Sample records for primary management choice

  1. Exploring preferences for symptom management in primary care: a discrete choice experiment using a questionnaire survey

    PubMed Central

    McAteer, Anne; Yi, Deokhee; Watson, Verity; Norwood, Patricia; Ryan, Mandy; Hannaford, Philip C; Elliott, Alison M

    2015-01-01

    Background Symptoms are important drivers for the use of primary care services. Strategies aimed at shifting the focus away from the GP have broadened the range of primary healthcare available. Aim To explore preferences for managing symptoms and investigate trade-offs that the public are willing to make when deciding between different primary care services. Design and setting UK-wide postal questionnaire survey of 1370 adults. Method A discrete choice experiment examined management preferences for three symptoms of differing seriousness (diarrhoea, dizziness, and chest pain). Willingness-to-pay estimates compared preferences between symptoms, and by sex, age, and income. Results Preferences differed significantly between symptoms. ‘Self-care’ was the preferred action for diarrhoea and ‘consulting a GP’ for dizziness and chest pain. ‘Waiting time’ and ‘chance of a satisfactory outcome’ were important factors for all three symptoms, although their relative importance differed. Broadly, people were more prepared to wait longer and less prepared to trade a good chance of a satisfactory outcome for symptoms rated as more serious. Generally, preferences within subgroups followed similar patterns as for the whole sample, although there were differences in the relative strength of preferences. Conclusion Despite increased choices in primary care, ‘traditional’ actions of ‘self-care’ for minor symptoms and ‘GP consultation’ for more serious symptoms were preferred. The present findings suggest, however, that people may be willing to trade between different health services, particularly for less serious symptoms. Understanding the relative importance of different factors may help inform interventions aimed at changing management behaviour or improving services. PMID:26077269

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

    Microsoft Academic Search

    Jeffrey M. Ulmer; Troy E. Ollison

    2008-01-01

    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

  3. Primary eye care management.

    PubMed

    De Beer, Annelize

    2003-01-01

    Due to a financial recession in South Africa, the registered nurses (RNs) at an excimer laser center faced dismissal. In order to continue a career in ophthalmology, these nurses needed to create their own income. To this end, a primary eye care (PEC) clinic was established to provide examination and treatment(s) to the underprivileged community with the assistance of local ophthalmologists. The PEC clinic, which provides basic services for a nominal fee, has bridged the gap between excellent private eye care and inadequate government eye care. Since 1999, 791 patients have been examined and 515 surgical procedures have been performed. PMID:12703249

  4. Managing Depression in Primary Care

    Microsoft Academic Search

    Larry Culpepper; Peggy Johnson

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

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

    E-print Network

    Mastako, Kimberley Allen

    2005-02-17

    , and finds systematic variations among four choice set groups in user preferences for price managed lanes. Rather than assume the same values of the coefficients for all users, the model is separately estimated for each choice set group, and the null...

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

    E-print Network

    Mastako, Kimberley Allen

    2005-02-17

    hypothesis of no taste variations among them is rejected, suggesting that choice set is an indicator for choice behavior. In the State Route 91 study corridor, the price-managed lanes compete with at least two other congestion-avoiding alternatives...

  7. Management of primary sclerosing cholangitis

    PubMed Central

    Lutz, Holger H; Tischendorf, Jens JW

    2011-01-01

    Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease with major morbidity and mortality. Therapeutic management is difficult, due to lack of conclusive data and individual disease progression. High-dose UDCA was used for years as a pharmacotherapeutic agent to prevent disease progression, based on a positive trend in pilot studies, but has recently been proven to have a negative effect in advanced disease. Immunosuppressants might be useful in patients with overlap syndromes. Dominant bile duct stenoses should be treated endoscopically, and cholangiocellular carcinoma (CCC) still remains a therapeutic challenge in PSC patients. Early diagnosis of CCC must be improved and new strategies such as neoadjuvant radiochemotherapy with subsequent liver transplantation in selected patients are further options to be considered. PMID:21860672

  8. Unconscious Influences on Career Choice: Entrepreneur vs. Manager.

    ERIC Educational Resources Information Center

    Malach-Pines, Ayala

    2003-01-01

    Explores unconscious influences on career choice using a psychoanalytic-existential framework. Case studies illustrate how internalized images of their fathers led two men to management and entrepreneurial careers and influenced later feelings of burnout. (Contains 72 references.) (SK)

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

    PubMed Central

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

    2014-01-01

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

  10. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Primary care case management services. 440.168...PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case...

  11. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Primary care case management services. 440.168...PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case...

  12. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  13. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Primary care case management services. 440.168...PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case...

  14. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Primary care case management services. 440.168...PROVISIONS Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case...

  15. Developing Value Propositions: Strategic Choice in Supply Management

    Microsoft Academic Search

    Alvin J. Williams

    Value creation and delivery have both become the mantra of supply management theorists and practitioners. In the quest to create and deliver value, little focus is placed on the mechanics of developing and implementing value propositions that lead to enhanced performance for all supply partners. The strategic choices made by supply professionals should be based upon carefully conceptualized value propositions.

  16. Primary urban energy-management-planning methodology

    SciTech Connect

    Revis, Joseph; Meador, Toni

    1980-11-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2013-06-01

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

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

    ERIC Educational Resources Information Center

    Siefert, Darin William

    2011-01-01

    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…

  20. Stated Choice for Transportation Demand Management Models: Using a Disaggregate Truth Set To Study Predictive Validity

    Microsoft Academic Search

    Patrick Beaton; Cynthia Chen; Hamo Meghdir

    1997-01-01

    Discrete choice models have expanded the ability of transportation plan- ners to forecast future trends. Where new services or policies are pro- posed, the stated-choice approach can provide an objective basis for forecasts. Stated-choice models are subject to a range of experimental error not found in revealed-preference designs. Primary among the con- cerns facing researchers is the ability of respondents

  1. Multiple-use management of forest recreation sites: a spatially explicit choice experiment

    Microsoft Academic Search

    Paula Horne; Peter C. Boxall; Wiktor L. Adamowicz

    2005-01-01

    This study examined visitors’ preferences for forest management at five adjacent municipal recreation sites in Finland, using a spatially explicit choice experiment. The study design accounted for changes in scenery and biodiversity indices in the forest environment resulting from forest management practices. Respondents were asked to choose their preferred management option from alternative management regimes for the sites. The options

  2. Building Choice and Quality into Your Managed Care Plan.

    ERIC Educational Resources Information Center

    Rinaldi, Stephen J.

    1997-01-01

    The challenge of containing health-care costs continues despite a break from cost increases. Most experts would advise school employees to replace existing health plans with a triple-choice HMO plan using $10 copayments. Armed with quality data and a choice-based plan design, school business officials can improve their chances for long-term cost…

  3. The Choice of Interactive Control Systems under Different Innovation Management Modes

    Microsoft Academic Search

    Josep Bisbe; Ricardo Malagueño

    2009-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Moore, Jennifer Dawn

    2006-12-01

    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.

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

    ERIC Educational Resources Information Center

    Lilley, Rozanna

    2015-01-01

    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…

  6. Pooling and segmentation to improve primary care prescription management

    E-print Network

    Sanderson, Thomas Daniel

    2014-01-01

    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 ...

  7. Restorative management of severely ankylosed primary molars.

    PubMed

    de Moura, Marcoeli Silva; Pontes, Alessandra Silva; Brito, Maria Hellen Sâmia Fortes; de Deus Moura, Lucia; de Deus Moura de Lima, Marina; de Melo Simplício, Alexandre Henrique

    2015-01-01

    Severe dentoalveolar ankylosis is an etiological factor for malocclusion. When infraocclusion occurs early, it progresses with time, leading to severe consequences in young children because of compensatory supra-eruption of the antagonist tooth and mesialization of adjacent teeth. Early diagnosis allows for interception of the problem and may prevent orthodontic treatment. The purpose of this manuscript is to report two cases of infraocclusion of primary mandibular second molars that were diagnosed early and were treated with composite resin crowns. The use of indirect composite restorations for ankylosed teeth is a good option for primary teeth with a moderate/ severe degree of ankylosis. PMID:25909842

  8. Application of Total Quality Management System in Thai Primary Schools

    ERIC Educational Resources Information Center

    Prueangphitchayathon, Setthiya; Tesaputa, Kowat; Somprach, Kanokorn

    2015-01-01

    The present study seeks to develop a total quality management (TQM) system that can be applied to primary schools. The approach focuses on customer orientation, total involvement of all constituencies and continuous improvement. TQM principles were studied and synthesized according to case studies of the best practices in 3 primary schools (small,…

  9. Chronic disease management in primary care: from evidence to policy

    Microsoft Academic Search

    Sarah M Dennis; Nicholas Zwar; Rhonda Griffiths; Martin Roland; Iqbal Hasan; Gawaine Powell Davies; Mark Harris

    Objectives: To review the effectiveness of chronic disease management interventions for physical health problems in the primary care setting, and to identify policy options for implementing successful interventions in Australian primary care. Methods: We conducted a systematic review with qualitative data synthesis, using the Chronic Care Model as a framework for analysis between January 1990 and February 2006. Interventions were

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

    PubMed Central

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

    1992-01-01

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

  11. Improving the Primary School. Educational Management Series.

    ERIC Educational Resources Information Center

    Dean, Joan

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

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

    Microsoft Academic Search

    Steven D. Bullock; Steven R. Lawson

    2008-01-01

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

  13. A New Dynamic Programming Decomposition Method for the Network Revenue Management Problem with Customer Choice Behavior

    E-print Network

    Topaloglu, Huseyin

    A New Dynamic Programming Decomposition Method for the Network Revenue Management Problem. Keywords: Network revenue management; customer choice; approximate dynamic programming. #12;An interesting-255-9129 September 2, 2009 Abstract In this paper, we propose a new dynamic programming decomposition method

  14. The Firm's Choice of HRM Practices: Economics Meets Strategic Human Resource Management

    Microsoft Academic Search

    Bruce E. Kaufman; Ben I. Miller

    2011-01-01

    The authors compare and contrast two theoretical approaches to explaining a firm’s choice of human resource management (HRM) practices—one from strategic human resource management (SHRM) and the other from economics. They present HRM frequency distributions depicting key empirical patterns that both theories must explain and then review and apply SHRM theory to explain these patterns. Since no economic model has

  15. Surgical contribution to the management of primary hyperparathyroidism.

    PubMed

    Libánský, P; Adámek, S; Broulík, P; Pafko, P; Pozniak, J; Tvrdon, J

    2004-01-01

    Surgical management of primary hyperparathyroidism is a very effective method. The target is to cure primary hyperparathyroidism and to reach normal calcium levels. This results in an improvement of health condition and resolution or at least moderation of symptoms. Complications are infrequent and mortality is very low. Surgical management is definite, safe and effective. Authors of this article address the diagnosis of primary hyperparathyroidism, clarify bone, metabolic and biochemical syndromes and present series of 151 patients that have been operated on at the 3rd Department of Surgery of the Motol University Hospital, Prague, with the diagnosis of primary hyperparathyroidism. The survey is focused on the primary hyperparathyroidism concomitant diseases and on the possible sequelae in the postoperative period. PMID:15782553

  16. An Approximate Dynamic Programming Approach to Network Revenue Management with Customer Choice

    Microsoft Academic Search

    Dan Zhang; Daniel Adelman

    2009-01-01

    We consider a network revenue management problem where customers choose among open fare products according to some pre-specifled choice model. Starting with a Markov decision process (MDP) formulation, we approximate the value function with an a-ne function of the state vector. We show that the resulting problem provides a tighter bound for the MDP value than the choice-based linear program

  17. Factors influencing the choice of the first ward: comparison between newly qualified nurses and managers.

    PubMed

    Palese, Alvisa; Tosatto, Donella; Borghi, Gianni; Maura, Mesaglio

    2007-01-01

    We had given a questionnaire to a group of newly qualified nurses and nursing managers responsible for their recruitment with the purpose of understanding the factors influencing the choice of the first ward. For this study, 45 nurses and 10 nursing managers had been recruited. There are 19 factors that influence the choice of the first ward: the most important is the kind of patient, both, nursing managers and newly qualified nurses agreed about, while about the other factors there were different answers. Reflecting on the choice factors may help hospitals to better understand the expectations of the newly qualified nurses and start improving projects to make even the less requested wards more attractive; it can also help the faculty to reflect about the academic curriculum that mostly influences the professional future of the students. PMID:17207008

  18. Asymptomatic primary hyperparathyroidism: surgical and medical management.

    PubMed

    Francucci, C M; Ceccoli, L; Caudarella, R; Rilli, S; Vescini, F; Boscaro, M

    2011-07-01

    Primary hyperparathyroidism (PHPT) is a common endocrine disorder, frequently asymptomatic. Notwithstanding, mild PHPT may cause adverse skeletal effects that include high bone remodeling, reduced bone mineral density (BMD), and increased fracture risk. The definitive therapy for symptomatic and asymptomatic PHPT (aPHPT) is parathyroidectomy, which has been shown to increase BMD. In patients who choose not to be treated surgically or have contraindications for surgery, medical therapy should include drugs designed to protect the skeleton and/or to lower serum calcium, such as bisphosphonates, hormone replacement, and/or calcimimetic agents. However, there are currently no fracture data for any of these options. Obviously, there is the need for larger randomized controlled trials with fractures as end-points to evaluate the efficacy of medical treatment. PMID:21985981

  19. Diagnosis and management of primary ciliary dyskinesia.

    PubMed

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

    2014-09-01

    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

  20. Diagnosis and management of primary ciliary dyskinesia

    PubMed Central

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

    2014-01-01

    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

  1. Management of advanced primary urethral carcinomas.

    PubMed

    Dayyani, Farshid; Hoffman, Karen; Eifel, Patricia; Guo, Charles; Vikram, Raghu; Pagliaro, Lance C; Pettaway, Curtis

    2014-07-01

    Primary urethral carcinoma (PUC) is a rare malignancy accounting for <1% of genitourinary cancers, with a predilection for men and African-Americans. The sites and histology of urethral carcinoma vary by gender and anatomical location. Squamous cell carcinoma is most common among both genders but adenocarcinomas are noted in 15-35% of cases among women. Obstructive or irritative symptoms and haematuria are common modes of presentation. Clinical evaluation includes cystourethroscopy with biopsy and examination under anaesthesia. Magnetic resonance imaging provides a highly effective method to image the primary tumour while def?ning the potential involvement of surrounding structures. Most tumours are localised, with regional metastases to nodal sites seen in up to 30% of cases in both genders, while distant metastases at presentation are rare (0-6%), but occur in up to 40% of cases with recurrent disease. Among men, the two most important prognostic factors are disease location and stage. Low-stage tumours (T1-2) and tumours involving the fossa navicularis or the penile urethra have a better prognosis than higher stage tumours (>T2 or N+) and lesions involving the bulbomembranous urethra. In women, in addition to stage and location, the size of the tumour has also prognostic implications. While surgery and radiation therapy (RT) are of benefit in early stage disease, advanced stage PUC requires multimodal treatment strategies to optimise local control and survival. These include induction chemotherapy followed by surgery or RT and concurrent chemoradiation with or without surgery. The latter strategy has been used successfully to treat other human papillomavirus-related cancers of the vagina, cervix and anus and may be of value in achieving organ preservation. Given the rarity of PUC, prospective multi-institutional studies are needed to better define the optimal treatment approach for this disease entity. PMID:24447439

  2. Estimating the public preferences for solid waste management programmes using choice experiments in Macao.

    PubMed

    Jin, Jianjun; Wang, Zhishi; Ran, Shenghong

    2006-08-01

    This paper reports on the potential to apply the choice experiment method to understand the public's preferences for solid waste management programmes in Macao. A random sample survey of 260 respondents in Macao was conducted during the summer in 2004. The survey data was analysed using conditional multinomial logit models. The study results indicate that Macao residents prefer: (1) waste segregation and recycling at source; (2) noise reduction during waste collection and transportation and (3) lower garbage fees. The study concludes that choice experiment is a reliable tool in the analysis of respondents' preferences for developing a suitable solid waste management programme in Macao. PMID:16941989

  3. The health plan choices of retirees under managed competition.

    PubMed Central

    Buchmueller, T C

    2000-01-01

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

  4. Diagnosing and managing psychosis in primary care.

    PubMed

    Saunders, Kate; Brain, Susannah; Ebmeier, Klaus P

    2011-05-01

    Psychosis is broadly defined as the presence of delusions and hallucinations. It can be organic or functional. The former is secondary to an underlying medical condition, such as delirium or dementia, the latter to a psychiatric disorder, such as schizophrenia or bipolar disorder. The identification and treatment of psychosis is vital as it is associated with a 10% lifetime risk of suicide and significant social exclusion. Psychosis can be recognised by taking a thorough history, examining the patient's mental state and obtaining a collateral history. The history usually enables a distinction to be made between bipolar disorder, schizophrenia and other causes. Early symptoms often include low mood, declining educational or occupational functioning, poor motivation, changes in sleep, perceptual changes, suspiciousness and mistrust. The patient's appearance, e.g. unkempt or inappropriately attired, may reflect their predominant mental state. There may be signs of agitation, hostility or distractibility. Speech may be disorganised and difficult to follow or there may be evidence of decreased speech. Mood may be depressed or elated or change rapidly. Patients may describe abnormal thoughts and enquiry into thoughts of suicide should be routine. Disturbances of thought such as insertion or withdrawal may be present along with perceptual abnormalities i.e. illusions, hallucinations. Insight varies during the course of a psychotic illness but should be explored as it has implications for management. All patients presenting with first episode psychosis for which no organic cause can be found should be referred to the local early intervention service. In patients with a known diagnosis consider referral if there is: poor response or nonadherence to treatment; intolerable side effects; comorbid substance misuse; risk to self or others. PMID:21714473

  5. On the Choice-Based Linear Programming Model for Network Revenue Management

    Microsoft Academic Search

    Qian Liu; Garrett J. van Ryzin

    2008-01-01

    Gallego et al. [Gallego, G., G. Iyengar, R. Phillips, A. Dubey. 2004. Managing flexible products on a network. CORC Technical Report TR-2004-01, Department of Industrial Engineering and Operations Research, Columbia University, New York.] recently proposed a choice-based deterministic linear programming model (CDLP) for network revenue management (RM) that parallels the widely used deterministic linear programming (DLP) model. While they focused

  6. An Energy Demand and Generalized Fuel Choice Model for the Primary Metals Industry

    Microsoft Academic Search

    LuAnn McClernan Duffus; Wen S. Chern

    1984-01-01

    The primary metals industry is defined by the Bureau of the Census as the Standard Industrial Classification (SIC) 33. In terms of both absolute amount of energy use and energy intensiveness, SIC-33 is large relative to other industries.' This paper estimates essential energy demand relationships for this important sector. Although there are basically four energy sources used in the primary

  7. Teaching Teachers about Supply Chain Management to Influence Students' Career and Education Choices

    ERIC Educational Resources Information Center

    Gardner, Leslie L.

    2013-01-01

    Since teachers are influential in high school students' career choices, enabling high school teachers to introduce educational and career opportunities in supply chain management is a viable strategy for reaching high school students about these opportunities. This article presents a pilot program of supply chain workshops to educate high school…

  8. The Organization and Management of Schools Under a System of Parent Choice.

    ERIC Educational Resources Information Center

    Rasmussen, Roger L.

    This paper describes some aspects of the organization and management of 14 schools that have been participating in the voucher demonstration in Alum Rock, California. The kinds of alternative programs being offered, the allocation of decision-making within the participating schools, and the effects of parent choice are briefly discussed. An…

  9. A refined deterministic linear program for the network revenue management problem with customer choice behavior

    Microsoft Academic Search

    Sumit Kunnumkal; Huseyin Topaloglu

    2008-01-01

    We present a new deterministic linear program for the network revenue management problem with customer choice behavior. The novel aspect of our linear program is that it naturally generates bid prices that depend on how much time is left until the time of departure. Similar to the earlier linear program used by van Ryzin and Liu (2004), the optimal objective

  10. Piloting a Quality Management System for study case using Multi-Choice Goal Programming

    Microsoft Academic Search

    Hajer Ben Mahmoud Dammak; Raouf Ketata; Taieb Ben Romdhane; Samir Ben Ahmed

    2010-01-01

    This paper proposes an approach respectively Multi-Choice Goal Programming (MCGP) that integrated Analytical Hierarchy Process (AHP) for piloting a Quality Management System (QMS) designed for a real study case. This approach is used to determine the best solution verifies simultaneously the multi-objective functions and satisfying the different constraints of real company which presents a major problem for controlling the quality

  11. Venous access in haemophilic children: choice and management.

    PubMed

    Santagostino, E; Mancuso, M E

    2010-01-01

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

  12. Total Quality Management Practices in Turkish Primary Schools

    ERIC Educational Resources Information Center

    Toremen, Fatih; Karakus, Mehmet; Yasan, Tezcan

    2009-01-01

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

  13. Nonlethal Techniques for Managing Predation: Primary and Secondary Repellents

    Microsoft Academic Search

    JOHN A. SHIVIK; ADRIAN TREVES; PEGGY CALLAHAN

    2003-01-01

    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.)

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

    PubMed Central

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

    2009-01-01

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

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

    PubMed

    King, Brenda

    2014-06-01

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

  16. Labor pain management in the United States: understanding patterns and the issue of choice.

    PubMed

    Marmor, Theodore R; Krol, David M

    2002-05-01

    We reviewed a considerable body of literature in an attempt to characterize the patterns of managing pain in US childbirth. In doing so, we noted the relatively restricted range of choice most US women have in this situation and the limited amount of information available about what US women prefer, the reasons for their preferences, and what influences them. What is clear is that the range of choice available is substantially narrower than in many of the advanced industrial democracies of Western Europe. The reasons for this include professional training, economic rewards, staffing constraints, and understandable inclinations to avoid pain. What is not clear is what could be done to increase women's choices. Simply supplying more information, however accurate, will surely be inadequate. Changes in training programs could make a difference, as would shifts in payment. There are, however, deeper cultural forces at work that are less open to direction. PMID:12011881

  17. Management of liver cirrhosis between primary care and specialists

    PubMed Central

    Grattagliano, Ignazio; Ubaldi, Enzo; Bonfrate, Leonilde; Portincasa, Piero

    2011-01-01

    This article discusses a practical, evidence-based approach to the diagnosis and management of liver cirrhosis by focusing on etiology, severity, presence of complications, and potential home-managed treatments. Relevant literature from 1985 to 2010 (PubMed) was reviewed. The search criteria were peer-reviewed full papers published in English using the following MESH headings alone or in combination: “ascites”, “liver fibrosis”, “cirrhosis”, “chronic hepatitis”, “chronic liver disease”, “decompensated cirrhosis”, “hepatic encephalopathy”, “hypertransaminasemia”, “liver transplantation” and “portal hypertension”. Forty-nine papers were selected based on the highest quality of evidence for each section and type (original, randomized controlled trial, guideline, and review article), with respect to specialist setting (Gastroenterology, Hepatology, and Internal Medicine) and primary care. Liver cirrhosis from any cause represents an emerging health issue due to the increasing prevalence of the disease and its complications worldwide. Primary care physicians play a key role in early identification of risk factors, in the management of patients for improving quality and length of life, and for preventing complications. Specialists, by contrast, should guide specific treatments, especially in the case of complications and for selecting patient candidates for liver transplantation. An integrated approach between specialists and primary care physicians is essential for providing better outcomes and appropriate home care for patients with liver cirrhosis. PMID:21633593

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

    PubMed

    Tsai, Jack; Rosenheck, Robert A

    2012-11-01

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

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

    PubMed

    Hendel, Tova; Fish, Miri; Berger, Ornit

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    Schultz, Madeleine

    2011-01-01

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

  1. Managing Suicide Attempts: Guidelines for the Primary Care Physician

    PubMed Central

    Carrigan, Catherine Goertemiller; Lynch, Denis J.

    2003-01-01

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

  2. [Management of the esophageal candidiasis by the primary care physician].

    PubMed

    Behrens, Garance; Bocherens, Astrid; Senn, Nicolas

    2014-05-14

    Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary. PMID:24930154

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

    E-print Network

    Kuhl, Kathleen Marie

    1993-01-01

    AN ASSESSMENT OF THE IMPACT OF A WEIGHT MANAGEMENT PROGRAM ON ADOLESCENTS' FOOD CHOICES AND SELF-ESTEEM A Thesis by KATHLEEN MARIE KUHL Submitted to the Office of Graduate Studies of Texas A&M University in partial fulfillment... of the requirements for the degree of MASTER OF SCIENCE August 1993 Major Subject: Nutrition AN ASSESSMENT OF THE IMPACT OF A WEIGHT MANAGEMENT PROGRAM ON ADOLESCENTS' FOOD CHOICES AND SELF-ESTEEM A Thesis by KATHLEEN MARIE KUHL Submitted to Texas A...

  4. Current Management of Primary Central Nervous System Lymphoma

    SciTech Connect

    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

    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.

  5. [Choice experiment method and its application to solid waste management in Macao].

    PubMed

    Jin, Jian-jun; Wang, Zhi-shi

    2006-04-01

    Economic valuation of environmental goods or services has been becoming a research frontier and hotspot of environmental economics in the world. Choice experiment (CE) is a relatively new method that can be used to value the economic benefits of environmental goods or services. This paper reports an attempt to apply the CE method in Macao that aimed to understand Macao residents' preferences for solid waste management programs. A random sample survey of 260 respondents in Macao was conducted during the summer in 2004. Survey data was analyzed using multinomial logit models. Results from 260 in-person interviews indicate that Macao residents preferred waste segregation and recycling at source and noise reduction during waste collection and transportation. The study concludes that CE is a reliable tool in the analysis of respondents' preferences for the development of suitable solid waste management programs in Macao. PMID:16768014

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

    PubMed

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

    2007-06-01

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

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

    ERIC Educational Resources Information Center

    O'Hanlon, Fiona

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  9. Management of primary ciliary dyskinesia in European children: recommendations and clinical practice.

    PubMed

    Strippoli, Marie-Pierre F; Frischer, Thomas; Barbato, Angelo; Snijders, Deborah; Maurer, Elisabeth; Lucas, Jane S A; Eber, Ernst; Karadag, Bulent; Pohunek, Petr; Zivkovic, Zorica; Escribano, Amparo; O'Callaghan, Chris; Bush, Andrew; Kuehni, Claudia E

    2012-06-01

    The European Respiratory Society Task Force on primary ciliary dyskinesia (PCD) in children recently published recommendations for diagnosis and management. This paper compares these recommendations with current clinical practice in Europe. Questionnaires were returned by 194 paediatric respiratory centres caring for PCD patients in 26 countries. In most countries, PCD care was not centralised, with a median (interquartile range) of 4 (2-9) patients treated per centre. Overall, 90% of centres had access to nasal or bronchial mucosal biopsy. Samples were analysed by electron microscopy (77%) and ciliary function tests (57%). Nasal nitric oxide was used for screening in 46% of centres and saccharine tests in 36%. Treatment approaches varied widely, both within and between countries. European region, size of centre and the country's general government expenditure on health partly defined availability of advanced diagnostic tests and choice of treatments. In conclusion, we found substantial heterogeneity in management of PCD within and between countries, and poor concordance with current recommendations. This demonstrates how essential it is to standardise management and decrease inequality between countries. Our results also demonstrate the urgent need for research: to simplify PCD diagnosis, to understand the natural history and to test the effectiveness of interventions. PMID:22282549

  10. Resistant hypertension: an approach to management in primary care

    PubMed Central

    Yaxley, Julian P.; Thambar, Sam V.

    2015-01-01

    Hypertension is widely encountered in family medicine. Despite its prevalence, many patients have uncontrolled or difficult-to-control blood pressure. Resistant hypertension is defined as hypertension that is poorly responsive to treatment and requires the use of multiple medications to achieve acceptable blood pressure ranges. It may be a consequence of secondary hypertension or have no identifiable cause. Resistant hypertension is important to recognise because it places patients at risk of end-organ damage. Primary care physicians should be aware of the therapeutic approach for hypertension when traditional therapy fails. This article aims to familiarise readers with the evaluation and management of resistant hypertension by outlining the most recent evidence-based treatment options. PMID:25949966

  11. Biodiversity informatics: managing and applying primary biodiversity data.

    PubMed Central

    Soberón, Jorge; Peterson, A Townsend

    2004-01-01

    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

  12. Contemporary management of primary immune thrombocytopenia in adults.

    PubMed

    Lakshmanan, S; Cuker, A

    2012-10-01

    Immune thrombocytopenia (ITP) comprises a syndrome of diverse disorders that have in common immune-mediated thrombocytopenia, but that differ with respect to pathogenesis, natural history and response to therapy. ITP may occur in the absence of an evident predisposing etiology (primary ITP) or as a sequela of a growing list of associated conditions (secondary ITP). Primary ITP remains a diagnosis of exclusion and must be differentiated from non-autoimmune etiologies of thrombocytopenia and secondary causes of ITP. The traditional objective of management is to provide a hemostatic platelet count (> 20-30 × 10(9) L(-1) in most cases) while minimizing treatment-related toxicity, although treatment goals should be tailored to the individual patient and clinical setting. Corticosteroids, supplemented with either intravenous immune globulin G or anti-Rh(D) as needed, are used as upfront therapy to stop bleeding and raise the platelet count acutely in patients with newly diagnosed or newly relapsed disease. Although most adults with primary ITP respond to first-line therapy, the majority relapse after treatment is tapered and require a second-line approach to maintain a hemostatic platelet count. Standard second-line options include splenectomy, rituximab and the thrombopoietin receptor agonists, romiplostim and eltrombopag. Studies that directly compare the efficacy, safety and cost-effectiveness of these approaches are lacking. In the absence of such data, we do not favor a single second-line approach for all patients. Rather, we consider the pros and cons of each option with our patients and engage them in the decision-making process. PMID:22863415

  13. What do physicians dislike about managed care? Evidence from a choice experiment.

    PubMed

    Rischatsch, Maurus; Zweifel, Peter

    2013-08-01

    Managed care (MC) imposes restrictions on physician behavior, but also holds promises, especially in terms of cost savings and improvements in treatment quality. This contribution reports on private-practice physicians' willingness to accept (WTA, compensation asked, respectively) for several MC features. In 2011, 1,088 Swiss ambulatory care physicians participated in a discrete choice experiment, which permits putting WTA values on MC attributes. With the exception of shared decision making and up to six quality circle meetings per year, all attributes are associated with non-zero WTA values. Thus, health insurers must be able to achieve substantial savings in order to create sufficient incentives for Swiss physicians to participate voluntarily in MC plans. PMID:22717653

  14. Simplified stepwise management of primary spontaneous pneumothorax: a pilot study.

    PubMed

    Marquette, C-H; Marx, A; Leroy, S; Vaniet, F; Ramon, P; Caussade, S; Smaiti, N; Bonfils, C

    2006-03-01

    In primary spontaneous pneumothorax (PSP) requiring intervention, removal of air from the pleural space can be achieved by manual needle aspiration or by pleural drainage after insertion of a chest tube. This study aimed to evaluate the efficacy and safety of a serial-steps approach with a single system (small-calibre catheter/Heimlich valve) in a homogeneous population of patients with a first episode of PSP. All patients had an 8.5 F distally multiperforated polyurethane pigtail catheter inserted via the anterior route, at the bedside without any guidance, using the Seldinger technique. A one-way Heimlich valve was connected to the catheter, allowing the air to flow spontaneously outwards for 24-48 h. Thereafter, if the lung failed to re-expand wall suction was applied. Patients with an air leak persisting for >4 days were referred for surgery. Primary end-points were success rates at 24 h and 1 week, and 1 yr recurrence-free survival. In total, 41 consecutive patients entered the study. They were typically thin, young, smoking males. No procedure-related complications were observed. The need for pain relief medication was minimal. Within the first 24 h, most of the patients were able to walk around and half of them were able to take a shower with their catheter in place. The 24-h and 1-week success rates were 61 and 85%, respectively, and the actuarial 1-yr recurrence rate was 24%. Four patients underwent surgical pleurodesis because of a persistent air leak. The length of stay when excluding the four surgical cases was 2.3+/-1.3 days. When 24-h and 1-week success rates and recurrence at 12 months were taken as end-points, the method described here is as effective as simple manual needle aspiration or a conventional chest tube thoracotomy. These results support further studies assessing this "one system, serial-steps approach" in an outpatient management algorithm. PMID:16507845

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

    PubMed

    Hegedüs, Laszlo; Bonnema, Steen J

    2010-12-01

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

  16. Primary Care Provider Turnover and Quality in Managed Care Organizations

    Microsoft Academic Search

    Mary E. Plomondon; David J. Magid; John F. Steiner; Samantha MaWhinney; Blair D. Gifford; Sarah C. Shih; Gary K. Grunwald; John S. Rumsfeld

    Although associations with continuity of care have been studied, little is known about associations with a specific aspect of continuity of care, namely, primary care provider turnover. From literature, primary care provider turnover is the rate at which primary care providers leave a health plan organization. Known to be costly, healthcare turnover, including physicians, nurses, allied health personnel, and staff,

  17. Development and validation of quality indicators for dementia diagnosis and management in a primary care setting

    Microsoft Academic Search

    Marieke Perry; I. Draskovic; Theo van Achterberg; Monique van Eijken; P. L. B. J. Lucassen; M. J. F. J. Vernooij-Dassen; Marcel Olde Rikkert

    2010-01-01

    OBJECTIVES: To construct a set of quality indicators (QIs) for dementia diagnosis and management in a primary care setting. DESIGN: RAND modified Delphi method, including a postal survey, a stakeholders consensus meeting, a scientific expert consensus meeting, and a demonstration project. SETTING: Primary care. PARTICIPANTS: General practitioners (GPs), primary care nurses (PCNs), and informal caregivers (ICs) in postal survey and

  18. The Role of Client Choice and Target Selection in Self-Management Therapy for Depression in Older Adults

    Microsoft Academic Search

    Paul D. Rokke; Judith A. Tomhave; Zeljko Jocic

    1999-01-01

    In a study designed to maximize the effectiveness of treatment by allowing participants to select the target of treatment, 40 depressed older adults were randomly assigned to a waiting-list control condition or to conditions in which the target of treatment was either chosen or assigned. All participants received self-management therapy and the choice was between changing behavior or changing cognition.

  19. Diagnosis and management of cholangiocarcinoma in primary sclerosing cholangitis

    Microsoft Academic Search

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

    1999-01-01

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

  20. Challenges of implementing depression care management in the primary care setting.

    PubMed

    Belnap, Bea Herbeck; Kuebler, Julie; Upshur, Carole; Kerber, Kevin; Mockrin, Deborah Ruth; Kilbourne, Amy M; Rollman, Bruce L

    2006-01-01

    Empirical evidence shows that care management is an effective tool for improving depression treatment in primary care patients. However, several conceptual and practical issues have not been sufficiently addressed. This article explores questions concerning the scope of care management services within the chronic illness care model; optimal ways to identify depressed patients in the primary care setting; responsibilities and desirable qualifications of depression care managers; the location and manner in which care managers interact with patients; costs of services provided by care managers; and the level of supervision by mental health specialists that is necessary to ensure quality care. PMID:16215660

  1. Cost Analysis in Primary Health Care. A Training Manual for Programme Managers.

    ERIC Educational Resources Information Center

    Creese, Andrew, Ed.; Parker, David, Ed.

    This manual is designed to provide primary health care program managers with guidance on how to use cost analysis and cost-effectiveness analysis as tools to achieve better understanding and management of resource flows. Although it has been prepared primarily for program managers at national, regional, and district levels, other health…

  2. Protocol for the Osteoporosis Choice trial. A pilot randomized trial of a decision aid in primary care practice

    Microsoft Academic Search

    Laurie J Pencille; Megan E Campbell; Holly K Van Houten; Nilay D Shah; Rebecca J Mullan; Brian A Swiglo; Maggie Breslin; Rebecca L Kesman; Sidna M Tulledge-Scheitel; Thomas M Jaeger; Ruth E Johnson; Gregory A Bartel; Robert A Wermers; L Joseph Melton; Victor M Montori

    2009-01-01

    BACKGROUND: Bisphosphonates can reduce fracture risk in patients with osteoporosis, but many at-risk patients do not start or adhere to these medications. The aims of this study are to: (1) preliminarily evaluate the effect of an individualized 10-year osteoporotic fracture risk calculator and decision aid (OSTEOPOROSIS CHOICE) for postmenopausal women at risk for osteoporotic fractures; and (2) assess the feasibility

  3. Patient Self-management of Chronic Disease in Primary Care

    Microsoft Academic Search

    Thomas Bodenheimer; Kate Lorig; Halsted Holman; Kevin Grumbach

    2005-01-01

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

  4. Values, Increasing Autonomy and Managing the Primary School.

    ERIC Educational Resources Information Center

    Hooge, Edith

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

  5. Breast cancer risk assessment and management in primary care: Provider attitudes, practices, and barriers

    Microsoft Academic Search

    Susan A. Sabatino; Ellen P. McCarthy; Russell S. Phillips; Risa B. Burns

    2007-01-01

    Background: We surveyed primary care providers to evaluate breast cancer risk assessment and management practices. Methods: Primary care providers included staff (attendings, fellows, nurse practitioners) and residents practicing ?1 session\\/week in an outpatient general medicine practice or community practices. Of 201 eligible providers, 107 (53%) completed a self-administered questionnaire ascertaining attitudes, perceived barriers, and clinical practices related to assessing and

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

    ERIC Educational Resources Information Center

    Cheng, Alison Lai Fong; Yau, Hon Keung

    2011-01-01

    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…

  7. The Effective Management of Primary Schools in Ekiti State, Nigeria: An Analytical Assessment

    ERIC Educational Resources Information Center

    Adeyemi, T. O.

    2009-01-01

    This study investigated the management of education in primary schools in Ekiti State, Nigeria. As a correlational research, the study population comprised all the 694 primary schools in the State. Out of this, a sample of 320 schools was selected through the stratified random sampling technique. Two instruments were used to collect data for the…

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

    Microsoft Academic Search

    Donna Felber Neff; Elizabeth S. Kinion; Christen Cardina

    2007-01-01

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

  9. Biodiversity informatics: managing and applying primary biodiversity data

    Microsoft Academic Search

    Jorge Soberon; T. Peterson

    2004-01-01

    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

  10. Diagnostic and therapeutic management of cancer of an unknown primary

    Microsoft Academic Search

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

    2003-01-01

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

  11. Identifying Primary Care Skills and Competencies in Opioid Risk Management

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    PubMed

    Haslam, David

    2014-01-01

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

  13. Management of epididymo-orchitis in primary care: results from a large UK primary care database

    PubMed Central

    Nicholson, Amanda; Rait, Greta; Murray-Thomas, Tarita; Hughes, Gwenda; Mercer, Catherine H; Cassell, Jackie

    2010-01-01

    Background Epididymo-orchitis is a common urological presentation in men but recent incidence data are lacking. Guidelines for management recommend detailed investigation and treatment for sexually transmitted pathogens, such as Chlamydia trachomatis. Data from secondary care indicate that these guidelines are poorly followed. It is not known how epididymo-orchitis is managed in UK general practice. Aim To estimate the incidence of cases of epididymo-orchitis seen in UK general practice, and to describe their management. Design of study Cohort study. Setting UK general practices contributing to the General Practice Research Database (GPRD). Method Men, aged 15–60 years, consulting with a first episode of epididymo-orchitis between 30 June 2003 and 30 June 2008 were identified. All records within 28 days either side of the diagnosis date were analysed to describe the management of these cases (including location) and to compare this management with guidelines. Results A total of 12 615 patients with a first episode of epididymo-orchitis were identified. The incidence was highest in 2004–2005 (25/10 000) and declined in the later years of the study. Fifty-seven per cent (6943) of patients were managed entirely within general practice. Of these, over 92% received an antibiotic, with ciprofloxacin being the most common one prescribed. Only 18% received a prescription for doxycycline. Most men, including those under 35 years, had no investigation recorded and fewer than 3% had a test for chlamydia. Conclusion These results indicate low rates of specific testing and treatment for sexually transmitted infections in males who attend general practice with symptoms of epididymo-orchitis. There is a need for further research to understand the pattern of care delivered in general practice. PMID:20883615

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

    ERIC Educational Resources Information Center

    O'Neill, Sue C.; Stephensen, Jennifer

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Fitzgerald, Sarah; Drake, Julie

    2013-01-01

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

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

    PubMed

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

    2014-03-01

    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

  17. Prevalence, evaluation and management of overactive bladder in primary care

    PubMed Central

    Cheung, Wellman W; Khan, Nadia H; Choi, Karmina K; Bluth, Martin H; Vincent, Miriam T

    2009-01-01

    Background Patients with overactive bladder (OAB) are under-diagnosed in the primary care setting. Primary care physicians (PCP) approach to the patient and appropriate patient disclosure may contribute to under-diagnosis. Methods An outpatient primary care setting was used to determine the prevalence and characteristics of OAB. Patients who visited the family medicine outpatient clinic were invited to answer a self-administered questionnaire. It included questions on evidence of lower urinary tract symptoms (modified Overactive Bladder-Validated 8-question Screener [OAB-V8]), relevant medical and surgical history, and demographic data. Relationship between OAB and other independent variables were analyzed using chi-square and risk ratio (RR) analysis. Results Of 325 questionnaires distributed, 311 were returned completed. Patients ranged from 18 to 97 years, the majority women (74.0%) and African American (74.3%). OAB was present in 60.5% of men and 48.3% of women (p = 0.058). OAB was significantly associated with obesity (BMI > = 30) in women (p = 0.018, RR = 1.72), specifically obese premenopausal women (age < 55 years) (p = 0.011, RR = 1.98). Conclusion OAB prevalence is more than double and higher in men than previously reported. The relative risk for OAB is significantly greater in obese premenopausal women. PMID:19166611

  18. Implementation and evaluation of a clinical data management programme in a primary care centre.

    PubMed

    Sweeney, J; McHugh, S; Perry, I J

    2014-01-01

    Electronic health records (EHR)support clinical management, administration, quality assurance, research, and service planning. The aim of this study was to evaluate a clinical data management programme to improve consistency, completeness and accuracy of EHR information in a large primary care centre with 10 General Practitioners (GPs). A Clinical Data Manager was appointed to implement a Data Management Strategy which involved coding consultations using ICPC-2 coding, tailored support and ongoing individualised feedback to clinicians. Over an eighteen month period there were improvements in engagement with and level of coding. Prior to implementation (August 2011) 4 of the 10 GPs engaged in regular coding and 69% of their consultation notes were coded. After 12 months, all 10 GPs and 6 nurses were ICPC-2 coding their consultations and monthly coding levels had increased to 98%. This structured Data Management Strategy provides a feasible sustainable way to improve information management in primary care. PMID:25556259

  19. Classroom Behaviour Management Content in Australian Undergraduate Primary Teaching Programmes

    ERIC Educational Resources Information Center

    O'Neill, Sue; Stephenson, Jennifer

    2012-01-01

    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…

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

    PubMed Central

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

    2015-01-01

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

  1. Influence of walking route choice on primary school children's exposure to air pollution - A proof of concept study using simulation.

    PubMed

    Mölter, Anna; Lindley, Sarah

    2015-10-15

    This study developed a walking network for the Greater Manchester area (UK). The walking network allows routes to be calculated either based on the shortest duration or based on the lowest cumulative nitrogen dioxide (NO2) or particulate matter (PM10) exposure. The aim of this study was to analyse the costs and benefits of faster routes versus lower pollution exposure for walking routes to primary schools. Random samples of primary schools and residential addresses were used to generate 100,000 hypothetical school routes. For 60% (59,992) and 40% (40,460) an alternative low NO2 and PM10 route was found, respectively. The median change in travel time (NO2: 4.5s, PM10: 0.5s) and average route exposure (NO2: -0.40?g/m(3), PM10: -0.03?g/m(3)) was small. However, quantile regression analysis indicated that for 50% of routes a 1% increase in travel time was associated with a 1.5% decrease in NO2 and PM10 exposure. The results of this study suggest that the relative decrease in pollution exposure on low pollution routes tends to be greater than the relative increase in route length. This supports the idea that a route planning tool identifying less polluted routes to primary schools could help deliver potential health benefits for children. PMID:26047859

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

    PubMed Central

    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

    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

  3. Car fuel-type choice under travel demand management and economic incentives

    Microsoft Academic Search

    Gordon O. Ewing; Emine Sarigöllü

    1998-01-01

    Future levels of vehicle air pollution in urban areas will depend on the proportion of new car buyers who opt for less polluting vehicles, as these appear on the market. This paper examines the factors likely to influence the demand for lower emission and zero emission vehicles. Using a discrete choice experiment, suburban driver commuters choose between three types of

  4. Patients' preferences for the management of non-metastatic prostate cancer: discrete choice experiment

    Microsoft Academic Search

    Mark Sculpher; Stirling Bryan; Pat Fry; Patricia de Winter; Heather Payne; Mark Emberton

    2004-01-01

    Objective To establish which attributes of conservative treatments for prostate cancer are most important to men. Design Discrete choice experiment. Setting Two London hospitals. Participants 129 men with non-metastatic prostate cancer, mean age 70 years; 69 of 118 (58%) with T stage 1 or 2 cancer at diagnosis. Main outcome measures Men's preferences for, and trade-offs between, the attributes of

  5. Results of radiotherapeutic management of primary carcinoma of the vagina.

    PubMed

    Reddy, S; Saxena, V S; Reddy, S; Lee, M S; Yordan, E L; Graham, J E; Phillips, R; Hendrickson, F R

    1991-09-01

    Forty-five previously untreated patients with primary carcinoma of the vagina were treated with curative radiotherapy from 1965 through 1985. All patients were staged according to the FIGO system. One patient was classified as Stage 0, 15 as Stage I, 22 as Stage II, 6 as Stage III, and 1 as Stage IV. Treatment consisted of intracavitary irradiation alone in Stage 0 patients. Stage I patients received intracavitary/interstitial irradiation alone or in combination with external irradiation and an implant when feasible. When treated with an implant only, the total tumor dose delivered was between 65-70 Gy. External irradiation consisted of delivering a dose of 45-50 Gy over a period of 4 1/2-5 weeks to the whole pelvis to treat the regional lymph nodes. An additional dose of 20-25 Gy was delivered to the site of original involvement using an implant when feasible. If not technically feasible, as in advanced stages, the patient was treated with additional external irradiation to a total dose of 65-70 Gy by a shrinking field technique. All patients except one were followed either until death or for a minimum of 2 years. The actuarial 5-year survival rates were 100% for Stage 0, 78% for Stage I, and 71% for Stage II patients. None of the patients with Stage III or IV disease survived. Of the patients who recurred, all but two did so within 16 months after diagnosis. Pelvic recurrence as the first site of recurrence occurred in 86% of the patients who recurred. Distant recurrence as a component occurred in 20% of all failures. Complications as a consequence of therapy occurred in 18% of the patients. Vaginal necrosis that healed with conservative treatment was seen in four patients and the other four patients had rectal complications of varying severity. Thus, curative radiotherapy is an effective method of treatment, with acceptable morbidity, in patients with early stage primary carcinoma of the vagina. PMID:1917600

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

    PubMed

    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

    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

  7. Capital Structure Choice When Managers Are in Control: Entrenchment versus Efficiency

    Microsoft Academic Search

    Walter Novaes

    2003-01-01

    In the free-cash-flow theory, shareholders use debt to discipline managers and maximize firm value. In contrast, managerial models assume that, without a takeover threat, managers will not lever up to constrain themselves. This article demonstrates that a takeover threat is unlikely to reconcile these two theories. In particular, with low takeover costs, target managers may overlever. Yet, both theories are

  8. Primary care management of otitis media among Australian children.

    PubMed

    Gunasekera, Hasantha; O'Connor, Tony E; Vijayasekaran, Shyan; Del Mar, Christopher B

    2009-11-01

    Acute otitis media (AOM) is diagnosed on the basis of acute onset of pain and fever; a red, bulging tympanic membrane; and middle ear effusion. AOM is managed with analgesia (paracetamol or non-steroidal anti-inflammatory drugs). Antibiotic therapy is minimally effective for most patients; it is most effective for children < 2 years with bilateral otitis media and for children with discharging ears. National guidelines recommend antibiotic therapy for Indigenous children with AOM. Evidence for corticosteroids, topical analgesia and xylitol are scant. Otitis media with effusion (OME) is diagnosed as the presence of middle ear effusion (type B tympanogram or immobile tympanic membrane on pneumatic otoscopy) without AOM criteria. Well children with OME with no speech and language delays can be observed for the first 3 months; perform audiological evaluation and refer to an ear, nose and throat (ENT) specialist if they have bilateral hearing impairment > 30 dB or persistent effusion. Children with effusions persisting longer than 3 months can benefit from a 2-4-week course of amoxycillin. Chronic suppurative otitis media is a chronic discharge through a tympanic membrane perforation. It is managed with regular ear cleaning (dry mopping or povidone-iodine [Betadine] washouts) until discharge resolves; topical ear drops (eg, ciprofloxacin); audiological evaluation; and ENT review. PMID:19883358

  9. Algorithms for the assessment and management of insomnia in primary care

    PubMed Central

    Hilty, Donald; Young, Julie S; Bourgeois, James A; Klein, Sally; Hardin, Kimberly A

    2009-01-01

    Insomnia is a leading cause of sleep disturbance in primary care practice affecting >30% of people in the United States and can result in psychological and physiological consequences. We aim for a focused discussion of some of the underpinnings of insomnia and practical tips for management (eg, algorithms). A PubMed search was conducted using English language papers between 1997–2007, with the terms “sleep,” “insomnia”; “primary care” and “clinics”; “comorbid conditions”; “treatment” and “management.” Sleep, psychiatric and medical disorders significantly affect sleep, causing patient suffering, potentially worsening of other disorders and increasing the use of primary care services. We provide an outline for practical assessment and treatment of insomnia in primary care, including the strengths and weaknesses of medications. PMID:19936140

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

    ERIC Educational Resources Information Center

    Pansiri, Nkobi Owen

    2008-01-01

    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…

  11. Natural history and management of primary biliary cirrhosis

    PubMed Central

    Al-Harthy, Nadya; Kumagi, Teru

    2012-01-01

    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

  12. Allergy management in primary care across European countries -- actual status.

    PubMed

    Agache, I; Ryan, D; Rodriguez, M R; Yusuf, O; Angier, E; Jutel, M

    2013-07-01

    The standard of care for allergies within a primary care (PC) setting has a strong influence on disease prevention and control, quality of life, and patient satisfaction. The level of knowledge of allergic diseases and the accessibility to regular follow-up are essential. EAACI and IPCRG conducted a survey to evaluate the actual status of care for allergic diseases in PC. Access to allergy and asthma specialist treatment was identified as the greatest 'unmet need'. The average waiting time between a referral and being seen in a public health service is usually >6 weeks. Referring the patients to an 'organ' specialist is much easier compared with referral to an allergist. Most PCPs have access to blood tests for total and specific IgE. Skin prick testing is available in only half of the cases, while provocation tests, allergen quantification in homes, and a dietician service are even less available. 20.6% of practices do not have access to allergy tests at all. Other issues raised were low political or general public awareness, lack of understanding by the patients of their allergic disease, the need to invest in PC, and to achieve sufficient competence at the appropriate level of care. PMID:23735183

  13. Facilitating patients' diabetes self-management: a primary care intervention framework.

    PubMed

    Corser, William; Xu, Yin

    2009-01-01

    A quality primary care framework for diabetes self-management (DSM) is presented on the basis of prevalent office setting changes. Recent DSM research and literature are reviewed concerning (a) patients' DSM perceptions and office visit experiences and (b) more effective office-based DSM programs. This quality primary care framework enables nurse clinicians to more consistently assess and integrate individual patient factors using typically limited clinic resources into office visits to optimize DSM patient outcomes. PMID:19287258

  14. Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study

    Microsoft Academic Search

    Michael F. Fialkow; Katherine M. Newton; Noel S. Weiss

    2008-01-01

    We conducted this study to estimate the rate of, and identify risk factors for, recurrent pelvic organ prolapse (POP) following\\u000a primary surgical repair. The study consisted of a retrospective cohort study of 142 women who underwent primary surgical management\\u000a of POP in 1993 and were followed up to 10 years. Prolapse severity was graded using an established classification system of\\u000a clinical

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

    PubMed Central

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

    2010-01-01

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

  16. Managing major depression: improving the interface between psychiatrists and primary care.

    PubMed

    Thompson, C

    2001-01-01

    Responsibility for identifying and managing most people with major depressive disorder (MDD) rests firmly within the primary care setting. Unfortunately, circumstances continue to have a negative impact on depression outcomes, with low recognition rates, inadequate levels of treatment and poor follow-up all contributing to the provision of a less than optimal service for patients. The Hampshire Depression Project confirmed that improved primary care education, in isolation, does not have any long-term benefits for patients with MDD. However, many other studies have shown that stronger collaboration between psychiatrists and primary care can significantly improve the quality of care provided in the primary care setting, and ensure that most patients are managed effectively and in accordance with international and national guidelines. Simple collaborative care models, which encourage mental health specialists to work within the primary care system, have had a dramatic impact on the outcomes for patients, and significantly enhanced the satisfaction of both patients and physicians with treatment. These interventions could easily and cost-effectively be applied more broadly and would ensure that effective management of MDD in primary care becomes the rule and not just the exception. ( Int J Psych Clin Pract 2001; 5 (Suppl 1): S11-S18). PMID:24936989

  17. Approach to the surgical management of primary aldosteronism

    PubMed Central

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

    2015-01-01

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

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

    Microsoft Academic Search

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

    2007-01-01

    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

  19. Why the EU's common foreign and security policy will remain intergovernmental: a rationalist institutional choice analysis of European crisis management policy

    Microsoft Academic Search

    Wolfgang Wagner

    2003-01-01

    Critics have suggested communitarizing the European Union's common foreign and security policy in order to increase its effectiveness. Drawing on rationalist theories of regimes and institutional choice, this paper argues that the delegation of competencies to the EU's supranational institutions is unlikely to make European crisis management more effective. Crisis management policy is best understood as a fast co-ordination game

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

    PubMed

    Kayihan, Kutlu Sevinç; Tönük, Seda

    2012-01-01

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

  1. Musculoskeletal conditions in children and adolescents managed in Australian primary care

    PubMed Central

    2014-01-01

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

  2. Fingerponds: managing nutrients and primary productivity for enhanced fish production in Lake Victoria's wetlands, Uganda

    Microsoft Academic Search

    R. C. Kaggwa

    2006-01-01

    Fingerponds are earthen ponds dug at the edge of natural wetlands and stocked naturally with wild fish during flooding. In this study, the management of nutrients and primary productivity in enhancing fish production in these systems is examined in Lake Victorias wetlands, Uganda. Key factors determining natural food production for fish are determined and the processes determining variability in water

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

    ERIC Educational Resources Information Center

    Ogunfowokan, Adesola A.; Babatunde, Oluwayemisi A.

    2010-01-01

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

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

    Microsoft Academic Search

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

    2008-01-01

    BACKGROUND: Guidelines on COPD diagnosis and management encourage primary care physicians to detect the disease at an early stage and to treat patients according to their condition and needs. Problems in guideline implementation include difficulties in diagnosis, using spirometry and the disputed role of reversibility testing. These lead to inaccurate diagnostic registers and inadequacy of administered treatments. This study represents

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

    SciTech Connect

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

    2007-04-23

    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.

  6. Computer-based decision support in the management of primary gastric non-Hodgkin lymphoma

    Microsoft Academic Search

    Peter Lucas; B. Taal

    1998-01-01

    Primary non-Hodgkin lymphoma of the stomach is a rare disorder for which clinical management has not yet been settled completely. Faced with the many uncertainties associated with the selection of a treatment for a patient with this disorder, it is dicult to determine the treatment that is optimal for the patient, as well as the prognosis to be expected. The

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

    PubMed Central

    Stellefson, Michael; Stopka, Christine

    2013-01-01

    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

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

    PubMed

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

    2014-01-01

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

  9. The Choice of the Correct Imaging Modality in Breast Cancer Management

    Microsoft Academic Search

    Paola Mariani; Luca Gianni

    Substantial progress has been made in the diagnosis and treatment of primary and metastatic breast cancer in the last 20 years.\\u000a New technical instruments and laboratory tools have emerged in recent years that expand the options for the study of breast\\u000a cancer at different stages. Such an improved platform requires a departure from standard approaches and prompts testing of\\u000a the

  10. How to launch a high-tech product successfully: An analysis of marketing managers' strategy choices

    Microsoft Academic Search

    Jan P. L. Schoormans

    1995-01-01

    The launch strategy for a new product is a crucial decision issue for marketing managers. Little agreement exists however about the content of a launch strategy and about the individual and combined effects of its constituent parts on new-product success. In this study, the relative importance of some launch strategy tactics (pricing, promotion, product assortment and competitive advantage) on the

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  12. Multidisciplinary care planning in the primary care management of completed stroke: a systematic review

    PubMed Central

    Mitchell, Geoffrey K; Brown, Robyn M; Erikssen, Lars; Tieman, Jennifer J

    2008-01-01

    Background Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care. Methods A Systematic review of Medline, EMBASE, CINAHL (all 1990–2006), Cochrane Library (Issue 1 2006), and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1) a multi-disciplinary primary care team or 2) through shared care by primary and secondary providers. Results One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided. Conclusion While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact of active GP involvement in multidisciplinary care planning is warranted. PMID:18681977

  13. Feasible evidence-based strategies to manage depression in primary care.

    PubMed

    Kurian, Benji T; Grannemann, Bruce; Trivedi, Madhukar H

    2012-08-01

    According to the World Health Organization, major depressive disorder (MDD) is a leading cause of disability-adjusted life years worldwide. However, recent evidence suggests depression remains undertreated in primary care settings. Measurement-based care (MBC) is an evidence-based strategy that can feasibly assist primary care physicians in managing patients with MDD. Utilizing health information technology tools, such as computer decision support software, can improve adherence to evidence-based treatment guidelines and MBC at the point of care. PMID:22733047

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

    PubMed

    Srivastava, Sanjay K

    2009-03-01

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

  15. Family caregivers as case managers. A statewide model for enhancing consumer choice.

    PubMed

    Friss, L R

    1993-01-01

    Families spend considerably more time caring for their relatives than service providers do. Most family caregivers of persons with dementing illnesses express a strong preference to be their own case managers. This article describes the history, philosophy, and service components of a model statewide system of caregiver resource centers serving families and caregivers of cognitively impaired adults in California. An overview of the population served and salient characteristics is provided. California's Caregiver Resource Center system utilizes a philosophy of service planning, coordination, and delivery that is unusual among publicly funded programs in the United States: It seeks to give caregivers the specialized information, support and training to enable them to become their own case managers for their loved ones. Vesting authority about care decisions with the caregiver is considered central to the implementation of this innovative family support system. PMID:8130744

  16. Linking primary health care and self-care through case management.

    PubMed

    Holzemer, W L

    1992-01-01

    Primary health care (PHC) strategies have heightened health care providers' awareness of the need to understand their communities and provided knowledge on how to mobilize communities for health. Orem, a nurse theorist, has developed a similar philosophical position on mobilizing individuals for self-care, which complements PHC theory at the community level. This article links the philosophies and strategies of PHC with self-are and proposes a delivery model of case management, drawing on examples from the HIV/AIDS pandemic and the aging population to illustrate the type of coordinating activities required of case managers in the 21st century. PMID:1639590

  17. Practical Suicide-Risk Management for the Busy Primary Care Physician

    PubMed Central

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

    2011-01-01

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

  18. Improving population management through pharmacist-primary care integration: a pilot study.

    PubMed

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

    2015-02-01

    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. PMID:25029631

  19. Suicide risk in primary care: identification and management in older adults.

    PubMed

    Raue, Patrick J; Ghesquiere, Angela R; Bruce, Martha L

    2014-09-01

    The National Strategy for Suicide Prevention (2012) has set a goal to reduce suicides by 20% within 5 years. Suicide rates are higher in older adults compared to most other age groups, and the majority of suicide completers have visited their primary care physician in the year before suicide. Primary care is an ideal setting to identify suicide risk and initiate mental health care. We review risk factors for late-life suicide; methods to assess for different levels of suicidality; and recent research developments regarding both effective assessment and management of suicide risk among older primary care patients. We highlight that broader scale screening of suicide risk may be considered in light of findings that suicidality can occur even in the absence of major risk factors like depression. We also highlight collaborative care models targeting suicide risk, and recent innovative interventions that aim to prevent the development of suicidal ideation and suicidal behavior. PMID:25030971

  20. Primary care physician versus urologist: How does their medical management of LUTS associated with BPH differ?

    Microsoft Academic Search

    Martin M. Miner

    2009-01-01

    Medical and surgical therapies for benign prostatic hyperplasia (BPH) are based largely on the results from adherence to the\\u000a 2003 American Urological Association Guidelines. However, with the emergence of medical therapies as first-line treatment\\u000a and the expansion of medical therapy for lower urinary tract symptoms (LUTS) into the primary care office, the evaluation\\u000a and management of men presenting with urinary

  1. Primary malignant clavicular tumours: a clinicopathological analysis of six cases and evaluation of surgical management

    Microsoft Academic Search

    Barbara Rossi; Carlo Fabbriciani; Byron E. Chalidis; Federico Visci; Giulio Maccauro

    2011-01-01

    Primary malignant tumours of the clavicle are extremely rare and little is known regarding their clinicopathological characteristics\\u000a and outcomes of surgical management. The aim of the study is to analyse the clinical, imaging, and histological features of\\u000a six patients with malignant tumours of the clavicle and present the outcome of cleidectomy in four of them. A review of the\\u000a literature

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

    PubMed Central

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

    2013-01-01

    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

  3. Primary care management of alcohol use disorder and at-risk drinking

    PubMed Central

    Spithoff, Sheryl; Kahan, Meldon

    2015-01-01

    Abstract Objective To provide primary care physicians with evidence-based information and advice on the screening and assessment of at-risk drinking and alcohol use disorder (AUD). A companion article outlines the management of at-risk drinking and AUD. Sources of information We conducted a nonsystematic literature review, using search terms on primary care, AUD, alcohol dependence, alcohol abuse, alcohol misuse, unhealthy drinking, and primary care screening, identification, and assessment. Main message Family physicians should screen all patients at least yearly for unhealthy drinking with a validated screening test. Screen patients who present with medical or psychosocial problems that might be related to alcohol use. Determine if patients who have positive screening results are at-risk drinkers or have AUD. If patients have AUD, categorize it as mild, moderate, or severe using the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, criteria. Share this diagnosis with the patient and offer assistance. Do a further assessment for patients with AUD. Screen for other substance use, concurrent disorders, and trauma. Determine whether there is a need to report to child protection services or the Ministry of Transportation. Determine the need for medical management of alcohol withdrawal. Conduct a brief physical examination and order laboratory tests to assess complete blood count and liver transaminase levels, including ?-glutamyl transpeptidase. Conclusion Primary care is well suited to screening and assessment of alcohol misuse. PMID:26071154

  4. Primary care management of alcohol use disorder and at-risk drinking

    PubMed Central

    Spithoff, Sheryl; Kahan, Meldon

    2015-01-01

    Abstract Objective To provide primary care physicians with evidence-based information and advice on the management of at-risk drinking and alcohol use disorder (AUD). Sources of information We conducted a nonsystematic literature review using search terms that included primary care; screening, interventions, management, and treatment; and at-risk drinking, alcohol use disorders, alcohol dependence, and alcohol abuse; as well as specific medical and counseling interventions of relevance to primary care. Main message For their patients with at-risk drinking and AUD, physicians should counsel and, when indicated (ie, in patients with moderate or severe AUD), prescribe and connect. Counsel: Offer all patients with at-risk drinking a brief counseling session and follow-up. Offer all patients with AUD counseling sessions and ongoing (frequent and regular) follow-up. Prescribe: Offer medications (disulfiram, naltrexone, acamprosate) to all patients with moderate or severe AUD. Connect: Encourage patients with AUD to attend counseling, day or residential treatment programs, and support groups. If indicated, refer patients to an addiction medicine physician, concurrent mental health and addiction services, or specialized trauma therapy. Conclusion Family physicians can effectively manage patients with at-risk drinking and AUD. PMID:26071155

  5. Designing a complex intervention for dementia case management in primary care

    PubMed Central

    2013-01-01

    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

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

    Microsoft Academic Search

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

    1998-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Lemieux, Christopher J.; Scott, Daniel J.

    2011-10-01

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

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

    PubMed

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

    2006-01-01

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

  9. A New Approach to the Management of Uninvestigated Dyspepsia in Primary Care

    PubMed Central

    Salihefendic, Nizama; Zildzic, Muharem; Cabric, Emir

    2015-01-01

    Introduction: The prevalence of dyspepsia in the general population worldwide is very high (20-40%). Upper abdominal complaints are one of the most common cause of patients’ visits to primary care settings. Making an accurate etiological diagnosis of dyspepsia is difficult, but is an important challenge and goal for every doctor in primary care practice. Clinical guidelines have standards for gastroesophageal reflux disease, management of Helicobacter infection and indications for the use of endoscopy (empiric treatment, prompt endoscopy, “test and treat”). In spite of the application of those standards, many patients experience no improvement in their symptoms or often the recurrence of disease. Aim: This study presents a new approach to the diagnostic and therapeutic management of uninvestigated dyspepsia in primary care settings to provide long-term effective control of symptoms for family doctors. Material and methods: 3000 unselected consecutive dyspeptic patients underwent abdominal ultrasound, and 1000 dyspeptic patients from the same group upper endoscopy.. In this approach diagnostic evaluation of dyspepsia includes: abdominal ultrasonography as a first line obligatory routine method and the exact estimation of nutritional condition. Results: Abdominal ultrasound, physical examination and BMI control have significant value in the diagnostic evaluation of dyspepsia. The therapeutic approach includes, besides general standards (acid suppressive drugs, eradication of H. pylori, prokinetic and antidepressant agents), life style modification and nutritional interventions as first-line treatments. In this approach the use of new drugs such as ursodeoxycholic acid (UDCA), pre and probiotics, and digestive enzymes supplements is recommended. Conclusion: Throug the combination of different diagnostic procedures as first line methods, including abdominal ultrasound and nutritional condition (BMI), a family doctor can manage successfully uninvestigated dyspepsia at the primary care level. PMID:26005267

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

    PubMed Central

    2014-01-01

    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

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

    PubMed Central

    2010-01-01

    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

  12. Prescription Practice for Diabetes Management among a Female Population in Primary Health Care

    PubMed Central

    ALHreashy, Fouzia A.; Mobierek, Abdulelah F.

    2014-01-01

    Introduction. Prescription for diabetes care is an important practice in primary care. Methods. This is a descriptive study carried out on at primary care clinics over a five-month period at Al Imam Medical Complex, Riyadh, Saudi Arabia. It was cross-sectional study of 160 female diabetic patients, who visited the services between January and May, 2012. Data were collected from the medical records on the clinical characteristics and drugs prescribed for their diabetic management. Results. The majority of the sample population (82%) was older than 40?years old. Half of them had concomitant hypertension, hyperlipidemia, and obesity. There were 500 prescriptions for diabetes management. More than 57% of participants were on two or more drugs for hyperglycemia. Metformin was the most common drug prescribed. Metformin and sulphonylurea were the most common combined medications. Most of cases ( 70%) were on a combination of antihypertensive drugs. ACE or ARBs and diuretic was the most common combined prescriptions. Statins and aspirin were used by 41% and 23.8% of the research population, respectively. Conclusion. Polypharmacy is a feature in diabetes care. Most of the prescription practice for diabetic care follows the recommended guidelines for hyperglycemia and hypertension. Management of dyslipidemia among diabetic patients, however, is an area that needs to be developed. PMID:24778876

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

    PubMed Central

    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

    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

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

    PubMed

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

    2014-12-01

    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

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

    PubMed Central

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

    2014-01-01

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

  16. Impact of a Clinical Decision Support System on the Management of Patients with Hypercholesterolemia in the Primary Healthcare Setting

    Microsoft Academic Search

    Alex Bassa; Miguel del Val; Albert Cobos; Salvador Bergonon; Carlos Crespo; Max Brosa; Silvia Munio; Cristina Espinosa

    2005-01-01

    Introduction and objectives: The Optimcare study objective was to assess the impact on effectiveness and costs of a practice guideline implemented through a clinical decision support system (CDSS) for the management of patients with hypercholesterolemia in the primary healthcare setting. Study design and perspective: The study design was a prospective, naturalistic, single-center (Vila Olimpica Primary Health Care Center, Barcelona, Spain),

  17. Resection of a primary oral malignant melanoma and rehabilitative management using nasolabial flap: a case report

    Microsoft Academic Search

    Ulrike Stephanie Beier; Thomas Salinas; Wolfgang Puelacher

    Background  The primary malignant melanoma is a rare neoplasm of melanocytic origin in the oral cavity. Only about 1% of all melanomas\\u000a arise in the oral mucosa and these account for 0.5% of all oral malignancies\\u000a \\u000a \\u000a \\u000a \\u000a Case report  This report describes an oral malignant melanoma occurring in the right maxilla of a 73-year-old patient. The interdisciplinary\\u000a management using a nasolabial flap and

  18. Supraventricular tachycardia in the pediatric primary care setting: Age-related presentation, diagnosis, and management.

    PubMed

    Schlechte, Emily Anne; Boramanand, Nicole; Funk, Marjorie

    2008-01-01

    As many as 1 in 250 children experience supraventricular tachycardia (SVT), but its presentation is often vague and its symptoms mistakenly attributed to other common pediatric conditions. If SVT is correctly identified in a timely manner, most children will go on to live normal healthy lives. SVT is not covered in depth in most pediatric advanced practice nursing programs, but because of its prevalence, it should be familiar to all pediatric primary care providers. This article reviews common mechanisms of SVT and their age-related presentation, diagnosis, and management. A case study of an 8-year-old boy with SVT is presented. PMID:18761230

  19. Managing eating disorder patients in primary care in the UK: a qualitative study.

    PubMed

    Reid, Marie; Williams, Sarah; Hammersley, Richard

    2010-01-01

    It is the general practitioner's (GP's) responsibility to diagnose and manage the care of eating disorder patients but recent surveys suggest that there may be problems. In this qualitative study we have explored the perceptions of 20 GPs. In general they felt that eating disorders had little quantitative impact on their services due to low prevalence, but a high impact when they did occurr due to their complexity. Patients' needs in primary care include improved assessment, constructive holding and monitoring, staff training, referral and continuity of care. PMID:20390604

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

    PubMed Central

    Dufour, Carlo

    2015-01-01

    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

  1. Unmet Medical Needs among Patients with Gastroesophageal Reflux Disease: A Foundation for Improving Management in Primary Care

    Microsoft Academic Search

    Harley R. Liker; Philippe Ducrotté; Peter Malfertheiner

    2009-01-01

    Gastroesophageal reflux disease (GERD) is a common disease that has a significant impact on patients’ health-related quality of life. While proton pump inhibitors have transformed GERD therapy, effective management of this disease is still a challenge. This review consolidates data from the recently published Burning Questions and Burning Desires surveys to provide a foundation for improved primary care management of

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

    PubMed

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

    2013-08-01

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

  3. Infectious diseases in primary care; managing the interface between the person and the community.

    PubMed

    Coenen, Samuel

    2012-06-01

    Respiratory infections are still among the most common new diagnoses in primary care. The most frequent reason for encounter is acute cough. General practitioners have to make antibiotic prescribing decisions in a context of diagnostic uncertainty, patient preferences and antimicrobial resistance. There is a causal link between antimicrobial resistance and antibiotic prescribing in primary care. GRACE observational studies (www.grace-lrti.org), show that variation in clinical presentation does not explain the considerable variation in antibiotic prescribing in Europe for adults presenting in primary care with acute cough and that recovery is similar between those treated with any antibiotic, a particular antibiotic class, or no antibiotic. A GRACE randomized controlled trial (RCT) of the effect of antibiotics for acute cough has recruited more patients than all RCTs combined in the current Cochrane Review and will have the power to identify subgroups of patients who will (not) benefit from amoxicillin. Another multi-country GRACE RCT assessing the effect on antibiotic prescribing of largely web-based versions of successful interventions including a C-reactive protein point-of-care test, a communication skill training and an interactive patient booklet is awaited. Given potential long-term cost-effectiveness, the GRACE suite of observational and interventional studies are enhancing the evidence base for reducing diagnostic uncertainty and managing patient expectations in a patient-centred way to achieve greater evidence-based antibiotic prescribing that is likely to help containing antimicrobial resistance. PMID:22548288

  4. The Effect of Improving Primary Care Depression Management on Employee Absenteeism and Productivity A Randomized Trial

    PubMed Central

    Rost, Kathryn; Smith, Jeffrey L.; Dickinson, Miriam

    2005-01-01

    Objective: To test whether an intervention to improve primary care depression management significantly improves productivity at work and absenteeism over 2 years. Setting and Subjects: Twelve community primary care practices recruiting depressed primary care patients identified in a previsit screening. Research Design: Practices were stratified by depression treatment patterns before randomization to enhanced or usual care. After delivering brief training, enhanced care clinicians provided improved depression management over 24 months. The research team evaluated productivity and absenteeism at baseline, 6, 12, 18, and 24 months in 326 patients who reported full-or part-time work at one or more completed waves. Results: Employed patients in the enhanced care condition reported 6.1% greater productivity and 22.8% less absenteeism over 2 years. Consistent with its impact on depression severity and emotional role functioning, intervention effects were more observable in consistently employed subjects where the intervention improved productivity by 8.2% over 2 years at an estimated annual value of $1982 per depressed full-time equivalent and reduced absenteeism by 28.4% or 12.3 days over 2 years at an estimated annual value of $619 per depressed full-time equivalent. Conclusions: This trial, which is the first to our knowledge to demonstrate that improving the quality of care for any chronic disease has positive consequences for productivity and absenteeism, encourages formal cost-benefit research to assess the potential return-on-investment employers of stable workforces can realize from using their purchasing power to encourage better depression treatment for their employees. PMID:15550800

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

    PubMed Central

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

    2010-01-01

    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

  6. Incremental Benefits and Cost of Coordinated Anxiety Learning and Management for Anxiety Treatment in Primary Care

    PubMed Central

    Joesch, Jutta M.; Sherbourne, Cathy D.; Sullivan, Greer; Stein, Murray B.; Craske, Michelle G.; Roy-Byrne, Peter

    2012-01-01

    Background Improving the quality of mental health care requires integrating successful research interventions into “real-world” practice settings. Coordinated Anxiety Learning and Management (CALM) is a treatment-delivery model for anxiety disorders encountered in primary care. CALM offers cognitive behavioral therapy (CBT), medication, or both; non-expert care managers assisting primary care clinicians with adherence promotion and medication optimization; computer-assisted CBT delivery; and outcome monitoring. This study describes incremental benefits, costs, and net benefits of CALM versus usual care. Methods The CALM randomized, controlled effectiveness trial was conducted in 17 primary care clinics in 4 US cities from 2006 to 2009. Of 1,062 eligible patients, 1,004 English- or Spanish-speaking patients age 18–75 years with panic, generalized anxiety, social anxiety, and/or posttraumatic stress disorder with or without major depression were randomized. Anxiety-free days, quality-adjusted life years (QALYs), and expenditures for outpatient visits, emergency room visits, inpatient stays, and psychiatric medications were estimated based on blinded telephone assessments at baseline, 6, 12, and 18 months. Results Over 18 months, CALM participants, on average, experienced 57.1 more anxiety-free days [95% confidence interval (CI) 31–83] and $245 additional medical expenses (95% CI $ ?733 to $1,223). The mean incremental net benefit of CALM versus usual care was positive when an anxiety-free day was valued ? $4. For QALYs based on the Short-Form Health Survey-12 and the EQ-5D the mean incremental net benefit was positive at ? $5,000. Conclusions Compared with usual care, CALM provides significant benefits with modest increases in health care expenditures. PMID:22152230

  7. Managing externally financed projects: the Integrated Primary Health Care Project in Bolivia.

    PubMed

    Homedes, N

    2001-12-01

    Bolivia is one of the poorest countries in Latin America. Health indicators are very poor, communicable diseases are prevalent and, coupled with malnutrition, remain the major killers of children under 5 years old. The Integrated Primary Health Care Project (PROISS) was a US$39 million project executed by the Ministry of Health (MOH), 50% financed by the World Bank and aimed at improving primary health care in the four largest Bolivian municipalities. The implementation of the project started in 1990 and ended in 1997. During implementation it went through three distinct phases: Phase 1 (1990-94) was a period characterized by conflict and confusion; Phase 2 (1995-mid-1996) documented major improvements in coverage and service quality; and Phase 3 (mid-1996-97) witnessed the decline of the project. This paper explores the factors that contributed to the success and the decline of the project, draws lessons for project managers and international agencies involved in the definition and implementation of social sector projects, and discusses the unlikelihood that externally financed projects can have a sustainable impact on the development of the health sector of recipient countries. PMID:11739363

  8. Is diabetes management in primary care improving clinical outcomes? A study in Qatar.

    PubMed

    Mochtar, I; Al-Monjed, M F

    2015-04-01

    There has been little research into the effectiveness of primary-care diabetes clinics in the Middle East. This study in Qatar compared patient outcomes at a primary-care facility with a dedicated diabetes clinic and one without. Using a cross-sectional method, data on demographics, diabetes status and 6 clinical outcomes of diabetes care were collected from the records of patients who visited the clinics during 2012. Diabetes management in both facilities improved clinical outcomes over the 1-year observation period. The mean total cholesterol of patients attending the special clinic (n = 102) decreased significantly from 4.66 to 4.27 mmol/dL and LDL cholesterol from 3.42 to 3.22 mmol/dL. The LDL cholesterol of patients receiving standard care (n = 108) reduced significantly from 3.41 to 3.22 mmol/dL and HDL cholesterol increased from 0.83 to 0.87 mmol/dL. Inter-provider comparisons indicated that the outcomes in the facility with a diabetes clinic were not superior to those in the facility with standard care. PMID:26077518

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

    PubMed

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

    2014-11-01

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

  10. Impact of an integrated transition management program in primary care on hospital readmissions.

    PubMed

    Farrell, Timothy W; Tomoaia-Cotisel, Andrada; Scammon, Debra L; Brunisholz, Kimberly; Kim, Jaewhan; Day, Julie; Gren, Lisa H; Wallace, Stephanie; Gunning, Karen; Tabler, Jennifer; Magill, Michael K

    2015-01-01

    Poorly executed transitions in care from hospital to home are associated with increased vulnerability to adverse medication events and hospital readmissions, and also excess healthcare costs. Efforts to improve care coordination on hospital discharge have been shown to reduce hospital readmission rates but often rely on interventions that are not fully integrated within the primary care setting. The Patient Centered Medical Home (PCMH) model, whose core principles include care coordination in the posthospital setting, is an approach that addresses transitions in care in a more integrated fashion. We examined the impact of multicomponent transition management (TM) services on hospital readmission rates and time to hospital readmission among 118 patients enrolled in a TM program that is part of Care By Design™, the University of Utah Community Clinics' version of the PCMH. We conducted a retrospective analysis comparing outcomes for patients before receiving TM services with outcomes for the same patients after receiving TM services. The all-cause 30-day hospital readmission rate decreased from 17.9% to 8.0%, and the mean time to hospital readmission within 180 days was delayed from 95 to 115 days. These findings support the effectiveness of TM activities integrated within the primary care setting. PMID:26042380

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

    Microsoft Academic Search

    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

    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

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

    PubMed

    Marks, Anne; Wilson, Valerie; Crisp, Jackie

    2013-01-01

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

  13. Critical issues and needs in management of primary immunodeficiency diseases in Latin America.

    PubMed

    Condino-Neto, A; Franco, J L; Trujillo-Vargas, C; Espinosa-Rosales, F J; Leiva, L E; Rodriguez-Quiroz, F; King, A; Lagos, M; Oleastro, M; Bezrodnik, L; Grumach, A S; Costa-Carvalho, B T; Sorensen, R U

    2011-01-01

    Experts from six Latin American countries met to discuss critical issues and needs in the diagnosis and management of primary immunodeficiency diseases (PIDD). The diagnosis of PIDD is generally made following referral to an immunology centre located in a major city, but many paediatricians and general practitioners are not sufficiently trained to suspect PIDD in the first place. Access to laboratory testing is generally limited, and only some screening tests are typically covered by government health programmes. Specialised diagnostic tests are generally not reimbursed. Access to treatment varies by country reflecting differences in healthcare systems and reimbursement policies. An online PIDD Registry Programme for Latin America has been available since 2009, which will provide information about PIDD epidemiology in the region. Additional collaboration across countries appears feasible in at least two areas: a laboratory network to facilitate the diagnosis of PIDD, and educational programmes to improve PIDD awareness. In total, these collaborations should make it possible to advance the diagnosis and management of PIDD in Latin America. PMID:21167629

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

    PubMed Central

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

    2014-01-01

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

  15. Historical Choices.

    ERIC Educational Resources Information Center

    Schick, James B. M.

    1988-01-01

    States that history instruction can be made meaningful and enlightening only by examining historical choices and their results against available options and likely consequences. Presenting examples, the author argues that well-crafted historical simulations focusing on such elements as choice and consequence, strategy and tactics provide a useful…

  16. Tough Choice.

    ERIC Educational Resources Information Center

    Shapiro, Walter

    1991-01-01

    To help public schools experience free-market competition, Secretary of Education Lamar Alexander and President Bush propose parental choice among private, parochial, and public schools, supported by public financing for program design and tuition grants. Sidebars highlight church/state separation concerns and school choice experiments in…

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

    PubMed Central

    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

    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

  18. Estimation and Analysis of Gross Primary Production of Soybean Under Various Management Practices and Drought Conditions

    NASA Astrophysics Data System (ADS)

    Wagle, P.; Xiao, X.; Suyker, A.

    2014-12-01

    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 evaluate the biophysical performance of VIs and crop phenology, and to model GPP using a satellite-based vegetation photosynthesis model (VPM). The VIs tracked soybean phenology well and delineated the growing season length. The results show that the carbon uptake period and seasonal sums of net ecosystem CO2 exchange (NEE) and GPP can be inferred from the length of the vegetation activity period from satellite remote sensing data. Land surface water index (LSWI) tracked drought-impacted vegetation well. 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 GPP. Diurnal GPP 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. The results of this study demonstrate the potential use of remotely sensed VIs for better understanding of carbon dynamics and extrapolation of GPP of soybean croplands.

  19. Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis

    PubMed Central

    Stokes, Jonathan; Panagioti, Maria; Alam, Rahul; Checkland, Kath; Cheraghi-Sohi, Sudeh; Bower, Peter

    2015-01-01

    Background An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care ‘at-risk’ of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis. Methods and Findings We carried out a systematic review and meta-analysis of the effectiveness of case management for ‘at-risk’ patients in primary care. Six bibliographic databases were searched using terms for ‘case management’, ‘primary care’, and a methodology filter (Cochrane EPOC group). Effectiveness compared to usual care was measured across a number of relevant outcomes: Health – self-assessed health status, mortality; Cost – total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately), and; Satisfaction – patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14). A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36) and long-term (0.35, 0.04 to 0.66). Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial ‘strength’ of primary care. Conclusions This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and considered also the effects of key moderators. Current results do not support case management as an effective model, especially concerning reduction of secondary care use or total costs. We consider reasons for lack of effect and highlight key research questions for the future. Review Protocol The review protocol is available as part of the PROSPERO database (registration number: CRD42014010824). PMID:26186598

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

    PubMed Central

    2013-01-01

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

  1. Climate impacts on net primary productivity trends in natural and managed ecosystems of the central and eastern United States

    Microsoft Academic Search

    Tracy E. Twine; Christopher J. Kucharik

    2009-01-01

    The central and eastern United States is an important food and timber production region and could potentially be a large-scale carbon sink. These characteristics are functions of the human management of the landscape and favorable soil and climate conditions. Large-scale assessments of carbon uptake and trends in net primary productivity (NPP) have been previously reported for this region using satellite

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

    Microsoft Academic Search

    Ruth Bell; Taathi Ithindi; Anne Low

    2002-01-01

    This paper draws lessons from a review of primary health care services in Windhoek, the capital of Namibia, undertaken by a regional health management team. The review was carried out because of perceived increases in workload and inadequate staffing levels, arising from the rapid expansion of the city associated with inward migration. A survey of the utilization of government clinics

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

    Microsoft Academic Search

    Peter Griffiths; Jill Maben; Trevor Murrells

    2011-01-01

    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

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

    ERIC Educational Resources Information Center

    Click, Ivy A.

    2013-01-01

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

  5. Cost-Effectiveness of Preoperative Sestamibi Scan for Primary Hyperparathyroidism Is Dependent Solely upon the Surgeon’s Choice of Operative Procedure

    Microsoft Academic Search

    Daphne W Denham; James Norman

    1998-01-01

    Background: In 1991, a National Institutes of Health Consensus Panel stated that preoperative localization for primary hyperparathyroidism is not cost effective. Since then, the sestamibi scan has been applied to parathyroid disease with excellent results, even allowing unilateral exploration under local anesthesia.Study Design: A metaanalysis of the English literature over the past 10 years was performed to determine the collective

  6. Industrial hazardous waste management in Turkey: current state of the field and primary challenges.

    PubMed

    Salihoglu, Güray

    2010-05-15

    A holistic evaluation of a country's hazardous waste management (HWM) practices is useful in identifying the necessary actions to focus on. Based on an analysis of industrial hazardous waste (HW) generation in Turkey, this paper attempts to critically evaluate and report current Turkish HWM practices and discuss the primary challenges to be addressed. The generation of industrial HW for Turkey reported in 2004 was 1.195 million tons, which accounted for 7% of the total industrial solid waste (ISW) generated by the manufacturing industry, and for nearly 4.9% of the total solid waste generated in the country. The HW generated by the top five manufacturing product categories--basic metals, chemicals and chemical products, food and beverages, coke and refined petroleum, motor vehicles and trailers--accounted for 89.0% of total industrial HW. 21% of the HW generated in 2004 was recycled or reused, and 6% was sold or donated, whereas 73% was sent to ultimate disposal. 67% of the HW sent to ultimate disposal was disposed of at municipal landfills. The total capacity of the existing regional HW facilities is 212,500 tons/year, which accounts for about 24% of the HW to be disposed. Turkey has identified the HW problem in the country and enacted legislation, designated a lead agency, and promulgated rules and regulations. Several new initiatives are planned for improving HW management nationally; however, some HWM problems will be persistent due to previous and existing industrial development plans. These development policies led to the concentration of industry in regions marked by precious agricultural fields and high population density. This occurred because the government previously exhibited a default prioritization towards industrial development, leading to insufficient implementation of regulations on HW generators. Some of the problems may also be rooted in other countries that allow illegal trans boundary HW movements despite international regulations. PMID:20015592

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

    PubMed

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

    2013-05-01

    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

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

    PubMed

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

    2012-06-01

    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

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

    PubMed Central

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

    2014-01-01

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

  10. Endoscopic stent insertion versus primary operative management for spontaneous rupture of the esophagus (Boerhaave syndrome): an international study comparing the outcome.

    PubMed

    Schweigert, Michael; Beattie, Rory; Solymosi, Norbert; Booth, Karen; Dubecz, Attila; Muir, Andrew; Moskorz, Kerstin; Stadlhuber, Rudolf J; Ofner, Dietmar; McGuigan, Jim; Stein, Hubert J

    2013-06-01

    Spontaneous rupture of the esophagus (Boerhaave syndrome) is an extremely rare, life-threatening condition. Traditionally surgery was the treatment of choice. Endoscopic stent insertion offers a promising alternative. The aim of this study was to compare the results of primary surgical therapy with endoscopic stenting. A British and a German high-volume center for esophageal surgery participated in this retrospective study. At the British center, operative therapy (primary repair or surgical drainage) was routinely carried out. Endoscopic stent insertion was the primary treatment option at the German center. Only patients with nonmalignant, spontaneous rupture of the esophagus (Boerhaave syndrome) were included. Demographic characteristics, comorbidity, clinical course, and outcome were analyzed. The study comprises 38 patients with a median age of 60 years. Time between rupture and treatment was less than 24 hours in 22 patients. Overall mortality was four of 38. Diagnosis greater than 24 hours was associated with higher risk for fatal outcome (odds ratio [OR], 4.64; 95% confidence interval [CI], 0.33 to 265.79). The surgery (S) and the endoscopic stent group (E) included 20 and 13 cases, respectively. Esophagectomy was unavoidable in three cases and two were managed conservatively. There were no significant differences in age, time to diagnosis less than 24 hours, intensive care unit days, hospital stay, sepsis, renal failure, slow respiratory weaning, or presence of comorbidity between the two groups. In 11 of 13 in the stent group, operative intervention (video-assisted thoracic surgery, thoracotomy, mediastinotomy) was eventually mandatory and three of 13 even required repeated surgery. The rate of reoperation in the surgery group was six of 20. Mortality was two of 13 (E) versus one of 20 (S). The odds for fatal outcome were 3.3 times higher in the stent group than in the surgery group (OR, 3.32; 95% CI, 0.15 to 213.98). Management of Boerhaave syndrome by means of endoscopic stent insertion offers no advantage regarding morbidity, intensive care unit or hospital stay, and is associated with frequent treatment failure eventually requiring surgical intervention. Furthermore, endoscopic stenting shows a higher risk for fatal outcome than primary surgical therapy. PMID:23711276

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

    PubMed

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

    2013-09-01

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

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

    PubMed Central

    Alshammari (Al-Shammari YF), Yousef Fadhel Fahad

    2014-01-01

    Background Obesity is a global world-wide health problem in both developing and developed countries. In Saudi Arabia, this problem becomes an alarming disease both during childhood and adulthood among males and females. Primary health care physicians are identified as the first line of defense and contributor to cost-effective for the management and prevention of the disease; they are expected to normalize the weights in the community. Objective The aim of this study was to determine attitudes and practice by physician working in primary health care centers regarding management of obesity in the cities of Dammam and Al-Khobar in the Eastern Province of Saudi Arabia. Methods This study is a cross-sectional study that took place from December 2009 to March 2010. A specially made questionnaire with a Cronbach alpha reliability of 0.86 and content validity by 5 experts was used to measure the attitudes and practices from several different aspects of care provided at primary health care centers to obesity were distributed and collected from 76 physicians working in primary health centers in Dammam and 73 in Al-Khobar in Saudi Arabia. One hundred thirty physicians responded (12.8% non-response rate) and became the sample. Results Eighty-three per cent of physicians has negative attitude toward the concept of obesity, and more than two-thirds of primary care physicians see themselves play a key role in the management of obesity; The mean attitude scores of studied nurses was ranged from 2.95±1.06 to 4.34 ±0.82 with an agreement that obesity is considered as a disease and the role of the primary health care physician is not only to refer obese patients to other specialized care as well as difficulties in counseling for weight reduction. However, the majority of physicians gave their obese patients advice on dietary habits and physical activities and also they are sometimes referred obese people to dieticians. Moreover, half of physicians provide educational materials as part of the management and above two third of the studied physicians never use medications in weight reduction. Only one third of them believe that they are well prepared for the treatment of obesity. Conclusion There exist gaps in attitudes contradictory for the management of obesity which indicates Physicians in Eastern Saudi Arabia showed a reasonable level of interest in participating in obesity prevention and management. Accordingly, they need for more education and training in management and prevention of obesity, and should continue education from medical school till post-graduate. PMID:25246882

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

    PubMed Central

    Bell, Ruth; Ithindi, Taathi; Low, Anne

    2002-01-01

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

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

    SciTech Connect

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

    2011-11-15

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

  15. Associations between primary care physician satisfaction and self-reported aspects of utilization management.

    PubMed Central

    Kerr, E A; Mittman, B S; Hays, R D; Zemencuk, J K; Pitts, J; Brook, R H

    2000-01-01

    OBJECTIVE: To evaluate the association between physician-reported utilization management (UM) techniques in capitated physician groups and physician satisfaction with capitated care. STUDY SETTING: 1,138 primary care physicians from 89 California capitated physician groups in 1995. STUDY DESIGN: Eighty percent of physicians (N = 910) responded to a mail survey regarding the UM policies in their groups and their satisfaction with the care they deliver. Physician-reported UM strategies measured included group-mandated preauthorization (number of referrals requiring preauthorization, referral denial rate, and referral turnaround time), group-provided explicit practice guidelines, and group-delivered educational programs regarding capitated care. We also measured two key dimensions of satisfaction with capitated care (multi-item scales): (1) satisfaction with capitated care autonomy and quality, and (2) satisfaction with administrative burden for capitated patients. EXTRACTION METHODS: We constructed two multivariate linear regression models to examine associations between physician-reported UM strategies and physician satisfaction, controlling for demographic and practice characteristics and adjusting for clustering. PRINCIPAL FINDINGS: Physician-reported denial rate and turnaround time were significantly negatively associated with capitated care satisfaction. Physicians who reported that their groups provided more guidelines were more satisfied on both dimensions, while physicians who reported that their groups sponsored more educational programs were more satisfied with administrative burden. The number of clinical decisions requiring preauthorization was not significantly associated with either dimension of satisfaction. CONCLUSIONS: Physicians who reported that their groups used UM methods that directly affected their autonomy (high denial rates and long turnaround times) were less satisfied with care for capitated patients. However, a preauthorization policy for referrals or tests was not, in and of itself, associated with satisfaction. Indirect control mechanisms such as guidelines and education were positively associated with satisfaction. PMID:10778819

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

    PubMed

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

    2002-02-01

    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

  17. Managing the Arsenic Disaster in Water Supply: Risk Measurement, Costs of Illness and Policy Choices for Bangladesh

    Microsoft Academic Search

    M. Zakir Hossain

    Arsenic poisoning is a major public health concern in Bangladesh. This study uses primary data to examine health impacts and costs associated with arsenic contamination of groundwater. The study estimates that some 7 to 12 million person-days per year are lost as a result of arsenic exposure. In addition, individuals who are sick spend between 207 (US$ 3.5) million to

  18. Managing the Arsenic Disaster in Water Supply:Risk Measurement, Costs of Illness and PolicyChoices for Bangladesh

    Microsoft Academic Search

    M. Zakir Hossain Khan Khan

    2008-01-01

    Arsenic poisoning is a major public health concern in Bangladesh. This study uses primary data to examine health impacts and costs associated with arsenic contamination of groundwater. The study estimates that some 7 to 12 million person-days per year are lost as a result of arsenic exposure. In addition, individuals who are sick spend between 207 (US$ 3.5) million to

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

    PubMed Central

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

    1995-01-01

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

  20. Angelina's choice.

    PubMed

    Goel, Nishu Singh

    2013-10-01

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

  1. From policy to reality: clinical managers' views of the organizational challenges of primary care reform in Portugal.

    PubMed

    Lapão, Luís Velez; Dussault, Gilles

    2012-01-01

    The primary healthcare reform in Portugal is based on the development of a new management model and clinical governance framework. The objective is to strengthen primary healthcare services to reduce the inappropriate utilization of secondary and emergency services and to make efficiency gains and to better control costs. New interventions include the introduction of a system of production-based incentives for family health units. This paper presents an initial assessment of the implementation of the new policies and tries to explain the gap between its expected results and what was observed in the field 5?years later. We used a Strengths, Weaknesses, Opportunities, and Threats analysis conducted in 12 regions, to collect the perceptions of members of Clinical Councils of Health Centers Groups, responsible for the implementation of the reform. The analysis looked at the dimensions of coverage, productivity, technical quality, and service quality. It identifies weaknesses in human resources management (shortages, incentives, team management) and lack of support from central and regional management. There is a perceived gap between the framework for reform as defined by law and the support made available for its implementation, leading to tensions between decision makers, managers, and health professionals. PMID:22648961

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

    PubMed

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

    2014-11-01

    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

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

    Microsoft Academic Search

    H. Sinnema; G. C. Franx; D. Volker; C. Majo; B. Terluin; M. J. P. Wensing; A. van Balkom

    2011-01-01

    ABSTRACT\\\\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

  4. European course on HPV associated pathology: guidelines for primary care physicians for the diagnosis and management of anogenital warts

    PubMed Central

    von Krogh, G; Lacey, C; Gross, G; Barrasso, R; Schneider, A

    2000-01-01

    The European Course on HPV Associated Pathology (ECHPV) was founded in 1990 by a group of clinicians, pathologists, and virologists to teach important principles for the practice and management of human papillomavirus (HPV) disease to gynaecologists, dermatologists, and other medical disciplines. These guidelines are intended to assist the practice of primary care physicians for diagnosis and treatment of anogenital warts. Key Words: anogenital warts; human papillomavirus; condylomata acuminata; guidelines PMID:10961190

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

    Microsoft Academic Search

    Sanford C. Garner; George S. Leight

    1999-01-01

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

  6. Development and evaluation of an online tool for management of overweight children in primary care: a pilot study

    PubMed Central

    Park, Min Hae; Skow, Áine; Puradiredja, Dewi Ismajani; Lucas, Anna; Syrad, Hayley; Sovio, Ulla; White, Billy; Kessel, Anthony S; Taylor, Barry; Saxena, Sonia; Viner, Russell M; Kinra, Sanjay

    2015-01-01

    Objective To explore the acceptability of implementing an online tool for the assessment and management of childhood obesity (Computer-Assisted Treatment of CHildren, CATCH) in primary care. Design and setting An uncontrolled pilot study with integral process evaluation conducted at three general practices in northwest London, UK (November 2012–April 2013). Participants Families with concerns about excess weight in a child aged 5–18?years (n=14 children). Intervention Families had a consultation with a doctor or nurse using CATCH, which assessed child weight status, cardiometabolic risk and risk of emotional and behavioural difficulties and provided personalised lifestyle advice. Families and practitioners completed questionnaires to assess the acceptability and usefulness of the consultation, and participated in semistructured interviews which explored user experiences. Outcome measures The primary outcome was family satisfaction with the tool-assisted consultation. Secondary outcomes were practitioners’ satisfaction, and acceptability and usefulness of the intervention to families and practitioners. Results The majority of families (86%, n=12) and all practitioners (n=4) were satisfied with the consultation. Participants reported that the tool was easy to use, the personalised lifestyle advice useful and the use of visual aids beneficial. Families and practitioners identified a need for practical, structured support for weight management following the consultation. Conclusions The results of this pilot study indicate that an online tool for assessment and management of childhood obesity can be implemented in primary care, and is acceptable to patients, families and practitioners. Further development and evaluation of the tool is warranted. PMID:26070794

  7. Are managed care organizations in the United States impeding the delivery of primary care by nurse practitioners? A 2012 update on managed care organization credentialing and reimbursement practices.

    PubMed

    Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick

    2013-10-01

    In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014. PMID:23540569

  8. Recognizing and managing anxiety disorders in primary health care in Turkey

    Microsoft Academic Search

    Mehtap Kartal; Ozlem Coskun; Nesrin Dilbaz

    2010-01-01

    BACKGROUND: Anxiety disorders are common and are frequently not diagnosed accurately in primary care. Our aim was to determine the knowledge gaps of general practitioners (GPs) in the diagnosis and treatment of anxiety disorders by using vignettes. METHODS: A cross-sectional survey was completed with 255 primary care physicians (response rate 59.4%) in Manisa, a city in western Turkey. From the

  9. Management guidelines for improvement of otolaryngology referrals from primary care physicians

    Microsoft Academic Search

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

    1995-01-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  11. 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

    2014-01-01

    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

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

    PubMed

    Willcocks, S; Conway, A

    2002-05-01

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

  13. Unusual breast neoplasm: primary breast lymphoma

    PubMed Central

    Binesh, Fariba; Vahedian, Hassanali; Akhavan, Ali; Hakiminia, Marjan

    2013-01-01

    Primary breast lymphoma (PBL) is a rare clinical entity. The clinical and imaging findings in breast lymphoma can mimic those of breast carcinoma. As a result, the diagnosis of PBL relies on histological evaluation and confirmed by immunohistochemical staining. The treatment of choice of this rare disease is controversial. This case report highlights the diagnosis and management of a 48-year-old woman residing in Iran with PBL. PMID:23749857

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

    PubMed Central

    Munyewende, Pascalia O.; Rispel, Laetitia C.

    2014-01-01

    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

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

    PubMed Central

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

    2013-01-01

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

  16. COMMUNITY CHOICE AGGREGATION PILOT PROJECT

    E-print Network

    . John Dalessi Rancho Cordova, California 95670 Contract No. 500-03-004 Gerald Braun, Team Lead Contract Hassan Mohammed Contract Manager Kenneth Koyama Office Manager Energy Generation Research Martha Krebs in this report. #12;«CCA_Name» - DRAFT - COMMUNITY CHOICE AGGREGATION IMPLEMENTATION PLAN «Date

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

    Microsoft Academic Search

    Cary Perry

    2008-01-01

    This article is the third article in the Human Resources for Health journal's feature on the theme of leadership and management in public health. The series of six articles has been contributed by Management Sciences for Health (MSH) and will be published article-by-article over the next few weeks. The third article presents a successful application in Mozambique of a leadership

  18. Model for understanding consumer textural food choice

    PubMed Central

    Jeltema, Melissa; Beckley, Jacqueline; Vahalik, Jennifer

    2015-01-01

    The current paradigm for developing products that will match the marketing messaging is flawed because the drivers of product choice and satisfaction based on texture are misunderstood. Qualitative research across 10 years has led to the thesis explored in this research that individuals have a preferred way to manipulate food in their mouths (i.e., mouth behavior) and that this behavior is a major driver of food choice, satisfaction, and the desire to repurchase. Texture, which is currently thought to be a major driver of product choice, is a secondary factor, and is important only in that it supports the primary driver—mouth behavior. A model for mouth behavior is proposed and the qualitative research supporting the identification of different mouth behaviors is presented. The development of a trademarked typing tool for characterizing mouth behavior is described along with quantitative substantiation of the tool's ability to group individuals by mouth behavior. The use of these four groups to understand textural preferences and the implications for a variety of areas including product design and weight management are explored. PMID:25987995

  19. Surgical Management and Outcome in Primary Adenocarcinoma of the Small Bowel

    Microsoft Academic Search

    Shefali Agrawal; Edward C. McCarron; John F. Gibbs; Hector R. Nava; Gregory E. Wilding; Ashwani Rajput

    2007-01-01

    Background  Primary adenocarcinoma of the small bowel is a rare malignancy and is associated with poor survival outcome. Patient, tumor\\u000a and treatment-related factors were analyzed for their association with recurrence and survival.\\u000a \\u000a \\u000a \\u000a Methods  Between 1971 and 2005, 64 patients with primary adenocarcinoma of the small bowel were treated at our institution. Clinico-pathologic\\u000a data, operative details, postoperative treatment, recurrence pattern and survival were

  20. 5As Team obesity intervention in primary care: development and evaluation of shared decision-making weight management tools.

    PubMed

    Osunlana, A M; Asselin, J; Anderson, R; Ogunleye, A A; Cave, A; Sharma, A M; Campbell-Scherer, D L

    2015-08-01

    Despite several clinical practice guidelines, there remains a considerable gap in prevention and management of obesity in primary care. To address the need for changing provider behaviour, a randomized controlled trial with convergent mixed method evaluation, the 5As Team (5AsT) study, was conducted. As part of the 5AsT intervention, the 5AsT tool kit was developed. This paper describes the development process and evaluation of these tools. Tools were co-developed by the multidisciplinary research team and the 5AsT, which included registered nurses/nurse practitioners (n?=?15), mental health workers (n?=?7) and registered dieticians (n?=?7), who were previously randomized to the 5AsT intervention group at a primary care network in Edmonton, Alberta, Canada. The 5AsT tool development occurred through a practice/implementation-oriented, need-based, iterative process during learning collaborative sessions of the 5AsT intervention. Feedback during tool development was received through field notes and final provider evaluation was carried out through anonymous questionnaires. Twelve tools were co-developed with 5AsT. All tools were evaluated as either 'most useful' or 'moderately useful' in primary care practice by the 5AsT. Four key findings during 5AsT tool development were the need for: tools that were adaptive, tools to facilitate interdisciplinary practice, tools to help patients understand realistic expectations for weight loss and shared decision-making tools for goal setting and relapse prevention. The 5AsT tools are primary care tools which extend the utility of the 5As of obesity management framework in clinical practice. PMID:26129630

  1. Therapeutic management of primary central nervous system lymphoma: Lessons from prospective trials

    Microsoft Academic Search

    A. J. M. Ferreri; M. Reni; E. Villa

    Summary Primary central nervous system lymphomas (PCNSL) are aggressive malignancies, exhibiting one of the worst prognoses among lymphomas. The best treatment modality for PCNSL has not yet been identified. Several therapeutic questions still remain unanswered, and some methodological pitfalls in clin- ical trials prevent definitive conclusions from being drawn. In this review, certain aspects of trial design as well as

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

    ERIC Educational Resources Information Center

    Baranyai, Valeria

    2013-01-01

    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…

  3. Primary brain lymphoma. A brief review of clinical aspects and management

    Microsoft Academic Search

    Kartikeya Sharma; Neeraj Rastogi; Ranjana Srivastva; V. K. Jain; S. Hukku

    1995-01-01

    Primary C.N.S. lymphoma is a rare tumor. Five such cases were treated in our clinic between January, 1991, and October, 1993. Four patients had tumor decompression and one had total resection. All of them received radiotherapy (radiation dose 40 Gy) and chemotherapy. One patient expired during the immediate postoperative period. Four patients showed a disappearance of the tumor on CT

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    2012-01-01

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

  6. Agenesis of multiple primary and permanent teeth unilaterally and its possible management.

    PubMed

    Ephraim, Rena; Rajamani, T; Feroz, Tp Mohammed; Abraham, Sajith

    2015-05-01

    Oligodontia is the agenesis of numerous teeth (more than six teeth). Agenesis of teeth in primary and permanent dentition is a rare incidence and very few are reported in the dental literature. Although the etiology of congenital agenesis of teeth is unclear, several factors such as a tendency toward genetic predilection, metabolic disorders, trauma, infection, radiation or idiopathic reasons are found to be responsible. Available literature reports agenesis most often of third molars, maxillary lateral incisors, mandibular central and lateral incisors, and mandibular second premolars in decreasing order of frequency of occurrence. Males are more often affected than females. Maxillary primary teeth are more often found affected by agenesis than mandibular primary teeth. Available literature reports missing teeth to be found unilaterally or orbilaterally with a predisposition toward a similar phenomenon occurring in the permanent dentition. In congenital agenesis impaired growth of the alveolar process, reduced lower facial height, speech impairment, deep bite, restriction in the movement of the tongue due to ankyloglossia, asymmetry of the affected side of the face are clinical features evident. There has been no report of complete agenesis of primary and permanent teeth in a whole mandibular quadrant in conjunction with the absence of maxillary second and third molars on the affected side. Here, we report an incidence of a rare occurrence of complete agenesis of more than 10 primary and permanent teeth, unilaterally, in the right mandibular quadrant, in a child of 10 years presenting with a chief complaint of several missing primary teeth and difficulty in speech due to its complete absence. Treatment strategies included various orthodontic and restorative procedures to improve esthetics and function. The orthodontic procedures involved expansion of the narrow maxillary arch to obtain a functionally adapted occlusion and creation of space for future alignment, and uprighting and protecting maxillary right posteriors to accommodate the tongue and rectify speech. Restorative procedures involved fabrication of a removable partial denture as a temporary measure to restore missing teeth, improve esthetics, give lingual support to the lower lip, prevent further downward growth of the right maxillary ridge and to prevent supra eruption of these teeth. PMID:26028909

  7. Agenesis of Multiple Primary and Permanent Teeth Unilaterally and its Possible Management

    PubMed Central

    Ephraim, Rena; Rajamani, T; Feroz, TP Mohammed; Abraham, Sajith

    2015-01-01

    Oligodontia is the agenesis of numerous teeth (more than six teeth). Agenesis of teeth in primary and permanent dentition is a rare incidence and very few are reported in the dental literature. Although the etiology of congenital agenesis of teeth is unclear, several factors such as a tendency toward genetic predilection, metabolic disorders, trauma, infection, radiation or idiopathic reasons are found to be responsible. Available literature reports agenesis most often of third molars, maxillary lateral incisors, mandibular central and lateral incisors, and mandibular second premolars in decreasing order of frequency of occurrence. Males are more often affected than females. Maxillary primary teeth are more often found affected by agenesis than mandibular primary teeth. Available literature reports missing teeth to be found unilaterally or orbilaterally with a predisposition toward a similar phenomenon occurring in the permanent dentition. In congenital agenesis impaired growth of the alveolar process, reduced lower facial height, speech impairment, deep bite, restriction in the movement of the tongue due to ankyloglossia, asymmetry of the affected side of the face are clinical features evident. There has been no report of complete agenesis of primary and permanent teeth in a whole mandibular quadrant in conjunction with the absence of maxillary second and third molars on the affected side. Here, we report an incidence of a rare occurrence of complete agenesis of more than 10 primary and permanent teeth, unilaterally, in the right mandibular quadrant, in a child of 10 years presenting with a chief complaint of several missing primary teeth and difficulty in speech due to its complete absence. Treatment strategies included various orthodontic and restorative procedures to improve esthetics and function. The orthodontic procedures involved expansion of the narrow maxillary arch to obtain a functionally adapted occlusion and creation of space for future alignment, and uprighting and protecting maxillary right posteriors to accommodate the tongue and rectify speech. Restorative procedures involved fabrication of a removable partial denture as a temporary measure to restore missing teeth, improve esthetics, give lingual support to the lower lip, prevent further downward growth of the right maxillary ridge and to prevent supra eruption of these teeth. PMID:26028909

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed

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

    2014-06-01

    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

  10. Improving the Management of Late-Life Depression in Primary Care: Barriers and Facilitators

    PubMed Central

    Sussman, Tamara; Yaffe, Mark; McCusker, Jane; Parry, David; Sewitch, Maida; Van Bussel, Lisa; Ferrer, Ilyan

    2011-01-01

    The objectives of this study were to elicit Canadian health professionals' views on the barriers to identifying and treating late-life depression in primary care settings and on the solutions felt to be most important and feasible to implement. A consensus development process was used to generate, rank, and discuss solutions. Twenty-three health professionals participated in the consensus process. Results were analysed using quantitative and qualitative methods. Participants generated 12 solutions. One solution, developing mechanisms to increase family physicians' awareness of resources, was highly ranked for importance and feasibility by most participants. Another solution, providing family physicians with direct mental health support, was highly ranked as important but not as feasible by most participants. Deliberations emphasized the importance of case specific, as needed support based on the principles of shared care. The results suggest that practitioners highly value collaborative care but question the feasibility of implementing these principles in current Canadian primary care contexts. PMID:21738868

  11. [Soft-tissue management in primary knee arthroplasty: common techniques, navigation and force-sensing devices].

    PubMed

    Schmidt, F; Lampe, F; Elfring, R; Nebelung, S; Mumme, T; Andereya, S; Radermacher, K; Niethard, F U; Müller-Rath, R

    2007-01-01

    Soft-tissue management is essential for the outcome in total knee arthroplasty. In combination with osseous resections and component positioning, correction of the underlying ligamentous dysbalance should yield a stable joint throughout the flexion arc. Different "philosophies" with regard to technique, timing and tactics in ligament balancing are described. So far, surgeons have not been provided with standardised devices that allow the objective measurement of this complex issue. Moreover, knowledge concerning the "ideal" soft-tissue stability following knee arthroplasty is still sparse. As part of the scientific project "OrthoMIT" (minimal invasive orthopaedic therapy) an approach to combine conventional soft-tissue management with navigation and force-sensing devices should be realized technically. The aim is to develop an instrument for the objective measurement of soft-tissue management in scientific and clinical applications. PMID:17939070

  12. The intrinsic features of Environmental Management Systems that facilitate adoption and encourage innovation in primary industries.

    PubMed

    Carruthers, Genevieve; Vanclay, Frank

    2012-11-15

    This paper examines the theoretical underpinnings of the adoption of innovations, and applies this knowledge to the uptake of Environmental Management Systems (EMS) amongst Australian farmers. We examine the specific features of the EMS process that might encourage or inhibit EMS adoption. We also consider elements of the EMS process to assess their utility in promoting adoption of various other innovations. We evaluate the EMS process in the light of two characteristics previously found to influence adoption of improved natural resource management practices - 'relative advantage' and 'trialability'. Drawing on literature, and our research and experience with farmers, we conclude that there are inherent features of EMS that promote the adoption of new practices, and that the elements of the EMS process actually create an on-going process of culture change as it is implemented. We believe that the EMS process offers significant advantages to farmers seeking to improve production whilst simultaneously meeting societal expectations for enhanced natural resource management. PMID:22776757

  13. Problems of management of medical solid waste at primary health care centres in the Palestinian Territory and their remedial measures.

    PubMed

    Al-Khatib, I A

    2014-01-01

    This study was conducted to investigate the management aspects of medical solid waste (MSW) at primary health care centres in Nablus and Salfit governorates in the West Bank, Palestine. We interviewed 190 health care staff from primary health care centres in this area. The most frequent type of waste produced was sharps waste: only 5.3% of respondents said this was never produced. Infectious waste was the second most frequent type produced. Only 40.4% of the respondents stated that hazardous MSW was always treated. Over 80% said that non-sharps MSW was separated into its different components, but almost 20% said that sharps were not placed in special containers. We recorded a mean of 34 g of hazardous solid waste and 55 g of non-hazardous solid waste generated per outpatient per day. Staff awareness and training, separation of MSW, establishment of simple treatment facilities are the major measures suggested for improvement of the waste management practices. PMID:24995739

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

    PubMed

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

    2011-01-01

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

  15. Association of practice size and pay-for-performance incentives with the quality of diabetes management in primary care

    PubMed Central

    Vamos, Eszter P.; Pape, Utz J.; Bottle, Alex; Hamilton, Fiona Louise; Curcin, Vasa; Ng, Anthea; Molokhia, Mariam; Car, Josip; Majeed, Azeem; Millett, Christopher

    2011-01-01

    Background: Not enough is known about the association between practice size and clinical outcomes in primary care. We examined this association between 1997 and 2005, in addition to the impact of the Quality and Outcomes Framework, a pay-for-performance incentive scheme introduced in the United Kingdom in 2004, on diabetes management. Methods: We conducted a retrospective open-cohort study using data from the General Practice Research Database. We enrolled 422 general practices providing care for 154 945 patients with diabetes. Our primary outcome measures were the achievement of national treatment targets for blood pressure, glycated hemoglobin (HbA1c) levels and total cholesterol. Results: We saw improvements in the recording of process of care measures, prescribing and achieving intermediate outcomes in all practice sizes during the study period. We saw improvement in reaching national targets after the introduction of the Quality and Outcomes Framework. These improvements significantly exceeded the underlying trends in all practice sizes for achieving targets for cholesterol level and blood pressure, but not for HbA1c level. In 1997 and 2005, there were no significant differences between the smallest and largest practices in achieving targets for blood pressure (1997 odds ratio [OR] 0.98, 95% confidence interval [CI] 0.82 to 1.16; 2005 OR 0.92, 95% CI 0.80 to 1.06 in 2005), cholesterol level (1997 OR 0.94, 95% CI 0.76 to 1.16; 2005 OR 1.1, 95% CI 0.97 to 1.40) and glycated hemoglobin level (1997 OR 0.79, 95% CI 0.55 to 1.14; 2005 OR 1.05, 95% CI 0.93 to 1.19). Interpretation: We found no evidence that size of practice is associated with the quality of diabetes management in primary care. Pay-for-performance programs appear to benefit both large and small practices to a similar extent. PMID:21810950

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

    ERIC Educational Resources Information Center

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

    2009-01-01

    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…

  17. 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...

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

    Microsoft Academic Search

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

    2010-01-01

    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

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

    E-print Network

    Paris-Sud XI, Université de

    coordination and collaboration between different players in the supply chain has to be assured [Dietrich, Kirn the customer and the company, the company and its supply chain partners, or the different members of the company's value chain. Knowledge management is a tool that assures this collaboration by better capturing

  20. Diagnosis and management of depression in primary care: a clinical update and review

    PubMed Central

    Remick, Ronald A.

    2002-01-01

    THERE HAS BEEN SIGNIFICANT PROGRESS in the area of mood disorders over the last 2 decades, encompassing advances in our knowledge of epidemiology, diagnosis, pathogenesis and treatment. This article presents a clinically oriented update and review on the diagnosis and management of major depressive disorder. PMID:12451082

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

    ERIC Educational Resources Information Center

    Bossetti, Brenda; Gallagher-Allred, Charlette R.

    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…

  2. 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...

  3. 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...

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

    ERIC Educational Resources Information Center

    Gregg, Carmen; McRobert, Jim; Piller, Meeta

    2002-01-01

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

  5. Breast and ovarian cancer risk management in a French cohort of 158 women carrying a BRCA1 or BRCA2 germline mutation: patient choices and outcome.

    PubMed

    This, Pascale; de la Rochefordière, Anne; Savignoni, Alexia; Falcou, Marie Christine; Tardivon, Anne; Thibault, Fabienne; Alran, Séverine; Fourchotte, Virgine; Fitoussi, Alfred; Couturaud, Benoit; Dolbeault, Sylvie; Salmon, Remy J; Sigal-Zafrani, Brigitte; Asselain, Bernard; Stoppa-Lyonnet, Dominique

    2012-09-01

    Description of the various modalities of breast and ovarian cancer risk management, patient choices and their outcome in a single-center cohort of 158 unaffected women carrying a BRCA1 or BRCA2 germline mutation. Between 1998 and 2009, 158 unaffected women carrying a BRCA1 or BRCA2 gene mutation were prospectively followed. The following variables were studied: general and gynecological characteristics, data concerning any prophylactic procedures, and data concerning the outcome of these patients. Median age at inclusion was 37 years and median follow-up was 54 months. Among the 156 women who received systematic information about prophylactic mastectomy, 5.3 % decided to undergo surgery within 36 months after disclosure of genetic results. Prophylactic salpingo-oophorectomy was performed in 68 women. Among women in whom follow-up started between the ages of 40 and 50 years, prophylactic salpingo-oophorectomy was performed, within 24 months after start of follow-up, in 83.7 and 52 % of women with BRCA1 and BRCA2 mutations, respectively. Twenty four women developed breast cancer. Ovarian cancer was detected during prophylactic salpingo-oophorectomy in two women (2.9 %). In this cohort of French women carrying BRCA1/2 mutations, prophylactic mastectomy was a rarely used option. However, good compliance with prophylactic salpingo-oophorectomy was observed. This study confirms the high breast cancer risk in these women. PMID:22711610

  6. Empowerment through Choice? A Critical Analysis of the Effects of Choice in Organizations

    Microsoft Academic Search

    Roy Yong-Joo Chua; Sheena S. Iyengar

    2006-01-01

    The provision of choice is one of the most common vehicles through which managers empower employees in organizations. Although past psychological and organizational research persuasively suggests that choice confers personal agency, and is thus intrinsically motivating, emerging research indicates that there could be potential pitfalls. In this chapter, we examine the various factors that could influence the effects of choice.

  7. [Promoting Self-Management in Primary Care - the Association of Motivation for Change, Self-Efficacy and Psychological Distress Prior to the Onset of Intervention].

    PubMed

    Zimmermann, Thomas; Puschmann, Egina; Porzelt, Sarah; Ebersbach, Martin; Ernst, Annette; Thomsen, Patricia; Scherer, Martin

    2015-07-01

    Anxiety, depressive and somatoform 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 resources for the management of these patients are limited by the increasing workload in primary care practices, especially in the German health care system. In order to address the SMADS-study within psychenet - the Hamburg Network for Mental Health (NCT01726387) implements and evaluates a complex, low-threshold, nurse-led intervention using a goal-oriented set of case management and counseling techniques to promote self-management in these patients. This paper investigates the association of the patients' motivation for change and their perceived self-efficacy, the primary outcome - to get to know whether the intervention will target the appropriate population. PMID:26135280

  8. Primary brain lymphoma. A brief review of clinical aspects and management.

    PubMed

    Sharma, K; Rastogi, N; Srivastva, R; Jain, V K; Hukku, S

    1995-01-01

    Primary C.N.S. lymphoma is a rare tumor. Five such cases were treated in our clinic between January, 1991, and October, 1993. Four patients had tumor decompression and one had total resection. All of them received radiotherapy (radiation dose 40 Gy) and chemotherapy. One patient expired during the immediate postoperative period. Four patients showed a disappearance of the tumor on CT scan after the complete course of therapy of 9 months. Three patients showed recurrence intracranially at 15, 12, and 10 months. All patients died during follow up except one, who has been alive without recurrence for 10 months. Median survival was 13 months. PMID:8570067

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

    PubMed Central

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

    2015-01-01

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

  10. Free Choice Writing in the Early Years.

    ERIC Educational Resources Information Center

    Millard, Carolyn

    1995-01-01

    Investigated the relationship between free choice writing in primary classrooms and gender construction. Suggests that girls are rewarded for producing gendered content, form, and structure in their writing, and are not offered opportunities to learn to write in different forms for different audiences. Thus, free choice does not appear to lead to…

  11. The role of full thickness scalp resection for management of primary scalp melanoma

    PubMed Central

    Pannucci, Christopher J.; Collar, Ryan M.; Johnson, Timothy M.; Bradford, Carol R.; Rees, Riley S.

    2015-01-01

    BACKGROUND Scalp melanoma is aggressive and has a proclivity for regional metastasis. We hypothesize that subperiosteal scalp melanoma resection reduces in-transit/satellite recurrence, when compared to subgaleal resection. METHODS We identified patients with intermediate to deep, primary scalp melanoma referred to head/neck surgery over an eight-year period. Patients were compared based on scalp resection depth, including subperiosteal (resection to the level of calvarium) and subgaleal (resection including skin, subcutaneous tissue, and galea). The dependent variables were in-transit/satellite recurrence and time to in-transit/satellite recurrence. RESULTS Among 48 identified patients, the in-transit/satellite recurrence rate was 16.7%. Subgaleal resection patients had higher in-transit/satellite recurrence rates than subperiosteal resection patients (24.0% vs. 8.7%, p=0.155). Among node-negative patients, subgaleal resection had significantly higher in-transit/satellite metastasis rates when compared to subperiosteal resection (26.3% vs. 0%, p=0.047). CONCLUSION For node-negative, primary scalp melanoma, subperiosteal resection significantly decreases in-transit/satellite recurrence when compared to subgaleal resection. Given our small sample size, further studies are necessary to confirm these results. PMID:21734540

  12. Management of patients during and after exacerbations of chronic obstructive pulmonary disease: the role of primary care physicians.

    PubMed

    Yawn, Barbara P; Thomashow, Byron

    2011-01-01

    Current treatments have failed to stem the continuing rise in health care resource use and fatalities associated with exacerbations of chronic obstructive pulmonary disease (COPD). Reduction of severity and prevention of new exacerbations are therefore important in disease management, especially for patients with frequent exacerbations. Acute exacerbation treatment includes short-acting bronchodilators, systemic corticosteroids, and antibiotics if bacterial infections are present. Oxygen and/or ventilatory support may be necessary for life-threatening conditions. Rising health care costs have provided added impetus to find novel therapeutic approaches in the primary care setting to prevent and rapidly treat exacerbations before hospitalization is required. Proactive interventions may include risk reduction measures (eg, smoking cessation and vaccinations) to reduce triggers and supplemental pulmonary rehabilitation to prevent or delay exacerbation recurrence. Long-term treatment strategies should include individualized management, addressing coexisting nonpulmonary conditions, and the use of maintenance pharmacotherapies, eg, long-acting bronchodilators as monotherapy or in combination with inhaled corticosteroids to reduce exacerbations. Self-management plans that help patients recognize their symptoms and promptly access treatments have the potential to prevent exacerbations from reaching the stage that requires hospitalization. PMID:21941453

  13. Marketplace reforms and primary care career decisions.

    PubMed

    Retchin, S M; Boling, P A; Nettleman, M D; Mick, S S

    2001-04-01

    A dramatic shift in the postgraduate career choices of medical school graduates toward primary care occurred during the mid-1990s. While some attributed this shift to changes in medical school curricula, perceptions stemming from marketplace reforms were probably responsible. For the most part, these perceptions were probably generated through informal communications among medical students and through the media. More recently, additional marketplace influences, such as the consumer backlash toward managed care and unrealized gains in primary care physicians' personal incomes, may have fostered contrasting perceptions among medical students, leading to career choices away from primary care, particularly family practice. The authors offer two recommendations for enhancing the knowledge of medical students concerning workforce supply and career opportunities: an educational seminar in the second or third year of medical school, and a public-private partnership between the Bureau of Health Professions and the Association of American Medical Colleges to create a national database about the shape of the primary care and specialty workforces, accessible through the Internet for educators, students, and policymakers. The authors conclude that appropriate career counseling through these efficient methods could avoid future abrupt swings in specialty choices of medical school graduates and may facilitate a more predictable physician workforce supply. PMID:11299142

  14. Surgical Management of a Primary Retroperitoneal Venous Aneurysm Originating from the Presacral Venous Plexus.

    PubMed

    Wang, Yuchen; Shao, Jiang; Li, Fangda; Zheng, Yuehong

    2015-07-01

    Venous aneurysms are rare vascular abnormalities, and primary venous aneurysm originating from sacral venous plexus is exceedingly rare. In this article, we report a 28-year-old man with a large venous aneurysm (?15 × 10 cm in size) originating from presacral venous plexus. The patient complained of 1 year of constant back pain associated with frequent defecation and urination, caused by the compression from the aneurysm. Exploratory laparotomy was performed for diagnosis, with successful aneurysmectomy to relieve the compression. The patient recovered uneventfully with complete relief of symptoms. Postoperative histopathologic examination manifested classic venous aneurysm. During follow-up 6 months after surgery, all symptoms were resolved without significant postoperative complications. PMID:25747888

  15. Pathogenesis of Primary Sclerosing Cholangitis and Advances in Diagnosis and Management

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-09-01

    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

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

    PubMed

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

    2015-02-01

    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

  18. [Role of intensive medical training on Law 38 to improve pain management in primary care].

    PubMed

    Mammucari, Massimo; Muscas, Fabrizio; Arpino, Giovanni; Aronica, Alberto; Russo, Pasquale; Visconti, Marco

    2014-04-01

    The Italian Law no. 38/2010 requires that the physician reports in the medical record the type and the intensity of pain, analgesic therapies and clinical results. We developed a training model for 256 primary care physicians (GPs). After a period of intensive training on the content of the law no. 38, diagnostic and pharmacological approach of pain, we carried out a clinical audit by a web based clinical record to assess doctor's compliance to Law no. 38 and the use of opioids. 2631 patients were assessed (age 71,5±13,7 years; median 74). The mean of chronic non oncologic pain intesity was 5.41±2.0 (static) and 6.10±2.32 (dynamic). After a systematic measurement of pain, a better control of patients was achieved (2.22±2.12 points lower for static, 2.37±2.34 lower for dynamic pain (p<0.001 vs basal time). An increased use of opioids have been detected. GPs have also used strong opioids in opioid-naïve patients, avoiding the first or the second step if intensity of pain detected was severe. In fact, a greater pain control was achieved with oxycodone compared to tramadol or codeine (all of them with normal release and combined with acetaminophen). Chronic non cancer pain remains one of the major clinical problems in the primary care setting, especially in the elderly. The standard measurement of parameters related to pain and the proper use of opioids depends on the scientific update and how this is delivered. GPs are crucial to implement the Law 38 and to increase the degree of complexity of the patient to be properly admitted to a SPOKE/HUB center. PMID:24770542

  19. School Choice. IDRA Focus.

    ERIC Educational Resources Information Center

    Robledo Montecel, Maria, Ed.; Supik, Josie Danini, Ed.

    1994-01-01

    This newsletter contains five articles on the implications of school choice for minority and disadvantaged students. "School Choice: Choices for Whom? Promises and Panaceas," by Maria Robledo Montecel, discusses some major problems related to school choice and vouchers, particularly who would have the choice (families or schools), who would pay…

  20. Role for therapeutic drug monitoring during induction therapy with TNF antagonists in IBD: evolution in the definition and management of primary nonresponse.

    PubMed

    Papamichael, Konstantinos; Gils, Ann; Rutgeerts, Paul; Levesque, Barrett G; Vermeire, Séverine; Sandborn, William J; Vande Casteele, Niels

    2015-01-01

    : Primary nonresponse and primary nonremission are important limitations of tumor necrosis factor (TNF) antagonists, occurring in 10% to 40% and 50% to 80% of patients with inflammatory bowel disease, respectively. The magnitude of primary nonresponse differs between phase III clinical trials and cohort studies, indicating differences, e.g., in definition, patient population or blinding. The causes of nonresponse can be attributed to the drug (pharmacokinetics, immunogenicity), the patient (genetics, disease activity), the disease (type, location, severity), and/or the treatment strategy (dosing regimen, combination therapy). Primary nonresponse has been attributed to "non-TNF-driven disease" which is an overly simplified and potentially misleading approach to the problem. Many patients with primary nonresponse could successfully be treated with dose optimization during the induction phase or switching to another TNF antagonist. Therefore, primary nonresponse is frequently not a non-TNF-driven disease. Recent studies from rheumatoid arthritis and preliminary data from inflammatory bowel disease evaluating therapeutic drug monitoring have suggested that early measurement of drug and anti-drug antibody concentrations could help to define primary nonresponse and rationalize patient management of this problem. Moreover, a modeling approach including pharmacological parameters and patient-related covariants could potentially be predictive for response to the treatment. We describe an overview of this evolution in thinking, underpinned by previous findings, and assess the potential role of early measurement of drug and antidrug antibody concentrations in the definition and management of primary nonresponse. PMID:25222660

  1. Splenic trauma. Choice of management.

    PubMed Central

    Lucas, C E

    1991-01-01

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

  2. Impact of an EHR-based diabetes management form on quality and outcomes of diabetes care in primary care practices.

    PubMed

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

    2015-01-01

    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

  3. School Choice vs. School Choice. Policy Backgrounder.

    ERIC Educational Resources Information Center

    Goodman, John C.; Moore, Matt

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

  4. Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care

    PubMed Central

    Gabbay, John; le May, Andrée

    2004-01-01

    Objective To explore in depth how primary care clinicians (general practitioners and practice nurses) derive their individual and collective healthcare decisions. Design Ethnographic study using standard methods (non-participant observation, semistructured interviews, and documentary review) over two years to collect data, which were analysed thematically. Setting Two general practices, one in the south of England and the other in the north of England. Participants Nine doctors, three nurses, one phlebotomist, and associated medical staff in one practice provided the initial data; the emerging model was checked for transferability with general practitioners in the second practice. Results Clinicians rarely accessed and used explicit evidence from research or other sources directly, but relied on “mindlines”—collectively reinforced, internalised, tacit guidelines. These were informed by brief reading but mainly by their own and their colleagues' experience, their interactions with each other and with opinion leaders, patients, and pharmaceutical representatives, and other sources of largely tacit knowledge. Mediated by organisational demands and constraints, mindlines were iteratively negotiated with a variety of key actors, often through a range of informal interactions in fluid “communities of practice,” resulting in socially constructed “knowledge in practice.” Conclusions These findings highlight the potential advantage of exploiting existing formal and informal networking as a key to conveying evidence to clinicians. PMID:15514347

  5. Management of Chronic Pain among Older Patients: Inside Primary Care in the U.S.

    PubMed Central

    Tai-Seale, Ming; Bolin, Jane; Bao, Xiaoming; Street, Richard

    2011-01-01

    Under-treatment of pain is a worldwide problem. We examine how often pain was addressed and the factors that influence how much time was spent on treating pain. We analyzed 385 videotapes of routine office visits in several primary care practices in the Southwest and Midwest regions of the United States. We coded the visit contents and the time spent on pain and other topics. Logistic regression and survival analyses examined the effects of time constraint, physician’s supportiveness, patient’s health, and demographic concordance. We found that discussion of pain occurred in 48% of visits. A median of 2.3 minutes was spent on addressing pain. The level of pain, physician’s supportiveness, and gender concordance were significantly associated with the odds of having a pain discussion. Time constraints and racial concordance significantly influenced the length of discussion. We conclude that despite repeated calls for addressing under-treatment for pain, only a limited amount of time is used to address pain among elderly patients. This phenomenon could contribute to the under-treatment of pain. PMID:21784680

  6. Cholesterol knowledge and practices among patients compared with physician management in a university primary care setting.

    PubMed

    Whiteside, C; Robbins, J A

    1989-07-01

    Lowering elevated serum cholesterol has been shown to reduce the risk of symptomatic coronary heart disease. The National Institute of Health and National Cholesterol Education Program recommend that all adults obtain a cholesterol screening and state that desirable adult levels are less than 200 mg/dl. This study examined the knowledge and practices regarding cholesterol among patients and physicians in a university-based primary care clinic that serves a large proportion of elderly and indigent patients. One hundred fifty-nine patients were interviewed and their medical records were examined. Twenty-four percent of patients were aware of their elevated cholesterol levels, 60% were aware of the health risks associated with hypercholesterolemia, and 83% were able to state methods of lowering cholesterol levels. Approximately 50% stated that they were making considerable efforts to lower fat and cholesterol consumption. Physicians listed cholesterol as a problem in 29% of patients with elevated values (greater than 200 mg/dl) and counseled 17%. Results indicate a good level of knowledge and interest in cholesterol as a health risk even in this group of patients with the multiple problems associated with low socioeconomic status. Knowledge of personal risk status, however, was poor. Physicians need to improve documentation, counseling, and monitoring of patients with elevated cholesterol levels. Long-term follow-up is needed to evaluate efficacy. PMID:2798374

  7. Evidence-based guidance for the management of postherpetic neuralgia in primary care.

    PubMed

    Harden, R Norman; Kaye, Alan David; Kintanar, Thomas; Argoff, Charles E

    2013-07-01

    This article aims to help primary care physicians negotiate gaps in current guidelines for postherpetic neuralgia (PHN). The objectives of this article are to: 1) briefly review the available guidelines and identify their strengths and weaknesses; 2) review the gaps in the guidelines; 3) review new data that were not included in the most recent guidelines; 4) provide expert opinion on how the new data and current guidelines can be used to make treatment decisions; and 5) review several important dimensions of care (eg, tolerability, dosing) and provide guidance. In general, all guidelines recognize the ?2? ligands, tricyclic antidepressants (TCAs), opioids, and tramadol as efficacious systemic options, with topical lidocaine serving as an efficacious nonsystemic approach for localized PHN treatment. The first-line treatment options typically recommended in the guidelines are ?2? ligands and TCAs, while opioids and tramadol are often recommended as second- or third-line options. Since the latest guidelines were published, newer agents (eg, topical capsaicin [8%] patch and gastroretentive gabapentin) have met the standard as first-line therapy with the publication of ? 1 randomized controlled trial. However, gabapentin enacarbil has not met this standard due to a lack of a published randomized controlled trial in PHN. PMID:23933906

  8. Managing bleeding and emergency reversal of newer oral anticoagulants: a review for primary care providers.

    PubMed

    Peacock, W Frank

    2014-10-01

    The therapeutic landscape for anticoagulation management is undergoing a shift from the use of traditional anticlotting agents such as heparins and warfarin as the only options to the growing adoption of newer target-specific oral anticoagulants (TSOACs) with novel mechanisms of action. Dabigatran, the first TSOAC approved for use in the United States, is a direct competitive inhibitor of thrombin. It has predictable kinetics, with an elimination half-life of 12 to 17 hours in healthy volunteers. Apixaban and rivaroxaban are selective inhibitors of factor Xa, and also display first-order kinetics. In younger healthy individuals, apixaban has an apparent half-life of approximately 12 hours, whereas rivaroxaban has an elimination half-life of 5 to 9 hours. Understanding the pharmacologic properties of these newer drugs can lead to better insights regarding their respective safety and efficacy profiles and their application in clinical practice. Laboratory assessments have been developed to measure the anticoagulant efficacy of these newer agents. However, the results of these tests can be highly variable, and are therefore not always useful for monitoring the anticoagulation effects of these agents. In addition, several strategies have been documented for the potential reversal of the anticoagulant effects of these drugs, from the temporary discontinuation of an agent before elective surgery to suggested emergency procedures in the case of major bleeding events. New, specific reversal agents for dabigatran, apixaban, and rivaroxaban are currently being developed, and dabigatran has received fast-track designation from the US Food and Drug Administration. Until comprehensive clinical guidelines are developed, institutions involved in emergency care should establish their own procedures for the management of patients undergoing anticoagulation who require emergency treatment. These protocols should include appropriate laboratory testing to assess anticoagulant activity as part of the inpatient workup if time allows, and the potential use of hemodialysis, prohemostatic agents, and reversal agents when available. PMID:25502131

  9. Preventing and managing aberrant drug-related behavior in primary care: systematic review of outcomes evidence.

    PubMed

    Argoff, Charles E; Kahan, Meldon; Sellers, Edward M

    2014-01-01

    Several strategies for preventing, identifying, and responding to aberrant opioid-related behaviors are recommended in pain management guidelines. This systematic review evaluated data supporting basic strategies for addressing aberrant opioid-related behaviors. Risk reduction strategies were identified via a review of available guidelines. Systematic literature searches of PubMed (May 1, 2007-January 18, 2013) identified articles with evidence relevant to nine basic strategies. Reference lists from relevant articles were reviewed for additional references of interest. Levels of evidence for articles identified were graded on a four-point scale (strongest evidence = level 1; weakest evidence = level 4) using Oxford Centre for Evidence-Based Medicine Levels of Evidence criteria. Weak to moderate evidence supports the value of thorough patient assessment, risk-screening tools, controlled-substance agreements, careful dose titration, opioid dose ceilings, compliance monitoring, and adherence to practice guidelines. Moderate to strong evidence suggests that prescribing tamper-resistant opioids may help prevent misuse but may also have the unintended consequence of prompting a migration of users to other marketed opioids, heroin, or other substances. Similarly, preliminary evidence suggests that although recent regulatory and legal efforts may reduce misuse, they also impose barriers to the legitimate treatment of pain. Despite an absence of consistent, strong supporting evidence, clinicians are advised to use each of the available risk-mitigation strategies in combination in an attempt to minimize the risk of abuse in opioid treatment patients. Physicians must critically evaluate their opioid prescribing and not only increase their efforts to prevent substance abuse but also not compromise pain management in patients who benefit from it. PMID:24715667

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed Central

    2014-01-01

    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

  13. [Diagnosis and management of acute pharyngotonsillitis in the primary care pediatrician's office].

    PubMed

    Vicedomini, D; Lalinga, G; Lugli, N; D'Avino, A

    2014-02-01

    Acute pharyngotonsillitis is one of the most frequent causes of visits in the primary care pediatrician'office. Group A b-hemolytic streptococci (GABHS) or Streptococcus pyogenes causes 15-30% of cases of acute pharyngotonsillitis in pediatric age. Children with pharyngotonsillitis due to GABHS commonly present sore throat, fever more than 38 °C, tonsillar exudate, and tender cervical adenopathy, but the severity of illness ranges from mild throat pain to classic exudative tonsillitis with high fever. The McIsaac criteria is a clinical scoring system to predict the likelihood of streptococcal infection among children. This score is based on 5 clinical criteria: age 3-14 years, fever more than 38°C, tonsillar swelling or exudate, tender and enlarged anterior cervical lymph nodes, and absence of cough, but none of these findings is specific for GABHS pharyngotonsillitis. Culture of a throat swab on a blood agar plate (BAP) remains the gold standard for the diagnosis of acute streptococcal pharyngotonsillitis. Because of the major disadvantage of culturing throat swabs on BAP culture is the delay in obtaining the results (at least 1 day), in the past decades rapid antigen detection test (RAD) were introduced for the rapid identification of GABHS directly from throat swabs. Accurate diagnosis and treatment of GABHS pharyngotonsillitis provides positive benefits, including prevention of complications, such as acute rheumatic fever and peritonsillar abscess and reduce the acute morbidity associated with the illness. Conversely, improper diagnosis may result in negative consequences, including unnecessary antibiotic prescriptions that confer increased health care costs and contibute to the development of bacterial resistance. PMID:24608583

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

    PubMed Central

    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

    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

  15. Cost-effectiveness of cardiovascular risk management by practice nurses in primary care

    PubMed Central

    2013-01-01

    Background Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascular risk management by practice nurses in general practice with and without self-monitoring both decreases cardiovascular risk, with no additional effect of self-monitoring. For considering future approaches of cardiovascular risk reduction, cost effectiveness analyses of regular care and additional self-monitoring are performed from a societal perspective on data from the SPRING-RCT. Methods Direct medical and productivity costs are analysed alongside the SPRING-RCT, studying 179 participants (men aged 50–75 years, women aged 55–75 years), with an elevated cardiovascular risk, in 20 general practices in the Netherlands. Standard cardiovascular treatment according to Dutch guidelines is compared with additional counselling based on self-monitoring at home (pedometer, weighing scale and/ or blood pressure device) both by trained practice nurses. Cost-effectiveness is evaluated for both treatment groups and patient categories (age, sex, education). Results Costs are €98 and €187 per percentage decrease in 10-year cardiovascular mortality estimation, for the control and intervention group respectively. In both groups lost productivity causes the majority of the costs. The incremental cost-effectiveness ratio is approximately €1100 (95% CI: -5157 to 6150). Self-monitoring may be cost effective for females and higher educated participants, however confidence intervals are wide. Conclusions In this study population, regular treatment is more cost effective than counselling based on self-monitoring, with the majority of costs caused by lost productivity. Trial registration Trialregister.nl identifier: http://NTR2188 PMID:23418958

  16. What We Know about School Choice.

    ERIC Educational Resources Information Center

    Froese-Germain, Bernie

    1998-01-01

    School choice is a market-driven reform in which schools compete for students. Discusses characteristics of choice and lessons drawn from the international experience: increased segregation, unimproved learning, low participation, parental criteria, inequity, lack of options, administrative emphasis on management, and right-wing support. Describes…

  17. 42 CFR 431.51 - Free choice of providers.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  18. 42 CFR 431.51 - Free choice of providers.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  19. 42 CFR 431.51 - Free choice of providers.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  20. 42 CFR 431.51 - Free choice of providers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  1. 42 CFR 431.51 - Free choice of providers.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

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

    PubMed Central

    2012-01-01

    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

  3. Experimental analysis of choice

    Microsoft Academic Search

    Richard R. Batsell; Jordan J. Louviere

    1991-01-01

    Our paper reviews and summarizes the state-of-the-art in the design and analysis of consumer choice experiments. We emphasize experiments involving discrete choices, but also review related work on the design and analysis of ranking and resource allocation experiments. Major topics include 1) Choice experiments and conjoint analysis, 2) Random utility and constant utility probabilistic discrete choice models as a theoretical

  4. Public School Choice.

    ERIC Educational Resources Information Center

    Hardy, Lawrence

    2000-01-01

    Currently 15 percent of K-12 students attend public schools of choice, including charter, magnet, and controlled-choice schools. Support for choice is growing, but a recent report says 81 percent of adults surveyed know little about charters or vouchers. Profiles of successful choice schools are presented. (MLH)

  5. International Expert Consensus on Primary Systemic Therapy in the Management of Early Breast Cancer: Highlights of the Fifth Symposium on Primary Systemic Therapy in the Management of Operable Breast Cancer, Cremona, Italy (2013).

    PubMed

    Amoroso, Vito; Generali, Daniele; Buchholz, Thomas; Cristofanilli, Massimo; Pedersini, Rebecca; Curigliano, Giuseppe; Daidone, Maria Grazia; Di Cosimo, Serena; Dowsett, Mitchell; Fox, Stephen; Harris, Adrian L; Makris, Andreas; Vassalli, Lucia; Ravelli, Andrea; Cappelletti, Maria Rosa; Hatzis, Christos; Hudis, Clifford A; Pedrazzoli, Paolo; Sapino, Anna; Semiglazov, Vladimir; Von Minckwitz, Gunter; Simoncini, Edda L; Jacobs, Michael A; Barry, Peter; Kühn, Thorsten; Darby, Sarah; Hermelink, Kerstin; Symmans, Fraser; Gennari, Alessandra; Schiavon, Gaia; Dogliotti, Luigi; Berruti, Alfredo; Bottini, Alberto

    2015-05-01

    Expert consensus-based recommendations regarding key issues in the use of primary (or neoadjuvant) systemic treatment (PST) in patients with early breast cancer are a valuable resource for practising oncologists. PST remains a valuable therapeutic approach for the assessment of biological antitumor activity and clinical efficacy of new treatments in clinical trials. Neoadjuvant trials provide endpoints, such as pathological complete response (pCR) to treatment, that potentially translate into meaningful improvements in overall survival and disease-free survival. Neoadjuvant trials need fewer patients and are less expensive than adjuvant trial, and the endpoint of pCR is achieved in months, rather than years. For these reasons, the neoadjuvant setting is ideal for testing emerging targeted therapies in early breast cancer. Although pCR is an early clinical endpoint, its role as a surrogate for long-term outcomes is the key issue. New and better predictors of treatment efficacy are needed to improve treatment and outcomes. After PST, accurate management of post-treatment residual disease is mandatory. The surgery of the sentinel lymph-node could be an acceptable option to spare the axillary dissection in case of clinical negativity (N0) of the axilla at the diagnosis and/or after PST. No data exists yet to support the modulation of the extent of locoregional radiation therapy on the basis of the response attained after PST although trials are underway. PMID:26063896

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

    ERIC Educational Resources Information Center

    Altunay, Esen; Arli, Didem; Yalcinkaya, Munevver

    2012-01-01

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

  7. Adherence to management guidelines in acute respiratory infections and diarrhoea in children under 5 years old in primary health care in Botswana

    Microsoft Academic Search

    EELCO BOONSTRA; MORTEN LINDBÆK; ENOCH NGOME

    2005-01-01

    Objective. To evaluate health care providers' adherence to management guidelines for acute respiratory infection and diar- rhoea in children under 5 years old in Botswana primary health care. Design. Cross-sectional prospective field survey. Data collection was carried out through observation of consecutive consulta- tions at 30 randomly assigned clinics and health posts in three purposely chosen districts. Study participants. This

  8. An evaluation of the cost-effectiveness of booklet-based self-management of dizziness in primary care, with and without expert telephone support

    Microsoft Academic Search

    Lucy Yardley; Sarah Kirby; Fiona Barker; Paul Little; James Raftery; Debbie King; Anna Morris; Mark Mullee

    2009-01-01

    BACKGROUND: Dizziness is a very common symptom that often leads to reduced quality of life, anxiety and emotional distress, loss of fitness, lack of confidence in balance, unsteadiness and an increased risk of falling. Most dizzy patients are managed in primary care by reassurance and medication to suppress symptoms. Trials have shown that chronic dizziness can be treated effectively in

  9. Risk management in primary apicultural production. Part 2: a Hazard Analysis Critical Control Point approach to assuring the safety of unprocessed honey

    Microsoft Academic Search

    Giovanni Formato; Romano Zilli; Roberto Condoleo; Selene Marozzi; Ivor Davis; Frans J. M. Smulders

    2011-01-01

    In managing risks associated with the human consumption of honey, all sectors of the production chain must be considered, including the primary production phase. Although the introduction of the Hazard Analysis Critical Control Point (HACCP) system has not been made compulsory for purposes of quality and safety control in farming operations, European legislation makes many references to the key role

  10. STOCK AND DISTRIBUTION OF TOTAL AND CORN-DERIVED SOIL ORGANIC CARBON IN AGGREGATE AND PRIMARY PARTICLE FRACTIONS FOR DIFFERENT LAND USE AND SOIL MANAGEMENT PRACTICES

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Land use, soil management, and cropping systems affect stock, distribution, and residence time of soil organic carbon (SOC). Therefore, SOC stock and its depth distribution and association with primary and secondary particles were assessed in long-term experiments at the North Appalachian Experimen...

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

    Microsoft Academic Search

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

    2009-01-01

    BACKGROUND: Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape

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

    Microsoft Academic Search

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

    2008-01-01

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

  13. Evaluation of the implementation of an integrated primary care network for prevention and management of cardiometabolic risk in Montréal

    PubMed Central

    2011-01-01

    Background The goal of this project is to evaluate the implementation of an integrated and interdisciplinary program for prevention and management of cardiometabolic risk (PCMR). The intervention is based on the Chronic Care Model. The study will evaluate the implementation of the PCMR in 6 of the 12 health and social services centres (CSSS) in Montréal, and the effects of the PCMR on patients and the practice of their primary care physicians up to 40 months following implementation, as well as the sustainability of the program. Objectives are: 1-to evaluate the effects of the PCMR and their persistence on patients registered in the program and the practice of their primary care physicians, by implementation site and degree of exposure to the program; 2-to assess the degree of implementation of PCMR in each CSSS territory and identify related contextual factors; 3-to establish the relationships between the effects observed, the degree of PCMR implementation and the related contextual factors; 4-to assess the impact of the PCMR on strengthening local services networks. Methods/Design The evaluation will use a mixed design that includes two complementary research strategies. The first strategy is similar to a quasi-experimental "before-after" design, based on a quantitative approach; it will look at the program's effects and their variations among the six territories. The effects analysis will use data from a clinical database and from questionnaires completed by participating patients and physicians. Over 3000 patients will be recruited. The second strategy corresponds to a multiple case study approach, where each of the six CSSS constitutes a case. With this strategy, qualitative methods will set out the context of implementation using data from semi-structured interviews with program managers. The quantitative data will be analyzed using linear or multilevel models complemented with an interpretive approach to qualitative data analysis. Discussion Our study will identify contextual factors associated with the effectiveness, successful implementation and sustainability of such a program. The contextual information will enable us to extrapolate our results to other contexts with similar conditions. Trial registration ClinicalTrials.gov: NCT01326130 PMID:22074614

  14. Risk management in primary apicultural production. Part 2: a Hazard Analysis Critical Control Point approach to assuring the safety of unprocessed honey.

    PubMed

    Formato, Giovanni; Zilli, Romano; Condoleo, Roberto; Marozzi, Selene; Davis, Ivor; Smulders, Frans J M

    2011-06-01

    In managing risks associated with the human consumption of honey, all sectors of the production chain must be considered, including the primary production phase. Although the introduction of the Hazard Analysis Critical Control Point (HACCP) system has not been made compulsory for purposes of quality and safety control in farming operations, European legislation makes many references to the key role of primary production in food safety management and the HACCP system has been indicated as the preferred tool to ensure that consumers are provided with safe foods. This article describes a systematic HACCP-based approach to identifying, preventing and controlling food safety hazards occurring in primary apicultural production. This approach serves as a useful tool for beekeepers, food business operators, veterinary advisors, and for Food and Veterinary Official Control Bodies in their planning and conducting of audits and for establishing priorities for the evaluation of training programmes in the apicultural sector. PMID:22029853

  15. From Victim to Survivor to Thriver: Helping Women with Primary Ovarian Insufficiency Integrate Recovery, Self-Management, and Wellness

    PubMed Central

    Sterling, Evelina Weidman; Nelson, Lawrence M.

    2015-01-01

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

  16. Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program

    PubMed Central

    Lalonde, Lyne; Choinière, Manon; Martin, Elisabeth; Lévesque, Lise; Hudon, Eveline; Bélanger, Danielle; Perreault, Sylvie; Lacasse, Anaïs; Laliberté, Marie-Claude

    2015-01-01

    Purpose There is evidence that the management of chronic non-cancer pain (CNCP) in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care. Methods Using the Chronic Care Model as a conceptual framework, physicians (n=6), pharmacists (n=6), nurses (n=6), physiotherapists (n=6), psychologists (n=6), pain specialists (n=6), patients (n=3), family members (n=3), decision makers and managers (n=4), and pain researchers (n=7) took part in seven focus groups and five nominal groups. Results Challenges identified in focus group discussions were related to five dimensions: knowledge gap, “work in silos”, lack of awareness that CNCP represents an important clinical problem, difficulties in access to health professionals and services, and patient empowerment needs. Based on the nominal group discussions, the following priority interventions were identified: interdisciplinary continuing education, interdisciplinary treatment approach, regional expert leadership, creation and definition of care paths, and patient education programs. Conclusion Barriers to optimal management of CNCP in primary care are numerous. Improving its management cannot be envisioned without considering multifaceted interventions targeting several dimensions of the Chronic Care Model and focusing on both clinicians and patients. PMID:25995648

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

    PubMed

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

    2014-01-01

    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

  18. Choosing Choice: School Choice in International Perspective.

    ERIC Educational Resources Information Center

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

    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…

  19. America's Climate Choices, Maryland's Climate Choices

    E-print Network

    Maryland at College Park, University of

    America's Climate Choices, Maryland's Climate Choices Donald F. Boesch Department of Atmospheric on What We Know about Climate Change #12;MVN RSM Program Congress Requested Guidance about What to Do to global climate change and make recommendations regarding what steps must be taken and what strategies

  20. 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

    2014-01-01

    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

  1. Making Smart Food Choices

    MedlinePLUS

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

  2. Franchising as a Choice of Organizational Structure: The FINCA Case

    Microsoft Academic Search

    Laura I. Frederick

    1998-01-01

    This paper seeks to determine whether franchising is a good choice of organizational structure for a non-profit organization attempting to expand rapidly. It examines the management implications of that choice: specifically, is franchising the best choice of an organizational structure for FINCA International, given its current stage of organizational development? The research for this paper involved conducting a thorough search

  3. 42 CFR 438.52 - Choice of MCOs, PIHPs, PAHPs, and PCCMs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

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

  4. 42 CFR 438.52 - Choice of MCOs, PIHPs, PAHPs, and PCCMs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

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

  5. 42 CFR 438.52 - Choice of MCOs, PIHPs, PAHPs, and PCCMs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  6. 42 CFR 438.52 - Choice of MCOs, PIHPs, PAHPs, and PCCMs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  7. 42 CFR 438.52 - Choice of MCOs, PIHPs, PAHPs, and PCCMs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

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

  8. Experimental analysis of choice

    Microsoft Academic Search

    Richard R. Batsell; Jordan J. Louviere

    1991-01-01

    Our paper reviews and summarizes the state-of-the-art in the design and analysis of consumer choice experiments. We emphasize\\u000a experiments involving discrete choices, but also review related work on the design and analysis of ranking and resource allocation\\u000a experiments. Major topics include 1) Choice experiments and conjoint analysis, 2) Random utility and constant utility probabilistic\\u000a discrete choice models as a theoretical

  9. biotechnologies: technology, choice

    E-print Network

    Sussex, University of

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

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

    PubMed

    Atkinson, Sarah; Robson, Mary

    2012-11-01

    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

  11. Febrile neutropenia and related complications in breast cancer patients receiving pegfilgrastim primary prophylaxis versus current practice neutropaenia management: Results from an integrated analysis

    Microsoft Academic Search

    G. von Minckwitz; M. Schwenkglenks; T. Skacel; G. H. Lyman; A. Lopez Pousa; P. Bacon; V. Easton; M. S. Aapro

    2009-01-01

    Granulocyte colony-stimulating factors (G-CSFs) reduce febrile neutropaenia (FN) incidence but may be used inconsistently in current practice (CP). This study compared the efficacy of pegfilgrastim primary prophylaxis (PPP) with CP neutropaenia management in breast cancer. Individual patient data (N=2282) from 11 clinical trials and observational studies using chemotherapy regimens with ?15% FN risk and PPP (6mg, all cycles) or CP

  12. Utilization of Rural Primary Care Physicians’ Visit Services for Diabetes Management of Public Health in Southwestern China: A Cross-Sectional Study from Patients’ View

    PubMed Central

    MIAO, Yudong; YE, Ting; QIAN, Dongfu; LI, Jinlong; ZHANG, Liang

    2014-01-01

    Abstract Background Primary care physicians’ visit services for diabetes management are now widely delivered in China’s rural public health care. Current studies mainly focus on supply but risk factors from patients’ view have not been previously explored. This study aims to present the utilization of rural primary care physicians’ visit services for diabetes management in the last 12 months in southwestern China, and to explore risk factors from patients’ view. Methods This cross sectional study selected six towns at random and all 385 diabetics managed by primary care physicians were potential participants. Basing on the inclusion and exclusion criteria, 374 diabetics were taken as valid subjects and their survey responses formed the data resource of analyses. Descriptive indicators, ?2 contingency table analyses and Logistic regression were used. Results 54.8% respondents reported the utilization of visit services. According to the multivariate analysis, the positive factors mainly associated with utilization of visit services include disease duration (OR=1.654), use of diabetic drugs (OR=1.869), consulting diabetes care knowledge (OR=1.602), recognition of diabetic complications (OR=1.662), needs of visit services (OR=2.338). Conclusion The utilization of rural primary care physicians’ visit services still remains unsatisfactory. Mass rural health policy awareness, support, and emphasis are in urgent need and possible risk factors including disease duration, use of diabetic drugs, consulting diabetes care knowledge, recognition of diabetic complications and needs of visit services should be taken into account when making rural health policy of visit services for diabetes management in China and many other low- and middle-income countries.

  13. Constrained Innovation in Managing Care for High-Risk Seniors in Medicare+Choice Risk Plans. Princeton, NJ: Mathematica Policy Research

    Microsoft Academic Search

    Craig Thornton; Sheldon Retchin; Kenneth D. Smith; Peter D. Fox; William Black; Rita Stapulonis

    2002-01-01

    This case study of four well-regarded managed care organizations found that they made numerous innovations to improve care delivery for elderly Medicare beneficiaries with chronic illnesses and disabilities. Using the flexibility provided by capitation, they added new services in 1) screening to identify high-risk seniors, 2) care management and disease management, 3) network credentialing, 4) occasional provision of off-policy benefits,

  14. "Should I and Can I?": A mixed methods study of clinician beliefs and attitudes in the management of lifestyle risk factors in primary health care

    PubMed Central

    Laws, Rachel A; Kirby, Sue E; Davies, Gawaine P Powell; Williams, Anna M; Jayasinghe, Upali W; Amoroso, Cheryl L; Harris, Mark F

    2008-01-01

    Background Primary health care (PHC) clinicians have an important role to play in addressing lifestyle risk factors for chronic diseases. However they intervene only rarely, despite the opportunities that arise within their routine clinical practice. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about this for PHC clinicians working outside general practice. The aim of this study was to explore the beliefs and attitudes of PHC clinicians about incorporating lifestyle risk factor management into their routine care and to examine whether these varied according to their self reported level of risk factor management. Methods A cross sectional survey was undertaken with PHC clinicians (n = 59) in three community health teams. Clinicians' beliefs and attitudes were also explored through qualitative interviews with a purposeful sample of 22 clinicians from the teams. Mixed methods analysis was used to compare beliefs and attitudes for those with high and low levels of self reported risk factor management. Results Role congruence, perceived client acceptability, beliefs about capabilities, perceived effectiveness and clinicians' own lifestyle were key themes related to risk factor management practices. Those reporting high levels of risk factor screening and intervention had different beliefs and attitudes to those PHC clinicians who reported lower levels. Conclusion PHC clinicians' level of involvement in risk factor management reflects their beliefs and attitudes about it. This provides insights into ways of intervening to improve the integration of behavioural risk factor management into routine practice. PMID:18298865

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

    ERIC Educational Resources Information Center

    Jones, Jane

    2010-01-01

    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…

  16. Managing dental emergencies: A descriptive study of the effects of a multimodal educational intervention for primary care providers at six months

    PubMed Central

    2012-01-01

    Background Clinicians providing primary emergency medical care often receive little training in the management of dental emergencies. A multimodal educational intervention was designed to address this lack of training. Sustained competency in managing dental emergencies and thus the confidence to provide this care well after an educational intervention is of particular importance for remote and rural healthcare providers where access to professional development training may be lacking. Methods A descriptive study design with a survey instrument was used to evaluate the effectiveness of a brief educational intervention for primary care clinicians. The survey was offered immediately before and at six months following the intervention. A Wilcoxon signed rank test was performed on pre and six month post-workshop matched pair responses, measuring self-reported proficiency in managing dental emergencies. The level of significance was set at p?management of avulsed teeth and dental trauma, as reported by clinicians at six months after the education. This was associated with a greater number of cases where dental local anaesthesia was utilised by the participants. Comments from participants before the intervention, noted the lack of dental topics in professional training. Conclusions The sustained effects of a brief multimodal educational intervention in managing dental emergencies on practice confidence and proficiency demonstrates its value as an educational model that could be applied to other settings and health professional groups providing emergency primary care, particularly in rural and remote settings. PMID:23110579

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

    ERIC Educational Resources Information Center

    Bolman, Lee G.; Deal, Terrence E.

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    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

    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

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

    PubMed

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

    2014-07-01

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

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

    PubMed Central

    2014-01-01

    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

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

    PubMed Central

    2012-01-01

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

  3. Antithrombotic Management after an Ischemic Stroke in French Primary Care Practice: Results from Three Pooled Cross-Sectional Studies

    Microsoft Academic Search

    Emmanuel Touzé; Jean-Pierre Cambou; Jean Ferrières; Alec Vahanian; Gérard Coppé; Alain Leizorovicz; Gérard Jullien; Martine Guérillot; Marie-Annick Herrmann; Jean-Louis Mas

    2005-01-01

    Background and Purpose: We aimed at quantifying and explaining the underuse of antithrombotic treatments after an ischemic stroke in patients seen in French primary care. Methods: We pooled all ischemic stroke patients included in 3 observational primary care-based observational studies. French general practitioners and cardiologists recruited 14,544 patients with atherothrombotic disease including 4,322 with an ischemic stroke. Antithrombotic therapies and

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

    PubMed Central

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

    2013-01-01

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

  5. Water heaters and energy conservation - choices, choices!

    Microsoft Academic Search

    L. Weingarten; S. Weingarten

    1996-01-01

    This article reviews how to best find an energy efficient water heating system. Most people already know they should look for energy efficiency from the heater itself but additional savings can be found in water distribution, equipment sizing and selection and maintenance. Topic areas in the article include the following: is a new water heater needed; new heater choices; heater

  6. More Choice, Less Crime

    ERIC Educational Resources Information Center

    Dills, Angela K.; Hernandez-Julian, Rey

    2011-01-01

    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…

  7. Attention in risky choice.

    PubMed

    Brandstätter, Eduard; Körner, Christof

    2014-10-01

    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

  8. Making School Choice Work

    ERIC Educational Resources Information Center

    DeArmond, Michael; Jochim, Ashley; Lake, Robin

    2014-01-01

    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…

  9. Children's Choices for 2008

    ERIC Educational Resources Information Center

    Reading Teacher, 2008

    2008-01-01

    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…

  10. Latinos and School Choice

    ERIC Educational Resources Information Center

    Gastic, Billie; Coronado, Diana Salas

    2011-01-01

    The authors describe how Latino students are underrepresented in public schools of choice. They provide evidence to refute the claim that Latino students who choose to leave assigned public schools enroll in religious schools instead. Charter schools stand out as the type of public schools of choice where Latino students are well represented.…

  11. Effectiveness and efficiency of primary care based case management for chronic diseases: rationale and design of a systematic review and meta-analysis of randomized and non-randomized trials [CRD32009100316

    Microsoft Academic Search

    Tobias Freund; Felizitas Kayling; Antje Miksch; Joachim Szecsenyi; Michel Wensing

    2010-01-01

    BACKGROUND: Case management is an important component of structured and evidence-based primary care for chronically ill patients. Its effectiveness and efficiency has been evaluated in numerous clinical trials. This protocol describes aims and methods of a systematic review of research on the effectiveness and efficiency of case management in primary care. METHODS\\/DESIGN: According to this protocol Medline, Embase, CINAHL, PsychInfo,

  12. Primary and secondary hyperoxaluria: Understanding the enigma

    PubMed Central

    Bhasin, Bhavna; Ürekli, Hatice Melda; Atta, Mohamed G

    2015-01-01

    Hyperoxaluria is characterized by an increased urinary excretion of oxalate. Primary and secondary hyperoxaluria are two distinct clinical expressions of hyperoxaluria. Primary hyperoxaluria is an inherited error of metabolism due to defective enzyme activity. In contrast, secondary hyperoxaluria is caused by increased dietary ingestion of oxalate, precursors of oxalate or alteration in intestinal microflora. The disease spectrum extends from recurrent kidney stones, nephrocalcinosis and urinary tract infections to chronic kidney disease and end stage renal disease. When calcium oxalate burden exceeds the renal excretory ability, calcium oxalate starts to deposit in various organ systems in a process called systemic oxalosis. Increased urinary oxalate levels help to make the diagnosis while plasma oxalate levels are likely to be more accurate when patients develop chronic kidney disease. Definitive diagnosis of primary hyperoxaluria is achieved by genetic studies and if genetic studies prove inconclusive, liver biopsy is undertaken to establish diagnosis. Diagnostic clues pointing towards secondary hyperoxaluria are a supportive dietary history and tests to detect increased intestinal absorption of oxalate. Conservative treatment for both types of hyperoxaluria includes vigorous hydration and crystallization inhibitors to decrease calcium oxalate precipitation. Pyridoxine is also found to be helpful in approximately 30% patients with primary hyperoxaluria type 1. Liver-kidney and isolated kidney transplantation are the treatment of choice in primary hyperoxaluria type 1 and type 2 respectively. Data is scarce on role of transplantation in primary hyperoxaluria type 3 where there are no reports of end stage renal disease so far. There are ongoing investigations into newer modalities of diagnosis and treatment of hyperoxaluria. Clinical differentiation between primary and secondary hyperoxaluria and further between the types of primary hyperoxaluria is very important because of implications in treatment and diagnosis. Hyperoxaluria continues to be a challenging disease and a high index of clinical suspicion is often the first step on the path to accurate diagnosis and management. PMID:25949937

  13. Blue Choice New EnglandSM Summary of Benefits

    E-print Network

    Aalberts, Daniel P.

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

  14. Discretionary Accounting Choices: A Debt covenants Based Signalling Approach

    Microsoft Academic Search

    Pascal Frantz

    1997-01-01

    This paper seeks to explain the discretionary accounting choices made by managers in a world characterised by asymmetric information between managers and investors. It considers a firm whose capital structure consists of both debt and equity, a manager who protects the interests of the firm's existing shareholders, and a financial market. The manager is committed to engage in an investment

  15. Self-Management Support and Communication from Nurse Care Managers Compared with Primary Care Physicians: A Focus Group Study of Patients with Chronic Musculoskeletal Pain

    Microsoft Academic Search

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

    2010-01-01

    Pain is a critical health problem, with over half of Americans suffering from chronic or recurrent pain. Many patients also experience comorbid depression. Although numerous self-management interventions have been implemented in an effort to improve pain outcomes, little attention has been devoted to the role of the provider of these services, typically a nurse care manager (NCM). Given the robust literature

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

    PubMed Central

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

    2007-01-01

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

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

    PubMed

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

    2015-04-01

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

  18. 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

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

    2011-01-01

    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

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

    E-print Network

    Woodall, Jerry M.

    process stations 2, 3, 11, acid & base fume hood2. If heated only acid & base fume hood. Additional and Mixing 4. Hotplates 5. Hydrofluoric Acid 6. Haz Waste Management Ammonium Fluoride Process: Highly toxic with acids will cause toxic HF outgassing. Personal Protective Equipment: Goggles, face shield, heavy

  20. *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

    Woodall, Jerry M.

    , 12, acid & base fume hood2. If hotter than a simmer, only acid & base fume hood. Additional Process and Mixing 4. Hotplates 5. Haz Waste Management PAN: Phosphoric, Acetic and Nitric Acids Process: PAN for Aluminum Etch and some cleaning solutions. Materials: Phosphoric Acid (85% wt), Acetic Acid (Glacial

  1. *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

    Woodall, Jerry M.

    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

  2. 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

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

    2009-01-01

    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…

  3. Advances in primary writing tremor.

    PubMed

    Hai, Chen; Yu-ping, Wang; Hua, Wei; Ying, Sun

    2010-11-01

    Primary writing tremor (PWT) is considered to be a type of task-specific tremor in which tremor predominantly occurs and interferes with handwriting. The pathophysiology of PWT is not clear. Primary writing tremor may be a variant of essential tremor, a type of focal dystonia such as writer's cramp, or a separate nosological entity. Botulinum toxin injections and deep brain stimulation may be treatment choices for primary writing tremor. PMID:20630791

  4. Evaluating and Increasing Meal-Related Choices throughout a Service Setting for People with Severe Disabilities.

    ERIC Educational Resources Information Center

    Parsons, Marsha B.; And Others

    1993-01-01

    A program was developed to offer meal-related choices to adults with severe/profound mental retardation. Results indicated that the program, which included a choice-making skill assessment and teaching component along with a staff training and management component, effectively increased choice opportunities offered as well as actual choices made…

  5. Rapid appraisal of barriers to the diagnosis and management of patients with dementia in primary care: a systematic review

    Microsoft Academic Search

    Tamar Koch; Steve Iliffe

    2010-01-01

    BACKGROUND: The diagnosis of dementia in primary care is perceived as a problem across countries and systems, resulting in delayed recognition and adverse outcomes for patients and their carers. Improving its early detection is an area identified for development in the English National Dementia Strategy 2009; there are thought to be multiple benefits to the patient, family, and resources by

  6. Exploring the Landscape of Primary School Leadership and Management Problems: Drafting Conceptual Maps of a Professional Minefield

    ERIC Educational Resources Information Center

    Dunning, Gerald

    2009-01-01

    This article considers the problematic nature of primary headship. It reviews evidence of some of the most significant problems encountered by new and experienced heads derived from two sources: the UK dimension of a European questionnaire survey undertaken in the mid 1990s and more recent reports gained from interviews with serving school…

  7. Red Light-Green Light: A Classwide Management System for Students with Behavior Disorders in Primary Grades.

    ERIC Educational Resources Information Center

    Barbetta, Patricia M.

    1990-01-01

    Red Light-Green Light is a levels system providing immediate behavior modification feedback and varying privilege levels throughout the school day for primary students with behavior disorders. This article presents guidelines for implementation, covering development of classroom rules, classroom expectations, and system maintenance. Tips for…

  8. How to Manage Organisational Change and Create Practice Teams: Experiences of a South African Primary Care Health Centre

    Microsoft Academic Search

    BJ Mash; P Mayers; H Conradie; A Orayn; M Kuiper; J Marais

    A B S T R A C T Background: In South Africa, first-contact primary care is delivered by nurses in small clinics and larger community health centres (CHC). CHCs also employ doctors, who often work in isolation from the nurses, with poor differentiation of roles and little effective teamwork or communication. Worcester CHC, a typical public sector CHC in rural

  9. Explaining the variation in the management of lifestyle risk factors in primary health care: A multilevel cross sectional study

    Microsoft Academic Search

    Rachel A Laws; Upali W Jayasinghe; Mark F Harris; Anna M Williams; Gawaine Powell Davies; Lynn A Kemp

    2009-01-01

    BACKGROUND: Despite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice. Little is known about the relative importance of various determinants of practice. This study aimed to examine the relative importance of provider characteristics and attitudes, patient characteristics and consultation factors

  10. Factors Influencing Medical Students to Choose Primary Care or Non-primary Care Specialties.

    ERIC Educational Resources Information Center

    Rogers, Laura Q.; And Others

    1990-01-01

    A questionnaire was administered to 339 graduating senior medical students at the Medical College of Georgia to determine different potential sources of influence on career choice. Indebtedness may be associated with the choice of a non-primary care specialty with greater remuneration than primary care specialty. (MLW)

  11. Inside the Primary Classroom.

    ERIC Educational Resources Information Center

    Simon, Brian

    1980-01-01

    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)

  12. Time discounting for primary rewards.

    PubMed

    McClure, Samuel M; Ericson, Keith M; Laibson, David I; Loewenstein, George; Cohen, Jonathan D

    2007-05-23

    Previous research, involving monetary rewards, found that limbic reward-related areas show greater activity when an intertemporal choice includes an immediate reward than when the options include only delayed rewards. In contrast, the lateral prefrontal and parietal cortex (areas commonly associated with deliberative cognitive processes, including future planning) respond to intertemporal choices in general but do not exhibit sensitivity to immediacy (McClure et al., 2004). The current experiments extend these findings to primary rewards (fruit juice or water) and time delays of minutes instead of weeks. Thirsty subjects choose between small volumes of drinks delivered at precise times during the experiment (e.g., 2 ml now vs 3 ml in 5 min). Consistent with previous findings, limbic activation was greater for choices between an immediate reward and a delayed reward than for choices between two delayed rewards, whereas the lateral prefrontal cortex and posterior parietal cortex responded similarly whether choices were between an immediate and a delayed reward or between two delayed rewards. Moreover, relative activation of the two sets of brain regions predicts actual choice behavior. A second experiment finds that when the delivery of all rewards is offset by 10 min (so that the earliest available juice reward in any choice is 10 min), no differential activity is observed in limbic reward-related areas for choices involving the earliest versus only more delayed rewards. We discuss implications of this finding for differences between primary and secondary rewards. PMID:17522323

  13. 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

    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

    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

  14. Oral anticoagulation and self-management: analysis of the factors that determine the feasibility of using self-testing and self-management in primary care

    PubMed Central

    2013-01-01

    Background The skills of patients on oral anticoagulants are critical for achieving good outcomes with this treatment. Self-management, or the capacity of patients to control their INR level and adjust their treatment, is an effective strategy of treatment. Capacity of patients to self manage is determined by a range of factors. The identification of these factors would improve the design of self management programmes and in turn increase the number of patients able to self-manage. The objective of our study is to identify those factors that determine the ability of patients on oral anticoagulant therapy to achieve self-management of their treatment. Design This will be a three year quasi- experimental prospective study with a control group. 333 patients on anticoagulant therapy from five health centres of the Basque Health Service are to be followed up for a period of six months each after the intervention, to assess their ability to self-test and self-manage. The intervention will consist of a patient training programme involving the provision of information and practical training concerning their condition and its treatment, as well as how to use a portable blood coagulation monitoring device and adjust their anticoagulant dose. Discussion The ease-of-use of this technique lead us to believe that self-management is feasible and will represent an innovative advance that should have a substantial impact on the quality of life of this patients and their families as well as on the health care provision systems. Trial registration Osakidetza Protocol Record ISCIII-11/02285, Oral anticoagulation and self-management, ClinicalTrials.gov Identifier: NCT01878539 PMID:23968316

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

    PubMed Central

    2014-01-01

    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

  16. Management of Type 2 Diabetes in the Primary Care Setting: A Practice-Based Research Network Study

    PubMed Central

    Spann, Stephen J.; Nutting, Paul A.; Galliher, James M.; Peterson, Kevin A.; Pavlik, Valory N.; Dickinson, L. Miriam; Volk, Robert J.

    2006-01-01

    PURPOSE We wanted to describe how primary care clinicians care for patients with type 2 diabetes. METHODS We undertook a cross-sectional study of 95 primary care clinicians and 822 of their established patients with type 2 diabetes from 4 practice-based, primary care research networks in the United States. Clinicians were surveyed about their training and practice. Patients completed a self-administered questionnaire about their care, and medical records were reviewed for complications, treatment, and diabetes-control indicators. RESULTS Participating clinicians (average age, 45.7 years) saw an average of 32.6 adult patients with diabetes per month. Patients (average age, 59.7 years) reported a mean duration of diabetes of 9.1 years, with 34.3% having had the disease more than 10 years. Nearly one half (47.5%) of the patients had at least 1 diabetes-related complication, and 60.8% reported a body mass index greater than 30. Mean glycosylated hemoglobin (HbA1c) level was 7.6% (SD 1.73), and 40.5% of patients had values <7%. Only 35.3% of patients had adequate blood pressure control (<130/85 mm Hg), and only 43.7% had low-density lipoprotein cholesterol (LDL-C) levels <100 mg/dL. Only 7.0% of patients met all 3 control targets. Multilevel models showed that patient ethnicity, practice type, involvement of midlevel clinicians, and treatment were associated with HbA1c level; patient age, education level, and practice type were associated with blood pressure control; and patient ethnicity was associated with LDL-C control. CONCLUSIONS Only modest numbers of patients achieve established targets of diabetes control. Reengineering primary care practice may be necessary to substantially improve care. PMID:16449393

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

    PubMed Central

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

    2009-01-01

    Background Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed. Methods The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data. Results The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices. Conclusion The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices. PMID:19825189

  18. How Happiness Affects Choice

    E-print Network

    Mogilner, Cassie

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

  19. Propulsion System Choices and Their Implications

    NASA Technical Reports Server (NTRS)

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

    2010-01-01

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

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

    PubMed Central

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

    2014-01-01

    A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ?40?kg·m?2, or 30?kg·m?2 with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4?kg and mean body mass index was 44.1?kg·m?2. A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2?kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9?kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services. PMID:25825858

  1. Documentation of sexual partner gender is low in electronic health records: observations, predictors, and recommendations to improve population health management in primary care.

    PubMed

    Nguyen, Giang T; Yehia, Baligh R

    2015-06-01

    The 2011 Institute of Medicine report on LGBT health recommended that sexual orientation and gender identity (SO/GI) be documented in electronic health records (EHRs). Most EHRs cannot document all aspects of SO/GI, but some can record gender of sexual partners. This study sought to determine the proportion of patients who have the gender of sexual partners recorded in the EHR and to identify factors associated with documentation. A retrospective analysis was done of EHR data for 40 family medicine (FM) and general internal medicine (IM) practices, comprising 170,570 adult patients seen in 2012. The primary outcome was EHR documentation of sexual partner gender. Multivariate logistic regression assessed the impact of patient, provider, and practice factors on documentation. In all, 76,767 patients (45%) had the gender of sexual partners recorded, 4.3% of whom had same-gender partners (3.5% of females, 5.6% of males). Likelihood of documentation was independently higher for women; blacks; those with a preventive visit; those with a physician assistant, nurse practitioner, or resident primary care provider (vs. attending); those at urban practices; those at smaller practices; and those at a residency FM practice. Older age and Medicare insurance were associated with lower documentation. Sexual partner gender documentation is important to identify patients for targeted prevention and support, and holds great potential for population health management, yet documentation in the EHR currently is low. Primary care practices should routinely record the gender of sexual partners, and additional work is needed to identify best practices for collecting and using SO/GI data in this setting. (Population Health Management 2015;18:217-222). PMID:25290634

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

    PubMed

    Steinbrucker, S

    2011-10-01

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

  3. The Interface between Substance Abuse and Chronic Pain Management in Primary Care: A Curriculum for Medical Residents

    ERIC Educational Resources Information Center

    Gunderson, Erik W.; Coffin, Phillip O.; Chang, Nancy; Polydorou, Soteri; Levin, Frances R.

    2009-01-01

    Objectives: To develop and assess a housestaff curriculum on opioid and other substance abuse among patients with chronic noncancer pain (CNCP). Methods: The two-hour, case-based curriculum delivered to small groups of medical housestaff sought to improve assessment and management of opioid-treated CNCP patients, including those with a substance…

  4. European Practice Assessment of Cardiovascular risk management (EPA Cardio): protocol of an international observational study in primary care

    Microsoft Academic Search

    Michel Wensing; Sabine Ludt; Stephen Campbell; Jan van Lieshout; Eckhard Volbracht; Richard Grol

    2009-01-01

    BACKGROUND: Despite important improvements in available prevention and treatment, cardiovascular diseases (CVD) remain an important cause of morbidity and mortality. Not all high-risk patients and patients with CVD have healthy lifestyles and receive the best possible healthcare. Internationally comparative data are needed to compare cardiovascular risk management in different countries, and to examine the impact of improvement programs and others

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

    ERIC Educational Resources Information Center

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

    2011-01-01

    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…

  6. Mother Tongue Education in Primary Teacher Education in Kenya: A Language Management Critique of the Quota System

    ERIC Educational Resources Information Center

    Mwaniki, Munene

    2014-01-01

    Mother tongue education (MTE) has been a subject of rigorous debate for more than half a century, in both industrialised and developing societies. Despite disparate views on MTE, there is an uneasy consensus on its importance in educational systems, especially in the foundational years. Using the Language Management Framework, the article provides…

  7. Risk management in primary apicultural production. Part 1: bee health and disease prevention and associated best practices

    Microsoft Academic Search

    Giovanni Formato; Frans J. M. Smulders

    2011-01-01

    Prompted by FAO\\/WHO's and the European Commission's recognition that documents on Good Farming Practices (GFPs) and Good Veterinary Practices (GVPs) in apicultural production are hardly available, part 1 of this contribution provides an update of current apicultural production and associated best practices to ensure animal and public health. Major bee health and disease prevention issues and risk management options at

  8. Primary Care's Denominator Problem

    PubMed Central

    Anderson, John E.

    1985-01-01

    It is usually impossible to determine the size of a primary care practice for use as a denominator in calculating rates of morbid and other events within a practice. Although this denominator problem has been a major hurdle for primary care researchers, its nature and significance are not broadly appreciated. This article describes the need for a denominator, defines the term ‘practice population’, outlines the need for the practice population as a valid denominator, and identifies the areas in which the practice population is the denominator of choice. PMID:21279144

  9. Career Orientations in the Primary Care Specialties.

    ERIC Educational Resources Information Center

    Plovnick, Mark S.

    1979-01-01

    A review of current trends in primary care career choice is reported. Questions addressed include whether students choosing the primary care specialties share similar attitudes toward their medical role, and whether student attitudes have changed during the last few years as the result of the national focus on primary care. (JMD)

  10. Multiplexed modulation of behavioral choice.

    PubMed

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

    2014-08-15

    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

  11. Medical student debt and major life choices other than specialty

    PubMed Central

    Rohlfing, James; Navarro, Ryan; Maniya, Omar Z.; Hughes, Byron D.; Rogalsky, Derek K.

    2014-01-01

    Background Median indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face. Methods Medical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students). No incentives were offered for survey completion. Results Responses were recorded from 102 US Allopathic medical schools (n=3,032), with 22 institutions (11 public, 11 private) meeting inclusion criteria of 10% student body response proportion (n=1,846). Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice. Conclusions Medical student debt and particularly debt relative to peers at the same institution appears to influence the way that students approach major life choices like when to start a family, when to buy a home, and what specialty to choose. Future research should take into account cost of attendance when looking for the impact of medical student debt on major life choices. PMID:25391976

  12. Recognition and Management of Migraine in Primary Care: Influence of Functional Impact Measured by the Headache Impact Test (HIT)

    Microsoft Academic Search

    E Vuillaume De Diego; M Lanteri-Minet

    2005-01-01

    The objective of the present study was to investigate the influence of headache-related disability on the recognition and management of migraine by French general practitioners (GPs). Forty-nine teaching GPs at the Faculty of Medicine in the Nice-Sophia-Antipolis University were involved in this study. On one day, each patient who presented during the surgery hours of these GPs was invited to

  13. 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

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

    2014-01-01

    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

  14. Causes and consequences of lexicographic choices in stated choice studies

    Microsoft Academic Search

    Kjartan Saelensminde

    2006-01-01

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

  15. Energy Choices Game

    NSDL National Science Digital Library

    2014-09-18

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

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

    PubMed Central

    2013-01-01

    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

  17. Implementing the role of the primary care mental health worker: a qualitative study

    PubMed Central

    England, Elizabeth; Lester, Helen

    2007-01-01

    Background Primary care mental health workers are a new role recently introduced into primary care in England to help manage patients with common mental health problems. Aim To explore the views of GPs, primary care teams and patients on the value and development of the new role of primary care mental health workers in practice. Design of study Qualitative study. Setting The Heart of Birmingham Primary Care Teaching Trust in the West Midlands, UK. Method Thirty-seven semi-structured interviews involving seven primary care mental health workers, 21 patients and 11 focus groups involving 38 members of primary care teams were held with six teams with a worker. Two teams asked for the worker to be removed. Six practice managers also took part in the study. Results A number of different approaches were used to implement this new role. Strategies that incorporated the views of primary care trust senior management, primary care teams and workers' views appeared most successful. Rapid access to a healthcare professional at times of stress and the befriending role of the worker were also highly valued. Workers felt that their role left them professionally isolated at times. A number of workers described tension around ownership of the role. Conclusion Primary care mental health workers appear to provide a range of skills valued by patients and the primary care teams and can increase patient access and choice in this area of health care. Successful implementation strategies highlighted in this study may be generalisable to other new roles in primary care. PMID:17359607

  18. Social choice Approximate MAX CUT

    E-print Network

    Pansu, Pierre

    Social choice Un-friends Approximate MAX CUT Unique games Hardness of approximation P. Pansu;Social choice Un-friends Approximate MAX CUT Unique games Today's menu: A theorem in social choice theory-Sud Hardness of approximation #12;Social choice Un-friends Approximate MAX CUT Unique games Influences Noise

  19. REVIEW OF HEYMAN'S ADDICTION: A DISORDER OF CHOICE

    PubMed Central

    Kurti, Allison N; Dallery, Jesse

    2012-01-01

    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.

  20. 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

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

    2006-01-01

    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

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

    PubMed Central

    Harris, K; Mant, J

    2013-01-01

    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

  2. Choices, Values, and Frames

    Microsoft Academic Search

    Daniel Kahneman; Amos Tversky

    1984-01-01

    We discuss the cognitive and the psy- chophysical determinants of choice in risky and risk- less contexts. The psychophysics of value induce risk aversion in the domain of gains and risk seeking in the domain of losses. The psychophysics of chance induce overweighting of sure things and of improbable events, relative to events of moderate probability. De- cision problems can

  3. NBNews Editor's Choice Awards

    NSDL National Science Digital Library

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

  4. Green Lighting Choices

    NSDL National Science Digital Library

    Benya, James R.

    This brief article looks at sustainable choices in home and commercial lighting. The author discusses the energy use of several different types of bulbs, and their appropriate uses. The suggestions the author includes in the article are intended to be both environmentally responsible and have an appearance similar to other lighting projects. This document may be downloaded in Microsoft Word Doc file format.

  5. Learning from School Choice.

    ERIC Educational Resources Information Center

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

    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).…

  6. Paper Choices Mock Presentation

    E-print Network

    George, Steven C.

    Paper Choices Mock Presentation Fluorescence-guided optical coherence tomography imaging for colon-dimensional optical coherence tomography imaging of retinal sheet implants in live rats Seiler, M. J., Rao, B. Label-Free Biomedical Imaging with High Sensitivity by Stimulated Raman Scattering Microscopy Brown, P

  7. A Matter of Choice

    ERIC Educational Resources Information Center

    Vriend, John

    1973-01-01

    Since the goal of helping the client make wise decisions is at the core of counseling, it is suggested that existentialism as a state of mind may give the contemporary counselor an outlook most conducive to achieving that goal. The entire role of choice must be dealt with by the counselor in light of the reality of current events. (Author)

  8. Assessment Choices The challenge

    E-print Network

    Fuerschbach, Phillip

    , a vulnerability assessment, a red team assessment, or some combination of the three? How do you knowAssessment Choices The challenge If you have systems and assets you must defend, you have no doubt faced the challenge of decoding the wide variety of available service offerings and assessment types

  9. Supporting Family Choice

    ERIC Educational Resources Information Center

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

    2007-01-01

    Supporting family choice in the decision-making process is recommended practice in the field of early childhood and early childhood special education. These decisions may relate to the medical, educational, social, recreational, therapeutic/rehabilitative, and community aspects of the child's disability. Although this practice conveys the message…

  10. Mate choice turns cognitive

    Microsoft Academic Search

    Geoffrey F. Miller; Peter M. Todd

    1998-01-01

    Evolutionary psychology has revolutionized research on human mate choice and sexual attraction in recent years, combining a rigorous Darwinian framework based on sexual selection theory with a loosely cognitivist orientation to task analysis and mechanism modelling. This hard Darwinian, soft computational approach has been most successful at revealing the adaptive logic behind physical beauty, demonstrating that many sexual cues computed

  11. Multiple Choice Test

    NSDL National Science Digital Library

    Jay Parkes

    This site presents a guide to developing and deploying effective multiple choice tests. The site also discusses the costs and benefits of this method, as well as the philosophy of this commonly used assessment method. Links to more detailed information are included as well.

  12. Choice of Living Arrangements

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  13. Choices, frameworks and refinement

    Microsoft Academic Search

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

    1991-01-01

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

  14. Choices, Frameworks and Refinement

    NASA Technical Reports Server (NTRS)

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

    1991-01-01

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

  15. Primary breast lymphoma.

    PubMed

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

    2014-09-01

    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

  16. Serotonergic Genotypes, Neuroticism, and Financial Choices

    PubMed Central

    Kuhnen, Camelia M.; Samanez-Larkin, Gregory R.; Knutson, Brian

    2013-01-01

    Life financial outcomes carry a significant heritable component, but the mechanisms by which genes influence financial choices remain unclear. Focusing on a polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR), we found that individuals possessing the short allele of this gene invested less in equities, were less engaged in actively making investment decisions, and had fewer credit lines. Short allele carriers also showed higher levels of the personality trait neuroticism, despite not differing from others with respect to cognitive skills, education, or wealth. Mediation analysis suggested that the presence of the 5-HTTLPR short allele decreased real life measures of financial risk taking through its influence on neuroticism. These findings show that 5-HTTLPR short allele carriers avoid risky and complex financial choices due to negative emotional reactions, and have implications for understanding and managing individual differences in financial choice. PMID:23382929

  17. Serotonergic genotypes, neuroticism, and financial choices.

    PubMed

    Kuhnen, Camelia M; Samanez-Larkin, Gregory R; Knutson, Brian

    2013-01-01

    Life financial outcomes carry a significant heritable component, but the mechanisms by which genes influence financial choices remain unclear. Focusing on a polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR), we found that individuals possessing the short allele of this gene invested less in equities, were less engaged in actively making investment decisions, and had fewer credit lines. Short allele carriers also showed higher levels of the personality trait neuroticism, despite not differing from others with respect to cognitive skills, education, or wealth. Mediation analysis suggested that the presence of the 5-HTTLPR short allele decreased real life measures of financial risk taking through its influence on neuroticism. These findings show that 5-HTTLPR short allele carriers avoid risky and complex financial choices due to negative emotional reactions, and have implications for understanding and managing individual differences in financial choice. PMID:23382929

  18. A randomised controlled trial of delayed antibiotic prescribing as a strategy for managing uncomplicated respiratory tract infection in primary care.

    PubMed Central

    Dowell, J; Pitkethly, M; Bain, J; Martin, S

    2001-01-01

    BACKGROUND: Despite evidence that uncomplicated lower respiratory tract infection (cough) does not respond appreciably to antibiotics and that bacterial resistance is increasing, general practitioners (GPs) still prescribe frequently. AIM: To assess delayed antibiotic prescribing as a strategy for reducing the unnecessary use of antibiotics for cough in primary care. DESIGN OF STUDY: Open randomised controlled trial of delayed versus immediate prescribing of antibiotics. SETTING: One hundred and ninety-one adult patients with uncomplicated cough in 22 Scottish practices who would have received antibiotics under the GP's usual practice were randomised to receive either an immediate prescription (92 patients) or a delayed prescription (99 patients). METHOD: Delayed subjects were asked to wait a week before deciding whether to collect their prescription. Outcome measures included symptom duration, prescription uptake, patient satisfaction, patient enablement, and subsequent consultation rates. The 48 GPs who recruited patients were surveyed six months after the trial to see whether they used delayed prescribing as a part of their normal practice. RESULTS: Study and control groups were similar at baseline. Of the subjects in the delayed arm, 55% did not pick up their prescription. Although most patients were satisfied, more patients in the immediate arm were very satisfied with the treatment (P = 0.001) and the consultation (P = 0.03). The patients in the immediate arm were also more enabled (3.3 versus 2.4; P = 0.04), although more of them intended to consult for similar complaints in the future (85% versus 69%, P = 0.02). We were unable to detect any difference in actual consulting behaviour in the follow-up period (mean = 15 months [SD = 5 months]). Subsequently, 68% of GPs used delayed prescribing at least monthly; all gave the prescription to the patient. CONCLUSION: Delayed prescribing is effective at reducing the use of antibiotics for self-limiting cough; however, patients are less satisfied and enabled as a result. Patients may be deterred from consulting rather than becoming enabled. PMID:11255901

  19. Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations.

    PubMed

    Josephs, Lynn K; Coker, Robina K; Thomas, Mike

    2013-06-01

    Air travel poses medical challenges to passengers with respiratory disease, principally because of exposure to a hypobaric environment. In 2002 the British Thoracic Society published recommendations for adults and children with respiratory disease planning air travel, with a web update in 2004. New full recommendations and a summary were published in 2011, containing key recommendations for the assessment of high-risk patients and identification of those likely to require in-flight supplemental oxygen. This paper highlights the aspects of particular relevance to primary care practitioners with the following key points: (1) At cabin altitudes of 8000 feet (the usual upper limit of in-flight cabin pressure, equivalent to 0.75 atmospheres) the partial pressure of oxygen falls to the equivalent of breathing 15.1% oxygen at sea level. Arterial oxygen tension falls in all passengers; in patients with respiratory disease, altitude may worsen preexisting hypoxaemia. (2) Altitude exposure also influences the volume of any air in cavities, where pressure x volume remain constant (Boyle's law), so that a pneumothorax or closed lung bulla will expand and may cause respiratory distress. Similarly, barotrauma may affect the middle ear or sinuses if these cavities fail to equilibrate. (3) Patients with respiratory disease require clinical assessment and advice before air travel to: (a) optimise usual care; (b) consider contraindications to travel and possible need for in-flight oxygen; (c) consider the need for secondary care referral for further assessment; (d) discuss the risk of venous thromboembolism; and (e) discuss forward planning for the journey. PMID:23732637

  20. A comparative study of sutureless scleral tunnel trabeculectomy versus conventional trabeculectomy in the management of primary open-angle glaucoma.

    PubMed

    Arish, Mohammad; Khallaghi, Hoda; Soltani, Elham; Akbarpour, Reza

    2014-10-01

    The aim of this study was to compare the outcome and complications of sutureless trabeculectomy with conventional trabeculectomy. A total of 52 eyes were randomly assigned to two groups. One group received standard conventional trabeculectomy and the other group received sutureless trabeculectomy. The patients were evaluated at 1, 3, 6 and 12 months after surgery. Patient data such as sex, age, intraocular pressure (IOP), logMAR visual acuity, antiglaucoma medications, and intraoperative and postoperative complications were collected and statistically analyzed. The mean age of the conventional and sutureless groups was 48.5 ± 15.4 and 57.3 ± 13.9 years, respectively. All patients achieved IOP levels <21 mmHg with a mean IOP of 13.4 ± 5.3 mmHg in the conventional group and 12.8 ± 2.6 mmHg in the sutureless group at 6 months and 11.00 ± 1.3 and 12.4 ± 3.2 mmHg at 12 months post surgery, respectively. These results showed a significant decrease compared to preoperative measures but did not show a significant difference between the two groups (p = 0.659). The number of antigalucoma medications used postoperatively showed a significant decline from preoperative status of 0.7 ± 0.58 in the conventional group and 0.4 ± 0.4 in the sutureless trabeculectomy group after 6 months and 0.68 ± 0.8 and 0.78 ± 0.9 after 12 months, respectively; however, there was no significant difference between the two groups (p = 0.112). No intraoperative complications were encountered in any of the groups. One patient in the sutureless trabeculectomy group developed mild hyphema which was managed medically. In the conventional group, two patients had failed trabeculectomy which was successfully revised, two patients showed hypotony 2 days after surgery which was managed medically and normal pressure was achieved within 5 days. Sutureless trabeculectomy appears to be a safe and easy method with results comparable to conventional trabeculectomy. PMID:24488091

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

    PubMed Central

    2014-01-01

    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

  2. Explaining the variation in the management of lifestyle risk factors in primary health care: A multilevel cross sectional study

    PubMed Central

    Laws, Rachel A; Jayasinghe, Upali W; Harris, Mark F; Williams, Anna M; Davies, Gawaine Powell; Kemp, Lynn A

    2009-01-01

    Background Despite evidence for the effectiveness of interventions to modify lifestyle behaviours in the primary health care (PHC) setting, assessment and intervention for these behaviours remains low in routine practice. Little is known about the relative importance of various determinants of practice. This study aimed to examine the relative importance of provider characteristics and attitudes, patient characteristics and consultation factors in determining the rate of assessment and intervention for lifestyle risk factors in PHC. Methods A prospective audit of assessment and intervention for lifestyle risk factors was undertaken by PHC nurses and allied health providers (n = 57) for all patients seen (n = 732) over a two week period. Providers completed a survey to assess key attitudes related to addressing lifestyle issues. Multi-level logistic regression analysis of patient audit records was undertaken. Associations between variables from both data sources were examined, together with the variance explained by patient and consultation (level 1) and provider (level 2) factors. Results There was significant variance between providers in the assessment and intervention for lifestyle risk factors. The consultation type and reason for the visit were the most important in explaining the variation in assessment practices, however these factors along with patient and provider variables accounted for less than 20% of the variance. In contrast, multi-level models showed that provider factors were most important in explaining the variance in intervention practices, in particular, the location of the team in which providers worked (urban or rural) and provider perceptions of their effectiveness and accessibility of support services. After controlling for provider variables, patients' socio-economic status, the reason for the visit and providers' perceptions of the 'appropriateness' of addressing risk factors in the consultation were all significantly associated with providing optimal intervention. Together, measured patient consultation and provider variables accounted for most (80%) of the variation in intervention practices between providers. Conclusion The findings highlight the importance of provider factors such as beliefs and attitudes, team location and work context in understanding variations in the provision of lifestyle intervention in PHC. Further studies of this type are required to identify variables that improve the proportion of variance explained in assessment practices. PMID:19480660

  3. Department of Primary Care Respiratory

    E-print Network

    Cheng, Mei-Fang

    Department of Primary Care Respiratory Therapy - South - about it's all ChoiCes... exclusively dedicated to healthcare state-of-the-art equipment the very best faculty & students rigorous course work to the Program office at Rutgers SHRP, Respiratory Therapy Program, 40 East Laurel Road, Suite 2105, Stratford

  4. 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 ...

  5. CropChoice

    NSDL National Science Digital Library

    2007-04-16

    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.

  6. Enhancing Informed Choice to Undergo Health Screening: A Systematic Review

    PubMed Central

    Biesecker, Barbara Bowles; Schwartz, Marc D.; Marteau, Theresa M.

    2012-01-01

    Objective To assess the effectiveness of health screening interventions aimed at enhancing informed choice. Methods Studies were selected if (1) they were randomized controlled trials conducted between January 1, 2000, and March 30, 2010, (2) participants in one arm underwent a prescreening intervention aimed at improving informed choice, and (3) informed choice was the primary outcome. Results Eight studies that met the inclusion criteria involved screening for prostate, colorectal and breast cancer, and diabetes. Five of the 8 prescreening interventions led to greater informed choice. Conclusions With researchers mindful of the limited number of studies, findings were encouraging, but conclusions regarding the most effective ways of facilitating informed choice for screening are at best tentative. PMID:23985182

  7. Choice Based Revenue Management for Parallel Flights

    E-print Network

    2014-03-05

    Mar 5, 2014 ... where there are many flights per day, and most passengers travel ..... or the customer does not get space on a later flight, and the airline pays a penalty e0 ...... The details of estimation model and its effectiveness is presented as follows. ..... version, the problem is still hard to solve directly by a commercial ...

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

    ERIC Educational Resources Information Center

    Palmatier, Larry L., Ed.

    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…

  9. 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

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

    2012-01-01

    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…

  10. Case management for the treatment of patients with major depression in general practices – rationale, design and conduct of a cluster randomized controlled trial – PRoMPT (Primary care Monitoring for depressive Patient's Trial) [ISRCTN66386086] – Study protocol

    Microsoft Academic Search

    Jochen Gensichen; Marion Torge; Monika Peitz; Heike Wendt-Hermainski; Martin Beyer; Thomas Rosemann; Christian Krauth; Heiner Raspe; Josef B Aldenhoff; Ferdinand M Gerlach

    2005-01-01

    BACKGROUND: Depression is a disorder with high prevalence in primary health care and a significant burden of illness. The delivery of health care for depression, as well as other chronic illnesses, has been criticized for several reasons and new strategies to address the needs of these illnesses have been advocated. Case management is a patient-centered approach which has shown efficacy

  11. Social Choice Majority Vote Graphs

    E-print Network

    Goddard, Wayne

    #12;Social Choice Majority Vote Graphs Supermajority Voting Supermajority Vote Graphs Clemson Miniconference on Discrete Mathematics October 2004 Craig A. Tovey Georgia Tech #12;Social Choice HOW should maximizes the probability of the better alternative being chosen. #12;Social Choice Majority Vote Graphs

  12. Dynamics of Choice: A Tutorial

    ERIC Educational Resources Information Center

    Baum, William M.

    2010-01-01

    Choice may be defined as the allocation of behavior among activities. Since all activities take up time, choice is conveniently thought of as the allocation of time among activities, even if activities like pecking are most easily measured by counting. Since dynamics refers to change through time, the dynamics of choice refers to change of…

  13. After Busing: Education and Choice.

    ERIC Educational Resources Information Center

    Armor, David J.

    1989-01-01

    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

  14. Management

    Microsoft Academic Search

    Michael Cotta-Schönberg

    2000-01-01

    The area of management is a naturally fertile ground for theory making, development of models and ... fads! Moreover, gurus, consultant firms, and publishers alike have vested interests in keeping the management mill going. Finally, our political lords and masters regularly come up with new trendy demands on public managers. So, it is no wonder that library managers may sometimes

  15. Country of Origin Effect on Job Choice Decisions

    Microsoft Academic Search

    Moulik M. Zaveri; Rajendra Mulye; Christopher White

    Country-of-origin (COO) research has acquired growing importance over the past four decades in both marketing and international human resources management (IHRM) literature. Theoretical and empirical investigations in both streams have found COO to be an influential predictor of consumer choice in marketing and management practices in IHRM. As a review of the literature from both streams did not yield a

  16. Intraocular pressure-lowering effects of commonly used fixed combination drugs with timolol in the management of primary open angle glaucoma

    PubMed Central

    Ozer, Murat Atabey; Acar, Mutlu; Yildirim, Cem

    2014-01-01

    AIM To evaluate intraocular pressure (IOP)-lowering effect and ocular tolerability of brimonidine/timolol, dorzolamide/timolol and latanoprost/timolol fixed combination therapies in the management of primary open angle glaucoma. METHODS Each drug was administered for two months, after which a circadian tonometric curve was recorded using a Goldmann applanation tonometer. Ocular discomfort (conjunctival hyperemia, burning or stinging, foreign body sensation, itching, ocular pain) of each eye was assessed by the subject on a standardized ocular discomfort scale. RESULTS Among the three study groups, there were no significant differences in the mean baseline IOP measurements, mean 2nd mo IOP measurements, and mean (%) change of IOPs from baseline. Among the three study groups, there were no significant differences in the mean IOP measurements obtained at circadian tonometric curves at baseline and at two months controls. In sum brimonidine/timolol, dorzolamide/timolol and latanoprost/timolol fixed combination therapies showed similar effects on IOP levels. CONCLUSION Brimonidine/timolol, dorzolamide/timolol and latanoprost/timolol fixed combination therapies showed similar lowering efficaties on IOP levels whereas there was no any difference between each other. PMID:25349802

  17. Primary glomerular disease

    Microsoft Academic Search

    Peter Mathieson

    2011-01-01

    This article reviews the clinical features, pathogenesis, investigation and management of glomerulonephritis (GN). This can occur as a primary isolated renal disease, as a manifestation of systemic diseases such as vasculitis or lupus, or secondary to drugs, infections or tumours. It is an important cause of morbidity and mortality and a potentially preventable cause of end-stage renal disease, so early

  18. Primary glomerular disease

    Microsoft Academic Search

    Momir Macanovic; Peter Mathieson

    2007-01-01

    This article reviews the clinical features, pathogenesis, investigation and management of glomerulonephritis (GN). This can occur as a primary isolated renal disease, as a manifestation of systemic diseases such as vasculitis or lupus, or secondary to drugs, infections or tumours. It is an important cause of morbidity and mortality and a potentially preventable cause of end-stage renal disease, so early

  19. Variation, Repetition, And Choice

    PubMed Central

    Abreu-Rodrigues, Josele; Lattal, Kennon A; dos Santos, Cristiano V; Matos, Ricardo A

    2005-01-01

    Experiment 1 investigated the controlling properties of variability contingencies on choice between repeated and variable responding. Pigeons were exposed to concurrent-chains schedules with two alternatives. In the REPEAT alternative, reinforcers in the terminal link depended on a single sequence of four responses. In the VARY alternative, a response sequence in the terminal link was reinforced only if it differed from the n previous sequences (lag criterion). The REPEAT contingency generated low, constant levels of sequence variation whereas the VARY contingency produced levels of sequence variation that increased with the lag criterion. Preference for the REPEAT alternative tended to increase directly with the degree of variation required for reinforcement. Experiment 2 examined the potential confounding effects in Experiment 1 of immediacy of reinforcement by yoking the interreinforcer intervals in the REPEAT alternative to those in the VARY alternative. Again, preference for REPEAT was a function of the lag criterion. Choice between varying and repeating behavior is discussed with respect to obtained behavioral variability, probability of reinforcement, delay of reinforcement, and switching within a sequence. PMID:15828592

  20. Context effects on choice.

    PubMed Central

    Goldshmidt, J N; Lattal, K M; Fantino, E

    1998-01-01

    Four pigeons responded on a concurrent-chains schedule in four experiments that examined whether the effectiveness of a stimulus as a conditioned reinforcer is best described by a global approach, as measured by the average interreinforcement interval, or by a local contextual approach, as measured by the onset of the stimulus preceding the conditioned reinforcer. The interreinforcement interval was manipulated by the inclusion of an intertrial interval, which increased the overall time to reinforcement but did not change the local contingencies on a given trial A global analysis predicted choice for the richer alternative to decrease with the inclusion of an intertrial interval, whereas a local analysis predicted no change in preference. Experiment 1 examined sensitivity to intertrial intervals when each was signaled by the same houselight that operated throughout the session. In Experiment 2, the intertrial interval always was signaled by the stimulus correlated with the richer terminal link. In Experiment 3, the intertrial interval was signaled by the keylights correlated with the initial links and two novel houselights. Experiment 4 provided free food pseudorandomly during the intertrial interval. In all experiments, subjects' preferences were consistent with a local analysis of choice in concurrent chains. These results are discussed in terms of delay-reduction theory, which traditionally has failed to distinguish global and local contexts. PMID:9821681

  1. Seeds Of Knowledge: Case Study Of A Grassroots Planned And Managed Project For School Fee Reduction And Food Security For Primary Schools In Jinja, Uganda

    Microsoft Academic Search

    Steven Rozmus

    2010-01-01

    The government of Uganda has accomplished much through 12 years of Universal Primary Education (UPE) to attempt to bring basic primary education to all children. Currently, primary enrollment rates in Uganda are around 88% for both boys and girls however, as this paper shows, the quality of the education the children are receiving is a big issue that is continually

  2. After the withdrawal of 'informed choice': the meanings and social effects of mothers' choice for HIV prevention in Senegal.

    PubMed

    Desclaux, Alice

    2014-01-01

    To prevent HIV transmission through breastfeeding, African health services in 1998 implemented the World Health Organization's approach of 'informed choice' when recommending infant feeding options to HIV-positive mothers. In 2010, 'informed choice' was withdrawn in favour of antiretroviral prophylaxis with breastfeeding. A 2010-11 ethnographic study conducted in Senegal among HIV-positive mothers revealed three broad responses to the withdrawal of choice and formula provision: 'resistance' from association members claiming the health system was responsible for providing formula to ensure efficient prevention; 'compliance' among mothers adopting 'protected breastfeeding' without complaints; and 'self-reliance' among women trying to obtain formula through other means without mentioning choice. These three responses shed light on the meanings attributed to choice and on the social impact of formula provision during the 'informed choice era.' The analysis shows that the top-down introduction of 'informed choice' as an ethical and management imperative was appropriated and re-signified locally, making space for new forms of sociality within medical and associative social spaces. These social forms could not easily be maintained after the withdrawal of formula provision; women who continue to exert choice do so silently. By focusing on the upheaval of social care arrangements after the introduction of prophylaxis by pharmaceuticals, this paper sheds light on the understudied local consequences of changes in public health policies and the social framing of 'choice' in low-income countries' health systems. PMID:24975228

  3. Personality type and medical specialty choice.

    PubMed

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

    1999-09-01

    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

  4. A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care

    PubMed Central

    2012-01-01

    Background Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care. Methods An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination) on change in use or the reach of services in defined population groups (evaluated interventions). Results The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n?=?45), episodic care (n?=?19), and chronic disease management (n?=?11). They were undertaken in a number of countries including Australia (n?=?25), USA (n?=?25), and UK (n?=?15). Study quality was ranked as high (31% of studies), medium (61%) and low (8%). The 75 evaluated interventions tested a range of strategies either singly (n?=?46 studies) or as a combination of two (n?=?20) or more strategies (n?=?9). Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n?=?43 studies), patient support (n?=?29), provision of new services (n?=?19), workforce development (n?=?11), and financial incentives (n?=?9). Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results. Conclusions This review suggests that multiple, linked strategies targeting different levels of the health care system are most likely to improve access to best practice PHC. The proposed changes in the structure of PHC in Australia may provide opportunities to investigate the factors that influence access to best practice PHC and to develop and implement effective, evidence based strategies to address these. PMID:23170843

  5. SWORDTAIL MATE CHOICE AND REPRODUCTIVE ALLOCATION: EFFECTS OF MALE CONDITION 

    E-print Network

    Simpson, Suzanne

    2011-04-26

    was recorded for ten minutes on primary and back-up webcams. The side on which the groups? water dripped was varied to account for side bias. After the trial the females were returned to their housing tanks. These choice tests had a low response rate...

  6. Why Am I Here? Student Choice in the Biosciences

    ERIC Educational Resources Information Center

    Scott, Jon

    2006-01-01

    Undergraduate recruitment is a significant activity for all universities. This brief report sets out the results of a survey regarding the course and institutional choices of the 2005-06 entry cohort of bioscience students in four universities. The key findings show that enjoyment of the subject and the wish to learn more are the primary reasons…

  7. School Choice 2000 Annual Report

    NSDL National Science Digital Library

    2000-01-01

    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.

  8. Silvopasture: a natural choice

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Appalachian region is one of the most beautiful areas of the world. The mosaic of open areas (pasture and hayfields) and forestland is very productive in terms of animal and timber products. Livestock production can be improved through better herbage and animal management with Appalachian farm...

  9. Primary Economics

    NSDL National Science Digital Library

    2010-01-01

    In this math lesson, learners play the role of a consumer as they learn how to use different combinations of coins to make money amounts up to 25 cents. Learners earn money and save it in their piggy banks until they have the exact amount to purchase an item of their choice. This lesson guide includes questions for learners, assessment options, extensions, and reflection questions.

  10. Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study

    PubMed Central

    Morales-Asencio, JM; Gonzalo-Jiménez, E; Martin-Santos, FJ; Morilla-Herrera, JC; Celdráan-Mañas, M; Carrasco, A Millán; García-Arrabal, JJ; Toral-López, I

    2008-01-01

    Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016) – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001) and, on average, required fewer home care visits (9.40 95%CI: 7.89–10.92 vs.11.30 95%CI: 9.10–14.54). No differences were found in terms of frequency of visits to A&E or hospital re-admissions. Furthermore, patients in the control group perceived higher levels of satisfaction (16.88; 95%CI: 16.32–17.43; range: 0–21, vs. 14.65 95%CI: 13.61–15.68; p = 0,001). Conclusion A home care service model that includes nurse-led case management streamlines access to healthcare services and resources, while impacting positively on patients' functional ability and caregiver burden, with increased levels of satisfaction. Trial registration ISRCTN44054549 PMID:18811927

  11. Separation of car-dependent commuters from normal-choice riders in mode-choice analysis

    Microsoft Academic Search

    Keemin Sohn; Jiyoung Yun

    2009-01-01

    The ever-increasing use of cars is a big problem in metropolitan areas. To manage the traffic stream and alleviate air pollution,\\u000a most metropolitan governments are attempting to discourage the use of cars. Nevertheless, the results have not been satisfactory.\\u000a It is well known that normal-choice riders choose their travel mode based on utility, which is determined by mode-specific\\u000a impedances and

  12. Addiction: Choice or Compulsion?

    PubMed Central

    Henden, Edmund; Melberg, Hans Olav; Røgeberg, Ole Jørgen

    2013-01-01

    Normative thinking about addiction has traditionally been divided between, on the one hand, a medical model which sees addiction as a disease characterized by compulsive and relapsing drug use over which the addict has little or no control and, on the other, a moral model which sees addiction as a choice characterized by voluntary behavior under the control of the addict. Proponents of the former appeal to evidence showing that regular consumption of drugs causes persistent changes in the brain structures and functions known to be involved in the motivation of behavior. On this evidence, it is often concluded that becoming addicted involves a transition from voluntary, chosen drug use to non-voluntary compulsive drug use. Against this view, proponents of the moral model provide ample evidence that addictive drug use involves voluntary chosen behavior. In this article we argue that although they are right about something, both views are mistaken. We present a third model that neither rules out the view of addictive drug use as compulsive, nor that it involves voluntary chosen behavior. PMID:23966955

  13. The couple's choices.

    PubMed

    Seewald, R

    1993-03-01

    The Secretary of Health under President Ramos emphasizes prevention rather than curative medicine and plans on starting a family planning program in the Philippines. Family planning was basically neglected during 1986-1992. The goal of the program is to reduce infant and maternal mortality and to curb population growth which is outstripping the country's ability to feed itself (annual population growth - 2.3%, agriculture growth rate - 1%). Family planning includes limiting the number of births, birth spacing, and helping infertile women (10-12% of women). The entire health budget of the Philippines is only 2% of the national budget which is smaller than the 5% recommended by WHO. Thus, the Secretary intends to ask for international assistance, but not until he first develops the program. The guideline he uses for program development is that any program must be simple, practical, economical, effective, and duplicable (SPEED). He wants to incorporate nongovernmental organizations into the program since they are flexible and innovative, emphasize quality, and change quickly. Many women (17% of all women of reproductive age in 4 villages in Cavite Province) have had at least 1 abortion, even though it is illegal. The leading reason for abortions is unwanted or unplanned pregnancy, so family planning will reduce the number of abortions. The Secretary wants people to participate in family planning for instance, to make their own choice about what method to use, be it artificial or natural. PMID:12286380

  14. Variables Impacting an Academic Pharmacy Career Choice

    PubMed Central

    Brown, Bonnie K.; Byrd, Debbie C.; Gupchup, Gireesh V.; Mark, Scott M.; Mobley Smith, Miriam A.; Rospond, Raylene M.

    2008-01-01

    Objectives To identify the variables associated with an academic pharmacy career choice among the following groups: final professional-year doctor of pharmacy (PharmD) students, pharmacy residents, pharmacy faculty members within the first 5 years of academic employment, and clinical pharmacy practitioners. Methods A cross-sectional design Web-based survey instrument was developed using the online tool SurveyMonkey. The survey link was distributed via e-mail and postcards, and data were collected anonymously. Quantitative analyses were used to describe the 2,494 survey respondents and compare their responses to 25 variables associated with an academic pharmacy career choice. Logistic regression models were used to predict the motivators/deterrents associated with an academic pharmacy career choice for each participant group. Results Across all participant groups, the potential need to generate one's salary was the primary deterrent and autonomy, flexibility, and the ability to shape the future of the profession were the primary motivators. Final-year pharmacy students who considered a career in academic pharmacy were significantly deterred by grant writing. The overall sample of participants who considered an academic pharmacy career was more likely to be motivated by the academic environment and opportunities to teach, conduct professional writing and reviews, and participate in course design and/or assessment. Conclusions This study demonstrates specific areas to consider for improved recruitment and retention of pharmacy faculty. For example, providing experiences related to pharmacy academia, such as allowing student participation in teaching and research, may stimulate those individuals' interest in pursuing an academic pharmacy career. PMID:18698388

  15. School Choice with Chinese Characteristics

    ERIC Educational Resources Information Center

    Wu, Xiaoxin

    2012-01-01

    This paper explores the major characteristics of school choice in the Chinese context. It highlights the involvement of cultural and economic capital, such as choice fees, donations, prize-winning certificates and awards in gaining school admission, as well as the use of social capital in the form of "guanxi". The requirement for these resources…

  16. The Supply Side of Choice

    ERIC Educational Resources Information Center

    Hill, Paul T.

    2005-01-01

    New school creation is key to success of choice. For the last two decades, the struggle over school choice has focused on freeing up parents to choose. It continues to this day, with growing success in the forms of public and private voucher programs, charter school laws in 40 states and the District of Columbia, and state and federal laws that…

  17. Demystifying the Delayed Choice Experiments

    E-print Network

    Bram Gaasbeek

    2010-07-22

    The delayed choice experiments are a collection of experiments where the counterintuitive laws of quantum mechanics are manifested in a very striking way. Although the delayed choice experiments can be very accurately described with the standard framework of quantum optics, a more didactical and intuitive explanation seems not to have been given so far. In this note, we fill that gap.

  18. School Choice: Examining the Evidence.

    ERIC Educational Resources Information Center

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

    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…

  19. Rational choice theory in sociology

    Microsoft Academic Search

    Robert J. Holton

    1995-01-01

    James Coleman attempted to reconcile rational choice theory with the classical sociological concerns: the relationship between the individual and society, and the historical and normative status of rationality. He identifies limits to the rational choice model, and suggests some promising but ultimately unconvincing ways around them. His project does, however, offer an important critique of Weber's theory of bureaucracy, which

  20. Primary thrombocytosis in children.

    PubMed

    Kucine, Nicole; Chastain, Katherine M; Mahler, Michelle B; Bussel, James B

    2014-04-01

    Myeloproliferative neoplasms are uncommon disorders in children, for which we have limited understanding of the pathogenesis and optimal management. JAK2 and MPL mutations, while common drivers of myeloproliferative neoplasms in adult patients, are not clearly linked to pediatric disease. Management and clinical outcomes in adults have been well delineated with defined recommendations for risk stratification and treatment. This is not the case for pediatric patients, for whom there is neither a standard approach to workup nor any consensus regarding management. This review will discuss thrombocytosis in children, including causes of thrombocytosis in children, the limited knowledge we have regarding pediatric primary thrombocytosis, and our thoughts on potential risk stratification and management, and future questions to be answered by laboratory research and collaborative clinical study. PMID:24688110

  1. Primary thrombocytosis in children

    PubMed Central

    Kucine, Nicole; Chastain, Katherine M.; Mahler, Michelle B.; Bussel, James B.

    2014-01-01

    Myeloproliferative neoplasms are uncommon disorders in children, for which we have limited understanding of the pathogenesis and optimal management. JAK2 and MPL mutations, while common drivers of myeloproliferative neoplasms in adult patients, are not clearly linked to pediatric disease. Management and clinical outcomes in adults have been well delineated with defined recommendations for risk stratification and treatment. This is not the case for pediatric patients, for whom there is neither a standard approach to workup nor any consensus regarding management. This review will discuss thrombocytosis in children, including causes of thrombocytosis in children, the limited knowledge we have regarding pediatric primary thrombocytosis, and our thoughts on potential risk stratification and management, and future questions to be answered by laboratory research and collaborative clinical study. PMID:24688110

  2. Role of risk sharing and transaction costs in contract choice: Theory and evidence from groundwater contracts

    Microsoft Academic Search

    Rimjhim M. Aggarwal

    2007-01-01

    Empirical modeling of contract choice has been problematic because routine large-scale surveys do not contain sufficient information on matched partners and on contractual terms. This paper is based on a primary level survey of groundwater contracts in India. We discuss several different measures for riskiness and transaction costs and use them to test for alternative theories of contract choice. Although

  3. South Africa's Education Legislation, Quasi-Markets and "De Facto" School Choice. Research Article

    ERIC Educational Resources Information Center

    Woolman, Stuart; Fleisch, Brahm

    2006-01-01

    School choice is often identified with right-leaning, voucher-happy, market-oriented public school systems like those found in the United States. Thus the proposition that a social democratic state such as South Africa will offer many primary and secondary school learners far greater choice strikes many as counter-intuitive and implausible. The…

  4. Pilot Study of Implementation of an Internet-Based Depression Prevention Intervention (CATCH-IT) for Adolescents in 12 US Primary Care Practices: Clinical and Management/Organizational Behavioral Perspectives

    PubMed Central

    Eisen, Jeffrey C.; Marko-Holguin, Monika; Fogel, Joshua; Cardenas, Alonso; Bahn, My; Bradford, Nathan; Fagan, Blake; Wiedmann, Peggy

    2013-01-01

    Objective: To explore the implementation of CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral Humanistic and Interpersonal Training), an Internet-based depression intervention program in 12 primary care sites, occurring as part of a randomized clinical trial comparing 2 versions of the intervention (motivational interview + Internet program versus brief advice + Internet program) in 83 adolescents aged 14 to 21 years recruited from February 1, 2007, to November 31, 2007. Method: The CATCH-IT intervention model consists of primary care screening to assess risk, a primary care physician interview to encourage participation, and 14 online modules of Internet training to teach adolescents how to reduce behaviors that increase vulnerability to depressive disorders. Specifically, we evaluated this program from both a management/organizational behavioral perspective (provider attitudes and demonstrated competence) and a clinical outcomes perspective (depressed mood scores) using the RE-AIM model (Reach, Efficacy, Adoption, Implementation, and Maintenance of the intervention). Results: While results varied by clinic, overall, clinics demonstrated satisfactory reach, efficacy, adoption, implementation, and maintenance of the CATCH-IT depression prevention program. Measures of program implementation and management predicted clinical outcomes at practices in exploratory analyses. Conclusion: Multidisciplinary approaches may be essential to evaluating the impact of complex interventions to prevent depression in community settings. Primary care physicians and nurses can use Internet-based programs to create a feasible and cost-effective model for the prevention of mental disorders in adolescents in primary care settings. Trial Registration: ClinicalTrials.gov identifiers: NCT00152529 and NCT00145912 PMID:24800110

  5. Modelling Portfolio Choice in Transportation Research

    Microsoft Academic Search

    James B. Wiley; Harry J. P. Timmermans

    2009-01-01

    This paper argues that certain choice problems in transportation research can be best conceptualized as problems of portfolio choice. It discusses how portfolio choice problems can be studied using discrete choice experiments, stated choice (conjoint) methods. Issues in the construction in the design of experiments, model specification and estimation are discussed. A working example illustrates the basic approach. Finally, possible

  6. Web-based self-management with and without coaching for type 2 diabetes patients in primary care: design of a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs have the potential of supporting type 2 diabetes patients with managing their diabetes and reducing the workload for the care provider, where the addition of online coaching could improve patient motivation and reduce program attrition. This study aims to test the hypothesis that a web-based self-management program with coaching will prove more effective on improving patient self-management behavior and clinical outcome measures than a web-based self-management program without coaching. Methods The effects of a web-based self-management program with and without coaching will be tested with a nested randomized controlled trial within a healthcare group in the Netherlands. In one year 220 type 2 diabetes patients will be randomized into an intervention group (n?=?110) or a control group (n?=?110). The control group will receive only the online self-management program. The intervention group will receive the online self-management program and additional online coaching. Participants will be followed for one year, with follow-up measurements at 6 and 12 months. Discussion The intervention being tested is set to support type 2 diabetes patients with their diabetes self-management and is expected to have beneficial effects on self-care activities, well being and clinical outcomes. When proven effective this self-management support program could be offered to other health care groups and their type 2 diabetes patients in the Netherlands. Trial registration Nederlands Trial Register NTR4064 PMID:24238104

  7. PUBLIC FINANCE AND PUBLIC CHOICE

    Microsoft Academic Search

    James M. Poterba

    Abstract - This paper,explores the contribution,that public choice models can make,to the traditional efficiency and,distributional analyses of tax policy. It notes the relative lack of attention to political economy,issues in public finance, at least in comparison with other policy-oriented subfields in economics. It then discusses two,key insights that emerge,from,public choice models,of taxation. The first is the notion,that different tax systems

  8. Evoked Emotions Predict Food Choice

    PubMed Central

    Dalenberg, Jelle R.; Gutjar, Swetlana; ter Horst, Gert J.; de Graaf, Kees; Renken, Remco J.; Jager, Gerry

    2014-01-01

    In the current study we show that non-verbal food-evoked emotion scores significantly improve food choice prediction over merely liking scores. Previous research has shown that liking measures correlate with choice. However, liking is no strong predictor for food choice in real life environments. Therefore, the focus within recent studies shifted towards using emotion-profiling methods that successfully can discriminate between products that are equally liked. However, it is unclear how well scores from emotion-profiling methods predict actual food choice and/or consumption. To test this, we proposed to decompose emotion scores into valence and arousal scores using Principal Component Analysis (PCA) and apply Multinomial Logit Models (MLM) to estimate food choice using liking, valence, and arousal as possible predictors. For this analysis, we used an existing data set comprised of liking and food-evoked emotions scores from 123 participants, who rated 7 unlabeled breakfast drinks. Liking scores were measured using a 100-mm visual analogue scale, while food-evoked emotions were measured using 2 existing emotion-profiling methods: a verbal and a non-verbal method (EsSense Profile and PrEmo, respectively). After 7 days, participants were asked to choose 1 breakfast drink from the experiment to consume during breakfast in a simulated restaurant environment. Cross validation showed that we were able to correctly predict individualized food choice (1 out of 7 products) for over 50% of the participants. This number increased to nearly 80% when looking at the top 2 candidates. Model comparisons showed that evoked emotions better predict food choice than perceived liking alone. However, the strongest predictive strength was achieved by the combination of evoked emotions and liking. Furthermore we showed that non-verbal food-evoked emotion scores more accurately predict food choice than verbal food-evoked emotions scores. PMID:25521352

  9. Primary immunodeficiency diseases: a primer for PCPs.

    PubMed

    Younger, Elizabeth M; Epland, Kristin; Zampelli, Annette; Hintermeyer, Mary K

    2015-02-15

    Primary care providers (PCPs) play a key role in identifying patients with primary immunodeficiency diseases (PIDDs). This diagnosis has implications for PCPs, as patients continue to require primary care and management after a PIDD diagnosis has been made. This review presents essential information for PCPs regarding PIDDs. PMID:25594294

  10. [Primary familial erythromelalgia. A case report].

    PubMed

    Bouyahyaoui, Y; Meziane, M; Hanaae, Z; Mikou, O; Mernissi, F-Z; Baba Khouya, A; Otmani, S; Hida, M

    2013-04-01

    Erythromelalgia is a rare disease whose etiology is poorly understood. It is characterized by paroxysmal attacks of erythema, pain, and warmth of the extremities and can be primary or secondary. We report a case of primary familial erythromelalgia and stress the difficulties in its therapeutic management. We provide a brief update on the pathophysiology and treatment of primary erythromelalgia. PMID:23433844

  11. Why Continuous Improvement Is a Poor Substitute for School Choice

    ERIC Educational Resources Information Center

    Rose, David C.; Rochester, J. Martin

    2008-01-01

    Efforts to introduce school choice have produced pressures on public schools to improve their performance. As a result, many public schools have embraced the total quality management principle of continuous improvement. In this article we explain that while this may be well intentioned, it may have perverse unintended consequences. A likely…

  12. Harvard and Money; A Memorandum on Issues and Choices.

    ERIC Educational Resources Information Center

    Harvard Univ., Cambridge , MA. Univ. Committee on Governance.

    This report discusses some of the financial issues and choices with which Harvard University will have to cope in an environment of increased stringency: issues of money-allocation, money raising, and money management. Part I presents highlights of Harvard's recent financial history and its prospects in quantitative terms. Part II presents some…

  13. Part-time student labour: strategic choice or pragmatic response?

    Microsoft Academic Search

    Rosemary Lucas; Lisa Ralston

    1996-01-01

    Increasing proportions of students are working part-time in industries such as hospitality. To understand more about this phenomenon, 11 case studies of hospitality establishments employing a significant proportion of students were compiled by matching data provided by managers and students working in these establishments. Concludes that employers’ employment of student labour could be a combination of strategic choice and pragmatic

  14. Presidential Primaries

    NSDL National Science Digital Library

    The Washington Weekly (an Internet newspaper) offers a 1996 Presidential Primaries Page that is organized by candidate within each party. For most candidates there is biographical information, voting record, list of accomplishments or stands on key issues, and a connection to the candidate's home page when available. This is a non-graphical but well organized page that provides the user with quick access to voting records, speeches and press releases, and Web pages of the candidates.

  15. The effect of physical attractiveness comparison on choice of partners.

    PubMed

    Kowner, R

    1995-04-01

    The roles of several presumed factors in the choice of partners during a first group encounter were examined, when the only available information was a ranking of group members' physical attractiveness. After they had received bogus feedback about their own attractiveness rank in a newly formed group, 99 Japanese students were asked to choose a partner for a task. The results indicated that feedback about one's own attractiveness was the primary factor that determined choice of others and that susceptibility to this type of feedback was characterized by a notable gender difference. These findings suggest that when the only information available about others concerns their physical appearance, the choice of partner or competitor, even for appearance-irrelevant tasks, is partially dependent on others' rankings of one's own physical attractiveness. PMID:7776639

  16. Optimal and Competitive Assortments with Endogenous Pricing Under Hierarchical Consumer Choice Models

    Microsoft Academic Search

    A. Gürhan Kök; Yi Xu

    2011-01-01

    This paper studies assortment planning and pricing for a product category with heterogeneous product types from two brands. We model consumer choice using the nested multinomial logit framework with two different hierarchical structures: a brand-primary model in which consumers choose a brand first, then a product type in the chosen brand, and a type-primary model in which consumers choose a

  17. PRIMARY PARTICLES GENERATED BY THE COMBUSTION OF HEAVY FUEL OIL AND COAL: REVIEW OF RESEARCH RESULTS FROM EPA'S NATIONAL RISK MANAGEMENT RESEARCH LABORATORY

    EPA Science Inventory

    Researchers at the U.S. Environmental Protection Agency's (EPA's) Office of Research and Development (ORD) have conducted a series of tests to characterize the size and composition of primary particulate matter (PM) generated from the combustion of heavy fuel oil and pulverize...

  18. Differential recruitment in a cluster randomized trial in primary care: the experience of the UK Back pain, Exercise, Active management and Manipulation (UK BEAM) feasibility study

    Microsoft Academic Search

    Amanda Farrin; Ian Russell; David Torgerson; Martin Underwood

    2005-01-01

    Background Cluster randomized trials, which randomize groups of patients rather than individuals, are commonly used to evaluate healthcare interventions such as training programmes targeted at health professionals. This article reports the dangers of randomizing entire primary care practices when participants cannot be identified before randomization, as shown by a UK national trial.Method The UK BEAM trial, a national cluster randomized

  19. Primary School Children and Self Harm: The Emotional Impact upon Education Professionals, and Their Understandings of Why Children Self Harm and How This Is Managed

    ERIC Educational Resources Information Center

    Simm, Rebecca; Roen, Katrina; Daiches, Anna

    2010-01-01

    There is evidence suggesting that self harm among young people is beginning earlier, in childhood and adolescent years. This paper reports on a qualitative study of primary school staff responses to self harm among children. Some studies with adolescents show self harm presents challenges to education professionals who may lack training or…

  20. Tuition Fees in Primary and Secondary Education in Lesotho: The Levels and Implications for Access, Equity, and Efficiency. Financial Management of Education Systems.

    ERIC Educational Resources Information Center

    Lerotholi, Liteboho Maqalika

    This publication addresses tuition and other fees practiced in education as a means of cost sharing in Lesotho (a small, underdeveloped African nation). The case of Lesotho is an extreme example of household and community financing of education, both at the primary and secondary level, with parents paying for the bulk of their children's…

  1. 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

    PubMed Central

    Innes, Nicola P; Evans, Dafydd JP; Stirrups, David R

    2007-01-01

    Background Scotland has high levels of untreated dental caries in primary teeth. The Hall Technique is a simplified method of managing carious primary molars using preformed metal crowns (PMCs) cemented with no local anaesthesia, caries removal or tooth preparation. This study compared the acceptability of the Hall Technique for children, their carers, and dentists, and clinical outcomes for the technique, with conventional restorations. Methods General dental practice based, split mouth, randomized controlled trial (132 children, aged 3–10). General dental practitioners (GDPs, n = 17) in Tayside, Scotland (dmft 2.7) placed conventional (Control) restorations in carious primary molars, and Hall Technique PMCs on the contralateral molar (matched clinically and radiographically). Dentists ranked the degree of discomfort they felt the child experienced for each procedure; then children, their carers and dentists stated which technique they preferred. The teeth were followed up clinically and radiographically. Results 128 conventional restorations were placed on 132 control teeth, and 128 PMCs on 132 intervention teeth. Using a 5 point scale, 118 Hall PMCs (89%) were rated as no apparent discomfort up to mild, not significant; for Control restorations the figure was 103 (78%). Significant, unacceptable discomfort was recorded for two Hall PMCs (1.5%) and six Control restorations (4.5%). 77% of children, 83% of carers and 81% of dentists who expressed a preference, preferred the Hall technique, and this was significant (Chi square, p < 0.0001). There were 124 children (94% of the initial sample) with a minimum follow-up of 23 months. The Hall PMCs outperformed the Control restorations: a) 'Major' failures (signs and symptoms of irreversible pulpal disease): 19 Control restorations (15%); three Hall PMCs (2%) (P < 0.000); b) 'Minor' failures (loss of restoration, caries progression): 57 Control restorations (46%); six Hall PMCs (5%) (P < 0.000) c) Pain: 13 Control restorations (11%); two Hall PMCs (2%) (P = 0.003). Conclusion The Hall Technique was preferred to conventional restorations by the majority of children, carers and GDPs. After two years, Hall PMCs showed more favourable outcomes for pulpal health and restoration longevity than conventional restorations. The Hall Technique appears to offer an effective treatment option for carious primary molar teeth. Trial registration number Current Controlled Trials ISRCTN47267892 – A randomized controlled trial in primary care of a novel method of using preformed metal crowns to manage decay in primary molar teeth: the Hall technique. PMID:18096042

  2. Leadership Practice in the Context of U.S. School Choice Reform

    ERIC Educational Resources Information Center

    Cravens, Xiu Chen; Goldring, Ellen; Penaloza, Roberto

    2012-01-01

    Choice schools provide a unique laboratory where variation in governance and management structure is predicted. We examine the results from principal surveys from traditional and choice public schools, and compare challenges faced by principals and their leadership practice. Analyses show that while differences across school types are small, there…

  3. Dynamic Assortment Optimization with a Multinomial Logit Choice Model and Capacity Constraint

    E-print Network

    Rusmevichientong, Paat

    in retail, online advertising, and revenue management. For instance, given a limited shelf capacityDynamic Assortment Optimization with a Multinomial Logit Choice Model and Capacity Constraint Paat by a multinomial logit choice model. We consider both the static and dynamic optimization problems. In the static

  4. Primary myxoid chondrosarcoma of the breast.

    PubMed

    Farahat, A; Magdy, N; Elaffandi, A

    2014-01-01

    Primary breast chondrosarcoma has been rarely reported in the literature. Conservative breast surgery has never been part of the management of previously reported cases. Surgery remains the mainstay management of such a disease as it is resistant to chemotherapy and radiotherapy. In this report, we present a case of rare primary myxoid chondrosarcoma of the breast that was managed successfully with a conservative approach. PMID:24417859

  5. Community Choice Community Choice Aggregation (CCA) enables California cities

    E-print Network

    electricity in 1997, many Californians switched to buy "green"energy. After the energy crisis of 2000 is Community Choice Aggregation? Local control over retail electric rates is another important motivation resources and public benefit programs will be made locally and be accountable to local customers

  6. PRIMARY CARE ASSOCIATE PROGRAM PRIMARY PRECEPTOR MANUAL

    E-print Network

    Puglisi, Joseph

    PRIMARY CARE ASSOCIATE PROGRAM 2011-2013 PRIMARY PRECEPTOR MANUAL http://pcap.stanford.edu 1215 or Supplemental Preceptor PRIMARY PRECEPTOR/PRIMARY CARE ASSOCIATE PROGRAM RELATIONSHIP PRECEPTOR REQUIREMENTS: Thank you for your interest in precepting a student in the Primary Care Associate Program. Your services

  7. The choices to be made.

    PubMed

    Adler-Karlsson, G

    1987-01-01

    If we are to avoid unemployment when technology increases productivity, we have two choices. We must increase our level of material living (more private luxury gadgets or more public luxury services) and/or decrease our total working time. These choices reflect social power relations. Capital owners and leaders of labour unions normally endorse the standard increase solution. The unemployed are for the reduction in hours, hoping to get a share of the labour time. Studies reported here indicate that a solid majority of ordinary men and women also seem to prefer the reduction in working time solution. PMID:3660002

  8. iStart smart: a primary-care based and community partnered childhood obesity management program for Chinese-American children: feasibility study.

    PubMed

    Chen, Jyu-Lin; Kwan, Monica; Mac, Allison; Chin, Nai-Ching; Liu, Katrina

    2013-12-01

    Children who are ethnic minorities, low income and live in urban neighborhoods are at higher risk for obesity. This study examined the feasibility and efficacy of a primary care-based and community partnered obesity intervention in Chinese American children. An experimental design with a historical comparison group was used to explore the feasibility of an obesity intervention for overweight Chinese American children, ages 7-12. Data were collected on weight, height, blood pressure, waist circumference, physical activity, food intake, knowledge, and self-efficacy about diet and physical activity at baseline, 2 months, and 6 months post-baseline. Significant improvements in BMI, blood pressure, and nutrition knowledge and self-efficacy were found in the intervention group. Intervention group reduced their BMI compared to the comparison group (F = 8.65, p = .004). An obesity intervention in primary care setting is feasible and demonstrates a short-term effect on weight loss in Chinese American children. PMID:23595264

  9. Management of Febrile Neutropenia – a German Prospective Hospital Cost Analysis in Lymphoproliferative Disorders, Non-Small Cell Lung Cancer, and Primary Breast Cancer

    Microsoft Academic Search

    Angela Ihbe-Heffinger; Bernadette J. Paessens; Christoph von Schilling; Margarita Shlaen; Nina Gottschalk; Karin Berger; Rudolf Bernard; Marion Kiechle; Christian Peschel; Volker R. Jacobs

    2011-01-01

    SummaryBackground: Febrile neutropenia\\/leukopenia (FN\\/FL) is the most frequent dose-limiting toxicity of myelosuppressive chemotherapy, but German data on economic consequences are limited. Patients and Methods: A prospective, multicentre, longitudinal, observational study was carried out to evaluate the occurrence of FN\\/FL and its impact on health resource utilization and costs in non-small cell lung cancer (NSCLC), lymphoproliferative disorder (LPD), and primary breast

  10. Radiation Therapy in the Management of Head-and-Neck Cancer of Unknown Primary Origin: How Does the Addition of Concurrent Chemotherapy Affect the Therapeutic Ratio?

    SciTech Connect

    Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.edu [Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA (United States); Farwell, D. Gregory [Department of Otolaryngology-Head and Neck Surgery, University of California Davis School of Medicine, Sacramento, CA (United States); Lau, Derick H. [Department of Medical Oncology, University of California Davis School of Medicine, Sacramento, CA (United States); Li Baoqing [Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA (United States); Luu, Quang; Donald, Paul J. [Department of Otolaryngology-Head and Neck Surgery, University of California Davis School of Medicine, Sacramento, CA (United States)

    2011-10-01

    Purpose: To determine how the addition of cisplatin-based concurrent chemotherapy to radiation therapy influences outcomes among a cohort of patients treated for head-and-neck cancer of unknown primary origin. Methods and Materials: The medical records of 60 consecutive patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Thirty-two patients (53%) were treated by concurrent chemoradiation, and 28 patients (47%) were treated by radiation therapy alone. Forty-five patients (75%) received radiation therapy after surgical resection, and 15 patients (25%) received primary radiation therapy. Thirty-five patients (58%) were treated by intensity-modulated radiotherapy. Results: The 2-year estimates of overall survival, local-regional control, and progression-free survival were 89%, 89%, and 79%, respectively, among patients treated by chemoradiation, compared to 90%, 92%, and 83%, respectively, among patients treated by radiation therapy alone (p > 0.05, for all). Exploratory analysis failed to identify any subset of patients who benefited from the addition of concurrent chemotherapy to radiation therapy. The use of concurrent chemotherapy was associated with a significantly increased incidence of Grade 3+ acute and late toxicity (p < 0.001, for both). Conclusions: Concurrent chemoradiation is associated with significant toxicity without a clear advantage to overall survival, local-regional control, and progression-free survival in the treatment of head-and-neck cancer of unknown primary origin. Although selection bias cannot be ignored, prospective data are needed to further address this question.

  11. A Pilot Trial of a Stress Management Intervention for Primary Caregivers of Children Newly Diagnosed With Cancer: Preliminary Evidence That Perceived Social Support Moderates the Psychosocial Benefit of Intervention

    PubMed Central

    Long, Kristin A.; Howe, Chelsea; Thompson, Amanda L.; Tersak, Jean; Ewing, Linda J.

    2013-01-01

    Objectives?(1) To examine the acceptability and feasibility of a stress management intervention for caregivers of children recently diagnosed with cancer. (2) To explore whether caregivers with lower baseline perceived social support derive greater benefit from the intervention than those with higher perceived support.?Methods?45 primary caregivers were randomly assigned to intervention or standard care. Of these, 37 completed measures of social support, depression, anxiety, and perceived stress at both pre-intervention (T1; mean = 24 days post-diagnosis) and post-intervention time points (T2; mean = 165 days post-diagnosis).?Results?Enrollment, retention, and satisfaction data support feasibility and acceptability of the intervention. There was no overall significant impact of participation in the intervention on levels of distress at T2. However, T1 social support moderated intervention response, with caregivers who perceived lower T1 support showing greater psychological benefit from the intervention.?Conclusions?Primary caregivers with lower levels of perceived social support may benefit from preemptive stress management intervention. PMID:23341547

  12. Private Citizenship and School Choice.

    ERIC Educational Resources Information Center

    Johanek, Michael

    1992-01-01

    The current school choice debate reflects inevitable tensions between private and public education goals. Dramatic social geographic shifts since World War II may have changed the meaning of "private" and "public" so that a new public-private arrangement has evolved. This article discusses the origin of "private citizenship," identifies its key…

  13. Fuel type based vehicles choice

    Microsoft Academic Search

    Matteo Russo

    2011-01-01

    The aim of the paper is to analyse the researches performed so far on vehicle choice according to the fuel type. There are different reasons to be interested in this theme. Among the most relevant we recall the following: a. increasing costs of conventional fuel; b. development of new fuel types; c. different fuel efficiency; d. higher productivity standards, due

  14. Axon guidance at choice points

    Microsoft Academic Search

    Esther T Stoeckli; Lynn T Landmesser

    1998-01-01

    The common theme in many recent axonal pathfinding studies, both in vertebrates and invertebrates, is the demonstration of the importance of a balance between positive and negative cues. The integration of multiple and often opposing molecular interactions at each site along the axon's trajectory, especially at choice points, helps to fine tune the directional response of its growth cone, which

  15. Students' Choices and Moral Growth

    ERIC Educational Resources Information Center

    Goodman, Joan F.

    2006-01-01

    Can schools encourage children to become independent moral decision-makers, maintaining controlled environments suitable to instructing large numbers of children? Two opposing responses are reviewed: one holds that the road to morality is through discipline and obedience, the other through children's experimentation and choice-making.…

  16. Fresh Perspectives on School Choice

    ERIC Educational Resources Information Center

    Ferrero, David J.

    2004-01-01

    School choice advocacy is dominated by perspectives that reflect a tendency to regard public schooling as a private service commodity. In recent years, numerous works of Anglo-American political philosophy, sociology and legal theory have attempted to restore a conception of public schooling as an institution that cultivates civic virtue.…

  17. Improving Multiple-Choice Questions

    ERIC Educational Resources Information Center

    Torres, Cristina; Lopes, Ana Paula; Babo, Lurdes; Azevedo, Jose

    2011-01-01

    A MC (multiple-choice) question can be defined as a question in which students are asked to select one alternative from a given set of alternatives in response to a question stem. The objective of this paper is to analyse if MC questions may be considered as an interesting alternative for assessing knowledge, particularly in the mathematics area,…

  18. "America's Choice" Taps Profit Motive

    ERIC Educational Resources Information Center

    Trotter, Andrew

    2004-01-01

    In this article, the author features the America's Choice School Design, a school improvement program that has enlisted 547 schools in 16 states in its brand of comprehensive reform, and describes the program's move to loosen its nonprofit moorings and change to a for-profit company. The purpose of the move to for-profit status is to raise capital…

  19. Career Choices for Chemical Engineers

    NSDL National Science Digital Library

    1997-01-01

    The American Institute of Chemical Engineers has recently added a new feature, Career Choices for Chemical Engineers, to their Website. The AIChE Career Services sections provide a listing of job openings in academia and industry under the Employers section. In addition, this page includes sections that publish information on job searches, salary surveys, and career fairs.

  20. Self-Determination and Choice

    ERIC Educational Resources Information Center

    Wehmeyer, Michael L.; Abery, Brian H.

    2013-01-01

    Promoting self-determination and choice opportunities for people with intellectual and developmental disabilities has become best practice in the field. This article reviews the research and development activities conducted by the authors over the past several decades and provides a synthesis of the knowledge in the field pertaining to efforts to…

  1. Career Choices: Industry vs. Academia

    E-print Network

    Rohs, Remo

    Career Choices: Industry vs. Academia Yan Liu Assistant Professor Computer Science Department industry, and where can one make the most impact? · Best virtues in all jobs ­ Hardworking ­ Good attitude many students ­ Industry: you are on board of a big ship that makes a lot of impact #12;3) What compels

  2. Machining strategy choice: performance VIEWER

    Microsoft Academic Search

    Laurent Tapie; Kwamivi Bernardin Mawussi; Bernard Anselmetti

    2009-01-01

    Nowadays high speed machining (HSM) machine tool combines productivity and part quality. So mould and die maker invested in HSM. Die and mould features are more and more complex shaped. Thus, it is difficult to choose the best machining strategy according to part shape. Geometrical analysis of machining features is not sufficient to make an optimal choice. Some research show

  3. Childfree by choice: a review

    Microsoft Academic Search

    Christian Agrillo; Cristian Nelini

    2008-01-01

    The decision not to have children represents one of the most remarkable changes in the modern family: during the last few decades the number of couples who voluntarily do not want to become parents (usually called ‘childfree’) has drastically increased around the world, becoming an important issue for cultural geography. The present paper presents a review of the childfree choice

  4. Primary myelolipoma in posterior mediastinum

    PubMed Central

    Xiong, Yan; Wang, Yong

    2014-01-01

    Myelolipoma in posterior mediastinum is indeed rare. As a benign tumor, it consists of mature fat with scattered foci of haematopoietic elements resembling bone marrow. The computed tomography (CT) and magnetic resonance imaging (MRI) are effective methods to detect them, while the definite diagnosis still depends on pathological diagnosis. Up to now, there is no standard treatment for this disease. Surgery is thought to be the best choice in some literatures reports. In this paper, two patients with primary posterior mediastinal tumor are reported, both of whom were underwent Video-assisted thoracoscopic surgery (VATS). Postoperative pathological diagnosis was myelolipoma. PMID:25276393

  5. A Comparative Analysis of SMTs (School Management Teams) and Teachers Perceived Preferred Leadership Style: A Case of Selected Primary Schools in Botswana

    ERIC Educational Resources Information Center

    Tsayang, Gabatshwane

    2011-01-01

    The study compared the SMTs (School Management Teams) and teachers' perceptions of preferred leadership styles in some selected schools in Botswana. SMTs and teachers completed a questionnaire adopted from the leadership styles questionnaires. The findings of the study pointed to an overwhelming view that the preferred style of leadership is the…

  6. Some Possible Effects of Behaviour Management Training on Teacher Confidence and Competence: Evidence from a Study of Primary School Teachers in Hong Kong

    ERIC Educational Resources Information Center

    Cooper, Paul; Yan, Zi

    2015-01-01

    This study aims to explore the relationships between the extent and perceived quality of teachers' experience of training in behaviour management (BM), and their awareness of the nature and extent of behavioural problems among school students, and their confidence in their own competence to deal with such problems. Teachers (n = 183) from…

  7. Randomized Trial of Problem-Based versus Didactic Seminars for Disseminating Evidence-Based Guidelines on Asthma Management to Primary Care Physicians

    ERIC Educational Resources Information Center

    White, Marc; Michaud, Gaetane; Pachev, George; Lirenman, David; Kolenc, Anna; FitzGerald, J. Mark

    2004-01-01

    Introduction: This randomized controlled trial (RCT) investigated the effectiveness of and satisfaction with small-group problem-based learning (PBL) versus a didactic lecture approach to guideline dissemination in asthma management controlling for confounders common in comparative educational interventions. Methods: Sites were selected as either…

  8. Evaluation of Effectiveness and Cost?Effectiveness of a Clinical Decision Support System in Managing Hypertension in Resource Constrained Primary Health Care Settings: Results From a Cluster Randomized Trial

    PubMed Central

    Anchala, Raghupathy; Kaptoge, Stephen; Pant, Hira; Di Angelantonio, Emanuele; Franco, Oscar H.; Prabhakaran, D.

    2015-01-01

    Background Randomized control trials from the developed world report that clinical decision support systems (DSS) could provide an effective means to improve the management of hypertension (HTN). However, evidence from developing countries in this regard is rather limited, and there is a need to assess the impact of a clinical DSS on managing HTN in primary health care center (PHC) settings. Methods and Results We performed a cluster randomized trial to test the effectiveness and cost?effectiveness of a clinical DSS among Indian adult hypertensive patients (between 35 and 64 years of age), wherein 16 PHC clusters from a district of Telangana state, India, were randomized to receive either a DSS or a chart?based support (CBS) system. Each intervention arm had 8 PHC clusters, with a mean of 102 hypertensive patients per cluster (n=845 in DSS and 783 in CBS groups). Mean change in systolic blood pressure (SBP) from baseline to 12 months was the primary endpoint. The mean difference in SBP change from baseline between the DSS and CBS at the 12th month of follow?up, adjusted for age, sex, height, waist, body mass index, alcohol consumption, vegetable intake, pickle intake, and baseline differences in blood pressure, was ?6.59 mm Hg (95% confidence interval: ?12.18 to ?1.42; P=0.021). The cost?effective ratio for CBS and DSS groups was $96.01 and $36.57 per mm of SBP reduction, respectively. Conclusion Clinical DSS are effective and cost?effective in the management of HTN in resource?constrained PHC settings. Clinical Trial Registration URL: http://www.ctri.nic.in. Unique identifier: CTRI/2012/03/002476. PMID:25559011

  9. Food choice by people with intellectual disabilities at day centres: A qualitative study.

    PubMed

    Cartwright, Luke; Reid, Marie; Hammersley, Richard; Blackburn, Chrissie; Glover, Lesley

    2015-06-01

    People with intellectual disabilities experience a range of health inequalities. It is important to investigate possible contributory factors that may lead to these inequalities. This qualitative study identified some difficulties for healthy eating in day centres. (1) Service users and their family carers were aware of healthy food choices but framed these as diets for weight loss rather than as everyday eating. (2) Paid carers and managers regarded the principle of service user autonomy and choice as paramount, which meant that they felt limited in their capacity to influence food choices, which they attributed to the home environment. (3) Carers used food as a treat, a reward and for social bonding with service users. (4) Service users' food choices modelled other service users' and carers' choices at the time. It is suggested that healthy eating should be made more of a priority in day care, with a view to promoting exemplarily behaviour that might influence food choice at home. PMID:25524597

  10. Choices 

    E-print Network

    Feyrer, G.

    1986-01-01

    wholikesextremes?sometimes even false intensity seems better than tameness. But I get sick of the charade. Sometimes, all I really want is an old friend. I gethungry for someone whoknows me...someone I can share myself with...without all the games." The Vulcan..., andclasped Jim's handagain. The current arced betweenthem, electric, pulsating. Spock felt the vibration shiver through his body, felt his cock stir between his legs. He knew, without Xd ?** 6t < < doubt, that Kirk was aroused too, wanting him...

  11. An Integrated Choice Model Incorporating Alternative Mechanisms for Consumers' Reactions to In-Store Display and Feature Advertising

    Microsoft Academic Search

    Jie Zhang

    2006-01-01

    The marketing literature has suggested two prominent decision mechanisms through which in-store display and feature advertising can affect brand choice, which I call and . The primary objective of this study is to propose an integrated brand choice model that incorporates these two possible behavioral mechanisms, which have been shown to work by previous research. The model allows consumers to

  12. The Influence of Prior Choices on Current Choice

    PubMed Central

    de la Piedad, Xochitl; Field, Douglas; Rachlin, Howard

    2006-01-01

    Three pigeons chose between random-interval (RI) and tandem, continuous-reinforcement, fixed-interval (crf-FI) reinforcement schedules by pecking either of two keys. As long as a pigeon pecked on the RI key, both keys remained available. If a pigeon pecked on the crf-FI key, then the RI key became unavailable and the crf-FI timer began to time out. With this procedure, once the RI key was initially pecked, the prospective value of both alternatives remained constant regardless of time spent pecking on the RI key without reinforcement (RI waiting time). Despite this constancy, the rate at which pigeons switched from the RI to the crf-FI decreased sharply as RI waiting time increased. That is, prior choices influenced current choice—an exercise effect. It is argued that such influence (independent of reinforcement contingencies) may serve as a sunk-cost commitment device in self-control situations. In a second experiment, extinction was programmed if RI waiting time exceeded a certain value. Rate of switching to the crf-FI first decreased and then increased as the extinction point approached, showing sensitivity to both prior choices and reinforcement contingencies. In a third experiment, crf-FI availability was limited to a brief window during the RI waiting time. When constrained in this way, switching occurred at a high rate regardless of when, during the RI waiting time, the crf-FI became available. PMID:16602373

  13. A Web-Based Clinical Decision Support Tool for Primary Health Care Management of Back Pain: Development and Mixed Methods Evaluation

    PubMed Central

    Williams, Christopher; Holbrook, Rachel; Lindner, Robyn; Reeve, James; Das, Anurina; Maher, Christopher

    2014-01-01

    Background Many patients with back pain do not receive health care in accordance with best practice recommendations. Implementation trials to address this issue have had limited success. Despite the known effectiveness of clinical decision support systems (CDSS), none of these are available for back pain management. Objective The objective of our study was to develop a Web-based CDSS to support Australian general practitioners (GPs) to diagnose and manage back pain according to guidelines. Methods Asking a panel of international experts to review recommendations for sixteen clinical vignettes validated the tool. It was then launched nationally as part of National Pain Week and promoted to GPs via a media release and clinic based visits. Following this, a mixed methods evaluation was conducted to determine tool feasibility, acceptability, and utility. The 12 month usage data were analyzed, and in-depth, semistructured interviews with 20 GPs were conducted to identify barriers and enablers to uptake. Results The tool had acceptable face validity when reviewed by experts. Over a 12 month period there were 7125 website visits with 4503 (63.20%) unique users. Assuming most unique users are GPs, around one quarter of the country’s GPs may have used the tool at least once. Although usage was high, GP interviews highlighted the sometimes complex nature of management where the tool may not influence care. Conversely, several “touch-points”, whereby the tool may exert its influence, were identified, most notably patient engagement. Conclusions A novel CDSS tool has the potential to assist with evidence-based management of back pain. A clinical trial is required to determine its impact on practitioner and patient outcomes. PMID:24694921

  14. A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

    Microsoft Academic Search

    Paul R Chelminski; Timothy J Ives; Katherine M Felix; Steven D Prakken; Thomas M Miller; J Stephen Perhac; Robert M Malone; Mary E Bryant; Darren A DeWalt; Michael P Pignone

    2005-01-01

    BACKGROUND: Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. METHODS: Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists,

  15. Housing choices and care home design for people with dementia.

    PubMed

    Hadjri, Karim; Rooney, Cliona; Faith, Verity

    2015-01-01

    This article reviews the current state of housing for people with dementia by exploring housing choices available to this group, and identifying potential issues with design of care homes. Older people who wish to age in place are faced with the challenge of adapting their domestic environment to ensure independence, accessibility, and social connectivity. This is even more challenging for people with dementia who continue to live at home, given the risks of self-harm and getting lost. More imaginative and inclusive forms of collective housing are needed. For people with dementia, a move to a new environment is often a stressful experience that causes shock, withdrawal, and anger. Hence, more research is needed to develop more fitting long-term housing options for people with dementia. This article presents a brief review on housing choices and housing design for people with dementia. Interviews with managers of 22 care homes were conducted to explore housing choices and design issues. Results show that the main housing choices available to people with dementia offer different levels of care. The choice of care homes relates to the atmosphere of a home as some occupants favor a homely or relaxing environment and others prefer dynamic settings. A combination of appropriate level of care, a good atmosphere, and design quality within the care home are elements that lead to a more enabling environment. Design of a successful caring environment also requires appropriate care and a positive therapeutic and domestic-looking environment. PMID:25929473

  16. Crossing The Divide: Primary Care And Mental Health Integration

    Microsoft Academic Search

    Carole C. Upshur

    2005-01-01

    This paper describes the views of primary care providers about treating depression among adult Medicaid patients and their experiences with managed behavioral health care. It also shows the outcomes of an intervention project that provides a care manager to facilitate connections among PCPs, patients, and behavioral health providers. Despite widespread initiatives to improve depression management in primary care and to

  17. Child Care Choices in Spain

    Microsoft Academic Search

    Cristina Borra; Luis Palma

    2009-01-01

    In this paper we examined the determinants of child care choices among families with young children in Spain, by means of\\u000a a conceptual framework that encompassed need, costs, and availability. Based on data from the Spanish Time Use Survey and\\u000a Household Budget Survey, our study indicated that, regardless of model specification, the age of the child, the mother’s labor\\u000a force

  18. Destruction As a Constructive Choice

    Microsoft Academic Search

    David A. Winter

    This chapter presents a personal construct theory view of serial killing and other acts of homicide and extreme violence.\\u000a Such acts may be considered, as any others, a reflection of the individual’s attempts to anticipate his or her world and are\\u000a therefore, from the perpetrator’s perspective, constructive choices. A personal construct theory taxonomy of these acts is\\u000a illustrated by the

  19. Geriatric Depression in Primary Care

    PubMed Central

    Park, Mijung; Unützer, Jürgen

    2011-01-01

    Primary care settings present important opportunities for the detection and management of depression in older adults. As many as 10 % of older adults presenting in primary care have clinically significant depression, but only about half are recognized and only one in five depressed older adults receive effective treatment in primary care. We review common barriers to effective treatment such as atypical clinical presentations and comorbid medical conditions that are common in older adults. We identify treatment strategies such as measurement-based stepped care and collaborative care that can substantially improve the effectiveness of treatment in this setting and we highlight opportunities for addressing health disparities in geriatric depression care. We also point out the importance of engaging and supporting family caregivers of depressed older adults. We conclude by identifying three strategic areas to improve the treatment of geriatric depression in primary care: activation and engagement of patients and family members, health care provider training, and broader system changes. PMID:21536169

  20. Sonography of the pelvis in patients with primary amenorrhea.

    PubMed

    Rosenberg, Henrietta Kotlus

    2009-12-01

    Duplex/color Doppler sonography (US) is the imaging modality of choice for the evaluation of patients with primary amenorrhea. Careful correlation with clinical history, physical examination and laboratory findings significantly narrows the diagnostic possibilities thus allowing for a more precise diagnosis. This article discusses the wide gamut of etiologies of primary amenorrhea, the US appearance of pathologic processes that result in primary amenorrhea, and helps the reader understand when additional higher tech imaging is indicated. PMID:19944290