Science.gov

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. Nonparametric choice modeling : applications to operations management

    E-print Network

    Jagabathula, Srikanth

    2011-01-01

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

  3. Software Engineering Management: strategic choices in a new decade

    E-print Network

    Finkelstein, Anthony

    Software Engineering Management: strategic choices in a new decade Barbara Farbey & Anthony.farbey|a.finkelstein}@ucl.ac.uk 1. ABSTRACT This paper discusses the strategic choices faced by software engineering managers and organisational advances in software engineering and in its application. For the software engineering manager

  4. Knowledge Management Technology: Making Good Choices.

    ERIC Educational Resources Information Center

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

    2001-01-01

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

  5. Factors Influencing Career Choice of Management Students in India

    ERIC Educational Resources Information Center

    Agarwala, Tanuja

    2008-01-01

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

  6. The Surprising Influence of Delayed Primary Reinforcement on Choice

    ERIC Educational Resources Information Center

    McDevitt, Margaret A.

    2007-01-01

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

  7. Friendship Choice in a Mixed-Race Primary School.

    ERIC Educational Resources Information Center

    Braha, Vania; Rutter, D. R.

    1980-01-01

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

  8. 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

  9. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 2010-10-01 false Primary care case management services. 440.168 Section 440...Definitions § 440.168 Primary care case management services. (a) Primary care case management services means case management related...

  10. Medical students' attitudes toward underserved populations: changing associations with choice of primary care versus non-primary care residency.

    PubMed

    Wayne, Sharon; Timm, Craig; Serna, Lisa; Solan, Brian; Kalishman, Summers

    2010-05-01

    The number of medical students entering primary care residencies continues to decrease. The association between student attitudes toward underserved populations and residency choice has received little attention even though primary care physicians see a larger proportion of underserved patients than most other specialists. We evaluated attitudes toward underserved populations in 826 medical students using a standardized survey, and used logistic regression to assess the effect of attitudes, along with other variables, on selection of a primary care residency. We compared results between two groups defined by year of entry to medical school (1993-99 and 2000-05) to determine whether associations differed by time period. Students' attitudes regarding professional responsibility toward underserved populations remained high over the study period; however, there was a statistically. significant association between positive attitudes and primary care residency in the early cohort only. This association was not found in the more recent group. PMID:20453348

  11. Choices 

    E-print Network

    Feyrer, G.

    1986-01-01

    Mate choice behavior underlies many significant phenomena in biology including sexual conflict, selection, hybridization and speciation. Members of the genus Xiphophorus provide an excellent model for studying these processes because swordtail fish...

  12. Managing coastal area resources by stated choice experiments

    NASA Astrophysics Data System (ADS)

    Liu, Xin; Wirtz, Kai W.

    2010-02-01

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

  13. Primary care management of celiac disease.

    PubMed

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

    2015-02-15

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

  14. Managing injuries to the primary dentition.

    PubMed

    McTigue, Dennis J

    2009-10-01

    This article overviews the diagnosis and management of traumatic injuries to primary teeth. The child's age, ability to cooperate for treatment, and the potential for collateral damage to developing permanent teeth can complicate the management of these injuries. The etiology of these injuries is reviewed including the disturbing role of child abuse. Serious medical complications including head injury, cervical spine injury, and tetanus are discussed. Diagnostic methods and the rationale for treatment of luxation injuries, crown, and crown/root fractures are included. Treatment priorities should include adequate pain control, safe management of the child's behavior, and protection of the developing permanent teeth. PMID:19958902

  15. Choice of biodiversity index drives optimal fire management decisions.

    PubMed

    Giljohann, K M; McCarthy, M A; Kelly, L T; Regan, T J

    2015-01-01

    Preservation of biodiversity is a central goal of conservation management, yet the conditions that promote persistence may differ for the species in the community. For systems subject to stochastic disturbances such as fire, understanding which management practices promote persistence for all species in a community is complex. Before deciding on the best course of action, an objective must be specified. Yet an overarching goal of species persistence can be specified into a measureable objective many different ways. We investigated four alternative management objectives for maximizing species persistence that use common biodiversity indices: (1) attaining the minimally acceptable mix of successional vegetation states to support species' relative abundances, (2) maximizing the arithmetic mean abundance of species, (3) maximizing the geometric mean abundance of species, and (4) minimizing the average extinction risk of species. We used stochastic dynamic programming to model successional changes in vegetation in the presence of both planned and unplanned fires, and utilize an extensive data set on the occurrence of birds, reptiles, and small mammals in different successional states in semiarid Australia. We investigated the influence the choice of objective function and taxonomic focus has on the optimal fire management recommendations. We also evaluated a recent hazard reduction policy to annually burn a fixed amount of the landscape and compare results to the optimal solution. The optimal management strategy to maximize species persistence over a 100-year period is predominantly to minimize wildfires. This is because the majority of species are more likely to occur in intermediate, and late successional vegetation. However the optimal solution showed sensitivity to the objective and the species included in the analysis. These results highlight the need for careful consideration when specifying an objective to represent overarching conservation goals. Using the extinction risk objective, we show that a policy to annually burn 5% of the landscape could increase the average probability of extinction for the modelled species by 7% over the next 100 years compared to the optimal management scenario. PMID:26255372

  16. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... care case management services. (a) Primary care case management services means case management...

  17. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... care case management services. (a) Primary care case management services means case management...

  18. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... care case management services. (a) Primary care case management services means case management...

  19. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... care case management services. (a) Primary care case management services means case management...

  20. Radiotherapeutic management of primary thyroid lymphoma

    SciTech Connect

    Blair, T.J.; Evans, R.G.; Buskirk, S.J.; Banks, P.M.; Earle, J.D.

    1985-02-01

    The purpose of this study was to evaluate the radiotherapeutic management of 38 patients, with malignant lymphoma of the thyroid, seen at the Mayo Clinic between 1965 and 1979. There were 8 males and 30 females with ages ranging from 34 to 90 years. A tissue diagnosis was made in all patients and tissue was available for reclassification under the Working Formulation in 31 of the 38 patients. Twenty-six patients had intermediate grade histology, four low grade and one indeterminate. All patients were treated with approximately 4000 rad megavoltage irradiation (range 2400-6000 rad) to the neck only (10 patients) or neck and mediastinum (28 patients). Twenty patients received subdiaphragmatic radiotherapy and four patients received adjuvant chemotherapy. Patients receiving radiation treatment to the neck and mediastinum and those with no gross residual disease at the initation of radiotherapy were less likely to develop a recurrence. Patients receiving a planned break during the course of therapy did not have reduced overall disease-free survival. Only 1 of 4 patients (25%) receiving adjuvant chemotherapy survived one year. Side effects of radiotherapy were minimal. The authors believe the radiotherapeutic management of clinical Stage IE and IIE primary thyroid lymphoma should include treatment of the neck, axillae and mediastinum to a dose of approximately 4000 rad using a continuous course technique. Additionally, gross total removal of the disease surgically may be beneficial.

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

    E-print Network

    Mastako, Kimberley Allen

    2005-02-17

    ......................................................................................83 Table 8.4 Men vs. Women, 1998 Annual Household Income ........................................84 Table 8.5 Men vs. Women, Household Structure ............................................................84 Table 8.6 Women vs. Men, Education... choice sets are established and each commuter is assumed to choose from one of the four sets. In this study, a sample of travelers from the State Route 91 (SR-91) value-priced corridor in Orange County, California, who participated in a telephone...

  2. 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…

  3. Perioperative management of primary liver cancer

    PubMed Central

    Yan, Lu-Nan; Chen, Xiao-Li; Li, Zhi-Hui; Li, Bo; Lu, Shi-Chun; Wen, Tian-Fu; Zeng, Yong; Yiao, Hui-Hua; Yang, Jia-Yin; Wang, Wen-Tao; Xu, Ming-Qing

    2007-01-01

    AIM: To minimize the complications and mortality and improve the survival in primary liver cancer (PLC) patients undergoing hepatic resection. METHODS: We conducted a retrospective analysis of 2143 PLC patients treated from January 1990 to January 2004. The patients were divided into two groups using January 1997 as a cut-off. Small tumor size (< 5 cm), preoperative redox tolerance index (RTI), vascular control method, and postoperative arterial ketone body ratio (AKBR) were used as indicators of surgical outcome. RESULTS: Small tumors had less complications and lower mortality and higher overall survival rate. Use of RTI for selecting patients and types of hepatectomy, reduced complications (21.1% vs 11.0%) and mortality (1.6% vs 0.3%). The half liver vascular occlusion protocol (n = 523) versus the Pringle method (n = 476) showed that the former significantly reduced the postoperative complications (25.8% vs 11.9%) and mortality (2.3% vs 0.6%) respectively, and cut mean hospital stay was 3.5 d. Postoperative AKBR was a reliable indicator of the energy status in survivors. CONCLUSION: RTI is of value in predicting hepatic functional reserve, half liver occlusion could protect the residual liver function, and AKBR measurement is a simple and accurate means of assessing the state of postoperative metabolism. Optimal perioperative management is an important factor for minimizing complications and mortality in patients undergoing hepatic resection. PMID:17461499

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

    E-print Network

    Laval, Université

    DST development to guide their management: (1) the upland red/roe deer--fragmented temperate/ borealReview Choice and development of decision support tools for the sustainable management of deer happens when native deer populations, which are managed for sport are overexploiting forests to a point

  6. 42 CFR 440.168 - Primary care case management services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Primary care case management services. 440.168 Section 440.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168 Primary care case management services. (a)...

  7. Caries Management Strategies for Primary Molars

    PubMed Central

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

    2014-01-01

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

  8. School Management Information Systems in Primary Schools

    ERIC Educational Resources Information Center

    Demir, Kamile

    2006-01-01

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

  9. Better Choices: Evaluating the Effectiveness of Behavior Management Programs

    ERIC Educational Resources Information Center

    Acuna, Miguel T.

    2011-01-01

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

  10. 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 ...

  11. Crisis Management in a Primary School

    ERIC Educational Resources Information Center

    Barclay, Colette

    2004-01-01

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

  12. Managing Health and Safety in Primary Science

    ERIC Educational Resources Information Center

    Borrows, Peter

    2003-01-01

    Since science in primary schools is very safe, the coordinator's role in respect of health and safety can be a relatively modest one and integrated with other parts of the job. In this article, the author outlines the role of the science coordinator and sources of advice.

  13. 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,…

  14. Women in Municipal Management: Choice, Challenge and Change.

    ERIC Educational Resources Information Center

    Burns, Ruth Ann; And Others

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

  15. Perceptual classes established with forced-choice primary generalization tests and transfer of function.

    PubMed Central

    Reeve, K F; Fields, L

    2001-01-01

    In Experiment 1, 20 college students learned two identity conditional discriminations using squares that differed in interior-fill percentage (called Fill23 and Fill77). A two-choice generalization test was then presented with number of test trials varied across groups of subjects. The test samples were 19 squares that ranged in fill value from 23% to 77%; the comparisons were squares with Fill23 and Fill77. The resulting gradients did not vary as a function of number of test trials. When the generalization test was repeated with a third comparison, "neither," the ranges of fill values that occasioned the exclusive selection of Fill23 or Fill77 were direct functions of the number of prior two-choice generalization trials. Finally, a disriminability test revealed that Fill23 and Fill77 were disciminable from the intermediate fill values. In Experiment 2, perceptual classes were established with 5 new students using 760 forced-choice generalization test trials. The student were then trained to select a different glyph in the presence of Fill23 and Fill77, followed by a three-choice generalization test in which the 19 fill stimuli served as samples and the two glyphs served as comparisons. The gradients ovelapped with those previously obtained during the three-choice generalization test that used Fill23 and Fill77 as comparisons. Finally, a discriminability test showed that many adjacent stimuli along thc fill dimension were discriminable from each other. Together, the results of both experiments suggest that ranges of fill-based stimuli functioned as members of perceptual classes, and each class also functioned as a transfer network for a new selection-based response. PMID:11516117

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

    ERIC Educational Resources Information Center

    Malach-Pines, Ayala; Kaspi-Baruch, Oshrit

    2008-01-01

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

  17. 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…

  18. Assessment and management of fall risk in primary care settings.

    PubMed

    Phelan, Elizabeth A; Mahoney, Jane E; Voit, Jan C; Stevens, Judy A

    2015-03-01

    Falls among older adults are neither purely accidental nor inevitable; research has shown that many falls are preventable. Primary care providers play a key role in preventing falls. However, fall risk assessment and management is performed infrequently in primary care settings. This article provides an overview of a clinically relevant, evidence-based approach to fall risk screening and management. It describes resources, including the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) tool kit that can help providers integrate fall prevention into their practice. PMID:25700584

  19. Modern approaches to caries management of the primary dentition.

    PubMed

    Innes, N P T; Evans, D J P

    2013-06-01

    When prevention of dental caries fails, and a child is exposed to the risk of pain and infection, the disease must be managed to reduce this risk. There is growing evidence supporting more 'biological' and fewer 'surgical' approaches to managing dental caries in primary teeth. These biological methods include partial and stepwise caries removal procedures, as well as techniques where no caries is removed. An overview of clinical trials comparing these biological methods to complete caries removal shows that they perform as well as traditional methods and have the advantage of reducing the incidence of iatrogenic pulpal exposures. The Hall Technique is one biological approach to managing caries in primary molars which involves sealing caries beneath preformed metal (stainless steel) crowns. The crown is cemented over the tooth without caries removal, tooth preparation or use of local anaesthesia. The clinical steps for the Hall Technique are straightforward but, as with all dental care provision, appropriate treatment planning for the procedure requires skill. The Hall Technique offers another method of managing early to moderately advanced, active carious lesions in primary molars, with good evidence of effectiveness and acceptability. This evidence aligns with the positive findings of other studies on biological strategies for managing caries in primary teeth. PMID:23744209

  20. 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

  1. The effect of managed care on the incomes of primary care and specialty physicians.

    PubMed Central

    Simon, C J; Dranove, D; White, W D

    1998-01-01

    OBJECTIVE: To determine the effects of managed care growth on the incomes of primary care and specialist physicians. DATA SOURCES: Data on physician income and managed care penetration from the American Medical Association, Socioeconomic Monitoring System (SMS) Surveys for 1985 and 1993. We use secondary data from the Area Resource File and U.S. Census publications to construct geographical socioeconomic control variables, and we examine data from the National Residency Matching Program. STUDY DESIGN: Two-stage least squares regressions are estimated to determine the effect of local managed care penetration on specialty-specific physician incomes, while controlling for factors associated with local variation in supply and demand and accounting for the potential endogeneity of managed care penetration. DATA COLLECTION: The SMS survey is an annual telephone survey conducted by the American Medical Association of approximately one percent of nonfederal, post-residency U.S. physicians. Response rates average 60-70 percent, and analysis is weighted to account for nonresponse bias. PRINCIPAL FINDINGS: The incomes of primary care physicians rose most rapidly in states with higher managed care growth, while the income growth of hospital-based specialists was negatively associated with managed care growth. Incomes of medical subspecialists were not significantly affected by managed care growth over this period. These findings are consistent with trends in postgraduate training choices of new physicians. CONCLUSIONS: Evidence is consistent with a relative increase in the demand for primary care physicians and a decline in the demand for some specialists under managed care. Market adjustments have important implications for health policy and physician workforce planning. PMID:9685122

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

    PubMed Central

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

    2014-01-01

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

  3. 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…

  4. Overview of trauma management for primary and young permanent teeth.

    PubMed

    McTigue, Dennis J

    2013-01-01

    This overview covers diagnosis and management of the most common dental injuries in children and identifies those children at greatest risk. Crown fractures and luxation injuries in both the primary and permanent dentition are discussed and treatment options based on current international guidelines are detailed. PMID:23174609

  5. Role of radiology in the management of primary aldosteronism.

    PubMed

    Patel, Shilpan M; Lingam, Ravi K; Beaconsfield, Tina I; Tran, Tan L; Brown, Beata

    2007-01-01

    The diagnosis of primary aldosteronism, the most common form of secondary hypertension, is based on clinical and biochemical features. Although radiology plays no role in the initial diagnosis, it has an important role in differentiating between the two main causes of primary aldosteronism: aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). This distinction is important because APAs are generally managed surgically and BAH medically. Adrenal venous sampling is considered the standard of reference for determining the cause of primary aldosteronism but is technically demanding, operator dependent, costly, and time consuming, with a low but significant complication rate. Other imaging modalities, including computed tomography, magnetic resonance imaging, and adrenal scintigraphy, have also been used to determine the cause of primary aldosteronism. Cross-sectional imaging has traditionally focused on establishing the diagnosis of an APA, with that of BAH being one of exclusion. A high specificity for detecting an APA is desirable, since it will avert unnecessary surgery in patients with BAH. However, an overreliance on cross-sectional imaging can lead to the incorrect treatment of affected patients, mainly due to the wide variation in the reported diagnostic performance of these modalities. A combination of modalities is usually required to confidently determine the cause of primary aldosteronism. The quest for optimal radiologic management of primary aldosteronism continues just over a half century since this disease entity was first described. PMID:17620472

  6. A case of severe ectopic ACTH syndrome from an occult primary – diagnostic and management dilemmas

    PubMed Central

    Griffin, Katherine; Amer, Saima

    2015-01-01

    Summary Resection of primary tumour is the management of choice in patients with ectopic ACTH syndrome. However, tumours may remain unidentified or occult in spite of extensive efforts at trying to locate them. This can, therefore, pose a major management issue as uncontrolled hypercortisolaemia can lead to life-threatening infections. We present the case of a 66-year-old gentleman with ectopic ACTH syndrome from an occult primary tumour with multiple significant complications from hypercortisolaemia. Ectopic nature of his ACTH-dependent Cushing's syndrome was confirmed by non-suppression with high-dose dexamethasone suppression test and bilateral inferior petrosal sinus sampling. The primary ectopic source remained unidentified in spite of extensive anatomical and functional imaging studies, including CT scans and Dotatate-PET scan. Medical adrenolytic treatment at maximum tolerated doses failed to control his hypercortisolaemia, which led to recurrent intra-abdominal and pelvic abscesses, requiring multiple surgical interventions. Laparoscopic bilateral adrenalectomy was considered but decided against given concerns of technical difficulties due to recurrent intra-abdominal infections and his moribund state. Eventually, alcohol ablation of adrenal glands by retrograde adrenal vein approach was attempted, which resulted in biochemical remission of Cushing's syndrome. Our case emphasizes the importance of aggressive management of hypercortisolaemia in order to reduce the associated morbidity and mortality and also demonstrates that techniques like percutaneous adrenal ablation using a retrograde venous approach may be extremely helpful in patients who are otherwise unable to undergo bilateral adrenalectomy. Learning points Evaluation and management of patients with ectopic ACTH syndrome from an unidentified primary tumour can be very challenging.Persisting hypercortisolaemia in this setting can lead to debilitating and even life-threatening complications and hence needs to be managed aggressively.Bilateral adrenalectomy should be considered when medical treatment is ineffective or poorly tolerated.Percutaneous adrenal ablation may be considered in patients who are otherwise unable to undergo bilateral adrenalectomy. PMID:26649179

  7. Primary lens extraction for glaucoma management: A review article

    PubMed Central

    Eid, Tarek M.

    2011-01-01

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

  8. Guideline for primary care management of headache in adults

    PubMed Central

    Becker, Werner J.; Findlay, Ted; Moga, Carmen; Scott, N. Ann; Harstall, Christa; Taenzer, Paul

    2015-01-01

    Abstract Objective To increase the use of evidence-informed approaches to diagnosis, investigation, and treatment of headache for patients in primary care. Quality of evidence A comprehensive search was conducted for relevant guidelines and systematic reviews published between January 2000 and May 2011. The guidelines were critically appraised using the AGREE (Appraisal of Guidelines for Research and Evaluation) tool, and the 6 highest-quality guidelines were used as seed guidelines for the guideline adaptation process. Main message A multidisciplinary guideline development group of primary care providers and other specialists crafted 91 specific recommendations using a consensus process. The recommendations cover diagnosis, investigation, and management of migraine, tension-type, medication-overuse, and cluster headache. Conclusion A clinical practice guideline for the Canadian health care context was created using a guideline adaptation process to assist multidisciplinary primary care practitioners in providing evidence-informed care for patients with headache. PMID:26273080

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

    PubMed

    Thouvenin, D

    2011-03-01

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

  10. Potential benefits of integrated COPD management in primary care.

    PubMed

    Kruis, A L; Chavannes, N H

    2010-09-01

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

  11. 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…

  12. 25 CFR 558.2 - Review of notice of results for a key employee or primary management official.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...false Review of notice of results for a key employee or primary management official...LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT...

  13. 25 CFR 558.3 - Procedures for forwarding applications and reports for key employees and primary management...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...for forwarding applications and reports for key employees and primary management officials...LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT...

  14. 25 CFR 558.3 - Procedures for forwarding applications and reports for key employees and primary management...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...for forwarding applications and reports for key employees and primary management officials...LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT...

  15. 25 CFR 558.3 - Procedures for forwarding applications and reports for key employees and primary management...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...for forwarding applications and reports for key employees and primary management officials...LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT...

  16. 25 CFR 558.2 - Review of notice of results for a key employee or primary management official.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...false Review of notice of results for a key employee or primary management official...LICENSES AND BACKGROUND INVESTIGATIONS FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT OFFICIALS GAMING LICENSES FOR KEY EMPLOYEES AND PRIMARY MANAGEMENT...

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

    PubMed Central

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

    2009-01-01

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

  18. Current Management of Primary Central Nervous System Lymphoma

    SciTech Connect

    Schultz, Christopher J.; Bovi, Joseph

    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.

  19. 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

  20. 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

  1. Early trabeculectomy versus conventional management in primary open angle glaucoma.

    PubMed Central

    Jay, J L; Murray, S B

    1988-01-01

    The results of a randomised, prospective, multicentre trial of the management of primary open angle glaucoma are presented at up to five years' follow up. Previously undiagnosed cases were selected with intraocular pressure of 26 mmHg or more on two occasions together with field loss characteristic of glaucoma. Analysis was performed on one eye selected at random from each of 99 patients. Conventional medical treatment followed in unsuccessful cases by trabeculectomy (group A) was compared with trabeculectomy at diagnosis followed when necessary by supplementary medical therapy (group B). The life expectancy of these glaucoma patients was found to be similar to that for the local population matched for age and sex. In group A after four years trabeculectomy had been performed in 53% of eyes because medical management had failed to control the disease. The rate of operation was lower in those patients with intraocular pressure less than 31 mmHg and mild relative field loss (17% at three years) than in those with intraocular pressure greater than 30 mmHg and dense scotomas (75% at three years). Early surgery provided much more stable control with fewer changes in treatment than in group A. The group mean intraocular pressure after trabeculectomy was 15.0 mmHg irrespective of the time of operation, and this was significantly lower than the intraocular pressure in those cases thought to be controlled on medical therapy alone at the end of the first year (20.8 mmHg). Early operation provided significantly better protection of visual field, and the extra loss of visual field with delayed operation occurred in the preoperative period. Changes in visual fields were not related to the use of miotics. There was no significant difference in the final visual acuity in the two groups, but six cases in group A lost central fixation because of progressive loss of visual field, and there were no such cases in group B. Cataract occurred in approximately 10% of cases in both groups, but in group A this happened with only half the number of operations and at a shorter postoperative follow-up than in group B. It appears that in cases of primary open angle glaucoma of this severity the risk of delaying operation are significantly greater than those of performing trabeculectomy as the primary treatment. PMID:3067743

  2. Surgical Management of Stone Disease in Patient with Primary Hyperoxaluria

    PubMed Central

    Carrasco, Alonso; Granberg, Candace F.; Gettman, Matthew T.; Milliner, Dawn S.; Krambeck, Amy E.

    2015-01-01

    Objectives To present our experience with surgical management of nephrolithiasis in patients with primary hyperoxaluria (PH). Methods A retrospective chart review from 1994–2012 was perform to identify patients with diagnosis of PH. Results A total of 14 patients with PH were identified with median follow-up of 18.6 years (range: 0.9–51). Median age at initial symptom and subsequent diagnosis were 6.7 years (range: 1.1–35.5) and 0.42 years (range: 0–33.25), respectively. Patients underwent a total of 54 procedures at our institution including: ureteroscopy 27 (50%), percutaneous nephrolithotomy 15 (28%), shock wave lithotripsy 8 (15%), and combined procedures 4 (7%). Overall non-intraparenchymal stone free rate after first, second, and third procedure(s) were 59%, 76%, and 78%, respectively. On average 1.6 procedures (range: 1–4) were required to rid patients of symptomatic stones, which subsequently afforded them a mean of 3.62 years (range: 0.25–21.5) without the need of additional intervention. There were 6 Clavien grade ? III complications in 4 patients, including immediate postoperative ESRD in 3. Conclusions Despite optimal medical and surgical management, patients experience recurrent acute stone events requiring multiple urologic interventions. Significant complications such as ESRD can occur secondary to surgical intervention. PMID:25733260

  3. Improving the management of asthma in adults in primary care.

    PubMed

    Funston, Wendy; Higgins, Bernard

    2014-11-01

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

  4. Public management ‘reform’ narratives and the changing organisation of primary care

    PubMed Central

    2010-01-01

    This paper explores how different models of public management affect the changing organisation of primary care. It examines important non-clinical drivers of major organisational change. It uses the concept of a ‘reform narrative’ to connect public management reform ideas, political doctrines and their effects on primary care organisations. It outlines a set of possible models of public management and their application with primary care settings. It explores what might be the dominant reform ideas of the next decade. PMID:25949627

  5. Management of primary gastric small cell carcinoma in China

    PubMed Central

    Wu, Qin-Qin; Qiang, Wei-Guang; Wang, Feng; Dai, Ke-Jun; Xu, En-Ci; Luo, Ju-Dong; Li, Qing; Tang, Hua; Zhou, Xi-Fa; Lu, Xu-Jing

    2015-01-01

    Background: Primary gastric small cell carcinomas (GSCCs) are increasingly identified by endoscopy, and account for 15-20% of all gastric neuroendocrine tumors (NETs). GSCCs have the worst prognosis with the highest rate of metastases. Purpose: To provide useful information for clinicians and researchers to better manage patients with GSCC, we studied the clinical features of GSCC and explored the corresponding therapies and prognosis. Methods: A literature search was conducted through PUBMED, EMBASE, CNKI and WanFang Databases using search terms “stomach” or “gastric” and “small cell carcinoma” or “poorly differentiated neuroendocrine carcinoma”, for the period 1999 to 2012. And the cases reported were all from China. Relevant articles were identified through manual review. The reference lists of these articles were reviewed to include further appropriate articles. Results: Two hundred and five eligible cases were analyzed. The median age of patients was 62 years, with a male-to-female ratio of 5.4:1. Of the tumors, 53.17% were located in the upper stomach, 25.37% in the mid, 18.54% in the distal stomach, the remaining 2.93% were found in the total stomach. The mean size was 68mm in maximum diameter, with a range of 15-150 mm. Of the one hundred and thirty-five patients, fifty appeared to be pure GSCCs, eighty-five were mixed. The median overall survival time of 195 patients was 18.50 months. The 1-, 2-, and 5-year average survival rates of 142 patients were 66.75%, 37.13%, and 20.15%, respectively. Conclusions: GSCC is a rare tumor and it is notoriously aggressive with a strong propensity for both regional and distant spread. Therapies including surgical resection, chemotherapy, and local radiotherapy, by itself or in combination with other treatment, have been used to treat GSCCs in China. To identify the most effective treatment modalities for GSCCs, we still need prospective, multicenter, randomized clinical researches. PMID:25932087

  6. Fatigue in Primary Biliary Cirrhosis: Prevalence, Pathogenesis and Management.

    PubMed

    Jopson, Laura; Jones, David E J

    2015-01-01

    Fatigue is a significant problem in approximately 50% of primary biliary cirrhosis (PBC) patients, with 20% of all patients experiencing significant or life-altering fatigue. Large-scale population studies show that fatigue has a major impact on quality of life (QoL) in PBC, and that it disproportionately affects younger patients. The presence of social dysfunction that accompanies fatigue appears to be a major factor in determining whether fatigue of a particular severity impacts on QoL. The pathogenesis of fatigue in PBC remains unclear, although it is unrelated to the severity of underlying disease and is unresponsive to ursodeoxycholic acid. Perhaps, unsurprisingly, it appears to be complex in origin, probably multifactorial in the majority of patients and associated with depression, autonomic dysfunction and sleep disturbance. Clinically, fatigue has both central and peripheral components. The central component is associated with cognitive impairment and sleep disturbance and characterised by neurophysiological abnormalities of activation and facilitation, together with CNS changes. Peripheral fatigue is associated with muscle dysfunction and an inability to sustain exercise. One hypothesis is that the central processes result directly from cholestasis, which impacts autonomic centres in the brain; these processes then regulate peripheral muscle perfusion, leading to systemic peripheral effects. At present, there is no specific drug therapy for fatigue in PBC and no significant improvement following transplantation. In managing patients with fatigue, understanding their situation is crucial and advice regarding pacing and maintaining social interactions is critical. Most important of all is an understanding of the impact this symptom has on patients' lives and an empathetic clinical interaction. PMID:26641884

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

    ERIC Educational Resources Information Center

    Mokkonen, Alicia Copp

    2013-01-01

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

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

    E-print Network

    Utrecht, Universiteit

    of outcome-speci#12;c clinical pro#12;les, such as the typical clinical picture of a patient with microscopic evidence of tumour cell elimination after treatment, may help in clinical management and in the choice prognostic factors that help identifying patients at risk [9]. For example, the histological classi#12;cation

  9. School Management Related Knowledge Levels of Primary School Teachers

    ERIC Educational Resources Information Center

    Ugurlu, Celal Teyyar

    2013-01-01

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

  10. Management of pathological fracture in patients with primary hyperparathyroidism.

    PubMed

    Dutta, Prasenjit; Mandal, Ananda; Bandyopadhyay, Utpal; Santra, Sabyasachi; Sarkar, Partha Sarathi

    2013-12-01

    Primary hyperparathyroidism due to parathyroid adenoma is sporadic in nature and seldom symptomatic. Patients usually present with pathological fractures. The objective of this study was to diagnose primary hyperparathyroidism in patients presenting with pathological neck of femur fractures, detection of the adenoma or ectopic tissue, removal of the tissue, and treatment of the fracture. All patients presenting with pathological fracture neck of femur, with clinical features suggestive of hyperparathyroidism were investigated for blood calcium, alkaline phosphatase, parathyroid hormone. If found to be raised patients underwent nuclear scan for detection of primary hyperparathyroidism. Primary hyperparathyroidism (usually parathyroid adenoma) when found was excised. After 2 weeks fixation of fracture was done. Follow-up at 6 weeks, 12 weeks, 6 months, 1 year were done. Time to radiological union, functional assessment and other systemic complaints were noted. Nine patients were included in the study as they presented with pathological fracture due to hyperparathyroidism. All except 1 were due to parathyroid adenoma. Excision of the tumour with early fracture fixation lead to quick rehabilitation of the patient. All fractures united. Hyperparathyroidism is asymptomatic in many patients, and may present only with a fracture. Orthopaedicians should keep this possibility in mind while diagnosing these cases, failure to which may result in disastrous complications. PMID:25154156

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-01-01

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

  14. 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…

  15. 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

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

    PubMed Central

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

    2003-01-01

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

  17. Managed Care, Physician Job Satisfaction, and the Quality of Primary Care

    PubMed Central

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

    2005-01-01

    OBJECTIVE To determine the associations between managed care, physician job satisfaction, and the quality of primary care, and to determine whether physician job satisfaction is associated with health outcomes among primary care patients with pain and depressive symptoms. DESIGN Prospective cohort study. SETTING Offices of 261 primary physicians in private practice in Seattle. PATIENTS We screened 17,187 patients in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms; 2,004 patients completed a 6-month follow-up survey. MEASUREMENTS AND RESULTS For each patient, managed care was measured by the intensity of managed care controls in the patient's primary care office, physician financial incentives, and whether the physician read or used back pain and depression guidelines. Physician job satisfaction at baseline was measured through a 6-item scale. Quality of primary care at follow-up was measured by patient rating of care provided by the primary physician, patient trust and confidence in primary physician, quality-of-care index, and continuity of primary physician. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. Pain and depression patients of physicians with greater job satisfaction had greater trust and confidence in their primary physicians. Pain patients of more satisfied physicians also were less likely to change physicians in the follow-up period. Depression patients of more satisfied physicians had higher ratings of the care provided by their physicians. These associations remained after controlling statistically for managed care. Physician job satisfaction was not associated with health outcomes. CONCLUSIONS For primary care patients with pain or depressive symptoms, primary physician job satisfaction is associated with some measures of patient-rated quality of care but not health outcomes. PMID:15836532

  18. 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…

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

    ERIC Educational Resources Information Center

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

    2010-01-01

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

  20. Collaborative Classroom Management in a Co-Taught Primary School Classroom

    ERIC Educational Resources Information Center

    Rytivaara, Anna

    2012-01-01

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

  1. Primary adrenal causes of Cushing's syndrome. Diagnosis and surgical management.

    PubMed Central

    Perry, R R; Nieman, L K; Cutler, G B; Chrousos, G P; Loriaux, D L; Doppman, J L; Travis, W D; Norton, J A

    1989-01-01

    Cushing's syndrome is rare with only 20% of patients having a primary adrenal cause of hypercortisolism. We have developed a strategy to evaluate patients with suspected Cushing's syndrome and to localize the pathologic condition responsible for the hypercortisolism. This report reviews the last 11 consecutive patients who had a primary adrenal cause of hypercortisolism. Each patient had elevated 24-hour urine free cortisol and 17-hydroxycorticosteroid excretion consistent with hypercortisolism. All but one patient had undetectable plasma ACTH levels. No patient suppressed urinary steroid levels with high-dose dexamethasone and only one patient increased plasma ACTH or cortisol levels with oCRH, findings that were consistent with a pituitary-independent form of hypercortisolism. No patient had a pituitary tumor detected by computed tomography or magnetic resonance imaging, and eight patients had adrenal tumors accurately imaged. MRI of the adrenal glands correctly diagnosed adenoma in 5 of 6 patients with adenomas, carcinoma in 1 patient, and ACTH-producing pheochromocytoma in 1 patient. One tumor classified as carcinoma by MRI appeared on pathologic examination to be an adenoma. Three patients underwent petrosal sinus sampling for measurement of ACTH before and after oCRH administration, and each had petrosal sinus ACTH levels equal to peripheral levels, consistent with a primary adrenal cause of hypercortisolism. Two of these patients had typical bilateral pigmented micronodular adrenocortical disease and the third patient had macronodular adrenocortical hyperplasia. Each of the 11 patients was cured of hypercortisolism by unilateral or bilateral adrenalectomy and no patient has developed recurrent disease during the 7 to 29 month follow-up period. New modalities including the ovine CRH test, MRI, and petrosal sinus sampling have improved the evaluation of certain patients with Cushing's syndrome. Images Figs. 2A-C. Figs. 2A-C. Figs. 3A-C. Figs. 3A-C. PMID:2742414

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

    PubMed

    Mancuso, Andrea

    2015-03-01

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

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

    PubMed

    Jouneau, Stéphane; Brinchault, Graziella; Desrues, Benoît

    2014-12-01

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

  4. Arthroscopic management of a chronic primary anterior shoulder dislocation.

    PubMed

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

    2010-07-01

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

  5. 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…

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

    PubMed Central

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

    2015-01-01

    Healthcare systems throughout the world continue to face emerging challenges associated with chronic disease management. Due to the likely increase in chronic conditions in the future it is now vital that cooperation and support between specialists, generalists and primary health care physicians is conducted. Inflammatory bowel disease (IBD) is one such chronic disease. Despite specialist care being essential, much IBD care could and probably should be delivered in primary care with continued collaboration between all stakeholders. Whilst most primary care physicians only have few patients currently affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician’s IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and associated supportive literature. The purpose of this review is to investigate what non-specialist tools, action plans or guidelines for IBD are published in readily searchable medical literature and compare these to those which exist for other chronic conditions. PMID:25914455

  7. A collaborative approach to diabetes management: the choice made for Colorado schools.

    PubMed

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

    2011-08-01

    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 nursing leadership partnered with the National Association of School Nurses to adapt components of the Managing and Preventing Diabetes and Weight Gain Program (MAP), funded by the Centers for Disease Control and Prevention. The Healthy Learner Model for Chronic Condition Management, integral to MAP, provided guidance for the Colorado Collaborative to design the Diabetes Resource Nurse Program. The program supports the practicing school nurse, and facilitates collaboration between the family, school, and health care provider. This article describes how stakeholders in Colorado chose to collaborate when faced with rising tensions over how to best manage students with diabetes. PMID:21586632

  8. Parental Perspectives Regarding Primary-Care Weight-Management Strategies for School-Age Children

    PubMed Central

    Turer, Christy Boling; Mehta, Megha; Durante, Richard; Wazni, Fatima; Flores, Glenn

    2014-01-01

    To identify parental perspectives regarding weight-management strategies for school-age children, focus groups were conducted of parents of overweight and obese (BMI ? 85th percentile) 6–12 year-old children recruited from primary-care clinics. Questions focused on the role of the primary-care provider, effective components of weight-management strategies, and feasibility of specific dietary strategies. Focus groups were recorded, transcribed, and analyzed using margin-coding and grounded theory. Six focus groups were held. The mean age (in years) for parents was 32, and for children, eight; 44% of participants were Latino, 33%, African-American, and 23%, white. Parents’ recommendations on the primary-care provider’s role in weight management included monitoring weight, providing guidance regarding health risks and lifestyle changes, consistent follow-up, and using discretion during weight discussions. Weight-management components identified as key included emphasizing healthy lifestyles and enjoyment, small changes to routines, and parental role-modeling. Parents prefer guidance regarding healthy dietary practices rather than specific weight-loss diets, but identified principles that could enhance the acceptability of these diets. For dietary guidance to be feasible, parents recommended easy-to-follow instructions and emphasizing servings over counting calories. Effective weight-management strategies identified by parents include primary-care provider engagement in weight management, simple instructions regarding healthy lifestyle changes, parental involvement, and deemphasizing specific weight-loss diets. These findings may prove useful in developing primary-care weight-management strategies for children that maximize parental acceptance. PMID:24720565

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

    PubMed Central

    2014-01-01

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

  10. Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

    PubMed Central

    Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

    2015-01-01

    Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36?months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. PMID:25900466

  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. Prevalence and management of osteoarthritis in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network

    PubMed Central

    Morkem, Rachael; Peat, George; Williamson, Tyler; Green, Michael E.; Khan, Shahriar; Jordan, Kelvin P.

    2015-01-01

    Background Osteoarthritis is a common chronic condition that affects many older Canadians and is a considerable cause of disability. Our objective was to describe the epidemiology of osteoarthritis in patients aged 30 years and older using electronic medical records (EMRs) in a Canadian primary care population. Methods In this retrospective cohort study, we analyzed the EMRs of 207 610 patients over 30 years of age (extracted on December 31, 2012) who had at least one clinic visit during the preceding 2 years. We calculated the age–sex standardized prevalence of diagnosed osteoarthritis and its association with comorbidities and covariates available in the Canadian Primary Care Sentinel Surveillance Network database. Results The estimated prevalence of diagnosed osteoarthritis was 14.2% (15.6% among women, 12.4% among men). The diagnosis of osteoarthritis was associated with several comorbidities: hypertension (prevalence ratio [PR] 1.17, 95% confidence interval [CI] 1.15–1.18), depression (PR 1.26, 95% CI 1.22–1.3), chronic obstructive pulmonary disease (COPD) (PR 1.16, 95% CI 1.11–1.21) and epilepsy (PR 1.27, 95% CI 1.13–1.43). In addition, 56.6% of patients had received a prescription for a range of nonsteroidal anti-inflammatory drugs, 45% of which were topical. Opioid medications were prescribed to 33% of patients for pain management. Conclusion Osteoarthritis is a common disease in middle-aged and older Canadians. It is more common in women than in men and is associated with comorbid conditions. Most patients with osteoarthritis received pharmacotherapy for inflammation and pain management. As the Canadian population ages, osteoarthritis will become an increasing burden for individuals and the health care system. PMID:26442224

  13. Using a Learning Management System to Personalise Learning for Primary School Students

    ERIC Educational Resources Information Center

    Edmunds, Bronwyn; Hartnett, Maggie

    2014-01-01

    This paper reports on one aspect of a descriptive multiple-case study which set out to explore the role of a learning management system (LMS) in personalising learning for students from the perspective of three teachers in one primary school in New Zealand. The intention was to provide insight into the role the LMS could play in classrooms when…

  14. The Organizational Strategies of School Management in Japan: Focus on Primary School Principals

    ERIC Educational Resources Information Center

    Cisse, Makia; Okato, Toshitaka

    2009-01-01

    The study examines the organizational strategies of Japanese principals in school management. One hundred principals of primary schools in Hiroshima Prefecture were surveyed in 2007. The samples comprised of the differences between the two groups aged 51-55 and 56-60 in terms of how competency level should be exerted in school. The study was…

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

    ERIC Educational Resources Information Center

    Oghuvbu, Enamiroro Patrick; Atakpo, Theresa Edirin

    2008-01-01

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

  16. 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,…

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

    PubMed

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

    2014-01-01

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

  18. Successful childhood obesity management in primary care in Canada: what are the odds?

    PubMed Central

    Kuhle, Stefan; Doucette, Rachel; Piccinini-Vallis, Helena

    2015-01-01

    Background. The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada. Methods. Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada. Results. We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process. Conclusions. In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated. PMID:26623175

  19. 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

  20. Non-Vitamin K Antagonist Oral Anticoagulants: New Choices for Patient Management in Atrial Fibrillation.

    PubMed

    Saliba, Walid

    2015-10-01

    Atrial fibrillation (AF) is a significant problem for the aging population and remains a major factor underlying stroke risk. Warfarin anticoagulation has been proven effective for stroke prevention in AF, but can be difficult to manage and requires frequent monitoring. The non-vitamin K antagonist oral anticoagulants (NOACs) have been shown to be as effective as warfarin for stroke prevention in nonvalvular AF (NVAF) and are associated with a reduced risk of bleeding compared with warfarin. Dabigatran, rivaroxaban, apixaban, and edoxaban have been approved in the USA for reducing the risk of stroke in patients with NVAF. In this article, AF risk assessment is discussed and NOAC phase III clinical trials for the prevention of stroke and systemic embolic events are reviewed. Further, differences in stroke and bleeding outcomes between NOACs are highlighted, the use of NOACs for cardioversion and special patient populations is discussed, and management considerations for patients with AF are reviewed. PMID:26055615

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

    PubMed

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

    2006-02-01

    COPD is a common and under-diagnosed disease which is increasing in prevalence worldwide. A more aggressive and optimistic approach must be adopted towards its management in primary care. This IPCRG Guideline on the management of COPD in primary care is fully consistent with GOLD guidelines. It highlights the goals of COPD treatment and the need for spirometric testing to make the diagnosis. It covers the classification of the disease according to disease severity, non-pharmacologic therapy including smoking cessation, avoidance of risk factors, patient education, pharmacologic therapy including the use of oxygen treatment, the management of exacerbations, the role of pulmonary rehabilitation, and the need for monitoring and ongoing care for COPD patients. PMID:16701758

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

    USGS Publications Warehouse

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

    2003-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-09-01

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

  5. When Government Is No Longer Employer of Choice: What May the Sector Perceptions of Public Managers Be Like after the Economy Recovers?

    ERIC Educational Resources Information Center

    Boardman, Craig; Ponomariov, Branco

    2012-01-01

    In today's economic climate, government is now considered by many to be the "employer of choice." However, employers at all levels of government may eventually lose their recent gains in the war for talent, as the economy improves. Accordingly, it is important to explain how public sector managers viewed the relative advantages and…

  6. Primary care physicians’ experiences with case finding for practice-based care management

    PubMed Central

    Freund, Tobias; Wensing, Michel; Geißler, Stefan; Peters-Klimm, Frank; Mahler, Cornelia; Boyd, Cynthia M.; Szecsenyi, Joachim

    2012-01-01

    Objective The identification of patients most likely to benefit from care management programs case finding – is a crucial determinant of their effectiveness regarding improved health outcomes and reduced costs. Until now, research has mainly focused on claims data-based case finding. This study aimed to explore how primary care physicians (PCPs) select patients for practice-based care management and how risk prediction may complement their case finding. Study design Qualitative study Methods We performed 12 semi-structured interviews with PCPs from 10 small- to middle-sized primary care practices in Germany. The interviews focused on their criteria for selecting patients as potential participants of an on-site care management program and how PCPs evaluate claims data-based risk prediction as a case finding tool. All interviews were transcribed verbatim. We performed qualitative content analysis using the ATLAS.ti software. Results Three major categories emerged from the physicians interviewed: 1) the physicians’ interpretation of the program’s eligibility criteria, 2) physician-related criteria and 3) patient-related criteria. The physician-related criteria included “sympathy/aversion” and “knowing the patient”. Patient-related criteria concerned care sensitivity in terms of “willingness to participate”, “ability to participate” (e.g. sufficient language skills, cognitive status) and “manageable care needs”. PCPs believed that their case finding can be supported by additional information from claims-data based risk prediction. Conclusions Case finding for care management programs in primary care may benefit from a structured approach combining clinical judgement by PCPs and claims-data based risk modelling. However, further research is needed to identify the optimal case finding strategy for practice-based care management. PMID:22554041

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

    PubMed

    Newham, Roger; Hudgell, Lynne

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

  8. Suicide Risk in Primary Care: Identification and Management in Older Adults

    PubMed Central

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

    2014-01-01

    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

  9. 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.

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

    ERIC Educational Resources Information Center

    Kastner, Theodore A.; Walsh, Kevin K.

    2006-01-01

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

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

    PubMed

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

    2013-03-01

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

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

    PubMed Central

    McSherry, J.; Weiss, R.

    2000-01-01

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

  13. 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

  14. Management of asymptomatic primary tumours in stage IV colorectal cancer: Review of outcomes

    PubMed Central

    Wilkinson, Kate Jessica; Chua, Wei; Ng, Weng; Roohullah, Aflah

    2015-01-01

    AIM: To compare outcomes for patients presenting with stage IV colorectal cancer and an asymptomatic primary tumour, undergoing primary tumour resection (PTR) plus palliative chemotherapy vs primary chemotherapy up-front. METHODS: A literature search was conducted using MEDLINE and EMBASE. The primary outcome was overall survival. Secondary outcomes included perioperative mortality, morbidity and delayed surgical intervention rates in patients undergoing PTR and subsequent complication rates in patients with an un-resected primary tumour. Tertiary outcomes included impact on systemic treatment and identification of prognostic factors relevant for survival in this cohort. RESULTS: Twenty non-randomised studies met the inclusion criteria. Eleven studies included comparative overall survival data. Three studies showed an overall survival advantage for PTR, 7 studies showed no statistically significant advantage, and 1 study showed a significant worsening in survival in the surgical group. The perioperative mortality rate ranged from 0% to 8.5%, and post-operative morbidity rate from 10% to 35%, mainly minor complications that did not preclude subsequent chemotherapy. The rate of delayed primary-tumour related symptoms, most commonly obstruction, in patients with an un-resected primary tumour ranged from 3% to 46%. The strongest independent poor prognostic factor was extensive hepatic metastases, in addition to poor performance status, M1b stage and non-use of modern chemotherapy agents. CONCLUSION: Based on the current literature, both PTR and up front chemotherapy appear appropriate initial management strategies, with a trend towards an overall survival advantage with PTR. The procedure has a low post-operative mortality, and most complications are transient and minor. The results of recruiting randomised trials are eagerly anticipated. PMID:26691885

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

    PubMed Central

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

    2014-01-01

    Objective: To study the influence of adolescence characteristics on asthma management. Methods: This was a qualitative study conducted in the city of Divinópolis, Minas Gerais, Southeast Brazil. Data were collected through semistructured interviews guided by a questionnaire with seven asthmatic adolescents followed-up in the primary public health care service of the city. Results: Using content analysis, three thematic categories were observed in the adolescents' responses: 1) family relationships in the treatment of asthma in adolescence; 2) the asthmatic adolescents and their peers; and 3) the role of the school for the asthmatic adolescents. Conclusions: The results demonstrated that peers, family, and school should be more valued by health professionals and by health care services when treating asthmatic adolescents, as these social relationships are closely associated with the adolescent and have an important role in asthma management. Attempts to meet the demands of adolescents contribute to improve asthma management. PMID:25479845

  16. Differences in Cardiovascular Disease Risk Factor Management in Primary Care by Sex of Physician and Patient

    PubMed Central

    Tabenkin, Hava; Eaton, Charles B.; Roberts, Mary B.; Parker, Donna R.; McMurray, Jerome H.; Borkan, Jeffrey

    2010-01-01

    PURPOSE The purpose of this study was to evaluate differences in the management of cardiovascular disease (CVD) risk factors based upon the sex of the patient and physician and their interaction in primary care practice. METHODS We evaluated CVD risk factor management in 4,195 patients cared for by 39 male and 16 female primary care physicians in 30 practices in southeastern New England. RESULTS Many of the sex-based differences in CVD risk factor management on crude analysis are lost once adjusted for confounding factors found at the level of the patient, physician, and practice. In multilevel adjusted analyses, styles of CVD risk factor management differed by the sex of the physician, with more female physicians documenting diet and weight loss counseling for hypertension (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.12–4.40) and obesity (OR = 2.14; 95% CI, 1.30–3.51) and more physical activity counseling for obesity (OR = 2.03; 95% CI, 1.30–3.18) and diabetes (OR = 6.55; 95% CI, 2.01–21.33). Diabetes management differed by the sex of the patient, with fewer women receiving glucose-lowering medications (OR = 0.49; 95% CI, 0.25–0.94), angiotensin-converting enzyme inhibitor therapy (OR = 0.39; 95% CI, 0.22–0.72), and aspirin prophylaxis (OR = 0.30; 95% CI, 0.15–0.58). CONCLUSION Quality of care as measured by patients meeting CVD risk factors treatment goals was similar regardless of the sex of the patient or physician. Selected differences were found in the style of CVD risk factor management by sex of physician and patient. PMID:20065275

  17. Translating Atopic Dermatitis Management Guidelines Into Practice for Primary Care Providers.

    PubMed

    Eichenfield, Lawrence F; Boguniewicz, Mark; Simpson, Eric L; Russell, John J; Block, Julie K; Feldman, Steven R; Clark, Adele R; Tofte, Susan; Dunn, Jeffrey D; Paller, Amy S

    2015-09-01

    Atopic dermatitis affects a substantial number of children, many of whom seek initial treatment from their pediatrician or other primary care provider. Approximately two-thirds of these patients have mild disease and can be adequately managed at the primary care level. However, recent treatment guidelines are written primarily for use by specialists and lack certain elements that would make them more useful to primary care providers. This article evaluates these recent treatment guidelines in terms of evaluation criteria, treatment recommendations, usability, accessibility, and applicability to nonspecialists and integrates them with clinical evidence to present a streamlined severity-based treatment model for the management of a majority of atopic dermatitis cases. Because each patient's situation is unique, individualization of treatment plans is critical as is efficient communication and implementation of the plan with patients and caregivers. Specifically, practical suggestions for individualizing, optimizing, implementing, and communicating treatment plans such as choosing a moisturizer formulation, avoiding common triggers, educating patients/caregivers, providing written treatment plans, and scheduling physician follow-up are provided along with a discussion of available resources for patients/caregivers and providers. PMID:26240216

  18. Management of patients with respiratory infections in primary care: procalcitonin, C-reactive protein or both?

    PubMed

    Meili, Marc; Müller, Beat; Kulkarni, Prasad; Schütz, Philipp

    2015-10-01

    Use of inflammatory biomarkers to guide antibiotic decisions has shown promising results in the risk-adapted management of respiratory tract infections, mainly in the inpatient setting. Several observational and interventional trials have investigated the benefits of procalcitonin (PCT) and C-reactive protein (CRP) testing in primary care. Both markers have shown promising results, although CRP is an inflammatory biomarker while PCT is more specific for bacterial infections. For CRP, point-of-care testing is widely established. Recently, sensitive point-of-care testing for PCT has also become available. A high-quality trial comparing these two markers for the management of patients in primary care is currently lacking. The aim of this paper is to review the existing literature investigating the use of PCT and CRP in primary care. The authors compare their performance for guiding antibiotic stewardship and analyze the cut-off values and endpoints to put these parameters into context in a low-acuity environment. PMID:26366806

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

    PubMed

    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

  20. Survivorship after allogeneic transplantation-management recommendations for the primary care provider.

    PubMed

    Tichelli, André; Rovó, Alicia

    2015-03-01

    Prognosis after allogeneic hematopoietic stem cell transplantation (HSCT) has greatly improved. Therefore, long-term survivorship becomes an important issue. A number of malignant and nonmalignant late effects can cause substantial morbidity, with considerable impact on health and quality of life. The main factors responsible for late effects after HSCT are total body irradiation-based conditioning and chronic graft-versus-host disease and its treatment. The knowledge on late effects serves as guidance for surveillance and management decision. Aftercare includes screening and counseling for prevention and treatment of late complications. The care of HSCT recipients tends with time to be transferred from the transplant center back to the primary care provider, who might not be however familiar with the unique needs of long-term survivors. A broad expertise is needed for the post-transplant management; therefore, transplant centers together with primary care providers should ensure complementary care delivery. Standardized follow-up guidelines on late effects represent the best tool to guaranty good management of long-term survivors. Distribution, broad promotion, and applications of these guidelines are therefore needed. PMID:25667128

  1. 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

  2. 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

  3. 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

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

    PubMed Central

    2013-01-01

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

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

    PubMed

    Friedman, Benjamin Wolkin; Grosberg, Brian Mitchell

    2009-02-01

    Headache continues to be a frequent cause of emergency department (ED) use, accounting for 2% of all visits. Most of these headaches prove to be benign but painful exacerbations of chronic headache disorders, such as migraine, tension-type, and cluster. The goal of ED management is to provide rapid and quick relief of benign headache, without causing undue side effects, and to recognize headaches with malignant course. Although these headaches have distinct epidemiologies and clinical phenotypes, there is overlapping response to therapy; nonsteroidals, triptans, dihydroergotamine, and the antiemetic dopamine antagonists may play a therapeutic role for each of these acute headaches. This article reviews the diagnostic criteria and management strategies for the primary headache disorders. PMID:19218020

  6. Obstacles in Managing Mental Health Problems for Primary Care Physicians in Hong Kong.

    PubMed

    Sun, Kai Sing; Lam, Tai Pong; Lam, Kwok Fai; Lo, Tak Lam

    2015-11-01

    This study investigated the obstacles for primary care physicians (PCPs) to managing mental health problems in Hong Kong. Focus group data collected from PCPs and psychiatrists were used to construct a questionnaire for a quantitative survey with 516 PCPs respondents. The results showed that their commonly perceived obstacles were lack of timely access to public psychiatrists, lack of feedback from both public and private psychiatrists after referrals; as well as patients' reluctance to be referred. Factor analysis and correlational analysis found that the numbers of mental health patients treated by the PCPs were mainly determined by the PCPs' own clinical constraints, including limited confidence in diagnosis and management, time constraint, and limited job satisfaction. PMID:25331448

  7. A Comparison of the Quality of Hypertension Management in Primary Care Between Shanghai and Shenzhen

    PubMed Central

    Li, Haitao; Wei, Xiaolin; Wong, Martin C.; Yang, Nan; Wong, Samuel Y.; Lao, Xiangqian; Griffiths, Sian M.

    2015-01-01

    Abstract Strong primary care is in urgent need for the management and control of hypertension. This study aimed to compare the quality of hypertensive care delivered by community health centers (CHCs) in Shanghai and Shenzhen. Multistage random sampling method was used to select 4 CHCs in each city as study settings. A cohort of hypertensive patients under the hypertensive management program in the CHCs was selected from the electronic information system by using a systematic random sampling method. Binary logistic regression models were constructed for comparison between the 2 cities. A total of 3196 patients’ records were assessed. The proportions of hypertensive patients who received advice on smoking cessation (33.8 vs 7.7%, P?primary care is effective in managing hypertension irrespective of management and operation models of CHCs in urban China. Our study suggests that improvements in the process of hypertensive care may lead to better hypertension control. PMID:25654383

  8. The Testimony of Neoliberal Contradiction in Education Choice and Privatisation in a Poor Country: The Case of a Private, Undocumented Rural Primary School in Uganda

    ERIC Educational Resources Information Center

    Mayengo, Nathaniel; Namusoke, Jane; Dennis, Barbara

    2015-01-01

    With international momentum to achieve "Education for All" by 2015, global attention is being paid to those parts of the world where mass formal primary schooling is relatively new. Uganda is such a place. In the context of ethnographic fieldwork at a poor, undocumented, private primary school in rural Uganda, parents were interviewed in…

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

    PubMed Central

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

    2009-01-01

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

  10. Management of minor ailments in primary schoolchildren in rural and urban areas.

    PubMed

    Cantrill, J A; Johannesson, B; Nicolson, M; Noyce, P R

    1996-05-01

    The concept of self-management in healthcare includes disease prevention, self-diagnosis, self-treatment and appropriate consultation with health care practitioners. Within the context of childrens' ailments the decision-maker will usually be a carer. The aim of this study was to examine carers' management of minor childhood ailments within urban and rural settings. The subjects were primary schoolchildren (4-12 years of age) and the respondents were their parents or carers. Data were gathered using a pre-piloted structured questionnaire. The questionnaires were distributed through and collected by the head teachers of the 13 participating schools. Of the 491 questionnaires distributed, 306 (62%) were returned and suitable for analysis. In total, 96 (31%) children had experienced a minor ailment in the preceding 2 weeks; the most commonly reported were cold, headache and gastrointestinal disturbance. Ninety-five respondents indicated how they managed this episode; the most common response was to treat the child with a medicine which they already had in the house (41%). A further 24 obtained a medicine specifically to manage the episode; 12 on prescription and 12 purchased an over-the-counter (OTC) medicine. The majority of respondents (86%) felt that they based their management decision on their own experience, only 10 felt their action was influenced by the advice of a pharmacist or doctor. Fifty children (16%) were reported to have a chronic illness. Several respondents volunteered comments suggesting that they would be cautious in their use of OTC medicines. This study indicates that in the majority of cases, carers manage children's minor ailments without recourse to professional advice. PMID:8735671

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

    PubMed Central

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

    2013-01-01

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

  12. Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know

    PubMed Central

    Singh, Siddharth; Watt, Kymberly D.

    2012-01-01

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

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

    PubMed Central

    Atlas, Steven J; Deyo, Richard A

    2001-01-01

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

  14. Diabetes Case Management in Primary Care: The New Brunswick Experience and Expanding the Practice of the Certified Diabetes Educator Nurse into Primary Care.

    PubMed

    Jones, Shelley L

    2015-08-01

    The role of the outreach diabetes case manager in New Brunswick, Canada, was first developed in the Moncton Area of Horizon Health Network in response to a physician-identified gap between patients' diagnoses of diabetes and their attendance at the local diabetes education centre. This model of collaborative interprofessional practice increases support for primary care providers and people living with diabetes in that they are being provided the services of certified diabetes educators who can address knowledge gaps with respect to evidence-based guidelines and best practice, promote advancement of diabetes and chronic-disease management therapies and support adherence to treatment plans and self-management practices. This report chronicles a review of the implementation, expansion and evaluation of the outreach diabetes case manager model in the province of New Brunswick, Canada, along with the rationale for development of the role for registered nurses in other jurisdictions. PMID:25797113

  15. Primary Care Providers' Knowledge and Practices of Diabetes Management During Ramadan.

    PubMed

    Ali, Mujtaba; Adams, Alexandra; Hossain, Md Anwar; Sutin, David; Han, Benjamin Hyun

    2016-01-01

    There are an estimated 3.5 million Muslims in North America. During the holy month of Ramadan, healthy adult Muslims are to fast from predawn to after sunset. While there are exemptions for older and sick adults, many adults with diabetes fast during Ramadan. However, there are risks associated with fasting and specific management considerations for patients with diabetes. We evaluated provider practices and knowledge regarding the management of patients with diabetes who fast during Ramadan. A 15-question quality improvement survey based on a literature review and the American Diabetes Association guidelines was developed and offered to providers at the outpatient primary care and geriatric clinics at an inner-city hospital in New York City. Forty-five providers completed the survey. Most respondents did not ask their Muslim patients with diabetes if they were fasting during the previous Ramadan. Knowledge of fasting practices during Ramadan was variable, and most felt uncomfortable managing patients with diabetes during Ramadan. There is room for improvement in educating providers about specific cultural and medical issues regarding fasting for patients with diabetes during Ramadan. PMID:26294052

  16. The role of public relations activities in hospital choice.

    PubMed

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

    2007-01-01

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

  17. Perioperative Management Difficulties in Parathyroidectomy for Primary Versus Secondary and Tertiary Hyperparathyroidism

    PubMed Central

    CORNECI, Marioara; STANESCU, Bogdan; TRIFANESCU, Raluca; NEACSU, Elena; CORNECI, Dan; POIANA, Catalina; HORVAT, Teodor

    2012-01-01

    ABSTRACT Background: In patients with hyperparathyroidism, parathyroidectomy is the only curative therapy. Anaesthetic management differs function of etiology (primary vs. secondary or tertiary hyperparathyroidism) and surgical technique (minimally invasive or classic parathyroidectomy). Objectives: To evaluate peri-operative management (focusing on hemodynamic changes, cardiac arrhythmias and patients’ awakening quality) in parathyroidectomy for hyperparathyroidism of various etiologies, in a tertiary center. Material and methods: 292 patients who underwent surgery for hyperparathyroidism between 2000-2011 were retrospectively reviewed; 96 patients (19M/77F) presented with primary hyperparathyroidism (group A) and 196 (80M/116F) with secondary and tertiary hyperparathyroidism due to renal failure (group B). Biochemical parameters (serum calcium, phosphate, creatinine) were determined by automated standard laboratory methods. Serum intact PTH was measured by ELISA (iPTH - normal range: 15-65 pg/mL). Outcomes: Median surgery duration was 30 minutes in group A (minimally invasive or classic parathyroidectomy) and 75 minutes in group B (total parathyroidectomy and re implantation of a small parathyroid fragment into the sternocleidomastoid muscle). During anaesthesia induction, arterial hypotension developed significantly more frequent in group B (57 out of 196 pts, 29.1%) than in group A (8 out of 96 pts, 8.34%), p<0.0001, especially in patients receiving Fentanyl-Propofol. During surgery and anaesthesia maintenance, bradycardia was significantly more frequent in group A (67 out of 96 pts, 69.8%) than in group B (26 out of 196 pts, 13.3%), p<0.0001, especially during searching of parathyroid glands. By contrary, ventricular premature beats were less frequent in group A (25 out of 96 pts, 25.25%) than in group B (84 out of 196 pts, 42.85%), p=0.003. There were no statistically significant differences between the studied group regarding frequency of arterial hypertension and hypotension, paroxysmal atrial fibrillation. Conclusions: anaesthetic management in parathyroid surgery may be difficult because of cardiac arrhythmias (bradycardia in primary hyperparathyroidism and ventricular premature beats in secondary and tertiary hyperparathyroidism, respectively) and arterial hypotension during anaesthesia induction in patients with secondary and tertiary hyperparathyroidism. PMID:23399537

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

    E-print Network

    Columbia University

    - Suggestions on Choice of Technology in Indian Context (Ref: `Asim Barman Report' & `Almitra Patel­Document No explores the success rate and viability of these different waste- processing options in the Indian context. until they are proven under Indian conditions. It is therefore, suggested that local bodies should

  19. Severe primary pulmonary lymphangiectasis in a premature infant: management and follow up to early childhood.

    PubMed

    Reiterer, Friedrich; Grossauer, Karin; Pfleger, Andreas; Häusler, Martin; Resch, Bernhard; Eber, Ernst; Popper, Helmut; Urlesberger, Berndt

    2015-02-01

    Primary pulmonary lymphangiectasis (PPL) is a rare congenital developmental abnormality of the lung with a generally poor prognosis. Only a limited number of patients with neonatal-onset PPL have been reported to survive. We present the case of a male preterm infant (gestational age 34?weeks 6?days) with histologically confirmed PPL, complicated by hydrops fetalis, bilateral hydrothorax (treated in utero with pleuro-amniotic shunts), and immediate respiratory distress at birth. He survived after extensive neonatal intensive care therapy and was discharged home at the age of 7?months. At last follow up he was 3?years 7?months old, still requiring assisted ventilation via tracheostomy, having recurrent episodes of wheezing and had mild global developmental delay. This case demonstrates that survival beyond the neonatal period is possible even with severe PPL but long-term morbidity may be relevant, and multidisciplinary management and close follow up are essential. PMID:25711257

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

    ERIC Educational Resources Information Center

    Harma, Joanna

    2010-01-01

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

  1. 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…

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

    PubMed Central

    2012-01-01

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

  3. 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

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

    PubMed Central

    Järvenpää, Salme; Kautiainen, Hannu

    2014-01-01

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

  5. 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.

  6. Improving management of gout in primary care using a customised electronic records template

    PubMed Central

    Moffat, Keith; McNab, Duncan

    2015-01-01

    It is known that the management of chronic gout in relation to serum uric acid (SUA) monitoring, allopurinol dosing, and lifestyle advice is often sub-optimal in primary care.[1] A quality improvement project in the form of a criterion based audit was carried out in an urban general practice to improve the care of patients being treated for gout. Baseline searching of EMIS confirmed that management of patients with gout who were taking allopurinol was not in line with current guidance. 51(40%) had a SUA checked in the past 12 months, 88(25%) had a SUA below target level, and gout lifestyle advice was not being recorded. An audit was performed to measure and improve the following criteria: Monitoring of SUA levels in the past 12 monthsTitration of urate lowering therapy to bring the SUA below target levelLifestyle advice in the past 12 months An audit standard of 60% achievement at 2 months and 80% achievement at 4 months was set. The intervention consisted of a custom electronic template within EMIS which allowed guidance of gout management to be displayed and for data to be entered. All members of the team including GPs and administrative staff were educated regarding the intervention. This resulted in a sustained improvement over a 6 month period in all 3 components of the audit with 112(84%) having a SUA level checked, 79(51%) having a SUA below target level and 76(57%) receiving lifestyle advice. Although the improvement did not reach the audit standard in 2 of the criteria it would be expected that outcomes would continue given the systems changes which have been made.

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

    SciTech Connect

    Moreira, A.M.M.; Guenther, W.M.R.

    2013-01-15

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

  8. 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

  9. 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

  10. Choice Matters.

    ERIC Educational Resources Information Center

    Hicks, Darcy

    2001-01-01

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

  11. Project Choice.

    ERIC Educational Resources Information Center

    Ewing Marion Kauffman Foundation, Kansas City, MO.

    Project Choice was begun with the goal of increasing the number of inner-city students who graduate on time. Ewing M. Kauffman and his business and foundation associates designed and elected to test a model that used the promise of postsecondary education or training as the incentive to stay in school. This report details the evolution of Project…

  12. 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

  13. Conflicts in Schools, Conflict Management Styles and the Role of the School Leader: A Study of Greek Primary School Educators

    ERIC Educational Resources Information Center

    Saiti, Anna

    2015-01-01

    Conflict may occur in any organization (and hence school) and, for schools, conflict management style is a joint activity and the degree of its effectiveness determines the type of impact of conflict on school performance. This empirical study investigates the potential sources of conflict in Greek primary schools, determine appropriate approaches…

  14. Challenges to the Implementation of PLAP in Primary Schools: Perceptions of ZOU Bachelor of Educational Management Students

    ERIC Educational Resources Information Center

    Mercy, Kurebwa; Mabhanda, Wilson

    2015-01-01

    The study explored the challenges that impact on the implementation of PLAP in the Primary schools. The research was conducted with teachers who study towards the BEd Management degree with Zimbabwe Open University (ZOU) in the Midlands Region. The study used a qualitative research approach and collected data through open ended questionnaires and…

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

    PubMed Central

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

    2013-01-01

    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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2000-01-01

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

  18. Using Parental Perceptions of Childhood Allergic Rhinitis to Inform Primary Care Management

    PubMed Central

    Garbutt, Jane M.; Sterkel, Randall; Mullen, Kathy B.; Conlon, Bridget; Leege, Erin; Bloomberg, Gordon; Strunk, Robert C.

    2014-01-01

    Objective To describe parents’ experience with their child’s allergic rhinitis (AR) to inform management by the primary care provider (PCP). Study Design Two hundred parents with a child 7 to 15 years old with AR symptoms within the past 12-months completed a paper survey. Results The child’s AR was identified as a significant problem in spring (89.3%), fall (63.4%), summer (50.3%) and winter (21.4%); 51.3% had persistent disease. AR symptoms most commonly interfered with the child’s outdoor activities and sleeping, and frequently bothered the parent and other family members. Most parents (88.3%) wanted to know what their child was allergic to and had many concerns about treatment options. 62.9% had sought AR care from the PCP in the past 12 months. Conclusions Many families experience significant morbidity from their child’s AR and turn to their PCP for help. We identified opportunities for the PCP to reduce AR morbidity. PMID:24803628

  19. An exploration of opioid medication management for non-malignant pain in primary care.

    PubMed

    Song, Jia; Foell, Jens

    2015-08-01

    The present study aimed to explore how prescription of opioid medication for chronic non-malignant pain (CNMP) is managed in primary care. We used audit as a research tool, and one general practitioner (GP) practice in West London acted as an exemplar. Of the practice population with CNMP, 1% had repeat prescription of at least 12?months duration for opioid analgesics at the time of data collection. These 1% are on highly controlled opioids. Our study showed the following: (1) long-term opioid prescription appears to follow a fluctuating course as opposed to staying the same; (2) we found that medication reviews were done in most cases (85.7%), but the quality of the process is difficult to assess and ascertain; and (3) we identified two incidences where opioid contract was implemented. In both cases, contracts were used as a last chance warning for patients who were already problematic, suggesting that opioid contracts served as a disciplinary tool rather than a preventative measure. Our findings highlight a need for a more structured and specific review of analgesic medication, and a need for a simple and effective way to identify patients at high risk of developing problematic use, to ensure better monitoring and early presentations. PMID:26516575

  20. An exploration of opioid medication management for non-malignant pain in primary care

    PubMed Central

    Foell, Jens

    2015-01-01

    The present study aimed to explore how prescription of opioid medication for chronic non-malignant pain (CNMP) is managed in primary care. We used audit as a research tool, and one general practitioner (GP) practice in West London acted as an exemplar. Of the practice population with CNMP, 1% had repeat prescription of at least 12?months duration for opioid analgesics at the time of data collection. These 1% are on highly controlled opioids. Our study showed the following: (1) long-term opioid prescription appears to follow a fluctuating course as opposed to staying the same; (2) we found that medication reviews were done in most cases (85.7%), but the quality of the process is difficult to assess and ascertain; and (3) we identified two incidences where opioid contract was implemented. In both cases, contracts were used as a last chance warning for patients who were already problematic, suggesting that opioid contracts served as a disciplinary tool rather than a preventative measure. Our findings highlight a need for a more structured and specific review of analgesic medication, and a need for a simple and effective way to identify patients at high risk of developing problematic use, to ensure better monitoring and early presentations. PMID:26516575

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

    NASA Astrophysics Data System (ADS)

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

    2015-01-01

    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 test the capabilities of remotely sensed VIs and soybean phenology to estimate the seasonal dynamics of carbon fluxes. The modeled GPP (GPPVPM) using vegetation photosynthesis model (VPM) was compared with the GPP (GPPEC) estimated from eddy covariance measurements. The VIs tracked soybean phenology well and delineated the growing season length (GSL), which was closely related to carbon uptake period (CUP, R2 = 0.84), seasonal sums of net ecosystem CO2 exchange (NEE, R2 = 0.78), and GPPEC (R2 = 0.54). Land surface water index (LSWI) tracked drought-impacted vegetation well, as the LSWI values were positive during non-drought periods and negative during severe droughts within the soybean growing season. On a seasonal scale, NEE of the soybean sites ranged from -37 to -264 g C m-2. The result suggests that rainfed soybean fields needed about 450-500 mm of well-distributed seasonal rainfall to maximize the net carbon sink. During non-drought conditions, VPM accurately estimated seasonal dynamics and interannual variation of GPP of soybean under different management practices. However, some large discrepancies between GPPVPM and GPPEC were observed under drought conditions as the VI did not reflect the corresponding decrease in GPPEC. Diurnal GPPEC dynamics showed a bimodal distribution with a pronounced midday depression at the period of higher water vapor pressure deficit (>1.2 kPa). A modified Wscalar based on LSWI to account for the water stress in VPM helped quantify the reduction in GPP during severe drought and the model's performance improved substantially. In conclusion, this study demonstrates the potential of integrating vegetation activity through satellite remote sensing with ground-based flux and climate data for a better understanding and upscaling of carbon fluxes of soybean croplands.

  2. Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care

    PubMed Central

    Hiratsuka, Vanessa Y.; Smith, Julia J.; Norman, Sara M.; Manson, Spero M.; Dillard, Denise A.

    2015-01-01

    Background A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs). Objectives (a) To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with guideline concordant management and (b) to assess whether management varied by patient and provider factors. Research design Secondary analysis of electronic and paper medical record information of 400 AN/AIs. Measures Provider variables, patient demographics and patient clinical factors were electronically queried. Manual chart audits assessed depression notation, diagnoses and management within 12 weeks of positive screening. Multilevel ordinal logistic modelling assessed management by patient and provider factors. Results A depression diagnosis was present in 141 (35%) charts and 151 (38%) had depressive symptoms noted. Detection was higher among AN/AIs with moderate and severe depression (p<0.001). In total, 258 patients (66%) received guideline concordant management, 32 (8%) had some management, and 110 (28%) received no management. Younger patient age and increased provider tenure increased odds of management. Conclusions Most AN/AIs screening positive for depression received initial guideline concordant management. Additional outreach to older patients and additional support for providers newer to practices appears warranted. PMID:26519359

  3. 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

  4. 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

  5. [How I treat...The choice between a sulphonylulrea and a gliptin to manage hyperglycaemia in type 2 diabetes].

    PubMed

    Scheen, A J

    2014-09-01

    The pharmacological therapy of hyperglycaemia in type 2 diabetes becomes increasingly complex. After failure of metformin monotherapy, several choices are possible. In clinical practice, the most common dilemma is to choose between adding a sulphonylurea or adding a dipeptidyl peptidase-4 inhibitor (gliptin). This review analyses the arguments in favour of one or the other pharmacological option, based upon criteria of efficacy, tolerance, safety, easiness of use, use in at risk populations and, last but not least, cost of therapy. In general, a patient-centered approach is recommended with an individualization of the therapy in function of the characteristics of each patient with the aim to obtain the best benefits/ risks ratio, at an affordable cost. PMID:25796755

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

    PubMed

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

    2013-11-01

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

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

    SciTech Connect

    Goda, Jayant Sastri; Le, Lisa W.; Lapperriere, Normand J.; Millar, Barbara-Ann; Payne, David; Gospodarowicz, Mary K.; Wells, Woodrow; Hodgson, David C.; Sun, Alexander; Simpson, Rand; Tsang, Richard W.

    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.

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

    PubMed

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

    2014-11-01

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

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

    PubMed Central

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

    2014-01-01

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

  10. 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

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

    ERIC Educational Resources Information Center

    Tamm, Anni; Tõugu, Pirko; Tulviste, Tiia

    2014-01-01

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

  12. Part-time, e-learning interprofessional pain management education for the primary and community care setting

    PubMed Central

    Bean, W Geinor; Luke, Karl

    2014-01-01

    Chronic pain is a long-term condition, which has a major impact on patients, carers and the health service. Despite the Chief Medical Officer setting chronic pain and its management as a national priority in 2008, the utilisation of health services by patients with long-term conditions is increasing, people with pain-related problems are not seen early enough and pain-related attendances to accident and emergency departments is increasing. Early assessment with appropriate evidence-based intervention and early recognition of when to refer to specialist and specialised services is key to addressing the growing numbers suffering with chronic pain. Pain education is recommended in many guidelines, as part of the process to address pain in these issues. Cardiff University validated an e-learning, master’s level pain management module for healthcare professionals working in primary and community care. The learning outcomes revolve around robust early assessment and management of chronic pain in primary and community care and the knowledge when to refer on. The module focuses on the biopsychosocial aspects of pain and its management, using a blog as an online case study assessment for learners to demonstrate their knowledge, understanding and application to practice. The module has resulted in learners developing evidence-based recommendations, for pain management in clinical practice. PMID:26516530

  13. Part-time, e-learning interprofessional pain management education for the primary and community care setting.

    PubMed

    Jenkins, M Sue; Bean, W Geinor; Luke, Karl

    2014-02-01

    Chronic pain is a long-term condition, which has a major impact on patients, carers and the health service. Despite the Chief Medical Officer setting chronic pain and its management as a national priority in 2008, the utilisation of health services by patients with long-term conditions is increasing, people with pain-related problems are not seen early enough and pain-related attendances to accident and emergency departments is increasing. Early assessment with appropriate evidence-based intervention and early recognition of when to refer to specialist and specialised services is key to addressing the growing numbers suffering with chronic pain. Pain education is recommended in many guidelines, as part of the process to address pain in these issues. Cardiff University validated an e-learning, master's level pain management module for healthcare professionals working in primary and community care. The learning outcomes revolve around robust early assessment and management of chronic pain in primary and community care and the knowledge when to refer on. The module focuses on the biopsychosocial aspects of pain and its management, using a blog as an online case study assessment for learners to demonstrate their knowledge, understanding and application to practice. The module has resulted in learners developing evidence-based recommendations, for pain management in clinical practice. PMID:26516530

  14. Long-Term Clinical Outcomes of Care Management for Chronically Depressed Primary Care Patients: A Report From the Depression in Primary Care Project

    PubMed Central

    Klinkman, Michael S.; Bauroth, Sabrina; Fedewa, Stacey; Kerber, Kevin; Kuebler, Julie; Adman, Tanya; Sen, Ananda

    2010-01-01

    PURPOSE Recent studies examining depression disease management report improvements in short-term outcomes, but less is known about whether improvements are sustainable over time. This study evaluated the sustained clinical effectiveness of low-intensity depression disease management in chronically depressed patients. METHODS The Depression in Primary Care (DPC) intervention was introduced in 5 primary care practices in the University of Michigan Health System, with 5 matched practices selected as control sites. Clinicians were free to refer none, some, or all of their depressed patients at their discretion. Core clinical outcomes of remission and serial change in Patient Health Questionnaire (PHQ-8) scores for 728 DPC enrollees observed for up to 18 months after enrollment were compared with those for 78 patients receiving usual care who completed mailed questionnaires at baseline, 6, 12, and 18 months. RESULTS DPC enrollees had sustained improvement in remission rates and reduced-function days over the full 18 months. Mean change in the PHQ-8 score over each 6-month interval was more favorable for DPC enrollees than for usual care patients, and the proportion of DPC enrollees in remission was higher at 6 months (43.4% vs 33.3%; P = .11), 12 months (52.0% vs 33.9%; P=.012), and 18 months (49.2% vs 27.3%; P = .004). Multivariate analysis controlling for age, sex, ethnicity, baseline severity, and comorbid medical illness confirmed that DPC enrollees had significantly more reduction in depressive symptom burden over 18 months. CONCLUSIONS The DPC intervention produced sustained improvement in clinical outcomes over 18 months in a cohort of chronically depressed patients with persistent symptoms despite active treatment. PMID:20843879

  15. Classroom Management: A Study on the Training Needs of Primary School Teachers

    ERIC Educational Resources Information Center

    El Warfali, Faida Imhemid Salem; Yusoff, Nik Mohd Rahimi Nik

    2014-01-01

    This study aimed to identify the training needs of the in-service primary school teachers in the city of Benghazi, Libya. Data collection involved the administration of a set of questionnaire to 420 teachers and interviews with ten of them. The study found that the most important training needs of the primary school teachers in terms of classroom…

  16. 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

  17. 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

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

    PubMed Central

    2013-01-01

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

  19. 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

  20. Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization.

    PubMed

    Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K

    2013-01-01

    The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described. PMID:23324507

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

    USGS Publications Warehouse

    Allen, Arthur W.; Vandever, Mark W.

    2012-01-01

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

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

    PubMed

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

    2014-12-01

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

  3. Inequalities in primary care management of knee pain and disability in older adults: an observational cohort study

    PubMed Central

    Vohora, Kanchan; Young, Julie; Handy, June; Porcheret, Mark; Jordan, Kelvin P.

    2011-01-01

    Objectives. To describe primary care management of knee pain, in relation to National Institute for Health and Clinical Excellence (NICE) OA guidelines, and examine variation in management by patient characteristics. Methods. Subjects were 755 adults aged ?50 years who responded to baseline and 3-year surveys and had consulted primary care for knee pain. Medical records (1997–2006) were searched. Associations of having interventions from the outer circle (adjunctive treatments or Step 3) of the NICE guidelines with self-reported socio-demographic and knee-specific factors were determined. Results. Eighty per cent had received a Step 3 intervention. Thirty-eight per cent had been referred to secondary care, and 10% had received a knee replacement. Forty-three per cent had been prescribed an opioid and 41% an NSAID. Severe knee pain or disability at baseline and follow-up was the main association with receiving a Step 3 intervention [adjusted odds ratio (OR) 2.26; 95% CI 1.38, 3.70] and with referral (OR 2.57; 95% CI 1.72, 3.83). Older patients were less likely to be referred. Although non-significant, those of higher social class, in more affluent areas, older age or overweight or obese, appeared more likely to receive a knee replacement. Fifty per cent of those reporting severe knee pain or disability in both surveys had not been referred to secondary care. Conclusion. Most of the older adults who consult primary care with knee pain receive at least one Step 3 intervention from the OA guidelines. Inequalities in the management and referral of knee problems in primary care were generally not observed, although there were some trends towards differences in likelihood of total knee replacement. PMID:21733968

  4. The role of primary plastic surgery in the management of open fractures.

    PubMed

    Court-Brown, Charles M; Honeyman, Calum S; Clement, Nick D; Hamilton, Stuart A; McQueen, Margaret M

    2015-12-01

    A study was undertaken to determine the requirement for primary plastic surgery in the treatment of open fractures. We reviewed 3297 consecutive open fractures in a 22-year period in a defined population. Analysis showed that 12.6% of patients required primary plastic surgery with 5.6% being treated with split skin grafting and 7.2% with a flap. Only 3.5% of open upper limb fractures required primary plastic surgery compared to 27.9% of open lower limb fractures. The fractures that required most primary plastic surgery were those of the femoral diaphysis and all fractures between the proximal tibia and the midfoot. The incidence of open fractures that require primary plastic surgery was 28/10(6)/year. The incidence in open upper and lower limb fractures was 5.3/10(6)/year and 22.7/10(6)/year respectively. Using these figures it is possible to estimate the numbers of open fractures that will require primary plastic surgery each year in the United Kingdom. PMID:26456270

  5. Enlightened Choices

    ERIC Educational Resources Information Center

    Craig, Will

    2006-01-01

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

  6. Understanding the College Choice Process of Catholic Homeschooled Students

    E-print Network

    Henry, Linda Mary

    2011-05-31

    ) college choice model, and primary influences on college choice, including cultural and social capital. Several themes emerged through data analysis. First, participants aspired to attend college and had parents who expected them to go to college. Second...

  7. 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

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

    PubMed Central

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

    2014-01-01

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

  10. 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

  11. The Attitudes of Men and Women Primary School Teachers to Promotion and Education Management.

    ERIC Educational Resources Information Center

    Jones, Mary-Lyn

    1990-01-01

    A questionnaire and indepth interviews were designed to test the gender differences in attitudes regarding the promotion of men and women primary school teachers. Responses from a sample drawn from a Welsh local education authority show clear gender differentiation; that women teachers need assistance and guidance to achieve their potential in the…

  12. 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…

  13. "It's One of Those Scary Areas": Leadership and Management of Music in Primary Schools

    ERIC Educational Resources Information Center

    Beauchamp, Gary; Harvey, Janet

    2006-01-01

    The role of the subject leader, or co-ordinator, in the primary school has evolved considerably over recent years. Ultimately, responsibility for individual subjects remains with the headteacher and governors, but much work has been increasingly devolved, at least theoretically, to subject leaders. In this role they need to demonstrate the ability…

  14. Journal of Environmental Management 85 (2007) 597606 Assessing the impact of urbanization on regional net primary

    E-print Network

    Nassar, Ray

    2007-01-01

    on regional net primary productivity in Jiangyin County, China C. Xua , M. Liua,Ã, S. Ana , J.M. Chenb , P rates of urbanization in China. In this study, carried out in Jiangyin County as a representative region areas were the major forms of land transformation in Jiangyin County during this period. Mean NPP

  15. Inter-Professional Primary Care Practices Addressing Diabetes Prevention and Management

    ERIC Educational Resources Information Center

    Beagrie, Lesley

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Durmuscelebi, Mustafa

    2010-01-01

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

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

    PubMed Central

    2014-01-01

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

  18. 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…

  19. 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

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

    PubMed Central

    2013-01-01

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

  1. 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

  2. An interdisciplinary clinical practice model for the management of low-back pain in primary care: the CLIP project

    PubMed Central

    Poitras, Stéphane; Rossignol, Michel; Dionne, Clermont; Tousignant, Michel; Truchon, Manon; Arsenault, Bertrand; Allard, Pierre; Coté, Manon; Neveu, Alain

    2008-01-01

    Background Low-back pain is responsible for significant disability and costs in industrialized countries. Only a minority of subjects suffering from low-back pain will develop persistent disability. However, this minority is responsible for the majority of costs and has the poorest health outcomes. The objective of the Clinic on Low-back pain in Interdisciplinary Practice (CLIP) project was to develop a primary care interdisciplinary practice model for the clinical management of low-back pain and the prevention of persistent disability. Methods Using previously published guidelines, systematic reviews and meta-analyses, a clinical management model for low-back pain was developed by the project team. A structured process facilitating discussions on this model among researchers, stakeholders and clinicians was created. The model was revised following these exchanges, without deviating from the evidence. Results A model consisting of nine elements on clinical management of low-back pain and prevention of persistent disability was developed. The model's two core elements for the prevention of persistent disability are the following: 1) the evaluation of the prognosis at the fourth week of disability, and of key modifiable barriers to return to usual activities if the prognosis is unfavourable; 2) the evaluation of the patient's perceived disability every four weeks, with the evaluation and management of barriers to return to usual activities if perceived disability has not sufficiently improved. Conclusion A primary care interdisciplinary model aimed at improving quality and continuity of care for patients with low-back pain was developed. The effectiveness, efficiency and applicability of the CLIP model in preventing persistent disability in patients suffering from low-back pain should be assessed. PMID:18426590

  3. The role of radionuclide imaging in the surgical management of primary hyperparathyroidism.

    PubMed

    Hindié, Elif; Zanotti-Fregonara, Paolo; Tabarin, Antoine; Rubello, Domenico; Morelec, Isabelle; Wagner, Tristan; Henry, Jean-François; Taïeb, David

    2015-05-01

    Primary hyperparathyroidism is a frequent and potentially debilitating endocrine disorder for which surgery is the only curative treatment. The modalities of parathyroid surgery have changed over the last 2 decades, as conventional bilateral neck exploration is no longer the only surgical approach. Parathyroid scintigraphy plays a major role in defining the surgical strategy, given its ability to orient a targeted (focused) parathyroidectomy and to recognize ectopic locations or multiglandular disease. This review, which represents a collaborative effort between nuclear physicians, endocrinologists, and endocrine surgeons, emphasizes the importance of performing imaging before any surgery for primary hyperparathyroidism, even in the case of conventional bilateral neck exploration. We discuss the advantages and drawbacks of targeted parathyroidectomy and the performance of various scintigraphic protocols to guide limited surgery. We also discuss the optimal strategy to localize the offending gland before reoperation for persistent or recurrent hyperparathyroidism. Finally, we describe the potential applications of novel PET tracers, with special emphasis on (18)F-fluorocholine. PMID:25858040

  4. Electronic clinical records in primary care for estimating disease burden and management. An example of COPD.

    PubMed

    Verde-Remeseiro, Luis; López-Pardo, Estrella; Ruano-Ravina, Alberto; Gude-Sampedro, Francisco; Castro-Calvo, Ramón

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is a significant health problem in developed countries. We aimed to estimate the prevalence of COPD in a single Spanish healthcare area. We also aimed to assess if there are any differences in prevalence and spirometry use among primary care services by utilizing already registered information. We designed a cross-sectional study to determine the prevalence of COPD and the performance of spirometries in each primary care service. A total of 8,444 patients were diagnosed with COPD, with a prevalence of 2.6% for individuals older than 39 years. The prevalence increased with age and was much higher in men. Significant heterogeneity was found in the prevalence of COPD and spirometry use among primary care services. COPD was underdiagnosed and there was wide variability in spirometry use in our area. Greater efforts are needed to diagnose COPD in order to improve its clinical outcomes and to refine registries so that they can be used as reliable sources of information. PMID:25959609

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

    PubMed Central

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

    2014-01-01

    Background: Primary extradural tumors of the spine comprise only a small percentage of all spinal tumors. However, given their relative radioresistance and their typical malignant, invasive nature, surgery may be associated with fairly high morbidity and mortality rates. Furthermore, it may be especially difficult to achieve gross total resections with tumor-free margins. Case Descriptions: We present two cases and review the literature regarding the presentation, diagnosis, and evidence-based guidance/treatment of primary extradural spinal tumors. The first patient with an L1 chordoma presented with cauda equina syndrome. Following surgery, the second patient, with a giant cell tumor of the cervicothoracic junction, responded well to the novel drug denosumab, a monoclonal antibody to the RANK ligand. Conclusion: Primary extradural spine tumors pose significant challenges to surgeons as the aim is to achieve satisfactory surgical outcomes with clean tumor margins (e.g, thus avoid recurrence) while minimizing morbidity. Improvements in radiotherapy, chemotherapy, and novel molecular drugs may increase survival rates and improve overall outcomes. PMID:25289164

  6. Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism.

    PubMed

    Monticone, Silvia; Satoh, Fumitoshi; Dietz, Anna S; Goupil, Remi; Lang, Katharina; Pizzolo, Francesca; Gordon, Richard D; Morimoto, Ryo; Reincke, Martin; Stowasser, Michael; Mulatero, Paolo

    2016-01-01

    Aldosterone-producing adenoma and bilateral adrenal hyperplasia account for >90% of all primary aldosteronism cases. Distinguishing between bilateral and unilateral disease is of fundamental importance because it allows targeted therapy. Adrenal vein sampling (AVS) is the only reliable means to preoperatively differentiate between unilateral and bilateral subtypes. A rare but serious complication of AVS is an adrenal hemorrhage (AH). We retrospectively examined in detail 24 cases of AH during AVS in 6 different referral hypertension centers. AH more often affected the right adrenal (n=18) than the left (n=5, P<0.001); 1 bilateral. Median duration of experience of the radiologist in AVS at the time of AH was 5.0 years (0.6-7.8) and AH occurred with both highly experienced (>10 years) and less experienced radiologists. Of 9 patients who suffered AH in the gland contralateral to an aldosterone-producing adenoma and who underwent complete (n=6) or partial (n=3) unilateral adrenalectomy, only one required long-term corticosteroid replacement for adrenal insufficiency. No reduction in blood pressure or biochemical resolution of primary aldosteronism occurred in any of those patients who experienced AH in the gland ipsilateral to an aldosterone-producing adenoma (n=6) or who had bilateral adrenal hyperplasia (n=9). No patient required invasive treatments to control bleeding or blood transfusion. In conclusion, AH usually has a positive outcome causing either no or minor effects on adrenal function, and AVS should remain the best approach to primary aldosteronism subtype differentiation. PMID:26573704

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

    PubMed

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

    2015-01-01

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

  8. Managing an Online Survey about Influenza Vaccination in Primary Healthcare Workers

    PubMed Central

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

    2015-01-01

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

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

    NASA Technical Reports Server (NTRS)

    Dawson, David L.

    2000-01-01

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

  10. 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

  11. 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

  12. 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…

  13. 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...

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Hurley, Roberta Smith; 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…

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

    ERIC Educational Resources Information Center

    Molleson, Ann L.; 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…

  17. 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...

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

    ERIC Educational Resources Information Center

    Stein, Joan Z.; 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…

  19. 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...

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

    PubMed Central

    2012-01-01

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

  1. Analysis of benzodiazepine withdrawal program managed by primary care nurses in Spain

    PubMed Central

    2012-01-01

    Background Benzodiazepine (BZD), the long-term treatment of which is harmful for cognitive function, is widely prescribed by General Practitioners in Spain. Based on studies performed in other countries we designed a nurse-led BZD withdrawal program adapted to Spanish Primary Care working conditions. Results A pseudo-experimental (before-after) study took place in two Primary Care Centres in Barcelona. From a sample of 1150 patients, 79 were identified. They were over 44 years old and had been daily users of BZD for a period exceeding six months. Out of the target group 51 patients agreed to participate. BZD dosage was reduced every 2-4 weeks by 25% of the initial dose with the optional support of Hydroxyzine or Valerian. The rating measurements were: reduction of BZD prescription, demographic variables, the Short-Form Health Survey (SF-12) to measure quality of life, the Medical Outcomes Study (MOS) Sleep Scale, and the Goldberg Depression and Anxiety Scale. By the end of the six-month intervention, 80.4% of the patients had discontinued BZD and 64% maintained abstinence at one year. An improvement in all parameters of the Goldberg scale (p <0.05) and in the mental component of SF-12 at 3.3 points (p = 0.024), as well as in most components of the MOS scale, was observed in the group that had discontinued BZD. No significant differences in these scales before and after the intervention were observed in the group that had not discontinued. Conclusions At one year approximately 2/3 of the patients had ceased taking BZD. They showed an overall improvement in depression and anxiety scales, and in the mental component of the quality of life scale. There was no apparent reduction in the sleep quality indicators in most of the analysed components. Nurses in a Primary Care setting can successfully implement a BZD withdrawal program. PMID:23237104

  2. Managing gout in the primary care setting: what you and your patients need to know.

    PubMed

    Doghramji, Paul P; Edwards, N Lawrence; McTigue, Joan

    2010-08-01

    The US prevalence of gout, a rapidly progressive inflammatory arthritic condition linked to serum uric acid levels, has grown in recent years, in part due to the increasing prevalence and incidence of predisposing factors in the population, such as metabolic syndrome, obesity, and the use of diuretics. Left untreated, gout can be debilitating and cause deformity. Although a definitive diagnosis requires joint aspiration, only approximately 11% of patients with suspected gout undergo this procedure, and a presumptive diagnosis based on patient medical history and presentation with characteristic symptoms and comorbidities is a reasonable guidelines-based approach that has utility in the primary care setting, where approximately 70% of all cases and nearly 3,000,000 visits occur. The therapeutic standard for patients with recurrent gout flares is urate-lowering therapy (ULT), including allopurinol and the recently introduced febuxostat, the first new treatment for gout in 40 years. Although ULT must be taken consistently to sustain benefits, inadequate dosing and patient nonadherence or intolerance to therapy often lead to treatment failure. It is important that primary care clinicians understand gout diagnosis and therapeutic approaches and can communicate effectively with patients to improve treatment adherence. ONLINE ACCESS: http://cmeaccess.com/cme/ajm_gout_program/ This CME Multimedia Activity is also available through the Website of The American Journal of Medicine (www.amjmed.com). Click on the CME Multimedia Activity button in the navigation bar for full access. PMID:20670699

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

    PubMed

    Thille, Patricia; Ward, Natalie; Russell, Grant

    2014-05-01

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

  4. Management of STDs and cost of treatment in primary health care centres in Pikine, Senegal.

    PubMed

    Van der Veen, F H; Ndoye, I; Guindo, S; Deschampheleire, I; Fransen, L

    1994-01-01

    We studied the current management of STD-related syndromes by urban health facilities in Pikine (Senegal) in 252 consecutive patients presenting with STD-related complaints, to assess the cost and effectiveness of services and to estimate the potential benefit by introducing management protocols. Most common presenting complaints for women were vaginal discharge and low abdominal pain, reported for 122 (82.9%) and 22 (15.0%) of 147 female patients. Urethral discharge and genital ulceration were reported for 80 (76.2%) and for 17 (16.2%) of 105 male patients. The average cost was 4.01 ECU (1 European Currency Unit = 1.2 US$ = 334 Franc CFA) for male patients (ranging from 0.57 to 25.70 ECU) and 12.75 ECU for female patients (ranging from 0.57 to 37.60 ECU). Only 20 of 80 patients with urethral discharge (25%) received effective treatment. Effectiveness was not related to cost of therapy or qualification of staff. Utilization of management protocols improves the quality and accessibility of care for STD, by potentially doubling effectiveness and reducing the costs for patients to 12% of the current level. PMID:7948156

  5. Antiphospholipase A2 Receptor Autoantibodies: A Step Forward in the Management of Primary Membranous Nephropathy

    PubMed Central

    Obrisca, Bogdan; Ismail, Gener; Jurubita, Roxana; Baston, Catalin; Andronesi, Andreea; Mircescu, Gabriel

    2015-01-01

    Since the identification of PLA2R (M-type phospholipase A2 receptor) as the first human antigenic target in primary membranous nephropathy (MN), perpetual progress has been made in understanding the pathogenesis of this disease. Accumulating clinical data support a pathogenic role for the anti-PLA2R antibodies (PLA2R ABs), but confirmation in an animal model is still lacking. However, PLA2R ABs were related to disease activity and outcome, as well as to response therapy. Accordingly, PLA2R ABs assay seems to be promising tool not only to diagnose MN but also to predict the course of the disease and could open the way to personalize therapy. Nevertheless, validation of a universal assay with high precision and definition of cut-off levels, followed by larger studies with a prolonged follow-up period, are needed to confirm these prospects. PMID:26576418

  6. Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services.

    PubMed

    Straiton, Melanie L; Powell, Kathryn; Reneflot, Anne; Diaz, Esperanza

    2016-01-01

    Researchers in Norway explore treatment options in primary care for immigrant women with mental health problems compared with nonimmigrant women. Three national registers were linked together for 2008. Immigrant women from Sweden, Poland, the Philippines, Thailand, Pakistan, and Russia were selected for analysis and compared with Norwegian women. Using logistic regression, we investigated whether treatment type varied by country of origin. Rates of sickness leave and psychiatric referrals were similar across all groups. Conversational therapy and use of antidepressants and anxiolytics were lower among Filipina, Thai, Pakistani, and Russian women than among Norwegians. Using the broad term "immigrants" masks important differences in treatment and health service use. By closely examining mental health treatment differences by country of origin, gaps in service provision and treatment uptake may be identified and addressed with more success. PMID:26251953

  7. Antiphospholipase A2 Receptor Autoantibodies: A Step Forward in the Management of Primary Membranous Nephropathy.

    PubMed

    Obrisca, Bogdan; Ismail, Gener; Jurubita, Roxana; Baston, Catalin; Andronesi, Andreea; Mircescu, Gabriel

    2015-01-01

    Since the identification of PLA2R (M-type phospholipase A2 receptor) as the first human antigenic target in primary membranous nephropathy (MN), perpetual progress has been made in understanding the pathogenesis of this disease. Accumulating clinical data support a pathogenic role for the anti-PLA2R antibodies (PLA2R ABs), but confirmation in an animal model is still lacking. However, PLA2R ABs were related to disease activity and outcome, as well as to response therapy. Accordingly, PLA2R ABs assay seems to be promising tool not only to diagnose MN but also to predict the course of the disease and could open the way to personalize therapy. Nevertheless, validation of a universal assay with high precision and definition of cut-off levels, followed by larger studies with a prolonged follow-up period, are needed to confirm these prospects. PMID:26576418

  8. [Use of evaluation by primary healthcare managers: a case study in southern Brazil].

    PubMed

    Nickel, Daniela Alba; Natal, Sonia; Hartz, Zulmira Maria de Araújo; Calvo, Maria Cristina Marino

    2014-12-01

    This article reports on a meta-evaluation, focused on utilization, in a state in southern Brazil. This was a single case study with primary data collection using semi-structured interviews with health department administrators and staff. Content analysis used categories defined in the evaluation matrix: political and organizational context and implementation of evaluation. The political and organizational context revealed weaknesses in the items on experience, evaluation team, and time and space for reflection. Technical autonomy was verified in the State and in one municipality. In the implementation of evaluation, evaluative quality met the established criteria, but there was no prior definition of the uses and users of evaluation. One report referred to use for planning actions and political use. The study concluded that evaluation produced important information for stakeholders, with the political and organizational context as the principal limiting factor for use. PMID:26247991

  9. Group diabetes self-management education in a primary care setting: a quality improvement project.

    PubMed

    Harris, Tara; Silva, Susan; Intini, Ronald; Smith, Tommy; Vorderstrasse, Allison

    2014-01-01

    This quality improvement project evaluated the effectiveness of a monthly diabetes self-management education intervention on HbA1C and knowledge levels in patients with type 2 diabetes mellitus. A retrospective analysis evaluating 51 patients found no significant improvement in HbA1C levels; however, there was a significant improvement in knowledge levels. Race was an influential factor on HbA1C levels showing a significant elevation in mean HbA1C in African Americans, while there was a decrease in mean HbA1c in Caucasians over the 6-month evaluation period. PMID:24121861

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

    PubMed

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

    2015-05-01

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

  11. Critical appraisal of laropiprant and extended-release niacin combination in the management of mixed dyslipidemias and primary hypercholesterolemia

    PubMed Central

    Hussein, Ayman A; Nicholls, Stephen J

    2010-01-01

    Niacin is a B-complex vitamin which has been used for decades for the management of mixed dyslipidemias and primary hypercholesterolemia. It decreases the risk of cardiovascular events either when used as a monotherapy or in combination with other lipid lowering medications. However, a major limitation to its use is niacin-induced flushing occurring even with the extended-release formulations. Laropiprant, a selective prostaglandin-2 receptor inhibitor, specifically targets the cascade of events causing the flushing. It has been recently used in combination with extended-release niacin. This article will review the early experience with this combination with focus on efficacy, safety, tolerability and current place in therapy. Early data are promising and suggest that more patients in clinical practice will benefit from niacin combined with laropiprant. Ongoing clinical trials will provide a better insight on the long-term safety of the drug and its efficacy for reducing cardiovascular events. PMID:20421916

  12. Critical appraisal of laropiprant and extended-release niacin combination in the management of mixed dyslipidemias and primary hypercholesterolemia.

    PubMed

    Hussein, Ayman A; Nicholls, Stephen J

    2010-01-01

    Niacin is a B-complex vitamin which has been used for decades for the management of mixed dyslipidemias and primary hypercholesterolemia. It decreases the risk of cardiovascular events either when used as a monotherapy or in combination with other lipid lowering medications. However, a major limitation to its use is niacin-induced flushing occurring even with the extended-release formulations. Laropiprant, a selective prostaglandin-2 receptor inhibitor, specifically targets the cascade of events causing the flushing. It has been recently used in combination with extended-release niacin. This article will review the early experience with this combination with focus on efficacy, safety, tolerability and current place in therapy. Early data are promising and suggest that more patients in clinical practice will benefit from niacin combined with laropiprant. Ongoing clinical trials will provide a better insight on the long-term safety of the drug and its efficacy for reducing cardiovascular events. PMID:20421916

  13. Laparoscopic management of primary pelvi-ureteric junction obstruction: Single-centre experience

    PubMed Central

    Nour, Hani; Mostafa, Ahmad; Gobashy, Samir; Elganzoury, Hossam; Elkholy, Amr; Riad, Essam

    2011-01-01

    Objective To evaluate the effect and safety of laparoscopic pyeloplasty in the treatment of pelvi-ureteric junction obstruction (PUJO). Patients and methods In 34 patients, laparoscopic dismembered pyeloplasty was used to treat primary PUJO. Information was obtained for symptoms, results of a nuclear scan before and after surgery, intraoperative blood loss, operative duration, stenting method, and hospital stay. Under general anaesthesia and in the flank position, a 10 mm trocar was first placed above the umbilicus; three 5 mm working ports were then placed. The ureter and pelvis were freed from surrounding adhesions. The obstructive pelvi-ureteric segment was then excised, and the opened point of the ureter spatulated. Ureteropyeloplasty between the lower pole, pelvis and spatulated ureter was made using a 4-0 polyglactin suture around a JJ stent. Results The mean (SD) preoperative nuclear scan result was 23.6 (6.4) mL/min, with retention of tracer. The median operative duration was 200 min, and the median blood loss 120 mL. All patients were stented with a JJ stent. The mean hospital stay was 5 days. The final results were assessed at 6 months after surgery, when the mean (SD) nuclear scan result was 30 (7.4) mL/min. Conclusion Laparoscopic pyeloplasty is a safe and effective option which can produce satisfactory results both clinically and radiologically.

  14. Computer visualisation of patient safety in primary care: a systems approach adapted from management science and engineering.

    PubMed

    Singh, Ranjit; Singh, Ashok; Fox, Chester; Seldan Taylor, John; Rosenthal, Thomas; Singh, Gurdev

    2005-01-01

    Patient safety and medical errors in ambulatory primary care are receiving increasing attention from policy makers, accreditation bodies and researchers, as well as by practising family physicians and their patients. While a great deal of progress has been made in understanding errors in hospital settings, it is important to recognise that ambulatory settings pose a very large and different set of challenges and that the types of hazards that exist and the strategies required to reduce them are very different. What is needed is a logical theoretical model for understanding the causes of errors in primary care, the role of healthcare systems in contributing to errors, the propagation of errors through complex systems and, importantly, for understanding ambulatory primary care in the context of the larger healthcare system. The authors have developed such a model using a formal 'systems engineering' approach borrowed from the management sciences and engineering. This approach has not previously been formally described in the medical literature.This paper outlines the formal systems approach, presents our visual model of the system, and describes some experiences with and potential applications of the model for monitoring and improving safety. Applications include providing a framework to help focus research efforts, creation of new (visual) error reporting and taxonomy systems, furnishing a common and unambiguous vision for the healthcare team, and facilitating retrospective and prospective analyses of errors and adverse events. It is aimed at system redesign for safety improvement through a computer-based patient-centred safety enhancement and monitoring instrument (SEMI-P). This model can be integrated with electronic medical records (EMRs). PMID:15992498

  15. 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

  16. [Community resources prescription for self-care improvement in chronic illnesses. Clinical case management in Primary Health Care].

    PubMed

    Pérez-Vico-Díaz de Rada, Lucía; González-Suárez, Miriam; Duarte-Clíments, Gonzalo; Brito-Brito, Pedro Ruymán

    2014-01-01

    A case is presented of a 52 year-old male seen in a Primary Care nursing clinic for a type 2 diabetes mellitus metabolic control. The frequency of the visits increased due to perceived difficulties caused by changing the medical treatment. A focused interview was conducted under functional health patterns framework. The patient was unable to write or read, had not worked for the last 25 years, and expressed a lack of control over his self-care. An action plan was prepared, prioritizing Ineffective Health Maintenance, Powerlessness, and Impaired Social Interaction NANDA-I nursing diagnoses. The goals were set at improving knowledge and control over his disease and participating in leisure activities. To achieve these, the social health resources in the area were contacted, and agreed that the patient could attend activities that could improve his self-care and his quality of life. An improvement in his diabetes control was observed in the following evaluations, with an increase in his level of knowledge and self-care. The Primary Health care nurse should consider available community resources by using a comprehensive approach to chronic diseases for their therapeutic benefit and management, especially in those patients with adverse sociocultural conditions. PMID:24786984

  17. 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…

  18. 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

  19. Effect of crew resource management on diabetes care and patient outcomes in an inner?city primary care clinic

    PubMed Central

    Taylor, Cathy R; Hepworth, Joseph T; Buerhaus, Peter I; Dittus, Robert; Speroff, Theodore

    2007-01-01

    Background Diabetes care in our inner?city primary care clinic was suboptimal, despite provider education and performance feedback targeting improved adherence to evidence?based clinical guidelines. A crew resource management (CRM) intervention (communication and teamwork, process and workflow organisation, and standardised information debriefings) was implemented to improve diabetes care and patient outcomes. Objective To assess the effect of the CRM intervention on adherence to evidence?based diabetes care standards, work processes, standardised clinical communication and patient outcomes. Methods Time?series analysis was used to assess the effect on the delivery of standard diabetes services and patient outcomes among medically indigent adults (n?=?619). Results The CRM principles were translated into useful process redesign and standardised care approaches. Significant improvements in microalbumin testing and associated patient outcome measures were attributed to the intervention. Conclusions The CRM approach provided tools for management that, in the short term, enabled reorganisation and prevention of service omissions and, in the long term, can produce change in the organisational culture for continuous improvement. PMID:17693668

  20. Using an internet intervention to support self-management of low back pain in primary care: protocol for a randomised controlled feasibility trial (SupportBack)

    PubMed Central

    Geraghty, Adam W A; Stanford, Rosie; Little, Paul; Roberts, Lisa; Foster, Nadine E; Hill, Jonathan C; Hay, Elaine; Stuart, Beth; Turner, David; Yardley, Lucy

    2015-01-01

    Introduction Low back pain (LBP) is a prevalent and costly condition. The majority of patients experiencing LBP are managed in primary care, where first-line care recommendations consist of advice to self-manage and remain active. Internet interventions present a potential means of providing patients with tailored self-management advice and evidence-based support for increasing physical activity. Methods/analysis This protocol describes a single-blind, randomised controlled feasibility trial of an internet intervention developed to support the self-management of LBP in primary care. Patients are being randomised to 1 of 3 groups receiving either usual primary care, usual primary care with the addition of an internet intervention or an internet intervention with physiotherapist telephone support. Patients are followed up at 3?months. Primary outcomes are the feasibility of (1) the trial design/methods, (2) the delivery of the internet intervention and (3) the provision of telephone support by physiotherapists. Secondary outcomes will include exploratory analysis of estimates and variation in clinical outcomes of pain and disability, in order to inform a future main trial. Ethics/dissemination This feasibility trial has undergone ethical scrutiny and been approved by the National Health Service (NHS) Research Ethics Committee, REC Reference 13/SC/0202. The feasibility findings will be disseminated to the research community through presentations at conferences and publication in peer review journals. Broader dissemination will come following a definitive trial. Trial registration number ISRCTN 31034004. PMID:26399575

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

    PubMed

    Hard, Bernadette

    2014-01-01

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

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

    PubMed

    Schwarzenbach, H R; Jenzer, S

    2012-09-01

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

  3. 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

  4. Implementation of a collaborative care management program with buprenorphine in primary care: A comparison between opioid-dependent patients and chronic pain patients using opioids non-medically

    PubMed Central

    Suzuki, Joji; Matthews, Michele L.; Brick, David; Nguyen, Minh-Thuy; Jamison, Robert N.; Ellner, Andrew L.; Tishler, Lori W.; Weiss, Roger D.

    2014-01-01

    Objective To implement a collaborative care management program with buprenorphine in a primary care clinic. Design Prospective observational study. Setting A busy urban academic primary care clinic affiliated with a tertiary care hospital. Participants Opioid dependent patients or chronic pain patients using opioids non-medically were recruited for the study. A total of 45 participants enrolled. Interventions Patients were treated with buprenorphine and managed by a supervising psychiatrist, pharmacist care manager and health coaches. The care manager conducted buprenorphine inductions and all follow-ups visits. Health coaches offered telephonic support. The psychiatrist supervised both the care manager and health coaches. Main outcome measures Primary outcomes were treatment retention at 6 months, and change in the proportion of aberrant toxicology results and opioid craving scores from baseline to 6 months. After data collection, clinical outcomes were compared between opioid dependent patients and chronic pain patients using opioids non-medically. Overall, 55.0% (25/45) of participants remained in treatment at 6 months. PCPs’ attitudes about opioid dependence treatment were surveyed at baseline and at 18-months. Results Forty-three patients (95.6%) accepted treatment and 25 (55.0%) remained in treatment at 6 months. The proportion of aberrant urine toxicology results decreased significantly from baseline to 6 months (p<0.01). Craving scores significantly decreased from baseline to 6 months (p<0.01). Opioid dependent patients, as opposed to chronic pain patients using opioids non-medically, were significantly more likely to complete 6 months of treatment (p<0.05). PCPs’ confidence in treating opioid dependence in primary care increased significantly from baseline to 18-months post-implementation (p<0.01). Conclusion Collaborative care management for opioid dependence with buprenorphine may be feasible in a primary care clinic. More research is needed to understand the role of buprenorphine in managing chronic pain patients using opioids non-medically. PMID:24944066

  5. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care

    PubMed Central

    van Tulder, Maurits; Lin, Chung-Wei Christine; Macedo, Luciana G.; McAuley, James; Maher, Chris

    2010-01-01

    The aim of this study was to present and compare the content of (inter)national clinical guidelines for the management of low back pain. To rationalise the management of low back pain, evidence-based clinical guidelines have been issued in many countries. Given that the available scientific evidence is the same, irrespective of the country, one would expect these guidelines to include more or less similar recommendations regarding diagnosis and treatment. We updated a previous review that included clinical guidelines published up to and including the year 2000. Guidelines were included that met the following criteria: the target group consisted mainly of primary health care professionals, and the guideline was published in English, German, Finnish, Spanish, Norwegian, or Dutch. Only one guideline per country was included: the one most recently published. This updated review includes national clinical guidelines from 13 countries and 2 international clinical guidelines from Europe published from 2000 until 2008. The content of the guidelines appeared to be quite similar regarding the diagnostic classification (diagnostic triage) and the use of diagnostic and therapeutic interventions. Consistent features for acute low back pain were the early and gradual activation of patients, the discouragement of prescribed bed rest and the recognition of psychosocial factors as risk factors for chronicity. For chronic low back pain, consistent features included supervised exercises, cognitive behavioural therapy and multidisciplinary treatment. However, there are some discrepancies for recommendations regarding spinal manipulation and drug treatment for acute and chronic low back pain. The comparison of international clinical guidelines for the management of low back pain showed that diagnostic and therapeutic recommendations are generally similar. There are also some differences which may be due to a lack of strong evidence regarding these topics or due to differences in local health care systems. The implementation of these clinical guidelines remains a challenge for clinical practice and research. PMID:20602122

  6. Engagement with eHealth Self-Monitoring in a Primary Care-Based Weight Management Intervention

    PubMed Central

    Wolin, Kathleen Y.; Steinberg, Dori M.; Lane, Ilana B.; Askew, Sandy; Greaney, Mary L.; Colditz, Graham A.; Bennett, Gary G.

    2015-01-01

    Background While eHealth approaches hold promise for improving the reach and cost-effectiveness of behavior change interventions, they have been challenged by declining participant engagement over time, particularly for self-monitoring behaviors. These are significant concerns in the context of chronic disease prevention and management where durable effects are important for driving meaningful changes. Purpose “Be Fit, Be Well” was an eHealth weight loss intervention that allowed participants to self-select a self-monitoring modality (web or interactive voice response (IVR)). Participants could change their modality. As such, this study provides a unique opportunity to examine the effects of intervention modality choice and changing modalities on intervention engagement and outcomes. Methods Intervention participants, who were recruited from community health centers, (n = 180) were expected to self-monitor health behaviors weekly over the course of the 24-month intervention. We examined trends in intervention engagement by modality (web, IVR, or changed modality) among participants in the intervention arm. Results The majority (61%) of participants chose IVR self-monitoring, while 39% chose web. 56% of those who selected web monitoring changed to IVR during the study versus no change in those who initially selected IVR. Self-monitoring declined in both modalities, but completion rates were higher in those who selected IVR. There were no associations between self-monitoring modality and weight or blood pressure outcomes. Conclusions This is the first study to compare web and IVR self-monitoring in an eHealth intervention where participants could select and change their self-monitoring modality. IVR shows promise for achieving consistent engagement. PMID:26469065

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

    PubMed

    Lebovics, Edward; Czobor, Klara

    2014-11-01

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

  8. 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

  9. Severity of obesity and management of hypertension, hypercholesterolaemia and smoking in primary care: population-based cohort study.

    PubMed

    Booth, H P; Prevost, A T; Gulliford, M C

    2016-01-01

    Obesity and obesity-associated cardiovascular risk are increasing worldwide. This study aimed to determine how different levels of obesity are associated with the management of smoking, hypertension and hypercholesterolaemia in primary care. We conducted a cohort study of adults aged 30-100 years in England, sampled from the primary care electronic health records in the Clinical Practice Research Datalink. Prevalence, treatment and control were estimated for each risk factor by body mass index (BMI) category. Adjusted odds ratios (AOR) were estimated, allowing for age, gender, comorbidity and socioeconomic status, with normal weight as reference category. Data were analysed for 247?653 patients including 153?308 (62%) with BMI recorded, of whom 46?149 (30%) were obese. Participants were classified into simple (29?257), severe (11?059) and morbid obesity (5833) categories. Smoking declined with the increasing BMI category, but smoking cessation treatment increased. Age-standardised hypertension prevalence was twice as high in morbid obesity (men 78.6%; women 66.0%) compared with normal weight (men 37.3%; women 29.4%). Hypertension treatment was more frequent (AOR 1.75, 1.59-1.92) but hypertension control less frequent (AOR 0.63, 0.59-0.69) in morbid obesity, with similar findings for severe obesity. Hypercholesterolaemia was more frequent in morbid obesity (men 48.2%; women 36.3%) than normal weight (men 25.0%; women 20.0%). Lipid lowering therapy was more frequent in morbid obesity (AOR 1.83, 1.61-2.07) as was cholesterol control (AOR 1.19, 1.06-1.34). Increasing obesity category is associated with elevated risks from hypertension and hypercholesterolaemia. Inadequate hypertension control in obesity emerges as an important target for future interventions. PMID:25810065

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

    PubMed

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

    1993-03-01

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

  11. 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

  12. Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo)

    PubMed Central

    Ciccone, Marco Matteo; Aquilino, Ambrogio; Cortese, Francesca; Scicchitano, Pietro; Sassara, Marco; Mola, Ernesto; Rollo, Rodolfo; Caldarola, Pasquale; Giorgino, Francesco; Pomo, Vincenzo; Bux, Francesco

    2010-01-01

    Purpose Project Leonardo represented a feasibility study to evaluate the impact of a disease and care management (D&CM) model and of the introduction of “care manager” nurses, trained in this specialized role, into the primary health care system. Patients and methods Thirty care managers were placed into the offices of 83 general practitioners and family physicians in the Apulia Region of Italy with the purpose of creating a strong cooperative and collaborative “team” consisting of physicians, care managers, specialists, and patients. The central aim of the health team collaboration was to empower 1,160 patients living with cardiovascular disease (CVD), diabetes, heart failure, and/or at risk of cardiovascular disease (CVD risk) to take a more active role in their health. With the support of dedicated software for data collection and care management decision making, Project Leonardo implemented guidelines and recommendations for each condition aimed to improve patient health outcomes and promote appropriate resource utilization. Results Results show that Leonardo was feasible and highly effective in increasing patient health knowledge, self-management skills, and readiness to make changes in health behaviors. Patient skill-building and ongoing monitoring by the health care team of diagnostic tests and services as well as treatment paths helped promote confidence and enhance safety of chronic patient management at home. Conclusion Physicians, care managers, and patients showed unanimous agreement regarding the positive impact on patient health and self-management, and attributed the outcomes to the strong “partnership” between the care manager and the patient and the collaboration between the physician and the care manager. Future studies should consider the possibility of incorporating a patient empowerment model which considers the patient as the most important member of the health team and care managers as key health care collaborators able to enhance and support services to patients provided by physicians in the primary health care system. PMID:20479952

  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. 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…

  15. Implementing and managing self-management skills training within primary care organisations: a national survey of the expert patients programme within its pilot phase.

    PubMed

    Lee, Victoria; Kennedy, Anne; Rogers, Anne

    2006-01-01

    A key element of the United Kingdom (UK) health policy reform in relation to chronic disease management is the introduction of a national programme seeking to promote self-care from within the National Health Service (NHS). The mainstay of the Expert Patients Programme (EPP) is a six-week training course that provides the opportunity for anyone with a long-term condition to develop new skills to manage their condition better on a day-to-day basis. The course forms part of the NHS self-care support programme, is administered by Primary Care Trusts (PCTs) and delivered by people who have personal experience of living with a long-term condition. The NHS' official Expert Patients Programme website presently states that, "Pilot EPP courses began at 26 NHS PCT sites across England in May 2002, and by May 2004 approximately 300 PCTs had either actively implemented pilot courses or had committed to joining. The majority of PCTs are now coming to the end of the pilot phase, with many implementing plans to make EPP sustainable for the long-term." The NHS website heralds the pilot "a success."A national, postal survey of PCT EPP Leads was undertaken in order to examine both the evolvement of EPP during its pilot stage and future plans for the programme. A questionnaire was sent out to the 299 PCTs known to have committed to the EPP pilot, and an excellent 100% response rate was obtained over a 3-month period (April-July 2005). One marker of success of the Expert Patients Programme implementation is the actual running of courses by the Primary Care Trusts. This paper explores the extent to which the implementation of the pilot can indeed be viewed as a "success," primarily in terms of the number of courses run, and considers the extent to which PCTs have carried out all that they were committed to do. Findings suggest that the more time an EPP Lead dedicates to the Programme, the more likely it is that EPP has run successfully in the past, and the more likely it is that it will continue to run successfully in the future. Other factors indicating future EPP success include collaborating across PCTs to share co-ordinators, tutors, and funding. PMID:16722568

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

    PubMed

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

    2015-01-01

    According to the 2008 revision of the World Health Organization (WHO) classification of myeloid malignancies, philadelphia chromosome (Ph)-negative myeloproliferative neoplasms (MPNs) include clonal, hematologic disorders such as polycythemia vera, primary myelofibrosis, and essential thrombocythemia.Recent years have witnessed major advances in the understanding of the molecular pathophysiology of these rare subgroups of chronic, myeloproliferative disorders. Identification of somatic mutations in genes associated with pathogenesis and evolution of these myeloproliferative conditions (Janus Kinase 2; myeloproliferative leukemia virus gene; calreticulin) led to substantial changes in the international guidelines for diagnosis and treatment of Ph-negative MPN during the last few years.The MPN-Working Group (MPN-WG), a panel of hematologists with expertise in MPN diagnosis and treatment from various parts of India, examined applicability of this latest clinical and scientific evidence in the context of hematology practice in India.This manuscript summarizes the consensus recommendations formulated by the MPN-WG that can be followed as a guideline for management of patients with Ph-negative MPN in the context of clinical practice in India. PMID:25810569

  17. Blood pressure control and management of very elderly patients with hypertension in primary care settings in Spain.

    PubMed

    Rodriguez-Roca, Gustavo C; Llisterri, Jose L; Prieto-Diaz, Miguel A; Alonso-Moreno, Francisco J; Escobar-Cervantes, Carlos; Pallares-Carratala, Vicente; Valls-Roca, Francisco; Barrios, Vivencio; Banegas, Jose R; Alsina, Diegogonzalez-Segura

    2014-02-01

    This study aimed to determine the clinical profile, blood pressure (BP) control rates, therapeutic management and physicians' therapeutic behavior regarding very elderly hypertensive patients. A total of 1540 hypertensive patients ?80 years old on antihypertensive therapy and receiving care in primary care settings in Spain were included in this cross-sectional study. The mean patient age was 83.4±3.1 years, 61.9% of patients were women and 49.3% of patients had cardiovascular disease. Of the patients, 27.7% were on monotherapy and 72.3% were on combined therapy (47.4% on two antihypertensive agents and 24.9% on three or more antihypertensive agents). A total of 40.8% (95% confidence interval (CI): 38.4-43.3%) of patients achieved BP goals (<140/90?mm?Hg; <130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). Patients with uncontrolled BP were more likely to have metabolic syndrome, diabetes, obesity, a history of cardiovascular disease, ischemic heart disease, renal disease and stroke and were more frequently smokers. Physicians modified the antihypertensive regimens for 27.4% (95% CI: 23.9-30.8%) of the patients with uncontrolled BP, and the addition of another antihypertensive agent was the most frequent modification. With regard to the physicians' perception of patients' BP control, the BPs of 44.1% of the patients with uncontrolled BP were considered well controlled by the physicians. PMID:24089262

  18. A randomized, controlled trial of disease management modules, including telepsychiatric care, for depression in rural primary care.

    PubMed

    Hilty, Donald M; Marks, Shayna; Wegelin, Jacob; Callahan, Edward J; Nesbitt, Thomas S

    2007-02-01

    Introduction. Disease management modules (DMM), including education, tracking, support, and medical care, have improved health for patients with asthma and diabetes. For rural patients, novel ways of delivery are needed to access clinical expertise from urban or academic specialists. Telemedicine (telephone and televideo) could be instrumental in this process, though no randomized, controlled trials have assessed their effectiveness.Methods. Self-report and structured psychiatric interviews were used to screen potential depressed subjects. Subjects were randomized to: 1) usual care with a DMM using telephone and self-report questionnaires; or 2) a DMM using telephone, questionnaires, and monthly televideo psychiatric consultation emphasizing primary care physician (PCP) skill development. Subjects' depressive symptoms, health status, and satisfaction with care were tabulated at three, six, and 12 months after study entry.Results. There was significant clinical improvement for depression in both groups, with a trend toward significance in the more intensive module. Satisfaction and retention was superior in the more intensive group. There was no overall change in health functioning in either group.Conclusions. Intensive modules using telepsychiatric educational interventions toward PCPs may be superior, but the most critical ingredient may be administrative tracking of patients, prompted intervention by PCPs, and (when necessary) new ideas by a specialist. PMID:20805900

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

    PubMed Central

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

    2015-01-01

    According to the 2008 revision of the World Health Organization (WHO) classification of myeloid malignancies, philadelphia chromosome (Ph)-negative myeloproliferative neoplasms (MPNs) include clonal, hematologic disorders such as polycythemia vera, primary myelofibrosis, and essential thrombocythemia.Recent years have witnessed major advances in the understanding of the molecular pathophysiology of these rare subgroups of chronic, myeloproliferative disorders. Identification of somatic mutations in genes associated with pathogenesis and evolution of these myeloproliferative conditions (Janus Kinase 2; myeloproliferative leukemia virus gene; calreticulin) led to substantial changes in the international guidelines for diagnosis and treatment of Ph-negative MPN during the last few years.The MPN-Working Group (MPN-WG), a panel of hematologists with expertise in MPN diagnosis and treatment from various parts of India, examined applicability of this latest clinical and scientific evidence in the context of hematology practice in India.This manuscript summarizes the consensus recommendations formulated by the MPN-WG that can be followed as a guideline for management of patients with Ph-negative MPN in the context of clinical practice in India. PMID:25810569

  20. 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

  1. Improving Osteoporosis Management in Primary Care: An Audit of the Impact of a Community Based Fracture Liaison Nurse

    PubMed Central

    Chan, Tom

    2015-01-01

    Background Osteoporosis and associated fragility fractures are a major health problem; they are more common in women over 50 years old. Fracture liaison nurses have been widely used in secondary care to promote the recognition of fragility fractures and to promote the use of bone-sparing medication to reduce the risk of recurrent facture. Objective Audit the impact of a primary care based fracture liaison nurse on the detection of fragility fractures in people with osteoporosis and their treatment with a bone-sparing medication. Method This audit took place in 12 GP practices using ‘before and after’ cross-sectional extractions of anonymised routine data. We report, for females 50–74 years and ?75 years old, socio-economic deprivation index, the prevalence of osteoporosis, recording of fragility fractures, dual-energy X-ray absorptiometry (DXA), smoking, and body-mass index (BMI) and use of appropriate bone-sparing medication. We used Altman’s test of independent proportions to compare before and after data. Results Recording of the diagnosis of osteoporosis increased from 1.5% to 1.7% (p = 0.059); the rate of DXA scans fell (1.8% to 1.4%; p = 0.002); recording of fractures and fragility fractures more than doubled (0.8% to 2.0%; p<0.001 and 0.5% to 1.5%; p<0.001, respectively) with approximate doubling of the recording of smoking, and BMI (p<0.001 level). Fragility fracture recording rose from 8.8% to 15% in females aged 50 to 74, and from 0.8% to 2.3% in people aged ?75years old (p<0.001). There appeared to be inequity in the service, people who were least deprived were more likely to receive DXA scans and the more deprived to be prescribed bone sparing agents. Conclusion A fracture liaison nurse in primary care has been associated with a period of improved management. Liaison nurses based in different parts of the health system should be tested in a prospective trial. PMID:26313924

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

    PubMed Central

    2013-01-01

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

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

    PubMed Central

    2013-01-01

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

  4. Origins of choice-related activity in mouse somatosensory cortex.

    PubMed

    Yang, Hongdian; Kwon, Sung E; Severson, Kyle S; O'Connor, Daniel H

    2016-01-01

    During perceptual decisions about faint or ambiguous sensory stimuli, even identical stimuli can produce different choices. Spike trains from sensory cortex neurons can predict trial-to-trial variability in choice. Choice-related spiking is widely studied as a way to link cortical activity to perception, but its origins remain unclear. Using imaging and electrophysiology, we found that mouse primary somatosensory cortex neurons showed robust choice-related activity during a tactile detection task. Spike trains from primary mechanoreceptive neurons did not predict choices about identical stimuli. Spike trains from thalamic relay neurons showed highly transient, weak choice-related activity. Intracellular recordings in cortex revealed a prolonged choice-related depolarization in most neurons that was not accounted for by feed-forward thalamic input. Top-down axons projecting from secondary to primary somatosensory cortex signaled choice. An intracellular measure of stimulus sensitivity determined which neurons converted choice-related depolarization into spiking. Our results reveal how choice-related spiking emerges across neural circuits and within single neurons. PMID:26642088

  5. Does audit improve diabetes care in a primary care setting? A management tool to address health system gaps

    PubMed Central

    Pruthu, T. K.; Majella, Marie Gilbert; Nair, Divya; Ramaswamy, Gomathi; Palanivel, C.; Subitha, L.; Kumar, S. Ganesh; Kar, Sitanshu Sekhar

    2015-01-01

    Introduction: Diabetes mellitus is one of the emerging epidemics. Regular clinical and biochemical monitoring of patients, adherence to treatment and counseling are cornerstones for prevention of complications. Clinical audits as a process of improving quality of patient care and outcomes by reviewing care against specific criteria and then reviewing the change can help in optimizing care. Objective: We aimed to audit the process of diabetes care using patient records and also to assess the effect of audit on process of care indicators among patients availing diabetes care from a rural health and training center in Puducherry, South India. Materials and Methods: A record based study was conducted to audit diabetes care among patients attending noncommunicable disease clinic in a rural health center of South India. Monitoring of blood pressure (BP), blood glucose, lipid profile and renal function test were considered for auditing in accordance with standard guidelines. Clinical audit cycle (CAC), a simple management tool was applied and re-audit was done after 1-year. Results: We reviewed 156 and 180 patients records during year-1 and year-2, respectively. In the audit year-1, out of 156 patients, 78 (50%), 70 (44.9%), 49 (31.4%) and 19 (12.2%) had got their BP, blood glucose, lipid profile and renal function tests done. Monitoring of blood glucose, BP, lipid profile and renal function improved significantly by 35%, 20.7%, 36.4% and 56.1% over 1-year. Conclusion: CAC improves process of diabetes care in a primary care setting with existing resources. PMID:26604621

  6. Choice, Conditioned Reinforcement, and the Prius Effect

    ERIC Educational Resources Information Center

    Fantino, Edmund

    2008-01-01

    Psychologists have long been intrigued with the rationales that underlie our decisions. Similarly, the concept of conditioned reinforcement has a venerable history, particularly in accounting for behavior not obviously maintained by primary reinforcers. The studies of choice and of conditioned reinforcement have often developed in lockstep. Many…

  7. Does Challenge by Choice Increase Participation?

    ERIC Educational Resources Information Center

    Chase, Daniel L.

    2015-01-01

    Challenge by choice (CBC) has been regarded as a foundational principle for challenge ropes course programs. Although CBC is widely accepted as the primary mechanism for facilitating intended ropes course outcomes, especially a participant's involvement, until recently it had remained an untested assumption. This study explored the role of CBC as…

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

    PubMed Central

    Atkinson, Sarah; Robson, Mary

    2012-01-01

    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

  9. 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

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

    PubMed Central

    2014-01-01

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

  11. 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…

  12. 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…

  13. The Choice Controversy.

    ERIC Educational Resources Information Center

    Cookson, Peter W., Jr., Ed.

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

  14. School Choice Marches forward

    ERIC Educational Resources Information Center

    Butcher, Jonathan

    2013-01-01

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

  15. Minimally Invasive Parathyroidectomy Versus Bilateral Neck Exploration for Primary Hyperparathyroidism.

    PubMed

    Laird, Amanda M; Libutti, Steven K

    2016-01-01

    Primary hyperparathyroidism is a disease that is caused by excess parathyroid hormone (PTH) secretion from 1 or more of the parathyroid glands. Surgery is the only cure. Traditional surgical management consists of a 4-gland cervical exploration. Development of imaging specific to identification of parathyroid glands and application of the rapid PTH assay to operative management have made more minimal exploration possible. There are distinct advantages and disadvantages of minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE). The advantages of MIP seem to outweigh those of BNE, and MIP has replaced BNE as the operation of choice by many surgeons. PMID:26610777

  16. 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…

  17. Choice and reinforcement delay

    SciTech Connect

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

    1980-01-01

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

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

    PubMed Central

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

    2007-01-01

    Background Most depressed patients are attended at primary care. However, there are significant shortcomings in the diagnosis, management and outcomes of these patients. The aim of this study is to determine whether the implementation of a structured programme for managing depression will provide better health outcomes than usual management. Methods/Design Design: A cluster-randomized controlled trial involving two groups, one of which is the control group consisting of patients who are treated for depression in the usual way and the other is the intervention group consisting of patients on a structured programme for treating depression. Setting: 20 primary care centres in the province of Tarragona (Spain) Sample: 400 patients over 18 years of age who have experienced an episode of major depression (DSM-IV) and who need to initiate antidepressant treatment Intervention: A multi-component programme with clinical, educational and organisational procedures that includes training for the health care provider and evidence-based clinical guidelines. It also includes primary care nurses working as care-managers who provide educational and emotional support for the patients and who are responsible for active and systematic clinical monitoring. The programme aims to improve the primary care/specialized level interface. Measurements: The patients will be monitored by telephone interviews. The interviewer will not know which group the patient belongs to (blind trial). These interviews will be given at 0, 3, 6 and 12 months. Main variables: Severity of the depressive symptoms, response rate and remission rate. Analysis: Outcomes will be analyzed on an intent-to-treat basis and the unit of analysis will be the individual patient. This analysis will take into account the effect of study design on potential lack of independence between observations within the same cluster. Discussion The effectiveness of caring for depression in primary care can be improved by various strategies. The most effective models involve organisational changes and a greater role of nurses. However, these models are almost exclusively from the USA, and this randomized clinical trial will determine if this approach could be effective to improve the outcomes of depression in primary care in the Spanish health care system. Trial registration ISRCTN16384353 PMID:17883845

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

    PubMed Central

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

    2014-01-01

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

  1. [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

  2. 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 ...

  3. *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

    Yoo, S. J. Ben

    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

  4. 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…

  5. *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

    Yoo, S. J. Ben

    and Mixing 4. Hotplates 5. Haz Waste Management Hydrofluoric acid Process: Highly toxic etchant for Silicon premixed. Incompatible Materials: Will dissolve glassware. Be cautious when mixing with acids as toxic HF fume hood. Never open bottles or carry baths away from these ventilated areas because the toxic fumes

  6. *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

    Yoo, S. J. Ben

    and Mixing 4. Hotplates 5. Haz Waste Management SulphoNitric Process: SulphoNitric for cleaning, etch and dispose in the wrong bottle- toxic brown Nitrogen Dioxide may erupt out as a result. Disposal: Allow of in the "Persistently Oxidizing Acids" bottle. To avoid a waste bottle explosion, always use a venting cap or leave

  7. *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

    Yoo, S. J. Ben

    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 so be sure to rinse your work station after use2. Its residues form toxic, white crystals when dry

  8. *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

    Yoo, S. J. Ben

    and Mixing 4. Hotplates 5. Haz Waste Management Hydrogen Peroxide Process: Hydrogen Peroxide for etches, cleaning solutions, monolayer deposition and others. Materials: Hydrogen Peroxide (30% wt), sometimes Hydrogen Peroxide to water, then stir3. Heat only after mixing is complete if greater than ambient

  9. *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

    Yoo, S. J. Ben

    For Use: Wet process stations 2, 3, 8, 9, 11, 12, 13, acid & base fume hood2. Baths hotter than 120C in acid & base fume hood. Additional Process Notes: Measure water if necessary and slowly add Phosphoric and Mixing 4. Hotplates 5. Haz Waste Management Phosphoric Acid Process: Phosphoric acid for Silicon Nitride

  10. *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

    Yoo, S. J. Ben

    , 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

  11. *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

    Yoo, S. J. Ben

    stations 2, 3, 8, 9, 11, 12, 13, acid & base fume hood2. If hotter than a simmer, only acid & base fume and Mixing 4. Hotplates 5. Haz Waste Management Sulphuric Acid Process: Sulphuric Acid for cleaning solutions etches and metal polishing, Materials: Sulphuric Acid (98%), sometimes diluted with water. Incompatible

  12. *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

    Yoo, S. J. Ben

    , acid & base fume hood2. If hotter than a simmer, only acid & base fume hood. Additional Process Notes and Mixing 4. Hotplates 5. Hydrofluoric Acid 6. Haz Waste Management BOE: Buffered Oxide Etch Process: Highly Fluoride, Hydrofluoric Acid and water for dilution, typically premixed. Incompatible Materials: Will slowly

  13. *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

    Yoo, S. J. Ben

    stations 3, 8, 9, 12, 13 acid & base fume hood2. If hotter than a simmer, only acid & base fume hood and Mixing 4. Hotplates 5. Haz Waste Management Acetic Acid Process: Acetic Acid for metal etching, polishing and surface modification. Materials: Acetic Acid (Glacial), sometimes diluted with water. Incompatible

  14. *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

    Yoo, S. J. Ben

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

  15. Primary and secondary hyperoxaluria: Understanding the enigma.

    PubMed

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

    2015-05-01

    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

  16. 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

  17. 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.

  18. Training Peer Educators to Promote Self-Management Skills in People with Serious Mental Illness (SMI) and Diabetes (DM) in a Primary Health Care Setting

    PubMed Central

    Blixen, Carol; Perzynski, Adam; Kanuch, Stephanie; Dawson, Neal; Kaiser, Denise; Lawless, Mary Ellen; Seeholzer, Eileen; Sajatovic, Martha

    2015-01-01

    Aim To describe the training and participant experience of patients with both serious mental illness (SMI) and diabetes (DM) who were enrolled in a Peer Educator Training Program adapted to a primary care setting. Background The mortality of patients with both SMI and DM is high. Illness self-management for SMI includes medications, psychosocial treatments, and healthy behaviors, yet treatment engagement is often sub-optimal with adherence rates of 52% for diabetic medications and 62% for antipsychotic medications among the SMI. To address this problem, a new behavioral intervention study targeting SMI and DM self-management used trained Peer Educators with the same chronic conditions to enhance program effectiveness. A manual facilitated training on intervention topics such as SMI and DM therapies, stress management, and stigma reduction as well as training in group intervention techniques, telephone skills, and crisis management. Methods We assessed participant attitudes and input using in-depth face-to-face interviews. Interviews were audio-taped, transcribed, coded and analyzed using the classic method of content analysis emphasizing dominant themes. A member-check was conducted where participants commented on analysis results. Findings Six relevant descriptive Themes emerged. Themes were: 1) Positive group experience; 2) Success with learning manual content; 3) Increased knowledge about SMI and DM); 4) Improved self-management skills; 5) Increased self-confidence and self-efficacy in becoming a Peer Educator; and being 6) United in purpose to help others self-manage their SMI and DM. Qualitative evidence supports structured training for SMI-DM peer educators. Key components include written educational materials and the power of the group process to increase knowledge, self-management skills, confidence, and self-efficacy. Recommendations are offered to support further endeavours to mobilize peers with SMI to help other patients with complex comorbidities better self-manage their own health. PMID:24703014

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  20. Primary Hyperparathyroidism: An Overview

    PubMed Central

    MacKenzie-Feder, Jessica; Sirrs, Sandra; Anderson, Donald; Sharif, Jibran; Khan, Aneal

    2011-01-01

    Primary hyperparathyroidism is a common condition that affects 0.3% of the general population. Primary and tertiary care specialists can encounter patients with primary hyperparathyroidism, and prompt recognition and treatment can greatly reduce morbidity and mortality from this disease. In this paper we will review the basic physiology of calcium homeostasis and then consider genetic associations as well as common etiologies and presentations of primary hyperparathyroidism. We will consider emerging trends in detection and measurement of parathyroid hormone as well as available imaging modalities for the parathyroid glands. Surgical indications and approach will be reviewed as well as medical management of primary hyperparathyroidism with bisphosphonates and calcimimetics. PMID:21747852

  1. A Common Mechanism Underlying Food Choice and Social Decisions

    PubMed Central

    Krajbich, Ian; Hare, Todd; Bartling, Björn; Morishima, Yosuke; Fehr, Ernst

    2015-01-01

    People make numerous decisions every day including perceptual decisions such as walking through a crowd, decisions over primary rewards such as what to eat, and social decisions that require balancing own and others’ benefits. The unifying principles behind choices in various domains are, however, still not well understood. Mathematical models that describe choice behavior in specific contexts have provided important insights into the computations that may underlie decision making in the brain. However, a critical and largely unanswered question is whether these models generalize from one choice context to another. Here we show that a model adapted from the perceptual decision-making domain and estimated on choices over food rewards accurately predicts choices and reaction times in four independent sets of subjects making social decisions. The robustness of the model across domains provides behavioral evidence for a common decision-making process in perceptual, primary reward, and social decision making. PMID:26460812

  2. A Common Mechanism Underlying Food Choice and Social Decisions.

    PubMed

    Krajbich, Ian; Hare, Todd; Bartling, Björn; Morishima, Yosuke; Fehr, Ernst

    2015-10-01

    People make numerous decisions every day including perceptual decisions such as walking through a crowd, decisions over primary rewards such as what to eat, and social decisions that require balancing own and others' benefits. The unifying principles behind choices in various domains are, however, still not well understood. Mathematical models that describe choice behavior in specific contexts have provided important insights into the computations that may underlie decision making in the brain. However, a critical and largely unanswered question is whether these models generalize from one choice context to another. Here we show that a model adapted from the perceptual decision-making domain and estimated on choices over food rewards accurately predicts choices and reaction times in four independent sets of subjects making social decisions. The robustness of the model across domains provides behavioral evidence for a common decision-making process in perceptual, primary reward, and social decision making. PMID:26460812

  3. Quality Competition, Insurance, and Consumer Choice

    E-print Network

    Lyon, Thomas P.

    to lock in market share via managed-care plans with less choice and lower prices. As technology becomes is the adoption of expensive quality-enhancing technologies and procedures.1 They also recognize care payment plans. The interplay of technology, insur- ance, quality of care, and cost containment has

  4. Program to Combat Stereotyping in Career Choice.

    ERIC Educational Resources Information Center

    Harrison, Laurie R.

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

  5. 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

  6. Multiplexed modulation of behavioral choice

    PubMed Central

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

    2014-01-01

    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

  7. A quality improvement project to improve the effectiveness and patient-centredness of management of people with mild-to-moderate kidney disease in primary care

    PubMed Central

    Thomas, Nicola; Gallagher, Hugh; Jain, Neerja

    2014-01-01

    Chronic kidney disease (CKD) stages 3 to 5, affects 6–7% of the adult population and is an important risk factor for both advanced kidney disease and cardiovascular disease. This paper describes a quality improvement project that aimed to establish consistent implementation of best practice in people with stage 3–5 kidney disease who were managed in primary care. The intervention was a Care Bundle for CKD. The bundle included three evidence-based, high impact interventions based on National Institute for Care Excellence (NICE, 2008) guidance, with an additional and novel self-management element. 29 GP Practices in England and Wales began the study. They undertook training in clinical management of CKD and in facilitation of self-management, with the self-management content designed and led by patients. Practices were asked to report baseline and then monthly outcome data extracted from practice computer systems. The project team provided implementation and ongoing quality improvement support for participating Practices. Ten Practices dropped out of the study following the training. Data submissions were incomplete in six Practices who continued to apply the care bundle. At the project end, a decision was taken by the study team to perform the final analysis on those thirteen Practices which completed the project and submitted at least six sets of monthly Practice-level outcome data. In these Practices the Care Bundle was applied to under 20% of the registered CKD stage 3 to 5 population in 5 Practices, 20–29% in 3 Practices, 30–49% in 2 Practices and ?50% in 3 Practices (998 patients in total). Of these, 671 patients (75%) agreed to the self-management component of the intervention. The reliability (at project end) in those who received the Bundle was 100%. The Bundle was applied to an additional 315 patients in the six Practices who completed the project but did not submit regular practice-level monthly data. In the thirteen remaining Practices, the achievement of NICE (2008) blood pressure targets at the start of the project was 74.8% in people with CKD stage 3–5 and no diabetes and 48% in people with CKD stage 3–5 and diabetes. At the project end these figures in the same Practices were 76.7% and 49.2% respectively. These improvements were achieved in spite of Practices increasing their recording of prevalence rate (that is, identifying and recording more patients with CKD on the Practice CKD Register). In conclusion, a care bundle can be implemented in primary care. However, maintaining engagement with primary care health care professionals and maximising exposure to an intervention in patients seen infrequently are significant challenges to generalisation and sustainability.

  8. A partnership model for implementing electronic health records in resource-limited primary care settings: experiences from two nurse-managed health centers

    PubMed Central

    Dennehy, Patricia; White, Mary P; Hamilton, Andrew; Pohl, Joanne M; Tanner, Clare; Onifade, Tiffiani J

    2011-01-01

    Objective To present a partnership-based and community-oriented approach designed to ease provider anxiety and facilitate the implementation of electronic health records (EHR) in resource-limited primary care settings. Materials and Methods The approach, referred to as partnership model, was developed and iteratively refined through the research team's previous work on implementing health information technology (HIT) in over 30 safety net practices. This paper uses two case studies to illustrate how the model was applied to help two nurse-managed health centers (NMHC), a particularly vulnerable primary care setting, implement EHR and get prepared to meet the meaningful use criteria. Results The strong focus of the model on continuous quality improvement led to eventual implementation success at both sites, despite difficulties encountered during the initial stages of the project. Discussion There has been a lack of research, particularly in resource-limited primary care settings, on strategies for abating provider anxiety and preparing them to manage complex changes associated with EHR uptake. The partnership model described in this paper may provide useful insights into the work shepherded by HIT regional extension centers dedicated to supporting resource-limited communities disproportionally affected by EHR adoption barriers. Conclusion NMHC, similar to other primary care settings, are often poorly resourced, understaffed, and lack the necessary expertise to deploy EHR and integrate its use into their day-to-day practice. This study demonstrates that implementation of EHR, a prerequisite to meaningful use, can be successfully achieved in this setting, and partnership efforts extending far beyond the initial software deployment stage may be the key. PMID:21828225

  9. Intercultural Communication in the Malaysian Vision Schools: Implications for the Management and Leadership in a Multicultural Primary School

    ERIC Educational Resources Information Center

    Othman, Azam; Ruslan, Norbaiduri; Ahmad, Ismail Sheikh

    2012-01-01

    This article discusses intercultural communication in Vision Schools in Malaysia. It also elaborates the extent to which the Vision Schools foster racial interaction across the three major ethnic groups: Malays, Chinese, and Indians. A total of 887 primary school students were surveyed across the Vision Schools. It was found that the intercultural…

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

    ERIC Educational Resources Information Center

    Flessa, Joseph J.

    2012-01-01

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

  11. Predicting affective choice.

    PubMed

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

    2013-08-01

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

  12. 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)

  13. The Maastricht Ultrasound Shoulder pain trial (MUST): Ultrasound imaging as a diagnostic triage tool to improve management of patients with non-chronic shoulder pain in primary care

    PubMed Central

    2011-01-01

    Background Subacromial disorders are considered to be one of the most common pathologies affecting the shoulder. Optimal therapy for shoulder pain (SP) in primary care is yet unknown, since clinical history and physical examination do not provide decisive evidence as to the patho-anatomical origin of the symptoms. Optimal decision strategies can be furthered by applying ultrasound imaging (US), an accurate method in diagnosing SP, demonstrating a clear relationship between diagnosis and available therapies. Yet, the clinical cost-effectiveness of applying US in the management of SP in primary care has not been studied. The aim of this paper is to describe the design and methods of a trial assessing the cost-effectiveness of ultrasound imaging as a diagnostic triage tool to improve management of primary care patients with non-chronic shoulder pain. Methods/Design This randomised controlled trial (RCT) will involve 226 adult patients with suspected subacromial disorders recruited by general practitioners. During a Qualification period of two weeks, patients receive care as usual as advised by the Dutch College of General Practitioners, and patients are referred for US. Patients with insufficient improvement qualify for the RCT. These patients are then randomly assigned to the intervention or the control group. The therapies used in both groups are the same (corticosteroid injections, referral to a physiotherapist or orthopedic surgeon) except that therapies used in the intervention group will be tailored based on the US results. Ultrasound diagnosed disorders include tendinopathy, calcific tendinitis, partial and full thickness tears, and subacromial bursitis. The primary outcome is patient-perceived recovery at 52 weeks, using the Global Perceived Effect questionnaire. Secondary outcomes are disease specific and generic quality of life, cost-effectiveness, and the adherence to the initial applied treatment. Outcome measures will be assessed at baseline, 13, 26, 39 and 52 weeks after inclusion. An economic evaluation will be performed from both a health care and societal perspective with a time horizon of 52 weeks. Discussion The results of this trial will give unique evidence regarding the cost-effectiveness of US as a diagnostic triage tool in the management of SP in primary care. PMID:21740540

  14. Primary Versus Specialty Care Outcomes for Depressed Outpatients Managed with Measurement-Based Care: Results from STAR*D

    PubMed Central

    Rush, A. John; Trivedi, Madhukar H.; Wisniewski, Stephen R.; Balasubramani, G.K.; McGrath, Patrick J.; Thase, Michael E.; Klinkman, Michael; Nierenberg, Andrew A.; Yates, William R.; Fava, Maurizio

    2008-01-01

    Background Whether the acute outcomes of major depressive disorder (MDD) treated in primary (PC) or specialty care (SC) settings are different is unknown. Objective To compare the treatment and outcomes for depressed outpatients treated in primary versus specialty settings with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (www.star-d.org), a broadly inclusive effectiveness trial. Design Open clinical trial with citalopram for up to 14 weeks at 18 primary and 23 specialty sites. Participants received measurement-based care with 5 recommended treatment visits, manualized pharmacotherapy, ongoing support and guidance by a clinical research coordinator, the use of structured evaluation of depressive symptoms and side effects at each visit, and a centralized treatment monitoring and feedback system. Participants A total of 2,876 previously established outpatients in primary (n?=?1091) or specialty (n?=?1785) with nonpsychotic depression who had at least 1 post-baseline measure. Measurements and Main Results Remission (Hamilton Depression Rating Scale for Depression [Hamilton] or 16-item Quick Inventory of Depressive Symptomatology-Self-Rated [QIDS-SR16]); response (QIDS-SR16); time to first remission (QIDS-SR16). Remission rates by Hamilton (26.6% PC vs 28.0% SC, p?=?.40) and by QIDS-SR16 (32.5% PC vs 33.1% SC, p?=?.78) and response rates by QIDS-SR16 (45.7% PC vs 47.6% SC, p?=?.33) were not different. For those who reached remission or response at exit, the time to remission (6.2 weeks PC vs 6.9 weeks SC, p?=?.12) and to response (5.5 weeks PC vs 5.4 weeks SC, p?=?.97) did not differ by setting. Conclusions Identical remission and response rates can be achieved in primary and specialty settings when identical care is provided. PMID:18247097

  15. 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

  16. Management of Stress Urinary Incontinence

    PubMed Central

    Cornella, Jeffrey L

    2004-01-01

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

  17. [The development of evaluation capacity in primary healthcare management: a case study in Santa Catarina State, Brazil, 2008-2011].

    PubMed

    Nickel, Daniela Alba; Calvo, Maria Cristina Marino; Natal, Sonia; Freitas, Sérgio Fernando Torres de; Hartz, Zulmira Maria de Araújo

    2014-04-01

    This article analyzes evaluation capacity-building based on the case study of a State Health Secretariat participating in the Project to Strengthen the Technical Capacity of State Health Secretariats in Monitoring and Evaluating Primary Healthcare. The case study adopted a mixed design with information from documents, semi-structured interviews, and evaluation of primary care by the State Health Secretariat in 2008-2011. Process analysis was used to identify the logical events that contributed to evaluation capacity-building, with two categories: evaluation capacity-building events and events for building organizational structure. The logical chain of events was formed by negotiation and agreement on the decision-making levels for the continuity of evaluation, data collection and analysis by the State Health Secretariat, a change in key indicators, restructuring of the evaluation matrix, and communication of the results to the municipalities. The three-way analysis showed that the aim of developing evaluation capacity was achieved. PMID:24896058

  18. Choice of School and Career, and Its System of Motivation in Hungary.

    ERIC Educational Resources Information Center

    Kiss, Erno; Schuttler, Tamas

    In Hungary, a countrywide survey of school and/or career choice intentions among seventh-grade primary school pupils was complemented by an examination of the motives playing a role in the choice. School achievement was the strongest factor that decides the tendency of the intention of choosing a secondary school. Regarding career choices, the…

  19. Visit to a Choice-Based Art Classroom

    ERIC Educational Resources Information Center

    Douglas, Katherine

    2012-01-01

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

  20. 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

  1. Primary Syphilis

    MedlinePLUS

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

  2. Choices and Consequences.

    ERIC Educational Resources Information Center

    Thorp, Carmany

    1995-01-01

    Describes student use of Hyperstudio computer software to create history adventure games. History came alive while students learned efficient writing skills; learned to understand and manipulate cause, effect choice and consequence; and learned to incorporate succinct locational, climatic, and historical detail. (ET)

  3. The Choice for Learning

    ERIC Educational Resources Information Center

    Bennett, Scott

    2006-01-01

    We are building conventional library space without making the paradigm shift our digital environment requires. The chief obstacles to change lie in our conception of readers as information consumers, in our allegiance to library operations as the drivers of library design, and in the choice made between foundational and non-foundational views of…

  4. Deterministic Walks with Choice

    SciTech Connect

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

    2014-01-10

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

  5. A Matter of Choice.

    ERIC Educational Resources Information Center

    Dance, Frank E. X.

    The intent of a liberal education is to enhance the student's freedom, the faculty of intentional choice. The capacity of humans to step outside of themselves, which allows development of self-concept and subsequently self-esteem, is potentiated by the humans' unique sign, the symbol. Each of the liberal arts is concerned with the development and…

  6. Making Good: Technology Choices.

    ERIC Educational Resources Information Center

    Coutler, Bob

    2000-01-01

    The push to implement classroom technology, regardless of cost or real benefit, often intrudes on making wise choices. Strong technology candidates will provide a compelling extension to ongoing classroom work, be good curriculum enhancers, offer cost-effective software and equipment options, and offer a gentle professional-development learning…

  7. School Choice in Philadelphia.

    ERIC Educational Resources Information Center

    Keefe, Connie; Scher, Lauren; Sparks, Andrew; Weinbaum, Elliot

    Throughout the country, a wide range of educational options exist, from neighborhood public schools to cyber-schools. This study focuses on school choice in improving the educational experience in one city, Philadelphia. The study employed interviews with policymakers, teachers, and others; a focus group of middle-school students; a collection of…

  8. 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).…

  9. Your Genes, Your Choices

    MedlinePLUS

    ... to science literacy and the public understanding of science. Through its Directorate for Education and Human Resources Programs, AAAS has been a ... Your Genes, Your Choices is a publication of Science + Literacy for Health, a project of ... for Education and Human Resources . The publication was funded by ...

  10. Project Choice: Lessons Learned.

    ERIC Educational Resources Information Center

    Ewing Marion Kauffman Foundation, Kansas City, MO.

    Project Choice began with a simple goal: to increase the number of inner-city students who graduate from high school on time and become productive members of society. To that end, Ewing M. Kauffman, his Foundation, and associates designed and implemented a program that promised postsecondary education or training to some students in the Kansas…

  11. [The influence of structural and organizational factors on the performance of primary health care in Belo Horizonte, Minas Gerais State, Brazil, according to nurses and managers].

    PubMed

    Turci, Maria Aparecida; Lima-Costa, Maria Fernanda; Macinko, James

    2015-09-01

    The aim of this study was to evaluate the performance of primary health care (PHC) in Belo Horizonte, Minas Gerais State, Brazil, using the Portuguese-language version of the Primary Health Care Assessment Tool among nurses and managers of family health teams. Total PHC score was 0.75 (good). The dimensions first contact (0.95), longitudinality (0.83), comprehensiveness (0.83), and coordination (0.78) performed the best. Family approach, community orientation, and access received the lowest scores (0.68, 0.56, and 0.45, respectively). Better PHC performance was associated with the following factors (p < 0.05): availability of health care equipment and other inputs (adjusted PR = 1.57), education and training for family health teams (PR = 1.44), a physician on duty for more than 30 hours per week (PR = 1.42), and presence of four or more teams per primary care unit (PR = 1.09). The results show the importance of structural and organizational factors for PHC performance and suggest that permanent evaluation can identify aspects that require quality improvement. PMID:26578018

  12. Understanding Predisposition in College Choice: Toward an Integrated Model of College Choice and Theory of Reasoned Action

    ERIC Educational Resources Information Center

    Pitre, Paul E.; Johnson, Todd E.; Pitre, Charisse Cowan

    2006-01-01

    This article seeks to improve traditional models of college choice that draw from recruitment and enrollment management paradigms. In adopting a consumer approach to college choice, this article seeks to build upon consumer-related research, which centers on behavior and reasoning. More specifically, this article seeks to move inquiry beyond the…

  13. 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

  14. Syphilis - primary

    MedlinePLUS

    Primary syphilis; Secondary syphilis; Late syphilis; Tertiary syphilis ... Syphilis has three stages: Primary syphilis Secondary syphilis Tertiary syphilis (the late phase of the illness) Secondary ...

  15. Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care

    PubMed Central

    van der Plas, Annicka G. M.; Vissers, Kris C.; Francke, Anneke L.; Donker, Gé A.; Jansen, Wim J. J.; Deliens, Luc; Onwuteaka-Philipsen, Bregje D.

    2015-01-01

    Background Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. Objectives To compare cancer patients with and without additional support from a case manager on: 1) the patients’ general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. Methods This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. Results The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Conclusions Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is ‘only’ advisory and he or she does not provide hands-on care or prescribe medication. PMID:26208099

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

    PubMed

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

    2014-01-01

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

  17. 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

  18. Time Management in the Work Economy of A Class, A Case Study: Integration of Cabri in Primary School Mathematics Teaching

    ERIC Educational Resources Information Center

    Assude, Teresa

    2005-01-01

    Time is a constraint but also a condition of operating within a didactic system. Don't we need to distinguish several kinds of times? Our study will focus on teachers' time management strategies. We will identify these strategies by taking into account two temporal dimensions--didactic time and time capital--and the rate at which the former…

  19. 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…

  20. 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…

  1. The Impact of Supervision on Internal Medicine Residents' Attitudes and Management of Depression in Primary Care: A Pilot Study

    ERIC Educational Resources Information Center

    Milone, Jennifer M.; Gottumukkala, Aruna; Ward, Christopher P.; York, Kaki M.

    2013-01-01

    Objective: The authors examined the effect of supervision on internal medicine residents' attitudes toward and management of depression. Method: Internal medicine residents completed a survey during preclinical conferences. The survey included a published, validated questionnaire, the Depression Attitude Questionnaire, and items developed by the…

  2. 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…

  3. Private financing and operation of a space station: Investment requirements, risk, government support and other primary business management considerations

    NASA Technical Reports Server (NTRS)

    Simon, M.

    1982-01-01

    Private investment in a manned space station is considered as an alternative to complete government sponsorship of such a program. The implications of manned space operations are discussed from a business perspective. The most significant problems and risks which would be faced by a private company involved in a space station enterprise are outlined and possible government roles in helping to overcome these difficulties suggested. Economic factors such as inflation and the rate of interest are of primary concern, but less obvious conditions such as antitrust and appropriate regulatory laws, government appropriations for space activities, and national security are also considered.

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

    PubMed Central

    2013-01-01

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

  5. 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

  6. 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

  7. An exploratory retrospective assessment of a quantitative measure of diabetes risk: medical management and patient impact in a primary care setting

    PubMed Central

    Courtney, Maureen R; Moler, Edward J; Osborne, John A; Whitney, Geoff; Conard, Scott E

    2015-01-01

    Background Primary care providers with limited time and resources bear a heavy responsibility for chronic disease prevention or progression. Reliable clinical tools are needed to risk stratify patients for more targeted care. This exploratory study examined the care of patients who had been risk stratified regarding their likelihood of clinically progressing to type 2 diabetes. Methods This was a retrospective chart review pilot study conducted to assess a primary care provider’s use of a risk screening test. In this quality improvement project, the result of the risk screening was examined in relation to its influence on medical management and clinical impact on patients at risk for diabetes. All providers were board certified in family medicine and had more than 10 years clinical experience in managing diabetes and prediabetes. No specific clinical practice guidelines were mandated for patient care in this pilot study. Physicians in the practice group received an orientation to the diabetes risk measure and its availability for use in a pilot study to be conducted over a 6-month period. We identified the 696 nondiabetic adults in family practices who received a risk screening test (PreDx®, a multi-marker blood test that estimates the 5-year likelihood of conversion to type 2 diabetes) between June and November 2011 for a 6-month sample. A comparison group of 2,002 patients from a total database of 3.2 million patients who did not receive the risk test was randomly selected from the same clinical database after matching for age, sex, selected diagnoses, and metabolic risk factors. Patient groups were compared for intensity of care provided and clinical impact. Results Compared to patients with a similar demographic and diagnostic profile, patients who had the risk test received more intensive primary care and had better clinical outcome than comparison patients. Risk-tested patients were more likely to return for follow-up visits, be monitored for relevant cardio-metabolic risk factors, and receive prescription medications with P<0.001. Further, intensity of care was associated with the level of risk test result: patients with moderate or high scores were more likely to return for follow-up visits and receive prescription medications than patients with low scores. All P-values for comparison patients between the low and moderate groups, low and high groups, and moderate and high groups resulted in P<0.001. Risk-tested patients were more likely than their comparison group counterparts to achieve weight reduction, lowered blood pressure, and improved blood glucose and cholesterol as demonstrated by P-values of <0.001. Conclusion Use of a risk stratification test in primary care may help providers to more effectively identify high risk patients, manage diabetes risk, increase patient involvement in diabetes risk management, and improve clinical outcomes. A randomized controlled study is the next step to investigate the impact of diabetes risk stratification in primary care. PMID:26425102

  8. Complex Open Distal Femur Fracture Managed By Primary Autogenous Fibular Graft in Conjunction with DFLP- A Case Report

    PubMed Central

    Gawri, Vishant; Garg, Yashika; Singh, Dharam; Choudhary, Nishant

    2015-01-01

    Fractures of the distal part of the femur account for 7% of all femoral fractures. They are complex injuries that are difficult to manage; despite advances in technique and improved implants, treatment remains a challenge in many situations. An 18-year-old boy presented with an open fracture of the femur with bone loss. After initial emergency management, patient was given skeletal traction and kept on bohler braun splint. Regular antiseptic dressings of loosely stitched wound were done and intravenous antibiotics given. After 2 weeks when wound healed and twice cultures from wound site were negative, the fractured femur was stabilized with a dflp along with an autogenous free fibular graft and cortico-cancellous graft to bridge the bone defect. At one-year follow-up, fracture united with incorporation of free fibular graft. An autogenous free fibular graft in conjunction with a dflp is a viable option to manage bone defects in complicated supracondylar fractures of the femur. PMID:26672770

  9. Influencing choice without awareness.

    PubMed

    Olson, Jay A; Amlani, Alym A; Raz, Amir; Rensink, Ronald A

    2015-12-01

    Forcing occurs when a magician influences the audience's decisions without their awareness. To investigate the mechanisms behind this effect, we examined several stimulus and personality predictors. In Study 1, a magician flipped through a deck of playing cards while participants were asked to choose one. Although the magician could influence the choice almost every time (98%), relatively few (9%) noticed this influence. In Study 2, participants observed rapid series of cards on a computer, with one target card shown longer than the rest. We expected people would tend to choose this card without noticing that it was shown longest. Both stimulus and personality factors predicted the choice of card, depending on whether the influence was noticed. These results show that combining real-world and laboratory research can be a powerful way to study magic and can provide new methods to study the feeling of free will. PMID:25666736

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

    PubMed

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

    2015-01-01

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

  11. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial

    PubMed Central

    Hill, Jonathan C; Whitehurst, David GT; Lewis, Martyn; Bryan, Stirling; Dunn, Kate M; Foster, Nadine E; Konstantinou, Kika; Main, Chris J; Mason, Elizabeth; Somerville, Simon; Sowden, Gail; Vohora, Kanchan; Hay, Elaine M

    2011-01-01

    Summary Background Back pain remains a challenge for primary care internationally. One model that has not been tested is stratification of the management according to the patient's prognosis (low, medium, or high risk). We compared the clinical effectiveness and cost-effectiveness of stratified primary care (intervention) with non-stratified current best practice (control). Methods 1573 adults (aged ?18 years) with back pain (with or without radiculopathy) consultations at ten general practices in England responded to invitations to attend an assessment clinic. Eligible participants were randomly assigned by use of computer-generated stratified blocks with a 2:1 ratio to intervention or control group. Primary outcome was the effect of treatment on the Roland Morris Disability Questionnaire (RMDQ) score at 12 months. In the economic evaluation, we focused on estimating incremental quality-adjusted life years (QALYs) and health-care costs related to back pain. Analysis was by intention to treat. This study is registered, number ISRCTN37113406. Findings 851 patients were assigned to the intervention (n=568) and control groups (n=283). Overall, adjusted mean changes in RMDQ scores were significantly higher in the intervention group than in the control group at 4 months (4·7 [SD 5·9] vs 3·0 [5·9], between-group difference 1·81 [95% CI 1·06–2·57]) and at 12 months (4·3 [6·4] vs 3·3 [6·2], 1·06 [0·25–1·86]), equating to effect sizes of 0·32 (0·19–0·45) and 0·19 (0·04–0·33), respectively. At 12 months, stratified care was associated with a mean increase in generic health benefit (0·039 additional QALYs) and cost savings (£240·01 vs £274·40) compared with the control group. Interpretation The results show that a stratified approach, by use of prognostic screening with matched pathways, will have important implications for the future management of back pain in primary care. Funding Arthritis Research UK. PMID:21963002

  12. Anesthetic management of right atrial mass removal and pulmonary artery thrombectomy in a patient with primary antiphospholipid antibody syndrome.

    PubMed

    Rawat, S K S; Mehta, Yatin; Vats, Mayank; Mishra, Yugal; Khurana, Poonam; Trehan, Naresh

    2010-01-01

    Antiphospholipid antibody syndrome (APLAS) characterises a clinical condition of arterial and venous thrombosis associated with phospholipids directed antibodies. APLAS occurs in 2% of the general population. However, one study demonstrated that 7.1% of hospitalised patients were tested positive for at least one of the three anticardiolipin antibody idiotype. Antiphospholipid antibodies often inhibit phospholipids dependent coagulation in vitro and interfere with laboratory testing of hemostasis. Therefore, the management of anticoagulation during cardiopulmonary bypass can be quite challenging in these patients. Here, we present a case of right atrial mass removal and pulmonary thrombectomy in a patient of APLAS. PMID:20075534

  13. The Cambridge Controlled Choice Plan.

    ERIC Educational Resources Information Center

    Rossell, Christine H.; Glenn, Charles L.

    1988-01-01

    Analyzes the history and outcomes of parent choice and magnet schools in Cambridge, Massachusetts. Finds that parent choice has resulted in greater interracial exposure than the prior mandatory reassignment plan, and that student achievement has increased. (FMW)

  14. Indication and management of allogeneic stem cell transplantation in primary myelofibrosis: a consensus process by an EBMT/ELN international working group.

    PubMed

    Kröger, N M; Deeg, J H; Olavarria, E; Niederwieser, D; Bacigalupo, A; Barbui, T; Rambaldi, A; Mesa, R; Tefferi, A; Griesshammer, M; Gupta, V; Harrison, C; Alchalby, H; Vannucchi, A M; Cervantes, F; Robin, M; Ditschkowski, M; Fauble, V; McLornan, D; Ballen, K; Popat, U R; Passamonti, F; Rondelli, D; Barosi, G

    2015-11-01

    The aim of this work is to produce recommendations on the management of allogeneic stem cell transplantation (allo-SCT) in primary myelofibrosis (PMF). A comprehensive systematic review of articles released from 1999 to 2015 (January) was used as a source of scientific evidence. Recommendations were produced using a Delphi process involving a panel of 23 experts appointed by the European LeukemiaNet and European Blood and Marrow Transplantation Group. Key questions included patient selection, donor selection, pre-transplant management, conditioning regimen, post-transplant management, prevention and management of relapse after transplant. Patients with intermediate-2- or high-risk disease and age <70 years should be considered as candidates for allo-SCT. Patients with intermediate-1-risk disease and age <65 years should be considered as candidates if they present with either refractory, transfusion-dependent anemia, or a percentage of blasts in peripheral blood (PB) >2%, or adverse cytogenetics. Pre-transplant splenectomy should be decided on a case by case basis. Patients with intermediate-2- or high-risk disease lacking an human leukocyte antigen (HLA)-matched sibling or unrelated donor, should be enrolled in a protocol using HLA non-identical donors. PB was considered the most appropriate source of hematopoietic stem cells for HLA-matched sibling and unrelated donor transplants. The optimal intensity of the conditioning regimen still needs to be defined. Strategies such as discontinuation of immune-suppressive drugs, donor lymphocyte infusion or both were deemed appropriate to avoid clinical relapse. In conclusion, we provided consensus-based recommendations aimed to optimize allo-SCT in PMF. Unmet clinical needs were highlighted. PMID:26293647

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

    PubMed Central

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

    2013-01-01

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

  16. 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…

  17. 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. PMID:25290634

  18. A comparative clinical study on the effect of Tagara (Valeriana wallichii DC.) and Jatamansi (Nardostachys jatamansi DC.) in the management of Anidra (primary insomnia)

    PubMed Central

    Toolika, E.; Bhat, Narayana Prakash; Shetty, Suhas Kumar

    2015-01-01

    Introduction: The World Health Organization's 2004 Global Burden of Disease report indicated 3.6 million years of productive, healthy life is lost worldwide as a result of primary insomnia. Approximately 30–35% of people meet diagnostic criteria for primary insomnia characterized by impairment resulting from problems of falling and staying asleep. Aims: To evaluate the effect of Tagara (Valeriana wallichii DC.) and Jatamansi (Nardostachys jatamansi DC.) in the management of Anidra. Materials and Methods: A total of 34 patients were selected fulfilling the criteria for inclusion for primary insomnia were randomly selected from Out Patient Department and In Patient Department of Manasa Roga and assigned into two groups, wherein 30 patients completed the study (15 in each). Tagara Churna (powder of V. wallichii) and Jatamansi Churna (powder of N. jatamansi) in the dose of 4 gm with milk was administered three times a day for a period of 1 month. Results: Tagara provided significant improvement in initiation of sleep (76.00%; P < 0.001), duration of sleep (55.17%; P < 0.001), disturbed sleep (69.58%; P < 0.001), and disturbances in routine work (73.95%; P < 0.001). Jatamansi provided improvement in initiation of sleep (61.34%; P < 0.001), duration of sleep (48.25%; P < 0.001), disturbed sleep (53.08%; P < 0.001), and disturbance in routine works (43.85%; P < 0.001). Conclusion: Both the groups showed good results, but Tagara group showed better results in comparison to Jatamansi group.

  19. Design considerations in a clinical trial of a cognitive behavioural intervention for the management of low back pain in primary care: Back Skills Training Trial

    PubMed Central

    Lamb, Sarah E; Lall, Ranjit; Hansen, Zara; Withers, Emma J; Griffiths, Frances E; Szczepura, Ala; Barlow, Julie; Underwood, Martin R

    2007-01-01

    Background Low back pain (LBP) is a major public health problem. Risk factors for the development and persistence of LBP include physical and psychological factors. However, most research activity has focused on physical solutions including manipulation, exercise training and activity promotion. Methods/Design This randomised controlled trial will establish the clinical and cost-effectiveness of a group programme, based on cognitive behavioural principles, for the management of sub-acute and chronic LBP in primary care. Our primary outcomes are disease specific measures of pain and function. Secondary outcomes include back beliefs, generic health related quality of life and resource use. All outcomes are measured over 12 months. Participants randomised to the intervention arm are invited to attend up to six weekly sessions each of 90 minutes; each group has 6–8 participants. A parallel qualitative study will aid the evaluation of the intervention. Discussion In this paper we describe the rationale and design of a randomised evaluation of a group based cognitive behavioural intervention for low back pain. PMID:17316434

  20. System hazards in managing laboratory test requests and results in primary care: medical protection database analysis and conceptual model

    PubMed Central

    Bowie, Paul; Price, Julie; Hepworth, Neil; Dinwoodie, Mark; McKay, John

    2015-01-01

    Objectives To analyse a medical protection organisation's database to identify hazards related to general practice systems for ordering laboratory tests, managing test results and communicating test result outcomes to patients. To integrate these data with other published evidence sources to inform design of a systems-based conceptual model of related hazards. Design A retrospective database analysis. Setting General practices in the UK and Ireland. Participants 778 UK and Ireland general practices participating in a medical protection organisation's clinical risk self-assessment (CRSA) programme from January 2008 to December 2014. Main outcome measures Proportion of practices with system risks; categorisation of identified hazards; most frequently occurring hazards; development of a conceptual model of hazards; and potential impacts on health, well-being and organisational performance. Results CRSA visits were undertaken to 778 UK and Ireland general practices of which a range of systems hazards were recorded across the laboratory test ordering and results management systems in 647 practices (83.2%). A total of 45 discrete hazard categories were identified with a mean of 3.6 per practice (SD=1.94). The most frequently occurring hazard was the inadequate process for matching test requests and results received (n=350, 54.1%). Of the 1604 instances where hazards were recorded, the most frequent was at the ‘postanalytical test stage’ (n=702, 43.8%), followed closely by ‘communication outcomes issues’ (n=628, 39.1%). Conclusions Based on arguably the largest data set currently available on the subject matter, our study findings shed new light on the scale and nature of hazards related to test results handling systems, which can inform future efforts to research and improve the design and reliability of these systems. PMID:26614621

  1. Safety and efficacy of laropiprant and extended-release niacin combination in the management of mixed dyslipidemias and primary hypercholesterolemia

    PubMed Central

    Viljoen, Adie; Wierzbicki, Anthony S

    2010-01-01

    Statins form the cornerstone of pharmaceutical cardiovascular disease prevention. However, despite very effective statin intervention, the majority of events remain unpreventable. In some cases statin therapy alone is insufficient to achieve adequate lipid levels whereas other patients are unable to tolerate statins. This calls for additional treatment options. Niacin has a long history of success in reducing low-density lipoprotein cholesterol and triglycerides, and increasing high-density lipoprotein cholesterol. It was the first lipid-lowering drug to demonstrate a reduction in cardiovascular events, and remains the only one that has consistently shown benefits on surrogate outcomes when added to background therapies of other lipid-lowering drugs, including statins. Niacin’s uptake in clinical practice has been less successful due to its side-effect profile, most notable being flushing. The uncovering of the mechanism by which flushing is induced, together with the development of a prostaglandin D2 receptor inhibitor (laropiprant) which reduces this downstream flushing effect of niacin, has sparked new promise in therapeutic lipid management. It provides an additional treatment option into managing lipid abnormalities. The uptake in clinical practice of the niacin–laropiprant combination will depend on the relative improvements experienced by the patient in the side-effect profile compared to other treatment options, as well as on the the keenly-awaited outcome studies currently underway. Until these data become available guidelines and recommendations are unlikely to change and niacin’s position in therapeutic cardiovascular risk prevention will be determined by clinician opinion and experience, and patient preferences. PMID:21701618

  2. Safety and efficacy of laropiprant and extended-release niacin combination in the management of mixed dyslipidemias and primary hypercholesterolemia.

    PubMed

    Viljoen, Adie; Wierzbicki, Anthony S

    2010-01-01

    Statins form the cornerstone of pharmaceutical cardiovascular disease prevention. However, despite very effective statin intervention, the majority of events remain unpreventable. In some cases statin therapy alone is insufficient to achieve adequate lipid levels whereas other patients are unable to tolerate statins. This calls for additional treatment options. Niacin has a long history of success in reducing low-density lipoprotein cholesterol and triglycerides, and increasing high-density lipoprotein cholesterol. It was the first lipid-lowering drug to demonstrate a reduction in cardiovascular events, and remains the only one that has consistently shown benefits on surrogate outcomes when added to background therapies of other lipid-lowering drugs, including statins. Niacin's uptake in clinical practice has been less successful due to its side-effect profile, most notable being flushing. The uncovering of the mechanism by which flushing is induced, together with the development of a prostaglandin D(2) receptor inhibitor (laropiprant) which reduces this downstream flushing effect of niacin, has sparked new promise in therapeutic lipid management. It provides an additional treatment option into managing lipid abnormalities. The uptake in clinical practice of the niacin-laropiprant combination will depend on the relative improvements experienced by the patient in the side-effect profile compared to other treatment options, as well as on the the keenly-awaited outcome studies currently underway. Until these data become available guidelines and recommendations are unlikely to change and niacin's position in therapeutic cardiovascular risk prevention will be determined by clinician opinion and experience, and patient preferences. PMID:21701618

  3. 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

  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. Department of Primary Care Respiratory

    E-print Network

    Delgado, Mauricio

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

  6. The Primary Headteacher's Handbook: The Essential Guide for Primary Heads. Primary Essentials Series.

    ERIC Educational Resources Information Center

    Smith, Roger

    Although the setting is British, the primary head's problems are similar to those faced by U.S. elementary principals. This is a guidebook for managing primary schools. It shows the day-to-day running of a primary school and the organizational structures in which staff and pupils can be inspired. Chapter 1 considers the creation of a positive…

  7. Primary Aldosteronism

    MedlinePLUS

    ... MD, MSc What is primary aldosteronism? Primary aldosteronism (PA) is a type of hyperaldosteronism. This condition occurs ... stroke may be even greater in people with PA than in other people with high blood pressure. ...

  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. More Choices Available for Diabetes Management

    MedlinePLUS

    ... The Animas Vibe System combines the DexCom G4 Platinum CGM with an Animas insulin pump. This approval ... enabled pumps, including ones that integrate the G4 Platinum System, as a component. The availability of an ...

  10. Risk Management and Fumigation Choice in Florida

    E-print Network

    Ma, Lena

    & Resource Economics Department UF/IFAS #12;Fresh tomato market value and yield for Florida's fresh tomatoes 1997 1999 2001 2003 2005 2007 2009 2011 2013 Value(Million$) Market Value Fresh Tomato Yield Yield Activity Fumigant Nematode Disease Weed 1) Methyl Bromide 50/50 Good to Excellent Excellent Fair

  11. 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

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

    NASA Astrophysics Data System (ADS)

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

    2014-05-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-04-01

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

  14. An Economic Evaluation of TENS in Addition to Usual Primary Care Management for the Treatment of Tennis Elbow: Results from the TATE Randomized Controlled Trial

    PubMed Central

    Lewis, Martyn; Chesterton, Linda S.; Sim, Julius; Mallen, Christian D.; Hay, Elaine M.; van der Windt, Daniëlle A.

    2015-01-01

    Background The TATE trial was a multicentre pragmatic randomized controlled trial of supplementing primary care management (PCM)–consisting of a GP consultation followed by information and advice on exercises–with transcutaneous electrical nerve stimulation (TENS), to reduce pain intensity in patients with tennis elbow. This paper reports the health economic evaluation. Methods and Findings Adults with new diagnosis of tennis elbow were recruited from 38 general practices in the UK, and randomly allocated to PCM (n = 120) or PCM plus TENS (n = 121). Outcomes included reduction in pain intensity and quality-adjusted-life-years (QALYs) based on the EQ5D and SF6D. Two economic perspectives were evaluated: (i) healthcare–inclusive of NHS and private health costs for the tennis elbow; (ii) societal–healthcare costs plus productivity losses through work absenteeism. Mean outcome and cost differences between the groups were evaluated using a multiple imputed dataset as the base case evaluation, with uncertainty represented in cost-effectiveness planes and through probabilistic cost-effectiveness acceptability curves). Incremental healthcare cost was £33 (95%CI -40, 106) and societal cost £65 (95%CI -307, 176) for PCM plus TENS. Mean differences in outcome were: 0.11 (95%CI -0.13, 0.35) for change in pain (0–10 pain scale); -0.015 (95%CI -0.058, 0.029) for QALYEQ5D; 0.007 (95%CI -0.022, 0.035) for QALYSF6D (higher score differences denote greater benefit for PCM plus TENS). The ICER (incremental cost effectiveness ratio) for the main evaluation of mean difference in societal cost (£) relative to mean difference in pain outcome was -582 (95%CI -8666, 8113). However, incremental ICERs show differences in cost–effectiveness of additional TENS, according to the outcome being evaluated. Conclusion Our findings do not provide evidence for or against the cost-effectiveness of TENS as an adjunct to primary care management of tennis elbow. PMID:26317528

  15. Group interprofessional chronic pain management in the primary care setting: A pilot study of feasibility and effectiveness in a family health team in Ontario

    PubMed Central

    Angeles, Ricardo N; Guenter, Dale; McCarthy, Lisa; Bauer, Martha; Wolfson, Miriam; Chacon, Maria; Bullock, Lana

    2013-01-01

    BACKGROUND Approximately 18.9% of Canadians live with chronic pain. Primary care reform in Ontario presents unique opportunities to assess approaches to help these patients. OBJECTIVE: To assess the feasibility of an interprofessional primary care-based program for patients living with chronic pain, and to examine the potential impact of such a program on quality of life and health resource utilization. METHODS: An embedded mixed-methods evaluation (randomized controlled trial with waiting list control and semistructured interviews) of an eight-week series of small group sessions exploring multifactoral aspects of pain management was performed. Participants were randomly assigned to early intervention (EI) or delayed intervention (DI) groups. All participants received the intervention; the DI group served as a control group for comparison with the EI group. Outcomes included the Short Form-36 Health Survey version 2 (SF-36v2), medication use and health care utilization. Qualitative interviews were conducted to identify areas for program improvement. RESULTS: A total of 240 patients were recruited and 63 agreed to participate. The mean (± SD) age of the participants was 55±14.1 years and 62.3% were female. There was no significant difference in the mean change in SF-36v2 summary scores between the EI and DI groups. However, the SF-36v2 subscale score for bodily pain was significantly improved in the EI group compared with the DI group after six months of observation (mean difference = 13.1 points; P<0.05). There was also significant improvement in this score when both groups were pooled and aggregate preintervention and postintervention scores were compared. There was a significant decrease in the mean number of clinic visits in the six-month period following the intervention compared with the six-month period before the intervention (P=0.043). CONCLUSION: An interprofessional program in primary care for patients living with chronic pain may lead to improvements in quality of life and health resource utilization. The challenges to the feasibility of the program and its evaluation are recruitment and retention of patients, leading to the conclusion that the program, as it was conducted in the present study, is not appropriate for this setting. PMID:23875181

  16. 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…

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

    E-print Network

    Parrott, Wayne

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

  18. Parental Voucher Enrollment Decisions: Choice within Choice in New Orleans

    ERIC Educational Resources Information Center

    Beabout, Brian R.; Cambre, Belinda M.

    2013-01-01

    Set in the context of a choice-saturated public school system, this study examines the school choice process of low-income parents who participated in Louisiana's 2008 voucher program. Based on semistructured interviews with 16 parents at 1 Catholic school, we report that spirituality, small class and school size, character/values,…

  19. Waste. Choices for Communities.

    ERIC Educational Resources Information Center

    Knaus, Andy; And Others

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

  20. Choice-Based Conjoint Analysis: Classification vs. Discrete Choice Models

    NASA Astrophysics Data System (ADS)

    Giesen, Joachim; Mueller, Klaus; Taneva, Bilyana; Zolliker, Peter

    Conjoint analysis is a family of techniques that originated in psychology and later became popular in market research. The main objective of conjoint analysis is to measure an individual's or a population's preferences on a class of options that can be described by parameters and their levels. We consider preference data obtained in choice-based conjoint analysis studies, where one observes test persons' choices on small subsets of the options. There are many ways to analyze choice-based conjoint analysis data. Here we discuss the intuition behind a classification based approach, and compare this approach to one based on statistical assumptions (discrete choice models) and to a regression approach. Our comparison on real and synthetic data indicates that the classification approach outperforms the discrete choice models.

  1. Appropriateness of Advice: DCT and Multiple Choice Data.

    ERIC Educational Resources Information Center

    Hinkel, Eli

    1997-01-01

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

  2. Some Findings on Career Choice in General Medicine in Yugoslavia

    ERIC Educational Resources Information Center

    Barath, Arpad

    1976-01-01

    The career choice study in Croatia was undertaken as part of a larger, multidisciplinary program evaluating postgraduate training. Certain premises and limitations of the education of primary physicians were studied, notably the social and/or personality factors that motivate those aspiring to be general practitioners. (LBH)

  3. Offering Choice of Surgical Treatment to Women with Breast Cancer.

    ERIC Educational Resources Information Center

    Fallowfield, Lesley

    1997-01-01

    Few differences in quality of life results are reported between different primary surgical treatments for breast cancer. Assumptions regarding the role of informed choice in psychosocial morbidity have not been substantiated, and fewer women than expected take an active role in decision making. Rigorous research is needed. (Author/EMK)

  4. 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

  5. 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

  6. Management experiences of primary angiosarcoma of breast: a retrospective study from single institute in the People’s Republic of China

    PubMed Central

    Hu, Qun-Chao; Mei, Xin; Feng, Yan; Ma, Jin-Li; Yang, Zhao-Zhi; Shao, Zhi-Min; Yu, Xiao-Li; Guo, Xiao-Mao

    2015-01-01

    Background Primary angiosarcoma of breast (PAOB) is a rare and highly aggressive malignancy. There is no general agreement on optimal treatments or prognostic factors for this orphan disease. The objective of this study was to investigate the clinicopathologic features and management experiences of PAOB. Methods We performed a retrospective review of medical and pathologic records of 17 consecutive patients diagnosed with PAOB between January 2000 and February 2014 at FuDan University Shanghai Cancer Center. We evaluated the clinical characteristics, multimodality treatments, and associated clinical outcomes. Results A total of 16 patients were included in this retrospective study (median age at PAOB presentation 33.5 years, range: 19–56 years). Palpable tumor with or without breast skin ecchymosis presented as the most common initial symptom. All patients underwent surgery with curative intent. Median disease-free survival and overall survival (OS) were 9 months and 13.6 months, respectively. One-year and 3-year disease-free survival rates were 43.8% and 6.3%, with OS rates of 93.8% and 78.1%, respectively. High histologic grade indicated poorer OS by univariate analysis (P=0.01). However, neither adjuvant chemotherapy nor radiotherapy contributed to clinical outcomes in our series. Conclusion PAOB is considered as an infrequent breast neoplasm with aggressive characteristics. Histologic grade and early metastasis (within 12 months after diagnosis) are associated with poor prognosis. Regardless of grade, additional benefit was not observed with adjuvant therapy. PMID:26604790

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

    PubMed Central

    2013-01-01

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

  8. The Globalisation of School Choice?

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  9. PATERNAL INFLUENCE ON CAREER CHOICE.

    ERIC Educational Resources Information Center

    WERTS, CHARLES E.

    FATHER'S OCCUPATION WAS COMPARED WITH SON'S CAREER CHOICE FOR A SAMPLE OF 76,015 MALE, COLLEGE FRESHMEN. RESULTS INDICATED THAT CERTAIN TYPES OF FATHERS' OCCUPATIONS WERE ASSOCIATED WITH SIMILAR TYPES OF CAREER CHOICES BY SONS. BOYS WHOSE FATHERS WERE IN SCIENTIFIC OCCUPATIONS (ENGINEERS, MILITARY OFFICERS, ARCHITECTS, BIOLOGISTS, CHEMISTS, AND…

  10. Religious Education and Religious Choice

    ERIC Educational Resources Information Center

    Hand, Michael

    2015-01-01

    According to the "religious choice case" for compulsory religious education, pupils have a right to be made aware of the religious and irreligious paths open to them and equipped with the wherewithal to choose between them. A familiar objection to this argument is that the idea of religious choice reduces religion to a matter of taste. I…

  11. College Choice in the Philippines

    ERIC Educational Resources Information Center

    Tan, Christine Joy

    2009-01-01

    This descriptive and correlational study examined the applicability of major U.S. college choice factors to Philippine high school seniors. A sample of 226 students from a private school in Manila completed the College Choice Survey for High School Seniors. Cronbach's alpha for the survey composite index was 0.933. The purposes of this…

  12. 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…

  13. Private Public Choice Felix Brandt

    E-print Network

    Cengarle, María Victoria

    Private Public Choice Felix Brandt Computer Science Department Technical University of Munich of conflicting preferences in a group of agents is one of the cen- tral topics of economics and multiagent choice problem 1 The problem is to find a function that "fairly" aggre- gates conflicting preferences

  14. Preference Reversal in Multiattribute Choice

    ERIC Educational Resources Information Center

    Tsetsos, Konstantinos; Usher, Marius; Chater, Nick

    2010-01-01

    A central puzzle for theories of choice is that people's preferences between options can be reversed by the presence of decoy options (that are not chosen) or by the presence of other irrelevant options added to the choice set. Three types of reversal effect reported in the decision-making literature, the attraction, compromise, and similarity…

  15. Contextual Explanations of School Choice

    ERIC Educational Resources Information Center

    Lauen, Douglas Lee

    2007-01-01

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

  16. MANAGING OBESITY IN PRIMARY CARE

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  17. Other primary headaches

    PubMed Central

    Bahra, Anish

    2012-01-01

    The ‘Other Primary Headaches’ include eight recognised benign headache disorders. Primary stabbing headache is a generally benign disorder which often co-exists with other primary headache disorders such as migraine and cluster headache. Primary cough headache is headache precipitated by valsalva; secondary cough has been reported particularly in association with posterior fossa pathology. Primary exertional headache can occur with sudden or gradual onset during, or immediately after, exercise. Similarly headache associated with sexual activity can occur with gradual evolution or sudden onset. Secondary headache is more likely with both exertional and sexual headache of sudden onset. Sudden onset headache, with maximum intensity reached within a minute, is termed thunderclap headache. A benign form of thunderclap headache exists. However, isolated primary and secondary thunderclap headache cannot be clinically differentiated. Therefore all headache of thunderclap onset should be investigated. The primary forms of the aforementioned paroxysmal headaches appear to be Indomethacin sensitive disorders. Hypnic headache is a rare disorder which is termed ‘alarm clock headache’, exclusively waking patients from sleep. The disorder can be Indomethacin responsive, but can also respond to Lithium and caffeine. New daily persistent headache is a rare and often intractable headache which starts one day and persists daily thereafter for at least 3 months. The clinical syndrome more often has migrainous features or is otherwise has a chronic tension-type headache phenotype. Management is that of the clinical syndrome. Hemicrania continua straddles the disorders of migraine and the trigeminal autonomic cephalalgias and is not dealt with in this review. PMID:23024566

  18. Symptomatic management in multiple sclerosis

    PubMed Central

    Shah, Pushkar

    2015-01-01

    Multiple sclerosis (MS) is the commonest cause of disability in young adults. While there is increasing choice and better treatments available for delaying disease progression, there are still, very few, effective symptomatic treatments. For many patients such as those with primary progressive MS (PPMS) and those that inevitably become secondary progressive, symptom management is the only treatment available. MS related symptoms are complex, interrelated, and can be interdependent. It requires good understanding of the condition, a holistic multidisciplinary approach, and above all, patient education and empowerment. PMID:26538847

  19. Age Differences in Choice Deferrals as Functions of Interattribute Conflict and Decision Domain

    ERIC Educational Resources Information Center

    Pethtel, Olivia L.; Chen, Yiwei

    2013-01-01

    The primary purpose of the present study was to examine age differences in choice deferral when young and older adults make high vs. low conflict decisions in two domains (i.e., health and commodity). Sixty young and 60 older adults were presented with four different decision scenarios in which they could either choose an option or use choice

  20. The Role of Family in Vocational Education and Training Choices: A Case Study in Vietnam

    ERIC Educational Resources Information Center

    Dormeier Freire, Alexandre; Giang, Hong Trinh

    2012-01-01

    This article examines the role of family in vocational education and training (VET) choices, using primary qualitative data collected in the commune of Hung An, Vietnam. The authors demonstrate that, next to issues relating to income, it is family characteristics that are the predominant influence on an individual's choice of the VET track,…

  1. Anatomy of a systemic choice

    SciTech Connect

    Mann, W.C.

    1982-09-01

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

  2. [Primary hyperparathyroidism].

    PubMed

    Maruani, G; Cornière, N; Nicolet, L; Baron, S; Courbebaisse, M; Renaud, S; Houillier, P

    2013-10-01

    For the past 40 years, primary hyperparathyroidism has been recognized as a common endocrine disease which is, most often, "non-symptomatic", without the occurrence of nephrolithiasis or osteitis fibrosa cystica. Our knowledge in the pathophysiology has increased largely and diagnosis of primary hyperparathyroidism is usually easy. The only radical treatment is surgery and the surgical indications have been codified by several consensus conferences. For patients who do not undergo surgery, prolonged medical monitoring is needed. PMID:23195909

  3. Cultural specificity in food choice - The case of ethnography in Japan.

    PubMed

    Freedman, Irith

    2016-01-01

    Previous studies examining food choice from a cross-cultural perspective were based primarily on quantitative research using the Food Choice Questionnaire (FCQ). This study suggests ethnography as a complementary research method in cross-cultural food choice studies. While use of the FCQ resulted in findings of cultural differences in food choice processes, within a preliminary motive list, ethnography allows the exploration of new, possibly culture-specific motives for food choice. Moreover, ethnography allows a deeper understanding of the cultural background of food choice processes in a studied culture. Using Japan as a case study, this research demonstrates the use of ethnography to argue that variety is a primary motive for food choice in contemporary Japanese culture. Variety is hence regarded here as a part of a larger food culture attribute, an "adventurous palate," which can also provide a background for previous FCQ findings (Prescott, Young, O'neill, Yau, & Stevens, 2002). PMID:26363421

  4. 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

    SciTech Connect

    Puget, P; Lal, Rattan; Izaurralde, R Cesar C.; Post, M; Owens, Lloyd

    2005-04-01

    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 Experimental Watersheds near Coshocton, Ohio, through *13C techniques. These measurements were made for five land use and soil management treatments: (1) secondary forest, (2) meadow converted from no-till (NT) corn since 1988, (3) continuous NT corn since 1970, (4) continuous NT corn-soybean in rotation with ryegrass since 1984, and (5) conventional plow till (PT) corn since 1984. Soil samples to 70-cm depth were obtained in 2002 in all treatments. Significant differences in soil properties were observed among land use treatments for 0 to 5-cm depth. The SOC concentration (g C kg*1 of soil) in the 0 to 5-cm layer was 44.0 in forest, 24.0 in meadow, 26.1 in NT corn, 19.5 in NT corn-soybean, and 11.1 i n PT corn. The fraction of total C in corn residue converted to SOC was 11.9% for NT corn, 10.6% for NT corn-soybean, and 8.3% for PT corn. The proportion of SOC derived from corn residue was 96% for NT corn in the 0 to 5-cm layer, and it decreased gradually with depth and was 50% in PT corn. The mean SOC sequestration rate on conversion from PT to NT was 280 kg C ha*1 y*1. The SOC concentration decreased with reduction in aggregate size, and macro-aggregates contained 15 to 35% more SOC concentration than microaggregates. In comparison with forest, the magnitude of SOC depletion in the 0 to 30-cm layer was 15.5 Mg C/ha (24.0%) in meadow, 12.7 Mg C/ha (19.8%) in NT corn, 17.3 Mg C/ha (26.8%) in NT corn-soybean, and 23.3 Mg C/ha (35.1%) in PT corn. The SOC had a long turnover time when located deeper in the subsoil.

  5. The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial

    PubMed Central

    2012-01-01

    Background To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm). Methods This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36. Results Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were ?30.09% and ?27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended). Conclusion Patients who received coaching and advice from primary care physicians (with or without the assistance by nurse educators) showed improvement in LDL-cholesterol. Disease management services delivered by PCP-NE demonstrated a trend towards add-on improvements in cholesterol control compared to care delivered by physicians alone; however, the improvements were not maintained when the services were withdrawn. Trial registration National Medical Research Registration (NMRR) Number: NMRR-08-287-1442 Trial Registration Number (ClinicalTrials.gov Identifier): NCT00708370 PMID:23046818

  6. Interpretations of informed choice in antenatal screening: a cross-cultural, Q-methodology study.

    PubMed

    Ahmed, Shenaz; Bryant, Louise D; Tizro, Zahra; Shickle, Darren

    2012-04-01

    Informed choice is internationally recognised and accepted as an important aspect of ethical healthcare. In the U.K., NHS antenatal screening policies state that their primary aim is to facilitate reproductive informed choices. These policies, implemented within a multiethnic population, are largely guided by the ethical principle of autonomy. This study was carried out in 2009 in the U.K. and used Q-methodology to explore diversity in the value attached to autonomous informed choice in antenatal screening for genetic disorders and similarities and differences in this value in women from different ethnic origins. Ninety-eight participants of African, British White, Caribbean, Chinese and Pakistani origin completed a 41-statement Q-sort in English, French, Mandarin or Urdu. Q-Factor analysis produced five statistically independent viewpoints of the value of informed choice: choice as an individual right; choice informed by religious values; choice as a shared responsibility; choice advised by health professionals; and choice within the family context. The findings show that women hold a variety of views on the nature of informed choice, and that, contradictory to policies of autonomous informed choice, many women seek and value the advice of health professionals. The findings have implications for the role of health professionals in facilitating informed choice, quality of care and equity of access. PMID:22326381

  7. Assessing the institutional choice process of student-athletes.

    PubMed

    Doyle, C A; Gaeth, G J

    1990-03-01

    The primary purpose of this investigation was to determine the relative importance of the attributes that student-athletes use when determining their choice of a university. A second purpose was to compare previous athletic institutional choice studies with the results of this study to determine if the most important attributes were similar and to compare and contrast methodologies. Six hundred five Division I student-athletes (344 baseball players and 261 softball players) from all eight national geographic regions of the NCAA participated in this study. The experimental procedure was based on Information Integration Theory and a 2(10) fractional factorial design that resulted in 32 "choice sets." These choice sets were composed of universities described by 10 attributes. This framework required that the student-athletes choose from among three university profiles, thereby realistically simulating the decision process. The results for the aggregate sample show that the "Amount of Scholarship" attribute was the most important factor in the institutional choice process. Many demographic variables were analyzed (sex, race, amount of scholarship received as a freshman, amount of perceived financial need, self-reported grade-point average, questionnaire completion procedures, in-state/out-of-state status, NCAA region, and rank in high school) in conjunction with the choice set data in a post-hoc framework. The results for a subset of these variables are reported in this paper; differences (in the order of importance of the attributes) were found among groups. A primary finding of this study is that a student-athlete's perceived financial need has a critical impact on the institutional choice process.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2091172

  8. How do stereotypes influence choice?

    PubMed

    Chaxel, Anne-Sophie

    2015-05-01

    In the study reported here, I tracked one process through which stereotypes affect choice. The Implicit Association Test (IAT) and a measurement of predecisional information distortion were used to assess the influence of the association between male gender and career on the evaluation of information related to the job performance of stereotypical targets (male) and nonstereotypical targets (female). When the IAT revealed a strong association between male gender and career and the installed leader in the choice process was a stereotypical target, decision makers supported the leader with more proleader distortion; when the IAT revealed a strong association between male gender and career and the installed leader in the choice process was a nonstereotypical target, decision makers supported the trailer with less antitrailer distortion. A stronger association between male gender and career therefore resulted in an upward shift of the evaluation related to the stereotypical target (both as a trailer and a leader), which subsequently biased choice. PMID:25749702

  9. Household savings and portfolio choice

    E-print Network

    Klein, Sean Patrick

    2010-01-01

    This thesis consists of three essays that examine household savings and portfolio choice behavior. Chapter One analyses the effects of employer matching contributions and tax incentives on participation and contribution ...

  10. Autotuning programs with algorithmic choice

    E-print Network

    Ansel, Jason (Jason Andrew)

    2014-01-01

    The process of optimizing programs and libraries, both for performance and quality of service, can be viewed as a search problem over the space of implementation choices. This search is traditionally manually conducted by ...

  11. Network knowledge and route choice

    E-print Network

    Ramming, Michael Scott

    2002-01-01

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

  12. Connecting cognition and consumer choice.

    PubMed

    Bartels, Daniel M; Johnson, Eric J

    2015-02-01

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

  13. Primary biliary cirrhosis.

    PubMed

    Carey, Elizabeth J; Ali, Ahmad H; Lindor, Keith D

    2015-10-17

    Primary biliary cirrhosis is a chronic cholestatic liver disease characterised by destruction of small intrahepatic bile ducts, leading to fibrosis and potential cirrhosis through resulting complications. The serological hallmark of primary biliary cirrhosis is the antimitochondrial antibody, a highly disease-specific antibody identified in about 95% of patients with primary biliary cirrhosis. These patients usually have fatigue and pruritus, both of which occur independently of disease severity. The typical course of primary biliary cirrhosis has changed substantially with the introduöction of ursodeoxycholic acid (UDCA). Several randomised placebo-controlled studies have shown that UDCA improves transplant-free survival in primary biliary cirrhosis. However, about 40% of patients do not have a biochemical response to UDCA and would benefit from new therapies. Liver transplantation is a life-saving surgery with excellent outcomes for those with decompensated cirrhosis. Meanwhile, research on nuclear receptor hormones has led to the development of exciting new potential treatments. This Seminar will review the current understanding of the epidemiology, pathogenesis, and natural history of primary biliary cirrhosis, discuss management of the disease and its sequelae, and introduce research on new therapeutic options. PMID:26364546

  14. 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

  15. 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

  16. RESTORE: an exploratory trial of an online intervention to enhance self-efficacy to manage problems associated with cancer-related fatigue following primary cancer treatment: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background There are over 25 million people worldwide living with or beyond cancer and this number is increasing. Cancer survivors face a range of problems following primary treatment. One of the most frequently reported and distressing symptoms experienced by cancer survivors is fatigue. There is growing support for survivors who are experiencing problems after cancer treatment to engage in supported self-management. To date there is some evidence of effective interventions to manage fatigue in this population; however, to our knowledge there are no online resources that draw on this information to support self-management of fatigue. This paper describes the protocol for an exploratory randomized controlled trial of an online intervention to support self-management of cancer-related fatigue after primary cancer treatment. Methods/design This is a parallel-group two-armed (1:1) exploratory randomized controlled trial including 125 cancer survivors experiencing fatigue (scoring ?4 on a unidimensional 11-point numeric rating scale for fatigue intensity) within five years of primary treatment completion with curative intent. Participants will be recruited from 13 NHS Trusts across the UK and randomized to either the online intervention (RESTORE), or a leaflet comparator (Macmillan Cancer Backup, Coping with Fatigue). The primary outcome is a change in Perceived Self-Efficacy for Fatigue Self-Management (as measured by the Perceived Self-Efficacy for Fatigue Self-Management Instrument). Secondary outcomes include impact on perception and experience of fatigue (measured by the Brief Fatigue Inventory), and quality of life (measured by the Functional Assessment of Cancer Therapy - General and the Personal Wellbeing Index). Outcome measures will be collected at baseline, 6 weeks (completion of intervention), and 3 months. Process evaluation (including telephone interviews with recruiting staff and participants) will determine acceptability of the intervention and trial processes. Discussion Data from this trial will be used to refine the intervention and contribute to the design of an effectiveness trial. This intervention will be expanded to address other cancer-related problems important to cancer survivors following primary cancer treatment. Trial registration ISRCTN67521059 PMID:23786716

  17. Modeling one-choice and two-choice driving tasks.

    PubMed

    Ratcliff, Roger

    2015-08-01

    An experiment is presented in which subjects were tested on both one-choice and two-choice driving tasks and on non-driving versions of them. Diffusion models for one- and two-choice tasks were successful in extracting model-based measures from the response time and accuracy data. These include measures of the quality of the information from the stimuli that drove the decision process (drift rate in the model), the time taken up by processes outside the decision process and, for the two-choice model, the speed/accuracy decision criteria that subjects set. Drift rates were only marginally different between the driving and non-driving tasks, indicating that nearly the same information was used in the two kinds of tasks. The tasks differed in the time taken up by other processes, reflecting the difference between them in response processing demands. Drift rates were significantly correlated across the two two-choice tasks showing that subjects that performed well on one task also performed well on the other task. Nondecision times were correlated across the two driving tasks, showing common abilities on motor processes across the two tasks. These results show the feasibility of using diffusion modeling to examine decision making in driving and so provide for a theoretical examination of factors that might impair driving, such as extreme aging, distraction, sleep deprivation, and so on. PMID:25944448

  18. Primary Hyperparathyroidism

    MedlinePLUS

    ... in osteoporosis (weak bones that break easily), kidney stones (small clumps of calcium), and a decline in kidney function. DiD YOu knOW? Women are more likely than men to develop primary hyperparathyroidism, and the risk increases with age. FAcT SHeeT Parathyroid Glands thyroid Gland Back View ...

  19. Primary Hyperparathyroidism

    MedlinePLUS

    ... D.C.: American Society of Bone and Mineral Research; 2009: 361–367. Eastell R, Arnold A, Brandi ML, et al. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Third International Workshop. Journal of Clinical Endocrinology and Metabolism. 2009;94(2): ...

  20. 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…

  1. "Choice" Can Be a Mirage as Schools Vie in Market.

    ERIC Educational Resources Information Center

    Chira, Susan

    1992-01-01

    Discusses the change to a choice-based school system in Great Britain under the Education Reform Act of 1988. Compares the British system with proposed changes in the United States. Describes the changes that have placed budgeting and management in the hands of the individual schools that have the power to "opt out" of school district control. (DK)

  2. A qualitative study of a primary-care based intervention to improve the management of patients with heart failure: the dynamic relationship between facilitation and context

    E-print Network

    Tierney, Stephanie; Kislov, Roman; Deaton, Christi

    2014-09-18

    , University of Warwick, Coventry, UK. 2Manchester Business School, University of Manchester, Manchester, UK. 3Florence Nightingale Foundation Professor of Clinical Nursing Research, Department of Public Health and Primary Care, University of Cambridge School...

  3. Consumer health plan choice: current knowledge and future directions.

    PubMed

    Scanlon, D P; Chernew, M; Lave, J R

    1997-01-01

    A keystone of the competitive strategy in health insurance markets is the assumption that "consumers" can make informed choices based on the costs and quality of competing health plans, and that selection effects are not large. However, little is known about how individuals use information other than price in the decision making process. This review summarizes the state of knowledge about how individuals make choices among health plans and outlines an agenda for future research. We find that the existing literature on health plan choice is no longer sufficient given the widespread growth and acceptance of managed care, and the increased proportion of consumers' income now going toward the purchase of health plans. Instead, today's environment of health plan choice requires better understanding of how plan attributes other than price influence plan choice, how other variables such as health status interact with plan attributes in the decision making process, and how specific populations differ from one another in terms of the sensitivity of their health plan choices to these different types of variables. PMID:9143729

  4. Prospective Teachers' Interest in Teaching, Professional Plans about Teaching and Career Choice Satisfaction: A Relevant Framework?

    ERIC Educational Resources Information Center

    Eren, Altay

    2012-01-01

    This study aimed to examine the relationships among prospective teachers' interest in teaching, professional engagement and career development aspirations, and career choice satisfaction. A total of 602 prospective teachers from various primary (for example, primary school teaching) and secondary (for example, English language teaching) teacher…

  5. Who Is Joining Physics and Why? Factors Influencing the Choice of Physics among Ethiopian University Students

    ERIC Educational Resources Information Center

    Semela, Tesfaye

    2010-01-01

    This paper investigates the enrolment trends and the critical factors that impinge on students' choice of physics as major field of study. The data were generated from primary and secondary sources. Primary data was acquired based on a semi-structured interview with 14 sophomore and 11 senior students and five instructors of the department of…

  6. From School Choice to Educational Choice. Education Outlook. No. 3

    ERIC Educational Resources Information Center

    Hess, Frederick M.; Meeks, Olivia; Manno, Bruno V.

    2011-01-01

    In recent decades, many calls for transformative change in American schooling have advocated school choice. Yet these calls themselves have too often accepted the orthodoxies of the nineteenth-century schoolhouse. In the new book "Customized Schooling: Beyond Whole-School Reform" (Harvard Education Press, 2011), the authors worked with the Walton…

  7. Primary angioplasty: preprocedural pharmacological therapy

    PubMed Central

    Ernst, N.; de Boer, M-J.; Zijlstra, F.; Suryapranata, H.; Dambrink, J-H.E.; Hoorntje, J.C.A.; van 't Hof, A.W.J.

    2006-01-01

    Primary coronary angioplasty has been shown to be an effective reperfusion therapy for patients with acute myocardial infarction, not only for those who present to PTCA centres but also for patients who present to hospitals without angioplasty facilities. With the increasing use of primary angioplasty more patients will be transferred to a (tertiary) PTCA centre. An increase in treatment delay is associated with a worse clinical outcome. The importance of an open infarct-related vessel at acute angiography is becoming clear. Pharmacological pretreatment of patients during transportation to a PTCA centre with the aim to open the infarct-related vessel in advance might be beneficial. Glycoprotein IIb/IIIa receptor blockers seem to be the agents of choice for facilitated PTCA. The safety and (cost) effectiveness of this pretreatment of patients transported to undergo primary angioplasty remain to be evaluated. ImagesFigure 1 PMID:25696594

  8. Flooring choices for newborn ICUs.

    PubMed

    White, R D

    2007-12-01

    Floors are a major element of newborn intensive care unit (NICU) construction. They provide visual cues, sound control, and with certain materials, some degree of physical comfort for workers. Flooring materials may entail a significant cost for installation and upkeep and can have substantial ecological impact, both in the choice of the flooring itself, as well as the substances used to clean it. In this article the important aspects to consider for each factor are explored and recommendations are offered for appropriate choices in various NICU areas. PMID:18034176

  9. More Choice Isn't Always Better

    ERIC Educational Resources Information Center

    Schuller, Tom

    2012-01-01

    Choice is important to everyone, for one's identity as well as one's material satisfaction. Everyone has choices, but even the head of state's choices are constrained. In recent years choice has risen up the political agenda in the UK. It has become a key component of the drive to reform public services such as health and education. The…

  10. Florida CHOICES Counselor Manual, 1982-1983.

    ERIC Educational Resources Information Center

    Thomas, Glenn R.; And Others

    This manual is intended to acquaint counselors with CHOICES, a computer-assisted career information program. Following an overview of the CHOICES system, and a brief discussion of the usefulness of the program for counselors, the three-step CHOICES process is presented: Step 1, the Initial Interview (pre- CHOICES), involves determining student…

  11. Florida CHOICES Counselor's Manual 1983-84.

    ERIC Educational Resources Information Center

    Glenn, Thomas R.; Rogers, Zelda

    This manual for counselors is intended for use with CHOICES, a computer assisted career guidance system. Following a brief introduction to CHOICES, the structure (in chart form) and an overview of the contents of the CHOICES system are given. Chapter 2 focuses on counseling clients, emphasizing the three-step helping process, i.e., preCHOICES, to…

  12. 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

  13. Supermarket Choice, Shopping Behavior, Socioeconomic Status, and Food Purchases

    PubMed Central

    Pechey, Rachel; Monsivais, Pablo

    2015-01-01

    Introduction Both SES and supermarket choice have been associated with diet quality. This study aimed to assess the contributions of supermarket choice and shopping behaviors to the healthfulness of purchases and social patterning in purchases. Methods Observational panel data on purchases of fruit and vegetables and less-healthy foods/beverages from 2010 were obtained for 24,879 households, stratified by occupational social class (analyzed in 2014). Households’ supermarket choice was determined by whether they ever visited market-defined high- or low-price supermarkets. Analyses also explored extent of use within supermarket choice groups. Shopping behaviors included trip frequency, trip size, and number of store chains visited. Results Households using low-price (and not high-price) supermarkets purchased significantly lower percentages of energy from fruit and vegetables and higher percentages of energy from less-healthy foods/beverages than households using high-price (and not low-price) supermarkets. When controlling for SES and shopping behaviors, the effect of supermarket choice was reduced but remained significant for both fruit and vegetables and less-healthy foods/beverages. The extent of use of low- or high-price supermarkets had limited effects on outcomes. More-frequent trips and fewer small trips were associated with healthier purchasing for both outcomes; visiting more store chains was associated with higher percentages of energy from fruit and vegetables. Conclusions Although both supermarket choice and shopping behaviors are associated with healthfulness of purchases, neither appears to contribute to socioeconomic differences. Moreover, differences between supermarket environments may not be primary drivers of the relationship between supermarket choice and healthfulness of purchases. PMID:26163172

  14. Choices in Cataloging Electronic Journals

    ERIC Educational Resources Information Center

    Leathem, Cecilia A.

    2005-01-01

    Libraries and catalogers face choices in the treatment of the growing collections of electronic journals. Policies issued by CONSER and the Library of Congress allow libraries to edit existing print records to accommodate information pertaining to the electronic versions (single record option) or to create new records for them. The discussion…

  15. 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…

  16. Moral Dimensions of Curriculum Choices.

    ERIC Educational Resources Information Center

    MacMillan, C. J. B.

    This paper argues that just as subject matter is inherently value-laden, educators should not feel trepidation about morally justifying their criteria for choosing curricula to be taught in the classroom. It recommends that true "moral" choices should be made on the bases of relevance to student experiences; moral propriety of subject matter…

  17. No Easy Road to Choice

    ERIC Educational Resources Information Center

    Robelen, Erik W.

    2008-01-01

    In the new educational landscape of New Orleans--where public school choice is a fundamental element--pounding the pavement to drum up students has become a familiar pursuit. Proponents say a central idea of the education system that has emerged since Hurricane Katrina hit in 2005 is to provide a diverse array of high-quality school options, with…

  18. Coming Around on School Choice.

    ERIC Educational Resources Information Center

    Viteritti, Joseph P.

    2002-01-01

    Asserts that opponent's predictions that school choice would result in mass exodus of students and a disparate impact on public schools have failed to materialize. Argues that disadvantaged students, especially blacks, in inner-city schools are the principal beneficiaries of voucher programs. (Contains 13 references.) (PKP)

  19. 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.…

  20. Prioritising patients for bariatric surgery: building public preferences from a discrete choice experiment into public policy

    PubMed Central

    Whitty, Jennifer A; Ratcliffe, Julie; Kendall, Elizabeth; Burton, Paul; Wilson, Andrew; Littlejohns, Peter; Harris, Paul; Krinks, Rachael; Scuffham, Paul A

    2015-01-01

    Objectives To derive priority weights for access to bariatric surgery for obese adults, from the perspective of the public. Setting Australian public hospital system. Participants Adults (N=1994), reflecting the age and gender distribution of Queensland and South Australia. Primary and secondary outcome measures A discrete choice experiment in which respondents indicated which of two individuals with different characteristics should be prioritised for surgery in repeated hypothetical choices. Potential surgery recipients were described by seven key characteristics or attributes: body mass index (BMI), presence of comorbid conditions, age, family history, commitment to lifestyle change, time on the surgical wait list and chance of maintaining weight loss following surgery. A multinomial logit model was used to evaluate preferences and derive priority weights (primary analysis), with a latent class model used to explore respondent characteristics that were associated with variation in preference across the sample (see online supplementary analysis). Results A preference was observed to prioritise individuals who demonstrated a strong commitment to maintaining a healthy lifestyle as well as individuals categorised with very severe (BMI?50?kg/m2) or (to a lesser extent) severe (BMI?40?kg/m2) obesity, those who already have obesity-related comorbidity, with a family history of obesity, with a greater chance of maintaining weight loss or who had spent a longer time on the wait list. Lifestyle commitment was considered to be more than twice as important as any other criterion. There was little tendency to prioritise according to the age of the recipient. Respondent preferences were dependent on their BMI, previous experience with weight management surgery, current health state and education level. Conclusions This study extends our understanding of the publics’ preferences for priority setting to the context of bariatric surgery, and derives priority weights that could be used to assist bodies responsible for commissioning bariatric services. PMID:26474940

  1. 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...

  2. 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…

  3. A stepped care programme for depression management: an uncontrolled pre-post study in primary and secondary care in The Netherlands

    PubMed Central

    Meeuwissen, Jolanda A.C.; van der Feltz-Cornelis, Christina M.; van Marwijk, Harm W.J.; Rijnders, Paul B.M.; Donker, Marianne C.H.

    2008-01-01

    Introduction Stepped care strategies are potentially effective to organise integrated care but unknown is whether they function well in practice. This paper evaluates the implementation of a stepped care programme for depression in primary care and secondary care. Theory and methods We developed a stepped care algorithm for diagnostics and treatment of depression, supported by a liaison-consultation function. In a 2½ year study with pre-post design in a pilot region, adherence to the protocol was assessed by interviewing 28 caregivers of 235 patients with mild, moderate, or severe major depression. Consultation and referral patterns between primary and secondary care were analysed. Results Adherence of general practitioners and consultant caregivers to the stepped care protocol proved to be 96%. The percentage of patients referred for depression to secondary care decreased significantly from 26% to 21% (p=0.0180). In the post-period more patients received treatment in primary care and requests for consultation became more concordant with the stepped care protocol. Conclusions Implementation of a stepped care programme is feasible in a primary and secondary care setting and is associated with less referrals. Discussion Further research on all subsequent treatment steps in a standardised stepped care protocol is needed. PMID:18317562

  4. Neural Activity Reveals Preferences Without Choices

    PubMed Central

    Smith, Alec; Bernheim, B. Douglas; Camerer, Colin

    2014-01-01

    We investigate the feasibility of inferring the choices people would make (if given the opportunity) based on their neural responses to the pertinent prospects when they are not engaged in actual decision making. The ability to make such inferences is of potential value when choice data are unavailable, or limited in ways that render standard methods of estimating choice mappings problematic. We formulate prediction models relating choices to “non-choice” neural responses and use them to predict out-of-sample choices for new items and for new groups of individuals. The predictions are sufficiently accurate to establish the feasibility of our approach. PMID:25729468

  5. 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

  6. Which Fish Should I Eat? Perspectives Influencing Fish Consumption Choices

    PubMed Central

    Choi, Anna L.; Karagas, Margaret R.; Mariën, Koenraad; Rheinberger, Christoph M.; Schoeny, Rita; Sunderland, Elsie; Korrick, Susan

    2012-01-01

    Background: Diverse perspectives have influenced fish consumption choices. Objectives: We summarized the issue of fish consumption choice from toxicological, nutritional, ecological, and economic points of view; identified areas of overlap and disagreement among these viewpoints; and reviewed effects of previous fish consumption advisories. Methods: We reviewed published scientific literature, public health guidelines, and advisories related to fish consumption, focusing on advisories targeted at U.S. populations. However, our conclusions apply to groups having similar fish consumption patterns. Discussion: There are many possible combinations of matters related to fish consumption, but few, if any, fish consumption patterns optimize all domains. Fish provides a rich source of protein and other nutrients, but because of contamination by methylmercury and other toxicants, higher fish intake often leads to greater toxicant exposure. Furthermore, stocks of wild fish are not adequate to meet the nutrient demands of the growing world population, and fish consumption choices also have a broad economic impact on the fishing industry. Most guidance does not account for ecological and economic impacts of different fish consumption choices. Conclusion: Despite the relative lack of information integrating the health, ecological, and economic impacts of different fish choices, clear and simple guidance is necessary to effect desired changes. Thus, more comprehensive advice can be developed to describe the multiple impacts of fish consumption. In addition, policy and fishery management inter-ventions will be necessary to ensure long-term availability of fish as an important source of human nutrition. PMID:22534056

  7. Identity Management CyberCIEGE Identity Management

    E-print Network

    the security of the link between your ID devices and the remote database. Note that CyberCIEGE ID devicesIdentity Management CyberCIEGE Identity Management CyberCIEGE is an information assurance (IA management trade-offs. CyberCIEGE players construct computer networks and make choices affecting the ability

  8. Rituximab as Single Agent in Primary MALT Lymphoma of the Ocular Adnexa

    PubMed Central

    Annibali, Ombretta; Chiodi, Francesca; Sarlo, Chiara; Cortes, Magdalena; Quaranta-Leoni, Francesco M.; Quattrocchi, Carlo; Bianchi, Antonella; Bonini, Stefano; Avvisati, Giuseppe

    2015-01-01

    Ocular Adnexal Lymphomas are the first cause of primary ocular malignancies, and among them the most common are MALT Ocular Adnexal Lymphomas. Recently systemic immunotherapy with anti-CD20 monoclonal antibody has been investigated as first-line treatment; however, the optimal management for MALT Ocular Adnexal Lymphomas is still unknown. The present study evaluated retrospectively the outcome of seven consecutive patients with primary MALT Ocular Adnexal Lymphomas, of whom six were treated with single agent Rituximab. All patients received 6 cycles of Rituximab 375?mg/mq every 3 weeks intravenously. The overall response rate was 100%; four patients (67%) achieved a Complete Remission, and two (33%) achieved a partial response. In four patients an additional Rituximab maintenance every 2-3 months was given for two years. After a median follow-up of 29 months (range 8–34), no recurrences were observed, without of therapy- or disease-related severe adverse events. None of the patients needed additional radiotherapy or other treatments. Rituximab as a single agent is highly effective and tolerable in first-line treatment of primary MALT Ocular adnexal Lymphomas. Furthermore, durable responses are achievable with the same-agent maintenance. Rituximab can be considered the agent of choice in the management of an indolent disease in whom the “quality of life” matter is of primary importance. PMID:26425558

  9. Grading School Choice: Evaluating School Choice Programs by the Friedman Gold Standard. School Choice Issues in Depth

    ERIC Educational Resources Information Center

    Enlow, Robert C.

    2008-01-01

    In 2004, The Friedman Foundation for Educational Choice published a report titled "Grading Vouchers: Ranking America's School Choice Programs." Its purpose was to measure every existing school choice program against the gold standard set by Milton and Rose Friedman: that the most effective way to improve K-12 education and thus ensure a stable…

  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.; Farwell, D. Gregory; Lau, Derick H.; Li Baoqing; Luu, Quang; Donald, Paul J.

    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. The relative importance of perceived doctor’s attitude on the decision to consult for symptomatic osteoarthritis: a choice-based conjoint analysis study

    PubMed Central

    Coxon, Domenica; Frisher, Martin; Jinks, Clare; Jordan, Kelvin; Paskins, Zoe; Peat, George

    2015-01-01

    Objectives Some patients spend years with painful osteoarthritis without consulting for it, including times when they are experiencing persistent severe pain and disability. Beliefs about osteoarthritis and what primary care has to offer may influence the decision to consult but their relative importance has seldom been quantified. We sought to investigate the relative importance of perceived service-related and clinical need attributes in the decision to consult a primary care physician for painful osteoarthritis. Design Partial-profile choice-based conjoint analysis study, using a self-complete questionnaire containing 10 choice tasks, each presenting two scenarios based on a combination of three out of six selected attributes. Setting General population. Participants Adults aged 50?years and over with hip, knee or hand pain registered with four UK general practices. Outcome measures Relative importance of pain characteristics, level of disruption to everyday life, extent of comorbidity, assessment, management, perceived general practitioner (GP) attitude. Results 863 (74%) people responded (55% female; mean age 70?years, range: 58–93). The most important determinants of the patient's decision to consult the GP for joint pain were the extent to which pain disrupted everyday life (‘most’ vs ‘none’: relative importance 31%) and perceived GP attitude (‘legitimate problem, requires treatment’ vs ‘part of the normal ageing process that one just has to accept’: 24%). Thoroughness of assessment (14%), management options offered (13%), comorbidity (13%) and pain characteristics (5%) were less strongly associated with the decision to consult. Conclusions Anticipating that the GP will regard joint pain as ‘part of the normal ageing process that one just has to accept’ is a strong disincentive to seeking help, potentially outweighing other aspects of quality of care. Alongside the recognition and management of disrupted function, an important goal of each primary care consultation for osteoarthritis should be to avoid imparting or reinforcing this perception. PMID:26503396

  12. Risk and Career Choice: Evidence from Turkey

    ERIC Educational Resources Information Center

    Caner, Asena; Okten, Cagla

    2010-01-01

    In this paper, we examine the college major choice decision in a risk and return framework using university entrance exam data from Turkey. Specifically we focus on the choice between majors with low income risk such as education and health and others with riskier income streams. We use a unique dataset that allows us to control for the choice set…

  13. School Choice Acceptance: An Exploratory Explication

    ERIC Educational Resources Information Center

    Koven, Steven G.; Khan, Mobin

    2014-01-01

    School choice is presented by some as a panacea to the challenges facing education in the United States. Acceptance of choice as a solution, however, is far from universal. This article examines two possible contributors to choice adoption: ideology and political culture. Political culture was found to better explain the complex phenomenon of…

  14. School Choice as a Bounded Ideal

    ERIC Educational Resources Information Center

    Ben-Porath, Sigal R.

    2009-01-01

    School choice is most often viewed through the lens of provision: most of the debate on the issue searches for desirable ways to offer vouchers, scholarships or other tools that provides choice as a way to achieve equality and/or freedom. This paper focuses on the consumer side of school choice, and utilises behavioural economics as well as…

  15. 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…

  16. 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…

  17. 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…

  18. Pricing effects on food choices.

    PubMed

    French, Simone A

    2003-03-01

    Individual dietary choices are primarily influenced by such considerations as taste, cost, convenience and nutritional value of foods. The current obesity epidemic has been linked to excessive consumption of added sugars and fat, as well as to sedentary lifestyles. Fat and sugar provide dietary energy at very low cost. Food pricing and marketing practices are therefore an essential component of the eating environment. Recent studies have applied economic theories to changing dietary behavior. Price reduction strategies promote the choice of targeted foods by lowering their cost relative to alternative food choices. Two community-based intervention studies used price reductions to promote the increased purchase of targeted foods. The first study examined lower prices and point-of-purchase promotion on sales of lower fat vending machine snacks in 12 work sites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions. The second study examined the impact of a 50% price reduction on fresh fruit and baby carrots in two secondary school cafeterias. Compared with usual price conditions, price reductions resulted in a four-fold increase in fresh fruit sales and a two-fold increase in baby carrot sales. Both studies demonstrate that price reductions are an effective strategy to increase the purchase of more healthful foods in community-based settings such as work sites and schools. Results were generalizable across various food types and populations. Reducing prices on healthful foods is a public health strategy that should be implemented through policy initiatives and industry collaborations. PMID:12612165

  19. A cluster randomised intervention trial of asthma clubs to improve quality of life in primary school children: the School Care and Asthma Management Project (SCAMP)

    PubMed Central

    Patterson, E; Brennan, M; Linskey, K; Webb, D; Shields, M; Patterson, C

    2005-01-01

    Aim: To evaluate the effectiveness of a programme of asthma clubs in improving quality of life in primary school children with asthma. Methods: A cluster randomised intervention trial was undertaken in 22 primary schools within the urban area of south and east Belfast, Northern Ireland. Schools were randomised in pairs to immediate or delayed groups. The study subjects comprised 173 children aged 7–11 years whose parents had notified the school of their asthma diagnosis. Children attended school based weekly clubs over an 8 week period. The main outcome measures were the interview administered Paediatric Quality of Life Questionnaire scores, ranging from 1 (worst) to 7 (best), spirometry, and inhaler technique. Results: Over 15 weeks, small but non-significant improvements in the overall quality of life score (mean 0.20; 95% confidence interval (CI) –0.20 to 0.61) and in each of its three components, activity limitation (0.20; –0.43 to 0.84), symptoms (0.23; –0.23 to 0.70), and emotional function (0.17; –0.18 to 0.52), were observed in the immediate compared with the delayed group. Inhaler technique at week 16 was markedly better in the immediate group, with 56% having correct technique compared with 15% in the delayed group. No significant effect of the intervention on spirometry results could be demonstrated. Conclusion: This primary school based asthma education programme resulted in sustained improvements in inhaler technique, but changes in quality of life scores were not significant. PMID:16040874

  20. Delayed choice for entanglement swapping

    E-print Network

    Asher Peres

    1999-04-11

    Two observers (Alice and Bob) independently prepare two sets of singlets. They test one particle of each singlet along an arbitrarily chosen direction and send the other particle to a third observer, Eve. At a later time, Eve performs joint tests on pairs of particles (one from Alice and one from Bob). According to Eve's choice of test and to her results, Alice and Bob can sort into subsets the samples that they have already tested, and they can verify that each subset behaves as if it consisted of entangled pairs of distant particles, that have never communicated in the past, even indirectly via other particles.

  1. Functional MRI of Challenging Food Choices: Forced Choice between Equally Liked High- and Low-Calorie Foods in the Absence of Hunger.

    PubMed

    Charbonnier, Lisette; van der Laan, Laura N; Viergever, Max A; Smeets, Paul A M

    2015-01-01

    We are continuously exposed to food and during the day we make many food choices. These choices play an important role in the regulation of food intake and thereby in weight management. Therefore, it is important to obtain more insight into the mechanisms that underlie these choices. While several food choice functional MRI (fMRI) studies have been conducted, the effect of energy content on neural responses during food choice has, to our knowledge, not been investigated before. Our objective was to examine brain responses during food choices between equally liked high- and low-calorie foods in the absence of hunger. During a 10-min fMRI scan 19 normal weight volunteers performed a forced-choice task. Food pairs were matched on individual liking but differed in perceived and actual caloric content (high-low). Food choice compared with non-food choice elicited stronger unilateral activation in the left insula, superior temporal sulcus, posterior cingulate gyrus and (pre)cuneus. This suggests that the food stimuli were more salient despite subject's low motivation to eat. The right superior temporal sulcus (STS) was the only region that exhibited greater activation for high versus low calorie food choices between foods matched on liking. Together with previous studies, this suggests that STS activation during food evaluation and choice may reflect the food's biological relevance independent of food preference. This novel finding warrants further research into the effects of hunger state and weight status on STS, which may provide a marker of biological relevance. PMID:26167916

  2. Midlife Career Choices: How Are They Different from Other Career Choices?

    ERIC Educational Resources Information Center

    Zemon, Candy (Bogar)

    2002-01-01

    Presents a personal narrative of a midlife decision point and the choice that one librarian made regarding a career change. Topics include initial career choice; lateral and interim career choices; differences in midlife career choices; and continuing along a similar career path versus starting over in something very different. (LRW)

  3. Choice as a Global Language in Local Practice: A Mixed Model of School Choice in Taiwan

    ERIC Educational Resources Information Center

    Mao, Chin-Ju

    2015-01-01

    This paper uses school choice policy as an example to demonstrate how local actors adopt, mediate, translate, and reformulate "choice" as neo-liberal rhetoric informing education reform. Complex processes exist between global policy about school choice and the local practice of school choice. Based on the theoretical sensibility of…

  4. 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

  5. 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

  6. Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong

    PubMed Central

    2014-01-01

    Background Upper respiratory tract infection (URTI) has a significant healthcare burden worldwide. Considerable resources are consumed through health care consultations and prescribed treatment, despite evidence for little or no effect on recovery. Patterns of consultations and care including use of symptomatic medications and antibiotics for upper respiratory tract infections are poorly described. Methods We performed a retrospective review of computerized clinical data on patients presenting to all public primary care clinics in Hong Kong with symptoms of respiratory tract infections. International Classification of Primary care (ICPC)codes used to identify patients included otitis media (H71), streptococcal pharyngitis (R72), acute URTI (R74), acute sinusitis (R75), acute tonsillitis (R76), acute laryngitis (R77), and influenza (R80). Sociodemographic variables such as gender, age, chronic illness status, attendance date, type and duration of drug prescribed were also collected. Results Of the 5,529,755 primary care consultations for respiratory symptoms from 2005 to 2010, 98% resulted in a prescription. Prescription patterns of symptomatic medication were largely similar across the 5 years. In 2010 the mean number of drugs prescribed per consultation was 3.2, of which the commonly prescribed medication were sedating antihistamines (79.9%), analgesia (58.9%), throat lozenges (40.4%) and expectorant cough syrup (33.8%). During the study period, there was an overall decline in antibiotic prescription (8.1% to 5.1%). However, in consultations where the given diagnosis was otitis media (H71), streptococcal pharyngitis (R72), acute sinusitis (R75) or acute laryngitis (R76), over 90% resulted in antibiotic prescription. Conclusion There was a decline in overall antibiotic prescription over the study period. However, the use of antibiotics was high in some conditions e.g. otitis media and acute laryngitis a. Multiple symptomatic medications were given for upper respiratory tract infections. Further research is needed to develop clinical and patients directed interventions to reduce the number of prescriptions of symptomatic medications and antibiotics that could reduce costs for health care services and iatrogenic risk to patients. PMID:24885376

  7. Recommendations to the primary care practitioners and the patients for managing pelvic pain, especially in painful bladder syndrome for early and better prognosis

    PubMed Central

    Chung, Kyung Jin; Han, Adelaide Na Yeon; Kim, Khae Hawn

    2015-01-01

    Painful bladder syndrome (PBS) is a common disease presenting with chronic pelvic pain and discomfort with at least one urinary symptom with no identifiable cause. The etiology is still unknown, and the medication has limited effects on pelvic pain or other urinary symptoms. This article presents advanced insight regarding the approach to PBS, particularly pelvic pain for primary care practitioners and patients. We suggest six tips for medical staff and suspected patients for easy diagnosis and proper treatment of pelvic pain. These six tips cover: Self-awareness of the disease; immediate urine culture test; specifying the location of pain urinary incontinence; frequency, or urgency without functional disorder of an overactive bladder helpful dietary control; complementary, and alternative medicine, and finding an expert. These tips might be helpful in advancing the schematic approach and in achieving better prognosis of PBS. Further study should be conducted to achieve better treatment for this disease, including development of a definitive test and diagnosis. PMID:26535214

  8. Recommendations to the primary care practitioners and the patients for managing pelvic pain, especially in painful bladder syndrome for early and better prognosis.

    PubMed

    Chung, Kyung Jin; Han, Adelaide Na Yeon; Kim, Khae Hawn

    2015-10-01

    Painful bladder syndrome (PBS) is a common disease presenting with chronic pelvic pain and discomfort with at least one urinary symptom with no identifiable cause. The etiology is still unknown, and the medication has limited effects on pelvic pain or other urinary symptoms. This article presents advanced insight regarding the approach to PBS, particularly pelvic pain for primary care practitioners and patients. We suggest six tips for medical staff and suspected patients for easy diagnosis and proper treatment of pelvic pain. These six tips cover: Self-awareness of the disease; immediate urine culture test; specifying the location of pain urinary incontinence; frequency, or urgency without functional disorder of an overactive bladder helpful dietary control; complementary, and alternative medicine, and finding an expert. These tips might be helpful in advancing the schematic approach and in achieving better prognosis of PBS. Further study should be conducted to achieve better treatment for this disease, including development of a definitive test and diagnosis. PMID:26535214

  9. 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 capacity). In online advertising, the capacity constraint may represent the limited number of locations on the web page management. When the choice model is known, the focus is to determine the assortment of itinerary and fare

  10. IQuaD dental trial; improving the quality of dentistry: a multicentre randomised controlled trial comparing oral hygiene advice and periodontal instrumentation for the prevention and management of periodontal disease in dentate adults attending dental primary care

    PubMed Central

    2013-01-01

    Background Periodontal disease is the most common oral disease affecting adults, and although it is largely preventable it remains the major cause of poor oral health worldwide. Accumulation of microbial dental plaque is the primary aetiological factor for both periodontal disease and caries. Effective self-care (tooth brushing and interdental aids) for plaque control and removal of risk factors such as calculus, which can only be removed by periodontal instrumentation (PI), are considered necessary to prevent and treat periodontal disease thereby maintaining periodontal health. Despite evidence of an association between sustained, good oral hygiene and a low incidence of periodontal disease and caries in adults there is a lack of strong and reliable evidence to inform clinicians of the relative effectiveness (if any) of different types of Oral Hygiene Advice (OHA). The evidence to inform clinicians of the effectiveness and optimal frequency of PI is also mixed. There is therefore an urgent need to assess the relative effectiveness of OHA and PI in a robust, sufficiently powered randomised controlled trial (RCT) in primary dental care. Methods/Design This is a 5 year multi-centre, randomised, open trial with blinded outcome evaluation based in dental primary care in Scotland and the North East of England. Practitioners will recruit 1860 adult patients, with periodontal health, gingivitis or moderate periodontitis (Basic Periodontal Examination Score 0–3). Dental practices will be cluster randomised to provide routine OHA or Personalised OHA. To test the effects of PI each individual patient participant will be randomised to one of three groups: no PI, 6 monthly PI (current practice), or 12 monthly PI. Baseline measures and outcome data (during a three year follow-up) will be assessed through clinical examination, patient questionnaires and NHS databases. The primary outcome measures at 3 year follow up are gingival inflammation/bleeding on probing at the gingival margin; oral hygiene self-efficacy and net benefits. Discussion IQuaD will provide evidence for the most clinically-effective and cost-effective approach to managing periodontal disease in dentate adults in Primary Care. This will support general dental practitioners and patients in treatment decision making. Trial registration Protocol ID: ISRCTN56465715 PMID:24160246

  11. Choice theories: What are they good for?

    PubMed

    Johnson, Eric J

    2013-01-01

    Simonson et al. present an ambitious sketch of an integrative theory of context. Provoked by this thoughtful proposal, I discuss what is the function of theories of choice in the coming decades. Traditionally, choice models and theory have attempted to predict choices as a function of the attributes of options. I argue that to be truly useful, they need to generate specific and quantitative predictions of the effect of the choice environment upon choice probability. To do this, we need to focus on rigorously modeling and measuring the underlying processes causing these effects, and use the Simonson et al. proposal to provide some examples. I also present some examples from research in decision-making and decision neuroscience, and argue that models that fail, and fail spectacularly are particularly useful. I close with a challenge: How would consumer researcher aid the design of real world choice environments such as the health exchanges under the Patient Protection and Affordable Care Act? PMID:23794793

  12. Comparison of SPECT/CT and planar MIBI in terms of operating time and cost in the surgical management of primary hyperparathyroidism.

    PubMed

    Setabutr, Dhave; Vakharia, Kavita; Nogan, Stephen J; Kamel, George N; Allen, Thomas; Saunders, Brian D; Goldenberg, David

    2015-01-01

    We conducted a retrospective study to compare operating times and costs in patients who underwent guided parathyroidectomies with either (1) technetium-99m ((99m)Tc) multiplex ion-beam imaging (MIBI) parathyroid scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) fusion images or (2) sestamibi dual-phase (99m)Tc MIBI planar parathyroid scintigraphy alone preoperatively. Our study population was made up of the first 24 patients at our facility who had undergone SPECT/CT parathyroid imaging with technetium-99m ((99m)Tc) MIBI and a group of 24 patients who had undergone MIBI planar imaging alone. Patient demographics, preoperative laboratory test results, operating times, and hospital charges were analyzed. We found that less operating time was required for the planar MIBI group than in the SPECT/CT group (mean: 135 vs. 158 min), although the difference was not statistically significant. Likewise, the total cost of treatment was lower in the planar MIBI group (mean: $10,035 vs. $11,592); the difference was statistically significant by one measure (p × 0.02, Wilcoxon rank sum test) but not by another (p × 0.06, Student t test). Although SPECT/CT is efficient for patients with small and difficult-to-localize adenomas, it has yet to demonstrate greater efficacy or cost-effectiveness than planar MIBI for routine parathyroidectomy in patients with primary hyperparathyroidism when an easily identifiable parathyroid adenoma is localized. PMID:26535821

  13. Management of primary ciliary dyskinesia/Kartagener's syndrome in infertile male patients and current progress in defining the underlying genetic mechanism

    PubMed Central

    Sha, Yan-Wei; Ding, Lu; Li, Ping

    2014-01-01

    Kartagener's syndrome (KS) is an autosomal recessive genetic disease accounting for approximately 50% of the cases of primary ciliary dyskinesia (PCD). As it is accompanied by many complications, PCD/KS severely affects the patient's quality of life. Therapeutic approaches for PCD/KS aim to enhance prevention, facilitate rapid definitive diagnosis, avoid misdiagnosis, maintain active treatment, control infection and postpone the development of lesions. In male patients, sperm flagella may show impairment in or complete absence of the ability to swing, which ultimately results in male infertility. Assisted reproductive technology will certainly benefit such patients. For PCD/KS patients with completely immotile sperm, intracytoplasmic sperm injection may be very important and even indispensable. Considering the number of PCD/KS susceptibility genes and mutations that are being identified, more extensive genetic screening is indispensable in patients with these diseases. Moreover, further studies into the potential molecular mechanisms of these diseases are required. In this review, we summarize the available information on various aspects of this disease in order to delineate the therapeutic objectives more clearly, and clarify the efficacy of assisted reproductive technology as a means of treatment for patients with PCD/KS-associated infertility. PMID:24369140

  14. Level of distress, somatisation and beliefs on health-disease in newly arrived immigrant patients attended in primary care centres in Catalonia and definition of professional competences for their most effective management: PROMISE Project

    PubMed Central

    2013-01-01

    Background Newly arrived immigrant patients who frequently use primary health care resources have difficulties in verbal communication. Also, they have a system of beliefs related to health and disease that makes difficult for health care professionals to comprehend their reasons for consultation, especially when consulting for somatic manifestations. Consequently, this is an important barrier to achieve optimum care to these groups. The current project has two main objectives: 1. To define the different stressors, the level of distress perceived, and its impact in terms of discomfort and somatisation affecting the main communities of immigrants in our area, and 2. To identify the characteristics of cross-cultural competence of primary health care professionals to best approach these reasons for consultation. Methods/Design It will be a transversal, observational, multicentre, qualitative-quantitative study in a sample of 980 people from the five main non-European Union immigrant communities residing in Catalonia: Maghrebis, Sub-Saharans, Andean South Americans, Hindustanis, and Chinese. Sociodemographic data, level of distress, information on the different stressors and their somatic manifestations will be collected in specific questionnaires. Through a semi-structured interview and qualitative methodology, it will be studied the relation between somatic manifestations and particular beliefs of each group and how these are associated with the processes of disease and seeking for care. A qualitative methodology based on individual interviews centred on critical incidents, focal groups and in situ questionnaires will be used to study the cross-cultural competences of the professionals. Discussion It is expected a high level of chronic stress associated with the level of somatisations in the different non-European Union immigrant communities. The results will provide better knowledge of these populations and will improve the comprehension and the efficacy of the health care providers in prevention, communication, care management and management of resources. PMID:23641671

  15. Primary Omental Hydatid Cyst”: A Rare Entity

    PubMed Central

    Sable, Shailesh; Mehta, Jyoti; Yadav, Sudeep; Jategaokar, Priyadarshan; Haldar, Premashish J.

    2012-01-01

    Hydatid cyst is caused by the parasite Echinococcus granulosus commonly seen in temperate regions. Primary omental hydatid cyst is rare entity. Diagnosis can be achieved with contrast-enhanced computed tomography of abdomen and pelvis along with serology. Eosinophilia is a strong pointer to hydatid cyst as a differential diagnosis. Open or laparoscopic excision of the cyst along with medical therapy remains the treatment of choice. PMID:23050190

  16. Primary ovarian insufficiency: an update

    PubMed Central

    Cox, Leticia; Liu, James H

    2014-01-01

    Primary ovarian insufficiency is a condition that represents impaired ovarian function on a continuum with intermittent ovulation. This condition commonly leads to premature menopause, defined as cessation of ovulation prior to the age of 40 years. Because there are potential immediate and long-term consequences of hypoestrogenism, a timely diagnosis is invaluable. This comprehensive review will discuss identifiable causes for primary ovarian insufficiency, including genetic disorders and metabolic abnormalities, as well as review current strategies for diagnosis, evaluation, and management of women with this condition. PMID:24591848

  17. Immunotherapy for primary immunodeficiency diseases.

    PubMed

    Wood, Philip

    2012-05-01

    The 2 most commonly encountered primary immunodeficiency syndromes in adult practice are antibody deficiency disorders and hereditary angioedema.Immunologic therapy for these disorders has significantly improved patient management. Therapy with immunoglobulin leads to improvement in overall quality of life. With increasing survival rates and decreasing levels of life-threatening infections in patients with primary antibody deficiencies, disease complications are more commonly encountered. Treatment of these complications with monoclonal antibody therapy seems promising and is likely to increase in the future. More recently,several additional agents have become available, including novel drugs targeted at different elements of the disease process. PMID:22703850

  18. Choice mechanisms for past, temporally extended outcomes

    E-print Network

    Vestergaard, Martin D.; Schultz, Wolfram

    2015-06-10

    choice model that can predict choice of domina- ted options for temporally extended outcomes. The critical mechanism is a leaky integrator to characterize the competing incentives. Our behavioural results indicate a distinct over- valuation of positive... between the decay factor and domina- ted choice score (r2 ¼ 0.57, p ¼ 0.00002; figure 5c; electronic supplementary material, figure S4). Dominated choice for participants who accumulated evidence suboptimally was 0.24 compared with 0.099 (t30 ¼ 2.6, p ¼ 0...

  19. Intertemporal choice as discounted value accumulation.

    PubMed

    Rodriguez, Christian A; Turner, Brandon M; McClure, Samuel M

    2014-01-01

    Two separate cognitive processes are involved in choosing between rewards available at different points in time. The first is temporal discounting, which consists of combining information about the size and delay of prospective rewards to represent subjective values. The second involves a comparison of available rewards to enable an eventual choice on the basis of these subjective values. While several mathematical models of temporal discounting have been developed, the reward selection process has been largely unexplored. To address this limitation, we evaluated the applicability of the Linear Ballistic Accumulator (LBA) model as a theory of the selection process in intertemporal choice. The LBA model formalizes the selection process as a sequential sampling algorithm in which information about different choice options is integrated until a decision criterion is reached. We compared several versions of the LBA model to demonstrate that choice outcomes and response times in intertemporal choice are well captured by the LBA process. The relationship between choice outcomes and response times that derives from the LBA model cannot be explained by temporal discounting alone. Moreover, the drift rates that drive evidence accumulation in the best-fitting LBA model are related to independently estimated subjective values derived from various temporal discounting models. These findings provide a quantitative framework for predicting dynamics of choice-related activity during the reward selection process in intertemporal choice and link intertemporal choice to other classes of decisions in which the LBA model has been applied. PMID:24587243

  20. Management of multivessel coronary disease after primary angioplasty: staged reintervention versus optimized clinical treatment and two-year follow-up

    PubMed Central

    de Paula, José Guilherme Rodrigues; de Godoy, Moacir Fernandes; dos Santos, Márcio Antônio; Pivatelli, Flávio Corrêa; Osti, Alan Vinicius Gamero; Trindade, Luciano Folchine; Novelli, Diego; Nakazone, Marcelo Arruda

    2014-01-01

    Objective In the clinical scenario of ST-segment elevation acute myocardial infarction, several patients with multivessel coronary atherosclerotic disease are discharged without a defined strategy to monitor the residual atherosclerotic lesions. The clinical endpoints evaluated were cardiovascular death, symptoms of angina pectoris, rehospitalization for a new acute coronary syndrome, and the necessity of reintervention during the two-year follow-up. Methods This observational, prospective, and historical study included multivessel coronary atherosclerotic disease patients who were admitted to a tertiary care university hospital with ST-segment elevation acute myocardial infarction and underwent primary percutaneous coronary intervention with stent implantation only at the culprit lesion site; these patients were monitored in the outpatient clinic according to two treatments: the Clinical Group - CG (optimized pharmacological therapy associated with counseling for a healthy diet and cardiac rehabilitation) or the Intervention Group - IG (new staged percutaneous coronary intervention or surgical coronary artery bypass graft surgery combined with the previously prescribed treatment). Results Of 143 patients consecutively admitted with ST-segment elevation acute myocardial infarction, 57 were eligible for the study (CG=44 and IG=13). Regarding the clinical endpoints, the cardiovascular death rate did not differ between the CG and IG. The symptom of angina pectoris and the rehospitalization rate for a new episode of acute coronary syndrome were accentuated in the CG (P=0.020 and P=0.049, respectively) mainly in individuals with evidence of ischemia evidenced by myocardial scintigraphy (P<0.001 and P=0.001, respectively) which culminated in an even greater need for reintervention (P=0.001) in this subgroup of patients. Conclusion The staged intervention was demonstrated to be safe and able to reduce angina pectoris and rehospitalization for a new episode of acute coronary syndrome. In addition, it decreases the likelihood of unplanned reinterventions of patients without ischemia evidenced by myocardial scintigraphy. PMID:25140467

  1. Primary haemangiopericytoma of lung

    PubMed Central

    Meade, J. B.; Whitwell, F.; Bickford, B. J.; Waddington, J. K. B.

    1974-01-01

    Meade, J. B., Whitwell, F., Bickford, B. J., and Waddington, J. K. B. (1974).Thorax,29, 1-15. Primary haemangiopericytoma of lung. Haemangiopericytoma is a rare neoplasm which may occur at any age and arise in almost any part of the body. At least 247 examples have been reported in the world literature, but only 24 appear to have arisen primarily in the lung. A summary of the features of these cases, collected from the literature, is presented, and four additional cases are described. The tumour may be innocent [ill] malignant, but there are no characteristic clinical or radiological features to distinguish it from other neoplasms of the lung. Because of uncertainty as to diagnosis and prognosis, surgical excision appears to be the treatment of choice. In the whole series of 28 cases, rather more than half (16) were female, and they tended to be older than the male patients. The mortality from recurrence was higher in males than in females (50% compared with 32%). The prognosis in general seems to be best with small, asymptomatic tumours, especially in female patients. A brief account is given of the nature and function of the pericyte. It was originally thought to be a cell of muscular type, but recent research suggests that it is a multipotent cell capable of development into other cell types and having phagocytic properties. It lies in the basement membrane of capillary blood vessels and may have some connection with antibody formation, but its exact function has not yet been elucidated. Images PMID:4825550

  2. Primary Lateral Sclerosis

    MedlinePLUS

    ... Enhancing Diversity Find People About NINDS NINDS Primary Lateral Sclerosis Information Page Table of Contents (click to ... being done? Clinical Trials Organizations What is Primary Lateral Sclerosis? Primary lateral sclerosis (PLS) is a rare ...

  3. The WISE telescope and scanner: design choices and hardware results

    NASA Astrophysics Data System (ADS)

    Sampath, Deepak; Akerstrom, Alan; Barry, Mark; Guregian, Jim; Schwalm, Mark; Ugolini, Virginia

    2010-08-01

    L-3 Integrated Optical Systems/SSG designed and built the telescope, aft imager, and scanner for the Widefield Infrared Survey Explorer (WISE) under subcontract to Utah State University/Space Dynamics Laboratory. The WISE mission and collection scheme imparted several driving requirements on the telescope and scanner, including the need for low cost implementation, <11 Kelvin operation, and the need to back-scan by half a degree during detector integration in order to freeze the line of sight on the sky as the spacecraft pitched in orbit. These requirements led to several unique design and implementation choices for the telescope and scanner. In this paper we highlight several of those design choices as well as lessons learned from the telescope and scanner design, fabrication, and test. WISE, a NASA MIDEX mission within the Explorers program, was managed by the Jet Propulsion Laboratory. WISE launched on December 14, 2009 and is currently operating successfully.

  4. Strategy Choices of Potential Entrepreneurs

    ERIC Educational Resources Information Center

    Alstete, Jeffrey W.

    2014-01-01

    The author examined the written business plans of 380 students who completed courses in entrepreneurship and small business management over an 11-year period. An analysis categorized the plans into five generic competitive strategy types, and the results found that 58% chose a traditional, focused differentiation approach. A large portion (28%)…

  5. Birds Do It, Bees Do It: Evolution and the Comparative Psychology of Mate Choice

    ERIC Educational Resources Information Center

    Boothroyd, Lynda G.; McLaughlin, Edward

    2011-01-01

    The primary theoretical framework for the study of human physical attraction is currently Darwinian sexual selection. Not only has this perspective enabled the discovery of what appear to be strong universals in human mate choice but it has also facilitated our understanding of systematic variation in preferences both between and within…

  6. Dual Effects on Choice of Conditioned Reinforcement Frequency and Conditioned Reinforcement Value

    ERIC Educational Resources Information Center

    McDevitt, Margaret A.; Williams, Ben A.

    2010-01-01

    Pigeons were presented with a concurrent-chains schedule in which the total time to primary reinforcement was equated for the two alternatives (VI 30 s VI 60 s vs. VI 60 s VI 30 s). In one set of conditions, the terminal links were signaled by the same stimulus, and in another set of conditions they were signaled by different stimuli. Choice was…

  7. Computer conferencing: Choices and strategies

    NASA Technical Reports Server (NTRS)

    Smith, Jill Y.

    1991-01-01

    Computer conferencing permits meeting through the computer while sharing a common file. The primary advantages of computer conferencing are that participants may (1) meet simultaneously or nonsimultaneously, and (2) contribute across geographic distance and time zones. Due to these features, computer conferencing offers a viable meeting option for distributed business teams. Past research and practice is summarized denoting practical uses of computer conferencing as well as types of meeting activities ill suited to the medium. Additionally, effective team strategies are outlined which maximize the benefits of computer conferencing.

  8. A randomised controlled trial of a consumer-focused e-health strategy for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) study protocol

    PubMed Central

    Redfern, Julie; Usherwood, T; Harris, M F; Rodgers, A; Hayman, N; Panaretto, K; Chow, C; Lau, A Y S; Neubeck, L; Coorey, G; Hersch, F; Heeley, E; Patel, A; Jan, S; Zwar, N; Peiris, D

    2014-01-01

    Introduction Fewer than half of all people at highest risk of a cardiovascular event are receiving and adhering to best practice recommendations to lower their risk. In this project, we examine the role of an e-health-assisted consumer-focused strategy as a means of overcoming these gaps between evidence and practice. Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) aims to test whether a consumer-focused e-health strategy provided to Aboriginal and Torres Strait Islander and non-indigenous adults, recruited through primary care, at moderate-to-high risk of a cardiovascular disease event will improve risk factor control when compared with usual care. Methods and analysis Randomised controlled trial of 2000 participants with an average of 18?months of follow-up to evaluate the effectiveness of an integrated consumer-directed e-health portal on cardiovascular risk compared with usual care in patients with cardiovascular disease or who are at moderate-to-high cardiovascular disease risk. The trial will be augmented by formal economic and process evaluations to assess acceptability, equity and cost-effectiveness of the intervention. The intervention group will participate in a consumer-directed e-health strategy for cardiovascular risk management. The programme is electronically integrated with the primary care provider's software and will include interactive smart phone and Internet platforms. The primary outcome is a composite endpoint of the proportion of people meeting the Australian guideline-recommended blood pressure (BP) and cholesterol targets. Secondary outcomes include change in mean BP and fasting cholesterol levels, proportion meeting BP and cholesterol targets separately, self-efficacy, health literacy, self-reported point prevalence abstinence in smoking, body mass index and waist circumference, self-reported physical activity and self-reported medication adherence. Ethics and dissemination Primary ethics approval was received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council. Results will be disseminated via the usual scientific forums including peer-reviewed publications and presentations at international conferences Clinical Trials registration number ACTRN12613000715774. PMID:24486732

  9. Implementation of Incident Learning in the Safety and Quality Management of Radiotherapy: The Primary Experience in a New Established Program with Advanced Technology

    PubMed Central

    Yang, Ruijie; Wang, Junjie; Zhang, Xile; Sun, Haitao; Gao, Yang; Liu, Lu; Lin, Lei

    2014-01-01

    Objective. To explore the implementation of incident learning for quality management of radiotherapy in a new established radiotherapy program. Materials and Methods. With reference to the consensus recommendations by American Association of Physicist in Medicine, an incident learning system was specifically established for reporting, investigating, and learning of individual incidents. The incidents that occurred in external beam radiotherapy from February, 2012, to February, 2014, were reported. Results. A total of 28 near misses and 5 incidents were reported. Among them, 5 originated in imaging for planning, 25 in planning, and 1 in plan transfer, commissioning, and delivery, respectively. One near miss/incident was classified as wrong patient, 7 wrong sites, 6 wrong laterality, and 5 wrong dose. Five reported incidents were all classified as grade 1/2 of dosimetric severity, 1 as grade 0, and the other 4 as grade 1 of medical severity. For the causes/contributory factors, negligence, policy not followed, and inadequate training contributed to 19, 15, and 12 near misses/incidents, respectively. The average incident rate per 100 patients treated was 0.4. Conclusion. Effective implementation of incident learning can reduce the occurrence of near misses/incidents and enhance the culture of safety. PMID:25140309

  10. Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population

    PubMed Central

    Petursson, Halfdan; Getz, Linn; Sigurdsson, Johann A; Hetlevik, Irene

    2009-01-01

    Background Previous studies indicate that clinical guidelines using combined risk evaluation for cardiovascular diseases (CVD) may overestimate risk. The aim of this study was to model and discuss implementation of the current (2007) hypertension guidelines in a general Norwegian population. Methods Implementation of the current European Guidelines for the Management of Arterial Hypertension was modelled on data from a cross-sectional, representative Norwegian population study (The Nord-Trøndelag Health Study 1995-97), comprising 65,028 adults, aged 20-89, of whom 51,066 (79%) were eligible for modelling. Results Among individuals with blood pressure ?120/80 mmHg, 93% (74% of the total, adult population) would need regular clinical attention and/or drug treatment, based on their total CVD risk profile. This translates into 296,624 follow-up visits/100,000 adults/year. In the Norwegian healthcare environment, 99 general practitioner (GP) positions would be required in the study region for this task alone. The number of GPs currently serving the adult population in the study area is 87 per 100,000 adults. Conclusion The potential workload associated with the European hypertension guidelines could destabilise the healthcare system in Norway, one of the world's most long- and healthy-living nations, by international comparison. Large-scale, preventive medical enterprises can hardly be regarded as scientifically sound and ethically justifiable, unless issues of practical feasibility, sustainability and social determinants of health are considered. PMID:19878542

  11. The role of primary care prescribers in the diagnosis and management of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections.

    PubMed

    Lawrence, Kenneth R; Golik, Monica V; Davidson, Lisa

    2009-01-01

    Nosocomial infections caused by methicillin-resistant Staphylococcus aureus were first reported in the United States in the early 1960s. Beginning in the 1990s, healthy individuals from the community with no risk factors for resistant bacteria began presenting with methicillin-resistant Staphylococcus aureus infections, acquiring the name "community-associated methicillin-resistant Staphylococcus aureus" (CA-MRSA). CA-MRSA has a tendency to affect the skin and skin structures, generally in the form of abscesses and furuncles, carbuncles, and cellulitis. Cases of invasive infections including bacteremia, endocarditis, and necrotizing pneumonia have also been reported. A patient complaint of a "spider bite" is frequently associated with CA-MRSA. CA-MRSA and the traditional health care-associated methicillin-resistant Staphylococcus aureus are distinguished by their genetic composition, virulence factors, and susceptibility patterns to non-beta-lactam antibiotics. Appropriate management of CA-MRSA skin and skin structure infections includes incision and drainage of infected tissue and appropriate antimicrobial therapy. It has been suggested that when prevalence of CA-MRSA within a community eclipses 10%-15%, empiric use of non-beta-lactam antibiotics with in vitro activity against CA-MRSA be initiated when treating skin and skin structure infections. CA-MRSA retains susceptibility to a range of older antibiotics available in oral formulations such as minocycline, doxycycline, sulfamethoxazole-trimethoprim, moxifloxacin, levofloxacin, and clindamycin. Local susceptibility patterns and individual patient factors should guide the selection of antibiotics. PMID:19617720

  12. Dopaminergic function and intertemporal choice.

    PubMed

    Joutsa, J; Voon, V; Johansson, J; Niemelä, S; Bergman, J; Kaasinen, V

    2015-01-01

    The discounting of delayed rewards, also known as temporal or delay discounting, is intrinsic to everyday decisions and can be impaired in pathological states such as addiction disorders. Preclinical and human studies suggest a role for dopaminergic function in temporal discounting but this relationship has not yet been verified using molecular imaging of the living human brain. Here, we evaluated dopaminergic function in temporal discounting using positron emission tomography (PET) with two different dopaminergic ligands assessing three populations in whom temporal discounting has been shown to be impaired. First, we show using [11C]raclopride PET that in pathological gamblers, greater temporal discounting correlates with decreased ventral striatal binding potential, convergent with translational findings of lower nucleus accumbens D2/D3 receptor density in high-impulsive rodents. Temporal discounting also correlates with lower ventral striatal dopamine release in response to high-reward magnitude suggesting that dopamine-mediated devaluation of larger delayed rewards may drive choice preferences. Second, we show using [18F]fluorodopa PET that in Parkinson's disease, temporal discounting correlates with greater left caudate dopaminergic terminal function. Finally, in subjects with Parkinson's disease and dopamine medication-induced behavioral addictions, temporal discounting is further correlated with greater dopaminergic terminal function in the anterior putamen. These findings provide insights into the relationship between striatal dopamine function and temporal discounting, and its potential role in pathological disorders and mechanisms underlying treatment interventions. PMID:25562841

  13. Dopaminergic function and intertemporal choice

    PubMed Central

    Joutsa, J; Voon, V; Johansson, J; Niemelä, S; Bergman, J; Kaasinen, V

    2015-01-01

    The discounting of delayed rewards, also known as temporal or delay discounting, is intrinsic to everyday decisions and can be impaired in pathological states such as addiction disorders. Preclinical and human studies suggest a role for dopaminergic function in temporal discounting but this relationship has not yet been verified using molecular imaging of the living human brain. Here, we evaluated dopaminergic function in temporal discounting using positron emission tomography (PET) with two different dopaminergic ligands assessing three populations in whom temporal discounting has been shown to be impaired. First, we show using [11C]raclopride PET that in pathological gamblers, greater temporal discounting correlates with decreased ventral striatal binding potential, convergent with translational findings of lower nucleus accumbens D2/D3 receptor density in high-impulsive rodents. Temporal discounting also correlates with lower ventral striatal dopamine release in response to high-reward magnitude suggesting that dopamine-mediated devaluation of larger delayed rewards may drive choice preferences. Second, we show using [18F]fluorodopa PET that in Parkinson's disease, temporal discounting correlates with greater left caudate dopaminergic terminal function. Finally, in subjects with Parkinson's disease and dopamine medication-induced behavioral addictions, temporal discounting is further correlated with greater dopaminergic terminal function in the anterior putamen. These findings provide insights into the relationship between striatal dopamine function and temporal discounting, and its potential role in pathological disorders and mechanisms underlying treatment interventions. PMID:25562841

  14. The effect of cognitive load on choice related affect and selection strategy in human mate choice 

    E-print Network

    Cooper, David

    2011-06-29

    Previous research has demonstrated that an increasing selection of choice, although perceived as more desirable, can result in lower levels of choice satisfaction due to increased effort required to make evaluations between ...

  15. Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program

    E-print Network

    Abaluck, Jason

    We evaluate the choices of elders across their insurance options under the Medicare Part D Prescription Drug plan, using a unique dataset of prescription drug claims matched to information on the characteristics of choice ...

  16. Heterogeneity in Choice Inconsistencies among the Elderly: Evidence from Prescription Drug Plan Choice

    E-print Network

    Abaluck, Jason

    This paper investigates the degree to which choice inconsistencies documented in the context of Medicare Part D plan choice vary across consumers and geographic regions. Our main finding is that there is surprisingly little ...

  17. Supporting teachers and children in schools: the effectiveness and cost-effectiveness of the incredible years teacher classroom management programme in primary school children: a cluster randomised controlled trial, with parallel economic and process evaluations

    PubMed Central

    2012-01-01

    Background Childhood antisocial behaviour has high immediate and long-term costs for society and the individual, particularly in relation to mental health and behaviours that jeopardise health. Managing challenging behaviour is a commonly reported source of stress and burn out among teachers, ultimately resulting in a substantial number leaving the profession. Interventions to improve parenting do not transfer easily to classroom-based problems and the most vulnerable parents may not be easily able to access them. Honing teachers’ skills in proactive behaviour management and the promotion of socio-emotional regulation, therefore, has the potential to improve both child and teacher mental health and well-being and the advantage that it might potentially benefit all the children subsequently taught by any teacher that accesses the training. Methods/Design Cluster randomised controlled trial (RCT) of the Incredible Years teacher classroom management (TCM) course with combined economic and process evaluations. One teacher of children aged 4–9?years, from 80 schools in the South West Peninsula will be randomised to attend the TCM (intervention arm) or to “teach as normal” (control arm). The primary outcome measure will be the total difficulties score from the Strengths and Difficulties Questionnaire (SDQ) completed by the current class teachers prior to randomisation, and at 9, 18 and 30?months follow-up, supplemented by parent SDQs. Secondary measures include academic attainment (teacher report supplemented by direct measurement in a sub-sample), children’s enjoyment of school, and teacher reports of their professional self-efficacy, and levels of burn out and stress, supplemented by structured observations of teachers classroom management skills in a subsample. Cost data for the economic evaluation will be based on parental reports of services accessed. Cost-effectiveness, using the SDQ as the measure of effect, will be examined over the period of the RCT and over the longer term using decision analytic modelling. The process evaluation will use quantitative and qualitative approaches to assess fidelity to model, as well as explore Head teacher and teachers’ experiences of TCM and investigate school factors that influence the translation of skills learnt to practice. Discussion This study will provide important information about whether the Teacher Classroom Management course influences child and teacher mental health and well-being in both the short and long term. It will also provide valuable insights into factors that may facilitate or impede any impact. The trial has been registered with ISCTRN (Controlled Trials Ltd) and assigned an ISRCTN number ISRCTN84130388. (http://www.controlled-trials.com/isrctn/search.html?srch=ISRCTN84130388&sort=3&dir=desc&max=10) PMID:22935476

  18. Implications of habitat choice for protected polymorphisms

    E-print Network

    Dieckmann, Ulf

    Implications of habitat choice for protected polymorphisms Virginie Ravigné, 1 * Isabelle Olivieri of dispersal and selection in two habitats, we systematically investigate how the maintenance of polymorphisms habitats to the next generation. We show that, for populations capable of habitat choice, a third

  19. Primate copulation calls and postcopulatory female choice

    E-print Network

    Maestripieri, Dario

    of postcopulatory female choice. According to this hypothesis, copulation calls are honest signals of fertility (iPrimate copulation calls and postcopulatory female choice Dario Maestripieri and James R. Roney, USA Females in some species of Old World monkeys and apes vocalize after copulation, but the function

  20. SPECIAL SECTION: CHOICES AND CONSEQUENCES OF

    E-print Network

    Johnson, Matthew

    . Optimal foraging theory, for example, relates choice of foraging patch to some measure of fitness, usually distributions and population dynamics of foraging birds (Still- man et al. 2000). A principal lesson of optimal cycle. A choice of habitat at first glance seems to be similar to a foraging decision, but the two