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1

Using discrete choice experiments to inform randomised controlled trials: an application to chronic low back pain management in primary care  

Microsoft Academic Search

Pain Management Programmes (PMPs) are a multi-disciplinary approach to the management of chronic low back pain (CLBP). Notwithstanding evidence of effectiveness, successful take-up of programmes requires acceptability to patients. We used a discrete choice experiment to investigate patient preferences for alternative PMPs for managing CLBP in primary care. Specifically, we estimated the probability of uptake of alternative configurations of PMPs.

Deokhee Yi; Mandy Ryan; Susan Campbell; Alison Elliott; Nicola Torrance; Alastair Chambers; Marie Johnston; Philip Hannaford; Blair H. Smith

2011-01-01

2

Consumer satisfaction with primary care provider choice and associated trust  

PubMed Central

Background Development of managed care, characterized by limited provider choice, is believed to undermine trust. Provider choice has been identified as strongly associated with physician trust. Stakeholders in a competitive healthcare market have competing agendas related to choice. The purpose of this study is to analyze variables associated with consumer's satisfaction that they have enough choice when selecting their primary care provider (PCP), and to analyze the importance of these variables on provider trust. Methods A 1999 randomized national cross-sectional telephone survey conducted of United States residential households, who had a telephone, had seen a medical professional at least twice in the past two years, and aged ? 20 years was selected for secondary data analyses. Among 1,117 households interviewed, 564 were selected as the final sample. Subjects responded to a core set of questions related to provider trust, and a subset of questions related to trust in the insurer. A previously developed conceptual framework was adopted. Linear and logistic regressions were performed based on this framework. Results Results affirmed 'satisfaction with amount of PCP choice' was significantly (p < .001) associated with provider trust. 'PCP's care being extremely effective' was strongly associated with 'satisfaction with amount of PCP choice' and 'provider trust'. Having sought a second opinion(s) was associated with lower trust. 'Spoke to the PCP outside the medical office,' 'satisfaction with the insurer' and 'insurer charges less if PCP within network' were all variables associated with 'satisfaction with amount of PCP choice' (all p < .05). Conclusion This study confirmed the association of 'satisfaction with amount of PCP choice' with provider trust. Results affirmed 'enough PCP choice' was a strong predictor of provider trust. 'Second opinion on PCP' may indicate distrust in the provider. Data such as 'trust in providers in general' and 'the role of provider performance information' in choice, though import in PCP choice, were not available for analysis and should be explored in future studies. Results have implications for rethinking the relationships among consumer choice, consumer behaviors in making trade-offs in PCP choice, and the role of healthcare experiences in 'satisfaction with amount of PCP choice' or 'provider trust.' PMID:17059611

Chu-Weininger, Ming Ying L; Balkrishnan, Rajesh

2006-01-01

3

Alternative Energy Choices, Conservation, and Management: A Primer for Advanced Manufacturing Managers  

Microsoft Academic Search

Manufacturing managers need to understand the interrelated links between advanced manufacturing technology, primary and alternative energy choices, energy output values and costs, and energy conservation over the life of a project. Through an overview of these topics and the manager’s energy conservation processing optimization model developed in this paper, manufacturing managers, engineering technologists, and academics gain greater insight to the

Jeffrey M. Ulmer; Troy E. Ollison

2008-01-01

4

Nonparametric choice modeling : applications to operations management  

E-print Network

With the recent explosion of choices available to us in every walk of our life, capturing the choice behavior exhibited by individuals has become increasingly important to many businesses. At the core, capturing choice ...

Jagabathula, Srikanth

2011-01-01

5

Public perspectives on health human resources in primary healthcare: context, choices and change.  

PubMed

The purpose of this study was to examine factors identified by patients as relevant to health human resources (HHR) planning for primary healthcare (PHC). Eleven focus groups were conducted in British Columbia and a thematic analysis was undertaken, informed by a needs-based HHR planning framework. Three themes emerged: (a) the importance of geographic context, (b) change management at the practice level and (c) the need for choices and changes in delivery of PHC. Findings suggest that more attention could be focused on overcoming geographic barriers to providing services, change management within office-based practices, and providing support structures that allow primary care providers to work closer to their full scope of practice. That these factors align with many strategic directions set out by government and planners signals the readiness for change in how PHC is delivered and HHR planned. PMID:21286262

Regan, Sandra; Wong, Sabrina T; Watson, Diane E

2010-02-01

6

Knowledge Management Technology: Making Good Choices.  

ERIC Educational Resources Information Center

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

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

2001-01-01

7

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

8

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

9

Financial Flexibility, Risk Management, and Payout Choice* Alice Adams Bonaim  

E-print Network

Financial Flexibility, Risk Management, and Payout Choice* Alice Adams Bonaimé University as financial distress-- is a central concern for managers (Graham and Harvey (2001), Gamba and Triantis (2008)). Two key components of financial flexibility are payout policy and risk management. The level and form

University of Technology, Sydney

10

Parental Choice and the Rural Primary School: Lifestyle, Locality and Loyalty  

ERIC Educational Resources Information Center

This paper discusses the geography of parental choice in a rural locale and shows how a group of parents negotiated their way through the process of primary school choice. Using ethnographic data collected through interviews and observations with parents and staff from three rural primary schools in England, the research utilises Bourdieu's…

Walker, Marion; Clark, Gordon

2010-01-01

11

Choosing Schools: Explorations in Post-Primary School Choice in an Urban Irish Working Class Community  

ERIC Educational Resources Information Center

This paper examines post-primary school choice processes in the urban Irish working-class community of Portown. Here, there is an awareness of hegemonic neoliberal ideals and how school choice becomes a significantly classed space characterised by market ideologies and structural inequality. This critical ethnography explored the world through…

Cahill, Kevin; Hall, Kathy

2014-01-01

12

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

13

Management of primary biliary cirrhosis  

Microsoft Academic Search

Primary biliary cirrhosis (PBC) is a presumed autoim- mune disease of the liver, which predominantly affects women once over the age of 20 years. Most cases are diagnosed when asymptomatic (60%). The antimitochon- drial antibody is present in serum in most, but not in all, patients with PBC. The disease generally progresses slowly but survival is less than an age-

E. Jenny Heathcote

2000-01-01

14

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

15

Variation in Predictors of Primary Care Career Choice by Year and Stage of Training  

PubMed Central

CONTEXT It is not known whether factors associated with primary care career choice affect trainees differently at different times or stages of medical education. OBJECTIVE To examine how role models, encouragement, and personal characteristics affect career choice at different stages (medical school vs residency) and periods (1994 vs 1997) of training. DESIGN A split-panel design with 2 cross-sectional telephone surveys and a panel survey in 1994 and 1997. PARTICIPANTS A national probability sample of fourth-year students (307 in 1994, 219 in 1997), 645 second-year residents in 1994, and 494 third-year residents in 1997. Of the fourth-year students interviewed in 1994, 241 (78.5%) were re-interviewed as third-year residents in 1997. MAIN OUTCOME MEASURE Primary care (general internal medicine, general pediatrics, or family medicine) career choice. RESULTS Having a primary care role model was a stronger predictor of primary care career choice for residents (odds ratio [OR], 18.0; 95% confidence interval [95% CI], 11.2 to 28.8 in 1994; OR, 43.7; 95% CI, 24.4 to 78.3 in 1997) than for students (OR, 6.5; 95% CI, 4.3 to 10.2; no variation by year). Likewise, peer encouragement was more predictive for residents (OR, 5.4; 95% CI, 3.3 to 8.9 in 1994; OR, 16.6; 95% CI; 9 .7 to 28.4 in 1997) than for students (OR, 2.1; 95% CI, 1.3 to 3.2; no variation by year). Orientation to the emotional aspects of care was consistently associated with primary care career choice across stages and years of training. CONCLUSIONS The effect of peer encouragement and role models on career choice differed for students and residents and, in the case of residents, by year of training, suggesting that interventions to increase the primary care workforce should be tailored to stage of training. PMID:12648246

Connelly, Maureen T; Sullivan, Amy M; Peters, Antoinette S; Clark-Chiarelli, Nancy; Zotov, Natasha; Martin, Nina; Simon, Steven R; Singer, Judith D; Block, Susan D

2003-01-01

16

Short and long multiple-choice question stems in a primary care oriented undergraduate medical curriculum.  

PubMed

In this study Year 1 students in a new, primary care-oriented undergraduate course were offered a practice multiple-choice question (MCQ) examination with two question item formats--with and without brief primary care-based clinical scenarios--with the same correct answers. Data collected included: completion time; number correct; and responses to a questionnaire seeking student perception on the time required, clarity, ease of choice, and curriculum relevance. The mean scores for both groups of students were no different, although about 20% more time was required to complete clinical scenario stem question sets. Students perceived that the clinical scenarios had little effect on choosing the correct answer, improved question clarity and increased relevance to the curriculum. This study suggests that it is possible to assess junior medical students studying integrated undergraduate medical curricula by using MCQs containing brief clinical scenario stems, so long as either item numbers or timing are adjusted. This item format better reflects the learning process and may better prepare students for later professional practice assessment. GPs have an important role in developing assessment items that reflect early clinical integration. PMID:19583903

Hays, Richard B; Coventry, Peter; Wilcock, David; Hartley, Kirsty

2009-05-01

17

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

18

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

19

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

20

District nurses' experiences with the free-choice system in Swedish primary care.  

PubMed

This article aims to describe the experiences of district nurses regarding their work situation after the free-choice system in primary care in Sweden was implemented. The study comprised a total of 17 semi-structured narratives with district nurses. The narratives were analysed using manifest qualitative content analysis. One category,'being an underused resource', and three subcategories, 'being financially aware','being flexible' and 'being appealing', were identified. A focus on economic benefit can limit the cooperation and exchange of experiences within and between different care units, which could have a negative impact on the quality of care due to competition between different care providers. Underused resources and restrictions in terms of improvement skills have an impact on job satisfaction and the working environment, and affect the quality of care as a result. PMID:24800324

Hollman, Djana; Lennartsson, Sandra; Rosengren, Kristina

2014-01-01

21

Improving patient access and choice: Assisted Bibliotherapy for mild to moderate stress/anxiety in primary care.  

PubMed

Current traditional methods of mental healthcare service delivery, based on 'specialists' providing 'outpatient appointments' for formal therapy, are often inappropriate for the needs of patients in primary care. The estimated numbers of adults with mental health problems are immense, and it is this, combined with Department of Health initiatives aimed at improving choice and access, which make it essential that new ways of delivering services are explored. This trial examines the use of an assisted self-help treatment package for mild to moderate stress/anxiety [Assisted Bibliotherapy (AB)] with an adult clinical population referred by their general practitioner. Assisted Bibliotherapy is a brief intervention (8 weeks), with limited therapist contact (20-min sessions). Non-parametric statistical testing of scores from the Zung Anxiety Scale and the Clinical Outcomes in Routine Evaluation (CORE) questionnaire indicated positive results. There was significant improvement at post-treatment, which was maintained at 3 month follow-up. The results from this trial and a previous trial of AB by Kupshik & Fisher in 1999, indicate that it is an effective treatment which could be used as part of a stepped care approach to managing and treating stress/anxiety in primary care. PMID:15876242

Reeves, T; Stace, J M

2005-06-01

22

Primary epiploic appendagitis and successful outpatient management  

PubMed Central

Summary Background Primary epiploic appendagitis (PEA) is a rare cause of abdominal acute or subacute complaints. Diagnosis of PEA is made with ultrasonography (US) or when computed tomography (CT) reveals a characteristic lesion. Case Report We report on two patients with PEA. In one patient PEA was first seen with US and confirmed with contrast enhanced CT, and in the second patient CT without contrast enhancement demonstrated PEA. In both patients an outpatient recovery with conservative non-surgical treatment is described. Conclusions Medical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions. A correct diagnosis of PEA with imaging procedures enables conservative and successful outpatient management avoiding unnecessary surgical intervention and additional costs. PMID:22648258

Schnedl, Wolfgang J.; Krause, Robert; Wallner-Liebmann, Sandra J.; Tafeit, Erwin; Mangge, Harald; Tillich, Manfred

2012-01-01

23

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

24

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

25

Diagnosis and management of primary ciliary dyskinesia.  

PubMed

Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder with defective structure and/or function of motile cilia/flagella, causing chronic upper and lower respiratory tract infections, fertility problems, and disorders of organ laterality. Diagnosing PCD requires a combined approach utilizing characteristic phenotypes and complementary methods for detection of defects of ciliary function and ultrastructure, measurement of nasal nitric oxide and genetic testing. Currently, biallelic mutations in 31 different genes have been linked to PCD allowing a genetic diagnosis in approximately ~?60% of cases. Management includes surveillance of pulmonary function, imaging, and microbiology of upper and lower airways in addition to daily airway clearance and prompt antibiotic treatment of infections. Early referral to specialized centers that use a multidisciplinary approach is likely to improve outcomes. Currently, evidence-based knowledge on PCD care is missing let alone management guidelines. Research and clinical investigators, supported by European and North American patient support groups, have joined forces under the name of BESTCILIA, a European Commission funded consortium dedicated to improve PCD care and knowledge. Core programs of this network include the establishment of an international PCD registry, the generation of disease specific PCD quality of life questionnaires, and the first randomized controlled trial in PCD. PMID:25610612

Werner, Claudius; Onnebrink, Jörg Große; Omran, Heymut

2015-01-01

26

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

27

Laryngeal mask airway as the only choice for primary airway control in newborn with tracheal stenosis.  

PubMed

Congenital tracheal stenosis is a rare disorder characterized by the presence of focal or diffuse complete tracheal cartilage rings, resulting in afixed tracheal narrowing. The prognosis for this disorder is currently assumed to be poor, with some sources stating that the natural outcome of this problem is inevitably fatal. Tracheal stenosis requires a tracheostomy at delivery for the infant to survive before the definitive reconstruction. The laryngeal mask airway is the most commonly used airway device in pediatric anaesthesia as well as the primary airway control during the resuscitation. We present a premature infant with congenital tracheal stenosis, in whom the airway could be controlled only by the laringeal mask. In this case the laryngeal mask airway was a life saving device for the airway control in the period before tracheostomy was done. Tracheostomy was made in first few hours after birth. In severe tracheal stenosis the laryngeal mask airway can be a device of choice for the initial control of the airway. PMID:21049697

Draskovi?, Biljana; Uram-Benka, Anna; Kljaji?, Vladimir

2010-01-01

28

Choice and development of decision support tools for the sustainable management of deerforest systems  

E-print Network

forest system of Scotland; and (2) the white-tailed deer--eastern boreal forest system of AnticostiReview Choice and development of decision support tools for the sustainable management of deer happens when native deer populations, which are managed for sport are overexploiting forests to a point

Laval, Université

29

PROGRESS IN PRIMARY ALDOSTERONISM: Mineralocorticoid receptor antagonists and management of primary aldosteronism in pregnancy.  

PubMed

Primary aldosteronism (PA) is the most common cause of secondary hypertension. In this review, we discuss the diagnosis and management of PA during pregnancy based on the literature. As aldosterone and renin are physiologically increased during pregnancy and confirmation tests are not recommended, the diagnosis of PA during pregnancy relies on a repeatedly suppressed plasma renin level. Mineralocorticoid receptor antagonists (MRAs) are the most effective drugs to treat hypertension and hypokalemia in patients with PA. However, spironolactone (FDA pregnancy category C) might lead to undervirilization of male infants due to the anti-androgenic effects. Although data in the literature are very limited, treatment with spironolactone is not recommended. Eplerenone (FDA pregnancy category B) is a selective MRA without anti-androgenic potential. If MRA treatment is required in pregnancy, eplerenone appears to be a safe and effective alternative, although symptomatic treatment with approved antihypertensive drugs and supplementation with potassium is the first choice. In case of aldosterone-producing adenoma, laparoscopic adrenalectomy is a therapeutic option in the second trimester of pregnancy. PMID:25163723

Riester, Anna; Reincke, Martin

2015-01-01

30

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

31

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

32

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

33

Clinical Decision-Making for Caries Management in Primary Teeth  

Microsoft Academic Search

The aim of this review of clinical decision-making for caries management in primary teeth is to integrate current knowledge in the field of cariology into clinically usable concepts and procedures to aid in the diagnosis and therapy of dental caries in primary teeth. The evidence for this paper is derived from other manuscripts of this conference; computer and hand searches

Joanna M. Douglass

2001-01-01

34

Management of the pulp in primary teeth--an update.  

PubMed

Management of the pulpal tissue in primary teeth is a clinical challenge facing dental practitioners on a regular basis. This article reviews the most common treatments used at the present time in the management of the pulp in deciduous teeth. It gives an overview of treatment options and the indications and contra-indications for the different treatment modalities. The evidence behind the medicaments used, their actions and success rates are discussed. Practical guidelines for choosing to retain or extract deciduous teeth and management of the primary tooth pulp with different clinical presentations are discussed. Areas of future research are highlighted. PMID:25597190

Brosnan, M G; Natarajan, A K; Campbell, J M; Drummond, B K

2014-12-01

35

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

36

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

37

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

38

Primary sclerosing cholangitis: diagnosis, prognosis, and management.  

PubMed

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 with an age- and sex-matched population. Progressive biliary and hepatic damage results in portal hypertension and hepatic failure in a significant majority of patients over a 10- to 15-year period from the initial diagnosis. In addition, PSC confers a markedly increased risk of hepatobiliary cancer, including cholangiocarcinoma and gallbladder cancer, as compared with the general population, and cancer is the leading cause of mortality in patients with PSC. It is associated with inflammatory bowel disease in 70% of 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

2013-08-01

39

Surgical management of primary aortoesophageal fistula secondary to thoracic aneurysm.  

PubMed

Aortoesophageal fistula, secondary to thoracic aortic aneurysm, is an uncommon cause of gastrointestinal bleeding that is uniformly fatal without surgical intervention. These may be primary fistulas, in cases of thoracic aortic aneurysm without previous repair, or secondary fistulas occurring after surgical repair of thoracic aortic aneurysm. Surgical treatment has been successful in a small number of cases of primary aortoesophageal fistula, secondary to thoracic aortic aneurysm, but techniques used have varied. We report a successful repair of primary aortoesophageal fistula, secondary to descending thoracic aortic aneurysm, and review the evolution of management since the three previously reported successful repairs at our institution. PMID:10750807

Reardon, M J; Brewer, R J; LeMaire, S A; Baldwin, J C; Safi, H J

2000-03-01

40

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

41

Diagnosis and management of benign prostatic hyperplasia in primary care  

PubMed Central

Benign prostatic hyperplasia (BPH), and its clinical manifestation as lower urinary tract symptoms (LUTS), is a major health concern for aging men. There have been significant advances in the diagnosis and treatment of BPH in recent years. There has been a renewed interest in medical therapies and less invasive surgical techniques. As a consequence, the treatment needs of men with mild to moderate LUTS without evidence of prostate cancer can now be accomplished in a primary care setting. There are differences in the way urologists and primary care physicians approach the evaluation and management of LUTS due to BPH, which is not reflected in Canadian Urological Association (CUA) and American Urological Association (AUA) guidelines. A “shared care” approach involving urologists and primary care physicians represents a reasonable and viable model for the care of men suffering from LUTS. The essence of the model centres around educating and communicating effectively with the patient on BPH. This article provides primary care physicians with an overview of the diagnostic and management strategies outlined in recent CUA and AUA guidelines so that they may be better positioned to effectively deal with this patient population. It is now apparent that we must move away from the urologist as the first-line physician, and allow primary care physicians to accept a new role in the diagnosis and management of BPH. PMID:19543429

Tanguay, Simon; Awde, Murray; Brock, Gerald; Casey, Richard; Kozak, Joseph; Lee, Jay; Nickel, J. Curtis; Saad, Fred

2009-01-01

42

Classroom behaviour management content in Australian undergraduate primary teaching programmes  

Microsoft Academic Search

The ability to differentiate classroom behaviour management (CBM) strategies is an important skill for novice teachers in increasingly diverse classrooms. Worldwide, little is known about the curriculum content offered to pre-service teachers in the area of CBM. This article reports the findings from the first nationwide survey of Australian primary pre-service teacher educators coordinating units and programmes with CBM content.

Sue O’Neill; Jennifer Stephenson

2012-01-01

43

Nonlethal Techniques for Managing Predation: Primary and Secondary Repellents  

Microsoft Academic Search

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

JOHN A. SHIVIK; ADRIAN TREVES; PEGGY CALLAHAN

2003-01-01

44

[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

45

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

46

Primary lens extraction for glaucoma management: A review article  

PubMed Central

Recently, primary lens extraction alone gained more acceptance as an alternative surgical approach for glaucoma management. This view was supported by the advances in phacoemulsification and intraocular lenses with greater safety and visual recovery, in addition to a substantial reduction of intraocular pressure and deepening of the anterior chamber and filtration angle. The decrease in IOP after cataract surgery in primary open-angle glaucoma (POAG) is mild, less predictable, related to baseline levels, and may return to presurgical values after an initial period of reduction. Therefore, the IOP-lowering effect of primary cataract extraction in POAG may be insufficient to achieve adequate IOP control. The IOP reduction after lens extraction is consistently greater in eyes with primary angle closure glaucoma (PACG) than in eyes with POAG. Primary lens extraction in acute PACG eliminates, or at least, reduces the risk of recurrence of acute attacks and deepens the anterior chamber and widens the angle which reduces the risk of progression of peripheral anterior synechiae and development of chronic PACG. Primary lens extraction may be more preferable to glaucoma incisional surgery in mild to moderate PACG eyes with appositional angle closure. The decision to do lens extraction as a primary treatment for glaucoma should be individualized based upon several factors other than the effect on IOP. These factors include patients’ characteristics, surgeons’ skills and preferences, status of glaucoma control, type of cataract and intraocular lens implanted, and potential harm of laser treatment for late capsular opacification and fibrosis. PMID:23960947

Eid, Tarek M.

2011-01-01

47

[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

48

Care management: outcomes-based practice for the primary nurse.  

PubMed

Managed care penetration is increasingly dramatically in most health care markets across the country. The impact is the radical redesign of health care systems and the reshaping of the approach to health care from an illness model to a wellness, health promotion model. Integrated delivery systems will facilitate the patient's journey through the continuum of care. The article describes how one institution is streamlining that journey through the integration of care management into the role of the primary nurse who provides direct care. PMID:9212547

Johnson, T; Tahan, H

1997-06-01

49

Surgery in the management of primary intracranial germ cell tumors  

Microsoft Academic Search

Surgery plays an important part in the overall management of primary central nervous system (CNS) germ cell tumors. While\\u000a the general surgical objectives in patients with these neoplasms are similar to those with other types of CNS tumors, to obtain\\u000a an accurate histopathologic diagnosis and to contribute towards improving patient survival the unique features of germ cell\\u000a tumors have necessitated

Howard L. Weiner; Jonathan L. Finlay

1999-01-01

50

Management development for primary health care: a framework for analysis.  

PubMed

Strengthening management has been widely promoted as a critical component of any strategy concerned with improving the implementation of primary health care (PHC). Management development programmes are, however, subject to conflicting demands and differing expectations. The situation is confounded by the wide diversity of strategies subsumed under the heading of management development, and the confusing nature of much of the terminology currently in use. This article presents a simple conceptual framework that can guide analysis and help programme planners review the options, opportunities and limitations of management development programmes. The framework presented examines management development from three different perspectives: the approach adopted; the outcomes expected; and the process of expansion, extension and adaptation. Our analysis of management development strategies allows us to reach some conclusions in areas where there is a degree of consensus. In countries where there is a mismatch between the strategies of PHC and the organizational structures through which they are to be implemented, management development has a role to play in effecting change. Its potential to do so is limited by powerful social, political, economic and organizational forces. Therefore, the capacity to critically analyse the context in which change is planned, emerges as a key element in programme design. We argue that there is no one best approach to management development, and the design of strategies will be contingent on a variety of factors. We do, however, reaffirm the view that where organizational structures and conditions do not support the implementation of PHC strategies, intervention through training alone is almost certain to be inadequate. To be effective, a more comprehensive programme will be required. Finally, the article points to a number of unresolved issues in areas where there is either controversy, lack of clarity or limited experience. PMID:10112478

Cassels, A; Janovsky, K

1991-01-01

51

Management of primary sclerosing cholangitis: Conventions and controversies  

PubMed Central

Primary sclerosing cholangitis (PSC) is a chronic inflammatory cholangiopathy that results in fibrotic strictures and dilations of the intra- and extrahepatic bile ducts. PSC is uncommon, occurs predominantly in males and has a strong association with inflammatory bowel disease. While the pathogenesis of PSC has not been fully elucidated, emerging evidence supports roles for the innate and adaptive immune systems, and genome-wide analyses have identified several genetic associations. Using the best available evidence, the present review summarizes the current understanding of the diagnosis, pathogenesis and management of PSC. Despite its rarity, there is an urgent need for collaborative research efforts to advance therapeutic options for PSC beyond liver transplantation. PMID:22590699

Chandok, Natasha; Hirschfield, Gideon M

2012-01-01

52

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

53

Diagnosis and management of dementia in primary care  

PubMed Central

Abstract Objective To assess the current identification and management of patients with dementia in a primary care setting; to determine the accuracy of identification of dementia by primary care physicians; to examine reasons (triggers) for referral of patients with suspected dementia to the geriatric assessment team (GAT) from the primary care setting; and to compare indices of identification and management of dementia between the GAT and primary care network (PCN) physicians and between the GAT and community care (CC). Design Retrospective chart review and comparisons, based on quality indicators of dementia care as specified in the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, were conducted from matching charts obtained from 3 groups of health care providers. Setting Semirural region in the province of Alberta involving a PCN, CC, and a GAT. Participants One hundred patients who had been assessed by the GAT randomly selected from among those diagnosed with dementia or mild cognitive impairment by the GAT. Main outcome measures Diagnosis of dementia and indications of high-quality dementia care listed in PCN, CC, and GAT charts. Results Only 59% of the patients diagnosed with dementia by the GAT had a documented diagnosis of dementia in their PCN charts. None of the 12 patients diagnosed with mild cognitive impairment by the GAT had been diagnosed by the PCN. Memory decline was the most common reason for referral to the GAT. There were statistically significant differences between the PCN and the GAT on all quality indicators of dementia, with underuse of diagnostic and functional assessment tools and lack of attention to wandering, driving, medicolegal, and caregiver issues, and underuse of community supports in the PCN. There was higher congruence between CC and the GAT on assessment and care indices. Conclusion Dementia care remains a challenge in primary care. Within our primary care setting, there are opportunities for synergistic collaboration among the health care professionals from the PCN, CC, and the GAT. Currently they exist as individual entities in the system. An integrated model of care is required in order to build capacity to meet the needs of an aging population. PMID:24829010

Parmar, Jasneet; Dobbs, Bonnie; McKay, Rhianne; Kirwan, Catherine; Cooper, Tim; Marin, Alexandra; Gupta, Nancy

2014-01-01

54

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

55

Multiprofessional training for breastfeeding management in primary care in the UK  

PubMed Central

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

Ingram, Jennifer

2006-01-01

56

Biodiversity informatics: managing and applying primary biodiversity data.  

PubMed Central

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

Soberón, Jorge; Peterson, A Townsend

2004-01-01

57

Current consensus on the management of primary sclerosing cholangitis.  

PubMed

Guidelines for the management of primary sclerosing cholangitis (PSC) have recently been published by both the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD). The current review focuses on the management of PSC, based on these guidelines. There is no established medical therapy for PSC. The role for UDCA in slowing the disease progression and improving survival is as yet unclear, and there are no specific recommendations for the general use of UDCA in this condition. Guidelines recommend that dominant bile duct strictures with significant cholestasis should be treated with biliary dilatation, with or without stenting. Prospective studies to define type, duration, optimal frequency and long-term effects of endoscopic therapy are needed. Liver transplantation is recommended for end stage disease and has excellent results. PSC patients with dysplasia in biliary brush cytology specimens should also be considered for transplantation. There is no evidence-based algorithm for the follow-up of PSC patients, but some regular investigations are recommended (surveillance colonoscopies in patients with IBD and ultrasound to detect gallbladder mass lesions). PMID:21963085

Wiencke, K; Boberg, K M

2011-12-01

58

Improving the management of asthma in adults in primary care.  

PubMed

Studies in adult patients have suggested that 30% of those diagnosed with asthma do not have the condition and it is likely that the diagnosis is missed in many others. Initial clinical assessment should explore symptoms of wheeze, breathlessness, chest tightness and cough. The probability of asthma is increased if more than one of these symptoms is present and particularly if symptoms are worse at night and in the early morning or are exacerbated by triggers such as exercise, allergen exposure, cold air or drugs. The BTS/SIGN guideline advocates spirometry after taking the history. If airflow obstruction is present, a trial of treatment can commence, but a firm diagnosis also requires a symptomatic response and an improvement in the measured airflow obstruction. The FeNO level correlates well with airway inflammation, and is therefore a good indicator of asthma and in particular of the likely response to inhaled corticosteroids. The test is especially useful for patients with suggestive symptoms but normal spirometry. The cornerstone of asthma monitoring is a structured clinical review conducted in primary care on at least an annual basis. Health outcomes are improved by education in self-management, incorporating written personalised asthma action plans. Checking concordance with existing therapies and inhaler technique before escalating treatment is an important part of improving the pharmacological management of asthma. Any patient prescribed more than one short-acting bronchodilator device a month should be identified and have their asthma assessed urgently and measures taken to improve overall control. PMID:25597198

Funston, Wendy; Higgins, Bernard

2014-11-01

59

The management of diabetes in indigenous Australians from primary care  

PubMed Central

Background Indigenous Australians have high rates of diabetes and its complications. This study examines ethnic differences in the management of patients with type 2 diabetes in Australian primary care. Methods Diabetes management and outcomes in Indigenous patients enrolled in the NEFRON study (n = 144) was systematically compared with that in non-Indigenous patients presenting consecutively to the same practitioner (n = 449), and the NEFRON cohort as a whole (n = 3893). Results Indigenous Australians with diabetes had high rates of micro- and macrovascular disease. 60% of Indigenous patients had an abnormal albumin to creatinine ratio compared to 33% of non-Indigenous patients (p < 0.01). When compared to non-Indigenous patients, Indigenous patients were more likely to have established macrovascular disease ((adjusted Odds ratio 2.7). This excess in complications was associated with poor glycemic control, with an HbA1c ? 8.0%, observed in 55% of all Indigenous patients, despite the similar frequency use of oral antidiabetic agents and insulin. Smoking was also more common in Indigenous patients (38%vs 10%, p < 0.01). However, the achievement of LDL and blood pressure targets was the same or better in Indigenous patients. Conclusion Although seeing the same doctors and receiving the same medications, glycaemic and smoking cessation targets remain unfulfilled in Indigenous patients. This cross-sectional study confirms Aboriginal ethnicity as a powerful risk factor for microvascular and macrovascular disease, which practitioners should use to identify candidates for intensive multifactorial intervention. PMID:17958918

Thomas, Mark; Weekes, Andrew J; Thomas, Merlin C

2007-01-01

60

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

61

ITI choice for the optimal management of inhibitor patients - from a clinical and pharmacoeconomic perspective.  

PubMed

The development of alloantibody inhibitors against factor VIII (FVIII) represents the most significant complication of haemophilia care. Inhibitors tend to develop early in the course of treatment in about 20-30% of patients with severe haemophilia who receive on-demand or prophylactic FVIII therapy. Many factors are associated with inhibitor formation, including disease severity, major FVIII gene defects, family history and non-Caucasian race, as well as age at first treatment, intensity of early treatment, use of prophylaxis and product choice. As these latter treatment-related variables are modifiable, they provide opportunity to minimize inhibitor incidence at the clinical level. Data from the Bonn Centre in Germany have indicated an overall success rate of 78% for immune tolerance induction (ITI) therapy, with a failure rate of 15% and with some treatments either ongoing (3%) or withdrawn (4%). Similarly, data from the G-ITI study, the largest international multicentre ITI study using a single plasma-derived (pd) FVIII/von Willebrand factor (VWF) product, have demonstrated success rates (complete and partial) in primary and rescue ITI of 87% and 74%, respectively, with 85% of poor prognosis patients achieving success. Favourable clinical results based on success rates and time to tolerization continue to be reported for use of pdFVIII/VWF in ITI, with pdFVIII/VWF having a particular role in patients who require rescue ITI and those with a poor prognosis for success. Data from prospective, randomized, controlled clinical studies, such as RES.I.ST (Rescue Immune Tolerance Study), are eagerly awaited. Another factor to consider with ITI therapy is cost; preliminary data from an updated decision analytic model have provided early evidence that ITI has an economic advantage compared with on-demand or prophylactic therapy. PMID:24975701

Oldenburg, J; Austin, S K; Kessler, C M

2014-09-01

62

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

PubMed

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

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

2014-01-01

63

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

64

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

PubMed

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

1993-01-01

65

Implementation of a Primary Care Physician Network Obesity Management Program  

Microsoft Academic Search

Most primary care physicians do not treat obesity, citing lack of time, resources, insurance reimbursement, and knowledge of effective interventions as significant barriers. To address this need, a 10-minute intervention delivered by the primary care physician was coupled with individual dietary counseling sessions delivered by a registered dietitian via telephone with an automated calling system (House-Calls, Mobile, AL). Patients were

Susan Bowerman; Mindy Bellman; Pamela Saltsman; Denise Garvey; Kevin Pimstone; Samuel Skootsky; He-Jing Wang; Robert Elashoff; David Heber

2001-01-01

66

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

E-print Network

evidence of tumour cell elimination after treatment, may help in clinical management and in the choice Department of Gastroenterology & Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek eradication [5], i.e. elimination of the bacterium #3; Published in Methods of Information in Medicine 37

Utrecht, Universiteit

67

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

68

Depression: Diagnosis and Management for the Primary Care Physician.  

PubMed

BACKGROUND: Much has been learned in recent years about the diagnosis and treatment of depression, a serious, commonly overlooked psychiatric illness often seen initially by the primary care physician. The objective of this article is to review the diagnosis and treatment of depression in primary care practice. METHOD: Relevant articles on depression were identified by a comprehensive MEDLINE search and classified into the following categories: diagnosis and screening, nonpharmacologic therapy, pharmacologic therapy, newer antidepressant agents, and maximizing antidepressant therapy. The importance to primary care practice was considered in determining the significance of each article reviewed. RESULTS: Because no laboratory tests exist for depression and no biological markers can be measured routinely, the diagnosis of depression must be made with a number of reliable depression scales and questionnaires that can be completed quickly in the primary care setting. The considerable overlap between depressive and anxiety disorders further complicates an accurate diagnosis. Remission (i.e., absence of symptoms) is the ultimate goal of therapy for patients who have depressive symptoms. CONCLUSION: Many patients can be treated safely and effectively for depression in the primary care setting with pharmacologic therapy, which, if completely successful, can lead to full remission of the disorder. PMID:15014639

Ferguson, James M.

2000-10-01

69

Controlling shareholders' propping or tunneling: A choice of earnings management — Evidence from target firms in China  

Microsoft Academic Search

This paper documents a unique form of controlling shareholders' propping and tunneling through earnings management prior to China's equity transactions, and we find the significant evidence that the controlling shareholders of targets attempt to employ income-increasing accruals management prior to the mergers that acquirers are not the controlling shareholders of targets so as to increase their revenue from equity transactions

Li Shan-min; Mao Ya-juan

2010-01-01

70

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

71

Current Management of Primary Central Nervous System Lymphoma  

Microsoft Academic Search

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

Christopher J. Schultz; Joseph Bovi

2010-01-01

72

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

73

Managed Care, Access to Specialists, and Outcomes among Primary Care Patients with Pain  

PubMed Central

Objective To determine whether managed care controls were associated with reduced access to specialists and worse outcomes among primary care patients with pain. Data Sources/Study Setting Patient, physician, and office manager questionnaires collected in the Seattle area in 1996–1997, plus data abstracted from patient records and health plans. Study Design A prospective cohort study of 2,275 adult patients with common pain problems recruited in the offices of 261 primary care physicians in Seattle. Data Collection Patients completed a waiting room questionnaire and follow-up surveys at the end of the first and sixth months to measure access to specialists and outcomes. Intensity of managed care controls measured by plan managed care index and benefit/cost-sharing indexes, office managed care index, physician compensation, financial incentives, and use of clinical guidelines. Principal Findings A financial withhold for referral was associated with a lower likelihood of referral to a physician specialist, a greater likelihood of seeing a specialist without referral, and a lower patient rating of care from the primary physician. Otherwise, patients in more managed offices and with greater out-of-network plan benefits had greater access to specialists. Patients with more versus less managed care had similar health outcomes, but patients in more managed offices had lower ratings of care provided by their primary physicians. Conclusions Increased managed care controls were generally not associated with reduced access to specialists and worse health outcomes for primary care patients with pain, but patients in more managed offices had lower ratings of care provided by their primary physicians. PMID:12650378

Grembowski, David E; Martin, Diane; Diehr, Paula; Patrick, Donald L; Williams, Barbara; Novak, Louise; Deyo, Richard; Katon, Wayne; Dickstein, Deborah; Engelberg, Ruth; Goldberg, Harold

2003-01-01

74

Removing barriers and improving choices: a case study in reproductive health services and managed care.  

PubMed

Managed care contains inherent structural features that can create obstacles to time-sensitive, confidential reproductive health services. Such structural impediments often exacerbate the sociocultural barriers that have historically affected low-income women--the population that has been targeted for mandatory enrollment in Medicaid managed care plans in many states. This article recommends public policy strategies to overcome and prevent multiple barriers that were identified in a New York-based study in 1995, which focused on access to reproductive health services in managed care settings. This article also includes updated evidence supporting the study's findings and its relevance to other states. PMID:10187074

Gordon, S G

1998-11-01

75

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

PubMed

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

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

2014-03-01

76

The Role of the Primary Care Physician in the Management of Bladder Dysfunction  

PubMed Central

Urinary incontinence is a major health challenge for primary care physicians. Unfortunately, the majority of incontinent patients remain untreated. Primary care physicians are ideally positioned to screen for and manage urinary incontinence. A knowledge of basic micturition physiology is important for the physician to accurately identify the cause of incontinence and arrive at the correct treatment course. To this end, this article reviews the physiology of the lower urinary tract, describes the clinical types of urinary incontinence, and outlines a stepwise approach for the primary care physician to the basic evaluation and management of patients with this condition. PMID:16985854

Imam, Khaled A

2004-01-01

77

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

Microsoft Academic Search

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

Torsten Kühlmann; Kate Hutchings

2010-01-01

78

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

79

Impact of a PDA-Based Diabetes Electronic Management System in a Primary Care Office  

Microsoft Academic Search

The objective was to determine if a personal digital assistant (PDA) diabetes management system improves processes and outcomes of diabetes care in a primary care setting. Outcomes and processes of care were compared between and within 2 groups of patients with type II diabetes. The intervention group of 58 patients was managed for 16 months with the aid of a

Dallon Jones; William Curry

2006-01-01

80

The Health Management Information System in Primary Health Care: The Palestinian Model  

Microsoft Academic Search

The management capabilities and performance of primary health care (PHC) can be improved by strengthening the information system. This study focuses on the Palestinian Health Management Information System (HMIS), used in PHC and reports on the achievements and shortcomings. A retrospective review and content analysis of the HMIS documentation was carried out and a Strengths, Weaknesses, Opportunities, and Threats (SWOT)

Tayser Abu Mourad; Mohammed A. Afifi; Suzanne Shashaa; Dimitris Kounalakis; Christos Lionis; Anastas Philalithis

81

Collaborative Classroom Management in a Co-Taught Primary School Classroom  

ERIC Educational Resources Information Center

The purpose of this study was to examine how teachers manage their classroom in co-taught lessons. The data were collected by observing and interviewing a pair of primary school teachers. The most important influence of collaboration on classroom management seemed to be the emotional support of another adult, and the opportunity to use different…

Rytivaara, Anna

2012-01-01

82

Tough Choices: A Guide to Administrative Cost Management in Colleges and Universities.  

ERIC Educational Resources Information Center

This guide is a product of a study conducted as part of a broader effort by the Department of Education to identify the causes of rising college costs and find and disseminate ways to contain these costs. In institutions of higher education most costs are manageable and can be contained without jeopardizing key services. This can be achieved by…

Cresap, Rosslyn, VA.

83

Travel using managed lanes: An application of a stated choice model for Houston, Texas  

E-print Network

a,1 , Mark Burris b,n , W. Douglass Shaw c a RAND Europe, Westbrook Center, Milton Road, Cambridge Station, TX- 77843-2124, USA a r t i c l e i n f o Keywords: Stated preference Managed lanes Survey design

Shaw, W. Douglass

84

On the Choice Between the Stocking Rate and Time in Range Management  

Microsoft Academic Search

A long standing question in range management concerns the relative importance of the stocking rate versus the length oftime during which animals graze a particular rangeland. Weaddress this question by analyzing the problem faced by a privaterancher who wishes to minimize the long run expected net unit cost (LRENC) from range operations by choosing either the stocking rate or the

Amitrajeet A. Batabyal; Basudeb Biswas; E. Bruce Godfrey

2001-01-01

85

New perspectives in the management of primary hyperparathyroidism  

PubMed Central

Primary hyperparathyroidism (PHPT) is a biochemical syndrome caused by the inappropriate or unregulated overproduction of parathyroid hormone, Leading to hypercalcae-mia. It was previously considered a relatively rare disorder, with clinical manifestations dominated by renal and/or bone disease. However, in modern times the diagnosis is most frequently recognized coincidentally on biochemical testing in patients evaluated for unrelated complaints. Parathyroidectomy is the only curative treatment for PHPT, with improved outcomes in symptomatic patients following this procedure. However, surgical intervention in patients with no clear clinical features remains controversial. The National Institutes for Health (NIH) have developed consensus guidelines giving specific indications for when surgery is recommended in patients with asymptomatic PHPT. This article examines the impact of treatment on asymptomatic PHPT, focusing on bone disease, neurocognitive function, quality of Life, cardiovascular disease and mortality. Medical treatment options, including bisphospho-nates and cinacalcet, are also discussed. PMID:23148164

Ayuk, John; Cooper, Mark S.; Gittoes, Neil J. L.

2010-01-01

86

Systematic review of guidelines for the management of suspected lung cancer in primary care  

PubMed Central

Abstract Objective To systematically review the literature and provide an update and integration of existing peer-reviewed guidelines with recent systematic reviews and with primary studies related to the early recognition and management of lung cancer in primary care. Data sources MEDLINE and EMBASE were searched for relevant articles. The quality of the evidence to support existing guideline recommendations, and the consistency of recommendations with updated evidence, were assessed. Applicability in a Canadian primary care setting was also evaluated. Study selection All studies that explored signs or symptoms of or risk factors for lung cancer in the primary care setting were included. All diagnostic studies in which symptomatic primary care patients underwent 1 or more investigations were also searched. Synthesis Recommendations were consistent among guidelines despite a paucity of supporting evidence. Updated evidence provided further support for the recommendations. Recommendations for identifying signs and symptoms of lung cancer presenting in primary care and for initial management can be adopted and applied within a Canadian primary care setting. Conclusion This updated review of recommendations might help promote evidence-based practice and, ultimately, more timely management and improved prognosis for lung cancer patients. It might also assist in the development of lung cancer diagnostic assessment programs. PMID:25122830

Giudice, M. Elisabeth Del; Young, Sheila-Mae; Vella, Emily T.; Ash, Marla; Bansal, Praveen; Robinson, Andrew; Skrastins, Roland; Ung, Yee; Zeldin, Robert; Levitt, Cheryl

2014-01-01

87

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

88

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

89

[Management of COPD exacerbations: from primary care to hospitalization].  

PubMed

The Société de pneumologie de langue française defines acute exacerbation of chronic obstructive pulmonary disease (AE COPD) as an increase in daily respiratory symptoms, basically duration ? 48h or need for treatment adjustment. Etiology of EA COPD are mainly infectious, viral (rhinovirus, influenzae or parainfluenzae virus, coronavirus, adenovirus and respiratory syncytial virus) or bacterial (Haemophilus influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis). Pollutant exposure can also lead to AE COPD, such as NO2, SO2, ozone or particulates (PM10 and PM2.5). In 30% the etiology remains unknown. Differential diagnoses of AE COPD include infectious pneumonia, pneumothorax, acute heart failure and pulmonary embolism. Presences of signs of severity impose hospitalization: signs of respiratory distress, shock, acute confusion but also fragile patients, insufficient home support or absence of response to initial treatment. AE COPD treatments consist on increase in bronchodilators, chest physiotherapy, and antibiotics if sputum is frankly purulent. Systemic corticosteroids should not be systematic. Recommended dose is 0.5 mg/kg on short course (5-7 days). During hospitalization, oxygen supplementation and thromboprophylaxis could be prescribed. The main interest in non-invasive ventilation is persistent hypercapnia despite optimal medical management. During ambulatory management or hospitalization, clinical assessment at 48-72 h is mandatory. PMID:25451635

Jouneau, Stéphane; Brinchault, Graziella; Desrues, Benoît

2014-12-01

90

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

91

Creating the Management Academy for Public Health: relationships are primary.  

PubMed

True collaboration among large federal agencies is rare, as is that among large and influential national foundations. The collaboration between two major government health agencies (The Centers for Disease Control and Prevention and the Health Resources and Services Administration) and three major health foundations (the W.K. Kellogg Foundation, the Robert Wood Johnson Foundation, and the CDC Foundation) to create the Management Academy for Public Health is unprecedented in public health over the past quarter century. We attribute this success to the unique combination of a strong foundation of relationships between the partners and a commitment to generative dialogue throughout the design and implementation of the program. The success and sustainability of the Academy derive directly from these critical success factors, serving as an exemplary model for future collaborative endeavors. PMID:16912603

Baker, Edward L; Fox, Claude Earl; Hassmiller, Susan B; Sabol, Barbara J; Stokes, C Charles

2006-01-01

92

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

93

[Risk analysis of primary endoprosthetic management of proximal femur fractures].  

PubMed

From 1984 to 1991 439 patients with fractures of the coxal femur (303 femoral neck fractures, 136 pertrochanteric fractures) were treated by primary arthroplasty. The average age of the 370 female and 69 male patients was 80.9 (+/- 9.9) years. In 368 patients (83.8%) concomitant diseases were diagnosed and 212 patients (48.3%) showed more than 1 risk factor. There were 205 alloarthroplasties and 234 hemiarthroplasties performed. The percentage of patients treated by total hip endoprosthesis was 31.2% in 1984 and increased to 63.1% in 1991. In 49.2% of all cases general complications occurred, pre-dominantly nosocomial infections and pressure sores. Local (surgical) complications were diagnosed after 10.5% of all operations. The 30-day-mortality was 5.2%, the in-hospital-mortality 5.9%. Statistical analysis by multivariate logistic regression showed an independent negative influence of pre-operative immobility, pertrochanteric fractures, diabetes mellitus and multiple concomitant diseases on mortality. Age, sex or other single risk factors were not independently associated with an increased mortality. Patients with the above mentioned risk factors are easy to identify pre-operatively and do perform better after intensive preparation, short operation time and early mobilisation after surgery. PMID:7941112

Schwenk, W; Eyssel, M; Badke, A; Hucke, H P; Stock, W

1994-08-01

94

Natural history and management of primary biliary cirrhosis  

PubMed Central

Primary biliary cirrhosis (PBC) is a chronic inflammatory autoimmune disease that mainly targets the cholangiocytes of the interlobular bile ducts in the liver. It is a rare disease with prevalence of less than one in 2000. Its prevalence in developing countries is increasing presumably because of growth in recognition and knowledge of the disease. PBC is thought to result from a combination of multiple genetic factors and superimposed environmental triggers. The contribution of the genetic predisposition is evidenced by familial clustering. Several risk factors, including exposure to infectious agents and chemical xenobiotics, have been suggested. Common symptoms of the disease are fatigue and pruritus, but most patients are asymptomatic at first presentation. The prognosis of PBC has improved because of early diagnosis and use of ursodeoxycholic acid, the only established medical treatment for this disorder. When administered at adequate doses of 13–15 mg/kg/day, up to two out of three patients with PBC may have a normal life expectancy without additional therapeutic measures. However, some patients do not respond adequately to ursodeoxycholic acid and might need alternative therapeutic approaches. PMID:24367233

Al-Harthy, Nadya; Kumagi, Teru

2012-01-01

95

Instructional Leadership for Quality Learning: An Assessment of the Impact of the Primary School Management Development Project in Botswana  

ERIC Educational Resources Information Center

A descriptive study using questionnaires was conducted in 2004 to assess the effectiveness of instructional leadership displayed by primary school management teams following the implementation of the Primary School Management Project in Botswana. Leadership skills, Coordination of instructional activities, management of curriculum and quality of…

Pansiri, Nkobi Owen

2008-01-01

96

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

97

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

98

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

99

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

Code of Federal Regulations, 2012 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...

2012-04-01

100

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

101

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

Code of Federal Regulations, 2011 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...

2011-04-01

102

Unilateral persistent hyperplastic primary vitreous: intensive management approach with excellent outcome beyond visual maturation.  

PubMed

Persistent hyperplastic primary vitreous (PHPV) is an ocular developmental disorder resulting from incomplete apoptosis of the embryonic hyaloid vasculature. Unilateral PHPV is traditionally associated with a poor prognosis because of the challenges associated with managing progressive anisometropic amblyopia. We report a child with unilateral PHPV who underwent cataract extraction, primary posterior capsulotomy with anterior vitrectomy and intraocular lens implantation followed by combined trabeculectomy/trabeculotomy within the first 8?weeks of life. Intensive optometric and orthoptic input was required for many years to manage the increasing anisometropic amblyopia with final visual acuity of 20/40 unaided in the affected eye and without evidence of glaucomatous optic neuropathy. This case illustrates the excellent visual outcome possible in a child with complex, unilateral PHPV using an intensive management approach comprising: early surgical intervention for congenital cataract and secondary glaucoma, meticulous monitoring of refraction, visual acuity and intraocular pressure and motivated parents who engaged in the management. PMID:25564632

Yusuf, Imran H; Patel, Chetan Kantibhai; Salmon, John F

2015-01-01

103

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

Microsoft Academic Search

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

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

2007-01-01

104

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

105

International consensus report on the investigation and management of primary immune thrombocytopenia  

Microsoft Academic Search

Previously published guidelines for the diagnosis and management of primary immune thrombocytopenia (ITP) require updating largely due to the introduction of new classes of therapeutic agents, and a greater understanding of the disease pathophysiology. However, treatment- related decisions still remain principally dependent on clinical expertise or patient preference rather than high-quality clini- cal trial evidence. This consensus docu- ment aims

Drew Provan; Roberto Stasi; Adrian C. Newland; Victor S. Blanchette; Paula Bolton-Maggs; James B. Bussel; Beng H. Chong; Douglas B. Cines; Terry B. Gernsheimer; Bertrand Godeau; John Grainger; Ian Greer; Beverley J. Hunt; Paul A. Imbach; Gordon Lyons; Robert McMillan; Francesco Rodeghiero; Miguel A. Sanz; Michael Tarantino; Joan Young; David J. Kuter

106

Pharmacologic Management of Overactive Bladder: Practical Options for the Primary Care Physician  

Microsoft Academic Search

Overactive bladder (OAB) affects millions of people in the United States and is associated with poor health, impaired quality of life, social isolation, and depressive symptoms. Despite the high prevalence of this syndrome, studies show that it is not adequately addressed by the busy primary care physician, who may be preoccupied with management of other chronic diseases perceived as more

David R. Staskin; Scott A. MacDiarmid

2006-01-01

107

The influence of gender on the primary care management of diabetes in Tunisia  

Microsoft Academic Search

Background: Gender differences in access to high quality care for chronic illnesses have been suggested yet little work in this potentially vital area of health care inequality has been undertaken in Africa. We explored the influence of patient gender on the care of people with diabetes within a multi-method, national study of diabetes management in primary care in Tunisia. Methods:

Hugh Alberti; Benjamin Alberti

2009-01-01

108

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

NASA Astrophysics Data System (ADS)

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

Sahagia, Maria; Razdolescu, Anamaria Cristina; Luca, Aurelian; Ivan, Constantin

2007-04-01

109

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

110

Barriers to obesity management: a pilot study of primary care clinicians  

Microsoft Academic Search

: BACKGROUND: Obesity is an increasing epidemic in both the US and veteran populations, yet it remains largely understudied in the Veteran's Health Administration (VHA) setting. The purpose of our study was to identify barriers to the effective management of obesity in VHA primary care settings. METHODS: Three focus groups of clinicians from a Veteran's Affairs Medical Center (VAMC) and

Valerie Forman-Hoffman; Amanda Little; Terry Wahls

2006-01-01

111

Analysis of Classroom Management Problems in Primary Schools in Delta State, Nigeria  

ERIC Educational Resources Information Center

This article identifies classroom management problems, their causes, and possible ways to reduce these problems in primary schools located in Delta State, Nigeria. A total of 600 teachers selected from twelve local government areas participated in this study. Data were collected in a checklist containing 27 items and a two section questionnaire…

Oghuvbu, Enamiroro Patrick; Atakpo, Theresa Edirin

2008-01-01

112

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

PubMed Central

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

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

2012-01-01

113

The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review  

PubMed Central

Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. PMID:23428085

Stellefson, Michael; Stopka, Christine

2013-01-01

114

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

115

Improving Population Management through Pharmacist-Primary Care Integration: A Pilot Study.  

PubMed

Abstract Pharmacists have unique skills that may benefit primary care practices. The objective of this demonstration project was to determine the impact of integrating pharmacists into patient-centered medical homes, with a focus on population management. Pharmacists were partnered into 5 primary care practices in Vermont 1 day per week to provide direct patient care, population-based medication management, and prescriber education. The main measures included a description of drug therapy problems identified and cost avoidance models. The pharmacists identified 708 drug therapy problems through direct patient care (336/708; 47.5%), population-based strategies (276/708; 38.9%), and education (96/708; 13.6%). Common population-based strategies included adjusting doses and discontinuing unnecessary medications. Pharmacists' recommendations to correct drug therapy problems were accepted by prescribers 86% of the time, when data about acceptance were known. Of the 49 recommendations not accepted, 47/49 (96%) were population-based and 2/49 (4%) were related to direct patient care. The cost avoidance model suggests $2.11 in cost was avoided for every $1.00 spent on a pharmacist ($373,092/$176,690). There was clear value in integrating pharmacists into primary care teams. Their inclusion prevented adverse drug events, avoided costs, and improved patient outcomes. Primary care providers should consider pharmacists well suited to offer direct patient care, population-based management, and prescriber education to their practices. To be successful, pharmacists must have full permission to document findings in the primary care practices' electronic health records. Given that many pharmacist services do not involve billable activities, sustainability requires identifying alternative funding mechanisms that do not rely on a traditional fee-for-service approach. (Population Health Management 20xx;xx:xxx-xxx). PMID:25029631

Kennedy, Amanda G; Chen, Harry; Corriveau, Michele; MacLean, Charles D

2014-07-16

116

Management commitments and primary care: another lesson from Costa Rica for the world?  

PubMed

Maintained dedication to primary care has fostered a public health delivery system with exceptional outcomes in Costa Rica. For more than a decade, management commitments have been part of Costa Rican health reform. We assessed the effect of the Costa Rican management commitments on access and quality of care and on compliance with their intended objectives. We constructed seven hypotheses on opinions of primary care providers. Through a mixed qualitative and quantitative approach, we tested these hypotheses and interpreted the research findings. Management commitments consume an excessive proportion of consultation time, inflate recordkeeping, reduce comprehensiveness in primary care consultations, and induce a disproportionate consumption of hospital emergency services. Their formulation relies on norms in need of optimization, their control on unreliable sources. They also affect professionalism. In Costa Rica, management commitments negatively affect access and quality of care and pose a threat to the public service delivery system. The failures of this pay-for-performance-like initiative in an otherwise well-performing health system cast doubts on the appropriateness of pay-for-performance for health systems strengthening in less advanced environments. PMID:24919308

Soors, Werner; De Paepe, Pierre; Unger, Jean-Pierre

2014-01-01

117

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

PubMed Central

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

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

2014-01-01

118

Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry  

Microsoft Academic Search

Background  In contrast to surveys in cardiologist settings, presentation and management of atrial fibrillation (AF) in primary care patients\\u000a is less well studied.\\u000a \\u000a \\u000a \\u000a \\u000a Methods and results  The prospective ATRIUM (Outpatient\\u000a Registry Upon Morbidity of Atrial Fibrillation) collected data from patients with AF seen by 730 physicians representing a random sample\\u000a of all primary care physicians in Germany. ATRIUM enrolled 3,667 patients (mean

Thomas Meinertz; Wilhelm Kirch; Ludger Rosin; David Pittrow; Stefan N. Willich; Paulus Kirchhof

119

Initial manifestation of primary hyperoxaluria type I in adults-- recognition, diagnosis, and management.  

PubMed Central

Primary hyperoxaluria type I may initially manifest as urolithiasis, renal insufficiency, or symptoms of systemic oxalosis. This hereditary disorder was fatal until effective therapies evolved during the past two decades. Difficulty in recognizing and diagnosing this disorder in adults is illustrated in a report of a patient eventually restored to good health by high-flux dialysis and combined renal and hepatic transplantation. I explore the molecular processes of the genetic defect and discuss clinical indicators of primary hyperoxaluria type I, manifestations of oxalosis, the pathogenesis of chronic oxalate nephropathy, and the diagnosis and management of this disease. Images Figure 2. Figure 3. Figure 4. PMID:8779202

Kuiper, J J

1996-01-01

120

Late-Onset Primary Intestinal Lymphangiectasia Successfully Managed with Octreotide: A Case Report  

PubMed Central

We report a case of a patient with late-onset primary lymphangiectasia whose persistent diarrhoea was successfully managed with octreotide. A 63?year-old man visited our clinic with a complaint of worsening general edema. Gastrointestinal endoscopy revealed typical whitish jejunal villi, which suggested primary intestinal lymphangiectasia. Despite a diet, supplemented with medium-chain triglycerides; antiplasmin therapy; oral corticosteroids; and surgery, including pericardial window and lymphaticovenous anastomoses; his symptoms, including watery diarrhoea, showed no improvement. After administration of octreotide, his persistent diarrhoea resolved within a couple of days. Octreotide was continued for 2 months. Thereafter, his diarrhoea has not recurred for 6 months. PMID:23555496

Suehiro, Kotaro; Morikage, Noriyasu; Murakami, Masanori; Yamashita, Osamu; Hamano,, Kimikazu

2012-01-01

121

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

122

The MS Choices Survey: findings of a study assessing physician and patient perspectives on living with and managing multiple sclerosis  

PubMed Central

Background Treatment of multiple sclerosis (MS) with disease-modifying drugs (DMDs) can reduce relapse frequency and delay disability progression. Although adherence to DMDs is difficult to measure accurately, evidence suggests that poor adherence is common and can compromise treatment success. There are likely to be multiple factors underlying poor adherence. To better understand these factors, the global MS Choices Survey investigated patient and physician perspectives regarding key aspects of MS diagnosis, treatment adherence and persistence, and disease management. Methods The survey was conducted in seven countries and involved patients with MS (age 18–60 years; MS diagnosis for ?1 year; current treatment with a DMD) and physicians (neurologist for 3–30 years; treating ?15 patients with MS per average month; >60% of time spent in clinical practice). Separate questionnaires were used for physicians and patients, each containing approximately 30 questions. Results Questionnaires were completed by 331 patients and 280 physicians. Several differences were observed between the responses of patients and physicians, particularly for questions relating to treatment adherence. Overall, the proportion of patients reporting taking a treatment break (31%) was almost twice that estimated by physicians (on average 17%). The reasons cited for poor adherence also differed between patients and physicians. For example, more physicians cited side effects as the main reason for poor patient adherence (82%), than responding patients (42%). Conclusions Physicians may underestimate the scale of poor adherence to DMDs, which could impact on their assessment of treatment efficacy and result in inappropriate treatment escalation. In addition, disparities were identified between patient and physician responses regarding the underlying reasons for poor adherence. Improvements in the dialog between patients and neurologists may increase adherence to DMDs. PMID:22259240

Riñon, Alberto; Buch, Mandy; Holley, Derek; Verdun, Elisabetta

2011-01-01

123

[Improvement of management of hypertension by implementation of alcohol screening and subsequent interventions in primary practice].  

PubMed

Hypertension and alcohol use are both part of the five most important risk factors for burden of disease in Western Europe, mainly because of their impact on non-communicable diseases (NCD). Both risk factors are prevalent with high overlap among patients in primary care. Implementation of a screening for alcohol among patients of hypertension in primary care followed by brief intervention for problem alcohol use or formal treatment for people with alcohol dependence could constitute an important step to reach the goals of the Global WHO Action Plan for Prevention and Control of NCD. In addition, such an intervention could improve the management of hypertension. In a working group of experts from clinical practice and research the rationale and potential barriers for this intervention were discussed and steps for implementation in primary care were developed. PMID:25409405

Rehm, Jürgen; Gmel, G; Kiefer, F; Kreutz, R; Kugler, J; Müller-Walther, M; Sandow, P; Weisser, B

2014-11-01

124

Primary mucinous carcinoma of the periocular region: successful management with local resections over 30 years.  

PubMed

Primary mucinous carcinoma of the skin is a rare malignant neoplasm, often with periocular involvement, believed to originate from eccrine sweat glands. It is slow growing and locally destructive, at times forming tumour satellites. We present a case with six local recurrences treated with surgical resections over a period of 30 years. We have not been able to find longer follow-up in the literature, and believe this case may offer insight into the management of these uniquely indolent malignancies. PMID:23417934

Burris, Christopher Keith; Rajan, K D Anand; Iliff, Nicholas T

2013-01-01

125

Primary mucinous carcinoma of the periocular region: successful management with local resections over 30?years  

PubMed Central

Primary mucinous carcinoma of the skin is a rare malignant neoplasm, often with periocular involvement, believed to originate from eccrine sweat glands. It is slow growing and locally destructive, at times forming tumour satellites. We present a case with six local recurrences treated with surgical resections over a period of 30?years. We have not been able to find longer follow-up in the literature, and believe this case may offer insight into the management of these uniquely indolent malignancies. PMID:23417934

Burris, Christopher Keith; Rajan, K D Anand; Iliff, Nicholas T

2013-01-01

126

Managing benign prostatic hyperplasia in primary care. Patient-centred approach.  

PubMed Central

PROBLEM ADDRESSED: Management of benign prostatic hyperplasia (BPH) is changing from a surgical approach to a medical approach, and the role of primary care physicians is expanding. OBJECTIVE OF PROGRAM: To introduce a patient-centred approach to managing BPH in primary care through a continuing medical education (CME) program. MAIN COMPONENTS OF PROGRAM: A practice-based, small group, peer-led CME program focused on application of the International Prostate Symptom Score and Quality of Life Assessment in four case studies on prostatism, including BPH. At 86 workshops held across Canada, 658 physicians participated in discussions with case materials that included videos and a handbook. A before-after practice behaviour questionnaire was administered at each workshop to evaluate "intent to change." CONCLUSIONS: Participating physicians showed willingness to learn new skills for patient-centred management of BPH. These results suggest that peer-led, small group CME can successfully encourage use of new practice guidelines in primary are and teach physicians practical steps for developing therapeutic alliances with their patients. PMID:10690495

McSherry, J.; Weiss, R.

2000-01-01

127

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

128

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

PubMed Central

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

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

2014-01-01

129

Chlamydia Screening and Management Practices of Primary Care Physicians and Nurse Practitioners in California  

PubMed Central

BACKGROUND Because sexually transmitted chlamydial infections are common among young women, it is critical that providers screen and manage these infections appropriately. OBJECTIVE To assess the Chlamydia care practices of California primary care physicians and nurse practitioners. DESIGN Cross-sectional, self-report mail survey. PARTICIPANTS A stratified random sample of primary care physicians and a convenience sample of primary care nurse practitioners in California. MEASUREMENTS AND MAIN RESULTS Survey content included 5 topic areas: sexual history taking, management of cervicitis, management of a nonpregnant Chlamydia-infected patient, availability of onsite STD services, and Chlamydia screening practices and attitudes. Main outcome measure was the reported frequency of Chlamydia screening of sexually active women age 25 and younger. Respondents included 708 physicians (49% response rate) and 895 nurse practitioners (63% response rate). Nearly half of physicians (47%, 95% confidence interval [CI], 42% to 51%) and a majority of nurse practitioners (79%, 95% CI, 77% to 82%) reported routine Chlamydia screening of women under age 20; similar proportions reported routinely screening women aged 20 to 25 years. Independent predictors of screening among physicians were adolescent medicine specialty, female gender, practicing in a nonprivate setting, and having a higher volume of female patients. Additional findings included the overscreening of women over age 25 by nurse practitioners and the shared concern among providers that Chlamydia screening may not be reimbursed. CONCLUSIONS The Chlamydia care practices of many California primary care providers are inconsistent with current guidelines. Targeted provider education and improved reimbursements are potential strategies for improvement. PMID:16423098

Guerry, Sarah L; Bauer, Heidi M; Packel, Laura; Samuel, Michael; Chow, Joan; Rhew, Miriam; Bolan, Gail

2005-01-01

130

Telemonitoring can assist in managing cardiovascular disease in primary care: a systematic review of systematic reviews  

PubMed Central

Background There has been growing interest regarding the impact of telemonitoring and its ability to reduce the increasing burden of chronic diseases, including chronic cardiovascular disease (CVD), on healthcare systems. A number of randomised trials have been undertaken internationally and synthesised into various systematic reviews to establish an evidence base for this model of care. This study sought to synthesise and critically evaluate this large body of evidence to inform clinicians, researchers and policy makers. Methods A systematic review of systematic reviews investigating the impact of telemonitoring interventions in the primary care management of CVD was conducted. Reviews were included if they explored primary care based telemonitoring in either CVD, heart failure or hypertension, were reported in the English language and were published between 2000 and 2013. Data was extracted by one reviewer and checked by a second reviewer using a standardised form. Two assessors then rated the quality of each review using the Overview Quality Assessment Questionnaire (OQAQ). Results Of the 13 included reviews, four focused on telemonitoring interventions in hypertension or CVD management and the remaining 9 reviews investigated telemonitoring in HF management. Seven reviews scored a five or above on the OQAQ evidencing good quality reviews. Findings suggest that telemonitoring can contribute to significant reductions in blood pressure, decreased all-cause and HF related hospitalisations, reduced all-cause mortality and improved quality of life. Telemonitoring was also demonstrated to reduce health care costs and appears acceptable to patients. Conclusion Telemonitoring has the potential to enhance primary care management of CVD by improving patient outcomes and reducing health costs. However, further research needs to explore the specific elements of telemonitoring interventions to determine the relative value of the various elements. Additionally, the ways in which telemonitoring care improves health outcomes needs to be further explored to understand the nature of these interventions. PMID:24606887

2014-01-01

131

A review of recent literature - nurse case managers in diabetes care: equivalent or better outcomes compared to primary care providers.  

PubMed

Primary care has changed remarkably with chronic disease burden growth. Nurse case managers assist with this chronic disease by providing if not significantly better care, than equivalent care to that provided by usual primary care providers. Chronic disease management requires patient-centered skills and tools, such as registries, panel management, review of home data, communicating with patients outside of face-to-face care, and coordinating multiple services. Evidence reviewed in this article demonstrates that registered nurse care managers (RNCM) perform many actions required for diabetes chronic disease management including initiation and titration of medications with similar or improved physiologic and patient satisfaction outcomes over usual care providers. Selection and training of the nurse case managers is of utmost importance for implementation of a successful chronic disease management program. Evidence based guidelines, algorithms, protocols, and adequate ongoing education and mentoring are generally cited as necessary support tools for the nurse case managers. PMID:24816751

Watts, Sharon A; Lucatorto, Michelle

2014-07-01

132

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.

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

2014-01-01

133

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

134

Concussion management for the adolescent patient: an algorithm for primary-care providers.  

PubMed

A sharp increase in the number of diagnosed concussions has been observed for the traditional adultathlete, as well as the young recreational athlete. An enhancing awareness and growing concern has been noted for the potentially larger number of concussions that go undiagnosed and the unknown capability for long-term complications associated with this injury. This increase in concussion awareness has appropriately led to an enhanced utilization of the health-care system for concussion evaluation and management. As is always the case in the practice of medicine, it is important for healthcare providers, from all points of entry in the healthcare system, to provide consistent management for the best outcomes for any disease process. Millions of sport-related concussions occur each year in the United States, placing a large demand on the healthcare system. Utilization of appropriate and congruent treatment plans during the medical discourse when transferring care of patients between providers is paramount. In the co-management model of care, subspecialists lend expertise to assist primary-care providers (PCPs) in gaining the core competencies necessary to provide appropriate levels of care for certain conditions. Increased use of co-management could make the health-care system more efficient and collaborative, leading to: increased access for patients, lower overall costs, and improved quality of care and health outcomes. Co-management allows patients and families to have access to the expert knowledge of subspecialist while receiving more of their care from their PCP, increasing their comfort and making treatment more convenient. The intent of this paper is to distribute an algorithm created by a multidisciplinary group of medical providers to provide a rational approach, congruent with the standard of care, for the primary-care provider to institute an individualized stepwise progression. PMID:23061213

Kostyun, Regina O; Hafeez, Imran

2012-09-01

135

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

136

Improving cellular therapy for primary immune deficiency diseases: Recognition, diagnosis, and management  

PubMed Central

More than 20 North American academic centers account for the majority of hematopoietic stem cell transplantation (HCT) procedures for primary immunodeficiency diseases (PIDs), with smaller numbers performed at additional sites. Given the importance of a timely diagnosis of these rare diseases and the diversity of practice sites, there is a need for guidance as to best practices in management of patients with PIDs before, during, and in follow-up for definitive treatment. In this conference report of immune deficiency experts and HCT physicians who care for patients with PIDs, we present expert guidance for (1) PID diagnoses that are indications for HCT, including severe combined immunodeficiency disease (SCID), combined immunodeficiency disease, and other non-SCID diseases; (2) the critical importance of a high degree of suspicion of the primary care physician and timeliness of diagnosis for PIDs; (3) the need for rapid referral to an immune deficiency expert, center with experience in HCT, or both for patients with PIDs; (4) medical management of a child with suspicion of SCID/combined immunodeficiency disease while confirming the diagnosis, including infectious disease management and workup; (5) the posttransplantation follow-up visit schedule; (6) antimicrobial prophylaxis after transplantation, including gamma globulin administration; and (7) important indications for return to the transplantation center after discharge. Finally, we discuss the role of high-quality databases in treatment of PIDs and HCTas an element of the infrastructure that will be needed for productive multicenter clinical trials in these rare diseases. PMID:20004776

Griffith, Linda M.; Cowan, Morton J.; Notarangelo, Luigi D.; Puck, Jennifer M.; Buckley, Rebecca H.; Candotti, Fabio; Conley, Mary Ellen; Fleisher, Thomas A.; Gaspar, H. Bobby; Kohn, Donald B.; Ochs, Hans D.; O'Reilly, Richard J.; Rizzo, J. Douglas; Roifman, Chaim M.; Small, Trudy N.; Shearer, William T.

2010-01-01

137

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

138

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

139

[Perioperative management of a patient with primary adrenal insufficiency who underwent general anesthesia twice].  

PubMed

Perioperative corticosteroid supplementation is generally applied in patients with primary adrenal insufficiency or treated with long-term corticosteroid. Currently, appropriate dose and timing of corticosteroid were revised. A 77-year-old woman with primary adrenal insufficiency underwent transurethral resection of bladder tumor (operation 1) and mastectomy (operation 2). In both operations, we supplied stress dose of hydrocortisone on the operative day (100 mg x day(-1) of hydrocortisone for operation 1 or 300 mg x day(-1) of hydrocortisone for operation 2) and decreased gradually in one day (operation 1) or in three days (operation 2), respectively. No remarkable symptoms of adrenal deficiency and side effects of corticosteroid during perioperative period were observed. According to current recommendation, the dose of corticosteroid we used could be smaller. Perioperative management of adrenal insufficiency is still controversial, and further investigation is necessary. PMID:24783617

Yamamoto, Natsuhiro; Kojima, Keisuke; Naito, Rina; Sumitomo, Masakazu

2014-04-01

140

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

Microsoft Academic Search

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

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

2007-01-01

141

Cost-Effectiveness of Enhancing Primary Care Depression Management on an Ongoing Basis  

PubMed Central

PURPOSE Although potentially costly, enhancing primary care depression management on an ongoing basis results in substantial long-term treatment effectiveness. The purpose of this article is to compare the cost-effectiveness of this approach with that of usual care. METHODS The study was conducted in 12 community primary care practices randomized to enhanced or usual care after stratification by baseline practice patterns. Practices assigned to enhanced care encouraged depressed patients to engage in active treatment, using practice nurses to provide regularly scheduled care management during the course of 24 months. We analyze outcomes for 211 adults (73.4% of potential eligible patients) beginning a new treatment episode for major depression determined by previsit screening. Outcomes included blinded estimates of days free of depression impairment as well as health care costs for 2 years. RESULTS Enhanced care significantly increased the number of days free of depression impairment for 2 years when compared with usual care (647.6 days vs 588.2 days, P <.01). The incremental cost-effectiveness ratio for enhanced care ranged from $9,592 to $14,306 per quality-adjusted life-year (QALY). The number of incremental days free of depression impairment increased between the first year and the second year (23.0 vs 36.4, respectively, P <.001) while incremental health plan costs decreased significantly ($568 vs -$12, P <.001). CONCLUSIONS Enhancing primary care depression management on an ongoing basis should be considered for adoption by policy and health plan leaders. PMID:15671185

Rost, Kathryn; Pyne, Jeffrey M.; Dickinson, L. Miriam; LoSasso, Anthony T.

2005-01-01

142

Systemic Rituximab Immunotherapy in the Management of Primary Ocular Adnexal Lymphoma: Single Institution Experience.  

PubMed

Abstract Purpose: To evaluate the efficacy of systemic rituximab immunotherapy in the management of primary ocular adnexal lymphomas (OAL). Materials and methods: Clinical records of 10 consecutive patients (11 eyes) with biopsy-proven OAL managed with systemic anti-CD20 monoclonal antibody (rituximab; 375?mg/m(2) intravenously once every three weeks for 6-8 cycles) between June 2008-March 2013 were evaluated retrospectively. Orbital magnetic resonance imaging and positron emission tomography were performed to evaluate any orbital and systemic involvement, respectively. Clinical response was classified as complete or partial. Results: The age of patients ranged between 27-85 (median, 55) years. Nine patients (90%) presented with unilateral and one (10%) with bilateral conjunctival involvement. Orbit was affected in 4 patients (40%), one of which had also choroidal involvement (10%). None of the patients had systemic involvement at initial presentation. All patients received an average of 7 cycles (range, 6-8) of systemic immunotherapy. After a median follow-up of 31 months (range, 10-61 months), complete response without recurrence could be achieved in 4 eyes (36%) with rituximab monotherapy. No systemic or ocular side effects were observed in any patient. Additional radiotherapy was required in 6 patients (7 eyes; 64%) with partial response or recurrence. Conclusions: Complete regression of primary OALs without recurrence was observed in about one-third of eyes after systemic rituximab monotherapy. Adjunctive radiotherapy was required in remaining two-thirds of the cases to achieve complete response. Thus, considering the balance between high rate of local control and potential ocular complications of radiotherapy, systemic rituximab can be considered as a first-line therapeutic option in the management of primary OAL. PMID:25247376

Tuncer, Samuray; Tany?ld?z, Burak; Basaran, Mert; Buyukbabani, Nesimi; Dogan, Oner

2014-09-23

143

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

144

Management of the clinically node-negative axilla in primary and locally recurrent breast cancer.  

PubMed

For patients with primary breast cancer, nodal status remains a key determinant for overall prognosis. Sentinel lymph node biopsy (SLNB) has become standard care for staging patients who have clinically node-negative disease. However, a new dilemma has arisen: how to manage the clinically negative axilla in patients with ipsilateral breast tumor recurrences (IBTRs). Are outcomes in these patients improved with repeat SLNB? Although observational studies suggest SLNB is feasible in patients with IBTR and a clinically node-negative axilla, the overall impact on morality and local recurrence is not yet known as no randomized trials have addressed this issue. PMID:24882345

McGinity, Ashley C; Lautner, Meeghan A; Jatoi, Ismail

2014-07-01

145

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

PubMed Central

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

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

1998-01-01

146

Performance of newly implemented Environmental Management Systems in primary schools in South Africa.  

PubMed

Quantitative results from Environmental Management Systems (EMS) at primary schools have rarely been examined in literature. This paper presents the monitoring results of environmental care in 39 primary schools in Northern South Africa. During 2 years, after the EMS was implemented in the curriculum and in the school's management, the progress of environmental performances of the participating schools has been measured, by means of detailed questionnaires, related to four environmental aspects: water, waste, energy and greening. At the beginning of the project, 50% of the schools performed well on water-related environmental actions. Two years later it was 76%. For waste-related activities the improvement was even stronger: from 50% to 100%. The environmental performances of the schools improved also for greening-related actions, from 50% at the start of the project to 64% two years later. Only energy-related activities did not improve significantly with only 24% of all schools performing well at the end of the survey period. In general, the introduction of an EMS succeeded in an improvement of the overall environmental performances of the schools, but cost-intensive activities were less successful than others. PMID:20034728

Hens, Luc; Wiedemann, Torsten; Raath, Schalk; Stone, Riana; Renders, Paul; Craenhals, Eric

2010-01-01

147

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

148

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

PubMed Central

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

2013-01-01

149

Management of visceral leishmaniasis in rural primary health care services in Bihar, India  

PubMed Central

Summary Introduction In 2005 a visceral leishmaniasis (VL) elimination initiative was launched on the Indian subcontinent, with early diagnosis based on a rapid diagnostic test and treatment with the oral drug miltefosine as its main strategy. Several recent studies have signaled underreporting of VL cases in the region. Information on treatment outcomes is scanty. We conducted a study to document VL case management by the primary health care services in India. Methods We took a random sample of all VL patients registered in rural PHC facilities of Muzaffarpur district, Bihar, India during 2008. Patients were traced at home for an interview and their records were reviewed. We recorded patient and doctor delay, treatment regimens, treatment outcomes and costs incurred by patients. Results We could review records of all 150 patients sampled and interview 139 patients or their guardian. Most patients (81%) had first presented to unqualified practitioners; median delay before reaching the appropriate primary healthcare facility was 40 days (IQR 31-59 days). Existing networks of village health workers were under utilized. Forty eight percent of VL patients were treated with antimonials; 40% of those needed a second treatment course. Median direct expenditure by patients was 4000 rupees per episode (IQR 2695 – 5563 rupees), equivalent to almost two months of household income. Conclusion In 2008 there were still critical flaws in VL case management in the primary health care services in Bihar: obsolete use of antimonials with high failure rates and long patient delay. To meet the target of the VL elimination, more active case detection strategies are needed, and the existing village health worker networks could be more involved. Costs to patients remain an obstacle to early case finding. PMID:20591081

Hasker, E; Singh, SP; Malaviya, P; Singh, RP; Shankar, R; Boelaert, M; Sundar, S

2010-01-01

150

The Development and Evaluation of an Integrated Electronic Prescribing and Drug Management System for Primary Care  

PubMed Central

Objective: To develop and evaluate the acceptability and use of an integrated electronic prescribing and drug management system (MOXXI) for primary care physicians. Design: A 20-month follow-up study of MOXXI (Medical Office of the XXIst Century) implementation in 28 primary care physicians and 13,515 consenting patients. Measurement: MOXXI was developed to enhance patient safety by integrating patient demographics, retrieving active drugs from pharmacy systems, generating an automated problem list, and providing electronic prescription, stop order, automated prescribing problem alerts, and compliance monitoring functions. Evaluation of technical performance, acceptability, and use was conducted using audit trails, questionnaires, standardized tasks, and information from comprehensive health insurance databases. Results: Perceived improvements in continuity of care and professional autonomy were associated with physicians' expected use of MOXXI. Physician speed in using MOXXI improved substantially in the first three months; however, only the represcribing function was faster using MOXXI than by handwritten prescription. Physicians wrote electronic prescriptions in 36.9 per 100 visits and reviewed the patient's drug profile in 12.6 per 100 visits. Physicians rated printed prescriptions, the current drug list, and the represcribing function as the most beneficial aspects of the system. Physicians were more likely to use the drug profile for patients who used more medication, made more emergency department visits, had more prescribing physicians, and lower continuity of care. Conclusion: Primary care physicians believed an integrated electronic prescribing and drug management system would improve continuity of care, and they were more likely to use the system for patients with more complex, fragmented care. PMID:16357357

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

2006-01-01

151

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

PubMed

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

Aitken, K L; Hawkins, M A

2014-09-01

152

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

PubMed Central

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

Atlas, Steven J; Deyo, Richard A

2001-01-01

153

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

154

School Choice: To What End?  

ERIC Educational Resources Information Center

Debunks two fantasies: the feasibility of a free-market educational system and the idea that greater choice automatically means better schools. Public education is too labor-intensive and undercapitalized to be profitable. Communities need "skunk works" schools of choice to do research and development and smaller, collaboratively managed schools…

Wagner, Tony

1996-01-01

155

Management of an intruded primary central incisor with a natural crown under general anesthesia  

PubMed Central

Tooth intrusion is the most common trauma during early infancy. Primary maxillary central incisors are the most affected teeth. There are a few treatment approaches which depend upon the severity of the trauma, and the treatment must be managed professionally. In this case report, a 3-year-old girl with a history of trauma 40 days before referring to our pediatric clinic is presented. Deciduous maxillary right central incisor was intruded through labial and alveolar socket and completely covered with soft tissue. The intruded deciduous incisor tooth was surgically extracted and impression was taken under general anesthesia. The removable partial prosthesis was completed by using the patient's own extracted tooth. Using natural crown on removable prosthesis gives psychological satisfaction to the patient and his/her family, and can be better tolerated since its shape, size, and color are exactly in harmony. PMID:24966781

Altunsoy, Mustafa; Bilgin, Mehmet Selim

2014-01-01

156

Management of an intruded primary central incisor with a natural crown under general anesthesia.  

PubMed

Tooth intrusion is the most common trauma during early infancy. Primary maxillary central incisors are the most affected teeth. There are a few treatment approaches which depend upon the severity of the trauma, and the treatment must be managed professionally. In this case report, a 3-year-old girl with a history of trauma 40 days before referring to our pediatric clinic is presented. Deciduous maxillary right central incisor was intruded through labial and alveolar socket and completely covered with soft tissue. The intruded deciduous incisor tooth was surgically extracted and impression was taken under general anesthesia. The removable partial prosthesis was completed by using the patient's own extracted tooth. Using natural crown on removable prosthesis gives psychological satisfaction to the patient and his/her family, and can be better tolerated since its shape, size, and color are exactly in harmony. PMID:24966781

Altunsoy, Mustafa; Bilgin, Mehmet Selim

2014-04-01

157

Coronary thrombus in patients undergoing primary PCI for STEMI: Prognostic significance and management  

PubMed Central

Acute ST-elevation myocardial infarction (STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator, which is mostly proportional to their size and composition. Particularly, intracoronary thrombi impair both epicardial blood flow and myocardial perfusion, by occluding major coronary arteries and causing distal embolization, respectively. Thus, although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting, the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients, by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used in the setting of STEMI to manage thrombotic lesions. PMID:24976910

Vecchio, Sabine; Varani, Elisabetta; Chechi, Tania; Balducelli, Marco; Vecchi, Giuseppe; Aquilina, Matteo; Ricci Lucchi, Giulia; Dal Monte, Alessandro; Margheri, Massimo

2014-01-01

158

Vincent's Choice  

Microsoft Academic Search

Official publication to accompany the important exhibition Vincent's Choice, Van Gogh's 'musee imaginaire' at the Van Gogh Museum, Amsterdam marking the 150th anniversary of the artist's birth. The exhibition runs from 14th February to 15th June 2003.Thanks to van Gogh's correspondence, it has been possible to identify the works he knew and admired. The exhibition will assemble as many as

Chris Stolwijk

2003-01-01

159

Development and application of an electronic health record information extraction tool to assess quality of pain management in primary care.  

PubMed

Chronic pain is one of the most common presenting problems in primary care. Standards and guidelines have been developed for managing chronic pain, but it is unclear whether primary care providers routinely engage in guideline-concordant care. The purpose of this study is to develop a tool for extracting information about the quality of pain care in the primary care setting. Quality indicators were developed through review of the literature, input from an interdisciplinary panel of pain experts, and pilot testing. A comprehensive coding manual was developed, and inter-rater reliability was established. The final tool consists of 12 dichotomously scored indicators assessing quality and documentation of pain care in three domains: assessment, treatment, and reassessment. Presence of indicators varied widely. The tool is reliable and can be utilized to gather valuable information about pain management in the primary care setting. PMID:24904702

Dorflinger, Lindsey M; Gilliam, Wesley P; Lee, Allison W; Kerns, Robert D

2014-06-01

160

One Year On: First-Year Primary Teachers' Perceptions of Preparedness to Manage Misbehaviour and Their Confidence in the Strategies They Use  

ERIC Educational Resources Information Center

This article reports the findings of a one-year follow-up study of Australian beginning primary teachers' perceived preparedness to manage a variety of problematic student behaviours, and their confidence and use of behaviour management strategies based on their preservice coursework in classroom behaviour management. A total of 216 primary

O'Neill, Sue; Stephenson, Jennifer

2013-01-01

161

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

Microsoft Academic Search

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

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

2006-01-01

162

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

ERIC Educational Resources Information Center

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

Harma, Joanna

2010-01-01

163

Pharmacotherapeutic management of chronic noncancer pain in primary care: lessons for pharmacists  

PubMed Central

Purpose Describe the pharmacotherapeutic management of primary-care patients with chronic noncancer pain, assess their satisfaction with pain treatment, and identify the determinants of their satisfaction. Methods A cohort study was conducted in Quebec (Canada). Patients reporting chronic noncancer pain with an average pain intensity of at least 4 on a 0–10 scale (10= worst possible pain) and having an active analgesic prescription from a primary-care physician were recruited. They completed a telephone interview and a self-administered questionnaire to document their pain, emotional well-being, satisfaction with treatment, and barriers/beliefs/attitudes about pain and its treatment. Information on pharmacotherapy was based on an administrative provincial database and pharmacies’ charts. Determinants of patients’ satisfaction were identified using multivariate linear regression models. Results Four hundred and eighty six patients participated. Their mean age was 58.4 years and they had had pain for a mean of 11.7 years (standard deviation, ±11.1) at an average pain intensity of 6.5 in the past week. Although 90% reported adverse gastrointestinal effects, 36.4% and 54.4% of these patients took no over-the-counter or prescribed medication for constipation or nausea, respectively. On a scale from 0–100, the mean overall satisfaction score was 64.7 (95% confidence interval [CI] =63.5–65.9). Patient satisfaction was low, particularly regarding the “information about pain and its treatment” (mean 50.6; 95% CI =47.6–53.7) and “treatment efficacy” (mean 53.6; 95% CI =51.5–55.6) subscales. The overall treatment satisfaction score decreased with more pain disability, probable depression and anxiety, more barriers to pain treatment, higher incidence of nausea, and use of over-the-counter analgesics. Conclusion In primary care, patients’ level of satisfaction with their pain treatment is not optimal. This study underlines how the expanded scope of practice of community pharmacists may allow them to play a pivotal role in providing information, discussing barriers to pain treatment, and monitoring pain disability, and by appropriately managing pharmacotherapy to optimize effectiveness while minimizing adverse effects. PMID:24711711

Jouini, Ghaya; Choinière, Manon; Martin, Elisabeth; Perreault, Sylvie; Berbiche, Djamal; Lussier, David; Hudon, Eveline; Lalonde, Lyne

2014-01-01

164

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

165

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.

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

2014-01-01

166

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

PubMed Central

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

Friedman, Benjamin Wolkin; Grosberg, Brian Mitchell

2009-01-01

167

Views of patients about sickle cell disease management in primary care: a questionnaire-based pilot study  

PubMed Central

Objectives To determine how patients with sickle cell disease (SCD) perceive the quality of care that they receive from their primary healthcare providers. Design A questionnaire-based pilot study was used to elicit the views of patients about the quality of care they have been receiving from their primary healthcare providers and what they thought was the role of primary care in SCD management. Setting Sickle Cell Society and Sickle Cell and Thalassaemia Centre, in the London Borough of Brent. Participants One hundred questionnaires were distributed to potential participants with SCD between November 2010 and July 2011 of which 40 participants responded. Main outcome measures Analysis of 40 patient questionnaires collected over a nine-month period. Results Most patients are generally not satisfied with the quality of care that they are receiving from their primary healthcare providers for SCD. Most do not make use of general practitioner (GP) services for management of their SCD. Collecting prescriptions was the reason most cited for visiting the GP. Conclusion GPs could help improve the day-to-day management of patients with SCD. This could be facilitated by local quality improvement schemes in areas with high disease prevalence. The results of the survey have been used to help develop a GP education intervention and a local enhanced service to support primary healthcare clinicians with SCD's ongoing management. PMID:23323196

AlJuburi, G; Okoye, O; Majeed, A; Knight, Y; Green, SA; Banarsee, R; Nkohkwo, A; Ojeer, P; Ndive, C; Oni, L; Phekoo, KJ

2012-01-01

168

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

169

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

PubMed Central

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

2014-01-01

170

Cell shape and TGF-beta signaling define the choice of lineage during in vitro differentiation of mouse primary hepatic precursors.  

PubMed

Cellular differentiation relies on both physical and chemical environmental cues. The bipotential mouse embryonic liver (BMEL) cells are early progenitors of liver epithelial cells with an apparently infinite proliferative potential. These cells, which remain undifferentiated in a monolayer culture, differentiate upon release from geometrical constraints imposed by growth on a stiff plastic plate. In a complex three dimensional environment of a Matrigel extracellular matrix, BMEL cells form two types of polarized organoids of distinct morphologies: cyst-like structures suggesting cholangiocyte-type organization or complex organoids, reminiscent of liver parenchyma and associated with acquisition of hepatocyte-specific phenotypic markers. The choice of the in vitro differentiation lineage is governed by Transforming Growth Factor-beta (TGF-beta) signaling. Our results suggest that morphological cues initiate the differentiation of early hepatic precursors and confirm the inhibitory role of TGF-beta on hepatocytic lineage differentiation. PMID:20458741

Akkari, Leila; Haouzi, Delphine; Binamé, Fabien; Floc'h, Nicolas; Lassus, Patrice; Baghdiguian, Stephen; Hibner, Urszula

2010-10-01

171

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

172

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

PubMed Central

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

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

2009-01-01

173

Management of firearm injuries to the facial skeleton: Outcomes from early primary intervention  

PubMed Central

Aim: Treatment of maxillofacial firearm injuries is still controversial with regard to timing of management. We postulate that not all maxillofacial firearm injuries need be delayed and that many may be treated early. To this end, a 19-year retrospective study was undertaken seeking to evaluate patients treated for firearm injuries to the facial skeleton at our center. The criteria which dictated when to operate are presented as are the results, benefits, and outcomes of the patients treated acutely. Patients and Methods: From 1991 to 2010, 51 patients with maxillofacial firearm injuries were treated; 30/51 patients received early primary repair and simultaneous open reduction for facial fractures. These underwent primary debridement and arch bar placement followed by open reduction of fractures (with or without osteosynthesis) and primary wound closure. Patient age ranged from 8 to 50 years, with a mean age of 24.4±7.8 years. Primary early intervention was done when there was no gross infection, no bone comminution or extensive soft tissue avulsion (precluding wound coverage), and when general health, concomitant injuries requiring more urgent attention or those requiring major grafts did not preclude this. Primary intervention included extensive oral and extraoral irrigation (dilute hydrogen peroxide + povidone iodide), debridement of the facial wound, removal of floating fragments (teeth particles, debris, and shell fragments) precluding viable bone within the wound, access to the bone, finding the scattered bone segments and putting them back into place to restore bone continuity. Projectiles beyond the wound were not searched for. Tooth roots within the alveolus were not extracted at this stage. In addition to arch bars, titanium miniplates or wire osteosynthesis was done when necessary. All wounds were closed primarily (using local advancement flaps when necessary) and all patients were placed on antibiotics (cephalosporin + aminoglycoside or ciprofloxacin) upon admission. Results: Of 51 patients, 30 were treated acutely and 21 warranted delayed intervention. In the acute-treated group, 6/30 patients had minor complications such as scarring and wound discharge. Early intervention for firearm wounds to the face was effective for facial firearm injuries in selected cases. This resulted in restoration of occlusion and continuity of the jaw, fixation of luxated teeth, early return of function, prevention of segment displacement and tissue contracture, less scarring, and decreased the need for major bone graft reconstruction later on. Those treated secondarily were only debrided and had arch bars placed. Definitive treatment of hard and soft tissue management was rendered in another subsequent operation. Bone reduction was more difficult because of scarring, and displacement of remaining segments. No significant differences were noted in terms of infection or other major complications. Conclusions: Firearm wounds were associated with a high incidence of maxillofacial injuries requiring surgical intervention. Many may be treated definitively and acutely with procedures designed to repair both bone and soft tissue injuries simultaneously aiming to restore bony continuity, esthetics and function using the tissues at hand (especially in the mandible). Early treatment is advocated because the course of healing is not disrupted with another subsequent operation (in the same wound) and because it may decrease hospital stay without increasing patient morbidity in selected patients. Patients with residual defects can be treated later as out-patients. PMID:21769208

Motamedi, Mohammad Hosein Kalantar

2011-01-01

174

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

175

The Humelock Hemiarthoplasty Device for Both Primary and Failed Management of Proximal Humerus Fractures: A Case Series  

PubMed Central

Fractures of the proximal humerus account for 4-5% of all fractures. Managing proximal humerus fractures operatively and non-operatively have their respective complications both short- and long-term. We present our experience using the Humelock hemiarthoplasty device for both primary and failed management of proximal humeral fractures. We present four different examples from ten cases that include a failure of internal fixation, a failure of intramedullary nailing, a complex case in a patient with multiple co-morbidities, and a failure of nonoperative management. The patients in our series had multiple injuries and the device allowed early mobilization and produced good results. We suggest that this device has a role in the failure of primary and secondary management of proximal humeral fractures in a district general hospital setting.

A, Ikram; J, Singh; S, Jagarnauth; W.S, Khan; J, Hambidge

2015-01-01

176

Hypothetical Intertemporal Choice and Real Economic Behavior: Delay Discounting Predicts Voucher Redemptions During Contingency-Management Procedures  

Microsoft Academic Search

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

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

2010-01-01

177

Differential Effect of Low-Dose Aspirin for Primary Prevention of Atherosclerotic Events in Diabetes Management  

PubMed Central

OBJECTIVE Recent reports showed that low-dose aspirin was ineffective in the primary prevention of cardiovascular events in diabetic patients overall. We hypothesized that low-dose aspirin would be beneficial in patients receiving insulin therapy, as a high-risk group. RESEARCH DESIGN AND METHODS This study is a subanalysis of the Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial—a randomized, controlled, open-label trial. We randomly assigned 2,539 patients with type 2 diabetes and no previous cardiovascular disease to the low-dose aspirin group (81 or 100 mg daily) or to the no-aspirin group. The median follow-up period was 4.4 years. We investigated the effect of low-dose aspirin on preventing atherosclerotic events in groups receiving different diabetes management. RESULTS At baseline, 326 patients were treated with insulin, 1,750 with oral hypoglycemic agents (OHAs), and 463 with diet alone. The insulin group had the longest history of diabetes, the worst glycemic control, and the highest prevalence of diabetic microangiopathies. The diet-alone group had the opposite characteristics. The incidence of atherosclerotic events was 26.6, 14.6, and 10.4 cases per 1,000 person-years in the insulin, OHA, and diet-alone groups, respectively. In the insulin and OHA groups, low-dose aspirin did not affect atherosclerotic events (insulin: hazard ratio [HR] 1.19 [95% CI 0.60?2.40]; OHA: HR 0.84 [0.57?1.24]). In the diet-alone group, low-dose aspirin significantly reduced atherosclerotic events, despite the lowest event rates (HR 0.21 [0.05?0.64]). CONCLUSIONS Low-dose aspirin reduced atherosclerotic events predominantly in the diet-alone group and not in the insulin or OHA groups. PMID:21515838

Okada, Sadanori; Morimoto, Takeshi; Ogawa, Hisao; Kanauchi, Masao; Nakayama, Masafumi; Uemura, Shiro; Doi, Naofumi; Jinnouchi, Hideaki; Waki, Masako; Soejima, Hirofumi; Sakuma, Mio; Saito, Yoshihiko

2011-01-01

178

Management of Chlamydia trachomatis genital infections: reported practices of primary care physicians.  

PubMed Central

OBJECTIVE: To determine the knowledge of primary care physicians about Chlamydia trachomatis genital infection and its management. DESIGN: Self-administered questionnaire comprising direct questions and hypothetical cases. PARTICIPANTS: All 108 general and family practitioners on the north shore of Vancouver were sent the questionnaire; 79 (73%) responded. RESULTS: There was a reasonable level of knowledge in many areas, particularly among the physicians who had graduated more recently than the others. Virtually all stated that they have access to chlamydial diagnostic testing, and most indicated that they test for chlamydial infection at least occasionally. However, many of the respondents failed to consider that youths in their practice may be sexually active, and only 28% knew that women 15 to 19 years of age have the highest reported rates of chlamydial infection. Many of the physicians were confused about syndromes that are or are not associated with C. trachomatis infection; this indicated the possibility of inappropriate testing and treatment decisions. If they had to test for C. trachomatis in a prepubescent girl 34% reported that they would obtain a specimen from the endocervix, a technique that is inappropriately invasive. When presented with a positive test result many of the respondents failed to consider the possibility of a false-positive result. Fortunately all of the physicians were well informed about correct treatment regimens for C. trachomatis infection, although many did not realize how effective they really are. In the case of a young man with suspected or proven gonorrhea or a young female outpatient with pelvic inflammatory disease, only 19% and 20% respectively stated that they would prescribe a regimen appropriate for both penicillinase-producing Neisseria gonorrhoeae and C. trachomatis. Many of the respondents had not heard of management guidelines, and fewer still reported that they consult them. CONCLUSIONS: Despite the availability of several sets of guidelines there appear to be important gaps in the knowledge and practice of many primary care physicians with respect to genital infections. Since the preparation of guidelines is time-consuming and expensive, further work should be done to evaluate their impact and to address their limitations. PMID:1562944

McDougall, L; Mathias, R G; O'Connor, B A; Bowie, W R

1992-01-01

179

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

Microsoft Academic Search

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

Peter Griffiths; Jill Maben; Trevor Murrells

2011-01-01

180

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

PubMed

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

Cueto-Manzano, Alfonso M; Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura

2013-05-01

181

Energy-Smart Building Choices: How School Facilities Managers and Business Officials Are Reducing Operating Costs and Saving Money  

SciTech Connect

Most K-12 schools could save 25% of their energy costs by being smart about energy. Nationwide, the savings potential is $6 billion. While improving energy use in buildings and busses, schools are likely to create better places for teaching and learning, with better lighting, temperature control, acoustics, and air quality. This brochure, targeted to school facilities managers and business officials, describes how schools can become more energy efficient.

Energy Smart Schools Team

2001-08-06

182

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

PubMed

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

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

2013-01-01

183

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition.  

PubMed

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome. PMID:22583659

Malmgren, Barbro; Andreasen, Jens O; Flores, Marie Therese; Robertson, Agneta; DiAngelis, Anthony J; Andersson, Lars; Cavalleri, Giacomo; Cohenca, Nestor; Day, Peter; Hicks, Morris Lamar; Malmgren, Olle; Moule, Alex J; Onetto, Juan; Tsukiboshi, Mitsuhiro

2012-06-01

184

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

PubMed Central

Background As a major public health issue in China and worldwide, late-life depression is associated with physical limitations, greater functional impairment, increased utilization and cost of health care, and suicide. Like other chronic diseases in elders such as hypertension and diabetes, depression is a chronic disease that the new National Health Policy of China indicates should be managed in primary care settings. Collaborative care, linking primary and mental health specialty care, has been shown to be effective for the treatment of late-life depression in primary care settings in Western countries. The primary aim of this project is to implement a depression care management (DCM) intervention, and examine its effectiveness on the depressive symptoms of older patients in Chinese primary care settings. Methods/Design The trial is a multi-site, primary clinic based randomized controlled trial design in Hangzhou, China. Sixteen primary care clinics will be enrolled in and randomly assigned to deliver either DCM or care as usual (CAU) (8 clinics each) to 320 patients (aged ? 60 years) with major depression (20/clinic; n = 160 in each treatment condition). In the DCM arm, primary care physicians (PCPs) will prescribe 16 weeks of antidepressant medication according to the treatment guideline protocol. Care managers monitor the progress of treatment and side effects, educate patients/family, and facilitate communication between providers; psychiatrists will provide weekly group psychiatric consultation and CM supervision. Patients in both DCM and CAU arms will be assessed by clinical research coordinators at baseline, 4, 8, 12, 18, and 24 months. Depressive symptoms, functional status, treatment stigma and clients' satisfaction will be used to assess patients' outcomes; and clinic practices, attitudes/knowledge, and satisfaction will be providers' outcomes. Discussion This will be the first trial of the effectiveness of a collaborative care intervention aiming to the management of late-life depression in China primary care. If effective, its finding will have relevance to policy makers who wish to scale up DCM treatments for late-life depression in national wide primary care across China. Study Registration The DCM project is registered through the National Institutes of Health sponsored by clinical trials registry and has been assigned the identifier: NCT01287494 PMID:21569445

2011-01-01

185

Defining physicians' readiness to screen and manage intimate partner violence in Greek primary care settings.  

PubMed

The current article aims to translate the PREMIS (Physician Readiness to Manage Intimate Partner Violence) survey into the Greek language and test its validity and reliability in a sample of primary care physicians. The validation study was conducted in 2010 and involved all the general practitioners serving two adjacent prefectures of Greece (n = 80). Maximum-likelihood factor analysis (MLF) was used to extract key survey factors. The instrument was further assessed for the following psychometric properties: (a) scale reliability, (b) item-specific reliability, (c) test-retest reliability, (d) scale construct validity, and (e) internal predictive validity. The MLF analysis of 23 opinion items revealed a seven-factor solution (preparation, constraint, workplace issues, screening, self-efficacy, alcohol/drugs, victim understanding), which was statistically sound (p = .293). Most of the newly derived scales displayed satisfactory internal consistency (? ? .60), high item-specific reliability, strong construct, and internal predictive validity (F = 2.82; p = .004), and high repeatability when retested with 20 individuals (intraclass correlation coefficient [ICC] > .70). The tool was found appropriate to facilitate the identification of competence deficits and the evaluation of training initiatives. PMID:22158688

Papadakaki, Maria; Prokopiadou, Dimitra; Petridou, Eleni; Kogevinas, Manolis; Lionis, Christos

2012-06-01

186

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

PubMed

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 São 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. PMID:23122204

Moreira, A M M; Günther, W M R

2013-01-01

187

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

188

HPV testing is an efficient management choice for women with inadequate liquid-based cytology in cervical cancer screening.  

PubMed

This study compares colposcopy referrals of 2 management strategies: oncogenic human papillomavirus (HPV)-DNA testing (Hybrid Capture 2 assay, Qiagen, Germantown, MD) and repeat cytology. In the New Technology in Cervical Cancer Trial, 22,708 subjects were randomly assigned to undergo both HPV and liquid-based cytologic testing. Women aged 35 to 60 years old with unsatisfactory cytologic findings were directly referred for colposcopy if the HPV test result was positive, and were referred for repeat cytologic examination if the HPV test result was negative; women aged 25 to 35 years old were referred for repeat cytologic examination independent of HPV test results. A positive or a second unsatisfactory cytologic examination referred women for colposcopy. Five hundred sixty women had unsatisfactory cytologic findings. Colposcopy referral was not significant and slightly higher with HPV testing than repeat cytologic test (9.8% vs 6.8%, P = .11). When cytologic testing was repeated 36.8% were unavailable for follow-up and most of the colposcopies were performed in HPV-negative women. For unsatisfactory cytologic findings, HPV triage is a more logical and efficient management strategy than a repeat cytologic test. PMID:22706859

Giorgi Rossi, Paolo; Carozzi, Francesca; Collina, Guido; Confortini, Massimo; Dalla Palma, Paolo; De Lillo, Margherita; Del Mistro, Annarosa; Ghiringhello, Bruno; Gillio-Tos, Anna; Maioli, Patrizia; Pellegrini, Antonella; Schiboni, Maria Luisa; Segnan, Nereo; Zaffina, Leandra M T; Zorzi, Manuel; Ronco, Guglielmo

2012-07-01

189

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

190

Educating primary care physicians in the management of Alzheimer's disease: using practice guidelines to set quality benchmarks.  

PubMed

This paper presents a strategy for training primary care physicians in the identification, diagnosis and management of Alzheimer's disease and related disorders. The strategy uses evidence-based practice guidelines to establish quality benchmarks and then provides training and other interventions to improve the quality of care received by these patients. The three projects described in this paper assumed that training of primary care physicians alone would not be sufficient to achieve the quality benchmarks derived from guidelines. The projects used creative training strategies supplemented by provider "tool kits", provider checklists, educational detailing, and endorsement from organizational leadership to reinforce what the primary care providers learned in educational sessions. Each project also implemented a system of dementia care management to "wrap around" traditional primary care to ensure that quality benchmarks would be achieved. Outcomes of two completed studies support the premise that it is possible to improve quality of dementia care through physician education that occurs in association with a coordinated system of dementia care management and in collaboration with community agencies to access guideline-recommended social services. PMID:19288963

Cherry, Debra L; Hahn, Carol; Vickrey, Barbara G

2009-04-01

191

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

PubMed

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

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

2014-11-01

192

Long-Term Opioid Contract Use for Chronic Pain Management in Primary Care Practice. A Five Year Experience  

Microsoft Academic Search

\\u000a Background  The use of opioid medications to manage chronic pain is complex and challenging, especially in primary care settings. Medication\\u000a contracts are increasingly being used to monitor patient adherence, but little is known about the long-term outcomes of such\\u000a contracts.\\u000a \\u000a \\u000a \\u000a Objective  To describe the long-term outcomes of a medication contract agreement for patients receiving opioid medications in a primary\\u000a care setting.\\u000a \\u000a \\u000a \\u000a Design  Retrospective

Jaishree Hariharan; Geoffrey C. Lamb; Joan M. Neuner

2007-01-01

193

Iron chelation therapy with deferasirox in the management of iron overload in primary myelofibrosis.  

PubMed

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

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

2014-01-01

194

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

PubMed Central

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

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

2014-01-01

195

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

196

Enlightened Choices  

ERIC Educational Resources Information Center

In this article, the author has taken a little excursion back in time to illustrate the importance of two vital concepts in the minds of smart IT project managers, when they begin to consider smart-classroom installations and implementations, and the technologies they will choose. Those watchwords are: "standardization" and "boring." Certainly,…

Craig, Will

2006-01-01

197

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

198

Managing patients on bisphosphonates: The practice of primary care dentists before and after the publication of national guidance.  

PubMed

Background In April 2011 the Scottish Dental Clinical Effectiveness Programme published the Oral health management of patients prescribed bisphosphonates guidance document. The aims of this study were to examine whether dentists' practice and beliefs changed after guidance publication to determine whether a knowledge translation intervention was required, and to inform its development.Methods Three postal surveys sent to three independent, random samples of dentists throughout Scotland pre- and post-guidance publication. The questionnaire, framed using the theoretical domains framework (TDF), assessed current practice and beliefs relating to recommended management of patients on bisphosphonates.Results The results (N = 420) suggest that any significant impact the guidance may have had on the recommended management of patients on bisphosphonates by primary care dentists, had reached its peak ten months post publication. A more positive attitude, greater perceived ability, and greater motivation were all associated with significantly more performing of all recommended behaviours at every time point.Conclusions Prior to this study, there was little available information about how patients on bisphosphonates were being managed in primary dental care, or what beliefs may be influencing management decisions. This study was able to identify levels of compliance pre- and post-guidance publication and determine that further intervention was necessary to enable sustained uptake of recommendations. Using the TDF to identify beliefs associated with best practice made it possible to suggest theoretically informed strategies for service improvement. The next step is to test the intervention(s) in a randomised controlled trial. PMID:25525031

Bonetti, D L; Clarkson, J E; Elouafkaoui, P; Stirling, D A; Young, L; Templeton, A R

2014-12-19

199

Summary of: Managing patients on bisphosphonates: The practice of primary care dentists before and after the publication of national guidance.  

PubMed

Background In April 2011 the Scottish Dental Clinical Effectiveness Programme published the Oral health management of patients prescribed bisphosphonates guidance document. The aims of this study were to examine whether dentists' practice and beliefs changed after guidance publication to determine whether a knowledge translation intervention was required, and to inform its development.Methods Three postal surveys sent to three independent, random samples of dentists throughout Scotland pre- and post-guidance publication. The questionnaire, framed using the theoretical domains framework (TDF), assessed current practice and beliefs relating to recommended management of patients on bisphosphonates.Results The results (N = 420) suggest that any significant impact the guidance may have had on the recommended management of patients on bisphosphonates by primary care dentists, had reached its peak ten months post publication. A more positive attitude, greater perceived ability, and greater motivation were all associated with significantly more performing of all recommended behaviours at every time point.Conclusions Prior to this study, there was little available information about how patients on bisphosphonates were being managed in primary dental care, or what beliefs may be influencing management decisions. This study was able to identify levels of compliance pre- and post-guidance publication and determine that further intervention was necessary to enable sustained uptake of recommendations. Using the TDF to identify beliefs associated with best practice made it possible to suggest theoretically informed strategies for service improvement. The next step is to test the intervention(s) in a randomised controlled trial. PMID:25525016

McGurk, Mark

2014-12-19

200

Case management and self-management support for frequent users with chronic disease in primary care: a pragmatic randomized controlled trial  

PubMed Central

Background Chronic diseases represent a major challenge for health care and social services. A number of people with chronic diseases require more services due to characteristics that increase their vulnerability. Given the burden of increasingly vulnerable patients on primary care, a pragmatic intervention in four Family Medicine Groups (primary care practices in Quebec, Canada) has been proposed for individuals with chronic diseases (diabetes, cardiovascular diseases, respiratory diseases, musculoskeletal diseases and/or chronic pain) who are frequent users of hospital services. The intervention combines case management by a nurse with group support meetings encouraging self-management based on the Stanford Chronic Disease Self-Management Program. The goals of this study are to: (1) analyze the implementation of the intervention in the participating practices in order to determine how the various contexts have influenced the implementation and the observed effects; (2) evaluate the proximal (self-efficacy, self-management, health habits, activation and psychological distress) and intermediate (empowerment, quality of life and health care use) effects of the intervention on patients; (3) conduct an economic analysis of the efficiency and cost-effectiveness of the intervention. Methods/Design The analysis of the implementation will be conducted using realistic evaluation and participatory approaches within four categories of stakeholders (Family Medicine Group and health centre management, Family Medicine Group practitioners, patients and their families, health centre or community partners). The data will be obtained through individual and group interviews, project documentation reviews and by documenting the intervention. Evaluation of the effects on patients will be based on a pragmatic randomized before-after experimental design with a delayed intervention control group (six months). Economic analysis will include cost-effectiveness and cost-benefit analysis. Discussion The integration of a case management intervention delivered by nurses and self-management group support into primary care practices has the potential to positively impact patient empowerment and quality of life and hopefully reduce the burden on health care. Decision-makers, managers and health care professionals will be aware of the factors to consider in promoting the implementation of this intervention into other primary care practices in the region and elsewhere. Trial Registration NCT01719991 PMID:23391214

2013-01-01

201

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

202

A Case of Primary Postpartum Bleeding due to Vaginal Laceration after Vaginal Delivery: Successful Management with Transcatheter Arterial Embolization  

PubMed Central

Postpartum hemorrhage is one of the major causes of maternal mortality. There are medical and surgical options to control the bleeding, some of which can impair future fertility. Transcatheter arterial embolization might be a useful option in the management of intractable postpartum bleeding before the consideration of more invasive and radical methods. In this report, we report a 33-year-old patient who presented with primary postpartum hemorrhage due to vaginal laceration and was eventually treated with transcatheter arterial embolization.

Ingec, Metin; Levent, Akin; Delibas, Ilhan Bahri; Pulur, Alparslan; Karaca, Ibrahim

2011-01-01

203

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

Microsoft Academic Search

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

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

2011-01-01

204

Delivering the WISE (Whole Systems Informing Self-Management Engagement) training package in primary care: learning from formative evaluation  

Microsoft Academic Search

BACKGROUND: The WISE (Whole System Informing Self-management Engagement) approach encompasses creating, finding, and implementing appropriate self-care support for people with long-term conditions. A training package for primary care to introduce the approach was developed and underwent formative evaluation. This entailed exploring the acceptability of the WISE approach and its effectiveness in changing communication within consultations. The study aimed to refine

Anne Kennedy; Carolyn Chew-Graham; Thomas Blakeman; Andrew Bowen; Caroline Gardner; Joanne Protheroe; Anne Rogers; Linda Gask

2010-01-01

205

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

Microsoft Academic Search

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

Derek Johnson; Marcia Polansky; Marlene Matosky; Michelle Teti

2010-01-01

206

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

207

Assessment of an enhanced program for depression management in primary care: a cluster randomized controlled trial. The INDI project (Interventions for Depression Improvement)  

Microsoft Academic Search

BACKGROUND: Most depressed patients are attended at primary care. However, there are significant shortcomings in the diagnosis, management and outcomes of these patients. The aim of this study is to determine whether the implementation of a structured programme for managing depression will provide better health outcomes than usual management. METHODS\\/DESIGN: Design: A cluster-randomized controlled trial involving two groups, one of

Enric Aragonès; Antonia Caballero; Josep Ll Piñol; Germán López-Cortacans; Waleska Badia; Josep M Hernández; Pilar Casaus; Sílvia Folch; Josep Basora; Antonio Labad

2007-01-01

208

Optimising the detection and management of familial hypercholesterolaemia: central role of primary care and its integration with specialist services.  

PubMed

Familial hypercholesterolaemia (FH) is the most common monogenic lipid disorder associated with premature coronary heart disease (CHD). However, the majority of people with FH are undiagnosed or undertreated. Early cholesterol lowering therapy reduces cardiovascular disease mortality in FH. Low awareness and knowledge of FH in specialty and general practice highlights the need for strategies to improve the detection and management of FH. We present an algorithm describing a multidisciplinary approach to FH detection and management. We highlight the role of primary care, and where GPs can work with preventive cardiologists to improve care of FH. Novel strategies to detect index cases with FH are presented including the community laboratory, highlighting patients at high risk of FH, and targeted FH detection through searching the general practice database. General practitioners request over 90% of LDL cholesterol measurements in the community. Once an individual with FH is detected only a small proportion of patients require specialty management with the majority of patients suitably managed in primary care. However, it is crucial to screen family members, as 50% of first-degree family members are expected to have FH due to the autosomal dominant inheritance. PMID:25130889

Vickery, Alistair W; Bell, Damon; Garton-Smith, Jacquie; Kirke, Andrew B; Pang, Jing; Watts, Gerald F

2014-12-01

209

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

210

Implementing a Children's Choice Award at Your School  

ERIC Educational Resources Information Center

Children's choice awards are intended to encourage children, primary age through teens, to read quality literature for enjoyment. The reasons for joining a children's choice program before deciding to participate are presented.

Obert, Beverly J.

2005-01-01

211

Pediatric Hypertension Specialists' Perspectives About Adolescent Hypertension Management: Implications for Primary Care Providers.  

PubMed

Background. The current specialty-centric hypertension paradigm is unsustainable given the high prevalence of primary hypertension in adolescents. Objective. To describe specialists' perspectives on referral and comanagement for adolescents with hypertension. Methods. Cross-sectional mailed survey of a national sample of 397 pediatric cardiologists and 389 pediatric nephrologists, conducted January to May 2014. Results. Response rate was 61%. Both specialties agreed that primary care providers can make the hypertension diagnosis, try lifestyle changes, and comanage monitoring of patient blood pressure control and medication side effects, but they felt antihypertensive medication use should mainly occur in the specialty setting. Conclusions. Our study suggests specialist support for changing the hypertension paradigm to encourage primary care providers, in collaboration with specialists, to diagnose hypertension, initiate lifestyle changes, and monitor progress and side effects. Future work should focus on supporting primary care physician comanagement of adolescents with hypertension. PMID:25398627

Yoon, Esther; McCool, Brigitte; Filipp, Stephanie; Rocchini, Albert; Kershaw, David; Clark, Sarah

2014-11-13

212

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

213

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

Microsoft Academic Search

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

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

1997-01-01

214

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

PubMed Central

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

XIA, XIANGYU; CUI, KAIJUN

2014-01-01

215

Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of chronic heart failure management.  

PubMed

Uzbekistan has a well-developed primary care system, with universal access to care, but faces challenges in improving the quality of clinical care provided. This study aimed to identify barriers to quality improvement by focusing on one common condition, Chronic Heart Failure (CHF), for which there are evidence-based international guidelines for management. To identify the challenges to improving the quality of care for CHF in line with such guidelines we took a qualitative approach, interviewing 15 physicians and 30 patients in detail about their experiences of CHF management. Despite recent improvements to the training of primary care physicians, their access to up-to-date information was limited, and they were disproportionately reliant on information from pharmaceutical companies. The main barriers to implementing international standards of care were: reluctance of physicians (and patients) to abandon ineffective interventions; enduring, system-wide incentives for clinically unnecessary hospitalization; and the lack of structural support for evidence-based health services improvement. Patients were in general positive about adherence to medications, but faced some problems in affording drugs and hospital care. Future interventions to strengthen primary care should be implemented with evaluations of their impact on the processes and outcomes of care for chronic conditions. PMID:22987825

Ahmedov, Mohir; Green, Judith; Azimov, Ravshan; Avezova, Guloyim; Inakov, Sherzod; Mamatkulov, Bahrom

2013-08-01

216

[A case of primary epiploic appendagitis of the sigmoid colon diagnosed by abdominal CT and managed conservatively].  

PubMed

A 40-year-old man presented to our department with left lower abdominal pain. Laboratory test showed slight leukocytosis and moderately elevated C-reactive protein (CRP). Computed tomography (CT) of the abdomen showed a typical fat density lesion adjacent to the sigmoid colon. The diagnosis of primary epiploic appendagitis of the sigmoid colon was established, and the patient was managed conservatively. Primary epiploic appendagitis is a self-limiting illness, and diagnosed by characteristic radiographic findings. Inaccurate diagnosis can lead to unnecessary treatments including surgical intervention. When we encounter a case of acute abdomen, we should consider the possibility of this disease to make accurate diagnosis and give proper treatment. PMID:22688104

Higashi, Yusuke; Ueda, Hiroyuki; Ohno, Atsushi; Boda, Tomoyuki; Fukuhara, Takayuki; Masuda, Hiromichi; Yamaguchi, Toshiki; Kamada, Koji; Hattori, Yoshihiro; Nakashima, Koichiro

2012-05-01

217

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

218

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

219

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

220

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

221

The role of primary care physician assistants in managing chronic hepatitis B.  

PubMed

This article informs physician assistants of an algorithm designed for primary care practice to guide the screening of patients for hepatitis B virus infection. The algorithm also provides guidance on evaluation, follow-up, and referral of patients who screen positive. The algorithm is a synthesis of several published, evidence-based practice guidelines and reports. PMID:24566346

Beckett, Geoff A; Block, Joan M; Cohen, Chari; McMahon, Brian J

2014-03-01

222

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

223

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

E-print Network

, such as the typical clinical picture of a patient with microscopic evidence of tumour cell elimination after treatment, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital Amsterdam, The Netherlands Abstract Primary non, more recently, H. pylori eradication [5], i.e. elimination of the bacterium from the stomach by means

Lucas, Peter

224

Evaluation of a Continuing Medical Education Program for Primary Care Physicians on the Management of Alcoholism.  

ERIC Educational Resources Information Center

A problem-based continuing medical education program to improve the diagnosis and treatment of alcoholism by primary care physicians used a computer-simulated patient, individualized feedback, and a follow-up reading. Participating physicians felt the program improved their performance, but the results could not be substantiated. (MSE)

Brown, Richard L.

1988-01-01

225

Conditioned reinforcement and choice  

PubMed Central

In a series of three experiments, rats were exposed to successive schedule components arranged on two levers, in which lever pressing produced a light, and nose-key pressing produced water in 50% of the light periods. When one auditory signal was presented only during those light periods correlated with water on one lever, and a different signal was presented only during those light periods correlated with nonreinforcement on the other lever, the former lever was preferred in choice trials, and higher rates of responding were maintained on the former lever in nonchoice (forced) trials. Thus, the rats preferred a schedule component that included a conditioned reinforcer over one that did not, with the schedules of primary reinforcement and the information value of the signals equated. Preferences were maintained when one or the other of the auditory signals was deleted, but were not established in naive subjects when training began with either the positive or negative signal only. Discriminative control of nose-key pressing by the auditory signals was highly variable across subjects and was not correlated with choice. PMID:16812034

Nevin, J. A.; Mandell, C.

1978-01-01

226

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

PubMed Central

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

2013-01-01

227

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

228

The Role of the Primary Care Practitioner in the Diagnosis and Management of Substance Abuse  

Microsoft Academic Search

\\u000a Substance abuse has become a major threat and cause of disability for persons of all ages, races, and socioeconomic levels.\\u000a Neither educational achievement, domicile, nor family background and make-up are guarantees against either direct involvement\\u000a in substance abuse or the consequences of abuse by others. It is evident that the primary care health practitioner, regardless\\u000a of his\\/her focus of clinical

George D. Comerci

229

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.

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

230

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

231

Managing an Online Survey about Influenza Vaccination in Primary Healthcare Workers  

PubMed Central

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

232

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; Ciberesp Working Group For The Survey On Influenza Vaccination In Primary Health Care Workers

2015-01-01

233

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...

234

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

235

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.

236

Who Really Leads and Manages the Curriculum in Primary Schools? A Hong Kong Case-Study  

ERIC Educational Resources Information Center

Surprisingly little is known about the micro-leadership and management of the curriculum within schools. This study first applies a purpose-designed set of research instruments to penetrate the micro-workings of school decision-making in curriculum, teaching and learning. Second, it reports the findings from an application of the instruments in…

Lee, John Chi-Kin; Dimmock, Clive; Yeung, Tai-Yuen Au

2009-01-01

237

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

ERIC Educational Resources Information Center

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

Bossetti, Brenda; Gallagher-Allred, Charlette R.

238

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...

239

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...

240

Recurrent acute coronary events in a patient with primary Antiphospholipid syndrome: successful management with intracoronary stenting  

Microsoft Academic Search

Patients with Antiphospholipid syndrome usually present with recurrent deep vein thrombosis, pulmonary thromboembolism and thromboembolic stroke. Recurrent coronary events, though reported, are rare. We describe an unusual case of Antiphospholipid syndrome who presented with recurrent acute ischaemic events in two different coronary territories, who was managed successfully with intracoronary stenting.

C. V. Umesan; Aditya Kapoor; Sonia Nityanand; Satyendra Tiwari; Nakul Sinha

1999-01-01

241

Recurrent acute coronary events in a patient with primary antiphospholipid syndrome: successful management with intracoronary stenting.  

PubMed

Patients with Antiphospholipid syndrome usually present with recurrent deep vein thrombosis, pulmonary thromboembolism and thromboembolic stroke. Recurrent coronary events, though reported, are rare. We describe an unusual case of Antiphospholipid syndrome who presented with recurrent acute ischaemic events in two different coronary territories, who was managed successfully with intracoronary stenting. PMID:10522574

Umesan, C V; Kapoor, A; Nityanand, S; Tiwari, S; Sinha, N

1999-09-30

242

Diagnostic accuracy and treatment management of depression in elderly primary care patients  

Microsoft Academic Search

Background: The negative impact of major depression on the risk of somatic diseases, mortality and social functioning is prominent in elderly patients. Aim: We investigated how accurately general practitioners (GPs) diagnose depression in old age and if diagnostic accuracy is related to patient and clinical characteristics (study 1). Additionally, we evaluated the management of depression with antidepressants in this age

A. C. Volkers; J. Nuyen; P. F. M. Verhaak; F. G. Schellevis

2003-01-01

243

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.

244

Dietary Management in Obesity. Nutrition in Primary Care Series, Number 9.  

ERIC Educational Resources Information Center

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

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

245

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.

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

2015-01-01

246

How is gout managed in primary care? A review of current practice and proposed guidelines.  

PubMed

Twelve practices with a total list of 74,111 patients were audited; 429 patients were identified with a diagnosis of gout. A wide variation in various clinical and laboratory assessments was detected. Similar variations were also noted regarding dietary advice and medical treatment. Monitoring of patients was infrequent. As a result of this audit, guidelines are proposed to improve the diagnosis and management of gout in the community. PMID:10752494

Pal, B; Foxall, M; Dysart, T; Carey, F; Whittaker, M

2000-01-01

247

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

PubMed

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

Thille, Patricia; Ward, Natalie; Russell, Grant

2014-05-01

248

Co-existent thyroid disease in patients treated for primary hyperparathyroidism: implications for clinical management.  

PubMed

Treatment for primary hyperparathyroidism necessitates complete excision of involved parathyroid tissue. Simultaneous thyroidectomy may also be required in order to optimise operative access and/or where suspicion of synchronous abnormal thyroid pathology exists. We sought to determine how often simultaneous removal of thyroid tissue was required during parathyroidectomy and the nature of any associated pathology. Radiology reports were also reviewed to determine how often confirmed thyroid pathology from histological specimens, benign or malignant, had been identified pre-operatively. A retrospective chart review of 135 parathyroidectomy procedures performed between 2003 and 2013 was performed. Of 135 parathyroidectomy procedures, 39 patients (29 %) underwent simultaneous partial thyroidectomy of which 36 (27 % of total parathyroidectomies) had dual pathology confirmed. Specifically, malignant lesions were identified in 14 % (n = 5), Graves' disease 3 % (n = 1), thyroiditis 17 % (n = 6), multinodular goitre 50 % (n = 18), unilateral nodule 6 % (n = 2), hyperplasia 8 % (n = 3) and intra-thyroid adenoma 3 % (n = 1). Reference to these thyroid lesions was made in only 47 % of preoperative radiology reports. In conclusion, synchronous thyroid surgery was required in 29 % of all parathyroidectomy procedures performed for treatment of primary hyperparathyroidism with malignant thyroid lesions incidentally detected in 14 % of cases. Less than half of all confirmed concomitant thyroid pathology had been referred to or recognised on pre-operative radiology studies. These findings highlight the importance of considering the potential need to perform thyroid surgery during parathyroidectomy and obtaining appropriate informed consent. PMID:24633247

Ryan, S; Courtney, D; Timon, C

2015-02-01

249

Successful management of primary non Hodgkins lymphoma of the cranial vault.  

PubMed

Primary bone lymphoma (PBL) is a relatively uncommon entity. However, involvement of the cranial vault is an unusual manifestation of aggressive non-Hodgkin's lymphoma. We report the case of a 42-year old immunocompetent woman who presented with an enlarging mass involving the right parietal bone. Magnetic resonance imaging (MRI) of the brain revealed an expansive tumor that affects the right parietal bone. Computed tomographic (CT) scans of the abdomen, chest and pelvis were negative for lymphadenopathy or organomegaly. Biopsy of the mass showed diffuse large B-cell non-Hodgkin's lymphoma confirmed by immunohistochemical study. The patient had a complete response after 4 cycles of chemotherapy followed by external beam radiotherapy. After a follow-up of more than 9 months the patient is still in good local control without distant metastasis. The aim of our work is to report a case of Primary bone lymphoma of the cranial vault with good response to treatment combining sequential chemotherapy and radiotherapy. PMID:22121457

Fadoukhair, Zouhour; Lalya, Issam; Amzerin, Mounia; Elkhanoussi, Basma; Sbitti, Yassir; Boutayeb, Saber; M'rabti, Hind; Benjaafar, Noureddine; Errihani, Hassan

2011-01-01

250

Primary tethered cord syndrome--clinical and urological manifestations, diagnosis and management: a prospective study.  

PubMed

Primary tethered cord syndrome refers to a group of neural tube defects that are not externally obvious, and, if detected at an early age, surgical intervention may prevent the significant irreversible neurological deficits. This study was performed to evaluate the presenting clinical features of patients with primary tethered cord syndrome and the indications of surgery in such patients as well as the clinical and urological outcome. In all cases, the indication for surgery was the presence of a tethered cord on magnetic resonance imaging, the criteria for tethering being a low-lying conus (below L1-L2) and a thickened filum (>2 mm). Urodynamic studies were performed before detethering. Microsurgical detethering of low-lying cord was then performed, and the patients were then followed clinically and urologically for 6 months. Pain responded the most to detethering while limb weakness and urological symptoms responded the least. Clinical improvement in urological symptoms correlated with improvement in urodynamic parameters. A urodynamic study identified improvement in a larger number of patients and also deterioration in a few patients which was not visible clinically; this may point to its high sensitivity and usefulness in preceding clinical manifestations in a future follow-up. PMID:23713055

Ailawadhi, Pankaj; Kale, S S; Agrawal, Deepak; Mahapatra, A K; Kumar, Rajeev

2012-01-01

251

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

SciTech Connect

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

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

2007-07-15

252

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.

253

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

254

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

255

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

PubMed Central

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

2012-01-01

256

Pathogenesis of primary sclerosing cholangitis and advances in diagnosis and management.  

PubMed

Primary sclerosing cholangitis (PSC), first described in the mid-1850s, is a complex liver disease that is heterogeneous in its presentation. PSC is characterized by chronic cholestasis associated with chronic inflammation of the biliary epithelium, resulting in multifocal 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 the 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

2013-09-01

257

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

258

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

259

Cost-effectiveness of supported self-management for CFS/ME patients in primary care  

PubMed Central

Background Nurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis (CFS/ME) have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown. Methods Cost-effectiveness analysis conducted alongside a single blind randomised controlled trial comparing pragmatic rehabilitation (PR) and supportive listening (SL) delivered by primary care nurses, and treatment as usual (TAU) delivered by the general practitioner (GP) in North West England. A within trial analysis was conducted comparing the costs and quality adjusted life years (QALYs) measured within the time frame of the trial. 296 patients aged 18 and over with CFS/ME diagnosed using the Oxford criteria were included in the cost-effectiveness analysis. Results Treatment as usual is less expensive and leads to better patient outcomes compared with Supportive Listening. Treatment as usual is also less expensive than Pragmatic Rehabilitation. PR was effective at reducing fatigue in the short term, but the impact of the intervention on QALYs was uncertain. However, based on the results of this trial, PR is unlikely to be cost-effective in this patient population. Conclusions This analysis does not support the introduction of SL. Any benefits generated by PR are unlikely to be of sufficient magnitude to warrant recommending PR for this patient group on cost-effectiveness grounds alone. However, dissatisfaction with current treatment options means simply continuing with ‘treatment as usual’ in primary care is unlikely to be acceptable to patients and practitioners. Trial registration The trial registration number is IRCTN74156610 PMID:23327355

2013-01-01

260

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

PubMed Central

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

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

2012-01-01

261

Medication management for people with dementia in primary care: description of implementation in the DelpHi study  

PubMed Central

Background As the population ages, the relative and absolute number of age-associated diseases such as dementia will increase. Evaluation of the suitability and intake of medication and pharmacological treatment is an important aspect of care for people with dementia, especially if they live at home. Regular medication reviews and systematic cooperation between physicians and pharmacists are not common in routine care. Medication management (MM), based on such a comprehensive home medication review could help to reduce drug-related problems and costs. The present article presents a medication management specifically for the application in the ambulatory setting and describes its implementation as part of a larger trial. Methods/design A home medication review (HMR) and MM is implemented as part of the DelpHi study, a population based prospective, cluster-randomized controlled intervention study to test the efficacy and efficiency of the implementation of a collaborative care model in primary care. Participants: people with dementia (PWD) and their caregivers are recruited by the patient’s general practitioner. Inclusion criteria are a positive screening result for dementia, living at home and regular intake of drugs. PWD are asked to specify their regular pharmacy which is asked to participate in the study, too. Intervention: a comprehensive HMR is conducted as computer-assisted personal interview by specifically qualified Dementia Care Manager (DCM) at the people’s home. It includes detailed information about drugs taken, their storage, administration, adherence and adverse events. The MM is conducted in cooperation between DCM, pharmacist and general practitioner and consists of a pharmaceutical evaluation, pharmaceutical recommendations and their application. Pharmacists are trained and provided with regularly updated information. The MM is designed to give information and recommendations concerning antidementia drugs, occurrence of drug related problems, intake of anticholinergic drugs, potentially clinically relevant drug-drug-interactions, adverse drug events and medication adherence. Discussion The DelpHi-approach for medication management employs comprehensive instruments and procedures in the primary care setting under routine care conditions, and this approach should be useful in improving pharmacotherapy as part of the comprehensive treatment and care for people with dementia. Trial registration The trial is registered at ClinicalTrials.gov, number NCT01401582. PMID:24225205

2013-01-01

262

Endodontic treatment and esthetic management of a primary double tooth with direct composite using silicone buildup guide  

PubMed Central

Gemination and fusion are morphological dental anomalies, characterized by the formation of a clinically wide tooth. Gemination occurs when one tooth bud tries to divide, while fusion occurs if two buds unite. The terms double teeth, double formation, conjoined teeth, geminifusion, vicinifusion and dental twinning are often used to describe fusion and gemination. Double teeth are associated with clinical problems such as poor esthetics, spacing problems and caries susceptibility. Management of such cases requires a comprehensive knowledge of the clinical entity as well as the problems associated with it. This report presents a case of primary double tooth in a 6-year-old boy involving maxillary left central incisor. The anomalous tooth was carious and pulpally involved. This was treated conservatively by endodontic treatment and esthetic rehabilitation was done with direct composite restoration using a silicone buildup guide. The treated tooth was followed up until exfoliation. PMID:22629077

Kulkarni, Vinaya Kumar; Ragavendra, T. Raju; Deshmukh, Jeevanand; Vanka, Amit; Duddu, Mahesh Kumar; Patil, Anand Kumar G.

2012-01-01

263

Knowledge, Attitudes, and Practices of Public Sector Primary Health Care Physicians of Rural North Karnataka Towards Obesity Management  

PubMed Central

Introduction: Obesity is a risk factor for cardiovascular disease (CVD), diabetes mellitus (DM), and hypertension (HTN). In an era of rapidly growing prevalence of obesity, it is important to explore the current knowledge, attitude, and practices of primary care physicians. Materials and Methods: Study participants were medical officers (MOs) of primary health centers in three districts of North Karnataka. The questionnaire was developed by a review of literature in the field and validated with five participants for scope, length, and clarity. Results/Discussion: Of the 102 participants, only 15% were aware about the burden of obesity in India. HTN, DM, and CVD were indicated as comorbidities by 73, 78, and 60 participants, respectively. Only 25 and 12 participants indicated appropriate body mass index (BMI) cut-off values for overweight and obesity diagnosis. Of the 102 participants, 54 were not aware of the guidelines for obesity management. Practices and attitudes of the participants were encouraging. Nearly all of them felt that the adults with BMI within the healthy range should be encouraged to maintain their weight and, three-fourth of them agreed that most overweight persons should be treated for weight loss and small weight loss can achieve major medical benefit. However, nearly half of the participants’ responses were stereotypical as they felt only obese and overweight with comorbidities should be treated for weight loss. Two-thirds of them use BMI to diagnose overweight/obese and nearly all of them advice their patients to increase physical activity and restrict fat. Most of the participants were advising their patients to restrict sugar intake, increase fruits and vegetable consumption, reduce red meat, and avoid alcohol consumption. Conclusion: Present study exposed the lack of knowledge regarding obesity. However, practices and attitudes of the participants were promising. There is a need of in-service training to MOs to further improve their knowledge and practices towards management of obesity.

Somannavar, Manjunath S.; Appajigol, Jayaprakash S.

2014-01-01

264

Primary signet-ring cell carcinoma of the urinary bladder successfully managed with cisplatin and gemcitabine: a case report  

PubMed Central

Introduction Primary signet-ring cell carcinoma of the urinary bladder is a rare variant of mucus-producing adenocarcinoma constituting approximately 0.5% to 2.0% of all primary carcinomas of the bladder. This tumor initially presents as a high-grade, high-stage lesion and diffusely invades the bladder wall without forming intraluminal growth. The patients have no specific symptoms, which leads to delayed diagnosis and poor prognosis. Case presentation We report the case of a 51-year-old Moroccan Berber man consulting for gross hematuria. Ultrasonography and a computed tomography scan found a bladder tumor diffusely invading the bladder wall. A histopathological examination of the tumor chips from a transurethral resection of the bladder revealed signet-ring cell adenocarcinoma. The gastrointestinal tract exploration did not reveal any other tumor localization. A radical cystectomy and adjuvant cisplatin and gemcitabine chemotherapy were therefore performed resulting in 18 months of survival without metastasis and a good quality of life within that time. Conclusion The rarity and the successful management with carboplatin and gemcitabine as adjuvant chemotherapy of this entity, which is rarely reported in the literature, are two remarkable characteristics described in this case report. PMID:23388175

2013-01-01

265

Impact of an EHR-Based Diabetes Management Form on Quality and Outcomes of Diabetes Care in Primary Care Practices.  

PubMed

Health information technology shows promise for improving chronic disease care. This study assessed the impact of a diabetes management form (DMF), accessible within an electronic health record. From 2007 to 2009, 2108 diabetes patients were seen in 20 primary care practices; 1103 visits involved use of the DMF in 2008. The primary outcome was "optimal care": HbA1c ?8%, low-density lipoprotein (LDL) cholesterol <100 mg/dL, blood pressure <130/80 mm Hg, not smoking, and aspirin prescription in patients ?40 years. After adjusting for number of visits, age, sex, and insulin use, DMF-exposed patients showed less improvement in attaining "optimal care" (estimated difference-in-difference [DID] = -2.06 percentage points; P < .001), LDL cholesterol (DID = -2.30; P = .023), blood pressure (DID = -3.05; P < .001), and total cholesterol (DID = -0.47; P = .004) targets. Documented microalbumin tests, aspirin prescription, and eye and foot exams increased more. Thus, DMF use was associated with smaller gains in achieving evidence-based targets, but greater improvement in documented delivery of care. PMID:24399633

Herrin, Jeph; da Graca, Briget; Aponte, Phil; Stanek, H Greg; Cowling, Terianne; Fullerton, Cliff; Hollander, Priscilla; Ballard, David J

2015-01-01

266

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

PubMed

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

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

2014-12-01

267

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

268

The role of radiation therapy in the management of primary central nervous system lymphoma.  

PubMed

Primary central nervous system lymphoma (PCNSL) is an aggressive neoplasm with a poor prognosis. Early studies of whole brain radiation therapy (WBRT) alone revealed a robust initial response but high rates of local recurrence with long-term follow-up. The addition of high-dose methotrexate (HDMTX)-based chemotherapy improved the durability of disease control. However, delayed neurotoxicity emerged as an important complication, mainly in elderly patients. Therefore, researchers have investigated eliminating WBRT or reducing its dose. Multiple studies of chemotherapy alone have demonstrated inferior disease control. On the other hand, a phase III trial reported that WBRT may be deferred until relapse without compromising survival; however, this trial is fraught with flaws. A recent study of immunochemotherapy and dose-reduced WBRT demonstrated excellent outcomes. Currently, this regimen is being studied in a multi-institutional trial by the Radiation Therapy Oncology Group. WBRT maintains an important position in the armamentarium against PCNSL. This article aims to describe its evolving role. PMID:25219590

Milgrom, Sarah A; Yahalom, Joachim

2014-10-21

269

Novel insight into etiology, diagnosis and management of primary adrenal insufficiency.  

PubMed

Primary adrenal insufficiency (PAI) is a rare condition in childhood which is either inherited (mostly) or acquired. It is characterized by glucocorticoid and maybe mineralocorticoid deficiency. The most common form in children is 21-hydroxylase deficiency, which belongs to the steroid biosynthetic defects causing PAI. Newer forms of complex defects of steroid biosynthesis are P450 oxidoreductase deficiency and (apparent) cortisone reductase deficiency. Other forms of PAI include metabolic disorders, autoimmune disorders and adrenal dysgenesis, e.g. the IMAGe syndrome, for which the underlying genetic defect has been recently identified. Newer work has also expanded the genetic causes underlying isolated, familial glucocorticoid deficiency (FGD). Mild mutations of CYP11A1 or StAR have been identified in patients with FGD. MCM4 mutations were found in a variant of FGD in an Irish travelling community manifesting with PAI, short stature, microcephaly and recurrent infections. Finally, mutations in genes involved in the detoxification of reactive oxygen species were identified in patients with unsolved FGD. Most mutations were found in the enzyme nicotinamide nucleotide transhydrogenase, which uses the mitochondrial proton pump gradient to produce NADPH. NADPH is essential in maintaining high levels of reduced forms of antioxidant enzymes for the reduction of hydrogen peroxide. Similarly, mutations in the gene for TXNRD2 involved in this system were found in FGD patients, suggesting that the adrenal cortex is particularly susceptible to oxidative stress. PMID:25096886

Malikova, Jana; Flück, Christa E

2014-01-01

270

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 ...

271

Myths of Educational Choice.  

ERIC Educational Resources Information Center

This book presents concerns and raises questions about the choice programs being proposed and implemented around the United States. It argues that poorly conceived, hastily enacted choice programs may do more harm than good. The demand for educational choice may result in lost opportunities for students (some groups more than others), weakened…

Pearson, Judith

272

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

273

Management of opioid painkiller dependence in primary care: ongoing recovery with buprenorphine/naloxone.  

PubMed

Opioid painkiller dependence is a growing problem and best-practice management is not well defined. We report a case of a young woman exhibiting dependence on codeine, originally prescribed for myalgic encephalopathy, after escalating use over a 10-year period. In 2012, a consultation with a new general practitioner, who had extensive experience of patients with substance abuse, revealed the underlying dependence. After building trust for 6?months, she was able to admit to medication abuse, and was referred to the community drug and alcohol team. On presentation to the team, the patient had no pain issues and the dihydrocodeine use-600 tablets/week-solely reflected her dependence. The patient successfully underwent rapid induction with buprenorphine/naloxone as opioid substitution treatment over 2?days. She is currently stable, engaged with recovery support services and psychosocial counselling, and has just returned to work. She is maintained on a therapeutic dose of buprenorphine 10?mg/naloxone 2.5?mg. PMID:25432908

Hard, Bernadette

2014-01-01

274

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

275

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

276

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

PubMed Central

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

2012-01-01

277

Choice Theory as a Model of Adult Development  

Microsoft Academic Search

Choice Theory is popularly recognized as a basis for the practice of Reality Therapy, Quality Education and Lead Management. There seems to be little thought given, how- ever, to Choice Theory as a broader model for human development. This lack of perspective is surprising given the Institute's training emphasis on application of Choice Theory in practitioners' lives, as well as

Ron Mottern

2008-01-01

278

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

PubMed

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 as well: that the system be socially and culturally acceptable, and that communities are active participants in the development and implementation of the system. Further, the PHC system should be compatible with larger system of a region or country, and possibly serve as a prototype for the development of larger health systems. With these requirements in mind, the Aga Khan University has developed a series of community-based, urban PHC systems, each serving a population of about 10,000, in the katchi abadis (squatter settlements) of Karachi. These communities are severely deprived, with high infant, child and maternal mortality rates. The PHC systems are designed to achieve equity, effectiveness and affordability, and within 3-5 years have advanced substantially toward those goals. A key factor in those developments has been the management information system (MIS), which has served as a basis for planning, managing and evaluating the PHC systems. Central questions about such an MIS are: What kind of MIS design is necessary to support the pursuit of those goals? What problems arise in the MIS as such a system is implemented? What kinds of changes and adaptations need to be considered in the MIS as the PHC system itself matures? What does the PHC system cost, and what part of the total cost of the PHC system is attributable to the MIS? How practical is this kind of MIS, developed in small prototype PHC systems, for replicability in larger health systems? What are the possibilities and requirements for simplification in order to be used in health systems that are less intensively managed? The experience of AKU in Pakistan in the development of PHC systems, with associated management information systems, helps to answer these questions. PMID:8456328

Husein, K; Adeyi, O; Bryant, J; Cara, N B

1993-03-01

279

Primary neuroleptospirosis  

PubMed Central

Leptospirosis is an important zoonosis of worldwide distribution. It is uncommon for leptospirosis to present as a primary neurological disease. In this study of patients who presented with an acute neurological disease, and who were subsequently found to have leptospirosis, aseptic meningitis was the commonest manifestation. The other presentations were myeloradiculopathy, myelopathy, Guillain-Barré syndrome-like presentation, meningoencephalitis, intracerebral bleed, cerebellar dysfunction, iridocyclitis, and tremor/rigidity. Treatment consists of antibiotics, crystalline penicillin being the drug of choice, which reduces the course of illness if given early. The role of steroids is controversial. The prognosis after primary neuroleptospirosis is generally good but altered sensorium and seizures herald a worse prognosis.???Keywords: neuroleptospirosis; aseptic meningitis; Weil's disease PMID:11524519

Panicker, J; Mammachan, R; Jayakumar, R

2001-01-01

280

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

PubMed Central

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

2012-01-01

281

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

ERIC Educational Resources Information Center

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

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

2004-01-01

282

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

Microsoft Academic Search

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

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

2002-01-01

283

A Randomized Trial Comparing Peak Expiratory Flow and Symptom Self-management Plans for Patients with Asthma Attending a Primary Care Clinic  

Microsoft Academic Search

Great emphasis is placed on educating asthmatics to use action plans to achieve better control of symptoms. The use of peak flow meters (PFM) has been recommended as an important part of self- management plans. We studied 92 (47 F) adult patients with asthma in a primary care setting to compare the effectiveness of action plans using either peak flow

MARK O. TURNER; DARLENE TAYLOR; RON BENNETT; J. MARK FITZGERALD

1998-01-01

284

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

PubMed Central

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

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

2013-01-01

285

Dietary patterns in cardiovascular diseases prevention and management: review of the evidence and recommendations for primary care physicians in Lebanon.  

PubMed

The objective of this paper is to discuss the advantages of using the dietary pattern approach in evaluating the role of diet in cardiovascular diseases (CVD) prevention and management and to report on the association between major dietary patterns and CVD risk factors among Lebanese adults. The significance of this type of research to primary care physicians is also highlighted. The dietary pattern approach overcomes the inconsistent findings of single nutrient analysis in evaluating diet-disease associations, takes into consideration the synergistic effects of nutrients, and provides culture specific recommendations. Using data from the national Nutrition and Non-Communicable Disease Risk Factor Survey, we appraised the association of dietary patterns with CVD risk factors among Lebanese adults. Two major dietary patterns were identified: Western pattern, characterized by high intake of fast food sandwiches, desserts, and carbonated beverages and the traditional Lebanese pattern, characterized by high intakes of fruits and vegetables, olives and olive oil, and traditional dishes. Only the Western pattern was associated with increased risk of obesity (abdominal obesity), hyperglycemia and the metabolic syndrome. These findings demonstrated the valuable results that can be obtained using the dietary patterns approach in evaluating the association between diet and CVD risk factors and provided evidence that this approach can be used as a tool to push for desirable dietary changes in the country. PMID:25011370

Naja, Farah; Nasreddine, Lara; Itani, Leila; Dimassi, Hani; Sibai, Abla-Mehio; Hwalla, Nahla

2014-01-01

286

Initial Choices and Final Outcomes in Lower Urinary Tract Symptoms  

Microsoft Academic Search

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

Mark J. Speakman

2001-01-01

287

Facility Manager Primary Purpose  

E-print Network

), extensive knowledge of building automation / mechanical systems, HVAC systems, access control operation; b. overseeing building and grounds maintenance and cleaning; c. ensuring the building meets and their adherence to commitments 3. Preparing and maintaining annual operating and capital budgets for buildings

Saskatchewan, University of

288

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

289

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

290

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

291

THE AXIOM OF CHOICE  

E-print Network

A choice function on a family S of sets is a function f with domain S such that, for each nonempty set X in S, f(X) is an element of X: figuratively put, f "chooses " an element of each member of S. If S is finite, the existence of a choice function on S is a straightforward consequence of the basic principles of set formation and the rules of classical logic. When S is infinite, however, these principles no longer suffice and so the existence of a choice function on S must be postulated. The assertion that on any family of nonempty sets — even if it be infinite —there exists at least one choice function is called the axiom of choice. This principle was first explicitly stated (in a different, but equivalent form) by Zermelo in 1904 and employed in his proof that any set can be well ordered — his famous well-ordering theorem. Its highly nonconstructive character provoked considerable initial criticism: while it asserts the possibility of making arbitrarily many arbitrary "choices " —or at least of crystallizing such an imagined procedure into a genuine function —it provides no indication whatsoever of how these "choices" are to be made, or how the resulting function is to be defined. For example, the scepticism of the French mathematician Emile Borel concerning such a possibility was sufficient to move him to declare that "any argument where one supposes an arbitrary choice a non-denumerably infinite

unknown authors

292

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

293

Children's Choices for 2008  

ERIC Educational Resources Information Center

Each year 12,500 school children from different regions of the United States read and vote on the newly published children's and young adults' trade books that they like best. The Children's Choices for 2008 list is the 34th in a series that first appeared as "Classroom Choices" in the November 1975 issue of "The Reading Teacher" (RT), a…

Reading Teacher, 2008

2008-01-01

294

Effectiveness of a primary care based complex intervention to promote self-management in patients presenting psychiatric symptoms: study protocol of a cluster-randomized controlled trial  

PubMed Central

Background Anxiety, Depression and Somatoform (ADSom) disorders are highly prevalent in primary care. Managing these disorders is time-consuming and requires strong commitment on behalf of the General Practitioners (GPs). Furthermore, the management of these patients is restricted by the high patient turnover rates in primary care practices, especially in the German health care system. In order to address this problem, we implement a complex, low-threshold intervention by an Advanced Practice Nurse (APN) using a mixture of case management and counseling techniques to promote self-management in these patients. Here we present the protocol of the “Self-Management Support for Anxiety, Depression and Somatoform Disorders in Primary Care” (SMADS)-Study. Methods/Design The study is designed as a cluster-randomized controlled trial, comparing an intervention and a control group of 10 primary care practices in each case. We will compare the effectiveness of the intervention applied by an APN with usual GP-care. A total of 340 participants will be enrolled in the study, 170 in either arm. We use the Patient Health Questionnaire-German version (PHQ-D) as a screening tool for psychiatric symptoms, including patients with a score above 5 on any of the three symptom scales. The primary outcome is self-efficacy, measured by the General Self-Efficacy Scale (GSE), here used as a proxy for self-management. As secondary outcomes we include the PHQ-D symptom load and questionnaires regarding coping with illness and health related quality of life. Outcome assessments will be applied 8 weeks and 12 months after the baseline assessment. Discussion The SMADS-study evaluates a complex, low threshold intervention for ambulatory patients presenting ADSom-symptoms, empowering them to better manage their condition, as well as improving their motivation to engage in self-help and health-seeking behaviour. The benefit of the intervention will be substantiated, when patients can enhance their expected self-efficacy, reduce their symptom load and engage in more self-help activities to deal with their everyday lives. After successfully evaluating this psychosocial intervention, a new health care model for the management of symptoms of anxiety, depression and somatoform disorders for ambulatory patients could emerge, supplementing the work of the GP. Trial registration Clinicaltrials.gov Identifier: NCT01726387 PMID:24387048

2014-01-01

295

Randomised controlled trial of tailored interventions to improve the management of anxiety and depressive disorders in primary care  

PubMed Central

Background Anxiety and depressive disorders are highly prevalent disorders and are mostly treated in primary care. The management of these disorders by general practitioners is not always consistent with prevailing guidelines because of a variety of factors. Designing implementation strategies tailored to prospectively identified barriers could lead to more guideline-recommended care. Although tailoring of implementation strategies is promoted in practice, little is known about the effect on improving the quality of care for the early recognition, diagnosis, and stepped care treatment allocation in patients with anxiety or depressive disorders in general practice. This study examines whether the tailored strategy supplemented with training and feedback is more effective than providing training and feedback alone. Methods In this cluster randomised controlled trial, a total of 22 general practices will be assigned to one of two conditions: (1) training, feedback, and tailored interventions and (2) training and feedback. The primary outcome measure is the proportion of patients who have been recognised to have anxiety and/or depressive disorder. The secondary outcome measures in patients are severity of anxiety and depressive symptoms, level of functioning, expectation towards and experience with care, quality of life, and economic costs. Measures are taken after the start of the intervention at baseline and at three- and six-month follow-ups. Secondary outcome measures in general practitioners are adherence to guideline-recommended care in care that has been delivered, the proportion of antidepressant prescriptions, and number of referrals to specialised mental healthcare facilities. Data will be gathered from the electronic medical patient records from the patients included in the study. In a process evaluation, the identification of barriers to change and the relations between prospectively identified barriers and improvement interventions selected for use will be described, as well as the factors that influence the provision of guideline-recommended care. Discussion It is hypothesised that the adherence to guideline recommendations will be improved by designing implementation interventions that are tailored to prospectively identified barriers in the local context of general practitioners. Currently, there is insufficient evidence on the most effective and efficient approaches to tailoring, including how barriers should be identified and how interventions should be selected to address the barriers. Trial registration NTR1912 PMID:21777463

2011-01-01

296

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

PubMed Central

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

2013-01-01

297

Effectiveness of a tailored intervention to improve cardiovascular risk management in primary care: study protocol for a randomised controlled trial  

PubMed Central

Background Cardiovascular disease (CVD) is an important worldwide cause of mortality. In The Netherlands, CVD is the leading cause of death for women and the second cause of death for men. Recommendations for diagnosis and treatment of CVD are not well implemented in primary care. In this study, we aim to examine the effectiveness of a tailored implementation program targeted at practice nurses to improve healthcare for patients with (high risk for) CVD. Methods/design A two-arm cluster randomized trial is planned. We offer practice nurses a tailored program to improve adherence to six specific recommendations related to blood pressure and cholesterol target values, risk profiling and lifestyle advice. Practice nurses are offered training and feedback on their motivational interviewing technique and an e-learning program on cardiovascular risk management (CVRM). They are also advised to screen for the presence and severity of depressive symptoms in patients. We also advise practice nurses to use selected E-health options (selected websites and Twitter-consult) in patients without symptoms of depression. Patients with mild depressive symptoms are referred to a physical exercise group. We recommend referring patients with major depressive symptoms for assessment and treatment of depressive symptoms if appropriate before starting CVRM. Data from 900 patients at high risk of CVD or with established CVD will be collected in 30 general practices in several geographical areas in The Netherlands. The primary outcome measure is performance of practice nurses in CVRM and reflects application of recommendations for personalized counselling and education of CVRM patients. Patients’ health-related lifestyles (physical exercise, diet and smoking status) will be measured with validated questionnaires and medical record audit will be performed to document estimated CVD risk. Additionally, we will survey and interview participating healthcare professionals for exploration of processes of change. The control practices will provide usual care. Discussion Tailored interventions can improve healthcare. An understanding of the methods to reach the improved healthcare can be improved. This research contributes a share of it. Identification of the determinants of practice and developing implementation interventions were two steps which were completed. The subsequent step was implementation of the tailored intervention program. Trial registration Name trial register: Nederlands trial register Web address of trial register: http://www.trialregister.nl Data of registration: 11 July 2013 Number of registration: NTR4069 PMID:24341368

2013-01-01

298

Haptic choice blindness.  

PubMed

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

Steenfeldt-Kristensen, Catherine; Thornton, Ian M

2013-01-01

299

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. Copyright © 2013 John Wiley & Sons, Ltd. PMID:24123653

Turner, Lesley J

2015-02-01

300

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

301

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

PubMed

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

Kirkland, Paul; Beeson, Paul

2013-01-01

302

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

303

*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

and Mixing 4. Hotplates 5. Haz Waste Management Nitric Acid Process: Nitric Acid for metallic thin film etches, cleaning solutions and others. Materials: Nitric Acid (70% wt), sometimes diluted with water. Nitric acid leaves invisible residues, so rinse gloves often. Acceptable Locations For Use: Wet process

Woodall, Jerry M.

304

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

305

Point of care testing for urinary tract Infection in primary care (POETIC): protocol for a randomised controlled trial of the clinical and cost effectiveness of FLEXICULT¿ informed management of uncomplicated UTI in primary care.  

PubMed

BackgroundUrinary tract infections (UTI) are the most frequent bacterial infection affecting women and account for about 15% of antibiotics prescribed in primary care. However, some women with a UTI are not prescribed antibiotics or are prescribed the wrong antibiotics, while many women who do not have a microbiologically confirmed UTI are prescribed antibiotics. Inappropriate antibiotic prescribing unnecessarily increases the risk of side effects and the development of antibiotic resistance, and wastes resources.POETIC is a randomised controlled trial of a Point Of Care Test (POCT) (Flexicult¿) guided UTI management strategy for use in primary care, which may help General Practitioners more effectively decide both whether or not to prescribe antibiotics, and if so, to select the most appropriate antibiotic.Methods/design614 adult female patients will be recruited from four primary care research networks (Wales, England, Spain, the Netherlands) and individually randomised to either POCT guided care or the guideline-informed `standard care¿ arm. Urine and stool samples (where possible) will be obtained at presentation (day 1) and two weeks later for microbiological analysis. All participants will be followed up on the course of their illness and their quality of life, using a 2 week self-completed symptom diary. At 3 months, a primary care notes review will be conducted for evidence of further evidence of treatment failures, recurrence, complications, hospitalisations and health service costs.The primary objective is to compare appropriate antibiotic use on day 3 between the POCT and standard care arms using multi-level logistic regression to produce an odds ratio and associated 95% confidence interval. Costs of the two management approaches will be assessed in terms of the primary outcome.DiscussionAlthough the Flexicult¿ POCT is used in some countries in routine primary care, it¿s clinical and cost effectiveness has never been evaluated in a randomised clinical trial. If shown to be effective, the use of this POCT could benefit individual sufferers and provide evidence for health care authorities to develop evidence based policies to combat the spread and impact of the unprecedented rise of infections caused by antibiotic resistant bacteria in Europe.Trial registration number ISRCTN65200697 (Registered 10 September 2013). PMID:25425162

Bates, Janine; Thomas-Jones, Emma; Pickles, Timothy; Kirby, Nigel; Gal, Micaela; Bongard, Emily; Hood, Kerenza; Francis, Nicolas; Little, Paul; Moore, Michael; Rumsby, Kate; Llor, Carlos; Burgman, Curt; Verheij, Theo; Cohen, David; Wootton, Mandy; Howe, Robin; Butler, Christopher C

2014-11-25

306

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

PubMed

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

2012-11-01

307

Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care  

PubMed Central

Background There is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity. Automated web-based interventions might provide a solution, but evidence suggests that they may be ineffective without additional human support. The main aim of this study was to carry out a feasibility trial of a web-based weight management intervention in primary care, comparing different levels of nurse support, to determine the optimal combination of web-based and personal support to be tested in a full trial. Methods This was an individually randomised four arm parallel non-blinded trial, recruiting obese patients in primary care. Following online registration, patients were randomly allocated by the automated intervention to either usual care, the web-based intervention only, or the web-based intervention with either basic nurse support (3 sessions in 3 months) or regular nurse support (7 sessions in 6 months). The main outcome measure (intended as the primary outcome for the main trial) was weight loss in kg at 12 months. As this was a feasibility trial no statistical analyses were carried out, but we present means, confidence intervals and effect sizes for weight loss in each group, uptake and retention, and completion of intervention components and outcome measures. Results All randomised patients were included in the weight loss analyses (using Last Observation Carried Forward). At 12 months mean weight loss was: usual care group (n?=?43) 2.44 kg; web-based only group (n?=?45) 2.30 kg; basic nurse support group (n?=?44) 4.31 kg; regular nurse support group (n?=?47) 2.50 kg. Intervention effect sizes compared with usual care were: d?=?0.01 web-based; d?=?0.34 basic nurse support; d?=?0.02 regular nurse support. Two practices deviated from protocol by providing considerable weight management support to their usual care patients. Conclusions This study demonstrated the feasibility of delivering a web-based weight management intervention supported by practice nurses in primary care, and suggests that the combination of the web-based intervention with basic nurse support could provide an effective solution to weight management support in a primary care context. Trial registration Current Controlled Trials ISRCTN31685626. PMID:24886516

2014-01-01

308

[International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Hebrew edition].  

PubMed

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome. The Hebrew Edition is part of the IADT global effort to provide a worldwide accessibility to these guidelines. This third part will discuss injuries in the primary dentition. PMID:25252473

Diangelis, A J; Andreasen, J O; Ebeleseder, K A; Kenny, D J; Trope, M; Sigurdsson, A; Andersson, L; Bourguignon, C; Flores, M T; Hicks, M l; Lenzi, A R; Malmgren, B; Moule, A J; Pohl, Y; Tsukiboshi, M

2014-04-01

309

When choice is demotivating: Can one desire too much of a good thing?  

Microsoft Academic Search

Current psychological theory and research affirm the positive affective and motivational consequences of having personal choice. These findings have led to the popular notion that the more choice, the better—that the human ability to manage, and the human desire for, choice is unlimited. Findings from 3 experimental studies starkly challenge this implicit assumption that having more choices is necessarily more

Sheena S. Iyengar; Mark R. Lepper

2000-01-01

310

The Role of Assessment for Learning in the Management of Primary to Secondary Transition: Implications for Language Teachers  

ERIC Educational Resources Information Center

Among the transitions during a pupil's school career, the transfer from primary to secondary school arguably has the most impact. Far from being linear, this transition is a kind of "pupil pilgrim's progress"; a journey with orientations, stops and reorientations, checking and refining skills that the pupils bring with them from primary to…

Jones, Jane

2010-01-01

311

Intertemporal choice in lemurs.  

PubMed

Different species vary in their ability to wait for delayed rewards in intertemporal choice tasks. Models of rate maximization account for part of this variation, but other factors such as social structure and feeding ecology seem to underly some species differences. Though studies have evaluated intertemporal choice in several primate species, including Old World monkeys, New World monkeys, and apes, prosimians have not been tested. This study investigated intertemporal choices in three species of lemur (black-and-white ruffed lemurs, Varecia variegata, red ruffed lemurs, Varecia rubra, and black lemurs, Eulemur macaco) to assess how they compare to other primate species and whether their choices are consistent with rate maximization. We offered lemurs a choice between two food items available immediately and six food items available after a delay. We found that by adjusting the delay to the larger reward, the lemurs were indifferent between the two options at a mean delay of 17 s, ranging from 9 to 25 s. These data are comparable to data collected from common marmosets (Callithrix jacchus). The lemur data were not consistent with models of rate maximization. The addition of lemurs to the list of species tested in these tasks will help uncover the role of life history and socio-ecological factors influencing intertemporal choices. PMID:22024661

Stevens, Jeffrey R; Mühlhoff, Nelly

2012-02-01

312

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

313

Decision Support for Choice of Security  

E-print Network

Decision Support for Choice of Security Solution The Aspect-Oriented Risk Driven Development (AORDD-82-471-4588-3 (printed version) ISBN 978-82-471-4591-3 (electronic version) ISSN 1503-8181 Doctoral theses at NTNU, 2007:208 Printed by NTNU-trykk #12;To Erlend #12;#12;Abstract In security assessment and management

Langseth, Helge

314

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.

315

Practical Diagnosis and Management of Dementia Due to Alzheimer’s Disease in the Primary Care Setting: An Evidence-Based Approach  

PubMed Central

Objective: To review evidence-based guidance on the primary care of Alzheimer’s disease and clinical research on models of primary care for Alzheimer’s disease to present a practical summary for the primary care physician regarding the assessment and management of the disease. Data Sources: References were obtained via search using keywords Alzheimer’s disease AND primary care OR collaborative care OR case finding OR caregivers OR guidelines. Articles were limited to English language from January 1, 1990, to January 1, 2013. Study Selection: Articles were reviewed and selected on the basis of study quality and pertinence to this topic, covering a broad range of data and opinion across geographical regions and systems of care. The most recent published guidelines from major organizations were included. Results: Practice guidelines contained numerous points of consensus, with most advocating a central role for the primary care physician in the detection, diagnosis, and treatment of Alzheimer’s disease. Review of the literature indicated that optimal medical and psychosocial care for people with Alzheimer’s disease and their caregivers may be best facilitated through collaborative models of care involving the primary care physician working within a wider interdisciplinary team. Conclusions: Evidence-based guidelines assign the primary care physician a critical role in the care of people with Alzheimer’s disease. Research on models of care suggests the need for an appropriate medical/nonmedical support network to fulfill this role. Given the diversity and breadth of services required and the necessity for close coordination, nationwide implementation of team-based, collaborative care programs may represent the best option for improving care standards for patients with Alzheimer’s disease. PMID:24392252

Kerwin, Diana R.

2013-01-01

316

Are Treatment Preferences Relevant in Response to Serotonergic Antidepressants and Cognitive-Behavioral Therapy in Depressed Primary Care Patients? Results from a Randomized Controlled Trial Including a Patients’ Choice Arm  

Microsoft Academic Search

Background: Little is known about the influence of depressed patients’ preferences and expectations about treatments upon treatment outcome. We investigated whether better clinical outcome in depressed primary care patients is associated with receiving their preferred treatment. Methods: Within a randomized placebo-controlled single-centre 10-week trial with 5 arms (sertraline; placebo; cognitive-behavioral group therapy, CBT-G; moderated self-help group control; treatment with sertraline

Roland Mergl; Verena Henkel; Antje-Kathrin Allgaier; Dietmar Kramer; Martin Hautzinger; Ralf Kohnen; James Coyne; Ulrich Hegerl

2011-01-01

317

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

318

Multiplexed modulation of behavioral choice.  

PubMed

Stimuli in the environment, as well as internal states, influence behavioral choice. Of course, animals are often exposed to multiple external and internal factors simultaneously, which makes the ultimate determinants of behavior quite complex. We observed the behavioral responses of European leeches, Hirudo verbana, as we varied one external factor (surrounding water depth) with either another external factor (location of tactile stimulation along the body) or an internal factor (body distention following feeding). Stimulus location proved to be the primary indicator of behavioral response. In general, anterior stimulation produced shortening behavior, midbody stimulation produced local bending, and posterior stimulation usually produced either swimming or crawling but sometimes a hybrid of the two. By producing a systematically measured map of behavioral responses to body stimulation, we found wide areas of overlap between behaviors. When we varied the surrounding water depth, this map changed significantly, and a new feature - rotation of the body along its long axis prior to swimming - appeared. We found additional interactions between water depth and time since last feeding. A large blood meal initially made the animals crawl more and swim less, an effect that was attenuated as water depth increased. The behavioral map returned to its pre-feeding form after approximately 3 weeks as the leeches digested their blood meal. In summary, we found multiplexed impacts on behavioral choice, with the map of responses to tactile stimulation modified by water depth, which itself modulated the impact that feeding had on the decision to swim or crawl. PMID:24902753

Palmer, Chris R; Barnett, Megan N; Copado, Saul; Gardezy, Fred; Kristan, William B

2014-08-15

319

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

Microsoft Academic Search

This paper identifies some scientific impediments to ecosystem management and describes bio-physical databases required to help systematically and empirically address the ecological sustainability challenge. Examples are drawn from ongoing work in Ontario. This work has implications for efforts in ecological land classification, landscape ecology, more efficient locating of research and monitoring plots, wildlife management and ultimately trade-off analyses. We conclude

Daniel W. McKenney; Brendan G. Mackey; Richard A. Sims

1996-01-01

320

Potential implications of the choice among three alternative treatment targets for apolipoprotein B100 in the management of patients with type 2 diabetes and chronic kidney disease.  

PubMed

This study analyses discordance rates between attainment of therapeutic goals for apolipoprotein B100 (apoB) and both low-density lipoprotein-cholesterol (LDL-C) and non-high-density lipoprotein-cholesterol (non-HDL-C) in a sample of 152 patients with type 2 diabetes and chronic kidney disease from Gran Canaria (Spain), using treatment targets recommended by the American Diabetes Association/American College of Cardiology (ADA/ACC), the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) and by a Spanish population-based study. Among subjects with LDL-C levels at therapeutic goal, apoB was above target in 16.3% (ADA/ACC), 6.5% (ESC/EAS) and 39.1% (population-based criteria), and among subjects with non-HDL-C levels at therapeutic goal, apoB was above target in 10.5% (ADA/ACC), 1.2% (ESC/EAS) and 29.6% (population-based criteria). These findings show that clinical management would be very differently altered depending on the criteria used to set treatment targets for apoB. Cut-off points derived from population data identify a greater number of subjects suitable for a more intensive lipid-lowering therapy. PMID:24254975

Boronat, Mauro; García-Cantón, César; López-Ríos, Laura; Quevedo, Virginia; Lorenzo, Dionisio L; Batista, Fátima; Riaño, Marta; Nóvoa, Francisco J

2014-01-01

321

The clinical features, management and prognosis of primary and secondary indolent lymphoma of the bone: a retrospective study of the International Extranodal Lymphoma Study Group (IELSG #14 study).  

PubMed

Indolent lymphomas primarily involving the skeleton (iPBL) represent < 1% of all primary bone lymphomas. The management and prognosis have not been previously described. Patients with primary and secondary iPBL were selected from an international database of 499 patients with a histopathological diagnosis of non-Hodgkin lymphoma and skeleton involvement, and clinical features, management and prognosis were analyzed. Twenty-six (5%) patients had an iPBL. Ten patients had small lymphocytic lymphoma, 10 had follicular lymphoma and six had lymphoplasmacytic lymphoma. Eleven patients had limited stage and 15 had advanced disease. The overall response rate was 73% (95% confidence interval [CI] = 57-89%). Median follow-up was 58 months, and the 5- and 10-year progression-free survival (PFS) rates were 37 ± 10% and 25 ± 12%, respectively. Nine patients are alive, with 5- and 10-year overall survival (OS) rates of 46 ± 10% and 29 ± 11%, respectively. Patients with small lymphocytic lymphoma showed significantly better outcome than patients with follicular lymphoma. Performance status and stage of disease were independently associated with OS. The prognosis of patients with primary bone lymphoplasmacytic or follicular lymphoma was less favorable. PMID:24295130

Govi, Silvia; Christie, David; Mappa, Silvia; Marturano, Emerenziana; Bruno-Ventre, Marta; Messina, Carlo; Medina, Elías A Gracia; Porter, David; Radford, John; Heo, Dae Seog; Park, Yeon; Pro, Barbara; Jayamohan, Jayasingham; Pavlakis, Nick; Zucca, Emanuele; Gospodarowicz, Mary; Ferreri, Andrés J M

2014-08-01

322

Special Issue Topic: School Choice.  

ERIC Educational Resources Information Center

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

Brogan, Bernard R.; And Others

1991-01-01

323

Management of irritable bowel syndrome in primary care: the results of an exploratory randomised controlled trial of mebeverine, methylcellulose, placebo and a self-management website  

PubMed Central

Background Many patients with IBS suffer on-going symptoms. The evidence base is poor for IBS drugs but they are widely prescribed and advised in Guidelines. Cognitive Behavioural Therapy (CBT) can be helpful, but availability is poor in the NHS. We developed a web-based CBT self-management programme (Regul8) in partnership with patients and trialled it and common IBS medications in an exploratory factorial RCT to test trial procedures and provide information for a larger trial. Methods Patients, 16 to 60 years, with IBS symptoms fulfilling Rome III criteria were recruited via GP practices and randomised to over-encapsulated mebeverine, methylcellulose or placebo for 6 weeks and to 1 of 3 website conditions: Regul8 with a nurse telephone session and email support, Regul8 with minimal email support, or no website. Results 135 patients recruited from 26 GP practices. Mean IBS SSS score 241.9 (sd 87.7), IBS-QOL 64 (sd 20) at baseline. 91% follow-up at 12 weeks. Mean IBS SSS decreased by 35 points from baseline to 12 weeks. There was no significant difference in IBS SSS or IBS-QOL score between medication or website groups at 12 weeks, or in medication groups at 6 weeks, or IBS-QOL in website groups at 6 weeks. However, IBS SSS at 6 weeks was lower in the No website group than the website groups (IBS SSS no website =162.8 (95% CI 137.4-188.3), website 197.0 (172.4 - 221.7), Website + telephone support 208.0 (183.1-233.0) p?=?0.037). Enablement and Subjects Global Assessment of relief (SGA) were significantly improved in the Regul8 groups compared to the non-website group at 12 weeks (Enablement =?0 in 56.8% of No website group, 18.4% website, 10.5% Website + support, p?=?0.001) (SGA; 32.4% responders in No website group, 45.7% website group, 63.2% website + support group, p?=?0.035). Conclusions This exploratory study demonstrates feasibility and high follow-up rates and provides information for a larger trial. Primary outcomes (IBS SS and IBS QOL) did not reach significance at 6 or 12 weeks, apart from IBS SSS being lower in the no-website group at 6 weeks - this disappeared by 12 weeks. Improved Enablement suggests patients with access to the Regul8 website felt better able to cope with their symptoms than the non-website group. Improved SGA score in the Regul8 groups may indicate some overall improvement not captured on other measures. Trial registration ClinicalTrials.gov Identifier (NCT number): NCT00934973. PMID:23602047

2013-01-01

324

[Institutional support as a fundamental aspect for joint management in primary health care: the experience of a program in Rio de Janeiro, Brazil].  

PubMed

This article presents reflections regarding the concepts and praxis of a new feature for health care and management, namely institutional support. It is seen as a management tool for enhancing quality of care, which has the potential to reformulate the hierarchical and authoritarian practices of health coordination and planning. Institutional support is a trigger for change that can enhance the autonomy, accountability, collective practices and new relationships between managers, professionals and users of the health system. These assumptions are aligned with the concepts of comprehensive and participatory Primary Health Care (PHC), which lead us to the conclusion that matricial and institutional support are processes that generate new models of health care and management. To appreciate the modus operandi of this feature, the Teias Escola Manguinhos/ENSP/Fiocruz experience is presented as a case study, one of the main pillars of which is the adoption of institutional support as a strategy for joint accountability and participative management of PHC in a community in the city of Rio de Janeiro. PMID:25351308

Casanova, Angela Oliveira; Teixeira, Mirna Barros; Montenegro, Elyne

2014-11-01

325

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

326

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

327

Modelling television programming choices  

Microsoft Academic Search

The paper extends Waterman's application of Salop's monopolistically competitive model of circular product space to television programming, by introducing considerations of a program's breadth of appeal and consumer intensity of demand in the analysis of programming choices. The effects of external cultural benefits associated with domestic programming are also examined. Consistent with the findings of previous researchers, the model illustrates

Franco Papandrea

1997-01-01

328

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.

329

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

330

Moody choice Paola Manzini  

E-print Network

-22-3474 is gratefully acknowl- edged. 1 #12;1 Introduction Mood affects choice. This relationship has been analysed and exercise habits (Thayer [58], [59]), and recently it has been discovered that the experience of stress is associated with a preference among men for heavier female bodies (Swami and Tovee [57]). Positive or negative

Sheldon, Nathan D.

331

Choices 2010 Participation Overview  

E-print Network

the personal and financial health of you and your family. Just look for the "Back 2 Basics" logo for tips time again--time to think about your family, your health and your benefits needs for 2010. How to Use choices. For most JHU faculty and staff, there will be no significant changes to your 2010 health

Niebur, Ernst

332

Choices and Challenges.  

ERIC Educational Resources Information Center

The president of the National Council of Teachers of Mathematics (NCTM) examines the definition of basic mathematics skills. One basic skill is understanding formulas that are used in real life. Recommends that educators use the message of NCTM's standards to make choices that will reinvent mathematics education. Challenges teachers to teach…

Burrill, Gail

1997-01-01

333

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

334

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

335

Principals as Middle Managers: School Leadership during the Implementation of Primary Class Size Reduction Policy in Ontario  

ERIC Educational Resources Information Center

Previous work on policy implementation has often suggested that schools leave their "thumbprints" on policies received from above. During the implementation of Primary Class Size Reduction (PCS) Initiative in Ontario, Canada, however, school principals spoke with remarkable uniformity about the ways PCS affected their work. This article reports…

Flessa, Joseph J.

2012-01-01

336

Using the UK primary care Quality and Outcomes Framework to audit health care equity: preliminary data on diabetes management  

Microsoft Academic Search

Background The incentivization of UK primary care through the Quality and Outcomes Framework (QOF) has released an unprecedented supply of data that in theory could aid health equity audit and reduce health inequalities. The current system allows for 'exception reporting' whereby patients can be excluded from calculation of payment for reasons such as failure to attend review. We speculated that

L. A. Sigfrid; C. Turner; D. Crook; S. Ray

2006-01-01

337

Structural differences between a primary and a secondary forest in the Argentine Dry Chaco and management implications  

Microsoft Academic Search

We studied the structure of a primary and a secondary forest in the driest portion of the South American Chaco (average annual precipitation 400mm) and the forest evolution after exploitation. The work was conducted in Chancaní Provincial Natural Park and Forest Reserve, Córdoba, Argentina, where the best preserved forests of the region are found. The secondary forest was subjected to

Emma E. Bonino; Publio Araujo

2005-01-01

338

Clinical determinants of migraine preventive treatment: Contribution of SMILE, an observational survey of primary care migraine management in France  

Microsoft Academic Search

Methods: SMILE was an observational study carried out in France among office-based general practitioners (GPs) and neurologists from November 2005 to July 2006 to assess the determinants of prescription of migraine preventive therapy in primary care medicine. A total of 1467 GPs and 83 neurologists were included, treating 5417 and 248 migraine sufferers, respectively.Results: The main factors leading physicians to

D. Valade; M. Lanteri-Minet; F. Radat; C. Mekies; C. Lucas; E. Vivies; JM Joubert; G. Geraud

2010-01-01

339

Confidence and quality in managing CKD compared with other cardiovasculardiseases and diabetes mellitus: a linked study of questionnaire androutine primary care data  

Microsoft Academic Search

Much of chronic disease is managed in primary care and chronic kidney\\u000d\\u000a\\u0009disease (CKD) is a recent addition. We are conducting a cluster randomised\\u000d\\u000a\\u0009study of quality improvement interventions in CKD (QICKD) - Clinical\\u000d\\u000a\\u0009Trials Registration: ISRCTN56023731. CKD registers have a lower than\\u000d\\u000a\\u0009expected prevalence and an initial focus group study suggested variable\\u000d\\u000a\\u0009levels of confidence in managing CKD. Our

Mohammad A. Tahir; Olga Dmitrieva; Simon de Lusignan; Jeremy van Vlymen; Tom Chan; Ramez Golmohamad; Kevin Harris; Charles Tomson; Nicola Thomas; Hugh Gallagher

2011-01-01

340

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

341

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

342

Are ADHD Symptoms Associated with Delay Aversion or Choice Impulsivity? A General Population Study  

ERIC Educational Resources Information Center

The relationship of attention-deficit/hyperactivity disorder (ADHD) with choice impulsivity is examined. Findings were found to indicate that primary constitutional processes that underlie choice impulsivity and their potential role in behavioral inattention are important. It was also found that behavioral and brain processes that underlie choice

Paloyelis, Yannis; Asherson, Philip; Kuntsi, Jonna

2009-01-01

343

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial  

PubMed Central

Background The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. Methods In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n?=?253), protocolized (n?=?197), and usual care (n?=?333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Results Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Conclusions Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. Trial registration Current Controlled trials: ISRCTN66124817. PMID:24966055

2014-01-01

344

Primary ciliary dyskinesia: recent advances in epidemiology, diagnosis, management and relationship with the expanding spectrum of ciliopathy.  

PubMed

Human cilia were once thought merely to be important in respiratory mucociliary clearance, with primary ciliary dyskinesia (PCD) the sole manifestation of ciliary dysfunction. There are now known to be three types of cilia: primary, nodal and motile. Cilia are complex, likely involving more than 1000 gene products; in this review, recent advances in PCD genetics, and the potential relationships with genes causing other ciliopathies, are discussed. PCD is the most important respiratory disease, characterized by upper and lower airway infection and inflammation and disorders of laterality. Ciliary gene mutations are now known to cause single organ disease, as well as complex syndromes. The focus of the review is primarily PCD, in the context of the expanding ciliopathy spectrum. The authors consider the clinical situations in which ciliary disease should be considered, and the implications for specialist respiratory practice. PMID:23234452

Bush, Andrew; Hogg, Claire

2012-12-01

345

CropChoice  

NSDL National Science Digital Library

CropChoice is an alternative news and information source for American farmers and consumers about genetically modified crops, corporate agribusiness concentration, farm and trade policy, sustainable agriculture, wind farming and alternative energy, and rural economic and social issues. Users can explore the site's resources by topic, search past headlines and view press releases. Links are provided to sites that involve similar issues and information.

2007-04-16

346

Contraceptive counselling and factors affecting women's contraceptive choices: results of the CHOICE study in Austria.  

PubMed

Empirical evidence of the impact of contraceptive counselling and factors affecting women's contraceptive choices are limited. CHOICE (Contraceptive Health Research Of Informed Choice Experience) was a large-scale study in 11 European countries. Women in Austria aged 15-40 years considering a short-acting, reversible form of combined hormonal contraceptive were eligible to participate. The choices included the combined daily pill, weekly transdermal patch, and monthly vaginal ring. This study assessed and compared 2478 women's original preferences with their post-counselling choices and evaluated their perceptions and criteria for their choice. Women who were 'undecided' decreased from 18.1% pre-counselling to 3.2% post-counselling; significantly more women post-counselling chose the monthly ring (8.7% to 23.8%; difference 15.1%, 95% CI 13.3-16.8%; P<0.0001) or the weekly patch (6.2% to 7.8%; difference 1.7%, 95% CI 0.5-2.9%; P=0.0014). Women's primary reasons for choosing a method included 'easy to use' (daily pill, weekly patch and monthly ring) and 'still effective if I experience vomiting, diarrhoea' (weekly patch and monthly ring). Structured and balanced counselling led to changes in the method chosen. PMID:22285247

Egarter, Christian; Grimm, Christoph; Nouri, Kazem; Ahrendt, Hans-Joachim; Bitzer, Johannes; Cermak, Christine

2012-06-01

347

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

348

Quality indicators for the prevention and management of cardiovascular disease in primary care in nine European countries  

Microsoft Academic Search

BACKGROUND: With free movement of labour in Europe, European guidelines on cardiovascular care and the enlargement of the European Union to include countries with disparate health care systems, it is important to develop common quality standards for cardiovascular prevention and risk management across Europe. METHODS: Panels from nine European countries (Austria, Belgium, Finland, France, Germany, Netherlands, Slovenia, United Kingdom and

Stephen M. Campbell; Sabine Ludt; Jan Van Lieshout; Nicole Boffin; Michel Wensing; Davorina Petek; Richard Grol; Martin O. Roland

2008-01-01

349

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

350

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

351

Are Forms of Financial Support and Employment Choices of Recent Science and Engineering Ph.D.s Related?  

NSF Publications Database

... Choices of Recent Science and Engineering Ph.D.s Related? (July 22, 1998) This issue brief ... employment choices of recent S&E Ph.D.s and their primary mechanisms of financial support while in ...

352

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

353

Primary renal angiosarcoma  

PubMed Central

Primary angiosarcoma of the kidney is a rare tumor with only a few case reports in the literature. Management is not standardized and the prognosis is poor. However, clinicians need to be aware of this uncommon entity. PMID:23956520

Sabharwal, Sagar; John, Nirmal Thampi; Kumar, Ramani M.; Kekre, Nitin S.

2013-01-01

354

Inside the Primary Classroom.  

ERIC Educational Resources Information Center

Presents some of the findings of the ORACLE research program (Observational Research and Classroom Learning Evaluation), a detailed observational study of teacher-student interaction, teaching styles, and management methods within a sample of primary classrooms. (Editor/SJL)

Simon, Brian

1980-01-01

355

Undergraduate studies in primary education,  

E-print Network

with Teaching Qualification #12;BSc (Hons) Environmental Stewardship Stewardship is the care and managementUndergraduate studies in primary education, environmental subjects and health & social policy Work west Scotland. It's a specialist campus for primary education, environmental studies and health

Guo, Zaoyang

356

Routing problem with service choices  

E-print Network

This thesis finds solutions to the routing problem with service choices which is formulated as a capacitated minimum cost flow circulation problem with GUB constraints. The routing problem with service choices is solved ...

Lee, Boon Chai

1986-01-01

357

A Primary Care Migraine Education Program has Benefit on Headache Impact and Quality of Life: Results from the Mercy Migraine Management Program  

PubMed Central

Objective The objective of this study was to evaluate the effectiveness of the Mercy Migraine Management Program (MMMP), an educational program for physicians and patients. The primary outcome was change in headache days from baseline at 3, 6, and 12 months. Secondary outcomes were changes in migraine-related disability and quality of life, worry about headaches, self-efficacy for managing migraines, ER visits for headache, and satisfaction with headache care. Background Despite progress in the understanding of the pathophysiology of migraine and development of effective therapeutic agents, many practitioners and patients continue to lack the knowledge and skills to effectively manage migraine. Educational efforts have been helpful in improving the quality of care and quality of life for migraine sufferers. However, little work has been done to evaluate these changes over a longer period of time. Also, there is a paucity of published research evaluating the influence of education about migraine management on cognitive and emotional factors (e.g., self-efficacy for managing headaches, worry about headaches). Methods In this open-label, prospective study, 284 individuals with migraine (92% female, mean age = 41.6) participated in the MMMP, an educational and skills based program. Of the 284 who participated in the program, 228 (80%) provided data about their headache frequency, headache-related disability (as measured by the Headache Impact Test-6 (HIT-6), migraine-specific quality of life (MSQ), worry about headaches, self-efficacy for managing headaches, ER visits for headaches, and satisfaction with care at four time points over 12 months (baseline, 3 months, 6 months, 12 months). Results Overall, 46% (106) of subjects reported a 50% or greater reduction in headache frequency. Over 12 months, patients reported fewer headaches and improvement on the HIT-6 and MSQ (all p < .001). The improvement in headache impact and quality of life was greater among those who had more worry about their headaches at baseline. There were also significant improvements in ‘worry about headaches’, ‘self-efficacy for managing headaches’, and ‘satisfaction with headache care’. Conclusion The findings demonstrate that patients participating in the MMMP reported improvements in their headache frequency as well as the cognitive and emotional aspects of headache management. This program was especially helpful among those with high amounts of worry about their headaches at the beginning of the program. The findings from this study are impetus for further research that will more clearly, through evaluate the effects of education and skill development not only on headache but also emotional and cognitive influences. PMID:20148982

Smith, Timothy R.; Nicholson, Robert A.; Banks, James W.

2010-01-01

358

More Choices Available for Diabetes Management  

MedlinePLUS

... those questions, continuous glucose monitors (CGMs) and insulin pumps are tools that you and your health care ... healthcare provider may want to consider: • an insulin pump, which is a computerized device that can deliver ...

359

Choice Based Revenue Management for Parallel Flights  

E-print Network

Mar 5, 2014 ... world, involving about 30 flights per day by three major airlines that we ..... products, for example, the airline's own web site, the airline's call center, ...... Some customers are flexible and may consider all flights in a wide time ...

2014-03-05

360

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

361

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

PubMed

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 inner city schools. Teachers completed the Sutter-Eyberg Student Behavior Inventory (SESBI) and the Teacher's Rating Scale of Child's Actual Competence and Social Acceptance (TRS) at baseline and again upon completion of the intervention. Boys participating in INSIGHTS, compared with those in the Read Aloud program, showed a significant decline in attentional difficulties and overt aggression toward others. Teachers in INSIGHTS, compared to those in the attention control condition, reported significantly fewer problems managing the emotional-oppositional behavior, attentional difficulties, and covert disruptive behavior of their male students. They also perceived the boys as significantly more cognitively and physically competent. PMID:20234765

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

2010-03-01

362

Fertilization effects on forest carbon storage and exchange, and net primary production: A new hybrid process model for stand management  

Microsoft Academic Search

A critical ecological question in plantation management is whether fertilization, which generally increases yield, results in enhanced C sequestration over short rotations. We present a rotation-length hybrid process model (SECRETS-3PG) that was calibrated (using control treatments; CW) and verified (using fertilized treatments; FW) using daily estimates of H2O and CO2 fluxes, canopy leaf area index (L), and annual estimates of

D. A. Sampson; R. H. Waring; C. A. Maier; C. M. Gough; M. J. Ducey; K. H. Johnsen

2006-01-01

363

RECODE: Design and baseline results of a cluster randomized trial on cost-effectiveness of integrated COPD management in primary care  

PubMed Central

Background Favorable effects of formal pulmonary rehabilitation in selected moderate to severe COPD patients are well established. Few data are available on the effects and costs of integrated disease management (IDM) programs on quality of care and health status of COPD patients in primary care, representing a much larger group of COPD patients. Therefore, the RECODE trial assesses the long-term clinical and cost-effectiveness of IDM in primary care. Methods/design RECODE is a cluster randomized trial with two years of follow-up, during which 40 clusters of primary care teams (including 1086 COPD patients) are randomized to IDM or usual care. The intervention started with a 2-day multidisciplinary course in which healthcare providers are trained as a team in essential components of effective COPD IDM in primary care. During the course, the team redesigns the care process and defines responsibilities of different caregivers. They are trained in how to use feedback on process and outcome data to guide implement guideline-driven integrated healthcare. Practice-tailored feedback reports are provided at baseline, and at 6 and 12 months. The team learns the details of an ICT program that supports recording of process and outcome measures. Afterwards, the team designs a time-contingent individual practice plan, agreeing on steps to be taken in order to integrate a COPD IDM program into daily practice. After 6 and 12 months, there is a refresher course for all teams simultaneously to enable them to learn from each other’s experience. Health status of patients at 12 months is the primary outcome, measured by the Clinical COPD Questionnaire (CCQ). Secondary outcomes include effects on quality of care, disease-specific and generic health-related quality of life, COPD exacerbations, dyspnea, costs of healthcare utilization, and productivity loss. Discussion This article presents the protocol and baseline results of the RECODE trial. This study will allow to evaluate whether IDM implemented in primary care can positively influence quality of life and quality of care in mild to moderate COPD patients, thereby making the benefits of multidisciplinary rehabilitation applicable to a substantial part of the COPD population. Trial registration Netherlands Trial Register (NTR): NTR2268 PMID:23522095

2013-01-01

364

BRIEF REPORT Predicting Affective Choice  

E-print Network

BRIEF REPORT Predicting Affective Choice Gaurav Suri Stanford University Gal Sheppes Tel Aviv quantified the role of two basic dimensions of affect--valence and arousal--in determining choice. We predicted choice and outperformed competing models drawn from well-established theoretical views. Finally

Gross, James J.

365

After Busing: Education and Choice.  

ERIC Educational Resources Information Center

Argues that mandatory busing, while resulting in cases of "White flight," has had positive consequences in the re-emergence of "choice" programs and magnet schools. Contends that choice programs can be expanded on intradistrict, metropolitan, and statewide levels. Suggests that Federal funding and private education should be included in choice

Armor, David J.

1989-01-01

366

Overcoming Barriers in the Management of Hypertension: The Experience of the Cardiovascular Health Program in Chilean Primary Health Care Centers  

PubMed Central

Objective. To assess the blood pressure control and cardiovascular risk factors (CVRFs) in a population of hypertensive patients with access to care under a government-financed program, the Cardiovascular Health Program (CHP). Design. A cross-sectional and multicenter study. Setting. 52 primary care centers, metropolitan area of Santiago, Chile. Participants. 1,194 patients were selected by a systematic random sampling from a universe of 316,654 hypertensive patients. Key Measurements. Demographic information, blood pressure (BP) measurements, and CVRF were extracted from medical records of patients followed for a 12-month period. Results. 59.7% of patients reached target BP <140/90?mmHg. More women were captured in the sampling (2.1?:?1), achieving better BP control than men. Diabetic patients (26.4%) had worse BP control than nondiabetics. Antihypertensive medications were used in 91.5%, with multidrug therapy more frequent in patients with higher BP and more difficult control. Conclusions. The success in improving the BP control to values <140/90?mmHg from 45.3% to 59.7% underscores the contribution of this program in the Chilean primary care cardiovascular preventive strategies. However, fewer hypertensive men than women were captured by this program, and it is of concern the underperforming of BP control observed in diabetics. PMID:22701781

Sandoval, Daniela; Bravo, Miguel; Koch, Elard; Gatica, Sebastián; Ahlers, Ivonne; Henríquez, Oscar; Romero, Tomás

2012-01-01

367

Factors facilitating and constraining the scaling up of an evidence-based strategy of community-based primary care: Management perspectives from northern Ghana.  

PubMed

From 1994 to 2003, the government of Ghana investigated the child survival and fertility impacts of community-based primary care nurses and volunteer mobilisation efforts. This study, known as the Navrongo Project, demonstrated improved health outcomes and was scaled-up as the Community-based Health Planning and Services (CHPS) Initiative. Studies suggest that scaled-up CHPS services have not fully replicated the impact of the Project. This study investigates implementation challenges that could explain this atrophy by assembling the perspectives of health care managers that have experience with both the Project and CHPS. Data from in-depth interviews of health managers are analysed using deductive content analysis. Respondents exhibited a consistent vision of doorstep services with regard to the Project and CHPS. They shared the perspective that while scale-up has progressed slowly, it has expanded the range of services provided. Respondents felt, however, that the original emphasis on community involvement has atrophied with scale-up and that current operations are managed less rigorously than during the Project. Thus, while the expanded scope of CHPS has increased access to health care, the original focus on community engagement has faded. The original Project leadership strategy merits review for ways to integrate leadership development into scale-up activities. PMID:25436901

Krumholz, Abigail R; Stone, Allison E; Dalaba, Maxwell A; Phillips, James F; Adongo, Philip B

2015-03-01

368

Intraoperative management of a carbon dioxide embolus in the setting of laparoscopic cholecystectomy for a patient with primary biliary cirrhosis: A case report  

PubMed Central

INTRODUCTION Carbon dioxide (CO2) embolism is a rare complication of laparoscopic cholecystectomy of which both surgeons and anesthesiologists must be aware. This paper presents a case of a CO2 embolus that occurred in a patient with primary biliary cirrhosis (PBC) and discusses the possible correlation between these two events. PRESENTATION OF CASE Our patient with PBC presented with symptomatic biliary dyskinesia and was determined to be a good candidate for laparoscopic cholecystectomy. During this routine surgery a CO2 embolus entered through the altered hepatic parenchyma and progressed to the heart leading to acute hemodynamic collapse. Rapid detection and management aided in the subsequent dissolution of the embolus and recovery of the patient. DISCUSSION In patients with PBC, pathological changes that have taken place in the liver may increase the risk of CO2 embolism. Hepatic alterations that have been previously described include increased angiogenesis and vasodilation. Prior to the operation, the most appropriate method of monitoring should be determined for patients with known liver disease. CONCLUSION Both the surgical and anesthesia team must keep in mind the potential for CO2 embolism during laparoscopic surgery. It is imperative that the medical staff be aware of the risks, signs, and subsequent management so this rare, but potentially fatal event can be managed appropriately. PMID:25462045

Cadis, Amy Susan; Velasquez, Chelsea Diane; Brauer, Mark; Hoak, Bruce

2014-01-01

369

Febrile illness management in children under five years of age: a qualitative pilot study on primary health care workers’ practices in Zanzibar  

PubMed Central

Background In Zanzibar, malaria prevalence dropped substantially in the last decade and presently most febrile patients seen in primary health care facilities (PHCF) test negative for malaria. The availability of rapid diagnostic tests (RDTs) allows rural health workers to reliably rule out malaria in fever patients. However, additional diagnostic tools to identify alternative fever causes are scarce, often leaving RDT-negative patients without a clear diagnosis and management plan. This pilot study aimed to explore health workers’ practices with febrile children and identify factors influencing their diagnostic and management decisions in non-malarial fever patients. Methods Semi-structured key informant interviews were conducted with 12 health workers in six PHCFs in North A district, Zanzibar, April to June 2011. Interviews were coded using Atlas.ti to identify emerging themes that play a role in the diagnosis and management of febrile children. Results The following themes were identified: 1) health workers use caregivers’ history of illness and RDT results for initial diagnostic and management decisions, but suggest caregivers need more education to prevent late presentation and poor health outcomes; 2) there is uncertainty regarding viral versus bacterial illness and health workers feel additional point-of-care diagnostic tests would help with differential diagnoses; 3) stock-outs of medications and limited caregivers’ resources are barriers to delivering good care; 4) training, short courses and participation in research as well as; 5) weather also influences diagnostic decision-making. Conclusions This pilot study found that health workers in Zanzibar use caregiver history of fever and results of malaria RDTs to guide management of febrile children. However, since most febrile children test negative for malaria, health workers believe additional training and point-of-care tests would improve their ability to diagnose and manage non-malarial fevers. Educating caregivers on signs and symptoms of febrile illness, as well as the introduction of additional tests to differentiate between viral and bacterial illness, would be important steps to get children to PHCFs earlier and decrease unnecessary antibiotic prescribing without compromising patient safety. More research is needed to expand an understanding of what would improve fever management in other resource-limited settings with decreasing malaria. PMID:23356837

2013-01-01

370

A mobile phone application for the assessment and management of youth mental health problems in primary care: health service outcomes from a randomised controlled trial of mobiletype  

PubMed Central

Background GPs detect at best 50c of mental health problems in young people. Barriers to detecting mental health problems include lack of screening tools, limited appointment times and young people’s reluctance to report mental health symptoms to GPs. The mobiletype program is a mobile phone mental health assessment and management application which monitors mood, stress and everyday activities then transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. The current aims were to examine: (i) mobiletype as a clinical assistance tool, ii) doctor-patient rapport and, iii) pathways to care. Methods We conducted a randomised controlled trial in primary care with patients aged 14 to 24 years recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress and daily activities were monitored) or the attention-comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants and researchers were blind to group allocation at randomisation. GPs assessed the mobiletype program as a clinical assistant tool. Doctor-patient rapport was assessed using the General Practice Assessment Questionnaire Communication and Enablement subscales, and the Trust in Physician Scale (TPS). Pathways to care was measured using The Party Project’s Exit Interview. Results Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention n?=?68, attention-comparison n?=?46). T-tests showed that the intervention program increased understanding of patient mental health, assisted in decisions about medication/referral and helped in diagnosis when compared to the attention-comparison program. Mixed model analysis showed no differences in GP-patient rapport nor in pathways to care. Conclusions We conducted the first RCT of a mobile phone application in the mental health assessment and management of youth mental health in primary care. This study suggests that mobiletype has much to offer GPs in the often difficult and time-consuming task of assessment and management of youth mental health problems in primary care. Trial registration ClinicalTrials.gov NCT00794222 PMID:23782796

2013-01-01

371

Frontline: The Choice 2000  

NSDL National Science Digital Library

According to the polls, many Americans have yet to make up their minds about who they will vote for next Tuesday in the Presidential race. This Website could help them decide. The companion site to a recent two-hour Frontline special on the backgrounds and character of Al Gore and George W. Bush, The Choice offers the entire broadcast in RealPlayer as well as significant additional materials. Among these are issue briefs from Frontline on the candidates's stands on issues such as abortion, health care, education, the environment, campaign finance reform, and others, as well as supplemental video interviews with friends and family of the candidates and a photo gallery of both candidates from birth to the present. A Tools for Choice feature invites visitors to take a 20-question quiz to find out which candidate, including Nader and Buchanan, better reflects their views and offers links to NPR and Newshour stories about the "Nader Factor," the candidates's economic plans, the decision process for undecideds in the battleground state of Ohio, and a review of the candidates's Websites, entitled WWW.Dull.

372

Health education in the management of diabetes at the primary health care level: is there a gender difference?  

PubMed

We examined differences between male and female diabetic patients, as recipients of health education messages provided in a primary health care setting and its implications on the control of the disease. The files of 198 diabetic patients attending a diabetes clinic in Abha, Saudi Arabia were analysed. The results showed that females had significantly higher body mass index and fasting blood sugar levels than men with significantly fewer mean number of health education sessions in the last 12 months. Multiple logistic regression model pointed to the female sex as a significant predictor of poor glycaemic control. The model for females alone showed significantly poorer diabetes control when the number of health education sessions received was less. PMID:15330556

Abdelmoneim, I; Al-Homrany, M A

2002-01-01

373

Primary cutaneous B-cell lymphomas: part II. Therapy and future directions.  

PubMed

The choice of therapy for primary cutaneous B-cell lymphoma (PCBCL) relies on correct histopathologic classification and the exclusion of systemic disease. In part II of this continuing medical education article, we will review the available therapies for the different types of PCBCL. Primary cutaneous follicle center lymphoma (PCFCL) and primary cutaneous marginal zone lymphoma (PCMZL) are indolent tumors with an excellent prognosis. They are managed similarly with local therapy, such as radiotherapy or surgical excision, for isolated disease and observation for asymptomatic multifocal presentations. Relapses are common in both PCFCL and PCMZL, but overall survival remains excellent. Primary cutaneous diffuse large B-cell lymphoma (both leg type and other) has a much poorer prognosis than indolent PCBCL, and it often requires an aggressive approach with radiation therapy and/or multiagent chemotherapy. Investigational approaches hold promise for the treatment of these malignancies, particularly primary cutaneous diffuse large B-cell lymphoma. PMID:23957985

Suárez, Andrea Luísa; Querfeld, Christiane; Horwitz, Steven; Pulitzer, Melissa; Moskowitz, Alison; Myskowski, Patricia L

2013-09-01

374

Crisis Counseling for a Quality School Community: Applying William Glasser's Choice Therapy.  

ERIC Educational Resources Information Center

This book draws upon William Glasser's choice theory, which categorically rejects external control psychology. Part I, "Seeing Crises in a Context," includes: (1) "Managing for Quality in the Schools" (W. Glasser); (2) "Reality Therapy and Choice Theory: Making Personal Choices for a Change" (L. L. Palmatier); (3) "Crisis Theory: Counseling…

Palmatier, Larry L., Ed.

375

A Randomized Controlled Trial to Improve Primary Care to Prevent and Manage Childhood Obesity: The High Five for Kids Study  

PubMed Central

Objective To examine the effectiveness of a primary care-based obesity intervention over the first year (6 intervention contacts) of a planned 2 year study. Design Cluster-randomized controlled trial. Setting 10 pediatric practices; 5 Intervention and 5 Usual Care. Participants 475 children ages 2 – 6 years with body mass index (BMI) ? 95th percentile or 85th- < 95th percentile if at least one parent was overweight; 445 (93%) had 1 year outcomes. Intervention Intervention practices received primary care restructuring, and families received motivational interviewing by clinicians and educational modules targeting TV, fast food, and sugar sweetened beverages. Outcome Measures Change in BMI and obesity-related behaviors from baseline to 1 year. Results Compared with usual care, intervention participants had a smaller, non-significant increase in BMI (?0.21 kg/m2; 95% CI: ?0.50, 0.07; p=0.15), greater decreases in TV viewing (?0.36 hours/day; 95% CI: ?0.64, ?0.09; p=0.01) and had slightly greater decreases in fast food (?0.16 servings/week; 95% CI: ?0.33, 0.01; p=0.07) and sugar sweetened beverages (?0.22 servings/day; 95% CI: ?0.52, 0.08; p=0.15). In post-hoc analyses, we observed significant effects on BMI among females (?0.38 kg/m2; 95% CI: ?0.73, ?0.03; p=0.03) but not males (0.04 kg/m2; 95% CI: ?0.55, 0.63; p=0.89) and among participants in households with annual incomes $50,000 or less (?0.93 kg/m2; 95% CI: ?1.60, ?0.25; p=0.01) but not in higher income households (0.02 kg/m2; 95% CI: ?0.30, 0.33; p=0.92). Conclusions After 1 year, the High Five for Kids intervention was effective in reducing TV viewing but did not significantly reduce BMI. PMID:21464376

Taveras, Elsie M.; Gortmaker, Steven L.; Hohman, Katherine H.; Horan, Christine M.; Kleinman, Ken P.; Mitchell, Kathleen; Price, Sarah; Prosser, Lisa A.; Rifas-Shiman, Sheryl L.; Gillman, Matthew W.

2013-01-01

376

Office diagnosis and management of group A streptococcal pharyngitis employing the rapid antigen detecting test. A 1-year prospective study of reliability and cost in primary care centres.  

PubMed

The impact of introducing the rapid antigen detecting test for the diagnosis of group A streptococcal pharyngitis in primary care centres and the direct and comprehensive cost-effectiveness of four alternative strategies for the management of group A streptococcal pharyngitis and the prevention of rheumatic fever were assessed in a 1-year prospective randomized study, carried out in children between the ages of 5 and 14 years. Data from the study showed that the test was easy to perform and reliable when introduced as a service in primary care. The strategy of using the rapid antigen detecting test and a 10-day oral penicillin course for diagnosis and treatment proved to be the safest and most cost-effective. If compliance with a 10-day course of oral penicillin is unlikely to be achieved, the strategy of introducing the test and treatment by intramuscular benzathin penicillin G proved to be the second best cost-effective alternative. In developing countries, where acute rheumatic fever is still common and the cost of the test and a 10-day course of penicillin may prove to be formidable, a strategy of treating all children with pharyngitis with intramuscular benzathin penicillin G seems to be the most cost-effective. The strategy of diagnosing group A streptococcal pharyngitis on clinical grounds proved to be the worst. PMID:7681647

Majeed, H A; al-Doussary, L; Moussa, M M; Yusuf, A R; Suliman, A H

1993-01-01

377

Understanding awareness of pharmacist-led medication therapy management among primary care physicians in New York City using qualitative methods: part I.  

PubMed

Pharmacist-led medication therapy management (MTM) programs have been shown to be an effective method of optimizing patient therapy for multiple disease states through improved clinical outcomes and decreased healthcare costs. Physicians have recognized pharmacists' ability to identify and prevent prescription errors, and educate patients about safe and appropriate medication use. Pharmacist interventions may help ease the burden of chronic disease among primary care providers and pave the way for a team-based approach in caring for underserved patients with heavy disease burdens. The New York City Department of Health and Mental Hygiene performed a qualitative study to obtain a better understanding of the perceptions related to pharmacist-led MTM programs among primary care physicians in New York City. Key findings from our study suggest that educating physicians on MTM and the role of pharmacists in the healthcare team is crucial to building trusting relationships for collaborative patient care. Key concerns among physicians included demonstrated pharmacist competency, integration of documentation systems, impact on workload, and effective collaboration between physicians and pharmacists. In this article, we describe our study rationale, design, and preliminary findings. A more detailed report and potential impact of our findings will be provided in Part II of this article. PMID:24228367

Arya, Vibhuti; Pinto, Sharrel; Singer, Jesse; Khan, Tasmiya

2013-01-01

378

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

PubMed Central

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 cross-sectional sample of 648 patients with non-specific low back pain was recruited by 75 physicians (out of 361 – 20.8%) working in 40 primary care centers in 10 of the 17 administrative regions in Spain, covering 693,026 out of the 40,499,792 inhabitants. Patients were assessed on the day they were recruited, and prospectively followed-up 14 and 60 days later. The principal patient characteristics that were analyzed were: sex, duration of the episode, history of LBP, working status, severity of LBP, leg pain and disability, and results of straight leg raising test. Descriptors of management were: performance of the straight leg raising test, ordering of diagnostic procedures, prescription of drug treatment, referral to physical therapy, rehabilitation or surgery, and granting of sick leave. Regression analysis was used to analyze the relationship between patients' baseline characteristics and physicians' management decisions. Only workers were included in the models on sick leave. Results Mean age (SD) of included patients was 46.5 (15.5) years, 367 (56.6%) were workers, and 338 (52.5%) were females. Median (25th–75th interquartile range) duration of pain when entering the study was 4 (2–10) days and only 28 patients (4.3%) had chronic low back pain. Diagnostic studies included plain radiographs in 43.1% of patients and CT or MRI scans in 18.8%. Drug medication was prescribed to 91.7% of patients, 19.1% were sent to physical therapy or rehabilitation, and 9.6% were referred to surgery. The main determinants of the clinical management were duration of the episode and, to a lesser extent, the intensity of the pain (especially leg pain), a positive straight leg raising test, and degree of disability. The main determinant of sick leave was the degree of disability, followed by the characteristics of the labor contract and the intensity of leg pain (but not low back pain). After at least 2 months of treatment, 37% of patients were still in pain and approximately 10% of patients had not improved or had worsened. Conclusion Although the use of X-Rays is high, determinants of physicians' management of LBP in primary care made clinical sense and were consistent with patterns suggested by evidence-based recommendations. However, after 2 months of treatment more than one third of patients continued to have back pain and about 10% had worsened. PMID:16707005

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

2006-01-01

379

Potential impact of new oral anticoagulants on the management of atrial fibrillation-related stroke in primary care  

PubMed Central

Aim Anticoagulant prophylaxis with vitamin K antagonists (such as warfarin) is effective in reducing the risk of stroke in patients with atrial fibrillation (AF). New oral anticoagulants have emerged as potential alternatives to traditional oral agents. The purpose of this review was to summarise the effectiveness and safety of rivaroxaban, dabigatran and apixaban in stroke prevention in patients with AF in phase III trials, evaluate their cost-effectiveness and consider the implications for primary care. Methodology A literature search was performed between 2007 and 2012, selecting all phase III trials (ROCKET AF, RE-LY and ARISTOTLE) of new oral anticoagulants and relevant cost–benefit studies. Results Evidence shows that all three agents are at least as effective as warfarin in the prevention of stroke and systemic emboli, with similar safety profiles. Cost–benefit studies of rivaroxaban and dabigatran further confirm their potential use as alternatives to warfarin in clinical practice. These observations may allow stratification of the general practice AF population, to help prioritise which patients may benefit from receiving a new oral anticoagulant. Conclusion The clinical and economic benefits of the new oral anticoagulants, along with appropriate risk stratification, may enable a higher number of patients with AF to receive effective and convenient prophylaxis for stroke prevention. PMID:23621153

Harris, K; Mant, J

2013-01-01

380

Primary Syphilis  

MedlinePLUS

newsletter | contact Share | Primary Syphilis Information for adults A A A This image displays a painless ulcer with a red base, typical of primary syphilis. Overview Primary syphilis is a disease caused by ...

381

Teen Choice of Inwood House.  

PubMed

The Teen Choice Program in New York City was described and the outcome of the program evaluation was reported. Teen Choice is a school based sex education and pregnancy prevention program run by trained social workers. The aim is to provide information, counseling, and referrals on a range of issues relating to sexuality. The program is elective and meets during a regularly scheduled gym period for one or two semesters from the 7th to the 12th grades. There are single sex and coeducational classes. The program aim is to change attitudes toward birth control, to change risky sexual behavior, such as unprotected coitus, to offer accurate knowledge about contraception, and to prevent unplanned pregnancies. Abstinence is encouraged, but for those sexually experienced, there is attention to responsible and reliable use of contraception. Program methods include small group discussion, individual counseling, and classroom discussion. Topics of discussion range from sexuality issues and birth control to values clarification and peer pressure. Small groups may discuss human sexual growth, relationship formation, family life, responsibility to self and others, consequences of teenage pregnancy, and social and cultural peer pressures. Girls are encouraged to assume more assertive and less reactive roles. Communication skills are reinforced in respectful exchanges of personal views and questions. Differentiating facts and issues is a primary focus. A question about when an individual first had sex would be redirected to asking about the appropriate age to first have sex. Respect for privacy helps to build students confidence in the program. A longitudinal evaluation conducted between 1984 and 1987 found that the program was effective in reaching and recruiting high risk adolescents. Students left the program with increased knowledge about contraception, more mature and responsible attitudes about the use of birth control, and reduced frequency of unprotected coitus. Boys were found to take more responsibility for birth control. Sexually active youth were found to have reduced reports of never having used contraception. An Inwood House descriptive evaluation found the mandates were being fulfilled. A program impact evaluation is pending. PMID:12345545

1994-05-01

382

The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months  

Microsoft Academic Search

Background  Scotland has high levels of untreated dental caries in primary teeth. The Hall Technique is a simplified method of managing\\u000a carious primary molars using preformed metal crowns (PMCs) cemented with no local anaesthesia, caries removal or tooth preparation.\\u000a This study compared the acceptability of the Hall Technique for children, their carers, and dentists, and clinical outcomes\\u000a for the technique, with

Nicola P Innes; Dafydd JP Evans; David R Stirrups

2007-01-01

383

The Inherent Reward of Choice  

PubMed Central

Research suggests that the exercise of control is desirable and adaptive, but the precise mechanisms underlying the value of control are not well understood. The current study characterizes the affective experience of personal control by examining the neural substrates recruited when anticipating the opportunity for choice, the means by which individuals exercise control. Using an experimental paradigm that probed the value of choice, participants reported liking cues that predicted future choice opportunity more than cues predicting no-choice. Anticipation of choice itself was associated with increased activity in corticostriatal regions involved in affective and motivational processes, particularly the ventral striatum. This study provides the first direct examination of the affective value of having the opportunity to choose. These findings have important implications for understanding the role of perception of control, and choice itself, in self-regulatory processes. PMID:21931157

Leotti, Lauren A.; Delgado, Mauricio R.

2012-01-01

384

Patient choice of primary care practitioner for orofacial symptoms  

Microsoft Academic Search

Objective To determine patients' preferences regarding consultation of medical or dental practitioners for various orofacial symptoms, including patients' perceptions of practitioners' training and ability to diagnose and treat these symptoms.Method Patients attending oral and maxillofacial clinics in Dumfries & Galloway, Scotland in relation to a variety of complaints were invited to complete a questionnaire.Results From a sample size of 254

G. L. F. Smith; J. M. Rodgers; R. W. Flynn; C. H. Malone; G. W. Bell

2008-01-01

385

Carbon sequestration in croplands is mainly driven by management leading to increased net primary production - evidence from long-term field experiments in Northern Europe  

NASA Astrophysics Data System (ADS)

Sustainable intensification of agriculture in regions with high production potential is a prerequisite for providing services for an increasing human population, not only food, animal feed, fiber and biofuel but also to promote biodiversity and the beauty of landscapes. We investigated the effect of different management practices on soil fertility and carbon sequestration in long-term experiments, mainly from Northern Europe. In addition, a meta-analysis on the effect of catch crops was conducted. Improved management of croplands was found to be a win-win strategy resulting in both increased soil fertility and carbon sequestration. We quantified the effect of different management practices such as N fertilization, organic amendments, catch crops and ley-arable rotations versus continuous annual cropping systems on soil carbon stocks. Increasing net primary productivity (NPP) was found to be the main driver for higher soil carbon storage. Mineral N fertilization increased soil carbon stocks by 1-2 kg C ha-1 for each kg of N applied to cropland. Ley-arable rotations, being a combination of annual and perennial crops, are expected to have C stocks intermediate between those of continuous grass- and croplands. A summary of data from 15 long-term sites showed that on average 0.5 Mg ha-1 yr-1 (range 0.3 to 1.1; median 0.4 Mg ha-1 yr-1) more carbon was retained in soils in ley-arable compared to exclusively annual systems, depending on species composition, management, soil depth and the duration of the studies. The annual C accumulation rate for catch crops determined in the meta-analysis was well within that range (0.32±0.08 Mg C ha-1 yr-1). Retention factors calculated for straw, manure, sawdust, peat, sewage sludge and composted household waste varied widely in a decadal time scale. Retention of root and rhizodeposit carbon was higher than for above-ground crop residues. We conclude that NPP is the major driver for C sequestration and emphasize that increased soil carbon stocks not always lead to net sequestration of atmospheric CO2 and that C sequestration not always leads to mitigation of greenhouse gas emissions. The consequences of different land use and management are discussed, taking into account two critical boundaries - the limited area of agricultural land on Earth and requirements to produce sufficient food, fibres and energy for a growing population.

Kätterer, Thomas; Bolinder, Martin Anders; Börjesson, Gunnar; Kirchmann, Holger; Poeplau, Christopher

2014-05-01

386

Strengthening the capacity of managers in pharmaceutical services based on Primary Health Care (PHC) at different levels of the health system  

PubMed Central

Introduction Distance learning methods have been widely used because of their advantages to continuing professional development processes. The Primary Health Care (PHC) is a strategy which has been implemented in order to improve the efficiency of health systems. Due to the need for access to medicines and technologies regardless of the strengthening of health systems, a new approach that better integrates both pharmaceutical services and health systems has been implemented. Case description This is a case study which consists of describing the process of restructuring, developing and implementing the second version of the Virtual Course on Primary Health Care-based Pharmaceutical Services for managers (CVSERVFAPS-12). The main objective is to strengthen the capacity of managers in pharmaceutical services, based on PHC at different levels of the health system, in order to support the restructuring and empowering of these services and, consequently, the health systems in the American region. Discussion and evaluation Many evaluation tools were applied to identify the achievement/improvement of planned competencies. The intervention proposals were collectively built and intended to be more than an academic exercise, looking forward to being implemented as a strategic intervention to promote changes in the pharmaceutical services of the American region. The main strengths identified for the second version of the course were related to the quality of the didactic material and content. Additionally, the tutors’ support was commented upon as a positive aspect. The main challenges faced in this rebuilding process related to the due dates of the activities and lectures as well as the time to capture and assimilate the content. Conclusions The CVSERVFAPS-Pilot was reformulated and CVSERVFAPS-12 is consistent with the issues raised in the pilot course’s evaluation in 2011, which were successfully implemented. The use of the distance learning strategy, through a virtual environment, for the application of the Virtual Course on PHC- based pharmaceutical services for managers, is appropriate and confirmed its role in public policy promotion through effective retention and distribution of health workers. PMID:24927816

2014-01-01

387

Waste. Choices for Communities.  

ERIC Educational Resources Information Center

The purpose of this booklet is to provide an introduction to the many complex issues of waste management in the United States. It is designed to raise public awareness of the serious impact of current waste generation and disposal practices and to promote alternatives. It encourages citizens to involve themselves in decisions about the way waste…

Knaus, Andy; And Others

388

Servings and Choices  

NSDL National Science Digital Library

In this nutrition activity (page 16 of PDF), learners document their individual eating habits and learn whether their eating patterns meet their needs. This activity requires learners to first complete the "Your Energy Needs" activity on page 8 of the same resource. This guide includes background information, setup and management tips, extensions, information about eating in space and handouts.

2012-06-26

389

School Choice 2000 Annual Report  

NSDL National Science Digital Library

This online version of the Heritage Foundation's annual report on school choice provides a substantive, if somewhat biased, state-by-state report on political, judicial, communal, and education developments linked to the issues of school choice. Each state's profile gives a status report on the numbers of charter schools and publicly funded private school choices as well as data on enrollment, expenditures, and results on the National Assessment of Educational Progress (NAEP, see the October 1, 1999 Scout Report). A background report, complete with developments in 1999 and 2000, is also posted for each state. The report's introduction was written by Florida governor and school choice advocate Jeb Bush.

2000-01-01

390

Career choices of lesbian women.  

PubMed

I focus on lesbian women's career choices and analyse how they explain their choices in relation to their sexuality. In addition to personal accounts and experiences, I use survey data that shows that several factors influence lesbian women's occupational circumstances. The Sexual Minority Survey included 726 respondents, of which 415 are women. The survey was conducted as part of the project Sexual and Gender Minorities at Work. Although many lesbian women claim that their sexuality did not influence their career choices, their career choice processes seem to be linked in many ways with sexuality, gender, and heteronormativity in society. PMID:19042296

Lehtonen, Jukka

2008-01-01

391

Primary and secondary effects of climate variability on carbon and water exchange in a managed subalpine Eucalyptus forest.  

NASA Astrophysics Data System (ADS)

Climate variability and change, ecosystem disturbance and land management operate over a large range of temporal and spatial scales and lead to variability in carbon and water fluxes. Diagnosing the climate controls over these fluxes is not simple but key to improving prediction and understanding of water and carbon cycle-climate interactions. We use a novel technique to investigate the variability of the fluxes from daily to multiannual timescales. We rank direct controlling factors of climate on water use and carbon uptake (changes in radiation, temperature, humidity) and indirect factors (disturbance triggered by changes in climate conditions). Direct climate impacts depend on the time scale under consideration but are generally strongest on the annual time scale. To investigate the spatio-temporal variability caused by disturbance we use NDVI and albedo. They provide information on status and dynamics of the vegetation and we find that the whole area within Bago State Forest that was classified as native Eucalyptus forest (305.05 km2) was affected by a disturbance by insect attack. This disturbance affected tree species differently, led to a reduced photosynthetically active leaf area, reduced canopy conductance and hence photosynthetic capacity. The reduced net carbon uptake of the trees was evident as reduced biomass increment and increased mortality was observed. Net ecosystem exchange measurements at the Tumbarumba flux tower indicate that the ecosystem turned from a generally strong carbon sink to a source. We further find that the coherence between albedo and carbon and water exchange is strong on annual and multi-annual time scales. At a multi-annual time scale, carbon and water fluxes are coherent with the multivariate El Niño index.

van Gorsel, Eva; Berni, Jose. A. J.; Briggs, Peter; Cabello-Leblic, Arancha; Chasmer, Laura; Cleugh, Helen A.; Hacker, Joerg; Hantson, Stijn; Haverd, Vanessa; Hughes, Dale; Hopkinson, Chris; Keith, Heather; Kljun, Natascha; Leuning, Ray; Yebra, Marta; Zegelin, Steve

2013-04-01

392

Consumer Choice of Modularized Products: A Conjoint Choice Experiment Approach  

Microsoft Academic Search

Recent increases in flexibility and automation in the production of goods and services allow a growing number of suppliers to offer their products in flexible sets of modules from which consumers can create their own individualized packages. This paper addresses the question how consumer choices of such modularized products can be modeled and measured by applying conjoint choice experiments. We

B. G. C. Dellaert; A. W. J. Borgers; J. J. Louviere; H. J. P. Timmermans

1998-01-01

393

Child Care Choices, Food Choices, and Children's Obesity Status  

E-print Network

Child Care Choices, Food Choices, and Children's Obesity Status: A Comparison of Two-parent and One December 10, 2012 B.Mandal and Lisa M. Powell Childhood Obesity December, 2012 1 / 36 #12;Motivation Public-19 years were obese Childhood obesity remains a costly public health issue as it has both immediate

Illinois at Chicago, University of

394

Editor's Choice Editor's Choice: Crop Genome Plasticity and Its Relevance  

E-print Network

. The term GE is preferred over the term "genetically modified" (commonly referred to as GMEditor's Choice Editor's Choice: Crop Genome Plasticity and Its Relevance to Food and Feed Safety of Genetically Engineered Breeding Stacks1 Genetically engineered (GE) stacks, combinations of two or more single

Parrott, Wayne

395

Evidence based contraceptive choices.  

PubMed

People who attend for contraceptive advice have usually formulated an idea of the type of contraceptive that will suit them best. They may wish to use a method that is long, short or medium acting. These are defined as follows: Long-acting method requires renewal no more frequently than every 3 months (e.g. injectable or intrauterine). Short-acting method used daily or with every act of intercourse (e.g. pills, condoms) Medium-acting method requires renewal weekly or monthly (e.g. ring, patch). For men the choice is limited to condoms or vasectomy. Some women do not wish to use hormonal preparations or have an intrauterine device (IUD) or implant inserted. There may also be cultural influences making certain methods of contraception unacceptable. Each of these factors influences the final decision of which method of contraception is decided upon. In addition to taking a full medical and sexual history to identify any risks to the individual's health, which might be increased by a particular contraceptive, time must be spent discussing the options available. It is important to ensure that there is a full understanding of the advantages and disadvantages of each method. The most successful contraceptive method is likely to be the one that the woman (or man) chooses, rather than the one the clinician chooses for them. Access for women to contraception can be improved by having convenient clinic times and service developments such as nurse prescribing and Patient Group Directions. PMID:16707277

Scott, Alison; Glasier, Anna

2006-10-01

396

Primary breast lymphoma.  

PubMed

Primary breast lymphoma is a rare form of extranodal lymphoma, defined by the presence of a primary lesion within the breast with or without regional nodal involvement but no other extra-mammary sites of involvement. It comprises diverse histologic subtypes, but diffuse large B-cell lymphoma is the most common. In this review, we describe in detail the clinical features, diagnosis and staging, pathogenesis, risk factors and therapy of primary breast diffuse large B-cell lymphoma. We consider choice and number of cycles of chemotherapy, the indications for radiotherapy and discuss the need for central nervous system prophylaxis. We also provide a brief overview of the less commonly encountered histologic subtypes including marginal zone, follicular, Burkitt and breast implant associated anaplastic large cell lymphoma. We conclude with a suggested treatment approach and potential areas of future research. PMID:24953564

Cheah, Chan Y; Campbell, Belinda A; Seymour, John F

2014-09-01

397

Personality type and medical specialty choice.  

PubMed

The July 1999 issue of the Journal of the Louisiana State Medical Society reported results of the Myers-Briggs Type Indicator administered to 1,797 students at Louisiana State University School of Medicine in New Orleans, Louisiana from 1988 through 1998. The current follow-up study has as its subjects 1,262 matriculants who entered the School from 1988 through 1995 and completed their medical undergraduate studies by May 1999. In addition to identification of the graduates' Myers-Briggs type, information on their residency choice was also available. In this study, the authors explore possible association between the graduates' personality type and their chosen career, along with possible type differences of those graduates selecting primary care and those choosing non-primary care specialties. PMID:11284147

Wallick, M M; Cambre, K M; Randall, H M

1999-09-01

398

The Ligurian Human Immunodeficiency Virus Clinical Network: A Web Tool to Manage Patients With Human Immunodeficiency Virus in Primary Care and Multicenter Clinical Trials  

PubMed Central

Background In recent years, Highly-Active Anti-Retroviral Therapies (HAARTs) have modified the Human Immunodeficiency Virus (HIV) life-cycle and the disease is now considered chronic. Consequently, a longitudinal and complex follow-up is now required for HIV positive patients during their lifetime. Moreover, patients often encounter various complications due to comorbidities, related to the immunodeficiency state and HAARTs’ side effects. Thus, HIV positive patients are involved in multicenter clinical trials (MCTs) to improve treatments and discover a preventive vaccine. Therefore, physicians require proper instruments to access comprehensive patient data for managing patients during follow-ups, and tools for data collection and analysis in MCTs. Objective The Ligurian HIV Clinical Network aims to provide physicians with a Web-tool to administrate HIV positive patients’ data within primary-care and to reuse the collected clinical information to perform MCTs in Northern Italy. Methods The key aspect of the system is a relational database which allows the storage of various types of clinical information (eg, related to HIV, cardiovascular, or hepatic diseases) in multiple formats. The modular design of the database permits a rapid insertion of new parameters without requiring any changes in the database structure. Furthermore, codes from biomedical ontologies controlled vocabularies (“Logical Observation Identifier Names and Codes”, and “International Classification of Diseases 9”) and ontologies (“Systematized Nomenclature of Medicine Clinical Terms”), units and normality ranges used by all partners participating in the project were collected to achieve a complete semantic interoperability. Accordingly, data can be automatically normalized through the z score formula and physicians can extract and correctly compare information with external statistical tools. Moreover, to respect patients’ privacy and legal issues, a local identifier, determined through an HASH cryptography algorithm, is assigned to each patient during the registration process. The database is managed by a user-friendly Web-platform which allows quick access to information during medical examinations and the reusing of the collected data for present and future MCTs. Furthermore, a bidirectional middleware was created in order to import/export information through HL7 messaging. Hence, data can be manually entered by physicians or automatically collected within HL7-compliant Hospital Information systems. Results Presently, the direct storage of patients’ information from the San Paolo Hospital (Savona, Italy), and San Martino and Galliera hospitals in Genoa is in a test phase. Currently, 8 centers of Infectious Diseases (located in Liguria and Piedmont) are participating in the project and almost 400 HIV positive patients have been recorded in the system. Patient data has been used for primary care and research purposes. Currently, there are 4 on-going MCTs and preliminary results have already been presented at International HIV congresses. Conclusions The Web-platform allows effective management, sharing and reuse of information within primary care and clinical research. In the future it is planned to share the clinical information from this network with other HL7-compliant workgroups and to extend the platform to other infective diseases (eg, hepatitis). PMID:25075240

Pupella, Valeria; Gazzarata, Roberta; Dentone, Chiara; Cenderello, Giovanni; De Leo, Pasqualina; Bozzano, Federica; Casalino Finocchio, Giorgetta; De Maria, Andrea; Fenoglio, Daniela; Filaci, Gilberto; Guerra, Michele; Di Biagio, Antonio; Mantia, Eugenio; Orofino, Giancarlo; Ferrea, Giuseppe; Viscoli, Claudio; Giacomini, Mauro

2013-01-01

399

School Choice: Examining the Evidence.  

ERIC Educational Resources Information Center

This book presents a summary of school-choice issues, and is organized around a 1992 seminar entitled "Choice: What Role in American Education?" Each part presents a set of conference papers, followed by discussants' remarks and excerpts from audience discussion. The introduction summarizes the papers' positions and conclusions. Participants…

Rasell, Edith, Ed.; Rothstein, Richard, Ed.

400

The Globalisation of School Choice?  

ERIC Educational Resources Information Center

"Which school should I choose for my child?" For many parents, this question is one of the most important of their lives. "School choice" is a slogan being voiced around the globe, conjuring images of a marketplace with an abundance of educational options. Those promoting educational choice also promise equality, social advantage, autonomy, and…

Forsey, Martin, Ed.; Davies, Scott, Ed.; Walford, Geoffrey, Ed.

2008-01-01

401

Contextual Explanations of School Choice  

ERIC Educational Resources Information Center

Participation in school-choice programs has been increasing across the country since the early 1990s. While some have examined the role that families play in the school-choice process, research has largely ignored the role of social contexts in determining where a student attends school. This article improves on previous research by modeling the…

Lauen, Douglas Lee

2007-01-01

402

On School and School Choice.  

ERIC Educational Resources Information Center

Compares the ideas and conclusions presented in "School Choice and Culture Wars in the Classroom: What Different Parents Seek from Education" (SO 532 108) to "Liberal Equity on Education: A Comparison of Choice Options." (SO 532 109) Argues that these authors want to achieve the authentic common good and simultaneously respect those people with…

Coons, John

1998-01-01

403

Discrete Choice Methods with Simulation  

Microsoft Academic Search

This book describes the new generation of discrete choice methods, focusing on the many advances that are made possible by simulation. Researchers use these statistical methods to examine the choices that consumers, households, firms, and other agents make. Each of the major models is covered: logit, generalized extreme value, or GEV (including nested and cross-nested logits), probit, and mixed logit,

Kenneth E. Train

2003-01-01

404

Lessons learnt in the management of primary invasive penile cancer in an Australian tertiary referral centre: Clinical outcomes with a minimum 48 months follow-up study  

PubMed Central

Purpose To report on lessons learnt in the management of primary invasive penile cancer in a major tertiary hospital in Australia. Materials and Methods Medical records for all patients who underwent surgery for primary invasive penile cancer between January 2000 and January 2011 were obtained. Patient demographics, clinical status of inguinal node, cancer stage and clinical outcomes were reviewed. All patients were followed up for a minimum of 48 months postoperative unless patient deceased within the first 48 months from the time of penile cancer surgery. Results Over the 11-year period, a total of 23 cases of invasive penile cancer were identified. Partial penectomy was the most common form of organ preserving surgery and the majority of patients have pT1b disease. Of the 9 patients with clinically palpable inguinal nodes, 7 patients were diagnosed with pN3 disease following inguinal lymphadenectomy. The Kaplan-Meier cancer-specific survival at 72 months showed decreasing survival based on tumour stage (83% in pT1, 79% in pT2, and 64% in pT3 disease) and nodal disease (100% in node negative, 50% in superficial inguinal lymphadenopathy, and 38% in patients with deep inguinal and/or pelvic lymphadenopathy) (p=0.082). The Kaplan-Meier cancer-specific survival revealed statistically significant difference in survival outcome in patients with local recurrence vs. systemic metastasis disease (33% vs. 17%, p=0.008). Conclusions The presence of high risk features such as tumour stage, lymph node involvement and distant metastasis carries a significant higher risk of death and tumour recurrence in patients with penile cancer and inguinal lymph node metastasis.

Yang, Sun; White, Louise; Wood, Simon; Nicol, David

2015-01-01

405

Department of Primary Care Respiratory  

E-print Network

Department of Primary Care Respiratory Therapy - South - about it's all ChoiCes... exclusively to the Program office at Rutgers SHRP, Respiratory Therapy Program, 40 East Laurel Road, Suite 2105, Stratford Commission of Accreditation of Healthcare Organizations (JCAHO). The Respiratory Therapy Program

Cheng, Mei-Fang

406

Choosing a primary care provider  

MedlinePLUS

Family doctor - how to choose one; Primary care provider - how to choose one; Doctor - how to choose a family doctor ... A PCP is your main health care provider in non-emergency ... and teach healthy lifestyle choices Identify and treat common ...

407

Appropriateness of Advice: DCT and Multiple Choice Data.  

ERIC Educational Resources Information Center

Investigates what can be learned about second language (L2) speech acts using English language multiple choice (MC) instruments and discourse completion tests (DCTs). The study focuses on the primary language (L1) responses of native speakers and the L2 responses given by speakers of Chinese to MC questionnaires and DCTs dealing with the…

Hinkel, Eli

1997-01-01

408

Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine  

Microsoft Academic Search

BACKGROUND: Patient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and ultimately matching in a primary care specialty. METHODS: We determined the relationship

Paul S Ciechanowski; Linda LM Worley; Joan E Russo; Wayne J Katon

2006-01-01

409

A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial  

PubMed Central

Background Over 75% of mental health problems begin in adolescence and primary care has been identified as the target setting for mental health intervention by the World Health Organisation. The mobiletype program is a mental health assessment and management mobile phone application which monitors mood, stress, coping strategies, activities, eating, sleeping, exercise patterns, and alcohol and cannabis use at least daily, and transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. Methods We conducted a randomised controlled trial in primary care to examine the mental health benefits of the mobiletype program. Patients aged 14 to 24 years were recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants, and researchers were blind to group allocation at randomisation. Participants completed pre-, post-, and 6-week post-test measures of the Depression, Anxiety, Stress Scale and an Emotional Self Awareness (ESA) Scale. Results Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention group n = 68, comparison group n = 46). Mixed model analyses revealed a significant group by time interaction on ESA with a medium size of effect suggesting that the mobiletype program significantly increases ESA compared to an attention comparison. There was no significant group by time interaction for depression, anxiety, or stress, but a medium to large significant main effect for time for each of these mental health measures. Post-hoc analyses suggested that participation in the RCT lead to enhanced GP mental health care at pre-test and improved mental health outcomes. Conclusions Monitoring mental health symptoms appears to increase ESA and implementing a mental health program in primary care and providing frequent reminders, clinical resources, and support to GPs substantially improved mental health outcomes for the sample as a whole. Trial Registration ClinicalTrials.gov NCT00794222. PMID:22123031

2011-01-01

410

Effects of a Hypertension Management Program by Seongcheon Primary Health Care Post in South Korea: An Analysis of Changes in the Level of Knowledge of Hypertension in the Period from 2004 to 2009  

ERIC Educational Resources Information Center

The objective of this study was to examine the effects of a hypertension management program provided by a primary health care post located in a distant rural area in South Korea on the level of knowledge of hypertension. The panel data consisted of a total of 319 people or the entire population aged above 40 years of five villages located in…

Song, In Han; Kim, Sang-A; Park, Woong-Sub

2012-01-01

411

Current choice of treatments for neovascular AMD.  

PubMed

Age-related macular degeneration is the leading cause of irreversible blindness in developed countries with the neovascular form accounting for the majority of severe vision loss in the disease. The management of wet age-related macular degeneration has improved drastically in the past decade as anti-VEGF agents took its place at the forefront of treatment. As the choice of therapy is based on a number of factors, this review summarizes the pivotal studies that brought these agents to use and compares the different agents currently available. This review also briefly describes the promising new therapies that are in development. PMID:25487081

Lai, Kevin; Landa, Gennady

2015-01-01

412

Anatomy of a systemic choice  

SciTech Connect

Systemic grammar is one of the major varieties of syntactic theory in modern linguistics. It was originally defined by Michael A. K. Halliday around 1960 and has since been developed extensively by him and others. Unlike transformational grammar, systemic grammar is oriented to the ways that language functions for its users. Systemic grammars have been used in several well-known language-processing programs and have been found to be very advantageous for computer generation of text. This report presents a framework for expressing how choices are made in systemic grammars. Formalizing the description of choice processes enriches descriptions of the syntax and semantics of languages, and it contributes to constructive models of language use. There are applications in education and computation. The framework represents the grammar as a combination of systemic syntatic description and explicit choice processes, called 'choice experts'. Choice experts communicate across the boundary of the grammar to its environment, exploring an external intention to communicate. The environment's answers lead to choices and thereby to creation of sentences and other units, tending to satisfy the intention to communicate. The experts' communicative framework includes an extension to the systemic notion of a function, in the direction of a more explicit semantics. Choice expert processes are presented in two notations, one informal and the other formal. The informal notation yields a grammar-guided conversation in English between the grammar and its environment, while the formal notation yields complete accounts of what the grammar produces given a particular circumstance and intent.

Mann, W.C.

1982-09-01

413

Improving dementia diagnosis and management in primary care: a cohort study of the impact of a training and support program on physician competency, practice patterns, and community linkages  

PubMed Central

Background Primary care physicians routinely provide dementia care, but may lack the clinical skills and awareness of available resources to provide optimal care. We conducted a community-based pilot dementia training intervention designed to both improve clinical competency and increase utilization of local dementia care services. Methods Physicians (N?=?29) and affiliated staff (N?=?24) participated in a one-day training program on dementia screening, diagnosis and management that included direct engagement with local support service providers. Questionnaires about their dementia care competency and referral patterns were completed before and 6 months after the training intervention. Results Physicians reported significantly higher overall confidence in their dementia care competency 6 months post-training compared to pre-training. The largest reported improvements were in their ability to educate patients and caregivers about dementia and making appropriate referrals to community care services. Participants also reported markedly increased use of cognitive screening tools in providing care. Community service providers recorded approximately 160 physician-initiated referrals over a 2 year-period post-training, compared to few beforehand. Conclusions Combining a targeted physician practice-based educational intervention with community service engagement improves dementia care competency in clinicians and promotes linkages between clinical and community dementia care providers. PMID:24325194

2013-01-01

414

MANAGING OBESITY IN PRIMARY CARE  

Technology Transfer Automated Retrieval System (TEKTRAN)

Obesity is a major health problem in the United States and other industrialized nations. Obesity has been traditionally defined as an excess of body fat (i.e., 25% body fat in men and 33% in women. This increased body fat is associated with greater risk for a number of health problems, including c...

415

Connecting cognition and consumer choice.  

PubMed

We describe what can be gained from connecting cognition and consumer choice by discussing two contexts ripe for interaction between the two fields. The first-context effects on choice-has already been addressed by cognitive science yielding insights about cognitive process but there is promise for more interaction. The second is learning and representation in choice where relevant theories in cognitive science could be informed by consumer choice, and in return, could pose and answer new questions. We conclude by discussing how these two fields of research stand to benefit from more interaction, citing examples of how interfaces of cognitive science with other fields have been illuminating for theories of cognition. PMID:25527275

Bartels, Daniel M; Johnson, Eric J

2015-02-01

416

Network knowledge and route choice  

E-print Network

Models of urban traveler route choice are reviewed in the context of Intelligent Transportation Systems, particularly Advanced Traveler Information S ystems. Existing models suffer from assumptions of perfect information ...

Ramming, Michael Scott

2002-01-01

417

PRIVATIZED PENSIONS: An Irrational Choice?  

E-print Network

PRIVATIZED PENSIONS: An Irrational Choice? ETHICS AFTER ENRON: Restoring Accountability and Trust Timothy Akin Director of Marketing and Communications CONTRIBUTING EDITORS Shannon Tanguay Alumni First-Ever Student Fellowships . . . . . . . . . . 11 Distinguished Speaker Ethics After Enron

California at Davis, University of

418

Autotuning programs with algorithmic choice  

E-print Network

The process of optimizing programs and libraries, both for performance and quality of service, can be viewed as a search probl