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Sample records for current management strategy

  1. Radiation Proctitis: Current Strategies in Management

    PubMed Central

    Do, Nhue L.; Nagle, Deborah; Poylin, Vitaliy Y.

    2011-01-01

    Radiation proctitis is a known complication following radiation therapy for pelvic malignancy. The majority of cases are treated nonsurgically, and an understanding of the available modalities is crucial in the management of these patients. In this paper, we focus on the current treatments of radiation proctitis. PMID:22144997

  2. Current Models and Innovative Strategies in Management Education in China.

    ERIC Educational Resources Information Center

    Wang, Zhong-Ming

    1999-01-01

    Current models of management education in China include national training, on-the-job technical training, and the national master's of business administration supervisory committee. Effective strategies being used include teamwork, process skills, action learning, cross-cultural management learning, and competency-based management development. (SK)

  3. Blepharitis: current strategies for diagnosis and management.

    PubMed

    Jackson, W Bruce

    2008-04-01

    The aim of this article is to present a consensus on the appropriate identification and management of patients with blepharitis based on expert clinical recommendations for 4 representative case studies and evidence from well-designed clinical trials. The case study recommendations were developed at a consensus panel meeting of Canadian ophthalmologists and a guest ophthalmologist from the U.K., with additional input from family doctors and an infectious disease/medical microbiologist, which took place in Toronto in June 2006. A MEDLINE search was also conducted of English language articles describing randomized controlled clinical trials that involved patients with blepharitis. Blepharitis involving predominantly the skin and lashes tends to be staphylococcal and (or) seborrheic in nature, whereas involvement of the meibomian glands may be either seborrheic, obstructive, or a combination (mixed). The pathophysiology of blepharitis is a complex interaction of various factors, including abnormal lid-margin secretions, microbial organisms, and abnormalities of the tear film. Blepharitis can present with a range of signs and symptoms, and is associated with various dermatological conditions, namely, seborrheic dermatitis, rosacea, and eczema. The mainstay of treatment is an eyelid hygiene regimen, which needs to be continued long term. Topical antibiotics are used to reduce the bacterial load. Topical corticosteroid preparations may be helpful in patients with marked inflammation. Blepharitis can present with a range of signs and symptoms, and its management can be complicated by a number of factors. Expert clinical recommendations and a review of the evidence on treatment supports the practice of careful lid hygiene, possibly combined with the use of topical antibiotics, with or without topical steroids. Systemic antibiotics may be appropriate in some patients.

  4. Current strategies for endoscopic management of acute cholangitis.

    PubMed

    Isayama, Hiroyuki; Yasuda, Ichiro; Tan, Damien

    2017-04-01

    At the pancreatobiliary session of Endoscopic Forum Japan (EFJ) 2016, current strategies for the endoscopic management of acute cholangitis were discussed. The topics consisted of two major parts, namely endoscopic management of acute cholangitis caused by common bile duct stones (CBDS) and biliary stent occlusion. Endoscopists from nine Japanese high-volume centers along with two overseas centers participated in the questionnaires and discussion. Strategies for management of cholangitis due to CBDS were agreed upon, and the clinical guideline of acute cholangitis (Tokyo guidelines 2013) was accepted. The best timing for drainage in Grade 2 (moderate) cholangitis urgent or early (<24 h) was inconclusive, and more data is required on this issue. Another controversy was the feasibility of one step stone extraction in the patient with cholangitis vs stone removal after the cholangitis had resolved. There were various opinions with regards to the management of acute cholangitis due to stent occlusion, and the strategies differed according to the stricture location (distal or hilar) and stent type initially placed (Covered or uncovered metal stent). Strategies for management of cholangitis caused by CBD stones are well established according to the TG13. More evidence is required before further recommendations can be made with regards to cholangitis due to stent occlusion. We aim to clarify this in the near future with questionnaires and consensus from experts. © 2017 The Authors. Digestive Endoscopy © 2017 Japan Gastroenterological Endoscopy Society.

  5. Current nutritional recommendations and novel dietary strategies to manage sarcopenia

    PubMed Central

    Calvani, Riccardo; Miccheli, Alfredo; Landi, Francesco; Bossola, Maurizio; Cesari, Matteo; Leeuwenburgh, Christiaan; Sieber, Cornel C.; Bernabei, Roberto; Marzetti, Emanuele

    2015-01-01

    Sarcopenia, the loss of skeletal muscle mass and function that occurs with aging, is associated with increased risk for several adverse health outcomes, including frailty, disability, falls, loss of independent living, and mortality. At present, no pharmacological treatment exists that is able to definitely halt the progression of sarcopenia. Likewise, no pharmacological remedies are yet available to prevent the onset of age-related muscle wasting. In this scenario, the combination of nutritional interventions and physical exercise appears to be the most effective strategy presently available for the management of sarcopenia. The purposes of this review are to summarize the current knowledge on the role of nutrition as a countermeasure for sarcopenia, illustrate the mechanisms of action of relevant dietary agents on the aging muscle, and introduce novel nutritional strategies that may help preserve muscle mass and function into old age. Issues related to the identification of the optimal timing of nutritional interventions in the context of primary and secondary prevention are also discussed. Finally, the prospect of elaborating personalized dietary and physical exercise recommendations through the implementation of integrated, high-throughput analytic approaches is illustrated. PMID:26082911

  6. Sports-related concussions: diagnosis, complications, and current management strategies.

    PubMed

    Hobbs, Jonathan G; Young, Jacob S; Bailes, Julian E

    2016-04-01

    Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.

  7. Current Management Strategy for Active Surveillance in Prostate Cancer.

    PubMed

    Syed, Jamil S; Javier-Desloges, Juan; Tatzel, Stephanie; Bhagat, Ansh; Nguyen, Kevin A; Hwang, Kevin; Kim, Sarah; Sprenkle, Preston C

    2017-02-01

    Active surveillance has been increasingly utilized as a strategy for the management of favorable-risk, localized prostate cancer. In this review, we describe contemporary management strategies of active surveillance, with a focus on traditional stratification schemes, new prognostic tools, and patient outcomes. Patient selection, follow-up strategy, and indication for delayed intervention for active surveillance remain centered around PSA, digital rectal exam, and biopsy findings. Novel tools which include imaging, biomarkers, and genetic assays have been investigated as potential prognostic adjuncts; however, their role in active surveillance remains institutionally dependent. Although 30-50% of patients on active surveillance ultimately undergo delayed treatment, the vast majority will remain free of metastasis with a low risk of dying from prostate cancer. The optimal method for patient selection into active surveillance is unknown; however, cancer-specific mortality rates remain excellent. New prognostication tools are promising, and long-term prospective, randomized data regarding their use in active surveillance will be beneficial.

  8. Risk definition and management strategies in retinoblastoma: current perspectives

    PubMed Central

    Ghassemi, Fariba; Khodabande, Alireza

    2015-01-01

    This manuscript focuses on high-risk factors of metastatic disease in retinoblastoma and evaluation of the current treatments of retinoblastoma. Presence of histopathologic high-risk factors is associated with a higher risk of local recurrence and systemic metastasis. Currently, globe-sparing therapies, including systemic chemotherapy, intra-arterial chemoreduction, intravitreal chemotherapy, focal consolidation, and combination therapies, are being used and investigated actively. Major advances are being made in the diagnosis and management of retinoblastoma that will lead to improved morbidity and mortality rates in patients with retinoblastoma. By saving the globes, fronting with some high-risk factors for metastasis would be inevitable. International multi-institutional prospective studies could resolve current uncertainties regarding the main tumor treatment regimens for each patient and indications for chemoprophylaxis for high-risk-factor-bearing retinoblastoma cases. PMID:26089630

  9. Optimal Management of Metastatic Melanoma: Current Strategies and Future Directions

    PubMed Central

    Batus, Marta; Waheed, Salman; Ruby, Carl; Petersen, Lindsay; Bines, Steven D.; Kaufman, Howard L.

    2013-01-01

    Melanoma is increasing in incidence and remains a major public health threat. Although the disease may be curable when identified early, advanced melanoma is characterized by widespread metastatic disease and a median survival of less than 10 months. In recent years, however, major advances in our understanding of the molecular nature of melanoma and the interaction of melanoma cells with the immune system have resulted in several new therapeutic strategies that are showing significant clinical benefit. Current therapeutic approaches include surgical resection of metastatic disease, chemotherapy, immunotherapy, and targeted therapy. Dacarbazine, interleukin-2, ipilimumab, and vemurafenib are now approved for the treatment of advanced melanoma. In addition, new combination chemotherapy regimens, monoclonal antibodies blocking the programmed death-1 (PD-1)/PD-ligand 1 pathway, and targeted therapy against CKIT, mitogen-activated protein/extracellular signal-regulated kinase (MEK), and other putative signaling pathways in melanoma are beginning to show promise in early-phase clinical trials. Further research on these modalities alone and in combination will likely be the focus of future clinical investigation and may impact the outcomes for patients with advanced melanoma. PMID:23677693

  10. Caries management by risk assessment: A review on current strategies for caries prevention and management

    PubMed Central

    Maheswari, S. Uma; Raja, Jacob; Kumar, Arvind; Seelan, R. Gnana

    2015-01-01

    The current trend in treating dental caries is using nondestructive risk-based caries management strategies rather than focusing on the restorative treatment alone. Currently, there have been many changes in understanding of the multifaceted nature of caries process and its management. Caries Management by Risk Assessment (CAMBRA) which is an evidence-based approach focuses on determining many factors causing the expression of disease and take corrective action. The clinicians can ascertain what behaviors are increasing a patient's risk for disease and disease progression by evaluating the current caries risk of a patient. With this modern CAMBRA protocol, a novel treatment plan can be designed to arrest dental caries thereby decreasing the chance of cavitation. After the recognition of the multi factorial nature of caries involving the biofilm, the contemporary approaches focused mainly on the various options to cope with the locally out-of-balance oral biofilm and stop the progression of the disease. The initial caries lesions can be diagnosed with modern diagnostic aids and with the help of CAMBRA, reestablishment of the integrity of the tooth surface early on in the caries process will bring great rewards for patients. This review focuses on the repair of hard tooth tissues using noninvasive strategies. PMID:26538870

  11. Childhood food allergies: current diagnosis, treatment, and management strategies.

    PubMed

    Gupta, Ruchi S; Dyer, Ashley A; Jain, Namrita; Greenhawt, Matthew J

    2013-05-01

    Food allergy is a growing public health concern in the United States that affects an estimated 8% of children. Food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a specific food. Nearly 40% of children with food allergy have a history of severe reactions that if not treated immediately with proper medication can lead to hospitalization or even death. The National Institute of Allergy and Infectious Diseases (NIAID) convened an expert panel in 2010 to develop guidelines outlining evidence-based practices in diagnosing and managing food allergy. The purpose of this review is to aid clinicians in translating the NIAID guidelines into primary care practice and includes the following content domains: (1) the definition and mechanism of childhood food allergy, (2) differences between food allergy and food intolerance, (3) the epidemiology of childhood food allergy in the United States, (4) best practices derived from the NIAID guidelines focused on primary care clinicians' management of childhood food allergy, (5) emerging food allergy treatments, and (6) future directions in food allergy research and practice. Articles focused on childhood food allergy were considered for inclusion in this review. Studies were restricted to the English language and to those published within the past 40 years. A cross-listed combination of the following words, phrases, and MeSH terms was searched in PubMed and Google Scholar to identify relevant articles: food allergy, food hypersensitivity, child, pediatric, prevalence, and epidemiology. Additional sources were identified through the bibliographies of the retrieved articles. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  12. Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists.

    PubMed

    Smith, Benjamin E; Hendrick, Paul; Bateman, Marcus; Moffatt, Fiona; Rathleff, Michael Skovdal; Selfe, James; Smith, Toby O; Logan, Pip

    2017-05-08

    Patellofemoral pain (PFP) is considered one of the commonest forms of knee pain. This study aimed to identify how physiotherapists in the United Kingdom (UK) currently manage patellofemoral pain (PFP), particularly in relation to exercise prescription, and response to pain. An anonymous survey was designed with reference to previous surveys and recent systematic reviews. Practising UK physiotherapists who treat patients with PFP were invited to take part via an invitation email sent through professional networks, the 'interactive Chartered Society of Physiotherapy (iCSP)' message board, and social media (Twitter). Descriptive statistics were used to analyse the data. A total of 99 surveys were completed. Responders reported a wide range of management strategies, including a broad selection of type and dose of exercise prescription. The five most common management strategies chosen were: closed chain strengthening exercises (98%); education and advice (96%); open chain strengthening exercises (76%); taping (70%) and stretches (65%). Physiotherapists with a special interest in treating PFP were statistically more likely to manage patients with orthotics (P = 0.02) and bracing (P = 0.01) compared to physiotherapists without a special interest. Approximately 55% would not prescribe an exercise if it was painful. Thirty-one percent of physiotherapists would advise patients not to continue with leisure and/or sporting activity if they experienced any pain. Current UK practice in the management strategies of PFP is variable. Further high quality research on which to inform physiotherapy practice is warranted for this troublesome musculoskeletal condition.

  13. Water Utility Management Strategies in Turkey: The current situation and the challenges

    NASA Astrophysics Data System (ADS)

    Alp, E.; Aksoy, M. N.; Koçer, B.

    2013-12-01

    As the effects of climate change becomes more prominent, current challenges related to water and wastewater management is becoming more serious. Providing water that satisfies environmental and safety standards in terms of quantity and quality is needed to maintain human life without compromising the need of future generations. Besides providing safe and affordable water, necessary treatment should be achieved according to several important factors such as receiving body standards, discharge standards, water reuse options. Therefore, management of water becomes more crucial than ever that states have to provide accessibility of safe water with affordable cost to its citizens with the means of effective utility management, including water treatment facilities, wastewater treatment facilities, water supply facilities and water distribution systems. Water utilities encounter with several challenges related to cost, infrastructure, population, legislation, workforce and resource. This study aims to determine the current situation and the necessary strategies to improve utility management in Turkish municipalities in a sustainable manner. US Environment Protection Agency (EPA) has formed a tool on effective utility management that assists utilities to provide a solution for both current and future challenges. In this study, we used EPA's guidelines and developed a survey consists of 60 questions under 10 sub-topics (Product Quality, Employee & Leadership Development, Stakeholder Understanding & Support, Operational Optimization, Infrastructure Stability, Financial Viability, Community Sustainability, Customer Satisfaction, Operational Resiliency, and Water Resource Adequacy). This survey was sent to the managers of 25 metropolitan municipalities in Turkey to assess the current condition of municipalities. After the evaluation of the survey results for each topic, including the importance given by managers, facilities were rated according to their level of achievement

  14. Pulmonary hypertension in adults with congenital heart disease and Eisenmenger syndrome: current advanced management strategies.

    PubMed

    D'Alto, Michele; Diller, Gerhard-Paul

    2014-09-01

    The presence of pulmonary arterial hypertension (PAH) increases morbidity and reduces survival in patients with congenital heart disease (CHD). PAH-CHD is a heterogeneous condition, depending on the type of the underlying defect and previous repair strategies. There is growing evidence of the benefits of PAH-specific therapy in the PAH-CHD population, but despite recent advances mortality rates remain relatively high. In the last years, an increasing focus has been placed on patients with PAH-CHD and net left-to-right shunt. Currently, there are limited data to guide the management of these patients and uncertainty on the cut-off values for eventual defect closure. Pregnancy conveys significant risks in PAH-CHD patients: appropriate counselling and care, including psychological support and a multidisciplinary team, should be part of the routine management of women with PAH-CHD of reproductive age. Some subgroups, such as patients with Down's syndrome, Fontan circulation and 'segmental' pulmonary hypertension, present particular challenges in terms of management and therapy. The current review focuses on contemporary treatment strategies in PAH-CHD patients with particular emphasis on challenging patient groups and conditions.

  15. Management of urinary tract infections: historical perspective and current strategies: Part 2--Modern management.

    PubMed

    Nickel, J Curtis

    2005-01-01

    emergence of resistance, limiting the clinical usefulness of this therapy in the modern management of UTI. Fluoroquinolones offer an attractive alternative to TMP/SMX, and American and European guidelines recommend their empirical use in areas where TMP/SMX resistance is 10% or higher. The development of antimicrobial therapy was the defining moment of 20th century medicine and one of the key innovations in medical history. While the initial promise of antimicrobials has been validated in clinical practice, overuse of certain agents has led to the emergence of resistance, illustrating the importance of using evidence based strategies to select therapy.

  16. Antimicrobial resistance in Helicobacter pylori: current situation and management strategy in Vietnam.

    PubMed

    Phan, Trung Nam; Tran, Van Huy; Tran, Thi Nhu Hoa; Le, Van An; Santona, Antonella; Rubino, Salvatore; Paglietti, Bianca

    2015-07-04

    Increasing antimicrobial resistance to key antibiotics in Helicobacter pylori has become a main cause of treatment failures in many countries, including Vietnam. For this reason it is advisable to perform antimicrobial sensitivity tests to provide more focused regimens for H. pylori eradication. However, this approach is generally unavailable for H. pylori in Vietnam and the selection of treatment regimens is mainly based on the trend of antibiotic use in the population, resistance development in the region, and history of H. pylori eradication of patients. The aim of this review is to examine the current situation of antimicrobial resistance in Vietnam and suggest management strategies for treatment selection.

  17. Soil environmental quality in greenhouse vegetable production systems in eastern China: Current status and management strategies.

    PubMed

    Hu, Wenyou; Zhang, Yanxia; Huang, Biao; Teng, Ying

    2017-03-01

    Greenhouse vegetable production (GVP) has become an important source of public vegetable consumption and farmers' income in China. However, various pollutants can be accumulated in GVP soils due to the high cropping index, large agricultural input, and closed environment. Ecological toxicity caused by excessive pollutants' accumulation can then lead to serious health risks. This paper was aimed to systematically review the current status of soil environmental quality, analyze their impact factors, and consequently to propose integrated management strategies for GVP systems. Results indicated a decrease in soil pH, soil salinization, and nutrients imbalance in GVP soils. Fungicides, remaining nutrients, antibiotics, heavy metals, and phthalate esters were main pollutants accumulating in GVP soils comparing to surrounding open field soils. Degradation of soil ecological function, accumulation of major pollutants in vegetables, deterioration of neighboring water bodies, and potential human health risks has occurred due to the changes of soil properties and accumulation of pollutants such as heavy metals and fungicides in soils. Four dominant factors were identified leading to the above-mentioned issues including heavy application of agricultural inputs, outmoded planting styles with poor environmental protection awareness, old-fashion regulations, unreasonable standards, and ineffective supervisory management. To guarantee a sustainable GVP development, several strategies were suggested to protect and improve soil environmental quality. Implementation of various strategies not only requires the concerted efforts among different stakeholders, but also the whole lifecycle assessment throughout the GVP processes as well as effective enforcement of policies, laws, and regulations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. NSAIDs for musculoskeletal pain management:current perspectives and novel strategies to improve safety.

    PubMed

    Atchison, James W; Herndon, Christopher M; Rusie, Erica

    2013-01-01

    Musculoskeletal disorders are a growing burden on the health care system in the United States. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to assist in the management of mild-to moderate musculoskeletal pain. After the withdrawal of rofecoxib because of cardiovascular toxicity, the safety of these agents became a topic of controversy and confusion. Recent evidence is facilitating a better understanding of the risks and mechanisms by which NSAIDs cause injury. In an effort to raise awareness, this review addresses the current challenges, recent progress, and novel strategies for improving tolerability. With new data to help guide decision making and the anticipated increase in pharmacological options for managing musculoskeletal pain, the role of the managed care professional is particularly important in this evolving field. To review recommendations for the appropriate use of NSAIDs, incorporate risk/benefit analysis into decision making, and evaluate the efficacy and safety of recently approved and emerging NSAID formulations. Musculoskeletal-related conditions are a major public health burden. NSAIDs are among the most commonly used medications for musculoskeletal conditions. Since the introduction of selective cyclooxygenease-2 (COX-2) inhibitors (or coxibs), there has been ongoing discussion and debate about the safety of all NSAIDs. Current available evidence suggests both traditional NSAIDs and coxibs increase the risk of gastrointestinal and cardiovascular toxicity; however, with proper risk assessment, these dangers can be limited. Moreover, new and emerging NSAID formulations and delivery systems aim to enhance the effectiveness and reduce the toxicity associated with these anti-inflammatory agents.

  19. Rural domestic waste management in Zhejiang Province, China: Characteristics, current practices, and an improved strategy.

    PubMed

    Guan, Yidong; Zhang, Yuan; Zhao, Dongye; Huang, Xiaofeng; Li, Haini

    2015-06-01

    Lack of access to adequate sanitation facilities has serious health implications for rural dwellers and can degrade the ecosystems. This study offers a systemantic and quantitative overview of historical data on rural domestic waste (RDW) production and past and current management practices in a prototype region in China, where rural areas are undergoing rapid urbanization and are confronted with great environmental challenges associated with poor RDW management practices. The results indicate that RDW is characterized with a large fraction of kitchen waste (42.9%) and high water content (53.4%). The RDW generation (RDWG) per capita between 2012 and 2020 is estimated to increase from 0.68 to 1.01 kg/d-cap. The Hill 1 model is able to adequately simulate/project the population growth in a rural area from 1993 to 2020. The annual RDWG in the region is estimated to double from 6,033,000 tons/year in 2008 to 12,030,000 tons/year by 2020. By comparing three RDW management scenarios based on the life-cycle inventory approach and cost-benefit analysis, it is strongly recommended that the present Scenario 2 (sanitary landfill treatment) be upgraded to Scenario 3 (source separation followed by composting and landfill of RDW) to significantly reduce the ecological footprint and to improve the cost-effectiveness and long-term sustainability. Rural domestic waste (RDW) is affecting 720 million people in China and more than 3221 million people worldwide. Consequently, handling and disposal of RDW have serious health implications to rural dwellers and the ecosystems. This study offers a systemantic and quantitative overview and analysis of historical data on RDW production and management practices in a prototype region in China, which is confronted with great environmental challenges associated with RDW. Then we predict future production of RDW and propose a sustainable RDW management strategy, which holds the promise of greatly mitigating the mounting environmental pressure

  20. Current strategies for the prevention and management of central line-associated bloodstream infections

    PubMed Central

    Han, Zhuolin; Liang, Stephen Y; Marschall, Jonas

    2010-01-01

    Central venous catheters are an invaluable tool for diagnostic and therapeutic purposes in today’s medicine, but their use can be complicated by bloodstream infections (BSIs). While evidence-based preventive measures are disseminated by infection control associations, the optimal management of established central line-associated BSIs has been summarized in infectious diseases guidelines. We prepared an overview of the state-of-the-art of prevention and management of central line-associated BSIs and included topics such as the role of antibiotic-coated catheters, the role of catheter removal in the management, and a review of currently used antibiotic compounds and the duration of treatment. PMID:21694903

  1. The cardiometabolic effect of current management of polycystic ovary syndrome: strategies of prevention and treatment.

    PubMed

    Baldani, Dinka Pavicic; Skrgatic, Lana; Ougouag, Roya; Kasum, Miro

    2017-09-23

    Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder amongst women of reproductive age, which is characterized by reproductive and cardiometabolic disturbances with long-term health repercussions. Insulin resistance (IR), impaired glucose tolerance, type 2 diabetes mellitus (DM2), obesity and dyslipidemia occur more in women with PCOS than in age-comparable women without PCOS. Long term data regarding risks or benefits of medical intervention for metabolic dysfunction of PCOS are lacking. Therapies, such as oral contraceptives (OCPs) and anti-androgenic medications used to manage the reproductive manifestations of PCOS, may themselves be the cause of cardiometabolic perturbations. Hence, strategies regarding the management of reproductive issues in PCOS encompass a patient-specific tailored approach. Factors that influence the cardiometabolic side effects arising during treatment of the reproductive manifestations of PCOS (hirsutism/anovulation) are also discussed in this paper in order to build future strategies to minimize the overall cardiometabolic risk.

  2. E-waste management challenges in Iran: presenting some strategies for improvement of current conditions.

    PubMed

    Taghipour, Hassan; Nowrouz, Parviz; Jafarabadi, Mohamad Asghari; Nazari, Jalil; Hashemi, Ahmad Asl; Mosaferi, Mohammad; Dehghanzadeh, Reza

    2012-11-01

    E-waste is one of the fastest-growing waste streams in Iran, owing to an increase in consumption of electrical and electronic equipment. Nevertheless, as is the case in some other countries, E-waste management has not received sufficient attention. For the successful implementation of any waste management plan (including an E-waste management plan), the availability of sufficient and accurate information on the quantities and composition of the waste generated and on current management conditions is a fundamental prerequisite. At present, in Iran, there is no available and accurate information that describes the characteristics and generation rate of E-waste or the actual practice of management and handling of the waste. For this initial study, eight electronic products were selected for the determination of their E-waste generation rate in the country, and two cities, Tehran and Tabriz, were selected for assessment of the current condition of E-waste management. The study found that the amount of E-waste generation in the country for the eight selected electronic items alone was 115,286, 112,914 and 115,151 metric tons in 2008, 2009 and 2010, respectively. Of the types of electronic items included in the study, televisions, with an average of 42.42%, and PCs, with an average of 32.66% accounted for the greatest proportions of the total mass of E-waste generated during 2008-2010. Currently, despite the fact that primary legislation for E-waste management (as part of general waste legislation) exists in Iran, this primary legislation has not yet been implemented. In practical terms, there is no definite policy or plan for the allocation of funds to prepare suitable equipment and facilities for the management and recycling of E-waste at the end of the products' useful life. Proposed improvements in current conditions are identified, first by considering other countries' experiences and then suggesting specific practical policies, rules, and regulations that should be

  3. Current and emerging strategies in the management of venous thromboembolism: benefit-risk assessment of dabigatran.

    PubMed

    Fanola, Christina L

    2015-01-01

    Venous thromboembolism (VTE) is a disease state that carries significant morbidity and mortality, and is a known cause of preventable death in hospitalized and orthopedic surgical patients. There are many identifiable risk factors for VTE, yet up to half of VTE incident cases have no identifiable risk factor and carry a high likelihood of recurrence, which may warrant extended therapy. For many years, parenteral unfractionated heparin, low-molecular weight heparin, fondaparinux, and oral vitamin K antagonists (VKAs) have been the standard of care in VTE management. However, limitations in current drug therapy options have led to suboptimal treatment, so there has been a need for rapid-onset, fixed-dosing novel oral anticoagulants in both VTE treatment and prophylaxis. Oral VKAs have historically been challenging to use in clinical practice, with their narrow therapeutic range, unpredictable dose responsiveness, and many drug-drug and drug-food interactions. As such, there has also been a need for novel anticoagulant therapies with fewer limitations, which has recently been met. Dabigatran etexilate is a fixed-dose oral direct thrombin inhibitor available for use in acute and extended treatment of VTE, as well as prophylaxis in high-risk orthopedic surgical patients. In this review, the risks and overall benefits of dabigatran in VTE management are addressed, with special emphasis on clinical trial data and their application to general clinical practice and special patient populations. Current and emerging therapies in the management of VTE and monitoring of dabigatran anticoagulant-effect reversal are also discussed.

  4. Diabetic cardiomyopathy: from the pathophysiology of the cardiac myocytes to current diagnosis and management strategies

    PubMed Central

    Voulgari, Christina; Papadogiannis, Dimitrios; Tentolouris, Nicholas

    2010-01-01

    Diabetic cardiomyopathy (DCM), although a distinct clinical entity, is also a part of the diabetic atherosclerosis process. It may be independent of the coexistence of ischemic heart disease, hypertension, or other macrovascular complications. Its pathological substrate is characterized by the presence of myocardial damage, reactive hypertrophy, and intermediary fibrosis, structural and functional changes of the small coronary vessels, disturbance of the management of the metabolic cardiovascular load, and cardiac autonomic neuropathy. These alterations make the diabetic heart susceptible to ischemia and less able to recover from an ischemic attack. Arterial hypertension frequently coexists with and exacerbates cardiac functioning, leading to the premature appearance of heart failure. Classical and newer echocardiographic methods are available for early diagnosis. Currently, there is no specific treatment for DCM; targeting its pathophysiological substrate by effective risk management protects the myocardium from further damage and has a recognized primary role in its prevention. Its pathophysiological substrate is also the objective for the new therapies and alternative remedies. PMID:21057575

  5. Characterization of inflammatory bowel disease in elderly patients: A review of epidemiology, current practices and outcomes of current management strategies

    PubMed Central

    Stepaniuk, Peter; Bernstein, Charles N; Targownik, Laura E; Singh, Harminder

    2015-01-01

    The authors review and summarize the current literature regarding the epidemiology, clinical presentation and management of inflammatory bowel disease (IBD) in elderly patients. Among elderly patients, the incidence of ulcerative colitis (UC) is higher than that of Crohn disease (CD). Elderly patients with a new diagnosis of UC are more likely to be male and have left-sided colitis. Elderly patients with a new diagnosis of CD are more likely to be female and have colonic disease. Conversely, increasing age at diagnosis has been associated with a lower likelihood of having any of a family history of IBD, perianal disease in CD and extraintestinal manifestations. Although response to drug therapies appears to be similar in elderly patients and younger individuals, the elderly are more likely to receive 5-aminosalicylic acid agents, and less likely to receive immunomodulators and biologics. Corticosteroid use in the elderly is comparable with use in younger individuals. The rates of surgical intervention appear to be lower for elderly CD patients but not elderly UC patients. Elderly individuals with UC are more likely to need urgent colectomy, which is associated with an increased mortality rate. Elective surgery is associated with similar outcomes among the elderly and young patients with IBD. Therefore, the use of immunomodulators and biologics, and earlier consideration of elective surgery for medically refractory disease in elderly patients with IBD, should be emphasized and further evaluated to prevent complications of chronic corticosteroid(s) use and to prevent emergency surgery. PMID:26069892

  6. A qualitative study of senior hospital managers' views on current and innovative strategies to improve hand hygiene.

    PubMed

    McInnes, Elizabeth; Phillips, Rosemary; Middleton, Sandy; Gould, Dinah

    2014-11-18

    Despite universal recognition of the importance of hand hygiene in reducing the incidence of healthcare associated infections, health care workers' compliance with best practice has been sub-optimal. Senior hospital managers have responsibilities for implementing patient safety initiatives and are therefore ideally placed to provide suggestions for improving strategies to increase hand hygiene compliance. This is an under-researched area, accordingly the aim of this study was to identify senior hospital managers' views on current and innovative strategies to improve hand hygiene compliance. Qualitative design comprising face-to-face interviews with thirteen purposively sampled senior managers at a major teaching and referral hospital in Sydney, Australia. Data were analysed thematically. Seven themes emerged: culture change starts with leaders, refresh and renew the message, connect the five moments to the whole patient journey, actionable audit results, empower patients, reconceptualising non-compliance and start using the hammer. To strengthen hand hygiene programmes, strategies based on the five moments of hand hygiene should be tailored to specific roles and settings and take into account the whole patient journey including patient interactions with clinical and non-clinical staff. Senior clinical and non-clinical leaders should visibly champion and mandate best practice initiatives and articulate that hand hygiene non-compliance is culturally and professionally unacceptable to the organization. Strategies that included a disciplinary component and which conceptualise hand hygiene non-compliance as a patient safety error may be worth evaluating in terms of staff acceptability and effectiveness.

  7. [Current problems and strategies in the management of intra-abdominal infection].

    PubMed

    Ren, Jian-An

    2011-07-01

    The incidence of intra-abdominal infection increases annually. The current management of intra-abdominal infection includes immediate resuscitation, prompt source control and appropriate usage of antibiotics. For patients with septic shock, fluid resuscitation should begin immediately when hypotension is present. Fluid resuscitation should be combined with vasoactive drugs. Damage control surgery promotes the development of ultrasound or CT guided percutaneous abscess drainage and open abdomen therapy. Rational use of anti-infective drugs could prevent prevalence of multiple antibiotics resistant bacteria and pan-resistant bacteria. The gut rehabilitation measures can improve the recovery of gut function and restore of enteral nutrition, and thus prevents bacterial translocation in intra-abdominal infection patients. Monitoring and modulations of immune function may further improve the successful rate of treatment of intra-abdominal infections. Non-thyroidal illness syndrome may develop in the severe intra-abdominal infection patients and should be promptly corrected.

  8. Mycotoxin problem in Africa: current status, implications to food safety and health and possible management strategies.

    PubMed

    Wagacha, J M; Muthomi, J W

    2008-05-10

    Mycotoxins are toxic secondary metabolites of fungal origin and contaminate agricultural commodities before or under post-harvest conditions. They are mainly produced by fungi in the Aspergillus, Penicillium and Fusarium genera. When ingested, inhaled or absorbed through the skin, mycotoxins will cause lowered performance, sickness or death on humans and animals. Factors that contribute to mycotoxin contamination of food and feed in Africa include environmental, socio-economic and food production. Environmental conditions especially high humidity and temperatures favour fungal proliferation resulting in contamination of food and feed. The socio-economic status of majority of inhabitants of sub-Saharan Africa predisposes them to consumption of mycotoxin contaminated products either directly or at various points in the food chain. The resulting implications include immuno-suppression, impaired growth, various cancers and death depending on the type, period and amount of exposure. A synergistic effect between mycotoxin exposure and some important diseases in the continent such as malaria, kwashiorkor and HIV/AIDS have been suggested. Mycotoxin concerns have grown during the last few decades because of their implications to human and animal health, productivity, economics of their management and trade. This has led to development of maximum tolerated limits for mycotoxins in various countries. Even with the standards in place, the greatest recorded fatal mycotoxin-poisoning outbreak caused by contamination of maize with aflatoxins occurred in Africa in 2004. Pre-harvest practices; time of harvesting; handling of produce during harvesting; moisture levels at harvesting, transportation, marketing and processing; insect damage all contribute to mycotoxin contamination. Possible intervention strategies include good agricultural practices such as early harvesting, proper drying, sanitation, proper storage and insect management among others. Other possible interventions

  9. Non-alcoholic fatty liver disease in obese adults: clinical aspects and current management strategies.

    PubMed

    Pallayova, M; Taheri, S

    2014-10-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder whose prevalence is strongly linked to the current epidemic of obesity in many western countries. The prevalence of NAFLD is two to four times higher in populations with pre-existing metabolic comorbidities than in the general population. The diagnosis of primary NAFLD involves establishing the presence of hepatic steatosis or steatohepatitis by imaging or histology, along with establishing the non-alcoholic nature of the disease process and excluding competing aetiologies for hepatic steatosis. Among the indirect serum biomarkers, the NAFLD fibrosis score can help to identify patients with NAFLD and with higher likelihood of having fibrosis or cirrhosis. A liver biopsy should be considered in NAFLD patients at increased risk for steatohepatitis/advanced fibrosis and in cases where a liver biopsy is necessary to exclude co-existing chronic liver diseases and other aetiologies for hepatic steatosis. The treatment and management recommendations for obesity-associated NAFLD are aimed towards weight reduction. The currently available interventions employed to promote weight loss and improve the metabolic responses in NAFLD include lifestyle modification, pharmacotherapy and bariatric surgery.

  10. HTLV-1 in solid-organ transplantation: current challenges and future management strategies.

    PubMed

    Armstrong, Matthew J; Corbett, Christopher; Rowe, Ian A; Taylor, Graham P; Neuberger, James M

    2012-12-15

    Human T-cell lymphotrophic virus (HTLV)-1 has been reported after solid-organ transplantation, with a related fatal outcome in less than five cases. The natural history of HTLV-1 transmission from donor to recipient is unknown in this setting, because available screening platforms are suboptimal in low-prevalence areas and there is a lack of long-term follow-up. Minimizing organ wastage due to false-positive screening and avoiding donor-derived HTLV-associated diseases remain the goal. To date, only six HTLV-naive organ recipients from four donors (only one had confirmed HTLV) have developed HTLV-associated disease after transplantation. All of these cases were described in countries or from donors from HTLV-endemic regions. To the best of our knowledge, there have been no reported cases of donor-derived HTLV-1-associated death after organ transplantation in the world. Based on data from low-prevalence countries (Europe and the United States) and the current shortage of donor organs, it appears plausible to authorize the decision to transplant an organ without the prior knowledge of the donor's HTLV-1 status. Currently, it is not possible to exclude such transmission and recipients should be informed of the possible inadvertent transmission of this (and other) infections at the time of consent. In those cases where HTLV-1 transmission does occur, there may be a therapeutic window in which use of antiviral agents (i.e., zidovudine and raltegravir) may be of benefit. The development of national/international registries should allow a greater understanding of the extent and consequences of transmission risk and so allow a more evidence-based approach to management.

  11. Current strategies for reproductive management of gilts and sows in North America.

    PubMed

    Kraeling, Robert R; Webel, Stephen K

    2015-01-01

    Many advances in genetic selection, nutrition, housing and disease control have been incorporated into modern pork production since the 1950s resulting in highly prolific females and practices and technologies, which significantly increased efficiency of reproduction in the breeding herd. The objective of this manuscript is to review the literature and current industry practices employed for reproductive management. In particular the authors focus on assisted reproduction technologies and their application for enhanced productivity. Modern maternal line genotypes have lower appetites and exceptional lean growth potential compared to females of 20 yr ago. Thus, nutrient requirements and management techniques and technologies, which affect gilt development and sow longevity, require continuous updating. Failure to detect estrus accurately has the greatest impact on farrowing rate and litter size. Yet, even accurate estrus detection will not compensate for the variability in the interval between onset of estrus and actual time of ovulation. However, administration of GnRH analogs in weaned sows and in gilts after withdrawal of altrenogest do overcome this variability and thereby synchronize ovulation, which makes fixed-time AI practical. Seasonal infertility, mediated by temperature and photoperiod, is a persistent problem. Training workers in the art of stockmanship is of increasing importance as consumers become more interested in humane animal care. Altrenogest, is used to synchronize the estrous cycle of gilts, to prolong gestation for 2-3 d to synchronize farrowing and to postpone post-weaning estrus. P.G. 600® is used for induction of estrus in pre-pubertal gilts and as a treatment to overcome seasonal anestrous. Sperm cell numbers/dose of semen is significantly less for post cervical AI than for cervical AI. Real-time ultrasonography is used to determine pregnancy during wk 3-5. PGF2α effectively induces farrowing when administered within two d of normal

  12. [Hyperkalemia - current therapuetic strategies].

    PubMed

    Głogowski, Tomasz; Wojtaszek, Ewa

    Hyperkalemia is a medical emergency that requires immediate therapy, followed by interventions aimed at preventing its recurrence. Hyperkalemia occurs especially frequently in patients with chronic kidney disease (CKD), in part because of impaired kidney function and in part due to coexisting comorbidities such as diabetes or heart failure and the medications used to treat them, first of all the inhibitors of renin-angiotensin-aldosterone system (RAASi). Both acute and chronic management of hyperkalemia are equally important, though, with currently available therapeutic possibilities, the effective restoration of potassium homeostasis are in fact limited to the correction of its triggers. The emergence of new medications (patiromer and ZS-9) could lead to a therapeutic paradigm shift from intermittent treatment of incidentally discovered hyperkalemia toward preventive measures preventing fluctuations in serum potassium levels and enabling the continuation of beneficial, but hyperkalemia inducing agents.

  13. Concussions: What a neurosurgeon should know about current scientific evidence and management strategies

    PubMed Central

    Neal, Matthew T.; Wilson, Jonathan L.; Hsu, Wesley; Powers, Alexander K.

    2012-01-01

    Background: There has been a tremendous amount of interest focused on the topic of concussions over the past few decades. Neurosurgeons are frequently consulted to manage patients with mild traumatic brain injuries (mTBI) that have radiographic evidence of cerebral injury. These injuries share significant overlap with concussions, injuries that typically do not reveal radiographic evidence of structural injury, in the realms of epidemiology, pathophysiology, outcomes, and management. Further, neurosurgeons often manage patients with extracranial injuries that have concomitant concussions. In these cases, neurosurgeons are often the only “concussion experts” that patients encounter. Results: The literature has been reviewed and data have been synthesized on the topic including sections on historical background, epidemiology, pathophysiology, diagnostic advances, clinical sequelae, and treatment suggestions, with neurosurgeons as the intended target audience. Conclusions: Neurosurgeons should have a fundamental knowledge of the scientific evidence that has developed regarding concussions and be prepared to guide patients with treatment plans. PMID:22439107

  14. Current concepts and management strategies in chronic kidney disease-mineral and bone disorder.

    PubMed

    Chauhan, Veeraish; Kelepouris, Ellie; Chauhan, Nishtha; Vaid, Megha

    2012-09-01

    The term renal osteodystrophy describes the pathological changes in bone structure in chronic kidney disease (CKD); however, this term fails to describe adequately the adverse changes in mineral and hormonal metabolism in CKD that have grave consequences for patient survival. CKD-mineral and bone disorder (CKD-MBD) is a broader, newly defined term that should be used instead of renal osteodystrophy to define the mineral, bone, hormonal, and calcific cardiovascular abnormalities that are seen in CKD. The new paradigm in the management of renal bone disease is to "think beyond the bones" and strive to improve cardiovascular outcomes and survival. This means treating other aspects of the disease process that go beyond merely controlling parathyroid hormone levels. Primary physicians need to take a proactive approach to the management of CKD-MBD because the disorder begins early in the course of CKD, well before a patient is referred to a nephrologist. This review outlines the evidence behind the understanding of CKD-MBD, its implications for overall mortality, and the latest recommendations for management of CKD-MBD in patients with predialysis CKD.

  15. The nuances of atherogenic dyslipidemia in diabetes: focus on triglycerides and current management strategies.

    PubMed

    Manoria, P C; Chopra, H K; Parashar, S K; Dutta, A L; Pinto, Brian; Mullasari, Ajit; Prajapati, Samir

    2013-12-01

    Diabetes mellitus (DM) is a pandemic disease and an important cardiovascular (CV) risk factor. The atherogenic dyslipidemia in diabetes (ADD) is characterized by high serum triglycerides, high small dense LDL levels, low HDL levels and postprandial lipemia. Insulin resistance is a primary cause for ADD. Though statins are highly effective for CVD prevention in DM but a significant residual CV risk remains even after optimal statin therapy. Fibrates, niacin and omega-3 fatty acids are used in addition to statin for treatment of ADD (specifically hypertriglyceridemia). All these drugs have some limitations and they are far from being ideal companions of statins. Many newer drugs are in pipeline for management of ADD. Dual PPAR α/γ agonists are in most advanced stage of clinical development and they have a rational approach as they control blood glucose levels (by reducing insulin resistance, a primary factor for ADD) in addition to modulating ADD. Availability of dual PPAR α/γ agnosits and other drugs for ADD management may improve CV outcomes and decrease morbidity and mortality in diabetic patients in future. Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  16. The nuances of atherogenic dyslipidemia in diabetes: Focus on triglycerides and current management strategies

    PubMed Central

    Manoria, P.C.; Chopra, H.K.; Parashar, S.K.; Dutta, A.L.; Pinto, Brian; Mullasari, Ajit; Prajapati, Samir

    2013-01-01

    Diabetes mellitus (DM) is a pandemic disease and an important cardiovascular (CV) risk factor. The atherogenic dyslipidemia in diabetes (ADD) is characterized by high serum triglycerides, high small dense LDL levels, low HDL levels and postprandial lipemia. Insulin resistance is a primary cause for ADD. Though statins are highly effective for CVD prevention in DM but a significant residual CV risk remains even after optimal statin therapy. Fibrates, niacin and omega-3 fatty acids are used in addition to statin for treatment of ADD (specifically hypertriglyceridemia). All these drugs have some limitations and they are far from being ideal companions of statins. Many newer drugs are in pipeline for management of ADD. Dual PPAR α/γ agonists are in most advanced stage of clinical development and they have a rational approach as they control blood glucose levels (by reducing insulin resistance, a primary factor for ADD) in addition to modulating ADD. Availability of dual PPAR α/γ agnosits and other drugs for ADD management may improve CV outcomes and decrease morbidity and mortality in diabetic patients in future. PMID:24407538

  17. Management of Chyle Leak after Head and Neck Surgery: Review of Current Treatment Strategies

    PubMed Central

    Shi, Haoran; Sinha, Uttam K.

    2017-01-01

    Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body. Chyle extravasation can result in delayed wound healing, dehydration, malnutrition, electrolyte disturbances, and immunosuppression. Prompt identification and treatment of a chyle leak are essential for optimal surgical outcome. In this article we will review the current treatment options for iatrogenic cervical chyle leaks. PMID:28203252

  18. Current strategies for the long-term assessment, monitoring, and management of cystic fibrosis patients treated with CFTR modulator therapy.

    PubMed

    Elborn, J Stuart; Davies, Jane; Mall, Marcus A; Flume, Patrick A; Plant, Barry

    2017-01-01

    The content for this activity is based on the satellite symposium, "Current Strategies for the Long-term Assessment, Monitoring, and Management for Cystic Fibrosis Patients Treated with CFTR Modulator Therapy" that was presented at the 39th European Cystic Fibrosis Society Conference on June 10, 2016 (Online access: http://courses.elseviercme.com/ecfs2016e/619e). The emergence of novel targeted agents, that directly correct CFTR loss function alleles, has created new treatment opportunities for patients with cystic fibrosis with advanced disease. Knowledge of the role of these agents in the clinical setting is quickly evolving and will require physicians to stay acquainted with the latest data as well as evidence-based treatment guidelines in order to achieve optimized cystic fibrosis patient care. Ideally, after diagnosis, a personalized approach would be adapted and tailored to the patient through genome-informed medicine. However, due to the relative recentness of genomic-based therapeutics, physicians may have a limited knowledge base regarding these new treatment options and how to best incorporate these agents into patient management plans. Although cystic fibrosis is still largely regarded as a pediatric disease, the median survival for patients is 35years of age. Consequently, pediatric-to-adult cystic fibrosis care programs would allow suitable preparation time for this transition and develop a standardized group of self-care and management skills.

  19. Narrative review of current context of malaria and management strategies in Uganda (Part I).

    PubMed

    Kassam, Rosemin; Collins, John B; Liow, Eric; Rasool, Nabeela

    2015-12-01

    In accordance with international targets, the Uganda National Malaria Control Strategic Plan established specific targets to be achieved by 2010. For children under five, this included increasing the number of children sleeping under mosquito nets and those receiving a first-line antimalarial to 85%, and decreasing case fatality to 2%. This narrative review offers contextual information relevant to malaria management in Uganda since the advent of artemisinin combination therapy (ACT) as first-line antimalarial treatment in 2004. A comprehensive search using key words and phrases was conducted using the web search engines Google and Google Scholar, as well as the databases of PubMed, ERIC, EMBASE, CINAHL, OvidSP (MEDLINE), PSYC Info, Springer Link, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews were searched. A total of 147 relevant international and Ugandan literature sources meeting the inclusion criteria were included. This review provides an insightful understanding on six topic areas: global and local priorities, malarial pathology, disease burden, malaria control, treatment guidelines for uncomplicated malaria, and role of the health system in accessing antimalarial medicines. Plasmodium falciparum remains the most common cause of malaria in Uganda, with children under five being most vulnerable due to their underdeveloped immunity. While international efforts to scale up malaria control measures have resulted in considerable decline in malaria incidence and mortality in several regions of sub-Saharan Africa, this benefit has yet to be substantiated for Uganda. At the local level, key initiatives have included implementation of a new antimalarial drug policy in 2004 and strengthening of government health systems and programs. Examples of such programs include removal of user fees, training of frontline health workers, providing free ACT from government systems and subsidized ACT from licensed private

  20. Clinical management of sleep disturbances in Alzheimer’s disease: current and emerging strategies

    PubMed Central

    Urrestarazu, Elena; Iriarte, Jorge

    2016-01-01

    Sleep and circadian disorders in Alzheimer’s disease (AD) are more frequent than in the general population and appear early in the course of the disease. Quality of sleep and quality of life are parallel in these patients, and such disorders also represent a heavy burden for caregivers. Although alterations in melatonin and hypocretins (orexins) seem to play a key role in the origin of these disturbances, the etiology of these disorders is multifactorial, including many factors such as environment, behavior, treatments, and comorbidities, among others. A comprehensive evaluation of sleep in each patient is essential in the design of the treatment that includes nonpharmacological and pharmacological approaches. One particularly interesting point is the possibility of a role of sleep disorders in the pathogenesis of AD, raising the possibility that treating the sleep disorder may alter the course of the disease. In this review, we present an update on the role of sleep disorders in AD, the bidirectional influence of sleep problems and AD, and treatment options. Behavioral measures, bright light therapy (BLT), melatonin, and other drugs are likely well known and correctly managed by the physicians in charge of these patients. In spite of the multiple treatments used, evidence of efficacy is scarce and more randomized double-blind placebo-controlled studies are needed. Future directions for treatment are the establishment of BLT protocols and the development of drugs with new mechanisms of action, especially hypocretin receptor antagonists, melatonin receptor agonists, and molecules that modulate the circadian clock. PMID:26834500

  1. Clinical management of sleep disturbances in Alzheimer's disease: current and emerging strategies.

    PubMed

    Urrestarazu, Elena; Iriarte, Jorge

    2016-01-01

    Sleep and circadian disorders in Alzheimer's disease (AD) are more frequent than in the general population and appear early in the course of the disease. Quality of sleep and quality of life are parallel in these patients, and such disorders also represent a heavy burden for caregivers. Although alterations in melatonin and hypocretins (orexins) seem to play a key role in the origin of these disturbances, the etiology of these disorders is multifactorial, including many factors such as environment, behavior, treatments, and comorbidities, among others. A comprehensive evaluation of sleep in each patient is essential in the design of the treatment that includes nonpharmacological and pharmacological approaches. One particularly interesting point is the possibility of a role of sleep disorders in the pathogenesis of AD, raising the possibility that treating the sleep disorder may alter the course of the disease. In this review, we present an update on the role of sleep disorders in AD, the bidirectional influence of sleep problems and AD, and treatment options. Behavioral measures, bright light therapy (BLT), melatonin, and other drugs are likely well known and correctly managed by the physicians in charge of these patients. In spite of the multiple treatments used, evidence of efficacy is scarce and more randomized double-blind placebo-controlled studies are needed. Future directions for treatment are the establishment of BLT protocols and the development of drugs with new mechanisms of action, especially hypocretin receptor antagonists, melatonin receptor agonists, and molecules that modulate the circadian clock.

  2. Medical and neurologic complications of the current management strategy of angiographically negative nontraumatic subarachnoid hemorrhage patients.

    PubMed

    Sprenker, Collin; Patel, Jaymin; Camporesi, Enrico; Vasan, Rosit; Van Loveren, Harry; Chen, Henian; Agazzi, Siviero

    2015-02-01

    Common management of angionegative subarachnoid hemorrhage includes mandatory intensive care unit stay for up to 14 days with strict bedrest, constant neurologic serial examination, invasive arterial and central line monitoring, and aneurysm rupture precautions. We evaluated the frequency of neurologic and nonneurologic complications in this patient population. This was a retrospective chart review from July 2008 to 2011. Adult patients with International Classification of Diseases, Ninth Revision code for nontraumatic subarachnoid hemorrhage who had angiograms and cranial cat scans (CTs) were evaluated as the first screening measure. Negative screening angiograms constituted our study population and were divided into 2 groups (aneurysmal or perimesencephalic) based on the CT blood pattern. Fifty-one patients met the study criteria (aneurysmal CT, n = 26; perimesencephalic CT pattern, n = 25). There were no incidences of rebleeding or mortality, and patients were discharged after a mean of 15.24 hospital days and a mean of 11 bedrest days. Seventeen patients (65%) in the aneurysmal group developed at least 1 nonneurologic complication compared with 2 patients (8%) in the perimesencephalic group (P = .001). Eleven patients in the aneurysmal group (42.3%) developed at least 1 neurologic complication compared with 1 patient (4%) in the perimesecephalic group (P = .001). Based on our results, we propose admission to the medical floor for patients with World Federation of Neurosurgical Societies score 1 to 3, perimesencephalic CT pattern, and no hydrocephalus. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Management of malignancy-associated pleural effusion: current and future treatment strategies.

    PubMed

    Marchi, Evaldo; Teixeira, Lisete R; Vargas, Francisco S

    2003-01-01

    Management of recurrent malignant pleural effusion, a common complication of malignancy, poses a challenge to clinicians. Although almost one century has elapsed since the introduction of the pleurodesis procedure, the ideal approach and best agent are still to be defined. Optimally, pleurodesis should be done at the bedside with a minimally invasive procedure, and suitable agents to achieve pleural symphysis should be inexpensive, available worldwide and free of adverse effects. To date, no substance completely fulfills these requirements. Silver nitrate should be considered for pleurodesis because of its low cost and ease of handling. Although talc has been used most frequently to induce pleurodesis, reports of death due to acute respiratory failure have raised concerns about the safety of this agent. Tetracycline, an effective alternative used in the past, is no longer commercially available. This agent has been substituted with derivatives of tetracycline, such as minocycline and doxycycline with success rates similar to those with tetracycline. Several antineoplastic agents have been injected into the pleural space with the aim of producing pleural symphysis, the most representative of this group being bleomycin. Recent knowledge of the molecular mechanisms involved in pleural inflammation has brought into focus new substances, such as transforming growth factor beta and vascular endothelial growth factor, which may be used as pleurodesis agents in the future. Nevertheless, more studies are necessary to better define the potential of these substances in the induction of pleural symphysis.Ideally, a sclerosing agent should be cost-effective, available worldwide and easily administered. Talc will probably stand as the preferred agent to be used for pleurodesis in malignant pleural effusion because of its efficacy, easy manipulation and handling. However, further investigation is necessary to minimize adverse effects related to talc.

  4. Human capital strategy: talent management.

    PubMed

    Nagra, Michael

    2011-01-01

    Large organizations, including the US Army Medical Department and the Army Nurse Corps, are people-based organizations. Consequently, effective and efficient management of the human capital within these organizations is a strategic goal for the leadership. Over time, the Department of Defense has used many different systems and strategies to manage people throughout their service life-cycle. The current system in use is called Human Capital Management. In the near future, the Army's human capital will be managed based on skills, knowledge, and behaviors through various measurement tools. This article elaborates the human capital management strategy within the Army Nurse Corps, which identifies, develops, and implements key talent management strategies under the umbrella of the Corps' human capital goals. The talent management strategy solutions are aligned under the Nurse Corps business strategy captured by the 2008 Army Nurse Corps Campaign Plan, and are implemented within the context of the culture and core values of the organization.

  5. Revisiting Current Golden Rules in Managing Acute Ischemic Stroke: Evaluation of New Strategies to Further Improve Treatment Selection and Outcome.

    PubMed

    Yuh, William T C; Alexander, Matthew David; Ueda, Toshihiro; Maeda, Masayuki; Taoka, Toshiaki; Yamada, Kei; Beauchamp, Norman J

    2017-01-01

    Advanced stroke imaging has generated much excitement for the early diagnosis of acute ischemic stroke (AIS) and facilitation of intervention. However, its therapeutic impact has not matched its diagnostic utility; most notably, lacking significant contributions to recent major AIS clinical trials. It is time to reexamine the fundamental hypotheses from the enormous body of imaging research on which clinical practices are based and reassess the current standard clinical and imaging strategies, or golden rules, established over decades for AIS. In this article, we will investigate a possible new window of opportunity in managing AIS through a better understanding of the following: first, the potential limitations of the golden rules; second, the significance of imaging-based parenchymal hypoperfusion (i.e., lower-than-normal relative cerebral blood flow [rCBF] may not be indicative of ischemia); third, the other critical factors (e.g., rCBF, collateral circulation, variable therapeutic window, chronicity of occlusion) that reflect more individual ischemic injury for optimal treatment selection; and, fourth, the need for penumbra validation in successfully reperfused patients (not in untreated patients). Individual variations in the therapeutic window, ischemic injury (rCBF), and chronicity of vascular lesion development have not been comprehensively incorporated in the standard algorithms used to manage AIS. The current established imaging parameters have not been consistently validated with successfully reperfused patients and rCBF to quantitatively distinguish between oligemia and ischemia and between penumbra and infarct core within ischemic tissue. A novel paradigm incorporating rCBF values or indirectly incorporating relative rCBF values with higher statistically powered imaging studies to more reliably assess the severity of ischemic injury and differentiate reversibility from viability within the area of imaging-based parenchymal hypoperfusion may provide a

  6. Cost-effectiveness in the management of Dupuytren's contracture. A Canadian cost-utility analysis of current and future management strategies.

    PubMed

    Baltzer, H; Binhammer, P A

    2013-08-01

    In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.

  7. The need to clot: a review of current management strategies for adverse bleeding events with new oral anticoagulants.

    PubMed

    Whalley, D; Skappak, C; Lang, E S

    2014-07-01

    The new factor Xa inhibitors and direct thrombin inhibitors have offered alternatives to traditional anticoagulants, with benefits of no routine monitoring, less drug interactions, and oral administration. Current approved uses of these agents include prophylaxis of stroke in non-valvular atrial fibrillation and prevention of venous thromboembolism (VTE) following hip and knee arthroplasty. However, concern over bleeding risk in the context of having no specific antidotes available is a topic of focus for many physicians in an acute care setting. This manuscript examines the recent literature in the management of acute bleeding and the various methods of reversing anticoagulation in this setting. Literature published over the last 18 months (2011/07/01-present) was gathered from PubMed, Ovid, and Medline under a combined search strategy covering bleeding, reversal, and new oral anticoagulants, both factor Xa and direct thrombin inhibitors. The use of prothrombin complex concentrate, fresh frozen plasma, activated recombinant factor VII, activated prothrombin complex concentrate, as well as adjuncts of charcoal, hemodialysis, and antifibrinolytics are discussed. Recommendations are based on the determination of the severity of the bleed and physiological markers of anticoagulation, and involve the use of prothrombin complex concentrate, activated recombinant factor VII, and adjunctive therapy as appropriate.

  8. [Undesired awareness phenomena during general anesthesia: Evidence-based state of knowledge, current discussions and strategies for prevention and management].

    PubMed

    Bischoff, P; Rundshagen, I; Schneider, G

    2015-10-01

    Patient awareness during general anesthesia and the later recall of what happened during surgery can be experienced by patients as horrifying events that leave lasting mental trauma in the form of posttraumatic stress syndrome (PTSS). Awareness is related to a temporary insufficient depth of anesthesia. This phenomenon has been discussed for more than 20 years. According to randomized controlled studies, in the absence of risk factors awareness phenomena occur in 1-2 per 1000 operations involving general anesthesia (0.1-0.2%) and are classified as occasionally occurring critical events. An astonishing twist occurred elicited by the recent data from the 5th National Audit Project from Great Britain (NAP5) published in the British Journal of Anaesthesia and in Anaesthesia. The NAP5 evaluated patient reports of accidental awareness during general anesthesia (AAGA) in a multicenter manner in more than 2.7 million cases and indicated incidences of awareness of only 1:19,600, a frequency 20 times less than previously reported. These results gave rise to some controversy. It seems likely that, due to the absence of structured interviews, the NAP5 data only demonstrated the tip of the iceberg and may have vastly underestimated the real incidence of intraoperative awareness. The present overview summarizes the current knowledge about awareness. Furthermore, it addresses the question whether the awareness problem has been overestimated by evidence-based criteria or underestimated by the results of the NAP5. The responsibility for sufficient anesthesia in the clinical routine requires knowledge of awareness risks and potential sequelae. A formal recommendation from the German Society of Anesthesia and Intensive Care Medicine (DGAI) concerning awareness is not yet available; however, the recognition of evidence-based strategies in the management of anesthesia may minimize the occurrence of awareness and its sequelae.

  9. Determining heavy metals in spent compact fluorescent lamps (CFLs) and their waste management challenges: Some strategies for improving current conditions

    SciTech Connect

    Taghipour, Hassan; Amjad, Zahra; Jafarabadi, Mohamad Asghari; Gholampour, Akbar; Norouz, Prviz

    2014-07-15

    Highlights: • Heavy metals in spent compact fluorescent lamps (CFLs) determined. • Current waste management condition of CFLs in Iran assessed. • Currently, waste of CFLs is disposed by municipal waste stream in waste landfills. • We propose extended producer responsibility (EPR) for CFLs waste management. - Abstract: From environmental viewpoint, the most important advantage of compact fluorescent lamps (CFLs) is reduction of green house gas emissions. But their significant disadvantage is disposal of spent lamps because of containing a few milligrams of toxic metals, especially mercury and lead. For a successful implementation of any waste management plan, availability of sufficient and accurate information on quantities and compositions of the generated waste and current management conditions is a fundamental prerequisite. In this study, CFLs were selected among 20 different brands in Iran. Content of heavy metals including mercury, lead, nickel, arsenic and chromium was determined by inductive coupled plasma (ICP). Two cities, Tehran and Tabriz, were selected for assessing the current waste management condition of CFLs. The study found that waste generation amount of CFLs in the country was about 159.80, 183.82 and 153.75 million per year in 2010, 2011 and 2012, respectively. Waste generation rate of CFLs in Iran was determined to be 2.05 per person in 2012. The average amount of mercury, lead, nickel, arsenic and chromium was 0.417, 2.33, 0.064, 0.056 and 0.012 mg per lamp, respectively. Currently, waste of CFLs is disposed by municipal waste stream in waste landfills. For improving the current conditions, we propose by considering the successful experience of extended producer responsibility (EPR) in other electronic waste management. The EPR program with advanced recycling fee (ARF) is implemented for collecting and then recycling CFLs. For encouraging consumers to take the spent CFLs back at the end of the products’ useful life, a proportion of

  10. Anomalous aortic origin of a coronary artery with an interarterial course: understanding current management strategies in children and young adults.

    PubMed

    Brothers, Julie; Gaynor, J William; Paridon, Stephen; Lorber, Richard; Jacobs, Marshall

    2009-10-01

    Anomalous aortic origin of a coronary artery from the opposite sinus of Valsalva with an interarterial course (AAOCA) is a rare congenital anomaly that is the second leading cardiovascular cause of sudden death in children and adolescents. Management practices with respect to this lesion vary among clinicians. We surveyed practitioners' opinions on treatment and management strategies for patients with AAOCA. A 17-question "Patient Management Questionnaire" was sent to all Congenital Heart Surgeons' Society (CHSS) members (n = 90), who were asked to respond and to distribute the questionnaire to pediatric cardiologists and nurse practitioners at their institutions. Questions addressed patient presentation, diagnostic modalities, therapeutic intervention, complications to therapy, follow-up visits, and type and frequency of follow-up testing. Descriptive statistics were used for analyses. We received 113 responses. Almost all respondents agree that ischemia at presentation or with provocative testing warrants surgical repair, whereas the majority believes that any patient with symptoms but no evidence of ischemia should have surgery. Approximately one-half and one-third of the respondents manage patients who are awaiting surgery or not having surgery by completely restricting exercise or not allowing competitive athletics, respectively. In asymptomatic patients, patient age determines timing of surgical repair but almost one-quarter did not believe that an asymptomatic child should undergo surgery. Among patients managed medically, there were six sudden deaths; there were two deaths in those who had surgical repair. There is marked heterogeneity in physician opinions regarding AAOCA treatment and management. A multicenter registry would facilitate the development of evidence-based treatment and management guidelines for children and young adults with AAOCA.

  11. Management strategies for fibromyalgia.

    PubMed

    Le Marshall, Kim Francis; Littlejohn, Geoffrey Owen

    2011-01-01

    What are the effective, evidence-based strategies available for the management of fibromyalgia? There are a number of management strategies available with robust evidence to support their use in clinical practice. Fibromyalgia is a complex pain syndrome characterized by widespread, chronic muscular pain and tenderness, disordered sleep, emotional distress, cognitive disturbance, and fatigue. Its prevalence is estimated to be 3%-5% in the population and higher yet in patients with comorbid rheumatic diseases. Systematic reviews, meta-analyses, randomized controlled trials (RCTs). PubMed, Cochrane Library, manual search. Key messages for patients and clinicians are: There are many effective pharmacological management strategies available for fibromyalgia.A nonpharmacological, multicomponent approach utilizing education, aerobic exercise, psychological therapy, and other strategies is also effective for fibromyalgia.Despite the significant and, at times, disabling physical and psychological symptoms, fibromyalgia can be a manageable condition with a potentially good outcome.

  12. Footrot and interdigital dermatitis in sheep: farmer satisfaction with current management, their ideal management and sources used to adopt new strategies.

    PubMed

    Wassink, G J; George, T R N; Kaler, J; Green, L E

    2010-08-01

    The aims of this research were to identify management practices that sheep farmers currently use to treat and prevent footrot in sheep and whether they consider that these are successful management tools and to find out how sheep farmers would ideally like to manage footrot in their flock. Over 90% of lameness in sheep in the UK is caused by Dichelobacter nodosus, which presents clinically as interdigital dermatitis (ID) alone or with separation of hoof horn (FR). A questionnaire was sent to 265 farmers to investigate their current management and their satisfaction with current management of the spectrum of clinical presentations of footrot. Farmers were also asked their ideal management of footrot and their interest in, and sources of information for, change. Approximately 160 farmers responded. Farmers satisfied with current management reported a prevalence of lameness < or = 5%. These farmers caught and treated lame sheep within 3 days of first seeing them lame, and treated sheep with FR and ID with parenteral antibacterials. Farmers dissatisfied with their management reported a prevalence of lameness >5%. These farmers practised routine foot trimming, footbathing and vaccination against footrot. Whilst 89% of farmers said they were satisfied with their management of FR over 34% were interested in changing management. Farmers identified veterinarians as the most influential source for new information. Farmers reported that ideally they would control FR by culling/isolating lame sheep, sourcing replacements from non-lame parents, trimming feet less, using antibacterial treatments less and using vaccination more. Footbathing was a commonly used management that was linked with dissatisfaction and that also was listed highly as an ideal management. Consequently, some of the ideal managements are in agreement with our understanding of disease control (culling and isolation, sourcing healthy replacements) but others are in contrast with our current knowledge of

  13. Funding strategies for wilderness management

    Treesearch

    Carolyn Alkire

    2000-01-01

    Funding wilderness protection will continue to be a challenge for public land managers. With continuing competition for federal funds and balanced budget goals, other sources of funds may be necessary to supplement annual federal appropriations. This paper identifies and evaluates five potential funding strategies and provides examples of each that are currently in use...

  14. Current Management of NAFLD

    PubMed Central

    MUNTEANU, MIHAI ALEXANDRU; NAGY, GEORGIANA ANCA; MIRCEA, PETRU ADRIAN

    2016-01-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in Western countries. It affects about 1 billion individuals worldwide. While people with simple steatosis have no higher risk of death than the general population, people with non-alcoholic steatohepatitis are at increased risk of death compared to general population. Current management for NAFLD includes diet and lifestyle changes, management of underlying metabolic risk factors and pharmacological therapies. The objective of therapy is to prevent the complications. The problem with dietary and lifestyle interventions is that they are hard to implement. Compliance is the key. Until now, there is still no approved drug for the treatment of NAFLD. Insulin resistance is the main target of pharmacological therapy, but the question that we ask ourselves as physicians is who should receive medical treatment among NAFLD patients and for how long. PMID:27004021

  15. Fault Management Design Strategies

    NASA Technical Reports Server (NTRS)

    Day, John C.; Johnson, Stephen B.

    2014-01-01

    Development of dependable systems relies on the ability of the system to determine and respond to off-nominal system behavior. Specification and development of these fault management capabilities must be done in a structured and principled manner to improve our understanding of these systems, and to make significant gains in dependability (safety, reliability and availability). Prior work has described a fundamental taxonomy and theory of System Health Management (SHM), and of its operational subset, Fault Management (FM). This conceptual foundation provides a basis to develop framework to design and implement FM design strategies that protect mission objectives and account for system design limitations. Selection of an SHM strategy has implications for the functions required to perform the strategy, and it places constraints on the set of possible design solutions. The framework developed in this paper provides a rigorous and principled approach to classifying SHM strategies, as well as methods for determination and implementation of SHM strategies. An illustrative example is used to describe the application of the framework and the resulting benefits to system and FM design and dependability.

  16. Fault Management Design Strategies

    NASA Technical Reports Server (NTRS)

    Day, John C.; Johnson, Stephen B.

    2014-01-01

    Development of dependable systems relies on the ability of the system to determine and respond to off-nominal system behavior. Specification and development of these fault management capabilities must be done in a structured and principled manner to improve our understanding of these systems, and to make significant gains in dependability (safety, reliability and availability). Prior work has described a fundamental taxonomy and theory of System Health Management (SHM), and of its operational subset, Fault Management (FM). This conceptual foundation provides a basis to develop framework to design and implement FM design strategies that protect mission objectives and account for system design limitations. Selection of an SHM strategy has implications for the functions required to perform the strategy, and it places constraints on the set of possible design solutions. The framework developed in this paper provides a rigorous and principled approach to classifying SHM strategies, as well as methods for determination and implementation of SHM strategies. An illustrative example is used to describe the application of the framework and the resulting benefits to system and FM design and dependability.

  17. Diffuse low-grade glioma: a review on the new molecular classification, natural history and current management strategies.

    PubMed

    Delgado-López, P D; Corrales-García, E M; Martino, J; Lastra-Aras, E; Dueñas-Polo, M T

    2017-03-02

    The management of diffuse supratentorial WHO grade II glioma remains a challenge because of the infiltrative nature of the tumor, which precludes curative therapy after total or even supratotal resection. When possible, functional-guided resection is the preferred initial treatment. Total and subtotal resections correlate with increased overall survival. High-risk patients (age >40, partial resection), especially IDH-mutated and 1p19q-codeleted oligodendroglial lesions, benefit from surgery plus adjuvant chemoradiation. Under the new 2016 WHO brain tumor classification, which now incorporates molecular parameters, all diffusely infiltrating gliomas are grouped together since they share specific genetic mutations and prognostic factors. Although low-grade gliomas cannot be regarded as benign tumors, large observational studies have shown that median survival can actually be doubled if an early, aggressive, multi-stage and personalized therapy is applied, as compared to prior wait-and-see policy series. Patients need an honest long-term therapeutic strategy that should ideally anticipate neurological, cognitive and histopathologic worsening.

  18. Brain abscess: Current management

    PubMed Central

    Alvis Miranda, Hernando; Castellar-Leones, Sandra Milena; Elzain, Mohammed Awad; Moscote-Salazar, Luis Rafael

    2013-01-01

    Brain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA. PMID:24174804

  19. Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear.

    PubMed

    Mehta, S B; Banerji, S; Millar, B J; Suarez-Feito, J-M

    2012-01-13

    The aim of this series of four articles on tooth wear management is to provide the reader with the necessary information in order to be able to successfully manage cases of tooth wear, regardless of the cause, severity and location of the wear pattern seen. The content will largely focus on contemporary clinical techniques, illustrated where possible by case examples. Emphasis will be placed on 'additive adhesive techniques' utilising fixed prosthodontic protocols; however, cases of tooth wear amongst partially dentate patients involving the use of removable prostheses will also be described. The importance of patient consent and contingency planning will also be discussed. Paper 1 will describe the assessment of the wear patient, including the rationale for the planning of dental care. Also discussed will be the administration of preventative and passive management strategies for cases displaying tooth wear.

  20. Medical equipment management strategies.

    PubMed

    Wang, Binseng; Furst, Emanuel; Cohen, Ted; Keil, Ode R; Ridgway, Malcolm; Stiefel, Robert

    2006-01-01

    Clinical engineering professionals need to continually review and improve their management strategies in order to keep up with improvements in equipment technology, as well as with increasing expectations of health care organizations. In the last 20 years, management strategies have evolved from the initial obsession with electrical safety to flexible criteria that fit the individual institution's needs. Few hospitals, however, are taking full advantage of the paradigm shift offered by the evolution of joint Commission standards. The focus should be on risks caused by equipment failure, rather than on equipment with highest maintenance demands. Furthermore, it is not enough to consider risks posed by individual pieces of equipment to individual patients. It is critical to anticipate the impact of an equipment failure on larger groups of patients, especially when dealing with one of a kind, sophisticated pieces of equipment that are required to provide timely and accurate diagnoses for immediate therapeutic decisions or surgical interventions. A strategy for incorporating multiple criteria to formulate appropriate management strategies is provided in this article.

  1. Fanconi anemia: current management.

    PubMed

    Kook, Hoon

    2005-01-01

    Fanconi anemia (FA) is an autosomal recessive chromosomal instability disorder, characterized by congenital anomalies, defective hematopoiesis and a high risk of developing acute myeloid leukemia and certain solid tumors. All racial and ethnic groups are at risk, and at least 11 complementation groups have been identified and the genes defective in eight of these have been identified (FANCA, C, D2, E, F, G, L and BRCA2). FA-A is the most common complementation group, accounting for approximately 65% of all affected individuals. The gold-standard screening test for FA is based on the characteristic hypersensitivity of FA cells to the crosslinking agents, such as mitomicin C or diepoxybutane. Recent progress has been made in identifying the genes bearing pathogenetically relevant mutations, but slower progress has been made in defining the precise functions of the proteins in normal cells, in part because that the proteins are multifunctional. Molecular studies have established that a common pathway exist, both between the FA proteins and other proteins involved in DNA repair such as NBS1, ATM, BRCA1 and BRCA2. Stem cell transplantation (SCT) is the only option for establishing normal hematopoiesis. To reduce undue toxicities due to inherent hypersensitivity, nonmyeloablative conditioning for transplants has been advocated. This review summarizes the general clinical and hematologic features and the current management of FA. Fanconi anemia (FA) is the commonest type of inherited bone marrow failure syndrome with the birth incidence of around three per million. The inheritance pattern is autosomal recessive with the estimated heterozygote frequency being one in 300 in Europe and the US.

  2. Management strategies of Barrett's esophagus.

    PubMed

    De Palma, Giovanni D

    2012-11-21

    Barrett's esophagus is a condition resulting from chronic gastro-esophageal reflux disease with a documented risk of esophageal adenocarcinoma. Current strategies for improved survival in patients with Barrett's adenocarcinoma focus on detection of dysplasia. This can be obtained by screening programs in high-risk cohorts of patients and/or endoscopic biopsy surveillance of patients with known Barrett's esophagus (BE). Several therapies have been developed in attempts to reverse BE and reduce cancer risk. Aggressive medical management of acid reflux, lifestyle modifications, antireflux surgery, and endoscopic treatments have been recommended for many patients with BE. Whether these interventions are cost-effective or reduce mortality from esophageal cancer remains controversial. Current treatment requires combinations of endoscopic mucosal resection techniques to eliminate visible lesions followed by ablation of residual metaplastic tissue. Esophagectomy is currently indicated in multifocal high-grade neoplasia or mucosal Barrett's carcinoma which cannot be managed by endoscopic approach.

  3. Strategies in managing asthma.

    PubMed Central

    Barker, A F

    1989-01-01

    The management of adult asthma involves a concerted effort to identify and remove or mollify inciting or triggering stimuli such as respiratory tract infections, gastric reflux, aspirin, beta-antagonists, and environmental agents; educate patients, using written treatment plans and pulmonary function monitoring; and properly use the antiasthmatic medications including beta-agonists, theophylline, anticholinergics, and corticosteroids, with an emphasis on aerosol delivery and the use of corticosteroids during exacerbations. This strategy is summarized with suggestions on therapy in emergency departments, during the transition from hospital to ambulatory care, before exercise, and during pregnancy. PMID:2660411

  4. Osteochondral tissue engineering: current strategies and challenges.

    PubMed

    Nukavarapu, Syam P; Dorcemus, Deborah L

    2013-01-01

    Osteochondral defect management and repair remain a significant challenge in orthopedic surgery. Osteochondral defects contain damage to both the articular cartilage as well as the underlying subchondral bone. In order to repair an osteochondral defect the needs of the bone, cartilage and the bone-cartilage interface must be taken into account. Current clinical treatments for the repair of osteochondral defects have only been palliative, not curative. Tissue engineering has emerged as a potential alternative as it can be effectively used to regenerate bone, cartilage and the bone-cartilage interface. Several scaffold strategies, such as single phase, layered, and recently graded structures have been developed and evaluated for osteochondral defect repair. Also, as a potential cell source, tissue specific cells and progenitor cells are widely studied in cell culture models, as well with the osteochondral scaffolds in vitro and in vivo. Novel factor strategies being developed, including single factor, multi-factor, or controlled factor release in a graded fashion, not only assist bone and cartilage regeneration, but also establish osteochondral interface formation. The field of tissue engineering has made great strides, however further research needs to be carried out to make this strategy a clinical reality. In this review, we summarize current tissue engineering strategies, including scaffold design, bioreactor use, as well as cell and factor based approaches and recent developments for osteochondral defect repair. In addition, we discuss various challenges that need to be addressed in years to come. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. Using Rewards and Sanctions in the Classroom: Pupils' Perceptions of Their Own Responses to Current Behaviour Management Strategies

    ERIC Educational Resources Information Center

    Payne, Ruth

    2015-01-01

    The use of systems of rewards and sanctions within behaviour policies has now been adopted formally in UK schools. Such systems potentially represent competing theoretical ideas when considered alongside current approaches to teaching and learning. There is also opportunity for inconsistent use of rewards and sanctions resulting from the absence…

  6. Using Rewards and Sanctions in the Classroom: Pupils' Perceptions of Their Own Responses to Current Behaviour Management Strategies

    ERIC Educational Resources Information Center

    Payne, Ruth

    2015-01-01

    The use of systems of rewards and sanctions within behaviour policies has now been adopted formally in UK schools. Such systems potentially represent competing theoretical ideas when considered alongside current approaches to teaching and learning. There is also opportunity for inconsistent use of rewards and sanctions resulting from the absence…

  7. Combination strategies for pain management.

    PubMed

    Raffa, Robert B; Clark-Vetri, Rachel; Tallarida, Ronald J; Wertheimer, Albert I

    2003-10-01

    At least two factors relating to pain management using oral analgesics suggest that combination strategies merit consideration: many pains arise from more than one physiological cause and current analgesics have adverse effect profiles that might be reduced by combination with another agent in smaller doses or with less frequent dosing. In addition to increased convenience, combinations sometimes also result in the unexpected benefit of synergy. But not all pains, clinical settings or combinations merit the extra expense or other potential negative features of fixed-ratio products. This review examines the multiple basic science, clinical and pharmacoeconomic issues relating to analgesic combinations and the methodologies available for assessing these issues.

  8. Relapsed Hodgkin Lymphoma: Management Strategies

    PubMed Central

    Montanari, Francesca; Diefenbach, Catherine

    2016-01-01

    Although Hodgkin lymphoma (HL) is largely curable with first-line therapy, approximately one-third of patients will not have a complete response to frontline treatment or will subsequently relapse. Only 50 % of these patients will be effectively salvaged with conventional therapies. The prognosis is particularly poor for those patients with chemotherapy refractory disease, who are unable to obtain even transient disease control, and for patients who relapse following high dose chemotherapy and autologous stem cell transplant. In this review, we summarize the most recent updates on the management of patients with relapsed HL, the role of novel therapies such as brentuximab vedotin, and an overview of promising new agents currently under investigation. We also discuss the role of consolidation strategies such as high-dose chemotherapy and autologous stem cell transplant, and reduced-intensity allogeneic hematopoietic stem cell transplant, and the need for new strategies in the elderly patient population. PMID:24942298

  9. Alcoholic hepatitis: current management.

    PubMed

    Spengler, Erin K J; Dunkelberg, Jeffrey; Schey, Ron

    2014-10-01

    Alcoholic hepatitis is an acute manifestation of alcoholic liver disease with mortality as high as 40-50% in severe cases. Patients usually have a history of prolonged alcohol abuse with or without a known history of liver disease. Although there is significant range in severity at presentation, patients with severe alcoholic hepatitis typically present with anorexia, fatigue, fever, jaundice, and ascites. The use of either pentoxifylline or corticosteroids in those with severe disease (Maddrey's discriminate function >32) has significant mortality benefit. The addition of N-acetylcysteine to corticosteroids decreases the incidences of hepatorenal syndrome, infection, and short-term mortality, but does not appear to significantly affect 6-month mortality. Nutritional support with high-calorie, high-protein diet is recommended in all patients screening positive for malnutrition. Liver transplantation for a highly selected group of patients with severe alcoholic hepatitis may be an option in the future, but is not currently recommended or available at most transplant institutions.

  10. Current and emerging strategies for the treatment and management of systemic lupus erythematosus based on molecular signatures of acute and chronic inflammation

    PubMed Central

    Das, Undurti N

    2010-01-01

    Lupus is a chronic, systemic inflammatory condition in which eicosanoids, cytokines, nitric oxide (NO), a deranged immune system, and genetics play a significant role. Our studies revealed that an imbalance in the pro- and antioxidants and NO and an alteration in the metabolism of essential fatty acids exist in lupus. The current strategy of management includes administration of nonsteroidal anti-inflammatory drugs such as hydroxychloroquine and immunosuppressive drugs such as corticosteroids. Investigational drugs include the following: 1) belimumab, a fully human monoclonal antibody that specifically recognizes and inhibits the biological activity of B-lymphocyte stimulator, also known as B-cell-activation factor of the TNF family; 2) stem cell transplantation; 3) rituximab, a chimeric monoclonal antibody against CD20, which is primarily found on the surface of B-cells and can therefore destroy B-cells; and 4) IL-27, which has potent anti-inflammatory actions. Our studies showed that a regimen of corticosteroids and cyclophosphamide, and methods designed to enhance endothelial NO synthesis and augment antioxidant defenses, led to induction of long-lasting remission of the disease. These results suggest that methods designed to modulate molecular signatures of the disease process and suppress inflammation could be of significant benefit in lupus. Some of these strategies could be vagal nerve stimulation, glucose–insulin infusion, and administration of lipoxins, resolvins, protectins, and nitrolipids by themselves or their stable synthetic analogs that are known to suppress inflammation and help in the resolution and healing of the inflammation-induced damage. These strategies are likely to be useful not only in lupus but also in other conditions, such as rheumatoid arthritis, scleroderma, ischemia-reperfusion injury to the myocardium, ischemic heart disease, and sepsis. PMID:22096364

  11. [Constipation and cancer: Current strategies].

    PubMed

    Gervais, Claire; Ducrotté, Philippe; Piche, Thierry; Di Palma, Mario; Jovenin, Nicolas; Scotté, Florian

    2016-09-01

    Digestive disorders, in particular constipation, are symptoms very often reported by cancer patients as having a major impact on their quality of life. An accurate diagnosis of bowel delayed transit and defecation disorders is required to best adapt therapeutic management. Constipation associated with cancer may be related to several causes, which can be placed in three nosological categories that sometimes overlap: chronic constipation prior to cancer and having its own evolution; constipation related to the cancer condition, in particular the occlusive syndrome, and constipation induced by cancer therapies. The stricter application of diet and lifestyle measures is often necessary and sometimes sufficient. Laxative drug treatments come under various galenic forms and administration routes and must be selected according to the clinical features of constipation. Surgical management can be indicated in case of ileus or pelvic static disorders. In the case of refractory constipation induced by opioids and within the framework of palliative care to treat an advanced pathology, a peripheral morphinic antagonist can offer fast symptom relief. A way forward to improve the patients' quality of life could be to identify the contributing factors (in particular, genetic factors) to determine which patients are the more at risk and anticipate their management.

  12. Sexual rehabilitation and cancer survivorship: a state of art review of current literature and management strategies in male sexual dysfunction among prostate cancer survivors.

    PubMed

    Chung, Eric; Brock, Gerald

    2013-02-01

    The challenges for prostate cancer survivors include the surveillance of prostate cancer recurrence and management of physical, cognitive, sexual, and socioeconomic quality of life issues. Sexual function remains an important issue in men, who often continue to be interested in sex after prostate cancer treatment. The various post-prostate cancer treatment-related sexual dysfunctions are penile deformities and erectile dysfunction (ED); sexual desire and mental health; ejaculatory and orgasmic dysfunctions; and changes in partner relationship and dynamics. The aim of this study is to provide state of art review of the various male sexual dysfunctions in prostate cancer survivors and the management strategies in sexual rehabilitation. A literature search for English language original and review articles either published or e-published was performed using PubMed database. Keywords included prostate cancer, prostate cancer treatment, prostate prostatectomy (RP), sexual dysfunction, erectile dysfunction (ED), sexual desire, mental health, ejaculation, orgasmic, climacturia, and relationship. There has been considerable volume of publication in recent years on prostate cancer-related male sexual dysfunction. Penile deformities and ED shared similar pathophysiology and that penile smooth muscle fibrosis ultimately results in structural alterations and end-organ failure. Penile rehabilitation using oral phosphodiesterase type 5 (PDE5) inhibitors is considered the standard of care especially in patients who received nerve-sparing RP and should be instituted as soon as possible to protect and prevent corporal endothelial and smooth muscle damage. However, there is no consensus on the exact timing, dose, and duration of PDE5 inhibitors and its impact in non-nerve-sparing RP and other forms of prostate cancer treatment modalities. Current literature on hypoactive sexual desire, ejaculatory, and orgasmic dysfunctions in patients who received prostate cancer treatment is

  13. Health management education: current alternatives.

    PubMed

    Weil, Thomas P

    2014-01-01

    The past several decades have witnessed a significant increase in the number of graduate programs in health management, either on campus or online. The alternative for a health professional to attending a graduate program on campus is to receive an MBA or MHA degree online. The current cost ranges from $13,600 to $78,000, with the more expensive online programs tied to graduate programs that are accredited by the Commission on the Accreditation of Healthcare Management Education and provide the names and qualifications of their faculty. The for-profit online programs have not been forthcoming to this author concerning their health management faculty or their curriculum. For the individual desiring more health management education who is unable to enroll, for family or financial reasons, in an on-campus program, the top-tier online programs seem like a worthwhile but is a relatively expensive option.

  14. Knowledge management: an innovative risk management strategy.

    PubMed

    Zipperer, Lorri; Amori, Geri

    2011-01-01

    Knowledge management effectively lends itself to the enterprise risk process. The authors introduce the concept of knowledge management as a strategy to drive innovation and support risk management. They align this work with organizational efforts to improve patient safety and quality through the effective sharing of experience and lessons learned. The article closes with suggestions on how to develop a knowledge management initiative at an organization, who should be on the team, and how to sustain this effort and build the culture it requires to drive success.

  15. Current management of paediatric urolithiasis.

    PubMed

    Gnessin, Ehud; Chertin, Leonid; Chertin, Boris

    2012-07-01

    We aimed to review a current management of paediatric nephrolithiasis. The current literature, including our own experience on the treatment of paediatric nephrolithiasis was reviewed by MEDLINE/PubMed search. We have used in our search following keywords: urolithiasis, nephrolithiasis, paediatrics, surgical treatment, conservative management, ESWL, ureteroscopy, and open renal surgery. The search was limited to the English language literature during the period of time from 1990 to 2011. All papers were reviewed independently by all co-authors and only the manuscripts directly related to the reviewed subjects were included into the current review. Due to the high incidence of predisposing factors for urolithiasis in children and high stone recurrence rates, every child with urinary stone should be given a complete metabolic evaluation. Most stones in children can be managed by ESWL and endoscopic techniques. Paediatric stone disease is an important clinical problem in paediatric urology practice. Because of its recurrent nature, every effort should be made to discover the underlying metabolic abnormality so that it can be treated appropriately. Obtaining a stone-free state with interventional management and close follow-up are of utmost importance.

  16. The office of strategy management.

    PubMed

    Kaplan, Robert S; Norton, David P

    2005-10-01

    There is a disconnect in most companies between strategy formulation and strategy execution. On average, 95% of a company's employees are unaware of, or do not understand, its strategy. If employees are unaware of the strategy, they surely cannot help the organization implement it effectively. It doesn't have to be like this. For the past 15 years, the authors have studied companies that achieved performance breakthroughs by adopting the Balanced Scorecard and its associated tools to help them better communicate strategy to their employees and to guide and monitor the execution of that strategy. Some companies, of course, have achieved better, longer-lasting improvements than others. The organizations that have managed to sustain their strategic focus have typically established a new corporate-level unit to oversee all activities related to strategy: an office of strategy management (OS M). The OSM, in effect, acts as the CEO's chief of staff. It coordinates an array of tasks: communicating corporate strategy; ensuring that enterprise-level plans are translated into the plans of the various units and departments; executing strategic initiatives to deliver on the grand design; aligning employees' plans for competency development with strategic objectives; and testing and adapting the strategy to stay abreast of the competition. The OSM does not do all the work, but it facilitates the processes so that strategy is executed in an integrated fashion across the enterprise. Although the companies that Kaplan and Norton studied use the Balanced Scorecard as the framework for their strategy management systems, the authors say the lessons of the OSM are applicable even to companies that do not use it.

  17. Management Strategies for Clopidogrel Hypersensitivity.

    PubMed

    Beavers, Craig J; Carris, Nicolas W; Ruf, Kathryn M

    2015-06-01

    Clopidogrel is a cornerstone of dual antiplatelet therapy. Hypersensitivity reactions potentially limit the use of this treatment and present a significant clinical challenge. The authors have developed recommendations for the management of clopidogrel hypersensitivity with consideration for the etiology, pathophysiology, and critical evaluation of potential management strategies. The clopidogrel hypersensitivity reaction is complex in mechanism and presents generally around day 5 of treatment. Generalized reactions are most common, but the reaction may also be localized or systemic. Screening patients for hypersensitivity is not always possible because the type IV delayed reaction is not detected reliably by conventional skin prick, intradermal challenge, or patch testing. Proposed strategies for management of clopidogrel hypersensitivity include treatment of the reaction with corticosteroids, clopidogrel desensitization, substituting an alternative P2Y12 inhibitor, or clopidogrel avoidance. The safety, efficacy, and cost of each potential strategy must be considered when managing a patient with clopidogrel hypersensitivity.

  18. Crisis management strategies.

    PubMed

    Koster, Maria C; Politis-Norton, Helen

    2004-01-01

    This paper discusses the different facets of crisis as experienced within the pharmaceutical industry but which are also prevalent throughout other industries. It highlights the importance of early identification and management of crises and issues, which in return are strongly intertwined with a fundamental positive internal corporate climate. A corporate philosophy should always embrace crisis management with the attitude of 'when' and not 'if'; therefore, a company should act today and not tomorrow once a crisis is on its doorstep. Preparation is of utmost importance and there are several items that can be addressed even before a crisis has arisen. Further, this paper also provides guidance on how to deal with the media, what to do and what not to do, and how to appoint the appropriate spokesperson. In this era of fast exchange of information, crisis, which previously may have stayed behind corporate doors, may not do so any longer. Image is very important and should therefore not be risked. Crisis and issue management should therefore be integrated in every company's philosophy and standard operating procedures.

  19. Workforce management strategies in a disaster scenario.

    SciTech Connect

    Kelic, Andjelka; Turk, Adam L.

    2008-08-01

    A model of the repair operations of the voice telecommunications network is used to study labor management strategies under a disaster scenario where the workforce is overwhelmed. The model incorporates overtime and fatigue functions and optimizes the deployment of the workforce based on the cost of the recovery and the time it takes to recover. The analysis shows that the current practices employed in workforce management in a disaster scenario are not optimal and more strategic deployment of that workforce is beneficial.

  20. Current management of immune thrombocytopenia.

    PubMed

    Neunert, Cindy E

    2013-01-01

    Immune thrombocytopenia (ITP) is an autoimmune-mediated condition that results from antibody-mediated destruction of platelets and impaired megakaryocyte platelet production. ITP patients exhibit severe thrombocytopenia and are at risk for significant hemorrhage. Few randomized trials exist to guide management of patients with ITP. Ultimately, each patient requires an individualized treatment plan that takes into consideration the platelet count, bleeding symptoms, health-related quality of life, and medication side effects. This article provides an up-to-date review of management strategies drawing on links between the expanding amounts of clinical trial data and associated biology studies to enhance understanding of the disease heterogeneity with regard to the complex pathogenesis and response to treatment.

  1. [Current management of hepatitis C].

    PubMed

    Lange, Christian M

    2015-09-01

    During the last decade, the therapeutic management of hepatitis C virus (HCV) infection has changed dramatically. Due to the recent approval of several directly acting antiviral agents (DAAs) such as sofosbuvir, daclatasvir, or ledipasvir, HCV eradication is possible in the vast majority of HCV infected individuals by DAA combinations with or without pegylated interferon-α. This review summarized these exciting developments with a focus on current recommendations for the treatment of chronic hepatitis C.

  2. Management of Current Psychiatric Disorders

    PubMed Central

    Carbonnel, François; David, Michel; Norton, Joanna; Bourrel, Gérard; Boulenger, Jean-Philippe; Capdevielle, Delphine

    2016-01-01

    Objective: Describe and analyse the experience of family physicians in managing current psychiatric disorders to obtain a better understanding of the underlying reasons of under-detection and inadequate prescribing identified in studies. Methods: A qualitative study using in-depth interviews. Sample of 15 practicing family physicians, recruited by telephone from a precedent cohort (Sesame1) with a maximum variation: sex, age, single or group practice, urban or rural. Qualitative method is inspired by the completed grounded theory of a verbatim semiopragmatic analysis from 2 experts in this approach. Results: Family physicians found that current psychiatric disorders were related to psychological symptoms in reaction to life events. Their role was to make patients aware of a psychiatric symptom rather than establish a diagnosis. Their management responsibility was considered in contrasting ways: it was claimed or endured. They defined their position as facilitating compliance to psychiatrist consultations, while assuring a complementary psychotherapeutic approach. Prescribing medication was not a priority for them. Conclusions: The identified under-detection is essentially due to inherent frontline conditions and complexity of clinical forms. The family physician role, facilitating compliance to psychiatrist consultations while assuring a support psychotherapy is the main result of this study. More studies should be conducted to define more accurately the clinical reality, management and course of current psychiatric disorders in primary care.

  3. Managing incontinence: women's normalizing strategies.

    PubMed

    Skoner, M M; Haylor, M J

    1993-01-01

    Women's strategies for managing urinary incontinence were examined in a grounded-theory study. The women's basic social concern was dealing with incontinence in a manner that enabled them to feel normal. Feeling normal meant being able to do what they wanted to do and needed to do to have a normal life-style as they perceived it. This goal was accomplished by normalizing incontinence and its management. Normalization was achieved by directing its course through self-management, accounting for it in terms of personal history and life experiences, and delaying medical counsel. These strategies are described. The findings provide fresh insights about women's response to incontinence and their practice of self-managing its consequences.

  4. Opportunities for improvement in anti-thrombotic therapy and other strategies for the management of acute coronary syndromes: Insights from EPICOR, an international study of current practice patterns.

    PubMed

    Bueno, Héctor; Sinnaeve, Peter; Annemans, Lieven; Danchin, Nicolas; Licour, Muriel; Medina, Jesús; Pocock, Stuart; Sánchez-Covisa, Joaquín; Storey, Robert F; Jukema, J Wouter; Zeymer, Uwe; Van de Werf, Frans

    2016-02-01

    To describe international patterns and opportunities for improvement of pre- and in-hospital care of patients hospitalized for acute coronary syndromes (ACS), with special focus on anti-thrombotic therapy. EPICOR (long-tErm follow-uP of anti-thrombotic management patterns In acute CORonary syndrome patients), an international, cohort study, which enrolled 10,568 consecutive ACS survivors from 555 hospitals in 20 countries across Europe and Latin America (September 2010 to March 2011), prospectively registered detailed information on pre- and in-hospital management. Globally, 4738 (44.8%) were attended before hospitalization, 4241 (40.1%) had an ECG, 2119 (20%) received anti-platelet therapy and 101 STEMI patients (2%) fibrinolysis. In-hospital, 7944 patients (75.2%) received dual anti-platelet therapy, most often with clopidogrel (69.7%), and less with prasugrel (5.4%); 1705 (16.1%) had triple anti-platelet therapy, and 849 (8%) single anti-platelet therapy. STEMI patients more often received pre-hospital anti-thrombotics, and prasugrel, GP IIb/IIIa inhibitors and UFH in-hospital (all p < 0.001). More NSTE-ACS patients received clopidogrel, single anti-platelet therapy, and fondaparinux (all p < 0.001). As many as 33% of ACS patients were medically managed. A significant decreasing gradient was found between Northern, Southern and Eastern Europe and Latin America in use of more potent patterns of anti-platelet therapy, reperfusion therapy and invasive strategy. This large international study shows room for improvement in use of anti-thrombotic drugs and other strategies for optimal management of ACS, including pre-hospital ECG and anti-thrombotic therapy. Regional practice differences not based on evidence or conditioned by economic constraints should be reduced. © The European Society of Cardiology 2015.

  5. Management strategies for encouraging creativity.

    PubMed

    Preston, P

    1998-01-01

    Change, chaos, and uncertainty touch every part of every institution. The laboratory is not immune. Managers content to continue on their familiar path soon will find themselves bypassed. To meet today's challenges, directors of technical operations, laboratory directors, team leaders, and coordinators need plenty of creativity--from everyone on their staff. It is no longer just "nice" to improve group output and problem-solving skills while staying within a "shoestring" budget. It is absolutely necessary. In this article, we explore strategies laboratory managers can use to tap the creative potential and commitment of their people. These strategies work. Whether it involves using humor, creating "idea centers," or "deconstructing the bureaucracy," the goal is the same: to encourage clinical managers to think beyond their technical and managerial experience. The examples in this article may not suit the needs, situations, or tastes of all laboratory managers. They are "food for thought." The concepts and strategies these examples illustrate are every laboratory manager's keys to adapting successfully to future challenges.

  6. Current penile-rehabilitation strategies: Clinical evidence.

    PubMed

    Segal, Robert L; Bivalacqua, Trinity J; Burnett, Arthur L

    2013-09-01

    We review the current strategies used for penile rehabilitation (PR) after a radical prostatectomy, where PR is defined as the attempt to restore spontaneous erectile function so that the patient can generate erections with no need for erectile aids. We searched PubMed for relevant reports, using the keywords 'radical prostatectomy', 'penile rehabilitation', 'phosphodiesterase inhibitors', 'vacuum erection device', 'injection therapy', 'urethral suppository', and 'erectile dysfunction'. In all, 155 articles were identified and reviewed, and had a level of evidence ranging from 1b-4. The use of PR strategies should be based on the patient's goals after a thorough explanation of realistic expectations, and the risks and consequences of the various treatment options. While a multitude of studies suggest a benefit with PR strategies, there are no established, proven regimens. Further research is needed to establish the optimal approaches to PR.

  7. Current penile-rehabilitation strategies: Clinical evidence

    PubMed Central

    Segal, Robert L.; Bivalacqua, Trinity J.; Burnett, Arthur L.

    2013-01-01

    We review the current strategies used for penile rehabilitation (PR) after a radical prostatectomy, where PR is defined as the attempt to restore spontaneous erectile function so that the patient can generate erections with no need for erectile aids. We searched PubMed for relevant reports, using the keywords ‘radical prostatectomy’, ‘penile rehabilitation’, ‘phosphodiesterase inhibitors’, ‘vacuum erection device’, ‘injection therapy’, ‘urethral suppository’, and ‘erectile dysfunction’. In all, 155 articles were identified and reviewed, and had a level of evidence ranging from 1b-4. The use of PR strategies should be based on the patient’s goals after a thorough explanation of realistic expectations, and the risks and consequences of the various treatment options. While a multitude of studies suggest a benefit with PR strategies, there are no established, proven regimens. Further research is needed to establish the optimal approaches to PR. PMID:26558087

  8. Sleep bruxism: Current knowledge and contemporary management.

    PubMed

    Yap, Adrian U; Chua, Ai Ping

    2016-01-01

    Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that "cures" or "stops" SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief.

  9. Sleep bruxism: Current knowledge and contemporary management

    PubMed Central

    Yap, Adrian U.; Chua, Ai Ping

    2016-01-01

    Bruxism is defined as the repetitive jaw muscle activity characterized by the clenching or grinding of teeth. It can be categorized into awake and sleep bruxism (SB). Frequent SB occurs in about 13% of adults. The exact etiology of SB is still unknown and probably multifactorial in nature. Current literature suggests that SB is regulated centrally (pathophysiological and psychosocial factors) and not peripherally (morphological factors). Cited consequences of SB include temporomandibular disorders, headaches, tooth wear/fracture, implant, and other restoration failure. Chairside recognition of SB involves the use of subjective reports, clinical examinations, and trial oral splints. Definitive diagnosis of SB can only be achieved using electrophysiological tools. Pharmacological, psychological, and dental strategies had been employed to manage SB. There is at present, no effective treatment that “cures” or “stops” SB permanently. Management is usually directed toward tooth/restoration protection, reduction of bruxism activity, and pain relief. PMID:27656052

  10. Current imaging strategies in rheumatoid arthritis

    PubMed Central

    Zeman, Merissa N; Scott, Peter JH

    2012-01-01

    As remission has now become a realistic therapeutic goal in the clinical management of RA due to the introduction and widespread adoption of biologic agents, there is a greater need for earlier diagnoses and objective methods for evaluating disease activity and response to treatment. In this capacity, advanced imaging strategies are assuming an expansive clinical role, particularly as they take advantage of newer imaging technologies and the shift toward imaging at the molecular level. Molecular imaging utilizes target-specific probes to non-invasively visualize molecular, cellular, and physiological perturbations in response to the underlying pathology. Probes for nuclear and MR imaging have been and are being developed that react with discrete aspects of inflammatory and destructive pathways specific to RA. These probes in addition to new MR sequences and contrast agents have the potential to provide an earlier and more reliable assessment of clinical outcome, disease activity, severity, and location, and therapeutic response. Furthermore, these imaging strategies may enable a more fundamental understanding of critical pathophysiological processes and the advent of new molecular therapies. This review will discuss these advances in both nuclear medicine and MRI strategies for imaging RA with a particular emphasis on molecular imaging. PMID:23133812

  11. Current data and strategy in glioblastoma multiforme

    PubMed Central

    Dinca, EB

    2009-01-01

    Glioblastoma multiforme (GBM) or astrocytoma grade Ⅳ on WHO classification is the most aggressive and the most frequent of all primary brain tumors. Glioblastoma is multiforme , resistant to therapeutic interventions illustrating the heterogeneity exhibited by this tumor in its every aspect, including clinical presentation, pathology, genetic signature. Current data and treatment strategy in GBM are presented focusing on basic science data and key clinical aspects like surgery, including personal experience; adjuvant modalities: radiotherapy, chemotherapy, but also for experimental approaches. Therapeutic attitude in recurrent GBM is also widely discussed. PMID:20108752

  12. Managing human resources for successful strategy execution.

    PubMed

    Arnold, Edwin

    2010-01-01

    Managers face difficult challenges when they implement organizational strategies to achieve important goals. Execution of strategy has become more dependent upon the effective management of human resources. This article suggests how people can be managed more effectively to facilitate the execution of strategies and improve organizational performance.

  13. Disease management strategies for wildlife.

    PubMed

    Wobeser, G

    2002-04-01

    Three basic forms of management strategies exist for wildlife disease, as follows: prevention of introduction of disease, control of existing disease or eradication. Management may be directed at the disease agent, host population, habitat or be focused on human activities. Disease agents may be dealt with in the environment through disinfection or in the host through treatment. Disinfection and pesticides used to destroy agents or vectors are limited to local situations, may have serious environmental effects and may result in acquired resistance. Difficulty in delivering treatment limits chemotherapy to local situations. Host populations may be managed by immunisation, by altering their distribution or density, or by extirpation. Immunisation is best suited for microparasitic exogenous infections with a low reproductive rate and in populations which have a low turnover. Mass immunisation with oral baits has been effective, but this strategy is limited to a few serious diseases. It is difficult to move wild animals and techniques to discourage animals from entering an area become ineffective rapidly. The setting up of fences is feasible only in local situations. Selective culling is limited to situations in which affected individuals are readily identifiable. General population reduction has had little success in disease control but reducing populations surrounding a focus or creating a barrier to disease movement have been successful. Population reduction is a temporary measure. Eradication of a wildlife population has not been attempted for disease management. Habitat modification may be used to reduce exposure to disease agents, or to alter host distribution or density. Management of diseases of wild animals usually requires a change in human activities. The most important method is by restricting translocation of wild animals to prevent movement of disease.

  14. Quality management under current conditions

    NASA Astrophysics Data System (ADS)

    Vasiliev, V. A.; Aleksandrova, S. V.

    2015-12-01

    The diversity of the concept of quality is defined. Modern quality management methods and tools are considered. The global components of quality management and quality management system ISO 9000 are discussed. Education requirements for specialists in the field of quality are formulated.

  15. Molecular Imaging: Current Status and Emerging Strategies

    PubMed Central

    Pysz, Marybeth A.; Gambhir, Sanjiv S.; Willmann, Jürgen K.

    2011-01-01

    In vivo molecular imaging has a great potential to impact medicine by detecting diseases in early stages (screening), identifying extent of disease, selecting disease- and patient-specific therapeutic treatment (personalized medicine), applying a directed or targeted therapy, and measuring molecular-specific effects of treatment. Current clinical molecular imaging approaches primarily use PET- or SPECT-based techniques. In ongoing preclinical research novel molecular targets of different diseases are identified and, sophisticated and multifunctional contrast agents for imaging these molecular targets are developed along with new technologies and instrumentation for multimodality molecular imaging. Contrast-enhanced molecular ultrasound with molecularly-targeted contrast microbubbles is explored as a clinically translatable molecular imaging strategy for screening, diagnosing, and monitoring diseases at the molecular level. Optical imaging with fluorescent molecular probes and ultrasound imaging with molecularly-targeted microbubbles are attractive strategies since they provide real-time imaging, are relatively inexpensive, produce images with high spatial resolution, and do not involve exposure to ionizing irradiation. Raman spectroscopy/microscopy has emerged as a molecular optical imaging strategy for ultrasensitive detection of multiple biomolecules/biochemicals with both in vivo and ex vivo versatility. Photoacoustic imaging is a hybrid of optical and ultrasound modalities involving optically-excitable molecularly-targeted contrast agents and quantitative detection of resulting oscillatory contrast agent movement with ultrasound. Current preclinical findings and advances in instrumentation such as endoscopes and microcatheters suggest that these molecular imaging modalities have numerous clinical applications and will be translated into clinical use in the near future. PMID:20541650

  16. Population communication management training strategy.

    PubMed

    Bayan Salas, E

    1985-01-01

    The discussion presents some thoughts on a general training strategy in information/education/communication (IEC) management which might meet the needs of 3rd world countries. Management by objectives (MBO) has emerged as the central doctrine in management theory and practice since its initial formulation in 1954. Yet, little evidence exists to date of its successful application in IEC activities. Population IEC activities, being staff activities in a nonprofit, public sector program, are in the "twilight zone" of MBO where hasty efforts to comply with the form if not the substance of this management technique can lead to lower levels of performance and achievement than before the goal setting system was implemented. Yet, clearly, IEC managers need the benefits that management by objectives can bring if done properly. It is essential that IEC managers and workers stop looking at IEC materials as end products in themselves but rather as inputs to be combined with other inputs in realizing the desired output of voluntary behavioral change on a mass level. To overcome tendencies toward provincialism, all IEC managers should initially spend time working in other areas of the population program. The experience of using IEC materials and approaches in face-to-face transactions with potential acceptors is a prerequisite to the successful formulation of such materials and approaches. Training programs for IEC managers and supervisors should emphasize development of consensual decision making skills. The success or failure of the program depends on the ability of its workers to resolve potential conflicts between an individual's priorities and national priorities in a noncoercive manner. The social dynamics approach that seeks a conscious, voluntary, nonmanipulated shift of shared attitudes, opinions, feelings, and actions is the approach underlying the most successful population programs. All IEC managers and supervisors should be systematically trained in norm shifting

  17. Current Management of Undescended Testes

    PubMed Central

    Kurz, David

    2016-01-01

    Opinion Statement Undescended testes (UDTs) are a relatively common finding in newborn males, especially in those born prematurely. Upon discovering a non-intrascrotal testis, it is important to determine whether the testis is palpable or non-palpable and whether the finding is unilateral or bilateral. Imaging should not be used in this workup, as no current modality has been shown to be adequately sensitive or specific to aid in management decisions. Patients with UDTs diagnosed after 6 months of age should be referred to a specialist for correction so that surgery may be performed within 1 year thereafter. This allows testes to descend spontaneously if they are to do so while facilitating early intervention to decrease the risk of subfertility and testicular malignancy for those patients in whom spontaneous descent does not occur. The surgical approach is often dependent on the location of the testis on physical exam. Most orchiopexies for palpable testes are performed through an inguinal incision, although a scrotal approach can be safely utilized depending on the testis position. Diagnostic laparoscopy is most often used for non-palpable testes, as it not only allows for the identification of an atrophic or absent testicle, but it also provides an opportunity to perform an orchiopexy simultaneously should a viable testis be found. Hormonal therapy is not recommended for treatment of UDTs due to its low success rate, the incidence of secondary re-ascent, and the possible detrimental effects on spermatogenesis. Finally, patients with bilateral non-palpable UDTs require a more extensive preliminary evaluation to rule out congenital adrenal hyperplasia (CAH) and disorders of sexual development (DSD). This involves serum electrolytes, karyotype analysis and hormonal testing including a serum müllerian inhibiting substance (MIS), in order to determine if testicular tissue is present and functional. PMID:27158583

  18. Overview of current immunotherapeutic strategies for glioma

    PubMed Central

    Calinescu, Anda-Alexandra; Kamran, Neha; Baker, Gregory; Mineharu, Yohei; Lowenstein, Pedro Ricardo; Castro, Maria Graciela

    2015-01-01

    In the last decade, numerous studies of immunotherapy for malignant glioma (glioblastoma multiforme) have brought new knowledge and new hope for improving the prognosis of this incurable disease. Some clinical trials have reached Phase III, following positive outcomes in Phase I and II, with respect to safety and immunological end points. Results are encouraging especially when considering the promise of sustained efficacy by inducing antitumor immunological memory. Progress in understanding the mechanisms of tumor-induced immune suppression led to the development of drugs targeting immunosuppressive checkpoints, which are used in active clinical trials for glioblastoma multiforme. Insights related to the heterogeneity of the disease bring new challenges for the management of glioma and underscore a likely cause of therapeutic failure. An emerging therapeutic strategy is represented by a combinatorial, personalized approach, including the standard of care: surgery, radiation, chemotherapy with added active immunotherapy and multiagent targeting of immunosuppressive checkpoints. PMID:26598957

  19. Configuration Management Process Assessment Strategy

    NASA Technical Reports Server (NTRS)

    Henry, Thad

    2014-01-01

    Purpose: To propose a strategy for assessing the development and effectiveness of configuration management systems within Programs, Projects, and Design Activities performed by technical organizations and their supporting development contractors. Scope: Various entities CM Systems will be assessed dependent on Project Scope (DDT&E), Support Services and Acquisition Agreements. Approach: Model based structured against assessing organizations CM requirements including best practices maturity criteria. The model is tailored to the entity being assessed dependent on their CM system. The assessment approach provides objective feedback to Engineering and Project Management of the observed CM system maturity state versus the ideal state of the configuration management processes and outcomes(system). center dot Identifies strengths and risks versus audit gotcha's (findings/observations). center dot Used "recursively and iteratively" throughout program lifecycle at select points of need. (Typical assessments timing is Post PDR/Post CDR) center dot Ideal state criteria and maturity targets are reviewed with the assessed entity prior to an assessment (Tailoring) and is dependent on the assessed phase of the CM system. center dot Supports exit success criteria for Preliminary and Critical Design Reviews. center dot Gives a comprehensive CM system assessment which ultimately supports configuration verification activities.*

  20. Neurocysticercosis: Diagnostic problems & current therapeutic strategies

    PubMed Central

    Rajshekhar, Vedantam

    2016-01-01

    Neurocysticercosis (NCC) is the most common single cause of seizures/epilepsy in India and several other endemic countries throughout the world. It is also the most common parasitic disease of the brain caused by the cestode Taenia solium or pork tapeworm. The diagnosis of NCC and the tapeworm carrier (taeniasis) can be relatively inaccessible and expensive for most of the patients. In spite of the introduction of several new immunological tests, neuroimaging remains the main diagnostic test for NCC. The treatment of NCC is also mired in controversy although, there is emerging evidence that albendazole (a cysticidal drug) may be beneficial for patients by reducing the number of seizures and hastening the resolution of live cysts. Currently, there are several diagnostic and management issues which remain unresolved. This review will highlight some of these issues. PMID:28139530

  1. DETERMINANTS OF NETWORK OUTCOMES: THE IMPACT OF MANAGEMENT STRATEGIES

    PubMed Central

    YSA, TAMYKO; SIERRA, VICENTA; ESTEVE, MARC

    2014-01-01

    The literature on network management is extensive. However, it generally explores network structures, neglecting the impact of management strategies. In this article we assess the effect of management strategies on network outcomes, providing empirical evidence from 119 urban revitalization networks. We go beyond current work by testing a path model for the determinants of network outcomes and considering the interactions between the constructs: management strategies, trust, complexity, and facilitative leadership. Our results suggest that management strategies have a strong effect on network outcomes and that they enhance the level of trust. We also found that facilitative leadership has a positive impact on network management as well as on trust in the network. Our findings also show that complexity has a negative impact on trust. A key finding of our research is that managers may wield more influence on network dynamics than previously theorized. PMID:25520529

  2. Management strategies for idiopathic urethritis.

    PubMed

    Henderson, L; Farrelly, P; Dickson, A P; Goyal, A

    2016-02-01

    Williams and Mikhael (1971) described idiopathic urethritis (IU) as a self-limiting condition that affects boys aged 5-15 years, with symptoms of urethrorrhagia, dysuria and haematuria. However, a proportion of boys will remain symptomatic for several years, and may develop urethral stricture (Poch et al., 2007; Palagiri et al., 2003). There is no universally effective treatment for IU, although various strategies have been employed. To review the presentation and long-term outcomes of boys with IU, and present the efficacy of management strategies that have been utilised. A retrospective review was performed of all boys with IU. It was based on clinical and cystoscopic findings for presentation, medical history, management and clinical progress. Fifty-four boys were included, with a median age of 11 years (range 5-15 years) at presentation. The median duration of symptoms was 18 months (range 2-132 months). The median follow-up was 18.5 months (range 1-120 months). Seven (13.0%) boys had early urethral stricture at initial cystourethroscopy, and one (1.9%) developed stricture during follow-up. Thirty-six boys (66.7%) had previous circumcision and four (7.4%) had meatal stenosis. Eight (14.8%) had previous hypospadias repair. Whilst 50% of boys with IU do not require any specific treatment, those with severe/unremitting symptoms may benefit from a trial of urethral steroids or short-term urethral catheterisation. The mechanisms of benefit from these modalities are unclear and they require further evaluation. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  3. Homosexuality in Turkey: strategies for managing heterosexism.

    PubMed

    Bakacak, Ayça Gelgeç; Oktem, Pinar

    2014-01-01

    The goal of this study was to identify the strategies used by young homosexuals to manage their sexual minority status in Turkey. In-depth interviews were conducted with 15 self-identified homosexual university students. The data on the strategies employed by homosexuals suggested a categorization of these strategies into four interrelated areas: strategies employed in the process of self-acceptance; strategies to manage sexual stigma and prejudice; strategies specific to the coming-out process; and the strategies used while openly expressing their sexual identities.

  4. Novel strategies for managing pancreatic cancer

    PubMed Central

    Loc, Welley S; Smith, Jill P; Matters, Gail; Kester, Mark; Adair, James H

    2014-01-01

    With the incidence reports of pancreatic cancer increasing every year, research over the last several decades has been focused on the means to achieve early diagnosis in patients that are at a high risk of developing the malignancy. This review covers current strategies for managing pancreatic cancer and further discusses efforts in understanding the role of early onset symptoms leading to tumor progression. Recent investigations in this discussion include type 3c diabetes, selected biomarkers and pathways related to pancreatic intraepithelial neoplasia lesions, drug resistance, and advances in nanomedicine which may provide significant solutions for improving early detection and treatments in future medicine. PMID:25356034

  5. Disease management strategies: managing care giving in managed care.

    PubMed

    Nesse, R E; Hagedorn, S D; Scheitel, S M; Nyman, M A; Broers, J K

    2000-01-01

    The rapid rate of change in health care delivery systems has challenged and troubled health care providers. Some new health care delivery systems primarily emphasize the economics of medical care and leave providers with a sense that their profession has strayed from its mission. In addition, there is an increasing demand by payers and the public for public accountability for the quality and expense of clinical services. One response to these changes in health care is the use of disease management strategies. There is a growing body of knowledge regarding disease management strategies and practice guidelines in the literature. This article discusses how a provider group can implement improvement in the clinical process successfully by applying techniques of disease management.

  6. Current Management of Fecal Incontinence

    PubMed Central

    Wang, Jennifer Y; Abbas, Maher A

    2013-01-01

    Objective: To review the management of fecal incontinence, which affects more than 1 in 10 people and can have a substantial negative impact on quality of life. Methods: The medical literature between 1980 and April 2012 was reviewed for the evaluation and management of fecal incontinence. Results: A comprehensive history and physical examination are required to help understand the severity and type of symptoms and the cause of incontinence. Treatment options range from medical therapy and minimally invasive interventions to more invasive procedures with varying degrees of morbidity. The treatment approach must be tailored to each patient. Many patients can have substantial improvement in symptoms with dietary management and biofeedback therapy. For younger patients with large sphincter defects, sphincter repair can be helpful. For patients in whom biofeedback has failed, other options include injectable medications, radiofrequency ablation, or sacral nerve stimulation. Patients with postdefecation fecal incontinence and a rectocele can benefit from rectocele repair. An artificial bowel sphincter is reserved for patients with more severe fecal incontinence. Conclusion: The treatment algorithm for fecal incontinence will continue to evolve as additional data become available on newer technologies. PMID:24355892

  7. Management Strategies for CLN2 Disease.

    PubMed

    Williams, Ruth E; Adams, Heather R; Blohm, Martin; Cohen-Pfeffer, Jessica L; de Los Reyes, Emily; Denecke, Jonas; Drago, Kristen; Fairhurst, Charlie; Frazier, Margie; Guelbert, Norberto; Kiss, Szilárd; Kofler, Annamaria; Lawson, John A; Lehwald, Lenora; Leung, Mary-Anne; Mikhaylova, Svetlana; Mink, Jonathan W; Nickel, Miriam; Shediac, Renée; Sims, Katherine; Specchio, Nicola; Topcu, Meral; von Löbbecke, Ina; West, Andrea; Zernikow, Boris; Schulz, Angela

    2017-04-01

    CLN2 disease (neuronal ceroid lipofuscinosis type 2) is a rare, autosomal recessive, pediatric-onset, rapidly progressive neurodegenerative lysosomal storage disorder caused by tripeptidyl peptidase 1 (TPP1) enzyme deficiency, and is characterized by language delay, seizures, rapid cognitive and motor decline, blindness, and early death. No management guidelines exist and there is a paucity of published disease-specific evidence to inform clinical practice, which currently draws upon experience from the field of childhood neurodisability. Twenty-four disease experts were surveyed on CLN2 disease management and a subset met to discuss current practice. Management goals and strategies are consistent among experts globally and are guided by the principles of pediatric palliative care. Goals and interventions evolve as the disease progresses, with a shift in focus from maintenance of function early in the disease to maintenance of quality of life. A multidisciplinary approach is critical for optimal patient care. This work represents an initial step toward the development of consensus-based management guidelines for CLN2 disease. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Galveston Island, Texas, Sand Management Strategies

    DTIC Science & Technology

    2016-07-01

    conducted a study to support a sand management strategy for the Galveston Park Board of Trustees of Galveston, TX. The long-term management strategy ...ER D C/ CH L TR -1 6- 13 Galveston Island, Texas, Sand Management Strategies Co as ta l a nd H yd ra ul ic s La bo ra to ry...online library at http://acwc.sdp.sirsi.net/client/default. ERDC/CHL TR-16-13 July 2016 Galveston Island, Texas, Sand Management Strategies

  9. [Current strategies for the prevention of malaria].

    PubMed

    Gentilini, M; Danis, M; Mouchet, J

    1990-01-01

    Two billion of persons live in regions where endemic malaria prevails or has reappeared. An estimated on hundred million infected individuals per year have been reported around the world. In front of this alarming situation, the diversity and even the incoherence of the currently proposed prophylactic regimens confuses the therapists and renders difficult the adoption of an efficacious strategy. The extension and gravity of drug resistance of P. falciparum and the withdrawal of anti-vectorial campaign constitute two reasons for the present recrudescence of malaria. The preventive strategies in 1990 are based on: rehabilitation of anti-vectorial campaign particularly against nocturnal mosquito bites, applicable to all, everywhere and at all times, by the means of individual and collective measures and mostly by impregnated nets; chemoprophylaxis for which two situations should be distinguished: the non immune traveler leaving for a short period (inferior or equal to 3 months) to an endemic area: individuals living permanently or for long periods in tropical regions. Prevention for short stays In low risk transmission zone (North Africa, Mexico, large cities of South East Asia) whatever the duration, suppression of chemoprophylaxis is acceptable. In high risk transmission zone, three strategies exist according to the intensity and frequency of drug resistance: zone 1 (P. vivax or drug sensitive P. falciparum): chloroquine at a dose of 100 mg/day for adults (1.5 mg/kg/day for children) 6 days out of 7, from the day of departure trough the whole stay and for one month after the return, is still efficacious; zone 2 (moderate frequency of drug resistance): protection is again ensured by chloroquine only, as in zone 1, or better than that by the association of chloroquine 300 mg once a week and proguanil 200 mg/day (3 mg/kg/day for children). The side effects of mefloquine and the risk of generation drug resistance argue against its general use in this zone particularly

  10. Current management of wound healing.

    PubMed

    Gottrup, F; Karlsmark, T

    2009-06-01

    While the understanding of wound pathophysiology has progressed considerably over the past decades the improvements in clinical treatment has occurred to a minor degree. During the last years, however, new trends and initiatives have been launched, and we will continue to attain new information in the next decade. It is the hope that increasing parts of the new knowledge from basic wound healing research will be implemented in daily clinical practice. The development of new treatment products will also continue, and especially new technologies with combined types of dressing materials or dressing containing active substances will be accentuated. Further developments in the management structure and education will also continue and consensus of treatment guidelines, recommendations and organization models will hopefully be achieved.

  11. Current management of molar pregnancy.

    PubMed

    Hancock, Barry W; Tidy, John A

    2002-05-01

    Molar pregnancy remains an uncommon and still not fully understood disorder. The clinical presentation has changed over recent decades. In developed countries complete moles are now usually diagnosed early (on clinical and/or ultrasound scan criteria) so that the more severe clinical presentations are much less commonly seen. The important differences between complete and partial moles and their risk factors are now well recognized. Common protocols for managing persistent gestational trophoblastic disease are being derived, and molecular genetic studies are advancing our understanding of molar pregnancy and its sequelae. Cure rates approaching 100% should now be the rule rather than the exception. There is a strong case for formal registration and monitoring of all cases through specialist centers.

  12. Diabetes benefit management: evolving strategies for payers.

    PubMed

    Tzeel, Albert L

    2011-11-01

    Over the next quarter century, the burden of type 2 diabetes mellitus (T2DM) is expected to at least double. Currently, 1 in every 10 healthcare dollars is spent on diabetes management; by 2050, it has been projected that the annual costs of managing T2DM will rise to $336 billion. Without substantial, systemic changes, T2DM management costs will lead to a potentially untenable strain on the healthcare system. However, the appropriate management of diabetes can reduce associated mortality and delay comorbidities. In addition, adequate glycemic control can improve patient outcomes and significantly reduce diabetes-related complications. This article provides an overview of key concepts associated with a value-based insurance design (VBID) approach to T2DM coverage. By promoting the use of services or treatments that provide high benefits relative to cost, and by alternatively discouraging patients from utilizing services whose benefits do not justify their cost, VBID improves the quality of healthcare while simultaneously reining in spending. VBID initiatives tend to focus on chronic disease management and generally target prescription drug use. However, some programs have expanded their scope by incorporating services traditionally offered by wellness and disease management programs. The concept of VBID is growing, and it is increasingly being implemented by a diverse and growing number of public and private entities, including pharmacy benefit managers, health plans, and employers. This article provides key background on VBID strategies, with a focus on T2DM management. It also provides a road map for health plans seeking to implement VBID as part of their programs.

  13. Orofacial pain management: current perspectives

    PubMed Central

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. PMID:24591846

  14. Orofacial pain management: current perspectives.

    PubMed

    Romero-Reyes, Marcela; Uyanik, James M

    2014-01-01

    Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities.

  15. Current perioperative management of pheochromocytomas

    PubMed Central

    Ramachandran, Rashmi; Rewari, Vimi

    2017-01-01

    Neuroendocrine tumors which have the potential to secrete catecholamines are either associated with sympathetic adrenal (pheochromocytoma) or nonadrenal (paraganglioma) tissue. Surgical removal of these tumors is always indicated to cure and prevent cardiovascular and other organ system complications associated with catecholamine excess. Some of these tumors have malignant potential as well. The diagnosis, localization and anatomical delineation of these tumors involve measurement of catecholamines and their metabolic end products in plasma and urine, 123I-metaiodobenzylguanidine scintigraphy, computed tomography, and/or magnetic resonance imaging. Before surgical removal of the tumors, the optimization of blood pressure, as well as intravascular volume, is an important measure to avoid and suppress perioperative adverse hemodynamic events. Preoperative preparation includes the use of alpha-adrenergic antagonists, beta-adrenergic antagonists with or without other antihypertensive agents, fluid therapy as well as insulin therapy for hyperglycemia if required. Due attention should be given to type and dose of alpha-receptor antagonists to be used and the duration of this therapy to achieve an optimal level of preoperative “alpha-blockade.” Despite this preoperative preparation, many patients will have hypertensive crises intraoperatively which need to be promptly and carefully managed by the anesthesia team which requires intensive and advanced monitoring techniques. The most common complication after tumor removal is hypotension which may require fluid therapy and vasopressor support for a few hours. With advancement in surgical and anesthetic techniques, the incidence of severe morbidity and mortality associated with the surgery is low in high volume centers. PMID:28197025

  16. Current Management of Pediatric Vitiligo.

    PubMed

    Van Driessche, Freya; Silverberg, Nanette

    2015-08-01

    Vitiligo is a common inflammatory disorder with worldwide prevalence of 0.4-2 % of the population, with half of cases beginning in childhood. The management of childhood vitiligo should be tailored to avoid negative effects on the overall growth and psychological development of the patient. Therapy of vitiligo in childhood is chosen based on the location of the lesions, lesion age, and extent of lesions in the context of the child's age and the developmental status of the child. There are four age categories in childhood vitiligo: [1] infantile and toddler (rare) (ages 0-3 years), [2] ages 4-8 years, [3] ages 9-12 years, and [4] 13+ years of age, based on developmental stage, psychological maturation, and ability to comply or participate in therapy. These categories are also differentiated psychologically by susceptibility to bullying, self-image development, and personal concern with lesion appearance, which increases with time. Intervention is advisable in cases with facial and leg involvement due to prominence of lesions and cosmetic defect. Medical interventions are largely the usage of topical therapies including corticosteroids and calcineurin inhibitors, some vitamin therapy (oral and topical vitamin D), and judicious introduction of phototherapy sources based on age and severity. Screening and appropriate subspecialist referral for co-morbidities (e.g., thyroid disease, celiac disease, psychological distress, and vitamin D deficiency) may enhance overall health. Cosmesis and camouflage are generally safe in childhood and have been noted to improve overall quality of life in this grouping. Genetic transmission of vitiligo is minimal at 5-6 % in first-degree relatives. This article reviews the therapeutics of pediatric vitiligo from the perspective of developmental stages and response to therapy.

  17. An ecosystem management strategy for Sierran mixed-conifer forests

    Treesearch

    Malcolm North; Peter Stine; Kevin O' Hara; William Zielinski; Scott Stephens

    2009-01-01

    Current Sierra Nevada forest management is often focused on strategically reducing fuels without an explicit strategy for ecological restoration across the landscape matrix. Summarizing recent scientific literature, we suggest managers produce different stand structures and densities across the landscape using topographic variables (i.e., slope shape, aspect, and slope...

  18. Stereotactic body radiotherapy: current strategies and future development

    PubMed Central

    2016-01-01

    Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged non-small cell lung cancer (NSCLC). The local control rate after SBRT is over 90%. Some forms of tumour motion management and image-guided radiation delivery techniques are the prerequisites for fulfilment of its goal to deliver a high radiation dose to the tumour target without overdosing surrounding normal tissues. In this review, the current strategies of tumour motion management will be discussed, followed by an overview of various image-guided radiotherapy (RT) systems and devices available for clinical practice. Besides medically inoperable stage I NSCLC, SBRT has also been widely adopted for treatment of oligometastasis involving the lungs. Its possible applications in various other cancer illnesses are under extensive exploration. The progress of SBRT is critically technology-dependent. With advancement of technology, the ideal of personalised, effective and yet safe SBRT is already on the horizon. PMID:27606082

  19. State Strategies To Manage Budget Shortfalls.

    ERIC Educational Resources Information Center

    National Conference of State Legislatures, Denver, CO.

    Some of the strategies that states have used to manage budget shortfalls are presented in this report. It provides information, evaluations, and case studies that policymakers can refer to when considering their options, and it emphasizes strategies to manage budget shortfalls, which tend to need a quick resolution. The report also examines some…

  20. Anthelmintic treatment strategies: current status and future.

    PubMed

    Williams, J C

    1997-11-01

    Despite the array of anthelmintics and endectocides and delivery systems available for use in the prevention and control of nematode parasites of ruminants, the number of highly effective control programs that have been developed and even the number of such programs that have been successfully implemented in commercial animal production, there have been no recent innovations or discoveries in regard to strategies, new anthelmintics, or systems for controlling nematode parasites through anthelmintic use. In the traditional sense of chemotherapy-chemoprophylaxis, we have probably achieved the maximum effect of what is possible from excellent anthelmintics developed by the pharmaceutical industry over the last 35 years, i.e. from thiabendazole through levamisole and morantel tartrate, to more advanced benzimidazoles and to the avermectins and milbemycins. At the core of all anthelmintic treatment-related problems is the lingering conception among a large body of animal producers that anthelmintic treatment is the only effort needed to control parasitism and its effects on host animals. This concept has given rise to the long-standing difficulty of drug resistance in sheep nematodes and the not remote possibility of its development in nematodes of cattle. Along with this are serious concerns over environmental toxicity, tissue residues and enormous financial investment to develop new and novel anthelmintic compounds. Progress is being made in current and intensive searches for development and testing of control approaches alternative to anthelmintics, e.g. helminth vaccines, biological control agents such as fungi, selection of resistant sires, alternative chemicals and nematode growth regulators. A timetable for when alternative controls can be developed fully and put into practical use cannot be predicted. It is universally acknowledged among parasitologists that existing anthelmintics must be preserved and utilized judiciously to ensure continued effectiveness. A

  1. Current status and strategies for viral hepatitis control in Korea.

    PubMed

    Sinn, Dong Hyun; Cho, Eun Ju; Kim, Ji Hoon; Kim, Do Young; Kim, Yoon Jun; Choi, Moon Seok

    2017-09-01

    Viral hepatitis is one of major global health challenges with increasing disease burden worldwide. Hepatitis B virus and hepatitis C virus infections are major causes of chronic liver diseases. They can lead to cirrhosis, hepatocellular carcinoma, and death in significant portion of affected people. Transmission of hepatitis B virus can be blocked by vaccination. Progression of hepatitis B virus-related liver diseases can be prevented by long-term viral suppression with effective drugs. Although vaccine for hepatitis C virus is currently unavailable, hepatitis C virus infection can be eradicated by oral direct antiviral agents. To eliminate viral hepatitis, World Health Organization (WHO) has urged countries to develop national goals and targets through reducing 90% of new infections and providing universal access to key treatment services up to 80%. This can lead to 65% reduction of viral hepatitis-related mortality. Here, we discuss some key features of viral hepatitis, strategies to control viral hepatitis suggested by WHO, and current status and strategies for viral hepatitis control in South Korea. To achieve the goal of viral hepatitis elimination by 2030 in South Korea, an independent 'viral hepatitis sector' in Centers for Disease Control & Prevention (CDC) needs to be established to organize and execute comprehensive strategy for the management of viral hepatitis in South Korea.

  2. Barrett's Esophagus: Emerging Knowledge and Management Strategies

    PubMed Central

    Bhardwaj, Atul; Stairs, Douglas B.; Mani, Haresh; McGarrity, Thomas J.

    2012-01-01

    The incidence of esophageal adenocarcinoma (EAC) has increased exponentially in the last 3 decades. Barrett's esophagus (BE) is the only known precursor of EAC. Patients with BE have a greater than 40 folds higher risk of EAC compared with the general population. Recent years have witnessed a revolution in the clinical and molecular research related to BE. However, several aspects of this condition remain controversial. Data regarding the true prevalence of BE have varied widely. Recent studies have suggested a lower incidence of EAC in nondysplastic BE (NDBE) than previously reported. There is paucity of prospective data showing a survival benefit of screening or surveillance for BE. Furthermore, the ever-increasing emphasis on healthcare cost containment has called for reexamination of the screening and surveillance strategies for BE. There is a need for identification of reliable clinical predictors or molecular biomarkers to risk-stratify patients who might benefit the most from screening or surveillance for BE. Finally, new therapies have emerged for the management of dysplastic BE. In this paper, we highlight the key areas of controversy and uncertainty surrounding BE. The paper discusses, in detail, the current literature about the molecular pathogenesis, biomarkers, histopathological diagnosis, and management strategies for BE. PMID:22701199

  3. Multiple Strategies for Teaching Current Events.

    ERIC Educational Resources Information Center

    Haas, Mary E.; Laughlin, Margaret A.

    Teacher members of the National Council for the Social Studies (NCSS) describe the study of current events as essential or very important to the social studies curriculum. Most teachers indicated using current events to provide contemporary examples of abstract historical, social, economic, and political concepts or to illustrate the continuity of…

  4. Multiple Strategies for Teaching Current Events.

    ERIC Educational Resources Information Center

    Haas, Mary E.; Laughlin, Margaret A.

    Teacher members of the National Council for the Social Studies (NCSS) describe the study of current events as essential or very important to the social studies curriculum. Most teachers indicated using current events to provide contemporary examples of abstract historical, social, economic, and political concepts or to illustrate the continuity of…

  5. Leadership Strategies for Managing Conflict.

    ERIC Educational Resources Information Center

    Kormanski, Chuck

    1982-01-01

    Discusses the impact of conflict in small group development theory. Views conflict as a positive, normally occurring behavior and presents leadership strategies involving withdrawal, suppression, integration, compromise, and power. Examines situational contingencies and presents a rationale for strategy selection and intervention. (Author)

  6. Pharmacological and psychosocial management of mental, neurological and substance use disorders in low- and middle-income countries: issues and current strategies.

    PubMed

    de Jesus Mari, Jair; Tófoli, Luís Fernando; Noto, Cristiano; Li, Li M; Diehl, Alessandra; Claudino, Angélica M; Juruena, Mario F

    2013-09-01

    Mental, neurological, and substance use disorders (MNS) are among the largest sources of medical disability in the world, surpassing both cardiovascular disease and cancer. The picture is not different in low- and middle-income countries (LAMIC) where the relative morbidity associated with MNS is increasing, as a consequence of improvement in general health indicators and longevity. However, 80 % of individuals with MNS live in LAMIC but only close to 20 % of cases receive some sort of treatment. The main aim of this article is to provide non-specialist health workers in LAMIC with an accessible guide to the affordable essential psychotropics and psychosocial interventions which are proven to be cost effective for treating the main MNS. The MNS discussed in this article were selected on the basis of burden, following the key priority conditions selected by the Mental Health Action Programme (mhGAP) developed by the World Health Organization (WHO) (anxiety, stress-related and bodily distress disorders; depression and bipolar disorder; schizophrenia; alcohol and drug addiction; and epilepsy), with the addition of eating disorders, because of their emergent trend in middle-income countries. We review best evidence-based clinical practice in these areas, with a focus on drugs from the WHO Model List of Essential Medicines and the psychosocial interventions available in LAMIC for the management of these conditions in primary care. We do this by reviewing guidelines developed by prestigious professional associations and government agencies, clinical trials conducted in LAMIC and systematic reviews (including Cochrane reviews) identified from the main international literature databases (MEDLINE, EMBASE and PsycINFO). In summary, it can be concluded that the availability and use of the psychotropics on the WHO Model List of Essential Medicines in LAMIC, plus an array of psychosocial interventions, can represent a cost-effective way to expand treatment of most MNS. The

  7. Epidemiology of MRSA and current strategies in Europe and Japan

    PubMed Central

    Kramer, Axel; Wagenvoort, Hans; Åhrén, Christina; Daniels-Haardt, Inka; Hartemann, Philippe; Kobayashi, Hiro; Kurcz, Andrea; Picazo, Juan; Privitera, Gaetano; Assadian, Ojan

    2010-01-01

    The prevalence of health-care associated infections caused by multi-drug resistant organisms has significantly increased over the past decade. Among these organisms, Methicillin-resistant Staphylococcus aureus (MRSA) plays a prominent and increasing role. Because of consequences for patients and the economic burden in course of prolonged treatment following MRSA infections and additional indirect costs for e.g. isolation or antiseptic treatment, this trend will further damage European health-care systems. In 2006, a workshop was initiated at the 8th International Congress of the German Society of Hospital Hygiene held in Berlin. The aim of this workshop was to give an overview of the current situation of MRSA in selected European countries and to elaborate on potential strategies to prevent MRSA-infections and dissemination. A questionnaire encompassing 20 questions addressed topics such as epidemiology, current measures and future prospects was distributed to representatives from various European countries and Japan. A variety of widely different answers was obtained. It was shown that in all countries prevalence of MRSA is on a rising tide. This trend is observable in all European countries, albeit less strong in The Netherlands, Slovenia, France, Austria and Scandinavian countries. It was conclude that prevention strategies in a united and expanding European Community will become of utmost importance and that rapid screening strategies, e.g. PCR, might be of assistance in such an approach. A potential strategy to improve infection control measures could be the requirement of health-insurance providers to sign contracts only with hospitals able to proof having an infection control management in place. PMID:20204100

  8. Disease management as a performance improvement strategy.

    PubMed

    McClatchey, S

    2001-11-01

    Disease management is a strategy of organizing care and services for a patient population across the continuum. It is characterized by a population database, interdisciplinary and interagency collaboration, and evidence-based clinical information. The effectiveness of a disease management program has been measured by a combination of clinical, financial, and quality of life outcomes. In early 1997, driven by a strategic planning process that established three Centers of Excellence (COE), we implemented disease management as the foundation for a new approach to performance improvement utilizing five key strategies. The five implementation strategies are outlined, in addition to a review of the key elements in outcome achievement.

  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. Biventricular pacing: current trends and future strategies.

    PubMed

    Singh, Jagmeet P; Gras, Daniel

    2012-02-01

    The role of biventricular pacing is expanding beyond the New York Heart Association classes III and IV heart failure (HF) patient to include less symptomatic patients, earlier in the course of their disease process. This multisite pacing strategy has substantially altered the natural course of ventricular failure, exerting its physiological impact through favourable cardiac remodelling and improving the ejection fraction. This has in turn resulted in long-term clinical benefits such as improved quality of life and functional capacity with a concomitant reduction in hospitalization for HF and overall mortality. Despite the successes of cardiac resynchronization therapy (CRT) and the recent expansion of its role in the treatment of HF patients, there remain some inherent limitations to the technology and its delivery. A significant minority of patients continue to remain non-responsive to this pacing strategy. This review will highlight biventricular pacing in its present form, will elaborate on strategies to enhance response to CRT, and outline future trends and synergies towards maximizing the potential benefit of this therapeutic modality.

  11. Contemporary management strategies for fibromyalgia.

    PubMed

    Navarro, Robert P

    2009-06-01

    A roundtable meeting that comprised clinical, patient advocacy, and managed care experts discussed issues regarding the diagnosis and management of fibromyalgia. The panel agreed that earlier diagnosis and treatment, additional education for the medical community, and appropriate management by health plans, including patient access to US Food and Drug Administration-approved fibromyalgia medications, are needed. In addition, physicians, payers, and patient advocates must work to improve clinical, economic, and quality-of-life outcomes for fibromyalgia patients. Finally, treatment and diagnostic guidelines must be updated as advances in disease management are made (including approvals of 3 new pharmacologic agents), and development of a therapeutic category for "fibromyalgia" on payer formularies is needed.

  12. Time management strategies for research productivity.

    PubMed

    Chase, Jo-Ana D; Topp, Robert; Smith, Carol E; Cohen, Marlene Z; Fahrenwald, Nancy; Zerwic, Julie J; Benefield, Lazelle E; Anderson, Cindy M; Conn, Vicki S

    2013-02-01

    Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress.

  13. Gingival overgrowth: Part 2: management strategies.

    PubMed

    Chesterman, J; Beaumont, J; Kellett, M; Durey, K

    2017-02-10

    The effective and predictable management of gingival overgrowth requires correct diagnosis and consideration of aetiological factors, as discussed in Part 1 (BDJ 2017; 222: 85-91). Initial management should involve cause-related therapy, which may resolve or reduce the lesion. If functional, aesthetic and maintenance complications persist following this phase; further treatment may be required in the form of surgery. This paper discusses management strategies, including management of aetiological factors and surgical techniques.

  14. What's your strategy for managing knowledge?

    PubMed

    Hansen, M T; Nohria, N; Tierney, T

    1999-01-01

    The rise of the computer and the increasing importance of intellectual assets have compelled executives to examine the knowledge underlying their businesses and how it is used. Because knowledge management as a conscious practice is so young, however, executives have lacked models to use as guides. To help fill that gap, the authors recently studied knowledge management practices at management consulting firms, health care providers, and computer manufacturers. They found two very different knowledge management strategies in place. In companies that sell relatively standardized products that fill common needs, knowledge is carefully codified and stored in databases, where it can be accessed and used--over and over again--by anyone in the organization. The authors call this the codification strategy. In companies that provide highly customized solutions to unique problems, knowledge is shared mainly through person-to-person contacts; the chief purpose of computers is to help people communicate. They call this the personalization strategy. A company's choice of knowledge management strategy is not arbitrary--it must be driven by the company's competitive strategy. Emphasizing the wrong approach or trying to pursue both can quickly undermine a business. The authors warn that knowledge management should not be isolated in a functional department like HR or IT. They emphasize that the benefits are greatest--to both the company and its customers--when a CEO and other general managers actively choose one of the approaches as a primary strategy.

  15. Speed Management Strategies; A Systematic Review

    PubMed Central

    Sadeghi-Bazargani, Homayoun; Saadati, Mohammad

    2016-01-01

    Objective: To systematically identify the various methods of speed management and their effects. Methods: A systematic search was performed in Science Direct, Ovid Medline, Scopus, PubMed and ProQuest databases from April to June 2015. Hand searching and reference of selected articles were used to improve article identification. Articles published after 1990 which had reported on efficacy/effectiveness of speed management strategies were included. Data were extracted using pre-defined extraction table. Results: Of the 803 retrieved articles, 22 articles were included in this review. Most of the included articles (63%) had before-after design and were done in European countries. Speed cameras, engineering schemes, intelligent speed adaption (ISA), speed limits and zones, vehicle activated sign and integrated strategies were the most common strategies reported in the literature. Various strategies had different effects on mean speed of the vehicles ranging from 1.6 to 10 km/h. Moreover, 8-65% and 11-71% reduction was reported in person injured accidents and fatal accidents, respectively as a result of employing various strategies. Conclusion: Literature revealed positive effects of various speed management strategies. Using various strategies was mostly dependent on road characteristics, driver’s attitude about the strategy as well as economic and technological capabilities of the country. Political support is considered as a main determinant in selecting speed management strategies. PMID:27540546

  16. Active pharmaceutical management strategies of health insurance systems to improve cost-effective use of medicines in low- and middle-income countries: a systematic review of current evidence.

    PubMed

    Faden, Laura; Vialle-Valentin, Catherine; Ross-Degnan, Dennis; Wagner, Anita

    2011-05-01

    Health insurance systems have great potential to improve the cost-effective use of medicines by leveraging better provider prescribing, more cost-effective use by consumers, and lower prices from industry. Despite ample evidence from high-income countries, little is known about insurance system strategies targeting medicines in low- and middle-income countries (LMIC). This paper provides a critical review of the literature on these strategies and their impacts in LMIC. We conducted a systematic review of published peer-reviewed and grey literature and organized the insurance system strategies into four categories: medicines selection, purchasing, contracting and utilization management. In n=63 reviewed publications we found reasonable evidence supporting the use of insurance as an overall strategy to improve access to pharmaceuticals and outcomes in LMIC. Beyond this, most of the literature focused on provider contracting strategies to influence prescribing. There was very little evidence on medicines selection, purchasing, or utilization management strategies. There is a paucity of published evidence on the impact of insurance system strategies on improving the use of medicines in LMIC. The existing evidence is questionable since the majority of the published studies utilize weak study designs. This review highlights the need for well-designed studies to build an evidence base on the impact of medicines management strategies deployed by LMIC insurance programs. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  17. Strategies for data management engagement.

    PubMed

    Charbonneau, Deborah H

    2013-01-01

    The research landscape is growing dramatically, and librarians are examining new roles, services, and types of collaborations to support data-intensive research. This column describes curricular enhancements at one School of Library and Information Science in the United States. Several key areas of data management in which health sciences librarians may wish to build or enhance their skills are outlined. Possible roles and opportunities for health sciences librarians to strategically engage in data management initiatives are also presented.

  18. Current guidelines in defining therapeutic strategies.

    PubMed

    Ferrajoli, Alessandra; Keating, Michael J

    2004-08-01

    The past three decades have brought major changes in the approach toward chronic lymphocytic leukemia (CLL). This disease was considered a simple form of leukemia for which the only goal of treatment was control of the leukocytosis and of the symptoms related to disease expansion. Many biologic discoveries have increased our understanding of the disease process. New prognostic markers have been identified and are being incorporated into clinical practice. Now, CLL is considered a complex and challenging leukemia for which multiple treatment options are emerging, from chemotherapy to monoclonal antibodies, from vaccines to immunomodulatory strategies. The evaluation of treatment results also has been revolutionized: clones carrying genetic aberrations are monitored, and patients who have had a response are assessed for the presence of minimal residual disease.

  19. Ulcerative colitis: current and future treatment strategies.

    PubMed

    Lissner, Donata; Siegmund, Britta

    2013-01-01

    Since the incidence of inflammatory bowel diseases including ulcerative colitis is continuously increasing worldwide, there is a strong need for effective treatment strategies. However, there is no therapy allowing for healing ulcerative colitis; consequently, the available medications will have to be applied at their best. The preferred option for mild pan- or left-sided colitis is still mesalazine. One can only emphasize that the formulations allowing for once daily dosing are not only equally effective, but even facilitate the implication of long-term therapy in daily life. In case steroids are frequently required to control disease, further immunosuppressive therapy should be introduced in order to minimize steroid exposure. Thiopurines represent the first-choice immunosuppressive medication. In more severe cases, early escalation to combinatory therapies with anti-TNF antibodies should be considered with the possibility of therapy deescalation after induction of remission. Major difficulties arise with steroid-refractory acute flares. Here cyclosporine as well as anti-TNF strategies can be initiated. However, in case of severe disease, the high 1-year colectomy rate of about 50% should be considered. If short-term surgery is an option due to disease severity, cyclosporine might be advantageous since the half-life is short compared to infliximab or adalimumab. The central problem of all therapeutic approaches is that because we chase after the disease, solid markers that allow for prediction of the future disease course are desirable. In fact, the CD8+ transcriptome might fill this gap and will potentially lead to the classification of patients in low- and high-risk groups. Copyright © 2013 S. Karger AG, Basel.

  20. Optimizing diabetes management: managed care strategies.

    PubMed

    Tzeel, E Albert

    2013-06-01

    Both the prevalence of type 2 diabetes mellitus (DM) and its associated costs have been rising over time and are projected to continue to escalate. Therefore, type 2 DM (T2DM) management costs represent a potentially untenable strain on the healthcare system unless substantial, systemic changes are made. Managed care organizations (MCOs) are uniquely positioned to attempt to make the changes necessary to reduce the burdens associated with T2DM by developing policies that align with evidence-based DM management guidelines and other resources. For example, MCOs can encourage members to implement healthy lifestyle choices, which have been shown to reduce DM-associated mortality and delay comorbidities. In addition, MCOs are exploring the strengths and weaknesses of several different benefit plan designs. Value-based insurance designs, sometimes referred to as value-based benefit designs, use both direct and indirect data to invest in incentives that change behaviors through health information technologies, communications, and services to improve health, productivity, quality, and financial trends. Provider incentive programs, sometimes referred to as "pay for performance," represent a payment/delivery paradigm that places emphasis on rewarding value instead of volume to align financial incentives and quality of care. Accountable care organizations emphasize an alignment between reimbursement and implementation of best practices through the use of disease management and/ or clinical pathways and health information technologies. Consumer-directed health plans, or high-deductible health plans, combine lower premiums with high annual deductibles to encourage members to seek better value for health expenditures. Studies conducted to date on these different designs have produced mixed results.

  1. 15 Strategies for Managing Attention Problems

    ERIC Educational Resources Information Center

    Thorne, Glenda; Thomas, Alice; Lawson, Candy

    2005-01-01

    In this document, 15 strategies are offered for enhancing attention and managing attention problems. This listing is by no means exhaustive, but rather is meant as a place to begin. The best resources for strategies are the creative, inventive minds of enlightened assessment professionals, teachers and parents, in partnership with the students…

  2. Winning Strategies for Classroom Management.

    ERIC Educational Resources Information Center

    Cummings, Carol

    This book offers advice on arranging classrooms, diagnosing student behavior, and responding to students' emotional needs, examining intellectual, emotional, and physical challenges students face and providing strategies which help teachers create communities of learners, design classrooms, diagnose student behavior, and respond to student needs.…

  3. Managing burned landscapes: Evaluating future management strategies for resilient forests under a warming climate

    Treesearch

    K. L. Shive; P. Z. Fule; C. H. Sieg; B. A. Strom; M. E. Hunter

    2014-01-01

    Climate change effects on forested ecosystems worldwide include increases in drought-related mortality, changes to disturbance regimes and shifts in species distributions. Such climate-induced changes will alter the outcomes of current management strategies, complicating the selection of appropriate strategies to promote forest resilience. We modelled forest growth in...

  4. Current strategies of blood doping detection.

    PubMed

    Pottgiesser, Torben; Schumacher, Yorck Olaf

    2013-12-01

    During the last 30 years, the artificial increase of red blood cell volume ("blood doping") has changed the level of performance in all endurance sports. Many doping scandals have shown the extent of the problem. The detection of blood doping relies on two different approaches: the direct detection of exogenous manipulating substances (erythropoietic stimulants) or red cells (homologous transfusion) and the indirect detection, where not the doping substance or technique itself, but its effect on certain biomarkers is measured. Whereas direct detection using standard laboratory procedures such as isoelectric focusing can identify erythropoietic stimulants, homologous blood transfusion is identified through mismatches in minor blood group antigens by flow cytometry. Indirect methods such as the athlete biological passport are the only means to detect autologous transfusion and may also be used for the detection of erythropoietic stimulants or homologous transfusion. New techniques to unmask blood doping include the use of high-throughput 'omics' technologies (proteomics/metabolomics) and the combination of different biomarkers with the help of mathematical approaches. Future strategies should aim at improving the use of the available data and resources by applying pattern recognition algorithms to recognize suspicious athletes and, on the basis of these findings, use the appropriate testing method. Different types of information should be combined in the quest for a forensic approach to anti-doping.

  5. Transgenic animals: current and alternative strategies.

    PubMed

    Chan, A W

    1999-01-01

    Transgenic animal technology is one of the most fascinating technologies developed in the last two decades. It allows us to address questions in life sciences that no other methods have achieved. The impact on biomedical and biological research, as well as commercial interests are overwhelming. The questions accompanying this fast growing technology and its diversified applications attract the attention from a variety of entities. Still, one of the most fundamental problems remaining is the search for an efficient and reliable gene delivery system for creating transgenic animals. The traditional method of pronuclear microinjection has displayed great variability in success among species. While an acceptable efficiency in the production of transgenic mice has been attained, the relative low efficiency (<1%) in creating transgenic livestock has become one of the barriers for its application. In the past decades, improvements in producing transgenic livestock have made a slow progression, however, the recent advancement in cloning technology and the ability to create transgenic livestock in a highly efficient manner, have opened the gate to a new era in transgenic technology. Discoveries of new gene delivery systems have created an enthusiastic atmosphere that has made this technology so unique. This review focuses on gene delivery strategies as well as various approaches that may assist the advancement of transgenic efficiency in large animals.

  6. Current drug discovery strategies against arenavirus infections.

    PubMed

    Pasquato, Antonella; Burri, Dominique J; Kunz, Stefan

    2012-11-01

    Arenaviruses are a large group of emerging viruses including several causative agents of severe hemorrhagic fevers with high mortality in man. Considering the number of people affected and the currently limited therapeutic options, novel efficacious therapeutics against arenaviruses are urgently needed. Over the past decade, significant advances in knowledge about the basic virology of arenaviruses have been accompanied by the development of novel therapeutics targeting different steps of the arenaviral life cycle. High-throughput, small-molecule screens identified potent and broadly active inhibitors of arenavirus entry that were instrumental for the dissection of unique features of arenavirus fusion. Novel inhibitors of arenavirus replication have been successfully tested in animal models and hold promise for application in humans. Late in the arenavirus life cycle, the proteolytic processing of the arenavirus envelope glycoprotein precursor and cellular factors critically involved virion assembly and budding provide further promising 'druggable' targets for novel therapeutics to combat human arenavirus infection.

  7. Strategies for Management of Colorectal Endometriosis.

    PubMed

    Abrão, Mauricio Simões; Borrelli, Giuliano Moysés; Clarizia, Roberto; Kho, Rosanne Marie; Ceccaroni, Marcello

    2017-01-01

    Endometriosis has clearly three distinct clinical presentations and deep endometriosis, especially compromising the rectosigmoid is probably the most concerning one for both patients and surgeons. Currently, with the available tools, it is mandatory to have a precise diagnostic of this type of disease prior to indication of treatment. Strategies to manage this form of endometriosis will take into account several involved aspects, such as age of the patient, reproductive desire or infertility, clinical symptoms, as well as the extension and localization of the disease. Treatment could vary from more conservative to more radical depending on those aspects. As we pointed out in this article, the key to manage colorectal endometriosis is to start with a good diagnosis. Knowing exactly what is the extension and localization of the disease and knowing the patient's wishes as well as the clinical complaints, surgeons are able to define the best option for each patient. Critical points should always be discussed; for example, patients chosen to have clinical treatment should be aware of important issues regarding the follow-up, while patients undergoing surgery must be advised about all surgical possibilities and related complications.

  8. Current strategies for myocardial gene delivery

    PubMed Central

    Katz, Michael G.; Swain, JaBaris D.; Tomasulo, Catherine E.; Sumaroka, Marina; Fargnoli, Anthony; Bridges, Charles R.

    2013-01-01

    Existing methods of cardiac gene delivery can be classified by the site of injection, interventional approach and type of cardiac circulation at the time of transfer. General criteria to assess the efficacy of a given delivery method include: global versus regional myocardial transduction, technical complexity and the pathophysiological effects associated with its use, delivery-related collateral expression and the delivery-associated inflammatory and immune response. Direct gene delivery (intramyocardial, endocardial, epicardial) may be useful for therapeutic angiogenesis and for focal arrhythmia therapy but with gene expression which is primarily limited to regions in close proximity to the injection site. An often unappreciated limitation of these techniques is that they are frequently associated with substantial systemic vector delivery. Percutaneous infusion of vector into the coronary arteries is minimally invasive and allows for transgene delivery to the whole myocardium. Unfortunately, efficiency of intracoronary delivery is highly variable and the short residence time of vector within the coronary circulation and significant collateral organ expression limit its clinical potential. Surgical techniques, including the incorporation of cardiopulmonary bypass with isolated cardiac recirculation, represent novel delivery strategies that may potentially overcome these limitations; yet, these techniques are complex with inherent morbidity that must be thoroughly evaluated before safe translation into clinical practice. Characteristics of the optimal technique for gene delivery include low morbidity, increased myocardial transcapillary gradient, extended vector residence time in the coronary circulation and exclusion of residual vector from the systemic circulation after delivery to minimize extracardiac expression and to mitigate a cellular immune response. This article is part of a Special Section entitled “Special Section: Cardiovascular Gene Therapy”. PMID

  9. Internationalisation Strategies for Management Education.

    ERIC Educational Resources Information Center

    Howe, W. Stewart; Martin, Graeme

    1998-01-01

    A literature review and case study of a British business school examined these areas: (1) competing rationales for internationalizing management education; (2) transfer of best practice from the west; and (3) problems that parent and host countries face in joint ventures. (SK)

  10. Selecting habitat management strategies on refuges

    USGS Publications Warehouse

    Schroeder, Richard L.; King, Wayne J.; Cornely, John E.

    1998-01-01

    This report is a joint effort of the Biological Resources Division, U.S. Geological Survey and the U.S. Fish and Wildlife Service (FWS) to provide National Wildlife Refuge (NWR) managers guidance on the selection and evaluation of habitat management strategies to meet stated objectives. The FWS recently completed a handbook on writing refuge management goals and objectives (U.S. Fish and Wildlife Service 1996a). the National Wildlife Refuge System Improvement Act of 1997 requires that National Wildlife Refuge System (NWRS) lands be managed according to approved Comprehensive Conservation Plans to guide management decisions and devise strategies for achieving refuge unit purposes and meeting the NWRS mission. It is expected that over the next several years most refuges will develop new or revised refuge goals and objectives for directing their habitat management strategies. This paper outlines the steps we recommend in selecting and evaluating habitat management strategies to meet specific refuge habitat objectives. We selected two examples to illustrate the process. Although each refuge is unique and will require specific information and solutions, these two examples can be used as guidance when selecting and evaluating habitat management strategies for other refuge resources: Example 1. Management of floodplain woods habitat for forest interior birds. The biological recourse of concern is the quality and quantity of floodplain woods habitat for eastern forest interior birds in the Cypress Creek NWR (U.S. Fish and Wildlife Service 1996b). Example 2. Management of habitat for biodiversity: Historical landscape proportions. The biological resource of concern is the change in diversity associated with man-induced changes in the distribution and abundance of habitat types at the Minnesota Valley NWR (U.S. Fish and Wildlife Service 1996c).

  11. Cancer pain management-current status

    PubMed Central

    Thapa, Deepak; Rastogi, V; Ahuja, Vanita

    2011-01-01

    Cancer pain is still one of the most feared entities in cancer and about 75% of these patients require treatment with opioids for severe pain.The cancer pain relief is difficult to manage in patients with episodic or incidental pain, neuropathic pain, substance abuse and with impaired cognitive or communication skills. This non-systematic review article aims to discuss reasons for under treatment, tools of pain assessment, cancer pain and anxiety and possibly carve new approaches for cancer pain management in future. The current status of World Health Organization analgesic ladder has also been reviewed. A thorough literature search was carried out from 1998 to 2010 for current status in cancer pain management in MEDLINE, WHO guidelines and published literature and relevant articles have been included. PMID:21772673

  12. Atrial fibrillation: review of current treatment strategies.

    PubMed

    Xu, Joshua; Luc, Jessica G Y; Phan, Kevin

    2016-09-01

    Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF.

  13. Tissue Engineering: Current Strategies and Future Directions

    PubMed Central

    Olson, Jennifer L.; Atala, Anthony

    2011-01-01

    Novel therapies resulting from regenerative medicine and tissue engineering technology may offer new hope for patients with injuries, end-stage organ failure, or other clinical issues. Currently, patients with diseased and injured organs are often treated with transplanted organs. However, there is a shortage of donor organs that is worsening yearly as the population ages and as the number of new cases of organ failure increases. Scientists in the field of regenerative medicine and tissue engineering are now applying the principles of cell transplantation, material science, and bioengineering to construct biological substitutes that can restore and maintain normal function in diseased and injured tissues. In addition, the stem cell field is a rapidly advancing part of regenerative medicine, and new discoveries in this field create new options for this type of therapy. For example, new types of stem cells, such as amniotic fluid and placental stem cells that can circumvent the ethical issues associated with embryonic stem cells, have been discovered. The process of therapeutic cloning and the creation of induced pluripotent cells provide still other potential sources of stem cells for cell-based tissue engineering applications. Although stem cells are still in the research phase, some therapies arising from tissue engineering endeavors that make use of autologous, adult cells have already entered the clinical setting, indicating that regenerative medicine holds much promise for the future. PMID:22111050

  14. Atrial fibrillation: review of current treatment strategies

    PubMed Central

    Xu, Joshua; Luc, Jessica G. Y.

    2016-01-01

    Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5–2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF. PMID:27747025

  15. Current and Future Parts Management at NASA

    NASA Technical Reports Server (NTRS)

    Sampson, Michael J.

    2011-01-01

    This presentation provides a high level view of current and future electronic parts management at NASA. It describes a current perspective of the new human space flight direction that NASA is beginning to take and how that could influence parts management in the future. It provides an overview of current NASA electronic parts policy and how that is implemented at the NASA flight Centers. It also describes some of the technical challenges that lie ahead and suggests approaches for their mitigation. These challenges include: advanced packaging, obsolescence and counterfeits, the global supply chain and Commercial Crew, a new direction by which NASA will utilize commercial launch vehicles to get astronauts to the International Space Station.

  16. Heat Management Strategy Trade Study

    SciTech Connect

    Nick Soelberg; Steve Priebe; Dirk Gombert; Ted Bauer

    2009-09-01

    This Heat Management Trade Study was performed in 2008-2009 to expand on prior studies in continued efforts to analyze and evaluate options for cost-effectively managing SNF reprocessing wastes. The primary objective was to develop a simplified cost/benefit evaluation for spent nuclear fuel (SNF) reprocessing that combines the characteristics of the waste generated through reprocessing with the impacts of the waste on heating the repository. Under consideration were age of the SNF prior to reprocessing, plutonium and minor actinide (MA) separation from the spent fuel for recycle, fuel value of the recycled Pu and MA, age of the remaining spent fuel waste prior to emplacement in the repository, length of time that active ventilation is employed in the repository, and elemental concentration and heat limits for acceptable glass waste form durability. A secondary objective was to identify and qualitatively analyze remaining issues such as (a) impacts of aging SNF prior to reprocessing on the fuel value of the recovered fissile materials, and (b) impact of reprocessing on the dose risk as developed in the Yucca Mountain Total System Performance Assessment (TSPA). Results of this study can be used to evaluate different options for managing decay heat in waste streams from spent nuclear fuel.

  17. Evolution in clinical knowledge management strategy at Intermountain Healthcare.

    PubMed

    Hulse, Nathan C; Galland, Joel; Borsato, Emerson P

    2012-01-01

    In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs.

  18. Managing Work and Family: Do Control Strategies Help?

    ERIC Educational Resources Information Center

    Versey, H. Shellae

    2015-01-01

    How can we effectively manage competing obligations from work and family without becoming overwhelmed? This question inspires the current study by examining control strategies that may facilitate better work-life balance, with a specific focus on the role of lowered aspirations and positive reappraisals, attitudes that underlie adaptive coping…

  19. Managing Work and Family: Do Control Strategies Help?

    ERIC Educational Resources Information Center

    Versey, H. Shellae

    2015-01-01

    How can we effectively manage competing obligations from work and family without becoming overwhelmed? This question inspires the current study by examining control strategies that may facilitate better work-life balance, with a specific focus on the role of lowered aspirations and positive reappraisals, attitudes that underlie adaptive coping…

  20. Planning your UST management strategy

    SciTech Connect

    Reeves, T.S.; Bacon, P.A. )

    1993-09-01

    For the past six years, federal regulations have required underground storage tank (UST) owners to manage their tank facilities more carefully and accountably than ever before. As mandated by the Resource Conservation and Recovery Act (RCRA), all 50 states have implemented programs to monitor existing USTs, regulate new tank installations and levy fines for leaking tanks. The liability stipulation may be most important. This provision makes the investment in monitoring and safety equipment worthwhile for the tank owner. Equally important, it serves as a deterrent for careless practices and provides financial recourse for the cleanup of leaks or spills. While each state has the option of expanding on the federal government's UST management guidelines, all states had to adopt at least those basics. The minimum standards require that owners protect new USTs from corrosion, leaks and overfills, install leak detection devices and acquire liability insurance. The federal regulations also exempt certain tanks from compliance. These include tanks that hold less than 1,100 gallons, flow-through or process tanks and tanks that hold heating oil used for on-premises heating. Some state, however, have set more stringent regulations disallowing some of these exemptions. Either way, gasoline dealerships are by far the largest group of UST owners affected by the regulations. The rules also affect regulated substances such as heating oil, aviation fuels, and chemical solvents.

  1. Ocular onchocerciasis: current management and future prospects

    PubMed Central

    Babalola, Olufemi Emmanuel

    2011-01-01

    This paper reviews the current management of onchocerciasis and its future prospects. Onchocerciasis is a disease affecting millions of people in Africa, South and Central America, and Yemen. It is spread by the blackfly as a vector and caused by the filarial nematode, Onchocerca volvulus. A serious attempt was made by the Onchocerciasis Control Program between 1975 and 2002 to eliminate the vector in eleven of the endemic countries in West Africa, and with remarkable success. Formerly, the treatment was with diethyl carbamazine for the microfilaria and suramin for the adult worm. These drugs are now known to be toxic and unsuitable for mass distribution. In particular, they precipitate optic nerve disease. With the discovery of ivermectin, a much safer microfilaricide, and the decision of Merck to distribute the drug free of charge for as long as needed, the strategy of control switched to mass drug administration through community-directed treatment with ivermectin. So far, millions have received this annual or biannual treatment through the African Program for Onchocerciasis Control and the Onchocerciasis Elimination Program for the Americas. However, the problem with ivermectin is that it is a monotherapy microfilaricide which has limited effect on the adult worm, and thus will need to be continued for the life span of the adult worm, which may last up to 15 years. There are also early reports of resistance. Serious encephalopathy and death may occur when ivermectin is used in subjects heavily infested with loiasis. It seems unlikely that a break in transmission will occur with community-directed treatment with ivermectin in Africa because of population migrations and the highly efficient vector, but in the Americas some countries such as Columbia and the Oaxaca focus in Mexico have reported eradication. Vector control is only now applicable in selected situations, and particularly to control the nuisance value of the blackfly. Trials are ongoing for

  2. Current concepts in management of slipped capital femoral epiphysis.

    PubMed

    Bittersohl, Bernd; Hosalkar, Harish S; Zilkens, Christoph; Krauspe, Rüdiger

    2015-01-01

    Slipped capital femoral epiphysis (SCFE) is a common hip condition that can be disabling. In this review, we provide an orientation on current trends in the clinical management of SCFE including conventional procedures and specialised surgical developments. Different methods of fixation of the epiphysis, risks of complications, and the rationale of addressing deformity, primarily or secondarily, are presented. Although improved understanding of the anatomy, vascularity and implications of residual deformity have changed management strategies, the best modality of treatment that would restore complete vascularity to the femoral head and prevent any residual deformity, impingement and early osteoarthritis remains elusive.

  3. Nonpharmacologic strategies for managing hypertension.

    PubMed

    Wexler, Randy; Aukerman, Glen

    2006-06-01

    The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends lifestyle modification for all patients with hypertension or prehypertension. Modifications include reducing dietary sodium to less than 2.4 g per day; increasing exercise to at least 30 minutes per day, four days per week; limiting alcohol consumption to two drinks or less per day for men and one drink or less per day for women; following the Dietary Approaches to Stop Hypertension eating plan (high in fruits, vegetables, potassium, calcium, and magnesium; low in fat and salt); and achieving a weight loss goal of 10 lb (4.5 kg) or more. Alternative treatments such as vitamin C, coenzyme Q10, magnesium, and omega-3 fatty acids have been suggested for managing hypertension, but evidence for their effectiveness is lacking.

  4. Management strategies for acne vulgaris

    PubMed Central

    Whitney, Kristen M; Ditre, Chérie M

    2011-01-01

    Clinical question: What are the most effective treatment(s) for mild, moderate, severe, and hormonally driven acne? Results: Mild acne responds favorably to topical treatments such as benzoyl peroxide, salicylic acid, and a low-dose retinoid. Moderate acne responds well to combination therapy comprising-topical benzoyl peroxide, antibiotics, and/or retinoids, as well as oral antibiotics in refractory cases and oral contraceptive pills for female acne patients. Severe nodulocystic acne vulgaris responds best to oral isotretinoin therapy. In female patients with moderate to severe acne, facial hair, loss of scalp hair and irregular periods, polycystic ovarian syndrome should be considered and appropriate treatment with hormonal modulation given. Adjunctive procedures can also be considered for all acne patients. Implementation: Pitfalls to avoid when treating acne: treatment of acne in women of child-bearing age; familiarization of all acne treatments in order to individualize management for patients; indications for specialist referral. PMID:21691566

  5. Management and prevention of neonatal anemia: current evidence and guidelines.

    PubMed

    von Lindern, Jeannette S; Lopriore, Enrico

    2014-04-01

    Neonatal anemia is a common disorder, particularly in (very) preterm neonates. Management of neonatal anemia is based principally on red blood cell (RBC) transfusion. Although the use of blood products is nowadays widespread in neonatal medicine, evidence on the potential benefit is extremely limited. Recent studies suggest that RBC transfusions in newborns may be associated with an increased risk for necrotizing enterocolitis, transfer of infectious agents and negative effects on neurodevelopmental outcome. Whether the benefits of RBC transfusions outweigh the risks is controversial and requires further studies. In this review, we summarize the current evidence on the management of neonatal anemia and compare the various international guidelines. In addition, we discuss the various strategies to prevent neonatal anemia and reduce the need for RBC transfusions and discuss important trials currently enrolling patients to improve the management in neonatal anemia.

  6. [Global brain metastases management strategy: a multidisciplinary-based approach].

    PubMed

    Métellus, P; Tallet, A; Dhermain, F; Reyns, N; Carpentier, A; Spano, J-P; Azria, D; Noël, G; Barlési, F; Taillibert, S; Le Rhun, É

    2015-02-01

    Brain metastases management has evolved over the last fifteen years and may use varying strategies, including more or less aggressive treatments, sometimes combined, leading to an improvement in patient's survival and quality of life. The therapeutic decision is subject to a multidisciplinary analysis, taking into account established prognostic factors including patient's general condition, extracerebral disease status and clinical and radiological presentation of lesions. In this article, we propose a management strategy based on the state of current knowledge and available therapeutic resources. Copyright © 2015. Published by Elsevier SAS.

  7. Current management of coarctation of the aorta

    PubMed Central

    Suradi, Hussam; Hijazi, Ziyad M.

    2015-01-01

    Coarctation of the aorta (C) is the sixth most common lesion in congenital heart disease and represents a spectrum of aortic narrowing that varies from a discrete entity to tubular hypoplasia. This condition was once thought to be a relatively simple lesion that would be “cured” upon repair of the narrowing, however, despite relief of the anatomical obstruction the subsequent risk of early morbidity and death persists. This review outlines the optimal management strategy of this disease from neonatal to adult life and provides insights to approach this straightforward but challenging condition. PMID:26779519

  8. Current management of coarctation of the aorta.

    PubMed

    Suradi, Hussam; Hijazi, Ziyad M

    2015-01-01

    Coarctation of the aorta (C) is the sixth most common lesion in congenital heart disease and represents a spectrum of aortic narrowing that varies from a discrete entity to tubular hypoplasia. This condition was once thought to be a relatively simple lesion that would be "cured" upon repair of the narrowing, however, despite relief of the anatomical obstruction the subsequent risk of early morbidity and death persists. This review outlines the optimal management strategy of this disease from neonatal to adult life and provides insights to approach this straightforward but challenging condition.

  9. Momentum management strategy during Space Station buildup

    NASA Technical Reports Server (NTRS)

    Bishop, Lynda; Malchow, Harvey; Hattis, Philip

    1988-01-01

    The use of momentum storage devices to control effectors for Space Station attitude control throughout the buildup sequence is discussed. Particular attention is given to the problem of providing satisfactory management of momentum storage effectors throughout buildup while experiencing variable torque loading. Continuous and discrete control strategies are compared and the effects of alternative control moment gyro strategies on peak momentum storage requirements and on commanded maneuver characteristics are described.

  10. Initial management strategies for follicular lymphoma

    PubMed Central

    Chen, Qiushi; Ayer, Turgay; Nastoupil, Loretta J; Seward, Miray; Zhang, Hongzheng; Sinha, Rajni; Flowers, Christopher R

    2013-01-01

    SUMMARY Follicular lymphoma (FL) can vary markedly in its initial presentation, and no single standard approach for its initial management has been adopted. Available options for the initial management of FL include watchful waiting, radiation, single-agent rituximab and combination of rituximab and chemotherapy with strategies segregated for patients who have low and high tumor burden disease based on established criteria. However, marked debate occurs regarding the role of watchful waiting in the modern era for low tumor burden, asymptomatic patients, the optimal timing of rituximab, the selection of chemotherapy regimen to partner with rituximab in high tumor burden patients, and strategies for the management of relapsed disease. We provide an evidence-based discussion on these and other issues regarding the management of FL, and propose a mathematical modeling approach for addressing some of these questions. PMID:23476737

  11. Future strategies in the management of coronary artery disease.

    PubMed

    Schwitter, Jürg

    2006-09-01

    New diagnostic techniques have now become available that will enable us to obtain information on coronary artery disease (CAD), which was not previously possible. This is urgently needed, since changes in CAD management are highly desirable considering that up to 60% of patients die due to an insufficient diagnostic strategy (reactive strategy). In this article, the pathophysiology of CAD and the evidence of current concepts on coronary atherosclerosis are critically reviewed. Consequently, a shift from a 'reactive strategy' of CAD management to an active strategy is proposed in order to detect and treat patients before acute myocardial infarcts occur. Reliability, repeatability, cost-effectiveness and comfort are important features of an optimal test for this active strategy. This perspective gives an overview of current and future tests with respect to these features. The novel tomographic techniques are particularly promising with respect to standardization and reproducibility, which will set the basis for the determination of test performance and, consequently, cost-effectiveness. Assessment of cost-effectiveness is increasingly important, since prevalence of CAD is high and will most likely increase, while resources will remain restricted in most countries. Considering these economic restrictions, this article also proposes new mathematical tools using data from prospective trials and large international registries as an objective means to select the best tests for CAD diagnosis and management, and to identify those patient subsets which benefit most from an active strategy.

  12. Evolutionary space station fluids management strategies

    NASA Technical Reports Server (NTRS)

    1989-01-01

    Results are summarized for an 11-month study to define fluid storage and handling strategies and requirements for various specific mission case studies and their associated design impacts on the Space Station. There are a variety of fluid users which require a variety of fluids and use rates. Also, the cryogenic propellants required for NASA's STV, Planetary, and Code Z missions are enormous. The storage methods must accommodate fluids ranging from a high pressure gas or supercritical state fluid to a sub-cooled liquid (and superfluid helium). These requirements begin in the year 1994, reach a maximum of nearly 1800 metric tons in the year 2004, and trail off to the year 2018, as currently planned. It is conceivable that the cryogenic propellant needs for the STV and/or Lunar mission models will be met by LTCSF LH2/LO2 tanksets attached to the SS truss structure. Concepts and corresponding transfer and delivery operations have been presented for STV propellant provisioning from the SS. A growth orbit maneuvering vehicle (OMV) and associated servicing capability will be required to move tanksets from delivery launch vehicles to the SS or co-orbiting platforms. Also, appropriate changes to the software used for OMV operation are necessary to allow for the combined operation of the growth OMV. To support fluid management activities at the Space Station for the experimental payloads and propellant provisioning, there must be truss structure space allocated for fluid carriers and propellant tanksets, and substantial beam strengthening may be required. The Station must have two Mobile Remote Manipulator Systems (MRMS) and the growth OMV propellant handling operations for the STV at the SS. Propellant needs for the Planetary Initiatives and Code Z mission models will most likely be provided by co-orbiting propellant platform(s). Space Station impacts for Code Z mission fluid management activities will be minimal.

  13. Strategies for Managing a Multigenerational Workforce

    NASA Astrophysics Data System (ADS)

    Iden, Ronald

    The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to explore the multigenerational strategies used by 3 managers from a Franklin County, Ohio manufacturing facility with a population size of 6 participants. The conceptual framework for this study was built upon generational theory and cohort group theory. The data were collected through face-to-face semistructured interviews, company documents, and a reflexive journal. Member checking was completed to strengthen the credibility and trustworthiness of the interpretation of participants' responses. A modified van Kaam method enabled separation of themes following the coding of data. Four themes emerged from the data: (a) required multigenerational managerial skills, (b) generational cohort differences, (c) most effective multigenerational management strategies, and (d) least effective multigenerational management strategies. Findings from this study may contribute to social change through better understanding, acceptance, and appreciation of the primary generations in the workforce, and, in turn, improve community relationships.

  14. Clinical nutrition management position: responsibilities and skill development strategies.

    PubMed

    Witte, S S; Messersmith, A M

    1995-10-01

    To determine the duties of clinical nutrition managers, the factors associated with the performance of the duties, the job specifications for the position, and the skill development strategies used by clinical nutrition managers. Clinical nutrition managers from 700 randomly selected, acute-care hospitals in the United States (with 300 or more beds) received a survey questionnaire. Respondents were asked to indicate performance or nonperformance, perceived importance, and methods used to develop skills for 54 duties related to clinical nutrition management. We requested additional information about position requirements, position characteristics, and demographic information. An 82% response rate with 67% usable responses (n = 472) was achieved. Frequencies for performance and nonperformance, mean importance, and frequencies for methods of skill development were determined for each duty. chi 2 Analysis with P < .10 was used to determine if an association existed between performance of a duty and time allotted to the position, number of personnel supervised, and type of personnel supervised. This study validated 46 of the duties as responsibilities of practicing clinical nutrition manager. Three duties not validated were related to financial management. The duty performed least often was conducting research/investigative studies. The number and type of personnel supervised was found to influence performance of duties, but time allotted to position was not an influence. The major strategies used for skill development were continuing education, networking, work experience in clinical dietetics, work experience in management dietetics, and their present job. These results can be used by clinical nutrition managers to assess the characteristics of their current position and develop a plan for enhancing their scope of responsibility. The identification of duties actually performed by clinical nutrition managers can also be used to develop standards of practice with

  15. Signal Processing Strategies for Cochlear Implants Using Current Steering

    NASA Astrophysics Data System (ADS)

    Nogueira, Waldo; Litvak, Leonid; Edler, Bernd; Ostermann, Jörn; Büchner, Andreas

    2009-12-01

    In contemporary cochlear implant systems, the audio signal is decomposed into different frequency bands, each assigned to one electrode. Thus, pitch perception is limited by the number of physical electrodes implanted into the cochlea and by the wide bandwidth assigned to each electrode. The Harmony HiResolution bionic ear (Advanced Bionics LLC, Valencia, CA, USA) has the capability of creating virtual spectral channels through simultaneous delivery of current to pairs of adjacent electrodes. By steering the locus of stimulation to sites between the electrodes, additional pitch percepts can be generated. Two new sound processing strategies based on current steering have been designed, SpecRes and SineEx. In a chronic trial, speech intelligibility, pitch perception, and subjective appreciation of sound were compared between the two current steering strategies and standard HiRes strategy in 9 adult Harmony users. There was considerable variability in benefit, and the mean results show similar performance with all three strategies.

  16. A Synthesis of Language Learning Strategies: Current Issues, Problems and Claims Made in Learner Strategy Research

    ERIC Educational Resources Information Center

    Barjesteh, Hamed; Mukundan, Jayakaran; Vaseghi, Reza

    2014-01-01

    The current paper presented theoretical assumptions behind language learning strategies (LLS) and an overview of methods used to identify learners' strategies, first, and then summarized what have been reported from large number of descriptive studies of strategies by language learners. Moreover, the paper tried to present the variety of…

  17. Group-Oriented Behavior Management Strategies.

    ERIC Educational Resources Information Center

    Salend, Spencer J.

    1987-01-01

    A variety of group oriented behavior management strategies to modify classroom behavior problems is suggested. Advantages, disadvantages, and implementation guidelines for the group response cost system, the good behavior game, the group timeout ribbon, hero method, peer-mediated extinction, and peer confrontation. (DB)

  18. Management Strategies for Promoting Teacher Collective Learning

    ERIC Educational Resources Information Center

    Cheng, Eric C. K.

    2011-01-01

    This paper aims to validate a theoretical model for developing teacher collective learning by using a quasi-experimental design, and explores the management strategies that would provide a school administrator practical steps to effectively promote collective learning in the school organization. Twenty aided secondary schools in Hong Kong were…

  19. Classroom Management Strategies for Students with Autism

    ERIC Educational Resources Information Center

    Valdivia, Joe S.

    2007-01-01

    Classroom management strategies designed to improve problem behavior directly affect student achievement. Researchers have demonstrated positive behavior supports (PBS) can reduce problem behavior. However, researchers have also found evidence that PBS may not always be successful and further studies are needed to improve the use of PBS as a…

  20. Practical management strategies for diaper dermatitis.

    PubMed

    Humphrey, S; Bergman, J N; Au, S

    2006-09-01

    Common diaper dermatitis is an irritant contact diaper dermatitis (IDD) created by the combined influence of moisture, warmth, urine, feces, friction, and secondary infection. It is difficult to completely eradicate these predisposing factors in a diapered child. Thus, IDD presents an ongoing therapeutic challenge for parents, family physicians, pediatricians, and dermatologists. This article will focus on practical management strategies for IDD.

  1. Seeking sustainability: Israel's evolving water management strategy.

    PubMed

    Tal, Alon

    2006-08-25

    The water management policies adopted to address Israel's chronic scarcity have not been without environmental consequences. Yet, through a trial-and-error process, a combined strategy of water transport, rainwater harvesting, and wastewater reuse and desalination, along with a variety of water conservation measures, have put the country on a more sustainable path for the future.

  2. Strategies to manage antifungal drug resistance.

    PubMed

    Tseng, Hsiang-Kuang; Perfect, John R

    2011-02-01

    Invasive fungal infections continue to cause significant morbidity and mortality in immunocompromised hosts. From more than half a million deaths from cryptococcosis in sub-Saharan Africa to an unchanging death rate from invasive candidiasis, despite three antifungal classes of drugs, insights into better strategies to reduce therapeutic failures or resistance are needed. This review examines the issues around antifungal drug resistance from both a basic description of the failures and how they are detected to the variety of issues that need to be addressed to help prevent failures for successful management. The reader will gain an understanding of the clinical complexities in this patient population for management of invasive fungal infections. Throughout the review, principles of management are given along with some specific clinical examples to illustrate the issues and frame the knowledge base. From this discussion it is hoped that the clinician can use the insights provided to manage individual patients and find links to the evidence-based material that support its conclusions. Also, this review specifically identifies the limitations of present management and directs clinicians to gather additional information and provide even better treatment strategies. Invasive fungal infections are life-threatening complications of serious underlying diseases. Their management can be complicated by both direct and clinical drug resistance and by understanding these possibilities and correcting them; most patients can be successfully managed with present antifungal drugs if the underlying diseases can be controlled.

  3. Assessment of two BWR accident management strategies

    SciTech Connect

    Hodge, S.A.; Petek, M.

    1991-01-01

    Candidate mitigative strategies for management of in-vessel events during the late phase (after core degradation has occurred) of postulated BWR severe accidents were considered at Oak Ridge National Laboratory (ORNL) during 1990. The identification of new strategies was subject to the constraint that they should, to the maximum extent possible, make use of the existing equipment and water resources of the BWR facilities and not require major equipment modifications or additions. As a result of this effort, two of these candidate strategies were recommended for additional assessment. The first is a strategy for containment flooding to maintain the core and structural debris within the reactor vessel in the event that vessel injection cannot be restored to terminate a severe accident sequence. The second strategy pertains to the opposite case, for which vessel injection would be restored after control blade melting had begun; its purpose is to provide an injection source of borated water at the concentration necessary to preclude criticality upon recovering a damaged BWR core. Assessments of these two strategies have been performed during 1991 under the auspices of the Detailed Assessment of BWR In-Vessel Strategies Program. This paper provides a discussion of the motivation for and purpose of these strategies and the potential for their success. 33 refs., 9 figs.

  4. Managing the Chronically Overworked Team: Twenty Strategies.

    PubMed

    Hills, Laura

    2015-01-01

    Overwork, at first glance, seems like a problem that affects only the employee. But for medical practices and those who manage them, the problem is far greater than that. Chronically overworked employees may not be meeting their goals. They may be making more mistakes and letting things slip through the cracks. Ultimately, patients may have less-than-ideal experiences in a practice where the employees are stretched thin. And turnover may skyrocket in practices where employees are chronically overworked. This article offers practice managers 20 practical and affordable strategies they can use to manage a chronically overworked medical practice team. It suggests an effective technique they can use to tell their bosses that their employees are overworked. This article also suggests the costs to the practice of a chronically overworked staff, including a hidden cost many people overlook. It provides four coping strategies practice managers can teach to their overworked employees. It summarizes research exploring how overwork affects employees' sleep and eating habits, and additional research linking long hours of overwork to diminished productivity. Finally, this article provides five strategies practice managers can use to make their overworked employees feel valued.

  5. Current strategies for prevention, detection, and treatment of ovarian cancer.

    PubMed

    Shepherd, J E

    2000-01-01

    To review the prevalence, etiology, risk factors, diagnosis, and treatment of ovarian cancer. English-language journal articles retrieved from a MEDLINE search from 1990 to the present, and selected references retrieved from the bibliographies of those articles. Clinical trials and pertinent review articles that discussed the detection, prevention, and clinical management of ovarian cancer. Although relatively uncommon, ovarian cancer is the leading cause of mortality from gynecologic cancer. Because most ovarian cancers are not detected until the disease has metastasized beyond the ovary, the 5-year survival rate for all cases is only 50%. Pharmacists can educate women about strategies that can reduce ovarian cancer risk, especially the use of oral contraceptives. To aid in earlier detection, pharmacists also should be aware of the nonspecific symptoms that can be associated with the disease, and refer women with suggestive symptoms to their physicians for further evaluation. Treatment usually consists of hysterectomy with debulking surgery to remove as much tumor as possible, followed by chemotherapy, for which the current gold standard is cisplatin and paclitaxel. Pharmacist-provided education can help women reduce their risk of ovarian cancer. As integral members of the health care team, pharmacists also can optimize the efficacy and tolerability of chemotherapeutic regimens; assist with palliative care for nausea, vomiting, and pain; and serve as a resource for patient information and support.

  6. Soil contamination in China: current status and mitigation strategies.

    PubMed

    Zhao, Fang-Jie; Ma, Yibing; Zhu, Yong-Guan; Tang, Zhong; McGrath, Steve P

    2015-01-20

    China faces great challenges in protecting its soil from contamination caused by rapid industrialization and urbanization over the last three decades. Recent nationwide surveys show that 16% of the soil samples, 19% for the agricultural soils, are contaminated based on China’s soil environmental quality limits, mainly with heavy metals and metalloids. Comparisons with other regions of the world show that the current status of soil contamination, based on the total contaminant concentrations, is not worse in China. However, the concentrations of some heavy metals in Chinese soils appear to be increasing at much greater rates. Exceedance of the contaminant limits in food crops is widespread in some areas, especially southern China, due to elevated inputs of contaminants, acidic nature of the soil and crop species or cultivars prone to heavy metal accumulation. Minimizing the transfer of contaminants from soil to the food chain is a top priority. A number of options are proposed, including identification of the sources of contaminants to agricultural systems, minimization of contaminant inputs, reduction of heavy metal phytoavailability in soil with liming or other immobilizing materials, selection and breeding of low accumulating crop cultivars, adoption of appropriate water and fertilizer management, bioremediation, and change of land use to grow nonfood crops. Implementation of these strategies requires not only technological advances, but also social-economic evaluation and effective enforcement of environmental protection law.

  7. Irritable bowel syndrome: contemporary nutrition management strategies.

    PubMed

    Mullin, Gerard E; Shepherd, Sue J; Chander Roland, Bani; Ireton-Jones, Carol; Matarese, Laura E

    2014-09-01

    Irritable bowel syndrome is a complex disorder whose pathophysiology involves alterations in the enteric microbiota, visceral hypersensitivity, gut immune/barrier function, hypothalamic-pituitary-adrenal axis regulation, neurotransmitters, stress response, psychological factors, and more. The importance of diet in the management of irritable bowel syndrome has taken center stage in recent times as the literature validates the relationship of certain foods with the provocation of symptoms. Likewise, a number of elimination dietary programs have been successful in alleviating irritable bowel syndrome symptoms. Knowledge of the dietary management strategies for irritable bowel syndrome will help guide nutritionists and healthcare practitioners to deliver optimal outcomes. This tutorial reviews the nutrition management strategies for irritable bowel syndrome.

  8. Assessing Fishers' Support of Striped Bass Management Strategies.

    PubMed

    Murphy, Robert D; Scyphers, Steven B; Grabowski, Jonathan H

    2015-01-01

    Incorporating the perspectives and insights of stakeholders is an essential component of ecosystem-based fisheries management, such that policy strategies should account for the diverse interests of various groups of anglers to enhance their efficacy. Here we assessed fishing stakeholders' perceptions on the management of Atlantic striped bass (Morone saxatilis) and receptiveness to potential future regulations using an online survey of recreational and commercial fishers in Massachusetts and Connecticut (USA). Our results indicate that most fishers harbored adequate to positive perceptions of current striped bass management policies when asked to grade their state's management regime. Yet, subtle differences in perceptions existed between recreational and commercial fishers, as well as across individuals with differing levels of fishing experience, resource dependency, and tournament participation. Recreational fishers in both states were generally supportive or neutral towards potential management actions including slot limits (71%) and mandated circle hooks to reduce mortality of released fish (74%), but less supportive of reduced recreational bag limits (51%). Although commercial anglers were typically less supportive of management changes than their recreational counterparts, the majority were still supportive of slot limits (54%) and mandated use of circle hooks (56%). Our study suggests that both recreational and commercial fishers are generally supportive of additional management strategies aimed at sustaining healthy striped bass populations and agree on a variety of strategies. However, both stakeholder groups were less supportive of harvest reductions, which is the most direct measure of reducing mortality available to fisheries managers. By revealing factors that influence stakeholders' support or willingness to comply with management strategies, studies such as ours can help managers identify potential stakeholder support for or conflicts that may

  9. Assessing Fishers' Support of Striped Bass Management Strategies

    PubMed Central

    Murphy, Robert D.; Scyphers, Steven B.; Grabowski, Jonathan H.

    2015-01-01

    Incorporating the perspectives and insights of stakeholders is an essential component of ecosystem-based fisheries management, such that policy strategies should account for the diverse interests of various groups of anglers to enhance their efficacy. Here we assessed fishing stakeholders’ perceptions on the management of Atlantic striped bass (Morone saxatilis) and receptiveness to potential future regulations using an online survey of recreational and commercial fishers in Massachusetts and Connecticut (USA). Our results indicate that most fishers harbored adequate to positive perceptions of current striped bass management policies when asked to grade their state’s management regime. Yet, subtle differences in perceptions existed between recreational and commercial fishers, as well as across individuals with differing levels of fishing experience, resource dependency, and tournament participation. Recreational fishers in both states were generally supportive or neutral towards potential management actions including slot limits (71%) and mandated circle hooks to reduce mortality of released fish (74%), but less supportive of reduced recreational bag limits (51%). Although commercial anglers were typically less supportive of management changes than their recreational counterparts, the majority were still supportive of slot limits (54%) and mandated use of circle hooks (56%). Our study suggests that both recreational and commercial fishers are generally supportive of additional management strategies aimed at sustaining healthy striped bass populations and agree on a variety of strategies. However, both stakeholder groups were less supportive of harvest reductions, which is the most direct measure of reducing mortality available to fisheries managers. By revealing factors that influence stakeholders’ support or willingness to comply with management strategies, studies such as ours can help managers identify potential stakeholder support for or conflicts that

  10. Beyond PARR - PMEL's Integrated Data Management Strategy

    NASA Astrophysics Data System (ADS)

    Burger, E. F.; O'Brien, K.; Manke, A. B.; Schweitzer, R.; Smith, K. M.

    2016-12-01

    NOAA's Pacific Marine Environmental Laboratory (PMEL) hosts a wide range of scientific projects that span a number of scientific and environmental research disciplines. Each of these 14 research projects have their own data streams that are as diverse as the research. With its requirements for public access to federally funded research results and data, the 2013 White House Office of Science and Technology memo on Public Access to Research Results (PARR) changed the data management landscape for Federal agencies. In 2015, with support from the PMEL Director, Dr. Christopher Sabine, PMEL's Science Data Integration Group (SDIG) initiated a multi-year effort to formulate and implement an integrated data-management strategy for PMEL research efforts. Instead of using external requirements, such as PARR, to define our approach, we focussed on strategies to provide PMEL science projects with a unified framework for data submission, interoperable data access, data storage, and easier data archival to National Data Centers. This improves data access to PMEL scientists, their collaborators, and the public, and also provides a unified lab framework that allows our projects to meet their data management objectives, as well as those required by the PARR. We are implementing this solution in stages that allows us to test technology and architecture choices before comitting to a large scale implementation. SDIG developers have completed the first year of development where our approach is to reuse and leverage existing frameworks and standards. This presentation will describe our data management strategy, explain our phased implementation approach, the software and framework choices, and how these elements help us meet the objectives of this strategy. We will share the lessons learned in dealing with diverse and complex datasets in this first year of implementation and how these outcomes will shape our decisions for this ongoing effort. The data management capabilities now

  11. The problem of current toxic chemicals management.

    PubMed

    Tickner, Joel; Geiser, Ken

    2004-01-01

    In this article, we explore the limitations of current chemicals management policies worldwide and the evolution of new European, International and U.S. policies to address the problem of toxic chemicals control. It is becoming increasingly apparent that current chemicals management policies in Europe and the United States are inadequate. There is a general lack of toxicity and exposure information on chemicals in commerce and the vast majority of chemicals were considered safe until proven guilty in legislation. Governments must then prove each chemical is dangerous through a slow and resource-intensive risk assessment process. For more than a decade, Nordic countries, such as Denmark and Sweden, have actively promoted integrated chemicals policies to address contamination of critical waterways. They have successfully used a variety of voluntary and mandatory policy tools, such as education, procurement, lists of chemicals of concern, eco-labeling, research and development on safer substitutes, and chemical phase-out requirements, to encourage companies using chemicals to reduce their reliance on harmful substances and to develop safer substitutes. While previously isolated to particular countries, innovative and exciting European-wide policies to promote sustainable chemicals management are now moving forward, including the recently published draft Registration, Evaluation and Authorization of CHemicals (REACH) policy of the European Union. A sweeping change in chemicals management policies in Europe is inevitable and it will ultimately affect manufacturers in the U.S. and globally. The European movement provides an opportunity to initiate a discussion on integrated chemicals policy in the U.S. where some innovative initiatives already are underway.

  12. Current possibilities in occlusal caries management.

    PubMed

    Jurić, Hrvoje

    2013-11-01

    Dental caries is a multifactorial disease that affects most populations throughout the world and it is still the primary cause of oral pain and tooth loss. The occlusal surfaces of posterior teeth are the most vulnerable sites for dental caries due to their anatomy. Therefore, the aim of the following article is to summarize current knowledge on occlusal caries development and the possibilities of its prevention. Although the overall caries rate today has fallen for populations in industrialized countries, the rate of occlusal surface caries has not decreased. This may be explained with fact that topically applied fluorides and their mode of action prevent caries better on smooth than on occlusal surfaces. As we know, tooth decay of first permanent molars causes a great deal of different short and long term difficulties for patients. Therefore, there is a continuous need for implementation of programs for caries prevention in permanent teeth. Nowadays, we like to treat our patients by minimally invasive methods. A very important step in our effective preventive treatment is sealing pits and fissures as a cornerstone of occlusal caries management. Reliable assessment of caries activity is also very important for defining treatment needs and plans. A very important decision, which should be made during occlusal caries management, is the selection of restorative material according to the treatment plan. Current possibilities in occlusal caries prevention and management are very effective. Therefore, dentists today do not have any excuse for avoiding the philosophy of Minimally Invasive Dentistry, especially when we talk about caries management of occlusal surfaces in permanent molars. Copyright © 2013 by Academy of Sciences and Arts of Bosnia and Herzegovina.

  13. Current clinical management of brainstem cavernomas.

    PubMed

    Bozinov, Oliver; Hatano, Taketo; Sarnthein, Johannes; Burkhardt, Jan-Karl; Bertalanffy, Helmut

    2010-11-26

    Over the last two decades a favourable course for treated or nontreated brainstem cavernomas has become possible with enhanced diagnostic tools and clinical experience, as well as minimally invasive microsurgical improvements. Currently, brainstem cavernoma can be treated microsurgically with excellent results and an acceptable morbidity rate. The preferred surgical route has progressively shifted from a dorsal to a lateral approach, but this remains dependent on the location of the lesion in the brainstem. Surgical evaluation and management of all cases of this rare disease should be performed by experienced teams from the outset.

  14. Sepsis: Current Definition, Pathophysiology, Diagnosis, and Management.

    PubMed

    Taeb, Abdalsamih M; Hooper, Michael H; Marik, Paul E

    2017-06-01

    Sepsis is a clinical syndrome that results from the dysregulated inflammatory response to infection that leads to organ dysfunction. The resulting losses to society in terms of financial burden, morbidity, and mortality are enormous. We provide a review of sepsis, its underlying pathophysiology, and guidance for diagnosis and management of this common disease. Current established treatments include appropriate antimicrobial agents to target the underlying infection, optimization of intravascular volume to improve stroke volume, vasopressors to counteract vasoplegic shock, and high-quality supportive care. Appropriate implementation of established treatments combined with novel therapeutic approaches promises to continue to decrease the impact of this disease.

  15. Osteoporosis: current trends in diagnosis and management.

    PubMed

    Kulenović, Indira; Rasić, Senija; Kulenović, Elvedin

    2006-02-01

    Osteoporosis (OP) is a generalized skeletal disorder characterized by low bone mineral density (BMD), deterioration of the microarchitecture of bone tissue and susceptibility to fracture. Most frequently it occurs in postmenopausal women and the aged. It is a chronic condition of multifactorial etiology and is a major global healthcare problem in developed and rising in developing countries. Patients with uncomplicated OP are usually asymptomatic which contributes to serious under-diagnosing of this potentially devastating condition. It is estimated that less than half of patients with OP are diagnosed in many developed countries. Therefore preventive measures and timely diagnosis have to be a key aspect of management of this disorder. In this article we briefly underline pato-physiology of the disorder, review current methods of measuring bone mineral density, describe risk factors and evaluate current and potential therapies.

  16. Fever management: Evidence vs current practice.

    PubMed

    El-Radhi, A Sahib Mehdi

    2012-12-08

    Fever is a very common complaint in children and is the single most common non-trauma-related reason for a visit to the emergency department. Parents are concerned about fever and it's potential complications. The biological value of fever (i.e., whether it is beneficial or harmful) is disputed and it is being vigorously treated with the belief of preventing complications such as brain injury and febrile seizures. The practice of alternating antipyretics has become widespread at home and on paediatric wards without supporting scientific evidence. There is still a significant contrast between the current concept and practice, and the scientific evidence. Why is that the case in such a common complaint like fever The article will discuss the significant contrast between the current concepts and practice of fever management on one hand, and the scientific evidence against such concepts and practice.

  17. Chordoma: current concepts, management, and future directions.

    PubMed

    Walcott, Brian P; Nahed, Brian V; Mohyeldin, Ahmed; Coumans, Jean-Valery; Kahle, Kristopher T; Ferreira, Manuel J

    2012-02-01

    Chordoma is a rare bone cancer that is aggressive, locally invasive, and has a poor prognosis. Chordomas are thought to arise from transformed remnants of notochord and have a predilection for the axial skeleton, with the most common sites being the sacrum, skull base, and spine. The gold standard treatment for chordomas of the mobile spine and sacrum is en-bloc excision with wide margins and postoperative external-beam radiation therapy. Treatment of clival chordomas is unique from other locations with an enhanced emphasis on preservation of neurological function, typified by a general paradigm of maximally safe cytoreductive surgery and advanced radiation delivery techniques. In this Review, we highlight current standards in diagnosis, clinical management, and molecular characterisation of chordomas, and discuss current research.

  18. Current management of allergic rhinitis in children.

    PubMed

    Georgalas, Christos; Terreehorst, Ingrid; Fokkens, Wytske

    2010-02-01

    Over the last 20 years, there has been significant progress in our understanding of the pathophysiology of allergic rhinitis, including the discovery of new inflammatory mediators, the link between asthma and allergic rhinitis ('one airway-one disease' concept) and the introduction of novel therapeutic modalities. These new insights have been documented in the Allergic Rhinitis and its Impact on Asthma guidelines and have led to the creation of evidence-based management algorithms. We now understand the importance of a common strategy for treating allergic inflammation of the upper and lower airway as a way of improving outcome, reducing hospital admissions, providing better quality of life and perhaps, altering the natural course of the 'allergic march'. A therapeutic ladder is suggested: Whereas for mild intermittent allergic rhinitis, allergen avoidance should be the first line of treatment with subsequent addition of a second generation topical or oral antihistamine, nasal saline or cromoglycate, in cases of moderate to severe allergic rhinitis, a nasal steroid is the treatment of choice. If a patient with moderate/severe persistent allergic rhinitis fails to improve after 4 wk of adequate treatment, patient compliance or the diagnosis must be re-assessed. In such cases, when the diagnosis is in doubt, a careful clinical examination including nasal endoscopy is mandatory to assess for other potential causes of nasal obstruction. In children who suffer from concomitant allergic rhinitis and asthma, a management algorithm that addresses concurrently asthma and allergic rhinitis is vital, both from a theoretical and from a practical point of view: Parents overwhelmingly prefer a single strategy for the treatment of their child's upper and lower airway symptoms; however, the overall quality of life in children with severe asthma can be significantly improved if rhinitis is adequately addressed.

  19. Current Management of Refractory Germ Cell Tumors and Future Directions.

    PubMed

    Allen, J Clayton; Kirschner, Austin; Scarpato, Kristen R; Morgans, Alicia K

    2017-02-01

    We review current management strategies for patients with relapsed and refractory germ cell tumors (GCTs), defined as relapsed or persistent disease following at least one line of cisplatin-based chemotherapy. Additionally, we discuss future directions in the management of these patients. Recent studies involving targeted therapies have been disappointing. Nevertheless, studies of the management of refractory germ cell cancer are ongoing, with a focus on optimal utilization of high-dose chemotherapy and autologous stem cell transplant, as well as the role of immune checkpoint inhibitors in refractory germ cell tumors. Studies aiming to identify those patients who may benefit from more intensive treatment up front to prevent the development of refractory disease are also in progress. Testicular germ cell tumors are among the most curable of all solid tumor malignancies, with cure being possible even in the refractory, metastatic setting. Treatment of refractory disease remains a challenging clinical scenario, but potentially practice changing studies are ongoing.

  20. Status epilepticus. Current concepts and management.

    PubMed Central

    Starreveld, E.; Starreveld, A. A.

    2000-01-01

    OBJECTIVE: To inform primary care physicians about current issues around generalized convulsive status epilepticus (GCSE) emphasizing definition, pathophysiology, treatment, and prognosis. QUALITY OF EVIDENCE: MEDLINE (1994 to 1999) provided 479 references using the MeSH terms "status epilepticus" and "treatment." From these we selected 30 English-language articles covering clinical aspects, treatment, and animal research. Key source documents from previous years and information from modern textbooks and recent symposia were also included. MAIN MESSAGE: Generalized convulsive status epilepticus continues to be a medical emergency with high morbidity and mortality. It must be managed promptly and effectively. The operational definition of GCSE is a seizure that lasts longer than 5 minutes or two or more seizures between which patients do not recover. Main differential diagnosis is nonepileptic status. Intravenous therapy with combined lorazepam and phenytoin is the initial treatment of choice. Other preferred medications are diazepam, midazolam, and propofol. Some of these medications should be considered before arrival at hospital. Prognosis of GCSE is determined by underlying cause, delay in adequate treatment, and comorbidity. Patients with GCSE lasting longer than 30 minutes require intensive care and electroencephalogram monitoring. CONCLUSION: Intravenous lorazepam and phenytoin are currently the most effective drugs for initial management of GCSE. Timely administration of antiepileptic medication can prevent development of GCSE in some patients with known epilepsy. Main differential diagnosis is nonepileptic status. PMID:11013800

  1. Pediatric enteric neuropathies: diagnosis and current management.

    PubMed

    Westfal, Maggie L; Goldstein, Allan M

    2017-06-01

    Neurointestinal diseases are increasingly recognized as causes of significant gastrointestinal morbidity in children. This review highlights the most common pediatric enteric neuropathies and their diagnosis and management, emphasizing insights and discoveries from the most recent literature available. The embryologic and histopathologic causes of enteric neuropathies are varied. They range from congenital aganglionosis in Hirschsprung disease, to autoimmune-mediated loss of neuronal subtypes in esophageal achalasia and Chagas disease, to degenerative neuropathies in some cases of chronic intestinal pseudo-obstruction and gastroparesis. Increased awareness of the clinical presentation and diagnostic evaluation of these conditions is essential as it allows for earlier initiation of treatment and improved outcomes. Most current therapies, which include medical management, neurostimulation, and operative intervention, aim to minimize the symptoms caused by these conditions. The evidence base for many of these treatments in children is poor, and multiinstitutional prospective studies are needed. An innovative therapy on the horizon involves using neuronal stem cell transplantation to treat the underlying disorder by replacing the missing or damaged neurons in these diseases. Although recent advances in basic and clinical neurogastroenterology have significantly improved our awareness and understanding of enteric neuropathies, the efficacy of current treatment approaches is limited. The development of novel therapies, including pharmacologic modulators of neurointestinal function, neurostimulation to enhance gut motility, and neuronal cell-based therapies, is essential to improve the long-term outcomes in children with these disorders.

  2. Current Australian physiotherapy management of hip osteoarthritis.

    PubMed

    Cowan, Sallie M; Blackburn, Meagan S; McMahon, Kylie; Bennell, Kim L

    2010-12-01

    Symptomatic osteoarthritis can be a painful, costly and debilitating condition. Whilst there is a substantial body of literature surrounding osteoarthritis of the knee, there is less reported research on the hip joint, especially pertaining to physiotherapy intervention. This descriptive study aimed to describe current physiotherapy management of osteoarthritis of the hip by Australian physiotherapists in private practice and acute hospital settings. Cross-sectional survey. A questionnaire was administered to 364 public and private practitioners in the state of Victoria. A response rate of 66% was achieved. Physiotherapists working in the private and public sectors reported frequent use of manual therapy (78% and 87%, respectively), aquatic therapy (82% and 58%, respectively) and home exercise programmes (88% and 80%, respectively). Class-based physiotherapy is employed less frequently (44% and 28%, respectively). Strengthening exercises are the most common treatment technique. The widespread use of exercise and manual therapy in the management of osteoarthritis of the hip is highlighted. There was little difference in overall physiotherapy management between the public and private settings. The results identify interventions commonly used in clinical practice. The need for further research to evaluate the effectiveness of frequently used interventions is also highlighted. Copyright © 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  3. CURRENT MANAGEMENT OF PERIPARTUM CARDIOMYOPATHY: A REVIEW.

    PubMed

    Dodiyi-Manuel, S T; Ezennaka, R C

    2015-01-01

    Demarkis et al in 1971 described 27 patients who presented during pueperium with cardiomegaly, abnormal electrocardiographic findings, congestive heart failure and named the syndrome "peripartum cardiomyopathy". The aim of this review is to document the current concepts in the management of peripartum cardiomyopathy. A search of the literature was done using PubMed, Goggle scholar and books from authors' collections. The cause of the disease might be environmental and genetic factors. Diagnostic echocardiographic criteria include left ventricular ejection fraction of less than 45% or a combination of M-mode fractional shortening of less than 30% and end diastolic dimension of greater than 2.7 cm/m². Electrocardiogram, magnetic resonance imaging, endomyocardial biopsy and cardiac catheterization aid in the diagnosis and management of peripartum cardiomyopathy. Treatment includes both conventional pharcomological heart failure and peripartum cardiomyopathy targeted therapies.Therapeutic decisions are influenced by drug safety profiles during pregnancy and lactation. Mechanical support and transplantation might be necessary in severe cases. Peripartum cardiomyopathy is an uncommon but life threatening cardiac failure of unknown aetiology encountered in late pregnancy or postpartum period. Management aims at improving heart failure symptoms through conventional therapies and then at administering targeted therapies.The risk of recurrence in future pregnancies should always be considered.

  4. Managing hyperthyroidism in pregnancy: current perspectives

    PubMed Central

    Andersen, Stine Linding; Laurberg, Peter

    2016-01-01

    Hyperthyroidism in women who are of childbearing age is predominantly of autoimmune origin and caused by Graves’ disease. The physiological changes in the maternal immune system during a pregnancy may influence the development of this and other autoimmune diseases. Furthermore, pregnancy-associated physiological changes influence the synthesis and metabolism of thyroid hormones and challenge the interpretation of thyroid function tests in pregnancy. Thyroid hormones are crucial regulators of early development and play an important role in the maintenance of a normal pregnancy and in the development of the fetus, particularly the fetal brain. Untreated or inadequately treated hyperthyroidism is associated with pregnancy complications and may even program the fetus to long-term development of disease. Thus, hyperthyroidism in pregnant women should be carefully managed and controlled, and proper management involves different medical specialties. The treatment of choice in pregnancy is antithyroid drugs (ATDs). These drugs are effective in the control of maternal hyperthyroidism, but they all cross the placenta, and so need careful management and control during the second half of pregnancy considering the risk of fetal hyper- or hypothyroidism. An important aspect in the early pregnancy is that the predominant side effect to the use of ATDs in weeks 6–10 of pregnancy is birth defects that may develop after exposure to available types of ATDs and may be severe. This review focuses on four current perspectives in the management of overt hyperthyroidism in pregnancy, including the etiology and incidence of the disease, how the diagnosis is made, the consequences of untreated or inadequately treated disease, and finally how to treat overt hyperthyroidism in pregnancy. PMID:27698567

  5. Current Trends in Supraventricular Tachycardia Management

    PubMed Central

    Sohinki, Daniel; Obel, Owen A.

    2014-01-01

    Background Supraventricular tachycardia (SVT) is a general term describing a group of arrhythmias whose mechanism involves or is above the atrioventricular node. The mechanisms of most forms of SVT have been elucidated, and pharmacologic and invasive therapies have evolved simultaneously. Methods We provide a brief overview of the mechanisms, classifications, and electrocardiographic characteristics of different SVTs and describe current trends in noninvasive and invasive therapies. Results The term SVT encompasses a heterogeneous group of arrhythmias with different electrophysiologic characteristics. Knowledge of the mechanism of each SVT is important in determining management at the bedside and in the electrophysiology laboratory. Conclusion In the acute setting, vagal maneuvers and pharmacologic therapy can be effective in arrhythmia termination. Catheter-based radiofrequency ablation has revolutionized therapy for many SVTs, and newer techniques have significantly improved ablation efficacy and reduced periprocedural complications and procedure times. Cryoablation is currently being investigated as an alternative form of energy delivery, although the long-term effectiveness of this procedure currently limits its use for many SVTs. PMID:25598724

  6. Environmental management strategy: four forces analysis.

    PubMed

    Doyle, Martin W; Von Windheim, Jesko

    2015-01-01

    We develop an analytical approach for more systematically analyzing environmental management problems in order to develop strategic plans. This approach can be deployed by agencies, non-profit organizations, corporations, or other organizations and institutions tasked with improving environmental quality. The analysis relies on assessing the underlying natural processes followed by articulation of the relevant societal forces causing environmental change: (1) science and technology, (2) governance, (3) markets and the economy, and (4) public behavior. The four forces analysis is then used to strategize which types of actions might be most effective at influencing environmental quality. Such strategy has been under-used and under-valued in environmental management outside of the corporate sector, and we suggest that this four forces analysis is a useful analytic to begin developing such strategy.

  7. Environmental Management Strategy: Four Forces Analysis

    NASA Astrophysics Data System (ADS)

    Doyle, Martin W.; Von Windheim, Jesko

    2015-01-01

    We develop an analytical approach for more systematically analyzing environmental management problems in order to develop strategic plans. This approach can be deployed by agencies, non-profit organizations, corporations, or other organizations and institutions tasked with improving environmental quality. The analysis relies on assessing the underlying natural processes followed by articulation of the relevant societal forces causing environmental change: (1) science and technology, (2) governance, (3) markets and the economy, and (4) public behavior. The four forces analysis is then used to strategize which types of actions might be most effective at influencing environmental quality. Such strategy has been under-used and under-valued in environmental management outside of the corporate sector, and we suggest that this four forces analysis is a useful analytic to begin developing such strategy.

  8. Heat management strategies for MSW landfills.

    PubMed

    Yeşiller, Nazli; Hanson, James L; Kopp, Kevin B; Yee, Emma H

    2016-10-01

    Heat is a primary byproduct of landfilling of municipal solid waste. Long-term elevated temperatures have been reported for MSW landfills under different operational conditions and climatic regions around the world. A conceptual framework is presented for management of the heat generated in MSW landfills. Three main strategies are outlined: extraction, regulation, and supplementation. Heat extraction allows for beneficial use of the excess landfill heat as an alternative energy source. Two approaches are provided for the extraction strategy: extracting all of the excess heat above baseline equilibrium conditions in a landfill and extracting only a part of the excess heat above equilibrium conditions to obtain target optimum waste temperatures for maximum gas generation. Heat regulation allows for controlling the waste temperatures to achieve uniform distribution at target levels at a landfill facility. Two approaches are provided for the regulation strategy: redistributing the excess heat across a landfill to obtain uniform target optimum waste temperatures for maximum gas generation and redistributing the excess heat across a landfill to obtain specific target temperatures. Heat supplementation allows for controlling heat generation using external thermal energy sources to achieve target waste temperatures. Two approaches are provided for the supplementation strategy: adding heat to the waste mass using an external energy source to increase waste temperatures and cooling the waste mass using an external energy source to decrease waste temperatures. For all strategies, available landfill heat energy is determined based on the difference between the waste temperatures and the target temperatures. Example analyses using data from landfill facilities with relatively low and high heat generation indicated thermal energy in the range of -48.4 to 72.4MJ/m(3) available for heat management. Further modeling and experimental analyses are needed to verify the effectiveness

  9. Management strategies for promoting successful breastfeeding.

    PubMed

    Bear, K; Tigges, B B

    1993-06-01

    Clinicians can promote a successful breastfeeding experience by providing support, anticipatory guidance and practical information. This article presents the components of early follow-up and guidelines for assessment. Management strategies for common problems are discussed, such as nipple soreness, cracked nipples, plugged ducts and mastitis, insufficient infant weight gain, perceived inadequacy of milk supply, breast-milk jaundice, sexual adjustment and failure at breastfeeding. Breastfeeding guidelines for employed mothers and adoptive mothers are indicated.

  10. Strategies for Management of Synchronous Colorectal Metastases.

    PubMed

    Castellanos, Jason A; Merchant, Nipun B

    2014-06-01

    The management of synchronous presentation of colorectal cancer and liver metastases has long been a topic of debate and discussion for surgeons due to the unique dilemma of balancing operative timing along with treatment strategy. Operative strategies for resection include staged resection with colon first approach, "reverse" staged resection with liver metastases resected first, and one-stage, or simultaneous, resection of both the primary tumor and liver metastases approach. These operative strategies can be further augmented with perioperative chemotherapy and other novel approaches that may improve resectability and patient survival. The decision on operative timing and approach, however, remains largely dependent on the surgeon's determination of disease resectability, patient fitness, and the need for neoadjuvant chemotherapy.

  11. Evolution in Clinical Knowledge Management Strategy at Intermountain Healthcare

    PubMed Central

    Hulse, Nathan C.; Galland, Joel; Borsato, Emerson P.

    2012-01-01

    In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs. PMID:23304309

  12. Optimal management of genital herpes: current perspectives.

    PubMed

    Sauerbrei, Andreas

    2016-01-01

    As one of the most common sexually transmitted diseases, genital herpes is a global medical problem with significant physical and psychological morbidity. Genital herpes is caused by herpes simplex virus type 1 or type 2 and can manifest as primary and/or recurrent infection. This manuscript provides an overview about the fundamental knowledge on the virus, its epidemiology, and infection. Furthermore, the current possibilities of antiviral therapeutic interventions and laboratory diagnosis of genital herpes as well as the present situation and perspectives for the treatment by novel antivirals and prevention of disease by vaccination are presented. Since the medical management of patients with genital herpes simplex virus infection is often unsatisfactory, this review aims at all physicians and health professionals who are involved in the care of patients with genital herpes. The information provided would help to improve the counseling of affected patients and to optimize the diagnosis, treatment, and prevention of this particular disease.

  13. Optimal management of genital herpes: current perspectives

    PubMed Central

    Sauerbrei, Andreas

    2016-01-01

    As one of the most common sexually transmitted diseases, genital herpes is a global medical problem with significant physical and psychological morbidity. Genital herpes is caused by herpes simplex virus type 1 or type 2 and can manifest as primary and/or recurrent infection. This manuscript provides an overview about the fundamental knowledge on the virus, its epidemiology, and infection. Furthermore, the current possibilities of antiviral therapeutic interventions and laboratory diagnosis of genital herpes as well as the present situation and perspectives for the treatment by novel antivirals and prevention of disease by vaccination are presented. Since the medical management of patients with genital herpes simplex virus infection is often unsatisfactory, this review aims at all physicians and health professionals who are involved in the care of patients with genital herpes. The information provided would help to improve the counseling of affected patients and to optimize the diagnosis, treatment, and prevention of this particular disease. PMID:27358569

  14. Catastrophic antiphospholipid syndrome: The current management approach.

    PubMed

    Rodriguez-Pintó, Ignasi; Espinosa, Gerard; Cervera, Ricard

    2016-04-01

    The current recommendation for catastrophic antiphospholipid syndrome (CAPS) management is the standard triple therapy with anticoagulation (AC), glucocorticoids (GCs), plasma exchange (PE), and/or intravenous immunoglobulins (IVIGs). Of note, only AC has a significant effect on the prognosis of these patients. However, from the experimental or basic point of view, there is only indirect evidence to advocate the use of these immunomodulatory therapies (GC, PE, and IVIG) in CAPS. Recently, there have been reports of severe or refractory CAPS patients treated with the monoclonal antibodies rituximab and eculizumab. The first blocks CD20, a surface protein expressed on the cytoplasmic membrane of B cells, and decreases the generation of pathogenic autoantibodies such as antiphospholipid (aPL) antibodies. The second binds with high affinity to C5 complement protein, inhibiting its cleavage and thus preventing the generation of C5b-C9 complex. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Avian influenza vaccination in Egypt: Limitations of the current strategy.

    PubMed

    Peyre, Marisa; Samaha, Hamid; Makonnen, Yilma Jobre; Saad, Ahmed; Abd-Elnabi, Amira; Galal, Saber; Ettel, Toni; Dauphin, Gwenaelle; Lubroth, Juan; Roger, François; Domenech, Joseph

    2009-12-09

    Vaccination of domestic poultry against avian influenza (AI) has been used on a large-scale in South East Asia since 2003 and in Egypt since 2006 to fight H5N1 highly-pathogenic avian influenza (HPAI) epidemics. The decision to use mass vaccination against HPAI in Egypt was taken as an emergency measure based on positive impact of such control measures in Vietnam and the People's Republic of China. However, three years on, the impact on disease control of AI vaccination in Egypt has been very limited. Despite the continuous vaccination of poultry against HPAI, poultry outbreaks and human cases are reported regularly. A recent assessment study highlighted substantial weaknesses in the current immunisation programme and its lack of positive impact on the spread of infection or the maintenance of public health safety. The shortcomings of the vaccination strategy may be attributed in part to a lack of sufficient support in terms of funding and communication, the absence of an efficient monitoring system, and inadequate training of field technicians. The difficulties of blanket vaccinations in semi-commercial farms and household poultry sectors are well known, however, improvements in the industrial sector should be possible though better government controls and greater collaboration with the private sector. AI vaccination should be regarded as just one control tool within a broader disease control program integrating surveillance, outbreak investigation, disease management systems, and the rigorous implementation of bio-security measures. If incorrectly implemented, AI vaccination has a limited impact as a disease control measure. Moreover, without strict bio-security precautions undertaken during its application, farm visits to vaccinate poultry could facilitate the spread of the virus and therefore become a risk factor with important implications on the maintenance of the virus and potential risk for human exposure.

  16. Financial Planning and Management--New Strategies.

    ERIC Educational Resources Information Center

    Mann, William J.

    1979-01-01

    The goal of the future financial manager should be to educate college personnel to the level necessary to make balanced decisions. The challenge is to maintain the current operable systems and develop new approaches to maximize scarce resources through effective communication. (RC)

  17. [Current recommendations for the management of TTTS].

    PubMed

    Ropacka-Lesiak, Mariola; Breborowicz, Grzegorz H

    2014-08-01

    The paper presents current views and recommendations for pregnancy complicated by TTTS. The symptoms that should attract our attention during the first-trimester ultrasound, i.e. CRL asymmetry NT > 95th percentile, or 20% or more of the NT difference between the fetuses, absent or reversed A wave in DV, and TV regurgitation, are discussed and presented. Similarly symptoms that should attract our attention in the second trimester such as amniotic fluid volume imbalance, asymmetry in the size of the urinary bladders, abdominal circumferences discordance, inter-twin membrane folding, membranous attachment of the donor's umbilical cord, different placental echogenicity and abnormal Doppler measurements, are listed. The paper presents the principle of monitoring based on ultrasound examination, including Doppler studies. The necessity and usefulness of echocardiography is underlined. It is also stressed that the frequency of monitoring depends on the severity of hemodynamic changes and the check-up rate varies from once a week to daily monitoring in extreme cases. This paper presents a variety of therapeutic options, including conservative management, septostomy amnioreduction, laser and selective fetoreduction. Taking into account the level of disease severity stages I and V can be managed conservatively. Fetoscopic laser coagulation of anastomoses, which can be used almost in all stages of TTTS (I-IV), remains to be the treatment of choice. However the current level of evidence does not yet allow us to determine whether laser coagulation increases or reduces the risk of neurodevelopmental delay and mental retardation in children, as compared to other types of therapy. Amnioreduction may be recommended in cases when laser therapy is unavailable or as first-line therapy before transporting the patient to the intrauterine therapy center.

  18. HRD Strategies for Expatriate Development: Review of Current Strategies and Potentials of Expatriate Mentoring

    ERIC Educational Resources Information Center

    Kim, Eunok Alice

    2007-01-01

    Expatriates are critical human resources and means of global organizations. Through review of literature, this paper examines HRD strategies that have been utilized to develop expatriates for international assignments, identifies gaps in current HRD strategies, and investigates unique potentials of expatriate mentoring contributing expatriate…

  19. Peripartum cardiomyopathy: current management and future perspectives

    PubMed Central

    Hilfiker-Kleiner, Denise; Haghikia, Arash; Nonhoff, Justus; Bauersachs, Johann

    2015-01-01

    Pregnancy is associated with marked physiological changes challenging the cardiovascular system. Among the more severe pregnancy associated cardiovascular complications, peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months in previously healthy women. A major challenge is to distinguish the peripartum discomforts in healthy women (fatigue, shortness of breath, and oedema) from the pathological symptoms of PPCM. Moreover, pregnancy-related pathologies such as preeclampsia, myocarditis, or underlying genetic disease show overlapping symptoms with PPCM. Difficulties in diagnosis and the discrimination from other pathological conditions in pregnancy may explain why PPCM is still underestimated. Additionally, underlying pathophysiologies are poorly understood, biomarkers are scarce and treatment options in general limited. Experience in long-term prognosis and management including subsequent pregnancies is just beginning to emerge. This review focuses on novel aspects of physiological and pathophysiological changes of the maternal cardiovascular system by comparing normal conditions, hypertensive complications, genetic aspects, and infectious disease in PPCM-pregnancies. It also presents clinical and basic science data on the current state of knowledge on PPCM and brings them in context thereby highlighting promising new insights in diagnostic tools and therapeutic approaches and management. PMID:25636745

  20. Intrahepatic cholangiocarcinoma: current management and emerging therapies.

    PubMed

    Rahnemai-Azar, Amir A; Weisbrod, Allison B; Dillhoff, Mary; Schmidt, Carl; Pawlik, Timothy M

    2017-05-01

    Intrahepatic cholangiocarcinoma (iCCA) is a malignancy with an increasing incidence and a high-case fatality. While surgery offers the best hope at long-term survival, only one-third of tumors are amenable to surgical resection at the time of the diagnosis. Unfortunately, conventional chemotherapy offers limited survival benefit in the management of unresectable or metastatic disease. Recent advances in understanding the molecular pathogenesis of iCCA and the use of next-generation sequencing techniques have provided a chance to identify 'target-able' molecular aberrations. These novel molecular therapies offer the promise to personalize therapy for patients with iCCA and, in turn, improve the outcomes of patients. Area covered: We herein review the current management options for iCCA with a focus on defining both established and emerging therapies. Expert commentary: Surgical resection remains as an only hope for cure in iCCA patients. However, frequently the diagnosis is delayed till advanced stages when surgery cannot be offered; signifying the urge for specific diagnostic tumor biomarkers and targeted therapies. New advances in genomic profiling have contributed to a better understanding of the landscape of molecular alterations in iCCA and offer hope for the development of novel diagnostic biomarkers and targeted therapies.

  1. Fluid management strategies in heart failure.

    PubMed

    Albert, Nancy M

    2012-04-01

    In patients with chronic heart failure, fluid retention (or hypervolemia) is often the stimulus for acute decompensated heart failure that requires hospitalization. The pathophysiology of fluid retention is complex and involves both hemodynamic and clinical congestion. Signs and symptoms of both hemodynamic and clinical congestion should be assessed serially during hospitalization. Core heart failure drug and cardiac device therapies should be provided, and ultrafiltration may be warranted. Critical care, intermediate care, and telemetry nurses have roles in both assessment and management of patients hospitalized with acute decompensated heart failure and fluid retention. Nurse administrators and managers have heightened their attention to fluid retention because the Medicare performance measure known as the risk-standardized 30-day all-cause readmission rate after heart failure hospitalization can be attenuated by fluid management strategies initiated by nurses during a patient's hospitalization.

  2. Opt-in medical management strategies.

    PubMed

    Fetterolf, Donald; Olson, Marty

    2008-02-01

    Historically, health plans and disease management companies have employed "opt-out" strategies for evaluating medical management outcomes across larger populations, targeting the entire population of eligible individuals and allowing those not interested to opt out. Recent observations that the predominant effort of these programs is on high-risk patients has lead some managers to suggest that the focus be on only those individuals with an anticipated higher effectiveness and lower cost to the payers of such services. They believe such "opt-in" models, in which only higher risk participants are targeted and enrolled, will deliver higher value. The use of common opt-in models, however, is not only methodologically unsound, but experience in the field suggests there may be less overall effect as well. Calculation methods for developing impact remain extremely sensitive to methodology

  3. Current management of advanced and castration resistant prostate cancer.

    PubMed

    Gomella, Leonard G; Petrylak, Daniel P; Shayegan, Bobby

    2014-04-01

    Newer approaches to the management of advanced prostate cancer have rapidly evolved. While basic androgen deprivation remains as the first line in newly diagnosed hormone naïve metastatic prostate cancer, the agents used and strategies followed have undergone significant changes. Numerous new agents such as sipuleucel-T, abiraterone, enzalutamide, cabazitaxel and radium 223 have all been approved since 2010 to treat metastatic castration resistant prostate cancer (CRPC). New imaging techniques to detect advanced disease such as F-18 PET, 11 C-choline PET and other modalities are becoming available. The concepts of "bone health" and the management of side effects related to androgen deprivation therapy are also gaining attention as men are being treated with longer courses of androgen deprivation. Understanding the theory behind these new agents and management approaches while focusing on the practical clinical considerations are essential to improve outcomes in advanced prostate cancer. A review of the current state of the art in the management of advanced and castration resistant prostate cancer presented in this Canadian Journal of Urology International supplement was performed. Key findings are summarized and presented along with critical updates based on recent publications and meeting presentations. Key concepts identified in the management of advanced prostate cancer included the new understanding of prostate cancer based on translational discoveries, applications of various hormonally based strategies in advanced disease including traditional and recently approved agents. The use of new imaging modalities to identify metastatic disease, immunotherapy approaches and discussions of sequencing and which new agents are likely to be available in the future in the management of CRPC were identified. Bone targeted strategies are also addressed in the setting of androgen deprivation and metastatic disease. The management of men with advanced prostate cancer has

  4. Current laparoscopic management of inflammatory bowel disease.

    PubMed

    Zoccali, M; Fichera, A

    2011-12-01

    Since the introduction of laparoscopic surgery in the management of colorectal disease in the early '90s, minimally invasive techniques have gained popularity. While good quality studies have been published in the literature on laparoscopy for colorectal cancer, evidence supporting the use of minimally invasive surgery for inflammatory bowel disease is lacking. This patient population represents a challenge to the colorectal surgeon even in conventional open surgery and this has limited the widespread application of minimally invasive techniques especially in Crohn's disease. Laparoscopic ileocecal resection for Crohn's disease is the most performed minimally invasive procedure in the field of inflammatory bowel disease, with promising short-term outcomes but with still some concerns related to prolonged operative times and overall costs. For ulcerative colitis the magnitude of restorative procedures has also restricted the use of minimally invasive approaches to highly specialized tertiary referral centers. The benefits of performing restorative procedures laparoscopically for ulcerative colitis are less obvious based on the limited reports available in the literature with adequate follow-up for assessing long-term outcomes, and controversies still remains about the need for a staged approach in the era of biologic therapy. Nevertheless, surgeons are actively working in an effort to obviate to the current technical limitations of laparoscopy, and to further minimize surgical trauma. In this manuscript we will present the current evidence supporting the use of laparoscopy and minimally invasive techniques in inflammatory bowel disease and present the future direction of development and research.

  5. Contemporary Strategies in the Management of Hepatocellular Carcinoma

    PubMed Central

    Khorsandi, Shirin Elizabeth; Heaton, Nigel

    2012-01-01

    Liver transplantation is the treatment of choice for selected patients with hepatocellular carcinoma (HCC) on a background of chronic liver disease. Liver resection or locoregional ablative therapies may be indicated for patients with preserved synthetic function without significant portal hypertension. Milan criteria were introduced to select suitable patients for liver transplant with low risk of tumor recurrence and 5-year survival in excess of 70%. Currently the incidence of HCC is climbing rapidly and in a current climate of organ shortage has led to the re-evaluation of locoregional therapies and resectional surgery to manage the case load. The introduction of biological therapies has had a new dimension to care, adding to the complexities of multidisciplinary team working in the management of HCC. The aim of this paper is to give a brief overview of present day management strategies and decision making. PMID:23197879

  6. Fibromyalgia: management strategies for primary care providers.

    PubMed

    Arnold, L M; Gebke, K B; Choy, E H S

    2016-02-01

    Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management. We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements. The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes. The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training. Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting. © 2016 John Wiley & Sons Ltd.

  7. Forest management strategies for reducing carbon emissions, the French case

    NASA Astrophysics Data System (ADS)

    Valade, Aude; Luyssaert, Sebastiaan; Bellassen, Valentin; Vallet, Patrick; Martin, Manuel

    2015-04-01

    International agreements now recognize the role of forest in the mitigation of climate change through the levers of in-situ sequestration, storage in products and energy and product substitution. These three strategies of carbon management are often antagonistic and it is still not clear which strategy would have the most significant impact on atmospheric carbon concentrations. With a focus on France, this study compares several scenarios of forest management in terms of their effect on the overall carbon budget from trees to wood-products. We elaborated four scenarios of forest management that target different wood production objectives. One scenario is 'Business as usual' and reproduces the current forest management and wood production levels. Two scenarios target an increase in bioenergy wood production, with either long-term or short-term goals. One scenario aims at increasing the production of timber for construction. For this, an empirical regression model was developed building on the rich French inventory database. The model can project the current forest resource at a time horizon of 20 years for characteristic variables diameter, standing volume, above-ground biomass, stand age. A simplified life-cycle analysis provides a full carbon budget for each scenario from forest management to wood use and allows the identification of the scenario that most reduces carbon emissions.

  8. Multiple system atrophy: current and future approaches to management

    PubMed Central

    Flabeau, Olivier; Meissner, Wassilios G.; Tison, François

    2010-01-01

    Multiple system atrophy (MSA) is a rare neurodegenerative disorder without any effective treatment in slowing or stopping disease progression. It is characterized by poor levodopa responsive Parkinsonism, cerebellar ataxia, pyramidal signs and autonomic failure in any combination. Current therapeutic strategies are primarily based on dopamine replacement and improvement of autonomic failure. However, symptomatic management remains disappointing and no curative treatment is yet available. Recent experimental evidence has confirmed the key role of alpha-synuclein aggregation in the pathogenesis of MSA. Referring to this hypothesis, transgenic and toxic animal models have been developed to assess candidate drugs for MSA. The standardization of diagnosis criteria and assessment procedures will allow large multicentre clinical trials to be conducted. In this article we review the available symptomatic treatment, recent results of studies investigating potential neuroprotective drugs, and future approaches for the management in MSA. PMID:21179616

  9. Optimal management of familial hypercholesterolemia: treatment and management strategies

    PubMed Central

    Nemati, Mohammad Hassan; Astaneh, Behrooz

    2010-01-01

    Familial hypercholesterolemia is an autosomally dominant disorder caused by various mutations in low-density lipoprotein receptor genes. This will lead to elevated levels of total and low-density lipoprotein cholesterol, which may in turn lead to premature coronary atherosclerosis and cardiac-related death. The symptoms are more severe in the homozygous type of the disease. Different options for the treatment of affected patients are now available. Diet therapy, pharmacologic therapy, lipid apheresis, and liver transplantation are among the various treatments. We clinically review the treatment and management strategies for the disease in order to shed light on the optimal management of familial hypercholesterolemia. PMID:21191428

  10. Suicide Gene Therapy for Cancer – Current Strategies

    PubMed Central

    Zarogoulidis, Paul; Darwiche, Kaid; Sakkas, Antonios; Yarmus, Lonny; Huang, Haidong; Li, Qiang; Freitag, Lutz; Zarogoulidis, Konstantinos; Malecki, Marek

    2013-01-01

    Current cancer treatments may create profound iatrogenic outcomes. The adverse effects of these treatments still remain, as the serious problems that practicing physicians have to cope with in clinical practice. Although, non-specific cytotoxic agents constitute an effective treatment modality against cancer cells, they also tend to kill normal, quickly dividing cells. On the other hand, therapies targeting the genome of the tumors are both under investigation, and some others are already streamlined to clinical practice. Several approaches have been investigated in order to find a treatment targeting the cancer cells, while not affecting the normal cells. Suicide gene therapy is a therapeutic strategy, in which cell suicide inducing transgenes are introduced into cancer cells. The two major suicide gene therapeutic strategies currently pursued are: cytosine deaminase/5-fluorocytosine and the herpes simplex virus/ganciclovir. The novel strategies include silencing gene expression, expression of intracellular antibodies blocking cells’ vital pathways, and transgenic expression of caspases and DNases. We analyze various elements of cancer cells’ suicide inducing strategies including: targets, vectors, and mechanisms. These strategies have been extensively investigated in various types of cancers, while exploring multiple delivery routes including viruses, non-viral vectors, liposomes, nanoparticles, and stem cells. We discuss various stages of streamlining of the suicide gene therapy into clinical oncology as applied to different types of cancer. Moreover, suicide gene therapy is in the center of attention as a strategy preventing cancer from developing in patients participating in the clinical trials of regenerative medicine. In oncology, these clinical trials are aimed at regenerating, with the aid of stem cells, of the patients’ organs damaged by pathologic and/or iatrogenic factors. However, the stem cells carry the risk of neoplasmic transformation. We

  11. Blood Management Strategies in Total Knee Arthroplasty

    PubMed Central

    Dan, Michael; Martinez Martos, Sara; Beller, Elaine

    2016-01-01

    A perioperative blood management program is one of a number of important elements for successful patient care in total knee arthroplasty (TKA) and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risk of blood transfusion whilst at the same time maximizing hemoglobin (Hb) in the postoperative period, leading to a positive effect on outcome and cost. An individualized strategy based on patient specific risk factors, anticipated blood loss and comorbidities are useful in achieving this aim. Multiple blood conservation strategies are available in the preoperative, intraoperative and postoperative periods and can be employed in various combinations. Recent literature has highlighted the importance of preoperative Hb optimization, minimizing blood loss and evidence-based transfusion guidelines. Given TKA is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal. PMID:27595070

  12. TASKILLAN II - Pilot strategies for workload management

    NASA Technical Reports Server (NTRS)

    Segal, Leon D.; Wickens, Christopher D.

    1990-01-01

    This study focused on the strategies used by pilots in managing their workload level, and their subsequent task performance. Sixteen licensed pilots flew 42 missions on a helicopter simulation, and were evaluated on their performance of the overall mission, as well as individual tasks. Pilots were divided in four groups, defined by the presence or absence of scheduling control over tasks and the availability of intelligence concerning the type and stage of difficulties imposed during the flight. Results suggest that intelligence supported strategies that yielded significant higher performance levels, while scheduling control seemed to have no impact on performance. Both difficulty type and the stage of difficulty impacted performance significantly, with strongest effects for time stresss and difficulties imposed late in the flight.

  13. It's magic: a unique practice management strategy.

    PubMed

    Schwartz, Steven

    2003-11-15

    For thousands of years prior to the advent of modern dentistry, magic has been used to entertain, impress, and motivate individuals. Today's dental professionals are using the concept of The Magic of a Healthy Smile through their use of modern clinical techniques and as a means for practice marketing, patient education, and the reduction of patient stress and fear. This article describes how dentists/magicians have incorporated magic into their practices and the benefits of this useful patient management strategy. A script of the "Happy Tooth Magic Show" and resources for dentists to create their own dental magic show are provided.

  14. Railgun current guard plates - Active current management and augmentation

    NASA Astrophysics Data System (ADS)

    Beno, Joseph H.; Weldon, William F.

    1989-06-01

    A system of auxiliary conductors designed to reduce current density peaks in railgun rails is described, and the effects on rail current density and projectile force are discussed. Performance comparisons with simple railguns and typical augmented railguns are made. It is shown that the wrap-around design of the guard plates can produce four to eight times the force produced by the usual augmented railgun design, without increasing local peak current densities. The range of performance contained in the factors between four and eight is primarily a function of the complexity of design. The more complex designs involve allowing the guard plates to overhang the rail slightly (intruding into the bore space, similar to rifling in a conventional gun barrel), and the use of separate power supplies for the rail and guard-plate conductors. These added complexities represent unacceptable complications for many applications, but may be justifiable for others.

  15. Current and new cytomegalovirus antivirals and novel animal model strategies.

    PubMed

    McGregor, Alistair

    2010-09-01

    Cytomegalovirus (CMV) is a significant health problem among immunosuppressed individuals. In particular, transplant and AIDS patients and the developing fetus in utero are highly susceptible to CMV. In these vulnerable populations, infection leads to life threatening end organ viral disease or in surviving newborn babies to deafness or to mental retardation. Currently, the most effective way to control CMV infection, given the lack of an effective vaccine, is by antiviral therapy. However, available antivirals suffer from complications associated with prolonged use, such as drug toxicity as well as the emergence of resistant strains of virus. Additionally, since CMV has multiple complex immune evasion strategies, to avoid innate and adaptive immune responses, there is a need for new antiviral development. Any antiviral should be tested in a controlled animal model but species specificity of HCMV precludes the direct study of the virus in an animal model. Consequently, animal CMV in their respective animal host are used to study intervention strategies. In this review, both current and new antiviral strategies are discussed as are the various animal models and strategies to improve existing antiviral animal models by humanizing animal CMV.

  16. Peritoneal mesothelioma: current understanding and management

    PubMed Central

    Chua, Terence C.; Yan, Tristan D.; Morris, David L.

    2009-01-01

    Mesothelioma is an asbestos-related tumour. Mesothelioma in the thorax occurs on the pleura and is known as pleural mesothelioma. It is the more common form of mesothelioma, accounting for 70% of cases. The other form occurs in the abdomen. It accounts for much of the remaining 30% and is known as peritoneal mesothelioma. Early diagnosis of peritoneal mesothelioma is often difficult because the early symptoms are often overlooked as being a benign ailment of the gastrointestinal tract. Therefore, diagnosis often occurs at an advanced stage when disease is widespread throughout the peritoneal cavity. Treatment approaches have evolved in the last decade from systemic chemotherapy and palliative surgery to aggressive cytoreductive surgery and perioperative intraperitoneal chemotherapy. This has led to a marked increase in survival among patients who were once classified as “preterminal.” We update on the current understanding of peritoneal mesothelioma from a clinical perspective in hope that greater clinician awareness will promote best practice management of this condition. PMID:19234654

  17. Managing the injured tendon: current concepts.

    PubMed

    Evans, Roslyn B

    2012-01-01

    Despite advances in understanding of the mechanical aspects of tendon management with improved suture technique and early stress application with postoperative therapy, clinical results remain inconsistent after repair, especially within the synovial regions. Complementary research to enhance the intrinsic pathway of healing, suppress the extrinsic pathway of healing, and manipulate frictional resistance to tendon gliding is now the focus of current basic science research on tendons. In the future, application of these new biologic therapies may increase the "safety zone" (or tolerance for load and excursion without dysfunctional gapping) as therapists apply stress to healing tendons and may alter future rehabilitation protocols by allowing greater angles of motion (and thus tendon excursion), increased external load, and decreased time in protective orthoses (splints). However, at this time, the stronger repair techniques and the application of controlled stress remain the best and most well-supported intervention after tendon injury and repair in the recovery of functional tendon excursion and joint range of motion. The hand therapist's role in this process remains a critical component contributing to satisfactory outcomes. Copyright © 2012 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  18. Management of refractory ischemic priapism: current perspectives.

    PubMed

    Capece, Marco; Gillo, Arianna; Cocci, Andrea; Garaffa, Giulio; Timpano, Massimiliano; Falcone, Marco

    2017-01-01

    The aim of the present manuscript is to review the current literature on priapism, focusing on the state-of-the-art knowledge of both the diagnosis and the treatment of the refractory ischemic priapism (IP). Pubmed and EMBASE search engines were used to search for words "priapism", "refractory priapism", "penile prosthesis", "diagnosis priapism", "priapism treatment", "penile fibrosis", "priapism therapy". All the studies were carefully examined by the authors and then included in the review. First-line treatment involves ejaculation, physical exercise and cold shower followed by corporal blood aspiration and injection of α-adrenoceptor agonists. Subsequently, a distal or proximal shunt may be considered. If none of the treatment is effective or the priapism episode lasts >48 hours penile prosthesis implantation could be the only option to solve the priapism and treat the ongoing erectile dysfunction. The management of IP is to achieve detumescence of persistent penile erection and to preserve erectile function after resolution of the priapic episode. On the other hand, penile fibrosis and following shortening should be prevented. Early penile prosthesis implantation in patients with refractory IP is able to solve both the priapic episode and prevent the otherwise certain penile shortening. Penile prosthesis implantation is the actual gold standard of care in cases of refractory IP.

  19. Strategies for pain management: a review.

    PubMed

    Sollami, Alfonso; Marino, Leonardo; Fontechiari, Simona; Fornari, Marta; Tirelli, Pierangela; Zenunaj, Elisabetta

    2015-09-09

    PROBLEM/BACKGROUND: Pain management is a major worldwide health problem. It manifests itself in a variety of forms involving in turn a multiplicity of responses and therapeutic strategies. Following from this, the training of health personnel must deal with this situation and must not only offer technical assistance, but must also deal with the psychological and social aspects of the problem. In recent years various guidelines and protocols have become popular for pain management. The aim of this paper is to present a literature review of the major international databases. Type of research: Systematic review. To identify relevant studies in the literature on pain management and identify the guidelines recognized by the scientific community. A literature search was conducted using the keywords "pain management" and "nurse" published since 2000 in English and Italian in the following databases: PubMed, CINAHL, Med Line. Excluding items which did not meet the inclusion criteria, 49 articles were included in the review. Despite a growing availability of evidence-based guidelines, drugs for pain control and the enactment of legislation to promote the use of opioid analgesics in pain therapy, a substantial proportion of the European population continues to have pain. Estimates of the prevalence of pain symptoms in the literature show that between 40% and 63% of hospitalized patients reported pain, peaking at 82.3% in cancer patients in advanced stages of the disease or terminally ill (in hospital or at home). Several studies published in recent years have agreed on a definition of some key points in the management of pain. Studies agree that pain should be recognized as the 5th vital sign, hence the need for validated scales whether single or multi-dimensional, quantitative or qualitative. The approach to the management of pain must be multi-professional, and the use of pharmacology must be in accordance with the WHO three-step approach. Several studies have demonstrated

  20. Part 2 -- current program integrating strategies and lubrication technology

    SciTech Connect

    Johnson, B.

    1996-12-01

    This paper is the second of two that describe the Predictive Maintenance Program for rotating machinery at the Palo Verde Nuclear Generating Station. The Predictive Maintenance program has been enhanced through organizational changes and improved interdisciplinary usage of technology. This paper will discuss current program strategies that have improved the interaction between the Vibration and Lube Oil programs. The {open_quotes}Lube Oil{close_quotes} view of the combined program along with case studies will then be presented.

  1. Invasive mycoses: strategies for effective management.

    PubMed

    Kontoyiannis, Dimitrios P

    2012-01-01

    Effective management of invasive fungal infections (IFIs) depends on early individualized therapy that optimizes efficacy and safety. Considering the negative consequences of IFI, for some high-risk patients the potential benefits of prophylactic therapy may outweigh the risks. When using a prophylactic, empiric, or preemptive therapeutic approach, clinicians must take into account the local epidemiology, spectrum of activity, pharmacokinetic and pharmacodynamic parameters, and safety profile of different antifungal agents, together with unique host-related factors that may affect antifungal efficacy or safety. Therapeutic drug monitoring is increasingly recognized as important or necessary when employing lipophilic triazoles (itraconazole, voriconazole, posaconazole) or flucytosine. Because early diagnostics remain limited for uncommon, yet emerging opportunistic molds (e.g., Mucorales), and treatment delay is associated with increased mortality, early effective management often depends on a high index of suspicion, taking into account predisposing factors, host cues favoring mucormycosis, and local epidemiology. Antifungal options for mucormycosis are limited, and optimal management depends on a multimodal approach that includes early diagnosis/clinical suspicion, correction of underlying predisposing factors, radical debridement of affected tissues, and extended antifungal therapy. This article discusses strategies for the effective management of invasive mycoses, with a particular focus on antifungal hepatotoxicity.

  2. Managing work and family: Do control strategies help?

    PubMed

    Versey, H Shellae

    2015-11-01

    How can we effectively manage competing obligations from work and family without becoming overwhelmed? This question inspires the current study by examining control strategies that may facilitate better work-life balance, with a specific focus on the role of lowered aspirations and positive reappraisals, attitudes that underlie adaptive coping behaviors. Data from the Midlife in the United States Survey (MIDUS II) were used to explore the relationship between negative spillover, control strategies, and well-being among full-time working men and women (N = 2,091). In this nationally representative sample, findings indicate that while positive reappraisals function as a protective buffer, lowering aspirations exacerbate the relationship between work-family spillover and well-being, with moderating effects stronger among women. This study extends prior research tying work-life conflict to health and mental health, and suggests further investigation is needed to consider types of resources that may be effective coping strategies in balancing work and family.

  3. Patient Experience Shows Little Relationship with Hospital Quality Management Strategies

    PubMed Central

    Groene, Oliver; Arah, Onyebuchi A.; Klazinga, Niek S.; Wagner, Cordula; Bartels, Paul D.; Kristensen, Solvejg; Saillour, Florence; Thompson, Andrew; Thompson, Caroline A.; Pfaff, Holger; DerSarkissian, Maral; Sunol, Rosa

    2015-01-01

    Objectives Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for public reporting or reimbursement. However, it is currently unclear whether hospitals with more mature quality management systems or stronger focus on patient involvement and patient-centered care strategies perform better on patient-reported experience. We assessed the effect of such strategies on a range of patient-reported experience measures. Materials and Methods We employed a cross-sectional, multi-level study design randomly recruiting hospitals from the Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey between May 2011 and January 2012. Each hospital contributed patient level data for four conditions/pathways: acute myocardial infarction, stroke, hip fracture and deliveries. The outcome variables in this study were a set of patient-reported experience measures including a generic 6-item measure of patient experience (NORPEQ), a 3-item measure of patient-perceived discharge preparation (Health Care Transition Measure) and two single item measures of perceived involvement in care and hospital recommendation. Predictor variables included three hospital management strategies: maturity of the hospital quality management system, patient involvement in quality management functions and patient-centered care strategies. We used directed acyclic graphs to detail and guide the modeling of the complex relationships between predictor variables and outcome variables, and fitted multivariable linear mixed models with random intercept by hospital, and adjusted for fixed effects at the country level, hospital level and patient level. Results Overall, 74 hospitals and 276 hospital departments contributed data on 6,536 patients to this study (acute

  4. Present and New Treatment Strategies in the Management of Glaucoma

    PubMed Central

    Kolko, M.

    2015-01-01

    Glaucoma is a neurodegenerative disease characterized by retinal ganglion cell (RGC) death and axonal loss. It remains a major cause of blindness worldwide. All current modalities of treatment are focused on lowering intraocular pressure (IOP), and it is evident that increased IOP is an important risk factor for progression of the disease. However, it is clear that a significant number of glaucoma patients show disease progression despite of pressure lowering treatments. Much attention has been given to the development of neuroprotective treatment strategies, but the identification of such has been hampered by lack of understanding of the etiology of glaucoma. Hence, in spite of many attempts no neuroprotective drug has yet been clinically approved. Even though neuroprotection is without doubt an important treatment strategy, many glaucoma subjects are diagnosed after substantial loss of RGCs. In this matter, recent approaches aim to rescue RGCs and regenerate axons in order to restore visual function in glaucoma. The present review seeks to provide an overview of the present and new treatment strategies in the management of glaucoma. The treatment strategies are divided into current available glaucoma medications, new pressure lowering targets, prospective neuroprotective interventions, and finally possible neuroregenrative strategies. PMID:26069521

  5. Do fibromyalgia patients use active pain management strategies? A cohort study.

    PubMed

    Gauffin, Jarno; Hankama, Tiina; Hannonen, Pekka; Kautiainen, Hannu; Pohjolainen, Timo; Haanpää, Maija

    2013-05-01

    The aim of this study was to examine the types of pain management strategies used by patients with fibromyalgia. A total of 158 patients with primary fibromyalgia attended a clinical visit to confirm the diagnosis. They completed 3 questionnaires: (i) a self-made questionnaire, (ii) Beck Depression Inventory IA (BDI IA), and (iii) Finnish version of Fibromyalgia Impact Questionnaire. The self-made questionnaire included questions about: intensity of current pain; general well-being; pain management strategies, including pain medications; efficacy of the pain management methods; current health problems other than fibromyalgia. The pain management strategies were subcategorized (e.g., physical exercise, massage and heat treatment). The strategies were also divided into active and passive types. The most frequently reported pain management strategies were physical exercise (54%), physical therapy (32%) and cold treatment (27%). The use of active pain management strategies, BDI IA < 10 points and age were independent predictors of the reported pain management efficacy. Patients who used active pain management strategies reported better efficacy with the BDI IA score ≥ 10 points. Active pain management strategies are most efficacious for fibromyalgia patients, regardless of the severity of fibromyalgia or optional comorbid depression.

  6. Current Therapeutic Strategies and Novel Approaches in Osteosarcoma

    PubMed Central

    Ando, Kosei; Heymann, Marie-Françoise; Stresing, Verena; Mori, Kanji; Rédini, Françoise; Heymann, Dominique

    2013-01-01

    Osteosarcoma is the most frequent malignant primary bone tumor and a main cause of cancer-related death in children and adolescents. Although long-term survival in localized osteosarcoma has improved to about 60% during the 1960s and 1970s, long-term survival in both localized and metastatic osteosarcoma has stagnated in the past several decades. Thus, current conventional therapy consists of multi-agent chemotherapy, surgery and radiation, which is not fully adequate for osteosarcoma treatment. Innovative drugs and approaches are needed to further improve outcome in osteosarcoma patients. This review describes the current management of osteosarcoma as well as potential new therapies. PMID:24216993

  7. Ulcerative Colitis: Current Treatment Strategies and Future Prospects

    PubMed Central

    Peppercorn, Mark A.

    2009-01-01

    Ulcerative colitis (UC) is a disease of unknown etiology characterized by inflammation of the mucosa and occasionally the submucosa of the colon. Conventional drug therapy for UC involves use of aminosalicylates, corticosteroids, azathioprine/6-mercaptopurine, cyclosporine and anti-tumor necrosis factor therapy. Alternative therapies include probiotics, nicotine and fish oil. Drugs like tacrolimus, rosiglitazone and Trichuris suis ova are being evaluated for use in UC patients. With the new biologic agents, new treatment options for UC continue to evolve. In this article we will discuss the conventional drugs, the alternative therapies and the management strategies according to the severity and extent of UC. PMID:21180538

  8. Ulcerative colitis: current treatment strategies and future prospects.

    PubMed

    Garud, Sagar; Peppercorn, Mark A

    2009-03-01

    Ulcerative colitis (UC) is a disease of unknown etiology characterized by inflammation of the mucosa and occasionally the submucosa of the colon. Conventional drug therapy for UC involves use of aminosalicylates, corticosteroids, azathioprine/6-mercaptopurine, cyclosporine and anti-tumor necrosis factor therapy. Alternative therapies include probiotics, nicotine and fish oil. Drugs like tacrolimus, rosiglitazone and Trichuris suis ova are being evaluated for use in UC patients. With the new biologic agents, new treatment options for UC continue to evolve. In this article we will discuss the conventional drugs, the alternative therapies and the management strategies according to the severity and extent of UC.

  9. Why Leading Consumer Product Companies Develop Proactive Chemical Management Strategies.

    PubMed

    Scruggs, Caroline E; Van Buren, Harry J

    2016-05-01

    Scholars have studied the various pressures that companies face related to socially responsible behavior when stakeholders know the particular social issues under consideration. Many have examined social responsibility in the context of environmental responsibility and the general approaches companies take regarding environmental management. The issue of currently unregulated, but potentially hazardous, chemicals in consumer products is not well understood by the general public, but a number of proactive consumer product companies have voluntarily adopted strategies to minimize use of such chemicals. These companies are exceeding regulatory requirements by restricting from their products chemicals that could harm human or environmental health, despite the fact that these actions are costly. They do not usually advertise the details of their strategies to end consumers. This article uses interviews with senior environmental directors of 20 multinational consumer product companies to investigate why these companies engage in voluntary chemicals management. The authors conclude that the most significant reasons are to achieve a competitive advantage and stay ahead of regulations, manage relationships and maintain legitimacy with stakeholders, and put managerial values into practice. Many of the characteristics related to the case of chemicals management are extendable to other areas of stakeholder management in which risks to stakeholders are either unknown or poorly understood.

  10. Specialty pharmacy cost management strategies of private health care payers.

    PubMed

    Stern, Debbie; Reissman, Debi

    2006-01-01

    The rate of increase in spending on specialty pharmaceuticals is outpacing by far the rate of increase in spending for other drugs. To explore the strategies payers are using in response to challenges related to coverage, cost, clinical management, and access of specialty pharmaceuticals and to describe the potential implications for key stakeholders, including patients, physicians, and health care purchasers. Sources of information were identified in the course of providing consulting services in the subject area of specialty pharmaceuticals to health plans, pharmacy benefit managers, employers, and pharmaceutical manufacturers. Specialty pharmaceuticals represent the fastest growing segment of drug spending due to new product approvals, high unit costs, and increasing use. Health care payers are faced with significant challenges related to coverage, cost, clinical management, and access. A variety of short- and long-term strategies have been employed to address these challenges. Current management techniques for specialty pharmaceuticals often represent a stop-gap approach for controlling rising drug costs. Optimum cost and care management methods will evolve as further research identifies the true clinical and economic value of various specialty pharmaceuticals.

  11. Why Leading Consumer Product Companies Develop Proactive Chemical Management Strategies

    PubMed Central

    Scruggs, Caroline E.; Van Buren, Harry J.

    2014-01-01

    Scholars have studied the various pressures that companies face related to socially responsible behavior when stakeholders know the particular social issues under consideration. Many have examined social responsibility in the context of environmental responsibility and the general approaches companies take regarding environmental management. The issue of currently unregulated, but potentially hazardous, chemicals in consumer products is not well understood by the general public, but a number of proactive consumer product companies have voluntarily adopted strategies to minimize use of such chemicals. These companies are exceeding regulatory requirements by restricting from their products chemicals that could harm human or environmental health, despite the fact that these actions are costly. They do not usually advertise the details of their strategies to end consumers. This article uses interviews with senior environmental directors of 20 multinational consumer product companies to investigate why these companies engage in voluntary chemicals management. The authors conclude that the most significant reasons are to achieve a competitive advantage and stay ahead of regulations, manage relationships and maintain legitimacy with stakeholders, and put managerial values into practice. Many of the characteristics related to the case of chemicals management are extendable to other areas of stakeholder management in which risks to stakeholders are either unknown or poorly understood. PMID:27471326

  12. Management strategies in hospitals: scenario planning

    PubMed Central

    Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

    2015-01-01

    Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”. Results: Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management. PMID:26504735

  13. Regional economic effects of current and proposed management alternatives for Arrowwood National Wildlife Refuge

    USGS Publications Warehouse

    Koontz, Lynne; Lambert, Heather

    2005-01-01

    This report first provides a description of the local community and economy near the Refuge. An analysis of current and proposed management strategies that could affect the local economy is then presented. The Refuge management activities of economic concern in this analysis are Refuge personnel staffing and Refuge spending within the local community, and spending in the local community by Refuge visitors.

  14. Regional economic effects of current and proposed management alternatives for Sand Lake National Wildlife Refuge

    USGS Publications Warehouse

    Koontz, Lynne; Lambert, Heather

    2005-01-01

    This report first provides a description of the local community and economy near the Refuge. An analysis of current and proposed management strategies that could affect the local economy is then presented. The Refuge management activities of economic concern in this analysis are Refuge personnel staffing and Refuge spending within the local community, and spending in the local community by Refuge visitors.

  15. Current and Potential Therapeutic Strategies for Hemodynamic Cardiorenal Syndrome

    PubMed Central

    Obi, Yoshitsugu; Kim, Taehee; Kovesdy, Csaba P.; Amin, Alpesh N.; Kalantar-Zadeh, Kamyar

    2016-01-01

    Background Cardiorenal syndrome (CRS) encompasses conditions in which cardiac and renal disorders co-exist and are pathophysiologically related. The newest classification of CRS into seven etiologically and clinically distinct types for direct patient management purposes includes hemodynamic, uremic, vascular, neurohumoral, anemia- and/or iron metabolism-related, mineral metabolism-related and protein-energy wasting-related CRS. This classification also emphasizes the pathophysiologic pathways. The leading CRS category remains hemodynamic CRS, which is the most commonly encountered type in patient care settings and in which acute or chronic heart failure leads to renal impairment. Summary This review focuses on selected therapeutic strategies for the clinical management of hemodynamic CRS. This is often characterized by an exceptionally high ratio of serum urea to creatinine concentrations. Loop diuretics, positive inotropic agents including dopamine and dobutamine, vasopressin antagonists including vasopressin receptor antagonists such as tolvaptan, nesiritide and angiotensin-neprilysin inhibitors are among the pharmacologic agents used. Additional therapies include ultrafiltration (UF) via hemofiltration or dialysis. The beneficial versus unfavorable effects of these therapies on cardiac decongestion versus renal blood flow may act in opposite directions. Some of the most interesting options for the outpatient setting that deserve revisiting include portable continuous dobutamine infusion, peritoneal dialysis and outpatient UF via hemodialysis or hemofiltration. Key Messages The new clinically oriented CRS classification system is helpful in identifying therapeutic targets and offers a systematic approach to an optimal management algorithm with better understanding of etiologies. Most interventions including UF have not shown a favorable impact on outcomes. Outpatient portable dobutamine infusion is underutilized and not well studied. Revisiting traditional and

  16. Nanomedicinal strategies to treat multidrug-resistant tumors: current progress

    PubMed Central

    Dong, Xiaowei; Mumper, Russell J

    2010-01-01

    Multidrug resistance (MDR) is a major impediment to the success of cancer chemotherapy. P-glycoprotein is an important and the best-known membrane transporter involved in MDR. Several strategies have been used to address MDR, especially P-glycoprotein-mediated drug resistance in tumors. However, clinical success has been limited, largely due to issues regarding lack of efficacy and/or safety. Nanoparticles have shown the ability to target tumors based on their unique physical and biological properties. To date, nanoparticles have been investigated primarily to address P-glycoprotein and the observed improved anticancer efficacy suggests that nanomedicinal strategies provide a new opportunity to overcome MDR. This article focuses on nanotechnology-based formulations and current nanomedicine approaches to address MDR in tumors and discusses the proposed mechanisms of action. PMID:20528455

  17. Current Antiplatelet Treatment Strategy in Patients with Diabetes Mellitus

    PubMed Central

    Jung, Jung Hwa; Tantry, Udaya S.; Gurbel, Paul A.

    2015-01-01

    Patients with diabetes mellitus (DM) have accelerated atherosclerosis with an increased risk for atherothrombotic cardiovascular complications. A state of high platelet reactivity and activation, hypercoagulability (prothrombotic state) and a subdued response to standard antiplatelet agents may explain high rate of adverse cardiovascular events in patients with DM. Several antithrombotic treatment strategies have been developed to control the prothrombotic state in patients with DM: dose modification of commonly used agents; use of potent agents; and addition of a third antithrombotic drug (triple therapy) to commonly prescribed dual antiplatelet therapy of aspirin and a P2Y12 inhibitor. The present review aims to provide an overview of the current knowledge on platelet abnormalities in patients with DM, focusing on the challenges and perspectives of antiplatelet treatment strategies in this population. PMID:25922803

  18. Health plans' strategies for managing outpatient specialty pharmaceuticals.

    PubMed

    Mullins, C Daniel; Lavallee, Danielle Chauncey; Pradel, Françoise G; DeVries, Andrea R; Caputo, Nadine

    2006-01-01

    Balancing increased spending for specialty pharmaceuticals while providing affordable and equitable coverage for consumers is a key issue for public and private payers. Health plans rely on an array of strategies, including both medical management and those used for more traditional pharmaceuticals. To explore specific management strategies for outpatient specialty pharmaceuticals, a survey was administered to thirty-eight Blue Cross and Blue Shield plans, focused on identifying core strategies. Prior authorization was the most commonly used strategy, implemented by 83.3 percent of respondents. Other frequently implemented management strategies included claims review (82.8 percent), formulary management (76.7 percent), and utilization review (70 percent).

  19. Epilepsy during pregnancy: focus on management strategies

    PubMed Central

    Borgelt, Laura M; Hart, Felecia M; Bainbridge, Jacquelyn L

    2016-01-01

    In the US, more than one million women with epilepsy are of childbearing age and have over 20,000 babies each year. Patients with epilepsy who become pregnant are at risk of complications, including changes in seizure frequency, maternal morbidity and mortality, and congenital anomalies due to antiepileptic drug exposure. Appropriate management of epilepsy during pregnancy may involve frequent monitoring of antiepileptic drug serum concentrations, potential preconception switching of antiepileptic medications, making dose adjustments, minimizing peak drug concentration with more frequent dosing, and avoiding potentially teratogenic medications. Ideally, preconception planning will be done to minimize risks to both the mother and fetus during pregnancy. It is important to recognize benefits and risks of current and emerging therapies, especially with revised pregnancy labeling in prescription drug product information. This review will outline risks for epilepsy during pregnancy, review various recommendations from leading organizations, and provide an evidence-based approach for managing patients with epilepsy before, during, and after pregnancy. PMID:27703396

  20. Relationship-Driven Classroom Management: Strategies That Promote Student Motivation.

    ERIC Educational Resources Information Center

    Vitto, John M.

    This book combines information about resiliency, classroom management, and discipline into a user-friendly discussion suitable for all teachers. The material covers both preventive strategies and reactive strategies. The chapters of part 1, "Reinventive Strategies," are: (1) "Relationship-Driven Classroom Management and Resilience"; (2)…

  1. Relationship-Driven Classroom Management: Strategies That Promote Student Motivation.

    ERIC Educational Resources Information Center

    Vitto, John M.

    This book combines information about resiliency, classroom management, and discipline into a user-friendly discussion suitable for all teachers. The material covers both preventive strategies and reactive strategies. The chapters of part 1, "Reinventive Strategies," are: (1) "Relationship-Driven Classroom Management and Resilience"; (2)…

  2. Effectiveness of alternative management strategies in meeting conservation objectives

    Treesearch

    Richards S. Holthausen; Carolyn Hull Sieg

    2007-01-01

    This chapter evaluates how well various management strategies meet a variety of conservation objectives, summarizes their effectiveness in meeting objectives for rare or little-known (RLK) species, and proposes ways to combine strategies to meet overall conservation objectives. We address two broad categories of management strategies. Species approaches result in...

  3. Antibiotic resistance: how it arises, the current position and strategies for the future.

    PubMed

    Perry, Christine; Hall, Carly

    After 70 years of antibiotic therapy, the threat of untreatable infections is again a reality with resistance to antibiotics increasing in both Gram positive and Gram negative bacteria. Antibiotic-resistant bacteria cause both community and healthcare associated infections, presenting challenges in treatment and management. The development of new and novel antibiotics, particularly for Gram negative bacteria, is worryingly lacking. This article reviews the current situation and examines future strategies to tackle the continued threat of bacterial resistance.

  4. 2013 update on current vaccination strategies in puppies and kittens.

    PubMed

    Davis-Wurzler, Gina M

    2014-03-01

    Vaccines remain one of the practitioner's greatest tools in preventing disease and maintaining individual and population health. This article is an update to "Current Vaccination Strategies in Puppies and Kittens" published in Veterinary Clinics of North America, Small Animal Practitioner, in May 2006. There are now comprehensive guidelines readily available for small animal practitioners regarding canine and feline pediatric (and adult) vaccination recommendations. Perhaps more importantly, there is an increased dialogue regarding all aspects of preventive medicine, of which vaccination is only a small, yet significant portion; and an increased drive to provide scientific evidence for developing vaccination recommendations.

  5. Current therapeutic strategies for inflammation following traumatic spinal cord injury☆

    PubMed Central

    Singh, Priyanka L.; Agarwal, Nitin; Barrese, James C.; Heary, Robert F.

    2012-01-01

    Damage from spinal cord injury occurs in two phases – the trauma of the initial mechanical insult and a secondary injury to nervous tissue spared by the primary insult. Apart from damage sustained as a result of direct trauma to the spinal cord, the post-traumatic inflammatory response contributes significantly to functional motor deficits exacerbated by the secondary injury. Attenuating the detrimental aspects of the inflammatory response is a promising strategy to potentially ameliorate the secondary injury, and promote significant functional recovery. This review details how the inflammatory component of secondary injury to the spinal cord can be treated currently and in the foreseeable future. PMID:25624806

  6. National launch strategy vehicle data management system

    NASA Technical Reports Server (NTRS)

    Cordes, David

    1990-01-01

    The national launch strategy vehicle data management system (NLS/VDMS) was developed as part of the 1990 NASA Summer Faculty Fellowship Program. The system was developed under the guidance of the Engineering Systems Branch of the Information Systems Office, and is intended for use within the Program Development Branch PD34. The NLS/VDMS is an on-line database system that permits the tracking of various launch vehicle configurations within the program development office. The system is designed to permit the definition of new launch vehicles, as well as the ability to display and edit existing launch vehicles. Vehicles can be grouped in logical architectures within the system. Reports generated from this package include vehicle data sheets, architecture data sheets, and vehicle flight rate reports. The topics covered include: (1) system overview; (2) initial system development; (3) supercard hypermedia authoring system; (4) the ORACLE database; and (5) system evaluation.

  7. Current concepts in the management of tendon disorders.

    PubMed

    Rees, J D; Wilson, A M; Wolman, R L

    2006-05-01

    Primary disorders of tendons are common and constitute a high proportion of referrals to rheumatologists. Certain tendons are particularly vulnerable to degenerative pathology; these include the Achilles, patella, elements of the rotator cuff, forearm extensors, biceps brachi and tibialis posterior tendons. Disorders of these tendons are often chronic and can be difficult to manage successfully in the long term. Significant advances have been made in understanding the pathophysiology of these conditions. Histopathological evidence, together with advances in imaging techniques, has made us more appreciative of the degenerative (rather that inflammatory) nature of these conditions. Additionally the presence of neovascularization is now well-recognized in long-standing tendinopathy. We review the mechanical, vascular and developing neural theories that attempt to explain the aetiology of degenerative tendinopathy. We also explore theories of why specific tendons (such as the Achilles and supraspinatus tendons) are particularly prone to degenerative pathology. Traditionally, treatments have placed a heavy emphasis on anti-inflammatory strategies, which are often inappropriate. Recently, however, significant advances in the practical management of tendon disorders have been made. In particular the advent of 'eccentric loading' training programmes has revolutionized the treatment of Achilles tendinopathy in some patients. This concept is currently being extended to include other commonly injured tendons. Other current treatments are reviewed, as are potential future treatments.

  8. Current Status of On-Site Wastewater Management

    ERIC Educational Resources Information Center

    Senn, Charles L.

    1978-01-01

    Wastewater management is becoming an important environmental issue nationally. This article reports the history and current status of wastewater management. Regulatory programs are discussed with specific state examples. Needs assessment is also included. (MA)

  9. Current Status of On-Site Wastewater Management

    ERIC Educational Resources Information Center

    Senn, Charles L.

    1978-01-01

    Wastewater management is becoming an important environmental issue nationally. This article reports the history and current status of wastewater management. Regulatory programs are discussed with specific state examples. Needs assessment is also included. (MA)

  10. Cutaneous Scar Prevention and Management: Overview of current therapies.

    PubMed

    Al-Shaqsi, Sultan; Al-Bulushi, Taimoor

    2016-02-01

    Cutaneous scarring is common after trauma, surgery and infection and occurs when normal skin tissue is replaced by fibroblastic tissue during the healing process. The pathophysiology of scar formation is not yet fully understood, although the degree of tension across the wound edges and the speed of cell growth are believed to play central roles. Prevention of scars is essential and can be achieved by attention to surgical techniques and the use of measures to reduce cell growth. Grading and classifying scars is important to determine available treatment strategies. This article presents an overview of the current therapies available for the prevention and treatment of scars. It is intended to be a practical guide for surgeons and other health professionals involved with and interested in scar management.

  11. Current Concepts in the Management of the Rheumatoid Hand

    PubMed Central

    Chung, Kevin C; Pushman, Allison G

    2011-01-01

    Hand surgeons are an integral part of the management team for patients with rheumatoid arthritis. There is now a greater understanding of the national utilization of rheumatoid hand surgery, which highlights the differences between hand surgeons and rheumatologists regarding the treatment of the rheumatoid hand. Advances in medical treatments have also decreased the prevalence of hand deformities caused by this disease. Hand surgeons today have less exposure to treating rheumatoid hand, but despite more effective medical options, surgery may still offer patients hope for improvement of hand function and appearance. This article will summarize the current state of rheumatoid hand surgery and discuss the surgical treatment strategies for optimizing outcomes for patients suffering from rheumatoid arthritis. PMID:21463736

  12. Preparing Future Leaders: Project Management Strategies for Service Learning

    ERIC Educational Resources Information Center

    Munger, Roger; Gutowski, Amanda

    2008-01-01

    This article makes a case for teaching project management strategies in service-learning courses. The authors describe three specific documents students can create to help them manage a service-learning project and then present strategies that can help students manage their project teams. Such skills, the authors argue, provide the tools students…

  13. Preparing Future Leaders: Project Management Strategies for Service Learning

    ERIC Educational Resources Information Center

    Munger, Roger; Gutowski, Amanda

    2008-01-01

    This article makes a case for teaching project management strategies in service-learning courses. The authors describe three specific documents students can create to help them manage a service-learning project and then present strategies that can help students manage their project teams. Such skills, the authors argue, provide the tools students…

  14. Preservice Teachers' Knowledge and Perceptions of Effective Behavior Management Strategies

    ERIC Educational Resources Information Center

    Nields, Allison N.

    2014-01-01

    This study examined student teachers' perceptions and knowledge of behavior management strategies. A questionnaire that included questions about broad behavior management techniques, behavioral learning theory, and behavior management strategies related to behavioral learning theory was given to sixty-one student teacher candidates at a large…

  15. Preservice Teachers' Knowledge and Perceptions of Effective Behavior Management Strategies

    ERIC Educational Resources Information Center

    Nields, Allison N.

    2014-01-01

    This study examined student teachers' perceptions and knowledge of behavior management strategies. A questionnaire that included questions about broad behavior management techniques, behavioral learning theory, and behavior management strategies related to behavioral learning theory was given to sixty-one student teacher candidates at a large…

  16. [Current concepts of polytrauma management: from ATLS to "damage control"].

    PubMed

    Stahel, P F; Heyde, C E; Wyrwich, W; Ertel, W

    2005-09-01

    In recent years, the implementation of standardized protocols for polytrauma management has led to a significant improvement in trauma care as well as to a decrease in post-traumatic morbidity and mortality. As such, the "Advanced Trauma Life Support" (ATLS) protocol of the American College of Surgeons for the acute management of severely injured patients has been established as a gold standard in most European countries since the 1990s. Continuative concepts to the ATLS program include the "Definitive Surgical Trauma Care" (DSTC) algorithm and the concept of "damage control" surgery for polytraumatized patients with immediate life-threatening injuries. These phase-oriented therapeutic strategies appraise the injured patient of the whole extent of the sustained injuries and are in sharp contrast to previous modalities of "early total care" which advocate immediate definitive surgical intervention. The approach of "damage control" surgery takes into account the influence of systemic post-traumatic inflammatory and metabolic reactions of the organism and is aimed at reducing both the primary and the secondary, delayed, mortality in severely injured patients. The present paper provides an overview of the current state of management algorithms for polytrauma patients, with a focus on the standard concepts of ATLS and "damage control".

  17. Therapeutic strategies for Leber's hereditary optic neuropathy: A current update.

    PubMed

    Gueven, Nuri; Faldu, Dharmesh

    2013-11-01

    Leber's hereditary optic neuropathy (LHON) is a rare mitochondrial retinopathy, caused by mutations in subunits of complex I of the respiratory chain, which leads to elevated levels of oxidative stress and an insufficient energy supply. This molecular pathology is thought to be responsible for the dysfunction and eventual apoptotic loss of retinal ganglion cells in the eye, which ultimately results in blindness. Many strategies, ranging from neuroprotectants, antioxidants, anti-apoptotic- and anti-inflammatory compounds have been tested with mixed results. Currently, the most promising compounds are short-chain quinones that have been shown to protect the vision of LHON patients during the early stages of the disease. This commentary gives a brief overview on the current status of tested therapeutics and also addresses future developments such as the use of gene therapy that hopefully will provide safe and efficient therapy options for all LHON patients.

  18. Pharmacological treatment for Alzheimer's disease: current approaches and future strategies.

    PubMed

    Fan, Ling-Yun; Chiu, Ming-Jang

    2010-12-01

    More than a decade after the first approval of the use of acetylcholine esterase inhibitor on patients with Alzheimer's disease, we still not have a single treatment or combination therapy that can effectively stop or reverse the relentless progression of such neurodegenerative disease. Recently therapeutics targeting amyloid hypothesis have undergone scrutiny by many clinical trials. These include gamma secretase inhibitor for reducing beta amyloid formation, agents for preventing aggregation of amyloid oligomers, and immunotherapy for enhancing clearance of amyloid and plaque. Therapies targeting hyperphosphorylated tau is another promising mechanism to be tackled with. Other agents enforcing mitochondria functions, enhancing serotonin receptors, modulating advanced glycation end products, and neurotrophic factors, as well as other therapies are also emerging. We review current treatments and therapeutic strategies already undergone different stage of clinical trails in this report. We propose that therapeutics of various combination composed of symptomatic treatments and disease modifying therapies will become standard regimens of AD treatment with much better efficacy than current approaches.

  19. Current therapeutic strategies for premature ejaculation and future perspectives

    PubMed Central

    Xin, Zhong-Cheng; Zhu, Yi-Chen; Yuan, Yi-Ming; Cui, Wan-Shou; Jin, Zhe; Li, Wei-Ren; Liu, Tao

    2011-01-01

    Premature ejaculation (PE) is a common sexual disorder in men that is mediated by disturbances in the peripheral and central nervous systems. Although all pharmaceutical treatments for PE are currently used ‘off-label', some novel oral agents and some newer methods of drug administration now provide important relief to PE patients. However, the aetiology of this condition has still not been unified, primarily because of the lack of a standard animal model for basic research and the absence of a widely accepted definition and assessment tool for evidence-based clinical studies in patients with PE. In this review, we focus on the current therapeutic strategies and future treatment perspectives for PE. PMID:21532601

  20. Liquid Acquisition Strategies for Exploration Missions: Current Status 2010

    NASA Technical Reports Server (NTRS)

    Chato, David J.

    2010-01-01

    NASA is currently developing the propulsion system concepts for human exploration missions to the lunar surface. The propulsion concepts being investigated are considering the use of cryogenic propellants for the low gravity portion of the mission, that is, the lunar transit, lunar orbit insertion, lunar descent and the rendezvous in lunar orbit with a service module after ascent from the lunar surface. These propulsion concepts will require the vapor free delivery of the cryogenic propellants stored in the propulsion tanks to the exploration vehicles main propulsion system (MPS) engines and reaction control system (RCS) engines. Propellant management devices (PMD s) such as screen channel capillary liquid acquisition devices (LAD s), vanes and sponges currently are used for earth storable propellants in the Space Shuttle Orbiter OMS and RCS applications and spacecraft propulsion applications but only very limited propellant management capability exists for cryogenic propellants. NASA has begun a technology program to develop LAD cryogenic fluid management (CFM) technology through a government in-house ground test program of accurately measuring the bubble point delta-pressure for typical screen samples using LO2, LN2, LH2 and LCH4 as test fluids at various fluid temperatures and pressures. This presentation will document the CFM project s progress to date in concept designs, as well ground testing results.

  1. Healthcare management strategies: interdisciplinary team factors.

    PubMed

    Andreatta, Pamela; Marzano, David

    2012-12-01

    Interdisciplinary team factors are significant contributors to clinical performance and associated patient outcomes. Quality of care and patient safety initiatives identify human factors associated with team performance as a prime improvement area for clinical patient care. The majority of references to interdisciplinary teams in obstetrics and gynecology in the literature recommends the use of multidisciplinary approaches when managing complex medical cases. The reviewed literature suggests that interdisciplinary team development is important for achieving optimally efficient and effective performance; however, few reports provide specific recommendations for how to optimally achieve these objectives in the process of providing interdisciplinary care to patients. The absence of these recommendations presents a significant challenge for those tasked with improving team performance in the workplace. The prescribed team development programs cited in the review are principally built around communication strategies and simulation-based training mechanisms. Few reports provide descriptions of optimal team-based competencies in the various contexts of obstetric and gynecology teams. However, team-based evaluation strategies and empirical data documenting the transfer of team training to applied clinical care are increasing in number and quality. Our findings suggest that research toward determining team factors that promote optimal performance in applied clinical practice requires definition of specific competencies for the variable teams serving obstetrics and gynecology.

  2. A review of current treatment strategies for gestational diabetes mellitus

    PubMed Central

    Kelley, Kristi W; Carroll, Dana G; Meyer, Allison

    2015-01-01

    Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM). It is well known that uncontrolled glucose results in poor pregnancy outcomes in both the mother and fetus. Worldwide there are many guidelines with recommendations for appropriate management strategies for GDM once lifestyle modifications have been instituted and failed to achieve control. The efficacy and particularly the safety of other treatment modalities for GDM has been the source of much debate in recent years. Studies that have demonstrated the safety and efficacy of both glyburide and metformin in the management of patients with GDM will be reviewed. There is a lack of evidence with other oral and injectable non-insulin agents to control blood glucose in GDM. The role of insulin will be discussed, with emphasis on insulin analogs. Ideal patient characteristics for each treatment modality will be reviewed. In addition, recommendations for postpartum screening of patients will be described as well as recommendations for use of agents to manage subsequent type 2 diabetes in patients who are breastfeeding. PMID:26213555

  3. Advanced blood management strategies for elective joint arthroplasty.

    PubMed

    Layton, Jodi L; Rubin, Lee E; Sweeney, Joseph D

    2013-03-01

    There is a high prevalence of anemia detected in the preoperative work-up of elective surgical patients preparing for total joint replacement. The impact of anemia in this population has significant implications due to elevations in postoperative morbidity and mortality. By using current clinical guidelines and medical evidence, clinicians can improve outcomes for these patients by employing a three-phase approach, focused on preoperative assessment, intraoperative hemostasis, and postoperative blood product management. Strategies to optimize preoperative hemoglobin levels, reduce intraoperative blood losses, and decrease postoperative transfusion rates can independently and collectively improve overall patient care and surgical outcomes following lower extremity total joint arthroplasty.

  4. Current management and prevention of malaria in pregnancy: a review.

    PubMed

    Agboghoroma, C O

    2014-01-01

    Pregnant women suffer more frequent and severe malaria than non-pregnant women. Malaria in pregnancy contributes to the high maternal and perinatal morbidity and mortality in Africa. To review the burden and highlight the current management and prevention strategies for control of malaria in pregnancy in Africa. Papers for this review were identified by searches of PubMed and Google, and references from relevant articles. Search terms were "malaria", "malaria in pregnancy", "Malaria during pregnancy" and "antimalarial drug". Only papers published in English between 1983 and 2013 were included. In malarial endemic areas, acquired partial malarial immunity is not effective during pregnancy. Pregnant women are prone to frequent malaria infections which may be severe or asymptomatic but associated with placental parasitization. Malaria contributes 2-15% to maternal anaemia, 13-70% to intrauterine growth restriction, 8-14% to low birth weight, 8-36% to prematurity, 3-8% to infant deaths and 2.9-17.6% to maternal mortality. The control of malaria in pregnancy is currently predicated on three main strategies: 1) Prompt and effective case management of malaria; 2).Use of Insecticide-treated nets; and 3).Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine. Artemisinin-based combined therapy is the recommended treatment for uncomplicated malaria in the second and third trimesters of pregnancy, while quinine is used in the first trimester and for severe cases of malaria at any gestational age. The control of malaria during pregnancy should be an integral part of efforts to reduce maternal and perinatal morbidity and mortality in Africa.

  5. Clinical multi-omics strategies for the effective cancer management.

    PubMed

    Yoo, Byong Chul; Kim, Kyung-Hee; Woo, Sang Myung; Myung, Jae Kyung

    2017-08-15

    Cancer is a global health issue as a multi-factorial complex disease, and early detection and novel therapeutic strategies are required for more effective cancer management. With the development of systemic analytical -omics strategies, the therapeutic approach and study of the molecular mechanisms of carcinogenesis and cancer progression have moved from hypothesis-driven targeted investigations to data-driven untargeted investigations focusing on the integrated diagnosis, treatment, and prevention of cancer in individual patients. Predictive, preventive, and personalized medicine (PPPM) is a promising new approach to reduce the burden of cancer and facilitate more accurate prognosis, diagnosis, as well as effective treatment. Here we review the fundamentals of, and new developments in, -omics technologies, together with the key role of a variety of practical -omics strategies in PPPM for cancer treatment and diagnosis. In this review, a comprehensive and critical overview of the systematic strategy for predictive, preventive, and personalized medicine (PPPM) for cancer disease was described in a view of cancer prognostic prediction, diagnostics, and prevention as well as cancer therapy and drug responses. We have discussed multi-dimensional data obtained from various resources and integration of multisciplinary -omics strategies with computational method which could contribute the more effective PPPM for cancer. This review has provided the novel insights of the current applications of each and combined -omics technologies, which showed their powerful potential for the establishment of PPPM for cancer. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Improving Recall Using Database Management Systems: A Learning Strategy.

    ERIC Educational Resources Information Center

    Jonassen, David H.

    1986-01-01

    Describes the use of microcomputer database management systems to facilitate the instructional uses of learning strategies relating to information processing skills, especially recall. Two learning strategies, cross-classification matrixing and node acquisition and integration, are highlighted. (Author/LRW)

  7. A holistic strategy for adaptive land management

    USDA-ARS?s Scientific Manuscript database

    Adaptive management is widely applied to natural resources management. Adaptive management can be generally defined as an iterative decision-making process that incorporates formulation of management objectives, actions designed to address these objectives, monitoring of results, and repeated adapta...

  8. Pheochromocytoma resection: Current concepts in anesthetic management

    PubMed Central

    Ramakrishna, Harish

    2015-01-01

    Pheochromocytoma represents very significant challenges to the anesthetist, especially when undiagnosed. These chromaffin tissue tumors are not uncommon in anesthetic practice and have varied manifestations. The perioperative management of these tumors has improved remarkably over the years, in conjunction with the evolution of surgical techniques (open laparotomy to laparoscopic techniques and now to robotic approaches in the present day). This review attempts to comprehensively address the intraoperative and postoperative issues in the management of these challenging tumors with an emphasis on hemodynamic monitoring and anesthetic technique. PMID:26330708

  9. Pleural infection-current diagnosis and management

    PubMed Central

    2012-01-01

    Pleural infection is a common and increasing clinical problem in thoracic medicine, resulting in significant morbidity and mortality. In recent years there has been a marked increase in interests and publications relating to evolving interventions and management options for pleural infection and empyema. Recently published research data as well as guidelines have suggested better approaches of radiological assessment, updated management algorithms for pleural infection, intrapleural adjunct therapies and re-examined the roles of biomarkers, pleural drainage techniques, and the role of surgery. This review highlights some of the recent advances and recommendations relevant to clinical care of pleural infection. PMID:22833824

  10. How drug life-cycle management patent strategies may impact formulary management.

    PubMed

    Berger, Jan; Dunn, Jeffrey D; Johnson, Margaret M; Karst, Kurt R; Shear, W Chad

    2016-10-01

    Drug manufacturers may employ various life-cycle management patent strategies, which may impact managed care decision making regarding formulary planning and management strategies when single-source, branded oral pharmaceutical products move to generic status. Passage of the Hatch-Waxman Act enabled more rapid access to generic medications through the abbreviated new drug application process. Patent expirations of small-molecule medications and approvals of generic versions have led to substantial cost savings for health plans, government programs, insurers, pharmacy benefits managers, and their customers. However, considering that the cost of developing a single medication is estimated at $2.6 billion (2013 dollars), pharmaceutical patent protection enables companies to recoup investments, creating an incentive for innovation. Under current law, patent protection holds for 20 years from time of patent filing, although much of this time is spent in product development and regulatory review, leaving an effective remaining patent life of 7 to 10 years at the time of approval. To extend the product life cycle, drug manufacturers may develop variations of originator products and file for patents on isomers, metabolites, prodrugs, new drug formulations (eg, extended-release versions), and fixed-dose combinations. These additional patents and the complexities surrounding the timing of generic availability create challenges for managed care stakeholders attempting to gauge when generics may enter the market. An understanding of pharmaceutical patents and how intellectual property protection may be extended would benefit managed care stakeholders and help inform decisions regarding benefit management.

  11. Consensus on Current Injectable Treatment Strategies in the Asian Face.

    PubMed

    Wu, Woffles T L; Liew, Steven; Chan, Henry H; Ho, Wilson W S; Supapannachart, Nantapat; Lee, Hong-Ki; Prasetyo, Adri; Yu, Jonathan Nevin; Rogers, John D

    2016-04-01

    The desire for and use of nonsurgical injectable esthetic facial treatments are increasing in Asia. The structural and anatomical features specific to the Asian face, and differences from Western populations in facial aging, necessitate unique esthetic treatment strategies, but published recommendations and clinical evidence for injectable treatments in Asians are scarce. The Asian Facial Aesthetics Expert Consensus Group met to discuss current practices and consensus opinions on the cosmetic use of botulinum toxin and hyaluronic acid (HA) fillers, alone and in combination, for facial applications in Southeastern and Eastern Asians. Consensus opinions and statements on treatment aims and current practice were developed following discussions regarding pre-meeting and meeting survey outcomes, peer-reviewed literature, and the experts' clinical experience. The indications and patterns of use of injectable treatments vary among patients of different ages, and among Asian countries. The combination use of botulinum toxin and fillers increases as patients age. Treatment aims in Asians and current practice regarding the use of botulinum toxin and HA fillers in the upper, middle, and lower face of patients aged 18 to >55 years are presented. In younger Asian patients, addressing proportion and structural features and deficiencies are important to achieve desired esthetic outcomes. In older patients, maintaining facial structure and volume and addressing lines and folds are essential to reduce the appearance of aging. This paper provides guidance on treatment strategies to address the complex esthetic requirements in Asian patients of all ages. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  12. Current Research on Effective Classroom Management.

    ERIC Educational Resources Information Center

    Emmer, Edmund T.

    This presentation provides an overview of research on classroom management, emphasizing results from a program of research conducted at the Research and Development Center for Teacher Education (University of Texas) during the last 5 years. These studies, along with others, provide a basis for describing important dimensions of teacher behavior…

  13. Pediatric asthma self-management: current concepts.

    PubMed Central

    Robinson, L. D.

    1999-01-01

    The concept of asthma self-management began in asthma camps in the 1970s. Today all asthma camps are required to provide an educational asthma self-management program. The interaction between children and educators is brief, and if the children do not continue in an associated program after camp, the benefits may be lost. Open Airways, the first program developed specifically for minority children, has been the prototype for community asthma self-management. School-based intervention programs have incorporated asthma education into the health curriculum. Some asthma education programs include an emphasis on the environment. Another approach is to develop intervention projects with parents, as in the Head Start program. This program has been very effective in increasing early recognition of asthma and decreasing recidivism in a high-risk population. Another type of project addressed the reading ability and reading comprehension of asthmatic children. Improvement in reading skills resulted in a 47% decrease in asthma recidivism. After 18 months, there were only two hospitalizations among the enrolled participants. Asthma self-management programs that are most effective for inner-city children provide an interactive, culturally relevant form of asthma education and address issues such as literacy and continuity. PMID:12653391

  14. Library and Learning Resources Management: Current Trends.

    ERIC Educational Resources Information Center

    Armsby, Allen; And Others

    1987-01-01

    The seven papers that make up this report focus on the impact of new information technology on curriculum and resource management at the college level in England and Wales. A brief preface, an introduction, and a foreword provide background information on the report and introduce the following papers: (1) "Curriculum Developments in Further…

  15. SUSTAINABLE MSW MANAGEMENT STRATEGIES IN THE UNITED STATES

    EPA Science Inventory

    Under increasing pressure to minimize potential environmental burdens and costs for municipal solid waste (MSW) management, state and local governments often must modify programs and adopt more efficient integrated MSW management strategies that reflect dynamic shifts in MSW mana...

  16. Current status and strategies for hepatitis B control in Korea.

    PubMed

    Cho, Eun Ju; Kim, Sung Eun; Suk, Ki Tae; An, Jihyun; Jeong, Soung Won; Chung, Woo Jin; Kim, Yoon Jun

    2017-09-01

    Hepatitis B virus (HBV) infection is the most common cause of chronic liver diseases in Korea. After the introduction of the universal HBV vaccination program, the prevalence of hepatitis B surface antigen was markedly reduced, and Korea is now classified as an area of intermediate endemicity for HBV. However, there are still hurdles for elimination of hepatitis B, such as immunoprophylaxis failure against vertical transmission, occurrence of acute hepatitis B among peoples who did not have vaccination at younger age, and rapid increase of immigrant populations from HBV endemic areas. To achieve the World Health Organization goal of viral hepatitis elimination by 2030 in Korea, we suggest comprehensive policies for more effective control of hepatitis B as following: i) insurance coverage for antiviral prophylaxis in mothers with high viremia, ii) screening for hepatitis B seromarkers and catch-up HBV vaccinations of susceptible persons with hepatitis B, iii) establishment of an independent 'viral hepatitis sector' in Centers for Disease Control & Prevention to organize and execute comprehensive strategy for management of viral hepatitis, iv) encourage of management of HBV infection in immigrant populations, v) national campaign to promote awareness of hepatitis B.

  17. Current status of pain management in China: an overview.

    PubMed

    Huang, Y

    2001-01-01

    China is a large country with a huge population. It is estimated that 1.8 million patients suffer initially from cancer and 1.4 million patients die from it each year in Mainland China. Cancer ranks as the primary reason for death among the common diseases in cities and the second in rural areas. The management of pain is still a critical issue in the care of patients both with cancer and non-cancer pain. A national survey suggested that the fear of addicting patients was still a major barrier for medical professionals in prescribing opioid analgesics. The major reasons for poor management or negative factors of pain relief came from patients' own reasons including their over-concern about addiction to opioid analgesics, their reluctance to report pain and their resistance to use opioid analgesics. Oral long-acting opioids are the most commonly used drugs for third ladder pain management. With policy support from the government, the consumption of morphine for medical purposes has increased significantly for the first time in recent Chinese history as this new cancer pain relief policy has been developed in the country. As a result, the three-step analgesic ladder of the World Health Organization (WHO) has been gradually accepted by medical personnel and patients. Although pain management has been improved since the WHO's strategy of the three-step approach was implemented in China, variations still exist in different regions of the Mainland. Currently the three main aspects of work on pain measurement are going to be undertaken including (1) continuous support from government policy; (2) consistent education and training; and (3) better availability of drugs for medical use throughout the whole country. Copyright 2001 European Federation of Chapters of the International Association for the Study of Pain.

  18. Anaplastic glioma: current treatment and management.

    PubMed

    Le Rhun, Emilie; Taillibert, Sophie; Chamberlain, Marc C

    2015-06-01

    Anaplastic glioma (AG) is divided into three morphology-based groups (anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic oligoastrocytoma) as well as three molecular groups (glioma-CpG island methylation phenotype [G-CIMP] negative, G-CIMP positive non-1p19q codeleted tumors and G-CIMP positive codeleted tumors). The RTOG 9402 and EORTC 26951 trials established radiotherapy plus (procarbazine, lomustine, vincristine) chemotherapy as the standard of care in 1p/19q codeleted AG. Uni- or non-codeleted AG are currently best treated with radiotherapy only or alkylator-based chemotherapy only as determined by the NOA-04 trial. Maturation of NOA-04 and results of the currently accruing studies, CODEL (for codeleted AG) and CATNON (for uni or non-codeleted AG), will likely refine current up-front treatment recommendations for AG.

  19. Pediatric papillary thyroid cancer: current management challenges

    PubMed Central

    Verburg, Frederik A; Van Santen, Hanneke M; Luster, Markus

    2017-01-01

    Although with a standardized incidence of 0.54 cases per 100,000 persons, differentiated thyroid cancer (DTC) is a rare disease in children and adolescents, it nonetheless concerns ~1.4% of all pediatric malignancies. Furthermore, its incidence is rising. Due to the rarity and long survival of pediatric DTC patients, in most areas of treatment little evidence exists. Treatment of pediatric DTC is therefore littered with controversies, many questions therefore remain open regarding the optimal management of pediatric papillary thyroid cancer (PTC), and many challenges remain unsolved. In the present review, we aim to provide an overview of these challenging areas of patient and disease management in pediatric PTC patients. Data on diagnosis, surgery, radionuclide, and endocrine therapy are discussed, and the controversies therein are highlighted. PMID:28096684

  20. Current Management of Sickle Cell Anemia

    PubMed Central

    McGann, Patrick T.; Nero, Alecia C.; Ware, Russell E.

    2013-01-01

    Proper management of sickle cell anemia (SCA) begins with establishing the correct diagnosis early in life, ideally during the newborn period. The identification of affected infants by neonatal screening programs allows early initiation of prophylactic penicillin and pneumococcal immunizations, which help prevent overwhelming sepsis. Ongoing education of families promotes the early recognition of disease-released complications, which allows prompt and appropriate medical evaluation and therapeutic intervention. Periodic evaluation by trained specialists helps provide comprehensive care, including transcranial Doppler examinations to identify children at risk for primary stroke, plus assessments for other parenchymal organ damage as patients become teens and adults. Treatment approaches that previously highlighted acute vaso-occlusive events are now evolving to the concept of preventive therapy. Liberalized use of blood transfusions and early consideration of hydroxyurea treatment represent a new treatment paradigm for SCA management. PMID:23709685

  1. MANAGEMENT OF VARICEAL HEMORRHAGE: CURRENT CONCEPTS

    PubMed Central

    COELHO, Fabricio Ferreira; PERINI, Marcos Vinícius; KRUGER, Jaime Arthur Pirola; FONSECA, Gilton Marques; de ARAÚJO, Raphael Leonardo Cunha; MAKDISSI, Fábio Ferrari; LUPINACCI, Renato Micelli; HERMAN, Paulo

    2014-01-01

    Introduction The treatment of portal hypertension is complex and the the best strategy depends on the underlying disease (cirrhosis vs. schistosomiasis), patient's clinical condition and time on it is performed (during an acute episode of variceal bleeding or electively, as pre-primary, primary or secondary prophylaxis). With the advent of new pharmacological options and technical development of endoscopy and interventional radiology treatment of portal hypertension has changed in recent decades. Aim To review the strategies employed in elective and emergency treatment of variceal bleeding in cirrhotic and schistosomotic patients. Methods Survey of publications in PubMed, Embase, Lilacs, SciELO and Cochrane databases through June 2013, using the headings: portal hypertension, esophageal and gastric varices, variceal bleeding, liver cirrhosis, schistosomiasis mansoni, surgical treatment, pharmacological treatment, secondary prophylaxis, primary prophylaxis, pre-primary prophylaxis. Conclusion Pre-primary prophylaxis doesn't have specific treatment strategies; the best recommendation is treatment of the underlying disease. Primary prophylaxis should be performed in cirrhotic patients with beta-blockers or endoscopic variceal ligation. There is controversy regarding the effectiveness of primary prophylaxis in patients with schistosomiasis; when indicated, it is done with beta-blockers or endoscopic therapy in high-risk varices. Treatment of acute variceal bleeding is systematized in the literature, combination of vasoconstrictor drugs and endoscopic therapy, provided significant decline in mortality over the last decades. TIPS and surgical treatment are options as rescue therapy. Secondary prophylaxis plays a fundamental role in the reduction of recurrent bleeding, the best option in cirrhotic patients is the combination of pharmacological therapy with beta-blockers and endoscopic band ligation. TIPS or surgical treatment, are options for controlling rebleeding on

  2. Current management of the short bowel syndrome.

    PubMed

    Thompson, Jon S; Weseman, Rebecca; Rochling, Fedja A; Mercer, David F

    2011-06-01

    Short bowel syndrome is a challenging clinical problem that benefits from a multidisciplinary approach. Much progress has recently been made in all aspects of management. Medical intestinal rehabilitation should be the initial treatment focus, and several new potential pharmacologic agents are being investigated. Surgical rehabilitation using nontransplant procedures in selected patients may further improve intestinal function. Intestinal lengthening procedures are particularly promising. Intestinal transplantation has increasingly been used with improving success in patients with life-threatening complications of intestinal failure.

  3. Current management of Helicobacter pylori infection.

    PubMed

    Pasternak, H I

    1999-08-01

    Helicobacter pylori infection continues to be one of the hottest topics in gastroenterology, challenging the primary care physician daily with the clinical application of its new developments and frequency of involvement in differential diagnosis. This article offers the primary care physician a practical approach to the dyspeptic office patient that emphasizes the differential diagnosis of H pylori. Included is a strategy for rapid patient evaluation through key questions in the history, simple maneuvers in the physical examination, and a logical approach to testing and therapy based on the latest literature. The recommendations for all these office-based steps are designed to be efficient, cost-effective, and clinically relevant.

  4. Current Medical Management of Peptic Ulcer Disease

    PubMed Central

    Lukie, Bryan E.

    1989-01-01

    Peptic ulceration occurs when the digestive action of gastric secretions overcomes gastroduodenal mucosal defences. The therapeutic strategy used to correct this imbalance uses drugs that either reduce gastric secretion or increase mucosal resistance. Traditional therapies of dietary manipulation and antacid administration no longer play major roles in peptic ulcer therapy. Uncomplicated peptic ulcers respond quite well to drug treatment, although recurrences are common and may require long-term maintenance therapy. Drug-induced gastric ulcers have represented a challenging problem, for which effective therapy is now available. PMID:21249091

  5. Animal bites: the current management guidelines.

    PubMed

    Chhabra, Mala; Ichhpujani, R L

    2003-03-01

    Rabies is a major public health problem in India. It is mainly transmitted by stray dogs, which form an overwhelming population in the country. Dogs are responsible for upto 95% of animal bites requiring antirabies treatment. In view of the exceptionally high fatality rate of human rabies, the prevention of infection after exposure is of utmost importance. With the availability of safe and effective tissue culture vaccines prevention of this dreaded disease is virtually assured by immediate and appropriate post exposure treatment. This is a three pronged approach including proper wound management, judicious use of antirabies serum and modern tissue culture vaccines. In India, Neural Tissue Vaccine is still used for post exposure treatment in public sector, though effective, this vaccine has serious side effects. The production and use of tissue culture vaccine should be encouraged with the aim to phase out neural tissue vaccine. WHO recommends use of intradermal route of inoculation of Tissue Culture Vaccine which makes the treatment very economical. However, this route as yet, is not approved by Drug Controller, Government of India (DCGI). There are no uniform guidelines for management of animal bite cases in India. In this article an attempt is made to discuss various aspects of animal bite management.

  6. Implementing bedside handover: strategies for change management.

    PubMed

    McMurray, Anne; Chaboyer, Wendy; Wallis, Marianne; Fetherston, Cathy

    2010-09-01

    To identify factors influencing change in two hospitals that moved from taped and verbal nursing handover to bedside handover. Bedside handover is based on patient-centred care, where patients participate in communicating relevant and timely information for care planning. Patient input reduces care fragmentation, miscommunication-related adverse events, readmissions, duplication of services and enhances satisfaction and continuity of care. Analysing change management was a component of a study aimed at developing a standard operating protocol for bedside handover communication. The research was undertaken in two regional acute care hospitals in two different states of Australia. Data collection included 532 semi-structured observations in six wards in the two hospitals and 34 in-depth interviews conducted with a purposive sample of nursing staff involved in the handovers. Observation and interview data were analysed separately then combined to generate thematic analysis of factors influencing the change process in the transition to bedside handover. Themes included embedding the change as part of the big picture, the need to link the project to standardisation initiatives, providing reassurance on safety and quality, smoothing out logistical difficulties and learning to listen. We conclude that change is more likely to be successful when it is part of a broader initiative such as a quality improvement strategy. Nurses are generally supportive of quality improvement initiatives, particularly those aimed at standardising care. For successful implementation, change managers should be mindful of clinicians' attitudes, motivation and concerns and their need for reassurance when changing their practice. This is particularly important when change is dramatic, as in moving from verbal handover, conducted in the safety of the nursing office, to bedside handover where there is greater transparency and accountability for the accuracy and appropriateness of communication

  7. Evidence-based Management Strategies for Treatment of Chronic Wounds

    PubMed Central

    Werdin, Frank; Tennenhaus, Mayer; Schaller, Hans-Eberhardt; Rennekampff, Hans-Oliver

    2009-01-01

    The care and management of patients with chronic wounds and their far-reaching effects challenge both the patient and the practitioner. Further complicating this situation is the paucity of evidence-based treatment strategies for chronic wound care. After searching both MEDLINE and Cochrane databases, we reviewed currently available articles concerning chronic wound care. Utilizing this information, we have outlined a review of current, evidence-based concepts as they pertain to the treatment of chronic wounds, focusing on fundamental treatment principles for the management of venous, arterial, diabetic, and pressure ulcers. Individualized treatment options as well as general wound management principles applicable to all varieties of chronic wounds are described. Classification and treatment guidelines as well as the adoption of the TIME acronym facilitate an organized conceptional approach to wound care. In so doing, individual aspects of generalized wound care such as debridement, infection, and moisture control as well as attention to the qualities of the wound edge are comprehensively evaluated, communicated, and addressed. Effective adjuvant agents for the therapy of chronic wounds including nutritional and social support measures are listed, as is a brief review of strategies helpful for preventing recurrence. An appreciation of evidence-based treatment pathways and an understanding of the pathophysiology of chronic wounds are important elements in the management of patients with chronic wounds. To achieve effective and long-lasting results, a multidisciplinary approach to patient care, focused on the education and coordination of patient, family as well as medical and support staff can prove invaluable. PMID:19578487

  8. [Current operative techniques and strategies in endocrine surgery].

    PubMed

    Gürtler, Thomas; Weber, Markus

    2011-06-01

    Technical advances and focusing on subsets modified endocrine surgery in the last ten years tremendously. There is on one side a clear trend towards minimal invasive approaches, first of all in the surgery of the adrenal glands, where the transperitoneal or retroperitoneal laparoscopic adrenalectomy has become the gold standard for tumors up to a size of 10 cm in diameter. But also in pancreatic endocrine surgery for small tumors localized in the pancreas tail and up to a certain extend in thyroid and parathyroid surgery, laparoscopic or video assisted techniques are used. On the other side more precise techniques allow a more complete and radical removal of endocrine tissue, especially in thyroid surgery. This article presents a summary of current operative techniques and strategies in endocrine surgery.

  9. Cell sheet engineering for regenerative medicine: current challenges and strategies.

    PubMed

    Owaki, Toshiyuki; Shimizu, Tatsuya; Yamato, Masayuki; Okano, Teruo

    2014-07-01

    Substantial progress made in the areas of stem cell research and regenerative medicine has provided a number of innovative methods to repair or regenerate defective tissues and organs. Although previous studies regarding regenerative medicine, especially those involving induced pluripotent stem cells, have been actively promoted in the past decade, there remain some challenges that need to be addressed in order to enable clinical applications. Designed for use in clinical applications, cell sheet engineering has been developed as a unique, scaffold-free method of cell processing utilizing temperature-responsive cell culture vessels. Clinical studies using cell sheets have shown positive outcomes and will be translated into clinical practice in the near future. However, several challenges stand in the way of the industrialization of cell sheet products and the widespread acceptance of regenerative medicine based on cell sheet engineering. This review describes current strategies geared towards the realization of the regenerative medicine approach.

  10. Steam generator degradation: Current mitigation strategies for controlling corrosion

    SciTech Connect

    Millett, P.

    1997-02-01

    Steam Generator degradation has caused substantial losses of power generation, resulted in large repair and maintenance costs, and contributed to significant personnel radiation exposures in Pressurized Water Reactors (PWRs) operating throughout the world. EPRI has just published the revised Steam Generator Reference Book, which reviews all of the major forms of SG degradation. This paper discusses the types of SG degradation that have been experienced with emphasis on the mitigation strategies that have been developed and implemented in the field. SG degradation is presented from a world wide perspective as all countries operating PWRs have been effected to one degree or another. The paper is written from a US. perspective where the utility industry is currently undergoing tremendous change as a result of deregulation of the electricity marketplace. Competitive pressures are causing utilities to strive to reduce Operations and Maintenance (O&M) and capital costs. SG corrosion is a major contributor to the O&M costs of PWR plants, and therefore US utilities are evaluating and implementing the most cost effective solutions to their corrosion problems. Mitigation strategies developed over the past few years reflect a trend towards plant specific solutions to SG corrosion problems. Since SG degradation is in most cases an economic problem and not a safety problem, utilities can focus their mitigation strategies on their unique financial situation. Accordingly, the focus of R&D has shifted from the development of more expensive, prescriptive solutions (e.g. reduced impurity limits) to corrosion problems to providing the utilities with a number of cost effective mitigation options (e.g. molar ratio control, boric acid treatment).

  11. Office-based strategies for the management of obesity.

    PubMed

    Rao, Goutham

    2010-06-15

    Roughly two thirds of U.S. adults are overweight or obese. Obesity increases the risk of hypertension, type 2 diabetes mellitus, hyperlipidemia, heart disease, pulmonary disease, hepatobiliary disease, cancer, and a number of psychosocial complications. Physicians often feel unprepared to handle this important problem. Practical office-based strategies include: (1) making recommendations for assisted self-management, including guidance on popular diets, (2) advising patients about commercial weight-loss programs, (3) advising patients about and prescribing medications, (4) recommending bariatric surgery, and (5) supplementing these strategies with counseling about lifestyle changes using a systematic approach. Family physicians should provide basic information about the effectiveness and safety of popular diets and commercial weight-loss programs, and refer patients to appropriate information sources. Sibutramine and orlistat, the only medications currently approved for the long-term treatment of obesity, should only be prescribed in combination with lifestyle changes. Bariatric surgery is an option for adults with a body mass index of 40 kg per m2 or higher, or for those with a body mass index of 35 kg per m2 or higher who have obesity-related comorbidities such as type 2 diabetes. The five A's behavioral counseling paradigm (ask, advise, assess, assist, and arrange) can be used as the basis for a systematic, practical approach to the management of obesity that incorporates evidence for managing common obesity-related behaviors.

  12. Current perspectives in bladder cancer management.

    PubMed

    Griffiths, T R L

    2013-05-01

    More than 350,000 new cases of bladder cancer are diagnosed worldwide each year; the vast majority (> 90%) of these are transitional cell carcinomas (TCC). The most important risk factors for the development of bladder cancer are smoking and occupational exposure to toxic chemicals. Painless visible haematuria is the most common presenting symptom of bladder cancer; significant haematuria requires referral to a specialist urology service. Cystoscopy and urine cytology are currently the recommended tools for diagnosis of bladder cancer. Excluding muscle invasion is an important diagnostic step, as outcomes for patients with muscle invasive TCC are less favourable. For non-muscle invasive bladder cancer, transurethral resection followed by intravesical chemotherapy (typically Mitomycin C or epirubicin) or immunotherapy [bacillus Calmette-Guérin (BCG)] is the current standard of care. For patients failing BCG therapy, cystectomy is recommended; for patients unsuitable for surgery, the choice of treatment options is currently limited. However, novel interventions, such as chemohyperthermia and electromotive drug administration, enhance the effects of conventional chemotherapeutic agents and are being evaluated in Phase III trials. Radical cystectomy (with pelvic lymphadenectomy and urinary diversion) or radical radiotherapy are the current established treatments for muscle invasive TCC. Neoadjuvant chemotherapy is recommended before definitive treatment of muscle invasive TCC; cisplatin-containing combination chemotherapy is the recommended regimen. Palliative chemotherapy is the first-choice treatment in metastatic TCC. © 2012 Blackwell Publishing Ltd.

  13. Current management of talar osteochondral lesions

    PubMed Central

    Gianakos, Arianna L; Yasui, Youichi; Hannon, Charles P; Kennedy, John G

    2017-01-01

    Osteochondral lesions of the talus (OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation (BMS), or replacement procedures, such as autologous osteochondral transplantation (AOT). Reparative procedures are generally indicated for OLT < 150 mm2 in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although short- and medium-term results have been reported, long-term studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures. PMID:28144574

  14. Reimbursed Price of Orphan Drugs: Current Strategies and Potential Improvements.

    PubMed

    Mincarone, Pierpaolo; Leo, Carlo Giacomo; Sabina, Saverio; Sarriá-Santamera, Antonio; Taruscio, Domenica; Serrano-Aguilar, Pedro Guillermo; Kanavos, Panos

    2017-01-01

    The pricing and reimbursement policies for pharmaceuticals are relevant to balance timely and equitable access for all patients, financial sustainability, and reward for valuable innovation. The proliferation of high-cost specialty medicines is particularly true in rare diseases (RDs) where the pricing mechanism is characterised by a lack of transparency. This work provides an overall picture of current strategies for the definition of the reimbursed prices of orphan drugs (ODs) and highlights some potential improvements. Current strategies and suggestions are presented along 4 dimensions: (1) comprehensive value assessment, (2) early dialogs among relevant stakeholders, (3) innovative reimbursement approaches, and (4) societal participation in producing ODs. Comprehensive value assessment could be achieved by clarifying the approach of distributive justice to adopt, ensuring a representative participation of stakeholders, and with a broad consideration of value-bearing factors. With respect to early dialogs, cross-border cooperation can be determinant to companies and agencies. The cost-benefit ratio of early dialogs needs to be demonstrated and the "regulatory capture" effect should be monitored. Innovative reimbursement approaches were developed to balance the need for evidence-based decisions with the timely access to innovative drugs. The societal participation in producing ODs needs to be recognised in a collaborating framework where adaptive agreements can be developed with mutual satisfaction. Such agreements could also impact on coverage and reimbursement decisions as additional elements for the determination of a comprehensive societal value of ODs. Further research is needed to investigate the highlighted open challenges so that RDs will not remain, in practical terms, orphan diseases. © 2017 S. Karger AG, Basel.

  15. Management of polycythaemia vera: a critical review of current data.

    PubMed

    McMullin, Mary F; Wilkins, Bridget S; Harrison, Claire N

    2016-02-01

    Polycythaemia vera (PV) is a chronic blood cancer; its clinical features are dominated by myeloproliferation (erythrocytosis, often leucocytosis and/or thrombocytosis) and a tendency for thrombosis and transformation to myelofibrosis or acute myeloid leukaemia. In the past 10 years the pathophysiology of this condition has been defined as JAK/STAT pathway activation, almost always due to mutations in JAK2 exons 12 or 14 (JAK2 V617F). In the same time period our understanding of the optimal management of PV has expanded, most recently culminating in the approval of JAK inhibitors for the treatment of PV patients who are resistant or intolerant to therapy with hydroxycarbamide. It has also been demonstrated that life expectancy for many patients with PV is not normal, nor is their quality of life. We critically explore these findings and discuss their impact. In addition, we highlight persisting gaps in our current management strategy; for example, what is the optimal first line cytoreductive therapy and, indeed, which patients need cytoreductive drugs.

  16. Current management of autosomal dominant polycystic kidney disease

    PubMed Central

    Akoh, Jacob A

    2015-01-01

    Autosomal dominant polycystic kidney disease (ADPKD), the most frequent cause of genetic renal disease affecting approximately 4 to 7 million individuals worldwide and accounting for 7%-15% of patients on renal replacement therapy, is a systemic disorder mainly involving the kidney but cysts can also occur in other organs such as the liver, pancreas, arachnoid membrane and seminal vesicles. Though computed tomography and magnetic resonance imaging (MRI) were similar in evaluating 81% of cystic lesions of the kidney, MRI may depict septa, wall thickening or enhancement leading to upgrade in cyst classification that can affect management. A screening strategy for intracranial aneurysms would provide 1.0 additional year of life without neurological disability to a 20-year-old patient with ADPKD and reduce the financial impact on society of the disease. Current treatment strategies include reducing: cyclic adenosine monophosphate levels, cell proliferation and fluid secretion. Several randomised clinical trials (RCT) including mammalian target of rapamycin inhibitors, somatostatin analogues and a vasopressin V2 receptor antagonist have been performed to study the effect of diverse drugs on growth of renal and hepatic cysts, and on deterioration of renal function. Prophylactic native nephrectomy is indicated in patients with a history of cyst infection or recurrent haemorrhage or to those in whom space must be made to implant the graft. The absence of large RCT on various aspects of the disease and its treatment leaves considerable uncertainty and ambiguity in many aspects of ADPKD patient care as it relates to end stage renal disease (ESRD). The outlook of patients with ADPKD is improving and is in fact much better than that for patients in ESRD due to other causes. This review highlights the need for well-structured RCTs as a first step towards trying newer interventions so as to develop updated clinical management guidelines. PMID:26380198

  17. Current Management for Improved Railgun Performance

    DTIC Science & Technology

    1989-08-01

    studs" deserve special recognition. Although there has been no significance to the order in which I previously mentioned people or organizations, I have...milliseconds. This dictates that useful railguns operate as pulsed current devices, driven by pulsed power supplies. Maximization of projectile...how to control it to maximize railgun acceleration capabilities. 0 1.2 The Present State of Railgun Technology Although there was some interest in

  18. Current management of surgical oncologic emergencies.

    PubMed

    Bosscher, Marianne R F; van Leeuwen, Barbara L; Hoekstra, Harald J

    2015-01-01

    For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  19. Current management of occult bacteremia in infants.

    PubMed

    Mekitarian Filho, Eduardo; Carvalho, Werther Brunow de

    2015-01-01

    To summarize the main clinical entities associated with fever without source (FWS) in infants, as well as the clinical management of children with occult bacteremia, emphasizing laboratory tests and empirical antibiotics. A non-systematic review was conducted in the following databases--PubMed, EMBASE, and SciELO, between 2006 and 2015. The prevalence of occult bacteremia has been decreasing dramatically in the past few years, due to conjugated vaccination against Streptococcus pneumoniae and Neisseria meningitidis. Additionally, fewer requests for complete blood count and blood cultures have been made for children older than 3 months presenting with FWS. Urinary tract infection is the most prevalent bacterial infection in children with FWS. Some known algorithms, such as Boston and Rochester, can guide the initial risk stratification for occult bacteremia in febrile infants younger than 3 months. There is no single algorithm to estimate the risk of occult bacteremia in febrile infants, but pediatricians should strongly consider outpatient management in fully vaccinated infants older than 3 months with FWS and good general status. Updated data about the incidence of occult bacteremia in this environment after conjugated vaccination are needed. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  20. Strategies for sustainable management of renewable resources during environmental change.

    PubMed

    Lindkvist, Emilie; Ekeberg, Örjan; Norberg, Jon

    2017-03-15

    As a consequence of global environmental change, management strategies that can deal with unexpected change in resource dynamics are becoming increasingly important. In this paper we undertake a novel approach to studying resource growth problems using a computational form of adaptive management to find optimal strategies for prevalent natural resource management dilemmas. We scrutinize adaptive management, or learning-by-doing, to better understand how to simultaneously manage and learn about a system when its dynamics are unknown. We study important trade-offs in decision-making with respect to choosing optimal actions (harvest efforts) for sustainable management during change. This is operationalized through an artificially intelligent model where we analyze how different trends and fluctuations in growth rates of a renewable resource affect the performance of different management strategies. Our results show that the optimal strategy for managing resources with declining growth is capable of managing resources with fluctuating or increasing growth at a negligible cost, creating in a management strategy that is both efficient and robust towards future unknown changes. To obtain this strategy, adaptive management should strive for: high learning rates to new knowledge, high valuation of future outcomes and modest exploration around what is perceived as the optimal action. © 2017 The Author(s).

  1. Dual Therapy Treatment Strategies for the Management of Patients Infected with HIV: A Systematic Review of Current Evidence in ARV-Naive or ARV-Experienced, Virologically Suppressed Patients.

    PubMed

    Baril, Jean-Guy; Angel, Jonathan B; Gill, M John; Gathe, Joseph; Cahn, Pedro; van Wyk, Jean; Walmsley, Sharon

    2016-01-01

    We reviewed the current literature regarding antiretroviral (ARV)-sparing therapy strategies to determine whether these novel regimens can be considered appropriate alternatives to standard regimens for the initial treatment of ARV-naive patients or as switch therapy for those patients with virologically suppressed HIV infection. A search for studies related to HIV dual therapy published from January 2000 through April 2014 was performed using Biosis, Derwent Drug File, Embase, International Pharmaceutical Abstracts, Medline, Pascal, SciSearch, and TOXNET databases; seven major trial registries, and the abstracts of major conferences. Using predetermined criteria for inclusion, an expert review committee critically reviewed and qualitatively evaluated all identified trials for efficacy and safety results and potential limitations. Sixteen studies of dual therapy regimens were critiqued for the ARV-naive population. Studies of a protease inhibitor/ritonavir in combination with the integrase inhibitor raltegravir or the nucleoside reverse transcriptase inhibitor lamivudine provided the most definitive evidence supporting a role for dual therapy. In particular, lopinavir/ritonavir or darunavir/ritonavir combined with raltegravir and lopinavir/ritonavir combined with lamivudine demonstrated noninferiority to standard of care triple therapy after 48 weeks of treatment. Thirteen trials were critiqued in ARV-experienced, virologically suppressed patients. The virologic efficacy outcomes were mixed. Although overall data regarding toxicity are limited, when compared with standard triple therapy, certain dual therapy regimens may offer advantages in renal function, bone mineral density, and limb fat changes; however, some dual combinations may elevate lipid or bilirubin levels. The potential benefits of dual therapy regimens include reduced toxicity, improved tolerability and adherence, and reduced cost. Although the data reviewed here provide valuable insights into the

  2. Current Approaches to the Management of Pediatric Overweight and Obesity

    PubMed Central

    Ridolfi, Danielle R.; Hayes, Jacqueline F.; St Paul, Michelle; Wilfley, Denise E.

    2015-01-01

    Opinion Statement Family-based behavioral intervention has been demonstrated to be an effective and safe treatment for childhood obesity and should be considered a first-line treatment option. However, access to such intensive evidence-based treatment is limited and, currently, obesity care is dominated by high intensity behavioral treatment implemented in specialty clinics or less effective, low intensity treatments implemented in primary care. However, capitalizing on the established and ongoing relationship between primary care providers and families, primary care providers hold an invaluable role in early identification of overweight and obesity, and subsequent referral to an evidence-based treatment. key aspects of effective treatment include: early intervention, moderate- to high-intensity intervention of sufficient duration, multi-component intervention targeting dietary modification, physical activity and behavioral strategies, family involvement and goals targeting family members, and follow-up contact during maintenance. The purpose of this review is to present the current empirically supported treatment options for pediatric obesity including primary care-based interventions and diagnostic tools, multi-component behavioral intervention with a focus on family-based behavioral intervention, immersion treatment, and pharmacologic and surgical management. PMID:25205083

  3. Oligometastatic non-small-cell lung cancer: current treatment strategies

    PubMed Central

    Richard, Patrick J; Rengan, Ramesh

    2016-01-01

    The oligometastatic disease theory was initially described in 1995 by Heilman and Weichselbaum. Since then, much work has been performed to investigate its existence in many solid tumors. This has led to subclassifications of stage IV cancer, which could redefine our treatment approaches and the therapeutic outcomes for this historically “incurable” entity. With a high incidence of stage IV disease, non-small-cell lung cancer (NSCLC) remains a difficult cancer to treat and cure. Recent work has proven the existence of an oligometastatic state in NSCLC in terms of properly selecting patients who may benefit from aggressive therapy and experience long-term overall survival. This review discusses the current treatment approaches used in oligometastatic NSCLC and provides the evidence and rationale for each approach. The prognostic factors of many trials are discussed, which can be used to properly select patients for aggressive treatment regimens. Future advances in both molecular profiling of NSCLC to find targetable mutations and investigating patient selection may increase the number of patients diagnosed with oligometastatic NSCLC. As this disease entity increases, it is of utmost importance for oncologists treating NSCLC to be aware of the current treatment strategies that exist and the potential advantages/disadvantages of each. PMID:28210169

  4. Recreational user attitudes towards management strategies of Allegany State Park

    Treesearch

    Michael Nisengard; Miklos Gratzer

    1998-01-01

    This project examines attitudes towards management strategies of four Allegany State Park recreational user groups: cabin users, recreational vehicle users, tent users, and day users. It investigates recreational user group attitude differences, and attitude change over a ten year time period, in regard to the following park management strategy categories: park...

  5. Current surgical strategies for total arthroplasty in valgus knee

    PubMed Central

    Nikolopoulos, Dimitrios; Michos, Ioannis; Safos, George; Safos, Petros

    2015-01-01

    The majority of orthopaedic surgeons even currently agree that primary total arthroplasty in valgus knees with a deformity of more than ten degrees may prove challenging. The unique sets of bone and soft tissue abnormalities that must be addressed at the time of the operation make accurate axis restoration, component orientation and joint stability attainment a difficult task. Understanding the specific pathologic anatomic changes associated with the valgus knee is a prerequisite so as to select the proper surgical method, to optimize component position and restore soft-tissue balance. The purpose of this article is to review the valgus knee anatomical variations, to assess the best pre-operative planning and to evaluate how to choose the grade of constraint of the implant. It will also be underlying the up-to-date main approaches and surgical techniques be proposed in the English literature both for bone cuts and soft tissue management of valgus knees. PMID:26191494

  6. Current challenges in the management of hemophilia.

    PubMed

    Bauer, Kenneth A

    2015-03-01

    Hemophilia is characterized by genetic mutations resulting in the deficiency of factors critical to the normal process of coagulation, sometimes resulting in spontaneous bleeding into soft tissue, joints, and internal organs. The 2 most common subtypes are hemophilia A, or factor VIII deficiency, and hemophilia B, or factor IX deficiency. Hemophilia affects an estimated 20,000 individuals in the United States. The diagnosis and management of patients with severe hemophilia is complex, and requires preventive treatment (prophylaxis) to avoid bleeding episodes and related complications and the use of replacement therapy with coagulation factors during acute bleeding episodes. To achieve optimal long-term results, the treatment of patients with hemophilia requires a comprehensive approach coordinated by a multidisciplinary team of specialists. Hemophilia imposes a substantial burden from economic, societal, and patient perspectives.

  7. Upper extremity trauma: current trends in management.

    PubMed

    Stone, W M; Fowl, R J; Money, S R

    2007-10-01

    Upper extremity trauma can be penetrating or blunt in etiology. The close proximity of vein, artery and nerve makes for a complicated presentation and potentially complicated reconstruction. Orthopedic and neurologic injuries can cause the more long term disability of these patients, but vascular injuries are initially more life threatening. Control of vascular injuries can be particularly difficult due to anatomic issues in the upper extremities. The intervention carried significant morbidity until evolution to endovascular approaches occurred. By reconstructing the injury from a more ''remote'' access site, less concomitant injury to the extremity can be encountered. However, although control of vascular injuries may result in greater survival rates with less morbidity from the procedure, long term outcome remains dependent upon concomitant injuries. This review will encompass both vascular and neurologic injuries secondary to trauma to the upper extremity and outline some of the trends in management.

  8. Current Management of Surgical Oncologic Emergencies

    PubMed Central

    Bosscher, Marianne R. F.; van Leeuwen, Barbara L.; Hoekstra, Harald J.

    2015-01-01

    Objectives For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. Method A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. Results In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. Conclusion In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy. PMID:25933135

  9. Development of a Consumable Inventory Management Strategy for the Supply Management Unit

    DTIC Science & Technology

    2007-12-01

    efficiently balances readiness with supply chain system-wide costs. 15. NUMBER OF PAGES 107 14. SUBJECT TERMS Supply Chain Management , Inventory...management strategy for the SMU by incorporating operations management, business modeling, simulation, supply chain management , and logistics...management, supply chain management , and logistics engineering concepts. Next, the project group used the information gathered from these sources to

  10. Alcoholic Liver Disease: Pathogenesis and Current Management

    PubMed Central

    Osna, Natalia A.; Donohue, Terrence M.; Kharbanda, Kusum K.

    2017-01-01

    Excessive alcohol consumption is a global healthcare problem. The liver sustains the greatest degree of tissue injury by heavy drinking because it is the primary site of ethanol metabolism. Chronic and excessive alcohol consumption produces a wide spectrum of hepatic lesions, the most characteristic of which are steatosis, hepatitis, and fibrosis/cirrhosis. Steatosis is the earliest response to heavy drinking and is characterized by the deposition of fat in hepatocytes. Steatosis can progress to steatohepatitis, which is a more severe, inflammatory type of liver injury. This stage of liver disease can lead to the development of fibrosis, during which there is excessive deposition of extracellular matrix proteins. The fibrotic response begins with active pericellular fibrosis, which may progress to cirrhosis, characterized by excessive liver scarring, vascular alterations, and eventual liver failure. Among problem drinkers, about 35 percent develop advanced liver disease because a number of disease modifiers exacerbate, slow, or prevent alcoholic liver disease progression. There are still no FDA-approved pharmacological or nutritional therapies for treating patients with alcoholic liver disease. Cessation of drinking (i.e., abstinence) is an integral part of therapy. Liver transplantation remains the life-saving strategy for patients with end-stage alcoholic liver disease.

  11. Giant cell arteritis: Current treatment and management

    PubMed Central

    Ponte, Cristina; Rodrigues, Ana Filipa; O’Neill, Lorraine; Luqmani, Raashid Ahmed

    2015-01-01

    Glucocorticoids remain the cornerstone of medical therapy in giant cell arteritis (GCA) and should be started immediately to prevent severe consequences of the disease, such as blindness. However, glucocorticoid therapy leads to significant toxicity in over 80% of the patients. Various steroid-sparing agents have been tried, but robust scientific evidence of their efficacy and safety is still lacking. Tocilizumab, a monoclonal IL-6 receptor blocker, has shown promising results in a number of case series and is now being tested in a multi-centre randomized controlled trial. Other targeted treatments, such as the use of abatacept, are also now under investigation in GCA. The need for surgical treatment is rare and should ideally be performed in a quiescent phase of the disease. Not all patients follow the same course, but there are no valid biomarkers to assess therapy response. Monitoring of disease progress still relies on assessing clinical features and measuring inflammatory markers (C-reactive protein and erythrocyte sedimentation rate). Imaging techniques (e.g., ultrasound) are clearly important screening tools for aortic aneurysms and assessing patients with large-vessel involvement, but may also have an important role as biomarkers of disease activity over time or in response to therapy. Although GCA is the most common form of primary vasculitis, the optimal strategies for treatment and monitoring remain uncertain. PMID:26090367

  12. TRALI risk reduction: donor and component management strategies.

    PubMed

    Eder, Anne F; Benjamin, Richard J

    2009-01-01

    Transfusion-related lung injury (TRALI) occurs in approximately 1 in 5,000 transfusions and may cause considerably more morbidity and mortality that is not recognized in clinical practice. Based on the current understanding of the etiology of TRALI, blood centers have implemented or are evaluating various donor and component management strategies in an effort to mitigate the risk of TRALI. Many cases of TRALI are likely caused by antibodies to leukocyte antigens (HLA or HNA) in blood components. Approximately 10 to 20% of female blood donors with a history of pregnancy and 1 to 5% of male blood donors harbor these antibodies. Alternatively, TRALI may be mediated by other bioactive lipids or substances that accumulate during storage and cause a reaction when transfused to susceptible patients. The complex interplay among various donor-, component-, and patient-related factors underlying TRALI guarantees that effective prevention will not be a single or simple intervention but rather will require a multifaceted approach. Perhaps, the most important risk reduction strategy is the effort to ensure appropriate use of blood products and eliminate unnecessary transfusions. Blood collection agencies, however, have more proximate control over donor selection and component management than transfusion practice. AABB has provided some guidance on deferring donors implicated in TRALI and minimizing the preparation of high plasma volume components from donors who have anti-leukocyte antibodies or are at increased risk of leukocyte alloimmunization. Blood centers have taken various approaches to mitigate the risk of TRALI, and the possible benefit and the inherent limitations of the current strategies will be reviewed.

  13. Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey.

    PubMed

    San-Juan, R; Manuel, O; Hirsch, H H; Fernández-Ruiz, M; López-Medrano, F; Comoli, P; Caillard, S; Grossi, P; Aguado, J M

    2015-06-01

    There is limited clinical evidence on the utility of the monitoring of Epstein-Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients.

  14. Strategy Maps in University Management: A Comparative Study

    ERIC Educational Resources Information Center

    Han, Shuangmiao; Zhong, Zhou

    2015-01-01

    In this study, the conceptual use of the strategy map approach and the strategy map which it produces have been adapted from the business sector and introduced as tools for achieving more effective strategic planning and management in higher education institutions (HEIs). This study discusses the development of strategy maps as transformational…

  15. Strategy Maps in University Management: A Comparative Study

    ERIC Educational Resources Information Center

    Han, Shuangmiao; Zhong, Zhou

    2015-01-01

    In this study, the conceptual use of the strategy map approach and the strategy map which it produces have been adapted from the business sector and introduced as tools for achieving more effective strategic planning and management in higher education institutions (HEIs). This study discusses the development of strategy maps as transformational…

  16. Determining management strategies for the Sarikum Nature Protection Area.

    PubMed

    Öztürk, Sevgi

    2015-03-01

    In recent years, many environmental problems have become important factors in promoting the economic need to develop tourist activity: climate change such as energy wars, increasing hunger and aridity, population increases in urban areas, excessive and unthinking use of natural resources, difficult international relations, economic competition, and increasing environmental stress. Trends in global tourism have changed with changes in culture and our attitude to nature. Changes in both the profile and consumption patterns of tourists have called for the need to balance the use of natural and cultural assets with the need to adequately protect them. In this study, the Sarikum Nature Protection Area (SNPA) was selected as a case study because of its significance as a Turkish wetland area and the variety of different ecosystems coexisting within it. The study focussed on management strategies, but also provides a broader strategy for an area that currently has no management plan. Strengths and weaknesses, opportunities and threats (SWOT) analyses of the area were gathered and analyzed using R'WOT analysis (ranking + SWOT), a multi-criteria assessment method, in order to determine strategies, obtain the participation of interest groups, and assess their opinions and attitudes. The analysis showed the following: the rich biological diversity and the existence of endemic species were the reserve's most significant strength; the presence of natural areas in surrounding regions was the most significant opportunity; the shortage of infrastructure and lack of legal regulation of ecotourism was the most significant weakness; and the lack of a management plan was the most immediate threat.

  17. Current Strategies for the Treatment of Aneurysmal Bone Cysts

    PubMed Central

    Brosjö, Otte

    2015-01-01

    Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient. PMID:26793296

  18. Current management of heparin-induced thrombocytopenia.

    PubMed

    Cosmi, Benilde

    2015-12-01

    Heparin-induced thrombocytopenia (HIT) is an immune adverse reaction to heparin (both unfractionated and low-molecular-weight), which is mediated by the formation of IgG antibodies against platelet factor 4-heparin complexes. The IgG/platelet factor 4 immunocomplexes activate platelets with resulting thrombocytopenia, which is not associated with bleeding, but with paradoxical life-threatening thrombotic complications, for coagulation activation. HIT diagnosis requires the assessment of pre-test clinical probability in combination with the measurement of platelet activating antibodies against platelet factor 4-heparin complexes with immunological and functional assays. When HIT is diagnosed, any form of heparin should be stopped and a non-heparin alternative anticoagulant should be started. Argatroban and danaparoid are currently the only drugs licensed for HIT, with different country availability. Bivalirudin is an option in cardiac surgery and procedures in HIT patients.

  19. [Electronic health strategies in The Americas: current situation and perspectives].

    PubMed

    D Agostino, Marcelo

    2015-01-01

    The main objective of the Strategy and Plan of Action on eHealth (2012-2017) is to contribute to sustainable development of health systems of member states. Its adoption aims to improve quality and access to health services through the use of information and communication technologies (ICT), the implementation of digital literacy programs and access to quality information to advance towards more informed, equitable, competitive and democratic societies. PAHO/WHO considers that in society, free and equal access to health information should be a fundamental right of individuals. Access to information, knowledge sharing and use of information and communication technology in the health sector continues to grow and is driving significant changes in the way people interact with health services and among themselves in social networks and through the use of mobile devices (mHealth). This hyper-connected society, or information society, brings new challenges and opportunities related to the use of massive data (Big Data) that forces us to rethink our relationship with reality and the traditional ways of managing health information.

  20. Osteochondral tissue engineering with biphasic scaffold: current strategies and techniques.

    PubMed

    Shimomura, Kazunori; Moriguchi, Yu; Murawski, Christopher D; Yoshikawa, Hideki; Nakamura, Norimasa

    2014-10-01

    The management of osteoarthritis (OA) remains challenging and controversial. Although several clinical options exist for the treatment of OA, regeneration of the damaged articular cartilage has proved difficult due to the limited healing capacity. With the advancements in tissue engineering and cell-based technologies over the past decade, new therapeutic options for patients with osteochondral lesions potentially exist. This review will focus on the feasibility of tissue-engineered biphasic scaffolds, which can mimic the native osteochondral complex, for osteochondral repair and highlight the recent development of these techniques toward tissue regeneration. Moreover, basic anatomy, strategy for osteochondral repair, the design and fabrication methods of scaffolds, as well as the choice of cells, growth factor, and materials will be discussed. Specifically, we focus on the latest preclinical animal studies using large animals and clinical trials with high clinical relevance. In turn, this will facilitate an understanding of the latest trends in osteochondral repair and contribute to the future application of such clinical therapies in patients with OA.

  1. Current concepts in acute pain management.

    PubMed

    Huynh, Mai-Phuong; Yagiela, John A

    2003-05-01

    Analgesics most commonly prescribed in dentistry for acute pain relief include the nonsteroidal anti-inflammatory drug, acetaminophen, and various opioid-containing analgesic combinations. The NSAIDs and presumably acetaminophen act by inhibiting cyclooxgenase enzymes responsible for the formation of prostaglandins that promote pain and inflammation. Opioids such as codeine, hydrocodone, and oxycodone stimulate endogenous opioid receptors to bring about analgesic and other effects. Numerous clinical studies have confirmed that moderate to severe pain of dental origin is best managed through the use of ibuprofen or another NSAID whose maximum analgesic effect is at least equal to that of standard doses of acetaminophen-opioid combinations. If an NSAID cannot be prescribed because of patient intolerance, analgesic preparations that combine effective doses of an orally active opioid with 600 to 1,000 mg of acetaminophen are preferred in the healthy adult. On occasion, prescribing both an NSAID and an acetaminophen-opioid combination may be helpful in patients not responding to a single product. In all cases, however, the primary analgesic should be taken on a fixed schedule, not on a "prn" (or as needed) basis, which only guarantees the patient will experience pain.

  2. Current management of urethral stricture disease

    PubMed Central

    Smith, Thomas G.

    2016-01-01

    Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts. PMID:26941491

  3. Current surgical management of carotid body tumors.

    PubMed

    Davila, Victor J; Chang, James M; Stone, William M; Fowl, Richard J; Bower, Thomas C; Hinni, Michael L; Money, Samuel R

    2016-12-01

    Carotid body tumors (CBTs) are rare. Management guidelines may include genetic testing for succinate dehydrogenase (SDH) mutations. We performed an institutional review of the surgical management of CBT. A retrospective analysis (1994-2015) of CBT excisions at our institution was performed. Data obtained included demographics, genetic testing (if performed), intraoperative details, postoperative morbidity, and long-term outcomes. Data from the first CBT excision were included in patients with bilateral tumors. Genetic testing was routinely offered in patients with a family history of CBT or multiple paragangliomas. A total of 183 CBTs (124 female [67.7%]) were excised. A neck mass was present in 106 patients (57.9%), 24 patients (12.1%) presented with tenderness or neck pain, and 3 (1.6%) presented with cranial nerve dysfunction. Computed tomography (57.9%) or magnetic resonance imaging (51.3%) were the most commonly used imaging modalities. Preoperative angiography was performed in 73 patients (39.8%), and 62 of them (84.5%) underwent embolization or internal carotid balloon occlusion testing, or both. Mean tumor diameter was 3.2 cm (range, 0.6-7.2 cm). There were 71 (38.8%), 75 (41%), and 37 (20.2%) Shamblin type 1, 2, and 3 tumors, respectively. Average operating time was 224 minutes (range, 52-696 minutes). Average blood loss was 143.9 mL (range, 10-2000 mL). Arterial reconstruction with an interposition graft was required in 10, and patch angioplasty was performed in four. Cranial nerve injury was permanent in 10 (5.5%), and the rate of stroke was 1% (n = 2). A total of 382 lymph nodes were excised, and all were benign. There were no deaths ≤30 days. Only one patient presented with malignant disease 2 years after CBT excision, and this patient did not undergo genetic testing. Thirty-four (18.6%) had a family history of CBT. SDH testing was performed in 18 patients, and 17 tested positive. Positive genetic testing had a correlation with earlier age

  4. The current management of septic shock.

    PubMed

    Russel, J A

    2008-10-01

    This is a review of the management of septic shock that suggests an approach to treatment (ABCDEF: Airway, Breathing, Circulation, Drugs, Evaluate the source of sepsis, Fix the source of sepsis) for clinicians. The incidence of septic shock is increasing and mortality ranges from 30% to 70%. The commonest sources of infection are lung (25%), abdomen (25%), and other sources. Septic shock occurs because of highly complex interactions between the infecting microorganism(s) and the responses of the human host. The innate immune response is rapidly followed by the more specific adaptive immune response. Septic shock is characterized by alterations in the coagulant/anticoagulant balance such that there is a more pro-coagulant phenotype. Lung protective ventilation (which means the use of relatively low tidal volumes of 4 -6 mL/kg ideal body weight) is recommended for treatment of patients who have septic shock. Rivers early goal-directed therapy is recommended because it showed a significant increase in survival. Surviving Sepsis guidelines recommend resuscitation of septic shock with either crystalloid or colloid. Patients who have septic shock should be treated with intravenous broad-spectrum antibiotics as rapidly as possible and certainly within one hour. Activated protein C (APC) is a vitamin K dependent serine protease that is an anticoagulant and is also cytoprotective and anti-inflammatory. APC (24 mg/kg/hour infusion for 96 hours) decreased mortality (APC 25% vs placebo 31%, relative risk 0.81P=0.005) and improved organ dysfunction in patients at high risk of death (e.g. APACHE II >25 [APC 31% vs placebo 44%]). APC is not recommended to treat surgical patients who have one organ system dysfunction. In 2006, the European regulatory authority indicated that there must be another randomized placebo-controlled trial of APC to further establish efficacy as assessed by mortality reduction. Vasopressin is a key stress hormone in response to hypotension. The VASST

  5. Ewing's sarcoma family of tumors: current management.

    PubMed

    Bernstein, Mark; Kovar, Heinrich; Paulussen, Michael; Randall, R Lor; Schuck, Andreas; Teot, Lisa A; Juergens, Herbert

    2006-05-01

    Ewing's sarcoma is the second most frequent primary bone cancer, with approximately 225 new cases diagnosed each year in patients less than 20 years of age in North America. It is one of the pediatric small round blue cell tumors, characterized by strong membrane expression of CD99 in a chain-mail pattern and negativity for lymphoid (CD45), rhabdomyosarcoma (myogenin, desmin, actin) and neuroblastoma (neurofilament protein) markers. Pathognomonic translocations involving the ews gene on chromosome 22 and an ets-type gene, most commonly the fli1 gene on chromosome 11, are implicated in the great majority of cases. Clinical presentation is usually dominated by local bone pain and a mass. Imaging reveals a technetium pyrophosphate avid lesion that, on plain radiograph, is destructive, diaphyseal and classically causes layered periosteal calcification. Magnetic resonance best defines the extent of the lesion. Biopsy should be undertaken by an experienced orthopedic oncologist. Approximately three quarters of patients have initially localized disease. About two thirds survive disease-free. Management, preferably at a specialist center with a multi-disciplinary team, includes both local control-either surgery, radiation or a combination-and systemic chemotherapy. Chemotherapy includes cyclic combinations, incorporating vincristine, doxorubicin, cyclophosphamide, etoposide, ifosfamide and occasionally actinomycin D. Topotecan in combination with cyclophosphamide has shown preliminary activity. Patients with initially metastatic disease fare less well, with about one quarter surviving. Studies incorporating intensive therapy followed by stem cell infusion show no clear benefit. New approaches include anti-angiogenic therapy, particularly since vascular endothelial growth factor is an apparent downstream target of the ews-fli1 oncogene.

  6. Management of asthma in adults: current therapy and future directions

    PubMed Central

    Green, R; Brightling, C; Pavord, I; Wardlaw, A

    2003-01-01

    Asthma is increasing in prevalence worldwide and results in significant use of healthcare resources. Although most patients with asthma can be adequately treated with inhaled corticosteroids, an important number of patients require additional therapy and an increasing number of options are available. A further minority of patients develop severe persistent asthma which remains difficult to manage despite current pharmacological therapies. This review discusses the various treatment options currently available for each stage of asthma severity, highlights some of the limitations of current management, and outlines directions which may improve the management of asthma in the future. PMID:12782771

  7. Total Quality Management Implementation Strategy: Directorate of Quality Assurance

    DTIC Science & Technology

    1989-05-01

    Directorate of Quality Assurance Total Quality Management Implementation Strategy 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADORESS(ES) 8...that job. DTIC 7: t-I ECTE I SEP29 1989 14. SUBJECT TERMS 15. NUMBER OF PAGES TOM ( Total Quality Management ), Quality Assurance, Continuous Process...Prescribed by ANSI Std Z39-18 29d- 102 DEFENSE LOGISTICS AGENCY DIRECTORATE OF QUALITY ASSURANCE 0 TOTAL QUALITY MANAGEMENT IMPLEMENTATION STRATEGY 0 89 9

  8. Slope stability effects of fuel management strategies – inferences from Monte Carlo simulations

    Treesearch

    R. M. Rice; R. R. Ziemer; S. C. Hankin

    1982-01-01

    A simple Monte Carlo simulation evaluated the effect of several fire management strategies on soil slip erosion and wildfires. The current condition was compared to (1) a very intensive fuelbreak system without prescribed fires, and (2) prescribed fire at four time intervals with (a) current fuelbreaks and (b) intensive fuel-breaks. The intensive fuelbreak system...

  9. Nonulcer dyspepsia. Current concepts and management.

    PubMed

    Mc Namara, D A; Buckley, M; O'Morain, C A

    2000-12-01

    NUD is a common heterogeneous condition with a multifactorial cause. NUD is a cause of considerable morbidity with an annual incidence of 8% and similar incidence of spontaneous resolution. Its economic effects are considerable. The estimated annual cost to the community of NUD is $431 per patient for the initial 6 months after diagnosis. The annual Health Maintenance Organization (HMO) expenditure on acid-related disorders in one Northern California HMO was estimated to be $59.4 million, of which NUD represented a significant proportion. The association of H. pylori infection with NUD is controversial. There are strong epidemiologic evidence and supportive pathophysiological mechanisms to implicate H. pylori causally in a subset of cases. Treatment studies are likewise conflicting. Evidence suggests that treatment cannot guarantee improvement in all cases of H. pylori-related NUD but that a subset would benefit with complete symptom resolution in the long term. It is not possible currently to predict which patients would or would not respond to eradication therapy. The strength of evidence is such that empiric eradication therapy, based on noninvasive H. pylori testing, can be advocated in young patients with dyspepsia safely and effectively with resultant financial savings.

  10. Current Pharmacological Management of Gastroesophageal Reflux Disease

    PubMed Central

    Wang, Yao-Kuang; Hsu, Wen-Hung; Wang, Sophie S. W.; Lu, Chien-Yu; Kuo, Fu-Chen; Su, Yu-Chung; Yang, Sheau-Fang; Chen, Chiao-Yun; Wu, Deng-Chyang

    2013-01-01

    Gastroesophageal reflux disease (GERD), a common disorder with troublesome symptoms caused by reflux of gastric contents into the esophagus, has adverse impact on quality of life. A variety of medications have been used in GERD treatment, and acid suppression therapy is the mainstay of treatment for GERD. Although proton pump inhibitor is the most potent acid suppressant and provides good efficacy in esophagitis healing and symptom relief, about one-third of patients with GERD still have persistent symptoms with poor response to standard dose PPI. Antacids, alginate, histamine type-2 receptor antagonists, and prokinetic agents are usually used as add-on therapy to PPI in clinical practice. Development of novel therapeutic agents has focused on the underlying mechanisms of GERD, such as transient lower esophageal sphincter relaxation, motility disorder, mucosal protection, and esophageal hypersensitivity. Newer formulations of PPI with faster and longer duration of action and potassium-competitive acid blocker, a newer acid suppressant, have also been investigated in clinical trials. In this review, we summarize the current and developing therapeutic agents for GERD treatment. PMID:23878534

  11. Current management of differentiated thyroid carcinoma.

    PubMed

    Lupoli, Gelsy Arianna; Fonderico, Francesco; Colarusso, Sara; Panico, Annalisa; Cavallo, Annalisa; Di Micco, Lucia; Paglione, Angela; Costa, Luisa; Lupoli, Giovanni

    2005-12-01

    Papillary and follicular thyroid cancers, together termed differentiated thyroid cancers (DTC), comprise the majority of thyroid carcinomas and have an optimal prognosis. Most DTCs appear as asymptomatic thyroid nodules. Fine-needle aspiration (FNA) cytology is the first diagnostic test for a thyroid nodule in a euthyroid patient. Surgery is the primary treatment for thyroid cancers. Most clinicians recommend near-total or total thyroidectomy, and then 131I ablation therapy, since its consequences are minimal and follow-up is facilitated. A total body scan (TBS) is performed 4 to 7 days after 131I treatment. At a later stage, all patients should be treated with L-tiroxine so as to suppress TSH, and must undergo a periodic evaluation of TSH and thyroglobulin (Tg), the most sensitive and specific marker of DTC. After 6-12 months, TBS with 131I is performed, a technique complementary to serum Tg evaluation. For this technique, it is also necessary to have a high serum TSH concentration, obtained by withdrawing thyroxine therapy for 4 to 6 weeks. This standard method induces hypothyroidism. An alternative method to the withdrawal of thyroid hormones in the follow-up of DTC patients is to administer recombinant human TSH (rh-TSH). After the dose of rhTSH, 131I is administered, and then TBS can be performed 48-72 hours later. Currently, several authors have explored the possibility that rh-TSH-stimulated Tg levels may represent the only necessary test to differentiate patients with persistent disease from disease-free patients, without performing a diagnostic TBS.

  12. Recent Advances in Nanosystems and Strategies for Managing Leishmaniasis.

    PubMed

    Vaghela, Rudra; Kulkarni, Parthasarathi K; Osmani, Riyaz Ali M; Bhosale, Rohit R; Naga Sravan Kumar Varma, V

    2016-04-01

    Parasitic infection such as Leishmaniasis, a neglected tropical disease, presents a significant global burden which is responsible for high mortality rate especially in less developed countries. Its intracellular nature and disseminated locations of parasite, limited number of chemotherapeutic agents, increasing incidences of resistance to first line drugs and toxicities, poses a great challenge to formulation scientists that have necessitated effective management of leishmanial infection by modulating the delivery of existing drugs. Over the past decade, research on development of alternative treatments such as nanotechnology-based drug delivery systems (nanoparticles, nanosuspensions, liposomes etc.), use of natural products as well as development of antileishmanial vaccine have been extensively investigated. The present review focuses on different facets of therapeutic strategies, existing miscellaneous drug delivery systems and approaches intended for management, as well as treatment of the infection, with an aim to summarize the current trends and strategies adopted for antileishmanial therapy in a systematic manner. Moreover, the article encloses an eclectic collection of patents allied to new-fangled chemotherapeutics for antileishmanial therapy.

  13. The 'Toolbox' of strategies for managing Haemonchus contortus in goats: What's in and what's out.

    PubMed

    Kearney, P E; Murray, P J; Hoy, J M; Hohenhaus, M; Kotze, A

    2016-04-15

    A dynamic and innovative approach to managing the blood-consuming nematode Haemonchus contortus in goats is critical to crack dependence on veterinary anthelmintics. H. contortus management strategies have been the subject of intense research for decades, and must be selected to create a tailored, individualized program for goat farms. Through the selection and combination of strategies from the Toolbox, an effective management program for H. contortus can be designed according to the unique conditions of each particular farm. This Toolbox investigates strategies including vaccines, bioactive forages, pasture/grazing management, behavioural management, natural immunity, FAMACHA, Refugia and strategic drenching, mineral/vitamin supplementation, copper Oxide Wire Particles (COWPs), breeding and selection/selecting resistant and resilient individuals, biological control and anthelmintic drugs. Barbervax(®), the ground-breaking Haemonchus vaccine developed and currently commercially available on a pilot scale for sheep, is prime for trialling in goats and would be an invaluable inclusion to this Toolbox. The specialised behaviours of goats, specifically their preferences to browse a variety of plants and accompanying physiological adaptations to the consumption of secondary compounds contained in browse, have long been unappreciated and thus overlooked as a valuable, sustainable strategy for Haemonchus management. These strategies are discussed in this review as to their value for inclusion into the 'Toolbox' currently, and the future implications of ongoing research for goat producers. Combining and manipulating strategies such as browsing behaviour, pasture management, bioactive forages and identifying and treating individual animals for haemonchosis, in addition to continuous evaluation of strategy effectiveness, is conducted using a model farm scenario. Selecting strategies from the Toolbox, with regard to their current availability, feasibility, economical cost

  14. Developing management strategies for riparian areas.

    Treesearch

    D.E. Hibbs; S. Chan

    2001-01-01

    This talk outlines four principles that are critical to successful management of a riparian area. First, given problems both with defining historic conditions and with returning to them, attaining management goals based on restoration of ecological processes and functions will be far more successful. Second, the management goals for any stream reach must be placed in a...

  15. Strategies for Managing a Multigenerational Workforce

    ERIC Educational Resources Information Center

    Iden, Ronald

    2016-01-01

    The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to…

  16. Strategies for Managing a Multigenerational Workforce

    ERIC Educational Resources Information Center

    Iden, Ronald

    2016-01-01

    The multigenerational workforce presents a critical challenge for business managers, and each generation has different expectations. A human resource management study of organizations with more than 500 employees reported 58% of the managers experiencing conflict between younger and older workers. The purpose of this single case study was to…

  17. A national cohesive wildland fire management strategy

    Treesearch

    Forest Service U.S. Department of Agriculture; Office of Wildland Fire Coordination. Department of the Interior

    2011-01-01

    Addressing wildfire is not simply a fire management, fire operations, or wildland-urban interface problem - it is a larger, more complex land management and societal issue. The vision for the next century is to: Safely and effectively extinguish fire, when needed; use fire where allowable; manage our natural resources; and as a Nation, live with wildland fire. Three...

  18. Current Research Therapeutic Strategies for Alzheimer's Disease Treatment

    PubMed Central

    Folch, Jaume; Petrov, Dmitry; Ettcheto, Miren; Abad, Sonia; Sánchez-López, Elena; García, M. Luisa; Olloquequi, Jordi; Beas-Zarate, Carlos; Auladell, Carme; Camins, Antoni

    2016-01-01

    Alzheimer's disease (AD) currently presents one of the biggest healthcare issues in the developed countries. There is no effective treatment capable of slowing down disease progression. In recent years the main focus of research on novel pharmacotherapies was based on the amyloidogenic hypothesis of AD, which posits that the beta amyloid (Aβ) peptide is chiefly responsible for cognitive impairment and neuronal death. The goal of such treatments is (a) to reduce Aβ production through the inhibition of β and γ secretase enzymes and (b) to promote dissolution of existing cerebral Aβ plaques. However, this approach has proven to be only modestly effective. Recent studies suggest an alternative strategy centred on the inhibition of the downstream Aβ signalling, particularly at the synapse. Aβ oligomers may cause aberrant N-methyl-D-aspartate receptor (NMDAR) activation postsynaptically by forming complexes with the cell-surface prion protein (PrPC). PrPC is enriched at the neuronal postsynaptic density, where it interacts with Fyn tyrosine kinase. Fyn activation occurs when Aβ is bound to PrPC-Fyn complex. Fyn causes tyrosine phosphorylation of the NR2B subunit of metabotropic glutamate receptor 5 (mGluR5). Fyn kinase blockers masitinib and saracatinib have proven to be efficacious in treating AD symptoms in experimental mouse models of the disease. PMID:26881137

  19. Current Research Therapeutic Strategies for Alzheimer's Disease Treatment.

    PubMed

    Folch, Jaume; Petrov, Dmitry; Ettcheto, Miren; Abad, Sonia; Sánchez-López, Elena; García, M Luisa; Olloquequi, Jordi; Beas-Zarate, Carlos; Auladell, Carme; Camins, Antoni

    2016-01-01

    Alzheimer's disease (AD) currently presents one of the biggest healthcare issues in the developed countries. There is no effective treatment capable of slowing down disease progression. In recent years the main focus of research on novel pharmacotherapies was based on the amyloidogenic hypothesis of AD, which posits that the beta amyloid (Aβ) peptide is chiefly responsible for cognitive impairment and neuronal death. The goal of such treatments is (a) to reduce Aβ production through the inhibition of β and γ secretase enzymes and (b) to promote dissolution of existing cerebral Aβ plaques. However, this approach has proven to be only modestly effective. Recent studies suggest an alternative strategy centred on the inhibition of the downstream Aβ signalling, particularly at the synapse. Aβ oligomers may cause aberrant N-methyl-D-aspartate receptor (NMDAR) activation postsynaptically by forming complexes with the cell-surface prion protein (PrPC). PrPC is enriched at the neuronal postsynaptic density, where it interacts with Fyn tyrosine kinase. Fyn activation occurs when Aβ is bound to PrPC-Fyn complex. Fyn causes tyrosine phosphorylation of the NR2B subunit of metabotropic glutamate receptor 5 (mGluR5). Fyn kinase blockers masitinib and saracatinib have proven to be efficacious in treating AD symptoms in experimental mouse models of the disease.

  20. Prostate biopsy strategies: current state of the art.

    PubMed

    Mian, Badar M

    2004-05-01

    Prostate-specific antigen testing and prostate biopsy have revolutionized our ability to detect prostate cancer at an early stage. The transrectal ultrasound-guided biopsy procedure has undergone a number of modifications over the past 10 years to meet our goal of early detection of cancer at a curable stage. Biopsy schemes have evolved from lesion-directed biopsies to systematic mapping of the peripheral zone of the prostate, which harbors almost all of the significant tumor foci. An increase in the number of biopsy cores from 6 to 10 (or 12) has resulted in a significant improvement in the detection of clinically localized cancer, without any appreciable increase in the number of indolent cancers. Current biopsy schemes also have enhanced our ability to determine the true prognostic value of pathologic lesions such as high-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation which have been associated with cancer detection in repeat biopsies. I discuss the rationale behind, and the outcomes of, various biopsy strategies. More than 15 years after PSA testing was popularized for early detection, a number of men are presenting for evaluation regarding repeat prostate biopsy for various clinical indications. The indications, biopsy scheme, and cancer detection rates for repeat prostate biopsy are discussed in detail.

  1. Open Source for Knowledge and Learning Management: Strategies beyond Tools

    ERIC Educational Resources Information Center

    Lytras, Miltiadis, Ed.; Naeve, Ambjorn, Ed.

    2007-01-01

    In the last years, knowledge and learning management have made a significant impact on the IT research community. "Open Source for Knowledge and Learning Management: Strategies Beyond Tools" presents learning and knowledge management from a point of view where the basic tools and applications are provided by open source technologies.…

  2. Survival strategies in the era of managed care.

    PubMed

    Rudomin, M L; Spirakes, A S

    1996-02-01

    The era of managed care has forced an unprecedented restructuring of the health care environment. As hospitals downsize in response, materiel managers should consider adopting strategies that may help ensure their survival, including innovative approaches to supply management and the development of individual responses that will best position them to succeed in this new reality.

  3. Effects of new forest management strategies on squirrel populations.

    Treesearch

    Andrew B. Carey

    2000-01-01

    Two strategies for managing forests for multiple values have achieved prominence in debates in the Pacific Northwest: (1) legacy retention with passive management and long rotations, and (2) intensive management for timber with commercial thinnings and long rotations. Northern flying squirrels (Glaucomys sabrinus), Townsend's chipmunks (

  4. Open Source for Knowledge and Learning Management: Strategies beyond Tools

    ERIC Educational Resources Information Center

    Lytras, Miltiadis, Ed.; Naeve, Ambjorn, Ed.

    2007-01-01

    In the last years, knowledge and learning management have made a significant impact on the IT research community. "Open Source for Knowledge and Learning Management: Strategies Beyond Tools" presents learning and knowledge management from a point of view where the basic tools and applications are provided by open source technologies.…

  5. Soil Contamination and Remediation Strategies. Current research and future challenge

    NASA Astrophysics Data System (ADS)

    Petruzzelli, G.

    2012-04-01

    eliminating the source of pollution, but also on blocking the pathways from contaminants to receptors or reducing the exposure to contaminants,. Future challenge integration of sustainability into remediation decision-making. Soil is not a waste! There is a growing interest in the clean up approaches that maintain soil quality after remediation treatments. This issue is of great importance in the U.S.A. where the EPA from 2009 is promoting innovative clean-up strategies (Green Remediation). Green remediation is defined as the practice of considering all environmental effects of remedy and incorporating options to maximize environmental benefit of cleanup actions . These remediation strategies restore contaminated sites to productive use with a great attention to the global environmental quality, including the preservation of soil functionality according to the following principles: use minimally invasive technologies; use passive energy technologies such as bioremediation and phytoremediation as primary remedies or finishing steps where possible and effective; minimize soil and habitat disturbance; minimize bioavailability of contaminants trough adequate contaminant source and plume control If we move from the current definition of remedial targets based on total concentrations, technologies with low impact on the environment can be utilized reducing the wrong choice to disposal soil in landfill destroying quickly a not renewable essential resource.

  6. Salivary gland malignancies - an update on current management for oral healthcare practitioners.

    PubMed

    Green, B; Rahimi, S; Brennan, P A

    2016-11-01

    Salivary gland tumours represent a diverse range of tumours with many histological subtypes which occur in major and minor salivary glands. The management of these tumours is complex owing to their heterogeneity. Surgery together with radiotherapy and/or chemotherapy remains the treatment strategy for these tumours. The aim of this review is to examine the current management of these tumours. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. A holistic strategy for adaptive land management

    USGS Publications Warehouse

    Herrick, Jeffrey E.; Duniway, Michael C.; Pyke, David A.; Bestelmeyer, Brandon T.; Wills, Skye A.; Brown, Joel R.; Karl, Jason W.; Havstad, Kris M.

    2012-01-01

    Adaptive management is widely applied to natural resources management (Holling 1973; Walters and Holling 1990). Adaptive management can be generally defined as an iterative decision-making process that incorporates formulation of management objectives, actions designed to address these objectives, monitoring of results, and repeated adaptation of management until desired results are achieved (Brown and MacLeod 1996; Savory and Butterfield 1999). However, adaptive management is often criticized because very few projects ever complete more than one cycle, resulting in little adaptation and little knowledge gain (Lee 1999; Walters 2007). One significant criticism is that adaptive management is often used as a justification for undertaking actions with uncertain outcomes or as a surrogate for the development of specific, measurable indicators and monitoring programs (Lee 1999; Ruhl 2007).

  8. Clinicians' strategies for managing their emotions during difficult healthcare conversations.

    PubMed

    Luff, Donna; Martin, Elliott B; Mills, Kelsey; Mazzola, Natalia M; Bell, Sigall K; Meyer, Elaine C

    2016-09-01

    To examine strategies employed by clinicians from different disciplines to manage their emotions during difficult healthcare conversations. Self-report questionnaires were collected prior to simulation-based Program to Enhance Relational and Communication Skills (PERCS) workshops for professionals representing a range of experience and specialties at a tertiary pediatric hospital. In response to an open-ended prompt, clinicians qualitatively described their own strategies for managing their emotions during difficult healthcare conversations. 126 respondents reported emotion management strategies. Respondents included physicians (42%), nurses (29%), medical interpreters (16%), psychosocial professionals (9%), and other (4%). Respondents identified 1-4 strategies. Five strategy categories were identified: Self-Care (51%), Preparatory and Relational Skills, (29%), Empathic Presence (28%), Team Approach (26%), and Professional Identity (20%). Across disciplines and experience levels, clinicians have developed strategies to manage their emotions when holding difficult healthcare conversations. These strategies support clinicians before, during and after difficult conversations. Understanding what strategies clinicians already employ to manage their emotions when holding difficult conversations has implications for educational planning and implementation. This study has potential to inform the development of education to support clinicians' awareness of their emotions and to enhance the range and effectiveness of emotion management during difficult healthcare conversations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Evidence-Based Classroom Behaviour Management Strategies

    ERIC Educational Resources Information Center

    Parsonson, Barry S.

    2012-01-01

    This paper reviews a range of evidence-based strategies for application by teachers to reduce disruptive and challenging behaviours in their classrooms. These include a number of antecedent strategies intended to help minimise the emergence of problematic behaviours and a range of those which provide positive consequences for appropriate student…

  10. Surgical Management of Rib Fractures: Strategies and Literature Review.

    PubMed

    de Jong, M B; Kokke, M C; Hietbrink, F; Leenen, L P H

    2014-06-01

    Rib fractures can cause significant problems in trauma patients, often resulting in pain and difficulty with respiration. To prevent pulmonary complications and decrease the morbidity and mortality rates of patients with rib fractures, currently there is a trend to provide surgical management of patients with flail chest. However, the indications for rib fracture fixation require further specification. Past and current strategies are described according to a review of the medical literature. A systematic review was performed including current indications for rib fracture fixation. MEDLINE (2000-2013) was searched, as well as Embase (2000-2013) and Cochrane Databases, using the keywords rib, fracture, fixation, plate, repair, and surgery. Three retrospective studies were found that described different techniques for rib fracture fixation. The results demonstrated a reduced number of ventilation days, decreased long-term morbidity and pain, and satisfactory rehabilitation after surgical treatment. In addition to flail chest, age, Injury Severity Score, and the number of rib fractures were important predictive factors for morbidity and mortality. Surgical rib fracture fixation might be indicated in a broader range of cases than is currently performed. Prospective randomized trials are needed for further confirmation. © The Finnish Surgical Society 2014.

  11. Intraoperative nonpharmacotherapeutic blood management strategies in total knee arthroplasty.

    PubMed

    Banerjee, Samik; Issa, Kimona; Kapadia, Bhaveen H; Khanuja, Harpal S; Harwin, Steven F; McInerney, Vincent K; Mont, Michael A

    2013-12-01

    Substantial amounts of perioperative blood loss occur during total knee arthroplasty (TKA) that may require allogeneic transfusion in more than 30% of patients. Increased blood loss leads to poor physical functioning, increases infection risks, and prolongs hospitalization, which may eventually affect the overall clinical outcomes of TKA. In addition, allogeneic blood transfusions are associated with increased risks of transfusion reactions, immunosuppression, and a variety of immunological reactions. These concerns have led surgeons and anesthesiologists to develop various strategies to conserve blood, reduce costs, and decrease complications related to blood transfusions. Multiple nonpharmacologic intraoperative blood-saving measures have been used including acute normovolemic hemodilution, hypotensive anesthesia, tourniquets, bipolar sealants, intraoperative blood salvage systems, intramedullary femoral plugs, computer-assisted surgery, and the use of patient-specific instrumentation. However, no clear protocol exists currently to help surgeons choose the appropriate method for blood preservation. The aim of this article was to review the various nonpharmacologic intraoperative blood management strategies that have been used in TKA and to analyze their effectiveness and potential complications according to current evidence.

  12. Human resource management strategies and the retention of older RNs.

    PubMed

    Armstrong-Stassen, Marjorie

    2005-01-01

    This study investigated the human resource management strategies that are most important in retaining older RNs in the workforce and the extent to which hospitals are currently engaging in these practices. The participants (n=361) were RNs aged 50 and over employed in hospitals across Ontario. Along with flexible work schedules, the human resource practices rated as most important in the decision of these RNs to remain in the workforce involved compensation (improving benefits; offering incentives for continued employment), recognition and respect (showing appreciation for a job well done; recognizing the experience, knowledge, skill and expertise of older nurses; ensuring that older nurses are treated with respect by others in the organization) and pre- and post-retirement arrangements (retirement with callback; partial or phased retirement options). There were significant differences between the importance that RNs attributed to the 34 human resource practices and the extent to which their hospitals are currently engaged in each practice, with the largest discrepancies occurring for those practices that RNs indicated were most important in their decision to remain in the workforce. While some hospitals may have difficulty in implementing strategies that have budgetary implications, all could implement recognition and respect with minimal financial consequences.

  13. Cancer of the cervix: current management and new approaches.

    PubMed

    Shivnani, Anand T; Rimel, B J; Schink, Julian; Small, William

    2006-11-01

    This article summarizes the current management of patients with newly diagnosed cervical cancer. The topics range from the management of early-stage disease to the phase III randomized studies that have established the current standard of care for patients with locally advanced cancer of the cervix. New approaches to combined-modality therapy with the goal of improving outcomes and decreasing complications are also described.

  14. Environmental factors and health information technology management strategy.

    PubMed

    Menachemi, Nir; Shin, Dong Yeong; Ford, Eric W; Yu, Feliciano

    2011-01-01

    : Previous studies have provided theoretical and empirical evidence that environmental forces influence hospital strategy. : Rooted in resource dependence theory and the information uncertainty perspective, this study examined the relationship between environmental market characteristics and hospitals' selection of a health information technology (HIT) management strategy. : A cross-sectional design is used to analyze secondary data from the American Hospital Association Annual Survey, the Healthcare Information and Management Systems Society Analytics Database, and the Area Resource File. Univariate and multinomial logistic regression analyses are used. : Overall, 3,221 hospitals were studied, of which 60.9% pursed a single-vendor HIT management strategy, 28.9% pursued a best-of-suite strategy, and 10.2% used a best-of-breed strategy. Multivariate analyses controlling for hospital characteristics found that measures of environmental factors representing munificence, dynamism, and/or complexity were systematically associated with various hospital HIT management strategy use. Specifically, the number of generalist physicians per capita was positively associated with the single-vendor strategy (B = -5.64, p = .10). Hospitals in urban markets were more likely to pursue the best-of-suite strategy (B = 0.622, p < .001). Dynamism, measured as the number of managed care contracts for a given hospital, was negatively associated with the single-vendor strategy (B = 0.004, p = .049). Lastly, complexity, measured as market competition, was positively associated with the best-of-breed strategy (B = 0.623, p = .042). : By and large, environmental factors are associated with hospital HIT management strategies in mostly theoretically supported ways. Hospital leaders and policy makers interested in influencing the adoption of hospital HIT should consider how market conditions influence HIT management decisions as part of programs to promote meaningful use.

  15. Current imaging strategies for the evaluation of uterine cervical cancer

    PubMed Central

    Bourgioti, Charis; Chatoupis, Konstantinos; Moulopoulos, Lia Angela

    2016-01-01

    Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma. PMID:27158421

  16. Current treatment strategies for brain metastasis and complications from therapeutic techniques: a review of current literature.

    PubMed

    Platta, Christopher S; Khuntia, Deepak; Mehta, Minesh P; Suh, John H

    2010-08-01

    Each year approximately 170,000 patients are diagnosed with brain metastasis in the United States, making this the most common intracranial tumor in adults. Historically, treatment strategies focused on the use of whole brain radiation therapy (WBRT) for palliation, yielding a median survival time of only 3 to 6 months. The possible effect of WBRT on cognitive function has generated much concern and debate regarding the use of this modality. Thus, the use of WBRT alone, or in conjunction with other treatment modalities should take into account both risks and benefits, to ensure the best patient outcome with regard to disease state and functional status. The advent of technologies permitting local dose-escalation have clearly increased local control rates, and in select patients, even survival, thereby, further intensifying the debate regarding the use of WBRT. Here, we review the use of WBRT, radiosurgery, and resection for the treatment of brain metastases. Further, we will review the use of radiation sensitizers and blood-brain barrier penetrating cytotoxics such as temozolomide. Finally, we will discuss current treatment strategies for possibly maintaining and improving cognitive function for these patients.

  17. Current Issues for Higher Education Information Resources Management.

    ERIC Educational Resources Information Center

    CAUSE/EFFECT, 1995

    1995-01-01

    Current issues that are important for the future of information resources management in higher education are presented. They include: integrating planning for information resources within institution-wide strategic planning; reengineering fundamental services; change management; distributed computing support; networking; the changing communication…

  18. Current Issues for Higher Education Information Resources Management.

    ERIC Educational Resources Information Center

    CAUSE/EFFECT, 1995

    1995-01-01

    Current issues that are important for the future of information resources management in higher education are presented. They include: integrating planning for information resources within institution-wide strategic planning; reengineering fundamental services; change management; distributed computing support; networking; the changing communication…

  19. Current concepts of oxygen management in retinopathy of prematurity.

    PubMed

    Owen, Leah A; Hartnett, M Elizabeth

    2014-01-01

    Retinopathy of prematurity (ROP) is a potentially blinding disorder in premature infants. The underlying pathophysiology is incompletely understood, limiting the prevention and treatment of this devastating condition. Current therapies are directed toward management of aberrant neovascularization thought to result from retinal ischemia in the developing preterm retina. The molecular mediators important for development of retinal ischemia and subsequent neovascular pathology are not fully understood. However, oxygen has been shown to be a key mediator of disease and the oxygen environment for preterm infants has been extensively studied. Despite this, the optimal oxygen environment for preterm infants remains unclear and recent works seeking to clarify this relationship demonstrate somewhat disparate findings. These data further substantiate that ROP is a complex disease with multifactorial etiology including genetic and environmental factors. Therefore, while environmental factors such as oxygen are important to our understanding of the disease process and care of preterm infants, identification of the molecular mediators downstream of oxygen which are necessary for development of ROP pathology will be critical to improve prevention, diagnosis and treatment strategies.

  20. French consensus. Management of patients with hypersomnia: Which strategy?

    PubMed

    Lopez, R; Arnulf, I; Drouot, X; Lecendreux, M; Dauvilliers, Y

    Central hypersomnias principally involves type 1 narcolepsy (NT1), type 2 narcolepsy (NT2) and idiopathic hypersomnia (IH). Despite great progress made in understanding the physiopathology of NT1 with low cerebrospinal fluid hypocretin-1 levels, current treatment remains symptomatic. The same applies to NT2 and IH, for which the physiopathology is still largely unknown. Controlling excessive daytime sleepiness (EDS), cataplexy, hypnagogic hallucinations, sleep paralysis and disturbed night-time sleep are key therapeutic targets in NT1. For IH and NT2, reducing EDS is the main objective. Based on European and American directives for the treatment of narcolepsy, we propose French recommendations for managing central hypersomnias as well as strategies in the case of drug-resistance. Stimulating treatments target EDS, and Modafinil is the first-line treatment. Other stimulants such as methylphenidate, pitolisant, and exceptionally dextro-amphetamine can be prescribed. Selective serotonin and noradrenaline reuptake inhibitor antidepressants are effective for the management of cataplexy in NT1. Sodium oxybate is an effective treatment for several symptoms, including EDS, cataplexy and disturbed night-time sleep. Treatment of central hypersomnia must also take into consideration frequent cardiovascular, metabolic and psychiatric comorbidities, particularly in NT1. New therapies are currently under study with the development of new stimulants and anti-cataplectics. The next few years will see innovative emerging therapies, based on a physiopathological approach, aiming to restore hypocretinergic transmission or to interrupt the autoimmune processes causing the loss of hypocretin neurons.

  1. Use of single large or several small policies as strategies to manage people-park interactions.

    PubMed

    Mackenzie, Catrina A; Baird, Timothy D; Hartter, Joel

    2014-12-01

    Biodiversity conservation has been criticized for undermining or ignoring social well-being. Currently efforts to mutually promote social justice, rural development, and biodiversity conservation, which have been contentious and yielded mixed results, continue to spread despite a general dearth of effective management strategies. We contend that social and economic concerns should be integral to conservation planning and propose that the scale of these phenomena is also critical. To evaluate the merit of this proposal, we adopted and expanded a conservation management strategy framework developed by Joel Heinen and examined how population density, economic disparity, and ethnic heterogeneity vary spatially surrounding 2 contrasting protected areas in East Africa: Kibale National Park in Uganda and Tarangire National Park in Tanzania. Analyses of demographic, wealth, and ethnicity data from regional censuses and household surveys conducted in 2009 and 2010 indicated that choice of scale (landscape or community) changed the management strategies recommended by the model. Therefore, "several small" people-park management strategies varying around a given protected area may be more appropriate than a "single large" people-park strategy applied across an entire protected area. Correspondingly, scale adjusted Heinen recommendations offered new strategies for effective conservation management within these human landscapes not incorporated in current in situ management plans. © 2014 Society for Conservation Biology.

  2. Conservation values and management strategies of coastal windbreaks

    NASA Astrophysics Data System (ADS)

    Lee, M. J.; Song, G. Z. M.

    2015-12-01

    Taiwan is surrounded by oceans, so that the citizens' daily lives and the industrial activities in coast areas are exposed to and affected by strong winds and dust storms caused by the winter monsoon. Tree windbreaks present the functions of windproof, dust inhibition, damp-proof, and climate moderation. However, in recent years, the construction of roads, establishment industrial districts, development of recreation areas, building of wind turbines, and the cultivation of local citizens have greatly changed the width and integrity of tree windbreak belts, and in turn affected their functionality. Our study focus on tree windbreaks right next to the estuary of the Zhoushui River in Taiwan. Through environmental investigations, questionnaire surveys for local citizens, and vegetation sureys, the current functions of windbreaks and impacts of human disturbances on windbreaks will be evaluated. The conservation values and management strategies of tree windbreaks will be proposed after all.

  3. Strategies to address management challenges in larger intensive care units.

    PubMed

    Matlakala, M C; Bezuidenhout, M C; Botha, A D H

    2015-10-01

    To illustrate the need for and suggest strategies that will enhance sustainable management of a large intensive care unit (ICU). The challenges faced by intensive care nursing in South Africa are well documented. However, there appear to be no strategies available to assist nurses to manage large ICUs or for ICU managers to deal with problems as they arise. Data sources to illustrate the need for strategies were challenges described by ICU managers in the management of large ICUs. A purposive sample of managers was included in individual interviews during compilation of evidence regarding the challenges experienced in the management of large ICUs. The challenges were presented at the Critical Care Society of Southern Africa Congress held on 28 August to 2 September 2012 in Sun City North-West province, South Africa. Five strategies are suggested for the challenges identified: divide the units into sections; develop a highly skilled and effective nursing workforce to ensure delivery of quality nursing care; create a culture to retain an effective ICU nursing team; manage assets; and determine the needs of ICU nurses. ICUs need measures to drive the desired strategies into actions to continuously improve the management of the unit. Future research should be aimed at investigating the effectiveness of the strategies identified. This research highlights issues relating to large ICUs and the strategies will assist ICU managers to deal with problems related to large unit sizes, shortage of trained ICU nurses, use of agency nurses, shortage of equipment and supplies and stressors in the ICU. The article will make a contribution to the body of nursing literature on management of ICUs. © 2014 John Wiley & Sons Ltd.

  4. Current approaches to the management of early active diffuse scleroderma skin disease.

    PubMed

    Nihtyanova, Svetlana I; Denton, Christopher P

    2008-02-01

    Skin sclerosis is a clinical hallmark of systemic sclerosis (SSc) and provides a means to classify and evaluate patients. In the diffuse cutaneous subset, skin involvement is often extensive and warrants direct therapy. Currently, broad spectrum immunosuppressive strategies are used, but more targeted specific approaches are now emerging. This article reviews the evidence for efficacy of current treatment approaches and future developments for managing skin disease in early diffuse cutaneous SSc.

  5. A Comparison of Current Guidelines of Five International Societies on Clostridium difficile Infection Management.

    PubMed

    Fehér, Csaba; Mensa, Josep

    2016-09-01

    Clostridium difficile infection (CDI) is increasingly recognized as an emerging healthcare problem of elevated importance. Prevention and treatment strategies are constantly evolving along with the apperance of new scientific evidence and novel treatment methods, which is well-reflected in the differences among consecutive international guidelines. In this article, we summarize and compare current guidelines of five international medical societies on CDI management, and discuss some of the controversial and currently unresolved aspects which should be addressed by future research.

  6. Current and emerging treatment strategies for Duchenne muscular dystrophy

    PubMed Central

    Mah, Jean K

    2016-01-01

    Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in childhood. It is caused by mutations of the DMD gene, leading to progressive muscle weakness, loss of independent ambulation by early teens, and premature death due to cardiorespiratory complications. The diagnosis can usually be made after careful review of the history and examination of affected boys presenting with developmental delay, proximal weakness, and elevated serum creatine kinase, plus confirmation by muscle biopsy or genetic testing. Precise characterization of the DMD mutation is important for genetic counseling and individualized treatment. Current standard of care includes the use of corticosteroids to prolong ambulation and to delay the onset of secondary complications. Early use of cardioprotective agents, noninvasive positive pressure ventilation, and other supportive strategies has improved the life expectancy and health-related quality of life for many young adults with DMD. New emerging treatment includes viral-mediated microdystrophin gene replacement, exon skipping to restore the reading frame, and nonsense suppression therapy to allow translation and production of a modified dystrophin protein. Other potential therapeutic targets involve upregulation of compensatory proteins, reduction of the inflammatory cascade, and enhancement of muscle regeneration. So far, data from DMD clinical trials have shown limited success in delaying disease progression; unforeseen obstacles included immune response against the generated mini-dystrophin, inconsistent evidence of dystrophin production in muscle biopsies, and failure to demonstrate a significant improvement in the primary outcome measure, as defined by the 6-minute walk test in some studies. The long-term safety and efficacy of emerging treatments will depend on the selection of appropriate clinical end points and sensitive biomarkers to detect meaningful changes in disease progression. Correction of the underlying

  7. Unique strategies for technical information management at Johnson Space Center

    NASA Technical Reports Server (NTRS)

    Krishen, Vijay

    1994-01-01

    In addition to the current NASA manned programs, the maturation of Space Station and the introduction of the Space Exploration programs are anticipated to add substantially to the number and variety of data and documentation at NASA Johnson Space Center (JSC). This growth in the next decade has been estimated at five to ten fold compared to the current numbers. There will be an increased requirement for the tracking and currency of space program data and documents with National pressures to realize economic benefits from the research and technological developments of space programs. From a global perspective the demand for NASA's technical data and documentation is anticipated to increase at local, national, and international levels. The primary users will be government, industry, and academia. In our present national strategy, NASA's research and technology will assume a great role in the revitalization of the economy and gaining international competitiveness. Thus, greater demand will be placed on NASA's data and documentation resources. In this paper the strategies and procedures developed by DDMS, Inc., to accommodate the present and future information utilization needs are presented. The DDMS, Inc., strategies and procedures rely on understanding user requirements, library management issues, and technological applications for acquiring, searching, storing, and retrieving specific information accurately and quickly. The proposed approach responds to changing customer requirements and product deliveries. The unique features of the proposed strategy include: (1) To establish customer driven data and documentation management through an innovative and unique methods to identify needs and requirements. (2) To implement a structured process which responds to user needs, aimed at minimizing costs and maximizing services, resulting in increased productivity. (3) To provide a process of standardization of services and procedures. This standardization is the central

  8. Strategies used for managing symptoms by women with fibromyalgia.

    PubMed

    Kengen Traska, Theresa; Rutledge, Dana N; Mouttapa, Michele; Weiss, Jie; Aquino, Jordan

    2012-03-01

    The goal of this study was to describe how persons with fibromyalgia manage their lives given the multiple symptoms they experience, in particular how they use non-pharmacologic strategies, or how they incorporate these strategies along with pharmacologic agents. Persons with fibromyalgia, a widespread chronic pain condition, often suffer from considerable fatigue, sleep disturbances and morning stiffness. Medical management does not lead to a cure, and sufferers must self-manage to maintain a good quality of life. This qualitative descriptive study used group interview methodology. Data were obtained from eight women with fibromyalgia. Women's mean age was 61 (range 54-81). Participants were invited to participate in a 90- minute group interview focused on symptom management. In the interview, open-ended questions allowed them to speak freely about managing multiple fibromyalgia symptoms. Content analysis by the first and second authors led to the identification of themes, which were validated by the co-authors who attended the interviews. Participants reported many strategies to cope with fibromyalgia symptoms and manage their lives. Main strategies included: 'pacing/planning', 'distraction techniques', 'coping with touch sensitivity', 'putting on the mask' and 'medications'. In addition, 'social support' from others with fibromyalgia and from family members was reported to be very important. Study findings demonstrate that women with fibromyalgia can develop strategies that enable them to cope with a life encumbered with chronic pain and fatigue. Moreover, this study confirmed effective fibromyalgia management strategies reported in other studies. Further research is needed on risks/benefits of these and other self-management strategies used by women with fibromyalgia. Our findings suggest that nurses should discuss the self-management strategies found with persons who have fibromyalgia in the context of individual patient experiences. © 2011 Blackwell

  9. Osteoarthritis 2: pain management and treatment strategies.

    PubMed

    Swift, Amelia

    Osteoarthritis (OA) is a painful, progressive joint disorder. This article discusses pharmacological management of OA, such as non-steroidal anti-inflammatory drugs and opioids, and non-pharmacological management, including weight reduction, acupuncture and joint replacement surgery. The third part, to be published online, will cover the physical, psychological and social impact of OA.

  10. 10 Budget-Savvy Content Management Strategies

    ERIC Educational Resources Information Center

    Hillis, David J.

    2004-01-01

    Facing an overall budget reduction of 10 percent, most colleges or universities would postpone investing in a Web content management system. However, for California State University Monterey Bay (CSUMB), a large budget cut made Web content management even more important. CSUMB found an innovative way to purchase and implement a new Content…

  11. Teaching Self-Management Strategies to Adolescents.

    ERIC Educational Resources Information Center

    Young, K. Richard; And Others

    This book presents a behavioral program to teach adolescents basic self-management skills; two chapters provide the theoretical basis for the program and four chapters supply sample lesson plans. The first chapter is an introduction to behavioral self-management. It proposes a behavior change model with four major components: assessment,…

  12. 10 Budget-Savvy Content Management Strategies

    ERIC Educational Resources Information Center

    Hillis, David J.

    2004-01-01

    Facing an overall budget reduction of 10 percent, most colleges or universities would postpone investing in a Web content management system. However, for California State University Monterey Bay (CSUMB), a large budget cut made Web content management even more important. CSUMB found an innovative way to purchase and implement a new Content…

  13. Strategies and algorithms for management of the difficult airway.

    PubMed

    Heidegger, Thomas; Gerig, Hans J; Henderson, John J

    2005-12-01

    Management of the difficult airway is the most important patient safety issue in the practice of anaesthesia. Many national societies have developed algorithms and guidelines for management of the difficult airway. The key issues of this chapter are definition of terms, the advantages and disadvantages of the use of guidelines, and a comparison of different algorithms and guidelines for management of the most important clinical airway scenarios. Although there is no strong evidence of benefit for any specific strategy or algorithm for management of the difficult airway, there is strong agreement that a pre-planned strategy may lead to improved outcome.

  14. Using scenario analysis to determine managed care strategy.

    PubMed

    Krentz, S E; Gish, R S

    2000-09-01

    In today's volatile healthcare environment, traditional planning tools are inadequate to guide financial managers of provider organizations in developing managed care strategies. These tools often disregard the uncertainty surrounding market forces such as employee benefit structure, the future of Medicare managed care, and the impact of consumer behavior. Scenario analysis overcomes this limitation by acknowledging the uncertain healthcare environment and articulating a set of plausible alternative futures, thus supplying financial executives with the perspective to craft strategies that can improve the market position of their organizations. By being alert for trigger points that might signal the rise of a specific scenario, financial managers can increase their preparedness for changes in market forces.

  15. Spatial strategies for managing visitor impacts in National Parks

    USGS Publications Warehouse

    Leung, Y.-F.; Marion, J.L.

    1999-01-01

    Resource and social impacts caused by recreationists and tourists have become a management concern in national parks and equivalent protected areas. The need to contain visitor impacts within acceptable limits has prompted park and protected area managers to implement a wide variety of strategies and actions, many of which are spatial in nature. This paper classifies and illustrates the basic spatial strategies for managing visitor impacts in parks and protected areas. A typology of four spatial strategies was proposed based on the recreation and park management literature. Spatial segregation is a common strategy for shielding sensitive resources from visitor impacts or for separating potentially conflicting types of use. Two forms of spatial segregation are zoning and closure. A spatial containment strategy is intended to minimize the aggregate extent of visitor impacts by confining use to limited designated or established Iocations. In contrast, a spatial dispersal strategy seeks to spread visitor use, reducing the frequency of use to levels that avoid or minimize permanent resource impacts or visitor crowding and conflict. Finally, a spatial configuration strategy minimizes impacting visitor behavior though the judicious spatial arrangement of facilities. These four spatial strategics can be implemented separately or in combination at varying spatial scales within a single park. A survey of national park managers provides an empirical example of the diversity of implemented spatial strategies in managing visitor impacts. Spatial segregation is frequently applied in the form of camping restrictions or closures to protect sensitive natural or cultural resources and to separate incompatible visitor activities. Spatial containment is the most widely applied strategy for minimizing the areal extent of resource impacts. Spatial dispersal is commonly applied to reduce visitor crowding or conflicts in popular destination areas but is less frequently applied or

  16. HMO strategies for managing workers' compensation claims.

    PubMed

    Gallagher, P A

    1996-03-01

    Health maintenance organizations (HMOs) have become very active in managing workers' compensation medical expense benefits. A survey of 316 HMOs shows that this activity takes the form of various network models and a range of services--such as utilization review and case management--that may not be linked to a provider network. Of the HMOs surveyed, 78 reported that, by using managed care services and provider discounts, they were able to save from 20 percent to 30 percent on occupational health claim costs.

  17. Current trends in pharmacy benefit designs: a threat to disease management in chronic complex diseases.

    PubMed

    Owens, Gary; Emons, Matthew F; Christian-Herman, Jennifer; Lawless, Grant

    2007-04-01

    With a focus on those patients who are candidates for treatment with biologic agents, we review the impact that current pharmacy benefit trends have on patients with chronic complex diseases and how they affect opportunities for disease management in this unique patient population. Dramatic increases in health care costs have led to a variety of strategies to manage cost. Many of these strategies either limit access to care or increase the patient's responsibility for choosing and paying for care, especially for medications. These strategies have a disproportionate impact on patients with chronic complex diseases, particularly those who require the use of biologic medications. A fundamental prerequisite of disease management has been coverage of disease-modifying therapies. If current pharmacy benefit trends continue, unintended consequences will likely occur including lost opportunities for disease management. Current pharmacy benefit trends could adversely impact disease management, particularly for patients requiring the use of biologic agents. Health plans should consider innovative benefit designs that reflect an appropriate level of cost sharing across all key stake-holders, ensuring appropriate access to needed therapies. Additional research is needed to clarify the value of newer approaches to therapies or benefit design changes.

  18. Adaptive Management as an Effective Strategy: Interdisciplinary Perceptions for Natural Resources Management

    NASA Astrophysics Data System (ADS)

    Dreiss, Lindsay M.; Hessenauer, Jan-Michael; Nathan, Lucas R.; O'Connor, Kelly M.; Liberati, Marjorie R.; Kloster, Danielle P.; Barclay, Janet R.; Vokoun, Jason C.; Morzillo, Anita T.

    2017-02-01

    Adaptive management is a well-established approach to managing natural resources, but there is little evidence demonstrating effectiveness of adaptive management over traditional management techniques. Peer-reviewed literature attempts to draw conclusions about adaptive management effectiveness using social perceptions, but those studies are largely restricted to employees of US federal organizations. To gain a more comprehensive insight into perceived adaptive management effectiveness, this study aimed to broaden the suite of disciplines, professional affiliations, and geographic backgrounds represented by both practitioners and scholars. A questionnaire contained a series of questions concerning factors that lead to or inhibit effective management, followed by another set of questions focused on adaptive management. Using a continuum representing strategies of both adaptive management and traditional management, respondents selected those strategies that they perceived as being effective. Overall, characteristics (i.e., strategies, stakeholders, and barriers) identified by respondents as contributing to effective management closely aligned with adaptive management. Responses were correlated to the type of adaptive management experience rather than an individual's discipline, occupational, or regional affiliation. In particular, perceptions of characteristics contributing to adaptive management effectiveness varied between respondents who identified as adaptive management scholars (i.e., no implementation experience) and adaptive management practitioners. Together, these results supported two concepts that make adaptive management effective: practitioners emphasized adaptive management's value as a long-term approach and scholars noted the importance of stakeholder involvement. Even so, more communication between practitioners and scholars regarding adaptive management effectiveness could promote interdisciplinary learning and problem solving for improved

  19. Adaptive Management as an Effective Strategy: Interdisciplinary Perceptions for Natural Resources Management.

    PubMed

    Dreiss, Lindsay M; Hessenauer, Jan-Michael; Nathan, Lucas R; O'Connor, Kelly M; Liberati, Marjorie R; Kloster, Danielle P; Barclay, Janet R; Vokoun, Jason C; Morzillo, Anita T

    2017-02-01

    Adaptive management is a well-established approach to managing natural resources, but there is little evidence demonstrating effectiveness of adaptive management over traditional management techniques. Peer-reviewed literature attempts to draw conclusions about adaptive management effectiveness using social perceptions, but those studies are largely restricted to employees of US federal organizations. To gain a more comprehensive insight into perceived adaptive management effectiveness, this study aimed to broaden the suite of disciplines, professional affiliations, and geographic backgrounds represented by both practitioners and scholars. A questionnaire contained a series of questions concerning factors that lead to or inhibit effective management, followed by another set of questions focused on adaptive management. Using a continuum representing strategies of both adaptive management and traditional management, respondents selected those strategies that they perceived as being effective. Overall, characteristics (i.e., strategies, stakeholders, and barriers) identified by respondents as contributing to effective management closely aligned with adaptive management. Responses were correlated to the type of adaptive management experience rather than an individual's discipline, occupational, or regional affiliation. In particular, perceptions of characteristics contributing to adaptive management effectiveness varied between respondents who identified as adaptive management scholars (i.e., no implementation experience) and adaptive management practitioners. Together, these results supported two concepts that make adaptive management effective: practitioners emphasized adaptive management's value as a long-term approach and scholars noted the importance of stakeholder involvement. Even so, more communication between practitioners and scholars regarding adaptive management effectiveness could promote interdisciplinary learning and problem solving for improved

  20. [Waste management strategy and the role of the environmental protection and energy efficiency fund].

    PubMed

    Kalambura, Sanja

    2006-09-01

    On 14 October 2005, the Croatian Parliament adopted the National Strategy of Waste Management pursuant to Article 8 of the Waste Act. This strategy defines its objectives and the means to reach them, and gives an overview of the current situation in waste management. It seeks to provide a realistic framework for the effective reduction of national waste load and for a sustainable waste management. This Strategy defines 15 major waste flows which are in concordance with the EU practice. It also defines waste management buildings and plants, and looks into the remediation of municipal waste landfills. According to the Strategy, waste management will be present on all levels of administration: from national to local, and will include all areas of production, consumption, and everyday life. Founded on the EU's general principles of waste management, this Strategy provides the ideal framework for a sustained waste management in Croatia by the year 2025. Environmental Protection and Energy Efficiency Fund is one of the key administration bodies within the waste management system. It collects taxes for motor vehicles, for sulphur and nitrogen oxide pollution sources, for environmental hazardous and non-hazardous industrial waste load, and for the use of the environment. The Fund participates in the ongoing municipal landfill remediation projects and programmes all over Croatia (currently 161 landfills are being remedied) and helps to establish new regional and county waste management centres. It co-finances clean production technology projects, projects whose aim is to reduce the emission of harmful gases, projects for reusable energy sources and for more efficient use of energy, projects for remediation of unregulated municipal landfills, projects for primary recycling, and projects for biodiversity landscapes. According to an estimate, the implementation of the National Strategy of Waste Management will cost over 24 billion Croatian kunas (about 3.3 billion Euros

  1. Emphysematous pyelonephritis with calculus: Management strategies

    PubMed Central

    Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph

    2007-01-01

    Objective: Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Materials and Methods: Over four years, we diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. Results: EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. Conclusion: In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures. PMID:19718324

  2. Knowledge Management and the Competitive Strategy of the Firm

    ERIC Educational Resources Information Center

    Halawi, Leila A.; McCarthy, Richard V.; Aronson, Jay E.

    2006-01-01

    Purpose: Knowledge management (KM) has emerged as a strategy to improve organizational competitiveness. Our purpose is to identify the relationship between KM and the firm's competitive advantage. Design/methodology/approach: We review the existing literature on KM and strategy formulation. We utilize the resource-based view approach as a lens for…

  3. Knowledge Management and the Competitive Strategy of the Firm

    ERIC Educational Resources Information Center

    Halawi, Leila A.; McCarthy, Richard V.; Aronson, Jay E.

    2006-01-01

    Purpose: Knowledge management (KM) has emerged as a strategy to improve organizational competitiveness. Our purpose is to identify the relationship between KM and the firm's competitive advantage. Design/methodology/approach: We review the existing literature on KM and strategy formulation. We utilize the resource-based view approach as a lens for…

  4. Analysis of Human Resources Management Strategy in China Electronic Commerce Enterprises

    NASA Astrophysics Data System (ADS)

    Shao, Fang

    The paper discussed electronic-commerce's influence on enterprise human resources management, proposed and proved the human resources management strategy which electronic commerce enterprise should adopt from recruitment strategy to training strategy, keeping talent strategy and other ways.

  5. Current Events and the International Relations Curriculum: Instructional Strategies.

    ERIC Educational Resources Information Center

    Chernotsky, Harry I.

    One of the most significant challenges confronting college instructors who teach international politics survey courses is the coverage of current events issues and how to stimulate student interest about the issues. This paper describes two techniques, a current events sweepstakes and a Great Decisions roundtable, designed to infuse current events…

  6. Managing organizational change: strategies for the female health care supervisor.

    PubMed

    Davies, G

    1990-07-01

    In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Strategies for initial management of hypertension

    PubMed Central

    Gupta, Rajeev; Guptha, Soneil

    2010-01-01

    High blood pressure (BP) is a major public health problem in India and its prevalence is rapidly increasing among urban and rural populations. Reducing systolic and diastolic BP can decrease cardiovascular risk and this can be achieved by non-pharmacological (lifestyle measures) as well as pharmacological means. Lifestyle changes should be the initial approach to hypertension management and include dietary interventions (reducing salt, increasing potassium, alcohol avoidance, and multifactorial diet control), weight reduction, tobacco cessation, physical exercise, and stress management. A number of pharmaceutical agents, well evidenced by large randomized clinical trials, are available for initial treatment of high BP. These include older molecules such as thiazide diuretics and beta-blocking agents and newer molecules, dihydropyridine calcium channel blockers (CCB), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARB). In view of the recent clinical trials data, some international guidelines suggest that CCB, ACE inhibitors or ARB and not beta-blockers or diuretics should be the initial therapy in hypertension management. Comprehensive hypertension management focuses on reducing overall cardiovascular risk by lifestyle measures, BP lowering and lipid management and should be the preferred initial treatment approach. PMID:21150005

  8. Improved control strategy for PI-R current of DFIG considering voltage and current harmonics compensation

    NASA Astrophysics Data System (ADS)

    Song, S. Y.; Liu, Q. H.; Zhao, Y. N.; Liu, S. Y.

    2016-08-01

    With the rapid development of wind power generation, the related research of wind power control and integration issues has attracted much attention, and the focus of the research are shifting away from the ideal power grid environment to the actual power grid environment. As the main stream wind turbine generator, a doubly-fed induction generator (DFIG) is connected to the power grid directly by its stator, so it is particularly sensitive to the power grid. This paper studies the improvement of DFIG control technology in the power grid harmonic environment. Based on the DFIG dynamic model considering the power grid harmonic environment, this paper introduces the shortcomings of the common control strategy of DFIG, and puts forward the enhanced method. The decoupling control of the system is realized by compensating the coupling between the rotor harmonic voltage and harmonic current, improving the control performance. In addition, the simulation experiments on PSCAD/EMTDC are carried out to verify the correctness and effectiveness of the improved scheme.

  9. Meralgia paresthetica: diagnosis and management strategies.

    PubMed

    Harney, Donal; Patijn, Jacob

    2007-01-01

    Meralgia paresthetica (MP), coined from the Greek words meros (thigh and algos), meaning pain, is a neurological disorder characterized by a localized area of paresthesia and numbness on the anterolateral aspect of the thigh. The incidence of MP is more common than often reported in the literature. The etiology of MP includes mechanical factors such as obesity, pregnancy, and other conditions associated with increased intrabdominal pressure, surgery of the spine, and pelvic osteotomy. A coherent history and pertinent physical examination is essential in making the diagnosis; however, red flags such as tumor and lumbar disk herniations must be recognized and appropriately treated. While the diagnosis of MP is essentially a clinical diagnosis, sensory nerve conduction velocity studies are a useful adjunctive diagnostic tool. The management of MP includes treating the underlying cause (if any) and conservative management. Surgery should only be adopted when all nonoperative therapies have failed to manage the condition in an effective manner.

  10. Management Strategies for Mycosis Fungoides in India

    PubMed Central

    Raychaudhury, Tanumay

    2017-01-01

    Mycosis fungoides is the most common primary cutaneous T-cell lymphoma. The approach to diagnosis and further follow-up is outlined. Evidence for interventions is based classically on a Tumor Node Metastasis Blood TNMB “stage-based” approach. The treatment options in India are limited. The options as per risk stratification and prognostic index are discussed. Early stages and low-risk patients can be managed with expectant policy or skin-directed therapies including topical steroids and phototherapy; intermediate-risk patients can be opted for interferons or retinoids or low dose methotrexate along with radiotherapy including total skin electron beam therapy while high-risk patients are managed most often with single agent or multiagent palliative chemotherapy. Patients who are intermediate- or high-risk need management by a multispecialty team at tertiary care centers. PMID:28400632

  11. Municipal solid waste management strategies in Turkey.

    PubMed

    Turan, N Gamze; Coruh, Semra; Akdemir, Andaç; Ergun, Osman Nuri

    2009-01-01

    Municipal solid waste (MSW) is a major environmental problem in Turkey, as in many developing countries. Problems associated with municipal solid waste are difficult to address, but efforts towards more efficient collection and transportation and environmentally acceptable waste disposal continue in Turkey. Although strict regulations on the management of solid waste are in place, primitive disposal methods such as open dumping and discharge into surface water have been used in various parts of Turkey. This study presents a brief history of the legislative trends in Turkey for MSW management. The study also presents the MSW responsibility and management structure together with the present situation of generation, composition, recycling, and treatment. The results show that approximately 25 million ton of MSW are generated annually in Turkey. About 77% of the population receives MSW services. In spite of efforts to change open dumping areas into sanitary landfills and to build modern recycling and composting facilities, Turkey still has over 2000 open dumps.

  12. Classroom Management Strategies and Behavioral Interventions to Support Academic Achievement

    ERIC Educational Resources Information Center

    Gilpatrick, Robin Sue Holzworth

    2010-01-01

    This mixed method project study identified the need for effective classroom management strategies to dissuade student noncompliant behavior and to ensure academic success for all students. Enhancing classroom management practices is vital to improved student achievement and teacher self-efficacy. Within a constructivist framework, it is critical…

  13. A Strategy for Optimizing Item-Pool Management

    ERIC Educational Resources Information Center

    Ariel, Adelaide; van der Linden, Wim J.; Veldkamp, Bernard P.

    2006-01-01

    Item-pool management requires a balancing act between the input of new items into the pool and the output of tests assembled from it. A strategy for optimizing item-pool management is presented that is based on the idea of a periodic update of an optimal blueprint for the item pool to tune item production to test assembly. A simulation study with…

  14. Strategies for job creation through national forest management

    Treesearch

    Susan Charnley

    2014-01-01

    This chapter explores the ways in which national forest managers may contribute to community well-being by designing projects that accomplish forest management in ways that not only meet their ecological goals, but also create economic opportunities for nearby communities. The chapter summarizes a number of strategies for enhancing the economic benefits to communities...

  15. A Strategy for Optimizing Item-Pool Management

    ERIC Educational Resources Information Center

    Ariel, Adelaide; van der Linden, Wim J.; Veldkamp, Bernard P.

    2006-01-01

    Item-pool management requires a balancing act between the input of new items into the pool and the output of tests assembled from it. A strategy for optimizing item-pool management is presented that is based on the idea of a periodic update of an optimal blueprint for the item pool to tune item production to test assembly. A simulation study with…

  16. Classroom Management Strategies and Behavioral Interventions to Support Academic Achievement

    ERIC Educational Resources Information Center

    Gilpatrick, Robin Sue Holzworth

    2010-01-01

    This mixed method project study identified the need for effective classroom management strategies to dissuade student noncompliant behavior and to ensure academic success for all students. Enhancing classroom management practices is vital to improved student achievement and teacher self-efficacy. Within a constructivist framework, it is critical…

  17. A Policy Change Strategy for Head Lice Management

    ERIC Educational Resources Information Center

    Andresen, Kathleen; McCarthy, Ann Marie

    2009-01-01

    The purpose of this project was to formulate an effective change strategy for head lice management in a group of five separate school districts within one county. Despite a desire to use evidence to support their practice, school nurses often encounter educational system barriers that prevent independent management of health conditions. The use of…

  18. Socioeconomic evaluation of broad-scale land management strategies.

    Treesearch

    Lisa K. Crone; Richard W. Haynes

    2001-01-01

    This paper examines the socioeconomic effects of alternative management strategies for Forest Service and Bureau of Land Management lands in the interior Columbia basin. From a broad-scale perspective, there is little impact or variation between alternatives in terms of changes in total economic activity or social conditions in the region. However, adopting a finer...

  19. Delegation: Win-Win Strategies for Managing Early Childhood Settings.

    ERIC Educational Resources Information Center

    Hayden, Jacqueline

    1999-01-01

    This issue of the Australian Early Childhood Association Research in Practice Series provides staff management strategies for directors and others involved with the management of early childhood settings and suggests ways to effectively delegate authority and tasks in order to reduce administrative pressures and workload. The booklet presents…

  20. Primary care referral management: a marketing strategy for hospitals.

    PubMed

    Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J

    1990-06-01

    With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.

  1. A Policy Change Strategy for Head Lice Management

    ERIC Educational Resources Information Center

    Andresen, Kathleen; McCarthy, Ann Marie

    2009-01-01

    The purpose of this project was to formulate an effective change strategy for head lice management in a group of five separate school districts within one county. Despite a desire to use evidence to support their practice, school nurses often encounter educational system barriers that prevent independent management of health conditions. The use of…

  2. Modeling the cumulative watershed effects of forest management strategies

    Treesearch

    R. R. Ziemer; J. Lewis; R. M. Rice; T. E. Lisle

    1991-01-01

    Abstract - There is increasing concern over the possibility of adverse cumulative watershed effects from intensive forest management. It is impractical to address many aspects of the problem experimentally because to do so would require studying large watersheds for 100 yr or more. One such aspect is the long-term effect of forest management strategies on erosion and...

  3. Ecological principles underpinning invasive plant management tools and strategies

    USDA-ARS?s Scientific Manuscript database

    The broad focus of ecologically-based invasive plant management is to identify and repair the ecological processes facilitating plant invasion. To be useful, however, EBIPM requires that our application of management tools and strategies be based on ecological principles that determine the rate and ...

  4. Multigeneration employees: strategies for effective management.

    PubMed

    Kupperschmidt, B R

    2000-09-01

    Today's health care workforce comprises Traditional, Baby Boomer, and Generation X employees. Effective managers must understand the times and generational characteristics of these employees and they must assure that employees understand and respect one another's differences. They must foster open discussion of how generational differences influence attitudes toward work and organizations. They must provide opportunities for multigeneration employees to contribute their best concurrent with meeting organizational goals. Employees must be offered a conditional security based upon value-added results and collaboration. Managers must use leadership practices that encourage the hearts of dispirited employees.

  5. Strategies for managing impressions of racial identity in the workplace.

    PubMed

    Roberts, Laura Morgan; Cha, Sandra E; Kim, Sung Soo

    2014-10-01

    This article deepens understanding of the workplace experiences of racial minorities by investigating racial identity-based impression management (RIM) by Asian American journalists. Racial centrality, directly or indirectly, predicted the use of 4 RIM strategies (avoidance, enhancement, affiliation, and racial humor). Professional centrality also predicted strategy use, which was related to life satisfaction and perceived career success. By shedding light on proactive strategies that individuals use to influence colleagues' impressions of their racial identity, we contribute to research on diversity in organizations, impression management, and racial identity.

  6. Current management of severe pelvic and perineal trauma.

    PubMed

    Arvieux, C; Thony, F; Broux, C; Ageron, F-X; Rancurel, E; Abba, J; Faucheron, J-L; Rambeaud, J-J; Tonetti, J

    2012-08-01

    Mortality associated with pelvic and perineal trauma (PPT) has fallen from 25% to 10% in the last decade thanks to progress accomplished in medical, surgical and interventional radiology domains (Dyer and Vrahas, 2006) [1]. The management strategy depends on the hemodynamic status of the patient (stable, unstable or extremely unstable). Open trauma requires specific treatment in addition to control of bleeding. All surgical centers can be confronted some day with patients with hemorrhagic PPT and for this reason, all surgeons should be familiar with the initial management. In expert centers, management of patients with severe PPT is complex, multidisciplinary and often requires several re-interventions. Obstetrical and sexual trauma, also requiring specific management, will not be dealt with herein. Copyright © 2012. Published by Elsevier Masson SAS.

  7. Alertness Management Strategies for Operational Contexts

    DTIC Science & Technology

    2008-08-01

    or reproductive disorders. In addition, there is evidence from some studies that night work is associated with increased accide’nts. In fact, Folkard...behaviorally based strategies for avoiding insomnia in many situations, but in some cases, hypnotic medications or so- called "sleeping pills" may be necessary...preferable to being sleep deprived. Choosing the best hypnotic for each situation requires consideration of a variety of factors. From a strictly

  8. Current treatments and advances in pain and anxiety management.

    PubMed

    Huang, David; Wun, Edmund; Stern, Avichai

    2011-07-01

    In light of preoperative and postoperative mortality and morbidity, continued advancement in pain and anxiety management would benefit millions. Although significant strides have been made in the past few decades, it is imperative that research and development continue. This article discusses types of pain and anxiety, the relationship between pain and anxiety, the physiology of pain and anxiety, and current trends in pain and anxiety management.

  9. Population health management: a "start small" strategy.

    PubMed

    Sanford, Kathleen D

    2013-01-01

    Catholic Health Initiatives (CHI) is piloting population health management for a test population that comprises CHI employees and their families. CHI is using a medical home model to coordinate care. The system anticipates a reduction in its employee healthcare costs of 10 to 14 percent.

  10. Classroom Strategies: Classroom Management Systems. Volume 3.

    ERIC Educational Resources Information Center

    Speiss, Madeleine F.; And Others

    Classroom management is defined as procedures for arranging the classroom environment so that children learn what the teacher wants to teach them in the healthiest and most effective way possible. The Southwestern Cooperative Educational Laboratory presents a discussion of these procedures as they relate to social controls and components of…

  11. Evaluation and experimentation with duck management strategies

    USGS Publications Warehouse

    Nichols, J.D.; Johnson, F.A.

    1989-01-01

    Our knowledge of the effects of hunting regulations on duck populations has been based largely on retrospective studies of historical data. We have reached the limits of what can be learned in this way. Future knowledge gains will likely come about only through experimentation and adaptive management.

  12. Evaluating Executive Strategies (Management Strategies and Teaching-Learning Strategies) of Graduate Curriculum: Case Study in Isfahan University

    ERIC Educational Resources Information Center

    Rahmanpour, Muhammad; Ahmadi, Mojtaba; Hatami, Mostafa; Mirzaee, Hamzeh

    2017-01-01

    The present study seeks to evaluate executive strategies in graduate Curriculum of Isfahan University from the point of view of management and teaching-learning strategies. This study is an applied survey. The population comprised BA students and faculty members of the University of Isfahan. In order to do so, 141 professors and 278 students were…

  13. Development of risk-based air quality management strategies under impacts of climate change.

    PubMed

    Liao, Kuo-Jen; Amar, Praveen; Tagaris, Efthimios; Russell, Armistead G

    2012-05-01

    Climate change is forecast to adversely affect air quality through perturbations in meteorological conditions, photochemical reactions, and precursor emissions. To protect the environment and human health from air pollution, there is an increasing recognition of the necessity of developing effective air quality management strategies under the impacts of climate change. This paper presents a framework for developing risk-based air quality management strategies that can help policy makers improve their decision-making processes in response to current and future climate change about 30-50 years from now. Development of air quality management strategies under the impacts of climate change is fundamentally a risk assessment and risk management process involving four steps: (1) assessment of the impacts of climate change and associated uncertainties; (2) determination of air quality targets; (3) selections of potential air quality management options; and (4) identification of preferred air quality management strategies that minimize control costs, maximize benefits, or limit the adverse effects of climate change on air quality when considering the scarcity of resources. The main challenge relates to the level of uncertainties associated with climate change forecasts and advancements in future control measures, since they will significantly affect the risk assessment results and development of effective air quality management plans. The concept presented in this paper can help decision makers make appropriate responses to climate change, since it provides an integrated approach for climate risk assessment and management when developing air quality management strategies. Development of climate-responsive air quality management strategies is fundamentally a risk assessment and risk management process. The risk assessment process includes quantification of climate change impacts on air quality and associated uncertainties. Risk management for air quality under the impacts of

  14. Change in MSW characteristics under recent management strategies in Taiwan.

    PubMed

    Chang, Yu-Min; Liu, Chien-Chung; Hung, Chao-Yang; Hu, Allen; Chen, Shiao-Shing

    2008-12-01

    Reduction and recycling initiatives such as producer responsibility and pay-as-you-throw are being implemented in Taiwan. This paper presents a study assessing the impact of recently implemented municipal solid waste (MSW) reduction and recycling management strategies on the characteristics of waste feedstock for incineration in Taiwan. Through the periodic sampling of two typical MSW incineration plants, proximate and ultimate analyses were conducted according to standard methods to explore the influence of MSW reduction and recycling management strategies on incineration feed waste characteristics. It was observed that the annual amount of MSW generated in 2005 decreased by about 10% compared to 2003 and that the characteristics of MSW have changed significantly due to recent management strategies. The heating value of the MSW generated in Taiwan increased yearly by about 5% after program implementation. A comparison of the monthly variations in chemical concentrations indicated that the chlorine content in MSW has changed. This change results from usage reduction of PVC plastic due to the recycling fund management (RFM) program, and the food waste as well as salt content reduction due to the total recycling for kitchen garbage program. This achievement will improve the reduction of dioxin emissions from MSW incineration. In summary, management strategies must be conducted in tandem with the global trend to achieve a zero-waste-discharge country. When implementing these strategies and planning for future MSW management systems, it is important to consider the changes that may occur in the composition and characteristics of MSW over time.

  15. Mistakes to avoid when planning managed care strategies.

    PubMed

    Scheur, B S

    1997-06-01

    Hospital executives, steeped in hospital business traditions, sometimes fall victim to those traditions when planning their managed care strategies. They may fail to sufficiently evaluate their hospitals' market position or set appropriate priorities for their various business strategies. They may not recruit individuals with managed care expertise, develop effective marketing plans, or construct realistic physician networks. Some hospital executives may be ill-equipped to deal with cultural clashes and reluctant to share control of their managed care organizations with physicians. Or, they may not always understand the true nature of the arrangement they have entered into, the information and technology needs of the arrangement, and their own strategic advantages. Today's hospital executives must plan their managed care strategies carefully and execute them intelligently to ensure success.

  16. Power Management Based Current Control Technique for Photovoltaic-Battery Assisted Wind-Hydro Hybrid System

    NASA Astrophysics Data System (ADS)

    Ram Prabhakar, J.; Ragavan, K.

    2013-07-01

    This article proposes new power management based current control strategy for integrated wind-solar-hydro system equipped with battery storage mechanism. In this control technique, an indirect estimation of load current is done, through energy balance model, DC-link voltage control and droop control. This system features simpler energy management strategy and necessitates few power electronic converters, thereby minimizing the cost of the system. The generation-demand (G-D) management diagram is formulated based on the stochastic weather conditions and demand, which would likely moderate the gap between both. The features of management strategy deploying energy balance model include (1) regulating DC-link voltage within specified tolerances, (2) isolated operation without relying on external electric power transmission network, (3) indirect current control of hydro turbine driven induction generator and (4) seamless transition between grid-connected and off-grid operation modes. Furthermore, structuring of the hybrid system with appropriate selection of control variables enables power sharing among each energy conversion systems and battery storage mechanism. By addressing these intricacies, it is viable to regulate the frequency and voltage of the remote network at load end. The performance of the proposed composite scheme is demonstrated through time-domain simulation in MATLAB/Simulink environment.

  17. Budd-Chiari syndrome: illustrated review of current management.

    PubMed

    Horton, John D; San Miguel, Francisco L; Membreno, Fernando; Wright, Francis; Paima, Juan; Foster, Preston; Ortiz, Jorge A

    2008-04-01

    Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow obstruction at any level from the small hepatic veins to the atriocaval junction. BCS is a complex disease with a wide spectrum of aetiologies and presentations. This article reviews the current literature with respect to presentation, management and prognosis of the disease. Medical, interventional and surgical management of BCS is discussed. Particular attention is paid to interventional and surgical aspects of management. The review is augmented by images, which provide a clinical corollary to the text.

  18. Managing incidental pancreatic cystic neoplasms with integrated molecular pathology is a cost-effective strategy.

    PubMed

    Das, Ananya; Brugge, William; Mishra, Girish; Smith, Dennis M; Sachdev, Mankanwal; Ellsworth, Eric

    2015-10-01

    Current guidelines recommend using endoscopic ultrasound (EUS), carcinoembryonic antigen (CEA) testing and cytology to manage incidental pancreatic cystic neoplasms (PCN); however, studies suggest a strategy including integrated molecular pathology (IMP) of cyst fluid may further aid in predicting risk of malignancy. Here, we evaluate several strategies for diagnosing and managing asymptomatic PCN using healthcare economic modeling. A third-party-payer perspective Markov decision model examined four management strategies in a hypothetical cohort of 1000 asymptomatic patients incidentally found to have a 3 cm solitary pancreatic cystic lesion. Strategy I used cross-sectional imaging, recommended surgery only if symptoms or risk factors emerged. Strategy II considered patients for resection without initial EUS. Strategy III (EUS + CEA + Cytology) referred only those with mucinous cysts (CEA > 192 ng/mL) for resection. Strategy IV implemented IMP; a commercially available panel provided a "Benign," "Mucinous," or "Aggressive" classification based on the level of mutational change in cyst fluid. "Benign" and "Mucinous" patients were followed with surveillance; "Aggressive" patients were referred for resection. Quality-adjusted life-years (QALY), relative risk with 95 %CI, Number Needed to Treat (NNT), and incremental cost-effectiveness ratios were calculated. Strategy IV provided the greatest increase in QALY at nearly identical cost to the cheapest approach, Strategy I. Relative risk of malignancy compared to the current standard of care and nearest competing strategy, Strategy III, was 0.18 (95 %CI 0.06 - 0.53) with an NNT of 56 (95 %CI 34 - 120). Use of IMP was the most cost-effective strategy, supporting its routine clinical use.

  19. Result Merging Strategies for a Current News Metasearcher.

    ERIC Educational Resources Information Center

    Rasolofo, Yves; Hawking, David; Savoy, Jacques

    2003-01-01

    Metasearching of online current news services is a potentially useful Web application of distributed information retrieval techniques. Reports experiences in building a metasearcher designed to provide up-to-date searching over a significant number of rapidly changing current news sites, focusing on how to merge results from the search engines at…

  20. Reservoir management strategy for East Randolph Field, Randolph Township, Portage County, Ohio

    SciTech Connect

    Safley, L.E.; Salamy, S.P.; Young, M.A.; Fowler, M.L.; Wing, J.L.; Thomas, J.B.; Mills, J.; Wood, D.

    1998-07-01

    The primary objective of the Reservoir Management Field Demonstration Program is to demonstrate that multidisciplinary reservoir management teams using appropriate software and methodologies with efforts scaled to the size of the resource are a cost-effective method for: Increasing current profitability of field operations; Forestalling abandonment of the reservoir; and Improving long-term economic recovery for the company. The primary objective of the Reservoir Management Demonstration Project with Belden and Blake Corporation is to develop a comprehensive reservoir management strategy to improve the operational economics and optimize oil production from East Randolph field, Randolph Township, Portage County, Ohio. This strategy identifies the viable improved recovery process options and defines related operational and facility requirements. In addition, strategies are addressed for field operation problems, such as paraffin buildup, hydraulic fracture stimulation, pumping system optimization, and production treatment requirements, with the goal of reducing operating costs and improving oil recovery.

  1. Solubility and dissolution enhancement strategies: current understanding and recent trends.

    PubMed

    Jain, Shashank; Patel, Niketkumar; Lin, Senshang

    2015-06-01

    Identification of lead compounds with higher molecular weight and lower aqueous solubility has become increasingly prevalent with the advent of high throughput screening. Poor aqueous solubility of these lipophilic compounds can drastically affect the dissolution rate and subsequently the drug absorbed in the systemic circulation, imposing a significant burden of time and money during drug development process. Various pre-formulation and formulation strategies have been applied in the past that can improve the aqueous solubility of lipophilic compounds by manipulating either the crystal lattice properties or the activity coefficient of a solute in solution or both, if possible. However, despite various strategies available in the armor of formulation scientist, solubility issue still remains an overriding problem in the drug development process. It is perhaps due to the insufficient conceptual understanding of solubility and dissolution phenomenon that hinders the judgment in selecting suitable strategy for improving aqueous solubility and/or dissolution rate. This article, therefore, focuses on (i) revisiting the theoretical and mathematical concepts associated with solubility and dissolution, (ii) their application in making rationale decision for selecting suitable pre-formulation and formulation strategies and (iii) the relevant research performed in this field in past decade.

  2. Diversity in Current Ecological Thinking: Implications for Environmental Management

    NASA Astrophysics Data System (ADS)

    Moore, Susan A.; Wallington, Tabatha J.; Hobbs, Richard J.; Ehrlich, Paul R.; Holling, C. S.; Levin, Simon; Lindenmayer, David; Pahl-Wostl, Claudia; Possingham, Hugh; Turner, Monica G.; Westoby, Mark

    2009-01-01

    Current ecological thinking emphasizes that systems are complex, dynamic, and unpredictable across space and time. What is the diversity in interpretation of these ideas among today’s ecologists, and what does this mean for environmental management? This study used a Policy Delphi survey of ecologists to explore their perspectives on a number of current topics in ecology. The results showed general concurrence with nonequilibrium views. There was agreement that disturbance is a widespread, normal feature of ecosystems with historically contingent responses. The importance of recognizing multiple levels of organization and the role of functional diversity in environmental change were also widely acknowledged. Views differed regarding the predictability of successional development, whether “patchiness” is a useful concept, and the benefits of shifting the focus from species to ecosystem processes. Because of their centrality to environmental management, these different views warrant special attention from both managers and ecologists. Such divergence is particularly problematic given widespread concerns regarding the poor linkages between science (here, ecology) and environmental policy and management, which have been attributed to scientific uncertainty and a lack of consensus among scientists, both jeopardizing the transfer of science into management. Several suggestions to help managers deal with these differences are provided, especially the need to interpret broader theory in the context of place-based assessments. The uncertainty created by these differences requires a proactive approach to environmental management, including clearly identifying environmental objectives, careful experimental design, and effective monitoring.

  3. Regional economic impacts of current and proposed management alternatives for Don Edwards National Wildlife Refuge

    USGS Publications Warehouse

    Richardson, Leslie; Huber, Chris; Koontz, Lynne

    2012-01-01

    The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan. The Comprehensive Conservation Plan must describe the desired future conditions of a Refuge and provide long-range guidance and management direction to achieve refuge purposes. The Don Edwards San Francisco Bay National Wildlife Refuge, located at the south end of California's San Francisco Bay and one of seven refuges in the San Francisco Bay National Wildlife Refuge Complex, is in the process of developing a range of management goals, objectives, and strategies for the Comprehensive Conservation Plan. The Comprehensive Conservation Plan must contain an analysis of expected effects associated with current and proposed Refuge management strategies. For Refuge Comprehensive Conservation Plan planning, a regional economic analysis provides a means of estimating how current management (No Action Alternative) and proposed management activities (alternatives) affect the local economy. This type of analysis provides two critical pieces of information: (1) it illustrates the Don Edwards San Francisco Bay National Wildlife Refuge's contribution to the local community, and (2) it can help in determining whether economic effects are or are not a real concern in choosing among management alternatives. This report first presents a description of the local community and economy near the Don Edwards San Francisco Bay National Wildlife Refuge. Next, the methods used to conduct a regional economic impact analysis are described. An analysis of the final Comprehensive Conservation Plan management strategies that could affect stakeholders, residents, and the local economy is then presented. The management activities of economic concern in this analysis are: * Spending in the local community by Refuge visitors; * Refuge personnel salary spending; and * Refuge purchases of goods and services within the local

  4. Electronic mail communication--management strategies.

    PubMed

    Strasser, Patricia B

    2003-12-01

    Electronic communication has come a long way in the past 30 years. It will no doubt continue to improve and remain the primary communication vehicle for businesses. Occupational health nurses, like other business professionals, must use email to their advantage to improve their practice. However, electronic mail communication must be managed in the same manner as records and documents produced in any form or media.

  5. Anesthesia information management systems marketplace and current vendors.

    PubMed

    Stonemetz, Jerry

    2011-09-01

    This article addresses the brief history of anesthesia information management systems (AIMS) and discusses the vendors that currently market AIMS. The current market penetration based on the information provided by these vendors is presented and the rationale for the purchase of AIMS is discussed. The considerations to be evaluated when making a vendor selection are also discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Compounds with anti-influenza activity: present and future of strategies for the optimal treatment and management of influenza. Part I: Influenza life-cycle and currently available drugs.

    PubMed

    Gasparini, R; Amicizia, D; Lai, P L; Bragazzi, N L; Panatto, D

    2014-09-01

    Influenza is a contagious respiratory acute viral disease characterized by a short incubation period, high fever and respiratory and systemic symptoms. The burden of influenza is very heavy. Indeed, the World Health Organization (WHO) estimates that annual epidemics affect 5-15% of the world's population, causing up to 4-5 million severe cases and from 250,000 to 500,000 deaths. In order to design anti-influenza molecules and compounds, it is important to understand the complex replication cycle of the influenza virus. Replication is achieved through various stages. First, the virus must engage the sialic acid receptors present on the free surface of the cells of the respiratory tract. The virus can then enter the cells by different routes (clathrin-mediated endocytosis or CME, caveolae-dependent endocytosis or CDE, clathrin-caveolae-independent endocytosis, or macropinocytosis). CME is the most usual pathway; the virus is internalized into an endosomal compartment, from which it must emerge in order to release its nucleic acid into the cytosol. The ribonucleoprotein must then reach the nucleus in order to begin the process of translation of its genes and to transcribe and replicate its nucleic acid. Subsequently, the RNA segments, surrounded by the nucleoproteins, must migrate to the cell membrane in order to enable viral assembly. Finally, the virus must be freed to invade other cells of the respiratory tract. All this is achieved through a synchronized action of molecules that perform multiple enzymatic and catalytic reactions, currently known only in part, and for which many inhibitory or competitive molecules have been studied. Some of these studies have led to the development of drugs that have been approved, such as Amantadine, Rimantadine, Oseltamivir, Zanamivir, Peramivir, Laninamivir, Ribavirin and Arbidol. This review focuses on the influenza life-cycle and on the currently available drugs, while potential antiviral compounds for the prevention and

  7. Weight management strategies for women: a review for nurses.

    PubMed

    Stramiello, Giovanna M

    2009-10-01

    Upon completion of this activity, the learner will be able to: 1. Cite the statistics surrounding overweight and obesity and list the potential health effects of overweight and obesity. 2. List and explain different strategies for weight loss, including their risks and benefits as shown by the current evidence. 3. List effective strategies for maintaining weight loss and cite examples from the literature.

  8. Understanding beef-cattle farming management strategies by identifying motivations behind farmers' priorities.

    PubMed

    Magne, M A; Cerf, M; Ingrand, S

    2012-06-01

    This study aimed to identify and better understand management strategies that help livestock farmers adapt to changes in their production contexts, a fundamental challenge. A total of nine beef-cattle farmers were interviewed three times over 1 year to discuss 13 dimensions of livestock farming (e.g. reproduction, feeding, sales, etc.). Characterisation of management strategies rested on three main factors: (i) ranking of the dimensions according to the degree to which farmers desired to control them, (ii) reasons for the ranking and (iii) management guidelines. Although farmers agreed upon the rank of certain dimensions, such as herd management, they differed on that of others, such as sales and administration/regulations. Four motivation categories were identified: risk, pleasure, efficiency and ability to control the dimension. Three management guidelines were identified, which indicated that farmers managed for future survival of their farms at different scales (animal/herd v. whole-farm), involving different resources (biological v. financial) and based on different animal categories (reproductive cows v. animals sold). These results improve understanding of individual livestock farmers and their current management strategies by integrating the motivations behind their strategies. For this reason, they constitute methodological elements that agricultural advisors can use to provide relevant information to farmers while accommodating differences in farm management.

  9. Evaluating a push-pull strategy for management of Drosophila suzukii Matsumura in red raspberry

    USDA-ARS?s Scientific Manuscript database

    Drosophilia suzukii Matsumura is a serious pest of small fruits and cherries that lays its eggs in ripe and ripening fruit. Current management strategies rely on an unsustainable schedule of foliar applications of chemical insecticides. Alternative approaches to suppressing oviposition are under inv...

  10. Warehouse Performance and Supply Chain Management: Current Practices in the Use of Performance Measures.

    DTIC Science & Technology

    1996-05-01

    This thesis addresses the question of how warehouses, which use a supply chain management logistics strategy, measure performance compared to...distinguish which companies use supply chain management versus companies which use a traditional logistics strategy, this study also provides a...comprehensive literature review on supply chain management , to include company additional information on how a supply chain management strategy is developed

  11. CURRENT METHODS AND RESEARCH STRATEGIES FOR MODELING ATMOSPHERIC MERCURY

    EPA Science Inventory

    The atmospheric pathway of the global mercury cycle is known to be the primary source of mercury contamination to most threatened aquatic ecosystems. Current efforts toward numerical modeling of atmospheric mercury are hindered by an incomplete understanding of emissions, atmosp...

  12. CURRENT METHODS AND RESEARCH STRATEGIES FOR MODELING ATMOSPHERIC MERCURY

    EPA Science Inventory

    The atmospheric pathway of the global mercury cycle is known to be the primary source of mercury contamination to most threatened aquatic ecosystems. Current efforts toward numerical modeling of atmospheric mercury are hindered by an incomplete understanding of emissions, atmosp...

  13. Current Strategies to Improve the Bioactivity of PEEK

    PubMed Central

    Ma, Rui; Tang, Tingting

    2014-01-01

    The synthetic thermoplastic polymer polyetheretherketone (PEEK) is becoming a popular component of clinical orthopedic and spinal applications, but its practical use suffers from several limitations. Although PEEK is biocompatible, chemically stable, radiolucent and has an elastic modulus similar to that of normal human bone, it is biologically inert, preventing good integration with adjacent bone tissues upon implantation. Recent efforts have focused on increasing the bioactivity of PEEK to improve the bone-implant interface. Two main strategies have been used to overcome the inert character of PEEK. One approach is surface modification to activate PEEK through surface treatment alone or in combination with a surface coating. Another strategy is to prepare bioactive PEEK composites by impregnating bioactive materials into PEEK substrate. Researchers believe that modified bioactive PEEK will have a wide range of orthopedic applications. PMID:24686515

  14. MicroRNA Detection: Current Technology and Research Strategies

    NASA Astrophysics Data System (ADS)

    Hunt, Eric A.; Broyles, David; Head, Trajen; Deo, Sapna K.

    2015-07-01

    The relatively new field of microRNA (miR) has experienced rapid growth in methodology associated with its detection and bioanalysis as well as with its role in -omics research, clinical diagnostics, and new therapeutic strategies. The breadth of this area of research and the seemingly exponential increase in number of publications on the subject can present scientists new to the field with a daunting amount of information to evaluate. This review aims to provide a collective overview of miR detection methods by relating conventional, established techniques [such as quantitative reverse transcription polymerase chain reaction (RT-qPCR), microarray, and Northern blotting (NB)] and relatively recent advancements [such as next-generation sequencing (NGS), highly sensitive biosensors, and computational prediction of microRNA/targets] to common miR research strategies. This should guide interested readers toward a more focused study of miR research and the surrounding technology.

  15. Nurses' strategies for managing pain in the postoperative setting.

    PubMed

    Manias, Elizabeth; Bucknall, Tracey; Botti, Mari

    2005-03-01

    Acute pain is a significant problem in the postoperative setting. Patients report a lack of information about pain-control measures and ineffective pain control. Nurses continue to rely on pharmacologic measures and tend to under-administer analgesics. The purpose of this study was to determine the strategies nurses used to manage patients' pain in the postoperative setting. It also sought to examine the effect of context, including organization of care, nurses' prioritization of work activities, and pressures during a working shift, on their pain-management strategies. An observational design was used in two surgical units of a metropolitan teaching hospital in Melbourne, Australia. Six fixed observation times were identified as key periods for pain activities, each comprising a 2-hour duration. An observation period was examined at least 12 times, resulting in the completion of 74 observations and the identification of 316 pain cases. Fifty-two nurses were observed during their normal day's work with postoperative patients. Six themes were identified: managing pain effectively; prioritizing pain experiences for pain management; missing pain cues for pain management; regulators and enforcers of pain management; preventing pain; and reactive management of pain. The findings highlighted the critical nature of communication between clinicians and patients and among clinicians. It also demonstrated the influence of time on management strategies and the relative importance that nurses place on nonpharmacologic measures in actual practice. This research, which portrays what happens in actual clinical practice, has facilitated the identification of new data that were not evident from other research studies.

  16. Management strategies in hospitals: scenario planning.

    PubMed

    Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

    2015-01-01

    Hintergrund: Das Krankenhausmanagement ist stets Herausforderungen ausgesetzt. Anstatt auf die Herausforderungen zu warten, sollten Ärzte und Manager im Voraus handeln, um ein optimiertes und nachhaltig wertorientiertes Gesundheitswesen zu sichern. Diese Arbeit unterstreicht die Bedeutung der Szenarienplanung in Krankenhäusern, schlägt eine ausgearbeitete Definition der Stakeholder eines Krankenhauses vor und definiert die Einflussfaktoren, denen Krankenhäuser ausgesetzt sind.Methodik: Basierend auf einer Literaturanalyse sowie auf persönlichen Interviews mit Stakeholdern eines Krankenhauses schlagen wir eine ausgearbeitete Definition von Stakeholdern vor und erarbeiteten einen Fragebogen. Dieser Fragebogen berücksichtigt folgende Einflussfaktoren, die entsprechende Auswirkungen auf das Krankenhaus-Management haben: politische/rechtliche, wirtschaftliche, soziale, technologische und Umweltkräfte.Diese Einflussfaktoren werden untersucht, um die so genannten kritischen Unsicherheiten zu entwickeln. Die gründliche Identifizierung von Unsicherheiten basierte auf „Stakeholder Feedback“.Ergebnisse: Zwei Haupt-Unsicherheiten wurden identifiziert und in dieser Studie berücksichtigt:die Entwicklung der Arbeitsbelastung für das medizinische Personaldie gewinnorientierte Leistung des medizinischen Personals.Entsprechend der entwickelten Szenarien konnten wir folgende Kernstrategie empfehlen: komplementäre Ausbildung sowohl des medizinischen Personals als auch der nicht-medizinischen Top-Führungskräfte und Manager von Krankenhäusern. Ergänzende szenariospezifische strategische Optionen sollen, falls erforderlich, in Betracht gezogen werden, um eine bestimmte zukünftige Entwicklung des medizinischen Umfeldes zu optimieren.Schlussfolgerung: Strategische Planung in Krankenhäusern ist wichtig, um nachhaltigen Erfolg zu gewährleisten. Diese Planung soll mehrere Situationen berücksichtigen und integriert interne und externe Ein- und Ausblicke. Darüber hinaus

  17. [Behavioral and cognitive strategies in stress management].

    PubMed

    Légeron, P

    1993-03-01

    Stress is a specific response of the individual to all nonspecific demands. However, this process of adaptation is very complex and varies considerably from person to person. The stress response or "stress reactivity" is triggered by various stressors, ranging from live events to daily hassles and including chronic stressors. These stressors need to be identified. The stress response is not univocal: it has physiological, cognitive and behavioral components. Most of the time, physiological, cognitive and behavioral responses are maladaptive and harmful for the individual. Stress management is directed at teaching individuals specific skills to modify parts of these responses in order to reduce stress. Relaxation therapies are the cornerstone of any stress management program. They mostly include autogenic training and progressive relaxation training, sometimes biofeedback. The relaxation response is a learned response. There are a variety of different methods of inducing this response. They share the common goal of countering the physiological aspects of the stress reaction. All the relaxation techniques involve long and exacting training. But proper training leads to a gradual reduction in time and effort required to relax. When properly pursued, these techniques produce a state of relaxation quickly and on demand. Cognitive approaches to stress management derive from the constatation that the individual's interpretation of events or situations which have been labeled stressful, the individual's anticipation of the consequences of the stressor and the individual's view of his or her ability to cope with the stressor or the stress reaction are fundamental in the stress process. There are a variety of cognitive theories and techniques, ranging from Beck's cognitive therapy to Ellis' Rational-Emotive Therapy. Initial phases of these therapies are directed at teaching the individual to recognize, record, analyse and modify maladaptive cognitions. The second phase is

  18. Technology and Current Reading/Literacy Assessment Strategies

    ERIC Educational Resources Information Center

    Balajthy, Ernest

    2007-01-01

    Computer-based technologies offer promise as a means to assess students and provide teachers with better understandings of their students' achievement. This article describes recent developments in computer-based and web-based reading and literacy assessment, focusing on assessment administration, information management, and report creation. In…

  19. Technology and Current Reading/Literacy Assessment Strategies

    ERIC Educational Resources Information Center

    Balajthy, Ernest

    2007-01-01

    Computer-based technologies offer promise as a means to assess students and provide teachers with better understandings of their students' achievement. This article describes recent developments in computer-based and web-based reading and literacy assessment, focusing on assessment administration, information management, and report creation. In…

  20. Current concepts in wound management and wound healing products.

    PubMed

    Davidson, Jacqueline R

    2015-05-01

    Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing.

  1. Tinnitus--Current Concepts in Diagnosis and Management.

    ERIC Educational Resources Information Center

    Epstein, Stephen

    1997-01-01

    This article discusses the causes of tinnitus, sound or noise in the ears or head without any external stimulation. Classification of tinnitus, the essentials of medical evaluation of a patient with tinnitus, essential test procedures, and current concepts in the management of tinnitus are addressed. (CR)

  2. Current knowledge and attitudes: Russian olive biology, ecology and management

    Treesearch

    Sharlene E. Sing; Kevin J. Delaney

    2016-01-01

    The primary goals of a two-day Russian olive symposium held in February 2014 were to disseminate current knowledge and identify data gaps regarding Russian olive biology and ecology, distributions, integrated management, and to ascertain the feasibility and acceptance of a proposed program for classical biological control of Russian olive. The symposium was...

  3. Amyloid beta (Aβ) peptide modulators and other current treatment strategies for Alzheimer’s disease (AD)

    PubMed Central

    Lukiw, Walter J.

    2012-01-01

    Introduction Alzheimer’s disease (AD) is a common, progressive neurological disorder whose incidence is reaching epidemic proportions. The prevailing ‘amyloid cascade hypothesis’, which maintains that the aberrant proteolysis of beta-amyloid precursor protein (βAPP) into neurotoxic amyloid beta (Aβ)-peptides is central to the etiopathology of AD, continues to dominate pharmacological approaches to the clinical management of this insidious disorder. This review is a compilation and update on current pharmacological strategies designed to down-regulate Aβ42-peptide generation in an effort to ameliorate the tragedy of AD. Areas Covered This review utilized on-line data searches at various open online-access websites including the Alzheimer Association, Alzheimer Research Forum; individual drug company databases; the National Institutes of Health (NIH) Medline; Pharmaprojects database; Scopus; inter-University research communications and unpublished research data. Expert Opinion Aβ immunization-, anti-acetylcholinesterase-, β-secretase-, chelation-, γ-secretase-, N-methyl D-aspartate (NMDA) receptor antagonist-, statin-based and other strategies to modulate βAPP processing have dominated pharmacological approaches directed against AD-type neurodegenerative pathology. Cumulative clinical results of these efforts remain extremely disappointing, and have had little overall impact on the clinical management of AD. While a number of novel approaches are in consideration and development, to date there is still no effective treatment or cure for this expanding healthcare concern. PMID:22439907

  4. Complexity Science Applications to Dynamic Trajectory Management: Research Strategies

    NASA Technical Reports Server (NTRS)

    Sawhill, Bruce; Herriot, James; Holmes, Bruce J.; Alexandrov, Natalia

    2009-01-01

    The promise of the Next Generation Air Transportation System (NextGen) is strongly tied to the concept of trajectory-based operations in the national airspace system. Existing efforts to develop trajectory management concepts are largely focused on individual trajectories, optimized independently, then de-conflicted among each other, and individually re-optimized, as possible. The benefits in capacity, fuel, and time are valuable, though perhaps could be greater through alternative strategies. The concept of agent-based trajectories offers a strategy for automation of simultaneous multiple trajectory management. The anticipated result of the strategy would be dynamic management of multiple trajectories with interacting and interdependent outcomes that satisfy multiple, conflicting constraints. These constraints would include the business case for operators, the capacity case for the Air Navigation Service Provider (ANSP), and the environmental case for noise and emissions. The benefits in capacity, fuel, and time might be improved over those possible under individual trajectory management approaches. The proposed approach relies on computational agent-based modeling (ABM), combinatorial mathematics, as well as application of "traffic physics" concepts to the challenge, and modeling and simulation capabilities. The proposed strategy could support transforming air traffic control from managing individual aircraft behaviors to managing systemic behavior of air traffic in the NAS. A system built on the approach could provide the ability to know when regions of airspace approach being "full," that is, having non-viable local solution space for optimizing trajectories in advance.

  5. Current management for improved railgun performance. Doctoral thesis

    SciTech Connect

    Beno, J.H.

    1989-01-01

    Continued railgun development toward high-energy devices that launch useful projectiles and have a lifetime of hundreds to thousands of shots, requires progress in two related aspects of accelerator design: (1) rail containment structures must be made capable of withstanding greater rail repulsion forces, without causing accelerators to become too bulky for their intended use; and (2) rails must sustain very minor heat-related damage during projectile launch. The potential for managing rail current and its distribution to alleviate the two aforementioned problems is investigated. Techniques for calculating pulsed, rail current distribution, in the infinite-conductivity approximation, and resultant projectile force are developed. Then, passive, current management methods -- involving multiple rail pairs to distribute currents and rail-repulsive forces in a few, evenly-spaced, radial directions, for easier rail containment -- are explored. Optimized multi-rail, railgun cross sectional shapes that produce more projectile force than conventional two-rail railguns operating under the same local peak current density constraints are determined. These railguns have nontraditional bore shapes, i.e., not square or round. The use of neighboring, current-carrying conductors to actively influence rail current distribution is then studied.

  6. Applying disease management strategies to Medicare.

    PubMed

    Tompkins, C P; Bhalotra, S; Trisolini, M; Wallack, S S; Rasgon, S; Yeoh, H

    1999-01-01

    Medicare coverage begins for many when they have already developed one or more chronic diseases, and it often pays for the latest and costliest phases. Population-based disease modeling, patient screening, and monitoring would be appropriate interventions for chronic renal disease. Patients who have not yet advanced to end-stage renal disease would benefit from management of diabetes and hypertension, avoidance of nephrotoxic substances, and better preparation for dialysis. Administrative support could take the form of clinical guidelines, physician-led multidisciplinary teams, integrated delivery systems, provider and patient education, and new information technologies. Medicare reflects the long-term public perspective, and thus should further this new direction by supporting education, reimbursing for prevention efforts and allied health services, encouraging efficiency, and monitoring cost and quality outcomes.

  7. New Management Strategies for Ectopia Lentis.

    PubMed

    Simon, Melissa A; Origlieri, Catherine A; Dinallo, Anthony M; Forbes, Brian J; Wagner, Rudolph S; Guo, Suqin

    2015-01-01

    Ectopia lentis refers to displacement of the crystalline lens in the setting of various systemic and metabolic disorders. A literature review was conducted to investigate the management of non-traumatic ectopia lentis in the pediatric population, particularly focusing on surgical intervention. Both limbal and pars plana approaches for lensectomy are well established in the literature. Surgical options for intraocular lens implantation in pediatric eyes with ectopia lentis include anterior chamber intraocular lenses and iris-fixated or scleral-fixated posterior chamber intraocular lenses. Recently, the use of capsular tension rings has also been described with promising results. Visual rehabilitation and treatment of amblyopia are essential for patients within the amblyogenic age group following surgical intervention.

  8. Roles of managers in academic health centers: strategies for the managed care environment.

    PubMed

    Guo, Kristina L

    2002-03-01

    This article addresses survival strategies of academic health centers (AHCs) in responding to market pressures and government reforms. Using six case studies of AHCs, the study links strategic changes in structure and management to managerial role performance. Utilizing Mintzberg's classification of work roles, the roles of liaison, monitor, entrepreneur, and resource allocator were found to be used by top-level managers as they implement strategies to enhance the viability of their AHCs. Based on these new roles, the study recommends improving management practices through education and training as well as changing organizational culture to support management decision making and foster the continued growth of managers and their AHCs.

  9. A framework for the assessment of severe accident management strategies

    SciTech Connect

    Kastenberg, W.E.; Apostolakis, G.; Dhir, V.K.

    1993-09-01

    Severe accident management can be defined as the use of existing and/or altemative resources, systems and actors to prevent or mitigate a core-melt accident. For each accident sequence and each combination of severe accident management strategies, there may be several options available to the operator, and each involves phenomenological and operational considerations regarding uncertainty. Operational uncertainties include operator, system and instrumentation behavior during an accident. A framework based on decision trees and influence diagrams has been developed which incorporates such criteria as feasibility, effectiveness, and adverse effects, for evaluating potential severe accident management strategies. The framework is also capable of propagating both data and model uncertainty. It is applied to several potential strategies including PWR cavity flooding, BWR drywell flooding, PWR depressurization and PWR feed and bleed.

  10. Sustainability: orthopaedic surgery wait time management strategies.

    PubMed

    Amar, Claudia; Pomey, Marie-Pascale; SanMartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

    2015-01-01

    The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months. The research design is a multiple cases study. The paper selected three cases: Case 1 - staff were able to maintain compliance with requirements for more than 18 months; Case 2 - staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 - staff were never able to meet the requirements. For each case the authors interviewed persons involved in the strategies and collected documents. The paper analysed systemic and organizational-level factors; including governance and leadership, culture, resources, methods and tools. Findings indicate that the hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit. The authors' research highlights an important gradient between three cases regarding the factors that sustain waiting times. The paper show that the hospital factory model seems attractive in a super-specialized surgery context. However, patients are selected for simple surgeries, without complications, and so this cannot be considered a unique model.

  11. Current Cell-Based Strategies for Whole Kidney Regeneration.

    PubMed

    Poornejad, Nafiseh; Schaumann, Lara B; Buckmiller, Evan M; Roeder, Beverly L; Cook, Alonzo D

    2016-10-01

    Chronic kidney diseases affect thousands of people worldwide. Although hemodialysis alleviates the situation by filtering the patient's blood, it does not replace other kidney functions such as hormone release or homeostasis regulation. Consequently, orthotopic transplantation of donor organs is the ultimate treatment for patients suffering from end-stage renal failure. Unfortunately, the number of patients on the waiting list far exceeds the number of donors. In addition, recipients must remain on immunosuppressive medications for the remainder of their lives, which increases the risk of morbidity due to their weakened immune system. Despite recent advancements in whole organ transplantation, 40% of recipients will face rejection of implanted organs with a life expectancy of only 10 years. Bioengineered patient-specific kidneys could be an inexhaustible source of healthy kidneys without the risk of immune rejection. The purpose of this article is to review the pros and cons of several bioengineering strategies used in recent years and their unresolved issues. These strategies include repopulation of natural scaffolds with a patient's cells, de-novo generation of kidneys using patient-induced pluripotent stem cells combined with stepwise differentiation, and the creation of a patient's kidney in the embryos of other mammalian species.

  12. Nationwide trends in the current management of desmoid (aggressive) fibromatosis.

    PubMed

    Eastley, N C; Hennig, I M; Esler, C P; Ashford, R U

    2015-06-01

    The optimal management of desmoid fibromatosis remains unclear, leading to significant variability in patient management. To assess this problem, the current approach of clinicians managing this complex condition in the UK was investigated. A hypothetical case of intramuscular limb girdle desmoid fibromatosis in a fit 65-year-old patient was devised. Surgical and non-surgical oncology members of the British Sarcoma Group were questioned on how they would manage this case in three scenarios: primary disease with function-sparing surgery possible, primary disease with neurovascular involvement and disease recurrence after a previous R0 resection. Initial management, management of symptomatic disease progression, follow-up preferences and any differences in respondents' management choices in a younger case were investigated. The responses from 14 sarcoma surgeons and 23 oncologists (14 clinical, nine medical) were analysed. Desmoid fibromatosis management is generally shared by surgeons and oncologists within sarcoma multidisciplinary teams in the UK. Variation exists in the chosen initial management of primary desmoid fibromatosis in the UK, with function-sparing surgery possible (observation 51%, resection 51%), primary desmoid fibromatosis with neurovascular involvement (hormone therapy with non-steroidal anti-inflammatory drugs 51%, radiotherapy 27%, observation 22%) and for cases of desmoid fibromatosis recurrence (radiotherapy 41%, hormone therapy and non-steroidal anti-inflammatory drugs 27%, observation 24%). There was a clear preference of surgical resection of symptomatic disease progression in cases of primary desmoid fibromatosis without neurovascular involvement (60%). By contrast, radiotherapy was the preferred treatment for progression in cases with neurovascular involvement (47%) or cases of recurrence after a previous R0 resection (34%). Clinical follow-up was selected 3 months after intervention in 68% of scenarios. Follow-up imaging was selected 3

  13. Self-Management Strategies for Stress and Anxiety Used by Nontreatment Seeking Veteran Primary Care Patients.

    PubMed

    Shepardson, Robyn L; Tapio, Jennie; Funderburk, Jennifer S

    2017-07-01

    One of the most common reasons individuals do not seek mental health treatment is a preference to manage emotional concerns on their own. Self-management refers to the strategies that individuals use on their own (i.e., without professional guidance) to manage symptoms. Little research has examined self-management for anxiety despite its potential utility as the first step in a stepped care approach to primary care. The objectives of this study were to describe patients' anxiety self-management strategies, identify which types were perceived to be effective, and explore potential correlates. This was an exploratory descriptive study (N = 182) of nontreatment seeking Veterans Health Administration primary care patients (M = 58.3 years of age, SD = 14.9) who reported current anxiety symptoms (≥8 on Generalized Anxiety Disorder-7). The Institutional Review Board approved the study, and all participants provided informed consent. We assessed self-management strategies, anxiety and depression symptoms, and past-year treatment via telephone. Two independent raters coded strategies into 1 of 7 categories (kappa = 0.85) and 23 subcategories (kappa M = 0.82, SD = 0.16). Participants reported nearly universal (98%) use of self-management, with an average of 2.96 (SD = 1.2) strategies used in the past 3 months, and 91% of all strategies perceived as effective. Self-care (37.0%), cognitive (15.8%), and avoidance (15.1%) strategies were reported most commonly; the most prevalent subcategories were exercise (11.0% of all strategies), redirecting thoughts (9.1%), and family/friends (8.1%). Age and depression screen status were associated with self-management strategy use. Our results demonstrate the ubiquity and high perceived effectiveness of self-management for anxiety among Veteran primary care patients. Although avoidance strategies were fairly common, self-care strategies, particularly exercising, and cognitive strategies, such as redirecting thoughts, were most prevalent

  14. Caries Management Strategies for Primary Molars

    PubMed Central

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

    2014-01-01

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

  15. Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency

    PubMed Central

    Ysunza, Pablo Antonio; Repetto, Gabriela M.; Pamplona, Maria Carmen; Calderon, Juan F.; Shaheen, Kenneth; Chaiyasate, Konkgrit; Rontal, Matthew

    2015-01-01

    Background. One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI). Objective. This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate. Materials and Methods. An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy. Results. Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented. Conclusion. This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management. PMID:26273595

  16. SECONDARY WASTE MANAGEMENT STRATEGY FOR EARLY LOW ACTIVITY WASTE TREATMENT

    SciTech Connect

    TW, CRAWFORD

    2008-07-17

    This study evaluates parameters relevant to River Protection Project secondary waste streams generated during Early Low Activity Waste operations and recommends a strategy for secondary waste management that considers groundwater impact, cost, and programmatic risk. The recommended strategy for managing River Protection Project secondary waste is focused on improvements in the Effiuent Treatment Facility. Baseline plans to build a Solidification Treatment Unit adjacent to Effluent Treatment Facility should be enhanced to improve solid waste performance and mitigate corrosion of tanks and piping supporting the Effiuent Treatment Facility evaporator. This approach provides a life-cycle benefit to solid waste performance and reduction of groundwater contaminants.

  17. Optimal management strategies for placenta accreta.

    PubMed

    Eller, A G; Porter, T F; Soisson, P; Silver, R M

    2009-04-01

    To determine which interventions for managing placenta accreta were associated with reduced maternal morbidity. Retrospective cohort study. Two tertiary care teaching hospitals in Utah. All identified cases of placenta accreta from 1996 to 2008. Cases of placenta accreta were identified using standard ICD-9 codes for placenta accreta, placenta praevia, and caesarean hysterectomy. Medical records were then abstracted for maternal medical history, hospital course, and maternal and neonatal outcomes. Maternal and neonatal complications were compared according to antenatal suspicion of accreta, indications for delivery, preoperative preparation, attempts at placental removal before hysterectomy, and hypogastric artery ligation. Early morbidity (prolonged maternal intensive care unit admission, large volume of blood transfusion, coagulopathy, ureteral injury, or early re-operation) and late morbidity (intra-abdominal infection, hospital re-admission, or need for delayed re-operation). Results Seventy-six cases of placenta accreta were identified. When accreta was suspected, scheduled caesarean hysterectomy without attempting placental removal was associated with a significantly reduced rate of early morbidity compared with cases in which placental removal was attempted (67 versus 36%, P=0.038). Women with preoperative bilateral ureteric stents had a lower incidence of early morbidity compared with women without stents (18 versus 55%, P=0.018). Hypogastric artery ligation did not reduce maternal morbidity. Scheduled caesarean hysterectomy with preoperative ureteric stent placement and avoiding attempted placental removal are associated with reduced maternal morbidity in women with suspected placenta accreta.

  18. Hand fractures: a review of current treatment strategies.

    PubMed

    Meals, Clifton; Meals, Roy

    2013-05-01

    Fractures of the tubular bones of the hand are common and potentially debilitating. The majority of these injuries may be treated without an operation. Surgery, however, offers distinct advantages in properly selected cases. We present a review of hand fracture management, with special attention paid to advances since 2008. The history and mechanisms of these fractures are discussed, as are treatment options and common complications. Early mobilization of the fractured hand is emphasized because soft tissue recovery may be more problematic than that of bone. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Impact of Conflict Management Strategies on the Generation Mechanism of Miners' Unsafe Behavior Tendency

    ERIC Educational Resources Information Center

    Li, Ji-Zu; Zhang, Ya-Ping; Liu, Xiao-Guang; Liu, Yao-Long; Wang, Tian-Ri

    2017-01-01

    In this paper, we examine the relationship between the generation mechanism of miners' unsafe behavior tendency and conflict management strategies, including cooperative conflict management strategy, competitive conflict management strategy and avoidant conflict management strategy. Miners from 3 collieries in Shanxi province completed a…

  20. Model predictive control power management strategies for HEVs: A review

    NASA Astrophysics Data System (ADS)

    Huang, Yanjun; Wang, Hong; Khajepour, Amir; He, Hongwen; Ji, Jie

    2017-02-01

    This paper presents a comprehensive review of power management strategy (PMS) utilized in hybrid electric vehicles (HEVs) with an emphasis on model predictive control (MPC) based strategies for the first time. Research on MPC-based power management systems for HEVs has intensified recently due to its many inherent merits. The categories of the existing PMSs are identified from the latest literature, and a brief study of each type is conducted. Then, the MPC approach is introduced and its advantages are discussed. Based on the acquisition method of driver behavior used for state prediction and the dynamic model used, the MPC is classified and elaborated. Factors that affect the performance of the MPC are put forward, including prediction accuracy, design parameters, and solvers. Finally, several important issues in the application of MPC-based power management strategies and latest developing trends are discussed. This paper not only provides a comprehensive analysis of MPC-based power management strategies for HEVs but also puts forward the future and emphasis of future study, which will promote the development of energy management controller with high performance and low cost for HEVs.

  1. Current development in genetic engineering strategies of Bacillus species.

    PubMed

    Dong, Huina; Zhang, Dawei

    2014-05-03

    The complete sequencing and annotation of the genomes of industrially-important Bacillus species has enhanced our understanding of their properties, and allowed advances in genetic manipulations in other Bacillus species. Post-genomic studies require simple and highly efficient tools to enable genetic manipulation. Here, we summarize the recent progress in genetic engineering strategies for Bacillus species. We review the available genetic tools that have been developed in Bacillus species, as well as methods developed in other species that may also be applicable in Bacillus. Furthermore, we address the limitations and challenges of the existing methods, and discuss the future research prospects in developing novel and useful tools for genetic modification of Bacillus species.

  2. Current strategies for vitamin E biofortification of crops.

    PubMed

    Mène-Saffrané, Laurent; Pellaud, Sébastien

    2017-03-16

    Vitamin E refers to four tocopherols and four tocotrienols that are exclusively synthesized by photosynthetic organisms. While α-tocopherol is the most potent vitamin E compound, it is not the main form consumed since the composition of most major crops is dominated by γ-tocopherol. Nutritional studies show that populations of developed countries do not consume enough vitamin E and that a large proportion of individuals exhibit plasma α-tocopherol deficiency. Following the identification of vitamin E biosynthetic genes, several strategies including metabolic engineering, classic breeding and mutation breeding, have been undertaken to improve the vitamin E content of crops. In addition to providing crops in which vitamin E content is enhanced, these studies are revealing the bottlenecks limiting its biosynthesis.

  3. Antithrombotic Strategies in Endovascular Interventions: Current Status and Future Directions.

    PubMed

    Shishehbor, Mehdi H; Katzen, Barry T

    2013-10-01

    Despite increasing numbers of endovascular interventions to treat arterial and venous disease, scant level 1 evidence is available regarding the role of antithrombotic and antiplatelet therapy in patients undergoing these procedures. The current practice in this regard is heterogeneous and has mainly been driven by data from coronary artery disease and percutaneous coronary intervention. This article discusses the role of antithrombotic and antiplatelet agents for endovascular intervention. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Management Strategies for Skull Base Inverted Papilloma.

    PubMed

    Grayson, Jessica W; Khichi, Sunny S; Cho, Do-Yeon; Riley, Kristen O; Woodworth, Bradford A

    2016-07-01

    Inverted papilloma attached to the ventral skull base presents a surgical dilemma because surgical removal of the bony pedicle is critical to decrease risk of recurrence. The objective of this study is to evaluate the effectiveness of endoscopic management of skull base inverted papilloma. Case series with planned data collection. Tertiary medical center. Patients with skull base inverted papilloma. Over 7 years, 49 patients with skull base inverted papilloma were referred for surgical resection. Demographics, operative technique, pathology, complications, recurrence, and postoperative follow-up were evaluated. Average age at presentation was 57 years. Twenty-six patients (53%) had prior attempts at resection elsewhere, and 5 had squamous cell carcinoma (SCCA) arising in an inverted papilloma. Six patients (12%) suffered major complications, including skull base osteomyelitis in 2 previously irradiated patients, cerebrospinal fluid leak with pneumocephalus (n = 1), meningitis (n = 1), invasive fungal sinusitis (n = 1), and cerebrovascular accident (n = 1). The mean disease-free interval was 29 months (range, 10-78 months). One patient with SCCA recurred in the nasopharynx (overall 2% recurrence rate). He is disease-free 3 years following endoscopic nasopharyngectomy. Three patients with SCCA had endoscopic resection of the skull base, while 1 subject with inverted papilloma pedicled on the superior orbital roof had an osteoplastic flap in conjunction with a Draf III procedure. All others received endoscopic resection. Removal of the bony pedicle resulted in excellent local control of skull base inverted papillomas. Our experience demonstrates that disease eradication with limited morbidity is attainable with this approach. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  5. Strategies to improve outcomes from operative childhood management of DDH.

    PubMed

    Wedge, John H; Kelley, Simon P

    2012-07-01

    The operative management of DDH is technically challenging. To achieve excellent results, surgeons need to select the most appropriate operative treatment, minimize the risk of complications, and be aggressive in the management of serious complications, such as redislocation and AVN, when they occur. We have described specific steps and strategies to assist in each of these key steps. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Exploring strategies used following a group-based fatigue management programme for people with multiple sclerosis (FACETS) via the Fatigue Management Strategies Questionnaire (FMSQ)

    PubMed Central

    Thomas, S; Kersten, P; Thomas, P W; Slingsby, V; Nock, A; Jones, R; Davies Smith, A; Galvin, K T; Baker, R; Hillier, C

    2015-01-01

    Objectives To explore cross-sectional patterns of use of fatigue management strategies in people with multiple sclerosis (MS) who had attended a group-based fatigue management programme, Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle (‘FACETS’). In a multicentre randomised controlled trial (RCT) the FACETS programme was shown to reduce fatigue severity and improve self-efficacy and quality of life. Design A questionnaire substudy within a RCT involving the self-completed Fatigue Management Strategies Questionnaire (FMSQ). The FMSQ includes: (1) closed questions about the use and helpfulness of fatigue management strategies taught in FACETS and (2) open items about changes to lifestyle, attitudes or expectations, barriers or difficulties encountered and helpful strategies not covered in FACETS. Participants All had a clinical diagnosis of MS, significant fatigue, were ambulatory and had attended at least 4 of 6 scheduled FACETS sessions. Methods Participants (n=72) were posted the FMSQ with a prepaid return envelope 4 months after the end of the FACETS programme. Results 82% (59/72) of participants returned the FMSQ. The fatigue management strategies most frequently used since attending FACETS were prioritisation (80%), pacing (78%), saying no to others (78%), grading tasks (75%) and challenging unhelpful thoughts (71%). Adding in those participants who were already using the respective strategies prior to FACETS, the three most used strategies at 4 months were prioritisation (55/59), grading (54/59) and pacing (53/58). Free-text comments illustrated the complex interplay between attitudes/expectations, behaviours, emotions and the environment. Issues related to expectations featured strongly in participants’ comments. Expectations (from self and others) were both facilitators and barriers to effective fatigue management. Conclusions Individuals’ comments highlighted the complex, multifaceted nature of fatigue

  7. New Management Strategies of Oral Tongue Cancer in Bangladesh.

    PubMed

    Sultana, Jachmen; Bashar, Abul; Molla, Motiur Rahman

    2014-12-01

    Malignancies of the tongue represent one of the greatest management challenges for the maxillofacial surgeons as well as oncologists, because of the adverse effects of treatment on oral and pharyngeal function, the eventual quality of life, and the poor prognosis of advanced disease. Therefore, it is important to use judgment and experience in determining the best method of treatment. We reviewed forty cases of oral tongue cancer patients admitted in the Dental and Facio-Maxillary Surgical Oncology department in National Institute of Cancer Research and Hospital, and department of Oral and Maxillofacial Surgery, Dhaka Dental College and Hospital, Dhaka, Bangladesh, during the past four years and followed till the lesion healed or recurred and followed later on upto two years. All cases were thoroughly examined, investigated with routine blood examinations and radiography of the involved region. Preoperative biopsy of the lesion and staging was done in each and every case. Postoperative biopsy was taken where there was a doubt about the possibility of recurrence. Squamous cell carcinoma (well differentiated) is by far the most common malignancy of the oral tongue. Generally a correlation is recognized between tumor size, nodal presence, metastasis, and eventual prognosis. When surgeons detect oral tongue cancer at an early stage, they can often treat it with surgery or can, often treat it with surgery or radiation. In later stages the cancer may require a combination of surgery, radiation and chemotherapy. Standard and uniform protocol has not been explored till now for the practice in our country. So current management strategies of oral tongue cancer cannot be underestimated.

  8. Research on transient hysteresis current control strategy of DC-DC converter

    NASA Astrophysics Data System (ADS)

    Zhang, Ting; Wang, Zu-liang; Zhao, Yu-kai

    2017-01-01

    In order to improve the dynamic performance of DC-DC converter, transient hysteresis current control strategy is proposed which is based on parallel computing and combinational logic. By making a comparison between the real-time inductor current and the threshold inductor current, the switch is controlled more accurately. Under the Matlab/Simulink environment, the process of the Buck-Boost converter was simulated. The simulation results show that the transient hysteresis current control strategy can effectively overcome the disadvantages when load changes or input voltage disturbance occurs, it posses high load regulation and short dynamic response time, and it verifies the feasibility of the proposed strategy.

  9. Reducing Hospital Readmission: Current Strategies and Future Directions

    PubMed Central

    Kripalani, Sunil; Theobald, Cecelia N; Anctil, Beth; Vasilevskis, Eduard E

    2014-01-01

    New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up), have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented, whereas single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to post-acute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage common medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, a number of risk stratification methods are available. Future work should better define the role of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel. PMID:24160939

  10. Reducing hospital readmission rates: current strategies and future directions.

    PubMed

    Kripalani, Sunil; Theobald, Cecelia N; Anctil, Beth; Vasilevskis, Eduard E

    2014-01-01

    New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.

  11. Current UK practices in the management of subacromial impingement

    PubMed Central

    Drury, Colin; Tait, Gavin R

    2015-01-01

    Background Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. Methods BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Results Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Conclusions Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections. PMID:27582972

  12. Psychosomatic pain: new insights and management strategies.

    PubMed

    Rubin, Jay J

    2005-11-01

    insight about the relationship between abuse and their current symptoms leads to decreased health care utilization. Practical guidelines are provided for identifying psychopathology, communicating effectively, and achieving better treatment outcomes for these unfortunate patients.

  13. Current status of management of malignant disease: current management of gastric cancer.

    PubMed

    Schwarz, Roderich E

    2015-04-01

    Despite a continually decreasing incidence trend, gastric cancer remains a high-risk malignancy. Symptoms are often unspecific, and upper gastrointestinal endoscopy is the key modality for diagnosing early and intermediate-stage disease. Surgeons play a critical role in guiding and managing multiple aspects of gastric cancer diagnosis and care. Potentially curable gastric adenocarcinoma has to be free of distant metastasis and should be staged through endoscopic ultrasound and computed tomography. Early (T1N0) gastric cancer can be considered for endosopic mucosal resection or submucosal dissection. All other M0 stage groups should be evaluated for preoperative chemotherapy or chemoradiation followed by resection through a multidisciplinary approach. Laparoscopic staging, complete (R0) resection, and extended lymphadenectomy (D2 dissection) are critical operative components that optimize curability during gastrectomy. The morbidity potential after gastrectomy remains high; splenectomy and distal pancreatectomy should be avoided if possible to minimize postoperative complications. Laparoscopic gastric cancer resections are increasingly pursued and have not shown disadvantages to open gastrectomy as long as oncologic principles are followed. For the palliation of specific symptoms in patients with incurable gastric cancer, operative interventions should be applied selectively if less invasive modalities are insufficient and only if a meaningful benefit can be expected from a resection or bypass procedure. Prophylactic total gastrectomy should be considered for individuals at risk for hereditary diffuse-type gastric cancer through germline E-cadherin gene mutations. Surgeons engaging in gastric cancer care are expected to provide specialty expertise in order to plan and deliver appropriate care, minimize postoperative morbidity, and optimize resulting survival.

  14. SSAT State-of-the-Art Conference: Current Surgical Management of Gastric Tumors.

    PubMed

    Norton, Jeffrey A; Kim, Teresa; Kim, Joseph; McCarter, Martin D; Kelly, Kaitlyn J; Wong, Joyce; Sicklick, Jason K

    2017-08-14

    The current era of gastric surgery is marked by low morbidity and mortality rates, innovative strategies to approach resections with a minimally invasive fashion or hyperthermic intraperitoneal chemotherapy (HIPEC), as well as improved understanding of the biology of sporadic and hereditary stromal, neuroendocrine, and epithelial malignancies. In 2017, the Society for Surgery of the Alimentary Tract convened a State-of-the-Art Conference on Current Surgical Management of Gastric Tumors with both international experts and emerging leaders in the field of gastric surgery. Martin D. McCarter, MD of the University of Colorado discussed the current management of gastric gastrointestinal stromal tumors (GIST). Kaitlyn J. Kelly, MD of the University of California, San Diego discussed the management of gastric carcinoid tumors. Jeffrey A. Norton of Stanford University discussed recent advances in the management of gastric adenocarcinoma including a focus on hereditary diffuse gastric cancer (HDGC). Joseph Kim, MD of Stony Brook University discussed a systematic approach to minimally invasive gastrectomy for cancer. Joyce Wong, MD of Pennsylvania State University discussed the role for cytoreductive surgery (CRS) and HIPEC for gastric adenocarcinoma. This review provides gastrointestinal surgeons with a concise update on the current surgical management of gastric tumors.

  15. Fabry disease: a review of current management strategies.

    PubMed

    Mehta, A; Beck, M; Eyskens, F; Feliciani, C; Kantola, I; Ramaswami, U; Rolfs, A; Rivera, A; Waldek, S; Germain, D P

    2010-09-01

    Fabry disease is an X-linked inherited condition due to the absence or reduction of alpha-galactosidase activity in lysosomes, that results in accumulation of globotriaosylceramide (Gb3) and related neutral glycosphingolipids. Manifestations of Fabry disease include serious and progressive impairment of renal and cardiac function. In addition, patients experience pain, gastrointestinal disturbance, transient ischaemic attacks and strokes. Additional effects on the skin, eyes, ears, lungs and bones are often seen. The first symptoms of classic Fabry disease usually appear in childhood. Despite being X-linked, females can suffer the same severity of symptoms as males, and life expectancy is reduced in both females and males. Enzyme replacement therapy (ERT) can stabilize the progression of the disease. The rarity of the classic form of Fabry disease, however, means that there is a need to improve the knowledge and understanding that the majority of physicians have concerning Fabry disease, in order to avoid misdiagnosis and/or delayed diagnosis. This review aims to raise awareness of the signs and symptoms of Fabry disease; to provide a general diagnostic algorithm and to give an overview of the effects of ERT and concomitant treatments. We highlight a need to develop comprehensive international guidelines to optimize ERT and adjunctive therapy in patients with Fabry disease, including females and children.

  16. Invasive Aspergillosis: Current Strategies for Diagnosis and Management.

    PubMed

    Cadena, Jose; Thompson, George R; Patterson, Thomas F

    2016-03-01

    Aspergillosis remains a significant cause of morbidity and mortality in the immunocompromised population. The spectrum of disease is broad, ranging from severe and rapidly fatal infection to noninvasive disease. The diversity of patients and risk factors complicates diagnostic and therapeutic decision-making. Invasive procedures are often precluded by host status; noninvasive diagnostic tests vary in their sensitivity and specificity. Advancements in understanding the pathophysiology of invasive aspergillosis and host genetics in differential risk have also occurred. Future work may assist in therapeutic decision-making and patient prognosis. Voriconazole remains the preferred agent for treatment. Additional alternatives have emerged.

  17. Wind disasters: A comprehensive review of current management strategies

    PubMed Central

    Marchigiani, Raffaele; Gordy, Stephanie; Cipolla, James; Adams, Raeanna C; Evans, David C; Stehly, Christy; Galwankar, Sagar; Russell, Sarah; Marco, Alan P; Kman, Nicholas; Bhoi, Sanjeev; Stawicki, Stanislaw P A; Papadimos, Thomas J

    2013-01-01

    Wind disasters are responsible for tremendous physical destruction, injury, loss of life and economic damage. In this review, we discuss disaster preparedness and effective medical response to wind disasters. The epidemiology of disease and injury patterns observed in the early and late phases of wind disasters are reviewed. The authors highlight the importance of advance planning and adequate preparation as well as prompt and well-organized response to potential damage involving healthcare infrastructure and the associated consequences to the medical response system. Ways to minimize both the extent of infrastructure damage and its effects on the healthcare system are discussed, focusing on lessons learned from recent major wind disasters around the globe. Finally, aspects of healthcare delivery in disaster zones are reviewed. PMID:23961458

  18. Role of Emotional Intelligence in Conflict Management Strategies of Nurses.

    PubMed

    Başoğul, Ceyda; Özgür, Gönül

    2016-09-01

    This study analyzes the emotional intelligence levels and conflict management strategies of nurses and the association between them. This cross-sectional, descriptive study was conducted with 277 nurses in a stratified random sample from a university hospital in Turkey. The data were collected from nurses who gave their informed consent to participate using a personal information form, the Rahim Organizational Conflict Inventory-II and Bar-On's Emotional Quotient Inventory (EQ-I). Data were assessed by descriptive statistics, t tests, and Pearson correlation analyses, using SPSS software. The levels of the nurses' strategies were as follows: avoiding (M = 2.98), dominating (M = 2.76), and obliging (M = 2.71) were medium; compromising (M = 1.99) and integration (M = 1.96) were low. The levels of the emotional intelligence of nurses (mean = 2.75) were medium on a 5-point scale. Integration (r = .168), obliging (r = .25), dominating (r = .18), and compromising (r = .33), which are conflict management strategies, were positively correlated with scores of emotional intelligence, and avoiding (r = -.25) was negatively correlated with scores of emotional intelligence (p < .05). The study determined that nurses' emotional intelligence affects conflict management strategies. To use effective strategies in conflict management, nurses must develop emotional intelligence. Training programs on conflict management and emotional intelligence are needed to improve effective conflict management in healthcare facilities. Copyright © 2016. Published by Elsevier B.V.

  19. Current Strategies and Challenges in Engineering a Bioartificial Kidney

    PubMed Central

    Kim, Steven; Fissell, William H.; Humes, H. David; Roy, Shuvo

    2015-01-01

    Renal replacement therapy was an early pioneer in both extra-corporeal organ replacement and whole organ transplantation. Today, the success of this pioneering work is directly demonstrated in the millions of patients worldwide successfully treated with dialysis and kidney transplantation. However, there remain significant shortcomings to current treatment modalities that limit clinical outcomes and quality of life. To address these problems, researchers have turned to using cell-based therapies for the development of a bioartificial kidney. These approaches aim to recapitulate the numerous functions of the healthy kidney including solute clearance and fluid homeostasis as well as metabolic and endocrine function. This review will examine the state-of-the-art in kidney bioengineering by evaluating the various techniques currently being utilized to create a bioartificial kidney. These promising new technologies, however, still need to address key issues that may limit the widespread adoption of cell therapy including cell sourcing, organ scaffolding, and immune response. Additionally, while these new methods have shown success in animal models, it remains to be seen whether these techniques can be successfully adapted for clinical treatment in humans. PMID:25553375

  20. Current strategies and challenges in engineering a bioartificial kidney.

    PubMed

    Kim, Steven; Fissell, William H; Humes, David H; Roy, Shuvo

    2015-01-01

    Renal replacement therapy was an early pioneer in both extra-corporeal organ replacement and whole organ transplantation. Today, the success of this pioneering work is directly demonstrated in the millions of patients worldwide successfully treated with dialysis and kidney transplantation. However, there remain significant shortcomings to current treatment modalities that limit clinical outcomes and quality of life. To address these problems, researchers have turned to using cell-based therapies for the development of a bioartificial kidney. These approaches aim to recapitulate the numerous functions of the healthy kidney including solute clearance, fluid homeostasis and metabolic and endocrine functions. This review will examine the state-of-the-art in kidney bioengineering by evaluating the various techniques currently being utilized to create a bioartificial kidney. These promising new technologies, however, still need to address key issues that may limit the widespread adoption of cell therapy including cell sourcing, organ scaffolding, and immune response. Additionally, while these new methods have shown success in animal models, it remains to be seen whether these techniques can be successfully adapted for clinical treatment in humans.