in patients with HT and CKD 65.1% and 53.3%; in patients with HT, CKD and DM 67.8% and 29.6%. Confidence in managing proteinuria in CKD is low (42%, n = 62). 87% of respondents knew BP treatment thresholds in CKD, but only 53% when proteinuria is factored in. Male GPs, younger (< 35 yrs), and older (> 54 yrs) clinicians are more confident than females and 35 to 54 year olds in managing CKD. 84% of patients with hypertension treated with angiotensin modulating drugs achieve achieved P4P targets compared to 67% of patients with CKD. Conclusions Practitioners are less likely to achieve management targets where their confidence is low. PMID:21819552

2011-01-01

392

A partnership model for implementing electronic health records in resource-limited primary care settings: experiences from two nurse-managed health centers  

PubMed Central

Objective To present a partnership-based and community-oriented approach designed to ease provider anxiety and facilitate the implementation of electronic health records (EHR) in resource-limited primary care settings. Materials and Methods The approach, referred to as partnership model, was developed and iteratively refined through the research team's previous work on implementing health information technology (HIT) in over 30 safety net practices. This paper uses two case studies to illustrate how the model was applied to help two nurse-managed health centers (NMHC), a particularly vulnerable primary care setting, implement EHR and get prepared to meet the meaningful use criteria. Results The strong focus of the model on continuous quality improvement led to eventual implementation success at both sites, despite difficulties encountered during the initial stages of the project. Discussion There has been a lack of research, particularly in resource-limited primary care settings, on strategies for abating provider anxiety and preparing them to manage complex changes associated with EHR uptake. The partnership model described in this paper may provide useful insights into the work shepherded by HIT regional extension centers dedicated to supporting resource-limited communities disproportionally affected by EHR adoption barriers. Conclusion NMHC, similar to other primary care settings, are often poorly resourced, understaffed, and lack the necessary expertise to deploy EHR and integrate its use into their day-to-day practice. This study demonstrates that implementation of EHR, a prerequisite to meaningful use, can be successfully achieved in this setting, and partnership efforts extending far beyond the initial software deployment stage may be the key. PMID:21828225

Dennehy, Patricia; White, Mary P; Hamilton, Andrew; Pohl, Joanne M; Tanner, Clare; Onifade, Tiffiani J

2011-01-01

393

Serotonergic Genotypes, Neuroticism, and Financial Choices  

PubMed Central

Life financial outcomes carry a significant heritable component, but the mechanisms by which genes influence financial choices remain unclear. Focusing on a polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR), we found that individuals possessing the short allele of this gene invested less in equities, were less engaged in actively making investment decisions, and had fewer credit lines. Short allele carriers also showed higher levels of the personality trait neuroticism, despite not differing from others with respect to cognitive skills, education, or wealth. Mediation analysis suggested that the presence of the 5-HTTLPR short allele decreased real life measures of financial risk taking through its influence on neuroticism. These findings show that 5-HTTLPR short allele carriers avoid risky and complex financial choices due to negative emotional reactions, and have implications for understanding and managing individual differences in financial choice. PMID:23382929

Kuhnen, Camelia M.; Samanez-Larkin, Gregory R.; Knutson, Brian

2013-01-01

394

Serotonergic genotypes, neuroticism, and financial choices.  

PubMed

Life financial outcomes carry a significant heritable component, but the mechanisms by which genes influence financial choices remain unclear. Focusing on a polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR), we found that individuals possessing the short allele of this gene invested less in equities, were less engaged in actively making investment decisions, and had fewer credit lines. Short allele carriers also showed higher levels of the personality trait neuroticism, despite not differing from others with respect to cognitive skills, education, or wealth. Mediation analysis suggested that the presence of the 5-HTTLPR short allele decreased real life measures of financial risk taking through its influence on neuroticism. These findings show that 5-HTTLPR short allele carriers avoid risky and complex financial choices due to negative emotional reactions, and have implications for understanding and managing individual differences in financial choice. PMID:23382929

Kuhnen, Camelia M; Samanez-Larkin, Gregory R; Knutson, Brian

2013-01-01

395

The Maastricht Ultrasound Shoulder pain trial (MUST): Ultrasound imaging as a diagnostic triage tool to improve management of patients with non-chronic shoulder pain in primary care  

PubMed Central

Background Subacromial disorders are considered to be one of the most common pathologies affecting the shoulder. Optimal therapy for shoulder pain (SP) in primary care is yet unknown, since clinical history and physical examination do not provide decisive evidence as to the patho-anatomical origin of the symptoms. Optimal decision strategies can be furthered by applying ultrasound imaging (US), an accurate method in diagnosing SP, demonstrating a clear relationship between diagnosis and available therapies. Yet, the clinical cost-effectiveness of applying US in the management of SP in primary care has not been studied. The aim of this paper is to describe the design and methods of a trial assessing the cost-effectiveness of ultrasound imaging as a diagnostic triage tool to improve management of primary care patients with non-chronic shoulder pain. Methods/Design This randomised controlled trial (RCT) will involve 226 adult patients with suspected subacromial disorders recruited by general practitioners. During a Qualification period of two weeks, patients receive care as usual as advised by the Dutch College of General Practitioners, and patients are referred for US. Patients with insufficient improvement qualify for the RCT. These patients are then randomly assigned to the intervention or the control group. The therapies used in both groups are the same (corticosteroid injections, referral to a physiotherapist or orthopedic surgeon) except that therapies used in the intervention group will be tailored based on the US results. Ultrasound diagnosed disorders include tendinopathy, calcific tendinitis, partial and full thickness tears, and subacromial bursitis. The primary outcome is patient-perceived recovery at 52 weeks, using the Global Perceived Effect questionnaire. Secondary outcomes are disease specific and generic quality of life, cost-effectiveness, and the adherence to the initial applied treatment. Outcome measures will be assessed at baseline, 13, 26, 39 and 52 weeks after inclusion. An economic evaluation will be performed from both a health care and societal perspective with a time horizon of 52 weeks. Discussion The results of this trial will give unique evidence regarding the cost-effectiveness of US as a diagnostic triage tool in the management of SP in primary care. PMID:21740540

2011-01-01

396

CropChoice  

NSDL National Science Digital Library

CropChoice is an alternative news and information source for American farmers and consumers about genetically modified crops, corporate agribusiness concentration, farm and trade policy, sustainable agriculture, wind farming and alternative energy, and rural economic and social issues. Users can explore the site's resources by topic, search past headlines and view press releases. Links are provided to sites that involve similar issues and information.

2007-04-16

397

Managing depression in primary care: A meta-synthesis of qualitative and quantitative research from the UK to identify barriers and facilitators  

Microsoft Academic Search

Background  Current management in primary care of depression, with or without comorbid physical illness, has been found to be suboptimal.\\u000a We therefore conducted a systematic review to identify clinician perceived barriers to and facilitators for good depression\\u000a care.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We conducted a systematic literature search to identify qualitative and quantitative studies published in the UK since 2000\\u000a of GPs' and practice nurses'

Elizabeth A Barley; Joanna Murray; Paul Walters; André Tylee

2011-01-01

398

Effectiveness and efficiency of primary care based case management for chronic diseases: rationale and design of a systematic review and meta-analysis of randomized and non-randomized trials [CRD32009100316  

Microsoft Academic Search

BACKGROUND: Case management is an important component of structured and evidence-based primary care for chronically ill patients. Its effectiveness and efficiency has been evaluated in numerous clinical trials. This protocol describes aims and methods of a systematic review of research on the effectiveness and efficiency of case management in primary care. METHODS\\/DESIGN: According to this protocol Medline, Embase, CINAHL, PsychInfo,

Tobias Freund; Felizitas Kayling; Antje Miksch; Joachim Szecsenyi; Michel Wensing

2010-01-01

399

[The diabetes traffic light scheme - development of an instrument for the case management in patients with diabetes mellitus in primary care].  

PubMed

In order to sustain the continuity and quality of treatment in diabetic primary care patients, it is necessary to introduce structured and regularly performed monitoring system into the practice team. The monitoring aims at early and valid recognition of potential complications resulting from a chronic disease. Ideally the practice nurse is in charge of the case management. The central element of the case management is a colour coded instrument, the diabetes traffic light scheme, by which means the most important clinical parameters and patient adherence can be screened in regular intervals. Additionally, the instrument regulates in-practice communication by means of stratified action plans and enables ideal treatment continuity also in larger teams. The experiences resulting from the development of this diabetes-specific traffic light scheme can be beneficial for the future development of similar instruments in other chronic diseases. PMID:22124957

Chmiel, C; Birnbaum, B; Gensichen, J; Rosemann, T; Frei, A

2011-11-30

400

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial  

PubMed Central

Background The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. Methods In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n?=?253), protocolized (n?=?197), and usual care (n?=?333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Results Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Conclusions Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. Trial registration Current Controlled trials: ISRCTN66124817. PMID:24966055

2014-01-01

401

Patient reported barriers and facilitators to using a self-management booklet for hip and knee osteoarthritis in primary care: results of a qualitative interview study  

PubMed Central

Background To enhance guideline-based non-surgical management of hip or knee osteoarthritis (OA), a multidisciplinary, stepped-care strategy has been implemented in primary care in a region of the Netherlands. To facilitate this implementation, the self-management booklet “Care for Osteoarthritis” was developed and introduced. The aim of the booklet was to educate patients about OA, to enhance the patient’s active role in the treatment course, and to improve the communication with health care providers. To successfully introduce the booklet on a large scale we assessed barriers and facilitators for patients to using this booklet. Methods Seventeen primary care patients with hip or knee OA who received the self-management booklet participated in this qualitative study using semi-structured interviews. Purposive sampling was used to ensure diversity of the patients’ view about the booklet. The interviews were transcribed verbatim and analysed using a thematic analysis approach. Results Three core themes with patient perceived barriers and facilitators to use the booklet emerged from the interviews: 1) the role of health care providers, 2) the patient’s perceptions about OA and its manageability, and 3) the patient’s perceptions about the usefulness of the booklet and patient’s information needs. Regarding the first theme, a barrier was the lack of encouragement from health care providers to use the booklet in the treatment course of OA. Moreover, patients had doubts concerning the health care providers’ endorsement of non-surgical treatment for OA. Barriers from the second theme were: thinking that OA is not treatable or that being pro-active during the treatment course is not important. In contrast, being convinced about the importance of an active participation in the treatment course was a facilitator. Third, patients’ perceptions about the usefulness of the booklet and patients’ information needs were both identified as barriers as well as facilitators for booklet use. Conclusions This study contributes to the understanding of patient perceived barriers and facilitators to use a self-management booklet in the treatment course of OA. The results offer practical starting points to tailor the implementation activities of the booklet nationwide and to introduce comparable educational tools in OA primary care or in other chronic diseases. PMID:24289303

2013-01-01

402

Systematic Age-Related Differences in Chronic Disease Management in a Population-Based Cohort Study: A New Paradigm of Primary Care Is Required  

PubMed Central

Background Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF) and coronary heart disease (CHD), by age group. Methods This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ?16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level. Results The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16–44 year-olds), adults (45–64), and oldest old (+85) than for patients aged 65–74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16–44 y), adults (45–64 y), the very old (75–84 y) and the oldest old (+85 y) patients with CHD, CHF and diabetes are less likely than 65–74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old. Conclusion Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly. PMID:24632818

Buja, Alessandra; Damiani, Gianfranco; Gini, Rosa; Visca, Modesta; Federico, Bruno; Donato, Daniele; Francesconi, Paolo; Marini, Alessandro; Donatini, Andrea; Brugaletta, Salvatore; Baldo, Vincenzo; Donata Bellentani, Maria

2014-01-01

403

Surgery for primary hyperparathyroidism.  

PubMed

In the Western world, primary hyperparathyroidism is now a relatively common disorder that is diagnosed in 0.7% of the general population and in 2% of postmenopausal women. Although patients today typically present with less severe manifestations of disease, the evaluation and management of patients with parathyroid disease remains challenging. Primary hyperparathyroidism is a complex disease process that requires careful diagnosis and thoughtful medical and surgical management. The surgical management of patients with persistent or recurrent disease, inherited primary hyperparathyroidism syndromes, and parathyroid carcinoma is particularly challenging. High-quality imaging and reliable intraoperative adjuncts are critical to success. Cancer 2014;120:3602-3616. © 2014 American Cancer Society. PMID:25042934

Callender, Glenda G; Udelsman, Robert

2014-12-01

404

Medical management for intractable pain arising from primary sjögren syndrome involving both brain and spinal cord: a case report.  

PubMed

Primary Sjögren syndrome, which involves lesions in both the brain and spinal cord, is rarely reported. Related symptoms, such as intractable pain due to central nervous system involvement, are very rare. A 73-year-old woman diagnosed with primary Sjögren syndrome manifested with subacute encephalopathy and extensive transverse myelitis. She complained of severe whole body neuropathic pain. Magnetic resonance imaging demonstrated a non-enhancing ill-defined high intensity signal involving the posterior limb of the both internal capsule and right thalamus on a T2 fluid-attenuated inversion recovery image. Additionally, multifocal intramedullary ill-defined contrast-enhancing lesion with cord swelling from the C-spine to L-spine was also visible on the T2-weighted image. Her intractable pain remarkably improved after administration of concomitant oral doses of gabapentin, venlafaxine, and carbamazepine. PMID:25229038

Lee, Kyoung Moo; Han, Kyu Yong; Kwon, Oh Pum

2014-08-01

405

[The development of evaluation capacity in primary healthcare management: a case study in Santa Catarina State, Brazil, 2008-2011].  

PubMed

This article analyzes evaluation capacity-building based on the case study of a State Health Secretariat participating in the Project to Strengthen the Technical Capacity of State Health Secretariats in Monitoring and Evaluating Primary Healthcare. The case study adopted a mixed design with information from documents, semi-structured interviews, and evaluation of primary care by the State Health Secretariat in 2008-2011. Process analysis was used to identify the logical events that contributed to evaluation capacity-building, with two categories: evaluation capacity-building events and events for building organizational structure. The logical chain of events was formed by negotiation and agreement on the decision-making levels for the continuity of evaluation, data collection and analysis by the State Health Secretariat, a change in key indicators, restructuring of the evaluation matrix, and communication of the results to the municipalities. The three-way analysis showed that the aim of developing evaluation capacity was achieved. PMID:24896058

Nickel, Daniela Alba; Calvo, Maria Cristina Marino; Natal, Sonia; de Freitas, Sérgio Fernando Torres; Hartz, Zulmira Maria de Araújo

2014-04-01

406

An interdisciplinary clinical practice model for the management of low-back pain in primary care: the CLIP project  

Microsoft Academic Search

BACKGROUND: Low-back pain is responsible for significant disability and costs in industrialized countries. Only a minority of subjects suffering from low-back pain will develop persistent disability. However, this minority is responsible for the majority of costs and has the poorest health outcomes. The objective of the Clinic on Low-back pain in Interdisciplinary Practice (CLIP) project was to develop a primary

Stéphane Poitras; Michel Rossignol; Clermont Dionne; Michel Tousignant; Manon Truchon; Bertrand Arsenault; Pierre Allard; Manon Coté; Alain Neveu

2008-01-01

407

Preferences for access to the GP: a discrete choice experiment  

PubMed Central

Background Access to primary care services is one of the key components of the NHS Plan which states that patients should be able to see a health professional with 24 hours and a GP with 48 hours. However, it is not clear how patients value speed of access in comparison with other aspects of primary care. Aim To investigate patient preferences when making an routine appointment for a GP, and to describe the trade-offs and relationships between speed of access, choice of time and choice of doctor in different patient groups. Design of study Discrete choice experiment. Setting Adults consulting a GP in six general practices in Sunderland Method Choice sets based on three attributes (time to appointment, choice of time, choice of doctor) were presented in a self-completion questionnaire. Results We obtained 6985 observations from 1153 patients. We found that the waiting time to make an appointment was only important if the appointment is for a child or when attending for a new health problem. Other responders would trade-off a shorter waiting time and be willing to wait in order to either see their own choice of doctor or attend an appointment at their own choice of time. For responders who work, choice of time is six times more important than a shorter waiting time and they are willing to wait up to 1 day extra for this. Those with a long-standing illness value seeing their own GP more than seven times as much as having a shorter waiting time for an appointment and will wait an extra 1 day for an appointment with the GP of their choice, women will wait an extra 2 days, and older patients an extra 2.5 days. Conclusion Speed of access is of limited importance to patients accessing their GP, and for many is outweighed by choice of GP or convenience of appointment. PMID:17007703

Rubin, Greg; Bate, Angela; George, Ajay; Shackley, Phil; Hall, Nicola

2006-01-01

408

Routing problem with service choices  

E-print Network

This thesis finds solutions to the routing problem with service choices which is formulated as a capacitated minimum cost flow circulation problem with GUB constraints. The routing problem with service choices is solved ...

Lee, Boon Chai

1986-01-01

409

Mountain Health Choices Beneficiary Report  

E-print Network

Mountain Health Choices Beneficiary Report A Report to the West Virginia Bureau for Medical of Health and Human Resources, Bureau for Medical Services. #12; 1 Table of Contents I. EXECUTIVE .......................................................................................................................... 5 II. MOUNTAIN HEALTH CHOICES

Mohaghegh, Shahab

410

Are Forms of Financial Support and Employment Choices of Recent Science and Engineering Ph.D.s Related?  

NSF Publications Database

... Choices of Recent Science and Engineering Ph.D.s Related? (July 22, 1998) This issue brief ... employment choices of recent S&E Ph.D.s and their primary mechanisms of financial support while in ...

411

The Impact of Supervision on Internal Medicine Residents' Attitudes and Management of Depression in Primary Care: A Pilot Study  

ERIC Educational Resources Information Center

Objective: The authors examined the effect of supervision on internal medicine residents' attitudes toward and management of depression. Method: Internal medicine residents completed a survey during preclinical conferences. The survey included a published, validated questionnaire, the Depression Attitude Questionnaire, and items developed by the…

Milone, Jennifer M.; Gottumukkala, Aruna; Ward, Christopher P.; York, Kaki M.

2013-01-01

412

Primary Children's Management of Themselves and Others in Collaborative Group Work: "Sometimes It Takes Patience…"  

ERIC Educational Resources Information Center

We focus on children's approaches to managing group work in classrooms where collaborative learning principles are explicit. Small groups of 8-10 year olds worked on collaborative science activities using an interactive whiteboard. Insubsequent interviews, they spoke of learning to "be patient" and "wait", for multiple…

Kershner, Ruth; Warwick, Paul; Mercer, Neil; Kleine Staarman, Judith

2014-01-01

413

The Interface between Substance Abuse and Chronic Pain Management in Primary Care: A Curriculum for Medical Residents  

ERIC Educational Resources Information Center

Objectives: To develop and assess a housestaff curriculum on opioid and other substance abuse among patients with chronic noncancer pain (CNCP). Methods: The two-hour, case-based curriculum delivered to small groups of medical housestaff sought to improve assessment and management of opioid-treated CNCP patients, including those with a substance…

Gunderson, Erik W.; Coffin, Phillip O.; Chang, Nancy; Polydorou, Soteri; Levin, Frances R.

2009-01-01

414

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study  

PubMed Central

Background Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed. Methods The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data. Results The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices. Conclusion The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices. PMID:19825189

Laws, Rachel A; Kemp, Lynn A; Harris, Mark F; Davies, Gawaine Powell; Williams, Anna M; Eames-Brown, Rosslyn

2009-01-01

415

Performance of first-line management functions on productivity of hospital unit personnel.  

PubMed

Eight management functions influence the productivity of unit personnel differently. Although leadership of the first-line manager is the primary driving force, time and effort expended in operations detract from this unit output. Better use of second-line managers is a choice strategy to enhance productivity. Benner's model of professional development, in combination with the creation of a first-second line shared leadership operational framework, is recommended, with follow-up evaluations on unit productivity effect. PMID:10491664

Fox, R T; Fox, D H; Wells, P J

1999-09-01

416

Primary care Physicians' perspective on the management of anxiety and depressive disorders: a cross-sectional survey in Emilia Romagna Region  

PubMed Central

Background Evidences from literature suggest that Primary Care Physicians’ (PCPs) knowledge and attitude about psychological and pharmacological treatments of anxiety and depressive disorders could influence their clinical practice. The aim of the study is double: 1) to assess PCPs’ opinions about antidepressants (ADs) and psychotherapy for the management of anxiety and depressive disorders; 2) to evaluate the influence of PCPs’ gender, age, duration of clinical practice, and office location on their opinions and attitudes. Methods This cross-sectional multicentre survey involved 816 PCPs working in four Local Health Units of the Emilia Romagna Region. Participating PCPs were asked to complete a questionnaire during educational meetings between October 2006 and December 2008. Results The response rate was 65.1%. Eighty-five percent of PCPs agreed on the effectiveness of ADs for depressive disorder whereas lower agreement emerged for anxiety disorder and on psychotherapy for both anxiety and depression. Forty percent of PCPs reported to feel “very/extremely confident” in recognizing depression and 20.0% felt equally confident in treating it with pharmacotherapy. Considering anxiety disorder, these proportions increased. Female PCPs and those located in the rural/mountain areas reported to adopt more psycho-educational support compared to male and suburban colleagues. Conclusions Our results suggest that an effort should be made to better disseminate recent evidences about the management of anxiety and depressive disorders in Primary Care. In particular, the importance of psychological interventions and the role of drugs for anxiety disorder should be addressed. PMID:23758941

2013-01-01

417

BRIEF REPORT Predicting Affective Choice  

E-print Network

BRIEF REPORT Predicting Affective Choice Gaurav Suri Stanford University Gal Sheppes Tel Aviv quantified the role of two basic dimensions of affect--valence and arousal--in determining choice. We predicted choice and outperformed competing models drawn from well-established theoretical views. Finally

Gross, James J.

418

Language Choices at Naha Airport  

Microsoft Academic Search

This paper investigates regimented language choices at Naha Airport in Okinawa Prefecture in order to study how these language choices relate to language ideology on one hand and to creating a self-supporting language ecology of maximum diversity on the other. Issues of power and ideology underlie the language choice and the language ecology which evolve from them, as well as

Patrick Heinrich

2010-01-01

419

Constructing Food Choice Decisions  

Microsoft Academic Search

Background  Food choice decisions are frequent, multifaceted, situational, dynamic, and complex and lead to food behaviors where people\\u000a acquire, prepare, serve, give away, store, eat, and clean up. Many disciplines and fields examine decision making.\\u000a \\u000a \\u000a \\u000a Purpose  Several classes of theories are applicable to food decision making, including social behavior, social facts, and social definition\\u000a perspectives. Each offers some insights but also makes

Jeffery Sobal; Carole A. Bisogni

2009-01-01

420

Private financing and operation of a space station: Investment requirements, risk, government support and other primary business management considerations  

NASA Technical Reports Server (NTRS)

Private investment in a manned space station is considered as an alternative to complete government sponsorship of such a program. The implications of manned space operations are discussed from a business perspective. The most significant problems and risks which would be faced by a private company involved in a space station enterprise are outlined and possible government roles in helping to overcome these difficulties suggested. Economic factors such as inflation and the rate of interest are of primary concern, but less obvious conditions such as antitrust and appropriate regulatory laws, government appropriations for space activities, and national security are also considered.

Simon, M.

1982-01-01

421

Testing the Efficacy of INSIGHTS on Student Disruptive Behavior, Classroom Management, and Student Competence in Inner City Primary Grades  

Microsoft Academic Search

A prevention trial tested the efficacy of INSIGHTS into Children’s Temperament as compared to a Read Aloud attention control condition in reducing student disruptive behavior and enhancing student competence\\u000a and teacher classroom management. Participants included 116 first and second grade students, their parents, and their 42 teachers\\u000a in six inner city schools. Teachers completed the Sutter-Eyberg Student Behavior Inventory (SESBI)

Sandra Graham McClowry; David L. Snow; Catherine S. Tamis-LeMonda; Eileen T. Rodriguez

2010-01-01

422

Yes, But It’s Somewhat Difficult-Managing End of Life Care in Primary Health Care  

Microsoft Academic Search

A qualitative study was undertaken to investigate the perceptions of General Practitioners regarding the management of older\\u000a people with heart failure, particularly at the end of life. Semi-structured interviews were conducted with 30 General Practitioners\\u000a in Auckland, New Zealand during 2008. Participants identified that the needs of older patients with heart failure could not\\u000a be addressed in isolation from the

Susan Waterworth; Deborah Raphael; Margaret Horsburgh

423