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Sample records for attempt case management

  1. Clinical Characteristics of the Suicide Attempters Who Refused to Participate in a Suicide Prevention Case Management Program.

    PubMed

    Park, Soyoung; Choi, Kyoung Ho; Oh, Youngmin; Lee, Hae-Kook; Kweon, Yong-Sil; Lee, Chung Tai; Lee, Kyoung-Uk

    2015-10-01

    Case management interventions for suicide attempters aimed at helping adjust their social life to prevent reattempts have high nonparticipation and dropout rates. We analyzed the clinical characteristics of the group who refused to participate in the suicide prevention program in Korea. A total of 489 patients with a suicide attempt who visited Uijeongbu St. Mary's Hospital, the Catholic University of Korea, from December 2009 to December 2013 were analyzed. All patients were divided into the participation group (n = 262) and the refusal group (n = 227) according to their participation in the case management program. Demographic and clinical characteristics of each group were examined. Results showed that the refusal group had low risks for suicide in terms of risk factors related with psychopathologies and presenting suicide behavior. That is, the refusal group had less patients with co-morbid medical illnesses and more patients with mild severity of depression compared to the participation group. However, the refusal group had more interpersonal conflict, more isolation of social integrity, and more impaired insight about suicide attempt. The results suggest that nonparticipation in the case management program may depend upon the patient's impaired insight about the riskiness of suicide and lack of social support.

  2. Aripiprazole augmentation in managing comorbid obsessive-compulsive disorder and bipolar disorder: a case with suicidal attempts.

    PubMed

    Lai, Jianbo; Lu, Qiaoqiao; Zhang, Peng; Xu, Tingting; Xu, Yi; Hu, Shaohua

    2017-01-01

    Comorbid obsessive-compulsive disorder (OCD) and bipolar disorder (BD) have long been an intractable problem in clinical practice. The increased risk of manic/hypomanic switch hinders the use of antidepressants for managing coexisting OCD symptoms in BD patients. We herein present a case of a patient with BD-OCD comorbidity, who was successfully treated with mood stabilizers and aripiprazole augmentation. The young female patient reported recurrent depressive episodes and aggravating compulsive behaviors before hospitalization. Of note, the patient repetitively attempted suicide and reported dangerous driving because of intolerable mental sufferings. The preexisting depressive episode and OCD symptoms prompted the use of paroxetine, which consequently triggered the manic switching. Her diagnosis was revised into bipolar I disorder. Minimal response with mood stabilizers prompted the addition of aripiprazole (a daily dose of 10 mg), which helped to achieve significant remission in emotional and obsessive-compulsive symptoms. This case highlights the appealing efficacy of a small dose of aripiprazole augmentation for treating BD-OCD comorbidity. Well-designed clinical trials are warranted to verify the current findings.

  3. Aripiprazole augmentation in managing comorbid obsessive–compulsive disorder and bipolar disorder: a case with suicidal attempts

    PubMed Central

    Lai, Jianbo; Lu, Qiaoqiao; Zhang, Peng; Xu, Tingting; Xu, Yi; Hu, Shaohua

    2017-01-01

    Comorbid obsessive–compulsive disorder (OCD) and bipolar disorder (BD) have long been an intractable problem in clinical practice. The increased risk of manic/hypomanic switch hinders the use of antidepressants for managing coexisting OCD symptoms in BD patients. We herein present a case of a patient with BD–OCD comorbidity, who was successfully treated with mood stabilizers and aripiprazole augmentation. The young female patient reported recurrent depressive episodes and aggravating compulsive behaviors before hospitalization. Of note, the patient repetitively attempted suicide and reported dangerous driving because of intolerable mental sufferings. The preexisting depressive episode and OCD symptoms prompted the use of paroxetine, which consequently triggered the manic switching. Her diagnosis was revised into bipolar I disorder. Minimal response with mood stabilizers prompted the addition of aripiprazole (a daily dose of 10 mg), which helped to achieve significant remission in emotional and obsessive–compulsive symptoms. This case highlights the appealing efficacy of a small dose of aripiprazole augmentation for treating BD–OCD comorbidity. Well-designed clinical trials are warranted to verify the current findings. PMID:28096676

  4. Coping Card Usage can Further Reduce Suicide Reattempt in Suicide Attempter Case Management Within 3-Month Intervention.

    PubMed

    Wang, Ying-Chuan; Hsieh, Ling-Yu; Wang, Ming-Yu; Chou, Cheng-Hsiang; Huang, Min-Wei; Ko, Huei-Chen

    2016-02-01

    This randomized controlled trial was designed to evaluate the effectiveness of using crisis coping cards (n = 32) in the case management of suicide prevention compared with case management without the use of coping cards (n = 32) over a 3-month intervention period. The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk, depression, anxiety, and hopelessness. Results indicated that subsequent suicidal behaviors, severity of suicide risk, depression, anxiety, and hopelessness were reduced more in the coping card intervention group compared to the case management only group. Moreover, for the survival curves of time to suicide reattempt, the coping card group showed a significantly longer time to reattempt than the case management only group at 2-month and 3-month intervention periods.

  5. Conservative management of iatrogenic superior vena cava (SVC) perforation after attempted dialysis catheter placement: case report and literature review.

    PubMed

    Kabutey, Nii-Kabu; Rastogi, Neeraj; Kim, Ducksoo

    2013-01-01

    A 68-year-old male with end-stage renal disease, congestive heart failure, and facial and bilateral arm swelling was referred for placement of a tunneled dialysis catheter. Distal left subclavian vein access was obtained. The procedure was complicated by iatrogenic perforation of the superior vena cava (SVC). This resulted in rapid development of a right-sided hemothorax and hemodynamic instability. A right-sided thoracostomy tube was placed to drain the pleural cavity. Extrapericardial perforation of the SVC can be managed conservatively in select cases without endovascular balloon dilatation and/stent graft deployment or surgical repair provided the antegrade blood flow is maintained via patent collateral circulation. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. A very unusual case of attempted suicide.

    PubMed

    Misiak, Piotr; Jabłoński, Sławomir; Dziwińska, Katarzyna; Terlecki, Artur

    2016-06-01

    We would like to present a case report of a very unusual suicide attempt. A 48-year-old female patient tried to commit suicide by stabbing herself with a kitchen knife into her neck. Suicide by self-stabbing is uncommon, constituting only 1-3% of suicide attempts. Patients with self-inflicted stab wounds may have a higher incidence of surgical interventions based on the stab location. Surprisingly, the mortality associated with this kind of wound is low. Most medical centers have very limited experience with this infrequent injury. There are only a few case reports and small series published in the literature of the subject.

  7. Accidental subclavian artery catheterization during attempted internal jugular central venous catheter placement: a case report.

    PubMed

    Paliwal, Bharat; Kamal, Manoj; Purohit, Anamika; Rana, Kirti; Chouhan, Dilip Singh

    2015-01-01

    Central venous catheter placement has been routinely employed for anesthetic and intensive care management. Despite proper technique used and expertise complications do occur; some of which are related to catheter misplacements. We report a case in which subclavian artery was accidently catheterized during attempted internal jugular venous cannulation.

  8. Attempted Suicide by Massive Warfarin Ingestion Conservatively Managed Using Phytonadione

    PubMed Central

    Patel, Kruti S.

    2016-01-01

    Treatment strategies for acute toxicity following massive ingestion of warfarin are not well described in the literature. Warfarin is the primary oral anticoagulation agent used in the treatment of thromboembolic disease, and patients with acute toxicity are at risk for life-threatening hemorrhages. Treatment options include phytonadione (vitamin K1), fresh frozen plasma (FFP), and prothrombin complex concentrates (PCCs) used alone or in combination. FFP and PCC can be associated with volume complications, undesirable thromboembolic events, and increased costs. We describe the case of a 63-year-old female with acute warfarin toxicity following a massive ingestion of warfarin (420 mg–450 mg) in an attempt to commit suicide. Upon arrival to the emergency department, serial INR checks were initiated to help guide dosing strategy and later adjusted based on INR response to treatment using only phytonadione. PMID:28044113

  9. Suicide attempt by hanging in preadolescent children: a case series.

    PubMed

    Omigbodun, O O; Adejumo, O A; Babalola, O O

    2008-10-01

    Suicide is now among the five top causes of death in youth worldwide. However, during the preadolescent period, suicidal behaviour is rare and difficult to define because the cognitive level of young children limits their ability to plan and understand the consequences or the finality of suicide. There is virtually no information about preadolescent suicidal behaviour in Nigeria. To illustrate the presentation and psychosocial issues associated with preadolescent suicidal attempt using the 'hanging' method in Nigeria. Three case scenarios of suicide attempt by hanging in preadolescents seen at the University College Hospital, Ibadan between 2005 and 2006 were interviewed in detail along with mental state and physical examination. Family and individual therapies were embarked upon. Types of psychopathology found in the preadolescents include depressive symptoms, conduct and oppositional defiant disorder and impulse control problems. Stressful life events such as family disruption, physical abuse, and bullying at school were factors associated with suicidal behaviour. The influence of the media in providing information about 'hanging' as a method of suicide was evident. Therapy yield varying results. High risk parameters for suicide in children should be known to all health professionals. The importance of intervention strategies particularly media education, monitoring systems and further research on suicidal behaviour in this environment is apparent.

  10. Eszopiclone-induced Parasomnia with Suicide Attempt: A Case Report.

    PubMed

    Pennington, J Gibson; Guina, Jeffrey

    2016-01-01

    Eszopiclone is a benzodiazepine-like hypnotic that is commonly prescribed to treat insomnia. However, eszopiclone's efficacy has been questionable in several clinical trials, and its pharmacologic profile makes its effects on sleep and behavior difficult to predict. We report a case demonstrating an instance of eszopiclone-induced parasomnia involving paranoia and a suicide attempt in a patient taking eszopiclone. We explore possible biochemical explanations examining the pharmacologic profile of eszopiclone and its potential for drug-drug interactions, especially with concomitant administration of monoaminergic medications such as antidepressants. Caution should be exercised when prescribing these medications, and evidence-based treatments for insomnia (e.g., cognitive behavioral therapy, biofeedback, sedating antidepressants) should be considered prior to sedative-hypnotic administration.

  11. A case of aldicarb poisoning: a possible murder attempt.

    PubMed

    Covaci, A; Manirakiza, P; Coucke, V; Beckers, R; Jorens, P G; Schepens, P

    1999-01-01

    A couple showing signs of cholinergic crisis was admitted to the hospital. Analyses with high-performance liquid chromatography and gas chromatography-mass spectrometry conducted on serum, urine, and stomach contents that were collected few hours after first symptoms showed the presence of aldicarb, which is the most potent carbamate insecticide on the market. A murder attempt was suspected because the patients showed the first signs some minutes after drinking coffee upon returning home and no commercial products containing aldicarb were found in the house. Because of the reversibility of inhibition of acetylcholinesterase, the patients recovered after treatment with atropine and toxogonin. They left the hospital after 12 days. To our knowledge, the serum concentrations of aldicarb reported in this paper are the highest reported for a nonfatal case.

  12. Eszopiclone-induced Parasomnia with Suicide Attempt: A Case Report

    PubMed Central

    Guina, Jeffrey

    2016-01-01

    Eszopiclone is a benzodiazepine-like hypnotic that is commonly prescribed to treat insomnia. However, eszopiclone’s efficacy has been questionable in several clinical trials, and its pharmacologic profile makes its effects on sleep and behavior difficult to predict. We report a case demonstrating an instance of eszopiclone-induced parasomnia involving paranoia and a suicide attempt in a patient taking eszopiclone. We explore possible biochemical explanations examining the pharmacologic profile of eszopiclone and its potential for drug-drug interactions, especially with concomitant administration of monoaminergic medications such as antidepressants. Caution should be exercised when prescribing these medications, and evidence-based treatments for insomnia (e.g., cognitive behavioral therapy, biofeedback, sedating antidepressants) should be considered prior to sedative-hypnotic administration. PMID:27974999

  13. Case Management Directors

    PubMed Central

    Bankston White, Cheri; Birmingham, Jackie

    2015-01-01

    Purpose and Objectives: Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the “moving parts” of such a complex role. This is Part 2 of a two-part article written for case management directors, particularly new ones. Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes. This article attempts to answer the following questions: Are case management directors prepared for an expanded role that affects departments and organizations outside of their own?How does a case management director manage the transition of care of patients while managing required relationships outside the department?How does the director manage program outcomes in such a complex department? Primary Practice Setting: The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Findings/Conclusions: Part 1 found that case management directors would benefit from further research and documentation of “best practices” related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations

  14. An unusual case of suicide attempt using intravenous injection of kerosene.

    PubMed

    Jayaprasad, Sushmitha; Metikurke, Vijayashankar

    2013-01-01

    Kerosene is refined oil belonging to the hydrocarbon group of compounds, available for domestic use in developing countries. Poisoning is due to inhalation, ingestion. Kerosene. We report a rare case of attempted suicide by means of intravenous injection of kerosene. It has a devastating effect and it is important to initiate active and immediate surgical intervention. Psychotherapy should also be an integral part of the management.

  15. [Current Clinical Variables in Schizophrenia Cases with Suicide Attempt History].

    PubMed

    Sağlam Aykut, Demet; Civil Arslan, Filiz; Özkorumak Karagüzel, Evrim; Karakullukçu, Serdar; Tiryaki, Ahmet

    2017-01-01

    High suicide risk was shown to be related with depression and low quality of life in studies investigating clinical variables related to suicidal behavior. The aim of this study was to investigate the effects of a suicide attempt on clinical presentation by comparing sociodemographic variables, clinical signs, symptoms of depression, quality of life, social functionality, and reported adverse drug reactions in schizophrenic patients with and without suicide. Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Social Functioning Scale (SFS), and Udvalg for Kliniske Undersøgelser Side Effect Rating Scale (UKU) were administered to 115 patients with schizophrenia. 44.3% of patients had at least one suicide attempt. Among sociodemographic variables, a family history of suicide, smoking, and total duration of disease were significantly higher in patients with suicide history than without. Scores of CDS and UKU subscores were significantly higher, and quality of life and social occupation in social functionality were significantly lower in patients with a history of suicide. In correlation analysis, CSD was negatively correlated with Q-LES-Q and independency/performance subscore of SFI, and positively correlated with UKU-Neurological subscore. In line with this data, suicidal behavior may be suggested to affect clinical presentation and course characteristic of schizophrenic patients. Additional treatments towards factors that may impact on the clinical course and social support programs might be suggested for these patients.

  16. Accidental carotid artery catheterization during attempted central venous catheter placement: a case report.

    PubMed

    Maietta, Pauline Marie

    2012-08-01

    More than 2.1 million central venous catheters are placed annually. While carotid artery cannulation is rare, its effects can be devastating. Anesthesia providers frequently work with central venous catheters in the perioperative setting. Therefore, it is imperative that they be able to identify and react appropriately to carotid artery injury both in preexisting central lines and those that they have placed. This case report details a case of accidental carotid artery catheterization during attempted right internal jugular vein catheterization and the steps taken to treat the patient following its recognition. A discussion of technique for central venous catheterization, indications for suspicion of arterial puncture, methods for confirming venous or arterial placement, appropriate methods for management of carotid artery cannulation, and the benefit of ultrasound in central venous cannulation follow. Through the appropriate use of equipment, early detection and management of carotid artery injury, and proper training, patient outcomes may be improved.

  17. Penetrating Brain Injury after Suicide Attempt with Speargun: Case Study and Review of Literature

    PubMed Central

    Williams, John R.; Aghion, Daniel M.; Doberstein, Curtis E.; Cosgrove, G. Rees; Asaad, Wael F.

    2014-01-01

    Penetrating cranial injury by mechanisms other than gunshots are exceedingly rare, and so strategies and guidelines for the management of PBI are largely informed by data from higher-velocity penetrating injuries. Here, we present a case of penetrating brain injury by the low-velocity mechanism of a harpoon from an underwater fishing speargun in an attempted suicide by a 56-year-old Caucasian male. The case raised a number of interesting points in management of low-velocity penetrating brain injury (LVPBI), including benefit in delaying foreign body removal to allow for tamponade; the importance of history-taking in establishing the social/legal significance of the events surrounding the injury; the use of cerebral angiogram in all cases of PBI; advantages of using dual-energy CT to reduce artifact when available; and antibiotic prophylaxis in the context of idiosyncratic histories of usage of penetrating objects before coming in contact with the intracranial environment. We present here the management of the case in full along with an extended discussion and review of existing literature regarding key points in management of LVPBI vs. higher-velocity forms of intracranial injury. PMID:25071701

  18. Multiple Attempts for Online Assessments in an Operations Management Course: An Exploration

    ERIC Educational Resources Information Center

    Orchard, Ryan K.

    2016-01-01

    In learning management systems, tools for online homework assessments include a number of alternatives for the assessment settings, including the ability to permit students to attempt an assessment multiple times, with options for how the multiple attempts are administered. A specific implementation of online assessments in an introductory…

  19. Multiple Attempts for Online Assessments in an Operations Management Course: An Exploration

    ERIC Educational Resources Information Center

    Orchard, Ryan K.

    2016-01-01

    In learning management systems, tools for online homework assessments include a number of alternatives for the assessment settings, including the ability to permit students to attempt an assessment multiple times, with options for how the multiple attempts are administered. A specific implementation of online assessments in an introductory…

  20. Attempted suicide by massive insulin injection: a case report and review of the literature.

    PubMed

    Thewjitcharoen, Yotsapon; Lekpittaya, Nampetch; Himathongkam, Thep

    2008-12-01

    The authors present a case of an 80-year-old man, non-diabetic, who attempted suicide by injecting himself subcutaneously with 10,000 units of Humulin R and 6000 units of Humulin N. Administration of dextrose intravenously was required for 13 days to maintain the capillary blood glucose within the range of 100-180 mg/dl. Hyponatremia, hypokalemia, hypophosphatemia, and elevated liver enzymes were also seen after massive insulin injection. Glucose requirement index was established to demonstrate the trend of glucose requirement during hospitalization. He recovered completely without any complication after monitoring blood glucose and titrating intravenous glucose carefully for two weeks. Current literature about how to manage insulin overdose was reviewed in the present article.

  1. Characteristics of suicide attempts in anorexia and bulimia nervosa: a case-control study.

    PubMed

    Guillaume, Sébastien; Jaussent, Isabelle; Olié, Emilie; Genty, Catherine; Bringer, Jacques; Courtet, Philippe; Schmidt, Ulrike

    2011-01-01

    Compared to other eating disorders, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an eating disorders (ED). Case-control study in a cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity. AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4-7.9), with a higher expectation of dying (OR = 3.7,95% CI 1.1-13.5), and an increased risk of severity (OR = 3.4,95% CI 1.2-9.6). BN patients did not differ from the control group. Clinical markers of the severity of ED were associated with the seriousness of the attempt. There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Higher completed suicide rates in AN may be partially explained by AN patients' higher desire to die and their more severe and lethal attempts.

  2. Sleep problems and suicide attempts among adolescents: a case-control study.

    PubMed

    Koyawala, Neel; Stevens, Jack; McBee-Strayer, Sandra M; Cannon, Elizabeth A; Bridge, Jeffrey A

    2015-01-01

    This study used a case-control design to compare sleep disturbances in 40 adolescents who attempted suicide with 40 never-suicidal adolescents. Using hierarchical logistic regression analyses, we found that self-reported nighttime awakenings were significantly associated with attempted suicide, after controlling for antidepressant use, antipsychotic use, affective problems, and being bullied. In a separate regression analysis, the parent-reported total sleep problems score also predicted suicide attempt status, controlling for key covariates. No associations were found between suicide attempts and other distinct sleep problems, including falling asleep at bedtime, sleeping a lot during the day, trouble waking up in the morning, sleep duration, and parent-reported nightmares. Clinicians should be aware of sleep problems as potential risk factors for suicide attempts for adolescents.

  3. Alcohol Abuse and Suicide Attempt in Iran: A Case-Crossover Study

    PubMed Central

    Ghanbari, Behrooz; Malakouti, Seyed Kazem; Nojomi, Marzieh; Leo, Diego De; Saeed, Khalid

    2016-01-01

    Alcohol use and its disorders are associated with increased risk of suicidal behaviors Research has shown that 6-8% of those who use alcohol have a history of suicide attempt. Given the prohibition of alcohol use legally, the increased alcohol consumption, and the lack of strong evidence in favor of its use associated with suicide in Iran, this study was conducted to determine the link between suicide attempt and alcohol abuse. The case-crossover method was used in this research. Out of 305 referrals to the emergency room due to a suicide attempt, 100 reported drinking alcohol up to six hours before their attempt. Paired Matching and Usual Frequency were employed to analyze the data with STATA 12.0. The probability of attempting suicide up to six hours after drinking alcohol appeared increased by 27 times (95% CI: 8.1-60.4). Separate analysis for each of these hours from the first to the sixth hour after alcohol use was also performed. Fifty percent of attempted suicides happened one hour after alcohol use. Relative risk for the first and second hour was 10% and 5% respectively. Alcohol use is a strong proximal risk factor for attempted suicide among Iranian subjects. Prevention of alcohol use should be considered in setting up of the national Suicide attempt prevention program. PMID:26925903

  4. Case-control association study of TGOLN2 in attempted suicide.

    PubMed

    Mahon, Pamela B; Stütz, Adrian M; Seifuddin, Fayaz; Huo, Yuqing; Goes, Fernando S; Jancic, Dubravka; Judy, Jennifer T; Depaulo, J Raymond; Gershon, Elliot S; McMahon, Francis J; Zandi, Peter P; Potash, James B; Willour, Virginia L

    2010-07-01

    Family, twin, and adoption studies provide convincing evidence for a genetic contribution to suicidal behavior. The heritability for suicidal behavior depends in part on the transmission of psychiatric disorders, such as mood disorders and substance use disorders, but is also partly independent of them. Three linkage studies using the attempted suicide phenotype in pedigrees with bipolar disorder, major depression, or alcoholism have provided consistent evidence that 2p11-12 harbors a susceptibility gene for attempted suicide. A microarray expression study using postmortem brain samples has implicated a gene from the 2p11-12 candidate region, the trans-Golgi network protein 2 (TGOLN2) gene, as being consistently up-regulated in suicide cases as compared to controls. Here, we present a TGOLN2 case-control association study using nine single nucleotide polymorphisms (SNPs). These nine SNPs, which include seven tag SNPs and two coding SNPs, have been genotyped in 517 mood disorder subjects with a history of attempted suicide and 515 normal controls. Allelic and genotypic analyses of the case-control sample did not provide evidence for association with the attempted suicide phenotype. Eight of the nine SNPs provided supportive evidence for association (P-values ranging from 0.008 to 0.03) when we compared the attempted suicide cases with a history of alcoholism to the attempted suicide cases without a history of alcoholism. However, this association finding was not replicated in an independent sample. Taken together, these analyses do not provide support for the hypothesis that common genetic variation in TGOLN2 contributes significantly to the risk for attempted suicide in subjects with major mood disorders.

  5. [A report on attempted suicide cases involving patients accepted by public health care institutions].

    PubMed

    Tsujimoto, Tetsushi; Tsuji, Motohiro; Yamada, Naoto

    2011-01-01

    We investigated attempted suicide cases, both successful and failed involving patients, accepted by public health care institutions in Shiga Prefecture, whose population is about 1. 4 million, from the 12th January 2010 to 14th February 2010. Prefectural emergency hospitals, fire stations, and pathologists cooperated in the investigation, and the cases were reported with the age and sex as well as the means and results of the attempts. How these institutions cooperated in the cases was also reported. A total number of 104 people attempted suicide, in which 40 people (38.5%) succeeded, 54 people (51.9%) failed, and the outcome was unknown in 10 people (9.6%). Forty-one people (39.4%) were in their 30s, being the most common age group. Successful suicides were most prominent among elderly males, and failed attempts were most prominent among young females. Hanging and poisonous gassing were the common means of suicide among the successful cases, and overdose, drinking, and wrist -cutting were the common means among the failed attempts. Sixty-four people (61.5%) were admitted to public emergency hospitals, 51 people (49.0%) were rescued by fire workers, and 34 people (32.7%) were sent for autopsy following police reports on fatal cases as suicide. Successful suicides and males were mostly sent for pathological examination without any coordinated care from different medical institutions, whereas, failed cases and females were often taken care of by several institutions. Five people (4.8%) were referred for psychiatric help. Suicide intervention needs to take account of differences in the sex, age, means, and other characteristics of those who attempt suicide. Each institution plays an important role, and they need to cooperate in order to establish an effective intervention.

  6. Acute Substance Use as a Warning Sign for Suicide Attempts: A Case-Crossover Examination of the 48 Hours Prior to a Recent Suicide Attempt.

    PubMed

    Bagge, Courtney L; Borges, Guilherme

    2017-01-31

    The extent to which specific categories of acute substance use are short-term risk factors, or warning signs, for suicide attempts is unknown. The aim of the current study was to quantify the near-term effects of sole use and co-use of substances on medically attended suicide attempts. The current study used a case-crossover design, comparing substance use within the 24 hours prior to a suicide attempt (case day) to the control day, the matched 24 hours the day prior to the case day. Participants were 363 recent suicide attempters presenting to a Level 1 trauma hospital between October 2008 and April 2014. A timeline follow-back methodology was used to assess acute exposures within the 48 hours before the suicide attempt. Conditional logistic regression was used to report odds ratios (ORs) and 95% confidence intervals (CIs). Results indicated that patients were at increased odds of attempting suicide after drinking alcohol within a 24-hour period (OR = 4.40; 95% CI, 2.31-8.40) and using a drug from another class of substances with central nervous system (CNS) depressant characteristics (sedatives/anxiolytics and opioids; OR = 2.82; 95% CI, 1.13-7.01), after adjustment for other acute substance use. The acute use of cannabis and CNS stimulants (stimulants/amphetamines and cocaine) was not uniquely associated with suicide attempt. Co-use of alcohol synergized effects of other CNS depressants (OR = 8.76; 95% CI, 1.02-75.44). Findings suggest the importance of considering acute alcohol use and use of CNS depressants, and the concurrent use of both substances, when evaluating short-term risk for suicide attempts in clinical settings.

  7. Acute Substance Use as a Warning Sign for Suicide Attempts: A Case-Crossover Examination of the 48 Hours Prior to a Recent Suicide Attempt.

    PubMed

    Bagge, Courtney L; Borges, Guilherme

    2017-06-01

    The extent to which specific categories of acute substance use are short-term risk factors, or warning signs, for suicide attempts is unknown. The aim of the current study was to quantify the near-term effects of sole use and co-use of substances on medically attended suicide attempts. The current study used a case-crossover design, comparing substance use within the 24 hours prior to a suicide attempt (case day) to the control day, the matched 24 hours the day prior to the case day. Participants were 363 recent suicide attempters presenting to a Level 1 trauma hospital between October 2008 and April 2014. A timeline follow-back methodology was used to assess acute exposures within the 48 hours before the suicide attempt. Conditional logistic regression was used to report odds ratios (ORs) and 95% confidence intervals (CIs). Results indicated that patients were at increased odds of attempting suicide after drinking alcohol within a 24-hour period (OR = 4.40; 95% CI, 2.31-8.40) and using a drug from another class of substances with central nervous system (CNS) depressant characteristics (sedatives/anxiolytics and opioids; OR = 2.82; 95% CI, 1.13-7.01), after adjustment for other acute substance use. The acute use of cannabis and CNS stimulants (stimulants/amphetamines and cocaine) was not uniquely associated with suicide attempt. Co-use of alcohol synergized effects of other CNS depressants (OR = 8.76; 95% CI, 1.02-75.44). Findings suggest the importance of considering acute alcohol use and use of CNS depressants, and the concurrent use of both substances, when evaluating short-term risk for suicide attempts in clinical settings.

  8. A Case Control Study of Suicide and Attempted Suicide in Older Adults.

    ERIC Educational Resources Information Center

    Beautrais, Annette L.

    2002-01-01

    Risk factors for serious suicidal behavior among older adults were examined in a case control study of adults aged 55 and older who died by suicide or made suicide attempts and who were compared with randomly selected comparison subjects. Multivariate analyses suggested that mood disorders were the most significant risk factor for suicidal…

  9. A Case Control Study of Suicide and Attempted Suicide in Older Adults.

    ERIC Educational Resources Information Center

    Beautrais, Annette L.

    2002-01-01

    Risk factors for serious suicidal behavior among older adults were examined in a case control study of adults aged 55 and older who died by suicide or made suicide attempts and who were compared with randomly selected comparison subjects. Multivariate analyses suggested that mood disorders were the most significant risk factor for suicidal…

  10. "Tuberculosis Case Management" Training.

    ERIC Educational Resources Information Center

    Knebel, Elisa; Kolodner, Jennifer

    2001-01-01

    The need to isolated health providers with critical knowledge in tuberculosis (TB) case management prompted the development of "Tuberculosis Case Management" CD-ROM. Features include "Learning Center,""Examination Room," and "Library." The combination of audio, video, and graphics allows participants to…

  11. "Tuberculosis Case Management" Training.

    ERIC Educational Resources Information Center

    Knebel, Elisa; Kolodner, Jennifer

    2001-01-01

    The need to isolated health providers with critical knowledge in tuberculosis (TB) case management prompted the development of "Tuberculosis Case Management" CD-ROM. Features include "Learning Center,""Examination Room," and "Library." The combination of audio, video, and graphics allows participants to…

  12. Management of a complex pancreaticoduodenal lesion following a suicidal attempt with a crossbow

    PubMed Central

    Benmohamed, Nadja; Abbassi, Ziad; Naiken, Surennaidoo P.; Morel, Philippe; Platon, Alexandra; Poletti, Pierre-Alexandre; Toso, Christian

    2016-01-01

    Traumatic pancreaticoduodenal lesions are rare, often involve a challenging management, and have high rates of morbidity and mortality. A 43-year-old male patient committed a suicidal attempt by shooting an arrow with a crossbow into his upper abdomen. He was successfully treated with cautious multidisciplinary approach. Crossbow lesions demonstrate low kinetics. Sharp tips of arrows result in localized damage, likely to involve several organs. Pancreatic lesions are of particular interest because of their difficult surgery. Surgical exploration and drainage can allow an efficient management of pancreatic penetrating lesions, even in the presence of a complete pancreatic duct disruption. PMID:28040790

  13. An Unusual Case of Suicide Attempt Using Intravenous Injection of Kerosene.

    PubMed

    Hasan, M N; Sutradhar, S R; Ahmed, S M; Chowdhury, I H

    2016-07-01

    Kerosene belongs to the hydrocarbon group of compounds, used as a fuel for lamps, as well as heating and cooking in developing countries. Accidental kerosene poisoning and intoxication usually occur by inhalation or by occupational percutaneous absorption. Adults usually ingest kerosene for the purpose of self-harm, and children may ingest accidentally. Suicidal attempt using intravenous kerosene is an extra ordinary and very rare occurrence. A very few data are available regarding effects of intravenous administration of kerosene and its management.

  14. Attempted Serial Neonaticides: Case Report and a Brief Review of the Literature.

    PubMed

    Barros, Alcina Juliana Soares; Rosa, Regis Goulart; Telles, Lisieux Elaine de Borba; Taborda, José Geraldo Vernet

    2016-01-01

    Neonaticide is an infant murder occurring on the day of birth. The case reports found in the literature are often focused on the mother as the agent in the context of pregnancy denial, dissociative symptoms, or psychosis. However, this report describes a rare case of attempted serial neonaticides, in which the acts were committed by a nurse at the nursery of a referral hospital in Brazil. The authors describe a forensic psychiatric evaluation for criminal responsibility and correlate the information from this particular case with relevant forensic themes, namely neonaticide, Munchausen by proxy syndrome, and serial healthcare killers.

  15. Young adults' strategies for managing social support during weight-loss attempts.

    PubMed

    Faw, Meara H

    2014-02-01

    Obesity and being overweight often result in serious health problems. Despite growing awareness of the dangers associated with being overweight, many individuals struggle to lose weight. Investigators have identified social support as a key element in weight-loss attempts. Unfortunately, little has been done to investigate how people solicit social support from members of their pre-existing social network without a structured intervention. To address this limitation, I conducted in-depth interviews with 25 participants. Through grounded theory analysis of these interviews, I developed a typology of support management strategies used by overweight young adults when attempting to lose weight. I outline these strategies, their perceived success, and implications for future research in this article.

  16. Case Management Directors

    PubMed Central

    Bankston-White, Cheri; Birmingham, Jackie

    2015-01-01

    Purpose and Objectives: Case management directors are in a dynamic position to affect the transition of care for patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the “moving parts” of such a complex role. The purpose of this two-part article is to provide case management directors, particularly new ones, with a framework for understanding and fulfilling their role. We have divided the guide into seven tracks of responsibility. Part 1 discusses the first four tracks: (1) staffing and human resources, (2) compliance and accreditation, (3) discharge planning, and (4) utilization review and revenue cycle. Part 2 addresses (5) internal departmental relationships (organizational), (6) external relationships (Community agency), and (7) quality and program outcomes. Primary Practice Setting: The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems, and have frontline case managers reporting to them. Findings/Conclusions: Case management directors would benefit from further research and documentation of “best practices” related to their role, particularly in the areas of leadership and management. New directors would benefit from mentoring and networking with one another. Implications for Case Management: As new regulations and models of care bring increased emphasis and focus to transitions of care, the role of the case management director continues to evolve, growing in importance and complexity. The growing financial impact of readmissions also brings added scrutiny and increased pressure to get the transitions of care right the first time. To operate most effectively, case management directors must understand the full range of their

  17. The effectiveness of control strategies for dementia-driven wandering, preventing escape attempts: a case report.

    PubMed

    Padilla, Daniel Valle; González, María Teresa Daza; Agis, Inmaculada Fernández; Strizzi, Jenna; Rodríguez, Raquel Alarcón

    2013-03-01

    One of the most complicated aspects of caring for patients with dementia is dementia-driven wandering due to its adverse ramifications. We report a case of an 80-year-old man who had been previously diagnosed with dementia (with a score of 6 on the Reisberg Global Deterioration Scale - GDS). The patient went to an Adult Day Care Center on a daily basis where he demonstrated wandering behavior with a high rate of escape attempts (the number of times the Center's glass exit door was approached). The objective of this study is to present effective non-pharmacological intervention strategies for dementia-driven wandering; assessed strategies included: environmental (subjective barriers), cognitive/behavioral (cognitive training with differential reinforcement), and combined (subjective barriers + cognitive/behavioral). The results showed that all of these three strategies significantly decreased the number of escape attempts.

  18. Management of a complex pancreaticoduodenal lesion following a suicidal attempt with a crossbow.

    PubMed

    Benmohamed, Nadja; Abbassi, Ziad; Naiken, Surennaidoo P; Morel, Philippe; Platon, Alexandra; Poletti, Pierre-Alexandre; Toso, Christian

    2016-12-31

    Traumatic pancreaticoduodenal lesions are rare, often involve a challenging management, and have high rates of morbidity and mortality. A 43-year-old male patient committed a suicidal attempt by shooting an arrow with a crossbow into his upper abdomen. He was successfully treated with cautious multidisciplinary approach. Crossbow lesions demonstrate low kinetics. Sharp tips of arrows result in localized damage, likely to involve several organs. Pancreatic lesions are of particular interest because of their difficult surgery. Surgical exploration and drainage can allow an efficient management of pancreatic penetrating lesions, even in the presence of a complete pancreatic duct disruption. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

  19. Management of 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decisions in the perioperative period.

    PubMed

    Dawson, S R; McBrien, M E

    2015-01-01

    It is increasingly common for patients to be scheduled for anaesthesia and surgery with a 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decision in place. Updated guidelines for the implementation and management of DNACPR decisions were published jointly by the British Medical Association (BMA), the Resuscitation Council (UK) and the Royal College of Nursing (RCN) in 2014 (BMA, RC(UK), RCN 2014). The Association of Anaesthetists of Great Britain and Ireland (AAGBI) published specific guidelines in 2009 to guide the perioperative management of such patients (AAGBI 2009). In this article, we explain these guidelines with a focus on how DNACPR decisions are made and how they can be modified in order to permit appropriate surgery to take place.

  20. A Case of Attempted Suicide in Huntington's Disease: Ethical and Moral Considerations.

    PubMed

    Furfari, Kristin; Zehnder, Nichole; Abbott, Jean

    2016-01-01

    A 62-year-old female with Huntington's disease presented after a suicide attempt. Her advance directive stated that she did not want intubation or resuscitation, which her family acknowledged and supported. Despite these directives, she was resuscitated in the emergency department and continued to state that she would attempt suicide again. Her suicidality in the face of a chronic and advancing illness, and her prolonged consistency in her desire to take her own life, left careproviders wondering how to provide ethical, respectful care to this patient. Tension between the ethical principles of autonomy and beneficence is central in this case. The patient's narrative demonstrated that her suicide was an autonomous decision, free from coercion or disordered thinking from mental illness. Beneficence then would seem to necessitate care aligned with the patient's desire to end her life, which created ethical uneasiness for her family and careproviders. The case highlights several end-of-life ethical considerations that have received much recent attention. With ongoing discussions about the legalization of aid in dying across the country, caregivers are challenged to understand what beneficence means in people with terminal illnesses who want a say in their death. This case also highlights the profound moral distress of families and careproviders that arises in such ethically challenging scenarios. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

  1. [Multimodal pain therapy - implementation of process management - an attempt to consider management approaches].

    PubMed

    Dunkel, Marion; Kramp, Melanie

    2012-07-01

    The combination of medical and economical proceedings allows new perspectives in the illustration of medical workflows. Considering structural and developmental aspects multimodal therapy programs show similarities with typical subjects of economic process systems. By pointing out the strategic appearance of the multimodal pain therapy concept multimodal approaches can be described to some extent by using management approaches. E. g., an economic process landscape can be used to represent procedures of a multimodal pain therapy program. © Georg Thieme Verlag Stuttgart · New York.

  2. [Developing an attitude scale towards attempted suicide cases for evaluating emergency medical teams (ASETSA)].

    PubMed

    Er, Gülastan; Şimşek, Zeynep; Aker, Ahmet Tamer

    2013-01-01

    Suicide attempt is one of the most important risk factors for completed suicide, and generally, the first intervention is performed in the emergency department. The attitudes of health professionals towards suicide attempt cases affect their treatment and medical care. There is no related attitude assessment scale for health professionals in Turkey. The aim of this study was to develop a scale for assessing the attitudes of emergency medical teams towards cases of attempted suicide. In this methodological, epidemiological study, a pool of 140 items was compiled using a previously developed similar scale available in the literature, as well as, testimonies of health professionals. Two hundred and fifty-one doctors, nurses and emergency medical technicians from 14 local hospitals in Sanlıurfa were included in this study. Surface validity was determined using the Lawshe content validity index and ratio. Factor analysis (principal components) was used to evaluate structural validity and internal consistency (Cronbach's alpha), and test-retest reliability was analyzed. The mean age of the study cohort was 27.9 ± 5.15 years, and 50% of the participants were female. A 28-entry attitude scale, which explained 58.5% of the total variance, was developed, including subscales for prevention and protection, individual help, institutional help, triggers and psychopathology, casual attributions, and medical help. The Cronbach's alpha parameter of the scale was 0.84. In test-retest analysis; there is no significant difference between point averages of the first and last application of the scale. The psychometric features of the developed scale were determined to be acceptable.

  3. Ectopic abdominal pregnancy due to uterine perforation after an attempt to terminate pregnancy: a case presentation.

    PubMed

    Hernández Núñez, Jónathan; Abreu Díaz, Alexander; Michael Ndwambi, Ndivhuwo; Martínez, Fermín Luis

    2017-07-17

    Secondary abdominal ectopic pregnancy is rare in clinical practice, but may lead to an increased maternal mortality. We present the case of a patient with an abdominal pregnancy secondary to a uterine perforation caused by a voluntary attempt to interrupt pregnancy that presented with nine weeks of abdominal pain and minimal vaginal bleeding which was mistakenly diagnosed as acute pelvic inflammatory disease, urinary tract infection, and post-abortion products of conception. Finally, the abdominal ultrasound test found an abdominal ectopic pregnancy. An exploratory laparotomy was performed and the fetus and placenta were removed without difficulties with a favorable postoperative course. It was concluded that uterine perforation during curettage of the cavity went unnoticed, leading to secondary abdominal implantation of pregnancy with a inconclusive clinical presentation, where ultrasound plays a fundamental diagnostic role. Laparotomy is indicated in most of these cases.

  4. Community case management for mental illness.

    PubMed

    Kelly, J; Stephens, I

    1999-05-01

    These case vignettes clearly illustrate the complexity which is modern psychiatric case management. In the case of Mr D, one of the salient facets of case management was medication monitoring in the context of the introduction of a new depot injection. This was a function in which nursing knowledge of medications and their side effects was undoubtedly advantageous. Any adverse experience with medication is likely to have negative ramifications regarding future compliance. Therefore, a nurse case manager is ideally suited to provide the appropriate information on psychotropic medications and to confidently answer most questions about these medications, and promptly identify any possible emerging side effects. In the case of Mr X, the management began with a practical and crisis focus involving suicide prevention. This developed into supportive psychotherapy, which required sensitive but proactive intervention and, ultimately, significant counselling skills. Mr L's case management had a different focus again, characterised by the development of a new and comprehensive case formulation and a creative nurturing of an individual's identified strength in music. The vignettes not only serve to highlight the well-established heterogeneity of mental illness, but they also importantly illuminate the heterogeneity of case management, a reality obscured in the descriptions of case management models which perhaps misleadingly have given the impression of the process as being merely a number of clearly defined tasks or functions. In actual fact, though the coordination of care appears to represent a common feature, the case management relationship remains an ever changing one, with adaptability, refined clinical skills and practical problem solving skills being the essential requisites of an effective case manager. Therefore, attempts to present this important activity in terms of any one model seem to miss the point. For the consumers of psychiatric services, the experience of

  5. Case report: a rare case of attempted homicide with Gloriosa superba seeds.

    PubMed

    Kande Vidanalage, Chaminda J; Ekanayeka, Rohan; Wijewardane, Deepthi K

    2016-06-21

    Gloriosa superba, well known as the glory lily or superb lily, is a tropical climbing plant that features an exotic red flower. The plant is poisonous because of high concentrations of colchicine in all parts of the plant. It is commercially grown for use in Ayurveda medicine and as a cash crop for extracting colchicine in India and Africa. It is a wild plant in Sri Lanka and commercial cultivation is rare. Accidental and suicidal poisonings with Gloriosa tubers are well known and reported. There are no case reports of poisoning by Gloriosa seeds in Sri Lanka. Google and PubMed searches showed no reported cases of poisoning with seeds or their use with homicidal intent in other parts of the world. A 27-year-old man was brought to hospital with profuse vomiting and diarrhea after drinking coriander tea, which is a common traditional treatment for common cold. The family members suspected poisoning by Gloriosa because they had seeds at home and the victim's sister-in-law who had made the herbal tea went missing from home. They were able to identify Gloriosa seeds, which looked similar to coriander, in the pot. The patient developed shock and respiratory distress and needed ventilation and intensive care. He also developed mild renal impairment, and thrombocytopenia. He developed massive generalized alopecia while recovering from acute illness. Full recovery was achieved after 15 days of hospital care. There are many poisonous plants in Asian countries. This case highlights the possibility of accidental or intentional use of Gloriosa seeds or its extracts to cause potentially fatal poisoning. It would be difficult to identify Gloriosa as the cause of poisoning without any background information because of multiple complications that can mimic a systemic infection. This case is a good example of the use of plants as biological weapons.

  6. Case Management: A Resource Manual.

    ERIC Educational Resources Information Center

    Adams, Anne Thomas; Franklin, Sundra; Taylor, Rebecca

    This resource manual has been developed to assist both case managers and management staff in implementing a case management system as an infrastructure for delivering services that will facilitate the positive growth and development of youth and the achievement of individual and organizational performance goals. (The goal of case managers is to…

  7. An attempt at the computer-aided management of HIV infection

    NASA Astrophysics Data System (ADS)

    Ida, A.; Oharu, Y.; Sankey, O.

    2007-07-01

    The immune system is a complex and diverse system in the human body and HIV virus disrupts and destroys it through extremely complicated but surprisingly logical process. The purpose of this paper is to make an attempt to present a method for the computer-aided management of HIV infection process by means of a mathematical model describing the dynamics of the host pathogen interaction with HIV-1. Treatments for the AIDS disease must be changed to more efficient ones in accordance with the disease progression and the status of the immune system. The level of progression and the status are represented by parameters which are governed by our mathematical model. It is then exhibited that our model is numerically stable and uniquely solvable. With this knowledge, our mathematical model for HIV disease progression is formulated and physiological interpretations are provided. The results of our numerical simulations are visualized, and it is seen that our results agree with medical aspects from the point of view of antiretroviral therapy. It is then expected that our approach will take to address practical clinical issues and will be applied to the computer-aided management of antiretroviral therapies.

  8. Juvenile perpetrators of homicides and attempted homicides--a case control study.

    PubMed

    Britvić, Dolores; Urlić, Ivan; Definis-Gojanović, Marija

    2006-03-01

    The aim of this study was to explore the influence of certain aspects of family dynamics, as well as some behavior and psychological development disorders on the occurrence of homicides and attempted homicides among juveniles in the Split Dalmatian County over a period of 10 years (1989-1998). A retrospective case-control study was performed to compare juvenile murderers and attempted murderers with minors who committed other offences, i.e. property crimes. The subjects were paired according to demographic and socio-economic background. The data obtained from County Court's files included social anamnesis, specialists' observation and psychiatric expertise results. There was a significant difference between the study group and their controls in the frequency of physical violence and parental rejection during childhood. Neuropsychological and neurophysiological abnormalities were more frequent in the experimental than in the control group. Stealing occurred more often in the control group. No significant differences were found for other studied risk factors. There is no unique type of juvenile murderer. A juvenile homicide is committed under the influence of various developmental characteristics, family milieu, and constitution combined with environmental factors and perpetrator's perception of the victim.

  9. A case of suicide attempt with long-acting methylphenidate (Concerta).

    PubMed

    Ozdemir, Esra; Karaman, Mehmet Goksin; Yurteri, Nihal; Erdogan, Ayten

    2010-11-01

    The prescribed use of methylphenidate in the treatment of attention deficit hyperactivity disorder (ADHD) is widespread. The intranasal and parenteral abuse of methylphenidate (Ritalin) among teenagers is becoming increasingly more common, and deaths have been reported. Newer medical treatment options of long-acting stimulants offer effective treatment with a lower risk of abuse potential. We describe a case of a 17-year-old girl who had attempted suicide by ingesting 270 mg of Concerta. During the third years of treatment with Concerta, parents of patient reported that the patient had a depressive mood in the last week, and had attempted suicide with five tablets of Concerta 54 mg. She was sent to a local hospital with a diagnosis of long-acting methylphenidate overdose. All of vital and laboratory findings were normal except heart rate, which was 132 beats/min. Since more than 3 h have elapsed after the time of ingestion, activated charcoal administration was not carried out at the hospital. She was only observed for 12 h at the emergency department and later discharged from the hospital. While long-acting stimulants offer lower risk of abuse, their greater availability increases the likelihood of ingestion of this nature. Education of clinicians and families to be aware of this risk should reduce the frequency of this complication of treatment.

  10. [Unsuccessful suicidal attempt with use of self-prepared bullet -- case report].

    PubMed

    Malec, Katarzyna; Gasiński, Mateusz; Kuchta, Krzysztof; Kozok, Andrzej

    2013-01-01

    Gunshot injuries of the viscerocranium are rarely reported during times of peace in Europe. Penetrating wounds to the maxillofacial region pose a significant challenge for surgeons as they often comprise serious soft and bone tissue defects.We present a case report of 38-year-old male with gunshot wound to the viscerocranium after suicidal attempt. The patient's general condition was stable. The inlet wound was found in the submental region in the central line penetrating deep into the floor of the mouth, to the left, avoiding large vessels and hypoglossal nerve. No exit wound was identified. The ophthalmic examination revealed the limitation of motion in the left eyeball and diplopia in the whole field of vision. The revision was performed under general anesthesia. Control CT scan revealed the presence of one metallic fragment wedged in the hard palate. Second look of oral cavity with particular emphasis on the hard palate was performed. Shrapnel proved to be wedged in the bone of the hard palate very firmly and complete removal without damaging the function of the palate was impossible. The decision was made to withdraw from surgical removal of the remaining piece of the projectile. In most cases, it is recommended to remove all foreign material from human body. However, in the illustrated case we decided to leave small debris in the craniofacial skeleton. In our opinion, further surgical revision would result in greater tissue damage, disproportionate to the benefits of the removal of all fragments of the projectile.

  11. Petechial hemorrhages of the tympanic membrane in attempted suicide by hanging: A case report.

    PubMed

    Rasmussen, Eva Rye; Larsen, Per Leganger; Andersen, Kjeld; Larsen, Michael; Qvortrup, Klaus; Hougen, Hans Petter

    2013-02-01

    It is important to determine whether a person has been strangulated and the diagnosis is not always straightforward since ligature marks are not always present. In forensic medicine the physical examination recommended is careful inspection of the head and neck region, oral cavity, examination of the eyes including the conjunctiva on both the upper and lower eyelids and photo documentation. Petechial hemorrhages of the conjunctiva are considered marker of life threatening hanging or strangulation. Hemorrhage from ears, perforated tympanic membrane and haematotympanum are scarcely described in case reports of strangulated patients. To our knowledge we are the first to report petechial hemorrhages of the tympanic membrane in a patient following attempted suicide by hanging. We believe that the petechial hemorrhages develop from the capillaries located in lamina propria of the epidermal layer above the fibrous layer. This assumption is made on the basis of our assessment of a normal tympanic membrane with light microscopy. Petechial hemorrhages of the tympanic membrane might in fact be the only sign of life threatening pressure applied to the neck. This is a very important finding and prospective studies should be conducted for further clarification on the matter. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  12. Suicide attempt by complete self-removal of a 12-year-old permanent pacemaker system: case report.

    PubMed

    Norgaard, Mette Lykke; Melchior, Thomas; Wagner, Thomas; Haugan, Ketil

    2014-01-01

    Psychological adaption after pacemaker implantation can be challenging in patients with psychiatric disease. Suicide by self-removal of a permanent pacemaker system is a rare phenomenon described in a few cases in patients with psychiatric disorders. We describe a case of attempted suicide by complete self-removal of a 12-year-old permanent pacemaker system in a 70-year-old male patient with a bipolar disorder and a history of previous suicide attempts. Suicide attempt by self-removal of a permanent pacemaker system is very rare. In patients with a history of psychiatric disease and previous suicide attempts, careful information about the function of a pacemaker should be given. © 2014 Wiley Periodicals, Inc.

  13. Attempted vaginal birth after cesarean section: a multicenter comparison of outpatient prostaglandin E(2) gel with expectant management.

    PubMed

    Rayburn; Lucas; Gittens; Goodwin; Baxi; Gall; Mostello; Heyl

    1998-07-01

    Objective: To compare the clinical effectiveness and safety of outpatient administration of an intracervical prostaglandin (PG) E(2) gel with expectant management for women with an unfavorable cervix who wish to attempt a vaginal birth after cesarean section.Study Design: This outpatient study was a randomized, multicenter investigation involving pregnant women at term with one previous low transverse cesarean section. Each had an unfavorable cervix (Bishop score management, were given a 0.5 mg dose of PGE(2) (Prepidil) intracervically at 39 weeks gestation. This cervical ripening treatment was repeated at weekly office visits for up to 3 doses.Results: Of the 294 cases, 143 received the gel while 151 underwent expectant management. No differences between the two groups were found for maternal demographics, race, parity, or predose Bishop score. The rates of repeat cesarean section did not differ (P =.68) with use of the gel (61, 42%) or with expectant therapy (48, 45%). The onset of active labor, the duration of labor among those delivering vaginally, and the 1-minute and 5-minute Apgar scores were not different between the two groups. No uterine rupture was apparent, and adverse effects during labor were as likely to occur in the two groups.Conclusions: Although its safety was confirmed for outpatient use and for persons with a prior cesarean delivery, intracervical prostaglandin E(2) gel did not improve the chance of a vaginal birth after a cesarean delivery.

  14. Characteristics of Impulsive Suicide Attempts and Attempters.

    ERIC Educational Resources Information Center

    Simon, Thomas R.; Swann, Alan C.; Powell, Kenneth E.; Potter, Lloyd B.; Kresnow, Marcie-jo; O'Carroll, Patrick W.

    2002-01-01

    Examined impulsive suicide attempts within a population-based, case-control study of nearly lethal suicide attempts among adolescents and young adults. Impulsive attempts were more likely among those who had been in a physical fight and less likely among those who were depressed. Findings suggest inadequate control of aggressive impulses as a…

  15. A Cognitive Therapy Intervention for Suicide Attempters: An Overview of the Treatment and Case Examples

    ERIC Educational Resources Information Center

    Berk, Michele S.; Henriques, Gregg R.; Warman, Debbie M.; Brown, Gregory K.; Beck, Aaron T.

    2004-01-01

    Although suicidal behavior is a serious public health problem, few effective treatments exist to treat this population. This article describes a new cognitive therapy intervention that has been developed for treating recent suicide attempters. The intervention is based on general principles of cognitive therapy and targets the automatic thoughts…

  16. An Unmatched Case-Control Study of Nearly Lethal Suicide Attempts in Houston, Texas: Research Methods and Measurements.

    ERIC Educational Resources Information Center

    Kresnow, Marcie-jo; Ikeda, Robin M.; Mercy, James A.; Powell, Kenneth E.; Potter, Lloyd B.; Simon, Thomas R.; Lee, Roberta K.; Frankowski, Ralph F.

    2002-01-01

    This article details the research methods and measurements used in conducting a population-based, case-control study of nearly lethal suicide attempts among persons aged 13-34 years. This study was designed to extend understanding of suicidal behavior and prevention activities beyond identification of mental illnesses. Overall strengths and…

  17. An Unmatched Case-Control Study of Nearly Lethal Suicide Attempts in Houston, Texas: Research Methods and Measurements.

    ERIC Educational Resources Information Center

    Kresnow, Marcie-jo; Ikeda, Robin M.; Mercy, James A.; Powell, Kenneth E.; Potter, Lloyd B.; Simon, Thomas R.; Lee, Roberta K.; Frankowski, Ralph F.

    2002-01-01

    This article details the research methods and measurements used in conducting a population-based, case-control study of nearly lethal suicide attempts among persons aged 13-34 years. This study was designed to extend understanding of suicidal behavior and prevention activities beyond identification of mental illnesses. Overall strengths and…

  18. Electronic case management with homeless youth.

    PubMed

    Bender, Kimberly; Schau, Nicholas; Begun, Stephanie; Haffejee, Badiah; Barman-Adhikari, Anamika; Hathaway, Jessica

    2015-06-01

    Case management, a widely practiced form of service brokerage, is associated with a variety of positive outcomes for homeless youth, but it may be difficult to implement, as youth face logistical barriers to attending in-person meetings. As part of a larger clinical trial, the current study investigates the feasibility of providing electronic case management (ECM) to homeless youth, using cell-phones, texts, email, and Facebook. Youth were given prepaid cell-phones and a case manager who provided four ECM sessions every 2-3 weeks over a 3-month period. Contact logs were used to record how many youth engaged in ECM, how many attempts were necessary to elicit engagement, and youths' preferred technology methods for engaging. Although engagement in the number of ECM sessions varied, the majority of youth (87.5%) engaged in at least one ECM session. Youth (41%) most commonly needed one contact before they engaged in an ECM session, and the majority responded by the third attempt. While youth most commonly answered calls directly, their chosen method of returning calls was texting. The majority of youth (80%) described ECM positively, reporting themes of convenience, connection, and accountability. The use of ECM, particularly of texting, offers promising implications for providing services to homeless youth. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Attempting to improve function and quality of life using the FTM Protocol: case report.

    PubMed

    Butler, Andrew; Blanton, Sarah; Rowe, Veronica; Wolf, Steven

    2006-09-01

    The Functional Tone Management (FTM) arm training program uses repetitive task practice, stretching, and electrical stimulation as patients with moderate upper extremity hemiparesis wear a dynamic hand orthosis to retrain grasp and release of objects. The case study quantitatively evaluates the extent to which FTM training improved function and quality of life in a patient who met criteria for which the device was intended. The participant, a 44-year-old male in the chronic stage of stroke recovery with moderate right upper extremity motor impairment, was trained for 10 days over a 2-week period by a licensed clinician with extensive experience in FTM training methods. Measurements were taken over 3 baseline visits, then immediately preintervention, postintervention, and at a 3-month follow-up. The outcome measures, following the International Classification of Functioning, Disability, and Health (ICF) Model, included the: Fugl-Meyer assessment (FMA) (upper extremity portion), UE range of motion (ROM), Modified Ashworth scale, Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). Health related quality of life was measured using the Stroke Impact Scale (SIS). The participant showed limited gains in upper extremity function immediately postintervention. Increases in AROM occurred in forearm supination and wrist flexion and extension, but no improvements were noted in finger ROM. A slight decrease in tone was found in forearm pronators (1 to 0) and wrist flexors (1+ to 1). WMFT values for the more affected upper extremity did not change immediately after training, but a 17% reduction in time occurred at follow-up, with improvements, most notably in the tasks of lifting a pencil and lifting a paper clip. No changes occurred in UE-FMA scores immediately following the intervention, however, a 17% improvement was measured at followup. A slight improvement in MAL scores was noted but not to a level of independent functional use of the impaired upper extremity

  20. Is religiosity a protective factor against attempted suicide: a cross-cultural case-control study.

    PubMed

    Sisask, Merike; Varnik, Airi; Kolves, Kairi; Bertolote, Jose M; Bolhari, Jafar; Botega, Neury J; Fleischmann, Alexandra; Vijayakumar, Lakshmi; Wasserman, Danuta

    2010-01-01

    This cross-cultural study investigates whether religiosity assessed in three dimensions has a protective effect against attempted suicide. Community controls (n = 5484) were more likely than suicide attempters (n = 2819) to report religious denomination in Estonia (OR = 0.5) and subjective religiosity in four countries: Brazil (OR = 0.2), Estonia (OR = 0.5), Islamic Republic of Iran (OR = 0.6), and Sri Lanka (OR = 0.4). In South Africa, the effect was exceptional both for religious denomination (OR = 5.9) and subjective religiosity (OR = 2.7). No effects were found in India and Vietnam. Organizational religiosity gave controversial results. In particular, subjective religiosity (considering him/herself as religious person) may serve as a protective factor against non-fatal suicidal behavior in some cultures.

  1. Mental pain, communication difficulties, and medically serious suicide attempts: a case-control study.

    PubMed

    Levi-Belz, Yossi; Gvion, Yari; Horesh, Netta; Fischel, Tsvi; Treves, Ilan; Or, Evgenia; Stein-Reisner, Orit; Weiser, Mark; David, Haim Shem; Apter, Alan

    2014-01-01

    Medical severe suicide attempts (MSSA) are epidemiologically very similar to individuals who complete suicide. Thus the investigation of individuals who have made MSSAs may add to our understanding of the risk factors for completed suicide. The aim of this study was to assess the role of mental pain and communication difficulties in MSSA. A total of 336 subjects were divided into 4 groups: 78 meeting criteria for MSSA compared with116 subjects who made a medically non-serious suicide attempt (MNSSA), 47 psychiatric controls with no history of suicidal behavior, and 95 healthy controls. Mental pain variants (e.g., hopelessness), facets of communication difficulties (e.g., self-disclosure), as well as socio-demographic and clinical characteristics were assessed. The MSSA had significantly higher communication difficulties than the other 3 groups. Moreover, the interaction between mental pain and communication difficulties explained some of the variance in suicide lethality, above and beyond the contribution of each component alone. This report underlines the importance of mental pain for suicide attempts in general while difficulties in communication abilities play a critical role in differentiating MSSA from MNSSA. The co-existence of unbearable mental pain with difficulties in communication significantly enhances the risk for more lethal forms of suicidal behavior.

  2. [Subcutaneous injection of insecticide for attempted suicide: a report of two cases].

    PubMed

    Aydin, Atakan; Aköz, Funda; Erer, Metin

    2004-01-01

    We present two patients (30-year-old female, and 20-year-old male) who attempted suicide by injecting commercially available insecticides into the forearm. No systemic signs of intoxication were observed during the acute and subacute periods. Since both patients had severe swelling, pain, and tension in the affected limb, suggesting acute atraumatic compartment syndrome, immediate fasciotomy and surgical debridement were performed. At surgery, extensive subcutaneous necrosis was observed. During long-term follow-ups, no motor and sensory deficits or contractures were seen.

  3. [Hyoid fracture and traumatic subcutaneous cervical emphysema from an attempted hanging. Apropos a case].

    PubMed

    Cañizares, M A; Arnau, A; Fortea, A; Zarzuela, V; Martínez-Vallina, P; Cantó, A

    2000-01-01

    We describe a patient with a history of psychiatric disorder who was brought to our hospital after attempted suicide by hanging. Severe subcutaneous facial, palpebral and cervical emphysema was present, with dysphonia, dysphagia and slight respiratory difficulty. Fiberoptic bronchoscopy revealed upper airway obstruction due to edema in an intact airway. Successive CAT scans gave evidence of hyoid fracture and laryngocele, in addition to the corresponding emphysema of the subcutaneous area and pneumomediastinum. Given the persistence of dysphagia, we ordered esophageal tests, which showed functional alteration of the upper esophageal sphincter. Suprasternal cervicotomy to drain the pneumomediastinum and laryngeal microsurgery to treat the laryngocele resolved the problem.

  4. Suicide attempt by swallowing sponge or pica disorder: a case report.

    PubMed

    Zganjer, Vlasta; Zganjer, Mirko; Cizmić, Ante; Pajid, Anto; Zupancić, Bozidar

    2011-01-01

    There are many ways how children with mental illness have actually tried to hurt themselves. Suicidal thinking or attempts always indicate that professional help is needed (2). Every object which can be potential dangerous should be removed but this is very difficult to do. Some of children with these symptoms had Pica diseases. Pica is a medical disorder characterized by an appetite for substances largely non-nutritive (e.g. metal, coal, soil, feces, paper, soap, gum, etc.) or an abnormal appetite for some things that may be considered foods. The patient swallow sponge from a pillow over a long period of time and she came into our hospital with abdominal pain. She was 16 years old and had abdominal distension, vomiting, abdominal cramping and failure to pass gas or stool. Immediately we suspected mechanical blockade of the intestine. Diagnosis was clinically confirmed by X-rays of the abdomen and with ultrasound. The operative treatment was indicated and we found the proximal bowel distended and the distal segment collapsed. The part of bowel necrosis was removed and anastomosis was done. When patients are determined to attempt suicide or have Pica disorder it is very difficult to prevent.

  5. Nursing case management: a rural practice model.

    PubMed

    Stanton, M P; Packa, D

    2001-01-01

    Nursing case management is a blend of individual case- and/or disease-management activities used in urban hospitals or community health settings. The authors propose that in rural communities, a third form of case management is also used. Nursing case management in the rural community has a broader and more diverse scope of practice than nurse case managers practicing in urban settings.

  6. [Antidepressant treatment and risk of suicidal attempts. A case series report].

    PubMed

    Henzen, Alexandre; Sentissi, Othman; Arnold, Myriam

    2013-12-04

    Scientific evidence that fluoxetine is one of the effective treatment of depression exists. Since 2000, a debate has been launched concerning the possibility of antidepressant drugs, especially, selective serotonin reuptake inhibitor to induce suicidality in some depressive patients. Suicidal attempts of 3 of the outpatients taken into care in a crisis center in Geneva, following the introduction of fluoxetine in the usual dose of 20 mg per day, led us to investigate and to carry out a non-exhaustive comprehensive literature review of available randomized trials, meta-analyses and epidemiological studies. This work enabled us to highlight some points of interest, including medical attitudes and therapeutic guidelines that sometimes seem to be contradictory, especially regarding the use of antidepressants in children and adolescents.

  7. Experiment 2018, First Fracturing Attempt Below Casing Shoe in EE-2 (1982-7-19/20)

    SciTech Connect

    Hoffers, Bernard

    1983-03-15

    The purpose of Experiment 2018 was to achieve a hydraulic connection between EE-2 and EE-3 in the region just below their respective casing shoes. To protect the cassing of EE-2, the fracturing fluid had to be pumped down a 3-1/2 inch drill string to an Otis casing packer set 240 ft above the casing shoe of EE-2. Pumping started at 16:23 of July 19, 1982, and was terminated at 2:02 on July 20, 1982, due to hardware failure, after some trouble with the setting of the casing packer had delayed the beginning of the experiment for approximately two days. Prior to the experiment, a sand plug in EE-2 had been set, with its top at 11,910 ft (all depths referenced her are cable depths). A total of 5,698 bbls had been pumped. No hydraulic connection appeared at the end of Experiment 2018.

  8. Credit cues and impression management: a preliminary attempt to explain the credit card effect.

    PubMed

    McCall, Michael; Trombetta, Jessica; Gipe, Aimee

    2004-08-01

    Prior research had suggested that individuals would estimate higher product values and even tip more in the presence of credit cues. In the absence of a clear theoretical interpretation of this credit card effect we propose that this tendency is an impression management strategy such that credit cue exposure influences perceptions of the self and focuses attention on individual wealth. Thus, in the presence of others, credit cues serve to enhance images of the self. Preliminary data in support of this alternative theoretical perspective are presented.

  9. Analysis of hydrogen cyanide in air in a case of attempted cyanide poisoning.

    PubMed

    Magnusson, R; Nyholm, S; Åstot, C

    2012-10-10

    A 32-year-old man attempted to poison his ex-girlfriend with hydrogen cyanide by hiding the pesticide Uragan D2 in her car. During the police investigation, chemical analysis of the air inside the car was performed. Hydrogen cyanide was detected through on-site air analysis using a portable Fourier transform infrared (FTIR) spectroscopy gas analyzer and colorimetric gas detection tubes. Furthermore, impinger air-sampling was performed for off-site sample preparation and analysis by gas chromatography-mass spectrometry (GC-MS). All three independent techniques demonstrated the presence of hydrogen cyanide, at concentrations of 14-20 ppm. Owing to the high volatility of hydrogen cyanide, the temperature and the time since exposure have a substantial effect on the likelihood of detecting hydrogen cyanide at a crime scene. The prevailing conditions (closed space, low temperature) must have supported the preservation of HCN in the car thus enabling the identification even though the analysis was performed several days after the hydrogen cyanide source was removed. This paper demonstrates the applicability of combining on-site FTIR measurements and off-site GC-MS analysis of a crime scene in order to ensure fast detection as well as unambiguous identification for forensic purposes of hydrogen cyanide in air.

  10. Delayed high anion gap metabolic acidosis after a suicide attempt: case report.

    PubMed

    Hsiao, Po-Jen; Chen, Tsu-Yi; Chiu, Chih-Chien; Wu, Tsung-Jui; Chan, Jenq-Shyong; Wu, Chia-Chao; Chen, Jin-Shuen

    2014-09-25

    Metabolic acidosis, especially when induced by multiple drug poisoning, often makes rapid and accurate differential diagnosis of the condition challenging. We closely followed anion and osmolal gaps to differentiate among the aetiologies of metabolic acidosis caused by poisoning with unknown drugs. The patient was admitted to our emergency department (ED) in an alert and consciousness state after attempting suicide by ingestion of an uncertain quantity of rodenticides combined with an unknown liquid. Initially, metabolic acidosis (pH7.23) with normal anion gap (12.8) was observed. However, a change in consciousness and hypotension subsequently developed 6h later, combined with severe metabolic acidosis (pH7.16), high anion gap (25.5), and high osmolal gap (83). A presumed diagnosis of methanol intoxication was suspected. After 4h of high-flux haemodialysis (HD), the serum bicarbonate returned to 23 mmol/l, and the patient regained consciousness. The serum level of methanol before HD was 193.8 mg/dl. The patient was discharged nine days later without sequelae. Delayed high anion gap metabolic acidosis may occur in the ED. Frequent monitoring of anion and osmolal gaps is a feasible method to perform a rapid differential diagnosis, particularly in response to drug poisoning. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Five-Year Olds, but Not Chimpanzees, Attempt to Manage Their Reputations

    PubMed Central

    Engelmann, Jan M.; Herrmann, Esther; Tomasello, Michael

    2012-01-01

    Virtually all theories of the evolution of cooperation require that cooperators find ways to interact with one another selectively, to the exclusion of cheaters. This means that individuals must make reputational judgments about others as cooperators, based on either direct or indirect evidence. Humans, and possibly other species, add another component to the process: they know that they are being judged by others, and so they adjust their behavior in order to affect those judgments – so-called impression management. Here, we show for the first time that already preschool children engage in such behavior. In an experimental study, 5-year-old human children share more and steal less when they are being watched by a peer than when they are alone. In contrast, chimpanzees behave the same whether they are being watched by a groupmate or not. This species difference suggests that humans' concern for their own self-reputation, and their tendency to manage the impression they are making on others, may be unique to humans among primates. PMID:23119015

  12. Suicide Attempt by Intravenous Potassium Self-Poisoning: A Case Report

    PubMed Central

    Battefort, Florent; Dehours, Emilie; Vallé, Baptiste; Hamdaoui, Ahmed; Bounes, Vincent; Ducassé, Jean-Louis

    2012-01-01

    Introduction. Overdose of potassium is not as frequently encountered in clinical practice as hyperkalaemia due to acute or chronic renal disease. However, potassium overdoses leading to serious consequences do occur. Case Presentation. A 20-year-old nurse student presented with a cardiac arrest with asystole rhythm. Beside the patient were found four 50-mL syringes and empty vials of potassium chloride (20 mL, 10%). After initial resuscitation with epinephrine, 125 mL of a 4.2% intravenous solution of sodium bicarbonate were injected which resulted in the recovery of an effective cardiac activity. The patient recovered without sequelae. Conclusion. The difficulty in this case was to recognize the potassium poisoning. The advanced resuscitation with the use of a specific treatment helped to resuscitate the patient. PMID:23326708

  13. "Otis": A Case Study of an Online Attempt to Purchase Children for Sex.

    PubMed

    Litam, Stacey Diane A; Bach, Jesse

    2017-09-12

    The researchers analyzed court documents to develop a case study of an individual convicted of buying sexual services from exploited children. Findings indicate that the subject deviates from preexisting victim selection processes and demonstrates characteristics inconsistent with existing sexual offender typologies that likens offender behaviors to the hunting techniques and behaviors of predatory animals. As evidenced in the case study, the individual perceived the victims solely as a means of deviant sexual satiation and did not participate in traditionally established victim acquisition techniques. In addition, the researchers propose adopting terminology that adheres to the term consumer rather than buyer as it better represents some offenders' disconnect and lack of empathy in the victim acquisition process.

  14. [A case of bilateral lesions in the temporal convexity: attempt to define symptoms].

    PubMed

    Sabouraud, O; Gagnepain, J; Chatel, M; Menault, F

    1976-06-01

    The case is reported of a boy aged 15 who suffered a bilateral lesion of the temporal convexity after a brain traumatism; he died 5 years later and the symptoms during that period are described. The clinical picture is adequately described neither under the title of dementia, nor under that of aphasia. The concept of an abolition involving the systems of cultural mediation (linguistic, technical) is introduced. The status of echolalia and echo-praxia is discussed.

  15. Practices of Management Development: A Malaysian Case Study

    ERIC Educational Resources Information Center

    Law, Kian Aun

    2008-01-01

    This paper deals with a case study of Management Development (MD) practices at Malaysian Assurance Alliance (MAA). The aim of this research is to investigate how a large Malaysian insurance corporation developed and integrated MD initiatives with current organizational needs and tasks. Attempts were made to map and categorize the MD initiatives…

  16. Attempted suicide by ingestion of hair dye containing p-phenylenediamine: a case report.

    PubMed

    Beshir, Lamis; Kaballo, Babiker; Young, Donald

    2017-07-01

    Para-phenylenediamine is widely used as a chemical in hair dyes and in combination with henna. This dye is used to paint the body for decorative reasons, to speed the processing time of henna and to intensify the results. Para-phenylenediamine is widely used in the Middle East, North Africa and India. Several reports have been published of the fatal ingestion of hair dye containing para-phenylenediamine. Here, we describe the case of a 14-year-old girl who ingested the compound but whose prompt treatment prevented her death. Ingestion of para-phenylenediamine produces a typical triad of angioneurotic oedema, rhabdomyolysis and acute tubular necrosis. Awareness of signs of these associated conditions in our patient, together with a comprehensive history, facilitated appropriate treatment to be instituted. We document the steps we took to enable her complete physical recovery.

  17. Case study of attempts to enact self service tobacco display ordinances: a tale of three communities

    PubMed Central

    Bidell, M.; Furlong, M.; Dunn, D.; Koegler, J.

    2000-01-01

    OBJECTIVE—To examine self service tobacco displays (SSTDs) and youth retail tobacco access by comparing longitudinal illegal tobacco sales rates in three communities in Santa Barbara County, California, that considered or implemented ordinances banning SSTDs. A confirmatory survey was also conducted to substantiate the longitudinal data.
DESIGN—A longitudinal case study design was utilised. Five undercover tobacco buys were conducted between 1994 and 1997 (n = 332). In addition, one confirmatory survey was conducted in a geographically separated area, which had no ordinances banning SSTDs (n = 57).
RESULTS—Decreases in youth buy rates were reported in all three communities. Most notably, the first city to enact a SSTD ban, Carpinteria, achieved a 0% sales rate, which was maintained throughout the study period. In contrast, Santa Barbara and Goleta experienced considerable drops in their illegal sales rates, but neither community obtained results as dramatic as those found in Carpinteria. The confirmatory survey showed that 32.1% of stores with SSTDs sold cigarettes to minors; this compares to a sales rate of 3.4% in stores without SSTDs (χ2 (1) = 8.11, p = 0.004).
CONCLUSIONS—Efforts to enact self service bans are likely to meet with retail and tobacco industry opposition, as was the case in this study's three communities. The process of community debate, resultant publicity surrounding the issue, and enactment of SSTD ordinances may serve to not only increase merchant awareness of youth tobacco laws and their penalties but also may contribute to reduced youth cigarette sales rates. Implications and limitations of the findings are discussed.


Keywords: self service tobacco displays; youth tobacco access; community tobacco control efforts PMID:10691760

  18. Repair of Penetrating Pericardial and Diaphragmatic Injury with Cormatrix® Patch in a Case of Suicide Attempt

    PubMed Central

    Jiritano, Federica; Garrasi, Carlo; Cristodoro, Lucia; Bevacqua, Egidio; Mastroroberto, Pasquale

    2017-01-01

    The authors report the case of a suicide attempt. A 59-year-old man with self-inflicted penetrating chest trauma underwent emergency cardiothoracic surgery. Pre-operative computed tomography scan showed critical proximity between the blade and the right ventricle. Intraoperative findings showed a pericardial laceration and a huge diaphragmatic lesion with heart and abdominal organs integrity. The diaphragm muscle was repaired with a CorMatrix® patch, an acceptable alternative to the traditional synthetic mesh avoiding infection and repeated herniation.

  19. Case management: heart and soul.

    PubMed

    McCollom, Patricia

    2005-01-01

    Dear Colleagues: As a seasoned case manager, I have had the opportunity to serve our specialty practice in the development of the definition of case management, the creation of our standards of practice, the evolution of our professional code of conduct, and, of course, the process of certification. Yet it is the stories of our shared time with our clients that truly define what we do and who we are and clarify our contribution to health care. It is by the telling of the story that we understand our roles, our behavior, and the value of our activities.

  20. What's funny about case management?

    PubMed

    Saxton, S E

    1997-01-01

    Humor is an effective tool to prevent and resolve burnout, a common problem associated with the practice of case management. Easily accessed by almost everyone, humor has many physiological and psychological benefits. The conscious use of humor in an organization requires a commitment at all levels in order for the organization to benefit as a whole. Offering formal seminars, using humor in company newsletters, and encouraging cartoon or joke sharing impacts on the physical and mental health of the employees. Techniques for bringing laughter to the workplace are outlined, as well as examples from the practice of case management.

  1. Blunted striatal response to monetary reward anticipation during smoking abstinence predicts lapse during a contingency-managed quit attempt

    PubMed Central

    Sweitzer, Maggie M.; Geier, Charles F.; Denlinger, Rachel; Forbes, Erika E.; Raiff, Bethany R.; Dallery, Jesse; McClernon, F.J.; Donny, Eric C.

    2017-01-01

    Rationale Tobacco smoking is associated with dysregulated reward processing within the striatum, characterized by hypersensitivity to smoking rewards and hyposensitivity to non-smoking rewards. This bias toward smoking reward at the expense of alternative rewards is further exacerbated by deprivation from smoking, which may contribute to difficulty maintaining abstinence during a quit attempt. Objective We examined whether abstinence-induced changes in striatal processing of rewards predicted lapse likelihood during a quit attempt supported by contingency management (CM), in which abstinence from smoking was reinforced with money. Methods Thirty-six non-treatment seeking smokers participated in two fMRI sessions, one following 24-hr abstinence and one following smoking as usual. During each scan, participants completed a rewarded guessing task designed to elicit striatal activation in which they could earn smoking and monetary rewards delivered after the scan. Participants then engaged in a 3-week CM-supported quit attempt. Results As previously reported, 24-hr abstinence was associated with increased striatal activation in anticipation of smoking reward and decreased activation in anticipation of monetary reward. Individuals exhibiting greater decrements in right striatal activation to monetary reward during abstinence (controlling for activation during non-abstinence) were more likely to lapse during CM (p<.05), even when controlling for other predictors of lapse outcome (e.g., craving); no association was seen for smoking reward. Conclusions These results are consistent with a growing number of studies indicating the specific importance of disrupted striatal processing of non-drug reward in nicotine dependence, and highlight the importance of individual differences in abstinence-induced deficits in striatal function for smoking cessation. PMID:26660448

  2. Blunted striatal response to monetary reward anticipation during smoking abstinence predicts lapse during a contingency-managed quit attempt.

    PubMed

    Sweitzer, Maggie M; Geier, Charles F; Denlinger, Rachel; Forbes, Erika E; Raiff, Bethany R; Dallery, Jesse; McClernon, F J; Donny, Eric C

    2016-03-01

    Tobacco smoking is associated with dysregulated reward processing within the striatum, characterized by hypersensitivity to smoking rewards and hyposensitivity to non-smoking rewards. This bias toward smoking reward at the expense of alternative rewards is further exacerbated by deprivation from smoking, which may contribute to difficulty maintaining abstinence during a quit attempt. We examined whether abstinence-induced changes in striatal processing of rewards predicted lapse likelihood during a quit attempt supported by contingency management (CM), in which abstinence from smoking was reinforced with money. Thirty-six non-treatment-seeking smokers participated in two functional MRI (fMRI) sessions, one following 24-h abstinence and one following smoking as usual. During each scan, participants completed a rewarded guessing task designed to elicit striatal activation in which they could earn smoking and monetary rewards delivered after the scan. Participants then engaged in a 3-week CM-supported quit attempt. As previously reported, 24-h abstinence was associated with increased striatal activation in anticipation of smoking reward and decreased activation in anticipation of monetary reward. Individuals exhibiting greater decrements in right striatal activation to monetary reward during abstinence (controlling for activation during non-abstinence) were more likely to lapse during CM (p < 0.025), even when controlling for other predictors of lapse outcome (e.g., craving); no association was seen for smoking reward. These results are consistent with a growing number of studies indicating the specific importance of disrupted striatal processing of non-drug reward in nicotine dependence and highlight the importance of individual differences in abstinence-induced deficits in striatal function for smoking cessation.

  3. Case Studies in Broadcast Management.

    ERIC Educational Resources Information Center

    Coleman, Howard W.

    This collection of case studies, based on factual situations which have challenged broadcast managers in recent years, is designed to stimulate thinking about and solving of "real world" problems in commercial radio and television operations. Topics of a serious, long-run nature include enlarging the radio audience; station revenue and economy;…

  4. Families as Case Managers: A Longitudinal Study.

    ERIC Educational Resources Information Center

    Seltzer, Marsha Mailick; And Others

    1989-01-01

    Performed follow-up study measuring effects of case management training on management activities of families of elderly persons. Interviewed 78 subjects from original study and found case management to be normative activity for families of elderly. Noted differences reported between male and female case managers and in types of obstacles…

  5. Anesthesia case management for thyroidectomy.

    PubMed

    Elisha, Sass; Boytim, Michael; Bordi, Sandy; Heiner, Jeremy; Nagelhout, John; Waters, Ed

    2010-04-01

    An intimate knowledge of the anatomy, physiology, pathophysiology, pharmacology, and specific issues related to anesthesia case management for thyroidectomy is essential to provide high-quality care. Airway management may be difficult despite a normal airway examination due to impingement of a thyroid mass on the laryngeal and tracheal structures. Anesthetists must be prepared to use emergency airway adjuncts in case a patient cannot be ventilated or intubated. Because sympathetic nervous system hyperactivity is associated with increased amounts of thyroid hormone, it is essential that all patients having an elective thyroidectomy be in a euthyroid state before surgery. There are multiple preoperative antithyroid medication regimens that effectively treat thyroid hormone hypersecretion. However, although a rare event, thyroid storm can still occur during the perioperative period. Anesthetic considerations and surgical complications are presented.

  6. State of the art case management.

    PubMed

    Hall, J C

    1998-01-01

    Case management traditionally has been performed by occupational health nurses and rehabilitation professionals. The rapid growth of managed care was the impetus for defined standards and formal credentialing.

  7. Integrative Medicine and Case Management.

    PubMed

    Powell, Suzanne K

    2016-01-01

    The evolution of the integration of health care modalities has changed. The National Institutes of Health founded office of the National Center for Complementary and Alternative Medicine in the early 1990s to investigate integrative therapies through scientific research. In December 2014, the name and mission were updated to the National Center for Complementary and Integrative Health. Case managers, the coordinators of health care, must understand the changes to "integrative medicine" and the allure of the alternative modalities.

  8. The impact of staff case manager-case management supervisor relationship on job satisfaction and retention of RN case managers.

    PubMed

    Hogan, Tierney D

    2005-01-01

    A positive relationship between staff RN case managers and their case management supervisor significantly impacts job satisfaction and retention in case managers. Literature review supports the premise that staff need to trust their supervisor and that there is a connection between this trust and job satisfaction. Staff case managers need to have a voice at work and feel empowered, and a supervisor's leadership style can influence job satisfaction and retention in their staff.

  9. Demand management and case management: a conservation strategy.

    PubMed

    Bryant, C D R Anna K

    2007-01-01

    This article reviews the history and development of managed competition, and explores the possibilities of a new demand management strategy in the context of nurse case management to offer less costly, higher quality care for a greater number of patients. The article examines the history and principles of healthcare demand management, its implementation in the hospital and clinical practices of nurse case managers, and its impacts in reducing costs while maintaining care levels. The article develops and analyzes the conflicts and common ground between demand management and case management. First, demand-side strategies can be effective in reducing costs while maintaining quality of nursing care; second, nurse case managers should employ patient education, self-care, and staffing solutions to manage demand. Nurse case managers must apply demand management principles carefully. Their goal is not to restrict care, but to maintain the highest levels of care possible within the limits of their practice's resources and staffing. Two critical themes emerge: (1) demand management is a potential alternative to market-driven managed competition and (2) nursing case management can affect an effective form of demand management. However, the long-term implications of these nursing case management strategies on healthcare staffing need further exploration.

  10. Case Management for Families and Children.

    ERIC Educational Resources Information Center

    McManus, Marilyn C., Ed.

    1993-01-01

    This theme issue of "Focal Point" offers an overview of a range of children's mental health case management issues. Articles include: "Case Management for Families and Children" (Theresa J. Early); "Expectations of Case Management for Children with Emotional Problems: Parent Perspectives" (Richard Donner and others);…

  11. Implementing managed care and case management: the neuroscience experience.

    PubMed

    Marr, J A; Reid, B

    1992-10-01

    The case management model for patient care in the neuroscience area was recently implemented in the neurosciences area at a tertiary care hospital. Understanding of the concepts of case management and managed care were essential to the implementation process. Clustering of case types and appointment of group leaders made the development of individual care maps a manageable task. Case management of 2 case types, Parkinson's disease and Guillain Barré syndrome are described, including the rationale for selection, care map development and education. The process of continuing education focused on operational issues regarding utilization of the map and professional issues such as health teaching responsibilities.

  12. Young people's risk of suicide attempts after contact with a psychiatric department - a nested case-control design using Danish register data.

    PubMed

    Christiansen, Erik; Larsen, Kim Juul

    2012-01-01

    There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. A complete extraction of Danish register data for every individual born in the period 1983-1989 was made. Of these 403,431 individuals, 3,465 had attempted suicide. In order to control for confounder effects from gender, age and calendar-time, a nested case-control study was designed. A total population of 72,765 individuals was used to analyze the risk of suicide attempts after contact with a psychiatric department. The case-control data were analyzed using conditional logistic regression. This study shows that a child/adolescent's risk of suicide attempt peaks immediately after discharge from last contact with a psychiatric department. The risk of suicide attempt is highest for children and adolescents suffering from personality disorders, depression and substance use disorders. Children and adolescents with previous contact with a psychiatric department and parental income in the lowest third have a significantly higher risk of suicide attempt. Suicide attempters were more likely to have been given several different diagnoses and several different psychopharmacological drugs prior to their attempted suicide. The findings in this study highlight the need for psychopathology assessment in every case of attempted suicide. This study also shows that well-known risk factors such as contact with a psychiatric department do not affect all individuals in the same way. Individuals from families with low SES had the highest risk. This suggests that the presence of factors influencing both vulnerability and resiliency, e.g., family level of SES, needs to be included in the assessment. © 2011 The Authors. Journal of Child Psychology and Psychiatry © 2011 Association for Child and Adolescent Mental

  13. Case management - a pillar of community psychiatry.

    PubMed

    Ivezić, Sladana Strkalj; Muzinić, Lana; Filipac, Vanda

    2010-03-01

    This review is describing different models of case management, showing their similarities and differences with regards to the way they operate. Good relationship between patient and case manager, application of the biopsychosocial model, availability of psychosocial treatment methods and rehabilitation programs, and individual treatment plan are all important factors in case management's success. Large number of studies supports the application of case management in practice as effective treatment method in treating people with severe mental disorder, particularly those, who are less co-operative. Therefore, the implementation of case management into psychiatric practice should be supported.

  14. Psychiatric and Substance Use Disorders as Risk Factors for Attempted Suicide among Adolescents: A Case Control Study.

    ERIC Educational Resources Information Center

    Kelly, Thomas M.; Cornelius, Jack R.; Lynch, Kevin G.

    2002-01-01

    Tests substance-related and non-substance-related psychiatric disorders as predictors of attempted suicide among adolescents. Bipolar disorder, cocaine use disorders, and conduct disorder were found to be predictive of attempted suicide in univariate testing. Higher rates of cocaine use disorder/conduct disorder, hallucinogen use disorder/conduct…

  15. Retaining a Legacy while Avoiding Trademark Infringement: A Case Study of One University's Attempt to Develop a Consistent Athletic Brand Identity

    ERIC Educational Resources Information Center

    Alessandri, Sue Westcott

    2007-01-01

    This case study chronicles Syracuse University's athletic department's attempt to achieve consistency in its identity program by changing its identity during 2004, and then again in 2005. The changes were owing to high-level personnel changes on both the academic and athletic sides of the university. This case details the many issues arising from…

  16. Retaining a Legacy while Avoiding Trademark Infringement: A Case Study of One University's Attempt to Develop a Consistent Athletic Brand Identity

    ERIC Educational Resources Information Center

    Alessandri, Sue Westcott

    2007-01-01

    This case study chronicles Syracuse University's athletic department's attempt to achieve consistency in its identity program by changing its identity during 2004, and then again in 2005. The changes were owing to high-level personnel changes on both the academic and athletic sides of the university. This case details the many issues arising from…

  17. Suicide attempt by an overdose of sitagliptin, an oral hypoglycemic agent: a case report and a review of the literature.

    PubMed

    Furukawa, Shinya; Kumagi, Teru; Miyake, Teruki; Ueda, Teruhisa; Niiya, Tetsuji; Nishino, Keiichiro; Murakami, Shigeto; Murakami, Masato; Matsuura, Bunzo; Onji, Morikazu

    2012-01-01

    Dipeptidyl peptidase-4 (DPP-4) inhibitors are a newer class of oral hypoglycemic agents for the management of diabetes that elevate the plasma concentration of active glucagon-like peptide-1 via inhibition of DPP-4. They effectively lower not only glycosylated hemoglobin levels, but also fasting and postprandial plasma glucose levels. Patients with diabetes occasionally consume an overdose of oral hypoglycemic agents in suicide attempts: the prevalence of depression is high in patients with diabetes, and depression is a strong risk factor for suicide. We encountered an 86-year-old woman with type 2 diabetes and depression, who was transferred to the emergency room 4h after ingestion of 1,700 mg of the DPP-4 inhibitor sitagliptin (1,700 mg is 17 times greater than the approved maximum dose). Upon arrival, she was fully conscious, plasma glucose was 124 mg/dL, and serum immunoreactive insulin level was 5.81 µU/mL. Thereafter, the plasma concentration of sitagliptin rose to 3,793 nM, which is 4.5 times higher than the value found under regular treatment with the maximum dose. The patient did not suffer from hypoglycemia, suggesting that a single oral overdose of sitagliptin is unlikely to cause hypoglycemia. A literature review of oral anti-diabetic agents revealed that overdose of biguanides is occasionally fatal when immediate intensive care is not provided. In summary, sitagliptin is a good treatment option for diabetic elderly patients or patients with psychiatric disorders who are suicidal and do not require insulin.

  18. Community matrons and case managers: who are they?

    PubMed

    Lillyman, Sue; Saxon, Ann; Treml, Helen

    2009-02-01

    In 2005 John Reid, the then Secretary of Health, announced the need for 3?000 community matrons to be appointed to coordinate the care of the growing numbers of people living with long term conditions. Although by the date agreed there were only 1?348 in post, according to Snow (2007), some PCTs have decided not to recruit further community matrons. Following the first evaluations of the role there also appears to be some confusion as to the title used by professionals who case manage this client group. The title of community matron has been used interchangeably with case manager, and therefore requires some clarification. This paper attempts to review the role of community matron and case manager, identify the professionals who take up these posts, and the professional qualifications and preparation required for the roles.

  19. Relationship between Personality Profiles and Suicide Attempt via Medicine Poisoning among Hospitalized Patients: A Case-Control Study

    PubMed Central

    Shafiee-Kandjani, Ali Reza; Amiri, Shahrokh; Arfaie, Asghar; Ahmadi, Azadeh; Farvareshi, Mahmoud

    2014-01-01

    Objectives. Inflexible personality traits play an important role in the development of maladaptive behaviors among patients who attempt suicide. This study was conducted to investigate the relationship between personality profiles and suicide attempt via medicine poisoning among the patients hospitalized in a public hospital. Materials and Methods. Fifty-nine patients who attempted suicide for the first time and hospitalized in the poisoning ward were selected as the experimental group. Sixty-three patients hospitalized in the other wards for a variety of reasons were selected as the adjusted control group. Millon Clinical Multiaxial Personality Inventory, 3rd version (MCMI-III) was used to assess the personality profiles. Results. The majority of the suicide attempters were low-level graduates (67.8% versus 47.1%, OR = 2.36). 79.7% of the suicide attempters were suffering from at least one maladaptive personality profile. The most common maladaptive personality profiles among the suicide attempters were depressive personality disorder (40.7%) and histrionic personality disorder (32.2%). Among the syndromes the most common ones were anxiety clinical syndrome (23.7%) and major depression (23.7%). Conclusion. Major depression clinical syndrome, histrionic personality disorder, anxiety clinical syndrome, and depressive personality disorder are among the predicators of first suicide attempts for the patients hospitalized in the public hospital due to the medicine poisoning. PMID:27433491

  20. Relationship between Personality Profiles and Suicide Attempt via Medicine Poisoning among Hospitalized Patients: A Case-Control Study.

    PubMed

    Shafiee-Kandjani, Ali Reza; Amiri, Shahrokh; Arfaie, Asghar; Ahmadi, Azadeh; Farvareshi, Mahmoud

    2014-01-01

    Objectives. Inflexible personality traits play an important role in the development of maladaptive behaviors among patients who attempt suicide. This study was conducted to investigate the relationship between personality profiles and suicide attempt via medicine poisoning among the patients hospitalized in a public hospital. Materials and Methods. Fifty-nine patients who attempted suicide for the first time and hospitalized in the poisoning ward were selected as the experimental group. Sixty-three patients hospitalized in the other wards for a variety of reasons were selected as the adjusted control group. Millon Clinical Multiaxial Personality Inventory, 3rd version (MCMI-III) was used to assess the personality profiles. Results. The majority of the suicide attempters were low-level graduates (67.8% versus 47.1%, OR = 2.36). 79.7% of the suicide attempters were suffering from at least one maladaptive personality profile. The most common maladaptive personality profiles among the suicide attempters were depressive personality disorder (40.7%) and histrionic personality disorder (32.2%). Among the syndromes the most common ones were anxiety clinical syndrome (23.7%) and major depression (23.7%). Conclusion. Major depression clinical syndrome, histrionic personality disorder, anxiety clinical syndrome, and depressive personality disorder are among the predicators of first suicide attempts for the patients hospitalized in the public hospital due to the medicine poisoning.

  1. Risk for attempted suicide in children and youths after contact with somatic hospitals: a Danish register based nested case-control study.

    PubMed

    Christiansen, E; Stenager, E

    2012-03-01

    A range of studies have found an association between some somatic diseases and increased risk of suicide and attempted suicide. These studies are mostly analyses of adult populations and illnesses related to adulthood. To study the risk of attempted suicide in children and youths with a somatic diagnosis, and to assess a possible association from a somatic perspective. From a cohort of 403 431 individuals (born 1983-89), 3465 children and youths who had attempted suicide were identified. Each case was matched with 20 population controls. 72 765 children and youths constituted the case-control population. All data were obtained from national population registers and analysed in a nested case-control design. Contact of children and youths with a somatic hospital is correlated with increased risk of attempted suicide; the risk peaks in the time immediately after contact. Risk factors were treatment for injury caused by violence, epilepsy, asthma and malformation for males; and spontaneous and medical abortions, treatment for injury caused by violence, epilepsy, asthma, insulin dependent diabetes mellitus and malformation for females. Not all the mentioned diagnoses were significant in the adjusted model. Based on the results of the study a strategy to minimise the risk of attempted suicide among children and youths must be implemented. The strategy should mainly focus on children at high risk-that is, children from families with low socioeconomic status, and children with a psychiatric history, a history of previous suicide attempts and with an unstable somatic disease subsequently causing many admissions.

  2. Fleurs-de-lis in the forest: "absolute" monarchy and attempts at resource management in eighteenth-century France.

    PubMed

    Graham, Hamish

    2009-01-01

    The notion of "resource management" has inspired some historians to rethink the nature of the state authority in early modern Europe. Like recent work on parts of Italy and Germany, this article investigates the development and implementation of legislation that sought to regulate the management and exploitation of forests. This was self-interested policymaking: as ancien régime France strove to match Britain's naval, colonial and maritime strength, the monarchy's priority was ship timbers. Yet the most sought-after pieces of wood were large, heavy and difficult to transport. According to standard accounts, such resources became rare during the eighteenth century, and the French navy turned increasingly to timber supplies from abroad. This article offers a wider view, by finding ways to analyse bureaucratic records created by the royal forestry officials (Eaux et Forêts), which have been largely neglected by historians. A regional case study suggests that, besides extending the authority of royal agents to acquire timbers for the naval dockyards, the application of Louis XIV's Ordinance on Waterways and Forests (1669) generated huge amounts of information about the extent, nature and location of mature timber reserves across France.

  3. Chapter 10: Case studies in ecosystem management: the Mammoth-June ecosystem management project, Inyo National Forest

    Treesearch

    Constance I. Millar

    1996-01-01

    To assess the various ways organizations and people come together to manage Sierran ecosystems, SNEP conducted four case studies to examine the efficacy of different institutional arrangements:The Mammoth-June case study examines how a single national forest is attempting to implement the new Forest Service policy for ecosystem analysis...

  4. Antiepileptic drugs and risk of suicide attempts: a case-control study exploring the impact of underlying medical conditions.

    PubMed

    Grimaldi-Bensouda, Lamiae; Nordon, Clementine; Rossignol, Michel; Jardon, Vincent; Boss, Virginie; Warembourg, Frédérique; Reynolds, Robert; Kurz, Xavier; Rouillon, Frédéric; Abenhaim, Lucien

    2017-03-01

    Randomized-controlled trials and claims databases suggest that antiepileptic drug (AED) use may increase the risk of suicide attempts (SA). The present case-control study explores the impact of underlying indications on this potential association. Physicians collected the medical history; prior 12-month drug use was obtained from standardized telephone interviews with patients. The association between AED use and SA was explored using multivariate conditional logistic regression. The analyses were replicated after stratification on depression and neurological disorders (epilepsy, migraine, and chronic neuropathic pain). Between 2008 and 2012, 506 adults with an incident SA were recruited in suicide treatment centers from across France and socio-demographically matched to 2829 controls from primary care settings. The association between AED use and odds of SA was not significant overall (odds ratio [OR], 1.5; 95% confidence interval [CI], 0.9-2.4). No association was observed for patients with neurological disorders (OR, 1.1; 95%CI, 0.5-2.4) as opposed to patients with depression (OR, 1.6; 95%CI, 1.0-2.5), but unmeasured confounding was suspected. Our results suggest that the association observed between AED use and increased odds of non-fatal SA in patients with either a lifetime history of depression or no neurological disorder may be explained by the presence of an underlying psychiatric disorder. Accounting for underlying indications is crucial in drug safety studies, as these can cause a reported association (or lack thereof) to be misleading. This may require the prospective collection of medical data at a patient level. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Case Studies for Management Development in Bangladesh.

    ERIC Educational Resources Information Center

    McLean, Gary N.

    Eight case studies appropriate for use in a course in management development were prepared and are provided in this document. The typical case describes a real business situation in which a real manager had to reach a decision. The case gives quantitative and qualitative information that is, or may be, relevant to that decision. Questions for…

  6. Study on Case Teaching of Financial Management

    ERIC Educational Resources Information Center

    Che, Zhenghong; Che, Zhengmei

    2011-01-01

    Case teaching is an efficient teaching method of management. It plays an important role to enhance the students' ability to practice the theory. However, case teaching of financial management has not achieved the expected results. The paper aims to study the importance, characteristics and corresponding methods of case teaching method of financial…

  7. ATTEMPTED SUICIDE IN LUDHIANA

    PubMed Central

    Narang, R.L.; Mishra, B.P.; Nitesh, Mohan

    2000-01-01

    This study assesses the various socio-demographic correlates, the method adopted and the psychiatric disorders in patients with attempted suicide. Out of 208 cases presented to the hospital, one hundred individuals with suicide attempt were included in the present study. They were evaluated for socio-demographic profile and psychiatric illness on the basis of ICD-10 criteria. Analysis of the results showed that single males outnumbered single females, whereas married females outnumbered married males in suicidal attempt. The prevalence of suicidal attempt was high among males with psychiatric illness, whereas more female suicide attempters were without psychiatric illness. The most common psychiatric illnesses were found to be mood disorders (35%) and adjustment disorders (13%) as per the ICD-10 criteria. Family type, economic status and education levels appears to be playing non significant role in suicide attempt in this part of the country Marital status and psychiatric illnesses are playing important role in suicide attempt. Other demographic variables, though, were statistically non significant, but, below 30 years of age group, low socio-economic status, low education and nuclear families were found to be more vulnerable factors for suicide. PMID:21407914

  8. Nursing case management activities. How they differ between employment settings.

    PubMed

    Goodwin, D R

    1994-02-01

    The diversity of case management approaches raises many questions. Are multiple case managers really required to duplicate each others' services, and if so, to what degree? How does the case manager actually "case manage" a client? How do the activities of the case manager in a direct care environment differ from case managers employed by case management companies or insurance companies? In this article, the author describes differences in case management activities in various employment settings.

  9. Emotionally intelligent case managers make a difference.

    PubMed

    Tahan, H A

    2000-01-01

    Emotional intelligence is a skill necessary for case managers because of the diversity of their work, the multiple stakeholders they have to deal with on daily basis, and the increased potential for conflict. Managers and administrators need to be cognizant of the role emotional intelligence plays in employee performance and the importance of developing training programs to assist case managers in learning to deal with change and conflict. Case managers must assume responsibility for their actions and work to develop and improve their emotional intelligence skills set. Ultimately, patients and work associates will appreciate the case manager's efforts. Finally, case managers will find work an enjoyable experience and look forward to new opportunities the future holds.

  10. Pre-Service Teachers' Attempts at Debating Contemporary Issues in Science Education: A Case Study from Botswana

    ERIC Educational Resources Information Center

    Koosimile, Anthony T.; Suping, Shanah M.

    2011-01-01

    This paper constitutes an attempt to explore trends, issues and challenges that emerge when three different cohorts of pre-service teachers debate contemporary issues in science education at the University of Botswana. Apart from the author's experience of teaching the course, the impetus for this study also comes from a growing interest in the…

  11. Serum lithium levels and suicide attempts: a case-controlled comparison in lithium therapy-naive individuals.

    PubMed

    Kanehisa, Masayuki; Terao, Takeshi; Shiotsuki, Ippei; Kurosawa, Keiko; Takenaka, Ryuichi; Sakamoto, Teruo; Shigemitsu, Osamu; Ishii, Nobuyoshi; Hatano, Koji; Hirakawa, Hirofumi

    2017-08-28

    Several epidemiological studies have shown the inverse association of lithium levels in drinking water and suicide rates; however, it is necessary to perform a clinical study dealing with individual patients. We analyzed 199 patients including 31 patients with suicide attempts, 21 patients with self-harm, and 147 control patients. All were transferred to a university emergency department suffering from intoxication or injury, were aged 20 or more years, and were alive at the start of the study. The exclusion criteria consisted of suffering from schizophrenia and a past or present history of lithium therapy. These exclusions were applied because it is difficult to determine whether their suicide attempt was induced by the intent to end their life or by psychotic symptoms such as auditory hallucinations, and if the patient had received lithium therapy, the association between the small amount of lithium taken from drinking water and food and serum lithium levels cannot be detected. There was a significant difference (p = 0.043) between the three groups whereby patients with suicide attempts had significantly lower lithium levels than control patients (p = 0.012) in males but not females. Multivariate logistic regression analysis with adjustment for age and gender revealed that patients with suicide attempts had significantly lower lithium levels than control patients (p = 0.032, odds ratio 0.228, 95% CI 0.059-0.883). The limitations of the present study are the nature of observational research which cannot reveal a causal relationship and the relatively small number of subjects. The present findings suggest that higher serum lithium levels may be protective against suicide attempts in lithium therapy-naive individuals.

  12. The Case Management Team: Building Community Connections.

    ERIC Educational Resources Information Center

    Lippert, Toni

    This guidebook presents ideas about how families and case managers can use case management to increase the integration of people with developmental disabilities into their communities, and how public officials and advocates can promote the trend toward community integration. The guide advocates implementation of the integration philosophy, which…

  13. Iowa Case Management for Rural Drug Abuse

    ERIC Educational Resources Information Center

    Hall, James A.; Vaughan Sarrazin, Mary S.; Huber, Diane L.; Vaughn, Thomas; Block, Robert I.; Reedy, Amanda R.; Jang, MiJin

    2009-01-01

    Objective: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual…

  14. 75 FR 27375 - Postal Rate Case Management

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-14

    ... From the Federal Register Online via the Government Publishing Office POSTAL REGULATORY COMMISSION Postal Rate Case Management AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is seeking comments relevant to management of an anticipated exigent postal rate case. It has...

  15. Case Studies in Middle Management Supervision

    ERIC Educational Resources Information Center

    White, Lori S.

    2011-01-01

    This chapter presents a series of supervision-related case studies of situations that midlevel managers might face. Individuals enrolled in a midlevel management professional development course recommended the topics selected for this chapter. Drawing upon her experience teaching the course, the author selected four case studies that individuals…

  16. A Case Management Approach to School Counselling.

    ERIC Educational Resources Information Center

    Eng, Allen; Jevne, Ronna

    1989-01-01

    Provides an example of a functioning case management system in a K-9 school used by a practicing counselor for managing individually referred cases. Contends that this approach affords counselor a time-effective means to work with wide variety of individual referrals while simultaneously gathering a data base which can be used to address…

  17. Iowa Case Management for Rural Drug Abuse

    ERIC Educational Resources Information Center

    Hall, James A.; Vaughan Sarrazin, Mary S.; Huber, Diane L.; Vaughn, Thomas; Block, Robert I.; Reedy, Amanda R.; Jang, MiJin

    2009-01-01

    Objective: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual…

  18. Case management in France: an economic perspective.

    PubMed

    Frossard, M

    1996-01-01

    Case management is currently an important issue in France. Because neither service providers nor consumers pay for case management in this country, a cost-benefit analysis is often required by the organizations that do pay. Given the context of French social policy and the current focus on justifying case management through cost-benefit analysis, we have developed a way to evaluate its costs. This article presents the limitations of standard economic choice theory, provides a methodology based on the principles of limited rationality, and gives the results of an evaluation of four case management programs. The article provides a method to measure case management costs and efficiency, as well as the willingness of consumers to pay for services.

  19. Use Case for Information Management

    DTIC Science & Technology

    2008-07-01

    information management system, Operation Information Management (formerly known as the Joint Battlespace Infosphere) can be utilized during an operation involving a multi-national coalition force. In this instance, the scenario is carried out in a fictional nation located in the Middle East. The information management structure is demonstrated during a mission that takes place during the course of the much larger operation. This is allegorical to an event such as Operation Anaconda during Operation Enduring Freedom in

  20. Personal assistance services and case management.

    PubMed

    Gilson, S F; Casebolt, G J

    1997-01-01

    Case managers can serve a vital role in the coordination and support of consumer-driven personal assistance services (PAS) for people with disabilities. Personal assistants provide services such as assistance with mobility needs, transferring in and out of a bed or wheelchair, bathing, dressing, grooming, toileting, preparing meals, check writing, and communication interpretation. Maximum independence and autonomy are often achieved when disabled people manage the services that they need. By focusing case management on doing what the individual directs, the case manager can enhance independence, autonomy, and accommodation. In response to needs identified by its members, the Paralyzed Veterans of America (PVA) began to develop a comprehensive PAS training program for institutions, agencies, families, and individuals. The Independent Living Training Program is based on an approach to PAS that incorporates a case management model that supports the principles of consumer empowerment and self-determination.

  1. Rapid improvement of depressive symptoms in suicide attempters following treatment with milnacipran and tricyclic antidepressants - a case series.

    PubMed

    Kirino, Eiji; Gitoh, Masao

    2011-01-01

    Suicide is a serious social problem in many countries, including Japan. The majority of people who commit suicide suffer from depression. Suicide attempt patients suffering from serious physical injuries are initially treated in hospital emergency departments. The present post hoc analysis examined data from patients admitted to an emergency hospital for treatment of physical injuries, resulting from a suicide attempt, and initial psychiatric treatment for depression and prevention of future suicide attempts. The effects on depressive symptoms were studied in two groups of patients using the 17-item Hamilton depression scale (HAMD). One group (n = 6) had received intravenous tricyclic antidepressants (TCA) (amitriptyline or clomipramine) while the other group (n = 7) had been treated orally with milnacipran, a serotonin and norepinephrine reuptake inhibitor antidepressant. Prior to treatment the four highest scoring items on the HAMD scale were the same in both groups namely, item 1 (depressed mood), item 3 (suicidality), item 7 (interest in work and activities), and item 10 (psychic anxiety). After 1 week of treatment, mean global HAMD scores were significantly reduced in both groups. Treatment resulted in a significant reduction of five HAMD items in the TCA group, whereas in the milnacipran group 12 HAMD items were significantly reduced. Suicidality (item 3) was significantly improved by 1 week treatment with milnacipran, but not by TCAs. Milnacipran rapidly improved a wide range of depressive symptoms, including suicidality within the first week. The improvement with milnacipran would appear to be, at least, equivalent to that achieved with TCAs, possibly affecting a wider range of symptoms. Since milnacipran has been shown in comparative studies to be better tolerated than TCAs, this antidepressant offers an interesting option for the treatment of suicidal patients in an emergency setting.

  2. Hospital program weds case, disease management.

    PubMed

    1997-10-01

    To lower its readmission rates and inpatient length of stay for three high-volume chronic conditions, Memorial Hospital in Colorado Springs, CO, developed a program that combines clinical pathways with a cross-continuum disease management program. Community physicians refer patients to the program. Hospital-based care managers guide patients in the acute setting before handing them off to outpatient case managers, who coordinate the patient's transition to home care. Clinicians at Memorial sold administrators on the "care-case management" approach by arguing that increased inpatient efficiency would offset potential revenue shortfalls due to fewer admissions.

  3. Coccidioidomycosis: case report and update on diagnosis and management.

    PubMed

    Kim, Amy; Parker, Sareeta Singh

    2002-05-01

    Coccidioidomycosis is a disease known for its endemicity to the Southwest United States. However, given the current trends of more frequent tourist and business travel, an increasing number of coccidioidomycosis infections are being seen in patients in other areas of the United States. Because the majority of patients with disseminated disease experience cutaneous manifestations, dermatologists can be of primary importance in the diagnosis of this disease. We report a case of coccidioidomycosis manifesting as granulomatous cutaneous nodules on the face of an otherwise healthy white man. We attempt to provide an update on the diagnosis, management, and treatment of patients who present with cutaneous lesions caused by coccidioidomycosis infection.

  4. 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... care case management services. (a) Primary care case management services means case management related... services. (b) Primary care case management services may be offered by the State— (1) As a voluntary...

  5. 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... care case management services. (a) Primary care case management services means case management related... services. (b) Primary care case management services may be offered by the State— (1) As a voluntary...

  6. 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... care case management services. (a) Primary care case management services means case management related... services. (b) Primary care case management services may be offered by the State— (1) As a voluntary...

  7. 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... care case management services. (a) Primary care case management services means case management related... services. (b) Primary care case management services may be offered by the State— (1) As a voluntary...

  8. Multimedia case management system implemented in Java

    NASA Astrophysics Data System (ADS)

    Stewart, Howard D.; Davis, Midge L.; Handy, Dale L.; Kvarfordt, Kent B.; Ford, Glenn

    1999-01-01

    Managing the timely access of information is a major challenge facing law enforcement agencies. One of the areas of greatest need is that of the case management process. During the course of FY98, the Office of National Drug Control Policy (ONDCP), the Counterdrug Technology Assessment Center (CTAC), the Idaho National Engineering and Environmental Laboratory (INEEL), and the Criminal Investigative Bureau (CIB) of the state of Idaho, created a Northwest testbed to develop and integrate a multimedia case management system. A system was developed to assist investigators in tracking and maintaining investigative cases and improving access to internal and external data resources. In this paper, we discuss the results of our case management system development and the ability to present state and federal information incorporating object oriented and multimedia techniques. We then outline our plans for future research and development.

  9. Managing severe peripartum hyponatraemia: A case report

    PubMed Central

    Lim, Jerry; Laing, Christopher M; MacCallum, Niall S; Brealey, David A

    2014-01-01

    We present a case of severe peripartum hyponatraemia that occurred following a major obstetric haemorrhage causing both an ischaemic stroke and Sheehan's syndrome and outline the investigations and management strategy required. PMID:27512448

  10. Suicide Attempt Characteristics, Diagnoses, and Future Attempts: Comparing Multiple Attempters to Single Attempters and Ideators

    ERIC Educational Resources Information Center

    Miranda, Regina; Scott, Michelle; Hicks, Roger; Wilcox, Holly C.; Munfakh, Jimmie Lou Harris; Shaffer, David

    2008-01-01

    The study compares psychiatric diagnoses and future suicide attempt outcomes of multiple attempters (MAs), single attempters (SAs) and ideators. The results conclude that MAs strongly predict later suicide attempts and diagnosis than SAs and ideators.

  11. Suicide Attempt Characteristics, Diagnoses, and Future Attempts: Comparing Multiple Attempters to Single Attempters and Ideators

    ERIC Educational Resources Information Center

    Miranda, Regina; Scott, Michelle; Hicks, Roger; Wilcox, Holly C.; Munfakh, Jimmie Lou Harris; Shaffer, David

    2008-01-01

    The study compares psychiatric diagnoses and future suicide attempt outcomes of multiple attempters (MAs), single attempters (SAs) and ideators. The results conclude that MAs strongly predict later suicide attempts and diagnosis than SAs and ideators.

  12. Palliative care after attempted suicide in the absence of premorbid terminal disease: a case series and review of the literature.

    PubMed

    Eastman, Peter; Le, Brian

    2013-02-01

    Palliative care involvement in the management of incomplete suicide in patients without terminal illness is rare. This paper documents two such cases and explores some of the clinical and ethical issues raised.

  13. Polarity Analysis in Child Abuse Case Management.

    ERIC Educational Resources Information Center

    Hurst, Joe Brannan; And Others

    1993-01-01

    The use of polarity analysis in child abuse case management provides a way to identify interdependent polar opposites, their positive and negative consequences, and actions to manage them over time, rather than compete for one right solution. An example of polarity analysis is presented with the two poles being parental autonomy and the agency as…

  14. Polarity Analysis in Child Abuse Case Management.

    ERIC Educational Resources Information Center

    Hurst, Joe Brannan; And Others

    1993-01-01

    The use of polarity analysis in child abuse case management provides a way to identify interdependent polar opposites, their positive and negative consequences, and actions to manage them over time, rather than compete for one right solution. An example of polarity analysis is presented with the two poles being parental autonomy and the agency as…

  15. "Since I have my case manager, I am back to life" case management in Croatia.

    PubMed

    Gruber, Ema N; Ivezić-Strkalj, Sladana; Agius, Mark; Martić-Biocina, Sanja

    2008-03-01

    The authors present a case report of a patient who was treated by a case manager, a member of a Croatian Community Mental Health (CMH) Team, following the recommendations of WHO 2004 as well as the IRIS guidelines and the Basic Standards for Management of Patients with Serious Mental Illness in the Community (Agius 2005) and using the elements of Clinical case management (Muser 1998), Assertive community treatment model (Burns 1995, Scott 1995, Wolfsan 1990), the personal strength model (Rapp 1988) and Rehabilitation model (Anthony 1993). In order to emphasize the importance of the therapist-patient relationship in the treatment of chronic schizophrenic patients (Ivezic 2001) and creating the group atmosphere a Croatian model of case management is created where the patient's needs and risks are assessed by a multidisciplinary team which also conducts the recommended psychosocial interventions plan. The majority of interventions are conducted in groups. The case manager develops a confident relationship with a patient, nourishes the positive transference and aids the delivery of the treatment. The main goals of the interventions are empowerment of the patient, improvement of his abilities and decreasing of disabilities. The case manager also carries out a full assessment of the needs of the patient's family so that the family or carers are also included in the treatment or support if necessary (Gruber 2006). A case report of a patient and the work of her case manager as well as the case manager's diary (Gruber 2007) and the Croatian model of case management is presented in this article.

  16. RESULTS OF A DATING ATTEMPT -CHEMICAL AND PHYSICAL MEASUREMENTS RELEVANT TO THE CASE OF THE CRETACEOUS TERTIARY EXTINCTIONS

    SciTech Connect

    Asaro, Frank; Michel, Helen V.; Alvarez, Luis W.; Alvarez, Walter

    1980-09-01

    In Gubbio, Italy, a l em layer of clay between extensive limestone formations marks the boundary between the Cretaceous and Tertiary Periods. This clay layer was known to have been deposited about 65 million years ago when many life forms became extinct, but the length of time associated with the deposition was not known. In an attempt to measure this time with normally deposited meteoritic material as a clock, extensive measurements of iridium abundances (and those of many other elements) were made on the Gubbio rocks. Neutron activation analysis was the principal tool used in these studies. About 50 elements are searched for in materials like the earth's crust, about 40 are detected and about 30 are measured with useful precision. We were not able to determine exactly how long the clay deposition took. Instead the laboratory studies on the chemical and physical nature of the Cretaceous-Tertiary boundary led to the theory that an asteroid collision with the earth was responsible for the extinction of many forms of life including the dinosaurs.

  17. Cecal Leiomyoma: Can We Attempt Endoscopic Resection?

    PubMed Central

    Badipatla, Kanthi Rekha; Kamireddy, Chandana; Niazi, Masooma; Nayudu, Suresh Kumar

    2016-01-01

    Gastrointestinal leiomyomas are smooth muscle tumors arising from the muscularis mucosae, muscularis propriae and possibly from smooth muscle of the vessel wall. Management depends on the size, location and the clinical scenario. Endoscopic snare cauterization with or without saline lift has been described in literature for tumors involving the left colon. To the best of our knowledge, endoscopic resection of right colon leiomyoma was never attempted in the past. We present a case of cecal leiomyoma which was resected endoscopically. PMID:28058080

  18. Collaborative practice through nursing case management.

    PubMed

    Chimner, N E; Easterling, A

    1993-01-01

    A 528-bed community teaching hospital redesigned its patient care delivery system, implementing a collaborative practice model on the 30-bed inpatient rehabilitation unit in April 1990. This model is a patient-centered delivery model that encourages the healthcare team to facilitate the achievement of patient outcomes within effective time frames and with an appropriate use of resources. The collaborative practice model includes a nurse case manager's role for the staff nurse, which had as its frame-work the concept of nursing case management. Tested project management techniques were used to ensure a successful implementation process. Various strategies, such as using project teams and providing educational programs, were used to respond to the issues of role conflict and overlap, especially between social workers and nurse case managers. The implementation of this model provided a number of benefits, including improved interdisciplinary relationships and decreased length of stay.

  19. Case management directors: how to manage in a transition-focused world: part 2.

    PubMed

    Bankston White, Cheri; Birmingham, Jackie

    2015-01-01

    Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role.This is Part 2 of a two-part article written for case management directors, particularly new ones.Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes.This article attempts to answer the following questions: : The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Part 1 found that case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations that include payer, provider, and regulatory agencies. At the same time, they must also develop the skills to positively influence the revenue cycle and financial health of both the organization for which they work and those to whom they transition patients. A director of case management with responsibility for transitions of care has more power and influence over patient safety than is commonly known. Few of the

  20. Information technology implications of case management.

    PubMed

    Remmlinger, E; Ault, S; Hanrahan, L

    1995-01-01

    Information technology is a critical component to implementing a comprehensive and effective case management process. The vendor marketplace is aggressively working to address gaps in function and integration. In the meantime, organizations must begin now to plan their case management processes. This is no small task. Most organizations are struggling to develop the necessary manual systems through consensus building on a multidisciplinary basis. Success in developing and implementing a good manual system, although cumbersome, is an essential prerequisite to automation. Major organizational growth and restructuring is already under way in most settings to respond to the pressures of health care reform. Availability of a tight case management process with appropriate information technology support is the key to success.

  1. Exploring Predictors of Graduate School and Career Success: A Case Study in Sport Management

    ERIC Educational Resources Information Center

    LeCrom, Carrie; Rufer, Lisa; Slavich, Mark; Dwyer, Brendan; Greenhalgh, Gregory

    2016-01-01

    The following case study attempted to assess what factors contribute to graduate school and early-career success among sport management graduate students. As faculty members charged with admitting the next generation of leaders in the sport industry, how should admissions decisions be made and what factors should be considered? The authors…

  2. Exploring Predictors of Graduate School and Career Success: A Case Study in Sport Management

    ERIC Educational Resources Information Center

    LeCrom, Carrie; Rufer, Lisa; Slavich, Mark; Dwyer, Brendan; Greenhalgh, Gregory

    2016-01-01

    The following case study attempted to assess what factors contribute to graduate school and early-career success among sport management graduate students. As faculty members charged with admitting the next generation of leaders in the sport industry, how should admissions decisions be made and what factors should be considered? The authors…

  3. "Site-Based Management" and Reform. Toledo Public Schools, a Case in Point.

    ERIC Educational Resources Information Center

    Lopez, Thomas R.; Balzer, David M.

    The expression "site-based management" (SBM) has become part of the rhetoric of reform of U.S. public schools. The United States has been involved in school reform efforts for many years now, including attempts at SBM. The case of the Toledo (Ohio) public schools serves as a prime example of an urban school district that, like many…

  4. Negative Life Events and Attempted Suicide in Rural China

    PubMed Central

    Zhang, Wen-Chao; Jia, Cun-Xian; Zhang, Ji-Yu; Wang, Lin-Lin; Liu, Xian-Chen

    2015-01-01

    Objective This study aimed to examine the association between negative life events (NLEs) and attempted suicide in rural China. Methods Six rural counties were selected from disease surveillance points in Shandong province, China. A total of 409 suicide attempters in rural areas between October 1, 2009, and March 31, 2011, and an equal number of matched controls were interviewed. We compared negative life events experienced within 1 month, 1–3 months, 3–6months, and 6–2 months prior to attempted suicide for cases and prior to interview for controls. We used multivariate logistic regression to examine the association between NLEs and attempted suicide. Results Suicide attempters experienced more NLEs within the last year prior to suicide attempt than controls prior to interview (83.1% vs. 33.5%). There was a significant dose-response relationship between NLEs experienced within the last year and increased risk of attempted suicide. Timing of NLEs analysis showed that NLEs experienced in the last month and 6–12 months prior to suicide attempt were significantly associated with elevated risk of attempted suicide, even after adjusting for mental disorders and demographic factors. Of NLEs, quarrelling with spouse, quarrelling with other family members, conflicting with friends or neighbors, family financial difficulty, and serious illness were independently related to attempted suicide. Conclusion NLEs are significantly associated with increased risk for attempted suicide in rural China. Stress management and intervention may be important to prevent suicidal behavior in rural China. PMID:25611854

  5. Tool Version Management Technology: A Case Study.

    DTIC Science & Technology

    1990-11-01

    Technical Report AD-A235 639 CMU/SEI-90-TR-25 Tool Version Management Technology: A Case Study Peter H. Feiler Grace F. Downey November 1990 x 91...00304 90 7 Technical Report CMU/SEI-90-TR-25 ESD-90-TR-226 November 1990 Tool Version Management Technology: A Case Study Peter H. Feiler Grace F. Downey...trademark holder. Table of Contents 1. lntroducton 1 2. The Problem 3 2.1. Tool Version Organization and Selection 3 2.2. Stability of Selected Tool

  6. Self-injection of household cleaning detergents into a ventriculoperitoneal shunt reservoir during a suicide attempt: a case report and literature review.

    PubMed

    Signorelli, Jason W; Osbun, Joshua W; Arias, Eric J; Reynolds, Lauren C; Chyatte, Douglas; Reynolds, Matthew R

    2016-09-01

    Self-injection of household cleaning detergents (more specifically, commercial toilet bowl cleaner) into the reservoir of a ventriculoperitoneal shunt (VPS) has never been reported in the neurosurgical literature. A right-handed 41-year-old female with a past medical history significant for bipolar depression (with multiple prior hospital admissions for suicide attempts) and pseudotumor cerebri (status-post VPS placement from a right frontal approach) successfully injected ∼5 ml of toilet bowl cleaner into her ventricular shunt reservoir during a suicide attempt. She was found unresponsive by a family member 48 h after this event and presented to our hospital in moribund neurological condition (bilaterally fixed and dilated pupils with decerebrate posturing). Head computed tomography (CT) demonstrated marked ventriculomegaly. She was taken emergently to the operating room for placement of a left frontal ventriculostomy. Cerebrospinal fluid (CSF) sampled intraoperatively showed numerous Gram-positive cocci (later determined to be Staphylococcus epidermidis). For this reason, her right-sided shunt system was also removed in its entirety. She was treated with broad-spectrum intravenous and intraventricular antibiotics for her bacterial ventriculitis and her CSF was aggressively drained to treat her hydrocephalus. Once her infection had resolved, the shunt was replaced (using a right parietal approach) and she went on to make an excellent neurological recovery. Here, the authors present the case of a patient who self-injected household cleaning detergents into her VPS reservoir-and, likely, the ventricular system-during a suicide attempt and subsequently developed hydrocephalus and ventriculitis. Following this infrequent clinical scenario, consideration should be given to temporary ventriculostomy placement and shunt removal. Moreover, in patients with a known history of psychiatric co-morbidities-and particularly those patients with prior suicide attempts

  7. The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement.

    PubMed

    Choksi, Neel S; Fogel, Evan L; Cote, Gregory A; Romagnuolo, Joseph; Elta, Grace H; Scheiman, James M; Chak, Amitabh; Mosler, Patrick; Higgins, Peter D R; Korsnes, Sheryl J; Schmidt, Suzette E; Sherman, Stuart; Lehman, Glen A; Elmunzer, B Joseph

    2015-01-01

    It is believed, based on limited observational data, that an unsuccessful attempt to place a prophylactic pancreatic stent substantially increases the risk of post-ERCP pancreatitis (PEP). To better understand the risk of PEP in patients with failed pancreatic stent placement (FPS) and the impact of rectal indomethacin on this risk. Secondary analysis of randomized, controlled trial data. University of Michigan and Indiana University. A total of 577 clinical trial participants at elevated risk for PEP. Pancreatic stent placement. Within the placebo group, we compared PEP rates in patients with FPS, patients who underwent successful stent placement, and in those without a stent attempt. We also performed a regression analysis evaluating the association between FPS and PEP. To define the protective effect of indomethacin, we repeated these analyses in the indomethacin group and in the full study cohort. The incidence of PEP among patients in the placebo group who experienced FPS was 34.7%, significantly exceeding rates in patients who underwent successful stent placement (16.4%) and in those without a stent attempt (12.1%). After we adjusted for known PEP risk factors, FPS was found to be independently associated with PEP. Among the indomethacin group and in the full cohort, FPS was not associated with a higher risk of PEP. Low event rate, FPS not prospectively captured. FPS appears to confer an increased risk of PEP, which is attenuated by rectal indomethacin administration. These findings highlight the importance of adequate training and proficiency before endoscopists attempt pancreatic stent placement and the routine use of rectal indomethacin in high-risk ERCP cases. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  8. The Case Management Model: Concept and Process Definition. Volume I.

    ERIC Educational Resources Information Center

    Regional Inst. of Social Welfare Research, Athens, GA.

    This report describes a case management model and was designed to serve as a basic text for training social service workers. Chapter I defines the term case management and discusses the role of case management in the field of social services. Chapter II delineates the main features of the case management model and the activities required of the…

  9. Conservative Management of Invasive Placentation: Two Cases with Different Surgical Approaches.

    PubMed

    Fay, Emily E; Norquist, Barbara; Jolley, Jennifer; Hardesty, Melissa

    2016-04-01

    Background When placenta accreta complicates a delivery, the typical management is to perform a cesarean hysterectomy. Other management strategies, including leaving the placenta in situ, have been attempted and supported in some cases. This may allow for an interval hysterectomy, which can potentially decrease average blood loss and/or allow a minimally invasive approach to the hysterectomy. Cases We present two cases of women with invasive placentation managed conservatively with interval hysterectomy. One woman was managed with robotic-assisted laparoscopic surgery and the other with an open surgical approach. Conclusion These cases highlight the successful use of conservative management for invasive placentation in two stable patients and showcase the novel use of a robotic-assisted laparoscopic surgery for management of invasive placentation.

  10. Conservative Management of Invasive Placentation: Two Cases with Different Surgical Approaches

    PubMed Central

    Fay, Emily E.; Norquist, Barbara; Jolley, Jennifer; Hardesty, Melissa

    2016-01-01

    Background When placenta accreta complicates a delivery, the typical management is to perform a cesarean hysterectomy. Other management strategies, including leaving the placenta in situ, have been attempted and supported in some cases. This may allow for an interval hysterectomy, which can potentially decrease average blood loss and/or allow a minimally invasive approach to the hysterectomy. Cases We present two cases of women with invasive placentation managed conservatively with interval hysterectomy. One woman was managed with robotic-assisted laparoscopic surgery and the other with an open surgical approach. Conclusion These cases highlight the successful use of conservative management for invasive placentation in two stable patients and showcase the novel use of a robotic-assisted laparoscopic surgery for management of invasive placentation. PMID:27294007

  11. Case Management of Adolescents with Chronic Disease.

    ERIC Educational Resources Information Center

    Lankard, Bettina A.

    This training guide presents a model for optimum delivery of the primary duties, tasks, and steps required in the comprehensive case management of adolescents with chronic disease. Using a team approach to coordinated health care, the guide involves the patient and family as key members of the care team along with the physician, nurse, dietitian,…

  12. The Cocoa Shop: A Database Management Case

    ERIC Educational Resources Information Center

    Pratt, Renée M. E.; Smatt, Cindi T.

    2015-01-01

    This is an example of a real-world applicable case study, which includes background information on a small local business (i.e., TCS), description of functional business requirements, and sample data. Students are asked to design and develop a database to improve the management of the company's customers, products, and purchases by emphasizing…

  13. Anesthesic Management for Escobar Syndrome: Case Report

    PubMed Central

    Arpaci, Ayse Hande; Bozkirli, Fusun; Konuk, Onur

    2011-01-01

    Escobar syndrome is a rare autosomal recessive disorder which is characterized by growth retardation, axillary, antecubital, popliteal digital, and intercrural joint flexion contracture, pterygium in the eyes, cleft palate, decreased lung capacity, genital abnormalities, and spinal deformity. In this case, we presented the anesthesic management of a 2-year-old child undergoing frontal sling operation for ptosis and amblyopia etiology exploration. PMID:21541234

  14. Anesthesic management for escobar syndrome: case report.

    PubMed

    Arpaci, Ayse Hande; Bozkirli, Fusun; Konuk, Onur

    2011-01-01

    Escobar syndrome is a rare autosomal recessive disorder which is characterized by growth retardation, axillary, antecubital, popliteal digital, and intercrural joint flexion contracture, pterygium in the eyes, cleft palate, decreased lung capacity, genital abnormalities, and spinal deformity. In this case, we presented the anesthesic management of a 2-year-old child undergoing frontal sling operation for ptosis and amblyopia etiology exploration.

  15. An Evaluation of Learnfare Case Management Services.

    ERIC Educational Resources Information Center

    Wisconsin State Legislative Audit Bureau, Madison.

    Wisconsin's Learnfare program requires 13- to 19-year-old recipients of Aid to Families with Dependent Children (AFDC) to maintain good school attendance or risk losing a portion of their families' grants. The program offers those with attendance problems the opportunity to work with case managers to identify causes of their poor attendance, as…

  16. Linking case management and community development.

    PubMed

    Austin, Carol D; McClelland, Robert W; Gursansky, Di

    2006-01-01

    Case management, in various forms, is now institutionalized as a core part of policy and programs designed to deliver home- and community-based services to older adults. The case management role, in theory, requires attention to both client and system goals, although in practice the system goals that have received most attention have been gatekeeping and resource allocation. While case managers have been admonished to find and develop resources in the community, this has primarily taken the form of including informal services in individual client care plans. What has been missing is focused attention to the potential of the community as a nurturing environment with the capacity to support older adults and their caregivers. Sustainable care for older adults cannot be achieved by formal service and family support alone. This article proposes the creation of linkages between case managers, who build the service arrangements for older people, and community developers, who are responsible for building community capacity and social capital. It is argued that this linkage is essential for establishing the foundations of a caring community with the capacity to support older people.

  17. Telehealth technology in case/disease management.

    PubMed

    Park, Eun-Jun

    2006-01-01

    Case managers can better coordinate and facilitate chronic illness care by adopting telehealth technology. This article overviews four major categories of telehealth technology based on patients' roles in self-management: surveillance, testing peripherals and messaging, decision support aids, and online support groups related to patients' subordinate, structured, collaborative, and autonomous roles, respectively. These various telehealth technologies should be selected on the basis of patients' care needs and preferences. Moreover, when they are integrated with other clinical information systems, case management practice can be better performed. However, the specific role functions and skill sets needed to be competent in telehealth environments have not yet been clearly identified. Considering role ambiguity and stress among telehealth clinicians, clarifying relevant roles is an urgent task.

  18. Case management: an ethically responsible solution.

    PubMed

    Mullahy, C M

    1999-01-01

    How can we meet the many ethical challenges we face every day in our practice settings? When health care values and services were strong, no one questioned the motivation behind a referral or lack of a referral. Financial decisions and knowledge of health care costs were left to accountants and the bookkeeping departments in hospitals. When payers ran out of dollars to support the growing numbers of ill people, money managers moved in. The challenge we face now is to strike a balance between acceptable levels of profit and socially responsible care. Ethical case management (CM) is an important part of the solution.

  19. Influences on Case-Managed Community Aged Care Practice.

    PubMed

    You, Emily Chuanmei; Dunt, David; Doyle, Colleen

    2016-10-01

    Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers' professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers' practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts.

  20. [The case manager--from words to deeds?].

    PubMed

    Lindegaard, Birthe Rosenkrantz; Qvist, Peter

    2010-04-19

    Allocation of a case manager is now mandatory for both in- and outpatients in Denmark. Case manager allocation is reported quarterly to the regions and results are generally satisfying. Knowledge about fulfillment of the case manager role is, however, sparse. This study aims to examine the degree of fulfillment of the case manager role for a sample of inpatients. Two medical and two surgical wards participated. Patients were interviewed in relation to discharge while staff assigned as case managers completed a survey. Both patients and case managers answered questions regarding the defined roles as case managers: Planning/coordination, continuous information and discharge planning. 107 of 125 eligible patients were interviewed. Only 25 declared themselves informed about the allocation of a case manager. The patients' assessment of the service provided by the staff in relation to case manager tasks was generally good, but the services were seldom provided by the named case manager. 22% of patients did not experience continuous information, while only 13% did not experience a generally coherent stay in hospital. 110 case managers completed the survey. Less than half felt themselves well informed about the case manager role. Only a few case managers feel that they succeed in fulfilling the role, particularly regarding the participation in discharge planning. There seems to be a need for a targeted effort to improve the conditions for case managers in Danish hospitals in order to meet the intentions of this initiative.

  1. Case management for the elderly with complex needs: cross-linking the views of their role held by elderly people, their informal caregivers and the case managers.

    PubMed

    Balard, Frédéric; Gely-Nargeot, Marie-Christine; Corvol, Aline; Saint-Jean, Olivier; Somme, Dominique

    2016-11-08

    In 2009, case management interventions were a new social service in France implemented within the framework of the PRISMA-France program (2006-2010). People who had benefitted from case management intervention were individuals, over 60 years old living at home in situations deemed complex by professionals. Their informal caregivers were also considered as users of the service. This research accompanied the interventions during the implementation of PRISMA-France attempting to explore the users' (old people and their informal caregivers) and case managers' first experiences of case management. Its aim is to provide a thorough knowledge of the dispositive in order to reveal any initial failings and to ensure optimum conditions for the onset of full implementation. The study had a qualitative explorative design. Cross-linked representations of case-management were obtained through opened-ended and guided interviews with three types of informants: old people (19), their informal caregivers (11) and the case managers (5) who participated in the program during the first 6 months. Thematic analysis of the data was carried out. The analysis revealed that each group of people generated its own representations of the case manager's role, even though the three groups of informants shared the idea that the case manager is first and foremost a helper. The case managers insisted on their proximity to the old people and their role as coordinators. The informal caregivers saw the professional as a partner and potential provider of assistance in accompanying old people. The old people focused on the personal connections established with the case manager. The innovative and experimental dimension of case management in France and the flexible nature of the role generated a broad spectrum of representations by those involved. These different representations are, in part, the fruit of each individual's projected expectations of this social service. Analyzing the first representations

  2. The Science Manager's Guide to Case Studies

    SciTech Connect

    Branch, Kristi M.; Peffers, Melissa S.; Ruegg, Rosalie T.; Vallario, Robert W.

    2001-09-24

    This guide takes the science manager through the steps of planning, implementing, validating, communicating, and using case studies. It outlines the major methods of analysis, describing their relative merits and applicability while providing relevant examples and sources of additional information. Well-designed case studies can provide a combination of rich qualitative and quantitative information, offering valuable insights into the nature, outputs, and longer-term impacts of the research. An objective, systematic, and credible approach to the evaluation of U.S. Department of Energy Office of Science programs adds value to the research process and is the subject of this guide.

  3. Making the case for OWTS management: lessons from case studies and research

    NASA Astrophysics Data System (ADS)

    Rahm, B.; Woods, F.; Hwang, S.; Walter, M. T.; Grantham, D. G.; Riha, S. J.

    2016-12-01

    On-site wastewater treatment systems (OWTS) are used in 20-25% of homes in the United States and can be an efficient and cost-effective alternative to conventional centralized systems. However, OWTS also represent a source of non-point nutrient, pathogen, and micro-contaminant pollution to surface and groundwater if they are poorly designed, sited and/or maintained. Despite their ubiquity and potential to negatively impact water resources, the contribution of OWTS to local and regional water contamination issues is poorly understood. There are no federal regulations or uniform standards for the operation, maintenance, and management of these systems. The effectiveness of educational programs and best management practices developed by the US Environmental Protection Agency, along with local and regional governments, remains uncertain. Here we describe attempts to increase our knowledge of the state of OWTS in relation to water resources and their management. Specifically, we summarize 1) efforts to modernize a NY State-wide inventory of residential OWTS using GIS-based tools; 2) research aimed at better understanding the impact of OWTS on surface and ground water in 5 upstate NY counties across a gradient of land uses; 3) lessons learned from 13 case studies of municipal OWTS management programs across the US; and 4) observations on the roles of data, education and policy in creating and evaluating successful municipal OWTS management programs. Initial results show that total numbers of OWTS in NY State continue to grow, particularly in areas associated with ex-urban migration. Research into the relationship between OWTS and nutrient and pathogen contamination in ground and surface waters, respectively, suggests location-specific variation. This has implications for management approaches: preventing failure of any individual OWTS may be just as effective as programs attempting to bring all OWTS up to a high level of performance. Case studies of management programs

  4. Case management's value is finally recognized. What happens now? .

    PubMed

    2015-10-01

    In recent years, case management has been recognized as a key in improving healthcare quality and reducing costs, but while hospitals are giving case managers more responsibilities, many administrators are not approving an increase in staff to handle the extra work. Case managers can help their hospital succeed with the Centers for Medicare & Medicaid Services' Value-based Purchasing program, the readmission reduction program, and bundled payments. Case management directors should make sure the hospital's senior leadership understands the roles and responsibilities of case managers and how their interventions can affect outcomes and the bottom line. The number of caseloads depends on the case management model, the responsibilities of case managers, and whether they have assistants or case management extenders who can take over some tasks and allow the licensed staff to work at the top of their licenses. Don't let technology replace communication and patient-centered interactions.

  5. Perinatal conditions and parental age at birth as risk markers for subsequent suicide attempt and suicide: a population based case-control study.

    PubMed

    Niederkrotenthaler, Thomas; Rasmussen, Finn; Mittendorfer-Rutz, Ellenor

    2012-09-01

    Restricted fetal growth and young maternal age have been associated with increased risk of suicidal behaviour later in life. Research investigating the independent and interacting effects of these risk factors with parental mental health and socio-economic status is scarce. A case-control study was effected through record linkage between Swedish registers. Individuals born 1973-1983 who were hospitalized due to a suicide attempt (n = 17,159) or committed suicide (n = 1,407) were matched to ≤10 controls by sex, month and county of birth. Controlling for parental conditions, significantly increased odds ratios (OR) for suicide attempt were found for low birth weight (OR = 1.12, 95 % CI 1.01-1.25), short birth length (OR = 1.15, 95 % CI 1.08-1.22), short and light for gestational age (OR = 1.23, 95 % CI: 1.10-1.38), short but not light for gestational age (OR = 1.18, 95 % CI: 1.09, 1.29), teenage motherhood (OR = 1.66, 95 % CI 1.53-1.80), young fatherhood (OR = 1.33, 95 % CI 1.27-1.39) and multiparity (OR = 1.40, 95 % CI 1.31-1.50). For completed suicide, increased odds ratios were found for low birth weight (OR = 1.65, 95 % CI 1.16-2.35), teenage motherhood (OR = 1.44, 95 % CI 1.09-1.90) and young fatherhood (OR = 1.20, 95 % CI 1.02-1.41). There was a synergy effect between teenage motherhood and parental psychiatric inpatient care with regard to suicide attempt in offspring [synergy index = 1.53 (95 % CI 1.27-1.84)]. Low birth weight and length, and short and light for gestational age may increase the risk of subsequent suicidal behaviour, and more research is needed to investigate underlying mechanisms. Public health implications from this study include measures to improve pre- and perinatal parental mental health, particularly in teenage pregnancies.

  6. An attempt at conservative treatment in selected cases of type I endometrial carcinoma (stage I a/G1) in young women.

    PubMed

    Stanosz, S

    2009-01-01

    The aim of the study was to evaluate an attempt of conservative treatment in selected cases of endometrial carcinoma Stage I A/type I in young women. The study comprised five young nulliparous women aged 24-38 (30.8 +/- 4.2) with well-defined type I endometrial carcinoma Stage I A/G1. Diagnostic dilatation and curettage (D&C) in these women was performed. Biochemical hormonal studies comprised the assessment of estrone, estradiol, progesterone, prolactin in basal conditions, prolactin after a metoclopramide test and total testosterone. In the treatment phase estriol was given intravaginally. Additionally progesterone was applied for 12 days in the second phase of therapeutic cycles. Moreover the women were given ergocryptine and metformin. After six months of therapy and during two years of follow-up histopathological examinations of material obtained from D&C the endometrial pattern was normal and free of cancer cells. 1) In selected cases the conservative treatment of young women diagnosed with type I endometrial carcinoma Stage I A/G1 could be indicated. 2) Conservative pharmacological treatment of young women with well-defined endometrial carcinoma Stage I A/G1 type I should be monitored with followup histopathological examinations of material obtained from D&C of the endometrium and assessment of concentrations of sex hormones in the serum. 3) This kind of therapy requires frequent and thorough gynecological and clinical follow-up.

  7. Case histories in pharmaceutical risk management.

    PubMed

    McCormick, Cynthia G; Henningfield, Jack E; Haddox, J David; Varughese, Sajan; Lindholm, Anders; Rosen, Susan; Wissel, Janne; Waxman, Deborah; Carter, Lawrence P; Seeger, Vickie; Johnson, Rolley E

    2009-12-01

    The development and implementation of programs in the U.S. to minimize risks and assess unintended consequences of new medications has been increasingly required by the Food and Drug Administration (FDA) since the mid 1990s. This paper provides four case histories of risk management and post-marketing surveillance programs utilized recently to address problems associated with possible abuse, dependence and diversion. The pharmaceutical sponsors of each of these drugs were invited to present their programs and followed a similar template for their summaries that are included in this article. The drugs and presenting companies were OxyContin, an analgesic marketed by Purdue Pharma L.P., Daytrana and Vyvanse, ADHD medications marketed by Shire Pharmaceuticals, Xyrem for narcolepsy marketed by Jazz Pharmaceuticals, and Subutex and Suboxone for opioid dependence marketed by Reckitt Benckiser Pharmaceuticals Inc. These case histories and subsequent discussions provide invaluable real-world examples and illustrate both the promise of risk management programs in providing a path to market and/or for keeping on the market drugs with serious potential risks. They also illustrate the limitations of such programs in actually controlling unintended consequences, as well as the challenge of finding the right balance of reducing risks without posing undue barriers to patient access. These experiences are highly relevant as the FDA increasingly requires pharmaceutical sponsors to develop and implement the more formalized and enforceable versions of the risk management term Risk Evaluation and Mitigation Strategies (REMS).

  8. Case Management in Community Corrections: Current Status and Future Directions

    ERIC Educational Resources Information Center

    Day, Andrew; Hardcastle, Lesley; Birgden, Astrid

    2012-01-01

    Case management is commonly regarded as the foundation of effective service provision across a wide range of human service settings. This article considers the case management that is offered to clients of community corrections, identifying the distinctive features of case management in this particular setting, and reviewing the empirical evidence…

  9. Case Management in Community Corrections: Current Status and Future Directions

    ERIC Educational Resources Information Center

    Day, Andrew; Hardcastle, Lesley; Birgden, Astrid

    2012-01-01

    Case management is commonly regarded as the foundation of effective service provision across a wide range of human service settings. This article considers the case management that is offered to clients of community corrections, identifying the distinctive features of case management in this particular setting, and reviewing the empirical evidence…

  10. Shaping Case Management in Minnesota: In Theory, Reality and Practice.

    ERIC Educational Resources Information Center

    Lang, Joyce; Kragthorpe, Candice

    This monograph reports the conclusions of seven 6-month projects addressing issues of case management in the field of developmental disabilities in Minnesota. First, the theory supporting case management is reviewed and alternative definitions and guiding principles are offered. Next, the Minnesota rule on case management is detailed, noting…

  11. Clinical ICT systems: augmenting case management.

    PubMed

    Baldwin, Lynne P; Clarke, Malcolm; Jones, Russell

    2002-01-01

    In order to improve the diagnosis and subsequent care given to patients, health-care workers involved in the management of their care, as well as the treatment itself, are increasingly looking at the role that information and communication technologies (ICTs) can play in supporting the complex interactions between patient, doctor or nurse, consultant and medical equipment. Effective communication both amongst health-care workers and between health-care workers and their patients in both primary and secondary care is vital; ICTs can play an important role in this. In this paper possible interpretations given to the term "telemedicine" are discussed, and then attention is turned to the challenges involved in human interaction and the role of ICTs. An example of a clinical ICT system (AIDMAN) is used to illustrate how face-to-face interaction has usefully been supported by way of a "virtual" consultation, which facilitates remote medical diagnosis and can provide improved case management.

  12. Integrating end-of-life care with disease management programs: a new role for case managers.

    PubMed

    Lazarus, A

    2001-03-01

    Case managers are crucial to any well-designed disease management program. However, in the progressive course of serious illness, patients, their families, and MCOs need the skills of case manager more than ever to help them through end-of-life care choices. The author describes what case managers will need in their "toolbox" to provide insight to these health plan members.

  13. Essentials of Advocacy in Case Management: Part 2: Client Advocacy Model and Case Manager's Advocacy Strategies and Competencies.

    PubMed

    Tahan, Hussein M

    2016-01-01

    This article describes a client advocacy model for use by case managers. It delineates necessary competencies for the case manager and shares important strategies for effective client advocacy. All practice settings across the continuum of health and human services and case managers of diverse professional backgrounds. Advocacy is a primary role and necessary competency of professional case managers functioning in various care settings. It is rooted in ethical theory and principles. Successful case managers apply ethical principles of advocacy at every step of the case management process and in the decisions they make. Part II of this two-part article presents a client advocacy model for case managers to apply in their practice, describes the role of advocacy in client engagement, and identifies important strategies and a set of essential competencies for effective case management advocacy. Part I already explored the ethical theories and principles of advocacy, the perception of case management-related professional organizations of advocacy, and the common types of advocacy based on scope, complexity, impact, and reach. Acquiring foundational knowledge, skills, and competencies in what advocacy is and how to effectively enact its related behaviors is essential for success of case managers and for achieving desired outcomes for both the clients and health care agencies/providers alike. Case management leaders are urged to use the knowledge shared in this article to develop advocacy training and competency management programs for their case managers.

  14. Forest planning in an Oregon case study: Defining the problem and attempting to meet goals with a spatial-analysis technique

    NASA Astrophysics Data System (ADS)

    Bettinger, Pete; Johnson, K. Norman; Sessions, John

    1996-07-01

    Five major management goals were identified for the upper Grande Ronde River Basin on the Wallowa-Whitman National Forest in northeastern Oregon: to produce high-quality fish habitat, to maintain elk habitat, to restore and maintain forest conditions within the natural range of viability, and to contribute to community economic stability. From the broad goals, specific goals for stream temperature, habitat effectiveness index (HEI), habitat corridors, maintenance of land in late or old seral stages, and a nondeclining even flow of timber were selected. A case study was undertaken in a small watershed that is under typical societal constraints to determine whether one decisionsupport tool, SNAP II+, could evaluate the selected goals in a single planning exercise. Three riparian management strategies and two forest road scenarios were used. The exclusion of harvest and road-building from riparian zones in order to increase habitat protection decreased harvest levels and net present value but maintained preactivity stream temperatures. Other resources were generally maintained within prescribed management levels. Although the technique has limitations (e.g., it does not account for riparian zones in calculations of forage and cover for HEI, and it can use the maximum but not minimum acreage goal for some resources), it shows promise for evaluating management tradeoffs in watershed analysis.

  15. Secondary Prevention of Attempted Suicide in Adolescence.

    ERIC Educational Resources Information Center

    Cotgrove, Andrew; And Others

    1995-01-01

    Studies adolescents discharged from a hospital following suicide attempt who were randomly allocated to a treatment group receiving standard management plus a token allowing readmission to the hospital on demand, or a control group receiving standard management only. Results suggest lower rates of repeat suicide attempts in the group that received…

  16. A Database of Systems Management Cases

    DTIC Science & Technology

    1990-09-01

    flaws in the Argyris analysis. Argyris contended that "the case method produced learner problems of conformity, error camouflage, risk minimization, and...would "buy"/take over management of the existing AIL contract. This would decrease the risk associated with th- contract 44 because of Rockwell’s...Irft o 014a00Mad taon. 121 IS 40 eWUM O6ISHihwev l uite 1204. Arlington. ’IA 22202-4302, and to the Oflce of Managemnet and Suidgert PacerwOrs

  17. An electronic case manager for diabetes control.

    PubMed

    Meneghini, L F; Albisser, A M; Goldberg, R B; Mintz, D H

    1998-04-01

    To evaluate the usage and safety of an electronic case manager (ECM) system designed to facilitate the task of glycemic control. Sustained improvement in blood glucose control is the proven treatment outcome that will reduce or eliminate the long-term complications of diabetes. A customized microcomputer system served as the ECM. Located at the clinic, this voice-interactive system required the remote patient to need only a touch-tone telephone. Patients accessed the system to report daily self-measured glucose levels or hypoglycemic symptoms together with associated lifestyle events. System beta-testing was in an open-case series (n = 184) in an academic diabetes center with the goal of evaluating the ECM in terms of utilization, frequency of crises, and fiscal matters. Of the patients, 58% (n = 107) actively used the ECM for their daily diabetes care, accumulating 788 patient-months of follow-up. Over 45,000 telephone calls were received by the ECM during the start-up year. Each call was processed instantly and automatically. Patients benefited from having 24-h access to the ECM. Prevalence of diabetes-related crises (hyperglycemia > 400 mg/dl [22 mmol/l] or hypoglycemia < 50 mg/dl [2.8 mmol/l]) decreased approximately threefold (P < 0.05), with a concomitant statistically significant decrease in HbA1c of 0.8% at 6 months (n = 45, P = 0.024) and 0.9% at 12 months (n = 30, P = 0.044). The ECM provided 24-h on-line assistance in adjusting daily insulin and/or tablet therapy, automatic generation of standardized medical reports, electronic medical-legal documentation, as well as a marked reduction in the time spent on the phone with patients. Clinic visits in managing complex diabetes were reduced approximately twofold (P < 0.0001), and the effort spent by case managers was estimated. Patients with diabetes who accessed the ECM system received timely, cost-effective, and reliable medical intervention. This reduced the incidence of diabetic crises and the need for

  18. Case Management of Dengue: Lessons Learned.

    PubMed

    Kalayanarooj, Siripen; Rothman, Alan L; Srikiatkhachorn, Anon

    2017-03-01

    The global burden of dengue and its geographic distribution have increased over the past several decades. The introduction of dengue in new areas has often been accompanied by high case-fatality rates. Drawing on the experience in managing dengue cases at the Queen Sirikit National Institute of Child Health in Bangkok, Thailand, this article provides the authors' perspectives on key clinical lessons to improve dengue-related outcomes. Parallels between this clinical experience and outcomes reported in randomized controlled trials, results of efforts to disseminate practice recommendations, and suggestions for areas for further research are also discussed. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  19. Management case study: Tampa Bay, Florida

    USGS Publications Warehouse

    Morrison, Gerold; Greening, Holly; Yates, Kimberly K.; Wolanski, Eric; McLusky, Donald S.

    2011-01-01

    Tampa Bay, Florida, USA, is a shallow, subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of seagrasses and other selected habitat types, to support estuarine-dependent faunal guilds. Over the past three decades, nitrogen controls involving sources such as wastewater treatment plants, stormwater conveyance systems, fertilizer manufacturing and shipping operations, and power plants have been undertaken to meet these and other management objectives. Cumulatively, these controls have resulted in a 60% reduction in annual total nitrogen (TN) loads relative to earlier worse-case (latter 1970s) conditions. As a result, annual water-clarity and chlorophyll a targets are currently met in most years, and seagrass cover measured in 2008 was the highest recorded since 1950. Factors that have contributed to the observed improvements in Tampa Bay over the past several decades include the following: (1) Development of numeric, science-based water-quality targets to meet a long-term goal of restoring seagrass acreage to 1950s levels. Empirical and mechanistic models found that annual average chlorophyll a concentrations were a primary manageable factor affecting light attenuation. The models also quantified relationships between TN loads, chlorophyll a concentrations, light attenuation, and fluctuations in seagrass cover. The availability of long-term monitoring data, and a systematic process for using the data to evaluate the effectiveness of management actions, has allowed managers to track progress and

  20. Attempted Non-Family Abductions.

    ERIC Educational Resources Information Center

    Finkelhor, David; And Others

    1995-01-01

    Examined cases of attempted nonfamily abductions, to determine child and family characteristics that may serve as risk factors for such incidents. The prevalence and risk-marker findings from this study reinforce the need to continue teaching "stranger danger" and suggest that children living in stressful or unstable family environments…

  1. Integrated case management: the 21st century challenge for HMO case managers: Part I.

    PubMed

    Coleman, J R

    1999-01-01

    As HMOs approach the new millennium, their care and cost management strategies still will be under attack by policy-makers, legislative bodies, the media, American businesses, and the medical professions. The HMO industry will continue to be held accountable for the efficiency of its services, the quality of its care, and the performance and outcome measures that are the results of managing both the care and medical costs of its membership. This first of a two-part series put forward the concept of an integrated CM model to manage the total care of needs of HMO members at the turn of the century. This model consists of three care management approaches commonly used in mature HMOs: demand management, CM, and DM, as illustrated in Figure 1 and defined in Table 1. This article also described the new challenges facing HMOs, physicians, and nurse case managers and how they are navigating the difficult process of mapping demand management and CM approaches to the medical, social, and environmental needs of HMO members. With the costs of chronic conditions consuming 61% of the nation's annual health bill and increased numbers of the elderly joining HMOs, HMOs strongly need to implement DM approaches for economic survival reasons alone. Part two of this series will focus on the newest care management approach: disease state management.

  2. Quick management of accidental tritium exposure cases.

    PubMed

    Singh, Vishwanath P; Badiger, N M; Managanvi, S S; Bhat, H R

    2012-07-01

    Removal half-life (RHL) of tritium is one of the best means for optimising medical treatment, reduction of committed effective dose (CED) and quick/easy handling of a large group of workers for medical treatment reference. The removal of tritium from the body depends on age, temperature, relative humidity and daily rainfall; so tritium removal rate, its follow-up and proper data analysis and recording are the best techniques for management of accidental acute tritium exposed cases. The decision of referring for medical treatment or medical intervention (MI) would be based on workers' tritium RHL history taken from their bodies at the facilities. The workers with tritium intake up to 1 ALI shall not be considered for medical treatment as it is a derived limit of annual total effective dose. The short-term MI may be considered for tritium intake of 1-10 ALI; however, if the results show intake ≥100 ALI, extended strong medical/therapeutic intervention may be recommended based on the severity of exposure for maximum CED reduction requirements and annual total effective dose limit. The methodology is very useful for pressurized heavy water reactors (PHWRs) which are mainly operated by Canada and India and future fusion reactor technologies. Proper management will optimise the cases for medical treatment and enhance public acceptance of nuclear fission and fusion reactor technologies.

  3. How do cathartic drugs act? A case study on Gregor Horst (1578-1636) and his attempt to defend Galenist theory.

    PubMed

    Schweikardt, C

    1998-12-01

    This case study deals with the argument of the Galenist author Gregor Horst (1578-1636), Medical Professor at Giessen University, Germany, and later town phyusician in Ulm, in the discussion on how purgatives act. Horst tried to reconcile a number of different opinions within a Galenist framework. His vast erudition enabled him to compare several classical as well as contemporary opinions. He takes into account Galen (129-c.200/216), Erasistratos (c. 330-255 BC), Asclepiades (fl. 1st century BC), the Hippocratic Corpus and the Problemata Aristotelis from antiquity, Mesue and Mundinus (c. 1270-1326) from the Middle Ages, and Jean Fernel (c. 1497-1558), Girolamo Cardano (1501-c. 1576), Johannes Costaeus (d. 1603), Laurent Joubert (1529-1583), Francisco Valles (1524-1592), Tobias Dorncreilius (1571-1605) and Gavriele Falloppio (1523-1562) from contemporary authors. Horst also integrated some Paracelsian ideas from Joseph Duchesne alias Quercetanus (1549-1609). In his attempt to preserve fundamentals of Galenic thought, Horst created a complicated theory nearly breaking under its own weight. He shows a rising divergence within traditional views as well as the fragmentation of Renaissance Galenism which took place already before the discovery of the blood circulation.

  4. Arrow shaft injury of the wrist and hand: case report, management, and surgical technique.

    PubMed

    Launikitis, Robert A; Viegas, Steven F

    2009-01-01

    A case of accidental, self-inflicted injury to the hand from a hollow carbon shaft arrow which broke in its midshaft while attempting to shoot the arrow from a compound bow is presented. Basic knowledge of low velocity gunshot wounds and arrow injuries was applied in the treatment of this injury along with a unique management technique. The outcome, including hand function was good without any functional loss.

  5. Managing change in the culture of general practice: qualitative case studies in primary care trusts.

    PubMed

    Marshall, Martin N; Mannion, Russell; Nelson, Elizabeth; Davies, Huw T O

    2003-09-13

    To explore the potential tension between the need for managers to produce measurable change and the skills required to produce cultural change, and to investigate how managers of primary care trusts are attempting to deal with this tension. Qualitative case studies using data derived from semistructured interviews and a review of published documents. An established cultural framework was to used to help interpret the findings. Six primary care trusts in England purposefully sampled to represent a range of cultural, structural, geographical, and demographic characteristics. 42 interviews with 39 different senior and middle primary care trust managers conducted over an 18 month period. We found two distinct and polarised styles of management. One group of managers adopts a directive style and challenges the prevailing norms and values of clinicians, an approach characteristically seen in organisations with hierarchical cultures. This group is made up mostly of senior managers who are driven principally by the imperative to deliver a political agenda. Managers in the second group are more inclined to work with the prevailing cultures found in general practice, attempting to facilitate change from within rather than forcing change from outside. This management style is characteristically seen in organisations with a clan-type culture. The approach was manifest mostly by middle managers, who seem to act as buffers between the demands of senior managers and their own perception of the ability and willingness of health professionals to cope with change. The different management approaches can lead to tension and dysfunction between tiers of management. The development of primary care depends on high quality managers who are able to draw on a range of different management skills and styles. Managers are most likely to be effective if they appreciate the merits and drawbacks of their different styles and are willing to work in partnership.

  6. Leadership development and succession planning in case management.

    PubMed

    Miodonski, Kathleen; Hines, Patricia

    2013-01-01

    The director of case management is one of health care's leadership positions most frequently in demand. The lack of qualified and effective case management leaders will continue to be an issue for organizations for years to come, influenced by increasing pressures on health care reimbursement and the aging case management workforce. Organizations have an opportunity to create a program to develop future case management leaders from their internal talent. The proposed strategies are designed for the acute care hospital but also have applicability in other health care settings where there are case managers and a need for case management leadership. The business community offers leadership research and leadership development models with relevance to case management. Identifying and developing internal talent for leadership roles has been proven to be effective in preparation for advanced responsibilities, has a positive effect on staff morale, and minimizes the impact of vacant leadership positions during recruitment and onboarding activities. Creating a case management leadership development program for an organization can be an alternative to the process of external recruitment for case management department leaders. Such a program can be undertaken even in today's budget conscious environment by accessing existing resources in an organization in a creative and organized manner. The authors outline an approach for case management leaders to accept responsibility for succession planning and for case managers to accept responsibility for promoting their own career development through creation of a leadership development program.

  7. Multiple suicide attempts.

    PubMed

    Tuckman, J; Youngman, W F; Kreizman, G

    1968-04-01

    A sample of 157 persons who attempted suicide from 2 to 6 times was compared with a sample of 1,045 single attempted suicides on a number of personal and social characteristics and other factors related to the act itself. Suicide death rates, obtained through a follow-up of both groups for a year following the last attempt, were also compared. It is concluded (1) that the two groups are essentially similar in their general characteristics and in their risk of suicide and (2) that, among multiples, little change occurs from first to second attempt. However, it is pointed out that both groups are at considerably higher risk of suicide than those who have not made attempts.

  8. Factors facilitating dementia case management: Results of online focus groups.

    PubMed

    de Lange, Jacomine; Deusing, Eline; van Asch, Iris Fm; Peeters, José; Zwaanswijk, Marieke; Pot, Anne Margriet; Francke, Anneke L

    2016-02-24

    To obtain insight into facilitating factors for case management in dementia care, we conducted a qualitative study with 13 online focus groups (OFGs). Participants were professionals involved in dementia case management (N = 99). We used mind-maps and the method of constant comparison for analysis. Participants perceived OFGs as a useful tool to explore their perspectives. The perceived advantage of OFGs was the flexibility and convenience of logging in at any time or place preferred. Five facilitating factors for case management were identified in the OFGs: 1. Good cooperation between partners; 2. Organisational embedding with an independent position of case managers; 3. Structural funding; 4. Competent case managers; 5. Familiarity with case management in the region. Good cooperation was essential for successful dementia case management and should thus be a primary concern for care providers.

  9. Young People's Risk of Suicide Attempts after Contact with a Psychiatric Department--A Nested Case-Control Design Using Danish Register Data

    ERIC Educational Resources Information Center

    Christiansen, Erik; Larsen, Kim Juul

    2012-01-01

    Background: There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. Methods: A complete extraction of Danish register data…

  10. Young People's Risk of Suicide Attempts after Contact with a Psychiatric Department--A Nested Case-Control Design Using Danish Register Data

    ERIC Educational Resources Information Center

    Christiansen, Erik; Larsen, Kim Juul

    2012-01-01

    Background: There seems to be an increased risk of children and adolescents committing or attempting suicide after contact with a psychiatric department. Children and adolescents living in families with low socio-economic status (SES) might have an especially increased suicide attempt risk. Methods: A complete extraction of Danish register data…

  11. Managing Emerging Technology: Case Studies in Document Imaging Systems

    DTIC Science & Technology

    1990-01-01

    1990 Thesis/Dissertation 00 S Managing Emerging Technology : Case Studies in Document ( Imaging Systems Richard Kevin Brown AFIT Student at...older report. blank, the abstract is assumed to be unlimited. Standard Form 298 Back (Rev. 2-89) MANAGING EMERGING TECHNOLOGY : CASE STUDIES IN...Brancheau Carroll Fren el Iz e 71 &ur s Date . Brown, Richard Kevin (M.S., Management Science/ Information Systems) Managing Emerging Technology : Case

  12. [When a Suicide Attempt is Kid's Stuff].

    PubMed

    Vásquez-Rojas, Rafael; Quijano-Serrano, Margarita

    2013-01-01

    Attempted suicide in children and adolescents is a disturbing and painful issue for patients, their families and physicians. Current medical literature provides little information about minors who attempt suicide, possibly because there is under-reporting of this condition as a diagnosis, or maybe because it is sometimes considered as a way for the child to draw attention. To present the experience of the Department of Psychiatry (Universidad Nacional de Colombia) at the Hospital Infantil de La Misericordia, from 2003 to 2013. An observational retrospective study was conducted by reviewing 213 cases of children and adolescents treated for attempted suicide at the Hospital Infantil de La Misericordia from January 1, 2003 to October 31, 2013, and who received hospital or outpatient care in Child Psychiatry. A review was performed of the diagnosis, the number of suicide attempts, the peak months of consultation for this reason, and the methods selected, as well as a detailed description of the group of patients under 12 years old, and those managed with outpatient follow-up. The average patient is a female teenager who becomes intoxicated with drugs. Most often, patients do not return to outpatient follow-up. Those with follow-up have multiple psychopathologies and a high level of suffering. The most common methods, other than poisoning by drugs, are hanging and jumping from heights. Patients under 12 years old generally have their first attempt by drug poisoning. There is a predominance of anxiety disorder and depression, with a strong association with cognitive dysfunction, as a vulnerability factor. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  13. Gabapentin and Suicide Attempts

    PubMed Central

    Gibbons, Robert D.; Hur, Kwan; Brown, C. Hendricks; Mann, J. John

    2010-01-01

    Purpose On December 16, 2008 FDA issued a class warning for antiepileptic drugs and suicidal thoughts and behavior. The purpose of this study was to determine if the antiepileptic drug gabapentin increases risk of suicide attempt in patients to which it was prescribed for various indications. Methods We conducted a pharmacoepidemiologic study in which suicide attempt rates were compared before and after gabapentin was prescribed. We used the PharMetrics medical claims database to study the relationship between gabapentin and suicide attempts in a cohort of 131,178 patients with a one-year window of information before and after initial prescription. Patients had diagnoses of epilepsy, pain disorders, bipolar illness, major depressive disorder, schizophrenia, and other psychiatric disorders. Results Overall, there was no significant difference in suicide attempt rates before (3.48/1000 patient years - PY) versus after (3.45/1000 PY) gabapentin prescription. Pre-prescription suicide attempt rates were five times higher in psychiatric populations compared with non-psychiatric populations leading us to analyze the two groups separately. No drug effect was detected in the non-psychiatric populations. Significant reductions in suicide attempt rates were seen for bipolar disorder (47.85/1000 PY versus 31.46/1000 PY), major depressive disorder (17.30/1000 PY versus 12.66/1000 PY), and other psychiatric disorders (12.84/1000 PY versus 10.14/1000 PY). Person-time analysis revealed an overall significant reduction in suicide attempt rates (2.01/1000 PY on drug versus 2.30/1000 PY off drug). Conclusions This study finds that gabapentin does not increase risk of suicide attempts in non-psychiatric populations and is associated with a reduction in suicide attempt risk in patients with psychiatric disorders. PMID:20922708

  14. Case management insider. The 2-midnight rule--a game-changer for case management.

    PubMed

    Cesta, Toni

    2014-04-01

    As a case manager or case management leader, it is important for you to stay in touch with how CMS continues to roll out the two-midnight rules as well as the manner of auditing on a go-forward basis. It is also important that your department continue to have a close working relationship with the billing department in your hospital to ensure that the hospital remains compliant with this new rule. Finally, it is also critical that your emergency department and its physicians are kept up to date on the rule and its implications for hospital admissions. Having a case management presence in the emergency department will help to ensure a sound review process at this important route of entry to the hospital. A working team should be created to review the cases that fall outside of the rule, and these cases should also be presented to the utilization review committee so that the hospital can continue to learn and move forward. Finally, listen to the CMS National Provider Calls (www.cms. gov/NPC) to gain additional and updated information as it becomes available! For additional information on the two-midnight rule go to www.cms.gov and search for CMS-1599-F.

  15. Quality improvement initiatives in a case management service: case study.

    PubMed

    Davies, Deborah J

    2015-01-01

    This article explores the importance of quality practices in underpinning the person-centred approach at a Community Options Program (COP) case management service in northern NSW. The NSW community care sector does not have a statutory excellence body to identify, promote and support improved practices and quality and safety across community services, and therefore the COP provider decided to establish a dedicated role to focus on the quality improvement of its service. The subsequent quality improvement initiatives have included mapping the clients' journey through the service, identifying areas to standardise practice, and creating service pathways. The clients' journey was used as the framework to identify where standardised practice was required, and a robust process was implemented to develop over 25 good practice guidelines and tools that addressed the variations in practice and enabled the service pathways to be developed. Prior to trialling the guidelines and tools, staff received education sessions on the anticipated changes to practice, and the practicality and applicability of the guidelines were evaluated at the end of the trials. This information was reviewed and the guidelines were amended accordingly before being rolled out. The guidelines have been in use for over 12 months and have provided the benchmark against which to audit practice, and have resulted in key performance improvements such as an increase in client review rates and a rise in the feedback response rate from clients, with a noticeable shift in the comments about the brokered support worker to acknowledging the role of their case manager. Formalising informal supports for those clients that lived alone also increased, which means these people are less reliant on services and there is a reduced risk of social isolation.

  16. Socio-Demographic, Clinical and Behavioral Characteristics Associated with a History of Suicide Attempts among Psychiatric Outpatients: A Case Control Study in a Northern Mexican City

    PubMed Central

    Alvarado-Esquivel, Cosme; Sánchez-Anguiano, Luis Francisco; Arnaud-Gil, Carlos Alberto; Hernández-Tinoco, Jesús; Molina-Espinoza, Luis Fernando; Rábago-Sánchez, Elizabeth

    2014-01-01

    Background: Little is known about the epidemiology of suicide attempts among psychiatric outpatients in Mexico. This study was aimed to determine the socio-demographic, clinical and behavioral characteristics associated with suicide attempts in psychiatric outpatients in two public hospitals in Durango, Mexico. Methods: Two hundred seventy six psychiatric outpatients (154 suicide attempters and 122 patients without suicide attempt history) attended the two public hospitals in Durango City, Mexico were included in this study. Socio-demographic, clinical and behavioral characteristics were obtained retrospectively from all outpatients and compared in relation to the presence or absence of suicide attempt history. Results: Increased prevalence of suicide attempts was associated with mental and behavioral disorders due to psychoactive substance use (F10-19) (P=0.01), schizophrenia, schizotypal and delusional disorders (F20-29) (P=0.02), mood (affective) disorders (F30-39) (P<0.001), and disorders of adult personality and behavior (F60-69) (P<0.001). Multivariate analysis showed that suicide attempts were associated with young age (OR=1.21, 95% CI: 1.06-1.39; P=0.003), female gender (OR=2.98, 95% CI: 1.55-5.73; P=0.001), urban residence (OR=2.31, 95% CI: 1.17-4.57; P=0.01), memory impairment (OR=1.91, 95% CI: 1.07-3.40; P=0.02), alcohol consumption (OR=2.39, 95% CI: 1.21-4.70; P=0.01), and sexual promiscuity (OR=3.90, 95% CI: 1.74-8.77; P<0.001). Conclusions: We report the association of suicide attempts with socio-demographic, clinical and behavioral characteristics in psychiatric outpatients in Mexico. Results may be useful for an optimal planning of preventive measures against suicide attempts in psychiatric outpatients. PMID:24711751

  17. The role of the case manager in a disease management program.

    PubMed

    Huston, Carol J

    2002-01-01

    Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.

  18. The role of the case manager in a disease management program.

    PubMed

    Huston, C J

    2001-01-01

    Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.

  19. Nurse case management and general practice: implications for GP consortia

    PubMed Central

    Iliffe, Steve; Drennan, Vari; Manthorpe, Jill; Gage, Heather; Davies, Sue L; Massey, Helen; Scott, Cherill; Brearley, Sally; Goodman, Claire

    2011-01-01

    Background Case management is widely promoted as a means of ensuring continuity of care, improving patient outcomes, and achieving efficient management of resources. Community matrons have been introduced recently as specialists in the case management of patients with multiple complex problems. Aim To understand how nurse case managers are seen by GPs and NHS managers. Setting (1) Telephone interviews with 41 community nurse managers recruited from 10 English strategic health authorities and two Welsh health boards; (2) face-to-face interviews with 12 nurse case managers, 12 GPs and five NHS community service managers in three study sites with different population and practitioner characteristics. Method Semi-structured individual interviews, by telephone or face to face. Results Attitudes among GPs to nurse case managers were shaped by perceptions of the quality of community nursing on the one hand and the perceived benefit of case management as a method of reducing hospital use on the other. The dominant mood was scepticism about the ability of nurse case managers to reduce hospital admissions. Community matrons were seen as staff who were imposed on local health services, sometimes to detrimental effect. Conclusion The introduction of case management and community matrons may disrupt existing communities of practice and be perceived negatively, at least in areas where good working relationships between nurses and GPs have developed. Commissioners should be aware of the potential resistance to changes in skill mix and role in nursing services, and promote innovation in ways that minimise disruption to functional communities of practice. PMID:22152848

  20. Implementation of Network Leader Sponsored Supply Chain Management Systems: A Case Study of Supplier IT Business Value

    ERIC Educational Resources Information Center

    Miller, Mark S.

    2010-01-01

    This qualitative multiple-case study was conducted to explore and understand how the implementation of required relationship-specific supply chain management system (SCMS) dictated by the network leader within a supplier network affects a supplier organization. The study, on a very broad sense, attempted to research the current validity of how the…

  1. Implementation of Network Leader Sponsored Supply Chain Management Systems: A Case Study of Supplier IT Business Value

    ERIC Educational Resources Information Center

    Miller, Mark S.

    2010-01-01

    This qualitative multiple-case study was conducted to explore and understand how the implementation of required relationship-specific supply chain management system (SCMS) dictated by the network leader within a supplier network affects a supplier organization. The study, on a very broad sense, attempted to research the current validity of how the…

  2. Assessing the Risk of Re-Offending for Juvenile Offenders Using the Youth Level of Service/Case Management Inventory

    ERIC Educational Resources Information Center

    Bechtel, Kristin; Lowenkamp, Christopher T.; Latessa, Edward

    2007-01-01

    The purpose of the Youth Level of Service Case Management Inventory (YLS/CMI) is to assess, classify, and assist agencies with developing treatment and service plans according to the offender's criminogenic risk factors. Given the limited research in the predictive validity for this instrument, the current study attempts to examine this issue on a…

  3. Assessing the Risk of Re-Offending for Juvenile Offenders Using the Youth Level of Service/Case Management Inventory

    ERIC Educational Resources Information Center

    Bechtel, Kristin; Lowenkamp, Christopher T.; Latessa, Edward

    2007-01-01

    The purpose of the Youth Level of Service Case Management Inventory (YLS/CMI) is to assess, classify, and assist agencies with developing treatment and service plans according to the offender's criminogenic risk factors. Given the limited research in the predictive validity for this instrument, the current study attempts to examine this issue on a…

  4. Case Studies for Management Development in Bangladesh. Second Book.

    ERIC Educational Resources Information Center

    McLean, Gary N.

    These 15 case studies developed by faculty at institutions in Bangladesh are appropriate for use in a course in management development. The typical case describes a real business situation in which a real manager had to reach a decision. The case gives quantitative and qualitative information that is, or may be, relevant to that decision.…

  5. The Woodworker's Website: A Project Management Case Study

    ERIC Educational Resources Information Center

    Jance, Marsha

    2014-01-01

    A case study that focuses on building a website for a woodworking business is discussed. Project management and linear programming techniques can be used to determine the time required to complete the website project discussed in the case. This case can be assigned to students in an undergraduate or graduate decision modeling or management science…

  6. Intensive case management for severe mental illness

    PubMed Central

    Dieterich, Marina; Irving, Claire B; Park, Bert; Marshall, Max

    2014-01-01

    Background Intensive Case Management (ICM) is a community based package of care, aiming to provide long term care for severely mentally ill people who do not require immediate admission. ICM evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (less than 20) and high intensity input. Objectives To assess the effects of Intensive Case Management (caseload <20) in comparison with non-Intensive Case Management (caseload > 20) and with standard community care in people with severe mental illness. To evaluate whether the effect of ICM on hospitalisation depends on its fidelity to the ACT model and on the setting. Search methods For the current update of this review we searched the Cochrane Schizophrenia Group Trials Register (February 2009), which is compiled by systematic searches of major databases, hand searches and conference proceedings. Selection criteria All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community-care setting, where Intensive Case Management, non-Intensive Case Management or standard care were compared. Outcomes such as service use, adverse effects, global state, social functioning, mental state, behaviour, quality of life, satisfaction and costs were sought. Data collection and analysis We extracted data independently. For binary outcomes we calculated relative risk (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data we estimated mean difference (MD) between groups and its 95% confidence interval (CI). We employed a random-effects model for analyses. We performed a random-effects meta-regression analysis to examine the association of the intervention’s fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. Main results We included 38 trials

  7. Repeated suicide attempts.

    PubMed

    Mynatt, S

    2000-12-01

    Attempted suicide is an act associated with childhood sexual abuse, depression, bipolar illness, substance abuse, and other diagnoses, as documented in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association [APA], 1994). Three women, who attended a group to decrease their depression and increase their self-esteem and who had histories of multiple suicide attempts, agreed to participate in interviews designed to determine the common factors associated with their suicide attempts and to examine the assertion that their suicide attempts were an addiction, similar to their addictions to alcohol and drugs. The common factors found were depression, substance use disorders with early abuse and risky behaviors, history of sexual abuse, faulty relationships, alteration of mood with a suicide plan, and distorted and illogical thinking and motivation. The similarities to addiction also were described. Based on the complexity of factors that emerged and the addictive nature of the suicide attempts, treatment for similar patients needs to be multidimensional and ongoing to allow sufficient time to monitor progress and address the numerous factors involved.

  8. Case management for the baby boom generation: a strengths perspective.

    PubMed

    Tice, C; Perkins, K

    1998-01-01

    To understand the challenges and opportunities for case management as the turn of the century approaches, we must consider the 76 million individuals born between 1946 and 1964, commonly referred to as the baby boom generation. This article examines the baby boom generation in the context of planning effective case management services. The generation's strengths are highlighted to suggest how case management systems can meet the anticipated service needs of baby boomers as they age.

  9. Knowledge Management Analysis: A Case Study

    ERIC Educational Resources Information Center

    Mecha, Ezi I.; Desai, Mayur S.; Richards, Thomas C.

    2009-01-01

    It is imperative for businesses to manage knowledge and stay competitive in the marketplace. Knowledge management is critical and is a key to prevent organizations from duplicating their efforts with a subsequent improvement in their efficiency. This study focuses on overview of knowledge management, analyzes the current knowledge management in…

  10. Knowledge Management Analysis: A Case Study

    ERIC Educational Resources Information Center

    Mecha, Ezi I.; Desai, Mayur S.; Richards, Thomas C.

    2009-01-01

    It is imperative for businesses to manage knowledge and stay competitive in the marketplace. Knowledge management is critical and is a key to prevent organizations from duplicating their efforts with a subsequent improvement in their efficiency. This study focuses on overview of knowledge management, analyzes the current knowledge management in…

  11. Alexithymia and low cooperativeness are associated with suicide attempts in male military personnel with adjustment disorder: a case-control study.

    PubMed

    Na, Kyoung-Sae; Oh, Sei-Joong; Jung, Han-Yong; Irene Lee, Soyoung; Kim, Yong-Ku; Han, Changsu; Ko, Young-Hoon; Paik, Jong-Woo; Kim, Shin-Gyeom

    2013-02-28

    Subpopulations of patients with adjustment disorder are at increased risk for suicide. The current study investigated whether personality traits, including alexithymia, temperament, and character, are associated with an increased risk of suicide in individuals with adjustment disorder. Age- and sex-matched patients meeting the diagnostic and statistical manual of mental disorders (DSM-IV) criteria for adjustment disorder with (n=92) and without (n=92) a history of suicide attempts were recruited for the present study. Ninety-two healthy individuals who did not meet diagnostic criteria for Axis I or II diagnoses were used as controls. The Toronto alexithymia scale-20 (TAS-20) and the temperament and character inventory (TCI) were used to assess personality traits. Significantly higher total and subscale scores on the TAS-20, including on the difficulty-identifying-feelings (DIF) and difficulty-describing-feelings (DDF) subscales, and lower scores on the TCI cooperativeness subscale were noted in adjustment-disorder patients with previous suicide attempts. In the multivariate regression analysis, high DDF and DIF and low cooperativeness increased the risk of suicide attempts in adjustment-disorder patients. A subsequent path analysis revealed that high DDF had a direct effect on suicide attempts, whereas high DIF had an indirect effect on suicide attempts via low cooperativeness.

  12. Science plus management equals successful remediation -- A case study

    SciTech Connect

    Buehlman, M.D.; Rogers, D.T.; Payne, F.C.

    1997-12-31

    In the past, owners of contaminated sites attempted to remediate as quickly as possible, usually by excavating contaminated soil or pumping and treating contaminated groundwater. Often, they started remediation before identifying all potential types and sources of contaminants, and before conducting a thorough hydrogeologic study. Such premature action usually resulted in the selected remedy not working, the contamination spreading, or unnecessary remedial activities. Today, successful site remediation is recognized as a complex and time-consuming undertaking--requiring a combination of careful scientific study, effective negotiation with the regulatory agencies and skillful management of multidisciplinary efforts. A case study involving a Brownfields site in southeastern Michigan clearly illustrates the elements of successful remediation. The site`s soil was contaminated with polychlorinated biphenyls (PCBs) and its groundwater with a variety of chlorinated solvents. The original estimate for remediation had exceeded $30 million. Several phases of investigation were conducted to evaluate the nature and sources of contaminants, the site`s hydrogeology, potential risks to human health and the environment, and feasible remedial technologies. Multiple cleanup criteria were established for different affected areas based on the results of the investigations, changes that were taking place with the state cleanup regulations and standards and subsequent negotiations with state and federal regulators. Innovative remedial technologies were selected. The result was a remediation that met or exceeded all soil and groundwater cleanup objectives, was performed on schedule, and was highly cost-effective. The final cost was limited to $3 million--one-tenth of the original estimate.

  13. Psychiatric nursing case management: past, present, and future.

    PubMed

    Herrick, Charlotte A; Bartlett, Robin

    2004-09-01

    This literature review examines the evolution of psychiatric nursing case management in the United States. Various models, both inpatient and outpatient, are described, along with the roles of the case manager in each setting. The development of clinical pathways to monitor and document outcomes in acute settings is examined, along with the difficulties in adapting them specifically to psychiatric nursing case management. The types of data collected and the use of outcomes to support programs for the mentally ill are reviewed. Finally, recommendations for psychiatric nursing case management are made to provide guidelines for the future.

  14. Management of recalcitrant Trichomonas vaginalis in pregnancy: a case report.

    PubMed

    Tayal, Sarup

    2016-02-01

    A case report of a pregnant woman with recalcitrant Trichomonas vaginalis is described. This case was managed with suppressive treatment with metronidazole during pregnancy and cleared with paromomycin vaginal treatment after delivery.

  15. Nurse-managed wound clinic. A case study in success.

    PubMed

    Crumbley, D R; Ice, R C; Cassidy, R

    1999-01-01

    The wound Care Clinic at Naval Hospital Charleston is a nurse-managed ambulatory clinic that has demonstrated the successful application of nursing case management in caring for patients with chronic and complex wounds. Nursing case management is an outcomes-based system of assessment, planning, provision of nursing services, coordination of interdisciplinary efforts, education, and referral. Nursing case management has been shown, in the literature and at Naval Hospital Charleston, to be an extension of role of professional nursing practice and results in decreased costs, improved quality of care, faster wound healing times, decreased complications, and greater coordination of care between specialty disciplines. These positive results are illustrated in several case studies. Nursing case management has many implications for the successful implementation of any healthcare delivery system where decreased costs and improved quality of care are valued, and it has special benefit in the complex management of chronically ill patients.

  16. Comprehensive nursing case management. An advanced practice model.

    PubMed

    Taylor, P

    1999-01-01

    Under managed care and capitated reimbursement systems, case management is a core strategy for providing high-quality, cost-effective care by decreasing fragmentation, enhancing quality, ensuring efficient use of resources, and containing costs. Although case management is used in various areas of the healthcare arena, it suffers from a lack of consensus regarding its definition, essential components, and appropriate application. The purpose of this paper is to examine the components and limitations of existing case management models, outline the competencies of an effective case manager, and present a model of advanced practice nursing case management that focuses on a continuum of care that integrates medical and psychosocial resources to promote optimal clinical fiscal outcomes and enables patients to work as partners with the healthcare team in facilitating and maintaining their physical and emotional well-being.

  17. Intensive case management for severe mental illness.

    PubMed

    Dieterich, Marina; Irving, Claire B; Bergman, Hanna; Khokhar, Mariam A; Park, Bert; Marshall, Max

    2017-01-06

    Intensive Case Management (ICM) is a community-based package of care aiming to provide long-term care for severely mentally ill people who do not require immediate admission. Intensive Case Management evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (fewer than 20) and high-intensity input. To assess the effects of ICM as a means of caring for severely mentally ill people in the community in comparison with non-ICM (caseload greater than 20) and with standard community care. We did not distinguish between models of ICM. In addition, to assess whether the effect of ICM on hospitalisation (mean number of days per month in hospital) is influenced by the intervention's fidelity to the ACT model and by the rate of hospital use in the setting where the trial was conducted (baseline level of hospital use). We searched the Cochrane Schizophrenia Group's Trials Register (last update search 10 April 2015). All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community care setting, where ICM is compared to non-ICM or standard care. At least two review authors independently selected trials, assessed quality, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses.We performed a random-effects meta-regression analysis to examine the association of the intervention's fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. We assessed overall quality for clinically important outcomes using the GRADE approach and investigated possible risk of bias within included trials. The 2016 update included two more

  18. Problems in Office Management: Cases in Practice

    ERIC Educational Resources Information Center

    Hemby, K. Virginia; Smith, Vincent W.

    2006-01-01

    Office managers face an increasing array of job responsibilities in today's business environment. To prepare new office administration employees and managers, educational institutions must maintain a progressive curriculum to meet position demands. Using a population of members of the Association of Professional Office Managers, this study was…

  19. Problems in Office Management: Cases in Practice

    ERIC Educational Resources Information Center

    Hemby, K. Virginia; Smith, Vincent W.

    2006-01-01

    Office managers face an increasing array of job responsibilities in today's business environment. To prepare new office administration employees and managers, educational institutions must maintain a progressive curriculum to meet position demands. Using a population of members of the Association of Professional Office Managers, this study was…

  20. Estimating clinical and economic impact in case management programs.

    PubMed

    Fetterolf, Donald; Holt, Albert E; Tucker, Travis; Khan, Nazmul

    2010-04-01

    Case management programs are commonly offered by health plans, hospitals, freestanding case management vendors, and others to various purchasers of these services. Case management programs are materially different from standard medical management or disease management programs in a number of ways. The patients have complex medical conditions combined with many other variables that tend to increase their costs and patterns of utilization. Purchasers of case management services frequently demand some form of performance guarantees as evidence that these case management programs are reducing utilization and medical costs. Inherent challenges of high variation in clinical and cost characteristics of the case management population make it difficult to develop standard return on investment performance guarantees. There are, however, other methodologies and statistical approaches to measure and evaluate program performance. We seek to outline major limiting issues that differentiate case management financial impact analyses from other clinical programs, and to define a framework for beginning a dialogue between suppliers and purchasers of these services to create a program value proposition.

  1. Sociodemographic profile of suicide attempters among the rural agrarian community of central India.

    PubMed

    Mishra, Kshirod Kumar; Gupta, Neha; Bhabulkar, Sneha

    2015-01-01

    Suicides, attempted suicides and different form of suicidal behaviors are on the rise in most part of the world. It is generally assumed that official suicidal rate are underestimated from the true rate by 20-100 % due to prevailing socio-cultural issues, religious attitude, stigma attached, and legal process involved. Attempted suicides occur 8-20 times more frequently than complete suicide. Statistics on attempted suicide or deliberate self harm are not usually available officially. All the cases of attempted suicide who were admitted and referred for psychiatric evaluation and management to a rural medical college of central India during a period of one Year (April 13-March-14), following initial recovery they were evaluated on a semi-structured performa on socio demographic profile, mode of attempt and reason for attempt. Data collected was analyzed using suitable statistical methods. Total 68 cases were evaluated during the study period. 43% of the cases were involved in farming. Among 85% of the study population pesticide consumption was the common mode of attempt, which is easily available among the agrarian community of rural India. Interpersonal conflict in the family due to indebtedness, financial loss due to crop failure was the commonest reason for attempt. Though there is reduced reporting in the incidents of suicide cases in media from this region, still quite a number of people attempt suicide due to financial constraint from crop failure, ongoing indebtedness, and poor socioeconomic condition culminating into poor mental health among the rural agrarian community of central Maharashtra.

  2. [Case management applied to the treatment of alcohol dependence].

    PubMed

    Figlie, Neliana Buzi; Laranjeira, Ronaldo

    2004-05-01

    This article aims is to conceptualize and describe the main steps in case management applied to the treatment of alcohol dependence. It is important to note the case manager functions, the importance of the first appointment, check the motivation to the treatment, some goals and activities suggestions for adherence reinforcement.

  3. Case management for special populations. Moving beyond categorical distinctions.

    PubMed

    Falik, M; Lipson, D; Lewis-Idema, D; Ulmer, C; Kaplan, K; Robinson, G; Hickey, E; Veiga, R

    1993-01-01

    Case management has evolved as a flexible, pragmatic, and compassionate strategy for improving client access and care continuity within fragmented systems of health and social services. The first-generation case management programs have been designed for various settings that serve different "target" populations with varying social, medical, and psychological needs. This proliferation of categorical case management programs is a mixed blessing. While a categorical focus reflects both historical and public financing priorities, it creates a potentially duplicative and inefficient system in an era of limited resources. As the federal government assumes a more substantial role in supporting case management, greater attention is being given to accountability--demonstrating value-added benefits and identifying best practices for structuring case management. The essential first step is reaching agreement on two critical dimensions of case management, major goals and essential services. This article, based on a review of the literature, examines the extent to which seemingly disparate programs for special populations share common attributes, and thus present opportunities for structuring client-focused rather than categorical case management programs. The authors seek to stimulate a dialogue that would lead to specification of common goals and essential services, and a cross-cutting framework for designing client-focused case management programs.

  4. Case Management in Welfare and Medicaid Programs: An Annotated Bibliography.

    ERIC Educational Resources Information Center

    Hallingby, Leigh, Comp.; And Others

    This 60-item annotated bibliography focuses on case management as it relates to welfare, Medicaid, and/or the Family Support Act of 1988. While specific definitions, types of practice, and goals of case management vary greatly, the term here refers to a strategy of coordinating or integrating services for a client or group of clients in the social…

  5. Discursive Hierarchical Patterning in Law and Management Cases

    ERIC Educational Resources Information Center

    Lung, Jane

    2008-01-01

    This paper investigates the differences in the discursive patterning of cases in Law and Management. It examines a corpus of 271 Law and Management cases and discusses the kind of information that these two disciplines call for and how discourses are constructed in discursive hierarchical patterns. A discursive hierarchical pattern is a model…

  6. A Guide to Case Management for At-Risk Youth.

    ERIC Educational Resources Information Center

    Kingsley, Christopher

    This guide addresses many of the most common questions about case management asked by employment and training administrators and practitioners. Its table of contents is organized in a question-and-answer format. The content of the guide flows directly from program administrators, practitioners, case managers, and others in the field, gathered at…

  7. Development of an Integrated Case Management Program for Vulnerable Children.

    ERIC Educational Resources Information Center

    Halfon, Neal; And Others

    1993-01-01

    Describes the development of a case management program for children at the Center for the Vulnerable Child at Children's Hospital in Oakland, California. Case management was introduced into multidisciplinary clinical programs for foster children, drug-exposed infants, and adolescent mothers and their infants. (PAM)

  8. Computer-Based Case Management for the Elderly.

    ERIC Educational Resources Information Center

    Blazyk, Stan; And Others

    1987-01-01

    Notes that economic, demographic, and political factors pressure health care providers into improving discharge planning and long-term care services for clients. Examines the application of computer technology to case management and describes a computerized, hospital-based case management program for the elderly. (Author/NB)

  9. 42 CFR 440.169 - Case management services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Case management services. 440.169 Section 440.169 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.169 Case management...

  10. Effective Case Study Methodologies in the Management of IT Courses.

    ERIC Educational Resources Information Center

    Buffington, James R.; Harper, Jeffrey S.

    Many Association to Advance Collegiate Schools of Business (AACSB) accredited schools require undergraduate Management Information Systems (MIS) majors to take a course in the management of information technology. Over half of these schools utilize case studies in the teaching of this course. Case studies are an important vehicle for teaching…

  11. Reflective practice: a framework for case manager development.

    PubMed

    Brubakken, Karen; Grant, Sara; Johnson, Mary K; Kollauf, Cynthia

    2011-01-01

    The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.

  12. Laparoscopic management of recurrent pheochromocytoma: A case report

    PubMed Central

    Garg, Harshit; Uppal, Manpreet; Sreedharan, Sreesanth Kelu; Aggarwal, Sandeep

    2016-01-01

    Recurrence of pheochromocytoma after a total adrenalectomy is uncommon. Such recurrent tumours are mostly managed by the open technique, with very few studies reporting laparoscopic management. We hereby report a case of successful laparoscopic management of a recurrent pheochromocytoma after total adrenalectomy for left adrenal pheochromocytoma. PMID:27279402

  13. Integrating behavior change theory into geriatric case management practice.

    PubMed

    Enguidanos, S

    2001-01-01

    Case management practices have continued to grow despite a lack of clear evidence of their efficacy. With the expanding segment of the elderly population, there is a critical need to develop and identify programs that will address the many needs of the aging. Geriatric Case Management has been the avenue selected by many health care providers to address these issues, focusing on maintaining health status and improving linkages with medical and community resources. Studies testing the effectiveness of these models have failed to demonstrate their effectiveness in reducing depression, reducing acute care service use, and improving or maintaining health status. The Geriatric Case Management models presented in these lack an evidence-based, theoretical framework that provides definition and direction for case management practice. This article introduces behavior change theories as a method of structuring and delineating the case management intervention. The Transtheoretical Model and the Theory of Planned Behavior are discussed and methods of integrating these theories into practice are discussed.

  14. WITHDRAWN: Case management for people with severe mental disorders.

    PubMed

    Marshall, Max; Gray, Alastair; Lockwood, Austin; Green, Rex

    2011-04-13

    Since the 1960s, in many parts of the world, large psychiatric were closed down and people were treated in outpatient clinics, day centres or community mental health centres. Rising readmission rates suggested that this type of community care may be less effective than anticipated. In the 1970s case management arose as a means of co-ordinating the care of severely mentally ill people in the community. To determine the effects of case management as an approach to caring for severely mentally ill people in the community. Case management was compared against standard care on four main indices: (i) numbers remaining in contact with the psychiatric services; (ii) extent of psychiatric hospital admissions; (iii) clinical and social outcome; and (iv) costs. Electronic searches of CINAHL (1997), the Cochrane Schizophrenia Group's Register of trials (1997), EMBASE (1980-1995), MEDLINE (1966-1995), PsycLIT (1974-1995) and SCISEARCH (1997) were undertaken. References of all identified studies were searched for further trial citations. The inclusion criteria were that studies should be randomised controlled trials that (i) had compared case management to standard community care; and (ii) had involved people with severe mental disorder mainly between the ages of 18-65. Studies of case management were defined as those in which the investigators described the intervention as 'case' or 'care' management rather than 'Assertive Community Treatment' or 'ACT'. A study was carried out to test the reliability of the inclusion criteria. Categorical data were extracted twice and then cross-checked, any disagreements being resolved by discussion. Odds ratios and the number needed to treat were estimated. Continuous data collected by a measuring instrument was only included if the instrument (i) had been described in a peer-reviewed journal; (ii) was a self-report or had been completed by an independent rater; and (iii) provided a summary score for a broad area of functioning. Normally

  15. STS-130 Launch Attempt

    NASA Image and Video Library

    2010-02-07

    NASA Associate Administrator for Space Operations Bill Gerstenmaier, center, reacts to an updated weather report during the countdown of the launch of the space shuttle Endeavour and the start of the STS-130 mission at NASA Kennedy Space Center in Cape Canaveral, Fla. on Sunday Feb. 7, 2010. Space shuttle Endeavour's launch attempt was scrubbed due to a low cloud ceiling over Kennedy Space Center. Photo Credit: (NASA/Bill Ingalls)

  16. Professional relationships and power dynamics between urban community-based nurses and social work case managers: advocacy in action.

    PubMed

    Young, Staci

    2009-01-01

    The purpose of this study was to explore how community-based case managers interface with their clients' healthcare providers and other community organizations as a function within their advocacy efforts. Case managers previously defined advocacy as occurring at individual, organizational, and community levels. The relationships they attempt to develop and maintain are consistent with case management ideology, yet this is a complex process to ensure care for vulnerable populations with many medical and socioeconomic needs. Community-based case management settings. In-depth qualitative interviews with a total of 20 nurse and social work case managers working in public housing, university-affiliated community nursing centers, local parishes, and community ministry. The case managers in this study reflected on how they interface with their clients, other healthcare providers, and community organizations on behalf of their clients. They reflect on the importance of trust and communication to facilitate this process. The advocacy work of case managers is influenced by the setting, others' perceptions of their knowledge and expertise, and power dynamics. Their ability to effectively advocate is greatly influenced by the strength of the relationships they forge. Advocacy for vulnerable clients is influenced by the existing relationship between case managers and their clients' healthcare providers. Case managers need to be persistent in their interactions with other providers to ensure that their clients have access to valuable community resources. Clear lines of communication should be established between case managers so that there is clarity around roles and expectations in service provision. Case managers should also participate in the mentoring of future health professions students so they may learn the application of advocacy work in community settings.

  17. Alcohol Consumption and Nearly Lethal Suicide Attempts.

    ERIC Educational Resources Information Center

    Powell, Kenneth E.; Kresnow, Marcie-jo; Mercy, James A.; Potter, Lloyd B.; Swann, Alan C.; Frankowski, Ralph F.; Lee, Roberta K.; Bayer, Timothy L.

    2002-01-01

    Presents a case-control study of the association between nearly lethal suicide attempts and facets of alcohol consumption; namely, drinking frequency, drinking quantity, binge drinking, alcoholism, drinking within 3 hours of suicide attempt, and age began drinking. In bivariate analyses, all measures were associated with nearly lethal suicide…

  18. Alcohol Consumption and Nearly Lethal Suicide Attempts.

    ERIC Educational Resources Information Center

    Powell, Kenneth E.; Kresnow, Marcie-jo; Mercy, James A.; Potter, Lloyd B.; Swann, Alan C.; Frankowski, Ralph F.; Lee, Roberta K.; Bayer, Timothy L.

    2002-01-01

    Presents a case-control study of the association between nearly lethal suicide attempts and facets of alcohol consumption; namely, drinking frequency, drinking quantity, binge drinking, alcoholism, drinking within 3 hours of suicide attempt, and age began drinking. In bivariate analyses, all measures were associated with nearly lethal suicide…

  19. CASE MANAGEMENT INSIDER. The Top 10 Mistakes You May Be Making In Your Case Management Department! Part 4.

    PubMed

    Cesta, Toni

    2015-10-01

    We have now completed our review of the top 10 mistakes you may be making in your case management department. I've included tips and strategies for correcting these mistakes if you are facing them in your organization. If you follow these suggestions, you will help to keep your case management practice and your department on track and moving forward!

  20. An Action Research in Young Children (3-5) with Activities on Solid Waste Management in Greece: An Attempt for Assessment.

    ERIC Educational Resources Information Center

    Apanomeritaki, Olga

    This action research project sought to increase the waste management and recycling knowledge among 20 children age 4 and 5 years enrolled in a preschool program in Thessaloniki, Greece. A structured interview was developed to assess the children's pre-intervention knowledge of waste management and recycling. It indicated that most children knew…

  1. Interdependency Management in Universities: A Case Study

    ERIC Educational Resources Information Center

    Braun, Dietmar; Benninghoff, Martin; Ramuz, Raphaël; Gorga, Adriana

    2015-01-01

    There remains uncertainty in scientific discussions regarding the governance of universities in new public management regimes in terms of who actually "rules" in the university. Apparently, a strengthened management leadership is confronted with continuing elements of academic self-regulation and professional autonomy in knowledge…

  2. Privileged Emotion Managers: The Case of Actors

    ERIC Educational Resources Information Center

    Orzechowicz, David

    2008-01-01

    Theatre provides a unique set of conditions for the management of emotions. Drawing on participant observation from one repertory theater, three university productions, and interviews with stage actors, directors, and acting instructors, I conceptualize actors as privileged emotion managers. Actors access structural resources that enable their…

  3. Interdependency Management in Universities: A Case Study

    ERIC Educational Resources Information Center

    Braun, Dietmar; Benninghoff, Martin; Ramuz, Raphaël; Gorga, Adriana

    2015-01-01

    There remains uncertainty in scientific discussions regarding the governance of universities in new public management regimes in terms of who actually "rules" in the university. Apparently, a strengthened management leadership is confronted with continuing elements of academic self-regulation and professional autonomy in knowledge…

  4. Public Management of Science Case Studies.

    ERIC Educational Resources Information Center

    American Univ., Washington, DC. Coll. of Public Affairs.

    Presented are six papers pertaining to the management of science, research, and development by federal agencies. The papers were prepared by students in a management of science course offered at the American University, Washington, D.C. Federal agencies reviewed include: National Aeronautics and Space Administration (NASA); Department of…

  5. A qualitative study of case management of children with asthma.

    PubMed

    Sterling, Yvonne M; Linville, Lisa J

    2015-01-01

    The purpose of this study was to describe the process of case management delivered to Head-off Environmental Asthma in Louisiana (HEAL) study participants. Participants' homes; community facilities (clinic and library meeting rooms, schools) in a post-Katrina environment. A qualitative descriptive study consisted of analysis of existing data that describe the case management provided by HEAL asthma counselors to 151 children, aged 4-12 years, with moderate-severe asthma, and their families. The HEAL study (2006-09) was conducted in the New Orleans area after Hurricane Katrina. Case management was intensive and comprehensive and consisted of asthma education, symptom management, addressing caretaker/participant/family issues, consistent follow-up, referrals, and goal-setting. Several factors impacted the case management process, including caretaker beliefs, accessibility, and posthurricane issues. Health care providers must recognize the complexity of case management in a postdisaster environment, consider the influence of social determinants and one's health literacy on asthma treatment adherence and outcomes, and develop models of case management to effectively manage children with asthma and their families.

  6. Optimal race strategy for a 200-m flying sprint in a human-powered vehicle: A case study of a world-record attempt.

    PubMed

    de Koning, Jos J; van der Zweep, Cees-Jan; Cornelissen, Jesper; Kuiper, Bouke

    2013-03-01

    Optimal pacing strategy was determined for breaking the world speed record on a human-powered vehicle (HPV) using an energy-flow model in which the rider's physical capacities, the vehicle's properties, and the environmental conditions were included. Power data from world-record attempts were compared with data from the model, and race protocols were adjusted to the results from the model. HPV performance can be improved by using an energy-flow model for optimizing race strategy. A biphased in-run followed by a sprint gave best results.

  7. Case Management Return on Investment: An Analysis of Naval Hospital Jacksonville’s Family Practice Clinic Case Management Program

    DTIC Science & Technology

    2005-06-01

    is experiencing an expansion of duties varying from disease management to population-based services (Wolfe, 1995). Day (1996) explained that CM...common diseases . For example, the case manager may focus on diabetic patients who require minimal healthcare intervention. The population-based CM...cord injuries, neoplasm, and end stage renal disease patients. Priority group II cases are complex cases which include high cost or high-risk

  8. An Attempt at Quantifying Factors that Affect Efficiency in the Management of Solid Waste Produced by Commercial Businesses in the City of Tshwane, South Africa

    PubMed Central

    Worku, Yohannes; Muchie, Mammo

    2012-01-01

    Objective. The objective was to investigate factors that affect the efficient management of solid waste produced by commercial businesses operating in the city of Pretoria, South Africa. Methods. Data was gathered from 1,034 businesses. Efficiency in solid waste management was assessed by using a structural time-based model designed for evaluating efficiency as a function of the length of time required to manage waste. Data analysis was performed using statistical procedures such as frequency tables, Pearson's chi-square tests of association, and binary logistic regression analysis. Odds ratios estimated from logistic regression analysis were used for identifying key factors that affect efficiency in the proper disposal of waste. Results. The study showed that 857 of the 1,034 businesses selected for the study (83%) were found to be efficient enough with regards to the proper collection and disposal of solid waste. Based on odds ratios estimated from binary logistic regression analysis, efficiency in the proper management of solid waste was significantly influenced by 4 predictor variables. These 4 influential predictor variables are lack of adherence to waste management regulations, wrong perception, failure to provide customers with enough trash cans, and operation of businesses by employed managers, in a decreasing order of importance. PMID:23209483

  9. Pediatric Emergency Department Suicidal Patients: Two-Site Evaluation of Suicide Ideators, Single Attempters, and Repeat Attempters

    ERIC Educational Resources Information Center

    Asarnow, Joan Rosenbaum; Baraff, Larry J.; Berk, Michele; Grob, Charles; Devich-Navarro, Mona; Suddath, Robert; Piacentini, John; Tang, Lingqi

    2008-01-01

    The study examines ideators, single attempters, and repeats attempters of suicide to clarify optimal strategies for emergency department management and risk assessment to help them in reducing youth suicide and suicide attempts. Depression was found to be a strong predictor of suicide/suicide attempts along with substance use, externalizing…

  10. Pediatric Emergency Department Suicidal Patients: Two-Site Evaluation of Suicide Ideators, Single Attempters, and Repeat Attempters

    ERIC Educational Resources Information Center

    Asarnow, Joan Rosenbaum; Baraff, Larry J.; Berk, Michele; Grob, Charles; Devich-Navarro, Mona; Suddath, Robert; Piacentini, John; Tang, Lingqi

    2008-01-01

    The study examines ideators, single attempters, and repeats attempters of suicide to clarify optimal strategies for emergency department management and risk assessment to help them in reducing youth suicide and suicide attempts. Depression was found to be a strong predictor of suicide/suicide attempts along with substance use, externalizing…

  11. The nursing case management computerized system: meeting the challenge of health care delivery through technology.

    PubMed

    DiJerome, L

    1992-01-01

    Does nursing case management compute? In this article, the author attempts to explain how computerizing the team plan of care and critical pathways decreases paperwork, makes it easier to develop standardized team care plans, enhances quality improvement trending, and is flexible enough to update the plan of care according to the patient's changing needs. The Nurse Case Management Computerized System puts the patient care team plan into an interactive computer program. The computer does the work of presenting the nurse with care plan options and printing a hard copy ready to implement. Use of the computer program enhances the health care team's ability to individualize the team plan of care while maintaining patient care standards. The system is also used to collect patient care data automatically and to trend for quality improvement.

  12. The effectiveness of inpatient case management. Fact or fiction?

    PubMed

    Cook, T H

    1998-04-01

    Production processes and service delivery in acute care hospitals can be fragmented. Inpatient case management has the potential to improve both processes and outcomes of hospital care. The author reports on 18 research studies that used inpatient case management as the treatment variable. These outcome studies, using case management, did not provide the evidence needed to address deficiencies in inpatient settings. However, these studies do provide clear direction for nurse administrators and nurse researchers to take concerning the next steps needed to address this critical issue.

  13. An attempt to extend the Habitat Harshness Hypothesis to tidal flats: A case study of Anomalocardia brasiliana (Bivalvia: Veneridae) reproductive biology

    NASA Astrophysics Data System (ADS)

    Corte, Guilherme Nascimento; Yokoyama, Leonardo Querobim; Amaral, A. Cecília Z.

    2014-10-01

    The Habitat Harshness Hypothesis (HHH) predicts that populations inhabiting the intertidal area of a dissipative beach should produce more gametes and have a longer reproductive cycle than those inhabiting an intermediate or reflective beach. This hypothesis was proposed for the exposed morphodynamic continuum between the reflective and dissipative states; however, no attempt has been made thus far to verify whether the HHH is valid for tidal flats. In this study, we analysed the reproductive cycle of Anomalocardia brasiliana in an intermediate beach and in a tidal flat and compared the results to determine whether the reproductive cycles of A. brasiliana were in agreement with the predictions of the HHH and to examine the possibility of extending this hypothesis to tidal flats. A continuous spawning season and synchrony between sexes were observed at both sites, although the reproductive effort was higher in the intermediate beach. The results of this first attempt did not support the extension of the HHH to tidal flats. It is possible that hypotheses that take into account only physical variables may not be the most adequate for describing environments with such a high species richness and high abundance as tidal flats. Nevertheless, other studies are necessary to confidently expand or refute the HHH with regard to tidal flats, and this topic should be considered as a priority in future investigations in sandy beach ecology.

  14. Mineral scale management. Part 1, Case studies

    Treesearch

    Peter W. Hart; Alan W. Rudie

    2006-01-01

    Mineral scale increases operating costs, extends downtime, and increases maintenance requirements. This paper presents several successful case studies detailing how mills have eliminated scale. Cases presented include calcium carbonate scale in a white liquor strainer, calcium oxalate scale in the D0 stage of the bleach plant, enzymatic treatment of brown stock to...

  15. Redesigned nursing practice: a case management model for critical care.

    PubMed

    Ritter, J; Fralic, M F; Tonges, M C; McCormac, M

    1992-03-01

    Changes within the health care system necessitate changes in nursing practice. Given the financial environment and the need to balance the cost/quality equation, case management will become increasingly important and has the potential to become the predominant care delivery system of the 1990s. This transition represents a tremendous opportunity for nursing. The CCM role offers many potential advantages and benefits for individual nurses and the profession as a whole. Nurses practicing as case managers have the opportunity to function in a highly professional, independent manner with a great deal of interdisciplinary collaboration. In addition to the challenges and satisfactions of the work itself, the nurse case manager may also enjoy a higher salary and more scheduling control and flexibility. The broader advantages of case management include its benefits to patients and institutions and its fit with current trends in the health care environment. Nurse case managers manage hospital systems to produce optimal clinical outcomes for patients in the shortest time using as few resources as possible. This approach to care delivery places nurses in a position to demonstrate the tremendous contribution they can make to achieving the institution's goal of delivering high-quality, cost-effective care. Thus, case management fits extremely well with current trends in health care financing and outcome measurement. The model described in this article illustrates one approach to implementing these important concepts in a critical care setting.

  16. Accounting for Case Manager Effects in the Evaluation of Mental Health Services.

    ERIC Educational Resources Information Center

    Ryan, Carey S.; And Others

    1994-01-01

    Explored three methods of accounting for case manager effects in tests of efficacy of mental health services (case manager as fixed factor, case manager as random factor, service effects within case manager). Results provide support for effects attributable to case managers and some support for efficacy of habilitation-rehabilitation and community…

  17. Dacryomeniscometry: an early attempt

    NASA Astrophysics Data System (ADS)

    Ho, Arthur; Papas, Eric B.; Keshavarzi, Kaykhosrow; Lum, Edward; Ehrmann, Klaus

    2000-06-01

    The pre-corneal tear layer provides an important optical as well as physiological function. Hence, the ability to assess the quality and behavior of tears, especially in dry-eye, marginal dry-eye and contact lens patients is important. While a large range of clinical tests exists for assessing tear quality, many are subjective and show poor repeatability. Since the tear meniscus is dependent on factors such as volume, viscosity and 'wettability,' we attempted to develop an optical system for imaging the tear meniscus. A basic prototype to test feasibility has been constructed. An algorithm for computing the profile of the meniscus was also developed. The methodology is described together with some examples of tear menisci imaged and analyzed.

  18. Attempted suicide and pregnancy

    PubMed Central

    Czeizel, Andrew E.

    2011-01-01

    Abstract: Background: The aim of the Budapest Monitoring System of Self-Poisoning Pregnant Women was to evaluate the potential congenital abnormality inducing effect of extremely large doses of drugs among pregnant women who attempted suicide. This system was appropriate to describe the characteristics of these pregnant women as a secondary finding from this model. Methods: All self-poisoned patients were cared for at a toxicological inpatient clinic in Budapest, between 1960 and 1993. Of a total of 1,044 pregnant women identified from the three different periods of the project, only 19 (1.8%) died. Women who survived were visited at home to reveal birth outcomes, and their exposed children were examined medically to identify congenital abnormalities and tested to estimate their cognitive-behavioral status. The previous or subsequent children of these pregnant women were used as controls with a similar examination protocol. Results: In general, self-poisoned pregnant women were young (peak age was between 18 and 20 years), 62% had their first pregnancy, 55% were unmarried, they had lower socioeconomic status, 46% were smokers and 22.5% drinkers, but depression/panic disorder occurred only among 17 pregnant women. Suicide attempts with drugs were most frequent in the fourth post-conceptional week and second month of pregnancy. In general they used smaller doses of drugs for suicide than non-pregnant age-matched women. Of 1,044 self-poisoned pregnant women, 926 had known pregnancy outcomes and 411 (44.4%) delivered live-born babies. Conclusions: The self-poisoning model appears to have several benefits (e.g., dose-response estimation of drugs) in comparison with other methods when evaluating teratogenic/fetotoxic effect of drugs. It is suggested that an international monitoring system of self-poisoned pregnant women should be established to provide a larger data base. PMID:21483214

  19. Suicide attempts and resuscitation dilemmas.

    PubMed

    Karlinsky, H; Taerk, G; Schwartz, K; Ennis, J; Rodin, G

    1988-11-01

    The conventional psychiatric opinion that suicide is a manifestation of psychiatric illness may not apply to circumstances in which suicide or the refusal of life-sustaining medical treatment results from the rational decisions of autonomous individuals. As medical technology advances, questions about the prolongation of life and the discontinuation of medical treatment have become commonplace in the medical setting. In this context, contradictions may exist between the principle of patient autonomy and that of physician responsibility. Dilemmas about treatment decisions that emerge from these conflicting perspectives are highlighted in this article. We report two cases of attempted suicide in the context, respectively, of (1) terminal illness and (2) advanced age. Some of the complex psychiatric, ethical, and legal issues related to the case reports are addressed.

  20. Putting conflict management into practice: a nursing case study.

    PubMed

    Vivar, Cristina García

    2006-04-01

    This paper is intended to put knowledge in conflict management into practice through reflecting on a nursing case study. Nursing organizations are particularly vulnerable to conflict as the context of nurses' work may be difficult and stressful. Power conflict is argued to be an important source of tension within nursing units. Learning to manage conflict at an early stage is therefore crucial to the effective functioning of nursing organizations. A nursing case study that illustrates power conflict in an oncology nursing unit is displayed and reflection on conflict management from the case is provided. There is no appropriate or inappropriate strategy to deal with conflict. However, detecting initial symptoms of conflict and adopting the most effective behaviour to conflict resolution is essential in nursing units. Further nursing education in conflict management for staff nurses and nurse managers is greatly needed.

  1. Preparing health care organizations for successful case management programs.

    PubMed

    Bonvissuto, C A; Kastens, J M; Atwell, S R

    1997-01-01

    This article reports the results of a study of four hospital-based providers in varying stages of implementing case management programs. Three of the providers had most of the necessary elements in place to ensure success, such as a mix of reimbursement sources, an effective and integrated information management system, a full range of clinical services, and continuous quality improvement programs. The authors make several suggestions for key activities that must be pursued by any health care organization seeking to implement a case management program in an era of managed care, tightening reimbursement, and consumer demand for quality care. These include the need to (a) organize essential case management functions under a centralized structure; (b) set realistic, quantifiable targets, and (c) design a communications plan for the program.

  2. The employer's case for health management.

    PubMed

    Coulter, Christopher H

    2006-01-01

    Employers' past solutions to rising health benefit costs--adopting managed care strategies, cost shifting to employees and reducing benefits-are no longer effectively controlling costs and are depressing the value of health benefits for employee recruitment and retention. An alternative strategy is to implement health management approaches that improve the health status of employees. These programs reduce medical costs and have a documented positive impact on workers' compensation, disability costs, absenteeism and productivity. Further, this approach is complementary to health care consumerism as a strategy for health improvement and benefit cost reduction and results in improved employee health, outlook and satisfaction.

  3. Medical postoperative management of massive conjunctival prolapse: a case report.

    PubMed

    Serrano, F G; Mora, L M

    1990-03-01

    A severe case of conjunctival prolapse secondary to a posttraumatic carotid-cavernous fistula is presented. Management with a humid chamber and topical ointments obviated surgical intervention that might have compromised the inferior cul de sac.

  4. Nurse's Breakout Session Injury/Illness Case Management

    NASA Technical Reports Server (NTRS)

    Hesselgesser, Connie

    2001-01-01

    An overview of the work related injury and illness case management model developed at the Johnson Space Center was presented. The major accomplishments and the challenges of implementation were discussed.

  5. Effectiveness of Case Management for Homeless Persons: A Systematic Review

    PubMed Central

    de Vet, Renée; van Luijtelaar, Maurice J. A.; Brilleslijper-Kater, Sonja N.; Vanderplasschen, Wouter; Beijersbergen, Mariëlle D.

    2013-01-01

    We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness. PMID:23947309

  6. The introduction of case management on a rehabilitation floor.

    PubMed

    Waterman, H; Waters, K; Awenat, Y

    1996-11-01

    An exchange for 1 day a week between a clinical nurse specialist and a lecturer gave rise to the opportunity to evaluate the introduction of case management on a newly created rehabilitation floor at an elderly care hospital. The aims of the study were to examine the feelings and concerns of new case managers, their conception of case management and their perceived educational needs. Qualitative research methods were employed to achieve the aims. Rigour was addressed, in part, through concurrent analysis of data with data collection, which encouraged probing of issues important to research participants. Thematic categories are presented under the headings: 'structure' and 'process'. The data collected revealed vividly that, as with any change, the people involved experienced anxieties and/or confusion over their new roles, but that some of the problems arose from the relocation of staff when the rehabilitation floor was established. Despite these difficulties, there was general enthusiasm for the potential of case management.

  7. Effectiveness of case management for homeless persons: a systematic review.

    PubMed

    de Vet, Renée; van Luijtelaar, Maurice J A; Brilleslijper-Kater, Sonja N; Vanderplasschen, Wouter; Beijersbergen, Mariëlle D; Wolf, Judith R L M

    2013-10-01

    We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness.

  8. Role of Academic Managers in Workload and Performance Management of Academic Staff: A Case Study

    ERIC Educational Resources Information Center

    Graham, Andrew T.

    2016-01-01

    This small-scale case study focused on academic managers to explore the ways in which they control the workload of academic staff and the extent to which they use the workload model in performance management of academic staff. The links that exist between the workload and performance management were explored to confirm or refute the conceptual…

  9. Role of Academic Managers in Workload and Performance Management of Academic Staff: A Case Study

    ERIC Educational Resources Information Center

    Graham, Andrew T.

    2016-01-01

    This small-scale case study focused on academic managers to explore the ways in which they control the workload of academic staff and the extent to which they use the workload model in performance management of academic staff. The links that exist between the workload and performance management were explored to confirm or refute the conceptual…

  10. Management of dental implant fractures. A case history.

    PubMed

    Al Quran, Firas A M; Rashan, Bashar A; Al-Dwairi, Ziad N

    2009-01-01

    The widespread use of endosseous osseointegrated implants to replace missing natural teeth increases the chances of implant complications and failures, despite the high initial success rate reported in the literature. Implant fracture is one possible complication that results in ultimate failure of the dental implant. Such a complication poses a management crisis even for the most experienced clinician. This article reports on a case of implant fracture, its possible causes, and how the case was managed.

  11. Time management for case managers--so much work, so little time.

    PubMed

    Cesta, Toni

    2014-08-01

    The world of a case manager is a busy one, and you may not have all the resources you need each and every day. If you can maintain a routine it will make the workload more manageable for you and will allow room for those surprises that invariably happen. Whether you are a new or a seasoned case manager, organizing your workload can always help smooth out the rough edges in anyone's hectic day!

  12. Anesthetic management of a case of Sanjad-Sakati syndrome

    PubMed Central

    Alshoaiby, AN; Rafiq, M; Jan, R; Shahbaz, M; Faqeeh, A; Alsohaibani, MA

    2016-01-01

    Sanjad-Sakati syndrome is an autosomal recessive genetic disorder first described in Saudi Arabia. Anesthetic management of these patients is challenging due to airway difficulties, electrolyte imbalance, growth and mental retardation, and seizures. The anesthetic management of the syndrome is described in this case report. PMID:27833494

  13. Essentials of Enrollment Management: Cases in the Field

    ERIC Educational Resources Information Center

    Black, Jim

    2004-01-01

    In AACRAO's new publication Essentials of Enrollment Management: Cases in the Field experts in enrollment management representing all types of institutions reveal the evolution of the enrollment strategies implemented at their institutions, the results, and the lessons learned. The introductory chapter provides an overview of themes and models…

  14. Conservative management of vesicouterine fistula. A report of 2 cases.

    PubMed

    Ravi, Bala; Schiavello, Henry; Abayev, David; Kazimir, Michal

    2003-12-01

    Vesicouterine fistulas usually require laparotomy for repair. A vesicouterine fistula occurring after cesarean section was successfully managed hormonally. In another case it developed in association with an intrauterine device and was repaired translaparoscopically. Laparotomy may be avoidable in the management of a vesicouterine fistula.

  15. Essentials of Enrollment Management: Cases in the Field

    ERIC Educational Resources Information Center

    Black, Jim

    2004-01-01

    In AACRAO's new publication Essentials of Enrollment Management: Cases in the Field experts in enrollment management representing all types of institutions reveal the evolution of the enrollment strategies implemented at their institutions, the results, and the lessons learned. The introductory chapter provides an overview of themes and models…

  16. [Crisis management in clinical nursing practice: a case analysis].

    PubMed

    Kuo, Chun-Hua; Yen, Miaofen

    2006-02-01

    The clinical medical environment is highly changeable. Hospital administrators must face and resolve various kinds of crisis. Effective crisis management can preempt or reduce negative impacts on an organization, as well as reduce unnecessary costs and bolster an organization's reputation. This article uses actual cases to describe crisis management with reference to four stages of crisis development and 6M models, providing instruction from experience, Educational growth, and enhanced crisis handling and crisis management skills.

  17. Consequences of clinical case management for caregivers: a systematic review.

    PubMed

    Corvol, Aline; Dreier, Adina; Prudhomm, Joachim; Thyrian, Jochen René; Hoffmann, Wolfgang; Somme, Dominique

    2017-05-01

    Informal caregivers are deeply involved in the case management process. However, little is known about the consequences of such programs for informal caregivers. This systematic literature review, reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, addressed the consequences of clinical case management programs, whether positive or negative, for caregivers of frail older persons or persons with dementia. We systematically identified and analyzed published randomized trials and quasi-experimental studies comparing case management programs to usual care, which discussed outcomes concerning caregivers. Sixteen studies were identified, and 12 were included after quality assessment. Seven identified at least one positive result for caregivers, and no negative effect of case management has been found. Characteristics associated with positive results for caregivers were a high intensity of case management and programs specifically addressed to dementia patients. Despite the numerous methodological challenges in the assessment of such complex social interventions, our results show that case management programs can be beneficial for caregivers of dementia patients and that positive results for patients are achieved without increasing caregivers' burden. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  18. Case management considerations of progressive dementia in a home setting.

    PubMed

    Pierce, Mary Ellen

    2010-01-01

    Nursing theory, research, and best practice guidelines contribute substantially to the field of dementia care. Interventional plans are challenged most by those dementias considered progressive and deteriorative in nature, requiring ongoing reassessment and modification of care practices as the clinical course changes. The purpose of this article is to provide guidelines for case managers in the development of effective, individualized care plans for clients with progressive dementia residing in a home setting. The application of these guidelines is illustrated through the presentation of an actual case. The practice setting is a private home in the Pacific Northwest. Geriatric case management is provided by an RN case manager. Progressive dementia presents challenges to home care. Professional case management using comprehensive, holistic assessment, collaborative approaches, and best practice fundamentals serve to create an effective, individualized plan of care. The increasing geriatric population presents great opportunities for case managers in strategic management for creating successful home care models in clients with progressive dementia. Use of nursing diagnoses, dementia research, and collaborative approaches with families and other medical providers creates a viable alternative for clients with progressive dementia.

  19. Cracked teeth--treatment rationale and case management: case reports.

    PubMed

    Liu, H H; Sidhu, S K

    1995-07-01

    The treatment rationale for, and successful management of, six teeth with cracks in the form of incomplete vertical fractures are reported. Further crack propagation was prevented by placement of either stainless steel orthodontic bands or aluminum or acrylic resin provisional crowns, and endodontic treatment was subsequently carried out. The teeth were restored with intraradicular amalgam cores and complete veneer crowns. The teeth were reexamined periodically for up to 3.5 years after treatment. During the period of review, all teeth remained asymptomatic.

  20. Economic assessment of managing processionary moth in pine forests: a case-study in Portugal.

    PubMed

    Gatto, Paola; Zocca, Alessia; Battisti, Andrea; Barrento, Maria João; Branco, Manuela; Paiva, Maria Rosa

    2009-02-01

    This paper assesses the private and social profitability of current strategies for managing processionary moth (Thaumetopoea pityocampa) in Portuguese pine forests, looking at economic and environmental costs and benefits. Costs include the expenses for forest treatment and the social costs of threats to human health (dermatitis amongst others); benefits are assessed in terms of both revenue and social benefits such as carbon fixation and recreation. The evaluation was done using Cost Benefit Analysis (CBA) as an analytical framework. While this tool is currently applied to forest and environmental assessment and specific applications to pest management strategies are to be found in agricultural economics, rather few attempts have been made in the field of forest pest management. In order to assess and compare with--without options, a case-study was analysed for the Setúbal Peninsula, south of Lisbon, an area where extensive stands of maritime pine (Pinus pinaster) grow. The exercise has shown that CBA can be a valuable tool for assessing the economic and social profitability of pest management. The results demonstrate that the loss of revenues in the no-management option is not sufficient to make pest management profitable for private forest owners in the short-term. Conversely, a social profit is gained as pest management minimizes health risks for humans and avoids possible recreational losses.

  1. Surviving a Suicide Attempt

    PubMed Central

    Al-Harrasi, Ahmed; Al Maqbali, Mandhar; Al-Sinawi, Hamed

    2016-01-01

    Suicide is a global phenomenon in all regions of the world affecting people of all age groups. It has detrimental consequences on patients, their families, and the community as a whole. There have been numerous risk factors described for suicide including mental illness, stressful life situations, loss of social support, and general despair. The association of suicide with Islam has not been extensively studied. The common impression from clinical practice is that being a practicing Muslim reduces the risk of suicide. Another factor associated with suicide is starting a patient on antidepressants. However, this has been questioned recently. This report describes a middle-aged man with depression and multiple social stressors who survived a serious suicide attempt. The discussion will focus on the factors that lead him to want to end his life and the impact of the assumed protective factors such as religious belief and family support on this act of self-harm. Such patients can be on the edge when there is an imbalance between risk factors (such as depression, insomnia, and psychosocial stressors) and protective factors (like religious affiliation and family support). All physicians are advised to assess the suicide risk thoroughly in patients with depression regardless of any presumed protective factor. PMID:27602193

  2. An attempt to replace an ivermectin-resistant Cooperia spp. population by a susceptible one on grazing pastures based on epidemiological principles and refugia management.

    PubMed

    Fiel, C A; Steffan, P E; Muchiut, S M; Fernández, A S; Bernat, G; Riva, E; Lloberas, M M; Almada, A; Homer, D

    2017-11-15

    The maintenance of anthelmintic-susceptible parasite refugia to delay the onset of anthelmintic resistance is an almost impossible effort in many grazing livestock production countries given that current refugia consist of already resistant parasites. Rather, efforts could be focused on replacing the resistant parasite refugia by susceptible parasite ones and implementing sustainable parasite control measures from then on. To this purpose, a trial was conducted to attempt to establish a new population of ivermectin-susceptible Cooperia sp. on a beef cattle farm with proven problems of ivermectin-resistant Cooperia. During two consecutive years, 82 (Year 1) and 100 (Year 2) recently weaned and parasite-free heifers were inoculated with 40,000 or 30,000 susceptible Cooperia L3, respectively, at a time when levels of resistant parasite refugia were normally low. The animals were subsequently allowed to graze on the problem pastures during autumn until the end of spring. Levels of parasitism in the animals and on pasture were monitored monthly and animals were treated with levamisole when needed. The combination of parasitological monitoring and local epidemiological knowledge was essential to determine when treatments were to be administered. No clinical signs of gastrointestinal parasitosis in the herd were observed throughout the study and unnecessary treatments were avoided. Faecal egg counts reduction tests (FECRT) and controlled efficacy tests (CET) employing worm counts were carried out at different times throughout the study to determine the clinical efficacy (FECRT) and the absolute efficacy (CET) of ivermectin, respectively. The clinical efficacy of ivermectin increased from an initial 73% to 99.4%, while the absolute efficacy increased from 54.1% to 87.5% after just two animal production cycles. The switch from a resistant parasite population to a susceptible one requires knowledge of parasitological epidemiology, especially in relation to seasonal

  3. ACUTE MANAGEMENT CONCEPTS OF THE ACROMIOCLAVICULAR JOINT: A CASE REPORT

    PubMed Central

    2012-01-01

    Acromioclavicular injuries are quite common and approaches to early management of those that are described as a Type III are controversial. The Rockwood Type III classification implies complete disruption of the acromioclavicular and coracoclavicular ligaments, resulting in inferior positioning of the scapula and, thus, the glenohumeral complex while the clavicle appears more superiorly prominent. Clinical management can include surgical or conservative techniques. This case report outlines the decision making process related to this type of injury, as applied in the diagnosis and management of 61 year‐old recreational athlete. Level of Evidence 5 (Single Case report) PMID:23091789

  4. Translating childhood tuberculosis case management research into operational policies.

    PubMed

    Safdar, N; Hinderaker, S G; Baloch, N A; Enarson, D A; Khan, M A; Morkve, O

    2011-08-01

    The control of childhood tuberculosis (TB) has been of low priority in TB programmes in high-burden settings. The objective of this paper was to describe the development and testing of tools for the management of childhood TB. The Pakistan National TB Control Programme embarked on a number of activities, including the establishment of policy guidelines for the management of childhood TB and later a guidance document, 'Case Management Desk Guide and Structured Monitoring', to demonstrate the implementation of childhood TB interventions in a programme context. Initial results showed improved case finding and treatment outcome in implementation sites compared with control districts. However, further programme attention is required to improve quality.

  5. A lesbian older adult managing identity disclosure: a case study.

    PubMed

    Jenkins, David; Walker, Charles; Cohen, Harriet; Curry, Linda

    2010-01-01

    The aim of this study was to explore the experience of an older lesbian in managing the disclosure of her sexual identity. Specifically, the team wanted to better understand the ways she managed her identity in an assisted living facility. Using a qualitative case study methodology, 2 in-depth interviews were conducted. The following 5 themes were identified in the data: keeping her own counsel, maintaining "family" connection, celebrating second chances, living outside the L box, and staying morally centered. Practice and research implications are offered and the case study is used to expand understanding of disclosure management and resiliency theory.

  6. 42 CFR 440.169 - Case management services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Case management services. 440.169 Section 440.169 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.169 Case...

  7. School Nurse Case Management: Achieving Health and Educational Outcomes

    ERIC Educational Resources Information Center

    Bonaiuto, Maria M.

    2007-01-01

    Educators and health care professionals alike understand that healthy students are likely to be successful learners. The goal of school nurse case management is to support students so that they are ready to learn. This article describes the outcomes of a 4-year process improvement project designed to show the impact of school nurse case management…

  8. Case studies in disease management for congestive heart failure.

    PubMed

    Quilty, M; Lewis, A

    1997-03-01

    Today, case management is neither science nor art. Successful programs have little in common except corporate commitment, the right people for the right job, and an understanding of the playing field. The author provides three case studies of HMOs who tried to jump into the field, with varying levels of success.

  9. Cost-Effectiveness of Case Management in Substance Abuse Treatment

    ERIC Educational Resources Information Center

    Saleh, Shadi S.; Vaughn, Thomas; Levey, Samuel; Fuortes, Laurence; Uden-Holmen, Tanya; Hall, James A.

    2006-01-01

    Objective: The purpose of this study, which is part of a larger clinical trial, was to examine the cost-effectiveness of case management for individuals treated for substance abuse in a residential setting. Method: Clients who agreed to participate were randomly assigned to one of four study groups. Two groups received face-to-face case management…

  10. Combining Cases and Computer Simulations in Strategic Management Courses

    ERIC Educational Resources Information Center

    Mitchell, Rex C.

    2004-01-01

    In this study, the author compared the effectiveness of two different strategic management course designs: one centered on case discussions and the other combining a computer-based simulation with some cases. In addition to evaluation of the research literature, the study involved experiments with six course sections composed of 130 students, Both…

  11. School Nurse Case Management: Achieving Health and Educational Outcomes

    ERIC Educational Resources Information Center

    Bonaiuto, Maria M.

    2007-01-01

    Educators and health care professionals alike understand that healthy students are likely to be successful learners. The goal of school nurse case management is to support students so that they are ready to learn. This article describes the outcomes of a 4-year process improvement project designed to show the impact of school nurse case management…

  12. A CASE STUDY OF ENVIRONMENTAL DATA MANAGEMENT

    EPA Science Inventory

    In order to support our ongoing research in watershed ecology and global climate change, we gather and analyze environmental data from several government agencies. This case study demonstrates a researcher’s approach to accessing, organizing, and using intersectoral data. T...

  13. [Pancreas divisum: endoscopic management. Case report].

    PubMed

    Martínez, Henry; Espinoza, Miguel; Huaman, César; Monge, Eduardo; Salazar, Sonia; Tapia, Abel

    2002-01-01

    This is a case report of a 19 year-old woman, with an acute recurrent pancreatitis diagnose, and pancreas divisum as anatomic alteration. An extensive evaluation including specialized labs, ERCP was done. The diagnosis is suspected during ERCP and confirmed by minor papilla injection. Treatment is directed towards relieving outflow obstruction at the level of the minor papilla, with successful results.

  14. Management of velopharyngeal disorders. A case series.

    PubMed

    Anandakrishna, G N; Gali, Sivaranjani

    2010-07-01

    Patients with acquired defects or congenital malformations of the palate exhibit disturbances in speech, including hypernasality, nasal emission, and decreased intelligibility of speech. Maxillofacial prosthetic treatment can reestablish the palatopharyngeal integrity to provide the potential for acceptable speech. This article describes a case series of patients with palatopharyngeal disorders and their treatment approaches.

  15. Management of traumatic macular holes: case report.

    PubMed

    Brasil, Oswaldo Ferreira Moura; Brasil, Oswaldo Moura

    2008-01-01

    Traumatic macular hole is a disease whose pathogenesis is not fully understood and the best treatment guideline is controversial. We report 2 cases of traumatic macular hole with different treatment approaches. In the first case, a 9-year-old boy presented with a traumatic macular hole secondary to blunt ocular trauma with a stone, and initial vision of 20/300. He underwent surgical repair and his final vision was 20/70 with hole closure after a 1 year follow-up. In the second case, a 20-year-old woman suffered a penetrating bullet wound on the left side of her forehead. The injury caused optic nerve head avulsion in the left eye with loss of light perception. The right eye had a traumatic macular hole and signs suggestive of sclopetaria chorioretinitis, with 20/60 vision. This case was initially observed and vision improved to 20/30 with reduction of the hole diameter. Vision and hole diameter remained stable after 8 months.

  16. A CASE STUDY OF ENVIRONMENTAL DATA MANAGEMENT

    EPA Science Inventory

    In order to support our ongoing research in watershed ecology and global climate change, we gather and analyze environmental data from several government agencies. This case study demonstrates a researcher’s approach to accessing, organizing, and using intersectoral data. T...

  17. Disease Management, Case Management, Care Management, and Care Coordination: A Framework and a Brief Manual for Care Programs and Staff.

    PubMed

    Ahmed, Osman I

    2016-01-01

    With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.

  18. Hospital case management and the Utilization Review Committee.

    PubMed

    Orland, Richard A

    2011-01-01

    This article describes the overall regulatory mandate governing the Utilization Review Committee (URC) in the hospital setting. General structure, function, and meeting format of the URC are important considerations. Furthermore, the URC can serve as a vital platform for medical staff leadership and case management practice to use pertinent risk-adjusted data to drive needed change at the organizational, departmental, service line, and physician level. A case history illustrates the importance of these issues. Acute care hospitals. Case management staff, medical advisors, and physician leaders play important roles in driving changes. The URC will become ever-more important in the rapidly accelerating changes, driving heightened accountability on the part of hospitals.

  19. Corporate Information Management: A Case Study

    DTIC Science & Technology

    1991-03-01

    information systems plan. [Ref. 23:p. 628] 32 E. MIS STAFF A key ingredient to any successful management information system (MIS) is an MIS staff which is...frame- work under which DoD and other departments operate, and more broadly to restore some breathing space for judgment and incentive necessary to...managec so nmuch In add~tin **Nultttrnces-tn the tradtnnaf mint .- satd a adde’- %lIit the nottce schedule contract 4 rrnt0 he 5a. it th- irst step

  20. Management case study: Tampa Bay, Florida

    USGS Publications Warehouse

    Morrison, G.; Greening, H.S.; Yates, K.K.

    2012-01-01

    Tampa Bay, Florida,USA, is a shallow,subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of sea grasses and other selected habitat types, to support estuarine-dependent faunal guilds.

  1. Species Conservation and Management: Case Studies

    USGS Publications Warehouse

    Akcakaya, H.R.; Burgman, M.A.; Kindvall, O.; Wood, C.C.; Sjogren-Gulve, P.; Hatfield, J.S.; McCarthy, M.A.

    2004-01-01

    This edited volume is a collection of population and metapopulation models for a wide variety of species, including plants, invertebrates, fishes, amphibians, reptiles, birds, and mammals. Each chapter of the book describes the application of RAMAS GIS 4.0 to one species, with the aim of demonstrating how various life history characteristics of the species are incorporated into the model, and how the results of the model has been or can be used in conservation and management of the species. The book comes with a CD that includes a demo version of the program, and the data files for each species.

  2. Psychopathology Associated with Suicide Attempts among Rural Adolescents of China

    ERIC Educational Resources Information Center

    Liu, Xianchen; Tein, Jenn-Yun; Sandler, Irwin N.; Zhao, Zhongtang

    2005-01-01

    This case control study examined the relationship between psychopathological profiles and self reported suicide attempts among rural adolescents of China. Cases consisted of 142 adolescents who reported a suicide attempt in the past 6 months in a questionnaire survey (n = 1,365). An equal number of adolescents without reporting a suicide attempt,…

  3. Psychopathology Associated with Suicide Attempts among Rural Adolescents of China

    ERIC Educational Resources Information Center

    Liu, Xianchen; Tein, Jenn-Yun; Sandler, Irwin N.; Zhao, Zhongtang

    2005-01-01

    This case control study examined the relationship between psychopathological profiles and self reported suicide attempts among rural adolescents of China. Cases consisted of 142 adolescents who reported a suicide attempt in the past 6 months in a questionnaire survey (n = 1,365). An equal number of adolescents without reporting a suicide attempt,…

  4. Case Study and Maturity Model for Business Process Management Implementation

    NASA Astrophysics Data System (ADS)

    Rohloff, Michael

    This paper presents the implementation of Business Process Management in a large international company. The business case illustrates the main objectives and approach taken with the BPM initiative. It introduces a process management maturity assessment which was developed to assess the implementation of Business Process Management and the achievements. The maturity model is based on nine categories which comprehensively cover all aspects which impact the success of Business Process Management. Some findings of the first assessment cycle are pinpointed to illustrate the benefits and best practice exchange as a result of the assessment.

  5. Medical Conditions and Nearly Lethal Suicide Attempts.

    ERIC Educational Resources Information Center

    Ikeda, Robin M.; Kresnow, Marcie-jo; Mercy, James A.; Powell, Kenneth E.; Simon, Thomas R.; Potter, Lloyd B.; Durant, Tonji M.; Swahn, Monica H.

    2002-01-01

    This population-based, case-control study examined physical illness as a risk factor for suicidal behavior. Case patients were more likely than controls to report having any serious medical conditions. Results suggest that young men with medical conditions are at increased risk for nearly lethal suicide attempts. (Contains 33 references and 3…

  6. Medical Conditions and Nearly Lethal Suicide Attempts.

    ERIC Educational Resources Information Center

    Ikeda, Robin M.; Kresnow, Marcie-jo; Mercy, James A.; Powell, Kenneth E.; Simon, Thomas R.; Potter, Lloyd B.; Durant, Tonji M.; Swahn, Monica H.

    2002-01-01

    This population-based, case-control study examined physical illness as a risk factor for suicidal behavior. Case patients were more likely than controls to report having any serious medical conditions. Results suggest that young men with medical conditions are at increased risk for nearly lethal suicide attempts. (Contains 33 references and 3…

  7. Case manager as therapy extender for cognitive behavior therapy of serious mental illness: a case report.

    PubMed

    Pinninti, Narsimha R; Schmidt, Lisa T; Snyder, Richard P

    2014-05-01

    Cognitive behavior therapy (CBT) is an evidence-based intervention for individuals with serious mental illness and potentiates standard medication management. Americans receiving publicly funded treatment for serious mental illnesses have limited access to CBT and hence we need to devise innovative ways of providing access to this important intervention. We present a case of a man who had severe disability, was medication resistant, and diagnosed with Obsessive Compulsive Disorder and Major Depressive Disorder. After being home bound for many years he was provided CBT utilizing his existing case manager as a therapy extender. The specific roles of the primary therapist and case manager as well as the improvement in quality of life of the individual are delineated. This case report opens up the possibility of further studying case managers as therapy extenders for treating serious mental illnesses.

  8. Huntington's disease: review and anesthetic case management.

    PubMed

    Cangemi, C F; Miller, R J

    1998-01-01

    Huntington's disease is a dominantly inherited progressive autosomal disease that affects the basal ganglia. Symptoms appear later in life and manifest as progressive mental deterioration and involuntary choreiform movements. Patients with Huntington's disease develop a progressive but variable dementia. Dysphagia, the most significant related motor symptom, hinders nutrition intake and places the patient at risk for aspiration. The combination of involuntary choreoathetoid movements, depression, and apathy leads to cachexia. Factors of considerable concern to the anesthesiologist who treats patients with Huntington's disease may include how to treat frail elderly people incapable of cooperation, how to treat patients suffering from malnourishment, and how to treat patients with an increased risk for aspiration or exaggerated responses to sodium thiopental and succinylcholine. The successful anesthetic management of a 65-yr-old woman with Huntington's disease who presented for full-mouth extractions is described.

  9. Adapters, Strugglers, and Case Managers: A Typology of Spouse Caregivers

    PubMed Central

    Davis, Linda Lindsey; Chestnutt, Deborah; Molloy, Margory; Deshefy-Longhi, Tess; Shim, Bomin; Gilliss, Catherine L.

    2015-01-01

    Although family home care problems are frequently described in the health care literature, the ways in which families and other informal caregivers manage those problems are not often addressed. We conducted a descriptive analysis of interviews in which spouses caring for a partner with Alzheimer’s or Parkinson’s disease were asked to describe difficult home care problems and how they managed those problems. Analysis of these interviews indicated three recurring management styles. Adapters told stories about applying pre-existing skills to manage home care problems. Strugglers told stories of reoccurring home care problems for which they had few or no management strategies. Case Managers’ interview stories focused on the challenges of finding and coordinating home care services. These findings suggest that caregiving burden might be influenced more by the caregiver’s management style than the demands of the care situation. Suggestions for tailoring support programs for the three types of caregivers are proposed. PMID:25189535

  10. Heavy Metal Risk Management: Case Analysis

    PubMed Central

    Kim, Ji Ae; Lee, Seung Ha; Choi, Seung Hyun; Jung, Ki Kyung; Park, Mi Sun; Jeong, Ji Yoon; Hwang, Myung Sil; Yoon, Hae Jung; Choi, Dal Woong

    2012-01-01

    To prepare measures for practical policy utilization and the control of heavy metals, hazard control related institutions by country, present states of control by country, and present states of control by heavy metals were examined. Hazard control cases by heavy metals in various countries were compared and analyzed. In certain countries (e.g., the U.S., the U.K., and Japan), hazardous substances found in foods (e.g., arsenic, lead, cadmium, and mercury) are controlled. In addition, the Joint FAO/WHO Expert Committee on Food Additives (JECFA) recommends calculating the provisional tolerable weekly intake (PTWI) of individual heavy metals instead of the acceptable daily intake (ADI) to compare their pollution levels considering their toxicity accumulated in the human body. In Korea, exposure assessments have been conducted, and in other countries, hazardous substances are controlled by various governing bodies. As such, in Korea and other countries, diverse food heavy metal monitoring and human body exposure assessments are conducted, and reducing measures are prepared accordingly. To reduce the danger of hazardous substances, many countries provide leaflets and guidelines, develop hazardous heavy metal intake recommendations, and take necessary actions. Hazard control case analyses can assist in securing consumer safety by establishing systematic and reliable hazard control methods. PMID:24278603

  11. Obesity weight management and bariatric surgery case management programs: a review of literature.

    PubMed

    Echols, Jennie

    2010-01-01

    The proportion of Americans with clinically severe obesity has vast implications for the nation's healthcare system since this population have twice as many chronic medical conditions as people with normal weight. Through the use of review of literature, this article (a) describes the types of weight loss programs; (b) reviews the results from studies on effectiveness of bariatric surgery; and (c) identifies recommendations for obesity and bariatric surgery case management programs. Disease management companies appear to be concentrating on general weight loss strategies associated with wellness and other condition-specific disease management products, whereas larger national healthcare companies with at-risk and insurance products offer specific bariatric surgery management products. Case management programs within healthcare systems, health management organizations, and insurance companies are frequently faced with the management of individuals with morbid obesity and, increasingly, those who are requesting or have undergone bariatric surgery. Research shows that morbid obesity is a disease that remains generally unresponsive to diet and drug therapy but appears to respond well to bariatric surgery. Research findings suggest that surgical treatment is more effective than pharmacological treatment of weight loss and the control of some comorbidities associated with obesity. The number of Americans having weight loss surgery increased by 804% between 1998 and 2004, which appears to be a driver for the recent development of obesity disease management and bariatric surgery case management programs. Although the immaturity and lack of studies citing outcomes of obesity disease and case management programs limit the identification of best practices based on outcomes, emerging practices can be identified and recommendations for case management can be formulated. In addition to primary prevention and treatment programs for obesity, this article describes program

  12. Interactive televideo and the Internet in rural case management.

    PubMed

    Redford, L J; Parkins, L G

    1997-01-01

    The purpose of this article is to stir the imagination and incite the creative energies of case managers in finding ways to capitalize on communication and information technologies to improve access to care as well as the quality of care in rural communities. Today, the general dearth of services and logistics of providing services in rural areas challenges even the most seasoned case managers. Given the current economic and political climate, it is unlikely that these challenges will lessen, particularly if we continue to pursue our more traditional approaches to case management and service delivery. Telecommunications technologies are opening exciting opportunities for changing this trajectory and expanding the role and reach of case managers, while improving access to many services. This article highlights the new and the potential applications of interactive televideo in health and human services, as well as the vast opportunities offered by the Internet. There are, however, also pitfalls we must overcome to realize the full potential of these technologies. Case managers, in their roles as advocates, coordinators, and facilitators, are ideally positioned to be on the cutting edge of these technological applications and play a catalytic role in moving rural communities into the "information age."

  13. Attempting to detect and record brushland in the northeastern United States using MSS data - Schoharie County, N.Y., as a case study

    NASA Technical Reports Server (NTRS)

    Baumann, Paul R.

    1990-01-01

    Before county and local governments will utilize satellite data extensively for landcover inventories, digital image processing techniques must be developed to identify transitional land-use conditions and create large-scale, readable land-cover maps. This study examines a satellite-based land-cover inventory done for Schoharie County, New York and reviews the problems encountered in identifying and mapping brushland - a significant transitional land use - within the county and region. Brushland throughout the Northeast represents a barometer for measuring the shift away from agricultural land use to second-home property. Detecting and locating brushland on a regular basis can greatly assist county and local government officials in planning and managing a county's future.

  14. Attempting to detect and record brushland in the northeastern United States using MSS data - Schoharie County, N.Y., as a case study

    NASA Technical Reports Server (NTRS)

    Baumann, Paul R.

    1990-01-01

    Before county and local governments will utilize satellite data extensively for landcover inventories, digital image processing techniques must be developed to identify transitional land-use conditions and create large-scale, readable land-cover maps. This study examines a satellite-based land-cover inventory done for Schoharie County, New York and reviews the problems encountered in identifying and mapping brushland - a significant transitional land use - within the county and region. Brushland throughout the Northeast represents a barometer for measuring the shift away from agricultural land use to second-home property. Detecting and locating brushland on a regular basis can greatly assist county and local government officials in planning and managing a county's future.

  15. Attempted Suicide among Iranian Population

    ERIC Educational Resources Information Center

    Sheikholeslami, Homayoun; Kani, Camellia; Ziaee, Amir

    2008-01-01

    Predictors of suicide attempts in Iran, to distinguish any similarities and differences of these predictors between suicide attempts in Iran and other developed and developing countries and to investigate the relation between general psychiatric symptoms and repetition of suicidal attempts were assessed. The validated Farsi version of the General…

  16. Defense Styles in Suicide Attempters

    ERIC Educational Resources Information Center

    Scholz, James A.

    1973-01-01

    Thirty-five serious suicide attempters, paired to neuropsychiatric controls on relevant variables, were tested within two weeks of their attempt with the Defense Mechanisms Inventory. Attempters revealed more turning-against-self defenses as hypothesized but showed no differences from controls in use of fantasized hostility. Implications for…

  17. Suicide Attempts among Drug Abusers.

    ERIC Educational Resources Information Center

    Harrsi, Rachel; And Others

    1979-01-01

    The relationship between substance abuse and suicide is indicated by high rate of attempted suicide among alcoholics and drug abusers, as well as increased likelihood of repeated attempts in these populations. This study reports on psychological characteristics of male drug suicide attempters who are in treatment for their addiction problem.…

  18. Otitis externa: management of the recalcitrant case.

    PubMed

    Selesnick, S H

    1994-05-01

    Most cases of otitis externa respond to routine treatment, however, there is a subset of patients who frequently develop otitis externa that is usually severe and recalcitrant to routine therapy. These patients include the immunocompromised, those with AIDS, transplant recipients, severe diabetics, patients treated with high dose steroids or chemotherapeutic agents, and those who are malnourished or are chronically ill. Local factors that lead to worsening of otitis externa include dermatitides and prior local irradiation. Patients who find topical therapy painful may be noncompliant with medications, and they too, may develop recalcitrant otitis externa. For successful treatment, a broad understanding of external auditory canal anatomy, the microbiology and pathophysiology of otitis externa, and available treatment options, including topical and systemic medications, must be attained. These topics are reviewed.

  19. The "wins" of change: evaluating the impact of predicted changes on case management practice.

    PubMed

    Stanton, Marietta P; Barnett Lammon, Carol Ann

    2008-01-01

    A variety of strategies were employed to identify current and future trends that would impact the practice of case management. Historical review, consultation with case management experts, literature review, and environmental scanning by practicing case managers were strategies employed to determine the impact of current and future trends on case management. The trends identified in this article have implications for case managers in a variety of settings. Case managers participating in the environmental scanning process to evaluate the impact of the identified trends on their organization included representation from acute care, home care, behavioral health, workers' compensation, and private insurance settings. The top 7 trends identified by experts in the field of case management included pay for performance, recovery audit contractors, Medicare demonstration projects, transitions of care, informatics in healthcare and case management, metrics for case management, and the impact of an aging population in case management. Practicing case managers were asked to react to these trends in terms of likelihood of occurrence in their organization and impact of these trends on their case management practice. Case management will ultimately have a higher degree of accountability for its practice if metrics to evaluate and reimbursement for case management become a reality. A multitude of performance measures exist that will be monitored and be tied to reimbursement. To ensure that agencies are accomplishing these performance measures, case management will potentially have a growing importance. Case managers perceive that these trends have a predominantly positive impact on case management.

  20. Integrated dementia care in The Netherlands: a multiple case study of case management programmes.

    PubMed

    Minkman, Mirella M N; Ligthart, Suzanne A; Huijsman, Robbert

    2009-09-01

    The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive case management programmes concerned with long-term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes.A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and case managers of the eight case management programmes. During 16 semistructured face-to-face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long-term dementia care. The programmes show overlap in terms of their vision, tasks of case managers, case management process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the case managers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of case managers, investment in a strong provider network and coherent conditions for effective inter-organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long-term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy

  1. Ductal Carcinoma In Situ of the Breast: Evaluating the Role of Radiation Therapy in the Management and Attempts to Identify Low-risk Patients.

    PubMed

    Shah, Chirag; Vicini, Frank A; Berry, Sameer; Julian, Thomas B; Wilkinson, John Ben; Shaitelman, Simona F; Khan, Atif; Finkelstein, Steven E; Goldstein, Neal

    2015-10-01

    Ductal carcinoma in situ of the breast has rapidly increased in incidence over the past several decades secondary to an increased use of screening mammography. Local treatment options for women diagnosed with ductal carcinoma in situ include mastectomy or breast-conserving therapy. Although several randomized trials have confirmed a >50% reduction in the risk of local recurrence with the administration of radiation therapy (RT) compared with breast-conserving surgery alone, controversy persists regarding whether or not RT is needed in selected "low-risk" patients. Over the past two decades, two prospective single-arm studies and one randomized trial have been performed and confirm that the omission of RT after surgery is associated with higher rates of local recurrence even after selecting patients with optimal clinical and pathologic features. Importantly, these trials have failed to consistently and reproducibly identify a low-risk cohort of patients (based on clinical and pathologic features) that does not benefit from RT. As a result, adjuvant RT is still advocated in the majority of patients, even in low-risk cases. Future research is moving beyond traditional clinical and pathologic risk factors and instead focusing on approaches such as multigene assays and biomarkers with the hopes of identifying truly low-risk patients who may not require RT. However, recent studies confirm that even low-risk patients identified from multigene assays have higher rates of local recurrence with local excision alone than would be expected with the addition of RT.

  2. Understanding the incomprehensible: a guide to the new Medicare prescription drug benefit for case managers.

    PubMed

    Marshall, Carter L

    2004-01-01

    Much of the health news over the last few months has centered on problems elderly patients encounter in obtaining and effectively using the prescription drug discount cards that became available on June 1 under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This article focuses on the next prescription drug newsmaker, Medicare Part D, that will supercede the discount cards on January 1, 2006. There are many complex issues that case managers must evaluate when assisting beneficiaries with queries about "what to do." This article attempts to clarify the "incomprehensible" twists and turns of these issues and provides access to a "Medicare Drug Prescription Benefit Calculator" that may assist the beneficiary and case manager in decision making. Case managers need to understand that there are many opposing viewpoints on this benefit, and it promises to become the subject of a major national debate. For this reason, substantial changes may occur prior to the launch of Part D. If you think discount drug cards are confusing, "you ain't seen nothin' yet!"

  3. Interdisciplinary Management of Gingivitis Artefacta Major: A Case Series

    PubMed Central

    Pattnaik, Naina; Satpathy, Anurag; Mohanty, Rinkee; Nayak, Rashmita; Sahoo, Surjeet

    2015-01-01

    Cases described here discuss interdisciplinary (periodontal and behavioral) approach in the management of rare and difficult to diagnose self-inflicted injuries of gingiva such as gingivitis artefacta major. Self-inflicted injuries to the gingiva are rare and their management by periodontal therapy alone is inadequate. Proper management of this condition requires early detection and effective psychological treatment through behavioral therapy in addition to the treatment of dental lesion. Three male patients in their twenties presented with traumatic injuries of gingiva with history of self-injury and underlying emotional disturbances. Following basic periodontal intervention, their self-inflicting behavior was confirmed on psychiatric consultation. All of them underwent cognitive behavior therapy and were able to successfully curb their self-inflicting behavior prior to any definitive dental procedures. These cases illustrate the essentiality of behavioral intervention in addition to periodontal procedures in the management of such lesions. PMID:26664762

  4. Essential case management services for young children in foster care.

    PubMed

    Zlotnick, C; Kronstadt, D; Klee, L

    1999-10-01

    A growing number of children in the United States are being placed into foster care. Past studies indicate that effective case manager interventions have helped foster families with a variety of different problems. This study enrolled a randomly selected sample of 130 children under age four who had been newly placed into foster care. The purpose of this study was to identify the services needed by foster care families and determine which services require the most case manager effort. Consistent with other research, many foster care children in this study exhibited developmental, medical and psychosocial concerns. Nevertheless, we found that it was services aimed at the foster care parents, rather than the foster care children, that required the most labor-intensive case management services.

  5. Building Perinatal Case Manager Capacity Using Quality Improvement.

    PubMed

    Fitzgerald, Elaine

    2015-01-01

    Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum.

  6. Building Perinatal Case Manager Capacity Using Quality Improvement

    PubMed Central

    Fitzgerald, Elaine

    2015-01-01

    ABSTRACT Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum. PMID:26937160

  7. A case study of nursing case management in a rural hospital.

    PubMed

    Anderson-Loftin, W; Wood, D; Whitfield, L

    1995-01-01

    This article describes the process of implementing a New England model of case management in a rural hospital and the modifications necessary in adapting an urban model to a rural setting. Nursing case management at this institution has been associated with a decrease in the length of stay by 1.7 days at an estimated cost savings of $65,932 for the 16-month study period. Case management has also been instrumental in improving quality of care through a program of continuous quality improvement and in redesigning the RN role. The vision for the future is to extend the nurse case manager role outside the hospital walls to the community in a collaborative plan that would bill nursing services through physicians' offices.

  8. Call to action: sharing our case management resources in case of an event.

    PubMed

    Powell, Suzanne K

    2012-01-01

    Disasters happen. Disaster drills are geared to bring out the worst and best of an organization's preparedness. Case management departments can be prepared, but sharing our thoughts, procedures, and resources can benefit all.

  9. Ductal Carcinoma in Situ of the Breast: Evaluating the Role of Radiation Therapy in the Management and Attempts to Identify Low-Risk Patients

    PubMed Central

    Shah, Chirag; Vicini, Frank A.; Berry, Sameer; Julian, Thomas B.; Ben Wilkinson, J.; Shaitelman, Simona F.; Khan, Atif; Finkelstein, Steven E.; Goldstein, Neal

    2015-01-01

    Ductal carcinoma in-situ (DCIS) of the breast has rapidly increased in incidence over the past several decades secondary to an increased use of screening mammography. Local treatment options for women diagnosed with DCIS include mastectomy or breast-conserving therapy (BCT). While several randomized trials have confirmed a greater than 50% reduction in the risk of local recurrence with the administration of radiation therapy (RT) compared to breast-conserving surgery (BCS) alone, controversy persists regarding whether or not RT is needed in selected ‘low-risk’ patients. Over the past two decades, two prospective single-arm studies and one randomized trial have been performed and confirm that the omission of RT after surgery alone is associated with higher rates of local recurrence even after selecting patients with the most optimal clinical and pathologic features. Importantly, these trials have failed to consistently and reproducibly identify a low-risk cohort of patients (based on clinical and pathologic features) that does not benefit from RT. As a result, adjuvant RT is still advocated in the majority of patients, even in these low-risk cases. Future research is moving beyond traditional clinical and pathologic risk factors and instead employing more modern approaches such as multi-gene assays and biomarkers with the hopes of identifying truly low-risk patients who may not require RT. However, recent studies confirm that even low-risk patients identified from multi-gene assays have higher rates of local recurrence with local excision alone than would be expected with the addition of radiation therapy. PMID:25036472

  10. Managing Bullying and Managing Difference: A Case Study of One Secondary School

    ERIC Educational Resources Information Center

    Dixon, Roz; Smith, Peter; Jenks, Chris

    2004-01-01

    Much work on school bullying focuses on developing our understanding of the various factors that contribute to bullying and its management. This case study focuses on the possible connections between parts and offers a metaperspective of one mainstream secondary school. Demonstrating that bullying and its management is embedded within the network…

  11. Case management training needs to support vocational rehabilitation for case managers and general practitioners: a survey study

    PubMed Central

    2014-01-01

    Background The use of the biopsychosocial model of health and case management for effective vocational rehabilitation (VR) has been confirmed for many health conditions. While Case and Condition Managers (CCMPs) use this approach in their everyday work, little is known about their views on training needs. A review of the training curriculum for General Practitioners’ (GPs) revealed little training in VR and the biopsychosocial model of care. This study aims to identify Case and Condition Managers and GPs perceptions of their training needs in relation to employability and VR. Methods 80 Case and Condition Managers and 304 GPs working in NHS Lanarkshire, providing a comparison group, were invited to participate in this study. A self-completion questionnaire was developed and circulated for online completion with a second round of hardcopy questionnaires distributed. Results In total 45 responses were obtained from CCMPs, 5 from occupational health nurses (62% response rate) and 60 from GPs (20% response rate). CCMPs and the nursing group expressed a need for training but to a lesser extent than GP’s. The GP responses demonstrated a need for high levels of training in case/condition management, the biopsychosocial model, legal and ethical issues associated with employment and VR, and management training. Conclusions This survey confirms a need for further training of CCMPs and that respondent GPs in one health board are not fully equipped to deal with patients employability and vocational needs. GPs also reported a lack of understanding about the role of Case and Condition managers. Training for these professional groups and others involved in multidisciplinary VR could improve competencies and mutual understanding among those advising patients on return-to-work. PMID:24884477

  12. Attempted suicide among Iranian population.

    PubMed

    Sheikholeslami, Homayoun; Kani, Camellia; Ziaee, Amir

    2008-08-01

    Predictors of suicide attempts in Iran, to distinguish any similarities and differences of these predictors between suicide attempts in Iran and other developed and developing countries and to investigate the relation between general psychiatric symptoms and repetition of suicidal attempts were assessed. The validated Farsi version of the General Health Questionnaire-28 (GHQ-28) was used to assess multiple dimensions of quality of life of suicide attempters as depression, anxiety, social dysfunction, and somatic symptoms. Pivotal differences emerged in the clinical profiles of suicide attempters living in a developing country versus developed countries. In developing countries, those who attempt suicides are more likely to have no psychiatric disorder and are less likely to have used alcohol as part of the suicide attempt, but are more likely to have been assaulted physically or verbally. The results on the GHQ-28 indicate that the process through which individuals move from suicidal thought to action may decrease multiple dimensions of quality of life.

  13. The business of for-profit case management.

    PubMed

    Cress, C

    1992-01-01

    The growing number of older Americans is creating a major market for home care and case management services. Large corporations are entering the field to cash in on the beckoning profits. Individuals who are moving from not-for-profit case management agencies to start their own for-profit businesses bring solid values and much needed experience. However, they must learn to respect their knowledge for its financial worth and to apply solid business skills if they are to succeed against the large diversified corporations entering the field.

  14. Care for the case manager: balancing your wheel of life.

    PubMed

    Crowell, D M

    1998-01-01

    The case manager's role in our complex health care system is demanding and draining without some self-reflective attention. The Wheel of Life is a key tool for individuals to assess how well they are leading a fully balanced life. The eight aspects of a balanced life--values, self-care, work, relationships, leisure, relaxation, exercise, and centering--are explained and discussed. A self-reflective activity is presented that encourages readers to assess their current life balance. This focused clarification of personal and professional life will facilitate a more fully balanced life with rewards for case managers as individuals, and for their family, clients, and the health care organization.

  15. [Case management. The nursing business of care or cost].

    PubMed

    Sandhu, B K; Duquette, A; Kérouac, S; Rouillier, L

    1992-01-01

    Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management.

  16. Giant Inguinal Herniae Managed by Primary Repair: A Case Series

    PubMed Central

    Anand, Madhur; Naku, Narang; Hajong, Debobratta; Singh, K Lenish

    2017-01-01

    Giant inguinal hernia are usually found in developing countries due to delay in seeking medical attention. The management of such hernias may sometimes require procedures to increase the intra-peritoneal capacity prior to the repair of the giant hernia. Otherwise patients may develop abdominal compartment syndrome leading to various unwanted complications. Primary repair of giant hernias are possible in some cases without having significant post-operative complications. In this present case series, we have managed a total of four patients of giant inguinal hernia by primary repair without much post-operative complications. PMID:28384934

  17. Community response to low-level radioactive waste: A case study of an attempt to establish a waste reduction and incineration facility

    SciTech Connect

    Bord, R.J.; Ponzurick, P.J.; Witzig, W.F.

    1986-01-01

    The Federal Low-Level Radioactive Wast Policy Act of 1980 specified a 1986 deadline for the establishment of state and regional low-level radioactive waste disposal sites. There is little optimism that the deadline will be met. Morris K. Udall has introduced Bill HR 1083 in Congress which proposes extending the deadline to 1993 and specifying a 40 percent reduction in the volume of wastes shipped. Waste volume can be reduced through incineration and compaction technologies. However, it may be as difficult to convince communities that a waste treatment facility is a good investment as it is to convince them that a disposal site is worth having. In other words, the waste volume reduction argument may ultimately depend on cutbacks in the nuclear industry. This research reports one community's response to the possibility of a local low-level radioactive waste compaction and incineration facility. The case is especially interesting because the community needs new industries and has a history of living with a nuclear materials facility. In spite of that the community's response was quite negative, fueled by a vocal local opposition group and anti-nuclear activists.

  18. A disease management case study in infectious disease.

    PubMed

    Wert, S M

    1996-01-01

    One of the earliest attempts at risk sharing between a managed-care organization and a pharmaceutical company is the infectious disease management program developed since late 1993 by Intergroup of Arizona and Eli Lilly and Company (Indianapolis, Indiana) in conjunction with the Center for Pharmaceutical Economics at The University of Arizona (Tucson, Arizona) and other entities. In the first phase of the program, protocols were built around eight infectious disease states, and it was recognized that second-line antibiotics were often prescribed when more economical first-line antibiotics would be equally effective. The second phase of the program emphasized developing treatment algorithms focused on patient outcomes, using merged medical and pharmacy claims databases to determine the effects of the antibiotic changes. To implement the program successfully, some significant shifts in corporate, medical, and patient mind-sets had to be addressed. A primary goal was to encourage a movement from a rebate, volume-driven, cost structure to a shared-risk, appropriate-use, reimbursement method in which both managed-care and the pharmaceutical company incentives could mesh as far as possible. Over the long term, it is hoped that this project will lay the groundwork for other disease management programs for high-impact, frequently occurring diseases.

  19. Complete tracheal rupture after a failed suicide attempt.

    PubMed

    Costache, Victor S; Renaud, Claire; Brouchet, Laurent; Toma, Tudor; Le Balle, François; Berjaud, Jean; Dahan, Marcel

    2004-04-01

    Tracheal rupture is life-threatening and its management poses a considerable challenge to both anesthesiologists and surgeons. We report the case of a 44-year-old patient with a complete tracheal rupture after a failed suicide attempt by hanging. A rare bilateral injury of the laryngeal nerves was associated. An original tracheal intubation was performed using the video unit for thoracoscopy. The severity of the lesions required the placement of a tracheostomy cannula after the tracheal repair. The postoperative course was uneventful. The patient was discharged on the 12th day, with a remaining moderate dysphonia.

  20. Assessing infant suck dysfunction: case management.

    PubMed

    Marmet, C; Shell, E; Aldana, S

    2000-11-01

    Based on this more thorough assessment, the lactation consultant may be able to identify all of the factors contributing to this complex case. In some situations, her skilled interventions will suffice once the underlying problem is addressed. Occasionally, she will identify a factor that falls outside of her area of expertise; when this happens, she must make the appropriate referrals. For example, a referral to a physician for a frenotomy or suspected neurological or other medical problem is appropriate. It is clear that because Baby E's problems were not resolved after 6 weeks of concerned effort, something was missed. It would certainly be appropriate for the lactation consultant to refer the dyad to another lactation consultant who has more expertise in handling clinically challenging breastfeeding problems. If possible, the referring lactation consultant should accompany the dyad so that she can improve her clinical skills. Assuming Baby E does not have underlying medical problems, the most likely causes of Baby E's difficulties are anatomical variation and/or sucking dysfunction. Because the baby is so fussy, it also would be wise to consider the possibility of allergies or food tolerance. Our first rule is " Feed the baby." The second rule is " Correct or work on correcting the problem or problems." Our goal is to achieve exclusive breastfeeding or as close an approximation as possible. We almost never give up on this goal, but we do educate the mother and work professionally with her choices. Until the baby is breastfeeding well, the lactation consultant will probably need to instruct the mother to continue using a pump ( preferably a hospital-grade, electric, bilateral pump). The mother should use the pump physiologically, pumping as many times a day as the baby would breastfeed. As soon as the situation improves, the mother should be instructed to wean gradually from the pump and any other breastfeeding equipment she is using. The goal should always be

  1. MMP3 and TIMP2 gene variants as predisposing factors for Achilles tendon pathologies: Attempted replication study in a British case-control cohort.

    PubMed

    El Khoury, Louis; Ribbans, William J; Raleigh, Stuart M

    2016-09-01

    Variants within the MMP3 (rs679620) and TIMP2 (rs4789932) genes have been associated with the risk of Achilles tendon pathology (ATP) in populations from South Africa and Australia. This study aimed to determine whether these variants were associated with the risk of ATP in British Caucasians. We recruited 118 cases with ATP, including a subset of 25 individuals with Achilles tendon rupture (RUP) and 131 controls. DNA samples were isolated from saliva and genotyped using qPCR. For the TIMP2 rs4789932 variant we found a significant (p = 0.038) difference in the genotype distribution frequency between males with ATP (CC, 39.4%; CT, 43.7%; TT, 16.9%) compared to male controls (CC, 20.7%; CT, 59.8%; TT, 19.5%). We also observed a difference in the TIMP2 rs4789932 genotype distribution between males with rupture compared to male controls (p = 0.038). The MMP3 rs679620 GG genotype was found to be overrepresented in the Achilles tendon rupture (RUP) group (AA, 24.0%; AG, 32.0%; GG, 44.0%) compared to controls (AA, 26.7%; AG, 54.2%; GG, 19.1%). In conclusion, the CT genotype of the TIMP2 rs4789932 variant was associated with lower risk of ATP in males. Furthermore, while we revealed differences for both variants in genotype distribution between the RUP and control groups, the sample size of the RUP group was small and confirmation would be required in additional cohorts. Finally, although both the TIMP2 rs4789932 and MMP3 rs679620 variants tentatively associated with ATP, there were differences in the direction of association compared to earlier work.

  2. Case I: Managing people--the case of the frustrated faculty member.

    PubMed

    Glickman, Gerald N; Comer, Robert W; Filler, Steven J; Fine, James Burke

    2002-04-01

    Managing people is a continuing leadership challenge. The foundation discipline for managing people relates to human resource management and faculty development in academic settings. In human resource management, administrators are challenged to balance the needs of individuals and the expectations of the organization for the mutual benefit of both. A primary goal of management is to lead and develop people and manage the organization in alignment with the mission and vision of the organization. The purpose of this paper is, first, to present an overview of human resource management and faculty development fundamentals including motivating, mentoring, and performance counseling. Second, a hypothetical case is presented for readers to apply theory to situation. Finally, the case is analyzed by reviewing central issues and the management concepts that may apply to the scenario. These include managing resources, mentoring, motivation, and development. In this case-based analysis, Dr. Orsten is a junior faculty member employed in a developing school. With a shortage of faculty in her field, she succumbs to the pressures of teaching and administration at the expense of her own professional advancement through research. The tenure clock is ticking, however, and Dr. Orsten has serious doubts about her ability to redirect her priorities and earn tenure. Dr. Hightower, the Associate Dean, also faces a dilemma: there is a shortage of faculty in Dr. Orsten's specialty, and the system is poised to exercise the "up-or-out" option.

  3. Student Affairs Case Management: Merging Social Work Theory with Student Affairs Practice

    ERIC Educational Resources Information Center

    Adams, Sharrika D.; Hazelwood, Sherry; Hayden, Bruce

    2014-01-01

    Case management is a functional area in higher education and student affairs that emerged after the mass shootings at Virginia Tech in 2007. Although new to higher education, case management emerged from established social work practice. This article compares social work theory and case management standards with a new case management model for…

  4. Student Affairs Case Management: Merging Social Work Theory with Student Affairs Practice

    ERIC Educational Resources Information Center

    Adams, Sharrika D.; Hazelwood, Sherry; Hayden, Bruce

    2014-01-01

    Case management is a functional area in higher education and student affairs that emerged after the mass shootings at Virginia Tech in 2007. Although new to higher education, case management emerged from established social work practice. This article compares social work theory and case management standards with a new case management model for…

  5. Evaluation of Probation Case Management (PCM) for Drug-Involved Women Offenders

    ERIC Educational Resources Information Center

    Chan, Monica; Guydish, Joseph; Prem, Rosemary; Jessup, Martha A.; Cervantes, Armando; Bostrom, Alan

    2005-01-01

    Based on availability of case management services, drug-involved women offenders entered either a probation case management (PCM) intervention(n = 65) or standard probation(n = 44). Participants were placed in the case management condition until all slots were filled, then placed in standard probation until case management slots opened.…

  6. [Rare side effects in management of hyperthyroidism. Case report].

    PubMed

    Sohár, Gábor; Kovács, Mónika; Györkös, Andrea; Gasztonyi, Beáta

    2016-05-29

    The authors present the case history of a patient suffering from hyperthyroidism. The diagnostic procedures revealed the presence of propylthiouracyl induced vasculitis with renal involvement, that recovered completely after the withdrawal of propylthiouracyl and corticosteroid treatment. Thereafter, the patient was treated with thiamasol, that caused agranulocytosis with fever. After transient litium carbonate therapy a succesful thyreoidectomy was performed. Cumulative serious side effects of antithyroid drugs are rare. This case highlights some of the challenges and complications encountered in the management of hyperthyroidism.

  7. Reasons for Attempted Suicide in Later Life

    PubMed Central

    Van Orden, Kimberly A.; Wiktorsson, Stefan; Duberstein, Paul; Berg, Anne Ingeborg; Fässberg, Madeleine Mellqvist; Waern, Margda

    2014-01-01

    Objectives Using the Interpersonal Theory of Suicide as a guiding framework, we investigated older adults' causal attributions for suicidal behavior. We hypothesized that older adults who attributed their suicidal behavior to thwarted belongingness or perceived burdensomeness would be more likely to use more immediately lethal means and to re-attempt suicide during the 12-month follow-up. Design Prospective cohort study in western Sweden. Participants A total of 101 older adults who presented to medical emergency rooms for suicide attempts. Measurements Participants were asked why they attempted suicide. Results Attributions included: a desire to escape (n=29), reduced functioning and autonomy (n=24), psychological problems, including depression (n=24), somatic problems and physical pain (n=16), perceived burdensomeness (n=13), social problems that reflected either thwarted belongingness or family conflict (n=13) and lack of meaning in life (n=8); 41 participants provided more than one reason. No specific reason was given by 28 participants, 15 of whom reported not understanding or remembering why they attempted suicide and 13 reported simply wanting to die (or go to sleep and not wake up). As hypothesized, patients who attributed the attempt to thwarted belongingness were more likely to use more immediately lethal means for their index attempt and were more likely to re-attempt during follow-up. This was not the case for those reporting burdensomeness. Conclusions People who attribute suicide attempts to thwarted belongingness use more lethal methods and have a poorer prognosis. Replications across diverse cultural settings are needed to determine whether attributing suicide attempts to thwarted belongingness may warrant increased monitoring. PMID:25158916

  8. Reasons for attempted suicide in later life.

    PubMed

    Van Orden, Kimberly A; Wiktorsson, Stefan; Duberstein, Paul; Berg, Anne Ingeborg; Fässberg, Madeleine Mellqvist; Waern, Margda

    2015-05-01

    Using the Interpersonal Theory of Suicide as a guiding framework, we investigated older adults' causal attributions for suicidal behavior. We hypothesized that older adults who attributed their suicidal behavior to thwarted belongingness or perceived burdensomeness would be more likely to use more immediately lethal means and to re-attempt suicide during the 12-month follow-up. Prospective cohort study in western Sweden. A total of 101 older adults who presented to medical emergency rooms for suicide attempts. Participants were asked why they attempted suicide. Attributions included: a desire to escape (N = 29), reduced functioning and autonomy (N = 24), psychological problems, including depression (N = 24), somatic problems and physical pain (N = 16), perceived burdensomeness (N = 13), social problems that reflected either thwarted belongingness or family conflict (N = 13), and lack of meaning in life (N = 8); 41 participants provided more than one reason. No specific reason was given by 28 participants, 15 of whom reported not understanding or remembering why they attempted suicide and 13 reported simply wanting to die (or go to sleep and not wake up). As hypothesized, patients who attributed the attempt to thwarted belongingness were more likely to use more immediately lethal means for their index attempt and were more likely to re-attempt during follow-up. This was not the case for those reporting burdensomeness. People who attribute suicide attempts to thwarted belongingness use more lethal methods and have a poorer prognosis. Replications across diverse cultural settings are needed to determine whether attributing suicide attempts to thwarted belongingness may warrant increased monitoring. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  9. Case management of childhood tuberculosis in children's hospitals in Khartoum.

    PubMed

    Osman, T; El Sony, A

    2014-07-08

    No published information is available on the case management of childhood tuberculosis (TB) in Sudan. The aim of this study was to describe the case management of childhood TB in 4 children's hospitals in Khartoum State, Sudan. Data on 467 children aged 0-14 years registered in 2009 were collected from patient records; 52.9% males and 53.0% aged 5-14 years. Most cases were registered as new cases (89.5%) and most had pulmonary TB (72.4%). Of all cases, 31.0% had sputum smear microscopy done, 35.8% had X-ray and none had a record of being culture confirmed. Category III regimen was given to 58.5%. Reported outcomes were: cured (1.5%), completed treatment (14.6%), transferred out (13.1%), default (17.3%), death (4.3%) and treatment failure (0.6%). Age was significantly associated with treatment outcome, while sex, type of patient, site of TB and treatment category were not significant. Case management of childhood TB is suboptimal in this region.

  10. Case studies illustrating the management of trigeminal neuropathic pain using topical 5% lidocaine plasters

    PubMed Central

    Yilmaz, Zehra; Renton, Tara

    2013-01-01

    Chronic trigeminal pain, with its severe related functional problems, is difficult to treat. Treatment is often empirically based on medications used for other chronic pain conditions. Systemic sodium channel and calcium channel blocking agents may cause a multitude of complications that are often poorly tolerated by the patient. Aim: The aim of this case report was to assess the efficacy of topical 5% lidocaine plasters in reducing pain and reducing adjuvant medication in patients with orofacial neuropathic pain. Method: Fourteen patients with chronic orofacial pain conditions referred to the oral surgery department were instructed to wear 5% lidocaine plasters for 12 hours each day over the painful area. The conditions included post-surgical neuropathy (n = 10), multiple sclerosis-related pain (n = 1), persistent idiopathic facial pain (n = 1), Ramsay Hunt syndrome (post-herpetic neuralgia, n = 1) and trigeminal neuralgia (n = 1). Data were collected on patient demographics, pain levels and medication. Results: Pain levels improved in 12 out of 14 patients. Nine patients had a reduction in adjuvant medication, two of whom completely stopped adjuvant treatment. Conclusion: This case series demonstrates that of the use of 5% lidocaine plasters may play a useful role in the management of chronic trigeminal pain. A suggested novel approach for the management of orofacial pain, for clinicians, is presented. Summary points Management of chronic orofacial pain continues to be a major challenge to the clinician. Patients are often placed on a multitude of medications in an attempt to alleviate pain without success. Topical 5% lidocaine plasters, currently used for the management of post-herpetic neuralgia, offer the option of locally targeting trigeminal pain without the multiple side-effects of systemic medication. This case series demonstrates that lidocaine plasters decrease verbal pain scores in extraoral, trigeminal and neuropathic pain, and reduce the use of other

  11. Responding to the Increased Needs of College Students: A Case Study of Case Management

    ERIC Educational Resources Information Center

    Shelesky, Kristin; Weatherford, Ryan D.; Silbert, Janelle

    2016-01-01

    The psychological needs of college students lead to overwhelming demand on college counseling centers' resources. In this article, we review models of case management in Higher Education including the administrative, behavioral intervention, and counseling center models. We also present a case study of the 3-year development of a counseling center…

  12. Responding to the Increased Needs of College Students: A Case Study of Case Management

    ERIC Educational Resources Information Center

    Shelesky, Kristin; Weatherford, Ryan D.; Silbert, Janelle

    2016-01-01

    The psychological needs of college students lead to overwhelming demand on college counseling centers' resources. In this article, we review models of case management in Higher Education including the administrative, behavioral intervention, and counseling center models. We also present a case study of the 3-year development of a counseling center…

  13. Case I: Managing People--The Case of the Frustrated Faculty Member.

    ERIC Educational Resources Information Center

    Glickman, Gerald N.; Comer, Robert W.; Filler, Steven J.; Fine, James Burke

    2002-01-01

    Presents an overview of some critical theories in human relations management. Offers a hypothetical case, drawn from a faculty development workshop, involving a dental school faculty member and her dean, for discussion and application of principles. Finally, presents the central issues of the case along with a review of relevant management…

  14. Feasibility trial of GP and case-managed support for workplace sickness absence.

    PubMed

    Rannard, Anne; Gabbay, Mark; Sen, Dil; Riley, Richard; Britt, David

    2014-07-01

    Aim Our aim was to compare the return-to-work rates between individuals supported by their GP plus workplace health advisers (intervention group) and those supported by their GP alone. Workplace sickness absence places a significant cost burden on individuals and the wider economy. Previous research shows better outcomes for individuals if they are supported while still in employment, or have been on sick leave for four weeks or less. Those helped back to work at an early stage are more likely to remain at work. A non-medicalised case-managed approach appears to have the best outcomes and can prevent or reduce the slide onto out-of-work benefits, but UK literature on its effectiveness is sparse. The design was a feasibility-controlled trial in which participants were sickness absentees, or presentees in employment with work-related health problems. Individuals completed health status measures (SF-36; EQ-5D) and a Job Content Questionnaire at baseline and again at four-month follow-up. Findings In the intervention group, 29/60 participants completed both phases of the trial. GP practices referred two control patients, and, despite various attempts by the research team, GPs failed to engage with the trial. This finding is of concern, although not unique in primary care research. In earlier studies, GPs reported a lack of knowledge and confidence in dealing with workplace health issues. Despite this, we report interesting findings from the case-managed group, the majority of whom returned to work within a month. Age and length of sickness absence at recruitment were better predictors of return-to-work rates than the number of case-managed contacts. The traditional randomised controlled trial approach was unsuitable for this study. GPs showed low interest in workplace sickness absence, despite their pivotal role in the process. This study informed a larger Department for Work and Pensions study of case-managed support.

  15. Cognitive Distortions and Suicide Attempts

    PubMed Central

    Jager-Hyman, Shari; Cunningham, Amy; Wenzel, Amy; Mattei, Stephanie; Brown, Gregory K.; Beck, Aaron T.

    2014-01-01

    Although theorists have posited that suicidal individuals are more likely than non-suicidal individuals to experience cognitive distortions, little empirical work has examined whether those who recently attempted suicide are more likely to engage in cognitive distortions than those who have not recently attempted suicide. In the present study, 111 participants who attempted suicide in the 30 days prior to participation and 57 psychiatric control participants completed measures of cognitive distortions, depression, and hopelessness. Findings support the hypothesis that individuals who recently attempted suicide are more likely than psychiatric controls to experience cognitive distortions, even when controlling for depression and hopelessness. Fortune telling was the only cognitive distortion uniquely associated with suicide attempt status. However, fortune telling was no longer significantly associated with suicide attempt status when controlling for hopelessness. Findings underscore the importance of directly targeting cognitive distortions when treating individuals at risk for suicide. PMID:25294949

  16. Management Science in Higher Education Institutions: Case Studies from Greece

    ERIC Educational Resources Information Center

    Saiti, Anna

    2010-01-01

    Regardless of the source of funding, university quality is based on knowledge, teaching, and research, and hence cannot be run like private enterprises as they are expert organisations that provide solely a public service. The purpose of this paper is to investigate, through the analysis of case studies, whether or not management theory,…

  17. 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 SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.168...

  18. Establishing Classroom Management for Cooperative Learning: Three Cases

    ERIC Educational Resources Information Center

    Emmer, Edmund T.; Gerwels, Mary Claire

    2005-01-01

    The purpose of this study was to identify how effective teachers manage productive groups in elementary grade classrooms. Multiple instrumental case study methods were used to document the managerial actions of selected teachers who made extensive use of cooperative learning (CL) activities. Four teachers in three elementary grade classrooms (two…

  19. School Asthma Screening and Case Management: Attendance and Learning Outcomes

    ERIC Educational Resources Information Center

    Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.

    2013-01-01

    Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…

  20. School Asthma Screening and Case Management: Attendance and Learning Outcomes

    ERIC Educational Resources Information Center

    Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.

    2013-01-01

    Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…

  1. Management of Drooling in Cerebral Palsy: Three Single Case Studies.

    ERIC Educational Resources Information Center

    Owen, S. E.; Stern, L. M.

    1992-01-01

    This study examined use of benztropine drug therapy to control drooling in 3 children (ages 5, 9, and 12) with moderately severe cerebral palsy. Significant improvement in all three cases suggested a role for medication in the management of drooling in prepubescent children who fail to respond to physical therapy or behavioral programs. (DB)

  2. Linklng guidelines for case management to risk of institutionalization.

    PubMed

    Hadjistavropoulos, Heather; Bierlein, Cecily; Sagan, Mark; Quine, Allisson

    2003-01-01

    In this study, we developed time-and-need-based community case management guidelines by tracking case management activity for 234 elderly clients over their first 6 months of care. Clients were interviewed at the time services began and again 6 months later to determine physical, emotional, and cognitive status. We found that the Regina Risk Indicator Tool (RRIT), a brief measure of risk for requiring institutional care, differentiated clients needing varying amounts of case management. Using these results, an expert panel devised guidelines for ranges of case management time for clients at different levels of need: low risk, some risk, and high risk. Quality measures, response times for initial contact and assessment, and service review parameters were also incorporated into the guidelines. Tools for workload measurement, quality review, client satisfaction, and service provider communication were developed. Focus group analysis of the guidelines with various stakeholders and a pilot implementation guided further revision. Future directions are outlined in the article, including the need to focus on outcomes of the guidelines and study of guideline implementation processes.

  3. Technology Solutions Case Study: Moisture Management of High-Walls

    SciTech Connect

    2013-12-01

    Moisture management of high-R walls is important to ensure optimal performance. This case study, developed by Building America team Building Science Corporation, focuses on how eight high-R walls handle the three main sources of moisture—construction moisture, air leakage condensation, and bulk water leaks.

  4. Medical Training Skills Curriculum for Case Management Assistants.

    ERIC Educational Resources Information Center

    Family Planning Council of Southeastern Pennsylvania, Philadelphia.

    This manual helps service care providers working with HIV-infected people learn how HIV affects the body's major systems, emphasizing the structure and functions of each system and direct and indirect effects of HIV on each system. The curriculum was developed for case management assistants (CMAs) who work in homes of HIV-infected people. Lessons…

  5. Managing Educational Change: A Case of Two Leadership Approaches

    ERIC Educational Resources Information Center

    Chow, Alice

    2013-01-01

    This article reports a case study that investigated the ways in which heads of subject departments managed the development and application of new assessment strategies in one secondary school in Hong Kong. The data of the study were gathered through participant observation and interviews with 12 teachers who participated in an assessment for…

  6. Managing Educational Change: A Case of Two Leadership Approaches

    ERIC Educational Resources Information Center

    Chow, Alice

    2013-01-01

    This article reports a case study that investigated the ways in which heads of subject departments managed the development and application of new assessment strategies in one secondary school in Hong Kong. The data of the study were gathered through participant observation and interviews with 12 teachers who participated in an assessment for…

  7. Case management: key to access, quality, and financial success.

    PubMed

    Smith, Alison P

    2003-01-01

    Several strategic, organizational, and operational variables drive successful case management programs. Organizational goals and accountability for support by administrative and medical staff leaders set the stage for a comprehensive program. The integration of utilization review, discharge planning, and other functions into the role of the case manager improves productivity and continuity. Choosing a model for assigning patients, a variable unique to the institution, should be carefully considered. Regardless of the power of strategic goals or the creative selection of a model, daily practices that promote daily review and communication will reveal all of the opportunities for improved performance. Complications are avoided one patient at a time and patients deserve vigilance. Length of stay is shortened 1 day at a time and we can no longer afford to miss these opportunities. In the period of high census, an unnecessary day for one patient at the end of his/her stay may mean another patient being diverted to another hospital away from his/her physician and past medical records. Creating constructive physician partnerships and cooperative relationships with postacute care providers can bring a case management program to higher level of performance. While many organizations have employees called "case managers," fewer have a comprehensive approach that has the potential to drive so many important indicators of performance.

  8. 34 CFR 303.34 - Service coordination services (case management).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 2 2013-07-01 2013-07-01 false Service coordination services (case management). 303.34 Section 303.34 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF... INFANTS AND TODDLERS WITH DISABILITIES General Definitions Used in This Part § 303.34 Service...

  9. 34 CFR 303.34 - Service coordination services (case management).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 2 2014-07-01 2013-07-01 true Service coordination services (case management). 303.34 Section 303.34 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF... INFANTS AND TODDLERS WITH DISABILITIES General Definitions Used in This Part § 303.34 Service...

  10. 34 CFR 303.34 - Service coordination services (case management).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Service coordination services (case management). 303.34 Section 303.34 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF... INFANTS AND TODDLERS WITH DISABILITIES General Definitions Used in This Part § 303.34 Service...

  11. Magic from Social Networks that Talk to Management: Four Cases

    ERIC Educational Resources Information Center

    Sugarman, Barry

    2010-01-01

    Purpose: The purpose of this paper is to understand how social networks can help to produce the "magic" of extraordinary results for organizations. Design/methodology/approach: In this exploratory study four cases (from published reports) are compared in order to illustrate different management approaches to utilizing the power of networks.…

  12. Impact of School Nurse Case Management on Students with Asthma

    ERIC Educational Resources Information Center

    Taras, Howard; Wright, Sandra; Brennan, Jesse; Campana, Jack; Lofgren, RoseMarie

    2004-01-01

    This project determined asthma prevalence in a large school district, absentee rates, and potential effects of school nurse case management for student asthma over three years. Data were derived from an asthma tracking tool used by nurses in one school district for every student reported as having asthma by their parent. School nurses began…

  13. Anaesthetic Management in Brugada Syndrome - A Case Report.

    PubMed

    Dash, Sulochana; Pragathee, Shanmugam

    2017-02-01

    Brugada Syndrome (BS) is a rare congenital cardiac disorder involving cardiac sodium channels, sometimes presenting with ventricular arrhythmia and sudden cardiac death. Here, we are reporting a case of BS who presented for laparotomy due to obstructed inguinal hernia which was managed satisfactorily with combined epidural and general anaesthesia without any complications.

  14. Case Management and Rehabilitation Counseling: Procedures and Techniques. Fourth Edition

    ERIC Educational Resources Information Center

    Roessler, Richard T.; Rubin, Stanford E.

    2006-01-01

    "Case Management and Rehabilitation Counseling" discusses procedures that are useful to rehabilitation professionals working in many settings. Specifically, this book reviews the finer points relating to diagnosing, arranging services, monitoring program outcomes, arranging for placement, planning for accommodations, ethical decision making,…

  15. Case Management and Rehabilitation Counseling: Procedures and Techniques. Fourth Edition

    ERIC Educational Resources Information Center

    Roessler, Richard T.; Rubin, Stanford E.

    2006-01-01

    "Case Management and Rehabilitation Counseling" discusses procedures that are useful to rehabilitation professionals working in many settings. Specifically, this book reviews the finer points relating to diagnosing, arranging services, monitoring program outcomes, arranging for placement, planning for accommodations, ethical decision making,…

  16. 42 CFR 441.18 - Case management services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Case management services. 441.18 Section 441.18 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... individuals with developmental disability or chronic mental illness, in accordance with § 431.51(a)(4) of this...

  17. 42 CFR 441.18 - Case management services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Case management services. 441.18 Section 441.18 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... individuals with developmental disability or chronic mental illness, in accordance with § 431.51(a)(4) of this...

  18. Management of Federally Sponsored Libraries: Case Studies and Analysis.

    ERIC Educational Resources Information Center

    Missar, Charles D., Ed.

    This book provides insight into how managers of federally sponsored libraries view their roles and carry out their duties. Seven federally supported libraries were selected to serve as case studies. These libraries represent a cross-section of various types, and the nine chapters are written by librarians from these facilities. The discussion…

  19. Management of Federally Sponsored Libraries: Case Studies and Analysis.

    ERIC Educational Resources Information Center

    Missar, Charles D., Ed.

    This book provides insight into how managers of federally sponsored libraries view their roles and carry out their duties. Seven federally supported libraries were selected to serve as case studies. These libraries represent a cross-section of various types, and the nine chapters are written by librarians from these facilities. The discussion…

  20. The Management of Training in Multinational Corporations: Comparative Case Studies.

    ERIC Educational Resources Information Center

    Noble, Charles

    1997-01-01

    Case studies of British and Australian multinational corporations in the food and drink industry investigated how training and development are managed. Competency-based education and industry boards are important elements in both countries. Lack of a training culture in the industry and little innovation in training were observed. (SK)

  1. Magic from Social Networks that Talk to Management: Four Cases

    ERIC Educational Resources Information Center

    Sugarman, Barry

    2010-01-01

    Purpose: The purpose of this paper is to understand how social networks can help to produce the "magic" of extraordinary results for organizations. Design/methodology/approach: In this exploratory study four cases (from published reports) are compared in order to illustrate different management approaches to utilizing the power of networks.…

  2. Case Studies in Managing School Library Media Centers.

    ERIC Educational Resources Information Center

    Callison, Daniel; Morris, Jacqueline

    Thirty-two case studies illustrating problem areas and situations that develop in the modern environment of the electronic school library media program are presented for use by library science students and library/media center managers. Based on input from practicing librarians at the elementary and secondary levels, the studies are designed to…

  3. Successful School Management in India: Case Studies of Navodaya Vidyalayas

    ERIC Educational Resources Information Center

    Khaparde, M. S.; Srivastava, Ashok K.; Meganathan, R.

    2004-01-01

    This research explored the management devices followed in successful schools in the Indian context. In-depth case studies of three successful Navodaya schools were carried out. The schools were identified on the basis of the academic performance of students in the last three years in the national examinations and their participation in…

  4. Anaesthetic Management in Brugada Syndrome - A Case Report

    PubMed Central

    Pragathee, Shanmugam

    2017-01-01

    Brugada Syndrome (BS) is a rare congenital cardiac disorder involving cardiac sodium channels, sometimes presenting with ventricular arrhythmia and sudden cardiac death. Here, we are reporting a case of BS who presented for laparotomy due to obstructed inguinal hernia which was managed satisfactorily with combined epidural and general anaesthesia without any complications. PMID:28384965

  5. Management Science in Higher Education Institutions: Case Studies from Greece

    ERIC Educational Resources Information Center

    Saiti, Anna

    2010-01-01

    Regardless of the source of funding, university quality is based on knowledge, teaching, and research, and hence cannot be run like private enterprises as they are expert organisations that provide solely a public service. The purpose of this paper is to investigate, through the analysis of case studies, whether or not management theory,…

  6. Chiropractic management of chronic idiopathic meralgia paresthetica: a case study

    PubMed Central

    Houle, Sébastien

    2012-01-01

    Objectives This report describes the case of a patient with chronic idiopathic meralgia paresthetica associated with bilateral sacroiliac joint dysfunction who was managed with chiropractic care. Clinical Features A 35-year-old white woman presented to a private chiropractic clinic with a complaint of numbness in the right anterolateral thigh region. Neurological assessment revealed a diminution of sensibility and discrimination on the right lateral femoral cutaneous nerve territory. Pain was rated as 8.5 on a numeric pain scale of 0 to 10. Musculoskeletal examination of the pelvic region disclosed bilateral sacroiliac joint dysfunction. Intervention and Outcomes Chiropractic management included pelvic mobilizations, myofascial therapy, transverse friction massage, and stretching exercises. After 3 visits (2 weeks later), result of neurological evaluation was normal, with no residual numbness over the lateral thigh. Conclusion In the present case, chiropractic management with standard and applied kinesiology techniques resulted in recovery of meralgia paresthetica symptoms for this patient. PMID:22942840

  7. Anesthetic management of Costello syndrome: a case report.

    PubMed

    Williams, Christol

    2014-04-01

    Costello syndrome is a rare genetic disorder with an estimated 300 medical cases worldwide. Typical features that characterize this syndrome include short stature, macrocephaly, developmental delay, loose skin folds, distinctive coarse facial features, and multiorgan system anomalies. The following case report discusses the anesthetic management for a 3-year-old boy undergoing general anesthesia for a scheduled dental restoration, hydrocelectomy, inguinal hernia repair, and bilateral myringotomy with placement of pressure equalization tubes. A scarcity of literature for the anesthetic management of Costello syndrome (also known as faciocutaneoskeletal syndrome) exists. Utilizing an overview of the pertinent literature, clinical practice recommendations are suggested for the anesthetic implications of managing a pediatric patient with this rare syndrome.

  8. Managing Residual Contaminants – Reuse and Isolation Case Studies

    SciTech Connect

    Kevin M. Kostelnik, Ph.D.; James H. Clarke, Ph. D.

    2008-03-01

    Contaminants remaining on sites after regulatory-approved environmental remediation operations are complete represent continued risk to human health and the environment. Many sites require continued management efforts to: (1) protect the integrity of the engineered remedy/control, (2) limit the exposure of individuals to residual contamination by limiting reuse activities, (3) maintain ready access to accurate records/information, and (4) protect against vulnerabilities from intentional threats/actions. This paper presents performance information from selected case studies to provide insight into various management approaches employed for addressing the risks associated with residual contaminants. The case studies involve sites remediated within the U.S. CERCLA framework, and illustrate two prevailing management approaches for addressing the risks. Sacrifice Zones are sites that are purposefully isolated to prevent human access onto the property. Reuse Sites provide limited access for specific use.

  9. Chiropractic management of chronic idiopathic meralgia paresthetica: a case study.

    PubMed

    Houle, Sébastien

    2012-03-01

    This report describes the case of a patient with chronic idiopathic meralgia paresthetica associated with bilateral sacroiliac joint dysfunction who was managed with chiropractic care. A 35-year-old white woman presented to a private chiropractic clinic with a complaint of numbness in the right anterolateral thigh region. Neurological assessment revealed a diminution of sensibility and discrimination on the right lateral femoral cutaneous nerve territory. Pain was rated as 8.5 on a numeric pain scale of 0 to 10. Musculoskeletal examination of the pelvic region disclosed bilateral sacroiliac joint dysfunction. Chiropractic management included pelvic mobilizations, myofascial therapy, transverse friction massage, and stretching exercises. After 3 visits (2 weeks later), result of neurological evaluation was normal, with no residual numbness over the lateral thigh. In the present case, chiropractic management with standard and applied kinesiology techniques resulted in recovery of meralgia paresthetica symptoms for this patient.

  10. A multifaceted education intervention for improving family physicians' case management.

    PubMed

    Reyes-Morales, Hortensia; Flores-Hernández, Sergio; Tomé-Sandoval, Patricia; Pérez-Cuevas, Ricardo

    2009-04-01

    The Mexican Institute of Social Security (IMSS) is the largest public health care system in Mexico. IMSS family physicians' management of clinical problems is frequently not consistent with published evidence. This study aimed to evaluate the effects of a multifaceted educational intervention to improve management of acute respiratory infections (ARI) by IMSS family physicians. A non-randomized pre-post intervention with comparison group design was conducted in eight IMSS family medicine clinics in which 106 family physicians practiced. An evidence-based clinical guideline for ARI management was developed, and clinical tutors were trained. The three-stage intervention comprised interactive workshops, individual tutorials, and round-table peer-review sessions. The main outcome was appropriate ARI case management. The intervention effect was calculated by using the differences-in-differences model, adjusting for cluster of physicians. In the intervention group, the difference in mean proportion of improvement compared with baseline evaluation was 22.6% (95% confidence interval [CI]=10.3 to 34.9) for appropriate prescription of antibiotics, 29.8% (95% CI=17.2 to 42.4) for indication of worsening signs, and 19.6% (95% CI=11.2 to 28.0) for overall appropriate case management. The comparison group showed no significant changes. The educational intervention improved ARI management. Further studies are needed to analyze organizational implications, cost, sustainability, and effects on health outcomes.

  11. [Management of emergency cases, hospitalized in Romania in 2007].

    PubMed

    Tarcea, Monica; Zugravu, Corina; Szavuj, J; Finta, Hajnal; Patraulea, F; Szasz, F

    2009-01-01

    We evaluated the main aspects of the management of emergency cases, hospitalized in Romania in 2007, by following the frequency of main diagnosis, their distribution by place and hospital and hospital indicators. We collected our data from the Insurance Houses and National Institute of Statistics. Emergency cases represented in 2007 half of total cases hospitalized in Romania. Women are more frequent hospitalized then man or children. The Romanian South-East area had the highest frequency of emergency cases hospitalized. From all types of deceased cases, the emergency cases had the highest frequency. In emergency, the main category of diagnosis by frequency is "pregnancy, birth and recently given birth", much higher than non-emergency cases registered, also at the Obstretics-Gynecology and Emergency Hospitals. The medium period of days hospitalized for emergency cases was one week time. Most of the emergency cases are healed comparing to non-emergency ones. The main problem of hospitals in Romania is related to health services financing, costs for health care are still growing but also did the quality of health services and number of cases coming in emergency rooms.

  12. Evaluation method for determining management priorities for special case waste

    SciTech Connect

    Kudera, D.E.; Wickland, C.E.

    1990-08-01

    The U.S. Department of Energy (DOE) Radioactive Waste Technical Support Program (TSP) began the Special Case Waste (SCW) Inventory and Characterization Project in April 1989. The collection of data has been completed and a final draft report, Department of Energy Special Case Radioactive Waste Inventory and Characterization Data Report (DOE/LLW-96), was submitted in May 1990. A second final draft report, Supplemental Data Report to the Department of Energy Special Case Radioactive Waste Inventory and Characterization Data Report (DOE/LLW-95), containing additional and more detailed data and graphical presentations, was completed in July 1990. These two reports contain details on the special case waste categories and summaries of the total volumes and curies associated with each category of waste. It is anticipated that some version or combination of these two reports will be included in the final version of this report, which will describe an evaluation method for determining management priorities for special case waste. Preliminary analysis of the inventory data indicates that approximately 1,000,000 m{sup 3} of special case waste exist in the DOE system with possible insufficient treatment/storage/disposal capability or capacity. To help DOE prioritize the actions required to manage this large volume of special case waste, an evaluation method is required.

  13. [Poliomyelitis case surveillance data management in Burkina Faso].

    PubMed

    Drabo, Koiné Maxime; Nana, Félicité; Kouassi, Kouassi Lazare; Konfé, Salifou; Hien, Hervé; Saizonou, Jacques; Ouedraogo, Tinoaga Laurent

    2015-01-01

    The global initiative for poliomyelitis eradication can only remain relevant if survey systems are regularly assessed. In order to identify shortcomings and to propose improvement, the data collection and transmission during case investigation were assessed in the Banfora health district in Burkina Faso. The survey targeted six (6) primary health centres, the district laboratory and the national laboratory, all involved in the poliomyelitis surveillance system. Data from registers, forms documenting suspected cases, stool sample forms and weekly reports were collected by means of a data grid. Data from actors involved in the poliomyelitis case investigation system were collected by means of an individual questionnaire. The reactivity of investigating suspected cases was satisfactory with a median alert questionnaire notification time of 18 hours. The completeness of the reporting system was satisfactory. Nevertheless, the promptness of data management by primary heath centres and the national laboratory remained unsatisfactory. Evaluation of data management revealed logistic and organization shortcomings. The overall efficacy of the poliomyelitis surveillance could be improved by using management tools for laboratory supplies, collecting data related to the homes of suspected cases and implementing a cold chain maintenance plan.

  14. Surviving shot through the heart: Management in two cases.

    PubMed

    Siddiqui, Fraz Anwar; Kabeer, Jamal; Shahabuddin, Syed

    2015-01-01

    Penetrating cardiac injuries after gunshot are usually fatal and are very challenging to manage for surgeons even in fully- equipped centres. Such injuries can cause ventricular septal defect (VSD) or cardiac tamponade depending upon the distance, direction and velocity of the bullet. Stable patients can be subjected to investigations like computed tomography (CT) to avoid unnecessary intervention, but unstable patients should be rushed to the operating room. We discuss management in two cases of traversing bullet injury to the heart. In the first case, traumatic VSD was significant, requiring closure on cardiopulmonary bypass (CPB) along with repair of right and left ventricular injury. In the second case, only the repair of right and left ventricles was performed without CPB. They both had traversing bullet injury through the heart.

  15. A Standardized Certification Program for Case Managers Serving Frail Elderly Texans. Module I: Foundations of Case Management and Intake Interview.

    ERIC Educational Resources Information Center

    Lusky, Richard A.; And Others

    This learning module is one of three training modules that were developed for members of the Texas Gerontological Consortium for Continuing Education to use in preparing case managers working in human service professions coordinating community-based programs for frail elderly Texans. Module I deals with the following topics: foundations of case…

  16. Case management directors: how to manage in a transition-focused world: part 1.

    PubMed

    Bankston-White, Cheri; Birmingham, Jackie

    2015-01-01

    Case management directors are in a dynamic position to affect the transition of care for patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role. The purpose of this two-part article is to provide case management directors, particularly new ones, with a framework for understanding and fulfilling their role.We have divided the guide into seven tracks of responsibility. Part 1 discusses the first four tracks: (1) staffing and human resources, (2) compliance and accreditation, (3) discharge planning, and (4) utilization review and revenue cycle. Part 2 addresses (5) internal departmental relationships (organizational), (6) external relationships (Community agency), and (7) quality and program outcomes. The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems, and have frontline case managers reporting to them. Case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. New directors would benefit from mentoring and networking with one another. As new regulations and models of care bring increased emphasis and focus to transitions of care, the role of the case management director continues to evolve, growing in importance and complexity. The growing financial impact of readmissions also brings added scrutiny and increased pressure to get the transitions of care right the first time.To operate most effectively, case management directors must understand the full range of their responsibilities and impact. They must find opportunities for themselves and their departments to learn and stay

  17. Energy management study: A proposed case of government building

    NASA Astrophysics Data System (ADS)

    Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Baharum, Mohd Faizal

    2015-05-01

    Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.

  18. Energy management study: A proposed case of government building

    SciTech Connect

    Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Baharum, Mohd Faizal

    2015-05-15

    Align with the current needs of the sustainable and green technology in Malaysian construction industry, this research is conducted to seek and identify opportunities to better manage energy use including the process of understand when, where, and how energy is used in a building. The purpose of this research is to provide a best practice guideline as a practical tool to assist construction industry in Malaysia to improve the energy efficiency of the office building during the post-production by reviewing the current practice of the building operation and maintenance in order to optimum the usage and reduce the amount of energy input into the building. Therefore, this paper will review the concept of maintenance management, current issue in energy management, and on how the research process will be conducted. There are several process involves and focuses on technical and management techniques such as energy metering, tracing, harvesting, and auditing based on the case study that will be accomplish soon. Accordingly, a case study is appropriate to be selected as a strategic research approach in which involves an empirical investigation of a particular contemporary phenomenon within its real life context using multiple sources of evidence for the data collection process. A Government office building will be selected as an appropriate case study for this research. In the end of this research, it will recommend a strategic approach or model in a specific guideline for enabling energy-efficient operation and maintenance in the office building.

  19. Management of dancers with symptomatic accessory navicular: 2 case reports.

    PubMed

    Smith, Teresa Riemer

    2012-05-01

    Case report. Symptomatic accessory navicular can be a source of pain and disability. The treatment considerations for accessory navicular in dancers may differ due to increased demands on the foot, the repetitive nature of the movements, and the specific footwear required. The purpose of this report is to describe the management (1 conservative and 1 postoperative) of 2 adolescent dancers with symptomatic accessory navicular. Case 1 was an 11-year-old female who underwent surgical excision of a symptomatic accessory navicular. Case 2 was a 15-year-old female who, following a traumatic injury that caused pain judged to be related to her accessory navicular, was managed nonsurgically. Treatment included pain management, range-of-motion exercises, trunk and lower extremity strengthening, balance and proprioception training, orthoses, crosstraining, and a guided return-to-dance progression. Both patients had improved pain, dance technique, strength, and patient-reported outcome scores that allowed a full return to dance. The 2 dancers presented here had foot pain believed to be related to a symptomatic accessory navicular. In both cases, treatment targeted specific impairments to improve function and disability. The guided progression of activities was intended to facilitate a return to dance that protected healing tissues and prevented a recurrence of symptoms. Clinicians should be aware of the effect of a symptomatic accessory navicular in the young dancer and potentially effective nonsurgical treatment options for this condition.

  20. Case reports and clinical guidelines for managing radix entomolaris

    PubMed Central

    Thomas, Bejoy J.; Nishad, A.; Paulaian, Benin; Sam, Jonathan Emil

    2016-01-01

    Knowledge about the external and internal anatomy of the tooth is essential for successful dental practice. Anomalies in the tooth are often encountered which poses difficulties in dental treatments. As like any other tooth, mandibular first molars are also prone for anatomic malformations. One such anatomic variation is the presence of extra root distolingually. This distolingual root is called radix entomolaris (RE). The presence of an additional root can lead to difficulties during endodontic therapy. This article is a report of two cases describing the management of the first mandibular molars with an RE and clinical guidelines for its management. PMID:27829770

  1. Management challenges in a case of gender identity disorder.

    PubMed

    Rathi, Anubhav; Bhatia, Manjeet Singh

    2014-01-01

    Gender identity disorder (GID) is a complex disorder and can be defined as a group of disorders whose common feature is a strong and persistent preference for living as a person of the other sex. It is associated with significant impairment in social, occupational, interpersonal, and other areas of functioning. We describe the case of an adolescent, biologically male who was brought to our outpatient department primarily with symptoms of adjustment disorder with GID and the management provided. The role of a psychiatrist in the management, ethical and legal issues involved is also discussed.

  2. [Hepatic subcapsular hematoma: a case report and management update].

    PubMed

    Berveiller, P; Vandenbroucke, L; Popowski, T; Afriat, R; Sauvanet, E; Giovangrandi, Y

    2012-06-01

    Hepatic subcapsular hematoma (HSH) is a rare complication of pregnancy that keeps a materno-fetal high mortality rate. Given this severity, HSH management requires a prompt diagnosis and an appropriate care. Before focusing on the current management strategy of HSH, we illustrate this article with a clinical case presenting an original method of abdominal exploration, which has not been described to our knowledge. Thus, taking into account the presence of a moderate hemoperitoneum during a caesarean section procedure for HSH, introduction of laparoscopy through the same incision allowed a satisfactory evaluation of the abdominal cavity and hepatic area without performing an invasive midline laparotomy.

  3. It takes data to justify ED case management.

    PubMed

    2012-10-01

    When it comes to justifying staff in the emergency department, case management directors need to provide financial data, not anecdotal information to the hospital's finance department. Experts recommend the following: Track your facility's avoidable admissions and patients admitted in the wrong status and calculate how much reimbursement the hospital lost. Collect information on people treated for non-emergent conditions who didn't pay and what the hospital lost. Add up the number of frequent utilizers who use the emergency department to manage their chronic conditions and how many could have benefitted from a referral to community services.

  4. 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

  5. Nursing Case Management: Adapting to the Challenges of Today’s Healthcare Environment

    DTIC Science & Technology

    1993-05-01

    nursing practice model; Peplau case manag-ment model, Carondelet St. Marys nursing :ase management model and the New England Medical Center nursing case...environment and health is implied, but few of the NCM models specify a relationship to nursing conceptual models. The Peplau case management model is one of

  6. Case formulation and management using pattern-based formulation (PBF) methodology: clinical case 1.

    PubMed

    Fernando, Irosh; Cohen, Martin

    2014-02-01

    A tool for psychiatric case formulation known as pattern-based formulation (PBF) has been recently introduced. This paper presents an application of this methodology in formulating and managing complex clinical cases. The symptomatology of the clinical presentation has been parsed into individual clinical phenomena and interpreted by selecting explanatory models. The clinical presentation demonstrates how PBF has been used as a clinical tool to guide clinicians' thinking, that takes a structured approach to manage multiple issues using a broad range of management strategies. In doing so, the paper also introduces a number of patterns related to the observed clinical phenomena that can be re-used as explanatory models when formulating other clinical cases. It is expected that this paper will assist clinicians, and particularly trainees, to better understand PBF methodology and apply it to improve their formulation skills.

  7. Embedding care management in the medical home: a case study.

    PubMed

    Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D

    2014-04-01

    Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.

  8. Conservative management of abnormally invasive placenta: four case reports.

    PubMed

    Ramoni, Angela; Strobl, Eva-Maria; Tiechl, Johanna; Ritter, Magdalena; Marth, Christian

    2013-04-01

    Prenatal diagnosis of placenta increta and percreta is essential to avoid potentially life-threatening hemorrhage by optimizing peripartal management. Invasive placentation presents significant challenges at cesarean section even for highly skilled surgeons. In the four cases of placenta increta/percreta presented here we tried to avoid hysterectomy by leaving the placenta behind and tried to accelerate regression of placental tissue by administering methotrexate. The outcome in each of the four women was different, but no major bleeding occurred in any of the cases. Close follow-up for many weeks is mandatory.

  9. The chiropractic management of two cases of cervical spondylotic radiculopathy

    PubMed Central

    Dufton, John A.; Giantomaso, Tony

    2003-01-01

    Cervical spondylotic radiculopathy (CSR) is one of the potential sources of radiculopathy, particularly in patients aged 40 to 60 years. The hallmark sign of cervical-brachial pain presents in the majority of the cases, however a definitive clinical diagnosis is often difficult in the absence of reliable and valid diagnostic tests. Two cases of presumed CSR illustrate the usefulness of applying a comprehensive mechanical assessment that guides the patient's rehabilitation regardless of the traditional anatomical diagnosis. A brief overview of the epidemiology, clinical presentation, and management of CSR is also presented.

  10. Productive interdisciplinary team relationships: the hospitalist and the case manager.

    PubMed

    Amin, Alpesh N; Owen, Mary M

    2006-01-01

    Since the introduction of the National Patient Safety Goals (Joint Commission International Center for Patient Safety, 2005) into the Joint Commission on Accreditation of Healthcare Organizations standards, there appears to be a positive movement toward improvement in patient care outcomes and safety. Case management has been an integral part of the care team, and has emphasized standards of performance in quality of care, collaboration and resource utilization since 1995. When Leapfrog defined hospitalist intensivists as one of the three requirements necessary to be a safe hospital, an opportunity was borne to create a professional partnership. With the patient and the safety as the central focus of care, case managers and hospitalists are beginning to exponentially change the face of healthcare. This article will demonstrate the value of this partnership.

  11. [Management of chicken pox purpura fulminans: a pediatric case report].

    PubMed

    Domergue, S; Rodiere, M; Bigorre, M; Guye, E; Captier, G

    2006-06-01

    The authors report a case of a 4 years old girl who had presented a chicken-pox purpura fulminans. Lesions appeared 5 days after chicken-pox start and were quickly evoluted in cutaneous and sub-cutaneous necrosis on external side of thighs and behind side of right calf. A medical management was done with fresh plasma, blood, antithrombine 3, and fibrin. Specifics treatments were done: heparin and activated C protein. Surgical treatment was realised 5 weeks later. It consisted of clean necrosis areas and put a thin skin graft witch was took on the scalp. The evolution was fast good. The follow-up is 3 years without big esthetic and functional consequences. Some cases of this pathology were described in literature with serious lesions. The management should be multidisciplinary. Surgical treatment should be realised when lesions are stabilized. Scalp is a donor site for skin graft very interesting because of big quantity of skin and not esthetic consequence.

  12. Application of integrative information system improves the quality and effectiveness of cancer case management.

    PubMed

    Lee, Pei-Yi; Chang, Tsue-Rung

    2015-01-01

    Cancer case management provides consecutive care during the entire process through diagnosis to treatment and follow-up. We established an integrative information system with integration of the health information system. This integrative information system shortened the time spent on case screening, follow-up data management, and monthly data summarization of case managers. It also promoted the case follow-up rate. This integrative information system may improve the quality and effectiveness for cancer case management, one important part of cancer nursing.

  13. Predictors of Suicide Attempts in Clinically Depressed Korean Adolescents

    PubMed Central

    Kwon, Ahye; Song, Jungeun; Yook, Ki-Hwan; Jon, Duk-In; Jung, Myung Hun; Hong, Narei; Hong, Hyun Ju

    2016-01-01

    We examined predictors of suicide attempts in clinically depressed adolescents in Korea and gender differences in suicidal behavior. In total, 106 adolescents diagnosed with depressive disorder were recruited in South Korea. We assessed various variables that might affect suicide attempts, and used a structured interview for the diagnosis of depression and comorbidities and to evaluate suicidality. Demographic and clinical characteristics of the subjects were compared between suicide attempt and non-suicide attempt groups and we examined significant predictors of suicide attempts. Gender differences in suicidal ideation and suicidal behavior were also analyzed. Among 106 depressed participants, 50 (47.2%) adolescents were classified in the suicide attempt group. Generally, the suicide attempt and non-suicide attempt group shared similar clinical characteristics. The suicide attempt group had more females, more major depressive disorder diagnoses, more depressive episodes, and higher suicidal ideation than the non-suicide attempt group. Suicidal ideation was the only significant predictor of suicidal attempt, regardless of gender. Higher suicidal ideation frequency scores and more non-suicidal self-injurious behaviors were shown in the female suicide attempt group than the male suicide attempt group. It is recommended that suicidal ideation be assessed regularly and managed rigorously to decrease suicide risks in depressive adolescents. PMID:27776392

  14. Clinical Management of Two Root Resorption Cases in Endodontic Practice

    PubMed Central

    2016-01-01

    Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment. PMID:27648314

  15. Clinical Management of Two Root Resorption Cases in Endodontic Practice.

    PubMed

    Mincik, Jozef; Urban, Daniel; Timkova, Silvia

    2016-01-01

    Root resorption is a pathological process involving loss of hard dental tissues. It may occur as a consequence of dental trauma, orthodontic treatment, and bleaching, and occasionally it accompanies periodontal disease. Although the mechanism of resorption process is examined in detail, its etiology is not fully understood. Wide open apical foramen is more difficult to manage and the root canal may often overfill. In this report we present two cases of root resorption and describe means for its clinical management. We conclude that useful measure of a success or failure in managing root resorption is the persistence of the resorption process. It is a clear sign of an active ongoing inflammatory process and shows the clinical need for retreatment.

  16. The relationship between case manager expectations and outcomes of persons diagnosed with schizophrenia.

    PubMed

    O'Connell, Maria J; Stein, Catherine H

    2011-08-01

    The present study examined the relationship between case managers' expectations about the abilities of persons diagnosed with schizophrenia and the outcomes (as indicated via chart review) of a randomly selected sample of clients diagnosed with schizophrenia on their caseload. Results indicate that clients of case managers with higher expectations averaged significantly more months of progress in employment than clients of case managers with lower expectations. Case manager expectations were also better predictors of the number of days employed than other case manager and consumer characteristics, however the type of expectation was a critical determinant of the direction of the effect. Case manager expectations were not related to outcomes in living situation.

  17. Doctors as managers: moving towards general management? The case of unitary management reform in Norwegian hospitals.

    PubMed

    Mo, Tone Opdahl

    2008-01-01

    The paper seeks to explore whether the development in department management in Norwegian hospitals after the unitary management reform in 2001 constitutes a development in the direction of general management. Interviews were conducted with ten managers from different levels in a large Norwegian university hospital in 2001-2002, as a unitary management model was implemented. There is an emerging change of practice among the physician managers according to this study. The manager function is more explicit and takes a more general responsibility for the department and the professions. However, the managerial function is substantiated by conditions related to the professional field of knowledge, which gives legitimacy within a medical logic. Contact with the clinic is stressed as important, but it is possible to adjust both amount and content of a clinical engagement to the demands of the new manager position. This has both a symbolic and a practical significance, as it involves both legitimacy and identity issues. The paper shows that the institutionalised medical understanding of management has a bearing on managerial reforms. Managerial changes need to relate to this if they are to have consequences for the managerial roles and structures on department level in hospitals. The paper suggests that the future development of this role will depend on the way the collectivist and individualist aspects of responsibility are handled, as well as on the further development of managerial knowledge of physicians.

  18. A Case for Customizable Resource Management in Networks,

    DTIC Science & Technology

    2007-11-02

    00C Ca~aegie ej=)n ’C= 4P -jý A Case for Customizable Resource Management in Networks Peter Steenkiste Allan Fisher Hui Zhang October 21, 1998 CMU-CS-98...167 School of Computer Science Carnegie Mellon University Pittsburgh, PA 15213 Abstract We envision the deployment of an electronic services market ...that will deliver a wide range of electronic ser- vices over networks. This market will allow applications to combine resources at endpoints with

  19. Anesthetic management in a case of antiphospholipid antibody syndrome.

    PubMed

    Mikkiliineni, Venkata Rama Rao; Panidapu, Nagarjuna; Parasa, Mrunalini; Shaik, Mastan Saheb

    2015-01-01

    Antiphospholipid antibody (APLA) syndrome is one of the most common thrombocytophilias but, unfortunately, goes unrecognized most often. It is an auto-immune disorder in which thrombotic events and a recurrent fetal loss occur in the presence of antibodies to phospholipids. It is the most common acquired hyper-coagulable state. There is a limited literature on peroperative management of patients with this syndrome. We report a case of APLA syndrome in a parturient due to its rarity and complexity.

  20. Management of haemangioma with sclerosing agent: a case report

    PubMed Central

    M K, Parvathidevi; Koppal, Shrinivas; Rukmangada, Thriveni; Byatnal, Amit R

    2013-01-01

    The use of multiple weekly intralesional injections of 3% sodium tetradecyl sulfate as a sclerosing agent for the management of facial haemangiomas is a safe treatment with acceptable results. As presented in this case report, this technique offers the patient considerable relief of symptoms with minimal complications. However, the possibility of second-stage surgery to correct residual deformity is still considered. Sclerotherapy with 3% sodium tetradecyl sulfate provides a good preparation for further surgery. PMID:24130207

  1. Oral bullous lichen planus: Case report and review of management

    PubMed Central

    Patil, Archana; Prasad, Shiva; Ashok, L.; Sujatha, G. P.

    2012-01-01

    A 34-year-old female patient with the chief complaint of burning sensation in the oral cavity associated with generalized pruritis, scalp and skin lesions diagnosed as Bullous lichen planus and treated with systemic prednisolone, levamisole, benzydamine oral rinse. Patient is in follow up since 1 year and free of lesions. Here we report the case and review current modalities in the management of oral lichen planus. PMID:23293497

  2. Integration of QR codes into an anesthesia information management system for resident case log management.

    PubMed

    Avidan, Alexander; Weissman, Charles; Levin, Phillip D

    2015-04-01

    Quick response (QR) codes containing anesthesia syllabus data were introduced into an anesthesia information management system. The code was generated automatically at the conclusion of each case and available for resident case logging using a smartphone or tablet. The goal of this study was to evaluate the use and usability/user-friendliness of such system. Resident case logging practices were assessed prior to introducing the QR codes. QR code use and satisfactions amongst residents was reassessed at three and six months. Before QR code introduction only 12/23 (52.2%) residents maintained a case log. Most of the remaining residents (9/23, 39.1%) expected to receive a case list from the anesthesia information management system database at the end of their residency. At three months and six months 17/26 (65.4%) and 15/25 (60.0%) residents, respectively, were using the QR codes. Satisfaction was rated as very good or good. QR codes for residents' case logging with smartphones or tablets were successfully introduced in an anesthesia information management system and used by most residents. QR codes can be successfully implemented into medical practice to support data transfer. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Standard case management of asthma in Sudan: a pilot project.

    PubMed

    El Sony, A I; Chiang, C-Y; Malik, E; Hassanain, S A; Hussien, H; Khamis, A H; Bassilli, A F; Enarson, D A

    2013-09-21

    A pilot project for asthma management in selected hospitals in Khartoum and Gezira States, Sudan. To assess standard case management of asthma in 2007-2008. Local adaptation of guidelines, followed by situational analysis, pre-intervention study, training and implementation. Treatment outcome was assessed 1 year after patient enrolment. Situational analysis revealed that inhaled beclometasone was not available in the public sector. During the project, 2068 patients were enrolled: severity of asthma was intermittent in 185 (9.0%), mild persistent in 231 (11.2%), moderate persistent in 640 (31.0%), severe persistent in 812 (39.3%) and unclassified in 200 (9.7%). Of the 1654 patients with persistent asthma who were treated with inhaled corticosteroids, 1157 (70.0%) had treatment cards available for outcome assessment. Of these, 652 (56.4%) did not attend their annual evaluation, among whom 1 (0.1%) died and 651 (56.3%) were lost to follow-up. Of the 505 patients who attended their annual evaluation, 417 (82.6%) improved, 32 (6.3%) were stable and 56 (11.1%) were worse. The frequency of emergency visits and hospitalisation decreased substantially among those who presented for the 1 year follow-up assessment. The results of standard case management of asthma were encouraging; however, a high proportion of patients did not return for long-term management.

  4. Improving reimbursement with nursing case manager status assignment.

    PubMed

    Bledsoe, Marlyn K; Marshall, Michele L

    2013-01-01

    Historically, physicians completed status assignment during the admission process. Incorrect status assignment of patients can result in reimbursement problems and denial of payment by Medicare, Medicaid, and private insurance companies. The purpose of this study was to evaluate the impact of case manager's role with status assignment during the admission process by looking at the denial of payment for services rendered. Denial rates were evaluated for two 15-month time periods: preintervention group (status assignment completed by physicians) and intervention group (status assignment recommended by case managers with physician signature). Denial data for all diagnosis-related groups possessing a more than 2% denial rate related to status assignment were further examined to identify the rationale for denial of payment. FINDINGS/OUTCOMES: The greatest denial rates for payment occurred during the Preintervention Period, when physicians assigned status for patients independently. There was a significant reduction in denial of payment for most diagnosis-related groups during the Intervention time period when case managers were recommending status assignment. Evaluation of denial data provides an opportunity to target creative performance improvement solutions to reduce denial of payment related to incorrect status assignment.

  5. Development of a standardized language for case management among high-risk elderly.

    PubMed

    Maravilla, Vilma; Graves, Maria T; Newcomer, Robert

    2005-01-01

    Consistency and communication remain key barriers to tracking case management outcomes and developing the best practices. A dictionary of case management problems, goals, interventions, and outcomes was developed to support a prevention-oriented case management program targeted on elderly high-risk patients. Case management featured an annual screening questionnaire, appointment monitoring, disease education, self-management support, and ongoing care coordination. The dictionary resulted in a Standardized Language for Case Management (SLED). This has since been reviewed and modified on the basis of comments and recommendations from 5 leading case management organizations and is aligned with Standards of Practice for Case Management. The article provides a description of the standardized language terms, the rationale underlying the documentation, examples of how this dictionary of definitions can be incorporated into the daily practice of case management, and examples of some of the benefits to the field that can be achieved with the use of a common data-recording system.

  6. Intracranial epidermoid tumor; microneurosurgical management: An experience of 23 cases

    PubMed Central

    Chowdhury, Forhad Hossain; Haque, Mohammod Raziul; Sarker, Mainul Haque

    2013-01-01

    Objectives: An intracranial epidermoid tumor is relatively a rare tumor, accounting for approximately 0.1% of all intracranial space occupying lesions. These are also known as pearly tumor due to their pearl like appearance. In this series, the localization of the tumor, presenting age and symptoms, imaging criteria for diagnosis, surgical management strategy with completeness of excision and overall outcome were studied prospectively. Here, we report our short experience of intracranial epidermoid as a whole. Materials and Methods: Between January 2006 to December 2010, 23 cases of intracranial epidermoid were diagnosed preoperatively with almost certainty by computed tomography (CT) and magnetic resonance imaging (MRI) of brain in plain, contrast and other relevant studies. All of them underwent operation in Dhaka Medical College Hospital and in some Private Hospital in Dhaka, Bangladesh. All patients were followed-up routinely by clinical examination and neuroimaging. Average follow-up was 39 (range-71-11months) months. Patients of the series were prospectively studied. Results: Supratentorial epidermoids were 04 cases and infratemporal epidermoids were 19 cases. Clinical features and surgical strategy varies according to the location and extension of the tumors. Age range was 19-71 years (37.46 years). Common clinical features were headache, cerebellar features, seizure, vertigo, hearing impairment and features of raised intracranial pressure (ICP). Investigation was CT scan or/+ MRI of brain in all cases. Pre-operative complete excision was 20 cases, but post-operative images showed complete excision in 17 cases. Content of tumor was pearly white/white material in all cases except one, where content was putty material. Re-operation for residual/recurrent tumor was nil. Complications included pre-operative mortality one case, persisted sixth nerve palsy in one case, transient memory disturbance one case, and extra dural hematoma one case. One senior patient

  7. The Influence of Geographic Mobility on Nearly Lethal Suicide Attempts.

    ERIC Educational Resources Information Center

    Potter, Lloyd B.; Kresnow, Marcie-jo; Powell, Kenneth E.; Simon, Thomas R.; Mercy, James A.; Lee, Roberta K.; Frankowski, Ralph F.; Swann, Alan C.; Bayer, Timothy; O'Carroll, Patrick W.

    2002-01-01

    Presents a population-based, case-control study of nearly lethal suicide attempts with 153 cases and 513 controls. Results indicate that moving in the past year is positively associated with a nearly lethal suicide attempt, as are specific characteristics of the move. Findings confirm and extend prior research by demonstrating a relationship…

  8. The Influence of Geographic Mobility on Nearly Lethal Suicide Attempts.

    ERIC Educational Resources Information Center

    Potter, Lloyd B.; Kresnow, Marcie-jo; Powell, Kenneth E.; Simon, Thomas R.; Mercy, James A.; Lee, Roberta K.; Frankowski, Ralph F.; Swann, Alan C.; Bayer, Timothy; O'Carroll, Patrick W.

    2002-01-01

    Presents a population-based, case-control study of nearly lethal suicide attempts with 153 cases and 513 controls. Results indicate that moving in the past year is positively associated with a nearly lethal suicide attempt, as are specific characteristics of the move. Findings confirm and extend prior research by demonstrating a relationship…

  9. Airport Managers' Perspectives on Security and Safety Management Systems in Aviation Operations: A Multiple Case Study

    NASA Astrophysics Data System (ADS)

    Brown, Willie L., Jr.

    Global terrorism continues to persist despite the great efforts of various countries to protect and safely secure their citizens. As airports form the entry and exit ports of a country, they are one of the most vulnerable locations to terror attacks. Managers of international airports constantly face similar challenges in developing and implementing airport security protocols. Consequently, the technological advances of today have brought both positive and negative impacts on security and terrorism of airports, which are mostly managed by the airport managers. The roles of the managers have greatly increased over the years due to technological advances. The developments in technology have had different roles in security, both in countering terrorism and, at the same time, increasing the communication methods of the terrorists. The purpose of this qualitative multiple case study was to investigate the perspectives of airport managers with regard to societal security and social interactions in the socio-technical systems of the National Terrorism Advisory System (NTAS). Through the data gained regarding managers' perception and experiences, the researcher hoped to enable the development of security measures and policies that are appropriate for airports as socio-technical systems. The researcher conducted interviews with airport managers to gather relevant data to fulfill the rationale of the study. Ten to twelve airport managers based in three commercial aviation airports in Maryland, United States participated in the study. The researcher used a qualitative thematic analysis procedure to analyze the data responses of participants in the interview sessions.

  10. Nonoperative management for major blunt hepatic trauma. A case report.

    PubMed

    Mingoli, Andrea; Saracino, Andrea; Brachini, Gioia; Mariotta, Giovanni; Migliori, Emanuele; Silvestri, Vania

    2015-03-16

    Over the past 20 years the management of blunt liver trauma has evolved from a primary operative approach to a nonoperative one, for both low and high grade injuries, only on the basis of hemodynamic stability. However, in spite of a high success rate of non operative management, it is frequently observed, also in our country, an old fashioned way to approach these patients, based on habit more than observation and evidence based medicine. We present a case of successful nonoperative treatment of a grade IV blunt liver trauma (lacero-contusive injury of V, VI and VII segments) in a 34-year-old woman. Nowadays more than 85% of liver injuries are managed without operative intervention, irrespective of the injury grade. Success rate of the conservative approach ranges from 82% to 100% and almost all complications (14% in high grade injuries) can be managed with interventional radiology procedures, still avoiding major surgery. Today, in the absence of other abdominal injuries requiring surgical exploration, hemodynamic instability from ongoing hemorrhage after primary evaluation and resuscitative treatment, is the only indication to an operative management of traumatic liver injuries.

  11. Clinicopathological profile and management of 161 cases of actinic cheilitis*

    PubMed Central

    Lopes, Maria Luiza Diniz de Sousa; da Silva Júnior, Francisco Leonardo; Lima, Kenio Costa; de Oliveira, Patrícia Teixeira; da Silveira, Éricka Janine Dantas

    2015-01-01

    BACKGROUND Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun. OBJECTIVES To evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading. METHODS Demographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system. RESULTS There was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803). CONCLUSION This study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies. PMID:26375219

  12. Farmers' use of nutrient management: lessons from watershed case studies.

    PubMed

    Osmond, Deanna L; Hoag, Dana L K; Luloff, Al E; Meals, Donald W; Neas, Kathy

    2015-03-01

    Nutrient enrichment of water resources has degraded coastal waters throughout the world, including in the United States (e.g., Chesapeake Bay, Gulf of Mexico, and Neuse Estuary). Agricultural nonpoint sources have significant impacts on water resources. As a result, nutrient management planning is the primary tool recommended to reduce nutrient losses from agricultural fields. Its effectiveness requires nutrient management plans be used by farmers. There is little literature describing nutrient management decision-making. Here, two case studies are described that address this gap: (i) a synthesis of the National Institute of Food and Agriculture, the Conservation Effects Assessment Project, and (ii) field surveys from three nutrient-impaired river basins/watersheds in North Carolina (Neuse, Tar-Pamlico, and Jordan Lake drainage areas). Results indicate farmers generally did not fully apply nutrient management plans or follow basic soil test recommendations even when they had them. Farmers were found to be hesitant to apply N at university-recommended rates because they did not trust the recommendations, viewed abundant N as insurance, or used recommendations made by fertilizer dealers. Exceptions were noted when watershed education, technical support, and funding resources focused on nutrient management that included easing management demands, actively and consistently working directly with a small group of farmers, and providing significant resource allocations to fund agency personnel and cost-share funds to farmers. Without better dialogue with farmers and meaningful investment in strategies that reward farmers for taking what they perceive as risks relative to nutrient reduction, little progress in true adoption of nutrient management will be made. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  13. Chiropractic management of breast-feeding difficulties: a case report

    PubMed Central

    Holleman, Annique C.; Nee, John; Knaap, Simone F.C.

    2011-01-01

    Objective The purpose of this study is to discuss a chiropractic case of management and resolution of breast-feeding difficulties. Clinical Features The case involves an 8-day-old baby unable to breast-feed since 4 days old. Initial examination revealed cervical, cranial, and sacral restrictions. She was diagnosed with craniocervical syndrome by a doctor of chiropractic. Intervention and Outcome Following history and examination, the infant received gentle chiropractic manipulation based on clinical findings. Immediate improvement and complete resolution of the nursing problems were observed after 3 treatments over 14 days. Conclusion The results of this case suggest that neuromusculoskeletal dysfunction may influence the ability of an infant to suckle successfully and that intervention via chiropractic adjustments may result in improving the infant's ability to suckle efficiently. PMID:22014911

  14. Conservative management of retrocaval Ureter: A case series

    PubMed Central

    Yen, Jia Min; Lee, Lui Shiong; Cheng, Christopher Wai Sam

    2015-01-01

    Introduction Retrocaval ureter is a rare congenital anomaly with the ureter passage posterior to the inferior vena cava. Surgical repair is suggested for patients with significant functional obstruction. However, there is little literature to suggest the management of asymptomatic patients. Case presentation Case 1 patient is a 29 year-old Indonesian man and case 2 patient is a 41 year-old Malay man. Both patients were asymptomatic and well. Discussion This report is the short follow-up, therefore making it impossible to elucidate the natural history of uncorrected retrocaval ureters. Conclusion At 8 month and 6 month respectively, they remained well without symptoms. Our report suggests that immediate surgical repair is not always needed. Longer follow-up with larger patient population is needed to formally elucidate the natural history of this uncommon condition. PMID:26322820

  15. Endodontic management of dens invaginatus Type IIIb: Case series

    PubMed Central

    Martins, Jorge N. R.; da Costa, Rui Pereira; Anderson, Craig; Quaresma, Sérgio André; Corte-Real, Luís S. M.; Monroe, Adam D.

    2016-01-01

    Dens invaginatus may be seen as a developmental malformation. It is characterized by an invagination of the enamel and dentin, creating a lumen inside the affected tooth, which may extend as deep as the apical foramen. Oehlers Type IIIb is considered the most challenging clinical conditions. The purpose of this study is to discuss the nonsurgical endodontic management of vital and necrotic dens invaginatus Type IIIb cases. Due to the complex anatomical consideration of dens invaginatus Type IIIb, endodontic treatment is extremely technique sensitive. A conservative approach was used in a vital case to treat the invaginated lumen only, to preserve the vitality of the pulp, and a more invasive approach was used in a necrotic case to debride the lumen and necrotic pulp for proper disinfection of the root canal system. Although different, all the approaches were successful. The clinical signs and symptoms were resolved. The vital case remains vital after 19 months, and the recall radiographs were able to show satisfactory periapical healing both in vital and necrotic cases. Due to the highly complex anatomy of dens invaginatus Type IIIb, the decision of preserving the pulp vitality may not be related only to pulpal diagnosis but also to the technical requirements of the treatment. Although very technically sensitive, it may be possible to treat the invaginated lumen exclusively, while preserving the vitality of the pulp. Necrotic cases may require a more aggressive approach to achieve a favorable prognosis. PMID:28042276

  16. Endodontic management of dens invaginatus Type IIIb: Case series.

    PubMed

    Martins, Jorge N R; da Costa, Rui Pereira; Anderson, Craig; Quaresma, Sérgio André; Corte-Real, Luís S M; Monroe, Adam D

    2016-01-01

    Dens invaginatus may be seen as a developmental malformation. It is characterized by an invagination of the enamel and dentin, creating a lumen inside the affected tooth, which may extend as deep as the apical foramen. Oehlers Type IIIb is considered the most challenging clinical conditions. The purpose of this study is to discuss the nonsurgical endodontic management of vital and necrotic dens invaginatus Type IIIb cases. Due to the complex anatomical consideration of dens invaginatus Type IIIb, endodontic treatment is extremely technique sensitive. A conservative approach was used in a vital case to treat the invaginated lumen only, to preserve the vitality of the pulp, and a more invasive approach was used in a necrotic case to debride the lumen and necrotic pulp for proper disinfection of the root canal system. Although different, all the approaches were successful. The clinical signs and symptoms were resolved. The vital case remains vital after 19 months, and the recall radiographs were able to show satisfactory periapical healing both in vital and necrotic cases. Due to the highly complex anatomy of dens invaginatus Type IIIb, the decision of preserving the pulp vitality may not be related only to pulpal diagnosis but also to the technical requirements of the treatment. Although very technically sensitive, it may be possible to treat the invaginated lumen exclusively, while preserving the vitality of the pulp. Necrotic cases may require a more aggressive approach to achieve a favorable prognosis.

  17. Case management for medical aid beneficiaries in Korea: findings from case-control study.

    PubMed

    Shin, Hee-Sun; Oh, Jin-Joo

    2014-12-01

    This study was to evaluate effects of case management provided for 7 months for medical aid in Korea. This study was a retrospective comparative study using secondary data analysis. Data from two pre-existing survey were reanalyzed. The data were collected through door to-door interviews using the structured questionnaire. For the medical service use, claims data from the Korea National Health Insurance Corporation was used. Subjects were 73 in the intervention group and 118 in the control group. There was no significant change in the intervention group in self-care ability (p = .296), medication adherence (p = .194) or quality of life (p = .903) compared to those of the control group. For hospital visiting days, it appeared to decrease in the intervention group (p = .038) but with no significant difference from that of the control group (p = .157). Neither were there significant differences in medical expenditures (p = .605). Although the effect of case management in this study appeared extremely limited, the short intervention period and characteristics of the medical aid beneficiaries and the limit of controlling only the demand side were discussed as factors to be considered. Nurses have been carrying out professional roles in case management in Korea. However more efforts are needed to develop case management as an area for nursing specialization. Copyright © 2014. Published by Elsevier B.V.

  18. Case management approaches to home support for people with dementia.

    PubMed

    Reilly, Siobhan; Miranda-Castillo, Claudia; Malouf, Reem; Hoe, Juanita; Toot, Sandeep; Challis, David; Orrell, Martin

    2015-01-05

    Over 35 million people are estimated to be living with dementia in the world and the societal costs are very high. Case management is a widely used and strongly promoted complex intervention for organising and co-ordinating care at the level of the individual, with the aim of providing long-term care for people with dementia in the community as an alternative to early admission to a care home or hospital. To evaluate the effectiveness of case management approaches to home support for people with dementia, from the perspective of the different people involved (patients, carers, and staff) compared with other forms of treatment, including 'treatment as usual', standard community treatment and other non-case management interventions. We searched the following databases up to 31 December 2013: ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group,The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, Web of Science (including Science Citation Index Expanded (SCI-EXPANDED) and Social Science Citation Index), Campbell Collaboration/SORO database and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group. We updated this search in March 2014 but results have not yet been incorporated. We include randomised controlled trials (RCTs) of case management interventions for people with dementia living in the community and their carers. We screened interventions to ensure that they focused on planning and co-ordination of care. We used standard methodological procedures as required by The Cochrane Collaboration. Two review authors independently extracted data and made 'Risk of bias' assessments using Cochrane criteria. For continuous outcomes, we used the mean difference (MD) or standardised mean difference (SMD) between groups along with its confidence interval (95% CI). We applied a fixed- or random-effects model as appropriate. For binary or dichotomous data, we generated the corresponding odds

  19. Multilingualism among University Staff: A Case Study of Language Management at an Australian University

    ERIC Educational Resources Information Center

    Marriott, Helen

    2013-01-01

    Employing the language management framework, this paper reports on multilingual use among the staff of a major metropolitan university in Melbourne and covers both simple and organised management. It describes a top-down attempt to survey staffs' (academic and general) background in Languages other than English (LOTE), LOTE usage and evaluative…

  20. Neurosurgical management of anterior meningo-encephaloceles about 60 cases.

    PubMed

    Rifi, Loubna; Barkat, Amina; El Khamlichi, Abdeslam; Boulaadas, Malek; El Ouahabi, Abdessamad

    2015-01-01

    Anterior meningo-encephaloceles (AME) are congenital malformations characterized by herniation of brain tissue and meninges through a defect in the cranium, in frontal, orbital, nasal and ethmoidal regions. The management of this complex congenital malformation is controversial according to whether use, an intracranial, extra-cranial or combined approach. This is the first largest series published in Africa, in which we present our experience in the operative management of AME; we share our recommendation in technical consideration for surgical approach with review of the literature. All patients beneficed of neuro-radiological investigations including Plan X rays, Spiral Three dimensional CT scan and MRI. Ophthalmologic and maxillo-facial evaluations were done in all the cases. MEA are surgically approached in various ways, mainly on the basis of its location and type, by cranio-facial approach in one-step, or in two stages by intracranial approach followed by facial approach, only by cranial approach or facial approach. The surgical results were evaluated in the follow up on the basis of disappearance of cranio-facial tumefaction with correction of hypertelorism. 60 children with AME were treated in our department between January 1992 and December 2012. The mean age at time of surgery was 14 months (20 days to 18 years) with slight men predominance (28 females/32 males). Cranio-facial team operated 21 patients, 16 were operated in two stages by intracranial approach followed by facial approach, 20 cases beneficed the neurosurgical approach and three only the facial approach Some post operative complications were observed: 2 cases of post operative hydrocephalus underwent shunt; CSF fistulas in three cases cured by spinal drainage, one death due to per operative hypothermia, 3 cases of recurrence how needed second surgery. After mean follow up for 80 months (1 year to 19 years) theses techniques permitted a good cosmetics results in 42 cases, average cosmetics

  1. Neurosurgical management of anterior meningo-encephaloceles about 60 cases

    PubMed Central

    Rifi, Loubna; Barkat, Amina; El Khamlichi, Abdeslam; Boulaadas, Malek; El Ouahabi, Abdessamad

    2015-01-01

    Anterior meningo-encephaloceles (AME) are congenital malformations characterized by herniation of brain tissue and meninges through a defect in the cranium, in frontal, orbital, nasal and ethmoidal regions. The management of this complex congenital malformation is controversial according to whether use, an intracranial, extra-cranial or combined approach. This is the first largest series published in Africa, in which we present our experience in the operative management of AME; we share our recommendation in technical consideration for surgical approach with review of the literature. All patients beneficed of neuro-radiological investigations including Plan X rays, Spiral Three dimensional CT scan and MRI. Ophthalmologic and maxillo-facial evaluations were done in all the cases. MEA are surgically approached in various ways, mainly on the basis of its location and type, by cranio-facial approach in one-step, or in two stages by intracranial approach followed by facial approach, only by cranial approach or facial approach. The surgical results were evaluated in the follow up on the basis of disappearance of cranio-facial tumefaction with correction of hypertelorism. 60 children with AME were treated in our department between January 1992 and December 2012. The mean age at time of surgery was 14 months (20 days to 18 years) with slight men predominance (28 females/32 males). Cranio-facial team operated 21 patients, 16 were operated in two stages by intracranial approach followed by facial approach, 20 cases beneficed the neurosurgical approach and three only the facial approach Some post operative complications were observed: 2 cases of post operative hydrocephalus underwent shunt; CSF fistulas in three cases cured by spinal drainage, one death due to per operative hypothermia, 3 cases of recurrence how needed second surgery. After mean follow up for 80 months (1 year to 19 years) theses techniques permitted a good cosmetics results in 42 cases, average cosmetics

  2. Videophones for intensive case management of psychiatric outpatients.

    PubMed

    Nieves, J Edwin; Godleski, Linda S; Stack, Kathleen M; Zinanni, Tracy

    2009-01-01

    When visiting patients with serious mental illness at their homes, case managers carried a portable videophone. This was used to access the hospital clinical team via the home telephone line, when an acute clinical need arose in addressing questions related to medication management and treatment planning; travel was therefore avoided. In an acceptability study lasting 12 months, 24 patients received the supplemental videophone mental health service and 19 of them completed a satisfaction survey. Only one patient was not satisfied with the videophone treatment, while 74% of them were very satisfied. Specific areas of satisfaction concerned the savings of time and travel, assistance with medication questions and increased involvement in treatment. No patient reported any difficulty in using the equipment. Staff members were enthusiastic about the decrease in travel time and there were no complaints about the videophone process or encounters. During the study, 135 h of the case manager's time was saved by using the videophone for urgent access visits, equivalent to a saving of $4000 in salary costs. In addition, the patients saved 135 h in travel time. We believe that there are other potential uses of videophones for seriously mentally ill patients, including discharge planning, intensive post-discharge monitoring and transition to community life.

  3. Empowerment and change management in Aboriginal organisations: a case study.

    PubMed

    McEwan, Alexandra B; Tsey, Komla; McCalman, Janya; Travers, Helen J

    2010-08-01

    The social organisation of work, management styles and social relationships in the workplace all matter for health. It is now well recognised that people who have control over their work have better health and that stress in the workplace increases the level of disease. In the context of organisational change, the potential benefits of empowerment strategies are two-fold: a positive impact on the organisation's effectiveness and enhancements in staff health, wellbeing and sense of control. This case study describes the University of Queensland Empowerment Research Program's experience working with the Apunipima Cape York Health Council in a change management process. Participatory action research and empowerment strategies were utilised to facilitate shifts in work culture and group cohesion towards achieving Apunipima's vision of being an effective lead agency for Indigenous health reform in Cape York. As part of the project, staff morale and confidence were monitored using a pictorial tool, Change Curve, which outlined the phases of organisational change. The project findings indicated that organisational change did not follow a clear linear trajectory. In some ways the dynamics mapped over a period of 18 months mirror the type of struggles individuals commonly encounter as a part of personal growth and development. In this case, one of the factors which influenced the program's success was the willingness of executive employees to actively support and participate in the change management process.

  4. [Study protocol of a prevention of recurrent suicidal behaviour program based on case management (PSyMAC)].

    PubMed

    Sáiz, Pilar A; Rodríguez-Revuelta, Julia; González-Blanco, Leticia; Burón, Patricia; Al-Halabí, Susana; Garrido, Marlen; García-Alvarez, Leticia; García-Portilla, Paz; Bobes, Julio

    2014-01-01

    Prevention of suicidal behaviour is a public health priority in the European Union. A previous suicide attempt is the best risk predictor for future attempts, as well as completed suicides. The primary aim of this article is to describe a controlled study protocol designed for prevention of recurrent suicidal behaviour that proposes case management, and includes a psychoeducation program, as compared with the standard intervention (PSyMAC). Patients admitted from January 2011 to June 2013 to the emergency room of the Hospital Universitario Central de Asturias were evaluated using a protocol including sociodemographic, psychiatric, and psychosocial assessment. Patients were randomly assigned to either a group receiving continuous case management including participation in a psychoeducation program (experimental group), or a control group receiving standard care. The primary objective is to examine whether or not the period of time until recurrent suicidal behaviour in the experimental group is significantly different from that of the control group. PSyMAC proposes low cost and easily adaptable interventions to the usual clinical setting that can help to compensate the shortcoming of specific action protocols and suicidal behaviour prevention programs in our country. The evaluation of PSyMAC results will determine their real effectivity as a case-magament program to reduce suicidal risk. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.

  5. [Tasks of case managers in statutory accident insurance].

    PubMed

    Böhnert, W

    1997-02-01

    The present article gives an outline of vocational rehabilitation in the Federal Republic of Germany from the perspective of the statutory accident insurance scheme. Termed "Berufshilfe", occupational assistance, the services and benefits provided under the scheme also encompass elements of medical and social rehabilitation of persons who have incurred an industrial injury or occupational disease. Given the scheme's comprehensive catalog of benefits and services, a multitude of possibilities result for assistance to eligible workers and their relatives, which are illustrated by examples. Central to the presentation is the work of the "Berufshelfer", the accident insurance agency's case manager for vocational rehabilitation service provision. Along with competence of the accident insurance agency for medical, vocational and social rehabilitation, this case manager is the point of contact for all those involved in rehabilitation in the individual case, hence in particular for the individual affected, his or her relatives, physicians, rehabilitation facilities, employers as well as third parties, moreover being the point of liaison among these various parties and the administration. The primary objective of these entire efforts is to achieve lasting reintegration of people with physical or emotional disablement in employment, career, and society.

  6. Case management in a DUI lab: effect on drugs reported.

    PubMed

    Tiscione, Nicholas B; Shan, Xiaoqin; Yeatman, Dustin Tate

    2014-10-01

    An evaluation of an internal laboratory decision to implement a protocol for limiting drug testing based on ethanol concentration in laboratory analysis for driving under the influence (DUI) cases is presented. The described case management strategy is supported by known impairment of ethanol at relatively high concentrations, difficulty assigning a level of contributing impairment from drugs in the presence of high ethanol levels and the likelihood that the drug results may be suppressed at trial. Although the results of this study reinforce the assertion that such protocols lead to the under reporting of drugs in DUI cases, for the majority of cases, 95% in this study, the drug analysis results were not significant and did not warrant the time and resources needed for the additional blood drug testing. Furthermore, the study demonstrated that a high drug positivity rate does not necessarily mean that those drug results are legally or pharmacologically meaningful. Additional research should be conducted with quantitative drug results and casework impact of blood drug screen protocols as previous studies only report drug positivity rates and not whether the drug results would be meaningful to the case.

  7. [Airway management in Ludwig's angina - a challenge: case report].

    PubMed

    Fellini, Roberto Taboada; Volquind, Daniel; Schnor, Otávio Haygert; Angeletti, Marcelo Gustavo; Souza, Olívia Egger de

    2015-07-31

    Ludwig's angina (LA) is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. It represents an entity difficult to manage due to the rapid progression and difficulty in maintaining airway patency, a major challenge in medical practice, resulting in asphyxia and death in 8-10% of patients. Describe a case of a patient with Ludwig's angina undergoing surgery, with emphasis on airway management, in addition to reviewing the articles published in the literature on this topic. Male patient, 21 years, drug addict, admitted by the emergency department and diagnosed with LA. Difficult airway was identified during the anesthetic examination. In additional tests, significant deviation from the tracheal axis was seen. Undergoing bilateral thoracoscopic pleural drainage, we opted for airway management through tracheal intubation using fiberoptic bronchoscopy, and balanced general anesthesia was proposed. There were no complications during the surgical-anesthetic act. After the procedure, the patient remained intubated and mechanically ventilated in the intensive care unit. Airway management in patients with Ludwig's angina remains challenging. The choice of the safest technique should be based on clinical signs, technical conditions available, and the urgent need to preserve the patient's life. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. [Lean logistics management in healthcare: a case study].

    PubMed

    Aguilar-Escobar, V G; Garrido-Vega, P

    2013-01-01

    To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs. This study is based on a case study. 2005-10. Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments. The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics. The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.

  9. Depression management in the workplace: a case study.

    PubMed

    Columbi, Alberto M

    2005-04-01

    To review a case of a depression management program at PPG Industries with the potential to improve outcomes on functioning and productivity in the workplace. The need for major improvements in depression management has been well established. While most in the corporate world are aware of these deficiencies, the perception is that this fragmented system is difficult to change. PPG Industries, a medium-sized, Fortune 500 company manufacturing paints, stains, and sealants, has launched a successful and comprehensive program in the workplace that has improved outcomes for depressed employees. The PPG approach is practical, addressing each step in the process one at a time. This process began by establishing a close working relationship between all entities responsible for employee health, many of which are currently carved out. This enabled the company to have a comprehensive view of their depressed population and to examine their functional outcomes as well. In an effort to help identify depressed employees, the company educated their physicians and care managers and launched a confidential Web site to reduce mental health stigma and aid in employee screening and education. A multidisciplinary team was then assembled to facilitate the treatment of these patients. All of these steps were measurable, and the preliminary results of this process are summarized. A disease management program that incorporates a multifaceted, collaborative approach to treat depression is feasible and may improve care and decrease cost to employers.

  10. Sustainable watershed management: an international multi-watershed case study.

    PubMed

    Wagner, Walter; Gawel, James; Furuma, Hiroak; De Souza, Marcelo Pereira; Teixeira, Denilson; Rios, Leonardo; Ohgaki, Shinichiro; Zehnder, Alexander J B; Hemond, Harold F

    2002-02-01

    Global freshwater resources are being increasingly polluted and depleted, threatening sustainable development and human and ecosystem health. Utilizing case studies from 4 different watersheds in the United States, Japan, Switzerland, and Brazil, this paper identifies the most relevant sustainability deficits and derives general vectors for more sustainable water management. As a consequence of the demographic and economic developments experienced in the last few decades, each watershed has suffered declines in water quality, streamflow and biotic resources. However, the extent and the cultural perception of these water-related problems vary substantially in the different watersheds, leading to specific water-management strategies. In industrialized countries, exemplified by the US, Switzerland, and Japan, these strategies have primarily consisted of finance- and energy-intensive technologies, allowing these countries to meet water requirements while minimizing human health risks. But, from a sustainability point of view, such strategies, relying on limited natural resources, are not long-term solutions. For newly industrialized countries such as Brazil, expensive technologies for water management are often not economically feasible, thus limiting the extent to which newly industrialized and developing countries can utilize the expertise offered by the industrialized world. Sustainable water management has to be achieved by a common learning process involving industrialized, newly industrialized, and developing countries, following general sustainability guidelines as exemplified in this paper.

  11. Role of the HIV/AIDS case manager: analysis of a case management adherence training and coordination program in North Carolina.

    PubMed

    Shelton, Rachel C; Golin, Carol E; Smith, Scott R; Eng, Eugenia; Kaplan, Andrew

    2006-03-01

    Highly active antiretroviral therapy (HAART) adherence rates of 90%-95% or more are required to be effective at treating the virus and preventing drug resistance. From both a medical and public health perspective, it is essential that HIV-positive clients strictly adhere to antiretroviral treatment regimens. One promising approach to promoting optimal adherence rates among HIV-positive individuals is training and reimbursing case managers to provide adherence coordination services to HIV-positive clients. In this study, a sample of 16 HIV/ AIDS case managers from agencies across North Carolina participated in a Case Management Adherence Training and Coordination Program for a 3-month period. After case manager training, case managers enrolled 1-4 of their existing clients, who met eligibility criteria, to receive the adherence coordination program. Data were analyzed from focus group interviews and individual interviews conducted with case manager participants; their respective client care plans were also analyzed to identify primary barriers and strategies reported by case managers. Although case managers perceived themselves to be well positioned to provide adherence coordination services for their HIV-positive clients, they also identified barriers that they face in providing these services, including lack of reimbursement for their time, inadequate training, and insufficient knowledge of HIV/AIDS and medications. The findings of this study suggest that, with appropriate training and reimbursement, HIV/AIDS case managers can play a pivotal role in promoting and improving client adherence to antiretroviral medications.

  12. Designing a system of case management for a rural nursing clinic for elderly patients with depression.

    PubMed

    Stanton, Marietta P; Dunkin, Jeri W; Williams Thomas, L Kathleen

    2007-01-01

    This article provides an overview of the process and procedures used to develop and implement a system of case management for middle-aged and older depressed adults in a rural health nursing clinic. This system included on-site case management for elderly clients and telephonic follow-up by case managers on an ongoing basis.

  13. Managing environmental sensitivity: an overview illustrated with a case report

    PubMed Central

    Busse, Jason W.; Reid, Steven; Leznoff, Arthur; Barsky, Arthur J.; Qureshi, Roohi; Guyatt, Gordon H.

    2008-01-01

    While the adverse impact of certain environmental agents is well established and affect individuals in a predictable dose-dependent manner, the validity of some exposure syndromes, such as environmental sensitivity, attributed to the influence of environmental chemicals in low, usually harmless doses, is less certain. Diagnosis of environmental sensitivity is subjective, and both standard medical and complementary and alternative treatment often fails to provide clinically meaningful functional gains. Existing evidence suggests that in many individuals with these syndromes, psychosocial factors play a prominent role. In this article we present an approach to managing patients presenting with sensitivities to environmental agents that includes identifying and managing organic disease, obtaining a thorough biopsychosocial history, confirming a diagnosis, and developing a rehabilitative process that focuses on support and improvements in function. A case of multiple chemical sensitivity illustrates this approach. PMID:18516285

  14. Use of case mix tools for utilization management and planning.

    PubMed

    Perry, Sheril; Homan, Craig

    2009-01-01

    An aging population, new technologies and drugs, and tightening constraints on financial and human resources have placed increased demands on hospitals to meet health care needs. Canadian hospitals, health regions, and ministries are placing a high priority on the evaluation of appropriateness and efficiency of medical care and on the proactive and targeted reduction of inefficiencies. The CMG+ grouping methodology is a case mix tool produced by the Canadian Institute for Health Information (CIHI) to analyze the acute-care inpatient population in Canada. CMG+ methodology can be applied, for example, to utilization management. The expected length of stay (ELOS) indicator can be used as a benchmark for assessing the length-of-stay distribution of various subgroups of patient activity. It can also be used to compute potentially conservable days and to identify those patient subgroups where gains in efficiency may be realized. We describe CMG+ utilization management using this and other examples.

  15. Intensive case management for high-risk patients with first-episode psychosis: service model and outcomes.

    PubMed

    Brewer, Warrick J; Lambert, Timothy J; Witt, Katrina; Dileo, John; Duff, Cameron; Crlenjak, Carol; McGorry, Patrick D; Murphy, Brendan P

    2015-01-01

    The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual. Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15-24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge. Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts. Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis

  16. The challenges of managing coexistent disorders with phenylketonuria: 30 cases.

    PubMed

    MacDonald, A; Ahring, K; Almeida, M F; Belanger-Quintana, A; Blau, N; Burlina, A; Cleary, M; Coskum, T; Dokoupil, K; Evans, S; Feillet, F; Giżewska, M; Gokmen Ozel, H; Lotz-Havla, A S; Kamieńska, E; Maillot, F; Lammardo, A M; Muntau, A C; Puchwein-Schwepcke, A; Robert, M; Rocha, J C; Santra, S; Skeath, R; Strączek, K; Trefz, F K; van Dam, E; van Rijn, M; van Spronsen, F; Vijay, S

    2015-12-01

    The few published case reports of co-existent disease with phenylketonuria (PKU) are mainly genetic and familial conditions from consanguineous marriages. The clinical and demographic features of 30 subjects with PKU and co-existent conditions were described in this multi-centre, retrospective cohort study. Diagnostic age of PKU and co-existent condition, treatment regimen, and impact of co-existent condition on blood phenylalanine (Phe) control and PKU management were reported. 30 patients (11 males and 19 females), with PKU and a co-existent condition, current median age of 14 years (range 0.4 to 40 years) from 13 treatment centres from Europe and Turkey were described. There were 21 co-existent conditions with PKU; 9 were autoimmune; 6 gastrointestinal, 3 chromosomal abnormalities, and 3 inherited conditions. There were only 5 cases of parental consanguinity. Some patients required conflicting diet therapy (n=5), nutritional support (n=7) and 5 children had feeding problems. There was delayed diagnosis of co-existent conditions (n=3); delayed treatment of PKU (n=1) and amenorrhea associated with Grave's disease that masked a PKU pregnancy for 12 weeks. Co-existent conditions adversely affected blood Phe control in 47% (n=14) of patients. Some co-existent conditions increased the complexity of disease management and increased management burden for patients and caregivers. Occurrence of co-existent disease is not uncommon in patients with PKU and so investigation for co-existent disorders when the clinical history is not completely consistent with PKU is essential. Integrating care of a second condition with PKU management is challenging. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Anaesthetic management in a case of huge plunging ranula

    PubMed Central

    Sheet, Jagabandhu; Mandal, Anamitra; Sengupta, Swapnadeep; Jana, Debaleena; Mukherji, Sudakshina; Swaika, Sarbari

    2014-01-01

    Plunging ranula is a rare form of mucous retention cyst arising from submandibular and sublingual salivary glands, which may occasionally become huge occupying the whole of the floor of the mouth and extending into the neck, thus, restricting the neck movement as well as disfiguring the normal airway anatomy. Without fiberoptic assistance, blind or retrograde nasal intubation remains valuable choices in this type of situation. Here, we present a case of successful management of airway by blind nasal intubation in a patient posted for excision of a huge plunging ranula. PMID:25886120

  18. Pineal cyst apoplexy: report of an unusual case managed conservatively.

    PubMed

    Ayhan, Selim; Bal, Ercan; Palaoglu, Selcuk; Cila, Aysenur

    2011-01-01

    Pineal cyst apoplexy is a very rare entity with previously reported symptoms of severe frontal or occipital headache, gaze paresis and visual field defects, nausea or vomiting, syncope, ataxia, hearing loss and sudden death. The treatment options for symptomatic pineal cysts are observation, shunting, aspiration via stereotactic guidance or endoscopy, third ventriculostomy, ventriculocysternostomy, and/or surgical resection by craniotomy and microsurgery. Here, the authors report an unusual case of a 28-year-old male patient with pineal cyst apoplexy, presenting with headache, insomnia, and sexual dysfunction symptoms who is being managed conservatively and observed for two years by an academic tertiary care unit.

  19. Analysis of Selection Process for Management Education: Korean Military Case.

    DTIC Science & Technology

    1984-06-01

    OF SELECTION PROCESS FOR MANAGE.Y"FNT EDUCATION: KOREAN MILITARY CASE I ~~by 4 . m 3 Durk Kwan, Park * June 1984 * L.D Thesis Advisor: T. r.Swenson A...Anlyisof selection ?2-ocess for "aster’s Thcsis Vianajertent Eclucat ’on Korean M itiaryJue14 Cas 6 PERFORM-NO R RIEPCRT N-uMBER *7 A.~OR(., 8 CONTRACT...predicted [Ref. E]. 14 Chaptiz IV iresents the ierscnal characteristics tc takce into acccunt :or miana ~einent education and the identificatioz imethcd

  20. Management of Ectopically Erupting Maxillary Incisors: A Case Series.

    PubMed

    Suresh, Kotumachagi Sangappa; Uma, H L; Nagarathna, J; Kumar, Pravin

    2015-01-01

    Eruption disturbances related to the position include ectopic eruption and transpositions. The occurrence of ectopic eruption is most commonly associated with maxillary incisors. The normal eruption, position and morphology of these teeth are crucial to craniofacial development, facial esthetics as well as phonetics. It is essential that the clinicians have thorough knowledge of the eruption disturbances in order to make an appropriate, as well as timely intervention, as dictated by the complexity of the problem. How to cite this article: Suresh KS, Uma HL, Nagarathna J, Kumar P. Management of Ectopically Erupting Maxillary Incisors: A Case Series. Int J Clin Pediatr Dent 2015;8(3):227-233.

  1. ED case managers are crucial to help maximize reimbursement.

    PubMed

    2011-08-01

    As payers tighten their belts and recoup payments for inappropriate care and regulators increase penalties for fraud and abuse, hospitals need to ensure all admissions are appropriate and patient are placed in the right level of care. Hospitals are likely to have to return reimbursement for patients who don't meet inpatient criteria. Improper admissions can exacerbate capacity problems and result in hospital-acquired conditions. Correcting inappropriate admissions retrospectively can be a red flag to auditors. ED case managers can impact length of stay by ensuring that care starts in the emergency department.

  2. Unusual Traumatic Midthoracic Spondyloptosis and Its Surgical Management: Case Report

    PubMed Central

    Hasturk, Askin Esen; Ilik, Kemal; Coven, Ilker; Ozdemir, Ozgur

    2013-01-01

    Posttraumatic spondyloptosis develops as a result of complete subluxation of the vertebral bodies and causes complete transection of the spinal cord. Severe trauma-related spondyloptosis of the upper-mid thoracic region is a rare form of spinal trauma. Traumatic midthoracic spondyloptosis is quite rare, and radiology plays an important role in the diagnosis and treatment of this condition. Surgical reconstruction and stabilization are required for early mobilization and rehabilitation of patients with this injury. Here, we report the clinical features, radiographic findings, and management of an unusual case of traumatic midthoracic spondyloptosis that showed complete spinal cord transection and was operated. PMID:24097091

  3. A case management protocol: reducing unnecessary Medicare admissions in Florida.

    PubMed

    Michelman, Mark; Collier, Patricia; Dion, Charles; Richards, Ferdinand; Ohleyer, Henry; Vasey, Paulette; Henshaw, Zachary; Davison, Karen

    2005-01-01

    The Florida Medicare quality improvement organization implemented a case management project with 20 acute care hospitals to reduce unnecessary Medicare admissions. The project called for hospitals to implement a protocol to assign patients to observation or inpatient admission status. Results of the project showed a 67% reduction in the denial rate for the participating facilities. This relative reduction in denial rates was nearly 3 times greater for the participating facilities as compared to the control facilities. The protocol can easily be adopted by hospitals.

  4. Management of an unusual maxillary dentoalveolar fracture: a case report.

    PubMed

    Prabhakar, A R; Tauro, David P; Shubha, A B

    2006-01-01

    The purpose of this case report was to describe the management of a trauma-induced maxillary dentoalveolar fracture of the right maxilla in an 8-year-old boy. The child presented with swelling of the right maxillary region, difficulty in chewing and closing the mouth, and a sutured laceration on the cheek. Complete palatal displacement of the fractured fragment involving the deciduous canine and molars was observed clinically and confirmed by radiological examination. The fracture was reduced and stabilized using a custom-fabricated, open-cap acrylic splint with modified interdental wiring under general anesthesia.

  5. Esthetic management of anterior dental anomalies: A clinical case.

    PubMed

    Chafaie, Amir

    2016-09-01

    Many types of dental abnormality can be observed in the anterior sectors, where they can cause genuine esthetic problems for our patients. While conventional prosthetic treatments offer the best solutions in terms of esthetic result and durability, they involve the sacrifice of significant quantities of mineralized dental material and cannot be undertaken before the periodontal tissues are mature. Other less invasive alternatives should be envisaged as transitional, or sometimes even permanent, solutions for the management of these anomalies in children and adolescents. This article discusses these options and presents a clinical case where composite resin veneers and microabrasion of the enamel were used to treat dental agenesis and enamel dysplasia.

  6. Anaesthetic management in a case of huge plunging ranula.

    PubMed

    Sheet, Jagabandhu; Mandal, Anamitra; Sengupta, Swapnadeep; Jana, Debaleena; Mukherji, Sudakshina; Swaika, Sarbari

    2014-01-01

    Plunging ranula is a rare form of mucous retention cyst arising from submandibular and sublingual salivary glands, which may occasionally become huge occupying the whole of the floor of the mouth and extending into the neck, thus, restricting the neck movement as well as disfiguring the normal airway anatomy. Without fiberoptic assistance, blind or retrograde nasal intubation remains valuable choices in this type of situation. Here, we present a case of successful management of airway by blind nasal intubation in a patient posted for excision of a huge plunging ranula.

  7. A case of error disclosure: a communication privacy management analysis.

    PubMed

    Petronio, Sandra; Helft, Paul R; Child, Jeffrey T

    2013-12-01

    To better understand the process of disclosing medical errors to patients, this research offers a case analysis using Petronios's theoretical frame of Communication Privacy Management (CPM). Given the resistance clinicians often feel about error disclosure, insights into the way choices are made by the clinicians in telling patients about the mistake has the potential to address reasons for resistance. Applying the evidenced-based CPM theory, developed over the last 35 years and dedicated to studying disclosure phenomenon, to disclosing medical mistakes potentially has the ability to reshape thinking about the error disclosure process. Using a composite case representing a surgical mistake, analysis based on CPM theory is offered to gain insights into conversational routines and disclosure management choices of revealing a medical error. The results of this analysis show that an underlying assumption of health information ownership by the patient and family can be at odds with the way the clinician tends to control disclosure about the error. In addition, the case analysis illustrates that there are embedded patterns of disclosure that emerge out of conversations the clinician has with the patient and the patient's family members. These patterns unfold privacy management decisions on the part of the clinician that impact how the patient is told about the error and the way that patients interpret the meaning of the disclosure. These findings suggest the need for a better understanding of how patients manage their private health information in relationship to their expectations for the way they see the clinician caring for or controlling their health information about errors. Significance for public healthMuch of the mission central to public health sits squarely on the ability to communicate effectively. This case analysis offers an in-depth assessment of how error disclosure is complicated by misunderstandings, assuming ownership and control over information

  8. Case study: negative reinforcement and behavioral management of conversion disorder.

    PubMed

    Campo, J V; Negrini, B J

    2000-06-01

    Behavioral interventions have been advocated for conversion disorder, but controlled trials are lacking. The authors report the case of a 12-year-old boy with conversion disorder after 3 months of persistent right arm pain and immobility whose symptoms rapidly resolved after an outpatient behavioral intervention using negative reinforcement. The importance of careful assessment, frank discussion of the diagnosis, patient and family psychoeducation, and a rehabilitative mindset are emphasized. Negative reinforcement may be a powerful tool in the management of pediatric conversion disorder, with the potential to reduce parental anxiety and prevent unnecessary physical assessments and interventions.

  9. Management of Ectopically Erupting Maxillary Incisors: A Case Series

    PubMed Central

    Suresh, Kotumachagi Sangappa; Uma, HL; Nagarathna, J

    2015-01-01

    ABSTRACT Eruption disturbances related to the position include ectopic eruption and transpositions. The occurrence of ectopic eruption is most commonly associated with maxillary incisors. The normal eruption, position and morphology of these teeth are crucial to craniofacial development, facial esthetics as well as phonetics. It is essential that the clinicians have thorough knowledge of the eruption disturbances in order to make an appropriate, as well as timely intervention, as dictated by the complexity of the problem. How to cite this article: Suresh KS, Uma HL, Nagarathna J, Kumar P. Management of Ectopically Erupting Maxillary Incisors: A Case Series. Int J Clin Pediatr Dent 2015;8(3):227-233. PMID:26604543

  10. Quality in translation: case management in the international marketplace.

    PubMed

    Beichl, Lisa; Craig, Kathy

    2009-01-01

    This article identifies three categories of case management (CM), in-country, international, and micro, that are poised to serve as the quality proxy for the international medical patient in the rapidly emerging globalized healthcare marketplace. The content concentrates on describing in-country CM and international CM (ICM). Because CM professionals are the providers of patient-centered quality and safety improvements, they are capable of filling the chasm between the travel industry and the regulators who specialize in accrediting hospital systems. In-country and ICM case managers are equipped to perform surveillance and intervention at the level of the international patient's bedside, activate network connections, and use culture-sensitive communication skills to safeguard patients in their individual sojourns abroad. The article discusses useful concepts and sources, including an algorithmic tool under development that is geared to identify and quantify risks for lay and business individuals who seek to engage the global medical market. The article's information is provided for front-line and front-office healthcare practitioners to understand or enter the worldwide medical marketplace. Content is targeted to CM generalists, specialists, and business developers interested in learning about safeguarding the patients who travel internationally to receive medical care. It can also be applied by those within and outside the healthcare practice arena, particularly those interested in the development of quality initiatives. All research and syntheses were executed by the authors. Sources included scholarly treatises, business correspondence, medical tourism literature, corporate Internet profiles, news releases, and healthcare industry investigative and monitoring agencies. International health insurance, economics, and financing expertise stems from one author (L.B.). Clinical competencies stem from the international practice experiences of one author (K.C.). This

  11. [Rehabilitation networking illustrated by case management after occupational accidents].

    PubMed

    Mehrhoff, F

    2000-08-01

    No net without a spider! After work accidents the victims can rely on the infrastructure created by the German accident insurance scheme (Berufsgenossenschaften). A surgeon, a so-called transit physician, is responsible after acute treatments also for all phases of rehabilitation. A Case Manager (Berufshelfer), an employee of the Berufsgenossenschaften, advises the victim in all matters, including vocational rehabilitation and personal concerns. Both factors combine to form a network that orientates on the social needs of the injured worker, on the financial tasks of the insurance agency and on incentives to the rehabilitation facilities. The goals comprise "rehabilitation before compensation" and "job retention instead of job loss".

  12. Attempted suicide, by mail order: Abrus precatorius.

    PubMed

    Jang, David H; Hoffman, Robert S; Nelson, Lewis S

    2010-12-01

    Abrus precatorius is cultivated in many subtropical areas. The seeds exist in a variety of colors such as black, orange, and most commonly, glossy red. A black band is found at the end of the seed. The plant contains multiple pods which typically contain three to five Abrus seeds. The seeds contain abrin, which inhibits ribosomal function, halting protein synthesis and leading to cellular death. A unique aspect of this case is the use of the internet to order a potentially lethal poison as well as transmission of a picture to identify the seed. A 20-year-old man presented to the emergency department complaining of vomiting and watery diarrhea for 6-8 h prior to arrival. He denied any medication use, recent illness, travel, or changes in his diet. Initial vital signs were normal. The patient was diagnosed with viral gastroenteritis. During his evaluation, the patient admitted to feeling suicidal. While awaiting psychiatry evaluation, the patient's father arrived with a box of small hard red seeds, which he believed that his son ingested in a suicide attempt. The seeds could not be identified by the staff. A picture of the seeds was transmitted by e-mail to the New York City Poison Control Center, allowing their identification as A. precatorius. The patient was reinterviewed and admitted to chewing and swallowing 10 seeds. Given the potential toxicity of abrin, the patient was admitted to the intensive care unit. He continued to have frequent episodes of emesis as well as diarrhea. He gradually improved over 2 days. He admitted to ordering a box of Abrus seeds online from Asia after reading on the Internet about their use in suicide. He was eventually discharged for outpatient follow-up with no permanent sequelae. Abrin has an estimated human fatal dose of 0.1-1 μg/kg. Most cases of Abrus seed ingestions are unintentional and occur in children. Ingesting the intact seeds typically results in no clinical findings, as they pass through the gastrointestinal tract

  13. The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study.

    PubMed

    Iliffe, Steve; Waugh, Amy; Poole, Marie; Bamford, Claire; Brittain, Katie; Chew-Graham, Carolyn; Fox, Chris; Katona, Cornelius; Livingston, Gill; Manthorpe, Jill; Steen, Nick; Stephens, Barbara; Hogan, Vanessa; Robinson, Louise

    2014-08-01

    only 60% of the expected number of people, most living in care homes. All stakeholders were positive about the potential of case management; however, only one of the four practices achieved a level of case management activity that might have influenced patient and carer outcomes. Case managers' activity levels were not related solely to time available for case management. Delivery of case management was hindered by limited clarity about the role, poor integration with existing services and a lack of embeddedness within primary care. There were discrepancies between case manager and researcher judgements about need, and evidence of a high threshold for acting on unmet need. The practice nurses experienced difficulties in ring-fencing case management time. The model of case management developed and evaluated in this feasibility study is unlikely to be sustainable in general practice under current conditions and in our view it would not be appropriate to attempt a definitive trial of this model. This study could inform the development of a case management role with a greater likelihood of impact. Different approaches to recruiting and training case managers, and identifying people with dementia who might benefit from case management, are needed, as is exploration of the scale of need for this type of working. Current Controlled Trials ISRCTN74015152. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 52. See the NIHR Journals Library website for further project information.

  14. Teenage attempted suicide in Hong Kong.

    PubMed

    Yip, P S; Chiu, L H

    1998-01-01

    We examined the epidemiological profiles and characteristics of suicide attempters admitted to the Accident and Emergency Department of a regional hospital in Hong Kong (Princess Margaret Hospital) in the period from January to December 1995. These consisted of 101 adolescents (16 males and 85 females) aged between 10 to 24 years. There were significantly more female attempters than males, especially in the group aged 10-19, which had a male-to-female ratio of suicide rates of 1:11. Most of the methods used were nonlethal; the attempters were not serious enough and had no real intention to die. The use of painkillers and sleeping pills was most common. The main precipitating factor was interpersonal problems, for example, relationships, spousal and parental problems, especially among teenage girls. More than 90% of the cases stayed at the hospital for further observation, the mean length of stay in the hospital being 3.3 days. The potential health cost to the hospital system was around HK $11.7 million. Underestimating the prevalence of attempted suicides in Hong Kong could be a serious matter.

  15. Management of Acute Patellar Dislocation: A Case Report

    PubMed Central

    Enix, Dennis E.; Sudkamp, Kasey; Scali, Frank; Keating, Robbyn; Welk, Aaron

    2015-01-01

    Objective The purpose of this case study is to describe the evaluation and management of patellar dislocations and the different approaches used from providers in different countries. Clinical Features An individual dislocated her left patella while traveling abroad and received subsequent care in Thailand, China, and the United States. Intervention and Outcome Nonoperative treatment protocols including manual closed reduction of the patella, casting of the leg, and rehabilitation exercises were employed. Conclusion Receipt of care when abroad can be challenging. The patient’s knee range of motion and pain continued to improve when she was diligent about performing the home exercise program. This case highlights the importance of a thorough examination, a proper regimen of care, and patient counseling to ensure a full recovery and minimize the chance of re-injury. PMID:26778935

  16. Management of unerupted maxillary deciduous central incisor: a case report.

    PubMed

    Shakra, Karam Abu

    2014-01-01

    Failure of eruption of primary teeth can be considered rare, especially in maxillary anterior teeth. The problem can be either mechanical obstruction of eruption or a failure of the eruption mechanism. This case report presents failure of eruption of the maxillary right deciduous central incisor in a 4-year-old girl. The unerupted primary tooth was removed surgically. The histological finding revealed fibroma with reactive giant cells. Periodic follow-up visits were advised to monitor the developing dentition and to ensure enough space for the permanent incisor. How to cite this article: Shakra KA. Management of Unerupted Maxillary Deciduous Central Incisor: A Case Report. Int J Clin Pediatr Dent 2014;7(1):58-60.

  17. A survey of hospitals managing human rabies cases in India.

    PubMed

    Sudarshan, M K; Ashwath Narayana, D H

    2010-01-01

    A survey of 23 infectious diseases (ID) hospitals/ID wards of general hospitals was done during 2008-09 to assess the facilities for and management of rabies patients. All were Government hospitals and 0.5% of total beds was earmarked for rabies cases. The hospitals were mostly run by medical colleges (47.8%) and ID hospitals (30.4%) and located outside city limits (52.2%). The patients were admitted to 'rooms (39.1%)' and 'wards (43.5%)'. The general conditions of rabies sections i.e. sanitation and linen (65%), space and toilet (52% and 56%) and bed (47.8%) require improvements. There is a need to improve staff availability, use of personal protective wears, preventive vaccination of care providers and medicinal supplies. It is recommended to encourage hospitalization of human rabies cases to ensure a 'painless and dignified death' and this must be considered as a 'human rights' issue.

  18. Managed care and ERISA: synopsis and case law review.

    PubMed

    Gerbasi, Joan B

    2003-01-01

    Managed care organizations (MCOs) have become the predominant health care model in the United States. Through cost containment arrangements with providers, incentives for patients to pursue less costly care and reductions in the provision of unnecessary care, MCOs are more intimately involved in the delivery of health care than their former fee-for-service insurance company counterparts. However, this new role has not implied increased liability, largely because of The Employee Retirement Income Security Act of 1974 (ERISA). This article provides an overview of ERISA and a review of the important legal cases in this area, including the three most recent Supreme Court cases. Courts have struggled with interpreting ERISA, and decisions have been difficult to reconcile. Frustration with this statute and the failure of the U.S. Congress to amend it, has led to more liberal interpretations of ERISA in recent years.

  19. Chronic case management: Clinical governance with cost reductions.

    PubMed

    Costa, Élide Sbardellotto Mariano da; Hyeda, Adriano

    2016-01-01

    With increasing global impact of chronic degenerative non-communicable diseases (CDNCD), multidisciplinary chronic disease management care programs (CDMCP) come as a solution to improve the quality of patients care. We conducted a cross-sectional epidemiologic prospective cohort study with data comparing a group of patients monitored by a CDMCP with subjects without CDMCP care, from 2010 to 2012. The patients monitored in this program were selected because they presented CDNCD with frequent hospitalization and/or emergency care in the year prior to study selection. Also, the patients could be referred to the program by their physicians and/or other programs such as HomeCare or family medicine. All costs related to the program were included and compared with the costs of users with the same epidemiological profile who opted for not participating in the CDMCP. We analyzed data from 1,256 cases, including 639 (51%) men and 617 (49%) women. The mean age was 56.99 years and 73% were older than 50 years. There was a prevalence of 34% (428) cases with ischemic heart disease (myocardial infarction and stroke) and 17% (210) with neoplasms. The cases studied showed a reduction of 79% in the number of days of hospitalization compared with the cases without CDMCP monitoring. The average reduction of total costs (hospitalizations, emergency room visits and/or disease complications) was 31.94%, with average reduction of 8.36% in monthly costs. Multidisciplinary monitoring carried out by CDNCD patient management programs can reduce hospitalizations, emergency room visits and complications, positively impacting the costs with health care.

  20. Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

    PubMed Central

    Rusnak, James E.

    1987-01-01

    Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The hospital must insure the CMMS project provides a means to implement an integrated on-line hospital information data base for use by departments in operating under a DRG-based Prospective Payment System. This paper presents guidelines for use in selecting a Case Mix Mangement System to meet the hospital's financial and operations planning, budgeting, marketing, and other management needs, while considering the data base implications of the implementation.

  1. Meta-case based realization of design rationale management systems

    SciTech Connect

    Paul, G.

    1996-12-31

    System design is an iterative, creative, and cooperative process where informal ideas are transformed into a detailed definition of how a system can be implemented. Design rationale aims at capturing and preserving the why underlying the what, the argument behind the artifact in the design process. Recording deliberations of the design process therefore promises benefits for the overall system engineering life cycle. Providing adequate computer support for design rationale is an interesting issue and a real need for effective application. A design rationale management system (DRMS) supports the capturing, storing and retrieval of interaction rationale in a shared corporate knowledge base and allows organizational learning through long-term and inter-project reuse. The intent of meta-CASE systems is to capture the specification of a required CASE tool and then generate the tool for actual production from the specification. In this paper we identify the requirements for a DRMS and investigate the applicability of meta-CASE tools for the implementation of DRMS`s. Furthermore we describe the experiences gained in the development of two DRMS`s adopting the meta CASE tools MaestroII GED/TCI and Hardy.

  2. What Case Managers Should Know About Their Roles and Functions: A National Study From the Commission for Case Manager Certification: Part 1.

    PubMed

    Tahan, Hussein M; Watson, Annette C; Sminkey, Patrice V

    2015-01-01

    The purpose of this national role and function study was to identify the essential activities and necessary knowledge areas for effective case manager practice from the perspective of those currently functioning in various care settings and across diverse professional disciplines. The national study covered all case management practices and/or work settings across the full continuum of health care. This cross-sectional descriptive study used the practice analysis method and online survey research design. It employed a purposive sample of case managers, in which 52,370 individuals received an invitation to participate. Data collection completed over a 4-week period, resulting in 7,668 useable survey responses (nearly a 15% response rate). The study identified the common activities and knowledge areas necessary for competent and effective performance of case managers, as is highlighted in this article, which is the first of a 2-part series on the role and function study. The results informed the needed update of the test specifications for the Certified Case Manager (CCM) certification examination, as will be delineated in Part 2 of the article series, to ensure that it continues to be substantiated in current practice. Of special note are the emergence of specific activity and knowledge domains in the area of case management ethical, legal, and practice standards, and an increase in the number of employers requiring certified case managers to fill vacant positions and compensating them financially for such qualifications. This study helps keep the CCM credentialing examination evidence-based and maintain its validity for evaluating competency of case managers. Specifically, the study identified essential activities and knowledge domains that define competent case management practice. Findings can be used for developing programs and curricula for the training and development of case managers. The study instrument also can be used for further research of case

  3. Providers' Perspectives on Case Management of a Healthy Start Program: A Qualitative Study.

    PubMed

    Moise, Imelda K; Mulhall, Peter F

    2016-01-01

    Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded

  4. Providers' Perspectives on Case Management of a Healthy Start Program: A Qualitative Study

    PubMed Central

    Moise, Imelda K.; Mulhall, Peter F.

    2016-01-01

    Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded

  5. Epidemiological aspects of suicide attempts among Moroccan children.

    PubMed

    Mekaoui, Nour; Karboubi, Lamiae; Ouadghiri, Fatima Zahra; Dakhama, Badr Sououd Benjelloun

    2016-01-01

    Suicidal behavior among children has significantly increased in Morocco. We conducted a study on the epidemiological aspect to propose a treatment strategy. Descriptive retrospective study over a period of 3 years (April 2012-April 2015) involving children who visited pediatric medical emergencies of the Children Hospital of Rabat after an autolysis attempt. We observed epidemiological parameters, history, social and family context, the means used, the presumed cause, clinical manifestation, and the management. 66 patients were identified. A female predominance was found (sex =15). The average age was 13 years old. This was a first episode in 97% of cases. Psychiatric history was found in 6 patients. The causes of suicide attempt were unidentified in 65%. The most frequent cause was family conflict (35%). The most frequent method was pharmaceutical drug ingestion (54.4%). Children were asymptomatic (57.6%). Neurological manifestations (30%) were most frequent. Digestive symptoms (12%) and hemodynamic (3%) were also discovered. Patients were hospitalized in a general pediatric service 92.4% of the times, admitted to intensive care 4.5% of the times, and two patients refused to be hospitalized. The treatment consisted of gastric lavage (18%) supplemented by symptomatic measures. The outcome was favorable in 95.4% of cases. We recorded 2 deaths by rat poison poisoning. All patients were advised in writing after leaving to follow up with a psychological treatment. Suicide attempts are the result of an ill being, mostly among children living in a family with conflict. Upstream treatment is essential to identify children at risk. Additionally, a psychiatric care in hospital is essential to avoid recurrences.

  6. Epidemiological aspects of suicide attempts among Moroccan children

    PubMed Central

    Mekaoui, Nour; Karboubi, Lamiae; Ouadghiri, Fatima Zahra; Dakhama, Badr Sououd Benjelloun

    2016-01-01

    Suicidal behavior among children has significantly increased in Morocco. We conducted a study on the epidemiological aspect to propose a treatment strategy. Descriptive retrospective study over a period of 3 years (April 2012-April 2015) involving children who visited pediatric medical emergencies of the Children Hospital of Rabat after an autolysis attempt. We observed epidemiological parameters, history, social and family context, the means used, the presumed cause, clinical manifestation, and the management. 66 patients were identified. A female predominance was found (sex =15). The average age was 13 years old. This was a first episode in 97% of cases. Psychiatric history was found in 6 patients. The causes of suicide attempt were unidentified in 65%. The most frequent cause was family conflict (35%). The most frequent method was pharmaceutical drug ingestion (54.4%). Children were asymptomatic (57.6%). Neurological manifestations (30%) were most frequent. Digestive symptoms (12%) and hemodynamic (3%) were also discovered. Patients were hospitalized in a general pediatric service 92.4% of the times, admitted to intensive care 4.5% of the times, and two patients refused to be hospitalized. The treatment consisted of gastric lavage (18%) supplemented by symptomatic measures. The outcome was favorable in 95.4% of cases. We recorded 2 deaths by rat poison poisoning. All patients were advised in writing after leaving to follow up with a psychological treatment. Suicide attempts are the result of an ill being, mostly among children living in a family with conflict. Upstream treatment is essential to identify children at risk. Additionally, a psychiatric care in hospital is essential to avoid recurrences. PMID:27642451

  7. Analysing water use patterns for demand management: the case of the city of Masvingo, Zimbabwe

    NASA Astrophysics Data System (ADS)

    Dube, Emmanuel; van der Zaag, Pieter

    Water use in urban centres is dynamic, fluctuates, differs between high and low-income users, and tends to increase over time. Supply infrastructure can often hardly keep pace with increased water consumption. Given (a) the high cost of infrastructure development, (b) the recent emphasis on demand management, and (c) the social obligation to provide water services to the poor, urban water providers are faced with an important choice: whether to go the demand management route, or to continue constructing new infrastructure. This paper sheds light on some of the possibilities and constraints of both choices by providing a case study of the city of Masvingo in Zimbabwe. The paper analyses water use patterns in this city with a population of 70,000, located in a drought prone region of average rainfall of 600 mm/a. Water consumption has reached the limits of the water supply capacity. The paper first looks at the long-term water use pattern of the city as a whole and the factors that have caused the observed pattern using multiple linear regression. The paper then analyses the patterns of water use of rich and poor households, and attempts to assess the (im)possibilities of influencing these by means of an appropriate tariff structure. In projecting future demand, the paper then considers a number of interventions that could influence demand, which include leakage control, pressure management, awareness campaigns, free technical advice to water users, as well as a new tariff structure. It also discusses when new supply infrastructure should be available, depending on the various demand management measures taken.

  8. [Inadequate management of a difficult airway. Case SENSAR of the trimester].

    PubMed

    2015-01-01

    A clinical case reported to SENSAR is presented (www.sensar.org). A patient came to the operating room for surgery for parathyroidectomy. She had several predictors of difficult airway management, including a story of difficulties in previous intubations in other hospitals, as the patient reported. Therefore, after evaluation in preoperative consultation, fibreoptic bronchoscopy intubation was recommended. The day of surgery after induction of general anesthesia direct laryngoscopy was performed, without recognizing any glottic structure (Cormack-Lehane grade iv). Conventional laryngoscope was changed to a videolaryngoscope (Airtraq(®)) to try to improve the laryngoscopic view, but there were difficulties with handling and insertion of it, causing minor injuries to the lingual mucosa. Finally, tracheal intubation was achieved after several attempts. Analysis of the incident revealed the active error due to lack of experience of the professional who performed intubation maneuvers, favored by latent factors or contributors as were the complex pathology of the patient and the absence of protocols to difficult airway management in the hospital. Communication and analysis of this incident served to highlight the importance of the security protocols in Anesthesia, and as a result a working group that conducted the current algorithm approach to a difficult airway management was formed, established guidelines for further information patient and deals since clinical training and professional practice for the management of airway devices availables in the hospital. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Management of common bile duct stones with a biliary endoprosthesis. Report on 40 cases.

    PubMed

    Peters, R; Macmathuna, P; Lombard, M; Karani, J; Westaby, D

    1992-10-01

    Endoscopic placement of a biliary endoprosthesis has been proposed for the management of choledocholithiasis when stone extraction is difficult or considered hazardous. Over a two year period this approach was used in 40 such patients. There were 24 women and 16 men with a median age of 76 years. In seven patients with severe cholangitis no attempt was made to extract the stones. Twenty three (57.5%) patients underwent a sphincterotomy and four (10%) needle knife papillotomy. The endoprosthesis insertion was considered a temporary measure in 13 (32.5%) patients and definitive treatment in 27 (67.5%). Bile duct drainage was established in all patients. Early complications occurred in six patients (15%), but were without sequelae. Late complications developed in eight (20%) of the patients and included biliary colic (four), cholangitis (three), and cholecystitis (one). Two patients (one cholangitis and one cholecystitis) died as a consequence of the complication. Only patients without a sphincterotomy developed cholangitis. A total of eight patients (20%) underwent surgery (one as an emergency) and nine a repeat endoscopic retrograde cholangio pancreatography (two as an emergency) to clear the duct. The remaining 23 patients are asymptomatic at a median of 13 months (range five to 24 months). Biliary endoprosthesis insertion for choledocholithiasis is an important alternative means of establishing drainage in selected cases, and is probably the optimum method of management for the elderly and or debilitated patients with previous cholecystectomy. Caution must be exercised, however, in patients with an in situ gall bladder.

  10. Suicide attempt with a mix of synthetic cannabinoids and synthetic cathinones: Case report of non-fatal intoxication with AB-CHMINACA, AB-FUBINACA, alpha-PHP, alpha-PVP and 4-CMC.

    PubMed

    Klavž, Janez; Gorenjak, Maksimiljan; Marinšek, Martin

    2016-08-01

    We report on a case of intoxication with a mix of new psychoactive substances. A 38-year-old male was brought to the emergency department (ED) following the ingestion of an unknown drug in a suicide attempt. During the transport, he became progressively more somnolent and unresponsive to painful stimuli. Urine and stomach content were collected on admission to be screened for drugs of abuse and medicinal drugs. After admission, the patient's next of kin presented five small grip seal plastic bags containing different powders/crystals, and they were sent for analysis along with urine and stomach content to the toxicology laboratory. An easy and rapid sample preparation technique was applied for the extraction of urine and stomach content. Samples were extracted with liquid-liquid extraction (LLE) technique and analysed using gas chromatography-mass spectrometry (GC-MS). A small amount of powder material from the bags was diluted in methanol and injected directly into the GC-MS instrument. Obtained spectra (EI) were evaluated against SWGDRUG library. Five different designer drugs were identified in the powder material, including synthetic cannabinoids (AB-CHMINACA, AB-FUBINACA) and synthetic cathinones (alpha-PHP, alpha-PVP and 4-CMC). With the exception of 4-CMC, all of these substances were also detected in the stomach content along with the prescription drugs. This is the first time that a positive identification of these five drugs has been made by a clinical laboratory in Slovenia.

  11. HIPAA Privacy 101: essentials for case management practice.

    PubMed

    DiBenedetto, Deborah V

    2003-01-01

    The Health Insurance Portability and Accountability Act (HIPAA) has significant impact on the delivery of healthcare in the United States. The Administrative Simplification (AS) requirements of HIPAA are aimed at reducing administrative costs and burdens in the healthcare industry. The core components of HIPAA's AS requirements address healthcare transactions, code sets, security, unique identifiers, and privacy of health information. HIPAA's privacy standard limits the nonconsensual use and release of private health information, gives patients new rights to access their medical records and to know who else has accessed them, restricts most disclosure of health information to the minimum needed for the intended purpose, establishes new criminal and civil sanctions for improper use or disclosure, and establishes new requirements for access to records by researchers and others. This article focuses on HIPAA's privacy requirements as related to case management of workers compensation populations, the treatment of protected health information, and how case managers can ensure they provide appropriate services while navigating the requirements of HIPAA's privacy standard.

  12. Therapeutic management of DRESS: a retrospective study of 38 cases.

    PubMed

    Funck-Brentano, Elisa; Duong, Tu-Anh; Bouvresse, Sophie; Bagot, Martine; Wolkenstein, Pierre; Roujeau, Jean-Claude; Chosidow, Olivier; Valeyrie-Allanore, Laurence

    2015-02-01

    There is no consensus regarding treatment for drug reaction with eosinophilia and systemic symptoms (DRESS). We report a single-center observational series of therapeutic management of DRESS. We examined data for 50 consecutive patients admitted from March 2005 to June 2009 with a discharge diagnosis of DRESS (RegiSCAR score). For the 38 patients with a DRESS score of 4 or more, topical steroid treatment alone was initiated in 66% of cases. On admission, 13 patients received systemic steroids; in 7 of them, systemic steroid treatment was initiated or maintained for life-threatening organ failure, with kidney, lung, and/or nervous system involvement. Complications of DRESS, such as relapse, viral reactivation, and sepsis, were less frequent with topical steroid than with systemic steroids. None of the patients died during their stay in hospital. Retrospective nonblinded design and dermatologic recruitment are limitations. The variables underlying the choice of treatment study were not analyzed. Systemic steroids may not be required for the management of mild forms of DRESS, and may thus be reserved for more severe cases. Prospective studies are required to evaluate strategies for treating DRESS. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  13. Role ambiguity and role conflict in nurse case managers: an integrative review.

    PubMed

    Smith, Amy C

    2011-01-01

    The purpose of this integrative review is to critically examine the relationship between the transition from a direct caregiver to a nurse case manager role and the perceived levels of role ambiguity and role conflict. Nurse case managers in acute care, postacute care, and managed care settings. Nurses can expect to experience substantial role ambiguity and role conflict as they take on the case manager role, primarily because of inadequate role definition, unexpected ethical challenges, and lack of prior insight into the case manager role. Role ambiguity and role conflict may impact nurse case managers' job satisfaction and job performance. Well-designed broad-scale descriptive studies are needed to further explicate the relationship between transition from direct caregiver to nurse case manager roles and the experience of role ambiguity and role conflict. Nurses transitioning from direct caregiver to nurse case manager roles should be systematically prepared to identify and manage specific ethical challenges commonly encountered by case managers. Further development of a nursing theoretical foundation for case management would be very useful in helping caregivers understand that as case managers, they remain practicing nurses with all the inherent rights and responsibilities of professional nursing.

  14. Chiropractic management of postpartum pubic symphysis diastasis: A case report.

    PubMed

    Henry, Lucian

    2015-03-01

    This case report describes the chiropractic management of a 30-year-old female patient with severe postpartum pelvic pain secondary to pubic symphysis diastasis. No literature was found on the chiropractic management of postpartum symphysis pubis diastasis. The existing literature concerning chiropractic care for symphysis pubis dysfunction during pregnancy is limited and indicates a potential benefit. Separation of the pubic symphysis may include ligamentous injury to the sacroiliac joints and may lead to chronic pain. Pubic symphysis separation of 17 millimeters was present on digital radiograph. Management consisted of chiropractic adjustments, trigger point release, electrical stimulation, moist heat, sacroiliac belt, and specific stabilizing exercises. The patient's pain improved immediately following treatment on the initial visit. Pain was reduced from 8/10 VAS at the first visit to 2/10 at the fourth visit. She was able to resume normal activities and reached a final pain level of 1/10. The diastasis was reduced by 7 millimeters at 14-weeks post radiograph for a final separation of just under 10 millimeters. Collaboration between obstetricians, midwives and chiropractors may be warranted.

  15. Chiropractic management of postpartum pubic symphysis diastasis: A case report

    PubMed Central

    Henry, Lucian

    2015-01-01

    This case report describes the chiropractic management of a 30-year-old female patient with severe postpartum pelvic pain secondary to pubic symphysis diastasis. No literature was found on the chiropractic management of postpartum symphysis pubis diastasis. The existing literature concerning chiropractic care for symphysis pubis dysfunction during pregnancy is limited and indicates a potential benefit. Separation of the pubic symphysis may include ligamentous injury to the sacroiliac joints and may lead to chronic pain. Pubic symphysis separation of 17 millimeters was present on digital radiograph. Management consisted of chiropractic adjustments, trigger point release, electrical stimulation, moist heat, sacroiliac belt, and specific stabilizing exercises. The patient’s pain improved immediately following treatment on the initial visit. Pain was reduced from 8/10 VAS at the first visit to 2/10 at the fourth visit. She was able to resume normal activities and reached a final pain level of 1/10. The diastasis was reduced by 7 millimeters at 14-weeks post radiograph for a final separation of just under 10 millimeters. Collaboration between obstetricians, midwives and chiropractors may be warranted. PMID:25729083

  16. Delusional infestations: case series, differential diagnoses, and management strategies.

    PubMed

    Diaz, James H; Nesbitt, Lee T

    2014-01-01

    Physicians are not infrequently consulted by distraught patients with delusions of infestation who believe that they are infested with external or internal parasites and describe a crawling sensation of bugs or worms on or under their skin. Internet search engines were queried with the keywords as search terms to examine the latest articles on delusional infestations in order to describe presenting manifestations, differential diagnoses, and effective management strategies. The demographic and behavioral features of delusional infestations have remained constant and include: (1) onset in well-educated, middle-aged adults who are pet owners; (2) production of purported specimens of causative parasites; (3) pesticide overtreatment of themselves, their households, and pets; (4) excessive cleaning or vacuuming of households; (5) intense anger and resentment directed at physicians failing to confirm their self-diagnoses; and (6) sharing delusional symptoms with spouses or relatives. Although some reports have suggested that cases of delusional infestation are increasing today in the tropics, most studies have confirmed a stable incidence over time and similar disorder demographics worldwide. However, management strategies for delusional infestations have changed significantly over time with second generation, atypical antipsychotics offering safer adverse effect profiles and better prognoses than earlier therapies with first generation, typical antipsychotics. The most effective management strategies for delusional infestations include empathetic history-taking and active listening to the patient, careful exclusion of true parasitoses, and a therapeutic regimen that includes a second generation neuroleptic agent.

  17. A case study of type 2 diabetes self-management

    PubMed Central

    Wu, Hsin-i

    2005-01-01

    Background It has been established that careful diabetes self-management is essential in avoiding chronic complications that compromise health. Disciplined diet control and regular exercise are the keys for the type 2 diabetes self-management. An ability to maintain one's blood glucose at a relatively flat level, not fluctuating wildly with meals and hypoglycemic medical intervention, would be the goal for self-management. Hemoglobin A1c (HbA1c or simply A1c) is a measure of a long-term blood plasma glucose average, a reliable index to reflect one's diabetic condition. A simple regimen that could reduce the elevated A1c levels without altering much of type 2 diabetic patients' daily routine denotes a successful self-management strategy. Methods A relatively simple model that relates the food impact on blood glucose excursions for type 2 diabetes was studied. Meal is treated as a bolus injection of glucose. Medical intervention of hypoglycaemic drug or injection, if any, is lumped with secreted insulin as a damping factor. Lunch was used for test meals. The recovery period of a blood glucose excursion returning to the pre-prandial level, the maximal reach, and the area under the excursion curve were used to characterize one's ability to regulate glucose metabolism. A case study is presented here to illustrate the possibility of devising an individual-based self-management regimen. Results Results of the lunch study for a type 2 diabetic subject indicate that the recovery time of the post-prandial blood glucose level can be adjusted to 4 hours, which is comparable to the typical time interval for non-diabetics: 3 to 4 hours. A moderate lifestyle adjustment of light supper coupled with morning swimming of 20 laps in a 25 m pool for 40 minutes enabled the subject to reduce his A1c level from 6.7 to 6.0 in six months and to maintain this level for the subsequent six months. Conclusions The preliminary result of this case study is encouraging. An individual life

  18. Case managers speak out: responding to depression in community long-term care.

    PubMed

    Munson, Michelle; Proctor, Enola; Morrow-Howell, Nancy; Fedoravicius, Nicole; Ware, Norma

    2007-08-01

    This study sought to understand how case managers in one publicly funded health and social service system, community long-term care, understand and address depression among their clients. Four focus groups with a total of 18 case managers were conducted. Case managers were asked a series of questions about their perspectives on the recognition and treatment of depression, including subthreshold depression, in community long-term care. Case managers perceived addressing depression as complex because of competing demands. Furthermore, case managers perceived conflict between their current role and what it would take to expand their role to include addressing depression. Case managers suggested that in order to successfully improve the detection and treatment of depression in community long-term care, systemic changes, such as increased support and training, may be necessary, along with a shift in the professional role of case managers.

  19. The laparoscopic management of Swyer syndrome: Case series

    PubMed Central

    Malhotra, Neena; Dadhwal, Vatsla; Sharma, Kandala Aparna; Gupta, Deepika; Agarwal, Sumita; Deka, Dipika

    2015-01-01

    Swyer syndrome, also known as 46 XY pure gonadal dysgenesis, is a rare endocrine disorder. Affected individuals are phenotypically female with female genitalia, normal Mullerian structures, absent testicular tissue, and a 46 XY chromosomal constitution. We report a series of eight cases of Swyer syndrome, of which six were managed by laparoscopic gonadectomy. The two other cases had to undergo an exploratory laparotomy in view of their presentation with adnexal masses. Two of the girls were siblings. The chief presenting complaint was primary amenorrhea. Four girls also presented with a history of poor development of secondary sexual characters. The average age at presentation was 16.19±2.85 years. The average height was 158.33 ±4.63 cm, and the average weight was 49.33±8.44 kg. Breast development was either Tanner 2 or 3 in four girls, whereas three girls had a Tanner 1 underdeveloped breasts. Axillary and pelvic hair was sparse in all the girls. The vagina was well canalized in all the girls. Hormonal evaluation revealed hypergonadotropic hypogonadism with a mean follicle-stimulating hormone (FSH) level of 95.81 mIU/L and a mean luteinizing (LH) level of 24.15 mIU/L. Imaging analysis revealed the presence of a small uterus in all the cases, except one. Bilateral ovaries were either not visualized or streak gonads were present. Adnexal mass was detected in two of the six cases with raised carcinoembryonic antigen (CA) 125 levels in one case. Genetic analysis revealed a karyotype of 46 XY in six girls, 46 XY/45 X in one, and the culture repeatedly failed in one girl. Because of the risk of malignancy, bilateral gonadectomy was performed in all cases. Histopathological analysis revealed that three of the six cases had dysgerminoma. The patients have been started on hormone replacement therapy. Laparoscopy is a minimally invasive modality for the definitive diagnosis and treatment of cases with Swyer syndrome. An early diagnosis of Swyer syndrome is possible

  20. Managing cultural diversity in healthcare partnerships: the case of LIFT.

    PubMed

    Mannion, Russell; Brown, Sally; Beck, Matthias; Lunt, Neil

    2011-01-01

    The National Health Service (NHS) Local Improvement Finance Trust (LIFT) programme was launched in 2001 as an innovative public-private partnership to address the historical under-investment in local primary care facilities in England. The organisations from the public and private sector that comprise a local LIFT partnership each have their own distinctive norms of behaviour and acceptable working practices - ultimately different organisational cultures. The purpose of this article is to assess the role of organisational culture in facilitating (or impeding) LIFT partnerships and to contribute to an understanding of how cultural diversity in public-private partnerships is managed at the local level. The approach taken was qualitative case studies, with data gathering comprising interviews and a review of background documentation in three LIFT companies purposefully sampled to represent a range of background factors. Elite interviews were also conducted with senior policy makers responsible for implementing LIFT policy at the national level. Interpreting the data against a conceptual framework designed to assess approaches to managing strategic alliances, the authors identified a number of key differences in the values, working practices and cultures in public and private organisations that influenced the quality of joint working. On the whole, however, partners in the three LIFT companies appeared to be working well together, with neither side dominating the development of strategy. Differences in culture were being managed and accommodated as partnerships matured. As LIFT develops and becomes the primary source of investment for managing, developing and channelling funding into regenerating the primary care infrastructure, further longitudinal work might examine how ongoing partnerships are working, and how changes in the cultures of public and private partners impact upon wider relationships within local health economies and shape the delivery of patient care