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1

A SOCIAL CHOICE APPROACH TO PRIMARY RESOURCE MANAGEMENT: THE RUBBER TREE CASE IN AFRICA  

E-print Network

A SOCIAL CHOICE APPROACH TO PRIMARY RESOURCE MANAGEMENT: THE RUBBER TREE CASE IN AFRICA MOUSSA approach to a decision making problem related to the management of a primary resource, namely the rubber operation research methods) by the african rubber tree planters in order to get a plantation at peak

Paris-Sud XI, Université de

2

Host nutritive quality and host plant choice in two grass miners: primary roles for primary compounds?  

PubMed

The relationship between host plant choice and plant nutritional quality was investigated in two oligophagous grass miners Chromatomyia milii and C. nigra (Diptera, Agromyzidae). We tested whether host choice is determined by chemically mediated host suitability for offspring performance and/or adult performance. A second goal was to relate the observed variation among the different fitness parameters to quantitative and qualitative variation in foliar food quality. Choice experiments illustrated that both miners discriminated among grass species, and that C. milii has a smaller host range than C. nigra, as observed under natural conditions. Oviposition preference was correlated with adult feeding preference and related adult performance (longevity and fecundity) for both miners. Offspring performance measures (survival and pupal size) of at least C. nigra were more weakly related to host preference. Nearly all variation in adult performance of both miners was explained by foliar protein content, which had a positive effect on adult longevity and fecundity. Pupal size of both miners was positively related to foliar water and amino acid content and negatively related to lignin content. No clear relationship between host chemistry and offspring survival was observed. These observations show that fitness parameters are differentially related to host chemistry. Secondly, they suggest that chemically mediated host suitability for adult performance is an important determinant of host choice in this species. Finally, the results suggest a primary role for foliar protein content in host choice of the study species in general and in shaping the host range of C. milii in particular. PMID:12918922

Scheirs, Jan; De Bruyn, Luc; Verhagen, Ron

2003-06-01

3

Choice-Based Segmentation as an Enrollment Management Tool  

ERIC Educational Resources Information Center

This article presents an approach to enrollment management based on target marketing strategies developed from a choice-based segmentation methodology. Students are classified into "switchable" or "non-switchable" segments based on their probability of selecting specific majors. A modified multinomial logit choice model is used to identify…

Young, Mark R.

2002-01-01

4

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

5

Household Risk Management and Optimal Mortgage Choice  

Microsoft Academic Search

A typical household has a home mortgage as its most significant financial contract. The form of this contract is correspondingly important. This paper studies the choice between a fixed-rate (FRM) and an adjustable-rate (ARM) mortgage. In an environment with uncertain inflation, a nominal FRM has risky real capital value whereas an ARM has a stable real capital value. However an

John Y. Campbell; Joao F. Cocco

2003-01-01

6

Using Contingent Choice Surveys to Inform National Park Management  

Microsoft Academic Search

Contingent choice surveys, in which respondents rate or rank alternative scenarios describing potential futures composed of varying levels of several different attributes, can help national park managers by identifying the preferences of visitors and also the nonuse values generated by park attributes. Many alternative combinations of park attributes can be explored efficiently, helping park managers to identify promising alternatives to

Robert W Turner

2012-01-01

7

More Choices Available for Diabetes Management  

MedlinePLUS

... to monitor and manage their glucose levels. The continuous glucose monitor (CGM) shown here includes a glucose ... tube (cannula) implanted just under the skin. • a continuous glucose monitor (CGM), which uses sensors that measure ...

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

Lodging control through variety choice and management  

Microsoft Academic Search

Summary Lodged crops are common in most summers and the consequent reductions in profit are known to be large, yet methods for control are poorly understood and qualitative. This paper describes how a recently developed model of lodging has been used to quantify how variety and other management factors affect lodging risk. This has shown that there are two types

P. BERRY; J. SPINK; R. SYLVESTER-BRADLEY; A. PICKETT

10

Friendship Choice in a Mixed-Race Primary School.  

ERIC Educational Resources Information Center

Discusses a study undertaken to determine whether young children are aware that people differ in skin color and to assess the value judgments that children attach to their color-related observations. Findings indicated that among 120 children from a mixed-race primary school, the White children named White friends predominantly and non-White…

Braha, Vania; Rutter, D. R.

1980-01-01

11

The Surprising Influence of Delayed Primary Reinforcement on Choice  

ERIC Educational Resources Information Center

It is well known that the duration of the delay between a response and consequence is inversely related to the impact of that consequence on future responding, and even short delays can greatly undermine the effectiveness of a consequence. However, several studies have shown that delayed primary reinforcement can have a substantial impact on…

McDevitt, Margaret A.

2007-01-01

12

Patient Choice for Older People in English NHS Primary Care: Theory and Practice  

PubMed Central

In the English National Health Service (NHS), patients are now expected to choose the time and place of treatment and even choose the actual treatment. However, the theory on which patient choice is based and the implementation of patient choice are controversial. There is evidence to indicate that attitudes and abilities to make choices are relatively sophisticated and not as straightforward as policy developments suggest. In addition, and surprisingly, there is little research on whether making individual choices about care is regarded as a priority by the largest NHS patient group and the single largest group for most GPs—older people. This conceptual paper examines the theory of patient choice concerning accessing and engaging with healthcare provision and reviews existing evidence on older people and patient choice in primary care. PMID:24967329

Harding, Andrew J. E.; Sanders, Frances; Lara, Antonieta Medina; van Teijlingen, Edwin R.; Wood, Cate; Galpin, Di; Baron, Sue; Crowe, Sam; Sharma, Sheetal

2014-01-01

13

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

14

Social choice procedures in water-resource management  

Microsoft Academic Search

Social choice procedures are introduced and applied to solve a special water-resources management problem of Northern Arizona. The methods include plurality voting, the Borda count, the Hare system, pairwise voting and dictatorship. These procedures are applicable in all cases when several alternatives are simultaneously ranked by different decision makers, or decision making groups or with respect to conflicting criteria. Since

Andre d'Angelo; Abdollah Eskandari; Ferenc Szidarovszky

1998-01-01

15

Management of primary and metastatic spinal tumors.  

PubMed

ìTumors of the spine, though rare, may significantly impact quality of life. The management depends not only on clinical presentation, but also on histology, stage and grade of the tumor. Primary benign tumors usually are a focal problem, however, may be focally aggressive. Primary malignant tumors are always considered aggressive and are managed in a multidisciplinary fashion. Surgical treatment often requires aggressive en bloc resection to maximize potential for cure. Metastatic tumors of the spine may cause a significant impact on the quality of life. In select cases with spine instability, pain and neurologic deficit surgical management is indicated. PMID:25649066

Arutyunyan, G G; Clarke, M J

2015-06-01

16

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

17

Primary care case management: lessons for Medicare?  

PubMed

This paper looks at primary care case management (PCCM) as a tool that states have used to manage the delivery of care to their Medicaid populations, an alternative to contracting with commercial managed care plans. PCCM has proved a flexible means of advancing state policy goals, including quality improvement, disease management, and coverage of special-needs populations. The paper considers provider and beneficiary perspectives on PCCM as well as state agency objectives and accomplishments. Finally, it raises the question of adapting the PCCM model for Medicare. Speakers at the accompanying Forum session will expand on these topics. PMID:11800002

Sprague, L

2001-10-01

18

Expanding Medicaid managed care: the right choice for Texas?  

PubMed

We set out to determine whether expanding Medicaid managed care in Texas is the solution to the challenges faced by the state of meeting the healthcare needs of a rapidly growing Medicaid population while addressing its own fiscal limitations. We reviewed the Texas Medicaid program, the potential effects of federal healthcare reform, and the state political climate through the perspectives (advantages and disadvantages) of the primary stakeholders: patients, practitioners, hospitals, and insurers. Research was performed through online, federal and state regulatory, and legislative review. In addition, we reviewed government and peer-reviewed reports and articles pertaining to issues related to Medicaid populations, healthcare practitioners, and hospitals that serve them. Each primary stakeholder had potential advantages and disadvantages associated with the expansion of Medicaid managed care. We conclude that expanding Medicaid managed care, if done in a manner responsive to the needs of recipients, can meet enrollees' healthcare needs while controlling the state's costs. PMID:23038487

Reddy, Swapna; Finley, Marisa; Posey, Dan; Rohack, James J

2012-10-01

19

Primary care management of celiac disease.  

PubMed

: Celiac disease is an autoimmune disorder with genetic predisposition that affects as many as 1 in 100 individuals. Treatment is a lifelong, strict adherence to a gluten-free diet. Management by a primary care provider may lead to increased adherence and can minimize effects of nonadherence to the diet. PMID:25574900

Robinson, Brittani Ledford; Davis, Stephanie C; Vess, Joy; Lebel, Joseph

2015-02-15

20

Use of the NHS Choices website for primary care consultations: results from online and general practice surveys  

PubMed Central

Objectives To determine the effect of using the NHS Choices website on primary care consultations in England and Wales. We examined the hypothesis that using NHS Choices may reduce the frequency of primary care consultations among young, healthy users. Design Two cross-sectional surveys of NHS Choices users. Setting Survey of NHS Choices users using an online pop-up questionnaire on the NHS Choices website and a snapshot survey of patients in six general practices in London. Participants NHS Choices website users and general practice patients. Main outcome measures For both surveys, we measured the proportion of people using NHS Choices when considering whether to consult their GP practice and on subsequent frequency of primary care consultations. Results Around 59% (n = 1559) of online and 8% (n = 125) of general practice survey respondents reported using NHS Choices in relation to their use of primary care services. Among these, 33% (n = 515) of online and 18% (n = 23) of general practice respondents reported reduced primary care consultations as a result of using NHS Choices. We estimated the equivalent capacity savings in primary care from reduced consultations as a result of using NHS Choices to be approximately £94 million per year. Conclusions NHS Choices has been shown to alter healthcare-seeking behaviour, attitudes and knowledge among its users. Using NHS Choices results in reduced demand for primary care consultations among young, healthy users for whom reduced health service use is likely to be appropriate. Reducing potentially avoidable consultations can result in considerable capacity savings in UK primary care. PMID:21847438

Murray, Joanna; Majeed, Azeem; Khan, Muhammad Saleem; Lee, John Tayu; Nelson, Paul

2011-01-01

21

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

22

Fairness hypothesis and managing the risks of societal technology choices  

SciTech Connect

Much of the literature on risk perception and management has asked how society should resolve the question, ''How safe is safe enough'' There has been political and technical disagreement over the types of answers that may be given, as well as over the social values attached to perceived probabilities and magnitudes of various outcomes. Despite controversy, there seems to have been a large measure of consensus that, ''How safe is safe enough'' is the right question to ask. This paper sets out to question that assumption. Various ingenious techniques of risk analysis have sought to discover the real risks inherent in various activities, but from a sociocultural viewpoint it can be seen that no single answer can be given to the problem of adequate safety in a complex society which contains a wide variety of perceptual biases about danger, expectations of the good life, and levels of demand for safety. The paper argues that, from a societal risk-management perspective, we should be addressing a different range of questions that views societal risk as a whole rather than as the sum of individual hazards. Resolving the question, ''How safe is safe enough'' is less important in making societal technology choices than ''How fair is safe enough.'' A recent empirical pilot study is reported which explored the fairness hypotheses in the context of nuclear power. The results indicate that the process of technology choice should recognize explicitly the preferred principles different parties hold with respect to obtaining consent from those affected by the risks, distributing the liabilities, and justifying trust in the relevant institutions. The paper closes with a discussion of future prospects for the fairness approach in areas such as noxious facility siting.

Cantor, R.; Rayner, S.

1986-08-01

23

Free cash flow, debt-monitoring and managers' LIFO\\/FIFO policy choice  

Microsoft Academic Search

This paper explores the explanatory power of Jensen's free cash flow hypothesis in managers' choice of LIFO versus FIFO. The association between FCF, and choice of inventory methods is based on the assumption that there is a potential conflict of interest between managers and shareholders when LIFO is the tax minimization method and that non-value-maximizing managers of firms with the

Ferdinand A. Gul

2001-01-01

24

Managing chronic conditions for elderly adults: the VNS CHOICE model.  

PubMed

Chronic illness combined with functional impairment often results in an increased need for medical care and supportive long-term care (LTC) services. Navigating the health care system is challenging and complex, and even more so for patients with complex needs. Traditional fee-for-service care does not support and facilitate coordination and collaboration between providers and service settings. In New York State, managed LTC, a model of coordinated care for the chronically ill, endeavors to provide a bridge between primary, acute, home and community-based, and institutional LTC services for a medically complex and functionally frail nursing home eligible population. PMID:17288076

Fisher, Holly Michaels; McCabe, Suzanne

2005-01-01

25

Knowledge of primary health care and career choice at primary health care settings among final year medical students - challenges to human resources for health in Vietnam.  

PubMed

There is a shortage of medical doctors in primary health care (PHC) settings in Vietnam. Evidence about the knowledge medical students have about PHC and their career decision-making is important for making policy in human resources for health. The objective of this study was to analyse knowledge and attitudes about PHC among medical students in their final year and their choice to work in PHC after graduation. A cross-sectional study was conducted among 400 final year general medical students from Hanoi Medical University. Self-administered interviews were conducted. Key variables were knowledge, awareness of the importance of PHC and PHC career choices. Descriptive and analytic statistics were performed. Students had essential knowledge of the concept and elements of PHC and were well aware of its importance. However, only one-third to one half of them valued PHC with regard to their professional development or management opportunities. Less than 1% of students would work at commune or district health facilities after graduation. This study evidences challenges related to increasing the number of medical doctors working in PHC settings. Immediate and effective interventions are needed to make PHC settings more attractive and to encourage medical graduates to start and continue a career in PHC. PMID:25482387

Giang, Kim Bao; Minh, Hoang Van; Hien, Nguyen Van; Ngoc, Nguyen Minh; Hinh, Nguyen Duc

2015-01-01

26

The Perceptions and Pressures Experienced by Male Primary Elementary Teachers and How These Affect Their Behaviors and Career Choices  

ERIC Educational Resources Information Center

This dissertation was a qualitative study of the perceptions and pressure of male primary elementary teachers and how these may affect their behavior and career choices. The researcher sought, through interviews of all stakeholders, to better understand the world of a male primary elementary teacher and how they are impacted by the thoughts and…

Siefert, Darin William

2011-01-01

27

Differences between primary auditory cortex and auditory belt related to encoding and choice for AM sounds  

PubMed Central

We recorded from middle-lateral (ML) and primary (A1) auditory cortex while macaques discriminated amplitude modulated (AM) from unmodulated noise. Compared to A1, ML had a higher proportion of neurons that encode increasing AM depth by decreasing their firing-rates (‘decreasing’ neurons), particularly with responses that were not synchronized to the modulation. Choice probability (CP) analysis revealed that A1 and ML activity were different during the first half of the test stimulus. In A1, significant CP begins prior to the test stimulus, remains relatively constant (or increases slightly) during the stimulus and increases greatly within 200 ms of lever-release. Neurons in ML behave similarly, except that significant CP disappears during the first half of the stimulus and reappears during the second half and pre-release periods. CP differences between A1 and ML depend on neural response type. In ML (but not A1), when activity is lower during the first half of the stimulus in non-synchronized ‘decreasing’ neurons, the monkey is more likely to report AM. Neurons that both increase firing rate with increasing modulation depth (‘increasing’ neurons) and synchronize their responses to AM had similar choice-related activity dynamics in ML and A1. The results suggest that, when ascending the auditory system, there is a transformation in coding AM from primarily synchronized ‘increasing’ responses in A1 to non-synchronized and dual (‘increasing’/’decreasing’) coding in ML. This sensory transformation is accompanied by changes in the timing of activity related to choice, suggesting functional differences between A1 and ML related to attention and/or behavior. PMID:23658177

Niwa, Mamiko; Johnson, Jeffrey S.; O’Connor, Kevin N.; Sutter, Mitchell L.

2013-01-01

28

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

29

The Choice of Interactive Control Systems under Different Innovation Management Modes  

Microsoft Academic Search

This paper contributes to the recent levers of control (LOC) literature on the relationships between innovation and management accounting and control systems (MACS) by emphasising the importance of the choice by which individual MACS are selected for interactive use. Using survey data collected from 57 medium-sized Spanish firms, we find evidence supporting (1) the choice of individual MACS selected for

Josep Bisbe; Ricardo Malagueño

2009-01-01

30

Managing Dilemmas in Education: The Tightrope Walk of Strategic Choice in More Autonomous Institutions.  

ERIC Educational Resources Information Center

This paper applies Cuban's (1992) concept of "managing dilemmas" to the current market-based reforms in English and Welsh education at both the macro (policy) and, particularly, at the micro (individual and school) levels. The Parental and School Choice Interaction (PASCI) Study is currently investigating the interaction between parental choice

Glatter, Ron

31

Investigating public preferences for managing Lake Champlain using a choice experiment  

Microsoft Academic Search

The Lake Champlain Basin in Vermont and New York, USA and Quebec, Canada includes a large lake and watershed with complex management issues. A transboundary comprehensive management plan prepared for the lake includes 11 goals across many issue areas. We developed a choice experiment to examine public preferences for alternative Lake Champlain management scenarios across these issue areas. Five ecosystem

Robyn L. Smyth; Mary C. Watzin; Robert E. Manning

2009-01-01

32

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

2006-12-01

33

Rumour Has It: The Impact of Maternal Talk on Primary School Choice for Children Diagnosed with Autism  

ERIC Educational Resources Information Center

This article explores the pivotal role of rumour in shaping primary school choice decisions for parents of children diagnosed with autism. Drawing on semi-structured interviews with 22 mothers conducted in Sydney, Australia, this study points to the varied functions of grapevine knowledge about schools gleaned in diverse contexts, including early…

Lilley, Rozanna

2015-01-01

34

Joint Labor-Management Decision Making: Choices, Outcomes, and Problems.  

ERIC Educational Resources Information Center

Reviews the literature and analyses of the joint problem-solving strategies that have emerged during the 1980s and are used by management and labor to improve company performance, employee welfare, and labor-management relations. Includes a 58-item bibliography and 32 additional references. (JOW)

Cooke, William N.

1991-01-01

35

Managed Care and Medical Education: Hard Cases and Hard Choices.  

ERIC Educational Resources Information Center

Discusses the conflicts between for-profit managed care and medical education, noting the shortcomings of both and the need for medical educators to understand the tense history of discord between the two, distinguish between responsible and irresponsible managed care plans, and not assume that they own the moral high ground on health-care issues.…

Friedman, Emily

1997-01-01

36

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

37

Forest Management Regime and Species choice options in a changing environment  

E-print Network

Forest Management Regime and Species choice ­ options in a changing environment Bill Mason, Forest.mason@forestry.gsi.gov.uk May 18 2010 #12;2 Talk Structure 1. Introduction; 2. Species 3. Forest types; 4. Management regime; 5 essential] to make it more resilient to climate change over the next 50-100 years. Resilience implies

38

Managing the “Commons” on Cadillac Mountain: A Stated Choice Analysis of Acadia National Park Visitors' Preferences  

Microsoft Academic Search

Stated choice analysis was used to assess visitors' preferences for alternative combinations of public access, resource protection, visitor regulation, and site hardening to manage the Cadillac Mountain summit. Results provide insight into visitor preferences concerning the management of national park icon sites like the summit of Cadillac Mountain. These areas have received limited research attention. Results suggest that visitors consider

Steven D. Bullock; Steven R. Lawson

2008-01-01

39

Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease.  

PubMed Central

Many advances have occurred in recent years in the diagnosis, localization, and treatment of primary hyperparathyroidism. Several different operative choices for primary hyperparathyroidism also have been proposed--a unilateral approach versus the standard bilateral parathyroid exploration. The unilateral approach is based on the concept that if an enlarged parathyroid gland and a normal gland are found on the first side of the neck that is explored, then this is an adenoma and the second side should not be explored. Only if both glands on the initial side are recognized to be abnormal is the second side explored. The theoretical advantages of this unilateral approach are a decrease in operative morbidity rates--hypoparathyroidism and nerve injuries--and a decrease in operative time. Furthermore, proponents argue that if persistent hyperparathyroidism occurs, the second side can be easily explored because it was previously untouched. In the hands of several expert parathyroid surgeons, excellent results have been achieved. However, the unilateral approach has a number of disadvantages. It places considerable pressure on the surgeon and pathologist, for they have only one parathyroid gland other than the large one to examine. There is a significant potential risk of missing double adenomas or asymmetric hyperplasia because the second, ipsilateral parathyroid gland may appear normal or near normal in these conditions. This could lead to an increased incidence of persistent or recurrent hyperparathyroidism. Furthermore, a significant reduction of operative time may be questioned, especially when the time for performing special fat stains, which often are performed with unilateral explorations, is added. Finally, even if the intent is to perform a unilateral exploration, a bilateral exploration will be necessary about half of the time. The authors strongly recommend a bilateral parathyroid exploration for all patients undergoing an initial parathyroid operation. In cases of adenoma, bilateral visualization of normal parathyroid glands and careful biopsy of only one of them will minimize hypoparathyroidism. This operative approach will lead to better results, especially for the less experienced parathyroid surgeon. Images FIG. 5. FIG. 6. FIG. 7. FIG. 8. FIG. 9. FIG. 10. PMID:1558410

Kaplan, E L; Yashiro, T; Salti, G

1992-01-01

40

What factors influence choice of waste management practice? Evidence from rice straw management in the Philippines.  

PubMed

This study applied a multinomial logit model to understand why farmers choose to burn, incorporate or remove rice straw in the field. Four hundred randomly selected farmers were interviewed in four major rice-producing provinces covering the 2009 wet and 2010 dry seasons. Results of the model with burning as the baseline category indicate farm type, location dummies, number of household members with older than 13 years, cow ownership and distance from farm to house as significant variables influencing farmers' choice of straw incorporation or removal over burning. Significant perception variables are the negative impacts of open-field burning, awareness of environmental regulations and attitude towards incentives. Other factors significantly influencing the decision to incorporate over-burn are training attendance and perceptions of effects of straw incorporation. Income from non-rice farming, total area cultivated, tenure status, presence of burning and solid waste management provincial ordinances are significant factors affecting choice to remove over burn. Continually providing farmers' training in rice production, increasing demand for rice straw for other uses, and increasing awareness of environmental laws and regulations are policy directions recommended. PMID:24519228

Launio, Cheryll C; Asis, Constancio A; Manalili, Rowena G; Javier, Evelyn F; Belizario, Annabelle F

2014-02-01

41

MARGINAL ABATEMENT COSTS OF REDUCING GROUNDWATER-N POLLUTION WITH INTENSIVE AND EXTENSIVE FARM MANAGEMENT CHOICES  

Microsoft Academic Search

Cost-effectiveness is an important consideration in evaluating choices for meeting environmental quality objectives. Estimated crop yield response functions and the associated groundwater-nitrate pollution production functions were used to evaluate the optimal N fertilization and on-farm abatement costs for alternative cropping systems, with management choices at both the intensive and extensive margins. The cost-effective corn production system, which meets the Health

Emmanuel K. Yiridoe; Alfons Weersink

1998-01-01

42

Women in Municipal Management: Choice, Challenge and Change.  

ERIC Educational Resources Information Center

This study on women in municipal management examines their personal agendas, the barriers they encounter as individual professionals, their career opportunities, the credentialing requirements they face, and the skills they perceive as necessary for their effective performance and career advancement. Data were collected through survey research,…

Burns, Ruth Ann; And Others

43

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

44

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

45

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

46

Rare bleeding disorders in children: identification and primary care management.  

PubMed

Bleeding symptoms are common in healthy children but occasionally may indicate an underlying congenital or acquired bleeding diathesis. The rare bleeding disorders (RBDs) comprise inherited deficiencies of coagulation factors I (congenital fibrinogen deficiencies), II, V, VII, X, XI, and XIII and combined factor deficiencies, most notably of factors V and VIII and of vitamin K-dependent factors. These disorders often manifest during childhood and may present with recurrent or even serious or life-threatening bleeding episodes, particularly during the neonatal period. Accordingly, primary care and other nonhematologist pediatric providers should be familiar with the clinical presentation and initial evaluation of these rare disorders. Bleeding manifestations generally vary within the same RBD and may be indistinguishable from 1 RBD to another or from other more common bleeding disorders. Serious bleeding events such as intracranial hemorrhage may be heralded by less serious bleeding symptoms. The results of initial coagulation studies, especially prothrombin time and activated partial thromboplastin time, are often helpful in narrowing down the potential factor deficiency, with factor XIII deficiency being an exception. Consultation with a hematologist is advised to facilitate accurate diagnosis and to ensure proper management and follow-up. The approach to bleeding episodes and invasive procedures is individualized and depends on the severity, frequency, and, in the case of procedures, likelihood of bleeding. Prophylaxis may be appropriate in children with recurrent serious bleeding and specifically after life-threatening bleeding episodes. When available, specific purified plasma-derived or recombinant factor concentrates, rather than fresh frozen plasma or cryoprecipitate, are the treatment of choice. PMID:24127475

Acharya, Suchitra S

2013-11-01

47

Design choices made by target users for a pay-for-performance program in primary care: an action research approach  

PubMed Central

Background International interest in pay-for-performance (P4P) initiatives to improve quality of health care is growing. Current programs vary in the methods of performance measurement, appraisal and reimbursement. One may assume that involvement of health care professionals in the goal setting and methods of quality measurement and subsequent payment schemes may enhance their commitment to and motivation for P4P programs and therefore the impact of these programs. We developed a P4P program in which the target users were involved in decisions about the P4P methods. Methods For the development of the P4P program a framework was used which distinguished three main components: performance measurement, appraisal and reimbursement. Based on this framework design choices were discussed in two panels of target users using an adapted Delphi procedure. The target users were 65 general practices and two health insurance companies in the South of the Netherlands. Results Performance measurement was linked to the Dutch accreditation program based on three domains (clinical care, practice management and patient experience). The general practice was chosen as unit of assessment. Relative standards were set at the 25th percentile of group performance. The incentive for clinical care was set twice as high as the one for practice management and patient experience. Quality scores were to be calculated separately for all three domains, and for both the quality level and the improvement of performance. The incentive for quality level was set thrice as high as the one for the improvement of performance. For reimbursement, quality scores were divided into seven levels. A practice with a quality score in the lowest group was not supposed to receive a bonus. The additional payment grew proportionally for each extra group. The bonus aimed at was on average 5% to 10% of the practice income. Conclusions Designing a P4P program for primary care with involvement of the target users gave us an insight into their motives, which can help others who need to discuss similar programs. The resulting program is in line with target users' views and assessments of relevance and applicability. This may enhance their commitment to the program as was indicated by the growing number of voluntary participants after a successfully performed field test during the procedure. The elements of our framework can be very helpful for others who are developing or evaluating a P4P program. PMID:22453028

2012-01-01

48

The Role of Culture and Gender in the Choice of a Career in Management  

ERIC Educational Resources Information Center

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…

Malach-Pines, Ayala; Kaspi-Baruch, Oshrit

2008-01-01

49

Venous access in haemophilic children: choice and management.  

PubMed

Current haemophilia treatment in children is based on regular intravenous infusions of concentrates for prolonged periods, according to prophylaxis regimens or immune tolerance induction treatment, in cases of inhibitor development. Therefore, a stable and uncomplicated venous access is required and as such peripheral veins represent the preferred option. However, frequent infusions in the home setting can be problematic in very young children and for this reason, central venous access devices (CVADs) have been widely used to improve treatment feasibility. Unfortunately CVADs' use is associated with a high rate of complications, and infections and thrombotic occlusion can influence treatment outcome by causing unwanted treatment interruption. CVADs can be grouped into three main categories: external non-tunnelled, external tunnelled and fully implantable devices known as ports. The management of CVADs at home often represents a challenge because a strict adherence to sterile procedures is required. Indeed, the incidence of infections with ports is much lower than that reported for external devices; however, ports carry the inconvenience of needle sticks. More recently, arteriovenous fistula was shown to be a suitable alternative to CVADs because it is easy to use and is associated with a lower rate of complication. PMID:20059565

Santagostino, E; Mancuso, M E

2010-01-01

50

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

51

Primary Sclerosing Cholangitis – Diagnosis, Prognosis and Management  

PubMed Central

Primary sclerosing cholangitis (PSC) is a chronic immune-mediated disease of the liver of unclear etiology, characterized by chronic inflammation and fibrosis of bile ducts. It primarily affects middle aged men, and is associated with 4-fold increased mortality as compared to ageand gender-matched population. Progressive biliary and hepatic damage results in portal hypertension and hepatic failure in a significant majority of patients over a 10–15 year period from initial diagnosis. In addition, PSC confers a markedly increased risk of hepatobiliary cancer, including cholangiocarcinoma and gallbladder cancer as compared to the general population, and cancer is the leading cause of mortality in patients with PSC. It is associated with inflammatory bowel disease in 70% patients, and increases the risk of colorectal cancer almost 10-fold. Despite significant research efforts in this field, the pathogenic mechanisms of PSC are still incompletely understood, although growing evidence supports the role of genetic and immunologic factors. There are no proven medical therapies that alter the natural course of the disease. Thus, liver transplantation is the only available treatment for patients with advanced PSC, with excellent outcomes in this population. PMID:23454027

Singh, Siddharth; Talwalkar, Jayant A.

2013-01-01

52

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

53

Administration to innovation: the evolving management challenge in primary care.  

PubMed

The concept of the primary health-care team involving an increasingly diverse range of health care professionals is widely recognized as central to the pursuit of a primary care-led health service in the UK. Although GPs are formally recognized as the team leaders, there is little by way of policy prescription as to how team roles and relationships should be developed, or evidence as to how their roles have in fact evolved. Thus the notion of the primary health-care team while commonly employed, is in reality lacking definition with the current contribution of practice managers to the operation of this team being poorly understood. Focusing on the career backgrounds of practice managers, their range of responsibilities, and their involvement in innovation in general practice, presents a preliminary account of a chief scientist office-funded project examining the role being played by practice managers in primary health-care innovation. More specifically, utilizing data gained from the ongoing study, contextualizes the role played by practice managers in the primary health-care team. By exploring the business environment surrounding the NHS general practice, the research seeks to understand the evolving world of the practice manager. Drawing on questionnaire data, reinforced by qualitative data from the current interview phase, describes the role played by practice managers in differing practice contexts. This facilitates a discussion of a set of ideal type general practice organizational and managerial structures. Discusses the relationships and skills required by practice managers in each of these organizational types with reference to data gathered to date in the research. PMID:10173249

Laing, A; Marnoch, G; McKee, L; Joshi, R; Reid, J

1997-01-01

54

Diagnosis and management of primary cicatricial alopecia: part I.  

PubMed

In this 2-part article, the authors review the primary cicatricial alopecias. Primary cicatricial alopecia can be defined as predominantly lymphocytic, neutrophilic, or mixed based on the nature of the follicular infiltrate that is present around affected hair follicles. Lymphocytic primary cicatricial alopecias include chronic cutaneous lupus erythematosus (discoid lupus erythematosus), lichen planopilaris, classic pseudopelade of Brocq, central centrifugal cicatricial alopecia, alopecia mucinosa, and keratosis follicularis spinulosa decalvans. In this first part, the authors summarize the classification, epidemiology, diagnostic approach, and patient management of lymphocytic cicatricial alopecias. In part II, the authors will focus on neutrophilic cicatricial alopecias and mixed cicatricial alopecias. PMID:18174797

Otberg, Nina; Wu, Wen-Yu; McElwee, Kevin John; Shapiro, Jerry

2008-01-01

55

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

56

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

PubMed Central

Background Screening invitations have traditionally been brief, providing information only about population benefits. Presenting information about the limited individual benefits and potential harms of screening to inform choice may reduce attendance, particularly in the more socially deprived. At the same time, amongst those who attend, it might increase motivation to change behavior to reduce risks. This trial assesses the impact on attendance and motivation to change behavior of an invitation that facilitates informed choices about participating in diabetes screening in general practice. Three hypotheses are tested: 1. Attendance at screening for diabetes is lower following an informed choice compared with a standard invitation. 2. There is an interaction between the type of invitation and social deprivation: attendance following an informed choice compared with a standard invitation is lower in those who are more rather than less socially deprived. 3. Amongst those who attend for screening, intentions to change behavior to reduce risks of complications in those subsequently diagnosed with diabetes are stronger following an informed choice invitation compared with a standard invitation. Method/Design 1500 people aged 40–69 years without known diabetes but at high risk are identified from four general practice registers in the east of England. 1200 participants are randomized by households to receive one of two invitations to attend for diabetes screening at their general practices. The intervention invitation is designed to facilitate informed choices, and comprises detailed information and a decision aid. A comparison invitation is based on those currently in use. Screening involves a finger-prick blood glucose test. The primary outcome is attendance for diabetes screening. The secondary outcome is intention to change health related behaviors in those attenders diagnosed with diabetes. A sample size of 1200 ensures 90% power to detect a 10% difference in attendance between arms, and in an estimated 780 attenders, 80% power to detect a 0.2 sd difference in intention between arms. Discussion The DICISION trial is a rigorous pragmatic denominator based clinical trial of an informed choice invitation to diabetes screening, which addresses some key limitations of previous trials. Trial registration Current Controlled Trials ISRCTN73125647 PMID:19232112

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

2009-01-01

57

Investigating public preferences for managing Lake Champlain using a choice experiment.  

PubMed

The Lake Champlain Basin in Vermont and New York, USA and Quebec, Canada includes a large lake and watershed with complex management issues. A transboundary comprehensive management plan prepared for the lake includes 11 goals across many issue areas. We developed a choice experiment to examine public preferences for alternative Lake Champlain management scenarios across these issue areas. Five ecosystem attributes (water clarity-algae blooms, public beach closures, land use change, fish consumption advisories and the spread of water chestnut, an invasive plant) were varied across three levels and arrayed into paired comparisons following an orthogonal fractional factorial design. Two thousand questionnaires were distributed to basin residents, each including nine paired comparisons that required trading off two, three or four attributes. Completed surveys yielded 6541 responses which were analyzed using binary logistic regression. The results showed that although water clarity and beach closures were important, safe fish consumption was the strongest predictor of choice. Land use pattern and water chestnut distribution were weaker but also significant predictors, with respondents preferring less land development and preservation of the agricultural landscape. Current management efforts in the Lake Champlain Basin are heavily weighted toward improving water clarity by reducing phosphorus pollution. Our results suggest that safe fish consumption warrants additional management attention. Because choice experiments provide information that is much richer than the simple categorical judgments more commonly used in surveys, they can provide managers with information about tradeoffs that could be used to enhance public support and maximize the social benefits of an ecosystem management program. PMID:18262328

Smyth, Robyn L; Watzin, Mary C; Manning, Robert E

2009-01-01

58

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

59

The fairness hypothesis and managing the risks of societal technology choices  

SciTech Connect

Much of the literature on risk perception and management published over the last few years has asked how society should resolve the question, ''How safe is safe enough.'' This paper argues that, from a societal risk-management perspective, we should be addressing a different range of questions that views societal risk as a whole rather than as the sum of individual hazards. Resolving the question, ''How safe is safe enough.'' is less important in making societal technology choices than ''How fair is safe enough.'' A recent empirical pilot study is reported which explored the fairness hypothesis in the context of nuclear power. The results indicate that the process of technology choice should recognize explicitly the preferred principles different parties hold with respect to obtaining consent from those affected by the risks, distributing the liabilities, and justifying trust in the relevant institutions. The paper closes with a discussion of future prospects for the fairness approach to areas such as noxious facility siting.

Cantor, R.; Rayner, S.

1987-01-01

60

Choice, Cost and Community: The Hidden Complexities of the Rural Primary School Market  

ERIC Educational Resources Information Center

National rural policy places the local primary school as a key resource within the rural community, yet as a consequence of countywide financial constraints, some small schools are undergoing reorganization, involving amalgamation, federation and school closure. This article considers the complexities involved in the workings of the English rural…

Walker, Marion

2010-01-01

61

Incentives and Children s Dietary Choices: A Field Experiment in Primary Schools  

E-print Network

Keywords: Incentives, Health, Habits, Child nutrition, Field experiments We thank the Esme Fairbairn is a primary cause behind the rising cost of health care in many developed countries.1 According to the World in the world: high blood pressure; high blood glucose; and overweight and obesity. In response, policy makers

Burton, Geoffrey R.

62

Disagreement between Human Papillomavirus Assays: An Unexpected Challenge for the Choice of an Assay in Primary Cervical Screening  

PubMed Central

We aimed to determine the disagreement in primary cervical screening between four human papillomavirus assays: Hybrid Capture 2, cobas, CLART, and APTIMA. Material from 5,064 SurePath samples of women participating in routine cervical screening in Copenhagen, Denmark, was tested with the four assays. Positive agreement between the assays was measured as the conditional probability that the results of all compared assays were positive given that at least one assay returned a positive result. Of all 5,064 samples, 1,679 (33.2%) tested positive on at least one of the assays. Among these, 41% tested positive on all four. Agreement was lower in women aged ?30 years (30%, vs. 49% at <30 years), in primary screening samples (29%, vs. 38% in follow-up samples), and in women with concurrent normal cytology (22%, vs. 68% with abnormal cytology). Among primary screening samples from women aged 30–65 years (n?=?2,881), 23% tested positive on at least one assay, and 42 to 58% of these showed positive agreement on any compared pair of the assays. While 4% of primary screening samples showed abnormal cytology, 6 to 10% were discordant on any pair of assays. A literature review corroborated our findings of considerable disagreement between human papillomavirus assays. This suggested that the extent of disagreement in primary screening is neither population- nor storage media-specific, leaving assay design differences as the most probable cause. The substantially different selection of women testing positive on the various human papillomavirus assays represents an unexpected challenge for the choice of an assay in primary cervical screening, and for follow up of in particular HPV positive/cytology normal women. PMID:24466262

Ejegod, Ditte Møller; Rygaard, Carsten; Lynge, Elsebeth; Bonde, Jesper

2014-01-01

63

Psychosocial correlates of healthy beliefs, choices, and behaviors in overweight and obese school-age children: a primary care healthy choices intervention pilot study.  

PubMed

The relationships among weight, mental health, social competence, healthy lifestyle beliefs, choices, and behaviors in overweight and obese school-age children (9 to 12 years) who were participating in a pilot Healthy Choices Intervention Program were examined using a descriptive correlational design. Results indicated that the children's weight negatively correlated with the children's self-concept, social skills, and, most importantly, healthy lifestyle choices. Their healthy lifestyle beliefs demonstrated positive correlations with their intentions to choose a healthy lifestyle. The children's healthy lifestyle beliefs and choices also were associated with increased cooperation and empathy behaviors. A positive self-concept was associated with decreased anxiety and depressive symptomology. These data support the need for health care providers to understand the psychological and social issues that overweight and obese school-age children experience. Cognitive behavior skills building techniques, such as those in the Healthy Choices Intervention Program, may promote healthy lifestyle choices and behaviors. PMID:21930032

Jacobson, Diana; Melnyk, Bernadette Mazurek

2011-10-01

64

Nurse/physician conflict management mode choices: implications for improved collaborative practice.  

PubMed

In today's complex healthcare organizations, conflicts between physicians and nurses occur daily. Consequently, organizational conflict has grown into a major subfield of organizational behavior. Researchers have claimed that conflict has a beneficial effect on work group function and identified collaboration as one of the intervening variables that may explain the relationship between magnet hospitals and positive patient outcomes. The purpose of this study was to identify and compare conflict mode choices of physicians and head nurses in acute care hospitals and examine the relationship of conflict mode choices with their background characteristics. In a cross-sectional correlational study, 75 physicians and 54 head nurses in 5 hospitals were surveyed, using the Thomas-Kilmann Conflict Mode Instrument. No difference was found between physicians and nurses in choice of the most frequently used mode in conflict management. The compromising mode was found to be the significantly most commonly chosen mode (P = .00) by both. Collaborating was chosen significantly more frequently among head nurses (P = .001) and least frequently among physicians (P = .00). Most of the respondents' characteristics were not found to be correlated with mode choices. The findings indicate a need to enhance partnerships in the clinical environment to ensure quality patient care and staff satisfaction. PMID:17607137

Hendel, Tova; Fish, Miri; Berger, Ornit

2007-01-01

65

[Management of onychocryptosis in primary care: A clinical case].  

PubMed

Onychocryptosis (ingrown toenail) is a condition commonly seen in Primary Care clinics. It is uncomfortable and restrictive for patients and has a high incidence in males between second and third decades of life. It is of unknown origin, with a number of predisposing triggering factors being involved. Treatment depends on the stage of the ingrown nail and the procedures may range from conservative to minor surgery that can be performed by the Primary Care physician in the health centre. We report the case of a 25-year onychocryptosis that did not respond to conservative management, and was extracted with partial matricectomy of the nail. PMID:24034767

Zavala Aguilar, K; Gutiérrez Pineda, F; Bozalongo de Aragón, E

2013-09-01

66

Sustainable Assessment for Large Science Classes: Non-Multiple Choice, Randomised Assignments through a Learning Management System  

ERIC Educational Resources Information Center

This paper reports on the development of a tool that generates randomised, non-multiple choice assessment within the BlackBoard Learning Management System interface. An accepted weakness of multiple-choice assessment is that it cannot elicit learning outcomes from upper levels of Biggs' SOLO taxonomy. However, written assessment items require…

Schultz, Madeleine

2011-01-01

67

[Management of infantile cataracts: surgical technics and choices in lens implantation].  

PubMed

Management of congenital or infantile cataracts benefited from progresses realized in adult surgery. It stays however specific to children's eyes and is incorporated in a global therapeutic strategy. It must be guided by a pediatric ophthalmogical team used to this kind of treatment. We report here, function of the type of cataract, uni or bilateral, congenital or infantile, the choice of the timing of surgery, of the therapeutic strategy, parental information, and preoperative evaluation. The actual standard of surgery is bimanual phacoaspiration with posterior capsulorhexis and anterior vitrectomy. It is described step by step. Indication of lens implantation, choice of the type and power of IOL function of age of the child is described, be it for initial or secondary lens implantation. PMID:21392844

Thouvenin, D

2011-03-01

68

Polyurethane: The Material of Choice for Occupant Protection and Energy Management  

Microsoft Academic Search

National Highway Traffic Safety Administration (NHTSA) is mandated to promote improvements in automotive occupant protection by specifying vehicle crash-worthiness regulations in terms of forces and accelerations measured during test crashes. A primary focus of these Federal Motor Vehicle Safety Standards (FMVSS) has been in the area of energy-management during the \\

Lorraine C. Yu-Hallada; Edward T. Kuczynski; Mark Weierstall

1998-01-01

69

Changing concepts in management of primary obstructive megaureter  

SciTech Connect

The management of neonatal urinary tract dilatations represents one of the most challenging dilemmas in pediatric urology today. We have been confronted with 44 renal units in 35 neonates diagnosed as having primary obstructive megaureter during the last 6 years. Of these units 23 in 17 infants were diagnosed antenatally and 20 (87 per cent) have been managed without surgical intervention. Notably, 16 renal units were graded as moderate to severe megaureters by an excretory urogram. The decision to manage conservatively was based on the initial extraction of the /sup 99m/diethylenetriaminepentaacetic acid renal scan (the extraction factor). This estimate of absolute renal function has been used to differentiate dilatations with obstructive implications for the renal parenchyma from those without. Significantly, expectant treatment has resulted in improvement of dilatation on sequential excretory urograms in 15 megaureters and none has shown a deterioration of function by renal scan. Similar diagnostic criterion also has resulted in conservative management for 12 of 21 additional neonatal megaureters seen during this period with symptoms or they were discovered serendipitously. Only 2 of these 12 megaureters required surgical correction. The neonatal primary megaureter appears in many cases to represent a different entity than those that commonly presented before the advent of antenatal and perinatal diagnosis.

Keating, M.A.; Escala, J.; Snyder, H.M. III; Heyman, S.; Duckett, J.W.

1989-08-01

70

Health plan disenrollment in a choice-based Medicaid managed care program.  

PubMed

Consumer decisions to switch health plans have implications for quality of care and risk selection. We examine factors related to time to disenrollment in a Medicaid managed care program where beneficiaries face a menu of plans and can change plans every month. Several findings have direct policy relevance. Families and individuals who make active choices upon entering the program are at substantially lower risk of disenrollment than those who are auto-assigned. Interactions between enrollee ethnicity and provider language proficiency suggest that enrollee satisfaction depends on the cultural competence of providers. Differential disenrollment by risk status results in adverse retention for certain types of plans. PMID:15835602

Buchmueller, Thomas C; Gilmer, Todd; Harris, Katherine

71

Categorizing Patients in a Forced-Choice Triad Task: The Integration of Context in Patient Management  

PubMed Central

Background Studies of experts' problem-solving abilities have shown that experts can attend to the deep structure of a problem whereas novices attend to the surface structure. Although this effect has been replicated in many domains, there has been little investigation into such effects in medicine in general or patient management in particular. Methodology/Principal Findings We designed a 10-item forced-choice triad task in which subjects chose which one of two hypothetical patients best matched a target patient. The target and its potential matches were related in terms of surface features (e.g., two patients of a similar age and gender) and deep features (e.g., two diabetic patients with similar management strategies: a patient with arthritis and a blind patient would both have difficulty with self-injected insulin). We hypothesized that experts would have greater knowledge of management categories and would be more likely to choose deep matches. We contacted 130 novices (medical students), 11 intermediates (medical residents), and 159 experts (practicing endocrinologists) and 15, 11, and 8 subjects (respectively) completed the task. A linear mixed effects model indicated that novices were less likely to make deep matches than experts (t(68)?=??3.63, p?=?.0006), while intermediates did not differ from experts (t(68)?=??0.24, p?=?.81). We also found that the number of years in practice correlated with performance on diagnostic (r?=?.39, p?=?.02), but not management triads (r?=?.17, p?=?.34). Conclusions We found that experts were more likely than novices to match patients based on deep features, and that this pattern held for both diagnostic and management triads. Further, management and diagnostic triads were equally salient for expert physicians suggesting that physicians recognize and may create management-oriented categories of patients. PMID:19516910

Devantier, Sarah L.; Minda, John Paul; Goldszmidt, Mark; Haddara, Wael

2009-01-01

72

Surgical management of primary carcinomas of the lower lip.  

PubMed

Carcinomas of lower lips are common neoplasms of the muco-cutaneous junction. Surgical resection of these tumors has the advantages of permitting histologic examination of the margins, achieving excellent cure rates, and yielding good aesthetic and functional results. We present the fundamental surgical procedures for management of pre-cancerous and primary cancerous neoplasms of the lower lip with which the surgical dermatologist should be familiar. These procedures may be done with local anesthesia in an outpatient surgical office. The techniques and case examples we describe include vermilionectomy and mucosal advancement, V-wedge resection, pentagonal wedge resection, and vermilionectomy combined with wedge resection. PMID:7175001

Knabel, M R; Koranda, F C; Olejko, T D

1982-11-01

73

Parental Choice of Schools and Parents' Perceptions of Multicultural and Co-Existence Education: The Case of the Israeli Palestinian-Jewish Bilingual Primary Schools  

ERIC Educational Resources Information Center

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…

Bekerman, Zvi; Tatar, Moshe

2009-01-01

74

Choice of Scottish Gaelic-Medium and Welsh-Medium Education at the Primary and Secondary School Stages: Parent and Pupil Perspectives  

ERIC Educational Resources Information Center

Results are presented of a comparative study of the reasons for parental choice of Scottish Gaelic-medium and Welsh-medium primary education in the year 2000 and of the reasons for pupils' decisions to continue with Gaelic or Welsh-medium education at secondary school in 2007. Parents in both contexts cited the quality of Celtic-medium…

O'Hanlon, Fiona

2015-01-01

75

Parental Choice of Schooling, Learning Processes and Inter-Ethnic Friendship Patterns: The Case of Malay Students in Chinese Primary Schools in Malaysia  

ERIC Educational Resources Information Center

This study surveys 200 Malay students enrolled in three Chinese primary schools in relation to three issues, i.e., parental choice of schooling, learning processes and inter-ethnic friendship patterns. The three issues are explored through a combination of quantitative and qualitative research methodologies. Parental expectations for their…

Sua, Tan Yao; Ngah, Kamarudin; Darit, Sezali Md.

2013-01-01

76

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

77

Documentation and Management of CKD in Rural Primary Care  

PubMed Central

Summary Background and objectives Recognition of CKD by primary care practitioners is essential in rural communities where nephrology access is limited. This study determined the prevalence of undocumented CKD in patients cared for in rural primary care practices and evaluated characteristics associated with undocumented CKD as well as CKD management. Design, setting, participants, & measurements A retrospective cohort study, conducted within the Oregon Rural Practice Based Research Network, consisted of 865 CKD patients with serum creatinine?1.5 mg/dl in males and ?1.3 mg/dl in females and an estimated GFR<60 ml/min per 1.73 m2. Documentation of a CKD diagnosis and laboratory values were abstracted by chart review. Results Of CKD patients, 51.9% had no documentation of CKD. Undocumented CKD occurred more frequently in female patients (adjusted odds ratio=2.93, 95% confidence interval=2.04, 4.21). The association of serum creatinine reporting versus automating reporting of estimated GFR on CKD documentation was dependent on patient sex, years of practitioner experience, and practitioner clinical training. Hypertensive patients with documented CKD were more likely to have a BP medication change than patients with undocumented CKD (odds ratio=2.07, 95% confidence interval=1.15, 3.73). Only 2 of 449 patients with undocumented CKD were comanaged with a nephrologist compared with 20% of patients with documented CKD (odds ratio=53.20, 95% confidence interval=14.90, 189.90). Conclusions Undocumented CKD in a rural primary care setting is frequent, particularly in female patients. Depending on practitioner characteristics, automatic reporting of estimated GFR might improve documentation of CKD in this population. PMID:23371962

Morris, Cynthia D.; O’Malley, Jean P.; Davis, Melinda M.; Mori, Motomi; Anderson, Sharon

2013-01-01

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

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

80

Managing the primary care practice on the Web  

PubMed

Physicians and administrators have little hope of responding appropriately to the challenges of the health care market without data to support decision making. Desired Mayo Clinic s Primary Care Practice was to have the ability to access and integrate data from many platforms in many formats from the Enterprise and bring this information to the desktop in a robust interactive display. The solution was delivery of the data to the Web through an interface using Java with access to Online Analytical Processing (OLAP) tools for summarization, graphical display and reporting. Communicating major trends, assisting in planning and management, visually displaying alerts in summary data and individual patients that are all possible through an easy-to-use Web application. To really understand what the summarized data represents, the physicians must be able to drill down, download and explore their own detail data. A pilot project was developed to test the capabilities of the development environment, the acceptance Web tools, the ability to deliver timely information and the methodology of using a multi-dimensional database to define the data. The Family Medicine practice at four separate locations was chosen for the demonstration project. Two practices in Rochester, MN and practices in two smaller towns, totaling 50 physicians and administrative personnel, were the first clients using the system. A cross-functional team examined a variety of development issues such as data sources, data definitions, levels of security, data analysis types, and style of display. Demonstrations of the prototype met with an overwhelming positive response from administrators and department leaders. The Physician Patient Management solution collects, analyzes, and communicates the information needed to meet today s health care challenges. PMID:11080032

Van Grevenhof P; Rahman; Cabanela; Naessens; Lassig

2000-01-01

81

Approach to management of the patient with primary or secondary intrathoracic goiter.  

PubMed

Intrathoracic (substernal) goiter, depending on definition, is seen in up to 45% of all patients operated for goiter. It can either be primary (ectopic thyroid tissue detached from a cervical thyroid mass), which is very rare (1%), or (more commonly) secondary, where a portion of the goiter extends retrosternally. There is no consensus on diagnostic or therapeutic management, partly because many are asymptomatic. Classification involves functional characterization with serum TSH and morphological characterization with diagnostic imaging and cytology to rule out malignancy, which is not more common than in cervical goiters. Pulmonary function is often affected in asymptomatic individuals also. Therefore, but also because natural history is continuous growth and evolution from euthyroidism to hyperthyroidism, most experts recommend therapy. In primary as well as secondary intrathoracic goiter, the therapy of choice is total/near-total thyroidectomy and subsequent levothyroxine substitution. Data suggest that complications are only slightly more prevalent than in cervical goiters. Although levothyroxine is not recommended for goiter shrinkage, there is increasing focus on radioactive iodine as an alternative to surgery in secondary intrathoracic goiters. Here it can reduce thyroid size by on average 40% after 1 yr and improve respiratory function and quality of life. Recent studies show that recombinant human TSH, currently used off-label, can augment the radioiodine-related goiter shrinkage by 30-50%. With currently used doses of recombinant human TSH, the side effects, besides hypothyroidism, are rare and mild. Future studies should also explore the use of radioiodine in primary intrathoracic goiter and compare surgery and radioiodine, head to head. PMID:21131536

Hegedüs, Laszlo; Bonnema, Steen J

2010-12-01

82

Linking pediatric primary care obesity management to community programs.  

PubMed

Guidelines for obesity management in primary care call for linking to community services. The Promoting Health Project (PHP) was a multi-component, practice-based intervention aimed at improving care of obese children, including referrals to community services. Promoting Health Project staff identified and interviewed representatives of 40 nutrition or physical activity services/programs. Quality improvement (QI) teams at three practices worked to improve overweight/obesity identification and care and implement practice-to-community connections that used the information gathered from the programs/ services. A practice community coordinator (PCC) facilitated interactions between practices, community programs and families. Researchers tracked patients referred, PCC to family interactions, and time spent. They surveyed parents of referred patients and interviewed key clinicians. Forty-six patients participated in programs. Substantial efforts were necessary to create smooth referral systems. Family motivation was perceived as a limiting factor in program attendance. Clinicians were satisfied with systems established. Effectively linking practitioners to community programs requires the use of additional resources. PMID:23727972

Ariza, Adolfo J; Hartman, Jennifer; Grodecki, Jennifer; Clavier, Alejandro; Ghaey, Kamala; Elsner, Mary; Moore, Chantal; Reina, Olga Ochoa; Binns, Helen J

2013-01-01

83

Diagnosis and management of cholangiocarcinoma in primary sclerosing cholangitis  

Microsoft Academic Search

Cholangiocarcinoma remains difficult to diagnose and is a major cause of death in patients with primary sclerosing cholangitis.\\u000a Recently serum carcinoembryonic antigen and carbohydrate antigen 19-9 (CA 19-9) levels have been reported to improve diagnostic\\u000a accuracy in patients with cholangiocarcinoma and primary sclerosing cholangitis. We reviewed our experience with cholangiocarcinoma\\u000a complicating primary sclerosing cholangitis to identify clinical factors associated with

Steven A. Ahrendt; Henry A. Pitt; Attila Nakeeb; Andrew S. Klein; Keith D. Lillemoe; Anthony N. Kalloo; John L. Cameron

1999-01-01

84

An assessment of the impact of a weight management program on adolescents' food choices and self-esteem  

E-print Network

, many menu items are low in nutrients, and portion sizes are standardized regardless of individual caloric needs (40, 41, 42). A study done on hamburger meals from eight fast food chains found that the meals were deficient in biotin, folacin...AN ASSESSMENT OF THE IMPACT OF A WEIGHT MANAGEMENT PROGRAM ON ADOLESCENTS' FOOD CHOICES AND SELF-ESTEEM A Thesis by KATHLEEN MARIE KUHL Submitted to the Office of Graduate Studies of Texas A&M University in partial fulfillment...

Kuhl, Kathleen Marie

1993-01-01

85

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

86

Clinical features and management of primary sclerosing cholangitis  

PubMed Central

Primary sclerosing cholangitis is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the bile ducts, resulting in cirrhosis and need for liver transplantation and reduced life expectancy. The majority of cases occur in young and middle-aged men, often in association with inflammatory bowel disease. The etiology of primary sclerosing cholangitis includes immune-mediated components and elements of undefined nature. No effective medical therapy has been identified. The multiple complications of primary sclerosing cholangitis include metabolic bone disease, dominant strictures, bacterial cholangitis, and malignancy, particularly cholangiocarcinoma, which is the most lethal complication of primary sclerosing cholangitis. Liver transplantation is currently the only life-extending therapeutic alternative for patients with end-stage disease, although recurrence in the allografted liver has been described. A PSC-like variant attracting attention is cholangitis marked by raised levels of the immunoglobulin G4 subclass, prominence of plasma cells within the lesions, and steroid responsiveness. PMID:18528931

Silveira, Marina G; Lindor, Keith D

2008-01-01

87

Primary care management of the liver transplant patient.  

PubMed

There are over 65,000 people in the United States who have received a liver transplant. In primary care practice, nurse practitioners must be aware of the special considerations necessary for this population. PMID:25397746

Chaney, Amanda

2014-12-13

88

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

89

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

90

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

91

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

92

Urolithiasis in primary obstructive megaureter: a management dilemma.  

PubMed

Megaureter with urolithiasis is an uncommon entity. These stones may be located in the kidney, ureter or both. Management of these cases is difficult due to free mobility and stone multiplicity. As there are no guidelines about the management, the surgeon usually manages according to her/his experience, stone location or burden. The goal is to remove the stones and reimplant the ureters in the same session, if possible. We describe single-stage management of one such patient who presented with bilateral multiple ureteral and left renal stones. The left ureteral stones were first flushed into the kidney by the ureteroscope. Percutaneous nephrolithotomy was then performed and stones were removed intact. The patient was then turned supine and the location of right ureteral stones was confirmed by fluoroscopy in the same location (right lower ureter). The patient underwent successful bilateral ureteroneocystostomy with simultaneous removal of right lower ureteral stones. PMID:24879732

Kumar, Arvind; Goel, Apul; Singh, Manmeet; Sankwar, Satya Narayan

2014-01-01

93

Barriers to accurate diagnosis and effective management of heart failure in primary care: qualitative study  

Microsoft Academic Search

AbstractObjective: To ascertain the beliefs, current practices, and decision making of general practitioners in the diagnosis and management of suspected heart failure in primary care, with a view to identifying barriers to good care.Design: A qualitative approach using focus groups with 30 general practitioners from four primary care groups. The sampling strategy was stratified and purposive. The contents of interviews

Ahmet Fuat; A Pali S Hungin; Jeremy James Murphy

2003-01-01

94

Management of primary non-refluxing upper urinary tract dilation: an analysis of 219 pediatric patients  

Microsoft Academic Search

Antenatal ultrasound (US) examinations have changed the diagnostic approach to and management of malformative uropathies. Primary non-refluxing upper urinary tract (UUT) dilation is one of the urinary malformations that has undergone significant evolution in recent years. From January 1972 to June 1991, 219 children with primary non-refluxing megaureter (caliber more than 10 mm on radiologic examination) were admitted to our

G. Belloli; P. Campobasso; F. Cappellari; A. Mercurella

1993-01-01

95

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

E-print Network

Computer-based Decision Support in the Management of Primary Gastric non-Hodgkin Lymphoma Peter, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital Amsterdam, The Netherlands Abstract Primary non-making process. The model has been incorporated into a computer-based system, that can be used as a decision

Lucas, Peter

96

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

97

Obesity in primary care: prevention, management and the paradox.  

PubMed

Government and societal efforts to combat obesity are aimed at prevention, although there is a generation for whom excess weight is the rule rather than the exception. Although measures to prevent a worsening of the current epidemic are important, management of obesity must also be prioritised. Obesity management is beset with problems ranging from attitudinal to clinical and pharmacological, and the individualisation of therapy. PMID:25154409

Haslam, David

2014-01-01

98

Identifying Primary Care Skills and Competencies in Opioid Risk Management  

ERIC Educational Resources Information Center

Introduction: Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of…

Chiauzzi, Emil; Trudeau, Kimberlee J.; Zacharoff, Kevin; Bond, Kathleen

2011-01-01

99

Biodiversity informatics: managing and applying primary biodiversity data  

Microsoft Academic Search

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

Jorge Soberon; T. Peterson

2004-01-01

100

Diagnostic and therapeutic management of cancer of an unknown primary  

Microsoft Academic Search

Metastatic Cancer of Unknown Primary Site (CUP) accounts for approximately 3% of all malignant neoplasms and is therefore one of the 10 most frequent cancer diagnoses in man. Patients with CUP present with metastatic disease for which the site of origin cannot be identified at the time of diagnosis. It is now accepted that CUP represents a heterogeneous group of

N. Pavlidis; E. Briasoulis; J. Hainsworth; F. A. Greco

2003-01-01

101

Delayed coronary occlusion following primary successful angioplasty: Management and outcome  

Microsoft Academic Search

Summary The treatment of delayed coronary occlusion after primary successful percutaneous transluminal coronary angioplasty (PTCA) is more difficult because surgical standby is often not available. The purpose of this study was to assess the therapeutic approaches and outcome of patients with delayed coronary occlusion from 30 to 180 minutes after successful PTCA. A delayed occlusion occurred in 18 (0.9%) (61±11

A. Schuchert; C. W. Hamm; P. Kalmar; W. Bleifeld

1991-01-01

102

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

103

An update on the management of Budd-Chiari syndrome: the issues of timing and choice of treatment.  

PubMed

Because of the rarity of Budd-Chiari syndrome (BCS), the flow chart of management comes from expert opinion and is not evidence based. To report an update on the management of BCS. I performed a review on published papers on BCS in an attempt to speculate in particular on the timing and the choice of treatment. Some authors suggest that the management of BCS should follow a step-wise strategy. Anticoagulation and medical therapy should be the first-line treatment. Revascularization or transjugular intrahepatic portosystemic shunt should be performed in case of no response to medical therapy. Orthotopic liver transplant should be used as a rescue therapy. The biggest criticism of this flow chart is that it is based on the assumption that patients with BCS should receive further treatment only when hemodynamic effects on portal hypertension become clinically evident, thus paying little attention to the chronic ischemic liver damage effects on hepatic function and to the possibility of preventing liver failure by relieving impaired hepatic veins outflow. Recently, I presented a proposal of a new algorithm for the management of BCS, in which medical therapy alone is suggested only for patients without any sign of portal hypertension, irrespective of whether early interventional treatment is suggested when either any symptoms or signs of portal hypertension appear, with the aim of preventing hepatic fibrosis development, disease progression, and finally improving outcome. Given that the benefit of treatments for BCS is not under debate, guidelines for the management of BCS should be re-evaluated and updated, with particular attention to both the timing and the choice of treatment. PMID:25590783

Mancuso, Andrea

2015-03-01

104

Riverine Threat Indices to Assess Watershed Condition and Identify Primary Management Capacity of Agriculture Natural Resource Management Agencies  

NASA Astrophysics Data System (ADS)

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.

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

2014-03-01

105

Pathogenesis, Diagnosis, and Management of Primary Antibody Deficiencies and Infections  

PubMed Central

Summary: Primary antibody deficiencies are the most common primary immunodeficiency diseases. They are a heterogeneous group of disorders with various degrees of dysfunctional antibody production resulting from a disruption of B-cell differentiation at different stages. While there has been tremendous recent progress in the understanding of some of these disorders, the etiology remains unknown for the majority of patients. As there is a large spectrum of underlying defects, the age at presentation varies widely, and the clinical manifestations range from an almost complete absence of B cells and serum immunoglobulins to selectively impaired antibody responses to specific antigens with normal total serum immunoglobulin concentrations. However, all of these disorders share an increased susceptibility to infections, affecting predominantly the respiratory tract. A delay of appropriate treatment for some diseases can result in serious complications related to infections, while timely diagnosis and adequate therapy can significantly decrease morbidity and increase life expectancy and quality of life. PMID:19597006

Fried, Ari J.; Bonilla, Francisco A.

2009-01-01

106

The surgical management of primary carcinoma of the liver  

Microsoft Academic Search

From 1964 to 1981, a total of 165 patients with primary carcinoma of the liver underwent various types of hepatic resections. Eighty-five percent of tumors were found in cirrhotic livers. In 78.4%, HBsAg could be demonstrated by the reverse passive hemagglutination technique, while 85.7% had positive alpha-fetoprotein in the serum. The complication rate was high (42.1%), while the hospital death

N. W. Lee; J. Wong; G. B. Ong

1982-01-01

107

Primary Sclerosing Cholangitis: Current and Future Management Strategies  

PubMed Central

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease. The etiology of this disorder is unknown and there are no effective medical therapies. PSC is associated with inflammatory bowel disease and an increased risk for hepatobiliary and colorectal malignancies. The aim of this review is to highlight the clinical features and diagnostic approach to patients with suspected PSC, characterize associated comorbidities, review screening strategies for PSC associated malignancies and review contemporary and future therapies. PMID:23682242

Eaton, John E.; Talwalkar, Jayant A.

2013-01-01

108

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

109

Responsibility for Financial Management in Primary Schools: Evidence from an English Local Authority  

ERIC Educational Resources Information Center

Financial management in primary schools has changed in the UK with the introduction of the Schools Financial Value Standard (SFVS). There is increasing delegation of financial responsibility to the management team in the school, increasing the role of the head teacher and the governing body as part of overall responsibility for the strategic…

Fitzgerald, Sarah; Drake, Julie

2013-01-01

110

Routine primary care management of acute low back pain: adherence to clinical guidelines  

Microsoft Academic Search

One of the major challenges for general practitioners is to manage individuals with acute low back pain appropriately to reduce the risk of chronicity. A prospective study was designed to assess the actual management of acute low back pain in one primary care setting and to determine whether existing practice patterns conform to published guidelines. Twenty-four family physicians from public

Violeta González-Urzelai; Loreto Palacio-Elua; Josefina López-de-Munain

2003-01-01

111

Teacher Classroom Behaviour Management Preparation in Undergraduate Primary Education in Australia: A Web-Based Investigation  

ERIC Educational Resources Information Center

Classroom behaviour management is an essential skill required by all teacher graduates to facilitate instruction in curriculum content. This article describes the classroom behaviour management (CBM) content on offer in Australian undergraduate primary education programs. To date, no nationwide studies exist that report the CBM instruction on…

O'Neill, Sue C.; Stephensen, Jennifer

2011-01-01

112

Practitioners' views on managing childhood obesity in primary care: a qualitative study  

PubMed Central

Background In 2006 the Department of Health and the National Institute for Health and Clinical Excellence (NICE) published guidance on the management of childhood obesity, for use by primary care practitioners. Little is known, however, about practitioners' views and experiences of managing childhood obesity in primary care. Aim To explore practitioners' views of primary care as a setting in which to treat childhood obesity. Design of study Qualitative interview study. Setting Primary care and other community settings based in Bristol, England. Method Interviews explored practitioners' views and experiences of managing childhood obesity and their knowledge of the recent guidance provided by the Department of Health and NICE. Interviews were audiotaped and transcribed verbatim. Analysis was thematic and comparisons made both within and across the interviews. Results Thirty practitioners were interviewed: 12 GPs, 10 practice nurses, four school nurses, and four health visitors. Participants varied in their views about whether primary care is an appropriate treatment setting for childhood obesity. However, all described factors that limited the extent to which they could intervene effectively: a lack of expertise, resources, and contact with primary school children; the causes of childhood obesity; and the need to work with parents. It was also apparent that very few participants had knowledge of the recent guidance. Conclusion Practitioners do not currently view primary care as an effective treatment setting for childhood obesity and it is unlikely that the guidance from the Department of Health and NICE will have a meaningful impact on their management of this condition. PMID:19712545

Turner, Katrina M; Shield, Julian PH; Salisbury, Chris

2009-01-01

113

Cervical pain syndromes: Primary care diagnosis and management  

Microsoft Academic Search

This article discusses treatment of the most common musculoskeletal causes of cervical pain syndromes. A thorough history\\u000a and physical exam can allow treatment of these disorders without use of unnecessary and costly testing in the current era\\u000a of managed care.

Howard I. Levy

2000-01-01

114

Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative  

PubMed Central

Quality problem Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. Initial assessment Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ?30% were estimated to have suboptimal management according to Public Health Observatory analyses. Choice of solution An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. Implementation A two-phase collaborative was implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do-Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. Evaluation Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as a marker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ?2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. Lessons learned An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention. PMID:25525148

Harvey, Gill; Oliver, Kathryn; Humphreys, John; Rothwell, Katy; Hegarty, Janet

2015-01-01

115

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

116

[Choice of nutritional interventions in Congo: an approach for primary health care centres and for the community].  

PubMed

This research is aimed at testing and adapting a comprehensive and participatory approach to identification, selection and evaluation of nutritional interventions in Congo. The mains tools utilized here are a causal model, a ranking table and a HIPPOPOC table. The causal model was built by a multi-sectional team of 35 persons and used to conceptualize the nutrition of young children in Congo, to identify vulnerable determinants and relevant interventions. Three main determinants were identified: i) Food consumption of the child; ii) Health status of the child and iii) Caring practices of children and mothers. Each determinant was developed into a sub-model. For each sub-model, the team identified vulnerable factors and relevant interventions. The identification of six interventions was based on experience, scientific knowledge and on-going interventions of the members of the group during participatory discussions. As resources were limited, it was not possible to implement all of the six interventions; thus a selection of the most appropriate interventions was made using a ranking table. Before building the ranking table, a choice of the most appropriate criteria was made by the group: technical feasibility, acceptability by the population, acceptability by health workers, financial feasibility, short-term impact, potential of participation and sustainability. The ranking table for intervention selection allows a critical discussion on each intervention and leads to prioritization. Once the table was completed, the three most appropriate interventions were selected: communication for behavior change, improvement of quality of care, and promotion of improved complementary foodstuff production. Two of the interventions (psychosocial stimulation and community-based) identified needed more research for implementation. In order to determine clear objectives for intervention and to set up a monitoring and evaluation system, a practical tool was used: the HIPPOPOC table. This table represents a simplified view of the intervention in which project inputs (resources), processes (activities), outputs (immediate results), outcomes (short- or mid-term effects) and impacts (long-term effects) are clearly defined. The approach used here is based firstly on completeness as a way of guaranteeing the success of the design, implementation and evaluation of an intervention. Completeness means that all factors that may affect actions and their impact are taken into account. Secondly, participation is a key element of the process. All actors playing an active role in the decision-making process are present during the planning and evaluation process. This approach is meant to empower individuals and the community as a whole and develop within the community an awareness and a competence for problem solving. It involves multiple stakeholders (target groups, supervisors, sponsors, central as well as peripheral workers, experts, etc.) in design, implementation, needs assessment, monitoring and evaluation. PMID:11943645

Tchibindat, Félicité; Mouyokani, Isabelle; Yila-Boumpoto, Madeleine

2002-01-01

117

Managing risk in cancer presentation, detection and referral: a qualitative study of primary care staff views  

PubMed Central

Objectives In the UK, there have been a number of national initiatives to promote earlier detection and prompt referral of patients presenting to primary care with signs and symptoms of cancer. The aim of the study was to explore the experiences of a range of primary care staff in promoting earlier presentation, detection and referral of patients with symptoms suggestive of cancer. Setting Six primary care practices in northwest England. Participants: 39 primary care staff from a variety of disciplines took part in five group and four individual interviews. Results The global theme to emerge from the interviews was ‘managing risk’, which had three underpinning organising themes: ‘complexity’, relating to uncertainty of cancer diagnoses, service fragmentation and plethora of guidelines; ‘continuity’, relating to relationships between practice staff and their patients and between primary and secondary care; ‘conflict’ relating to policy drivers and staff role boundaries. A key concern of staff was that policymakers and those implementing cancer initiatives did not fully understand how risk was managed within primary care. Conclusions Primary care staff expressed a range of views and opinions on the benefits of cancer initiatives. National initiatives did not appear to wholly resolve issues in managing risk for all practitioners. Staff were concerned about the number of guidelines and priorities they were expected to implement. These issues need to be considered by policymakers when developing and implementing new initiatives. PMID:24928585

Cook, Neil; Thomson, Gillian; Dey, Paola

2014-01-01

118

Advances in non-surgical management of primary liver cancer  

PubMed Central

Hepatocellular carcinoma (HCC) is the fifth most common cancer and the third most common cause of cancer-related death worldwide. There have been great improvements in the diagnosis and treatment of HCC in recent years, but the problems, including difficult diagnosis at early stage, quick progression, and poor prognosis remain unsolved. Surgical resection is the mainstay of the treatment for HCC. However, 70%-80% of HCC patients are diagnosed at an advanced stage when most are ineligible for potentially curative therapies such as surgical resection and liver transplantation. In recent years, non-surgical management for unrespectable HCC, such as percutaneous ethanol injection, percutaneous microwave coagulation therapy, percutaneous radiofrequency ablation, transcatheter arterial chemoembolization, radiotherapy, chemotherapy, biotherapy, and hormonal therapy have been developed. These therapeutic options, either alone or in combination, have been shown to control tumor growth, prolong survival time, and improve quality of life to some extent. This review covers the current status and progress of non-surgical management for HCC. PMID:25469032

Chen, Xiao; Liu, Hai-Peng; Li, Mei; Qiao, Liang

2014-01-01

119

The reality of waste management in primary health care units in Brazil.  

PubMed

A large number of users are serviced in primary health care units in Brazil, both in health facilities and in households. These services generate waste that must be managed safely, but there is no legislation that regulates this type of waste management in Brazil. The objective of this study was to analyse the production and management of waste in primary health care. A direct observation was performed of the stages in the handling and weighing of waste generated in primary health care units in the municipality of Goiânia (Brazil). The units generated infectious, chemical, and common waste, as well as sharp objects. The generation of waste ranged between 0.027 and 0.075?kg?user-day. The generated waste was classified mostly as common and recyclable. Flaws were observed in the management of all types of waste. The critical point is segregation. Only 34.1% of the waste disposed of as infectious actually belonged to this group, the rest was ordinary waste. Flaws at this stage increase the volume of infectious waste, the occupational and environmental risks, and associated costs. Intervention to change this reality is needed and it requires the careful preparation of a waste management plan, corroborating structural changes to the implementation of this plan, and professional training and public policies to guide waste management in primary care, especially those generated in households. PMID:25034368

Alves, Sergiane B; e Souza, Adenícia C S; Tipple, Anaclara F V; Rezende, Keyti C A D; de Resende, Fabiana R; Rodrigues, Érika G; Pereira, Milca S

2014-09-01

120

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

121

Arthroscopic management of a chronic primary anterior shoulder dislocation.  

PubMed

Chronic anterior dislocation of the glenohumeral joint often leads to functional impairment and pain. Duration of dislocation is correlated with complications, and this injury is traditionally treated with an open procedure. A right-hand - dominant woman in her late 70s presented with traumatic chronic anterior dislocation of the glenohumeral joint. Her physical exam and imaging studies were consistent with anterior shoulder dislocation, a large Hill-Sachs deformity, and rotator cuff and anterior labral tears. A shoulder reduction under anesthesia was performed followed by an arthroscopic double-row rotator cuff repair. In addition, a labral repair was performed via percutaneously inserted suture anchors. Following this treatment, stability was restored to the glenohumeral joint. The patient progressed well with physical therapy and, at 1-year follow-up, the patient had returned to all routine activities pain-free. Arthroscopic repair of chronic primary traumatic anterior shoulder dislocations requiring surgical treatment is a valuable alternative to open procedures and should be considered in higher-functioning elderly patients. Percutaneous suture anchor placement minimizes trauma to an already pathologic rotator cuff and joint capsule. PMID:20844774

Galano, Gregory J; Dieter, Alexis A; Moradi, Natan E; Ahmad, Christopher S

2010-07-01

122

[Role of medicinal coal in primary management of poisoning].  

PubMed

Primary detoxication by ipecac-induced emesis or gastric lavage is incomplete. In mild to moderate childhood poisoning administration of activated charcoal alone without gastric emptying is often more effective, because it binds toxins promptly. In-vitro and in-vivo studies of many substances have shown good adsorption to activated charcoal (e.g. digitalis, beta-blocking agents, phenobarbitone, carbamazepine, theophylline). If in-vitro adsorption is moderate to poor, administration of activated charcoal might nevertheless prove clinically valuable by altering the severity of symptoms such as has been shown with acetaminophen, salicylates or organophosphate insecticide intoxications. Possible risks are shown and dosage regimens of activated charcoal are given alongside an evaluation of additional cathartics in the initial treatment of childhood poisonings. The role of repeated doses of activated charcoal as a method of secondary detoxication in comparison with hemoperfusion techniques and its significance in clinical routine is pointed out. General conclusion: In mild to moderate childhood poisoning early administration of activated charcoal alone after consultation of pediatrician and/or poison center specialists is an adequate therapy. PMID:8145456

Brockstedt, M; Hoffmann-Walbeck, P

1993-12-01

123

Practice patterns in the evaluation and management of dementia by primary care residents, primary care physicians, and geriatricians  

PubMed Central

With the aim of determining if specialty type or the amount of geriatric training during primary care residencies correlated with the rate of and comfort with dementia identification and management in patients 65 years and older, physician practice patterns were compared through a web-based survey. The survey was sent to family medicine, internal medicine, and geriatric physicians in Dallas County and the HealthTexas Provider Network as well as third-year family medicine and internal medicine residents in Texas. Chi-square analyses revealed no relationship between the quantity of geriatric training and either dementia screening rates or comfort with dementia diagnosis. However, there was a significant difference in these areas based on specialty: more geriatricians reported asking senior patients about memory problems and being very comfortable in making a diagnosis of dementia, while fewer family medicine and internal medicine physicians reported being very comfortable in making the dementia diagnosis. Most physicians surveyed supported instituting routine screening and evaluation of senior patients during residency training. Further research is needed to determine if brief screening modalities, enhanced training, and institution of national guidelines would result in earlier identification and management of dementia in primary care. PMID:20396419

Baloch, Saira; Moss, Shannon Burton; Tingle, Leslie

2010-01-01

124

Approach to the surgical management of primary aldosteronism.  

PubMed

Primary aldosteronism (PA) is the most common cause of endocrine hypertension; it has been reported in more than 11% of referred hypertensive patients. PA may be caused by unilateral adrenal involvement [aldosterone producing adenoma (APA) or unilateral adrenal hyperplasia (UAH)], and bilateral disease (idiopathic adrenal hyperplasia). Only patients with unilateral adrenal hypersecretion may be cured by unilateral adrenalectomy, while patients with bilateral and non-surgically correctable PA are usually treated by mineralocorticoid receptor antagonists; thus the distinction between unilateral and bilateral aldosterone hypersecretion is crucial. Most experts agree that the referral diagnostic test for lateralization of aldosterone hypersecretion should be adrenal venous sampling (AVS) because the interpretation of other imaging techniques [computed tomography (CT), magnetic resonance imaging (MRI) and scintigraphy] may lead to inappropriate treatment. Adrenalectomy represents the elective treatment in unilateral PA variants. Laparoscopic surgery, using transperitoneal or retroperitoneal approaches, is the preferred strategy. Otherwise, the indications to laparoscopic unilateral total or partial adrenalectomy in patients with unilateral PA remain controversial. Adrenalectomy is highly successful in curing the PA, with correction of hypokalemia in virtually all patients, cure of hypertension in about 30-60% of cases, and a marked improvement of blood pressure values in the remaining patients. Interestingly, in several papers the outcomes of surgery focus only on blood pressure changes and the normalization of serum potassium levels is often used as a surrogate of PA recovery. However, the goal of surgery is the normalization of aldosterone, because chronically elevated levels of this hormone can lead to cardiovascular complications, independently from blood pressure levels. Thus, we strongly advocate the need of considering the postoperative normalization of aldosterone-renin ratio (ARR) as the main endpoint for determining outcomes of PA. PMID:25713782

Iacobone, Maurizio; Citton, Marilisa; Viel, Giovanni; Rossi, Gian Paolo; Nitti, Donato

2015-02-01

125

Approach to the surgical management of primary aldosteronism  

PubMed Central

Primary aldosteronism (PA) is the most common cause of endocrine hypertension; it has been reported in more than 11% of referred hypertensive patients. PA may be caused by unilateral adrenal involvement [aldosterone producing adenoma (APA) or unilateral adrenal hyperplasia (UAH)], and bilateral disease (idiopathic adrenal hyperplasia). Only patients with unilateral adrenal hypersecretion may be cured by unilateral adrenalectomy, while patients with bilateral and non-surgically correctable PA are usually treated by mineralocorticoid receptor antagonists; thus the distinction between unilateral and bilateral aldosterone hypersecretion is crucial. Most experts agree that the referral diagnostic test for lateralization of aldosterone hypersecretion should be adrenal venous sampling (AVS) because the interpretation of other imaging techniques [computed tomography (CT), magnetic resonance imaging (MRI) and scintigraphy] may lead to inappropriate treatment. Adrenalectomy represents the elective treatment in unilateral PA variants. Laparoscopic surgery, using transperitoneal or retroperitoneal approaches, is the preferred strategy. Otherwise, the indications to laparoscopic unilateral total or partial adrenalectomy in patients with unilateral PA remain controversial. Adrenalectomy is highly successful in curing the PA, with correction of hypokalemia in virtually all patients, cure of hypertension in about 30-60% of cases, and a marked improvement of blood pressure values in the remaining patients. Interestingly, in several papers the outcomes of surgery focus only on blood pressure changes and the normalization of serum potassium levels is often used as a surrogate of PA recovery. However, the goal of surgery is the normalization of aldosterone, because chronically elevated levels of this hormone can lead to cardiovascular complications, independently from blood pressure levels. Thus, we strongly advocate the need of considering the postoperative normalization of aldosterone-renin ratio (ARR) as the main endpoint for determining outcomes of PA. PMID:25713782

Citton, Marilisa; Viel, Giovanni; Rossi, Gian Paolo; Nitti, Donato

2015-01-01

126

A data mining approach to simulating farmers' crop choices for integrated water resources management.  

PubMed

Water and land resources in Thailand are increasingly under pressure from development. In particular, there are many resource conflicts associated with agricultural production in northern Thailand. Communities in these areas are significantly constrained in the land and water management decisions they are able to make. This paper describes the application of a data mining approach to describing and simulating farmers' decision rules in a catchment in northern Thailand. This approach is being applied to simulate social, economic and biophysical constraints on farmers' decisions in these areas as part of an integrated water management model. PMID:16289539

Ekasingh, B; Ngamsomsuke, K; Letcher, R A; Spate, J

2005-12-01

127

Tools for primary care management of inflammatory bowel disease: Do they exist?  

PubMed Central

Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians is conducted. Inflammatory bowel disease (IBD) is one such chronic disease. Despite specialist care being essential, much IBD care could and probably should be delivered in primary care with continued collaboration between all stakeholders. Whilst most primary care physicians only have few patients currently affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician’s IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and associated supportive literature. The purpose of this review is to investigate what non-specialist tools, action plans or guidelines for IBD are published in readily searchable medical literature and compare these to those which exist for other chronic conditions.

Bennett, Alice L; Munkholm, Pia; Andrews, Jane M

2015-01-01

128

Opioid analgesics in primary care: challenges and new advances in the management of noncancer pain.  

PubMed

Primary care attitudes affecting the use of strong opioids in pain management have changed considerably in the last 3 decades. Forces that have shaped current attitudes and trends in opioid prescribing include historical influences, regulatory factors, and technologic and scientific advances. The article identifies for primary care physicians the current challenges and issues surrounding the use of opioid analgesics for noncancer pain and examines how new technology and expanding knowledge have been applied to existing opioids such as morphine, oxymorphone, and fentanyl to address continuing challenges in pain management. PMID:16513905

Sinatra, Raymond

2006-01-01

129

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

130

Endoscopic management of a primary duodenal carcinoid tumor.  

PubMed

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

Positive practice environments influence job satisfaction of primary health care clinic nursing managers in two South African provinces  

PubMed Central

Background Nurses constitute the majority of the health workforce in South Africa and they play a major role in providing primary health care (PHC) services. Job satisfaction influences nurse retention and successful implementation of health system reforms. This study was conducted in light of renewed government commitment to reforms at the PHC level, and to contribute to the development of solutions to the challenges faced by the South African nursing workforce. The objective of the study was to determine overall job satisfaction of PHC clinic nursing managers and the predictors of their job satisfaction in two South African provinces. Methods During 2012, a cross-sectional study was conducted in two South African provinces. Stratified random sampling was used to survey a total of 111 nursing managers working in PHC clinics. These managers completed a pre-tested Measure of Job Satisfaction questionnaire with subscales on personal satisfaction, workload, professional support, training, pay, career prospects and standards of care. Mean scores were used to measure overall job satisfaction and various subscales. Predictors of job satisfaction were determined through multiple logistic regression analysis. Results A total of 108 nursing managers completed the survey representing a 97% response rate. The mean age of respondents was 49 years (SD?=?7.9) and the majority of them (92%) were female. Seventy-six percent had a PHC clinical training qualification. Overall mean job satisfaction scores were 142.80 (SD?=?24.3) and 143.41 (SD?=?25.6) for Gauteng and Free State provinces respectively out of a maximum possible score of 215. Predictors of job satisfaction were: working in a clinic of choice (RRR?=?3.10 (95% CI: 1.11 to 8.62, P?=?0.030)), being tired at work (RRR?=?0.19 (95% CI: 0.08 to 0.50, P?=?0.001)) and experience of verbal abuse (RRR?=?0.18 (95% CI: 0.06 to 0.55, P?=?0.001). Conclusion Allowing nurses greater choice of clinic to work in, the prevention of violence and addressing workloads could improve the practice environment and job satisfaction of PHC clinic nursing managers. PMID:24885785

2014-01-01

132

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

133

Managed care, physician job satisfaction, and the quality of primary care  

Microsoft Academic Search

OBJECTIVE: To determine the associations between managed care, physician job satisfaction, and the quality of primary care, and to determine\\u000a whether physician job satisfaction is associated with health outcomes among primary care patients with pain and depressive\\u000a symptoms.\\u000a \\u000a \\u000a DESIGN: Prospective cohort study.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Offices of 261 primary physicians in private practice in Seattle.\\u000a \\u000a \\u000a \\u000a \\u000a PATIENTS: We screened 17,187 patients in waiting

David Grembowski; David Paschane; Paula Diehr; Wayne Katon; Diane Martin; Donald L. Patrick

2005-01-01

134

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

135

Making choices: research paradigms and information management : Practical applications of philosophy in IM research  

Microsoft Academic Search

Purpose – The purpose of this paper is to examine a variety of research approaches which information managers may find useful to meet the needs of working in the networked, digitized age. Design\\/methodology\\/approach – This is achieved by a discussion of the research paradigms inherent within both information theory and social theory. Findings – The findings work towards a final

M. E. Burke

2007-01-01

136

A study of litter and waste management policies at (primary) eco-schools in Istanbul.  

PubMed

In addition to environmental and economic benefits, systematic application of sustainable waste management in elementary education buildings also makes a positive contribution to the education of future generations. This study examines elementary schools in Istanbul, which are part of the Eco-Schools International Programme. This programme was established in 1994 with European Union support and it aims to introduce environmental management systems into primary schools within the scope of ISO 14001/EMAS. A questionnaire study was administered on the theme of litter management and sustainable waste management within elementary schools located in the Asian and European parts of Istanbul city, and the findings of a field survey were examined. Questionnaire findings were gathered under five themes: litter management, composting of organic waste, re-use of school materials, reducing consumption-selection of recycled products, waste management and sorting of recyclable materials. PMID:21159739

Kayihan, Kutlu Sevinç; Tönük, Seda

2012-01-01

137

Constrained Choice and Ethical Dilemmas in Land Management: Environmental Quality and Food Safety in California Agriculture  

Microsoft Academic Search

As environmental and conservation efforts increasingly turn towards agricultural landscapes, it is important to understand\\u000a how land management decisions are made by agricultural producers. While previous studies have explored producer decision-making,\\u000a many fail to recognize the importance of external structural influences. This paper uses a case study to explore how consolidated\\u000a markets and increasing corporate power in the food system

Diana Stuart

2009-01-01

138

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

139

Integrating Load Management into Energy Management System's Normal Operations -- Primary Factors  

Microsoft Academic Search

This paper delineates the major considerations in integrating load management into the normal operations of power system control centers' energy management systems (EMS). It shows how the system operators would like to utilize load management in conjunction with the day-to-day scheduling and dispatch of generation and interchange resources in an electric utility company. The paper presents the results of a

M. L. Chan; Don Imamura; Farrokh Albuyeh; Gashy Mesbah

1986-01-01

140

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

141

Musculoskeletal conditions in children and adolescents managed in Australian primary care  

PubMed Central

Background Primary care settings play a vital role in the early detection and appropriate management of musculoskeletal conditions in paediatric populations. However, little data exist regarding these conditions in a primary care context or on the presentation of specific musculoskeletal disorders in children. The aim of this study was to estimate the caseload and describe typical management of musculoskeletal conditions in children and adolescents presenting to primary care in Australia. Methods An analysis of data from the Bettering the Evaluation and Care of Health (BEACH) study was performed. The BEACH study is a continuous national study of general practice (GP) activity in Australia. We identified all GP encounters with children and adolescents over the past five years and extracted data on demographic details, the problems managed, and GP management of each problem. SAS statistical software was used to calculate robust proportions and after adjustment for the cluster, the 95% confidence intervals (CIs). Results From the period April 2006 to March 2011, there were 65,279 encounters with children and adolescents in the BEACH database. Of the 77,830 problems managed at these encounters, 4.9% (95%CI 4.7% to 5.1%) were musculoskeletal problems. The rate of musculoskeletal problems managed increased significantly with age, however there was a significant decrease for girls aged 15–17 years. Upper and lower limb conditions were the most common, followed by spine and trunk conditions. Spine and trunk conditions were significantly more likely to be managed with medication, but less likely to receive imaging, than upper or lower limb problems. Conclusions Musculoskeletal problems in children and adolescents present a significant burden and an important challenge to the primary health care system in Australia. There is variability in rates of presentation between different age groups, gender and affected body region. PMID:24885231

2014-01-01

142

Globalization and Leadership and Management: A Comparative Analysis of Primary Schools in England and Finland  

ERIC Educational Resources Information Center

This article analyses the impact of processes of globalization on both policy and practice in relation to primary school leadership and management in England and Finland. Data are drawn from case study research carried out from 1994-1996 in six schools in Finland and six schools in England and a follow-up study on teacher professionalism…

Webb, Rosemary; Vulliamy, Graham; Sarja, Anneli; Hamalainen, Seppo

2006-01-01

143

Decision support software for dementia diagnosis and management in primary care: Relevance and potential  

Microsoft Academic Search

Dementia, which affects a large and growing number of older people, presents particular challenges to primary care. There is an acknowledged need to develop interventions that address practitioners' needs for information and guidance regarding the diagnosis and management of dementia. This paper examines the potential usefulness and constraints of a Computer Decision Support System (CDSS) to assist practitioners in diagnosing

S. Turner; S. Iliffe; M. Downs; M. Bryans; J. Wilcock; T. Austin

2003-01-01

144

Management of Primary Dysmenorrhea by School Adolescents in ILE-IFE, Nigeria  

ERIC Educational Resources Information Center

Dysmenorrhea is a problem that girls and women face and often manage themselves with or without support from health professionals. A cross-sectional, descriptive study was conducted among adolescents with dysmenorrhea (N = 150) in Ile-Ife, Nigeria. The aims of the study were to determine their knowledge of menstruation and primary dysmenorrhea,…

Ogunfowokan, Adesola A.; Babatunde, Oluwayemisi A.

2010-01-01

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

Managing service quality in higher education: the role of the student as primary consumer  

Microsoft Academic Search

Discusses aspects of current service quality theory in the context of British higher education (HE). Focuses on the role of the student as primary consumer of HE services (a relatively recent conceptualization in this country), and the implications of this for the management of service quality in higher education organizations (HEOs). Briefly discusses an exploratory study which has monitored a

Frances M. Hill

1995-01-01

147

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

E-print Network

Computer-based Decision Support in the Management of Primary Gastric non-Hodgkin Lymphoma #3; Peter Department of Gastroenterology & Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek of the uncertainties underlying the decision-making process. The model has been incorporated into a computer-based

Utrecht, Universiteit

148

Primary care management of the female patient presenting with nipple discharge.  

PubMed

Nipple discharge is a common primary care finding in female patients. The nurse practitioner must possess the skills and knowledge to correctly and safely manage this clinical finding. The following is a review of the etiology of nipple discharge, the differential diagnoses, and treatment modalities. PMID:25679138

Morgan, Hilary S

2015-03-12

149

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

150

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

151

International Primary Care Respiratory Group (IPCRG) Guidelines: management of chronic obstructive pulmonary disease (COPD).  

PubMed

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 the diagnosis. It covers the classification of the disease according to disease severity, non-pharmacologic therapy including smoking cessation, avoidance of risk factors, patient education, pharmacologic therapy including the use of oxygen treatment, the management of exacerbations, the role of pulmonary rehabilitation, and the need for monitoring and ongoing care for COPD patients. PMID:16701758

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

2006-02-01

152

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

153

Understanding the Intersection of Individual Needs and Choices with Organizational Practices: The Case of Medication Management in Assisted Living  

ERIC Educational Resources Information Center

Purpose: Making choices about everyday activities is a normal event for many adults. However, when an adult moves into an assisted living (AL) community, making choices becomes complicated by perceived needs and community practices. This study examines the relationship between choice and need in the context of practices, using medication…

Carder, Paula C.; Zimmerman, Sheryl; Schumacher, John G.

2009-01-01

154

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

155

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

156

Medicaid Managed Care Model of Primary Care and Health Care Management for Individuals with Developmental Disabilities  

ERIC Educational Resources Information Center

Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an…

Kastner, Theodore A.; Walsh, Kevin K.

2006-01-01

157

Pressure-ulcer management and prevention in acute and primary care.  

PubMed

This article describes a study to ascertain what it is like to follow the processes in practice for prevention and management of pressure ulcers as one aspect of care among others. The participants in this study were bands 5 and 6 staff nurses and healthcare assistants (HCAs) (n=72) recruited from two acute and two primary NHS trusts. Data were gathered from open-ended questions via an online survey (n=61) and interviews (n=11). The interviews were transcribed and all the data were analysed by thematic analysis. The findings show that participants believe there has been a high-profile imposition of guidelines and policies by management during at least the past 18 months, resulting in perceived good outcomes in the form of fewer pressure ulcers generally and less fragmentation of care, particularly within primary care. However, a number of perceived obstacles to the implementation of recommended interventions remain, notably lack of time and lack of knowledge. PMID:25816003

Newham, Roger; Hudgell, Lynne

2015-03-25

158

Managing dyspepsia without alarm signs in primary care: new national guidance for England and Wales  

Microsoft Academic Search

Aim: To report new recommendations for the primary care management of dyspepsia without alarm signs in England and Wales. Method: An independent, representative group of health care professionals, patient representatives and research- ers developed the guideline using evidence-based and small group-working principles, and incorporated extensive peer-reviewing and feedback from stakeholder organizations. Results: Referral to investigate dyspepsia should be made for

J. M. M ASON; B. D ELANEY

159

A novel approach in management of lateral luxation of primary tooth  

PubMed Central

Lateral luxation is defined as the displacement of the tooth in a direction other than axially. The present case report narrates management of laterally luxated primary maxillary central incisor with occlusal interference using an inclined plane fabricated with composite resin. The composite resin inclined plane was successfully used for correction of cross-bite caused due to lateral luxation particularly in delayed presentation of the case to the Pedodontics clinic after traumatic injury with occlusal interference. PMID:23524489

Wankhade, Abhijit D; Pandey, Ramesh Kumar; Singh, Rajeev Kumar; Gondhalekar, Rajashree

2013-01-01

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

Designing a complex intervention for dementia case management in primary care  

PubMed Central

Background Community-based support will become increasingly important for people with dementia, but currently services are fragmented and the quality of care is variable. Case management is a popular approach to care co-ordination, but evidence to date on its effectiveness in dementia has been equivocal. Case management interventions need to be designed to overcome obstacles to care co-ordination and maximise benefit. A successful case management methodology was adapted from the United States (US) version for use in English primary care, with a view to a definitive trial. Medical Research Council guidance on the development of complex interventions was implemented in the adaptation process, to capture the skill sets, person characteristics and learning needs of primary care based case managers. Methods Co-design of the case manager role in a single NHS provider organisation, with external peer review by professionals and carers, in an iterative technology development process. Results The generic skills and personal attributes were described for practice nurses taking up the case manager role in their workplaces, and for social workers seconded to general practice teams, together with a method of assessing their learning needs. A manual of information material for people with dementia and their family carers was also created using the US intervention as its source. Conclusions Co-design produces rich products that have face validity and map onto the complexities of dementia and of health and care services. The feasibility of the case manager role, as described and defined by this process, needs evaluation in ‘real life’ settings. PMID:23865537

2013-01-01

162

Managing risk: risk perception, trust and control in a Primary Care Partnership.  

PubMed

In this article, managers' perceptions of risk on entering a newly formed primary health care partnership are explored, as are the mechanisms of trust and control used to manage them. The article reports a qualitative component of a 2-year National Health and Medical Research Council funded study of trust within the structures of a Primary Care Partnership (PCP) in Victoria, Australia. Multiple methods of data collection were employed. We found that managers identified risks at system, partnership and agency levels, and that as trust was built, concern about risks diminished. Trust effectively facilitated joint action, but it was betrayed on occasions, in which case the informal power of group process was used to contain the problems. The implications of this study for policy makers are in terms of understanding how perceptions of risk are constructed, the ways managers use social control to create a safer context in which to locate the trust-based relationships that facilitate joint action, and the importance of institutional arrangements. Without trust, joint action is hard to achieve, and without control, it is difficult to prevent breaches of trust from inhibiting joint action. PMID:17137693

Walker, Rae; Bisset, Penny; Adam, Jenny

2007-02-01

163

Diagnosis and management of primary sclerosing cholangitis-perspectives from a therapeutic endoscopist  

PubMed Central

Primary sclerosing cholangitis (PSC) is a chronic, cholestatic liver condition characterized by inflammation, fibrosis, and destruction of the intra- and extrahepatic bile ducts. The therapeutic endoscopist plays a key role in the diagnosis and management of PSC. In patients presenting with a cholestatic profile, endoscopic retrograde cholangiopancreatography (ERCP) is warranted for a definite diagnosis of PSC. Dominant strictures of the bile duct occur in 36%-57% of PSC patients. Endoscopic balloon dilatation with or without stenting have been employed in the management of dominant strictures. In addition, PSC patients are at increased risk of developing cholangiocarcinoma with a 20% lifetime risk. Brush cytology obtained during ERCP and use of fluorescence in situ hybridization forms the initial diagnostic step in the investigation of patients with dominant biliary strictures. Our review aims to summarize the current evidence supporting the role of a therapeutic endoscopist in the management of PSC patients.

Modha, Kunjam; Navaneethan, Udayakumar

2015-01-01

164

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. PMID:25479845

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

2014-01-01

165

Patient self-management in the primary care treatment of depression.  

PubMed

Efforts to improve primary care treatment of depression incorporate elements of the chronic illness care model, including patient self-management strategies. Case studies, focus groups and the literature suggest six key components of depression self-management programs: (1) implement behavioral change interventions, (2) plan for crisis and relapse prevention, (3) re-establish personal meaning, (4) attend to patients' experience, context and community, (5) build a patient-clinician partnership and (6) create an integrated, self-management support structure. Successful implementation of these components is facilitated by (1) the care system's collective and empathic understanding of the disease itself; (2) sufficient time; (3) adequate funding and (4) robust clinical information systems. PMID:16215659

Bachman, John; Swenson, Sara; Reardon, M Elizabeth; Miller, Doriane

2006-01-01

166

Accuracy of diagnostic registers and management of chronic obstructive pulmonary disease: the Devon primary care audit  

PubMed Central

Background Guidelines on COPD diagnosis and management encourage primary care physicians to detect the disease at an early stage and to treat patients according to their condition and needs. Problems in guideline implementation include difficulties in diagnosis, using spirometry and the disputed role of reversibility testing. These lead to inaccurate diagnostic registers and inadequacy of administered treatments. This study represents an audit of COPD diagnosis and management in primary care practices in Devon. Methods Six hundred and thirty two patients on COPD registers in primary care practices were seen by a visiting Respiratory Specialist Nurse. Diagnoses were made according to the NICE guidelines. Reversibility testing was carried out either routinely or based on clinical indication in two sub-samples. Dyspnoea was assessed. Data were entered into a novel IT-based software which computed guideline-based treatment recommendations. Current and recommended treatments were compared. Results Five hundred and eighty patients had spirometry. Diagnoses of COPD were confirmed in 422 patients (73%). Thirty nine patients were identified as asthma only, 94 had normal spirometry, 23 were restrictive and 2 had a cardiac disorder. Reversibility testing changed diagnosis of 11% of patients with airflow obstruction, and severity grading in 18%. Three quarters of patients with COPD had been offered practical help with smoking cessation. Short and long-acting anticholinergics and long acting beta-2 agonists had been under-prescribed; in 15–18% of patients they were indicated but not received. Inhaled steroids had been over-prescribed (recommended in 17%; taken by 60%), whereas only 4% of patients with a chronic productive cough were receiving mucolytics. Pulmonary rehabilitation was not available in some areas and was under-used in other areas. Conclusion Diagnostic registers of COPD in primary care contain mistakes leading to inaccurate prevalence estimates and inappropriate treatment decisions. Use of pre-bronchodilator readings for diagnosis overestimates the prevalence and severity in a significant minority, thus post bronchodilator readings should be used. Management of stable COPD does often not correspond to guidelines. The IT system used in this study has the potential to improve diagnosis and management of COPD in primary care. PMID:18710575

Jones, Rupert CM; Dickson-Spillmann, Maria; Mather, Martin JC; Marks, Dawn; Shackell, Bryanie S

2008-01-01

167

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

168

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

169

A brief intervention for weight management in primary care: study protocol for a randomized controlled trial  

PubMed Central

Background Obesity affects 25% of the UK adult population but modest weight loss can reduce the incidence of obesity-related chronic disease. Some effective weight loss treatments exist but there is no nationally available National Health Service (NHS) treatment service, and general practitioners (GPs) rarely discuss weight management with patients or support behavior change. Evidence shows that commercial weight management services, that most primary care trusts have 'on prescription', are more effective than primary care treatment. Methods/design We propose a controlled trial where patients will be randomized to receive either the offer of help by referral to a weight management service and follow-up to assess progress, or advice to lose weight on medical grounds. The primary outcome will be weight change at 12-months. Other questions are: what actions do people take to manage their weight in response to the two GP intervention types? How do obese patients feel about GPs opportunistically discussing weight management and how does this vary by intervention type? How do GPs feel about raising the issue opportunistically and giving the two types of brief intervention? What is the cost per kg/m2 lost for each intervention? Research assistants visiting GP practices in England (n?=?60) would objectively measure weight and height prior to GP consultations and randomize willing patients (body mass index 30+, excess body fat, 18+ years) using sealed envelopes. Full recruitment (n?=?1824) is feasible in 46 weeks, requiring six sessions of advice-giving per GP. Participants will be contacted at 3 months (postintervention) via telephone to identify actions they have taken to manage their weight. We will book appointments for participants to be seen at their GP practice for a 12-month follow-up. Discussion Trial results could make the case for brief interventions for obese people consulting their GP and introduce widespread simple treatments akin to the NHS Stop Smoking Service. Likewise, the intervention could be introduced in the Quality and Outcomes Framework and influence practice worldwide. Trial registration Current Controlled Trials ISRCTN26563137. PMID:24252510

2013-01-01

170

Fluoroquinolones in the management of community-acquired pneumonia in primary care.  

PubMed

A literature search was conducted to evaluate the pharmacokinetic and pharmacodynamic profile of the respiratory fluoroquinolones (gemifloxacin, levofloxacin and moxifloxacin) and their efficacy and safety in the management of community-acquired pneumonia (CAP). Data show that CAP is a common presentation in primary care practice, and is associated with high rates of morbidity and mortality, particularly in the elderly. Although the causative pathogens differ depending on treatment setting and patient factors, Streptococcus pneumoniae is the primary pathogen in all treatment settings. As a class, the respiratory fluoroquinolones have a very favorable pharmacokinetic and pharmacodynamic profile. Pharmacodynamic criteria suggest that moxifloxacin and gemifloxacin are more potent against S. pneumoniae, which may have the added benefit of reducing resistance selection and enhancing bacterial eradication. The respiratory fluoroquinolones are also generally well tolerated, and are first-line options for outpatient treatment of CAP in patients with comorbidities or previous antibiotic use. PMID:21073291

Wispelwey, Brian; Schafer, Katherine R

2010-11-01

171

Continuing professional development in HIV chronic disease management for primary care providers.  

PubMed

Abstract Primary care providers need continuing professional development (CPD) in order to improve their knowledge and confidence in the care of patients with chronic conditions. We developed an intensive modular CPD program in the chronic disease management of HIV for primary care providers. The program combines self-directed learning, interactive tutorials with experts, small group discussions, case studies, clinical training, one-on-one mentoring and individualized learning objectives. We trained 27 family physicians and 7 nurse practitioners between 2011 and 2013. The trainees reported high levels of satisfaction with the program. There was a 136.76% increase in the number of distinct HIV-positive patients receiving HIV-related medication refills that were prescribed by the trainees. PMID:25490133

Kang, Helen; Yip, Benita; Chau, William; Nóhpal De La Rosa, Adriana; Hall, David; Barrios, Rolando; Montaner, Julio; Guillemi, Silvia

2014-12-01

172

The diagnosis and management of cow milk protein intolerance in the primary care setting.  

PubMed

Cow milk protein intolerance (CMPI) affects 3% of infants under the age of 12 months and is often misdiagnosed as GERD or colic, risking dangerous exposure to antigens. Most infants out grow CMPI by 12 months; however, those with IgE-mediated reactions usually continue to be intolerant to cow's milk proteins and also develop other allergens including environmental allergens that cause asthmatic symptoms. Clinical manifestations of CMPI include diarrhea, bloody stools, vomiting, feeding refusal, eczema, atopic dermatitis, urticaria, angioedema, allergic rhinitis, coughing, wheezing, failure to thrive, and anaphylaxis. The research and literature showed that CMPI is easily missed in the primary care setting and needs to be considered as a cause of infant distress and clinical symptoms. This article focuses on correctly diagnosing CMPI and managing it in the primary care setting. PMID:16411542

Ewing, Whitney Merrill; Allen, Patricia Jackson

2005-01-01

173

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

174

Diagnosis and management of primary autoimmune neutropenia in children: insights for clinicians  

PubMed Central

Autoimmune neutropenia of infancy (AIN), also called primary autoimmune neutropenia, is a disease in which antibodies recognize membrane antigens of neutrophils, mostly located on immunoglobulin G (IgG) Fc receptor type 3b (Fc?IIIb receptor), causing their peripheral destruction. It is the most frequent type of neutropenia in children under 3–4 years of age and in most cases shows a benign, self-limited course. The diagnosis is based on evidence of indirect antineutrophil antibodies, whose detection frequently remains difficult. In this review we have analyzed the literature regarding AIN and present our personal experience in diagnosis and management. PMID:25642312

Dufour, Carlo

2015-01-01

175

Understanding the Intersection of Individual Needs and Choices With Organizational Practices: The Case of Medication Management in Assisted Living  

PubMed Central

Purpose:?Making choices about everyday activities is a normal event for many adults. However, when an adult moves into an assisted living (AL) community, making choices becomes complicated by perceived needs and community practices. This study examines the relationship between choice and need in the context of practices, using medication administration practices as the case in point. Design and Methods:?A 5-year ethnographic study collected information from 6 AL settings in Maryland. Ethnographic interviews (n = 323) and field notes comprise the data described in this article. Results:?AL organizations used practice rationales based on state regulations, professional responsibility, safety concerns, and social model values to describe and explain their setting-specific practices. The result was varying levels of congruence between the setting's practices and individual resident's needs and choices. That is, in some cases, the resident's needs were lost to the organization's practices, and in other cases, organizations adapted to resident need and choices. These findings suggest that individuals and organizations adapt to each other, resulting in practices that are not bound by state requirement or other practice rationales. Implications:?AL residences vary due to both internal and external forces, not just the public policies that define them. State regulations need to be responsive to both the needs and the choices of individual residents and to the people who work in an AL. PMID:19491359

Carder, Paula C.; Zimmerman, Sheryl; Schumacher, John G.

2009-01-01

176

A decade after International Subarachnoid Aneurysm Trial: Coiling as a first choice treatment in the management of intracranial aneurysms - Technical feasibility and early management outcomes  

PubMed Central

Purpose: The technique of coiling has evolved in the last decade with evolution in both equipment and material. The preferable treatment of intracranial aneurysms at our center is endovascular coiling. We discuss the technical and management outcomes of consecutive patients treated with this approach and compare our results with a decade old International Subarachnoid Aneurysm Trial. Materials and Methods: Between January 2006 and November 2011, a total of 324 aneurysms in 304 consecutive patients were treated. Endovascular treatment was done in 308 aneurysms (95.0%) in 288 patients while 16 patients (5%) underwent surgical clipping. Of the 308 aneurysms treated endovascularly, 269 (87.3%) were ruptured, and 39 (12.7%) were unruptured aneurysms. Results: The endovascular coiling was feasible in all (99.6%) but 1 case. The immediate postoperative occlusion status was complete occlusion in 240 aneurysms (77.9%), neck remnant in 57 aneurysms (18.5%), and aneurysm remnant in 11 aneurysms (3.6%). Technical issues – with or without clinical effect–were encountered in 20 patients (6.9%). They included 18 thromboembolic events (6.2%) and intraprocedural aneurysmal rupture in 2 cases (0.7%). In “good grade” patients, H and H grade 1-3, a good outcome (modified Rankin score [mRS] 0-2) was in 87.6% patients while the bad outcome (mRS 3-5) was in 10.2% patients and mortality of 2.2%. In “bad grade” patients, H and H grade 3-5, a good outcome was in 29.2%, and bad outcome was in 41.7% patients with mortality was 29.1%. In the unruptured aneurysm group, the good outcome was seen in 97.7% and bad outcome in 2.3% with no mortality. Conclusions: In the current era, the favorable results of coiling demonstrated in previous studies may be applicable to the larger proportion of patients. In our series of consecutively treated patients using latest advances, such as three-dimensional imaging and the interventional material, endovascular management as first choice was feasible in 95% of patients with good technical and management outcomes. PMID:25685204

Goel, Gaurav; Gupta, Vipul; Chinchure, Swati; Gupta, Aditya; Kaur, Gurmeen; Jha, Ajaya N.

2014-01-01

177

School Choice.  

ERIC Educational Resources Information Center

This publication is the first in a series of reports that examine policy issues in education. It looks at the four major forms of school choice--charter schools, open enrollment, home schooling, and vouchers--and how they are changing the landscape of public education. School choice is one of the fastest-growing innovations in public education,…

The Progress of Education Reform 1999-2001, 1999

1999-01-01

178

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

179

Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum.  

PubMed Central

From 1982 to 1987, 114 patients underwent operation at Memorial Sloan-Kettering Cancer Center for soft-tissue sarcoma of the retroperitoneum. A retrospective analysis of these patients defines the biologic behavior, surgical management of primary and recurrent disease, predictive factors for outcome, and impact of multimodality therapy. Complete resection was possible in 65% of primary retroperitoneal sarcomas and strongly predicts outcome (p less than 0.001). The rate of complete resection was not altered by histologic type, size, or grade of tumor. These patients had a median survival of 60 months compared to 24 months for those undergoing partial resection and 12 months for those with unresectable tumors. Forty-nine per cent of completely resected patients have had local recurrence. This is the site of first recurrence in 75% of patients. These patients undergo reoperation when feasible. Complete resection of recurrent disease was performed in 39 of 88 (44%) operations, with a 41-month median survival time after reoperation. Tumor grade was a significant predictor of outcome (p less than 0.001). High-grade tumors (n = 65) were associated with a 20-month median survival time compared to 80 months for low-grade tumors (n = 49). Gender, histologic type, size, previous biopsy, and partial resection versus unresectable tumors did not predict outcome by univariate analysis. Adjuvant radiation therapy and chemotherapy could not be shown to have significant impact on survival. Concerted attempt at complete resection of both primary and recurrent retroperitoneal soft-tissue sarcoma is indicated. PMID:2363604

Jaques, D P; Coit, D G; Hajdu, S I; Brennan, M F

1990-01-01

180

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

181

Long-term medical management of the liver transplant recipient: what the primary care physician needs to know.  

PubMed

Recognition, management, and prevention of medical complications and comorbidities after liver transplant is the key to improved long-term outcomes. Beyond allograft-related complications, metabolic syndrome, cardiovascular disease, renal dysfunction, and malignancies are leading causes of morbidity and mortality in this patient population. Primary care physicians have an important role in improving outcomes of liver transplant recipients and are increasingly relied on for managing these complex patients. This review serves to assist the primary care physician in the long-term management issues of liver transplant recipients. PMID:22763347

Singh, Siddharth; Watt, Kymberly D

2012-08-01

182

The Quality and Outcomes Framework and self-management dialogue in primary care consultations: a qualitative study  

PubMed Central

Background Two key elements to improve the quality of care for people with long-term conditions in primary care are improved clinical information systems to support delivery of evidence-based care, and enhanced self-management support. Although both elements are viewed as necessary, their interaction is not well understood. Aim To explore the use of computer-based ‘disease management’ templates and their relevance to self-management dialogue within clinical encounters. Design and setting Qualitative study of general practices located in three primary care trusts in the north of England. Method A qualitative mixed methods study was conducted that included comparative analysis of (1) observations of general practice consultations (n = 86); and (2) interviews with health professionals in general practice (n = 17). Results The analysis suggested that use of the computer templates reinforced a checklist approach to consultations, which included professionals working through several self-management topics framed as discrete behaviours. As a consequence, conversation tended to become focused on the maintenance of the professional-patient relationship at the expense of expansion in self-management dialogue. The computer templates also shaped how patient-initiated self-management dialogue was managed when it arose, with a shift towards discussion around medical agendas. Conclusion In order to enhance the management of long-term conditions in primary care, the design and implementation of clinical information systems to improve evidence-based care need to take into account their potential impact on supporting self-management. PMID:22152849

Blakeman, Tom; Chew-Graham, Carolyn; Reeves, David; Rogers, Anne; Bower, Peter

2011-01-01

183

The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care  

PubMed Central

Background: Depressive and anxiety disorders commonly occur together in patients presenting in the primary care setting. Although recognition of individual depressive and anxiety disorders has increased substantially in the past decade, recognition of comorbidity still lags. The current report reviews the epidemiology, clinical implications, and management of comorbidity in the primary care setting. Method: Literature was reviewed by 2 methods: (1) a MEDLINE search (1980–2001) using the key words depression, depressive disorders, and anxiety disorders; comorbidity was also searched with individual anxiety diagnoses; and (2) direct search of psychiatry, primary care, and internal medicine journals over the past 5 years. Results: Between 10% and 20% of adults in any given 12-month period will visit their primary care physician during an anxiety or depressive disorder episode (although typically for a nonpsychiatric complaint); more than 50% of these patients suffer from a comorbid second depressive or anxiety disorder. The presence of depressive/anxiety comorbidity substantially increases medical utilization and is associated with greater chronicity, slower recovery, increased rates of recurrence, and greater psychosocial disability. Typically, long-term treatment is indicated, although far less research is available to guide treatment decisions. Selective serotonin reuptake inhibitor antidepressants are the preferred treatment based on efficacy, safety, and tolerability criteria. Knowledge of their differential clinical and pharmacokinetic profiles can assist in optimizing treatment. Conclusion: Increased recognition of the high prevalence and negative psychosocial impact of depression and anxiety disorder comorbidity will lead to more effective treatment. While it is hoped that early and effective intervention will yield long-term benefits, research is needed to confirm this. PMID:15014592

Hirschfeld, Robert M. A.

2001-01-01

184

Challenges in managing elderly people with diabetes in primary care settings in Norway  

PubMed Central

Abstract Objective To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. Design Focus-group interviews. Subjects and setting Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years. Results Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. Conclusion Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging. PMID:24205973

2013-01-01

185

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

E-print Network

Recommendations 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) for improvement of poor waste management countrywide, recommended in its March 1999 Report the composting

Columbia University

186

Recent trends in the management of dentoalveolar traumatic injuries to primary and young permanent teeth.  

PubMed

One of the commonly encountered dental emergencies is dentoalveolar traumatic injuries (DTIs). Unfortunately, DTIs result in fractured, displaced, or lost anterior teeth and this could have significant negative functional, esthetic, speech, and psychological effects on children thus affecting their quality of life. Although it is impossible to guarantee permanent retention of a traumatized tooth, patient age, severity of injury, and timely treatment and follow up of the tooth using recommended procedures can maximize the chances for success. This review examines the recent trends in the management of DTI to primary and young permanent teeth. Electronic search of scientific papers written in English from 1990s to 2009 was accomplished using Pub Med search engine. Dental practitioners should follow current literature and consider carefully evidenced-based recommendations that may enhance periodontal healing and revascularization of avulsed permanent teeth. PMID:21244628

Turkistani, Jihan; Hanno, Azzah

2011-02-01

187

Creating cross-racial primary care relationships in a nurse-managed center.  

PubMed

Culturally incompetent communication patterns with providers influence the health disparities of African Americans. Limited knowledge exists on cross-racial nurse practitioner nurse-patient relationships (NP-NPRs). The purpose of this paper is to describe how NPs and patients in cross-racial relationships developed primary care relationships in one nurse managed center (NMC). A qualitative design incorporated a social constructivist paradigm and the methodology of Interpretive Interactionism. Twenty cross-racial NP-patient dyads (White NPs and Black patients) participated in individual 1 to 3-hour audiotaped interviews regarding their ongoing relationships and the impact of the NMC. The analysis uncovered a rich description of the relationship processes from the initial meeting to its current state. Multiple themes for each phase, as well as, four typologies of primary care cross-racial NP-NPRs are described. Significant relationship work was needed by both partners to overcome communication misunderstandings, contextual aspects of cross-racial interactions and other overt and covert perceptions. PMID:15689143

Benkert, Ramona; Pohl, Joanne M; Coleman-Burns, Patricia

2004-01-01

188

Primary Closure without Diversion in Management of Operative Blunt Duodenal Trauma in Children  

PubMed Central

Background. Operative blunt duodenal trauma is rare in pediatric patients. Management is controversial with some recommending pyloric exclusion for complex cases. We hypothesized that primary closure without diversion may be safe even in complex (Grade II-III) injuries. Methods. A retrospective review of the American College of Surgeons' Trauma Center database for the years 2003–2011 was performed to identify operative blunt duodenal trauma at our Level 1 Pediatric Trauma Center. Inclusion criteria included ages <14 years and duodenal injury requiring operative intervention. Duodenal hematomas not requiring intervention and other small bowel injuries were excluded. Results. A total of 3,283 hospital records were reviewed. Forty patients with operative hollow viscous injuries and seven with operative duodenal injuries were identified. The mean Injury Severity Score was 10.4, with injuries ranging from Grades I–IV and involving all duodenal segments. All injuries were closed primarily with drain placement and assessed for leakage via fluoroscopy between postoperative days 4 and 6. The average length of stay was 11 days; average time to full feeds was 7 days. No complications were encountered. Conclusion. Blunt abdominal trauma is an uncommon mechanism of pediatric duodenal injuries. Primary repair with drain placement is safe even in more complex injuries. PMID:23213560

Smiley, Katherine; Wright, Tiffany; Skinner, Sean; Iocono, Joseph A.; Draus, John M.

2012-01-01

189

A Reappraisal of the Diagnostic and Therapeutic Management of Uncommon Histologies of Primary Ocular Adnexal Lymphoma  

PubMed Central

Lymphoma is the most common malignancy arising in the ocular adnexa, which includes conjunctiva, lachrymal gland, lachrymal sac, eyelids, orbit soft tissue, and extraocular muscles. Ocular adnexal lymphoma (OAL) accounts for 1%–2% of non-Hodgkin lymphoma and 5%–15% of extranodal lymphoma. Histology, stage, and primary localizations are the most important variables influencing the natural history and therapeutic outcome of these malignancies. Among the various lymphoma variants that could arise in the ocular adnexa, marginal zone B-cell lymphoma (OA-MZL) is the most common one. Other types of lymphoma arise much more rarely in these anatomical sites; follicular lymphoma is the second most frequent histology, followed by diffuse large B-cell lymphoma and mantle cell lymphoma. Additional lymphoma entities, like T-cell/natural killer cell lymphomas and Burkitt lymphoma, only occasionally involve orbital structures. Because they are so rare, related literature mostly consists of anecdotal cases included within series focused on OA-MZL and sporadic case reports. This bias hampers a global approach to clinical and molecular properties of these types of lymphoma, with a low level of evidence supporting therapeutic options. This review covers the prevalence, clinical presentation, behavior, and histological and molecular features of uncommon forms of primary OAL and provides practical recommendations for therapeutic management. PMID:23814042

Govi, Silvia; Licata, Giada; Mappa, Silvia; Giordano Resti, Antonio; Politi, Letterio S.; Spagnuolo, Lorenzo; Di Cairano, Eliana; Doglioni, Claudio; Ferreri, Andrés J. M.

2013-01-01

190

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

191

The management of type 1 diabetes in primary school: review of the literature.  

PubMed

Type 1 diabetes is one of the most common chronic health conditions in childhood. The introduction of intensive insulin therapy and the rising prevalence of diabetes in younger children has increased the need for involvement of diabetes educators and school personnel in school diabetes care. School encompasses a significant proportion of a child's day, therefore diabetes treatment at school needs to be optimal or the child will have poor metabolic control. The aim of this literature review is to examine diabetes management in the early primary school setting. The main areas of diabetes management explored are: type, provision, and location of treatment, the impact on the child, and the role of the credentialed diabetes educator. The review identifies that the majority of children are not receiving intensive diabetes treatment at school. Younger children require more assistance with care and may be disadvantaged due to lack of appropriate school staff support. Most schools do not have nurses to assist with diabetes care, therefore teaching and administration staff are utilized. The use of insulin pump therapy may increase access to insulin at school, as children and teaching staff appear more confident with this method of delivery than injections. Treatment is frequently performed away from the classroom and can impact on class attendance, metabolic control, and emergencies. Diabetes educators need to work in collaboration with children, parents, and school personnel to ensure diabetes care is fully integrated into the school day. PMID:23597278

Marks, Anne; Wilson, Valerie; Crisp, Jackie

2013-01-01

192

Depression case management by practice nurses in primary care: an audit  

PubMed Central

Introduction Depression is a common and debilitating condition. A body of evidence exists about improving depression outcomes in primary care, using collaborative care models. Such approaches, however, have not been routinely adopted within general practice settings. In this paper we outline the results of an audit of an enhanced care initiative that trained practice nurses to deliver such approaches. Method An audit of symptom outcome and satisfaction was conducted in depression case-management clinics run by practice nurses. Results were then benchmarked against appropriate randomised trial data. The cost of practice nurse time devoted to the delivery of the service was estimated by multiplying time by unit cost. Results A mean change of 9.07 (standard deviation (SD) 6.67, 95% confidence interval (CI) 7.93–10.22, P < 0.001) points on the Patient Health Questionnaire (PHQ9) score was observed in those who were using/had used the service. Clinical change demonstrated a shift from moderate-to-severe to mild depression. The results reflect the changes seen in randomised controlled trial data from similar interventions in similar samples, and are superior to expected treatment as usual outcomes. Overall, respondents were ‘very satisfied’ with the service on offer. The mean cost of practice nurse time was estimated at £45 per patient. Discussion While acknowledging the limitations of audit data, practice nurses in general practice appear to be able to offer effective and acceptable case management to patients experiencing depression. PMID:22477856

2008-01-01

193

Brazilian primary school teachers' knowledge about immediate management of dental trauma  

PubMed Central

OBJECTIVE: To assess the level of knowledge of primary school teachers in the public school network of Northeastern Brazil with respect to management of dental trauma and its relationship with prognosis. METHODS: A questionnaire was applied to 195 school teachers of public schools in Northeastern Brazil. The questionnaire comprised 12 objective questions about dental trauma and methods for its prevention and management. Data were submitted to chi-square test and Poisson regression test (P > 0.05). RESULTS: Out of the 141 teachers who responded the questionnaires, the majority were women (70.2%) and most of them had experienced previous dental accidents involving a child (53.2%). The majority (84.4%) had incomplete college education and few were given some training on how to deal with emergency situations during their undergraduate course (13.5%) or after it (38.3%). Their level of knowledge about dental trauma and emergency protocols showed that unsatisfactory knowledge level was associated with the male sex: 46% higher for men in comparison to women (P = 0.025). CONCLUSIONS: Approximately half of teachers evaluated had unsatisfactory knowledge about dental trauma and emergency protocols, with female teachers showing more knowledge than men. PMID:25715724

Pithon, Matheus Melo; dos Santos, Rogério Lacerda; Magalhães, Pedro Henrique Bomfim; Coqueiro, Raildo da Silva

2014-01-01

194

Management of Chronic Heart Failure in Primary Care: What Evidence do we have for Heart Failure with Preserved Systolic Function?  

PubMed

Chronic Heart Failure (CHF) is a debilitating illness commonly encountered in primary care. Its prevalence in developing countries is rising as a result of an ageing population, and an escalating epidemic of hypertension, type 2 diabetes and coronary heart disease. CHF can be specifically diagnosed as Heart Failure with Reduced Systolic Function (HF-RSF) or Heart Failure with Preserved Systolic Function (HF-PSF). This paper illustrates a common presentation of HF-PSF in primary care; and critically appraises the evidence in support of its diagnosis, prognosis and management. Regardless of the specific diagnosis, long term management of CHF is intricate as it involves a complex interplay between medical, psychosocial, and behavioural factors. Hence, there is a pressing need for a multidisciplinary team management of CHF in primary care, and this usually takes place within the broader context of an integrated chronic disease management programme. Primary care physicians are ideally suited to lead multidisciplinary teams to ensure better co-ordination, continuity and quality of care is delivered for patients with chronic conditions across time and settings. Given the rising epidemic of cardiovascular risk factors in the Malaysian population, preventive strategies at the primary care level are likely to offer the greatest promise for reducing the growing burden of CHF. PMID:25606191

Ramli, As; Jackson, B; Toh, Ct; Ambigga, D; Piterman, L

2010-01-01

195

Prevalence and management of hypertension in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network  

PubMed Central

Background Most epidemiologic reports on hypertension in Canada are based on data from surveys or on administrative data. We report on the prevalence and management of hypertension based on data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which consists of validated, national, point-of-care data from primary care practices. Methods We included CPCSSN data as of Dec. 31, 2012, for patients 18 years and older who had at least 1 clinical encounter during the previous 2 years with one of the 444 family physicians and nurse-practitioners who participate in the CPCSSN. We calculated the prevalence of hypertension, the proportion of patients who achieved blood pressure targets, the number of encounters with primary care providers, comorbidities and pharmacologic management. Results Of the 250 346 patients who met the eligibility criteria, 57 180 (22.8%) had a diagnosis of hypertension. Of the 44 981 patients for whom blood pressure data were available, 35 094 (78.0%) had achieved both targets for systolic (??140 mm Hg) and diastolic (??90 mm Hg) pressure. Compared with patients who did not have a hypertension diagnosis, those with hypertension were significantly more likely to have a comorbidity and visited their primary care provider more often. Among the patients with hypertension, 12.1% were not taking antihypertensive medications; nearly two-thirds (61.7%) had their condition controlled with 1 or 2 drugs. Interpretation The prevalence of hypertension based on CPCSSN data was similar to estimates from the Canadian Health Measures Survey. Although achievement of blood pressure targets was high, patients with hypertension had more comorbidities and saw their primary care provider more often than those without hypertension.

Williamson, Tyler; Khan, Shahriar; Kaczorowski, Janusz; Asghari, Shabnam; Morkem, Rachel; Dawes, Martin; Birtwhistle, Richard

2015-01-01

196

Assessment of medical waste management at a primary health-care center in Sao Paulo, Brazil  

SciTech Connect

Highlights: Black-Right-Pointing-Pointer Assessment of medical waste management at health-care center before/after intervention. Black-Right-Pointing-Pointer Qualitative and quantitative results of medical waste management plan are presented. Black-Right-Pointing-Pointer Adjustments to comply with regulation were adopted and reduction of waste was observed. Black-Right-Pointing-Pointer The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of Sao Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized. Total waste generation increased 9.8%, but it was possible to reduce the volume of non-recyclable materials (11%) and increase the volume of recyclable materials (4%). It was also possible to segregate organic waste (7%), which was forwarded for production of compost. The rate of infectious waste generation in critical areas decreased from 0.021 to 0.018 kg/procedure. Many improvements have been observed, and now the PHC complies with most of legal requirements, offers periodic training and better biosafety conditions to workers, has reduced the volume of waste sent to sanitary landfills, and has introduced indicators for monitoring its own performance. This evaluation method might subsidize the creation and evaluation of medical waste management plans in similar heath institutions.

Moreira, A.M.M., E-mail: anamariainforme@hotmail.com [Department of Environmental Health, School of Public Health, University of Sao Paulo, Avenida Doutor Arnaldo 715, Sao Paulo 01246-904 (Brazil); Guenther, W.M.R. [Department of Environmental Health, School of Public Health, University of Sao Paulo, Avenida Doutor Arnaldo 715, Sao Paulo 01246-904 (Brazil)

2013-01-15

197

Management of neck metastases of unknown primary origin united in two European centers.  

PubMed

Combined analysis of diagnostic and therapeutic management of neck metastases of carcinoma of unknown primary origin ('true CUP') in two European tertiary referral centers (University Medical Centers of Maastricht, NL and Cologne, D) to contribute to the ongoing discussion on management in CUP. Retrospective analysis of 29 (Maastricht) and 22 (Cologne) true cervical CUP syndrome patients (squamous cell carcinoma). The diagnostic and therapeutic approaches were correlated with clinical follow-up data and HPV status. In total, 48 out of 51 true CUP patients received postsurgical adjuvant radiotherapy. In eight patients from Cologne, this was combined with concomitant platin-based chemotherapy. Neither in Cologne nor in Maastricht, radiotherapy of the pharyngeal mucosa was commonly performed (n = 6, 12.5 %) The percentage of patients who were irradiated ipsilaterally or bilaterally did not differ between both institutes (N = 21/27 in Maastricht vs. 11/21 in Cologne), nor did the 5-year overall survival differ significantly. Oncogenic HPV was only found in 4 out of 51 CUPs (7, 8 %). Therefore, no relation with overall and recurrence-free survival could be detected. No occult primary tumors were revealed during follow-up despite de-escalation of therapy by abandoning irradiation of the pharyngeal mucosa in both institutes. There were no significant differences between ipsilateral and bilaterally irradiated patients regarding overall and recurrence-free survival. The occurrence of distant metastases was more often noticed in ipsilaterally treated patients as compared to bilaterally radiated patients (8 vs. 2, p = 0.099). Those patients all had been classified N2b or higher. International guidelines still are not unified and there is an urgent need for a consented therapeutic regimen. Comparison of two international strategies on the management of CUP patients is presented and further research is recommended regarding the role of radiotherapy of the pharyngeal axis, the value of unilateral and bilateral radiotherapy and the role of concomitant or induction chemotherapy in CUP patients, particularly in N2b or higher-staged neck disease. The prevalence and role of HPV in true CUP after thorough diagnostic work-up seem limited in our case series, particularly when compared to the role in oropharyngeal carcinomas. PMID:24615648

Straetmans, Jos; Vent, Julia; Lacko, Martin; Speel, Ernst-Jan; Huebbers, Christian; Semrau, Robert; Hoebers, Frank; Mujagic, Zlatan; Klussmann, Jens-Peter; Preuss, Simon F; Kremer, Bernd

2015-01-01

198

Nurse-patient communication in primary care diabetes management: an exploratory study  

PubMed Central

Background Diabetes is a major health issue for individuals and for health services. There is a considerable literature on the management of diabetes and also on communication in primary care consultations. However, few studies combine these two topics and specifically in relation to nurse communication. This paper describes the nature of nurse-patient communication in diabetes management. Methods Thirty-five primary health care consultations involving 18 patients and 10 nurses were video-recorded as part of a larger multi-site study tracking health care interactions between health professionals and patients who were newly diagnosed with Type 2 diabetes. Patients and nurses were interviewed separately at the end of the 6-month study period and asked to describe their experience of managing diabetes. The analysis used ethnography and interaction analysis. In addition to analysis of the recorded consultations and interviews, the number of consultations for each patient and total time spent with nurses and other health professionals were quantified and compared. Results This study showed that initial consultations with nurses often incorporated completion of extensive checklists, physical examination, referral to other health professionals and distribution of written material, and were typically longer than consultations with other health professionals. The consultations were driven more by the nurses’ clinical agenda than by what the patient already knew or wanted to know. Interactional analysis showed that protocols and checklists both help and hinder the communication process. This contradictory outcome was also evident at a health systems level: although organisational targets may have been met, the patient did not always feel that their priorities were attended to. Both nurses and patients reported a sense of being overwhelmed arising from the sheer volume of information exchanged along with a mismatch in expectations. Conclusions Conscientious nursing work was evident but at times misdirected in terms of optimal use of time. The misalignment of patient expectations and clinical protocols highlights a common dilemma in clinical practice and raises questions about the best ways to balance the needs of individuals with the needs of a health system. Video- recording can be a powerful tool for reflection and peer review. PMID:24028348

2013-01-01

199

Need and disparities in primary care management of patients with diabetes  

PubMed Central

Background An aging population means that chronic illnesses, such as diabetes, are becoming more prevalent and demands for care are rising. Members of primary care teams should organize and coordinate patient care with a view to improving quality of care and impartial adherence to evidence-based practices for all patients. The aims of the present study were: to ascertain the prevalence of diabetes in an Italian population, stratified by age, gender and citizenship; and to identify the rate of compliance with recommended guidelines for monitoring diabetes, to see whether disparities exist in the quality of diabetes patient management. Methods A population-based analysis was performed on a dataset obtained by processing public health administration databases. The presence of diabetes and compliance with standards of care were estimated using appropriate algorithms. A multilevel logistic regression analysis was applied to assess factors affecting compliance with standards of care. Results 1,948,622 Italians aged 16+ were included in the study. In this population, 105,987 subjects were identified as having diabetes on January 1st, 2009. The prevalence of diabetes was 5.43% (95% CI 5.33-5.54) overall, 5.87% (95% CI 5.82-5.92) among males, and 5.05% (95% CI 5.00-5.09) among females. HbA1c levels had been tested in 60.50% of our diabetic subjects, LDL cholesterol levels in 57.50%, and creatinine levels in 63.27%, but only 44.19% of the diabetic individuals had undergone a comprehensive assessment during one year of care. Statistical differences in diabetes care management emerged relating to gender, age, diagnostic latency period, comorbidity and citizenship. Conclusions Process management indicators need to be used not only for the overall assessment of health care processes, but also to monitor disparities in the provision of health care. PMID:25011729

2014-01-01

200

Practice Characteristics of Graduates of East Tennessee State University Quillen College of Medicine: Factors Related to Career Choices in Primary Care  

ERIC Educational Resources Information Center

The nation is facing a physician shortage, specifically in relation to primary care and in rural underserved areas. The most basic function of a medical school is to educate physicians to care for the national population. The purpose of this study was to examine the physician practicing characteristics of the graduates of East Tennessee State…

Click, Ivy A.

2013-01-01

201

Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care  

Microsoft Academic Search

Background  The risk of depression is increased in people with long term conditions (LTCs) and is associated with poorer patient outcomes\\u000a for both the depressive illness and the LTC, but often remains undetected and poorly managed. The aim of this study was to\\u000a identify and explore barriers to detecting and managing depression in primary care in people with two exemplar LTCs:

Peter A Coventry; Rebecca Hays; Chris Dickens; Christine Bundy; Charlotte Garrett; Andrea Cherrington; Carolyn Chew-Graham

2011-01-01

202

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

203

The management and site-specific prognostic factors of primary oral mucosal malignant melanoma.  

PubMed

Primary oral mucosal malignant melanoma (POMM) is uncommon. Its biological behavior is more aggressive than that of cutaneous malignant melanoma. Its site-specific prognostic factors and optimal management have not been determined yet. Retrospective POMM case analysis from peer-reviewed publications in the PubMed and Embase electronic database from January 1984 to December 2013, in which therapy and outcome data were available, was performed. A total of 151 primary cases were extracted from 39 peer-reviewed English literatures. The study population includes 63 males and 88 females with a medium age of 61 years. The treatment protocols include surgery alone (18%), radiotherapy alone (14%), surgery plus radiotherapy (14%), surgery plus chemotherapy (31%), as well as surgery plus chemoradiotherapy (15%) and chemoradiotherapy (8%). The male patients have a higher risk for metastasis than the female patients do (odds ratio [OR]; 3.41, P = 0.021). The POMM originating from specialized mucosa was associated with increased risk for tumor recurrence and mortality (OR, 4.03, P = 0.001; OR, 2.03, P = 0.031, respectively). The patients who had surgery-based multiple therapy have a significantly longer survival compared with those who had surgery alone and those who had no surgical treatment (P = 0.000). The age of 60 years or younger (hazard ratio [HR], 4.69; P = 0.000), nonsurgical treatment (HR, 12.838; P = 0.000), and surgery alone (HR, 1.517; P = 0.001) were independent adverse prognostic factors for overall survival. Taken together, the study results suggest that surgery-based multiple therapy is the most effective treatment protocol. The age of 60 years, nonsurgical treatment, and surgery alone were independent adverse prognostic factors for overall survival. PMID:25668115

Wushou, Alimujiang; Zhao, Ya-Jun

2015-03-01

204

Presentation and management of acne in primary care: a retrospective cohort study.  

PubMed Central

BACKGROUND: Acne is the most common skin disorder in young people, affecting up to 80% of teenagers. AIMS: To ascertain the incidence, prevalence, demographic distribution and severity of acne in primary care and to document the management of these patients for a two-year period after presentation. DESIGN OF STUDY: Retrospective cohort study using data from the medical records of 798 patients who had been treated for acne during a one-year identification period. SETTING: Fourteen general practices in a mixed urban area in north-east England. METHOD: Patients aged 13 to 25 years who had acne were identified from computerised practice medical records using diagnostic codes and medication records. The medical records of these patients were then hand-searched for data for two years after presentation. RESULTS: Data were collected for 798 patients from 14 practices. The prevalence of acne in 13- to 25-year-olds was 3.1%, and the incidence was 1.6%. The ratio of male to female patients with acne was 1:1.02. Median age at presentation was 15 years for male subjects and 16 years for female subjects. Recording of site and severity was rare (18.3%). In total, 55% of patients had two or more different prescriptions for acne, 21% of patients had six or more consultations during the two-year follow-up period, and 8.5% were referred to a dermatologist. CONCLUSION: Given previous estimates of community prevalence, it is clear that the majority of young people with acne do not present to primary care. These findings have implications for the provision of effective and appropriate health care for young people with acne. PMID:14694664

Purdy, Sarah; Langston, Joy; Tait, Lisa

2003-01-01

205

Amniotic membrane transplantation in the management of conjunctival malignant melanoma and primary acquired melanosis with atypia  

PubMed Central

AIM—To evaluate the efficacy of amniotic membrane transplantation (AMT) for the management of conjunctival malignant melanoma and primary acquired melanosis (PAM) with atypia.?METHODS—Four consecutive patients with histologically proved invasive, primary conjunctival malignant melanoma were treated with wide surgical excision and AMT. Amniotic membrane grafts were harvested and processed under sterile conditions according to a standard protocol. The grafts were sutured to the margins of the surface defect. In one case, AMT was combined with a corneoscleral graft.?RESULTS—A satisfactory result and rapid postoperative recovery with few, transient side effects was noted in three patients with limbal/epibulbar melanomas. In another patient with an extensive lesion, involving the epibulbar, forniceal, and palpebral conjunctiva, AMT following wide excision was complicated by symblepharon formation and restricted ocular motility. Monitoring of local recurrence was facilitated by the transparency of the thin graft in all cases. The postoperative follow up time varied between several months and 3 years. In one case, local recurrence of PAM was observed and treated using topical mitomycin.?CONCLUSIONS—AMT is a useful technique for the reconstruction of both small and large surface defects that result from the surgical excision of conjunctival malignant melanoma and PAM. This method facilitates wide conjunctivectomy, although its role in repairing larger defects involving the fornix or palpebral conjunctiva still needs to be established. The transparency of amniotic membrane allows for monitoring of tumour recurrence, which is—together with superior cosmesis—an advantage over thicker (for example, buccal) mucous membrane grafts.?? PMID:11371482

Paridaens, D.; Beekhuis, H.; van den Bosch, W.; Remeyer, L.; Melles, G.

2001-01-01

206

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

207

Cost, Utilization, and Quality of Care: An Evaluation of Illinois’ Medicaid Primary Care Case Management Program  

PubMed Central

PURPOSE In 2006, Illinois established Illinois Health Connect (IHC), a primary care case management program for Medicaid that offered enhanced fee-for-service, capitation payments, performance incentives, and practice support. Illinois also implemented a complementary disease management program, Your Healthcare Plus (YHP). This external evaluation explored outcomes associated with these programs. METHODS We analyzed Medicaid claims and enrollment data from 2004 to 2010, covering both pre- and post-implementation. The base year was 2006, and 2006–2010 eligibility criteria were applied to 2004–2005 data to allow comparison. We studied costs and utilization trends, overall and by service and setting. We studied quality by incorporating Healthcare Effectiveness Data and Information Set (HEDIS) measures and IHC performance payment criteria. RESULTS Illinois Medicaid expanded considerably between 2006 (2,095,699 full-year equivalents) and 2010 (2,692,123). Annual savings were 6.5% for IHC and 8.6% for YHP by the fourth year, with cumulative Medicaid savings of $1.46 billion. Per-beneficiary annual costs fell in Illinois over this period compared to those in states with similar Medicaid programs. Quality improved for nearly all metrics under IHC, and most prevention measures more than doubled in frequency. Medicaid inpatient costs fell by 30.3%, and outpatient costs rose by 24.9% to 45.7% across programs. Avoidable hospitalizations fell by 16.8% for YHP, and bed-days fell by 15.6% for IHC. Emergency department visits declined by 5% by 2010. CONCLUSIONS The Illinois Medicaid IHC and YHP programs were associated with substantial savings, reductions in inpatient and emergency care, and improvements in quality measures. This experience is not typical of other states implementing some, but not all, of these same policies. Although specific features of the Illinois reforms may have accounted for its better outcomes, the limited evaluation design calls for caution in making causal inferences. PMID:25354404

Phillips, Robert L.; Han, Meiying; Petterson, Stephen M.; Makaroff, Laura A.; Liaw, Winston R.

2014-01-01

208

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

209

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

PubMed Central

OBJECTIVE—To investigate the management of menorrhagia in primary care and its impact on referral and hysterectomy rates.?DESIGN—Prospective observational study.?SETTING—11 general practices from the Somerset Morbidity Project.?SUBJECTS—885 women consulting their general practitioner with menorrhagia over four years.?MAIN OUTCOME MEASURES—Proportions of these women investigated and treated with drugs in primary care, referred to a gynaecologist and undergoing operative procedures. The relation between investigation and prescribing in primary care and referral to and surgery in secondary care.?RESULTS—Less than half of women had a vaginal examination (42%, 95% CI 39% to 45%), or a full blood count (39%, 95% CI 36% to 43%). Almost a quarter of women, 23% (95% CI 20% to 26%), received no drugs and 37% (95% CI 34% to 40%) received norethisterone. Over a third, 38% (95% CI 34% to 40%), of women were referred, and once referred 43% (95% CI 38% to 48%) of women were operated on. Women referred to a gynaecologist were significantly more likely to have received tranexamic acid and/or mefenamic acid in primary care (?2=16.4, df=1, p<0.001). There were substantial between practice variations in management, for example in prescribing of tranexamic acid and/or mefenamic acid (range 16% to 72%) and referral to gynaecology (range 24% to 52%). There was a significant association between high referral and high operative rates (Spearman's correlation coefficient=0.86, p=0.001).?CONCLUSIONS—Substantial differences in management exist between practices when investigating and prescribing for menorrhagia in primary care. Rates of prescribing of effective medical treatment remain low. The decision to refer a woman impacts markedly on her chances of subsequently being operated on. Effective management in primary care may not reduce referral or hysterectomy rates.?? PMID:10942454

Grant, C.; Gallier, L.; Fahey, T.; Pearson, N.; Sarangi, J.

2000-01-01

210

Estimation and analysis of gross primary production of soybean under various management practices and drought conditions  

NASA Astrophysics Data System (ADS)

Gross primary production (GPP) of croplands may be used to quantify crop productivity and evaluate a range of management practices. Eddy flux data from three soybean (Glycine max L.) fields under different management practices (no-till vs. till; rainfed vs. irrigated) and Moderate Resolution Imaging Spectroradiometer (MODIS) derived vegetation indices (VIs) were used to test the capabilities of remotely sensed VIs and soybean phenology to estimate the seasonal dynamics of carbon fluxes. The modeled GPP (GPPVPM) using vegetation photosynthesis model (VPM) was compared with the GPP (GPPEC) estimated from eddy covariance measurements. The VIs tracked soybean phenology well and delineated the growing season length (GSL), which was closely related to carbon uptake period (CUP, R2 = 0.84), seasonal sums of net ecosystem CO2 exchange (NEE, R2 = 0.78), and GPPEC (R2 = 0.54). Land surface water index (LSWI) tracked drought-impacted vegetation well, as the LSWI values were positive during non-drought periods and negative during severe droughts within the soybean growing season. On a seasonal scale, NEE of the soybean sites ranged from -37 to -264 g C m-2. The result suggests that rainfed soybean fields needed about 450-500 mm of well-distributed seasonal rainfall to maximize the net carbon sink. During non-drought conditions, VPM accurately estimated seasonal dynamics and interannual variation of GPP of soybean under different management practices. However, some large discrepancies between GPPVPM and GPPEC were observed under drought conditions as the VI did not reflect the corresponding decrease in GPPEC. Diurnal GPPEC dynamics showed a bimodal distribution with a pronounced midday depression at the period of higher water vapor pressure deficit (>1.2 kPa). A modified Wscalar based on LSWI to account for the water stress in VPM helped quantify the reduction in GPP during severe drought and the model's performance improved substantially. In conclusion, this study demonstrates the potential of integrating vegetation activity through satellite remote sensing with ground-based flux and climate data for a better understanding and upscaling of carbon fluxes of soybean croplands.

Wagle, Pradeep; Xiao, Xiangming; Suyker, Andrew E.

2015-01-01

211

Identification, summary and comparison of tools used to measure organizational attributes associated with chronic disease management within primary care settings  

PubMed Central

Rationale, aims and objectives Given the increasing emphasis being placed on managing patients with chronic diseases within primary care, there is a need to better understand which primary care organizational attributes affect the quality of care that patients with chronic diseases receive. This study aimed to identify, summarize and compare data collection tools that describe and measure organizational attributes used within the primary care setting worldwide. Methods Systematic search and review methodology consisting of a comprehensive and exhaustive search that is based on a broad question to identify the best available evidence was employed. Results A total of 30 organizational attribute data collection tools that have been used within the primary care setting were identified. The tools varied with respect to overall focus and level of organizational detail captured, theoretical foundations, administration and completion methods, types of questions asked, and the extent to which psychometric property testing had been performed. The tools utilized within the Quality and Costs of Primary Care in Europe study and the Canadian Primary Health Care Practice-Based Surveys were the most recently developed tools. Furthermore, of the 30 tools reviewed, the Canadian Primary Health Care Practice-Based Surveys collected the most information on organizational attributes. Conclusions There is a need to collect primary care organizational attribute information at a national level to better understand factors affecting the quality of chronic disease prevention and management across a given country. The data collection tools identified in this review can be used to establish data collection strategies to collect this important information. PMID:24840066

Lukewich, Julia; Corbin, Renée; VanDenKerkhof, Elizabeth G; Edge, Dana S; Williamson, Tyler; Tranmer, Joan E

2014-01-01

212

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

213

Intra-annual variation in habitat choice by an endemic woodpecker: Implications for forest management and conservation  

NASA Astrophysics Data System (ADS)

The Canary Islands great spotted woodpecker Dendrocopos major canariensis is an endemic bird restricted to the Pinus canariensis forests of Tenerife and Gran Canaria. Classification tree models were applied to explore the relationship of the occurrence of this picid and habitat variables between two contrasting periods (breeding vs. non-breeding seasons) and for the entire annual cycle. During the reproductive period the availability of mature trees (DBH > 60 cm), and snags (dead trees), for nesting and roosting, characterize the breeding territory. Outside the breeding season the choice of locations was driven by a tree cover larger than 28.5% and the presence of trees taller than 8.5 m on average, a pattern explained by the availability of pine seeds in the cones of well-developed canopies, and less so by predation risk. Overall, during the annual cycle, well-developed canopy sites influenced the presence of this picidae (tree cover > 38%) and on more open sites (<38%) the presence of mature trees (DBH> 60 cm) became the second most important predictor of occurrence. We suggest that food abundance and availability could be the ultimate factor explaining the intra-annual variation observed, with the availability of snags being an important factor during nesting. In the range of this endemic, we recommend selective cuts in pine plantations, to allow the trees to set seed and improve their crops, minimizing the elimination of snags, and killing some large pine trees if the priority is to expand the distributional range of the woodpecker.

Garcia-del-Rey, Eduardo; Fernández-Palacios, José María; Muñoz, Pascual Gil

2009-09-01

214

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

215

Management of missiles injuries of the facial skeleton: primary, intermediate, and secondary phases.  

PubMed

This study included 235 patients with missile injuries of the facial skeleton, who were treated in the Maxillofacial Unit of the Hospital of Specialized Surgery in Medical City, Baghdad, Iraq, during a period of 4 years of war, since Iraq became the international battlefield for terrorism. There were 195 men and 40 women, with ages ranging from 1 to 70 years (mean, 39.5 years); all patients had severe facial injuries and posttraumatic missile deformities, including 27 patients with orbital injuries. This study also evaluates the management of the immediate, intermediate, and secondary phases.Deformities of the facial skeleton as a complication of missile injuries were classified into the following cases: 95 patients (40.43%) had bone loss, 72 patients (30.64%) had soft-tissue loss, 33 patients (14.05%) had orbital injuries, and 35 patients (14.90%) had other deformities of scar contracture, fistula, and sinus formation.The bony defects of the mandible were reconstructed by both bone chips carried by osteomesh tray harvested from the iliac crest in 24 patients and by block of corticocancellous bone graft from the iliac crest in 38 patients for reconstruction of the mandible, 4 cases for maxillary reconstruction, and 4 cases of orbital floor defect. K-wire was used in 23 cases for holding missing segments of the mandible. Soft-tissue reconstruction of the face was done in 72 cases, local flaps were used in 30 cases, regional flaps including lateral cervical flap in 10 cases, and cervicofacial flaps in 11 cases. The orbit was reconstructed by bone graft, lyophilized dura, and silastic implant. Low-velocity bullet injury to the frontal part of the head was treated by coronal flap, as an access in 6 cases required craniotomy and dura was reconstructed by galea or temporalis muscle. Scar contracture was treated by scar revision, and sinus tract was excised at the same time of scar revision. Primary phase required an urgent airway management, controlling an active bleeding by surgical intervention; most entrance and exit wounds as well as retained missile were located in the cheek, chin, and mandibular body. Few cases were reported of mortality due to complication related to head injuries. PMID:20613559

Kummoona, Raja

2010-07-01

216

Localized Orbital Mucosa-Associated Lymphoma Tissue Lymphoma Managed With Primary Radiation Therapy: Efficacy and Toxicity  

SciTech Connect

Purpose: To evaluate the clinical outcomes and late effects of radiation therapy (RT) in localized primary orbital mucosa-associated lymphoma tissue (MALT) lymphoma (POML). Methods and Materials: From 1989 to 2007, 89 patients with Stage IE POML received RT. The median age was 56 years old. Sites involved conjunctiva (59 patients [66%]), lacrimal gland (20 patients [23%]), and soft tissue (10 patients [11%]). Megavoltage beam(s) was used in 91%, electrons in 7%, and orthovoltage in 2% of cases. The dose given was 25 Gy in 97% and 30 Gy in 3% of patients. Lens shielding was possible in 57% of patients. Results: The median follow-up was 5.9 years. Complete response or unconfirmed complete response was seen in 88 patients (99%). Relapse occurred in 22 patients (25%). First relapse sites were local (2 patients [9%]), in the contralateral orbit (5 patients [23%]), and distant (15 patients [68%]). The 7-year overall survival (OS), cause-specific survival (CSS), relapse-free survival (RFS), and local control (LC) rates were 91%, 96%, 64%, and 97%, respectively. Radiation-related late sequelae were documented in 40 patients (45%). Cataracts were observed in 22 patients (Grade 1 in 2 patients; Grade 3 in 20 patients). The incidence of Grade 3 cataract at 7 years was 25%. Other late sequelae (n = 28) were dry eye(s) (22 patients [Grade 1 in 14 patients; Grade 2 in 2 patients; Grade 3 in 2 patients; n/s in 4 patients), keratitis (3 patients), macular degeneration/cystoid edema (2 patients), and vitreous detachment (1 patient). Five patients developed Grade 3 noncataract late effects. Lens shielding reduced the incidence of Grade 3 cataract and all Grade {>=}2 late sequelae. Seventeen patients (16 with cataracts) underwent surgery; 23 patients were treated conservatively. The outcome for managing late effects was generally successful, with 30 patients completely improved, and 9 patients with persisting late sequelae (10%). Conclusions: POML responds favorably to moderate doses of RT but results in significant late morbidity. The majority of late effects were successfully managed. Lens shielding reduced the risk of cataracts and other late sequelae.

Goda, Jayant Sastri [Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Le, Lisa W. [Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Lapperriere, Normand J.; Millar, Barbara-Ann; Payne, David; Gospodarowicz, Mary K.; Wells, Woodrow; Hodgson, David C.; Sun, Alexander [Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Simpson, Rand [Ocular Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Tsang, Richard W., E-mail: richard.tsang@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada)

2011-11-15

217

Hypothetical intertemporal choice and real economic behavior: delay discounting predicts voucher redemptions during contingency-management procedures.  

PubMed

Delay discounting rates are predictive of drug use status, the likelihood of becoming abstinent, and a variety of health behaviors. Rates of delay discounting may also be related to other relevant behaviors associated with addiction, such as the frequency at which individuals redeem contingency management voucher earnings. This study examined the discounting rates of 152 participants in a buprenorphine treatment program for opioid abuse. Participants received up to 12 weeks of buprenorphine treatment combined with contingency management. Participant's drug use was measured via urine specimens submitted three times a week. Successive negative urine specimens were reinforced with increasing amounts of money. After each negative urine specimen, a participant could either redeem his or her earnings or accumulate it in an account. Analysis of the frequency of redemptions showed that participants with higher rates of delay discounting at study intake redeemed their earnings significantly more often than participants with lower rates of discounting. Age and income also predicted redemption rates. We suggest that delay discounting rates can be used to predict redemption behaviors in a contingency management treatment program and that these findings are consistent with the recent theory of the competing neurobehavioral decision systems. PMID:21186929

Bickel, Warren K; Jones, Bryan A; Landes, Reid D; Christensen, Darren R; Jackson, Lisa; Mancino, Michael

2010-12-01

218

A comparison of two approaches to managing acute primary angle closure in Asian eyes  

PubMed Central

Purpose To review the management regimes of acute primary angle closure (APAC) in two hospitals in Singapore, and to identify the incidence of and risk factors for progression to glaucomatous optic neuropathy. Methods We conducted a retrospective review of 40 patients from National University Hospital (NUH) and 52 patients from Singapore National Eye Centre (SNEC) who were diagnosed with APAC. Patients were treated with similar protocols of intensive medical therapy until laser peripheral iridotomy could be performed. In the event of failed medical treatment, patients at NUH only underwent laser iridoplasty. The 1-year outcomes were reviewed. Results The demographic features of patients and presenting intraocular pressures (IOP) were similar in both centers. More patients from NUH presented within 3 days of symptom onset, compared to those from SNEC (90.0% versus 71.2%, respectively) (P = 0.037). The mean ± standard deviation time to break the attack was 18.2 ± 32.9 hours at SNEC and 9.80 ± 10.6 hours at NUH (P = 0.11). The mean follow up duration was 18.8 ± 14.0 months. Nineteen patients (36.5%) from SNEC and six patients (22.5%) from NUH developed raised IOP (P = 0.032) within 1-year of the attack. Of these, glaucomatous optic neuropathy developed in thirteen patients (68.4%) from SNEC and all six patients (100%) from NUH. At final review, the mean IOP of the APAC eye was 14.8 ± 4.3 mmHg from SNEC and 13.4 ± 3.0 mmHg from NUH. There was no significant difference in final visual acuity or IOP between both groups. Conclusion Treatment strategies in both centers were effective in aborting an APAC attack. The development of raised IOP appears to be associated with a longer period of attack suggesting that greater urgency in aborting APAC attacks may entail better long term outcomes. PMID:23818755

Ho, Henrietta; Chew, Paul T; Sng, Chelvin; Huang, Huiqi; Aung, Tin; Perera, Shamira A

2013-01-01

219

Management of the primary obstructed megaureter (POM) and indication for operative treatment.  

PubMed

Presented is the diagnostic and therapeutic management of the primary obstructed megaureter (POM). 42 patients presented with 53 ureteral units (UU) of POM (5 females, 37 males, 36 neonates and 6 children aged 3 to 8 years). Of the 53 megaureters 10 UU (19%) were on the right and 27 UU(51 %)were on the left. 8 patients (19%)with 16 UU (30%)showed a bilateral abnormality. In 41% of the patients, hydronephrosis had been discovered by prenatal ultrasound. All patients were evaluated postnatally by ultrasound (US), voiding cysturethrogram (VCUG), intravenous pyelogram (IVP) and diuresis renogram (MAG-3) (DR). Due to the percentage of urinary drainage,the renogram results were classified into different categories:no obstruction, functional obstruction, equivocal and obstruction. A partial renal function was also calculated. Follow-up of the patients ranges between 5 to 48 months (mean: 22.1). All patients underwent serial US and serial DR were obtained in 36 patients. Initially, 9 (17%) UU showed a functional obstruction, 34 (64.2%) an equivocal and 10 (18.8%) an obstructive urinary drainage pattern. 2 kidneys showed a significant decreased partial function of 20, respectively 26%. Surgery was performed in an initial im-paired renal function with an obstructive pattern or in cases with normal function and at least equivocal urinary drainage pattern with no improvement or deterioration of the urinary drainage and/or function in the follow-up. Considering these criteria, 5(9.6%) patients needed surgery. No loss of kidney function has been observed in follow-up. DR is the most valuable diagnostic tool. Criteria interpreting the results are demonstrated in this article. PMID:11967757

Stehr, M; Metzger, R; Schuster, T; Porn, U; Dietz, H-G

2002-02-01

220

Prostate disease: management options for the primary healthcare team. Report of a working party of the British Prostate Group.  

PubMed Central

The prostate gland has attracted a remarkable increase in interest in the past few years. The two most common diseases of this gland, benign prostatic hyperplasia and carcinoma of the prostate, have been brought into greater prominence by new diagnostic methods, public interest, and a wider choice of surgical and non-surgical treatments. Uncertainty about the significance of these changes has occurred because of the rapidity of change, the profusion of statements, opinions and promotions, and the relatively little guidance available from the profession. Ten urologists and two general practitioners have reviewed the relevant evidence about these two prostate diseases and the newer diagnostic methods; their conclusions are summarised here. Management options and guidance on clinical practice are also discussed. Because of a number of unresolved diagnostic and management issues, detailed requirements for practice guidelines have not been specified. PMID:7538216

Chisholm, G. D.; Carne, S. J.; Fitzpatrick, J. M.; George, N. J.; Gingell, J. C.; Keen, J. W.; Kirby, R. S.; Kirk, D.; O'Donoghue, E. P.; Peeling, W. B.

1995-01-01

221

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

222

Role of primary substrate composition and concentration on attenuation of trace organic chemicals in managed aquifer recharge systems.  

PubMed

This study was undertaken to investigate the role of primary substrate composition and concentration on the attenuation of biodegradable emerging trace organic chemicals (TOrCs) in simulated managed aquifer recharge (MAR) systems. Four sets of soil columns were established in the laboratory, each receiving synthetic feed solutions comprising different ratios and concentrations of peptone-yeast and humic acid as the primary substrate to investigate the effect on removal of six TOrCs (atenolol, caffeine, diclofenac, gemfibrozil, primidone, and trimethoprim). Based on abiotic control experiments, adsorption was not identified as a significant attenuation mechanism for primidone, gemfibrozil and diclofenac. Caffeine, atenolol and trimethoprim displayed initial adsorptive losses, however, adsorption coefficients derived from batch tests confirmed that adsorption was limited and in the long-term experiment, biodegradation was the dominant attenuation process. Within a travel time of 16 h, caffeine - an easily degradable compound exhibited removal exceeding 75% regardless of composition or concentration of the primary substrate. Primidone - a poorly degradable compound, showed no removal in any column regardless of the nature of the primary substrate. The composition and concentration of the primary substrate, however, had an effect on attenuation of moderately degradable TOrCs, such as atenolol, gemfibrozil and diclofenac, with the primary substrate composition seeming to have a larger impact on TOrC attenuation than its concentration. When the primary substrate consisted mainly of refractory substrate (humic acid), higher removal of the moderately degradable TOrCs was observed. The microbial communities in the columns receiving more refractory carbon, were noted to be more diverse and hence likely able to express a wider range of enzymes, which were more suitable for TOrC transformation. The effect of the primary substrate on microbial community composition, diversity and gene expression potential confirmed its influence on TOrC degradation. PMID:24921962

Alidina, Mazahirali; Li, Dong; Ouf, Mohamed; Drewes, Jörg E

2014-11-01

223

Initial experience with intraoperative PTH determinations in the surgical management of 130 consecutive cases of primary hyperparathyroidism  

Microsoft Academic Search

Background: Successful surgical management of primary hyperparathyroidism (1o HPT) historically has required bilateral neck exploration. The intraoperative parathyroid hormone (IO-PTH) assay allows a more limited procedure by confirming complete removal of hypersecreting tissue. Methods: Plasma samples were obtained from 130 consecutive patients both before (preincision and pre-excision baselines) and at approximately 5 and 10 minutes (and additional times) after removal

Sanford C. Garner; George S. Leight

1999-01-01

224

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

225

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

226

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

227

Management guidelines for improvement of otolaryngology referrals from primary care physicians  

Microsoft Academic Search

OBJECTIVE AND DESIGN:A prospective evaluation of the effectiveness of otolaryngology evaluation, treatment, and referral guidelines developed collaboratively by otolaryngologists and primary care physicians on referrals and access to otolaryngology. Comparisons of appropriate to unnecessary referrals, the percentage of patients referred with disorders addressed to those without disorders addressed in the guidelines, access to otolaryngology, and questionnaire evaluations of primary care

MICHAEL S. BENNINGER; FRANCES KING; RICHARD D. NICHOLS

1995-01-01

228

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.

229

Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care  

PubMed Central

Background The risk of depression is increased in people with long term conditions (LTCs) and is associated with poorer patient outcomes for both the depressive illness and the LTC, but often remains undetected and poorly managed. The aim of this study was to identify and explore barriers to detecting and managing depression in primary care in people with two exemplar LTCs: diabetes and coronary heart disease (CHD). Methods Qualitative in-depth interviews were conducted with 19 healthcare professionals drawn predominately from primary care, along with 7 service users and 3 carers (n = 29). One focus group was then held with a set of 6 healthcare professionals and a set of 7 service users and 1 carer (n = 14). Interviews and the focus group were digitally recorded, transcribed verbatim, and analysed independently. The two data sets were then inspected for commonalities using a constant comparative method, leading to a final thematic framework used in this paper. Results Barriers to detecting and managing depression in people with LTCs in primary care exist: i) when practitioners in partnership with patients conceptualise depression as a common and understandable response to the losses associated with LTCs - depression in the presence of LTCs is normalised, militating against its recognition and treatment; ii) where highly performanced managed consultations under the terms of the Quality and Outcomes Framework encourage reductionist approaches to case-finding in people with CHD and diabetes, and iii) where there is uncertainty among practitioners about how to negotiate labels for depression in people with LTCs in ways that might facilitate shared understanding and future management. Conclusion Depression was often normalised in the presence of LTCs, obviating rather than facilitating further assessment and management. Furthermore, structural constraints imposed by the QOF encouraged reductionist approaches to case-finding for depression in consultations for CHD and diabetes. Future work might focus on how interventions that draw on the principles of the chronic care model, such as collaborative care, could support primary care practitioners to better recognise and manage depression in patients with LTCs. PMID:21426542

2011-01-01

230

Linking internet-based diabetes self-management to primary care: lessons learned and implications for research translation and practice implementation.  

PubMed

There has been little discussion of or research on the key translational issue of how to integrate patient self-management programs across multiple primary care clinics within an HMO. The purpose of this study was to summarize our experiences and lessons learned in trying to integrate information from a web-based diabetes self-management program into primary care and the electronic health record (EHR). We describe plans, implementation, adaptations made, and data on patient and physician reactions to the My Path diabetes self-management program provided to 331 adult primary care patients. Mixed methods results revealed that, despite the availability of a state-of-the-art EHR, the intervention was not well integrated into primary care. Information from health-promotion and disease management programs, even within the same organization and with advanced EHR systems, is challenging to integrate into busy primary care. PMID:24073131

Glasgow, Russell E; Kurz, Deanna; Dickman, Jennifer M; Osuna, Diego; Strycker, Lisa; King, Diane K

2012-09-01

231

Socialising Multilingualism: Determinants of Codeswitching in Kenyan Primary Classrooms.  

ERIC Educational Resources Information Center

Using ethnographic observations of classroom interaction in three primary schools, determinants of teachers' language choice and codeswitching among English, Swahili, and mother-tongue were explored: official school policy, cognitive concerns, classroom management concerns, values and attitudes about societal multilingualism. (36 references)…

Merritt, Marilyn; And Others

1992-01-01

232

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

233

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

234

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

235

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

236

An 'Extra Pair of Hands'? Managing Classroom Assistants in Scottish Primary Schools.  

ERIC Educational Resources Information Center

Evaluates the Classroom Assistant Initiative in Scottish primary schools. Finds that in many schools, there was insufficient time for teachers and assistants to plan their work together, thus limiting the benefits of Initiative. (Contains 25 references.) (PKP)

Wilson, Valerie; Schlapp, Ursula; Davidson, Julia

2003-01-01

237

Endoscopic Management and the Role of Double Stenting for Primary Obstructive Megaureters  

Microsoft Academic Search

PurposeWe aimed to determine the efficacy and potential complications of endoscopic incision and balloon dilation with double stenting, in the treatment of primary obstructive megaureter (POM) in pediatric patients.

Matthew S. Christman; Sanjay Kasturi; Sarah M. Lambert; R. Caleb Kovell; Pasquale Casale

238

Primary megaureter detected by prenatal ultrasonography: Conservative management and prolonged follow-up  

Microsoft Academic Search

With the widespread use of obstetric echography the incidence of fetal hydronephrosis has been reported more frequently. Consequently,\\u000a many uropathies have been detected in asymptomatic neonates. The authors report their experience with prenatally detected\\u000a primary non-refluxing megaureter. Newborns with fetal hydronephrosis were investigated by ultrasonography and micturating\\u000a cystourethrogram after the beginning of chemoprophylaxis. If primary megaureter was identified, after 1

Eduardo A. Oliveira; José S. Diniz; Eli A. S. Rabelo; José M. P. Silva; Alamanda K. Pereira; Maria Tereza F. F. Filgueiras; Flávia M. G. Soares; Regina F. F. Sansoni

2000-01-01

239

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

240

Occult primary, version 3.2014.  

PubMed

The NCCN Guidelines for Occult Primary tumors provide recommendations for the evaluation, workup, management, and follow-up of patients with occult primary tumors (cancers of unknown primary). These NCCN Guidelines Insights summarize major discussion points of the 2014 NCCN Occult Primary panel meeting. The panel discussed gene expression profiling (GEP) for the identification of the tissue of origin and concluded that, although GEP has a diagnostic benefit, a clinical benefit has not been demonstrated. The panel recommends against GEP as standard management, although 20% of the panel believes the diagnostic benefit of GEP warrants its routine use. In addition, the panel discussed testing for actionable mutations (eg, ALK) to help guide choice of therapy, but declined to add this recommendation. PMID:24994917

Ettinger, David S; Handorf, Charles R; Agulnik, Mark; Bowles, Daniel W; Cates, Justin M; Cristea, Mihaela; Dotan, Efrat; Eaton, Keith D; Fidias, Panagiotis M; Gierada, David; Gilcrease, G Weldon; Godby, Kelly; Iyer, Renuka; Lenzi, Renato; Phay, John; Rashid, Asif; Saltz, Leonard; Schwab, Richard B; Shulman, Lawrence N; Smerage, Jeffrey B; Stevenson, Marvaretta M; Varadhachary, Gauri R; Zager, Jonathan S; Zhen, Weining Ken; Bergman, Mary Anne; Freedman-Cass, Deborah A

2014-07-01

241

Using diaries to explore the work experiences of primary health care nursing managers in two South African provinces  

PubMed Central

Background South Africa is on the brink of another wave of major health system reforms that underscore the centrality of primary health care (PHC). Nursing managers will play a critical role in these reforms. Objective The aim of the study was to explore the work experiences of PHC clinic nursing managers through the use of reflective diaries, a method hitherto under-utilised in health systems research in low- and middle-income countries. Design During 2012, a sub-set of 22 PHC nursing managers was selected randomly from a larger nurses’ survey in two South African provinces. After informed consent, participants were requested to keep individual diaries for a period of 6 weeks, using a clear set of diary entry guidelines. Reminders consisted of weekly short message service reminders and telephone calls. Diary entries were analysed using thematic content analysis. A diary feedback meeting was held with all the participants to validate the findings. Results Fifteen diaries were received, representing a 68% response rate. The majority of respondents (14/15) were female, each with between 5 and 15 years of nursing experience. Most participants made their diary entries at home. Diaries proved to be cathartic for individual nursing managers. Although inter-related and not mutually exclusive, the main themes that emerged from the diary analysis were health system deficiencies; human resource challenges; unsupportive management environment; leadership and governance; and the emotional impact of clinic management. Conclusions Diaries are an innovative method of capturing the work experiences of managers at the PHC level, as they allow for confidentiality and anonymity, often not possible with other qualitative research methods. The expressed concerns of nursing managers must be addressed to ensure the success of South Africa's health sector reforms, particularly at the PHC level. PMID:25537937

Munyewende, Pascalia O.; Rispel, Laetitia C.

2014-01-01

242

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

243

Assessing primary healthcare services quality in Spain: managers vs. patients perceptions  

Microsoft Academic Search

This paper measures the perceptions of the service quality by both the users and the health centre managers in Spain. With this information, it was possible to calculate the size of Gap-6, proposed by Lewis of discrepancy among the customers' perceptions and the perceptions of health centre managers. Using factor analysis and multiple regressions, significant associations were found between the

Francisco J. Miranda; Antonio Chamorro; Luis R. Murillo; Juan Vega

2010-01-01

244

First Diagnosis and Management of Incontinence in Older People with and without Dementia in Primary Care: A Cohort Study Using The Health Improvement Network Primary Care Database  

PubMed Central

Background Dementia is one of the most disabling and burdensome diseases. Incontinence in people with dementia is distressing, adds to carer burden, and influences decisions to relocate people to care homes. Successful and safe management of incontinence in people with dementia presents additional challenges. The aim of this study was to investigate the rates of first diagnosis in primary care of urinary and faecal incontinence among people aged 60–89 with dementia, and the use of medication or indwelling catheters for urinary incontinence. Methods and Findings We extracted data on 54,816 people aged 60–89 with dementia and an age-gender stratified sample of 205,795 people without dementia from 2001 to 2010 from The Health Improvement Network (THIN), a United Kingdom primary care database. THIN includes data on patients and primary care consultations but does not identify care home residents. Rate ratios were adjusted for age, sex, and co-morbidity using multilevel Poisson regression. The rates of first diagnosis per 1,000 person-years at risk (95% confidence interval) for urinary incontinence in the dementia cohort, among men and women, respectively, were 42.3 (40.9–43.8) and 33.5 (32.6–34.5). In the non-dementia cohort, the rates were 19.8 (19.4–20.3) and 18.6 (18.2–18.9). The rates of first diagnosis for faecal incontinence in the dementia cohort were 11.1 (10.4–11.9) and 10.1 (9.6–10.6). In the non-dementia cohort, the rates were 3.1 (2.9–3.3) and 3.6 (3.5–3.8). The adjusted rate ratio for first diagnosis of urinary incontinence was 3.2 (2.7–3.7) in men and 2.7 (2.3–3.2) in women, and for faecal incontinence was 6.0 (5.1–7.0) in men and 4.5 (3.8–5.2) in women. The adjusted rate ratio for pharmacological treatment of urinary incontinence was 2.2 (1.4–3.7) for both genders, and for indwelling urinary catheters was 1.6 (1.3–1.9) in men and 2.3 (1.9–2.8) in women. Conclusions Compared with those without a dementia diagnosis, those with a dementia diagnosis have approximately three times the rate of diagnosis of urinary incontinence, and more than four times the rate of faecal incontinence, in UK primary care. The clinical management of urinary incontinence in people with dementia with medication and particularly the increased use of catheters is concerning and requires further investigation. Please see later in the article for the Editors' Summary PMID:24015113

Grant, Robert L.; Drennan, Vari M.; Rait, Greta; Petersen, Irene; Iliffe, Steve

2013-01-01

245

Effectiveness of integrated disease management for primary care chronic obstructive pulmonary disease patients: results of cluster randomised trial  

PubMed Central

Objective To investigate the long term effectiveness of integrated disease management delivered in primary care on quality of life in patients with chronic obstructive pulmonary disease (COPD) compared with usual care. Design 24 month, multicentre, pragmatic cluster randomised controlled trial Setting 40 general practices in the western part of the Netherlands Participants Patients with COPD according to GOLD (Global Initiative for COPD) criteria. Exclusion criteria were terminal illness, cognitive impairment, alcohol or drug misuse, and inability to fill in Dutch questionnaires. Practices were included if they were willing to create a multidisciplinary COPD team. Intervention General practitioners, practice nurses, and specialised physiotherapists in the intervention group received a two day training course on incorporating integrated disease management in practice, including early recognition of exacerbations and self management, smoking cessation, physiotherapeutic reactivation, optimal diagnosis, and drug adherence. Additionally, the course served as a network platform and collaborating healthcare providers designed an individual practice plan to integrate integrated disease management into daily practice. The control group continued usual care (based on international guidelines). Main outcome measures The primary outcome was difference in health status at 12 months, measured by the Clinical COPD Questionnaire (CCQ); quality of life, Medical Research Council dyspnoea, exacerbation related outcomes, self management, physical activity, and level of integrated care (PACIC) were also assessed as secondary outcomes. Results Of a total of 1086 patients from 40 clusters, 20 practices (554 patients) were randomly assigned to the intervention group and 20 clusters (532 patients) to the usual care group. No difference was seen between groups in the CCQ at 12 months (mean difference –0.01, 95% confidence interval –0.10 to 0.08; P=0.8). After 12 months, no differences were seen in secondary outcomes between groups, except for the PACIC domain “follow-up/coordination” (indicating improved integration of care) and proportion of physically active patients. Exacerbation rates as well as number of days in hospital did not differ between groups. After 24 months, no differences were seen in outcomes, except for the PACIC follow-up/coordination domain. Conclusion In this pragmatic study, an integrated disease management approach delivered in primary care showed no additional benefit compared with usual care, except improved level of integrated care and a self reported higher degree of daily activities. The contradictory findings to earlier positive studies could be explained by differences between interventions (provider versus patient targeted), selective reporting of positive trials, or little room for improvement in the already well developed Dutch healthcare system. Trial registration Netherlands Trial Register NTR2268. PMID:25209620

Boland, Melinde R S; Assendelft, Willem J J; Gussekloo, Jacobijn; Tsiachristas, Apostolos; Stijnen, Theo; Blom, Coert; Sont, Jacob K; Rutten-van Mölken, Maureen P H M; Chavannes, Niels H

2014-01-01

246

Laparoscopic management of an isolated primary omental hydatid cyst: A case report and literature review  

PubMed Central

Primary isolated omental hydatid cysts are extremely rare. Usually, omental hydatid cysts are secondary, either resulting from spontaneous spread of cysts or occurring after operations involving hydatidosis in other regions. Here, we report a case of a primary isolated omental hydatid cyst treated with a laparoscopic approach. We report a 16-year-old female who admitted to hospital with right upper quadrant pain. Abdominal ultrasonography and computed tomography (CT) revealed a cyst located between the liver and right kidney. The cyst was enucleated from the omentum and removed with a laparoscopic approach. Histopathologic examination revealed a hydatid cyst. There was no recurrence during 3 years of follow-up. Primary isolated omental hydatid disease should be considered in patients in endemic regions with intra-abdominal cysts. Laparoscopic surgery seems to be effective and safe for hydatid cysts in accessible locations.

Ates, Mustafa; Dirican, Abuzer; MD, Burak Isik; Y?lmaz, Seazi

2011-01-01

247

Empowering primary care workers to improve health services: results from Mozambique's leadership and management development program.  

PubMed

This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The series of six articles has been contributed by Management Sciences for Health (MSH) and will be published article-by-article over the next few weeks. The third article presents a successful application in Mozambique of a leadership development program created by Management Sciences for Health (MSH). Through this program, managers from 40 countries have learned to work in teams to identify their priority challenges and act to implement effective responses. From 2003 to 2004, 11 health units in Nampula Province, participated in a leadership and management development program called the Challenges Program. This was following an assessment which found that the quality of health services was poor, and senior officials determined that the underlying cause was the lack of human resource capacity in leadership and management in a rapidly decentralizing health care system. The program was funded by the US Agency for International Development (USAID) and implemented in partnership between the Mozambican Ministry of Health (MOH) Provincial Directorate in Nampula and Management Sciences for Health (MSH). The Challenges Program used simple management and leadership tools to assist the health units and their communities to address health service challenges. An evaluation of the program in 2005 showed that 10 of 11 health centers improved health services over the year of the program. The Challenges Program used several strategies that contributed to successful outcomes. It integrated leadership strengthening into the day-to-day challenges that staff were facing in the health units. The second success factor in the Challenges Program was the creation of participatory teams. After the program, people no longer waited passively to be trained but instead proactively requested training in needed areas. MOH workers in Nampula reported that the program's approach to improving management and leadership capacity at all levels promoted the efficient use of resources and empowered staff to make a difference. PMID:18651973

Perry, Cary

2008-01-01

248

Empowering primary care workers to improve health services: results from Mozambique's leadership and management development program  

PubMed Central

This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The series of six articles has been contributed by Management Sciences for Health (MSH) and will be published article-by-article over the next few weeks. The third article presents a successful application in Mozambique of a leadership development program created by Management Sciences for Health (MSH). Through this program, managers from 40 countries have learned to work in teams to identify their priority challenges and act to implement effective responses. From 2003 to 2004, 11 health units in Nampula Province, participated in a leadership and management development program called the Challenges Program. This was following an assessment which found that the quality of health services was poor, and senior officials determined that the underlying cause was the lack of human resource capacity in leadership and management in a rapidly decentralizing health care system. The program was funded by the US Agency for International Development (USAID) and implemented in partnership between the Mozambican Ministry of Health (MOH) Provincial Directorate in Nampula and Management Sciences for Health (MSH). The Challenges Program used simple management and leadership tools to assist the health units and their communities to address health service challenges. An evaluation of the program in 2005 showed that 10 of 11 health centers improved health services over the year of the program. The Challenges Program used several strategies that contributed to successful outcomes. It integrated leadership strengthening into the day-to-day challenges that staff were facing in the health units. The second success factor in the Challenges Program was the creation of participatory teams. After the program, people no longer waited passively to be trained but instead proactively requested training in needed areas. MOH workers in Nampula reported that the program's approach to improving management and leadership capacity at all levels promoted the efficient use of resources and empowered staff to make a difference. PMID:18651973

Perry, Cary

2008-01-01

249

Comparing the Job Choice Exercise and the Multiple Choice Version of the Miner Sentence Completion Scale  

Microsoft Academic Search

Data were collected from 113 undergraduate management students, 31 campus leaders, and 28 campus nonleaders on the Job Choice Exercise (JCE) and the multiple choice version of the Miner Sentence Completion Scale (MSCS). The JCE and the multiple choice MSCS were not significantly correlated and therefore appear to measure different attributes, both of which have been labeled managerial motivation.

Michael J. Stahl; David W. Grigsby; Anil Gulati

1985-01-01

250

Prevention, early detection and team management of skin cancer in primary care: contribution to The health of the nation objectives.  

PubMed Central

The incidence of all skin cancers is increasing. If The health of the nation targets are to be addressed, incidence figures need to be more accurate. Solar damage is the major causal factor in all skin cancers. Certain individual risk factors also play an important part, especially in the development of malignant melanoma. Prevention and early detection are crucial in reducing morbidity and mortality from skin cancer. This paper considers the role of primary care skin screening clinics and cutaneous surgery facilities in the early detection and management of skin cancer. It also illustrates the value of a team approach in primary care in the prevention and early detection of skin cancer and in the more accurate recording of incidence rates. PMID:7702891

Jackson, A

1995-01-01

251

Photodynamic detection and management of intraperitoneal spreading of primary peritoneal papillary serous carcinoma in a man: report of a case.  

PubMed

As a peritoneal surface malignancy, primary peritoneal papillary serous carcinoma (PPPSC) almost always occurs in women. Our search of the literature found only two previous case reports of men with PPPSC, both with very short survival. We report the case of a 63-year-old man with PPPSC, treated effectively with cytoreductive surgery and docetaxel-based hyperthermic intraperitoneal chemotherapy following six cycles of docetaxel-based laparoscopic neoadjuvant intraperitoneal and cisplatin-based systemic chemotherapy. Furthermore, we detected intraoperative intraperitoneal spreading of the tumor after the oral administration of 5-amino levulinic acid (5-ALA). The patient remains in good health without ascites 18 months after his diagnosis. Thus, primary peritoneal papillary serous carcinoma should be managed by intraperitoneal chemotherapy combined with peritonectomy procedures. Moreover, the intraoperative detection of the intraperitoneal spreading of the tumor after administering oral 5-ALA shows that this is an exciting and promising diagnostic technique, which needs to be confirmed by further studies. PMID:23435809

Canbay, Emel; Ishibashi, Haruaki; Sako, Shouzou; Kitai, Toshiyuki; Nishino, Eisei; Hirano, Masamitsu; Mizumoto, Akiyoshi; Endo, Yoshio; Ogura, Shun-Ichiro; Yonemura, Yutaka

2014-02-01

252

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.; Wahlström, Rolf

2013-01-01

253

Single Cycle of Arsenic Trioxide–Based Consolidation Chemotherapy Spares Anthracycline Exposure in the Primary Management of Acute Promyelocytic Leukemia  

PubMed Central

Purpose Event-free survival following all-trans-retinoic acid (ATRA) –based therapy for acute promyelocytic leukemia (APL) averages 70% at 5 years. While arsenic trioxide (ATO) can induce remissions in 95% of relapsed patients, few studies have addressed the integration of ATO into the primary management of APL. This study examines the efficacy of a single cycle of ATO-based consolidation therapy in a treatment regimen designed to decrease exposure to other cytotoxic agents. Patients and Methods After induction with ATRA and daunorubicin (DRN), untreated patients with APL received 3 days of cytarabine and DRN followed by 30 doses of ATO beginning on day 8. Molecular remitters received 2 years of risk-based maintenance therapy. Results Forty-one of 45 patients receiving induction therapy achieved remission; four patients died (one before treatment was initiated). Thirty-seven patients received consolidation and maintenance; of these one patient relapsed (CNS) and one died in remission during maintenance therapy (hepatic sickle cell crisis). With a median follow-up of 2.7 years, estimated disease-free survival was 90%; overall survival for all patients was 88%. Despite a total anthracycline dose of only 360 mg/m2, cardiac ejection fraction decreased by ? 20% in 20% of patients. Conclusion These data, combined with other recent studies using ATO in the primary management of APL, demonstrate the important role that ATO can play in the primary management of this curable disease. Future studies should continue to focus on reducing the toxicity of treatment without increasing the relapse rate. PMID:20085935

Gore, Steven D.; Gojo, Ivana; Sekeres, Mikkael A.; Morris, Lawrence; Devetten, Marcel; Jamieson, Katarzyna; Redner, Robert L.; Arceci, Robert; Owoeye, Ibitayo; Dauses, Tianna; Schachter-Tokarz, Esther; Gallagher, Robert E.

2010-01-01

254

Development of a questionnaire to evaluate practitioners’ confidence and knowledge in primary care in managing chronic kidney disease  

PubMed Central

Background In the UK, chronic disease, including chronic kidney disease (CKD) is largely managed in primary care. We developed a tool to assess practitioner confidence and knowledge in managing CKD compared to other chronic diseases. This questionnaire was part of a cluster randomised quality improvement interventions in chronic kidney disease (QICKD; ISRCTN56023731). Methods The questionnaire was developed by family physicians, primary care nurses, academics and renal specialists. We conducted three focus groups (n?=?7, 6, and 8) to refine the questionnaire using groups of general practitioners, practice nurses and trainees in general practice. We used paper based versions to develop the questionnaire and online surveys to test it. Practitioners in a group of volunteer, trial practices received the questionnaire twice. We measured its reliability using Cohen’s Kappa (K). Results The practitioners in the focus groups reached a consensus as to the key elements to include in the instrument. We achieved a 73.1% (n?=?57/78) initial response rate for our questionnaire; of these 57, 54 completed the questionnaire a second time. Family physicians made up the largest single group of respondents (47.4%, n?=?27). Initial response showed more female (64.9%, n?=?37) than male (35.1%, n?=?20) respondents. The reliability results from retesting showed that there was moderate agreement (k?>?0.4) on all questions; with many showing substantial agreement (k?>?0.6). There was substantial agreement in the questions about loop diuretics (k?=?0.608, CI 0.432-0.784, p?managing hypertension (k?=?0.628, 95%CI 0.452-0.804, p?primary care practitioners on CKD management in the context of UK primary care. PMID:24886228

2014-01-01

255

A new approach: oblique excision and primary closure in the management of acute pilonidal disease  

PubMed Central

Aim: To compare incision and drainage with oblique excision and primary closure in the treatment of pilonidal abscesses. Materials and methods: In this prospective study, one of two surgeons at the same hospital performed incision and drainage as the treatment method for patients presenting with pilonidal abscesses. (Group A). The other surgeon performed oblique excision and primary closure (Group B). The rate of development of chronic pilonidal sinus and time to return to active work were assessed using the chi-square and Student’s t-tests to compare the two methods of treatment. Of the 128 patients, incision and simple drainage was applied to 69 patients and primary closure was applied to 59 patients. Results: The rate of development of chronic pilonidal sinus was 78.8% in Group A and 6.0% in Group B (P < 0.001). In Group A, the average healing time and time to return to active work were 18 and 25 days, respectively. In Group B, these times were 22 and 27 days, respectively (P < 0.001). Conclusion: Oblique excision and primary closure may be a preferable treatment for acute pilonidal abscesses because of its low rate of chronic sinus development. PMID:25664095

Ciftci, Fatih; Abdurrahman, Ibrahim; Tosun, Mirhan; Bas, Gurhan

2014-01-01

256

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

257

Role of aortopexy in the management of primary tracheomalacia and tracheobronchomalacia  

Microsoft Academic Search

Between 1986 and 1988 aortopexy was carried out on 12 patients with primary tracheomalacia and five with tracheobronchomalacia; their median age was 5 months (1 month-7 years). All patients had stridor, 14 had had cyanotic and apnoeic episodes, and 10 had had 'death' attacks. Eight patients (47%) had associated gastro-oesophageal reflux. Six patients (35%) were helped by aortopexy alone, and

P S Malone; E M Kiely

1990-01-01

258

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

259

The Talent Managing Work of the Balaton-Felvideki Szin-Vonal Primary Art School  

ERIC Educational Resources Information Center

In recent years, art education has been recognized as a suitable tool for enhancing emotional intelligence and nurturing a child's creative development. However, it seems that the education of art has lost the race against other primary school subjects, with only a minimal number of lessons being taught. The establishment of the afternoon art…

Baranyai, Valeria

2013-01-01

260

Inter-Professional Primary Care Practices Addressing Diabetes Prevention and Management  

ERIC Educational Resources Information Center

Imagine a partnership of university and community which addresses the needs of the community to keep its citizens healthy as long as possible. Through a planning exercise to address the community's needs in primary health care and health promotion, the university has developed key strategic directions to help support the needs of the community it…

Beagrie, Lesley

2011-01-01

261

Advanced Imaging Tools Rather Than Hemodynamics Should Be the Primary Approach for Diagnosing, Following, and Managing Pulmonary Arterial Hypertension  

PubMed Central

Pulmonary hypertension (PH) is currently defined based on invasive measurements: a resting pulmonary artery pressure ? 25 mm Hg. For pulmonary arterial hypertension, a pulmonary arterial wedge pressure ? 15 mm Hg and pulmonary vascular resistance > 3 Wood units are also required. Thus, right heart catheterization is inevitable at present. However, the diagnosis, follow-up, and management of PH by noninvasive techniques is progressing. Significant advances have been achieved in the imaging of pulmonary vascular disease and the right ventricle. We review the current sensitivities and specificities of noninvasive imaging of PH and discuss its role and future potential to replace hemodynamics as the primary approach to screening, diagnosing, and following/managing PH. PMID:25840101

Gerges, Mario; Gerges, Christian; Lang, Irene M.

2015-01-01

262

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

263

The structure of choice  

Microsoft Academic Search

Both J. A. Nevin (ses PA, Vol 44:4827) and C. P. Shimp found on different choice procedures that pigeons equate (match) the proportion of their choices to the proportion of reinforcers each choice delivers. Their results differed in terms of the order of successive choices: Shimp found that pigeons ordered successive choices so as to maximize the reinforcement rate, whereas

Alan Silberberg; Bruce Hamilton; John M. Ziriax; Jay Casey

1978-01-01

264

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

265

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

266

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

267

Recognition and management of addictive sexual disorders: guide for the primary care clinician.  

PubMed

With greater awareness of sexual exploitation, professional sexual misconduct, and the sexual issues of public figures, a growing awareness of the problem of sexual addiction is emerging. As a result of public awareness, more cases will be brought to the attention of primary care providers. When primary care providers are confronted by problematic sexual behavior that fits the parameters of addictive illness, they should know what the implications are in order to make appropriate clinical decisions and to evaluate treatment approaches. The purpose of this article is to summarize the nature of the problem, to review critical issues in assessment, to provide treatment options, and to suggest critical factors for monitoring progress. PMID:11271127

Carnes, P; Schneider, J P

2000-01-01

268

Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis  

PubMed Central

Background Primary hypophysitis causes varying degrees of endocrine dysfunction and mass effect. The natural course and best treatment have not been well established. Methods Medical records of 22 patients who had been diagnosed with primary hypophysitis between January 2001 and March 2013 were retrospectively reviewed. Based on the anatomical location, we classified the cases as adenohypophysitis (AH), infundibuloneurohypophysitis (INH), and panhypophysitis (PH). Clinical presentation, endocrine function, pathologic findings, magnetic resonance imaging findings, and treatment courses were reviewed. Results Among 22 patients with primary hypophysitis, 81.8% (18/22) had involvement of the posterior pituitary lobe. Two patients of the AH (2/3, 66.6%) and three patients of the PH (3/10, 30%) groups initially underwent surgical mass reduction. Five patients, including three of the PH (3/10, 33.3%) group and one from each of the AH (1/3, 33.3%) and INH (1/9, 11.1%) groups, initially received high-dose glucocorticoid treatment. Nearly all of the patients treated with surgery or high-dose steroid treatment (9/11, 82%) required continuous hormone replacement during the follow-up period. Twelve patients received no treatment for mass reduction due to the absence of acute symptoms and signs related to a compressive mass effect. Most of them (11/12, 92%) did not show disease progression, and three patients recovered partially from hormone deficiency. Conclusion Deficits of the posterior pituitary were the most common features in our cases of primary hypophysitis. Pituitary endocrine defects responded less favorably to glucocorticoid treatment and surgery. In the absence of symptoms related to mass effect and with the mild defect of endocrine function, it may not require treatment to reduce mass except hormone replacement. PMID:25325267

Park, Sun Mi; Bae, Ji Cheol; Joung, Ji Young; Cho, Yoon Young; Kim, Tae Hun; Jin, Sang-Man; Suh, Sunghwan; Hur, Kyu Yeon

2014-01-01

269

Managing an online survey about influenza vaccination in primary healthcare workers.  

PubMed

Online surveys are increasingly used due to their speed and efficiency. The aim of this study was to analyze factors that may have contributed to the quality and speed of response of an online survey on influenza vaccination in primary healthcare workers. A multicenter study including family physicians, nurses and pediatricians from primary healthcare teams from seven Spanish Autonomous Communities was designed. The centers were selected by simple random sampling. The survey remained active and accessible for 56 days and four reminders were sent. The odds ratios (OR) and their 95% confidence intervals (CI) were calculated to assess the association of sociodemographic variables and responding to the survey before the second reminder. Complete, validated information was obtained from 1965 primary healthcare workers. The total response rate was 36.2%. More nurses (46.3%) responded before the second reminder and more family physicians (52.8%) after the second reminder. The adjusted OR shows that family physicians responded later (AOR 1.46, 95% CI 1.2-1.8) than nurses. The responses obtained in the first 24 h after the initial sending and the reminders accounted for 41.7% of the completed surveys, indicating the importance of reminders. PMID:25584421

Toledo, Diana; Aerny, Nicole; Soldevila, Núria; Baricot, Maretva; Godoy, Pere; Castilla, Jesús; García-Gutierrez, Susana; Torner, Núria; Astray, Jenaro; Mayoral, José María; Tamames, Sonia; González-Candelas, Fernando; Martín, Vicente; Díaz, José; Domíguez, Angela

2015-01-01

270

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. PMID:25279174

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

2014-01-01

271

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. PMID:25289164

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

2014-01-01

272

Parent Report of Child's Health-Related Quality of Life after a Primary-Care-Based Weight Management Program  

PubMed Central

Abstract Background: Health-related quality of life (HRQoL) has been recognized as an important target and health outcome in obesity research. The current study aimed to examine HRQoL in overweight or obese children after a 10-week primary-care–based weight management program, Parent-Led Activity and Nutrition for Healthy Living, in southern Appalachia. Methods: Sixty-seven children (ages 5–12 years) and their caregivers were recruited from four primary care clinics, two of which were randomized to receive the intervention. Caregivers in the intervention groups received two brief motivational interviewing visits and four group sessions led by providers as well as four phone follow-ups with research staff. Caregivers completed the PedsQL and demographic questionnaires at baseline and at 3, 6, and 12 months postintervention. Child height and weight were collected to determine standardized BMI. Results: Caregivers of children receiving the weight control intervention reported no statistically significant improvements in child total HRQoL, as compared to the control group, across the course of treatment (?=0.178; 95% confidence interval, ?0.681, 1.037; p=0.687). Additionally, no statistically significant improvements were found across other HRQoL domains. Conclusions: Future studies examining HRQoL outcomes in primary care may consider treatment dose as well as methodological factors, such as utilization of multiple informants and different measures, when designing studies and interpreting outcomes. PMID:24152081

Schetzina, Karen E.; McBee, Matthew T.; Maphis, Laura; Fulton-Robinson, Hazel; Ho, Ai-Leng; Tudiver, Fred; Wu, Tiejian

2013-01-01

273

Septic necrosis of the midline wound in postoperative peritonitis. Successful management by debridement, myocutaneous advancement, and primary skin closure.  

PubMed Central

Wound management following laparotomy for postoperative peritonitis and varying degrees of parietal necrosis remains a challenging and controversial problem. Because maintained peritoneal integrity and primary wound closure offer the best opportunity for survival, an original technique involving bilateral incisions to relax skin and rectus fascia is proposed. This technique permits medial myocutaneous advancement and primary tension-free skin closure of midline laparotomy incisions. Sixty-nine patients with severe postoperative peritonitis were treated according from 1980 through 1985. Nine of these patients died of advanced multiple organ failure soon after referral, and eight more died after prolonged treatment. Fourteen patients had one or more reoperations for complications. Only nine wound failures resulted, including five eviscerations and four wound infections followed by progressive dehiscence. The bilateral relaxing incisions healed secondarily without complication. Survivors developed midline wound hernia; ten of the 52 surviving patients have had these repaired. This method of primary closure is safe when performed in conjunction with rigorous surgical care of intraperitoneal infection and may enhance survival. We recommend the technique to surgeons who treat severe postoperative peritonitis and septic necrosis of midline laparotomy wounds. Images Fig. 1. Fig. 4. Fig. 7. Figs. 8A and B. Fig. 9. PMID:3281613

Lévy, E; Palmer, D L; Frileux, P; Hannoun, L; Nordlinger, B; Tiret, E; Honiger, J; Parc, R

1988-01-01

274

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

275

Diagnosis and Management of Mild Cognitive Impairment in the Community: What is the Role of Primary Care Physician?  

PubMed

Dementia is a large and growing problem in the ageing population but often not diagnosed in its earlier stages which is Mild Cognitive Impairment (MCI). MCI represents the phase between normal ageing and early dementia. About 12% of patients with MCI develop dementia per year, usually Alzheimer's disease. It is a diagnosis given to individuals who have cognitive impairments beyond that is expected for their age and education. However, this condition does not interfere significantly with daily activities as these individuals retain their critical thinking and reasoning skills. Nevertheless, due to its complexity and vague initial presentation, many cases of MCI can be missed. Therefore, it is imperative for primary care physicians to recognise these symptoms as opposed to normal ageing memory changes, and refer these patients to the memory clinic early to confirm the diagnosis. This paper illustrates a common primary care presentation of a patient with MCI. As there is no proven pharmacological treatment for MCI, the mainstay of management is to provide lifestyle intervention and long term support to these patients in the community. Primary care physicians should work as a team with the geriatrician, allied health personnel, support groups and caregivers in providing this care. PMID:25606229

Ambigga, D; Suthahar, A; Ramli, As; Ng, Kk; Radziah, Ar; Marymol, K

2011-01-01

276

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.

277

The Hepatitis C Self-Management Program: Sustainability of Primary Outcomes at 1 Year  

ERIC Educational Resources Information Center

Objective: Chronic hepatitis C infection afflicts millions of people worldwide. Although antiviral treatments are increasingly effective, many hepatitis C virus (HCV) patients avoid treatment, do not complete or respond to treatment, or have contraindications. Self-management interventions are one option for promoting behavioral changes leading to…

Groessl, Erik J.; Ho, Samuel B.; Asch, Steven M.; Stepnowsky, Carl J.; Laurent, Diana; Gifford, Allen L.

2013-01-01

278

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.

279

Integrated palmer amaranth management in glufosinate-resistant cotton: II. primary, secondary, and conservation tillage  

Technology Transfer Automated Retrieval System (TEKTRAN)

A three-year field experiment was conducted to evaluate the role of inversion tillage, cover crops and spring tillage methods for Palmer amaranth between-row (BR) and within-row (WR) management in glufosinate-resistant cotton. Main plots were two inversion tillage systems: fall inversion tillage (IT...

280

Primary Prevention for Mental Health: Design and Delivery of a Generic Stress Management Program.  

ERIC Educational Resources Information Center

Evaluates a stress management program, "Balancing Out," that seeks to target the needs of the local community. Quantitative results indicate that the sample had significantly higher stress levels then the norm at the beginning of the program and below population norms at program completion. Qualitative responses indicated that respondents had…

Gregg, Carmen; McRobert, Jim; Piller, Meeta

2002-01-01

281

Resource consumption and management associated with monitoring of warfarin treatment in primary health care in Sweden  

Microsoft Academic Search

BACKGROUND: Warfarin is used for the prevention and treatment of various thromboembolic complications. It is an efficacious anticoagulant, but it has a narrow therapeutic range, and regular monitoring is required to ensure therapeutic efficacy and at the same time avoid life-threatening adverse events. The objective was to assess management and resource consumption associated with patient monitoring episodes during warfarin treatment

Stina Andersson; Ingela Björholt; Gunnar H Nilsson; Ingvar Krakau

2006-01-01

282

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

283

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...

284

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...

285

Facilitating Primary Head Teacher Succession in England: The Role of the School Business Manager  

ERIC Educational Resources Information Center

School leadership is significant for student learning, but increased workload and complexity are believed to be in part responsible for the difficulties internationally in managing succession, with experienced leaders leaving the profession prematurely and potential future leaders reluctant to take on the role. This article draws on a national…

Woods, Charlotte; Armstrong, Paul; Pearson, Diana

2012-01-01

286

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.

287

Learner Choice in Language Study.  

ERIC Educational Resources Information Center

Argues that a truly learner-centered approach in second language teaching should be concerned with allowing learners a greater role in the management of their learning by providing opportunities for learner choice in the method and scope of study. Reports on experiments in this approach at the University College of Bahrain. (SED)

Littlejohn, Andrew

1985-01-01

288

The management of dental caries in primary teeth - involving service providers and users in the design of a trial  

PubMed Central

Background There is a lack of evidence for the effective management of dental caries in children’s primary teeth. The trial entitled ‘Filling Children’s Teeth: Indicated Or Not?’ (FiCTION) was designed to examine the clinical and cost effectiveness, in primary dental care, of three different approaches to the management of caries in primary teeth. However, before the FiCTION main trial commenced, a pilot trial was designed. Service provider (dentists and other members of the team including dental nurses and practice managers) and participant (child participants and their parents) involvement was incorporated into the pilot trial. The aim of this study is to describe service providers’ and users’ perspectives on the pilot trial to identify improvements to the conduct and design of the FiCTION main trial. Methods Qualitative interviews (individual and group) were held with dentists, dental team members, children and parents involved in the FiCTION pilot trial. Individual interviews were held with four dentists and a group interview was held with 17 dental team members. Face-to-face interviews were held with four parents and children (four- to eight-years old) representing the three arms of the trial and five telephone interviews were conducted with parents. All interviews were transcribed verbatim. Framework analysis was used. Results Overall, service providers, children and parents found the pilot trial to be well conducted and an interesting experience. Service providers highlighted the challenges of adhering to research protocols, especially managing the documentation and undertaking new clinical techniques. They indicated that the time and financial commitments were greater than they had anticipated. Particular difficulties were found recruiting suitable patients within the timeframe. For parents recruitment was apparently more related to trusting their dentist than the content of information packs. While some of the older children understood what a study was, others did not understand or were not aware they were enrolled. Conclusions The findings provided valuable recommendations to improve the method of recruitment of dental practices and patients, the timing and content of the training, the type of support dentists would value and ways to further engage children and parents in the FiCTION main trial. Trial registration ISRCTN77044005 PMID:22913464

2012-01-01

289

Knowledge about bronchial asthma management in primary health care physicians in Al-Khobar City, Saudi Arabia  

PubMed Central

Context: The prevalence of bronchial asthma (BA) is increasing in the Kingdom of Saudi Arabia. Primary health care (PHC) centers follow the national protocol, which is based on the severity of the disease for the management of asthma. The Saudi initiative for asthma (SINA) management adopted from the global initiative for asthma guidelines, which was recommended by several recent studies, is based on the control level of asthma. Aims: To assess the knowledge of PHC physicians and family medicine (FM) residents in Al-Khobar, about the management of BA. Methodology: A cross-sectional study was conducted in all PHC centers and the university FM clinic in Al-Khobar. All PHC physicians and 3rd and 4th year FM residents were included in the study. A self-administered questionnaire developed according to SINA guidelines was used to assess theoretical knowledge of BA, and a predesigned checklist was used to assess the different inhaler techniques. Scoring was established and collected data were analyzed. Results: Only 8% of the sample had good theoretical knowledge of BA; 41% had poor knowledge. The knowledge of the residents was better than that of the PHC physicians. The mean knowledge score was significantly better among those using guidelines compared to the rest. About 23% had good knowledge of inhaler techniques. Knowledge of PHC physicians and FM residents about dry powder inhalers was deficient, and PHC physicians had little knowledge of metered dose inhalers with spacers. Conclusion: The knowledge of physicians about the management of BA was deficient. The national guidelines based on the level of control for asthma management should be updated and physicians given periodic training. PMID:25657604

Yousef, Haneen A.; Koura, Manal; Yousef, Abdullah A.

2015-01-01

290

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

291

Assessing the critical behavioral competencies of outstanding managed care primary care physicians.  

PubMed

This study used job competence assessment to identify the behavioral characteristics that distinguish outstanding job performances of primary care physicians (PCPs) within a network-model HMO. Primary care physicians were chosen for the study based on six standard performance measures: (1) member satisfaction, (2) utilization, (3) patient complaints, (4) emergency room referrals, (5) out-of-network referrals, and (6) medical record completeness. Outstanding PCPs (N = 16) were identified as those performing within one standard deviation above the mean on all six of the performance measures. A control group of typical PCPs (N = 10) was selected from those performing outside the peer group mean on at least two performance measures. Subjects were administered the Behavioral Event Interview and the Picture Story Exercise. Higher overall competency levels of achievement orientation, concern for personal influence, empathic caregiving, and empowerment drive distinguished outstanding from typical PCPs. Outstanding PCPs also had higher overall frequency of competency in building team effectiveness and interpersonal understanding when compared with typical PCPs. This study suggests that PCP performance is the product of measurable competencies that are potentially amenable to improvement. Competency assessment and development of PCPs may benefit both organizational efficiency and physician and patient satisfaction. PMID:10351412

Duberman, T L

1999-03-01

292

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

293

Tailored educational intervention for primary care to improve the management of dementia: the EVIDEM-ED cluster randomized controlled trial  

PubMed Central

Background Early diagnosis of dementia is important because this allows those with dementia and their families to engage support and plan ahead. However, dementia remains underdetected and suboptimally managed in general practice. Our objective was to test the effect of a workplace-based tailored educational intervention developed for general practice on the clinical management of people with dementia. Methods The tailored educational intervention was tested in an unblinded cluster randomized controlled trial with a pre/post-intervention design, with two arms: usual/normal care control versus educational intervention. The primary outcome measure was an increase in the proportion of patients with dementia who received at least two documented dementia-specific management reviews per year. Case identification was a secondary outcome measure. Results 23 practices in South-East England participated. A total of 1,072 patients with dementia (intervention: 512, control: 560) had information in their medical records showing the number of reviews within 12 months (or a proportion of) before intervention or randomization and within 12 months (or a proportion of) after. The mean total number of dementia management reviews after the educational intervention for people with dementia was 0.89 (SD 1.09; minimum 0; median 1; maximum 8) compared with 0.89 (SD 0.92; minimum 0; median 1; maximum 4) before intervention. In the control group prior to randomization the mean total number of dementia management reviews was 1.66 (SD 1.87; minimum 0; median 1; maximum 12) and in the period after randomization it was 1.56 (SD 1.79; minimum 0; median 1; maximum 11). Case detection rates were unaffected. The estimated incidence rate ratio for intervention versus control group was 1.03 (P?=?0.927, 95% CI 0.57 to 1.86). Conclusions The trial was timely, coinciding with financial incentives for dementia management in general practice (through the Quality Outcomes Framework); legal imperatives (in the form of the Mental Capacity Act 2005); policy pressure (The National Dementia Strategy 2009); and new resources (such as dementia advisors) that increased the salience of dementia for general practitioners. Despite this the intervention did not alter the documentation of clinical management of patients with dementia in volunteer practices, nor did it increase case identification. Trial registration NCT00866099/Clinical Trials PMID:24257429

2013-01-01

294

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

295

Prescribing drugs for Alzheimer's disease in primary care: managing cognitive symptoms.  

PubMed

There are currently no interventions that cure or even alter the progressive course of dementia. In the UK, donepezil, galantamine and rivastigmine are licensed for symptomatic treatment of mild to moderate Alzheimer's disease, and memantine is licensed for use in moderate to severe Alzheimer's disease.1-4 These drugs improve cognitive function by a modest amount compared with placebo.5 Although the National Institute for Health and Care Excellence (NICE) stipulates that such treatment should be initiated by a specialist, in many parts of the UK responsibility for continued prescription of these drugs is being transferred to primary care. Here we review the evidence for drugs prescribed for cognitive symptoms in Alzheimer's disease and highlight key issues for those who are prescribing them. PMID:24924683

2014-06-01

296

Pathogenesis of Primary Sclerosing Cholangitis and Advances in Diagnosis and Management  

PubMed Central

Primary sclerosing cholangitis (PSC), first described in the mid-1850’s, is a complex liver that is heterogeneous in its presentation. PSC is characterized by chronic cholestasis, associated with chronic inflammation of the biliary epithelium, resulting in multi-focal bile duct strictures that can affect the entire biliary tree. Chronic inflammation leads to fibrosis involving the hepatic parenchyma and biliary tree, which can lead to cirrhosis and malignancy. The etiology of PSC is not fully understood which in part explains a lack of effective medical therapy for this condition. However, we have begun to better understand the molecular pathogenesis of PSC. The recognition of specific clinical subtypes and their pattern of progression could improve phenotypic and genotypic classification of the disease. We review our current understanding of this enigmatic disorder and discuss important topics for future studies. PMID:23827861

Eaton, John E.; Talwalkar, Jayant A.; Lazaridis, Konstantinos N.; Gores, Gregory J.; Lindor, Keith D.

2013-01-01

297

Effects of Computerized Guidelines for Managing Heart Disease in Primary Care  

PubMed Central

BACKGROUND Electronic information systems have been proposed as one means to reduce medical errors of commission (doing the wrong thing) and omission (not providing indicated care). OBJECTIVE To assess the effects of computer-based cardiac care suggestions. DESIGN A randomized, controlled trial targeting primary care physicians and pharmacists. SUBJECTS A total of 706 outpatients with heart failure and/or ischemic heart disease. INTERVENTIONS Evidence-based cardiac care suggestions, approved by a panel of local cardiologists and general internists, were displayed to physicians and pharmacists as they cared for enrolled patients. MEASUREMENTS Adherence with the care suggestions, generic and condition-specific quality of life, acute exacerbations of their cardiac disease, medication compliance, health care costs, satisfaction with care, and physicians' attitudes toward guidelines. RESULTS Subjects were followed for 1 year during which they made 3,419 primary care visits and were eligible for 2,609 separate cardiac care suggestions. The intervention had no effect on physicians' adherence to the care suggestions (23% for intervention patients vs 22% for controls). There were no intervention-control differences in quality of life, medication compliance, health care utilization, costs, or satisfaction with care. Physicians viewed guidelines as providing helpful information but constraining their practice and not helpful in making decisions for individual patients. CONCLUSIONS Care suggestions generated by a sophisticated electronic medical record system failed to improve adherence to accepted practice guidelines or outcomes for patients with heart disease. Future studies must weigh the benefits and costs of different (and perhaps more Draconian) methods of affecting clinician behavior. PMID:14687254

Tierney, William M; Overhage, J Marc; Murray, Michael D; Harris, Lisa E; Zhou, Xiao-Hua; Eckert, George J; Smith, Faye E; Nienaber, Nancy; McDonald, Clement J; Wolinsky, Fredric D

2003-01-01

298

Management of Merkel cell carcinoma of unknown primary origin: the Vienna Medical School experience.  

PubMed

Merkel cell carcinoma is a rare, but highly aggressive skin tumor. We describe our single-institution experience with the diagnosis and treatment of Merkel cell carcinoma of unknown primary (MCCUP). We conducted a retrospective medical chart review of patients treated with MCCUP at the Vienna General Hospital between 2002 and 2011. Clinicopathologic variables and outcomes were analyzed. Of the entire cohort of 57 patients, 8 patients (14%) were diagnosed with MCCUP. Three patients presented with parotid gland involvement, four patients with positive inguinal lymph nodes and one with axillar lymph nodes. CK20 staining was positive in all tumor specimens, whereas MCPyV protein was positive in four out of six patients. The primary surgical modality in five cases was wide local excision. In one patient excisional biopsy was followed by re-resection. In one case only excisional biopsy was performed due to metastatic disease at first diagnosis. Two patients underwent concomitant parotidectomy and neck dissection, and four patients received adjuvant radiation therapy. Median recurrence-free survival was 20 months. Four patients died, three of disease and one of other cause. Recurrent disease was observed in two patients and treated with radiotherapy and chemotherapy. The 1- and 3-year overall survival rates were 87.5 and 37.5%, respectively. The 1- and 3-year disease-specific survival rates were 87.5 and 62.5%, respectively. Our study shows a poor outcome in patients with MCCUP, particularly in patients with node involvement of the trunk. We therefore suggest an aggressive and multimodal treatment approach for patients with MCCUP. PMID:24633244

Haymerle, Georg; Fochtmann, Alexandra; Kunstfeld, Rainer; Pammer, Johannes; Erovic, Boban M

2015-02-01

299

Screening, evaluation and management of depression in people with diabetes in primary care.  

PubMed

Family physicians are responsible for diagnosing and treating the majority of people with type 2 diabetes mellitus and co-morbid depression. As a result of the impact of co-morbid depression on patient self-care and treatment outcomes, screening for depression in the context of a structured approach to case management and patient follow up is recommended in people with diabetes and cardiovascular disease. This review summarizes the need for improved recognition and treatment of depression in diabetes; and makes expert recommendations with regard to integrating screening tools and therapies into a busy family or general medical practice setting. PMID:23280258

Hermanns, Norbert; Caputo, Salvatore; Dzida, Grzegorz; Khunti, Kamlesh; Meneghini, Luigi F; Snoek, Frank

2013-04-01

300

Team leaders' technology choice in virtual teams  

Microsoft Academic Search

Virtual teams face challenges arising from geographical distance, cultural differences, and differing modes of interaction. Team leaders in particular face these challenges because they are primarily responsible for efficient team management. Technology choices made by leaders have become a focus of interest in communication studies, but questions regarding media choice in virtual teams have not been widely studied. This article

ANU SIVUNEN; MAARIT VALO

2006-01-01

301

Homelessness as a Choice  

Microsoft Academic Search

It has long been assumed that homelessness is a personal choice. As a choice, homelessness is embedded within debates about deviant behaviours and problematic pathologies. The “homeless person” is either making calculated and immoral choices to be homeless, or they are perceived to be powerless agents who lack the capacity to exercise choices. Rarely has it been adequately explained, however,

Cameron Parsell; Mitch Parsell

2012-01-01

302

The prescription of addiction medications after implementation of chronic care management for substance dependence in primary care.  

PubMed

People with addictive disorders commonly do not receive efficacious medications. Chronic care management (CCM) is designed to facilitate delivery of effective therapies. Using data from the CCM group in a trial testing its effectiveness for addiction (N=282), we examined factors associated with the prescription of addiction medications. Among participants with alcohol dependence, 17% (95% CI 12.0-22.1%) were prescribed alcohol dependence medications. Among those with drug dependence, 9% (95% CI 5.5-12.6%) were prescribed drug dependence medications. Among those with opioids as a substance of choice, 15% (95% CI 9.3-20.9%) were prescribed opioid agonist therapy. In contrast, psychiatric medications were prescribed to 64% (95% CI 58.2-69.4%). Absence of co-morbid drug dependence was associated with prescription of alcohol dependence medications. Lower alcohol addiction severity and recent opioid use were associated with prescription of drug dependence medications. Better understanding of infrequent prescription of addiction medications, despite a supportive clinical setting, might inform optimal approaches to delivering addiction medications. PMID:25524751

Park, Tae Woo; Samet, Jeffrey H; Cheng, Debbie M; Winter, Michael R; Kim, Theresa W; Fitzgerald, Anna; Saitz, Richard

2015-05-01

303

The management of children with chronic fatigue syndrome-like illness in primary care: a cross-sectional study  

PubMed Central

Background Most studies on children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) have been undertaken in tertiary care and little is known about their management in primary care. Aim To describe the characteristics of patients aged 5–19 years with CFS-like illness in primary care and to examine how GPs investigate and manage patients. Design of study Descriptive retrospective questionnaire study. Setting Sixty-two UK GP practices in the MRC General Practice Research Framework (GPRF). Method One hundred and twenty-two practices were approached; 62 identified 116 patients consulting a GP with severe fatigue lasting over 3 months. Practice nurses and GPs completed questionnaires from medical notes and patients completed postal questionnaires. Results Ninety-four patients were considered by a clinical panel, blind to diagnosis, to meet the Oxford CFS criteria with a fatigue duration of 3 months. Seventy-three per cent were girls, 94% white, mean age was 12.9 years and median illness duration 3.3 years. GPs had principal responsibility for 62%. A diagnosis of CFS/ME was made in 55%, 30% of these within 6 months. Fifty per cent had a moderate illness severity. Paediatric referrals were made in 82% and psychiatric referrals in 46% (median time of 2 and 13 months respectively). Advice given included setting activity goals, pacing, rest and graded exercise. Conclusions Patient characteristics are comparable to those reported in tertiary care, although fewer are severe cases. GPs have responsibility for the majority of patients, are diagnosing CFS/ME within a short time and applying a range of referral and advice strategies. PMID:16438814

Saidi, Guitta; Haines, Linda

2006-01-01

304

Management of upper respiratory tract infections in primary care in Italy: a national survey.  

PubMed

This prospective study, carried out in Italy during the winter of 1998 by the means of questionnaires, was designed to investigate the diagnostic and therapeutic approach of the Italian general practitioners (GPs) to the management of acute upper respiratory tract infections (URTIs) in adult outpatients. A total of 354 GPs were questioned about ten adult patients each who had visited the surgery with an URTI requiring an antibiotic prescription. Our data showed there was a tendency to prescribe antibiotics only on the basis of clinical diagnosis, microbiological investigations being required very rarely. Orally administered antibiotics were preferred and compliance with the number of daily doses strongly influenced the antibiotic prescription. In patients affected by more severe infections, injectable antibiotics were frequently prescribed. PMID:11282263

Esposito, S; Noviello, S; Boccazzi, A; Tonelli, P

2001-03-01

305

Use of neutron therapy in the management of locally advanced nonresectable primary or recurrent rectal cancer.  

PubMed

Inoperable locally advanced or inoperable recurrent rectal cancer is a difficult problem. Tenesmus, discharge, bleeding and pelvic pain are frequently present and often are associated with infiltration of the sacral plexus. The value of radiotherapy in managing such patients is being appreciated, although up to 40% of the treated patients have no symptomatic response. Improvement in tumor response and control has been scored through efforts to overcome the radio resistance of the hypoxic tumor cells by neutron irradiation. This article is an account of the activity of neutron radiotherapy in such patients. Over 350 patients were entered in studies comparing neutrons used alone and neutrons used in a mixed-beam treatment schedule. At present no therapeutic gain for long-lasting survival has been achieved; however, local control and pain improvement seems to be better with neutrons than with photons. PMID:9670286

Engenhart-Cabillic, R; Debus, J; Prott, F J; Pötter, R; Höver, K H; Breteau, N; Krüll, A

1998-01-01

306

Phacoemulsification versus peripheral iridotomy in the management of chronic primary angle closure: long-term follow-up.  

PubMed

Primary angle closure occurs as a result of crowded anterior segment anatomy, causing appositional contact between the peripheral iris and trabecular meshwork, thereby obstructing aqueous outflow. Several studies highlight the role of the crystalline lens in its pathogenesis. The objective of this work is to compare the long-term efficacy of phacoemulsification versus laser peripheral iridotomy (LPI) in the management of chronic primary angle closure (CPAC). Prospective case-control study with 30 eyes of 30 patients randomly divided in two groups: 15 eyes in the LPI group and 15 eyes in the IOL group. Patients in the LPI group underwent LPI using argon and Nd:YAG laser. Patients in the IOL group underwent phacoemulsification with posterior chamber intraocular lens (IOL) implantation. Examinations before and after the procedure included gonioscopy, Goldmann applanation tonometry, and anterior chamber evaluation using the Pentacam rotating Scheimpflug camera. The mean follow-up time was 31.13 ± 4.97 months. There was a statistically significant reduction in the intraocular pressure (IOP) and number of anti-glaucoma medications (p < 0.01) only in the IOL group. Anterior chamber depth, angle, and volume were all higher in the IOL group (p < 0.01) at the end of the follow-up period. Phacoemulsification with posterior chamber IOL implantation results in a higher anterior chamber depth, angle, and volume, when compared to LPI. Consequently, phacoemulsification has greater efficacy in lowering IOP and preventing its long-term increase in patients with CPAC and cataract. PMID:24728533

Dias-Santos, Arnaldo; Ferreira, Joana; Abegão Pinto, Luís; Domingues, Isabel; Silva, José Pedro; Cunha, João Paulo; Reina, Maria

2015-04-01

307

PRIMARY NEOPLASMS OF THE ADRENAL GLAND—Diagnosis and Surgical Management  

PubMed Central

Tumors of the adrenal glands produce hormones which cause a variety of symptoms and signs including high blood pressure, excessive growth of hair on the body and precocious sexual development. By recently developed tests, it has been possible to differentiate high blood pressure due to these tumors from hypertension due to other causes. Removal of these tumors will often alleviate changes caused by them. Localization of the tumor and appraisal of the condition of the contralateral gland should be carried out preoperatively if possible. In this, several kinds of roentgen studies are helpful. Infusions of drugs during operation can be used to control the blood pressure which otherwise would vary widely. During a ten-year period (1942 to 1951) there were observed at the Los Angeles County General Hospital 100 proved cases of non-secreting and secreting primary neoplasms of the adrenal glands. In addition, there were three cases of Cushing's syndrome due to bilateral adrenal cortical hyperplasia, and ten probable cases (four, pheochromocytomas; five, Cushing's syndrome; one, adrenogenital syndrome) in which operation was not done. PMID:13009500

Davis, Harry A.; Fields, Irving A.; Gerber, Alex

1952-01-01

308

Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool  

PubMed Central

Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation. PMID:23667746

Ghoshal, Uday C; Gonlachanvit, Sutep; Chua, Andrew Seng Boon; Myung, Seung-Jae; Rajindrajith, Shaman; Patcharatrakul, Tanisa; Choi, Myung-Gyu; Wu, Justin C Y; Chen, Min-Hu; Gong, Xiao-Rong; Lu, Ching-Liang; Chen, Chien-Lin; Pratap, Nitesh; Abraham, Philip; Hou, Xiao-Hua; Ke, Meiyun; Ricaforte-Campos, Jane D; Syam, Ari Fahrial; Abdullah, Murdani

2013-01-01

309

Guide to CHOICE, A Center for Helping Organizations Improve Choice in Education.  

ERIC Educational Resources Information Center

CHOICE, Center for Helping Organizations Improve Choice in Education, has four primary purposes: (1) to collect and make available to the higher education community knowledge and materials relating to the provision of better information to college applicants; (2) to provide technical assistance to institutions seeking to review or improve the…

Syracuse Univ., NY. Dept. of Higher/Post Secondary Education.

310

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

311

Practical aspects of inhaler use in the management of chronic obstructive pulmonary disease in the primary care setting  

PubMed Central

Sustained bronchodilation using inhaled medications in moderate to severe chronic obstructive pulmonary disease (COPD) grades 2 and 3 (Global Initiative for Chronic Obstructive Lung Disease guidelines) has been shown to have clinical benefits on long-term symptom control and quality of life, with possible additional benefits on disease progression and longevity. Aggressive diagnosis and treatment of symptomatic COPD is an integral and pivotal part of COPD management, which usually begins with primary care physicians. The current standard of care involves the use of one or more inhaled bronchodilators, and depending on COPD severity and phenotype, inhaled corticosteroids. There is a wide range of inhaler devices available for delivery of inhaled medications, but suboptimal inhaler use is a common problem that can limit the clinical effectiveness of inhaled therapies in the real-world setting. Patients’ comorbidities, other physical or mental limitations, and the level of inhaler technique instruction may limit proper inhaler use. This paper presents information that can overcome barriers to proper inhaler use, including issues in device selection, steps in correct technique for various inhaler devices, and suggestions for assessing and monitoring inhaler techniques. Ensuring proper inhaler technique can maximize drug effectiveness and aid clinical management at all grades of COPD. PMID:22888221

Yawn, Barbara P; Colice, Gene L; Hodder, Rick

2012-01-01

312

People and Teams Matter in Organizational Change: Professionals’ and Managers’ Experiences of Changing Governance and Incentives in Primary Care  

PubMed Central

ObjectivesTo explore the experiences of governance and incentives during organizational change for managers and clinical staff. Study SettingThree primary care settings in England in 2006–2008. Study DesignData collection involved three group interviews with 32 service users, individual interviews with 32 managers, and 56 frontline professionals in three sites. The Realistic Evaluation framework was used in analysis to examine the effects of new policies and their implementation. Principal FindingsIntegrating new interprofessional teams to work effectively is a slow process, especially if structures in place do not acknowledge the painful feelings involved in change and do not support staff during periods of uncertainty. ConclusionsEliciting multiple perspectives, often dependent on individual occupational positioning or place in new team configurations, illuminates the need to incorporate the emotional as well as technocratic and system factors when implementing change. Some suggestions are made for facilitating change in health care systems. These are discussed in the context of similar health care reform initiatives in the United States. PMID:23829292

Allan, Helen T; Brearley, Sally; Byng, Richard; Christian, Sara; Clayton, Julie; Mackintosh, Maureen; Price, Linnie; Smith, Pam; Ross, Fiona

2014-01-01

313

Choosing Choice: School Choice in International Perspective.  

ERIC Educational Resources Information Center

The chapters in this book originated as papers for a conference, School Choice and Educational Change, held in March 2000 at Michigan State University. An introductory chapter provides a comparative analysis of the lessons learned from international experience with school-choice policies, based on a review of case studies in several countries. The…

Plank, David N., Ed.; Sykes, Gary, Ed.

314

Implementation and evaluation of the 5As framework of obesity management in primary care: design of the 5As Team (5AsT) randomized control trial  

PubMed Central

Background Obesity is a pressing public health concern, which frequently presents in primary care. With the explosive obesity epidemic, there is an urgent need to maximize effective management in primary care. The 5As of Obesity Management™ (5As) are a collection of knowledge tools developed by the Canadian Obesity Network. Low rates of obesity management visits in primary care suggest provider behaviour may be an important variable. The goal of the present study is to increase frequency and quality of obesity management in primary care using the 5As Team (5AsT) intervention to change provider behaviour. Methods/design The 5AsT trial is a theoretically informed, pragmatic randomized controlled trial with mixed methods evaluation. Clinic-based multidisciplinary teams (RN/NP, mental health, dietitians) will be randomized to control or the 5AsT intervention group, to participate in biweekly learning collaborative sessions supported by internal and external practice facilitation. The learning collaborative content addresses provider-identified barriers to effective obesity management in primary care. Evidence-based shared decision making tools will be co-developed and iteratively tested by practitioners. Evaluation will be informed by the RE-AIM framework. The primary outcome measure, to which participants are blinded, is number of weight management visits/full-time equivalent (FTE) position. Patient-level outcomes will also be assessed, through a longitudinal cohort study of patients from randomized practices. Patient outcomes include clinical (e.g., body mass index [BMI], blood pressure), health-related quality of life (SF-12, EQ5D), and satisfaction with care. Qualitative data collected from providers and patients will be evaluated using thematic analysis to understand the context, implementation and effectiveness of the 5AsT program. Discussion The 5AsT trial will provide a wide range of insights into current practices, knowledge gaps and barriers that limit obesity management in primary practice. The use of existing resources, collaborative design, practice facilitation, and integrated feedback loops cultivate an applicable, adaptable and sustainable approach to increasing the quantity and quality of weight management visits in primary care. Trial registration NCT01967797. PMID:24947045

2014-01-01

315

Management of COPD in the UK primary-care setting: an analysis of real-life prescribing patterns  

PubMed Central

Background Despite the availability of national and international guidelines, evidence suggests that chronic obstructive pulmonary disease (COPD) treatment is not always prescribed according to recommendations. This study evaluated the current management of patients with COPD using a large UK primary-care database. Methods This analysis used electronic patient records and patient-completed questionnaires from the Optimum Patient Care Research Database. Data on current management were analyzed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) group and presence or absence of a concomitant asthma diagnosis, in patients with a COPD diagnosis at ?35 years of age and with spirometry results supportive of the COPD diagnosis. Results A total of 24,957 patients were analyzed, of whom 13,557 (54.3%) had moderate airflow limitation (GOLD Stage 2 COPD). The proportion of patients not receiving pharmacologic treatment for COPD was 17.0% in the total COPD population and 17.7% in the GOLD Stage 2 subset. Approximately 50% of patients in both cohorts were receiving inhaled corticosteroids (ICS), either in combination with a long-acting ?2-agonist (LABA; 26.7% for both cohorts) or a LABA and a long-acting muscarinic antagonist (LAMA; 23.2% and 19.9%, respectively). ICS + LABA and ICS + LABA + LAMA were the most frequently used treatments in GOLD Groups A and B. Of patients without concomitant asthma, 53.7% of the total COPD population and 50.2% of the GOLD Stage 2 subset were receiving ICS. Of patients with GOLD Stage 2 COPD and no exacerbations in the previous year, 49% were prescribed ICS. A high proportion of GOLD Stage 2 COPD patients were symptomatic on their current management (36.6% with modified Medical Research Council score ?2; 76.4% with COPD Assessment Test score ?10). Conclusion COPD is not treated according to GOLD and National Institute for Health and Care Excellence recommendations in the UK primary-care setting. Some patients receive no treatment despite experiencing symptoms. Among those on treatment, most receive ICS irrespective of severity of airflow limitation, asthma diagnosis, and exacerbation history. Many patients on treatment continue to have symptoms. PMID:25210450

Price, David; West, Daniel; Brusselle, Guy; Gruffydd-Jones, Kevin; Jones, Rupert; Miravitlles, Marc; Rossi, Andrea; Hutton, Catherine; Ashton, Valerie L; Stewart, Rebecca; Bichel, Katsiaryna

2014-01-01

316

[Diagnosis and management of suspected nephrolithiasis in a primary care setting].  

PubMed

Based on the prevalence of asymptomatic kidney stones (5% in our general ward, in accordance with the literature) the value of abdominal ultrasonography in the clinical assessment of a suspected kidney-colic is discussed. The eminent importance of the stone-analysis is emphasized. In addition, the most common causes of kidney stone formation (low urine output, mechanical urinary obstruction in the renal pelvis, hypercalciuria, hyperoxaluria, insufficient urinary citric acid excretion, hyperuricosuria) are highlighted. The cardinal symptom of the urolithiasis is the presence of micro/macrohematuria (which is often absent - according to citations - in 20-80%!). Moreover, the differential diagnosis of acute flank pain, as neoplastic- or infectious diseases, reno-vascular and extrarenal causes (retro-peritoneal and mesenteric vascular processes and rupture of abdominal aneurysms), gynecological problems (e.g. rotation/rupture of ovarian cysts, ectopic pregnancy), appendicitis, diverticulitis, and splenic abscess/infarction, as well as hepato-pancreaticobiliary causes are discussed. Moreover, metabolic syndromes, e.g. the intermittant porphyria or infectious diseases (e.g, Fitz-Hugh-Curtis syndrome) and other rare pathologies (such as the «Mediterranean fever») may be at the origin of acute flank pains. A particular attention is given to possible diagnostic procedures in a primary care setting: in addition to medical history, clinical status and specific laboratory findings the value of diagnostic ultrasound, with special reference to the color-Doppler application, as the «twinkling artefact» from kidney stones and the «urinary-jet phenomenon» for the assessment of urinary outflow obstruction, is emphasized. In this context we point out that a lack of dilatation of the kidney pelvis never excludes a kidney-colic, on the other hand, a dilatation of the kidney pelvis does not necessarily mean congestion! The conservative treatment strategies (avoidance of excessive drinking - an obstructed kidney protects itself - NSAID in combination with Tamsulosin, especially in case of prevesical urolithiasis) are discussed. The critical stone size (?5 mm) and the absence of «red flags» (especially obstructive and inflammatory signs) allow a non-specialist medical outpatient treatment of acute nephro-and ureterolithiasis. The possible complications of the urolithiasis, especially the urosepsis and the (iatrogenic) fornix rupture are highlighted, as well as the formation of a renal abscess or hydronephrosis. A short look is given to the metaphylaxis of the urolithiasis and its «recurrence rate». PMID:22945820

Schwarzenbach, H R; Jenzer, S

2012-09-01

317

*Additional SOPs available, see: 1. PPE Choice and Cleaning 2. Work Station Cleaning 3. Pouring and Mixing 4. Hotplates 5. Hydrofluoric Acid 6. Haz Waste Management  

E-print Network

*Additional SOPs available, see: 1. PPE Choice and Cleaning 2. Work Station Cleaning 3. Pouring process stations 2, 3, 11, acid & base fume hood2. If heated only acid & base fume hood. Additional-MicroManufacturing Hazards: *Poor warning properties*: harmful exposure and workstation contamination are initially very

Woodall, Jerry M.

318

*Additional SOPs available, see: 1. PPE Choice and Cleaning 2. Work Station Cleaning 3. Pouring and Mixing 4. Hotplates 5. Haz Waste Management  

E-print Network

*Additional SOPs available, see: 1. PPE Choice and Cleaning 2. Work Station Cleaning 3. Pouring hood2. If hotter than a simmer, only acid & base fume hood. Additional Process Notes: Measure water immediately, burns may take minutes to become apparent. Harmful Hydrogen Chloride fumes will erupt from

Woodall, Jerry M.

319

*Additional SOPs available, see: 1. PPE Choice and Cleaning 2. Work Station Cleaning 3. Pouring and Mixing 4. Hotplates 5. Hydrofluoric Acid 6. Haz Waste Management  

E-print Network

*Additional SOPs available, see: 1. PPE Choice and Cleaning 2. Work Station Cleaning 3. Pouring, acid & base fume hood2. If hotter than a simmer, only acid & base fume hood. Additional Process Notes-MicroManufacturing Hazards: *Poor warning properties*: harmful exposure and workstation contamination are initially very

Woodall, Jerry M.

320

Screening, diagnosis, treatment, and management of hepatitis C: a novel, comprehensive, online resource center for primary care providers and specialists.  

PubMed

Current initiatives focusing on hepatitis C (HCV) screening and diagnosis, together with the advent of oral interferon (IFN)-free treatment regimens have prompted Elsevier Multimedia Publishing and the American Journal of Medicine (AJM) to develop a novel, comprehensive, online Resource Center dedicated to providing both primary care providers and specialists with the latest information on the screening, diagnosis, treatment, and management of HCV. To date, only 25% of infected patients have been diagnosed and only 5% cured. With the Centers for Disease Control and Prevention (CDC) and the US Prevention Services Task Force (USPSTF) recommendation of one-time screening for all individuals born between 1945 and 1965, and the availability of safe and effective therapy, it is anticipated that primary care providers and community practices will become increasingly responsible for the screening, diagnosis, and management of infected patients, as well as providing access to care by specialists when needed. The AJM Hepatitis C Resource Center site will have two major channels; one channel tailored to specifically address the needs of internal medicine physicians and other primary care providers, and one channel tailored to address the needs of specialists including hepatologists, gastroenterologists, and infectious disease specialists. Systematic surveys of these clinician audiences are being conducted by Elsevier to assess educational gaps, and ensure that the content of each channel of the Resource Center satisfies the needs of the intended audiences. In a recent Elsevier survey of primary care physicians (PCPs) who had screened and/or participated in the care of patients with HCV within 6 months of participating in the survey, 60% of PCPs stated that they were not very confident or only somewhat confident about screening patients for chronic HCV infection. A recent Elsevier survey of specialists revealed low levels of satisfaction with the treatment options available in 2013, with "no therapy" being selected for up to 38% of patients. This survey also showed that experience with newly-approved options for HCV including IFN-free regimens is currently limited, but the likelihood that a variety of patient types will be treated with these options is high. This provides an impetus for educational opportunities focusing on optimizing treatments for the different HCV genotypes and for patients with comorbidities. Further results of the PCP and specialist surveys will be published on the Resource Center. Each channel of the Resource Center will be comprised of a variety of specific communication elements, which are open to sponsorship, and include roundtable panel discussions, case studies, and direct links to relevant original research, review articles, and guidelines. All Resource Center components are peer-reviewed for publication on the Resource Center by the AJM Editorial Office and the Resource Center Guest Editor, Edward Lebovics, MD. The AJM Hepatitis C Resource Center will be accessible from the AJM online home page (http://www.amjmed.com) and will be launched immediately prior to the American Association for the Study of Liver Diseases (AASLD) Liver Meeting to be held from November 7 to 11, 2014 in Boston, Massachusetts. PMID:25308624

Lebovics, Edward; Czobor, Klara

2014-11-01

321

Making Smart Food Choices  

MedlinePLUS

... Get Free Stuff Be a Partner Making Smart Food Choices Regular physical activity and a healthy diet ... hand in hand. Go4Life points you to wise food choices important for good health: eat a variety ...

322

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 ...

323

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

324

biotechnologies: technology, choice  

E-print Network

Emerging biotechnologies: technology, choice and the public good #12;Nuf eld Council on Bioethics on Bioethics or visit the website. http://www.espcolour.co.uk #12;Emerging biotechnologies: technology, choice-opted member of the Council while chairing the Working Party on Emerging biotechnologies: technology, choice

Sussex, University of

325

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study  

Microsoft Academic Search

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

Rachel A Laws; Lynn A Kemp; Mark F Harris; Gawaine Powell Davies; Anna M Williams; Rosslyn Eames-Brown

2009-01-01

326

A Qualitative Study on Change Management in Primary Schools Award Winning and Non-Award Winning Schools Case in Study of TQM  

ERIC Educational Resources Information Center

The aim of this study was to determine the need of change in primary schools and to reveal out the principals' experiences during the change process by taking the total quality management practices into consideration and finally give suggestions according to the results of the study. In this study by employing qualitative research method, semi…

Altunay, Esen; Arli, Didem; Yalcinkaya, Munevver

2012-01-01

327

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

328

Using psychological theory to understand the clinical management of type 2 diabetes in Primary Care: a comparison across two European countries  

Microsoft Academic Search

BACKGROUND: Long term management of patients with Type 2 diabetes is well established within Primary Care. However, despite extensive efforts to implement high quality care both service provision and patient health outcomes remain sub-optimal. Several recent studies suggest that psychological theories about individuals' behaviour can provide a valuable framework for understanding generalisable factors underlying health professionals' clinical behaviour. In the

Susan Hrisos; Martin P Eccles; Jill J Francis; Marije Bosch; Rob Dijkstra; Marie Johnston; Richard Grol; Eileen FS Kaner; Ian N Steen

2009-01-01

329

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

330

Non-specific low back pain in primary care in the Spanish National Health Service: a prospective study on clinical outcomes and determinants of management  

Microsoft Academic Search

BACKGROUND: The Spanish National Health Service is a universal and free health care system. Non-specific low back pain (LBP) is a prevalent disorder, generating large health and social costs. The objectives of this study were to describe its management in primary care, to assess patient characteristics that influence physicians' decisions, and to describe clinical outcome at 2 months. METHODS: A

Francisco M Kovacs; Carmen Fernández; Antonio Cordero; Alfonso Muriel; Luis González-Luján; María Teresa Gil del Real

2006-01-01

331

From victim to survivor to thriver: helping women with primary ovarian insufficiency integrate recovery, self-management, and wellness.  

PubMed

Most women discover that they are infertile in a gradual manner after many failed attempts at conception. By contrast, most women with primary ovarian insufficiency (POI) uncover their infertility as part of an evaluation of other presenting complaints, frequently before attempts at conception have even been contemplated. The most common words women use to describe how they feel in the hours after getting the diagnosis of POI are "devastated," "shocked," and "confused." Clearly, the news propels some patients onto a difficult journey. POI is a serious and incurable chronic disease. The diagnosis is more than infertility and affects a woman's physical and emotional well-being. Management of the condition must address both. Patients face the acute shock of the diagnosis, associated stigma of infertility, grief from the death of dreams, anxiety from the disruption of life plans, confusion around the cause, symptoms of estrogen deficiency, worry over the associated potential medical sequelae such as reduced bone density and cardiovascular risk, and the uncertain future that all of these factors create. There is a need for an evidenced-based integrated program to assist women with POI in navigating the transition to acceptance of the diagnosis, ongoing management of the condition, and ongoing maintenance of wellness in the presence of the disorder. A health-centered approach can gradually replace the disease-centered approach and put patients in partnerships with professional health-care providers. Ideally, the journey transitions each patient from seeing herself as a victim, to a survivor, to a woman who is thriving. PMID:21969269

Sterling, Evelina Weidman; Nelson, Lawrence M

2011-07-01

332

Primary subclavian—axillary vein thrombosis: consensus and commentary  

Microsoft Academic Search

Fifteen multiple-choice questions concerning options in the management of primary subclavian-axillary vein thrombosis were discussed by a panel of experts and then voted upon by 25 attending vascular surgeons with a special interest in venous disease and considerable experience in subclavian-axillary vein thrombosis. The large majority favored, or agreed upon: (1) early clot removal for active, healthy patients with a

R. B Rutherford; S. N Hurlbert

1996-01-01

333

An Overview of Diabetes Management in Schizophrenia Patients: Office Based Strategies for Primary Care Practitioners and Endocrinologists  

PubMed Central

Diabetes is common and seen in one in five patients with schizophrenia. It is more prevalent than in the general population and contributes to the increased morbidity and shortened lifespan seen in this population. However, screening and treatment for diabetes and other metabolic conditions remain poor for these patients. Multiple factors including genetic risk, neurobiologic mechanisms, psychotropic medications, and environmental factors contribute to the increased prevalence of diabetes. Primary care physicians should be aware of adverse effects of psychotropic medications that can cause or exacerbate diabetes and its complications. Management of diabetes requires physicians to tailor treatment recommendations to address special needs of this population. In addition to behavioral interventions, medications such as metformin have shown promise in attenuating weight loss and preventing hyperglycemia in those patients being treated with antipsychotic medications. Targeted diabetes prevention and treatment is critical in patients with schizophrenia and evidence-based interventions should be considered early in the course of treatment. This paper reviews the prevalence, etiology, and treatment of diabetes in schizophrenia and outlines office based interventions for physicians treating this vulnerable population.

Annamalai, Aniyizhai; Tek, Cenk

2015-01-01

334

Myeloproliferative neoplasms working group consensus recommendations for diagnosis and management of primary myelofibrosis, polycythemia vera, and essential thrombocythemia  

PubMed Central

According to the 2008 revision of the World Health Organization (WHO) classification of myeloid malignancies, philadelphia chromosome (Ph)-negative myeloproliferative neoplasms (MPNs) include clonal, hematologic disorders such as polycythemia vera, primary myelofibrosis, and essential thrombocythemia.Recent years have witnessed major advances in the understanding of the molecular pathophysiology of these rare subgroups of chronic, myeloproliferative disorders. Identification of somatic mutations in genes associated with pathogenesis and evolution of these myeloproliferative conditions (Janus Kinase 2; myeloproliferative leukemia virus gene; calreticulin) led to substantial changes in the international guidelines for diagnosis and treatment of Ph-negative MPN during the last few years.The MPN-Working Group (MPN-WG), a panel of hematologists with expertise in MPN diagnosis and treatment from various parts of India, examined applicability of this latest clinical and scientific evidence in the context of hematology practice in India.This manuscript summarizes the consensus recommendations formulated by the MPN-WG that can be followed as a guideline for management of patients with Ph-negative MPN in the context of clinical practice in India.

Agarwal, M. B.; Malhotra, Hemant; Chakrabarti, Prantar; Varma, Neelam; Mathews, Vikram; Bhattacharyya, Jina; Seth, Tulika; Gayathri, K.; Menon, Hari; Subramanian, P. G.; Sharma, Ajay; Bhattacharyya, Maitreyee; Mehta, Jay; Vaid, A. K.; Shah, Sandeep; Aggarwal, Shyam; Gogoi, P. K.; Nair, Reena; Agarwal, Usha; Varma, Subhash; Prasad, S. V. S. S.; Manipadam, Marie Therese

2015-01-01

335

Reframing Organizations: Artistry, Choice, and Leadership. Jossey-Bass Management Series, Social and Behavioral Science Series, and Higher and Adult Education Series.  

ERIC Educational Resources Information Center

This book shows how educators can become more versatile managers and more artistic leaders. In part 1, chapter 1 shows why reframing--the use of multiple lenses--is vital to effective leadership and management. It introduces the four basic lenses for organizational analysis--the structural, human resource, political, and symbolic frames--and show…

Bolman, Lee G.; Deal, Terrence E.

336

Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey  

PubMed Central

Background Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. Methods We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000). Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection) were examined. Results Shoulder pain was associated with an injury in one third (33.2% (230/692)) of office visits in this population of US primary care physicians. Males, and younger adults (age ? 52) more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202)) of visits. An x-ray was performed in 29.0% (164/566) of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound) was infrequently performed (6.5%, 37/566). Physiotherapy was ordered in 23.9% (135/566) of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. Conclusion These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices. PMID:15691370

Wofford, James L; Mansfield, Richard J; Watkins, Raquel S

2005-01-01

337

The effect of medicaid policies on the diagnosis and treatment of children's mental health problems in primary care.  

PubMed

Primary care physicians play a substantial role in diagnosing and treating children's mental health disorders, but Medicaid managed care policies may limit these physicians' ability to serve low-income children. Using data from the universe of Medicaid recipients in three states, I evaluate how Medicaid managed care policies impact primary care diagnosis and treatment of children's mental health disorders. Specific policies examined include the presence of a behavioral carve-out, traditional health maintenance organization, or primary care case management program. To alleviate concerns of endogenous patient sorting, my preferred identification strategy uses variation in Medicaid policy penetration to instrument for individual plan choices. I show that while health maintenance organizations reduce diagnosis and non-drug treatment of mental health disorders, primary care case management program policies shift in diagnosis and treatment from within primary care to specialist providers such as psychiatrists, where serious mental health conditions are more likely to be identified. PMID:24123653

Turner, Lesley J

2015-02-01

338

PS2-13: Implementing a Lean Management System in Primary Care: Facilitators and Barriers from the Frontlines  

PubMed Central

Background/Aims As approximately $750 billion is wasted in the U.S. health system each year, equivalent to roughly one-third of every medical dollar, “Lean” thinking and techniques offer promising solutions for maximizing value in health care. This study examines a large, multispecialty practice’s journey of implementing a Lean management system beginning in primary care. We sought to understand initial drivers and barriers to implementation, with lessons contributing to a learning system of improvement in health care. Methods This case study was based on in-depth interviews with 16 physician and administrative leaders, and 4 focus groups of medical assistants and administrative staff. Transcripts were coded and analyzed using inductive, grounded methodology. Results Respondents’ insights were clustered around three main themes: organizational leadership, professional values/culture, and availability of resources. Informants described organizational characteristics critical to implementing Lean and to which they attributed its success so far, including: strong leadership and the importance that leaders embody qualities they are espousing, willingness to engage all levels of staff in the change process, and willingness to adjust performance measures according to new job roles. However, many noted that values and norms surrounding clinical practice are often at odds with the Lean principle of standardizing work to eliminate waste, representing the biggest challenge for physicians who are socialized into a culture where independent thinking and autonomy is valued. The availability of resources was also cited as an important factor in executing changes, including time to do one’s regular work while implementing change, time to absorb new ideas and changes, and proper space configurations to support the change. Conclusions Lean represents a non-traditional approach to managing the delivery of medical care. In a Lean operating system, value is seen first from the patient perspective and while this is a point of easy agreement, how that principle is operationalized can be fraught with challenges that must be negotiated. These challenges may be addressed in part by strong leadership and adequate resources. Further study is currently underway as the effort is extended to additional sites in the organization, with additional findings to be presented on how Lean can be successfully implemented in health care.

Hung, Dorothy; Gray, Caroline; Anderson, Katie; Hereford, James

2013-01-01

339

Evaluation of a tailored intervention to improve management of overweight and obesity in primary care: study protocol of a cluster randomised controlled trial  

PubMed Central

Background In the UK around 22% of men and 24% of women are obese, and there are varying but worrying levels in other European countries. Obesity is a chronic condition that carries an important health risk. National guidelines, for use in England, on the management of people who are overweight or obese have been published by the National Institute for Health and Clinical Excellence (NICE, 2006). NICE recommendations for primary care teams are: determine the degree of overweight and obesity; assess lifestyle, comorbidities and willingness to change; offer multicomponent management of overweight and obesity; referral to external services when appropriate. This study investigates a tailored intervention to improve the implementation of these recommendations by primary care teams. Methods/Design The study is a cluster randomised controlled trial. Primary care teams will be recruited from the East Midlands of England, and randomised into two study arms: 1) the study group, in which primary care teams are offered a set of tailored interventions to help implement the NICE guidelines for overweight and obesity; or 2) the control group in which primary care teams continue to practice usual care. The primary outcome is the proportion of overweight or obese patients for whom the primary care team adheres to the NICE guidelines. Secondary outcomes include the proportion of patients with a record of lifestyle assessment, referral to external weight loss services, the proportion of obese patients who lose weight during the intervention period, and the mean weight change over the same period. Discussion Although often recommended, the methods of tailoring implementation interventions to account for the determinants of practice are not well developed. This study is part of a programme of studies seeking to develop the methods of tailored implementation. Trial registration Current Controlled Trials ISRCTN07457585. Registered 09/08/2013. Randomisation commenced 30/08/2013. PMID:24641767

2014-01-01

340

BARRIERS AND FACILITATORS TO CHRONIC PAIN SELF-MANAGEMENT: A QUALITATIVE STUDY OF PRIMARY CARE PATIENTS WITH COMORBID MUSCULOSKELETAL PAIN AND DEPRESSION  

PubMed Central

OBJECTIVE To identify barriers and facilitators to self-management of chronic musculoskeletal pain among patients with comorbid pain and depression. DESIGN A qualitative study using focus group methodology SETTING Veteran Affairs (VA) and University primary care clinics PATIENTS Recruited after participation in a clinical trial INTERVENTION The Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) trial tested an intervention of optimized anti-depressant therapy combined with a pain self-management program versus usual care for primary care patients with comorbid chronic pain and depression. OUTCOME MEASURES Thematic content analysis from focus group data was used to identify patient-perceived barriers and facilitators to self-management of chronic musculoskeletal pain. RESULTS Patients (N = 18) were 27 to 84 years old (M = 54.8), 61% women, 72% White, and 22% Black. Barriers to pain self-management included: 1) lack of support from friends and family; 2) limited resources (e.g. transportation, financial); 3) depression; 4) ineffectiveness of pain-relief strategies; 5) time constraints and other life priorities; 6) avoiding activity because of fear of pain exacerbation; 7) lack of tailoring strategies to meet personal needs; 8) not being able to maintain the use of strategies after study completion; 9) physical limitations; and 10) difficult patient-physician interactions. Facilitators to improve pain self-management included 1) encouragement from nurse care managers; 2) improving depression with treatment; 3) supportive family and friends; and 4) providing a menu of different self-management strategies to use. CONCLUSIONS Future research is needed to confirm these findings and to design interventions that capitalize on the facilitators identified while at the same time addressing the barriers to pain self-management. PMID:19818038

Bair, Matthew J.; Matthias, Marianne S.; Nyland, Kathryn A.; Huffman, Monica A.; Stubbs, DaWana L.; Kroenke, Kurt; Damush, Teresa M.

2010-01-01

341

Integrating a tailored e-health self-management application for chronic obstructive pulmonary disease patients into primary care: a pilot study  

PubMed Central

Background Changes in reimbursement have been compelling for Dutch primary care practices to apply a disease management approach for patients with chronic obstructive pulmonary disease (COPD). This approach includes individual patient consultations with a practice nurse, who coaches patients in COPD management. The aim of this study was to gauge the feasibility of adding a web-based patient self-management support application, by assessing patients’ self-management, patients’ health status, the impact on the organization of care, and the level of application use and appreciation. Methods The study employed a mixed methods design. Six practice nurses recruited COPD patients during a consultation. The e-Health application included a questionnaire that captured information on demographics, self-management related behaviors (smoking cessation, physical activity and medication adherence) and their determinants, and nurse recommendations. The application provided tailored feedback messages to patients and provided the nurse with reports. Data were collected through questionnaires and medical record abstractions at baseline and one year later. Semi-structured interviews with patients and nurses were conducted. Descriptive statistics were calculated for quantitative data and content analysis was used to analyze the qualitative data. Results Eleven patients, recruited by three nurses, used the application 1 to 7 times (median 4). Most patients thought that the application supported self-management, but their interest diminished after multiple uses. Impact on patients’ health could not be determined due to the small sample size. Nurses reported benefits for the organization of care and made suggestions to optimize the use of the reports. Conclusion Results suggest that it is possible to integrate a web-based COPD self-management application into the current primary care disease management process. The pilot study also revealed opportunities to improve the application and reports, in order to increase technology use and appreciation. PMID:24400676

2014-01-01

342

Arts and health as a practice of liminality: Managing the spaces of transformation for social and emotional wellbeing with primary school children  

PubMed Central

Intervention to enhance wellbeing through participation in the creative arts has a transformative potential, but the spatialities to this are poorly theorised. The paper examines arts-based interventions in two primary schools in which small groups of children are taken out of their everyday classrooms to participate in weekly sessions. The paper argues that such intervention is usefully seen as a practice of liminality, a distinct time and space that needs careful management to realise a transformative potential. Such management involves negotiating multiple sources of tension to balance different modes of power, forms of art practices and permeability of the liminal time-space. PMID:22840601

Atkinson, Sarah; Robson, Mary

2012-01-01

343

Effectiveness and efficiency of a practice accreditation program on cardiovascular risk management in primary care: study protocol of a clustered randomized trial  

PubMed Central

Background Cardiovascular risk management is largely provided in primary healthcare, but not all patients with established cardiovascular diseases receive preventive treatment as recommended. Accreditation of healthcare organizations has been introduced across the world with a range of aims, including the improvement of clinical processes and outcomes. The Dutch College of General Practitioners has launched a program for accreditation of primary care practices, which focuses on chronic illness care. This study aims to determine the effectiveness and efficiency of a practice accreditation program, focusing on patients with established cardiovascular diseases. Methods/design We have planned a two-arm cluster randomized trial with a block design. Seventy primary care practices will be recruited from those who volunteer to participate in the practice accreditation program. Primary care practices will be the unit of randomization. A computer list of random numbers will be generated by an independent statistician. The intervention group (n = 35 practices) will be instructed to focus improvement on cardiovascular risk management. The control group will be instructed to focus improvement on other domains in the first year of the program. Baseline and follow-up measurements at 12 months after receiving the accreditation certificate are based on a standardized version of the audit in the practice accreditation program. Primary outcomes include controlled blood pressure, serum cholesterol, and prescription of recommended preventive medication. Secondary outcomes are 15 process indicators and two outcome indicators of cardiovascular risk management, self-reported achievement of improvement goals and perceived unintended consequences. The intention to treat analysis is statistically powered to detect a difference of 10% on primary outcomes. The economic evaluation aims to determine the efficiency of the program and investigates the relationship between costs, performance indicators, and accreditation. Discussion It is important to gain more information about the effectiveness and efficiency of the practice accreditation program to assess if participation is worthwhile regarding the quality of cardiovascular risk management. The results of this study will help to develop the practice accreditation program for primary care practices. Trial registration This cluster randomized trial is registered at ClinicalTrials.gov nr NCT00791362 PMID:23035760

2012-01-01

344

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

345

Making School Choice Work  

ERIC Educational Resources Information Center

School choice is increasingly the new normal in urban education. But in cities with multiple public school options, how can civic leaders create a choice system that works for all families, whether they choose a charter or district public school? To answer this question, the Center on Reinventing Public Education (CRPE) researchers surveyed 4,000…

DeArmond, Michael; Jochim, Ashley; Lake, Robin

2014-01-01

346

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.

347

School Choice Marches forward  

ERIC Educational Resources Information Center

One year ago, the "Wall Street Journal" dubbed 2011 "the year of school choice," opining that "this year is shaping up as the best for reformers in a very long time." School-choice laws took great strides in 2011, both in the number of programs that succeeded across states and also in the size and scope of the adopted programs. Yet education…

Butcher, Jonathan

2013-01-01

348

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

349

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

350

Role of cardiac surgery in the hospital phase management of patients treated with primary angioplasty for acute myocardial infarction  

Microsoft Academic Search

Although cardiac surgery is performed in ?10% of acute myocardial infarction (AMI) patients undergoing a primary percutaneous transluminal coronary angioplasty (PTCA) reperfusion strategy before discharge, the indications for and timing of operative revascularization, and the short- and long-term outcomes after surgery have not been characterized. In the prospective, controlled Primary Angioplasty in Myocardial Infarction-2 trial, cardiac catheterization was performed in

Gregg W. Stone; Bruce R. Brodie; John J. Griffin; Lorelei Grines; Judith Boura; William W. O’Neill; Cindy L. Grines

2000-01-01

351

Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial  

PubMed Central

Objectives To explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT. Design Regression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI). Setting Six general practices: Grampian (3); East Anglia (3). Participants 125 patients with complete resource use and short form-six-dimension questionnaire (SF-6D) data at baseline, 3?months and 6?months. Interventions Patients were randomised to either pharmacist medication review with face-to-face pharmacist prescribing or pharmacist medication review with feedback to general practitioner or treatment as usual (TAU). Main outcome measures Differences in mean total costs and effects measured as quality-adjusted life years (QALYs) at 6?months and EVSI for sample size calculation. Results Unadjusted total mean costs per patient were £452 for prescribing (SD: £466), £570 for review (SD: £527) and £668 for TAU (SD: £1333). After controlling for baseline costs, the adjusted mean cost differences per patient relative to TAU were £77 for prescribing (95% CI ?82 to 237) and £54 for review (95% CI ?103 to 212). Unadjusted mean QALYs were 0.3213 for prescribing (SD: 0.0659), 0.3161 for review (SD: 0.0684) and 0.3079 for TAU (SD: 0.0606). Relative to TAU, the adjusted mean differences were 0.0069 for prescribing (95% CI ?0.0091 to 0.0229) and 0.0097 for review (95% CI ?0.0054 to 0.0248). The EVSI suggested the optimal future trial size was between 460 and 690, and between 540 and 780 patients per arm using a threshold of £30?000 and £20?000 per QALY gained, respectively. Conclusions Compared with TAU, pharmacist-led interventions for chronic pain appear more costly and provide similar QALYs. However, these estimates are imprecise due to the small size of the pilot trial. The EVSI indicates that a larger trial is necessary to obtain more precise estimates of differences in mean effects and costs between treatment groups. Trial registration number ISRCTN06131530. PMID:25833666

Neilson, Aileen R; Bruhn, Hanne; Bond, Christine M; Elliott, Alison M; Smith, Blair H; Hannaford, Philip C; Holland, Richard; Lee, Amanda J; Watson, Margaret; Wright, David; McNamee, Paul

2015-01-01

352

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

353

*Additional SOPs available, see: 1. PPE Choice and Cleaning 2. Work Station Cleaning 3. Pouring and Mixing 4. Hotplates 5. Haz Waste Management  

E-print Network

stations 2, 3, 8, 9, 11, 12, 13, acid & base fume hood2. If hotter than a simmer, only acid & base fume or aspirate to neutralizer. Heavy metal bearing solutions should instead be disposed of in the "Ordinary Acids and Mixing 4. Hotplates 5. Haz Waste Management Sulphuric Acid Process: Sulphuric Acid for cleaning solutions

Woodall, Jerry M.

354

*Additional SOPs available, see: 1. PPE Choice and Cleaning 2. Work Station Cleaning 3. Pouring and Mixing 4. Hotplates 5. Haz Waste Management  

E-print Network

& base fume hood2. If hotter than a simmer, only acid & base fume hood. Additional Process Notes so be sure to rinse your work station after use2. Hydrochloric acid is occasionally used around bases and Mixing 4. Hotplates 5. Haz Waste Management Hydrochloric Acid Process: Hydrochloric acid for metal etches

Woodall, Jerry M.

355

Cross-sectoral collaboration in the choice and implementation of a library management system: the experience of the University of Edinburgh and the National Library of Scotland  

Microsoft Academic Search

This paper discusses cross-sectoral collaboration in procuring and implementing a new library management system. After a historical review of collaboration in this area in the UK and other countries, it focuses on the joint purchase of the Voyager system (supplied by Endeavor Information Systems Inc.) by Edinburgh University and the National Library of Scotland. The differing missions and automation histories

Sheila Cannell; Fred Guy

2001-01-01

356

To be or not to be …(a manager), that is the question: Factors that influence the career choices of Australian health professionals  

Microsoft Academic Search

A lot has been written about the nursing crisis in the Australian health industry, but little has been said about another serious staff shortage, a shortage of competent and motivated health service managers. This paper focuses on decisions made by people who have trained as health professionals and who have, at some stage in their career, considered taking on a

Carlene Boucher

357

Risk is not flat. Comprehensive approach to multidimensional risk management in ST-elevation myocardial infarction treated with primary angioplasty (ANIN STEMI Registry)  

PubMed Central

Introduction Current risk assessment concepts in ST-elevation myocardial infarction (STEMI) are suboptimal for guiding clinical management. Aim To elaborate a composite risk management concept for STEMI, enhancing clinical decision making. Material and methods 1995 unselected, registry patients with STEMI treated with primary percutaneous coronary intervention (pPCI) (mean age 60.1 years, 72.1% men) were included in the study. The independent risk markers were grouped by means of factor analysis, and the appropriate hazards were identified. Results In-hospital death was the primary outcome, observed in 95 (4.7%) patients. Independent predictors of mortality included age, leukocytosis, hyperglycemia, tachycardia, low blood pressure, impaired renal function, Killip > 1, anemia, and history of coronary disease. The factor analysis identified two significant clusters of risk markers: 1. age-anemia- impaired renal function, interpreted as the patient-related hazard; and 2. tachycardia-Killip > 1-hyperglycemia-leukocytosis, interpreted as the event-related (hemodynamic) hazard. The hazard levels (from low to high) were defined based on the number of respective risk markers. Patient-related hazard determined outcomes most significantly within the low hemodynamic hazard group. Conclusions The dissection of the global risk into the combination of patient- and event-related (hemodynamic) hazards allows comprehensive assessment and management of several, often contradictory sources of risk in STEMI. The cohort of high-risk STEMI patients despite hemodynamically trivial infarction face the most suboptimal outcomes under the current invasive management strategy. PMID:24570721

Przy?uski, Jakub; Kali?czuk, ?ukasz; Pr?gowski, Jerzy; Kaczmarska, Edyta; Petryka, Joanna; K?pka, Cezary; Bekta, Pawe?; Chmielak, Zbigniew; Demkow, Marcin; Ciszewski, Andrzej; Karcz, Maciej; K?opotowski, Mariusz; Witkowski, Adam; Ru?y??o, Witold

2013-01-01

358

[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

359

Motivation of Pharmacy Undergraduates in Curricular Choice: A Preliminary Study.  

ERIC Educational Resources Information Center

A survey of BS and PharmD students at the University of Kentucky examined factors affecting their program choice. BS students' major career goal was community pharmacy. Ownership, time factors, desire for experience, and cost are primary motivations. (MSE)

Fink, Joseph L., III; Smith, Harry A.

1983-01-01

360

Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial  

PubMed Central

Objective To evaluate the use of a computerised support system for decision making for implementing evidence based clinical guidelines for the management of asthma and angina in adults in primary care. Design A before and after pragmatic cluster randomised controlled trial utilising a two by two incomplete block design. Setting 60 general practices in north east England. Participants General practitioners and practice nurses in the study practices and their patients aged 18 or over with angina or asthma. Main outcome measures Adherence to the guidelines, based on review of case notes and patient reported generic and condition specific outcome measures. Results The computerised decision support system had no significant effect on consultation rates, process of care measures (including prescribing), or any patient reported outcomes for either condition. Levels of use of the software were low. Conclusions No effect was found of computerised evidence based guidelines on the management of asthma or angina in adults in primary care. This was probably due to low levels of use of the software, despite the system being optimised as far as was technically possible. Even if the technical problems of producing a system that fully supports the management of chronic disease were solved, there remains the challenge of integrating the systems into clinical encounters where busy practitioners manage patients with complex, multiple conditions. What is already known on this topicComputerised decision support systems produce improvements in patient care across a range of conditions and settingsPrevious evaluations have been undermined by flaws in study designFew studies have evaluated complex decision support systems for the management of chronic diseaseWhat this study addsNo impact was found of a computerised decision support system delivering evidence based guidelines for chronic diseases on either the process or outcomes of careIt is unclear whether there are benefits from integrating such systems into clinical encounters where busy practitioners manage patients with complex and multiple conditions PMID:12399345

Eccles, Martin; McColl, Elaine; Steen, Nick; Rousseau, Nikki; Grimshaw, Jeremy; Parkin, David; Purves, Ian

2002-01-01

361

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

362

Developing resources to support the diagnosis and management of Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME) in primary care: a qualitative study  

PubMed Central

Background NICE guidelines emphasise the need for a confident, early diagnosis of Chronic Fatigue Syndrome/ Myalgic Encephalitis (CFS/ME) in Primary Care with management tailored to the needs of the patient. Research suggests that GPs are reluctant to make the diagnosis and resources for management are currently inadequate. This study aimed to develop resources for practitioners and patients to support the diagnosis and management of CFS/ME in primary care. Methods Semi structured interviews were conducted with patients, carers, GPs, practice nurses and CFS/ME specialists in North West England. All interviews were audio recorded, transcribed and analysed qualitatively using open explorative thematic coding. Two patient involvement groups were consulted at each stage of the development of resources to ensure that the resources reflect everyday issues faced by people living with CFS/ME. Results Patients and carers stressed the importance of recognising CFS/ME as a legitimate condition, and the need to be believed by health care professionals. GPs and practice nurses stated that they do not always have the knowledge or skills to diagnose and manage the condition. They expressed a preference for an online training package. For patients, information on getting the most out of a consultation and the role of carers was thought to be important. Patients did not want to be overloaded with information at diagnosis, and suggested information should be given in steps. A DVD was suggested, to enable information sharing with carers and family, and also for those whose symptoms act as a barrier to reading. Conclusion Rather than use a top-down approach to the development of training for health care practitioners and information for patients and carers, we have used data from key stakeholders to develop a patient DVD, patient leaflets to guide symptom management and a modular e-learning resource which should equip GPs to diagnose and manage CFS/ME effectively, meet NICE guidelines and give patients acceptable, evidence-based information. PMID:22998151

2012-01-01

363

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

364

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

365

Factors Influencing Job Choice  

Microsoft Academic Search

This research sets out a Perceptual-Judgemental-Reinforcement approach to job choice under conditions of complexity and uncertainty.\\u000a It investigates the claim that job choices are based on seven implicit factors: such as the specific size of the occupation,\\u000a the proportion of employees working full-time, the earnings, the job prospects, gender dominance in an occupation, the level\\u000a of unemployment in the occupation

James A. Athanasou

2003-01-01

366

Adolescent Contraceptive Method Choices  

Microsoft Academic Search

This article analyzes determinants of contraceptive method choices among adolescent women in the United States. By using data\\u000a from the 1982 National Survey of Family Growth, we examine factors that differentiate users of various methods early in the\\u000a sexual careers of teenaged women. We find that patterns of method choice not only vary by race and region within the United

Joan R. Kahn; Ronald R. Rindfuss; David K. Guilkey

1990-01-01

367

Confronting Disparities in Diabetes Care: The Clinical Effectiveness of Redesigning Care Management for Minority Patients in Rural Primary Care Practices  

ERIC Educational Resources Information Center

Context: Diabetes mellitus and its complications disproportionately affect minority citizens in rural communities, many of whom have limited access to comprehensive diabetes management services. Purpose: To explore the efficacy of combining care management and interdisciplinary group visits for rural African American patients with diabetes…

Bray, Paul; Thompson, Debra; Wynn, Joan D.; Cummings, Doyle M.; Whetstone, Lauren

2005-01-01

368

Propulsion System Choices and Their Implications  

NASA Technical Reports Server (NTRS)

In defining a space vehicle architecture, the propulsion system and related subsystem choices will have a major influence on achieving the goals and objectives desired. There are many alternatives and the choices made must produce a system that meets the performance requirements, but at the same time also provide the greatest opportunity of reaching all of the required objectives. Recognizing the above, the SPST Functional Requirements subteam has drawn on the knowledge, expertise, and experience of its members, to develop insight that wiIJ effectively aid the architectural concept developer in making the appropriate choices consistent with the architecture goals. This data not only identifies many selected choices, but also, more importantly, presents the collective assessment of this subteam on the "pros" and the "cons" of these choices. The propulsion system choices with their pros and cons are presented in five major groups. A. System Integration Approach. Focused on the requirement for safety, reliability, dependability, maintainability, and low cost. B. Non-Chemical Propulsion. Focused on choice of propulsion type. C. Chemical Propulsion. Focused on propellant choice implications. D. Functional Integration. Focused on the degree of integration of the many propulsive and closely associated functions, and on the choice of the engine combustion power cycle. E. Thermal Management. Focused on propellant tank insulation and integration. Each of these groups is further broken down into subgroups, and at that level the consensus pros and cons are presented. The intended use of this paper is to provide a resource of focused material for architectural concept developers to use in designing new advanced systems including college design classes. It is also a possible source of input material for developing a model for designing and analyzing advanced concepts to help identify focused technology needs and their priorities.

Joyner, Claude R., II; Levack, Daniel J. H.; Rhodes, Russell, E.; Robinson, John W.

2010-01-01

369

Program to Combat Stereotyping in Career Choice.  

ERIC Educational Resources Information Center

Divided into three sections which deal with sex, race, and handicap stereotyping in career choice, the twenty-eight programs described here attempt to combat stereotypes among students and/or staff (K-12). Most descriptions list the goals of the program, target population, staffing and management, facilities and activities, program effectiveness…

Harrison, Laurie R.

370

Quality Competition, Insurance, and Consumer Choice  

E-print Network

managed care. 1. Introduction Health economists largely agree that the key driver of health care costs care payment plans. The interplay of technology, insur- ance, quality of care, and cost containment hasQuality Competition, Insurance, and Consumer Choice in Health Care Markets THOMAS P. LYON Kelley

Lyon, Thomas P.

371

Life choices simulation: Model and methodology  

Microsoft Academic Search

The life choices stimulation (LCS) is a computer-managed simulation which permits participants to explore the impact of decision making in an extended time frame. It is designed primarily for individuals who wish to explore a variety of possible futures and to develop an appreciation for the complexity of relationships and career planning. A general systems approach was used to design

Kathleen V. Cairns; J. Brian Woodward

1988-01-01

372

Qualitative study of depression management in primary care: GP and patient goals, and the value of listening  

PubMed Central

Background Guidelines for depression management have been developed but little is known about GP and patient goals, which are likely to influence treatment offers, uptake, and adherence. Aim To identify issues of importance to GPs, patients, and patients' supporters regarding depression management. GP and patient goals for depression management became a focus of the study. Design of study Grounded theory-based qualitative study. Setting GPs were drawn from 28 practices. The majority of patients and supporters were recruited from 10 of these practices. Method Sixty-one patients (28 depressed, 18 previously depressed, 15 never depressed), 18 supporters, and 32 GPs were interviewed. Results GPs described encouraging patients to view depression as separate from the self and ‘normal’ sadness. Patients and supporters often questioned such boundaries, rejecting the notion of a medical cure and emphasising self-management. The majority of participants who were considering depression-management strategies wanted to ‘get out’ of their depression. However, a quarter did not see this as immediately relevant or achievable. They focused on getting by from day to day, which had the potential to clash with GP priorities. GP frustration and uncertainty could occur when depression was resistant to cure. Participants identified the importance of GPs listening to patients, but often felt that this did not happen. Conclusion Physicians need greater awareness of the extent to which their goals for the management of depression are perceived as relevant or achievable by patients. Future research should explore methods of negotiating agreed strategies for management. PMID:17976282

Johnston, Olwyn; Kumar, Satinder; Kendall, Kathleen; Peveler, Robert; Gabbay, John; Kendrick, Tony

2007-01-01

373

An elderly woman with triple primary metachronous malignancy: A case report and review of literature  

PubMed Central

INTRODUCTION Prevalence of multiple primary malignancies is slowly increasing due to prolonged survival of cancer patients with advances in diagnostic and therapeutic modalities. The reasons may be environmental modifications, genetic predisposition or therapy induced. We describe a case of a 64-year-old woman with three different metachronous primary malignancies managed at our center since 4 years. PRESENTATION OF CASE First primary diagnosed in our patient was adenocarcinoma of small intestine which is a rare gastrointestinal malignancy. For this she underwent surgical resection followed by chemotherapy. After 21 months she developed infiltrating duct carcinoma of breast which was managed with modified radical mastectomy and chemotherapy. Again after latent period of 10 months patient had papillary adenocarcinoma of ovary for which she was administered chemotherapy. During follow up tumor was found to be chemoresistant and again she underwent cytoreductive surgery followed by chemotherapy. DISCUSSION In present case patient did not have significant risk factors for development of carcinoma of small intestine, breast and ovary. Our patient underwent surgical excision three times and received total 16 chemotherapy cycles of different regimens during management of all three primary malignancies. Development of second and higher order primary malignancy after successful management of previous one should be always kept in mind. CONCLUSION Awareness, suspicion of multiple primary malignancy and aggressive diagnostic work up plays crucial role in their detection at earlier stage for better outcome. In addition choice of appropriate chemotherapeutic agents and their regimens remains the cornerstone while managing the patients with multiple primary malignancies. PMID:23702365

Takalkar, Unmesh; Asegaonkar, Balaji N.; Kodlikeri, Pushpa; Asegaonkar, Shilpa; Sharma, Brijmohan; Advani, Suresh H.

2013-01-01

374

Conservative management of large radicular cysts associated with non-vital primary teeth: a case series and literature review.  

PubMed

Radicular cysts are the most common odontogenic cystic lesions of inflammatory origin. Large radicular cyst is comparatively less frequently associated with primary teeth. They represent only 0.5-3.3% of the total number of cysts in primary dentition. Radicular cysts arising from deciduous teeth are reported to occur in age range of 3-19 years with a male predominance. Although large radicular cysts are treated by enucleation with extensive removal of bone and vital teeth, marsupialization can be preferred as a conservative approach to reduce the morbidity. The purpose of this article is to report a case series of large radicular cysts associated with badly mutilated and traumatized primary teeth and to demonstrate how best they can be conservatively treated during mixed dentition period. PMID:25572375

Uloopi, K S; Shivaji, Raju U; Vinay, C; Shrutha, S P; Chandrasekhar, R

2015-01-01

375

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

376

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

377

Non-disclosure of chronic kidney disease in primary care and the limits of instrumental rationality in chronic illness self-management.  

PubMed

Early detection of long term conditions is predicated on assumptions that lifestyle changes and medications can be used to reduce or manage the risk of condition progression. However, ambiguity remains about the nature and place of diagnostic disclosure to people in newly recognised or asymptomatic 'pre' conditions such as early stage chronic kidney disease (CKD). The disclosure of a diagnosis is relevant to instigating strategies which rely on actively engaging patients as self-managers of their own care. Whilst primary care routinely records a diagnosis of early stage CKD, little is known about how patients learn about the fact that they have CKD or how they respond to this. This study aimed to explore patients' experiences of disclosure of CKD in primary care settings. A nested qualitative study of participants recruited to a trial of an intervention for CKD patients in Greater Manchester, UK was undertaken. A purposive sample of 26 patients, with a mean age of 72 years (range 59-89, median 71), were interviewed during 2012. Interview transcripts were analysed using constant comparative techniques. Narrative accounts reflected limited or partial disclosure of CKD; often cast in vague terms as "nothing to worry about". How patients described themselves in terms of participation and their tendencies towards 'active' or 'passive' involvement in consultations emerged as important components of narratives around disclosure. The findings illuminate the ways in which diagnosis is oriented in a context where it is possible to meet the requirements for remuneration under a pay for performance system of primary care, whilst apparently not disclosing a label or a diagnosis to patients. This challenges the presumptions inherent in wider health policy objectives that are increasingly built on the notion of responsible patients and the ethos of the active support of self-management for pre-conditions. PMID:25748112

Daker-White, Gavin; Rogers, Anne; Kennedy, Anne; Blakeman, Thomas; Blickem, Christian; Chew-Graham, Carolyn

2015-04-01

378

Management of Stress Urinary Incontinence  

PubMed Central

Although there is renewed interest in conservative therapies for stress urinary incontinence, such as pelvic floor exercises, electrical stimulation, and duloxetine therapy, surgery remains the primary choice in managing this condition. Surgical options include paravaginal defect repair, the Marshall-Marchetti-Krantz procedure, open and laparoscopic Burch urethropexy, and pubovaginal sling procedures. There is a growing trend in the United States toward use of the pubovaginal sling procedure as the primary operation for urinary incontinence due to less invasive techniques. Studies comparing the pubovaginal sling with open urethropexy have shown similar short-term cure rates. More large prospective, randomized studies are needed to assess long-term rates. PMID:16985904

Cornella, Jeffrey L

2004-01-01

379

Predicting affective choice.  

PubMed

Affect is increasingly recognized as central to decision making. However, it is not clear whether affect can be used to predict choice. To address this issue, we conducted 4 studies designed to create and test a model that could predict choice from affect. In Study 1, we used an image rating task to develop a model that predicted approach-avoidance motivations. This model quantified the role of two basic dimensions of affect--valence and arousal--in determining choice. We then tested the predictive power of this model for two types of decisions involving images: preference based selections (Study 2) and risk-reward trade-offs (Study 3). In both cases, the model derived in Study 1 predicted choice and outperformed competing models drawn from well-established theoretical views. Finally, we showed that this model has ecological validity: It predicted choices between news articles on the basis of headlines (Study 4). These findings have implications for diverse fields, including neuroeconomics and judgment and decision making. PMID:22924884

Suri, Gaurav; Sheppes, Gal; Gross, James J

2013-08-01

380

Energy Choices Game  

NSDL National Science Digital Library

Use this board game to introduce the concepts of energy use in our lives and the very real impact that personal choices can have on our energy consumption, energy bills and fuel supply. The game begins as students select cards that define their modes of transportation and home design. The players roll dice and move around the board, landing on "choice" or "situation" blocks and selecting cards that describe consumer choices and real-life events that impact their energy consumption and annual energy bills. As the players pass gasoline stations or energy bill gates, they must pay annual expenses as defined by their original cards, with amounts altered by the choices they've made along the way. Gasoline cards are collected to represent total consumption. Too many gas-guzzling vehicles can result in total depletion of their gasoline supply – at which point everyone must walk or ride the bus. At the end of the game, the players count their remaining dollars to determine the winner. Discussion questions probe the students to interpret what choices they made and which situations they encountered had the most impact on their energy consumption and energy bills. All game board, card and money files are available online free of charge.

Office of Educational Partnerships,

381

Developing a primary health care management information system that supports the pursuit of equity, effectiveness and affordability  

Microsoft Academic Search

A key set of goals of primary health care (PHC) includes equity, effectiveness and affordability. By equity, we mean universal coverage and care according to need; by effectiveness, that the system has a favorable impact on mortality and serious morbidity; by affordability, that the system is within the budgetary reach of government and communities. There are other requirements of PHC

Khatidja Husein; Olusoji Adeyi; John Bryant; Noorddin B. Cara

1993-01-01

382

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

383

[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

384

Improving the network management of integrated primary mental healthcare for older people in a rural Australian region: protocol for a mixed methods case study  

PubMed Central

Introduction An integrated approach to the mental healthcare of older people is advocated across health, aged care and social care sectors. It is not clear, however, how the management of integrated servicing should occur, although interorganisational relations theory suggests a reflective network approach using evaluation feedback. This research will test a network management approach to help regional primary healthcare organisations improve mental health service integration. Methods and analysis This mixed methods case study in rural South Australia will test facilitated reflection within a network of health and social care services to determine if this leads to improved integration. Engagement of services will occur through a governance group and a series of three 1-day service stakeholder workshops. Facilitated reflection and evaluation feedback will use information from a review of health sector and local operational policies, a network survey about current service links, gaps and enablers and interviews with older people and their carers about their help seeking journeys. Quantitative and qualitative analysis will describe the policy enablers and explore the current and ideal links between services. The facilitated reflection will be developed to maximise engagement of senior management in the governance group and the service staff at the operational level in the workshops. Benefit will be assessed through indicators of improved service coordination, collective ownership of service problems, strengthened partnerships, agreed local protocols and the use of feedback for accountability. Ethics, benefits and dissemination Ethics approval will deal with the sensitivities of organisational network research where data anonymity is not preserved. The benefit will be the tested utility of a facilitated reflective process for a network of health and social care services to manage linked primary mental healthcare for older people in a rural region. Dissemination will make use of the sectoral networks of the governance group. PMID:25227632

Fuller, Jeffrey; Oster, Candice; Dawson, Suzanne; O'Kane, Deb; Lawn, Sharon; Henderson, Julie; Gerace, Adam; Reed, Richard; Nosworthy, Ann; Galley, Philip; McPhail, Ruth; Cochrane, Eimear Muir

2014-01-01

385

Predicting Treatment Choice for Patients With Pelvic Organ Prolapse  

Microsoft Academic Search

OBJECTIVE: To evaluate which clinical factors were predic- tive of treatment choice for patients with pelvic organ prolapse. METHODS: One hundred fifty-two patients were enrolled in this cross-sectional study to collect clinical data on potential predictors of treatment choice. Continuous parametric, continuous nonparametric (ordinal), and categoric data were compared with chosen management plan (expectant, pessary, surgery) using analysis of variance,

Michael Heit; Chris Rosenquist; Patrick Culligan; Carol Graham; Miles Murphy; Susan Shott

2003-01-01

386

Visit to a Choice-Based Art Classroom  

ERIC Educational Resources Information Center

One can easily find a choice studio. In this choice-based art classroom, the students move comfortably within an organized structure of space, time and materials, managed by the teacher. They are well aware of their responsibilities and their possibilities. The teacher helps them to mine their lives and interests for the content of their…

Douglas, Katherine

2012-01-01

387

Ambulatory elderly patients of primary care physicians: functional, psychosocial and environmental predictors of need for social work care management.  

PubMed

With increasing numbers of elderly people, and the escalating costs of health care, screening becomes increasingly important for identifying those older people with social health care needs who appear in their primary care physicians' offices. Many people are not aware of available social services. Families with serious social problems are not finding the help they need. The aim of this study was to develop and refine a questionnaire as a screening tool to identify elderly outpatients in primary care settings who are at high risk for psychological, social or environmental needs. This study identified those ten factors at each site which were most indicative that further intervention was needed. There were consistencies among the coordinators across sites in terms of what factors triggered intervention. Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) were more likely to be predictive of the coordinator's intervention than were other factors. PMID:8724842

Berkman, B; Shearer, S; Simmons, W J; White, M; Robinson, M; Sampson, S; Holmes, W; Allison, D; Thomson, J A

1996-01-01

388

Assessment of Adherence to ACC/AHA Guidelines in Primary Management of Patients With NSTEMI in a Referral Cardiology Hospital.  

PubMed

Acute coronary syndromes are considered as a global major health-care problem, and Iran as a developing country is of no exception. We aimed to investigate the degree of adherence to American College of Cardiology and American Heart Association (ACC/AHA) guideline for the management of non-ST-segment elevation myocardial infarction (NSTEMI) in patients who presented to the emergency department at Tehran Heart Center. Data of the patients who presented with acute chest pain to the emergency department of Tehran Heart Center within 1 year and were diagnosed as NSTEMI by the cardiologist in charge were included. The details of the initial managements based on the ACC/AHA guideline for NSTEMI of the patients were recorded from the patients' files in the emergency department for this study. Then, the frequency of guideline-related management in the study population was calculated and reported. A total of 684 patients [mean age = 62.95 ± 12.19 years; male gender = 460 (67.3%)] were diagnosed as NSTEMI at the emergency department of our center. Initial management based on the current guideline including administration of aspirin and clopidogrel was performed in 98.4% and 95.0%, respectively. Intravenous heparin was administered in 67.0% of the patients, whereas 30.8% of patients received enoxaparin. Following the initial management, coronary angiography was performed in 563 (82.3%) patients within 48 hours from the admission. Adherence to ACC/AHA guideline for the management of NSTEMI in patients who presented to a tertiary health-care center was in a high degree. PMID:25679086

Farahzadi, Mohammadreza; Shafiee, Akbar; Bozorgi, Ali; Mahmoudian, Mehran; Sadeghian, Saeed

2015-03-01

389

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

390

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

391

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

392

Geography in Parental Choice  

ERIC Educational Resources Information Center

If we are to fully understand the demand side of school choice, we have to understand geography. But geography is not simply distance and commute time. It is also neighborhood and community. Using two conceptions of geography--space and place--I investigate how and when geography factored into parents' thinking. Drawing on spatial analyses of…

Bell, Courtney

2009-01-01

393

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

394

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

395

Saying No to "Choice."  

ERIC Educational Resources Information Center

Name of Bush Administration's choice game is publicly financed vouchers allowing those already sending their children to private and parochial schools to avoid tuition fees at taxpayer expense. Although private schools administer entrance exams, public schools accept every child regardless of academic record, status, or race. U.S. Senate recently…

Penning, Nick

1992-01-01

396

Learning from School Choice.  

ERIC Educational Resources Information Center

This volume contains revised versions of 16 essays presented at a conference, "Rethinking School Governance," hosted by Harvard's Program on Education Policy and Governance in June 1997. Part 1, "Introduction," contains two chapters: (1) "School Choice: A Report Card" (Paul E. Peterson); and (2) "The Case for Charter Schools" (Bryan C. Hassel).…

Peterson, Paul E., Ed.; Hassel, Bryan C., Ed.

397

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.

398

Deterministic Walks with Choice  

SciTech Connect

This paper studies deterministic movement over toroidal grids, integrating local information, bounded memory and choice at individual nodes. The research is motivated by recent work on deterministic random walks, and applications in multi-agent systems. Several results regarding passing tokens through toroidal grids are discussed, as well as some open questions.

Beeler, Katy E.; Berenhaut, Kenneth S.; Cooper, Joshua N.; Hunter, Meagan N.; Barr, Peter S.

2014-01-10

399

Public Policy Report. Choices.  

ERIC Educational Resources Information Center

Describes the current post-Superwoman era in which women are more free to make choices about homemaking and employment. Women are now secure enough in the workforce that they can quit or work part-time without feeling they have let the sisterhood down. (CB)

Mann, Judy

1985-01-01

400

Choice of Living Arrangements  

ERIC Educational Resources Information Center

Background: The rights to choose where and with whom to live are widely endorsed but commonly denied to adults with intellectual disabilities (ID). The current study provides a contemporary benchmark on the degree of choice exercised by adult service users in the USA. Method: Data came from the National Core Indicators programme. Participants were…

Stancliffe, R. J.; Lakin, K. C.; Larson, S.; Engler, J.; Taub, S.; Fortune, J.

2011-01-01

401

Too Few Choices  

ERIC Educational Resources Information Center

In this article, the author, who is a scientist, a wife and a mother of two preschool children talks about how these two roles exerted a disproportionate impact on her career choices. She is also an X-Gal, one of a group of nine female biologists who have banded together to offer one another advice and support as they seek careers in academic…

Murray, Meg

2007-01-01

402

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.

Jay Parkes

403

Primary Care Clinicians' Perspectives on Management of Skin and Soft Tissue Infections: An Iowa Research Network Study  

ERIC Educational Resources Information Center

An estimated 95,000 people developed methicillin-resistant "Staphylococcus aureus" (MRSA) infections during 2005 of which 14% were community-associated and 85% were hospital or other health setting associated, and 19,000 Americans died from these infections that year. Purpose: To explore health care providers' perspectives on management of skin…

Daly, Jeanette M.; Ely, John W.; Levy, Barcey T.; Smith, Tara C.; Merchant, Mary L.; Bergus, George R.; Jogerst, Gerald J.

2011-01-01

404

Update on the Safety Considerations in the Management of Insomnia With Hypnotics: Incorporating Modified-Release Formulations Into Primary Care  

Microsoft Academic Search

Objective: From a safety perspective, several issues require assessment when a decision is made to prescribe a sleep medication, including next-day residual effects, the potential for abuse, tolerance, and dependence. This article aims to provide an update of the safety profile of agents commonly used in the management of insomnia, with an emphasis on newly approved hypnotics. Data Sources: Publications

Joseph A. Lieberman

405

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

406

Physicians' view of primary care-based case management for patients with heart failure: a qualitative study  

Microsoft Academic Search

Background. As part of a trial aiming to improve care for patients with chronic (systolic) heart failure, a standardized, multifa- ceted case management approach was evaluated in German general practices. It consisted of regular telephone monitoring, home visits, health counselling, diagnostic screening and booklets for patients. Practice-based doctors' assistants (equivalent to a nursing role) adopted these new tasks and reported

FRANK PETERS-KLIMM; REBECCA OLBORT; STEPHEN CAMPBELL; CORNELIA MAHLER; ANTJE MIKSCH; ANNIKA BALDAUF; JOACHIM SZECSENYI

2009-01-01

407

Testing the Efficacy of "INSIGHTS" on Student Disruptive Behavior, Classroom Management, and Student Competence in Inner City Primary Grades  

ERIC Educational Resources Information Center

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 and teacher classroom management. Participants included 116 first and second grade students, their parents, and their 42 teachers in six…

McClowry, Sandra Graham; Snow, David L.; Tamis-LeMonda, Catherine S.; Rodriguez, Eileen T.

2010-01-01

408

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

409

Testing the Efficacy of INSIGHTS on Student Disruptive Behavior, Classroom Management, and Student Competence in Inner City Primary Grades  

Microsoft Academic Search

The Author(s) 2009. This article is published with open access at Springerlink.com Abstract 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 and teacher classroom management. Participants included 116 first and second grade students, their parents, and their 42 teachers

Sandra Graham; L. Snow; Catherine S. Tamis-LeMondaEileen; T. Rodriguez

410

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

411

Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy - a UK primary care practical guide  

PubMed Central

The UK NICE guideline on the Diagnosis and Assessment of Food Allergy in Children and Young People was published in 2011, highlighting the important role of primary care physicians, dietitians, nurses and other community based health care professionals in the diagnosis and assessment of IgE and non-IgE-mediated food allergies in children. The guideline suggests that those with suspected IgE-mediated disease and those suspected to suffer from severe non-IgE-mediated disease are referred on to secondary or tertiary level care. What is evident from this guideline is that the responsibility for the diagnostic food challenge, ongoing management and determining of tolerance to cow’s milk in children with less severe non-IgE-mediated food allergies is ultimately that of the primary care/community based health care staff, but this discussion fell outside of the current NICE guideline. Some clinical members of the guideline development group (CV, JW, ATF, TB) therefore felt that there was a particular need to extend this into a more practical guideline for cow’s milk allergy. This subset of the guideline development group with the additional expertise of a paediatric gastroenterologist (NS) therefore aimed to produce a UK Primary Care Guideline for the initial clinical recognition of all forms of cow’s milk allergy and the ongoing management of those with non-severe non-IgE-mediated cow’s milk allergy in the form of algorithms. These algorithms will be discussed in this review paper, drawing on guidance primarily from the UK NICE guideline, but also from the DRACMA guidelines, ESPGHAN guidelines, Australian guidelines and the US NIAID guidelines. PMID:23835522

2013-01-01

412

RCT of a Care Manager Intervention for Major Depression in Primary Care: 2-Year Costs for Patients With Physical vs Psychological Complaints  

PubMed Central

PURPOSE Depression care management for primary care patients results in sustained improvement in clinical outcomes with diminishing costs over time. Clinical benefits, however, are concentrated primarily in patients who report to their primary care clinicians psychological rather than exclusively physical symptoms. This study proposes to determine whether the intervention affects outpatient costs differentially when comparing patients who have psychological with patients who have physical complaints. METHODS We undertook a group-randomized controlled trial (RCT) of depression comparing intervention with usual care in 12 primary care practices. Intervention practices encouraged depressed patients to engage in active treatment, using nurses to provide regularly scheduled care management for 24 months. The study sample included 200 adults beginning a new depression treatment episode where patient presentation style could be identified. Outpatient costs were defined as intervention plus outpatient treatment costs for the 2 years. Cost-offset analysis used general linear mixed models, 2-part models, and bootstrapping to test hypotheses regarding a differential intervention effect by patients’ style, and to obtain 95% confidence intervals for costs. RESULTS Intervention effects on outpatient costs over time differed by patient style (P <.05), resulting in a $980 cost decrease for depressed patients who complain of psychological symptoms and a $1,378 cost increase for depressed patients who complain of physical symptoms only. CONCLUSIONS Depression intervention for a 2-year period produced observable clinical benefit with decreased outpatient costs for depressed patients who complain of psychological symptoms. It produced limited clinical benefit with increased costs, however, for depressed patients who complain exclusively of physical symptoms, suggesting the need for developing new intervention approaches for this group. PMID:15671186

Dickinson, L. Miriam; Rost, Kathryn; Nutting, Paul A.; Elliott, Carl E.; Keeley, Robert D.; Pincus, Harold

2005-01-01

413

Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care  

PubMed Central

A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ?40?kg·m?2, or 30?kg·m?2 with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4?kg and mean body mass index was 44.1?kg·m?2. A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2?kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9?kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services.

Jennings, A; Hughes, C A; Kumaravel, B; Bachmann, M O; Steel, N; Capehorn, M; Cheema, K

2014-01-01

414

REVIEW OF HEYMAN'S ADDICTION: A DISORDER OF CHOICE  

PubMed Central

Gene Heyman's Addiction: A Disorder of Choice (2009) advances the important, albeit controversial, view that addiction is not a chronic, relapsing brain disease, but instead is an example of typical everyday choice that is both voluntary and self-destructive. This review highlights Heyman's arguments for conceptualizing addiction as choice and discusses the utility of the treatment implications that are derived from the melioration model in which Heyman frames addiction. Self-control and behavioral economics are presented as additional complementary frameworks for understanding addiction as choice, from which pragmatic, evidence-based treatments for addiction (e.g., contingency management) might more easily be derived.

Kurti, Allison N; Dallery, Jesse

2012-01-01

415

Exploring the cost–utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups  

PubMed Central

Objectives Stratified management for low back pain according to patients' prognosis and matched care pathways has been shown to be an effective treatment approach in primary care. The aim of this within-trial study was to determine the economic implications of providing such an intervention, compared with non-stratified current best practice, within specific risk-defined subgroups (low-risk, medium-risk and high-risk). Methods Within a cost–utility framework, the base-case analysis estimated the incremental healthcare cost per additional quality-adjusted life year (QALY), using the EQ-5D to generate QALYs, for each risk-defined subgroup. Uncertainty was explored with cost–utility planes and acceptability curves. Sensitivity analyses were performed to consider alternative costing methodologies, including the assessment of societal loss relating to work absence and the incorporation of generic (ie, non-back pain) healthcare utilisation. Results The stratified management approach was a cost-effective treatment strategy compared with current best practice within each risk-defined subgroup, exhibiting dominance (greater benefit and lower costs) for medium-risk patients and acceptable incremental cost to utility ratios for low-risk and high-risk patients. The likelihood that stratified care provides a cost-effective use of resources exceeds 90% at willingness-to-pay thresholds of £4000 (? 4500; $6500) per additional QALY for the medium-risk and high-risk groups. Patients receiving stratified care also reported fewer back pain-related days off work in all three subgroups. Conclusions Compared with current best practice, stratified primary care management for low back pain provides a highly cost-effective use of resources across all risk-defined subgroups. PMID:22492783

Whitehurst, David G T; Bryan, Stirling; Lewis, Martyn; Hill, Jonathan; Hay, Elaine M

2012-01-01

416

Hypnotic self administration: forced-choice versus single-choice  

Microsoft Academic Search

Twenty-four men and women with insomnia, age 21–50?years, self administered hypnotics under a single-choice with placebo,\\u000a single-choice with triazolam (0.25?mg), or forced-choice of placebo versus triazolam (0.25?mg) paradigm. Subjects received\\u000a 4-sampling nights of placebo or triazolam in the single-choice conditions or 2 nights of each in the forced-choice condition.\\u000a Then on 7 choice nights they could self administer a capsule,

T. Roehrs; Bonita Pedrosi; Leon Rosenthal; Frank Zorick; Thomas Roth

1997-01-01

417

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

418

Therapeutic-diagnostic Evaluation of Chronic Cough Amongst Adults: Causes, Symptoms and Management at the Primary Care Level, Malaysia  

PubMed Central

Background: Patients presenting with chronic cough pose a common diagnostic dilemma during routine consultations at public primary care clinics in Malaysia. To date, there has been little attempt at designing a standardized model or algorithm to facilitate an accurate diagnosis of chronic cough. This study proposes a clinical method to detect the causes of chronic cough in a primary care setting in Malaysia. Materials and Methods: A total of 117 patients aged above 18 at an urban primary care clinic were tracked over a span of 5 months to diagnose the cause of chronic cough. A therapeutic-diagnostic method was employed to help identify the causes of chronic cough. Subsequently, the demographic details of patients, the prevalence of the different causes of chronic cough and the relationship between history and diagnosis were analyzed statistically. Results: Chronic cough had a slightly higher male preponderance (51.3% vs. 48.7%). Patients within the ‘above 60’ age category had the highest frequency of chronic cough. The most common cause of chronic cough was post-infectious cough (n = 42, 35.9%), followed closely by angiotensin-converting enzyme-inhibitor related cough (n = 14, 12%). Majority of patients had the symptom of phlegm production (n = 41, 54%). 33 patients (29.2%) had recent upper respiratory tract infection (<2 weeks ago) prior to the diagnosis of chronic cough. There were poor association between symptoms and the various entities comprising chronic cough. The exceptions were the following associations: (1) Bronchial asthma and itchiness of throat (P = 0021), (2) gastroesophageal reflux disease and heartburn (P < 0.001), (3) upper airway cough syndrome and running nose (P = 0.016) and (4) pulmonary tuberculosis and absence of weight loss (P = 0.004). Conclusion: This study demonstrates that the effectiveness of a therapeutic-diagnostic technique in the diagnosis of chronic cough. Consistent with previous studies, there was poor association between most symptoms and the causes of chronic cough. A study involving a larger primary care population is required to confirm the findings found in this analysis. PMID:25374855

Nantha, Yogarabindranath Swarna

2014-01-01

419

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

420

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